Behavioral activation for smoking cessation and mood management following a cardiac event: results of a pilot randomized controlled trial

Background: Smoking cessation following hospitalization for Acute Coronary Syndrome (ACS) significantly reduces subsequent mortality. Depressed mood is a major barrier to cessation post-ACS. Although existing counseling treatments address smoking and depression independently in ACS patients, no integrated treatment addresses both. We developed an integrated treatment combining gold standard cessation counseling with behavioral activation-based mood management; Behavioral Activation Treatment for Cardiac Smokers (BAT-CS). The purpose of this pilot randomized controlled trial was to test feasibility, acceptability, and preliminary efficacy of BAT-CS vs. Standard of Care (SC). Methods: Participants were recruited during hospitalization for ACS and were randomly assigned to BAT-CS or SC. The nicotine patch was offered in both conditions. Smoking, mood, and stress outcomes were collected at end-of-treatment and 24-week follow-up. Results: Fifty-nine participants (28 BAT-CS, 31 SC) were recruited over 42 weeks, and assessment completion was above 80% in both conditions. Treatment acceptability and fidelity were high. At 24 week follow-up adjusted odds ratios favoring BAT-CS were 1.27 (95% CI: 0.41–3.93) for 7-day point prevalence abstinence and 1.27 (95% CI: 0.42–3.82) for continuous abstinence. Time to first smoking lapse was significantly longer in BAT-CS (62.4 vs. 31.8 days, p = 0.03). At 24-weeks, effect sizes for mood and stress outcomes ranged from η2 of.07–.11, with significant between treatment effects for positive affect, negative affect, and stress. Conclusions: The design of this study proved feasible and acceptable. Results provide preliminary evidence that combining behavioral activation with standard smoking cessation counseling could be efficacious for this high risk population. A larger trial with longer follow-up is warranted. Trial registration: NCT01964898. First received by clinicaltrials.gov October 15, 2013

Effect of a moderate-intensity demonstration walk on accuracy of physical activity self-report.

Background/Objective:Providing a demonstration of a 10-minute bout of moderate-to-vigorous intensity physical activity (MVPA) immediately prior to subjective reporting of MVPA could influence self-reported activity by calibrating both duration and intensity. We assessed the effect of a demonstration of MVPA on subsequent MVPA recall, and explored whether this improved agreement with objective measures of MVPA. Methods:A total of 846 individuals participated in four different physical activity interventions; two of which included a 10-minute moderate-intensity demonstration walk on a treadmill at baseline and 6-month visits immediately prior to reporting MVPA. Participants from three studies also wore accelerometers during the week overlapping with self-reported MVPA. Results:Overall, those completing the demonstration walk reported significantly fewer minutes of MVPA per week at baseline (b = -11.69, standard error = 2.53, p < 0.01). The effect of the demonstration walk at 6 months was not significant (p = 0.06). Correlations with accelerometers at baseline were higher in the two studies with the demonstration walk (ρ = 0.28, 0.26) than the study without (ρ = 0.04). Correlations with accelerometers increased overall from baseline to follow-up. Conclusion:A 10-minute demonstration of MVPA was associated with reporting fewer minutes of MVPA and improved agreement with objective PA measures at baseline. These findings support combining self-report PA assessments with hands-on MVPA demonstrations

The relationship of psychosocial factors to mammograms, physical activity, and fruit and vegetable consumption among sisters of breast cancer patients

This study examined the relationship of psychosocial factors to health-promoting behaviors in sisters of breast cancer patients. One hundred and twenty sisters of breast cancer patients completed questionnaires assessing response efficacy of mammography screenings, physical activity, and fruit and vegetable consumption on decreasing breast cancer risk, breast cancer worry, involvement in their sister’s cancer care, mammography screenings, physical activity, and fruit and vegetable consumption. Results indicate that greater perceived effectiveness for mammograms was associated with a 67% increase in odds of yearly mammograms. Greater involvement in the patient’s care was associated with a 7% decrease in odds of yearly mammograms. Greater perceived effectiveness for physical activity was significantly related to greater physical activity. There was a trend for greater perceived effectiveness for fruits and vegetables to be associated with consuming more fruits and vegetables. Breast cancer worry was not significantly associated with the outcomes. While perceived effectiveness for a specific health behavior in reducing breast cancer risk was consistently related to engaging in that health behavior, women reported significantly lower perceived effectiveness for physical activity and fruits and vegetables than for mammograms. Making women aware of the health benefits of these behaviors may be important in promoting changes

The longitudinal, bidirectional relationships between parent reports of child secondhand smoke exposure and child smoking trajectories

This study examines the longitudinal relationships between child smoking and secondhand smoke exposure (SHSe). Participants were 222 parent–child dyads. The parents smoked, had a child with (48%) or without asthma, and were enrolled in a smoking/health intervention. Parent-reported child SHSe was measured at baseline and 4, 6, and 12-month follow-ups; self-reported child smoking was assessed at these points and at 2-months. A parallel process growth model was used. Baseline child SHSe and smoking were correlated (r = 0.30). Changes in child SHSe and child smoking moved in tandem as evidenced by a correlation between the linear slopes of child smoking and SHSe (r = 0.32), and a correlation between the linear slope of child smoking and the quadratic slope of child SHSe (r = − 0.44). Results may inform interventions with the potential to reduce child SHSe and smoking among children at increased risk due to their exposure to parental smoking.</p

Physical activity interventions and changes in perceived home and facility environments

To examine changes in environmental perceptions over time and associations between changes in perceptions and physical activity among participants in two physical activity interventions

Age Moderates the Effect of Self-Paced Exercise on Exercise Adherence among Overweight Adults

Objective: The present study tested the hypothesis that the effect of self-paced exercise on adherence to exercise programs is more pronounced with increasing age. Method: Fifty-nine low-active overweight adults (18-65 years) were encouraged to walk 30 to 60 min/day and randomized to either self-paced (n = 30) or prescribed moderate-intensity (n = 29) conditions. Results: The effect of study condition was moderated by age (main effect: b = 6.14, SE = 2.54, p = .02; Condition × Age: b = −11.55, SE = 3.77, p \u3c .01), such that among participants \u3e50 years, those in the self-paced condition exercised 6 more min/day than participants in the prescribed moderate-intensity condition (p = .02), whereas among participants \u3c50 \u3eyears, those in the self-paced condition exercised 5.4 fewer min/day compared with those in the moderate-intensity condition (p = .05). Affective response to physical activity did not mediate the moderating effect of age. Discussion: As age increases, adults may be more likely to adhere to self-paced versus prescribed moderate-intensity exercise

Impact of Baseline BMI upon the Success of Latina Participants Enrolled in a 6-Month Physical Activity Intervention

High rates of obesity in Latinas highlight the need to determine if physical activity interventions are equally effective across the body mass index (BMI) range. Thus, this study assessed how BMI impacts success of Spanish-speaking Latinas in a culturally and linguistically adapted theory-based physical activity intervention (N = 45). Longitudinal regression models tested the relationship between baseline BMI and outcomes. Overall, a trend for a negative association was found between baseline BMI and self-reported physical activity and theoretical constructs targeted by the intervention over time. For example, someone with a 25 kg/m2 BMI would report, on average, 27.5 more minutes/week of activity compared to someone with a 30 kg/m2 BMI at followup. Furthermore, higher baseline BMI was significantly associated with lower self-efficacy, behavioral and cognitive processes of change, and family social support over time. These findings suggest that participants with higher BMI may need additional intervention to promote physical activity

Affective response as a mediator of the association between the physical and social environment and physical activity behavior

Perceptions of the physical and social environment have been shown to be predictive of physical activity (PA) behavior. However, the mechanisms of this association have not been examined. Affective response to PA was examined as a putative mediator of the association between perceptions of the PA environment and subsequent PA behavior. As part of a PA promotion study, 59 low-active overweight or obese but otherwise healthy adults completed real-time assessments of the perceived physical and social PA environment, affective response to PA, and PA behavior over a 6-month period. As hypothesized, decreased latency to and greater duration of subsequent PA was predicted by engaging in PA with a partner (b = 17.24, SE = .45, p \u3c .01), engaging in PA outdoors versus indoors (b = 3.70, SE = 0.67, p \u3c .01), and perceived pleasantness of the physical (b = 0.59, SE = .17, p \u3c .01) and social settings (b = 0.68, SE = .16, p \u3c .01). Affective response to PA (a shift toward feeling good versus bad during PA) mediated the association between engaging in PA with a partner (a path: 0.53(.11), p \u3c .01, b path: 0.42(.12), p \u3c .01, ab path: 0.22(.08), 95% CI .09–.41) and perceived pleasantness of the physical (a path: .38(.02), p \u3c .01; b path: .65(.23), p = .01; ab path: .25(.09), 95% CI .08–.43) and social setting (apath: .35(.02), p \u3c .01; b path: .57(.23), p = .01; ab path: .20(.08), 95% CI .03–.37) and PA behavior, but not the association between engaging in PA outdoors versus indoors and PA behavior. These findings suggest that perceived environmental variables may have their effects on PA through the process of psychological hedonism

Pasos Hacia La Salud: a randomized controlled trial of an internet-delivered physical activity intervention for Latinas.

BackgroundInternet access has grown markedly in Latinos during the past decade. However, there have been no Internet-based physical activity interventions designed for Latinos, despite large disparities in lifestyle-related conditions, such as obesity and diabetes, particularly in Latina women. The current study tested the efficacy of a 6-month culturally adapted, individually tailored, Spanish-language Internet-based physical activity intervention.MethodsInactive Latinas (N = 205) were randomly assigned to the Tailored Physical Activity Internet Intervention or the Wellness Contact Control Internet Group. Participants in both groups received emails on a tapered schedule over 6 months to alert them to new content on the website. The primary outcome was minutes/week of moderate to vigorous physical activity (MVPA) at 6 months as measured by the 7-Day Physical Activity Recall; activity was also measured by accelerometers. Data were collected between 2011 and 2014 and analyzed in 2015 at the University of California, San Diego.ResultsIncreases in minutes/week of MVPA were significantly greater in the Intervention Group compared to the Control Group (mean difference = 50.00, SE = 9.5, p &lt; 0.01). Increases in objectively measured MVPA were also significantly larger in the Intervention Group (mean differences = 31.0, SE = 10.7, p &lt; .01). The Intervention Group was also significantly more likely to meet national physical activity guidelines at 6 months (OR = 3.12, 95% CI 1.46-6.66, p &lt; .05).ConclusionFindings from the current study suggest that this Internet-delivered individually tailored intervention successfully increased MVPA in Latinas compared to a Wellness Contact Control Internet Group.Trial registrationNCT01834287

Study Protocol for a Randomized Controlled Trial Comparing Two Low-Intensity Weight Loss Maintenance Interventions Based on Acceptance and Commitment Therapy or Self-Regulation

Background: Weight regain is common following behavioral obesity treatment and attenuates many of the benefits of initial weight loss. This paper describes a randomized controlled trial that will evaluate the efficacy of two low-contact weight loss maintenance interventions based on Acceptance and Commitment Therapy (ACT) and self-regulation (SR). Potential mechanisms of action and moderators of treatment effects will also be evaluated. Methods: Adults (anticipated N=480)with overweight or obesity will complete an initial 3-monthonline weight loss program (Phase 1). Participants who achieve ≥4 kg weight loss (anticipated N=288) will then be randomized to an ACT or SR weight loss maintenance intervention. Both interventions will entail four2.5 hour, face-to-face, group-based workshop sessions and 6 months of email contact. Assessments will be conducted at phase 1 baseline, phase 1 completion/pre-randomization, and 6, 12, 18, 24, and 30 months post-randomization. The primary outcome will be weight change for the period from randomization to 30 months. Potential process measures including ACT-based constructs (e.g., psychological acceptance, values-consistent behavior), self-weighing frequency, and motivation will be also be assessed, as will potential moderators (e.g., initial weight loss). Conclusions: This study will compare the efficacy of two intervention approaches (ACT and SR) delivered in a scalable workshop format for long-term weight loss maintenance. Future research could examine efficacy and cost-effectiveness of these approaches in real world settings