Outlook | Newsletter of the Society of Behavioral Medicine

Newest Articles from Annals of Behavioral Medicine and Translational Behavioral Medicine

SBM's two journals, Annals of Behavioral Medicine and Translational Behavioral Medicine (TBM), continuously publish articles online, many of which become available before issues are printed.

SBM members who have paid their 2012 membership dues are able to access the full text of all Annals and TBM articles via the SBM website by following the steps below.

Go to the Members Only section of the SBM website: https://www.sbm.org/membership/members
Log in with your username and password
Click on the Journals link (listed fourth in the list of Member Benefits)
Click on the title of the journal which you would like to electronically access

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

A few of the newest Annals and TBM articles currently accessible online are listed below.

Annals of Behavioral Medicine

Endogenous Inhibition of the Nociceptive Flexion Reflex (NFR) and Pain Ratings During the Menstrual Cycle in Healthy Women
Authors: Emily J. Bartley and Jamie L. Rhudy
Abstract:
The menstrual cycle influences pain, with symptoms often increasing during the premenstrual (late-luteal) phase. Deficiencies in endogenous inhibition of afferent nociception at the spinal level might contribute to menstrual phase-related changes in pain. This study assessed whether conditioned pain modulation (CPM) of spinal nociception differs between mid-follicular and late-luteal phases. CPM was evoked by a blood pressure cuff affixed to the right forearm and inflated to induce ischemia in 41 healthy women during both menstrual phases. Suprathreshold electric stimuli were delivered to the left sural nerve to evoke pain and the nociceptive flexion reflex (NFR) before, during, and after forearm ischemia. Forearm ischemia produced CPM of electrocutaneous pain and NFR, but inhibition did not differ across mid-follicular and late-luteal phases. Mechanisms contributing to changes in experimental pain across mid-follicular and late-luteal phases in healthy women are not due to deficits in CPM of spinal nociception.

The Associations of Multiple Dimensions of Discrimination and Abdominal Fat in African American Adults: The Jackson Heart Study
Authors: DeMarc A. Hickson, Tené T. Lewis, Jiankang Liu, David L. Mount and Sinead N. Younge, et al.
Abstract:
Discrimination may be adversely associated with abdominal obesity, but few studies have examined associations with abdominal fat. The purpose of this study was to examine whether discrimination was independently associated with visceral (VAT) and subcutaneous (SAT) fat and whether these associations differed by sex and age. Participants self-reported experiences of everyday and lifetime discrimination. The main reason for and the coping response to these experiences were also reported. VAT and SAT were quantified by computed tomography. In fully adjusted models, higher reports of everyday discrimination were associated with greater SAT, but not VAT, volumes in men only: SAT increased by 3.6 (standard error = 1.8) cm&3sup; for each unit increase in the everyday discrimination score. In women, higher reports of lifetime non-racial discrimination were associated with greater VAT (71.6 ± 32.0, P < 0.05) and SAT (212.6 ± 83.6, P < 0.05), but these relationships were attenuated after controlling for body mass index. These cross-sectional findings do not fully support the independent hypothesis of discrimination and abdominal fat. Additional investigations involving longitudinal designs are warranted.

Coping, Self-Management, and Adaptation in Adolescents with Type 1 Diabetes
Authors: Sarah S. Jaser, Melissa S. Faulkner, Robin Whittemore, Sangchoon Jeon and Kathryn Murphy, et al.
Abstract:
Adolescents with type 1 diabetes experience stress related to treatment management, feeling different from peers, and deciding to tell others about their diabetes. This study examined the relationship of stress reactivity and coping with self-management, quality of life, and metabolic control in an ethnically diverse sample of adolescents with type 1 diabetes. Adolescents (n = 327) completed measures of coping and stress reactivity, self-management, and quality of life. Glycosylated hemoglobin data were collected from medical records. Low-income and minority status were related to lower levels of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance), and higher levels of disengagement coping (e.g., avoidance). Self-management mediated the relationship between coping and stress reactivity with quality of life and metabolic control. Race/ethnicity and income moderated the relationship between coping and self-management goals. Results indicate differences in coping related to income and race/ethnicity and demonstrate the impact of coping on self-management and health outcomes in adolescents with type 1 diabetes.

Using the Interdependence Model to Understand Spousal Influence on Colorectal Cancer Screening Intentions: A Structural Equation Model
Authors: Sharon Manne, Deborah Kashy, David S. Weinberg, Joseph A. Boscarino and Deborah J. Bowen
Abstract:
Although it is widely thought that the marital relationship plays a role in individuals' decisions to have colorectal cancer screening, few studies have evaluated partner influences. We evaluated the role of marital relationship factors such as a relational perspective on the frequency of spouse discussions about screening and screening intentions. Individual-level factors were also evaluated. One hundred sixty-eight couples with both members non-adherent with screening completed measures of perceived risk, screening benefits and barriers, marital quality, relational perspective, discussion frequency, and screening intentions. Couples' attitudes about screening were interdependent and one partner's attitudes and behavior were associated with the other partner's intention. There was also evidence of joint effects in that intentions were associated with both one's partner's attitudes and one's own attitudes. Colorectal screening intentions are associated with both partners' attitudes as well as whether or not couples have discussed screening with one another.

I (should) Need a Cigarette: Adolescent Social Anxiety and Cigarette Smoking
Authors: Shayna L. Henry, Larry D. Jamner and Carol K. Whalen
Abstract:
Approximately half of high school students in the USA have used tobacco. Social anxiety can put adolescents at increased risk for smoking. This study aims to determine whether adolescents high in trait social anxiety report more cigarette use and greater urge to smoke before, during, and after friend interactions than do teens low in trait social anxiety. Four hundred two students who reported smoking more than once during high school were assessed approximately every 30 min during up to 84-day monitoring sessions. Controlling for momentary anxiety, high socially anxious teens were equally or less likely to smoke, but more likely to report urge to smoke, surrounding friend interactions than low socially anxious teens. Although high socially anxious adolescents do not smoke more than low socially anxious peers, they may believe that they should need a cigarette in anxiety-provoking situations. Such urges may later develop into smoking behaviors.

Translational Behavioral Medicine

Translational behavioral pain management: new directions and new opportunities
Author: Francis J. Keefe
Abstract: None

Medication-taking beliefs and diabetes in American Samoa: a qualitative inquiry
Authors: Diana W Stewart, Judith DePue, Rochelle K Rosen, Nicole Bereolos and Michael G Goldstein, et al.
Abstract:
In American Samoa (AS), nearly 22% of adults have type 2 diabetes. Diabetes is best managed by diet and lifestyle modifications and strict medication adherence. Cultural aspects might affect medication-taking beliefs, and thereby influence medication adherence. This study aims to explore diabetes medication-taking experiences and knowledge and related cultural beliefs in AS adults with diabetes and healthcare providers. Six focus groups were conducted with 39 AS adults with diabetes and individual interviews were performed with 13 diabetes healthcare providers. Data were transcribed and analyzed using NVivo 8 software. Themes pertaining to medication taking and adherence were identified. Patients and providers reported that barriers such as confusion about medications and concern about medication costs negatively influence medication taking, while cultural values and obligations both positively and negatively impact medication adherence. These findings help elucidate the relationship between medication-taking beliefs and culture in AS adults with diabetes and highlight the importance of continued research within this population.

Linking internet-based diabetes self-management to primary care: lessons learned and implications for research translation and practice implementation
Authors: Russell E Glasgow, Deanna Kurz, Jennifer M Dickman, Diego Osuna and Lisa Strycker, et al.
Abstract:
There has been little discussion of or research on the key translational issue of how to integrate patient self-management programs across multiple primary care clinics within an HMO. The purpose of this study was to summarize our experiences and lessons learned in trying to integrate information from a web-based diabetes self-management program into primary care and the electronic health record (EHR). We describe plans, implementation, adaptations made, and data on patient and physician reactions to the My Path diabetes self-management program provided to 331 adult primary care patients. Mixed methods results revealed that, despite the availability of a state-of-the-art EHR, the intervention was not well integrated into primary care. Information from health-promotion and disease management programs, even within the same organization and with advanced EHR systems, is challenging to integrate into busy primary care.

Interactive voice response technology for symptom monitoring and as an adjunct to the treatment of chronic pain
Authors: Gregory Lieberman and Magdalena R Naylor
Abstract:
Chronic pain is a medical condition that severely decreases the quality of life for those who struggle to cope with it. Interactive voice response (IVR) technology has the ability to track symptoms and disease progression, to investigate the relationships between symptom patterns and clinical outcomes, to assess the efficacy of ongoing treatments, and to directly serve as an adjunct to therapeutic treatment for chronic pain. While many approaches exist toward the management of chronic pain, all have their pitfalls and none work universally. Cognitive behavioral therapy (CBT) is one approach that has been shown to be fairly effective, and therapeutic interactive voice response technology provides a convenient and easy-to-use means of extending the therapeutic gains of CBT long after patients have discontinued clinical visitations. This review summarizes the advantages and disadvantages of IVR technology, provides evidence for the efficacy of the method in monitoring and managing chronic pain, and addresses potential future directions that the technology may take as a therapeutic intervention in its own right.

Managing pain in high-risk patients within a patient-centered medical home
Authors: Martin D Cheatle, John W Klocek and A Thomas McLellan
Abstract:
Chronic pain remains a major healthcare problem despite noteworthy advancements in diagnostics, pharmacotherapy, and invasive and non-invasive interventions. The prevalence of chronic pain in the United States is staggering and continues to grow, and the personal and societal costs are not inconsequential. The etiology of pain is complex, and individuals suffering from chronic pain tend to have significant medical and psychiatric comorbidities such as depression, anxiety, and in some cases, substance use disorders. There is great concern regarding the burgeoning rate of prescription opioid misuse/abuse both for non-medical use and in pain patients receiving chronic opioid therapy. While there is ongoing debate about the "true" incidence of opioid abuse in the pain population, clearly, patients afflicted with both pain and substance use disorder are particularity challenging. The majority of patients with chronic pain including those with co-occurring substance use disorders are managed in the primary care setting. Primary care practitioners have scant time, resources and training to effectively assess, treat and monitor these complicated cases. A number of evidence- and expert consensus-based treatment guidelines on opioid therapy and risk mitigation have been developed but they have been underutilized in both specialty and primary care clinics. This article will discuss the utilization of new technologies and delivery systems for risk stratification, intervention and monitoring of patients with pain receiving opioid.


Winter 2012	Return to Outlook Main page »
Newest Articles from Annals of Behavioral Medicine and Translational Behavioral Medicine SBM's two journals, Annals of Behavioral Medicine and Translational Behavioral Medicine (TBM), continuously publish articles online, many of which become available before issues are printed. SBM members who have paid their 2012 membership dues are able to access the full text of all Annals and TBM articles via the SBM website by following the steps below. Go to the Members Only section of the SBM website: https://www.sbm.org/membership/members Log in with your username and password Click on the Journals link (listed fourth in the list of Member Benefits) Click on the title of the journal which you would like to electronically access To check if you are a current member of SBM, or if you are having trouble accessing the journals online, please contact the national office at info@sbm.org or 414-918-3156. A few of the newest Annals and TBM articles currently accessible online are listed below. Annals of Behavioral Medicine Endogenous Inhibition of the Nociceptive Flexion Reflex (NFR) and Pain Ratings During the Menstrual Cycle in Healthy Women Authors: Emily J. Bartley and Jamie L. Rhudy Abstract: The menstrual cycle influences pain, with symptoms often increasing during the premenstrual (late-luteal) phase. Deficiencies in endogenous inhibition of afferent nociception at the spinal level might contribute to menstrual phase-related changes in pain. This study assessed whether conditioned pain modulation (CPM) of spinal nociception differs between mid-follicular and late-luteal phases. CPM was evoked by a blood pressure cuff affixed to the right forearm and inflated to induce ischemia in 41 healthy women during both menstrual phases. Suprathreshold electric stimuli were delivered to the left sural nerve to evoke pain and the nociceptive flexion reflex (NFR) before, during, and after forearm ischemia. Forearm ischemia produced CPM of electrocutaneous pain and NFR, but inhibition did not differ across mid-follicular and late-luteal phases. Mechanisms contributing to changes in experimental pain across mid-follicular and late-luteal phases in healthy women are not due to deficits in CPM of spinal nociception. The Associations of Multiple Dimensions of Discrimination and Abdominal Fat in African American Adults: The Jackson Heart Study Authors: DeMarc A. Hickson, Tené T. Lewis, Jiankang Liu, David L. Mount and Sinead N. Younge, et al. Abstract: Discrimination may be adversely associated with abdominal obesity, but few studies have examined associations with abdominal fat. The purpose of this study was to examine whether discrimination was independently associated with visceral (VAT) and subcutaneous (SAT) fat and whether these associations differed by sex and age. Participants self-reported experiences of everyday and lifetime discrimination. The main reason for and the coping response to these experiences were also reported. VAT and SAT were quantified by computed tomography. In fully adjusted models, higher reports of everyday discrimination were associated with greater SAT, but not VAT, volumes in men only: SAT increased by 3.6 (standard error = 1.8) cm&3sup; for each unit increase in the everyday discrimination score. In women, higher reports of lifetime non-racial discrimination were associated with greater VAT (71.6 ± 32.0, P < 0.05) and SAT (212.6 ± 83.6, P < 0.05), but these relationships were attenuated after controlling for body mass index. These cross-sectional findings do not fully support the independent hypothesis of discrimination and abdominal fat. Additional investigations involving longitudinal designs are warranted. Coping, Self-Management, and Adaptation in Adolescents with Type 1 Diabetes Authors: Sarah S. Jaser, Melissa S. Faulkner, Robin Whittemore, Sangchoon Jeon and Kathryn Murphy, et al. Abstract: Adolescents with type 1 diabetes experience stress related to treatment management, feeling different from peers, and deciding to tell others about their diabetes. This study examined the relationship of stress reactivity and coping with self-management, quality of life, and metabolic control in an ethnically diverse sample of adolescents with type 1 diabetes. Adolescents (n = 327) completed measures of coping and stress reactivity, self-management, and quality of life. Glycosylated hemoglobin data were collected from medical records. Low-income and minority status were related to lower levels of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance), and higher levels of disengagement coping (e.g., avoidance). Self-management mediated the relationship between coping and stress reactivity with quality of life and metabolic control. Race/ethnicity and income moderated the relationship between coping and self-management goals. Results indicate differences in coping related to income and race/ethnicity and demonstrate the impact of coping on self-management and health outcomes in adolescents with type 1 diabetes. Using the Interdependence Model to Understand Spousal Influence on Colorectal Cancer Screening Intentions: A Structural Equation Model Authors: Sharon Manne, Deborah Kashy, David S. Weinberg, Joseph A. Boscarino and Deborah J. Bowen Abstract: Although it is widely thought that the marital relationship plays a role in individuals' decisions to have colorectal cancer screening, few studies have evaluated partner influences. We evaluated the role of marital relationship factors such as a relational perspective on the frequency of spouse discussions about screening and screening intentions. Individual-level factors were also evaluated. One hundred sixty-eight couples with both members non-adherent with screening completed measures of perceived risk, screening benefits and barriers, marital quality, relational perspective, discussion frequency, and screening intentions. Couples' attitudes about screening were interdependent and one partner's attitudes and behavior were associated with the other partner's intention. There was also evidence of joint effects in that intentions were associated with both one's partner's attitudes and one's own attitudes. Colorectal screening intentions are associated with both partners' attitudes as well as whether or not couples have discussed screening with one another. I (should) Need a Cigarette: Adolescent Social Anxiety and Cigarette Smoking Authors: Shayna L. Henry, Larry D. Jamner and Carol K. Whalen Abstract: Approximately half of high school students in the USA have used tobacco. Social anxiety can put adolescents at increased risk for smoking. This study aims to determine whether adolescents high in trait social anxiety report more cigarette use and greater urge to smoke before, during, and after friend interactions than do teens low in trait social anxiety. Four hundred two students who reported smoking more than once during high school were assessed approximately every 30 min during up to 84-day monitoring sessions. Controlling for momentary anxiety, high socially anxious teens were equally or less likely to smoke, but more likely to report urge to smoke, surrounding friend interactions than low socially anxious teens. Although high socially anxious adolescents do not smoke more than low socially anxious peers, they may believe that they should need a cigarette in anxiety-provoking situations. Such urges may later develop into smoking behaviors. Translational Behavioral Medicine Translational behavioral pain management: new directions and new opportunities Author: Francis J. Keefe Abstract: None Medication-taking beliefs and diabetes in American Samoa: a qualitative inquiry Authors: Diana W Stewart, Judith DePue, Rochelle K Rosen, Nicole Bereolos and Michael G Goldstein, et al. Abstract: In American Samoa (AS), nearly 22% of adults have type 2 diabetes. Diabetes is best managed by diet and lifestyle modifications and strict medication adherence. Cultural aspects might affect medication-taking beliefs, and thereby influence medication adherence. This study aims to explore diabetes medication-taking experiences and knowledge and related cultural beliefs in AS adults with diabetes and healthcare providers. Six focus groups were conducted with 39 AS adults with diabetes and individual interviews were performed with 13 diabetes healthcare providers. Data were transcribed and analyzed using NVivo 8 software. Themes pertaining to medication taking and adherence were identified. Patients and providers reported that barriers such as confusion about medications and concern about medication costs negatively influence medication taking, while cultural values and obligations both positively and negatively impact medication adherence. These findings help elucidate the relationship between medication-taking beliefs and culture in AS adults with diabetes and highlight the importance of continued research within this population. Linking internet-based diabetes self-management to primary care: lessons learned and implications for research translation and practice implementation Authors: Russell E Glasgow, Deanna Kurz, Jennifer M Dickman, Diego Osuna and Lisa Strycker, et al. Abstract: There has been little discussion of or research on the key translational issue of how to integrate patient self-management programs across multiple primary care clinics within an HMO. The purpose of this study was to summarize our experiences and lessons learned in trying to integrate information from a web-based diabetes self-management program into primary care and the electronic health record (EHR). We describe plans, implementation, adaptations made, and data on patient and physician reactions to the My Path diabetes self-management program provided to 331 adult primary care patients. Mixed methods results revealed that, despite the availability of a state-of-the-art EHR, the intervention was not well integrated into primary care. Information from health-promotion and disease management programs, even within the same organization and with advanced EHR systems, is challenging to integrate into busy primary care. Interactive voice response technology for symptom monitoring and as an adjunct to the treatment of chronic pain Authors: Gregory Lieberman and Magdalena R Naylor Abstract: Chronic pain is a medical condition that severely decreases the quality of life for those who struggle to cope with it. Interactive voice response (IVR) technology has the ability to track symptoms and disease progression, to investigate the relationships between symptom patterns and clinical outcomes, to assess the efficacy of ongoing treatments, and to directly serve as an adjunct to therapeutic treatment for chronic pain. While many approaches exist toward the management of chronic pain, all have their pitfalls and none work universally. Cognitive behavioral therapy (CBT) is one approach that has been shown to be fairly effective, and therapeutic interactive voice response technology provides a convenient and easy-to-use means of extending the therapeutic gains of CBT long after patients have discontinued clinical visitations. This review summarizes the advantages and disadvantages of IVR technology, provides evidence for the efficacy of the method in monitoring and managing chronic pain, and addresses potential future directions that the technology may take as a therapeutic intervention in its own right. Managing pain in high-risk patients within a patient-centered medical home Authors: Martin D Cheatle, John W Klocek and A Thomas McLellan Abstract: Chronic pain remains a major healthcare problem despite noteworthy advancements in diagnostics, pharmacotherapy, and invasive and non-invasive interventions. The prevalence of chronic pain in the United States is staggering and continues to grow, and the personal and societal costs are not inconsequential. The etiology of pain is complex, and individuals suffering from chronic pain tend to have significant medical and psychiatric comorbidities such as depression, anxiety, and in some cases, substance use disorders. There is great concern regarding the burgeoning rate of prescription opioid misuse/abuse both for non-medical use and in pain patients receiving chronic opioid therapy. While there is ongoing debate about the "true" incidence of opioid abuse in the pain population, clearly, patients afflicted with both pain and substance use disorder are particularity challenging. The majority of patients with chronic pain including those with co-occurring substance use disorders are managed in the primary care setting. Primary care practitioners have scant time, resources and training to effectively assess, treat and monitor these complicated cases. A number of evidence- and expert consensus-based treatment guidelines on opioid therapy and risk mitigation have been developed but they have been underutilized in both specialty and primary care clinics. This article will discuss the utilization of new technologies and delivery systems for risk stratification, intervention and monitoring of patients with pain receiving opioid.