Professional Documents
Culture Documents
RAPID
April 7-10, 2010
Sheraton Seattle Hotel
Seattle, Washington
COMMUNICATIONS
www.sbm.org
Rapid Communications
Poster Session A
Wednesday, April 7, 2010
6:30 PM – 8:00 PM
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
2
p=.02. However, Ss with greater IL12 at Day 0 did not have A-032e
significantly greater odds of death 1 year post-HSCT, OR=1.43, LONGITUDINAL EFFECTS OF SOCIAL SUPPORT AND
p=.36, above and beyond the effects of high illness burden. ADAPTIVE COPING ON EMOTIONAL WELL-BEING IN
Also, IL12 at Day 0 was not associated with high illness burden, LOCALIZED PROSTATE CANCER SURVIVORS
F(1,32)=.15, p=.70, and thus did not mediate the illness burden- Eric S. Zhou, MS,1 Frank J. Penedo, PhD,1,2 Natalie E. Bustillo,
survival relationship. While based on a modest sample size, the BS,1 Catherine Benedict, BS,1 Mikal Rasheed, MS,1 Suzanne
results suggest that pre-HSCT high illness burden at the time of Lechner, PhD,2 Mark Soloway, MD,2,4 Bruce Kava, MD,2,3 Neil
HSCT may be independently associated with mortality follow- Schneiderman, PhD1,3 and Mike Antoni, PhD1,2
ing HSCT; thus perceptions of illness burden may be a clinically 1
Psychology, University of Miami, Coral Gables, FL; 2Sylvester
meaningful predictor of HSCT risk. Further research should Comprehensive Cancer Center, University of Miami School of
replicate these findings in a larger sample and examine other Medicine, Miami, FL; 3Miami VA Medical Center, Miami, FL
potential bio-behavioral mediators. and 4Medicine, University of Miami School of Medicine, Miami,
CORRESPONDING AUTHOR: Seema M. Patidar, BS, Clinical FL.
and Health Psychology, University of Florida, Gainesville, FL, Objective: Prostate cancer survivors experience treatment-
FL, 32610; patidar@ufl.edu related physical side effects that can compromise emotional
well-being for years post-treatment. There is limited research
A-032d investigating how social support and use of coping may affect
CANCER-RELATED POSITIVE EXPECTANCIES: OPTIMISM, emotional well-being in this population following treatment.
FAITH, OR SOMETHING ELSE? The aim of this study was to investigate how social support and
Sean Ransom, PhD1,2 and Paul B. Jacobsen, PhD3 coping impact emotional well-being two years following treat-
1
Department of Psychiatry and Neurology, Tulane University ment in localized prostate cancer survivors who have received
School of Medicine, New Orleans, LA; 2Friedler Center for either radical prostatectomy or radiotherapy.
Psychosocial Oncology, Tulane Cancer Center, New Orleans,
LA and 3Department of Health Outcomes and Behavior, H. Lee Methods: Psychosocial (social support, coping and emotional
Moffitt Cancer Center, Tampa, FL. well-being) and disease-specific measures were administered
to an ethnically and demographically diverse sample of men
Survivors of cancer often report experiencing personal growth, treated for localized prostate cancer at baseline, and at a 2-year
but patients still under treatment may also anticipate such follow-up (N=180).
benefits may happen to them. Although survivors’ reports of
posttraumatic growth (PTG) have attracted research interest Results: Regression analyses demonstrated that higher levels of
in the past decade, little is known about the positive expectan- social support at baseline predicted better emotional well-being
cies that patients in treatment believe may happen to them. 2 years later, after controlling for baseline emotional well-being,
To test this, 94 individuals with breast or prostate cancer were demographic variables and disease-specific physical function-
examined prior to their radiotherapy regimen. Positive expec- ing. Furthermore, higher levels of adaptive coping at baseline
tancies were assessed with a 5-item measure asking patients partially mediated the relationship between social support and
to report whether “most people who have had cancer” experi- emotional well-being.
ence improvements in various domains (e.g., feeling closer to Conclusions: Supportive relationships may contribute to im-
loved ones). Patients then completed a demographic question- proved emotional well-being following treatment by facilitating
naire and measures of religious faith and satisfaction with life. the use of adaptive coping strategies. Attention should be given
Following radiotherapy, patients completed measures of PTG to strengthening social support networks and educating pros-
and dispositional optimism. Results showed higher positive tate cancer survivors on adaptive coping techniques.
expectancies to be significantly related with lower education, CORRESPONDING AUTHOR: Eric S. Zhou, MS, Psychology,
higher religious faith, higher satisfaction with life, and higher University of Miami, Coral Gables, FL, 33146; e.zhou@miami.
optimism. Optimism did not predict expectancies after control- edu
ling for the other three related variables in regression analy-
sis. Regarding PTG, optimism was negatively related to PTG A-032f
whereas faith and expectancies were positively related to PTG. BLADDER CANCER PATIENTS LACK SURVIVORSHIP
Mediational analysis indicated that faith continued to explain RESOURCES AT ACADEMIC MEDICAL CENTERS
significant variance in PTG scores after controlling for expectan- David M. Latini, PhD,1,4 Cheryl T. Lee, MD,2,4 Scott Gilbert,
cies. Results suggest that, more than dispositional optimism, the MD3,4 and Diane Z. Quale, JD4
degree of patients’ religious faith is related to patients’ expecta- 1
Urology, Baylor College of Medicine, Houston, TX; 2University
tions about the positive impact of cancer. Those with stronger of Michigan, Ann Arbor, MI; 3University of Florida, Gainesville,
religious faith also report higher PTG at the conclusion of can- FL and 4Bladder Cancer Advocacy Network, Bethesda, MD.
cer treatment, but such growth cannot be fully explained by the Bladder cancer (BC) is a disease with high treatment burden.
expectancies associated with such faith. Results point toward Though little work as been done with BC survivors, support
a complex interplay between optimism, faith, posttraumatic groups and survivorship programs are effective methods at
growth, and positive expectancies in those with cancer. managing physical and psychosocial impairments experienced
CORRESPONDING AUTHOR: Sean Ransom, PhD, Tulane by other cancer survivors. The Institute of Medicine recom-
Cancer Center, Tulane University School of Medicine, New mends increased resources for cancer survivorship, but no
Orleans, LA, 70112; sransom@tulane.edu description of current resources exists for BC patients. We
conducted an internet survey of thought leaders at the 4th
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
Annual Bladder Cancer Think Tank about resources available RP choices, 92%). Avoiding incontinency was the strongest pre-
to BC survivors at high-volume academic centers. Descriptive dictor for both choices on radiotherapy (RT) (n = 58 of 65, 89%)
statistics were computed. A total of 59 respondents included and active surveillance (AS) (n = 18 of 19, 95%), yet the second
urologists (56%), medical oncologists (12%), BC survivors strongest predictor for each treatment clearly distinguished
(12%), and industry partners (10%). Physician respondents rep- choices: A desire for active treatment predicted RT (n = 44, 68%)
resented 25 academic centers and 1 private group. While 68% and a desire for the least invasive procedure predicted AS (n =
of respondents represented an NCI-designated cancer center, 14, 73%). To avoid impotence did not distinguish between treat-
only 36% had an active BC support group led by a nurse (44%), ment choices. CONCLUSION: The concept of interdisciplinary
social worker (33%), and/or peer (28%); most met monthly counseling appears to promotes preference-sensitive decision
(62%). Patient navigators were nurses (64%), peers (55%), and/ making, while not undermining doctors advice--a potential
or urologists (55%). Survivorship clinics were managed by promising step towards shared decision making.
urologists (25%), other physicians (38%), and/or a physician CORRESPONDING AUTHOR: Odette Wegwarth, PhD, Hard-
assistant (25%). Survivorship clinics managed sexual dysfunc- ing Center for Risk Literacy, Max Planck Institut for Human
tion (66%) and urinary (66%) and bowel (42%) incontinence. Development, Berlin, 14195; wegwarth@mpib-berlin.mpg.de
Physical symptom management was carried out by urologists
(62%), other physicians (35%), nurses (42%), and/or physician A-038a
assistants (23%). Respondent clinics managed depression (22%) DASH 2 WELLNESS:EFFECTS OF A MULTI-COMPONENT
and anxiety (19%), but 58% provided no distress management. LIFESTYLE MODIFICATION PROGRAM ON NUTRITION,
Survivorship care plans were rarely used. Resources for BC PHYSICAL ACTIVITY, & BLOOD PRESSURE IN MIDDLE-AGED
survivors vary widely and are lacking at most academic centers ADULTS WITH PREHYPERTENSION
with high volume BC populations. Survivorship clinics and Ashley E. Dorough, PhD, Emily Martin, MS and Richard
care plans have not been widely disseminated and psychosocial Winett, PhD
support for BC survivors lags behind physical symptom man- Virginia Tech University, Chapel Hill, NC.
agement. Behavioral medicine needs to advocate for additional Background: The goal of this project was to develop, imple-
resources and partner with other disciplines to provide appro- ment, and evaluate the initial efficacy of a lifestyle modifi-
priate care. cation intervention that did not require extensive, ongoing
CORRESPONDING AUTHOR: David M. Latini, PhD, Urology, personal contact to lower blood pressure(BP) in adults with
Baylor College of Medicine, Houston, TX, 77030; latini@bcm. prehypertension(N=23,mean age=54,mean BP=127/75).
tmc.edu Methods: Incorporating clinical practices and psychological
A-032g approaches to health behavior change this 10-week intervention
FACILITATING PREFERENCE-SENSITIVE DECISION used the DASH Eating Plan, home BP monitoring, a walking
MAKING AMONGST PROSTATE CANCER PATIENTS: program, and applied SCT, specifically self-regulation for self-
INTERDISCIPLINARY COUNSELING monitoring of BP, diet, exericse, & weight.The study compared
Odette Wegwarth, PhD1 and Martin Schostak, MD2 two conditions, DASH 2 Wellness Only standard of care
1
Harding Center for Risk Literacy, Max Planck Institut for condition and DASH 2 Wellness Plus tx condition, on measures
Human Development, Berlin, Germany and 2Urology, Charitè of fruit & vegetable(srvgs/day), sodium(mg/day), physical
Benjamin Franklin, Berlin, Germany. activity(steps/day), weight(kgs), and BP.
BACKGROUND: Studies have demonstrated that most prostate Results: MANOVAs detected significant differences between
cancer patients end up with a treatment that reflects the stan- conditions on the combined dependent variables [F(4,15)=3.46,
dard recommendation of the specialty of the counseling physi- p=.034; Wilks’ λ=.52].Follow-up univariate analyses re-
cian, but not their own preferences. Such situation contradicts vealed tx condition effects for 3 of the 4 measures, weight
the ideal of shared decision making. To tackle this problem we change (p=.032), daily step change (p=.011), and systolic BP
introduced regular interdisciplinary counseling to prostate can- change(p=.003).While conditions did not significantly differ on
cer patients, in which a radiotherapist together with a surgeon daily sodium reduction or F&V increase, D2W Plus evidenced
counsels a patient. METHOD: Survey data of 196 prostate can- a larger decrease in sodium(mg) (M=932.22,SD=1019.22) than
cer patients who had attended the interdisciplinary counseling D2W Only,(M=423.64,SD=749.15) and a larger increase in F&V
were analyzed. The survey examined: a) patient’s preferences increase,(M=2.10,SD=1.73) than D2W Only,(M=1.02,SD=2.24).
for specific outcomes, b) doctors’ treatment recommendation, It was also expected D2W Plus would show greater improve-
and c) the treatment received. The preference questions investi- ments in nutrition-specific and PA-specific health beliefs(HB)
gated desire to actively treat/remove the tumor, to avoid incon- of self-regulation, social support, self-efficacy, social sup-
tinence, and sexual dysfunction, and to avoid invasive treat- port, & outcome-expectancy compared to those in D2W Only.
ment by a 10-point Likert scale. Only scores > 8 were used to Significant group differences were detected in PA-specific
predict treatment received. The concordance between treatment HB primarily attributable to increased PA self-regulation in
received and stated perferences as well as doctors’ recommen- D2W Plus compared to D2W Only,(M=1.78,SD=0.75) and
dation were examined. RESULTS: Patients’ preference profiles (M=0.55,SD=0.57),respectively.
showed a higher concordance with treatment received (n = 168, Conclusions: Results provide preliminary support for the effica-
83%) than did doctors’ recommendation (n = 148, 75%). For cy of electronic delivery of an intervention aimed at improving
patients who highly preferred removal of the tumor (n = 150), lifestyle behaviors and lowering BP in middle-aged individuals
the majority chose radical prostatectomy (RP) (n = 104 of all 112 with prehypertension.
4
CORRESPONDING AUTHOR: Ashley E. Dorough, PhD, control (A1C), perceptions of emotional support, and contacts
Virginia Tech University, Chapel Hill, NC, 27516; aedorough@ with healthcare providers. Participants were either a Champion
gmail.com (N=19), if they were fluent in English, or a Partner (N=27). All
attended a community education meeting about diabetes self-
A-038b care; in addition, Champions attended a community meeting to
PHYSICAL ACTIVITY AND QUALITY OF LIFE AFTER ACUTE be instructed in on how to provide supportive communication.
CORONARY SYNDROME Champions and Peers, grouped in pairs or triads and matched
Rebecca L. Reese, MA, Kenneth E. Freedland, PhD, Brian C. by gender and age, were asked to make at least weekly con-
Steinmeyer, MS and Robert M. Carney, PhD tact with each other during the intervention. All participants
Washington University in St. Louis, St Louis, MO. and healthcare providers were given cell phones for which the
Purpose: Patients are usually advised to resume physical activ- airtime within the network was prepaid. Sixteen Champions
ity as soon as it is safe to do so after hospitalization for acute and 25 Partners completed the intervention; the mean age was
coronary syndrome (ACS), but little is known about how this 55 years, 56.5% reported education at the primary level, and
affects quality of life (QOL). We hypothesized that physical the occupation of about half the sample was farmer. The mean
activity helps to counteract factors that may decrease QOL in duration of diabetes was 6.5 years. The only difference between
post-ACS patients, including relatively early onset of heart dis- Champions and Peers was that Champions reported a higher
ease, multiple medical comorbidities, rehospitalizations, stress, education level (p < .001).Post-intervention, A1C significantly
and depression. decreased from 9.8% to 6.8% (p < .001), blood pressure im-
Methods: Participants were enrolled within the first few days proved from a mean of 146/85 to 140/76 (p < .025), and body
after hospitalization for ACS. The SF12 was used to measure mass index did not change. Significant change in eating behav-
physical and mental QOL 6 weeks, 3 months, and 6 months ior (p <.001) was the only behavior change. Scores on a 5-item
after enrollment. The Perceived Stress Scale (PSS) and the BDI- coping scale and ratings on a single item about confidence in
II were obtained at the same times, as well as at enrollment, managing diabetes both significantly decreased (p =. 01 and p
and participants maintained a weekly log of physical activi- = .02, respectively). Seventy-eight percent reported increased
ties based on the International Physical Activity Questionnaire contact with their healthcare provider during the program. No
(IPAQ). Prospective multiple regression models were used to differences in outcomes were found between Champions and
predict SF12 scores at each time point, based on IPAQ scores Peers. Explanation for the improvement in glycemic control
from the preceding interval, adjusting for gender, age, number and eating behavior and decline in coping scores and ratings of
of major comorbidities, occurrence of rehospitalization, and PSS confidence in managing diabetes will be presented.
and BDI-II scores obtained at the previous assessment time. CORRESPONDING AUTHOR: Linda C. Baumann, PhD, RN,
Results: Complete data were obtained from 184 patients (34% School of Nursing, university of Wisconsin-Madison, Madison,
women, age 60±11 years). Physical activity was positively as- WI, 53792-2455; ljbauman@wisc.edu
sociated with SF12 Physical at 3 and 6 months (r2=.08, p<.01; A-050a
r2=.06, p=.03, respectively); in contrast, medical comorbidities GRADUATE PSYCHIATRIC NURSES TRAINING ON FIREARM
and BDI-II predicted worse Physical QOL at each time point INJURY PREVENTION
(p<.01). Physical activity predicted better Mental QOL at 6 Michael Wiblishauser, MPH,2 Jagdish Khubchandani, MBBS,
months (r2=.05, p=.02), but not at early points in the post-ACS MPH, CHES,1 James H. Price, PhD, MPH, FASHA2 and Amy
recovery process. The BDI-II predicted worse Mental QOL at all Thompson, PhD2
3 time points (p<.0001). Younger age and higher levels of stress 1
Neurology, University of Toledo Medical Center, Toledo, OH
also predicted worse Mental QOL at some time points (p<.05). and 2Health and Rehab Services, University of Toledo, Toledo,
Conclusion: Early resumption of physical activity is associated OH.
with better Physical QOL as early as 3 months after ACS, and it Objective: Most suicides (60%) and homicides (45%) are com-
predicts better Mental QOL within 6 months of ACS. Physical mitted with firearms, and the vast majority (80%) of individu-
activity appears to counteract the negative effects of multimor- als attempting suicide or homicide meet diagnostic criteria for
bidity and depression on quality of life in these patients. mental illness. This study assessed the prevalence of firearm
CORRESPONDING AUTHOR: Rebecca L. Reese, MA, Wash- injury prevention training in graduate psychiatric nursing train-
ington University in St. Louis, St Louis, MO, 63130; rlreese@ ing programs.
wustl.edu Methods: A three-wave mail survey was sent to the directors of
A-046a 85 graduate psychiatric nursing programs. Outcome measures
A PEER SUPPORT INTERVENTION FOR UGANDAN ADULTS were the portion of programs offering training in anticipatory
WITH TYPE 2 DIABETES guidance for firearms safety, the content of training if offered,
Linda C. Baumann, PhD, RN,1 Fred Nakwagala, MS, MD,2 Dory and the perceived benefits and barriers to providing such train-
Blobner, RN, MS, CDE1 and Agatha Nambuya, MD2 ing.
1
School of Nursing, University of Wisconsin-Madison, Madison, Results: A total of 60 (70%) directors responded.The directors
WI and 2Mulago Hospital, Kampala, Uganda. perceived more benefits than barriers to offering such training.
The purpose of this 3-month pilot intervention was to test the Yet, the vast majority (70%) reported they had not seriously
feasibility of a peer support program for persons with type 2 thought about providing firearm injury prevention training.
diabetes in one community in Uganda to improve glycemic Also, the majority (54.8%) reported they did not routinely
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
6
depression). Due to how the survey was constructed, BED was once a week (high Activity) and less frequently (low Activity),
screened as positive if a liberal criterion of binge episodes 1-2 approximating a median split. Participants with high Activity
times per week was met. The sample, which included 8,597 were almost 5 times as likely to experience Encouragement sup-
college students drawn from 15 colleges and universities, was port compared to those with low Activity (adjusted OR 4.8 [95%
58.9% female, 62.2% Caucasian, with the majority (63.5%) in the CI 1.8-12.8]). Our results suggest that interacting at least weekly
18-22 year old range; 17.6% sought therapy in the past year and with other members of the online weight loss community is
6.8% were currently receiving psychological services; 82.1% saw strongly associated with receiving encouragement for weight
a health care professional in the past year; 100% of those who loss behaviors.
sought psychological services also sought physical health care. CORRESPONDING AUTHOR: Kevin O. Hwang, MD, MPH,
Logistic regression analyses indicated that BED alone conferred Internal Medicine, The University of Texas Medical School at
a nearly two-fold risk (OR=1.966; 95% CI [1.707, 2.266], p<.0001) Houston, Houston, TX, 77030; kevin.o.hwang@uth.tmc.edu
for past year use of psychological services and also significantly
increased the likelihood of seeing a health care provider in the A-079c
past year (OR=1.298; 95% CI [1.044, 1.614], p<.05). BED in com- EMOTION REGULATION MODULATES BRAIN ACTIVATION TO
bination with anxiety or depression conferred additional risk of FOOD IMAGES
mental health care utilization. BED in combination with drug Trisha Hay, BS,1,2 Rebecca Chambers, MA,1,2 Cary R. Savage,
use, depression, or binge drinking conferred additional risk PhD2 and Nancy A. Hamilton, PhD1
of health care utilization. Results suggest that BED, alone and 1
Department of Psychology, University of Kansas, Lawrence,
particularly in combination with other risk factors, increases KS and 2Hoglund Brain Imaging Center, University of Kansas
the likelihood of physical and mental health care utilization on Medical Center, Kansas City, KS.
college campuses. Future research should evaluate whether Functional magnetic resonance imaging (fMRI) research shows
prevention efforts targeting binge eating may reduce demand significant overlap between brain regions activated by emo-
on typically strained campus resources available to address tional and food motivation manipulations. Ability to regulate
students’ physical and mental health needs. emotional states may be an important contributor to brain
CORRESPONDING AUTHOR: Summar H. Reslan, BA, Clinical response to food pictures. This study investigated whether abil-
Psychology, Eastern Michigan University, Dearborn Heights, ity to reduce emotion intensity was associated with differential
MI, 48127; shabhab1@emich.edu brain activation under various conditions of food motivation.
Seventeen obese adults (13 females, mean age 37.12 years; 70.6%
A-079b Caucasian) were scanned using fMRI. Participants viewed
ACTIVITY IN AN ONLINE WEIGHT LOSS COMMUNITY Food and Nonfood images before (Pre) and after (Post) eating a
PREDICTS ENCOURAGEMENT SUPPORT small meal. Ability to regulate emotion was assessed with The
Kevin O. Hwang, MD, MPH,1 Jason M. Etchegaray, PhD,1 Elmer Emotion Amplification and Reduction Scales (TEARS). Hunger
V. Bernstam, MD, MSE1,2 and Eric J. Thomas, MD, MPH1 ratings were obtained prior to scanning sessions. Two groups
1
Internal Medicine, The University of Texas Medical School at were defined based on TEARS Reduction subscale scores. High
Houston, Houston, TX and 2The University of Texas School of TEARS Reduction (HTR) relative to Low TEARS Reduction
Health Information Sciences at Houston, Houston, TX. (LTR) scores reflect greater perceived ability to reduce emotion
In a previous mixed-methods study we described dimensions of intensity or duration. In this study, HTR and LTR groups did
social support for weight loss among members of the SparkPeo- not differ in age, body mass index, or hunger ratings. State (Pre,
ple online weight loss community. In this secondary analysis Post) by Image (Food, Nonfood) by TEARS Reduction (HTR,
we tested the hypothesis that use of interactive features of the LTR) ANOVA (p=.001 uncorrected) of fMRI data revealed
website is directly related to experiencing Encouragement, significant activation in the posterior orbitofrontal cortex (OFC;
Information, and Shared Experiences support. The original sur- F=23.38, p<.001). Post hoc comparison of this interaction (Food
vey had 7 items on the frequency of use of interactive features vs. Nonfood) showed that HTR was associated with a decrease
(forums and blogs) over the last 4 weeks. For this analysis we (t=4.837, p=.002) and LTR with an increase (t=3.683, p=.006)
combined the items into a single Activity scale (alpha=0.91) in OFC activation from Pre to Post. Previous fMRI findings
as the predictor. In the original survey, qualitative descrip- suggest that the posterior OFC processes food-related hedonic
tions of social support experiences over the last 4 weeks were information. In this study, HTR was associated with greater
categorized as Encouragement (motivation, congratulations), activation to Food pictures Pre, and less activation to Food
Information (advice, tips), and Shared Experiences (belong- pictures Post; the opposite was true for LTR. HTR individuals
ing to a group). For this analysis each category was a binary appeared to respond adaptively to food cues based on hunger
outcome (yes/no). We performed structural equation modeling and satiety states. For LTR individuals, consuming food may
(SEM) to determine which outcomes were associated with the have actually enhanced its rewarding properties. This may indi-
predictor, followed by logistic regression to obtain odds ratios cate that the ability to control emotions affects brain activation
adjusted for age, gender, race, education, marital status, BMI, to food-related stimuli.
and duration of SparkPeople membership. The 187 participants CORRESPONDING AUTHOR: Trisha Hay, BS, University of
were mostly female (95%) and white (91%), with mean [SD] age Kansas, Lawrence, KS, 66045; haytm@ku.edu
of 37.4 [11.6] years and mean [SD] BMI of 31 [7.5]. SEM yielded
a model in which Activity predicts Encouragement support,
but not Information or Shared Experiences support. The sample
was divided into those who used interactive features at least
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
A-079d loss. However, this study did not examine ethnic differences in
QUALITY OF LIFE AND HEALTH RISK BEHAVIORS AMONG the relationship between expectations and outcome, which is of
NORMAL, OVERWEIGHT AND OBESE ADULTS WITH AND particular importance given that African American women lose
WITHOUT PAIN-RELATED ACTIVITY DIFFICULTY less weight following bariatric surgery than Caucasian women,
E. Amy Janke, PhD,1,2 Frances Weaver, PhD,2,3 Sherri Lavela, even after accounting for level of psychological distress, diet,
PhD3 and Bonnie Spring, PhD2,4 or age. This study had two primary aims: (1) To examine ethnic
1
Department of Behavioral and Social Sciences, University of differences in pre-operative weight loss expectations (WLE)
the Sciences in Philadelphia, Philadelphia, PA; 2CMC3, Hines between Caucasian and African American women undergo-
VA Hospital, Hines, IL; 3SCI QUERI, Hines VA Hospital, Hines, ing gastric bypass (GB) surgery, and (2) To examine whether
IL and 4Department of Preventive Medicine, Northwestern pre-operative WLE predicted weight loss at 3, 6, and 12 months
University, Chicago, IL. post-surgery within each ethnic group. Methods: Participants
Background: Many obese individuals report ongoing pain, but were 187 women (56% African American, 44% Caucasian, BMI
little is known about whether the pairing of pain with obesity M=51; age M=42) undergoing GB surgery at an urban medical
also heightens the likelihood of other health risk behaviors and center. Hierarchical regression analysis was used to assess the
adversely affects quality of life (QOL). influence of WLE on percentage of excess weight lost (PEWL).
Results: African American and Caucasian women did not differ
Objective: To examine the associations among overweight/obe- with respect to expected PEWL (p=.30). However, both reported
sity, pain, health risk behaviors and QOL among U.S. adults. unrealistic WLE (~ 85% of excess weight) relative to normative
Design & Participants: A sample of 81,308 respondents was data. Among Caucasian women, WLE did not predict achieved
drawn from the 23 states completing the quality of life module weight loss at 3, 6, or 12 months post-surgery. However, among
of the 2002 Behavioral Risk Factor Surveillance System (BRFSS). African American women, WLE significantly predicted PEWL
Data were analyzed to examine variation in socio-demographic, at 12 months post surgery, such that greater pre-operative WLE
health behavior and QOL characteristics as a function of re- predicted greater weight loss (r2chg=0.12, p < .05). WLE were
ported pain-related activity difficulty during the prior 30 days not associated with weight loss at 3 or 6 months post-surgery in
(no pain = 0 pain days; infrequent pain = 1 to 13 pain days; fre- this group. Conclusion: Contrary to earlier research, higher ex-
quent pain ≥ 14 pain days) and body mass index (BMI; normal, pectations may promote greater one-year post-surgical weight
overweight, obese). loss among African American, but not Caucasian, women.
Results: Co-occurrence of obesity and frequent pain-related CORRESPONDING AUTHOR: Iulia Ivan, Bachelors, Behavioral
activity difficulty was associated with female gender, older age, Science, Rush Medical Center, Chicago, IL, 60612; jewels0219@
African-American race, lower educational attainment, divorce, sbcglobal.net
and inability to work (p≤.05). Increased BMI and increased days
with activity-interfering pain co-varied with physical inactivity, A-096b
low fruit and vegetable intake, impaired mental and physical MEASUREMENT OF PATIENT CENTERED OUTCOMES IN
health, low vitality, frequent need for assistance with personal PARKINSON’S DISEASE: WHAT DO PATIENTS CONSIDER
and routine care, frequent need for specialized health equip- SUCCESS IN THEIR TREATMENT?
ment, depressive symptoms, sleep insufficiency, and symptoms Anne N. Nisenzon, MS,1 Michael E. Robinson, PhD,1 Dawn
of anxiety. Bowers, PhD,1 Evangelia Banou, PhD,1 Irene A. Malaty, MD2
and Michael S. Okun, MD2
Conclusions: These cross-sectional survey data suggest a dose- 1
Dept. of Clinical and Health Psychology, University of Florida,
response relationship may exist between increasing days with Gainesville, FL and 2Department of Neurology, University of
pain-related activity difficulty, increasing BMI, and increased Florida, Gainesville, FL.
prevalence of impaired QOL and altered engagement in select
health behaviors in community dwelling adults. Parkinson’s disease (PD) and other forms of parkinsonism
impact several domains of functioning, although non-motor
CORRESPONDING AUTHOR: E. Amy Janke, PhD, Depart- symptoms are often underappreciated when designing treat-
ment of Behavioral and Social Sciences, University of the Sci- ment. We argue that taking the patients’ perspective of their
ences in Philadelphia, Philadelphia, PA, 19477; e.janke@usp.edu condition into account may allow for a more realistic assess-
A-079e ment of patient goals and subsequent tailoring of care. One
WEIGHT LOSS EXPECTATIONS PREDICT ONE-YEAR POST- hundred and sixty-two patients with PD or parkinsonism
OPERATIVE WEIGHT LOSS AMONG AFRICAN AMERICAN completed a modified version of the Patient Centered Outcomes
WOMEN UNDERGOING GASTRIC BYPASS SURGERY Questionnaire (PCOQ-M), to evaluate treatment success and
Iulia Ivan, Bachelors, Leila Azarbad, PhD, Megan Hood, PhD expectations from the patient’s point of view across 4 motor
and Joyce Corsica, PhD domains (e.g., tremor, stiffness, slowness, and walking difficul-
Behavioral Science, Rush Medical Center, Chicago, IL. ties) and 6 non-motor domains (e.g., pain, fatigue, emotional
distress, ADL, thinking problems, and sleeping problems). We
Background: Research consistently indicates that bariatric also examined patient clusters based on importance of improve-
surgery patients tend to have unrealistic expectations for post- ment in various domains. Results indicated that patients varied
operative weight loss. However, the prognostic influence of widely in their ratings of usual symptom levels, and that these
weight loss expectations on achieved post-surgical weight loss ratings were generally unrelated to demographic variables. On
remains unclear. Only one study to date has examined this average, across all domains, patients indicated a 49% reduc-
relationship in a bariatric surgery sample and found no associa- tion in symptoms as a successful outcome (range= 39% to 58%).
tion between weight loss expectations and post-surgical weight
8
Change scores between patients’ usual levels of symptom inter- A-096d
ference and their treatment success levels suggested a greater COMPARISON OF YOUNGER AND OLDER ADULTS
degree of change was desired in motor domains (i.e., slowness, ACCEPTABILITY OF TREATMENTS FOR COMORBID
gait disturbance) than non-motor domains (i.e., emotional dis- GENERAL ANXIETY AND PARKINSON’S DISEASE
tress) (p<.05). Finally, cluster analyses revealed two subgroups Duane A. Lundervold, RhD
of patients based on overall importance of improvement (High 1
Psychology, University of Central Missouri, Warrensburg,
vs. Low Importance Endorsement) across all tested domains. MO and 2Department of Neuroscience, Saint Luke’s Hopsital
Notably, the High Importance raters reported lowered expecta- of Kansas City and Plaza Primary Care and Geriatrics, Kansas
tions for improvement, specifically in non-motor domains. In City, MO.
examining treatment success from the PD patient’s view, we Seventy-nine younger adults and 54 older adults completed
aim to establish a more meaningful set of criteria by which to acceptability ratings for two treatments, Behavioral Relaxation
evaluate outcome. Training (BRT) and medication, for comorbid anxiety and
Funded by NIH Grant R01 NS047119 and with support from Parkinson’s disease (PD). Participants read a case description
the National Parkinson Foundation Center of Excellence. of an older adult with PD and general anxiety followed by a
CORRESPONDING AUTHOR: Anne N. Nisenzon, MS, Dept. of description of the treatments, presented in counter balanced
Clinical and Health Psychology, University of Florida, Gaines- order. They then completed the Abbreviated Acceptability Rat-
ville, FL, 32608; nisenzon@phhp.ufl.edu ing Profile (AARP), an eight-item likert scale measure. Correla-
tion analysis between AARP scores and selected demographic
A-096c variables, e.g., personal history of anxiety, were not significant.
MENTAL HEALTH FUNCTIONING RECOVERY CURVES A mixed analysis of variance was used to determine main
ASSOCIATED WITH BEHAVIORAL HEALTH CONSULTANT and interaction effects. Main effect of treatment was signifi-
SERVICES IN INTEGRATED PRIMARY CARE cant (F 14.71, df 131, p .0001) with BRT rated more acceptable
Meghan Corso, PsyD,2 Craig J. Bryan, PsyD,3 Kent Corso, PsyD,5 than medication. Age group x treatment interaction was non
Chad E. Morrow, PsyD1 and Kathryn Kanzler, PsyD4 significant (F 1.89, df 131, p .17) indicting no age cohort effect
1
USAF, MOntgomery, AL; 2National Naval Medical Center, relative to acceptability of behavioral versus pharmacological
Bethesda, MD; 3University of Texas Health Science Center at treatments. The findings are consistent with previous research
San Antonio, San Antonio, TX; 4Wilford Hall Medical Center, regarding greater acceptability of behavioral and cognitive
San Antonio, TX and 5Alternative Paths Training School, behavior treatment relative to medication. This is the only study
Bethesda, MD. that has directly compared younger and older adults accept-
The primary aim of the current study was to identify the rates ability of treatment ratings. Similarly,It is the only work that
at which mental health distress and global functioning remit has examined treatment acceptability ratings related to physical
to normal levels within the context of a Behavioral Health health and comorbid psychological disorders. Results provide
Consultant (BHC) model of integrated primary care. Related, a further information regarding older adult’s health care prefer-
secondary aim was to determine if greater severity of baseline ences. Education of physicians and other health care providers
symptom and functioning levels were associated with failure is needed regarding older adult’s preferences for behavioral
to recover within the BHC model. This study included 1477 and cognitive behavioral treatments. To ensure older adults
participants that were referred by their Primary Care Providers receive the treatment they prefer integrated behavioral health
(PCPs) to the BHC services. Each patient completed the Behav- care is necessary in primary and specialty care medical facilities.
ioral Health Measure (BHM) to assess global behavioral health CORRESPONDING AUTHOR: Duane A. Lundervold, RhD,
symptoms and functioning. The sample was predominantly Psychology, University of Central Missouri; Saint Luke’s Hospi-
married (75.1%) and female (62.3%). Referral reasons ranged tal, Warrensburg, MO, 64093; lundervold@ucmo.edu
from isolated problems such as depression alone to co-morbid
problems (e.g. depression, insomnia, and pain). Of the par- A-096e
ticipants, 982 (66.5%) pts met with the BHC once, 339 (23%) EFFECT OF EFT (EMOTIONAL FREEDOM TECHNIQUES) ON
kept two appointments, 94 (6.40%) kept three appointments, PSYCHOLOGICAL TRAUMA IN VETERANS: A RANDOMIZED
and 40 (2.7%) kept four appointments. A mixed linear model CONTROLLED TRIAL
with random effects was conducted to model recovery rates by Dawson Church, PhD,2 Audrey Brooks, PhD1 and Crystal
initial severity level. Results show that approximately one-third Hawk, MEd3
of the observed difference in recovery was accounted for by
1
Psychology, University of Arizona, Tucson, AZ; 2Foundation
increasing number of appointments. Results also indicated that for Epigenetic Medicine, Santa Rosa, CA and 3Therapeutic
more severe symptoms and functional limitations at the initial Touch Network, Ontario, ON, Canada.
appointment were associated with faster recovery. Overall, this The present study examined whether Emotional Freedom
study lends further support for the effectiveness of brief, prob- Techniques (EFT), a brief exposure therapy that combines
lem-focused treatment conducted by BHCs in a primary care cognitive and somatic elements, had an effect on post-traumatic
clinic. Additionally, the study demonstrates that even patients stress disorder (PTSD) and psychological distress symptoms
with severe levels of baseline functional impairment recover in in a sample of military veterans. Veterans were randomized to
an average of four appointments. either EFT (N=19) or a wait-list control group (N=13; WL). The
CORRESPONDING AUTHOR: Chad E. Morrow, PsyD, USAF, EFT treatment consisted of six hour-long EFT coaching sessions
MOntgomery, AL, 36116; chad.morrow@maxwell.af.mil administered either in person or over the phone. PTSD was as-
sessed using the PCL-M (PTSD Checklist Military). Severity and
9
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
breadth of psychological distress was measured using the SA-45 teaching about causes and outcomes, not just early detection
(Symptom Assessment 45). PTSD and psychological distress and accessing services.
were assessed prior to treatment and at the end of 6-sessions or CORRESPONDING AUTHOR: Marisa Sklar, BA, University of
at 1-month for the wait-list group. Additional assessments were California San Diego, San Diego, CA, 92121; masklar@ucsd.edu
conducted during treatment after 3-sessions and at 3-months
following treatment. The sample consisted of 29 males and 3 A-096g
females, with an average age of 52 years old (range 24-86). The THE FUTURE OF QUALITY OF LIFE (QOL) ASSESSMENT:
EFT group had a significant decrease in psychological distress DISEASE SPECIFIC OR GENERAL? ONLINE OR ON PAPER?
and PTSD from pretest (p<.001). A statistically significant dif- Bethany Gourley, BA,1 Flora Hoodin, PhD,1 Lauren Hart,1 Jillian
ference between the EFT and WL group was also present at Carey, BS,1 Teresa J. Lynch, PhD,1 Kevin N. Alschuler, MS,1
posttest on all measures indicating decreased distress for the Michelle Byrd, PhD1 and Michael J. Mendelow, MD2
EFT group. Sixteen participants in the treatment group (84%) no 1
Eastern Michigan University, Ypsilanti, MI and 2Providence
longer met the criteria for PTSD, while none of the WL group Hospital- St. John Health, Southfield, MI.
had dropped below the PTSD cut-off score (p<.001). There was QOL is an important aspect of treatment outcome in adolescent
no pre-post difference in PTSD symptoms or psychological dis- idiopathic scoliosis (AIS), a chronic health condition character-
tress for the WL group. In the combined group EFT treatment ized by lateral growth of the spine and rotation of its vertebrae.
analysis, statistically significant decreases in PTSD symptoms The SRS-22r, a measure of AIS disease-specific QOL, is reliable
and psychological distress were present after 3- and 6-ses- and internally valid in clinic-based samples. However, its online
sions of EFT. After 3 EFT sessions, 72% no longer met PTSD psychometrics are unknown. As internet data collection has
criteria. This increased to 28 participants (88%) after 6 sessions. potential for tracking natural history and long-term treatment
Thirteen participants completed a 3 month follow-up. None of outcomes, our study aimed to validate SRS-22r use online in a
the participants met PTSD criteria at this point. The results are community-based sample.
consistent with other published reports showing EFTs efficacy
at treating PTSD and co-morbid symptoms. We recruited 311 adults with AIS via the National Scoliosis
Foundation and like websites. Mean age was 40.3 + 13.5 years
CORRESPONDING AUTHOR: Audrey Brooks, PhD, Psychol- (18-72); 95.2% were female; 89.7% were white; 53.1% had
ogy, University of Arizona, Tucson, AZ, 85721; brooksaj@email. completed 4 years of college; 51.8% were post-surgery for AIS;
arizona.edu 21.2% were braced; 27% under structured observation.
A-096f Participants completed the SRS-22r, Oswestry Disability Index
BELIEFS ABOUT THE NATURE AND CAUSES OF (ODI) and SF-12. The SRS-22r , a 22-item self report measure
DEPRESSION INFLUENCE WILLINGNESS TO MEDICATE assesses QOL across 5 domains (functioning, pain, self-image,
Andrew Sarkin, PhD, Marisa Sklar, BA, Eliza Robillos, BA, mental health, and satisfaction with management). The ODI, a
Jennifer Leich, MA, Alexis Munoz, MPH, Richard Heller, MA 10-item measure assesses physical disability, social restriction
and David Thomas, BA and pain, and provides a total disability index. The SF-12, a 12-
Health Services Research Center, University of California San item general QOL measure assesses physical and mental health.
Diego, San Diego, CA. SRS-22r floor and ceiling effects for all domains were <1% and
Beliefs about the nature and causes of an illness can influence ≤6.4%, respectively, except satisfaction with management (6.8%
a person’s participation and response to treatment. This study and 10%, respectively). Internal consistency was strong (α≥0.80)
examined how beliefs about the causes of depression influ- in all domains except pain (α=.38). Concurrent validity was ≥.73
ence willingness to take psychiatric medications if depressed, relative to comparable domains of the SF-12 and ODI. Overall,
using data from the 2006 General Social Survey. In this study, online administration displayed comparable psychometrics to
participants (n=360) were read a vignette describing a person paper administration, documented by Bridwell et al. (2005).
with depression and were asked to rate the likelihood of several These psychometric findings suggest that orthopedic surgeons
possible origins for the person’s disorder. People were signifi- could use the SRS-22r online in ongoing QOL assessment. Ad-
cantly more willing to take psychiatric medication themselves vantages of time efficiency and cost effectiveness, make online
for depression if they believed that the depression is genetic in assessment a viable option for the future and highlight the
origin (r=.242,p<.0005) or caused by a brain chemical imbalance importance of validating other online QOL measures.
(r=.359,p<.0005), but not if they believed it was caused by “bad
character” (r=-.037,p=.481) or stress (r=.048,p=.364). People CORRESPONDING AUTHOR: Bethany Gourley, BA, Clinical
who interpreted that the depressed person in the vignette was Psychology, Eastern Michigan University, Ypsilanti, MI, 48197;
experiencing “the normal ups and downs of life” were signifi- bgourley@gmail.com
cantly less likely to be willing to take medications themselves
for depression(r=-.181,p=.001), while those who thought the
vignette person was experiencing mental illness were more
willing (r=.275,p<.0005). A belief that the person would get
better with treatment was related to being more willing to take
medication (r=.219,p<.0005), while a belief that they would
get better on their own was not (r=-.079,p=.136). These results
imply that public education efforts for prevention and early
intervention of mental health problems should also focus on
10
A-096h outcome measures over extended periods of time commensu-
COGNITIVE BEHAVIORAL STRESS MANAGEMENT EFFECTS rate with the duration of a clinical trial will provide information
ON STRESS, QUALITY OF LIFE, AND SYMPTOMS IN regarding spontaneous fluctuation in these measures attribut-
PERSONS WITH CHRONIC FATIGUE SYNDROME able to random error. The purpose of this study was to assess
Corina R. Lopez, BA, Michael Antoni, PhD, Frank Penedo, the stability of several well-established instruments used in
PhD, Nancy Klimas, MD, Mary Ann Fletcher, PhD and Neil chronic pain trials over 8-weeks, namely, Multidimensional
Schneiderman, PhD Pain Inventory Pain Severity Scale(MPI), Oswestry Disability
University of Miami, Miami, FL. Index(ODI), Center for Epidemiological Studies Depression
The present study was designed to aid individuals with Chronic Scale(CESD), Pain Anxiety Symptom Scale(PASS), State-Trait
Fatigue Syndrome (CFS) in relieving mental distress and symp- Anxiety Inventory(STAI), Hospital Anxiety and Depression
tomatology by offering a 12 week group-based Cognitive Be- Index(HADS), Pain Catastrophizing Scale(PCS), and a mea-
havioral Stress Management (CBSM) intervention that teaches sure of self-efficacy pain, for a sample of fibromyalgia patients
cognitive reappraisal, problem solving, coping, and relaxation awaiting treatment. Paired t-tests indicated all measures were
skills. We hypothesized that participants randomized to CBSM stable over the 8-week period (all p values >0.05). The most
would report improvements in perceived stress, mood, quality stable measure was the ODI (r=0.92). In addition, all psychoso-
of life, and CFS symptomatology from pre-post intervention cial measures had large and significant test-retest correlations:
(T1-T2) compared to those assigned to 1/2 day psychoeduca- HADS (r=0.81), PASS (r=0.76), PCS (r=0.76), CESD (r=0.72),
tional (PE) seminar. A total of 69 participants comprised our STAI (r=0.68), and Self-Efficacy (r=0.63). Although highly cor-
sample, with 44 randomized to CBSM and 25 to PE. Participants related, pain severity showed the lowest stability (r=0.61). The
were mainly Caucasian women (76.8%) with a mean age of 45.9, stability of the measures over 8 weeks demonstrates that fibro-
a high school diploma or greater (97%), on disability (44.5%), myalgia patients’ levels of pain, physical functioning, mood,
and a mean household income of $20,000-$30,000. Participants and self-efficacy are relatively enduring. Moreover, the results
completed self-report measures including the Perceived Stress support the use of these measures as outcomes in clinical trials
Scale (PSS; Cohen et al., 1983), Profile of Mood States (POMS; of up to 2months in length.
McNair et al., 1971), Quality of Life Inventory (QOLI; Frisch et CORRESPONDING AUTHOR: Christina A. Kemp, BA Psychol-
al., 1992), SF-36 health survey (Ware, 1997), and the Temporal- ogy, Anesthesiology and Pain Medicine, University of Washing-
ity and Nature of CFS scale at T1 and T2. Repeated Measures ton, Seattle, WA, 98195; kempc10@uw.edu
ANOVA analyses revealed a significant group x time interac-
tion for PSS [F(1, 53)= 5.07, p=.028], POMS-total mood distur- A-122a
bance [F(1, 51)= 4.12, p= .048], QOLI [F(1, 49)= 10.65, p=.002], DEVELOPMENT AND EVALUATION OF THE AUDIT OF
and SF-36 emotional wellbeing [F (1,53)= 5.35, p=.025], such that PHYSICAL ACTIVITY RESOURCES FOR SENIORS (APARS)
participants in CBSM evidenced greater improvements in these TOOL
areas from T1 -T2 than participants in PE. Significant interaction Jordan A. Carlson, MA,1 Jacqueline Kerr, PhD,1 Dori Rosenberg,
effects were also found on CFS symptoms, including decreases MS,1 James F. Sallis, PhD,1 Brian E. Saelens, PhD2 and Abby C.
in pain [F(1, 53)= 4.56, p= .04], severity of sore throat [F(1,46)= King, PhD3
4.80, p=.034], stomach pain [F(1,29)= 1.96, p= .02], and frequen-
1
San Diego State University, San Diego, CA; 2University of
cy of unrefreshed sleep [F(1,52)= 6.59, p=.01] in CBSM vs. PE. Washington, Seattle, WA and 3Stanford University, Stanford,
Results suggest that CBSM is beneficial for patients with CFS in CA.
managing distress and alleviating symptoms. A growing number of older adults reside in continuing care
CORRESPONDING AUTHOR: Corina R. Lopez, BA, University retirement communities(CCRCs), where restricted environ-
of Miami, Miami, FL, 33136; corina.lopez83@gmail.com ments may reduce physical activity (PA) and affect health.
Measures are needed to quantify PA related attributes within
A-104a CCRCs. This study evaluated a new tool, “the Audit of Physi-
ASSESSMENT OF THE LONG-TERM STABILITY OF cal Activity Resources for Seniors” (APARS), which assesses
SYMPTOMS AND OUTCOME MEASURES FOR CHRONIC PAIN the PA environment in CCRCs including PA-specific resources
CLINICAL TRIALS in- and out-doors (e.g. sports courts or exercise classes), outdoor
Christina A. Kemp, BA Psychology, Brian R. Theodore, PhD, environments that support walking (e.g. length and features of
Hilary D. Wilson, PhD, James P. Robinson, MD, PhD and walking routes), and indoor environments that support inci-
Dennis C. Turk, PhD dental activity such as access to stairs. Development included
Anesthesiology and Pain Medicine, University of Washington, interviews with facility staff and residents. Audits were
Seattle, WA. conducted by trained observers in 30 CCRCs in 4 U.S. cities.
Pain, mood, and physical function are routinely used as out- Inter-rater reliability intraclass correlation coefficients (ICCs)
comes to evaluate the efficacy of treatments for chronic pain. were assessed for 204 items. Seven day accelerometer data were
The stability of instruments used to assess these outcomes is es- collected from residents at 12 sites (N = 147) to evaluate predic-
sential as lack of consistency of the measure will inhibit ability tive utility. Pearson correlations were examined between each
to attribute any changes observed to the treatment. There is no APARS item and sedentary (< 100 counts) and moderate-to-
set time for the assessment of test-retest reliability of self-report vigorous PA (MVPA; > 1952 counts) minutes per day, adjusting
measures, although this is most frequently measured between for time the accelerometer was worn. ICCs ranged from .15 to
1 day and 6 weeks apart. However, clinical trials are typically 1.00. Seventy-seven percent of the items produced ICCs ≥ .80,
conducted between 6- 12 weeks. Knowledge of the stability of 16% were .60-.79, and 7% were < .60. Correlations ranged from
11
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
12
Methods: Fifty-eight male (mean age: 38 yrs) long-term smok- smoking cessation trial (N=158), a multiple mediator analysis
ers participated in a smoking cessation program and were revealed that positive affect was a significant partial mediator
assessed at baseline (while smoking), at mid-treatment (while of the relationship between mindfulness and dependence (b=-
using a nicotine transdermal patch), and at 1-month follow-up 1.46, SE=.56, p < .05). In contrast, neither negative affect (b=-.85,
(post-treatment). All participants received an 8-week nicotine SE=.66, ns) nor perceived stress (b=.83, SE=.77, ns) were found
transdermal patch intervention administered in a step-down to be significant mediators. More mindful individuals experi-
fashion. Physiological sexual arousal (mean circumferential ence more positive affect which in turn may reduce dependence
change, maximum erection, mean latency to maximum erec- on smoking. Mindfulness may target a pathway (positive affect)
tion) and self-reported sexual functioning (as measured by the not currently targeted by current conventional clinical practice
International Index of Erectile Functioning (IIEF)) were assessed guidelines, which focus on dealing with negative affect and
at each visit. stress. Mindfulness-based therapies may have potential as an
Results: Participants who completed the program and remained independent treatment for smoking cessation or as an adjunct
smoke free (n = 21; 36%), showed significant improvements in treatment alongside a treatment that targets negative affect. The
physiological sexual arousal. Specifically, at both mid-treatment data also suggest that further examination on the role of posi-
and follow-up, compared to baseline, they demonstrated tive affect in tobacco dependence and relapse is warranted.
increased mean erectile responses and decreased latencies CORRESPONDING AUTHOR: Aimee C. Ruscio, BS, Medical
to reach maximum erectile capacity. Quitting smoking also and Clinical Psychology, Uniformed Services University of the
significantly enhanced self-reported sexual functioning, such as Health Sciences, Washington, DC, 20016; aruscio@usuhs.mil
improved erectile functioning and orgasmic capacity. In fact, at
follow-up, 90% of men showed improved erectile functioning A-142b
and all men with erectile dysfunction at baseline (n = 6; 29%) LATINO AND NON-LATINO COMFORT WITH TECHNOLOGY
were remitted at follow-up. AMONG RURAL KANSAS SMOKERS ENROLLED IN A
TELEHEALTH VS. QUITLINE STUDY
Conclusions: Quitting smoking significantly improves sexual Genevieve Casey, MA,1 Leah Lambart, MPH,1 Jamie Hunt,
health in men. Men may be particularly persuaded to quit PhD,1 Ryan Spaulding, PhD,2 Paula Cuppertio, PhD1 and
smoking considering that they may show an increase in erection Kimber Richter, PhD, MPH1
as well as noticeable increases in sexual performance with a 1
Prev Med & Pub Health, KU Med Ceneter, Kansas City, KS and
partner. It is our hope that these results may have the potential 2
Center for Telemedicine & Telehealth, KU Med Center, Kansas
for facilitating programs and interventions targeting the pre- City, KS.
vention and cessation of cigarette smoking in men.
Telemedicine is a promising approach for reaching underserved
CORRESPONDING AUTHOR: Christopher B. Harte, MA, De- rural smokers. Some studies have explored the receptivity
partment of Psychology, University of Texas at Austin, Austin, of doctors to telehealth. Information on patients’ receptivity
TX, 78712; charte@mail.utexas.edu to health behavior interventions delivered via telehealth or
A-142a telemedicine is limited. The study purpose is to describe access
MINDFULNESS AND TOBACCO DEPENDENCE: MEDIATING and comfort with computers and communication technology
MECHANISMS among rural Latino and non-Latino participants in a random-
Aimee C. Ruscio, BS,1 Andrew J. Waters, PhD,1 Lorraine ized controlled trial.
R. Reitzel, PhD,2 Paul Cinciripini, PhD,3 Yisheng Li, PhD,4 This is an analysis of baseline data from a trial of video vs.
Marianne Marcus, EdD, RN,5 Jennifer I. Vidrine, PhD2 and phone counseling for smoking cessation. Subjects were re-
David W. Wetter, PhD2 cruited from primary care and community health practices. The
1
Department of Medical and Clinical Psychology, Uniformed baseline survey was conducted in both English and Spanish via
Services University of the Health Sciences, Washington, DC; phone. Technology questions consisted of three yes or no ques-
2
Department of Health Disparities Research, The University tions and four scaled items.
of Texas M. D. Anderson Cancer Center, Houston, TX; Over half of patients (68%) have a functional computer in
3
Department of Behavioral Science, The University of Texas their home, and (62%) have internet access. Few had ever been
M. D. Anderson Cancer Center, Houston, TX; 4Department seen by a doctor via video (8%). Some reported comfort using
of Biostatistics, The University of Texas M. D. Anderson computers (59%) and using other communication technolo-
Cancer Center, Houston, TX and 5Center for Substance Abuse gies (63%) such as mobile phones, mp3, or web cameras. Half
Prevention, Education and Research, School of Nursing, (52%) reported interest in receiving health care in their homes
University of Texas Health Science Center, Houston, TX. using computers or communication technologies. Many (65%)
Mindfulness involves paying attention to one’s moment to reported confidence that their information is kept private when
moment experience in a non-judgmental manner. Previous re- using communication technologies. While Latinos reported
search has revealed that more mindful individuals report lower slightly lower numbers for each item, there were few significant
levels of tobacco dependence, and may therefore find it easier differences between ethnic groups. One significant difference
to quit. We examined the mediators of the association between (p=0.0409) between groups, 47% of Latinos and 72% of non-
mindfulness, assessed using the Mindful Attention Awareness Latinos reported having a working computer at home.
Scale (MAAS), and tobacco dependence, assessed using the A significant number of rural smokers are not comfortable
Wisconsin Inventory of Smoking Dependence Motives (WIS- using communication technology. Fewer Latinos have home
DM). Using baseline data collected from a mindfulness-based
13
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
14
Rapid Communications
Poster Session B
Thursday, April 8, 2010
7:00 PM – 8:30 PM
15
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
16
Average yearly household income was below $10,000. The health care providers and scientists should work effectively
most common cancers were breast (37%) and colorectal (13%). with the media to ensure that balanced information is provided.
Fifty-nine percent preferred to leave decisions up to their doc- CORRESPONDING AUTHOR: Corinne M. Bruce, BS, The Uni-
tors. Patients held accurate and optimistic beliefs about cancer versity Of Texas Southwestern Medical Center at Dallas, Dallas,
treatment and outcomes (M=31.83±3.76; maximum=36) and TX, 75390-9066; corinne.bruce@utsouthwestern.edu
were emotionally healthy (M=19.31±4.63; maximum=24). Hier-
archical multiple regression analysis revealed that patients with B-033e
higher levels of education were likely to prefer SDM (t=2.68, RUMORS ABOUT CANCER: TRANSMISSION, BELIEF AND
p<.01). Neither cancer-specific beliefs nor the interaction of COPING FUNCTIONS
these beliefs with EWB were related to preference for SDM Nicholas DiFonzo, PhD,1 Nicole M. Robinson, MA,2 Jerry Suls,
(F=1.22, p=.29). PhD3 and Christine Rini, PhD4
Conclusion. Supporting earlier findings, the majority of this
1
Dept of Psychology, Rochester Institute of Technology,
primarily Black sample preferred to leave decisions up to the Rochester, NY; 2Dept of Communications, George Mason
doctor and those with higher levels of education preferred University, Fairfax, VA; 3Psychology, University of Iowa, Iowa
SDM. Identifying patient preferences and empowering those City, IA and 4Dept of Oncological Sciences, Mt Sinai School of
who may desire SDM, but may be reluctant to engage in SDM Medicine, New York, NY.
(e.g., minorities and those with less formal education), is an Cancer rumors are common, yet little is known about how
important goal. they affect health-related coping and behaviors. A web survey
CORRESPONDING AUTHOR: Shiquina L. Andrews, MS, Psy- (N=188) queried members of online cancer discussion groups
chology, Universtiy of Alabama at Birmingham, Birmingham, about cancer rumors heard from non-medical sources. Twen-
AL, 35294-1170; shiand25@uab.edu ty-nine percent had a personal history of cancer; 95% knew
someone with cancer (63% of whom died from it). Rumors were
B-033d coded by three judges as dread or wish (kappa = .60), and as
NEWS COVERAGE OF HPV VACCINE MANDATE POLICIES: IS primary or secondary (kappa = .27) control statements (all p’s
THERE A NEGATIVE BIAS IN REPORTING? < .01). Dread rumors exceeded wish rumors by more than 3 to
Corinne M. Bruce, BS,1,2 Margaret O. Caughy, ScD,1 Scott T. 1. Secondary control rumors (i.e., affording emotional cop-
Walters, PhD1 and Jasmin A. Tiro, PhD2,3 ing) outnumbered primary control rumors (affording control
1
Health Promotion & Behavioral Sciences, UT School of Public via direct action) by nearly 2 to 1. Respondents who discussed
Health, Dallas, TX; 2Clinical Sciences, UT Southwestern Medical rumors with medical personnel did so primarily for fact-finding
Center, Dallas, TX and 3Simmons Cancer Center, Dallas, TX. (47.1%) or threat-management (17.6%) purposes; those trans-
Background: Since 2006, several US states have considered mitting/discussing rumors with non-medical people reported
mandating the human papillomavirus (HPV) vaccine for mid- social (46.7%), pro-social (19.7%) or emotional coping (17.2%)
dle school girls. Debates over these policies have confounded motives. Transmitters (vs. non-transmitters) were more anxious,
criticisms of the policies with concerns about the vaccine itself. considered the rumors more important, and believed the rumor
The public’s and policymakers’ decisions regarding public more strongly. Most respondents strongly believed the rumors;
health policies are often influenced by news coverage. Thus, it is confidence was based on trust in family or friends, concordance
crucial to understand media’s framing of controversial policies. with beliefs and attitudes, and repeated hearing. Transmit-
None of the past content analyses on media coverage of the ters (vs. non-transmitters) reported the rumors helped them to
HPV vaccine have examined coverage of mandates.Objective: understand the disease. However, transmitters were no better
We examined the content and quality of news articles discuss- at deciding what to do about the disease, nor did they feel any
ing HPV vaccine mandate policies.Methods: Lexis-Nexis was better. About 70% of participants made behavioral changes after
used to identify 335 articles on HPV vaccine mandates pub- hearing the rumor. Findings add to rumor research on anteced-
lished in US newspapers from February 2006 to January 2008. ents and motives for transmission. Results suggest that rumors
Articles were coded for general characteristics (e.g., publication are an important means by which people achieve a sense of
date), facts about the mandate, and frequency of citing argu- secondary control for dreaded outcomes associated with cancer.
ments in favor or against the mandate as well as the vaccine. CORRESPONDING AUTHOR: Jerry Suls, PhD, Psychology,
Results: Mandating the HPV vaccine became a high-profile University of Iowa, Iowa City, IA, 52242; jerry-suls@uiowa.edu
story after Texas Governor Perry issued an executive order in
February 2007. Most stories did not explain provisions allow- B-033f
ing parents to opt out of the mandate (86%). Only 18% of the SPECIALTY DIFFERENCES IN PRIMARY CARE PHYSICIANS’
stories presented a balanced argument about mandates; most AGE AND COMORBIDITY-SPECIFIC RECOMMENDATIONS
focused solely on counter-arguments (e.g., intrusion on parental FOR BREAST CANCER SCREENING
autonomy [70%] and cost [40%]). Only 39% presented both pros Corinne R. Leach, PhD MPH, Carrie Klabunde, PhD, Catherine
and cons for the vaccine; most focused on potential negative Alfano, PhD and Julia Rowland, PhD
consequences (e.g., encouraging promiscuity [67%] and safety/ National Cancer Institute, Bethesda, MD.
side-effects [34%]). Coverage of the debate did not vary over In November 2009 the US Preventive Services Task Force
time or by article type.Conclusions: Our findings revealed released updated breast cancer screening recommendations,
that news coverage on HPV vaccine mandates was biased and citing that evidence remains insufficient to recommend for or
incomplete. Imbalanced reporting may have negatively affected against screening women age 75 and older. This has height-
HPV vaccine acceptability and uptake. Public health officials, ened debate concerning who should continue to be screened
17
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
for breast cancer, especially those at advanced age, with poor were more likely to be married, reported less frequent child-
health status, or with perceived limited life expectancy. Physi- hood life-threatening events (β = -2.27, p =.04), and lower levels
cian recommendation for mammography remains the most of depression (β = -.10 p=.00), while anxious attachment was
important predictor of screening. However, little is known associated with higher initial depression (β = .09, p = .00). Spe-
about when or under what circumstances physicians stop cific adult attachment styles moderated the effects of treatment
recommending mammography. This study analyzed data from on change in distress: less secure and most initially depressed
a large survey of primary care physicians (PCPs; N=1212) to women showed greatest decrease in depressive symptoms
examine breast cancer screening recommendations for hypo- (β = .63, p = .00) in both treatment models. Anxious-avoidant
thetical patients of varying age (50, 65, 80) and health status women showed the steepest decrease in depression and anxiety
(healthy, moderate comorbidity, terminal comorbidity) combi- following SET groups (β = -.61, p = .00; β = -.36, p = .01), while
nations. In general, almost all PCPs stated they would hypo- less anxious-avoidant individuals improved the most after
thetically recommend mammography alone or in combination community group treatment (β = -.61, p = .00). These results
with clinical breast exam (CBE) for healthy women age 50 or highlight the importance of examining individual differences to
65 and for women with a moderate comorbidity age 50 or 65. better understand which patients may be most at risk for poor
Greater differences in recommendations emerged for patients psychosocial adjustment and who may benefit the most from
age 80, regardless of health status, and for those with a terminal different models of cancer support groups.
comorbidity (unresectable non-small cell lung cancer). Specifi- CORRESPONDING AUTHOR: Maya Yutsis, PhD, Mayo Clinic
cally, 64.7% of OB/GYNs reported that they would hypotheti- College of Medicine, Rochester, MN, 55901; yutsis.maya@mayo.
cally recommend mammography alone or in combination with edu
CBE to a 50 year old woman with unresectable non-small cell
lung cancer, a terminal disease, compared to 46.7% of Family B-033i
Practitioners and 32.1% of Internists. These results suggest that DEPRESSIVE RUMINATION IN CANCER PATIENTS AND
many PCPs, OB/GYNs in particular, are aggressively screen- PARTNERS: IMPLICATIONS FOR MENTAL HEALTH AND
ing women with terminal disease and are continuing to expose ADJUSTMENT TO ILLNESS
women to the risks of mammography and follow-up diagnostic Nermin Bayman, MA,1 Jennifer Steiner, BA1 and Silvia Bigatti,
procedures when they likely would not be eligible for breast PhD2
cancer treatment if cancer were found. These findings suggest 1
Psychology, Indiana University Purdue University
the need for better physician-patient communication about can- Indianapolis, Indianapolis, IN and 2Public Health, Indiana
cer screening decision-making that is tailored to an individual’s University Purdue University Indianapolis, Indianapolis, IN.
risks as well as her potential benefits. This study examined the relationship of depressive rumina-
CORRESPONDING AUTHOR: Corinne R. Leach, PhD MPH, tion to the mental health and adjustment to illness of breast
Office of Cancer Survivorship, National Cancer Institute, cancer patients and their husbands. Depressive rumination has
Bethesda, MD, 20892; leachcr@mail.nih.gov been extensively studied in relation to other chronic and acute
health conditions, but little is known regarding its effect among
B-033h patients with cancer. Fifty-three women with breast cancer and
ADULT ATTACHMENT STYLE IN BREAST CANCER PATIENTS their spouses were recruited from the Indiana University Simon
AND ITS IMPACT ON TREATMENT OUTCOMES OF CANCER Cancer Center. Couples were mailed survey packets containing
SUPPORT GROUPS self-report questionnaires, including the Center for Epidemio-
Maya Yutsis, PhD,1 Janine Giese-Davis, PhD,2 Matthew logical Studies Depression Scale, Impact of Illness Scale, Avoid-
Cordova, PhD3 and Nigel Field, PhD4 ance and Intrusive Subscales of the Impact of Events Scale, and
1
Mayo Clinic College of Medicine, Rochester, MN; 2University Ruminative Responses Subscale of the Response Styles Ques-
of Calgary, Department of Oncology, Alberta, AB, Canada; 3VA tionnaire. Results showed that higher depressive rumination
Northern California Health Care System, Martinez, CA and in patients was associated with higher impact of illness, more
4
Palo Alto University, Palo Alto, CA. avoidance and intrusive thoughts about the cancer, and more
Despite the wealth of research demonstrating the psychologi- symptoms of depression. The same relationships were found in
cal and psychosocial benefits of group interventions for breast husbands such that higher depressive rumination in husbands
cancer (BC) patients, there is a scarcity of studies identifying was associated with higher impact of illness, more avoidance
patient variables that may contribute to the effectiveness of and intrusive thoughts about the cancer, and more symptoms
group therapy. This study examined the effects of adult at- of depression. All correlations were in the moderate range (.33
tachment styles in women with BC randomized to one of two to .68). Surprisingly, depressive rumination in patients had no
types of breast cancer support groups: Supportive Expressive relation to husband variables, and depressive rumination in
Therapy (SET) or Community Cancer Groups. We examined husbands had no relationship with patient variables. Findings
the moderating effects of four attachment styles on change in confirmed that depressive rumination is associated with poor
distress following the treatment. Depressive symptoms were outcomes in both patients and their partners. Implications for
measured with the Center for Epidemiologic Studies Depres- practice are the need to evaluate and address rumination in
sion Scale (CES-D) and anxiety symptoms were assessed with families dealing with cancer given its potential impact on men-
the Weinberger Adjustment Inventory (WAI). Sixty six women tal health and adjustment. Future research should attempt to ex-
diagnosed with primary BC who were 32 years of age and older amine the predictive role of rumination in physical and mental
(M=52.53; SD=9.41) completed this study. Hierarchical multiple well-being of patients and partners in more complex designs
regressions revealed that at baseline, securely attached women with larger and more diverse cancer populations.
18
CORRESPONDING AUTHOR: Nermin Bayman, MA, Psy- B-033k
chology, Indiana University Purdue University Indianapolis, COGNITIVE-BEHAVIORAL STRESS MANAGEMENT AND
Indianapolis, IN, 46260; nbayman@iupui.edu INCREASED PHYSICAL ACTIVITY ASSOCIATED WITH
LOWER FATIGUE-ASSOCIATED DISRUPTION IN WOMEN
B-033j WITH BREAST CANCER
FEAR OF RECURRENCE IN HEAD AND NECK CANCER Jamie M. Stagl, BA,1 Michael H. Antoni, PhD,1 Erin M. Fekete,
SURVIVORS PhD,2 Sara Vargas, BA,1 Suzanne Lechner, PhD2 and Charles S.
Shannon L. Madore, BA,1 Kevin McCarthy, BA,1 Allison Carver, PhD1
Costenaro, MA,1 Shih Ming Shih, MA,1 Jeff Kendall, PsyD,2 1
Psychology, University of Miami, Coral Gables, FL and
Andrea Bevan, BA,1 Derek Anderson, MA,3 Jennifer Allen, BA,1 2
Psychiatry and Behavioral Sciences, University of Miami Miller
David Raben, MD1 and Kristin Kilbourn, PhD MPH1 School of Medicine, Miami, FL.
1
University of Colorado, Denver, CO; 2St. Joesph’s Cancer
Center, Denver, CO and 3Ohio State University, Columbus, OH. Objective: Cognitive-behavioral stress management (CBSM) im-
proves quality of life in women undergoing treatment for breast
Introduction: An estimated 40,000 cases of head and neck cancer (BCa). The effects of CBSM on fatigue during active
cancer are diagnosed each year in the U.S. Among head and treatment have been less studied. Physical activity (PA) may
neck cancer survivors (HNCS) fear of cancer recurrence (FoR) is also contribute to fatigue levels during this period. Method: The
identified as a primary concern. FoR is associated with a poorer present study examines the effects of CBSM and the influence of
quality of life (QOL), psychosocial distress, and maladaptive corresponding changes in PA on fatigue-associated disruption
health behaviors (Llewellyn et al., 2008). FoR is particularly (FAD) in women with stage I-III breast cancer who were 8-10
relevant to HNCS due to the lasting physical impairments and weeks post-surgery (Mean age = 50.34, SD = 9.03). We random-
the high recurrence rate. This study examined the relationship ly assigned 240 women to receive a 10-week CBSM intervention
between psychosocial variables and FoR in HNCS 3 months (n = 120) or a 1-day psycho-educational control (PE, n = 120).
post-treatment. The mean duration of moderate and vigorous PA based on a
Methods: HANDSS (Head and Neck Descriptive Survivorship 7-day recall at baseline was 182 min/week (SD =383). Results:
Survey) is a longitudinal study involving a self-report survey Preliminary analyses showed that increases in duration of PA
assessing physical, psychosocial, and practical symptoms/con- from pre- to 3 months post-intervention were associated with
cerns in HNCS returning to radiation oncology for their 3 and lower FAD. Women assigned to CBSM showed a lower FAD
12-month post-treatment visit. This presentation will focus on than those in the PE group, Wilks’s Λ = .96, F(1,161) = 6.19,
results from the 3 month post-treatment assessment. p < .05, multivariate η2 =.04. We then classified women as
Results: The mean age of the 36 participants is 58 (SD=10.3), to whether they fell above or below the American College of
86 % are male, 42% are married, 56 % report an annual income Sports Medicine’s (ACSM) guidelines for PA of 150 min/week
of ≥ $25,000 and 67% completed at least some college. Thirty- at the pre- and 3 months post-intervention assessment. There
nine percent of the participants were diagnosed with late stage was a significant group x time x PA level interaction (Wilks’s
cancer and 78% were treated with concurrent radiation therapy Λ = .94, F[3,154] = 3.53, p < .05, multivariate η2 =.06) such that
and chemotherapy. FoR was reported by 67% of participants, the largest decrease in FAD was found in women assigned to
making it the most commonly reported emotional concern. FoR CBSM who shifted from below to above the minimum ACSM
was positively correlated with number of reported physical side guidelines from pre- to 3 months post-intervention (p <.05).
effects (r=.47, p<.05), anxiety (r=.86, p<.05), depression (r=.75, Conclusion: A CBSM intervention lowered fatigue-associated
p<.05), and number of emotional concerns (r=.78, p>.05), but disruption in women undergoing treatment for BCa, and these
not related to tumor stage. effects were most pronounced in women who correspondingly
increased time spent in physical activity.
Conclusions: FoR, which is associated with negative emotions
such as anxiety and depression, is a commonly experienced CORRESPONDING AUTHOR: Jamie M. Stagl, BA, Psychology,
psychosocial concern by HNCS in the early stages of survivor- University of Miami, Miami, FL, 33131; jstagl@psy.miami.edu
ship. In this study, FoR was not associated with the severity B-033l
of the cancer diagnosis (e.g. stage) but was associated with the NONMUSCLE-INVASIVE BLADDER CANCER SURVIVORS
number of side-effects. These findings suggest that FoR should REPORT SEXUAL DYSFUNCTION AND MISINFORMATION:
be a focus of psychosocial interventions for HNCS. RESULTS OF CROSS-SECTIONAL MIXED-METHODS
CORRESPONDING AUTHOR: Shannon L. Madore, BA, RESEARCH
University of Colorado, Denver, CO, 80209; shannon.madore@ Marc Kowalkowski, BS,1 Gilad E. Amiel, MD,1 Seth P. Lerner,
ucdenver.edu MD,1 David M. Latini, PhD1,2 and Heather H. Honoré, PhD2
1
Urology, Baylor College of Medicine, Houston, TX and
2
Houston VA HSR&D COE, MEDVAMC, Houston, TX.
Approximately 70,000 new cases of bladder cancer are diag-
nosed in the US each year, with 75% being nonmuscle-invasive
(NMIBC). We report mixed-method results from a quantitative
survey and qualitative interviews. Both studies explore NMIBC
survivorship; thematic findings from interviews clarified survey
results.
19
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
We conducted 78 surveys (Study 1) and 16 semi-structured screenings during annual check-ups, while rural residents were
interviews (Study 2) with NMIBC patients. Participants in the screened for detection in response to symptoms - (and ways to
2 studies were diverse: ages 29-87 years, female (16%), African overcome each) to CRC screenings for this population. Some of
American (6%), and primary relationships (79%). We carried the urban county males did not know the results of their CRC
out descriptive analyses of survey data and qualitative analysis screening test while all of the rural Appalachia county males
of transcribed interviews. reported that they knew their test results. For both groups,
Preliminary survey (Study 1) results linked NMIBC treatment low levels of health literacy, knowledge and awareness of CRC
to sexual symptoms and relationship issues. Many participants risk and screening were reported barriers. Additionally, for
reported sexual inactivity (40.7%) or not enjoying sex (22.2%). standard care, the importance of the family unit, strong social
Sexually active participants reported difficulties with erections support influencing their CRC screening behavior and practice
(63.6%), ejaculation (52.4%), vaginal dryness (66.6%), and worry were highlighted. We placed the identified barriers into five
about contaminating partner with treatment agents (24.4%). Al- categories: (a) physical environment, (b) structural factors, (c)
most half reported it was useful to talk with their partner about sociocultural factors, (d) individual factors, and (e) physician-
sexual function, but less than one-third of participants reported related barriers (barriers at the provider and/or patient end).
sharing all concerns with their partners. Conclusion: These finding suggest that a targeted CRC screen-
One-half of interviewees (Study 2) reported sexual dysfunction. ing intervention utilizing a take home screening test is preferred
Almost two-thirds reported negative impacts on their primary among these L/H residents over the traditional approach.
relationships including perceived loss of intimacy and divorce. CORRESPONDING AUTHOR: Oralia Dominic, PhD, MS, MA,
Over one-third were not sexually active for fear of contaminat- Penn State Milton S. Hershey Medical Center, Hershey, PA,
ing their partner or spreading NMIBC. 17033; oag102@psu.edu
Sexual symptoms among survivors may result from either B-033n
NMIBC or comorbid conditions or both. However, these results A MARKETING MODEL APPROACH TO UNDERSTANDING
inform the scientific literature and practice by raising awareness DECISIONS ABOUT HYPNOSIS USE BY BREAST BIOPSY
about the pervasiveness of these symptoms and their impact PATIENTS
on NMIBC survivors’ sexual/romantic relationships. Further Stephanie J. Sohl, PhD, Laurie Margolies, MD, Julie Schnur,
work is needed to design symptom management and educa- PhD and Guy Montgomery, PhD
tional programs to dispel misinformation about contamination Mount Sinai School of Medicine, New York, NY.
post-treatment and improve quality of life by addressing sexual
dysfunction in NMIBC survivors. Over 1 million women in the US will undergo a breast biopsy
each year, and many will undergo radiologic image-guided
CORRESPONDING AUTHOR: Marc Kowalkowski, BS, Urol- procedures. Unfortunately, breast biopsies are often associated
ogy / Health Services Research, Baylor College of Medicine/ with heightened emotional distress. Hypnosis has been dem-
Michael E. DeBakey VA Medical Center, Houston, TX, 77021; onstrated to reduce breast biopsy-related distress; however,
kowalkow@bcm.edu most patients do not use hypnosis. Therefore, it is important
B-033m to elucidate the decision-making process in regard to the use
BARRIERS TO CRC SCREENING AMONG LATINO/HISPANIC of hypnosis within this population. The Stimulus-Organism-
ADULTS IN URBAN AND RURAL PENNSYLVANIA: RESULTS Response (S-O-R) Marketing Model was adapted to explore the
FROM THE ACCN decision to use a hypnosis CD prior to an image-guided breast
Oralia Dominic, PhD, MS, MA,1 Eugene J. Lengerich, VMD, biopsy. The Stimulus in the current study is the hypnosis CD.
MS,1,2 Linda A. Wray, PhD,3 Roxanne Parrott, PhD,4 John A. The following constructs assessed individual differences in the
Ochoa, PhD,5 Carlos Renderos7 and Mark Dignan, PhD, MPH6 Organism (i.e., patient): Cognition (VAS scales of expectations
1
PHS, Div. Epidemiology, Penn State Milton S. Hershey for biopsy-related pain and anxiety), Affect (Attitudes toward
Medical Center, College of Medicine, Hershey, PA; 2Family and Hypnosis Questionnaire), Value (The Hedonic/Utilitarian
Community Medicine, Health Policy & Administration, Penn Scale), and Personality (The Self-Concept Congruity Scale).
State College of Medicine, Penn State Hershey Cancer Institute, The study team documented the Response, patients’ decision
Hershey, PA; 3Biobehavioral Health, Penn State University, to use a hypnosis CD or not. 85 patients participated in this
University Park, PA; 4Communications Arts & Sciences, study (Age: M=48.4, SD=14.3 years; 37% married; 51% college
Penn State University, University Park, PA; 5Spanish, Italian, graduates). The sample was racially and ethnically diverse (52%
Portuguese and Comaprative Literature, Penn State University, White; 33% Black; 7% Asian; 8% other; 32% Hispanic). 73% of
University Park, PA; 6Internal Medicine, KU, College of patients chose to use the hypnosis CD. Analyses revealed that
Medicine, Lexington, KY and 7Community Leader, Juniata and the decision to use the hypnosis CD was predicted by Affect
Mifflin Counties, PA. (χ2(1)=4.59, p<.05, β=.06), Utilitarian Value (χ2(1)=7.36, p<.01,
β=.12), and Personality (χ2(1)=6.17, p<.05, β=.71). Hedonic
We examined barriers to CRC among Urban and Rural Ap- Value was marginally significant (χ2(1)=3.57, p=.06, β=.08) and
palachia Pennsylvania Latino/Hispanic (L/H) adult residents. Cognitions were not significant predictors (ps>0.05). The results
Method: L/H (n=82) engaged in one of eight focus groups suggest that affect, values and personality are important predic-
(stratified by geography and sex) offered. Focus group data col- tors of the decision to use hypnosis prior to breast biopsy. This
lected were audio taped, transcribed and grouped into thematic study supports the application of the S-O-R model to the health
units using content analysis. Results: We found several unique context. Future studies should further investigate and address
barriers - including that urban residents received prevention the utility of the S-O-R model, as it may be useful in guiding
20
dissemination efforts of evidence-based interventions, and ulti- B-033p
mately lead to improvements in patients’ quality of life. SOCIAL SUPPORT AND DEPRESSIVE SYMPTOMS AMONG
CORRESPONDING AUTHOR: Stephanie J. Sohl, PhD, Mount WOMEN UNDERGOING SURGERY FOR SUSPECTED
Sinai School of Medicine, New York, NY, 10029-6574; Stephanie. ENDOMETRIAL CANCER
Sohl@mssm.edu Stacy M. Dodd, MS,1 Sally E. Jensen, PhD,2 Timothy Sannes,
MS,3 Stephanie Garey, BA,3 Seema Patidar, BA,3 Linda S.
B-033o Morgan, MD4 and Deidre B. Pereira, PhD3
SEXUALITY & VETERAN CANCER SURVIVORS 1
VA Palo Alto, San Carlos, CA; 2Kellogg Cancer Care Center,
Maggie Syme, PhD and Jennifer Moye, PhD NorthShore University HealthSystem, Evanston, IL; 3Clinical
Boston VA Healthcare System, Boston, MA. and Health Psychology, University of Florida, Gainesville, FL
More than 500,000 military veterans are currently diagnosed and 4Department of Obstetrics and Gynecology, University of
with cancer, representing 11% of those who receive their health- Florida, Gainesville, FL.
care in the Veterans Health Administration system. With the ex- Previous research has demonstrated that social support is
ception of prostate cancer, there is little research on the unique associated with health outcomes and psychological function-
needs of veteran cancer survivors. Sexual issues are one of the ing among both healthy individuals and cancer patients. This
most prevalent long-term complications after cancer treatment, cross-sectional study examined relationships between depres-
which vary by treatment, cancer type, and psychosocial vari- sive symptoms and social support quantity and quality among
ables such as social support and distress. Veterans likely also women undergoing surgery for suspected endometrial cancer.
experience distress related to sexual changes, which may inter- Study participants were 103 women (M = 61.10 years old, SD =
act with cancer-related anxiety, depression, and overall distress 9.23 years) scheduled to undergo surgery for suspected endo-
to complicate psychosocial adjustment after cancer treatment. metrial cancer. Participants completed the Structured Interview
In this pilot study, in-depth interviews were completed with 47 Guide for the Hamilton Anxiety and Depression Scale, Social
veterans (age 44-87, M= 65.40) diagnosed with cancer who had Network Index, and Sources of Social Support Scale. Partial
completed treatment on average one year previously (range correlation analyses were used to examine the relationship be-
1-42 months). They were recruited through fliers and the VA tween social support variables and depressive symptoms in this
tumor registry and screened via the medical record and phone sample. Controlling for age, larger social network size was as-
interview for inclusion. If eligible, a 60-minute interview was sociated with less depressive symptomatology (n = 53, network
conducted that gathered descriptive data on symptoms, coping diversity r = -.34, p = .02, number of people in social network
strategies, and self-identified gaps in personal healthcare. r = -.28, p = .05, and number of network domains in which
participant is active r = -.41, p = .002). Tangible support from
50% (N=23) of veterans reported feeling less sexually attractive friends and negative support from a husband/partner were
as a result of cancer; 48% stated they would go to their primary associated with more depressive symptoms (n = 95, r = .32, p
care doctor for sexual problems, while 26% indicated they were = .003 and r = .36, p = .004, respectively). Emotional support
unsure who they would go to. Those veterans who felt less was unrelated to depressive symptoms. These results indicate
sexually attractive had significantly higher levels of cancer-re- that for women undergoing surgery for suspected endometrial
lated PTSD (t(44)=-3.00, p<.01, η2=.17) and depression (t(44)=- cancer, both social support quality and quantity are associated
2.32, p=.03, η2=.11). Also, those with lower perceived sexual with depressive symptoms. Specifically, larger social networks
attractiveness tended to be younger (t(44)=3.79, p<.001), have are associated with less depressive symptoms, while tangible
significantly higher levels of fatigue (t(29)=-3.36, p<.01), have and negative social support are associated with more depres-
significantly lower levels of perceived emotional support from sive symptoms.
the VA (t(29)=3.25, p<.01) and family and friends (t(29)=3.04,
p<.01). CORRESPONDING AUTHOR: Stacy M. Dodd, MS, VA Palo
Alto, San Carlos, CA, 94070; smdodd@phhp.ufl.edu
Care for veteran cancer survivors is an emerging issue. A
significant number of veterans with cancer experience dis- B-033q
tress related to perceived sexual changes, which is associated FEASIBILITY OF RECRUITMENT AND DIFFERENCES IN
with increased psychological and physical problems. Further COMPLETERS OF PAPER, TABLET PC, AND INTERNET
research is needed to improve sexual satisfaction in veteran can- CANCER ASSESSMENT
cer survivors. Kim K. Engelman, PhD, Rachel M. Frische, BA and Trish Long,
CORRESPONDING AUTHOR: Maggie Syme, PhD, Boston VA PA
Healthcare System, Roxbury Crossing, MA, 02120; magstrum@ Dept of Prevenitve Medicine and Public Health, University of
hotmail.com Kansas Medical Center, Kansas City, KS.
The use of technology is of growing popularity in all forms
of medicine. Varying forms of technology have been utilized
in special populations to provide information to and gather
information from patients. The Healthy Living Kansas (HLK)
program promotes colon cancer screening among eligible rural
Kansans through the use of a colon cancer assessment and
intervention. The present study assessed the feasibility of colon
cancer assessment completion via varying forms of technology
(paper, tablet PC, and Internet) and the demographic differ-
21
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
ences between the completers of each assessment type. Rural depression become non-significant. Therefore the Medication
patients from 24 primary care offices were recruited by two Abuse scale completely and partially mediated the relationship
groups of medical students and the HLK research staff. Patients between adherence and depression and hostility, respectively.
were recruited by one group of students in the medical offices These results support utilization of personality measures such
by face-to-face completion of the HLK assessment using tablet as the MBMD and hostility scales in future studies investigating
PCs while the other group of students collected patient contact predictors of adherence and suggest that such personality mea-
information through medical chart reviews. Patient recruits sures might be used clinically to predict medication adherence
collected by chart reviews were then contacted and invited to among HF patients.
complete the assessment online or request a paper version of CORRESPONDING AUTHOR: Kristen Farrell, MS, Psychol-
the assessment. Data from the tablet PC completers has been ogy, University of Miami, Palmetto Bay, FL, 33157; k.farrell1@
collected and will be analyzed against the more recent online umiami.edu
and paper assessment completers. Preliminary findings indicate
that Internet completers tend to be more high risk than tablet B-039b
PC completers (15/77 vs. 0/163, p<0.0001). Internet completers THE DEVELOPMENT OF A COGNITIVE-BEHAVIOR GROUP
are often younger than tablet PC completers (51% vs. 25% aged INTERVENTION PROGRAM TO REDUCE THE HOSTILITY
<55, p=0.003). And Internet completers are more likely to be LEVELS OF CORONARY HEART DISEASE PATIENTS AND
female and college educated than tablet PC completers (61% vs ITS EFFECT ON BLOOD COAGULATION FUNCTION: A
54% and 85% vs. 69%). Further data analysis will be performed CONTROLLED STUDY
for the paper completers and additional Internet completers Chia-Ying Weng, PhD,1 Tin Kwang Lin, MD,2 Hsin-Hung
as the study progresses. The demographics, timeliness, and Chiang, BS,3 Chiu-Tien Hsu, Master,1 Ko-Chia Chen, Master,1
feasibility of assessment completers will be analyzed on the Chao Fen Chen, BS,1 Su-Ya Hseueh, BS3 and Chin-Lon Lin, MD2
basis of the form of technology utilized; either paper, tablet PC, 1
Psychology Department, National Chung Cheng University,
or Internet. Chia-Yi, Taiwan; 2Internal Medicine, The Buddhist Dalin
CORRESPONDING AUTHOR: Rachel M. Frische, BA, Dept of Tzu Chi General Hospital, Chia-Yi, Taiwan and 3Health
Prevenitve Medicine and Public Health, University of Kansas management center, The Buddhist Dalin Tzu Chi General
Medical Center, Kansas City, MO, 64108; rfrische@kumc.edu Hospital, Chia-Yi, Taiwan.
The purpose of this study is to develop a cognitive-behavior
B-039a group intervention program to reduce the hostility levels of cor-
UTILITY OF THE MILLON BEHAVIORAL MEDICINE onary heart disease (CHD) patients and to examine its effect on
DIAGNOSTIC (MBMD) TO PREDICT MEDICATION blood coagulation function. A case control study with matched
ADHERENCE IN PATIENTS DIAGNOSED WITH HEART age, sex and education, based on a two group pre- and post-test
FAILURE design was adopted. Participants of the experimental group
Kristen Farrell, MS,1 Biing-Jiun Shen, PhD,2 Stephen Mallon, were 9 CHD patients (mean age = 56.33±10.45, male 67%) who
MD,3 Frank J. Penedo, PhD1 and Michael H. Antoni, PhD1 attended a weekly two-and-a-half hour session and did home-
1
Psychology, University of Miami, Coral Gables, FL; work for two months. The intervention foci included psycho-
2
Psychology, University of Southern California, Los Angeles, education, biofeedback-assistant relaxation training, and cog-
CA and 3Miller School of Medicine, University of Miami, Coral nitive-behavior strategies to reduce the levels of hostility affect,
Gables, FL. hostility cognition, and hostility behavior. Participants of the
Medication non-adherence is common and a primary reason control group were 13 CHD patients (mean age = 59.23±6.80,
for poor medical outcomes among individuals with Heart male 69%) who did not receive any psychological treatment
Failure (HF). Demographic and medical factors are associated until they finished the three-month waiting status. After inter-
with adherence among patients with HF. Psychosocial and vention, participants showed a significant reduction in hostility
personality factors may also influence HF patients’ decisions level (t=4.27, p < .01) and respiration rate (t =3.06, p < .01), and
to adhere to medicine. We examined whether psychosocial a significant increase in prothrombin time (t=-4.75, p< .001). The
(depression, hostility) and personality variables were related to results of the repeated measure of ANOVA indicated that the
medication adherence (measured by the Medication Adherence experimental group revealed a significantly higher reduction
Scale [MAS]) beyond contributions of demographic and medi- of respiration rate (F=8.76, p < .01), and a marginally higher
cal variables in an ethnically-diverse sample of 105 men and increase of prothrombin time (F=-3.66, p = .06) than the waiting
women diagnosed with HF. Hierarchical regression analyses control group. In conclusion, the results of this study imply that
tested whether depression, hostility, and the Millon Behavioral psychological intervention is efficient to reduce the biological
Medicine Diagnostic (MBMD) Medication Abuse scale were risk of disease recurrence for CHD patients.
associated with adherence. Demographic and medical controls CORRESPONDING AUTHOR: Chia-Ying Weng, PhD, Psychol-
included education level and number of co-morbid diseases. ogy Department, National Chung Cheng University, Chia-Yi,
Greater MBMD Medication Abuse scale scores were associ- 62102; psycyw@ccu.edu.tw
ated with poorer adherence above and beyond depression (β
= .236, t[102] = 2.113, p = .037) and above and beyond hostility
(β = .244, t[102] = 2.506, p = .014). Both depression and hostility
were significantly associated with each of Medication Abuse
and adherence, and in regression analyses hostility remained
a significant predictor (β = .202, t[102] = 2.072, p = .041) while
22
B-039c controlling for demographics, global self-reported health, health
COMMITMENT AND LEVEL OF CONFIDENCE TO EXERCISE behaviors, and religious / spiritual factors. Mortality after three
AFTER A MOTIVATIONAL INTERVIEW IN A CARDIOLOGY- years was found to be associated with a weaker belief in the
BASED PREVENTION PROGRAM efficacy of prayer (b = .19, p < .003, OR = 1.21), lower frequency
Robert Scales, PhD,1 Susan Halli, DNP,1 Cengiz Akalan, PhD,2 of private prayer (b = .20, p < .001, OR = 1.23), and receiving
Aleese Murik, BS,1 Judith A. Turner-O’Connell, BS,1 Steven W. higher emotional support from the congregation (b = -.42, p <
Ressler, MD,1 Joseph H. Miller, MSW3 and Robert T. Hurst, MD1 .03, OR = 0.66). In addition, several religious factors were found
1
Cardiology, Mayo Clinic-Arizona, Scottsdale, AZ; 2Ankara to be associated with the self-reported onset of cardiovascular
University, Ankara, Turkey and 3The University of New health. Self-reported hypertension was associated with low lev-
Mexico, Albuquerque, NM. els of anticipated support from the congregation (b = -.35, p <
Motivational interviewing (MI) encourages talk about behav- .03, OR = 0.71), infrequent negative religious coping (b = -.27, p
ior change and it can elicit a verbal commitment that makes < .05, OR = 0.76), and stronger belief in perceived divine control
positive outcomes more likely. This study assessed commit- (b = .53, p < .02, OR = 1.70). Self-reported heart attack or other
ment and confidence to exercise after a motivational interview heart trouble was associated with infrequent positive religious
in people who had elected to participate in a cardiology-based coping (b = -.77, p < .006, OR = 0.46), a weak sense of connec-
prevention program (CBPP). MI was a component of a com- tion to other people (b = -.93, p < .004, OR = 0.40), and a strong
prehensive program that included a cardiac evaluation (blood sense of connection to God (b = .70, p < .04, OR = 2.02). Results
chemistry, carotid intima-media thickness & exercise stress indicate that religious factors predict mortality and cardiovas-
testing) with feedback from clinicians plus a nutrition consulta- cular health after three years with an older adult population.
tion. An exercise physiologist (EP) who had previously demon- However, these factors are nuanced and operate in complex
strated proficiency in MI conducted a motivational interview manner. Various religious factors have the capacity to influence
(45-mins) in conjunction with a physical performance evalua- health both positively and negatively. Given these findings,
tion. Outcome measures included a self-reported 7-day recall of researchers should take a multifaceted approach to measuring
structured exercise and an assessment of the stage of readiness religion in studies of health outcomes.
to exercise (>3 hrs/wk) and the level of confidence (1-10 scale) CORRESPONDING AUTHOR: Amy D. Owen, PhD, Duke
to attain a stated personalized 6-wk goal for exercise. The study University Medical Center, Durham, NC, 27705; amy.owen@
evaluated 83 (76% male) asymptomatic adults (30-64 yrs) with duke.edu
a mean age of 50.4 yrs (SD=8.9). No one had prior evidence of
atherosclerosis. The mean time invested to exercise on entry to B-047a
the program was 2.7 hrs/wk (SD=2.9) and after the motivation- GRANDPARENTS INVOLVEMENT IN ADOLESCENT
al interview the mean minimum goal for exercise was 5.4 hrs/ DIABETES CARE
wk (SD=2.5). Seventy-eight participants (94%) were either ready Linda Drew, PhD,1 Cynthia Berg, PhD2 and Deborah J. Wiebe,
to start (n=49, Preparation=59%) or continue (n=8, Action=10%; PhD1
n=21, Maintenance=25%) exercising >3 hrs/wk. The remaining
1
University of Texas Southwestern Medical School, Dallas, TX
5 participants (6%) all stated their intention to exercise >2 hrs/ and 2University of Utah, Salt Lake, UT.
wk. Everyone expressed a moderate to very high level of confi- Adolescents often require support for successful diabetes man-
dence to attain their personal goal (Moderate=11%; High=42%; agement, and the extended kin-network - such as grandpar-
Very High=47%). It appears that this self-selected group was ents - may be important when there are limited nuclear family
motivated to exercise after participation in a CBPP. Assess- resources. Grandparents can help with pediatric illness both
ing the level of commitment and confidence to change at the directly (e.g., distributing medications, attending clinic appoint-
conclusion of a motivational interview may provide a practical ments) and indirectly (e.g., emotionally supporting parents, the
self-audit of MI practice with strategic benefits. grandchild with a chronic illness, and their siblings) (Smith &
CORRESPONDING AUTHOR: Robert Scales, PhD, Cardiol- Drew, 2002). It is likely that grandparents of adolescents with
ogy, Mayo Clinic-Arizona, Scottsdale, AZ, 85259; scales.robert@ diabetes can be of tremendous help to their adult children and
mayo.edu grandchildren, and provide a vital source of emotional and
practical support when a grandchild has a chronic illness (Ka-
B-039d zak & Marvin, 1984; Mirfin-Veitch, Bray, & Watson, 1996). This
THE COMPLEX RELATIONSHIP OF RELIGIOUS FACTORS, may be particularly true when families have limited resources
CARDIOVASCULAR HEALTH, AND MORTALITY (e.g., parental depression, low income, single parent). The
Amy D. Owen, PhD and Richard D. Hayward, PhD current study investigated whether: (1) grandparents helped
Duke University Medical Center, Durham, NC. with adolescent diabetes care, (2) grandparent help occurred
Religious attendance has been found to predict mortality in when diabetes management was going poorly, (3) grandpar-
older adults, but a comprehensive investigation of the effects of ent help occurred when mothers were depressed, lone parents,
specific religious beliefs and practices on health and mortality is and low SES. Adolescents (n=252; 46% male and 54% female)
needed to better articulate this relationship. Longitudinal data aged 10-14 years with type 1 diabetes completed assessments of
were analyzed to investigate the prospective effects of religious frequency of grandparent help with diabetes care and adher-
variables on health and mortality among older adults. Religious ence (Self-Care Inventory). Parents provided depression scores
and demographic data were collected in 2001, and a follow-up (CESD) (maternal range 0-45, M=11.74; sd=9.65), adherence
study collected data on mortality and health in 2004. A binary (Self-Care Inventory), family income, and demographics (18.8%
logistic regression model was constructed to analyze the data, of mothers were not-married). HbA1c scores were indexed in
23
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
24
been studied in relation to training in the area of firearm safety nificant after controlling for city of residence, age, gender, and
counseling of patients. race (Adjusted O.R. = 0.031, 95% CI = 0.003-0.291). Participants
Methods: A three-wave mail survey was conducted in the Fall did not, however, significantly differ on levels of depression or
of 2009. All the program directors (n=145) of the physician anxiety (all p’s > 0.05).
assistant training programs were included in the study. The Implications: HIV secondary prevention efforts have tradition-
outcome measures were the portion of program directors in- ally targeted “at risk” groups such as intravenous drug us-
volved in training students on firearm injury prevention issues ers and men who have sex with men. As the number of older
and their perceived benefits and barriers of training students on adults living with HIV/AIDS in the United States continues to
firearm injury prevention issues. increase, age-appropriate risk-reduction interventions to correct
Results: 108 program directors responded to the survey (re- misinformation about transmission risk behaviors are urgently
sponse rate=75%). Only 25% of programs provided formal needed.
training on firearm injury prevention. Program directors who CORRESPONDING AUTHOR: Travis I. Lovejoy, MS, MPH,
provided formal training perceived significantly higher num- Psychology, Ohio University, Athens, OH, 45701; tl399805@
ber of benefits to offering such training than directors who did ohio.edu
not provide such training. No significant difference was found
between the two for number of perceived barriers. B-061b
GAY MEN EXPRESS MORE EMOTIONS THAN STRAIGHT MEN
Conclusions: If physician assistant training program graduates IN AN EXPRESSIVE WRITING INTERVENTION
are to play a role in reducing premature morbidity and mortal- Jonathan R. Atwood, BA, Gail Ironson, MD, PhD and Rachel
ity (e.g. suicides and homicides) from firearms it will require Kuhn, MS
more training programs to offer formal training in this area. The Psychology and Behavioral Medicine, University of Miami,
American Academy of Physician Assistants needs to develop Coral Gables, FL.
guidelines on specific curricular firearm topics.
Expressive writing (EW) as a therapeutic intervention has been
CORRESPONDING AUTHOR: Jagdish Khubchandani, MBBS, implemented in a variety of healthy, medical and psychologi-
MPH, CHES, Health and Rehab Services, University of Toledo, cal populations, and has been shown to provide significant
Toledo, OH, 43606; jagdish.khubchandani@utoledo.edu health benefits in many studies. Two previous studies found
B-061a that HIV-positive individuals with protected health status had
RISKY SEXUAL BEHAVIOR IN HIV-POSITIVE OLDER significantly higher levels of written emotional expression (EE)
ADULTS: A LONGITUDINAL ANALYSIS in trauma-related essays versus HIV-positive individuals with
Travis I. Lovejoy, MS, MPH,1 Timothy G. Heckman, PhD,2 typical disease progression. However, few studies have exam-
Kathleen J. Sikkema, PhD3 and Nathan Hansen, PhD4 ined which populations benefit most from EW, and none to
1
Psychology, Ohio University, Athens, OH; 2Osteopathic our knowledge have examined sexual orientation as a potential
Medicine, Ohio University, Athens, OH; 3Psychology and moderator. The present study examined levels of EE (i.e. the
Neuroscience, Duke University, Durham, NC and 4School of number or positive and negative emotion words or expressions)
Medicine, Yale University, New Haven, CT. in a sample of HIV-positive individuals, in which sub-samples
of self-identified exclusively gay (GM; n = 34) and exclusively
Objectives: In the past decade, the incidence of new HIV infec- straight (SM; n = 23) men were compared. Participants were
tions in older adults has steadily risen. Cross-sectional studies asked to write expressively and freely about their most trau-
have examined correlates of sexual risk behavior in HIV-posi- matic experiences for a 30-minute session. Specifically, the
tive older adults, but no study to date has examined longitudi- participants were probed to explore their deepest thoughts and
nal patterns of such behaviors in this population. feelings about the trauma for the first 20 minutes, and to make
Participants and Procedures: Participants were 251 HIV-posi- sense of the trauma for the last 10 minutes. Results show that
tive adults 50+ years of age (Mean Age = 55.6 years; 69% male; GM use significantly more total emotion words when probed
30% Caucasian) residing in three metropolitan regions in New to write expressively about a traumatic event (t(55) = 2.212, p =
York and Ohio. Participants completed a demographic battery .031; GM M = 8.99, SD = 5.83; SM M = 6.04, SD = 3.11). Severity
at baseline, in addition to detailed sexual behavior questions (t(58) = -.075, p = .941) and topic (t(56) = .161, p = .872) of par-
and a series of psychosocial measures at four evenly-spaced ticipants’ traumas were considered as confounds, but were not
time points over one year. significantly different between the groups. As previously noted,
Results: Four clusters emerged from the data that described higher levels of EE have been found to relate to health and psy-
the longitudinal sexual behavior of study participants over chological benefits derived from EW. Therefore, self-identified
the four time periods: sexually abstinent (43%), sexually active GM may be one demographic for which the EW paradigm
but always protected (30%), sexually active and occasionally would be particularly beneficial and therapeutic. Future analy-
unprotected (9%), and sexually active and regularly unpro- ses with this sample will examine whether the higher levels of
tected (18%). In bivariate analyses, participants who reported EE lead to greater improvements in health and psychological
low transmission-risk behaviors (i.e., being sexually abstinent outcomes in GM versus SM.
or engaging in only protected sex) had significantly greater HIV CORRESPONDING AUTHOR: Jonathan R. Atwood, BA, Psy-
knowledge than participants who engaged in high transmis- chology and Behavioral Medicine, University of Miami, Coral
sion-risk behaviors (i.e., any unprotected intercourse; O.R. = Gables, FL, 33146; jatwood@miami.edu
0.043, 95% CI = 0.005-0.335), and this relationship remained sig-
25
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
26
missed messages, non-interest, and confusion. Conclusion: Col- B-081b
lege students perceived Facebook as a feasible and acceptable PREDICTORS OF INTENTION TO SHARE EDUCATIONAL
form of communication for health information. Salient health HEALTH INFORMATION VIA ONLINE SOCIAL NETWORK TIES
information topics were identified and suggestions for optimiz- Kevin O. Hwang, MD, MPH,1 Jason M. Etchegaray, PhD,1 Elmer
ing Facebook as a communication method were provided. Sup- V. Bernstam, MD, MSE1,2 and Eric J. Thomas, MD, MPH1
ported by Plus One Active Research Grant on Wellness Using 1
Internal Medicine, The University of Texas Medical School at
Internet Technology through the American College of Sports Houston, Houston, TX and 2The University of Texas School of
Medicine Foundation. Health Information Sciences at Houston, Houston, TX.
CORRESPONDING AUTHOR: Shannon Smith, MS, Exercise Activating members of online communities to share educational
and Wellness, Arizona State University, Chandler, AZ, 85225; health information through social network ties may be a useful
shannon.b.smith@asu.edu dissemination strategy. We surveyed members of a volunteer
outreach group within the SparkPeople online weight loss com-
B-081a munity to gauge intention to share educational health informa-
THE FACTOR STRUCTURE OF THE BECK DEPRESSION tion with other members. Respondents viewed a webpage with
INVENTORY-II (BDI-II) IN BARIATRIC SURGERY educational osteoarthritis information. Intention to share the
CANDIDATES link (via email, forums, blogs) with members who have arthritis
Nina Stoeckel, MS, Thomas Martin, PhD, John Gerdes, PhD, was measured with 3 Likert-scale items. Intention to participate
Christopher Still, DO and Craig Wood, MS in a future project to share similar information with other mem-
Psychiatry, Geisinger Medical Center, Danville, PA. bers was measured with 1 item, dichotomized as (definitely,
Symptoms of depression are observed in morbidly obese pa- probably) vs (possibly, probably not, definitely not). Predictors
tients seeking bariatric surgery. The BDI-II is frequently used to were Theory of Planned Behavior constructs (attitudes, subjec-
assess depression during pre-operative mental health evalua- tive norms, perceived behavioral control); barriers to sharing
tions, but little is known about the factor structure of the BDI-II information; presence of arthritis; number of SparkPeople
in this population. A population-specific investigation of the “Friends”; frequency of interacting with other members; age;
BDI-II factor structure is important given that (1) to our knowl- and education. The 349 respondents were 43.8 [SD 11.6] years
edge its factor structure has not been examined in bariatric old, 94.7% female, and 88.1% white. On linear regression, at-
surgery candidates, and (2) factor solutions have varied across titudes, social norms, behavioral control, and barriers predicted
studies for different populations. Two- and three-factor solu- intention to share the information (p < .001), accounting for 72%
tions were found previously. of variance. 77.4% of respondents were definitely or probably
The aim of this study was to examine the factor structure of interested in sharing educational health information with other
the BDI-II in patients seeking bariatric surgery. BDI-II data for members in a future project. On logistic regression, each unit
this study were acquired via a retrospective data pull from a da- increase in attitudes (more favorable attitude) was directly asso-
tabase developed originally for studies of nonalcoholic steato- ciated with definitely/probably participating in the project (OR
hepatitis in patients undergoing bariatric surgery. All patients 3.48 [95% CI 1.95 - 6.22], p < .001). Each unit increase in barriers
in this program undergo psychological screening, including was inversely associated with definitely/probably participating
collection of BDI-II scores, several months prior to surgery. (OR 0.34 [95% CI 0.18 - 0.62], p < .001). Among members of the
volunteer outreach group within SparkPeople, attitudes, social
BDI-II protocols from 875 participants (81% female, 97% Cauca- norms, behavioral control, and barriers are significant predic-
sian) had been collected over a 54-month period. Participants’ tors of intention to share educational health information via
mean age was 46 years (SD: 11.2) and mean pre-surgical BMI online social network ties.
was 50 (SD: 8.7).
CORRESPONDING AUTHOR: Kevin O. Hwang, MD, MPH,
The reliability of the BDI-II in this population was similar to Internal Medicine, The University of Texas Medical School at
that reported for other populations, α = .92. The mean BDI-II Houston, Houston, TX, 77030; kevin.o.hwang@uth.tmc.edu
score was 13.4 (SD: 10.1). Exploratory principle components
factor analysis with varimax rotation yielded three factors with B-081c
eigenvalues greater than 1. Factor 1 closely resembles the cogni- IDENTIFYING PATTERNS OF EATING AND PHYSICAL
tive factor Beck, Steer, and Brown (1996) identified in their clini- ACTIVITY IN CHILDREN: A LATENT CLASS ANALYSIS OF
cal sample, and factors 2 and 3 divide their somatic-affective PEDIATRIC OBESITY RISK
factor into factors that appear to reflect variance unique to obese Jimi Huh, PhD, Nathaniel R. Riggs, PhD, Donna Spruijt-
bariatric surgery candidates and variance associated with more Metz, PhD, Chih-Ping Chou, PhD, Zhaoqing Huang, MD and
severe symptoms of depression, respectively. MaryAnn Pentz, PhD
Findings suggest that a three-factor structure of the BDI-II best Department of Preventive Medicine, University of Southern
fits the data in a sample of bariatric surgery candidates. Factors California, Alhambra, CA.
1 and 3 might be particularly helpful in screening for symptoms We used latent class analysis (LCA) to identify heterogeneous
of depression in bariatric surgery candidates. subgroups with respect to behavioral obesity risk factors in
CORRESPONDING AUTHOR: Nina Stoeckel, MS, Geisinger a sample of 4th grade children (n=997) residing in Southern
Medical Center, Danville, PA, 17822; njstoeck@syr.edu California. Multiple dimensions assessing physical activity,
eating and sedentary behavior, and weight perceptions were
explored. A set of 11 latent class indicators were used in the
analysis. The final model yielded a 5-class solution: “High
27
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
sedentary, junk food, not weight conscious (15.9%),” “Dieting failure and should be key components assessed and treated
without exercise, weight conscious (24.9%),” “High sedentary, prior to RYGBP surgery.
junk food, weight conscious (13.3%),” “Active, healthy eating CORRESPONDING AUTHOR: Leila Azarbad, PhD, Rush
(13.7%),” and “Low healthy and junk food intake, inactive, not University Medical Center, Chicago, IL, 60612; Leila_Azarbad@
weight conscious (32.1%).” Ethnicity, gender and a SES proxy rush.edu
variable significantly predicted the identified latent classes. The
children’s weight status according to their Body Mass Index B-081e
(BMI) was significantly associated with the latent classes. The WEIGHT LOSS ACTIVITY IN OVERWEIGHT AND OBESE
results suggest the distinct subtypes of children with respect to VETERANS
their obesity-related risk behaviors. The identified latent sub- Kristin L. MacGregor, MS,1,2 Allison K. Labbe, MS,1,2 Marketa
group membership, in turn, was associated with the children’s Krenek, BS,2,1 Jennifer S. Funderburk, PhD1,2 and Stephen A.
weight status. Specifically, obesity (BMI ≥ 95th percentile) was Maisto, PhD2,1
much more prevalent in the “High sedentary, junk food, weight 1
Syracuse VA Medical Center, Syracuse, NY and 2Syracuse
conscious” class and the “Dieting without exercise, weight con- University, Syracuse, NY.
scious” class. A majority of children in these classes were classi- Despite knowledge about the adverse effects of obesity on
fied as overweight or obese (68.5% and 72.0%, respectively). The health, the prevalence continues to increase, particularly in the
results support appropriate refinement of existing intervention VA population. Veterans who use the VA healthcare system
programs based on children’s characteristics to promote further are among those with the highest rates of obesity. The purpose
success of pediatric obesity intervention research. of this study was to examine if overweight and obese veterans
CORRESPONDING AUTHOR: Jimi Huh, PhD, Department of who are reporting trying to lose weight are actually behaving
Preventive Medicine, University of Southern California, Alham- any differently than those who are not with the goal of aiding
bra, CA, 91803; jimihuh@usc.edu primary care providers in understanding the behaviors as-
sociated with weight loss attempts in this population. A total
B-081d of 138 overweight or obese veterans (BMI≥25) presenting to
PATIENT KNOWLEDGE AND UNREALISTIC WEIGHT LOSS two VA primary care clinics completed self-report question-
EXPECTATIONS PREDICT TREATMENT FAILURE ONE YEAR naires assessing exercise, diet, and weight-related variables.
AFTER GASTRIC BYPASS SURGERY Participants had a mean BMI of 30.3 (SD=4.2), and 63% reported
Leila Azarbad, PhD,1 Brian Hall, MA,1 Joyce Corsica, PhD,1 currently trying to lose weight. Group differences were exam-
Megan Hood, PhD1 and Linda Gonder-Frederick, PhD2 ined between participants reporting trying to lose weight and
1
Rush University Medical Center, Chicago, IL and 2University those who are not. Demographic variables (e.g. age, sex, marital
of Virginia Health System, Charlottesville, VA. status) known to be associated with the outcomes of interest
Background: Roux-en-Y gastric bypass surgery (RYGBP) is were statistically controlled. Results revealed that individuals
among the most popular types of bariatric surgeries. How- in the weight-loss attempt group were 10 times more likely to
ever, roughly 20% of patients experience treatment failure, be dieting (χ2=15.0, p<.001) and 8 times more likely to receive
defined as inadequate weight loss or significant weight regain advice about weight loss (χ2=18.0, p<.0001). They also reported
after surgery. The potential influence of cognitive variables on greater readiness to change their weight (F=103.0, p<.0001) and
post-operative outcomes is not fully understood. The present exercise (F=20.3, p<.0001) and had higher BMI (F=11.1, p<.01).
study aimed to investigate the influence of 3 cognitive variables However, group differences did not exist for exercise behavior,
(knowledge about surgery, pre-operative weight loss expecta- implying that individuals trying to lose weight may perceive
tions, and cognitive ability) on treatment success/failure 1 weight loss as being achieved by dieting alone, or they consider
year after RYGBP surgery. Methods: Participants were 154 barriers to exercise too high that they give up. This information
patients (BMI M=55.3; age M=41.9) undergoing RYGBP sur- is important for primary care providers in that they may need
gery at an academic medical center. Knowledge about surgery to be more specific with these patients about the importance
was assessed via the Gastric Bypass Knowledge Scale. Weight of both diet and exercise in achieving weight-loss goals, and
loss expectations were assessed in writing by the following helping to council patients about barriers to exercise if they are
question:“How much weight do you expect to lose after sur- reported to exist. Increasing motivation among overweight and
gery?” Cognitive ability was assessed by The Shipley Institute obese people to initiate weight-loss behaviors should be more
of Living Scale. Logistic regression analysis (LRA) was used to frequent as part of usual care.
examine the influence of cognitive variables on post-operative CORRESPONDING AUTHOR: Kristin L. MacGregor, MS,
outcome. Consistent with past studies, treatment failure was Department of Psychology, Syracuse University, Syracuse, NY,
defined as less than 50% excess weight loss 1-year post-surgery. 13244; kmacgreg@syr.edu
Results: No significant relationships were noted between sex,
ethnicity, or age and treatment outcome, or between cognitive B-081f
ability and treatment outcome (p=.115). LRA indicated that ADOLESCENT BODY SIZE AND FAMILY STRUCTURE
higher scores on the Gastric Bypass Knowledge Scale were re- Daniel J. Sheridan, BA, Stephanie Fitzpatrick, MS, Judith R.
lated to treatment success (OR=1.05, 95% CI=1.01-1.08, p=.003), McCalla, PhD and Patrice G. Saab, PhD
and greater weight loss expectations were related to treatment Psychology, University of Miami, Miami, FL.
failure (OR=0.99, 95% CI=0.98-0.99, p=.003). Conclusion: Modi- In the past 30 years, two trends affecting adolescents have
fiable variables, such as poor patient knowledge and unrealistic become apparent in the United States. Rates of adolescent
weight loss expectations, are associated with 1-year treatment obesity have shown a steady increase, and family structure has
28
also changed from predominantly two-parent households to an in PHC scores for men. In women, the model accounted for ap-
increasing number of single-parent households. The purpose of proximately 16.7% of the variability observed in VO2max, and
this study was to examine the relationship between adolescent 7.4% in PHC scores. This suggests that aerobic capacity may
body size and family structure. The sample consisted of 163 be a more salient component of physical health in men than in
adolescents (120 boys; 43 girls) with a systolic and/or diastolic women. It appears that aerobic fitness is a mediator of the re-
blood pressure greater than or equal to the 90th percentile lationship between body fat % and HRQOL. Therefore, weight
(adjusted for age, gender, and height). The participants’ ages loss interventions should target improving aerobic fitness in ad-
ranged from 15 to 17 years-old (M = 16.1, SD = .63). Fifty-nine dition to decreasing body fat as a means of improving HRQOL.
adolescents came from single-parent households and 91 ado- CORRESPONDING AUTHOR: Ashley Moncrieft, BA, Psychol-
lescents came from two-parent households. Height and weight ogy, University of Miami, South Miami, FL, 33143; amoncrieft@
measurements were obtained to calculate BMI; waist measure- psy.miami.edu
ments were also recorded.
As hypothesized, compared to adolescents from two-parent B-081h
households, adolescents from single-parent households had SELF-DETERMINATION THEORY-BASED COUPLES
a higher BMI, t(148) = 2.14, p = .03 and a larger waist circum- INTERVENTION FOR WEIGHT LOSS
ference, t(147) = 2.12, p = .04. However, no family structure Anna Schierberl Scherr, BA,1 Ted Powers, PhD,2 Erin Lenz, BA,1
differences in parental education, caloric intake, or mother’s Kimberly McClure, MA1 and Amy Gorin, PhD1
BMI were obtained (ps > .05). Although the results indicate BMI
1
University of Connecticut, Storrs, CT and 2University of
and waist circumference differences in adolescents as a function Massachusetts, Dartmouth, Dartmouth, MA.
of family structure, the underlying causes of these differences Background: Research suggests that autonomous motivation
are still unclear. Future research would benefit from investiga- for behavior change predicts better weight loss outcomes and
tion of SES, adolescent exercise habits, parental health habits, is enhanced by autonomy supportive environments. Partners
and other factors that may have contributed to the observed who are skilled at providing autonomy support (e.g., encourage
adolescent BMI differences in single-parent and two-parent choice, minimize control) may enhance autonomous motiva-
households. tion and weight loss in their significant others. This pilot study
CORRESPONDING AUTHOR: Daniel J. Sheridan, BA, Univer- tested an intervention designed to teach spouses to engage
sity of Miami, Miami, FL, 33132; dsheridan87@aim.com in autonomy supportive behaviors. Methods: Overweight/
obese participants (N=20; 17 females; 95% Caucasian; aver-
B-081g age BMI=34) and their spouses (N=20, 17 males; 90% Cauca-
THE RELATIONSHIP BETWEEN OBESITY AND HEALTH- sian; average BMI=30) were randomly assigned to 12 weeks
RELATED QUALITY OF LIFE IS PARTIALLY MEDIATED BY of standard behavioral weight loss treatment (SBT) or to SBT
AEROBIC FITNESS plus an autonomy support intervention (SBT+AS). Partners
Ashley Moncrieft, BA, Judith R. McCalla, PhD, Miriam Gutt, in both conditions were invited to attend 6 sessions. SBT+AS
PhD, Marc D. Gellman, PhD and Neil Schneiderman, PhD partners were taught the ABCs of autonomy support (Ask
Psychology, University of Miami, South Miami, FL. to avoid assumptions; Be empathic; Curtail control and criti-
Obesity is a major global health concern associated with impair- cism) while SBT partners received standard weight loss infor-
ments in health-related quality of life (HRQOL), particularly in mation. Participants were weighed and completed measures
the physical domains. Obese individuals also have a reduced at 0, 4, and 12 weeks. Results: The couples-based format was
aerobic capacity indicating poorer aerobic fitness. Additionally, well received with spouses attending 88.3% of scheduled ses-
aerobic fitness has been linked to HRQOL in normal and over- sions. Participants lost ¬12.6+12.1 lbs. (6.2%) at 12 weeks, with
weight individuals. This study used path analysis to examine no differences between groups. SBT+AS did not differentially
the relationships between fat %, aerobic capacity (VO2max) and enhance autonomy support; however, across groups, increases
the physical aspects of HRQOL as measured by the SF-36 physi- in autonomy support at 4-weeks were associated with 12-week
cal health component summary score (PHC). The sample con- weight losses (p=.07). Increases in autonomy support were not
sisted of 228 overweight or obese participants (64.5% women, associated with increases in autonomous motivation (p=.45)
mean age= 52.38 yrs, mean Body Mass Index= 32.53 kg/m2) and changes in autonomous and controlled motivation were not
from one of two larger studies at the University of Miami which associated with weight loss outcomes (ps>.50). Conclusions:
tested the efficacy of lifestyle interventions designed to promote This pilot study demonstrated that a couples-based weight loss
physical activity and weight loss in depressed diabetics and intervention is feasible and that autonomy support may play a
individuals with the metabolic syndrome. Fifty-one percent of role in weight management. More research is needed on how
participants met criteria for the metabolic syndrome; 49% met best to train support partners and to understand the mecha-
criteria for type II diabetes and depression. Body fat % was a nisms through which autonomy support may influence treat-
significant predictor of VO2max when controlling for age (b= ment response.
-.083, S.E= .032, p<.05). A significant predictor of PHC scores CORRESPONDING AUTHOR: Anna Schierberl Scherr, BA,
was VO2max with higher values leading to better PHC scores University of Connecticut, Storrs, CT, 06269-1020; aesscherr@
(b= 2.275, S.E= .411, p<.05). The total indirect effect of body fat gmail.com
% on PHC scores (b=-.188, S.E = .081, p<.05) was significant;
however, the direct path between body fat % and PHC was not
significant. This model fit the data well accounting for approxi-
mately 16.5% of the variability observed in VO2max, and 19.5%
29
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
30
rals are completed, indicating that a patient was appropriate B-097e
for and attended the recommended appointment. Data will be A DYNAMIC SYSTEMS ANALYSIS: HEIGHTENED NIGHTTIME
presented detailing the program’s impact upon these 4 indica- ADRENOCORTICAL DYNAMICS IN CHRONIC FATIGUE
tors. Quantitative data will be presented regarding our univer- SYNDROME
sal suicide/homicide risk screening practice in primary care, Kirstin Aschbacher, PhD,1 Emma Adam, PhD,2 Leslie J.
our substance use co-integration initiative, and our integration Crofford, MD,3 Margaret E. Kemeny, PhD,1 Mark A. Demitrack,
project to address diabetic, HTN, and dyslipidemia. Qualitative MD4 and Amos Ben-Zvi, PhD5
data addressing primary care staff satisfaction with the pro- 1
University of California San Francisco, San Francisco, CA;
gram will also be presented. 2
Northwestern University, Chicago, IL; 3University of Kentucky,
CORRESPONDING AUTHOR: David Buyck, PhD, Mental Lexington, KY; 4Neuronetics, Inc., Malvern, PA and 5University
Health Integration, VAMC Salem, Salem, VA, 24153; david. of Alberta, Edmonton, AB, Canada.
buyck@va.gov Background: Dynamic systems analyses, an emerging paradigm
in medical research, may help better understand the role of
B-097d the HPA axis in Chronic Fatigue Syndrome (CFS). As fatigue
QUALITY OF LIFE AND HEALTH CARE UTILIZATION IN and sleep disturbance are primary symptoms of CFS, the study
FUNCTIONAL BOWEL DISORDERS focused on nighttime dynamics. Methods: 14 individuals with
Sarah W. Kinsinger, PhD, Jennifer Kiebles, PhD, Caroline Artz, CFS and 14 age and gender-matched individuals provided
BS and Laurie Keefer, PhD blood samples via an indwelling catheter every 10 minutes for
Gastroenterology, Northwestern University, Chicago, IL. 24 hours. Bedtimes, light exposure and mealtimes were stan-
Background and Aims: Health related quality of life is an im- dardized, while activity was restricted and daytime napping
portant indicator of physical and mental well-being in patients was not permitted. Blood plasma was assayed for adrenocorti-
with functional bowel disorders (FBD). The aim of this study cotropic hormone (ACTH) and cortisol. Data Analyses: Model
was to investigate correlates of quality of life in a sample of parameters were estimated using lagged regression predicting
patients with FBD. 10-minute change in cortisol. The discrete-time model specified
Methods: Adult patients with FBD (N = 123) were referred by included 3 parameters, which were permitted to vary every
their gastroenterologist for cognitive-behavioral therapy (CBT) two hours in order to capture circadian dynamics: β0 repre-
at a university medical center. The following questionnaires senting the intercept, β1 representing adrenal responsivity to
were collected at the onset of therapy: Irritable Bowel Syndrome ACTH (AR), and β2 representing the rate of cortisol removal
Quality of Life (IBS-QOL), Irritable Bowel Syndrome Symptom (CR) from the bloodstream. Akaike’s Information Criteria (AIC)
Severity Scale (IBS-SSS), and a checklist of psychosocial con- informed model fit. Regression tests compared whether aver-
cerns (PSC). Chart review was conducted to obtain information age HPA dynamic parameter values (i.e., AR and CR) differed
on the number of gastroenterology (GE) visits before and after for CFS versus healthy controls at night (11pm-7am), control-
psychological intake (n = 61). ling for nighttime disturbances. Results: CFS was associated
with higher AR and faster CR from 1-3am and 5-7am (all p’s
Results: The majority of patients were diagnosed with irritable <.05) compared to healthy age and gender-matched controls.
bowel syndrome (IBS; 69.9%). The mean overall IBS-QOL was A numerically similar but statistically insignificant trend was
60.80 (0-100 scale, 0=worst). Average IBS-SSS was in the moder- observed from 3-5am. Discussion: These preliminary findings
ate range (M = 276.63, SD = 101.73). Average number of GE suggest that CFS participants exhibit significantly different
visits before intake was 2.0 (SD=1.4, 0-9) and after intake was .6 nighttime dynamics of the HPA axis. Future research in larger
(SD=1.3, 0-8). Most frequently reported PSC included anxiety samples should explore whether altered HPA dynamics could
(76%), worry (55%), relationship problems (53%), and stress potentially constitute a consistent, CFS-specific marker of a
(53%). Anxiety (p < .01) and IBS-SSS (p < .01) were significant disease-perturbed network, or may reflect symptoms, which are
predictors of overall IBS-QOL, accounting for 19% of the vari- not limited to CFS.
ance (9% and 10% respectively). Further, the health worry sub-
scale of the IBS-QOL was significantly associated with increased CORRESPONDING AUTHOR: Kirstin Aschbacher, PhD, Psy-
GE visits in the year following intake(r= -.32, p < .05). chiatry, University of California San Francisco, San Francisco,
CA, 94118; kirstin.aschbacher@ucsf.edu
Conclusions: Anxiety symptoms are frequently reported among
FBD patients referred for psychological services within a gas- B-097f
troenterology clinic. Psychosocial concerns as well as symptom PSYCHOLOGICAL SYMPTOMS IN INFLAMMATORY BOWEL
severity play a role in patients’ quality of life. Furthermore, the DISEASE: DO MAST CELLS PLAY A ROLE?
degree that patients worry about the implications of their FBD Laura Mackner, PhD,1 Jaya Punati, MD,1 Kyle Kusek, MD,1
on their overall health is related to healthcare utilization. Future Kathleen Pajer, MD,1 Jackie Wood, PhD2 and Wallace Crandall,
research should examine the association of these variables in a MD1
prospective design as well as the effects of psychological treat- 1
Nationwide Children’s Hospital, Columbus, OH and 2The Ohio
ment on anxiety and healthcare utilization. State University, Columbus, OH.
CORRESPONDING AUTHOR: Sarah W. Kinsinger, PhD, Background: Relationships between immunity and psychologi-
Gastroenterology, Northwestern University, Chicago, IL, 60611; cal symptoms are well known. Depression and anxiety have
s-kinsinger@northwestern.edu been linked with mediators of inflammation such as proinflam-
matory cytokines. Inflammatory bowel disease (IBD) is associ-
ated with increased mediators of inflammation and increased
31
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
risk for psychological problems, but pathways between in- (97%), and had a mean age of 57; 92% of the sample completed
flammation and psychological symptoms in IBD have not yet the study intervention. Preliminary analysis reveals statistically
been described. Mast cells may be an important factor in these significant benefits at both 2 and 6 months for MBSR on mental
relationships because they produce and release inflammatory health (p<.01, p<.05); stress (p<.01, p<.07), and self-compassion
mediators, and increased mast cells have been associated with (p<.05, p<.04); with a trend toward improvement in mindful-
stress in IBD. ness (p<.06, p<.08). Significant improvements were also seen at
Aim: The purpose of this exploratory study was to examine 2 months in the MBSR group on depressive symptoms (p<.01).
relationships between mast cells and psychological functioning State anxiety, perceived burden, and social support improved
in children and adolescents with IBD. significantly in both groups.
Methods: Participants were 18 youths, 9 - 17 years of age, with Conclusion: MBSR is an acceptable intervention for caregiv-
Crohn’s disease who were undergoing clinically-indicated colo- ers. Preliminary results indicate MBSR is more effective in
noscopy. Biopsies were taken from the terminal ileum, ascend- improving mental health and decreasing stress than a psycho-
ing colon and descending colon, and well-established diamino- educational intervention and performed as well on improving
benzine staining was used to identify mast cells for quantitative depression, anxiety and social support. Results suggest that
immunohistology. Children and their parents completed MBSR may offer a safe, effective method for stress reduction for
questionnaires assessing psychological symptoms. caregivers and that a larger clinical trial is warranted.
Results: Increased colonic mast cells were significantly cor- CORRESPONDING AUTHOR: Robin R. Whitebird, PhD, MSW,
related with depression (r=.49) and anxiety (r=.68) symptoms, HealthPartners Research Foundation, Minneapolis, MN, 55440-
withdrawn behaviors (r=.73), attention problems (r=.63), and 1524; robin.r.whitebird@healthpartners.com
delinquent (r=.71) and aggressive (r=.68) behavior. B-097h
Conclusions: These preliminary results suggest that mast cells CORRELATES OF WILLINGNESS TO PARTICIPATE IN
may be related to psychological functioning across a range of BIOMEDICAL RESEARCH AMONG HISPANICS
problems. To our knowledge, this is the first study to examine Ana E. Cordova, BS, Gloria Coronado, PhD, Angela K. Ulrich,
relationships between mast cells and psychological symptoms BA and Beti Thompson, PhD
in IBD. Our findings suggest that investigating the role played Cancer Prevention, Fred Hutchinson Cancer Research Center,
by mast cells in the complex relationship between immunity Seattle, WA.
and psychological functioning could be an important new Hispanics are less likely to participate in biomedical research
avenue of research. studies than non-Hispanic whites. This study examined factors
CORRESPONDING AUTHOR: Laura Mackner, PhD, Psychol- that may correlate with a Hispanic individual’s choice to par-
ogy, Nationwide Children’s Hospital, Columbus, OH, 43205; ticipate in such studies. In-person interviews were conducted
Laura.Mackner@nationwidechildrens.org among a randomly selected sample of adults living in a rural,
predominantly Hispanic community in eastern Washington.
B-097g The interview addressed barriers and incentives to participa-
MBSR FOR CAREGIVERS OF PEOPLE WITH DEMENTIA: THE tion, demographics and healthcare access, attitudes and behav-
BALANCE STUDY ior related to medical research, and willingness to comply with
Robin R. Whitebird, PhD, MSW,1 Mary Jo Kreitzer, PhD, RN,2 common study procedures. A total of 117 adults completed the
Beth A. Lewis, PhD,2 A Lauren Crain, PhD,1 Leah R. Hanson, interview (80 women and 37 men). Forty-one percent reported
PhD3 and Chris J. Enstad, BS1 they were willing to participate in research studies. When asked
1
HealthPartners Research Foundation, Minneapolis, MN; about hypothetical procedures, willingness to comply was
2
University of Minnesota, Minneapolis, MN and 3Alzheimer’s highest for being interviewed in person, and lowest for under-
Research Center, Regions Hospital, St. Paul, MN. going major surgery. Commonly reported barriers were having
Purpose: The Balance Study is a randomized controlled pilot to take care of one’s family (83%) and the study being long
study to examine the feasibility and effectiveness of a mindful- (80%). Having a close friend or relative who has had the disease
ness-based stress reduction (MBSR) intervention compared to a being studied was the most common incentive (80%). Factors
standard community caregiver education and support (CCES) unassociated with willingness to participate were: age, gender,
program on measures of psychological distress and caregiver acculturation, occupation, insurance status, having a regular
burden. doctor, trust in research, and prior participation. Marital status
Methods: Family caregivers of individuals with dementia (p=.05) and income (p=.008) were associated, with those who
(n=78) were randomized to either the MBSR or CCES interven- were never married and those with incomes of $15,000-25,000 as
tion; both were group-based, 8 weeks long, 2 ½ hours each the most willing. Trusting one’s doctor was also associated with
session, with a 5 hour retreat. Participants in MBSR received willingness to participate (p=.03). Though 80% of respondents
mindfulness meditation and yoga, and CCES received educa- said that Hispanics are more likely to be taken advantage of in
tion and social support. Participants completed surveys at research studies, this did not appear to have an effect on will-
baseline, 2 months, and 6 months. Measures included stress, ingness to participate. Future research may use these findings
physical/ mental health, depression, state anxiety, self-compas- to tailor approaches to increase Hispanic participation in their
sion, mindfulness, caregiver burden, and social support. Mixed studies.
model regression estimated change across time between groups. CORRESPONDING AUTHOR: Ana E. Cordova, BS, Cancer
Results: Participants were predominately female (88%), white Prevention, Fred Hutchinson Cancer Research Center, Seattle,
WA, 98108; acordova@fhcrc.org
32
B-106a of CBT for persons who are obese. The current work reports on
HOW ARE USER CHARACTERISTICS ASSOCIATED WITH USE quantitative and qualitative findings from two studies focused
OF AN ONLINE SELF-MANAGEMENT PROGRAM FOR BACK on comorbid pain and obesity. The first is a quantitative com-
PAIN? parison of multidimensional pain treatment outcomes from a
Kimberlee J. Trudeau, PhD, Ryan Black, PhD, Mollie Wood, clinical trial of CBT for chronic low back pain. Obese and non-
MPH and Emil Chiauzzi, PhD obese participants (n = 74) were compared using repeated mea-
Inflexxion, Inc., Newton, MA. sures ANOVA’s with pre-and post-treatment data from various
BACKGROUND: Systematic reviews suggest that online pain treatment outcome measures. Results show that despite
behavioral health interventions are efficacious. User charac- a lack of pre-treatment differences, non-obese participants
teristics and website use have been proposed as key variables. showed significantly greater improvements in the domains of
PURPOSE: The goal of this project was to test the hypothesis physical disability, quality of life, and emotional functioning at
that certain demographic characteristics would be related to post-treatment than did their obese counterparts. One possible
differential site usage patterns and that different levels of usage explanation for these differences is that standard CBT treatment
would be related to outcomes. METHODS: We conducted a protocols for pain management are not sensitive to the unique
secondary data analysis of experimental group data from an needs and experiences of individuals who are obese. In an at-
RCT that assessed the efficacy of an online self-management tempt to elicit the significant aspects of the lived experience of
program for people with back pain (experimental group n=95, persons who are obese and who have chronic pain, a qualitative
control group n=104). Path models were run to evaluate (1) study was conducted that involved individual interviews with
whether demographic characteristics were associated with 9 persons who suffer from both conditions. A thematic analysis
differential usage of the website, and (2) whether higher levels of these interviews was performed, and the implications of the
of use were associated with an increase in health communica- elicited themes (e.g., “treatments as a catch-22”) are discussed
tion behaviors. Two different metrics of use, minutes and page as they relate to reforming standard CBT pain treatment pro-
views, were evaluated. RESULTS: When using minutes on web- tocols. Ideas for translation of these themes into new CBT pain
site as the indicator of usage, we noted that age (β=.28, p<.01), treatment modules for persons who are obese are also consid-
gender (β=-.25, p=.01), education (β=-.28, p<.01), and baseline ered.
worst pain (β=.23, p<.05) were associated with higher usage, CORRESPONDING AUTHOR: John J. Sellinger, PhD, Psycholo-
but that usage was not associated with health communication gy, VA Connecticut Healthcare System, West Haven, CT, 06405;
behavior (β=.12, p=.32). When using total page views as the us- john.sellinger1@va.gov
age metric, gender (β=-.24, p<.05) and education (β=-.35, p<.01)
were significantly associated with greater usage, while associa- B-123a
tions between baseline pain (β=.18, p=.14) and disability (β=.18, ARE DAILY FLUCTUATIONS IN PERCEIVED POSITIVE
p=.15) with usage were non-significant but potentially mean- CONTEXT MORE STRONGLY ASSOCIATED WITH WALKING
ingful; total page views was associated with health communi- THAN DAILY SELF-EFFICACY AND PERCEIVED BARRIERS?
cation behaviors (β=.21, p<.10). CONCLUSIONS: This study Eric B. Hekler, PhD,1 Matthew P. Buman, PhD,1 David Ahn,
suggests that a) website usage varies by user characteristics and PhD,1 Genevieve Dunton, PhD,3 Audie Atienza, PhD2 and Abby
b) total page views, but not total minutes, may have an impact C. King, PhD1
on outcomes. Generally, increased age, female gender, lower
1
Stanford Prevention Research Center, Stanford University,
education, and higher baseline pain were positively associated Stanford, CA; 2National Cancer Institute, Bethesda, MD and
with usage, and increased page views were associated with
3
University of Southern California, Los Angeles, CA.
increased health communication behavior. These findings have Self-efficacy and perceived barriers are key constructs previ-
implications for the development of future interventions. ously shown to explain physical activity participation. This
CORRESPONDING AUTHOR: Kimberlee J. Trudeau, PhD, prospective pilot study using ecological momentary assessment
Inflexxion, Inc., Newton, MA, 02464; ktrudeau@inflexxion.com examined if immediate perceived positive context (i.e., percep-
tion that ones environmental and social context is supportive
B-106c of physical activity) was more strongly associated with daily
CHRONIC PAIN AND OBESITY: MERGING QUANTITATIVE fluctuations in walking than self-efficacy and perceived barriers.
AND QUALITATIVE FINDINGS Participants (N=14, 50.0% men, 78.6% White, M age=59.4±6.4)
John J. Sellinger, PhD,1,2 Linda Pellico, PhD,3 Elizabeth A. Clark, were mid-life and older adults in the intervention arm of an
MA,1 Patricia Rosenberger, PhD1,2 and Robert Kerns, PhD1,2 8-week randomized controlled trial focused on promoting
1
Psychology, VA Connecticut Healthcare System, West Haven, walking using personal digital assistants. Participants com-
CT; 2Yale University School of Medicine, New Haven, CT and pleted electronic surveys twice a day (total entries=491) about
3
Yale University School of Nursing, New Haven, CT. total minutes of brisk walking, task self-efficacy, perceived bar-
Factors that contribute to the development and maintenance riers (9 items; e.g., too tired, too busy), and perceived positive
of chronic pain are often multidimensional, and thus, medical context (12 items; e.g., nice walking path, others encouraged).
interventions alone are rarely sufficient to provide adequate Multilevel modeling analyses were used to simultaneously
relief. Additional interventions which address the various examine between-subject (i.e., mean-level) and within-subject
biopsychosocial components of the chronic pain experience are (i.e., daily fluctuations) variations in self-efficacy, barriers, and
often indicated, such as cognitive-behavioral therapy (CBT). perceived positive context as determinants of concurrent and
CBT is well-established as an empirically supported treatment subsequent brisk walking. Results suggested that daily fluctua-
for chronic pain, but little has been done to examine the efficacy tions in self-efficacy and barriers were associated with walking
when perceived positive context was not in the model (p val-
33
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
ues<0.01). Perceived positive context was the only variable that B-123c
significantly predicted daily fluctuations in walking when all HEAT- US: A TOOL FOR ASSESSING ECONOMIC
variables were entered into the model (p<0.0001). These results BENEFITS OF INCREASED PHYSICAL ACTIVITY DUE TO
suggest that daily fluctuations in perceived positive context ENVIRONMENTAL CHANGES
may have a stronger association with walking than daily ratings Thomas Schmid, PhD, Candace Rutt, PhD and James Dills,
of self-efficacy and barriers in this age group. Future physical MPH, MUP
activity interventions should explore changing perceived posi- CDC, Atlanta, GA.
tive context as an intervention component. The social-ecological model of health promotion is a popular
CORRESPONDING AUTHOR: Eric B. Hekler, PhD, Stanford model for community-wide strategies in public health. Integral
Prevention Research Center, Stanford University, Stanford, CA, to this approach is broad, multi-sector participation in program
94305-5411; ehekler@stanford.edu planning and evaluation. Program planning in such situations
is facilitated by tools such as Health Impact Assessments (HIA)
B-123b which provide an opportunity for a wide range of potential
THE CHOICE STUDY: A “TASTE-TEST” OF UTILITARIAN VS. influences on health that result from the intervention of inter-
LEISURE WALKING IN OLDER ADULTS est to be systematically assessed and included in the decision
Eric B. Hekler, PhD, Matt P. Buman, PhD, Cynthia M. Castro, process. While HIAs are popular, additional more focused tools
PhD, Carolyn Prosak, RD and Abby C. King, PhD are need, especially to complement the decision processes when
Stanford Medical School, Stanford University, Stanford, CA. stakeholder groups are debating the economic value of infra-
Recent research has explored promoting utilitarian forms of structure changes such as expanding a cycling path or sidewalk.
physical activity (PA; eg, walking for transport) instead of This study reports on the development of HEAT-US (Health
leisure PA (eg, scheduled, sustained walking episodes for Enhancing Assessment Tool) we developed based on data
health/recreation). Few studies have explored factors that from Europe and then adapted for both waking and cycling
impact individuals choices between these forms of PA. This in the US. Default values for each variable are provided but
pilot study sought to counsel participants in both PA forms and can be tailored with local data. HEAT has proven popular and
then explores factors that influenced their choices. Participants effective in Europe, influencing decision making and putting
were randomized to counseling and practice in either utilitar- physical activity on the agenda when policy decisions are made.
ian or leisure PA for 2 weeks and then the other form for 2 For instance, a HEAT project in Austria calculated savings of
weeks. Then participants entered a 2-week “free choice” phase $570 million from cycling in Austria and in the UK a modal
in which they chose to engage in any mixture of the PA forms. share increase for cycling to 13% would result in a $1.5-3 billion
The primary outcome variable was the ratio of utilitarian vs. savings. HEAT-US uses the base model, substituting US based
leisure PA during the free choice phase. Participants completed attributable risk to determine economic benefits from decreases
surveys about their neighborhood (i.e., the NEWS), daily travel in morbidity and mortality resulting from increased cycling or
to multiple locations, and physical activity (i.e., CHAMPS). walking in the US. Results of a pilot study are provided.
Participants (N=16) were older adults (M age=64±8) who were CORRESPONDING AUTHOR: Thomas Schmid, PhD, Centers
mostly women (81%) and White (75%). Results across the for Disease Control, Atlanta, GA, 30329; tls4@cdc.gov
7-week period indicated that participants increased their total
walking levels (F=10.37, p=0.002), with 81% walking at least B-123d
150 min/week. Further, results suggested that 7 participants CHRONIC CONDITIONS AND PHYSICAL ACTIVITY AMONG
engaged in more utilitarian walking, 4 engaged in a balance of OLDER ADULTS: SUBJECTIVE AND OBJECTIVE MEASURES
utilitarian and leisure walking, and 5 engaged in more leisure OF PHYSICAL ACTIVITY
walking. Having to go to multiple locations throughout the day Young-Shin Lee, PhD1 and Kyeongra Yang, PhD, MPH2
was positively associated with engagement in more utilitarian 1
San Diego State University, San Diego, CA and 2University of
activity. Surprisingly, good walking paths, neighborhood aes- Pittsburgh, Pittsburgh, PA.
thetics, easy access to exercise facilities, neighborhood destina- Regular physical activity (PA) in older adults is evidenced
tions to walk, and shorter distances to locations were associated in preventing and controlling chronic conditions and recom-
with engagement in more leisure activity. These results are in mended as a treatment regimen. There is limited information on
line with other studies suggesting that, counter to younger age that how much PA those with chronic conditions are engaged
groups, perceived neighborhood characteristics may be enablers in. The purposes of this study were to examine 1) the common
of leisure walking (as opposed to primarily transport walking) health indicators and PA status among older adults, 2) the dif-
in older adults. They further indicate the potential importance ferences in PA between those with and without chronic condi-
of combining specific instruction in both utilitarian and leisure tions. Of the total 10,348 participants in the 2005-2006 National
walking to optimize walking levels in older adults. Health and Nutrition and Examination Survey, 1189 adults
CORRESPONDING AUTHOR: Eric B. Hekler, PhD, Stanford aged 65 and over were selected for the current study. Among
Prevention Research Center, Stanford University, Stanford, CA, the participants, 51.5% were men, 66% were White, 61% had an
94305-5411; ehekler@stanford.edu annual income less than $35,000, and 47% reported no spouse.
The findings showed 137/67mmHg for blood pressure, 28 kg/
m2 for body mass index, 194 mg/dL for total cholesterol, and
112mg/dL for fasting glucose; 87% had at least one chronic
condition.
34
PA was measured by self-reports and the accelerometers Discussion
(ACC). From self-reported PA, 45% of older adults engaged in This study suggests sedentary employees found the portable
moderate PA and 18% engaged in some muscle strengthening pedal exercise machine feasible for use while at work and
exercises, but 30% reported sitting all day. The ACC recording reported reduced sedentary time while at work. These findings
showed only 42% walked more than 6000 steps a day and lower are clinically significant due to the growing number of seden-
intensity or steps in those with hypertension, respiratory dis- tary jobs in the U.S. and this device’s potential (e.g. portable,
eases, and arthritis than the counterpart. However, older adults low cost, objective monitoring) for use in large scale worksite
on a high cholesterol level walked significantly more steps than health programs.
those on normal levels (6200 vs. 5700 steps, respectively). The
PA levels of the elderly, being overweight and with diabetes CORRESPONDING AUTHOR: Lucas J. Carr, PhD, Centers for
were not significantly different with the counterpart in both Behavioral and Preventive Medicine, The Miriam Hospital/
self-reports and ACC measures, while those with cardiovas- Brown University, Providence, RI, 02903; Lucas_Carr@Brown.
cular disease were significantly less engaged in PA than those edu
without the condition. B-123f
The findings suggest that PA level in older adults is below MAKING THE ENEMY AN ALLY: A PILOT STUDY USING
the recommended level for health benefits and the majority of EXERCISE VIDEOGAME MEDIA TO PROMOTE CHILD
older adults are borderline for having major chronic conditions. PHYSICAL ACTIVITY AT HOME
Arousing public awareness about the importance of PA in older Rachel S. Mark, MA, Ryan E. Rhodes, PhD, Anna-Marie de
adults, regardless of chronic conditions, is warranted. Zwager, BSc and Naomi Casiro, BSc
CORRESPONDING AUTHOR: Young-Shin Lee, PhD, San Di- School of Exercise Science, Physical and Health Education,
ego State University, San Diego, CA, 92182; ylee@mail.sdsu.edu University of Victoria, Victoria, BC, Canada.
Background: Over 57% of Canadian youth are not physically ac-
B-123e tive enough for optimal growth and development. Many physi-
FEASIBILITY OF A PORTABLE PEDAL EXERCISE MACHINE cal activity (PA) interventions have been developed but have
FOR REDUCING TIME SPENT SEDENTARY IN THE had modest success. Novel interventions are needed. Exercise
WORKPLACE videogame bikes (EV) provide positive physiological results
Lucas J. Carr, PhD and Bess H. Marcus, PhD and increased adherence rates compared to some traditional
Centers for Behavioral and Preventive Medicine, The Miriam exercise equipment; however, studies have been limited to labo-
Hospital/Brown University, Providence, RI. ratory settings and college-aged populations.
Background Purpose: To compare usage of EV to traditional stationary bikes
Time spent sedentary is independently associated with in- placed in front of the TV(C) among children in the home-setting
creased risk for metabolic disease. Progressive increases in and to perform a qualitative process evaluation following a 6
sedentary jobs have contributed to a rise in sedentary behaviors week period.
among U.S. adults. Worksite interventions designed to decrease Method: A single-blinded RCT design was employed random-
sedentary time at work may serve to improve health of seden- izing children between age 4 and 10 from families not meeting
tary employees. Canada’s PA Guidelines to receive an EV or C for 6 weeks at
Methods home (EV n=12; C n=13). The primary outcome of bike usage
Eighteen full-time employees (mean age=41.7+21.0 years; 88% was tracked in situ by parents through logs. Qualitative follow-
female) working in desk/computer dependent occupations up was performed with the EV group following the trial.
were recruited. Anthropometric (weight, body mass index, Results: An independent t-test for total minutes of use over 6
waist circumference, percent body fat), estimated fitness (As- weeks favored EV (t23=2.38, p=.03, d=.67). RM ANOVA across
trand 6 minute Cycle Test), and physical activity behavior data the trial yielded a significant time effect for bouts of usage per
(7 Day Physical Activity Recall) were collected at baseline. Par- week (F5,19=3.66, p=.02, η2=.49). Post-hoc tests showed signifi-
ticipants were given access to a portable pedal exercise machine cant declines for C only (t12=3.12, p=.01, d=.88). RM ANOVA
for four weeks to be used at work. The machine includes exer- for total minutes of use per week yielded a large group effect
cise tracking software and provides real time feedback (speed, (F1,23=5.18, p=.03, η2 = .18). Post-hoc tests showed significant
time used, distance, and calories) which displays on a computer differences between groups at week 6 in favor of EV (t23=2.53,
monitor. At four weeks, participants repeated all baseline tests p=.02, d=.70). Qualitative follow-up suggested that kids found
and completed a feasibility questionnaire focused on user expe- EV fun and exciting to use. It was noted, however, that the bike
riences, barriers to use and suggested improvements. was difficult for the younger children to use due to size.
Results Conclusions: This study shows that usage decreases less rapidly
Preliminary findings (N=9) indicate participants used the for EV than C among children providing initial support for the
machines an average of 13 of 20 possible working days and application of EV to childhood PA interventions and suggests
pedaled an average of 31 minutes or 6.8 miles per day. Feasibil- that children enjoy participating in this type of PA. The findings
ity data suggest participants found the machines to be “easy to support the expansion to a larger trial with a longer duration.
use” and “usable in a work setting”. Neither work productiv- CORRESPONDING AUTHOR: Rachel S. Mark, MA, School of
ity nor quality of work declined while using the machine. All Exercise Science, Physical and Health Education, University of
participants reported regular use of the feedback monitor and Victoria, Victoria, BC, V8R 4N4; rsmark@uvic.ca
reported the monitor increased their use of the machine.
35
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
36
sleep in older adults. cessation but often do not learn this skill in a mentored setting.
CORRESPONDING AUTHOR: Matthew P. Buman, PhD, Stan- We examined the relationship between residents’ prior experi-
ford Prevention Research Center, Stanford University, Stanford, ences (mentored and unmentored) providing smoking cessation
CA, 94305-5411; mbuman@stanford.edu counseling and their level of competency in simulated encoun-
ters with SPs who smoke. Methods: Residents (n=71) com-
B-133c pleted an Objective Structured Clinical Examination to assess
BARRIERS TO ADHERENCE IN PEDIATRIC OBSTRUCTIVE their competence in several behavioral domains using detailed
SLEEP APNEA simulations involving SPs (expert trained actors). SPs gave
Stacey Simon, MS,1 Christina Duncan, PhD2 and David Janicke, residents verbal feedback on their patient-centered communica-
PhD1 tion and assessed performance using a behaviorally anchored
1
University of Florida, Gainesville, FL and 2University of checklist. Consistent with Motivational Interviewing principles,
Arkansas for Medical Sciences, Little Rock, AR. the SPs assessed if the residents were collaborative, discussed
The use of Continuous Positive Airway Pressure (CPAP) treat- behavioral quitting methods, reviewed prior quitting attempts,
ment for youth with Obstructive Sleep Apnea (OSA) effectively and used reflective listening/empathy. After the OSCE, resi-
relieves disorder symptoms and prevents further complications. dents reported how often they had observed a faculty member
However, the device must be used consistently for benefits to providing smoking cessation counseling and how often they
be realized. Non-adherence to medical treatment is prevalent were observed when providing counseling (mentored and
among youth with chronic illness, yet little is known regard- unmentored experience). They also reported on the utility of
ing adherence to CPAP in pediatric OSA. Further information the SP feedback. Results: Most residents (94%) had observed
regarding specific barriers to adherence is needed in order to a faculty providing smoking cessation counseling, but many
identify patient-specific issues and develop targeted interven- (30%) lacked mentored experience. Residents varied greatly
tions to enhance adherence. Thus, the current study attempts to in the depth of their discussion of prior quit attempts. 98% felt
add to the literature by: 1) presenting descriptive data regard- the SP feedback very helpful. Interestingly, prior experience
ing CPAP adherence in youth with OSA; and 2) identifying (mentored or unmentored) did not predict performance on the
common barriers to adherence for youth with OSA. Study SP assessment, perhaps reflecting a lack of effective feedback or
measures include adherence information culled from electronic coaching during those experiences. Discussion/Conclusions: It
downloads from the CPAP device for a 3-month period and the appears that residents have limited competency and experience
Adherence Barriers to CPAP Questionnaire (ABCQ), developed in smoking cessation counseling and need more practice with
for the purpose of this study to identify parent- and child- feedback, which could be gained through more extensive use of
reported barriers (Cronbach’s alpha = 0.79 [child-version] and SPs.
0.89 [caregiver-version]). Participants thus far include 28 youth CORRESPONDING AUTHOR: Sheela Raja, PhD, University of
with OSA age 8-17 (M = 13.33, SD = 2.56) and their caregiver. Illinois at Chicago, Chicago, IL, 60612; sheelaraja@gmail.com
Families completed study measures at their regularly scheduled
appointment in a sleep specialty clinic. Preliminary results sug- B-143b
gest that adherence is generally poor: overall mean daily usage PREVALENCE AND CORRELATES OF SMOKING AMONG MSM
was 3.49 hours (SD = 2.87), and youth used their CPAP for at IN CHINA
least four hours on only 53.68% of nights. The most common Carla J. Berg, PhD,1 Na He, PhD,2 Eric J. Nehl, PhD,1 Frank Y.
barriers endorsed by parents were: 1) child not feeling well; 2) Wong, PhD,1 Jennifer Huang, PhD3 and Tony Zheng, PhD3
forgetting; 3) not using when away from home; and 4) child em-
1
Department of Behavioral Sciences and Health Education,
barrassment about using CPAP. Youth predominantly reported: Emory University, Atlanta, GA; 2Department of Epidemiology,
1) not feeling well; 2) not using when away from home; 3) Fudan University School of Public Health, Shanghai, China and
forgetting; and 4) a desire to forget about their OSA. Identifying
3
Department of International Health, Georgetown University,
barriers to CPAP adherence is beneficial to aid in the develop- Washington, DC.
ment of empirically-based intervention programs, as well to In 2000, smoking contributed to 4.83 million deaths, with half
help healthcare providers identify and address specific barriers occurring in developing countries. Men who have sex with men
salient to patients and families. (MSM) have higher smoking rates than the general population
CORRESPONDING AUTHOR: Stacey Simon, MS, Clinical in the U.S., but less is known about smoking among MSM in
& Health Psychology, University of Florida, Gainesville, FL, developing countries. Thus, we examined the prevalence and
32608; slsimon@phhp.ufl.edu correlates of smoking among MSM in China, the leading con-
sumer of tobacco.
B-143a This study was part of a larger cross-sectional study of drug use
DOES PRACTICE MAKE PERFECT: THE USE OF and HIV among MSM in Shanghai. Participants were recruited
STANDARDIZED PATIENTS IN TEACHING SMOKING through respondent-driven sampling and completed self-
CESSATION COUNSELING SKILLS TO MEDICAL RESIDENTS administered questionnaires. The current analyses examined
Sheela Raja, PhD and Rachel Yudkowsky, MD demographics (age, education, income), tobacco use, Center for
University of Illinois at Chicago, Chicago, IL. Epidemiological Studies Depression Scale (CESD) scores, and
Background: Standardized patients (SPs) have been widely the Lesbian Gay Identity Scale (LGIS) scores. Higher scores on
used in Medical Schools for over 30 years and are important the LGIS indicate greater sexual identity confusion, need for
in training residents on the behavioral aspects of patient care. privacy and acceptance regarding sexual orientation, difficulty
Problem: Residents are expected to counsel patients on smoking disclosing sexual orientation, and internalized homonegativity.
37
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
Smoking prevalence among this sample of 404 MSM was 65.9%. The findings of this study help inform health professionals’ and
Any smoking in the past 3 months was associated with lower providers’ efforts to improve reach and engagement in smoking
education (OR= 0.73; 95% CI 0.56-0.94) and higher LGIS scores cessation among those who smoke.
(OR= 1.48; CI 1.11-1.98). Among smokers, heavy cigarette use CORRESPONDING AUTHOR: Sareh Bahreinifar, Masters of
(≥10 cpd), in comparison to light smoking, was related to older Public Health, National Cancer Institute, Rockville, MD, 20852;
age (OR=1.03; CI 1.00-1.06) and lower LGIS scores (OR=0.64; CI bahreinifars@mail.nih.gov
0.44-0.92). Although bivariate analyses indicated a relationship
between CESD scores and any smoking (p<.05), CESD did not B-143d
significantly contribute to the regression models. PERCEPTIONS OF QUITTING MODERATE THE
The higher smoking rates among MSM in China are similar EFFECTIVENESS OF GAIN-FRAMED SMOKING CESSATION
to rates among U.S. MSM. Less comfort with one’s sexuality TELEPHONE COUNSELLING
was related to greater likelihood of smoking, particularly light Amy E. Latimer, PhD,1,2 E. Michael Cummings, PhD,3 Robert
smoking. Future research should focus on examining potential Makuch, PhD2 and Benjamin A. Toll, PhD2
mediators and moderators of this relationship and identify spe-
1
Queen’s University, Kingston, ON, Canada; 2Yale University,
cific aspects of gay identification that may influence smoking New Haven, CT and 3Roswell Park Cancer Institute, Buffalo,
among MSM, particularly in developing countries. NY.
CORRESPONDING AUTHOR: Carla J. Berg, PhD, Department People are persuaded by gain-framed messages when a behav-
of Behavioral Sciences and Health Education, Emory Univer- ior is risk-averse and loss-framed messages when a behavior
sity, Atlanta, GA, 30322; cjberg@emory.edu has risky outcomes. The categorical distinction between preven-
tion (i.e., risk-averse) and detection (i.e., risky) behaviors has
B-143c proven to be a relatively useful guideline for framing health
HEALTH BELIEFS AND INFORMATION SEEKING BEHAVIOR messages. Fundamentally, this guideline assumes that everyone
AMONG CANCER SURVIVORS WHO SMOKE perceives the risk associated with a behavior in a consistent
Sareh Bahreinifar, Masters of Public Health,1 Erik M. manner. However, individuals’ perceptions of a behavior vary.
Augustson, PhD, MPH,1 Yvonne M. Hunt, PhD1 and Lila Thus, the effects of framed messages may be optimized by con-
Finney-Rutten, PhD, MPH2 sidering individuals’ behavioral risk perceptions rather than the
1
National Cancer Institute, Rockville, MD and 2SAIC, Rockville, prevention versus detection function of the behavior. A second-
MD. ary analysis of data from a message framing smoking cessation
Despite the well-known risks associated with smoking, a sizable study (Toll et al., 2010) was conducted to test this hypothesis.
proportion of cancer survivors continue to smoke post diagno- Smokers (n = 2032) who called the New York State Smokers’
sis. Cancer survivors are a population of special concern given Quitline received either gain-framed or standard care messages.
their potential compromised health due to the late-effects of Medically eligible callers received nicotine replacement therapy.
treatment and increased risk of cancer recurrence. In attempt- Perceptions of the benefits/risks of quitting, intentions and self-
ing to better understand factors that may guide treatment efficacy to quit and stay quit, and smoking behavior were as-
development specific to this group, we explored differences sessed at Baseline, Week 2, and Week 12 using single items. Re-
in health beliefs and information seeking patterns among gression analyses controlling for sex and nicotine dependence
cancer survivors who smoke (CSS) versus survivors who do revealed a significant Message Frame x Perceptions of Quitting
not (CSNS), as well as compared to smokers with no history interaction for Week 2 behavior, OR=1.67, p<.05, and Week 12
of cancer (NCS). This project used data from the 2007 Health intentions, β=.07, p<.05, and self-efficacy, β=.08, p<.05. Post hoc
Information National Trend Survey (HINTS), a Random Digit regression analyses revealed that when exposed to gain-framed
Dialing (RDD) and mail-based nationally representative survey. counseling, individuals who perceived great benefit in quitting
Thus, SUDAAN was used to adjust for the complex sampling were more likely to make an early quit attempt and to have
frame of the survey. The primary comparisons of interest were stronger intentions and self-efficacy to quit and stay quit than
between CSS (n=134) and CSNS (n=853), although additional individuals who perceived some risk in quitting. Perceptions
analyses were performed comparing CSS versus NCS (n=1100). of quitting did not moderate the effectiveness of standard care
Key variables of interest were those assessing cancer-specific counseling. These findings suggest that there may be utility in
beliefs, health information seeking, healthcare utilization, and considering individual differences in behavioral risk percep-
demographics. tions when delivering gain-framed health messages.
Compared to CSNS, CSS were less likely to be married and Funding: NIH grants CA127818, K12-DA000167
reported lower income and poorer general health. Although CORRESPONDING AUTHOR: Amy E. Latimer, PhD, Queen’s
no differences were noted for number of healthcare visits, CSS University, Kingston, ON, K7L 3N6; amy.latimer@queensu.ca
were less likely to have insurance or a regular provider and
more likely to report psychological distress. Although some sig-
nificant differences were noted in trust of sources for informa-
tion and types of internet use, no global pattern of information
seeking differences was noted. However, CSS were significantly
more likely to endorse cancer beliefs suggesting frustration and
pessimism regarding their ability to reduce their risk of future
cancers and health problems.
38
B-151a B-154a
TREATING OPIOID DEPENDENCE WITH BUPRENORPHINE PSYCHOLOGICAL DISTRESS IN PATIENTS SEEKING RENAL
IN MEDICAL SETTINGS TRANSPLANT
Hannah K. Knudsen, PhD and Jamie L. Studts, PhD Kristin Kuntz, PhD1 and Diane Bonfiglio, PhD2
Behavioral Science, University of Kentucky, Lexington, KY. 1
Psychiatry, The Ohio State University Medical Center,
Background: Treatment of opioid dependence has tradition- Columbus, OH and 2Psychology, Ashland University, Ashland,
ally occurred in specialty substance abuse treatment programs OH.
(SATPs) and methadone maintenance programs (MMPs) rather The comorbidity of psychological disorder with end-stage renal
than general medical settings. The FDA’s approval of buprenor- disease (ESRD) presents challenges for renal transplantation.
phine in 2002 was accompanied by regulatory changes intended Previous research has shown that renal transplant recipients
to expand access to treatment by allowing the prescription of with higher depression and anxiety scores report more non-
buprenorphine by physicians who are not addiction specialists compliance with medication, worse sleep, more marital discord,
in office-based settings. This pilot study measured the percent- and worse quality of life. Estimates of rates and severity of
age of buprenorphine prescribers in non-addiction specialties affective and anxiety disorders have varied significantly across
and who practiced in general medical settings, while exploring studies of renal transplant patients, possibly due in part to
whether practice patterns vary by medical specialty. Methods: variation in methodology and timing of evaluations. The pres-
Using the Substance Abuse and Mental Health Services Ad- ent study adds clarity to this literature by assessing anxiety and
ministration’s (SAMHSA) online physician locator, a random depressive symptoms in a sample of ESRD patients at the spe-
sample of 134 current buprenorphine prescribers was identified, cific time point of first contact with the transplant center. Five
and 53 prescribers returned a mailed survey (40% response rate) hundred eighteen patients seeking a renal transplant at a large
in 2009. Results: Among respondents, 72% worked in general Midwestern transplant center completed the Patient Health
medical settings; about 13% practiced in specialty SATPs and Questionnaire (PHQ) as part of their pre-transplant evaluation.
15% in MMPs. About 42% represented general medical special- As soon as patients were referred for transplant, they were sent
ties, 30% worked in general psychiatry, and 28% were special- the PHQ to complete and return before coming to the transplant
ists in addiction medicine/addiction psychiatry. There were center for their initial appointment. The PHQ assesses for sev-
some differences in practice patterns between these groups. eral psychiatric conditions including depression and anxiety.
Psychiatrists treated significantly fewer patients (mean=21.4, Frequencies of depression and anxiety disorders were calculat-
SD=27.7) than addiction specialists (mean=49.5, SD=31.1; ed. Approximately 15% of patients reported a depressive condi-
p<.05). Psychiatrists (27%) and addiction specialists (17%) were tion and 8% of patients endorsed an anxiety condition. Rates
less likely to refer patients to external providers for counsel- of anxiety and depressive disorders in this sample were lower
ing than general practitioners (71%; χ2 = 15.7, p<.01). Conclu- than expected, suggesting that this sample of patients is less
sions: Although caution is warranted given the small sample distressed than other samples of ESRD patients. Other possible
size, this pilot study points to a promising expansion of opioid explanations include selection biases influencing both which
dependence treatment through the delivery of buprenorphine patients are referred for transplant and which of those patients
within general medical settings. Differences in practice patterns complete the pre-evaluation paperwork. Additionally, self-re-
suggest some limits to this expansion, given that psychiatrists porting of anxiety and depressive symptoms in this sample may
treat fewer patients than addiction specialists. The high rate have been underreported due to patients’ motivation to present
of referring patients to external counseling services by general themselves positively in the early stage of transplant evaluation.
practitioners suggests there may be additional training needed Given that a main motivation for renal transplant is to improve
for these physicians. well-being, it is wise to assess and treat psychiatric issues before
CORRESPONDING AUTHOR: Hannah K. Knudsen, PhD, transplant is undertaken.
Behavioral Science, University of Kentucky, Lexington, KY, CORRESPONDING AUTHOR: Kristin Kuntz, PhD, Psychia-
40536-0086; hannah.knudsen@uky.edu try, The Ohio State University Medical Center, Columbus, OH,
43212; kristin.kuntz@osumc.edu
39
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
Rapid Communications
Poster Session C
Friday, April 9, 2010
6:15 PM – 7:45 PM
40 40
C-032a enrolled in an NINR funded longitudinal intervention study
ADHERENCE BEHAVIORS OF “A HOME-BASED AEROBIC (5R01NR010190, M. Mishel, P.I.). Self-reported times of salivary
EXERCISE INTERVENTION” IN CHILDREN WITH ACUTE cortisol collection were recorded for each of 12 saliva samples
LYMPHOBLASTIC LEUKEMIA over the course of three timepoints. Trends of adherence were
Chao Hsing Yeh, PhD determined with respect to various demographic factors, in-
School of Nursing, University of Pittsburgh, Pittsburgh, PA. cluding race, living with a young child, and employment status.
Purpose: The purpose of this study was to examine adherence Analyses included frequencies, chi-square distributions, and
behaviors of the “home-based aerobic exercise intervention” polytomous response logistic regression modeling.
on fatigue, sleep and cardiorespiratory fitness in children with Results: Tests for proportionality indicated that demographic
ALL during the maintenance stage of chemotherapy, imme- predictors in our model had a similar association with each
diately after completion of the intervention (post-test), and 1 level of participant adherence (always, sometimes, or never).
month after completion. Although our model lacked statistical significance, women who
Methods: A quasi-experimental study was conducted with 12 did not adhere to the saliva collection protocol were more likely
pediatric oncology patients in the intervention group and 10 in to be African American (OR .58, CI .33 - 1.00), to work full-time
control group who were matched by age group (<10 years and (OR .67, CI .40 - 1.13), and to live with at least one child under
>=10 years) and sex. A six-week home-based aerobic exercise 18 years of age (OR .70, CI .41 - 1.18).
intervention was implemented for children who were in the Discussion: To our knowledge, this is the first study to examine
intervention group while patients in the control group received profiles of participant adherence to a cortisol sampling protocol.
routine care. Parents whose children enrolled in the interven- By conceptualizing adherence as a polytomous outcome, future
tion group had to agree to encourage and/or monitor the chil- studies may gain insight into adherence trends in other popula-
dren’s exercise as well as remind them to record in the exercise tions with the aim of promoting adherence and designing more
diary. informed saliva collection protocols.
Results: The adherence rate was used to calculate the feasibility CORRESPONDING AUTHOR: Daniel Hall, BA, University of
of patients to practice the home-based aerobics at home. The North Carolina at Chapel Hill, Chapel Hill, NC, 27599; dan-
adherence rate was defined as participants who were able to hall@email.unc.edu
follow at least two thirds of the exercise prescription during the
intervention program. The results indicated that the adherence C-032c
rate during six weeks intervention ranged from 67% to 83% FAMILY HISTORY OF BREAST CANCER AND CANCER WORRY
(mean=76%, SD=6.02). The lowest adherence rate occurred at AS PREDICTORS OF MAMMOGRAPHY SCREENING IN
week 3 (67%). Stage of behavior to exercise. At the pre-test, HISPANIC AMERICAN WOMEN
4 patients in the intervention group were at “contemplation Lona Cavallera, BA,1 Vanessa Malcarne, PhD,2,5 Elva
stage” (34%) (not doing any physical activity at that time); 7 Arredondo, PhD,1 Hector Lemus, DrPH,1 Natasha Riley, MA3
patients were at “preparation stage” (58%) (doing irregular and Georgia R. Sadler, PhD, MBA4
exercise) and 1 patient (8%) was at “action” stage (doing regular
1
Graduate School of Public Health, San Diego State University,
exercise). At the post-test, 25% patients (n=3) were at the “ac- San Diego, CA; 2Department of Psychology, San Diego State
tion stage” and 17% (n=2) were at maintenance stage (sustained University, San Diego, CA; 3Vista Community Clinic, Vista, CA;
their physical activity). However, the majority of the patients
4
University of California, San Diego, Medical Center, Moores
(n=11; 92%) were changing back to the stage of “preparation Cancer Center, San Diego, CA and 5SDSU/UCSD Joint Doctoral
stage” (doing irregular exercise) at 1-month follow up. Program in Clinical Psychology, San Diego, CA.
CORRESPONDING AUTHOR: Chao Hsing Yeh, PhD, Univer- Breast cancer continues to be a burden for many women in the
sity of Pittsburgh, Pittsburgh, PA, 15261; yehc@pitt.edu United States, and Hispanic American women are vulnerable to
late stage diagnosis of the disease, tumor types less responsive
C-032b to particular therapies, and lower breast cancer survival rates.
PREDICTORS AND PATTERNS OF PARTICIPANT ADHERENCE Mammogram utilization may be an effective means of improv-
TO A CORTISOL COLLECTION PROTOCOL ing such outcomes, yet screening rates are suboptimal. The
Daniel Hall, BA,1 Diane Blyler, PhD,1 Deborah Allen, MSN, present study investigated the relationships of family history
RN,1 Merle Mishel, PhD, RN,1 Jamie Crandell, PhD,1 Barbara of breast cancer (FHBC) and cancer worry (CW) to mammog-
Germino, PhD, RN1 and Laura S. Porter, PhD2 raphy adherence (MA) among Hispanic American women.
1
University of North Carolina at Chapel Hill, Chapel Hill, NC Five hundred (N = 500) Hispanic American women completed
and 2Duke University, Durham, NC. surveys including the Cancer Worry Scale, Personal Health
Background: Cortisol, a stress-related hormone, has been mea- Survey, and Brief Acculturation Scale for Hispanics. Women
sured in many psychoimmunological studies via collection of age 40 and older were selected for analysis of mammogram
saliva; however, patterns of participant adherence to protocol utilization, yielding a final sample of 194. Family history of BC
procedures have not been fully elucidated in the literature. was not significantly associated with MA, and CW did not sig-
nificantly mediate the relationship between these two variables
Objectives: In this poster we examine adherence to a cortisol (OR=1.034, p = .709). Age did not moderate the relationship
morning rise (CMR) collection protocol, and explore demo- between FHBC and CW (B = -.020, p = .656), or the relationship
graphic predictors of different adherence trends. between CW and MA (OR = 1.027, p = .189). Acculturation did
Method: Participants included 221 breast cancer survivors not significantly moderate the relationship between FHBC and
41
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
42
Hispanic American women’s knowledge and attitudes about CONCLUSIONS: Emphasizing progress in race-specific health
breast cancer clinical trials. Adult women (20 African American, information may motivate African Americans to change health
20 Hispanic American-English speaking, 20 Hispanic American- behaviors, but this approach appears to support or reinforce
Spanish Speaking) with a mean age of 37 years (range: 18-72) counterproductive attitudes in Whites. To maximize the impact
were randomly assigned to receive the BCCTEP or a control of race-specific health information, messages should be targeted
program about community safety. At pre- and post-interven- for different segments of the population.
tion, women completed a Clinical Trials Knowledge Survey and CORRESPONDING AUTHOR: Giovanina A. Gardiner, MSW,
the Barriers to Clinical Trials Participation Scale, which yields George Warren Brown School of Social Work, Washington Uni-
four subscales measuring mistrust of research, lack of com- versity in St. Louis, St. Louis, MO, 63112; ggardiner@gwbmail.
munity support, lack of personal benefits, and lack of famil- wustl.edu
iarity. Paired t-tests for the experimental and control groups
demonstrated that both groups showed significant reductions C-032h
in mistrust of research, lack of familiarity and lack of personal FACILITATING FACTORS AND BARRIERS OF MULTI-ETHNIC
benefits. The only barrier that showed no significant changes WOMEN’S DECISIONS TO PARTICIPATE IN PSYCHO-
was lack of community support. Results suggest that simply ONCOLOGY RESEARCH: BRIDGING THE GAP
participating in a research project may make women feel more Georita M. Frierson, PhD,1 Marissa C. Perales, BA,1 Kyle
trusting of the research process, more familiar with clinical Deaton, BA3 and Bernardine M. Pinto, PhD2
trials, more trusting of the research process, and more aware 1
Psychology, Southern Methodist University, Dallas, TX;
of possible personal benefits, independent of which education 2
Psychiatry, Brown Medical School, Providence, RI and
program they received. 3
Psychology, University of North Texas, Denton, TX.
CORRESPONDING AUTHOR: Amanda M. Marin, BA, Psy- Background:Recruitment of African-American women (AA)
chology, San Diego State University, san diego, CA, 92182; and Latinas into psycho-oncology research continues to receive
Amanda.marin@yahoo.com substantial attention due to the paradox of limited enrollment
into such studies while the burden of certain cancers is higher
C-032g for these groups. Multi-ethnic qualitative studies are needed
EFFECTS OF FRAMING RACE-SPECIFIC HEALTH to identify factors that influence racial/ethnic minorities to
INFORMATION ON A CAUCASIAN AUDIENCE participate in psycho-oncology research. Purpose:Bridging the
Giovanina A. Gardiner, MSW,1 Charlene Caburnay, PhD,1 Gap examined factors that influence AA women and Latinas’
Robert A. Nicholson, PhD,2 Susie Rath, MA1 and Matthew W. participation in research. A multi-ethnic sample was recruited
Kreuter, PhD1 to identify cross-cultural factors influencing research participa-
1
George Warren Brown School of Social Work, Washington tion. Methodology:57 AA women and 11 Latinas from RI and
University in St. Louis, St. Louis, MO and 2School of Medicine, TX completed a 29-item sociodemographic questionnaire and
St. Louis University, St. Louis, MO. participated in ethnic-specific focus groups. Wegner’s transla-
BACKGROUND: Research has shown that African Americans tion process model (1993) was used to indentify intra- and
experience fewer negative emotions and are more motivated to inter-cultural themes that influence participants’ research
pursue positive health behaviors when they read race-specific participation. Participants’ characteristics were analyzed
health information that highlights progress instead of dispari- through descriptive analyses and qualitative themes catego-
ties. However, little is known about how different presentations rized on 3 key focus group questions: 1) research perceptions,
of race-specific health information impacts other groups. This 2) facilitating factors, and 3) barriers to participate into research.
study seeks to understand how progress-framed and disparity- Results: Participants were 68 women (age M=47.75 years old,
framed cancer information about African Americans impacts a SD=14.38) and M=13.72 education level, SD=2.30. 25% of the
Caucasian audience. sample was married/partnered with 71% self-reported being
METHODS: In a double blind, randomized control trial, study AA. Among Latinas, 81% self-reported Mexican heritage. We
participants (N=238) were randomly assigned to read either identified 3, 8, and 9 central themes for research perceptions,
a positive or disparity framed newspaper article about colon facilitating factors, and barriers to research, respectively. All
cancer rates among African Americans and complete a short participants reported mistrust and lack of knowledge as re-
survey. Eligible participants were Caucasian, over 40 years old, search barriers; Latinas reported more barriers around cultural
and able to complete a written survey. The two main dependent sensitivity. A majority of participants reported addressing
variables were perceived equality in access to the health care trust and financial resources to increase research participation.
system and symbolic racism. For both scales, higher scores indi- Conclusions:Qualitative research revealed that trust, research
cated greater degrees of bias against African Americans. awareness, and health literacy need to be addressed to increase
minority women’s participation in psycho-oncology research.
RESULTS: Participants who read the progress framed article re-
ported higher scores on perceived equality in health care access CORRESPONDING AUTHOR: Georita M. Frierson, PhD,
than those who read the disparity framed article (t(232)=2.72 , Psychology, Southern Methodist University, Dallas, TX, 75275;
p <0.01, C.I. = 0.07-0.43). Similar results were found for sym- frierson@smu.edu
bolic racism, where participants reported higher scores on the
symbolic racism scale after reading the progress framed article
versus the disparity framed article (t(234)=3.15, p <0.01, C.I. =
0.09-0.43).
43
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
44
scales for fatigue frequency and severity (p < .05 for overall FSI reach obese women, however weight-targeted messages do not
and subscales). Baseline values for fatigue were not significantly appear to increase central processing or potential for behavior
different between groups. For QG/TCE, FSI decreased (4.34 change; tailoring messages may prove more efficacious given
to 2.03); less so for SQG ( 3.39 to 2.49). Body Mass Index (BMI) the heterogeneity within weight groups.
also dropped in the QG/TCE group and increased slightly in CORRESPONDING AUTHOR: Lucia A. Leone, BA, Nutrition,
the SQG group, approaching a significant difference in change University if North Carolina at Chapel Hill, Chapel Hill, NC,
between groups (p = .053). Combining both groups, significant 27516; lleone@email.unc.edu
improvements were found pre- to post-intervention, includ-
ing cognitive function (FACT-Cog)and performance (LNS), C-032m
depression (BDI), sleep quality (PSQI), global wellness (AIOS) VALIDITY TESTING OF A PROSTATE CANCER SCREENING
and SF-36 (pain, rolelimit, physfunction, emotional wb). Overall (PCS) ANXIETY MEASURE
level of activity (METS) significantly increased across both Suzanne K. Linder, PhD,1,2 Paul R. Swank, PhD,2 Patricia D.
groups; participants who were sedentary at study entry (n=43) Mullen, DrPH,2 Robert J. Volk, PhD,1 Robert O. Morgan, PhD2
nearly tripled from pre- to post-intervention (3.26 to 9.38 METs, and Sally W. Vernon, PhD2
p < .01), and more by 3-month post-intervention (9.82 METs), 1
UT M D A Cancer Ctr, Houston, TX and 2UT Hlth Science Ctr,
suggesting potential for gentle exercise to bridge from inactiv- Houston, TX.
ity to higher levels of activity. (Funding: NIH/NCCAM UO1 Background: Anxiety is shown to influence effective decision-
AT002706-03) making, especially in decisions that involve uncertainty. In or-
CORRESPONDING AUTHOR: Linda K. Larkey, PhD, College der to explore the moderating role of anxiety on decision-mak-
of Nursing and Health Innovation, Arizona State University, ing processes, reliable and valid anxiety measures are needed.
Phoenix, AZ, 85004; larkeylite@msn.com Following the Spielberger State-Trait Anxiety Inventory, we
developed an 18-item, 3-factor PCS anxiety scale intended to
C-032l measure anxiety related to the prostate-specific antigen (PSA)
TARGETED COLORECTAL CANCER PREVENTION MESSAGES test, the digital rectal examination (DRE), and the decision to be
FOR OBESE WOMEN: RESULTS OF AN ONLINE MESSAGE tested for PCS.
TESTING STUDY
Lucia A. Leone, BA and Marci K. Campbell, PhD, MPH, RD Purpose: To provide evidence of the reliability and validity of a
Nutrition, UNC Gillings School of Global Public Health, Chapel PCS anxiety measure.
Hill, NC. Methods: Using 2 samples of baseline PCS anxiety data from a
Obese women are at higher risk for multiple cancers, but are RCT of a decision aid for PCS (n=301, private clinic; n=149, pub-
less likely than normal weight women to engage in cancer lic clinic), 4 psychometric properties were assessed: 1) internal
prevention behaviors such as screening and physical activity consistency reliability, indicated by factor analysis intraclass
(PA). Research indicates that higher perceived barriers and correlations and Cronbach’s α; 2) construct validity, indicated
lower perceived benefits to screening/PA may affect behav- by patterns of Pearson correlations among subscales; 3) discrim-
ior. In order to address these disparities, we proposed using inant validity, indicated by the measure’s ability to discriminate
weight-targeted messages to improve colorectal cancer (CRC) between undecided men and those with a definite screening
prevention among obese women. Messages were tested online intention; and 4) factor validity and invariance using confirma-
with women age 50 and older (N=181). Participants were strati- tory factor analyses (CFA).
fied by weight (obese vs. non-obese) and randomized to either Results: The PCS anxiety measure had adequate internal consis-
receive 10 weight-targeted or 10 generic messages. Targeted tency reliability (total,α=.910) and good construct and discrimi-
messaged were written for obese women based on pre-study nant validity. CFAs indicated that the 3-factor model did not
focus groups and addressed health belief model constructs have adequate fit. There was evidence of method variance;
such as benefits and barriers to CRC screening/PA which were some factors consisted of similarly worded items across sub-
relevant to that population. After reading the messages, women scales. When subscales were considered separately, CFAs for a
were asked to evaluate them using an Elaboration Likelihood 6-item PCS decision anxiety measure and a 6-item PSA anxiety
Model (ELM) scale. We hypothesized that obese women who measure showed adequate fit. Additionally, the PCS decision
received targeted messages would have higher ELM scores than anxiety measure was invariant across clinics.
those who received generic messages; we did not expect higher Discussion: Our 6-item PCS decision anxiety measure can be
scores among non-obese women who received targeted mes- used in PCS decision aid studies to explore the moderating role
sages. We rejected our hypothesis and found that obese women of PCS anxiety on decision-making processes. The develop-
had higher ELM scores than non-obese women regardless of ment of PCS anxiety items relating to testing procedures is still
which messages they read (p=0.02). Obese women also found needed. We recommend avoiding the use of similar wording
the online messages to be more believable (p=0.047) and more across subscales to minimize method variance.
personally relevant (p=0.005) than non-obese women did. These
differences remained statistically significant when controlling CORRESPONDING AUTHOR: Suzanne K. Linder, PhD, School
for intervention condition, education, CRC screening status and of Public Health, University of Texas Health Science Center,
other potential confounders. Sub-group analyses indicated that Houston, TX, 77030; suzanneklinder@gmail.com
targeted messages produced higher ELM scores in women who
reported more obesity-related barriers. Message testing results
indicate that internet messages may be an effective way to
45
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
46
vors reported significantly higher levels of anxiety compared to Results shed light on lay beliefs about cancer causes and
women without a personal cancer history (t(130) = 1.98, p=.05). confirm that individuals hold similar, but not identical, beliefs
Repeated measures ANOVAs were conducted to examine about the factors that lead to cancer in others versus themselves.
whether levels of negative mood and anxiety changed from CORRESPONDING AUTHOR: Nikki A. Hawkins, PhD, Divi-
pre to post mammogram. Results showed that negative mood sion of Cancer Prevention & Control, Centers for Disease Con-
decreased among women with no cancer history, but levels of trol & Prevention, Atlanta, GA, 30341; cyt4@cdc.gov
negative mood did not change among breast cancer survivors
(Group x Time interaction F(1, 127) = 7.24, p=.01). From pre to C-032r
post mammogram, anxiety also significantly decreased among CIGARETTE SMOKING FOLLOWING HEAD AND NECK
women with no cancer history, but did not change among CANCER DIAGNOSIS: USING THEORY TO UNDERSTAND
breast cancer survivors (Group x Time interaction F(1, 126) = INTENTIONS TO QUIT
5.60, p=.02). An implication of these findings is that strategies Jessica L. Burris, MA and Michael Andrykowski, PhD
designed to help women manage psychological distress during Behavioral Science, University of Kentucky, Lexington, KY.
mammography may be beneficial to breast cancer survivors The etiology of head and neck squamous cell carcinoma (HN-
undergoing the procedure. SCC) is strongly linked to tobacco and alcohol use. Specifically
CORRESPONDING AUTHOR: Rebecca A. Shelby, PhD, among HNSCC patients who reported cigarette smoking in
Psychiatry and Behavioral Sciences, Duke University Medical the year preceding diagnosis, about one-third report cigarette
Center, Durham, NC, 27705; shelb003@mc.duke.edu smoking following completion of cancer treatment. Some stud-
ies have examined intentions to quit cigarette smoking among
C-032q HNSCC patients, but theory is generally ignored. By using
BELIEFS ABOUT THE CAUSES OF CANCER AMONG WOMEN Ajzen’s (1991) Theory of Planned Behavior to guide the selec-
WITH A CLOSE FRIEND OR RELATIVE AFFECTED BY THE tion of study variables, the current study - which is ongoing
DISEASE - addresses this limitation. HNSCC patients meeting eligibility
Nikki A. Hawkins, PhD, Lucy A. Peipins, PhD, Steven criteria were recruited from the UK Kentucky Clinic. Shortly
Leadbetter, MS, Juan Rodriguez, MPH, Natasha Buchanan, PhD after diagnosis but before beginning cancer treatment (# days
and Francis McCarty, PhD since diagnosis: M = 17.9, SD = 20.9), participants completed a
Division of Cancer Prevention, Centers for Disease Control, standardized questionnaire asking about their current beliefs
Atlanta, GA. and practices. Theory of Planned Behavior constructs were
Beliefs about the causes of cancer are central to research on assessed by multiple items that were directly compatible with
explanatory models and play an important role in perceived the behavior in question, namely, intentions to quit cigarette
risk and health behavior, including adherence to screening smoking in the next six months. Of the 27 HNSCC patients
recommendations and medical decision-making. Beliefs may be currently enrolled (85% male; age in years: M = 57.5, SD = 7.4),
influenced by witnessing close others diagnosed with cancer; 82% reported having smoked at least one cigarette in the week
however, the content of such beliefs and the level of congruence preceding assessment; # cigarettes smoked in that week: M =
between perceived cancer causes in others versus oneself have 91.6, SD = 113.8. Theory of Planned Behavior constructs were
not been closely examined. This study examined beliefs about successful in predicting intentions to quit cigarette smoking: F
cancer causes among women with a friend or relative with can- (3, 23) = 2.97, total R squared = .31, p < .05. Perceived behavioral
cer. Specific objectives were to describe women’s beliefs about control (B = .25, p < .01) was the greatest predictor followed
the causes of friends’ or relatives’ cancer, compare the content by subjective norms (B = -.08, ns) and personal attitudes (B =
of these beliefs with beliefs about personal risks of cancer, .01, ns). While HNSCC diagnosis may be considered a “teach-
and compare beliefs attributed to friends versus relatives with able moment,” in which the motivation for behavior change is
cancer. theorized to be high, not all HNSCC patients regard their diag-
As part of a study on cancer risk perception, 2,524 women nosis as a sufficient catalyst for smoking cessation. Preliminary
from racially and socioeconomically diverse backgrounds were results of this ongoing study suggest efforts to increase HNSCC
recruited from a managed care plan and completed telephone patients’ perceived behavioral control may be an important
interviews; 2,099 indicated having a close friend or relative with point of intervention when trying to elicit greater intentions to
cancer (483 female friends; 1,134 female relatives). Respondents quit cigarette smoking.
were asked what they believed contributed to their friend/ CORRESPONDING AUTHOR: Jessica L. Burris, MA, Behav-
relative’s cancer and what might contribute to their own risk of ioral Science, University of Kentucky, Lexington, KY, 40536;
cancer. Responses were assigned to 18 predefined categories of burris.jessica@gmail.com
cancer causes.
Most commonly-cited causes of family/friend’s cancer and per-
sonal cancer risk included family history (20%; 27%), smoking
(14%; 12%), and environment (11%; 15%). Respondents were
more likely to cite environmental factors, diet, overweight, and
poor health as increasing their own risk versus the risk of the
friend/relative, while they were more likely to cite smoking, al-
cohol, and fate as contributing to a friend/relative’s cancer. The
degree to which family history, stress and chance were cited
differed by relationship type.
47
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
48
sion, and returned to baseline levels by discharge. However, not C-032w
all aspects of QOL followed this pattern. Scores on the Physical THE M.A.P. (MIND AFFECTS THE PHYSICAL) PROJECT:
Well-Being subscale tended to decline then return to baseline by UNDERSTANDING THE PSYCHOSOCIAL NEEDS OF BREAST
discharge. However, the Functional Well-Being score declined CANCER SURVIVORS
from admission to reinfusion but did not improve by discharge. Joanne S. Buzaglo, PhD, Kasey Ryan Dougherty, BA and Mitch
Scores on the Emotional Well-Being subscale improved across Golant, PhD
the three time points, whereas Social Well-Being was perceived Research & Training Institute, Cancer Support Community,
as stable. Overall, the present study indicated that despite the Philadelphia, PA.
fact that individuals undergoing allogeneic BMT face greater Increasingly, breast cancer (BC) is managed as a chronic disease
risks and longer treatment courses, their psychological response with persistent physical and psychosocial demands. Yet, little
during initial hospitalization is largely consistent with patients research has focused on the psychosocial needs of women
undergoing an autologous BMT. across the care continuum. The Cancer Support Community
CORRESPONDING AUTHOR: Carolina Garcia, MS, Illinois (CSC) fielded a national survey to understand the current psy-
Institute of Technology, Chicago, IL, 60657; garccar@iit.edu chosocial needs of BC survivors.
C-032v Methods: CSC conducted an online survey of 1,004 BC survi-
SOCIAL SUPPORT PREDICTS STRESS FOR BREAST CANCER vors, 0 to 5 years post-diagnosis. Questions were developed
SURVIVORS with input from a National Advisory Council of experts repre-
Herzelene Martin, BA and Tammy Schuler, MA senting advocacy, oncology, psychology, policy, industry and
Ohio State University, Columbus, OH. managed care.
BACKGROUND: Social support may aid the person coping Results: 87% participants were white, with a mean age of 54.
with cancer diagnosis, treatment, and recovery (Koopman, et 45% graduated from college and 14% had a graduate degree.
al., 1998). We test this hypothesis using two measures of sup- 75% had stage II cancer or less and 13% had a BC recurrence.
port and a longitudinal design. METHOD: Data were from 81% survivors reported some form of physical, emotional or
patients with Stage II or III breast cancer (N=227) enrolled in an spiritual distress with 67% reporting emotional distress. 64%
RCT examining biobehavioral outcomes following a psycholog- women indicated fear of recurrence, 58% physical changes, 55%
ical intervention (Andersen et al., 2004). Participants were as- anxiety, 47% depression, 46% financial worries as the lead-
sessed after diagnosis/surgery (baseline), but prior to the start ing contributors to distress. Regarding their immediate needs,
of adjuvant treatment, and then followed for 24 months. The women wanted support around fears of recurrence (62%);
average participant was Caucasian (90%), middle-aged (mean making healthy lifestyle choices (60%); financial matters (42%);
= 50.90, SD=10.71), married (67%), and college-educated (72%). and reducing anxiety (41%). 86% believe emotional support is
85% later received chemotherapy and 54% radiation therapy. important to overall health, while only 52% had someone from
The Berkman-Syme Social Network Index (SNI; Berkman & their medical team address their emotional needs. 37% respon-
Syme, 1979) measured number of/involvement with social net- dents did not receive a referral for support services. Of those
work ties, and the Perceived Social Support Family and Friends that did receive a referral, 30% did not follow up on any refer-
Scales (PSSFam and PSSFr; Procidano & Heller, 1983) measured rals. To reduce the cost of breast cancer, 38% of respondents
the degree to which support needs were fulfilled by patients’ delayed seeking counseling or support. 64% would be likely to
network of family and friends. The outcome, perceived stress, seek psychosocial support if it were free of charge.
was measured using the 10-item Perceived Stress Scale (PSS-10; Discussion: Women with breast cancer recognize the impor-
Cohen, Kamarck, & Mermelstein, 1983). Hierarchical regression tance of emotional support as part of survivorship care, yet
analyses determined if SNI, PSS-Fam, and PSS-Fr, assessed at few survivors access the care they need. As part of the M.A.P.
baseline or 12 months post-diagnosis, predicted PSS-10 at 12 Project, these data will inform the development of a Cancer
months and 24 months post-diagnosis, respectively. Sociode- Survivor Registry to identify behavioral trends and gaps in
mographic and treatment (e.g., chemotherapy, RCT study arm) psychosocial care across the survivorship continuum.
control variables were entered, as was perceived stress at the CORRESPONDING AUTHOR: Joanne S. Buzaglo, PhD, Cancer
prior assessment. RESULTS: Baseline SNI significantly predict- Survivorship Research & Training Institute, Cancer Support
ed PSS-10 at 12 months (β = -0.135, p = 0.051) and 24 months (β Community, Philadelphia, PA, 19131; joanne@thewellnesscom-
= -0.168, p = 0.028). 12-month PSS-Fam and PSS-Fr significantly munity.org
predicted PSS-10 at 24 months (β = -0.156, p = 0.019; β = -0.160,
p = 0.018 respectively). DISCUSSION: Patients may experience C-032x
two-year benefits from increasing their number of/involvement THE HIDDEN COSTS OF CANCER: BARRIERS TO ACCESSING
with social ties (e.g., joining social groups) shortly after diagno- FINANCIAL ASSISTANCE
sis. Furthermore, as adjustment to cancer continues and treat- Joanne S. Buzaglo, PhD, Kasey Dougherty, BA, Ellyn Micco,
ment ends, women may benefit from seeking increased support MS, Melissa Miller, PhD and Mitch Golant, PhD
from their family and friends. Research & Training Institute, Cancer Support Community,
CORRESPONDING AUTHOR: Herzelene Martin, BA, Ohio Philadelphia, PA.
State University, Columbus, OH, 43210; martin.1565@osu.edu Many questions remain about the direct and indirect costs to
families incurred during the course of cancer care. Despite
availability, many patients fail to access co-pay assistance pro-
grams. The Cancer Support Community and Genentech piloted
49
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
a national survey investigating psychosocial barriers to access- subscales. Differences among Veterans vs. private-patients were
ing co-pay assistance and the hidden costs of care. assessed with student t-test. Multivariate regression models
Methods: Cancer patients (n=78) diagnosed over 6 months ago determined significant predictors of HRQOL. Analyses were
or had active treatment within 2 years and caregivers (n=29) of performed using the SAS v9.1.3.
patients who met the above criteria, completed a survey that Results: The Veterans’ group indicated lower physical, role,
included the Revised Impact of Event Scale to assess intrusive social, cognitive and global HRQOL but, higher FOR, BSI on
and avoidant ideation around the cost of care. somatic and anxiety subscales, and IITF on intimacy and instru-
Results: Respondents (N=107) were ethnically diverse; 25% mental life subscales compared to private-patients (p<0.05). Af-
patients and 18% caregivers had household incomes less than ter adjusting for number of comorbidities, gender and the two
$20K. Patients reported high levels of intrusion (18.5 ± 9.2) and groups, IITF was significant predictor of global HRQOL and
avoidance (20.2 ± 8.8). Caregiver levels were also high for intru- BSI (p<0.05). FOR was significant predictor of global HRQOL;
sion (15.0 ± 10.0) and avoidance (17.8 ± 10.1). Based on clinical but once IITF was introduced, FOR no longer predicted global
cut-offs, 82% reported stress within moderate to severe levels. HRQOL (p=0.0839).
Due to care costs, 74% patients depleted savings, 44% down- Conclusions: The Veterans’ group indicated lower HRQOL but
sized living accommodations; 32% caregivers worked extra higher level of FOR and PD than private-patients. IITF being
jobs to help pay for care, 60% reported extra stress at work. significant predictor of global HRQOL and PD, managing dis-
To reduce costs, 49% patients delayed seeking psychological ease related disruptions may help improve HRQOL.
counseling. Among patients, increased intrusion correlated CORRESPONDING AUTHOR: Shubhada Sansgiry, PhD, Bay-
with having no one to help with insurance questions (p<.0001). lor College of Medicine1; Health Services Research & Devel-
Increased avoidance was associated with delay in seeking psy- opment Center of Excellence, Michael E. DeBakey VA Medi-
chological counseling (p<.0001) and less awareness of co-pay cal Center, Houston, Texas, Houston, TX, 77030; shubhada.
assistance (p<.0001). 33% patients and 40% caregivers felt too sansgiry@va.gov
overwhelmed to apply for financial help.
Discussion: These data suggest that managing cancer costs is C-032z
associated with clinically significant stress levels. Those with IMPROVEMENTS IN SLEEP QUALITY AND FUNCTIONAL
greatest need may not seek help, underscoring the need for OUTCOMES AFTER A COGNITIVE-BEHAVIORAL STRESS
programs that help families manage the stress related to the MANAGEMENT INTERVENTION FOR WOMEN UNDERGOING
cost of care. TREATMENT FOR BREAST CANCER
Sara Vargas, BA,1 Michael H. Antoni, PhD,1 William K.
CORRESPONDING AUTHOR: Joanne S. Buzaglo, PhD, Cancer Wohlgemuth, PhD,2 Suzanne C. Lechner, PhD,3 Jamie Stagl,
Survivorship Research & Training Institute, Cancer Support BA,1 Janny M. Rodriguez, MS Ed1 and Charles S. Carver, PhD1
Community, Philadelphia, PA, 19131; joanne@thewellnesscom- 1
Psychology, University of Miami, Coral Gables, FL;
munity.org 2
Neurology, University of Miami School of Medicine, Miami, FL
C-032y and 3Psychiatry and Behavioral Sciences, University of Miami
HEALTH-RELATED QUALITY OF LIFE AND PSYCHOLOGICAL School of Medicine, Miami, FL.
FACTORS IN NON-MUSCLE INVASIVE BLADDER CANCER Previous work has related differences in sleep quality to
PATIENTS psychosocial functioning in women in the weeks after surgery
Shubhada Sansgiry, PhD,1,2 Seth P. Lerner, MD,1 Gilad E. Amiel, for non-metastatic breast cancer (BCa). We tested whether a 10-
MD,1 Minghua Mei, PhD1,2 and David M. Latini, PhD1,2 week cognitive behavioral stress management (CBSM) interven-
1
Baylor College of Medicine, Houston, TX and 2Health Services tion improved sleep quality in association with better psycho-
Research & Development Center of Excellence, Michael E. social functioning in a cohort of 240 women under treatment
DeBakey VA Medical Center, Houston, TX. for BCa. Latent growth modeling was used to assess differences
Introduction and Objectives: Nonmuscle-invasive bladder between women assigned to the 10-week CBSM intervention
cancer (NMIBC) survivors, developing treatment-related side- versus a one-day psychoeducation (PE) control at baseline and
effects will experience symptoms for years due to high cancer- for changes across three time points (baseline, 6 months, and 12
specific survival rates. Fear of recurrence (FOR), illness intru- months). Results indicate that CBSM improved sleep quality for
siveness (IITF) and psychological distress (PD) may all have up to 12 months compared to PE. In addition, those in CBSM
adverse ramification for health related quality of life (HRQOL). reported increased functional quality of life, increased positive
This study assesses the variation in psychological factors and its states of mind, and less disruption of recreations and pastimes.
impact on NMIBC survivors’ HRQOL, as the first step toward Specifically, the models fit the data well with time points set
developing a patient-education intervention. at 0, 6, and 12 months or allowing the third time point to be
estimated. In each of the models, condition did not predict dif-
Methods: Participants were drawn from a large private hospi- ferences between groups at baseline on any measures, but was
tal (N=38) and Veterans Affairs hospital (N=29). HRQOL was associated with differential change over time in these measures.
measured with the EORTC-QLQ-C30. FOR was measured with Condition did predict differential change for disruption of
5-item measure used in the Cancer of the Prostate Strategic social interactions, though the relationship only approached
Research Endeavor study. The IITF measure consists of three significance. In conclusion, CBSM was associated with improve-
subscales; intimacy, relationship-personal-development and ments in sleep quality and various measures of psychosocial
instrumental life. PD was measured with the Brief Symptom In- functioning in women undergoing treatment for breast cancer.
dex (BSI), which included depression, anxiety, and somatization
50
Full results will include model fit indices and parameter esti- environmental and policy level correlates of indoor tanning
mates, as well as an analysis of whether changes in sleep quality by adolescents (N=6125) in the 100 most populous US cities;
mediate changes in functional outcomes. it also provided a “report card” of existing laws for protecting
This work was funded by NCI grant number R01CA64710 youth. The goal of the NCI-funded dissemination phase was
to work with a media specialist, partner with relevant health
CORRESPONDING AUTHOR: Sara Vargas, BA, Psychology, organizations, and strategically share data with stakeholders,
University of Miami, Coral Gables, FL, 33146; svargas2@psy. who would be positioned to lobby for more effective legisla-
miami.edu tion. Using public attention and health advocacy models, we
C-32aa sought to increase public awareness via the news media and
PATIENT HOLIDAYS: AN ISSUE OF NON-ADHERENCE? a project website (www.indoortanningreportcard.com), with
Jill M. Gjerde, MA media attention timed around the publication of 2 papers. Even
Psychology, Washington State University, Pullman, WA. during data collection, we were cognizant of what may pique
public attention. For example, in addition to collecting data on
While the volume of research on psychosocial factors of adher- number of tanning salons in each city, we also reported data on
ence has grown in recent decades, patient-initiated treatment the relatively lower numbers of Starbucks and McDonald’s; this
breaks from cancer therapies remains relatively understudied as subsequently led to heavy media attention primarily via local
a form of nonadherence. Change in, or delay of, therapy often media outlets around the US. Our “undercover” compliance
stems from difficulties in tolerating the adverse side effects of survey of youth-related access practices of 3,647 tanning salons
toxic treatments (e.g., radiation therapy, chemotherapy, immu- was featured on Good Morning America, in Time magazine,
notherapy, surgery). Breaks from treatment are associated with and in dozens of other national news reports. Our data showing
prolonged treatment, poorer local control, and poorer survival. no association between parental consent laws and teen indoor
Moreover, if a patient is unable to continue treatment as direct- tanning use were used in expert testimony by the American
ed due to acute toxicity, the benefits of concurrent therapy may Cancer Society to lobby for a new law in Howard County, MD
be lost. When treatment breaks prolong treatment duration by that bans minors from use, and we have provided assistance
10 days, there is an average 10-20% decrease in 5-year relapse- to several states who wish to replicate our compliance survey
free survival rates. Risk of relapse increases when the cumula- for evidence that stronger laws are needed. In this presenta-
tive number of dose delays exceeds 30 days. Non-adherence to tion, we will share detailed data from 2009/2010 on the number
chronic illness regimens has been significantly linked through and types of media stories generated, and the processes of how
meta-analyses with lack of social support, depression, family our data were used by health organizations to promote policy
conflict, poor health professional-patient communication and changes. Moreover, we will recommend strategies for design-
low income. The ability to tolerate treatment or manage side ef- ing both research and dissemination activities that will be more
fects can affect ability to adhere to a medical regimen (McNeill, likely to engage gatekeepers and impact policy.
Reynolds, & Ney, 2007) and therefore it is important to deter-
mine who will tolerate such adverse effects in order to optimize CORRESPONDING AUTHOR: Joni Mayer, PhD, Grad School
the efficacy of treatment. Despite the evidence against treatment of Public Health, San Diego State University, San Diego, CA,
holidays there is potential benefit from planned breaks from ra- 92182-4162; jmayer@mail.sdsu.edu
diotherapy. We developed a conceptual model of factors related C-038a
to adherence that may be most relevant in predicting patient- INFLUENCE OF DISTRESS AND OBESITY ON ADHERENCE
initiated treatment holidays in cancer therapy. As adherence to TO HEALTH CARE PROVIDER HYPERTENSION TREATMENT
cancer therapy is often compromised by impairing side effects RECOMMENDATIONS: BRFSS 2007 FINDINGS
such as acute toxicity, it is warranted that we explore how to Eric R. Hanson, MA, Narineh Hartoonian, MS, Sarah Ormseth,
identify patients pre-treatment in order to reduce breaks that BS and Karen T. Lesniak, PhD
are associated with poorer local control, poorer survival, and Psychology, Loma Linda University, Loma Linda, CA.
prolonged treatment. Further, the benefit of treatment success
should be considered alongside the benefit of improved quality PURPOSE: Recommendations by health care providers (HCP)
of life during breaks. may influence patients to adopt certain health behavior chang-
es. This study examines the effects of patient characteristics
CORRESPONDING AUTHOR: Jill M. Gjerde, MA, Psychology, (distress and obesity) on adherence to HCP behavioral recom-
Washington State University, Pullman, WA, 99163; jill_gjerde@ mendations for hypertension treatment (i.e. eating habits; salt
wsu.edu and alcohol use; exercise; medication adherence). METHODS:
C-032ab Population-based data were used (2007 Behavioral Risk Fac-
USING RESEARCH DATA TO IMPACT CONSUMER tor Surveillance System [BRFSS]); 32829 hypertensive persons
PROTECTION LEGISLATION: LESSONS LEARNED FROM were eligible for the study. SAS 9.2 was used for analyses;
CITY100 DISSEMINATION EFFORTS CDC sample weights were used to adjust for sampling design
Joni Mayer, PhD, Katherine Hoerster, MPH, Dalila Butler, MPH and non-response; Taylor Series Method in SUDAAN calcu-
and Nicole Pizzi, MPH lated variance estimates to account for the stratified multistage
Grad School of Public Health, San Diego State University, San sampling design. Predictor variables were distress (Kessler-6)
Diego, CA. and BMI used to define four groups: Non-distressed/non-obese
(NDNO), Distressed/non-obese (DNO), Non-distressed/obese
Indoor tanning is a risk factor for melanoma and is used (NDO), Distressed/obese (DO). Outcomes were participant
frequently by adolescent girls. CITY100 evaluated built- adherence to HCP recommendations outlined above. Covariates
51
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
male blood donors were randomly assigned to engage in either (mean = -1.59) compared to HE (+1.36; p = 0.049) over 9 months.
applied muscle tensing or a placebo manipulation that involved Results of these trials indicate that mind-body interventions
repeated, gentle flexing of the feet at five second intervals such as Transcendental Meditation may be effective in reduc-
during their blood donation. Donors in the sample were, on ing depressive symptoms in older minority subjects at risk for
average, 37 years of age (SD = 16, range = 18-61), and had previ- CVD. Possible mechanisms are discussed.
ously donated blood an average of seven times (SD = 8, range CORRESPONDING AUTHOR: Sanford Nidich, EdD, Mahari-
= 0-30). The two groups did not differ significantly on these or shi University of Management Research Institute, Fairfield, IA,
other demographic variables. Results of correlation analyses 52556; snidich@mum.edu
revealed that state anxiety and number of prior donations were
positively associated with cerebral oxygenation levels during C-046a
the blood draw (r = 0.48, p < 0.05; r = 0.58, p < 0.01, respective- PARENT-ADOLESCENT NEGOTIATION OF DIABETES-
ly).After controlling for number of previous donations, partici- RELATED CONFLICTS
pants who engaged in applied muscle tensing were shown to Dianne K. Palladino, BS and Vicki S. Helgeson, PhD
have smaller decreases in cerebral oxygenation during blood Department of Psychology, Carnegie Mellon University,
draw relative to the placebo manipulation, F(1, 15) = 5.326, p = Pittsburgh, PA.
0.036, η2 = 0.26. These findings suggest that the beneficial effects To explore how parents and adolescents negotiate conflict
of reduced pre-syncopal symptoms following applied muscle around diabetes-related tasks, and to study what aspects of
tensing may be the result of an increase in oxygen available to caregiving are related to conflict resolution, we videotaped 30
the brain. adolescents with type 1 diabetes (mean age 18) and their par-
CORRESPONDING AUTHOR: Jennifer M. Kowalsky, BA, BS, ents discussing a diabetes-related conflict. The most common
Psychology, Ohio University, Athens, OH, 45701; jk167608@ sources of diabetes-related conflict were testing and logging
ohio.edu blood glucose results. Two independent raters coded videos of
adolescent and parent behavior using a well-established scor-
C-038h ing scheme. Parent hostility was the most robust predictor of
CHANGE IN SYMPTOMS OF DEPRESSION IN MINORITY adolescent outcomes, including less conflict resolution (r = -.47,
SUBJECTS AT RISK FOR CVD : RANDOMIZED CONTROLLED p < .01), conflict persistence (r = .59, p = .001), more negative
MIND-BODY INTERVENTION TRIALS impressions of the discussion (r=-.80, p < .001), and increases
Sanford Nidich, EdD,1 Mark Toomey, PhD,1 Hector Myers, in negative affect following the discussion (β=.27, p < .05).
PhD,3 Maxwell Rainforth, PhD,1 Andrew Grandinetti, PhD,2 By contrast, parent supportive behavior was associated with
John Salerno, PhD,1 Carolyn Gaylord-King, PhD1 and Robert greater conflict resolution (r=.42, p = < .05) and perceiving one
Schneider, MD1 was treated well during the discussion (r = .24, p = .06). When
1
Maharishi University of Management Research Institute, parents granted autonomy to adolescents during the discussion,
Fairfield, IA; 2University of Hawaii, Honolulu, HI and 3Charles adolescents perceived greater progress toward conflict resolu-
Drew University Medicine and Science, Los Angeles, CA. tion (r = .46, p = .01). When examining the adolescent’s behav-
Depression is an important risk factor for the development ior, adolescent hostility again was the most robust predictor of
and progression of cardiovascular disease (CVD). For example, adolescent outcomes, including less conflict resolution (r = -.44,
research has found that a dose-response effect exists whereby p < .05) and more negative emotions (r = -.62, p < .001). Interest-
the level of depressive symptoms is linearly associated with ingly, adolescent assertions of autonomy were correlated with
development of cardiac events. This presentation reports on more negative impressions of the discussion (r = -.50, p < .01),
the recent analysis of change in depressive symptoms from two believing that the conversation hindered progress (r = .41, p <
National Institute of Health-sponsored randomized controlled .05), and conflict persistence (r = .38, p < .05). We contacted ado-
mind-body intervention trials with older minority subjects at lescents six months later to examine conflict status and changes
risk for CVD. Both studies selected minority groups, African in behavior. Parent instrumental support during the discussion
American and Native Hawaiian, respectively, who have higher was related to follow-up reports of greater conflict resolution
risk for CVD than the majority population. Both studies com- (r= .46, p<.05) and positive changes in diabetes self care (r=.39,
pared the effects of Transcendental Meditation (TM) to health p =.06). Parent granting of autonomy was related to the per-
education (HE), controlling for time and attention, using the ception that the discussion was helpful (r= .47, p < .05). These
Center for Epidemiological Studies Depression (CESD) scale. results can be used to design interventions that help adolescents
All subjects had at least one major risk factor for CVD and were work with parents to negotiate better self care.
55 years or older. The first study conducted in South Central CORRESPONDING AUTHOR: Dianne K. Palladino, BS, School
Los Angeles had 80 African American subjects (39 in the TM of Psychology, Carnegie Mellon University, Pittsburgh, PA,
group and 41 in HE) who completed CESD testing (overall 15217; dkpalladino@cmu.edu
baseline mean CESD = 14.8). Using repeated-measures AN-
COVA, covarying for baseline scores, the TM group showed a
significant reduction in depressive symptoms compared to HE
over 12 months (-6.26 vs. -3.29; p = 0.03). The second study con-
ducted with Native Hawaiian men and women had 53 subjects
(26 in the TM group and 27 in HE) who completed CESD test-
ing (overall baseline mean CESD = 11.3). Analysis indicated a
significant reduction in depressive symptoms for the TM group
54
C-046b Diabetes Questionnaire (PDQ), a tool based on Social Learning
EVALUATION OF A PEER-LED DIABETES EDUCATION Theory, that assesses self-management behaviors and barriers
PROGRAM FOR DIVERSE LATINOS for planning behavioral interventions. Sample 1 was 589 adults
Levi Ross, PhD,1 Lina Jandorf, MA,2 Deborah O. Erwin, PhD,1 from a hospital-based diabetes clinic, serving primarily private-
Linda D. Thélémaque, MA2 and Rachel Shelton, PhD2 ly insured(94% White American, 6% African American/Hispan-
1
Office of Cancer Health Disparities Research, Roswell Park ic,47% male, M age=55 years, M HbA1-c=8.14). Sample 2 was
Cancer Institute, Buffalo, NY and 2Mount Sinai School of 255 adults from University and Health Department programs
Medicine, New York, NY. serving predominantly low income,uninsured or with Medicaid
Latinos are a high priority population for diabetes research in managed care(55% White American, 44% African American,
the United States (US). The current study assessed the reach and 40% male, M age=58 years, HBA1-c values not available). The
effectiveness of a peer-led, group diabetes education program PDQ exhibited good internal consistencies for both samples,
among a diverse sample of Latinos in Arkansas (AR), New for subscales reflecting Diet Knowledge and Skill (DKS), Diet
York, NY (NYC), and Buffalo, NY (BUF). The educational pro- Decision Making,Problematic Eating Patterns and Barriers to
gram was developed with a focus on screening for and prevent- Diet(BD), Exercise (BEx),BG Testing (BTest),Medication Use
ing type II diabetes among healthy Latinos. At each program, (BMed; Chronbach α range=.737-.865). Both samples yielded
bilingual program staff and peer volunteers provided partici- adequate reliability for a Perceived Blood Glucose Control
pants with information on (1) causation and risk factors, (2) pre- subscale(PBGC; αs=.522 & .563). PDQ Scores were comparable
vention, (3) screening, and (4) disease consequences. A pre-and in the samples; Sample 2 had more Testing(p=.013) and Medica-
posttest was administered to collect demographic information, tion Use (p=.012)Barriers and lower DKS (p<.001). Predictive
testing history, and diabetes knowledge. To overcome literacy validity was examined via PDQ associations with BMI in both
related barriers, all questions were read aloud to participants Samples and with HBA1-c in Sample 1. Separate regressions
and responses were collected, anonymously, using electronic controlled for age and sex, then added PDQ subscales. Signifi-
key pads. Between August 2007 - November 2009, 72 education- cant changes in R2 in associations with BMI were observed in
al programs were delivered to 952 participants. The majority both samples for BEx(p=.011), BMeds (p=.022)and the full set of
of programs (89%) were conducted in Spanish. The program PDQ scales (p=.002). Significant changes in R2 in associations
reached a diverse population of Latinos as illustrated by coun- with HbA1-c were observed for PBGC (p=.004)and the full set
try of birth—Mexico (32%), Puerto Rico (25%), other Hispanic of PDQ scales (p=.002). Data support the use of the PDQ across
countries (30%), and the US (12%). Bivariate analyses (Chi- diverse patient and diabetes care settings.
square, t-tests, and analysis of variance [ANOVA]) revealed that CORRESPONDING AUTHOR: Barbara Stetson, PhD, Uni-
individual sites were reaching different subgroups according to versity of Louisville, Louisville, KY, 40292; barbara.stetson@
participant’s gender (p < .01), age (p < .01), country of birth (p louisville.edu
< .01), number of years resided in the US (p < .01), and spoken
language preference (p < .01). Results from repeated measures C-050a
analysis of covariance, with demographic and programmatic SIMULATION STUDY OF MODIFICATIONS FOR IMPROVING
variables as covariates, indicated that the posttest knowledge THE ACCURACY OF THE MANTEL-HAENSZEL (MH) AND
score for the entire sample (77.71) was significantly higher than OTHER OBSERVED SCORE STATISTICAL PROCEDURES FOR
the pretest score (53.25) (p < .05). These findings show that there ASSESSING ETHNIC ITEM BIAS IN BEHAVIORAL MEDICINE
is geographic and ethnic diversity among Hispanics regarding Patrick Monahan, PhD
knowledge of diabetes and diabetes prevention. Opportunities Division of Biostatistics, Indiana University, Indianapolis, IN.
and challenges related to further cultural enhancements to this An important aspect of scale validity in behavioral medicine
effective educational program will be discussed. involves assessing item bias in ethnic groups using statistical
CORRESPONDING AUTHOR: Levi Ross, PhD, Office of Can- Differential Item Functioning (DIF) procedures. The problem
cer Health Disparities, Roswell Park Cancer Institute, Buffalo, is: when the DIF matching score is either less than perfectly
NY, New York; levi.ross@roswellpark.org reliable or not a sufficient statistic for determining latent
proficiency in data conforming to item response theory (IRT)
C-046c models, substantial Type I error (TIE) inflation may occur for
RELIABILITY AND VALIDITY OF A THEORETICALLY-BASED any DIF procedure (e.g., the popular MH method) that matches
DIABETES SELF-MANAGEMENT ASSESSMENT TOOL on summed-item score. Alternative matching scores were
Barbara Stetson, PhD,1 David Schlundt, PhD,2 Chelsea developed based on sufficient statistics, reliability, and explicit
Rothschild, MA,1 Whitney Rogers, BA,1 Floyd Jennifer, BA,1 corrections for measurement error. Simulation factors were
Sathya Krishnasamy, MD1 and Sri Prakash Mokshagundam, tests (20, 24, 26 items), reference/focal sample sizes (1000/1000,
MD1 800/200), proficiency distributions (identical, means differed,
1
University of Louisville, Louisville, KY and 2Vanderbilt variances differed, means and variances differed), and simula-
University, Nashville, TN. tion technique (three-parameter logistic IRT model, and four-
There are few validated comprehensive measures of diabetes parameter beta compound-binomial model with nonparametric
self-management to guide theoretically-based interventions to non-monotonic item-true score step functions). Outcomes were:
promote behavior change. Also lacking are studies of diabetes TIE of MH chi-square test at the .05 nominal level, and the bias,
self-management in diverse patient samples and settings. Us- standard error (SE) and root mean square error (RMSE) of the
ing 2 diverse samples of adults with type 2 diabetes (N=844), MH delta-DIF (MH-D-DIF) statistic under null-DIF conditions.
this study examined the reliability and validity of the Personal Of eight categorized alternative matching scores, four scores
55
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
56
C-050e changes in viral load from baseline to 72 weeks. In the entire
ALIGNING THEORY WITH PRACTICE: UNDERSTANDING sample, compared to baseline, viral load increased among those
PARENTAL INVOLVEMENT IN AN INNER-CITY HIGH who received 0 to 2.75 total hours of counseling, decreased to
SCHOOL baseline levels for those with 2.75 total hours to 5 total hours
Terrinieka Williams, PhD,1 Bernadette Sanchez, PhD2 and of counseling, and decreased below baseline levels for those
Jessica Hunnell, BA3 with 5.5 hours of counseling. From 5.5 to 10 hours of counsel-
1
School of Public Health, University of Michigan, Ann Arbor, ing viral load continued to decrease with each additional hour
MI; 2Psychology, DePaul University, Chicago, IL and 3Center of counseling. These results suggest a dynamic dose-response
for Community Research, DePaul University, Chicago, IL. relationship between amount of adherence counseling and viral
Ideally, theoretical constructs and real world practice should be load response, with longer interventions associated with better
closely related. This study was interested in the ways in which viral load outcomes.
ecological principles (i.e., cycling of resources, adaptation, CORRESPONDING AUTHOR: Nina Cooperman, PsyD, UMD-
interdependence, and succession) were reflected in parental NJ-Robert Wood Johnson Medical School, New Brunswick, NJ,
involvement. Parents (n = 15) and school personnel (n = 10) 08901; cooperna@umdnj.edu
at a predominantly African American inner city high school
completed in-depth interviews regarding their conceptualiza- C-060b
tions of parental involvement, home-school interactions and COMPARING HIV PREVALENCE, KNOWLEDGE, AND RISK
strengths and weaknesses of home-school communication. Four BEHAVIOR BETWEEN FEMALE SEX WORKERS AND AT-RISK
major themes emerged to highlight the connection between the NON-SEX WORKERS IN MUMBAI, INDIA
theoretical principles of ecology and the practice of parental Nina Cooperman, PsyD,1 Jayanthi Shastri, MD,2 Aditi Shastri,
involvement: effective communication, initiation of contact, MD3 and Ellie E. Schoenbaum, MD4
serve and protect, and contextual conditions. Although theory
1
UMDNJ-Robert Wood Johnson Medical School, New
and practice overlap, study findings suggest ways in which the Brunswick, NJ; 2Nair Hospital & Topiwala National Medical
ecological principals might expand to better align with the prac- College, Mumbai, India; 3Baylor College of Medicine, Houston,
tice of parental involvement in inner city high schools. Future TX and 4Albert Einstein College of Medicine, Bronx, NY.
directions for theory and practice are discussed. In Mumbai, India, 42.4% of sex workers are estimated to be
CORRESPONDING AUTHOR: Terrinieka Williams, PhD, HIV-infected, and the rate of infection among monogamous
School of Public Health, University of Michigan, Ann Arbor, married women is increasing. However, research investigating
MI, 48105; terriwil@umich.edu HIV prevalence, knowledge, and risk behavior among women
in India is in its infancy. Therefore, we investigated HIV preva-
C-060a lence, knowledge, and risk behavior among 300 disadvantaged
DOSE-EFFECT OF A COUNSELING INTERVENTION TO women seeking treatment at a women’s sexually transmitted
IMPROVE ANTIRETROVIRAL ADHERENCE AMONG HIV- disease clinic in Mumbai, India, and compared HIV prevalence,
INFECTED DRUG USERS ON METHADONE MAINTENANCE knowledge, and risk behavior between sex-workers and at-risk
TREATMENT non-sex-workers. Study participants completed a questionnaire
Nina Cooperman, PsyD,1 Moonseong Heo, PhD,2 Berg Karina, with an interviewer and were tested for HIV. On average, the
MD2 and Julia H. Arnsten, MD2 women were 30 years old; over 90% of the women lived on
1
UMDNJ-Robert Wood Johnson Medical School, New <5000 Rs (approximately $100) a month; and, 42% of both the
Brunswick, NJ and 2Albert Einstein College of Medicine, Brons, sex workers and non-sex workers were married. Thirty-nine
NY. percent were found to be HIV-infected, with no significant
Adherence counseling interventions can improve antiretro- difference in prevalence between the sex workers and non-sex
viral adherence and related health outcomes in HIV-infected workers (40% vs. 36%). Although the HIV prevalence rates were
individuals. However, little is known about how much adher- similar, the sex workers had a greater number of sex partners in
ence counseling is necessary to achieve clinically significant the past year than the non-sex workers (median=722.0 vs. 1.0).
effects. Therefore, we investigated changes in 7-day antiret- A smaller proportion of the sex workers used condoms with
roviral adherence and HIV viral load relative to the amount all of their sexual partners than the non-sex workers (62% vs.
of a voluntary adherence counseling intervention offered to a 74%). Eighty-three percent of the women ever heard of HIV and
sample of 57 HIV-infected, methadone maintained drug users received education about HIV, with no significant differences
over a 72 week period. The intervention combined motivational between the sex workers and non-sex workers. However, a
interviewing and cognitive-behavioral techniques, and was significantly greater percentage of the sex workers (98.3%) ever
designed to be approximately six 45-60 minute individual coun- heard of a condom as compared the non-sex workers (89.7%).
seling sessions with unlimited additional “booster” sessions, The similarly high HIV prevalence among the sex workers and
as needed. All participants were offered adherence counseling, non-sex workers indicate the need for HIV testing for all at-risk
and 34 (60%) participated in at least one session. The entire women, including sex workers and monogamous, non-sex
sample, on average, received 1.35 hours of counseling (SD=1.67, workers, in India. Further, Indian women, sex workers and
range=0.00-7.05). Participants who attended adherence coun- non-sex workers, need more education about HIV and tailored
seling sessions received a mean of 2.26 hours of counseling interventions to increase condom use.
(SD=1.62, range=.50-7.05). Mixed effects models of within sub- CORRESPONDING AUTHOR: Nina Cooperman, PsyD, UMD-
ject longitudinal outcomes revealed a significant quadratic rela- NJ-Robert Wood Johnson Medical School, New Brunswick, NJ,
tionship between number of hours of adherence counseling and 08901; cooperna@umdnj.edu
57
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-060c areas. The current study will determine whether the CIQOL
TRAUMA HISTORY AND HIV RISK BEHAVIOR model will apply to an older male urban sample living with
Sheela Raja, PhD,1 Christine Holland, MA,1 Kristi Allgood, HIV/AIDS. Participants were 160 HIV infected men (n= 84
MPH,2 David McKirnan, PhD1 and Nancy Glick, PhD2 Caucasian, n= 76 African American) recruited from New York
1
University of Illinois at Chicago, Chicago, IL and 2Mount Sinai City, Columbus, OH and Cincinnati, OH. The average partici-
Hospital, Chicago, IL. pant was 55.0 years of age (min=50, max = 73), received a high
Background: As HIV continues to disproportionately af- school diploma (77%), and unemployed (90%). Surveys were
fect African American communities, there is a growing need completed on shame, PWB, BACS, SS, ENG, and GWB dur-
to understand the predictors of sexual risk behavior in this ing the pre-intervention assessment period of an AIDS mental
population. This cross-sectional study of HIV+ clients in a large, health randomized clinical trial.
urban hospital setting explored the role of a history of traumatic Structural equation modeling assessed model fit between the
events on sexual risk behavior. Methods/Participants: As part data and the CIQOL model. Fit indices indicated that the CI-
of a Health Resources and Services Administration initiative, QOL model was a poor fit for the urban sample, X2(6, N=160)
HIV+ participants (n=174) enrolled in an intervention aimed = 68.6 p <.0001, CFI =.75, NFI= .75, RMSEA = .26. However,
at reducing high risk behavior. Using Audio Computer As- excellent fit was found with a new model constructed without
sisted Self-Interview software, participants completed baseline the path between BACS and GWB X2(2, N=160) = 1.405 p >.495,
measures of sexual risk behavior, trauma history, and other CFI =1.00, NFI= .99, RMSEA = .00.
psychosocial variables (e.g., depression, stigma). Participants CORRESPONDING AUTHOR: Valessa St. Pierre, BS /BA, Psy-
were mostly African American (87%) and had high rates of chology, Ohio University, Athens, OH, 45701; valessastpierre@
current depression (52%). Many (57%) reported they had been gmail.com
a victim of violence in their lifetime (domestic violence, sexual
assault, and street violence). Results: Unprotected vaginal or C-060e
anal sex (UPAV) in the last 6 months was prevalent in this TRAUMA TOPICS DIFFER BETWEEN HIV+ MEN AND WOMEN
sample (26.6% for both men and women). After controlling IN AN EXPRESSIVE WRITING INTERVENTION
for demographics, the psychosocial variables (e.g., HIV treat- Rachel Kuhn, MS, Gail Ironson, MD, PhD, Jonathan Atwood,
ment optimism, religiosity, stigma, social support, alcohol and BA and Neil Schneiderman, PhD
drug use) did not predict UPAV. In a series of stepwise logistic University of Miami, Miami, FL.
regression equations, we found that a history of domestic and Expressive writing (EW) has increasingly been examined as a
street violence was predictive of sexual risk behavior for men treatment for trauma-related symptoms in general and health
and women in our sample; street violence was overwhelming populations. HIV+ individuals have shown improvements in
associated with risk for women. Neither depression nor anxiety health outcomes following EW, but no studies to date have
retained the ability to predict UPAV after controlling for the examined the impact on PTSD symptoms in this population.
effect of violence. Discussion: This study suggests that future EW may be particularly beneficial for HIV+ individuals, as high
prevention efforts must examine the role of violence in sexual rates of lifetime trauma have been found in this population.
risk, particularly street violence. Because anxiety and depres- The present study compared HIV+ men (n = 67) and women
sion did not moderate the relationship between violence and (n = 50) on the severity and topic of traumatic life events that
UPAV in this study, future studies may want to measure “cog- they chose to write about during an EW session. Participants
nitive escape” variables, such as distancing from negative affect were asked to write expressively about their most traumatic
as possible moderators between trauma history and sexual risk. life experiences for 30 minutes. Severity was rated on a 7-point
CORRESPONDING AUTHOR: Sheela Raja, PhD, University of Likert scale (7 = highest severity), and trauma topic was divided
Illinois at Chicago, Chicago, IL, 60612; sheelaraja@gmail.com into 5 categories: death of a loved one, childhood trauma, adult-
hood physical/sexual trauma, HIV-related trauma, and “other”
C-060d (e.g. social or financial stressors, trauma to a loved one). Results
THE APPLICABILITY OF THE CIQOL MODEL TO OLDER HIV- show that men and women were not significantly different on
POSITIVE MEN LIVING IN URBAN AREAS the severity of traumas (t(115) = .320, p = .750; men M = 4.55
Valessa St. Pierre, BS /BA, Bernadette Heckman, PhD, Timothy (SD = 1.41); women M = 4.64 (SD = 1.56), but were significantly
Heckman, PhD and Francis Bellezza, PhD different on trauma topic (χ2(4) = 11.01, p = .027). A significant-
Psychology, Ohio University, Athens, OH. ly higher frequency of men wrote about HIV-related trauma
Advances in medicine have allowed those infected with HIV/ compared to women (p = .021), with 29.9% of the men writing
AIDS to live 30 years past their diagnosis. HIV/AIDS is now about this topic versus only 12.0% of the women. A significantly
perceived as a chronic illness with greater focus placed on higher frequency of women wrote about childhood trauma
enhancing general well-being (GWB). The Chronic Illness Qual- compared to men (p = .005), with 24.0% of women writing
ity of Life (CIQOL) model posits shame, physical well-being about this topic versus 6.0% of men. The two groups were not
(PWB), barriers to care (BACS), engagement coping (ENG), and significantly different in the frequency of trauma topics writ-
social support (SS) impact one’s overall well-being (Heckman, ten about for death (men = 19.4%, women = 18.0%), adulthood
2003).While excellent fit was demonstrated from the CIQOL trauma (men = 10.4%, women = 12.0%), or “other” traumas
model to a heterogeneous rural sample (Heckman, 2003), the (men = 34.3%, women = 34.0%). While HIV+ men and women
fit of the CIQOL model to an urban sample was unknown. The were similar in the severity of traumas disclosed during EW,
literature suggests BACS are a particular burden for individu- there were marked differences in type of trauma. The presence
als residing in rural locations compared to those living in urban of gender differences in type of traumatic experiences may have
58
implications for the efficacy of this brief intervention in com- C-060g
parison to full scale trauma-targeted therapy. RELATIONS AMONG ADHERENCE ASSESSMENT AND
CORRESPONDING AUTHOR: Rachel Kuhn, MS, University of BIOMARKERS IN YOUTH WITH HIV: DOES CONCURRENT
Miami, Miami, FL, 33145; rkuhn@psy.miami.edu VIRAL LOAD AND CD4 MEASUREMENT OUTPERFORM
STANDARD OF CARE COMPARISONS?
C-060f Patricia A. Garvie, PhD, Megan L. Wilkins, PhD, Ronald H.
HIV RISK AMONG DEPORTED MEXICAN MIGRANTS Dallas, MA, Sean D. Hollis, BA and Ericka L. Midgett, MA
Ana Martinez-Donate, PhD,1,2 Gudelia Rangel, PhD,3 Melbourne St. Jude Children’s Research Hospital, Memphis, TN.
F. Hovell, PhD, MPH,2 Jennifer A. Zellner, PhD,2 Carol L. Sipan, Background: No gold standard exists to assess antiretroviral
RN, MPH,2 Rodolfo Corona, MS,3 Norma J. Kelley, BS2 and medication adherence. Validation of adherence measures in-
Ahmed Asadi, MA2,3 volves comparison with HIV biomarkers (VL, CD4 count (CD4)
1
University of Wisconsin - Madison, Madison, WI; 2San Diego & CD4%) that reflect illness-related health status. Studies report
State University, San Diego, CA and 3El Colegio de la Frontera accepted comparison of biomarkers obtained within +/-90
Norte, Tijuana, Mexico. days of adherence assessment. This study aimed to evaluate the
This binational study investigated the prevalence of HIV risk value of concurrent (same day) HIV biomarker and adherence
practices among Mexican migrants and immigrants (MMIs) measurement in comparison to standard of care (SOC).
who are returned from the US to Mexico by immigration Methods: Youth with behaviorally acquired HIV participated in
authorities. From August to November 2009, a cross-sectional, a prospective cross-sectional pilot study that included concur-
probability survey was conducted with deported MMIs, imme- rent medication adherence assessment with biomarkers. Partici-
diately after their release by Mexican immigration authorities pants (n=61): Age: M=19.9 years (SD=1.98); Gender: Male (51%);
in Tijuana (N=674; response rate 96%). Respondents completed Race: African American (90%), Caucasian (5%), Latino (3%).
an anonymous questionnaire on HIV-related practices and Medication adherence assessment included pharmacy pill count
theoretical determinants, based on the Behavioral Ecological (PC), 3-day recall of doses missed (3DM) and of doses taken
Model. Deported MMIs were mostly male (93%), young (Mean off-schedule (3DO) collected concurrently with CD4, CD4% and
= 32, SD = 9.1), and low educated (15% had completed high VL. To examine contribution of more stringent concurrent data
school or higher). On average, they had spent 8.7 years in the collection over SOC, a retrospective chart review of VL, CD4
US (SD=8.7) and had been deported 2.6 times (SD = 3.0). Results and CD4% within a +/-120 day window occurred. Analyses
indicated high rates of last 12-month multiple sexual partners consisted of Pearson correlations.
(39% of males; 18% of females), unprotected vaginal or anal sex
(60% of males; 57% of females), sex with casual partners or sex Results: CD4 and CD4% measured within 120 days pre- adher-
workers (34.3% of males; 14.3% of females), and unprotected ence assessment marginally related to PC (p=.08) and 3DO
sex with casual partners or sex workers (17% of males; 8.2% of (p=.07). No other correlations among CD4 and CD4% with the 3
females). Sex with intravenous drug users (6.2% of males; 2.0% adherence strategies were significant. Dichotomized detectable
of females) and individuals who have multiple partners (18.2% VL collected concurrently (PC p=.04, 3DM p=.01, 3DO p=.03)
of males and 13.3% of females) was also prevalent. About 46% and within 120 days post- (p=.02, p=.03, p=.03, respectively)
had never been tested for HIV and only 26% had been tested adherence assessment significantly related with each adherence
during the last 12 months. Lifetime and last-12 month history strategy.
of other sexually transmitted infections was 22.6% and 8.5%, Conclusions: HIV biomarkers collected concurrently with and
respectively. Most MMIs (67%) were planning to return to the within 120 days post adherence assessment relationally outper-
US. HIV risk did not vary with amount of time spent in the US. formed biomarkers collected prior to adherence assessment.
Perceived discrimination, acculturative stress, availability of Findings negate use of biomarkers collected prior to adherence
social support, and previous history of deportation were posi- assessment as proxies for adherence or to validate adherence
tively associated with HIV risk. Binational collaborative efforts assessment tools. Implications for research and clinical practice
in Mexico and the US are necessary to reduce HIV risk and im- will be discussed.
prove health care access among this hard-to-reach, underserved CORRESPONDING AUTHOR: Megan Wilkins, PhD, St. Jude
population. Children’s Research Hospital, Memphis, TN, 38107; megan.
CORRESPONDING AUTHOR: Ana Martinez-Donate, PhD, wilkins@stjude.org
Population Health Sciences, University of Wisconsin - Madison,
Madison, WI, 53726; martinezdona@wisc.edu C-064a
SOCIODEMOGRAPHIC CHARACTERISTICS ASSOCIATED
WITH FRUIT AND VEGETABLE INTAKE
Magdalene M. Horton, Bachelors,1 Ling Shi, PhD,1 Laura L.
Hayman, PhD,1 John A. Morrison, PhD2 and Jean Wiecha, PhD1
1
College of Nursing and Health Sciences, University of
Massachusetts Boston, Boston, MA and 2Cincinnati Children’s
Hospital Medical Center, Cincinnati, OH.
Numerous studies examined individual and contextual factors
that influence dietary behaviors. Minimal population-based
data are available, however, regarding the relationship between
sociodemographic characteristics and fruit and vegetable intake.
59
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
This study included 1454 participants (26% black; 57% female) RESULTS: The majority of schools (85%) had implemented
from the population-based Lipid Research Clinics Princeton >75% of the new standards. Food service directors expressed
Follow-Up Study including 432 parents (age 66.5+/-6.6 years) strong support for the new standards, with all components
and 1022 adult children (age 39.9+/-4.9 years). Dietary intake except the local wellness policy being viewed favorably by a
was measured with the Block Quantified Food Frequency Ques- majority of respondents. 98% believed the standards would
tionnaire. Fruit and vegetable intake was defined as the number improve student nutrition and 96% believed the standards
of servings per day. A mixed-effect multivariate analysis ex- would educate students to make healthier choices. Significant
amined associations between fruit and vegetable intake and all improvements in dietary habits during the first year of imple-
covariates (age, sex, education, marital status, race and genera- mentation supported these beliefs, as students had consumed
tion), adjusted for within-family correlation. In fully-adjusted significantly more milk (p<.05) and fruits & vegetables (p<.05),
model, sex, age, and education were independently associated as well as less soda (p<.05) based on the interview data. 40%
with fruit and vegetable consumption. Females consumed 0.38 of principals reported generally or overwhelmingly negative
more fruit and vegetable servings per day than males (p=0.01). feedback about the standards from parents; 42% reported simi-
Compared to participants with some high school education, lar feedback from students. Parent and student reports were
participants with some college education consumed 0.70 more mixed, with 33% and 26% of parents and students (respectively)
servings of fruit and vegetables per day (p=0.01); participants reporting negative perceptions of the new standards. Vending
with a bachelor’s degree consumed 0.78 more servings per day revenues were not impacted for the majority of schools (68%).
(p< 0.01) and participants with a graduate degree consumed CORRESPONDING AUTHOR: Andrew S. Bradlyn, PhD,
1.67 more servings per day (p<0.01). Fruit and vegetable intake Health Research Center, West Virginia University, Morgan-
increased with increasing educational level (p for trend <0.001). town, WV, 26506-9136; abradlyn@hsc.wvu.edu
With every year increase in age, participants consumed 0.04
more servings of fruit and vegetables per day (p=0.01). Results C-064c
of this population-based study indicate females consume more COMPARING LONGITUDINAL EFFECTS OF PSYCHOSOCIAL
fruits and vegetables than males;educational level and age posi- INFLUENCES ON FRUIT AND VEGETABLE INTAKE IN TWO
tively and significantly influence daily consumption of fruit and DIFFERENT STUDIES
vegetables. No multigenerational clustering of dietary behav- Chondra M. Lockwood, PhD,1 Diane L. Elliot, MD,2 Deborah J.
iors was observed. The mechanisms through which sociodemo- Toobert, PhD,3 Lisa A. Stryker, MA3 and Carol A. DeFrancesco,
graphic characteristics influence dietary behaviors remain to be MA2
fully explicated. 1
Statistical Consulting, Portland, OR; 2Oregon Health & Science
CORRESPONDING AUTHOR: Magdalene M. Horton, Bache- University, Portland, OR and 3Oregon Research Institute,
lors, nursing, University of Massachusetts Boston, Quincy, MA, Eugene, OR.
02169; Magdalene.horton@gmail.com Mediation analysis allows the deconstruction of the process of
an intervention’s effects and can be used to compare the dif-
C-064b ferential influences of purported intermediate variables among
IMPLEMENTATION AND IMPACT OF IOM SCHOOL populations. We assessed the longitudinal mediation of changes
NUTRITION GUIDELINES: WEST VIRGINIA STANDARDS FOR in fruit & vegetable intake in two populations receiving differ-
SCHOOL NUTRITION ent interventions that shared certain common potential mediat-
Andrew S. Bradlyn, PhD,1 Carole V. Harris, PhD,1 Richard ing constructs. PHLAME (Promoting Healthy Lifestyles) was
Goff, MBA,2 Mollie Wood, MPA,2 Don Chapman, MA,4 Keri a worksite program targeting nutrition and physical activity
Kennedy, MPH,3 Kristy Blower, MA,3 Melanie Purkey, MA,4 behaviors of career firefighters, and the Mediterranean Lifestyle
Nancy O. Tompkins, PhD,5 Lucas Moore, EdD,1 Kim Blake, Program addressed similar outcomes using an initial retreat
MBA PharmD1 and Stephanie Frost, MA1 and weekly meetings among post-menopausal women with
1
Health Research Center, West Virginia University, type 2 diabetes. Although different in structure, both assessed
Morgantown, WV; 2Office of Child Nutrition, WV Department the potential impact of mood and social support to achieve an
of Education, Charleston, WV; 3Office of Healthy Lifestyles, WV increase in fruit and vegetable intake. We combined data from
Bureau for Public Health, Charleston, WV; 4Office of Healthy both sites to examine similarities in behavior change across
Schools, WV Department of Education, Charleston, WV and populations and intervention types. Complete three-year
5
Prevention Research Center, WVU, Morgantown, WV. (baseline, 2 annual follow-ups) data from 433 participants were
BACKGROUND: The West Virginia Board of Education imple- examined using depression as a mediator in logistic mediation
mented new Standards for School Nutrition (Policy 4321.1) models. The model reveals complicated changes over time.
during the 2008-2009 school year, and became the first state to The site and treatment condition both had significant effects on
adopt standards consistent with the 2007 Institute of Medicine depression (p<0.05) at time 1, interact at time 2 (p<0.05), and
recommendations. The purpose of this project was to evalu- only site continued to have a significant effect (p<0.05) at time
ate the implementation and early impact of these policies on 3. Depression early in the model continues to predict depres-
students, parents and school personnel. sion later on, and depression significantly predicts eating less
METHODS: A stratified random sample of 1500 parents of stu- than five servings of fruits and vegetables daily. These results
dents in kindergarten and grades 2, 5, 7 & 9, and 420 students in indicate the need to consider both baseline prevalence of me-
grades 5, 7 & 9 were interviewed. Food service directors (N=53; diating constructs, such as depression, as well as the impact of
96% RR), school superintendents (N=53; 95% RR), principals an intervention on the mediators. The findings also may inform
(N=601; 87% RR), and school nurses (N=231; 83% RR) com- other cross-site analyzes by highlighting the challenges faced in
pleted surveys.
60
designing interventions for varying populations and when com- C-064e
paring established studies and existing databases. PHYSIOLOGICAL AROUSAL FACILITATES GLOBAL MEMORY
CORRESPONDING AUTHOR: Chondra M. Lockwood, PhD, BIASES
Statistical Consulting, Portland, OR, 97212; cmlockwood@ Grace Giles, BA,2,1 Caroline Mahoney, PhD,2,1 Tad Brunye,
gmail.com PhD,2,1 Harris Lieberman, PhD3 and Holly Taylor, PhD1
1
Department of Psychology, Tufts University, Medford, MA;
C-064d 2
Consumer Research and Cognitive Science, US Army Soldier
INTER-INDIVIDUAL DIFFERENCES IN THE SELF- Systems Center, Natick, MA and 3U.S. Army Research Institute
REGULATION OF HEALTH (RISK) BEHAVIORS for Environmental Medicine, Natick, MA.
Kerstin E. Schroder, PhD and Cindy L. Ollis, MS Alterations in mood and emotional arousal can influence how
Psychology, Utah State University, Logan, UT. people process information. For instance, positive and nega-
Background: Self-regulation can be regarded as a multi-di- tive moods can induce global and local attentional biases,
mensional trait-like construct with systematic and theoretically respectively (Gasper & Clore, 2002). Recent work suggests these
meaningful patterns of association to different dimensions of effects may be explained by arousal modulation, with higher
behavior regulation. This hypothesis was tested using three emotional arousal leading to global biases in spatial and verbal
self-regulatory trait factors referring to action control (AC), memory (Brunye, Mahoney, Augustyn, & Taylor, 2009; Corson
impulse control (IC), and emotion control (resilience against & Verrier, 2008). The effects of physiological arousal are less
depression, EC). We hypothesized AC to be a superior predictor clear. The present work manipulated physiological arousal in
of planned behaviors that are typically a target of self-control a dose response fashion using caffeine, a commonly ingested
while IC was supposed to be a superior (negative) predictive of stimulant with known effects on the central nervous system
substance use. that result in stimulated neuronal activity, increased alertness,
Method: Online survey data were collected in a sample of 303 wakefulness, and motivation. Low consumers (n=36) completed
undergraduate college students (63% female, mean age = 20). 5 sessions, following an overnight fast, separated by 3 days. In
AC, IC, and EC were assessed with three self-rating scales (α >= each session, participants either consumed their normal caffeine
.83), two of which were developed by the first author. Depen- or were administered 1 of 4 capsules (0mg, 100mg, 200mg, and
dent variables were self-reported alcohol consumption, binge 400mg caffeine; double-blind). One hour later a map task and
eating, alcohol consumption, and weight loss among those with a spatial description task were completed. Heart rate, salivary
past weight loss attempts. Additionally, we collected three cur- cortisol, salivary caffeine, mood and subjective arousal were
rent action plans per person and assessed their completion at a also assessed. Results from the map task reveal a treatment
four-week follow-up. by distance interaction for accuracy (p=.004); memory for lo-
cal information does not change as a function of caffeine, but
Results: The three self-regulation variables were only mod- memory for global information increases with caffeine starting
erately correlated (.24 to .56), indicating non-redundancy. As at 100mg and continuing through 400mg. Analogous results are
expected, AC was the best predictor of bingeing (-.38) and past found for the spatial description task (p=.017). Further analyses
weight loss success (.28). Further, in longitudinal analyses, AC indicate these effects are not due to withdrawal. Taken to-
appeared as a superior predictor of the completion of action gether, data suggest that caffeine-induced physiological arousal
plans (.21) and satisfaction with goal achievement (.24). In produces global memory biases. Given caffeine’s prevalence in
multiple regressions, AC remained the sole predictor of all four the US and that doses chosen are commonly found in com-
outcomes (β = |.185| to |.30|), controlling for IC and EC. In mercial products, results have implications for the way people
contrast, IC was most strongly associated with alcohol con- learn and recall information and could influence performance
sumption (-.35) and remained the only significant predictor of on daily tasks such as studying, test-taking, and learning new
this outcome (β = -.38) controlling for AC and EC. environments.
Conclusions: Self-regulatory trait predictors associate distinctly CORRESPONDING AUTHOR: Caroline Mahoney, PhD, Con-
with diverse health (risk) behaviors, consistent with the theo- sumer Research and Cognitive Science, US Army Soldier Sys-
retical assumptions, and explain substantial variance in these tems Center, Natick, MA, 01760; caroline.mahoney@us.army.
outcomes. Inclusion of selected self-regulatory trait variables mil
in the prediction of health behavior and behavior change may
benefit future research. C-080a
CORRESPONDING AUTHOR: Kerstin E. Schroder, PhD, BODY SHAME AND APPEARANCE ANXIETY AS PREDICTORS
Psychology, Utah State University, Logan, UT, 84321; kerstin. OF MENTAL AND PHYSICAL HEALTH
schroder@usu.edu Elizabeth L. Ross, BA, Lisa C. Hughes, BA, Mary J. Naus, PhD
and Kristina Harper, BS
Psychology, University of Houston, Houston, TX.
Body image disturbance among women in the United States has
become a growing concern (Cash & Henry, 1995). According to
Frederickson and Roberts (1997), body dissatisfaction manifests
as body shame and appearance anxiety. Research suggests
that body shame and appearance anxiety are often linked with
poorer adjustment, particularly in non-clinical samples (e.g.,
Jakatdar, Cash, & Engle, 2006; Phillips, 2000; Donaghue, 2009;
61
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
Leahey & Crowther 2008). In the current study, 326 univer- CORRESPONDING AUTHOR: Lisa M. Nackers, MS, Clinical
sity- enrolled women aged 18-40 (M = 22) completed several & Health Psychology, University of Florida, Gainesville, FL,
self-report questionnaires pertaining to body satisfaction, and 32610-0165; lnackers@phhp.ufl.edu
a number of measures related to psychological outcome. Two
linear regression models were constructed with mental and C-080c
physical health (SF-36; Ware, Snow, Kosinski, & Gandek, 1993) THE DIFFERENTIAL EFFECTS OF PTSD SYMPTOM
as the dependent variables. Appearance anxiety (AAS; Dion, CLUSTERS ON BMI IN A VETERAN POPULATION WITH
Dion, & Keelan, 1990) and body shame (OBSC; McKinley & CHRONIC PAIN
Hyde, 1996) were entered simultaneously as the independent Elizabeth Johnson, MS,1 Kevin Alschuler, MS1 and John Otis,
variables. Results revealed that appearance anxiety was a PhD1,2
significant predictor of mental health problems, R2=0.179, F (2,
1
VA Boston Healthcare System, Boston, MA and 2Boston
313) =35.147, p < 0.001, and physical health problems, R2=0.097, University School of Medicine, Boston, MA.
F (2, 300) =17.032, p < 0.001, whereas body shame was not a Research examining the health effects of Post-traumatic stress
significant predictor of either outcome measure. These findings disorder (PTSD) has found a significant relationship between
indicate that appearance anxiety may be related to a number of PTSD and Body Mass Index (BMI) (Trief et al, 2006; Vieweg
negative psychological outcomes in non-clinical samples. Body et al, 2007). The goal of this study was to determine if par-
shame, alternatively, does not appear to be predictive of physi- ticular features of PTSD have a differential effect on BMI. The
cal or mental health concerns. cross-sectional design involved 164 primarily Caucasian male
CORRESPONDING AUTHOR: Elizabeth L. Ross, BA, Psycholo- veterans seeking psychological pain management treatment at a
gy, University of Houston, Houston, TX, 77027; liz479@aol.com VA healthcare facility. The primary outcome measure was BMI
while predictors included symptoms of PTSD (PTSD Checklist,
C-080b Military Version; Weathers et al, 1993). A multiple regression
FAMILY MATTERS: THE IMPACT OF CHILDREN IN THE approach to path analysis was used to determine the effects of
HOME ON WEIGHT CHANGE IN ADULTS UNDERGOING A these identified variables on BMI. Controlling for age and gen-
WEIGHT MANAGEMENT PROGRAM der, the analysis indicated the total PTSD symptom score was
Lisa M. Nackers, MS, Kathryn M. Ross, MS, Christy H. Thomas, a significant predictor of BMI (β=.206,p< .05). Further analyses
RD, Ninoska DeBraganza, MSESS, Rachel André, MS, Valerie revealed a significant relationship between BMI and the PTSD
J. Hoover, BS, Kristen E. Newell, MA, Vanessa A. Milsom, MS, clusters of hypervigilance (β=.232,p< .05) and re-experiencing
Kristina M. von Castel-Roberts, PhD, Melanie L. Thomas, BS, (β=.186,p< .05) but not avoidance and numbing (β=.165,p<
Katherine K. Allen, MA, Catherine J. Rogers, BS, Wendy W. .07). Pain variables (e.g., intensity, duration) were not found
Lynch, BS, Linda B. Bobroff, PhD, Anne E. Mathews, PhD and to be significantly related to BMI. These results support previ-
Michael G. Perri, PhD ous research indicating a relationship between PTSD and BMI
University of Florida, Gainesville, FL. while also indicating that specific PTSD symptom clusters
Caring for children may adversely impact a parent or are differentially predictive of health outcomes in this sample
guardians ability to perform healthy behaviors. Few studies of veterans seeking treatment for chronic pain. While it was
have compared weight change outcomes for participants with hypothesized that PTSD avoidance and hypervigilance clusters
or without children in the home who undergo a weight man- would be significant, only re-experiencing and hypervigilance
agement program for obesity. We examined weight changes were significant predictors of BMI. These results suggest that
and program adherence in a cohort of 180 obese adults recruit- hypervigilance related to PTSD may reduce overall function
ed from rural areas (71% women, mean ± SD body mass index and generalize to multiple areas of activity, whereas the effects
= 36.5 ± 3.9 kg/m2, age 53.4 ± 10.3 years), who participated in a of avoidance may be more trauma-specific. The results contrib-
weight management program with assessments at baseline and ute to our understanding of the relationship between PTSD and
six months. The majority of participants in this sample (60.8%) BMI, and demonstrate the importance of the development of
reported no children, while the remaining 39.2% of participants interventions tailored to veterans affected by PTSD and obesity
reported an average 1.5 ± .77 children living in the home. Mean in order to improve their health status.
weight change for all participants at six months was -8.8 ± 6.9 CORRESPONDING AUTHOR: Elizabeth Johnson, MS, VA Bos-
kg. Participants with children in the home experienced signifi- ton Healthcare System, Boston, MA, 02215; ejohns05@vt.edu
cantly smaller changes in body weight compared to those with-
out children (-7.2 ± 7.1% vs. -9.7 ± 6.6%, p = .019). In addition, C-080d
those with children in the home attended significantly fewer AORTIC STIFFNESS, FATNESS AND FITNESS IN
sessions than participants without children in the home (78.1 ± OVERWEIGHT SCHOOLCHILDREN
23.3% vs. 86.8 ± 12.9%, p < .001). Results suggest that family ob- Catherine L. Davis, PhD, Gary L. Pierce, PhD, Yanbin Dong,
ligations (e.g., caring for children, time conflicts with children’s MD PhD and Gaston Kapuku, MD PhD
schedules, etc.) and home food environment may lead to poorer Georgia Prevention Institute, Pediatrics, Medical College of
program adherence and smaller changes in body weight in indi- Georgia, Augusta, GA.
viduals with children who participate in weight management Child obesity has serious ramifications for cardiovascular
programs. This implies that facilitators of weight management health. Noninvasive measurement of arterial stiffness may be
programs should make accommodations, such as providing useful to quantify atherosclerotic risk in children.
multiple meeting times or flexible make-up sessions, in order to METHOD: Carotid-femoral pulse wave velocity (CF PWV),
assist participants with children in the home. a measure of arterial stiffness in the central vasculature (e.g.,
62
aorta), was measured on 44 overweight children (BMI ≥85th to-hip (WHR) >/= 0.80; EA ethnicity was associated with the
percentile, 8-11 yrs, 52% female, 93% Black). To determine latter at baseline (p < 0.01). Multivariate analyses adjusted for
PWV, pressure waveforms were recorded sequentially via parental income (PI) revealed that EA women had marginally
applanation tonometry at the C and F arteries and gated to higher WCs at both T1 and T2 (p = 0.07). BMI (p < 0.01) and PBF
simultaneous ECG using the Sphygmocor device (AtCor marginally (p = 0.06) increased over the first semester in the full
Medical). Transit distance from the suprasternal notch to the sample. When adjusted for PI and changes in BMI, IE scores
F site (SSN-F) was measured. PWV (m/sec) was calculated as marginally (p = 0.07) and CS appreciably declined (p = 0.04).
the SSN-F distance divided by the delay between the pressure Finally, changes in IE were negatively correlated with both
waveform at the C and F sites. Values were comparable to pub- changes in BMI (r = -.23) and changes in BES (r = -.32) in the
lished data in this age range. Anthropometrics and dual-energy full sample; changes in BES negatively covaried with changes
x-ray absorptiometry (DXA) data were obtained. Aerobic fitness in WC (r = -.34) and changes in IE (r = -.39) in the AA sample.
was assessed using a graded treadmill test and the Fitnessgram Preliminary results both suggest the importance of considering
PACER protocol. ethnicity in clarifying psychological correlates of body compo-
RESULTS: PWV was significantly related to measures of sition changes in the first semester of college and may reflect
adiposity and fitness. Thus, children with greater BMI, BMI more general regional disparities in obesigenic risk which may
z-score, or percent fat via DXA scan had stiffer central arteries transcend ethnicity in this particular context.
(r = .37, .36, .42, p ≤ .01); waist girth was nearly significant (r CORRESPONDING AUTHOR: Jennifer Webb, PhD, Psychol-
= .26, p = .09). Likewise, the fitter children on VO2 peak (ml/ ogy, UNC Charlotte, Charlotte, NC, 28223; jennifer.webb@uncc.
kg) or PACER had more compliant arteries (r = -.32, -.38, p < edu
.05). These relationships were not substantially affected when
systolic BP or height were partialled. There was a significant C-080f
sex difference, with girls having higher carotid-femoral PWV HEALTHWORKS: RESULTS OF A MULTI-COMPONENT
values than boys (5.6 ± 1.0 vs. 4.5 ± 0.6, t = -4.1, p<.001), inde- WORKSITE INTERVENTION TO PREVENT WEIGHT GAIN
pendent of fatness, fitness, and body size. There was no relation Jennifer A. Linde, PhD, Dan J. Graham, PhD and Robert W.
of PWV with age. Jeffery, PhD
Epidemiology and Community Health, School of Public Health,
CONCLUSION: Aortic stiffness is related to fatness and fitness University of Minnesota, Minneapolis, MN.
among overweight children. Girls appear to have stiffer arteries
than boys. Measurement of aortic stiffness may be informative Background: U.S. adults continue to be at risk for weight gain
in studies of childhood cardiovascular risk and its amelioration. over time. Worksites provide an opportunity to alter environ-
Supported by NIH HL087923 and MCG Diabetes & Obesity ments and shape behavior of employed adults.
Discovery Institute. Purpose: The purpose of the trial was to test whether a four-
CORRESPONDING AUTHOR: Catherine L. Davis, PhD, Geor- component program to alter worksite environments would
gia Prevention Institute, Pediatrics, Medical College of Georgia, have a positive impact on weight gain prevention over time.
Augusta, GA, 30912; cadavis@mcg.edu The four major components addressed food selection, weight
self-monitoring, enhancements to the health media environ-
C-080e ment, and promotion of walking / stair use.
ETHNICITY AND FIRST-SEMESTER CHANGES IN Methods: Six worksites in a U.S. metropolitan area were recruit-
OBESIGENIC RISK FACTORS IN COLLEGE WOMEN ed and randomized in pairs to either two-year intervention or
Jennifer Webb, PhD no-contact control. Evaluations included 1) height and weight
Psychology, UNC Charlotte, Charlotte, NC. measurement; 2) online surveys of eating behavior, physical
Contemporary public health scientists have targeted the col- activity, and environmental perceptions; and 3) detailed assess-
lege transition period as a key developmental time window to ment of the worksite environment.
evaluate risk for unhealthy weight gain. Although the average Results: Mean age of participants was 42.9 years (range 18-75),
weight gained during the first year of college is significantly 62.6% were female, 68.5% were married or cohabiting, 88.6%
smaller than the popular notion of the “Freshman 15” such were white, and 2.1% were Hispanic. Mean BMI was 28.5 kg/
increases in weight are not negligible. Further, given the dis- m2 (range 16.9-61.2 kg/m2). Outcome analyses controlled for
proportionate burden of obesity among African American (AA) age, gender, education level, race, and baseline smoking status
women, the possible role of ethnicity remains to be more fully and BMI. Participation in intervention activities was variable
articulated. Thus, the primary aims of this pilot investigation across sites, ranging from 46.8% to 63.5% (p<.0001). Relative to
were: 1) to examine whether ethnicity is associated with first- those at control sites, individuals at intervention sites signifi-
semester changes in biometric indices [e.g., weight, body mass cantly increased self-weighing frequency (p<.0001) and fitness
index (BMI), percent body fat (PBF), waist circumference (WC)], center use outside of work (p<.05), and significantly decreased
college stress (CS), and eating patterns [i.e. binge eating sever- donut consumption (p<.01) and soft drink vending use (p<.01)
ity (BES), night eating (NE), and intuitive eating (IE)] and 2) to during the study period. Presence of relevant media increased
explore the links between changes in biometric measures and dramatically at intervention sites (vs. control sites; mean per-
changes in stress and eating behavior across the first semester in cent increase = +4275% vs. +34.7%). However, BMI changes
a sample of 39 AA and 44 European American (EA) females at- were not statistically different between intervention and control
tending a large Southeastern public university. At entry, 34% of sites (p=.33).
the sample was overweight or obese and over 70% had a waist-
63
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
Conclusions: The trial had modest success at changing health of intervals of novel posttreatment campaigns (i.e., clusters
behaviors, with some components more successfully delivered of sessions devoted to a new treatment theme) may decrease
than others. Future studies should examine optimal delivery of habituation, increase participant interest, and enhance weight-
components to address weight gain prevention in worksites. loss progress. In the current study, we examined the impact of
CORRESPONDING AUTHOR: Jennifer A. Linde, PhD, Epide- implementing a posttreatment campaign on the weight-loss
miology and Community Health, University of Minnesota, Min- progress of adults who completed an initial period of obesity
neapolis, MN, 55454; linde074@umn.edu treatment followed by approximately a three month break
without additional therapy. Participants included ninety-seven
C-080g obese individuals, (mean ± SD: BMI = 36.19 ± 3.63 kg/m2; age
THE FAILURE OF AN ENVIRONMENTAL MODIFICATION = 53.43 ± 11.12 years). After attending up to 24 weekly obesity
APPROACH TO WEIGHT LOSS TO IMPROVE TREATMENT treatment sessions and losing a mean of 11.46 ± 6.34 kg, partici-
OUTCOMES BEYOND A TRADITIONAL BEHAVIORAL WEIGHT pants had approximately 12 weeks without further treatment
LOSS APPROACH followed by a posttreatment campaign consisting of 5 weekly
Robert A. Carels, PhD, Kathleen M. Young, MA, Afton Koball, sessions. Mean weight change per week was compared for the
MA, Amanda L. Gumble, MA, Marissa W. Oehlhof, MA, posttreatment period without intervention sessions versus the
Carissa Wott, MA and Nova Hinman, BA interval with campaign sessions. During the break period with-
Department of Psychology, Bowling Green State University, out session, participants experienced a mean weight loss of .05 ±
Bowling Green, OH. .31 kg per week. However, during the campaign period, partici-
Rates of overweight and obesity have increased dramatically pants achieved a mean weight loss of .21 ± .35 kg per week. The
in recent decades, and this increase has coincided with the difference in weight change during the posttreatment periods
development of an “obesogenic” environment that encourages with and without campaign sessions was statistically significant
excess food intake and discourages energy expenditure. This (p < .01). Limitations included the availability of partial data for
investigation compared a traditional behavioral weight loss 37 of the participants and the use of a within-subject rather than
program (the LEARN program) with Transforming Your Life a between-subject experimental design. Nonetheless, these find-
(TYL), a weight loss intervention emphasizing environmental ings suggest that the presentation of novel weight management
modification and habit formation and disruption. Fifty-four materials in posttreatment campaigns may increase participant
overweight and obese adults (BMI > 27 kg/m2) were randomly adherence and enhance weight-loss progress.
assigned to either the LEARN or TYL intervention. Each 12- Support: NHLBI R18 HL087800
week group-based intervention included weekly weigh-ins. CORRESPONDING AUTHOR: Kristen E. Newell, MA, Clini-
Forty participants completed the intervention and a 6-month cal & Health Psychology, University of Florida, Gainesville, FL,
follow-up assessment. Participants were able to lose weight in 32601; knewell@phhp.ufl.edu
both the LEARN (M = 11.6 lb, SD = 9.5) and TYL (M = 14.1 lb,
SD = 9.4); however, treatment outcome was not superior in the C-080i
TYL intervention, F(1, 38) = 0.67, p = .42. Similarly, 6-month A SMALL CHANGE APPROACH TO ADOLESCENT WEIGHT
follow-ups evidenced non-significant weight gain in both the LOSS APPLIED IN A RESIDENTIAL CAMP SETTING
LEARN (M = 2.1 lb, SD = 7.4) and TYL (M = 1.8 lb, SD = 8.1) Marissa Errickson, Bachelor of Arts,1 Emily Steinbaugh,
groups, and there was no difference in weight gain between Bachelor of Science,1 Lesley Lutes, Doctorate1,3 and David
the interventions, F(1, 38) = 0.02, p = .90. The TYL intervention Collier, Doctor of Medicine2,3
can be viewed as a viable alternative to a traditional behavioral 1
Psychology, East Carolina University, Greenville, NC;
weight loss program. Certain individuals may benefit from pro- 2
Pediatrics, Brody School of Medicine, Greenville, NC and
grams that address their behaviors within the obesogenic food 3
Pediatric Healthy Weight Research and Treatment Center, East
and physical activity environment. Carolina University, Greenville, NC.
CORRESPONDING AUTHOR: Kathleen M. Young, MA, Due to the growing percentage of obese adolescents, residential
Department of Psychology, Bowling Green State University, summer camps have been suggested as one viable treatment.
Bowling Green, OH, 43403; youngkm@bgsu.edu Traditionally, these camps result in significant weight loss
through extreme amounts of exercise combined with portion
C-080h controlled, low calorie, and low fat meals. However, weight re-
IMPACT OF A POSTTREATMENT CAMPAIGN ON WEIGHT gain is typical. While a small change approach to obesity treat-
CHANGE FOLLOWING OBESITY TREATMENT ment has shown promise in adult studies, this approach has
Kristen E. Newell, MA, Anne E. Mathews, PhD, RD, Lisa M. not been tested with children. The purpose of the present pilot
Nackers, MS, Kathryn M. Ross, MS, Ninoska DeBraganza, study was to examine the impact of this small change approach
MSESS, Rachel André, MS, Valerie J. Hoover, BS, Kristina with adolescents in a residential healthy lifestyle camp. Thirty
M. von Castel-Roberts, PhD, Christy H. Thomas, RD, LD/N, obese (initial BMI M = 41.31, SD = 8.88) male (n = 8) and female
Melanie L. Thomas, BS, Katherine K. Allen, MA, Catherine J. (n = 22) adolescents, ages 12-17 (M = 14, SD = 1.1), participated
Rogers, BS, Wendy W. Lynch, BS and Michael G. Perri, PhD in the 3 week summer camp in rural North Carolina. Campers
University of Florida, Gainesville, FL. made self-selected small changes in diet and physical activity,
When obesity treatment ends, participants typically regain were provided healthy food options, were assisted in practic-
weight. Simply providing refresher sessions (i.e., more of the ing appropriate portion sizes, learned activities and sports,
same type of treatment) may lead to boredom and decreased and wore pedometers to track physical activity. Campers also
treatment effectiveness due to habituation. The implementation received nutrition classes, cognitive behavioral group therapy,
64
and individual goal-setting meetings. Upon completion of C-080k
camp, campers had lost a significant amount of weight (weight INNOVATIONS IN CONDUCTING BILINGUAL HEALTH
loss in pounds M = 7.02, SD = 4.46, p < .001). Average BMI upon TRANSLATIONS IN COMMUNITY ENGAGED HEALTH
completion of camp (final BMI M = 39.98, SD = 8.63) was signifi- RESEARCH
cantly lower than initial BMI (change in BMI M = -1.3, SD = .84, Lisa A. Sanchez-Johnsen, PhD,1 Julia Escamilla, n/a,2 Gabriela
p < .001). In addition, a follow-up program comparing phone- Juarez, BA,1 Susan Vega, n/a,2 Kathleen Rivero, BA1 and Katty
based to in-person treatment is currently ongoing. Results sug- Cavero, BA1
gest that a small change approach in a residential camp setting 1
Psychiatry, University of Chicago, Chicago, IL and 2Alivio
may be a viable alternative to assist adolescents in achieving Medical Center, Chicago, IL.
initial weight loss. However, the ability of this program to pro- Many behavioral medicine materials have not been translated
duce continued weight loss remains unknown. into Spanish. For materials that do exist in Spanish, many have
CORRESPONDING AUTHOR: Marissa Errickson, Bachelor of not been translated properly, many are only appropriate for
Arts, Psychology, East Carolina University, Grimesland, NC, a subgroup of Latinos, and/or multiple versions of the same
27837; mae0312@ecu.edu materials exist. This presentation describes a novel and iterative
model of conducting bilingual Spanish/English translations as
C-080j part of community engaged health research studies. This work
ENERGY BALANCE AND EXTERNAL EATING: THE derives from experience on several bilingual projects focused on
INFLUENCE OF RELIANCE ON INTERNAL CUES obesity and cancer prevention research. The innovative trans-
Susan M. Schembre, PhD RD lational model includes the following 5 phases: 1) Planning,
Prevention and Control, Cancer Research Center Hawaii, which includes training research staff and community members
Honolulu, HI. in conducting translations, and developing a translation plan
Obesity-related eating behavior research has predominantly with community partners. 2) Preparation, which includes: a)
focused on what and/or how much to eat and how the Developing new English materials and reviewing new and
environment is shaping our food choices. While this research existing materials with community members and research staff;
is vital to the field, the drive to eat is not only regulated by b) Contacting authors or publishers of translated materials and
external influences. The simultaneous influence of hunger and obtaining permissions and releases of materials that were not
satiety (internal cues) are equally vital. Surprisingly, little is translated; c) Selecting and pilot-testing services of professional
known about how internal and external cues jointly influence translators; and d) Identifying additional resources to use in this
energy balance. Adults (n=307; 48% males) were recruited process. 3) Action, which includes: a) Professional translations
to complete on-line surveys including validated measures of of materials, using a forward and backward translation process;
Reliance on Internal Cues (RIC) and External/Emotional eating b) Research team review and pilot-testing by the PI and RA’s;
(EE). The sample was Caucasian (25%), Asian (35%), Hawaiian/ and c) Community team translation. d) Additional review by
other (6%), or mixed-race (29%), ranged in age from 24 to 59 yrs the research team, PI, and community partners. 4) Pre-Testing,
(46.9±12.8 yrs), and had BMIs of 17.5 to 52.5 kg/m2 (27.7±5.7 which includes: a) Pilot-testing the materials; b) Additional
kg/m2). Participants were grouped into high vs low RIC and review and edits by the research team and PI; c) Additional
EE by sex-specific median splits. Main effects and interactions review and edits by community partners and the research team;
on Weight Change rate (WtΔ) from age 21 yrs, Body Mass Index and d) Reviews, edits, and pilot-testing until the materials were
(BMI), perceived frequency of Overeating (OE), and Eating finalized. 5) Finalization, which includes the final review of
Frequency (EF) were explored by sex controlling for covariates. translated materials. Several recommendations are provided.
Significant interactions observed in the males showed that RIC Researchers, clinicians, and community collaborators will
had a strong protective effect on BMI, frequency of OE, and benefit from learning about this innovative community engaged
WtΔ (p=0.07) at a high EE. The effect of a high RIC was not translation model.
noted in those with a low EE. For females, there was a signifi- CORRESPONDING AUTHOR: Lisa A. Sanchez-Johnsen, PhD,
cant interaction effect on WtΔ. Unlike the males, the effect of Psychiatry, University of Chicago, Chicago, IL, 60637; lsan-
a high RIC on WtΔ was observed only at a low EE. The effect chez@bsd.uchicago.edu
of a high RIC on WtΔ was not significant at a high EE. Main
effects showed that females with a high RIC had a lower BMI C-080l
and less frequent OE and those with a high EE had a higher OE THE FINANCIAL IMPACT OF A LA CARTE IN KANSAS
and a greater EF. Results indicate that a high RIC has a protec- SCHOOLS
tive influence on determinants of energy balance and that these Nikki L. Nollen, PhD, Kim Kimminau, PhD, Niaman Nazir,
effects vary by sex, particularly in those with high EE. Effects on MBBS and Robert Lee, PhD
other behaviors including physical activity, fruit and vegetable University of Kansas Medical Center, Kansas City, KS.
intake, and dietary fat intake will be presented. Future research BACKGROUND: Most schools rely on a la carte (ALC) to
will explore how the interaction between RIC and EE impacts support the food service program. The nutritional quality of
energy intakes and eating in the absence of hunger. ALC is often poor. Decreasing dependence on ALC may have
CORRESPONDING AUTHOR: Susan M. Schembre, PhD RD, important implications for obesity prevention. This study ex-
Prevention and Control, Cancer Research Center Hawaii, Hono- amines factors associated with low ALC dependence in Kansas
lulu, HI, 96813; sschembre@crch.hawaii.edu schools. METHODS: Data were obtained from 2008 food service
financial records. Dependence was represented as the percent of
revenue generated from ALC as a function of total food service
65
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
revenue. Cut-points of 0%-13%, 14%-24%, and >24% were er, using the absolute value of weight change (change in weight
used to indicate low, moderate, and high ALC dependence. regardless of direction), soldiers did have significant changes
RESULTS: Rural districts (n=206) were significantly more in weight with a mean absolute change of 3.8kg (SD=3.3kg; 4%
likely than urban districts (n=76) to have low ALC dependence change).
(OR=2.4, 95% CI=1.2-4.8, p<0.01). Among rural districts, those Physical functioning was related to both pre-BMI (r= -.12) and
with low ALC dependence had higher lunch prices ($1.94 ver- post-BMI (r= -.12). Pre-BMI was correlated with weight change
sus $1.86, p<0.05), greater lunch participation (77% versus 72%, (r= -0.3) and absolute weight change (r=0.2). PTSD symptoms,
p<0.01), lower per meal costs ($3.05 versus $3.56, p<0.001), and combat experiences and pre-deployment mental health func-
fewer free/reduced price students (36% versus 41%, p<0.05) tioning were not related to pre- or post-BMI or weight change.
than high ALC dependent districts. Factors retained in a final,
reduced regression model predicting low dependence were Conclusion: This study demonstrated that soldiers experience
lunch price (OR=7.5, 95% CI=1.7-34.2, p<0.01) and free/reduced a great deal of weight change during combat deployment with
price meal participation (OR=6.5, 95% CI=1.6-27.0, p<0.05). For some gaining and others losing. This change was not related to
each one dollar increase in lunch price, districts were 7.5 times PTSD symptoms or combat experiences. Higher pre-BMI was
more likely to have low ALC dependence. Similarly, districts related to losing weight and lower pre-BMI was related to gain-
where free/reduced price meals made up less than one-third of ing weight. The possibility of a regression to the mean effect
the total meals sold were 6.5 times more likely to have low ALC will be considered.
dependence than districts where free/reduced price meals com- CORRESPONDING AUTHOR: Lisa McAndrew, PhD, WRIISC,
prised over half of the total meals sold. Findings for urban dis- VA NJHCS, East Orange, NJ, 07018; lisa.mcandrew@va.gov
tricts were inconclusive; t-tests found few individual differences
between low, moderate, and high ALC dependent districts and C-080n
no factors were retained in a final regression model. CONCLU- KOREANS AND OBESITY: MODEL MINORITY?
SIONS: Increases in lunch price and government reimburse- Roshan Bastani, PhD,1 Beth A. Glenn, PhD,1 Alison K.
ment for school meals coupled with decreases in per meal costs Herrmann, MS,1 Annette E. Maxwell, DrPH,1 Cindy Chang,
may be important factors in decreasing ALC dependence and MPH1 and Vicky Taylor, MD, MPH2
preventing obesity among rural schools. Factors associated with
1
UCLA School of Public Health & Cancer Center, Los Angeles,
low ALC dependence in urban schools requires further exami- CA and 2Fred Hutchinson Cancer Research Center, Seattle, WA.
nation. Aggregate data suggesting that US Asians have lower obesity
CORRESPONDING AUTHOR: Nikki L. Nollen, PhD, Pre- rates compared to other ethnic groups likely mask sub-group
ventive Medicine and Public Health, Univ of Kansas Medical differences. Because chronic disease risk accrues to Asians at
Center, Kansas City, KS, 66160; nnollen@kumc.edu lower levels of risk factors, the WHO has suggested lower BMI
obesity cut-offs for Asians. The Asian population in the US is
C-080m growing very rapidly, so it is important to attend to its obesity
IMPACT OF COMBAT DEPLOYMENT ON WEIGHT status.
Lisa McAndrew, PhD,1,2 Elizabeth A. D’Andrea, PhD,1,2 Adam We present baseline data (in-person interviews in Korean) on
Ackerman, BS,1 Helena Chandler, PhD,1 Batorsky Benjamin, 507 Koreans participating in a randomized trial to increase
BA,1 Conway Yen, BS,1 Charles C. Engel, MD, MPH3,4 and Karen cancer prevention behaviors. Participants were recruited from
S. Quigley, PhD1,2 a random sample of Los Angeles churches: average age 45yrs,
1
WRIISC, VA NJHCS, East Orange, NJ; 2NJ Medical School, 98% immigrants, 65% female, and the majority expressed a
Newark, NJ; 3WRAMC, Washington, DC and 4USUHS, strong Korean ethnic identity.
Washington, DC.
Using standard BMI cutoffs, 21% of the sample was overweight
Introduction: Population studies have found that veterans have (BMI 25-30) and 2% obese (BMI>30). These rates doubled when
higher rates of obesity. It is unclear if trauma experienced dur- Asian-specific cutoffs were applied, with 42% being overweight
ing combat deployment may lead to weight changes. (BMI 23-28) and 5% obese (BMI>28).
Methods: This study followed National Guard and Reserve Gender differences depicted a pattern opposite to that observed
soldiers immediately pre- and post-combat deployment. Weight in other groups, with males significantly more likely to be over-
and height were measured by trained research associates. weight or obese (68%) vs. females (37%).
Soldiers also completed questionnaires on functioning (SF-36),
PTSD symptoms (PCL) and combat experiences (DRRI). Higher BMI was associated with male gender, being married,
more time in the US, older age, and lower income. Contrary
These analyses are from the first 320 soldiers. T-tests were to expectations, lower acculturation and higher Korean ethnic
used to examine overall weight change. Correlation analyses identity predicted higher BMI.
examined the association of BMI, and weight change (post-BMI
minus pre-BMI) on PTSD symptoms, combat experiences and Clues to the higher male BMI rates may be found in eating
pre-deployment functioning (SF-36 mental and physical health patterns. Males were more likely than females to consume fried
composite scores). foods and sweets, and less likely than females to eat fruits/
vegetables. This may be related to more access among males
Results: Soldiers had an average pre-BMI of 27.3 (SD=4.4). Dur- to unhealthy foods in the work environment. Although PA
ing deployment, 43.3% lost and 45.5% gained weight. Because levels overall were poor (37% reported no moderate or vigorous
a similar number of soldiers lost and gained weight, the mean physical activity in the past week), males were more likely to be
change was non-significant (mean= -0.3kg; SD=5.1kg). Howev- physically active compared to females.
66
Our data indicate that obesity is a significant issue among Kore- C-080p
ans in Los Angeles, particularly among males. Uncovering the HEALTH COMMUNICATION CHANNELS AMONG
causes and modifiable predictors of these trends will be impor- NONTRADITIONAL COLLEGE STUDENTS
tant in informing the design and rigorous testing of culturally Lisa M. Quintiliani, PhD RD,1 Whiteley A. Jessica, PhD2 and K.
appropriate interventions to stem the tide. Vish Viswanath, PhD3
CORRESPONDING AUTHOR: Alison K. Herrmann, MS, Div.
1
Boston University Medical Center, Boston, MA; 2University of
Cancer Prev. & Control Research, UCLA SPH, Playa del Rey, Massachusetts, Boston, MA and 3Dana Farber Cancer Institute,
CA, 90293; alisonherrmann@yahoo.com Boston, MA.
While most health promotion in colleges focuses on young
C-080o traditional students, nontraditional [NT] students are associ-
THE USE OF YOGA AND VIDEO DANCE TO INCREASE ated with demographics related to obesity: being older, female,
ADHERENCE TO A PRIMARY CARE BASED WEIGHT low-income, and racial/ethnic minorities. Colleges serving
MANAGEMETN PROGRAM FOR ADOLESCENT GIRLS NT students may be a key channel for obesity prevention.
Lynn L. DeBar, PhD, MPH, Bobbi Jo Yarborough, PsyD, John This exploratory study compared availability/use, attention,
Dickerson, MS and Victor J. Stevens, PhD and preference for delivery channels between traditional and
KP Center for Health Research, Portland, OR. NT students to create a targeted nutrition and physical activ-
Background: This project examined two novel exercise strate- ity program. To date, 182 undergraduate students (RR=4%)
gies included as part of a multi-component lifestyle interven- responded to a randomized online survey from a large, urban
tion for overweight teen females and their families. We report 4-year university. Questions were adapted from the 2003/2007
here on 6- and 12-month physical activity and BMI outcomes. Health Information National Trends Surveys. The sample was
Methods: 2-year RCT with girls, age 12-17, who are members 68% female, 36% racial/ethnic minorities, and nearly 1/3rd
of a large HMO in the Pacific Northwest with a BMI (kg/m2) recently on food stamps and/or Medicaid; mean age=24 years.
≥90th percentile for their age/gender. Teens were randomized Five standard NT characteristics were assessed: financial inde-
to either a multi-component behavioral weight control program pendence (35% of total sample), enrollment gap between high
(intervention) or usual care (control). The program was tailored school and college (33%), full-time employment (20%), part-
for gender and developmental stage, with separate group meet- time enrollment (14%), and having a GED (4%). Student status
ings for teens and parents, in-session physical activity (yoga), was grouped into moderately NT (30%; MOD NT), minimally
and facilitated home practice (using the Dance Dance Revolu- NT (41%; MIN NT), or traditional (29%; TR). Availability of
tion [DDR] video game). Results: Analyses for the 80 teens high speed Internet access and use of email, social networking,
participating in the intervention with complete assessment data blogging, or instant messaging did not differ by student status.
(76.2%) showed a trend towards modest decrease in obesity Compared to TR students, both NT groups paid more attention
at the one year follow-up (95% ≥ 95th age/gender adjusted to books, brochures, health organizations, Internet, magazines,
percentile BMI at one year follow-up for those not reporting use and academic journals (p<.05 for all). More MOD/MIN NT
of novel exercise post-treatment versus 80.8% of those report- students preferred tailored print materials (75/79 vs 59%) and
ing use; OR: 4.5, p-value: .086, Number Needed Treat [NNT]: 7) interactive websites (87/81 vs 65%) compared to TR students
and greater amounts of continued physical activity (met target (p<.05 for both). Although we achieved a low response rate
of 5 or more days with 30 minutes or more of activity) (OR: 2.8 among students comfortable with online surveys, these findings
,p-value: .039, NNT: 5) among those reporting continued use of revealed programs for NT students can capitalize on a variety
these novel exercise strategies following the intervention. Large of computer technologies, as availability/use were similar.
effect sizes (NNT) suggest strong findings despite limited sam- Preference for tailored media and interactive websites allows
ple size. However, only a modest number of the intervention researchers to customize print and computer-based programs
participants reported continuing use of these strategies inde- for NT students according to their unique characteristics.
pendently following the completion of the intervention (overall CORRESPONDING AUTHOR: Lisa M. Quintiliani, PhD RD,
39.3%, 33.7% yoga/stretching, 9.0% DDR) and short duration of Boston University Medical Center, Boston, MA, 02118; lmquin-
activity (11.0 minutes per day overall [SD=13.9]). ti@bu.edu
Conclusions: These 12-month intervention results suggest a C-080q
modest role for novel exercise strategies in promoting physical WHO PARTICIPATES IN INTERNET-BASED WORKSITE
activity adherence and BMI reductions for teen girls participat- SURVEYS AND WEIGHT LOSS PROGRAMS?
ing in a primary care based weight management program. Wen You, PhD,1 Jamie M. Zoellner, PhD,2 Fabio A. Almeida,
CORRESPONDING AUTHOR: Lynn L. DeBar, PhD, MPH, KP PhD,2 Jennie L. Hill, PhD,2 Kacie C. Allen, student,2 Courtney
Center for Health Research, Portland, OR, 97227; lynn.debar@ A. Robert, student,2 Russell E. Glasgow, PhD3 and Paul A.
kpchr.org Estabrooks, PhD2
1
Agricultural & Applied Economics, Virginia Tech, Blacksburg,
VA; 2Human Nutrition Food and Exercise, Virginia Tech,
Blacksburg, VA and 3Kaiser-Permanente, Denver, CO.
Motivation: There is an obvious need to determine the work-
site weight loss programs’ reach and representativeness. This
requires knowing the proportion of employees that are over-
weight or obese and having a clear picture of the demographic
and behavioral characteristics of the total employee population.
67
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
Objectives: The purpose of this paper was to describe and illus- graders were overweight with 33% of the students being obese.
trate a method for assessing the reach and representativeness of Fifty-percent of 5th graders are overweight and 18% of these
participants in a worksite weight loss study. students are obese. Specific trends were observed within the
Methods: Prior to the implementation of worksite weight loss male student data. Thirty-two percent of the 4th grade males
programs a brief health survey (BHS) was administered to em- are overweight and 24% are obese, 13% higher than any other
ployees at 19 worksites to determine eligibility, and conserva- group. Thirty-one percent of 5th grade males are overweight
tively evaluate reach and predictors of study participation (e.g., and 11% are obese. Fourth and 5th grade males are 8% more
health status and behaviors, health literacy, demographics). All overweight than other age groups.
employees were blinded to the existence of a future weight loss Results indicate that while overall state level data can be valu-
program. able in assessing overall obesity trends in school children,
Results: The BHS participation rate was 66% and the weight county level data can point to specific opportunities for inter-
loss program participation rate was approximately 30%. For vention in high-risk grades.
a one category increase in household income and education CORRESPONDING AUTHOR: Jennifer Grewe, MS, Utah State
level, odds of program participation increased by 16% and University, Logan, UT, 84341; jenngrewe@gmail.com
12% respectively. Similarly, an increase in health literacy score
by one unit resulted in an 8% increase in the odds of program C-082a
participation. Holding other predictors constant, people who USING PRESURGICAL PSYCHOLOGICAL VARIABLES
participated in the weight loss program were more likely to: TO PREDICT COMPENSATION AND MEDICAL COSTS
be Caucasian, female, older, with at least one more doctor OF LUMBAR FUSION PATIENTS RECEIVING WORKERS’
diagnosed health complication besides obesity, not a current COMPENSATION IN UTAH
smoker, have good health literacy, higher BMI level, higher Anthony J. Wheeler, BA, Jessica M. Gundy, MA and M Scott
household income, and higher education level. DeBerard, PhD
Psychology, Utah State University, Logan, UT.
Conclusions: The use of a BHS provided an opportunity to
determine more accurate indicators of reach and representa- Low back pain impacts 80% of Americans at some point during
tiveness. Our findings suggest that employers and researchers their lives. Lumbar fusion surgery is a procedure designed to
should anticipate and attempt to mitigate the challenge of dif- fuse vertebrae together in the spine in order to lessen chronic
ferential recruitment rates by health literacy status. pain and/or neurological symptoms. Researchers have sought
out patient variables that will help identify compensated fusion
CORRESPONDING AUTHOR: Wen You, PhD, Agricultural patients who are likely to accrue high medical costs (DeBerard,
& Applied Economics, Virginia Tech, Blacksburg, VA, 24060; et al, 2003). It is unclear if such models will remain valid with
wenyou@vt.edu newer fusion procedures. The purpose of the present study was
C-080r to examine presurgical characteristics and cost outcomes in a
PREVALENCE OF OBESITY IN LOCAL COMMUNITIES retrospective sample of 246 patients (82% male) who received
Jennifer Grewe, MS,1 Scott DeBerard, PhD1 and Holly Budge, lumbar fusion surgery via the Workers’ Compensation Fund
MS2 of Utah (WCFU). Cost information and presurgical biopsycho-
1
Utah State University, Logan, UT and 2Bear River Health social variable information was obtained via WCFU databases.
Department, Logan, UT. Patients received their surgeries between 1998 and 2007. We
expected that medical and compensation costs would be higher
The Centers for Disease Control currently estimates that ap- than in our prior WCFU lumbar fusion study and the biopsy-
proximately 34% of adults were obese (BMI >30). Children have chosocial model would predict cost outcomes. Statistical analy-
followed a similar trend with 15.1% being overweight. The high ses indicated that medical costs for this more recent cohort were
prevalence of obesity in the US is further concerning as it is $82,335 (SD=$52,486) while compensation costs were $30,103
associated with increased risk for problematic health conditions (SD=$16,399). These data suggest that medical costs increased
and premature mortality. It is also suggested that a very strong 174% versus the prior WCFU study while compensation costs
risk factor for adult obesity is a history of childhood obesity. increased roughly with the pace of inflation. Biopsychosocial
While the nationwide prevalence of obesity has been examined, variables were predictive of both medical and compensation
less is known about individual state obesity rates. In 2007, a costs, as seen in correlations and multiple regressions . This
survey study sponsored by the Utah Department of Health study clearly demonstrates a drastic increase in medical costs
was conducted in order to examine rates of obesity in Utah associated with compensated lumbar fusion patients in Utah.
residents. This study indicated that that 68% of adult males and Further, this study supports the utility of conceptualizing lum-
50.8% of adult females were obese or overweight which were bar fusion costs from a biopsychosocial perspective. Possibilities
rates above national averages. The study found that 9.7% of el- for controlling lumbar fusion medical costs via insights gleaned
ementary children were classified as obese and that the percent- from the biopsychosocial model are discussed.
age of children at an unhealthy weight increased dramatically
from 3rd to 5th grades. CORRESPONDING AUTHOR: Anthony J. Wheeler, BA, Psy-
chology, Utah State University, Logan, UT, 84322-2810; antho-
A further smaller geographic area study of Utah Children liv- ny.wheeler@aggiemail.usu.edu
ing in Cache County was conducted by the Bear River Health
Department. The study included collecting height and weight
from all students, K through 5th by school nurses and a BMI
was calculated from this information. Fifty-six percent of 4th
68
C-082b version of the Social Support Questionnaire. Analyses indicated
COST EFFECTIVENESS OF NURSE CASE MANAGERS significant correlations between overall support received and
AND VOCATIONAL REHABILITATION IN LUMBAR FUSION emotional support and advice/help from family. Family sup-
WORKER’S COMPENSATION PATIENTS port significantly correlated with positive reframing of stress.
Jessica M. Gundy, MA (PhD Pending), Anthony J. Wheeler, BA Support from friends was significantly correlated to emotional
and M Scott DeBerard, PhD support, instrumental support, and acceptance. Support from
Psychology, Utah State University, Logan, UT. one’s partner was positively correlated with emotional sup-
Annually, approximately 149 million lost workdays result from port received and provision of advice/help. Listwise regression
work related low back pain injuries with productivity losses es- analyses revealed that social support from family, friends, and
timated at $28 billion. A recent study found that 1,950 compen- partner significantly predict the way people perceive and cope
sated workers who underwent lumbar fusion had a disability with their stress. The present study reports that social support
rate of 63.9%, a re-operation rate of 22.1%, and a complication can have a significant effect on exhibited coping styles and
rate of 11.8%. Due to such poor outcomes, perceived higher risk perceived levels of stress within the university workplace. The
surgery cases are often referred to nurse case managers who effects of overall social support on coping skills, as well as the
help manage medical care and to vocational rehabilitation who availability of social support on the ability to positively reframe
facilitate return to work. However, studies show an associa- one’s thinking and to utilize instrumental support appear to
tion of assigning nurse case managers with worse back surgery play a key role in levels of perceived stress within this environ-
patient outcomes and the effect this, as well as, vocational re- ment. These findings provide a stepping stone in terms of staff
habilitation has on cost is unknown. The purpose of this study needs’ assessment in order to employ appropriate interventions
was to examine the impact nurse case managers and vocational within such a demanding environment.
rehabilitation has on medical and compensation costs. A retro- CORRESPONDING AUTHOR: Eleni Karayianni, PsyD, Psy-
spective review of presurgical variables and medical and com- chology, University of Cyprus, Nicosia, 1678; ekarayia@ucy.
pensation costs were obtained in a cohort of 246 workers’ com- ac.cy
pensation patients who underwent lumbar fusion surgery from
1998 to 2007. Independent-sample t-tests revealed that medical C-097a
costs were significantly higher for patients assigned a nurse case COMPLEMENTARY AND ALTERNATIVE MEDICINE USE AND
manager (M=$95,424, SD=$56,626) compared to those not as- ASTHMA ILLNESS REPRESENTATIONS IN AN INNER-CITY
signed (M=$66,791, SD=$42,347), as well as for patients referred PEDIATRIC ASTHMA SAMPLE
to vocational rehabilitation (M=$87,886, SD=$53,130) compared Amanda M. Spray, MA,1 Jonathan M. Feldman, PhD1,3 and
to those not referred (M=$71,886, SD =$49,895). Compensation Kimberly Sidora-Arcoleo, PhD, MPH2
costs were significantly higher for patients assigned a nurse
1
Ferkauf Graduate School of Psychology, Yeshiva University,
case manager (M=$41,530, SD=$27,447) compared to those not Bronx, NY; 2College of Nursing & Health Innovation,
assigned (M =$30,328, SD=$21,723), while patients referred Arizona State University, Phoenix, AZ and 3Department of
to vocational rehabilitation services also showed significantly Epidemiology & Population Health, Albert Einstein College of
higher compensation costs (M=$40,339, SD=$25,054) compared Medicine, Bronx, NY.
to those not referred (M=$28,963, SD=$25,118). Initially, these Introduction: Evidence suggests that negative attitudes towards
findings seem counterintuitive, as the intention of providing inhaled corticosteroids (ICS), the use of complementary and
nurse case managers and vocational rehabilitation are to reduce alternative medicine (CAM), and asthma morbidity may be
risk and lower costs. Potential explanations for such results and associated with each other. This study sought to clarify this
implications for further evaluation of these services in terms of relationship among an ethnic minority, inner-city sample of
workers compensation patient costs are considered. children with asthma.
CORRESPONDING AUTHOR: Jessica M. Gundy, MA (PhD Methods: Participants were 121 parent-child dyads recruited
Pending), Psychology, Utah State University, Logan, UT, 84321; from an inner-city hospital in Bronx, New York. Children
jessica.gundy@aggiemail.usu.edu between the ages of 7 and 15 were included. The Asthma Illness
Representation Scale (AIRS), the Asthma Functional Severity
C-082c Scale, and a checklist of types of CAM were administered to
ASSOCIATIONS BETWEEN COPING, SOCIAL SUPPORT, AND parents.
WORKPLACE STRESS IN A UNIVERSITY SETTING
Irene Gregoriou, BA, Despina Themistocleous, BA, Georgia Results: The sample consisted of 6 Caucasian, 56 Puerto Rican,
Panayiotou, PhD and Eleni Karayianni, PsyD 36 African American, and 23 Afro-Caribbean parent-child
Psychology, University of Cyprus, Nicosia, Cyprus. dyads, with a mean child age of 10.8 years (SD = 2.31). Only
23% of primary caregivers endorsed CAM in response to a brief
Workplace stress is a growing problem due to the changing screening question, but nearly 90% endorsed the use of specific
workplace environment. Studies have identified several sources CAM types when individual items were administered. The top
of stress, as well as a number of moderating factors. The pres- five most frequently endorsed types of CAM were prayer (51%),
ent study focuses on the interplay of social support, individual Vicks Vaporub (47%), massage (41%), vaporizer (35%), and vi-
coping skills, and perceived stress levels as they pertain to a tamins (27%). No significant ethnic differences in type of CAM
sample of university staff. One hundred and twenty-seven staff endorsed or AIRS scores were found. As AIRS score decreased,
members at a university responded to an online questionnaire. indicating parental alignment with the lay model of asthma
The questionnaire included the Perceived Stress Scale, the Cop- management, functional morbidity significantly increased in
ing Orientations to Problems Experienced - Brief and a modified the last year (r = -.346, p < .05), and the last month (r = -.221, p
= .018).
69
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
70
The influence of rural environment was emphasized in all reactivity, suggesting no differential reactivity to homotypic or
groups. A total of 36 providers were included in groups at five heterotypic stressors within the noisy school. However, there
sites (Cody, WY, Jackson, WY, Cheyenne, WY, Laramie, WY were significant main effects of school on baseline-adjusted
and Fort Collins, CO). The majority of the providers were white systolic reactivity and heart rate reactivity. Children in the
(94.4%), female (75%), and held a graduate or professional de- noisy school had lower systolic blood pressure and heart rate
gree (69.4%). The most common job titles were Social Worker or reactivity scores during both tasks than did children in the
Case Manager (44.4%), Counselor (25%), and Psychiatric Nurse quite school. The diastolic blood pressure reactivity trended in
(11.1%). On average, providers were 42.6 years old, had 10.9 the same direction as systolic and heart rate reactivity, but was
years experience with SMI patients, and had an SMI caseload of not significant. The latter findings are consistent with previous
85%. research suggesting chronic stress results in hypo-reactivity to a
Providers consistently identified a number of barriers to ad- variety of stressors.
equate healthcare, including: poverty, transportation (in both CORRESPONDING AUTHOR: Bang Hyun Kim, PhD, Public
urban and rural settings), medical comorbidity, obesity, illness Health, Temple University, Philadelphia, PA, 19122; bkim@
management knowledge, motivation, medication management temple.edu
(motivational and financial), lack of social support (from family,
community, and providers), provider/patient communication, C-097f
poor diet, unstable housing and income, social stigma, and SUBJECTIVE MEASURES OF DISCRIMINATION AND
inconsistent medical care (including transient providers in rural OBJECTIVE MEASURES OF SKIN COLOR AS PREDICTORS OF
settings). PERCEIVED STRESS AMONG AFRICAN AMERICANS
Guy-Lucien Whembolua, PhD,1 Gary King, PhD2 and Kolawole
Providers indicated that a successful intervention would need S. Okuyemi, MD, MPH1
to address each of these areas. Special emphasis was placed on 1
Family Medicine &Community Health, University
the importance of motivation and involvement. Providers sug- of Minnesota Medical School, Minneapolis, MN and
gested direct modeling of healthy behavior, tailoring informa- 2
Biobehavioral Health, Pennsylvania State University,
tion for a range of levels of functioning, social and emotional University Park, PA.
support, concrete incentives and rewards (including money),
communication between intervention personnel and providers, BACKGROUND: In the United States, skin color plays an im-
follow-ups, and a length of at least six months. portant role in race relations and racial stratification. This reali-
ty has consequences in the daily lives of African Americans, one
CORRESPONDING AUTHOR: Thomas L. Wykes, BA, Psy- of which is increased stress. From a biological perspective, skin
chology, 3415, University of Wyoming, Laramie, WY, 82071; pigmentation is divided into two types: constitutive skin color
twykes@uwyo.edu that is the result of individual genetic content; and facultative
C-097e skin color or “tan” that is influenced by exposure to ultraviolet
CHRONIC STRESS AND BLOOD PRESSURE REACTIVITY radiation. METHODS: A criterion based non-probability design
AMONG YOUTH IN INDIA was used to select a sample (N=147) of African Americans from
Bang Hyun Kim, PhD,1 Stephen J. Lepore, PhD1 and Gary W. three selected sites in Harrisburg, PA. Subjects were given a
Evans, PhD2 questionnaire on socio-demographic characteristics, sociological
1
Public Health, Temple University, Philadelphia, PA and questions on skin color and perceived stress. A reflectometer
2
Department of Design & Environmental Analysis, Cornell was used to measure skin color. Two separate measurements
University, Ithaca, NY. were recorded for each physical location, the forehead for facul-
tative melanin and the upper underarm for constitutive melanin
Recent research and theorizing suggest that chronic stress expo- and an average M value was used in all the analyses for both
sure can compromise the physiological stress-response system. measurements. RESULTS: Four discrimination questions were
This study tested the theory that chronic stress exposure results found to be positively correlated with Perceived Stress (PSS 10)
in hypo-reactivity in response to a stressor that is similar to the (p<.05). In the final regression model a variable (NEWD), com-
chronic stressor (i.e., homotypic stressor) and results in hyper- puted as the addition of all four questions (Cronbach’s α=.775),
reactivity in response to a stressor that is different than the was found to be statistically significant (β =-.321, p <= .001) in
chronic stressor (i.e., heterotypic stressor). Ambient noise was explaining 10.3 % of the variance in PSS10 while facultative and
the chronic stressor. The outcome was blood pressure reactiv- constitutive melanin measures were non-significant. The vari-
ity during acute exposure to either a homotypic or heterotypic able (NEWD) was found to be positively associated with PSS10
stressor. The sample consisted of 189 children from a noisy or (p <= .001) but was not associated with facultative (p=.977) and
quiet public school located in Pune, India. The noisy school was constitutive melanin (p=.286) measures. CONCLUSIONS: This
located in a busy commercial district whereas the quiet school new composite discrimination measure based on skin color
was located in a more residential area district. Noise levels at was found statistically significant to be a stronger predictor of
the noisy school reached a peak of 82 dB(A) and at the quite perceived stress among African Americans than the use of an
school reached a peak of 65 dB(A). There were no significant objective measurement or reflectometer. The result obtained
differences between schools in level of resting blood pressure highlights the importance of the psychological perspective of
or heart rate, auditory discrimination ability, or math skills. discrimination.
Reactivity data (task-resting values of blood pressure or heart
rate) were analyzed using ANCOVA techniques, controlling for CORRESPONDING AUTHOR: Guy-Lucien Whembolua, PhD,
the appropriate baseline value of either blood pressure or heart Family Medicine &Community Health, University of Minnesota
rate. There were interactive effects of school x stressor type on Medical School, Minneapolis, MN, MN; wgl@umn.edu
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-097g ties. Although the CIQ was originally created for use with
INTEGRATING MENTAL HEALTH SERVICES INTO A brain-injured populations, researchers are now starting to use
RURAL HOSPITAL EMERGENCY DEPARTMENT USING this measure in studies on adults with other disabilities. The
TELEMEDICINE psychometric properties of the CIQ have not been established
Jonathan Neufeld, PhD,1 Stephanie Laws, BSN2 and Erik in any other disability populations. The purpose of the current
Southard, CFNP2 study was to evaluate the psychometric properties of the CIQ in
1
IN Rural Health Specialty Exchange, Goshen, IN and 2Richard a heterogeneous sample of adults with physical disabilities. 751
G. Lugar Center for Rural Health, Terre Haute, IN. community-dwelling adults with spinal cord injury (146), mul-
Background - Emergency tele-mental health provides special- tiple sclerosis (174), limb loss (158), or neuromuscular disease
ized mental health evaluations in medical settings via telemedi- (273) completed the CIQ and other measures of functioning. An
cine. To increase access to mental health services, Union Hos- exploratory factor analysis produced a 4-factor solution that
pital Clinton (UHC), a rural critical access hospital, partnered accounted for approximately 53% of the variance. Alternative
with Hamilton Center (HC), a community mental health center, solutions were also examined using confirmatory factor analytic
to establish an emergency tele-mental health program. techniques. Although there was some consistency with the indi-
vidual item loadings compared to the original scoring system,
Methods - A high-quality videoconferencing connection as these models did not provide a good fit to the data. When the
established between the UHC emergency department (ED) and derived CIQ factors in this sample were correlated with other
the HC intake department. The link was staffed by HC intake measures of functioning, the results were suggestive of moder-
clinicians during their normal hours of 7:00 AM to 11:00 PM. ate criterion-related validity for the factors. Overall, the findings
Clinicians were trained in appropriate procedures and stan- support the use of the CIQ as a measure of the general construct
dards for tele-mental health care. Procedures were developed of community integration in adults with disabilities. However,
to allow rapid referrals and evaluations via interactive 2-way the original factor structure of the CIQ was not supported in
video. HC psychiatrists were available by phone when neces- our sample. Based on these findings, we do not recommend that
sary. the original subscale scoring procedures be used in samples of
Results - Ninety-five emergency tele-mental health consults individuals with physical disabilities. Additional research is
were completed in 12 months. Most patients (78%) had a prior needed to further evaluate the psychometric characteristics of
treatment history at HC. Over 95% of evaluations started within the CIQ in adults with disabilities, with particular emphasis on
30 minutes of referral, and three-quarters occurred after 5:00 whether these characteristics differ across disability groups.
PM or on a weekend. Of patients seen, 12% were discharged CORRESPONDING AUTHOR: Adam Hirsh, PhD, Rehabilita-
immediately after the evaluation, 19% were admitted to the hos- tion Medicine, University of Washington, Seattle, WA, 98104;
pital, and 67% were discharged to home from the ED within 24 ahirsh@uw.edu
hours. Over 60% had outpatient follow up plans in place at the
time of discharge. C-097i
Conclusion - Use of tele-mental health can effectively extend A RANDOMIZED TRIAL OF A BRIEF BEHAVIORAL
the reach of community mental health centers into the ED and INTERVENTION TO PREVENT AN INCREASE IN
increase integration between mental health and emergency DEPRESSIVE SYMPTOMS DURING THE TRANSITION TO
medicine. This particular program, relying as it did on an exist- COLLEGE
ing local mental health organization and its established part- Anna M. Charbonneau, MA and Amy Mezulis, PhD
ners, experienced excellent acceptance and relatively smooth Clinical Psychology, Seattle Pacific University, Seattle, WA.
administrative development. One unforeseen key to its useful- Previous research has clearly demonstrated that the transi-
ness was the surprising extent to which the local mental health tion to college is stressful and associated with elevated risk for
center had prior knowledge and records of ED patients present- psychological problems, including depression. This risk may be
ing with mental health difficulties. additionally elevated among female students. For this research
CORRESPONDING AUTHOR: Jonathan Neufeld, PhD, IN study, we designed a behavioral health intervention titled
Rural Health Specialty Exchange, Goshen, IN, 46526; jneufeld@ Women ROCK (Relaxation, Openness, Contemplation, and
inrhse.net Kindness). This intervention is designed to impart behavioral
relaxation skills specifically to prevent an increase in depressive
C-097h symptoms in young women with high emotional reactivity. We
PSYCHOMETRIC PROPERTIES OF THE COMMUNITY recruited and randomly assigned 72 women with high emo-
INTEGRATION QUESTIONNAIRE IN ADULTS WITH tional reactivity to either the intervention or control condition.
DISABILITIES We assessed participants at baseline and one week post-inter-
Alan Braden, BA,1 Adam Hirsh, PhD,1 Jason Craggs, PhD2 and vention. Repeated measures ANOVA indicated that there was
Mark Jensen, PhD1 a significant main effect of time on depressive symptoms, F(1,
1
Rehabilitation Medicine, University of Washington, Seattle, 61) = 6.63, p = .012, and a significant interaction between time
WA and 2Clinical and Health Psychology, University of Florida, and group assignment, F(1, 61) = 11.43, p = .001. These results
Gainesville, FL. indicate that depressive symptoms for participants in the inter-
Community integration is an essential outcome for people vention group declined over time while depressive symptoms
living with a disability. The CIQ is a commonly used measure for control participants rose slightly. These initial results are
of this construct and conceptualizes 3 domains of function: promising, suggesting that participants in the intervention re-
home integration, social integration, and productive activi- ported significantly less depressive symptoms and less stressors
72
post-intervention than did their control counterparts. The aver- anxiety or depression, which have limited utility due to signifi-
age level of depressive symptoms also declined below the range cant symptom overlap. Therefore, what is not known is whether
of clinical concern for participants in the intervention condition. the identification of specific cognitive vulnerability factors that
These results suggest a true clinical relevance for this preven- underlie these broader constructs of depression and anxiety will
tive intervention. provide a better understanding of the link between psychopa-
CORRESPONDING AUTHOR: Anna M. Charbonneau, MA, thology and poor asthma control.
Clinical Psychology, Seattle Pacific University, Seattle, WA, The purpose of the current study was to examine the ability
WA; charba@spu.edu of anxiety sensitivity (fear of one’s own anxiety symptoms),
a cognitive risk factor for anxiety disorders, to predict poor
C-097j asthma control. Specifically, it was hypothesized that the physi-
MONITORING AND BLUNTING PERSONALITY STYLES: cal concerns factor of anxiety sensitivity (fears of anxiety-related
DOES STYLE OF INFORMATION SEEKING PREDICT A physical symptoms), because of its relevance to the physical
PROPENSITY TO DEVELOP ACUTE STRESS DISORDER OR symptoms produce by asthma, would be predictive of poorer
POST-TRAUMATIC STRESS DISORDER? perceived asthma control after controlling for the effects of
Julie A. Holmes, MA1 and Barbara Melamed, PhD2 depression and anxiety. Participants were 83 (n = 64 female)
1
Psychology, University of Hawaii, Honolulu, HI and undergraduate psychology students (Mage = 20.3 years) with
2
Psychology, Mercy College, New York, NY. self-reported physician-diagnosed asthma. Results indicated
Monitoring and Blunting personality styles have been associ- that, as predicted, after controlling for the variance accounted
ated with increased and decreased anxiety respectively in asso- for by depression and anxiety, anxiety sensitivity-physical con-
ciation with perceived threats but they have not been evaluated cerns significantly predicted asthma control, accounting for 10%
in association with acute stress disorder (ASD), post-traumatic of the variance. These results suggest that further exploration of
stress disorder (PTSD) or other PTSD predictors (avoidance the role of anxiety sensitivity, particularly the physical concerns
and intrusion). This study examined the effects of Monitoring factor, in asthma and asthma management would be a fruitful
and Blunting personality styles on ASD/PTSD, Avoidance and avenue of future research.
Intrusive measures one month after 911 in ninety-two Manhat- CORRESPONDING AUTHOR: Alison C. McLeish, PhD, Psy-
tan college students and staff. We predicted that high Monitors chology, University of Cincinnati, Cincinnati, OH, 45221-0376;
would have increased symptoms of acute stress disorder/PTSD alison.mcleish@uc.edu
symptoms where as a high Blunters would have decreased
symptoms of acute stress disorder/PTSD symptoms. The Miller C-097l
Behavioral Style Scale was used to measure Monitoring and AGREEMENT BETWEEN CLINICIAN AND CLIENT-
Blunting styles. The Impact of Events scale was used to deter- REPORTED MENTAL HEALTH RECOVERY OUTCOMES: THE
mine their use of avoidance or intrusions as reported for the last MODERATING EFFECTS OF GENDER AND ETHNICITY
seven days with respect to their feelings about the WTC attack. Marisa Sklar, BA,1 Andrew Sarkin, PhD,1 Rachel Lale, BA,1
The Posttraumatic Diagnostic Scale was used to measure acute Richard Heller, MA,1 Marshall Lewis, MD, DFAPA,2 Todd
stress disorder/PTSD. A Pearson correlation revealed that high Gilmer, PhD,1 Candace Milow, MA,2 Steven Tally, PhD1 and
Monitoring personality style was significantly correlated with Erik Groessl, PhD1
Avoidance [ r (85) = .306, .004], Intrusive [ r (80) = .404, .000], 1
Health Services Research Center, University of California San
Total PTSD [ r (73) = .282, .016], and Total PTSD severity [ r (65) Diego, San Diego, CA and 2Behavioral Health Division, Health
= .269, .031]. Blunting was not significantly correlated with any and Human Services Agency, San Diego, CA.
of the measures. The implications are discussed. Recovering from mental illness is a participatory effort (Depart-
CORRESPONDING AUTHOR: Julie A. Holmes, MA, Psychol- ment of Health, 2000) and insight into one’s own well-being
ogy, University of Hawaii, Honolulu, HI, 96813; jholmes@ can impact recovery (Olfson et al, 2000; Tait et al, 2003; Smith
hawaii.edu et al, 2004). This study aims to help better understand how to
effectively use self-reported recovery scales to measure clinical
C-097k outcomes as well as for program evaluation and improvement.
ANXIETY SENSITIVITY AND ASTHMA CONTROL We examined clients’ and clinicians’ reported rating of recovery
Alison C. McLeish, PhD, Cynthia L. Cominsky, MEd, Christina among individuals (n = 634) seeking outpatient treatment in
M. Luberto, BA and Joseph Oakwood, BA community mental health clinics across San Diego County. Cli-
Psychology, University of Cincinnati, Cincinnati, OH. nicians assessed clients’ recovery using the Illness Management
5-10% of asthma patients are unable to achieve significant and Recovery (IMR) scale (Mueser, et al., 2004), while clients
asthma control. Difficult-to-control asthma is associated with assessed their own recovery using the Recovery Markers Ques-
increased morbidity and mortality and accounts for more than tionnaire (RMQ) (Ridgway & Press, 2004). Multiple stepwise re-
50% of asthma-related healthcare costs in the U.S. each year. gression models were used to assess overall agreement between
Researchers have identified the presence of comorbid psycho- clinician reported and client self-reported ratings of recovery, as
pathology as an important contributor to poor asthma con- well as the moderating effects of age, gender, ethnicity, and di-
trol. Indeed, the presence of psychopathology among asthma agnosis. Results suggest that as clinician ratings of client recov-
patients is associated with more frequent asthma exacerbations, ery increases, the agreement between client ratings and clinician
doctor’s visits, emergency department visits, and hospitaliza- ratings of recovery strengthens. This relationship is moderated
tions. The research to date has primarily used broad symptom by gender, such that it is significantly stronger for females than
measures of psychopathology, such as measures of general males (t(634)=2.505, p=.012). Further, the relationship between
73
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
74
body tissue. Because SSc has no known cure and care is largely (r=.61) were significant. For the mixed acute rehab population,
palliative, identifying potentially modifiable psychosocial pre- LI scores approached significance with type of diagnosis (r=-.14;
dictors of fatigue is of particular importance. Participants (N = p=.055) and were significantly correlated to depressed mood
93) received clinical examinations and completed the Stanford (r=.52) and history of depressed mood (r=.16). Discussion: This
Health Assessment Questionnaire (HAQ), Psychosocial Ad- study supported the validity of the LI, and its generalizability to
justment to Illness Scale (PAIS), and a modified version of the two distinct medical populations.
Fatigue Severity Scale (FSS). Overall, 82.6% reported clinically CORRESPONDING AUTHOR: Rashelle B. Hayes, PhD, Depart-
significant fatigue (FSS ≥4), M = 5.13. Bivariate correlational ment of Medicine, University of Massachusetts Medical School,
analyses revealed significant associations between fatigue Worcester, MA, 01655; Rashelle.Hayes@umassmed.edu
scores and disability, pain, psychological distress, domestic
environment, and social environment; worse disease-related C-097q
functioning and adjustment were associated with higher fatigue STRESS AND DEPRESSION AS POSSIBLE MEDIATORS OF
scores. A hierarchical multiple regression analysis control- THE RELATIONSHIPS AMONG CAREGIVER PHYSICAL
ling for disease severity and demographic covariates (income, HEALTH AND PROTECTIVE FACTORS AGAINST CHILD
education) was performed to investigate which of these five ABUSE AND NEGLECT
variables were most strongly predictive of fatigue. The initial Stephanie C. Wallio, PhD,1 Alexander M. Schoemann, MA2 and
model with the covariates accounted for 13.7% of variance in Heather N. Rasmussen, PhD3
fatigue scores; inclusion of the 5 psychosocial variables in the 1
Psychiatry & Behavioral Sciences, University of Kansas
second step resulted in an additional 33.1% of the variance Medical Center, Kansas City, KS; 2Psychology, University of
explained (R2=.468). Pain (β = .248) and the social environment Kansas, Lawrence, KS and 3Institute for Educational Research
(β= .266) were the only significant predictors of variance. These and Public Service, University of Kansas, Lawrence, KS.
dimensions should be addressed when designing psychological Recent trends in child maltreatment prevention focus on protec-
treatment interventions. tive rather than risk factors against abuse and neglect. Physical
CORRESPONDING AUTHOR: Erin L. Merz, MA, SDSU/UCSD health has been linked to many risk factors such as depression
Joint Doctoral Program in Clinical Psychology, San Diego, CA, and parent-child bonding. However, no research has examined
92120-4913; emerz@ucsd.edu caregiver physical health in the child maltreatment context and
it has not been included in current prevention frameworks. This
C-097p study examined the relationship between caregiver physical
FACTOR STRUCTURE OF THE LOSS INVENTORY: A health and protective factors and possible mediation by caregiv-
NEW TOOL TO ASSESS EMOTIONAL REACTIONS TO er stress and depression in caregivers receiving child maltreat-
DISABLEMENT OR MEDICAL ILLNESS ment prevention services. 291 caregivers completed measures
Rashelle B. Hayes, PhD,1 Janet Niemeier, PhD2 and Joseph Fava, of physical health, stress, depression, and protective factors at
PhD3 two timepoints. The health measure, a modified RAND Health
1
Department of Medicine, University of Massachusetts Medical Survey, had six subscales. The Protective Factors Survey has
School, Worcester, MA; 2Department of Medicine, Virginia four subscales: family functioning/communication (FFC), emo-
Commonwealth University Health Systems, Richmond, VA and tional support, concrete support, and nurturing and attachment.
3
Centers for Behavioral and Preventive Medicine, The Miriam Structural Equation Modeling and bootstrapping were used
Hospital, Providence, RI. to test meditational hypotheses. All models examined a single
Background: Emotional reactions to illness or disablement may caregiver health latent variable as a predictor of stress, depres-
include depressed mood as well as symptoms unique to grief sion, and protective factors. Numerous predictive relationships
over the loss of functional independence. The Loss Inventory were found from caregiver health to stress and depression and
(LI) measures grief symptoms unique to disablement or illness. stress and depression to protective factors. Depression was
In two samples, the factor structure and validity of the 30-item found to mediate the relationship from role limitations due to
Loss Inventory (Niemeier et al., 2004) was examined. Meth- physical health to FFC (CI95 0.01:0.50) and general health to
ods: N=180 Parkinson’s Disease & Essential Tremor veterans FFC (CI95 0.01:0.44). Greater role limitations predicted higher
from an outpatient setting and N=203 adults admitted to an depression (β=-0.31, p<.05) which predicted lower FFC (β=-0.64,
acute mixed (e.g. SCI, TBI, stroke, etc.) rehabilitative inpatient p<.05). Lower general health also predicted higher depression
setting completed the LI as well as demographics and medical (β=-0.30, p<.05) which predicted lower FFC (β=-0.57, p<.05).
disease data. Analyses: Both principal components (PCA) and Results suggest that family functioning and communication
maximum likelihood factor (MLFA) analyses with varimax could be impacted through addressing caregiver depression
rotations were conducted to examine the underlying dimen- and physical health, specifically perceived general health and
sional structure. Correlations between LI scores, depressed role limitations.
mood, history of depressed mood, disease stage, activities of CORRESPONDING AUTHOR: Stephanie C. Wallio, PhD, Psy-
daily living (ADLs), and functional independence (FIM) scores chiatry and Behavioral Sciences, University of Kansas Medical
were also examined. Results: In both samples, LI items loaded Center, Lawrence, KS, 66049; stephanie.wallio@gmail.com
highly (>.40), accounting for 60 to 67% of the variance. Both the
PCA and the MLFA indicated similar results and supported a
one dimensional solution. In the mixed Parkinson and Essen-
tial Tremor sample, correlations of the LI measure with ADL
dysfunction (r=.42), disease stage (r=.26); and depressed mood
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
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31st Annual Meeting & Scientific Sessions
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78
tention Awareness Scale (MAAS) was used to assess patients’ non-significant for both women and men. PSE was negatively
receptive attention to and awareness of present events and related to depression for women (B = -.35, SE = .07, p < .001)
experience. There was a significant increase in MAAS scores and men (B = -.40, SE = .12, p < .01). Interestingly, our hypoth-
following the mindfulness intervention, [t48 = 2.296, p = .026], esis that PSE would buffer the relationship between rumina-
suggesting that the intervention was effective. We also exam- tion and depression was supported for only men (B = -.43, SE
ined whether change in MAAS scores was related to change = .02, p < .05). Our findings suggest that rumination may be an
in program outcomes. Outcome measures included the Center important factor in the maintenance of depression for men and
for Epidemiological Studies Depression Scale, all subscales women in a sample of chronic pain sufferers, and that PSE may
from the Coping Strategies Questionnaire-Revised, the Pain be a protective factor in the relationship between rumination
Willingness and Activity Engagement subscales of the Chronic and depression for men.
Pain Acceptance Questionnaire, the Pain Anxiety Symptoms CORRESPONDING AUTHOR: Eleni Romano, MA, Clini-
Scale, and the Pain Severity and Interference subscales from cal Psychology, Seattle Pacific University, Seattle, WA, 98119;
the Multidimensional Pain Inventory. Simple pre-post change romane1@spu.edu
scores were calculated for MAAS scores and outcome measures.
Results showed that an increase in MAAS scores was associ- C-106d
ated with a decrease in pain interference [r = -.376, p = .016], DISENTANGLING THE EXPERIENCE OF PAIN, DEPRESSION,
a decrease in pain-related anxiety [r = -.383, p = .016], and an AND DISABILITY IN MS
increase in activity engagement [r = .353, p = .027]. Change in Amy Kupper, BA, Anna L. Kratz, PhD, Tiara Dillworth, PhD,
MAAS scores was not related to change in depression, pain Christina L. Garcia, BA and Dawn M. Ehde, PhD
severity, or willingness to experience pain. Increase in MAAS Rehabilitation Medicine, University of Washington, Seattle,
scores was related to less use of distancing coping strategies [r WA.
= -.380, p = .020], but unrelated to change in other pain cop- Although pain and Major Depressive Disorder (MDD) have
ing (distraction, catastrophizing, ignoring, cognitive coping, or been shown to be common problems for individuals with
passive prayer). These results suggest that that the mindfulness multiple sclerosis (MS), the associations between pain, MDD,
intervention was effective in increasing mindful attention and and pain-related disability are not well understood. The aim of
awareness in a chronic pain population, and that an increase in this study was to describe pain intensity, pain-related disability,
mindful attention was related to positive program outcomes. depressive symptoms, rate of MDD and associations between
CORRESPONDING AUTHOR: Sara D. Barrett, PhD, Center for these variables in MS.
Pain Management, Rehabilitation Institute of Chicago, Chicago, Participants, 1236 adults (991 women) with MS, completed mea-
IL, 60611; sbarrett@ric.org sures of characteristic pain intensity and pain-related disability
C-106c (Korff et al., 1992) and depressive symptoms (PHQ-9). The
EXAMINING THE RELATIONSHIP OF STRESSORS, majority, (54.7%) endorsed “moderate” pain (40-60/100), 23.1%
RUMINATION, PAIN SELF-EFFICACY AND DEPRESSION IN A reported “mild” (≤ 30/100) pain and 22.2% reported “severe”
COMMUNITY SAMPLE OF MEN AND WOMEN WITH CHRONIC (≥ 70/100) pain. Using the same scale, 56.6% reported that pain
PAIN contributed to “mild”, 31.2% to “moderate” and 12.2% to “se-
Eleni Romano, MA, Jelena Agatonovic, MA, Lauren Smith, MA, vere” disability. In this sample, 18% of participants met criteria
Jay Skidmore, PhD and Kristen Perry, MA for MDD. Of the 1006 who did not meet MDD criteria, 41.2%
Clinical Psychology, Seattle Pacific University, Seattle, WA. reported no depressive symptoms, 36.6% reported mild symp-
toms and 19.7% reported moderate symptoms. Notably, 27
Chronic pain is a widespread and debilitating health concern. individuals (2.7%) who endorsed moderately-severe to severe
Depression not only highly co-occurs with chronic pain, but depressive symptoms did not meet MDD diagnostic criteria due
also is related to physical and psychosocial maladjustment to negative responses on the first two items.
to chronic pain. The cognitive-vulnerability stress model of
depression asserts that in response to stressors, a negative cog- Participant demographics (e.g., age, gender) did not show size-
nitive style is associated with depression. One such cognitive able correlations with pain intensity, pain-related disability, or
vulnerability is a ruminative response style. Although this rela- depressive symptoms. However, depressive symptoms were
tionship has been widely established, it has yet to be explored positively correlated with characteristic pain intensity (r = .61,
in chronic pain. Therefore, the first goal of this study was to test p <. 01) and pain-related disability (r = .47, p <. 01). Participants
the ruminative response style theory among a population of with MDD were more likely to report “severe” pain intensity,
individuals with chronic pain. Although this relationship has 35.8% compared to 18.4% of those with no MDD, χ2(3,834) =
been established primarily with women, we sought to explore 43.38, p < .01, and were more likely to report “severe” pain-re-
this relationship in men as well. Pain self-efficacy (PSE) is a lated disability, 28.5% compared to 7.4% of those with no MDD;
strong predictor of coping and adjustment to chronic pain. Our χ2(3,834) = 87.56, p < .01.
second goal was to examine the moderating effect of PSE on Rates of MDD, pain, and disability related to pain are reported
the relationship between stressors, rumination, and depression. with high frequency among individuals with MS, though a size-
Participants (N = 109) were recruited from online networks, able minority reported no problems with mood or pain. MDD
and data was analyzed with a hierarchical regression. Stressors and depressive symptomotology were related to higher pain
significantly predicted elevations in depression for women (B = intensity and pain-related disability.
.25, SE = .00, p < .001), but not for men. Rumination predicted of CORRESPONDING AUTHOR: Amy Kupper, BA, Rehabilita-
elevations in depression for women (B = .48, SE = .07, p < .001) tion Medicine, University of Washington, Seattle, WA, 98104;
and men (B = .41, SE = .145, p = .04). Contrary to our hypoth- akupper@uw.edu
esis, the interaction between stressors and rumination was
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
80
min of VPA (p<0.001) during the school day. These represent C-123d
respective increases of 51.2% and 112.2% in the adjusted means REMOTE INFORMATION AND TRAINING FOR EXERCISE -
of MPA and VPA during recess and respective increases of RITE
92.2% and 71.6% in the adjusted mean of MPA and VPA during NiCole R. Keith, PhD, Melissa L. Cusick, MS, Brittney S. Lange,
school day. BS and Daniel O. Clark, PhD
Conclusion: Staff training, recreational equipment, and play- Indiana University, Indianapolis, IN.
ground markings are inexpensive, simple ways to increase PA Current physical activity (PA) guidelines may be difficult for
during recess so that children can accumulate minutes of PA to the obese, chronically ill or frail to meet. Obese persons of any
meet the recommended guidelines of 60 minutes per day. age and older adults with multiple chronic conditions are at
CORRESPONDING AUTHOR: Jennifer L. Huberty, PhD, greater risk for decreased physical function (PF) which can
University of Nebraska at Omaha, Omaha, NE, 68116; jennifer- make walking and other PA difficult. In fact, 44% of older
white@mail.unomaha.edu adults have difficulty walking ¼ mile and 42% of obese per-
sons report difficulty. We developed and piloted a supervised,
C-123c seated exercise program delivered to patients homes.
INFLUENCES OF HOME, SCHOOL, AND NEIGHBORHOOD From a community health center we recruited 16 obese patients
ENVIRONMENTS ON YOUTH PHYSICAL ACTIVITY who were > age 50. We installed in subjects’ homes a videocon-
Rachel Millstein, MHS,1 Jacqueline Kerr, PhD,2 Joe Stroebel, ferencing-capable computer, provided instructions and trained
BA,3 James Sallis, PhD,3 Greg Norman, PhD,2 Sion Harris, PhD,4 subjects on computer use. We delivered supervised, seated, in
Nefertiti Durant, MD, MPH5 and Brian Saelens, PhD6 home, group exercise via videoconference twice a week. During
1
Clinical Psychology, SDSU/UCSD, San Diego, CA; 2University the exercise sessions the trainer led exercises from a remote site.
of California, San Diego, San Diego, CA; 3San Diego State Subjects were in their homes. All could see and hear one anoth-
University, San Diego, CA; 4Harvard Medical School, Boston, er and all remained seated in front of the web cam throughout.
MA; 5University of Alabama at Birmingham School of Medicine, The exercise sessions included interactive games and 40 min-
Birmingham, AL and 6University of Washington, Seattle, WA. utes of aerobic and flexibility exercises using all major muscle
Literature suggests that youth physical activity (PA) is related groups. There was a progressive increase in exercise intensity
to factors in homes, schools, and neighborhoods. We exam- during the 2-month session.
ined the relative contributions of these environments to youth Baseline and follow-up was completed in 15/16 subjects’
PA. Adolescents (ages 12-18; N=157), parents of adolescents homes. The missing subject had frequent back pain unrelated to
(N=155), and parents of children (ages 5-11; N=108) from 3 the study and could not finish the last 4 weeks. Overall adher-
US metropolitan areas completed a survey assessing features ence was 82% and 9/16 subjects had > 94% adherence. Satisfac-
of these environments and youth PA. Questions were taken tion ratings were 3.93/4.00. Mean chair stands improved by
from reliable and validated scales. Youth PA was indexed 24% (11.4+2.6 to 14.1+4.6), number of steps in 2 minutes by 31%
from z-scores of five items assessing overall PA, sports team (64.4+28.3 to 81.1+43.3) and mean arm curls by 34% (13.6+3.1
participation, and school physical education. For each group to 18.2+4.0). All improvements were statistically significant
(adolescent self report, parent report of adolescents, parent (P<0.001)
report of children), bivariate correlations were used to select
variables (p<0.05) for hierarchical regression models, adjusted This project shows the feasibility and promise of video-
for demographics. There were significant correlations for each conference for exercise training. In medically the vulnerable,
environment (Pearson’s rs: 0.20-0.29). For adolescents, amount supervised exercise may be important for safety, social support,
of home equipment, school equipment, and neighborhood aes- training and adherence. Providing seated, supervised exercise
thetics were entered into the model. For parents of adolescents, to patients in their homes has potential to reach those who may
amount of home equipment and neighborhood aesthetics, and not otherwise be reached. Future work will compare adherence
for parents of children, amount of home equipment and neigh- and outcomes between supervised and unsupervised formats
borhood street connectivity were entered into the model. The and address cost-effectiveness
blocks were entered into the regression in order: demographics, CORRESPONDING AUTHOR: NiCole R. Keith, PhD, Physical
home, school, and neighborhood. For adolescents the full model Education, Indiana University-Purdue University, Indianapolis,
explained 13.8% of variance and the home, school, and neigh- Indianapolis, IN, 46202; nkeith@iupui.edu
borhood blocks were each significant. For parent report of ado-
lescents and children, only the home and neighborhood blocks C-123e
were significant. Full models accounted for 14.3% and 17.5% of AEROBIC FITNESS IS RELATED TO WAIST CIRCUMFERENCE
variance, respectively. To optimize explanation of youth PA, IN OVERWEIGHT ADOLESCENTS
multiple environmental factors should be considered. Modifi- Erin N. Etzel, BA, Patrice G. Saab, PhD, Stephanie L. Fitzpatrick,
able factors like increasing access to PA equipment at home and MS, Amanda J. Countryman, MS, Katie E. Chipungu, BS, Judith
school, and improving neighborhood aesthetics may impact R. McCalla, PhD and Neil Schneiderman, PhD
youth PA. Psychology, University of Miami, Coral Gables, FL.
CORRESPONDING AUTHOR: Rachel Millstein, MHS, Clini- Research indicates that adolescents’ physical activity levels dif-
cal Psychology, SDSU/UCSD, San Diego, CA, 92116; rmillste@ fer by socioeconomic status (SES). Aerobically unfit youth pres-
ucsd.edu ent with cardiovascular (CV) risk factors, such as overweight.
This study examined whether SES, as indexed by parental edu-
cation, is associated with aerobic fitness, measured by maximal
81
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
oxygen uptake (VO2max) during a treadmill test, and, in turn, if attitudes, perceived barriers and physical self concept were sig-
aerobic fitness is related to waist circumference in adolescents. nificantly related to intentions of being active (R-square = .45).
Adolescent boys (n = 44) and girls (n = 17) with elevated blood Further, the model explained the relationships between inten-
pressure (BP; systolic BP and/or diastolic BP ≥ 90th percentile, tions, PSC, past behaviour and the practice of physical activity
adjusted for age, gender, and height) and normotensive boys (R-suqare “overall” = .27, R-square “fitness” = .30,R-square
(n = 80) and girls (n = 25), aged 15-17, participated in an as- “sports” = .39). PSC and past behaviour were better predictors
sessment of anthropometric measures, treadmill testing, and than the intentions to be active.
a 7-day activity recall as part of a larger study. Parents self-re- Conclusions: These findings contribute to the refinement of the
ported their education levels. The sample’s mean BMI was 28.1 theory of planned behaviour and suggest further developments
kg/m2, indicating a majority of the sample was overweight. regarding the role of the physical self-concept in the health/
Parental education was positively associated with VO2max physical education field.
(r = 0.22, p = 0.01). A multiple linear regression analysis was CORRESPONDING AUTHOR: Jean Lemoyne, M Sc, Physical
conducted to determine whether VO2max is associated with Education, College Shawinigan, Shawinigan Sud, QC, G9P 4T9;
waist circumference, controlling for minutes of weekly physi- jean.lemoyne@sympatico.ca
cal activity, parental education, gender, and BP status. This
model significantly accounted for 39.7% of the variance in waist C-123g
circumference (F(5, 127) = 16.73, p < .0001). The VO2max was SOCIAL COGNITIVE CORRELATES OF PHYSICAL ACTIVITY
associated with 24.4% of the variance in waist circumference (t IN ADULTS WITH MULTIPLE SCLEROSIS
= -7.17, p < .0001). Gender and BP status also made significant Deirdre Dlugonski, BS, Thomas R. Wójcicki, BS, Edward
contributions, accounting for 6.9% and 3.6% of the variance in McAuley, PhD and Robert W. Motl, PhD
waist circumference, respectively, p’s < 0.01. University of Illinois, Urbana-Champaign, IL.
These findings suggest adequate aerobic fitness may be critical Background: Physical inactivity is prevalent among persons
in primary prevention of obesity in youth. Overweight youth with multiple sclerosis (MS), despite the evidence that physical
with central adiposity may benefit from physical activity inter- activity has desirable effects on physical function and quality
ventions. Improved aerobic fitness may reduce waist circumfer- of life. This underscores the importance of identifying social-
ence, thereby decreasing their CV risk. cognitive variables such as self-efficacy, goal setting, outcome
expectations, and impediments as possible targets for chang-
CORRESPONDING AUTHOR: Erin N. Etzel, BA, Psychology, ing physical activity behavior in persons with MS. The present
University of Miami, Miami, FL, 33143; eetzel@psy.miami.edu study investigated these social-cognitive variables as correlates
C-123f of self-reported physical activity using baseline data from an
PREDICTING PHYSICAL ACTIVITY AMONG QUEBEC’S ongoing Internet intervention.
COLLEGE STUDENTS : ROLE OF THE THEORY OF PLANNED Methods: Participants were persons with MS (N = 54) who
BEHAVIOUR AND THE CONTRIBUTION OF PAST BEHAVIOR were enrolled in an Internet intervention for increasing physical
AND PHYSICAL SELF-CONCEPT activity. Prior to randomization, participants completed a bat-
Jean Lemoyne, M Sc1 and Pierre Valois, PhD2 tery of questionnaires which included the Godin Leisure-Time
1
Physical Education, College Shawinigan, Shawinigan Sud, QC, Exercise Questionnaire (GLTEQ), Exercise Self-efficacy Scale
Canada and 2Faculty of Education, Université Laval, Québec, (EXSE), Exercise Goal-Setting Scale (EGS), Multidimensional
QC, Canada. Outcome Expectancies for Exercise Scale (MOEES), and Late-
Background: Physical inactivity is considered a major problem Life Function and Disability Inventory (LL-FDI). The data were
at the international level. Most studies suggest a high preva- analyzed using bivariate correlation and multiple linear regres-
lence of sedentarity especially among the young adult popula- sion in SPSS 17.0.
tion. The theory of Planned Behaviour (TPB)is a theoretical Results: Bivariate correlation analysis indicated that GLTEQ
framework frequently used in health education. According to scores were significantly correlated with EGS (r = .31, p = .01),
some authors, the physical self concept (PSC) and past behav- MOEES (r = .29, p = .02), and LL-FDI (r = .28, p = .02) scores,
iour could contribute to the refinement of the TPB. but were not significantly correlated with EXSE (r = .13, p = .17)
Purpose: The purpose of this study is to predict different types scores. Multiple linear regression analysis with stepwise entry
of physical activities (total, fitness and sports) among college indicated that only EGS scores were significantly associated
students. We want to identify the factors the most related with with GLTEQ scores (β = .31, p = .01), and goal setting explained
different physical active behaviours. Furthermore, we want to 10% of the variance in self-reported physical activity.
evaluate the contribution on past behavior and the physical self- Conclusions: This cross-sectional analysis suggests that goal-
concept on the TPB. setting is a primary correlate of physical activity in persons with
Methods: A questionnaire was administered to 425 college stu- MS.
dents. TPB variables were measured. A follow-up questionnaire CORRESPONDING AUTHOR: Deirdre Dlugonski, BS, Univer-
was administered to the same group and self-reported physical sity of Illinois, Urbana, IL, 61801; dlugons1@illinois.edu
activity was measured. Structural equation modeling was used
for statistical analysis.
Results: The results revealed that the fit indices were accept-
able for each model tested (CFI > 0.94, RMSEA <0.05). Overall,
82
C-123h a paradigm previously shown to increase sexual arousal in
SELF-REGULATION IN A MULTIPLE BEHAVIOR CHANGE women (Meston & Gorzalka, 1996), we hypothesized that acute
INTERVENTION: LENDING SUPPORT FOR FURTHER exercise would increase women’s sexual arousal to sexually
RESEARCH IN MEDIATIONAL ANALYSES AND PHYSICAL explicit material. Women reporting at least “some difficulty”
ACTIVITY with sexual arousal while taking SSRIs or SNRIs (N= 26, Mage
Emily Martin, MS, Ashley Dorough, PhD, Richard Winett, PhD = 27.3) watched a neutral and then an erotic film while their
and Matthew Cox, MS physical sexual arousal (vaginal pulse amplitude, VPA) was
Psychology, Virginia Tech, Blacksburg, VA. recorded. VPA is an index of genital blood flow and is consid-
Support has been garnered for multiple behavior change inter- ered the gold standard measure of physical sexual arousal in
ventions that include physical activity (PA; Marcus et al, 2006). women. In a separate, counterbalanced session, participants ex-
Dash-2-Wellness (D2W), a multiple behavior change interven- ercised for 20 minutes at 80% of their maximum heart rate. Five
tion in individuals with prehypertension, was aimed at improv- minutes after exercising, participants watched another neutral
ing health behaviors known to lower blood pressure. It has been and erotic film while their arousal was recorded. We calculated
suggested that lifestyle change be the first line of treatment for percent change in sexual arousal between neutral and erotic
prehypertension, including PA (Chobanian et al, 2003). D2W films for each session. On average, women’s sexual arousal
utilized various social cognitive theory (SCT) variables, includ- to the erotic film during the exercise session was double that
ing self-regulation (SR). SR strategies have been associated with of the baseline session (i.e., 23% increase between neutral and
greater motivation and involvement with PA (Anderson et al, erotic films during the baseline session vs. 50 % increase after
2006; Umstattd, Wilcox, Saunders, Watkins, & Dowda, 2008). exercise). A paired t-test indicated that women’s sexual arousal
during the exercise condition was significantly greater than at
Participants (n=23) were randomized into D2W Plus, the baseline (t(25) = 3.37, p < Acute exercise immediately prior to
intervention group, or D2W Only, the standard care group. PA exposure to sexual stimuli appears to increase sexual arousal
was measured through daily step count. After the ten-week in women taking antidepressants. Although further work is
intervention, independent t-tests showed that participants in needed to validate the efficaciousness of the intervention in a
D2W Plus made greater increases in daily steps (M=2,900.14, non-laboratory environment, these results are promising and
SD=1903.83 steps/day) compared to D2W Only participants suggest that exercise may be used to aid women struggling with
(M=636.39, SD=1,653.26 steps/day; p=.01; Dorough, 2009). Fur- sexual side effects of antidepressants.
ther analyses indicate significant group differences in changes
in SR. Specifically, participants in D2W Plus made greater CORRESPONDING AUTHOR: Tierney K. Ahrold, MA, Depart-
increases compared to the D2W Only participants in SR for PA ment of Psychology, University of Texas at Austin, Austin, TX,
(M=1.96, SD=.83 vs. M=.53, SD=.55; p<.001). 78712; tierney.ahrold@mail.utexas.edu
Results suggest that changes in SR may be the mediating C-123j
variable between the intervention and outcomes. Results with DOES PHYSICAL ACTIVITY PROMOTE POSITIVE BODY
regard to changes in SR, coupled with the group differences IMAGE IN RECENT WEIGHT LOSERS?
in PA, warrant further examination into whether SR mediates Meghan M. Senso, MS,1 Lauren A. Crain, PhD,1 Julie D.
changes in PA. It has been suggested that mediational analysis Anderson, MPH, RD,1 Marcia G. Hayes, MPH, RD,1 Brian C.
is the next step for PA interventions, in order to assess “what Martinson, PhD,1 Patrick J. O’Connor, MD, MPH,1 Robert W.
works” in terms of behavior change (Lewis, Marcus, Pate & Jeffery, PhD2 and Nancy E. Sherwood, PhD1,2
Dunn, 2002; Lubans, Foster, & Biddle, 2008). Previous research 1
HealthPartners Research Foundation, Minneapolis, MN and
has found various SCT factors to be mediating variables of in- 2
University of Minnesota, Minneapolis, MN.
creases in PA. The above results indicate that a similar relation- Physical activity (PA) is important in weight loss and weight
ship is worth exploring within this important at-risk popula- loss maintenance. While energy expenditure is key, potential
tion. psychological benefits of PA, including improved body image,
CORRESPONDING AUTHOR: Emily Martin, MS, Psychology, may also be influential. Our aim was to determine if PA is asso-
Virginia Tech, Blacksburg, VA, 24060; ecmartin@vt.edu ciated with markers of body image, body shape satisfaction and
weight dissatisfaction, independent of body mass index (BMI).
C-123i A secondary aim was to determine if the relationship between
ACUTE EXERCISE AMELIORATES SEXUAL SIDE EFFECTS PA and body image differs depending on PA intensity. This
OF ANTIDEPRESSANTS IN WOMEN analysis presents baseline data from Keep It Off, a randomized
Tierney K. Ahrold, MA, Rachel Zincone, BS, Sharon Stasney, BA controlled trial of a weight loss maintenance program, which
and Cindy M. Meston, PhD included participants who lost at least 10% of body weight.
Department of Psychology, University of Texas at Austin, In total, 419 participants completed baseline measurements
Austin, TX. (mean age = 47.0±10.8 yrs, 81.6% female, mean BMI = 28.4±5.0).
Antidepressant drugs, while widely prescribed, carry a number PA was reported via the Paffenbarger. Data was categorized
of side effects, including sexual side effects such as impaired into minutes of light PA (LPA) and moderate-to-vigorous PA
sexual arousal (for review, see Clayton, Keller, & McGarvey, (MVPA). Body shape satisfaction was assessed with the Body
2006). Acute exercise has been shown to increase sexual arousal Shape Questionnaire. Weight dissatisfaction was defined as
in healthy women (e.g., Meston, 2000); as such, there is reason the discrepancy between dream weight and actual weight. On
to believe an exercise intervention may help increase sexual average, participants reported 110.8±157.2min of MVPA and
arousal in women taking antidepressants as well. Extending 34.1±109.3min of LPA. Average weight dissatisfaction was
83
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
31.2±24.3lbs. MVPA was positively correlated with body shape CORRESPONDING AUTHOR: Kristin L. Schneider, PhD,
satisfaction (p<0.01). This remained significant after control- Preventive and Behavioral Medicine, University of Massachu-
ling for BMI and depression (p<0.05). MVPA was inversely setts Medical School, Worcester, MA, 01655; Kristin.Schneider@
associated with weight dissatisfaction (p<0.01), even after umassmed.edu
controlling for BMI and depression (p<0.05). Amount of LPA
was not significantly related to body shape satisfaction (p>0.05) C-123l
or weight dissatisfaction (p>0.05). The results suggest PA is ACTIVE TRANSITION: PILOTING A WEBSITE-DELIVERED
positively correlated to body image after recent weight loss PHYSICAL ACTIVITY INTERVENTION
independent of BMI and depression. A relationship between PA Matthew Y. Kwan, MSc and Guy Faulkner, PhD
intensity and body image may also exist, with greater levels of Exercise Sciences, University of Toronto, Toronto, ON, Canada.
MVPA most strongly associated with markers of positive body Emerging empirical evidence suggests that the transition from
image. Further research could determine if the protective effect high school to university is associated with drastic declines in
of PA on body image is associated with long-term weight loss physical activity behaviours (Kwan et al., 2009). Intervention
maintenance. efforts are necessary to attenuate such declines. The Medical
CORRESPONDING AUTHOR: Meghan M. Senso, MS, Health- Research Council recommends a systematic staged approach
Partners Research Foundation, Minneapolis, MN, 55440-1524; prior to implementation of complex interventions, including the
meghan.m.senso@healthpartners.com piloting of a developed intervention (BMJ, 2008). The purpose
of this study was to examine the usability and acceptability of a
C-123k developed physical activity intervention aimed at first-year uni-
VALIDITY OF THE 24 HOUR PHYSICAL ACTIVITY RECALL versity students. Drawing on principles of social cognitive the-
AMONG LATINOS ory (e.g., outcome expectancy, self-efficacy), this theory-based
Kristin L. Schneider, PhD,1 Yunsheng Ma, PhD,1 Barbara intervention is website-delivered as the internet is the most
Olendzki, RD,1 Phillip Merriam, MPH,1 Milagros C. Rosal, used source for students to obtain health information (Kwan et
PhD,1 Patty Freedson, PhD,2 Trinidad Tellez, MD3 and Ira al., 2009). Participants were 15 undergraduate students, and 7
Ockene, MD1 physical activity experts. After navigating the intervention, stu-
1
Preventive and Behavioral Medicine, University of dents and experts rated their acceptance and satisfaction with
Massachusetts Medical School, Worcester, MA; 2University of the interface on a 17-item questionnaire (Likert scale, 1= poor
Massachusetts-Amherst, Amherst, MA and 3Greater Lawrence to 7= excellent). Suggestions for enhancements, deletions and
Family Health Center, Lawrence, MA. additions were also solicited. Furthermore, students were also
While numerous questionnaire and interview assessments for asked to complete 7 navigational tasks for usability testing, and
measuring physical activity exist, few have been validated asked to rate the difficulty of each task (Likert scale, 1= hard
in non-English speaking populations. Of the two validated to 7= easy). Results indicated that both students (Mscores= 6.6
in Spanish speaking populations, neither used an interview to 6.8) and experts (Mscores= 6.2 to 6.8) gave the intervention
administered recall to measure physical activity. The present high ratings overall. In terms of usability, students exhibited
study sought to validate the use of a Spanish version of a 24 little difficulty with navigation on 6 of the 7 tasks (Mscores=
hour physical activity recall that was created and validated by 6.6 to 6.9). Overall, process of engaging students and experts
our team in a sample of Latino men and women (n=37) who in the formative stage of intervention development is critical
participated in a larger study that tested whether a diet and in confirming the acceptability of this web-based intervention,
physical activity intervention improved weight in Latinos at and has helped indentified the components needing refinement.
risk for diabetes. Participants in this substudy were asked to Future research will evaluate the feasibility and effectiveness of
wear accelerometers for at least 14 days, during which they website intervention.
completed three 24 hour physical activity recalls conducted CORRESPONDING AUTHOR: Matthew Y. Kwan, MSc, Exer-
in Spanish by a trained dietitian. Physical activity recall data cise Sciences, University of Toronto, Toronto, ON, M5S2W6;
was then matched with the accelerometer data via date. The matty.kwan@utoronto.ca
total metabolic equivalent (MET) was calculated for the physi-
cal activity recall data and the accelerometer data. Correlation C-123m
analyses were used to examine the association between METs WHY SKIP ROPE? WHY SKIP A MEAL? A THEORY DRIVEN
from 24 hour physical activity recall and accelerometer data EXAMINATION OF THE FACTORS THAT PREDICT EXERCISE
for participants and by gender, whether differences existed AND DIETARY RESTRAINT INTENTIONS AMONG FEMALE
between men and women. Results revealed a significant corre- UNIVERSITY STUDENTS
lation between the 24 hour physical activity recall and acceler- Sophie Rayner, BKinH and Chris Shields, PhD
ometer METs (correlation coefficient (r)=.30, p=.006). Although Acadia University, Wolfville, NS, Canada.
the sample sizes are small and unequal, men (n=5) reported Research suggests that while exercise levels among university-
stronger correlations between the physical activity recall and aged women are relatively low, dieting is a common approach
accelerometer METs (r=.60, p=.06), compared to women (n=32; to weight management in this population. This pattern of
r=.26, p=.03). The 24 hour physical activity recall assessment behavior is troubling as regular exercise has been repeatedly
has adequate validity among Latinos when conducted in Span- associated with multiple health benefits while dieting behav-
ish, and is comparable to that of physical activity assessment in- iors alone (e.g., dietary restraint-deliberately eating less) have
struments and validation studies conducted among Caucasians. been shown to be less effective in long term weight manage-
ment and can be associated with a number of negative health
84
outcomes. Understanding the factors that influence the exer- Feasibility for dissemination was evaluated by the ease of
cise and dietary choices of young women may help to inform recruiting participants, the ability for the program to be incor-
health promotion efforts for this population. This prospective, porated into prenatal care, the comfortableness of participants
observational study used the Theory of Planned Behavior as a with using a computer, and enthusiasm expressed during key
framework with which to examine the cognitions that influence informant interviews. Acceptability and feasibility data build
female university students’ intentions to exercise and to restrict confidence both that the program will be effective at impacting
dietary intake for weight management. Also of interest was the the health behaviors of women at a critical time and that it can
extent to which female university students may use diet or exer- be disseminated easily on a population-basis through several
cise as compensatory behaviors in weight management. Partici- distribution channels.
pants (N=194) completed baseline measures of attitudes, subjec- CORRESPONDING AUTHOR: Leanne Mauriello, PhD, Pro-
tive norms, and perceived behavioral control (PBC) concerning Change Behavior Systems, Inc., West Kingston, RI, 02892; lmau-
physical activity and dietary restraint. Intentions to engage in riello@prochange.com
exercise or dietary restraint were assessed at time 2. Participants
also indicated whether they would engage in dieting or exercise C-132a
as compensatory behaviors for weight management. Separate PREDICTORS OF ATTRITION IN A CLINICAL TRIAL FOR
regressions revealed that PBC was the only significant predic- WOMEN SURVIVORS OF CHILDHOOD SEXUAL ABUSE
tor (p=.001) of intentions to exercise (Model R2=.09, p=.001), Lisa Dawn Hamilton, MA, Christopher B. Harte, MA and Cindy
whereas attitudes was the only significant predictor (p=.001) of M. Meston, PhD
intentions to engage in dietary restraint (Model R2=.15, p=.001). Psychology, University of Texas at Austin, Austin, TX.
Further, 90% of participants indicated that they would try to This study examined predictors of participant dropout from a
compensate for eating unhealthy food with the majority (55%) clinical trial for the treatment of sexual problems in childhood
changing both their exercise and dietary behaviors. These find- sexual abuse (CSA) survivors. To our knowledge, this is the first
ings suggest that increasing young women’s PBC for exercise study to investigate associated characteristics of dropout among
and informing them about the risks of dietary restraint may CSA survivors participating in a randomized clinical trial. Of
help to promote the use of healthier and more effective ap- 130 women who enrolled in the study, 35 withdrew before the
proaches to weight management. completion of the psychological treatment, an attrition rate
CORRESPONDING AUTHOR: Chris Shields, PhD, Acadia Uni- of 27%. We examined the following predictors of attrition:
versity, Wolfville, NS, B4P 2R6; chris.shields@acadiau.ca demographics, sexual abuse characteristics (e.g., relationship to
abuser, age, abuse type), psychiatric symptoms and diagnoses,
C-127a coping style, sexual and relationship functioning, and treat-
HEALTHY PREGNANCY STEP BY STEP: ACCEPTABILITY ment condition (i.e., placebo, existing treatment, experimental
AND FEASIBILITY OF A MULTIPLE BEHAVIOR COMPUTER treatment). Multivariate logistic regression analyses revealed
TAILORED INTERVENTION FOR UNDERSERVED PREGNANT that age, education, coping style, and sexual abuse type (rape
WOMEN vs. sexual assault) were all significant predictors of attrition.
Leanne Mauriello, PhD, Sharon Dyment, MPH and Janice Specifically, women 32 years and older were significantly less
Prochaska, PhD likely to withdraw from the study compared to younger women
Pro-Change Behavior Systems, Inc., West Kingston, RI. (adjusted OR [AOR] = 0.32; 95% CI = 0.12, 0.85). Women with
Acceptability and feasibility findings will be presented from a higher levels of education (advanced degree vs. high school)
pilot test of a computer tailored intervention to promote health were also significantly less likely to drop out of the study (AOR
behaviors during pregnancy among a low-income, multi-ethnic = 0.036; 95% CI = 0.02, 0.86). Those who scored low on positive
population. Transtheoretical Model-based content offered preg- coping ability were less likely to withdraw compared to those
nant women assistance with smoking cessation, stress manage- who scored high in positive coping (AOR = 0.18; 95% CI = 0.04,
ment, and fruit and vegetable consumption. 0.77). Women reporting a history of rape during childhood
Pregnant women (N=87) were recruited from health clinics were significantly more likely to drop out compared to women
(mean age=24; 62% non-White, 22% married, 73% on Medicaid/ reporting sexual assault without intercourse (AOR = 3.53; 95%
Medicare, 78% with HS education or less). Women completed a CI = 1.16, 10.72). Treatment condition, psychiatric characteris-
16-item evaluation. tics, sexual functioning, and relationship quality did not predict
dropout. Women who experience CSA are a diverse popula-
The program was rated very positively with 89.7% to 95.5% tion with heterogeneous psychiatric presentations, which may
of participants agreeing or strongly agreeing with all items. explain the lack of association between psychiatric symptoms/
For example, 95.4% of respondents reported that: the program diagnoses and attrition. Researchers working with this popula-
could help them be healthier; they learned new information; tion of women can use these data to direct retention efforts at
and the program was designed for pregnant women like them. those who are more likely to discontinue study participation.
There were no significant differences in the ratings based on
demographic characteristics. Qualitative responses confirmed CORRESPONDING AUTHOR: Lisa Dawn Hamilton, MA,
acceptability for the program. Further, pre and post assessments Psychology, University of Texas at Austin, Austin, TX, 78757;
indicated an increase in intention to make behavioral changes ldhamilton@mail.utexas.edu
with women planning to smoke fewer cigarettes, to practice
more minutes of stress management, and to eat more servings
of fruits and vegetables.
85
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
86
and interaction with gender (b = -2.20, p <.05) when controlling C-143c
for drinking or using other drugs in the past 30 days, ratings of THE IMPACT OF A TOBACCO CONTROL INTERVENTION ON
behavioral undercontrol, peer and parental smoking, national- AFRICAN AMERICAN PARENTS’ SELF-EFFICACY FOR ANTI-
ity, and the importance of religion and academics. There was TOBACCO SOCIALIZATION IN THE HOME
a significant interaction (b = -.963, p <.05) between gender and Martha S. Tingen, PhD,1 Jeannette O. Andrews, PhD,4 Janie
subscale 3 (“affinity for ethnic identity and pride”). The find- Heath, PhD,3 Jennifer L. Waller, PhD2 and Frank A. Treiber,
ings indicate that generational status and ethnic identity/pride PhD1
may have different effects for males and females and subscales 1
Georgia Prevention Institute, Medical College of Georgia,
may differ in predicting smoking behaviors. Discussion of the Augusta, GA; 2Biostatistics and Informatics, Medical College
limitations and implications for tailoring health interventions is of Georgia, Augusta, GA; 3School of Nursing, Medical College
provided. of Georgia, Augusta, GA and 4College of Nursing, Medical
CORRESPONDING AUTHOR: Kate E. Murray, PhD, SDSU/ University of South Carolina, Charleston, SC.
UCSD Cancer Center Partnership, San Diego State University, Background: African American families continue to suffer dis-
San Diego, CA, 92120-4913; kmurray@projects.sdsu.edu proportionate health disparities related to tobacco use and ex-
posure. Children’s exposure to socialization factors in the home
C-143b that promote risk-taking behaviors are associated with early
FATE AS A MODERATOR: THE RELATION BETWEEN CAUSAL experimentation. Parents who are self-efficacious in establishing
ATTRIBUTIONS AND BEHAVIORS an anti-tobacco socialization environment can model expecta-
Kate E. Murray, PhD,1 Luz M. Garcini, MA,2 Jessica L. Barnack- tions and provide reinforcement for desired behaviors that may
Tavlaris, PhD1 and Elizabeth A. Klonoff, PhD1,2 serve as protective factors for tobacco abstinence.
1
SDSU/UCSD Cancer Center Partnership, San Diego State
University, San Diego, CA and 2Joint Doctoral Program in Purpose: This randomized control trial investigated the impact
Clinical Psychology, SDSU/UCSD, San Diego, CA. of a family approach in promoting parent’s self-efficacy in
establishing an anti-tobacco socialization environment in the
Fatalistic beliefs, in particular within ethnic minority groups, home.
have been highlighted as a barrier for individuals in reducing
unhealthy behaviors and participating in preventive care. The Methods and Results: The treatment arm included concur-
current study aims to identify the ways in which fatalistic be- rent school-based and home-based interventions that aimed to
liefs may moderate the relation between smoking as a causal at- promote skill development for making healthy behavior choices
tribution of illness and smoking behaviors. In the current study, related to tobacco prevention in children, promote parental self-
a total of 678 diverse undergraduate students (70% female) efficacy in anti-tobacco socialization in the home, and tailored
reported a mean age of 18.39 (SD = 3.47) with 111 participants parental cessation in parent smokers. The control arm included
(15%) identifying as current smokers. Participants were asked the traditional health curriculum for children, home-based
to rate a list of causal attributions of “disease/illness” on a 5 component of general health education for parents, and written
point scale (1 = not important at all, 5 = extremely important). self-help materials for parent smokers. Subjects (N=673) were
Overall, participants rated smoking as a very important cause 4th grade children (N=329) and parents (N=344) from rural and
of disease (M = 4.21, SD = 1.14) and fate as a less important urban settings in the southeastern U.S.A. The majority of homes
cause (M = 2.01, SD = 1.27). Logistic regression analyses pre- were single-parent (61%). The intervention group significantly
dicting current smoking were run to test main and interaction increased their parent self-efficacy scores in anti-tobacco social-
effects of fate and smoking as causal attributions of disease ization from pre to post (pre=63.1, post=65.1, p=0.0037) while
(centered on their respective means). There were no main ef- the control group remained the same (pre=65.7, post=65.0,
fects for smoking (b = -.147, ns) or fate (b = .042, ns); however, p=0.4399).
there was a significant interaction (b = .177, p <.05) between Conclusions: Study results suggest that a family approach that
smoking and fate. When probing the interaction, individuals fosters parents’ self-efficacy may be positive in promoting anti-
who rated smoking as an extremely important cause of disease tobacco socialization in African American homes.
(1 SD above the mean) were more likely to be current smokers CORRESPONDING AUTHOR: Martha S. Tingen, PhD, Georgia
as their ratings of fate as a cause of disease increased (b = .447). Prevention Institute, Medical College of Georgia, Augusta, GA,
The relation between smoking attributions and behaviors was 30912; mtingen@mcg.edu
the reverse (b = -.362) for individuals who rated smoking as a
less important cause of disease (1 SD below the mean). The find- C-143d
ings underscore that fatalistic beliefs may differentially influ- TO THINK OR TO FEEL: CONTROLLED VS. AUTOMATIC
ence individuals who attribute smoking as a cause of illness and PROCESSING AND THE EFFECTS OF EMOTIONAL HEALTH
those who do not. Further discussion of limitations and future COMMUNICATIONS
directions are provided. Amber R. Koblitz, MS and Kevin D. McCaul, PhD
CORRESPONDING AUTHOR: Kate E. Murray, PhD, SDSU/ Psychology, North Dakota State University, Fargo, ND.
UCSD Cancer Center Partnership, San Diego State University, For over 50 years, researchers have examined the persuasive
San Diego, CA, 92120-4913; kmurray@projects.sdsu.edu impact of fear on health behaviors. However, we still do not
know whether it is the information within fear messages or fear
itself that underlies the effectiveness of such communications.
In a broader sense, researchers continue to ask questions about
the difference between controlled (thoughtful) and automatic
87
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
(feeling) components of persuasion. This study used a process- up. Providers’ confidence in their ability to motivate and assist
ing manipulation to determine whether focusing on the stylistic smokers to quit increased significantly from baseline (M=3.00,
content or the emotional content of anti-smoking messages SD=0.94) to follow-up (M=3.60, SD=0.66), t(104)=-7.81, p<0.001.
influenced message effectiveness. Sixty-one nonsmoking (but Further, providers’ negative attitudes towards tobacco cessation
willing to smoke) college students (32 males and 29 females) decreased significantly, including both attitudes towards pro-
were randomly assigned to either a content processing (n = viding tobacco cessation interventions and general negative at-
30) or emotion processing condition (n = 31) and were given titudes towards patients being likely to quit at all (from baseline
explicit instructions about the aspects of the advertisement to (M=2.79, SD=0.59) to follow-up (M=2.54, SD=0.67), t(104)=4.21,
which they should attend. Students then viewed three emotion- p<0.001 and from baseline (M=2.53, SD=0.61) to follow-up
provoking anti-smoking advertisements. Two (Condition) X 2 (M=2.09, SD=0.55), t(104)=8.57, p<0.001, respectively).
(Gender) ANCOVAs, controlling for pretest levels of the depen- Conclusions: An online training program can impact knowl-
dent variable, showed that condition assignment was related to edge and attitudes about tobacco cessation and state QL
posttest automatic attitude scores, F(1, 51) = 4.49, p = .04, η2p services.
= .08. Following the ads, students in the emotion processing
condition were more likely to rate smoking-related pictures as CORRESPONDING AUTHOR: Kelly Carpenter, PhD, Talaria,
negative. There was also a nearly significant condition X gender Inc, Seattle, WA, 98125; kcarpenter@talariainc.com
interaction for the controlled posttest measure of willingness C-143f
to smoke, F(1, 53) = 3.44, p = .069, η2p = .06. Simple effects USING EMPIRICAL BINOMIAL HIERARCHICAL BAYESIAN
revealed that the processing goals failed to influence men dif- MODELING (EBHBM) TO DETERMINE WHETHER A
ferentially, but women in the emotion processing condition said BEHAVIORAL INTERVENTION WORKS WELL FOR SOME
they would be less willing to smoke in the future than women PARTICIPANT GROUPS BUT LESS SO FOR OTHERS
in the content processing condition, F(1, 53) = 4.37, p = .04, η2p Yuelin Li, PhD,1 Mariya Shiyko, PhD,2 Jack Burkhalter, PhD,1
= .11. These results suggest that women are especially respon- Susan Holland, MS,1 Ruthie Manna, MA1 and Jamie Ostroff,
sive to emotional content in persuasive messages and may PhD1
benefit from smoking prevention messages targeted towards 1
Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering
systems of automatic and emotional processing. Cancer Center, New York, NY and 2The Methodology Center,
CORRESPONDING AUTHOR: Amber R. Koblitz, MS, Psychol- Pennsylvania State University, State College, PA.
ogy, North Dakota State University, Fargo, ND, 58108; amber. Behavioral medicine intervention trials often recruit partici-
koblitz@ndsu.edu pants from multiple groups or clusters but randomize them
C-143e individually to the intervention conditions. We present a Bayes-
REFER 2 QUIT: WEB-BASED PROVIDER TRAINING IN ian approach to test moderation of treatment effect by clusters.
TOBACCO QUITLINE REFERRAL SKILLS Smokers newly diagnosed with cancer and scheduled for
Kelly Carpenter, PhD,1 Beatriz Carlini, PhD, MPH,2 Emily surgery were recruited from 7 oncology clinics and randomized
Dolan, PhD1 and Tasha Mikko, MSW1 individually into the Scheduled Reduced Smoking interven-
1
Talaria, Inc, Seattle, WA and 2Free & Clear, Inc., Seattle, WA. tion (SRS, N=96) or Standard Care (SC, N=89). Patients in SRS
Tobacco quitlines (QLs) provide evidence-based tobacco ces- were prompted to smoke by a handheld computer according
sation counseling, free of charge, to any US resident, yet they to an algorithm that reduced daily cigarette smoking up to a
remain underutilitzed. In order to increase referral to QLs, an prespecified quit date. Patients in SC received nicotine replace-
online provider training program, “Refer 2 Quit,” was devel- ment therapy and counseling. EBHBM used biochemically veri-
oped to educate healthcare providers about QLs and facilitate fied 24-hour point abstinence rates to estimate the difference
referral. The web-based CME/CE program includes case-based between the SRS and SC quit rates across clinics.
referral skills training modules tailored to specific healthcare Overall abstinence rates at hospital admission were 46% (40/89
provider types and settings. For the present project modules in SRS) and 45% (44/96 in SC), respectively. Disaggregated by
were developed for outpatient, inpatient and emergency de- clinics, the observed abstinence rates were: Breast (7/14=50%
partments and customized for Washington State’s QL. in SRS vs 2/8=25% in SC), Colorectal (3/8=38% vs 4/8=50%),
Method: Four healthcare centers in Washington State were Gastric (4/10=40% vs 5/9=56%), Gyn (5/11=45% vs 4/11=36%),
recruited to participate in a study testing the educational ef- Head & Neck (2/8=25% vs 5/9=56%), Thoracic (10/25=40% vs
fectiveness of Refer 2 Quit. Provider knowledge about tobacco 14/30=47%) and Urology (13/20=65% vs 10/18=56%). EBHBM
cessation and the QL as well as their attitudes toward providing used these observed quit rates to estimate the probability that
smoking cessation counseling to their patients were assessed SRS is more efficacious than SC: highest in Colorectal (88%),
before and after training. Providers in the sample (N = 105) followed by Breast (85%), Urology (71%), and Gyn (68%). By
were primarily Caucasian (90.5%) and female (81.9%) with a contrast, SRS was less efficacious for Gastric (28%), Thoracic
mix of provider types, including MD/DOs, NPs, and PA-Cs (33%), and Head & Neck (15%).
(20.1%), RNs (46.7%), and others such as RTs, MSWs and MAs SRS was less efficacious than SC in cancers strongly associated
(33.2%). with smoking, partly due to high cessation rates in SC only. Our
Results: Provider knowledge about the QL increased signifi- findings have methodological implications for future cessation
cantly after completing the program, from M=1.73 (SD=1.16) at trials, e.g., on providers’ knowledge/attitudes toward smoking
baseline to M=4.13 (SD=0.62), t(104)=-19.19, p<0.001 at follow- abstinence prior to surgery contributing to patients’ quitting
smoking.
88
CORRESPONDING AUTHOR: Yuelin Li, PhD, Psychiatry and cents, age 12 at 7th grade baseline, taking part in the four-year
Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, Montreal Adolescent Depression Development Project. GPA
New York, NY, 10022; liy12@mskcc.org was assessed twice yearly across the four years, from official
school records.
C-143g
SOCIAL INFLUENCE AND SMOKING CESSATION AMONG The best model had three GPA trajectory classes: Elevated
HOMELESS PERSONS (n=267, 36%), Moderate (n=388, 52%), and Low (86, 12%), with
Kathryn Goldade, PhD,1 Janet Thomas, PhD,1 Hongfei Guo, the proportion smoking at last follow for the three classes being
PhD,2 John Connett, PhD,2 Jasjit S. Ahluwalia, MD, MPH, MS1 7%, 15%, and 49%, respectively. Females were less likely have
and Kolawole S. Okuyemi, MD, MPH1 moderate than elevated GPAs. Participants repeating a grade
1
Medical School, University of Minnesota, Minneapolis, were more likely to have moderate and low than elevated
MN and 2Division of Biostatistics, University of Minnesota, GPAs, and low than moderate GPAs. Parental support (e.g.,
Minneapolis, MN. bonding) and democratic control (e.g., strict but legitimate
rules), and parental education decreased the odds of hav-
Despite progress, smoking rates remain very high among some ing moderate and low compared to elevated GPAs. Parental
underserved populations. Among the 4 million homeless per- education also decreased the odds of having low compared to
sons, the prevalence of cigarette smoking is an alarming 70%. moderate GPAs.
Social influence has previously been associated with smoking
behaviors and level of dependence among the general popula- The results suggest that when adolescents do well in school,
tion but little is known about the influence of other smokers they are less likely to smoke. Further, as low parental education
on smoking behaviors among homeless persons. We describe is a risk factor for poor educational outcomes and adolescent
social influence (defined as how many of their 5 best friends smoking, when adolescents do poorly in school, they may
smoke) and smoking behaviors among homeless persons predispose their future children to negative developmental
enrolled in a randomized clinical trial targeting NRT adherence outcomes including smoking. However, as parental support
and cessation using motivational interviewing (N=428). Partici- and democratic control reduce the likelihood of low academic
pants were recruited from homeless shelters and completed a achievement, teaching parents essential parenting skills may
baseline survey that included questions on demographics and help reduce the intergenerational transmission of smoking.
smoking by family and friends (social influences). To date, 142 CORRESPONDING AUTHOR: Daniel Rodriguez, PhD, Psy-
participants mean age (SD) 46.7 (7.91), 75% male, 25% African chiatry, University of Pennsylvania, Philadelphia, PA, 18938;
American, 6% employed, 72% at least a high school education, drodrig2@mail.med.upenn.edu
70% monthly income < $400, 89.4% smoked their first cigarette
within 30 minutes of awaking, average cigarettes smoked per C-143i
day (CPD) was 21.7 (SD=19.0) and 4.26 (SD=1.32) of “their 5 PSYCHOSOCIAL PREDICTORS OF SECONDHAND SMOKE
best friends smoke”. Results indicate that the number of friends EXPOSURE AMONG CHILDREN WITH CANCER
who smoke was correlated with CPD (r=0.18, p=0.033). Results Jody S. Nicholson, PhD,1 Vida L. Tyc, PhD1 and Shelly Lensing,
suggest that social influence might be considered when de- MA2
signing cessation interventions among homeless persons who
1
Behavioral Medicine, St. Jude Children’s Research Hospital,
smoke. Memphis, TN and 2Biostatistics, University of Arkansas for
Medical Sciences, Little Rock, AR.
CORRESPONDING AUTHOR: Kathryn Goldade, PhD, Family
Medicine and Community Health, University of Minnesota, Objective: Medically compromised children are at greater risk
Minneapolis, MN, 55414; kgoldade@umn.edu for the consequences of secondhand smoke exposure (SHSe)
as compared to their peers, which may increase how amenable
C-143h parents are to smoking cessation programs. The current study
ACADEMIC ACHIEVEMENT AND ADOLSCENT SMOKING: A investigated psychosocial variables (perceived stress/vulner-
GENERAL GROWTH MIXTURE MODEL (GGMM) ability, social support, and self-efficacy) that may be predictive
Daniel Rodriguez, PhD,1 Alexandre J. Morin, PhD2 and Michel of children’s SHSe as measured by parental self-report and
Janosz, PhD3 urine cotinine among a sample of pediatric cancer patients.
1
Psychiatry, University of Pennsylvania, Philadelphia, PA; Methods: Data were drawn from 135 families whose children
2
Psychology, Universite de Sherbrooke, Sherbrooke, QC, (Mdn=7.6 years old) lived with a smoker, were being treated for
Canada and 3Psychoeducation, Universite de Montreal, cancer, and were at least one month from diagnosis. Participat-
Montreal, QC, Canada. ing parents were 77% female, 80% white, 70% smokers and 50%
Research suggests academic achievement is associated with low SES. Psychosocial predictors were measured using reliable
a reduced likelihood of adolescent smoking. No study to our and well-validated measures administered to parents. Parents
knowledge has yet assessed the prospective relation between also reported on children’s exposure over a week from all
developmental trajectories of academic achievement (GPA) and smokers in the home. Children’s urine samples were analyzed
adolescent smoking, and what factors influence the relation. for cotinine levels, a biomarker of recent SHSe. Results: Per-
Using GGMM, we assessed if there are unobserved relatively ceived stress, social support, and perceived vulnerability were
homogeneous GPA classes, the factors predicting class member- non-significant. However, there was a 17% reduction in median
ship, and the effect of class membership on smoking (number of exposure for each unit increase in self-efficacy (p < .001). Ad-
cigarettes smoked weekly) at last follow-up. ditionally, each unit increase in self-efficacy was associated with
an 8% reduction in median cotinine levels (p=.002). Conclusion:
Participants were 741 non-smoking secondary school adoles-
89
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
90
ings were the least popular of the four trainings offered, and examined the stages of change across the scales of the Drink-
(2) Referrals to the quitline typically peaked one to two months ing Motives Questionnaire-Revised. Participants in the earlier
after trainings and slowly declined thereafter. Based on analysis stages reported drinking to coping and for enhancement rea-
of these data, systems work was prioritized within outreach sons. Implications of the findings will be discussed.
efforts, despite clinic requests for other more appealing services. CORRESPONDING AUTHOR: Rose Marie Ward, PhD, Miami
By building chart reminders, system protocols, and training University, Oxford, OH, 45056; wardrm1@muohio.edu
policies, organizational processes could force continued use of
the resources that staff were initially so excited to use. C-150b
Free & Clear designed the “Conceptual Framework for Systems THE RELATIONSHIP BETWEEN THERAPEUTIC ALLIANCE
Change Outreach” to help visualize the change process occur- AND MINDFULNESS IN AN MBRP PILOT STUDY
ing in clinics and hospitals. This framework, which draws on Andrew J. Kurz, BA (anticipated), Sarah Bowen, PhD and Alan
best practices from the U.S. Public Health Service Guidelines, G. Marlatt, PhD
suggests that outreach staff work as catalysts to motivate pro- Psychology, University of Washington, Seattle, WA.
viders (Knowledge Phase) to address tobacco use with patients. The quality of the client/practitioner therapeutic alliance (TA)
Champion providers experiment (Practice Phase), addressing has been demonstrated to predict outcomes in numerous thera-
tobacco use with patients that they are comfortable treating. peutic settings (Macneil et al., 2009; Martin, Garske, & Davis,
However, to truly reach the Impact Phase, where referral or 2000). The present research examined the relationship between
treatment becomes routine, clinics must change their funda- TA and mindfulness using Mindfulness-Based Relapse Preven-
mental system of care so that all providers address tobacco use tion (MBRP), a novel mindfulness-based aftercare approach
with all patients (Implementation Phase). The outcome of this (Bowen, Chawla & Marlatt, in press). Data were drawn from the
institutionalized change is increased referral or treatment, yield- MBRP pilot study (Bowen et al., 2009). Participants included 93
ing increased quit attempts. This cycle continues due to staff adults (64.5% male, with an average age of 40.8 (SD 10.2) years)
changes and other variable factors. with substance use disorders who had recently completed
CORRESPONDING AUTHOR: Gillian Schauer, MPHc, Clinical intensive inpatient or outpatient treatment in the Pacific North-
and Behavioral Sciences, Free & Clear, Seattle, WA, 98104; gil- west. Data were analyzed using stepwise linear regression,
lian.schauer@freeclear.com where TA was measured using the Working Alliance Inventory
(Horvath & Greenberg, 1989) and mindfulness was measured
C-150a using the Five Factor Mindfulness Questionnaire (Baer et al.,
VALIDATION AND EXTENSION OF THE TRANSTHEORETICAL 2006). Results indicated that TA and mindfulness were not sig-
MODEL BINGE DRINKING STAGING nificantly related at baseline assessment; however, TA predicted
Rose Marie Ward, PhD and Terri Messman-Moore, PhD mindfulness at post treatment and at the two-month follow-up.
Miami University, Oxford, OH. Specifically, high client rating of TA during the treatment pe-
The Transtheoretical Model was developed utilizing a popula- riod predicted greater utilization of mindfulness skills over the
tion of smokers. It has been extended to a variety of behaviors two months following the end of treatment. Results suggest the
including binge drinking. Other than basic measurement successful transmission of mindfulness skills to clients can be
development and interventions based on the stage construct, aided by fostering healthy and collaborative client/practitioner
investigations of the binge drinking Transtheoretical Model relationships.
constructs are limited. The purpose of the current investigation CORRESPONDING AUTHOR: Andrew J. Kurz, BA (antici-
is to examine the Transtheoretical Model’s binge drinking stage pated), University of Washington, Tukwila, WA, 98188; kurza@
of change construct with respect to commonly used measures in uw.edu
the field of heavy episodic drinking.
C-150c
As part of a larger study, 424 female college students completed REINFORCEMENT SENSITIVITY THEORY AND COLLEGE
a study on alcohol use and emotion regulation. The majority of STUDENT DRINKING
the sample reported being Caucasian, middle class, and single. Hyoung S. Lee, MA and John S. Wiebe, PhD
They had a mean age of 19.78 (SD = 1.30). Psychology, University of Texas at El Paso, El Paso, TX.
Replicating the relationship in the literature between the stages Mood has been commonly viewed as an important determi-
of change and the decisional balance inventory, a series oneway nant of drinking, but studies of positive and negative affect
ANOVA were found to be significant; Pros of Alcohol, F(5, 405) and alcohol use have reported inconsistent results. It has been
= 33.58, p<.001; Cons of Alcohol, F(5, 405) = 14.20, p<.001. Con- suggested that the relationship between negative affect and
sistent with theory, participants in the earlier stages (Precon- heavy or problematic drinking depends on individual vulner-
templation, Contemplation, and Preparation) had higher levels ability dimensions. Gray’s Reinforcement Sensitivity Theory
of the Pros of binge drinking and lower levels of the Cons of (RST) may provide a particularly useful framework in stud-
binge drinking than the later stages (Action, Maintenance, and ies about alcohol use, emphasizing personality, motivational
Non-heavy drinker). Validating the binge drinking stages of processes, and responses to particular environmental stimuli.
change, ANOVAs examining the Alcohol Use Disorders Iden- In past studies, the sensitivity of Gray’s Behavioral Activation
tification Test (AUDIT) and the Rutgers Alcohol Problem Index System (BAS) has been linked to alcohol use, but results have
(RAPI) were also significant; AUDIT, F(5, 391) = 67.13, p<.001; been less consistent for the Behavioral Inhibition System (BIS).
RAPI, F(5, 386) = 29.57, p<.001. Participants in precontempla- The aim of this study was to test the relationship between the
tion reported problematic levels of drinking above the cutoffs BAS/BIS, positive/negative affect and events, and alcohol use
for both scales. In addition, a statistically significant MANOVA
91
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
in 312 college students who reported alcohol use in the previous check Med schedules from anywhere(school, vacation), and
6 months. Neither positive and negative affect nor positive and using text message reminders. Barriers to using technology: no
negative life events were significantly related to heavy drinking free text messaging, inconsistent internet access, or already had
or problematic drinking in this sample. BAS sensitivity was sig- good system for Med taking. This innovative technology may
nificantly related to heavy drinking (e.g., the number of drinks improve medication management for adolescents who spend
on a typical day, r = .13, p < .05; the number of days with 5 or much time on internet and cell phones, and allows health care
more drinks, r = .22, p < .01), but not to problematic drinking providers to deliver updated medical information to patients
(i.e., the Short Michigan Alcoholism Screening Test). Converse- for immediate access at home.
ly, BIS sensitivity was significantly associated with problem- CORRESPONDING AUTHOR: Nataliya Zelikovsky, PhD,
atic drinking (r = .18, p < .01), but not with heavy drinking. Psychology Dept, La Salle University; The Children’s Hospital
Structural equation modeling was used to demonstrate that the of Philadelphia, Philadelphia, PA, 19141; zelikovsky@email.
interaction between the BIS and negative life events predicted chop.edu
problem drinking via negative affect (χ2/df = 2.405, CFI = .960,
NNFI = .962, RMSEA = .067). This study replicates past research C-155a
on the role of the BAS in heavy drinking, and clarifies the role PROFILE OF SUBJECTIVE EXECUTIVE FUNCTION
of the BIS as an individual difference moderating the effect of PROBLEMS IN PATIENTS WITH HEPATITIS C
negative life events on problem drinking. Jane Plagge, PsyD,1 Hannah Luber, BA,1,2 Daniel Kriz, MSW,1
CORRESPONDING AUTHOR: Hyoung S. Lee, MA, Psychol- Alex Mitchell, BS,1 J Renee Anderson, BA,1 Daniel Schwartz,
ogy, University of Texas at El Paso, El Paso, TX, 79968; hslee@ BA,1,2 David Lahna, BA,1,2 Jennifer Loftis, PhD,1,2 William
miners.utep.edu Hoffman, PhD, MD1,2 and Marilyn Huckans, PhD1,2
1
Portland VA Medical Center, Portland, OR and 2Oregon Health
C-153a and Science University, Portland, OR.
EVALUATION OF MEDACTIONPLAN.COM TO IMPROVE Background: Research has consistently shown patients with
ADHERENCE IN ADOLESCENT TRANSPLANT PATIENTS chronic hepatitis C (HCV+) perform significantly worse on ob-
Nataliya Zelikovsky, PhD,1,2 Corinne Bower, BA3 and Genevieve jective, neuropsychological tests of executive function than non-
Millet, BA3 infected controls (HCV-). To our knowledge, no research has
1
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, examined HCV+ patients’ subjective perceptions of their own
PA; 2Psychology, La Salle University, Philadelphia, PA and executive function. Objective: This study aimed to better charac-
3
Psychology, St. Joes’ University, Philadelphia, PA. terize the pattern of self-reported executive functioning prob-
MedActionPlan.com, a HIPAA compliant website assists pa- lems in HCV+ patients. It was hypothesized that HCV+ patients
tients and health providers to develop customized medication would self-report more problems with executive function than
(Med) management plans using Med calendars, checklists, spe- HCV- controls. Method: Participants were 44 treatment naive
cial instructions, email and text message reminders to refill and HCV+ patients (age = 52 ± 8 years; 75% male; 71% Caucasian;
take Meds. Study evaluated use of technology with adolescent education = 14 ± 2 years) and 28 demographically similar HCV-
transplant recipients to improve adherence. Participants used controls (age = 47 ± 15 years; 70% male; 61% Caucasian; educa-
website for 3 mos, and completed baseline and post assess- tion = 15 ± 3 years). Participants completed the Behavior Rating
ments of adherence (interviews, blood serum levels), surveys Inventory of Executive Function - Adult Version (BRIEF-A), a
of perceived barriers and beliefs about Meds, and a satisfac- well-validated, widely available self-report measure of execu-
tion survey. 40 patients ages 13-21 enrolled (M age=16.47, 50% tive function. Independent t-tests and Mann-Whitney U tests
male, 68% Caucasian). Website components use: 61% Med were conducted. Results: HCV+ participants scored significant-
calendar; 23% Med checklists; 60% text message reminder; 21% ly higher than HCV- controls on the Behavioral Regulation In-
email reminder; 18% refill reminder; 9% Med instructions; 9% dex and the Inhibit, Emotional Control, and Initiate subscales of
appointment calendar. Baseline mean adherence: 2.6% missed the BRIEF-A. Conclusions: HCV+ patients perceive themselves
and 3.8% late weekly doses; Post mean adherence: 1% missed as less capable of initiating tasks and regulating their behavior
and <1% late weekly doses. Standard deviations between Tacro- and emotional responses than HCV- patients. This is consistent
limus levels (indicator of adherence consistency): baseline 1.6 with research indicating HCV+ patients perform significantly
and post website .83. Paired t-tests showed significant reduction worse on neuropsychological tests of mental flexibility and rea-
in late doses [t(28)=3.68, p=.001] and more consistent lab levels soning when compared with HCV- patients. Studies have found
[t(21)=2.31, p=.03] after website. Non-adherence related to teen HCV+ patients undergoing pegylated interferon and ribavirin
issues with disease (forget, interferes, don’t like it) [r=.49, p<.01] treatment for HCV frequently miss treatment doses. Objective
and issues with Meds (taste, # pills, side effects) [r=.39, p=.01], and perceived problems with executive function may represent
belief about Med necessity [r=-.40, p=.02] and specific Med con- a barrier to treatment adherence in HCV+ patients. Additional
cerns [r=.46, p=.03]. Satisfaction survey: teens like using website studies are needed to determine whether reduced executive
for reference of Meds (regimen details, pictures), being able to function influences treatment adherence in HCV+ patients.
CORRESPONDING AUTHOR: Jane M. Plagge, PsyD, Portland
VA Medical Center, Portland, OR, 97217; janeplagge@yahoo.
com
92
Rapid Communications
Poster Session D
Saturday, April 10, 2010
8:30 AM – 9:45 AM
93
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
D-033a ing women with and without familial risk of breast cancer, we
AN EXAMINATION OF THE INTEGRATION OF MENTAL recruited samples of healthy women with (n=102) and without
HEALTH SERVICES IN ONCOLOGICAL CARE IN THE UNITED (n=71) a familiar risk (FR+/-) of breast cancer, all of whom re-
STATES AND AUSTRALIA ported elevated levels of general distress (breast cancer worry,
Catalina R. Lawsin, PhD perceived stress or mood) at study entry. Acute stress response
Psychology, Baruch College, New York, NY. to the cancer-Stroop task was assessed with self-reported acute
Introduction: Between one-third and one-half of patients ex- stress ratings (mini-POMS) and salivary cortisol sampling im-
perience clinically significant levels of psychological distress. mediately before performing the Stroop task and after com-
Despite the growing literature demonstrating the benefit of pleting the task (at least 30 minutes later). Acute self-reported
psychological interventions on cancer patients’ quality of life, stress increased significantly from before to after the task in
psychosocial services for the most part are not part of standard all women regardless of FR status (t(172)=-3.61, p<.001). Using
care in cancer care. Health care systems vary internationally linear regression with robust standard errors, we found a sig-
with respect to the amount of government assistance patients nificant interaction between FR status and the change in acute
receive for medical care as well as how hospitals are funded self-reported stress, indicating that greater stress and positive
and in turn what programs receive priority within each institu- FR status are associated with slower RTs on the cancer-Stroop
tion. Much can be learned from international partners on what task, controlling for age and verbal ability (p<.01). We did not
does and does not work regarding health program implementa- find significant cortisol reactivity (defined as the residualized
tion, in this case the provision of mental health services within change from before to after the task) to the Stroop task, control-
oncological care. ling for FR status. Further, cortisol reactivity was not associated
with performance on the cancer-word lists, controlling for FR
Methods: This study reviews the literature to examine the cur- status, age and verbal ability. Overall, these results suggest that
rent status of how mental health services are implemented and distress associated with completion of the cancer-word Stroop
utilized within oncological treatment in the United States and task may contribute to variability in performance, while a bio-
Australia. logical measure of stress response was not found to be related.
Results: Systemic and socio-cultural differences were found CORRESPONDING AUTHOR: Emily D. Dolan, PhD, Cancer
between the two countries with regards to implementation of Prevention, Fred Hutchinson Cancer Research Center, Seattle,
mental health services in oncological care. Reimbursement for WA, 98109; edolan@fhcrc.org
services differentiated the availability of psychosocial services
while perceptions of mental health services differed between D-033c
cultures, influencing uptake. PERCEIVED MISTREATMENT AND QUALITY OF LIFE IN
Conclusions: This study highlighted the systemic and patient AFRICAN AMERICAN WOMEN WITH BREAST CANCER
factors that influence implementation and uptake of psycho- Courtney Sullivan, BA, Thomas Merluzzi, PH D, Carolyn
social services in cancer care. Recommendations based on Heitzmann, MA and Errol Philip, MA
the strengths of the two systems will be discussed in effort to Psychology, University of Notre Dame, Notre Dame, IN.
inform the restructuring or development of medical programs Purpose: Many studies support the relationship between per-
that integrate psychosocial services to be cost-effective and con- ceived mistreatment (PM), particularly racism/discrimination,
sumer-friendly, thus raising the standard of multidisciplinary and poor health outcomes and quality of life (QOL). PM has
medical care and improving patients’ quality of life. been linked to high blood pressure, psychological distress, low
CORRESPONDING AUTHOR: Catalina R. Lawsin, PhD, infant birth weight, and lower satisfaction with breast cancer
Psychology, Baruch College, New York, NY, 10010; catalina. care. African American (AA) women with breast cancer may
lawsin@mssm.edu experience “triple jeopardy” (woman, Black, cancer patient)
therefore, PM may play a heightened role in their perceptions of
D-033b QOL The current study investigated the incidence of PM in AAs
SELF-REPORTED ACUTE STRESS, BUT NOT BIOLOGICAL with breast cancer and whether self-efficacy for coping (SEC)
REACTIVITY, IS ASSOCIATED WITH PERFORMANCE ON A and avoidant coping (AC) mediated the relationship between
CANCER-WORD STROOP TASK PM and QOL. Method: 179 AA women with breast cancer com-
Emily D. Dolan, PhD,1,2 Denise L. Albano, MPH,1,2 Bonnie A. pleted measures of PM (Interpersonal Mistreatment Scale, IMS),
McGregor, PhD,1,2 S. Tyler Medick, BS1 and Dana H. Bovbjerg, SEC (Cancer Behavior Inventory, CBI), Avoidant Coping (COPE
PhD3 scales), and QOL (Functional Assessment of Cancer Therapy,
1
Cancer Prevention, Hutchinson Center, Seattle, WA; FACT). For the IMS, participants rated the frequency of the
2
Health Services, University of Washington, Seattle, WA and types of maltreatment and endorsed the causes (e.g., race, sex).
3
Biobehavioral Medicine, University of Pittsburgh, Pittsburgh, Results: 50.7% of participants reported racial discrimination;
PA. 23.2% sex discrimination, and 18.8% ethnic discrimination. Re-
Two previous studies have found slower processing of cancer- gression analyses were used to test mediation effects. The direct
related words compared to neutral words in an emotional relationship between PM and QOL was significant (-.13**) but
Stroop color-naming task. Neither study found that chronic attenuated to non-significance (.07 ns) with the inclusion of AC;
measures of emotional distress were predictive of processing thus, AC fully mediated the relationship between PM and QOL
speed. Not assessed in either study, however, was acute bio- (PM->AC=.38**; AC->QOL=-14**). PM was not related to SEC
logical reactivity of the stress response to the task. Because the (.04 ns), although SEC was highly related to QOL (.41**) and AC
previous studies validated the cancer-Stroop task by compar- (-.42 **). Discussion: The negative experience of maltreatment
94
may contribute to avoidant coping, which, in turn, compro- D-033e
mises QOL; however, SEC may be a countervailing force that CULTURALLY RELEVANT CANCER RISK COUNSELING FOR
mitigates the negative effects of avoidant coping (caused by UNDERSERVED LATINAS
maltreatment) on quality of life. Gloria Juarez, PhD, Martin A. Perez, PhD, Kathleen Blazer, MS,
CORRESPONDING AUTHOR: Thomas V. Merluzzi, PhD, PhDc, Raquel Ogaz, BS and Jeffrey Weitzel, MD
Psychology, University of Notre Dame, Notre Dame, IN, 46556; Population Sciences, City of Hope, Duarte, CA.
tmerluzzi@sbcglobal.net Background: Latinas are as likely as the majority to have high
cancer risk associated with genetic predisposition to breast
D-033d cancer and ovarian cancer. Disproportionately underserved,
MEDICAL MISTRUST MEDIATES THE RELATIONSHIP Latinas have a compelling need for access to genetic cancer
BETWEEN ETHNIC GROUP MEMBERSHIP AND DEPRESSION risk assessment (GCRA) and cancer screening and prevention
SYMPTOMS IN MEN DIAGNOSED WITH PROSTATE CANCER measures
Natalie E. Bustillo, BS,1 Frank J. Penedo, PhD,1,2 Mikal Rasheed,
MS,1 Eric Zhou, MS,1 Catherine Benedict, BS,1 Mark Soloway, Objectives: The primary purpose of this project was to evalu-
MD,1,2 Bruce Kava, MD,2 Jose Szapocznik, PhD3 and Michael ate the effects of a culturally relevant GCRA intervention for
Antoni, PhD1,2 Latinas.
1
Psychology, University of Miami, Coral Gables, FL; 2Sylvester Methods: Four focus groups were conducted consisting of
Comprehensive Cancer Center, UM/ Miller School of Medicine, Latinas that have undergone GCRA. Participants completed
Miami, FL and 3Epidemiology, UM/Miller School of Medicine, a demographic questionnaire that included items assessing
Miami, FL. perceived cancer risk and satisfaction with GCRA. The focus
Although Hispanic (H) men have lower prostate cancer (PC) in- groups entailed a facilitated discussion of the key study vari-
cidence rates than Non-Hispanic Whites (NHW), they are more ables and other culturally relevant issues that may impact the
likely to experience poorer quality of life and lower survival GCRA intervention.
from PC even after controlling for age and cancer stage. Medical Results: The pre-GCRA period may be the most distressing
mistrust (MM) has been associated with poorer cancer screen- time for these women. Perceived sense of lack of information
ing practices and less satisfaction with care in cancer popula- and uncertainty about what to expect appeared to play a key
tions. However, limited work has examined the extent to which role in distress. Most women initially had negative expectations
MM impacts emotional well being following a PC diagnosis. (expecting the worse or bad outcome), but ultimately felt hope-
The present study examined ethnic group differences in MM ful that they could learn more about the GCRA process and
and depression in men recently diagnosed with PC. Sixty-one what it meant for them. Information was cited as the primary
men completed a baseline assessment before initiating PC- contributor to positive psychosocial outcomes_specifically
related treatment within 3 months of diagnosis. Participants’ increased locus of control and self-efficacy. The major cultural
mean age was 60.03 years (SD=10.67); 49% NHW and 51% H. themes identified were destino, religious and spiritual coping,
Measures included the CES-D scale and the Group Disparities how cultural attitudes and belief influence lack of information,
in Health Care subscale of the Group-Based Medical Mistrust community awareness, and public health issues.
Scale. Results showed that Hs reported higher levels of MM Conclusions: Preliminary data indicate that the pre-GCRA
and depression than NHWs, ethnic group membership (EGM) window may be most distressing for this population indicating
was associated with MM, and MM was associated with depres- that this may be the most appropriate time for psychological
sion scores (all p’s<.05). A mediation model was tested where intervention.
MM was hypothesized to mediate the relationship between
EGM and depression, controlling for relevant covariates. The CORRESPONDING AUTHOR: Gloria Juarez, PhD, Population
final mediation model was significant and showed that MM Sciences, City of Hope, Duarte, CA, 90732; gjjuarez@coh.org
accounted for 21.1% of the variance of depression at baseline, D-033f
F(1,57)=7.72, p<.01. The results suggest that MM may be a SOCIODEMOGRAPHIC FACTORS INFLUENCING BREAST
mechanism that explains how EGM is related to depression. HEALTH IN MINORITY FEMALES: BRIDGING THE GAP
H men may be at greater risk than NHWs to develop depres- Marissa C. Perales, BA,1 Georita Frierson, PhD,1,2 Kyle Deaton,
sion symptoms post-PC diagnosis as a result of higher levels of BA3 and Bernardine Pinto, PhD2
mistrust of the healthcare system. Future research should inves- 1
Southern Methodist University, Dallas, TX; 2Brown Medical
tigate ethnic group differences in MM and depression using a School, Providence, RI and 3University of North Texas, Denton,
longitudinal design and larger sample size. EGM as a risk factor TX.
for poorer adjustment post-treatment is an area that should also
be explored. Over the past decade, significant attention has been given to
sociodemographic factors that influence health behavior given
CORRESPONDING AUTHOR: Natalie E. Bustillo, BS, Univer- the disparities across racial/ethnic groups for health outcomes.
sity of Miami, Miami, FL, 33174; nescobio@gmail.com Continued research on the sociodemographics that influence
breast health behaviors among minority females is warranted.
Participants (N=68) were African-American (AA; 86.8%) and
Latina (13.2%) women (mean age=47.75,SD=14.38). Participants
completed a sociodemographic questionnaire and participated
in a 90-minute focus group. Univariate and multivariate logistic
95
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
regression models were applied to compare possible differences (p=0.005) when adjusted for all other factors. Unadjusted age
in adjusted and unadjusted odds of health behaviors. (p=0.01) and having had a family member recommend mam-
Logistic regression models compared participants who per- mography (p=0.04) were statistically significant. However,
formed vs. did not perform BSE; have a healthcare provider adjusted outcomes were marginally significant (p=0.07 and 0.06,
vs. not; received a mammogram vs. not; and participate in respectively)
health-related research vs. not. Age, education, race/ethnicity, CONCLUSION: In this population, we found that education
and marital status were included in each model. For participat- and age were not as significant as expected. We also found that
ing in research, multivariate analyses found education to be family member recommendations were somewhat significant,
significant (OR)= 21.08, 95%CI=1.83-242.85). For BSE, univariate indicating a possible factor to implement in future interven-
analyses found race/ethnicity (OR=6.83, 95%CI=1.26-37.16) and tions. Future studies should consider conducting this analysis
marital status (OR=5.63, 95%CI=1.16-27.31) to be significant. using a larger sample as this study may have been limited by
Multivariate analyses confirmed that marital status (OR=9.51, low variability in age and education.
95%CI=1.06-85.37) and age (OR=4.87, 95%CI=1.07-22.22) were CORRESPONDING AUTHOR: Rachel M. Ceballos, PhD, Fred
statistically significant predictors of BSE. Women characterized Hutchinson Cancer Research Center, Seattle, WA, 98117; rce-
as older, Latina (univariate analysis), and married/partnered ballo@fhcrc.org
were more likely to perform BSE.
Although our small sample potentially restricted power to D-033h
detect consistent associations between univariate and multivari- WEIGHT CONTROL NEEDS AMONG RURAL BREAST CANCER
ate models, findings confirmed previously identified sociode- SURVIVORS
mographic factors that influence health behaviors in the AA Christie Befort, PhD,1 Heather Austin, MS, RD1 and Jennifer
community and extends to the Latina community. These initial Klemp, PhD2
findings may improve clinical recommendations/interventions
1
Preventive Medicine and Public Health, University of Kansas
in this population. Medical Center, Kansas City, KS and 2Medical Oncology,
University of Kansas Medical Center, Kansas City, KS.
This research was partially supported by a R25 Training Sup-
plement awarded to Georita M. Frierson, PhD from The Miriam Obese breast cancer (BrCa) patients have a 1.5 to 2.5 increased
Hospital/Brown Medical School. risk of recurrence and death compared to their normal weight
counterparts. Rural women constitute nearly 20% of women in
CORRESPONDING AUTHOR: Marissa C. Perales, BA, Psychol- the U.S., and they suffer from disparities related to both BrCa
ogy, Southern Methodist University, Dallas, TX, 75251; mpera- and obesity. Women from the most rural counties are 1.6 times
les@smu.edu more likely to be obese compared to women in metropolitan
D-033g counties. Despite this, rural women are under-represented in
THE IMPACT OF PHYSICIAN RECOMMENDATIONS ON research on weight control among BrCa survivors, and very
MAMMOGRAPHY SCREENING IN HISPANIC WOMEN LIVING little is known about their interest and perceived need for
IN A RURAL AREA weight control services. This needs assessment survey was
Noah L. Espinoza, BCH,1 Rachel M. Ceballos, PhD,1 Ilda Islas, mailed to rural BrCa survivors treated within the past 6 years at
BA,1 Genoveva Ibarra, BA1 and Beti Thompson, PhD1,2 one of 3 cancer centers in rural Kansas. The survey was accom-
1
Fred Hutchinson Cancer Research Center, Seattle, WA and panied by a cover letter from the patients oncology provider
2
Health Services, University of Washington, Seattle, WA. along with a small cash incentive. Survey items assessed breast
cancer history, general survivorship needs, weight history, and
OBJECTIVE: This study examined correlates of mammogra- interest in weight management services. Of the 1111 surveys
phy use among Latino women in the Lower Yakima Valley of that were delivered, 859 were completed and returned for a
Eastern Washington State. BACKGROUND: Mammography response rate of 77%. Respondents were 66.0 ± 13.0 years old,
screening has been established as an effective way to reduce the had been treated for BrCa on average 3.2 ± 2.6 years previously,
mortality rate of breast cancer through early detection and early and 83.2% had non-metastatic disease. Among six services
treatment. Since Latinas are less likely to engage in mammogra- assessed (support group, mental health services, lymphedema
phy, finding factors related to increased mammography use is treatment, exercise and diet program, personal training, and
a critical part of developing effective interventions in an effort secondary prevention trials), an exercise and diet program was
to reduce breast cancer health disparities. METHODS: A total the most commonly reported need (endorsed by 43.6% of the
of 87 Hispanic women aged 40-79 participated in this study. total sample). Patients had a mean BMI of 28.9 ± 6.7 kg/m2 and
This data was part of a larger project investigating the effect of 68.8% were overweight or obese (BMI > 25 kg/m2). Among
a breast cancer education program (Home Health Party) on psy- non-metastatic patients, 25.6% reported gaining greater than 5
chosocial factors. These analyses were conducted on the base- kg since being diagnosed with BrCa. Among overweight and
line data of the larger project. Factors examined included age, obese patients, 62.2% indicated they were currently attempt-
education, having some form of health insurance, and whether ing weight loss, and 65.0% were interested in learning about a
or not a physician or a relative had recommended mammog- weight management intervention study. The high response rate
raphy to the participant. The outcome variable was whether or indicates a general interest in follow-up care among rural BrCa
not the participants reported ever having had a mammography. survivors, and the findings highlight the need and interest in
Logistic regression was used to analyze the data. RESULTS: weight control programs.
Having had a physician recommend mammography was the
only statistically significant correlate of the outcome variable CORRESPONDING AUTHOR: Christie Befort, PhD, Preven-
tive Medicine and Public Health, University of Kansas Medical
Center, Kansas City, KS, 66205; cbefort@kumc.edu
96
D-033i Older Americans have many health concerns, including hyper-
AFRICAN AMERICAN WOMEN’S BREAST CANCER tension, arthritis, and heart disease, which may affect cancer
PREVENTION INFORMATION BELIEFS screening behavior. Research suggests that doctors’ recommen-
Heather Edwards, PhD, MPH dations are key predictors of cancer screening behavior, yet it
SAIC-Frederick, Inc., Rockville, MD. is unclear whether these comorbidities result in more screen-
Introduction ings for patients due to more encounters with doctors, or fewer
because patients have competing health priorities and barriers
African American women are less likely than white women to screening.
to be diagnosed with breast cancer but those who do get the
disease are more likely to die from it. Health communicators Purpose
explore ways to decrease such disparities through education This study’s purpose was to elucidate the relationship between
about breast cancer prevention and detection. comorbid conditions and cancer screening in the older popula-
The Internet is a popular source of health information and tion. We reviewed published literature with two research ques-
offers opportunities to deliver tailored information to at-risk tions in mind:
groups. To maximize benefit, health communicators need to un- 1. What does the literature reveal about older people’s attitudes
derstand potential users’ beliefs about and applications of that about screening when they are managing other health condi-
information. Research has investigated how African American tions?
women with breast cancer diagnoses use the Web for cancer 2. How do older people with comorbid conditions make deci-
information but has not thoroughly explored this population’s sions about screening?
prevention information-seeking beliefs and behavior.
Methods
Method
PubMed searches were performed for five combinations of
This study was a qualitative, grounded theory exploration of terms related to cancer screening, comorbid and chronic condi-
African American women’s beliefs about breast cancer preven- tions, and older adults. Relevant articles to the study had a
tion and the Internet as a source of prevention information. A patient attitudinal or preference component and included indi-
snowball sample of women without personal histories of breast viduals aged 65 and over with chronic physical illnesses. Of the
cancer resulted in nine interviews conducted in 2009. Three 630 results, 35 articles met our criteria.
women had family histories of the disease.
Results & Conclusions
Results
The literature review led to two categories of findings. The first
The women said the Internet would be a good source of breast was an assessment of the existing studies’ methods opportuni-
cancer information if they needed it, but most did not express ties/abilities to answer this study’s research questions. The
this need due to low perception of personal risk. Women had second category includes actual findings from the review that
many misconceptions of the disease and screening, includ- provide recommendations for future research. Conflicting
ing that having a mammogram could prevent a woman from findings about screening behavior in people with comorbidities
getting breast cancer and that women without family histories suggest the need for further research with new methods or the
were not at risk. addition of new questions on existing surveys.
Internet users believed they could find information they need- CORRESPONDING AUTHOR: Heather Edwards, PhD, MPH,
ed, however accounts of past searches for health topics hinted SAIC-Frederick, Inc., Rockville, MD, 20852; edwardshm@mail.
at a low understanding of Web site source credibility, consistent nih.gov
with literature about average users’ site credibility evaluation
skills. Outcomes of the study were recommendations for health D-033k
communication and promotion campaigns targeting African LONGITUDINAL STUDY OF THE INFLUENCE OF FALSE-
American women with breast cancer prevention messages. POSITIVE MAMMOGRAPHY RESULTS
CORRESPONDING AUTHOR: Heather Edwards, PhD, MPH, Jessica T. DeFrank, MPH,1,2 Barbara K. Rimer, DrPH,1 Michael
SAIC-Frederick, Inc., Rockville, MD, 20852; edwardshm@mail. Bowling, PhD,1 Jo Anne Earp, ScD,1 Erica S. Breslau, PhD3 and
nih.gov Noel T. Brewer, PhD1,2
1
UNC Gillings School of Global Public Health, Chapel HIll,
D-033j NC; 2Lineberger Comprehensive Cancer Center, Chapel Hill,
CANCER SCREENING ATTITUDES IN OLDER ADULTS WITH NC and 3Division of Cancer Control and Population Sciences,
COMORBID CONDITIONS National Cancer Institute, Bethesda, MD.
Heather Edwards, PhD, MPH1 and Erica S. Breslau, PhD2 BACKGROUND: Understanding potential harms from mam-
1
SAIC-Frederick, Inc., Rockville, MD and 2National Cancer mography is important as we contemplate new screening
Institute, Rockville, MD. guidelines. If screened regularly, as many as one-half of U.S.
Background women will have abnormal mammography results that re-
USPSTF guidelines provide colorectal, cervical, and breast quire additional follow-up but in which cancer is not detected
cancer screening age recommendations but also emphasize (false-positive result). This longitudinal study explored behav-
individuals’ health status as a factor in weighing screening risks ioral and psychological effects of false-positive mammography
and benefits. Older Americans (65 years and older) and their results.
physicians should consider preferences, health, and quality of
life concerns when deciding when to cease screening.
97
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
METHODS: We analyzed medical claims records and self- Few (24%) described treatment effects or care coordination as
report data gathered as part of an intervention trial to increase motivating their follow-up care seeking behavior. Implications
repeat mammography adherence among insured North Caro- from this research suggest that psychosocial interventions may
lina women. The sample included 2406 insured women who be useful in educating patients about the comprehensive nature
had mammograms upon study entry and completed telephone of survivor care and the importance of health seeking behaviors
interviews. Study participants were predominately white (88%), that entail more than simply monitoring for recurrence and
married (79%) and many had college educations or more (65%). surveillance for new cancers. These findings may help guide the
We analyzed data using logistic regression. design and tailoring of survivor health care plans that enhance
RESULTS: About 8% of women had received false-positive re- extended follow-up care behaviors in cancer survivor popula-
sults within the previous 14 months. Among women who said tions.
their physicians had not advised them to get mammograms, CORRESPONDING AUTHOR: Shawna Hudson, PhD, The
those who received false-positives were more likely to have no Cancer Institute of New Jersey, New Brunswick, NJ, 08903-2681;
subsequent mammogram on record compared to women who hudsonsh@umdnj.edu
received normal test results (18% vs 7%, OR=3.17, 95% CI=1.30-
7.71). However, among women who reported physician recom- D-033m
mendations, receipt of false-positive results was not associated PREDICTING BREAST CANCER SURVIVORS’ PHYSICAL
with adherence to subsequent screening. Receipt of false-posi- QUALITY OF LIFE FROM DEPRESSIVE SYMPTOMS AT THE
tive results was also associated with more breast cancer worry ONSET OF TREATMENT
(p<.001), lowered beliefs in mammography accuracy (p=.003), Joy M. Fairbanks, MS,1,2 Jovier D. Evans, PhD,2,4 Silvia M.
and thinking more about the benefits of regular screening Bigatti, PhD2,3 and Kathy D. Miller, MD5
(p<.001), regardless of physician recommendation. In mediation
1
Psychology and Psychiatry, Mayo Clinic, Rochester, MN;
analyses, none of these variables explained the association of
2
Department of Psychology, IUPUI, Indianapolis, IN;
false-positives and screening behavior.
3
Deparment of Public Health, IUPUI, Indianapolis, IN;
4
Geriatric Research Branch, NIMH, Bethesda, MD and 5School
DISCUSSION: Women who receive false-positive mammogra- of Medicine, Indiana University, Indianapolis, IN.
phy results, coupled with lack of physician recommendations
for screening, are at risk for non-adherence to regular screening. Breast cancer patients are at an increased risk for depression
and anxiety. The presence of depression and anxiety at the
CORRESPONDING AUTHOR: Jessica T. DeFrank, MPH, early stages of treatment may negatively influence response
Health Behavior and Health Education, UNC Gillings School of to treatment and ultimately physical health. This longitudinal
Global Public Health, Chapel HIll, NC, 27599; defrank@email. study sought to determine whether symptoms of depression
unc.edu and anxiety near the onset of treatment would predict physical
D-033l quality of life (HQOL) in breast cancer survivors. Twenty-six
BREAST AND PROSTATE CANCER SURVIVOR DECISION- patients were evaluated as part of a larger study. Participants
MAKING FOR SEEKING LONG-TERM CANCER FOLLOW-UP were predominantly Caucasian (89%), well-educated (M years
CARE of education = 14.81, SD = 3.21), and approximately 50 years
Shawna Hudson, PhD,1,2 Suzanne M. Miller, PhD,2 Jennifer in age (SD = 11.23). Initial assessments occurred following
Hemler, MA,1 Jennifer Lyle, MA,2 Antoinette R. Tan, MD1 and surgery. More than half (n = 15) received chemotherapy and 11
Robert DiPaola, MD1 underwent radiation or surgery alone. Women were later re-as-
1
The Cancer Institute of New Jersey, New Brunswick, NJ and sessed following treatment completion and approximately 5.46
2
Fox Chase Cancer Center, Philadelphia, PA. years post-diagnosis. Depression, anxiety, and health-related
QOL were assessed with the CES-D, the Spielberger State-Trait
Cancer follow-up beyond active treatment is important but Anxiety Inventory and the RAND-36 Health Status Inventory.
understudied. Essential components of extended cancer man- Depression and anxiety appeared to be examining a similar
agement include not only cancer surveillance and intervention construct (i.e., emotional well-being), as reflected in the high
for late and long-term treatment effects but also care coordina- correlations between these variables. Given that depression was
tion to meet the survivor’s health needs. Yet, it is unclear how most highly correlated with HQOL, this data only is presented.
patients understand and factor these aspects of cancer care into At all time periods, CES-D scores were moderately to highly
their follow-up decision making and care seeking behaviors. related to HQOL (r’s = -.432, -.511, and -.740 respectively). A re-
This qualitative study explores these issues among breast and gression examined the predictive power of baseline depression
prostate cancer survivors who received treatment either at a on follow-up HQOL, controlling for baseline HQOL. Results
comprehensive cancer center (54%) or a community hospital revealed that initial depression predicted HQOL at follow-
(46%). Forty-two semi-structured depth interviews (24 Breast, up, even after controlling for education as a covariate. These
18 Prostate) were conducted with early stage (I or II) survivors. findings support the view that breast cancer patients should be
Interviews lasted 45-90 minutes, were audio-taped and tran- assessed for symptoms of depression at the onset of treatment.
scribed. Interviews were coded independently by two research- Addressing emotional well-being from the onset would likely
ers who used consensus to resolve discrepancies. Length of improve treatment outcomes.
survivorship ranged from 2-5 yrs (33%), 6-9 yrs (36%) or 10+
yrs (31%). Two main themes were identified across the inter- CORRESPONDING AUTHOR: Joy M. Fairbanks, MS, Psy-
views. The majority of survivors (83%) had narrow definitions chology and Psychiatry, Mayo Clinic, Rochester, MN, 55901;
of follow-up that focused primarily on cancer surveillance. fairbanks.joy@mayo.edu
98
D-033n County, Wisconsin, completed a self-administered question-
INTENTIONS AND ACTIONS OF PROSTATE CANCER naire on BCC screening history, knowledge, and barriers prior
SCREENING IN IMMIGRANT BLACK MEN to their participation in the program. Study participants (Mean
Stacy N. Davis, MPH, Övgü I. Kaynak, MsEd and Stephen J. age = 35 years, SD = 11) were mostly low-educated (34.9% had
Lepore, PhD completed high school or higher), foreign born (93%), monolin-
Public Health, Temple University, Philadelphia, PA. gual Spanish speaker (65%), and uninsured (70%). About 37%
Black men in the United States bear an excess burden of pros- of women (40 and over) reported having had a mammogram
tate cancer (PCa). The choice to test for PCa is a preference and 58% reported having had a Pap smear within the last 12
sensitive decision and very little attention has been paid to how months. Lack of knowledge regarding BCC screening recom-
testing intentions get translated into actions. This study sought mendations was frequent, particularly regarding mammogram
to identify the variables that distinguish PCa testing intentions initiation age (53%); mammogram frequency (19.6%); and who
and actions in immigrant black men. This secondary analysis should have regular Pap smears (19.3 - 35.7%). On a 0-10 scale,
included 246 black men 45 - 71 years old from NYC, benefi- knowledge about risk and protective factors for breast (Mean
ciaries of a health insurer that covers PSA testing, that were = 5.4, SD = 2.1) and cervical cancer (Mean = 4.7, SD = 2.5) was
randomized to the control arm of a trial designed to promote relatively low. The main barriers to having regular mammo-
informed decision making about prostate cancer testing. Men grams and Pap smears were concern that the test would be
were interviewed twice over an 8-month period and medical expensive (68.3% and 53.9%, respectively); fear of an abnormal
claims for PSA tests were submitted for 78 participants. Three result (61.2% and 50%, respectively); lack of English fluency
groups of men were compared: “disinclined abstainers” at (38.3% and 32.2%, respectively); and concern that the test would
time 1 did not intend to get tested and did not test at time 2 be painful (38.2% and 29.8%, respectively). About 59.7% and
(n= 86), “inclined abstainers” at time 1 did intend to test, but 20.3% did not know where to go for a mammogram or Pap
had unverified testing at time 2 (n=94), and “inclined actors” smear, respectively. These results underscore the need for
at time 1 did intend to test and had a verified testing at time 2 interventions to promote adherence to BCC screening among
(n=32). Results revealed that “inclined actors” are significantly low-acculturated Latinas. These efforts need to be culturally
more likely than disinclined abstainers and inclined abstain- appropriate and address both cognitive and structural barriers
ers to have heard of PCa testing (p=.002), specifically DRE prevalent among this population.
(p=.005), have higher PCa testing knowledge (p=.05), perceived CORRESPONDING AUTHOR: Ana Martinez-Donate, PhD,
higher benefits of testing (p=.000), are more likely to believe Population Health Sciences, University of Wisconsin - Madison,
that benefits of testing outweighed risks of testing (p=.001), are Madison, WI, 53726; martinezdona@wisc.edu
more likely to have physician recommendation to get tested
(p=.000). Disinclined abstainers are more likely to not have had D-033p
a DRE in the past (p=.007) and believe they are less likely to get FORGIVENESS AND REDUCED RISK OF CANCER ONSET
PCa (p=.005) compared to other groups. PCa worry, absolute Amy D. Owen, PhD2 and Loren L. Toussaint, PhD1
PCa risk, age, and self-efficacy to communicate with physician
1
Luther College, Decorah, IA and 2Duke University Medical
were not able to distinguish PCa testing intention and action Center, Durham, NC.
in this population. This research highlights the need to identify Several studies have identified relationships between forgive-
variables that distinguish PCa testing intentions among differ- ness and health, but few, if any, have prospectively explored
ent groups men in order to develop interventions which allow potential associations between forgiveness and cancer. In
black men manage their PCa risk in a manner consistent with this study, longitudinal data from a nationally representative
their testing preferences. sample of older adults was analyzed to investigate the effects
CORRESPONDING AUTHOR: Stacy N. Davis, MPH, Public of forgiveness on self-reported onset of cancer. At wave 1,
Health, Temple University, Philadelphia, PA, 19122; stacy. 1500 participants completed face-to-face interviews, and 1024
davis@temple.edu follow-up interviews were completed three years later at wave
2. Relationships were assessed between wave 1 forgiveness and
D-033o control variables (socio-demographic, health behaviors, psy-
BREAST AND CERVICAL CANCER SCREENING AMONG A chosocial, religious/spiritual) and wave 2 self-reported onset of
COMMUNITY SAMPLE OF LOW-ACCULTURATED LATINAS cancer in the past year. Bivariate results found that self-forgive-
Ana Martinez-Donate, PhD,1 Lina Vera Cala, MD, MS,1 Rhea ness, unconditional forgiveness of others, and feeling forgiven
Vedro, MA,2 Rosario Angulo, BS2 and Tanya Atkinson, MSSW2 by others were all significantly associated with onset of cancer.
1
Population Health Sciences, University of Wisconsin - While higher levels of self-forgiveness (OR = .71, p < .05) and
Madison, Madison, WI and 2Planned Parenthood of Wisconsin, feeling forgiven by others (OR = .59, p < .01) were associated
Inc., Madison, WI. with lower odds of cancer onset, higher levels of unconditional
Early detection is critical to reduce breast and cervical cancer forgiveness of others was associated with higher odds of cancer
(BCC) morbidity and mortality. Latinas are less likely to adhere onset (OR = 1.78, p < .05). The effects of self-forgiveness and
to BCC screening guidelines than other ethnic groups. This unconditional forgiveness of others were reduced to nonsignifi-
study examines adherence to BCC screening recommenda- cance in multivariate analyses. However, the effect of feeling
tions among a community-sample of low-acculturated Latinas. forgiven by others (OR = .53, p = .01) was robust, predicting
Latino women (N=153) participating in Taking Care of Me subsequent self-reported cancer onset even after controlling
(Cuidándome), an ongoing communitywide intervention to for socio-demographic, psychosocial, religion/spirituality, and
decrease barriers to BCC screening among Latinas in Dane health behavior variables. In summary, associations of self-
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31st Annual Meeting & Scientific Sessions
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100
tions between HBPM usage, depression, medication adherence, 0.001), less depressive symptoms (Beta =-0.145, p=0.009), and
health literacy and sociodemographic variables. Adherence was older age (Beta=0.157, p=0.003). Gender and educational status
measured with Morisky scale, with scores >0 indicating non- were not associated with HBPM usage. There was no significant
adherence. Depressive symptoms were measured with PHQ-9 correlation with health literacy. Conclusion: Providing HBPM
and Health Literacy was assessed using the Rapid Estimate of to low-income African American populations will significantly
Adult Literacy in Medicine. All analyses were performed with improve their usage toward recommended goals. Also, initially
SPSS 18.0. Results: Among the 411 patients in the intervention focusing HBPM resources on patients who have demonstrated
arm, mean age = 56.6, 68% were women and 26% had more better medication adherence may increase yield on usage. The
than high school education. HBPM was successfully used by relationship between nonadherence and usage may be medi-
56%; 50% were non-adherent; 16% were depressed (PHQ-9 ated by depressive symptoms.
score = 10 or greater); and the mean REALM = 57. HBPM usage CORRESPONDING AUTHOR: Sherley Abraham, MD, General
was positively associated with older age (Odds Ratio (OR) = Internal Medicine, NYU School of Medicine, New York, NY,
1.04, p=.035); employment (OR = 2.59, p=.022); and being born 10016; sherley.abraham@nyumc.org
in the United States (OR = 2.31, p=.049). Usage was nega-
tively associated with medication non-adherence (OR = 0.69, D-046a
p=.019), and having more than high school education (OR = ADOLESCENT PROBLEM SOLVING SKILL AND PARENTAL
0.34, p=.020). Gender, health literacy, depression and smoking MONITORING MODERATE SELF-CONTROL DEFICITS ON
status were not associated with HBPM use. Conclusion: HBPM METABOLIC CONTROL IN TYPE 1 DIABETICS
use was prevalent among hypertensive African Americans, and Amy E. Hughes, BS,1 Cynthia Berg, PhD1 and Deborah Wiebe,
was associated with better medication adherence. In contrast to PhD2
other populations, HBPM use was more common among older 1
Psychology, University of Utah, Salt Lake City, UT and
African American patients with less than high school education. 2
Psychology, UT Southwestern, Dallas, TX.
These results indicate more research may be needed to facilitate Successful management of type-1 diabetes during adolescence
HBPM use among younger, unemployed African Americans necessitates complex adherence behaviors along with avoidance
with poorly controlled hypertension. of health-compromising behaviors. Deficits in self-control are
CORRESPONDING AUTHOR: Joseph Ravenell, MD, New noted risk factors for decreased behavioral self-regulation and
York University School of Medicine, New York, NY, 10010; increased risk-taking in healthy adolescents (Steinberg, 2005).
joseph.ravenell@nyumc.org Self-control deficits may also influence diabetes management.
The present study explored potential protective factors that
D-038d may compensate for low self-control, diabetes problem-solving
PSYCHOSOCIAL CORRELATES OF CHECKING BLOOD skill, and parental monitoring, and also determined if these
PRESSURE AT HOME moderating effects on metabolic control were mediated by ad-
Sherley Abraham, MD herence behavior. One hundred and ninety adolescents (M Age
General Internal Medicine, NYU School of Medicine, New York, = 13.52, SD = 1.52, 54.4% females) diagnosed with type 1 diabe-
NY. tes completed the Brief Self Control Scale (Tangney, Baumister
Home blood pressure monitoring (HBPM) is a standard recom- & Boone, 2004), the Self-Care Inventory (La Greca, Follansbee
mendation for management of hypertension. The psychosocial & Skyler, 1990), a diabetes specific problem-solving measure
correlates of HBPM use are limited, especially among African (Shaevitz & Berg, 2001), and a parental monitoring question-
Americans who bear a disproportionate burden of hyperten- naire (Berg et al. 2008). Metabolic control was measured via gly-
sion. Methods: This study was a part of CAATCH, a practice- cosolated hemoglobin (HbA1c) obtained from medical records.
based trial of BP control in hypertensive African Americans, in Regression analyses revealed significant interactions between
which patients from 30 primary care sites were randomized to self-control and problem solving skill, mothers’ general and dia-
lifestyle counseling, HBPM, and physician audit vs. usual care. betes monitoring, and fathers’ general monitoring on HbA1c.
Study methods have been published previously (Circulation Problem-solving skill was more facilitative of better HbA1c
2009;2:249-256). Data analyzed in this study included baseline for teens with low self-control. Parental monitoring also was a
socio-demographics, health literacy, depression and medication protective factor for HbA1c, but predominantly for those with
adherence. HBPM use was captured at 4 visits during the trial low self-control. Although adherence partially mediated the
via automated BP devices and patient diaries, and usage was relationship between self-control and HbA1c, adherence did not
measured on a scale of 0 to 4, with a score of 4 indicating HBPM mediate the relationships of the interactions discussed above
usage data at 4 visits. Adherence was measured with Morisky with HbA1c. These results suggest that despite the fact that
scale, with scores >0 indicating non-adherence. Depressive poor self-control is associated with worse adherence, the pro-
symptoms were measured with PHQ-9 and Health Literacy tective aspect of diabetes problem-solving skills and parental
was assessed using the Rapid Estimate of Adult Literacy in monitoring on HbA1c does not occur through better adherence,
Medicine. Multivariate analyses were performed with SPSS but through different monitoring for better metabolic control,
18.0. Results: This study was limited to 411 patients in interven- especially for adolescents experiencing poor self-control.
tion arm (age 57, 69 % female, 61% high school education or CORRESPONDING AUTHOR: Amy E. Hughes, BS, Psycholo-
greater, mean BP 149/91 mmHg). HBPM was used by 56% of gy, University of Utah, Salt Lake City, UT, 84112; amy.hughes@
the patients, mean adherence score 2.27, PHQ score 4.48, and psych.utah.edu
REALM score 57. Analyses revealed greater HBPM usage was
associated with better medication adherence (Beta=-0.204, p<
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31st Annual Meeting & Scientific Sessions
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102
or moving, were correlated with higher BDI scores (t=.170, D-060c
p=.043, n=142). Conclusions: HIV+ individuals who had goals A RANDOMIZED CLINICAL TRIAL OF A COPING
and identified a larger amount of goals were more likely to IMPROVEMENT GROUP INTERVENTION FOR HIV-INFECTED
have lower levels of depression as well as stress hormone. In OLDER ADULTS
addition, those individuals who listed social goals were more Timothy Heckman, PhD,1 Kathleen J. Sikkema, PhD,2,3 Nathan
likely to have lower levels of depression and anxiety. Individu- Hansen, PhD,2 Arlene Kochman, LCSW2,3 and Victor Heh, PhD1
als seeking to better their living situation had more depression. 1
Geriatric Medicine, Ohio University College of Osteopathic
Additional research is needed to further understand these Medicine, Athens, OH; 2Yale University School of Medicine,
relationships. New Haven, CT and 3Duke University, Durham, NC.
CORRESPONDING AUTHOR: Lindsay M. Bira, BS Psychol- Objectives: To test if a 12-session coping improvement group
ogy, Psychology, University of Miami, Miami, FL, 33133; lbira@ intervention (n=104) reduced depressive symptoms in HIV-in-
psy.miami.edu fected older adults compared to an interpersonal support group
intervention (n=105) and an individual therapy upon request
D-060b (ITUR) control condition (n=86).
CULTURE AND PUBLIC HEALTH: FACTORS BEHIND SAFER
SEX PRACTICES AMONG MEN WHO HAVE SEX WITH MEN Design: A randomized clinical trial with 4- and 8-month follow-
(MSM) up.
Anne Pendygraft, MA Methods: Participants were 295 HIV-infected men and women
Psychology, University of Colorado Denver, Denver, CO. 50-plus years of age living in New York City, Cincinnati, OH,
The purpose of the current study was to assess the cultural fac- and Columbus, OH. Most participants were African Ameri-
tors that comprise sexual behaviors amongst Latino men who can (49%) and male (67%). The average participant was 55.3
have sex with men (MSM) compared to other ethnic groups. years of age (range=50 to 76), had completed 13.0 years of
HIV rates are comparably higher among Latinos than White education, and had been living with HIV for 12.5 years. Fifty-
MSM. Therefore, more research is needed to understand this one percent of participants self-identified as gay or bisexual.
public health trend. The study collected data on 268 MSM and Forty-four percent of participants self-reported taking one
looked at a variety of sexual behaviors including serosorting, or more psychotropic medications at pre-intervention (most
strategic positioning, disclosure rates, and rates of HIV testing. commonly anti-depressants and anxiolytics). Using A-CASI
It compared these behaviors between ethnicities and identified assessment methodology, participants provided data on their
cultural trends. Overall, it was found that compared to non- depressive symptoms using the Geriatric Depression Screening
Latinos, Latinos participants partook in more public health risk Scale (GDS) at pre-intervention, post-intervention, and 4- and
behaviors such as getting tested less for HIV (χ2(2) = 26.089, p < 8-month follow-up.
.001) and disclosing their HIV statuses less often (χ2(3) = 18.235, Results: Whether conducted with all participants (N=295) or
p < .001). Such behaviors were correlated with traditional mas- only a subset of participants diagnosed with mild, moderate, or
culine attitudes and lower rates of acculturation. For instance, severe depressive symptoms (N=171), mixed models analyses
it was found that within Latino participants, endorsement of of repeated measures found that both coping improvement and
traditional masculine attitudes negatively correlated with HIV interpersonal support group intervention participants reported
disclosure rates (r = -.323, p < .001), HIV test rates (r = -.276, significantly fewer depressive symptoms than ITUR controls at
p < .001), and acculturation to mainstream American culture post-intervention and both follow-ups. At no assessment period
(-.461, p < .001). The high rates of both traditional masculine did coping improvement and interpersonal support group
attitudes and public health risk behaviors in Latino participants intervention participants differ in depressive symptoms.
indicate that the public health message aimed for the average Implications: Twelve-session coping improvement and interper-
American male is not reaching this subpopulation; specifically sonal support group interventions produce greater reductions
those that may possess more Machismo traits. The results of in depressive symptoms in HIV-infected older adults compared
this study signify that different approaches are needed to target to an individual therapy upon request control condition.
Latino MSM for prevention campaigns that may not identify
with gay culture due to high rates of Machismo. More creative CORRESPONDING AUTHOR: Timothy Heckman, PhD, Geri-
approaches are needed to seek out Latino MSM who carry atric Medicine, Ohio University College of Osteopathic Medi-
internalized homophobia and who may discriminate against cine, Athens, OH, 45701; heckmant@ohiou.edu
the gay community. Due to the limitations of this study’s data D-065a
collection method (at openly gay venues), future studies should GENDER DIFFERENCES IN PURSUING WEIGHT CHANGE:
use different data collection methods to incorporate MSM who BEHAVIORAL PREFERENCES AND NUTRITIONAL HABITS
do not identify as gay. Luz M. Garcini, MA,1 Kate Murray, PhD,2 Jessica L. Barnack-
CORRESPONDING AUTHOR: Anne Pendygraft, MA, Uni- Tavlaris, PhD2 and Elizabeth A. Klonoff, PhD1,2
versity of Colorado Denver, Broomfield, CO, 80020; annie167@ 1
SDSU/UCSD JDP, SDSU/UCSD JDP in Clinical Psychology,
gmail.com San Diego, CA and 2SDSU/UCSD Cancer Disparities
Partnership, San Diego, CA.
Men and women are frequently dissatisfied with their weight;
therefore, dieting is widespread (Oakes,et al.,2003). Unfortu-
nately, dieting is often ineffective, particularly when unhealthy
103
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
dieting approaches and poor nutritional habits are involved overeating and not exercising (77% vs. 73%, p=0.032). Seekers
(Markey & Markey, 2005). The present study evaluated gender were also more likely to participate in physical activity, try to
differences in pursuing weight change among 1119 ethnically lose weight in the past year, and eat more fruit and vegetables
diverse students (802 women and 317 men), including behav- (p<0.0001, for all comparisons).
ioral preferences to weight change and nutritional habits (i.e., Conclusions: Methods for increasing internet use for healthy
reading ingredient lists and nutritional labels). Results from lifestyle information among vulnerable populations should be
Chi squares showed a significant gender difference was found considered. The barrier is not entirely access since individuals
in present efforts to change weight, χ2(2,n= 1119)=228.89, p in our study used the internet. Those who perceive themselves
<.001,phi=.45. Specifically,61% of women were presently trying to be overweight, and perceive weight to be due to internal,
to lose weight with 3% trying to gain weight, whereas 23% of controllable causes tend to seek the internet for healthy lifestyle
men were trying to lose weight with 28% trying to gain weight. information. Seekers also tend to self-report better outcomes.
Men reported to be more satisfied with their present weight Future analyses will examine mechanisms whereby internet use
(49%) than women (36%). Men and women had similar behav- is associated with dietary and physical activity behavior.
ioral preferences to lose weight (i.e., eat fewer calories/less fat
(74% vs. 87% respectively), exercise (90% vs. 83%), and skip CORRESPONDING AUTHOR: Elaine R. Lipscomb, PhD,
meals (33% vs. 45%). Also, women were found to prefer taking Roudebush VA Medical Center, Indianapolis, IN, 46202; lip-
diet pills (17%) with men preferring to eat special products scome@iupui.edu
(11%). To gain weight, behavioral preferences included eating D-080a
special products (48% vs. 10% respectively) and exercising (83% FAMILY PREDICTORS OF WEIGHT CONTROL BEHAVIORS IN
vs. 50%). One-way, between-groups MANOVA showed small, OVERWEIGHT AND OBESE YOUTH
but statistically significant gender differences in nutritional Megan Crawford, BA and David Janicke, PhD
habits, F (2,1122)=7.70,p =.000,Wilks’ Lambda=.99; partial eta Clinical and Health Psychology, The University of Florida,
squared=.014. An evaluation of mean differences showed that, Gainesville, FL.
regardless of the small effect size, both groups were “never” or
“rarely” reading ingredient lists on foods and nutritional labels. As childhood obesity rates rise, more children experience
Discussion will consider findings in terms of relevance to the pressure to lose weight. Oftentimes, weight loss attempts are
development of dieting interventions, limitations of the study, unsupervised by healthcare professionals, leaving families to
and directions for future research. make their own decisions about the use of weight control be-
haviors (WCBs). When children choose to use unhealthy WCBs,
CORRESPONDING AUTHOR: Luz M. Garcini, MA, SDSU/ there are consequences such as eating disorder development,
UCSD JDP, SDSU/UCSD Joint Doctoral Program in Clinical malnutrition, and weight gain. Research shows that overweight
Psychology, San Diego, CA, 92130; lgarcini@righttodream.org children are more likely to engage in unhealthy WCBs when
D-065b compared to their healthy peers. However, little data exists to
INTERNET HEALTH INFORMATION-SEEKING AND DIETARY help identify children at risk for engaging in unhealthy WCBs.
AND PHYSICAL ACTIVITY BEHAVIORS The current study aims are to (1) describe the use of WCBs in
Elaine R. Lipscomb, PhD1 and David Haggstrom, MD, MAS1,2 overweight youth. (2) determine if family functioning is related
1
Health Services Research & Development, Center for to the use of unhealthy and healthy WCBs. Participants were 57
Implementing Evidence-based Practice, Roudebush VA Medical overweight or obese youths, ages 10-17 (mean age=13 years),
Center, Indianapolis, IN and 2Regenstrief, Indianapolis, IN. and their parents attending a regularly scheduled medical
appointment. Child height and weight was measured, which
Background: Health information-seeking behavior is often was then used to calculate body mass index (BMI). Families
recognized as an important step in an individual’s decision to completed the Demographic Questionnaire, Weight Control Be-
participate in healthy behaviors. havior Checklist, Family Assessment Device, Conflict Behavior
Purpose: To compare demographic characteristics and beliefs Questionnaire, and Family Mealtime Questionnaire. Pearson’s
(antecedents) of internet users who seek diet, weight, and correlations were conducted and children who were older
physical activity information online (seekers) to internet us- (r=.321, p<.05) and heavier for age and gender (r=.422, p<.01)
ers who do not seek this type of information online. We also reported increased use of unhealthy WCBs. While general fam-
wanted to examine whether seekers were more likely to pursue ily functioning was not related to WCBs, children who reported
healthy dietary and physical activity behaviors (outcomes). We positive family mealtime interactions reported fewer unhealthy
hypothesized seekers would report better outcomes. WCBs (r=-.4, p<.01). This effect was maintained in a hierarchical
Methods: We used chi-square and Wilcoxon to test associations regression after controlling for age and BMI z-score (R-square
between self-reported use of online diet, weight, and physical change=.085, p<.05). These data suggest that family interactions
activity information and both antecedents and outcomes from specific to mealtime environments are an important factor in
the 2007 Health Information National Trends Survey. children’s use of unhealthy WCBs rather than general family
functioning. Future research should focus on further identifying
Results: 36% of respondents used the internet for help with types of family interaction patterns which are related to both
diet, weight, and physical activity. Seekers were younger, more healthy and unhealthy WCBs to develop targets for interven-
educated, non-smokers, had higher income, and reported being tion.
overweight more (p<0.0001, for all comparisons). Seekers were
more likely to believe that physical activity decreases cancer CORRESPONDING AUTHOR: Megan Crawford, BA, Clinical
risk (74% vs. 64%, p<0.0001) and that obesity is caused by and Health Psychology, The University of Florida, Gainesville,
FL, 32610; mjcrawford@phhp.ufl.edu
104
D-080b Methods: Semi-structured interviews were conducted with
PARENT-CHILD COMMUNICATION AND MONITORING 30 primary care patients to elicit perspectives about the de-
AROUND HEALTHY EATING PRACTICES: A QUALITATIVE velopmental course of pain and weight symptoms, associated
STUDY USING PHOTOVOICE physical/psychosocial impact, and treatment status and history.
Margaret K. Pendzich, MSPH,1 Laura Haak-Marcial, BA2 and All participants reported BMI ≥ 30 and persistent pain (average
Bernard F. Fuemmeler, PhD, MPH1 intensity ≥ 3, scale 0-10), and a grounded theory approach was
1
Community and Family Medicine, Duke University Medical used to analyze interview results.
Center, Durham, NC and 2Information and Library Science, Results: Emerging themes include the role of depression in
University of North Carolina, Chapel Hill, NC. magnifying pain; hedonic qualities of food to sooth physical
The rise in adolescent obesity prevalence is a top public health pain; altered dietary choices and binge eating in response to
priority. Although there is a mounting effort to address early pain; and low motivation for and subsequently reduced physi-
childhood obesity, less attention has been directed at devel- cal activity due to pain. Obese individuals suggested that the
oping prevention and intervention efforts for older children. presence of depression magnified their experience of pain and
Knowing how children and their parents interact prior to and made weight loss more difficult. Participants described using
during adolescence (10 - 16 years) is pivotal to the develop- food to self-soothe, such that they ate more frequently, ate larg-
ment of family-based obesity prevention interventions. The er amounts, and chose less healthful items in response to pain
goal of the study was to 1) gather qualitative data on parenting or a combination of pain and low mood. Several participants
practices, specifically communication and parental monitoring described their daily activities as very sedentary and involving
around healthy eating practices, and 2) assess the usability of a good deal of ‘screen time’ with low motivation to engage even
smartphones with this population. PhotoVoice methodology in activities of daily living. Participants described eating as the
was used to enhance focus group participation. Fourteen child- only activity that brings regular pleasure, and something to ‘fill
parent dyads (M age of children = 12 years; range 10-16; 57% the time’ when they are home, inactive, and in pain.
African American) used the camera function of the Nokia N95 Conclusion: Results have important implications for clinical
smartphone to document a week of food habits and a pedom- providers and suggest pathways by which obesity, pain, and
eter app to track their daily steps. Focus groups were conducted depression may interact and negatively impact quality of life
at the conclusion of the week. Several themes emerged with and engagement in health risk behaviors.
general agreement between parents and children. Communi-
cation about healthy eating or unhealthy snack consumption CORRESPONDING AUTHOR: E. Amy Janke, PhD, Depart-
tended to be non-existent, confrontational, or the subject of ment of Behavioral and Social Sciences, University of the Sci-
negotiation for behavioral compliance. Monitoring and rule- ences in Philadelphia, Philadelphia, PA, 19477; e.janke@usp.edu
setting structure around children’s patterns of eating varied D-080d
between a lack of structure where children and parents made PILOTING AN OBESITY EXPERT SYSTEM: INITIATING
independent food choices to more highly structured interac- CHANGE BY INITIATING DIALOGUE
tions, such as collaborative meal planning and eating together Andrew DeMott, BA,1 Stephanie W. Russell, MPH,1 Jennifer
as a family. Both parents and children reported a sense of raised Duncan, PsyD,1 E. Amy Janke, PhD2 and Bonnie Spring, PhD1
consciousness regarding food choices as a result of the photo- 1
Northwestern University, Chicago, IL and 2University of the
voice exercise. This study offers insight into parent and child Sciences in Philadelphia, Philadelphia, IL.
views regarding food choices within the family. The acceptabil-
ity data from the use of smartphones suggests that this may be Introduction: The Veterans Administration (VA) faces an
a well received modality for family-based interventions for this obesity epidemic much greater than the general population’s.
hard to reach group. VA and public health guidelines advise providers to offer brief
behavioral counseling (the 5A’s—Assess, Advise, Agree, Assist,
CORRESPONDING AUTHOR: Bernard F. Fuemmeler, PhD, Arrange) to all obese patients. Yet few providers perform the
MPH, Community and Family Medicine, Duke University Medi- most potent 5A’s: Assist by referring to VA standard weight-
cal Center, Durham, NC, 27710; bernard.fuemmeler@duke.edu loss treatment (the MOVE! Program) and Arrange a follow-
D-080c up visit. The Obesity Expert System (OES) was developed to
“THE MORE PAIN I HAVE, THE MORE I WANT TO EAT”: activate patient-provider communication in shared decision-
IMPACT OF CO-MORBID PAIN AND OBESITY ON DIETARY making about weight loss. The aim of this pilot study is to
BEHAVIOR AND PHYSICAL ACTIVITY examine the OES’ impact on PCP performance of the obesity
E. Amy Janke, PhD1,2 and Andrea T. Kozak, PhD3 5A’s, especially Assist and Arrange.
1
Department of Behavioral and Social Sciences, University Method: Appointment lists of 8 PCP’s were reviewed for
of the Sciences in Philadelphia, Philadelphia, PA; 2CMC3, candidates with a BMI ≥ 25 and no prior MOVE! enrollment.
Hines VA Hospital, Hines, IL and 3Department of Psychology, Eligible candidates completed the OES assessment on a laptop
Oakland University, Rochester, MI. just prior to their PCP appointment. The OES assesses obesity-
Background: Despite co-prevalence of obesity and chronic pain, relevant information and produces an individualized report for
little is known about shared health risk behaviors that may con- both patient and PCP prior to their appointment. The one-page
tribute to their joint development and maintenance. report summarizes the patient’s weight, medical conditions,
barriers, and readiness to change weight. PCPs and participants
Objectives: Explore the multidimensional nature of co-occurring completed an exit interview to evaluate acceptability and 5A
pain and obesity, examine shared health risk behaviors, and performance.
guide practitioners in providing effective care.
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
Results: Data were collected from 9 participants and their PCPs. CORRESPONDING AUTHOR: Nicole Kahhan, MS, Depart-
Data show that PCPs stated they Assisted and Arranged on ment of Clinical and Health Psychology, University of Florida,
100% of visits. Patient data reports Assist and Arrange were Gainesville, FL, 32607; nkahhan@phhp.ufl.edu
performed on 88.9% of visits. Qualitative data suggests accept-
ability of the OES was very high, with 8/9 participants indicat- D-080f
ing a preference for daily use or use before every PCP visit. All MEDIATORS OF WEIGHT LOSS IN A MULTI-SITE
participants (100%) report they enjoyed interacting with the RANDOMIZED TRIAL OF A COMMERCIAL WEIGHT LOSS
OES and feel it is an effective way to communicate with their PROGRAM
PCP. Nancy E. Sherwood, PhD,1 Cheryl Rock, PhD, RD,2 Shirley Flatt,
PhD,2 Njeri Karanja, PhD3 and Cynthia Thomson, PhD, RD4
Discussion: The rate of 5A’s implementation achieved in this 1
HealthPartners Research Foundation, HealthPartners Research
pilot is greater than usual, although PCPs and patients differed Foundation, Minneapolis, MN; 2Department of Family and
in agreement about completion of all 5A’s. While further study Preventive Medicine, School of Medicine University of
is needed, decision-support tools such as the OES show promise California, San Diego, San Diego, CA; 3Kaiser Permanente
as a means to facilitate PCP performance of the 5A’s. Center for Health Research, Portland, OR and 4Department of
CORRESPONDING AUTHOR: Andrew DeMott, BA, North- Nutritional Sciences, University of Arizona, Tucson, Tucson,
western University, Chicago, IL, 60611; a-demott@northwest- OR.
ern.edu Background: Successful weight loss and maintenance is chal-
D-080e lenging, underscoring the need to better understand media-
PEER VICTIMIZATION, WEIGHT STATUS, AND CHILDREN’S tors of short and long-term success. Disinhibition and restraint
USE OF UNHEALTHY WEIGHT CONTROL BEHAVIORS have been linked with disturbed eating patterns, but also with
Nicole Kahhan, MS, Lindsay Baird, n/a and Crystal Lim, PhD weight loss success. Several restraint (flexible, rigid) and dis-
Department of Clinical and Health Psychology, University of inhibition (internal, external)dimensions have been identified;
Florida, Gainesville, FL. examining which are associated with success has important
implications for designing effective programs. These analyses
Unhealthy weight control behaviors are a major concern among examine whether dimensions of restraint, disinhibition and
youth, posing a serious threat to their physical and psychologi- hunger are mediators of weight loss in women enrolled in a
cal well-being. The adoption of these behaviors is related to a randomized clinical trial of a commercial weight loss program.
combination of environmental, psychological, and biological Method: Adult women (n=442) were randomized to one of
risk factors, for example, peer interactions. Few studies have three treatment arms, Jenny Craig (JC) Centre-based, JC Direct
focused on the direct link between peer victimization (PV) (phone-based), and usual care (UC) and are being followed for
and unhealthy weight control behaviors, nor have the possible 24 months. Baseline,6 and 12 month data are presented here.
buffering effects of positive social interactions on this relation- Sub-scales from the Eating Inventory, including Total, Internal
ship been studied. The purpose of this study was: (1) to exam- and External Disinhibition, Total, Flexible, and Rigid Restraint,
ine and describe unhealthy weight control behaviors and PV and Total, Internal Locus and External Locus Hunger, are exam-
in children as they differ by gender and/or weight status and ined as mediators of 6- and 12-month weight change. Results:
(2) to determine if positive social interactions serve to moder- Treatment group weight change differences were observed
ate the relationship between PV and unhealthy weight control at 6 (JC=-8.9 kg (sd=5.0) vs UC=-3.1 kg (sd=5.0), p < .005) and
behaviors. Participants were 107 children, ages 7-17 and their 12 months (JC=-9.9 kg (sd=7.6) vs UC = -2.8 kg (sd=6.7), p
parent(s) recruited from a pediatric primary care clinic. Par- < .0003). External disinhibition and total, rigid, and flexible
ents completed a demographic form. Children completed the restraint were significant mediators of 6-month weight change.
Revised Peer Experience Questionnaire, the Child/Adolescent Significant mediators of 12-month weight change included
Dietary Questionnaire, and the Social Experience Question- total (β=-0.77), flexible (β=-.346), and rigid (β=-.086) restraint.
naire. PV rates and unhealthy weight control behaviors did not Conclusions: Results suggest that external disinhibition and
differ by gender. Children who were overweight or obese dem- multiple aspects of restraint are important mediators of weight
onstrated higher rates of disordered eating than those who were loss. Future analyses will examine these constructs as mediators
not overweight. Total PV differed based on weight status such of long-term maintenance.
that those of higher weight status reported more victimization.
PV rates predicted 14.4% of the variance in weight control be- CORRESPONDING AUTHOR: Nancy E. Sherwood,
haviors, with higher rates of victimization related to increased PhD, HealthPartners Research Foundation, HealthPart-
use of unhealthy weight control behaviors. Moderator analyses ners Research Foundation, Minneapolis, MN, 55440-1524;
found that prosocial support did not moderate the relationship Nancy.E.Sherwood@HealthPartners.com
between victimization and weight control behaviors. Results D-083a
suggest that both children with higher rates of PV and those WORK OR RELATIONS? CORRELATIONS BETWEEN
of higher weight status report more unhealthy weight control BURNOUT AND THE CAUSES OF OVERTIME WORK
behaviors. Additionally, children of increased weight status re- Hao W. Chen, MS,1 Li H. Wang, MS2 and Henry S. Kao, PhD1
port higher rates of victimization. These data point to important 1
Psychology, Fu-Jen Catholic University, Sinchuan, Taiwan and
areas of future research and intervention in looking to decrease 2
Psychology, National Cheng Chi Universityy, Mucha, Taiwan.
the use of unhealthy weight control behaviors in youth.
The effects of overtime work on employee health has been
researched extensively (Beckers et al., 2008, Hughes & Parkes,
106
2007 ). The results are mixed (Allen, Slavin & Bunn 2007) and periods. Possible explanations and implications are that gender-
the causes of overtime work are seldom noticed. Tucker & related healthcare needs and help-seeking behaviors differ and
Rutherford (2005) found three factors: commitment, job mainte- that efforts to improve health and coping during a military
nance and pressure. This study was based on Tucker & Ruther- member’s deployment may need to be tailored to gender and to
ford (2005) and identified four most common causes of over- changes in deployment cycles.
time work in Taiwan (Job Demands ,Supervisory Impression , Note: The opinions expressed on this document do not repre-
Job Involvement and Peer Social Conformity). We examined the sent an endorsement by or the views of the U.S. Air Force, the
relationship between these causes of overtime work and burn- Department of Defense, or the U.S. Government.
out. To measure burnout, we used the Copenhagen Burnout
Inventory (CBI) with a reliability of alpha 0.91. We surveyed a CORRESPONDING AUTHOR: Rena A. Nicholas, PhD, Clinical
total of 258 working adults through internet and text. Health Psychology, Wilford Hall Medical Center, Lackland Air
Force Base, San Antonio, TX, 78253; rena.nicholas@lackland.
Results found that three of the four causes correlated signifi- af.mil
cantly with the scores of Personal Burnout (PB) and Work
Burnout (WB). A negative correlation of Job Involvement was D-098a
obtained respectively with PB (r=-.235 p=.000) and WB (r=-.422 STRESS IN PARENTS OF CHILDREN WITH SINGLE SUTURE
p=.000). We also found a positive correlation of Peer Social Con- CRANIOSYNOSTOSIS
formity with PB (r=.196 p=.003) and WB (r=.204 p=.002)as well Lynette Dufton, PhD,1,2 Matthew L. Speltz, PhD,2,1 Joseph L.
as a positive correlation of Supervisory Impression reaching sig- Piccianno, MS,1 Mary Mike Craddock, PhD4 and Kathy Kapp-
nificance with WB (r=.158 p=.018). These findings have provid- Simon, PhD3
ed evidence that the causes of overtime work have differential 1
Seattle Children’s Hospital, Seattle, WA; 2University of
impact on employee’s mental health, some being positive while Washington, Seattle, WA; 3Northwestern University, Chicago,
other negative. This study offers a case of occupational health IL and 4St. Louis Children’s Hospital, St. Louis, MO.
research having cross-cultural significance. Single suture craniosynostosis (SSC) is a condition in which a
CORRESPONDING AUTHOR: Henry S. Kao, PhD, Psychology, single suture in the infant skull fuses prematurely. Cranioplasty
University of Hong Kong, Hong Kong, -; hrnyksr@hkucc.hku. is required to release the fused suture and reshape the skull.
hk Children with SSC are likely to show delays in learning and be-
havior (Speltz et al., 2004). Parents of infants with SSC are thus
D-083b faced with a number of stressful events, including the child’s
THE IMPACT OF MILITARY DEPLOYMENTS ON SPOUSES’ unusual appearance, life-threatening surgeries, and the possibil-
HEALTHCARE UTILIZATION ity of future neurodevelopmental problems (Endriga & Kapp-
Rena A. Nicholas, PhD Simon, 1999). Rosenberg et al. (in press) compared parents of
Clinical Health Psychology, Wilford Hall Medical Center, San infants with and without SSC on levels of self-reported stress
Antonio, TX. before the child underwent cranioplasty. Average stress levels
The stress of military deployments on servicemembers’ spouses reported by parents of cases did not differ from those reported
could lead to adverse health outcomes. Recent studies examin- by parents of controls. The current study followed this same
ing the impact of deployments on spouses’ utilization of health- sample of children, giving parents the Parenting Stress Index
care, a possible indicator of health-related impacts of stress, (PSI) at two post-surgery time points, 12 months (Time 1) and
have had mixed outcomes as to whether deployments lead to 24 months (Time 2) after surgery. Eight hundred forty parents
increased healthcare demands. However, previous studies have (418 parents of cases) participated at Time 1 and 714 parents
limitations related to the use of convenience samples, cross-sec- (422 parents of cases) at Time 2. Parents of children with and
tional designs, and self-report data. This study aimed to address without SSC did not differ on PSI Total or Parent Domain
these gaps by examining objective counts of healthcare visits for scores. Fathers of cases reported higher levels of PSI Child Do-
spouses whose military partner was deployed for four months main stress than fathers of controls at Time 1 (t = 2.02, p < .05, d
to combat in Iraq or Afghanistan. Objective counts of healthcare = .2). Mothers of both cases and controls reported higher levels
utilization were examined across the predeployment, deploy- of parent stress than did fathers of cases and controls at Time 1
ment, and postdeployment phases to enable the identification (t = 3.66, p < .05, d = .2) and Time 2 (t = 5.07, p < .001, d = .2). On
of any trends across these time periods. The results of this study the PSI defensiveness scale, mothers of cases generated higher
show that there is a time effect of deployment on spouses’ scores than control group mothers at both time points. In sum,
healthcare utilization (F=4.9; p <.001) healthcare utilization parents of children with SSC reported levels of stress very simi-
markedly decreased during the postdeployment period com- lar to those of control group parents. These findings point to the
pared to the predeployment and during deployment periods. resiliency of parents of children with SSC and/or a repressive
Also, gender related differences were examined. A main effect adaptive style in their reporting of stressful experiences. Parent
of gender was found such that men tended to use less health- gender seems to exert a stronger effect on stress reports than
care compared to women (F=4.6; P<0.05). This study also found children’s medical status.
a gender by time interaction (F=3.1; p< 0.05) such that women’s CORRESPONDING AUTHOR: Lynette Dufton, PhD, Seattle
and men’s healthcare utilization were significantly different Children’s Hospital, Seattle, WA, 98105; lynette.dufton@seat-
during the deployment period (F=9.2; P<0.01) where women’s tlechildrens.org
healthcare usage increased and men’s decreased. The length of
deployment and number of children in the home had no effect
on any changes in healthcare utilization during the deployment
107
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
D-098b RESULTS: Adjusted only for age and sex, African Americans
COMPUTERIZED NEUROCOGNITIVE TESTING IN ADULT averaged a faster rate of decline in memory (b=-0.026 per year;
SICKLE CELL PATIENTS p=0.05). This was approximately 16% faster than whites of simi-
Regina Crawford, MD,1 Miriam H. Feliu, PsyD,2 Christopher lar age and sex. Southern birth also predicted faster memory
Edwards, PhD1,2 and Marilyn Telen, MD1 decline (b=-0.022; p=0.007). After adjustment for Southern birth,
1
Hematology, Duke University Medical Center, Durham, NC African American race was not significantly related to rate of
and 2Psychiatry, Duke University Medical Center, Durham, NC. memory decline (b=-0.015; p=0.29). After adjusting for race, pa-
Sickle cell disease (SCD) is a genetic disorder with multiple rental education and own education, Southern birth remained
medical manifestations. The vasoocclusion causes pain crisis as a significant predictor of rate of memory decline (b=-0.022;
well as higher incidence of cerebrovascular events (CVEs). At p=0.008).
least 20% of SCD patients with no history of strokes have abnor- CONCLUSIONS: Southern birth predicts faster rates of memory
mal brain MRI. There is limited literature addressing neurocog- decline in middle age to early old age. Southern birth appears to
nitive deficits in the adult SCD population. In the current study, confound the association between race and memory decline and
30 subjects (17 males,13 females) of African American descent should routinely be considered in analyses of race and cognitive
were administered a computer-based software program, the outcomes. The association between Southern birth and memory
CNS Vital Signs (CNS-VS) with measures for memory, psycho- loss is not accounted for by adult education, suggesting other
motor speed, reaction time, cognitive flexibility and complex psychosocial or behavioral pathways.
attention, as well as a global neurocognitive index. Mean age CORRESPONDING AUTHOR: M. Maria Glymour, ScD, Har-
for control 43.54 yrs +- 4.24; SCD group 34 +-12 . A significant vard School of Public Health, Boston, MA, 02115; mglymour@
difference was found between SCD patients and controls for hsph.harvard.edu
Symbol Digit Coding domain (p=0.001) and psychomotor
domain (p=0.02) between groups. The relevance of these results D-098d
point to diffuse brain damage involvement in SCD population NATURAL DISASTERS VERSUS TERRORISM ON COPING AND
even in the absence of CVEs as Symbol Digit Coding is the most DEPRESSION
sensitive test of brain damage. Using a computerized program Barbara G. Melamed, PhD, ABPP1 and Julie Holmes, MS2
to assess neurocognitive presentation in neurologically intact 1
Social and Behavioral Sciences, Mercy College, Dobbs Ferry,
SCD population can be a promising cost-effective method NY, NY and 2Insttute for Social Research, University of Hawai,
of assessment relevant for treatment. Implementing routine Honolulu, HI.
neurocognitive screening in this underserved population may Previous literature (Baum et al. 1996) indicated that the re-
promote access to needed care and increased quality of life. sponse to man-made disasters, such as three-mile island and
CORRESPONDING AUTHOR: Miriam H. Feliu, PsyD, Psy- trauma related to attacks on the person were different. They
chiatry, Duke University Medical Center, Durham, NC, 27705; also looked at intrusive thoughts as they delayed recovery.
feliu001@mc.duke.edu Therefore, similarities or differences in the use of avoidance and
intrusive thoughts in relationships to measures during WTC
D-098c and Hurricane Katrina were evaluated.
SOUTHERN BIRTH, AFRICAN-AMERICAN RACE, AND RATE
OF MEMORY LOSS IN ADULTHOOD Two weeks following the devastation caused by Hurricane
M. Maria Glymour, ScD Katrina, 98 college and staff members participating in a 4 year
Harvard School of Public Health, Boston, MA. follow-up of the influence of WTC disaster on depression and
coping style. Each participant filled out demographic informa-
BACKGROUND: Prior research on race and memory loss tion, Impact of Events and the Center for Epidemiological Stud-
has not fully accounted for differences between older African ies- Depression scale. The Impact of Events scale was used to
Americans and whites in place of birth. About half of older determine their use of avoidance and intrusions as reported for
African Americans were born in the southern United States, the last seven days to the WTC and the Hurricane. Hypothesis
whereas only a small fraction of older whites were born in the 1 predicted that there would be no difference in the responses
south. Southern birth predicts higher risk of cerebrovascular to the two events. Hypothesis 2 evaluated the relationship
disease, which contributes to cognitive and memory loss in later between intrusion or avoidance on their reported depression as
life. We test whether race and southern birth independently measured by the CESD.
predict rate of memory change in a nationally representative
sample of Americans aged 55-65 at baseline. Correlation coefficients with distress revealed a number of
significant correlations. Specifically there was support for the
METHODS: Among 7,302 participants in the 1996 wave of the hypotheses that intrusive and avoidance thinking would be
Health and Retirement Study, we used growth curve models associated with more self-report of depression whether it was
to assess rate of memory decline (immediate and delayed recall hurricane related or not. Hurricane -related intrusion and
of a 10-word list) over a 10 year follow-up (a total of 36,369 ob- avoidance were highly related to each other r(93)=.734 p,<.000,
servations). We examined whether self-identified race (African Also, Hurricane avoidance and intrusion were highly related
American or black versus all others) predicted rate of memory to WTC related intrusion r(90)=.550 p<.000 and avoidance
decline with or without adjustment for whether the respondent r(90)=.733,p<.000. Given the coping style of avoidance and in-
was born in a southern state. Finally, we adjusted for an indica- trusion and our past research (Melamed,2007) showing benefits
tor of parental and own education. All models were adjusted of active coping and Hope (active agency and optimism) the
for age and sex. best recommendation would be to apply Seligman’s Positive
108
therapeutic approaches to change negative and catastrophic Falls are associated with morbidity and mortality in older
thoughts and teach active coping. adults. Fear of falling may play a pivotal role in understand-
CORRESPONDING AUTHOR: Barbara G. Melamed, PhD, ing fall prevention and rehabilitation. Little is known about
ABPP, Social and Behavioral Sciences, Mercy College, Dobbs the determinants of fear of falling in older adults with knee
Ferry, NY, NY, 10522; bmelamed@mercy.edu osteoarthritis. The present study incorporated a social cognitive
framework to examine the relationships between physiological,
D-098e behavioral, and psychological determinants of fear of falling at
CONTENT ANALYSIS OF A CHRONIC ILLNESS FACEBOOK baseline of the Intensive Diet and Exercise for Arthritis (IDEA)
COMMUNITY study. To examine the effect of age, gender, BMI, efficacy and
Andrea L. Hobkirk, BS, Joseph De Leo, BS, Vivian Hwang, BS physical activity on fear of falling, we used a proportional odds
and Sharon Danoff-Burg, PhD model that takes into account the ordinal response for fear, with
Clinical Psychology, University at Albany, Albany, NY. backward variable selection. Data were available on 348 IDEA
Since the 1990s, technology has increasingly been recognized as participants: 71% female, mean age of 65.8 yrs (SD=6.1) and
a clinical resource for those in the healthcare field through the mean BMI of 33.4 (SD=3.6) kg/m2. 34%, 30% and 37% of par-
use of web-based interventions, online counseling, and Inter- ticipants reported none, some and moderate to very much fear
net operated therapeutic software (Barak, Klein & Proudfoot, related to falling, respectively. Females were 3.0 times (95%CI
2009). Based on the Roy Adaptation Model, researchers have = 1.9-4.8) more likely than males to have stronger fear of falling
found that peer-led online discussion forums can be effective and for an increase of 10% in balance-related efficacy, the odds
in facilitating psychosocial adaptation, improvements in the of having stronger fear decreased by a factor of 0.61 (95% CI =
self-management of chronic illness, and enhancement of overall 0.53-0.70). Physical activity was significantly (p≤.001) correlated
quality of life (Weinert, Cudney & Spring, 2008). Online social with efficacy for balance activities (r = .20). The findings suggest
networking sites, such as MySpace and Facebook, may provide that social cognitive factors are important correlates of fear of
similar benefits for those living with chronic illnesses by allow- falling. Future research is needed to examine the impact of in-
ing individuals the opportunity to share their personal experi- terventions that target self-efficacy and its subsequent influence
ences and health information, as well as offer emotional support on fear of falling in older adults with knee osteoarthritis.
for one another. Trial Registration: NCT00381290
In this study, Pennebaker’s LIWC text analysis software pro- CORRESPONDING AUTHOR: Shannon L. Mihalko, PhD,
gram (Pennebaker & Francis, 1999) was used to conduct a con- Health and Exercise Science, Wake Forest University, Winston-
tent analysis of the asynchronous communication of a chronic Salem, NC, 27109; mihalksl@wfu.edu
illness support group on the popular social networking site
Facebook (www.facebook.com). Messages posted on the site D-098g
‘Wall’ by users between July and December 2009 were analyzed DISPARITIES IN MAGAZINE MEDICATION ADS
to examine several hypotheses surrounding self-disclosure, Jessica L. Barnack-Tavlaris, PhD,1 Luz Garcini, MA,2 Lindsey
the expression of positive versus negative emotions, and the Shamp, BA,3 Jennifer Jensen, MPH3 and Elizabeth A. Klonoff,
exchange of health information. PhD2,1
1
SDSU/UCSD Comprehensive Cancer Center Partnership, San
Of the 209,992 words posted within messages on the site, 4.95% Diego, CA; 2Joint Doctoral Program in Clinical Psychology,
were singular personal pronouns (e.g. I, me, mine) compared SDSU/UCSD, San Diego, CA and 3San Diego State University,
to only 3.57% of all other pronouns (e.g. you, s/he). Members San Diego, CA.
expressed more positive emotion than negative emotion, 4.77%
and 1.37% respectively, and discussed topics relating to physi- Medications make up a large amount of health care expenses,
cal health more than mental health, 5.31% and 0.82% respec- leading to high profits for pharmaceutical companies. Direct
tively. These results suggest that social networking sites may to consumer medication advertising (DTCMA) proponents
provide individuals a chance to exchange health information, argue that the ads increase disease awareness, while critics
communicate their experiences, and provide encouragement for argue that the ads inundate the public with information about
one another. This lends support for the theory that unmanaged, medical therapy without comparing it to nonmedical therapies.
public networking sites may be used in conjunction with health- If DTCMA can increase disease awareness, then differences
care interventions designed to facilitate psychosocial adaptation in DTCMA across population subgroups could contribute to
and the management of chronic illness. health disparities. This study examined DTCMA across print
magazines for different audiences. Print DTCMA is convenient
CORRESPONDING AUTHOR: Andrea L. Hobkirk, BS, Clinical because patients can bring the ads to the doctor’s office, which
Psychology, University at Albany, Albany, NY, 12203; ahob- may encourage them to ask for the medication.
kirk@gmail.com
DTCMA were coded in the following popular magazines
D-098f (165 issues) for 2008-09: Cosmopolitan, Glamour, Vogue
CORRELATES OF FEAR OF FALLING IN OVERWEIGHT AND (women), Esquire (men), Ebony (African American), People
OBESE OLDER ADULTS WITH KNEE OSTEOARTHRITIS (English speaking), and People en Español (Spanish speaking).
Shannon L. Mihalko, PhD,1,2 Claudine Legault, PhD,2 Cralen There were 603 medication ads (prescription=63%, over-the-
Davis, MS2 and Stephen P. Messier, PhD1,2 counter=37%). One-way ANOVA with Tukey follow-up tests
1
Wake Forest University, Winston-Salem, NC and 2Wake Forest showed differences in the number of ads across magazines,
University School of Medicine, Winston-Salem, NC. F(6,158)=30.47, p<.005, with notable differences between
109
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
womens and mens magazines (Glamour:161 ads, M=6.71 CORRESPONDING AUTHOR: Jaimie Gradus, DSc, MPH, Na-
vs. Esquire:10 ads, M=.42, p<.005). There were no differences tional Center for PTSD, VA Boston Healthcare System, Boston,
in the number of ads between People, People en Español, and MA, 02130; jaimie.gradus@va.gov
Ebony, (p>.05), but the types of ads differed. For example,
the top 3 medication ads in People were for allergies, cold/ D-098i
flu, and womens health; the top 3 ads for People en Español RELIGIOUS CORRELATES OF STRUCTURAL BRAIN
were for cold/flu, allergies, and enlarged prostate; the top 3 ads CHANGES IN LATE ADULTHOOD
for Ebony were for diabetes, heart disease/stroke, and cold/ Richard D. Hayward, PhD, Amy Owen, PhD, David Steffens,
flu. All the ads in Esquire were for sexual functioning, mental MD and Martha Payne, PhD
health, and increasing body mass. Although heart disease and Duke University Medical Center, Durham, NC.
stroke are 2 of the top causes of death, preventive medications While studies of practices such as meditation and prayer have
comprised only 5% of the total ads, none of which were in the demonstrated changes in brain activity, the field of religion and
mens or womens magazines. Implications for health behav- neuroscience remains in its infancy. Recent functional brain
iors, disparities, and policy will be discussed. imaging studies have shown that the left orbital-frontal cortex
CORRESPONDING AUTHOR: Jessica L. Barnack-Tavlaris, (LOFC) and the hippocampus are active during engagement in
PhD, SDSU/UCSD Comprehensive Cancer Center Partnership, religious and spiritual practices. Decline in these regions has
San Diego, CA, 92120; jbarnack@projects.sdsu.edu been associated with depression and other deleterious mental
health outcomes in later adulthood. However, little evidence
D-098h is available regarding the long-term impact of religion on the
MILITARY SEXUAL TRAUMA AND SUICIDE ATTEMPTS IN A brain. This study uses longitudinal structural magnetic reso-
SAMPLE OF MARINES nance imaging (MRI) to examine the relationship between
Hannah L. Giasson, BA,1 Jaimie Gradus, DSc, MPH1,2 and Jillian various religious factors and changes in the brain among older
C. Shipherd, PhD1,2 adults. Participants (age 60+) have been enrolled on an ongoing
1
National Center for PTSD, VA Boston Healthcare System, basis since 1994; socio-behavioral measures were administered
Boston, MA and 2Psychiatry, Boston University, Boston, MA. annually, with biennial MRI scans to measure volume of brain
Research has indicated that sexual trauma occurring during regions. To date, the study has included 466 depressed and 161
military service is associated with suicide attempts in Veterans. non-depressed comparison subjects. Longitudinal MRI data
Tiet et al (2006) found that male Veterans experiencing sexual were available for 318 participants (average time in study 6.6
trauma were more likely than those who had not had such years). Regression analyses showed religious affiliation was
experiences to attempt suicide. Further, Belik et al (2009) found associated with change in both left and right hippocampal
associations between sexual trauma and suicide attempts in volume over the course of the study. Individuals who reported
a sample of Canadian military personnel. The current study no religious affiliation at baseline exhibited significantly greater
hypothesized that military sexual trauma experienced during decrease in hippocampus volume, after controlling for age, de-
Marine boot camp would be associated with suicide attempts pression status, duration in the study, and total brain size (left:
following boot camp among both males and females. To explore β = .12, p = .03; right: β = .11, p = .05). Two types of religious
this hypothesis, we utilized data from a longitudinal study of experience were associated with less decline in LOFC volume:
Marines obtained upon arrival for boot camp training at Par- born again Christian experiences prior to the start of the study
ris Island in 1997 and at four subsequent time points over the (β = -.16, p = .01), and other life-changing experiences that oc-
course of 12 years. As our hypothesis is an examination of the curred during the course of the study (β = -.18, p = .003). Other
sequelae of military sexual trauma occurring during boot camp, factors (worship attendance, prayer, and religiousness) were
the sample for the current study was restricted to Marines that not associated with changes in brain structure. These findings
participated in the post-boot camp assessment for the larger suggest that attenuation of declines in hippocampal and LOFC
study (n = 1469). Suicide attempts in the 12 years following volumes may be a potential neurophysiological mediator for
boot camp were assessed during the most recent wave of data some of the well-established beneficial effects of religion on late
collection. Conditional logistic regression was used to examine life mental health.
experiences of military sexual trauma as a predictor of suicide CORRESPONDING AUTHOR: Richard D. Hayward, PhD,
attempts, stratified by gender. Of the total sample, 118 men Center for Spirituality, Theology and Health, Duke University
(11.5%) and 89 women (10.7%) reported experiencing military Medical Center, Durham, NC, 27705; david.hayward@gmail.
sexual trauma during boot camp, while 9 men (0.9%)and 20 com
women (2.4%) endorsed attempting suicide since boot camp.
Analyses revealed that men who had experienced military D-107a
sexual trauma during boot camp had 8.7 times the odds of PATIENT-HEALTH CARE PROVIDER COMMUNICATION AND
suicide attempts following boot camp than men that did not HEALTH OUTCOMES AMONG PATIENTS WITH SICKLE CELL
have this experience (95% confidence interval: 1.4, 53). Interest- DISEASE
ingly, we did not find an association between military sexual Chante C. Wellington, PhD, Frank J. Keefe, PhD and
trauma during boot camp and suicide attempts following boot Christopher L. Edwards, PhD
camp among women (OR = 0.95; 95% confidence interval: 0.21, Psychiatry, Duke University Medical Center, Durham, NC.
4.2). Further examination of these results, and implications for Sickle cell disease (SCD) is a recurrent painful genetic blood
intervention, will be presented. disorder. Despite evidence that there is often times problems
in pain communication between SCD patients and health care
110
providers, there have been few research studies that have sys- to low fear participants, high fear participants predicted greater
tematically addressed this area. This study tested one primary pain and potential harm/injury following DOMS induction
hypothesis: lower levels of self-efficacy and higher levels of but not during initial baseline testing. In contrast to low fear
holding back will be associated with lower levels of physi- counterparts, high fear participants showed a pattern of increas-
cal functioning and higher ratings of pain and psychological ing kinematic caution across trials during the Baseline testing
distress. session, as evidenced by gradually decreasing lumbar flexion. A
We evaluated patient holding back and self efficacy for talking similar pattern was observed for thoracic spine flexion, irrespec-
about pain and pain related concerns as predictors of patient tive of testing session. To our knowledge this is the first study
pain rating, physical functioning and anxiety and depression to identify the impact of pain-related fear in a healthy sample
related to hospital visits among 70 African American patients, following experimental acute low back injury, suggesting
mean age 34.98 (11.79) with SCD. Disclosure was found to that maladaptive psychological and physical processes occur
predict role emotional dimension of physical functioning early in the injury process. The findings have both clinical and
(p=.05), the patient-physician interaction (p=.0009), and self theoretical implications, discussed in the context of the fear-
efficacy for communication with physician (p=.0004). Self ef- avoidance model of back pain.
ficacy for communication with physician was found to predict CORRESPONDING AUTHOR: Zina Trost, MS, Rehabilitatoin
the patient-physician interaction (p=.009). Self efficacy for pain Psychology, University of Washington Medical Center, Seattle,
communication was found to predict anxiety (p=.04), depres- WA, 98112; zinaidat@gmail.com
sion (p=.001), general health dimension of physical functioning
(p=.04), and patient-physician interaction (p=<.0001). Higher D-107c
levels of patient disclosure about pain and other pain related HEADACHE CHARACTERISTICS DIFFER BY RACE, SES, AND
concerns was associated with higher levels of physical func- PSYCHIATRIC COMORBID CONDITIONS IN PATIENTS WITH
tioning, patient’s confidence in their ability to interact with the MIGRAINE DISORDERS
health care provider and patient confidence in their ability to Bernadette D. Heckman, PhD, Kristin Lewis, MA, Rewadee
communicate with the health care provider. Whereas, lower Watakakosol, MA, Christina Wei, MA and Nicole Campbell,
patient confidence for pain communication was associated with MA
higher levels of anxiety, depression and lower levels of physical Psychology, Ohio University, Athens, OH.
functioning and patient’s confidence in their ability to interact Objectives: To determine how headache characteristics (e.g.,
with the health care. The authors conclude that better under- headache frequency, severity, and disability) vary by race, SES,
standing the relationship of patient’s level of pain communica- and psychiatric comorbid conditions in patients with severe
tion to health outcomes in patients with SCD may lead to better migraine disorders.
medical management by health care providers. Design: Cross-sectional design, data collected via self-report
CORRESPONDING AUTHOR: Chante C. Wellington, PhD, surveys and daily diaries.
Psychiatry, Duke University Medical Center, Durham, NC, Methods: Participants were 215 patients receiving treatment in
27705; chante.wellington@duke.edu headache specialty treatment clinics in Cleveland, Cincinnati,
D-107b Columbus, and Toledo, OH. Most patients were Caucasian/
APPRAISAL OF MOVEMENT AND KINEMATIC AVOIDANCE non-Hispanic (61%) and female (89%). Thirty-four percent
IN HIGH AND LOW FEAR PARTICIPANTS FOLLOWING (34%) of patients had no psychiatric condition, 24% were
DELAYED ONSET MUSCLE SORENESS diagnosed with major depressive disorder (MDD), 17% were
Zina Trost, MS,2,1 Christopher R. France, PhD2 and James S. diagnosed with one or more anxiety disorders, and 25% were
Thomas, PhD3 diagnosed with both MDD and one or more anxiety disorders.
1
Rehabilitatoin Psychology, University of Washington Medical The modal headache diagnosis among patients was episodic
Center, Seattle, WA; 2Psychology, Ohio University, Athens, OH migraine without aura (54%). Patients provided data through
and 3Department of Physical Therapy, Ohio University, Athens, self-administered surveys completed in headache clinics and
OH. 30-day daily diaries completed at home prior to initiating new
acute and preventive headache treatments. SES was calculated
Pain-related fear has been found to be predictive of disability using a composite score based on education and annual income
at acute, subacute and chronic stages of back pain. Further, fear and dichotomized at the median (i.e., low SES, high SES).
may play an important role in the development of chronic pain
and disability through exaggerated perception of threat dur- Results: Of the three independent variables examined, SES and
ing movement and the maladaptive maintenance of defensive psychiatric comorbidity had the strongest relationships with
movement strategies. The current study examined patterns of headache characteristics; the role of race was less apparent.
movement and pain/harm appraisal in healthy college students Based on 30-day daily diary data, lower SES and the presence of
asked to complete a standardized reaching task both prior any psychiatric condition were associated with more frequent
to and following induction of Delayed Onset Muscle Sore- and disabling headaches (p < .05) while African Americans
ness (DOMS) to the lower back. Participants were classified as experienced more severe headaches than whites (p < .05). The
“high” versus “low fear” based on their responses to the Tampa lowest quality of life levels were found in low SES patients and
Scale of Kinesiophobia. At each reaching trial, participants rated patients who had been diagnosed with MDD or MDD+anxiety.
predicted pain and potential harm/injury using a visual analog Implications: Psychiatric disorders are highly prevalent in
scale. Movements of the lumbar and thoracic spine were re- migraine patients. Migraine patients of low SES and with psy-
corded using Vicon motion capture technology. In comparison chiatric comorbid conditions are in urgent need of innovative
111
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
interventions to reduce the burden of their headaches and to (PA), yet few studies have examined these factors among
improve their overall quality of life. minority women. The purpose of this study was to investigate
CORRESPONDING AUTHOR: Bernadette D. Heckman, PhD, the associations of measured and self-reported neighborhood
Ohio University, Athens, OH, 5701; heckmanb@ohiou.edu characteristics with individual PA. The Pedestrian Environ-
ment Data Scan was completed for 25% of randomly selected
D-124a residential street segments within a 400 meter radius of each
YOUTH PHYSICAL ACTIVITY INTERVENTIONS: AN participants’ address. African American women (N=262, M
ECOLOGICAL PERSPECTIVE age=44.4 yrs) completed interviewer administered question-
Cynthia K. Perry, PhD,1 Sandra Christensen, BA2 and Laura L. naires assessing self-reported neighborhood characteristics. PA
Hayman, PhD2 was measured using the International Physical Activity Ques-
1
Family and Child Nursing, University of Washington, Seattle, tionnaire (IPAQ) long (M MET minutes/week=2519) and accel-
WA and 2College of Nursing and Health Sciences, University of erometry (M MVPA=19.0 min/day). Most women were obese
Massachusetts Boston, Boston, MA. (N=176, 67.2%; M BMI= 34.0). IPAQ PA was not associated with
Background: Changing physical activity behavior is a complex accelerometer PA. Bivariate correlations suggested relationships
process that involves intermediary outcomes across more than between greater measured pedestrian facility density and more
one ecological domain. Purpose: An ecological framework IPAQ transportation PA , greater reported pedestrian facil-
was used to review and summarize results of physical activ- ity density and more IPAQ leisure time PA, greater reported
ity interventions targeting youth aged 11-18 that measured bicycle facility density and more IPAQ moderate PA and IPAQ
primary outcome of physical activity and intervening outcomes, total PA (ps<.05). Simultaneous ecological multiple regression
such as behavioral intentions. Methods: A systematic search of models demonstrated that reported pedestrian facility density
pubmed, CINHAL, PSYCINFO databases from the years 1977 (Beta=.138, t=2.181) and body fat percentage (Beta= -.089, t=
through 2009 was conducted using key terms of physical activ- -1.398) were associated with IPAQ leisure time PA (R2=.027;
ity, youth, adolescent, and exercise. Results: Based on titles, 855 p=.04), reported bicycle facility density (Beta=.138, t=2.161) was
abstracts were reviewed; 143 papers were examined resulting associated with IPAQ moderate PA (R2=.019; p=.03), and report-
in 24 published reports on 17 interventions that met our criteria. ed bicycle facility density (Beta=.130, t=2.041) was associated
Strategies within the ecological domains of intrapersonal, fam- with IPAQ total PA (R2= .017; p=.04). No measured or reported
ily, socio-cultural, environmental, and policy were examined. neighborhood characteristics were associated with accelerom-
All 17 interventions employed strategies aimed at intrapersonal eter measured PA. Measured and reported built environment
domain, five aimed at the family domain, and five aimed at en- attributes are significantly associated with self-reported PA but
vironmental domain. Seven of the nine interventions aimed at may be mediated by weight status. Work supported by NIH
intrapersonal domain only demonstrated increases in physical 1R01CA109403.
activity. Three of the five interventions aimed at intrapersonal, CORRESPONDING AUTHOR: Kristen McAlexander, MA,
family and environmental domains demonstrated increases Health and Human Performance, University of Houston, Hous-
in physical activity for both genders; one showed increase in ton, TX, 77204; kp0313@hotmail.com
physical activity with girls only and another one with boys
only. One intervention aimed at intrapersonal and environ- D-124c
mental domains that targeted both genders showed increased USING PEDOMETERS TO COMPARE THE EFFECTIVENESS
physical activity with boys but not girls and one targeting only OF SMALL, RELATIVE STEP GOALS VERSUS A 10,000 STEPS
girls showed an increase in physical activity in girls. The one in- PER DAY GOAL
tervention aimed at intrapersonal and family domains showed Emily Steinbaugh, BS,1 Marissa Errickson, BA,1 Lesley D. Lutes,
no increase in physical activity. Studies used different designs, PhD1 and Tom Raedeke, PhD2
approaches to measuring change in physical activity, and thor-
1
Psychology, East Carolina University, Greenville, NC
oughness of reporting results in response to the intervention, and 2Exercise and Sport Science, East Carolina University,
making it difficult to quantitatively compare across studies. Greenville, NC.
Conclusions: The collective results suggest the importance of Pedometers are shown to be effective tools for increasing physi-
targeting ecological domains beyond the individual level. cal activity. However, the type of step goal that would be most
CORRESPONDING AUTHOR: Cynthia K. Perry, PhD, Fam- effective in activity promotion remains unknown. While most
ily and Child Nursing, University of Washington, Seattle, WA, research encourages a 10,000 steps per day goal, studies show
98195; perryc@u.washington.edu that most individuals increase by 2,300 to 3,000 steps a day
above baseline. The present pilot study compared the effective-
D-124b ness of a 10,000 steps a day goal versus a small, relative step
MEASURED AND SELF-REPORTED NEIGHBORHOOD goal. Participants were female, obese (BMI M = 32.71, SD =
CHARACTERISTICS AND PHYSICAL ACTIVITY AMONG 4.59), middle-aged (age M = 44.52, SD = 9.81), sedentary (steps
AFRICAN AMERICAN WOMEN per day M = 5253, SD = 2581), predominantly Caucasian (60%)
Kristen McAlexander, MA, Rebecca E. Lee, PhD, Scherezade K. and African American (37%) university employees (N = 29).
Mama, MPH and Ashley Medina, BS Participants were randomly assigned to either a 10,000 daily
Texas Obesity Research Center, University of Houston, step goal (n = 15) or a small relative step goal where partici-
Houston, TX. pants gradually increased step counts to a 3,000 step increase at
African American women are vulnerable to physical inactivity treatment completion (n = 14). Participants met weekly for 12
compared to white women. Measured and self-reported neigh- weeks with a lifestyle coach for 15 minutes to plan goal achieve-
borhood characteristics may be associated with physical activity
112
ment strategies. Seven meetings were in person and 5 were con- D-124e
ducted via phone. Ninety percent of participants completed the MOTIVATIONS ASSOCIATED WITH REGULAR PHYSICAL
study. The only difference between groups at baseline was level EXERCISE IN PREMENOPAUSAL BREAST CANCER
of education (p = .008). A repeated measures ANOVA showed SURVIVORS
a significant main effect of time on step counts (p < .001), but no Patricia Voege, MA,1 Julienne E. Bower, PhD,1 Annette Stanton,
step count differences between groups (p = .593). Notably, par- PhD1 and Patricia A. Ganz, MD2
ticipants in the relative group achieved their step goal increase 1
Dept of Psychology, University of California, Los Angeles,
of 3,000 steps (relative group: M = +3160, SD = 2610; 10,000 CA and 2School of Public Health, University of California, Los
group: M = +2669, SD = 2017) while participants in the 10,000 Angeles, CA.
group did not meet their set goal on average (10,000 group: M = There is growing evidence that regular physical activity is
8645, SD = 2068; relative group: M = 7686, SD = 3096), achieving associated with reduced risk of breast cancer recurrence and
10,000 steps less than 30% of the time. While the data is prelimi- mortality. However, many breast cancer survivors fall well
nary, it suggests that both goal types can increase step counts, below current physical activity guidelines. Thus, identification
but relative step goals result in more consistent goal achieve- of determinants of physical activity in this population is impor-
ment. tant. The current study was designed to examine motivations
CORRESPONDING AUTHOR: Emily Steinbaugh, BS, Psychol- for physical activity in women diagnosed with premenopausal
ogy, East Carolina University, Greenville, NC, 27858; eks0613@ breast cancer, focusing specifically on approach (e.g., exercis-
ecu.edu ing for health or enjoyment) and avoidance (e.g., exercising
to prevent a breast cancer recurrence) motivations. Drawing
D-124d from self-determination theory and the health belief model, we
EXAMINING PSYCHOSOCIAL OUTCOMES FROM A YOGA hypothesized that both types of motivations would be associ-
INTERVENTION IN CANCER SURVIVORS ated with higher activity levels. We also examined demographic
Michael J. Mackenzie, MSc, Nicole Culos-Reed, PhD and (age), disease-related (time since diagnosis, type of treatment
Lynette E. Stephenson, MSc received), and psychosocial factors (depressive symptoms,
Faculty of Kinesiology, University of Calgary, Calgary, AB, perceived stress, fatigue, social support) that have been associ-
Canada. ated with physical activity in previous research. Women (n =
Background: Preliminary research indicates yoga’s value as a 147) who had been diagnosed with early-stage, premenopausal
clinical intervention for managing cancer-related symptoms, breast cancer, completed their primary cancer treatments, and
including sleep, mood, stress and quality of life. The purpose of were currently disease free completed self-report measures to
the present study was to examine whether a 7-week therapeu- assess leisure-time physical activity, motivations for physical
tic yoga program for cancer survivors had beneficial effects on activity, and other factors. Women were 48 years old on average
mindfulness, mood and stress. and had been diagnosed 3.28 years previously. Consistent with
Method: 108 eligible participants were pre-screened with PAR- predictions, approach motivations were associated with higher
Q/PAR-MED-X. Demographic information, Mindful Attention levels of physical activity (p < .01); however, avoidance motiva-
Awareness Scale (MAAS), Profile of Mood States (POMS), and tions were not (p = .35). Among the other variables assessed,
Symptoms of Stress Inventory (SOSI) were completed pre and only fatigue was significantly associated with activity level,
post intervention. with greater fatigue associated with lower levels of physical
activity (p < .05). These findings highlight the importance of ap-
Analyses include descriptive statistics, correlations, and t-tests proach motivations as a correlate of physical activity in younger
examining pre-post differences. breast cancer survivors, and suggest that increasing the wom-
Results: Therapeutic yoga program participants included en’s enjoyment of exercise may be key for increasing physical
mostly females (86%), primarily breast cancer survivors (53%), activity in this population.
on average 35 months post cancer diagnosis (range from 1-20 CORRESPONDING AUTHOR: Patricia Voege, MA, Dept of
years). The average age of the participants was 52 years, and Psychology, UCLA, Los Angeles, CA, 90095-1563; patricia.
most were married (72%). voege@gmail.com
Results for the intervention completers (those who had both
pre and post-test scores) indicated significantly higher scores in D-124f
mindfulness (t(104)=-2.7, p<.01) and significantly lower scores USING DECISIONAL BALANCE SHEET TO MOTIVATE OLDER
in both mood disturbance (t(107)=12.9, p<.01) and stress symp- ADULTS ENGAGE IN PHYSICAL ACTIVITY
toms (t(107)=4.4, p<.01). The effect sizes ranged from small Karly S. Geller, PhD,1 Jasah Timbobolan, student,2 Ilora D.
(mindfulness) to large (mood). Mendoza, student,2 Claudio R. Nigg, PhD2 and Holly L.
Montjoy, BS, MED (pending)3
Conclusions: Therapeutic yoga for cancer survivors was effec- 1
Cancer Research Center of Hawaii, Honolulu, HI; 2University
tive in increasing mindfulness and decreasing mood distur- of Hawaii, Honolulu, HI and 3East Carolina University,
bance and stress symptoms in a heterogeneous group of cancer Greenville, NC.
survivors. These findings suggest yoga has significant potential
and should be further explored as a beneficial physical activity PURPOSE: This pilot study examined the effectiveness of a
option for cancer survivors. decisional balance intervention tailored to increase the lifestyle
physical activity of older adults. DESIGN AND METHODS:
CORRESPONDING AUTHOR: Nicole Culos-Reed, PhD, Fac- We randomized older adult participants (>50 years old) to a
ulty of Kinesiology, University of Calgary, Calgary, AB, T2N decisional balance lifestyle physical activity intervention or an
1N4; nculosre@ucalgary.ca
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31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
attention comparison group. Participants were recruited from was related to not only more pregnancy complications but to
an Elderly Hall, representing a diverse population in Hawaii lower familial social support during pregnancy. Together, these
(39% Filipino, 75% female) with a mean Body Mass Index studies indicate that psychosocial factors are related to increases
(BMI) slightly overweight (27.48). We examined intervention in inflammatory mediators and subsequently, increased risk of
effectiveness in promoting physical activity behavior using the pregnancy complications and untoward birth outcomes.
International Physical Activity Behavior Questionnaire (IPAQ) CORRESPONDING AUTHOR: Mary Coussons-Read, PhD,
among the 8 adults (9 control participants) who completed the Psychology, University of Colorado Denver, Denver, CO,
6-week program. The lifestyle physical activity intervention led 80217-3364; Mary.Coussons-Read@ucdenver.edu
participants through completion of a decisional balance sheet,
discussing participants’ perceptions regarding the gains, losses, D-133a
approvals and disapprovals associated with their daily activity THE INFLUENCE OF ACCULTURATION AND SEXUAL RISK
levels. RESULTS: At follow-up, both groups’ moderate physi- BEHAVIORS ON CERVICAL CYTOLOGY IN A HISPANIC
cal activity demonstrated improvements, with the 9 attention POPULATION
control participants increasing by 147 weekly minutes. On the Kristy K. Ward, MD, Angelica M. Roncancio, PhD and Carmen
other hand, the 8 intervention participants demonstrated a R. Breitkopf, PhD
superior improvement with just under a 3-fold increase, specifi- OB/GYN, University of Texas Medical Branch, Galveston, TX.
cally improving from 116 daily minutes of moderate physical Hispanic women have the highest incidence of cervical cancer
activity to 329 minutes. IMPLICATIONS: Results indicate that a in the United States. Understanding the role of acculturation
decisional balance intervention is effective in increasing elderly may help identify those most at risk for cervical cancer. We pre-
adults’ moderate physical activity. Given the lack of research dicted that level of acculturation serves as a mediator of engag-
among older adults, this study offers preliminary evidence for ing in sexual risk behaviors and cervical cytologic abnormali-
further evaluations, which are recommended in a larger, more ties. Specifically, highly acculturated Hispanic women are more
diverse sample. likely to have an abnormal Pap test result because they engage
CORRESPONDING AUTHOR: Karly S. Geller, PhD, Cancer in more risky sexual behavior than less acculturated Hispanic
Research Center of Hawaii, Honolulu, HI, 96822; kgeller@crch. women. Structural equation modeling (SEM) was employed
hawaii.edu to test the model. Participants were Hispanic women 18 to 55
years of age (mean = 30.5 ± 8.32) attending UTMB regional clin-
D-128a ics. The women underwent routine Papanicolaou (Pap) testing
MATERNAL ACCULTURATION, STRESS, AND SUPPORT and completed a comprehensive survey (N=3149). Results indi-
AFFECT PREGNANCY OUTCOME VIA NEURAL-IMMUNE cate that, as predicted, highly acculturated women engaged in a
PATHWAYS greater number of sexual risk behaviors and were more likely to
Mary Coussons-Read, PhD,1 Marci Lobel, PhD,2 Marianne have an abnormal Pap test when compared to less acculturated
Kreither, MA1 and Courtney Cage, BS1 Hispanic women (p < .001). The incorporation of acculturation
1
Psychology and Health and Behavioral Science, University of as part of culturally competent healthcare will aid in the pre-
Colorado Denver, Denver, CO and 2Psychology, Stony Brook vention of cervical cancer among Hispanic women.
University, Stony Brook, NY.
CORRESPONDING AUTHOR: Angelica M. Roncancio, PhD,
Growing evidence shows that that elevated stress during OB/GYN, University of Texas Medical Branch, Galveston, TX,
pregnancy may increase the risk of preterm delivery and other 77555; anroncan@utmb.edu
pregnancy and birth complications. Neuroendocrine, immune,
inflammatory, and cardiovascular factors have been suggested D-143a
as possible mediators of the relationship between stress and SMOKING MENTHOL CIGARETTES AND THE CESSATION
birth outcomes, and recent data suggest that stress-related PROCESS ACROSS RACIAL/ETHNIC GROUPS IN THE U.S
changes in inflammatory markers may contribute to these ef- Dennis R. Trinidad, PhD MPH,1 Eliseo J. Perez-Stable, MD,2
fects. Work in our laboratory has focused on quantifying the Karen Messer, PhD,3 Martha M. White, MS3 and John P. Pierce,
effects of perceived stress and social support on pregnancy out- PhD3
come and the degree to which neural-immune interactions may 1
Claremont Graduate University, San Dimas, CA; 2University of
be involved in these effects. The present study is focused on California, San Francisco, San Francisco, CA and 3University of
the role of maternal ethnicity and acculturation in the impact of California, San Diego, San Diego, CA.
stress on pregnancy, and on the role of catecholamines in these Background. Smoking mentholated cigarettes may affect the
relationships. Elevated proinflammatory cytokines were lower smoking cessation process across various racial/ethnic groups
levels of support and higher stress throughout pregnancy, and but relatively little research has been published.
higher social support was associated with higher levels of anti-
inflammatory cytokines late in pregnancy. Moreover, elevated Methods. A secondary data analysis of the combined 2003 and
inflammatory markers were related to higher pregnancy-specif- 2006-07 Tobacco Use Supplements to the Current Population
ic distress early in gestation, as well as lower 1-minute APGAR Survey was conducted to examine how smoking cessation is
scores, lower gestational age at birth, and increased occurrence affected by the use of mentholated cigarettes and how this dif-
of birth complications including meconium aspiration, nuchal fers across African American, Asian American/Pacific Islander,
cord, and asphyxia. Elevations in catecholamines were related Hispanic/Latino, Native American, Non-Hispanic White adults
to these changes in inflammatory cytokines, as well as with in the U.S.
poor pregnancy outcome. Finally, higher maternal acculturation
114
Results. Smoking mentholated cigarettes was significantly less effectiveness of these emerging technologies, the Internet has
predictive of being quit for at least 6 months than smoking non- created a fundamental shift in the way we communicate and
menthols for all racial/ethnic groups except Native Americans/ provides unlimited potential for disseminating health promo-
Alaska Natives (African Americans: OR=0.24, 95% CI: 0.17 - tion messaging. Data from the SFW project can help inform
0.32; Asian Americans/Pacific Islanders: OR=0.22, 95% CI: 0.11 future efforts targeted at “hard-to-reach” groups.
- 0.45; Hispanics/Latinos: OR=0.48, 95% CI: 0.34 - 0.69; Native CORRESPONDING AUTHOR: Alison M. Pilsner, MPH, CPH,
Americans/Alaska Natives: OR=0.52, 95% CI: 0.15 - 1.78; Non- CHES, DB Consulting Group / National Cancer Institute, Silver
Hispanic Whites: OR=0.28, 95% CI: 0.25 - 0.32). African Ameri- Spring, MD, 20910; apilsner@dbconsultinggroup.com
cans and Hispanics/Latinos who smoked mentholated ciga-
rettes were significantly more likely think they would have quit D-143c
smoking in the next 6 months compared to those who smoked AGE DIFFERENCES IN TREATMENT OUTCOME AND
non-mentholated cigarettes (African Americans: OR=1.82, 95% MOTIVATIONS TO QUIT SMOKING
CI: 1.56 - 2.14; Hispanics/Latinos: OR=1.21, 95% CI: 1.03 - 1.43;). Mary A. Gerend, PhD, Nicole Collins, BA, Natalie Sachs-
This was not found among Asian Americans/Pacific Islanders, Ericsson, PhD, Chris Blagg, BA, Mike Mallott, MA, Hannah
Native Americans/Alaska Natives and Non-Hispanic Whites. Mills, BA and Brad Schmidt, PhD
Conclusion. Smoking mentholated cigarettes is significantly Florida State University, Tallahassee, FL.
less predictive of long-term quitting success than smoking Background: Smokers seeking treatment may present with
non-mentholated cigarettes and belies the sense of confidence it different challenges, and different motives for quitting. One
engenders in future quitting success among African American factor that may motivate older adults to quit more than younger
and Hispanic/Latino smokers. adults is that older adults tend to experience greater smoking-
CORRESPONDING AUTHOR: Dennis R. Trinidad, PhD MPH, related health problems. The current study evaluated whether
Claremont Graduate University, San Dimas, CA, 91773; dennis. older adults would respond more favorably to a smoking
trinidad@cgu.edu cessation treatment intervention, and whether this age effect is
mediated by the presence of current health problems.
D-143b Method: We compared older (≥ age 55) and younger smokers
INFORMATION-SEEKING BEHAVIORS AND THE USE OF enrolled in a 12 session cognitive-behavioral smoking cessation
EMERGING TECHNOLOGIES FOR BEHAVIOR CHANGE: THE program (N=84) on smoking history variables, nicotine depen-
NATIONAL CANCER INSTITUTE “H.I.N.T.S.” AT WOMEN. dence, current health problems, and smoking outcomes one
SMOKEFREE.GOV month post treatment.
Alison M. Pilsner, MPH, CPH, CHES,1,2 Abdul R. Shaikh, PhD,
MHSc1 and Richard P. Moser, PhD2 Results: Although at baseline older smokers smoked more
1
DB Consulting Group, Inc., Silver Spring, MD and 2National cigarettes per day and were more nicotine dependent than
Cancer Institute (NIH), Bethesda, MD. younger smokers, older smokers were significantly less nicotine
dependent than younger smokers at one-month follow-up and
The Internet has transformed many spheres of society and has no longer smoked more cigarettes than younger adults. Older
enabled us to communicate and cultivate relationships that smokers also had higher rates of one-month abstinence than
would not have been possible otherwise. The launch of social younger smokers. Among participants who relapsed, older
networking sites has created a new phenomenon where users adults waited longer than younger adults to smoke their first
are changing from consumers to information generators. As cigarette of the day. This greater treatment efficacy among older
Internet access proliferates, more people are turning to comput- adults may have been motivated by the presence of more health
ers for health information. Different populations experience problems: older smokers were more likely to report health
varied access to health-related information and face greater problems than younger smokers, and when present illness was
language and educational barriers to obtaining health-related entered in the analysis, age was no longer related to decreased
information. Data from the 2007 Health Information National nicotine dependence at follow-up.
Trends Survey (HINTS) at the National Cancer Institute (NCI)
was used to explore health information-seeking and internet Conclusions: Despite higher nicotine dependence at baseline,
usage among respondents according to ethnicity, language, older adults had better treatment outcomes than younger adults
and birth status. Among self-identified Latinos, 38% reported one month post treatment. These positive outcomes may reflect
using the Internet compared to 71% of non-Latinos (p=.000). the fact that smoking-related health problems motivate older
16% of Spanish-speaking Latinos used the Internet or email adults to quit. Findings suggest that smoking cessation pro-
compared to 69% of English-speaking Latinos (p=.000), and 66% grams should be tailored to smokers’ motivations for quitting,
of US-born compared to 21% of those foreign-born (p=.000). which for older adults may reflect the presence of smoking-
Despite the disparity, among those who did use the Internet, related health problems.
the opposite trend was found in the use of online support CORRESPONDING AUTHOR: Mary A. Gerend, PhD, Florida
networks; less acculturated subgroups utilized these networks State University College of Medicine, Tallahassee, FL, 32306-
to a greater extent. Given that 46% of online Americans are on 4300; mary.gerend@med.fsu.edu
a social networking site, the NCI’s SmokefreeWomen (SFW)
project has begun to explore the feasibility of integrating social
media features with existing web-assisted tobacco interventions
as a strategy for optimizing reach, impact and engagement.
Although continued research needs to be done to evaluate the
115
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
116
D-151c very young. Practical advice was given regarding what to do if
URGE TO DRINK IN COLLEGE STUDENTS AS A FUNCTION menstruation would start when at school as well as the mean-
OF REINFORCEMENT SENSITIVITY AND BEHAVIORAL ing of a menstrual period, and the time pregnancy can occur.
CONTINGENCIES Realistic advice came when mothers discussed their daughters’
Hyoung S. Lee, MA and John S. Wiebe, PhD susceptibility to sexually transmitted infections (STI’s) and the
Psychology, University of Texas at El Paso, El Paso, TX. dangers associated with a STI in the context of immunosuppres-
According to Gray’s Reinforcement Sensitivity Theory (RST), sion. Triggers of RH discussions were friends or young celeb-
the Behavioral Approach System (BAS) is the neurological rities becoming pregnant and the daughter having a steady
substrate that responds to rewards and incentives and gener- boyfriend. Mothers used different methods of communication.
ates positive affect, while the Behavioral Inhibition System (BIS) Some used bibliotherapy, the use of books to address issues of
responds to punishment and aversive stimuli and causes nega- concern. One had the daughter explain her understanding of an
tive affect. Some correlational studies have suggested that both issue before having a discussion, while another encouraged her
the BAS and BIS are involved in alcohol use (e.g., urge to drink). daughter to write down her understanding or questions about
Authors suggested that this may reflect sensitivity to reward- RH to decrease the awkwardness of face-to-face communica-
ing stimuli or events in terms of the BAS and susceptibility to tion. All mothers lacked knowledge about liver transplantation
negative affect regarding the BIS. However, previous studies and the importance of preventing or planning a pregnancy or
have lacked experimental control. This study was designed to acquiring a STI but expressed interest in obtaining information;
test whether positive and negative events and affect that are ex- however, they did not know where or from whom to get the
perimentally induced motivate alcohol use differently, depend- information. These mothers are talking with their daughters
ing on BAS/BIS sensitivity. For this, 86 college student drinkers but are in serious need of education about how to prepare their
were divided into BAS-dominant and BIS-dominant groups and daughters for this important phase of life. Education and com-
randomly assigned to reward or punishment tasks. The group munication skills-building interventions may help to improve
by task interaction had a marginal effect on task performance: their RH communication and have a positive impact on their
(F (1,82) = 3.804, p = .06). The BAS-dominant group was more daughters’ RH behaviors.
accurate when rewarded than when punished, while BIS-dom- CORRESPONDING AUTHOR: Margaret Hannan, PhD, RN,
inant group was more accurate in the punishment condition. CPNP, University of Pittsburgh, Pittsburgh, PA, 15261; mhan-
Positive affect increased with the reward task (F (1,82) = 11.703, nan@pitt.edu
p < .01), and negative affect increased with the punishment task
(F (1,82) = 11.889, p < .01). The interaction between group and
task predicted change in participants’ urge to drink (F (1,82) =
10.745, p < .01). In the BAS-dominant group, urge to drink was
enhanced more by the reward task than the punishment task,
while in the BIS-dominant group, it was enhanced in the pun-
ishment task, but decreased in the reward task. The results lend
experimental support to the idea that BAS sensitivity motivates
drinking in response to reward, while BIS sensitivity enhances
vulnerability to drinking in response to stress and negative af-
fect.
CORRESPONDING AUTHOR: Hyoung S. Lee, MA, Psychol-
ogy, University of Texas at El Paso, El Paso, TX, 79968; hslee@
miners.utep.edu
D-154a
MOTHERS’ REPRODUCTIVE HEALTH COMMUNICATION
WITH TEEN DAUGHTERS WHO ARE LIVER TRANSPLANT
RECIPIENTS
Margaret Hannan, PhD, RN, CPNP, Beverly Kosmach-Park,
MSN, RN, Erin Meckley, SN and Mary Beth Happ, PhD
University of Pittsburgh, Pittsburgh, PA.
This study explored mothers’ perspectives of their reproduc-
tive health (RH) discussions with their teen daughters who are
liver transplant recipients. In this ongoing qualitative study,
open-ended semi-structured telephone interviews have been
conducted with 6 mothers, selected by purposeful sampling.
Qualitative content analysis techniques were used to analyze
the transcripts. Four preliminary themes describing mothers’
perspectives of RH discussions with their daughters have been
identified: practical/realistic advice; triggers to RH discussions;
method of RH discussions; and lack of RH knowledge. All 6
mothers stated they started RH discussions when the girls were
117