Abstract Objectives To examine whether functional health literacy moderates the effects of menu labeling formats on fast-food ordering behavior. Methods A total of 2829 US adults completed an online randomized controlled survey in 2022. Participants viewed 1 of 8 menus in a 2 × 2 × 2 factorial design varying calorie labels (present/absent), sodium stoplight icons (present/absent), and “all-natural” claims (present/absent), then selected an entrée, side, beverage, and optional dessert. Linear regression models tested main and interaction effects of labeling formats and functional health literacy on total calories and sodium ordered, adjusting for sociodemographic characteristics, fast-food consumption frequency, and typical ordering patterns. Results In covariate-adjusted within-literacy comparisons, several labeling experimental conditions were associated with lower-calorie and lower-sodium selections among participants with moderate functional health literacy, whereas no significant differences were observed among participants with low or high literacy. Significant differences among moderate-literacy participants ranged from 90 to 135 fewer calories and 123 to 154 mg less sodium compared with the control condition (nominal P < .05). Conclusion Menu labeling effects were not uniform in this online fast-food ordering experiment. Their impact depends on consumers’ ability to interpret basic nutrition information. Designing more intuitive labels may improve the equity and effectiveness of restaurant nutrition policies.
Abstract Background Gender disparities in COVID-19 prevention were likely driven by male gender socialization, but no research has tested beliefs that prospectively connect endorsement of masculine norms to reduced COVID-19 prevention behavior among men. Purpose We explored whether men’s endorsement of masculine norms influenced COVID-19 prevention behavior via illness-related beliefs and prevention intentions. Method Early in the COVID-19 pandemic (April 2020), American men (N = 355; Mage = 46.61, 78.9% White) reported their baseline prevention behavior, masculine norms, COVID-19 strength beliefs, and prevention intentions. Two weeks later, they reported participation in CDC (Center for Disease Control)-recommended COVID-19 prevention behaviors (eg, social distancing) and willingness to participate in prevention behavior not yet available (eg, COVID-19 vaccination). Results Mediation models indicated that masculine norms endorsement serially related to greater belief that strength protects against COVID-19, then lower intentions to participate in prevention behaviors, which predicted lower prevention behavior (b = −0.0073, SE = 0.0043, 95% CI, −0.0172 to −0.0004) and future prevention willingness (b = −0.0073, SE = 0.0046, 95% CI, −0.0180 to −0.0004). Conclusions Masculine norm endorsement indirectly predicted lower COVID-19 prevention behaviors and willingness to participate in emerging prevention behaviors via illness-related beliefs and reduced prevention intentions. These results suggest that masculine norms shape pandemic prevention-related decisions via beliefs that being strong can protect against the virus. Results persisted across demographic differences, political orientation, and severity of regional outbreaks. Public health efforts to reduce gender disparities in pandemics should consider how recommended actions interact with masculine norms and how to leverage interventions to promote men’s health.
Abstract Background Sleep disturbance is common among cancer survivors, but more research is needed to understand individual differences and predictors during the transition from primary treatment to early survivorship. Purpose This study aimed to: (1) model sleep disturbance trajectories among cancer survivors from post-primary treatment into early survivorship, (2) examine the relationships of general (i.e., anxiety, depression, emotion dysregulation) and cancer-specific (i.e., illness beliefs, fear of cancer recurrence) factors with sleep disturbance trajectories, and (3) examine the association between sleep disturbance trajectories and changes in physical health. Methods A total of 501 breast, colorectal, and prostate cancer survivors (24-80 years old, 69.9% female, 84.6% White) completed self-report measures at baseline (approximately 3 months post-primary cancer treatment) and 3-, 6-, 9-, and 12-month follow-ups. Latent class linear mixed modeling identified distinct trajectories of sleep disturbance. Psychosocial correlates of trajectory membership were examined using multinomial logistic regression. A linear regression tested whether sleep trajectory class was associated with changes in physical health over one year. Results Three sleep disturbance trajectories were identified: low and slightly improving (44.3%), average and slightly improving (32.9%), and high and slightly improving (22.8%). Individually, higher emotion dysregulation, anxiety, depression, fear of cancer recurrence, and illness beliefs significantly differentiated the high sleep disturbance group from the low and average groups. In the combined model, only anxiety and depression symptoms remained significant. The high sleep disturbance group had significantly less improvement in physical health over one year compared to the low group. Conclusions Both general and cancer-specific psychosocial factors appear to play a key role in identifying individuals at risk for persistent sleep disturbance following cancer treatment. Sleep disturbance trajectories were also associated with changes in physical health over one year, underscoring the importance of early intervention.
Abstract Background Chronic pain affects up to 40% of adults with sickle cell disease (SCD), yet treatment options remain limited. While cognitive behavioral therapy (CBT) is effective in other chronic pain conditions, it is underutilized for SCD pain, and its effectiveness remains unclear. Purpose The Cognitive Behavioral Therapy and Real-time Pain Management Intervention for Sickle Cell via Mobile Applications (CaRISMA) compared digital CBT to Education for chronic SCD pain in adults. At 6 months, the primary outcome (pain interference) showed no between-group difference but both groups improved (CBT: −2.13; Education: −2.66). This report presents 12-month outcomes. Methods A total of 359 participants with SCD chronic pain were randomized to 12 weeks of digital CBT (n = 181) or Education (n = 178), both with weekly health coach support. Results At 12 months, 56.5% (n = 203) completed follow-up. No between-group differences in pain interference were observed [0.43, 95% CI, −1.61 to 2.48; P = .68]; however, both groups sustained improvement from baseline (CBT: −1.50; Education: −1.93). Cognitive behavioral therapy participants reported greater improvement in emotional impact [2.00, 95% CI, 0.12-3.88; P = .04], while pain intensity, depression, anxiety, and opioid misuse did not differ between groups. Higher health coach engagement was associated with reduced pain interference [−0.073 per 10% increase in engagement; P < .01]. Conclusions Although no between-group differences were found, both groups showed sustained improvement in pain interference at 12 months. Personalized support may have contributed to these improvements, highlighting the value of human support within digital interventions. Further research is needed to clarify the relative contributions of digital CBT vs human support. Study registration This trial was registered on ClinicalTrials.gov (Identifier: NCT04419168. Registered 06/05/2020). Analytic plan registration The trial protocol and analytic plan were pre-registered and are publicly available (https://www.researchprotocols.org/2021/5/e29014).
Abstract Background Low back pain (LBP) is the leading cause of disability globally and contributes substantially to healthcare costs and lost productivity. Physical activity (PA) is recommended for managing LBP, nevertheless, many individuals with LBP remain insufficiently physically active, and strategies to support behavior change are needed. Motivational interviewing (MI) may support behavior change by enhancing intrinsic motivation and self-efficacy. Purpose To synthesize evidence on the effects of MI interventions targeting PA behavior in adults with LBP. Methods Six databases (MEDLINE, Embase, CINAHL, Web of Science, CENTRAL, PsycINFO) and clinical trial registries were searched from inception to February 2026. Eligible trials evaluated MI-based interventions targeting PA in adults with acute, subacute, or chronic LBP. Random-effects meta-analyses were conducted to calculate standardized mean differences (SMD; Hedges’ g) and 95% confidence intervals (CI). The primary outcome was change in PA; secondary outcomes included pain and disability-related outcomes. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was evaluated using GRADE. Results Motivational interviewing-based interventions were associated with a statistically significant increase in PA compared with control conditions (SMD: 0.57; 95% CI, 0.10-1.03; P = .02), representing a moderate effect. No statistically significant effects were observed for pain (SMD: 0.04; 95% CI, −0.27 to 0.36; P = .76) or disability (SMD: 0.08; 95% CI, −0.25 to 0.40; P = .60). Certainty of evidence was low for PA and very low for pain and disability outcomes. Conclusions Motivational interviewing interventions were associated with increased PA in adults with LBP but did not demonstrate significant effects on pain or disability. MI may serve as a client-centered support strategy within broader rehabilitation models. Further high-quality trials with fidelity assessment and longer follow-up are warranted.
Abstract Background The renin-angiotensin-aldosterone system (RAAS) is widely recognized for its role in maintaining fluid and electrolyte balance, as well as its involvement in the pathogenesis of certain forms of cardiovascular disease (CVD). Recent research suggests that, in addition, the RAAS may play a role in the body’s response to stress, making activity of the RAAS a potential mechanism linking stress exposure or psychopathology to cardiovascular disease risk. Purpose This rapid scoping review synthesizes the relevant literature that has been published on this topic over the past 16 years. Methods An original and updated search of the PubMed database resulted in 4632 titles for screening. Of these, 37 articles, reporting on 31 unique samples, met criteria for inclusion. Results The results of this review suggest that acute psychological stress results in short-term elevations in multiple components of the RAAS. Evidence supporting an association between psychopathology and RAAS activity is mixed and inconclusive. No studies have examined whether the effects of stress or psychopathology on CVD is mediated by the RAAS. Conclusions Current evidence suggests that the RAAS is involved in the acute response to psychological stress, and future research should seek to establish the unique downstream health effects of this RAAS activation. There is insufficient evidence to support a mediating role of RAAS activity in associations between stress and CVD risk at this time. Additional systematic reviews of select topic areas within this literature are warranted.
Abstract Background Virtual reality (VR) exercise is an alternative mode of physical activity with potential mental health benefits. The purpose of this study was to examine the effectiveness of a VR exercise program for improving community adults’ well-being (ie, subjective vitality), depression, anxiety, and executive functioning. Methods A 2-arm, parallel, single-blinded randomized controlled trial design was conducted to compare a 10-week home-based commercially available VR exercise program (Supernatural Fitness Application) (n = 73) with a waitlist control (WLC) condition (n = 81). Primary (well-being) and secondary (depression, anxiety, executive functioning) outcomes were self-reported at baseline, week 5, and week 10 of the study. Participants were enrolled between March 19, 2024, and March 18, 2025. Analyses were conducted using mixed-effects regression models. Results The VR exercise program resulted in statistically significant improvements (P < .01) in subjective vitality and decreases in depression and anxiety symptoms relative to the WLC condition across the 10-week study. At week 10, the VR exercise condition reported greater subjective vitality (d = 0.49; 95% CI, 0.17 to 0.81) and less depression (d = −0.42; 95% CI, −0.74 to −0.10) and anxiety (d = −0.22; 95% CI, −0.54 to 0.10) than the WLC condition. There were no statistically significant effects for executive functioning. Discussion Home-based commercially available VR exercise has similar effects on well-being and mental health compared to traditional modes of physical activity. Practitioners can recommend commercially available VR exercise to individuals as an alternative mode of physical activity to support mental health. Trial registration ClinicalTrials.gov NCT06367439 on April 11, 2024.
Background Digital health interventions are rapidly expanding in low- and middle-income countries (LMICs), yet little is known about how design and delivery components can be tailored to support engagement across diverse populations. Addressing this gap is critical for effective and equitable implementation.Purpose This study used a factorial experiment, embedded within the Optimization Phase of the Multiphase Optimization Strategy (MOST), to examine whether caregiver characteristics moderated the effects of design and delivery components on engagement with an app-based parenting intervention in Tanzania.Methods A 2 & times; 2 & times; 2 cluster-randomized factorial experiment was conducted in Mwanza, Tanzania (16 clusters; 614 caregivers of adolescents). Three components were tested: guidance (guided vs self-guided), app design (unstructured vs structured), and digital support (enhanced vs basic). Engagement was operationalized as the number of intervention modules completed, which was tracked automatically via the app. Generalized linear mixed-effects models examined moderation by caregiver gender, age, financial stress, food insecurity, positive parenting, child maltreatment, and caregiver depression.Results Gender, age, positive parenting, and depressive symptoms moderated the effects of specific components on engagement. Women showed significantly higher engagement with the unstructured versus structured app design (incidence rate ratio [IRR] = 1.48, 95% CI, 1.23-1.80), whereas no significant app design differences were observed among men. Older caregivers showed greater engagement under guided delivery (vs self-guided; IRR = 1.15, 95% CI, 1.06-1.25) and enhanced digital support (vs basic support; IRR = 1.15, 95% CI, 1.06-1.26). Greater engagement under guided versus self-guided delivery was also observed among caregivers reporting more positive parenting practices (IRR = 1.03, 95% CI, 1.02-1.04) and higher depressive symptoms (IRR = 1.06, 95% CI, 1.03-1.09). However, caregivers reporting more positive parenting practices showed lower engagement under enhanced digital support (vs basic support; IRR = 0.96, 95% CI, 0.95-0.98). No moderation effects were observed for financial stress, food insecurity, or child maltreatment.Conclusions Tailoring design and delivery components to specific caregiver characteristics may enhance engagement and promote more equitable implementation of digital parenting interventions in LMICs.Clinical trial registration number The trial was pre-registered on the Pan-African Clinical Trial Registry PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051. Violence against children is a major global health concern, and parenting programs are among the most effective ways to prevent it. This study examined whether caregiver characteristics influenced how different design and delivery components affected engagement with ParentApp, a non-commercial smartphone app designed for caregivers of adolescents in low- and middle-income countries.A total of 614 caregivers from low-income communities in Tanzania used ParentApp over a 12-week period. Communities were randomly assigned to different combinations of app design and delivery components. These included app use supported by facilitator-led WhatsApp groups versus self-guided app use, app designs that varied in content access and illustration style, and enhanced versus basic app onboarding support.Women engaged more when they received an app design that provided immediate access to all content alongside culturally adapted illustrations. Older caregivers engaged more when they received WhatsApp group support or enhanced app onboarding support. Caregivers reporting depressive symptoms and those already practicing more positive parenting also engaged more with WhatsApp group support. Together, these findings suggest that tailoring design and delivery components to specific caregiver characteristics may enhance engagement and promote more equitable delivery of digital parenting interventions in low- and middle-income countries.
Abstract Background Traditional randomized controlled trials are limited in their ability to inform the development of adaptive interventions tailored to the needs of individuals with a chronic physical and/or mental illness. Sequential Multiple Assignment Randomized Trials (SMARTs) provide a rigorous design for developing and evaluating adaptive interventions. Purpose This scoping review examined the application of SMARTs to develop and evaluate adaptive behavioral interventions for individuals with a chronic physical and/or mental illness. Methods A search was conducted in 4 electronic databases, using a three-step process following Joanna Briggs Institute recommendations. Records were screened using Rayyan. Narrative synthesis and deductive content analysis were performed. Results Fifteen unique SMARTs were found, all examining stage-specific main effects; few evaluated embedded adaptive interventions. Two-stage SMARTs with re-randomization of non-responders only were the most common design. SMARTs typically spanned 12-13 weeks, used a single tailoring variable (often the same as the primary outcome), and defined response using threshold-based criteria. Adaptations for non-responders involved continuing with or adding a new component to the stage 1 intervention, whereas responders continued with the stage 1 intervention or received boosters. Responder rates ranged from 6.1% to 87%. Based on the 12 large SMARTs (excluding pilots), stage 1 and 2 effects were often nonsignificant, and adaptive interventions did not seem to result in the intended improvements in outcomes. Reported challenges included complex logistics, large sample size requirements, and high costs, but SMARTs enabled real-world, dynamic comparisons. Conclusion Insights from this review can guide the design of SMARTs to meet diverse population needs.
Abstract Background Hand osteoarthritis (HOA) is a common and disabling condition that impairs hand function. Traditional joint protection programs (JPPs) are recommended for reducing pain and deformity and potentially slowing disease progression. While JPPs are supported by trials, programs are outdated, not co-designed and poorly implemented. Behavioral science frameworks and patient co-design methodologies may enhance relevance, adherence, effectiveness, and sustainability. Purpose This study aimed to map and characterize the behavioral components of JPPs for adults with HOA and to examine the extent of patient co‑design. Methods We conducted a scoping review with directed content analysis following Arksey and O’Malley’s framework. We used the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Six databases and 1 clinical-trial registry were searched from inception to April 3, 2025. Eligible studies included any empirical design that included interventions described as “joint protection” or clearly aligned with its core components for adults with HOA. Two reviewers independently coded intervention content using the Behavior Change Technique Taxonomy version 1 and assessed the presence of patient co-design with criteria derived from Experience-Based Co-Design frameworks. Discrepancies were resolved by consensus. Results A total of 32 studies met the inclusion criteria. We identified 22 unique behavioral change techniques across 11 clusters. “Instruction on how to perform the behavior” was the most common item (32 studies, 100%), followed by “Behavior substitution” (23 studies, 72%) and “Restructuring the Physical Environment” (17 studies, 53%). Patient co-design was explicitly integrated in 8 studies, with varying methods and levels of engagement. In most cases, patient input was included during the intervention design stage, while only a few studies involved patients in iterative feedback and refinement. Only 1 study combined theoretically informed behavioral content with active patient co-design, highlighting a substantial gap in the development of JPPs for HOA. Conclusions Most JPPs for HOA incorporate behavioral change techniques but rarely systematically apply behavior change theory, clearly articulate behavioral change mechanisms or engage patients meaningfully in co-design. Integrating established behavioral frameworks with authentic patient co‑design could yield interventions that are both relevant and sustainable. Future programs development should embed systematic behavioral theory and genuine patient partnership from conception through refinement to support durable behavior change in people with HOA.
Abstract Background Stigma associated with smoking, chronic obstructive pulmonary disease (COPD) and lung cancer is prevalent and can cause distress and delayed treatment-seeking. Interventions to reduce stigma are becoming more widespread and a variety of stigma scales have been developed, but it is unknown how psychometrically sound and appropriately worded they are. Purpose To (1) systematically identify scales that measure stigma in people who smoke, or those living with COPD or lung cancer; (2) analyze the content of items and language used; and (3) evaluate their psychometric properties. Methods PubMed, Embase, Web of Science, and Scopus were searched to identify quantitative scales measuring stigma in smoking, COPD, or lung cancer. The Lung Cancer Stigma Communications Assessment Tool was used to assess whether the scales contained language that could exacerbate stigma amongst participants. The COSMIN tool was used to evaluate the psychometric properties of the scales. Results We identified 962 articles for screening, of which 28 eligible scales were included. The majority (n = 17) measured lung cancer stigma. The content of items largely aligned with theoretical dimensions of stigma. No scales were free of language that could exacerbate stigma. In relation to psychometrics, the majority of the stigma scales assessed internal consistency (n = 25), construct validity (n = 20), and structural validity (n = 15). All scales were categorized as Class B, meaning that they have potential for use but require further research and psychometric testing. Conclusion A comprehensively validated stigma scale is needed that uses non-stigmatizing, bias-free, and person-first language.
Background A nationwide targeted lung cancer screening program is underway in the United Kingdom, but uptake in recent trials remains modest, and little is known about the psychological processes that might influence uptake.Purpose This study aimed to understand how individuals respond to a lung cancer screening invitation by identifying the key psychological, cognitive, and affective variables shaping screening intention and the thought processes underlying them.Methods UK screening-eligible current and former smokers aged 55-74 years (N = 1106) read an online lung screening invitation before providing their unprompted thoughts and completing measures of cognitive and affective variables (attitude; descriptive, subjective, and moral norms; perceived behavioral control; fear; anticipated regret; and fatalism). Logistic regressions examined predictors of screening intention, with follow-up analyses linking thought content to significant cognitive and affective predictors.Results Moral and descriptive norms, perceived behavioral control, and inaction regret were positively associated with intention, while fear and anticipated regret associated with taking part and receiving abnormal results were negatively associated. Thoughts reflecting NHS program doubts, stigma, and cancer worry were consistently negatively associated with cognitive and affective predictors, whereas perceived screening benefits of early detection and peace of mind, and personal/family cancer history were positively associated.Conclusion Screening motivation was shaped by both cognitive and affective factors, underpinned by distinct thoughts. Findings suggest that health communication interventions may strengthen moral and descriptive norms, leverage inaction regret, and enhance self-efficacy by addressing feelings of stigma, embarrassment, and cancer worry to increase screening participation at this critical stage of national implementation. This study examined how people may respond when they are invited to a new United Kingdom lung cancer screening program that will invite people who are current or former smokers. Screening can detect lung cancer earlier, when treatment is more successful. Researchers surveyed 1106 current and former smokers aged 55-74 years. Participants read a lung cancer screening invitation, shared their immediate thoughts, and answered questions about their views and feelings about screening. People were more willing to attend screening when they felt confident they could cope emotionally with taking part, believed that others like them would also attend, felt that attending was the right thing to do, and thought they might regret missing the opportunity for early detection or peace of mind. People with a family history of cancer were also more positive about the program. People were less willing when they felt fearful about cancer, or worried about feeling stigmatized by health care professionals. These findings suggest that screening invitations should strengthen confidence, highlight that similar others attend screening, encourage reflection on the regret of missing the opportunity, reinforce the value and benefits of taking part, and help people cope with their fears about bad news or being stigmatized.
Background Modest weight loss is associated with improved cardiovascular disease risk factors in binge-eating disorder (BED) with obesity following lifestyle behavioral weight loss treatment.Purpose This study examined changes in physical activity and associations with outcomes following lifestyle behavioral weight loss treatment.Methods In this secondary analysis of a randomized controlled trial for BED with obesity testing standard lifestyle behavioral weight loss treatment and a stepped-care approach built upon lifestyle behavioral weight loss treatment, physical activity, weight, cardiovascular disease risk factors, and eating-disorder psychopathology were assessed at baseline, posttreatment (after 6-month lifestyle behavioral weight loss treatment), and 12-month follow-up (18 months after baseline).Results Physical activity was infrequent at baseline (18.2% "active"), increased during treatment (49.1% "active" at posttreatment), and remained increased at 12-month follow-up (48.0% "active"). At posttreatment, moderate and active groups lost more weight than sedentary. At 12-month follow-up, active group had lower body mass index and greater percent weight loss than sedentary group. Physical activity and physical activity change were related to few cardiovascular disease risk factor outcomes, in contrast with significant associations between weight loss and improvements in several cardiovascular disease risk factor outcomes. Additionally, at posttreatment, active group had lower eating-disorder psychopathology, while sedentary group was less likely to attain binge-eating remission.Conclusions Lifestyle behavioral weight loss treatment for BED with obesity was associated with increased physical activity sustained through 12-month follow-up. Increased and moderate/active physical activity levels were associated with weight loss and improved eating-disorder psychopathology, but not cardiovascular disease risk factor outcomes/changes, which were associated with weight loss. People who are diagnosed with binge-eating disorder are more likely to have overweight/obesity, and are also more likely to be diagnosed with cardiac and metabolic disorders, like heart disease and diabetes. Compared to people who have obesity, people with both binge-eating disorder and obesity have a harder time losing weight and are also physically inactive. In the past, researchers have found that losing weight was related to improvements in cardiac and metabolic measures, but we do not know whether that is due to weight loss itself or something else-like increased movement or improved diet. In this study, we look to see if a behavioral intervention for binge-eating disorder can increase physical activity-so, things like gardening, running, bowling-and if an increase in physical activity is related to improvements in cardiac health (for example, decreased total cholesterol) and metabolic health (for example, decreased glycated hemoglobin A1c). Overall, we found that typically people with binge-eating disorder who completed our intervention did increase their physical activity-and this lasted for a year after treatment, and that these increases in activity were related to weight loss. Increases in activity did not seem to cause improvements in health, but decreases in weight were related to health improvements.
Abstract Background Compensatory health beliefs (CHBs), the belief that a healthy behavior can offset the effects of a health-compromising one, have been theorized to both justify unhealthy behaviors and motivate health-promoting ones. However, findings in the literature are inconsistent. Methods These meta-analyses synthesized 252 effect sizes from 59 independent samples using robust variance estimation to examine the relationships between CHBs and four outcomes: intentions and engagement in compensatory health behaviors and intentions and engagement in health-compromising behaviors. Results Approximately 13,760 individuals were represented across these analyses (ages 12-79; women ∼66.1%; college-based = 69.8%). CHBs were significantly associated with greater intentions to engage in compensatory health behaviors (r = 0.21) and with greater engagement in health-compromising behaviors (r = 0.18), but were not reliably associated with compensatory health behaviors or intentions to engage in health-compromising behaviors. Heterogeneity was substantial across all models, but only one significant moderator emerged: CHBs were more strongly associated with compensatory intentions in studies examining diet compared to physical activity. Funnel plot symmetry and stability across values of ρ supported the robustness of findings. Conclusions These results highlight the potential for CHBs to undermine health behavior change efforts, particularly when intentions to engage in healthy behaviors are not carried out. Future work should explore state-level CHBs and real-time decision-making to clarify how and when these beliefs influence behavior.
Background Food insecurity (FI), depression and anxiety are known risk factors for type 2 diabetes. FI can be transient, but short-term relationships between FI and symptoms of depression and anxiety are not described.Purpose We used a micro-longitudinal design to investigate the between- and within-person relationships between FI and symptoms of depression and anxiety.Methods Participants were n = 76 Latinas living in Hartford, CT, United States, who had high risk for type 2 diabetes, utilized SNAP benefits and screened positive for FI. Recruitment and data collection were from April 2021 to June 2023. Data were collected at 6 time points over 3 consecutive months. FI was measured over the phone by trained bilingual interviewers with the 15-item US Household Food Security Survey Module. FI scores across timepoints were categorized as food secure, intermittent food insecure, or persistent food insecure. Depressive symptoms were measured with the 8-item Personal Health Questionnaire and anxiety symptoms with the 8-item PROMIS anxiety scale. A multilevel regression model was used to predict FI from between- and within-person depression and anxiety predictors.Results Compared to those experiencing persistent food security or intermittent FI, those experiencing persistent FI reported higher symptoms of depression and anxiety overall. Within persons, when FI score was higher than an individual's own average, symptoms of anxiety and depression were also higher. Between-person associations were approximately twice the magnitude of within-person associations.Conclusions Food insecurity is associated with symptoms of depression and anxiety at the between- and within-person levels. Overall levels of depression and anxiety differ by persistence of FI. Repeated and/or prolonged exposures to FI and associated distress should be examined as risk factors for incident type 2 diabetes. Food insecurity is a major problem in the United States. Rates of food insecurity are highest among Latinos and in households headed by women. Monthly nutrition assistance can help, but financial assistance may run out before the next assistance is distributed; running out is usually distressing. Food insecurity (FI), depression, and anxiety each increase the likelihood that an individual may developing type 2 diabetes. This study looked at FI, anxiety, and depression among Latinas who are at high risk for type 2 diabetes. Researchers followed the same 76 women over a 3-month period. They assessed FI, symptoms of anxiety, and symptoms of depression 6 times over the 3 months. Researchers found that women who reported FI at every timepoint (persistent FI) had the highest overall levels of symptoms of anxiety and depression, women who reported FI at only some of the timepoints (intermittent FI) had intermediate levels of symptoms of anxiety and depression, and women who were food secure at every timepoint had the lowest levels of depression and anxiety. Researchers also found that when a woman's FI score increased her levels of depression and anxiety also increased, and when the same woman's FI score decreased, her levels of depression and anxiety decreased. Interventions should integrate more frequent nutrition assistance with mental health support. Studies should test whether such programs decrease risk for developing type 2 diabetes.
Abstract Background Global environmental change poses a significant threat to human health, necessitating effective communication strategies to raise public awareness and motivate mitigation and adaptation actions. Previous studies have examined whether framing climate change and other environmental issues as health problems can increase public engagement, with mixed results. Purpose This mixed-methods systematic review synthesizes existing evidence on the effectiveness of health framing in text-based environmental communication interventions. Methods We searched 5 electronic databases (Web of Science, Scopus, PubMed, PsycINFO, and Communication and Mass Media Complete) from inception to May 9, 2025, and identified 46 relevant articles (54 studies). The Mixed Methods Appraisal Tool was used to assess study quality, and qualitative narrative synthesis was performed. Results Most studies were randomized controlled trials conducted among the general public in high-income, English-speaking countries. Key findings indicate that health-framed environmental messages are generally perceived as clear and helpful, particularly when employing a gain frame and emphasizing mitigation benefits. Health framing also effectively increases threat perception, policy support, and health-protective intentions, although its impacts on sustainable lifestyle changes and advocacy behaviors are less consistent. Conclusions Future research should incorporate rigorous designs and diverse populations and focus on long-term, real-world outcomes to obtain a clearer understanding of effective communication strategies at the intersection of global environmental change and health. Registration The systematic review protocol was registered within the PROSPERO database (CRD420251050978).
Background Among US groups, Native Americans (NAs) have the highest rates of smoking and chronic pain. No study has examined whether smoking contributes to NA chronic pain disparities.Purpose We tested a biopsychosocial model linking smoking with chronic pain among NAs.Methods Social, psychological, and biological variables associated with chronic pain risk and smoking were assessed in healthy, pain-free NAs and non-Hispanic Whites (NHWs). Participants were followed for 5 years to assess who did (N = 49) and did not (N = 151) develop chronic pain (pain rated >= 3/10 on most days lasting >= 3 months).Results Native Americans had higher odds of smoking and developing chronic pain than NHWs, and smoking predicted chronic pain at 5 years (OR = 3.86, 95% CI, 1.59-9.35), even after controlling for age, sex, income, and education, but NA ethnicity did not confer greater chronic pain risk among those that smoke. A path analysis suggested that smoking contributed to the NA chronic pain disparity via 4 indirect paths. One linked NA ethnicity to chronic pain via smoking. Others suggested that the higher smoking rate in NAs was partially explained by interpersonal discrimination, and that cardiometabolic load (stress-related wear-and-tear on cardiovascular/metabolic systems) and impaired physiological pain inhibition (assessed by quantitative sensory testing) linked smoking to NA chronic pain.Conclusions Smoking fits within a biopsychosocial model of NA chronic pain risk. Discrimination is linked to higher rates of smoking among NAs; smoking is associated with the NA chronic pain disparity; and higher cardiometabolic load and impaired pain inhibition link smoking to NA pain disparities. Native Americans experience some of the highest rates of smoking and chronic pain in the United States, but the reasons for these disparities are not fully understood. This study followed healthy Native American and non-Hispanic White adults for 5 years to learn whether smoking contributes to the development of chronic pain, and what social, psychological, and biological factors might explain this link. We found that Native American participants were more likely to smoke and more likely to develop chronic pain. Smoking greatly increased the chances of developing chronic pain for everyone in the study. For Native Americans, higher smoking rates were partly explained by greater experiences of discrimination. Discrimination was also linked with stress-related wear-and-tear on the body and with disruptions in the body's natural ability to regulate pain. Our results suggest that discrimination may lead to smoking, which then increases physiological strain and weakens pain-regulating systems, raising the risk for chronic pain. These findings highlight that smoking cessation, culturally grounded support, and efforts to reduce discrimination are important strategies for preventing chronic pain and promoting health equity among Native Americans.
Background: Sequential physical activity interventions hold promise in developing effective interventions when adapted to participants' physical activity. Adaptive interventions can be further strengthened by understanding the moderators of their effects on physical activity outcomes. Purpose: To determine whether baseline personal characteristics moderated the impact of adaptive interventions on physical activity in the Working Women Walking trial. Methods: This study analyzed data from a sequential multiple assignment randomized trial (SMART) targeting 18- to 70-year-old women employed at an urban medical center who self-reported low physical activity (N = 301). Four adaptive interventions included combinations of Initial Treatments (Fitbit or Fitbit + Text Messages) and Augmented Treatments for nonresponders (Motivational Calls or Group Meetings). Personal characteristics, including demographics, health status, self-reported physical activity, and neighborhood walkability, were measured at baseline. Moderation of intervention effects was tested across ActiGraph-assessed physical activity at baseline, 9-10 weeks (end of Initial Phase), 35-36 weeks (end of Augmented Phase), and 49-50 weeks (end of Maintenance). Results: There was no evidence that personal characteristics moderated the differential impact of the Initial or Augmented Treatments on device-assessed steps or moderate-to-vigorous physical activity. Independent of the Initial Treatment, Black race, higher baseline body mass index, and higher baseline self-reported moderate-to-vigorous physical activity were associated with lower increases in physical activity (P < .05) during the Initial Phase. Lower neighborhood walkability was associated with relative decreases in physical activity during the Maintenance Phase. Conclusions: Although personal characteristics may have altered the degree to which participants increased their physical activity, they did not alter the differential impact of the adaptive interventions.
Background Firearm violence is a pressing public health crisis in the United States and disproportionately impacts sexual and gender minority (SGM) young adults of color who already face systemic inequities. Despite elevated risks of suicidality and violence victimization, firearm violence research rarely focuses on SGM populations.Purpose This study examined firearm experiences among SGM young adults of color in Detroit, MI, to inform trauma-informed care, firearm safety education, and inclusive prevention strategies.Methods Using a community-engaged convergent parallel mixed-methods design, we integrated survey data and in-depth qualitative interviews. Participants (N = 24; aged 18-29) were recruited through a community health center serving SGM young adults of color. Surveys assessed firearm behaviors, interpersonal and community exposures, and safety perceptions. Reflexive thematic analysis was applied to interview.Results Qualitative data revealed pervasive trauma linked to firearm violence, eroding mental health and feelings of safety. Transgender women in the sample described vulnerability to intimate partner firearm violence, while sexual minority cisgender men described violence in public spaces. Participants described firearms as both normalized and necessary for protection and noted a lack of culturally relevant firearm safety education. Quantitative findings from this small, purposive sample indicated that over half reported carrying or using a firearm (52.4%), two-thirds had been shot at (66.7%), and 42.9% experienced intimate partner firearm threats.Conclusions Findings highlight the urgency of integrating trauma-informed care into SGM health services, developing inclusive firearm safety initiatives, and reinstating sexual orientation and gender identity measures in surveillance systems to better track inequities and inform prevention policy. This study looked at experiences with firearm experiences among sexual and gender minority (SGM) young adults of color in Detroit, MI. SGM people include those who identify as lesbian, gay, bisexual, or transgender. Firearm research has largely excluded this population despite their elevated vulnerability to firearm exposure. Researchers interviewed and surveyed 24 SGM young adults of color through a Detroit community health center. Participants described high levels of exposure to firearm violence and lasting effects on their mental health and sense of safety. Transgender women described particular vulnerability to firearm threats from intimate partners. Participants expressed a strong desire for trauma-informed care and firearm safety education delivered through community organizations they already trusted. The findings highlight the importance of developing firearm violence prevention efforts in partnership with SGM young adults of color.
Background Both sleep and physical activity (PA) are essential for health. Previous studies found inconsistent effects of PA, including evening PA (EPA), on sleep.Purpose To examine the effects of PA and its timing on objectively and subjectively measured sleep in predominantly healthy, young adults.Methods In the Budapest Sleep, Experiences and Traits Study, a highly ecologically valid multiday observational study, 267 participants tracked their natural sleep and reported PA for at least 1 week, including mobile electroencephalography recordings. We estimated the effects of PA and its timing, quantifying it as the time elapsed between activity initiation and sleep onset.Results Our findings showed no substantial main effect of PA on sleep (all P >= .19). However, PA temporally close to sleep had a rapid eye movement (REM) sleep-suppressing effect: each additional hour between PA and sleep onset decreased REM latency by 1.8 minutes (B = -1.82, SE = 0.58, P = .002) and increased REM percentage by 0.30 percentage points (B = 0.30, SE = 0.11, P = .008), but no other timing effect was found. Results were robust across multiple analytical specifications.Conclusions Our results support neither a general sleep-promoting effect of PA nor a sleep-suppressing effect of EPA and suggest that for healthy young individuals, habitual, relatively low-intensity EPA is safe to perform and is a good alternative for those whose daily schedule permits no alternative timing, although the lack of detailed exercise intensity monitoring is a limitation of our study. General sleep hygiene advice is to avoid exercising in the evening, because it might worsen sleep quality. However, scientific evidence about the topic is mixed. We examined how physical activity and its timing relate to sleep quality in healthy young adults.Participants were monitored for multiple days in their homes. Physical activity was reported daily, and sleep was measured using a headband that records brain activity, allowing a detailed assessment of sleep structure. This approach allows us to study this relationship in participants' natural environment and provides more precise sleep measurements than movement-based trackers or self-reports used in previous studies.We found that daily physical activity had minimal effects on sleep quality or structure. Even when people reported evening physical activity, it was not associated with major sleep disruption. However, activity performed nearer to sleep onset was linked to a modest reduction in rapid eye movement sleep, a stage associated with dreaming. This is likely because this stage is particularly sensitive to the physiological effects of exercise.Based on these findings, evening physical activity is generally safe to perform. A limitation of our study is that it only investigated the effects of habitual exercise on healthy young adults.
