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Young adults (aged 18 to 39years) have the lowest hypertension control rates compared with older adults. Shorter follow-up encounter intervals are associated with faster hypertension control rates in older adults; however, optimal intervals are unknown for young adults. The study objective was to evaluate the relationship between ambulatory blood pressure encounter intervals (average number of provider visits with blood pressures over time) and hypertension control rates among young adults with incident hypertension. A retrospective analysis was conducted of patients aged 18 to 39 years (n = 2990) with incident hypertension using Kaplan-Meier survival and Cox proportional hazards analyses over 24months. Shorter encounter intervals were associated with higher hypertension control: 6months (13%). Young adults with shorter encounter intervals also had lower medication initiation, supporting the effectiveness of lifestyle modifications. Sustainable interventions for timely young adult follow-up are essential to improve hypertension control in this hard-to-reach population.

Objective To find clinically relevant combinations of chronic conditions among patients with diabetes and to examine their relationships with six diabetes quality metrics. Data Sources/Study Setting Twenty-nine thousand five hundred and sixty-two adult patients with diabetes seen at eight Midwestern U.S. health systems during 2010–2011. Study Design We retrospectively evaluated the relationship between six diabetes quality metrics and patients' combinations of chronic conditions. We analyzed 12 conditions that were concordant with diabetes care to define five mutually exclusive combinations of conditions (“classes”) based on condition co-occurrence. We used logistic regression to quantify the relationship between condition classes and quality metrics, adjusted for patient demographics and utilization. Data Collection We extracted electronic health record data using a standardized algorithm. Principal Findings We found the following condition classes: severe cardiac, cardiac, noncardiac vascular, risk factors, and no concordant comorbidities. Adjusted odds ratios and 95 percent confidence intervals for glycemic control were, respectively, 1.95 (1.7–2.2), 1.6 (1.4–1.9), 1.3 (1.2–1.5), and 1.3 (1.2–1.4) compared to the class with no comorbidities. Results showed similar patterns for other metrics. Conclusions Patients had distinct quality metric achievement by condition class, and those in less severe classes were less likely to achieve diabetes metrics.

Background Chronic alcohol abuse is related to numerous deleterious neurobiological consequences, including loss of gray matter, damage to white matter (WM), and impairment of cognitive and motor functions. Aerobic exercise has been demonstrated to slow cognitive decline and decrease the negative neural changes resulting from normal aging and from several diseases. It is possible that exercise may also prevent or repair alcohol-related neurological damage. This study tested the hypothesis that aerobic exercise protects WM in anterior and dorsal areas of the brain from damage related to heavy alcohol use. Methods Sixty individuals underwent a diffusion tensor imaging session and completed measures of alcohol consumption, loss of control over drinking, and aerobic exercise participation. Analyses examined the relationship of exercise, alcohol, and their interaction to fractional anisotropy (FA) in the superior longitudinal fasciculus (SLF), external capsule (EC), superior and anterior corona radiata, and fornix. The relationship of aerobic exercise and alcohol consumption to self-reported loss of control over drinking were also examined. Results A significant interaction was observed between alcohol consumption and aerobic exercise participation on FA in the SLF and EC. In the models examining loss of control over drinking, a significant interaction between aerobic exercise and alcohol consumption was observed, such that alcohol consumption was associated with loss of control more strongly for low exercisers than high exercisers. Conclusions These results indicate that the association between heavy alcohol consumption and WM damage in the EC and SLF and the association between alcohol consumption and loss of control over drinking are greater among individuals who do not exercise regularly. These results are consistent with the notion that exercise may protect WM integrity from alcohol-related damage.

In two studies, we examined nonsmokers' perceptions of smokers and consequences of the perceptions. In Study 1, smokers answered questions about their sense of self, dependence on smoking, and motivation to quit. Nonsmokers answered questions about their perceptions of these characteristics. Differences between smokers' self-descriptions and nonsmokers' perceptions were observed. Study 2 asked nonsmokers to judge two types of smokers for which the descriptions were based on Study 1 findings. Results showed that nonsmokers held a more negative attitude about and were less willing to engage in different close relationships with the smoker who was described in terms of nonsmokers' perceptions rather than smokers' reports. Attitude mediated the relationship between type of smoker and willingness to date a smoker.

When researchers communicate the negative health risks of smoking, smokers are likely to minimize such effects. This experiment addressed a way to reduce this defensiveness: allowing smokers to affirm aspects of the self. Smokers (n= 100) and nonsmokers (n= 30) viewed eight health-warning messages about smoking. Smokers were randomly assigned to view (a) warnings without a self-affirmation manipulation, (b) warnings after a self-affirmation manipulation, or (c) warnings that had a positive self-statement attached to it. Analyses indicated that compared to nonsmokers, no-affirmation smokers rated the warning messages as: (a) communicating less serious consequences, (b) less accurate, and (c) less likely to influence smokers. However, compared to no-affirmation smokers, smokers who affirmed the self were no more likely to rate the messages as serious, accurate, or effective. These data suggest that affirming the self before, or using a self-affirmation within a warning message may not encourage smokers to be more accepting of risk information.

A common criticism of social cognitive models predicting health behavior is their exclusion of affect—an important component of individual-level decision processes for behavior change. Yet the role of affect, and its interaction with cognitions, is complex. We provide an overview of affect and pathways through which it is proposed to influence outcomes. Then, we discuss several common social cognitive models of health behavior change. Next, we highlight specific affect-laden constructs (those that incorporate affective and cognitive components) related to health behavior change. We aim to provide clarity on terminology and measurement of the affect-laden constructs and evidence associating them with health behavior. Finally, we discuss strategies for incorporating these constructs within popular cognitive-based theories and provide suggestions for future work.