What are the keys to a longer, happier life? Answers from five decades of health psychology research

Biomarkers of aging: from molecules and surrogates to physiology and function

Many countries face an unprecedented challenge in aging demographics. This has led to an exponential growth in research on aging, which, coupled to a massive financial influx of funding in the private and public sectors, has resulted in seminal insights into the underpinnings of this biological process. However, critical validation in humans has been hampered by the limited translatability of results obtained in model organisms, additionally confined by the need for extremely time-consuming clinical studies in the ostensible absence of robust biomarkers that would allow monitoring in shorter time frames. In the future, molecular parameters might hold great promise in this regard. In contrast, biomarkers centered on function, resilience, and frailty are available at the present time, with proven predictive value for morbidity and mortality. In this review, the current knowledge of molecular and physiological aspects of human aging, potential antiaging strategies, and the basis, evidence, and potential application of physiological biomarkers in human aging are discussed.

Contributions of Health Psychology to Climate Change: A Review

Climate change poses a significant threat to human health, necessitating interdisciplinary approaches to mitigate its effects. Health psychology, with its focus on behavior change and well-being, is uniquely positioned to contribute to climate action. This review examines how health psychology can address climate-related challenges, emphasizing psychological responses to environmental stressors, behavior modification strategies, and public health interventions. The findings indicate that climate change functions as a psychological stressor, contributing to anxiety, depression, and eco-distress. Additionally, behavioral science insights are underutilized in climate governance, despite their potential to drive sustainable actions. Health psychology can enhance climate adaptation by promoting pro-environmental behaviors, fostering resilience, and integrating psychological well-being into policy frameworks. However, barriers such as limited interdisciplinary collaboration and insufficient emphasis on systemic change hinder progress. To maximize impact, health psychologists must engage in climate governance, advocate for policy integration, and address both individual and collective behavior change. Future research should explore the intersection of mental health, climate resilience, and behavior adaptation to develop comprehensive strategies for tackling climate change. This review underscores the urgent need for health psychology to play a more active role in shaping climate policy and fostering sustainable, health-promoting behaviors.

Complex and Bidirectional Interplay Between Marital Quality, Catastrophizing, Psychological Dysfunction, and Quality of Life in Married Malay Women With Disorder of Gut-Brain Interactions

BACKGROUND

Disorders of gut-brain interactions (DGBI) affect more women, and marital quality may have been a factor that explains clinical manifestations of DGBI-however, the mechanism is unclear. This study aimed to elucidate supported relationships between DGBI with marital quality and clinical attributes in married Malay women.

METHODS

This cross-sectional study involved married Malay women with functional dyspepsia (FD), irritable bowel syndrome (IBS), and FD-IBS overlap per Rome IV criteria. Multivariate analysis of variance (MANOVA) and Pearson correlation analysis were performed to determine the association between DGBI, marital quality, and clinical attributes of catastrophizing, psychological dysfunction, and quality of life. Path analysis models were developed, tested, and fitted to elucidate relationships that satisfied significance testing and fit indices (termed supported relationship).

KEY RESULTS

Of 1130 screened participants, 513 were analyzed. The prevalence of FD, IBS, and FD-IBS overlap was 33.9% (n = 174), 29.5% (n = 151), and 36.6% (n = 188), respectively. Of 17 variables in MANOVA, significant differences in variables were observed for FD vs. FD-IBS overlap (10), IBS versus FD (10), and IBS versus FD-IBS overlap (5). Pearson correlation matrices found significant correlations for 15 of 17 variables. After testing and fitting, the third path model (Model 3) was deemed the final model. Model 3 suggested that relationships between DGBI and marital and clinical attributes were complex and bidirectional. The number of supported relationships were 50, 43, and 39 for FD-IBS overlap, FD, and IBS, respectively.

CONCLUSIONS AND INFERENCES

Relationships between DGBI, marital quality, and clinical attributes among married Malay women are complex and bidirectional.

Regular Positive Human Contacts Do Not Improve Pigs' Response to a Lipopolysaccharide Immune Challenge

INTRODUCTION

Little is known about the effects of a positive human-animal relationship on animal health and resilience. This study investigated the effects of regular positive human-animal interactions on pigs' response to an immune challenge.

METHODS

Twenty-four female pigs were recruited at weaning (5 weeks old), and siblings of similar weights were allocated to either the positive contact treatment with positive contacts given by a human to groups of 3 pigs in their home pen or the control treatment only exposed to a human standing immobile and silently in front and outside their home pen. Treatment sessions were applied over 9 consecutive weeks, lasted 10 min per group, and occurred twice daily (morning and afternoon), 3 days a week. At 16 weeks of age, pigs were submitted to an immune challenge, which consisted of a single intravenous administration of lipopolysaccharide (LPS; 2 µg/kg). The sickness behaviours of pigs were observed using scan sampling every 5 min over 6 h post-administration, recording somnolence, vomiting, diarrhoea, cramping, shivering, and panting. Blood samples were taken before the LPS administration, after 1 h and 3 h. Blood plasma was analysed to quantify tumour necrosis factor alpha, interleukins 6 and 10, immunoglobulin A, and cortisol concentrations, and blood serum was analysed to quantify a brain-derived neurotrophic factor. Behavioural and physiological data were statistically analysed using general linear models in R.

RESULTS

Both treatments showed signs of sickness behaviour following LPS administration, but the two treatments did not differ in the frequency, severity of sickness behaviours, or length of recovery or in the blood plasma concentration of cytokines and cortisol measured.

CONCLUSION

Therefore, regular exposure to positive contacts with a human over several weeks, although leading to the development of a positive human-animal relationship, did not enhance the pigs' response to this immune challenge or the immune parameters measured in this study.

Exercise for peri- and postmenopausal women: Recommendations from synergistic alliances of women's medicine and health psychology for the promotion of an active lifestyle

Adopting healthy behaviors is a multifaceted and complex process that poses significant challenges for individuals. Despite awareness of the detrimental effects of certain behaviors on health, many individuals continue to engage in risky practices. Traditional medical advice and prescriptions, while well intentioned, often fall short in fostering lasting lifestyle changes. Although individuals may also have good intentions, solely relying on doctor's counsel does not ensure successful lifestyle adjustments. One primary reason for this limitation is the lack of specialized expertise in behavioral modification among gynecologists and healthcare providers. Health psychologists are specialized professionals capable of effectively guiding and assisting individuals in modifying health-related behaviors. Their expertise in behavior change strategies and psychological interventions proves invaluable in empowering individuals to embrace healthier lifestyles and contributes to people's well-being. This paper emphasizes the importance of collaborative efforts between medical professionals, such as gynecologists, and health psychologists to promote healthy behaviors among peri- and postmenopausal women and enhance women's health. By forging integrative alliances, they can develop comprehensive and tailored interventions. By bridging the gap between medical advice and behavior modification, this collaborative effort has the potential to ensure a more effective intervention process. This holistic approach not only addresses women's specific health needs but also fosters sustainable behavior change when promoting healthy behaviors among middle-aged women. The ultimate goal of such a synergy is to improve women's health outcomes and contribute to a healthier society overall.

Generativity as a Traditional Way of Life: Successful aging among Unangan Elders in the Aleutian Pribilof Islands

Predominantly Western-based biomedical models of successful aging have been used to research, understand, and explain successful aging among diverse populations. With an increasingly heterogeneous older adult population nationwide, scholars have been exploring Indigenous understandings of successful aging. To add to the accumulation of knowledge of diverse Alaska Native populations, this study involved semi-structured qualitative interviews with 20 Unangan Elders from the Aleutian and Pribilof Islands. This community-based participatory research study explores the aging experiences and conceptualization of successful aging of these Elders from this remote and culturally distinct region of Alaska. Thematic analysis was employed to identify themes related to successful aging within this specific region, which supported our previous four themes, or characteristics, of Alaska Native successful aging: physical health, social support and emotional well-being, generativity as a traditional way of life, and community engagement and Inidgenous cultural generativity. Each of these themes or characteristics of Eldership is intertwined and together support successful aging within two remote communities in the Bering Sea. The findings of this study illuminate how Alaska Native Elders can live in geographically diverse regions of the State, yet the values and teachings they possess on successful aging possess the same cultural values and teachings. This study highlighted two new emerging constructs that influence Alaska Native Elders' successful aging based on geographical location. Findings contribute to the thematic saturation of the four main successful aging domains while outlining the importance of future research to conduct deeper investigations into the role of environment and history on Elders' perceptions and understanding of aging.

Both religious and secular ethics to achieve both happiness and health: Panel data results based on a dynamic theoretical model

This paper evaluates the direct and indirect impacts (and their interactions) of individual and social ethics from (primary, secondary, tertiary) education and religion (Buddhism, Christianity, Hinduism, Islam, Judaism) on health and happiness in alternative religious contexts (majority and minority religions) and for alternative education policies (gross enrolment and per-student expenditure). It also specifies the time lag for the short-run indirect impact (and its size) of happiness on health and the long-run equilibria of both happiness and health. The statistical results show that there is no religious or secular ethics with beneficial impacts on both happiness and health at both the individual and social levels. Next, education policies have similar impacts on both happiness and health in all religious contexts, while most religious ethics have larger beneficial impacts on health and happiness if coupled with social and individual education policies, respectively. Combined statistical and analytical results show that the largest short-run indirect impact of happiness on health occurs after 4 years, where 1 out of 10 points of happiness produces approximately 3 additional years of healthy life expectancy at birth. Next, the long-run equilibria of both happiness and health are globally stable and are achieved after 8 years through oscillation dynamics.

The AHAWOMEN project: study protocol of a multi-design research for exploring HAPA predictors of exercise in postmenopausal women

BACKGROUND

The postmenopausal period can represent an opportunity for women to improve their health and well-being. The Active and Healthy Ageing in Women during early postmenopause (AHAWOMEN) study aims to identify the key determinants of an active lifestyle among middle-aged women, with a focus on the stages and the social-cognitive variables outlined in the Health Action Process Approach (HAPA) model, a theoretical framework for understanding health behaviour change. We expected that HAPA factors and processes of intention creation (motivational phase) and action adoption (volitional phase) will be significant predictors of exercise initiation and maintenance, supporting both the HAPA tenets and the efficacy of HAPA-based interventions.

METHODS/DESIGN

This study was approved by the authors' Institutional Review Committee. Postmenopausal women aged between 45 and 65 years will voluntarily participate. The participants will be allocated to one of three groups: Intervention-Initiators (n = 100, random allocation), Control-Sedentary (n = 100, random allocation) or Control-Active (n = 100, non-random allocation). The intervention group will engage in a supervised exercise programme lasting at least 3 months, supplemented with a HAPA-based intervention for behaviour change. The sedentary control group will not receive any intervention to change their physical activity, while the active control group will consist of women who are already regularly adhering to an active lifestyle. Study variables will be measured at baseline and postintervention phases, as well as at 1, 3, 6 and 12-month follow-ups. The predictors of exercise behaviour in the different phases of the behavioural change process will be explored and compared within and between groups throughout the study. These analyses will help identify the factors that determine the adoption of a healthy active behaviour. Additionally, the effectiveness of the model and the intervention for changing active behaviour will be evaluated.

DISCUSSION

This paper describes the rationale, development and methods used in the AHAWOMEN project. Supporting women who intend to become active can help them to translate their goals into sustainable action. Verifying that the HAPA predictions are applicable to postmenopausal women's adoption of exercise would provide the basis for designing effective interventions for promoting healthy and active ageing that are also tailored to the experiences of middle-aged women.

TRIAL REGISTRATION

ISRCTN16251361. Registration date: 01/06/2023 (retrospectively registered).

Health psychology and behavioral medicine researchers in Canada: An environmental scan

The purpose of this study is to characterize contemporary Canadian health psychology through an environmental scan by identifying faculty, research productivity and strengths, and collaborator interconnectivity. Profiles at Canadian universities were reviewed for faculty with psychology doctorates and health psychology research programs. Publications were obtained through Google Scholar and PubMed (Jan/18-Mar/21). A total of 284 faculty were identified. Cancer, pain, and sleep were key research topics. The collaborator network analysis revealed that most were linked through a common network, with clusters organized around geography, topic, and trainee relationships. Canada is a unique and productive contributor to health psychology.

The correlation between nursing students' healthy lifestyle behaviors, cardiovascular disease risk factors' knowledge level, and obsession symptoms

BACKGROUND

Nursing students have a role in the awareness of risk factors in the development of healthy lifestyle behaviors. Nursing students' awareness of disease risk factors plays a role in developing healthy lifestyle behaviors. Therefore, it was aimed to determine the relationship between the effect of nursing students' healthy lifestyle behaviors and cardiovascular disease risk factors' knowledge levels and obsessive-compulsive symptoms.

MATERIALS AND METHODS

This was a descriptive cross-sectional study. Two hundred and twenty-four students studying in the nursing departments of two foundation universities participated in the study between April and October 2020. Sociodemographic information form, Health Promoting Lifestyle Profile II (HPLP-II), Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL), and Maudsley Obsessive-Compulsive Inventory (MOCI) were applied to the students.

RESULTS

It was found that the nursing students' healthy lifestyle behaviors (123.53 ± 25.78) and cardiovascular risk factors' knowledge level (21.08 ±± 2.70) were high. Obsessive-compulsive symptoms (16.12 ± 6.22) were moderate. In the correlation of sociodemographic characteristics, it was found that age correlated with the nutrition subdimension of CARRF-KL and HPLP-II, income level correlated with HPLP-II, place of residence correlated with HPLP-II, CARRF-KL, and MOCI, and having a health problem correlated with health responsibility. Income status, place of residence, and presence of health problems were found to be correlated with HPLP-II in all subdimensions in the regression analysis. In the regression analysis of HPLP-II with CARRF-KL and MOCI scales, it was found that it was significantly related to interpersonal relations, spiritual growth, stress management, and total score dimensions.

CONCLUSION

Healthy lifestyle behaviors of nursing students are related to cardiovascular risk factors' knowledge level and obsession symptoms. In addition, some demographic characteristics affect healthy lifestyle behaviors.

Sex differences in the association between educational level and specific domains of physical activity: a Brazilian cross-national survey

Objective

Methods

Results

Conclusion

Supplementary Information

The search for scientific meaning in mindfulness research: Insights from a scoping review

There are on-going debates about what is and is not 'mindfulness'. These debates are stifling rigorous academic research as scientific precision is a precursor to shared meaning. While mindfulness is a growing field of research, these divergent and conflated meanings are limiting deeper interdisciplinary research. Interventions designed in one practice context may not be useful in other contexts because meaning is not transferred between settings. This review clarifies the various research domains that study mindfulness and the conceptual and operational definitions in each domain. This two-stage study comprises a scoping review of mindfulness classifications and a comparative content mapping of mindfulness studies from 2015 to 2021. The initial comprehensive search strategy followed the preferred reporting items for scoping reviews and meta-analysis (PRISMA) method. The comparative analysis was conducted using Leximancer. Findings illustrate a complex growing research corpus on mindfulness that is somewhat confused. The results from the scoping review show three shared domains in mindfulness classifications: short-term effects of mindfulness, long-term effects of mindfulness, and mindfulness practices. The results from the content mapping show four domains of mindfulness research: mental health, behavioural change, cognitive neuroscience, and ethical mindfulness. Operational definitions of mindfulness are not articulated clearly in these domains. Conceptual and operational definitions in the 'ethical mindfulness' domain are not yet developed. To enhance scientific progress in mindfulness research, further investigations of mindfulness classifications need to be developed. Content mapping and semantic typology is a potential candidate for future classification. More attention should be paid to developing operational definitions according to specific research domains. Scholars in the ethical mindfulness domain will need solid conceptual and operational definitions to support their research efforts.

COVID-19 Pandemic in Portugal: Psychosocial and Health-Related Factors Associated with Psychological Discomfort

The COVID-19 pandemic is a stressful long-lasting event with an increasingly negative impact upon individuals. This study aimed at assessing the magnitude of depression, anxiety, and stress among adults living in Portugal during the first mandatory lockdown of 2020, and the psychosocial and health-related factors associated with these symptoms. A sample of 484 adults (73% women) with an average age of 40 years old (Standard Deviation, SD = 14.03) responded to an online survey. The survey included measures of depression, anxiety, stress, social support, COVID-19 interference in daily life, attitudes towards COVID-19, and health perception. The impact of the lockdown on psychological well-being was large, with up to 36% of the participants showing signs of at least mild psychological discomfort (i.e., depression, anxiety, and stress). Social support, COVID-19 interference on daily life, health perception, and age, explained all the dependent variables. Education level, income, attitudes towards COVID-19, and gender explained some of the dependent variables. These results suggest that the COVID-19 pandemic has a serious impact on the psychological health of Portuguese adults. The role of the procedures to control the pandemic on the mental health of Portuguese adults should not be underestimated.

Internet-Based Approaches to Designing an Online Fitness Platform

In recent years, national fitness has become a hot topic. How to take healthy and effective exercise on a daily basis is an urgent problem to be tackled. Web-based platforms are accessible through cellphones, which include fitness records, teaching videos, and result feedback. These three aspects assist users in completing their initial evaluation, which further contributes to health improvement. Additionally, enhancement in the well-being of individuals is carried through video recommendations. In order to proceed fitness related videos suggestions, this platform uses a collaborative filtering algorithm, which is based on videos recommendation. To receive suggestions, this methodology acquires five queries to be completely addressed at the preliminary stage. This initial assessment is commonly known as a cold-start evaluation strategy. Furthermore, popularity punishment measures are incorporated to enhance productivity. Finally, this platform offers an online-based approach for the inspection, assessment of the national fitness, and orientation for the future improvement of the fitness database.

Physical activity as a health resource: a cross-sectional survey applying a salutogenic approach to what older adults consider meaningful in organised physical activity initiatives

Objectives

Examine health resources that physically active older adults consider meaningful when participating in physical activity initiatives. Health resources are protective factors, including attitudes, knowledge, material factors or social support, that potentially enable people to understand and make sense of their lives or to cope with life stressors.

Design and main outcome measures

A cross-sectional quantitative study was conducted with two questionnaires used to serve as a compiled ‘ageing well’ survey: the Salutogenic Physical Activity Health Resources Questionnaire (SPAHRQ) and the short form of the Sense of Coherence questionnaire, SOC-13.

Results

The study included 372 participants ranging from 60 to 96 years of age (mean age: 74.4 ± 7 years; 60% women). Social relations, positive energy, the habit of exercising and embodied satisfaction were considered important by more than 70% of the participants. Social relations were the most meaningful health resource for both men and women (89%). Women rated positive energy as a significantly more important consequence of their participation in physical activity than men (W 88%, M 72%; p = .001). The three health resources that were considered less important were capability in and about physical activity, self-worth and identity as an exercising person. Those who were more physically active considered social relations, self-worth and the habit of exercising to a higher extent. Participants with higher sense of coherence consider the habit of exercising to a greater extent to be important.

Conclusions

Findings that social relations, positive energy, the habit of exercising and embodied satisfaction were considered important by more than 70% of the participants, can contribute to a wider understanding of health resources that older adults consider meaningful in their participation in organised physical activity initiatives.

Social connectedness as a mediator for horticultural therapy's biological effect on community-dwelling older adults: Secondary analyses of a randomized controlled trial

BACKGROUND

Elevated levels of inflammatory marker and a lack of social connectedness are two prominent risk factors for developing dementia and depression. Horticultural therapy (HT) has been shown to improve social connectedness and inflammatory markers. However, the underpinning mechanisms of HT remained unknown. Within this study, we hypothesized that improved social connectedness mediates the effects of HT on IL-6 levels.

METHODS

The present study is a secondary analysis of a randomized controlled trial investigating the bio-psycho-social effects of HT. Social connectedness was operationalized as positive relationships with others (PRWO), a sub-scale of the Ryff's scale of psychological well-being. IL-6 was quantified using a commercial ELISA kit. Outcomes were assessed at baseline, 3-month and 6-month post-intervention. Mediation analyses with bootstrapping were run to investigate our primary hypothesis. All analyses were controlled for covariates.

RESULTS

We recruited 59 participants (78% women; 67.10 ± 4.31 years). 29 participants partook in HT and 30 participants were included in the waitlist control group. At baseline, social connectedness was significantly correlated with IL-6 levels (β = -0.12, 95% CI = -0.21 to -0.03, p = 0.008). Furthermore, social connectedness at 3-month significantly mediated the effects of HT on IL-6 levels at 6-month (β = 0.32, 95% CI = 0.09 to 0.54, p = 0.005; β = -0.25, 95% CI = -0.45 to -0.05, p = 0.016).

CONCLUSIONS

These findings highlight the critical roles of social connectedness as a social determinant of health in eliciting HT's biological effects. When administering HT, interventionalists should consider social connectedness as a modifiable factor for ameliorating increased inflammation in older adults.

Emotional well-being in COVID-19 mass quarantine: the role of personal response and life activity: a 14-day diary study in China

OBJECTIVES

This study aims to explore quarantined individuals' emotional well-being over time and how personal response and life activity predict emotional well-being and its change.

DESIGN/METHODS

Daily data were collected from 134 participants with 71 having 14 consecutive days' data. Hierarchical linear modeling (HLM) and General Linear Model (GLM) were used to examine the primary tests.

RESULTS

Overall, positive and negative emotions declined significantly during the surveyed period. Meanwhile, differences were observed in the level of positive, depressed, and negative emotions and/or patterns of change among different population categories. The personal response of worrying about work and life was positively related to depressed and negative emotions at baseline, but was negatively related to the development of both depressed and negative emotions over time. Among life activities, family stressor was a significant predictor for both depressed and negative emotions while social support predicted positive emotions. Moreover, health & hygiene activity was positively related to positive emotions at baseline.

CONCLUSIONS

The results provide scientific evidence for public health policymakers on quarantine policies and inform the general public about quarantine life. They highlight the importance of addressing the needs of vulnerable groups (parents with young children, divorcees, clinicians) during the pandemic, and demonstrate the benefits of promoting healthcare and hygiene activity, having a sense of worry and access to social support.

A thematic analysis exploring the psychological well-being of adults born with esophageal atresia

BACKGROUND

Living with a rare and chronic health condition can have a significant impact on psychological well-being and mental health. There is a growing understanding that Esophageal Atresia (EA), a rare birth defect often accompanied by a Trachea-Esophageal Fistula (TEF), is a complex health condition that requires lifelong medical attention beyond pediatric care into adulthood. Given the reciprocal relationship between one's physical and psychological well-being, the aim of this study was to develop a better understanding of the mental health of adults born with EA/TEF.

METHODS

An international online survey was designed and disseminated in collaboration with an EA/TEF patient charity. The qualitative data was analyzed using a reflexive and inductive Thematic Analysis to explore the research question "How can being born with EA/TEF affect psychological well-being in adulthood?"

RESULTS

A total of 92 adults born with EA/TEF completed the online survey from 11 different counties. Five themes were generated during the analysis: 'Negative Experience with Healthcare Professionals', 'The Perception of Surgical Scars', 'The Psychosocial Consequences of Dysphagia', 'The Legacy of Medical Trauma', and 'Resilience in the Face of Adversity'.

CONCLUSION

The results indicated that adults born with EA/TEF might face emotional challenges that can negatively affect their psychological well-being and mental health. It was also found that some adults born with EA/TEF demonstrate resilience through positive reappraisal of adverse experiences. The current study suggests that a multidisciplinary approach to the care of adults born with EA/TEF is necessary and directions for future research are discussed.

Longitudinal Associations Between Physical Activity and Purpose in Life Among Older Adults: A Cross-Lagged Panel Analysis

Objective: The purpose of the current study was to examine the bidirectional relationship between physical activity (PA) and purpose in life in an older adult sample using longitudinal data. Method: Data were collected from three waves (2006, 2010, and 2014) of the Health and Retirement Study. A total of 4591 participants who had complete information of PA and purpose in life at baseline were included in the current study. A series of cross-lagged models were tested separately for vigorous-intensity PA, moderate-intensity PA, and light-intensity PA. Results: While higher levels of purpose in life were associated with more frequent engagement in future vigorous-intensity PA, moderate-intensity PA, and light-intensity PA, none of the PA variables predicted subsequent purpose in life. Discussion: The results did not support a reciprocal relationship between PA and purpose in life in older adults. It is more likely that purpose in life predicts PA, rather than vice versa.

Mental-physical multimorbidity treatment adherence challenges in Brazilian primary care: A qualitative study with patients and their healthcare providers

Improved understanding of multimorbidity (MM) treatment adherence in primary health care (PHC) in Brazil is needed to achieve better healthcare and service outcomes. This study explored experiences of healthcare providers (HCP) and primary care patients (PCP) with mental-physical MM treatment adherence. Adults PCP with mental-physical MM and their primary care and community mental health care providers were recruited through maximum variation sampling from nine cities in São Paulo State, Southeast of Brazil. Experiences across quality domains of the Primary Care Assessment Tool-Brazil were explored through semi-structured in-depth interviews with 19 PCP and 62 HCP, conducted between April 2016 and April 2017. Through thematic conent analysis ten meta-themes concerning treatment adherence were developed: 1) variability and accessibility of treatment options available through PHC; 2) importance of coming to terms with a disease for treatment initation; 3) importance of person-centred communication for treatment initiation and maintenance; 4) information sources about received medication; 5) monitoring medication adherence; 6) taking medication unsafely; 7) perceived reasons for medication non-adherence; 8) most challenging health behavior change goals; 9) main motives for initiation or maintenance of treatment; 10) methods deployed to improve treatment adherence. Our analysis has advanced the understanding of complexity inherent to treatment adherence in mental-physical MM and revealed opportunities for improvement and specific solutions to effect adherence in Brazil. Our findings can inform research efforts to transform MM care through optimization.

Substance use behaviors in the daily lives of U.S. college students reporting recent use: The varying roles of romantic relationships

RATIONALE

While the detrimental consequences of problematic substance use behaviors in early adulthood are well-documented, the interpersonal predictors of substance use in the naturalistic context of daily life are less known.

METHODS

Using ecological momentary assessments to capture moments of binge drinking, marijuana use, nicotine use, and prescription misuse in everyday life, this study explored the romantic relationship contexts (status, quality, partner presence) of substance use among young adults (aged 18-21) attending a university in the Midwestern U.S. Between 2017 and 2019, 296 participants, who had endorsed recent substance use at screening for a larger study on prescription misuse, completed four reports per day for approximately 28 days, resulting in over 23,000 reports for this investigation.

RESULTS

Relationship status, partner support, and partner presence in the moment were all associated with at least one type of substance use behavior. Generalized multilevel models indicated that partnered participants engaged in less marijuana use, nicotine use, and prescription misuse in daily life compared to single participants. Higher partner support predicted less binge drinking, yet also predicted higher nicotine use and prescription misuse. When with a romantic partner in daily life, partnered participants were more likely to engage in binge drinking and marijuana use, and less likely to misuse prescription drugs. Nicotine use was more likely when with a partner, but only if partner support was high.

CONCLUSIONS

Findings highlight the intricate links between interpersonal contexts and substance behaviors and indicate supportive relationships are not universally protective against substance use among this population.

Optimizing aging: A call for a new narrative

Decades of research have shown that biological and psychosocial aging are not as predetermined as had been thought for a long time. Yet, despite a large and growing evidence base, most individuals still hold negative views of aging that keep them from optimizing their chances for healthy and productive aging. Given this general background, this article has three major objectives: (a) to show that the 3 big misconceptions at the heart of the public's negative views of aging can be refuted based on scientific evidence; (b) to illustrate that changing individuals' views of aging calls for the development of a new narrative on aging, one that incorporates the increasing diversity of the aging population; and (c) to discuss how psychologists can contribute to creating this new narrative on aging. We argue that growing old(er) in the United States is not the same old business anymore and that psychologists are uniquely positioned to contribute to the social and cultural transformation that population aging and increasing diversity in the U.S. society require. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Associations Among Sleep and Cancer Risk Behaviors: a Scoping Review of Experimental Studies in Healthy Adult Populations

BACKGROUND

Links among poor sleep and cancer risk behaviors have been largely overlooked in the context of cancer prevention and behavioral medicine. The goal of this scoping review was to determine the extent and nature of experimental studies conducted with healthy adult populations that tested the associations among poor sleep and cancer risk behaviors.

METHOD

Electronic databases and major sleep journals were searched to identify experimental studies in healthy adult samples published through January 2018. Studies examined associations among eight pairings of manipulated behaviors and outcomes ("independent variable (IV)-outcome pairs"): the impact of sleep manipulations on physical activity (PA), diet, alcohol consumption, and tobacco use outcomes; and the impact of PA, diet, alcohol consumption, and tobacco use manipulations on sleep outcomes. Studies were characterized in terms of sample characteristics; study design; IV type, dose, and duration; and outcome measurement and duration.

RESULTS

Abstracts of 5697 papers and 345 full texts were screened. Eighty-eight studies describing 125 comparisons met inclusion criteria. Only two studies tested the association between tobacco use and sleep; none tested whether sleep influenced alcohol consumption. Sample sizes were typically small, most studies used crossover designs, and studies tended to include younger and more male participants. Within each IV-outcome pair, there was substantial heterogeneity in how behaviors were manipulated, outcome measurement, and type of control group. Few studies assessed mechanisms.

CONCLUSION

There is a need for larger experimental studies with more representative samples. Overall, heterogeneity and limitations in study designs make it difficult to synthesize evidence across studies.

The Pathways from Type A Personality to Physical and Mental Health Amid COVID-19: A Multiple-Group Path Model of Frontline Anti-Epidemic Medical Staff and Ordinary People

During the COVID-19 pandemic, a survey was conducted using the questionnaire method among participants consisting of both ordinary people (n = 325) and frontline anti-epidemic medical staff (n = 310), and physiological data was obtained on the basis of physical examination. This study aimed to scrutinize the influence of Type A personality on the biochemical indicators of aspartate aminotransferase (AST) and the behavioral indicators of appetite and sleep disorder, and to analyze the mediating effect of depression. Meanwhile, multiple-group path analysis was used to evaluate path differences between the models of two samples. The results of the mediation analysis for both samples demonstrated that depression significantly mediated the relationship between Type A personality and appetite and sleep disorder. The results of multiple-group path analysis showed that the relationship between Type A personality and appetite and sleep disorder seems to be significantly stronger in ordinary people, whereas the relationship between depression and appetite and sleep disorder, as well as with the path towards AST, seems to be significantly stronger in frontline anti-epidemic medical staff. This paper provides ideas for the selection and distribution of medical personnel based on personality characteristics in major public health emergencies, and physical and mental health status should be taken into account to provide relative health assistance.

Hearing Impairment, Household Composition, Marital Status, and Mortality Among U.S. Adults

OBJECTIVES

This study investigates associations between hearing impairment, household composition, marital status, and all-cause mortality for a representative sample of United States adults aged 40 and older (N = 198,902).

METHODS

We use data from 11 waves of the National Health Interview Survey (2004-2014) linked to prospective mortality status through 2015. The risk of mortality over the follow-up period is estimated using Cox proportional hazard models.

RESULTS

Compared to those with good to excellent hearing, adults with moderate to severe hearing impairments and deaf adults had 11% and 21% higher risk of death from any cause over the follow-up period, respectively. Household composition and marital status, as indicators of household social support systems, associated independently with the risk of mortality but did not substantively change the association between hearing impairment and mortality.

DISCUSSION

Hearing impairment represents an important contributor to the length of life for adults age 40 and older, independent of other important and established determinants of mortality.

Analysis of Real-World Implementation of the Biopsychosocial Approach to Healthcare: Evidence From a Combination of Qualitative and Quantitative Methods

Aims: The modern medical model has been transformed into a biopsychosocial model. The integration of the biopsychosocial approach in healthcare can help improve the effectiveness of diagnosis and treatment. This study explored the actual application of the biopsychosocial approach in healthcare and provides a basis for targeted interventions to promote the biopsychosocial approach in healthcare. Methods: Study 1 involved one-on-one interviews with 30 medical staff and focus group interviews with 16 recent patients. Study 2 was a cross-sectional survey of 13,105 medical staff in Hangzhou, China that analyzed the status quo implementation of the biopsychosocial approach in healthcare. Results: Study 1 found that medical staff did not welcome patients to report information unrelated to their disease, hoping patients did not express their emotions. In the treatment process, patients believed that medical staff refused to attend to or did not encourage reporting of any information other than the disease, and that patients should have reasonable expectations for medical staff. Study 2 found that medical staff had a 37.5% probability of actively paying attention to the patient's psychosocial status. Female medical staff (38.5%) were actively concerned about the patient's psychosocial status significantly more than male medical staff (34.2%) (P < 0.01). The medical staff in the psychiatric department (58.4%) paid more active attention to the patient's psychosocial status than staff in the non-psychiatric departments (37.2%). Gender, department, hospital level, and professional title were the factors associated with the medical staff's attention to the patient's psychosocial status (P < 0.05). The influence of age on the probability of medical staff actively paying attention to the psychosocial status of patients increased with the number of years of employment. Participants that were 31-40 years old, had an intermediate professional title, and 11-15 years of employment were the least likely to actively pay attention to patients' psychosocial status. Conclusion: Although the biopsychosocial approach has been popularized for many years, it has not been widely used in medical care. Medical staff pay more attention to patients' physical symptoms and less attention to patients' psychosocial status. It is recommended that training will be provided to medical personnel on implementing a biopsychosocial approach with particular attention to the sociodemographic characteristics of medical personnel. Additionally, we propose helping patients set reasonable expectations, and formulating guidelines for implementing the biopsychosocial approach.

Rethinking the nature of the person at the heart of the biopsychosocial model: Exploring social changeways not just personal pathways

Karunamuni et al.'s (2020) biopsychosocial-pathways (BPS-P) model provides an important framework for elaborating on Engel's (1977) biopsychosocial (BPS) model of health. In particular, the BPS-P model improves on Engel's by articulating and evidencing the multiple pathways between biological, psychological, and social influences on health and identifying mechanisms that might be implicated in these pathways. Yet its analytic treatment of these influences as "separate systems" means that, as with Engel's model, the BPS-P model is more a list of ingredients than an integrated whole. In this commentary, following Haslam et al.'s (2019) specification of a sociopsychobio model, we underscore the value of a synthetic appreciation of biology, psychology, and society as dynamically interdependent aspects of an integrated whole which is more than just the sum of its parts and the pathways between them. In particular, our alternative framework centres on an appreciation of people as social beings whose group memberships and associated social identities open up 'changeways' (not just pathways) that, as we have seen during the COVID-19 pandemic, can fundamentally restructure biology, psychology and society.

The International Classification of Functioning, Disability, and Health (ICF) as a community participation model for people with multiple sclerosis: A hierarchical regression analysis

Multiple sclerosis (MS) is a central nervous system disorder that impacts more than 400,000 people in the U.S. The disease results in multiple functional impairments that are diverse and varied across individuals. Additonally, MS has a profound impact on community participation which, like other rehabilitation outcomes, cannot be explained on the basis of functional limitations alone. The purpose of this study was to develop and evaluate a model of community participation for people living with MS using the World Health Organization (WHO) International Classification of Functioning, Disability, and Health (ICF) framework. The model focused on the roles that personal factors have as predictors of community participation, while also serving as mediators and moderators for the relationship between activity limitation and participation. Results from the hierarchical regression analysis indicated that demographic characteristics (i.e. MS type), personal factors (i.e. core self-evaluations (CSE), MS self-management, resilience, and social skills), and activity limitations accounted for 64% of the variance in participation. Further, mediation analysis indicated that CSE mediated the relationship between activity limitation and community participation. Finally, moderation analysis indicated an interaction effect between educational attainment and MS self-management. Implications for future research in rehabilitation and clinical application are discussed.

The prevalence of psychological consequences of COVID-19: A systematic review and meta-analysis of observational studies

A systematic review and a meta-analysis were conducted to examine the overall prevalence of psychological health outcomes during COVID-19. Seven databases were systematically searched to include studies reporting on at least one psychological outcome. The pooled prevalence of primary psychological outcomes was 26% (95%CI: 21-32). Pooled prevalence for symptoms of PTSD was 33% (0-86), anxiety 28% (21-36), stress 27% (14-43), and depression 22% (13-33). The prevalence of psychological outcomes was similar in healthcare workers and in the general population (34% [24-44] and 33% [27-40] respectively). High prevalence figures support the importance of ensuring adequate provision of resources for mental health.

The effects of social adversity, discrimination, and health risk behaviors on the accelerated aging of African Americans: Further support for the weathering hypothesis

BACKGROUND

The weathering hypothesis views the elevated rates of illness, disability, and mortality seen among Black Americans as a physiological response to the structural barriers, material hardships, and identity threats that comprise the Black experience. While granting that lifestyle may have some significance, the fundamental explanation for heath inequalities is seen as race-related stressors that accelerate biological aging.

OBJECTIVE

The present study tests the weathering hypothesis by examining the impact on accelerated aging of four types of adversity frequently experienced by Black Americans. Further, we investigate whether health risk behaviors mediate the effect of these conditions.

METHOD

Our analyses utilize data from 494 middle-age, African American men and women participating in the Family and Community Healthy Study. The newly developed GrimAge index of accelerated aging is used as an indicator of weathering. Education, income, neighborhood disadvantage, and discrimination serve as the independent variables. Three health risk behaviors - diet, exercise, and alcohol consumption - are included as potential mediators of the four types of adversity. Marital status and gender are entered as controls.

RESULTS

Multivariate analyses indicated that the four types of adversity predicted acceleration whereas marriage predicted deceleration in speed of aging. Males showed greater accelerated aging than females, but there was no evidence that gender conditioned the effect of adversity. The health risk behaviors were unrelated to accelerated aging and did not mediate the effect of the stressors.

CONCLUSION

Modern medicine's emphasis on life style as the primary explanation for race-based health disparities ignores the way race-related adversity rooted in structural and cultural conditions serves to accelerate biological decline, thereby increasing risk of early onset of illness and death. Importantly, these social conditions can only be addressed through social policies and programs that target institutional racism and promote economic equity.

Effects of socio-structural variables in the theory of planned behavior: a mediation model in multiple samples and behaviors

Objective: Observed variation in health behavior may be attributable to socio-structural variables that represent inequality. We tested the hypothesis that variability related to socio-structural variables may be linked to variation in social cognition determinants of health behavior. A proposed model in which effects of socio-structural variables (age, education level, gender, income) on health behavior participation was mediated by social cognition constructs was tested. Design: Model effects were tested in correlational datasets (k = 13) in different health behaviors, populations, and contexts. Samples included self-report measures of age, highest attained education level, gender, and net household income, and constructs from the theory of planned behavior (attitude, subjective norms, perceived behavioral control, intention). Ten samples provided follow-up self-reports of health behavior. Results: Path analyses supported sample-specific indirect effects of gender and age on health behavior with comparatively few income and education level effects. Meta-analytic structural equation modeling indicated consistent indirect and total effects of gender on intentions and health behavior through social cognition constructs, and a total effect of education level on behavior. Conclusion: Results provide support for the proposed mechanism by which socio-structural variables relate to health behavior. Replication in larger samples and meta-analytic synthesis across multiple health behavior studies is warranted.

Childhood adversity and cardiovascular disease risk: An appraisal of recall methods with a focus on stress-buffering processes in childhood and adulthood

INTRODUCTION

Associations between childhood/adolescent adversity and poor adult physical health have been reported in past work. Much of this work has relied on either retrospective or prospective measures of childhood experiences. However, the effect of different assessment methods on potential stress buffering processes remains largely unknown.

OBJECTIVE

We first examined the extent to which long-term cardiovascular disease risk (CVD) was predicted by reports obtained from 10-year old youth regarding adversity experienced in the prior year and those obtained from the same individuals as adults (age 29) regarding their experience of childhood adversity from ages 0-10, focusing in each case on similar types of adversity. To test stress buffering perspectives, we examined the effects of parental emotional support on the association between each measure of childhood adversities and cardiovascular health.

METHODS

We used data from a longitudinal sample of 454 African Americans enrolled in the Family and Community Health Study. The outcome variable was a 30-year CVD risk score computed from the Framingham algorithm. The hypotheses were tested with beta regression models.

RESULTS

The findings revealed a link between childhood adversity and adult CVD risk at age 29, for both measures of adversity. Consistent with the stress-buffering hypothesis, prospectively assessed parental emotional support in adolescence, but not adulthood, buffered effects on cardiovascular risk for each type of assessment of childhood adversity.

CONCLUSIONS

Prospective and retrospective measures correlated in a manner similar to prior reports (i.e. significantly, but poorly). Further, in line with stress-buffering hypothesis, parental emotional support received at age 10 yielded different buffering effects than parental emotional support received at age 29. The study's findings suggest that theoretically consistent patterns of stress-buffering are detectable using either type of assessment of childhood adversity and provide useful information in the prediction of adult CVD risk.

Work and sleep quality in railway employees: an actigraphy study

This actigraphy study tests whether daily work stressors (time pressure, social stressors), work resources (control, social support) and mental detachment from work predict sleep quality, when controlling for demands and control after work. Fifty-two railway employees participated during five consecutive workdays by completing diary questionnaires and wearing an actigraphy device. The results confirmed that social stressors from supervisors predicted more frequent sleep fragmentation and lower sleep efficiency the following night. Higher levels of daily time control at work predicted shorter sleep-onset latency and better self-reported sleep quality. Leisure time control as a covariate turned out to be a private resource, followed by fewer awakenings the following night. Detachment after work related negatively to social stressors and time pressure at work but was unrelated to indicators of sleep quality; detachment after work neither mediated nor moderated the relationship between social stressors from supervisors and sleep quality. Work redesign to increase time control and reduce social stressors is recommended to preserve daily recovery in railway employees. Practitioner summary: Sleep is important to renew health- and safety-related resources in railway employees. This diary and actigraphy study shows that higher daily work stressors were antecedents of lower sleep quality the following night, while more time control was followed by better sleep quality. Work redesign could promote health and safety by improving sleep quality.

Culture moderates the link between perceived obligation and biological health risk: Evidence of culturally distinct pathways for positive health outcomes

RATIONALE

Although perceived obligations to meet the expectations of family, friends, and society can be detrimental to physical health, much research in this area has thus far been conducted exclusively on Western samples. Cross-cultural research importantly suggests that positive health can be dependent on whether one engages in modes of being that are sanctioned by one's culture. Specifically, studies show that better health is predicted when people from cultures that value independence are able to exercise their personal autonomy and when people from cultures that value interdependence are able to maintain relational harmony (Kitayama et al., 2010).

OBJECTIVE

Based on these lines of research, as the fulfillment of perceived obligations can facilitate relational harmony but infringe on personal autonomy, we posit that culture will moderate the impact of perceived obligations on health outcomes. To gain further insight, we additionally examined people's goal disengagement tendency as an individual difference that may influence their likelihood of shunning perceived obligations in order to avoid associated stressors.

METHOD

Drawing from the parallel biomarker projects of Midlife in the United States and Midlife in Japan, we examined the interaction between perceived obligations and goal disengagement tendency on health among American and Japanese middle-aged adults. Health outcomes were indexed by biomarkers of inflammation (interleukin-6 and C-reactive protein levels) and cardiovascular risk (systolic blood pressure and total/high-density lipoprotein cholesterol).

RESULTS

We found that a higher tendency to disengage from stressful social obligations is associated with better health for Americans. In contrast, we found poorer health outcomes amongst Japanese participants who tend to disengage from their perceived obligations.

CONCLUSIONS

Our results highlight the importance of examining how perceived obligations influence physical health from a cultural perspective. The current study supports the hypothesis that culturally distinct pathways underlie health outcomes.

Reacting to social discrimination? Men's individual and social risk behaviors in the context of a male marriage squeeze in rural China

RATIONALE

In China, a large number of men are being squeezed out of the marriage market due to a shortage of marriageable women. Previous research has largely discussed the consequences of gender imbalances and focused on the behavior of marriage-squeezed men that threatens public safety. No empirical studies explored the impact of the social environment on risky behaviors of marriage-squeezed men.

OBJECTIVE

The main objective of this paper is to examine whether social discrimination is associated with marriage-squeezed men's engagement in the behaviors that threaten their own wellbeing and community safety.

METHOD

Using individual-level data collected in Chaohu City, Anhui, this study employed binary logistic regression and linear regression to examine the impacts of discrimination on alcohol use disorder and suicidal ideation, respectively. Ordinary least squares regression was performed to predict the effects of discrimination on gambling and verbal conflict based on village-level data collected in 380 villages across 18 provinces in China.

RESULTS

The results showed that self-reported discrimination was positively associated with incidence of alcohol use disorder and suicidal ideation among marriage-squeezed men; villagers' discrimination was also positively associated with the number of marriage-squeezed men in the village who often gambled or were in conflict with others.

CONCLUSIONS

Evidence suggests that social discrimination is one important mechanism that triggers marriage-squeezed men to engage in risky behaviors that threaten self- and community safety. Commonly held stereotypes about rural bachelors is one of the reasons that causes marriage-squeezed men to pose a threat to public safety. It is necessary to develop and implement policies aimed at creating a friendly and tolerant social environment for marriage-squeezed men.

Sticks and Stones: Perceived Age Discrimination, Well-Being, and Health Over a 20-Year Period

This study examines associations between perceived day-to-day age discrimination, positive well-being, and physical health over a 20-year span. Data came from all three waves of the National Survey of Midlife Development in the United States (1995–2014). Generalized structural equation modeling was used to analyze 6,016 observations of 3,102 participants and test associations between age discrimination and (a) psychological well-being and positive affect, and (b) self-rated health, instrumental activities of daily living, and chronic conditions. Associations were also examined between the well-being measures and all three health outcomes. Between-persons and within-persons effects were modeled separately but simultaneously. Both between-persons and within-persons results revealed numerous significant associations between age discrimination and physical health, although results were stronger between-persons. Moreover, hypothesized associations of age discrimination with well-being, and of well-being with physical health, were supported both between- and within-persons. Findings suggest diminished well-being may be one mechanism whereby age discrimination harms health.

The Impact of Different Levels of Physical Activity on Health among Middle-Aged and Elderly Chinese Adults

BACKGROUND

There is a lack of specific study of the impact of physical activities on middle-aged and elderly adults in developing countries. We aimed to investigate the causal impact of different levels of physical activity on self-rated health status for Chinese adults with an average age of 61 yr from years 2011 to 2015.

METHODS

China Health and Retirement Longitudinal Study (CHARLS) conducted by the Peking University of China was utilized which was a longitudinal database and thus allowed to control for the effect of unobserved individual heterogeneities. In this study, this control was carried out using fixed effect and propensity score matching methods. In addition, this study further took into consideration of the discrete feature of our response variable, self-rated health status, by applying an ordered logit model.

RESULTS

Participating in moderate-to-vigorous physical activity significantly increased individuals' self-rated health status (P<.05) whereas lower intensity physical activity did not increase individuals' self-rated health status.

CONCLUSION

Moderate-to-vigorous physical activity is an important instrument to improve the health status of middle-aged and elderly population in China. Government should encourage people to involve in more moderate-to-vigorous physical activity as it is an efficient way to improve individuals' health status.

Testing Life Course Models Whereby Juvenile and Adult Adversity Combine to Influence Speed of Biological Aging

The present study extends prior research on the links between social adversity and aging by employing more comprehensive measures of adversity and a new gene expression index of aging. Hierarchical regression and 20 years of data from a sample of 381 black Americans were used to test models regarding the impact of social adversity on speed of aging. Consistent with the early life sensitivity model, early adversity continued to predict accelerated aging after controlling for adult adversity. Contrary to the pathway model, adult adversity was not related to aging following controls for early adversity. The cumulative stress model received partial support as high adversity during adulthood amplified the effect of early adversity on aging. Finally, consonant with the social change model, low adversity during adulthood buffered the effect of early adversity on aging. These findings held after controlling for health behaviors such as smoking, diet, and exercise.

Bridging the Reciprocal Gap between Sleep and Fruit and Vegetable Consumption: A Review of the Evidence, Potential Mechanisms, Implications, and Directions for Future Work

A substantial burden of disease and mortality globally is attributable to both sleep disruption and low intakes of fruit and vegetable (FV) and there is increasing mechanistic and epidemiological evidence to support a reciprocal relationship between the two. This review provides an overview of experimental and observational studies assessing the relations between sleep and FV consumption from 52 human adult studies. Experimental studies are currently limited and show inconsistent results. Observational studies support a non-linear association with adults sleeping the recommended 7–9 hours/day having the highest intakes of FV. The potential mechanisms linking sleep and FV consumption are highlighted. Disrupted sleep influences FV consumption through homeostatic and non-homeostatic mechanisms. Conversely, FV consumption may influence sleep through polyphenol content via several potential pathways. Few human experimental studies have examined the effects of FV items and their polyphenols on sleep and there is a need for more studies to address this. An appreciation of the relationship between sleep and FV consumption may help optimize sleep and FV consumption and may reduce the burden of chronic diseases. This review provides implications for public health and directions for future work.

Income inequality is detrimental to long-term well-being: A large-scale longitudinal investigation in China

BACKGROUND

Much of the research on the detrimental effects of inequality on well-being is based on cross-sectional surveys, which may have over- or under-estimated the relationship between income inequality and well-being. Moreover, the vast majority of the work comes from Western industrialized contexts but it is not known to what extent the same pattern holds in non-Western developing countries.

OBJECTIVE

The current research aims to address these two issues by investigating the longitudinal effects of income inequality on well-being in China.

METHOD

We used the China Family Panel Studies dataset in 2010-2014. Our study includes a representative sample of 29,331 residents from 20 provinces in China. The participants completed measures of well-being, including subjective well-being and psychological distress. We examined whether provincial-level income inequality in 2010 predicted individual-level well-being in 2014.

RESULTS

Multilevel analyses showed that residents in more unequal provinces had lower subjective well-being and greater psychological distress. The patterns still held, after controlling for baseline well-being and a number of covariates, including age, gender, education, income, ethnicity, marital status, and urban/rural residence. The effects of inequality on well-being differed across socioeconomic groups.

CONCLUSION

Findings suggest that income inequality has long-term adverse consequences on well-being in a non-Western developing society. Furthermore, its effects are moderated by financial wealth.

DEBATE: Do interventions based on behavioral theory work in the real world?

BACKGROUND

Behavioral scientists suggest that for behavior change interventions to work effectively, and deliver population-level health outcomes, they must be underpinned by behavioral theory. However, despite implementation of such interventions, population levels of both health outcomes and linked behaviors have remained relatively static. We debate the extent to which interventions based on behavioral theory work in the real world to address population health outcomes.

DISCUSSION

Hagger argues there is substantive evidence supporting the efficacy and effectiveness of interventions based on behavioral theory in promoting population-level health behavior change in the 'real world'. However, large-scale effectiveness trials within existing networks are relatively scarce, and more are needed leveraging insights from implementation science. Importantly, sustained investment in effective behavioral interventions is needed, and behavioral scientists should engage in greater advocacy to persuade gatekeepers to invest in behavioral interventions. Weed argues there is no evidence to demonstrate behavioral theory interventions are genuinely effective in real world settings in populations that are offered them: they are merely efficacious for those that receive them. Despite behavioral volatility that is a normal part of maintaining steady-state population behavior levels creating the illusion of effectiveness, interventions fail in shifting the curve of population behaviors because they focus on individuals rather than populations. Hagger responds that behavioral interventions work in the 'real world' in spite of, not because of, flux in health behaviors, and that the contention that behavioral theory focuses solely on individual behavior change is inaccurate. Weed responds that the focus on extending the controls of efficacy trials into implementation is impractical, uneconomic and futile, and this has squandered opportunities to conduct genuine effectiveness trials in naturalistic settings. Hagger contends that interventions based on behavioral theory are effective in changing population-level behavior in 'real world' contexts, but more evidence on how best to implement them and how to engage policymakers and practitioners to provide sustained funding is needed. Weed argues for a paradigm shift, away from aggregative attempts to effect individual behavior change towards a focus on disrupting social practices, underpinned by understanding social and economic causation of the distribution and acceptance of behaviors in a population.