Outlook: Newsletter of the Society of Behavorial Medicine
Spring/Summer 2016

New Articles from Annals of Behavioral Medicine and Translational Behavioral Medicine

SBM's two journals, Annals of Behavioral Medicine and Translational Behavioral Medicine: Practice, Policy, Research (TBM), continuously publish online articles, many of which become available before issues are printed. Three recently published Annals and TBM online articles are listed below.

SBM members who have paid their 2016 membership dues are able to access the full text of all Annals and TBM online articles via the SBM website by following the steps below.

  1. Go to the Members Only section of the SBM website (http://www.sbm.org/membership/members).
  2. Log in with your username and password.
  3. Click on the Journals link (listed third in the list of member benefits).
  4. Click on the title of the journal which you would like to electronically access.

To check if you are a current SBM member, or if you are having trouble accessing the journals online, please contact the SBM national office at info@sbm.org or (414) 918-3156.


Annals of Behavioral Medicine

Perceived Housing Discrimination and Self-Reported Health: How Do Neighborhood Features Matter?
Authors: Tse-Chuan Yang, Danhong Chen, Kiwoong Park
Abstract: While the association between perceived discrimination and health has been investigated, little is known about whether and how neighborhood characteristics moderate this association. We situate discrimination in the housing context and use relative deprivation and social capital perspectives to fill the knowledge gap. We applied multilevel logistic modeling to 9,842 adults in 830 neighborhoods in Philadelphia to examine three hypotheses. First, the detrimental effect of discrimination on self-reported health was underestimated without considering neighborhood features as moderators. The estimated coefficient (β) increased from approximately 0.02 to 1.84 or higher. Second, the negative association between discrimination and self-reported health was enhanced when individuals with discrimination experience lived in neighborhoods with higher housing values (β = 0.42). Third, the adverse association of discrimination with self-reported health was attenuated when people reporting discrimination resided in neighborhoods marked by higher income inequality (β = −4.34) and higher concentrations of single-parent households with children (β = −0.03) and minorities (β = −0.01). We not only confirmed the moderating roles of neighborhood characteristics, but also suggested that the relative deprivation and social capital perspectives could be used to understand how perceived housing discrimination affects self-reported health via neighborhood factors.

Parental History of Diabetes, Positive Affect, and Diabetes Risk in Adults: Findings from MIDUS
Authors: Vera K. Tsenkova, Arun S. Karlamangla, Carol D. Ryff
Abstract: Family history of diabetes is one of the major risk factors for diabetes, but significant variability in this association remains unexplained, suggesting the presence of important effect modifiers. To our knowledge, no previous work has examined whether psychological factors moderate the degree to which family history of diabetes increases diabetes risk. We investigated the relationships among parental history of diabetes, affective states (positive affect, negative affect, and depressed affect), and diabetes in 978 adults from the MIDUS 2 national sample. As expected, parental history of diabetes was associated with an almost threefold increase in diabetes risk. We found a significant interaction between positive affect and parental history of diabetes on diabetes (p = .009): higher positive affect was associated with a statistically significant lower relative risk for diabetes in participants who reported having a parental history of diabetes (RR = .66 per unit increase in positive affect; 95 % CI = .47; .93), but it did not influence diabetes risk for participants who reported no parental history of diabetes (p = .34). This pattern persisted after adjusting for an extensive set of health and sociodemographic covariates and was independent of negative and depressed affect. These results suggest that psychological well-being may protect individuals at increased risk from developing diabetes. Understanding such interactions between non-modifiable risk factors and modifiable psychological resources is important for delineating biopsychosocial pathways to diabetes and informing theory-based, patient-centered interventions to prevent the development of diabetes.

Baseline Characteristics and Generalizability of Participants in an Internet Smoking Cessation Randomized Trial
Authors: Sarah Cha, Bahar Erar, Raymond S. Niaura, Amanda L. Graham
Abstract: The potential for sampling bias in Internet smoking cessation studies is widely recognized. However, few studies have explicitly addressed the issue of sample representativeness in the context of an Internet smoking cessation treatment trial. The purpose of the present study is to examine the generalizability of participants enrolled in a randomized controlled trial of an Internet smoking cessation intervention using weighted data from the National Health Interview Survey (NHIS). A total of 5290 new users on a smoking cessation website enrolled in the trial between March 2012 and January 2015. Descriptive statistics summarized baseline characteristics of screened and enrolled participants, and multivariate analysis examined predictors of enrollment. Generalizability analyses compared demographic and smoking characteristics of trial participants to current smokers in the 2012–2014 waves of NHIS (n = 19,043) and to an NHIS subgroup based on Internet use and cessation behavior (n = 3664). Effect sizes were obtained to evaluate the magnitude of differences across variables. Predictors of study enrollment were age, gender, race, education, and motivation to quit. Compared to NHIS smokers, trial participants were more likely to be female, college educated, and daily smokers and to have made a quit attempt in the past year (all effect sizes 0.25–0.60). In comparisons with the NHIS subgroup, differences in gender and education were attenuated, while differences in daily smoking and smoking rate were amplified. Few differences emerged between Internet trial participants and nationally representative samples of smokers, and all were in expected directions. This study highlights the importance of assessing generalizability in a focused and specific manner.


Translational Behavioral Medicine

UWALK: the development of a multi-strategy, community-wide physical activity program
Authors: Cally A. Jennings, Tanya R. Berry, Valerie Carson, S. Nicole Culos-Reed, Mitch J. Duncan, Christina C. Loitz, Gavin R. McCormack, Tara-Leigh F. McHugh, John C. Spence, Jeff K. Vallance, W. Kerry Mummery
Abstract: UWALK is a multi-strategy, multi-sector, theory-informed, community-wide approach using e and mHealth to promote physical activity in Alberta, Canada. The aim of UWALK is to promote physical activity, primarily via the accumulation of steps and flights of stairs, through a single over-arching brand. This paper describes the development of the UWALK program. A social ecological model and the social cognitive theory guided the development of key strategies, including the marketing and communication activities, establishing partnerships with key stakeholders, and e and mHealth programs. The program promotes the use of physical activity monitoring devices to self-monitor physical activity. This includes pedometers, electronic devices, and smartphone applications. In addition to entering physical activity data manually, the e and mHealth program provides the function for objective data to be automatically uploaded from select electronic devices (Fitbit®, Garmin and the smartphone application Moves) The RE-AIM framework is used to guide the evaluation of UWALK. Funding for the program commenced in February 2013. The UWALK brand was introduced on April 12, 2013 with the official launch, including the UWALK website on September 20, 2013. This paper describes the development and evaluation framework of a physical activity promotion program. This program has the potential for population level dissemination and uptake of an ecologically valid physical activity promotion program that is evidence-based and theoretically framed.

Use of self-monitoring tools in a clinic sample of adults with type 2 diabetes
Authors: Molly L. Tanenbaum, Harikrashna B. Bhatt, Valerie A. Thomas, Rena R. Wing
Abstract: Self-monitoring is an effective strategy for chronic disease management; many readily available mobile applications allow tracking of diabetes-related health behaviors but their use has not yet been integrated into routine clinical care. How patients engage with these applications in the real world is not well understood. The specific aim of this study is to survey adults with type 2 diabetes (T2D) regarding self-monitoring behaviors, including mobile application use. In 2015, we surveyed an adult diabetes clinic population (n = 96) regarding self-monitoring behaviors: diet, physical activity, weight, and blood glucose. Self-monitoring with any method ranged from 20–90 %. About half of the participants owned smartphones; few had mobile applications. The most common app-tracked behavior was physical activity, then weight and diet. Despite numerous available mobile health-tracking applications, few T2D adults from our sample used them, though many reported self-monitoring with other methods.

A pilot study evaluating the effects of a youth advocacy program on youth readiness to advocate for environment and policy changes for obesity prevention
Authors: Rachel A. Millstein, Susan I. Woodruff, Leslie S. Linton, Christine C. Edwards, James F. Sallis
Abstract: Youth advocacy for obesity prevention is a promising but under-evaluated intervention. The aims of this study are to evaluate a youth advocacy program’s outcomes related to youth perceptions and behaviors, develop an index of youth advocacy readiness, and assess potential predictors of advocacy readiness. Youth ages 9–22 in an advocacy training program (n = 92 matched pairs) completed surveys before and after training. Youth outcomes and potential predictors of advocacy readiness were assessed with evaluated scales. All 20 groups who completed the evaluation study presented their advocacy projects to a decision maker. Two of six perception subscales increased following participation in the advocacy program: self-efficacy for advocacy behaviors (p < .001) and participation in advocacy (p < .01). Four of five knowledge and skills subscales increased: assertiveness (p < .01), health advocacy history (p < .001), knowledge of resources (p < .01), and social support for health behaviors (p < .001). Youth increased days of meeting physical activity recommendations (p < .05). In a mixed regression model, four subscales were associated with the advocacy readiness index: optimism for change (B = 1.46, 95 % CI = .49–2.44), sports and physical activity enjoyment (B = .55, 95 % CI = .05–1.05), roles and participation (B = 1.81, 95 % CI = .60–3.02), and advocacy activities (B = 1.49, 95 % CI = .64–2.32). The youth advocacy readiness index is a novel way to determine the effects of multiple correlates of advocacy readiness. Childhood obesity-related advocacy training appeared to improve youths’ readiness for advocacy and physical activity.