Austin S. Baldwin

Association between depressive symptoms and mortality risk in chronic kidney disease.

OBJECTIVE Previous examinations of depression as a predictor of mortality in end-stage renal disease have yielded inconsistent findings. We sought to clarify the possible link with mortality by assessing depression at an earlier stage of renal impairment before the uremic disease state and depressive symptoms become highly confounded, and then following patients during the period of disease progression. DESIGN Prospective design using an assessment of depression before initiation of renal replacement therapy to predict mortality status an average of 81 months later in patients in the early stages of chronic kidney disease. MAIN OUTCOME MEASURES Mortality status. RESULTS After controlling for relevant mortality risk factors (i.e., age, gender, presence of diabetes and cardiovascular disease, and potassium level), results of Cox regression analyses indicated that higher levels of nonsomatic depression symptoms were predictive of an increased mortality risk, χ²(1, N = 359) = 8.02, p = .005. Patients with nonsomatic depression scores 1 SD above the mean had an estimated mortality rate 21.4% higher than average scorers in this sample. CONCLUSION Clinical implications of these findings point to the importance of assessment and treatment of depressive symptoms in patients with chronic kidney disease.

Physical activity as a moderator of the association between anxiety sensitivity and binge eating

Individuals with elevated anxiety sensitivity (AS; i.e., fear of somatic arousal) may binge eat to reduce emotional distress. Because physical activity reduces stress reactivity, we predicted that: (1) the relation between AS and binge eating would be moderated by physical activity and (2) coping motives for eating would mediate the association between AS and binge eating such that the relation would be stronger for those low in physical activity. Participants (N=167) completed online self-report measures. Regression analyses revealed that moderate-intensity physical activity (MPA) moderated the relation between AS and binge eating such that AS was not related to binge eating among those who frequently engaged in MPA but was related to binge eating among those who did not report engaging in MPA. Vigorous-intensity physical activity (VPA) moderated in the opposite direction such that the relation between AS and binge eating was significant among persons reporting high levels of VPA but less strong among persons reporting low levels of VPA. The mediation model was also significant, but was not moderated by MPA or VPA. Theoretical and clinical implications are discussed.

WEEKLY VARIABILITY IN OUTCOME EXPECTATIONS: EXAMINING ASSOCIATIONS WITH RELATED PHYSICAL ACTIVITY EXPERIENCES DURING PHYSICAL ACTIVITY INITIATION

Little is known about how outcome expectations change after physical activity initiation and whether changes are associated with physical activity experiences. In a diary study, physically inactive adults (N = 102) initiated an exercise regimen and reported their experiences daily (e.g. progress toward goals) and corresponding outcome expectations weekly (e.g. how much progress they expect this week). Average levels (between-person effects) for eight experiences (ps < .01) and deviations from the average levels (within-person effects) for three experiences (ps < .05) were associated with changes in outcome expectations. The findings demonstrate that outcome expectations for exercise vary over time and are associated with people’s subjective experiences.

Understanding how mothers of adolescent girls obtain information about the human papillomavirus vaccine: Associations between mothers’ health beliefs, information seeking, and vaccination intentions in an ethnically diverse sample

We examined factors associated with information seeking about the human papillomavirus vaccine among mothers of adolescent girls by testing whether information seeking and vaccination intentions for their daughters are associated with perceived vulnerability, severity, and vaccine benefits in an ethnically diverse sample. Mothers (N = 256) of unvaccinated girls living in Dallas, Texas, were surveyed (49% Black, 29% Hispanic, and 18% White). Perceived vulnerability to human papillomavirus was associated with talking with others (odds ratio = 1.71, 95% confidence interval = 1.09, 2.66) and talking with a doctor about the vaccine (odds ratio = 1.42, 95% confidence interval = 1.01, 1.99), and perceived vaccine benefits were associated with vaccination intentions (odds ratio = 2.96, 95% confidence interval = 1.98, 4.42), but the perceived severity was not associated with any dependent measure. Beliefs about human papillomavirus risk are associated with seeking information from a doctor and interpersonal sources, but ethnic minorities are less likely to talk with others about the vaccine.

Examining the moderating effect of depressive symptoms on the relation between exercise and self-efficacy during the initiation of regular exercise.

OBJECTIVE People with depressive symptoms report lower levels of exercise self-efficacy and are more likely to discontinue regular exercise than others, but it is unclear how depressive symptoms affect the relation between exercise and self-efficacy. We sought to clarify whether depressive symptoms moderate the relations between exercise and same-day self-efficacy, and between self-efficacy and next-day exercise. METHODS Participants (n = 116) were physically inactive adults (35% reported clinically significant depressive symptoms) who initiated regular exercise and completed daily assessments for 4 weeks. Mixed linear models were used to test whether (a) self-efficacy differed on days when exercise did and did not occur, (b) self-efficacy predicted next-day exercise, and (c) these relations were moderated by depressive symptoms. RESULTS First, self-efficacy was lower on days when no exercise occurred, but this difference was larger for people with high depressive symptoms (p < .001). They had lower self-efficacy than people with low depressive symptoms on days when no exercise occurred (p = .03), but self-efficacy did not differ on days when exercise occurred (p = .34). Second, self-efficacy predicted greater odds of next-day exercise, OR = 1.12, 95% [1.04, 1.21], but depressive symptoms did not moderate this relation, OR = 1.00, 95% CI [.99, 1.01]. CONCLUSIONS During exercise initiation, daily self-efficacy is more strongly related to exercise occurrence for people with high depressive symptoms than those with low depressive symptoms, but self-efficacy predicts next-day exercise regardless of depressive symptoms. The findings specify how depressive symptoms affect the relations between exercise and self-efficacy and underscore the importance of targeting self-efficacy in exercise interventions, particularly among people with depressive symptoms. (PsycINFO Database Record

Statistical models for multilevel skewed physical activity data in health research and behavioral medicine.

OBJECTIVE Researchers who study physical activity often use outcome variables that have a lower bound of zero and are positively skewed (e.g., minutes of physical activity in a day). Researchers also often use statistical methods that assume the outcome is normally distributed or transform the outcome as an attempt to make it more normal, both of which can be problematic. In this article, the authors describe multilevel 2-part models that use a mixture of logistic regression-to predict whether a person was active-and gamma regression-to predict amount of activity if there was activity. METHOD The authors contrast the 2-part models to a linear multilevel model using data from a longitudinal study of physical activity (N = 113; 2,305 observations). The dependent variable was minutes of moderate-to-vigorous activity in a day and the predictor variables were day, satisfaction, and gender. RESULTS The 2-part models outperform the linear model and provide researchers critical information that is conceptually relevant, such as distinguishing between predictors of whether activity occurred and of how much activity occurred. CONCLUSIONS Two-part models represent a flexible and useful addition to the analysis repertoire of health researchers. To assist researchers in learning these methods, the online supplemental materials provide additional technical information as well as annotated computer code for estimating these models. (PsycINFO Database Record

Elucidating satisfaction with physical activity: An examination of the day-to-day associations between experiences with physical activity and satisfaction during physical activity initiation

Satisfaction with physical activity is known to be an important factor in physical activity maintenance, but the factors that influence satisfaction are not well understood. The purpose of this study was to elucidate how ongoing experiences with recently initiated physical activity are associated with satisfaction. Participants (n = 116) included insufficiently active volunteers who initiated a self-directed physical activity regimen and completed daily diaries about their experiences for 28 days. We used multilevel models to examine the associations between experiences with physical activity and satisfaction. Significant between-person effects demonstrated that people reporting higher average levels of positive experiences and lower levels of thinking about the negative aspects of exercise were more likely to report higher levels of satisfaction (ps < .05). Positive experiences and perceived progress toward goals had significant within-person effects (ps < .01), suggesting that day-to-day fluctuations in these experiences were associated with changes in satisfaction. These findings elucidate a process through which people may determine their satisfaction with physical activity.

Characterizing safety-net providers’ HPV vaccine recommendations to undecided parents: A pilot study

OBJECTIVE Although provider recommendation is a key predictor of HPV vaccination, how providers verbalize recommendations particularly strong ones is unknown. We developed a tool to describe strength and content of provider recommendations. METHODS We used electronic health records to identify unvaccinated adolescents with appointments at six safety-net clinics in Dallas, Texas. Clinic visit audio-recordings were qualitatively analyzed to identify provider recommendation types (presumptive vs. participatory introduction; strong vs. weak), describe content communicated, and explore patterns between recommendation type and vaccination. RESULTS We analyzed 43 audio-recorded discussions between parents and 12 providers. Most providers used a participatory introduction (42 discussions) and made weak recommendations (24 discussions) by using passive voice or adding a qualification (e.g., not school required). Few providers (11 discussions) gave strong recommendations (clear, personally-owned endorsement). HPV vaccination was lowest for those receiving only weak recommendations and highest when providers coupled the recommendation with an adjacent rationale. CONCLUSION Our new tool provides initial evidence of how providers undercut their recommendations through qualifications or support them with a rationale. Most providers gave weak HPV vaccine recommendations and used a participatory introduction. PRACTICE IMPLICATIONS Providers would benefit from communication skills training on how to make explicit recommendations with an evidence-based rationale.

Experiential Avoidance: An Examination of the Construct Validity of the AAQ-II and MEAQ

Experiential avoidance (also referred to as acceptance or psychological flexibility) is a core construct of third-wave behavior therapies. It is the tendency to avoid uncomfortable thoughts or feelings, even when doing so has negative long-term consequences. In order for developments in experiential avoidance and third-wave behavior therapies to continue, it is imperative to examine the construct validity of the most widely used measures of this construct, the Acceptance and Action Questionnaire-II (AAQ-II) and the Multidimensional Experiential Avoidance Questionnaire (MEAQ). In Amazons Mechanical Turk (N = 1,052) and college (N = 364) samples, we evaluated the construct validity of these measures. The AAQ-II demonstrated suboptimal patterns of convergent and discriminant validity with measures of neuroticism/negative affect (Big Five Inventory, Big Five Aspects Scale, Positive and Negative Affect Schedule), the MEAQ, and mindfulness (Five Factor Mindfulness Questionnaire). In contrast, the MEAQ demonstrated optimal convergent and discriminant validity. Factor analyses at the scale, subscale, and item levels demonstrated that the AAQ-II loads with indicators of neuroticism/negative affect and not with other constructs at the core of third-wave behavior therapies. In contrast, the MEAQ loads on factors with mindfulness or forms its own factors. These findings suggest the AAQ-II functions as a measure of neuroticism/negative affect, whereas the MEAQ functions as an indicator of experiential avoidance. These findings have substantial implications for research on experiential avoidance and third-wave behavior therapies. Therefore, in order to improve the theory, research, and practice of third-wave behavior therapies, we recommend using the MEAQ to assess experiential avoidance.

Cardiorespiratory fitness moderates the effect of an affect-guided physical activity prescription: a pilot randomized controlled trial

Abstract Physical activity (PA) interventions have a clear role in promoting mental health. Current PA guidelines directed toward specific PA intensities may have negative effects on affective response to exercise, and affective response is an important determinant of PA adherence. In this randomized trial of 67 previously inactive adults, we compared the effects of a PA prescription emphasizing the maintenance of positive affect to one emphasizing a target heart rate, and tested the extent to which the effect of the affect-guided prescription on PA is moderated by cardiorespiratory fitness (CRF). We found the effect of an affect-guided prescription was significantly moderated by CRF. At one week, for participants with lower CRF (i.e. poor conditioning), the affect-guided prescription resulted in significantly greater change in PA minutes (M = 240.8) than the heart rate-guided prescription (M = 165.7), reflecting a moderate-sized effect (d = .55). For those with higher CRF (i.e. good conditioning), the means were in the opposite direction but not significantly different. At one month, the same pattern emerged but the interaction was not significant. We discuss the implications of these findings for the type of PA prescriptions offered to individuals in need.