31st Annual Meeting & Scientific Sessions

Behavioral Medicine: Building for the Future

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

1
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
A-032a
CORTISOL IN CAUCASIAN AND AFRICAN AMERICAN
YOUNGER BREAST CANCER SURVIVORS: PRELIMINARY
FINDINGS FROM A PSYCHO-EDUCATIONAL INTERVENTION
STUDY
Laura Porter, PhD,1 Merle Mishel, PhD,2 Allen Deborah, MNS,2
Barbara Germino, PhD,2 Jamie Crandell, PhD,2 Diane Blyler,
PhD2 and Sheila Santacroce, RN, PhD2
1
Psychiatry & Behavioral Sciences, Duke University, Durham,
NC and 2School of Nursing, University of North Carolina,
Chapel Hill, NC.
There have been a growing number of studies examining corti-
sol in breast cancer (BC) survivors. Alterations in cortisol levels
and diurnal cycles have been linked with symptoms such as
fatigue, with survival time, and with outcomes of psychosocial
interventions. Findings are promising, but samples have been
predominantly Caucasian, over the age of 50, or including a
wide range of ages. Thus, little is known about these processes
in minority or younger women. We are conducting research
on the efficacy of a psycho-educational intervention targeted
to younger BC survivors 1-4 years post diagnosis. 313 women,
including 117 African Americans (AA), were randomized to an
uncertainty management intervention or attention control con-
dition. Salivary cortisol was assessed 4 times per day for 3 days
at 3 time points: baseline, 6 months post baseline, and at a stress
event (e.g., visit with oncologist or mammogram). Preliminary
analyses of cortisol data using mixed models to predict Area
Under the Curve (AUC) indicated that women in the interven-
tion group had lower levels of cortisol at the stress event com-
pared to women in the control condition (t(269)=-2.06, p=.04).
There was a significant race x group x time interaction indicat-
ing that the treatment effect was present only in AA women.
Analyses of diurnal cortisol slopes indicated no significant
treatment effects. However, there was a significant effect of race
on diurnal slope (F(3,269)=6.79, p<.001), with Caucasian women
displaying steeper diurnal slopes than AA women. These
findings suggest that cortisol in AA BC survivors may differ in
important ways from that in Caucasian BC survivors, and that
findings from previous studies with predominiately Caucasian
samples may not generalize to the larger population of multi-
ethnic BC survivors. Funded by NINR grant #5R01NR10190 to
M. Mishel.
CORRESPONDING AUTHOR: Laura Porter, PhD, Duke Uni-
versity, Durham, NC, 27705; laura.porter@duke.edu
A-032b
AMBIVALENT SOCIAL SUPPORT, PSYCHOLOGICAL
DISTRESS, AND VEGF ACROSS THE PERIOPERATIVE PERIOD
FOR WOMEN UNDERGOING SURGERY FOR ENDOMETRIAL
CANCER
Stacy M. Dodd, MS,1 Sally E. Jensen, PhD,2 Timothy Sannes,
MS,3 Stephanie Garey, BA,3 Seema Patidar, BA,3 Linda S.
Morgan, MD4 and Deidre B. Pereira, PhD3
1
VA Palo Alto, San Carlos, CA; 2Kellogg Cancer Care Center,
NorthShore University HealthSystem, Evanston, IL; 3Clinical
and Health Psychology, University of Florida, Gainesville, FL
and 4Department of Obstetrics and Gynecology, University of
Florida, Gainesville, FL.
Research has shown that positive social support (SS) is related
to better psychological functioning and has beneficial impacts
2
on health outcomes, while negative SS has opposite effects. No
research to date has examined the relationships between ambiv-
alent SS (high positive and negative SS), psychological function-
ing and health outcomes. The current study sought to examine
the relationship between ambivalent partner SS, psychological
distress, and vascular endothelial growth factor (VEGF)across
the perioperative period for women undergoing surgery for en-
dometrial cancer. This longitudinal study included 70 partnered
women (mean age = 60.5 yrs, SD = 9.6 yrs). Prior to surgery and
approximately 4-6 weeks post-surgery women provided demo-
graphic information, completed the Sources of Social Support
Survey
(SSSS) and the Structured Interview for the Hamilton Depres-
sion and Anxiety Scales (SIGH-AD), and underwent a blood
draw for quantitation of serum VEGF. Ambivalent SS was
calculated by creating a ratio of positive and negative SS from
SSSS scores. Psychological distress was calculated by summing
anxiety and depressive scores on the SIGH-AD. Path analysis
demonstrated that greater pre-operative ambivalent SS was re-
lated to greater pre-operative psychological distress (beta=-.36,
p=.002, negative ambivalence scores represent more ambiva-
lence), and less pre-operative ambivalent SS was marginally
associated with greater pre-operative VEGF levels (beta=.28,
p=.064). Post-operative ambivalent SS was unrelated to post-
operative psychological distress or VEGF. These results suggest
that ambivalent SS from a partner is associated with psychologi-
cal distress and proangiogenic cytokine levels prior to, but not
following, surgery for suspected endometrial cancer.
CORRESPONDING AUTHOR: Stacy M. Dodd, MS, VA Palo
Alto, San Carlos, CA, 94070; smdodd@phhp.ufl.edu
A-032c
ILLNESS BURDEN, IL12 AND SURVIVAL IN PATIENTS
UNDERGOING ALLOGENEIC HEMATOPOIETIC STEM CELL
TRANSPLANTATION (HSCT)
Seema M. Patidar, BS,1 D. Pereira, PhD,1 L. Christian, PhD,2 S.
Dodd, MS,1 M. Bishop, PhD,1 J. Wingard, MD1 and V. Reddy,
MD3
1
U of FL, Gainesville, FL, FL; 2OSU, Columbus, OH and 3FL
Hospital, Orlando, FL.
Cancer patients proceeding to HSCT undergo extensive medi-
cal treatment, and as such, they may experience high illness
burden, even prior to undergoing HSCT. Depression and
social support have been identified as psychosocial predictors
of survival post-HSCT. However, no research has examined
whether pre-HSCT illness-related perceptions are associated
with HSCT survival. The primary aim of this study was to
examine whether high illness burden (i.e. the degree to which
patients perceive a loss of independence and freedom to engage
in meaningful, instrumental activities) prior to HSCT was as-
sociated with shorter post-HSCT 1-year survival. A second aim
was to examine whether a significant illness burden-survival re-
lationship was mediated by lower levels of IL12, a cytokine that
stimulates cell-mediated immunity. Subjects (Ss) were 58 adults
(Mage=47.9yrs, SD=11.5yrs) undergoing allogeneic HSCT. Prior
to HSCT, Ss completed the Millon Behavioral Medicine Diag-
nostic (MBMD). The Functional Deficits scale was used to assess
illness burden. IL12 was measured on the day of HSCT (Day
0). Cox Survival Analysis showed that Ss with high perceived
illness burden had greater odds of death, Odds Ratio[OR]=6.35,
p=.02. However, Ss with greater IL12 at Day 0 did not have
significantly greater odds of death 1 year post-HSCT, OR=1.43,
p=.36, above and beyond the effects of high illness burden.
Also, IL12 at Day 0 was not associated with high illness burden,
F(1,32)=.15, p=.70, and thus did not mediate the illness burden-
survival relationship. While based on a modest sample size, the
results suggest that pre-HSCT high illness burden at the time of
HSCT may be independently associated with mortality follow-
ing HSCT; thus perceptions of illness burden may be a clinically
meaningful predictor of HSCT risk. Further research should
replicate these findings in a larger sample and examine other
potential bio-behavioral mediators.
CORRESPONDING AUTHOR: Seema M. Patidar, BS, Clinical
and Health Psychology, University of Florida, Gainesville, FL,
FL, 32610; patidar@ufl.edu
A-032d
CANCER-RELATED POSITIVE EXPECTANCIES: OPTIMISM,
FAITH, OR SOMETHING ELSE?
Sean Ransom, PhD1,2 and Paul B. Jacobsen, PhD3
1
Department of Psychiatry and Neurology, Tulane University
School of Medicine, New Orleans, LA; 2Friedler Center for
Psychosocial Oncology, Tulane Cancer Center, New Orleans,
LA and 3Department of Health Outcomes and Behavior, H. Lee
Moffitt Cancer Center, Tampa, FL.
Survivors of cancer often report experiencing personal growth,
but patients still under treatment may also anticipate such
benefits may happen to them. Although survivors’ reports of
posttraumatic growth (PTG) have attracted research interest
in the past decade, little is known about the positive expectan-
cies that patients in treatment believe may happen to them.
To test this, 94 individuals with breast or prostate cancer were
examined prior to their radiotherapy regimen. Positive expec-
tancies were assessed with a 5-item measure asking patients
to report whether “most people who have had cancer” experi-
ence improvements in various domains (e.g., feeling closer to
loved ones). Patients then completed a demographic question-
naire and measures of religious faith and satisfaction with life.
Following radiotherapy, patients completed measures of PTG
and dispositional optimism. Results showed higher positive
expectancies to be significantly related with lower education,
higher religious faith, higher satisfaction with life, and higher
optimism. Optimism did not predict expectancies after control-
ling for the other three related variables in regression analy-
sis. Regarding PTG, optimism was negatively related to PTG
whereas faith and expectancies were positively related to PTG.
Mediational analysis indicated that faith continued to explain
significant variance in PTG scores after controlling for expectan-
cies. Results suggest that, more than dispositional optimism, the
degree of patients’ religious faith is related to patients’ expecta-
tions about the positive impact of cancer. Those with stronger
religious faith also report higher PTG at the conclusion of can-
cer treatment, but such growth cannot be fully explained by the
expectancies associated with such faith. Results point toward
a complex interplay between optimism, faith, posttraumatic
growth, and positive expectancies in those with cancer.
CORRESPONDING AUTHOR: Sean Ransom, PhD, Tulane
Cancer Center, Tulane University School of Medicine, New
Orleans, LA, 70112; sransom@tulane.edu
A-032e
LONGITUDINAL EFFECTS OF SOCIAL SUPPORT AND
ADAPTIVE COPING ON EMOTIONAL WELL-BEING IN
LOCALIZED PROSTATE CANCER SURVIVORS
Eric S. Zhou, MS,1 Frank J. Penedo, PhD,1,2 Natalie E. Bustillo,
BS,1 Catherine Benedict, BS,1 Mikal Rasheed, MS,1 Suzanne
Lechner, PhD,2 Mark Soloway, MD,2,4 Bruce Kava, MD,2,3 Neil
Schneiderman, PhD1,3 and Mike Antoni, PhD1,2
1
Psychology, University of Miami, Coral Gables, FL; 2Sylvester
Comprehensive Cancer Center, University of Miami School of
Medicine, Miami, FL; 3Miami VA Medical Center, Miami, FL
and 4Medicine, University of Miami School of Medicine, Miami,
FL.
Objective: Prostate cancer survivors experience treatment-
related physical side effects that can compromise emotional
well-being for years post-treatment. There is limited research
investigating how social support and use of coping may affect
emotional well-being in this population following treatment.
The aim of this study was to investigate how social support and
coping impact emotional well-being two years following treat-
ment in localized prostate cancer survivors who have received
either radical prostatectomy or radiotherapy.
Methods: Psychosocial (social support, coping and emotional
well-being) and disease-specific measures were administered
to an ethnically and demographically diverse sample of men
treated for localized prostate cancer at baseline, and at a 2-year
follow-up (N=180).
Results: Regression analyses demonstrated that higher levels of
social support at baseline predicted better emotional well-being
2 years later, after controlling for baseline emotional well-being,
demographic variables and disease-specific physical function-
ing. Furthermore, higher levels of adaptive coping at baseline
partially mediated the relationship between social support and
emotional well-being.
Conclusions: Supportive relationships may contribute to im-
proved emotional well-being following treatment by facilitating
the use of adaptive coping strategies. Attention should be given
to strengthening social support networks and educating pros-
tate cancer survivors on adaptive coping techniques.
CORRESPONDING AUTHOR: Eric S. Zhou, MS, Psychology,
University of Miami, Coral Gables, FL, 33146; e.zhou@miami.
edu
A-032f
BLADDER CANCER PATIENTS LACK SURVIVORSHIP
RESOURCES AT ACADEMIC MEDICAL CENTERS
David M. Latini, PhD,1,4 Cheryl T. Lee, MD,2,4 Scott Gilbert,
MD3,4 and Diane Z. Quale, JD4
1
Urology, Baylor College of Medicine, Houston, TX; 2University
of Michigan, Ann Arbor, MI; 3University of Florida, Gainesville,
FL and 4Bladder Cancer Advocacy Network, Bethesda, MD.
Bladder cancer (BC) is a disease with high treatment burden.
Though little work as been done with BC survivors, support
groups and survivorship programs are effective methods at
managing physical and psychosocial impairments experienced
by other cancer survivors. The Institute of Medicine recom-
mends increased resources for cancer survivorship, but no
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
to BC survivors at high-volume academic centers. Descriptive
statistics were computed. A total of 59 respondents included
urologists (56%), medical oncologists (12%), BC survivors
(12%), and industry partners (10%). Physician respondents rep-
resented 25 academic centers and 1 private group. While 68%
of respondents represented an NCI-designated cancer center,
only 36% had an active BC support group led by a nurse (44%),
social worker (33%), and/or peer (28%); most met monthly
(62%). Patient navigators were nurses (64%), peers (55%), and/
or urologists (55%). Survivorship clinics were managed by
urologists (25%), other physicians (38%), and/or a physician
assistant (25%). Survivorship clinics managed sexual dysfunc-
tion (66%) and urinary (66%) and bowel (42%) incontinence.
Physical symptom management was carried out by urologists
(62%), other physicians (35%), nurses (42%), and/or physician
assistants (23%). Respondent clinics managed depression (22%)
and anxiety (19%), but 58% provided no distress management.
Survivorship care plans were rarely used. Resources for BC
survivors vary widely and are lacking at most academic centers
with high volume BC populations. Survivorship clinics and
care plans have not been widely disseminated and psychosocial
support for BC survivors lags behind physical symptom man-
agement. Behavioral medicine needs to advocate for additional
resources and partner with other disciplines to provide appro-
priate care.
CORRESPONDING AUTHOR: David M. Latini, PhD, Urology,
Baylor College of Medicine, Houston, TX, 77030; latini@bcm.
tmc.edu
A-032g
FACILITATING PREFERENCE-SENSITIVE DECISION
MAKING AMONGST PROSTATE CANCER PATIENTS:
INTERDISCIPLINARY COUNSELING
Odette Wegwarth, PhD1 and Martin Schostak, MD2
1
Harding Center for Risk Literacy, Max Planck Institut for
Human Development, Berlin, Germany and 2Urology, Charitè
Benjamin Franklin, Berlin, Germany.
BACKGROUND: Studies have demonstrated that most prostate
cancer patients end up with a treatment that reflects the stan-
dard recommendation of the specialty of the counseling physi-
cian, but not their own preferences. Such situation contradicts
the ideal of shared decision making. To tackle this problem we
introduced regular interdisciplinary counseling to prostate can-
cer patients, in which a radiotherapist together with a surgeon
counsels a patient. METHOD: Survey data of 196 prostate can-
cer patients who had attended the interdisciplinary counseling
were analyzed. The survey examined: a) patient’s preferences
for specific outcomes, b) doctors’ treatment recommendation,
and c) the treatment received. The preference questions investi-
gated desire to actively treat/remove the tumor, to avoid incon-
tinence, and sexual dysfunction, and to avoid invasive treat-
ment by a 10-point Likert scale. Only scores > 8 were used to
predict treatment received. The concordance between treatment
received and stated perferences as well as doctors’ recommen-
dation were examined. RESULTS: Patients’ preference profiles
showed a higher concordance with treatment received (n = 168,
83%) than did doctors’ recommendation (n = 148, 75%). For
patients who highly preferred removal of the tumor (n = 150),
the majority chose radical prostatectomy (RP) (n = 104 of all 112
4
RP choices, 92%). Avoiding incontinency was the strongest pre-
dictor for both choices on radiotherapy (RT) (n = 58 of 65, 89%)
and active surveillance (AS) (n = 18 of 19, 95%), yet the second
strongest predictor for each treatment clearly distinguished
choices: A desire for active treatment predicted RT (n = 44, 68%)
and a desire for the least invasive procedure predicted AS (n =
14, 73%). To avoid impotence did not distinguish between treat-
ment choices. CONCLUSION: The concept of interdisciplinary
counseling appears to promotes preference-sensitive decision
making, while not undermining doctors advice--a potential
promising step towards shared decision making.
CORRESPONDING AUTHOR: Odette Wegwarth, PhD, Hard-
ing Center for Risk Literacy, Max Planck Institut for Human
Development, Berlin, 14195; wegwarth@mpib-berlin.mpg.de
A-038a
DASH 2 WELLNESS:EFFECTS OF A MULTI-COMPONENT
LIFESTYLE MODIFICATION PROGRAM ON NUTRITION,
PHYSICAL ACTIVITY, & BLOOD PRESSURE IN MIDDLE-AGED
ADULTS WITH PREHYPERTENSION
Ashley E. Dorough, PhD, Emily Martin, MS and Richard
Winett, PhD
Virginia Tech University, Chapel Hill, NC.
Background: The goal of this project was to develop, imple-
ment, and evaluate the initial efficacy of a lifestyle modifi-
cation intervention that did not require extensive, ongoing
personal contact to lower blood pressure(BP) in adults with
prehypertension(N=23,mean age=54,mean BP=127/75).
Methods: Incorporating clinical practices and psychological
approaches to health behavior change this 10-week intervention
used the DASH Eating Plan, home BP monitoring, a walking
program, and applied SCT, specifically self-regulation for self-
monitoring of BP, diet, exericse, & weight.The study compared
two conditions, DASH 2 Wellness Only standard of care
condition and DASH 2 Wellness Plus tx condition, on measures
of fruit & vegetable(srvgs/day), sodium(mg/day), physical
activity(steps/day), weight(kgs), and BP.
Results: MANOVAs detected significant differences between
conditions on the combined dependent variables [F(4,15)=3.46,
p=.034; Wilks’ λ=.52].Follow-up univariate analyses re-
vealed tx condition effects for 3 of the 4 measures, weight
change (p=.032), daily step change (p=.011), and systolic BP
change(p=.003).While conditions did not significantly differ on
daily sodium reduction or F&V increase, D2W Plus evidenced
a larger decrease in sodium(mg) (M=932.22,SD=1019.22) than
D2W Only,(M=423.64,SD=749.15) and a larger increase in F&V
increase,(M=2.10,SD=1.73) than D2W Only,(M=1.02,SD=2.24).
It was also expected D2W Plus would show greater improve-
ments in nutrition-specific and PA-specific health beliefs(HB)
of self-regulation, social support, self-efficacy, social sup-
port, & outcome-expectancy compared to those in D2W Only.
Significant group differences were detected in PA-specific
HB primarily attributable to increased PA self-regulation in
D2W Plus compared to D2W Only,(M=1.78,SD=0.75) and
(M=0.55,SD=0.57),respectively.
Conclusions: Results provide preliminary support for the effica-
cy of electronic delivery of an intervention aimed at improving
lifestyle behaviors and lowering BP in middle-aged individuals
with prehypertension.
CORRESPONDING AUTHOR: Ashley E. Dorough, PhD,
Virginia Tech University, Chapel Hill, NC, 27516; aedorough@
gmail.com
A-038b
PHYSICAL ACTIVITY AND QUALITY OF LIFE AFTER ACUTE
CORONARY SYNDROME
Rebecca L. Reese, MA, Kenneth E. Freedland, PhD, Brian C.
Steinmeyer, MS and Robert M. Carney, PhD
Washington University in St. Louis, St Louis, MO.
Purpose: Patients are usually advised to resume physical activ-
ity as soon as it is safe to do so after hospitalization for acute
coronary syndrome (ACS), but little is known about how this
affects quality of life (QOL). We hypothesized that physical
activity helps to counteract factors that may decrease QOL in
post-ACS patients, including relatively early onset of heart dis-
ease, multiple medical comorbidities, rehospitalizations, stress,
and depression.
Methods: Participants were enrolled within the first few days
after hospitalization for ACS. The SF12 was used to measure
physical and mental QOL 6 weeks, 3 months, and 6 months
after enrollment. The Perceived Stress Scale (PSS) and the BDI-
II were obtained at the same times, as well as at enrollment,
and participants maintained a weekly log of physical activi-
ties based on the International Physical Activity Questionnaire
(IPAQ). Prospective multiple regression models were used to
predict SF12 scores at each time point, based on IPAQ scores
from the preceding interval, adjusting for gender, age, number
of major comorbidities, occurrence of rehospitalization, and PSS
and BDI-II scores obtained at the previous assessment time.
Results: Complete data were obtained from 184 patients (34%
women, age 60±11 years). Physical activity was positively as-
sociated with SF12 Physical at 3 and 6 months (r2=.08, p<.01;
r2=.06, p=.03, respectively); in contrast, medical comorbidities
and BDI-II predicted worse Physical QOL at each time point
(p<.01). Physical activity predicted better Mental QOL at 6
months (r2=.05, p=.02), but not at early points in the post-ACS
recovery process. The BDI-II predicted worse Mental QOL at all
3 time points (p<.0001). Younger age and higher levels of stress
also predicted worse Mental QOL at some time points (p<.05).
Conclusion: Early resumption of physical activity is associated
with better Physical QOL as early as 3 months after ACS, and it
predicts better Mental QOL within 6 months of ACS. Physical
activity appears to counteract the negative effects of multimor-
bidity and depression on quality of life in these patients.
CORRESPONDING AUTHOR: Rebecca L. Reese, MA, Wash-
ington University in St. Louis, St Louis, MO, 63130; rlreese@
wustl.edu
A-046a
A PEER SUPPORT INTERVENTION FOR UGANDAN ADULTS
WITH TYPE 2 DIABETES
Linda C. Baumann, PhD, RN,1 Fred Nakwagala, MS, MD,2 Dory
Blobner, RN, MS, CDE1 and Agatha Nambuya, MD2
1
School of Nursing, University of Wisconsin-Madison, Madison,
WI and 2Mulago Hospital, Kampala, Uganda.
The purpose of this 3-month pilot intervention was to test the
feasibility of a peer support program for persons with type 2
diabetes in one community in Uganda to improve glycemic
control (A1C), perceptions of emotional support, and contacts
with healthcare providers. Participants were either a Champion
(N=19), if they were fluent in English, or a Partner (N=27). All
attended a community education meeting about diabetes self-
care; in addition, Champions attended a community meeting to
be instructed in on how to provide supportive communication.
Champions and Peers, grouped in pairs or triads and matched
by gender and age, were asked to make at least weekly con-
tact with each other during the intervention. All participants
and healthcare providers were given cell phones for which the
airtime within the network was prepaid. Sixteen Champions
and 25 Partners completed the intervention; the mean age was
55 years, 56.5% reported education at the primary level, and
the occupation of about half the sample was farmer. The mean
duration of diabetes was 6.5 years. The only difference between
Champions and Peers was that Champions reported a higher
education level (p < .001).Post-intervention, A1C significantly
decreased from 9.8% to 6.8% (p < .001), blood pressure im-
proved from a mean of 146/85 to 140/76 (p < .025), and body
mass index did not change. Significant change in eating behav-
ior (p <.001) was the only behavior change. Scores on a 5-item
coping scale and ratings on a single item about confidence in
managing diabetes both significantly decreased (p =. 01 and p
= .02, respectively). Seventy-eight percent reported increased
contact with their healthcare provider during the program. No
differences in outcomes were found between Champions and
Peers. Explanation for the improvement in glycemic control
and eating behavior and decline in coping scores and ratings of
confidence in managing diabetes will be presented.
CORRESPONDING AUTHOR: Linda C. Baumann, PhD, RN,
School of Nursing, university of Wisconsin-Madison, Madison,
WI, 53792-2455; ljbauman@wisc.edu
A-050a
GRADUATE PSYCHIATRIC NURSES TRAINING ON FIREARM
INJURY PREVENTION
Michael Wiblishauser, MPH,2 Jagdish Khubchandani, MBBS,
MPH, CHES,1 James H. Price, PhD, MPH, FASHA2 and Amy
Thompson, PhD2
1
Neurology, University of Toledo Medical Center, Toledo, OH
and 2Health and Rehab Services, University of Toledo, Toledo,
OH.
Objective: Most suicides (60%) and homicides (45%) are com-
mitted with firearms, and the vast majority (80%) of individu-
als attempting suicide or homicide meet diagnostic criteria for
mental illness. This study assessed the prevalence of firearm
injury prevention training in graduate psychiatric nursing train-
ing programs.
Methods: A three-wave mail survey was sent to the directors of
85 graduate psychiatric nursing programs. Outcome measures
were the portion of programs offering training in anticipatory
guidance for firearms safety, the content of training if offered,
and the perceived benefits and barriers to providing such train-
ing.
Results: A total of 60 (70%) directors responded.The directors
perceived more benefits than barriers to offering such training.
Yet, the vast majority (70%) reported they had not seriously
thought about providing firearm injury prevention training.
Also, the majority (54.8%) reported they did not routinely
5
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
screen patients for firearm ownership. Additionally, the major-
ity (60%) thought the American Psychiatric Nursing Associa-
tion (APNA) should provide curriculum guidelines regarding
firearm injury prevention training.
Conclusions: Psychiatric nurses should be uniquely positioned
for helping to prevent firearm suicides and homicides among
the mentally ill. However, graduate psychiatric nursing pro-
grams are inadequately training students and thereby keeping
them from maximizing their roles as metal health profession-
als. Leaderships is needed by the APNA to help reduce firearm
violence in the mentally ill.
CORRESPONDING AUTHOR: Jagdish Khubchandani, MBBS,
MPH, CHES, Health and Rehab Services, University of Toledo,
Toledo, OH, 43606; jagdish.khubchandani@utoledo.edu
A-059a
DEVELOPMENT OF EXPERIMENTAL VIGNETTES FOR THE
INVESTIGATION OF HIGH-RISK SEXUAL BEHAVIOR AMONG
AFRICAN AMERICAN ADULTS
Sarah E. Woolf-King, MS, Stephen A. Maisto, PhD and Katie
Pinto
Department of Psychology, Syracuse University, Syracuse, NY.
The high prevalence of HIV/AIDS among African American
adults is a critical public health issue. Research has indicated
that understanding the combined influence of alcohol use, gen-
der, relationship power, and partner-type, as part of a multifac-
eted network of variables that predict condom use behavior, is
essential to developing targeted HIV prevention interventions.
Currently, there is a complete absence of experimental research
that addresses the causal influence of these factors on African
American men and women’s ability to implement condom use.
In order to address this gap in the literature, we present here
a series of pilot studies designed to create vignettes to be used
in a planned experimental study testing the relevance of the
aforementioned factors on perceived difficulty implementing
condom use among African American adults. The pilot studies
were designed to create vignettes that effectively manipulated
the following aspects of a sexual encounter: (a) level of per-
ceived relationship power (equal vs. low), (b) type of sexual
partner (casual vs. serious), and (c) presence or absence of
alcohol use. Manipulation checks for these independent vari-
ables (IVs), in addition to a check for perceived “realism” of the
vignettes, served as the main dependent variables of interest.
One qualitative study and five quantitative studies involving
N = 103 (n = 50 men; n = 53 women) African American adults
(aged 18+) produced a series of 8 experimental vignettes that ef-
fectively manipulated the IVs while concurrently being judged
as acceptably “realistic” by study participants. Together, these
studies provide a framework for the development of experi-
mental vignettes designed to study condom use behavior in
a laboratory setting. This type of methodology allows for the
investigation of the causal mechanisms underlying high risk
sexual behavior among African American adults, thereby in-
creasing our ability to ameliorate risk for HIV infection among
this target population.
CORRESPONDING AUTHOR: Sarah E. Woolf-King, MS, Syra-
cuse University, San Francisco, CA, 94112; sewoolf@syr.edu
6
A-059b
CHRONIC DISEASE BURDEN AND QUALITY OF LIFE IN AN
AGING HIV POPULATION
Benjamin Balderson, PhD, Christine Mahoney, MA, Robert G.
Harrison, BS and Sheryl Catz, PhD
Group Health Research Institute, Group Health, Seattle, WA.
With improvements in HIV care, a growing number of people
are living longer with HIV. It is predicted that this trend will be
increasingly important in the future as we extend the lifespan of
those with HIV and cohorts such as “baby boomers” enter their
senior years. Issues of aging and comorbid chronic conditions
may compound the psychosocial and quality of life challenges
of living with HIV. This study describes the frequency and type
of comorbid chronic conditions in a community cohort of older
adults living with HIV, as well as the relation between chronic
conditions and physical, social and mental health functioning.
Telephone surveys were conducted with 407 men and women
aged 50 and older recruited from nine AIDS Service Organiza-
tions as part of pre-trial assessment for an intervention program
targeting improved medication adherence and quality of life
in this age group. Survey measures included a chronic disease
checklist, SF-36 scales of physical, social, and mental health
functioning, the Patient Health Questionnaire (PHQ) depression
subscale, and the short Perceived Stress Scale (PSS). The modal
number of chronic conditions reported in addition to HIV
was 3 (M = 4.2; SD =2.8; range=0-16). High prevalence chronic
medical conditions (reported by more than one third of respon-
dents) included hypertension, chronic pain, asthma, arthritis,
and hepatitis. A higher number of comorbid chronic conditions
was associated with lower physical functioning (r=.51, p<.0001),
lower social functioning (r=-.39, p<.0001), and lower mental
health functioning (r=.42, p<.0001). Number of chronic condi-
tions was also significantly associated with depression (r=.46,
p<.0001), but not with perceived stress (r=.06, p=NS). Quality of
life and mood appear adversely impacted by the high chronic
disease burden frequently experienced by older persons living
with HIV. Improving chronic disease self-management skills
may be a key component to address in psychosocial interven-
tions targeting quality of life or depression among older adults
living with HIV.
CORRESPONDING AUTHOR: Benjamin Balderson, PhD,
Group Health Research Institute, Group Health, Seattle, WA,
98102; balderson.b@ghc.org
A-064a
BINGE EATING DISORDER AND ASSOCIATED PSYCHIATRIC
COMORBIDITY CONFER INCREASED RISK OF PHYSICAL
AND MENTAL HEALTH CARE UTILIZATION ON COLLEGE
CAMPUSES: RESULTS FROM A NATIONAL SAMPLE
Summar H. Reslan, BA,1 Karen K. Saules, PhD1 and Daniel
Eisenberg, PhD2
1
Clinical Psychology, Eastern Michigan University, Ypsilanti,
MI and 2Psychology, University of Michigan, Ann Arbor, MI.
Binge eating disorder (BED) is common on college campuses,
but little is known about its association with physical and men-
tal health care utilization. Using data from the Healthy Minds
Study, a national sample of college students, we estimated rela-
tive risk of past year mental and physical health care utilization
as a function of BED alone and in combination with psychiatric
comorbidity (binge drinking, cigarette smoking, anxiety, and
depression). Due to how the survey was constructed, BED was
screened as positive if a liberal criterion of binge episodes 1-2
times per week was met. The sample, which included 8,597
college students drawn from 15 colleges and universities, was
58.9% female, 62.2% Caucasian, with the majority (63.5%) in the
18-22 year old range; 17.6% sought therapy in the past year and
6.8% were currently receiving psychological services; 82.1% saw
a health care professional in the past year; 100% of those who
sought psychological services also sought physical health care.
Logistic regression analyses indicated that BED alone conferred
a nearly two-fold risk (OR=1.966; 95% CI [1.707, 2.266], p<.0001)
for past year use of psychological services and also significantly
increased the likelihood of seeing a health care provider in the
past year (OR=1.298; 95% CI [1.044, 1.614], p<.05). BED in com-
bination with anxiety or depression conferred additional risk of
mental health care utilization. BED in combination with drug
use, depression, or binge drinking conferred additional risk
of health care utilization. Results suggest that BED, alone and
particularly in combination with other risk factors, increases
the likelihood of physical and mental health care utilization on
college campuses. Future research should evaluate whether
prevention efforts targeting binge eating may reduce demand
on typically strained campus resources available to address
students’ physical and mental health needs.
CORRESPONDING AUTHOR: Summar H. Reslan, BA, Clinical
Psychology, Eastern Michigan University, Dearborn Heights,
MI, 48127; shabhab1@emich.edu
A-079b
ACTIVITY IN AN ONLINE WEIGHT LOSS COMMUNITY
PREDICTS ENCOURAGEMENT SUPPORT
Kevin O. Hwang, MD, MPH,1 Jason M. Etchegaray, PhD,1 Elmer
V. Bernstam, MD, MSE1,2 and Eric J. Thomas, MD, MPH1
1
Internal Medicine, The University of Texas Medical School at
Houston, Houston, TX and 2The University of Texas School of
Health Information Sciences at Houston, Houston, TX.
In a previous mixed-methods study we described dimensions of
social support for weight loss among members of the SparkPeo-
ple online weight loss community. In this secondary analysis
we tested the hypothesis that use of interactive features of the
website is directly related to experiencing Encouragement,
Information, and Shared Experiences support. The original sur-
vey had 7 items on the frequency of use of interactive features
(forums and blogs) over the last 4 weeks. For this analysis we
combined the items into a single Activity scale (alpha=0.91)
as the predictor. In the original survey, qualitative descrip-
tions of social support experiences over the last 4 weeks were
categorized as Encouragement (motivation, congratulations),
Information (advice, tips), and Shared Experiences (belong-
ing to a group). For this analysis each category was a binary
outcome (yes/no). We performed structural equation modeling
(SEM) to determine which outcomes were associated with the
predictor, followed by logistic regression to obtain odds ratios
adjusted for age, gender, race, education, marital status, BMI,
and duration of SparkPeople membership. The 187 participants
were mostly female (95%) and white (91%), with mean [SD] age
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
once a week (high Activity) and less frequently (low Activity),
approximating a median split. Participants with high Activity
were almost 5 times as likely to experience Encouragement sup-
port compared to those with low Activity (adjusted OR 4.8 [95%
CI 1.8-12.8]). Our results suggest that interacting at least weekly
with other members of the online weight loss community is
strongly associated with receiving encouragement for weight
loss behaviors.
CORRESPONDING AUTHOR: Kevin O. Hwang, MD, MPH,
Internal Medicine, The University of Texas Medical School at
Houston, Houston, TX, 77030; kevin.o.hwang@uth.tmc.edu
A-079c
EMOTION REGULATION MODULATES BRAIN ACTIVATION TO
FOOD IMAGES
Trisha Hay, BS,1,2 Rebecca Chambers, MA,1,2 Cary R. Savage,
PhD2 and Nancy A. Hamilton, PhD1
1
Department of Psychology, University of Kansas, Lawrence,
KS and 2Hoglund Brain Imaging Center, University of Kansas
Medical Center, Kansas City, KS.
Functional magnetic resonance imaging (fMRI) research shows
significant overlap between brain regions activated by emo-
tional and food motivation manipulations. Ability to regulate
emotional states may be an important contributor to brain
response to food pictures. This study investigated whether abil-
ity to reduce emotion intensity was associated with differential
brain activation under various conditions of food motivation.
Seventeen obese adults (13 females, mean age 37.12 years; 70.6%
Caucasian) were scanned using fMRI. Participants viewed
Food and Nonfood images before (Pre) and after (Post) eating a
small meal. Ability to regulate emotion was assessed with The
Emotion Amplification and Reduction Scales (TEARS). Hunger
ratings were obtained prior to scanning sessions. Two groups
were defined based on TEARS Reduction subscale scores. High
TEARS Reduction (HTR) relative to Low TEARS Reduction
(LTR) scores reflect greater perceived ability to reduce emotion
intensity or duration. In this study, HTR and LTR groups did
not differ in age, body mass index, or hunger ratings. State (Pre,
Post) by Image (Food, Nonfood) by TEARS Reduction (HTR,
LTR) ANOVA (p=.001 uncorrected) of fMRI data revealed
significant activation in the posterior orbitofrontal cortex (OFC;
F=23.38, p<.001). Post hoc comparison of this interaction (Food
vs. Nonfood) showed that HTR was associated with a decrease
(t=4.837, p=.002) and LTR with an increase (t=3.683, p=.006)
in OFC activation from Pre to Post. Previous fMRI findings
suggest that the posterior OFC processes food-related hedonic
information. In this study, HTR was associated with greater
activation to Food pictures Pre, and less activation to Food
pictures Post; the opposite was true for LTR. HTR individuals
appeared to respond adaptively to food cues based on hunger
and satiety states. For LTR individuals, consuming food may
have actually enhanced its rewarding properties. This may indi-
cate that the ability to control emotions affects brain activation
to food-related stimuli.
CORRESPONDING AUTHOR: Trisha Hay, BS, University of
Kansas, Lawrence, KS, 66045; haytm@ku.edu
7
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
A-079d
QUALITY OF LIFE AND HEALTH RISK BEHAVIORS AMONG
NORMAL, OVERWEIGHT AND OBESE ADULTS WITH AND
WITHOUT PAIN-RELATED ACTIVITY DIFFICULTY
E. Amy Janke, PhD,1,2 Frances Weaver, PhD,2,3 Sherri Lavela,
PhD3 and Bonnie Spring, PhD2,4
1
Department of Behavioral and Social Sciences, University of
the Sciences in Philadelphia, Philadelphia, PA; 2CMC3, Hines
VA Hospital, Hines, IL; 3SCI QUERI, Hines VA Hospital, Hines,
IL and 4Department of Preventive Medicine, Northwestern
University, Chicago, IL.
Background: Many obese individuals report ongoing pain, but
little is known about whether the pairing of pain with obesity
also heightens the likelihood of other health risk behaviors and
adversely affects quality of life (QOL).
Objective: To examine the associations among overweight/obe-
sity, pain, health risk behaviors and QOL among U.S. adults.
Design & Participants: A sample of 81,308 respondents was
drawn from the 23 states completing the quality of life module
of the 2002 Behavioral Risk Factor Surveillance System (BRFSS).
Data were analyzed to examine variation in socio-demographic,
health behavior and QOL characteristics as a function of re-
ported pain-related activity difficulty during the prior 30 days
(no pain = 0 pain days; infrequent pain = 1 to 13 pain days; fre-
quent pain ≥ 14 pain days) and body mass index (BMI; normal,
overweight, obese).
Results: Co-occurrence of obesity and frequent pain-related
activity difficulty was associated with female gender, older age,
African-American race, lower educational attainment, divorce,
and inability to work (p≤.05). Increased BMI and increased days
with activity-interfering pain co-varied with physical inactivity,
low fruit and vegetable intake, impaired mental and physical
health, low vitality, frequent need for assistance with personal
and routine care, frequent need for specialized health equip-
ment, depressive symptoms, sleep insufficiency, and symptoms
of anxiety.
Conclusions: These cross-sectional survey data suggest a dose-
response relationship may exist between increasing days with
pain-related activity difficulty, increasing BMI, and increased
prevalence of impaired QOL and altered engagement in select
health behaviors in community dwelling adults.
CORRESPONDING AUTHOR: E. Amy Janke, PhD, Depart-
ment of Behavioral and Social Sciences, University of the Sci-
ences in Philadelphia, Philadelphia, PA, 19477; e.janke@usp.edu
A-079e
WEIGHT LOSS EXPECTATIONS PREDICT ONE-YEAR POST-
OPERATIVE WEIGHT LOSS AMONG AFRICAN AMERICAN
WOMEN UNDERGOING GASTRIC BYPASS SURGERY
Iulia Ivan, Bachelors, Leila Azarbad, PhD, Megan Hood, PhD
and Joyce Corsica, PhD
Behavioral Science, Rush Medical Center, Chicago, IL.
Background: Research consistently indicates that bariatric
surgery patients tend to have unrealistic expectations for post-
operative weight loss. However, the prognostic influence of
weight loss expectations on achieved post-surgical weight loss
remains unclear. Only one study to date has examined this
relationship in a bariatric surgery sample and found no associa-
tion between weight loss expectations and post-surgical weight
8
loss. However, this study did not examine ethnic differences in
the relationship between expectations and outcome, which is of
particular importance given that African American women lose
less weight following bariatric surgery than Caucasian women,
even after accounting for level of psychological distress, diet,
or age. This study had two primary aims: (1) To examine ethnic
differences in pre-operative weight loss expectations (WLE)
between Caucasian and African American women undergo-
ing gastric bypass (GB) surgery, and (2) To examine whether
pre-operative WLE predicted weight loss at 3, 6, and 12 months
post-surgery within each ethnic group. Methods: Participants
were 187 women (56% African American, 44% Caucasian, BMI
M=51; age M=42) undergoing GB surgery at an urban medical
center. Hierarchical regression analysis was used to assess the
influence of WLE on percentage of excess weight lost (PEWL).
Results: African American and Caucasian women did not differ
with respect to expected PEWL (p=.30). However, both reported
unrealistic WLE (~ 85% of excess weight) relative to normative
data. Among Caucasian women, WLE did not predict achieved
weight loss at 3, 6, or 12 months post-surgery. However, among
African American women, WLE significantly predicted PEWL
at 12 months post surgery, such that greater pre-operative WLE
predicted greater weight loss (r2chg=0.12, p < .05). WLE were
not associated with weight loss at 3 or 6 months post-surgery in
this group. Conclusion: Contrary to earlier research, higher ex-
pectations may promote greater one-year post-surgical weight
loss among African American, but not Caucasian, women.
CORRESPONDING AUTHOR: Iulia Ivan, Bachelors, Behavioral
Science, Rush Medical Center, Chicago, IL, 60612; jewels0219@
sbcglobal.net
A-096b
MEASUREMENT OF PATIENT CENTERED OUTCOMES IN
PARKINSON’S DISEASE: WHAT DO PATIENTS CONSIDER
SUCCESS IN THEIR TREATMENT?
Anne N. Nisenzon, MS,1 Michael E. Robinson, PhD,1 Dawn
Bowers, PhD,1 Evangelia Banou, PhD,1 Irene A. Malaty, MD2
and Michael S. Okun, MD2
1
Dept. of Clinical and Health Psychology, University of Florida,
Gainesville, FL and 2Department of Neurology, University of
Florida, Gainesville, FL.
Parkinson’s disease (PD) and other forms of parkinsonism
impact several domains of functioning, although non-motor
symptoms are often underappreciated when designing treat-
ment. We argue that taking the patients’ perspective of their
condition into account may allow for a more realistic assess-
ment of patient goals and subsequent tailoring of care. One
hundred and sixty-two patients with PD or parkinsonism
completed a modified version of the Patient Centered Outcomes
Questionnaire (PCOQ-M), to evaluate treatment success and
expectations from the patient’s point of view across 4 motor
domains (e.g., tremor, stiffness, slowness, and walking difficul-
ties) and 6 non-motor domains (e.g., pain, fatigue, emotional
distress, ADL, thinking problems, and sleeping problems). We
also examined patient clusters based on importance of improve-
ment in various domains. Results indicated that patients varied
widely in their ratings of usual symptom levels, and that these
ratings were generally unrelated to demographic variables. On
average, across all domains, patients indicated a 49% reduc-
tion in symptoms as a successful outcome (range= 39% to 58%).
Change scores between patients’ usual levels of symptom inter-
ference and their treatment success levels suggested a greater
degree of change was desired in motor domains (i.e., slowness,
gait disturbance) than non-motor domains (i.e., emotional dis-
tress) (p<.05). Finally, cluster analyses revealed two subgroups
of patients based on overall importance of improvement (High
vs. Low Importance Endorsement) across all tested domains.
Notably, the High Importance raters reported lowered expecta-
tions for improvement, specifically in non-motor domains. In
examining treatment success from the PD patient’s view, we
aim to establish a more meaningful set of criteria by which to
evaluate outcome.
Funded by NIH Grant R01 NS047119 and with support from
the National Parkinson Foundation Center of Excellence.
CORRESPONDING AUTHOR: Anne N. Nisenzon, MS, Dept. of
Clinical and Health Psychology, University of Florida, Gaines-
ville, FL, 32608; nisenzon@phhp.ufl.edu
A-096c
MENTAL HEALTH FUNCTIONING RECOVERY CURVES
ASSOCIATED WITH BEHAVIORAL HEALTH CONSULTANT
SERVICES IN INTEGRATED PRIMARY CARE
Meghan Corso, PsyD,2 Craig J. Bryan, PsyD,3 Kent Corso, PsyD,5
Chad E. Morrow, PsyD1 and Kathryn Kanzler, PsyD4
1
USAF, MOntgomery, AL; 2National Naval Medical Center,
Bethesda, MD; 3University of Texas Health Science Center at
San Antonio, San Antonio, TX; 4Wilford Hall Medical Center,
San Antonio, TX and 5Alternative Paths Training School,
Bethesda, MD.
The primary aim of the current study was to identify the rates
at which mental health distress and global functioning remit
to normal levels within the context of a Behavioral Health
Consultant (BHC) model of integrated primary care. Related, a
secondary aim was to determine if greater severity of baseline
symptom and functioning levels were associated with failure
to recover within the BHC model. This study included 1477
participants that were referred by their Primary Care Providers
(PCPs) to the BHC services. Each patient completed the Behav-
ioral Health Measure (BHM) to assess global behavioral health
symptoms and functioning. The sample was predominantly
married (75.1%) and female (62.3%). Referral reasons ranged
from isolated problems such as depression alone to co-morbid
problems (e.g. depression, insomnia, and pain). Of the par-
ticipants, 982 (66.5%) pts met with the BHC once, 339 (23%)
kept two appointments, 94 (6.40%) kept three appointments,
and 40 (2.7%) kept four appointments. A mixed linear model
with random effects was conducted to model recovery rates by
initial severity level. Results show that approximately one-third
of the observed difference in recovery was accounted for by
increasing number of appointments. Results also indicated that
more severe symptoms and functional limitations at the initial
appointment were associated with faster recovery. Overall, this
study lends further support for the effectiveness of brief, prob-
lem-focused treatment conducted by BHCs in a primary care
clinic. Additionally, the study demonstrates that even patients
with severe levels of baseline functional impairment recover in
an average of four appointments.
CORRESPONDING AUTHOR: Chad E. Morrow, PsyD, USAF,
MOntgomery, AL, 36116; chad.morrow@maxwell.af.mil
A-096d
COMPARISON OF YOUNGER AND OLDER ADULTS
ACCEPTABILITY OF TREATMENTS FOR COMORBID
GENERAL ANXIETY AND PARKINSON’S DISEASE
Duane A. Lundervold, RhD
1
Psychology, University of Central Missouri, Warrensburg,
MO and 2Department of Neuroscience, Saint Luke’s Hopsital
of Kansas City and Plaza Primary Care and Geriatrics, Kansas
City, MO.
Seventy-nine younger adults and 54 older adults completed
acceptability ratings for two treatments, Behavioral Relaxation
Training (BRT) and medication, for comorbid anxiety and
Parkinson’s disease (PD). Participants read a case description
of an older adult with PD and general anxiety followed by a
description of the treatments, presented in counter balanced
order. They then completed the Abbreviated Acceptability Rat-
ing Profile (AARP), an eight-item likert scale measure. Correla-
tion analysis between AARP scores and selected demographic
variables, e.g., personal history of anxiety, were not significant.
A mixed analysis of variance was used to determine main
and interaction effects. Main effect of treatment was signifi-
cant (F 14.71, df 131, p .0001) with BRT rated more acceptable
than medication. Age group x treatment interaction was non
significant (F 1.89, df 131, p .17) indicting no age cohort effect
relative to acceptability of behavioral versus pharmacological
treatments. The findings are consistent with previous research
regarding greater acceptability of behavioral and cognitive
behavior treatment relative to medication. This is the only study
that has directly compared younger and older adults accept-
ability of treatment ratings. Similarly,It is the only work that
has examined treatment acceptability ratings related to physical
health and comorbid psychological disorders. Results provide
further information regarding older adult’s health care prefer-
ences. Education of physicians and other health care providers
is needed regarding older adult’s preferences for behavioral
and cognitive behavioral treatments. To ensure older adults
receive the treatment they prefer integrated behavioral health
care is necessary in primary and specialty care medical facilities.
CORRESPONDING AUTHOR: Duane A. Lundervold, RhD,
Psychology, University of Central Missouri; Saint Luke’s Hospi-
tal, Warrensburg, MO, 64093; lundervold@ucmo.edu
A-096e
EFFECT OF EFT (EMOTIONAL FREEDOM TECHNIQUES) ON
PSYCHOLOGICAL TRAUMA IN VETERANS: A RANDOMIZED
CONTROLLED TRIAL
Dawson Church, PhD,2 Audrey Brooks, PhD1 and Crystal
Hawk, MEd3
1
Psychology, University of Arizona, Tucson, AZ; 2Foundation
for Epigenetic Medicine, Santa Rosa, CA and 3Therapeutic
Touch Network, Ontario, ON, Canada.
The present study examined whether Emotional Freedom
Techniques (EFT), a brief exposure therapy that combines
cognitive and somatic elements, had an effect on post-traumatic
stress disorder (PTSD) and psychological distress symptoms
in a sample of military veterans. Veterans were randomized to
either EFT (N=19) or a wait-list control group (N=13; WL). The
EFT treatment consisted of six hour-long EFT coaching sessions
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
(Symptom Assessment 45). PTSD and psychological distress
were assessed prior to treatment and at the end of 6-sessions or
at 1-month for the wait-list group. Additional assessments were
conducted during treatment after 3-sessions and at 3-months
following treatment. The sample consisted of 29 males and 3
females, with an average age of 52 years old (range 24-86). The
EFT group had a significant decrease in psychological distress
and PTSD from pretest (p<.001). A statistically significant dif-
ference between the EFT and WL group was also present at
posttest on all measures indicating decreased distress for the
EFT group. Sixteen participants in the treatment group (84%) no
longer met the criteria for PTSD, while none of the WL group
had dropped below the PTSD cut-off score (p<.001). There was
no pre-post difference in PTSD symptoms or psychological dis-
tress for the WL group. In the combined group EFT treatment
analysis, statistically significant decreases in PTSD symptoms
and psychological distress were present after 3- and 6-ses-
sions of EFT. After 3 EFT sessions, 72% no longer met PTSD
criteria. This increased to 28 participants (88%) after 6 sessions.
Thirteen participants completed a 3 month follow-up. None of
the participants met PTSD criteria at this point. The results are
consistent with other published reports showing EFTs efficacy
at treating PTSD and co-morbid symptoms.
CORRESPONDING AUTHOR: Audrey Brooks, PhD, Psychol-
ogy, University of Arizona, Tucson, AZ, 85721; brooksaj@email.
arizona.edu
A-096f
BELIEFS ABOUT THE NATURE AND CAUSES OF
DEPRESSION INFLUENCE WILLINGNESS TO MEDICATE
Andrew Sarkin, PhD, Marisa Sklar, BA, Eliza Robillos, BA,
Jennifer Leich, MA, Alexis Munoz, MPH, Richard Heller, MA
and David Thomas, BA
Health Services Research Center, University of California San
Diego, San Diego, CA.
Beliefs about the nature and causes of an illness can influence
a person’s participation and response to treatment. This study
examined how beliefs about the causes of depression influ-
ence willingness to take psychiatric medications if depressed,
using data from the 2006 General Social Survey. In this study,
participants (n=360) were read a vignette describing a person
with depression and were asked to rate the likelihood of several
possible origins for the person’s disorder. People were signifi-
cantly more willing to take psychiatric medication themselves
for depression if they believed that the depression is genetic in
origin (r=.242,p<.0005) or caused by a brain chemical imbalance
(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
who interpreted that the depressed person in the vignette was
experiencing “the normal ups and downs of life” were signifi-
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
teaching about causes and outcomes, not just early detection
and accessing services.
CORRESPONDING AUTHOR: Marisa Sklar, BA, University of
California San Diego, San Diego, CA, 92121; masklar@ucsd.edu
A-096g
THE FUTURE OF QUALITY OF LIFE (QOL) ASSESSMENT:
DISEASE SPECIFIC OR GENERAL? ONLINE OR ON PAPER?
Bethany Gourley, BA,1 Flora Hoodin, PhD,1 Lauren Hart,1 Jillian
Carey, BS,1 Teresa J. Lynch, PhD,1 Kevin N. Alschuler, MS,1
Michelle Byrd, PhD1 and Michael J. Mendelow, MD2
1
Eastern Michigan University, Ypsilanti, MI and 2Providence
Hospital- St. John Health, Southfield, MI.
QOL is an important aspect of treatment outcome in adolescent
idiopathic scoliosis (AIS), a chronic health condition character-
ized by lateral growth of the spine and rotation of its vertebrae.
The SRS-22r, a measure of AIS disease-specific QOL, is reliable
and internally valid in clinic-based samples. However, its online
psychometrics are unknown. As internet data collection has
potential for tracking natural history and long-term treatment
outcomes, our study aimed to validate SRS-22r use online in a
community-based sample.
We recruited 311 adults with AIS via the National Scoliosis
Foundation and like websites. Mean age was 40.3 + 13.5 years
(18-72); 95.2% were female; 89.7% were white; 53.1% had
completed 4 years of college; 51.8% were post-surgery for AIS;
21.2% were braced; 27% under structured observation.
Participants completed the SRS-22r, Oswestry Disability Index
(ODI) and SF-12. The SRS-22r , a 22-item self report measure
assesses QOL across 5 domains (functioning, pain, self-image,
mental health, and satisfaction with management). The ODI, a
10-item measure assesses physical disability, social restriction
and pain, and provides a total disability index. The SF-12, a 12-
item general QOL measure assesses physical and mental health.
SRS-22r floor and ceiling effects for all domains were <1% and
≤6.4%, respectively, except satisfaction with management (6.8%
and 10%, respectively). Internal consistency was strong (α≥0.80)
in all domains except pain (α=.38). Concurrent validity was ≥.73
relative to comparable domains of the SF-12 and ODI. Overall,
online administration displayed comparable psychometrics to
paper administration, documented by Bridwell et al. (2005).
These psychometric findings suggest that orthopedic surgeons
could use the SRS-22r online in ongoing QOL assessment. Ad-
vantages of time efficiency and cost effectiveness, make online
assessment a viable option for the future and highlight the
importance of validating other online QOL measures.
CORRESPONDING AUTHOR: Bethany Gourley, BA, Clinical
Psychology, Eastern Michigan University, Ypsilanti, MI, 48197;
bgourley@gmail.com
A-096h
COGNITIVE BEHAVIORAL STRESS MANAGEMENT EFFECTS
ON STRESS, QUALITY OF LIFE, AND SYMPTOMS IN
PERSONS WITH CHRONIC FATIGUE SYNDROME
Corina R. Lopez, BA, Michael Antoni, PhD, Frank Penedo,
PhD, Nancy Klimas, MD, Mary Ann Fletcher, PhD and Neil
Schneiderman, PhD
University of Miami, Miami, FL.
The present study was designed to aid individuals with Chronic
Fatigue Syndrome (CFS) in relieving mental distress and symp-
tomatology by offering a 12 week group-based Cognitive Be-
havioral Stress Management (CBSM) intervention that teaches
cognitive reappraisal, problem solving, coping, and relaxation
skills. We hypothesized that participants randomized to CBSM
would report improvements in perceived stress, mood, quality
of life, and CFS symptomatology from pre-post intervention
(T1-T2) compared to those assigned to 1/2 day psychoeduca-
tional (PE) seminar. A total of 69 participants comprised our
sample, with 44 randomized to CBSM and 25 to PE. Participants
were mainly Caucasian women (76.8%) with a mean age of 45.9,
a high school diploma or greater (97%), on disability (44.5%),
and a mean household income of $20,000-$30,000. Participants
completed self-report measures including the Perceived Stress
Scale (PSS; Cohen et al., 1983), Profile of Mood States (POMS;
McNair et al., 1971), Quality of Life Inventory (QOLI; Frisch et
al., 1992), SF-36 health survey (Ware, 1997), and the Temporal-
ity and Nature of CFS scale at T1 and T2. Repeated Measures
ANOVA analyses revealed a significant group x time interac-
tion for PSS [F(1, 53)= 5.07, p=.028], POMS-total mood distur-
bance [F(1, 51)= 4.12, p= .048], QOLI [F(1, 49)= 10.65, p=.002],
and SF-36 emotional wellbeing [F (1,53)= 5.35, p=.025], such that
participants in CBSM evidenced greater improvements in these
areas from T1 -T2 than participants in PE. Significant interaction
effects were also found on CFS symptoms, including decreases
in pain [F(1, 53)= 4.56, p= .04], severity of sore throat [F(1,46)=
4.80, p=.034], stomach pain [F(1,29)= 1.96, p= .02], and frequen-
cy of unrefreshed sleep [F(1,52)= 6.59, p=.01] in CBSM vs. PE.
Results suggest that CBSM is beneficial for patients with CFS in
managing distress and alleviating symptoms.
CORRESPONDING AUTHOR: Corina R. Lopez, BA, University
of Miami, Miami, FL, 33136; corina.lopez83@gmail.com
A-104a
ASSESSMENT OF THE LONG-TERM STABILITY OF
SYMPTOMS AND OUTCOME MEASURES FOR CHRONIC PAIN
CLINICAL TRIALS
Christina A. Kemp, BA Psychology, Brian R. Theodore, PhD,
Hilary D. Wilson, PhD, James P. Robinson, MD, PhD and
Dennis C. Turk, PhD
Anesthesiology and Pain Medicine, University of Washington,
Seattle, WA.
Pain, mood, and physical function are routinely used as out-
comes to evaluate the efficacy of treatments for chronic pain.
The stability of instruments used to assess these outcomes is es-
sential as lack of consistency of the measure will inhibit ability
to attribute any changes observed to the treatment. There is no
set time for the assessment of test-retest reliability of self-report
measures, although this is most frequently measured between
1 day and 6 weeks apart. However, clinical trials are typically
conducted between 6- 12 weeks. Knowledge of the stability of
outcome measures over extended periods of time commensu-
rate with the duration of a clinical trial will provide information
regarding spontaneous fluctuation in these measures attribut-
able to random error. The purpose of this study was to assess
the stability of several well-established instruments used in
chronic pain trials over 8-weeks, namely, Multidimensional
Pain Inventory Pain Severity Scale(MPI), Oswestry Disability
Index(ODI), Center for Epidemiological Studies Depression
Scale(CESD), Pain Anxiety Symptom Scale(PASS), State-Trait
Anxiety Inventory(STAI), Hospital Anxiety and Depression
Index(HADS), Pain Catastrophizing Scale(PCS), and a mea-
sure of self-efficacy pain, for a sample of fibromyalgia patients
awaiting treatment. Paired t-tests indicated all measures were
stable over the 8-week period (all p values >0.05). The most
stable measure was the ODI (r=0.92). In addition, all psychoso-
cial measures had large and significant test-retest correlations:
HADS (r=0.81), PASS (r=0.76), PCS (r=0.76), CESD (r=0.72),
STAI (r=0.68), and Self-Efficacy (r=0.63). Although highly cor-
related, pain severity showed the lowest stability (r=0.61). The
stability of the measures over 8 weeks demonstrates that fibro-
myalgia patients’ levels of pain, physical functioning, mood,
and self-efficacy are relatively enduring. Moreover, the results
support the use of these measures as outcomes in clinical trials
of up to 2months in length.
CORRESPONDING AUTHOR: Christina A. Kemp, BA Psychol-
ogy, Anesthesiology and Pain Medicine, University of Washing-
ton, Seattle, WA, 98195; kempc10@uw.edu
A-122a
DEVELOPMENT AND EVALUATION OF THE AUDIT OF
PHYSICAL ACTIVITY RESOURCES FOR SENIORS (APARS)
TOOL
Jordan A. Carlson, MA,1 Jacqueline Kerr, PhD,1 Dori Rosenberg,
MS,1 James F. Sallis, PhD,1 Brian E. Saelens, PhD2 and Abby C.
King, PhD3
1
San Diego State University, San Diego, CA; 2University of
Washington, Seattle, WA and 3Stanford University, Stanford,
CA.
A growing number of older adults reside in continuing care
retirement communities(CCRCs), where restricted environ-
ments may reduce physical activity (PA) and affect health.
Measures are needed to quantify PA related attributes within
CCRCs. This study evaluated a new tool, “the Audit of Physi-
cal Activity Resources for Seniors” (APARS), which assesses
the PA environment in CCRCs including PA-specific resources
in- and out-doors (e.g. sports courts or exercise classes), outdoor
environments that support walking (e.g. length and features of
walking routes), and indoor environments that support inci-
dental activity such as access to stairs. Development included
interviews with facility staff and residents. Audits were
conducted by trained observers in 30 CCRCs in 4 U.S. cities.
Inter-rater reliability intraclass correlation coefficients (ICCs)
were assessed for 204 items. Seven day accelerometer data were
collected from residents at 12 sites (N = 147) to evaluate predic-
tive utility. Pearson correlations were examined between each
APARS item and sedentary (< 100 counts) and moderate-to-
vigorous PA (MVPA; > 1952 counts) minutes per day, adjusting
for time the accelerometer was worn. ICCs ranged from .15 to
1.00. Seventy-seven percent of the items produced ICCs ≥ .80,
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
-.48 to .38. Seventy-two items (35%) were significantly correlat-
ed with sedentary behavior and 64 items (31%) were correlated
with MVPA (P < .05; absolute value of r ≥ .17). Most correlations
were in the expected direction, positive for MVPA and negative
for sedentary behavior. The APARS demonstrated adequate
inter-rater reliability for assessing CCRCs. Numerous environ-
ment attributes were related to sedentary behavior and MVPA.
Further research is needed to explore attributes of CCRCs and
physical activity and to develop scales. Use of APARS could
inform more health-promoting designs of retirement facilities.
CORRESPONDING AUTHOR: Jordan A. Carlson, MA, Univer-
sity of California San Diego & San Diego State University, San
Diego, CA, 92103; jcarlson@projects.sdsu.edu
A-122b
CARBONLESS FOOTPRINTS AND ACTIVE LIFESTYLES:
PROMOTING HEALTH AND CLIMATE STABILIZATION
THROUGH ACTIVE TRANSPORTATION
Lawrence D. Frank, PhD,1 Michael Greenwald, PhD,3 Sarah
Kavage, MA,3 Jim Chapman, MSc3 and Steve Winkelman, MA2
1
School of Environmental Health, University of British
Columbia, Vancouver, BC, Canada; 2Center for Clean Air
Policy, Washington, DC and 3Urban Design 4 Health, Inc.,
Seattle, WA.
Supplanting travel in private vehicles with active forms of
transportation (walking, biking) can help meet both health and
greenhouse gas emissions goals but doing so will require walk-
able environments with public transportation. To date, no study
has evaluated the relationship between energy used for active
vs. motorized transportation. A cross-sectional analysis of a
2-day Atlanta travel survey was used to measure relationships
between energy (Kcal) burned from walking, energy (Kcal)
burned from motorized transportation, the ratio of the two
(transport energy index), and regional accessibility and local
walkability, adjusting for demographic factors. Ten percent of
the sample population reported a walk trip and average travel
time by car was 62 minutes per day, and 14 percent had access
by transit to the five major central business districts. Respon-
dents consumed 37,069 Kcal of energy driving and expended
4.03 Kcal walking per day. Residential density (p=.000), and
intersection density (p=.001) were positively correlated with
walk energy and inversely associated with motorized energy
(p=.000). Increased levels of land use mix was found to be as-
sociated with reduced average energy expended for all modes
of travel (p = .010) due to reduced distances to destinations and
the nature of mixed use environments in Atlanta which are
most often auto oriented. Increased energy from active trans-
port and reduced energy from sedentary travel was only found
in central areas with high levels of accessibility to major com-
mercial centers that also have a walkable pedestrian environ-
ment. Results suggest finding a win-win between health, energy
use, and climate change is best supported by policies that focus
development in central areas with high levels of accessibility to
regional destinations and investments that increase the walk-
ability of these locations.
CORRESPONDING AUTHOR: Lawrence D. Frank, PhD,
School of Environmental Health, University of British Colum-
bia, Vancouver, BC, V6T 1Z3; ldfrank@interchange.ubc.ca
12
A-122c
SOCIODEMOGRAPHIC FACTORS THAT PREDICT
SUCCESSFUL ENTRY OF WOMEN INTO THE LONG TERM
PHASE (LTP) OF AN INTERNET BASED PHYSICAL ACTIVITY
STUDY: THE WIN STUDY
Georita M. Frierson, PhD,1 James R. Morrow, PhD,2 Andrew
Vidales, BS3 and Bess Marcus, PhD4
1
Southern Methodist University, Dallas, TX; 2University of
North Texas, Dallas, TX; 3Cooper Institute, Dallas, TX and
4
Brown University, Providence, RI.
Background: WIN is a prospective observational study as-
sessing physical activity and the risk/rates of musculoskeletal
injuries weekly through a secured web-site in women for
≈3-years of surveillance/LTP. Participants complete 4 pre-LTP
phases before successful entry into the LTP. Sociodemographic
factors predicting successful entry into the LTP for this study
are unknown. Purpose: To identify sociodemographic fac-
tors predictive of participants who successfully enter the LTP.
Methodology: Women must complete the following successive
phases prior to successful entry into the LTP; 1) phone screen, 2)
orientation, 3) 2-week Practice Phase, and 4) orthopedic exam.
Univariate and multivariate logistic regressions were applied
to compare differences in (un)adjusted odds of who entered
the LTP, controlling for confounders. Results:Logistic regres-
sions contrasted participants who (n=918) vs. did not (n=385)
enter LTP. Age, race/ethnicity, Internet skills, marital status,
and moderate/vigorous physical activity (>150min of physical
activity) were included in the model. Univariate analyses found
age (OR=1.77, 95%CI=1.39-2.26), race/ethnicity (OR=1.58,
95%CI=1.18-2.11), and marital status (OR=1.54, 95%CI=1.21-
1.95) to be significant. Multivariate analyses confirmed that age,
marital status, and Internet skills were statistically significant.
Women characterized as older, married, and with good Inter-
net skills were more likely to successfully enter the LTP, with
the odds of successfully entry significantly increased by 81%,
43% and 87% as age increased, being married, and reporting
good Internet skills, respectively. Conclusions:These predic-
tive characteristics may afford women with the time, support,
and skills to successfully enter the LTP. Addressing variables
related to successful enrollment helps researchers focus recruit-
ment activities that generate random, representative samples
for external generalizability.
CORRESPONDING AUTHOR: Georita M. Frierson, PhD,
Psychology, Southern Methodist University, Dallas, TX, 75275;
frierson@smu.edu
A-130a
EFFECTS OF SMOKING CESSATION ON SEXUAL HEALTH IN
MEN
Christopher B. Harte, MA, Tyler W. Watts, BA, Hillary Perlman,
BS, Olivia Z. Bentkowski, BS, Alicia Whitaker, BA and Cindy M.
Meston, PhD
Department of Psychology, University of Texas at Austin,
Austin, TX.
Background: Tobacco use is the single most preventable cause
of disease and death in the world today and introduces a wide
range of pathogenic consequences, including impairments in
sexual functioning.
Purpose: To examine the effects of smoking cessation on several
indices of sexual functioning.
Methods: Fifty-eight male (mean age: 38 yrs) long-term smok-
ers participated in a smoking cessation program and were
assessed at baseline (while smoking), at mid-treatment (while
using a nicotine transdermal patch), and at 1-month follow-up
(post-treatment). All participants received an 8-week nicotine
transdermal patch intervention administered in a step-down
fashion. Physiological sexual arousal (mean circumferential
change, maximum erection, mean latency to maximum erec-
tion) and self-reported sexual functioning (as measured by the
International Index of Erectile Functioning (IIEF)) were assessed
at each visit.
Results: Participants who completed the program and remained
smoke free (n = 21; 36%), showed significant improvements in
physiological sexual arousal. Specifically, at both mid-treatment
and follow-up, compared to baseline, they demonstrated
increased mean erectile responses and decreased latencies
to reach maximum erectile capacity. Quitting smoking also
significantly enhanced self-reported sexual functioning, such as
improved erectile functioning and orgasmic capacity. In fact, at
follow-up, 90% of men showed improved erectile functioning
and all men with erectile dysfunction at baseline (n = 6; 29%)
were remitted at follow-up.
Conclusions: Quitting smoking significantly improves sexual
health in men. Men may be particularly persuaded to quit
smoking considering that they may show an increase in erection
as well as noticeable increases in sexual performance with a
partner. It is our hope that these results may have the potential
for facilitating programs and interventions targeting the pre-
vention and cessation of cigarette smoking in men.
CORRESPONDING AUTHOR: Christopher B. Harte, MA, De-
partment of Psychology, University of Texas at Austin, Austin,
TX, 78712; charte@mail.utexas.edu
A-142a
MINDFULNESS AND TOBACCO DEPENDENCE: MEDIATING
MECHANISMS
Aimee C. Ruscio, BS,1 Andrew J. Waters, PhD,1 Lorraine
R. Reitzel, PhD,2 Paul Cinciripini, PhD,3 Yisheng Li, PhD,4
Marianne Marcus, EdD, RN,5 Jennifer I. Vidrine, PhD2 and
David W. Wetter, PhD2
1
Department of Medical and Clinical Psychology, Uniformed
Services University of the Health Sciences, Washington, DC;
2
Department of Health Disparities Research, The University
of Texas M. D. Anderson Cancer Center, Houston, TX;
3
Department of Behavioral Science, The University of Texas
M. D. Anderson Cancer Center, Houston, TX; 4Department
of Biostatistics, The University of Texas M. D. Anderson
Cancer Center, Houston, TX and 5Center for Substance Abuse
Prevention, Education and Research, School of Nursing,
University of Texas Health Science Center, Houston, TX.
Mindfulness involves paying attention to one’s moment to
moment experience in a non-judgmental manner. Previous re-
search has revealed that more mindful individuals report lower
levels of tobacco dependence, and may therefore find it easier
to quit. We examined the mediators of the association between
mindfulness, assessed using the Mindful Attention Awareness
Scale (MAAS), and tobacco dependence, assessed using the
Wisconsin Inventory of Smoking Dependence Motives (WIS-
DM). Using baseline data collected from a mindfulness-based
smoking cessation trial (N=158), a multiple mediator analysis
revealed that positive affect was a significant partial mediator
of the relationship between mindfulness and dependence (b=-
1.46, SE=.56, p < .05). In contrast, neither negative affect (b=-.85,
SE=.66, ns) nor perceived stress (b=.83, SE=.77, ns) were found
to be significant mediators. More mindful individuals experi-
ence more positive affect which in turn may reduce dependence
on smoking. Mindfulness may target a pathway (positive affect)
not currently targeted by current conventional clinical practice
guidelines, which focus on dealing with negative affect and
stress. Mindfulness-based therapies may have potential as an
independent treatment for smoking cessation or as an adjunct
treatment alongside a treatment that targets negative affect. The
data also suggest that further examination on the role of posi-
tive affect in tobacco dependence and relapse is warranted.
CORRESPONDING AUTHOR: Aimee C. Ruscio, BS, Medical
and Clinical Psychology, Uniformed Services University of the
Health Sciences, Washington, DC, 20016; aruscio@usuhs.mil
A-142b
LATINO AND NON-LATINO COMFORT WITH TECHNOLOGY
AMONG RURAL KANSAS SMOKERS ENROLLED IN A
TELEHEALTH VS. QUITLINE STUDY
Genevieve Casey, MA,1 Leah Lambart, MPH,1 Jamie Hunt,
PhD,1 Ryan Spaulding, PhD,2 Paula Cuppertio, PhD1 and
Kimber Richter, PhD, MPH1
1
Prev Med & Pub Health, KU Med Ceneter, Kansas City, KS and
2
Center for Telemedicine & Telehealth, KU Med Center, Kansas
City, KS.
Telemedicine is a promising approach for reaching underserved
rural smokers. Some studies have explored the receptivity
of doctors to telehealth. Information on patients’ receptivity
to health behavior interventions delivered via telehealth or
telemedicine is limited. The study purpose is to describe access
and comfort with computers and communication technology
among rural Latino and non-Latino participants in a random-
ized controlled trial.
This is an analysis of baseline data from a trial of video vs.
phone counseling for smoking cessation. Subjects were re-
cruited from primary care and community health practices. The
baseline survey was conducted in both English and Spanish via
phone. Technology questions consisted of three yes or no ques-
tions and four scaled items.
Over half of patients (68%) have a functional computer in
their home, and (62%) have internet access. Few had ever been
seen by a doctor via video (8%). Some reported comfort using
computers (59%) and using other communication technolo-
gies (63%) such as mobile phones, mp3, or web cameras. Half
(52%) reported interest in receiving health care in their homes
using computers or communication technologies. Many (65%)
reported confidence that their information is kept private when
using communication technologies. While Latinos reported
slightly lower numbers for each item, there were few significant
differences between ethnic groups. One significant difference
(p=0.0409) between groups, 47% of Latinos and 72% of non-
Latinos reported having a working computer at home.
A significant number of rural smokers are not comfortable
using communication technology. Fewer Latinos have home
13
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
computers than non-Latinos, but most Latinos with computers
have home internet. Health interventions using home comput-
ers will miss almost half of the rural population, especially
Latinos. Clinics and community settings with internet access
may improve access to rural populations
CORRESPONDING AUTHOR: Genevieve Casey, MA, Preven-
tive Medicine & Public Health, University of Kansas Medical
Ceneter, Kansas City, KS, 66103; gcasey@kumc.edu
A-142c
SOCIAL CAPITAL AND SMOKING STATUS
Lila J. Rutten, PhD, MPH,1 Erik Augustson, PhD,2 Kelly Blake,
ScD2 and Bradford Hesse, PhD2
1
SAIC, Inc., National Cancer Institute - Frederick, Bethesda, MD
and 2National Cancer Institute, Bethesda, MD.
Social capital, which includes engagement in social networks
and trust among community members, is gaining traction in
public health research as an important determinant of health.
Our study compared social engagement and trust among
current, former and never smokers. Data were from the 2005
Health Information National Trends Survey (HINTS 2005).
The sample design for HINTS 2005 employed a list-assisted,
random digit dial (RDD) of all telephone exchanges in the U.S.
The survey was administered to a representative sample of
U.S. households wherein one adult was selected for interview
(n=5586). We used SUDAAN to calculate nationally representa-
tive estimates. Two multinomial regression models were con-
ducted to explore associations of smoking status with measures
of social network engagement and trust while controlling for
sociodemographic variables. Compared to current smokers,
never smokers (OR=2.08) and former smokers (OR=2.48) were
significantly more likely to belong to community organiza-
tions. Never smokers (OR=4.59) and former smokers (OR=1.96)
were also more likely than current smokers to attend weekly
religious services. Never smokers (OR=1.38) were significantly
more likely than current smokers to use the Internet and former
smokers (OR=1.41) were more likely than current smokers
to be married. Compared to current smokers, never smokers
were significantly more likely to trust health care profession-
als (OR=1.52) and less likely to trust the Internet (OR=.59) as a
source of health information. Former smokers (1.79) were more
likely than current smokers to trust health or medical informa-
tion from magazines. Current clinical guidelines recommend
attention to social support as part of smoking cessation counsel-
ing efforts. Our results speak to an unequally distributed deficit
in social capital wherein current smokers appear to be less
socially integrated than individuals who never smoke or those
who have successfully quit. Further research to understand the
ways in which social capital contribute to smoking uptake and
cessation are encouraged.
CORRESPONDING AUTHOR: Lila J. Rutten, PhD, MPH,
HCIRB, SAIC, Inc., National Cancer Institute - Frederick,
Bethesda, MD, 20892; finneyl@mail.nih.gov
14
A-150a
DOES PRACTICE MAKE PERFECT? REPEATED USE OF
SCRIPTED DRUG PREVENTION INTERVENTIONS
Diane L. Elliot, MD, Linn Goldberg, MD, Esther L. Moe, PhD,
MPH, Michelle H. Otis, BS and Erica T. Perrier, MS
Medicine, Oregon Health & Science University, Portland, OR.
Achieving fidelity for evidence-based drug use prevention
curricula in real world settings often is problematic. Initial
fidelity may be low and drift farther from the intended content
with repeated use, reducing effectiveness. We prospectively
assessed use and student outcomes of the evidence-based,
sport team-centered drug prevention programs ATLAS and
ATHENA. A contract from the National Football League (NFL)
Youth Football Fund underwrote use in high schools from
selected NFL franchises during two school years (2007-2009).
Coaches and student leaders attended one-day trainings and
were provided with curriculum materials. Both programs use
explicitly scripted lesson plans to enhance fidelity for their
coach-instructor and athlete-peer led components. Coaches
and local school liaisons completed implementation checklists
and were interviewed during school visits; student participants
completed anonymous surveys program completion. Descrip-
tive information was compiled, and student outcomes assessed.
Eight schools had two years of implementation and outcome
data. Effects of repeated use varied for the male ATLAS and fe-
male ATHENA programs. For both, self-assessed fidelity to the
explicitly scripted lesson plans was comparable across years,
although improvements that facilitated scheduling occurred in
the second year. For ATLAS, student athletes’ (n=381) outcomes
did not differ between years across a spectrum of knowledge,
attitude and ability domains. For ATHENA, which incorporates
a more demanding cognitive restructuring diary component,
student-athletes’ (n=304) outcomes were significantly greater
during the second year of use (p<0.001, for main effects). Find-
ings suggest that a tightly scripted curriculum can have durable
fidelity and sustained positive outcomes. Contrary to other
observations, repeated use of a scripted format may result in
more effective program delivery with repeated use. Results may
inform the formatting of school programs to enhance translat-
ing evidence-based interventions for sustained fidelity and
maintenance of effectiveness.
CORRESPONDING AUTHOR: Diane L. Elliot, MD, Medicine,
Oregon Health & Science University, Portland, OR, 97239; el-
liotd@ohsu.edu
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
B-033a
CLINICAL EFFECTIVENESS OF A HYPNOSIS CD FOR
BREAST CANCER SURGICAL PATIENTS
Guy Montgomery, PhD,1 Julie Schnur, PhD,1 Stephanie Sohl,
PhD,1 Dana Bovbjerg, PhD,2 Daniel David, PhD1 and Jeffrey H.
Silverstein, MD1
1
Oncological Sciences, Mount Sinai School of Medicine, New
York, NY and 2University of Pittsburgh Medical Center,
Pittsburgh, PA.
Background: Breast cancer surgery has been related to a num-
ber of post-surgical side effects, including pain, nausea and fa-
tigue. Such side effects negatively impact quality of life. “Live”
hypnosis has been demonstrated to reduce post-surgical side
effects. However, the effects of more easily disseminable and
less expensive methods of hypnosis administration have yet to
be tested in breast cancer surgical patients. The present study
was designed to examine the ability of a prerecorded hypnosis
intervention (CD) to reduce post-surgical side effects in this
population.
Methods: 100 women scheduled for breast conserving surgery
for diagnostic or curative purposes (excisional biopsy, lumpec-
tomy) were randomly assigned to: 1) the Hypnosis CD Group
(HCD, n=50; mean age = 45.89) that received a brief hypnosis
intervention administered via prerecorded CD in the presur-
gery waiting area, or 2) the standard care Control Group (CGrp,
n=50; mean age = 46.39). The sample was 72% Caucasian, 16%
African American, 4% Hispanic, 8% other; 76% of the sample
underwent excisional biopsy for diagnostic purposes, 24% un-
derwent lumpectomy as a part of a curative treatment program.
Outcome assessments were completed at hospital discharge
using visual analog scales.
Results: Patients receiving the hypnosis CD had significantly
less pain intensity (d=0.61, 95% CI=0.21 to 1.01), pain unpleas-
antness (d=0.43, 95% CI=0.03 to 0.83), nausea (d=0.49, 95%
CI=0.09 to 0.88), fatigue (d=0.50, 95% CI=0.10 to 0.90), physical
discomfort (d= 0.53, 95% CI =0.13 to 0.93), and emotional upset
(d=0.84, 95% CI =0.43 to 1.25) at discharge.
Conclusions: The results of this randomized study support the
efficacy of a brief pre-surgery hypnosis CD in reducing post-
surgical side effects in breast cancer surgery patients. These
results support the dissemination of the hypnosis intervention
via CD.
CORRESPONDING AUTHOR: Guy Montgomery, PhD, Onco-
logical Sciences, Mount Sinai School of Medicine, New York,
NY, 10029-6574; guy.montgomery@mssm.edu
B-033b
ALPHA-AMYLASE AND CORTISOL IN WOMEN WITH
ENDOMETRIAL CANCER: COMPARING DIURNAL PROFILES
IN RELATION TO STRESS
Stephanie Garey, BS,1 Deidre Pereira, PhD,1 Stacy Dodd, MS,1
Sally Jensen, PhD,2 Timothy Sannes, MS1 and Linda Morgan,
MD1
1
University of Florida, Gainesville, FL and 2NorthShore
University HealthSystem, Evanston, IL.
Alpha-amylase and cortisol are stress hormones produced via
independent stress systems. Following stress, alpha-amylase is
released by the sympathetic nervous system (SNS), while cor-
tisol is released by the hypothalamic-pituitary-adrenal (HPA)
16
axis. Although the psychoneuroimmunologic (PNI) mecha-
nisms involved in HPA stress responses have been studied in
medical populations, less is known about mechanisms of limbic
HPA-independent alpha-amylase, particularly in cancer. This
study (1) compared salivary alpha-amylase and cortisol levels,
and (2) examined stress/anxiety and alpha-amylase relations
among women scheduled for surgery for endometrial cancer
(EC). Participants were 15 women drawn from a larger study
of PNI relations in EC. Stress was measured with the Perceived
Stress Scale and stress ratings (0 [no stress] to 10 [highest stress
possible]) obtained at the time of saliva collection. Anxiety was
measured using the Millon Behavioral Medicine Diagnostic
and the Structured Interview Guide for the Hamilton Anxiety/
Depression Scales. Saliva was collected at 8AM, 12PM, 5PM,
and 9PM the day prior to surgery and assayed using ELISA.
A moderate effect size (ES) correlation (-0.34) emerged be-
tween greater 8AM cortisol and lower 8AM alpha-amylase. A
moderate ES correlation (0.39) also emerged between greater
changes in cortisol and greater changes in alpha-amylase per
unit time. Furthermore, a large and statistically significant ES
correlation (0.58) was revealed between greater 8AM stress
levels and greater 12PM alpha-amylase. Statistically significant
correlations emerged between greater anxiety and less change
in alpha-amylase per unit time (r = -0.72, p<.05) and less total
diurnal output (r = -0.71, p<.05), a possible pattern of SNS activ-
ity blunting. Although based on a small sample, these findings
suggest stress/anxiety may be associated with SNS-dependent
alpha-amylase in women with cancer. Future research should
replicate/expand upon these findings in a larger sample.
CORRESPONDING AUTHOR: Stephanie Garey, BS, Clinical
and Health Psychology, University of Florida, Gainesville, MD,
Florida; sgarey@phhp.ufl.edu
B-033c
DETERMINANTS FOR DECISION MAKING PREFERENCES
IN LOWER INCOME PREDOMINANTLY MINORITY CANCER
SURVIVORS
Shiquina L. Andrews, MS, Michelle Martin, PhD and Polly
Kratt, PhD
Preventive Medicine, Universtiy of Alabama at Birmingham,
Birmingham, AL.
Background. Shared decision-making (SDM) in the medical en-
counter is preferred by younger, educated, White patients (Ben-
bassat et al., 1998). Other factors, such as health beliefs (Gansler
et al., 2005) and emotional distress (McVea et al., 2001), can also
affect decision-making. Few studies however, have investigated
these variables in low-income, minority populations.
Aim. To examine the effect of cancer beliefs and emotional
health on SDM preference after controlling for demographics
among low-income cancer survivors.
Methods. Baseline data from a RCT evaluating a cancer educa-
tional program was used. The dependent variable, SDM prefer-
ence (extent to which patients wanted to leave decisions up to
the doctor), was assessed using 1 item of Levinson’s 3-item scale
(2005). Cancer-specific beliefs, Emotional Well-Being (EWB)
(from the Functional Assessment of Cancer Therapy-General
scale), and patient demographics were collected.
Results. Of the 152 patients, mean age was 53±11 years, 81%
were Black, 67% female, and 23% had less than HS education.
Average yearly household income was below $10,000. The
most common cancers were breast (37%) and colorectal (13%).
Fifty-nine percent preferred to leave decisions up to their doc-
tors. Patients held accurate and optimistic beliefs about cancer
treatment and outcomes (M=31.83±3.76; maximum=36) and
were emotionally healthy (M=19.31±4.63; maximum=24). Hier-
archical multiple regression analysis revealed that patients with
higher levels of education were likely to prefer SDM (t=2.68,
p<.01). Neither cancer-specific beliefs nor the interaction of
these beliefs with EWB were related to preference for SDM
(F=1.22, p=.29).
Conclusion. Supporting earlier findings, the majority of this
primarily Black sample preferred to leave decisions up to the
doctor and those with higher levels of education preferred
SDM. Identifying patient preferences and empowering those
who may desire SDM, but may be reluctant to engage in SDM
(e.g., minorities and those with less formal education), is an
important goal.
CORRESPONDING AUTHOR: Shiquina L. Andrews, MS, Psy-
chology, Universtiy of Alabama at Birmingham, Birmingham,
AL, 35294-1170; shiand25@uab.edu
B-033d
NEWS COVERAGE OF HPV VACCINE MANDATE POLICIES: IS
THERE A NEGATIVE BIAS IN REPORTING?
Corinne M. Bruce, BS,1,2 Margaret O. Caughy, ScD,1 Scott T.
Walters, PhD1 and Jasmin A. Tiro, PhD2,3
1
Health Promotion & Behavioral Sciences, UT School of Public
Health, Dallas, TX; 2Clinical Sciences, UT Southwestern Medical
Center, Dallas, TX and 3Simmons Cancer Center, Dallas, TX.
Background: Since 2006, several US states have considered
mandating the human papillomavirus (HPV) vaccine for mid-
dle school girls. Debates over these policies have confounded
criticisms of the policies with concerns about the vaccine itself.
The public’s and policymakers’ decisions regarding public
health policies are often influenced by news coverage. Thus, it is
crucial to understand media’s framing of controversial policies.
None of the past content analyses on media coverage of the
HPV vaccine have examined coverage of mandates.Objective:
We examined the content and quality of news articles discuss-
ing HPV vaccine mandate policies.Methods: Lexis-Nexis was
used to identify 335 articles on HPV vaccine mandates pub-
lished in US newspapers from February 2006 to January 2008.
Articles were coded for general characteristics (e.g., publication
date), facts about the mandate, and frequency of citing argu-
ments in favor or against the mandate as well as the vaccine.
Results: Mandating the HPV vaccine became a high-profile
story after Texas Governor Perry issued an executive order in
February 2007. Most stories did not explain provisions allow-
ing parents to opt out of the mandate (86%). Only 18% of the
stories presented a balanced argument about mandates; most
focused solely on counter-arguments (e.g., intrusion on parental
autonomy [70%] and cost [40%]). Only 39% presented both pros
and cons for the vaccine; most focused on potential negative
consequences (e.g., encouraging promiscuity [67%] and safety/
side-effects [34%]). Coverage of the debate did not vary over
time or by article type.Conclusions: Our findings revealed
that news coverage on HPV vaccine mandates was biased and
incomplete. Imbalanced reporting may have negatively affected
HPV vaccine acceptability and uptake. Public health officials,
health care providers and scientists should work effectively
with the media to ensure that balanced information is provided.
CORRESPONDING AUTHOR: Corinne M. Bruce, BS, The Uni-
versity Of Texas Southwestern Medical Center at Dallas, Dallas,
TX, 75390-9066; corinne.bruce@utsouthwestern.edu
B-033e
RUMORS ABOUT CANCER: TRANSMISSION, BELIEF AND
COPING FUNCTIONS
Nicholas DiFonzo, PhD,1 Nicole M. Robinson, MA,2 Jerry Suls,
PhD3 and Christine Rini, PhD4
1
Dept of Psychology, Rochester Institute of Technology,
Rochester, NY; 2Dept of Communications, George Mason
University, Fairfax, VA; 3Psychology, University of Iowa, Iowa
City, IA and 4Dept of Oncological Sciences, Mt Sinai School of
Medicine, New York, NY.
Cancer rumors are common, yet little is known about how
they affect health-related coping and behaviors. A web survey
(N=188) queried members of online cancer discussion groups
about cancer rumors heard from non-medical sources. Twen-
ty-nine percent had a personal history of cancer; 95% knew
someone with cancer (63% of whom died from it). Rumors were
coded by three judges as dread or wish (kappa = .60), and as
primary or secondary (kappa = .27) control statements (all p’s
< .01). Dread rumors exceeded wish rumors by more than 3 to
1. Secondary control rumors (i.e., affording emotional cop-
ing) outnumbered primary control rumors (affording control
via direct action) by nearly 2 to 1. Respondents who discussed
rumors with medical personnel did so primarily for fact-finding
(47.1%) or threat-management (17.6%) purposes; those trans-
mitting/discussing rumors with non-medical people reported
social (46.7%), pro-social (19.7%) or emotional coping (17.2%)
motives. Transmitters (vs. non-transmitters) were more anxious,
considered the rumors more important, and believed the rumor
more strongly. Most respondents strongly believed the rumors;
confidence was based on trust in family or friends, concordance
with beliefs and attitudes, and repeated hearing. Transmit-
ters (vs. non-transmitters) reported the rumors helped them to
understand the disease. However, transmitters were no better
at deciding what to do about the disease, nor did they feel any
better. About 70% of participants made behavioral changes after
hearing the rumor. Findings add to rumor research on anteced-
ents and motives for transmission. Results suggest that rumors
are an important means by which people achieve a sense of
secondary control for dreaded outcomes associated with cancer.
CORRESPONDING AUTHOR: Jerry Suls, PhD, Psychology,
University of Iowa, Iowa City, IA, 52242; jerry-suls@uiowa.edu
B-033f
SPECIALTY DIFFERENCES IN PRIMARY CARE PHYSICIANS’
AGE AND COMORBIDITY-SPECIFIC RECOMMENDATIONS
FOR BREAST CANCER SCREENING
Corinne R. Leach, PhD MPH, Carrie Klabunde, PhD, Catherine
Alfano, PhD and Julia Rowland, PhD
National Cancer Institute, Bethesda, MD.
In November 2009 the US Preventive Services Task Force
released updated breast cancer screening recommendations,
citing that evidence remains insufficient to recommend for or
against screening women age 75 and older. This has height-
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
health status, or with perceived limited life expectancy. Physi-
cian recommendation for mammography remains the most
important predictor of screening. However, little is known
about when or under what circumstances physicians stop
recommending mammography. This study analyzed data from
a large survey of primary care physicians (PCPs; N=1212) to
examine breast cancer screening recommendations for hypo-
thetical patients of varying age (50, 65, 80) and health status
(healthy, moderate comorbidity, terminal comorbidity) combi-
nations. In general, almost all PCPs stated they would hypo-
thetically recommend mammography alone or in combination
with clinical breast exam (CBE) for healthy women age 50 or
65 and for women with a moderate comorbidity age 50 or 65.
Greater differences in recommendations emerged for patients
age 80, regardless of health status, and for those with a terminal
comorbidity (unresectable non-small cell lung cancer). Specifi-
cally, 64.7% of OB/GYNs reported that they would hypotheti-
cally recommend mammography alone or in combination with
CBE to a 50 year old woman with unresectable non-small cell
lung cancer, a terminal disease, compared to 46.7% of Family
Practitioners and 32.1% of Internists. These results suggest that
many PCPs, OB/GYNs in particular, are aggressively screen-
ing women with terminal disease and are continuing to expose
women to the risks of mammography and follow-up diagnostic
procedures when they likely would not be eligible for breast
cancer treatment if cancer were found. These findings suggest
the need for better physician-patient communication about can-
cer screening decision-making that is tailored to an individual’s
risks as well as her potential benefits.
CORRESPONDING AUTHOR: Corinne R. Leach, PhD MPH,
Office of Cancer Survivorship, National Cancer Institute,
Bethesda, MD, 20892; leachcr@mail.nih.gov
B-033h
ADULT ATTACHMENT STYLE IN BREAST CANCER PATIENTS
AND ITS IMPACT ON TREATMENT OUTCOMES OF CANCER
SUPPORT GROUPS
Maya Yutsis, PhD,1 Janine Giese-Davis, PhD,2 Matthew
Cordova, PhD3 and Nigel Field, PhD4
1
Mayo Clinic College of Medicine, Rochester, MN; 2University
of Calgary, Department of Oncology, Alberta, AB, Canada; 3VA
Northern California Health Care System, Martinez, CA and
4
Palo Alto University, Palo Alto, CA.
Despite the wealth of research demonstrating the psychologi-
cal and psychosocial benefits of group interventions for breast
cancer (BC) patients, there is a scarcity of studies identifying
patient variables that may contribute to the effectiveness of
group therapy. This study examined the effects of adult at-
tachment styles in women with BC randomized to one of two
types of breast cancer support groups: Supportive Expressive
Therapy (SET) or Community Cancer Groups. We examined
the moderating effects of four attachment styles on change in
distress following the treatment. Depressive symptoms were
measured with the Center for Epidemiologic Studies Depres-
sion Scale (CES-D) and anxiety symptoms were assessed with
the Weinberger Adjustment Inventory (WAI). Sixty six women
diagnosed with primary BC who were 32 years of age and older
(M=52.53; SD=9.41) completed this study. Hierarchical multiple
regressions revealed that at baseline, securely attached women
18
were more likely to be married, reported less frequent child-
hood life-threatening events (β = -2.27, p =.04), and lower levels
of depression (β = -.10 p=.00), while anxious attachment was
associated with higher initial depression (β = .09, p = .00). Spe-
cific adult attachment styles moderated the effects of treatment
on change in distress: less secure and most initially depressed
women showed greatest decrease in depressive symptoms
(β = .63, p = .00) in both treatment models. Anxious-avoidant
women showed the steepest decrease in depression and anxiety
following SET groups (β = -.61, p = .00; β = -.36, p = .01), while
less anxious-avoidant individuals improved the most after
community group treatment (β = -.61, p = .00). These results
highlight the importance of examining individual differences to
better understand which patients may be most at risk for poor
psychosocial adjustment and who may benefit the most from
different models of cancer support groups.
CORRESPONDING AUTHOR: Maya Yutsis, PhD, Mayo Clinic
College of Medicine, Rochester, MN, 55901; yutsis.maya@mayo.
edu
B-033i
DEPRESSIVE RUMINATION IN CANCER PATIENTS AND
PARTNERS: IMPLICATIONS FOR MENTAL HEALTH AND
ADJUSTMENT TO ILLNESS
Nermin Bayman, MA,1 Jennifer Steiner, BA1 and Silvia Bigatti,
PhD2
1
Psychology, Indiana University Purdue University
Indianapolis, Indianapolis, IN and 2Public Health, Indiana
University Purdue University Indianapolis, Indianapolis, IN.
This study examined the relationship of depressive rumina-
tion to the mental health and adjustment to illness of breast
cancer patients and their husbands. Depressive rumination has
been extensively studied in relation to other chronic and acute
health conditions, but little is known regarding its effect among
patients with cancer. Fifty-three women with breast cancer and
their spouses were recruited from the Indiana University Simon
Cancer Center. Couples were mailed survey packets containing
self-report questionnaires, including the Center for Epidemio-
logical Studies Depression Scale, Impact of Illness Scale, Avoid-
ance and Intrusive Subscales of the Impact of Events Scale, and
Ruminative Responses Subscale of the Response Styles Ques-
tionnaire. Results showed that higher depressive rumination
in patients was associated with higher impact of illness, more
avoidance and intrusive thoughts about the cancer, and more
symptoms of depression. The same relationships were found in
husbands such that higher depressive rumination in husbands
was associated with higher impact of illness, more avoidance
and intrusive thoughts about the cancer, and more symptoms
of depression. All correlations were in the moderate range (.33
to .68). Surprisingly, depressive rumination in patients had no
relation to husband variables, and depressive rumination in
husbands had no relationship with patient variables. Findings
confirmed that depressive rumination is associated with poor
outcomes in both patients and their partners. Implications for
practice are the need to evaluate and address rumination in
families dealing with cancer given its potential impact on men-
tal health and adjustment. Future research should attempt to ex-
amine the predictive role of rumination in physical and mental
well-being of patients and partners in more complex designs
with larger and more diverse cancer populations.
CORRESPONDING AUTHOR: Nermin Bayman, MA, Psy-
chology, Indiana University Purdue University Indianapolis,
Indianapolis, IN, 46260; nbayman@iupui.edu
B-033j
FEAR OF RECURRENCE IN HEAD AND NECK CANCER
SURVIVORS
Shannon L. Madore, BA,1 Kevin McCarthy, BA,1 Allison
Costenaro, MA,1 Shih Ming Shih, MA,1 Jeff Kendall, PsyD,2
Andrea Bevan, BA,1 Derek Anderson, MA,3 Jennifer Allen, BA,1
David Raben, MD1 and Kristin Kilbourn, PhD MPH1
1
University of Colorado, Denver, CO; 2St. Joesph’s Cancer
Center, Denver, CO and 3Ohio State University, Columbus, OH.
Introduction: An estimated 40,000 cases of head and neck
cancer are diagnosed each year in the U.S. Among head and
neck cancer survivors (HNCS) fear of cancer recurrence (FoR) is
identified as a primary concern. FoR is associated with a poorer
quality of life (QOL), psychosocial distress, and maladaptive
health behaviors (Llewellyn et al., 2008). FoR is particularly
relevant to HNCS due to the lasting physical impairments and
the high recurrence rate. This study examined the relationship
between psychosocial variables and FoR in HNCS 3 months
post-treatment.
Methods: HANDSS (Head and Neck Descriptive Survivorship
Survey) is a longitudinal study involving a self-report survey
assessing physical, psychosocial, and practical symptoms/con-
cerns in HNCS returning to radiation oncology for their 3 and
12-month post-treatment visit. This presentation will focus on
results from the 3 month post-treatment assessment.
Results: The mean age of the 36 participants is 58 (SD=10.3),
86 % are male, 42% are married, 56 % report an annual income
of ≥ $25,000 and 67% completed at least some college. Thirty-
nine percent of the participants were diagnosed with late stage
cancer and 78% were treated with concurrent radiation therapy
and chemotherapy. FoR was reported by 67% of participants,
making it the most commonly reported emotional concern. FoR
was positively correlated with number of reported physical side
effects (r=.47, p<.05), anxiety (r=.86, p<.05), depression (r=.75,
p<.05), and number of emotional concerns (r=.78, p>.05), but
not related to tumor stage.
Conclusions: FoR, which is associated with negative emotions
such as anxiety and depression, is a commonly experienced
psychosocial concern by HNCS in the early stages of survivor-
ship. In this study, FoR was not associated with the severity
of the cancer diagnosis (e.g. stage) but was associated with the
number of side-effects. These findings suggest that FoR should
be a focus of psychosocial interventions for HNCS.
CORRESPONDING AUTHOR: Shannon L. Madore, BA,
University of Colorado, Denver, CO, 80209; shannon.madore@
ucdenver.edu
B-033k
COGNITIVE-BEHAVIORAL STRESS MANAGEMENT AND
INCREASED PHYSICAL ACTIVITY ASSOCIATED WITH
LOWER FATIGUE-ASSOCIATED DISRUPTION IN WOMEN
WITH BREAST CANCER
Jamie M. Stagl, BA,1 Michael H. Antoni, PhD,1 Erin M. Fekete,
PhD,2 Sara Vargas, BA,1 Suzanne Lechner, PhD2 and Charles S.
Carver, PhD1
1
Psychology, University of Miami, Coral Gables, FL and
2
Psychiatry and Behavioral Sciences, University of Miami Miller
School of Medicine, Miami, FL.
Objective: Cognitive-behavioral stress management (CBSM) im-
proves quality of life in women undergoing treatment for breast
cancer (BCa). The effects of CBSM on fatigue during active
treatment have been less studied. Physical activity (PA) may
also contribute to fatigue levels during this period. Method: The
present study examines the effects of CBSM and the influence of
corresponding changes in PA on fatigue-associated disruption
(FAD) in women with stage I-III breast cancer who were 8-10
weeks post-surgery (Mean age = 50.34, SD = 9.03). We random-
ly assigned 240 women to receive a 10-week CBSM intervention
(n = 120) or a 1-day psycho-educational control (PE, n = 120).
The mean duration of moderate and vigorous PA based on a
7-day recall at baseline was 182 min/week (SD =383). Results:
Preliminary analyses showed that increases in duration of PA
from pre- to 3 months post-intervention were associated with
lower FAD. Women assigned to CBSM showed a lower FAD
than those in the PE group, Wilks’s Λ = .96, F(1,161) = 6.19,
p < .05, multivariate η2 =.04. We then classified women as
to whether they fell above or below the American College of
Sports Medicine’s (ACSM) guidelines for PA of 150 min/week
at the pre- and 3 months post-intervention assessment. There
was a significant group x time x PA level interaction (Wilks’s
Λ = .94, F[3,154] = 3.53, p < .05, multivariate η2 =.06) such that
the largest decrease in FAD was found in women assigned to
CBSM who shifted from below to above the minimum ACSM
guidelines from pre- to 3 months post-intervention (p <.05).
Conclusion: A CBSM intervention lowered fatigue-associated
disruption in women undergoing treatment for BCa, and these
effects were most pronounced in women who correspondingly
increased time spent in physical activity.
CORRESPONDING AUTHOR: Jamie M. Stagl, BA, Psychology,
University of Miami, Miami, FL, 33131; jstagl@psy.miami.edu
B-033l
NONMUSCLE-INVASIVE BLADDER CANCER SURVIVORS
REPORT SEXUAL DYSFUNCTION AND MISINFORMATION:
RESULTS OF CROSS-SECTIONAL MIXED-METHODS
RESEARCH
Marc Kowalkowski, BS,1 Gilad E. Amiel, MD,1 Seth P. Lerner,
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
interviews (Study 2) with NMIBC patients. Participants in the
2 studies were diverse: ages 29-87 years, female (16%), African
American (6%), and primary relationships (79%). We carried
out descriptive analyses of survey data and qualitative analysis
of transcribed interviews.
Preliminary survey (Study 1) results linked NMIBC treatment
to sexual symptoms and relationship issues. Many participants
reported sexual inactivity (40.7%) or not enjoying sex (22.2%).
Sexually active participants reported difficulties with erections
(63.6%), ejaculation (52.4%), vaginal dryness (66.6%), and worry
about contaminating partner with treatment agents (24.4%). Al-
most half reported it was useful to talk with their partner about
sexual function, but less than one-third of participants reported
sharing all concerns with their partners.
One-half of interviewees (Study 2) reported sexual dysfunction.
Almost two-thirds reported negative impacts on their primary
relationships including perceived loss of intimacy and divorce.
Over one-third were not sexually active for fear of contaminat-
ing their partner or spreading NMIBC.
Sexual symptoms among survivors may result from either
NMIBC or comorbid conditions or both. However, these results
inform the scientific literature and practice by raising awareness
about the pervasiveness of these symptoms and their impact
on NMIBC survivors’ sexual/romantic relationships. Further
work is needed to design symptom management and educa-
tional programs to dispel misinformation about contamination
post-treatment and improve quality of life by addressing sexual
dysfunction in NMIBC survivors.
CORRESPONDING AUTHOR: Marc Kowalkowski, BS, Urol-
ogy / Health Services Research, Baylor College of Medicine/
Michael E. DeBakey VA Medical Center, Houston, TX, 77021;
kowalkow@bcm.edu
B-033m
BARRIERS TO CRC SCREENING AMONG LATINO/HISPANIC
ADULTS IN URBAN AND RURAL PENNSYLVANIA: RESULTS
FROM THE ACCN
Oralia Dominic, PhD, MS, MA,1 Eugene J. Lengerich, VMD,
MS,1,2 Linda A. Wray, PhD,3 Roxanne Parrott, PhD,4 John A.
Ochoa, PhD,5 Carlos Renderos7 and Mark Dignan, PhD, MPH6
1
PHS, Div. Epidemiology, Penn State Milton S. Hershey
Medical Center, College of Medicine, Hershey, PA; 2Family and
Community Medicine, Health Policy & Administration, Penn
State College of Medicine, Penn State Hershey Cancer Institute,
Hershey, PA; 3Biobehavioral Health, Penn State University,
University Park, PA; 4Communications Arts & Sciences,
Penn State University, University Park, PA; 5Spanish, Italian,
Portuguese and Comaprative Literature, Penn State University,
University Park, PA; 6Internal Medicine, KU, College of
Medicine, Lexington, KY and 7Community Leader, Juniata and
Mifflin Counties, PA.
We examined barriers to CRC among Urban and Rural Ap-
palachia Pennsylvania Latino/Hispanic (L/H) adult residents.
Method: L/H (n=82) engaged in one of eight focus groups
(stratified by geography and sex) offered. Focus group data col-
lected were audio taped, transcribed and grouped into thematic
units using content analysis. Results: We found several unique
barriers - including that urban residents received prevention
20
screenings during annual check-ups, while rural residents were
screened for detection in response to symptoms - (and ways to
overcome each) to CRC screenings for this population. Some of
the urban county males did not know the results of their CRC
screening test while all of the rural Appalachia county males
reported that they knew their test results. For both groups,
low levels of health literacy, knowledge and awareness of CRC
risk and screening were reported barriers. Additionally, for
standard care, the importance of the family unit, strong social
support influencing their CRC screening behavior and practice
were highlighted. We placed the identified barriers into five
categories: (a) physical environment, (b) structural factors, (c)
sociocultural factors, (d) individual factors, and (e) physician-
related barriers (barriers at the provider and/or patient end).
Conclusion: These finding suggest that a targeted CRC screen-
ing intervention utilizing a take home screening test is preferred
among these L/H residents over the traditional approach.
CORRESPONDING AUTHOR: Oralia Dominic, PhD, MS, MA,
Penn State Milton S. Hershey Medical Center, Hershey, PA,
17033; oag102@psu.edu
B-033n
A MARKETING MODEL APPROACH TO UNDERSTANDING
DECISIONS ABOUT HYPNOSIS USE BY BREAST BIOPSY
PATIENTS
Stephanie J. Sohl, PhD, Laurie Margolies, MD, Julie Schnur,
PhD and Guy Montgomery, PhD
Mount Sinai School of Medicine, New York, NY.
Over 1 million women in the US will undergo a breast biopsy
each year, and many will undergo radiologic image-guided
procedures. Unfortunately, breast biopsies are often associated
with heightened emotional distress. Hypnosis has been dem-
onstrated to reduce breast biopsy-related distress; however,
most patients do not use hypnosis. Therefore, it is important
to elucidate the decision-making process in regard to the use
of hypnosis within this population. The Stimulus-Organism-
Response (S-O-R) Marketing Model was adapted to explore the
decision to use a hypnosis CD prior to an image-guided breast
biopsy. The Stimulus in the current study is the hypnosis CD.
The following constructs assessed individual differences in the
Organism (i.e., patient): Cognition (VAS scales of expectations
for biopsy-related pain and anxiety), Affect (Attitudes toward
Hypnosis Questionnaire), Value (The Hedonic/Utilitarian
Scale), and Personality (The Self-Concept Congruity Scale).
The study team documented the Response, patients’ decision
to use a hypnosis CD or not. 85 patients participated in this
study (Age: M=48.4, SD=14.3 years; 37% married; 51% college
graduates). The sample was racially and ethnically diverse (52%
White; 33% Black; 7% Asian; 8% other; 32% Hispanic). 73% of
patients chose to use the hypnosis CD. Analyses revealed that
the decision to use the hypnosis CD was predicted by Affect
(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
Value was marginally significant (χ2(1)=3.57, p=.06, β=.08) and
Cognitions were not significant predictors (ps>0.05). The results
suggest that affect, values and personality are important predic-
tors of the decision to use hypnosis prior to breast biopsy. This
study supports the application of the S-O-R model to the health
context. Future studies should further investigate and address
the utility of the S-O-R model, as it may be useful in guiding
dissemination efforts of evidence-based interventions, and ulti-
mately lead to improvements in patients’ quality of life.
CORRESPONDING AUTHOR: Stephanie J. Sohl, PhD, Mount
Sinai School of Medicine, New York, NY, 10029-6574; Stephanie.
Sohl@mssm.edu
B-033o
SEXUALITY & VETERAN CANCER SURVIVORS
Maggie Syme, PhD and Jennifer Moye, PhD
Boston VA Healthcare System, Boston, MA.
More than 500,000 military veterans are currently diagnosed
with cancer, representing 11% of those who receive their health-
care in the Veterans Health Administration system. With the ex-
ception of prostate cancer, there is little research on the unique
needs of veteran cancer survivors. Sexual issues are one of the
most prevalent long-term complications after cancer treatment,
which vary by treatment, cancer type, and psychosocial vari-
ables such as social support and distress. Veterans likely also
experience distress related to sexual changes, which may inter-
act with cancer-related anxiety, depression, and overall distress
to complicate psychosocial adjustment after cancer treatment.
In this pilot study, in-depth interviews were completed with 47
veterans (age 44-87, M= 65.40) diagnosed with cancer who had
completed treatment on average one year previously (range
1-42 months). They were recruited through fliers and the VA
tumor registry and screened via the medical record and phone
interview for inclusion. If eligible, a 60-minute interview was
conducted that gathered descriptive data on symptoms, coping
strategies, and self-identified gaps in personal healthcare.
50% (N=23) of veterans reported feeling less sexually attractive
as a result of cancer; 48% stated they would go to their primary
care doctor for sexual problems, while 26% indicated they were
unsure who they would go to. Those veterans who felt less
sexually attractive had significantly higher levels of cancer-re-
lated PTSD (t(44)=-3.00, p<.01, η2=.17) and depression (t(44)=-
2.32, p=.03, η2=.11). Also, those with lower perceived sexual
attractiveness tended to be younger (t(44)=3.79, p<.001), have
significantly higher levels of fatigue (t(29)=-3.36, p<.01), have
significantly lower levels of perceived emotional support from
the VA (t(29)=3.25, p<.01) and family and friends (t(29)=3.04,
p<.01).
Care for veteran cancer survivors is an emerging issue. A
significant number of veterans with cancer experience dis-
tress related to perceived sexual changes, which is associated
with increased psychological and physical problems. Further
research is needed to improve sexual satisfaction in veteran can-
cer survivors.
CORRESPONDING AUTHOR: Maggie Syme, PhD, Boston VA
Healthcare System, Roxbury Crossing, MA, 02120; magstrum@
hotmail.com
B-033p
SOCIAL SUPPORT AND DEPRESSIVE SYMPTOMS AMONG
WOMEN UNDERGOING SURGERY FOR SUSPECTED
ENDOMETRIAL CANCER
Stacy M. Dodd, MS,1 Sally E. Jensen, PhD,2 Timothy Sannes,
MS,3 Stephanie Garey, BA,3 Seema Patidar, BA,3 Linda S.
Morgan, MD4 and Deidre B. Pereira, PhD3
1
VA Palo Alto, San Carlos, CA; 2Kellogg Cancer Care Center,
NorthShore University HealthSystem, Evanston, IL; 3Clinical
and Health Psychology, University of Florida, Gainesville, FL
and 4Department of Obstetrics and Gynecology, University of
Florida, Gainesville, FL.
Previous research has demonstrated that social support is
associated with health outcomes and psychological function-
ing among both healthy individuals and cancer patients. This
cross-sectional study examined relationships between depres-
sive symptoms and social support quantity and quality among
women undergoing surgery for suspected endometrial cancer.
Study participants were 103 women (M = 61.10 years old, SD =
9.23 years) scheduled to undergo surgery for suspected endo-
metrial cancer. Participants completed the Structured Interview
Guide for the Hamilton Anxiety and Depression Scale, Social
Network Index, and Sources of Social Support Scale. Partial
correlation analyses were used to examine the relationship be-
tween social support variables and depressive symptoms in this
sample. Controlling for age, larger social network size was as-
sociated with less depressive symptomatology (n = 53, network
diversity r = -.34, p = .02, number of people in social network
r = -.28, p = .05, and number of network domains in which
participant is active r = -.41, p = .002). Tangible support from
friends and negative support from a husband/partner were
associated with more depressive symptoms (n = 95, r = .32, p
= .003 and r = .36, p = .004, respectively). Emotional support
was unrelated to depressive symptoms. These results indicate
that for women undergoing surgery for suspected endometrial
cancer, both social support quality and quantity are associated
with depressive symptoms. Specifically, larger social networks
are associated with less depressive symptoms, while tangible
and negative social support are associated with more depres-
sive symptoms.
CORRESPONDING AUTHOR: Stacy M. Dodd, MS, VA Palo
Alto, San Carlos, CA, 94070; smdodd@phhp.ufl.edu
B-033q
FEASIBILITY OF RECRUITMENT AND DIFFERENCES IN
COMPLETERS OF PAPER, TABLET PC, AND INTERNET
CANCER ASSESSMENT
Kim K. Engelman, PhD, Rachel M. Frische, BA and Trish Long,
PA
Dept of Prevenitve Medicine and Public Health, University of
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
patients from 24 primary care offices were recruited by two
groups of medical students and the HLK research staff. Patients
were recruited by one group of students in the medical offices
by face-to-face completion of the HLK assessment using tablet
PCs while the other group of students collected patient contact
information through medical chart reviews. Patient recruits
collected by chart reviews were then contacted and invited to
complete the assessment online or request a paper version of
the assessment. Data from the tablet PC completers has been
collected and will be analyzed against the more recent online
and paper assessment completers. Preliminary findings indicate
that Internet completers tend to be more high risk than tablet
PC completers (15/77 vs. 0/163, p<0.0001). Internet completers
are often younger than tablet PC completers (51% vs. 25% aged
<55, p=0.003). And Internet completers are more likely to be
female and college educated than tablet PC completers (61% vs
54% and 85% vs. 69%). Further data analysis will be performed
for the paper completers and additional Internet completers
as the study progresses. The demographics, timeliness, and
feasibility of assessment completers will be analyzed on the
basis of the form of technology utilized; either paper, tablet PC,
or Internet.
CORRESPONDING AUTHOR: Rachel M. Frische, BA, Dept of
Prevenitve Medicine and Public Health, University of Kansas
Medical Center, Kansas City, MO, 64108; rfrische@kumc.edu
B-039a
UTILITY OF THE MILLON BEHAVIORAL MEDICINE
DIAGNOSTIC (MBMD) TO PREDICT MEDICATION
ADHERENCE IN PATIENTS DIAGNOSED WITH HEART
FAILURE
Kristen Farrell, MS,1 Biing-Jiun Shen, PhD,2 Stephen Mallon,
MD,3 Frank J. Penedo, PhD1 and Michael H. Antoni, PhD1
1
Psychology, University of Miami, Coral Gables, FL;
2
Psychology, University of Southern California, Los Angeles,
CA and 3Miller School of Medicine, University of Miami, Coral
Gables, FL.
Medication non-adherence is common and a primary reason
for poor medical outcomes among individuals with Heart
Failure (HF). Demographic and medical factors are associated
with adherence among patients with HF. Psychosocial and
personality factors may also influence HF patients’ decisions
to adhere to medicine. We examined whether psychosocial
(depression, hostility) and personality variables were related to
medication adherence (measured by the Medication Adherence
Scale [MAS]) beyond contributions of demographic and medi-
cal variables in an ethnically-diverse sample of 105 men and
women diagnosed with HF. Hierarchical regression analyses
tested whether depression, hostility, and the Millon Behavioral
Medicine Diagnostic (MBMD) Medication Abuse scale were
associated with adherence. Demographic and medical controls
included education level and number of co-morbid diseases.
Greater MBMD Medication Abuse scale scores were associ-
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
depression become non-significant. Therefore the Medication
Abuse scale completely and partially mediated the relationship
between adherence and depression and hostility, respectively.
These results support utilization of personality measures such
as the MBMD and hostility scales in future studies investigating
predictors of adherence and suggest that such personality mea-
sures might be used clinically to predict medication adherence
among HF patients.
CORRESPONDING AUTHOR: Kristen Farrell, MS, Psychol-
ogy, University of Miami, Palmetto Bay, FL, 33157; k.farrell1@
umiami.edu
B-039b
THE DEVELOPMENT OF A COGNITIVE-BEHAVIOR GROUP
INTERVENTION PROGRAM TO REDUCE THE HOSTILITY
LEVELS OF CORONARY HEART DISEASE PATIENTS AND
ITS EFFECT ON BLOOD COAGULATION FUNCTION: A
CONTROLLED STUDY
Chia-Ying Weng, PhD,1 Tin Kwang Lin, MD,2 Hsin-Hung
Chiang, BS,3 Chiu-Tien Hsu, Master,1 Ko-Chia Chen, Master,1
Chao Fen Chen, BS,1 Su-Ya Hseueh, BS3 and Chin-Lon Lin, MD2
1
Psychology Department, National Chung Cheng University,
Chia-Yi, Taiwan; 2Internal Medicine, The Buddhist Dalin
Tzu Chi General Hospital, Chia-Yi, Taiwan and 3Health
management center, The Buddhist Dalin Tzu Chi General
Hospital, Chia-Yi, Taiwan.
The purpose of this study is to develop a cognitive-behavior
group intervention program to reduce the hostility levels of cor-
onary heart disease (CHD) patients and to examine its effect on
blood coagulation function. A case control study with matched
age, sex and education, based on a two group pre- and post-test
design was adopted. Participants of the experimental group
were 9 CHD patients (mean age = 56.33±10.45, male 67%) who
attended a weekly two-and-a-half hour session and did home-
work for two months. The intervention foci included psycho-
education, biofeedback-assistant relaxation training, and cog-
nitive-behavior strategies to reduce the levels of hostility affect,
hostility cognition, and hostility behavior. Participants of the
control group were 13 CHD patients (mean age = 59.23±6.80,
male 69%) who did not receive any psychological treatment
until they finished the three-month waiting status. After inter-
vention, participants showed a significant reduction in hostility
level (t=4.27, p < .01) and respiration rate (t =3.06, p < .01), and
a significant increase in prothrombin time (t=-4.75, p< .001). The
results of the repeated measure of ANOVA indicated that the
experimental group revealed a significantly higher reduction
of respiration rate (F=8.76, p < .01), and a marginally higher
increase of prothrombin time (F=-3.66, p = .06) than the waiting
control group. In conclusion, the results of this study imply that
psychological intervention is efficient to reduce the biological
risk of disease recurrence for CHD patients.
CORRESPONDING AUTHOR: Chia-Ying Weng, PhD, Psychol-
ogy Department, National Chung Cheng University, Chia-Yi,
62102; psycyw@ccu.edu.tw
B-039c
COMMITMENT AND LEVEL OF CONFIDENCE TO EXERCISE
AFTER A MOTIVATIONAL INTERVIEW IN A CARDIOLOGY-
BASED PREVENTION PROGRAM
Robert Scales, PhD,1 Susan Halli, DNP,1 Cengiz Akalan, PhD,2
Aleese Murik, BS,1 Judith A. Turner-O’Connell, BS,1 Steven W.
Ressler, MD,1 Joseph H. Miller, MSW3 and Robert T. Hurst, MD1
1
Cardiology, Mayo Clinic-Arizona, Scottsdale, AZ; 2Ankara
University, Ankara, Turkey and 3The University of New
Mexico, Albuquerque, NM.
Motivational interviewing (MI) encourages talk about behav-
ior change and it can elicit a verbal commitment that makes
positive outcomes more likely. This study assessed commit-
ment and confidence to exercise after a motivational interview
in people who had elected to participate in a cardiology-based
prevention program (CBPP). MI was a component of a com-
prehensive program that included a cardiac evaluation (blood
chemistry, carotid intima-media thickness & exercise stress
testing) with feedback from clinicians plus a nutrition consulta-
tion. An exercise physiologist (EP) who had previously demon-
strated proficiency in MI conducted a motivational interview
(45-mins) in conjunction with a physical performance evalua-
tion. Outcome measures included a self-reported 7-day recall of
structured exercise and an assessment of the stage of readiness
to exercise (>3 hrs/wk) and the level of confidence (1-10 scale)
to attain a stated personalized 6-wk goal for exercise. The study
evaluated 83 (76% male) asymptomatic adults (30-64 yrs) with
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
the program was 2.7 hrs/wk (SD=2.9) and after the motivation-
al interview the mean minimum goal for exercise was 5.4 hrs/
wk (SD=2.5). Seventy-eight participants (94%) were either ready
to start (n=49, Preparation=59%) or continue (n=8, Action=10%;
n=21, Maintenance=25%) exercising >3 hrs/wk. The remaining
5 participants (6%) all stated their intention to exercise >2 hrs/
wk. Everyone expressed a moderate to very high level of confi-
dence to attain their personal goal (Moderate=11%; High=42%;
Very High=47%). It appears that this self-selected group was
motivated to exercise after participation in a CBPP. Assess-
ing the level of commitment and confidence to change at the
conclusion of a motivational interview may provide a practical
self-audit of MI practice with strategic benefits.
CORRESPONDING AUTHOR: Robert Scales, PhD, Cardiol-
ogy, Mayo Clinic-Arizona, Scottsdale, AZ, 85259; scales.robert@
mayo.edu
B-039d
THE COMPLEX RELATIONSHIP OF RELIGIOUS FACTORS,
CARDIOVASCULAR HEALTH, AND MORTALITY
Amy D. Owen, PhD and Richard D. Hayward, PhD
Duke University Medical Center, Durham, NC.
Religious attendance has been found to predict mortality in
older adults, but a comprehensive investigation of the effects of
specific religious beliefs and practices on health and mortality is
needed to better articulate this relationship. Longitudinal data
were analyzed to investigate the prospective effects of religious
variables on health and mortality among older adults. Religious
and demographic data were collected in 2001, and a follow-up
study collected data on mortality and health in 2004. A binary
logistic regression model was constructed to analyze the data,
controlling for demographics, global self-reported health, health
behaviors, and religious / spiritual factors. Mortality after three
years was found to be associated with a weaker belief in the
efficacy of prayer (b = .19, p < .003, OR = 1.21), lower frequency
of private prayer (b = .20, p < .001, OR = 1.23), and receiving
higher emotional support from the congregation (b = -.42, p <
.03, OR = 0.66). In addition, several religious factors were found
to be associated with the self-reported onset of cardiovascular
health. Self-reported hypertension was associated with low lev-
els of anticipated support from the congregation (b = -.35, p <
.03, OR = 0.71), infrequent negative religious coping (b = -.27, p
< .05, OR = 0.76), and stronger belief in perceived divine control
(b = .53, p < .02, OR = 1.70). Self-reported heart attack or other
heart trouble was associated with infrequent positive religious
coping (b = -.77, p < .006, OR = 0.46), a weak sense of connec-
tion to other people (b = -.93, p < .004, OR = 0.40), and a strong
sense of connection to God (b = .70, p < .04, OR = 2.02). Results
indicate that religious factors predict mortality and cardiovas-
cular health after three years with an older adult population.
However, these factors are nuanced and operate in complex
manner. Various religious factors have the capacity to influence
health both positively and negatively. Given these findings,
researchers should take a multifaceted approach to measuring
religion in studies of health outcomes.
CORRESPONDING AUTHOR: Amy D. Owen, PhD, Duke
University Medical Center, Durham, NC, 27705; amy.owen@
duke.edu
B-047a
GRANDPARENTS INVOLVEMENT IN ADOLESCENT
DIABETES CARE
Linda Drew, PhD,1 Cynthia Berg, PhD2 and Deborah J. Wiebe,
PhD1
1
University of Texas Southwestern Medical School, Dallas, TX
and 2University of Utah, Salt Lake, UT.
Adolescents often require support for successful diabetes man-
agement, and the extended kin-network - such as grandpar-
ents - may be important when there are limited nuclear family
resources. Grandparents can help with pediatric illness both
directly (e.g., distributing medications, attending clinic appoint-
ments) and indirectly (e.g., emotionally supporting parents, the
grandchild with a chronic illness, and their siblings) (Smith &
Drew, 2002). It is likely that grandparents of adolescents with
diabetes can be of tremendous help to their adult children and
grandchildren, and provide a vital source of emotional and
practical support when a grandchild has a chronic illness (Ka-
zak & Marvin, 1984; Mirfin-Veitch, Bray, & Watson, 1996). This
may be particularly true when families have limited resources
(e.g., parental depression, low income, single parent). The
current study investigated whether: (1) grandparents helped
with adolescent diabetes care, (2) grandparent help occurred
when diabetes management was going poorly, (3) grandpar-
ent help occurred when mothers were depressed, lone parents,
and low SES. Adolescents (n=252; 46% male and 54% female)
aged 10-14 years with type 1 diabetes completed assessments of
frequency of grandparent help with diabetes care and adher-
ence (Self-Care Inventory). Parents provided depression scores
(CESD) (maternal range 0-45, M=11.74; sd=9.65), adherence
(Self-Care Inventory), family income, and demographics (18.8%
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
medical records. About half (47.2%) of the adolescents indicated
grandparents helped with their diabetes care 1-2 times per week
to daily. Higher grandparent help with diabetes management
was associated with higher levels of HbA1c (worse glycemic
control), father reports of low treatment adherence, and mother
report of more depressive symptoms, being a single parent, and
low income. Results revealed grandparent involvement with
diabetes care might be a resource when adolescents have poorer
diabetes management, and mothers’ emotional and economic
resources are limited.
CORRESPONDING AUTHOR: Linda Drew, PhD, University
of Texas Southwestern Medical School, Dallas, TX, 75390; linda.
drew@utsw.edu
B-047b
INFLUENCE OF DISTRESS AND OBESITY ON HEALTH
BEHAVIORS IN DIABETICS: BRFSS 2007 FINDINGS
Karen Lesniak, PhD, Sarah Ormseth, BS, Narineh Hartoonian,
MS and Eric Hanson, MA
Psychology, Loma Linda University, Loma Linda, CA.
PURPOSE: To examine the effect of patient characteristics (in-
cluding distress and BMI) on meeting physical activity (PA) and
intake of fruits and vegetable guidelines in persons with diabe-
tes, health behaviors of critical relevance to the treatment of this
condition. METHODS: Population-based data were used (2007
Behavioral Risk Factor Surveillance System[BRFSS]); 47964 dia-
betic persons were eligible for the study. SAS 9.2 was used for
analyses; CDC sample weights were used to adjust for sampling
design and non-response; Taylor Series Method in SUDAAN
calculated variance estimates to account for the stratified
multistage sampling design. Predictor variables were distress
(Kessler-6 score≥13) and BMI (normal, overweight, obese). Out-
comes were participation in recommended level of PA (moder-
ate PA for 30+ min at least 5 days per week or vigorous PA for
20+ min at least 3 days per week) and intake of recommended
servings of fruits and vegetables (daily intake≥5 servings).
Covariates were age, gender, ethnicity, income level, education,
marital status, perceived general health and physical disabil-
ity. Multivariate logistic regression was used to predict health
behavior. RESULTS: In the multivariate model, decreased
likelihood of meeting PA recommendations was significantly
associated with distress and being classified as obese (ps=.01),
older age (p<.001), female gender (p=.04), lower income level
(p=.003), being African American (p=.01), lower perceived gen-
eral health (p<.001), and being physically disabled (p<.001). For
fruits and vegetables, decreased intake of recommended serv-
ings was associated with being classified as obese (p<.001), but
not distress (p=ns), male gender (p<.001), and lower education
level (p<.001). Increased intake was related to greater perceived
general health (p=.002). CONCLUSION: Characteristics affect
adherence to guidelines differentially. Implications and poten-
tial applied clinical value of results will be discussed.
CORRESPONDING AUTHOR: Karen Lesniak, PhD, Psychol-
ogy, Loma Linda University, Loma Linda, CA, 92354; klesniak@
llu.edu
24
B-051a
THEORY PAPER: HOW FAST AND FRUGAL HEURISTICS CAN
HELP DOCTORS MAKE BETTER DECISIONS
Odette Wegwarth, PhD and Gerd Gigerenzer, PhD
Harding Center for Risk Literacy, Max Planck Institut for
Human Development, Berlin, Germany.
BACKGROUND: How can doctors make sound decisions in an
environment in which they are confronted with probabilistic
data, time pressure, and a heavy workload? Over the last de-
cades, most decision support tools aimed at facilitating doctors’
decision making have been inspired by models of optimization,
which emphasize the need to integrate all information avail-
able and assume that with less information, inferior decisions
are inevitable. Yet many of these tools are not widely accepted
because of their complexity. This raises the question of whether
tools based on simple models might be a more promising ap-
proach.
METHOD: We introduce two medical problems that involve
decision making under uncertainty and time pressure: decisions
on coronary care administration and decisions on macrolide
prescriptions. In both settings, decision support tools have been
developed to assist doctors in making decisions, founded on the
principles of either optimization or heuristics. The structure of
these two types of tools will be introduced.
RESULTS: For decisions concerning both the coronary care unit
and macrolide prescriptions, we demonstrate that sacrificing
information does not diminish doctors’ predictive accuracy,
but in fact leads to equally accurate or even better decisions.
Moreover, in the case of the coronary care unit decisions, the
heuristic tool found high acceptance and doctors immediately
incorporated it into their decision making processes. We illus-
trate with further findings when and why ignoring parts of the
available information can lead to more robust predictions.
CONCLUSIONS: Heuristics are neither good nor bad per se
but, if applied in situations to which they have been adapted,
can be helpful companions for doctors. To be of benefit,
however, heuristics in medicine need to be openly discussed,
criticized, refined, and then taught to doctors-in-training rather
than being simply dismissed as harmful or irrelevant. A more
uniform use of explicit and accepted heuristics has the potential
to reduce variations in diagnoses and to improve medical care.
CORRESPONDING AUTHOR: Odette Wegwarth, PhD, Hard-
ing Center for Risk Literacy, Max Planck Institut for Human
Development, Berlin, 14195; wegwarth@mpib-berlin.mpg.de
B-051b
PHYSICIAN ASSISTANT’S ANTICIPATORY GUIDANCE
EDUCATION ON FIREARMS:PROGRAM DIRECTOR’S
PRACTICES AND PERCEPTIONS
Amy Thompson, PhD,1 James H. Price, PhD, FASHA,1 Jagdish
Khubchandani, MBBS, MPH, CHES,2 Patricia A. Hogue, PhD,2
Michele Bryant, MS1 and Diana Reindl, MS1
1
Health and Rehab Services, University of Toledo, Toledo, OH
and 2Medicine, University of Toledo Medical Center, Toledo,
OH.
Objective: Physician assistants can play a central role in reduc-
ing the number of deaths due to preventable causes of prema-
ture deaths. Physician assistant training programs have not
been studied in relation to training in the area of firearm safety
counseling of patients.
Methods: A three-wave mail survey was conducted in the Fall
of 2009. All the program directors (n=145) of the physician
assistant training programs were included in the study. The
outcome measures were the portion of program directors in-
volved in training students on firearm injury prevention issues
and their perceived benefits and barriers of training students on
firearm injury prevention issues.
Results: 108 program directors responded to the survey (re-
sponse rate=75%). Only 25% of programs provided formal
training on firearm injury prevention. Program directors who
provided formal training perceived significantly higher num-
ber of benefits to offering such training than directors who did
not provide such training. No significant difference was found
between the two for number of perceived barriers.
Conclusions: If physician assistant training program graduates
are to play a role in reducing premature morbidity and mortal-
ity (e.g. suicides and homicides) from firearms it will require
more training programs to offer formal training in this area. The
American Academy of Physician Assistants needs to develop
guidelines on specific curricular firearm topics.
CORRESPONDING AUTHOR: Jagdish Khubchandani, MBBS,
MPH, CHES, Health and Rehab Services, University of Toledo,
Toledo, OH, 43606; jagdish.khubchandani@utoledo.edu
B-061a
RISKY SEXUAL BEHAVIOR IN HIV-POSITIVE OLDER
ADULTS: A LONGITUDINAL ANALYSIS
Travis I. Lovejoy, MS, MPH,1 Timothy G. Heckman, PhD,2
Kathleen J. Sikkema, PhD3 and Nathan Hansen, PhD4
1
Psychology, Ohio University, Athens, OH; 2Osteopathic
Medicine, Ohio University, Athens, OH; 3Psychology and
Neuroscience, Duke University, Durham, NC and 4School of
Medicine, Yale University, New Haven, CT.
Objectives: In the past decade, the incidence of new HIV infec-
tions in older adults has steadily risen. Cross-sectional studies
have examined correlates of sexual risk behavior in HIV-posi-
tive older adults, but no study to date has examined longitudi-
nal patterns of such behaviors in this population.
Participants and Procedures: Participants were 251 HIV-posi-
tive adults 50+ years of age (Mean Age = 55.6 years; 69% male;
30% Caucasian) residing in three metropolitan regions in New
York and Ohio. Participants completed a demographic battery
at baseline, in addition to detailed sexual behavior questions
and a series of psychosocial measures at four evenly-spaced
time points over one year.
Results: Four clusters emerged from the data that described
the longitudinal sexual behavior of study participants over
the four time periods: sexually abstinent (43%), sexually active
but always protected (30%), sexually active and occasionally
unprotected (9%), and sexually active and regularly unpro-
tected (18%). In bivariate analyses, participants who reported
low transmission-risk behaviors (i.e., being sexually abstinent
or engaging in only protected sex) had significantly greater HIV
knowledge than participants who engaged in high transmis-
sion-risk behaviors (i.e., any unprotected intercourse; O.R. =
0.043, 95% CI = 0.005-0.335), and this relationship remained sig-
nificant after controlling for city of residence, age, gender, and
race (Adjusted O.R. = 0.031, 95% CI = 0.003-0.291). Participants
did not, however, significantly differ on levels of depression or
anxiety (all p’s > 0.05).
Implications: HIV secondary prevention efforts have tradition-
ally targeted “at risk” groups such as intravenous drug us-
ers and men who have sex with men. As the number of older
adults living with HIV/AIDS in the United States continues to
increase, age-appropriate risk-reduction interventions to correct
misinformation about transmission risk behaviors are urgently
needed.
CORRESPONDING AUTHOR: Travis I. Lovejoy, MS, MPH,
Psychology, Ohio University, Athens, OH, 45701; tl399805@
ohio.edu
B-061b
GAY MEN EXPRESS MORE EMOTIONS THAN STRAIGHT MEN
IN AN EXPRESSIVE WRITING INTERVENTION
Jonathan R. Atwood, BA, Gail Ironson, MD, PhD and Rachel
Kuhn, MS
Psychology and Behavioral Medicine, University of Miami,
Coral Gables, FL.
Expressive writing (EW) as a therapeutic intervention has been
implemented in a variety of healthy, medical and psychologi-
cal populations, and has been shown to provide significant
health benefits in many studies. Two previous studies found
that HIV-positive individuals with protected health status had
significantly higher levels of written emotional expression (EE)
in trauma-related essays versus HIV-positive individuals with
typical disease progression. However, few studies have exam-
ined which populations benefit most from EW, and none to
our knowledge have examined sexual orientation as a potential
moderator. The present study examined levels of EE (i.e. the
number or positive and negative emotion words or expressions)
in a sample of HIV-positive individuals, in which sub-samples
of self-identified exclusively gay (GM; n = 34) and exclusively
straight (SM; n = 23) men were compared. Participants were
asked to write expressively and freely about their most trau-
matic experiences for a 30-minute session. Specifically, the
participants were probed to explore their deepest thoughts and
feelings about the trauma for the first 20 minutes, and to make
sense of the trauma for the last 10 minutes. Results show that
GM use significantly more total emotion words when probed
to write expressively about a traumatic event (t(55) = 2.212, p =
.031; GM M = 8.99, SD = 5.83; SM M = 6.04, SD = 3.11). Severity
(t(58) = -.075, p = .941) and topic (t(56) = .161, p = .872) of par-
ticipants’ traumas were considered as confounds, but were not
significantly different between the groups. As previously noted,
higher levels of EE have been found to relate to health and psy-
chological benefits derived from EW. Therefore, self-identified
GM may be one demographic for which the EW paradigm
would be particularly beneficial and therapeutic. Future analy-
ses with this sample will examine whether the higher levels of
EE lead to greater improvements in health and psychological
outcomes in GM versus SM.
CORRESPONDING AUTHOR: Jonathan R. Atwood, BA, Psy-
chology and Behavioral Medicine, University of Miami, Coral
Gables, FL, 33146; jatwood@miami.edu
25
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
B-061c
INSTITUTIONAL MISTRUST AND SEXUAL RISK BEHAVIOR
Michael A. Hoyt, PhD,1 Joyce Lee, BA1 and Lisa L. Rubin, PhD2
1
Psychology, University of California, Merced, Merced, CA and
2
Psychology, New School for Social Research, New York, NY.
The degree to which one lacks confidence or trust in health and
prevention-promoting institutions might help to determine
related health risk behaviors. Further, institutional mistrust
may be particularly salient to those with presumably greater
degrees of marginalization, such as ethnic minority MSM (men
who have sex with men). METHOD: 398 MSM (M age = 35; 76%
White) completed self-report assessments initially (T1) and at
6-months (T2). The developed 11-item Institutional Mistrust
Scale measures the degree of mistrust for HIV/AIDS-related
institutions (e.g., medical services, government). EFA revealed
3 dimensions: systematic discrimination (“How much discrimi-
nation do you think there has been in access to HIV-related
prevention services?”), Organizational Mistrust (“How much
would you trust an HIV prevention organization that is run by
the state government?”), and Conspiracy Beliefs (“How likely
is it that AIDS was developed as part of a government plan?”
Sexual risk behavior in the past 6 months ranged from 0 (no
unprotected anal sex) to 3 (unprotected receptive anal sex).
RESULT: In separate regression analyses, T2 risk behavior was
regressed on T1 risk behavior, ethnic status(White vs. non-
White), the respective mistrust dimension, and the interaction
of minority status and mistrust. No significant main effects
of mistrust or minority status were observed. However, the
interaction of Organizational Mistrust and minority status was
significant (Β = .45, p < .001), in which higher levels of mistrust
were related to increased risk behavior (Β = -.33, p < .05) for eth-
nic minority MSM. No effect was apparent for White MSM (Β =
.05, ns). CONCLUSION: Various forms of institutional mistrust
might affect sexual risk behaviors differently between groups.
Higher levels of mistrust in HIV-prevention organizations may
be particularly detrimental to ethnic minority MSM.
CORRESPONDING AUTHOR: Michael A. Hoyt, PhD, Psy-
chology, University of California, Merced, Merced, CA, 95344;
mhoyt@ucmerced.edu
B-066a
EATING BEHAVIORS AND PUBLIC HEALTH MESSAGES OVER
TIME: AN INTERGENERATIONAL STUDY OF UK FAMILIES
Anne M. Haase, PhD and Janice Thompson, PhD
Exercise, Nutrition and Health Sciences, University of Bristol,
Bristol, United Kingdom.
There is little research exploring family eating behaviors over
time and related public health messages. This study examined
eating behaviors and changes due to health messages in three
family generations (grandparents, parents, children) over three
time points.
Baseline surveys were mailed in early winter, 2 following
surveys sent about 4 and 8 months later. Of 431 families (one
adult & one child between 8-16 years in the same household),
106 families replied with 101 and 77 families responding to 2nd
and 3rd surveys, respectively. Most adults (62% of parents, 65%
of grandparents) were female with an equal number of boys
and girls completing surveys. Parents and grandparents were
non-smokers, married, Caucasian and reasonably educated.
26
Parents/grandparents were overweight; children were normal
weight. No significant changes in BMI occurred over time.
Grandparents were more likely to eat the recommended serv-
ings per day of fruit and vegetables compared to parents (44%
vs 22%). 58% and 59% of children ate fruit and vegetables
respectively everyday, though 30% of children ate sweets nearly
every day and 15% ate potato chips every day. Breakfast was
consumed by most grandparents (78%) and younger children
(86%) but by just 58% of parents and 48% of adolescents. No
significant change in fruit and vegetable intake occurred over
time, except for parents significantly (p=.01) increasing their
fruit intake between time 1 (winter) and time 3 (summer). Par-
ents (62%) and grandparents (52%) got their public health mes-
sages from magazines and television, very few (13% of parents,
15% of grandparents) received these messages from healthcare
providers. Only 21% of parents and 26% of grandparents had
recently changed their behavior due to health messages. The
quality of diet over time in grandparents was better than in
other generations, yet the families’ eating habits failed to reflect
recommendations based on public health messages. It was not
clear if and how eating habits were passed between generations,
suggesting a need for research to explore potential mechanisms.
CORRESPONDING AUTHOR: Anne M. Haase, PhD, Exercise,
Nutrition and Health Sciences, University of Bristol, Bristol, BS9
4DA; anne.haase@bristol.ac.uk
B-066b
QUALITATIVELY ANALYZING PERCEPTIONS AND OPINIONS
ON THE FEASIBILITY OF USING FACEBOOK FOR A HEALTH
AND WELLNESS INTERVENTION IN COLLEGE STUDENTS
Shannon Smith, MS, Cheryl Der Ananian, PhD and Jesse
Vezina, BS
Program in Exercise and Wellness, Arizona State University,
Mesa, AZ.
Background: Social networking sites are a popular communi-
cation method in the college-age population (Raacke, 2007).
College is a transitional time for young adults and there is often
a disruption in health habits (Butler, 2004). Understanding
whether social networking sites can be used to change health
behaviors is important because of the potential broad impact.
Purpose: To qualitatively examine opinions on the feasibility
and acceptability of using Facebook as a means of communica-
tion of health and wellness information prior to implementa-
tion of a wellness intervention using Facebook. Methods: Three
focus groups were conducted with college freshmen (age 18+).
A trained moderator led discussions using a guide. Focus group
data were transcribed verbatim, coded, and themes identi-
fied. Results: Seventeen college freshmen (47% White; mean
age 19.4+3.8 years; 53% female) participated in the groups.
Thematic analyses revealed that participants use Facebook for
messaging, games, and applications. Many identified Facebook
as an appropriate communication method for health/wellness
information due to its popularity in college-age students. Par-
ticipants preferred obtaining health information via the Internet
versus other media. Health topics of interest to participants
included information on nutrition and exercise, healthy recipes,
workout plans and stress management. Participants suggested
that status updates and short, simple messages and links would
be the most effective ways to communicate information. Poten-
tial weaknesses of using Facebook for an intervention included
missed messages, non-interest, and confusion. Conclusion: Col-
lege students perceived Facebook as a feasible and acceptable
form of communication for health information. Salient health
information topics were identified and suggestions for optimiz-
ing Facebook as a communication method were provided. Sup-
ported by Plus One Active Research Grant on Wellness Using
Internet Technology through the American College of Sports
Medicine Foundation.
CORRESPONDING AUTHOR: Shannon Smith, MS, Exercise
and Wellness, Arizona State University, Chandler, AZ, 85225;
shannon.b.smith@asu.edu
B-081a
THE FACTOR STRUCTURE OF THE BECK DEPRESSION
INVENTORY-II (BDI-II) IN BARIATRIC SURGERY
CANDIDATES
Nina Stoeckel, MS, Thomas Martin, PhD, John Gerdes, PhD,
Christopher Still, DO and Craig Wood, MS
Psychiatry, Geisinger Medical Center, Danville, PA.
Symptoms of depression are observed in morbidly obese pa-
tients seeking bariatric surgery. The BDI-II is frequently used to
assess depression during pre-operative mental health evalua-
tions, but little is known about the factor structure of the BDI-II
in this population. A population-specific investigation of the
BDI-II factor structure is important given that (1) to our knowl-
edge its factor structure has not been examined in bariatric
surgery candidates, and (2) factor solutions have varied across
studies for different populations. Two- and three-factor solu-
tions were found previously.
The aim of this study was to examine the factor structure of
the BDI-II in patients seeking bariatric surgery. BDI-II data for
this study were acquired via a retrospective data pull from a da-
tabase developed originally for studies of nonalcoholic steato-
hepatitis in patients undergoing bariatric surgery. All patients
in this program undergo psychological screening, including
collection of BDI-II scores, several months prior to surgery.
BDI-II protocols from 875 participants (81% female, 97% Cauca-
sian) had been collected over a 54-month period. Participants’
mean age was 46 years (SD: 11.2) and mean pre-surgical BMI
was 50 (SD: 8.7).
The reliability of the BDI-II in this population was similar to
that reported for other populations, α = .92. The mean BDI-II
score was 13.4 (SD: 10.1). Exploratory principle components
factor analysis with varimax rotation yielded three factors with
eigenvalues greater than 1. Factor 1 closely resembles the cogni-
tive factor Beck, Steer, and Brown (1996) identified in their clini-
cal sample, and factors 2 and 3 divide their somatic-affective
factor into factors that appear to reflect variance unique to obese
bariatric surgery candidates and variance associated with more
severe symptoms of depression, respectively.
Findings suggest that a three-factor structure of the BDI-II best
fits the data in a sample of bariatric surgery candidates. Factors
1 and 3 might be particularly helpful in screening for symptoms
of depression in bariatric surgery candidates.
CORRESPONDING AUTHOR: Nina Stoeckel, MS, Geisinger
Medical Center, Danville, PA, 17822; njstoeck@syr.edu
B-081b
PREDICTORS OF INTENTION TO SHARE EDUCATIONAL
HEALTH INFORMATION VIA ONLINE SOCIAL NETWORK TIES
Kevin O. Hwang, MD, MPH,1 Jason M. Etchegaray, PhD,1 Elmer
V. Bernstam, MD, MSE1,2 and Eric J. Thomas, MD, MPH1
1
Internal Medicine, The University of Texas Medical School at
Houston, Houston, TX and 2The University of Texas School of
Health Information Sciences at Houston, Houston, TX.
Activating members of online communities to share educational
health information through social network ties may be a useful
dissemination strategy. We surveyed members of a volunteer
outreach group within the SparkPeople online weight loss com-
munity to gauge intention to share educational health informa-
tion with other members. Respondents viewed a webpage with
educational osteoarthritis information. Intention to share the
link (via email, forums, blogs) with members who have arthritis
was measured with 3 Likert-scale items. Intention to participate
in a future project to share similar information with other mem-
bers was measured with 1 item, dichotomized as (definitely,
probably) vs (possibly, probably not, definitely not). Predictors
were Theory of Planned Behavior constructs (attitudes, subjec-
tive norms, perceived behavioral control); barriers to sharing
information; presence of arthritis; number of SparkPeople
“Friends”; frequency of interacting with other members; age;
and education. The 349 respondents were 43.8 [SD 11.6] years
old, 94.7% female, and 88.1% white. On linear regression, at-
titudes, social norms, behavioral control, and barriers predicted
intention to share the information (p < .001), accounting for 72%
of variance. 77.4% of respondents were definitely or probably
interested in sharing educational health information with other
members in a future project. On logistic regression, each unit
increase in attitudes (more favorable attitude) was directly asso-
ciated with definitely/probably participating in the project (OR
3.48 [95% CI 1.95 - 6.22], p < .001). Each unit increase in barriers
was inversely associated with definitely/probably participating
(OR 0.34 [95% CI 0.18 - 0.62], p < .001). Among members of the
volunteer outreach group within SparkPeople, attitudes, social
norms, behavioral control, and barriers are significant predic-
tors of intention to share educational health information via
online social network ties.
CORRESPONDING AUTHOR: Kevin O. Hwang, MD, MPH,
Internal Medicine, The University of Texas Medical School at
Houston, Houston, TX, 77030; kevin.o.hwang@uth.tmc.edu
B-081c
IDENTIFYING PATTERNS OF EATING AND PHYSICAL
ACTIVITY IN CHILDREN: A LATENT CLASS ANALYSIS OF
PEDIATRIC OBESITY RISK
Jimi Huh, PhD, Nathaniel R. Riggs, PhD, Donna Spruijt-
Metz, PhD, Chih-Ping Chou, PhD, Zhaoqing Huang, MD and
MaryAnn Pentz, PhD
Department of Preventive Medicine, University of Southern
California, Alhambra, CA.
We used latent class analysis (LCA) to identify heterogeneous
subgroups with respect to behavioral obesity risk factors in
a sample of 4th grade children (n=997) residing in Southern
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
without exercise, weight conscious (24.9%),” “High sedentary,
junk food, weight conscious (13.3%),” “Active, healthy eating
(13.7%),” and “Low healthy and junk food intake, inactive, not
weight conscious (32.1%).” Ethnicity, gender and a SES proxy
variable significantly predicted the identified latent classes. The
children’s weight status according to their Body Mass Index
(BMI) was significantly associated with the latent classes. The
results suggest the distinct subtypes of children with respect to
their obesity-related risk behaviors. The identified latent sub-
group membership, in turn, was associated with the children’s
weight status. Specifically, obesity (BMI ≥ 95th percentile) was
much more prevalent in the “High sedentary, junk food, weight
conscious” class and the “Dieting without exercise, weight con-
scious” class. A majority of children in these classes were classi-
fied as overweight or obese (68.5% and 72.0%, respectively). The
results support appropriate refinement of existing intervention
programs based on children’s characteristics to promote further
success of pediatric obesity intervention research.
CORRESPONDING AUTHOR: Jimi Huh, PhD, Department of
Preventive Medicine, University of Southern California, Alham-
bra, CA, 91803; jimihuh@usc.edu
B-081d
PATIENT KNOWLEDGE AND UNREALISTIC WEIGHT LOSS
EXPECTATIONS PREDICT TREATMENT FAILURE ONE YEAR
AFTER GASTRIC BYPASS SURGERY
Leila Azarbad, PhD,1 Brian Hall, MA,1 Joyce Corsica, PhD,1
Megan Hood, PhD1 and Linda Gonder-Frederick, PhD2
1
Rush University Medical Center, Chicago, IL and 2University
of Virginia Health System, Charlottesville, VA.
Background: Roux-en-Y gastric bypass surgery (RYGBP) is
among the most popular types of bariatric surgeries. How-
ever, roughly 20% of patients experience treatment failure,
defined as inadequate weight loss or significant weight regain
after surgery. The potential influence of cognitive variables on
post-operative outcomes is not fully understood. The present
study aimed to investigate the influence of 3 cognitive variables
(knowledge about surgery, pre-operative weight loss expecta-
tions, and cognitive ability) on treatment success/failure 1
year after RYGBP surgery. Methods: Participants were 154
patients (BMI M=55.3; age M=41.9) undergoing RYGBP sur-
gery at an academic medical center. Knowledge about surgery
was assessed via the Gastric Bypass Knowledge Scale. Weight
loss expectations were assessed in writing by the following
question:“How much weight do you expect to lose after sur-
gery?” Cognitive ability was assessed by The Shipley Institute
of Living Scale. Logistic regression analysis (LRA) was used to
examine the influence of cognitive variables on post-operative
outcome. Consistent with past studies, treatment failure was
defined as less than 50% excess weight loss 1-year post-surgery.
Results: No significant relationships were noted between sex,
ethnicity, or age and treatment outcome, or between cognitive
ability and treatment outcome (p=.115). LRA indicated that
higher scores on the Gastric Bypass Knowledge Scale were re-
lated to treatment success (OR=1.05, 95% CI=1.01-1.08, p=.003),
and greater weight loss expectations were related to treatment
failure (OR=0.99, 95% CI=0.98-0.99, p=.003). Conclusion: Modi-
fiable variables, such as poor patient knowledge and unrealistic
weight loss expectations, are associated with 1-year treatment
28
failure and should be key components assessed and treated
prior to RYGBP surgery.
CORRESPONDING AUTHOR: Leila Azarbad, PhD, Rush
University Medical Center, Chicago, IL, 60612; Leila_Azarbad@
rush.edu
B-081e
WEIGHT LOSS ACTIVITY IN OVERWEIGHT AND OBESE
VETERANS
Kristin L. MacGregor, MS,1,2 Allison K. Labbe, MS,1,2 Marketa
Krenek, BS,2,1 Jennifer S. Funderburk, PhD1,2 and Stephen A.
Maisto, PhD2,1
1
Syracuse VA Medical Center, Syracuse, NY and 2Syracuse
University, Syracuse, NY.
Despite knowledge about the adverse effects of obesity on
health, the prevalence continues to increase, particularly in the
VA population. Veterans who use the VA healthcare system
are among those with the highest rates of obesity. The purpose
of this study was to examine if overweight and obese veterans
who are reporting trying to lose weight are actually behaving
any differently than those who are not with the goal of aiding
primary care providers in understanding the behaviors as-
sociated with weight loss attempts in this population. A total
of 138 overweight or obese veterans (BMI≥25) presenting to
two VA primary care clinics completed self-report question-
naires assessing exercise, diet, and weight-related variables.
Participants had a mean BMI of 30.3 (SD=4.2), and 63% reported
currently trying to lose weight. Group differences were exam-
ined between participants reporting trying to lose weight and
those who are not. Demographic variables (e.g. age, sex, marital
status) known to be associated with the outcomes of interest
were statistically controlled. Results revealed that individuals
in the weight-loss attempt group were 10 times more likely to
be dieting (χ2=15.0, p<.001) and 8 times more likely to receive
advice about weight loss (χ2=18.0, p<.0001). They also reported
greater readiness to change their weight (F=103.0, p<.0001) and
exercise (F=20.3, p<.0001) and had higher BMI (F=11.1, p<.01).
However, group differences did not exist for exercise behavior,
implying that individuals trying to lose weight may perceive
weight loss as being achieved by dieting alone, or they consider
barriers to exercise too high that they give up. This information
is important for primary care providers in that they may need
to be more specific with these patients about the importance
of both diet and exercise in achieving weight-loss goals, and
helping to council patients about barriers to exercise if they are
reported to exist. Increasing motivation among overweight and
obese people to initiate weight-loss behaviors should be more
frequent as part of usual care.
CORRESPONDING AUTHOR: Kristin L. MacGregor, MS,
Department of Psychology, Syracuse University, Syracuse, NY,
13244; kmacgreg@syr.edu
B-081f
ADOLESCENT BODY SIZE AND FAMILY STRUCTURE
Daniel J. Sheridan, BA, Stephanie Fitzpatrick, MS, Judith R.
McCalla, PhD and Patrice G. Saab, PhD
Psychology, University of Miami, Miami, FL.
In the past 30 years, two trends affecting adolescents have
become apparent in the United States. Rates of adolescent
obesity have shown a steady increase, and family structure has
also changed from predominantly two-parent households to an
increasing number of single-parent households. The purpose of
this study was to examine the relationship between adolescent
body size and family structure. The sample consisted of 163
adolescents (120 boys; 43 girls) with a systolic and/or diastolic
blood pressure greater than or equal to the 90th percentile
(adjusted for age, gender, and height). The participants’ ages
ranged from 15 to 17 years-old (M = 16.1, SD = .63). Fifty-nine
adolescents came from single-parent households and 91 ado-
lescents came from two-parent households. Height and weight
measurements were obtained to calculate BMI; waist measure-
ments were also recorded.
As hypothesized, compared to adolescents from two-parent
households, adolescents from single-parent households had
a higher BMI, t(148) = 2.14, p = .03 and a larger waist circum-
ference, t(147) = 2.12, p = .04. However, no family structure
differences in parental education, caloric intake, or mother’s
BMI were obtained (ps > .05). Although the results indicate BMI
and waist circumference differences in adolescents as a function
of family structure, the underlying causes of these differences
are still unclear. Future research would benefit from investiga-
tion of SES, adolescent exercise habits, parental health habits,
and other factors that may have contributed to the observed
adolescent BMI differences in single-parent and two-parent
households.
CORRESPONDING AUTHOR: Daniel J. Sheridan, BA, Univer-
sity of Miami, Miami, FL, 33132; dsheridan87@aim.com
B-081g
THE RELATIONSHIP BETWEEN OBESITY AND HEALTH-
RELATED QUALITY OF LIFE IS PARTIALLY MEDIATED BY
AEROBIC FITNESS
Ashley Moncrieft, BA, Judith R. McCalla, PhD, Miriam Gutt,
PhD, Marc D. Gellman, PhD and Neil Schneiderman, PhD
Psychology, University of Miami, South Miami, FL.
Obesity is a major global health concern associated with impair-
ments in health-related quality of life (HRQOL), particularly in
the physical domains. Obese individuals also have a reduced
aerobic capacity indicating poorer aerobic fitness. Additionally,
aerobic fitness has been linked to HRQOL in normal and over-
weight individuals. This study used path analysis to examine
the relationships between fat %, aerobic capacity (VO2max) and
the physical aspects of HRQOL as measured by the SF-36 physi-
cal health component summary score (PHC). The sample con-
sisted of 228 overweight or obese participants (64.5% women,
mean age= 52.38 yrs, mean Body Mass Index= 32.53 kg/m2)
from one of two larger studies at the University of Miami which
tested the efficacy of lifestyle interventions designed to promote
physical activity and weight loss in depressed diabetics and
individuals with the metabolic syndrome. Fifty-one percent of
participants met criteria for the metabolic syndrome; 49% met
criteria for type II diabetes and depression. Body fat % was a
significant predictor of VO2max when controlling for age (b=
-.083, S.E= .032, p<.05). A significant predictor of PHC scores
was VO2max with higher values leading to better PHC scores
(b= 2.275, S.E= .411, p<.05). The total indirect effect of body fat
% 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%
in PHC scores for men. In women, the model accounted for ap-
proximately 16.7% of the variability observed in VO2max, and
7.4% in PHC scores. This suggests that aerobic capacity may
be a more salient component of physical health in men than in
women. It appears that aerobic fitness is a mediator of the re-
lationship between body fat % and HRQOL. Therefore, weight
loss interventions should target improving aerobic fitness in ad-
dition to decreasing body fat as a means of improving HRQOL.
CORRESPONDING AUTHOR: Ashley Moncrieft, BA, Psychol-
ogy, University of Miami, South Miami, FL, 33143; amoncrieft@
psy.miami.edu
B-081h
SELF-DETERMINATION THEORY-BASED COUPLES
INTERVENTION FOR WEIGHT LOSS
Anna Schierberl Scherr, BA,1 Ted Powers, PhD,2 Erin Lenz, BA,1
Kimberly McClure, MA1 and Amy Gorin, PhD1
1
University of Connecticut, Storrs, CT and 2University of
Massachusetts, Dartmouth, Dartmouth, MA.
Background: Research suggests that autonomous motivation
for behavior change predicts better weight loss outcomes and
is enhanced by autonomy supportive environments. Partners
who are skilled at providing autonomy support (e.g., encourage
choice, minimize control) may enhance autonomous motiva-
tion and weight loss in their significant others. This pilot study
tested an intervention designed to teach spouses to engage
in autonomy supportive behaviors. Methods: Overweight/
obese participants (N=20; 17 females; 95% Caucasian; aver-
age BMI=34) and their spouses (N=20, 17 males; 90% Cauca-
sian; average BMI=30) were randomly assigned to 12 weeks
of standard behavioral weight loss treatment (SBT) or to SBT
plus an autonomy support intervention (SBT+AS). Partners
in both conditions were invited to attend 6 sessions. SBT+AS
partners were taught the “ABCs” of autonomy support (Ask
to avoid assumptions; Be empathic; Curtail control and criti-
cism) while SBT partners received standard weight loss infor-
mation. Participants were weighed and completed measures
at 0, 4, and 12 weeks. Results: The couples-based format was
well received with spouses attending 88.3% of scheduled ses-
sions. Participants lost ¬12.6+12.1 lbs. (6.2%) at 12 weeks, with
no differences between groups. SBT+AS did not differentially
enhance autonomy support; however, across groups, increases
in autonomy support at 4-weeks were associated with 12-week
weight losses (p=.07). Increases in autonomy support were not
associated with increases in autonomous motivation (p=.45)
and changes in autonomous and controlled motivation were not
associated with weight loss outcomes (p’s>.50). Conclusions:
This pilot study demonstrated that a couples-based weight loss
intervention is feasible and that autonomy support may play a
role in weight management. More research is needed on how
best to train support partners and to understand the mecha-
nisms through which autonomy support may influence treat-
ment response.
CORRESPONDING AUTHOR: Anna Schierberl Scherr, BA,
University of Connecticut, Storrs, CT, 06269-1020; aesscherr@
gmail.com
29
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
B-097a
PSYCHOSOCIAL STATUS OF CHILDREN WITH HEMIFACIAL
MICROSOMIA
Lynette Dufton, PhD,1,2 Matthew L. Speltz, PhD,2,1 Judith P.
Kelly, MS,3 Brent Collett, PhD2,1 and Martha M. Werler, ScD3
1
Seattle Children’s Hospital, Seattle, WA; 2University of
Washington, Seattle, WA and 3Boston University, Boston, MA.
Hemifacial microsomia (HFM) is a congenital disorder that
affects the development of the face, commonly the ears, mouth
and mandible. Research using combined samples of children
with craniofacial anomalies (including HFM) suggests that
this condition is associated with elevated risk for psychosocial
problems, including depression, anxiety, introversion, and so-
cial difficulties (Lefebvre & Barclay, 1982). The small number of
HFM cases and lack of control groups in prior research renders
the findings from these studies extremely tentative. The current
study assessed psychosocial status in children with HFM and
case-matched controls. One hundred thirty-six children with
HFM (64% male, mean age = 6.9 years old) were compared to
568 matched controls (50% male, mean age = 7.0 years old) on
parent and teacher measures of internalizing and externalizing
behavior problems. Child and parent reports of the child’s qual-
ity of life (QOL) were also collected, as well as teachers’ ratings
of peer acceptance and parents’ and teachers’ ratings of social
competence. Teachers rated cases as having more internalizing
problems than controls (p=0.011), primarily in girls of younger
mothers, but equivalent levels of externalizing problems. Teach-
ers rated cases as having lower social competence (p= 0.02), also
in girls of younger mothers, and peer acceptance (p=0.0) than
controls. Parent reports of behavior problems and social compe-
tence were similar across groups. Children with HFM received
lower QOL ratings from their parents than did controls (p=
.009), particularly male cases of older mothers. Children rated
their QOL similarly across groups. This study confirms ear-
lier impressions of elevated psychosocial risk in children with
HFM, specifically internalizing symptoms and social relation-
ship difficulties as observed by teachers. Such problems may be
largely confined to school or other peer group settings, with less
visibility in the family environment.
CORRESPONDING AUTHOR: Lynette Dufton, PhD, Seattle
Children’s Hospital, Seattle, WA, 98105; lynette.dufton@seat-
tlechildrens.org
B-097b
PERCEIVED CAREGIVER BURDEN AMONG AFRICAN
AMERICAN, CAUCASIAN AND HISPANIC WOMEN WITH
CHRONIC ILLNESS
Jessica C. Payne-Murphy, BA, Dana L. Brown, MA and Abbie
O. Beacham, PhD
University of Colorado Denver, Denver, CO.
Nearly 5.3 million Americans are living with Alzheimer’s
disease and are cared for by 9.9 million unpaid caregivers (CG),
primarily loved ones. The logistic and emotional burdens are
great for these families and studies suggest various factors
contribute to caregiver burnout. Chronic illness (CI) has been
shown to be related to higher levels of fatigue and psychologi-
cal distress and higher levels of CI are found among African
Americans (AA) and Hispanics (H/L) compared to White/
Caucasians (W/C). Secondary data analysis was conducted to
evaluate the role of factors contributing to perceived CG burden
30
in AA (N=145; Mean age=60, SD=12.5), W/C (N=133; Mean
age=65.2, SD=11.3), and H/L (N=125; Mean age=61.4, SD=11.8)
women CGs participating in the multi-site REACH II study. We
defined CI as MD diagnosed arthritis, hypertension, cirrhosis,
kidney, chronic lung, and/or coronary artery disease. Mean
number of CIs in CGs were AA=2.28 (SD=0.10), H/L=2.14
(SD=1.09) and W/C=1.92 (SD=0.10) [F(2, 400)=3.45, p=.032].
Stepwise linear regressions were conducted within each group
to ascertain most salient predictors of CG burden. In AA
women, the most salient predictors (R2 Model= .45, p<.01) were
age (β=-.24, p<.01), depression (β=.55, p<.01), and education
(β=.27, p<.01). Among W/C (R2 Model= .49; p<.01) and H/L
(R2 Model=.29; p=.01) in our sample, the most salient predic-
tors were age (β=-.27; β=-.21), and depression (β=.58; β=.55) (all
p’s<.01). Findings suggest that in all three groups, CG burden
was positively associated with depression and negatively as-
sociated with age. Only in AA’s was education retained in the
final model and was positively associated with CG burden.
Results suggest that in women who must manage their own
CI and across ethnicities, younger caregivers may experience
greater CG burden and more depression with highly educated
AAs potentially at higher risk. Practitioners and researchers
must continue to focus their treatment efforts on depression in
caregivers but also attend to possible increased role strain in
younger and more educated caregivers.
CORRESPONDING AUTHOR: Jessica C. Payne-Murphy, BA,
Psychology, University of Colorado Denver, Denver, CO, 80217;
jessica.payne-murphy@email.ucdenver.edu
B-097c
PRIMARY CARE/MENTAL HEALTH INTEGRATION: ITS
IMPACT ON SPECIALTY MENTAL HEALTH CARE AND COST-
EFFECTIVENESS
Sarah L. Hartley, PhD,1 David Buyck, PhD,1,3 Donald J. Gieck,
PhD,1,2 Hani Shabana, PhD,1 Derek Bacchus, PhD,1 Kathleen
Lynd, LCSW1 and Malinda Shelor-Rogers, LCSW1
1
Mental Health Integration, VAMC Salem, Salem, VA;
2
Psychiatry and Neurobehavioral Sciences, Universtiy of
Virginia, Charlottesville, VA and 3Nuring and Dental Hygiene,
University of Hawaii, Honolulu, HI.
Integration of mental health and primary care services has
made impressive strides in the past decade. Over the past three
years, MH/PC integration has received unprecedented support
within Veterans Affairs. This poster will detail how collabora-
tion among primary care and mental health services at one VA
has evolved into a successful integration program. The presen-
tation/poster will include a developmental timeline of primary
care/mental health integration and detailed information about
current co-location, integration, open-access and coverage
strategies as well as data regarding efficacy and model fidelity.
Evidence points to 4 measurable indicators of a successful MH/
PC integration program. These markers include: (1) rapidity of
mental-health consultant availability, (2) high market penetra-
tion (i.e., what percentage of patients seen are new patients), (3)
brief visits in order to ensure rapid availability, and (4) more
efficient/cost effective utilization of specialty mental health re-
sources (e.g., psychiatry, psychology, social-work clinics). With
regard to efficiency/cost-effectiveness, an integration program
is considered more effective when more mild-moderate cases
are treated in primary care, fewer referrals are sent to specialty
mental health care and a greater proportion of specialty refer-
rals are completed, indicating that a patient was appropriate
for and attended the recommended appointment. Data will be
presented detailing the program’s impact upon these 4 indica-
tors. Quantitative data will be presented regarding our univer-
sal suicide/homicide risk screening practice in primary care,
our substance use co-integration initiative, and our integration
project to address diabetic, HTN, and dyslipidemia. Qualitative
data addressing primary care staff satisfaction with the pro-
gram will also be presented.
CORRESPONDING AUTHOR: David Buyck, PhD, Mental
Health Integration, VAMC Salem, Salem, VA, 24153; david.
buyck@va.gov
B-097d
QUALITY OF LIFE AND HEALTH CARE UTILIZATION IN
FUNCTIONAL BOWEL DISORDERS
Sarah W. Kinsinger, PhD, Jennifer Kiebles, PhD, Caroline Artz,
BS and Laurie Keefer, PhD
Gastroenterology, Northwestern University, Chicago, IL.
Background and Aims: Health related quality of life is an im-
portant indicator of physical and mental well-being in patients
with functional bowel disorders (FBD). The aim of this study
was to investigate correlates of quality of life in a sample of
patients with FBD.
Methods: Adult patients with FBD (N = 123) were referred by
their gastroenterologist for cognitive-behavioral therapy (CBT)
at a university medical center. The following questionnaires
were collected at the onset of therapy: Irritable Bowel Syndrome
Quality of Life (IBS-QOL), Irritable Bowel Syndrome Symptom
Severity Scale (IBS-SSS), and a checklist of psychosocial con-
cerns (PSC). Chart review was conducted to obtain information
on the number of gastroenterology (GE) visits before and after
psychological intake (n = 61).
Results: The majority of patients were diagnosed with irritable
bowel syndrome (IBS; 69.9%). The mean overall IBS-QOL was
60.80 (0-100 scale, 0=worst). Average IBS-SSS was in the moder-
ate range (M = 276.63, SD = 101.73). Average number of GE
visits before intake was 2.0 (SD=1.4, 0-9) and after intake was .6
(SD=1.3, 0-8). Most frequently reported PSC included anxiety
(76%), worry (55%), relationship problems (53%), and stress
(53%). Anxiety (p < .01) and IBS-SSS (p < .01) were significant
predictors of overall IBS-QOL, accounting for 19% of the vari-
ance (9% and 10% respectively). Further, the health worry sub-
scale of the IBS-QOL was significantly associated with increased
GE visits in the year following intake(r= -.32, p < .05).
Conclusions: Anxiety symptoms are frequently reported among
FBD patients referred for psychological services within a gas-
troenterology clinic. Psychosocial concerns as well as symptom
severity play a role in patients’ quality of life. Furthermore, the
degree that patients worry about the implications of their FBD
on their overall health is related to healthcare utilization. Future
research should examine the association of these variables in a
prospective design as well as the effects of psychological treat-
ment on anxiety and healthcare utilization.
CORRESPONDING AUTHOR: Sarah W. Kinsinger, PhD,
Gastroenterology, Northwestern University, Chicago, IL, 60611;
s-kinsinger@northwestern.edu
B-097e
A DYNAMIC SYSTEMS ANALYSIS: HEIGHTENED NIGHTTIME
ADRENOCORTICAL DYNAMICS IN CHRONIC FATIGUE
SYNDROME
Kirstin Aschbacher, PhD,1 Emma Adam, PhD,2 Leslie J.
Crofford, MD,3 Margaret E. Kemeny, PhD,1 Mark A. Demitrack,
MD4 and Amos Ben-Zvi, PhD5
1
University of California San Francisco, San Francisco, CA;
2
Northwestern University, Chicago, IL; 3University of Kentucky,
Lexington, KY; 4Neuronetics, Inc., Malvern, PA and 5University
of Alberta, Edmonton, AB, Canada.
Background: Dynamic systems analyses, an emerging paradigm
in medical research, may help better understand the role of
the HPA axis in Chronic Fatigue Syndrome (CFS). As fatigue
and sleep disturbance are primary symptoms of CFS, the study
focused on nighttime dynamics. Methods: 14 individuals with
CFS and 14 age and gender-matched individuals provided
blood samples via an indwelling catheter every 10 minutes for
24 hours. Bedtimes, light exposure and mealtimes were stan-
dardized, while activity was restricted and daytime napping
was not permitted. Blood plasma was assayed for adrenocorti-
cotropic hormone (ACTH) and cortisol. Data Analyses: Model
parameters were estimated using lagged regression predicting
10-minute change in cortisol. The discrete-time model specified
included 3 parameters, which were permitted to vary every
two hours in order to capture circadian dynamics: β0 repre-
senting the intercept, β1 representing adrenal responsivity to
ACTH (AR), and β2 representing the rate of cortisol removal
(CR) from the bloodstream. Akaike’s Information Criteria (AIC)
informed model fit. Regression tests compared whether aver-
age HPA dynamic parameter values (i.e., AR and CR) differed
for CFS versus healthy controls at night (11pm-7am), control-
ling for nighttime disturbances. Results: CFS was associated
with higher AR and faster CR from 1-3am and 5-7am (all p’s
<.05) compared to healthy age and gender-matched controls.
A numerically similar but statistically insignificant trend was
observed from 3-5am. Discussion: These preliminary findings
suggest that CFS participants exhibit significantly different
nighttime dynamics of the HPA axis. Future research in larger
samples should explore whether altered HPA dynamics could
potentially constitute a consistent, CFS-specific marker of a
disease-perturbed network, or may reflect symptoms, which are
not limited to CFS.
CORRESPONDING AUTHOR: Kirstin Aschbacher, PhD, Psy-
chiatry, University of California San Francisco, San Francisco,
CA, 94118; kirstin.aschbacher@ucsf.edu
B-097f
PSYCHOLOGICAL SYMPTOMS IN INFLAMMATORY BOWEL
DISEASE: DO MAST CELLS PLAY A ROLE?
Laura Mackner, PhD,1 Jaya Punati, MD,1 Kyle Kusek, MD,1
Kathleen Pajer, MD,1 Jackie Wood, PhD2 and Wallace Crandall,
MD1
1
Nationwide Children’s Hospital, Columbus, OH and 2The Ohio
State University, Columbus, OH.
Background: Relationships between immunity and psychologi-
cal symptoms are well known. Depression and anxiety have
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-
flammation and psychological symptoms in IBD have not yet
been described. Mast cells may be an important factor in these
relationships because they produce and release inflammatory
mediators, and increased mast cells have been associated with
stress in IBD.
Aim: The purpose of this exploratory study was to examine
relationships between mast cells and psychological functioning
in children and adolescents with IBD.
Methods: Participants were 18 youths, 9 - 17 years of age, with
Crohn’s disease who were undergoing clinically-indicated colo-
noscopy. Biopsies were taken from the terminal ileum, ascend-
ing colon and descending colon, and well-established diamino-
benzine staining was used to identify mast cells for quantitative
immunohistology. Children and their parents completed
questionnaires assessing psychological symptoms.
Results: Increased colonic mast cells were significantly cor-
related with depression (r=.49) and anxiety (r=.68) symptoms,
withdrawn behaviors (r=.73), attention problems (r=.63), and
delinquent (r=.71) and aggressive (r=.68) behavior.
Conclusions: These preliminary results suggest that mast cells
may be related to psychological functioning across a range of
problems. To our knowledge, this is the first study to examine
relationships between mast cells and psychological symptoms
in IBD. Our findings suggest that investigating the role played
by mast cells in the complex relationship between immunity
and psychological functioning could be an important new
avenue of research.
CORRESPONDING AUTHOR: Laura Mackner, PhD, Psychol-
ogy, Nationwide Children’s Hospital, Columbus, OH, 43205;
Laura.Mackner@nationwidechildrens.org
B-097g
MBSR FOR CAREGIVERS OF PEOPLE WITH DEMENTIA: THE
BALANCE STUDY
Robin R. Whitebird, PhD, MSW,1 Mary Jo Kreitzer, PhD, RN,2
Beth A. Lewis, PhD,2 A Lauren Crain, PhD,1 Leah R. Hanson,
PhD3 and Chris J. Enstad, BS1
1
HealthPartners Research Foundation, Minneapolis, MN;
2
University of Minnesota, Minneapolis, MN and 3Alzheimer’s
Research Center, Regions Hospital, St. Paul, MN.
Purpose: The Balance Study is a randomized controlled pilot
study to examine the feasibility and effectiveness of a mindful-
ness-based stress reduction (MBSR) intervention compared to a
standard community caregiver education and support (CCES)
program on measures of psychological distress and caregiver
burden.
Methods: Family caregivers of individuals with dementia
(n=78) were randomized to either the MBSR or CCES interven-
tion; both were group-based, 8 weeks long, 2 ½ hours each
session, with a 5 hour retreat. Participants in MBSR received
mindfulness meditation and yoga, and CCES received educa-
tion and social support. Participants completed surveys at
baseline, 2 months, and 6 months. Measures included stress,
physical/ mental health, depression, state anxiety, self-compas-
sion, mindfulness, caregiver burden, and social support. Mixed
model regression estimated change across time between groups.
Results: Participants were predominately female (88%), white
32
(97%), and had a mean age of 57; 92% of the sample completed
the study intervention. Preliminary analysis reveals statistically
significant benefits at both 2 and 6 months for MBSR on mental
health (p<.01, p<.05); stress (p<.01, p<.07), and self-compassion
(p<.05, p<.04); with a trend toward improvement in mindful-
ness (p<.06, p<.08). Significant improvements were also seen at
2 months in the MBSR group on depressive symptoms (p<.01).
State anxiety, perceived burden, and social support improved
significantly in both groups.
Conclusion: MBSR is an acceptable intervention for caregiv-
ers. Preliminary results indicate MBSR is more effective in
improving mental health and decreasing stress than a psycho-
educational intervention and performed as well on improving
depression, anxiety and social support. Results suggest that
MBSR may offer a safe, effective method for stress reduction for
caregivers and that a larger clinical trial is warranted.
CORRESPONDING AUTHOR: Robin R. Whitebird, PhD, MSW,
HealthPartners Research Foundation, Minneapolis, MN, 55440-
1524; robin.r.whitebird@healthpartners.com
B-097h
CORRELATES OF WILLINGNESS TO PARTICIPATE IN
BIOMEDICAL RESEARCH AMONG HISPANICS
Ana E. Cordova, BS, Gloria Coronado, PhD, Angela K. Ulrich,
BA and Beti Thompson, PhD
Cancer Prevention, Fred Hutchinson Cancer Research Center,
Seattle, WA.
Hispanics are less likely to participate in biomedical research
studies than non-Hispanic whites. This study examined factors
that may correlate with a Hispanic individual’s choice to par-
ticipate in such studies. In-person interviews were conducted
among a randomly selected sample of adults living in a rural,
predominantly Hispanic community in eastern Washington.
The interview addressed barriers and incentives to participa-
tion, demographics and healthcare access, attitudes and behav-
ior related to medical research, and willingness to comply with
common study procedures. A total of 117 adults completed the
interview (80 women and 37 men). Forty-one percent reported
they were willing to participate in research studies. When asked
about hypothetical procedures, willingness to comply was
highest for being interviewed in person, and lowest for under-
going major surgery. Commonly reported barriers were having
to take care of one’s family (83%) and the study being long
(80%). Having a close friend or relative who has had the disease
being studied was the most common incentive (80%). Factors
unassociated with willingness to participate were: age, gender,
acculturation, occupation, insurance status, having a regular
doctor, trust in research, and prior participation. Marital status
(p=.05) and income (p=.008) were associated, with those who
were never married and those with incomes of $15,000-25,000 as
the most willing. Trusting one’s doctor was also associated with
willingness to participate (p=.03). Though 80% of respondents
said that Hispanics are more likely to be taken advantage of in
research studies, this did not appear to have an effect on will-
ingness to participate. Future research may use these findings
to tailor approaches to increase Hispanic participation in their
studies.
CORRESPONDING AUTHOR: Ana E. Cordova, BS, Cancer
Prevention, Fred Hutchinson Cancer Research Center, Seattle,
WA, 98108; acordova@fhcrc.org
B-106a
HOW ARE USER CHARACTERISTICS ASSOCIATED WITH USE
OF AN ONLINE SELF-MANAGEMENT PROGRAM FOR BACK
PAIN?
Kimberlee J. Trudeau, PhD, Ryan Black, PhD, Mollie Wood,
MPH and Emil Chiauzzi, PhD
Inflexxion, Inc., Newton, MA.
BACKGROUND: Systematic reviews suggest that online
behavioral health interventions are efficacious. User charac-
teristics and website use have been proposed as key variables.
PURPOSE: The goal of this project was to test the hypothesis
that certain demographic characteristics would be related to
differential site usage patterns and that different levels of usage
would be related to outcomes. METHODS: We conducted a
secondary data analysis of experimental group data from an
RCT that assessed the efficacy of an online self-management
program for people with back pain (experimental group n=95,
control group n=104). Path models were run to evaluate (1)
whether demographic characteristics were associated with
differential usage of the website, and (2) whether higher levels
of use were associated with an increase in health communica-
tion behaviors. Two different metrics of use, minutes and page
views, were evaluated. RESULTS: When using minutes on web-
site as the indicator of usage, we noted that age (β=.28, p<.01),
gender (β=-.25, p=.01), education (β=-.28, p<.01), and baseline
worst pain (β=.23, p<.05) were associated with higher usage,
but that usage was not associated with health communication
behavior (β=.12, p=.32). When using total page views as the us-
age metric, gender (β=-.24, p<.05) and education (β=-.35, p<.01)
were significantly associated with greater usage, while associa-
tions between baseline pain (β=.18, p=.14) and disability (β=.18,
p=.15) with usage were non-significant but potentially mean-
ingful; total page views was associated with health communi-
cation behaviors (β=.21, p<.10). CONCLUSIONS: This study
suggests that a) website usage varies by user characteristics and
b) total page views, but not total minutes, may have an impact
on outcomes. Generally, increased age, female gender, lower
education, and higher baseline pain were positively associated
with usage, and increased page views were associated with
increased health communication behavior. These findings have
implications for the development of future interventions.
CORRESPONDING AUTHOR: Kimberlee J. Trudeau, PhD,
Inflexxion, Inc., Newton, MA, 02464; ktrudeau@inflexxion.com
B-106c
CHRONIC PAIN AND OBESITY: MERGING QUANTITATIVE
AND QUALITATIVE FINDINGS
John J. Sellinger, PhD,1,2 Linda Pellico, PhD,3 Elizabeth A. Clark,
MA,1 Patricia Rosenberger, PhD1,2 and Robert Kerns, PhD1,2
1
Psychology, VA Connecticut Healthcare System, West Haven,
CT; 2Yale University School of Medicine, New Haven, CT and
3
Yale University School of Nursing, New Haven, CT.
Factors that contribute to the development and maintenance
of chronic pain are often multidimensional, and thus, medical
interventions alone are rarely sufficient to provide adequate
relief. Additional interventions which address the various
biopsychosocial components of the chronic pain experience are
often indicated, such as cognitive-behavioral therapy (CBT).
CBT is well-established as an empirically supported treatment
for chronic pain, but little has been done to examine the efficacy
of CBT for persons who are obese. The current work reports on
quantitative and qualitative findings from two studies focused
on comorbid pain and obesity. The first is a quantitative com-
parison of multidimensional pain treatment outcomes from a
clinical trial of CBT for chronic low back pain. Obese and non-
obese participants (n = 74) were compared using repeated mea-
sures ANOVA’s with pre-and post-treatment data from various
pain treatment outcome measures. Results show that despite
a lack of pre-treatment differences, non-obese participants
showed significantly greater improvements in the domains of
physical disability, quality of life, and emotional functioning at
post-treatment than did their obese counterparts. One possible
explanation for these differences is that standard CBT treatment
protocols for pain management are not sensitive to the unique
needs and experiences of individuals who are obese. In an at-
tempt to elicit the significant aspects of the lived experience of
persons who are obese and who have chronic pain, a qualitative
study was conducted that involved individual interviews with
9 persons who suffer from both conditions. A thematic analysis
of these interviews was performed, and the implications of the
elicited themes (e.g., “treatments as a catch-22”) are discussed
as they relate to reforming standard CBT pain treatment pro-
tocols. Ideas for translation of these themes into new CBT pain
treatment modules for persons who are obese are also consid-
ered.
CORRESPONDING AUTHOR: John J. Sellinger, PhD, Psycholo-
gy, VA Connecticut Healthcare System, West Haven, CT, 06405;
john.sellinger1@va.gov
B-123a
ARE DAILY FLUCTUATIONS IN PERCEIVED POSITIVE
CONTEXT MORE STRONGLY ASSOCIATED WITH WALKING
THAN DAILY SELF-EFFICACY AND PERCEIVED BARRIERS?
Eric B. Hekler, PhD,1 Matthew P. Buman, PhD,1 David Ahn,
PhD,1 Genevieve Dunton, PhD,3 Audie Atienza, PhD2 and Abby
C. King, PhD1
1
Stanford Prevention Research Center, Stanford University,
Stanford, CA; 2National Cancer Institute, Bethesda, MD and
3
University of Southern California, Los Angeles, CA.
Self-efficacy and perceived barriers are key constructs previ-
ously shown to explain physical activity participation. This
prospective pilot study using ecological momentary assessment
examined if immediate perceived positive context (i.e., percep-
tion that one’s environmental and social context is supportive
of physical activity) was more strongly associated with daily
fluctuations in walking than self-efficacy and perceived barriers.
Participants (N=14, 50.0% men, 78.6% White, M age=59.4±6.4)
were mid-life and older adults in the intervention arm of an
8-week randomized controlled trial focused on promoting
walking using personal digital assistants. Participants com-
pleted electronic surveys twice a day (total entries=491) about
total minutes of brisk walking, task self-efficacy, perceived bar-
riers (9 items; e.g., too tired, too busy), and perceived positive
context (12 items; e.g., nice walking path, others encouraged).
Multilevel modeling analyses were used to simultaneously
examine between-subject (i.e., mean-level) and within-subject
(i.e., daily fluctuations) variations in self-efficacy, barriers, and
perceived positive context as determinants of concurrent and
subsequent brisk walking. Results suggested that daily fluctua-
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
significantly predicted daily fluctuations in walking when all
variables were entered into the model (p<0.0001). These results
suggest that daily fluctuations in perceived positive context
may have a stronger association with walking than daily ratings
of self-efficacy and barriers in this age group. Future physical
activity interventions should explore changing perceived posi-
tive context as an intervention component.
CORRESPONDING AUTHOR: Eric B. Hekler, PhD, Stanford
Prevention Research Center, Stanford University, Stanford, CA,
94305-5411; ehekler@stanford.edu
B-123b
THE CHOICE STUDY: A “TASTE-TEST” OF UTILITARIAN VS.
LEISURE WALKING IN OLDER ADULTS
Eric B. Hekler, PhD, Matt P. Buman, PhD, Cynthia M. Castro,
PhD, Carolyn Prosak, RD and Abby C. King, PhD
Stanford Medical School, Stanford University, Stanford, CA.
Recent research has explored promoting utilitarian forms of
physical activity (PA; eg, walking for transport) instead of
leisure PA (eg, scheduled, sustained walking episodes for
health/recreation). Few studies have explored factors that
impact individuals’ choices between these forms of PA. This
pilot study sought to counsel participants in both PA forms and
then explores factors that influenced their choices. Participants
were randomized to counseling and practice in either utilitar-
ian or leisure PA for 2 weeks and then the other form for 2
weeks. Then participants entered a 2-week “free choice” phase
in which they chose to engage in any mixture of the PA forms.
The primary outcome variable was the ratio of utilitarian vs.
leisure PA during the free choice phase. Participants completed
surveys about their neighborhood (i.e., the NEWS), daily travel
to multiple locations, and physical activity (i.e., CHAMPS).
Participants (N=16) were older adults (M age=64±8) who were
mostly women (81%) and White (75%). Results across the
7-week period indicated that participants increased their total
walking levels (F=10.37, p=0.002), with 81% walking at least
150 min/week. Further, results suggested that 7 participants
engaged in more utilitarian walking, 4 engaged in a balance of
utilitarian and leisure walking, and 5 engaged in more leisure
walking. Having to go to multiple locations throughout the day
was positively associated with engagement in more utilitarian
activity. Surprisingly, good walking paths, neighborhood aes-
thetics, easy access to exercise facilities, neighborhood destina-
tions to walk, and shorter distances to locations were associated
with engagement in more leisure activity. These results are in
line with other studies suggesting that, counter to younger age
groups, perceived neighborhood characteristics may be enablers
of leisure walking (as opposed to primarily transport walking)
in older adults. They further indicate the potential importance
of combining specific instruction in both utilitarian and leisure
walking to optimize walking levels in older adults.
CORRESPONDING AUTHOR: Eric B. Hekler, PhD, Stanford
Prevention Research Center, Stanford University, Stanford, CA,
94305-5411; ehekler@stanford.edu
34
B-123c
HEAT- US: A TOOL FOR ASSESSING ECONOMIC
BENEFITS OF INCREASED PHYSICAL ACTIVITY DUE TO
ENVIRONMENTAL CHANGES
Thomas Schmid, PhD, Candace Rutt, PhD and James Dills,
MPH, MUP
CDC, Atlanta, GA.
The social-ecological model of health promotion is a popular
model for community-wide strategies in public health. Integral
to this approach is broad, multi-sector participation in program
planning and evaluation. Program planning in such situations
is facilitated by tools such as Health Impact Assessments (HIA)
which provide an opportunity for a wide range of potential
influences on health that result from the intervention of inter-
est to be systematically assessed and included in the decision
process. While HIAs are popular, additional more focused tools
are need, especially to complement the decision processes when
stakeholder groups are debating the economic value of infra-
structure changes such as expanding a cycling path or sidewalk.
This study reports on the development of HEAT-US (Health
Enhancing Assessment Tool) we developed based on data
from Europe and then adapted for both waking and cycling
in the US. Default values for each variable are provided but
can be tailored with local data. HEAT has proven popular and
effective in Europe, influencing decision making and putting
physical activity on the agenda when policy decisions are made.
For instance, a HEAT project in Austria calculated savings of
$570 million from cycling in Austria and in the UK a modal
share increase for cycling to 13% would result in a $1.5-3 billion
savings. HEAT-US uses the base model, substituting US based
attributable risk to determine economic benefits from decreases
in morbidity and mortality resulting from increased cycling or
walking in the US. Results of a pilot study are provided.
CORRESPONDING AUTHOR: Thomas Schmid, PhD, Centers
for Disease Control, Atlanta, GA, 30329; tls4@cdc.gov
B-123d
CHRONIC CONDITIONS AND PHYSICAL ACTIVITY AMONG
OLDER ADULTS: SUBJECTIVE AND OBJECTIVE MEASURES
OF PHYSICAL ACTIVITY
Young-Shin Lee, PhD1 and Kyeongra Yang, PhD, MPH2
1
San Diego State University, San Diego, CA and 2University of
Pittsburgh, Pittsburgh, PA.
Regular physical activity (PA) in older adults is evidenced
in preventing and controlling chronic conditions and recom-
mended as a treatment regimen. There is limited information on
that how much PA those with chronic conditions are engaged
in. The purposes of this study were to examine 1) the common
health indicators and PA status among older adults, 2) the dif-
ferences in PA between those with and without chronic condi-
tions. Of the total 10,348 participants in the 2005-2006 National
Health and Nutrition and Examination Survey, 1189 adults
aged 65 and over were selected for the current study. Among
the participants, 51.5% were men, 66% were White, 61% had an
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.
PA was measured by self-reports and the accelerometers
(ACC). From self-reported PA, 45% of older adults engaged in
moderate PA and 18% engaged in some muscle strengthening
exercises, but 30% reported sitting all day. The ACC recording
showed only 42% walked more than 6000 steps a day and lower
intensity or steps in those with hypertension, respiratory dis-
eases, and arthritis than the counterpart. However, older adults
on a high cholesterol level walked significantly more steps than
those on normal levels (6200 vs. 5700 steps, respectively). The
PA levels of the elderly, being overweight and with diabetes
were not significantly different with the counterpart in both
self-reports and ACC measures, while those with cardiovas-
cular disease were significantly less engaged in PA than those
without the condition.
The findings suggest that PA level in older adults is below
the recommended level for health benefits and the majority of
older adults are borderline for having major chronic conditions.
Arousing public awareness about the importance of PA in older
adults, regardless of chronic conditions, is warranted.
CORRESPONDING AUTHOR: Young-Shin Lee, PhD, San Di-
ego State University, San Diego, CA, 92182; ylee@mail.sdsu.edu
B-123e
FEASIBILITY OF A PORTABLE PEDAL EXERCISE MACHINE
FOR REDUCING TIME SPENT SEDENTARY IN THE
WORKPLACE
Lucas J. Carr, PhD and Bess H. Marcus, PhD
Centers for Behavioral and Preventive Medicine, The Miriam
Hospital/Brown University, Providence, RI.
Background
Time spent sedentary is independently associated with in-
creased risk for metabolic disease. Progressive increases in
sedentary jobs have contributed to a rise in sedentary behaviors
among U.S. adults. Worksite interventions designed to decrease
sedentary time at work may serve to improve health of seden-
tary employees.
Methods
Eighteen full-time employees (mean age=41.7+21.0 years; 88%
female) working in desk/computer dependent occupations
were recruited. Anthropometric (weight, body mass index,
waist circumference, percent body fat), estimated fitness (As-
trand 6 minute Cycle Test), and physical activity behavior data
(7 Day Physical Activity Recall) were collected at baseline. Par-
ticipants were given access to a portable pedal exercise machine
for four weeks to be used at work. The machine includes exer-
cise tracking software and provides real time feedback (speed,
time used, distance, and calories) which displays on a computer
monitor. At four weeks, participants repeated all baseline tests
and completed a feasibility questionnaire focused on user expe-
riences, barriers to use and suggested improvements.
Results
Preliminary findings (N=9) indicate participants used the
machines an average of 13 of 20 possible working days and
pedaled an average of 31 minutes or 6.8 miles per day. Feasibil-
ity data suggest participants found the machines to be “easy to
use” and “usable in a work setting”. Neither work productiv-
ity nor quality of work declined while using the machine. All
participants reported regular use of the feedback monitor and
reported the monitor increased their use of the machine.
Discussion
This study suggests sedentary employees found the portable
pedal exercise machine feasible for use while at work and
reported reduced sedentary time while at work. These findings
are clinically significant due to the growing number of seden-
tary jobs in the U.S. and this device’s potential (e.g. portable,
low cost, objective monitoring) for use in large scale worksite
health programs.
CORRESPONDING AUTHOR: Lucas J. Carr, PhD, Centers for
Behavioral and Preventive Medicine, The Miriam Hospital/
Brown University, Providence, RI, 02903; Lucas_Carr@Brown.
edu
B-123f
MAKING THE ENEMY AN ALLY: A PILOT STUDY USING
EXERCISE VIDEOGAME MEDIA TO PROMOTE CHILD
PHYSICAL ACTIVITY AT HOME
Rachel S. Mark, MA, Ryan E. Rhodes, PhD, Anna-Marie de
Zwager, BSc and Naomi Casiro, BSc
School of Exercise Science, Physical and Health Education,
University of Victoria, Victoria, BC, Canada.
Background: Over 57% of Canadian youth are not physically ac-
tive enough for optimal growth and development. Many physi-
cal activity (PA) interventions have been developed but have
had modest success. Novel interventions are needed. Exercise
videogame bikes (EV) provide positive physiological results
and increased adherence rates compared to some traditional
exercise equipment; however, studies have been limited to labo-
ratory settings and college-aged populations.
Purpose: To compare usage of EV to traditional stationary bikes
placed in front of the TV(C) among children in the home-setting
and to perform a qualitative process evaluation following a 6
week period.
Method: A single-blinded RCT design was employed random-
izing children between age 4 and 10 from families not meeting
Canada’s PA Guidelines to receive an EV or C for 6 weeks at
home (EV n=12; C n=13). The primary outcome of bike usage
was tracked in situ by parents through logs. Qualitative follow-
up was performed with the EV group following the trial.
Results: An independent t-test for total minutes of use over 6
weeks favored EV (t23=2.38, p=.03, d=.67). RM ANOVA across
the trial yielded a significant time effect for bouts of usage per
week (F5,19=3.66, p=.02, η2=.49). Post-hoc tests showed signifi-
cant declines for C only (t12=3.12, p=.01, d=.88). RM ANOVA
for total minutes of use per week yielded a large group effect
(F1,23=5.18, p=.03, η2 = .18). Post-hoc tests showed significant
differences between groups at week 6 in favor of EV (t23=2.53,
p=.02, d=.70). Qualitative follow-up suggested that kids found
EV fun and exciting to use. It was noted, however, that the bike
was difficult for the younger children to use due to size.
Conclusions: This study shows that usage decreases less rapidly
for EV than C among children providing initial support for the
application of EV to childhood PA interventions and suggests
that children enjoy participating in this type of PA. The findings
support the expansion to a larger trial with a longer duration.
CORRESPONDING AUTHOR: Rachel S. Mark, MA, School of
Exercise Science, Physical and Health Education, University of
Victoria, Victoria, BC, V8R 4N4; rsmark@uvic.ca
35
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
B-131a
THE RELATIONSHIP BETWEEN SEXUAL AROUSAL
AND SEXUAL DISTRESS IN WOMEN: THE SELECTIVE
PROTECTIVE VALUE OF GOOD RELATIONSHIPS
Kyle R. Stephenson, BS, Emily Lee, BA, Bryan De La Torre and
Cindy M. Meston, PhD
Psychology, The University of Texas at Austin, Austin, TX.
Recent studies have found that only a minority of sexual prob-
lems are associated with increased sexual distress in women
suggesting that important factors moderate the relationship
between sexual functioning and sexual distress. Two possible
moderators are intimacy within the relationship and attachment
anxiety. Research has shown that women place a great empha-
sis on the relational context of sexual activity and that individu-
als high in attachment anxiety may use sexual encounters as
barometers of the overall relationship, making sexual diffi-
culties more distressing. Thus, we hypothesized that arousal
difficulties would be more strongly related to high sexual
distress within low intimacy relationships than in high intimacy
relationships, especially for women high in attachment anxiety.
159 female undergraduates filled out questionnaires assessing
sexual functioning, relationship intimacy, and sexual distress.
We conducted linear regression analyses to test the interaction
between arousal, relationship intimacy, and attachment anxiety
in predicting sexual distress. The three-way interaction was
significant, with physiological sexual arousal exhibiting a stron-
ger relationship with sexual distress in low intimacy vs. high
intimacy relationships, but only for women high in attachment
anxiety. Our results suggest that intimacy within the relation-
ship is an important moderator of the association between
arousal difficulties and sexual distress, especially for highly
anxious individuals who are more prone to interpreting sexual
difficulties as problems with the overall relationship.
CORRESPONDING AUTHOR: Kyle R. Stephenson, BS, Psy-
chology, The University of Texas at Austin, Austin, TX, 78751;
krstephenson@gmail.com
B-133a
EFFECTS OF HOMEOPATHIC MEDICINES ON MOOD OF
ADULTS WITH HISTORIES OF COFFEE-RELATED INSOMNIA
Audrey Brooks, PhD,1 Iris Bell, MD, PhD,2,1 Amy Howerter,
MS,2 Nicholas Jackson, BS2 and Mikel Aickin, PhD2
1
Psychology, University of Arizona, Tucson, AZ and 2Family &
Community Medicine, University of Arizona, Tucson, AZ.
Background: The purpose of the present within-subjects fea-
sibility study was to determine whether two different homeo-
pathic remedies, Nux Vomica (NV) and Coffea Cruda (CC),
exert effects on subjective mood ratings in healthy adults with
a history of coffee-induced insomnia. The impact of individual
personality traits, anxiety sensitivity or Type A cynical hostility,
and homeopathic constitutional type (HTYPE-NV or HTYPE-
CC), on remedy effects was also examined to evaluate differen-
tial responsivity, in accord with clinical claims.
Methods: Young adults of both sexes (ages 18-31) with above-
average scores on standardized personality scales for either
cynical hostility or anxiety sensitivity (but not both), and a his-
tory of coffee-induced insomnia, participated in the month-long
study. At-home polysomnographic recordings were obtained
on successive pairs of nights once per week for a total of eight
36
recordings (nights 1, 2, 8, 9, 15, 16, 22, 23). Subjects (N=59)
received placebo pellets on night 8 (single-blind) and verum
pellets in 30c doses of one of two homeopathic remedies, NV or
CC, on night 22 (double-blind). Subjects completed the Profile
of Mood States Scales at bedtime on polysomnography nights.
Results: The remedies produced differential effects on anger
and overall mood, with improved mood following CC admin-
istration. A similar trend for depression was observed. Anxi-
ety sensitive subjects experienced less tension following CC,
whereas hostile subjects receiving CC became more tense. The
high HTYPE-CC receiving CC experienced less vigor. The high
HTYPE-CC receiving NV experienced more vigor.
Conclusions: Findings are consistent with homeopathic claims
of differential remedy effects as a function of both specific agent
and the individual traits of the patient.
CORRESPONDING AUTHOR: Audrey Brooks, PhD, Psychol-
ogy, University of Arizona, Tucson, AZ, 85721; brooksaj@email.
arizona.edu
B-133b
EXPLORING MODERATORS AND MEDIATORS OF EXERCISE-
INDUCED OBJECTIVE SLEEP IMPROVEMENTS IN OLDER
ADULTS
Matthew P. Buman, PhD,1 Eric Hekler, PhD,1 Donald Bliwise,
PhD2 and Abby King, PhD1
1
Stanford Prevention Research Center, Stanford University,
Stanford, CA and 2Neurology, Emory University, Atlanta, GA.
Growing evidence suggests that regular exercise can improve
sleep quality, but little is understood for whom and by what
means these changes occur. We examined moderators and
mediators of change in objective sleep outcomes in a 12-month
randomized controlled trial among initially underactive older
adults reporting mild/moderate sleep complaints. Participants
(N=66, 67% women, 55-79 years) were randomized to moder-
ate-intensity exercise or a health education control. Modera-
tors tested included baseline physical function (upper-body
physical performance test), reported sleep quality (Pittsburgh
Sleep Quality Inventory-Global score), and reported physical
activity (CHAMPS questionnaire). Mediators tested included 6
month changes in activity energy expenditure (AEE; CHAMPS),
depression (CESD scale), BMI, and physical function. Objec-
tive sleep outcomes measured by in-home polysomnography
included 12 month changes in Stage 1 and Stage 2 sleep time
(%) and number of awakenings. Results suggested that physical
function and sleep quality moderated changes in Stage 1 sleep;
individuals with higher physical function (p=.01) and poorer
sleep quality (p=.03) had greater improvements. Physical
activity level moderated changes in Stage 2 sleep (p=.038) and
number of awakenings (p=.01); more sedentary individuals had
greater improvements. Increased AEE (CI:-1.12 to -.07) and de-
creased depression (CI:-1.18 to -.01) mediated change in Stage 1
sleep. Decreased BMI (CI:.09 to 1.17), decreased depression (-.73
to -.01), and increased physical function (CI:.02 to .70) mediated
change in number of awakenings. Moderator results suggested
that initially less active individuals with baseline higher func-
tioning and poorer sleep quality improved the most in response
to the intervention. Mediator results suggested these effects are
carried through multiple mechanisms and are specific to differ-
ent parameters of sleep architecture. Collectively, these results
illuminate ways to optimize exercise interventions to improve
sleep in older adults.
CORRESPONDING AUTHOR: Matthew P. Buman, PhD, Stan-
ford Prevention Research Center, Stanford University, Stanford,
CA, 94305-5411; mbuman@stanford.edu
B-133c
BARRIERS TO ADHERENCE IN PEDIATRIC OBSTRUCTIVE
SLEEP APNEA
Stacey Simon, MS,1 Christina Duncan, PhD2 and David Janicke,
PhD1
1
University of Florida, Gainesville, FL and 2University of
Arkansas for Medical Sciences, Little Rock, AR.
The use of Continuous Positive Airway Pressure (CPAP) treat-
ment for youth with Obstructive Sleep Apnea (OSA) effectively
relieves disorder symptoms and prevents further complications.
However, the device must be used consistently for benefits to
be realized. Non-adherence to medical treatment is prevalent
among youth with chronic illness, yet little is known regard-
ing adherence to CPAP in pediatric OSA. Further information
regarding specific barriers to adherence is needed in order to
identify patient-specific issues and develop targeted interven-
tions to enhance adherence. Thus, the current study attempts to
add to the literature by: 1) presenting descriptive data regard-
ing CPAP adherence in youth with OSA; and 2) identifying
common barriers to adherence for youth with OSA. Study
measures include adherence information culled from electronic
downloads from the CPAP device for a 3-month period and the
Adherence Barriers to CPAP Questionnaire (ABCQ), developed
for the purpose of this study to identify parent- and child-
reported barriers (Cronbach’s alpha = 0.79 [child-version] and
0.89 [caregiver-version]). Participants thus far include 28 youth
with OSA age 8-17 (M = 13.33, SD = 2.56) and their caregiver.
Families completed study measures at their regularly scheduled
appointment in a sleep specialty clinic. Preliminary results sug-
gest that adherence is generally poor: overall mean daily usage
was 3.49 hours (SD = 2.87), and youth used their CPAP for at
least four hours on only 53.68% of nights. The most common
barriers endorsed by parents were: 1) child not feeling well; 2)
forgetting; 3) not using when away from home; and 4) child em-
barrassment about using CPAP. Youth predominantly reported:
1) not feeling well; 2) not using when away from home; 3)
forgetting; and 4) a desire to forget about their OSA. Identifying
barriers to CPAP adherence is beneficial to aid in the develop-
ment of empirically-based intervention programs, as well to
help healthcare providers identify and address specific barriers
salient to patients and families.
CORRESPONDING AUTHOR: Stacey Simon, MS, Clinical
& Health Psychology, University of Florida, Gainesville, FL,
32608; slsimon@phhp.ufl.edu
B-143a
DOES PRACTICE MAKE PERFECT: THE USE OF
STANDARDIZED PATIENTS IN TEACHING SMOKING
CESSATION COUNSELING SKILLS TO MEDICAL RESIDENTS
Sheela Raja, PhD and Rachel Yudkowsky, MD
University of Illinois at Chicago, Chicago, IL.
Background: Standardized patients (SPs) have been widely
used in Medical Schools for over 30 years and are important
in training residents on the behavioral aspects of patient care.
Problem: Residents are expected to counsel patients on smoking
cessation but often do not learn this skill in a mentored setting.
We examined the relationship between residents’ prior experi-
ences (mentored and unmentored) providing smoking cessation
counseling and their level of competency in simulated encoun-
ters with SPs who smoke. Methods: Residents (n=71) com-
pleted an Objective Structured Clinical Examination to assess
their competence in several behavioral domains using detailed
simulations involving SPs (expert trained actors). SPs gave
residents verbal feedback on their patient-centered communica-
tion and assessed performance using a behaviorally anchored
checklist. Consistent with Motivational Interviewing principles,
the SPs assessed if the residents were collaborative, discussed
behavioral quitting methods, reviewed prior quitting attempts,
and used reflective listening/empathy. After the OSCE, resi-
dents reported how often they had observed a faculty member
providing smoking cessation counseling and how often they
were observed when providing counseling (mentored and
unmentored experience). They also reported on the utility of
the SP feedback. Results: Most residents (94%) had observed
a faculty providing smoking cessation counseling, but many
(30%) lacked mentored experience. Residents varied greatly
in the depth of their discussion of prior quit attempts. 98% felt
the SP feedback very helpful. Interestingly, prior experience
(mentored or unmentored) did not predict performance on the
SP assessment, perhaps reflecting a lack of effective feedback or
coaching during those experiences. Discussion/Conclusions: It
appears that residents have limited competency and experience
in smoking cessation counseling and need more practice with
feedback, which could be gained through more extensive use of
SPs.
CORRESPONDING AUTHOR: Sheela Raja, PhD, University of
Illinois at Chicago, Chicago, IL, 60612; sheelaraja@gmail.com
B-143b
PREVALENCE AND CORRELATES OF SMOKING AMONG MSM
IN CHINA
Carla J. Berg, PhD,1 Na He, PhD,2 Eric J. Nehl, PhD,1 Frank Y.
Wong, PhD,1 Jennifer Huang, PhD3 and Tony Zheng, PhD3
1
Department of Behavioral Sciences and Health Education,
Emory University, Atlanta, GA; 2Department of Epidemiology,
Fudan University School of Public Health, Shanghai, China and
3
Department of International Health, Georgetown University,
Washington, DC.
In 2000, smoking contributed to 4.83 million deaths, with half
occurring in developing countries. Men who have sex with men
(MSM) have higher smoking rates than the general population
in the U.S., but less is known about smoking among MSM in
developing countries. Thus, we examined the prevalence and
correlates of smoking among MSM in China, the leading con-
sumer of tobacco.
This study was part of a larger cross-sectional study of drug use
and HIV among MSM in Shanghai. Participants were recruited
through respondent-driven sampling and completed self-
administered questionnaires. The current analyses examined
demographics (age, education, income), tobacco use, Center for
Epidemiological Studies Depression Scale (CESD) scores, and
the Lesbian Gay Identity Scale (LGIS) scores. Higher scores on
the LGIS indicate greater sexual identity confusion, need for
privacy and acceptance regarding sexual orientation, difficulty
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%.
Any smoking in the past 3 months was associated with lower
education (OR= 0.73; 95% CI 0.56-0.94) and higher LGIS scores
(OR= 1.48; CI 1.11-1.98). Among smokers, heavy cigarette use
(≥10 cpd), in comparison to light smoking, was related to older
age (OR=1.03; CI 1.00-1.06) and lower LGIS scores (OR=0.64; CI
0.44-0.92). Although bivariate analyses indicated a relationship
between CESD scores and any smoking (p<.05), CESD did not
significantly contribute to the regression models.
The higher smoking rates among MSM in China are similar
to rates among U.S. MSM. Less comfort with one’s sexuality
was related to greater likelihood of smoking, particularly light
smoking. Future research should focus on examining potential
mediators and moderators of this relationship and identify spe-
cific aspects of gay identification that may influence smoking
among MSM, particularly in developing countries.
CORRESPONDING AUTHOR: Carla J. Berg, PhD, Department
of Behavioral Sciences and Health Education, Emory Univer-
sity, Atlanta, GA, 30322; cjberg@emory.edu
B-143c
HEALTH BELIEFS AND INFORMATION SEEKING BEHAVIOR
AMONG CANCER SURVIVORS WHO SMOKE
Sareh Bahreinifar, Masters of Public Health,1 Erik M.
Augustson, PhD, MPH,1 Yvonne M. Hunt, PhD1 and Lila
Finney-Rutten, PhD, MPH2
1
National Cancer Institute, Rockville, MD and 2SAIC, Rockville,
MD.
Despite the well-known risks associated with smoking, a sizable
proportion of cancer survivors continue to smoke post diagno-
sis. Cancer survivors are a population of special concern given
their potential compromised health due to the late-effects of
treatment and increased risk of cancer recurrence. In attempt-
ing to better understand factors that may guide treatment
development specific to this group, we explored differences
in health beliefs and information seeking patterns among
cancer survivors who smoke (CSS) versus survivors who do
not (CSNS), as well as compared to smokers with no history
of cancer (NCS). This project used data from the 2007 Health
Information National Trend Survey (HINTS), a Random Digit
Dialing (RDD) and mail-based nationally representative survey.
Thus, SUDAAN was used to adjust for the complex sampling
frame of the survey. The primary comparisons of interest were
between CSS (n=134) and CSNS (n=853), although additional
analyses were performed comparing CSS versus NCS (n=1100).
Key variables of interest were those assessing cancer-specific
beliefs, health information seeking, healthcare utilization, and
demographics.
Compared to CSNS, CSS were less likely to be married and
reported lower income and poorer general health. Although
no differences were noted for number of healthcare visits, CSS
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
The findings of this study help inform health professionals’ and
providers’ efforts to improve reach and engagement in smoking
cessation among those who smoke.
CORRESPONDING AUTHOR: Sareh Bahreinifar, Masters of
Public Health, National Cancer Institute, Rockville, MD, 20852;
bahreinifars@mail.nih.gov
B-143d
PERCEPTIONS OF QUITTING MODERATE THE
EFFECTIVENESS OF GAIN-FRAMED SMOKING CESSATION
TELEPHONE COUNSELLING
Amy E. Latimer, PhD,1,2 E. Michael Cummings, PhD,3 Robert
Makuch, PhD2 and Benjamin A. Toll, PhD2
1
Queen’s University, Kingston, ON, Canada; 2Yale University,
New Haven, CT and 3Roswell Park Cancer Institute, Buffalo,
NY.
People are persuaded by gain-framed messages when a behav-
ior is risk-averse and loss-framed messages when a behavior
has risky outcomes. The categorical distinction between preven-
tion (i.e., risk-averse) and detection (i.e., risky) behaviors has
proven to be a relatively useful guideline for framing health
messages. Fundamentally, this guideline assumes that everyone
perceives the risk associated with a behavior in a consistent
manner. However, individuals’ perceptions of a behavior vary.
Thus, the effects of framed messages may be optimized by con-
sidering individuals’ behavioral risk perceptions rather than the
prevention versus detection function of the behavior. A second-
ary analysis of data from a message framing smoking cessation
study (Toll et al., 2010) was conducted to test this hypothesis.
Smokers (n = 2032) who called the New York State Smokers’
Quitline received either gain-framed or standard care messages.
Medically eligible callers received nicotine replacement therapy.
Perceptions of the benefits/risks of quitting, intentions and self-
efficacy to quit and stay quit, and smoking behavior were as-
sessed at Baseline, Week 2, and Week 12 using single items. Re-
gression analyses controlling for sex and nicotine dependence
revealed a significant Message Frame x Perceptions of Quitting
interaction for Week 2 behavior, OR=1.67, p<.05, and Week 12
intentions, β=.07, p<.05, and self-efficacy, β=.08, p<.05. Post hoc
regression analyses revealed that when exposed to gain-framed
counseling, individuals who perceived great benefit in quitting
were more likely to make an early quit attempt and to have
stronger intentions and self-efficacy to quit and stay quit than
individuals who perceived some risk in quitting. Perceptions
of quitting did not moderate the effectiveness of standard care
counseling. These findings suggest that there may be utility in
considering individual differences in behavioral risk percep-
tions when delivering gain-framed health messages.
Funding: NIH grants CA127818, K12-DA000167
CORRESPONDING AUTHOR: Amy E. Latimer, PhD, Queen’s
University, Kingston, ON, K7L 3N6; amy.latimer@queensu.ca
B-151a
TREATING OPIOID DEPENDENCE WITH BUPRENORPHINE
IN MEDICAL SETTINGS
Hannah K. Knudsen, PhD and Jamie L. Studts, PhD
Behavioral Science, University of Kentucky, Lexington, KY.
Background: Treatment of opioid dependence has tradition-
ally occurred in specialty substance abuse treatment programs
(SATPs) and methadone maintenance programs (MMPs) rather
than general medical settings. The FDA’s approval of buprenor-
phine in 2002 was accompanied by regulatory changes intended
to expand access to treatment by allowing the prescription of
buprenorphine by physicians who are not addiction specialists
in office-based settings. This pilot study measured the percent-
age of buprenorphine prescribers in non-addiction specialties
and who practiced in general medical settings, while exploring
whether practice patterns vary by medical specialty. Methods:
Using the Substance Abuse and Mental Health Services Ad-
ministration’s (SAMHSA) online physician locator, a random
sample of 134 current buprenorphine prescribers was identified,
and 53 prescribers returned a mailed survey (40% response rate)
in 2009. Results: Among respondents, 72% worked in general
medical settings; about 13% practiced in specialty SATPs and
15% in MMPs. About 42% represented general medical special-
ties, 30% worked in general psychiatry, and 28% were special-
ists in addiction medicine/addiction psychiatry. There were
some differences in practice patterns between these groups.
Psychiatrists treated significantly fewer patients (mean=21.4,
SD=27.7) than addiction specialists (mean=49.5, SD=31.1;
p<.05). Psychiatrists (27%) and addiction specialists (17%) were
less likely to refer patients to external providers for counsel-
ing than general practitioners (71%; χ2 = 15.7, p<.01). Conclu-
sions: Although caution is warranted given the small sample
size, this pilot study points to a promising expansion of opioid
dependence treatment through the delivery of buprenorphine
within general medical settings. Differences in practice patterns
suggest some limits to this expansion, given that psychiatrists
treat fewer patients than addiction specialists. The high rate
of referring patients to external counseling services by general
practitioners suggests there may be additional training needed
for these physicians.
CORRESPONDING AUTHOR: Hannah K. Knudsen, PhD,
Behavioral Science, University of Kentucky, Lexington, KY,
40536-0086; hannah.knudsen@uky.edu
B-154a
PSYCHOLOGICAL DISTRESS IN PATIENTS SEEKING RENAL
TRANSPLANT
Kristin Kuntz, PhD1 and Diane Bonfiglio, PhD2
1
Psychiatry, The Ohio State University Medical Center,
Columbus, OH and 2Psychology, Ashland University, Ashland,
OH.
The comorbidity of psychological disorder with end-stage renal
disease (ESRD) presents challenges for renal transplantation.
Previous research has shown that renal transplant recipients
with higher depression and anxiety scores report more non-
compliance with medication, worse sleep, more marital discord,
and worse quality of life. Estimates of rates and severity of
affective and anxiety disorders have varied significantly across
studies of renal transplant patients, possibly due in part to
variation in methodology and timing of evaluations. The pres-
ent study adds clarity to this literature by assessing anxiety and
depressive symptoms in a sample of ESRD patients at the spe-
cific time point of first contact with the transplant center. Five
hundred eighteen patients seeking a renal transplant at a large
Midwestern transplant center completed the Patient Health
Questionnaire (PHQ) as part of their pre-transplant evaluation.
As soon as patients were referred for transplant, they were sent
the PHQ to complete and return before coming to the transplant
center for their initial appointment. The PHQ assesses for sev-
eral psychiatric conditions including depression and anxiety.
Frequencies of depression and anxiety disorders were calculat-
ed. Approximately 15% of patients reported a depressive condi-
tion and 8% of patients endorsed an anxiety condition. Rates
of anxiety and depressive disorders in this sample were lower
than expected, suggesting that this sample of patients is less
distressed than other samples of ESRD patients. Other possible
explanations include selection biases influencing both which
patients are referred for transplant and which of those patients
complete the pre-evaluation paperwork. Additionally, self-re-
porting of anxiety and depressive symptoms in this sample may
have been underreported due to patients’ motivation to present
themselves positively in the early stage of transplant evaluation.
Given that a main motivation for renal transplant is to improve
well-being, it is wise to assess and treat psychiatric issues before
transplant is undertaken.
CORRESPONDING AUTHOR: Kristin Kuntz, PhD, Psychia-
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
ADHERENCE BEHAVIORS OF “A HOME-BASED AEROBIC
EXERCISE INTERVENTION” IN CHILDREN WITH ACUTE
LYMPHOBLASTIC LEUKEMIA
Chao Hsing Yeh, PhD
School of Nursing, University of Pittsburgh, Pittsburgh, PA.
Purpose: The purpose of this study was to examine adherence
behaviors of the “home-based aerobic exercise intervention”
on fatigue, sleep and cardiorespiratory fitness in children with
ALL during the maintenance stage of chemotherapy, imme-
diately after completion of the intervention (post-test), and 1
month after completion.
Methods: A quasi-experimental study was conducted with 12
pediatric oncology patients in the intervention group and 10 in
control group who were matched by age group (<10 years and
>=10 years) and sex. A six-week home-based aerobic exercise
intervention was implemented for children who were in the
intervention group while patients in the control group received
routine care. Parents whose children enrolled in the interven-
tion group had to agree to encourage and/or monitor the chil-
dren’s exercise as well as remind them to record in the exercise
diary.
Results: The adherence rate was used to calculate the feasibility
of patients to practice the home-based aerobics at home. The
adherence rate was defined as participants who were able to
follow at least two thirds of the exercise prescription during the
intervention program. The results indicated that the adherence
rate during six weeks intervention ranged from 67% to 83%
(mean=76%, SD=6.02). The lowest adherence rate occurred at
week 3 (67%). Stage of behavior to exercise. At the pre-test,
4 patients in the intervention group were at “contemplation
stage” (34%) (not doing any physical activity at that time); 7
patients were at “preparation stage” (58%) (doing irregular
exercise) and 1 patient (8%) was at “action” stage (doing regular
exercise). At the post-test, 25% patients (n=3) were at the “ac-
tion stage” and 17% (n=2) were at maintenance stage (sustained
their physical activity). However, the majority of the patients
(n=11; 92%) were changing back to the stage of “preparation
stage” (doing irregular exercise) at 1-month follow up.
CORRESPONDING AUTHOR: Chao Hsing Yeh, PhD, Univer-
sity of Pittsburgh, Pittsburgh, PA, 15261; yehc@pitt.edu
C-032b
PREDICTORS AND PATTERNS OF PARTICIPANT ADHERENCE
TO A CORTISOL COLLECTION PROTOCOL
Daniel Hall, BA,1 Diane Blyler, PhD,1 Deborah Allen, MSN,
RN,1 Merle Mishel, PhD, RN,1 Jamie Crandell, PhD,1 Barbara
Germino, PhD, RN1 and Laura S. Porter, PhD2
1
University of North Carolina at Chapel Hill, Chapel Hill, NC
and 2Duke University, Durham, NC.
Background: Cortisol, a stress-related hormone, has been mea-
sured in many psychoimmunological studies via collection of
saliva; however, patterns of participant adherence to protocol
procedures have not been fully elucidated in the literature.
Objectives: In this poster we examine adherence to a cortisol
morning rise (CMR) collection protocol, and explore demo-
graphic predictors of different adherence trends.
Method: Participants included 221 breast cancer survivors
enrolled in an NINR funded longitudinal intervention study
(5R01NR010190, M. Mishel, P.I.). Self-reported times of salivary
cortisol collection were recorded for each of 12 saliva samples
over the course of three timepoints. Trends of adherence were
determined with respect to various demographic factors, in-
cluding race, living with a young child, and employment status.
Analyses included frequencies, chi-square distributions, and
polytomous response logistic regression modeling.
Results: Tests for proportionality indicated that demographic
predictors in our model had a similar association with each
level of participant adherence (always, sometimes, or never).
Although our model lacked statistical significance, women who
did not adhere to the saliva collection protocol were more likely
to be African American (OR .58, CI .33 - 1.00), to work full-time
(OR .67, CI .40 - 1.13), and to live with at least one child under
18 years of age (OR .70, CI .41 - 1.18).
Discussion: To our knowledge, this is the first study to examine
profiles of participant adherence to a cortisol sampling protocol.
By conceptualizing adherence as a polytomous outcome, future
studies may gain insight into adherence trends in other popula-
tions with the aim of promoting adherence and designing more
informed saliva collection protocols.
CORRESPONDING AUTHOR: Daniel Hall, BA, University of
North Carolina at Chapel Hill, Chapel Hill, NC, 27599; dan-
hall@email.unc.edu
C-032c
FAMILY HISTORY OF BREAST CANCER AND CANCER WORRY
AS PREDICTORS OF MAMMOGRAPHY SCREENING IN
HISPANIC AMERICAN WOMEN
Lona Cavallera, BA,1 Vanessa Malcarne, PhD,2,5 Elva
Arredondo, PhD,1 Hector Lemus, DrPH,1 Natasha Riley, MA3
and Georgia R. Sadler, PhD, MBA4
1
Graduate School of Public Health, San Diego State University,
San Diego, CA; 2Department of Psychology, San Diego State
University, San Diego, CA; 3Vista Community Clinic, Vista, CA;
4
University of California, San Diego, Medical Center, Moores
Cancer Center, San Diego, CA and 5SDSU/UCSD Joint Doctoral
Program in Clinical Psychology, San Diego, CA.
Breast cancer continues to be a burden for many women in the
United States, and Hispanic American women are vulnerable to
late stage diagnosis of the disease, tumor types less responsive
to particular therapies, and lower breast cancer survival rates.
Mammogram utilization may be an effective means of improv-
ing such outcomes, yet screening rates are suboptimal. The
present study investigated the relationships of family history
of breast cancer (FHBC) and cancer worry (CW) to mammog-
raphy adherence (MA) among Hispanic American women.
Five hundred (N = 500) Hispanic American women completed
surveys including the Cancer Worry Scale, Personal Health
Survey, and Brief Acculturation Scale for Hispanics. Women
age 40 and older were selected for analysis of mammogram
utilization, yielding a final sample of 194. Family history of BC
was not significantly associated with MA, and CW did not sig-
nificantly mediate the relationship between these two variables
(OR=1.034, p = .709). Age did not moderate the relationship
between FHBC and CW (B = -.020, p = .656), or the relationship
between CW and MA (OR = 1.027, p = .189). Acculturation did
not significantly moderate the relationship between FHBC and
41
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
CW (B = -.037, p = .607), or the relationship between CW and
MA (OR=1.027, p=.189). Insurance was negatively associated
with MA, and age was positively associated with MA. Educa-
tion and acculturation were both negatively associated with
CW (all ps < .05). Results suggest that cancer worry is not an
important predictor of mammogram utilization, at least in this
sample, and that cancer screening interventions targeting wom-
en with/without a FHBC do not need to target this variable.
CORRESPONDING AUTHOR: Lona Cavallera, BA, Graduate
School of Public Health, San Diego State University, San Diego,
CA, 92108; lonacavallera1@sbcglobal.net
C-032d
REQUEST FOR ASSISTANCE NOT ALWAYS RELATED TO
REPORTED DISTRESS: A CANCER PATIENT SAMPLE
Amy Lowery, PhD1 and Melanie Greenberg, PhD2
1
Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering
Cancer Center, New York, NY and 2UCSD Department of
Veteran Affairs, La Jolla, CA.
Questionnaires assessing distress are frequently used to identify
cancer patients in need of assistance and intervention. How-
ever, often patients refuse further assistance and are non-com-
pliant with follow-up for psychosocial services. We compared
common problems with which cancer patients request assis-
tance and compared them with self-ratings of distress, and how
these results vary by demographic and disease characteristics.
Participants were 100 cancer patients (73 female, 23 male; stages
1-4) seeking treatment at the Moores UCSD Cancer Center,
who completed the CPBBSI during their outpatient clinic visit.
Distress was rated higherst on items assessing fatigue, trouble
sleeping, and sleep quality. However, the request for assistance
was highest for items assessing fatigue, concerns about side
effects of treatment, and trouble sleeping. While females had
significantly higher distress scores than males (t(98) = -2.17, p <
0.05), males (M=7.42, SD=7.41) requested assistance with more
items than females (M=4.66, SD=6.44). A similar trend was
seen with non-married patients (M= 7.78,SD= 10.13) requesting
assistance on more items than married patients (M= 4.33,SD=
5.09), Hispanic patients (M= 8.12,SD= 7.32) requesting assis-
tance on more items than Caucasian patients (M= 3.71,SD=
5.68), and ovarian cancer patients (M= 6.00,SD= 7.00) request-
ing assistance on more items than breast (M= 2.47,SD= 1.51)
and colorectal cancer patients (M= 2.67,SD= 2.89). The most
frequent requests for assistance are also listed by demographic
and disease characteristics. Data collected from the CPBBSI can
be used to better understand the types of problems patients
request assistance with, and how that openness for assistance
differs by various demographic patient populations, to develop
clinical interventions and evaluate barriers to treatment. Timely
screening, assessment and match of request for assistance with
treatment of problems associated with cancer are likely to in-
crease quality of life and treatment adherence.
CORRESPONDING AUTHOR: Amy Lowery, PhD, Psychiatry
& Behavioral Sciences, Memorial Sloan-Kettering Cancer Cen-
ter, New York, NY, 10022; lowerya@mskcc.org
42
C-032e
IMPLEMENTATION AND INTEGRATION OF AN ELECTRONIC
DISTRESS SCREENER IN A CANCER CLINIC
Amy Lowery, PhD,1 Danielle Casden, PhD,3 Melanie Greenberg,
PhD,2 Sharon Foster, PhD2 and Wayne Bardwell, PhD3
1
Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering
Cancer Center, New York, NY; 2Alliant International University,
San Diego, CA and 3UCSD Moores Cancer Center, La Jolla, CA.
Cancer often creates distress with various psychological, social
and physical implications. Timely screening and treatment of
distress can enhance treatment adherence and life quality. We
describe the development, implementation and practical issues
of integrating the CPBBSI (Cancer Problem-Based Biopsycho-
social Screening Instrument) into standard patient care. The
CPBBSI is a 39-item self-report distress screener administered
using wireless touchscreen technology. Patients rate items on
a 1-5 scale (1=Not a problem, 5=Very severe problem) and
indicate if they want to speak with a healthcare professional for
each problem. Wireless technology provides immediate results
to the healthcare team and patient. In a validation study, 100
patients completed the CPBBSI, Hospital Anxiety and Depres-
sion Scale (HADS), Brief Symptom Inventory (BSI), Functional
Assessment of Cancer Therapy-General (FACT-G), and Paul-
hus Deception Scale; 50 patients were involved in retest. The
CPBBSI showed strong internal consistency (α=.92), test-retest
reliability (r=.99, p<.01), and convergent validity (r=.55, p<.01
to r=.74, p<.01). Clear cutoff scores suggest high sensitivity and
specificity in the ability to detect depression, anxiety and over-
all distress. Although, the CPBBSI requires regular training and
reliable technical support for optimal implementation, it was
valued by the healthcare team. The CPBBSI is a brief, valid and
reliable distress screener for cancer patients. It triggers timely
evaluation and treatment, provided that appropriate train-
ing, technical support and healthcare team buy-in are in place.
Data collected from the CPBBSI can compare differing levels of
distress by various demographic patient populations (gender,
age, etc) to develop clinical interventions and evaluate treat-
ment outcomes. Timely screening, assessment and treatment of
problems associated with cancer are likely to increase quality of
life and treatment adherence.
CORRESPONDING AUTHOR: Amy Lowery, PhD, Psychiatry
& Behavioral Sciences, Memorial Sloan-Kettering Cancer Cen-
ter, New York, NY, 10022; lowerya@mskcc.org
C-032f
EFFICACY OF A NEW BREAST CANCER CLINICAL TRIALS
EDUCATION PROGRAM FOR AFRICAN AMERICAN AND
HISPANIC AMERICAN WOMEN
Amanda M. Marin, BA,1 Erin Merz, MA,3 Vanessa L. Malcarne,
PhD,1,3 Natasha Riley, MA4 and Georgia R. Sadler, PhD2
1
Psychology, San Diego State University, San Diego, CA;
2
UCSD Moores Cancer Center, San Diego, CA; 3SDSU/UCSD
Joint Doctoral Program, San Diego, CA and 4Vista Community
Clinic, San Diego, CA.
Racial and ethnic minorities are underrepresented in cancer
clinical trials participation. The gap in health disparities may
widen when clinical trials are conducted without diverse
samples. This pilot study tested whether a newly developed
and culturally aligned breast cancer clinical trials education
program (BCCTEP) can effect changes in African American and
Hispanic American women’s knowledge and attitudes about
breast cancer clinical trials. Adult women (20 African American,
20 Hispanic American-English speaking, 20 Hispanic American-
Spanish Speaking) with a mean age of 37 years (range: 18-72)
were randomly assigned to receive the BCCTEP or a control
program about community safety. At pre- and post-interven-
tion, women completed a Clinical Trials Knowledge Survey and
the Barriers to Clinical Trials Participation Scale, which yields
four subscales measuring mistrust of research, lack of com-
munity support, lack of personal benefits, and lack of famil-
iarity. Paired t-tests for the experimental and control groups
demonstrated that both groups showed significant reductions
in mistrust of research, lack of familiarity and lack of personal
benefits. The only barrier that showed no significant changes
was lack of community support. Results suggest that simply
participating in a research project may make women feel more
trusting of the research process, more familiar with clinical
trials, more trusting of the research process, and more aware
of possible personal benefits, independent of which education
program they received.
CORRESPONDING AUTHOR: Amanda M. Marin, BA, Psy-
chology, San Diego State University, san diego, CA, 92182;
Amanda.marin@yahoo.com
C-032g
EFFECTS OF FRAMING RACE-SPECIFIC HEALTH
INFORMATION ON A CAUCASIAN AUDIENCE
Giovanina A. Gardiner, MSW,1 Charlene Caburnay, PhD,1
Robert A. Nicholson, PhD,2 Susie Rath, MA1 and Matthew W.
Kreuter, PhD1
1
George Warren Brown School of Social Work, Washington
University in St. Louis, St. Louis, MO and 2School of Medicine,
St. Louis University, St. Louis, MO.
BACKGROUND: Research has shown that African Americans
experience fewer negative emotions and are more motivated to
pursue positive health behaviors when they read race-specific
health information that highlights progress instead of dispari-
ties. However, little is known about how different presentations
of race-specific health information impacts other groups. This
study seeks to understand how progress-framed and disparity-
framed cancer information about African Americans impacts a
Caucasian audience.
METHODS: In a double blind, randomized control trial, study
participants (N=238) were randomly assigned to read either
a positive or disparity framed newspaper article about colon
cancer rates among African Americans and complete a short
survey. Eligible participants were Caucasian, over 40 years old,
and able to complete a written survey. The two main dependent
variables were perceived equality in access to the health care
system and symbolic racism. For both scales, higher scores indi-
cated greater degrees of bias against African Americans.
RESULTS: Participants who read the progress framed article re-
ported higher scores on perceived equality in health care access
than those who read the disparity framed article (t(232)=2.72 ,
p <0.01, C.I. = 0.07-0.43). Similar results were found for sym-
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).
CONCLUSIONS: Emphasizing progress in race-specific health
information may motivate African Americans to change health
behaviors, but this approach appears to support or reinforce
counterproductive attitudes in Whites. To maximize the impact
of race-specific health information, messages should be targeted
for different segments of the population.
CORRESPONDING AUTHOR: Giovanina A. Gardiner, MSW,
George Warren Brown School of Social Work, Washington Uni-
versity in St. Louis, St. Louis, MO, 63112; ggardiner@gwbmail.
wustl.edu
C-032h
FACILITATING FACTORS AND BARRIERS OF MULTI-ETHNIC
WOMEN’S DECISIONS TO PARTICIPATE IN PSYCHO-
ONCOLOGY RESEARCH: BRIDGING THE GAP
Georita M. Frierson, PhD,1 Marissa C. Perales, BA,1 Kyle
Deaton, BA3 and Bernardine M. Pinto, PhD2
1
Psychology, Southern Methodist University, Dallas, TX;
2
Psychiatry, Brown Medical School, Providence, RI and
3
Psychology, University of North Texas, Denton, TX.
Background:Recruitment of African-American women (AA)
and Latinas into psycho-oncology research continues to receive
substantial attention due to the paradox of limited enrollment
into such studies while the burden of certain cancers is higher
for these groups. Multi-ethnic qualitative studies are needed
to identify factors that influence racial/ethnic minorities to
participate in psycho-oncology research. Purpose:Bridging the
Gap examined factors that influence AA women and Latinas’
participation in research. A multi-ethnic sample was recruited
to identify cross-cultural factors influencing research participa-
tion. Methodology:57 AA women and 11 Latinas from RI and
TX completed a 29-item sociodemographic questionnaire and
participated in ethnic-specific focus groups. Wegner’s transla-
tion process model (1993) was used to indentify intra- and
inter-cultural themes that influence participants’ research
participation. Participants’ characteristics were analyzed
through descriptive analyses and qualitative themes catego-
rized on 3 key focus group questions: 1) research perceptions,
2) facilitating factors, and 3) barriers to participate into research.
Results: Participants were 68 women (age M=47.75 years old,
SD=14.38) and M=13.72 education level, SD=2.30. 25% of the
sample was married/partnered with 71% self-reported being
AA. Among Latinas, 81% self-reported Mexican heritage. We
identified 3, 8, and 9 central themes for research perceptions,
facilitating factors, and barriers to research, respectively. All
participants reported mistrust and lack of knowledge as re-
search barriers; Latinas reported more barriers around cultural
sensitivity. A majority of participants reported addressing
trust and financial resources to increase research participation.
Conclusions:Qualitative research revealed that trust, research
awareness, and health literacy need to be addressed to increase
minority women’s participation in psycho-oncology research.
CORRESPONDING AUTHOR: Georita M. Frierson, PhD,
Psychology, Southern Methodist University, Dallas, TX, 75275;
frierson@smu.edu
43
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-032i
THE DEVELOPMENT AND TESTING OF AN ONLINE CANCER
EDUCATION MODULE
Lisa Ulmer, MSW, ScD and Aparna Swarup, BS 2nd year
Student
Public Health, Drexel University, Philadelphia, PA.
Background
Colorectal cancer is the second leading cause of cancer death
in men and women. Despite evidence of high survival rates
with early screening, less than 60% of the eligible population in
Pennsylvania has been screened, highlighting a critical need to
translate scientific knowledge to practice.
Goals and Objectives
The Pennsylvania Department of Health Pennsylvania Cancer
Education Network (PCEN) is a public-academic participatory
partnership that translates the science of cancer prevention to
statewide practice through community-based cancer educa-
tion sessions. PCEN colorectal cancer education has significant
proximal impact on subjects’ knowledge, attitudes and inten-
tion to screen. However, major stakeholders have identified
situations where community-based education is not feasible,
i.e., large worksites and rural areas. This presentation presents
the development, concept testing, and feasibility testing of an
online colorectal cancer education module, designed to address
stakeholder needs for an alternative delivery method.
Methods
We developed the online module by combining the theoreti-
cal frameworks of cognitive architecture, which provides best
practices for learning, with the extended parallel process model,
which provides best practices for behavior change. The proto-
type was concept tested by a group of experts and end-users,
and feasibility issues were identified in collaboration with a
large work setting.
Results
A demonstration of the prototype, results of concept testing,
major feasibility issues, and recommendations for next steps
will be presented at the conference.
Conclusions
Online colorectal cancer education may be a viable alternative
to community colorectal education sessions for state heath pro-
grams needing to serve large worksites and rural areas.
CORRESPONDING AUTHOR: Jamiliyah Gilliam, MS, Public
Health, Drexel University, Philadelphia, PA, 19102; jng25@
drexel.edu
C-032j
TECHNOLOGY USE AND HEALTH IN A LOW-INCOME
SAMPLE
Jason Q. Purnell, PhD, MPH, Enbal Shacham, PhD, MEd, MPE,
Lori B. Garibay, MPH and Matthew W. Kreuter, PhD, MPH
Health Communication Research Laboratory, Washington
University in St. Louis, St. Louis, MO.
Information and communication technologies (ICT) are poten-
tially powerful tools for eliminating health disparities. While
most studies have compared income groups, this study de-
scribes ICT use and its relationship to health status and health
behaviors in a low-income sample of Food Stamps clients
44
(N=522; M age=36.2; 74% female; 82% racial/ethnic minority).
ICT use, health information seeking, health status and health
behaviors were assessed. Analyses examined associations
between ICT use and health status, cancer screening, smok-
ing, and health information seeking. Most of the sample had
access to the Internet (71%), email (81%), and cell phones (65%).
While only 44% had a home computer, 96% had some type of
computer access (i.e., from home, friends, family, or community
organizations). Accessing the Internet was associated with good
to excellent health (all ps<.05), a Pap test in the last 2 years,
having ever looked for health information and smoking less
than 100 cigarettes in one’s lifetime. Having a home computer
was negatively associated with current smoking and positively
associated with health information seeking. Having a cell phone
was also associated with looking for health information. How-
ever, women who accessed the Internet were less likely to have
ever had a mammogram and those with home computers were
less likely to be up-to-date on mammography. In multivariate
analyses that accounted for demographic covariates, access-
ing the Internet remained positively associated with health
status (OR=1.80, CI=1.05-3.11) and health information seeking
(OR=3.83, CI=2.08-7.06). Having a home computer was nega-
tively associated with current smoking (OR=.29, CI=.14-.62) and
positively associated with health information seeking (OR=2.25,
CI=1.30-3.87). These results suggest that the prevalence of ICT
use among low-income individuals is high and is related to
health information seeking and some health behaviors. ICT-
based interventions appear feasible with this population, but
individuals with access to ICT may be more likely to engage in
health behaviors than those without it.
CORRESPONDING AUTHOR: Jason Q. Purnell, PhD, MPH,
Health Communication Research Laboratory, Washington
University in St. Louis, St. Louis, MO, 63112; jpurnell@gwbmail.
wustl.edu
C-032k
AN RCT OF QIGONG/TAI CHI EASY VS. SHAM QIGONG
INTERVENTION ACHIEVES SIGNIFICANT REDUCTION IN
FATIGUE FOR BREAST CANCER SURVIVORS
Linda K. Larkey, PhD,1,2 Denise Roe, PhD,2 Carol Rogers,
APRN-BC, CNOR,1 Ana Maria Lopez, MD, MPH2 and Karen
Weihs, MD2
1
College of Nursing and Health Innovation, Arizona State
University, Phoenix, AZ and 2Arizona Cancer Center,
University of Arizona, Tucson, AZ.
For some breast cancer survivors, fatigue may persist years
after treatment. A double-blind RCT tested effects of two gentle
forms of exercise on fatigue and other survivor symptoms: (a)
Qigong/Tai Chi Easy (QG/TCE) designed to cultivate “qi”
through meditative states and a focus on the breath and (b) a
sham Qigong (SQG) intervention. Both exercise forms were
called “Rejuvenating Movement” for participant blinding. 87
post-menopausal breast cancer survivors (Stage I-III, age 40-75)
reporting persistent, cancer-related fatigue, 6 months to 5 years
past primary treatment were randomized to participate in a
12-week QG/TCE or SQG intervention with weekly classes and
DVD-guided practice at home. Mean age = 59. The primary
hypothesized outcome variable, fatigue (Fatigue Symptom
Inventory, FSI), was significantly improved in response to
Qigong/TCE compared to the SQG control, including FSI sub-
scales for fatigue frequency and severity (p < .05 for overall FSI
and subscales). Baseline values for fatigue were not significantly
different between groups. For QG/TCE, FSI decreased (4.34
to 2.03); less so for SQG ( 3.39 to 2.49). Body Mass Index (BMI)
also dropped in the QG/TCE group and increased slightly in
the SQG group, approaching a significant difference in change
between groups (p = .053). Combining both groups, significant
improvements were found pre- to post-intervention, includ-
ing cognitive function (FACT-Cog)and performance (LNS),
depression (BDI), sleep quality (PSQI), global wellness (AIOS)
and SF-36 (pain, rolelimit, physfunction, emotional wb). Overall
level of activity (METS) significantly increased across both
groups; participants who were sedentary at study entry (n=43)
nearly tripled from pre- to post-intervention (3.26 to 9.38 METs,
p < .01), and more by 3-month post-intervention (9.82 METs),
suggesting potential for gentle exercise to bridge from inactiv-
ity to higher levels of activity. (Funding: NIH/NCCAM UO1
AT002706-03)
CORRESPONDING AUTHOR: Linda K. Larkey, PhD, College
of Nursing and Health Innovation, Arizona State University,
Phoenix, AZ, 85004; larkeylite@msn.com
C-032l
TARGETED COLORECTAL CANCER PREVENTION MESSAGES
FOR OBESE WOMEN: RESULTS OF AN ONLINE MESSAGE
TESTING STUDY
Lucia A. Leone, BA and Marci K. Campbell, PhD, MPH, RD
Nutrition, UNC Gillings School of Global Public Health, Chapel
Hill, NC.
Obese women are at higher risk for multiple cancers, but are
less likely than normal weight women to engage in cancer
prevention behaviors such as screening and physical activity
(PA). Research indicates that higher perceived barriers and
lower perceived benefits to screening/PA may affect behav-
ior. In order to address these disparities, we proposed using
weight-targeted messages to improve colorectal cancer (CRC)
prevention among obese women. Messages were tested online
with women age 50 and older (N=181). Participants were strati-
fied by weight (obese vs. non-obese) and randomized to either
receive 10 weight-targeted or 10 generic messages. Targeted
messaged were written for obese women based on pre-study
focus groups and addressed health belief model constructs
such as benefits and barriers to CRC screening/PA which were
relevant to that population. After reading the messages, women
were asked to evaluate them using an Elaboration Likelihood
Model (ELM) scale. We hypothesized that obese women who
received targeted messages would have higher ELM scores than
those who received generic messages; we did not expect higher
scores among non-obese women who received targeted mes-
sages. We rejected our hypothesis and found that obese women
had higher ELM scores than non-obese women regardless of
which messages they read (p=0.02). Obese women also found
the online messages to be more believable (p=0.047) and more
personally relevant (p=0.005) than non-obese women did. These
differences remained statistically significant when controlling
for intervention condition, education, CRC screening status and
other potential confounders. Sub-group analyses indicated that
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
reach obese women, however weight-targeted messages do not
appear to increase central processing or potential for behavior
change; tailoring messages may prove more efficacious given
the heterogeneity within weight groups.
CORRESPONDING AUTHOR: Lucia A. Leone, BA, Nutrition,
University if North Carolina at Chapel Hill, Chapel Hill, NC,
27516; lleone@email.unc.edu
C-032m
VALIDITY TESTING OF A PROSTATE CANCER SCREENING
(PCS) ANXIETY MEASURE
Suzanne K. Linder, PhD,1,2 Paul R. Swank, PhD,2 Patricia D.
Mullen, DrPH,2 Robert J. Volk, PhD,1 Robert O. Morgan, PhD2
and Sally W. Vernon, PhD2
1
UT M D A Cancer Ctr, Houston, TX and 2UT Hlth Science Ctr,
Houston, TX.
Background: Anxiety is shown to influence effective decision-
making, especially in decisions that involve uncertainty. In or-
der to explore the moderating role of anxiety on decision-mak-
ing processes, reliable and valid anxiety measures are needed.
Following the Spielberger State-Trait Anxiety Inventory, we
developed an 18-item, 3-factor PCS anxiety scale intended to
measure anxiety related to the prostate-specific antigen (PSA)
test, the digital rectal examination (DRE), and the decision to be
tested for PCS.
Purpose: To provide evidence of the reliability and validity of a
PCS anxiety measure.
Methods: Using 2 samples of baseline PCS anxiety data from a
RCT of a decision aid for PCS (n=301, private clinic; n=149, pub-
lic clinic), 4 psychometric properties were assessed: 1) internal
consistency reliability, indicated by factor analysis intraclass
correlations and Cronbach’s α; 2) construct validity, indicated
by patterns of Pearson correlations among subscales; 3) discrim-
inant validity, indicated by the measure’s ability to discriminate
between undecided men and those with a definite screening
intention; and 4) factor validity and invariance using confirma-
tory factor analyses (CFA).
Results: The PCS anxiety measure had adequate internal consis-
tency reliability (total,α=.910) and good construct and discrimi-
nant validity. CFAs indicated that the 3-factor model did not
have adequate fit. There was evidence of method variance;
some factors consisted of similarly worded items across sub-
scales. When subscales were considered separately, CFAs for a
6-item PCS decision anxiety measure and a 6-item PSA anxiety
measure showed adequate fit. Additionally, the PCS decision
anxiety measure was invariant across clinics.
Discussion: Our 6-item PCS decision anxiety measure can be
used in PCS decision aid studies to explore the moderating role
of PCS anxiety on decision-making processes. The develop-
ment of PCS anxiety items relating to testing procedures is still
needed. We recommend avoiding the use of similar wording
across subscales to minimize method variance.
CORRESPONDING AUTHOR: Suzanne K. Linder, PhD, School
of Public Health, University of Texas Health Science Center,
Houston, TX, 77030; suzanneklinder@gmail.com
45
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-032n
VALIDITY TESTING OF THE TRADITIONAL AND
ALTERNATIVE VERSIONS OF THE DECISIONAL CONFLICT
SCALE (DCS)
Suzanne K. Linder, PhD,1,2 Paul R. Swank, PhD,2 Robert J. Volk,
PhD,1 Patricia D. Mullen, DrPH,2 Sally W. Vernon, PhD2 and
Morgan O. Robert, PhD2
1
UT M D Anderson Cancer Ctr, Houston, TX and 2UT Health
Science Ctr, Houston, TX.
Background: Decisional conflict, or the uncertainty about a
course of action, is the most widely used outcome in patient
decision aid trials and is measured using the Decisional Conflict
Scale (DCS). However, there is some evidence questioning the
factor validity of the DCS, and the psychometric properties of
the low literacy version (LL) DCS have not been explored.
Purpose: To provide evidence of the reliability and validity of
the DCS for men eligible for prostate cancer screening (PCS) at a
private clinic and the LL DCS for men at a public clinic.
Methods: Using baseline DCS (T0; n=301, private; n=149,
public) and post-intervention DCS (T2; n=263, private; n=89,
public) data from a RCT of a decision aid for PCS, we assessed:
1) internal consistency reliability (factor analysis intraclass cor-
relations and Cronbach’s α); 2) construct validity (Pearson cor-
relations among subscales); 3) discriminant validity difference
between undecided men and those with a definite screening
intention; and 4) factor validity and invariance (confirmatory
factor analyses).
Results: Both DCS versions had adequate internal consistency
except for the support subscale, and adequate discriminate va-
lidity. Good construct validity was found for the DCS, but only
for the informed subscale of the LL DCS. The 5-factor model of
the DCS did not have adequate fit at T0 or at T2. Two subscales,
informed and clear about values, were not distinct factors. The
LL DCS had adequate fit for 4 factors at T0 but was unidentified
at T2.
Discussion: Additional research should address whether feeling
informed and feeling clear about values (both criteria for deci-
sion quality) are distinct cognitive processes. Additionally, feel-
ings of support may not be a salient concern for men making a
decision about PCS, given it is a low involvement decision for
many men. Future research should consider the factor validity
of the DCS for higher-involvement decisions, where support
from others may play a important role in the decision-making
process.
CORRESPONDING AUTHOR: Suzanne K. Linder, PhD, School
of Public Health, University of Texas Health Science Center,
Houston, TX, 77030; suzanneklinder@gmail.com
C-032o
MEDIA INFLUENCE AND SKIN AGING CONCERNS PREDICT
INDOOR TANNING BEHAVIOR IN YOUNG ADULTS
Gabriela Blaskovicova, na, Paula R. Prentice, BS, Amanda
Wheat, MS and Kevin Larkin, PhD
Psychology, West Virginia University, Morgantown, WV.
Tanning has been a popular practice for thousands of years.
However, by the early 20th century, sun exposure was linked
to increased risk for skin cancer. Despite common knowledge
pertaining to the dangers of tanning, people continue to engage
46
in this potentially life-threatening behavior. Previous research
has shown that the influence of family and friends, especially
parents, is a significant predictor of tanning behavior. Others
have found that the media exerts as much influence over ado-
lescent females in relation to tanning behavior as do friends and
family. The present study seeks to understand reasons behind
this dangerous behavior. Undergraduate students (N=496; 16.9
% men, 83.1% women; M = 19.0 years) completed question-
naires measuring frequency of indoor tanning, cancer anxiety
(Cancer Anxiety Scale) and motivations for tanning (Physi-
cal Appearance Reasons for Tanning Scale; PARTS). Results
of a linear regression analysis showed that media reasons for
tanning were significantly positively related to frequency of
tanning, β = .21, t(494) = 2.61, p < .05. Additionally, skin aging
concerns were inversely related to frequency of tanning, β =
-.13, t(494) = -2.36, p < .05. The influence of family and friends,
desire to conceal acne, and cancer anxiety were not significantly
related to frequency of indoor tanning. These results suggest
that our sample of young adults generally was more concerned
with physical appearance as they age and responding to influ-
ences of the media when deciding to engage in indoor tanning
than being influenced by family and friends, acne prevention,
and cancer anxiety. The present results, when combined with
previous research, suggest that individuals are more likely to be
influenced by the media and concerns over physical appearance
than by concerns over whether their actions might ultimately
lead to their demise. As a result, some health-related concerns
played a role in deterring tanning; however, more serious
health concerns such as risk for skin cancer were not considered
when deciding whether one should engage in indoor tanning.
CORRESPONDING AUTHOR: Paula R. Prentice, BS, Psychol-
ogy, West Virginia University, Morgantown, WV, 26505; Paula.
Prentice@mail.wvu.edu
C-032p
NEGATIVE MOOD AND ANXIETY IN BREAST CANCER
SURVIVORS AND HEALTHY WOMEN DURING ROUTINE
MAMMOGRAPHY SCREENING
Rebecca A. Shelby, PhD,1 Francis J. Keefe, PhD,1 Dana H.
Bovbjerg, PhD,2 Mary Scott Soo, MD,1 Sara Red, BS,1 Celette
Sugg Skinner, PhD,3 Sandra Stinnett, DPH,1 Mary Frances Luce,
PhD1 and Jules H. Sumkin, DO2
1
Duke University Medical Center, Durham, NC; 2University
of Pittsburgh Medical Center, Pittsburgh, PA and 3UT
Southwestern Medical Center, Dallas, TX.
Mammography has been cited as a powerful trigger of psycho-
logical distress for women who have been treated for breast
cancer. However, studies have not examined whether levels
of psychological distress at the time of mammography differ
among breast cancer survivors and women with no personal
history of cancer. This study examined levels of negative mood
and anxiety in a sample of breast cancer survivors (N=64) and
women with no personal cancer history (N=70) who were un-
dergoing routine mammography screening. Participants com-
pleted questionnaires assessing mood and anxiety immediately
prior to receiving a mammogram. Women then underwent
mammography, and immediately after the procedure women
again completed mood and anxiety questionnaires. All ques-
tionnaires were completed before women received their mam-
mogram results. Prior to mammography, breast cancer survi-
vors reported significantly higher levels of anxiety compared to
women without a personal cancer history (t(130) = 1.98, p=.05).
Repeated measures ANOVAs were conducted to examine
whether levels of negative mood and anxiety changed from
pre to post mammogram. Results showed that negative mood
decreased among women with no cancer history, but levels of
negative mood did not change among breast cancer survivors
(Group x Time interaction F(1, 127) = 7.24, p=.01). From pre to
post mammogram, anxiety also significantly decreased among
women with no cancer history, but did not change among
breast cancer survivors (Group x Time interaction F(1, 126) =
5.60, p=.02). An implication of these findings is that strategies
designed to help women manage psychological distress during
mammography may be beneficial to breast cancer survivors
undergoing the procedure.
CORRESPONDING AUTHOR: Rebecca A. Shelby, PhD,
Psychiatry and Behavioral Sciences, Duke University Medical
Center, Durham, NC, 27705; shelb003@mc.duke.edu
C-032q
BELIEFS ABOUT THE CAUSES OF CANCER AMONG WOMEN
WITH A CLOSE FRIEND OR RELATIVE AFFECTED BY THE
DISEASE
Nikki A. Hawkins, PhD, Lucy A. Peipins, PhD, Steven
Leadbetter, MS, Juan Rodriguez, MPH, Natasha Buchanan, PhD
and Francis McCarty, PhD
Division of Cancer Prevention, Centers for Disease Control,
Atlanta, GA.
Beliefs about the causes of cancer are central to research on
explanatory models and play an important role in perceived
risk and health behavior, including adherence to screening
recommendations and medical decision-making. Beliefs may be
influenced by witnessing close others diagnosed with cancer;
however, the content of such beliefs and the level of congruence
between perceived cancer causes in others versus oneself have
not been closely examined. This study examined beliefs about
cancer causes among women with a friend or relative with can-
cer. Specific objectives were to describe women’s beliefs about
the causes of friends’ or relatives’ cancer, compare the content
of these beliefs with beliefs about personal risks of cancer,
and compare beliefs attributed to friends versus relatives with
cancer.
As part of a study on cancer risk perception, 2,524 women
from racially and socioeconomically diverse backgrounds were
recruited from a managed care plan and completed telephone
interviews; 2,099 indicated having a close friend or relative with
cancer (483 female friends; 1,134 female relatives). Respondents
were asked what they believed contributed to their friend/
relative’s cancer and what might contribute to their own risk of
cancer. Responses were assigned to 18 predefined categories of
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.
Results shed light on lay beliefs about cancer causes and
confirm that individuals hold similar, but not identical, beliefs
about the factors that lead to cancer in others versus themselves.
CORRESPONDING AUTHOR: Nikki A. Hawkins, PhD, Divi-
sion of Cancer Prevention & Control, Centers for Disease Con-
trol & Prevention, Atlanta, GA, 30341; cyt4@cdc.gov
C-032r
CIGARETTE SMOKING FOLLOWING HEAD AND NECK
CANCER DIAGNOSIS: USING THEORY TO UNDERSTAND
INTENTIONS TO QUIT
Jessica L. Burris, MA and Michael Andrykowski, PhD
Behavioral Science, University of Kentucky, Lexington, KY.
The etiology of head and neck squamous cell carcinoma (HN-
SCC) is strongly linked to tobacco and alcohol use. Specifically
among HNSCC patients who reported cigarette smoking in
the year preceding diagnosis, about one-third report cigarette
smoking following completion of cancer treatment. Some stud-
ies have examined intentions to quit cigarette smoking among
HNSCC patients, but theory is generally ignored. By using
Ajzen’s (1991) Theory of Planned Behavior to guide the selec-
tion of study variables, the current study - which is ongoing
- addresses this limitation. HNSCC patients meeting eligibility
criteria were recruited from the UK Kentucky Clinic. Shortly
after diagnosis but before beginning cancer treatment (# days
since diagnosis: M = 17.9, SD = 20.9), participants completed a
standardized questionnaire asking about their current beliefs
and practices. Theory of Planned Behavior constructs were
assessed by multiple items that were directly compatible with
the behavior in question, namely, intentions to quit cigarette
smoking in the next six months. Of the 27 HNSCC patients
currently enrolled (85% male; age in years: M = 57.5, SD = 7.4),
82% reported having smoked at least one cigarette in the week
preceding assessment; # cigarettes smoked in that week: M =
91.6, SD = 113.8. Theory of Planned Behavior constructs were
successful in predicting intentions to quit cigarette smoking: F
(3, 23) = 2.97, total R squared = .31, p < .05. Perceived behavioral
control (B = .25, p < .01) was the greatest predictor followed
by subjective norms (B = -.08, ns) and personal attitudes (B =
.01, ns). While HNSCC diagnosis may be considered a “teach-
able moment,” in which the motivation for behavior change is
theorized to be high, not all HNSCC patients regard their diag-
nosis as a sufficient catalyst for smoking cessation. Preliminary
results of this ongoing study suggest efforts to increase HNSCC
patients’ perceived behavioral control may be an important
point of intervention when trying to elicit greater intentions to
quit cigarette smoking.
CORRESPONDING AUTHOR: Jessica L. Burris, MA, Behav-
ioral Science, University of Kentucky, Lexington, KY, 40536;
burris.jessica@gmail.com
47
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-032s
SELF-REPORTED MEANING-MAKING, PSYCHOLOGICAL
DISTRESS AND QUALITY OF LIFE IN HEMATOPOIETIC
STEM CELL TRANSPLANT SURVIVORS
Lisa M. Wu, PhD,1 Jane Austin, PhD,2 Katie Basmajian, MA,1
AnnaMarie Vu, BA,1 Christine Rini, PhD1 and Scott Rowley,
MD3
1
Oncological Sciences, Mount Sinai School of Medicine, New
York, NY; 2Psychology, William Paterson University, Wayne,
NJ and 3Cancer Center, Hackensack University Medical Center,
Hackensack, NJ.
Hematopoietic stem cell transplant (HSCT) is an aggressive
treatment for hematological and oncological diseases. Patients
experience significant distress and reduced quality of life
(QOL) even long after treatment has ended. Their ability to find
meaning in the experience may be important in explaining their
adjustment to it — a relation found in other populations facing
stressful events. The purpose of this study was to examine the
association of meaning making with psychological adjust-
ment and QOL in adults who had undergone HSCT. Survivors
(n=161) who were 9 months to 3 years post-HSCT completed
self-report measures of meaning-making (i.e., searching for
meaning and presence of meaning), psychological distress, and
QOL (both physical and mental). It was hypothesized that those
who reported searching for meaning would also report greater
distress and reduced QOL, and that those who reported pres-
ence of meaning would experience less distress and better QOL.
Findings from hierarchical multiple regression offered support
for some of these hypotheses. Specifically, searching for mean-
ing was associated with greater distress (p<.001) and reduced
mental health-related QOL (p<.001). Having greater presence
of meaning was associated with lower levels of distress (p<.01)
and better mental health-related QOL(p<.01). However, neither
searching for nor presence of meaning were related to physical
health-related QOL. The findings have clinical implications in
helping health professionals identify patients at greatest risk
of adjustment and QOL issues. Supporting such individuals in
their search for meaning yet helping them to refrain from the
potentially harmful ruminative aspects of this process may be
beneficial to survivors of HSCT.
CORRESPONDING AUTHOR: Lisa M. Wu, PhD, Oncologi-
cal Sciences, Mount Sinai School of Medicine, New York, NY,
10029; lisa.wu@mssm.edu
C-032t
PERCEIVED COGNITIVE FUNCTIONING MEDIATES THE
RELATIONSHIP BETWEEN FATIGUE AND DISTRESS
AND QUALITY OF LIFE IN HEMATOPOIETIC STEM CELL
TRANSPLANT SURVIVORS
Lisa M. Wu, PhD,1 Jane Austin, PhD,2 Katie Basmajian, MA,1
AnnaMarie Vu, BA,1 Scott Rowley, MD3 and Christine Rini,
PhD1
1
Oncological Sciences, Mount Sinai School of Medicine, New
York, NY; 2Psychology, William Paterson University, Wayne,
NJ and 3Cancer Center, Hackensack University Medical Center,
Hackensack, NJ.
Hematopoietic stem cell transplant (HSCT)—an aggressive
treatment for hematological malignancies—causes numerous
survivorship difficulties, including significant psychologi-
cal distress (anxiety and depression) and poor physical and
48
mental health-related quality of life (QOL). These difficulties
are elevated among survivors with self-reported fatigue. This
study examined the hypothesis that adverse effects of fatigue
can be partly explained by its tendency to reduce perceived
cognitive functioning. Patients (n=158) 9-months to 3-years
post-HSCT completed validated measures of fatigue, perceived
cognitive functioning, psychological distress and quality of life.
Mediation analyses using bootstrapping investigated whether
perceived cognitive functioning mediated associations between
self-reports of fatigue and each outcome. Results indicated
that perceived cognitive functioning mediated the association
between fatigue and most outcomes, including depression (total
indirect effect point estimate -.0067, 95% bias corrected and ac-
celerated confidence interval [BCa CI] -.0126 to -.0017), anxiety
(point estimate -.0100, BCa CI -.0184 to -.0045), and mental
health-related QOL (point estimate .0986, BCa CI .0155 to .2133).
In other words, greater self-reported fatigue led to lower per-
ceived cognitive functioning, which in turn led to greater levels
of depression, anxiety, and poorer mental well-being. However,
perceived cognitive functioning did not mediate the association
between fatigue and physical health-related QOL. The findings
indicate that survivors reporting more fatigue had poorer HSCT
outcomes in part because they felt less able to function cogni-
tively. Hence, strategies to help survivors manage problems
associated with fatigue may be more effective if they also focus
on enhancing survivors’ ability to compensate for perceived
cognitive problems.
CORRESPONDING AUTHOR: Lisa M. Wu, PhD, Oncologi-
cal Sciences, Mount Sinai School of Medicine, New York, NY,
10029; lisa.wu@mssm.edu
C-032u
QUALITY OF LIFE CHANGES DURING THE ACUTE PHASE OF
A BONE MARROW TRANSPLANT
Carolina Garcia, MS,1 Patricia Mumby, PhD,2 Patrick Stiff, MD2
and Chow Lam, PhD1
1
Institute of Psychology, Illinois Institute of Technology,
Chicago, IL and 2Cardinal Bernardin Cancer Center, Loyola
University Medical Center, Chicago, IL.
The present study explored changes in quality of life (QOL) as
measured by the Functional Assessment of Cancer Therapy-
Bone Marrow Transplant (FACT-BMT) in autologous and allo-
geneic bone marrow transplant (BMT) patients during the acute
phase of a BMT. The sample consisted of 105 cancer patients
(41 who received an autologous BMT and 64 who received an
allogeneic BMT) with no psychiatric diagnosis that completed
the FACT-BMT at three time points (hospital admission, day of
transplant, and discharge). No significant demographic dif-
ferences between the two transplant groups were found, but
expected clinical differences were found for length of hospital-
ization, days to engraftment, diagnosis, and treatment regi-
men. Despite the clinical differences between autologous and
allogeneic transplant patients, no interaction effect was found
between type of transplant and time point for any of the FACT-
BMT scores. A main effect for type of transplant was found
only for the Functional Well Being subscale, with allogeneic
patients having lower scores, at the time of hospital discharge.
Main effects for time were found for all the FACT-BMT scores
with the exception of the Social Well-Being subscale. For both
groups, overall QOL scores decreased from baseline to reinfu-
sion, and returned to baseline levels by discharge. However, not
all aspects of QOL followed this pattern. Scores on the Physical
Well-Being subscale tended to decline then return to baseline by
discharge. However, the Functional Well-Being score declined
from admission to reinfusion but did not improve by discharge.
Scores on the Emotional Well-Being subscale improved across
the three time points, whereas Social Well-Being was perceived
as stable. Overall, the present study indicated that despite the
fact that individuals undergoing allogeneic BMT face greater
risks and longer treatment courses, their psychological response
during initial hospitalization is largely consistent with patients
undergoing an autologous BMT.
CORRESPONDING AUTHOR: Carolina Garcia, MS, Illinois
Institute of Technology, Chicago, IL, 60657; garccar@iit.edu
C-032v
SOCIAL SUPPORT PREDICTS STRESS FOR BREAST CANCER
SURVIVORS
Herzelene Martin, BA and Tammy Schuler, MA
Ohio State University, Columbus, OH.
BACKGROUND: Social support may aid the person coping
with cancer diagnosis, treatment, and recovery (Koopman, et
al., 1998). We test this hypothesis using two measures of sup-
port and a longitudinal design. METHOD: Data were from
patients with Stage II or III breast cancer (N=227) enrolled in an
RCT examining biobehavioral outcomes following a psycholog-
ical intervention (Andersen et al., 2004). Participants were as-
sessed after diagnosis/surgery (baseline), but prior to the start
of adjuvant treatment, and then followed for 24 months. The
average participant was Caucasian (90%), middle-aged (mean
= 50.90, SD=10.71), married (67%), and college-educated (72%).
85% later received chemotherapy and 54% radiation therapy.
The Berkman-Syme Social Network Index (SNI; Berkman &
Syme, 1979) measured number of/involvement with social net-
work ties, and the Perceived Social Support Family and Friends
Scales (PSSFam and PSSFr; Procidano & Heller, 1983) measured
the degree to which support needs were fulfilled by patients’
network of family and friends. The outcome, perceived stress,
was measured using the 10-item Perceived Stress Scale (PSS-10;
Cohen, Kamarck, & Mermelstein, 1983). Hierarchical regression
analyses determined if SNI, PSS-Fam, and PSS-Fr, assessed at
baseline or 12 months post-diagnosis, predicted PSS-10 at 12
months and 24 months post-diagnosis, respectively. Sociode-
mographic and treatment (e.g., chemotherapy, RCT study arm)
control variables were entered, as was perceived stress at the
prior assessment. RESULTS: Baseline SNI significantly predict-
ed PSS-10 at 12 months (β = -0.135, p = 0.051) and 24 months (β
= -0.168, p = 0.028). 12-month PSS-Fam and PSS-Fr significantly
predicted PSS-10 at 24 months (β = -0.156, p = 0.019; β = -0.160,
p = 0.018 respectively). DISCUSSION: Patients may experience
two-year benefits from increasing their number of/involvement
with social ties (e.g., joining social groups) shortly after diagno-
sis. Furthermore, as adjustment to cancer continues and treat-
ment ends, women may benefit from seeking increased support
from their family and friends.
CORRESPONDING AUTHOR: Herzelene Martin, BA, Ohio
State University, Columbus, OH, 43210; martin.1565@osu.edu
C-032w
THE M.A.P. (MIND AFFECTS THE PHYSICAL) PROJECT:
UNDERSTANDING THE PSYCHOSOCIAL NEEDS OF BREAST
CANCER SURVIVORS
Joanne S. Buzaglo, PhD, Kasey Ryan Dougherty, BA and Mitch
Golant, PhD
Research & Training Institute, Cancer Support Community,
Philadelphia, PA.
Increasingly, breast cancer (BC) is managed as a chronic disease
with persistent physical and psychosocial demands. Yet, little
research has focused on the psychosocial needs of women
across the care continuum. The Cancer Support Community
(CSC) fielded a national survey to understand the current psy-
chosocial needs of BC survivors.
Methods: CSC conducted an online survey of 1,004 BC survi-
vors, 0 to 5 years post-diagnosis. Questions were developed
with input from a National Advisory Council of experts repre-
senting advocacy, oncology, psychology, policy, industry and
managed care.
Results: 87% participants were white, with a mean age of 54.
45% graduated from college and 14% had a graduate degree.
75% had stage II cancer or less and 13% had a BC recurrence.
81% survivors reported some form of physical, emotional or
spiritual distress with 67% reporting emotional distress. 64%
women indicated fear of recurrence, 58% physical changes, 55%
anxiety, 47% depression, 46% financial worries as the lead-
ing contributors to distress. Regarding their immediate needs,
women wanted support around fears of recurrence (62%);
making healthy lifestyle choices (60%); financial matters (42%);
and reducing anxiety (41%). 86% believe emotional support is
important to overall health, while only 52% had someone from
their medical team address their emotional needs. 37% respon-
dents did not receive a referral for support services. Of those
that did receive a referral, 30% did not follow up on any refer-
rals. To reduce the cost of breast cancer, 38% of respondents
delayed seeking counseling or support. 64% would be likely to
seek psychosocial support if it were free of charge.
Discussion: Women with breast cancer recognize the impor-
tance of emotional support as part of survivorship care, yet
few survivors access the care they need. As part of the M.A.P.
Project, these data will inform the development of a Cancer
Survivor Registry to identify behavioral trends and gaps in
psychosocial care across the survivorship continuum.
CORRESPONDING AUTHOR: Joanne S. Buzaglo, PhD, Cancer
Survivorship Research & Training Institute, Cancer Support
Community, Philadelphia, PA, 19131; joanne@thewellnesscom-
munity.org
C-032x
THE HIDDEN COSTS OF CANCER: BARRIERS TO ACCESSING
FINANCIAL ASSISTANCE
Joanne S. Buzaglo, PhD, Kasey Dougherty, BA, Ellyn Micco,
MS, Melissa Miller, PhD and Mitch Golant, PhD
Research & Training Institute, Cancer Support Community,
Philadelphia, PA.
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-
ing co-pay assistance and the hidden costs of care.
Methods: Cancer patients (n=78) diagnosed over 6 months ago
or had active treatment within 2 years and caregivers (n=29) of
patients who met the above criteria, completed a survey that
included the Revised Impact of Event Scale to assess intrusive
and avoidant ideation around the cost of care.
Results: Respondents (N=107) were ethnically diverse; 25%
patients and 18% caregivers had household incomes less than
$20K. Patients reported high levels of intrusion (18.5 ± 9.2) and
avoidance (20.2 ± 8.8). Caregiver levels were also high for intru-
sion (15.0 ± 10.0) and avoidance (17.8 ± 10.1). Based on clinical
cut-offs, 82% reported stress within moderate to severe levels.
Due to care costs, 74% patients depleted savings, 44% down-
sized living accommodations; 32% caregivers worked extra
jobs to help pay for care, 60% reported extra stress at work.
To reduce costs, 49% patients delayed seeking psychological
counseling. Among patients, increased intrusion correlated
with having no one to help with insurance questions (p<.0001).
Increased avoidance was associated with delay in seeking psy-
chological counseling (p<.0001) and less awareness of co-pay
assistance (p<.0001). 33% patients and 40% caregivers felt too
overwhelmed to apply for financial help.
Discussion: These data suggest that managing cancer costs is
associated with clinically significant stress levels. Those with
greatest need may not seek help, underscoring the need for
programs that help families manage the stress related to the
cost of care.
CORRESPONDING AUTHOR: Joanne S. Buzaglo, PhD, Cancer
Survivorship Research & Training Institute, Cancer Support
Community, Philadelphia, PA, 19131; joanne@thewellnesscom-
munity.org
C-032y
HEALTH-RELATED QUALITY OF LIFE AND PSYCHOLOGICAL
FACTORS IN NON-MUSCLE INVASIVE BLADDER CANCER
PATIENTS
Shubhada Sansgiry, PhD,1,2 Seth P. Lerner, MD,1 Gilad E. Amiel,
MD,1 Minghua Mei, PhD1,2 and David M. Latini, PhD1,2
1
Baylor College of Medicine, Houston, TX and 2Health Services
Research & Development Center of Excellence, Michael E.
DeBakey VA Medical Center, Houston, TX.
Introduction and Objectives: Nonmuscle-invasive bladder
cancer (NMIBC) survivors, developing treatment-related side-
effects will experience symptoms for years due to high cancer-
specific survival rates. Fear of recurrence (FOR), illness intru-
siveness (IITF) and psychological distress (PD) may all have
adverse ramification for health related quality of life (HRQOL).
This study assesses the variation in psychological factors and its
impact on NMIBC survivors’ HRQOL, as the first step toward
developing a patient-education intervention.
Methods: Participants were drawn from a large private hospi-
tal (N=38) and Veterans Affairs hospital (N=29). HRQOL was
measured with the EORTC-QLQ-C30. FOR was measured with
5-item measure used in the Cancer of the Prostate Strategic
Research Endeavor study. The IITF measure consists of three
subscales; intimacy, relationship-personal-development and
instrumental life. PD was measured with the Brief Symptom In-
dex (BSI), which included depression, anxiety, and somatization
50
subscales. Differences among Veterans vs. private-patients were
assessed with student t-test. Multivariate regression models
determined significant predictors of HRQOL. Analyses were
performed using the SAS v9.1.3.
Results: The Veterans’ group indicated lower physical, role,
social, cognitive and global HRQOL but, higher FOR, BSI on
somatic and anxiety subscales, and IITF on intimacy and instru-
mental life subscales compared to private-patients (p<0.05). Af-
ter adjusting for number of comorbidities, gender and the two
groups, IITF was significant predictor of global HRQOL and
BSI (p<0.05). FOR was significant predictor of global HRQOL;
but once IITF was introduced, FOR no longer predicted global
HRQOL (p=0.0839).
Conclusions: The Veterans’ group indicated lower HRQOL but
higher level of FOR and PD than private-patients. IITF being
significant predictor of global HRQOL and PD, managing dis-
ease related disruptions may help improve HRQOL.
CORRESPONDING AUTHOR: Shubhada Sansgiry, PhD, Bay-
lor College of Medicine1; Health Services Research & Devel-
opment Center of Excellence, Michael E. DeBakey VA Medi-
cal Center, Houston, Texas, Houston, TX, 77030; shubhada.
sansgiry@va.gov
C-032z
IMPROVEMENTS IN SLEEP QUALITY AND FUNCTIONAL
OUTCOMES AFTER A COGNITIVE-BEHAVIORAL STRESS
MANAGEMENT INTERVENTION FOR WOMEN UNDERGOING
TREATMENT FOR BREAST CANCER
Sara Vargas, BA,1 Michael H. Antoni, PhD,1 William K.
Wohlgemuth, PhD,2 Suzanne C. Lechner, PhD,3 Jamie Stagl,
BA,1 Janny M. Rodriguez, MS Ed1 and Charles S. Carver, PhD1
1
Psychology, University of Miami, Coral Gables, FL;
2
Neurology, University of Miami School of Medicine, Miami, FL
and 3Psychiatry and Behavioral Sciences, University of Miami
School of Medicine, Miami, FL.
Previous work has related differences in sleep quality to
psychosocial functioning in women in the weeks after surgery
for non-metastatic breast cancer (BCa). We tested whether a 10-
week cognitive behavioral stress management (CBSM) interven-
tion improved sleep quality in association with better psycho-
social functioning in a cohort of 240 women under treatment
for BCa. Latent growth modeling was used to assess differences
between women assigned to the 10-week CBSM intervention
versus a one-day psychoeducation (PE) control at baseline and
for changes across three time points (baseline, 6 months, and 12
months). Results indicate that CBSM improved sleep quality for
up to 12 months compared to PE. In addition, those in CBSM
reported increased functional quality of life, increased positive
states of mind, and less disruption of recreations and pastimes.
Specifically, the models fit the data well with time points set
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-
ferences between groups at baseline on any measures, but was
associated with differential change over time in these measures.
Condition did predict differential change for disruption of
social interactions, though the relationship only approached
significance. In conclusion, CBSM was associated with improve-
ments in sleep quality and various measures of psychosocial
functioning in women undergoing treatment for breast cancer.
Full results will include model fit indices and parameter esti-
mates, as well as an analysis of whether changes in sleep quality
mediate changes in functional outcomes.
This work was funded by NCI grant number R01CA64710
CORRESPONDING AUTHOR: Sara Vargas, BA, Psychology,
University of Miami, Coral Gables, FL, 33146; svargas2@psy.
miami.edu
C-32aa
PATIENT HOLIDAYS: AN ISSUE OF NON-ADHERENCE?
Jill M. Gjerde, MA
Psychology, Washington State University, Pullman, WA.
While the volume of research on psychosocial factors of adher-
ence has grown in recent decades, patient-initiated treatment
breaks from cancer therapies remains relatively understudied as
a form of nonadherence. Change in, or delay of, therapy often
stems from difficulties in tolerating the adverse side effects of
toxic treatments (e.g., radiation therapy, chemotherapy, immu-
notherapy, surgery). Breaks from treatment are associated with
prolonged treatment, poorer local control, and poorer survival.
Moreover, if a patient is unable to continue treatment as direct-
ed due to acute toxicity, the benefits of concurrent therapy may
be lost. When treatment breaks prolong treatment duration by
10 days, there is an average 10-20% decrease in 5-year relapse-
free survival rates. Risk of relapse increases when the cumula-
tive number of dose delays exceeds 30 days. Non-adherence to
chronic illness regimens has been significantly linked through
meta-analyses with lack of social support, depression, family
conflict, poor health professional-patient communication and
low income. The ability to tolerate treatment or manage side ef-
fects can affect ability to adhere to a medical regimen (McNeill,
Reynolds, & Ney, 2007) and therefore it is important to deter-
mine who will tolerate such adverse effects in order to optimize
the efficacy of treatment. Despite the evidence against treatment
holidays there is potential benefit from planned breaks from ra-
diotherapy. We developed a conceptual model of factors related
to adherence that may be most relevant in predicting patient-
initiated treatment holidays in cancer therapy. As adherence to
cancer therapy is often compromised by impairing side effects
such as acute toxicity, it is warranted that we explore how to
identify patients pre-treatment in order to reduce breaks that
are associated with poorer local control, poorer survival, and
prolonged treatment. Further, the benefit of treatment success
should be considered alongside the benefit of improved quality
of life during breaks.
CORRESPONDING AUTHOR: Jill M. Gjerde, MA, Psychology,
Washington State University, Pullman, WA, 99163; jill_gjerde@
wsu.edu
C-032ab
USING RESEARCH DATA TO IMPACT CONSUMER
PROTECTION LEGISLATION: LESSONS LEARNED FROM
CITY100 DISSEMINATION EFFORTS
Joni Mayer, PhD, Katherine Hoerster, MPH, Dalila Butler, MPH
and Nicole Pizzi, MPH
Grad School of Public Health, San Diego State University, San
Diego, CA.
Indoor tanning is a risk factor for melanoma and is used
frequently by adolescent girls. CITY100 evaluated built-
environmental and policy level correlates of indoor tanning
by adolescents (N=6125) in the 100 most populous US cities;
it also provided a “report card” of existing laws for protecting
youth. The goal of the NCI-funded dissemination phase was
to work with a media specialist, partner with relevant health
organizations, and strategically share data with stakeholders,
who would be positioned to lobby for more effective legisla-
tion. Using public attention and health advocacy models, we
sought to increase public awareness via the news media and
a project website (www.indoortanningreportcard.com), with
media attention timed around the publication of 2 papers. Even
during data collection, we were cognizant of what may pique
public attention. For example, in addition to collecting data on
number of tanning salons in each city, we also reported data on
the relatively lower numbers of Starbucks and McDonald’s; this
subsequently led to heavy media attention primarily via local
media outlets around the US. Our “undercover” compliance
survey of youth-related access practices of 3,647 tanning salons
was featured on Good Morning America, in Time magazine,
and in dozens of other national news reports. Our data showing
no association between parental consent laws and teen indoor
tanning use were used in expert testimony by the American
Cancer Society to lobby for a new law in Howard County, MD
that bans minors from use, and we have provided assistance
to several states who wish to replicate our compliance survey
for evidence that stronger laws are needed. In this presenta-
tion, we will share detailed data from 2009/2010 on the number
and types of media stories generated, and the processes of how
our data were used by health organizations to promote policy
changes. Moreover, we will recommend strategies for design-
ing both research and dissemination activities that will be more
likely to engage gatekeepers and impact policy.
CORRESPONDING AUTHOR: Joni Mayer, PhD, Grad School
of Public Health, San Diego State University, San Diego, CA,
92182-4162; jmayer@mail.sdsu.edu
C-038a
INFLUENCE OF DISTRESS AND OBESITY ON ADHERENCE
TO HEALTH CARE PROVIDER HYPERTENSION TREATMENT
RECOMMENDATIONS: BRFSS 2007 FINDINGS
Eric R. Hanson, MA, Narineh Hartoonian, MS, Sarah Ormseth,
BS and Karen T. Lesniak, PhD
Psychology, Loma Linda University, Loma Linda, CA.
PURPOSE: Recommendations by health care providers (HCP)
may influence patients to adopt certain health behavior chang-
es. This study examines the effects of patient characteristics
(distress and obesity) on adherence to HCP behavioral recom-
mendations for hypertension treatment (i.e. eating habits; salt
and alcohol use; exercise; medication adherence). METHODS:
Population-based data were used (2007 Behavioral Risk Fac-
tor Surveillance System [BRFSS]); 32829 hypertensive persons
were eligible for the study. SAS 9.2 was used for analyses;
CDC sample weights were used to adjust for sampling design
and non-response; Taylor Series Method in SUDAAN calcu-
lated variance estimates to account for the stratified multistage
sampling design. Predictor variables were distress (Kessler-6)
and BMI used to define four groups: Non-distressed/non-obese
(NDNO), Distressed/non-obese (DNO), Non-distressed/obese
(NDO), Distressed/obese (DO). Outcomes were participant
adherence to HCP recommendations outlined above. Covariates
51
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
included age, ethnicity, marital status, gender, and perceived
general health. Multivariate logistic regression was used to pre-
dict adherence. RESULTS: Distress and obesity were significant-
ly associated with exercise and medication use (ps<.001). For
medication use, greater adherence was found for NDO (p<.001)
and DO (p=.04). Additionally, greater medication adherence
was related to both being African American, older age, as well
as widowed, or never married (ps<.01). Lower reported exercise
adherence was found among DNO, DO, and NDO (ps<.001).
Greater exercise recommendation adherence was associated
with better perceived health (p<.001) and male gender (p=.03).
CONCLUSION: Findings suggest that distress and BMI dif-
ferentially influence adherence to HCP hypertension treatment
recommendations. Results will be discussed in terms of their
implications and potential applied value.
CORRESPONDING AUTHOR: Eric R. Hanson, MA, Loma
Linda University, Loma Linda, CA, 92354; ehanson@llu.edu
C-038b
A BRIEF PSYCHOSOCIAL-SKILLS TRAINING TO PRIMARY
CARE PROVIDERS BASED ON PATIENT-CENTERED
APPROACHES AND LEVENTHALS COMMONSENSE
MODEL: EFFECTS ON PATIENTS ADHERENCE AND BLOOD
PRESSURE
Eliana Guic, PhD, Regina Fernandez, Psychologist, Claudia
Gonzalez, Psychologist, Esperanza Muñoz, Psychologist, Susan
Galdames, Psychologist and Paula Repetto, PhD
Psychology, UC, Santiago, Chile.
Objetive: To evaluate the effect of a provider’s psychosocial-
skills training to promote hypertension medication adherence.
The intervention was based on patient-centered approaches and
Leventhals commonsense model of self-regulation.
Methods: Five Primary Health Care Centers from middle-low
income neighbourhoods were randomly assigned to the Inter-
vention (IG) or Control Group (CG). All participating providers
(N=22) received a 4-hour biomedical training to discuss High
Blood Pressure Guidelines. The IG additionally received an
8-hour psychosocial training. Eligible patients were in pharma-
cological treatment for hypertension and had blood pressure
measures over 140/90 mm Hg in 2 consecutive medical visits.
Main outcomes are follow-up blood pressure and adherence to
prescribed antihypertensive medication (Morisky questionnaire
and MEMs electronic monitoring system).
Results: We are reporting data from a sample of 77 patients
(IG= 37; CG= 40). The number of patients complying with medi-
cation at follow up is higher in the experimental than in the con-
trol group (Kendall’s tau =0.212; p<0.02). Medication adherence
is predicted by the intervention, after adjusting for demograph-
ics and base-line adherence (Exp(B)= 0,224; p<0,03). Systolic
and diastolic blood pressure decreased in experimental patients
from 156.46 to 141.6 (t=4.47; p<0.0001) and from 92.l7 to 85.35
mmHg (t= 3.40; p<0.002), respectively. However, a multivariate
regression analysis adjusted for demographics and blood pres-
sure at base-line is not statistically significant (β=0.198; p<0.08).
Systolic blood pressure also decreased in control group patients.
Conclusion: Patients medication adherence is modifiable by a
brief training to the health providers probably modifying the
patient-provider interaction during the medical visit.
CORRESPONDING AUTHOR: Eliana Guic, PhD, Psychology,
PUC, Santiago, 1; eguic@uc.cl
52
C-038c
RISK FOR HYPERTENSION IS NOT ASSOCIATED WITH
DIFFERENTIAL EMOTIONAL MODULATION OF PAIN
Sarah T. McGlone, MS,1 Jamie L. Rhudy, PhD2 and Christopher
R. France, PhD1
1
Psychology, Ohio University, Athens, OH and 2Psychology,
The University of Tulsa, Tulsa, OK.
Hypoalgesia (reduced pain responding) is observed in indi-
viduals with hypertension (HTN) and in those at risk for HTN.
This study examined the notion that hypoalgesia in individuals
at risk for HTN may result from dampened affective responses
to environmental stimuli, including nociceptive input. This hy-
pothesis was tested using the emotional modulation of nocicep-
tion paradigm wherein pain and nociceptive responding are re-
liably modulated by pleasant and unpleasant affective pictures.
It was hypothesized that emotional modulation of pain and
nociception would be decreased in individuals at risk for HTN.
Participants (N=117; 46 with and 71 without parental history
(PH) of HTN) viewed pleasant, unpleasant, and neutral images
during which suprathreshold electrocutaneous stimuli were
delivered. Consistent with previous results, pleasant images
were associated with lower pain ratings and nociceptive flexion
reflexes (NFR; a measure of spinal nociception) than unpleasant
images (ps<.001). There was modest support for affective blunt-
ing among those with HTN risk: persons with higher systolic
blood pressure (SBP) rated unpleasant images as less unpleas-
ant than those with lower SBP (p<.05). There was also some
support for hypoalgesia in those at greatest HTN risk; among
those with higher SBP, persons with positive PH of HTN had
higher NFR thresholds than those with negative PH (p<.05).
However, the predicted 3-way interaction between SBP, PH of
HTN, and affective picture valence (pleasant, neutral, unpleas-
ant) was not found for pain ratings or NFR (ps>.10). A potential
explanation for the nonsignificant findings may be that valence
and arousal ratings showed little variability as a function of risk
for high blood pressure; future research with more arousing
stimuli is advisable. Notwithstanding this call for further study,
the current results do not support the notion that hypoalgesia
in individuals at risk for HTN is related to dampened affective
responses to pain.
CORRESPONDING AUTHOR: Sarah T. McGlone, MS, Ohio
University, Athens, OH, 45701; sm160006@ohio.edu
C-038d
RACIAL DISCRIMINATION AND CARDIOVASCULAR DISEASE
AMONG AFRICAN AMERICANS: THE ROLE OF MOOD
DISORDERS
David H. Chae, ScD,1 Kimberly R. Jacob Arriola, PhD1 and
Karen D. Lincoln, PhD2
1
Department of Behavioral Sciences and Health Education,
Emory University, Atlanta, GA and 2School of Social Work,
University of Southern California, Los Angeles, CA.
In this study, we examined whether mood disorders may be
on the pathway linking racial discrimination and cardiovas-
cular disease among Africans. Using nationally representative
data on African Americans (n = 3570) in the National Survey
of American Life (NSAL; 2001-2003), we found evidence that
lifetime history of mood disorders may serve as both a partial
mediator and moderator. The effect of racial discrimination on
history of cardiovascular disease was reduced by 25% when
adding lifetime history of mood disorder in the model. Racial
discrimination was associated with increased odds of having a
lifetime history of mood disorder (odds ratio [OR] = 1.23; 95%
confidence interval [CI] = 1.12, 1.36); and lifetime mood disor-
der was associated with increased odds of having a history of
cardiovascular disease (OR = 2.12, 95% CI = 1.55, 2.89). Further-
more, the interaction between racial discrimination and lifetime
mood disorder was significant at the trend level (p = 0.07), in-
dicating that having a history of mood disorder may exacerbate
the effects of racial discrimination on cardiovascular health.
Findings from this study suggest experiencing racial discrimi-
nation may increase the risk of having a mood disorder which
may in turn have deleterious consequences for cardiovascular
health. In addition, racial discrimination may have particu-
larly negative cardiovascular consequences among those who
respond with poor affective reactions. This study suggests that
improving cardiovascular outcomes among African Americans
may entail efforts to address issues of racial discrimination and
social inequalities more broadly, as well as steps to ameliorate
their negative mental health consequences.
CORRESPONDING AUTHOR: David H. Chae, ScD, Depart-
ment of Behavioral Sciences and Health Education, Emory
University, Atlanta, GA, 30309; david.chae@emory.edu
C-038e
PREDICTING PARTICIPATION AFTER STROKE
Cynthia Dolezsar, MA,1 Nancy Mayo, PhD,2 Sydney Miller,
PhD,1 Lois Finch, PhD,2 Lisa Koski, PhD2 and Lesley Fellows,
PhD3
1
Psychology, Concordia University, Montreal, QC, Canada;
2
Faculty of Medicine, McGill University, Montreal, QC, Canada
and 3Dept of Neurology and Neurosurgery, McGill University,
Montreal, QC, Canada.
Stroke can lead to impairments that restrict participation in
social roles. Despite being recognized as an important outcome
in rehabilitation, little is known about the predictors of partici-
pation. The aim of this study was to estimate the independent
contributions of depressive symptomatology, gender and
functional independence and the interaction between gender
and depressive symptomatology in predicting participation
among stroke survivors 6 months post-stroke beyond those
afforded by age, co-morbid conditions and a history of depres-
sion. Participants (n=66) were patients admitted for stroke to
a regional hospital, did not have a co-morbid condition which
was expected to lead to death and were able to provide consent.
Two weeks post-stroke, the following variables were assessed:
Depressive symtomatology, as measured by the Stroke-Specific
Geriatric Depression Scale; gender; functional independence, as
measured by the Barthel Index; age and co-morbid conditions,
as measured by a checklist. Three months post-stroke, history of
depression was measured by the Structured Clinical Interview
for the Diagnosis of DSM-IV Axis I Disorders. Six months post-
stroke, participation was measured by the Stroke Impact Scale.
Multiple regression analyses generated a significant model
(F(5,60) = 5.74, R2=37%, p<0.01), where greater functional inde-
pendence predicted greater levels of participation. These results
are in line with other evidence that functional limitation is a risk
factor for restricted participation. Screening and targeting func-
tional independence during hospitalization for stroke will allow
for rehabilitation programs to identify those at risk for restricted
participation once stroke survivors return to the community.
CORRESPONDING AUTHOR: Cynthia Dolezsar, MA, Psychol-
ogy, Concordia University, Montreal, QC, H4B 1R6; c_dolezs@
live.concordia.ca
C-038f
PREVALENCE RATES OF ANXIETY DISORDERS AND
ASSOCIATION WITH HEALTH-RELATED VARIABLES IN
CARDIAC REHABILITATION PATIENTS
Sumner J. Sydeman, PhD, Derek W. Stalls, MA and Noel C.
Larson, BA
Psychology, Northern Arizona University, Flagstaff, AZ.
Anxiety is a common problem for cardiac patients and is associ-
ated with reduced quality of life and progression of CHD. How-
ever, research on the prevalence rates of DSM-IV anxiety disor-
ders in cardiac rehabilitation (CR) patients is limited. The aims
of this study were to determine the prevalence rates for current
and lifetime anxiety disorders in CR patients, and to examine
the association between anxiety disorders and demographic
and health-related variables. Participants included 132 CR
patients (mean age = 66, 28% female, 75% married, 89% Cauca-
sian). Current and lifetime prevalence of anxiety disorders were
assessed using the anxiety disorders module of the SCID-IV.
31.1% of CR patients met criteria for a current anxiety disorder,
while 49.1% of patients met criteria for an anxiety disorder at
some point in their lifetime. The most common anxiety disor-
ders were specific phobia (15.9% current, 27.3% lifetime) and so-
cial phobia (13.6% current, 25.8% lifetime). GAD (9.8% Current),
panic disorder/agoraphobia (9.1% current, 14.4% lifetime), and
PTSD (3.8% current, 11.4% lifetime) were also common, while
prevalence rates of OCD were low (.8% current, 1.5% lifetime).
Females were significantly more likely to experience current
(p = .01) and lifetime anxiety disorders (p = .01) than males.
Anxiety disorders were also more prevalent in younger (cur-
rent, p = .01, lifetime, p = .01), less educated (current, p = .05,
lifetime, p = .01), and non-white (current, p = .01, lifetime, = .01)
patients. SRH was lower in patients with lifetime anxiety disor-
ders (p = .05) though not current anxiety disorders. Those with
a history of smoking were more likely to have lifetime anxiety
disorders (p = .05). Findings suggest that anxiety disorders are
highly prevalent in CR patients and are related to demographic
and health-related variables. Future research should determine
optimal methods to screen for anxiety disorders and the impact
of anxiety disorders on CR outcomes.
CORRESPONDING AUTHOR: Sumner J. Sydeman, PhD,
Psychology, Northern Arizona University, Flagstaff, AZ, 86011;
sumner.sydeman@nau.edu
C-038g
THE EFFECT OF APPLIED MUSCLE TENSION ON CHANGES
IN CEREBRAL OXYGENATION DURING BLOOD DONATION
Jennifer M. Kowalsky, BA, BS and Christopher R. France, PhD
Psychology, Ohio University, Athens, OH.
Applied muscle tensing, which is a technique that involves
repeated tensing the muscles of the legs and abdomen at five
second intervals, has been used with success to delay or prevent
pre-syncopal symptoms (e.g., dizziness, lightheadedness)
experienced by blood donors. The purpose of this study was
to examine the effects of applied muscle tensing on changes in
cerebral oxygenation during blood donation using near infrared
spectroscopy (INVOS 5100, Somanetics, Troy, MI). Eighteen fe-
53
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
applied muscle tensing or a placebo manipulation that involved
repeated, gentle flexing of the feet at five second intervals
during their blood donation. Donors in the sample were, on
average, 37 years of age (SD = 16, range = 18-61), and had previ-
ously donated blood an average of seven times (SD = 8, range
= 0-30). The two groups did not differ significantly on these or
other demographic variables. Results of correlation analyses
revealed that state anxiety and number of prior donations were
positively associated with cerebral oxygenation levels during
the blood draw (r = 0.48, p < 0.05; r = 0.58, p < 0.01, respective-
ly).After controlling for number of previous donations, partici-
pants who engaged in applied muscle tensing were shown to
have smaller decreases in cerebral oxygenation during blood
draw relative to the placebo manipulation, F(1, 15) = 5.326, p =
0.036, η2 = 0.26. These findings suggest that the beneficial effects
of reduced pre-syncopal symptoms following applied muscle
tensing may be the result of an increase in oxygen available to
the brain.
CORRESPONDING AUTHOR: Jennifer M. Kowalsky, BA, BS,
Psychology, Ohio University, Athens, OH, 45701; jk167608@
ohio.edu
C-038h
CHANGE IN SYMPTOMS OF DEPRESSION IN MINORITY
SUBJECTS AT RISK FOR CVD : RANDOMIZED CONTROLLED
MIND-BODY INTERVENTION TRIALS
Sanford Nidich, EdD,1 Mark Toomey, PhD,1 Hector Myers,
PhD,3 Maxwell Rainforth, PhD,1 Andrew Grandinetti, PhD,2
John Salerno, PhD,1 Carolyn Gaylord-King, PhD1 and Robert
Schneider, MD1
1
Maharishi University of Management Research Institute,
Fairfield, IA; 2University of Hawaii, Honolulu, HI and 3Charles
Drew University Medicine and Science, Los Angeles, CA.
Depression is an important risk factor for the development
and progression of cardiovascular disease (CVD). For example,
research has found that a dose-response effect exists whereby
the level of depressive symptoms is linearly associated with
development of cardiac events. This presentation reports on
the recent analysis of change in depressive symptoms from two
National Institute of Health-sponsored randomized controlled
mind-body intervention trials with older minority subjects at
risk for CVD. Both studies selected minority groups, African
American and Native Hawaiian, respectively, who have higher
risk for CVD than the majority population. Both studies com-
pared the effects of Transcendental Meditation (TM) to health
education (HE), controlling for time and attention, using the
Center for Epidemiological Studies Depression (CESD) scale.
All subjects had at least one major risk factor for CVD and were
55 years or older. The first study conducted in South Central
Los Angeles had 80 African American subjects (39 in the TM
group and 41 in HE) who completed CESD testing (overall
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
(mean = -1.59) compared to HE (+1.36; p = 0.049) over 9 months.
Results of these trials indicate that mind-body interventions
such as Transcendental Meditation may be effective in reduc-
ing depressive symptoms in older minority subjects at risk for
CVD. Possible mechanisms are discussed.
CORRESPONDING AUTHOR: Sanford Nidich, EdD, Mahari-
shi University of Management Research Institute, Fairfield, IA,
52556; snidich@mum.edu
C-046a
PARENT-ADOLESCENT NEGOTIATION OF DIABETES-
RELATED CONFLICTS
Dianne K. Palladino, BS and Vicki S. Helgeson, PhD
Department of Psychology, Carnegie Mellon University,
Pittsburgh, PA.
To explore how parents and adolescents negotiate conflict
around diabetes-related tasks, and to study what aspects of
caregiving are related to conflict resolution, we videotaped 30
adolescents with type 1 diabetes (mean age 18) and their par-
ents discussing a diabetes-related conflict. The most common
sources of diabetes-related conflict were testing and logging
blood glucose results. Two independent raters coded videos of
adolescent and parent behavior using a well-established scor-
ing scheme. Parent hostility was the most robust predictor of
adolescent outcomes, including less conflict resolution (r = -.47,
p < .01), conflict persistence (r = .59, p = .001), more negative
impressions of the discussion (r=-.80, p < .001), and increases
in negative affect following the discussion (β=.27, p < .05).
By contrast, parent supportive behavior was associated with
greater conflict resolution (r=.42, p = < .05) and perceiving one
was treated well during the discussion (r = .24, p = .06). When
parents granted autonomy to adolescents during the discussion,
adolescents perceived greater progress toward conflict resolu-
tion (r = .46, p = .01). When examining the adolescent’s behav-
ior, adolescent hostility again was the most robust predictor of
adolescent outcomes, including less conflict resolution (r = -.44,
p < .05) and more negative emotions (r = -.62, p < .001). Interest-
ingly, adolescent assertions of autonomy were correlated with
more negative impressions of the discussion (r = -.50, p < .01),
believing that the conversation hindered progress (r = .41, p <
.05), and conflict persistence (r = .38, p < .05). We contacted ado-
lescents six months later to examine conflict status and changes
in behavior. Parent instrumental support during the discussion
was related to follow-up reports of greater conflict resolution
(r= .46, p<.05) and positive changes in diabetes self care (r=.39,
p =.06). Parent granting of autonomy was related to the per-
ception that the discussion was helpful (r= .47, p < .05). These
results can be used to design interventions that help adolescents
work with parents to negotiate better self care.
CORRESPONDING AUTHOR: Dianne K. Palladino, BS, School
of Psychology, Carnegie Mellon University, Pittsburgh, PA,
15217; dkpalladino@cmu.edu
C-046b
EVALUATION OF A PEER-LED DIABETES EDUCATION
PROGRAM FOR DIVERSE LATINOS
Levi Ross, PhD,1 Lina Jandorf, MA,2 Deborah O. Erwin, PhD,1
Linda D. Thélémaque, MA2 and Rachel Shelton, PhD2
1
Office of Cancer Health Disparities Research, Roswell Park
Cancer Institute, Buffalo, NY and 2Mount Sinai School of
Medicine, New York, NY.
Latinos are a high priority population for diabetes research in
the United States (US). The current study assessed the reach and
effectiveness of a peer-led, group diabetes education program
among a diverse sample of Latinos in Arkansas (AR), New
York, NY (NYC), and Buffalo, NY (BUF). The educational pro-
gram was developed with a focus on screening for and prevent-
ing type II diabetes among healthy Latinos. At each program,
bilingual program staff and peer volunteers provided partici-
pants with information on (1) causation and risk factors, (2) pre-
vention, (3) screening, and (4) disease consequences. A pre-and
posttest was administered to collect demographic information,
testing history, and diabetes knowledge. To overcome literacy
related barriers, all questions were read aloud to participants
and responses were collected, anonymously, using electronic
key pads. Between August 2007 - November 2009, 72 education-
al programs were delivered to 952 participants. The majority
of programs (89%) were conducted in Spanish. The program
reached a diverse population of Latinos as illustrated by coun-
try of birth—Mexico (32%), Puerto Rico (25%), other Hispanic
countries (30%), and the US (12%). Bivariate analyses (Chi-
square, t-tests, and analysis of variance [ANOVA]) revealed that
individual sites were reaching different subgroups according to
participant’s gender (p < .01), age (p < .01), country of birth (p
< .01), number of years resided in the US (p < .01), and spoken
language preference (p < .01). Results from repeated measures
analysis of covariance, with demographic and programmatic
variables as covariates, indicated that the posttest knowledge
score for the entire sample (77.71) was significantly higher than
the pretest score (53.25) (p < .05). These findings show that there
is geographic and ethnic diversity among Hispanics regarding
knowledge of diabetes and diabetes prevention. Opportunities
and challenges related to further cultural enhancements to this
effective educational program will be discussed.
CORRESPONDING AUTHOR: Levi Ross, PhD, Office of Can-
cer Health Disparities, Roswell Park Cancer Institute, Buffalo,
NY, New York; levi.ross@roswellpark.org
C-046c
RELIABILITY AND VALIDITY OF A THEORETICALLY-BASED
DIABETES SELF-MANAGEMENT ASSESSMENT TOOL
Barbara Stetson, PhD,1 David Schlundt, PhD,2 Chelsea
Rothschild, MA,1 Whitney Rogers, BA,1 Floyd Jennifer, BA,1
Sathya Krishnasamy, MD1 and Sri Prakash Mokshagundam,
MD1
1
University of Louisville, Louisville, KY and 2Vanderbilt
University, Nashville, TN.
There are few validated comprehensive measures of diabetes
self-management to guide theoretically-based interventions to
promote behavior change. Also lacking are studies of diabetes
self-management in diverse patient samples and settings. Us-
ing 2 diverse samples of adults with type 2 diabetes (N=844),
this study examined the reliability and validity of the Personal
Diabetes Questionnaire (PDQ), a tool based on Social Learning
Theory, that assesses self-management behaviors and barriers
for planning behavioral interventions. Sample 1 was 589 adults
from a hospital-based diabetes clinic, serving primarily private-
ly insured(94% White American, 6% African American/Hispan-
ic,47% male, M age=55 years, M HbA1-c=8.14). Sample 2 was
255 adults from University and Health Department programs
serving predominantly low income,uninsured or with Medicaid
managed care(55% White American, 44% African American,
40% male, M age=58 years, HBA1-c values not available). The
PDQ exhibited good internal consistencies for both samples,
for subscales reflecting Diet Knowledge and Skill (DKS), Diet
Decision Making,Problematic Eating Patterns and Barriers to
Diet(BD), Exercise (BEx),BG Testing (BTest),Medication Use
(BMed; Chronbach α range=.737-.865). Both samples yielded
adequate reliability for a Perceived Blood Glucose Control
subscale(PBGC; αs=.522 & .563). PDQ Scores were comparable
in the samples; Sample 2 had more Testing(p=.013) and Medica-
tion Use (p=.012)Barriers and lower DKS (p<.001). Predictive
validity was examined via PDQ associations with BMI in both
Samples and with HBA1-c in Sample 1. Separate regressions
controlled for age and sex, then added PDQ subscales. Signifi-
cant changes in R2 in associations with BMI were observed in
both samples for BEx(p=.011), BMeds (p=.022)and the full set of
PDQ scales (p=.002). Significant changes in R2 in associations
with HbA1-c were observed for PBGC (p=.004)and the full set
of PDQ scales (p=.002). Data support the use of the PDQ across
diverse patient and diabetes care settings.
CORRESPONDING AUTHOR: Barbara Stetson, PhD, Uni-
versity of Louisville, Louisville, KY, 40292; barbara.stetson@
louisville.edu
C-050a
SIMULATION STUDY OF MODIFICATIONS FOR IMPROVING
THE ACCURACY OF THE MANTEL-HAENSZEL (MH) AND
OTHER OBSERVED SCORE STATISTICAL PROCEDURES FOR
ASSESSING ETHNIC ITEM BIAS IN BEHAVIORAL MEDICINE
Patrick Monahan, PhD
Division of Biostatistics, Indiana University, Indianapolis, IN.
An important aspect of scale validity in behavioral medicine
involves assessing item bias in ethnic groups using statistical
Differential Item Functioning (DIF) procedures. The problem
is: when the DIF matching score is either less than perfectly
reliable or not a sufficient statistic for determining latent
proficiency in data conforming to item response theory (IRT)
models, substantial Type I error (TIE) inflation may occur for
any DIF procedure (e.g., the popular MH method) that matches
on summed-item score. Alternative matching scores were
developed based on sufficient statistics, reliability, and explicit
corrections for measurement error. Simulation factors were
tests (20, 24, 26 items), reference/focal sample sizes (1000/1000,
800/200), proficiency distributions (identical, means differed,
variances differed, means and variances differed), and simula-
tion technique (three-parameter logistic IRT model, and four-
parameter beta compound-binomial model with nonparametric
non-monotonic item-true score step functions). Outcomes were:
TIE of MH chi-square test at the .05 nominal level, and the bias,
standard error (SE) and root mean square error (RMSE) of the
MH delta-DIF (MH-D-DIF) statistic under null-DIF conditions.
Of eight categorized alternative matching scores, four scores
55
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
controlled TIE as well as or better than traditional summed-item
score in almost all items for all conditions: (a) estimated latent
proficiency from a 3PL IRT model; (b) the sum of weighted item
scores where the weight was the item-total score biserial corre-
lation coefficient excluding the item from total score; (c) the sum
of weighted item scores where the weight was the item loading
on the single common factor from factor analysis of tetrachoric
correlation coefficients; and (d) Kelley’s linear regressed true
score estimate.
CORRESPONDING AUTHOR: Patrick Monahan, PhD, Divi-
sion of Biostatistics, Indiana University, Indianapolis, IN, 46202;
pmonahan@iupui.edu
C-050b
PATIENTS ARE READY FOR DELIBERATION AND
INFORMATION
Odette Wegwarth, PhD
Harding Center for Risk Literacy, Max Planck Institute for
Human Development, Berlin, Germany.
Background: Although the scientific medical community agrees
that patients should receive sufficient information about medi-
cal actions, in practice doubts often remain whether patients
possess the cognitive capacity to use this information effec-
tively. Moreover, concepts such as less-is-more and deliber-
ation-without-attention suggest that people’s decisions may
suffer from excessive information and deliberation. Our study
investigated whether the amount of information and time of
deliberation negatively impact patients and whether the impact
depends on the severity of the medical situation.
Method: We asked 160 women (mean age: 63) to make hy-
pothetical choices between a) two treatments on breast can-
cer (severe situation) and b) two treatments on menopausal
symptoms (non-severe situation). Amount of information (10
versus 5 pieces per medical situation) and time for deliberation
(immediate decision versus after 1 week per medical situation)
was varied by a 2 x 2 design. Women were randomly assigned
to either of these four conditions. For each of the two medical
situations, decisional conflict (DC) and the selected decision
making strategy was measured. Results were controlled for
numeracy and need-for-cognition (NFC).
Results: No meaningful differences in DC or in the selection
of different decision making strategies was found between
the four conditions. However, DC was higher for the severe
medical situation than the non-severe situation within three
conditions (10, immediate: p > .01, r = -.39; 10, 1 week: p = .01,
r = -.36; 5, immediate: p = .04, r = -.28), albeit not in the fourth.
At the same time, severity of the medical situation did not
influence the selection of decision strategies. Different levels of
numeracy and NFC did not affect results.
Conclusion: Neither more information nor more time for
deliberation had any notable impact on their DC or selection of
decision making strategy. Patients thus appear to be able to deal
with a sufficient amount of information and deliberation—a
finding that will hopefully inspire an upsurge of informed deci-
sion making in practice.
CORRESPONDING AUTHOR: Odette Wegwarth, PhD, Hard-
ing Center for Risk Literacy, Max Planck Institut for Human
Development, Berlin, 14195; wegwarth@mpib-berlin.mpg.de
56
C-050d
THE NIH TOOLBOX - ASSESSMENT OF NEUROLOGICAL AND
BEHAVIORAL FUNCTION
Sureyya Dikmen, PhD,1 Richard Gershon, PhD,2 Molly Wagster,
PhD,3 David Cella, PhD,4 Nathan Fox, PhD,5 Hugh Hendrie,
MB,ChB,DSc6 and Richard Havlik, PhD7
1
University of Washington, Seattle, WA; 2Northwestern
University, Chicago, IL; 3National Institude on Aging, Bethesda,
MD; 4Northwestern University, Chicago, IL; 5University of
Maryland, College Park, MD; 6Westat Inc, Rockville, MD and
7
Indiana University Center for Aging Research, Indianapolis,
IN.
OBJECTIVES :
The NIH Toolbox for Assessment of Neurological and Behav-
ioral Function is a project to identify, create and validate brief
comprehensive assessment tools to measure outcomes in lon-
gitudinal, epidemiological and intervention studies across the
life span in the areas of cognition, emotion, motor and sensory
function. The project is one of the initiatives in the NIH Blue-
print for Neuroscience Research.
METHODS:
This is a five year project that involves the following phases
Phase I (2006-2007)- identification of content areas, expert inter-
views, research on instrumentation, and development of draft
instruments.
Phase II A (2008-2009)- Calibration of items for CAT instru-
ments, validation testing of new instruments, final instrument
selection, Spanish translations, development of single technol-
ogy platform, materials production.
Phase II B (2010-2011)- National norming study that involves
national random sample of 4,600 subjects Ages 3-85. All pri-
mary batteries will be administered to the entire sample.
Phase IIC (2011)-calculate scoring crosswalks with legacy in-
struments, develop technical manual, delivery final Toolbox at
a public conference.
CONCLUSIONS
The NIH Toolbox will allow: 1) Standardized measures to be
easily compared across studies; 2) Crosswalks to “gold stan-
dard” instruments; 3) Easily incorporate multiple areas of neu-
rological functioning (cognitive, motor, emotional and sensory);
4) Inexpensive equipment, no royalties; 5) Cutting edge, short
measures. The NIH Toolbox is intended to provide a form of
“common currency” across diverse study designs and popula-
tions and maximize yield from large, expensive studies with
minimal increment in subject burden and cost.
CORRESPONDING AUTHOR: Sureyya Dikmen, PhD, Univer-
sity of Washington, Seattle, WA, 98104; dikmen@u.washington.
edu
C-050e
ALIGNING THEORY WITH PRACTICE: UNDERSTANDING
PARENTAL INVOLVEMENT IN AN INNER-CITY HIGH
SCHOOL
Terrinieka Williams, PhD,1 Bernadette Sanchez, PhD2 and
Jessica Hunnell, BA3
1
School of Public Health, University of Michigan, Ann Arbor,
MI; 2Psychology, DePaul University, Chicago, IL and 3Center
for Community Research, DePaul University, Chicago, IL.
Ideally, theoretical constructs and real world practice should be
closely related. This study was interested in the ways in which
ecological principles (i.e., cycling of resources, adaptation,
interdependence, and succession) were reflected in parental
involvement. Parents (n = 15) and school personnel (n = 10)
at a predominantly African American inner city high school
completed in-depth interviews regarding their conceptualiza-
tions of parental involvement, home-school interactions and
strengths and weaknesses of home-school communication. Four
major themes emerged to highlight the connection between the
theoretical principles of ecology and the practice of parental
involvement: effective communication, initiation of contact,
serve and protect, and contextual conditions. Although theory
and practice overlap, study findings suggest ways in which the
ecological principals might expand to better align with the prac-
tice of parental involvement in inner city high schools. Future
directions for theory and practice are discussed.
CORRESPONDING AUTHOR: Terrinieka Williams, PhD,
School of Public Health, University of Michigan, Ann Arbor,
MI, 48105; terriwil@umich.edu
C-060a
DOSE-EFFECT OF A COUNSELING INTERVENTION TO
IMPROVE ANTIRETROVIRAL ADHERENCE AMONG HIV-
INFECTED DRUG USERS ON METHADONE MAINTENANCE
TREATMENT
Nina Cooperman, PsyD,1 Moonseong Heo, PhD,2 Berg Karina,
MD2 and Julia H. Arnsten, MD2
1
UMDNJ-Robert Wood Johnson Medical School, New
Brunswick, NJ and 2Albert Einstein College of Medicine, Brons,
NY.
Adherence counseling interventions can improve antiretro-
viral adherence and related health outcomes in HIV-infected
individuals. However, little is known about how much adher-
ence counseling is necessary to achieve clinically significant
effects. Therefore, we investigated changes in 7-day antiret-
roviral adherence and HIV viral load relative to the amount
of a voluntary adherence counseling intervention offered to a
sample of 57 HIV-infected, methadone maintained drug users
over a 72 week period. The intervention combined motivational
interviewing and cognitive-behavioral techniques, and was
designed to be approximately six 45-60 minute individual coun-
seling sessions with unlimited additional “booster” sessions,
as needed. All participants were offered adherence counseling,
and 34 (60%) participated in at least one session. The entire
sample, on average, received 1.35 hours of counseling (SD=1.67,
range=0.00-7.05). Participants who attended adherence coun-
seling sessions received a mean of 2.26 hours of counseling
(SD=1.62, range=.50-7.05). Mixed effects models of within sub-
ject longitudinal outcomes revealed a significant quadratic rela-
tionship between number of hours of adherence counseling and
changes in viral load from baseline to 72 weeks. In the entire
sample, compared to baseline, viral load increased among those
who received 0 to 2.75 total hours of counseling, decreased to
baseline levels for those with 2.75 total hours to 5 total hours
of counseling, and decreased below baseline levels for those
with 5.5 hours of counseling. From 5.5 to 10 hours of counsel-
ing viral load continued to decrease with each additional hour
of counseling. These results suggest a dynamic dose-response
relationship between amount of adherence counseling and viral
load response, with longer interventions associated with better
viral load outcomes.
CORRESPONDING AUTHOR: Nina Cooperman, PsyD, UMD-
NJ-Robert Wood Johnson Medical School, New Brunswick, NJ,
08901; cooperna@umdnj.edu
C-060b
COMPARING HIV PREVALENCE, KNOWLEDGE, AND RISK
BEHAVIOR BETWEEN FEMALE SEX WORKERS AND AT-RISK
NON-SEX WORKERS IN MUMBAI, INDIA
Nina Cooperman, PsyD,1 Jayanthi Shastri, MD,2 Aditi Shastri,
MD3 and Ellie E. Schoenbaum, MD4
1
UMDNJ-Robert Wood Johnson Medical School, New
Brunswick, NJ; 2Nair Hospital & Topiwala National Medical
College, Mumbai, India; 3Baylor College of Medicine, Houston,
TX and 4Albert Einstein College of Medicine, Bronx, NY.
In Mumbai, India, 42.4% of sex workers are estimated to be
HIV-infected, and the rate of infection among monogamous
married women is increasing. However, research investigating
HIV prevalence, knowledge, and risk behavior among women
in India is in its infancy. Therefore, we investigated HIV preva-
lence, knowledge, and risk behavior among 300 disadvantaged
women seeking treatment at a women’s sexually transmitted
disease clinic in Mumbai, India, and compared HIV prevalence,
knowledge, and risk behavior between sex-workers and at-risk
non-sex-workers. Study participants completed a questionnaire
with an interviewer and were tested for HIV. On average, the
women were 30 years old; over 90% of the women lived on
<5000 Rs (approximately $100) a month; and, 42% of both the
sex workers and non-sex workers were married. Thirty-nine
percent were found to be HIV-infected, with no significant
difference in prevalence between the sex workers and non-sex
workers (40% vs. 36%). Although the HIV prevalence rates were
similar, the sex workers had a greater number of sex partners in
the past year than the non-sex workers (median=722.0 vs. 1.0).
A smaller proportion of the sex workers used condoms with
all of their sexual partners than the non-sex workers (62% vs.
74%). Eighty-three percent of the women ever heard of HIV and
received education about HIV, with no significant differences
between the sex workers and non-sex workers. However, a
significantly greater percentage of the sex workers (98.3%) ever
heard of a condom as compared the non-sex workers (89.7%).
The similarly high HIV prevalence among the sex workers and
non-sex workers indicate the need for HIV testing for all at-risk
women, including sex workers and monogamous, non-sex
workers, in India. Further, Indian women, sex workers and
non-sex workers, need more education about HIV and tailored
interventions to increase condom use.
CORRESPONDING AUTHOR: Nina Cooperman, PsyD, UMD-
NJ-Robert Wood Johnson Medical School, New Brunswick, NJ,
08901; cooperna@umdnj.edu
57
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-060c
TRAUMA HISTORY AND HIV RISK BEHAVIOR
Sheela Raja, PhD,1 Christine Holland, MA,1 Kristi Allgood,
MPH,2 David McKirnan, PhD1 and Nancy Glick, PhD2
1
University of Illinois at Chicago, Chicago, IL and 2Mount Sinai
Hospital, Chicago, IL.
Background: As HIV continues to disproportionately af-
fect African American communities, there is a growing need
to understand the predictors of sexual risk behavior in this
population. This cross-sectional study of HIV+ clients in a large,
urban hospital setting explored the role of a history of traumatic
events on sexual risk behavior. Methods/Participants: As part
of a Health Resources and Services Administration initiative,
HIV+ participants (n=174) enrolled in an intervention aimed
at reducing high risk behavior. Using Audio Computer As-
sisted Self-Interview software, participants completed baseline
measures of sexual risk behavior, trauma history, and other
psychosocial variables (e.g., depression, stigma). Participants
were mostly African American (87%) and had high rates of
current depression (52%). Many (57%) reported they had been
a victim of violence in their lifetime (domestic violence, sexual
assault, and street violence). Results: Unprotected vaginal or
anal sex (UPAV) in the last 6 months was prevalent in this
sample (26.6% for both men and women). After controlling
for demographics, the psychosocial variables (e.g., HIV treat-
ment optimism, religiosity, stigma, social support, alcohol and
drug use) did not predict UPAV. In a series of stepwise logistic
regression equations, we found that a history of domestic and
street violence was predictive of sexual risk behavior for men
and women in our sample; street violence was overwhelming
associated with risk for women. Neither depression nor anxiety
retained the ability to predict UPAV after controlling for the
effect of violence. Discussion: This study suggests that future
prevention efforts must examine the role of violence in sexual
risk, particularly street violence. Because anxiety and depres-
sion did not moderate the relationship between violence and
UPAV in this study, future studies may want to measure “cog-
nitive escape” variables, such as distancing from negative affect
as possible moderators between trauma history and sexual risk.
CORRESPONDING AUTHOR: Sheela Raja, PhD, University of
Illinois at Chicago, Chicago, IL, 60612; sheelaraja@gmail.com
C-060d
THE APPLICABILITY OF THE CIQOL MODEL TO OLDER HIV-
POSITIVE MEN LIVING IN URBAN AREAS
Valessa St. Pierre, BS /BA, Bernadette Heckman, PhD, Timothy
Heckman, PhD and Francis Bellezza, PhD
Psychology, Ohio University, Athens, OH.
Advances in medicine have allowed those infected with HIV/
AIDS to live 30 years past their diagnosis. HIV/AIDS is now
perceived as a chronic illness with greater focus placed on
enhancing general well-being (GWB). The Chronic Illness Qual-
ity of Life (CIQOL) model posits shame, physical well-being
(PWB), barriers to care (BACS), engagement coping (ENG), and
social support (SS) impact one’s overall well-being (Heckman,
2003).While excellent fit was demonstrated from the CIQOL
model to a heterogeneous rural sample (Heckman, 2003), the
fit of the CIQOL model to an urban sample was unknown. The
literature suggests BACS are a particular burden for individu-
als residing in rural locations compared to those living in urban
58
areas. The current study will determine whether the CIQOL
model will apply to an older male urban sample living with
HIV/AIDS. Participants were 160 HIV infected men (n= 84
Caucasian, n= 76 African American) recruited from New York
City, Columbus, OH and Cincinnati, OH. The average partici-
pant was 55.0 years of age (min=50, max = 73), received a high
school diploma (77%), and unemployed (90%). Surveys were
completed on shame, PWB, BACS, SS, ENG, and GWB dur-
ing the pre-intervention assessment period of an AIDS mental
health randomized clinical trial.
Structural equation modeling assessed model fit between the
data and the CIQOL model. Fit indices indicated that the CI-
QOL model was a poor fit for the urban sample, X2(6, N=160)
= 68.6 p <.0001, CFI =.75, NFI= .75, RMSEA = .26. However,
excellent fit was found with a new model constructed without
the path between BACS and GWB X2(2, N=160) = 1.405 p >.495,
CFI =1.00, NFI= .99, RMSEA = .00.
CORRESPONDING AUTHOR: Valessa St. Pierre, BS /BA, Psy-
chology, Ohio University, Athens, OH, 45701; valessastpierre@
gmail.com
C-060e
TRAUMA TOPICS DIFFER BETWEEN HIV+ MEN AND WOMEN
IN AN EXPRESSIVE WRITING INTERVENTION
Rachel Kuhn, MS, Gail Ironson, MD, PhD, Jonathan Atwood,
BA and Neil Schneiderman, PhD
University of Miami, Miami, FL.
Expressive writing (EW) has increasingly been examined as a
treatment for trauma-related symptoms in general and health
populations. HIV+ individuals have shown improvements in
health outcomes following EW, but no studies to date have
examined the impact on PTSD symptoms in this population.
EW may be particularly beneficial for HIV+ individuals, as high
rates of lifetime trauma have been found in this population.
The present study compared HIV+ men (n = 67) and women
(n = 50) on the severity and topic of traumatic life events that
they chose to write about during an EW session. Participants
were asked to write expressively about their most traumatic
life experiences for 30 minutes. Severity was rated on a 7-point
Likert scale (7 = highest severity), and trauma topic was divided
into 5 categories: death of a loved one, childhood trauma, adult-
hood physical/sexual trauma, HIV-related trauma, and “other”
(e.g. social or financial stressors, trauma to a loved one). Results
show that men and women were not significantly different on
the severity of traumas (t(115) = .320, p = .750; men M = 4.55
(SD = 1.41); women M = 4.64 (SD = 1.56), but were significantly
different on trauma topic (χ2(4) = 11.01, p = .027). A significant-
ly higher frequency of men wrote about HIV-related trauma
compared to women (p = .021), with 29.9% of the men writing
about this topic versus only 12.0% of the women. A significantly
higher frequency of women wrote about childhood trauma
compared to men (p = .005), with 24.0% of women writing
about this topic versus 6.0% of men. The two groups were not
significantly different in the frequency of trauma topics writ-
ten about for death (men = 19.4%, women = 18.0%), adulthood
trauma (men = 10.4%, women = 12.0%), or “other” traumas
(men = 34.3%, women = 34.0%). While HIV+ men and women
were similar in the severity of traumas disclosed during EW,
there were marked differences in type of trauma. The presence
of gender differences in type of traumatic experiences may have
implications for the efficacy of this brief intervention in com-
parison to full scale trauma-targeted therapy.
CORRESPONDING AUTHOR: Rachel Kuhn, MS, University of
Miami, Miami, FL, 33145; rkuhn@psy.miami.edu
C-060f
HIV RISK AMONG DEPORTED MEXICAN MIGRANTS
Ana Martinez-Donate, PhD,1,2 Gudelia Rangel, PhD,3 Melbourne
F. Hovell, PhD, MPH,2 Jennifer A. Zellner, PhD,2 Carol L. Sipan,
RN, MPH,2 Rodolfo Corona, MS,3 Norma J. Kelley, BS2 and
Ahmed Asadi, MA2,3
1
University of Wisconsin - Madison, Madison, WI; 2San Diego
State University, San Diego, CA and 3El Colegio de la Frontera
Norte, Tijuana, Mexico.
This binational study investigated the prevalence of HIV risk
practices among Mexican migrants and immigrants (MMIs)
who are returned from the US to Mexico by immigration
authorities. From August to November 2009, a cross-sectional,
probability survey was conducted with deported MMIs, imme-
diately after their release by Mexican immigration authorities
in Tijuana (N=674; response rate 96%). Respondents completed
an anonymous questionnaire on HIV-related practices and
theoretical determinants, based on the Behavioral Ecological
Model. Deported MMIs were mostly male (93%), young (Mean
= 32, SD = 9.1), and low educated (15% had completed high
school or higher). On average, they had spent 8.7 years in the
US (SD=8.7) and had been deported 2.6 times (SD = 3.0). Results
indicated high rates of last 12-month multiple sexual partners
(39% of males; 18% of females), unprotected vaginal or anal sex
(60% of males; 57% of females), sex with casual partners or sex
workers (34.3% of males; 14.3% of females), and unprotected
sex with casual partners or sex workers (17% of males; 8.2% of
females). Sex with intravenous drug users (6.2% of males; 2.0%
of females) and individuals who have multiple partners (18.2%
of males and 13.3% of females) was also prevalent. About 46%
had never been tested for HIV and only 26% had been tested
during the last 12 months. Lifetime and last-12 month history
of other sexually transmitted infections was 22.6% and 8.5%,
respectively. Most MMIs (67%) were planning to return to the
US. HIV risk did not vary with amount of time spent in the US.
Perceived discrimination, acculturative stress, availability of
social support, and previous history of deportation were posi-
tively associated with HIV risk. Binational collaborative efforts
in Mexico and the US are necessary to reduce HIV risk and im-
prove health care access among this hard-to-reach, underserved
population.
CORRESPONDING AUTHOR: Ana Martinez-Donate, PhD,
Population Health Sciences, University of Wisconsin - Madison,
Madison, WI, 53726; martinezdona@wisc.edu
C-060g
RELATIONS AMONG ADHERENCE ASSESSMENT AND
BIOMARKERS IN YOUTH WITH HIV: DOES CONCURRENT
VIRAL LOAD AND CD4 MEASUREMENT OUTPERFORM
STANDARD OF CARE COMPARISONS?
Patricia A. Garvie, PhD, Megan L. Wilkins, PhD, Ronald H.
Dallas, MA, Sean D. Hollis, BA and Ericka L. Midgett, MA
St. Jude Children’s Research Hospital, Memphis, TN.
Background: No gold standard exists to assess antiretroviral
medication adherence. Validation of adherence measures in-
volves comparison with HIV biomarkers (VL, CD4 count (CD4)
& CD4%) that reflect illness-related health status. Studies report
accepted comparison of biomarkers obtained within +/-90
days of adherence assessment. This study aimed to evaluate the
value of concurrent (same day) HIV biomarker and adherence
measurement in comparison to standard of care (SOC).
Methods: Youth with behaviorally acquired HIV participated in
a prospective cross-sectional pilot study that included concur-
rent medication adherence assessment with biomarkers. Partici-
pants (n=61): Age: M=19.9 years (SD=1.98); Gender: Male (51%);
Race: African American (90%), Caucasian (5%), Latino (3%).
Medication adherence assessment included pharmacy pill count
(PC), 3-day recall of doses missed (3DM) and of doses taken
off-schedule (3DO) collected concurrently with CD4, CD4% and
VL. To examine contribution of more stringent concurrent data
collection over SOC, a retrospective chart review of VL, CD4
and CD4% within a +/-120 day window occurred. Analyses
consisted of Pearson correlations.
Results: CD4 and CD4% measured within 120 days pre- adher-
ence assessment marginally related to PC (p=.08) and 3DO
(p=.07). No other correlations among CD4 and CD4% with the 3
adherence strategies were significant. Dichotomized detectable
VL collected concurrently (PC p=.04, 3DM p=.01, 3DO p=.03)
and within 120 days post- (p=.02, p=.03, p=.03, respectively)
adherence assessment significantly related with each adherence
strategy.
Conclusions: HIV biomarkers collected concurrently with and
within 120 days post adherence assessment relationally outper-
formed biomarkers collected prior to adherence assessment.
Findings negate use of biomarkers collected prior to adherence
assessment as proxies for adherence or to validate adherence
assessment tools. Implications for research and clinical practice
will be discussed.
CORRESPONDING AUTHOR: Megan Wilkins, PhD, St. Jude
Children’s Research Hospital, Memphis, TN, 38107; megan.
wilkins@stjude.org
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)
from the population-based Lipid Research Clinics Princeton
Follow-Up Study including 432 parents (age 66.5+/-6.6 years)
and 1022 adult children (age 39.9+/-4.9 years). Dietary intake
was measured with the Block Quantified Food Frequency Ques-
tionnaire. Fruit and vegetable intake was defined as the number
of servings per day. A mixed-effect multivariate analysis ex-
amined associations between fruit and vegetable intake and all
covariates (age, sex, education, marital status, race and genera-
tion), adjusted for within-family correlation. In fully-adjusted
model, sex, age, and education were independently associated
with fruit and vegetable consumption. Females consumed 0.38
more fruit and vegetable servings per day than males (p=0.01).
Compared to participants with some high school education,
participants with some college education consumed 0.70 more
servings of fruit and vegetables per day (p=0.01); participants
with a bachelor’s degree consumed 0.78 more servings per day
(p< 0.01) and participants with a graduate degree consumed
1.67 more servings per day (p<0.01). Fruit and vegetable intake
increased with increasing educational level (p for trend <0.001).
With every year increase in age, participants consumed 0.04
more servings of fruit and vegetables per day (p=0.01). Results
of this population-based study indicate females consume more
fruits and vegetables than males;educational level and age posi-
tively and significantly influence daily consumption of fruit and
vegetables. No multigenerational clustering of dietary behav-
iors was observed. The mechanisms through which sociodemo-
graphic characteristics influence dietary behaviors remain to be
fully explicated.
CORRESPONDING AUTHOR: Magdalene M. Horton, Bache-
lors, nursing, University of Massachusetts Boston, Quincy, MA,
02169; Magdalene.horton@gmail.com
C-064b
IMPLEMENTATION AND IMPACT OF IOM SCHOOL
NUTRITION GUIDELINES: WEST VIRGINIA STANDARDS FOR
SCHOOL NUTRITION
Andrew S. Bradlyn, PhD,1 Carole V. Harris, PhD,1 Richard
Goff, MBA,2 Mollie Wood, MPA,2 Don Chapman, MA,4 Keri
Kennedy, MPH,3 Kristy Blower, MA,3 Melanie Purkey, MA,4
Nancy O. Tompkins, PhD,5 Lucas Moore, EdD,1 Kim Blake,
MBA PharmD1 and Stephanie Frost, MA1
1
Health Research Center, West Virginia University,
Morgantown, WV; 2Office of Child Nutrition, WV Department
of Education, Charleston, WV; 3Office of Healthy Lifestyles, WV
Bureau for Public Health, Charleston, WV; 4Office of Healthy
Schools, WV Department of Education, Charleston, WV and
5
Prevention Research Center, WVU, Morgantown, WV.
BACKGROUND: The West Virginia Board of Education imple-
mented new Standards for School Nutrition (Policy 4321.1)
during the 2008-2009 school year, and became the first state to
adopt standards consistent with the 2007 Institute of Medicine
recommendations. The purpose of this project was to evalu-
ate the implementation and early impact of these policies on
students, parents and school personnel.
METHODS: A stratified random sample of 1500 parents of stu-
dents in kindergarten and grades 2, 5, 7 & 9, and 420 students in
grades 5, 7 & 9 were interviewed. Food service directors (N=53;
96% RR), school superintendents (N=53; 95% RR), principals
(N=601; 87% RR), and school nurses (N=231; 83% RR) com-
pleted surveys.
60
RESULTS: The majority of schools (85%) had implemented
>75% of the new standards. Food service directors expressed
strong support for the new standards, with all components
except the local wellness policy being viewed favorably by a
majority of respondents. 98% believed the standards would
improve student nutrition and 96% believed the standards
would educate students to make healthier choices. Significant
improvements in dietary habits during the first year of imple-
mentation supported these beliefs, as students had consumed
significantly more milk (p<.05) and fruits & vegetables (p<.05),
as well as less soda (p<.05) based on the interview data. 40%
of principals reported generally or overwhelmingly negative
feedback about the standards from parents; 42% reported simi-
lar feedback from students. Parent and student reports were
mixed, with 33% and 26% of parents and students (respectively)
reporting negative perceptions of the new standards. Vending
revenues were not impacted for the majority of schools (68%).
CORRESPONDING AUTHOR: Andrew S. Bradlyn, PhD,
Health Research Center, West Virginia University, Morgan-
town, WV, 26506-9136; abradlyn@hsc.wvu.edu
C-064c
COMPARING LONGITUDINAL EFFECTS OF PSYCHOSOCIAL
INFLUENCES ON FRUIT AND VEGETABLE INTAKE IN TWO
DIFFERENT STUDIES
Chondra M. Lockwood, PhD,1 Diane L. Elliot, MD,2 Deborah J.
Toobert, PhD,3 Lisa A. Stryker, MA3 and Carol A. DeFrancesco,
MA2
1
Statistical Consulting, Portland, OR; 2Oregon Health & Science
University, Portland, OR and 3Oregon Research Institute,
Eugene, OR.
Mediation analysis allows the deconstruction of the process of
an intervention’s effects and can be used to compare the dif-
ferential influences of purported intermediate variables among
populations. We assessed the longitudinal mediation of changes
in fruit & vegetable intake in two populations receiving differ-
ent interventions that shared certain common potential mediat-
ing constructs. PHLAME (Promoting Healthy Lifestyles) was
a worksite program targeting nutrition and physical activity
behaviors of career firefighters, and the Mediterranean Lifestyle
Program addressed similar outcomes using an initial retreat
and weekly meetings among post-menopausal women with
type 2 diabetes. Although different in structure, both assessed
the potential impact of mood and social support to achieve an
increase in fruit and vegetable intake. We combined data from
both sites to examine similarities in behavior change across
populations and intervention types. Complete three-year
(baseline, 2 annual follow-ups) data from 433 participants were
examined using depression as a mediator in logistic mediation
models. The model reveals complicated changes over time.
The site and treatment condition both had significant effects on
depression (p<0.05) at time 1, interact at time 2 (p<0.05), and
only site continued to have a significant effect (p<0.05) at time
3. Depression early in the model continues to predict depres-
sion later on, and depression significantly predicts eating less
than five servings of fruits and vegetables daily. These results
indicate the need to consider both baseline prevalence of me-
diating constructs, such as depression, as well as the impact of
an intervention on the mediators. The findings also may inform
other cross-site analyzes by highlighting the challenges faced in
designing interventions for varying populations and when com-
paring established studies and existing databases.
CORRESPONDING AUTHOR: Chondra M. Lockwood, PhD,
Statistical Consulting, Portland, OR, 97212; cmlockwood@
gmail.com
C-064d
INTER-INDIVIDUAL DIFFERENCES IN THE SELF-
REGULATION OF HEALTH (RISK) BEHAVIORS
Kerstin E. Schroder, PhD and Cindy L. Ollis, MS
Psychology, Utah State University, Logan, UT.
Background: Self-regulation can be regarded as a multi-di-
mensional trait-like construct with systematic and theoretically
meaningful patterns of association to different dimensions of
behavior regulation. This hypothesis was tested using three
self-regulatory trait factors referring to action control (AC),
impulse control (IC), and emotion control (resilience against
depression, EC). We hypothesized AC to be a superior predictor
of planned behaviors that are typically a target of self-control
while IC was supposed to be a superior (negative) predictive of
substance use.
Method: Online survey data were collected in a sample of 303
undergraduate college students (63% female, mean age = 20).
AC, IC, and EC were assessed with three self-rating scales (α >=
.83), two of which were developed by the first author. Depen-
dent variables were self-reported alcohol consumption, binge
eating, alcohol consumption, and weight loss among those with
past weight loss attempts. Additionally, we collected three cur-
rent action plans per person and assessed their completion at a
four-week follow-up.
Results: The three self-regulation variables were only mod-
erately correlated (.24 to .56), indicating non-redundancy. As
expected, AC was the best predictor of bingeing (-.38) and past
weight loss success (.28). Further, in longitudinal analyses, AC
appeared as a superior predictor of the completion of action
plans (.21) and satisfaction with goal achievement (.24). In
multiple regressions, AC remained the sole predictor of all four
outcomes (β = |.185| to |.30|), controlling for IC and EC. In
contrast, IC was most strongly associated with alcohol con-
sumption (-.35) and remained the only significant predictor of
this outcome (β = -.38) controlling for AC and EC.
Conclusions: Self-regulatory trait predictors associate distinctly
with diverse health (risk) behaviors, consistent with the theo-
retical assumptions, and explain substantial variance in these
outcomes. Inclusion of selected self-regulatory trait variables
in the prediction of health behavior and behavior change may
benefit future research.
CORRESPONDING AUTHOR: Kerstin E. Schroder, PhD,
Psychology, Utah State University, Logan, UT, 84321; kerstin.
schroder@usu.edu
C-064e
PHYSIOLOGICAL AROUSAL FACILITATES GLOBAL MEMORY
BIASES
Grace Giles, BA,2,1 Caroline Mahoney, PhD,2,1 Tad Brunye,
PhD,2,1 Harris Lieberman, PhD3 and Holly Taylor, PhD1
1
Department of Psychology, Tufts University, Medford, MA;
2
Consumer Research and Cognitive Science, US Army Soldier
Systems Center, Natick, MA and 3U.S. Army Research Institute
for Environmental Medicine, Natick, MA.
Alterations in mood and emotional arousal can influence how
people process information. For instance, positive and nega-
tive moods can induce global and local attentional biases,
respectively (Gasper & Clore, 2002). Recent work suggests these
effects may be explained by arousal modulation, with higher
emotional arousal leading to global biases in spatial and verbal
memory (Brunye, Mahoney, Augustyn, & Taylor, 2009; Corson
& Verrier, 2008). The effects of physiological arousal are less
clear. The present work manipulated physiological arousal in
a dose response fashion using caffeine, a commonly ingested
stimulant with known effects on the central nervous system
that result in stimulated neuronal activity, increased alertness,
wakefulness, and motivation. Low consumers (n=36) completed
5 sessions, following an overnight fast, separated by 3 days. In
each session, participants either consumed their normal caffeine
or were administered 1 of 4 capsules (0mg, 100mg, 200mg, and
400mg caffeine; double-blind). One hour later a map task and
a spatial description task were completed. Heart rate, salivary
cortisol, salivary caffeine, mood and subjective arousal were
also assessed. Results from the map task reveal a treatment
by distance interaction for accuracy (p=.004); memory for lo-
cal information does not change as a function of caffeine, but
memory for global information increases with caffeine starting
at 100mg and continuing through 400mg. Analogous results are
found for the spatial description task (p=.017). Further analyses
indicate these effects are not due to withdrawal. Taken to-
gether, data suggest that caffeine-induced physiological arousal
produces global memory biases. Given caffeine’s prevalence in
the US and that doses chosen are commonly found in com-
mercial products, results have implications for the way people
learn and recall information and could influence performance
on daily tasks such as studying, test-taking, and learning new
environments.
CORRESPONDING AUTHOR: Caroline Mahoney, PhD, Con-
sumer Research and Cognitive Science, US Army Soldier Sys-
tems Center, Natick, MA, 01760; caroline.mahoney@us.army.
mil
C-080a
BODY SHAME AND APPEARANCE ANXIETY AS PREDICTORS
OF MENTAL AND PHYSICAL HEALTH
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-
sity- enrolled women aged 18-40 (M = 22) completed several
self-report questionnaires pertaining to body satisfaction, and
a number of measures related to psychological outcome. Two
linear regression models were constructed with mental and
physical health (SF-36; Ware, Snow, Kosinski, & Gandek, 1993)
as the dependent variables. Appearance anxiety (AAS; Dion,
Dion, & Keelan, 1990) and body shame (OBSC; McKinley &
Hyde, 1996) were entered simultaneously as the independent
variables. Results revealed that appearance anxiety was a
significant predictor of mental health problems, R2=0.179, F (2,
313) =35.147, p < 0.001, and physical health problems, R2=0.097,
F (2, 300) =17.032, p < 0.001, whereas body shame was not a
significant predictor of either outcome measure. These findings
indicate that appearance anxiety may be related to a number of
negative psychological outcomes in non-clinical samples. Body
shame, alternatively, does not appear to be predictive of physi-
cal or mental health concerns.
CORRESPONDING AUTHOR: Elizabeth L. Ross, BA, Psycholo-
gy, University of Houston, Houston, TX, 77027; liz479@aol.com
C-080b
FAMILY MATTERS: THE IMPACT OF CHILDREN IN THE
HOME ON WEIGHT CHANGE IN ADULTS UNDERGOING A
WEIGHT MANAGEMENT PROGRAM
Lisa M. Nackers, MS, Kathryn M. Ross, MS, Christy H. Thomas,
RD, Ninoska DeBraganza, MSESS, Rachel André, MS, Valerie
J. Hoover, BS, Kristen E. Newell, MA, Vanessa A. Milsom, MS,
Kristina M. von Castel-Roberts, PhD, Melanie L. Thomas, BS,
Katherine K. Allen, MA, Catherine J. Rogers, BS, Wendy W.
Lynch, BS, Linda B. Bobroff, PhD, Anne E. Mathews, PhD and
Michael G. Perri, PhD
University of Florida, Gainesville, FL.
Caring for children may adversely impact a parent or
guardian’s ability to perform healthy behaviors. Few studies
have compared weight change outcomes for participants with
or without children in the home who undergo a weight man-
agement program for obesity. We examined weight changes
and program adherence in a cohort of 180 obese adults recruit-
ed from rural areas (71% women, mean ± SD body mass index
= 36.5 ± 3.9 kg/m2, age 53.4 ± 10.3 years), who participated in a
weight management program with assessments at baseline and
six months. The majority of participants in this sample (60.8%)
reported no children, while the remaining 39.2% of participants
reported an average 1.5 ± .77 children living in the home. Mean
weight change for all participants at six months was -8.8 ± 6.9
kg. Participants with children in the home experienced signifi-
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,
those with children in the home attended significantly fewer
sessions than participants without children in the home (78.1 ±
23.3% vs. 86.8 ± 12.9%, p < .001). Results suggest that family ob-
ligations (e.g., caring for children, time conflicts with children’s
schedules, etc.) and home food environment may lead to poorer
program adherence and smaller changes in body weight in indi-
viduals with children who participate in weight management
programs. This implies that facilitators of weight management
programs should make accommodations, such as providing
multiple meeting times or flexible make-up sessions, in order to
assist participants with children in the home.
62
CORRESPONDING AUTHOR: Lisa M. Nackers, MS, Clinical
& Health Psychology, University of Florida, Gainesville, FL,
32610-0165; lnackers@phhp.ufl.edu
C-080c
THE DIFFERENTIAL EFFECTS OF PTSD SYMPTOM
CLUSTERS ON BMI IN A VETERAN POPULATION WITH
CHRONIC PAIN
Elizabeth Johnson, MS,1 Kevin Alschuler, MS1 and John Otis,
PhD1,2
1
VA Boston Healthcare System, Boston, MA and 2Boston
University School of Medicine, Boston, MA.
Research examining the health effects of Post-traumatic stress
disorder (PTSD) has found a significant relationship between
PTSD and Body Mass Index (BMI) (Trief et al, 2006; Vieweg
et al, 2007). The goal of this study was to determine if par-
ticular features of PTSD have a differential effect on BMI. The
cross-sectional design involved 164 primarily Caucasian male
veterans seeking psychological pain management treatment at a
VA healthcare facility. The primary outcome measure was BMI
while predictors included symptoms of PTSD (PTSD Checklist,
Military Version; Weathers et al, 1993). A multiple regression
approach to path analysis was used to determine the effects of
these identified variables on BMI. Controlling for age and gen-
der, the analysis indicated the total PTSD symptom score was
a significant predictor of BMI (β=.206,p< .05). Further analyses
revealed a significant relationship between BMI and the PTSD
clusters of hypervigilance (β=.232,p< .05) and re-experiencing
(β=.186,p< .05) but not avoidance and numbing (β=.165,p<
.07). Pain variables (e.g., intensity, duration) were not found
to be significantly related to BMI. These results support previ-
ous research indicating a relationship between PTSD and BMI
while also indicating that specific PTSD symptom clusters
are differentially predictive of health outcomes in this sample
of veterans seeking treatment for chronic pain. While it was
hypothesized that PTSD avoidance and hypervigilance clusters
would be significant, only re-experiencing and hypervigilance
were significant predictors of BMI. These results suggest that
hypervigilance related to PTSD may reduce overall function
and generalize to multiple areas of activity, whereas the effects
of avoidance may be more trauma-specific. The results contrib-
ute to our understanding of the relationship between PTSD and
BMI, and demonstrate the importance of the development of
interventions tailored to veterans affected by PTSD and obesity
in order to improve their health status.
CORRESPONDING AUTHOR: Elizabeth Johnson, MS, VA Bos-
ton Healthcare System, Boston, MA, 02215; ejohns05@vt.edu
C-080d
AORTIC STIFFNESS, FATNESS AND FITNESS IN
OVERWEIGHT SCHOOLCHILDREN
Catherine L. Davis, PhD, Gary L. Pierce, PhD, Yanbin Dong,
MD PhD and Gaston Kapuku, MD PhD
Georgia Prevention Institute, Pediatrics, Medical College of
Georgia, Augusta, GA.
Child obesity has serious ramifications for cardiovascular
health. Noninvasive measurement of arterial stiffness may be
useful to quantify atherosclerotic risk in children.
METHOD: Carotid-femoral pulse wave velocity (CF PWV),
a measure of arterial stiffness in the central vasculature (e.g.,
aorta), was measured on 44 overweight children (BMI ≥85th
percentile, 8-11 yrs, 52% female, 93% Black). To determine
PWV, pressure waveforms were recorded sequentially via
applanation tonometry at the C and F arteries and gated to
simultaneous ECG using the Sphygmocor device (AtCor
Medical). Transit distance from the suprasternal notch to the
F site (SSN-F) was measured. PWV (m/sec) was calculated as
the SSN-F distance divided by the delay between the pressure
waveform at the C and F sites. Values were comparable to pub-
lished data in this age range. Anthropometrics and dual-energy
x-ray absorptiometry (DXA) data were obtained. Aerobic fitness
was assessed using a graded treadmill test and the Fitnessgram
PACER protocol.
RESULTS: PWV was significantly related to measures of
adiposity and fitness. Thus, children with greater BMI, BMI
z-score, or percent fat via DXA scan had stiffer central arteries
(r = .37, .36, .42, p ≤ .01); waist girth was nearly significant (r
= .26, p = .09). Likewise, the fitter children on VO2 peak (ml/
kg) or PACER had more compliant arteries (r = -.32, -.38, p <
.05). These relationships were not substantially affected when
systolic BP or height were partialled. There was a significant
sex difference, with girls having higher carotid-femoral PWV
values than boys (5.6 ± 1.0 vs. 4.5 ± 0.6, t = -4.1, p<.001), inde-
pendent of fatness, fitness, and body size. There was no relation
of PWV with age.
CONCLUSION: Aortic stiffness is related to fatness and fitness
among overweight children. Girls appear to have stiffer arteries
than boys. Measurement of aortic stiffness may be informative
in studies of childhood cardiovascular risk and its amelioration.
Supported by NIH HL087923 and MCG Diabetes & Obesity
Discovery Institute.
CORRESPONDING AUTHOR: Catherine L. Davis, PhD, Geor-
gia Prevention Institute, Pediatrics, Medical College of Georgia,
Augusta, GA, 30912; cadavis@mcg.edu
C-080e
ETHNICITY AND FIRST-SEMESTER CHANGES IN
OBESIGENIC RISK FACTORS IN COLLEGE WOMEN
Jennifer Webb, PhD
Psychology, UNC Charlotte, Charlotte, NC.
Contemporary public health scientists have targeted the col-
lege transition period as a key developmental time window to
evaluate risk for unhealthy weight gain. Although the average
weight gained during the first year of college is significantly
smaller than the popular notion of the “Freshman 15” such
increases in weight are not negligible. Further, given the dis-
proportionate burden of obesity among African American (AA)
women, the possible role of ethnicity remains to be more fully
articulated. Thus, the primary aims of this pilot investigation
were: 1) to examine whether ethnicity is associated with first-
semester changes in biometric indices [e.g., weight, body mass
index (BMI), percent body fat (PBF), waist circumference (WC)],
college stress (CS), and eating patterns [i.e. binge eating sever-
ity (BES), night eating (NE), and intuitive eating (IE)] and 2) to
explore the links between changes in biometric measures and
changes in stress and eating behavior across the first semester in
a sample of 39 AA and 44 European American (EA) females at-
tending a large Southeastern public university. At entry, 34% of
the sample was overweight or obese and over 70% had a waist-
to-hip (WHR) >/= 0.80; EA ethnicity was associated with the
latter at baseline (p < 0.01). Multivariate analyses adjusted for
parental income (PI) revealed that EA women had marginally
higher WCs at both T1 and T2 (p = 0.07). BMI (p < 0.01) and PBF
marginally (p = 0.06) increased over the first semester in the full
sample. When adjusted for PI and changes in BMI, IE scores
marginally (p = 0.07) and CS appreciably declined (p = 0.04).
Finally, changes in IE were negatively correlated with both
changes in BMI (r = -.23) and changes in BES (r = -.32) in the
full sample; changes in BES negatively covaried with changes
in WC (r = -.34) and changes in IE (r = -.39) in the AA sample.
Preliminary results both suggest the importance of considering
ethnicity in clarifying psychological correlates of body compo-
sition changes in the first semester of college and may reflect
more general regional disparities in obesigenic risk which may
transcend ethnicity in this particular context.
CORRESPONDING AUTHOR: Jennifer Webb, PhD, Psychol-
ogy, UNC Charlotte, Charlotte, NC, 28223; jennifer.webb@uncc.
edu
C-080f
HEALTHWORKS: RESULTS OF A MULTI-COMPONENT
WORKSITE INTERVENTION TO PREVENT WEIGHT GAIN
Jennifer A. Linde, PhD, Dan J. Graham, PhD and Robert W.
Jeffery, PhD
Epidemiology and Community Health, School of Public Health,
University of Minnesota, Minneapolis, MN.
Background: U.S. adults continue to be at risk for weight gain
over time. Worksites provide an opportunity to alter environ-
ments and shape behavior of employed adults.
Purpose: The purpose of the trial was to test whether a four-
component program to alter worksite environments would
have a positive impact on weight gain prevention over time.
The four major components addressed food selection, weight
self-monitoring, enhancements to the health media environ-
ment, and promotion of walking / stair use.
Methods: Six worksites in a U.S. metropolitan area were recruit-
ed and randomized in pairs to either two-year intervention or
no-contact control. Evaluations included 1) height and weight
measurement; 2) online surveys of eating behavior, physical
activity, and environmental perceptions; and 3) detailed assess-
ment of the worksite environment.
Results: Mean age of participants was 42.9 years (range 18-75),
62.6% were female, 68.5% were married or cohabiting, 88.6%
were white, and 2.1% were Hispanic. Mean BMI was 28.5 kg/
m2 (range 16.9-61.2 kg/m2). Outcome analyses controlled for
age, gender, education level, race, and baseline smoking status
and BMI. Participation in intervention activities was variable
across sites, ranging from 46.8% to 63.5% (p<.0001). Relative to
those at control sites, individuals at intervention sites signifi-
cantly increased self-weighing frequency (p<.0001) and fitness
center use outside of work (p<.05), and significantly decreased
donut consumption (p<.01) and soft drink vending use (p<.01)
during the study period. Presence of relevant media increased
dramatically at intervention sites (vs. control sites; mean per-
cent increase = +4275% vs. +34.7%). However, BMI changes
were not statistically different between intervention and control
sites (p=.33).
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
behaviors, with some components more successfully delivered
than others. Future studies should examine optimal delivery of
components to address weight gain prevention in worksites.
CORRESPONDING AUTHOR: Jennifer A. Linde, PhD, Epide-
miology and Community Health, University of Minnesota, Min-
neapolis, MN, 55454; linde074@umn.edu
C-080g
THE FAILURE OF AN ENVIRONMENTAL MODIFICATION
APPROACH TO WEIGHT LOSS TO IMPROVE TREATMENT
OUTCOMES BEYOND A TRADITIONAL BEHAVIORAL WEIGHT
LOSS APPROACH
Robert A. Carels, PhD, Kathleen M. Young, MA, Afton Koball,
MA, Amanda L. Gumble, MA, Marissa W. Oehlhof, MA,
Carissa Wott, MA and Nova Hinman, BA
Department of Psychology, Bowling Green State University,
Bowling Green, OH.
Rates of overweight and obesity have increased dramatically
in recent decades, and this increase has coincided with the
development of an “obesogenic” environment that encourages
excess food intake and discourages energy expenditure. This
investigation compared a traditional behavioral weight loss
program (the LEARN program) with Transforming Your Life
(TYL), a weight loss intervention emphasizing environmental
modification and habit formation and disruption. Fifty-four
overweight and obese adults (BMI > 27 kg/m2) were randomly
assigned to either the LEARN or TYL intervention. Each 12-
week group-based intervention included weekly weigh-ins.
Forty participants completed the intervention and a 6-month
follow-up assessment. Participants were able to lose weight in
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
TYL intervention, F(1, 38) = 0.67, p = .42. Similarly, 6-month
follow-ups evidenced non-significant weight gain in both the
LEARN (M = 2.1 lb, SD = 7.4) and TYL (M = 1.8 lb, SD = 8.1)
groups, and there was no difference in weight gain between
the interventions, F(1, 38) = 0.02, p = .90. The TYL intervention
can be viewed as a viable alternative to a traditional behavioral
weight loss program. Certain individuals may benefit from pro-
grams that address their behaviors within the obesogenic food
and physical activity environment.
CORRESPONDING AUTHOR: Kathleen M. Young, MA,
Department of Psychology, Bowling Green State University,
Bowling Green, OH, 43403; youngkm@bgsu.edu
C-080h
IMPACT OF A POSTTREATMENT CAMPAIGN ON WEIGHT
CHANGE FOLLOWING OBESITY TREATMENT
Kristen E. Newell, MA, Anne E. Mathews, PhD, RD, Lisa M.
Nackers, MS, Kathryn M. Ross, MS, Ninoska DeBraganza,
MSESS, Rachel André, MS, Valerie J. Hoover, BS, Kristina
M. von Castel-Roberts, PhD, Christy H. Thomas, RD, LD/N,
Melanie L. Thomas, BS, Katherine K. Allen, MA, Catherine J.
Rogers, BS, Wendy W. Lynch, BS and Michael G. Perri, PhD
University of Florida, Gainesville, FL.
When obesity treatment ends, participants typically regain
weight. Simply providing “refresher” sessions (i.e., more of the
same type of treatment) may lead to boredom and decreased
treatment effectiveness due to habituation. The implementation
64
of intervals of novel posttreatment “campaigns” (i.e., clusters
of sessions devoted to a new treatment theme) may decrease
habituation, increase participant interest, and enhance weight-
loss progress. In the current study, we examined the impact of
implementing a posttreatment campaign on the weight-loss
progress of adults who completed an initial period of obesity
treatment followed by approximately a three month “break”
without additional therapy. Participants included ninety-seven
obese individuals, (mean ± SD: BMI = 36.19 ± 3.63 kg/m2; age
= 53.43 ± 11.12 years). After attending up to 24 weekly obesity
treatment sessions and losing a mean of 11.46 ± 6.34 kg, partici-
pants had approximately 12 weeks without further treatment
followed by a posttreatment campaign consisting of 5 weekly
sessions. Mean weight change per week was compared for the
posttreatment period without intervention sessions versus the
interval with campaign sessions. During the break period with-
out session, participants experienced a mean weight loss of .05 ±
.31 kg per week. However, during the campaign period, partici-
pants achieved a mean weight loss of .21 ± .35 kg per week. The
difference in weight change during the posttreatment periods
with and without campaign sessions was statistically significant
(p < .01). Limitations included the availability of partial data for
37 of the participants and the use of a within-subject rather than
a between-subject experimental design. Nonetheless, these find-
ings suggest that the presentation of novel weight management
materials in posttreatment campaigns may increase participant
adherence and enhance weight-loss progress.
Support: NHLBI R18 HL087800
CORRESPONDING AUTHOR: Kristen E. Newell, MA, Clini-
cal & Health Psychology, University of Florida, Gainesville, FL,
32601; knewell@phhp.ufl.edu
C-080i
A SMALL CHANGE APPROACH TO ADOLESCENT WEIGHT
LOSS APPLIED IN A RESIDENTIAL CAMP SETTING
Marissa Errickson, Bachelor of Arts,1 Emily Steinbaugh,
Bachelor of Science,1 Lesley Lutes, Doctorate1,3 and David
Collier, Doctor of Medicine2,3
1
Psychology, East Carolina University, Greenville, NC;
2
Pediatrics, Brody School of Medicine, Greenville, NC and
3
Pediatric Healthy Weight Research and Treatment Center, East
Carolina University, Greenville, NC.
Due to the growing percentage of obese adolescents, residential
summer camps have been suggested as one viable treatment.
Traditionally, these camps result in significant weight loss
through extreme amounts of exercise combined with portion
controlled, low calorie, and low fat meals. However, weight re-
gain is typical. While a small change approach to obesity treat-
ment has shown promise in adult studies, this approach has
not been tested with children. The purpose of the present pilot
study was to examine the impact of this small change approach
with adolescents in a residential healthy lifestyle camp. Thirty
obese (initial BMI M = 41.31, SD = 8.88) male (n = 8) and female
(n = 22) adolescents, ages 12-17 (M = 14, SD = 1.1), participated
in the 3 week summer camp in rural North Carolina. Campers
made self-selected small changes in diet and physical activity,
were provided healthy food options, were assisted in practic-
ing appropriate portion sizes, learned activities and sports,
and wore pedometers to track physical activity. Campers also
received nutrition classes, cognitive behavioral group therapy,
and individual goal-setting meetings. Upon completion of
camp, campers had lost a significant amount of weight (weight
loss in pounds M = 7.02, SD = 4.46, p < .001). Average BMI upon
completion of camp (final BMI M = 39.98, SD = 8.63) was signifi-
cantly lower than initial BMI (change in BMI M = -1.3, SD = .84,
p < .001). In addition, a follow-up program comparing phone-
based to in-person treatment is currently ongoing. Results sug-
gest that a small change approach in a residential camp setting
may be a viable alternative to assist adolescents in achieving
initial weight loss. However, the ability of this program to pro-
duce continued weight loss remains unknown.
CORRESPONDING AUTHOR: Marissa Errickson, Bachelor of
Arts, Psychology, East Carolina University, Grimesland, NC,
27837; mae0312@ecu.edu
C-080j
ENERGY BALANCE AND EXTERNAL EATING: THE
INFLUENCE OF RELIANCE ON INTERNAL CUES
Susan M. Schembre, PhD RD
Prevention and Control, Cancer Research Center Hawaii,
Honolulu, HI.
Obesity-related eating behavior research has predominantly
focused on ‘what’ and/or ‘how much’ to eat and how the
environment is shaping our food choices. While this research
is vital to the field, the drive to eat is not only regulated by
external influences. The simultaneous influence of hunger and
satiety (internal cues) are equally vital. Surprisingly, little is
known about how internal and external cues jointly influence
energy balance. Adults (n=307; 48% males) were recruited
to complete on-line surveys including validated measures of
Reliance on Internal Cues (RIC) and External/Emotional eating
(EE). The sample was Caucasian (25%), Asian (35%), Hawaiian/
other (6%), or mixed-race (29%), ranged in age from 24 to 59 yrs
(46.9±12.8 yrs), and had BMIs of 17.5 to 52.5 kg/m2 (27.7±5.7
kg/m2). Participants were grouped into high vs low RIC and
EE by sex-specific median splits. Main effects and interactions
on Weight Change rate (WtΔ) from age 21 yrs, Body Mass Index
(BMI), perceived frequency of Overeating (OE), and Eating
Frequency (EF) were explored by sex controlling for covariates.
Significant interactions observed in the males showed that RIC
had a strong protective effect on BMI, frequency of OE, and
WtΔ (p=0.07) at a high EE. The effect of a high RIC was not
noted in those with a low EE. For females, there was a signifi-
cant interaction effect on WtΔ. Unlike the males, the effect of
a high RIC on WtΔ was observed only at a low EE. The effect
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
and less frequent OE and those with a high EE had a higher OE
and a greater EF. Results indicate that a high RIC has a protec-
tive influence on determinants of energy balance and that these
effects vary by sex, particularly in those with high EE. Effects on
other behaviors including physical activity, fruit and vegetable
intake, and dietary fat intake will be presented. Future research
will explore how the interaction between RIC and EE impacts
energy intakes and eating in the absence of hunger.
CORRESPONDING AUTHOR: Susan M. Schembre, PhD RD,
Prevention and Control, Cancer Research Center Hawaii, Hono-
lulu, HI, 96813; sschembre@crch.hawaii.edu
C-080k
INNOVATIONS IN CONDUCTING BILINGUAL HEALTH
TRANSLATIONS IN COMMUNITY ENGAGED HEALTH
RESEARCH
Lisa A. Sanchez-Johnsen, PhD,1 Julia Escamilla, n/a,2 Gabriela
Juarez, BA,1 Susan Vega, n/a,2 Kathleen Rivero, BA1 and Katty
Cavero, BA1
1
Psychiatry, University of Chicago, Chicago, IL and 2Alivio
Medical Center, Chicago, IL.
Many behavioral medicine materials have not been translated
into Spanish. For materials that do exist in Spanish, many have
not been translated properly, many are only appropriate for
a subgroup of Latinos, and/or multiple versions of the same
materials exist. This presentation describes a novel and iterative
model of conducting bilingual Spanish/English translations as
part of community engaged health research studies. This work
derives from experience on several bilingual projects focused on
obesity and cancer prevention research. The innovative trans-
lational model includes the following 5 phases: 1) Planning,
which includes training research staff and community members
in conducting translations, and developing a translation plan
with community partners. 2) Preparation, which includes: a)
Developing new English materials and reviewing new and
existing materials with community members and research staff;
b) Contacting authors or publishers of translated materials and
obtaining permissions and releases of materials that were not
translated; c) Selecting and pilot-testing services of professional
translators; and d) Identifying additional resources to use in this
process. 3) Action, which includes: a) Professional translations
of materials, using a forward and backward translation process;
b) Research team review and pilot-testing by the PI and RA’s;
and c) Community team translation. d) Additional review by
the research team, PI, and community partners. 4) Pre-Testing,
which includes: a) Pilot-testing the materials; b) Additional
review and edits by the research team and PI; c) Additional
review and edits by community partners and the research team;
and d) Reviews, edits, and pilot-testing until the materials were
finalized. 5) Finalization, which includes the final review of
translated materials. Several recommendations are provided.
Researchers, clinicians, and community collaborators will
benefit from learning about this innovative community engaged
translation model.
CORRESPONDING AUTHOR: Lisa A. Sanchez-Johnsen, PhD,
Psychiatry, University of Chicago, Chicago, IL, 60637; lsan-
chez@bsd.uchicago.edu
C-080l
THE FINANCIAL IMPACT OF A LA CARTE IN KANSAS
SCHOOLS
Nikki L. Nollen, PhD, Kim Kimminau, PhD, Niaman Nazir,
MBBS and Robert Lee, PhD
University of Kansas Medical Center, Kansas City, KS.
BACKGROUND: Most schools rely on a la carte (ALC) to
support the food service program. The nutritional quality of
ALC is often poor. Decreasing dependence on ALC may have
important implications for obesity prevention. This study ex-
amines factors associated with low ALC dependence in Kansas
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
used to indicate low, moderate, and high ALC dependence.
RESULTS: Rural districts (n=206) were significantly more
likely than urban districts (n=76) to have low ALC dependence
(OR=2.4, 95% CI=1.2-4.8, p<0.01). Among rural districts, those
with low ALC dependence had higher lunch prices ($1.94 ver-
sus $1.86, p<0.05), greater lunch participation (77% versus 72%,
p<0.01), lower per meal costs ($3.05 versus $3.56, p<0.001), and
fewer free/reduced price students (36% versus 41%, p<0.05)
than high ALC dependent districts. Factors retained in a final,
reduced regression model predicting low dependence were
lunch price (OR=7.5, 95% CI=1.7-34.2, p<0.01) and free/reduced
price meal participation (OR=6.5, 95% CI=1.6-27.0, p<0.05). For
each one dollar increase in lunch price, districts were 7.5 times
more likely to have low ALC dependence. Similarly, districts
where free/reduced price meals made up less than one-third of
the total meals sold were 6.5 times more likely to have low ALC
dependence than districts where free/reduced price meals com-
prised over half of the total meals sold. Findings for urban dis-
tricts were inconclusive; t-tests found few individual differences
between low, moderate, and high ALC dependent districts and
no factors were retained in a final regression model. CONCLU-
SIONS: Increases in lunch price and government reimburse-
ment for school meals coupled with decreases in per meal costs
may be important factors in decreasing ALC dependence and
preventing obesity among rural schools. Factors associated with
low ALC dependence in urban schools requires further exami-
nation.
CORRESPONDING AUTHOR: Nikki L. Nollen, PhD, Pre-
ventive Medicine and Public Health, Univ of Kansas Medical
Center, Kansas City, KS, 66160; nnollen@kumc.edu
C-080m
IMPACT OF COMBAT DEPLOYMENT ON WEIGHT
Lisa McAndrew, PhD,1,2 Elizabeth A. D’Andrea, PhD,1,2 Adam
Ackerman, BS,1 Helena Chandler, PhD,1 Batorsky Benjamin,
BA,1 Conway Yen, BS,1 Charles C. Engel, MD, MPH3,4 and Karen
S. Quigley, PhD1,2
1
WRIISC, VA NJHCS, East Orange, NJ; 2NJ Medical School,
Newark, NJ; 3WRAMC, Washington, DC and 4USUHS,
Washington, DC.
Introduction: Population studies have found that veterans have
higher rates of obesity. It is unclear if trauma experienced dur-
ing combat deployment may lead to weight changes.
Methods: This study followed National Guard and Reserve
soldiers immediately pre- and post-combat deployment. Weight
and height were measured by trained research associates.
Soldiers also completed questionnaires on functioning (SF-36),
PTSD symptoms (PCL) and combat experiences (DRRI).
These analyses are from the first 320 soldiers. T-tests were
used to examine overall weight change. Correlation analyses
examined the association of BMI, and weight change (post-BMI
minus pre-BMI) on PTSD symptoms, combat experiences and
pre-deployment functioning (SF-36 mental and physical health
composite scores).
Results: Soldiers had an average pre-BMI of 27.3 (SD=4.4). Dur-
ing deployment, 43.3% lost and 45.5% gained weight. Because
a similar number of soldiers lost and gained weight, the mean
change was non-significant (mean= -0.3kg; SD=5.1kg). Howev-
66
er, using the absolute value of weight change (change in weight
regardless of direction), soldiers did have significant changes
in weight with a mean absolute change of 3.8kg (SD=3.3kg; 4%
change).
Physical functioning was related to both pre-BMI (r= -.12) and
post-BMI (r= -.12). Pre-BMI was correlated with weight change
(r= -0.3) and absolute weight change (r=0.2). PTSD symptoms,
combat experiences and pre-deployment mental health func-
tioning were not related to pre- or post-BMI or weight change.
Conclusion: This study demonstrated that soldiers experience
a great deal of weight change during combat deployment with
some gaining and others losing. This change was not related to
PTSD symptoms or combat experiences. Higher pre-BMI was
related to losing weight and lower pre-BMI was related to gain-
ing weight. The possibility of a regression to the mean effect
will be considered.
CORRESPONDING AUTHOR: Lisa McAndrew, PhD, WRIISC,
VA NJHCS, East Orange, NJ, 07018; lisa.mcandrew@va.gov
C-080n
KOREANS AND OBESITY: MODEL MINORITY?
Roshan Bastani, PhD,1 Beth A. Glenn, PhD,1 Alison K.
Herrmann, MS,1 Annette E. Maxwell, DrPH,1 Cindy Chang,
MPH1 and Vicky Taylor, MD, MPH2
1
UCLA School of Public Health & Cancer Center, Los Angeles,
CA and 2Fred Hutchinson Cancer Research Center, Seattle, WA.
Aggregate data suggesting that US Asians have lower obesity
rates compared to other ethnic groups likely mask sub-group
differences. Because chronic disease risk accrues to Asians at
lower levels of risk factors, the WHO has suggested lower BMI
obesity cut-offs for Asians. The Asian population in the US is
growing very rapidly, so it is important to attend to its obesity
status.
We present baseline data (in-person interviews in Korean) on
507 Koreans participating in a randomized trial to increase
cancer prevention behaviors. Participants were recruited from
a random sample of Los Angeles churches: average age 45yrs,
98% immigrants, 65% female, and the majority expressed a
strong Korean ethnic identity.
Using standard BMI cutoffs, 21% of the sample was overweight
(BMI 25-30) and 2% obese (BMI>30). These rates doubled when
Asian-specific cutoffs were applied, with 42% being overweight
(BMI 23-28) and 5% obese (BMI>28).
Gender differences depicted a pattern opposite to that observed
in other groups, with males significantly more likely to be over-
weight or obese (68%) vs. females (37%).
Higher BMI was associated with male gender, being married,
more time in the US, older age, and lower income. Contrary
to expectations, lower acculturation and higher Korean ethnic
identity predicted higher BMI.
Clues to the higher male BMI rates may be found in eating
patterns. Males were more likely than females to consume fried
foods and sweets, and less likely than females to eat fruits/
vegetables. This may be related to more access among males
to unhealthy foods in the work environment. Although PA
levels overall were poor (37% reported no moderate or vigorous
physical activity in the past week), males were more likely to be
physically active compared to females.
Our data indicate that obesity is a significant issue among Kore-
ans in Los Angeles, particularly among males. Uncovering the
causes and modifiable predictors of these trends will be impor-
tant in informing the design and rigorous testing of culturally
appropriate interventions to stem the tide.
CORRESPONDING AUTHOR: Alison K. Herrmann, MS, Div.
Cancer Prev. & Control Research, UCLA SPH, Playa del Rey,
CA, 90293; alisonherrmann@yahoo.com
C-080o
THE USE OF YOGA AND VIDEO DANCE TO INCREASE
ADHERENCE TO A PRIMARY CARE BASED WEIGHT
MANAGEMETN PROGRAM FOR ADOLESCENT GIRLS
Lynn L. DeBar, PhD, MPH, Bobbi Jo Yarborough, PsyD, John
Dickerson, MS and Victor J. Stevens, PhD
KP Center for Health Research, Portland, OR.
Background: This project examined two novel exercise strate-
gies included as part of a multi-component lifestyle interven-
tion for overweight teen females and their families. We report
here on 6- and 12-month physical activity and BMI outcomes.
Methods: 2-year RCT with girls, age 12-17, who are members
of a large HMO in the Pacific Northwest with a BMI (kg/m2)
≥90th percentile for their age/gender. Teens were randomized
to either a multi-component behavioral weight control program
(intervention) or usual care (control). The program was tailored
for gender and developmental stage, with separate group meet-
ings for teens and parents, in-session physical activity (yoga),
and facilitated home practice (using the Dance Dance Revolu-
tion [DDR] video game). Results: Analyses for the 80 teens
participating in the intervention with complete assessment data
(76.2%) showed a trend towards modest decrease in obesity
at the one year follow-up (95% ≥ 95th age/gender adjusted
percentile BMI at one year follow-up for those not reporting use
of novel exercise post-treatment versus 80.8% of those report-
ing use; OR: 4.5, p-value: .086, Number Needed Treat [NNT]: 7)
and greater amounts of continued physical activity (met target
of 5 or more days with 30 minutes or more of activity) (OR: 2.8
,p-value: .039, NNT: 5) among those reporting continued use of
these novel exercise strategies following the intervention. Large
effect sizes (NNT) suggest strong findings despite limited sam-
ple size. However, only a modest number of the intervention
participants reported continuing use of these strategies inde-
pendently following the completion of the intervention (overall
39.3%, 33.7% yoga/stretching, 9.0% DDR) and short duration of
activity (11.0 minutes per day overall [SD=13.9]).
Conclusions: These 12-month intervention results suggest a
modest role for novel exercise strategies in promoting physical
activity adherence and BMI reductions for teen girls participat-
ing in a primary care based weight management program.
CORRESPONDING AUTHOR: Lynn L. DeBar, PhD, MPH, KP
Center for Health Research, Portland, OR, 97227; lynn.debar@
kpchr.org
C-080p
HEALTH COMMUNICATION CHANNELS AMONG
NONTRADITIONAL COLLEGE STUDENTS
Lisa M. Quintiliani, PhD RD,1 Whiteley A. Jessica, PhD2 and K.
Vish Viswanath, PhD3
1
Boston University Medical Center, Boston, MA; 2University of
Massachusetts, Boston, MA and 3Dana Farber Cancer Institute,
Boston, MA.
While most health promotion in colleges focuses on young
traditional students, nontraditional [NT] students are associ-
ated with demographics related to obesity: being older, female,
low-income, and racial/ethnic minorities. Colleges serving
NT students may be a key channel for obesity prevention.
This exploratory study compared availability/use, attention,
and preference for delivery channels between traditional and
NT students to create a targeted nutrition and physical activ-
ity program. To date, 182 undergraduate students (RR=4%)
responded to a randomized online survey from a large, urban
4-year university. Questions were adapted from the 2003/2007
Health Information National Trends Surveys. The sample was
68% female, 36% racial/ethnic minorities, and nearly 1/3rd
recently on food stamps and/or Medicaid; mean age=24 years.
Five standard NT characteristics were assessed: financial inde-
pendence (35% of total sample), enrollment gap between high
school and college (33%), full-time employment (20%), part-
time enrollment (14%), and having a GED (4%). Student status
was grouped into moderately NT (30%; MOD NT), minimally
NT (41%; MIN NT), or traditional (29%; TR). Availability of
high speed Internet access and use of email, social networking,
blogging, or instant messaging did not differ by student status.
Compared to TR students, both NT groups paid more attention
to books, brochures, health organizations, Internet, magazines,
and academic journals (p<.05 for all). More MOD/MIN NT
students preferred tailored print materials (75/79 vs 59%) and
interactive websites (87/81 vs 65%) compared to TR students
(p<.05 for both). Although we achieved a low response rate
among students comfortable with online surveys, these findings
revealed programs for NT students can capitalize on a variety
of computer technologies, as availability/use were similar.
Preference for tailored media and interactive websites allows
researchers to customize print and computer-based programs
for NT students according to their unique characteristics.
CORRESPONDING AUTHOR: Lisa M. Quintiliani, PhD RD,
Boston University Medical Center, Boston, MA, 02118; lmquin-
ti@bu.edu
C-080q
WHO PARTICIPATES IN INTERNET-BASED WORKSITE
SURVEYS AND WEIGHT LOSS PROGRAMS?
Wen You, PhD,1 Jamie M. Zoellner, PhD,2 Fabio A. Almeida,
PhD,2 Jennie L. Hill, PhD,2 Kacie C. Allen, student,2 Courtney
A. Robert, student,2 Russell E. Glasgow, PhD3 and Paul A.
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-
trate a method for assessing the reach and representativeness of
participants in a worksite weight loss study.
Methods: Prior to the implementation of worksite weight loss
programs a brief health survey (BHS) was administered to em-
ployees at 19 worksites to determine eligibility, and conserva-
tively evaluate reach and predictors of study participation (e.g.,
health status and behaviors, health literacy, demographics). All
employees were blinded to the existence of a future weight loss
program.
Results: The BHS participation rate was 66% and the weight
loss program participation rate was approximately 30%. For
a one category increase in household income and education
level, odds of program participation increased by 16% and
12% respectively. Similarly, an increase in health literacy score
by one unit resulted in an 8% increase in the odds of program
participation. Holding other predictors constant, people who
participated in the weight loss program were more likely to:
be Caucasian, female, older, with at least one more doctor
diagnosed health complication besides obesity, not a current
smoker, have good health literacy, higher BMI level, higher
household income, and higher education level.
Conclusions: The use of a BHS provided an opportunity to
determine more accurate indicators of reach and representa-
tiveness. Our findings suggest that employers and researchers
should anticipate and attempt to mitigate the challenge of dif-
ferential recruitment rates by health literacy status.
CORRESPONDING AUTHOR: Wen You, PhD, Agricultural
& Applied Economics, Virginia Tech, Blacksburg, VA, 24060;
wenyou@vt.edu
C-080r
PREVALENCE OF OBESITY IN LOCAL COMMUNITIES
Jennifer Grewe, MS,1 Scott DeBerard, PhD1 and Holly Budge,
MS2
1
Utah State University, Logan, UT and 2Bear River Health
Department, Logan, UT.
The Centers for Disease Control currently estimates that ap-
proximately 34% of adults were obese (BMI >30). Children have
followed a similar trend with 15.1% being overweight. The high
prevalence of obesity in the US is further concerning as it is
associated with increased risk for problematic health conditions
and premature mortality. It is also suggested that a very strong
risk factor for adult obesity is a history of childhood obesity.
While the nationwide prevalence of obesity has been examined,
less is known about individual state obesity rates. In 2007, a
survey study sponsored by the Utah Department of Health
was conducted in order to examine rates of obesity in Utah
residents. This study indicated that that 68% of adult males and
50.8% of adult females were obese or overweight which were
rates above national averages. The study found that 9.7% of el-
ementary children were classified as obese and that the percent-
age of children at an unhealthy weight increased dramatically
from 3rd to 5th grades.
A further smaller geographic area study of Utah Children liv-
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
graders were overweight with 33% of the students being obese.
Fifty-percent of 5th graders are overweight and 18% of these
students are obese. Specific trends were observed within the
male student data. Thirty-two percent of the 4th grade males
are overweight and 24% are obese, 13% higher than any other
group. Thirty-one percent of 5th grade males are overweight
and 11% are obese. Fourth and 5th grade males are 8% more
overweight than other age groups.
Results indicate that while overall state level data can be valu-
able in assessing overall obesity trends in school children,
county level data can point to specific opportunities for inter-
vention in high-risk grades.
CORRESPONDING AUTHOR: Jennifer Grewe, MS, Utah State
University, Logan, UT, 84341; jenngrewe@gmail.com
C-082a
USING PRESURGICAL PSYCHOLOGICAL VARIABLES
TO PREDICT COMPENSATION AND MEDICAL COSTS
OF LUMBAR FUSION PATIENTS RECEIVING WORKERS’
COMPENSATION IN UTAH
Anthony J. Wheeler, BA, Jessica M. Gundy, MA and M Scott
DeBerard, PhD
Psychology, Utah State University, Logan, UT.
Low back pain impacts 80% of Americans at some point during
their lives. Lumbar fusion surgery is a procedure designed to
fuse vertebrae together in the spine in order to lessen chronic
pain and/or neurological symptoms. Researchers have sought
out patient variables that will help identify compensated fusion
patients who are likely to accrue high medical costs (DeBerard,
et al, 2003). It is unclear if such models will remain valid with
newer fusion procedures. The purpose of the present study was
to examine presurgical characteristics and cost outcomes in a
retrospective sample of 246 patients (82% male) who received
lumbar fusion surgery via the Workers’ Compensation Fund
of Utah (WCFU). Cost information and presurgical biopsycho-
social variable information was obtained via WCFU databases.
Patients received their surgeries between 1998 and 2007. We
expected that medical and compensation costs would be higher
than in our prior WCFU lumbar fusion study and the biopsy-
chosocial model would predict cost outcomes. Statistical analy-
ses indicated that medical costs for this more recent cohort were
$82,335 (SD=$52,486) while compensation costs were $30,103
(SD=$16,399). These data suggest that medical costs increased
174% versus the prior WCFU study while compensation costs
increased roughly with the pace of inflation. Biopsychosocial
variables were predictive of both medical and compensation
costs, as seen in correlations and multiple regressions . This
study clearly demonstrates a drastic increase in medical costs
associated with compensated lumbar fusion patients in Utah.
Further, this study supports the utility of conceptualizing lum-
bar fusion costs from a biopsychosocial perspective. Possibilities
for controlling lumbar fusion medical costs via insights gleaned
from the biopsychosocial model are discussed.
CORRESPONDING AUTHOR: Anthony J. Wheeler, BA, Psy-
chology, Utah State University, Logan, UT, 84322-2810; antho-
ny.wheeler@aggiemail.usu.edu
C-082b
COST EFFECTIVENESS OF NURSE CASE MANAGERS
AND VOCATIONAL REHABILITATION IN LUMBAR FUSION
WORKER’S COMPENSATION PATIENTS
Jessica M. Gundy, MA (PhD Pending), Anthony J. Wheeler, BA
and M Scott DeBerard, PhD
Psychology, Utah State University, Logan, UT.
Annually, approximately 149 million lost workdays result from
work related low back pain injuries with productivity losses es-
timated at $28 billion. A recent study found that 1,950 compen-
sated workers who underwent lumbar fusion had a disability
rate of 63.9%, a re-operation rate of 22.1%, and a complication
rate of 11.8%. Due to such poor outcomes, perceived higher risk
surgery cases are often referred to nurse case managers who
help manage medical care and to vocational rehabilitation who
facilitate return to work. However, studies show an associa-
tion of assigning nurse case managers with worse back surgery
patient outcomes and the effect this, as well as, vocational re-
habilitation has on cost is unknown. The purpose of this study
was to examine the impact nurse case managers and vocational
rehabilitation has on medical and compensation costs. A retro-
spective review of presurgical variables and medical and com-
pensation costs were obtained in a cohort of 246 workers’ com-
pensation patients who underwent lumbar fusion surgery from
1998 to 2007. Independent-sample t-tests revealed that medical
costs were significantly higher for patients assigned a nurse case
manager (M=$95,424, SD=$56,626) compared to those not as-
signed (M=$66,791, SD=$42,347), as well as for patients referred
to vocational rehabilitation (M=$87,886, SD=$53,130) compared
to those not referred (M=$71,886, SD =$49,895). Compensation
costs were significantly higher for patients assigned a nurse
case manager (M=$41,530, SD=$27,447) compared to those not
assigned (M =$30,328, SD=$21,723), while patients referred
to vocational rehabilitation services also showed significantly
higher compensation costs (M=$40,339, SD=$25,054) compared
to those not referred (M=$28,963, SD=$25,118). Initially, these
findings seem counterintuitive, as the intention of providing
nurse case managers and vocational rehabilitation are to reduce
risk and lower costs. Potential explanations for such results and
implications for further evaluation of these services in terms of
workers compensation patient costs are considered.
CORRESPONDING AUTHOR: Jessica M. Gundy, MA (PhD
Pending), Psychology, Utah State University, Logan, UT, 84321;
jessica.gundy@aggiemail.usu.edu
C-082c
ASSOCIATIONS BETWEEN COPING, SOCIAL SUPPORT, AND
WORKPLACE STRESS IN A UNIVERSITY SETTING
Irene Gregoriou, BA, Despina Themistocleous, BA, Georgia
Panayiotou, PhD and Eleni Karayianni, PsyD
Psychology, University of Cyprus, Nicosia, Cyprus.
Workplace stress is a growing problem due to the changing
workplace environment. Studies have identified several sources
of stress, as well as a number of moderating factors. The pres-
ent study focuses on the interplay of social support, individual
coping skills, and perceived stress levels as they pertain to a
sample of university staff. One hundred and twenty-seven staff
members at a university responded to an online questionnaire.
The questionnaire included the Perceived Stress Scale, the Cop-
ing Orientations to Problems Experienced - Brief and a modified
version of the Social Support Questionnaire. Analyses indicated
significant correlations between overall support received and
emotional support and advice/help from family. Family sup-
port significantly correlated with positive reframing of stress.
Support from friends was significantly correlated to emotional
support, instrumental support, and acceptance. Support from
one’s partner was positively correlated with emotional sup-
port received and provision of advice/help. Listwise regression
analyses revealed that social support from family, friends, and
partner significantly predict the way people perceive and cope
with their stress. The present study reports that social support
can have a significant effect on exhibited coping styles and
perceived levels of stress within the university workplace. The
effects of overall social support on coping skills, as well as the
availability of social support on the ability to positively reframe
one’s thinking and to utilize instrumental support appear to
play a key role in levels of perceived stress within this environ-
ment. These findings provide a stepping stone in terms of staff
needs’ assessment in order to employ appropriate interventions
within such a demanding environment.
CORRESPONDING AUTHOR: Eleni Karayianni, PsyD, Psy-
chology, University of Cyprus, Nicosia, 1678; ekarayia@ucy.
ac.cy
C-097a
COMPLEMENTARY AND ALTERNATIVE MEDICINE USE AND
ASTHMA ILLNESS REPRESENTATIONS IN AN INNER-CITY
PEDIATRIC ASTHMA SAMPLE
Amanda M. Spray, MA,1 Jonathan M. Feldman, PhD1,3 and
Kimberly Sidora-Arcoleo, PhD, MPH2
1
Ferkauf Graduate School of Psychology, Yeshiva University,
Bronx, NY; 2College of Nursing & Health Innovation,
Arizona State University, Phoenix, AZ and 3Department of
Epidemiology & Population Health, Albert Einstein College of
Medicine, Bronx, NY.
Introduction: Evidence suggests that negative attitudes towards
inhaled corticosteroids (ICS), the use of complementary and
alternative medicine (CAM), and asthma morbidity may be
associated with each other. This study sought to clarify this
relationship among an ethnic minority, inner-city sample of
children with asthma.
Methods: Participants were 121 parent-child dyads recruited
from an inner-city hospital in Bronx, New York. Children
between the ages of 7 and 15 were included. The Asthma Illness
Representation Scale (AIRS), the Asthma Functional Severity
Scale, and a checklist of types of CAM were administered to
parents.
Results: The sample consisted of 6 Caucasian, 56 Puerto Rican,
36 African American, and 23 Afro-Caribbean parent-child
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
screening question, but nearly 90% endorsed the use of specific
CAM types when individual items were administered. The top
five most frequently endorsed types of CAM were prayer (51%),
Vicks Vaporub (47%), massage (41%), vaporizer (35%), and vi-
tamins (27%). No significant ethnic differences in type of CAM
endorsed or AIRS scores were found. As AIRS score decreased,
indicating parental alignment with the lay model of asthma
management, functional morbidity significantly increased in
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
Conclusion: The current study found that it is more informa-
tive to ask about specific CAM modalities, rather than a single
screening question, when assessing CAM usage in this popu-
lation. Additionally, our research suggests the importance of
assessing parents’ illness representations in pediatric asthma as
a potential area to target in asthma education interventions.
CORRESPONDING AUTHOR: Amanda M. Spray, MA, Ferkauf
Graduate School of Psychology - Yeshiva University, Engle-
wood, NJ, 07631; AmandaSpray@gmail.com
C-097b
SPIRITUALITY IN STRESS REDUCTION FOR ABUSE
SURVIVORS
Michael D. Earley, MEd,1,2 Gina Poole, BS1,2 and Elizabeth
Kimbrough, PhD2
1
UMBC, Baltimore, MD and 2University of Maryland, Baltimore,
MD.
Mindfulness Based Stress Reduction (MBSR) has a strong
record of alleviating symptoms such as depression and anxi-
ety (Baer, 2003). 27 child sexual abuse survivors were enrolled
in an MBSR program including weekly classes on meditation
and practice of mindfulness skills. Significant reductions were
observed in depression, anxiety, and PTSD symptoms (Kim-
brough, 2010). The current study used secondary data analysis
to better understand how spiritual well-being was related to
treatment outcomes.
Analyses examined the relations between mindfulness (Mind-
fulness Attention Awareness Scale (MAAS)), psychological
distress (General Severity Index (GSI)), and spiritual well-being,
using a modified FACIT-SP. Regression analyses tested if GSI
changes from baseline were predicted by mindfulness and
spirituality. Then, participants were divided at the median level
of baseline spirituality to analyze whether mean GSI varied by
group at each time point.
Significant correlations were found between baseline spiri-
tuality and GSI (r = -.442, p=.021), and between baseline GSI
and MAAS (r = -.454, p=.017). Baseline mindfulness was not
significantly related to spirituality (r = .03, p=.883). GSI changes
were not predicted by baseline spirituality and mindfulness
(F(2,21)=1.97, p=.17; F(2,20)=2.01, p=.16). Dichotomized baseline
spirituality reflected two significantly different groups with
respect to GSI (F(1,21)=6.72, p=.017), with mean GSI between
groups marginally different at baseline (F(1,25)=4.091, p=.054,
significantly different at week 4 (F(1,22)=8.48, p=.008,), and not
different at week 8 (F(1,21)=3.179, p=.089).
In this sample of childhood abuse survivors, baseline spiri-
tual well-being was related to psychological distress but not
mindfulness. Those with higher baseline spirituality began and
ended with lower levels of psychological distress then those
with low baseline spirituality, although both groups had a
significant reduction in distress from baseline to 8 weeks with
MBSR. These data suggest that enhanced spirituality may be as-
sociated with decreased distress or enhanced resiliency among
childhood abuse survivors.
CORRESPONDING AUTHOR: Michael D. Earley, MEd, psy-
chology, UMBC, Catonsville, MD, 21228; earley1@umbc.edu
70
C-097c
INCREASING HEALTH CARE ACCESS FOR THE
UNDERSERVED UTILIZING A COMMUNITY HEALTH
SCIENCE MODEL
Mark DeHaven, PhD, Heather Kitzman-Ulrich, PhD and Nora
Gimpel, MD
Clinical Science, UT Southwestern Medical Center, Dallas, TX.
Underserved (low-income, ethnic minority) communities have
higher rates of chronic illness and reduced access to medical
care. Investigators are increasingly testing community-based
participatory research (CBPR) approaches for promoting health
behaviors to reduce chronic illness. CBPR approaches empha-
size establishing long-term commitments, local relevance, and
addressing multiple determinants of health to reduce health
disparities. Although there is increased interest in using CBPR
models in health promotion research, little research exists on
effective means for integrating medical institutions. This study
tested a CBPR approach - The Community Health Science
Model - combining public health, medical practice, and commu-
nity-based social services to reduce the need for emergency and
hospital services among an underserved population. The model
provided the conceptual framework for Project Access Dallas
(PAD), which provided increased access to health care for the
uninsured. Study patients (N=265; 69% African American, 21%
Hispanic; 63% female; mean age=35.7 yrs) were enrolled into
the PAD program if their income was < 200% of the federal
poverty level, were not eligible for health insurance, and were
not receiving Medicare or Medicaid. A similar patient popula-
tion was used for comparison (N=309; 74% African American,
16% Hispanic, 54% female, mean age=35.0 yrs). The primary
goal of PAD was to improve health care access through a coor-
dinated system of care, including: community care coordinator
or self-care resources, primary care provider, and pharmacy
benefits. At 12-months, PAD patients had significantly fewer
hospital visits (0.93 vs. 1.44, p<.01), inpatient hospital days
(0.37 vs. 1.07, p<.05), and hospital costs ($446 vs. $1188, p<.01)
as compared to comparison patients. This study supports the
effectiveness of the Community Health Science Model as an
approach to developing interventions that address the health
needs of the underserved and for future studies seeking to
engage communities, public health, and medical practice to
reduce health disparities.
CORRESPONDING AUTHOR: Heather Kitzman-Ulrich, PhD,
Clinical Science, UT Southwestern Medical Center, Dallas, TX,
75390; heather.kitzman-ulrich@utsouthwestern.edu
C-097d
IDENTIFYING SMI PATIENT HEALTHCARE AND LIFESTYLE
MANAGEMENT NEEDS AND BARRIERS USING PROVIDER
FOCUS GROUPS
Thomas L. Wykes, BA, Katherine A. Kitchen, BS, Michelle C.
Curley, BS, Emily J. Boal, BS (in progress), Douglas L. Welsh,
MS and Christine L. McKibbin, PhD
Psychology, 3415, University of Wyoming, Laramie, WY.
As part of a larger health promotion project, focus groups were
conducted with mental health providers in Wyoming and
Northeastern Colorado. The groups were designed to identify
needs and barriers for the healthcare and lifestyle management
of serious mental illness (SMI) patients, as well as to identify
useful elements to include in a healthy lifestyles intervention.
The influence of rural environment was emphasized in all
groups. A total of 36 providers were included in groups at five
sites (Cody, WY, Jackson, WY, Cheyenne, WY, Laramie, WY
and Fort Collins, CO). The majority of the providers were white
(94.4%), female (75%), and held a graduate or professional de-
gree (69.4%). The most common job titles were Social Worker or
Case Manager (44.4%), Counselor (25%), and Psychiatric Nurse
(11.1%). On average, providers were 42.6 years old, had 10.9
years experience with SMI patients, and had an SMI caseload of
85%.
Providers consistently identified a number of barriers to ad-
equate healthcare, including: poverty, transportation (in both
urban and rural settings), medical comorbidity, obesity, illness
management knowledge, motivation, medication management
(motivational and financial), lack of social support (from family,
community, and providers), provider/patient communication,
poor diet, unstable housing and income, social stigma, and
inconsistent medical care (including transient providers in rural
settings).
Providers indicated that a successful intervention would need
to address each of these areas. Special emphasis was placed on
the importance of motivation and involvement. Providers sug-
gested direct modeling of healthy behavior, tailoring informa-
tion for a range of levels of functioning, social and emotional
support, concrete incentives and rewards (including money),
communication between intervention personnel and providers,
follow-ups, and a length of at least six months.
CORRESPONDING AUTHOR: Thomas L. Wykes, BA, Psy-
chology, 3415, University of Wyoming, Laramie, WY, 82071;
twykes@uwyo.edu
C-097e
CHRONIC STRESS AND BLOOD PRESSURE REACTIVITY
AMONG YOUTH IN INDIA
Bang Hyun Kim, PhD,1 Stephen J. Lepore, PhD1 and Gary W.
Evans, PhD2
1
Public Health, Temple University, Philadelphia, PA and
2
Department of Design & Environmental Analysis, Cornell
University, Ithaca, NY.
Recent research and theorizing suggest that chronic stress expo-
sure can compromise the physiological stress-response system.
This study tested the theory that chronic stress exposure results
in hypo-reactivity in response to a stressor that is similar to the
chronic stressor (i.e., homotypic stressor) and results in hyper-
reactivity in response to a stressor that is different than the
chronic stressor (i.e., heterotypic stressor). Ambient noise was
the chronic stressor. The outcome was blood pressure reactiv-
ity during acute exposure to either a homotypic or heterotypic
stressor. The sample consisted of 189 children from a noisy or
quiet public school located in Pune, India. The noisy school was
located in a busy commercial district whereas the quiet school
was located in a more residential area district. Noise levels at
the noisy school reached a peak of 82 dB(A) and at the quite
school reached a peak of 65 dB(A). There were no significant
differences between schools in level of resting blood pressure
or heart rate, auditory discrimination ability, or math skills.
Reactivity data (task-resting values of blood pressure or heart
rate) were analyzed using ANCOVA techniques, controlling for
the appropriate baseline value of either blood pressure or heart
rate. There were interactive effects of school x stressor type on
reactivity, suggesting no differential reactivity to homotypic or
heterotypic stressors within the noisy school. However, there
were significant main effects of school on baseline-adjusted
systolic reactivity and heart rate reactivity. Children in the
noisy school had lower systolic blood pressure and heart rate
reactivity scores during both tasks than did children in the
quite school. The diastolic blood pressure reactivity trended in
the same direction as systolic and heart rate reactivity, but was
not significant. The latter findings are consistent with previous
research suggesting chronic stress results in hypo-reactivity to a
variety of stressors.
CORRESPONDING AUTHOR: Bang Hyun Kim, PhD, Public
Health, Temple University, Philadelphia, PA, 19122; bkim@
temple.edu
C-097f
SUBJECTIVE MEASURES OF DISCRIMINATION AND
OBJECTIVE MEASURES OF SKIN COLOR AS PREDICTORS OF
PERCEIVED STRESS AMONG AFRICAN AMERICANS
Guy-Lucien Whembolua, PhD,1 Gary King, PhD2 and Kolawole
S. Okuyemi, MD, MPH1
1
Family Medicine &Community Health, University
of Minnesota Medical School, Minneapolis, MN and
2
Biobehavioral Health, Pennsylvania State University,
University Park, PA.
BACKGROUND: In the United States, skin color plays an im-
portant role in race relations and racial stratification. This reali-
ty has consequences in the daily lives of African Americans, one
of which is increased stress. From a biological perspective, skin
pigmentation is divided into two types: constitutive skin color
that is the result of individual genetic content; and facultative
skin color or “tan” that is influenced by exposure to ultraviolet
radiation. METHODS: A criterion based non-probability design
was used to select a sample (N=147) of African Americans from
three selected sites in Harrisburg, PA. Subjects were given a
questionnaire on socio-demographic characteristics, sociological
questions on skin color and perceived stress. A reflectometer
was used to measure skin color. Two separate measurements
were recorded for each physical location, the forehead for facul-
tative melanin and the upper underarm for constitutive melanin
and an average M value was used in all the analyses for both
measurements. RESULTS: Four discrimination questions were
found to be positively correlated with Perceived Stress (PSS 10)
(p<.05). In the final regression model a variable (NEWD), com-
puted as the addition of all four questions (Cronbach’s α=.775),
was found to be statistically significant (β =-.321, p <= .001) in
explaining 10.3 % of the variance in PSS10 while facultative and
constitutive melanin measures were non-significant. The vari-
able (NEWD) was found to be positively associated with PSS10
(p <= .001) but was not associated with facultative (p=.977) and
constitutive melanin (p=.286) measures. CONCLUSIONS: This
new composite discrimination measure based on skin color
was found statistically significant to be a stronger predictor of
perceived stress among African Americans than the use of an
objective measurement or reflectometer. The result obtained
highlights the importance of the psychological perspective of
discrimination.
CORRESPONDING AUTHOR: Guy-Lucien Whembolua, PhD,
Family Medicine &Community Health, University of Minnesota
Medical School, Minneapolis, MN, MN; wgl@umn.edu
71
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-097g
INTEGRATING MENTAL HEALTH SERVICES INTO A
RURAL HOSPITAL EMERGENCY DEPARTMENT USING
TELEMEDICINE
Jonathan Neufeld, PhD,1 Stephanie Laws, BSN2 and Erik
Southard, CFNP2
1
IN Rural Health Specialty Exchange, Goshen, IN and 2Richard
G. Lugar Center for Rural Health, Terre Haute, IN.
Background - Emergency tele-mental health provides special-
ized mental health evaluations in medical settings via telemedi-
cine. To increase access to mental health services, Union Hos-
pital Clinton (UHC), a rural critical access hospital, partnered
with Hamilton Center (HC), a community mental health center,
to establish an emergency tele-mental health program.
Methods - A high-quality videoconferencing connection as
established between the UHC emergency department (ED) and
the HC intake department. The link was staffed by HC intake
clinicians during their normal hours of 7:00 AM to 11:00 PM.
Clinicians were trained in appropriate procedures and stan-
dards for tele-mental health care. Procedures were developed
to allow rapid referrals and evaluations via interactive 2-way
video. HC psychiatrists were available by phone when neces-
sary.
Results - Ninety-five emergency tele-mental health consults
were completed in 12 months. Most patients (78%) had a prior
treatment history at HC. Over 95% of evaluations started within
30 minutes of referral, and three-quarters occurred after 5:00
PM or on a weekend. Of patients seen, 12% were discharged
immediately after the evaluation, 19% were admitted to the hos-
pital, and 67% were discharged to home from the ED within 24
hours. Over 60% had outpatient follow up plans in place at the
time of discharge.
Conclusion - Use of tele-mental health can effectively extend
the reach of community mental health centers into the ED and
increase integration between mental health and emergency
medicine. This particular program, relying as it did on an exist-
ing local mental health organization and its established part-
ners, experienced excellent acceptance and relatively smooth
administrative development. One unforeseen key to its useful-
ness was the surprising extent to which the local mental health
center had prior knowledge and records of ED patients present-
ing with mental health difficulties.
CORRESPONDING AUTHOR: Jonathan Neufeld, PhD, IN
Rural Health Specialty Exchange, Goshen, IN, 46526; jneufeld@
inrhse.net
C-097h
PSYCHOMETRIC PROPERTIES OF THE COMMUNITY
INTEGRATION QUESTIONNAIRE IN ADULTS WITH
DISABILITIES
Alan Braden, BA,1 Adam Hirsh, PhD,1 Jason Craggs, PhD2 and
Mark Jensen, PhD1
1
Rehabilitation Medicine, University of Washington, Seattle,
WA and 2Clinical and Health Psychology, University of Florida,
Gainesville, FL.
Community integration is an essential outcome for people
living with a disability. The CIQ is a commonly used measure
of this construct and conceptualizes 3 domains of function:
home integration, social integration, and productive activi-
72
ties. Although the CIQ was originally created for use with
brain-injured populations, researchers are now starting to use
this measure in studies on adults with other disabilities. The
psychometric properties of the CIQ have not been established
in any other disability populations. The purpose of the current
study was to evaluate the psychometric properties of the CIQ in
a heterogeneous sample of adults with physical disabilities. 751
community-dwelling adults with spinal cord injury (146), mul-
tiple sclerosis (174), limb loss (158), or neuromuscular disease
(273) completed the CIQ and other measures of functioning. An
exploratory factor analysis produced a 4-factor solution that
accounted for approximately 53% of the variance. Alternative
solutions were also examined using confirmatory factor analytic
techniques. Although there was some consistency with the indi-
vidual item loadings compared to the original scoring system,
these models did not provide a good fit to the data. When the
derived CIQ factors in this sample were correlated with other
measures of functioning, the results were suggestive of moder-
ate criterion-related validity for the factors. Overall, the findings
support the use of the CIQ as a measure of the general construct
of community integration in adults with disabilities. However,
the original factor structure of the CIQ was not supported in
our sample. Based on these findings, we do not recommend that
the original subscale scoring procedures be used in samples of
individuals with physical disabilities. Additional research is
needed to further evaluate the psychometric characteristics of
the CIQ in adults with disabilities, with particular emphasis on
whether these characteristics differ across disability groups.
CORRESPONDING AUTHOR: Adam Hirsh, PhD, Rehabilita-
tion Medicine, University of Washington, Seattle, WA, 98104;
ahirsh@uw.edu
C-097i
A RANDOMIZED TRIAL OF A BRIEF BEHAVIORAL
INTERVENTION TO PREVENT AN INCREASE IN
DEPRESSIVE SYMPTOMS DURING THE TRANSITION TO
COLLEGE
Anna M. Charbonneau, MA and Amy Mezulis, PhD
Clinical Psychology, Seattle Pacific University, Seattle, WA.
Previous research has clearly demonstrated that the transi-
tion to college is stressful and associated with elevated risk for
psychological problems, including depression. This risk may be
additionally elevated among female students. For this research
study, we designed a behavioral health intervention titled
Women ROCK (Relaxation, Openness, Contemplation, and
Kindness). This intervention is designed to impart behavioral
relaxation skills specifically to prevent an increase in depressive
symptoms in young women with high emotional reactivity. We
recruited and randomly assigned 72 women with high emo-
tional reactivity to either the intervention or control condition.
We assessed participants at baseline and one week post-inter-
vention. Repeated measures ANOVA indicated that there was
a significant main effect of time on depressive symptoms, F(1,
61) = 6.63, p = .012, and a significant interaction between time
and group assignment, F(1, 61) = 11.43, p = .001. These results
indicate that depressive symptoms for participants in the inter-
vention group declined over time while depressive symptoms
for control participants rose slightly. These initial results are
promising, suggesting that participants in the intervention re-
ported significantly less depressive symptoms and less stressors
post-intervention than did their control counterparts. The aver-
age level of depressive symptoms also declined below the range
of clinical concern for participants in the intervention condition.
These results suggest a true clinical relevance for this preven-
tive intervention.
CORRESPONDING AUTHOR: Anna M. Charbonneau, MA,
Clinical Psychology, Seattle Pacific University, Seattle, WA,
WA; charba@spu.edu
C-097j
MONITORING AND BLUNTING PERSONALITY STYLES:
DOES STYLE OF INFORMATION SEEKING PREDICT A
PROPENSITY TO DEVELOP ACUTE STRESS DISORDER OR
POST-TRAUMATIC STRESS DISORDER?
Julie A. Holmes, MA1 and Barbara Melamed, PhD2
1
Psychology, University of Hawaii, Honolulu, HI and
2
Psychology, Mercy College, New York, NY.
Monitoring and Blunting personality styles have been associ-
ated with increased and decreased anxiety respectively in asso-
ciation with perceived threats but they have not been evaluated
in association with acute stress disorder (ASD), post-traumatic
stress disorder (PTSD) or other PTSD predictors (avoidance
and intrusion). This study examined the effects of Monitoring
and Blunting personality styles on ASD/PTSD, Avoidance and
Intrusive measures one month after 911 in ninety-two Manhat-
tan college students and staff. We predicted that high Monitors
would have increased symptoms of acute stress disorder/PTSD
symptoms where as a high Blunters would have decreased
symptoms of acute stress disorder/PTSD symptoms. The Miller
Behavioral Style Scale was used to measure Monitoring and
Blunting styles. The Impact of Events scale was used to deter-
mine their use of avoidance or intrusions as reported for the last
seven days with respect to their feelings about the WTC attack.
The Posttraumatic Diagnostic Scale was used to measure acute
stress disorder/PTSD. A Pearson correlation revealed that high
Monitoring personality style was significantly correlated with
Avoidance [ r (85) = .306, .004], Intrusive [ r (80) = .404, .000],
Total PTSD [ r (73) = .282, .016], and Total PTSD severity [ r (65)
= .269, .031]. Blunting was not significantly correlated with any
of the measures. The implications are discussed.
CORRESPONDING AUTHOR: Julie A. Holmes, MA, Psychol-
ogy, University of Hawaii, Honolulu, HI, 96813; jholmes@
hawaii.edu
C-097k
ANXIETY SENSITIVITY AND ASTHMA CONTROL
Alison C. McLeish, PhD, Cynthia L. Cominsky, MEd, Christina
M. Luberto, BA and Joseph Oakwood, BA
Psychology, University of Cincinnati, Cincinnati, OH.
5-10% of asthma patients are unable to achieve significant
asthma control. Difficult-to-control asthma is associated with
increased morbidity and mortality and accounts for more than
50% of asthma-related healthcare costs in the U.S. each year.
Researchers have identified the presence of comorbid psycho-
pathology as an important contributor to poor asthma con-
trol. Indeed, the presence of psychopathology among asthma
patients is associated with more frequent asthma exacerbations,
doctor’s visits, emergency department visits, and hospitaliza-
tions. The research to date has primarily used broad symptom
measures of psychopathology, such as measures of general
anxiety or depression, which have limited utility due to signifi-
cant symptom overlap. Therefore, what is not known is whether
the identification of specific cognitive vulnerability factors that
underlie these broader constructs of depression and anxiety will
provide a better understanding of the link between psychopa-
thology and poor asthma control.
The purpose of the current study was to examine the ability
of anxiety sensitivity (fear of one’s own anxiety symptoms),
a cognitive risk factor for anxiety disorders, to predict poor
asthma control. Specifically, it was hypothesized that the physi-
cal concerns factor of anxiety sensitivity (fears of anxiety-related
physical symptoms), because of its relevance to the physical
symptoms produce by asthma, would be predictive of poorer
perceived asthma control after controlling for the effects of
depression and anxiety. Participants were 83 (n = 64 female)
undergraduate psychology students (Mage = 20.3 years) with
self-reported physician-diagnosed asthma. Results indicated
that, as predicted, after controlling for the variance accounted
for by depression and anxiety, anxiety sensitivity-physical con-
cerns significantly predicted asthma control, accounting for 10%
of the variance. These results suggest that further exploration of
the role of anxiety sensitivity, particularly the physical concerns
factor, in asthma and asthma management would be a fruitful
avenue of future research.
CORRESPONDING AUTHOR: Alison C. McLeish, PhD, Psy-
chology, University of Cincinnati, Cincinnati, OH, 45221-0376;
alison.mcleish@uc.edu
C-097l
AGREEMENT BETWEEN CLINICIAN AND CLIENT-
REPORTED MENTAL HEALTH RECOVERY OUTCOMES: THE
MODERATING EFFECTS OF GENDER AND ETHNICITY
Marisa Sklar, BA,1 Andrew Sarkin, PhD,1 Rachel Lale, BA,1
Richard Heller, MA,1 Marshall Lewis, MD, DFAPA,2 Todd
Gilmer, PhD,1 Candace Milow, MA,2 Steven Tally, PhD1 and
Erik Groessl, PhD1
1
Health Services Research Center, University of California San
Diego, San Diego, CA and 2Behavioral Health Division, Health
and Human Services Agency, San Diego, CA.
Recovering from mental illness is a participatory effort (Depart-
ment of Health, 2000) and insight into one’s own well-being
can impact recovery (Olfson et al, 2000; Tait et al, 2003; Smith
et al, 2004). This study aims to help better understand how to
effectively use self-reported recovery scales to measure clinical
outcomes as well as for program evaluation and improvement.
We examined clients’ and clinicians’ reported rating of recovery
among individuals (n = 634) seeking outpatient treatment in
community mental health clinics across San Diego County. Cli-
nicians assessed clients’ recovery using the Illness Management
and Recovery (IMR) scale (Mueser, et al., 2004), while clients
assessed their own recovery using the Recovery Markers Ques-
tionnaire (RMQ) (Ridgway & Press, 2004). Multiple stepwise re-
gression models were used to assess overall agreement between
clinician reported and client self-reported ratings of recovery, as
well as the moderating effects of age, gender, ethnicity, and di-
agnosis. Results suggest that as clinician ratings of client recov-
ery increases, the agreement between client ratings and clinician
ratings of recovery strengthens. This relationship is moderated
by gender, such that it is significantly stronger for females than
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
clinician reported and client self-reported recovery rating was
significantly moderated by ethnicity (t(634)=2.174, p=.030), such
that client-clinician agreement was significantly weaker for His-
panic (r=.284, p=.002) than non-Hispanic individuals (r=.479,
p<.0005). In general, results from this study suggest self-report
measures of recovery may become less clinically meaningful for
individuals at lower levels of recovery. Implications for separat-
ing comparative response biases from true demographic and
language differences in outcomes studies are discussed.
CORRESPONDING AUTHOR: Marisa Sklar, BA, University of
California San Diego, San Diego, CA, 92121; masklar@ucsd.edu
C-097m
RELUCTANCE TO RECOMMEND SEEKING HELP FOR
MENTAL HEALTH ISSUES: THE EFFECTS OF GENDER AND
ETHNICITY
Eliza Robillos, BA, Andrew Sarkin, PhD, Marisa Sklar, BA,
Alexis Munoz, MPH, Rachel Lale, BA, Jennifer Leich, MA and
David Thomas, BA
Health Services Research Center, University of California San
Diego, San Diego, CA.
Physical health care advances have shaped perceptions of
illnesses like cancer, epilepsy, and HIV/AIDS, as “treatable,
survivable, even curable ailments” (U.S. Surgeon General
Report, 1999). Despite advances in mental health care, mental
illness remains feared and misunderstood, often prevent-
ing people from seeking help (Corrigan, 2004). As awareness
of mental health treatment success increases people should
become more likely to both seek help and recommend help
to others (U.S. Surgeon General Report, 1999). The purpose of
the present study is to explore the roles gender and ethnicity
play in advising others to seek mental health care. Data were
derived from a vignette study from the 2006 General Social
Survey. Respondents (n=1523) were randomly assigned to 1 of
4 vignettes, 3 depicting characters meeting diagnostic criteria
for alcohol dependence, depression, or schizophrenia, and the
fourth depicting characters with subclinical concerns. Partici-
pants reported whether or not the vignette character should
seek help from a variety of sources. Binomial logistic regression
models were used to assess demographic differences in the
likelihood of recommending various help seeking activities.
Results suggest Hispanic respondents were less likely to recom-
mend a variety of help seeking activities for alcohol dependence
(χ2religiousleader(1)=4.613, p=.032; χ2med.dr(1)=3.841, p=.050),
depression (χ2mentalhospital(1)=3.969, p=.046), and schizo-
phrenia (χ2family&friends(1)=4.775, p=.029). Also, males were
less likely to advise characters seek help from a spiritual leader
for alcohol dependence (χ2(1)=5.906, p=.015), or from a general
medical doctor for subclinical concerns (χ2(1)=7.925, p=.005),
but were more likely to advise characters seek help from fam-
ily and friends for alcohol dependence (χ2(1)=6.067, p=.014).
Findings suggest gender and ethnicity influence reluctance to
recommend help-seeking activities. Implications for how these
findings may guide future mental health promotion and out-
reach will be discussed.
CORRESPONDING AUTHOR: Marisa Sklar, BA, University of
California San Diego, San Diego, CA, 92121; masklar@ucsd.edu
74
C-097n
MOTHER’S LITTLE HELPER: GENDER DIFFERENCES IN
ATTITUDES TOWARDS PSYCHIATRIC MEDICATIONS
Andrew Sarkin, PhD, Eliza Robillos, BA, Marisa Sklar, BA,
Kenny Oyama, BA, Tung Nguyen, BA, Laetitia Truong, BA,
Tammy Liu, BA, Annabelle Cadang, BA and Rachel Chen, BA
Health Services Research Center, University of California San
Diego, San Diego, CA.
Although many psychiatric medications are considered safe
and effective (U.S. Surgeon General Report, 1999) and they are
continually improving, many people are still hesitant to use
them. This study used Chi-square and ANOVA analyses to
examine gender differences in attitudes towards taking psychi-
atric medication. Regardless of participant gender (χ2(4)=5.404,
p=.248), the majority of participants believe psychiatric medica-
tions help control symptoms (87.3% of females and 85.8% of
males). However, results suggest more females (53.1%) than
males (44.8%) were willing to take psychiatric medication
(χ2(4)=18.870, p=.001) and females were more likely to recom-
mend others take psychiatric medication for depression (F(1,
467)=4.943, p=.027). Significantly more females than males
believed psychiatric medication helps people deal with day
to day stresses (85.2% and 81.4% respectively; χ2(4)=16.334,
p=.003), believed psychiatric medication makes things easier in
relations (79.4% and 73% respectively; χ2(4)=20.765, p<.0005),
and believed psychiatric medication helps people feel better
about themselves (69.2% and 65.9% respectively; χ2(4)=12.577,
p=.014). Additionally, significantly more males (50.8%) than fe-
males (42.4%) believed taking psychiatric medication interferes
with daily activities (χ2(4)=17.650, p=.001). There was not a sta-
tistically significant gender difference in agreement that psychi-
atric medication is harmful to the body (33% of males and 26.5%
of females; χ2(4)=8.217, p=.084). These gender differences in
attitudes towards psychiatric medication might help to explain
previously reported gender differences in treatment preferences
(Robillos et al., 2008), providing further support that more di-
verse non-pharmacological treatment options might bring more
males into treatment for mental health issues.
CORRESPONDING AUTHOR: Marisa Sklar, BA, University of
California San Diego, San Diego, CA, 92121; masklar@ucsd.edu
C-097o
PSYCHOSOCIAL PREDICTORS OF FATIGUE IN SYSTEMIC
SCLEROSIS
Erin L. Merz, MA,1 Vanessa L. Malcarne, PhD,1,2 Ingunn
Hansdottir, PhD,1,3 Daniel E. Furst, MD,4 Philip J. Clements,
MD4 and Michael H. Weisman, MD5
1
SDSU/UCSD Joint Doctoral Program in Clinical Psychology,
San Diego, CA; 2Psychology, San Diego State University, San
Diego, CA; 3SAA National Center of Addiction Medicine,
Reykjavik, Iceland; 4Rheumatology, UCLA School of Medicine,
Los Angeles, CA and 5Rheumatology, Cedars-Sinai Medical
Center, Los Angeles, CA.
Fatigue is a common, severe, and distressing symptom that
reduces quality of life for many patients with chronic disease.
A number of studies have assessed the nature and psychosocial
correlates of fatigue in a range of clinical populations, but little
is known regarding the phenomenology of fatigue among indi-
viduals with Systemic Sclerosis (SSc), a chronic, degenerative,
rheumatic disease characterized by a buildup of collagen in
body tissue. Because SSc has no known cure and care is largely
palliative, identifying potentially modifiable psychosocial pre-
dictors of fatigue is of particular importance. Participants (N =
93) received clinical examinations and completed the Stanford
Health Assessment Questionnaire (HAQ), Psychosocial Ad-
justment to Illness Scale (PAIS), and a modified version of the
Fatigue Severity Scale (FSS). Overall, 82.6% reported clinically
significant fatigue (FSS ≥4), M = 5.13. Bivariate correlational
analyses revealed significant associations between fatigue
scores and disability, pain, psychological distress, domestic
environment, and social environment; worse disease-related
functioning and adjustment were associated with higher fatigue
scores. A hierarchical multiple regression analysis control-
ling for disease severity and demographic covariates (income,
education) was performed to investigate which of these five
variables were most strongly predictive of fatigue. The initial
model with the covariates accounted for 13.7% of variance in
fatigue scores; inclusion of the 5 psychosocial variables in the
second step resulted in an additional 33.1% of the variance
explained (R2=.468). Pain (β = .248) and the social environment
(β= .266) were the only significant predictors of variance. These
dimensions should be addressed when designing psychological
treatment interventions.
CORRESPONDING AUTHOR: Erin L. Merz, MA, SDSU/UCSD
Joint Doctoral Program in Clinical Psychology, San Diego, CA,
92120-4913; emerz@ucsd.edu
C-097p
FACTOR STRUCTURE OF THE LOSS INVENTORY: A
NEW TOOL TO ASSESS EMOTIONAL REACTIONS TO
DISABLEMENT OR MEDICAL ILLNESS
Rashelle B. Hayes, PhD,1 Janet Niemeier, PhD2 and Joseph Fava,
PhD3
1
Department of Medicine, University of Massachusetts Medical
School, Worcester, MA; 2Department of Medicine, Virginia
Commonwealth University Health Systems, Richmond, VA and
3
Centers for Behavioral and Preventive Medicine, The Miriam
Hospital, Providence, RI.
Background: Emotional reactions to illness or disablement may
include depressed mood as well as symptoms unique to grief
over the loss of functional independence. The Loss Inventory
(LI) measures grief symptoms unique to disablement or illness.
In two samples, the factor structure and validity of the 30-item
Loss Inventory (Niemeier et al., 2004) was examined. Meth-
ods: N=180 Parkinson’s Disease & Essential Tremor veterans
from an outpatient setting and N=203 adults admitted to an
acute mixed (e.g. SCI, TBI, stroke, etc.) rehabilitative inpatient
setting completed the LI as well as demographics and medical
disease data. Analyses: Both principal components (PCA) and
maximum likelihood factor (MLFA) analyses with varimax
rotations were conducted to examine the underlying dimen-
sional structure. Correlations between LI scores, depressed
mood, history of depressed mood, disease stage, activities of
daily living (ADLs), and functional independence (FIM) scores
were also examined. Results: In both samples, LI items loaded
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
(r=.61) were significant. For the mixed acute rehab population,
LI scores approached significance with type of diagnosis (r=-.14;
p=.055) and were significantly correlated to depressed mood
(r=.52) and history of depressed mood (r=.16). Discussion: This
study supported the validity of the LI, and its generalizability to
two distinct medical populations.
CORRESPONDING AUTHOR: Rashelle B. Hayes, PhD, Depart-
ment of Medicine, University of Massachusetts Medical School,
Worcester, MA, 01655; Rashelle.Hayes@umassmed.edu
C-097q
STRESS AND DEPRESSION AS POSSIBLE MEDIATORS OF
THE RELATIONSHIPS AMONG CAREGIVER PHYSICAL
HEALTH AND PROTECTIVE FACTORS AGAINST CHILD
ABUSE AND NEGLECT
Stephanie C. Wallio, PhD,1 Alexander M. Schoemann, MA2 and
Heather N. Rasmussen, PhD3
1
Psychiatry & Behavioral Sciences, University of Kansas
Medical Center, Kansas City, KS; 2Psychology, University of
Kansas, Lawrence, KS and 3Institute for Educational Research
and Public Service, University of Kansas, Lawrence, KS.
Recent trends in child maltreatment prevention focus on protec-
tive rather than risk factors against abuse and neglect. Physical
health has been linked to many risk factors such as depression
and parent-child bonding. However, no research has examined
caregiver physical health in the child maltreatment context and
it has not been included in current prevention frameworks. This
study examined the relationship between caregiver physical
health and protective factors and possible mediation by caregiv-
er stress and depression in caregivers receiving child maltreat-
ment prevention services. 291 caregivers completed measures
of physical health, stress, depression, and protective factors at
two timepoints. The health measure, a modified RAND Health
Survey, had six subscales. The Protective Factors Survey has
four subscales: family functioning/communication (FFC), emo-
tional support, concrete support, and nurturing and attachment.
Structural Equation Modeling and bootstrapping were used
to test meditational hypotheses. All models examined a single
caregiver health latent variable as a predictor of stress, depres-
sion, and protective factors. Numerous predictive relationships
were found from caregiver health to stress and depression and
stress and depression to protective factors. Depression was
found to mediate the relationship from role limitations due to
physical health to FFC (CI95 0.01:0.50) and general health to
FFC (CI95 0.01:0.44). Greater role limitations predicted higher
depression (β=-0.31, p<.05) which predicted lower FFC (β=-0.64,
p<.05). Lower general health also predicted higher depression
(β=-0.30, p<.05) which predicted lower FFC (β=-0.57, p<.05).
Results suggest that family functioning and communication
could be impacted through addressing caregiver depression
and physical health, specifically perceived general health and
role limitations.
CORRESPONDING AUTHOR: Stephanie C. Wallio, PhD, Psy-
chiatry and Behavioral Sciences, University of Kansas Medical
Center, Lawrence, KS, 66049; stephanie.wallio@gmail.com
75
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-097r
RELIGIOSITY PREDICTS PHYSICAL HEALTH IN YOUNG
ADULTS
Katie Watterson, BA, Claire Brownson, BA, Leta Hunt, BA,
Nicole Ehlert, BA and R. B. Giesler, PhD
Psychology, Butler University, Indianapolis, IN.
Although positive associations between religiosity and physical
health have been found in numerous studies, the vast majority
of prior work has focused on relatively older or health-impaired
populations. To investigate this relationship in young adults, a
cross-sectional questionnaire study was conducted using a con-
venience sample (n=117) of undergraduate students. Because
ceiling effects can limit the ability of standardized health inven-
tories to assess physical health in populations that are generally
healthy (e.g., young adults), several alternative measures of
physical health were employed. The current study used four
physical health measures: 1) a symptom count, based on self-
reported common illness symptoms (e.g., runny nose, cough,
etc.) during the past two weeks; 2) a single, likert-type item of
self-reported physical health; 3) self-reported number of recent
health care provider visits; 4) a single, likert-type item assess-
ing the extent to which illness interferes with desired activities.
Religiosity was assessed using a modified version of Hoge’s
(1972) measure of religious commitment. No linear relationship
was found between religiosity and physical health. However,
regression analyses revealed a significant quadratic relationship
between religiosity and the physical health measures (p<.03).
To investigate this relationship further, participants were
categorized into four groups by level of religiosity. A repeated
measures ANOVA, with health measure as the repeated factor,
indicated significant differences across the groups (p < .04):
highly religiously committed individuals tended to show the
best health (i.e., fewer symptoms, better self-rated health, etc.),
followed by moderately committed religious individuals, fol-
lowed by the least committed religious individuals. However,
individuals who were not at all committed (i.e., primarily non-
religious individuals such as agnostics and atheists) experi-
enced relatively high levels of physical health that most closely
approximated those of the moderately religiously committed.
CORRESPONDING AUTHOR: R. B. Giesler, PhD, Psychology,
Butler University, Indianapolis, IN, IN; rgiesler@butler.edu
C-097s
WHY DOES RELIGIOSITY PREDICT PHYSICAL HEALTH IN
YOUNG ADULTS?
Elliot Spengler, BA, Katherine Wainwright, BA, Elizabeth Erb,
BA, Jennifer Kelleher, BA and R. B. Giesler, PhD
Psychology, Butler University, Indianapolis, IN.
Religiosity has been found to predict physical health in reli-
gious older and younger adults, leading many investigators
to suggest that religiosity may play a causal role in promoting
health. Although prior work using older adults has identi-
fied several variables that may mediate the potential effects
of religiosity on physical health, these potential mediators
have not been investigated in younger adults. To address this
issue, a cross-sectional survey study was conducted using a
convenience sample of religious undergraduate students (n
= 93). Religiosity was assessed using a modified version of
Hoge’s (1972) religious commitment scale; physical health was
measured by combining standardized scores from a symptom
count, self-reported number of recent physician visits, self-
76
perceived overall physical health and an estimate of the extent
to which illness interferes with desired activities (alpha = .60).
Potential mediators, drawn from the literature and assessed via
self-report scales, included: 1) health protective behaviors (e.g.,
exercise), 2) health impairing behaviors (e.g., smoking), 3) social
support from religious groups, 4) meaning in life, 5) self-regu-
latory ability and 6) conscientiousness. Additionally, episodic
salutary experiences (ESE), or how often individuals experience
feelings of inner peace distinct from their normal state, was also
examined as a potential mediator. Individual regression-based
mediation analyses indicated that health impairing behaviors,
social support, meaning in life, self-regulatory ability and con-
scientiousness did not mediate the potential impact of religios-
ity on physical health. Of the remaining variables, ESE was
found to mediate the effects of religiosity. Additionally, exercise
proved to be a partial and marginally significant mediator.
These findings suggest that the mechanisms responsible for the
relationship between religiosity and physical health are likely to
differ in younger and older adult populations and highlight the
explanatory role ESE may play in this context.
CORRESPONDING AUTHOR: R. B. Giesler, PhD, Psychology,
Butler University, Indianapolis, IN, IN; rgiesler@butler.edu
C-097t
YOUNG ADULTS’ RELATIONSHIP WITH THE DIVINE
PREDICTS PSYCHOLOGICAL HEALTH
Stephanie Guetig, BA, Toni Maraldo, BA, Elizabeth Kaiser, BA
and R. B. Giesler, PhD
Psychology, Butler University, Indianapolis, IN.
Past investigations have demonstrated that the construct of
attachment style (i.e., type of relationship between a child and
caregiver) can be extended to symbolic relationships between
adults and God in religions where the Divine is viewed as a
personal figure. Although some previous investigations have
suggested that type of attachment to God may predict psycho-
logical outcomes in older adults (e.g., bereavement), very little
work has addressed these issues in young adults. The current
study was conducted to investigate whether young adults’ re-
lationship with God predicts both positive and negative aspects
of mental health. As part of a larger questionnaire study, sev-
eral scales addressing the targeted variables were administered
to a convenience sample of undergraduates (n=98). Attachment
to God was assessed using a modified form of the Distant God
Scale (Kilpatrick & Shaver, 1990); negative and positive aspects
of psychological health were assessed using the Center for
Epidemiologic Studies Depresion Scale (CES-D; Radloff, 1977)
and the Satisfaction with Life Scale (SLS; Diener et al., 1985),
respectively. Bivariate correlations revealed significant relation-
ships: the more participants perceived God as close, personal,
comforting, available and responsive, the less depression they
experienced (r = -.21, p<.05) and the more life satisfaction they
reported (r=.23, p<.03). However, after controlling for level of
religiosity, attachment to God no longer predicted depression,
but still marginally predicted life satisfaction (p<.07). These
findings suggest that young adults’ perceived relationship with
the Divine may independently affect positive aspects of psycho-
logical health, with more secure attachments engendering better
health.
CORRESPONDING AUTHOR: R. B. Giesler, PhD, Psychology,
Butler University, Indianapolis, IN, IN; rgiesler@butler.edu
C-097u
IDENTIFYING NEEDS AND INTERVENTIONS TO SUPPORT
CAREGIVERS OF PATIENTS WITH ALS
Barbara A. Bremer, PhD,1 Susam Walsh, MSN,2 Helen Stephens,
MS,3 Stephanie Felgoise, PhD4 and Zachary Simmons, MD3
1
Psychology, Penn State Harrisburg, Middletown, PA;
2
ALS Association, Philadelphia, PA; 3Medicine, Penn State
University, Hershey, PA and 4Psychology, Philadelphia College
of Osteopathic Medicine, Philadelphia, PA.
104 caregivers of individuals with amyotrophic lateral sclerosis
(ALS) were surveyed to identify task concerns, support strate-
gies, and risk factors (64% female; 90% Caucasian). Mean (SD)
age was 58.9 (12.7) years. Procedure. A team of health profes-
sionals working in an integrative ALS Clinic met with research
faculty and students to develop a comprehensive list of tasks,
support strategies, and risk factors based on literature and clini-
cal experience. A caregiver questionnaire with both closed and
open-ended items was mailed to caregivers. Results. A mean
(SD) of 14.8 (9.66) hours caregiving daily was reported. 17 con-
cerns (0 none, 5 high) were combined (Chronbach’s alpha .94)
to produce a mean (SD) task concern score of 1.93 (1.17), range 0
.12 to 4.88. Concern ratings ranged from a high related to injury
prevention (M=2.44) and emotional/spiritual support (M=2.38)
to lows of medications (M=1.48) and feeding (M=1.28). Fear
about the future was a common theme. 78.8% of caregivers re-
ported socializing was useful, followed by journaling/reading
(50%) and spiritual practices (48%). Least likely to be reported
as helpful were ALS education (1.0%), counseling and support
groups (6.7% each). Activities frequently discontinued while
caregiving included socializing and hobbies. Love and charac-
ter strengths were frequently cited as important for caregiving.
13.5% were positive on a depression screen, and 36.6% on a
stress screen. Discussion. 1) Specific concerns of ALS caregivers
can be identified, with injury prevention, providing emotional
and spiritual support, and fear of the future being among the
top ones; 2) Support strategies for ALS caregivers most com-
monly include socializing, journaling or reading, and spiritual
practices; 3) ALS caregivers often abandon supportive tasks
such as socializing and hobbies. The use of a caregiver survey is
one intervention that can be used to assess caregiver needs and
guide support.
CORRESPONDING AUTHOR: Barbara A. Bremer, PhD,
Psychology Program, Penn State Harrisburg, Middletown, PA,
17057; bab12@psu.edu
C-097v
CULTURAL COGNITIVE FRAME-SWITCHING: MORAL
REASONING ACROSS HOME AND SCHOOL CONTEXTS
AMONG EUROPEAN AMERICANS, ASIAN AMERICANS, AND
ASIAN IMMIGRANTS
Christopher A. Schroth, BA, Jennifer Truong, BA and Janxin
Leu, PhD
Psychology, University of Washington, Seattle, WA.
Evidence suggests that there are cultural differences in cogni-
tive styles between European Americans, who are socialized in
an analytic/independent context, and Asians, who are social-
ized in a holistic/interdependent context. However, Asian
youth raised in immigrant families in the US may be socialized
in both an analytical style of reasoning at school and a holistic
style of reasoning at home. Thus, Asian Americans from im-
migrant families and Asian immigrants may switch between
cognitive styles depending on whether they are in a home
environment versus a school environment. This competition
between cognitive styles may result in stress. For example,
cultural conflict in the family, which includes different ways of
thinking, is associated with greater perceived stress and depres-
sion symptoms, especially among Asian American youth (Leu,
Wang, & Koo, in prep). In a sample of 499 college students, we
predicted a culture by prime interaction effect on moral reason-
ing tasks among US born Asian Americans and foreign-born
Asian immigrants compared to European Americans. European
American (N = 268; 55% female), Asian American (N = 111; 47%
female) and Asian immigrant (N = 120; 57% female) students
completed a 10 minute survey. The survey consisted of a prime
in the form of an essay and vignettes that posed a moral di-
lemma and asked the participant to indicate how strongly they
feel about actions the character in the vignette can take. After
completing these tasks, participants completed measures of per-
ceived stress and identity. As predicted, both Asian Americans
and Asian immigrants were influence by the primes, reasoning
differently in home than in school context. However, European
Americans did not switch their moral reasoning style depend-
ing on the prime. Also, Asian youth reported greater levels of
perceived stress than European Americans. Future studies will
further examine psychological constructs and physiological
measures of stress and their relation to cultural cognitive frame-
switching and perceived stress.
CORRESPONDING AUTHOR: Christopher A. Schroth, BA,
Psychology, University of Washington, Seattle, WA, 98125;
christopher.schroth@gmail.com
C-097w
COLLEGIATE SPORTS AND EXERCISE PARTICIPATION:
PROTECTIVE OR HARMFUL FOR HEALTH AND EATING
DISORDER RISK?
Melissa Napolitano, PhD1 and Sharon Hayes, MA2
1
Kinesiology and Public Health, Temple University,
Philadelphia, PA and 2College of Health Professions and Social
Work, Temple, Philadelphia, PA.
Data suggest that collegiate athletes may be at higher risk for
having an eating disorder than the general collegiate popula-
tion. The purpose of this study was to examine health and eat-
ing disorder risk among athletes and non-athletes in sample of
female undergraduates (n=715; 76.8% Caucasian). In this study,
participants self-identified as being a varsity or club athlete
(n=95; 13.3%), independent exerciser (n=280; 39.2%), or non-
exerciser (n=340; 47.5%). The Eating Disorders Diagnostic Scale
was used to classify participants by eating disorder diagnosis
(anorexia, bulimia, binge eating disorder, not meeting criteria
for an eating disorder). In terms of eating disorder risk, 8.4%
of the club/varsity athletes, 16.4% of the independent exercis-
ers, and 10.3% of the non-exercisers met criteria for an eating
disorder (X2=6.28; p<0.05). When risk for eating disorder was
examined, independent exercisers had higher drive for thin-
ness (p<0.0001), more restrained eating (p<.001), higher body
dissatisfaction (p<.01), and greater eating disorder symptoms
(p<0.01) compared with non-exercisers; there were no differenc-
es between club/varsity athletes and independent exercisers.
The only variable that distinguished club/varsity athletes from
non-exercisers was restrained eating (p<0.0001), there were no
77
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
differences between club/varsity athletes and independent ex-
ercisers. In terms of other health risks, there were no differences
in smoking prevalence or depression by athletic category: ap-
proximately 50% of all students (regardless of athletic category)
reported high levels of depressed mood and approximately 30%
reported smoking 100 cigarettes in their lifetime. The results
from this study suggest that collegiate athletes are not at greater
risk for an eating disorder, yet athletic participation also may
not shield athletes from other health risks such as smoking or
mood disturbance.
CORRESPONDING AUTHOR: Melissa Napolitano, PhD, Ki-
nesiology and Public Health, Temple University, Philadelphia,
PA, 19140; napolita@temple.edu
C-097x
SPOUSES AS PROXIES: AGREEMENT, ACCURACY AND
ASSUMED SIMILARITY IN END-OF-LIFE DECISION MAKING
Elizabeth McDade-Montez, PhD1 and David Watson, PhD2
1
VA Palo Alto, Palo Alto, CA and 2University of Iowa, Iowa
City, IA.
Medical decisions near the end of life are often made by proxies
such as spouses yet research has shown that proxies can be in-
accurate in their judgments of patient preferences. The objective
of this study was to examine agreement, accuracy and assumed
similarity, a process whereby a rater relies on self-knowledge to
rate another person, in spousal ratings of end-of-life treatment.
Methods: 204 married couples completed self- and spouse-mea-
sures of medical care preferences given five different hypotheti-
cal scenarios (i.e., current health, stroke, cognitive impairment,
physical impairment, terminal cancer) and up to four potential
treatments (i.e., CPR, IV antibiotics, IV nutrition, mechanical
ventilation). Results: Several significant differences were seen
between spouse/proxy-ratings, with wives generally rating
their husbands as less interested in life-saving treatments than
husbands rated their wives. Husband and wife self-ratings were
significantly correlated with one another, indicating a moderate
level of similarity in treatment preferences (r = .20-.29). Spou-
sal/proxy-ratings were also moderately correlated with actual
self-ratings, indicating that spouses were fairly accurate in their
ratings of their spouses’ preferences (r = .18-.42). The largest
correlations were seen between self-preferences for treatment
and spouse/proxy-preferences for treatment (e.g., the correla-
tion between a husband’s self-rating of preferences and his rat-
ing of his wife’s preferences; r = .45-.69), indicating that spouse/
proxy-ratings were most strongly influenced by self-ratings.
Conclusions: Spouses share a moderate level of agreement in
their preferences for end-of-life treatment and a moderate level
of accuracy in predicting one another’s preferences. However,
proxy-ratings were most strongly correlated with self-ratings,
indicating that assumed similarity may impact proxy end-of-
life treatment preferences. Recognizing the potential impact of
personal preferences in end-of-life decisions may help improve
proxy accuracy in medical decision making and improve end-
of-life care.
CORRESPONDING AUTHOR: Elizabeth McDade-Montez,
PhD, VA Palo Alto HCS, Capitola, CA, 95010; liz-mcdade@
uiowa.edu
78
C-106a
COPING STRATEGIES AND BELIEFS ABOUT PAIN IN
PATIENTS WITH COMORBID CHRONIC PAIN AND PTSD
Kevin Alschuler, MS, Elizabeth Johnson, MS and John Otis, PhD
VA Boston Healthcare System, Boston, MA.
Patients’ beliefs about chronic pain and the coping strategies
employed can have a significant impact on positive adaptation
in the face of pain. Coping strategies may be categorized as
adaptive or maladaptive (Riley et al., 1999) and are influenced
by patients’ beliefs about the controllability, meaning, and man-
agement of pain (Jensen et al., 1994).
The experience of chronic pain by US Veterans is often exacer-
bated by the presence of posttraumatic stress disorder (PTSD).
However, no studies have examined the impact of the presence
of PTSD on the beliefs and coping strategies used by patients
with chronic pain. We hypothesized that patients with comor-
bid PTSD and pain would employ more maladaptive coping
strategies and beliefs about their pain compared to patients
with pain alone.
Participants were 131 veterans seeking chronic pain treatment
at a VA Medical Center in the northeastern U.S. Symptoms of
PTSD were assessed using the PTSD Checklist Military Version
(Weathers et al., 1993), with a cut-off score of 50 used to sepa-
rate patients with and without PTSD. The Coping Strategies
Questionnaire (Riley et al., 1999) and Survey of Pain Attitudes
(Jensen et al., 1994) were used to assess coping and beliefs.
Patients with PCL scores >50 catastrophize more than patients
with PCL scores <50 (F = 6.49, p < .001) and believe they have
less control over their pain (F = 2.40, p < .01), their emotions in-
fluence their pain (F =2.10, p < .05), medication should be used
to control pain (F = 3.21, p < .05), and others should respond
solicitously to them (F = 2.42, p < .05).
Consistent with our hypothesis, patients with comorbid pain
and PTSD endorsed more maladaptive coping strategies and
beliefs than patients with pain alone. Notably they believed
they had less control over their pain and exemplified this by
attributing pain control to external sources (medication, others’
responses) and emotions, which PTSD patients often have dif-
ficulty controlling. Understanding these patterns of beliefs and
coping strategies can serve to effectively guide clinical interven-
tions for comorbid pain and PTSD.
CORRESPONDING AUTHOR: Kevin Alschuler, MS, VA Bos-
ton Healthcare System, Boston, MA, 02130; kalschul@gmail.com
C-106b
EFFECTIVENESS OF BRIEF MINDFULNESS INTERVENTION
WITHIN AN INTERDISCIPLINARY CHRONIC PAIN
MANAGEMENT PROGRAM
Sara D. Barrett, PhD,1 Caryn Feldman, PhD,1,2 Chris Gagnon,
PhD1,2 and Steven Stanos, DO1,2
1
Center for Pain Management, Rehabilitation Institute of
Chicago, Chicago, IL and 2Physical Medicine and Rehabilitation,
Northwestern University Feinberg School of Medicine, Chicago,
IL.
Mindfulness-based interventions have been linked with im-
provements in mental and physical health in a variety of popu-
lations. Our interdisciplinary treatment program for chronic
pain recently implemented a brief group intervention designed
to increase mindfulness skills in our patients. The Mindful At-
tention Awareness Scale (MAAS) was used to assess patients’
receptive attention to and awareness of present events and
experience. There was a significant increase in MAAS scores
following the mindfulness intervention, [t48 = 2.296, p = .026],
suggesting that the intervention was effective. We also exam-
ined whether change in MAAS scores was related to change
in program outcomes. Outcome measures included the Center
for Epidemiological Studies Depression Scale, all subscales
from the Coping Strategies Questionnaire-Revised, the Pain
Willingness and Activity Engagement subscales of the Chronic
Pain Acceptance Questionnaire, the Pain Anxiety Symptoms
Scale, and the Pain Severity and Interference subscales from
the Multidimensional Pain Inventory. Simple pre-post change
scores were calculated for MAAS scores and outcome measures.
Results showed that an increase in MAAS scores was associ-
ated with a decrease in pain interference [r = -.376, p = .016],
a decrease in pain-related anxiety [r = -.383, p = .016], and an
increase in activity engagement [r = .353, p = .027]. Change in
MAAS scores was not related to change in depression, pain
severity, or willingness to experience pain. Increase in MAAS
scores was related to less use of distancing coping strategies [r
= -.380, p = .020], but unrelated to change in other pain cop-
ing (distraction, catastrophizing, ignoring, cognitive coping, or
passive prayer). These results suggest that that the mindfulness
intervention was effective in increasing mindful attention and
awareness in a chronic pain population, and that an increase in
mindful attention was related to positive program outcomes.
CORRESPONDING AUTHOR: Sara D. Barrett, PhD, Center for
Pain Management, Rehabilitation Institute of Chicago, Chicago,
IL, 60611; sbarrett@ric.org
C-106c
EXAMINING THE RELATIONSHIP OF STRESSORS,
RUMINATION, PAIN SELF-EFFICACY AND DEPRESSION IN A
COMMUNITY SAMPLE OF MEN AND WOMEN WITH CHRONIC
PAIN
Eleni Romano, MA, Jelena Agatonovic, MA, Lauren Smith, MA,
Jay Skidmore, PhD and Kristen Perry, MA
Clinical Psychology, Seattle Pacific University, Seattle, WA.
Chronic pain is a widespread and debilitating health concern.
Depression not only highly co-occurs with chronic pain, but
also is related to physical and psychosocial maladjustment
to chronic pain. The cognitive-vulnerability stress model of
depression asserts that in response to stressors, a negative cog-
nitive style is associated with depression. One such cognitive
vulnerability is a ruminative response style. Although this rela-
tionship has been widely established, it has yet to be explored
in chronic pain. Therefore, the first goal of this study was to test
the ruminative response style theory among a population of
individuals with chronic pain. Although this relationship has
been established primarily with women, we sought to explore
this relationship in men as well. Pain self-efficacy (PSE) is a
strong predictor of coping and adjustment to chronic pain. Our
second goal was to examine the moderating effect of PSE on
the relationship between stressors, rumination, and depression.
Participants (N = 109) were recruited from online networks,
and data was analyzed with a hierarchical regression. Stressors
significantly predicted elevations in depression for women (B =
.25, SE = .00, p < .001), but not for men. Rumination predicted of
elevations in depression for women (B = .48, SE = .07, p < .001)
and men (B = .41, SE = .145, p = .04). Contrary to our hypoth-
esis, the interaction between stressors and rumination was
non-significant for both women and men. PSE was negatively
related to depression for women (B = -.35, SE = .07, p < .001)
and men (B = -.40, SE = .12, p < .01). Interestingly, our hypoth-
esis that PSE would buffer the relationship between rumina-
tion and depression was supported for only men (B = -.43, SE
= .02, p < .05). Our findings suggest that rumination may be an
important factor in the maintenance of depression for men and
women in a sample of chronic pain sufferers, and that PSE may
be a protective factor in the relationship between rumination
and depression for men.
CORRESPONDING AUTHOR: Eleni Romano, MA, Clini-
cal Psychology, Seattle Pacific University, Seattle, WA, 98119;
romane1@spu.edu
C-106d
DISENTANGLING THE EXPERIENCE OF PAIN, DEPRESSION,
AND DISABILITY IN MS
Amy Kupper, BA, Anna L. Kratz, PhD, Tiara Dillworth, PhD,
Christina L. Garcia, BA and Dawn M. Ehde, PhD
Rehabilitation Medicine, University of Washington, Seattle,
WA.
Although pain and Major Depressive Disorder (MDD) have
been shown to be common problems for individuals with
multiple sclerosis (MS), the associations between pain, MDD,
and pain-related disability are not well understood. The aim of
this study was to describe pain intensity, pain-related disability,
depressive symptoms, rate of MDD and associations between
these variables in MS.
Participants, 1236 adults (991 women) with MS, completed mea-
sures of characteristic pain intensity and pain-related disability
(Korff et al., 1992) and depressive symptoms (PHQ-9). The
majority, (54.7%) endorsed “moderate” pain (40-60/100), 23.1%
reported “mild” (≤ 30/100) pain and 22.2% reported “severe”
(≥ 70/100) pain. Using the same scale, 56.6% reported that pain
contributed to “mild”, 31.2% to “moderate” and 12.2% to “se-
vere” disability. In this sample, 18% of participants met criteria
for MDD. Of the 1006 who did not meet MDD criteria, 41.2%
reported no depressive symptoms, 36.6% reported mild symp-
toms and 19.7% reported moderate symptoms. Notably, 27
individuals (2.7%) who endorsed moderately-severe to severe
depressive symptoms did not meet MDD diagnostic criteria due
to negative responses on the first two items.
Participant demographics (e.g., age, gender) did not show size-
able correlations with pain intensity, pain-related disability, or
depressive symptoms. However, depressive symptoms were
positively correlated with characteristic pain intensity (r = .61,
p <. 01) and pain-related disability (r = .47, p <. 01). Participants
with MDD were more likely to report “severe” pain intensity,
35.8% compared to 18.4% of those with no MDD, χ2(3,834) =
43.38, p < .01, and were more likely to report “severe” pain-re-
lated disability, 28.5% compared to 7.4% of those with no MDD;
χ2(3,834) = 87.56, p < .01.
Rates of MDD, pain, and disability related to pain are reported
with high frequency among individuals with MS, though a size-
able minority reported no problems with mood or pain. MDD
and depressive symptomotology were related to higher pain
intensity and pain-related disability.
CORRESPONDING AUTHOR: Amy Kupper, BA, Rehabilita-
tion Medicine, University of Washington, Seattle, WA, 98104;
akupper@uw.edu
79
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-106e
TRAJECTORIES OF TREATMENT RESPONSE IN PATIENTS
WITH SEVERE HEADACHES: DEMOGRAPHIC, CLINICAL, AND
BEHAVIORAL CORRELATES
Kristin Lewis, MA, Bernadette D. Heckman, PhD and Rewadee
Watakakosol, MA
Ohio University, Athens, OH.
Objective: To identify treatment outcome trajectories of head-
ache patients receiving treatment in community-based head-
ache specialty treatment clinics.
Methods: Data analyzed in the current study were collected
from 219 patients receiving treatment for episodic migraine,
chronic migraine, episodic tension-type headache, or chronic
tension-type headache in outpatient treatment clinics. Patients
were recruited from outpatient clinics in Cincinnati, Cleveland,
Columbus, and Toledo, OH. Using a naturalistic longitudinal
study design, patients completed psychosocial assessments at
pre-treatment and 1-, 2-, and 6-month follow-up that provided
data on headache disability (the study’s primary outcome
measure) and characteristics related to headache disability
(e.g., social support, headache management self-efficacy, etc.).
Patients initiated new headache treatments after completing the
pre-treatment appointment and assessment.
Results: The typical patient was Caucasian (67%), female (88%),
and 36.7 years of age. Seventy-percent of participants were
diagnosed with migraine headache, 17% with tension-type
headache, and 13% with both headache types. Latent-class
trajectory analysis of the headache disability measure identified
three treatment trajectory outcome groups: (1) a high-disability
at pre-treatment group that failed to respond to treatment
(34%; high-disability non-responders); (2) a high-disability at
pre-treatment group that responded successfully to treatment
(11%; high-disability responders); and (3) a low-disability at
pre-treatment group that still showed significant improvement
over the course of treatment (55%). Contrary to the study’s
hypothesis, the only variable that differentiated high-disability
non-responders from high-disability responders was treatment
appointment attendance; patients who missed one or more of
the three treatment appointments following their initial visit
failed to reduce their headache disability.
Implications: Study findings underscore the importance of
developing interventions that retain headache patients in treat-
ment.
CORRESPONDING AUTHOR: Bernadette D. Heckman, PhD,
Ohio University, Athens, OH, 5701; heckmanb@ohiou.edu
C-123a
THE BUILT ENVIRONMENT AND HEALTH IN OLDER ADULTS:
ASSOCIATIONS BETWEEN WALKABLE NEIGHBORHOODS,
MOBILITY IMPAIRMENT, AND PHYSICAL ACTIVITY
Abby King, PhD,1 James Sallis, PhD,2 Lawrence Frank, PhD,3
Brian Saelens, PhD,4 Matthew P. Buman, PhD1 and Eric Hekler,
PhD1
1
Stanford Prevention Research Center, Stanford University,
Stanford, CA; 2Psychology, San Diego State University, San
Diego, CA; 3Urban Design 4 Health, Inc., Atlanta, GA and
4
Seattle Children’s Hospital, Seattle, WA.
The built environment and mobility impairment are both
known to impact physical activity behavior, yet few studies
80
have explored relationships among built environment features,
mobility impairment, and various physical activity (PA) forms
among older adults. Adults ages 66 yrs and above (N=709)
living in Seattle or Baltimore regions were recruited from GIS-
enumerated neighborhoods identified as high or low afflu-
ent and high or low ‘walkable’ based on land use mix, street
connectivity, and other features. Variables included general PA
(via accelerometry and self-report), reported active transport
(walking/bicycling for errands), and reported BMI and mobility
impairments. Persons in less affluent neighborhoods reported
generally less PA and higher BMI. After controlling for indi-
vidual and neighborhood-level sociodemographic and regional
factors, walkability was positively associated with active trans-
port (p<.0001), total PA (p=.036), leisure walking/cycling/jog-
ging (p<.008), accelerometry-derived minutes/day of moderate
or vigorous PA (p=.056), and lower BMI (p=.02). A significant
walkability-mobility impairment interaction was observed
for active transport only; as mobility increased, differences in
minutes/week of active transport among those living in low
vs. high walkable neighborhoods increased (p=.001). Persons
in the lowest mobility tertile living in high walkable neighbor-
hoods had active transport levels comparable to persons in the
two higher mobility tertiles but living in less walkable neigh-
borhoods (means=35 mins/wk vs. 27 mins/wk, respectively,
p>.13). Results suggest the potential importance of environ-
mental features, across levels of mobility, in facilitating active
transport and other healthful patterns among older adults.
CORRESPONDING AUTHOR: Matthew P. Buman, PhD, Stan-
ford Prevention Research Center, Stanford University, Stanford,
CA, 94305-5411; mbuman@stanford.edu
C-123b
READY FOR RECESS: A PILOT STUDY TO INCREASE
PHYSICAL ACTIVITY (PA) IN ELEMENTARY SCHOOL
CHILDREN
Jennifer L. Huberty, PhD,1 Mohammad Siahpush, PhD,2 Aaron
Beighle, PhD,3 Erin Fuhrmeister, BS,1 Pedro Silva, MS4 and Greg
Welk, PhD4
1
University of Nebraska at Omaha, Omaha, NE; 2University
of Nebraska Medical Center, Omaha, NE; 3Kinesiology
and Health, University of Kentucky, Lexington, KY and
4
Kinesiology, Iowa State University, Ames, IA.
Background: Creating an optimal environment at recess may
be necessary to maximize physical activity (PA) participation
in youth. The purpose of this study was to determine the initial
effectiveness of an elementary school recess intervention on the
amount of moderate PA (MPA) and vigorous PA (VPA) during
recess and the school day.
Methods: This school-based intervention included staff train-
ing, activity zones, and playground equipment. The PA levels
of 3rd, 4th, and 5th grade students (n=93) at two schools were
measured at baseline and post-intervention using Actigraph
accelerometers. Paired t-tests were used to compare percentage
of time spent during recess in moderate and vigorous PA. Mul-
tiple regressions were utilized to model the effect of interven-
tion, age, sex, race, BMI, and school on minutes spent in MPA
and VPA.
Results: The multiple regression results demonstrated increases
of 2.5 min of MPA (p<0.001) and 2.2 min of VPA (p<0.001) at
recess and an increases of 18.7 min of MPA (p<0.001) and 4.7
min of VPA (p<0.001) during the school day. These represent
respective increases of 51.2% and 112.2% in the adjusted means
of MPA and VPA during recess and respective increases of
92.2% and 71.6% in the adjusted mean of MPA and VPA during
school day.
Conclusion: Staff training, recreational equipment, and play-
ground markings are inexpensive, simple ways to increase PA
during recess so that children can accumulate minutes of PA to
meet the recommended guidelines of 60 minutes per day.
CORRESPONDING AUTHOR: Jennifer L. Huberty, PhD,
University of Nebraska at Omaha, Omaha, NE, 68116; jennifer-
white@mail.unomaha.edu
C-123c
INFLUENCES OF HOME, SCHOOL, AND NEIGHBORHOOD
ENVIRONMENTS ON YOUTH PHYSICAL ACTIVITY
Rachel Millstein, MHS,1 Jacqueline Kerr, PhD,2 Joe Stroebel,
BA,3 James Sallis, PhD,3 Greg Norman, PhD,2 Sion Harris, PhD,4
Nefertiti Durant, MD, MPH5 and Brian Saelens, PhD6
1
Clinical Psychology, SDSU/UCSD, San Diego, CA; 2University
of California, San Diego, San Diego, CA; 3San Diego State
University, San Diego, CA; 4Harvard Medical School, Boston,
MA; 5University of Alabama at Birmingham School of Medicine,
Birmingham, AL and 6University of Washington, Seattle, WA.
Literature suggests that youth physical activity (PA) is related
to factors in homes, schools, and neighborhoods. We exam-
ined the relative contributions of these environments to youth
PA. Adolescents (ages 12-18; N=157), parents of adolescents
(N=155), and parents of children (ages 5-11; N=108) from 3
US metropolitan areas completed a survey assessing features
of these environments and youth PA. Questions were taken
from reliable and validated scales. Youth PA was indexed
from z-scores of five items assessing overall PA, sports team
participation, and school physical education. For each group
(adolescent self report, parent report of adolescents, parent
report of children), bivariate correlations were used to select
variables (p<0.05) for hierarchical regression models, adjusted
for demographics. There were significant correlations for each
environment (Pearson’s rs: 0.20-0.29). For adolescents, amount
of home equipment, school equipment, and neighborhood aes-
thetics were entered into the model. For parents of adolescents,
amount of home equipment and neighborhood aesthetics, and
for parents of children, amount of home equipment and neigh-
borhood street connectivity were entered into the model. The
blocks were entered into the regression in order: demographics,
home, school, and neighborhood. For adolescents the full model
explained 13.8% of variance and the home, school, and neigh-
borhood blocks were each significant. For parent report of ado-
lescents and children, only the home and neighborhood blocks
were significant. Full models accounted for 14.3% and 17.5% of
variance, respectively. To optimize explanation of youth PA,
multiple environmental factors should be considered. Modifi-
able factors like increasing access to PA equipment at home and
school, and improving neighborhood aesthetics may impact
youth PA.
CORRESPONDING AUTHOR: Rachel Millstein, MHS, Clini-
cal Psychology, SDSU/UCSD, San Diego, CA, 92116; rmillste@
ucsd.edu
C-123d
REMOTE INFORMATION AND TRAINING FOR EXERCISE -
RITE
NiCole R. Keith, PhD, Melissa L. Cusick, MS, Brittney S. Lange,
BS and Daniel O. Clark, PhD
Indiana University, Indianapolis, IN.
Current physical activity (PA) guidelines may be difficult for
the obese, chronically ill or frail to meet. Obese persons of any
age and older adults with multiple chronic conditions are at
greater risk for decreased physical function (PF) which can
make walking and other PA difficult. In fact, 44% of older
adults have difficulty walking ¼ mile and 42% of obese per-
sons report difficulty. We developed and piloted a supervised,
seated exercise program delivered to patients’ homes.
From a community health center we recruited 16 obese patients
who were > age 50. We installed in subjects’ homes a videocon-
ferencing-capable computer, provided instructions and trained
subjects on computer use. We delivered supervised, seated, in
home, group exercise via videoconference twice a week. During
the exercise sessions the trainer led exercises from a remote site.
Subjects were in their homes. All could see and hear one anoth-
er and all remained seated in front of the web cam throughout.
The exercise sessions included interactive games and 40 min-
utes of aerobic and flexibility exercises using all major muscle
groups. There was a progressive increase in exercise intensity
during the 2-month session.
Baseline and follow-up was completed in 15/16 subjects’
homes. The missing subject had frequent back pain unrelated to
the study and could not finish the last 4 weeks. Overall adher-
ence was 82% and 9/16 subjects had > 94% adherence. Satisfac-
tion ratings were 3.93/4.00. Mean chair stands improved by
24% (11.4+2.6 to 14.1+4.6), number of steps in 2 minutes by 31%
(64.4+28.3 to 81.1+43.3) and mean arm curls by 34% (13.6+3.1
to 18.2+4.0). All improvements were statistically significant
(P<0.001)
This project shows the feasibility and promise of video-
conference for exercise training. In medically the vulnerable,
supervised exercise may be important for safety, social support,
training and adherence. Providing seated, supervised exercise
to patients in their homes has potential to reach those who may
not otherwise be reached. Future work will compare adherence
and outcomes between supervised and unsupervised formats
and address cost-effectiveness
CORRESPONDING AUTHOR: NiCole R. Keith, PhD, Physical
Education, Indiana University-Purdue University, Indianapolis,
Indianapolis, IN, 46202; nkeith@iupui.edu
C-123e
AEROBIC FITNESS IS RELATED TO WAIST CIRCUMFERENCE
IN OVERWEIGHT ADOLESCENTS
Erin N. Etzel, BA, Patrice G. Saab, PhD, Stephanie L. Fitzpatrick,
MS, Amanda J. Countryman, MS, Katie E. Chipungu, BS, Judith
R. McCalla, PhD and Neil Schneiderman, PhD
Psychology, University of Miami, Coral Gables, FL.
Research indicates that adolescents’ physical activity levels dif-
fer by socioeconomic status (SES). Aerobically unfit youth pres-
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
aerobic fitness is related to waist circumference in adolescents.
Adolescent boys (n = 44) and girls (n = 17) with elevated blood
pressure (BP; systolic BP and/or diastolic BP ≥ 90th percentile,
adjusted for age, gender, and height) and normotensive boys
(n = 80) and girls (n = 25), aged 15-17, participated in an as-
sessment of anthropometric measures, treadmill testing, and
a 7-day activity recall as part of a larger study. Parents self-re-
ported their education levels. The sample’s mean BMI was 28.1
kg/m2, indicating a majority of the sample was overweight.
Parental education was positively associated with VO2max
(r = 0.22, p = 0.01). A multiple linear regression analysis was
conducted to determine whether VO2max is associated with
waist circumference, controlling for minutes of weekly physi-
cal activity, parental education, gender, and BP status. This
model significantly accounted for 39.7% of the variance in waist
circumference (F(5, 127) = 16.73, p < .0001). The VO2max was
associated with 24.4% of the variance in waist circumference (t
= -7.17, p < .0001). Gender and BP status also made significant
contributions, accounting for 6.9% and 3.6% of the variance in
waist circumference, respectively, p’s < 0.01.
These findings suggest adequate aerobic fitness may be critical
in primary prevention of obesity in youth. Overweight youth
with central adiposity may benefit from physical activity inter-
ventions. Improved aerobic fitness may reduce waist circumfer-
ence, thereby decreasing their CV risk.
CORRESPONDING AUTHOR: Erin N. Etzel, BA, Psychology,
University of Miami, Miami, FL, 33143; eetzel@psy.miami.edu
C-123f
PREDICTING PHYSICAL ACTIVITY AMONG QUEBEC’S
COLLEGE STUDENTS : ROLE OF THE THEORY OF PLANNED
BEHAVIOUR AND THE CONTRIBUTION OF PAST BEHAVIOR
AND PHYSICAL SELF-CONCEPT
Jean Lemoyne, M Sc1 and Pierre Valois, PhD2
1
Physical Education, College Shawinigan, Shawinigan Sud, QC,
Canada and 2Faculty of Education, Université Laval, Québec,
QC, Canada.
Background: Physical inactivity is considered a major problem
at the international level. Most studies suggest a high preva-
lence of sedentarity especially among the young adult popula-
tion. The theory of Planned Behaviour (TPB)is a theoretical
framework frequently used in health education. According to
some authors, the physical self concept (PSC) and past behav-
iour could contribute to the refinement of the TPB.
Purpose: The purpose of this study is to predict different types
of physical activities (total, fitness and sports) among college
students. We want to identify the factors the most related with
different physical active behaviours. Furthermore, we want to
evaluate the contribution on past behavior and the physical self-
concept on the TPB.
Methods: A questionnaire was administered to 425 college stu-
dents. TPB variables were measured. A follow-up questionnaire
was administered to the same group and self-reported physical
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
attitudes, perceived barriers and physical self concept were sig-
nificantly related to intentions of being active (R-square = .45).
Further, the model explained the relationships between inten-
tions, PSC, past behaviour and the practice of physical activity
(R-suqare “overall” = .27, R-square “fitness” = .30,R-square
“sports” = .39). PSC and past behaviour were better predictors
than the intentions to be active.
Conclusions: These findings contribute to the refinement of the
theory of planned behaviour and suggest further developments
regarding the role of the physical self-concept in the health/
physical education field.
CORRESPONDING AUTHOR: Jean Lemoyne, M Sc, Physical
Education, College Shawinigan, Shawinigan Sud, QC, G9P 4T9;
jean.lemoyne@sympatico.ca
C-123g
SOCIAL COGNITIVE CORRELATES OF PHYSICAL ACTIVITY
IN ADULTS WITH MULTIPLE SCLEROSIS
Deirdre Dlugonski, BS, Thomas R. Wójcicki, BS, Edward
McAuley, PhD and Robert W. Motl, PhD
University of Illinois, Urbana-Champaign, IL.
Background: Physical inactivity is prevalent among persons
with multiple sclerosis (MS), despite the evidence that physical
activity has desirable effects on physical function and quality
of life. This underscores the importance of identifying social-
cognitive variables such as self-efficacy, goal setting, outcome
expectations, and impediments as possible targets for chang-
ing physical activity behavior in persons with MS. The present
study investigated these social-cognitive variables as correlates
of self-reported physical activity using baseline data from an
ongoing Internet intervention.
Methods: Participants were persons with MS (N = 54) who
were enrolled in an Internet intervention for increasing physical
activity. Prior to randomization, participants completed a bat-
tery of questionnaires which included the Godin Leisure-Time
Exercise Questionnaire (GLTEQ), Exercise Self-efficacy Scale
(EXSE), Exercise Goal-Setting Scale (EGS), Multidimensional
Outcome Expectancies for Exercise Scale (MOEES), and Late-
Life Function and Disability Inventory (LL-FDI). The data were
analyzed using bivariate correlation and multiple linear regres-
sion in SPSS 17.0.
Results: Bivariate correlation analysis indicated that GLTEQ
scores were significantly correlated with EGS (r = .31, p = .01),
MOEES (r = .29, p = .02), and LL-FDI (r = .28, p = .02) scores,
but were not significantly correlated with EXSE (r = .13, p = .17)
scores. Multiple linear regression analysis with stepwise entry
indicated that only EGS scores were significantly associated
with GLTEQ scores (β = .31, p = .01), and goal setting explained
10% of the variance in self-reported physical activity.
Conclusions: This cross-sectional analysis suggests that goal-
setting is a primary correlate of physical activity in persons with
MS.
CORRESPONDING AUTHOR: Deirdre Dlugonski, BS, Univer-
sity of Illinois, Urbana, IL, 61801; dlugons1@illinois.edu
C-123h
SELF-REGULATION IN A MULTIPLE BEHAVIOR CHANGE
INTERVENTION: LENDING SUPPORT FOR FURTHER
RESEARCH IN MEDIATIONAL ANALYSES AND PHYSICAL
ACTIVITY
Emily Martin, MS, Ashley Dorough, PhD, Richard Winett, PhD
and Matthew Cox, MS
Psychology, Virginia Tech, Blacksburg, VA.
Support has been garnered for multiple behavior change inter-
ventions that include physical activity (PA; Marcus et al, 2006).
Dash-2-Wellness (D2W), a multiple behavior change interven-
tion in individuals with prehypertension, was aimed at improv-
ing health behaviors known to lower blood pressure. It has been
suggested that lifestyle change be the first line of treatment for
prehypertension, including PA (Chobanian et al, 2003). D2W
utilized various social cognitive theory (SCT) variables, includ-
ing self-regulation (SR). SR strategies have been associated with
greater motivation and involvement with PA (Anderson et al,
2006; Umstattd, Wilcox, Saunders, Watkins, & Dowda, 2008).
Participants (n=23) were randomized into D2W Plus, the
intervention group, or D2W Only, the standard care group. PA
was measured through daily step count. After the ten-week
intervention, independent t-tests showed that participants in
D2W Plus made greater increases in daily steps (M=2,900.14,
SD=1903.83 steps/day) compared to D2W Only participants
(M=636.39, SD=1,653.26 steps/day; p=.01; Dorough, 2009). Fur-
ther analyses indicate significant group differences in changes
in SR. Specifically, participants in D2W Plus made greater
increases compared to the D2W Only participants in SR for PA
(M=1.96, SD=.83 vs. M=.53, SD=.55; p<.001).
Results suggest that changes in SR may be the mediating
variable between the intervention and outcomes. Results with
regard to changes in SR, coupled with the group differences
in PA, warrant further examination into whether SR mediates
changes in PA. It has been suggested that mediational analysis
is the next step for PA interventions, in order to assess “what
works” in terms of behavior change (Lewis, Marcus, Pate &
Dunn, 2002; Lubans, Foster, & Biddle, 2008). Previous research
has found various SCT factors to be mediating variables of in-
creases in PA. The above results indicate that a similar relation-
ship is worth exploring within this important at-risk popula-
tion.
CORRESPONDING AUTHOR: Emily Martin, MS, Psychology,
Virginia Tech, Blacksburg, VA, 24060; ecmartin@vt.edu
C-123i
ACUTE EXERCISE AMELIORATES SEXUAL SIDE EFFECTS
OF ANTIDEPRESSANTS IN WOMEN
Tierney K. Ahrold, MA, Rachel Zincone, BS, Sharon Stasney, BA
and Cindy M. Meston, PhD
Department of Psychology, University of Texas at Austin,
Austin, TX.
Antidepressant drugs, while widely prescribed, carry a number
of side effects, including sexual side effects such as impaired
sexual arousal (for review, see Clayton, Keller, & McGarvey,
2006). Acute exercise has been shown to increase sexual arousal
in healthy women (e.g., Meston, 2000); as such, there is reason
to believe an exercise intervention may help increase sexual
arousal in women taking antidepressants as well. Extending
a paradigm previously shown to increase sexual arousal in
women (Meston & Gorzalka, 1996), we hypothesized that acute
exercise would increase women’s sexual arousal to sexually
explicit material. Women reporting at least “some difficulty”
with sexual arousal while taking SSRIs or SNRIs (N= 26, Mage
= 27.3) watched a neutral and then an erotic film while their
physical sexual arousal (vaginal pulse amplitude, VPA) was
recorded. VPA is an index of genital blood flow and is consid-
ered the gold standard measure of physical sexual arousal in
women. In a separate, counterbalanced session, participants ex-
ercised for 20 minutes at 80% of their maximum heart rate. Five
minutes after exercising, participants watched another neutral
and erotic film while their arousal was recorded. We calculated
percent change in sexual arousal between neutral and erotic
films for each session. On average, women’s sexual arousal
to the erotic film during the exercise session was double that
of the baseline session (i.e., 23% increase between neutral and
erotic films during the baseline session vs. 50 % increase after
exercise). A paired t-test indicated that women’s sexual arousal
during the exercise condition was significantly greater than at
baseline (t(25) = 3.37, p < Acute exercise immediately prior to
exposure to sexual stimuli appears to increase sexual arousal
in women taking antidepressants. Although further work is
needed to validate the efficaciousness of the intervention in a
non-laboratory environment, these results are promising and
suggest that exercise may be used to aid women struggling with
sexual side effects of antidepressants.
CORRESPONDING AUTHOR: Tierney K. Ahrold, MA, Depart-
ment of Psychology, University of Texas at Austin, Austin, TX,
78712; tierney.ahrold@mail.utexas.edu
C-123j
DOES PHYSICAL ACTIVITY PROMOTE POSITIVE BODY
IMAGE IN RECENT WEIGHT LOSERS?
Meghan M. Senso, MS,1 Lauren A. Crain, PhD,1 Julie D.
Anderson, MPH, RD,1 Marcia G. Hayes, MPH, RD,1 Brian C.
Martinson, PhD,1 Patrick J. O’Connor, MD, MPH,1 Robert W.
Jeffery, PhD2 and Nancy E. Sherwood, PhD1,2
1
HealthPartners Research Foundation, Minneapolis, MN and
2
University of Minnesota, Minneapolis, MN.
Physical activity (PA) is important in weight loss and weight
loss maintenance. While energy expenditure is key, potential
psychological benefits of PA, including improved body image,
may also be influential. Our aim was to determine if PA is asso-
ciated with markers of body image, body shape satisfaction and
weight dissatisfaction, independent of body mass index (BMI).
A secondary aim was to determine if the relationship between
PA and body image differs depending on PA intensity. This
analysis presents baseline data from Keep It Off, a randomized
controlled trial of a weight loss maintenance program, which
included participants who lost at least 10% of body weight.
In total, 419 participants completed baseline measurements
(mean age = 47.0±10.8 yrs, 81.6% female, mean BMI = 28.4±5.0).
PA was reported via the Paffenbarger. Data was categorized
into minutes of light PA (LPA) and moderate-to-vigorous PA
(MVPA). Body shape satisfaction was assessed with the Body
Shape Questionnaire. Weight dissatisfaction was defined as
the discrepancy between dream weight and actual weight. On
average, participants reported 110.8±157.2min of MVPA and
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
satisfaction (p<0.01). This remained significant after control-
ling for BMI and depression (p<0.05). MVPA was inversely
associated with weight dissatisfaction (p<0.01), even after
controlling for BMI and depression (p<0.05). Amount of LPA
was not significantly related to body shape satisfaction (p>0.05)
or weight dissatisfaction (p>0.05). The results suggest PA is
positively correlated to body image after recent weight loss
independent of BMI and depression. A relationship between PA
intensity and body image may also exist, with greater levels of
MVPA most strongly associated with markers of positive body
image. Further research could determine if the protective effect
of PA on body image is associated with long-term weight loss
maintenance.
CORRESPONDING AUTHOR: Meghan M. Senso, MS, Health-
Partners Research Foundation, Minneapolis, MN, 55440-1524;
meghan.m.senso@healthpartners.com
C-123k
VALIDITY OF THE 24 HOUR PHYSICAL ACTIVITY RECALL
AMONG LATINOS
Kristin L. Schneider, PhD,1 Yunsheng Ma, PhD,1 Barbara
Olendzki, RD,1 Phillip Merriam, MPH,1 Milagros C. Rosal,
PhD,1 Patty Freedson, PhD,2 Trinidad Tellez, MD3 and Ira
Ockene, MD1
1
Preventive and Behavioral Medicine, University of
Massachusetts Medical School, Worcester, MA; 2University of
Massachusetts-Amherst, Amherst, MA and 3Greater Lawrence
Family Health Center, Lawrence, MA.
While numerous questionnaire and interview assessments for
measuring physical activity exist, few have been validated
in non-English speaking populations. Of the two validated
in Spanish speaking populations, neither used an interview
administered recall to measure physical activity. The present
study sought to validate the use of a Spanish version of a 24
hour physical activity recall that was created and validated by
our team in a sample of Latino men and women (n=37) who
participated in a larger study that tested whether a diet and
physical activity intervention improved weight in Latinos at
risk for diabetes. Participants in this substudy were asked to
wear accelerometers for at least 14 days, during which they
completed three 24 hour physical activity recalls conducted
in Spanish by a trained dietitian. Physical activity recall data
was then matched with the accelerometer data via date. The
total metabolic equivalent (MET) was calculated for the physi-
cal activity recall data and the accelerometer data. Correlation
analyses were used to examine the association between METs
from 24 hour physical activity recall and accelerometer data
for participants and by gender, whether differences existed
between men and women. Results revealed a significant corre-
lation between the 24 hour physical activity recall and acceler-
ometer METs (correlation coefficient (r)=.30, p=.006). Although
the sample sizes are small and unequal, men (n=5) reported
stronger correlations between the physical activity recall and
accelerometer METs (r=.60, p=.06), compared to women (n=32;
r=.26, p=.03). The 24 hour physical activity recall assessment
has adequate validity among Latinos when conducted in Span-
ish, and is comparable to that of physical activity assessment in-
struments and validation studies conducted among Caucasians.
84
CORRESPONDING AUTHOR: Kristin L. Schneider, PhD,
Preventive and Behavioral Medicine, University of Massachu-
setts Medical School, Worcester, MA, 01655; Kristin.Schneider@
umassmed.edu
C-123l
ACTIVE TRANSITION: PILOTING A WEBSITE-DELIVERED
PHYSICAL ACTIVITY INTERVENTION
Matthew Y. Kwan, MSc and Guy Faulkner, PhD
Exercise Sciences, University of Toronto, Toronto, ON, Canada.
Emerging empirical evidence suggests that the transition from
high school to university is associated with drastic declines in
physical activity behaviours (Kwan et al., 2009). Intervention
efforts are necessary to attenuate such declines. The Medical
Research Council recommends a systematic staged approach
prior to implementation of complex interventions, including the
piloting of a developed intervention (BMJ, 2008). The purpose
of this study was to examine the usability and acceptability of a
developed physical activity intervention aimed at first-year uni-
versity students. Drawing on principles of social cognitive the-
ory (e.g., outcome expectancy, self-efficacy), this theory-based
intervention is website-delivered as the internet is the most
used source for students to obtain health information (Kwan et
al., 2009). Participants were 15 undergraduate students, and 7
physical activity experts. After navigating the intervention, stu-
dents and experts rated their acceptance and satisfaction with
the interface on a 17-item questionnaire (Likert scale, 1= poor
to 7= excellent). Suggestions for enhancements, deletions and
additions were also solicited. Furthermore, students were also
asked to complete 7 navigational tasks for usability testing, and
asked to rate the difficulty of each task (Likert scale, 1= hard
to 7= easy). Results indicated that both students (Mscores= 6.6
to 6.8) and experts (Mscores= 6.2 to 6.8) gave the intervention
high ratings overall. In terms of usability, students exhibited
little difficulty with navigation on 6 of the 7 tasks (Mscores=
6.6 to 6.9). Overall, process of engaging students and experts
in the formative stage of intervention development is critical
in confirming the acceptability of this web-based intervention,
and has helped indentified the components needing refinement.
Future research will evaluate the feasibility and effectiveness of
website intervention.
CORRESPONDING AUTHOR: Matthew Y. Kwan, MSc, Exer-
cise Sciences, University of Toronto, Toronto, ON, M5S2W6;
matty.kwan@utoronto.ca
C-123m
WHY SKIP ROPE? WHY SKIP A MEAL? A THEORY DRIVEN
EXAMINATION OF THE FACTORS THAT PREDICT EXERCISE
AND DIETARY RESTRAINT INTENTIONS AMONG FEMALE
UNIVERSITY STUDENTS
Sophie Rayner, BKinH and Chris Shields, PhD
Acadia University, Wolfville, NS, Canada.
Research suggests that while exercise levels among university-
aged women are relatively low, dieting is a common approach
to weight management in this population. This pattern of
behavior is troubling as regular exercise has been repeatedly
associated with multiple health benefits while dieting behav-
iors alone (e.g., dietary restraint-deliberately eating less) have
been shown to be less effective in long term weight manage-
ment and can be associated with a number of negative health
outcomes. Understanding the factors that influence the exer-
cise and dietary choices of young women may help to inform
health promotion efforts for this population. This prospective,
observational study used the Theory of Planned Behavior as a
framework with which to examine the cognitions that influence
female university students’ intentions to exercise and to restrict
dietary intake for weight management. Also of interest was the
extent to which female university students may use diet or exer-
cise as compensatory behaviors in weight management. Partici-
pants (N=194) completed baseline measures of attitudes, subjec-
tive norms, and perceived behavioral control (PBC) concerning
physical activity and dietary restraint. Intentions to engage in
exercise or dietary restraint were assessed at time 2. Participants
also indicated whether they would engage in dieting or exercise
as compensatory behaviors for weight management. Separate
regressions revealed that PBC was the only significant predic-
tor (p=.001) of intentions to exercise (Model R2=.09, p=.001),
whereas attitudes was the only significant predictor (p=.001) of
intentions to engage in dietary restraint (Model R2=.15, p=.001).
Further, 90% of participants indicated that they would try to
compensate for eating unhealthy food with the majority (55%)
changing both their exercise and dietary behaviors. These find-
ings suggest that increasing young women’s PBC for exercise
and informing them about the risks of dietary restraint may
help to promote the use of healthier and more effective ap-
proaches to weight management.
CORRESPONDING AUTHOR: Chris Shields, PhD, Acadia Uni-
versity, Wolfville, NS, B4P 2R6; chris.shields@acadiau.ca
C-127a
HEALTHY PREGNANCY STEP BY STEP: ACCEPTABILITY
AND FEASIBILITY OF A MULTIPLE BEHAVIOR COMPUTER
TAILORED INTERVENTION FOR UNDERSERVED PREGNANT
WOMEN
Leanne Mauriello, PhD, Sharon Dyment, MPH and Janice
Prochaska, PhD
Pro-Change Behavior Systems, Inc., West Kingston, RI.
Acceptability and feasibility findings will be presented from a
pilot test of a computer tailored intervention to promote health
behaviors during pregnancy among a low-income, multi-ethnic
population. Transtheoretical Model-based content offered preg-
nant women assistance with smoking cessation, stress manage-
ment, and fruit and vegetable consumption.
Pregnant women (N=87) were recruited from health clinics
(mean age=24; 62% non-White, 22% married, 73% on Medicaid/
Medicare, 78% with HS education or less). Women completed a
16-item evaluation.
The program was rated very positively with 89.7% to 95.5%
of participants agreeing or strongly agreeing with all items.
For example, 95.4% of respondents reported that: the program
could help them be healthier; they learned new information;
and the program was designed for pregnant women like them.
There were no significant differences in the ratings based on
demographic characteristics. Qualitative responses confirmed
acceptability for the program. Further, pre and post assessments
indicated an increase in intention to make behavioral changes
with women planning to smoke fewer cigarettes, to practice
more minutes of stress management, and to eat more servings
of fruits and vegetables.
Feasibility for dissemination was evaluated by the ease of
recruiting participants, the ability for the program to be incor-
porated into prenatal care, the comfortableness of participants
with using a computer, and enthusiasm expressed during key
informant interviews. Acceptability and feasibility data build
confidence both that the program will be effective at impacting
the health behaviors of women at a critical time and that it can
be disseminated easily on a population-basis through several
distribution channels.
CORRESPONDING AUTHOR: Leanne Mauriello, PhD, Pro-
Change Behavior Systems, Inc., West Kingston, RI, 02892; lmau-
riello@prochange.com
C-132a
PREDICTORS OF ATTRITION IN A CLINICAL TRIAL FOR
WOMEN SURVIVORS OF CHILDHOOD SEXUAL ABUSE
Lisa Dawn Hamilton, MA, Christopher B. Harte, MA and Cindy
M. Meston, PhD
Psychology, University of Texas at Austin, Austin, TX.
This study examined predictors of participant dropout from a
clinical trial for the treatment of sexual problems in childhood
sexual abuse (CSA) survivors. To our knowledge, this is the first
study to investigate associated characteristics of dropout among
CSA survivors participating in a randomized clinical trial. Of
130 women who enrolled in the study, 35 withdrew before the
completion of the psychological treatment, an attrition rate
of 27%. We examined the following predictors of attrition:
demographics, sexual abuse characteristics (e.g., relationship to
abuser, age, abuse type), psychiatric symptoms and diagnoses,
coping style, sexual and relationship functioning, and treat-
ment condition (i.e., placebo, existing treatment, experimental
treatment). Multivariate logistic regression analyses revealed
that age, education, coping style, and sexual abuse type (rape
vs. sexual assault) were all significant predictors of attrition.
Specifically, women 32 years and older were significantly less
likely to withdraw from the study compared to younger women
(adjusted OR [AOR] = 0.32; 95% CI = 0.12, 0.85). Women with
higher levels of education (advanced degree vs. high school)
were also significantly less likely to drop out of the study (AOR
= 0.036; 95% CI = 0.02, 0.86). Those who scored low on positive
coping ability were less likely to withdraw compared to those
who scored high in positive coping (AOR = 0.18; 95% CI = 0.04,
0.77). Women reporting a history of rape during childhood
were significantly more likely to drop out compared to women
reporting sexual assault without intercourse (AOR = 3.53; 95%
CI = 1.16, 10.72). Treatment condition, psychiatric characteris-
tics, sexual functioning, and relationship quality did not predict
dropout. Women who experience CSA are a diverse popula-
tion with heterogeneous psychiatric presentations, which may
explain the lack of association between psychiatric symptoms/
diagnoses and attrition. Researchers working with this popula-
tion of women can use these data to direct retention efforts at
those who are more likely to discontinue study participation.
CORRESPONDING AUTHOR: Lisa Dawn Hamilton, MA,
Psychology, University of Texas at Austin, Austin, TX, 78757;
ldhamilton@mail.utexas.edu
85
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
C-132b
SEROSORTING STRATEGIES AND RISK FACTORS AMONG
AMERICAN INDIAN/ALASKAN NATIVE (AI/AN) MEN WHO
HAVE SEX WITH MEN
Cynthia Pearson, PhD,1 Karina L. Walters, PhD,1 Jane Simoni,
PhD2 and Ramona Beltran, PhC1
1
Indigenous Wellness Research Institute, University of
Washington, Seattle, WA and 2Department of Psychology,
University of Washington, Seattle, WA.
Aims: To determine if AI/AN MSM are serosorting; whether
sexual behavior differs across HIV-serostatus; and identify risk
factors associated with unprotected anal intercourse (UAI).
Method: From a multi-site national study we categorized 174
AI/AN men who had sex with men in the last 12 months
based on their known HIV serostatus. In bivariate analyses,
we explored several psychosocial factors, such as depression,
PTSD, and childhood trauma associated with serostatus, sexual
behaviors, and risk factors; unprotected insertive and recep-
tive sex and ever having an STI (chlamydia, gonorrhea, herpes,
HPV, or syphilis).
Results: Overall 48% of the men were in seroconcordant part-
nerships. More HIV-negative men (49%), compared to HIV-pos-
itive men (33%) reported a seroconcordant partnership (P = .05).
There were no differences in sociodemographic, mental health,
or childhood trauma between HIV-positive and HIV-negative
men except that HIV-positive men reported ever having an STI
(60% vs. 27%, P = 001).
Among HIV-positive men, unprotected anal intercourse with
any partner was associated with PTSD symptoms (100% vs.
81%, P = .01) and higher sexual abuse scores (58 vs. 32, P = .05)
than those who had protected anal intercourse. Moreover, UAI
with HIV-negative partners was associated with elevated de-
pressive symptoms (18 vs. 13, P = .05) and higher sexual abuse
scores (64 vs. 33, P = .01).
Among HIV-negative men with HIV-positive partners, UAI
was associated with alcohol dependency (80% vs. 0, P = .01) and
insertive UAI (75% vs. 0% P = .05). Moreover, UAI with HIV-
negative partners, was associated with alcohol dependency
(54% vs. 29%, P = .05) and insertive UAI (53% vs. 25%, P = .05).
Conclusion: There is evidence of risk reduction strategies by
serosorting for sexual practices among AI/AN MSM. However
among MSM having UAI, mental health, childhood trauma,
and alcohol dependency are psychosocial factors that must be
addressed in prevention research and practice.
CORRESPONDING AUTHOR: Cynthia Pearson, PhD, Indig-
enous Wellness Research Institute, University of Washington,
Seattle, WA, 98105-6299; pearsonc@u.washington.edu
C-132c
THE EFFECTS OF ACUTE STRESS ON GENITAL AND
PSYCHOLOGICAL AROUSAL IN WOMEN
Kathy Chung, BA, Mallory Koai, BA, Lisa Dawn Hamilton, MA
and Cindy M. Meston, PhD
Psychology, University of Texas at Austin, Austin, TX.
Stress is generally considered to have a negative effect on sexual
function, but there have been several studies showing that
acute stress can actually enhance subsequent sexual arousal. We
hypothesized that a personally relevant stressor would decrease
sexual arousal because it would distract from the sexual stimuli,
86
while a non-personally relevant stressor would increase sexual
arousal because any feelings of arousal resulting from sympa-
thetic nervous system (SNS) activation by the stressor would be
more easily misattributed as sexual arousal. Participants were
40 women without any reported sexual problems. Each woman
participated in a control session and a stressful session in the
laboratory. Half of the women were exposed to a personally rel-
evant stressor, a modified Trier Social Stress Test, and half were
exposed to a non-personally relevant stressor, a violent movie.
In the control condition, all women completed a questionnaire.
At each session, after the questionnaires or stressors, partici-
pants viewed an erotic film while their genital (using vaginal
photoplethysmography) and psychological arousal were
measured. Both stressors were found to significantly increase
genital arousal, F (1, 36) = 11.41, p = .001 and heart rate F (1, 34)
= 8.69, p = .01 compared to the control condition. Psychologi-
cal arousal was not affected by the stressors, F (1, 30) = .11, p =
.74. These findings demonstrate that these laboratory-induced
stressors likely have a physiological effect (i.e. increased SNS
activation) that seems to enhance the physiological components
of arousal. There did not seem to be any cognitive misattribu-
tion of the physiological effects that resulted in participants
reporting higher psychological arousal. The personally-relevant
stressor, although ranked as significantly more stressful, did
not impair arousal. It is likely that these laboratory-induced
stressors are not ecologically valid enough to cause significant
distress to participants. This study adds to the evidence that
moderate increases in SNS activity enhances subsequent sexual
arousal.
CORRESPONDING AUTHOR: Lisa Dawn Hamilton, MA,
Psychology, University of Texas at Austin, Austin, TX, 78757;
ldhamilton@mail.utexas.edu
C-143a
THE DIFFERENTIAL INFLUENCES OF ASPECTS OF
ACCULTURATION ON HEALTH BEHAVIORS
Kate E. Murray, PhD,1 Elizabeth Klonoff, PhD,1,2 Luz Garcini,
MA,2 Mark Myers, PhD,3 Neal Doran, PhD4 and Tamara Wall,
PhD3
1
SDSU/UCSD Cancer Center Partnership, SDSU, San Diego,
CA; 2Joint Doctoral Program in Clinical Psychology, SDSU/
UCSD, San Diego, CA; 3VA San Diego Healthcare System,
UCSD, San Diego, CA and 4UCSD, San Diego, CA.
Acculturation is a dynamic, multi-dimensional process and
there is controversy over how to best define and measure the
construct. When assessing the influences of acculturation on
health behaviors, it is important to examine aspects of ac-
culturation that may differentially influence health behaviors
to more effectively target health interventions. In the current
study, 433 undergraduate Korean and Chinese students (Mean
age = 18) were assessed annually for four consecutive years to
identify factors influencing smoking initiation. A majority of
participants (96%) reported either first- or second-generational
status and 70% reported English was not their first language.
The current analyses included four of the five subscales of
the SL-ASIA which demonstrated moderate to high levels of
internal consistency (α = .6 to .8). There were no significant ef-
fects for acculturation when examining the SL-ASIA total scores
in predicting smoking initiation; however, logistic regression
analyses revealed subscale differences. Subscale 4 (“genera-
tional identity”) had a significant main effect (b = 1.49, p <.05)
and interaction with gender (b = -2.20, p <.05) when controlling
for drinking or using other drugs in the past 30 days, ratings of
behavioral undercontrol, peer and parental smoking, national-
ity, and the importance of religion and academics. There was
a significant interaction (b = -.963, p <.05) between gender and
subscale 3 (“affinity for ethnic identity and pride”). The find-
ings indicate that generational status and ethnic identity/pride
may have different effects for males and females and subscales
may differ in predicting smoking behaviors. Discussion of the
limitations and implications for tailoring health interventions is
provided.
CORRESPONDING AUTHOR: Kate E. Murray, PhD, SDSU/
UCSD Cancer Center Partnership, San Diego State University,
San Diego, CA, 92120-4913; kmurray@projects.sdsu.edu
C-143b
FATE AS A MODERATOR: THE RELATION BETWEEN CAUSAL
ATTRIBUTIONS AND BEHAVIORS
Kate E. Murray, PhD,1 Luz M. Garcini, MA,2 Jessica L. Barnack-
Tavlaris, PhD1 and Elizabeth A. Klonoff, PhD1,2
1
SDSU/UCSD Cancer Center Partnership, San Diego State
University, San Diego, CA and 2Joint Doctoral Program in
Clinical Psychology, SDSU/UCSD, San Diego, CA.
Fatalistic beliefs, in particular within ethnic minority groups,
have been highlighted as a barrier for individuals in reducing
unhealthy behaviors and participating in preventive care. The
current study aims to identify the ways in which fatalistic be-
liefs may moderate the relation between smoking as a causal at-
tribution of illness and smoking behaviors. In the current study,
a total of 678 diverse undergraduate students (70% female)
reported a mean age of 18.39 (SD = 3.47) with 111 participants
(15%) identifying as current smokers. Participants were asked
to rate a list of causal attributions of “disease/illness” on a 5
point scale (1 = not important at all, 5 = extremely important).
Overall, participants rated smoking as a very important cause
of disease (M = 4.21, SD = 1.14) and fate as a less important
cause (M = 2.01, SD = 1.27). Logistic regression analyses pre-
dicting current smoking were run to test main and interaction
effects of fate and smoking as causal attributions of disease
(centered on their respective means). There were no main ef-
fects for smoking (b = -.147, ns) or fate (b = .042, ns); however,
there was a significant interaction (b = .177, p <.05) between
smoking and fate. When probing the interaction, individuals
who rated smoking as an extremely important cause of disease
(1 SD above the mean) were more likely to be current smokers
as their ratings of fate as a cause of disease increased (b = .447).
The relation between smoking attributions and behaviors was
the reverse (b = -.362) for individuals who rated smoking as a
less important cause of disease (1 SD below the mean). The find-
ings underscore that fatalistic beliefs may differentially influ-
ence individuals who attribute smoking as a cause of illness and
those who do not. Further discussion of limitations and future
directions are provided.
CORRESPONDING AUTHOR: Kate E. Murray, PhD, SDSU/
UCSD Cancer Center Partnership, San Diego State University,
San Diego, CA, 92120-4913; kmurray@projects.sdsu.edu
C-143c
THE IMPACT OF A TOBACCO CONTROL INTERVENTION ON
AFRICAN AMERICAN PARENTS’ SELF-EFFICACY FOR ANTI-
TOBACCO SOCIALIZATION IN THE HOME
Martha S. Tingen, PhD,1 Jeannette O. Andrews, PhD,4 Janie
Heath, PhD,3 Jennifer L. Waller, PhD2 and Frank A. Treiber,
PhD1
1
Georgia Prevention Institute, Medical College of Georgia,
Augusta, GA; 2Biostatistics and Informatics, Medical College
of Georgia, Augusta, GA; 3School of Nursing, Medical College
of Georgia, Augusta, GA and 4College of Nursing, Medical
University of South Carolina, Charleston, SC.
Background: African American families continue to suffer dis-
proportionate health disparities related to tobacco use and ex-
posure. Children’s exposure to socialization factors in the home
that promote risk-taking behaviors are associated with early
experimentation. Parents who are self-efficacious in establishing
an anti-tobacco socialization environment can model expecta-
tions and provide reinforcement for desired behaviors that may
serve as protective factors for tobacco abstinence.
Purpose: This randomized control trial investigated the impact
of a family approach in promoting parent’s self-efficacy in
establishing an anti-tobacco socialization environment in the
home.
Methods and Results: The treatment arm included concur-
rent school-based and home-based interventions that aimed to
promote skill development for making healthy behavior choices
related to tobacco prevention in children, promote parental self-
efficacy in anti-tobacco socialization in the home, and tailored
parental cessation in parent smokers. The control arm included
the traditional health curriculum for children, home-based
component of general health education for parents, and written
self-help materials for parent smokers. Subjects (N=673) were
4th grade children (N=329) and parents (N=344) from rural and
urban settings in the southeastern U.S.A. The majority of homes
were single-parent (61%). The intervention group significantly
increased their parent self-efficacy scores in anti-tobacco social-
ization from pre to post (pre=63.1, post=65.1, p=0.0037) while
the control group remained the same (pre=65.7, post=65.0,
p=0.4399).
Conclusions: Study results suggest that a family approach that
fosters parents’ self-efficacy may be positive in promoting anti-
tobacco socialization in African American homes.
CORRESPONDING AUTHOR: Martha S. Tingen, PhD, Georgia
Prevention Institute, Medical College of Georgia, Augusta, GA,
30912; mtingen@mcg.edu
C-143d
TO THINK OR TO FEEL: CONTROLLED VS. AUTOMATIC
PROCESSING AND THE EFFECTS OF EMOTIONAL HEALTH
COMMUNICATIONS
Amber R. Koblitz, MS and Kevin D. McCaul, PhD
Psychology, North Dakota State University, Fargo, ND.
For over 50 years, researchers have examined the persuasive
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-
ing manipulation to determine whether focusing on the stylistic
content or the emotional content of anti-smoking messages
influenced message effectiveness. Sixty-one nonsmoking (but
willing to smoke) college students (32 males and 29 females)
were randomly assigned to either a content processing (n =
30) or emotion processing condition (n = 31) and were given
explicit instructions about the aspects of the advertisement to
which they should attend. Students then viewed three emotion-
provoking anti-smoking advertisements. Two (Condition) X 2
(Gender) ANCOVAs, controlling for pretest levels of the depen-
dent variable, showed that condition assignment was related to
posttest automatic attitude scores, F(1, 51) = 4.49, p = .04, η2p
= .08. Following the ads, students in the emotion processing
condition were more likely to rate smoking-related pictures as
negative. There was also a nearly significant condition X gender
interaction for the controlled posttest measure of willingness
to smoke, F(1, 53) = 3.44, p = .069, η2p = .06. Simple effects
revealed that the processing goals failed to influence men dif-
ferentially, but women in the emotion processing condition said
they would be less willing to smoke in the future than women
in the content processing condition, F(1, 53) = 4.37, p = .04, η2p
= .11. These results suggest that women are especially respon-
sive to emotional content in persuasive messages and may
benefit from smoking prevention messages targeted towards
systems of automatic and emotional processing.
CORRESPONDING AUTHOR: Amber R. Koblitz, MS, Psychol-
ogy, North Dakota State University, Fargo, ND, 58108; amber.
koblitz@ndsu.edu
C-143e
REFER 2 QUIT: WEB-BASED PROVIDER TRAINING IN
TOBACCO QUITLINE REFERRAL SKILLS
Kelly Carpenter, PhD,1 Beatriz Carlini, PhD, MPH,2 Emily
Dolan, PhD1 and Tasha Mikko, MSW1
1
Talaria, Inc, Seattle, WA and 2Free & Clear, Inc., Seattle, WA.
Tobacco quitlines (QLs) provide evidence-based tobacco ces-
sation counseling, free of charge, to any US resident, yet they
remain underutilitzed. In order to increase referral to QLs, an
online provider training program, “Refer 2 Quit,” was devel-
oped to educate healthcare providers about QLs and facilitate
referral. The web-based CME/CE program includes case-based
referral skills training modules tailored to specific healthcare
provider types and settings. For the present project modules
were developed for outpatient, inpatient and emergency de-
partments and customized for Washington State’s QL.
Method: Four healthcare centers in Washington State were
recruited to participate in a study testing the educational ef-
fectiveness of Refer 2 Quit. Provider knowledge about tobacco
cessation and the QL as well as their attitudes toward providing
smoking cessation counseling to their patients were assessed
before and after training. Providers in the sample (N = 105)
were primarily Caucasian (90.5%) and female (81.9%) with a
mix of provider types, including MD/DOs, NPs, and PA-Cs
(20.1%), RNs (46.7%), and others such as RTs, MSWs and MAs
(33.2%).
Results: Provider knowledge about the QL increased signifi-
cantly after completing the program, from M=1.73 (SD=1.16) at
baseline to M=4.13 (SD=0.62), t(104)=-19.19, p<0.001 at follow-
88
up. Providers’ confidence in their ability to motivate and assist
smokers to quit increased significantly from baseline (M=3.00,
SD=0.94) to follow-up (M=3.60, SD=0.66), t(104)=-7.81, p<0.001.
Further, providers’ negative attitudes towards tobacco cessation
decreased significantly, including both attitudes towards pro-
viding tobacco cessation interventions and general negative at-
titudes towards patients being likely to quit at all (from baseline
(M=2.79, SD=0.59) to follow-up (M=2.54, SD=0.67), t(104)=4.21,
p<0.001 and from baseline (M=2.53, SD=0.61) to follow-up
(M=2.09, SD=0.55), t(104)=8.57, p<0.001, respectively).
Conclusions: An online training program can impact knowl-
edge and attitudes about tobacco cessation and state QL
services.
CORRESPONDING AUTHOR: Kelly Carpenter, PhD, Talaria,
Inc, Seattle, WA, 98125; kcarpenter@talariainc.com
C-143f
USING EMPIRICAL BINOMIAL HIERARCHICAL BAYESIAN
MODELING (EBHBM) TO DETERMINE WHETHER A
BEHAVIORAL INTERVENTION WORKS WELL FOR SOME
PARTICIPANT GROUPS BUT LESS SO FOR OTHERS
Yuelin Li, PhD,1 Mariya Shiyko, PhD,2 Jack Burkhalter, PhD,1
Susan Holland, MS,1 Ruthie Manna, MA1 and Jamie Ostroff,
PhD1
1
Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering
Cancer Center, New York, NY and 2The Methodology Center,
Pennsylvania State University, State College, PA.
Behavioral medicine intervention trials often recruit partici-
pants from multiple groups or clusters but randomize them
individually to the intervention conditions. We present a Bayes-
ian approach to test moderation of treatment effect by clusters.
Smokers newly diagnosed with cancer and scheduled for
surgery were recruited from 7 oncology clinics and randomized
individually into the Scheduled Reduced Smoking interven-
tion (SRS, N=96) or Standard Care (SC, N=89). Patients in SRS
were prompted to smoke by a handheld computer according
to an algorithm that reduced daily cigarette smoking up to a
prespecified quit date. Patients in SC received nicotine replace-
ment therapy and counseling. EBHBM used biochemically veri-
fied 24-hour point abstinence rates to estimate the difference
between the SRS and SC quit rates across clinics.
Overall abstinence rates at hospital admission were 46% (40/89
in SRS) and 45% (44/96 in SC), respectively. Disaggregated by
clinics, the observed abstinence rates were: Breast (7/14=50%
in SRS vs 2/8=25% in SC), Colorectal (3/8=38% vs 4/8=50%),
Gastric (4/10=40% vs 5/9=56%), Gyn (5/11=45% vs 4/11=36%),
Head & Neck (2/8=25% vs 5/9=56%), Thoracic (10/25=40% vs
14/30=47%) and Urology (13/20=65% vs 10/18=56%). EBHBM
used these observed quit rates to estimate the probability that
SRS is more efficacious than SC: highest in Colorectal (88%),
followed by Breast (85%), Urology (71%), and Gyn (68%). By
contrast, SRS was less efficacious for Gastric (28%), Thoracic
(33%), and Head & Neck (15%).
SRS was less efficacious than SC in cancers strongly associated
with smoking, partly due to high cessation rates in SC only. Our
findings have methodological implications for future cessation
trials, e.g., on providers’ knowledge/attitudes toward smoking
abstinence prior to surgery contributing to patients’ quitting
smoking.
CORRESPONDING AUTHOR: Yuelin Li, PhD, Psychiatry and
Behavioral Sciences, Memorial Sloan-Kettering Cancer Center,
New York, NY, 10022; liy12@mskcc.org
C-143g
SOCIAL INFLUENCE AND SMOKING CESSATION AMONG
HOMELESS PERSONS
Kathryn Goldade, PhD,1 Janet Thomas, PhD,1 Hongfei Guo,
PhD,2 John Connett, PhD,2 Jasjit S. Ahluwalia, MD, MPH, MS1
and Kolawole S. Okuyemi, MD, MPH1
1
Medical School, University of Minnesota, Minneapolis,
MN and 2Division of Biostatistics, University of Minnesota,
Minneapolis, MN.
Despite progress, smoking rates remain very high among some
underserved populations. Among the 4 million homeless per-
sons, the prevalence of cigarette smoking is an alarming 70%.
Social influence has previously been associated with smoking
behaviors and level of dependence among the general popula-
tion but little is known about the influence of other smokers
on smoking behaviors among homeless persons. We describe
social influence (defined as how many of their 5 best friends
smoke) and smoking behaviors among homeless persons
enrolled in a randomized clinical trial targeting NRT adherence
and cessation using motivational interviewing (N=428). Partici-
pants were recruited from homeless shelters and completed a
baseline survey that included questions on demographics and
smoking by family and friends (social influences). To date, 142
participants mean age (SD) 46.7 (7.91), 75% male, 25% African
American, 6% employed, 72% at least a high school education,
70% monthly income < $400, 89.4% smoked their first cigarette
within 30 minutes of awaking, average cigarettes smoked per
day (CPD) was 21.7 (SD=19.0) and 4.26 (SD=1.32) of “their 5
best friends smoke”. Results indicate that the number of friends
who smoke was correlated with CPD (r=0.18, p=0.033). Results
suggest that social influence might be considered when de-
signing cessation interventions among homeless persons who
smoke.
CORRESPONDING AUTHOR: Kathryn Goldade, PhD, Family
Medicine and Community Health, University of Minnesota,
Minneapolis, MN, 55414; kgoldade@umn.edu
C-143h
ACADEMIC ACHIEVEMENT AND ADOLSCENT SMOKING: A
GENERAL GROWTH MIXTURE MODEL (GGMM)
Daniel Rodriguez, PhD,1 Alexandre J. Morin, PhD2 and Michel
Janosz, PhD3
1
Psychiatry, University of Pennsylvania, Philadelphia, PA;
2
Psychology, Universite de Sherbrooke, Sherbrooke, QC,
Canada and 3Psychoeducation, Universite de Montreal,
Montreal, QC, Canada.
Research suggests academic achievement is associated with
a reduced likelihood of adolescent smoking. No study to our
knowledge has yet assessed the prospective relation between
developmental trajectories of academic achievement (GPA) and
adolescent smoking, and what factors influence the relation.
Using GGMM, we assessed if there are unobserved relatively
homogeneous GPA classes, the factors predicting class member-
ship, and the effect of class membership on smoking (number of
cigarettes smoked weekly) at last follow-up.
Participants were 741 non-smoking secondary school adoles-
cents, age 12 at 7th grade baseline, taking part in the four-year
Montreal Adolescent Depression Development Project. GPA
was assessed twice yearly across the four years, from official
school records.
The best model had three GPA trajectory classes: Elevated
(n=267, 36%), Moderate (n=388, 52%), and Low (86, 12%), with
the proportion smoking at last follow for the three classes being
7%, 15%, and 49%, respectively. Females were less likely have
moderate than elevated GPAs. Participants repeating a grade
were more likely to have moderate and low than elevated
GPAs, and low than moderate GPAs. Parental support (e.g.,
bonding) and democratic control (e.g., strict but legitimate
rules), and parental education decreased the odds of hav-
ing moderate and low compared to elevated GPAs. Parental
education also decreased the odds of having low compared to
moderate GPAs.
The results suggest that when adolescents do well in school,
they are less likely to smoke. Further, as low parental education
is a risk factor for poor educational outcomes and adolescent
smoking, when adolescents do poorly in school, they may
predispose their future children to negative developmental
outcomes including smoking. However, as parental support
and democratic control reduce the likelihood of low academic
achievement, teaching parents essential parenting skills may
help reduce the intergenerational transmission of smoking.
CORRESPONDING AUTHOR: Daniel Rodriguez, PhD, Psy-
chiatry, University of Pennsylvania, Philadelphia, PA, 18938;
drodrig2@mail.med.upenn.edu
C-143i
PSYCHOSOCIAL PREDICTORS OF SECONDHAND SMOKE
EXPOSURE AMONG CHILDREN WITH CANCER
Jody S. Nicholson, PhD,1 Vida L. Tyc, PhD1 and Shelly Lensing,
MA2
1
Behavioral Medicine, St. Jude Children’s Research Hospital,
Memphis, TN and 2Biostatistics, University of Arkansas for
Medical Sciences, Little Rock, AR.
Objective: Medically compromised children are at greater risk
for the consequences of secondhand smoke exposure (SHSe)
as compared to their peers, which may increase how amenable
parents are to smoking cessation programs. The current study
investigated psychosocial variables (perceived stress/vulner-
ability, social support, and self-efficacy) that may be predictive
of children’s SHSe as measured by parental self-report and
urine cotinine among a sample of pediatric cancer patients.
Methods: Data were drawn from 135 families whose children
(Mdn=7.6 years old) lived with a smoker, were being treated for
cancer, and were at least one month from diagnosis. Participat-
ing parents were 77% female, 80% white, 70% smokers and 50%
low SES. Psychosocial predictors were measured using reliable
and well-validated measures administered to parents. Parents
also reported on children’s exposure over a week from all
smokers in the home. Children’s urine samples were analyzed
for cotinine levels, a biomarker of recent SHSe. Results: Per-
ceived stress, social support, and perceived vulnerability were
non-significant. However, there was a 17% reduction in median
exposure for each unit increase in self-efficacy (p < .001). Ad-
ditionally, each unit increase in self-efficacy was associated with
an 8% reduction in median cotinine levels (p=.002). Conclusion:
89
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
Self-efficacy, which is addressed in Social-Cognitive Theory and
the Health-Belief Model, was found to be the most predictive
psychosocial factor in children’s exposure rates. As self-efficacy
appraisals may be powerful predictors of motivation, this has
important implications for intervening with smoking parents
with medically compromised children. Those reporting less
self-efficacy, and whose children have greater exposure, may
need a more intensive smoking cessation intervention focused
on initially increasing their self-efficacy and motivation.
CORRESPONDING AUTHOR: Jody S. Nicholson, PhD, Behav-
ioral Medicine, St. Jude Children’s Research Hospital, Memphis,
TN, 38105-3678; jody.nicholson@stjude.org
C-143j
ROLES OF STRESS REACTIVITY IN THE EFFECTS OF
PRENATAL NICOTINE EXPOSURE ON CHILDHOOD MENTAL
HEALTH OUTCOMES: RESULTS FROM A PROSPECTIVE
POPULATION-BASED STUDY
Aesoon Park, PhD,1 Marina R. Picciotto, PhD2 and Stephanie S.
O’Malley, PhD2
1
Psychology, Syracuse University, Syracuse, NY and
2
Psychiatry, Yale University, New Haven, CT.
Aims: Prenatal exposure to nicotine in the third trimester
through maternal smoking has been associated with diverse
mental health problems in late childhood. To better understand
the mechanism underlying their association, the current study
investigated whether sensitized reactivity to minor stress in
early childhood mediated the effect of prenatal nicotine expo-
sure on mental health outcomes in late childhood.
Method: Derived from a large-scale prospective population-
based study, the Avon Longitudinal Study of Parents and
Children, the data from 14,573 participants were used. Prenatal
nicotine exposure in the third trimester was determined dichot-
omously based on maternal self-reports on their smoking status
for the last two months of pregnancy. Maternal reports were
also used to determine their children’s reactivity to non-severe
negative life events experienced at the ages of 2 to 6 and the ac-
cumulative counts of prosocial behaviors, emotional symptoms,
hyperactivity symptoms, conduct problems and peer problems
at the ages of 7 to 11.
Results: 25% of participants were reportedly exposed to nicotine
prenatally in the third trimester. After controlling for a mother’s
education level and age, prenatal nicotine exposure was signifi-
cantly associated with a lower level of prosocial behaviors and
higher levels of emotional symptoms and behavioral problems
at the ages of 7 to 11. The associations of prenatal nicotine
exposure with emotional symptoms and behavioral problems
(but not with prosocial behaviors) at the ages of 7 to 11 were
partially mediated by heightened reactivity to minor stress at
the ages of 2 to 6.
Conclusions: Our results suggest that adverse effects of prenatal
nicotine exposure on mental health outcomes in late childhood
is partially accounted for by heightened stress reactivity in early
childhood. Prevention efforts to decrease reactivity to minor
stress in early childhood as well as smoking during pregnancy
are implicated.
CORRESPONDING AUTHOR: Aesoon Park, PhD, Psychology,
Syracuse University, Syracuse, NY, 13211; aepark@syr.edu
90
C-143k
FIRST STUDY OF TELEPHONE-DELIVERED ACCEPTANCE
& COMMITMENT THERAPY FOR SMOKING CESSATION:
COUNSELOR ADHERENCE RATINGS
Allison Schimmel-Bristow, BA3,1 and Jonathan B. Bricker, PhD1,2
1
Public Health Sciences, Fred Hutchinson Cancer Research
Center, Seattle, WA; 2Psychology, University of Washington,
Seattle, WA and 3Psychology, Seattle University, Seattle, WA.
Background: Quitline smoking cessation counseling, an impor-
tant component of the US tobacco control program, results in a
mere 12% success rate. Testing new telephone-delivered cessa-
tion counseling approaches is needed. An emerging counseling
approach with new promise for telephone-delivered counseling
is Acceptance & Commitment Therapy (ACT). An important
part of testing its feasibility is determining the extent to which
ACT by telephone can be delivered with fidelity. Objective:
Determine counselor’s adherence to ACT in the first study
of telephone-delivered ACT for smoking cessation. Design:
A counselor delivered a five-session (90-minute total) ACT
telephone intervention for smoking cessation in a single-arm
feasibility study. Data were digital recordings of entire lengths
of 57 counseling calls from all 14 adult participants (57% racial/
ethnic minority; 8/14). Participants completed a mean of 3.5
calls (SD = 1.3). Using a validated ACT for smoking cessation
adherence measure (Gifford et al., 2004), counselor fidelity to
each of the critical components of ACT were independently
rated on a scale of 1 (ACT approach not at all addressed) to 5
(ACT approach addressed extensively). Ratings of 3 or more
show adherence. Results: The mean ratings (M) and standard
deviations (SD) for each component were: Values (M = 5, SD =
.001), Acceptance (M = 4.8, SD = .447), Committed Action (M
= 4.4, SD = .894), Therapeutic Relationship (M = 5, SD = .001),
and Contingency Management (M = 4, SD = .001). Regarding
participants’ cessation outcomes, at 12 months post-treatment,
29% (4/14) had not smoked at all in past 12 months. Conclu-
sion: Promising evidence that ACT for smoking cessation can be
delivered with fidelity in a relatively brief telephone format.
CORRESPONDING AUTHOR: Jonathan B. Bricker, PhD, Public
Health Sciences, Fred Hutchinson Cancer Research Center,
Seattle, WA, 98109; jbricker@u.washington.edu
C-143l
A FRAMEWORK FOR STATEWIDE TOBACCO CESSATION
SYSTEMS CHANGE
Gillian Schauer, MPHc1 and Juliet Thompson, BA2
1
Clinical and Behavioral Sciences, Free & Clear, Seattle, WA
and 2Tobacco Prevention and Control, Washington State
Department of Health, Tumwater, WA.
Free & Clear partnered with the Washington State Tobacco
Prevention and Control Program in 2007 to leverage existing
research to shape a statewide program to support healthcare
providers in treating patients with tobacco dependence. We de-
veloped an academic detailing approach consisting of devoted
field-based cessation outreach staff who work with provider
champions in multi-county territories to develop sustainable
systems of care to support and deliver tobacco cessation.
In preparation for the statewide program launch, Free & Clear
reviewed nine months of pilot data from a five-county area of
Washington State. Data indicated that: (1) Systems change train-
ings were the least popular of the four trainings offered, and
(2) Referrals to the quitline typically peaked one to two months
after trainings and slowly declined thereafter. Based on analysis
of these data, systems work was prioritized within outreach
efforts, despite clinic requests for other more appealing services.
By building chart reminders, system protocols, and training
policies, organizational processes could force continued use of
the resources that staff were initially so excited to use.
Free & Clear designed the “Conceptual Framework for Systems
Change Outreach” to help visualize the change process occur-
ing in clinics and hospitals. This framework, which draws on
best practices from the U.S. Public Health Service Guidelines,
suggests that outreach staff work as catalysts to motivate pro-
viders (Knowledge Phase) to address tobacco use with patients.
Champion providers experiment (Practice Phase), addressing
tobacco use with patients that they are comfortable treating.
However, to truly reach the Impact Phase, where referral or
treatment becomes routine, clinics must change their funda-
mental system of care so that all providers address tobacco use
with all patients (Implementation Phase). The outcome of this
institutionalized change is increased referral or treatment, yield-
ing increased quit attempts. This cycle continues due to staff
changes and other variable factors.
CORRESPONDING AUTHOR: Gillian Schauer, MPHc, Clinical
and Behavioral Sciences, Free & Clear, Seattle, WA, 98104; gil-
lian.schauer@freeclear.com
C-150a
VALIDATION AND EXTENSION OF THE TRANSTHEORETICAL
MODEL BINGE DRINKING STAGING
Rose Marie Ward, PhD and Terri Messman-Moore, PhD
Miami University, Oxford, OH.
The Transtheoretical Model was developed utilizing a popula-
tion of smokers. It has been extended to a variety of behaviors
including binge drinking. Other than basic measurement
development and interventions based on the stage construct,
investigations of the binge drinking Transtheoretical Model
constructs are limited. The purpose of the current investigation
is to examine the Transtheoretical Model’s binge drinking stage
of change construct with respect to commonly used measures in
the field of heavy episodic drinking.
As part of a larger study, 424 female college students completed
a study on alcohol use and emotion regulation. The majority of
the sample reported being Caucasian, middle class, and single.
They had a mean age of 19.78 (SD = 1.30).
Replicating the relationship in the literature between the stages
of change and the decisional balance inventory, a series oneway
ANOVA were found to be significant; Pros of Alcohol, F(5, 405)
= 33.58, p<.001; Cons of Alcohol, F(5, 405) = 14.20, p<.001. Con-
sistent with theory, participants in the earlier stages (Precon-
templation, Contemplation, and Preparation) had higher levels
of the Pros of binge drinking and lower levels of the Cons of
binge drinking than the later stages (Action, Maintenance, and
Non-heavy drinker). Validating the binge drinking stages of
change, ANOVAs examining the Alcohol Use Disorders Iden-
tification Test (AUDIT) and the Rutgers Alcohol Problem Index
(RAPI) were also significant; AUDIT, F(5, 391) = 67.13, p<.001;
RAPI, F(5, 386) = 29.57, p<.001. Participants in precontempla-
tion reported problematic levels of drinking above the cutoffs
for both scales. In addition, a statistically significant MANOVA
examined the stages of change across the scales of the Drink-
ing Motives Questionnaire-Revised. Participants in the earlier
stages reported drinking to coping and for enhancement rea-
sons. Implications of the findings will be discussed.
CORRESPONDING AUTHOR: Rose Marie Ward, PhD, Miami
University, Oxford, OH, 45056; wardrm1@muohio.edu
C-150b
THE RELATIONSHIP BETWEEN THERAPEUTIC ALLIANCE
AND MINDFULNESS IN AN MBRP PILOT STUDY
Andrew J. Kurz, BA (anticipated), Sarah Bowen, PhD and Alan
G. Marlatt, PhD
Psychology, University of Washington, Seattle, WA.
The quality of the client/practitioner therapeutic alliance (TA)
has been demonstrated to predict outcomes in numerous thera-
peutic settings (Macneil et al., 2009; Martin, Garske, & Davis,
2000). The present research examined the relationship between
TA and mindfulness using Mindfulness-Based Relapse Preven-
tion (MBRP), a novel mindfulness-based aftercare approach
(Bowen, Chawla & Marlatt, in press). Data were drawn from the
MBRP pilot study (Bowen et al., 2009). Participants included 93
adults (64.5% male, with an average age of 40.8 (SD 10.2) years)
with substance use disorders who had recently completed
intensive inpatient or outpatient treatment in the Pacific North-
west. Data were analyzed using stepwise linear regression,
where TA was measured using the Working Alliance Inventory
(Horvath & Greenberg, 1989) and mindfulness was measured
using the Five Factor Mindfulness Questionnaire (Baer et al.,
2006). Results indicated that TA and mindfulness were not sig-
nificantly related at baseline assessment; however, TA predicted
mindfulness at post treatment and at the two-month follow-up.
Specifically, high client rating of TA during the treatment pe-
riod predicted greater utilization of mindfulness skills over the
two months following the end of treatment. Results suggest the
successful transmission of mindfulness skills to clients can be
aided by fostering healthy and collaborative client/practitioner
relationships.
CORRESPONDING AUTHOR: Andrew J. Kurz, BA (antici-
pated), University of Washington, Tukwila, WA, 98188; kurza@
uw.edu
C-150c
REINFORCEMENT SENSITIVITY THEORY AND COLLEGE
STUDENT DRINKING
Hyoung S. Lee, MA and John S. Wiebe, PhD
Psychology, University of Texas at El Paso, El Paso, TX.
Mood has been commonly viewed as an important determi-
nant of drinking, but studies of positive and negative affect
and alcohol use have reported inconsistent results. It has been
suggested that the relationship between negative affect and
heavy or problematic drinking depends on individual vulner-
ability dimensions. Gray’s Reinforcement Sensitivity Theory
(RST) may provide a particularly useful framework in stud-
ies about alcohol use, emphasizing personality, motivational
processes, and responses to particular environmental stimuli.
In past studies, the sensitivity of Gray’s Behavioral Activation
System (BAS) has been linked to alcohol use, but results have
been less consistent for the Behavioral Inhibition System (BIS).
The aim of this study was to test the relationship between the
BAS/BIS, positive/negative affect and events, and alcohol use
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
6 months. Neither positive and negative affect nor positive and
negative life events were significantly related to heavy drinking
or problematic drinking in this sample. BAS sensitivity was sig-
nificantly related to heavy drinking (e.g., the number of drinks
on a typical day, r = .13, p < .05; the number of days with 5 or
more drinks, r = .22, p < .01), but not to problematic drinking
(i.e., the Short Michigan Alcoholism Screening Test). Converse-
ly, BIS sensitivity was significantly associated with problem-
atic drinking (r = .18, p < .01), but not with heavy drinking.
Structural equation modeling was used to demonstrate that the
interaction between the BIS and negative life events predicted
problem drinking via negative affect (χ2/df = 2.405, CFI = .960,
NNFI = .962, RMSEA = .067). This study replicates past research
on the role of the BAS in heavy drinking, and clarifies the role
of the BIS as an individual difference moderating the effect of
negative life events on problem drinking.
CORRESPONDING AUTHOR: Hyoung S. Lee, MA, Psychol-
ogy, University of Texas at El Paso, El Paso, TX, 79968; hslee@
miners.utep.edu
C-153a
EVALUATION OF MEDACTIONPLAN.COM TO IMPROVE
ADHERENCE IN ADOLESCENT TRANSPLANT PATIENTS
Nataliya Zelikovsky, PhD,1,2 Corinne Bower, BA3 and Genevieve
Millet, BA3
1
Pediatrics, Children’s Hospital of Philadelphia, Philadelphia,
PA; 2Psychology, La Salle University, Philadelphia, PA and
3
Psychology, St. Joes’ University, Philadelphia, PA.
MedActionPlan.com, a HIPAA compliant website assists pa-
tients and health providers to develop customized medication
(Med) management plans using Med calendars, checklists, spe-
cial instructions, email and text message reminders to refill and
take Meds. Study evaluated use of technology with adolescent
transplant recipients to improve adherence. Participants used
website for 3 mos, and completed baseline and post assess-
ments of adherence (interviews, blood serum levels), surveys
of perceived barriers and beliefs about Meds, and a satisfac-
tion survey. 40 patients ages 13-21 enrolled (M age=16.47, 50%
male, 68% Caucasian). Website components use: 61% Med
calendar; 23% Med checklists; 60% text message reminder; 21%
email reminder; 18% refill reminder; 9% Med instructions; 9%
appointment calendar. Baseline mean adherence: 2.6% missed
and 3.8% late weekly doses; Post mean adherence: 1% missed
and <1% late weekly doses. Standard deviations between Tacro-
limus levels (indicator of adherence consistency): baseline 1.6
and post website .83. Paired t-tests showed significant reduction
in late doses [t(28)=3.68, p=.001] and more consistent lab levels
[t(21)=2.31, p=.03] after website. Non-adherence related to teen
issues with disease (forget, interferes, don’t like it) [r=.49, p<.01]
and issues with Meds (taste, # pills, side effects) [r=.39, p=.01],
belief about Med necessity [r=-.40, p=.02] and specific Med con-
cerns [r=.46, p=.03]. Satisfaction survey: teens like using website
for reference of Meds (regimen details, pictures), being able to
92
check Med schedules from anywhere(school, vacation), and
using text message reminders. Barriers to using technology: no
free text messaging, inconsistent internet access, or already had
good system for Med taking. This innovative technology may
improve medication management for adolescents who spend
much time on internet and cell phones, and allows health care
providers to deliver updated medical information to patients
for immediate access at home.
CORRESPONDING AUTHOR: Nataliya Zelikovsky, PhD,
Psychology Dept, La Salle University; The Children’s Hospital
of Philadelphia, Philadelphia, PA, 19141; zelikovsky@email.
chop.edu
C-155a
PROFILE OF SUBJECTIVE EXECUTIVE FUNCTION
PROBLEMS IN PATIENTS WITH HEPATITIS C
Jane Plagge, PsyD,1 Hannah Luber, BA,1,2 Daniel Kriz, MSW,1
Alex Mitchell, BS,1 J Renee Anderson, BA,1 Daniel Schwartz,
BA,1,2 David Lahna, BA,1,2 Jennifer Loftis, PhD,1,2 William
Hoffman, PhD, MD1,2 and Marilyn Huckans, PhD1,2
1
Portland VA Medical Center, Portland, OR and 2Oregon Health
and Science University, Portland, OR.
Background: Research has consistently shown patients with
chronic hepatitis C (HCV+) perform significantly worse on ob-
jective, neuropsychological tests of executive function than non-
infected controls (HCV-). To our knowledge, no research has
examined HCV+ patients’ subjective perceptions of their own
executive function. Objective: This study aimed to better charac-
terize the pattern of self-reported executive functioning prob-
lems in HCV+ patients. It was hypothesized that HCV+ patients
would self-report more problems with executive function than
HCV- controls. Method: Participants were 44 treatment naive
HCV+ patients (age = 52 ± 8 years; 75% male; 71% Caucasian;
education = 14 ± 2 years) and 28 demographically similar HCV-
controls (age = 47 ± 15 years; 70% male; 61% Caucasian; educa-
tion = 15 ± 3 years). Participants completed the Behavior Rating
Inventory of Executive Function - Adult Version (BRIEF-A), a
well-validated, widely available self-report measure of execu-
tive function. Independent t-tests and Mann-Whitney U tests
were conducted. Results: HCV+ participants scored significant-
ly higher than HCV- controls on the Behavioral Regulation In-
dex and the Inhibit, Emotional Control, and Initiate subscales of
the BRIEF-A. Conclusions: HCV+ patients perceive themselves
as less capable of initiating tasks and regulating their behavior
and emotional responses than HCV- patients. This is consistent
with research indicating HCV+ patients perform significantly
worse on neuropsychological tests of mental flexibility and rea-
soning when compared with HCV- patients. Studies have found
HCV+ patients undergoing pegylated interferon and ribavirin
treatment for HCV frequently miss treatment doses. Objective
and perceived problems with executive function may represent
a barrier to treatment adherence in HCV+ patients. Additional
studies are needed to determine whether reduced executive
function influences treatment adherence in HCV+ patients.
CORRESPONDING AUTHOR: Jane M. Plagge, PsyD, Portland
VA Medical Center, Portland, OR, 97217; janeplagge@yahoo.
com
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
AN EXAMINATION OF THE INTEGRATION OF MENTAL
HEALTH SERVICES IN ONCOLOGICAL CARE IN THE UNITED
STATES AND AUSTRALIA
Catalina R. Lawsin, PhD
Psychology, Baruch College, New York, NY.
Introduction: Between one-third and one-half of patients ex-
perience clinically significant levels of psychological distress.
Despite the growing literature demonstrating the benefit of
psychological interventions on cancer patients’ quality of life,
psychosocial services for the most part are not part of standard
care in cancer care. Health care systems vary internationally
with respect to the amount of government assistance patients
receive for medical care as well as how hospitals are funded
and in turn what programs receive priority within each institu-
tion. Much can be learned from international partners on what
does and does not work regarding health program implementa-
tion, in this case the provision of mental health services within
oncological care.
Methods: This study reviews the literature to examine the cur-
rent status of how mental health services are implemented and
utilized within oncological treatment in the United States and
Australia.
Results: Systemic and socio-cultural differences were found
between the two countries with regards to implementation of
mental health services in oncological care. Reimbursement for
services differentiated the availability of psychosocial services
while perceptions of mental health services differed between
cultures, influencing uptake.
Conclusions: This study highlighted the systemic and patient
factors that influence implementation and uptake of psycho-
social services in cancer care. Recommendations based on
the strengths of the two systems will be discussed in effort to
inform the restructuring or development of medical programs
that integrate psychosocial services to be cost-effective and con-
sumer-friendly, thus raising the standard of multidisciplinary
medical care and improving patients’ quality of life.
CORRESPONDING AUTHOR: Catalina R. Lawsin, PhD,
Psychology, Baruch College, New York, NY, 10010; catalina.
lawsin@mssm.edu
D-033b
SELF-REPORTED ACUTE STRESS, BUT NOT BIOLOGICAL
REACTIVITY, IS ASSOCIATED WITH PERFORMANCE ON A
CANCER-WORD STROOP TASK
Emily D. Dolan, PhD,1,2 Denise L. Albano, MPH,1,2 Bonnie A.
McGregor, PhD,1,2 S. Tyler Medick, BS1 and Dana H. Bovbjerg,
PhD3
1
Cancer Prevention, Hutchinson Center, Seattle, WA;
2
Health Services, University of Washington, Seattle, WA and
3
Biobehavioral Medicine, University of Pittsburgh, Pittsburgh,
PA.
Two previous studies have found slower processing of cancer-
related words compared to neutral words in an emotional
Stroop color-naming task. Neither study found that chronic
measures of emotional distress were predictive of processing
speed. Not assessed in either study, however, was acute bio-
logical reactivity of the stress response to the task. Because the
previous studies validated the cancer-Stroop task by compar-
94
ing women with and without familial risk of breast cancer, we
recruited samples of healthy women with (n=102) and without
(n=71) a familiar risk (FR+/-) of breast cancer, all of whom re-
ported elevated levels of general distress (breast cancer worry,
perceived stress or mood) at study entry. Acute stress response
to the cancer-Stroop task was assessed with self-reported acute
stress ratings (mini-POMS) and salivary cortisol sampling im-
mediately before performing the Stroop task and after com-
pleting the task (at least 30 minutes later). Acute self-reported
stress increased significantly from before to after the task in
all women regardless of FR status (t(172)=-3.61, p<.001). Using
linear regression with robust standard errors, we found a sig-
nificant interaction between FR status and the change in acute
self-reported stress, indicating that greater stress and positive
FR status are associated with slower RTs on the cancer-Stroop
task, controlling for age and verbal ability (p<.01). We did not
find significant cortisol reactivity (defined as the residualized
change from before to after the task) to the Stroop task, control-
ling for FR status. Further, cortisol reactivity was not associated
with performance on the cancer-word lists, controlling for FR
status, age and verbal ability. Overall, these results suggest that
distress associated with completion of the cancer-word Stroop
task may contribute to variability in performance, while a bio-
logical measure of stress response was not found to be related.
CORRESPONDING AUTHOR: Emily D. Dolan, PhD, Cancer
Prevention, Fred Hutchinson Cancer Research Center, Seattle,
WA, 98109; edolan@fhcrc.org
D-033c
PERCEIVED MISTREATMENT AND QUALITY OF LIFE IN
AFRICAN AMERICAN WOMEN WITH BREAST CANCER
Courtney Sullivan, BA, Thomas Merluzzi, PH D, Carolyn
Heitzmann, MA and Errol Philip, MA
Psychology, University of Notre Dame, Notre Dame, IN.
Purpose: Many studies support the relationship between per-
ceived mistreatment (PM), particularly racism/discrimination,
and poor health outcomes and quality of life (QOL). PM has
been linked to high blood pressure, psychological distress, low
infant birth weight, and lower satisfaction with breast cancer
care. African American (AA) women with breast cancer may
experience “triple jeopardy” (woman, Black, cancer patient)
therefore, PM may play a heightened role in their perceptions of
QOL The current study investigated the incidence of PM in AAs
with breast cancer and whether self-efficacy for coping (SEC)
and avoidant coping (AC) mediated the relationship between
PM and QOL. Method: 179 AA women with breast cancer com-
pleted measures of PM (Interpersonal Mistreatment Scale, IMS),
SEC (Cancer Behavior Inventory, CBI), Avoidant Coping (COPE
scales), and QOL (Functional Assessment of Cancer Therapy,
FACT). For the IMS, participants rated the frequency of the
types of maltreatment and endorsed the causes (e.g., race, sex).
Results: 50.7% of participants reported racial discrimination;
23.2% sex discrimination, and 18.8% ethnic discrimination. Re-
gression analyses were used to test mediation effects. The direct
relationship between PM and QOL was significant (-.13**) but
attenuated to non-significance (.07 ns) with the inclusion of AC;
thus, AC fully mediated the relationship between PM and QOL
(PM->AC=.38**; AC->QOL=-14**). PM was not related to SEC
(.04 ns), although SEC was highly related to QOL (.41**) and AC
(-.42 **). Discussion: The negative experience of maltreatment
may contribute to avoidant coping, which, in turn, compro-
mises QOL; however, SEC may be a countervailing force that
mitigates the negative effects of avoidant coping (caused by
maltreatment) on quality of life.
CORRESPONDING AUTHOR: Thomas V. Merluzzi, PhD,
Psychology, University of Notre Dame, Notre Dame, IN, 46556;
tmerluzzi@sbcglobal.net
D-033d
MEDICAL MISTRUST MEDIATES THE RELATIONSHIP
BETWEEN ETHNIC GROUP MEMBERSHIP AND DEPRESSION
SYMPTOMS IN MEN DIAGNOSED WITH PROSTATE CANCER
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,
MD,1,2 Bruce Kava, MD,2 Jose Szapocznik, PhD3 and Michael
Antoni, PhD1,2
1
Psychology, University of Miami, Coral Gables, FL; 2Sylvester
Comprehensive Cancer Center, UM/ Miller School of Medicine,
Miami, FL and 3Epidemiology, UM/Miller School of Medicine,
Miami, FL.
Although Hispanic (H) men have lower prostate cancer (PC) in-
cidence rates than Non-Hispanic Whites (NHW), they are more
likely to experience poorer quality of life and lower survival
from PC even after controlling for age and cancer stage. Medical
mistrust (MM) has been associated with poorer cancer screen-
ing practices and less satisfaction with care in cancer popula-
tions. However, limited work has examined the extent to which
MM impacts emotional well being following a PC diagnosis.
The present study examined ethnic group differences in MM
and depression in men recently diagnosed with PC. Sixty-one
men completed a baseline assessment before initiating PC-
related treatment within 3 months of diagnosis. Participants’
mean age was 60.03 years (SD=10.67); 49% NHW and 51% H.
Measures included the CES-D scale and the Group Disparities
in Health Care subscale of the Group-Based Medical Mistrust
Scale. Results showed that Hs reported higher levels of MM
and depression than NHWs, ethnic group membership (EGM)
was associated with MM, and MM was associated with depres-
sion scores (all p’s<.05). A mediation model was tested where
MM was hypothesized to mediate the relationship between
EGM and depression, controlling for relevant covariates. The
final mediation model was significant and showed that MM
accounted for 21.1% of the variance of depression at baseline,
F(1,57)=7.72, p<.01. The results suggest that MM may be a
mechanism that explains how EGM is related to depression.
H men may be at greater risk than NHWs to develop depres-
sion symptoms post-PC diagnosis as a result of higher levels of
mistrust of the healthcare system. Future research should inves-
tigate ethnic group differences in MM and depression using a
longitudinal design and larger sample size. EGM as a risk factor
for poorer adjustment post-treatment is an area that should also
be explored.
CORRESPONDING AUTHOR: Natalie E. Bustillo, BS, Univer-
sity of Miami, Miami, FL, 33174; nescobio@gmail.com
D-033e
CULTURALLY RELEVANT CANCER RISK COUNSELING FOR
UNDERSERVED LATINAS
Gloria Juarez, PhD, Martin A. Perez, PhD, Kathleen Blazer, MS,
PhDc, Raquel Ogaz, BS and Jeffrey Weitzel, MD
Population Sciences, City of Hope, Duarte, CA.
Background: Latinas are as likely as the majority to have high
cancer risk associated with genetic predisposition to breast
cancer and ovarian cancer. Disproportionately underserved,
Latinas have a compelling need for access to genetic cancer
risk assessment (GCRA) and cancer screening and prevention
measures
Objectives: The primary purpose of this project was to evalu-
ate the effects of a culturally relevant GCRA intervention for
Latinas.
Methods: Four focus groups were conducted consisting of
Latinas that have undergone GCRA. Participants completed
a demographic questionnaire that included items assessing
perceived cancer risk and satisfaction with GCRA. The focus
groups entailed a facilitated discussion of the key study vari-
ables and other culturally relevant issues that may impact the
GCRA intervention.
Results: The pre-GCRA period may be the most distressing
time for these women. Perceived sense of lack of information
and uncertainty about what to expect appeared to play a key
role in distress. Most women initially had negative expectations
(expecting the worse or bad outcome), but ultimately felt hope-
ful that they could learn more about the GCRA process and
what it meant for them. Information was cited as the primary
contributor to positive psychosocial outcomes_specifically
increased locus of control and self-efficacy. The major cultural
themes identified were destino, religious and spiritual coping,
how cultural attitudes and belief influence lack of information,
community awareness, and public health issues.
Conclusions: Preliminary data indicate that the pre-GCRA
window may be most distressing for this population indicating
that this may be the most appropriate time for psychological
intervention.
CORRESPONDING AUTHOR: Gloria Juarez, PhD, Population
Sciences, City of Hope, Duarte, CA, 90732; gjjuarez@coh.org
D-033f
SOCIODEMOGRAPHIC FACTORS INFLUENCING BREAST
HEALTH IN MINORITY FEMALES: BRIDGING THE GAP
Marissa C. Perales, BA,1 Georita Frierson, PhD,1,2 Kyle Deaton,
BA3 and Bernardine Pinto, PhD2
1
Southern Methodist University, Dallas, TX; 2Brown Medical
School, Providence, RI and 3University of North Texas, Denton,
TX.
Over the past decade, significant attention has been given to
sociodemographic factors that influence health behavior given
the disparities across racial/ethnic groups for health outcomes.
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
in adjusted and unadjusted odds of health behaviors.
Logistic regression models compared participants who per-
formed vs. did not perform BSE; have a healthcare provider
vs. not; received a mammogram vs. not; and participate in
health-related research vs. not. Age, education, race/ethnicity,
and marital status were included in each model. For participat-
ing in research, multivariate analyses found education to be
significant (OR)= 21.08, 95%CI=1.83-242.85). For BSE, univariate
analyses found race/ethnicity (OR=6.83, 95%CI=1.26-37.16) and
marital status (OR=5.63, 95%CI=1.16-27.31) to be significant.
Multivariate analyses confirmed that marital status (OR=9.51,
95%CI=1.06-85.37) and age (OR=4.87, 95%CI=1.07-22.22) were
statistically significant predictors of BSE. Women characterized
as older, Latina (univariate analysis), and married/partnered
were more likely to perform BSE.
Although our small sample potentially restricted power to
detect consistent associations between univariate and multivari-
ate models, findings confirmed previously identified sociode-
mographic factors that influence health behaviors in the AA
community and extends to the Latina community. These initial
findings may improve clinical recommendations/interventions
in this population.
This research was partially supported by a R25 Training Sup-
plement awarded to Georita M. Frierson, PhD from The Miriam
Hospital/Brown Medical School.
CORRESPONDING AUTHOR: Marissa C. Perales, BA, Psychol-
ogy, Southern Methodist University, Dallas, TX, 75251; mpera-
les@smu.edu
D-033g
THE IMPACT OF PHYSICIAN RECOMMENDATIONS ON
MAMMOGRAPHY SCREENING IN HISPANIC WOMEN LIVING
IN A RURAL AREA
Noah L. Espinoza, BCH,1 Rachel M. Ceballos, PhD,1 Ilda Islas,
BA,1 Genoveva Ibarra, BA1 and Beti Thompson, PhD1,2
1
Fred Hutchinson Cancer Research Center, Seattle, WA and
2
Health Services, University of Washington, Seattle, WA.
OBJECTIVE: This study examined correlates of mammogra-
phy use among Latino women in the Lower Yakima Valley of
Eastern Washington State. BACKGROUND: Mammography
screening has been established as an effective way to reduce the
mortality rate of breast cancer through early detection and early
treatment. Since Latinas are less likely to engage in mammogra-
phy, finding factors related to increased mammography use is
a critical part of developing effective interventions in an effort
to reduce breast cancer health disparities. METHODS: A total
of 87 Hispanic women aged 40-79 participated in this study.
This data was part of a larger project investigating the effect of
a breast cancer education program (Home Health Party) on psy-
chosocial factors. These analyses were conducted on the base-
line data of the larger project. Factors examined included age,
education, having some form of health insurance, and whether
or not a physician or a relative had recommended mammog-
raphy to the participant. The outcome variable was whether or
not the participants reported ever having had a mammography.
Logistic regression was used to analyze the data. RESULTS:
Having had a physician recommend mammography was the
only statistically significant correlate of the outcome variable
96
(p=0.005) when adjusted for all other factors. Unadjusted age
(p=0.01) and having had a family member recommend mam-
mography (p=0.04) were statistically significant. However,
adjusted outcomes were marginally significant (p=0.07 and 0.06,
respectively)
CONCLUSION: In this population, we found that education
and age were not as significant as expected. We also found that
family member recommendations were somewhat significant,
indicating a possible factor to implement in future interven-
tions. Future studies should consider conducting this analysis
using a larger sample as this study may have been limited by
low variability in age and education.
CORRESPONDING AUTHOR: Rachel M. Ceballos, PhD, Fred
Hutchinson Cancer Research Center, Seattle, WA, 98117; rce-
ballo@fhcrc.org
D-033h
WEIGHT CONTROL NEEDS AMONG RURAL BREAST CANCER
SURVIVORS
Christie Befort, PhD,1 Heather Austin, MS, RD1 and Jennifer
Klemp, PhD2
1
Preventive Medicine and Public Health, University of Kansas
Medical Center, Kansas City, KS and 2Medical Oncology,
University of Kansas Medical Center, Kansas City, KS.
Obese breast cancer (BrCa) patients have a 1.5 to 2.5 increased
risk of recurrence and death compared to their normal weight
counterparts. Rural women constitute nearly 20% of women in
the U.S., and they suffer from disparities related to both BrCa
and obesity. Women from the most rural counties are 1.6 times
more likely to be obese compared to women in metropolitan
counties. Despite this, rural women are under-represented in
research on weight control among BrCa survivors, and very
little is known about their interest and perceived need for
weight control services. This needs assessment survey was
mailed to rural BrCa survivors treated within the past 6 years at
one of 3 cancer centers in rural Kansas. The survey was accom-
panied by a cover letter from the patient’s oncology provider
along with a small cash incentive. Survey items assessed breast
cancer history, general survivorship needs, weight history, and
interest in weight management services. Of the 1111 surveys
that were delivered, 859 were completed and returned for a
response rate of 77%. Respondents were 66.0 ± 13.0 years old,
had been treated for BrCa on average 3.2 ± 2.6 years previously,
and 83.2% had non-metastatic disease. Among six services
assessed (support group, mental health services, lymphedema
treatment, exercise and diet program, personal training, and
secondary prevention trials), an exercise and diet program was
the most commonly reported need (endorsed by 43.6% of the
total sample). Patients had a mean BMI of 28.9 ± 6.7 kg/m2 and
68.8% were overweight or obese (BMI > 25 kg/m2). Among
non-metastatic patients, 25.6% reported gaining greater than 5
kg since being diagnosed with BrCa. Among overweight and
obese patients, 62.2% indicated they were currently attempt-
ing weight loss, and 65.0% were interested in learning about a
weight management intervention study. The high response rate
indicates a general interest in follow-up care among rural BrCa
survivors, and the findings highlight the need and interest in
weight control programs.
CORRESPONDING AUTHOR: Christie Befort, PhD, Preven-
tive Medicine and Public Health, University of Kansas Medical
Center, Kansas City, KS, 66205; cbefort@kumc.edu
D-033i
AFRICAN AMERICAN WOMEN’S BREAST CANCER
PREVENTION INFORMATION BELIEFS
Heather Edwards, PhD, MPH
SAIC-Frederick, Inc., Rockville, MD.
Introduction
African American women are less likely than white women
to be diagnosed with breast cancer but those who do get the
disease are more likely to die from it. Health communicators
explore ways to decrease such disparities through education
about breast cancer prevention and detection.
The Internet is a popular source of health information and
offers opportunities to deliver tailored information to at-risk
groups. To maximize benefit, health communicators need to un-
derstand potential users’ beliefs about and applications of that
information. Research has investigated how African American
women with breast cancer diagnoses use the Web for cancer
information but has not thoroughly explored this population’s
prevention information-seeking beliefs and behavior.
Method
This study was a qualitative, grounded theory exploration of
African American women’s beliefs about breast cancer preven-
tion and the Internet as a source of prevention information. A
snowball sample of women without personal histories of breast
cancer resulted in nine interviews conducted in 2009. Three
women had family histories of the disease.
Results
The women said the Internet would be a good source of breast
cancer information if they needed it, but most did not express
this need due to low perception of personal risk. Women had
many misconceptions of the disease and screening, includ-
ing that having a mammogram could prevent a woman from
getting breast cancer and that women without family histories
were not at risk.
Internet users believed they could find information they need-
ed, however accounts of past searches for health topics hinted
at a low understanding of Web site source credibility, consistent
with literature about average users’ site credibility evaluation
skills. Outcomes of the study were recommendations for health
communication and promotion campaigns targeting African
American women with breast cancer prevention messages.
CORRESPONDING AUTHOR: Heather Edwards, PhD, MPH,
SAIC-Frederick, Inc., Rockville, MD, 20852; edwardshm@mail.
nih.gov
D-033j
CANCER SCREENING ATTITUDES IN OLDER ADULTS WITH
COMORBID CONDITIONS
Heather Edwards, PhD, MPH1 and Erica S. Breslau, PhD2
1
SAIC-Frederick, Inc., Rockville, MD and 2National Cancer
Institute, Rockville, MD.
Background
USPSTF guidelines provide colorectal, cervical, and breast
cancer screening age recommendations but also emphasize
individuals’ health status as a factor in weighing screening risks
and benefits. Older Americans (65 years and older) and their
physicians should consider preferences, health, and quality of
life concerns when deciding when to cease screening.
Older Americans have many health concerns, including hyper-
tension, arthritis, and heart disease, which may affect cancer
screening behavior. Research suggests that doctors’ recommen-
dations are key predictors of cancer screening behavior, yet it
is unclear whether these comorbidities result in more screen-
ings for patients due to more encounters with doctors, or fewer
because patients have competing health priorities and barriers
to screening.
Purpose
This study’s purpose was to elucidate the relationship between
comorbid conditions and cancer screening in the older popula-
tion. We reviewed published literature with two research ques-
tions in mind:
1. What does the literature reveal about older people’s attitudes
about screening when they are managing other health condi-
tions?
2. How do older people with comorbid conditions make deci-
sions about screening?
Methods
PubMed searches were performed for five combinations of
terms related to cancer screening, comorbid and chronic condi-
tions, and older adults. Relevant articles to the study had a
patient attitudinal or preference component and included indi-
viduals aged 65 and over with chronic physical illnesses. Of the
630 results, 35 articles met our criteria.
Results & Conclusions
The literature review led to two categories of findings. The first
was an assessment of the existing studies’ methods opportuni-
ties/abilities to answer this study’s research questions. The
second category includes actual findings from the review that
provide recommendations for future research. Conflicting
findings about screening behavior in people with comorbidities
suggest the need for further research with new methods or the
addition of new questions on existing surveys.
CORRESPONDING AUTHOR: Heather Edwards, PhD, MPH,
SAIC-Frederick, Inc., Rockville, MD, 20852; edwardshm@mail.
nih.gov
D-033k
LONGITUDINAL STUDY OF THE INFLUENCE OF FALSE-
POSITIVE MAMMOGRAPHY RESULTS
Jessica T. DeFrank, MPH,1,2 Barbara K. Rimer, DrPH,1 Michael
Bowling, PhD,1 Jo Anne Earp, ScD,1 Erica S. Breslau, PhD3 and
Noel T. Brewer, PhD1,2
1
UNC Gillings School of Global Public Health, Chapel HIll,
NC; 2Lineberger Comprehensive Cancer Center, Chapel Hill,
NC and 3Division of Cancer Control and Population Sciences,
National Cancer Institute, Bethesda, MD.
BACKGROUND: Understanding potential harms from mam-
mography is important as we contemplate new screening
guidelines. If screened regularly, as many as one-half of U.S.
women will have abnormal mammography results that re-
quire additional follow-up but in which cancer is not detected
(false-positive result). This longitudinal study explored behav-
ioral and psychological effects of false-positive mammography
results.
97
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
METHODS: We analyzed medical claims records and self-
report data gathered as part of an intervention trial to increase
repeat mammography adherence among insured North Caro-
lina women. The sample included 2406 insured women who
had mammograms upon study entry and completed telephone
interviews. Study participants were predominately white (88%),
married (79%) and many had college educations or more (65%).
We analyzed data using logistic regression.
RESULTS: About 8% of women had received false-positive re-
sults within the previous 14 months. Among women who said
their physicians had not advised them to get mammograms,
those who received false-positives were more likely to have no
subsequent mammogram on record compared to women who
received normal test results (18% vs 7%, OR=3.17, 95% CI=1.30-
7.71). However, among women who reported physician recom-
mendations, receipt of false-positive results was not associated
with adherence to subsequent screening. Receipt of false-posi-
tive results was also associated with more breast cancer worry
(p<.001), lowered beliefs in mammography accuracy (p=.003),
and thinking more about the benefits of regular screening
(p<.001), regardless of physician recommendation. In mediation
analyses, none of these variables explained the association of
false-positives and screening behavior.
DISCUSSION: Women who receive false-positive mammogra-
phy results, coupled with lack of physician recommendations
for screening, are at risk for non-adherence to regular screening.
CORRESPONDING AUTHOR: Jessica T. DeFrank, MPH,
Health Behavior and Health Education, UNC Gillings School of
Global Public Health, Chapel HIll, NC, 27599; defrank@email.
unc.edu
D-033l
BREAST AND PROSTATE CANCER SURVIVOR DECISION-
MAKING FOR SEEKING LONG-TERM CANCER FOLLOW-UP
CARE
Shawna Hudson, PhD,1,2 Suzanne M. Miller, PhD,2 Jennifer
Hemler, MA,1 Jennifer Lyle, MA,2 Antoinette R. Tan, MD1 and
Robert DiPaola, MD1
1
The Cancer Institute of New Jersey, New Brunswick, NJ and
2
Fox Chase Cancer Center, Philadelphia, PA.
Cancer follow-up beyond active treatment is important but
understudied. Essential components of extended cancer man-
agement include not only cancer surveillance and intervention
for late and long-term treatment effects but also care coordina-
tion to meet the survivor’s health needs. Yet, it is unclear how
patients understand and factor these aspects of cancer care into
their follow-up decision making and care seeking behaviors.
This qualitative study explores these issues among breast and
prostate cancer survivors who received treatment either at a
comprehensive cancer center (54%) or a community hospital
(46%). Forty-two semi-structured depth interviews (24 Breast,
18 Prostate) were conducted with early stage (I or II) survivors.
Interviews lasted 45-90 minutes, were audio-taped and tran-
scribed. Interviews were coded independently by two research-
ers who used consensus to resolve discrepancies. Length of
survivorship ranged from 2-5 yrs (33%), 6-9 yrs (36%) or 10+
yrs (31%). Two main themes were identified across the inter-
views. The majority of survivors (83%) had narrow definitions
of follow-up that focused primarily on cancer surveillance.
98
Few (24%) described treatment effects or care coordination as
motivating their follow-up care seeking behavior. Implications
from this research suggest that psychosocial interventions may
be useful in educating patients about the comprehensive nature
of survivor care and the importance of health seeking behaviors
that entail more than simply monitoring for recurrence and
surveillance for new cancers. These findings may help guide the
design and tailoring of survivor health care plans that enhance
extended follow-up care behaviors in cancer survivor popula-
tions.
CORRESPONDING AUTHOR: Shawna Hudson, PhD, The
Cancer Institute of New Jersey, New Brunswick, NJ, 08903-2681;
hudsonsh@umdnj.edu
D-033m
PREDICTING BREAST CANCER SURVIVORS’ PHYSICAL
QUALITY OF LIFE FROM DEPRESSIVE SYMPTOMS AT THE
ONSET OF TREATMENT
Joy M. Fairbanks, MS,1,2 Jovier D. Evans, PhD,2,4 Silvia M.
Bigatti, PhD2,3 and Kathy D. Miller, MD5
1
Psychology and Psychiatry, Mayo Clinic, Rochester, MN;
2
Department of Psychology, IUPUI, Indianapolis, IN;
3
Deparment of Public Health, IUPUI, Indianapolis, IN;
4
Geriatric Research Branch, NIMH, Bethesda, MD and 5School
of Medicine, Indiana University, Indianapolis, IN.
Breast cancer patients are at an increased risk for depression
and anxiety. The presence of depression and anxiety at the
early stages of treatment may negatively influence response
to treatment and ultimately physical health. This longitudinal
study sought to determine whether symptoms of depression
and anxiety near the onset of treatment would predict physical
quality of life (HQOL) in breast cancer survivors. Twenty-six
patients were evaluated as part of a larger study. Participants
were predominantly Caucasian (89%), well-educated (M years
of education = 14.81, SD = 3.21), and approximately 50 years
in age (SD = 11.23). Initial assessments occurred following
surgery. More than half (n = 15) received chemotherapy and 11
underwent radiation or surgery alone. Women were later re-as-
sessed following treatment completion and approximately 5.46
years post-diagnosis. Depression, anxiety, and health-related
QOL were assessed with the CES-D, the Spielberger State-Trait
Anxiety Inventory and the RAND-36 Health Status Inventory.
Depression and anxiety appeared to be examining a similar
construct (i.e., emotional well-being), as reflected in the high
correlations between these variables. Given that depression was
most highly correlated with HQOL, this data only is presented.
At all time periods, CES-D scores were moderately to highly
related to HQOL (r’s = -.432, -.511, and -.740 respectively). A re-
gression examined the predictive power of baseline depression
on follow-up HQOL, controlling for baseline HQOL. Results
revealed that initial depression predicted HQOL at follow-
up, even after controlling for education as a covariate. These
findings support the view that breast cancer patients should be
assessed for symptoms of depression at the onset of treatment.
Addressing emotional well-being from the onset would likely
improve treatment outcomes.
CORRESPONDING AUTHOR: Joy M. Fairbanks, MS, Psy-
chology and Psychiatry, Mayo Clinic, Rochester, MN, 55901;
fairbanks.joy@mayo.edu
D-033n
INTENTIONS AND ACTIONS OF PROSTATE CANCER
SCREENING IN IMMIGRANT BLACK MEN
Stacy N. Davis, MPH, Övgü I. Kaynak, MsEd and Stephen J.
Lepore, PhD
Public Health, Temple University, Philadelphia, PA.
Black men in the United States bear an excess burden of pros-
tate cancer (PCa). The choice to test for PCa is a preference
sensitive decision and very little attention has been paid to how
testing intentions get translated into actions. This study sought
to identify the variables that distinguish PCa testing intentions
and actions in immigrant black men. This secondary analysis
included 246 black men 45 - 71 years old from NYC, benefi-
ciaries of a health insurer that covers PSA testing, that were
randomized to the control arm of a trial designed to promote
informed decision making about prostate cancer testing. Men
were interviewed twice over an 8-month period and medical
claims for PSA tests were submitted for 78 participants. Three
groups of men were compared: “disinclined abstainers” at
time 1 did not intend to get tested and did not test at time 2
(n= 86), “inclined abstainers” at time 1 did intend to test, but
had unverified testing at time 2 (n=94), and “inclined actors”
at time 1 did intend to test and had a verified testing at time 2
(n=32). Results revealed that “inclined actors” are significantly
more likely than disinclined abstainers and inclined abstain-
ers to have heard of PCa testing (p=.002), specifically DRE
(p=.005), have higher PCa testing knowledge (p=.05), perceived
higher benefits of testing (p=.000), are more likely to believe
that benefits of testing outweighed risks of testing (p=.001), are
more likely to have physician recommendation to get tested
(p=.000). Disinclined abstainers are more likely to not have had
a DRE in the past (p=.007) and believe they are less likely to get
PCa (p=.005) compared to other groups. PCa worry, absolute
PCa risk, age, and self-efficacy to communicate with physician
were not able to distinguish PCa testing intention and action
in this population. This research highlights the need to identify
variables that distinguish PCa testing intentions among differ-
ent groups men in order to develop interventions which allow
black men manage their PCa risk in a manner consistent with
their testing preferences.
CORRESPONDING AUTHOR: Stacy N. Davis, MPH, Public
Health, Temple University, Philadelphia, PA, 19122; stacy.
davis@temple.edu
D-033o
BREAST AND CERVICAL CANCER SCREENING AMONG A
COMMUNITY SAMPLE OF LOW-ACCULTURATED LATINAS
Ana Martinez-Donate, PhD,1 Lina Vera Cala, MD, MS,1 Rhea
Vedro, MA,2 Rosario Angulo, BS2 and Tanya Atkinson, MSSW2
1
Population Health Sciences, University of Wisconsin -
Madison, Madison, WI and 2Planned Parenthood of Wisconsin,
Inc., Madison, WI.
Early detection is critical to reduce breast and cervical cancer
(BCC) morbidity and mortality. Latinas are less likely to adhere
to BCC screening guidelines than other ethnic groups. This
study examines adherence to BCC screening recommenda-
tions among a community-sample of low-acculturated Latinas.
Latino women (N=153) participating in Taking Care of Me
(Cuidándome), an ongoing communitywide intervention to
decrease barriers to BCC screening among Latinas in Dane
County, Wisconsin, completed a self-administered question-
naire on BCC screening history, knowledge, and barriers prior
to their participation in the program. Study participants (Mean
age = 35 years, SD = 11) were mostly low-educated (34.9% had
completed high school or higher), foreign born (93%), monolin-
gual Spanish speaker (65%), and uninsured (70%). About 37%
of women (40 and over) reported having had a mammogram
and 58% reported having had a Pap smear within the last 12
months. Lack of knowledge regarding BCC screening recom-
mendations was frequent, particularly regarding mammogram
initiation age (53%); mammogram frequency (19.6%); and who
should have regular Pap smears (19.3 - 35.7%). On a 0-10 scale,
knowledge about risk and protective factors for breast (Mean
= 5.4, SD = 2.1) and cervical cancer (Mean = 4.7, SD = 2.5) was
relatively low. The main barriers to having regular mammo-
grams and Pap smears were concern that the test would be
expensive (68.3% and 53.9%, respectively); fear of an abnormal
result (61.2% and 50%, respectively); lack of English fluency
(38.3% and 32.2%, respectively); and concern that the test would
be painful (38.2% and 29.8%, respectively). About 59.7% and
20.3% did not know where to go for a mammogram or Pap
smear, respectively. These results underscore the need for
interventions to promote adherence to BCC screening among
low-acculturated Latinas. These efforts need to be culturally
appropriate and address both cognitive and structural barriers
prevalent among this population.
CORRESPONDING AUTHOR: Ana Martinez-Donate, PhD,
Population Health Sciences, University of Wisconsin - Madison,
Madison, WI, 53726; martinezdona@wisc.edu
D-033p
FORGIVENESS AND REDUCED RISK OF CANCER ONSET
Amy D. Owen, PhD2 and Loren L. Toussaint, PhD1
1
Luther College, Decorah, IA and 2Duke University Medical
Center, Durham, NC.
Several studies have identified relationships between forgive-
ness and health, but few, if any, have prospectively explored
potential associations between forgiveness and cancer. In
this study, longitudinal data from a nationally representative
sample of older adults was analyzed to investigate the effects
of forgiveness on self-reported onset of cancer. At wave 1,
1500 participants completed face-to-face interviews, and 1024
follow-up interviews were completed three years later at wave
2. Relationships were assessed between wave 1 forgiveness and
control variables (socio-demographic, health behaviors, psy-
chosocial, religious/spiritual) and wave 2 self-reported onset of
cancer in the past year. Bivariate results found that self-forgive-
ness, unconditional forgiveness of others, and feeling forgiven
by others were all significantly associated with onset of cancer.
While higher levels of self-forgiveness (OR = .71, p < .05) and
feeling forgiven by others (OR = .59, p < .01) were associated
with lower odds of cancer onset, higher levels of unconditional
forgiveness of others was associated with higher odds of cancer
onset (OR = 1.78, p < .05). The effects of self-forgiveness and
unconditional forgiveness of others were reduced to nonsignifi-
cance in multivariate analyses. However, the effect of feeling
forgiven by others (OR = .53, p = .01) was robust, predicting
subsequent self-reported cancer onset even after controlling
for socio-demographic, psychosocial, religion/spirituality, and
health behavior variables. In summary, associations of self-
99
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
forgiveness and unconditional forgiveness of others with the
subsequent onset of cancer were mediated by other variables.
Feeling forgiven by others was associated with a 50% reduc-
tion in self-reported onset of cancer three years later, an effect
not mediated by other factors. Feeling forgiven by others may
stimulate reductions in stress and negative affect, which in turn
may have beneficial effects on neurochemical, endocrine and
immune system functioning, physiological processes implicated
in the development of cancer.
CORRESPONDING AUTHOR: Amy D. Owen, PhD, Duke
University Medical Center, Durham, NC, 27705; amy.owen@
duke.edu
D-038a
DUKE HEALTH PROFILE (DUKE) SCORES FOR CARDIAC
REHABILITATION PATIENTS IN RURAL UTAH: EVIDENCE
OF LOWER PERCEIVED MENTAL AND PHYSICAL HEALTH
VERSUS NATIONAL NORMS
Scott DeBerard, PhD1,2 and Cory J. Myler, MS1,2
1
Psychology, Utah State University, Logan, UT and 2Cardiac
Rehabilitation, Brigham City Community Hospital, Brigham
City, UT.
The Duke Health Profile (DUKE) is a widely used brief self-re-
port instrument consisting of six health scales (physical, mental,
social, general, perceived health, and self-esteem), and four
dysfunction scales (anxiety, depression, pain, and disability).
As rural populations are often at greater risk for poor mental
and physical health outcomes, there is a clear need to establish
norms for the DUKE reflective of rural hospital settings. These
rural norms may confirm and quantify the differences between
rural and national populations.
The DUKE was administered to 104 patients upon admittance
to a hospital-based Cardiac Rehabilitation Unit in rural Utah.
Participants had all experienced a recent cardiac event and/or
procedure (e.g., stent placement, CABG). The scores for these
patients (average age 66 years; 74% male) differed significantly
from the published reference values for primary care adult
patients of similar age. Specifically, the average cardiac rehab
patient scored lower on each of the function scales (where
high scores are better): physical health, mental health, social
health, general health, perceived health, and self esteem; and
higher on each of the dysfunction scales (where low scores are
better): anxiety, depression,, pain and disability. There were
particularly strong discrepancies between the two groups on
the mental health and disability scales. These score differences
were reflected in several moderate to strong standardized mean
difference effect sizes. In general, it appears cardiac patients
from rural Utah report worse physical and mental health upon
admittance to a cardiac rehabilitation center than is reflected
in national norms. These data are aligned with prior research
demonstrating worse health status in rural patients, and should
also prove useful in establishing norms for patients who have
experienced a cardiac event in rural settings.
CORRESPONDING AUTHOR: Cory J. Myler, MS, Psychology,
Utah State University, Logan, UT, 84321; cory.myler@gmail.com
100
D-038b
MID-TERM NEURODEVELOPMENTAL OUTCOME
FOLLOWING REPAIR OF VENTRICULAR SEPTAL DEFECT IN
INFANCY
Julie Simons, PhD and Christian Pizarro, MD
Nemours Cardiac Center, A.I. duPont Hospital for Children,
Wilmington, DE.
Approximately one out of 500 infants is born with a ventricular
septal defect (VSD). The postoperative course is relatively free
of complications and leaves patients with “normal” cardiac
physiology and expectations for typical development. Despite
the high prevalence of VSDs relative to other cardiac defects,
only a few studies have specifically examined the neurodevel-
opmental and psychosocial outcome of this population. The
purpose of this study was to provide data on the mid-term
neurodevelopmental outcome for children following repair
of a VSD. Neurodevelopmental outcome was assessed for 31
children (19 males, 12 females) using standardized tests of IQ,
memory, visual-motor ability, cognitive flexibility, and academ-
ic achievement as well as parent and teacher report of behav-
ioral and psychosocial functioning. Patients were grouped into
a younger cohort (less than 6 years old) and an older cohort (6
years and older). Overall intellectual functioning was compa-
rable to that of the general population (M = 95.6; SD = 15.3).
Patient functioning was lower in the areas of Performance IQ
for the younger cohort (M = 90.6, SD = 16.1, p = .023; n = 18),
visual memory among the older cohort (M = 84.5; SD = 15.3; p =
.003; n = 13), visual-motor ability (M = 87.9; SD = 14.2; p < .001,
n = 31), and adaptive behavior (M = 94.3; SD = 15.3; p = .05; n
= 30). Functioning was within the normal range in other areas
assessed. Three of the four domains where lower functioning
was observed tap into visual ability rather than verbal ability.
Lower mean scores in these areas were generally within one
standard deviation of the population mean, suggesting mild
weaknesses rather than significant impairments. These findings
are consistent with results of other studies which have shown
weaknesses in visual memory and visual-motor drawing ability
among children with congenital heart disease, but this is the
first known study to examine these domains in a VSD-specific
sample of children.
CORRESPONDING AUTHOR: Julie Simons, PhD, A.I. du-
Pont Hospital for Children, Wilmington, DE, 19803; jsimons@
nemours.org
D-038c
PSYCHOSOCIAL CORRELATES OF HOME BLOOD PRESSURE
MONITOR USE IN HYPERTENSIVE AFRICAN AMERICANS
Sherley Abraham, MD, Gbenga Ogedegbe, MD and Joseph
Ravenell, MD
New York University School of Medicine, New York, NY.
Home blood pressure monitoring (HBPM) is recommended
for patients with suspected or known hypertension. Little is
known about correlates of successful HBPM use in African
Americans, who suffer disproportionately from uncontrolled
hypertension. Methods: This study was a part of Counseling
African Americans to Control Hypertension, a practice-based
trial of BP control in hypertensive African Americans, in which
patients from 30 primary care sites were randomized to lifestyle
counseling, HBPM, and physician audit vs. usual care. Multi-
variate logistic regression analysis was used to assess associa-
tions between HBPM usage, depression, medication adherence,
health literacy and sociodemographic variables. Adherence was
measured with Morisky scale, with scores >0 indicating non-
adherence. Depressive symptoms were measured with PHQ-9
and Health Literacy was assessed using the Rapid Estimate of
Adult Literacy in Medicine. All analyses were performed with
SPSS 18.0. Results: Among the 411 patients in the intervention
arm, mean age = 56.6, 68% were women and 26% had more
than high school education. HBPM was successfully used by
56%; 50% were non-adherent; 16% were depressed (PHQ-9
score = 10 or greater); and the mean REALM = 57. HBPM usage
was positively associated with older age (Odds Ratio (OR) =
1.04, p=.035); employment (OR = 2.59, p=.022); and being born
in the United States (OR = 2.31, p=.049). Usage was nega-
tively associated with medication non-adherence (OR = 0.69,
p=.019), and having more than high school education (OR =
0.34, p=.020). Gender, health literacy, depression and smoking
status were not associated with HBPM use. Conclusion: HBPM
use was prevalent among hypertensive African Americans, and
was associated with better medication adherence. In contrast to
other populations, HBPM use was more common among older
African American patients with less than high school education.
These results indicate more research may be needed to facilitate
HBPM use among younger, unemployed African Americans
with poorly controlled hypertension.
CORRESPONDING AUTHOR: Joseph Ravenell, MD, New
York University School of Medicine, New York, NY, 10010;
joseph.ravenell@nyumc.org
D-038d
PSYCHOSOCIAL CORRELATES OF CHECKING BLOOD
PRESSURE AT HOME
Sherley Abraham, MD
General Internal Medicine, NYU School of Medicine, New York,
NY.
Home blood pressure monitoring (HBPM) is a standard recom-
mendation for management of hypertension. The psychosocial
correlates of HBPM use are limited, especially among African
Americans who bear a disproportionate burden of hyperten-
sion. Methods: This study was a part of CAATCH, a practice-
based trial of BP control in hypertensive African Americans, in
which patients from 30 primary care sites were randomized to
lifestyle counseling, HBPM, and physician audit vs. usual care.
Study methods have been published previously (Circulation
2009;2:249-256). Data analyzed in this study included baseline
socio-demographics, health literacy, depression and medication
adherence. HBPM use was captured at 4 visits during the trial
via automated BP devices and patient diaries, and usage was
measured on a scale of 0 to 4, with a score of 4 indicating HBPM
usage data at 4 visits. Adherence was measured with Morisky
scale, with scores >0 indicating non-adherence. Depressive
symptoms were measured with PHQ-9 and Health Literacy
was assessed using the Rapid Estimate of Adult Literacy in
Medicine. Multivariate analyses were performed with SPSS
18.0. Results: This study was limited to 411 patients in interven-
tion arm (age 57, 69 % female, 61% high school education or
greater, mean BP 149/91 mmHg). HBPM was used by 56% of
the patients, mean adherence score 2.27, PHQ score 4.48, and
REALM score 57. Analyses revealed greater HBPM usage was
associated with better medication adherence (Beta=-0.204, p<
0.001), less depressive symptoms (Beta =-0.145, p=0.009), and
older age (Beta=0.157, p=0.003). Gender and educational status
were not associated with HBPM usage. There was no significant
correlation with health literacy. Conclusion: Providing HBPM
to low-income African American populations will significantly
improve their usage toward recommended goals. Also, initially
focusing HBPM resources on patients who have demonstrated
better medication adherence may increase yield on usage. The
relationship between nonadherence and usage may be medi-
ated by depressive symptoms.
CORRESPONDING AUTHOR: Sherley Abraham, MD, General
Internal Medicine, NYU School of Medicine, New York, NY,
10016; sherley.abraham@nyumc.org
D-046a
ADOLESCENT PROBLEM SOLVING SKILL AND PARENTAL
MONITORING MODERATE SELF-CONTROL DEFICITS ON
METABOLIC CONTROL IN TYPE 1 DIABETICS
Amy E. Hughes, BS,1 Cynthia Berg, PhD1 and Deborah Wiebe,
PhD2
1
Psychology, University of Utah, Salt Lake City, UT and
2
Psychology, UT Southwestern, Dallas, TX.
Successful management of type-1 diabetes during adolescence
necessitates complex adherence behaviors along with avoidance
of health-compromising behaviors. Deficits in self-control are
noted risk factors for decreased behavioral self-regulation and
increased risk-taking in healthy adolescents (Steinberg, 2005).
Self-control deficits may also influence diabetes management.
The present study explored potential protective factors that
may compensate for low self-control, diabetes problem-solving
skill, and parental monitoring, and also determined if these
moderating effects on metabolic control were mediated by ad-
herence behavior. One hundred and ninety adolescents (M Age
= 13.52, SD = 1.52, 54.4% females) diagnosed with type 1 diabe-
tes completed the Brief Self Control Scale (Tangney, Baumister
& Boone, 2004), the Self-Care Inventory (La Greca, Follansbee
& Skyler, 1990), a diabetes specific problem-solving measure
(Shaevitz & Berg, 2001), and a parental monitoring question-
naire (Berg et al. 2008). Metabolic control was measured via gly-
cosolated hemoglobin (HbA1c) obtained from medical records.
Regression analyses revealed significant interactions between
self-control and problem solving skill, mothers’ general and dia-
betes monitoring, and fathers’ general monitoring on HbA1c.
Problem-solving skill was more facilitative of better HbA1c
for teens with low self-control. Parental monitoring also was a
protective factor for HbA1c, but predominantly for those with
low self-control. Although adherence partially mediated the
relationship between self-control and HbA1c, adherence did not
mediate the relationships of the interactions discussed above
with HbA1c. These results suggest that despite the fact that
poor self-control is associated with worse adherence, the pro-
tective aspect of diabetes problem-solving skills and parental
monitoring on HbA1c does not occur through better adherence,
but through different monitoring for better metabolic control,
especially for adolescents experiencing poor self-control.
CORRESPONDING AUTHOR: Amy E. Hughes, BS, Psycholo-
gy, University of Utah, Salt Lake City, UT, 84112; amy.hughes@
psych.utah.edu
101
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
D-051a
FULL DISCLOSURE: THE USE OF STANDARDIZED PATIENTS
IN TEACHING MEDICAL RESIDENTS TO DISCUSS ADVERSE
EVENTS
Sheela Raja, PhD, Rachel Yudkowsky, MD and Nikki
Centomani, RN
University of Illinois at Chicago, Chicago, IL.
Background/Problem: Disclosing an adverse event or medical
error to a patient is one of the most difficult behavioral/com-
munication challenges for medical residents. Because adverse
events are relatively rare in most settings, residents have little
opportunity to “practice” for these events. Standardized pa-
tients (SPs) have been used in Medical Schools for over 30 years
and provide an innovative opportunity to develop competency
in this area. Methods: Residents (n=41) completed an Objective
Structured Clinical Examination (OSCE) to assess their compe-
tence in several behavioral domains using simulations involv-
ing SPs (expert trained actors). In one encounter, residents
discussed an adverse event with a patient’s family member (a
missed Aortic Aneurism that resulted in the patient’s death).
SPs gave residents verbal feedback on their communication
skills and assessed performance using a behaviorally anchored
checklist. Residents were assess on: describing the error, taking
responsibility, not blaming others, expressing a sense of regret,
and discussing ways the error could be avoided in the future.
After the OSCE, residents were surveyed on their prior experi-
ence dealing with medical error. Residents participated in a
debriefing in which Risk Managers gave them general feedback
on approaches to disclosure. Results: Full disclosure of error
is challenging for residents, even in a simulated environment.
Most residents (66%) had no any prior experience with error
disclosure. While most residents (88%) disclosed the error in the
simulation, fewer expressed a sense of regret (78%) and most
failed to describe what they would do differently with to avoid
such an error in the future (56%). Consistent with our obser-
vations in debriefings, 98% felt the SP feedback very helpful.
Discussion/Conclusions: It appears that residents have limited
competency and experience in disclosing medical error, and
that SPs provide a valuable training resource in this area.
CORRESPONDING AUTHOR: Sheela Raja, PhD, University of
Illinois at Chicago, Chicago, IL, 60612; sheelaraja@gmail.com
D-051b
THE INFLUENCE OF RESEARCH AND EVALUATION
FINDINGS: THE EFFECTS OF TAILORING DISSEMINATION
TECHNIQUES
Marisa Sklar, BA,1,2 Andrew Sarkin, PhD,1 Rachel Lale, BA1,2 and
Georg Matt, PhD2
1
Health Services Research Center, University of California San
Diego, San Diego, CA and 2Department of Psychology, San
Diego State University, San Diego, CA.
Dissemination has been considered the answer to bridging
the gap between what we know to be true and effective from
research, and what is actually applied in practice (Wandersman
et al, 2008). Tailoring dissemination strategies has been noted
as critical in promoting the transfer of knowledge (Lawrenz,
Gullickson & Toal, 2007; Rossi, Freeman, & Lipsey, 1999), but
there is little advice on how to do so. This study intends to
inform future dissemination efforts by identifying the methods
that lead to the greatest influence of research findings across
102
diverse stakeholder groups. Five methods were used to dis-
seminate research findings to San Diego County Mental Health
administration and treatment program representatives. Evalua-
tion influence was assessed in a sample of 81 of these stakehold-
ers via interviewer-administered surveys that assessed partici-
pant involvement in the evaluation, access to each method of
dissemination, preferences for dissemination techniques, and
the influence of the findings in accordance to each dissemina-
tion method. Multiple regression analyses were used to as-
sess the influence of research findings between dissemination
techniques, as moderated by stakeholder group. Results suggest
the influence of findings when disseminated via meetings was
significantly greater than when disseminated via report, regard-
less of report type, (t(16)=-3.93, p=.001), which did not differ
by stakeholder group (t(16)=0.95, p=.358). Additionally, 52.9%
of participants identified the meetings as most useful of all
dissemination methods. Findings from this study are consistent
with research on passive diffusion, which has been shown to
be largely ineffective and unlikely to result in influence. These
findings reiterate the need of using an active dissemination
approach should influence of findings be the primary objective.
Implications for tailoring future research, evaluation, and dis-
semination efforts to maximize the influence of findings will be
discussed.
CORRESPONDING AUTHOR: Marisa Sklar, BA, University of
California San Diego, San Diego, CA, 92121; masklar@ucsd.edu
D-060a
SETTING GOALS: THE RELATIONSHIP TO WELLBEING AND
NOREPINEPHRINE IN AN HIV+ POPULATION
Lindsay M. Bira, BS Psychology, Gail Ironson, PhD, Mahendra
Kumar, PhD, Elizabeth Balbin, BA, Rachel Kuhn, MA and Neil
Schneiderman, PhD
Psychology, University of Miami, Miami, FL.
Although previous studies have looked at wellbeing and stress
in HIV+ populations, research on goals and their relationship
to wellbeing and stress in an HIV+ population is limited. The
aim of this study was to determine if having goals or not was
correlated to better wellbeing and lower stress hormones, using
measures of depression, anxiety and norepinephrine (NE) in
an HIV+ population. Methods: One hundred forty-two diverse,
HIV+ participants completed the Beck’s Depression Inventory
(BDI) and the State Trait Anxiety Inventory (State portion: SAT).
Goals reported during an interview were counted and catego-
rized. NE concentration, a physiological indicator of stress, was
determined using fifteen-hour urine collection, and assayed by
HPLC. A Pearson bivariate correlation matrix assessed whether
goals reported were significantly related to the measures of
wellbeing and stress. Results: It was found that having any
goals was correlated with lower NE (t=.278, p=.001, n=141) and
a lower BDI score (t=-.229, p=.006, n=142). Having no goals
was correlated with a higher NE (t=.278, p=.001, n=141), higher
BDI score (t=-.229, p=.006, n=142), and a trend was found with
anxiety (t=.155, p=.065, n=142). Follow-up analyses indicate
that in addition to whether someone had goals or not, those
who listed more goals had lower NE (t=-.201, p=.016, n=142).
It was also found that those who listed a goal of socializing/
meeting people had lower BDI scores (t=-.167, p=.047, n=142)
and lower SAT scores (t=-.180, p=.032, n=142). Goals associated
with bettering a living environment, such as doing housework
or moving, were correlated with higher BDI scores (t=.170,
p=.043, n=142). Conclusions: HIV+ individuals who had goals
and identified a larger amount of goals were more likely to
have lower levels of depression as well as stress hormone. In
addition, those individuals who listed social goals were more
likely to have lower levels of depression and anxiety. Individu-
als seeking to better their living situation had more depression.
Additional research is needed to further understand these
relationships.
CORRESPONDING AUTHOR: Lindsay M. Bira, BS Psychol-
ogy, Psychology, University of Miami, Miami, FL, 33133; lbira@
psy.miami.edu
D-060b
CULTURE AND PUBLIC HEALTH: FACTORS BEHIND SAFER
SEX PRACTICES AMONG MEN WHO HAVE SEX WITH MEN
(MSM)
Anne Pendygraft, MA
Psychology, University of Colorado Denver, Denver, CO.
The purpose of the current study was to assess the cultural fac-
tors that comprise sexual behaviors amongst Latino men who
have sex with men (MSM) compared to other ethnic groups.
HIV rates are comparably higher among Latinos than White
MSM. Therefore, more research is needed to understand this
public health trend. The study collected data on 268 MSM and
looked at a variety of sexual behaviors including serosorting,
strategic positioning, disclosure rates, and rates of HIV testing.
It compared these behaviors between ethnicities and identified
cultural trends. Overall, it was found that compared to non-
Latinos, Latinos participants partook in more public health risk
behaviors such as getting tested less for HIV (χ2(2) = 26.089, p <
.001) and disclosing their HIV statuses less often (χ2(3) = 18.235,
p < .001). Such behaviors were correlated with traditional mas-
culine attitudes and lower rates of acculturation. For instance,
it was found that within Latino participants, endorsement of
traditional masculine attitudes negatively correlated with HIV
disclosure rates (r = -.323, p < .001), HIV test rates (r = -.276,
p < .001), and acculturation to mainstream American culture
(-.461, p < .001). The high rates of both traditional masculine
attitudes and public health risk behaviors in Latino participants
indicate that the public health message aimed for the average
American male is not reaching this subpopulation; specifically
those that may possess more Machismo traits. The results of
this study signify that different approaches are needed to target
Latino MSM for prevention campaigns that may not identify
with gay culture due to high rates of Machismo. More creative
approaches are needed to seek out Latino MSM who carry
internalized homophobia and who may discriminate against
the gay community. Due to the limitations of this study’s data
collection method (at openly gay venues), future studies should
use different data collection methods to incorporate MSM who
do not identify as gay.
CORRESPONDING AUTHOR: Anne Pendygraft, MA, Uni-
versity of Colorado Denver, Broomfield, CO, 80020; annie167@
gmail.com
D-060c
A RANDOMIZED CLINICAL TRIAL OF A COPING
IMPROVEMENT GROUP INTERVENTION FOR HIV-INFECTED
OLDER ADULTS
Timothy Heckman, PhD,1 Kathleen J. Sikkema, PhD,2,3 Nathan
Hansen, PhD,2 Arlene Kochman, LCSW2,3 and Victor Heh, PhD1
1
Geriatric Medicine, Ohio University College of Osteopathic
Medicine, Athens, OH; 2Yale University School of Medicine,
New Haven, CT and 3Duke University, Durham, NC.
Objectives: To test if a 12-session coping improvement group
intervention (n=104) reduced depressive symptoms in HIV-in-
fected older adults compared to an interpersonal support group
intervention (n=105) and an individual therapy upon request
(ITUR) control condition (n=86).
Design: A randomized clinical trial with 4- and 8-month follow-
up.
Methods: Participants were 295 HIV-infected men and women
50-plus years of age living in New York City, Cincinnati, OH,
and Columbus, OH. Most participants were African Ameri-
can (49%) and male (67%). The average participant was 55.3
years of age (range=50 to 76), had completed 13.0 years of
education, and had been living with HIV for 12.5 years. Fifty-
one percent of participants self-identified as gay or bisexual.
Forty-four percent of participants self-reported taking one
or more psychotropic medications at pre-intervention (most
commonly anti-depressants and anxiolytics). Using A-CASI
assessment methodology, participants provided data on their
depressive symptoms using the Geriatric Depression Screening
Scale (GDS) at pre-intervention, post-intervention, and 4- and
8-month follow-up.
Results: Whether conducted with all participants (N=295) or
only a subset of participants diagnosed with mild, moderate, or
severe depressive symptoms (N=171), mixed models analyses
of repeated measures found that both coping improvement and
interpersonal support group intervention participants reported
significantly fewer depressive symptoms than ITUR controls at
post-intervention and both follow-ups. At no assessment period
did coping improvement and interpersonal support group
intervention participants differ in depressive symptoms.
Implications: Twelve-session coping improvement and interper-
sonal support group interventions produce greater reductions
in depressive symptoms in HIV-infected older adults compared
to an individual therapy upon request control condition.
CORRESPONDING AUTHOR: Timothy Heckman, PhD, Geri-
atric Medicine, Ohio University College of Osteopathic Medi-
cine, Athens, OH, 45701; heckmant@ohiou.edu
D-065a
GENDER DIFFERENCES IN PURSUING WEIGHT CHANGE:
BEHAVIORAL PREFERENCES AND NUTRITIONAL HABITS
Luz M. Garcini, MA,1 Kate Murray, PhD,2 Jessica L. Barnack-
Tavlaris, PhD2 and Elizabeth A. Klonoff, PhD1,2
1
SDSU/UCSD JDP, SDSU/UCSD JDP in Clinical Psychology,
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
(Markey & Markey, 2005). The present study evaluated gender
differences in pursuing weight change among 1119 ethnically
diverse students (802 women and 317 men), including behav-
ioral preferences to weight change and nutritional habits (i.e.,
reading ingredient lists and nutritional labels). Results from
Chi squares showed a significant gender difference was found
in present efforts to change weight, χ2(2,n= 1119)=228.89, p
<.001,phi=.45. Specifically,61% of women were presently trying
to lose weight with 3% trying to gain weight, whereas 23% of
men were trying to lose weight with 28% trying to gain weight.
Men reported to be more satisfied with their present weight
(49%) than women (36%). Men and women had similar behav-
ioral preferences to lose weight (i.e., eat fewer calories/less fat
(74% vs. 87% respectively), exercise (90% vs. 83%), and skip
meals (33% vs. 45%). Also, women were found to prefer taking
diet pills (17%) with men preferring to eat special products
(11%). To gain weight, behavioral preferences included eating
special products (48% vs. 10% respectively) and exercising (83%
vs. 50%). One-way, between-groups MANOVA showed small,
but statistically significant gender differences in nutritional
habits, F (2,1122)=7.70,p =.000,Wilks’ Lambda=.99; partial eta
squared=.014. An evaluation of mean differences showed that,
regardless of the small effect size, both groups were “never” or
“rarely” reading ingredient lists on foods and nutritional labels.
Discussion will consider findings in terms of relevance to the
development of dieting interventions, limitations of the study,
and directions for future research.
CORRESPONDING AUTHOR: Luz M. Garcini, MA, SDSU/
UCSD JDP, SDSU/UCSD Joint Doctoral Program in Clinical
Psychology, San Diego, CA, 92130; lgarcini@righttodream.org
D-065b
INTERNET HEALTH INFORMATION-SEEKING AND DIETARY
AND PHYSICAL ACTIVITY BEHAVIORS
Elaine R. Lipscomb, PhD1 and David Haggstrom, MD, MAS1,2
1
Health Services Research & Development, Center for
Implementing Evidence-based Practice, Roudebush VA Medical
Center, Indianapolis, IN and 2Regenstrief, Indianapolis, IN.
Background: Health information-seeking behavior is often
recognized as an important step in an individual’s decision to
participate in healthy behaviors.
Purpose: To compare demographic characteristics and beliefs
(antecedents) of internet users who seek diet, weight, and
physical activity information online (seekers) to internet us-
ers who do not seek this type of information online. We also
wanted to examine whether seekers were more likely to pursue
healthy dietary and physical activity behaviors (outcomes). We
hypothesized seekers would report better outcomes.
Methods: We used chi-square and Wilcoxon to test associations
between self-reported use of online diet, weight, and physical
activity information and both antecedents and outcomes from
the 2007 Health Information National Trends Survey.
Results: 36% of respondents used the internet for help with
diet, weight, and physical activity. Seekers were younger, more
educated, non-smokers, had higher income, and reported being
overweight more (p<0.0001, for all comparisons). Seekers were
more likely to believe that physical activity decreases cancer
risk (74% vs. 64%, p<0.0001) and that obesity is caused by
104
overeating and not exercising (77% vs. 73%, p=0.032). Seekers
were also more likely to participate in physical activity, try to
lose weight in the past year, and eat more fruit and vegetables
(p<0.0001, for all comparisons).
Conclusions: Methods for increasing internet use for healthy
lifestyle information among vulnerable populations should be
considered. The barrier is not entirely access since individuals
in our study used the internet. Those who perceive themselves
to be overweight, and perceive weight to be due to internal,
controllable causes tend to seek the internet for healthy lifestyle
information. Seekers also tend to self-report better outcomes.
Future analyses will examine mechanisms whereby internet use
is associated with dietary and physical activity behavior.
CORRESPONDING AUTHOR: Elaine R. Lipscomb, PhD,
Roudebush VA Medical Center, Indianapolis, IN, 46202; lip-
scome@iupui.edu
D-080a
FAMILY PREDICTORS OF WEIGHT CONTROL BEHAVIORS IN
OVERWEIGHT AND OBESE YOUTH
Megan Crawford, BA and David Janicke, PhD
Clinical and Health Psychology, The University of Florida,
Gainesville, FL.
As childhood obesity rates rise, more children experience
pressure to lose weight. Oftentimes, weight loss attempts are
unsupervised by healthcare professionals, leaving families to
make their own decisions about the use of weight control be-
haviors (WCBs). When children choose to use unhealthy WCBs,
there are consequences such as eating disorder development,
malnutrition, and weight gain. Research shows that overweight
children are more likely to engage in unhealthy WCBs when
compared to their healthy peers. However, little data exists to
help identify children at risk for engaging in unhealthy WCBs.
The current study aims are to (1) describe the use of WCBs in
overweight youth. (2) determine if family functioning is related
to the use of unhealthy and healthy WCBs. Participants were 57
overweight or obese youths, ages 10-17 (mean age=13 years),
and their parents attending a regularly scheduled medical
appointment. Child height and weight was measured, which
was then used to calculate body mass index (BMI). Families
completed the Demographic Questionnaire, Weight Control Be-
havior Checklist, Family Assessment Device, Conflict Behavior
Questionnaire, and Family Mealtime Questionnaire. Pearson’s
correlations were conducted and children who were older
(r=.321, p<.05) and heavier for age and gender (r=.422, p<.01)
reported increased use of unhealthy WCBs. While general fam-
ily functioning was not related to WCBs, children who reported
positive family mealtime interactions reported fewer unhealthy
WCBs (r=-.4, p<.01). This effect was maintained in a hierarchical
regression after controlling for age and BMI z-score (R-square
change=.085, p<.05). These data suggest that family interactions
specific to mealtime environments are an important factor in
children’s use of unhealthy WCBs rather than general family
functioning. Future research should focus on further identifying
types of family interaction patterns which are related to both
healthy and unhealthy WCBs to develop targets for interven-
tion.
CORRESPONDING AUTHOR: Megan Crawford, BA, Clinical
and Health Psychology, The University of Florida, Gainesville,
FL, 32610; mjcrawford@phhp.ufl.edu
D-080b
PARENT-CHILD COMMUNICATION AND MONITORING
AROUND HEALTHY EATING PRACTICES: A QUALITATIVE
STUDY USING PHOTOVOICE
Margaret K. Pendzich, MSPH,1 Laura Haak-Marcial, BA2 and
Bernard F. Fuemmeler, PhD, MPH1
1
Community and Family Medicine, Duke University Medical
Center, Durham, NC and 2Information and Library Science,
University of North Carolina, Chapel Hill, NC.
The rise in adolescent obesity prevalence is a top public health
priority. Although there is a mounting effort to address early
childhood obesity, less attention has been directed at devel-
oping prevention and intervention efforts for older children.
Knowing how children and their parents interact prior to and
during adolescence (10 - 16 years) is pivotal to the develop-
ment of family-based obesity prevention interventions. The
goal of the study was to 1) gather qualitative data on parenting
practices, specifically communication and parental monitoring
around healthy eating practices, and 2) assess the usability of
smartphones with this population. PhotoVoice methodology
was used to enhance focus group participation. Fourteen child-
parent dyads (M age of children = 12 years; range 10-16; 57%
African American) used the camera function of the Nokia N95
smartphone to document a week of food habits and a pedom-
eter app to track their daily steps. Focus groups were conducted
at the conclusion of the week. Several themes emerged with
general agreement between parents and children. Communi-
cation about healthy eating or unhealthy snack consumption
tended to be non-existent, confrontational, or the subject of
negotiation for behavioral compliance. Monitoring and rule-
setting structure around children’s patterns of eating varied
between a lack of structure where children and parents made
independent food choices to more highly structured interac-
tions, such as collaborative meal planning and eating together
as a family. Both parents and children reported a sense of raised
consciousness regarding food choices as a result of the photo-
voice exercise. This study offers insight into parent and child
views regarding food choices within the family. The acceptabil-
ity data from the use of smartphones suggests that this may be
a well received modality for family-based interventions for this
hard to reach group.
CORRESPONDING AUTHOR: Bernard F. Fuemmeler, PhD,
MPH, Community and Family Medicine, Duke University Medi-
cal Center, Durham, NC, 27710; bernard.fuemmeler@duke.edu
D-080c
“THE MORE PAIN I HAVE, THE MORE I WANT TO EAT”:
IMPACT OF CO-MORBID PAIN AND OBESITY ON DIETARY
BEHAVIOR AND PHYSICAL ACTIVITY
E. Amy Janke, PhD1,2 and Andrea T. Kozak, PhD3
1
Department of Behavioral and Social Sciences, University
of the Sciences in Philadelphia, Philadelphia, PA; 2CMC3,
Hines VA Hospital, Hines, IL and 3Department of Psychology,
Oakland University, Rochester, MI.
Background: Despite co-prevalence of obesity and chronic pain,
little is known about shared health risk behaviors that may con-
tribute to their joint development and maintenance.
Objectives: Explore the multidimensional nature of co-occurring
pain and obesity, examine shared health risk behaviors, and
guide practitioners in providing effective care.
Methods: Semi-structured interviews were conducted with
30 primary care patients to elicit perspectives about the de-
velopmental course of pain and weight symptoms, associated
physical/psychosocial impact, and treatment status and history.
All participants reported BMI ≥ 30 and persistent pain (average
intensity ≥ 3, scale 0-10), and a grounded theory approach was
used to analyze interview results.
Results: Emerging themes include the role of depression in
magnifying pain; hedonic qualities of food to sooth physical
pain; altered dietary choices and binge eating in response to
pain; and low motivation for and subsequently reduced physi-
cal activity due to pain. Obese individuals suggested that the
presence of depression magnified their experience of pain and
made weight loss more difficult. Participants described using
food to self-soothe, such that they ate more frequently, ate larg-
er amounts, and chose less healthful items in response to pain
or a combination of pain and low mood. Several participants
described their daily activities as very sedentary and involving
a good deal of ‘screen time’ with low motivation to engage even
in activities of daily living. Participants described eating as the
only activity that brings regular pleasure, and something to ‘fill
the time’ when they are home, inactive, and in pain.
Conclusion: Results have important implications for clinical
providers and suggest pathways by which obesity, pain, and
depression may interact and negatively impact quality of life
and engagement in health risk behaviors.
CORRESPONDING AUTHOR: E. Amy Janke, PhD, Depart-
ment of Behavioral and Social Sciences, University of the Sci-
ences in Philadelphia, Philadelphia, PA, 19477; e.janke@usp.edu
D-080d
PILOTING AN OBESITY EXPERT SYSTEM: INITIATING
CHANGE BY INITIATING DIALOGUE
Andrew DeMott, BA,1 Stephanie W. Russell, MPH,1 Jennifer
Duncan, PsyD,1 E. Amy Janke, PhD2 and Bonnie Spring, PhD1
1
Northwestern University, Chicago, IL and 2University of the
Sciences in Philadelphia, Philadelphia, IL.
Introduction: The Veterans Administration (VA) faces an
obesity epidemic much greater than the general population’s.
VA and public health guidelines advise providers to offer brief
behavioral counseling (the 5A’s—Assess, Advise, Agree, Assist,
Arrange) to all obese patients. Yet few providers perform the
most potent 5A’s: Assist by referring to VA standard weight-
loss treatment (the MOVE! Program) and Arrange a follow-
up visit. The Obesity Expert System (OES) was developed to
activate patient-provider communication in shared decision-
making about weight loss. The aim of this pilot study is to
examine the OES’ impact on PCP performance of the obesity
5A’s, especially Assist and Arrange.
Method: Appointment lists of 8 PCP’s were reviewed for
candidates with a BMI ≥ 25 and no prior MOVE! enrollment.
Eligible candidates completed the OES assessment on a laptop
just prior to their PCP appointment. The OES assesses obesity-
relevant information and produces an individualized report for
both patient and PCP prior to their appointment. The one-page
report summarizes the patient’s weight, medical conditions,
barriers, and readiness to change weight. PCPs and participants
completed an exit interview to evaluate acceptability and 5A
performance.
105
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.
Data show that PCPs stated they Assisted and Arranged on
100% of visits. Patient data reports Assist and Arrange were
performed on 88.9% of visits. Qualitative data suggests accept-
ability of the OES was very high, with 8/9 participants indicat-
ing a preference for daily use or use before every PCP visit. All
participants (100%) report they enjoyed interacting with the
OES and feel it is an effective way to communicate with their
PCP.
Discussion: The rate of 5A’s implementation achieved in this
pilot is greater than usual, although PCPs and patients differed
in agreement about completion of all 5A’s. While further study
is needed, decision-support tools such as the OES show promise
as a means to facilitate PCP performance of the 5A’s.
CORRESPONDING AUTHOR: Andrew DeMott, BA, North-
western University, Chicago, IL, 60611; a-demott@northwest-
ern.edu
D-080e
PEER VICTIMIZATION, WEIGHT STATUS, AND CHILDREN’S
USE OF UNHEALTHY WEIGHT CONTROL BEHAVIORS
Nicole Kahhan, MS, Lindsay Baird, n/a and Crystal Lim, PhD
Department of Clinical and Health Psychology, University of
Florida, Gainesville, FL.
Unhealthy weight control behaviors are a major concern among
youth, posing a serious threat to their physical and psychologi-
cal well-being. The adoption of these behaviors is related to a
combination of environmental, psychological, and biological
risk factors, for example, peer interactions. Few studies have
focused on the direct link between peer victimization (PV)
and unhealthy weight control behaviors, nor have the possible
buffering effects of positive social interactions on this relation-
ship been studied. The purpose of this study was: (1) to exam-
ine and describe unhealthy weight control behaviors and PV
in children as they differ by gender and/or weight status and
(2) to determine if positive social interactions serve to moder-
ate the relationship between PV and unhealthy weight control
behaviors. Participants were 107 children, ages 7-17 and their
parent(s) recruited from a pediatric primary care clinic. Par-
ents completed a demographic form. Children completed the
Revised Peer Experience Questionnaire, the Child/Adolescent
Dietary Questionnaire, and the Social Experience Question-
naire. PV rates and unhealthy weight control behaviors did not
differ by gender. Children who were overweight or obese dem-
onstrated higher rates of disordered eating than those who were
not overweight. Total PV differed based on weight status such
that those of higher weight status reported more victimization.
PV rates predicted 14.4% of the variance in weight control be-
haviors, with higher rates of victimization related to increased
use of unhealthy weight control behaviors. Moderator analyses
found that prosocial support did not moderate the relationship
between victimization and weight control behaviors. Results
suggest that both children with higher rates of PV and those
of higher weight status report more unhealthy weight control
behaviors. Additionally, children of increased weight status re-
port higher rates of victimization. These data point to important
areas of future research and intervention in looking to decrease
the use of unhealthy weight control behaviors in youth.
106
CORRESPONDING AUTHOR: Nicole Kahhan, MS, Depart-
ment of Clinical and Health Psychology, University of Florida,
Gainesville, FL, 32607; nkahhan@phhp.ufl.edu
D-080f
MEDIATORS OF WEIGHT LOSS IN A MULTI-SITE
RANDOMIZED TRIAL OF A COMMERCIAL WEIGHT LOSS
PROGRAM
Nancy E. Sherwood, PhD,1 Cheryl Rock, PhD, RD,2 Shirley Flatt,
PhD,2 Njeri Karanja, PhD3 and Cynthia Thomson, PhD, RD4
1
HealthPartners Research Foundation, HealthPartners Research
Foundation, Minneapolis, MN; 2Department of Family and
Preventive Medicine, School of Medicine University of
California, San Diego, San Diego, CA; 3Kaiser Permanente
Center for Health Research, Portland, OR and 4Department of
Nutritional Sciences, University of Arizona, Tucson, Tucson,
OR.
Background: Successful weight loss and maintenance is chal-
lenging, underscoring the need to better understand media-
tors of short and long-term success. Disinhibition and restraint
have been linked with disturbed eating patterns, but also with
weight loss success. Several restraint (flexible, rigid) and dis-
inhibition (internal, external)dimensions have been identified;
examining which are associated with success has important
implications for designing effective programs. These analyses
examine whether dimensions of restraint, disinhibition and
hunger are mediators of weight loss in women enrolled in a
randomized clinical trial of a commercial weight loss program.
Method: Adult women (n=442) were randomized to one of
three treatment arms, Jenny Craig (JC) Centre-based, JC Direct
(phone-based), and usual care (UC) and are being followed for
24 months. Baseline,6 and 12 month data are presented here.
Sub-scales from the Eating Inventory, including Total, Internal
and External Disinhibition, Total, Flexible, and Rigid Restraint,
and Total, Internal Locus and External Locus Hunger, are exam-
ined as mediators of 6- and 12-month weight change. Results:
Treatment group weight change differences were observed
at 6 (JC=-8.9 kg (sd=5.0) vs UC=-3.1 kg (sd=5.0), p < .005) and
12 months (JC=-9.9 kg (sd=7.6) vs UC = -2.8 kg (sd=6.7), p
< .0003). External disinhibition and total, rigid, and flexible
restraint were significant mediators of 6-month weight change.
Significant mediators of 12-month weight change included
total (β=-0.77), flexible (β=-.346), and rigid (β=-.086) restraint.
Conclusions: Results suggest that external disinhibition and
multiple aspects of restraint are important mediators of weight
loss. Future analyses will examine these constructs as mediators
of long-term maintenance.
CORRESPONDING AUTHOR: Nancy E. Sherwood,
PhD, HealthPartners Research Foundation, HealthPart-
ners Research Foundation, Minneapolis, MN, 55440-1524;
Nancy.E.Sherwood@HealthPartners.com
D-083a
WORK OR RELATIONS? CORRELATIONS BETWEEN
BURNOUT AND THE CAUSES OF OVERTIME WORK
Hao W. Chen, MS,1 Li H. Wang, MS2 and Henry S. Kao, PhD1
1
Psychology, Fu-Jen Catholic University, Sinchuan, Taiwan and
2
Psychology, National Cheng Chi Universityy, Mucha, Taiwan.
The effects of overtime work on employee health has been
researched extensively (Beckers et al., 2008, Hughes & Parkes,
2007 ). The results are mixed (Allen, Slavin & Bunn 2007) and
the causes of overtime work are seldom noticed. Tucker &
Rutherford (2005) found three factors: commitment, job mainte-
nance and pressure. This study was based on Tucker & Ruther-
ford (2005) and identified four most common causes of over-
time work in Taiwan (Job Demands ,Supervisory Impression ,
Job Involvement and Peer Social Conformity). We examined the
relationship between these causes of overtime work and burn-
out. To measure burnout, we used the Copenhagen Burnout
Inventory (CBI) with a reliability of alpha 0.91. We surveyed a
total of 258 working adults through internet and text.
Results found that three of the four causes correlated signifi-
cantly with the scores of Personal Burnout (PB) and Work
Burnout (WB). A negative correlation of Job Involvement was
obtained respectively with PB (r=-.235 p=.000) and WB (r=-.422
p=.000). We also found a positive correlation of Peer Social Con-
formity with PB (r=.196 p=.003) and WB (r=.204 p=.002)as well
as a positive correlation of Supervisory Impression reaching sig-
nificance with WB (r=.158 p=.018). These findings have provid-
ed evidence that the causes of overtime work have differential
impact on employee’s mental health, some being positive while
other negative. This study offers a case of occupational health
research having cross-cultural significance.
CORRESPONDING AUTHOR: Henry S. Kao, PhD, Psychology,
University of Hong Kong, Hong Kong, -; hrnyksr@hkucc.hku.
hk
D-083b
THE IMPACT OF MILITARY DEPLOYMENTS ON SPOUSES’
HEALTHCARE UTILIZATION
Rena A. Nicholas, PhD
Clinical Health Psychology, Wilford Hall Medical Center, San
Antonio, TX.
The stress of military deployments on servicemembers’ spouses
could lead to adverse health outcomes. Recent studies examin-
ing the impact of deployments on spouses’ utilization of health-
care, a possible indicator of health-related impacts of stress,
have had mixed outcomes as to whether deployments lead to
increased healthcare demands. However, previous studies have
limitations related to the use of convenience samples, cross-sec-
tional designs, and self-report data. This study aimed to address
these gaps by examining objective counts of healthcare visits for
spouses whose military partner was deployed for four months
to combat in Iraq or Afghanistan. Objective counts of healthcare
utilization were examined across the predeployment, deploy-
ment, and postdeployment phases to enable the identification
of any trends across these time periods. The results of this study
show that there is a time effect of deployment on spouses’
healthcare utilization (F=4.9; p <.001) healthcare utilization
markedly decreased during the postdeployment period com-
pared to the predeployment and during deployment periods.
Also, gender related differences were examined. A main effect
of gender was found such that men tended to use less health-
care compared to women (F=4.6; P<0.05). This study also found
a gender by time interaction (F=3.1; p< 0.05) such that women’s
and men’s healthcare utilization were significantly different
during the deployment period (F=9.2; P<0.01) where women’s
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
periods. Possible explanations and implications are that gender-
related healthcare needs and help-seeking behaviors differ and
that efforts to improve health and coping during a military
member’s deployment may need to be tailored to gender and to
changes in deployment cycles.
Note: The opinions expressed on this document do not repre-
sent an endorsement by or the views of the U.S. Air Force, the
Department of Defense, or the U.S. Government.
CORRESPONDING AUTHOR: Rena A. Nicholas, PhD, Clinical
Health Psychology, Wilford Hall Medical Center, Lackland Air
Force Base, San Antonio, TX, 78253; rena.nicholas@lackland.
af.mil
D-098a
STRESS IN PARENTS OF CHILDREN WITH SINGLE SUTURE
CRANIOSYNOSTOSIS
Lynette Dufton, PhD,1,2 Matthew L. Speltz, PhD,2,1 Joseph L.
Piccianno, MS,1 Mary Mike Craddock, PhD4 and Kathy Kapp-
Simon, PhD3
1
Seattle Children’s Hospital, Seattle, WA; 2University of
Washington, Seattle, WA; 3Northwestern University, Chicago,
IL and 4St. Louis Children’s Hospital, St. Louis, MO.
Single suture craniosynostosis (SSC) is a condition in which a
single suture in the infant skull fuses prematurely. Cranioplasty
is required to release the fused suture and reshape the skull.
Children with SSC are likely to show delays in learning and be-
havior (Speltz et al., 2004). Parents of infants with SSC are thus
faced with a number of stressful events, including the child’s
unusual appearance, life-threatening surgeries, and the possibil-
ity of future neurodevelopmental problems (Endriga & Kapp-
Simon, 1999). Rosenberg et al. (in press) compared parents of
infants with and without SSC on levels of self-reported stress
before the child underwent cranioplasty. Average stress levels
reported by parents of cases did not differ from those reported
by parents of controls. The current study followed this same
sample of children, giving parents the Parenting Stress Index
(PSI) at two post-surgery time points, 12 months (Time 1) and
24 months (Time 2) after surgery. Eight hundred forty parents
(418 parents of cases) participated at Time 1 and 714 parents
(422 parents of cases) at Time 2. Parents of children with and
without SSC did not differ on PSI Total or Parent Domain
scores. Fathers of cases reported higher levels of PSI Child Do-
main stress than fathers of controls at Time 1 (t = 2.02, p < .05, d
= .2). Mothers of both cases and controls reported higher levels
of parent stress than did fathers of cases and controls at Time 1
(t = 3.66, p < .05, d = .2) and Time 2 (t = 5.07, p < .001, d = .2). On
the PSI defensiveness scale, mothers of cases generated higher
scores than control group mothers at both time points. In sum,
parents of children with SSC reported levels of stress very simi-
lar to those of control group parents. These findings point to the
resiliency of parents of children with SSC and/or a repressive
adaptive style in their reporting of stressful experiences. Parent
gender seems to exert a stronger effect on stress reports than
children’s medical status.
CORRESPONDING AUTHOR: Lynette Dufton, PhD, Seattle
Children’s Hospital, Seattle, WA, 98105; lynette.dufton@seat-
tlechildrens.org
107
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
D-098b
COMPUTERIZED NEUROCOGNITIVE TESTING IN ADULT
SICKLE CELL PATIENTS
Regina Crawford, MD,1 Miriam H. Feliu, PsyD,2 Christopher
Edwards, PhD1,2 and Marilyn Telen, MD1
1
Hematology, Duke University Medical Center, Durham, NC
and 2Psychiatry, Duke University Medical Center, Durham, NC.
Sickle cell disease (SCD) is a genetic disorder with multiple
medical manifestations. The vasoocclusion causes pain crisis as
well as higher incidence of cerebrovascular events (CVEs). At
least 20% of SCD patients with no history of strokes have abnor-
mal brain MRI. There is limited literature addressing neurocog-
nitive deficits in the adult SCD population. In the current study,
30 subjects (17 males,13 females) of African American descent
were administered a computer-based software program, the
CNS Vital Signs (CNS-VS) with measures for memory, psycho-
motor speed, reaction time, cognitive flexibility and complex
attention, as well as a global neurocognitive index. Mean age
for control 43.54 yrs +- 4.24; SCD group 34 +-12 . A significant
difference was found between SCD patients and controls for
Symbol Digit Coding domain (p=0.001) and psychomotor
domain (p=0.02) between groups. The relevance of these results
point to diffuse brain damage involvement in SCD population
even in the absence of CVEs as Symbol Digit Coding is the most
sensitive test of brain damage. Using a computerized program
to assess neurocognitive presentation in neurologically intact
SCD population can be a promising cost-effective method
of assessment relevant for treatment. Implementing routine
neurocognitive screening in this underserved population may
promote access to needed care and increased quality of life.
CORRESPONDING AUTHOR: Miriam H. Feliu, PsyD, Psy-
chiatry, Duke University Medical Center, Durham, NC, 27705;
feliu001@mc.duke.edu
D-098c
SOUTHERN BIRTH, AFRICAN-AMERICAN RACE, AND RATE
OF MEMORY LOSS IN ADULTHOOD
M. Maria Glymour, ScD
Harvard School of Public Health, Boston, MA.
BACKGROUND: Prior research on race and memory loss
has not fully accounted for differences between older African
Americans and whites in place of birth. About half of older
African Americans were born in the southern United States,
whereas only a small fraction of older whites were born in the
south. Southern birth predicts higher risk of cerebrovascular
disease, which contributes to cognitive and memory loss in later
life. We test whether race and southern birth independently
predict rate of memory change in a nationally representative
sample of Americans aged 55-65 at baseline.
METHODS: Among 7,302 participants in the 1996 wave of the
Health and Retirement Study, we used growth curve models
to assess rate of memory decline (immediate and delayed recall
of a 10-word list) over a 10 year follow-up (a total of 36,369 ob-
servations). We examined whether self-identified race (African
American or black versus all others) predicted rate of memory
decline with or without adjustment for whether the respondent
was born in a southern state. Finally, we adjusted for an indica-
tor of parental and own education. All models were adjusted
for age and sex.
108
RESULTS: Adjusted only for age and sex, African Americans
averaged a faster rate of decline in memory (b=-0.026 per year;
p=0.05). This was approximately 16% faster than whites of simi-
lar age and sex. Southern birth also predicted faster memory
decline (b=-0.022; p=0.007). After adjustment for Southern birth,
African American race was not significantly related to rate of
memory decline (b=-0.015; p=0.29). After adjusting for race, pa-
rental education and own education, Southern birth remained
a significant predictor of rate of memory decline (b=-0.022;
p=0.008).
CONCLUSIONS: Southern birth predicts faster rates of memory
decline in middle age to early old age. Southern birth appears to
confound the association between race and memory decline and
should routinely be considered in analyses of race and cognitive
outcomes. The association between Southern birth and memory
loss is not accounted for by adult education, suggesting other
psychosocial or behavioral pathways.
CORRESPONDING AUTHOR: M. Maria Glymour, ScD, Har-
vard School of Public Health, Boston, MA, 02115; mglymour@
hsph.harvard.edu
D-098d
NATURAL DISASTERS VERSUS TERRORISM ON COPING AND
DEPRESSION
Barbara G. Melamed, PhD, ABPP1 and Julie Holmes, MS2
1
Social and Behavioral Sciences, Mercy College, Dobbs Ferry,
NY, NY and 2Insttute for Social Research, University of Hawai,
Honolulu, HI.
Previous literature (Baum et al. 1996) indicated that the re-
sponse to man-made disasters, such as three-mile island and
trauma related to attacks on the person were different. They
also looked at intrusive thoughts as they delayed recovery.
Therefore, similarities or differences in the use of avoidance and
intrusive thoughts in relationships to measures during WTC
and Hurricane Katrina were evaluated.
Two weeks following the devastation caused by Hurricane
Katrina, 98 college and staff members participating in a 4 year
follow-up of the influence of WTC disaster on depression and
coping style. Each participant filled out demographic informa-
tion, Impact of Events and the Center for Epidemiological Stud-
ies- Depression scale. The Impact of Events scale was used to
determine their use of avoidance and intrusions as reported for
the last seven days to the WTC and the Hurricane. Hypothesis
1 predicted that there would be no difference in the responses
to the two events. Hypothesis 2 evaluated the relationship
between intrusion or avoidance on their reported depression as
measured by the CESD.
Correlation coefficients with distress revealed a number of
significant correlations. Specifically there was support for the
hypotheses that intrusive and avoidance thinking would be
associated with more self-report of depression whether it was
hurricane related or not. Hurricane -related intrusion and
avoidance were highly related to each other r(93)=.734 p,<.000,
Also, Hurricane avoidance and intrusion were highly related
to WTC related intrusion r(90)=.550 p<.000 and avoidance
r(90)=.733,p<.000. Given the coping style of avoidance and in-
trusion and our past research (Melamed,2007) showing benefits
of active coping and Hope (active agency and optimism) the
best recommendation would be to apply Seligman’s Positive
therapeutic approaches to change negative and catastrophic
thoughts and teach active coping.
CORRESPONDING AUTHOR: Barbara G. Melamed, PhD,
ABPP, Social and Behavioral Sciences, Mercy College, Dobbs
Ferry, NY, NY, 10522; bmelamed@mercy.edu
D-098e
CONTENT ANALYSIS OF A CHRONIC ILLNESS FACEBOOK
COMMUNITY
Andrea L. Hobkirk, BS, Joseph De Leo, BS, Vivian Hwang, BS
and Sharon Danoff-Burg, PhD
Clinical Psychology, University at Albany, Albany, NY.
Since the 1990s, technology has increasingly been recognized as
a clinical resource for those in the healthcare field through the
use of web-based interventions, online counseling, and Inter-
net operated therapeutic software (Barak, Klein & Proudfoot,
2009). Based on the Roy Adaptation Model, researchers have
found that peer-led online discussion forums can be effective
in facilitating psychosocial adaptation, improvements in the
self-management of chronic illness, and enhancement of overall
quality of life (Weinert, Cudney & Spring, 2008). Online social
networking sites, such as MySpace and Facebook, may provide
similar benefits for those living with chronic illnesses by allow-
ing individuals the opportunity to share their personal experi-
ences and health information, as well as offer emotional support
for one another.
In this study, Pennebaker’s LIWC text analysis software pro-
gram (Pennebaker & Francis, 1999) was used to conduct a con-
tent analysis of the asynchronous communication of a chronic
illness support group on the popular social networking site
Facebook (www.facebook.com). Messages posted on the site
‘Wall’ by users between July and December 2009 were analyzed
to examine several hypotheses surrounding self-disclosure,
the expression of positive versus negative emotions, and the
exchange of health information.
Of the 209,992 words posted within messages on the site, 4.95%
were singular personal pronouns (e.g. I, me, mine) compared
to only 3.57% of all other pronouns (e.g. you, s/he). Members
expressed more positive emotion than negative emotion, 4.77%
and 1.37% respectively, and discussed topics relating to physi-
cal health more than mental health, 5.31% and 0.82% respec-
tively. These results suggest that social networking sites may
provide individuals a chance to exchange health information,
communicate their experiences, and provide encouragement for
one another. This lends support for the theory that unmanaged,
public networking sites may be used in conjunction with health-
care interventions designed to facilitate psychosocial adaptation
and the management of chronic illness.
CORRESPONDING AUTHOR: Andrea L. Hobkirk, BS, Clinical
Psychology, University at Albany, Albany, NY, 12203; ahob-
kirk@gmail.com
D-098f
CORRELATES OF FEAR OF FALLING IN OVERWEIGHT AND
OBESE OLDER ADULTS WITH KNEE OSTEOARTHRITIS
Shannon L. Mihalko, PhD,1,2 Claudine Legault, PhD,2 Cralen
Davis, MS2 and Stephen P. Messier, PhD1,2
1
Wake Forest University, Winston-Salem, NC and 2Wake Forest
University School of Medicine, Winston-Salem, NC.
Falls are associated with morbidity and mortality in older
adults. Fear of falling may play a pivotal role in understand-
ing fall prevention and rehabilitation. Little is known about
the determinants of fear of falling in older adults with knee
osteoarthritis. The present study incorporated a social cognitive
framework to examine the relationships between physiological,
behavioral, and psychological determinants of fear of falling at
baseline of the Intensive Diet and Exercise for Arthritis (IDEA)
study. To examine the effect of age, gender, BMI, efficacy and
physical activity on fear of falling, we used a proportional odds
model that takes into account the ordinal response for fear, with
backward variable selection. Data were available on 348 IDEA
participants: 71% female, mean age of 65.8 yrs (SD=6.1) and
mean BMI of 33.4 (SD=3.6) kg/m2. 34%, 30% and 37% of par-
ticipants reported none, some and moderate to very much fear
related to falling, respectively. Females were 3.0 times (95%CI
= 1.9-4.8) more likely than males to have stronger fear of falling
and for an increase of 10% in balance-related efficacy, the odds
of having stronger fear decreased by a factor of 0.61 (95% CI =
0.53-0.70). Physical activity was significantly (p≤.001) correlated
with efficacy for balance activities (r = .20). The findings suggest
that social cognitive factors are important correlates of fear of
falling. Future research is needed to examine the impact of in-
terventions that target self-efficacy and its subsequent influence
on fear of falling in older adults with knee osteoarthritis.
Trial Registration: NCT00381290
CORRESPONDING AUTHOR: Shannon L. Mihalko, PhD,
Health and Exercise Science, Wake Forest University, Winston-
Salem, NC, 27109; mihalksl@wfu.edu
D-098g
DISPARITIES IN MAGAZINE MEDICATION ADS
Jessica L. Barnack-Tavlaris, PhD,1 Luz Garcini, MA,2 Lindsey
Shamp, BA,3 Jennifer Jensen, MPH3 and Elizabeth A. Klonoff,
PhD2,1
1
SDSU/UCSD Comprehensive Cancer Center Partnership, San
Diego, CA; 2Joint Doctoral Program in Clinical Psychology,
SDSU/UCSD, San Diego, CA and 3San Diego State University,
San Diego, CA.
Medications make up a large amount of health care expenses,
leading to high profits for pharmaceutical companies. Direct
to consumer medication advertising (DTCMA) proponents
argue that the ads increase disease awareness, while critics
argue that the ads inundate the public with information about
medical therapy without comparing it to nonmedical therapies.
If DTCMA can increase disease awareness, then differences
in DTCMA across population subgroups could contribute to
health disparities. This study examined DTCMA across print
magazines for different audiences. Print DTCMA is convenient
because patients can bring the ads to the doctor’s office, which
may encourage them to ask for the medication.
DTCMA were coded in the following popular magazines
(165 issues) for 2008-09: Cosmopolitan, Glamour, Vogue
(women), Esquire (men), Ebony (African American), People
(English speaking), and People en Español (Spanish speaking).
There were 603 medication ads (prescription=63%, over-the-
counter=37%). One-way ANOVA with Tukey follow-up tests
showed differences in the number of ads across magazines,
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
women’s and men’s magazines (Glamour:161 ads, M=6.71
vs. Esquire:10 ads, M=.42, p<.005). There were no differences
in the number of ads between People, People en Español, and
Ebony, (p>.05), but the types of ads differed. For example,
the top 3 medication ads in People were for allergies, cold/
flu, and women’s health; the top 3 ads for People en Español
were for cold/flu, allergies, and enlarged prostate; the top 3 ads
for Ebony were for diabetes, heart disease/stroke, and cold/
flu. All the ads in Esquire were for sexual functioning, mental
health, and increasing body mass. Although heart disease and
stroke are 2 of the top causes of death, preventive medications
comprised only 5% of the total ads, none of which were in the
men’s or women’s magazines. Implications for health behav-
iors, disparities, and policy will be discussed.
CORRESPONDING AUTHOR: Jessica L. Barnack-Tavlaris,
PhD, SDSU/UCSD Comprehensive Cancer Center Partnership,
San Diego, CA, 92120; jbarnack@projects.sdsu.edu
D-098h
MILITARY SEXUAL TRAUMA AND SUICIDE ATTEMPTS IN A
SAMPLE OF MARINES
Hannah L. Giasson, BA,1 Jaimie Gradus, DSc, MPH1,2 and Jillian
C. Shipherd, PhD1,2
1
National Center for PTSD, VA Boston Healthcare System,
Boston, MA and 2Psychiatry, Boston University, Boston, MA.
Research has indicated that sexual trauma occurring during
military service is associated with suicide attempts in Veterans.
Tiet et al (2006) found that male Veterans experiencing sexual
trauma were more likely than those who had not had such
experiences to attempt suicide. Further, Belik et al (2009) found
associations between sexual trauma and suicide attempts in
a sample of Canadian military personnel. The current study
hypothesized that military sexual trauma experienced during
Marine boot camp would be associated with suicide attempts
following boot camp among both males and females. To explore
this hypothesis, we utilized data from a longitudinal study of
Marines obtained upon arrival for boot camp training at Par-
ris Island in 1997 and at four subsequent time points over the
course of 12 years. As our hypothesis is an examination of the
sequelae of military sexual trauma occurring during boot camp,
the sample for the current study was restricted to Marines that
participated in the post-boot camp assessment for the larger
study (n = 1469). Suicide attempts in the 12 years following
boot camp were assessed during the most recent wave of data
collection. Conditional logistic regression was used to examine
experiences of military sexual trauma as a predictor of suicide
attempts, stratified by gender. Of the total sample, 118 men
(11.5%) and 89 women (10.7%) reported experiencing military
sexual trauma during boot camp, while 9 men (0.9%)and 20
women (2.4%) endorsed attempting suicide since boot camp.
Analyses revealed that men who had experienced military
sexual trauma during boot camp had 8.7 times the odds of
suicide attempts following boot camp than men that did not
have this experience (95% confidence interval: 1.4, 53). Interest-
ingly, we did not find an association between military sexual
trauma during boot camp and suicide attempts following boot
camp among women (OR = 0.95; 95% confidence interval: 0.21,
4.2). Further examination of these results, and implications for
intervention, will be presented.
110
CORRESPONDING AUTHOR: Jaimie Gradus, DSc, MPH, Na-
tional Center for PTSD, VA Boston Healthcare System, Boston,
MA, 02130; jaimie.gradus@va.gov
D-098i
RELIGIOUS CORRELATES OF STRUCTURAL BRAIN
CHANGES IN LATE ADULTHOOD
Richard D. Hayward, PhD, Amy Owen, PhD, David Steffens,
MD and Martha Payne, PhD
Duke University Medical Center, Durham, NC.
While studies of practices such as meditation and prayer have
demonstrated changes in brain activity, the field of religion and
neuroscience remains in its infancy. Recent functional brain
imaging studies have shown that the left orbital-frontal cortex
(LOFC) and the hippocampus are active during engagement in
religious and spiritual practices. Decline in these regions has
been associated with depression and other deleterious mental
health outcomes in later adulthood. However, little evidence
is available regarding the long-term impact of religion on the
brain. This study uses longitudinal structural magnetic reso-
nance imaging (MRI) to examine the relationship between
various religious factors and changes in the brain among older
adults. Participants (age 60+) have been enrolled on an ongoing
basis since 1994; socio-behavioral measures were administered
annually, with biennial MRI scans to measure volume of brain
regions. To date, the study has included 466 depressed and 161
non-depressed comparison subjects. Longitudinal MRI data
were available for 318 participants (average time in study 6.6
years). Regression analyses showed religious affiliation was
associated with change in both left and right hippocampal
volume over the course of the study. Individuals who reported
no religious affiliation at baseline exhibited significantly greater
decrease in hippocampus volume, after controlling for age, de-
pression status, duration in the study, and total brain size (left:
β = .12, p = .03; right: β = .11, p = .05). Two types of religious
experience were associated with less decline in LOFC volume:
born again Christian experiences prior to the start of the study
(β = -.16, p = .01), and other life-changing experiences that oc-
curred during the course of the study (β = -.18, p = .003). Other
factors (worship attendance, prayer, and religiousness) were
not associated with changes in brain structure. These findings
suggest that attenuation of declines in hippocampal and LOFC
volumes may be a potential neurophysiological mediator for
some of the well-established beneficial effects of religion on late
life mental health.
CORRESPONDING AUTHOR: Richard D. Hayward, PhD,
Center for Spirituality, Theology and Health, Duke University
Medical Center, Durham, NC, 27705; david.hayward@gmail.
com
D-107a
PATIENT-HEALTH CARE PROVIDER COMMUNICATION AND
HEALTH OUTCOMES AMONG PATIENTS WITH SICKLE CELL
DISEASE
Chante C. Wellington, PhD, Frank J. Keefe, PhD and
Christopher L. Edwards, PhD
Psychiatry, Duke University Medical Center, Durham, NC.
Sickle cell disease (SCD) is a recurrent painful genetic blood
disorder. Despite evidence that there is often times problems
in pain communication between SCD patients and health care
providers, there have been few research studies that have sys-
tematically addressed this area. This study tested one primary
hypothesis: lower levels of self-efficacy and higher levels of
holding back will be associated with lower levels of physi-
cal functioning and higher ratings of pain and psychological
distress.
We evaluated patient holding back and self efficacy for talking
about pain and pain related concerns as predictors of patient
pain rating, physical functioning and anxiety and depression
related to hospital visits among 70 African American patients,
mean age 34.98 (11.79) with SCD. Disclosure was found to
predict role emotional dimension of physical functioning
(p=.05), the patient-physician interaction (p=.0009), and self
efficacy for communication with physician (p=.0004). Self ef-
ficacy for communication with physician was found to predict
the patient-physician interaction (p=.009). Self efficacy for pain
communication was found to predict anxiety (p=.04), depres-
sion (p=.001), general health dimension of physical functioning
(p=.04), and patient-physician interaction (p=<.0001). Higher
levels of patient disclosure about pain and other pain related
concerns was associated with higher levels of physical func-
tioning, patient’s confidence in their ability to interact with the
health care provider and patient confidence in their ability to
communicate with the health care provider. Whereas, lower
patient confidence for pain communication was associated with
higher levels of anxiety, depression and lower levels of physical
functioning and patient’s confidence in their ability to interact
with the health care. The authors conclude that better under-
standing the relationship of patient’s level of pain communica-
tion to health outcomes in patients with SCD may lead to better
medical management by health care providers.
CORRESPONDING AUTHOR: Chante C. Wellington, PhD,
Psychiatry, Duke University Medical Center, Durham, NC,
27705; chante.wellington@duke.edu
D-107b
APPRAISAL OF MOVEMENT AND KINEMATIC AVOIDANCE
IN HIGH AND LOW FEAR PARTICIPANTS FOLLOWING
DELAYED ONSET MUSCLE SORENESS
Zina Trost, MS,2,1 Christopher R. France, PhD2 and James S.
Thomas, PhD3
1
Rehabilitatoin Psychology, University of Washington Medical
Center, Seattle, WA; 2Psychology, Ohio University, Athens, OH
and 3Department of Physical Therapy, Ohio University, Athens,
OH.
Pain-related fear has been found to be predictive of disability
at acute, subacute and chronic stages of back pain. Further, fear
may play an important role in the development of chronic pain
and disability through exaggerated perception of threat dur-
ing movement and the maladaptive maintenance of defensive
movement strategies. The current study examined patterns of
movement and pain/harm appraisal in healthy college students
asked to complete a standardized reaching task both prior
to and following induction of Delayed Onset Muscle Sore-
ness (DOMS) to the lower back. Participants were classified as
“high” versus “low fear” based on their responses to the Tampa
Scale of Kinesiophobia. At each reaching trial, participants rated
predicted pain and potential harm/injury using a visual analog
scale. Movements of the lumbar and thoracic spine were re-
corded using Vicon motion capture technology. In comparison
to low fear participants, high fear participants predicted greater
pain and potential harm/injury following DOMS induction
but not during initial baseline testing. In contrast to low fear
counterparts, high fear participants showed a pattern of increas-
ing kinematic caution across trials during the Baseline testing
session, as evidenced by gradually decreasing lumbar flexion. A
similar pattern was observed for thoracic spine flexion, irrespec-
tive of testing session. To our knowledge this is the first study
to identify the impact of pain-related fear in a healthy sample
following experimental acute low back injury, suggesting
that maladaptive psychological and physical processes occur
early in the injury process. The findings have both clinical and
theoretical implications, discussed in the context of the fear-
avoidance model of back pain.
CORRESPONDING AUTHOR: Zina Trost, MS, Rehabilitatoin
Psychology, University of Washington Medical Center, Seattle,
WA, 98112; zinaidat@gmail.com
D-107c
HEADACHE CHARACTERISTICS DIFFER BY RACE, SES, AND
PSYCHIATRIC COMORBID CONDITIONS IN PATIENTS WITH
MIGRAINE DISORDERS
Bernadette D. Heckman, PhD, Kristin Lewis, MA, Rewadee
Watakakosol, MA, Christina Wei, MA and Nicole Campbell,
MA
Psychology, Ohio University, Athens, OH.
Objectives: To determine how headache characteristics (e.g.,
headache frequency, severity, and disability) vary by race, SES,
and psychiatric comorbid conditions in patients with severe
migraine disorders.
Design: Cross-sectional design, data collected via self-report
surveys and daily diaries.
Methods: Participants were 215 patients receiving treatment in
headache specialty treatment clinics in Cleveland, Cincinnati,
Columbus, and Toledo, OH. Most patients were Caucasian/
non-Hispanic (61%) and female (89%). Thirty-four percent
(34%) of patients had no psychiatric condition, 24% were
diagnosed with major depressive disorder (MDD), 17% were
diagnosed with one or more anxiety disorders, and 25% were
diagnosed with both MDD and one or more anxiety disorders.
The modal headache diagnosis among patients was episodic
migraine without aura (54%). Patients provided data through
self-administered surveys completed in headache clinics and
30-day daily diaries completed at home prior to initiating new
acute and preventive headache treatments. SES was calculated
using a composite score based on education and annual income
and dichotomized at the median (i.e., low SES, high SES).
Results: Of the three independent variables examined, SES and
psychiatric comorbidity had the strongest relationships with
headache characteristics; the role of race was less apparent.
Based on 30-day daily diary data, lower SES and the presence of
any psychiatric condition were associated with more frequent
and disabling headaches (p < .05) while African Americans
experienced more severe headaches than whites (p < .05). The
lowest quality of life levels were found in low SES patients and
patients who had been diagnosed with MDD or MDD+anxiety.
Implications: Psychiatric disorders are highly prevalent in
migraine patients. Migraine patients of low SES and with psy-
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
improve their overall quality of life.
CORRESPONDING AUTHOR: Bernadette D. Heckman, PhD,
Ohio University, Athens, OH, 5701; heckmanb@ohiou.edu
D-124a
YOUTH PHYSICAL ACTIVITY INTERVENTIONS: AN
ECOLOGICAL PERSPECTIVE
Cynthia K. Perry, PhD,1 Sandra Christensen, BA2 and Laura L.
Hayman, PhD2
1
Family and Child Nursing, University of Washington, Seattle,
WA and 2College of Nursing and Health Sciences, University of
Massachusetts Boston, Boston, MA.
Background: Changing physical activity behavior is a complex
process that involves intermediary outcomes across more than
one ecological domain. Purpose: An ecological framework
was used to review and summarize results of physical activ-
ity interventions targeting youth aged 11-18 that measured
primary outcome of physical activity and intervening outcomes,
such as behavioral intentions. Methods: A systematic search of
pubmed, CINHAL, PSYCINFO databases from the years 1977
through 2009 was conducted using key terms of physical activ-
ity, youth, adolescent, and exercise. Results: Based on titles, 855
abstracts were reviewed; 143 papers were examined resulting
in 24 published reports on 17 interventions that met our criteria.
Strategies within the ecological domains of intrapersonal, fam-
ily, socio-cultural, environmental, and policy were examined.
All 17 interventions employed strategies aimed at intrapersonal
domain, five aimed at the family domain, and five aimed at en-
vironmental domain. Seven of the nine interventions aimed at
intrapersonal domain only demonstrated increases in physical
activity. Three of the five interventions aimed at intrapersonal,
family and environmental domains demonstrated increases
in physical activity for both genders; one showed increase in
physical activity with girls only and another one with boys
only. One intervention aimed at intrapersonal and environ-
mental domains that targeted both genders showed increased
physical activity with boys but not girls and one targeting only
girls showed an increase in physical activity in girls. The one in-
tervention aimed at intrapersonal and family domains showed
no increase in physical activity. Studies used different designs,
approaches to measuring change in physical activity, and thor-
oughness of reporting results in response to the intervention,
making it difficult to quantitatively compare across studies.
Conclusions: The collective results suggest the importance of
targeting ecological domains beyond the individual level.
CORRESPONDING AUTHOR: Cynthia K. Perry, PhD, Fam-
ily and Child Nursing, University of Washington, Seattle, WA,
98195; perryc@u.washington.edu
D-124b
MEASURED AND SELF-REPORTED NEIGHBORHOOD
CHARACTERISTICS AND PHYSICAL ACTIVITY AMONG
AFRICAN AMERICAN WOMEN
Kristen McAlexander, MA, Rebecca E. Lee, PhD, Scherezade K.
Mama, MPH and Ashley Medina, BS
Texas Obesity Research Center, University of Houston,
Houston, TX.
African American women are vulnerable to physical inactivity
compared to white women. Measured and self-reported neigh-
borhood characteristics may be associated with physical activity
112
(PA), yet few studies have examined these factors among
minority women. The purpose of this study was to investigate
the associations of measured and self-reported neighborhood
characteristics with individual PA. The Pedestrian Environ-
ment Data Scan was completed for 25% of randomly selected
residential street segments within a 400 meter radius of each
participants’ address. African American women (N=262, M
age=44.4 yrs) completed interviewer administered question-
naires assessing self-reported neighborhood characteristics. PA
was measured using the International Physical Activity Ques-
tionnaire (IPAQ) long (M MET minutes/week=2519) and accel-
erometry (M MVPA=19.0 min/day). Most women were obese
(N=176, 67.2%; M BMI= 34.0). IPAQ PA was not associated with
accelerometer PA. Bivariate correlations suggested relationships
between greater measured pedestrian facility density and more
IPAQ transportation PA , greater reported pedestrian facil-
ity density and more IPAQ leisure time PA, greater reported
bicycle facility density and more IPAQ moderate PA and IPAQ
total PA (ps<.05). Simultaneous ecological multiple regression
models demonstrated that reported pedestrian facility density
(Beta=.138, t=2.181) and body fat percentage (Beta= -.089, t=
-1.398) were associated with IPAQ leisure time PA (R2=.027;
p=.04), reported bicycle facility density (Beta=.138, t=2.161) was
associated with IPAQ moderate PA (R2=.019; p=.03), and report-
ed bicycle facility density (Beta=.130, t=2.041) was associated
with IPAQ total PA (R2= .017; p=.04). No measured or reported
neighborhood characteristics were associated with accelerom-
eter measured PA. Measured and reported built environment
attributes are significantly associated with self-reported PA but
may be mediated by weight status. Work supported by NIH
1R01CA109403.
CORRESPONDING AUTHOR: Kristen McAlexander, MA,
Health and Human Performance, University of Houston, Hous-
ton, TX, 77204; kp0313@hotmail.com
D-124c
USING PEDOMETERS TO COMPARE THE EFFECTIVENESS
OF SMALL, RELATIVE STEP GOALS VERSUS A 10,000 STEPS
PER DAY GOAL
Emily Steinbaugh, BS,1 Marissa Errickson, BA,1 Lesley D. Lutes,
PhD1 and Tom Raedeke, PhD2
1
Psychology, East Carolina University, Greenville, NC
and 2Exercise and Sport Science, East Carolina University,
Greenville, NC.
Pedometers are shown to be effective tools for increasing physi-
cal activity. However, the type of step goal that would be most
effective in activity promotion remains unknown. While most
research encourages a 10,000 steps per day goal, studies show
that most individuals increase by 2,300 to 3,000 steps a day
above baseline. The present pilot study compared the effective-
ness of a 10,000 steps a day goal versus a small, relative step
goal. Participants were female, obese (BMI M = 32.71, SD =
4.59), middle-aged (age M = 44.52, SD = 9.81), sedentary (steps
per day M = 5253, SD = 2581), predominantly Caucasian (60%)
and African American (37%) university employees (N = 29).
Participants were randomly assigned to either a 10,000 daily
step goal (n = 15) or a small relative step goal where partici-
pants gradually increased step counts to a 3,000 step increase at
treatment completion (n = 14). Participants met weekly for 12
weeks with a lifestyle coach for 15 minutes to plan goal achieve-
ment strategies. Seven meetings were in person and 5 were con-
ducted via phone. Ninety percent of participants completed the
study. The only difference between groups at baseline was level
of education (p = .008). A repeated measures ANOVA showed
a significant main effect of time on step counts (p < .001), but no
step count differences between groups (p = .593). Notably, par-
ticipants in the relative group achieved their step goal increase
of 3,000 steps (relative group: M = +3160, SD = 2610; 10,000
group: M = +2669, SD = 2017) while participants in the 10,000
group did not meet their set goal on average (10,000 group: M =
8645, SD = 2068; relative group: M = 7686, SD = 3096), achieving
10,000 steps less than 30% of the time. While the data is prelimi-
nary, it suggests that both goal types can increase step counts,
but relative step goals result in more consistent goal achieve-
ment.
CORRESPONDING AUTHOR: Emily Steinbaugh, BS, Psychol-
ogy, East Carolina University, Greenville, NC, 27858; eks0613@
ecu.edu
D-124d
EXAMINING PSYCHOSOCIAL OUTCOMES FROM A YOGA
INTERVENTION IN CANCER SURVIVORS
Michael J. Mackenzie, MSc, Nicole Culos-Reed, PhD and
Lynette E. Stephenson, MSc
Faculty of Kinesiology, University of Calgary, Calgary, AB,
Canada.
Background: Preliminary research indicates yoga’s value as a
clinical intervention for managing cancer-related symptoms,
including sleep, mood, stress and quality of life. The purpose of
the present study was to examine whether a 7-week therapeu-
tic yoga program for cancer survivors had beneficial effects on
mindfulness, mood and stress.
Method: 108 eligible participants were pre-screened with PAR-
Q/PAR-MED-X. Demographic information, Mindful Attention
Awareness Scale (MAAS), Profile of Mood States (POMS), and
Symptoms of Stress Inventory (SOSI) were completed pre and
post intervention.
Analyses include descriptive statistics, correlations, and t-tests
examining pre-post differences.
Results: Therapeutic yoga program participants included
mostly females (86%), primarily breast cancer survivors (53%),
on average 35 months post cancer diagnosis (range from 1-20
years). The average age of the participants was 52 years, and
most were married (72%).
Results for the intervention completers (those who had both
pre and post-test scores) indicated significantly higher scores in
mindfulness (t(104)=-2.7, p<.01) and significantly lower scores
in both mood disturbance (t(107)=12.9, p<.01) and stress symp-
toms (t(107)=4.4, p<.01). The effect sizes ranged from small
(mindfulness) to large (mood).
Conclusions: Therapeutic yoga for cancer survivors was effec-
tive in increasing mindfulness and decreasing mood distur-
bance and stress symptoms in a heterogeneous group of cancer
survivors. These findings suggest yoga has significant potential
and should be further explored as a beneficial physical activity
option for cancer survivors.
CORRESPONDING AUTHOR: Nicole Culos-Reed, PhD, Fac-
ulty of Kinesiology, University of Calgary, Calgary, AB, T2N
1N4; nculosre@ucalgary.ca
D-124e
MOTIVATIONS ASSOCIATED WITH REGULAR PHYSICAL
EXERCISE IN PREMENOPAUSAL BREAST CANCER
SURVIVORS
Patricia Voege, MA,1 Julienne E. Bower, PhD,1 Annette Stanton,
PhD1 and Patricia A. Ganz, MD2
1
Dept of Psychology, University of California, Los Angeles,
CA and 2School of Public Health, University of California, Los
Angeles, CA.
There is growing evidence that regular physical activity is
associated with reduced risk of breast cancer recurrence and
mortality. However, many breast cancer survivors fall well
below current physical activity guidelines. Thus, identification
of determinants of physical activity in this population is impor-
tant. The current study was designed to examine motivations
for physical activity in women diagnosed with premenopausal
breast cancer, focusing specifically on approach (e.g., exercis-
ing for health or enjoyment) and avoidance (e.g., exercising
to prevent a breast cancer recurrence) motivations. Drawing
from self-determination theory and the health belief model, we
hypothesized that both types of motivations would be associ-
ated with higher activity levels. We also examined demographic
(age), disease-related (time since diagnosis, type of treatment
received), and psychosocial factors (depressive symptoms,
perceived stress, fatigue, social support) that have been associ-
ated with physical activity in previous research. Women (n =
147) who had been diagnosed with early-stage, premenopausal
breast cancer, completed their primary cancer treatments, and
were currently disease free completed self-report measures to
assess leisure-time physical activity, motivations for physical
activity, and other factors. Women were 48 years old on average
and had been diagnosed 3.28 years previously. Consistent with
predictions, approach motivations were associated with higher
levels of physical activity (p < .01); however, avoidance motiva-
tions were not (p = .35). Among the other variables assessed,
only fatigue was significantly associated with activity level,
with greater fatigue associated with lower levels of physical
activity (p < .05). These findings highlight the importance of ap-
proach motivations as a correlate of physical activity in younger
breast cancer survivors, and suggest that increasing the wom-
en’s enjoyment of exercise may be key for increasing physical
activity in this population.
CORRESPONDING AUTHOR: Patricia Voege, MA, Dept of
Psychology, UCLA, Los Angeles, CA, 90095-1563; patricia.
voege@gmail.com
D-124f
USING DECISIONAL BALANCE SHEET TO MOTIVATE OLDER
ADULTS ENGAGE IN PHYSICAL ACTIVITY
Karly S. Geller, PhD,1 Jasah Timbobolan, student,2 Ilora D.
Mendoza, student,2 Claudio R. Nigg, PhD2 and Holly L.
Montjoy, BS, MED (pending)3
1
Cancer Research Center of Hawaii, Honolulu, HI; 2University
of Hawaii, Honolulu, HI and 3East Carolina University,
Greenville, NC.
PURPOSE: This pilot study examined the effectiveness of a
decisional balance intervention tailored to increase the lifestyle
physical activity of older adults. DESIGN AND METHODS:
We randomized older adult participants (>50 years old) to a
decisional balance lifestyle physical activity intervention or an
113
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
attention comparison group. Participants were recruited from
an Elderly Hall, representing a diverse population in Hawaii
(39% Filipino, 75% female) with a mean Body Mass Index
(BMI) slightly overweight (27.48). We examined intervention
effectiveness in promoting physical activity behavior using the
International Physical Activity Behavior Questionnaire (IPAQ)
among the 8 adults (9 control participants) who completed the
6-week program. The lifestyle physical activity intervention led
participants through completion of a decisional balance sheet,
discussing participants’ perceptions regarding the gains, losses,
approvals and disapprovals associated with their daily activity
levels. RESULTS: At follow-up, both groups’ moderate physi-
cal activity demonstrated improvements, with the 9 attention
control participants increasing by 147 weekly minutes. On the
other hand, the 8 intervention participants demonstrated a
superior improvement with just under a 3-fold increase, specifi-
cally improving from 116 daily minutes of moderate physical
activity to 329 minutes. IMPLICATIONS: Results indicate that a
decisional balance intervention is effective in increasing elderly
adults’ moderate physical activity. Given the lack of research
among older adults, this study offers preliminary evidence for
further evaluations, which are recommended in a larger, more
diverse sample.
CORRESPONDING AUTHOR: Karly S. Geller, PhD, Cancer
Research Center of Hawaii, Honolulu, HI, 96822; kgeller@crch.
hawaii.edu
D-128a
MATERNAL ACCULTURATION, STRESS, AND SUPPORT
AFFECT PREGNANCY OUTCOME VIA NEURAL-IMMUNE
PATHWAYS
Mary Coussons-Read, PhD,1 Marci Lobel, PhD,2 Marianne
Kreither, MA1 and Courtney Cage, BS1
1
Psychology and Health and Behavioral Science, University of
Colorado Denver, Denver, CO and 2Psychology, Stony Brook
University, Stony Brook, NY.
Growing evidence shows that that elevated stress during
pregnancy may increase the risk of preterm delivery and other
pregnancy and birth complications. Neuroendocrine, immune,
inflammatory, and cardiovascular factors have been suggested
as possible mediators of the relationship between stress and
birth outcomes, and recent data suggest that stress-related
changes in inflammatory markers may contribute to these ef-
fects. Work in our laboratory has focused on quantifying the
effects of perceived stress and social support on pregnancy out-
come and the degree to which neural-immune interactions may
be involved in these effects. The present study is focused on
the role of maternal ethnicity and acculturation in the impact of
stress on pregnancy, and on the role of catecholamines in these
relationships. Elevated proinflammatory cytokines were lower
levels of support and higher stress throughout pregnancy, and
higher social support was associated with higher levels of anti-
inflammatory cytokines late in pregnancy. Moreover, elevated
inflammatory markers were related to higher pregnancy-specif-
ic distress early in gestation, as well as lower 1-minute APGAR
scores, lower gestational age at birth, and increased occurrence
of birth complications including meconium aspiration, nuchal
cord, and asphyxia. Elevations in catecholamines were related
to these changes in inflammatory cytokines, as well as with
poor pregnancy outcome. Finally, higher maternal acculturation
114
was related to not only more pregnancy complications but to
lower familial social support during pregnancy. Together, these
studies indicate that psychosocial factors are related to increases
in inflammatory mediators and subsequently, increased risk of
pregnancy complications and untoward birth outcomes.
CORRESPONDING AUTHOR: Mary Coussons-Read, PhD,
Psychology, University of Colorado Denver, Denver, CO,
80217-3364; Mary.Coussons-Read@ucdenver.edu
D-133a
THE INFLUENCE OF ACCULTURATION AND SEXUAL RISK
BEHAVIORS ON CERVICAL CYTOLOGY IN A HISPANIC
POPULATION
Kristy K. Ward, MD, Angelica M. Roncancio, PhD and Carmen
R. Breitkopf, PhD
OB/GYN, University of Texas Medical Branch, Galveston, TX.
Hispanic women have the highest incidence of cervical cancer
in the United States. Understanding the role of acculturation
may help identify those most at risk for cervical cancer. We pre-
dicted that level of acculturation serves as a mediator of engag-
ing in sexual risk behaviors and cervical cytologic abnormali-
ties. Specifically, highly acculturated Hispanic women are more
likely to have an abnormal Pap test result because they engage
in more risky sexual behavior than less acculturated Hispanic
women. Structural equation modeling (SEM) was employed
to test the model. Participants were Hispanic women 18 to 55
years of age (mean = 30.5 ± 8.32) attending UTMB regional clin-
ics. The women underwent routine Papanicolaou (Pap) testing
and completed a comprehensive survey (N=3149). Results indi-
cate that, as predicted, highly acculturated women engaged in a
greater number of sexual risk behaviors and were more likely to
have an abnormal Pap test when compared to less acculturated
Hispanic women (p < .001). The incorporation of acculturation
as part of culturally competent healthcare will aid in the pre-
vention of cervical cancer among Hispanic women.
CORRESPONDING AUTHOR: Angelica M. Roncancio, PhD,
OB/GYN, University of Texas Medical Branch, Galveston, TX,
77555; anroncan@utmb.edu
D-143a
SMOKING MENTHOL CIGARETTES AND THE CESSATION
PROCESS ACROSS RACIAL/ETHNIC GROUPS IN THE U.S
Dennis R. Trinidad, PhD MPH,1 Eliseo J. Perez-Stable, MD,2
Karen Messer, PhD,3 Martha M. White, MS3 and John P. Pierce,
PhD3
1
Claremont Graduate University, San Dimas, CA; 2University of
California, San Francisco, San Francisco, CA and 3University of
California, San Diego, San Diego, CA.
Background. Smoking mentholated cigarettes may affect the
smoking cessation process across various racial/ethnic groups
but relatively little research has been published.
Methods. A secondary data analysis of the combined 2003 and
2006-07 Tobacco Use Supplements to the Current Population
Survey was conducted to examine how smoking cessation is
affected by the use of mentholated cigarettes and how this dif-
fers across African American, Asian American/Pacific Islander,
Hispanic/Latino, Native American, Non-Hispanic White adults
in the U.S.
Results. Smoking mentholated cigarettes was significantly less
predictive of being quit for at least 6 months than smoking non-
menthols for all racial/ethnic groups except Native Americans/
Alaska Natives (African Americans: OR=0.24, 95% CI: 0.17 -
0.32; Asian Americans/Pacific Islanders: OR=0.22, 95% CI: 0.11
- 0.45; Hispanics/Latinos: OR=0.48, 95% CI: 0.34 - 0.69; Native
Americans/Alaska Natives: OR=0.52, 95% CI: 0.15 - 1.78; Non-
Hispanic Whites: OR=0.28, 95% CI: 0.25 - 0.32). African Ameri-
cans and Hispanics/Latinos who smoked mentholated ciga-
rettes were significantly more likely think they would have quit
smoking in the next 6 months compared to those who smoked
non-mentholated cigarettes (African Americans: OR=1.82, 95%
CI: 1.56 - 2.14; Hispanics/Latinos: OR=1.21, 95% CI: 1.03 - 1.43;).
This was not found among Asian Americans/Pacific Islanders,
Native Americans/Alaska Natives and Non-Hispanic Whites.
Conclusion. Smoking mentholated cigarettes is significantly
less predictive of long-term quitting success than smoking
non-mentholated cigarettes and belies the sense of confidence it
engenders in future quitting success among African American
and Hispanic/Latino smokers.
CORRESPONDING AUTHOR: Dennis R. Trinidad, PhD MPH,
Claremont Graduate University, San Dimas, CA, 91773; dennis.
trinidad@cgu.edu
D-143b
INFORMATION-SEEKING BEHAVIORS AND THE USE OF
EMERGING TECHNOLOGIES FOR BEHAVIOR CHANGE: THE
NATIONAL CANCER INSTITUTE “H.I.N.T.S.” AT WOMEN.
SMOKEFREE.GOV
Alison M. Pilsner, MPH, CPH, CHES,1,2 Abdul R. Shaikh, PhD,
MHSc1 and Richard P. Moser, PhD2
1
DB Consulting Group, Inc., Silver Spring, MD and 2National
Cancer Institute (NIH), Bethesda, MD.
The Internet has transformed many spheres of society and has
enabled us to communicate and cultivate relationships that
would not have been possible otherwise. The launch of social
networking sites has created a new phenomenon where users
are changing from consumers to information generators. As
Internet access proliferates, more people are turning to comput-
ers for health information. Different populations experience
varied access to health-related information and face greater
language and educational barriers to obtaining health-related
information. Data from the 2007 Health Information National
Trends Survey (HINTS) at the National Cancer Institute (NCI)
was used to explore health information-seeking and internet
usage among respondents according to ethnicity, language,
and birth status. Among self-identified Latinos, 38% reported
using the Internet compared to 71% of non-Latinos (p=.000).
16% of Spanish-speaking Latinos used the Internet or email
compared to 69% of English-speaking Latinos (p=.000), and 66%
of US-born compared to 21% of those foreign-born (p=.000).
Despite the disparity, among those who did use the Internet,
the opposite trend was found in the use of online support
networks; less acculturated subgroups utilized these networks
to a greater extent. Given that 46% of online Americans are on
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
effectiveness of these emerging technologies, the Internet has
created a fundamental shift in the way we communicate and
provides unlimited potential for disseminating health promo-
tion messaging. Data from the SFW project can help inform
future efforts targeted at “hard-to-reach” groups.
CORRESPONDING AUTHOR: Alison M. Pilsner, MPH, CPH,
CHES, DB Consulting Group / National Cancer Institute, Silver
Spring, MD, 20910; apilsner@dbconsultinggroup.com
D-143c
AGE DIFFERENCES IN TREATMENT OUTCOME AND
MOTIVATIONS TO QUIT SMOKING
Mary A. Gerend, PhD, Nicole Collins, BA, Natalie Sachs-
Ericsson, PhD, Chris Blagg, BA, Mike Mallott, MA, Hannah
Mills, BA and Brad Schmidt, PhD
Florida State University, Tallahassee, FL.
Background: Smokers seeking treatment may present with
different challenges, and different motives for quitting. One
factor that may motivate older adults to quit more than younger
adults is that older adults tend to experience greater smoking-
related health problems. The current study evaluated whether
older adults would respond more favorably to a smoking
cessation treatment intervention, and whether this age effect is
mediated by the presence of current health problems.
Method: We compared older (≥ age 55) and younger smokers
enrolled in a 12 session cognitive-behavioral smoking cessation
program (N=84) on smoking history variables, nicotine depen-
dence, current health problems, and smoking outcomes one
month post treatment.
Results: Although at baseline older smokers smoked more
cigarettes per day and were more nicotine dependent than
younger smokers, older smokers were significantly less nicotine
dependent than younger smokers at one-month follow-up and
no longer smoked more cigarettes than younger adults. Older
smokers also had higher rates of one-month abstinence than
younger smokers. Among participants who relapsed, older
adults waited longer than younger adults to smoke their first
cigarette of the day. This greater treatment efficacy among older
adults may have been motivated by the presence of more health
problems: older smokers were more likely to report health
problems than younger smokers, and when present illness was
entered in the analysis, age was no longer related to decreased
nicotine dependence at follow-up.
Conclusions: Despite higher nicotine dependence at baseline,
older adults had better treatment outcomes than younger adults
one month post treatment. These positive outcomes may reflect
the fact that smoking-related health problems motivate older
adults to quit. Findings suggest that smoking cessation pro-
grams should be tailored to smokers’ motivations for quitting,
which for older adults may reflect the presence of smoking-
related health problems.
CORRESPONDING AUTHOR: Mary A. Gerend, PhD, Florida
State University College of Medicine, Tallahassee, FL, 32306-
4300; mary.gerend@med.fsu.edu
115
31st Annual Meeting & Scientific Sessions
Behavioral Medicine: Building for the Future — April 7-10, 2010
D-143d
SMOKING PREVALENCE AMONG CANADIANS AS THEY
TRANSITION FROM ADOLESCENCE TO YOUNG ADULTHOOD
Matthew Y. Kwan, MSc,1 John Cairney, PhD2 and Guy Faulkner,
PhD1
1
Exercise Sciences, University of Toronto, Toronto, ON, Canada
and 2McMaster University, Hamilton, ON, Canada.
Smoking continues to be a critical public health issue (CDC,
2005). However, little research has been undertaken to under-
stand smoking behaviours around the transition from adoles-
cence to young adulthood. While there is evidence to suggest
that smoking initiation typically begins prior to this transition
(Rigotti et al., 2000), much of the research has been around the
collegiate population (e.g., Cairney & Lawrence, 2002). It must
also be recognized that a large proportion of young adults
do not choose to attend post-secondary (PS) institutions. The
purpose of this study is to use national, multi-wave panel data
to consider smoking prevalence of Canadian adolescences as
they transition into young adulthood, comparing smoking
behaviours for individuals who do, to those who do not, transi-
tion into PS education. Using the National Population Health
Survey, a representative sample of Canadian adolescents (N=
667, Mage = 13.58 +.89, at wave 1) were measured up to 7 times
biannually. Results indicated that there were significant differ-
ences in smoking behaviours (X2= 7.49-19.55, ps < .007), with
non- PS attendees having higher prevalence of smokers, than PS
attendees. Logistic regression models, controlling for baseline
age and gender, also confirmed PS attendance being a signifi-
cant predictor of smoking, with attendees being a half to two-
thirds less likely to smoke (ORs= 0.34-0.48, ps <.007). Overall,
these findings indicate that smoking prevalence differs based
on educational trajectory, with smoking being more common
among Canadians not transitioning into PS throughout their
adolescence and young adulthood. The implications are that
smoking prevention strategies need to be tailored for specific
subpopulations of adolescents, with greater emphasis on those
less likely to attend PS institutions.
CORRESPONDING AUTHOR: Matthew Y. Kwan, MSc, Exer-
cise Sciences, University of Toronto, Toronto, ON, M5S2W6;
matty.kwan@utoronto.ca
D-151a
PSYCHOSTIMULANT USE BEYOND COLLEGE:
EXPECTATIONS AND MOTIVES FOR FUTURE USE AMONG
COLLEGE STUDENTS AND RECENT GRADUATES
Brynne Underhill, Bachelor of Science in Spring 2010 and Susan
Langdon, Ed D
Psychology, Bates College, Lewiston, ME.
Although the licit and illicit use of psychostimulants is wide-
spread on college campuses and is well documented, continu-
ance of use beyond college is not well understood. This study
surveyed 96 junior and senior undergraduates and 337 recent
graduates on their previous, current, and planned future use
of psychostimulants. Prevalence of licit use was 6% and 3%
for undergraduates and alumni respectively. Illicit use was
significantly different for undergraduates (37%) and alumni
(11%). Continued licit and illicit use by alumni was significantly
greater than the undergraduate’s predicted continued use. The
motives for continued or discontinued use differed depending
on type of user (licit/illicit), gender, and frequency of use. Users
116
gave higher endorsement to motives to continue use than non-
users, while there were no significant differences by user status
on motives to discontinue use. Further, motives for continued
use differed significantly by employment status for alumni,
with the unemployed having the highest scores. It is evident
from this study that a large number of users continue their use
after college, but longitudinal studies are needed to provide
more information on how long alumni use ADHD medications
after college and whether long-term use of psychostimulants is
safe.
CORRESPONDING AUTHOR: Brynne Underhill, Bachelor of
Science in Spring 2010, Bates College, Jamestown, RI, 02835;
bunderhi@bates.edu
D-151b
NFL DISSEMINATION OF SCHOOL-BASED DRUG
PREVENTION PROGRAMS: TRAINING & TAILORING
EFFECTS
Diane L. Elliot, MD, Linn Goldberg, MD, Esther L. Moe, PhD,
MPH, Michelle H. Otis, BS and Erica T. Perrier, MS
Medicine, Oregon Health & Science University, Portland, OR.
Translating health promotion programs into widespread use is
a challenge, and little data guides the process. We prospectively
assessed diffusion of the evidence-based, high school sport
team-centered drug prevention programs ATLAS and ATHE-
NA in 45 schools. A contract from the National Football League
(NFL) Youth Football Fund underwrote implementing these
programs in schools from 12 NFL franchises during two school
years (2007-2009). Coaches and student leaders were invited to
attend one-day trainings and provided program materials. Fol-
low-up school visits were conducted to interview faculty and
assess program implementation; student participants completed
anonymous surveys after completing the programs. Descriptive
information was compiled, and student outcomes for different
settings were assessed. Although designed for extracurricular
sport team use, approximately one-quarter of schools moved
the curricula to an established health or physical education
class. Results revealed: 1) onsite training was a critical imple-
mentation component, as coaches not attending were unlikely
to use the programs, despite their scripted format and well
designed instructional DVDs; 2) sustaining programs required
a strong local advocate and coaches who were teachers at the
school; 3) classroom settings were more likely to be sustained
possibly due to greater turbulence in the team format’s fund-
ing and personnel; 4) both settings achieved positive outcomes
in targeted domains; and 5) comparing the team (n=2242) and
classroom (n=857) indicated positive self-reported behaviors
and abilities were significantly more robust for the team setting
(e.g., p<0.001 for alcohol use, healthy nutrition, media influence
and resistance skills). These findings add to understanding a
translational model that incorporates implementer character-
istics, personnel training, and setting. Results guide balancing
implementation choices, effectiveness and sustainability when
moving science to real-world use.
CORRESPONDING AUTHOR: Diane L. Elliot, MD, Medicine,
Oregon Health & Science University, Portland, OR, 97239; el-
liotd@ohsu.edu
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