Outlook: Newsletter of the Society of Behavorial Medicine

Winter 2021

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 articles are listed below.

SBM members who have paid their 2021 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.
  2. Log in with your username and password.
  3. Click on the Journals link.
  4. Click on the title of the journal which you would like to electronically access.

To check your membership status, 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

The Impact of Communicating Uncertainty on Public Responses to Precision Medicine Research

Chelsea L Ratcliff, PhD, Bob Wong, PhD, Jakob D Jensen, PhD, Kimberly A Kaphingst, ScD

Precision medicine research depends upon recruiting large and diverse participant cohorts to provide genetic, environmental, and lifestyle data. How prospective participants react to information about this research, including depictions of uncertainty, is not well understood.

The current study examined public responses to precision medicine research, focusing on reactions toward (a) uncertainty about the scientific impact of sharing data for research, and (b) uncertainty about the privacy, security, or intended uses of participant data.

U.S. adults (N = 674; 51.9% male; 50% non-Hispanic white; Mage = 42.23) participated in an online experimental survey. Participants read a manipulated news article about precision medicine research that conveyed either certainty or uncertainty of each type (scientific, data). Participants then rated their attitudes toward the research, trust in the researchers, and willingness to join a cohort. We tested direct and mediated paths between message condition and outcomes and examined individual characteristics as moderators.

Overall attitudes were positive and a majority of participants (65%) reported being somewhat or very likely to participate in precision medicine research if invited. Conveying uncertainty of either type had no overall main effect on outcomes. Instead, those who reported perceiving greater uncertainty had lower attitudes, trust, and willingness to join, while those with more tolerance for uncertainty, support for science, and scientific understanding responded favorably to the scientific uncertainty disclosure.

Findings suggest responses to precision medicine research uncertainty are nuanced and that successful cohort enrollment may be well-supported by a transparent approach to communicating with prospective participants.


Change in Perceived Stress and Health Behaviors of Emerging Adults in the Midst of the COVID-19 Pandemic

Lara J LaCaille, PhD, Stephanie A Hooker, PhD, Elaine Marshall, MA, Rick A LaCaille, PhD, Rhea Owens, PhD

The COVID-19 pandemic has resulted in unprecedented disruptions, restrictions, and concerns about physical and mental health. Emerging adulthood, including the first year of college, is associated with declines in healthy eating and physical activity, as well as possible heightened distress. The impact of COVID-19 may exacerbate these concerns.

The purpose of this study was to examine changes in health behaviors and perceived stress in emerging adults over the first year of college and to determine whether prepandemic health behaviors were protective for mental health and stress during the initial changes after the COVID-19 pandemic.

First-year college students (N = 234, 58.6% female) completed three surveys during their first year of school, the third being after the onset of COVID-19 and during a stay-at-home order. At Time 3, we also assessed symptoms of anxiety and depression.

Using linear mixed modeling, sedentary time increased and physical activity decreased over time, but 20%–35% of students reported improvements in these behaviors. Dietary changes appeared mixed, with some improvements noted early during COVID-19. Perceived stress increased over time. Multiple regression indicated that of the health behaviors examined for protective effects on mental health and stress during the pandemic, only diet quality emerged as a significant predictor.

Although notable declines in some health habits were observed over time, including following COVID-19 disruptions, some students reported improved health behaviors. Efforts should be directed at identifying and intervening with students most at risk for poor functioning.


Gender Affirmation as a Source of Resilience for Addressing Stigmatizing Healthcare Experiences of Transgender Youth of Color

Tamar Goldenberg, PhD, MPH, Kristi E Gamarel, PhD, Sari L Reisner, ScD, Laura Jadwin-Cakmak, MPH, Gary W Harper, PhD, MPH

Transgender and other gender diverse (TGD) youth of color experience stigma within healthcare. Gender affirmation can be a resilience resource; however, little is known about gender affirmation within healthcare.

This study explores TGD youth of color’s experiences of stigma and gender affirmation across the entire healthcare experience and their role on motivation to seek care.

In 2015, cross-sectional surveys and individual in-depth interviews were conducted among 187 TGD youth ages 16–24 living in 14 U.S. cities. Analyses followed a mixed-methods design whereby 33 participants were purposively selected for a qualitative phenomenological analysis based on quantitatively reported gender affirmation needs. Subsequent quantitative analyses examined how healthcare use differed by access to gender affirmation.

Participants qualitatively described experiencing stigma across multiple healthcare settings (e.g., primary care, emergency care, medical gender affirmation), including before (finding providers, scheduling), during (waiting rooms, provider interactions), and after (pharmacy) healthcare visits. Participants who quantitatively reported access to gender-affirming healthcare still described negative healthcare experiences, either because they accessed multiple healthcare services or because of prior negative experiences. Stigma and gender affirmation (both inside and outside of healthcare) influenced motivation to seek care, with variation depending on the type of care. Quantitative analyses confirmed these findings; access to gender affirmation differed for participants who delayed primary care vs. those who did not, but did not vary based on participants’ use of medical gender affirmation.

Findings highlight the importance of promoting gender-affirming healthcare environments to increase access to care for TGD youth of color.



Translational Behavioral Medicine

Trends in mental health symptoms, service use, and unmet need for services among U.S. adults through the first 9 months of the COVID-19 pandemic

Rebekah Levine Coley, Christopher F Baum

The COVID-19 pandemic has led to rising morbidity, mortality, and social and economic disruption, likely impairing mental health. The purpose of this study was to track trends in mental health symptoms, use of services, and unmet need for services among U.S. adults and to delineate variation across demographic strata. Data were drawn from the 2020 U.S. Household Pulse Survey from repeated cross-sectional online surveys collected between April 23 and November 23, 2020 from 1,483,378 US adults, weighted to represent the U.S. population. Survey respondents self-reported their symptoms of anxiety and depression, use of medication, counseling services, and unmet need for services. Reports of probable anxiety and depression rose significantly through the study period, to prevalence rates of 50% and 44%, respectively, by November 2020, rates six times higher than early 2019 U.S. norms. Use of prescription medication, counseling services, and unmet need for mental health services also rose significantly. Prevalence rates of probable mental health disorders were highest among young, less educated, single, female, Black and Hispanic respondents, with age and education disparities growing over cohorts. Young, female, and moderately educated respondents also reported higher unmet needs for services. Disparities in estimates of mental health disorders and mental health treatment indicate a striking disequilibrium between the potential need for and the use of mental health services during the COVID-19 pandemic. Rising mental health challenges are being borne largely by young, less advantaged people of color and women, with the potential for expanded interruptions to optimal functioning and societal recovery from COVID-19.


Multiple approaches to enhancing cancer communication in the next decade: translating research into practice and policy

Claire C Conley, Amy K Otto, Glynnis A McDonnell, Kenneth P Tercyak

Communicating risk and other health information in a clear, understandable, and actionable manner is critical for the prevention and control of cancer, as well as the care of affected individuals and their family members. However, the swift pace of development in communication technologies has dramatically changed the health communication landscape. This digital era presents new opportunities and challenges for cancer communication research and its impact on practice and policy. In this article, we examine the science of health communication focused on cancer and highlight important areas of research for the coming decade. Specifically, we discuss three domains in which cancer communication may occur: (a) among patients and their healthcare providers; (b) within and among families and social networks; and (c) across communities, populations, and the public more broadly. We underscore findings from the prior decade of cancer communication research, provide illustrative examples of future directions for cancer communication science, and conclude with considerations for diverse populations. Health informatics studies will be necessary to fully understand the growing and complex communication settings related to cancer: such works have the potential to change the face of information exchanges about cancer and elevate our collective discourse about this area as newer clinical and public health priorities emerge. Researchers from a wide array of specialties are interested in examining and improving cancer communication. These interdisciplinary perspectives can rapidly advance and help translate findings of cancer communication in the field of behavioral medicine.


Basic behavioral science research priorities in minority health and health disparities

Chanita Hughes Halbert, Caitlin G Allen

Achieving health equity among disparity populations has been a national, regional, and local priority for several years. Health promotion and disease prevention behaviors play an important role in achieving health equity; the first generation of behavioral science studies in minority health and health disparities have provided important insights about the nature and distribution of risk exposure behaviors in disparity populations. Interventions have also been developed to enhance health promotion and disease prevention behaviors using behavioral counseling, tailored health communications, and interventions that are developed collaboratively with community stakeholders. Although intervention development and evaluation are components of transdisciplinary translational behavior research, discovery science is a critical first step in translational research. Consistent with this, conceptual models and frameworks of minority health and health disparities have evolved to include multilevel determinants that include basic behavioral mechanisms such as stress responses and stress reactivity that have physiological, psychological, and behavioral components that are relevant to minority health and health disparities. This report describes priorities, opportunities, and barriers to conducting transdisciplinary translational behavioral research during the next generation of minority health and health disparities research.