Annals of Behavioral Medicine Advance Access en-us Tue, 16 Jul 2024 00:00:00 GMT Tue, 16 Jul 2024 23:46:37 GMT Silverchair The Role of Attention in Placebo and Nocebo Effects Tue, 16 Jul 2024 00:00:00 GMT <span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Although some existing models propose that attention may be crucially implicated in placebo/nocebo effects, empirical research on this aspect remains limited and scattered.<div class="boxTitle">Purpose</div>This systematic review aims to provide an inclusive overview of studies that have either directly manipulated or assessed attention within the context of placebo and nocebo procedures so to gain a synthetized picture of the role of this variable in placebo/nocebo effects. Importantly, only studies in which attention represented a mechanism or mediator of the placebo/nocebo response, and not a primary outcome, were included.<div class="boxTitle">Methods</div>A systematic search was conducted across multiple databases, including PubMed, Scopus, PsycINFO, Web of Science, and Embase, to identify peer-reviewed studies. These studies were subjected to methodological evaluation and eligibility criteria for inclusion.<div class="boxTitle">Results</div>We identified and classified 12 studies into three categories based on their focus: (i) those that directly assessed attention, (ii) those that directly manipulated participants’ attention, and (iii) those that combined both a direct manipulation and assessment of attention. In all selected studies attention acted as a mechanism or mediator of the placebo/nocebo response, and was not considered a primary outcome of the placebo/nocebo manipulation.<div class="boxTitle">Conclusions</div>The synthesis of the included studies reveals that the role of attention in placebo and nocebo effects is still a topic of debate, marked by variations in how attention is conceptualized and measured. Results suggest that attention has significant clinical implications, particularly in optimizing therapeutic efficacy by directing patients’ focus toward signs of healing and away from indicators of illness or distress. To advance our understanding, future research should explore these attentional mechanisms, in conjunction with neurophysiological correlates.</span> kaae038 10.1093/abm/kaae038 Sexual Orientation-Specific Policies Are Associated With Prenatal Care Use in the First Trimester Among Sexual Minority Women: Results From a Prospective Cohort Study Thu, 11 Jul 2024 00:00:00 GMT <span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Previous research has shown sexual minority women (SMW) are more likely to report multiple maternal and infant health outcomes compared to heterosexual women and that these outcomes are moderated by the policy environment. Little is known, however, about prenatal care use disparities or the social determinants of prenatal care use for SMW.<div class="boxTitle">Purpose</div>To examine the relationship between sexual orientation-specific policies that confer legal protections (e.g., hate crime protections, housing discrimination, same-sex marriage) and prenatal care use among women using a prospective, population-based data set.<div class="boxTitle">Methods</div>Using the National Longitudinal Study of Adolescent to Adult Health and logistic regression, we link measures of state policies to the use of prenatal care in the first trimester among women who had live births. The use of prospective data allows us to adjust for covariates associated with preconception care use prior to pregnancy (<span style="font-style:italic;">n</span> = 586 singleton births to SMW; <span style="font-style:italic;">n</span> = 4,539 singleton births to heterosexual women).<div class="boxTitle">Results</div>Sexual orientation-specific policies that conferred protections were associated with increased use of prenatal care among pregnancies reported by SMW (OR = 1.86, 95% CI 1.16, 2.96). In fact, in states with zero protections, we found no differences in prenatal care use by sexual minority status; however, in states with two or more protective policies, SMW were more likely to access prenatal care in the first trimester than heterosexual women. There was no relationship between sexual orientation-specific policy environments and prenatal care use among pregnancies reported by heterosexual women.<div class="boxTitle">Conclusions</div>Recent research has documented that SMW are more likely to have adverse perinatal and obstetrical outcomes than their heterosexual peers. These findings suggest that Lesbian/Gay/Bisexual-specific policy protections may facilitate the use of prenatal care among SMW, a potentially important pathway to improve reproductive health among this population.</span> kaae037 10.1093/abm/kaae037 Sexual Minority Women Report Higher Weight Stigma Levels Than Heterosexual Women in the National Weight Control Registry Thu, 11 Jul 2024 00:00:00 GMT <span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Little is known about weight stigma in sexual minority women, and even less is known about weight stigma in those who have attained substantial weight loss and maintenance.<div class="boxTitle">Purpose</div>This study examined weight stigma experiences and internalization in sexual minority women from the National Weight Control Registry (NWCR) who had lost ≥30 pounds and maintained this weight loss for ≥1 year, and compared weight stigma levels between sexual minority women versus heterosexual women in the NWCR.<div class="boxTitle">Methods</div>NWCR participants completed an electronic survey. Women who identified as a sexual minority (<span style="font-style:italic;">n</span> = 64; 98% White; <span style="font-style:italic;">M</span><sub>BMI</sub> = 29 ± 8; <span style="font-style:italic;">M</span><sub>age</sub> = 47 ± 13) and heterosexual women matched on body mass index (BMI), age, and race (<span style="font-style:italic;">n</span> = 64; 98% White; <span style="font-style:italic;">M</span><sub>BMI</sub> = 28 ± 7; <span style="font-style:italic;">M</span><sub>age</sub> = 51 ± 13) were included. Participants completed assessments of experienced and internalized weight stigma.<div class="boxTitle">Results</div>Generalized linear models showed that a significantly larger proportion of sexual minority women in the NWCR reported experiencing weight stigma in the past year (24.2%) compared with heterosexual women (4.7%; <span style="font-style:italic;">p</span> &lt; .05). Furthermore, sexual minority (vs. heterosexual) women reported significantly higher levels of internalized weight stigma (<span style="font-style:italic;">p</span> &lt; .001), and a greater proportion of sexual minority women (35%) reported clinically significant internalized weight stigma relative to heterosexual women (2%; <span style="font-style:italic;">p</span> &lt; .001).<div class="boxTitle">Conclusions</div>Sexual minority women are at greater risk for experienced and internalized weight stigma than their heterosexual counterparts among women who have attained significant long-term weight loss. It is critical to expand research on weight stigma in sexual minority women.</span> kaae042 10.1093/abm/kaae042 Caregiver Experiences With an Internet-Delivered Insomnia Intervention: SHUTi-CARE Trial Primary Qualitative Analysis Thu, 11 Jul 2024 00:00:00 GMT <span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background</div>Digital health interventions show potential to increase caregivers’ access to psychosocial care; however, it is unclear to what extent existing interventions may need to be tailored to meet caregivers’ unique needs.<div class="boxTitle">Purpose</div>This study aimed to determine whether—and if so, how—an efficacious Internet-delivered insomnia program should be modified for caregivers. The generalizability of these findings beyond the tested program was also examined.<div class="boxTitle">Methods</div>Higher-intensity family caregivers (<span style="font-style:italic;">N</span> = 100; age <span style="font-style:italic;">M</span> = 52.82 [<span style="font-style:italic;">SD</span> = 13.10], 75% non-Hispanic White, 66% ≥college degree) received access to an Internet-based cognitive-behavioral therapy for insomnia (CBT-I) program. Participants who completed one or more intervention “Cores” provided open-ended feedback on their experience; nonusers (completed no Cores) shared their barriers.<div class="boxTitle">Results</div>Most caregivers who used the program (<span style="font-style:italic;">n</span> = 82, 82%) found it feasible, citing its user-friendly, fully automated online format. Many reported that CBT-I strategies were helpful, although some faced challenges in implementing these strategies due to the unpredictability of their caregiving responsibilities. Opinions were divided on the utility of tailoring the program for caregivers. Nonusers (<span style="font-style:italic;">n</span> = 18, 18%) primarily cited concerns about time burden and lifestyle compatibility as usage barriers.<div class="boxTitle">Conclusions</div>Delivering fully automated behavioral interventions through the Internet appears suitable for many caregivers. Extensive tailoring may not be required for most caregivers to benefit from an existing online CBT-I program, although additional guidance on integrating CBT-I strategies in the context of challenging sleep schedules and environments may help a subset of caregivers. Future research should explore how such tailoring may enhance digital health intervention uptake and effectiveness for caregivers.</span> kaae041 10.1093/abm/kaae041