Health Psychology

This article describes a trial of a psychoeducational intervention designed to modify negative attitudes toward flexible sigmoidoscopy screening and thereby increase screening attendance. The intervention materials addressed the multiple barriers shown to be associated with participation in earlier studies. Adults ages 55-64 (N = 2,966), in a "harder-to-reach" group were randomized either to receive an intervention brochure or to a standard invitation group. Attitudes and expectations were assessed by questionnaire, and attendance at the clinic was recorded. Compared with controls, the intervention group had less negative attitudes, anticipated a more positive experience, and had a 3.6% higher level of attendance. These results indicate that psychoeducational interventions can provide an effective means of modifying attitudes and increasing rates of screening attendance.

A total of 4,213 boys and girls 11 years of age were screened in two Moscow administrative districts. Preventive measures were conducted in one district and were directed at excess body mass, systolic blood pressure, blood lipids (only among boys), cigarette smoking, and physical inactivity. A reference group of peers, who did not receive advice on prevention, was selected from another district. The intervention was targeted to three groups--schoolchildren, their parents, and teaching staff. It included round-table discussions, lectures, and the distribution of health-education materials relating to dietary habits and smoking. Over a 3-year period, these measures resulted in nonsignificant decline in the age-specific increase in body mass compared to the reference group. The intervention group had smaller subscapular skinfold thickness measurements than the reference group. These differences were significant. Mean systolic blood pressure increased with age in both groups. The increase was less in the intervention group than in the reference group and affected boys less than girls. A significant decrease in lipids (cholesterol and triglycerides) was observed in the intervention district. We conclude that additional study is needed to evaluate more precisely the effectiveness of such prevention efforts.

Although a large body of research on hardiness (a personality construct with dimensions of commitment, control, and challenge) has accumulated, several fundamental issues remain unresolved. Although there are several hardiness scales, the properties of these scales have not been compared. There is debate as to whether hardiness is one or several characteristics. Research studying the pathways through which hardiness exerts its effects has not been comprehensively evaluated. Whereas critics have argued that hardiness does not buffer stress, others have suggested that hardiness buffers for working adults, for males, and in prospective analyses. There is also growing concern that hardiness is related to neuroticism. A review of the literature supports the following conclusions: The Dispositional Resilience Scale (DRS) has several advantages over alternative scales; DRS items form three factors that are consistent with hardiness theory; hardiness dimensions generally show low to moderate intercorrelations; the most common way of categorizing subjects as high or low in hardiness is not consistent with hardiness theory; hardiness does not buffer stress, and it does not buffer stress for working adults, for males, or in prospective analyses; both old and new hardiness scales inadvertently measure neuroticism. Recommendations for future research are provided.

Reducing certain sedentary behaviors (e.g., watching television, using a computer) can be an effective weight loss strategy for youth. Knowledge about whether behaviors cluster together could inform interventions. Estimates of time spent in 6 sedentary behaviors (watching television, talking on the telephone, using a computer, listening to music, doing homework, reading) were cluster analyzed for a sample of 878 adolescents (52% girls, mean age = 12.7 years, 58% Caucasian). The clusters were based on the sedentary behaviors listed above and compared on environmental variables (e.g., household rules), psychosocial variables (e.g., self-efficacy, enjoyment), and health behaviors (e.g., physical activity, diet). Four clusters emerged: low sedentary, medium sedentary, selective high sedentary, and high sedentary. Analyses revealed significant cluster differences for gender (p < .002), age (p < .002), body mass index (p < .001), physical activity (p < .01), and fiber intake (p < .01). Results suggest a limited number of distinct sedentary behavior patterns. Further study is needed to determine how interventions may use cluster membership to target segments of the adolescent population.

The influence of cigarette smoking on resting energy expenditure (REE) in normal-weight and obese smokers was investigated. Participants were 20 normal-weight and 20 obese female smokers assessed over a 2-day period. The results indicated that REE increased in both obese and normal-weight smokers after smoking, but the increase was greater for normal-weight participants. The normal-weight group showed a 9.7%, 5.8%, and a 3.6% increase in REE during the three 10-min blocks constituting the 30-min postsmoking phase. However, the obese group showed a 3.9% and a 0.7% increase in REE and a 0.8% decrease in REE during this postsmoking phase. Between-group comparisons revealed a differential rate of change in REE after smoking, indicating that the obese group's change of REE at every postsmoking time point was on average 70 kcal/day below that of the normal-weight group. The metabolic effect of smoking is reproducible, and the obese smokers reliably show an attenuated effect. However, the reliability of the change is lower for both normal-weight and obese smokers. The results have potential implications for discouraging obese persons from taking up smoking and intervening among those who already smoke.

Within the past 20 years, public and professional attention has focused on the legitimacy of research and treatment of substance abuse in women as a “special population.” Recent efforts, however, have not as yet closed the gap in knowledge about factors promoting or perpetuating alcohol and other substance use problems in women. Materials that are presented in this article were selected to provide a broad spectrum of information about biological, psychological, and sociocultural aspects of substance abuse as it affects women. Data reported include findings from several studies conducted in our laboratories that have examined these effects. Overall, the discussion summarizes past knowledge, reviews current findings, points to unanswered questions, and concludes with a series of research recommendations that emerge from empirical data. Key words: women, alcohol, cocaine, marijuana, opiates, substance use problems

Objective: Following the trajectory hypothesis for the validity of self-rated health (SRH), we tested whether subjective recovery of health, that is, return to the same or higher level of SRH after a major health event, independently predicts better long-term prognosis. Methods: Participants were 640 patients (≤ 65 years) admitted to the eight medical centers in central Israel with incident MI in a 1-year period (mean age 54, 17% female). Baseline data were collected within days of the index MI. SRH in the preceding year was assessed at baseline, and current SRH was assessed 3-6 months later. Recurrent ischemic events (recurrent MI, hospitalization with unstable angina pectoris, or cardiac death) were recorded during a mean follow-up of 13 years. Results: A reduced risk of recurrent events was associated with an upward change of one level (e.g., from 3 at T1 to 4 at T2) in SRH (HR = 0.76, 95%CI: 0.69-0.85), controlling for baseline retrospective SRH. Risk was still significantly lower for each unit of improvement after adjusting for sociodemographics, preevent comorbidity, cardiac risk factors, MI severity, and early post-MI events (HR = 0.85, 95% CI 0.75-0.95). Conclusions: Individuals who perceived themselves 3-6 months after a first MI to be healthier than they had been in the year preceding the MI were more likely to survive event-free throughout the next 13 years, controlling for baseline retrospective SRH and multiple cardiac risk factors. Failure to experience such subjective recovery of one's health is a serious risk factor, which indicates that SRH should be monitored regularly after a MI.

An 8-year follow-up study of a representative sample of children with elevated and normal blood pressures (BPs) was conducted within the framework of cooperation under the Council for Mutual Economic Assistance. This study demonstrated the tracking phenomenon for systolic blood pressure for both boys and girls but no such phenomenon for diastolic blood pressure. Tracking was also observed for body mass. Using criteria for elevated BP developed under the cooperative study, we observed that the prevalence of elevated BP was higher for boys than girls. By ages 18 to 20 years, 16.7% of the boys had BP ≥ 140 mm Hg/90 mm Hg, but only 0.8% of the girls had reached this level. There were no statistically significant relationships between BP level, smoking, and physical activity. Increases in the prevalence of smoking and declines in the level of physical activity were observed with an increase in age. Key words: juvenile hypertension, blood pressure tracking, body mass, follow-up

In African American and White children and adolescents (N = 147), socioeconomic status (SES) was measured in 2 ways: (a) using neighborhood-level measures of population density, median income, educational attainment, and the number of children born to single mothers and (b) using family-level measures of parents' occupation and education. Structural equation modeling revealed that both lower family SES and lower neighborhood SES were independently associated with greater hostility and consequently greater cardiovascular reactivity to laboratory stressors in African Americans. Independent of neighborhood SES, only lower family SES was associated with greater cardiovascular reactivity in Whites. Heightened cardiovascular reactivity was associated with greater left ventricular mass (LVM) in Whites and marginally greater LVM in African Americans. Results suggest the importance of using multiple indicators of SES and confirm the relationship between SES and LVM in African Americans and Whites, albeit through different pathways.

Physical exercise has been linked to higher cognitive functioning and enhanced brain plasticity in aging humans. The most consistent positive effects have been reported for executive functions associated with frontal brain regions. In rodents, however, running has been shown to induce functional and structural changes in the hippocampus, a brain region known to be important for memory. It is still a matter of debate which cognitive functions are susceptible to exercise and whether an increase in cardiovascular fitness is beneficial for cognitive functioning. Moreover, little is known about the impact of exercise on cognition in middle-aged humans. Sixty-eight sedentary men and women between 40 and 56 years of age were randomly assigned to one of two training programs: aerobic endurance training (cycling) or nonendurance training (stretching/coordination). Both groups exercised twice a week for six months. Additionally, a sedentary control group was tested. At baseline and after six months, episodic memory, perceptual speed, executive functions, and spatial reasoning were assessed with standardized psychometric tests, and all participants underwent a cardiovascular fitness test. Significant improvements in memory were observed in both the cycling and the stretching/coordination group as compared with the sedentary control group. The improvement in episodic memory correlated positively with the increase in cardiovascular fitness. The stretching/coordination training particularly improved selective attention as compared with the cycling training. The results suggest that cardiovascular fitness has beneficial effects even in high-functioning middle-aged participants, but that these benefits are very specific to memory functions rather than a wider range of cognitive functions.

Self-perceptions of aging (SPA) are argued to be an indicator of the ability to adapt to heath decline in late life. Our objective was to examine the influence of psychological resources in maintaining positive self-perceptions of aging in the face of declining health in older adults. Time-varying change in health (medical conditions), physical functioning (ADLs), and psychological resources (expectancy of control and self-esteem) on change in SPA were examined over 16 years (5 waves) in a large representative sample (N = 1569) of older adults (65 + years at baseline) from the Australian Longitudinal Study of Aging. Multilevel structural equation models revealed mediating effects of psychological resources at the within-person level for the relationship between decline in ADLs and SPA. At the between-person level, the relationship between medical conditions and SPA was not mediated by psychological resources, whereas ADLs and SPA were shown to be indirectly associated through self-esteem and expectancy of control. Results demonstrate that maintaining self-esteem and an expectancy of personal control can buffer the effects of declining ADLs on perceptions of aging. Findings have clinical implications regarding psychological interventions aimed at improving resilience in older adults, which may ultimately increase health outcomes and quality of life.

Reports an error in "Posttraumatic stress symptoms in parents of children with cancer within six months of diagnosis" by Madeleine J. Dunn, Erin M. Rodriguez, Anna S. Barnwell, Julie C. Grossenbacher, Kathryn Vannatta, Cynthia A. Gerhardt and Bruce E. Compas (Health Psychology, 2012[Mar], Vol 31[2], 176-185). The authors have reported an error in their data that impacts the results and discussion sections of this published paper. The authors detected that they miscalculated the cut-off score on the Impact of Events Scale-Revised (IES-R). They reported that 66% of mothers and 60% of fathers met the modified diagnostic criteria for Posttraumatic Stress Disorder. Using the correct scoring, 11% of mothers and 9% of fathers met criteria. A corrected Table 2 is provided in the erratum. The erratum also provides corrections to: the note for Table 3; the first sentences of the second and third paragraphs of the Results section; and the second paragraph of the Discussion section. (The following abstract of the original article appeared in record 2011-21630-001.) Objective: To investigate levels and correlates of posttraumatic stress symptoms (PTSS) in mothers and fathers of children and youth with cancer. Methods: Mothers (n = 191) and fathers (n = 95), representing 195 families of children and youth with cancer, completed measures of PTSS (Impact of Event Scale-Revised), depression (Beck Depression Inventory-II), and anxiety (Beck Anxiety Inventory) between 2 and 22 weeks after their child's cancer diagnosis or recurrence of initial diagnosis. Results: Substantial subgroups of mothers (41%) and fathers (30%) reported levels of PTSS that exceeded cut-offs for elevated symptoms, and these subgroups of parents were characterized by heightened symptoms of depression and anxiety. Fathers of children and youth treated for relapse reported higher rates of elevated PTSS than fathers of children and youth treated for first-time diagnosis, but mothers' rates were similar. Mothers and fathers reported comparable mean levels of PTSS that were strongly positively correlated with symptoms of anxiety and depression. PTSS and other symptoms of distress were negatively related to education level for fathers. Conclusion: These findings provide additional evidence that mothers and fathers experience substantial PTSS near the time of their child or adolescent's cancer diagnosis during the first 6 months of treatment. Results suggest that PTSS may be part of a broader pattern of emotional distress and that a substantial portion of both mothers and fathers of children and youth with cancer may be in need of supportive mental health services within the first 6 months of their child's diagnosis. (PsycINFO Database Record (c) 2012 APA, all rights reserved).

Cancer may be viewed as a psychosocial transition with the potential for positive and negative outcomes. This cross-sectional study (a) compared breast cancer (BC) survivors' (n = 70) self-reports of depression, well-being, and posttraumatic growth with those of age- and education-matched healthy comparison women (n = 70) and (b) identified correlates of posttraumatic growth among BC survivors. Groups did not differ in depression or well-being, but the BC group showed a pattern of greater posttraumatic growth, particularly in relating to others, appreciation of life, and spiritual change. BC participants' posttraumatic growth was unrelated to distress or well-being but was positively associated with perceived life-threat, prior talking about breast cancer, income, and time since diagnosis. Research that has focused solely on detection of distress and its correlates may paint an incomplete and potentially misleading picture of adjustment to cancer.

Objective: This study, conducted in cancer patients, aimed to evaluate longitudinally whether the presence of insomnia is associated with the occurrence of self-reported infections. Method: Patients scheduled to receive a curative surgery for a first diagnosis of nonmetastatic cancer were solicited on the day of their preoperative visit. In total, 962 cancer patients completed the Insomnia Interview Schedule and a clinical interview to assess infectious symptoms at 6 time points: at the perioperative phase (baseline), as well as 2, 6, 10, 14, and 18 months later. At each assessment, patients were categorized into the following 3 groups: insomnia syndrome (SYN), insomnia symptoms (SX), and good sleepers (GS). Results: The analyses revealed that SYN patients at 1 time point were at a significantly higher risk of reporting at least 1 infectious episode at the subsequent assessment (OR = 1.31, p = .04), whereas SX patients were at a marginally significant higher risk of reporting such episodes (OR = 1.19, p = .08), as compared with GS. Conclusions: Although these results need replication and the causality needs to be established, they suggest that insomnia may potentiate the risk of experiencing infections during the cancer care trajectory. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

The transtheoretical model (TTM) posits that processes of change and the pros and cons of smoking predict progressive movement through the stages of change. This study provides both a cross-sectional replication and a prospective test of this hypothesis. As part of a larger study of worksite cancer prevention (the Working Well Trial), employees of 26 manufacturing worksites completed a baseline and 2 annual follow-up surveys. Of the 63% of employees completing baseline surveys, 27.7% were smokers (N = 1,535), and a cohort of these smokers completed the 2-year follow-up. Cross-sectional results replicated previous studies with virtually all the processes of change and the cons of smoking increasing in linear fashion from precontemplation to preparation (all ps < .00001), and the pros of smoking decreasing (p < .01). However, contrary to the hypothesis, the baseline processes of change and the pros and cons of smoking failed to predict progressive stage movements at either the 1- or the 2-year follow-ups. Possible explanations for these findings and concerns about the conceptual internal consistency of the TTM are discussed.

Objective: An automated telehealth counseling system, aimed at inactive midlife and older adults, was shown previously to achieve 12-month physical activity levels similar to those attained by human advisors. This investigation evaluated the sustained 18-month impacts of the automated advisor compared with human advisors. Methods: Following the end of the 12-month randomized, controlled trial, participants who had been randomized to either the human advisor (n = 73) or automated advisor (n = 75) arms were followed for an additional 6 months. During that period, human or automated advisor-initiated telephone contacts ceased and participants were encouraged to initiate contact with their advisor as deemed relevant. The primary outcome was moderate-to-vigorous physical activity (MVPA), measured using the Stanford Physical Activity Recall and validated during the major trial via accelerometry. Results: The two arms did not differ significantly in 18-month MVPA or the percentage of participants meeting national physical activity guidelines (ps >.50). No significant within-arm MVPA differences emerged between 12 and 18 months. Evaluation of the trajectory of physical activity change across the 18-month study period indicated that, for both arms, the greatest physical activity increases occurred during the first 6 months of intervention, followed by a relatively steady amount of physical activity across the remaining months. Conclusions: The results provide evidence that an automated telehealth advice system can maintain physical activity increases at a level similar to that achieved by human advisors through 18 months. Given the accelerated use of mobile phones in developing countries, as well as industrialized nations, automated telehealth systems merit further evaluation.

Behavioral and psychological consequences of HIV counseling and testing (HIV C&T) for women were examined in a longitudinal, prospective study. Women who received HIV C&T at community health clinics (n = 106) and a comparison group of never-tested women (n = 54) were interviewed five times over 18 months. There was no change in risk behaviors as a consequence of testing: tested and untested women engaged in high-risk sexual behavior at baseline and 18 months later. Tested women reported more anxiety, depression, and intrusive thoughts about AIDS than did untested women. Although tested women were more concerned about AIDS, their potential risk factors over the study period generally were equivalent to those for untested women. HIV counseling and testing should be considered one aspect of a broader program of HIV prevention. Identification of alternative interventions must be a public health priority.

Objective: Cross-sectional studies in cancer have revealed the presence of clusters of symptoms (e.g., gastrointestinal, emotional) and of patients (e.g., low or high levels of symptoms), but not much is known about their longitudinal evolution. In addition, their relationships with medical factors (e.g., cancer sites, treatments) and possible consequences (e.g., functioning) have yet to be established. This prospective study assessed the presence of clusters of patients in 828 participants scheduled to undergo surgery for cancer. Methods: The patients completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, the Multidimensional Fatigue Inventory, the EORTC Quality-of-Life-Questionnaire-C30, and a physical symptoms questionnaire at baseline and 2, 6, 10, 14, and 18 months later. Results: Cluster analyses identified between five and eight clusters of patients depending on the time point. The "Low Symptoms" cluster was the most common (24.8 to 35.0% of the sample), whereas one with predominant nausea and vomiting symptoms was among the least common (1.6 to 3.5%). Significant differences were found between cancer sites, treatment regimens, quality of life, and functioning scores. Prostate cancer patients and those treated by surgery only were overrepresented in the "Low" cluster, whereas breast cancer patients were more likely to fall into the "Moderate - Night Sweats" cluster. Clusters with more severe psychological symptoms were associated with lower functioning and quality of life. Conclusions: This study revealed distinct clusters of patients that varied in number during cancer treatments. Findings also identified some clusters associated with lower quality of life and functioning, which should receive more clinical attention.

The authors investigated the within-person association of reported mood with blood pressure and total cholesterol (TC) levels, each assessed 4 times over an 18-month period in 128 men and 154 women. Change over time in tense arousal was significantly positively associated with changes over time in systolic blood pressure (SBP) and diastolic blood pressure (DBP) but not TC. A change in hedonic tone was significantly associated with SBP (an increase in negative affect was associated with an increase in SBP) but not with DBP or TC. There were no sex differences in associations of mood with SBP or TC. However, increases in tense arousal and negative affect were significantly associated with an increase in DBP for women but not men.

This study examined the use of a stress and coping model of adjustment to multiple sclerosis (MS). A total of 122 MS patients were interviewed and completed self-administered scales at Time 1 and 12 months later, Time 2 (n = 96). Predictors included stressful life events, illness (duration, severity, and disability), social support, appraisal (threat and control/challenge), and coping (problem focused and emotion [wishful thinking, self-blame, and avoidance] focused). Adjustment outcomes were Time 2 depression, global distress, social adjustment, and subjective health status. Results from hierarchical regression analyses indicated that after controlling for the effects of Time-1 adjustment, better Time-2 adjustment was related to less disability, greater reliance on problem-focused coping, and less reliance on emotion-focused coping. There was limited support for the stress buffering effects of coping and social support. Findings offer some support for the use of a stress and coping model of adaptation to MS.

This article presents evidence for sex-specific temporal associations between major cigarette marketing campaigns and increases in youth smoking initiation using national survey data for 1910-1977 (N = 165,876). Considerable smoking initiation occurred in males under 18 and born before 1890 when marketing focused only on males. Initiation in male youth increased greatly during 1910-1919; in 1912, R.J. Reynolds launched its unprecedented campaign for Camel brand. Initiation in female youth began in the mid-1920s, coincident with the Chesterfield and Lucky Strike women's marketing campaigns. In the late 1960s, smoking uptake among young females again increased rapidly, coincident with large-scale marketing of women's brands. Male initiation did not increase with these campaigns. Thus, in each instance, major marketing impact occurred in youth smoking initiation only in the sex group targeted.

Researchers in many fields are interested in the robust observation that higher socioeconomic status (SES) is associated with better mental and physical health. Prominent explanations for the association involve effects of stress due to relative material and social adversity in lower socioeconomic environments, but early-life intelligence may also contribute directly to both later-life socioeconomic status and health. Here, we evaluated the effects of early-life IQ on mental and physical health outcomes at age 70, in the context of effects of SES. The Lothian Birth Cohort of 1936 took part in the Scottish Mental Survey of 1947, providing a measure of IQ at age 11. They have been extensively surveyed at age 70. Body mass index, constraints on daily life activities, hospital anxiety and depression, number of diseases, level of physical activity, weekly units of alcohol consumption, and pack-years of smoking. SES had apparently direct effects on most outcomes, but age 11 IQ was also involved in several, either directly or because it contributed to SES. Several interactions helped to integrate these associations. High age-11 IQ tended to buffer effects of adverse environments on physical and mental problems in old age.

Objective: To explore associations between the 5-factor model (FFM; neuroticism, extraversion, openness/intellect, agreeableness, and conscientiousness), personality traits, and measures of whole-brain integrity in a large sample of older people, and to test whether these associations are mediated by health-related behaviors. Method: Participants from the Lothian Birth Cohort 1936 completed the International Personality Item Pool measure, a 5-factor public-domain personality measure (http://ipip.ori.org), and underwent a structural magnetic resonance brain scan at the mean age of 73 years, yielding 3 measures of whole brain integrity: average white matter fractional anisotropy (FA), brain-tissue loss, and white matter hyperintensities (N = 529 to 565). Correlational and mediation analyses were used to test the potential mediating effects of health-related behaviors on the associations between personality and integrity. Results: Lower conscientiousness was consistently associated with brain-tissue loss (β = -0.11, p < 0.01), lower FA (β = 0.16, p < 0.001) and white matter hyperintensities (β = -0.10, p < 0.05). Smoking, alcohol consumption, diet, physical activity, body mass index and a composite health-behavior variable displayed significant associations with measures of brain integrity (range of r = 0.10 to 0.25). The direct effects of conscientiousness on brain integrity were mediated to some degree by health behaviors, with the proportions of explained direct effects ranging from 0.1% to 13.7%. Conclusion: Conscientiousness was associated with all 3 measures of brain integrity, which we tentatively interpret as the effects of personality on brain aging. Small proportions of the direct effects were mediated by individual health behaviors. RESULTS provide initial indications that lifetime stable personality traits may influence brain health in later life through health-promoting behaviors.

In a prospective cohort study the authors examined associations between childhood intelligence at age 11 and inflammatory and hemostatic biomarkers in middle age. Participants were 9,377 men and women born in the United Kingdom in March 1958, and whose blood plasma samples at age 45 years were analyzed for levels of C-reactive protein (CRP), D-dimer, fibrinogen, tissue plasminogen activator (t-PA) antigen, and von Willebrand factor (VWF). Sex-adjusted linear regression models tested cognition-blood biomarker associations, with and without adjustment for potential confounding by parental socioeconomic status and potential mediation by cardiovascular disease (CVD) risk factors at midlife. Cognitive tests taken at age 50 enabled the inflammation-cognition association to be tested for reverse causation, by adjusting for age 11 intelligence. Higher childhood intelligence test scores were significantly associated (p < .001) with lower adult levels of CRP (beta coefficient = -0.068), t-PA antigen (β = -0.014), D-dimer (β = -0.011), fibrinogen (β = -0.011), and VWF antigen (β = -0.008). Early life factors including parental socioeconomic status accounted for 24%-44% of these associations, whereas further adjustment for adult CVD risk factors largely attenuated the effects (82%-100%). The significant inverse associations between age 45 biomarker levels and age 50 cognition could be accounted for to a substantial degree by childhood intelligence (50%-100% attenuation). Childhood intelligence is predictive of inflammatory and hemostatic biomarker status at middle age, which may be largely explained by health behaviors. This highlights the need to consider possible bidirectional associations between cognition and inflammation (and hemostasis) in lifecourse models of CVD-related health.

Numerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults. This meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077). Effect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue). Compared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls. Overall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies' limited assessment period (measured typically within 1-week postintervention), participants' advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.