To investigate whether associations between perceived differential treatment based on race-ethnicity and sleep are mediated by coping strategies. We used data from the nationwide Sister Study. In 2008–2012, participants self-reported perceived lifetime differential treatment and completed adapted Coping Orientation to Problems Experienced Inventory (COPE)/Brief COPE questionnaires which assessed healthy/adaptive (e.g., using emotional support) and maladaptive (e.g., self-blame) coping. Sleep duration, poor sleep quality, and insomnia symptoms were self-reported in 2017–2019. Adjusting for sociodemographic and health characteristics, mediation analysis was performed using the Hayes PROCESS macro. Among 31,443 eligible women (mean ± SD age 55.5 ± 8.6 years), the prevalence of everyday (79
Previous studies have shown a positive association between perceived stress and delay discounting (DD; devaluation of a consequence as a function of its delay); individuals experiencing high levels of stress tend to prefer smaller, immediate rewards over larger, delayed rewards. However, the link between perceived stress and DD may be confounded by their mutual and well-documented association with socioeconomic disadvantage (e.g., low income, scarcity). Moreover, few studies have examined the association between perceived stress and probability discounting (PD; devaluation of probabilistic outcomes), which is also reliably associated with socioeconomic disadvantage. To isolate the association between perceived stress, DD, and PD from socioeconomic disadvantage, the current study recruited a sample of US adults (N = 247) reporting minimal income constraints (i.e., household incomes ≥ 100,000/year) on Prolific, an online crowdsourcing platform. Participants completed DD and PD assessments for two separate reward magnitudes (100 and 10,000), the Perceived Stress Scale (PSS), and a demographic questionnaire. In multiple regression, greater perceived stress was associated with higher DD rates for100 (p < .05) and PD rates for 100 (p < .01); however, perceived stress was not significantly associated with DD or PD for10,000. Thus, the association between perceived stress and both DD and PD appears independent of socioeconomic disadvantage, although our findings suggest that these associations are restricted to smaller reward magnitudes. Future research is needed to examine the association between these factors across varying populations, and how elevated stress levels may negatively impact real-world decision-making involving delay and uncertainty.
Although individual risk and protective factors have been identified, the extent to which these factors interact within a broader risk network remains inadequately understood. We used network analysis to characterize the partial correlation structure among previously identified risk factors for firearm violence. We used baseline data from a prospective longitudinal study of 1506 participants aged 18–24 recruited from four Level 1 trauma centers in Philadelphia, Flint, and Seattle (2021–2023), 14.4
Pathways through which advocacy training enhances engagement in advocacy among persons living with HIV (PLWH) are not well understood. In a secondary analysis from a randomized controlled trial of a peer advocacy training intervention for PLWH, we examined mediators of intervention effects on HIV prevention advocacy (i.e., encouraging others to engage in HIV protective behaviors) across members of their social network. A sample of 210 PLWH (105 in each of the intervention and control arms) provided information about their advocacy to their social network members at baseline, and 6-, 12-, and 18-month follow-up. Repeated measures linear regressions showed that PLWH in the intervention group targeted more social network members with advocacy for HIV testing, condom use, pre-exposure prophylaxis (PrEP) use, HIV care, and ART use over the follow-up period compared to those in the control group. In path analysis that examined each mediator in a separate model, reduced internalized HIV stigma and increased HIV knowledge as measured at month 6, each fully mediated the intervention effect on HIV care advocacy; reduced stigma partially mediated the effects on advocacy targeting each of the other four HIV protective behaviors, while increased knowledge partially mediated effects on HIV testing, condom and PrEP use advocacy. Results were unchanged when examining the joint mediation of stigma and knowledge. HIV disclosure and advocacy self-efficacy had no mediating effect. These findings highlight the importance of helping PLWH to cope with HIV stigma and gain knowledge about basic facts and common misconceptions related to HIV, to propel their engagement in advocacy for multiple HIV protective behaviors within their social networks.The trial was registered 2021-10-18 (NCT05098015).
Perceived discrimination, self-esteem, and self-acceptance have each been linked to pain outcomes, yet few studies have examined these factors together or investigated the psychological pathways connecting them. Grounded in the Biopsychosocial framework, this study explored the longitudinal mediating roles of self-esteem and self-acceptance in the relationship between perceived daily discrimination and pain interference. Archival data were drawn from the Midlife in the United States (MIDUS) study, with MIDUS II (2004–2006) as Time 1 and MIDUS III (2013–2014) as Time 2. The sample included 501 participants (ages 34–83) who self-reported chronic pain at both timepoints; the majority identified as White (92.2
Latine communities in the United States experience disproportionate exposure to trauma, yet gendered patterns of trauma and their relationship to posttraumatic stress disorder (PTSD) symptoms remain understudied. This study used a primarily quantitative investigation using quantitative content analysis to examine gender differences in trauma type (i.e., specific violence experience) and PTSD symptoms among 297 Latine American adults (i.e., cismen and ciswomen) recruited through an online survey. A content analysis of open-ended trauma descriptions identified fourteen categories, which were consolidated into four for quantitative analyses: structural/systemic trauma and severe accidents, interpersonal violence and abuse, sexual assault and abuse, and health- and loss-related trauma. An independent-samples t-test indicated no significant gender differences in PTSD symptoms with a negligible effect size (d = 0.11). However, a chi-square test revealed that trauma type differed significantly by gender (Cramér’s V = 0.25); Latinas reported more sexual/physical assault, while Latinos reported more health- and loss-related trauma. A 2 × 4 ANCOVA (controlling for generation status) showed that trauma type significantly predicted PTSD symptoms (partial η2 = 0.036), whereas gender (partial η2 = 0.002) and the gender × trauma interaction (η2 = 0.009) were not significant. Interpersonal violence and abuse were associated with more PTSD symptoms than structural/systemic trauma. Generation status significantly predicted PTSD severity (partial η2 = 0.043). These findings indicate that while PTSD severity may not differ by gender, gender is associated with differential exposure to trauma types, and trauma type, particularly interpersonal violence, is the primary predictor of PTSD symptom severity in this sample.
Systematic reviews of smoking, alcohol, diet and physical activity (PA) behaviour change interventions in pregnancy have high heterogeneity in effectiveness estimates for maternal behaviours and pregnancy outcomes, and it is unclear which features of interventions are integral to promoting effectiveness. This systematic review of reviews aimed to compare findings to identify any shared behaviour change techniques (BCTs), content, or delivery of interventions that may be associated with effectiveness across diet, physical activity, smoking and alcohol behaviours, and to identify intervention features showing promise in targeting one behaviour but have yet to be tested in addressing other behaviours. The search strategy covered reviews published between 2013 and 2025 and identified 66 reviews (9 smoking, 6 alcohol, 50 diet/PA, 1 smoking, diet, and/or PA). Diet/PA interventions should begin in the first trimester, run for a longer duration, and entail frequent engagement via a range of modalities in a supervised format (ideally from a specialist provider). Smoking intervention effectiveness was consistently associated with incentives and counselling. Brief interventions were consistently reported as effective interventions for alcohol use but there was a lack of standardisation in delivery. BCTs from the "goals and planning" and "feedback and monitoring" domains were routinely associated with effectiveness. Further research is required to explore intervention features that have shown promise in one behaviour but have yet to be tested for other behaviours, such as incentives in alcohol interventions.
Individuals with persistent pain have disproportionately high cigarette smoking prevalence and poorer cessation outcomes. There has been a shift from examining single pain diagnoses to a focus on co-occurring pain disorders referred to as chronic overlapping pain conditions (COPCs). COPCs represent a cluster of 10 disorders (e.g., irritable bowel syndrome [IBS], fibromyalgia, chronic low back pain, chronic tension-type headache) characterized by central sensitization. Yet, the relevance of COPC burden on smoking-related processes and internalizing psychopathology remains unexplored. The purpose of the present study is to improve understanding of whether the total number of COPCs is associated with smoking-related processes, including cigarette dependence severity, perceived barriers for cessation, and severity of problems when trying to quit, as well as anxiety and depression severity. Participants were 263 adults (52.1
Millions of individuals sustain traumatic injuries each year, yet the emotional impact of hospitalization and acute medical care remains understudied. Trauma-informed care (TIC) offers a framework for reducing retraumatization and supporting both patients and providers, but little is known about how TIC is understood or applied in trauma centers. This qualitative study used a human-centered design approach to examine healthcare workers’ experiences, perceptions, and training needs related to TIC within a Level 1 trauma center to inform development of a training on TIC. This study employed a qualitative approach guided by principles of Human-Centered Design (HCD) to explore healthcare workers’ perceptions, experiences, and training needs related to trauma-informed care (TIC) within a high-acuity trauma setting. Healthcare workers, including nursing assistants, registered nurses, physical therapists, advanced practice providers, and physicians were included as key informants in defining the relevance, challenges, and applicability of trauma-informed practice at the trauma center. Participants were recruited from the Trauma and Acute Care Division and hospital unit serving predominantly traumatically injured patients. Using thematic reflexive analysis, semi-structured interviews (range: 10–25 min) with 20 multidisciplinary staff revealed three overarching themes: the emotional toll and burnout associated with trauma work; TIC-aligned practices (including empathetic communication and perspective taking); and training needs including format and content and skills needed to deliver TIC effectively. Participants emphasized the need for practical, hands-on training tailored to the realities of trauma care. Trauma-informed approaches have the potential to improve patient recovery, reduce psychological distress, and lessen strain on healthcare systems. Study findings can inform broader behavioral medicine practices by guiding the development of scalable TIC interventions that meet providers’ identified needs which are adaptable to trauma centers, emergency care, and other high-acuity medical settings to enhance patient-centered care.
This study examined whether objective physiological arousal predicts patient-triggered recordings (PTRs) in patients with an implantable loop recorder (ILR), to clarify how normative autonomic activation and clinically meaningful rhythm disturbances relate to symptom-triggered monitoring behavior during long-term surveillance. Data were drawn from 2,266 ILR patients enrolled in the CERTITUDE registry between 2019 and 2025; analyses were restricted to the 878 individuals who used the PTR function at least once. Day-level ILR data from the first 12 months following implantation were analyzed. Daily physical activity percent per day (PA), weekly variability in PA, and counts of device-detected atrial fibrillation, bradycardia, and asystole were modeled as predictors of daily PTR counts using within-person repeated-measures correlations and linear mixed-effects models. Subgroup analyses were conducted by primary clinical indication. Daily PA showed near-zero within-person associations with PTR behavior (overall r = − .018), and mixed-effects models yielded very small coefficients. Weekly PA variability was not associated with PTR activation. Device-detected arrhythmic events accounted for only marginal additional variance in PTR counts, and asystole was not associated with PTR use. Patterns were consistent across ILR indications. Overall, objective physiological arousal explained little of the observed variation in PTR behavior. PTR behavior during long-term ILR monitoring appears to be shaped largely by interpretive and decisional processes, rather than by direct detection of physiological events alone. Conceptualizing PTRs as behavioral responses to ambiguity in bodily sensations highlights the importance of patient education, contextualized physiological feedback, and attention to symptom appraisal in the clinical management of ILR patients.
Healthful eating habits (i.e., increased fruit and vegetable and decreased hyperpalatable energy-dense food and drink consumption) are important for preventing chronic disease risk (e.g., obesity) and improving overall health in Black adolescents.This study examines the intrapersonal, interpersonal, and environmental factors associated with daily dietary intake in Black adolescents with overweight and obesity. Baseline data were analyzed from 241 Black parent-adolescent dyads who participated in the Families Improving Together (FIT) for Weight Loss trial (Adolescent: Mage = 12.8 years, SD = 1.8; 63
This study investigated the association between perceived weight discrimination and cardiometabolic health. A demographically diverse sample of 2632 US adults (36% Black/African American; 36% Hispanic/Latino; 29% sexual minority) completed a cross-sectional online survey. Linear regression was used to assess the association between perceived weight discrimination (assessed with the Stigmatizing Situations Survey-Brief) and cardiometabolic risk (indicated by the number of cardiometabolic conditions reported: high blood pressure, high cholesterol, heart disease, stroke, kidney disease, or diabetes), adjusting for body mass index and demographic characteristics. Cigarette smoking, alcohol use, and sleep disturbance were investigated as mediators. Perceived weight discrimination was associated with higher cardiometabolic risk. Further, greater exposure to weight discrimination was associated with higher likelihood of smoking, problematic drinking behavior, and disrupted sleep, and those behaviors in turn predicted higher cardiometabolic risk. Findings underscore the importance of addressing the negative health consequences of weight discrimination in cardiometabolic disease prevention programs.
Pain sensitivity is considered a stable characteristic that can influence the development of situational fears. It has been related to dental anxiety and expectation of pain before dental procedures. The objective of this analysis was to examine whether baseline pain sensitivity moderated the efficacy of an online cognitive-behavioral therapy (CBT) intervention for dental anxiety relative to an active control condition. Participants with high dental anxiety were recruited from a dental school clinic in the northeastern United States to participate in a randomized controlled trial. Patients were randomized to receive an online CBT intervention or a time- and attention-matched control intervention. Changes in dental anxiety were assessed using the Modified Dental Anxiety Scale (MDAS). Baseline pain sensitivity was measured by the Pain Sensitivity Index (PSI), which assesses the fearful appraisal of pain and expected consequences of pain. Participants completed questionnaires at baseline, and at 1- and 3-month follow ups. Linear mixed-effects model analyses using mean-centered interaction terms examined whether baseline levels of pain sensitivity moderated the treatment effect on dental anxiety. A total of 499 participants (70.6
Adverse childhood experiences (ACEs) increase the risk of developing chronic pain in adulthood. However, the impact of ACEs and specific ACEs subdomains on treatment response to cognitive behavioral interventions, which are among the frontline interventions for chronic pain, remains unexplored. This exploratory secondary analysis of a psychotherapy trial for chronic pain examined the associations among total ACEs and ACEs subdomains (household dysfunction and maltreatment) with pre-intervention level and treatment-related change in pain severity and interference. Trial participants (116 Veterans, Mage = 51.40; SD = 13.20) received one of two cognitive behavioral therapies for chronic pain that performed similarly in terms of pain outcomes. Participants completed self-report measures of ACEs at pre-treatment and measures of pain severity and interference at pre-treatment, weekly during treatment, post-treatment, and 3-month follow-up. There was a null association between ACEs (total and subdomains) and pain outcomes at pre-intervention. Higher total ACEs scores predicted significantly greater improvements in pain interference from pre-intervention to follow-up (p = .025). ACEs subdomains patterned differently with pain outcomes: higher maltreatment predicted significantly greater improvement in pain interference from pre-to-post-intervention (p = .049) and greater improvement from pre-intervention to follow-up, though above the threshold for statistical significance (p = .079). Further, higher household dysfunction predicted greater improvement in pain severity from pre-intervention to follow-up, though similarly above the threshold for statistical significance (p = .080). The present study yielded surprising and clinically informative results: cognitive behavioral interventions may be especially helpful for reducing pain interference in adults with higher ACEs. Furthermore, household dysfunction and maltreatment may be differentially associated with pain severity and interference. Future research is required to replicate the findings of this exploratory study.
Health compromising behaviors such as tobacco use, binge drinking, physical inactivity, sedentary behavior, obesity, and inadequate sleep are associated with increased cancer risk. Emerging adults (age 18-29) may be especially vulnerable to engaging in health compromising behaviors due to the transitional nature and novel independence during this developmental period. The current study uses data from the 2022 Health Information Trends Survey Data Linkage Project to understand relationships between aspects of the built environment (i.e., the Food Environment and the Exercise Environment) and area-based socioeconomic status (i.e., Yost index) on health behavior profiles of healthy emerging adults in the United States. Latent class analysis identified two patterns of health behaviors, of which both were considerably unhealthy for engaging in different health behaviors pertinent to cancer risk. Binary logistic regression analyses revealed a significant association between emerging adults with lower access to exercise environments and a trend towards significance for those residing in median level socioeconomic status environment (SES) with emerging adults in health behavior Class 2. Analyses focused on identifying sociodemographic factors that increase cancer risk revealed that education level moderated the relationship between SES and health behavior class, and that education level and, separately, living in a rural area moderated the relationship between the exercise environment and health behavior class. Findings provide a greater understanding of emerging adults' built and socioeconomic environments that present barriers to engaging in healthy lifestyles. The findings present opportunities for future research and evidence-based interventions to be conducted with consideration to the role of the built and socioeconomic environment in mitigating cancer risk among the emerging adult population.
Depression is common among individuals with chronic kidney disease (CKD). The Common-Sense model suggests that illness representations are related to coping responses and emotional outcomes as individuals interpret and respond to health-related threats. This study investigated the associations between illness representations and depression in Chinese CKD patients, with a focus on maladaptive emotional coping and positive reframing as potential mediators. A total of 442 participants (mean age = 36.28, SD = 10.23; 57.5
Childhood maltreatment has lasting adverse effects across multiple domains, contributing to cumulative disadvantage and accelerated aging. These outcomes may reflect not only individual vulnerability, but also ethnoracial-related differences in lived experience, highlighting how sociocultural contexts shape long-term risk. The effect of childhood maltreatment on cognitive functioning later in life varies, raising questions about the mechanisms that drive this association. Data were drawn from the Midlife in the United States (MIDUS) study. Participants were categorized into two racial groups for analysis; non-Hispanic white and ethnoracial minority. Physiological and psychosocial variables were pulled from wave II and cognitive variables were extracted from waves II and III. At wave II, the analytic sample included 692 adults (56
The colonization of Turtle Island, which includes the United States, involved the mass genocide of Indigenous Peoples and discriminatory policies. These harmful acts have resulted in massive group trauma disrupting family systems across generations. The role of historical trauma in ongoing intergenerational transmission and toxic stress among Indigenous families renders an opportunity to better understand the role of kinship systems to inform behavioral medicine. Although 87% of the American Indian and Alaska Native population in the U.S. reside in metropolitan areas, urban Indigenous peoples have often been made invisible and their experiences misrepresented. The current study centers the voices and the lived experiences of caregiving adults within the urban Indigenous community of one metropolitan area to identify what encompasses a strong sense of cultural connection and belongingness for families and communities to promote healing and break cycles of intergenerational trauma transmission. With the guidance of a Community Advisory Board, four talking circles, an Indigenous research method, were held with 14 adult participants who identified as urban Indigenous caregivers (i.e., parents, guardians, Elders, educators, practitioners) of children. Transcripts underwent hybrid coding and reflexive thematic analysis. Four primary themes were identified: (1) Grounding in identity; (2) Barriers to belongingness and strong sense of self; (3) Fostering belongingness; and (4) Pathways for healing. Participants called for culturally and trauma-informed community caregiving and healing initiatives that are inclusive of the diversity and multiplicities of urban Indigenous populations. Implications of these findings inform strengths-based approaches to promote generational healing through an Indigenous worldview.
Posttraumatic stress disorder (PTSD) is associated with elevated risk for cognitive decline and neurodegeneration in later life, yet the underlying biological mechanisms remain poorly understood. One hypothesized pathway involves dysfunction of the blood–brain barrier (BBB) via altered expression of claudin-5 (CLDN5), a tight junction protein key to BBB integrity. Our prior cross-sectional study found that DNA methylation (DNAm) in blood at three CLDN5 loci was associated with trauma exposure, PTSD symptom severity, and plasma neurofilament light (NFL). Building on these results, this study examined whether CLDN5 DNAm in blood predicted future PTSD symptom severity, NFL, neuropsychological performance, and CLDN5 RNA expression in blood, a possible proxy for CLDN5 in the brain. Trauma-exposed Veterans (N = 221; 174 returned for follow-up) were assessed twice over 5.6 years on average. Participants completed diagnostic interviews, provided blood samples at both timepoints, and completed a neuropsychological battery at follow-up (California Verbal Learning Test-II, Wechsler Adult Intelligence Scale and Delis-Kaplan Executive Function System subtests). Baseline CLDN5 DNAm at cg21872764 predicted increased PTSD symptom severity at follow-up, accounting for baseline PTSD symptoms (β = .128, p = .035). This probe was associated with future CLDN5 RNA expression (β= −.186, p-adj = .035) as was cg00804504 (β = .185, p-adj = .035). CLDN5 DNAm at cg16773741, linked to cognitive decline, predicted working memory performance at follow-up (β = .269, p-adj = .015). No loci were associated with NFL levels after corrections for multiple testing. Results suggest that CLDN5 DNAm is associated with increased PTSD severity over time among Veterans with substantial trauma histories and is associated with neuropsychological functioning. This raises the possibility that BBB disruption is part of PTSD pathology, which may help identify the biology underlying comorbidity between PTSD and neurodegenerative disorders.
Methods and theory are deeply intertwined in behavioral research: theoretical developments lead to the need for new methods, and methodological innovations, in turn, open the door to new theoretical insights. To continue advancing research in behavior medicine, new methods need to be developed and implemented. At the same time, data collected in this field are becoming increasingly complex, requiring quantitative approaches that are both rigorous and accessible to analyze them effectively. In this Special Issue we have included eighteen papers that highlight developments and applications of quantitative methods for behavioral medicine. Across the papers we identified six main themes: mixture modeling, longitudinal modeling, location-scale models, methods for randomized trials and causal inference, methods using Bayesian inference, and estimating complex, nonlinear relationships.
