Health Risk Behavior, and Stress and Trauma

Steffen, P. R., T. B. Smith, et al. (2006). "Acculturation to Western society as a risk factor for high blood pressure: a meta-analytic review." Psychosom Med 68(3): 386-97.
OBJECTIVE: A number of studies have documented that acculturation to western society is related to an increase in blood pressure (BP). Although there is evidence that higher socioeconomic status appears related to better cardiovascular health, increasing acculturation to western society appears related to worse cardiovascular health. The purpose of this meta-analysis was to investigate the association between acculturation and BP. METHODS: Literature searches yielded 125 relevant research manuscripts, which were coded by teams of two independent raters. This study was conducted in 2003 and 2004, and research databases such as MEDLINE and PsychINFO were searched through 2004. Measures of association (effect sizes) were extracted for both systolic blood pressure (SBP) and diastolic blood pressure (DBP) readings. Random effects models were used to analyze the resulting data. RESULTS: The overall effect sizes associated with acculturation were 0.28 for SBP and 0.30 for DBP, with increasing acculturation to western society related to higher BP. More acculturated individuals had an average of 4 mm Hg higher BP than less acculturated individuals, which is similar to the effect sizes of known risk factors for high BP such as diet and physical activity. The effects of acculturation on BP appear to be universal, with similar effect sizes found across all regions of the world. Change in BP due to acculturation was not related to body mass index (BMI) or cholesterol but was related to length of residence in the new culture, with the largest effect sizes seen on initial entry and then decreasing rapidly within the first few years. Sudden cultural changes, such as migration from rural to urban settings, resulted in the largest effect sizes, which finding supports the hypothesis that the stress of cultural change is important role in the acculturation effect. CONCLUSIONS: Acculturation to western society is associated with higher BP, and the distress associated with cultural change appears to be more influential than changes in diet or physical activity. Future studies would benefit from investigating how cultural change affects health and examining whether some non-Western cultural values and practices are health protective.

Gore-Felton, C., M. J. Rotheram-Borus, et al. (2005). "The Healthy Living Project: an individually tailored, multidimensional intervention for HIV-infected persons." AIDS Educ Prev 17(1 Suppl A): 21-39.
The NIMH Healthy Living Project (HLP), a randomized behavioral intervention trial for people living with HIV, enrolled 943 individuals, including women, heterosexual men, injection drug users, and men who have sex with men from Los Angeles, Milwaukee, New York, and San Francisco. The intervention, which is based on qualitative formative research and Ewart's Social Action Theory, addresses three interrelated aspects of living with HIV: stress and coping, transmission risk behavior, and medication adherence. Fifteen 90-minute structured sessions, divided into 3 modules of five sessions each, are delivered to individuals. Sessions are tailored to individuals within a structure that uses role-plays, problem solving, and goal setting techniques. A 'Life Project'--or overarching goal related to personal striving-provides continuity throughout sessions. Because this is an ongoing project with efficacy yet to be established, we do not report intervention outcomes. However, the intervention was designed to be useful for prevention case management, settings where repeated one-on-one contact is possible, and where a structured but highly individualized intervention approach is desired.

Epel, E. S., E. H. Blackburn, et al. (2004). "Accelerated telomere shortening in response to life stress." Proc Natl Acad Sci U S A 101(49): 17312-5.
Numerous studies demonstrate links between chronic stress and indices of poor health, including risk factors for cardiovascular disease and poorer immune function. Nevertheless, the exact mechanisms of how stress gets "under the skin" remain elusive. We investigated the hypothesis that stress impacts health by modulating the rate of cellular aging. Here we provide evidence that psychological stress--both perceived stress and chronicity of stress--is significantly associated with higher oxidative stress, lower telomerase activity, and shorter telomere length, which are known determinants of cell senescence and longevity, in peripheral blood mononuclear cells from healthy premenopausal women. Women with the highest levels of perceived stress have telomeres shorter on average by the equivalent of at least one decade of additional aging compared to low stress women. These findings have implications for understanding how, at the cellular level, stress may promote earlier onset of age-related diseases.

Kalichman, S. C., C. Gore-Felton, et al. (2004). "Trauma symptoms, sexual behaviors, and substance abuse: correlates of childhood sexual abuse and HIV risks among men who have sex with men." J Child Sex Abus 13(1): 1-15.
Childhood sexual abuse is associated with high-risk sexual behavior in men who have sex with men. This study examined psychological and behavioral correlates of HIV risk behavior associated with childhood sexual abuse in a sample of men who have sex with men. Men attending a large gay pride event (N = 647) completed anonymous surveys that assessed demographic characteristics, childhood sexual abuse history, symptoms of dissociation and trauma-related anxiety, borderline personality characteristics, substance use, and sexual risk behavior. Results indicated that men who have a history of childhood sexual abuse were more likely to: engage in high-risk sexual behavior (i.e., unprotected receptive anal intercourse), trade sex for money or drugs, report being HIV positive, and experience non-sexual relationship violence. Results of this study extend previous research to show that men who have sex with men and who have a history of child sexual abuse are more likely to be at high risk for HIV infection.

Matano, R. A., C. Koopman, et al. (2003). "Assessment of binge drinking of alcohol in highly educated employees." Addict Behav 28(7): 1299-310.
This study evaluated the usefulness of the Alcohol Use Disorders Identification Test (AUDIT) and CAGE, a standardized screening instrument for detecting alcohol dependence in identifying binge drinking among highly educated employees. Brochures were mailed to an entire workforce inviting employees to learn about their coping strategies, stress levels, and risk for alcohol-related problems, with 228 employees providing complete data. Binge drinking in the previous 3 months was reported by 29% of the employees, with greater binge drinking reported by White employees, of mixed/other ethnic background, or younger. The AUDIT achieved a sensitivity of 35% in identifying respondents who reported binge drinking and a specificity of 98% in accurately identifying respondents who did not report binge drinking. Sensitivity using the cut-off of scoring one or more positive hits on the CAGE was 67%, and specificity was 84%. Therefore, neither the AUDIT nor the CAGE achieved adequate sensitivity, as well as specificity, as screening tools for assessing binge drinking. A more accurate method for assessing binge drinking appears to be by directly asking for the largest number of drinks consumed in a single drinking session.

Koopman, C., B. Nouriani, et al. (2002). "Sleep disturbances in women with metastatic breast cancer." Breast J 8(6): 362-70.
We examined sleeping problems in women with metastatic breast cancer in relation to depression, social support, and salivary cortisol. Ninety-seven women with metastatic breast cancer were drawn from a larger study on the effects of group therapy on quality of life and survival. This study is based on the baseline assessments conducted prior to randomization into treatment conditions. Sleep, depression symptoms, and social support were assessed by self-reporting. Cortisol was assessed from saliva samples taken over a 3-day period. Medical status and demographic characteristics were also examined in relation to each sleep variable in multiple regression analysis. Most women (63%) reported one or more types of sleep disturbance and 37% reported using sleeping pills in the previous 30 days. Problems with falling to sleep were significantly related to greater pain and depressive symptoms. Problems of waking during the night were significantly associated with greater depression and less education. Problems in waking/getting up were significantly associated with greater depressive symptoms and less social support. Sleepiness during the day was not significantly related to the variables in the regression model. Fewer hours of sleep were significantly associated with metastases to the bone, higher depressive symptoms, and more social support. Women who reported sleeping 9 or more hours per night, compared to those who reported a moderate amount of sleep (6.5-8.5 hours), had significantly lower 9 p.m. cortisol levels. Use of sleeping pills was more frequent among women reporting greater pain and depressive symptoms. These results suggest that women with metastatic breast cancer who are at higher risk for having sleeping problems are those who are less educated, in pain, depressed, have bony metastases, or lack social support.

Koopman, C., K. R. Pelletier, et al. (2002). "Stanford presenteeism scale: health status and employee productivity." J Occup Environ Med 44(1): 14-20.
Workforce productivity has become a critical factor in the strength and sustainability of a company's overall business performance. Absenteeism affects productivity; however, even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality--a concept known as decreased presenteeism. This article describes the creation and testing of a presenteeism scale evaluating the impact of health problems on individual performance and productivity. A total of 175 county health employees completed the 34-item Stanford Presenteeism Scale (SPS-34). Using these results, we identified six key items to describe presenteeism, resulting in the SPS-6. The SPS-6 has excellent psychometric characteristics, supporting the feasibility of its use in measuring health and productivity. Further validation of the SPS-6 on actual presenteeism (work loss data) or health status (health risk assessment or utilization data) is needed.

Spiegel, D. (1996). "Cancer and depression." Br J Psychiatry Suppl(30): 109-16.
Half of all cancer patients have a psychiatric disorder, usually an adjustment disorder with depression. Anxiety about illness, such as cancer, often leads to delay in diagnosis, which has been estimated to reduce prospects of long-term cancer survival by 10% to 20%. Although earlier studies showed that depressed individuals were at higher risk for cancer incidence, later studies have not confirmed this predictive relationship. Nonetheless, effective psychotherapeutic treatment for depression has been found to affect the course of cancer. Psychotherapy for medically ill patients results in reduced anxiety and depression, and often pain reduction. In three randomised studies, psychotherapy resulted in longer survival time for patients with breast cancer (18 months), lymphoma, and malignant melanoma. The physiological mechanisms for these findings have not yet been determined, but four fundamental possibilities for psychotherapeutic effects on physiological change include health maintenance behaviour, health-care utilisation, endocrine environment, and immune function. Thus, effective treatment of depression in cancer patients results in better patient adjustment, reduced symptoms, reduced cost of care, and may influence disease course. The treatment of depression in these patients may be considered a part of medical as well as psychiatric treatment.

Rotheram-Borus, M. J., M. Rosario, et al. (1995). "Predicting patterns of sexual acts among homosexual and bisexual youths." Am J Psychiatry 152(4): 588-95.
OBJECTIVE: This longitudinal study examined predictors of patterns of change in HIV sexual risk acts among homosexual and bisexual adolescent males. METHOD: A consecutive series of 136 homosexual and bisexual males aged 14-19 years were recruited into the study. Subjects were predominantly Hispanic (51%) and African American (31%) and seeking services at a homosexual-identified community-based agency in New York City. All subjects participated in an intensive HIV intervention program. Patterns of change in HIV sexual risk acts were based on assessments at four points (intake and 3, 6, and 12 months later) and were used to classify youths as demonstrating one of five patterns of anal and oral sexual acts: protected (anal: 45%, oral: 25%), improved (32% and 28%, respectively), relapse (5% and 8%), variable (8% and 15%), and unprotected (10% and 24%). Components of the health belief, self-efficacy, peer influence, coping, and distress models were assessed as predictors of these patterns. RESULTS: Protected and improved patterns of sexual risk acts were associated with low levels of anxiety, depression, and substance use and high self-esteem. CONCLUSIONS: These data suggest that HIV interventions must address non-HIV-related issues confronting youths in difficult life circumstances, particularly emotional distress and the role of peer networks for homosexual and bisexual youths.

« Return to Publications List