Magnitude and determinants of behavioral risk reduction: Longitudinal analysis of a cohort at risk for AIDS

The magnitude and predictors of longitudinal behavioral change are reported in a cohort of homosexual men at risk for AIDS. Self-reports of sexual behavior were obtained at two points in time separated by an interval of approximately six months. These self-reports were used to construct both dichotomous and continuous measures of changes in behavior consistent with reduction in the transmission of the AIDS virus (HIV). Although there was considerable variability in behavior. mean changes were consistently in the desired direction. Avoidance of anonymous sexual partners, monogamy, and modification of receptive anal sex to reduce exposure to semen by condom use or withdrawal prior to ejaculation appeared to be especially important in this cohort. Both multiple linear regression and multiple logistic regression were used to examine the relationship between a model of health behavior and these outcomes. Variables examined included knowledge of AIDS. perceived risk of AIDS. the perceived efficacy of behavior in reducing AIDS risk, difficulties with sexual impulse control, belief in biomedical technology to provide a prevention or cure, social norms supportive of behavioral change, and gay network affiliation. Of all these factors, only the availability of supportive peer norms was consistently, significantly and positively related to multiple measures of outcome. Differences between these analyses and longitudinal analyses reported elsewhere are discussed. These results suggest the policies regarding HIV antibody testing should be developed cautiously. taking account of the failure of a sense of risk to predict subsequent behavioral change. They also emphasize the important role of gay organizations in developing social norms supportive of behavioral risk reduction.     

Smoking cross-culturally: Risk perceptions among young adults in Denmark and the United States

Research examining smokers’ understanding of their smoking risk reveals that smokers acknowledge some risk but often deny or minimize personal risk. We examined risk perceptions of lung cancer among smokers and non-smokers in a smoking-lenient (Denmark) and a smoking-prohibitive (the United States) culture. Participants were 275 Danish students attending trade schools (mean age 22.6 years) and 297 US students attending community colleges in Florida (mean age 23.6 years). Results revealed cross-cultural differences suggesting that Danish smokers showed greater risk minimization than US smokers. In addition, in both countries the risk of a typical smoker was rated as lower by smokers than non-smokers, and smokers rated their personal risk as lower than they rated the risk of the typical smoker. Cross-cultural differences in moralization of smoking might be one explanation for these findings.     

Type a behaviour pattern as a risk factor after myocardial infarction: A review

Abstract

This paper is a response to Eiser's (1996) call for a unifying theoretical perspective that would bridge the gap between 'individualistic and ‘social’ approaches to studying human social behaviour in general, and health behaviour in particular. While agreeing with Eiser's premise that it makes no sense to study cognition, affect, and behaviour independently of social context, the present paper takes issue with certain features of his argument that a connectionist approach provides the needed unifying theoretical framework. It is suggested that if connectionism can describe the psychological processes underlying social behavior better than non-connectionist theories, this would provide more compelling evidence of its value than claims that it affords new theoretical insights.     

A survey of smoking status and cancer risk perceptions among participants attending a hospital-based head and neck screening program

Abstract

Screening for head and neck cancer is underutilized. Given that lack of knowledge of the risk factors may partially account for screening underutilization. we surveyed subjective risk and knowledge of risk factors for head and neck cancer among 124 individuals who attended a free. hospital-based head and neck cancer screening. Few participants were current smokers. Most attendees perceived their risk as similar to others of their age and sex. Personal health habits comprised almost all of the risk-decreasing factors, yet less than half of the risk-increasing factors. generated. Personal habits were less frequently endorsed than factors such as pollution and heredity. Those who mentioned a risk behavior, or a family cancer history, reported higher subjective risk. Those who mentioned a personal health habit reported lower subjective risk. Results highlight needed efforts to increase screening among high-risk individuals through targeted education messages.     

Are fear-avoidance beliefs related to the inception of an episode of back pain? A prospective study

Abstract

Fear-avoidance beliefs and catastrophizing have been implicated in chronic pain and theoretical models have been developed that feature these factor in the transition from acute to chronic pain. However, little has been done to determine whether these factors occur in the general population or whether they arc associated with the inception of an episode of neck or back pain. The aim of this study was to evaluate prospectively the effects of fear-avoidance beliefs and catastrophizing on the development of an episode of self-reported pain and associated physical functioning. To achieve this, we selected a sample of 415 people from the general population who reported no spinal pain during the past year. At the pretest a battery of questionnaires was administered to assess beliefs about pain and activity and it featured the Pain Catastrophizing Scale and a modified version of the Fear-Avoidance Beliefs Questionnaire. One year later outcome was evaluated by self-reports of the occurrence of a pain episode as well as a self-administered physical function test. The results showed that scores on both fear-avoidme and cabstrophizing were quite low. During the one year follow-up, 19% of the sample suffered an episode of back pain. Those with scores above the median on fear-avoidance beliefs at the pretest had twice the risk of suffering an episode of back pain and a 1.7 times higher risk of lowered physical function at the follow-up. Catastrophizing was somewhat less salient, increasing the risk of pain or lowered function by 1.5. but with confidence intervals falling below unity. These data indicate that fear-avoidance beliefs may be involved at a very early pint in the development of pain and associated activity problems in people with back pain. Theoretically. our results support the idea that fear-avoidance beliefs may develop in an interaction with the experience of pain. Clinically, the results suggest that catastrophizing and particularly fear-avoidance beliefs are important in the development of a pain problem and might be of use in screening procedures.     

Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors

This observational study investigates whether persons with elevated coronary risk factors (CRFs >3 and/or diabetes) and depression [i.e., ≥16 on the Center for Epidemiological Scale – Depression (CES-D)] can make changes in health behaviours over 3 months and improve depressive symptoms and other CRFs. Analyses were based on data from 310 men and 687 women enrolled in the high-risk arm of the Multisite Cardiac Lifestyle Intervention Program, targeting diet (10% fat), exercise (3 h per week) and stress management (7 h per week). As expected, at study entry, depressed persons had a more adverse medical status, consumed more dietary fat and practiced less stress management than non-depressed persons. To examine 3-month changes, participants were grouped into (1) depressed persons who became non-depressed (CES-D ≤ 16, n = 248; 73%), (2) persons who remained or became depressed (CES-D >16, n = 76) and (3) non-depressed persons who remained non-depressed (n = 597). All persons, regardless of group, met program goals. The greatest improvements (i.e., diet, exercise, perceived stress, hostility and mental health) were observed in Group 1 relative to Groups 2 and 3, which did not differ from each other. Comprehensive lifestyle changes appear to be feasible and beneficial for initially depressed persons with elevated CRFs.     

A longitudinal study of psychosocial distress in breast cancer: Prevalence and risk factors

This longitudinal study was conducted among 102 women with non-metastasic breast cancer to identify the time evolution and prevalence of distress at specific times through diagnosis and treatment of disease: preliminary diagnosis, surgery, definitive diagnosis and chemotherapy. Additionally, the study aimed to examine the role of demographic, medical and psychosocial factors on distress. The results indicated that prevalence of distress was higher at initial diagnosis (25%) than the following time points (approximately 17%). The differences inter-individuals in the levels of distress were observed over the four assessments. No relation between distress and demographic and medical factors was found. However, psychosocial aspects were significant risk factors. Patterns of emotional suppression and specific coping responses like helplessness/hopelessness, anxious preoccupation, cognitive avoidance and fatalism were positively related to distress, whereas fighting spirit and perceived social support showed a protective role. Moreover, helplessness/hopelessness and anxious preoccupation jointly predicted 75% of cases and 98% non-cases of distress. Finally, a mediational model between emotional suppression and distress through helplessness/hopelessness was tested. Results support the necessity of routine distress screening all through the illness. Implications of data for psychosocial interventions with breast cancer patients are highlighted.     

Illness perceptions and distress in women at increased risk of breast cancer

Variation in the levels of distress in women at increased risk of breast cancer has been reported, yet there is limited understanding of the factors that are associated with heightened distress in this population. This study took a theoretical approach using Leventhal's Self Regulatory Model (SRM) to understand variation in distress levels. The study examined the associations between perceptions of breast cancer and distress in women at increased risk of breast cancer, and a comparison sample with no experience of the disease in their social environment. Questionnaire data from 117 women at increased risk of breast cancer and 100 comparison women were analysed. Women at increased risk of breast cancer showed comparable levels of general distress but significantly higher levels of cancer specific distress than the comparison group. There were few differences in illness perceptions between the samples, although a number of cognitive perceptions of breast cancer were related to both general and cancer specific distress in the increased risk sample, but not in the comparison sample. The results suggest that the SRM provides a useful framework to explore the psychological response to genetic risk. Further research is required in this population to examine illness perceptions in more detail, validate quantitative measures of illness perceptions, and examine interactions between risk perception and the SRM constructs.     

When the risks are low: the impact of absolute and comparative information on disturbance and understanding in US and UK samples

When Klein, W. M. gave participants absolute and comparative risk information (crossed experimentally) they were more disturbed by being above than below average, but not by being at higher rather than lower risk. The current experiment tests whether Klein's findings extend to situations involving lower risk figures more typical of genuine health risks, assesses participants’ understanding of the information, and directly compares responses of US and UK samples. Participants were presented with hypothetical information about comparative and absolute risks of deep vein thrombosis. There was a main effect of absolute risk information on disturbance and precaution intentions in the US sample, but no effects of comparative information on these measures in either sample. Understanding was poor among participants receiving both pieces of risk information. Future studies should include measures of understanding to establish whether people are failing to understand what they are told or failing to respond systematically to what they understand. Practically, the findings caution against providing comparative risk information when communicating low risk figures.