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Background: Integrated treatments for comorbid depression (often with anxiety) and obesity are lacking; mechanisms are poorly investigated., Methods: In a mechanistic pilot trial, adults with body mass index ≥30 and Patient Health Questionnaire-9 scores ≥10 were randomized to usual care ( n  = 35) or an integrated behavioral intervention ( n  = 71). Changes at 6 months in body mass index and Depression Symptom Checklist-20 scores were co-primary outcomes, and Generalized Anxiety Disorder Scale-7 score was a secondary outcome. Changes at 2 months in the activation and functional connectivity of regions of interest in the negative affect circuit were primary neural targets, and secondary targets were in the cognitive control, default mode, and positive affect circuits., Results: Participants were 47.0 years (SD = 11.9 years), 76% women, 55% Black, and 20% Latino. Depression Symptom Checklist-20 (between-group difference, -0.3 [95% CI: -0.6 to -0.1]) and Generalized Anxiety Disorder Scale-7 (-2.9 [-4.7 to -1.1]) scores, but not body mass index, decreased significantly at 6 months in the intervention versus usual care groups. Only Generalized Anxiety Disorder Scale-7 score changes at 6 months significantly correlated with neural target changes at 2 months in the negative affect (anterior insula, subgenual/pregenual anterior cingulate cortex, amygdala) and cognitive control circuits (dorsal lateral prefrontal cortex, dorsal anterior cingulate cortex). Effects were medium to large (0.41-1.18 SDs). Neural target changes at 2 months in the cognitive control circuit only differed by treatment group. Effects were medium (0.58-0.79 SDs)., Conclusions: Compared with usual care, the study intervention led to significantly improved depression but not weight loss, and the results on neural targets were null for both outcomes. The significant intervention effect on anxiety might be mediated through changes in the cognitive control circuit, but this warrants replication., (© 2022 The Authors.)

Data from 213 adults were analysed to test the stress accumulation and stress sensitization models as they relate to daily mood, health behaviours and social interactions. Adults reported on childhood adversity, past year adversity, and daily experiences on 14 evenings. Results largely supported the stress accumulation and not stress sensitization model such that childhood and past year adversity had independent but not synergistic effects on daily experiences. Both adversity measures were independently associated with greater daily negative affect and negative affect variability. Childhood adversity independently associated with greater mean variability in daily positive affect. Past year adversity was associated with more daily social activities, greater odds of reporting interpersonal tension at least once, and daily tension. Although childhood adversity was associated with greater odds of sharing about one's day at least once, past year adversity was associated with more daily sharing and childhood adversity with less. Both measures were unrelated to daily health behaviours except childhood adversity was associated with lower odds of being a current drinker. The only support for the stress sensitization model was number of daily cigarettes among smokers. Our findings suggest childhood and recent adversity independently relate to adults' daily experiences and should be considered jointly., (© 2021 John Wiley & Sons Ltd.)

Background: Research pairing ecological momentary assessment (EMA) methodology and ambulatory cortisol during daily life is still rare, as is careful testing of the within-person associations between stress, affect, and cortisol. Using a circumplex approach, we considered both valence and arousal components of affect., Purpose: To examine the within-person covariation of momentary cortisol with momentary perceived stress, affective valence, and affective arousal in everyday life., Methods: 115 working adults (Mage = 41.2; 76% women; 76% white) completed six EMA surveys per day over 3 days. Each assessment included reports of perceived stress and affect (used to construct indicators of affective valence and arousal), followed by a saliva sample (from which cortisol was assessed). Multi-level models were used to examine the momentary associations between perceived stress, affective valence, affective arousal, and cortisol., Results: Moments characterized by higher perceived stress were associated with higher cortisol (p = .036). Affective valence covaried with cortisol (p = .003) such that more positive valence was associated with lower cortisol and more negative valence with higher cortisol. Momentary affective arousal was not related to cortisol (p = .131). When all predictors were tested in the same model, only valence remained a significant predictor of cortisol (p = .047)., Conclusion: Momentary perceived stress and affective valence, but not affective arousal, were associated with naturalistic cortisol. Cortisol was more robustly associated with affective valence than perceived stress or affective arousal. These findings extend our understanding of how moments of stress and particular characteristics of affective states (i.e., valence but not arousal) may "get under the skin" in daily life., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Conceptualizing physical pain and negative affect as potentially interactive, we hypothesized that higher levels of peripheral inflammatory markers would be observed consistently only among individuals with both higher negative affect and pain symptomatology. Participants were generally healthy midlife adults from the Bronx, NY ( N  ​= ​212, M age  ​= ​46.77; 60.8% Black, 25.5% Hispanic/Latina/o) recruited as part of a larger study. Key measures were: reported pain intensity and pain interference at baseline, recent negative affect averaged from self-reports 5x/day for 7 days, and peripheral inflammatory markers (C-reactive protein [CRP] and a composite cytokine measure based on seven cytokines). Controlling for age, BMI, gender, and education, recent negative affect significantly interacted with both pain variables to explain variance in CRP, with higher CRP levels observed only in individuals with both higher negative affect and either higher pain intensity or pain interference. These findings contribute to an emerging literature suggesting that negative affect, pain, and inflammation are related in important and complex ways., (© 2022 The Authors.)

Objective This study explored associations between narcissistic grandiosity (including its component traits) and reported risky health behaviors in college students. Participants: College men and women ( N  = 122) participated between December 2015 and January 2016. Methods: Participants completed self-report measures of grandiosity, alcohol consumption, number of sex partners, and condom use. Results: Grandiosity was positively associated with alcohol consumption. Gender interacted with grandiose traits, driving associations with reported sexual behaviors. College men high in entitlement/exploitativeness reported more sex partners. Grandiose exhibitionism was associated with condom use among women but not men, such that college women higher in grandiose exhibitionism were more likely to report not using a condom with their most recent partner. Conclusions: Grandiosity (and grandiose traits) may influence health behavior and/or the reporting of health behavior in college students, but associations may differ for men and women.

An array of negative psychological states - including depressive symptoms, perceived stress, rumination, and negative affect - have been linked to immune function and inflammatory responses. Herein we show evidence of gender-dependent associations between ex vivo lipopolysaccharide (LPS)-stimulated cytokine responses and such psychological states, in both cross-sectional and longitudinal analyses from three annual waves (N = 162 at baseline, 67.3% female). In cross-sectional analyses (at baseline), gender moderated the associations of depressive symptoms (previously reported), perceived stress (B = -0.043, 95%CI [-0.080, -0.015]), rumination (B = -0.500, [-1.015, -0.232]), negative affect (B = -0.020, [-0.020, -0.005]), and positive affect (B = 0.024, [0.008, 0.047]) with LPS-stimulated cytokine responses. In each analysis, negative psychological states were positively associated with LPS-stimulated cytokine responses among men but negatively among women (with associations for positive affect in the opposite direction). In longitudinal analyses (across three annual measurements), similar associations were seen for depressive symptoms (B = -0.024, [-0.059, -0.004]), perceived stress (B = -0.045, [-0.069, -0.024]), and rumination (B = -0.381, [-0.622, -0.120]). These results indicate that gender is a critical factor in associations between a broad array of negative psychological states and inflammatory responses and identify one pathway by which gender may influence psychosomatic health., (Copyright © 2021. Published by Elsevier Inc.)

Evidence is mixed with regard to whether positively valanced affect (PA) is associated with engagement in health behaviors. Both affective arousal (activated/deactivated) and level of analysis (between and within-person) may influence such associations. Adults (N = 121; 25-65 years) completed ambulatory assessments of affect and daily reports of sleep, diet, and physical/sedentary activity. Patterns of association were generally consistent at between and within-person levels, although associations varied by arousal. Activated PA was positively associated with action tendencies (i.e., higher physical activity, lower sedentary activities) and riskier behaviors (such as poor diet) whereas deactivated PA was positively associated with engaging in satiety and rest (i.e., better diet, better sleep quality, and more sedentary activity). Results were maintained when covarying for indicators of relative socioeconomic advantage and neuroticism. Overall, arousal appears to be related to the nature of the associations between PA and health behaviors, highlighting the importance of assessing and evaluating a range of arousal states., (© 2021 The International Association of Applied Psychology.)

Background: Wearable transdermal alcohol concentration (TAC) sensors allow passive monitoring of alcohol concentration in natural settings and measurement of multiple features from drinking episodes, including peak intoxication level, speed of intoxication (absorption rate) and elimination, and duration. These passively collected features extend commonly used self-reported drink counts and may facilitate the prediction of alcohol-related consequences in natural settings, aiding risk stratification and prevention efforts., Method: A total of 222 young adults aged 21-29 (M age = 22.3, 64% female, 79% non-Hispanic white, 84% undergraduates) who regularly drink heavily participated in a 5-day study that included the ecological momentary assessment (EMA) of alcohol consumption (daily morning reports and participant-initiated episodic EMA sequences) and the wearing of TAC sensors (SCRAM-CAM anklets). The analytic sample contained 218 participants and 1274 days (including 554 self-reported drinking days). Five features-area under the curve (AUC), peak TAC, rise rate (rate of absorption), fall rate (rate of elimination), and duration-were extracted from TAC-positive trajectories for each drinking day. Day- and person-level associations of TAC features with drink counts (morning and episodic EMA) and alcohol-related consequences were tested using multilevel modeling., Results: TAC features were strongly associated with morning drink reports (r = 0.6-0.7) but only moderately associated with episodic EMA drink counts (r = 0.3-0.5) at both day and person levels. Higher peaks, larger AUCs, faster rise rates, and faster fall rates were significantly predictive of day-level alcohol-related consequences after adjusting for both morning and episodic EMA drink counts in separate models. Person means of TAC features added little above daily scores to the prediction of alcohol-related consequences., Conclusions: These results support the utility of TAC sensors in studies of alcohol misuse among young adults in natural settings and outline the specific TAC features that contribute to the day-level prediction of alcohol-related consequences. TAC sensors provide a passive option for obtaining valid and unique information predictive of drinking risk in natural settings., (© 2022 by the Research Society on Alcoholism.)

Background: Depression hinders obesity treatment; elucidating mechanisms may enable treatment enhancements., Objectives: The aim was to investigate whether changes in neural targets in the negative affect circuit following psychotherapy mediate subsequent changes in weight and behaviors., Methods: Adults (n = 108) with obesity and depression were randomly assigned to usual care or an intervention that delivered problem-solving therapy (PST) for depression over 2 mo. fMRI for brain imaging was performed at baseline and 2 mo. BMI, physical activity, and diet were measured at baseline and 12 mo. Mediation analysis assessed between-group differences in neural target changes using t test and correlations between neural target changes and outcome changes (simple and interaction effect) using ordinary least-squares regression., Results: Compared with usual care, PST led to reductions in left amygdala activation (-0.75; 95% CI: -1.49, -0.01) and global scores of the negative affect circuit (-0.43; -0.81, -0.06), engaged by threat stimuli. Increases in amygdala activation and global circuit scores at 2 mo correlated with decreases in physical activity outcomes at 12 mo in the usual-care group; these relations were altered by PST. In relation to change in leisure-time physical activity, standardized β-coefficients were -0.67 in usual care and -0.01 in the intervention (between-group difference: 0.66; 0.02, 1.30) for change in left amygdala activation and -2.02 in usual care and -0.11 in the intervention (difference: 1.92; 0.64, 3.20) for change in global circuit scores. In relation to change in total energy expenditure, standardized β-coefficients were -0.65 in usual care and 0.08 in the intervention (difference: 0.73; 0.29, 1.16) for change in left amygdala activation and -1.65 in usual care and 0.08 in the intervention (difference: 1.74; 0.85, 2.63) for change in global circuit scores. Results were null for BMI and diet., Conclusions: Short-term changes in the negative affect circuit engaged by threat stimuli following PST for depression mediated longer-term changes in physical activity. This trial was registered at www.clinicaltrials.gov as NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413)., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

Background: Sex influences health and related behaviors due to biological and psychosocial/socioeconomic factors. Assessing sex-specific responses to integrated treatment for comorbid obesity and depression could inform intervention targeting., Purpose: To test (a) whether sex moderates the effects of integrated collaborative care on weight and depression outcomes through 24 months and (b) whether treatment response at 6 months predicts 12 and 24 month outcomes by sex., Methods: Secondary data analyses on weight and depression severity (SCL-20) measured over 24 months among 409 adults with obesity and depression in the Research Aimed at Improving Both Mood and Weight trial., Results: Men achieved significantly greater weight reductions in intervention versus usual care than women, whereas women achieved significantly greater percentage reductions in SCL-20 than men at both 12 and 24 months. In logistic models, at 80% specificity for correctly identifying participants not achieving clinically significant long-term outcomes, women who lost <3.0% weight and men who lost <4.1% weight at 6 months had ≥84% probability of not meeting 5% weight loss at 24 months. Similarly, at 80% specificity, women who reduced SCL-20 by <39.5% and men who reduced by <53.0% at 6 months had ≥82% probability of not meeting 50% decrease in SCL-20 at 24 months., Conclusions: Sex modified the integrated treatment effects for obesity and depression. Sex-specific responses at 6 months predicted clinically significant weight loss and depression outcomes through 24 months. Based on early responses, interventions may need to be tailored to address sex-specific barriers and facilitators to achieving healthy weight and depression outcomes at later time points., Clinical Trial Registration: NCT02246413 (https://clinicaltrials.gov/ct2/show/NCT02246413)., (© Society of Behavioral Medicine 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The aim of this paper is to describe the utility of various recruitment modalities utilized in the Working to Increase Stability through Exercise (WISE) study. WISE is a pragmatic randomized trial that is testing the impact of a 3-year, multicomponent (strength, balance, aerobic) physical activity program led by trained volunteers or delivered via DVD on the rate of serious fall-related injuries among adults 65 and older with a past history of fragility fractures (e.g., vertebral, fall-related). The modified goal was to recruit 1130 participants over 2 years in three regions of Pennsylvania., Methods: The at-risk population was identified primarily using letters mailed to patients of three health systems and those over 65 in each region, as well as using provider alerts in the health record, proactive recruitment phone calls, radio advertisements, and presentations at community meetings., Results: Over 24 months of recruitment, 209,301 recruitment letters were mailed, resulting in 6818 telephone interviews. The two most productive recruitment methods were letters (72% of randomized participants) and the research registries at the University of Pittsburgh (11%). An average of 211 letters were required to be mailed for each participant enrolled. Of those interviewed, 2854 were ineligible, 2,825 declined to enroll and 1139 were enrolled and randomized. Most participants were female (84.4%), under age 75 (64.2%), and 50% took an osteoporosis medication. Not having a prior fragility fracture was the most common reason for not being eligible (87.5%). The most common reason provided for declining enrollment was not feeling healthy enough to participate (12.6%)., Conclusions: The WISE study achieved its overall recruitment goal. Bulk mailing was the most productive method for recruiting community-dwelling older adults at risk of serious fall-related injury into this long-term physical activity intervention trial, and electronic registries are important sources and should be considered., (© 2021. The Author(s).)

Women in midlife (ages 40-60) show decreases in physical activity (PA) that exacerbate risk for cardiovascular disease. Social comparisons (i.e., self-evaluations relative to others) are known to influence PA in other groups, but their association in this population is unknown. The present study used ecological momentary assessment to examine this relation among women in midlife with hypertension or another CVD risk condition (N = 75, M BMI  = 34.0 kg/m 2 ). Participants completed 5 surveys per day and wore tri-axial accelerometers for 10 days. PA engagement was lower after women reported more comparisons than were typical for them (7-14% reductions in PA for each additional comparison). These relations varied across days of observation and relations were positive on 34-58% of days. Findings call for careful consideration of how best to harness any potential benefits of social comparison for promoting PA in this and other groups., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Perceiving and interpreting eye gaze cues is foundational for social cognition and social interactions because it involves the ability to use eye gaze direction to predict the actions and intentions of others. Autism is a disability that impacts social interactions. A diagnostic symptom of autism is difficulty understanding eye gaze cues as social signals. This deficit has long-term consequences for understanding goal-directed behavior, language learning, and social communication. We hypothesize that targeted intervention methods designed to improve sensitivity to eye gaze cues may begin to treat core symptoms of autism and potentially alter multiple aspects of social functioning. Social Games for Autistic Adolescents (SAGA) is a serious computer game intervention designed to improve sensitivity to eye gaze cues. Serious games improve targeted skills with the goal of enhancing real life outcomes. In SAGA, participants progress through a narrative storyline and interact with animated characters. In so doing, they implicitly discover that eye gaze cues are useful for guiding their own goal-directed behavior to solve problems in the game., Methods: We evaluated the feasibility and effectiveness of SAGA in a hybrid phase 1/2, randomized controlled trial. Forty adolescents on the autism spectrum were randomized to either the treatment or standard care control group. Adolescents in the treatment group were asked to play SAGA for 30-minute sessions at home 3 times a week over 10 weeks., Results: A group × time interaction revealed that the treatment group developed increasing sensitivity to human eye gaze cues, whereas the standard care group did not. Participants who experienced a sufficient dose of gameplay showed larger treatment-related improvements. Critically, increases in sensitivity to human eye gaze cues were associated with improvements in social skills., Conclusions: This accessible, scalable, and affordable intervention shows promise as an effective tool for improving the ability to interpret and understand eye gaze cues and social skills in adolescents on the autism spectrum.

The purpose of this study was to investigate the feasibility, acceptability, and short-term adherence to an adult outdoor group sport play program designed to maximize enjoyment that was modified to incorporate COVID-19 risk mitigation strategies. We enrolled 17 healthy, but sedentary, central Pennsylvania adults ( mean age  = 31.6 ± 7.3) without obesity via mail advertisements to participate in four, 60-minute sessions of instructor-led modified sport games (e.g., handball, Ultimate Frisbee, soccer) over a two-week period in October 2020. Durign recrutiment and the study period, there were approximately 1000-2000 new cases of COVID-19 daily in central Pennsylvania . The overall adherence rate to the sessions was 91%, and no participants reported new or existing COVID-19 symptoms or diagnoses during the two-week study period or 10-days following the final session. Despite enforcing mandatory COVID-19 safety measures (e.g., universal masking, social distancing), the participants reported enjoying the program and feeling socially connected with one another, while perceiving the program to be safe. Additionally, all participants expressed a desire to participate again, if the program were offered in the future. These results suggest that an outdoor group sport play program for adults can be feasible, acceptable, and well-adhered to despite enforcing mandatory COVID-19 safety precautions. Physical activity programs similar to the one presented here may provide an easily-adaptable approach to outdoor physical activity during the current and potential future pandemics that have viral transmission characteristics similar to COVID-19., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered: Christopher Sciamanna has an investment, such as stock, in a company which has begun to investigate the possibility of creating a business that provides exercise programs., (© 2021 The Author(s).)

Background: Technological advancements make it possible to deliver depression interventions via smartphone applications ("Apps"), including those that deliver content "just-in-time" (e.g., in response to acute negative mood states). This study examined whether an app-based just-in-time intervention (ImproveYourMood+) decreased depressive symptoms, and whether the following features were related to symptom improvement: micro-intervention content, mood monitoring, and just-in-time prompts to use content., Methods: Participants (n = 235) from the general population who self-identified as wanting to improve their negative mood were randomised to a waitlist control group (n = 55) or one of three intervention groups: MoodTracker (monitoring-only, n = 58), ImproveYourMood (monitoring and content; n = 62), or ImproveYourMood+ (monitoring, content, and prompts; n = 60). The active intervention phase was 3 weeks. Depressive and anxiety symptoms, and negative automatic thoughts were assessed at baseline, immediately post-intervention, and one month following post-intervention., Results: Linear mixed modelling revealed greater declines over time in depressive and anxiety symptoms and negative automatic thoughts for the ImproveYourMood group (standardized mean differences [SMDs] ranged from .32 to .40) and improves for the ImproveYourMood+ group for negative automatic thoughts (SMDs ≥ .37) compared to the waitlist control group. No between-group differences were observed between the MoodTracker and control groups (SMDs = .04-.23). User experience appeared to be superior in more comprehensive/multi-modal versions., Limitations: The study employed a naturalistic design, whereby participants self-selected to utilise the program, did not complete eligibility assessments, and did not receive compensation. The study therefore attained considerable drop-out rate (~50% by the follow-up timepoints), potentially reflecting the usage patterns of real-world mental health apps., Conclusions: The findings suggest that micro-interventions can be an effective way to reduce depressive symptoms both in the moment and 1-2 months later. Integration of micro-interventions with full treatment programs is a viable next step in micro-intervention research., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Intensive ambulatory assessment, such as ecological momentary assessment (EMA), is increasingly used to capture naturalistic patient-reported outcomes. EMA design features (eg, study duration, prompt frequency) vary widely between studies, but it is not known if such design decisions influence potential subjects' willingness to participate in a study. We hypothesise that intentions to participate will be higher in studies that are less burdensome and have higher reward (eg, compensation)., Design: This experimental study examined if four EMA study design features (study duration, prompt frequency, prompt length, compensation) affected intentions to participate in a hypothetical EMA study and participation appraisals (eg, participation effort). Participants were randomly assigned to conditions (reflecting a fully crossed design of the four features, each with two levels). Each condition presented a vignette describing a study (each a unique combination of design features) and asked them to report on likelihood of participating and study appraisals., Participants: A convenience sample of participants (n=600; 46% female, M age=40.39) were recruited using an online service., Primary and Secondary Outcome Measures: Primary outcomes were willingness to participate (No/Yes) and reported participation likelihood (0-100 scale). Secondary outcomes included appraisals of interest, enjoyment, effort, and if the study makes a valuable contribution to science., Results: We examined main effects, and two-way interactions for participation likelihood, across study design features. Overall, reported willingness to participate and participation likelihood were high (89%, M =83.90, respectively). Shorter study duration, fewer prompts, shorter prompts and higher compensation increased willingness to participate and elicited higher participation likelihood (each associated with ~6%-8% increases). Findings suggested that more intensive studies were judged as somewhat less interesting and enjoyable, and requiring more effort., Conclusion: Hypotheses were generally supported. Design features influence behavioural intentions to participate in, and appraisals of, EMA studies. Implications for participant recruitment and generalisability, and remaining research questions, are discussed., Competing Interests: Competing interests: AAS is a Senior Scientist with the Gallup Organization and a consultant with Adelphi Values, Inc. Other authors have no competing interests to declare., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: With the growing interest in mobile health (mHealth), behavioral medicine researchers are increasingly conducting intervention studies that use mobile technology (eg, to support healthy behavior change). Such studies' scientific premises are often sound, yet there is a dearth of implementational data on which to base mHealth research methodologies. Notably, mHealth approaches must be designed to be acceptable to research participants to support meaningful engagement, but little empirical data about design factors influencing acceptability in such studies exist., Objective: This study aims to evaluate the impact of two common design factors in mHealth intervention research-requiring multiple devices (eg, a study smartphone and wrist sensor) relative to requiring a single device and providing individually tailored feedback as opposed to generic content-on reported participant acceptability., Methods: A diverse US adult convenience sample (female: 104/255, 40.8%; White: 208/255, 81.6%; aged 18-74 years) was recruited to complete a web-based experiment. A 2×2 factorial design (number of devices×nature of feedback) was used. A learning module explaining the necessary concepts (eg, behavior change interventions, acceptability, and tailored content) was presented, followed by four vignettes (representing each factorial cell) that were presented to participants in a random order. The vignettes each described a hypothetical mHealth intervention study featuring different combinations of the two design factors (requiring a single device vs multiple devices and providing tailored vs generic content). Participants rated acceptability dimensions (interest, benefit, enjoyment, utility, confidence, difficulty, and overall likelihood of participating) for each study presented., Results: Reported interest, benefit, enjoyment, confidence in completing study requirements, and perceived utility were each significantly higher for studies featuring tailored (vs generic) content, and the overall estimate of the likelihood of participation was significantly higher. Ratings of interest, benefit, and perceived utility were significantly higher for studies requiring multiple devices (vs a single device); however, multiple device studies also had significantly lower ratings of confidence in completing study requirements, and participation was seen as more difficult and was associated with a lower estimated likelihood of participation. The two factors did not exhibit any evidence of statistical interactions in any of the outcomes tested., Conclusions: The results suggest that potential research participants are sensitive to mHealth design factors. These mHealth intervention design factors may be important for initial perceptions of acceptability (in research or clinical settings). This, in turn, may be associated with participant (eg, self) selection processes, differential compliance with study or treatment processes, or retention over time., (©Frank T Materia, Joshua M Smyth. Originally published in JMIR mHealth and uHealth (https://mhealth.jmir.org), 26.07.2021.)

Objectives: The Strength and Vulnerability Integration (SAVI) theory posits boundary conditions, such as chronic stress, which place constraints on positive emotional aging. We examine SAVI's prediction that higher levels of chronic stress will attenuate favorable age gradients for multiple indices of well-being., Methods: We used cross-sectional data from a diverse systematic probability sample of adults (n = 260, ages 25-65). Multiple regression analysis was used to examine age gradients and test age × chronic stress interactions on 5 measures of well-being relevant for SAVI's prediction: positive and negative affect, life satisfaction, emotional distress, and rumination., Results: Age was unrelated to well-being unless individual differences in health limitations were statistically controlled, in which case older age was associated with more favorable levels of well-being. Chronic stress significantly interacted with age for negative affect, emotional distress, rumination, and life satisfaction; examination of the interactions indicated that age was no longer associated with more favorable levels of well-being at higher levels of chronic stress., Discussion: Our findings support a key prediction of SAVI by demonstrating that high levels of chronic stress present a boundary condition for favorable age gradients on well-being. We discuss the implications of these findings for understanding the "paradox" of well-being., (© The Author(s) 2020. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: The present nonrandomized controlled trial aimed to evaluate feasibility, acceptability, and preliminary efficacy of a tailored text message intervention for increasing adolescent physical activity, as compared with passive monitoring., Methods: Forty adolescents (13-18 years old) received either a tailored text messaging intervention (Network Underwritten Dynamic Goals Engine [NUDGE]; N = 20), or participated in an attention-control condition (N = 20), for 20 days. Physical activity was measured for all participants via continuous accelerometry. Frequency analyses were conducted on program usage and satisfaction ratings to evaluate feasibility and acceptability, and multilevel models were used to evaluate the efficacy hypotheses., Results: The vast majority of participants (90%) reported being very or mostly satisfied with the NUDGE program and rated their enjoyment as above average. The intervention group was estimated to spend an average of 20.84 more minutes per day in moderate-to-vigorous physical activity relative to the attention-control group (β = 20.84, SE = 8.19). Exploratory analyses revealed that the intervention group also engaged in 82 fewer minutes of sedentary time per day on average, although this effect was not significant due to the large variability in sedentary time (β = -81.98, SE = 46.86)., Conclusions: The NUDGE tailored text messaging intervention was feasible, acceptable, and efficacious in increasing physical activity in this sample. Findings warrant additional evaluation of NUDGE as both a standalone physical activity intervention or as part of a multicomponent package., (© The Author(s) 2021. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: There are emerging data indicating that sleep disturbance may be linked with an increase in opioid use. The majority of sickle cell disease (SCD) patients experience sleep disturbances, which can elevate pain severity and pain catastrophizing, both of which are important predictors of opioid consumption., Purpose: We conducted a preliminary investigation on the association between previous night sleep disturbance and short-acting opioid use, as well as the potential mediating roles of pain severity and pain catastrophizing. Because sex is associated with sleep disturbance, pain-related experiences, and opioid use, we also explored the potential moderating role of sex., Methods: Participants were 45 SCD patients who were prescribed opioids. For 3 months, sleep diaries were collected immediately upon participants' awakening. Daily pain severity, pain catastrophizing, and prescription opioid use measures were collected before bedtime., Results: Multilevel structural equation modeling revealed that wake time after sleep onset (WASO) during the previous night (Time 1) predicted greater short-acting opioid use during the next day (Time 2). Pain severity and pain catastrophizing measured during the next day (Time 2) also mediated the association between the two. Sex moderation analysis showed that the positive association between WASO and pain severity was largely driven by women., Conclusion: These findings provide some preliminary evidence as to the mechanism linking sleep continuity disturbance and opioid requirement in SCD patients. Future studies should replicate and extend these findings with clearer temporal information and employing more refined measures of sleep continuity and prescription opioid use in a larger sample., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Ecological momentary assessment (EMA) has the potential to minimize recall bias by having people report on their experiences in the moment (momentary model) or over short periods (coverage model). This potential hinges on the assumption that participants provide their ratings based on the reporting time frame instructions prescribed in the EMA items. However, it is unclear what time frames participants actually use when answering the EMA questions and whether participant training improves participants' adherence to the reporting instructions., Objective: This study aims to investigate the reporting time frames participants used when answering EMA questions and whether participant training improves participants' adherence to the EMA reporting timeframe instructions., Methods: Telephone-based cognitive interviews were used to investigate the research questions. In a 2×2 factorial design, participants (n=100) were assigned to receive either basic or enhanced EMA training and randomized to rate their experiences using a momentary (at the moment you were called) or a coverage (since the last phone call) model. Participants received five calls over the course of a day to provide ratings; after each rating, participants were immediately interviewed about the time frame they used to answer the EMA questions. A total of 2 raters independently coded the momentary interview responses into time frame categories (Cohen κ=0.64, 95% CI 0.55-0.73)., Results: The results from the momentary conditions showed that most of the calls referred to the period during the call (57/199, 28.6%) or just before the call (98/199, 49.2%) to provide ratings; the remainder were from longer reporting periods. Multinomial logistic regression results indicated a significant training effect (χ 2 1 =16.6; P<.001) in which the enhanced training condition yielded more reports within the intended reporting time frames for momentary EMA reports. Cognitive interview data from the coverage model did not lend themselves to reliable coding and were not analyzed., Conclusions: The results of this study provide the first evidence about adherence to EMA instructions to reporting periods and that enhanced participant training improves adherence to the time frame specified in momentary EMA studies., (©Cheng K Fred Wen, Doerte U Junghaenel, David B Newman, Stefan Schneider, Marilyn Mendez, Sarah E Goldstein, Sarah Velasco, Joshua M Smyth, Arthur A Stone. Originally published in JMIR Formative Research (https://formative.jmir.org), 26.05.2021.)

Background: Depression exerts a staggering toll that is worsened with co-occurring chronic conditions such as obesity. It is imperative to develop more effective interventions for depression and to identify objective and biological plausible neural mechanisms to understand intervention outcomes. The current study uses functional neuroimaging to determine whether a behavioural intervention changes the negative affect circuit and whether these changes relate to subsequent improvements in both symptom and problem-solving outcomes in depressed patients with co-occurring obesity., Methods: This study ('ENGAGE') was a pre-planned element of the randomized controlled trial, 'RAINBOW' (ClinicalTrials.gov NCT02246413). 108 depressed patients with obesity were randomized to receive an integrated collaborative care intervention (I-CARE) or usual care. Participants underwent functional neuroimaging using an established facial emotion task at baseline and two months (coinciding with the first two months of intervention focused on problem-solving therapy ('PST')). Amygdala, insula and anterior cingulate cortex activation was extracted using pre-planned definitions and standardized methods. The primary health and behavioural outcomes were depression symptom severity and problem-solving ability respectively, assessed at baseline, the main 6-month outcome point and at 12-month follow up. Mediation analyses used an intent-to-treat approach., Findings: PST, relative to usual care, reduced amygdala activation engaged by threat stimuli at two months. This reduction mediated subsequent improvements in depression severity in an intervention-dependent manner. PST did not change insula activation at two months but did temper the strength of the relationship between insula activation and improvements in problem-solving ability., Interpretation: The negative affect circuit may be an important neural target and potential mediator of PST in patients with comorbid obesity., Funding: US National Institutes of Health/National Heart Lung and Blood Institute R01 HL119453 and UH2/UH3 HL132368., Competing Interests: Declaration of Competing Interest LMW is on the Scientific Advisory Board for One Mind Psyberguide and the External Advisory Board for the Laureate Institute for Brain Research. JM is a paid scientific consultant for Health Mentor, Inc. (San Jose, CA). OA is the co-founder of Keywise AI and the servers on the advisory boards of Blueprint Health and Embodied Labs. TS reports in the last 36 months grants from Merck, grants from National Institute on Drug Abuse, grants from National Institute of Health, grants from Palo Alto Health Sciences, grants from Stanley Medical Research Institute, grants from Pathways Genomics, personal fees from Sunovion Pharmaceuticals, Inc., personal fees from American Society of Clinical Psychopharmacology, personal fees from Impel NeuroPharma Inc., personal fees from Intracellular Therapies, personal fees from Servier (Australia), personal fees from Allergan, Inc., personal fees from Medscape (WebMD), personal fees from CME Institute (Physicians Postgraduate Press, Inc.), personal fees from CMEology, personal fees from American Psychiatric Association Publishing, personal fees from Hogrefe Publishing, personal fees from Jones and Bartlett, personal fees from Wolters Kluwer Health (UpToDate), outside the submitted work., (Copyright © 2021 The Author(s). Published by Elsevier B.V. All rights reserved.)

Mindfulness interventions have been shown to improve several subcomponents of attention; however, the psychological mechanisms driving these improvements are unknown. Mindfulness interventions train individuals to monitor present moment experiences while adopting an attitude of acceptance toward these experiences. We conducted a theoretically driven randomized controlled trial to test the putative mechanisms of mindfulness training that drive improvements in attentional control. Participants were randomly assigned to 1 of 3 conditions: (a) monitor and accept (MA) training, a standard 8-week mindfulness-based stress reduction (MBSR) intervention that included cultivation of both monitoring and acceptance skills; (b) monitor only (MO) training, a well-matched modified 8-week MBSR-adapted intervention that focused on monitoring skills only; or (c) no treatment (NT) control. Momentary attentional control was measured via ecological momentary assessment for 3 days at baseline and postintervention. Trait attentional control was assessed at baseline and postintervention using traditional self-report. Participants also completed a dichotic listening task to assess sustained attention at baseline and postintervention. We found that MA and MO participants improved in momentary and trait attentional control (but not attention task performance) relative to NT participants. Analyses of indirect effects were consistent with the possibility that increased momentary attentional control partially accounts for MA/MO intervention-related increases in trait attentional control. This randomized controlled trial provides one of the first experimental tests of the mechanisms of mindfulness interventions that drive improvements in attention outcomes. These findings support the notion that present-focused monitoring skills training drives mindfulness intervention-related improvements in momentary attentional control, which in turn fosters greater trait attentional control. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The RAINBOW trial demonstrated that an integrated collaborative care intervention was effective for improving weight and depression. This study examined mediation of the treatment effect by a priori specified lifestyle behaviors and cognitive functioning. Participants were randomized to a 12-month integrated intervention (n = 204) or usual care (n = 205). Body mass index (BMI) and 20-item Depression Symptom Check List (SCL-20) were co-primary outcomes (Y). To examine mediation, we assessed (a) the effect of the integrated intervention (X) on lifestyle behaviors (diet and physical activity) and cognitive functioning (problem-solving; M, X→M path a) and (b) the association of these behaviors with BMI and SCL-20 (M→Y path b). Mediation existed if paths a and b were significant or if path a and the product of coefficients test (paths a and b) were significant. Compared with usual care, the intervention led to significant improvements in leisure time physical activity (201.3 MET minutes/week [SD, 1,457.6]) and total calorie intake (337.4 kcal/day [818.3]) at 6 months but not 12 months (path a). These improvements were not significantly associated with improvements in BMI or SCL-20 (path b). However, avoidant problem-solving style score and increased fruit and vegetable intake significantly correlated with improvements in BMI at 6 and 12 months, respectively. Also, increased fruit and vegetable intake, higher dietary quality, and better problem-solving abilities significantly correlated with improvements in SCL-20 at 6 and 12 months. These findings did not support the hypothesized mediation, but suggest lifestyle behaviors and cognitive functioning to target in future intervention optimization., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Examining variability in the presenting symptoms of depression may be particularly important in characterizing depression in patients with comorbid conditions such as obesity. Identifying the underlying constructs of depression in such patients may produce phenotypic information to aid diagnosis and treatment decisions., Objective: To examine the latent factors of symptoms using the depression Symptom Checklist (SCL-20) and the Patient Health Questionnaire (PHQ-9), separately, in patients with obesity and elevated depressive symptoms., Methods: Exploratory factor analysis (EFA) was performed on baseline data from 409 patients with obesity and elevated depressive symptoms recruited in primary care. Bootstrap analysis was performed to estimate the precision and potential replicability of identified latent factors., Results: Participants (70% women, mean age of 51.0 ± 12.1 years) had moderate depression. EFA of the SCL-20 suggested two reliable factors: dysphoric mood (71% of the variance) and anhedonia (15% of the variance). EFA of the PHQ-9 yielded one factor: dysphoric mood (87% of the variance). Bootstrapped results supported the replicability of these results. The top most endorsed symptoms were feeling low energy, overeating and disturbed sleep., Limitations: The generalizability of these findings to severe depression may be limited., Conclusions: Patients with elevated depressive symptoms and obesity present with heterogeneous symptoms. The SCL-20 seems more sensitive than the PHQ-9 for differentiating symptom profiles in this population. Some possible reasons include: 1) differences in number of scale items, and 2) differences in the aspects of depression they tap into; the SCL-20 measures the severity of symptoms, whereas the PHQ-9 measures the frequency of symptoms., (Copyright © 2020. Published by Elsevier B.V.)

Despite the myriad benefits associated with regular physical activity (PA), few American adults accrue sufficient weekly PA. Although "lack of time" is often cited as a correlate of physical inactivity, a growing body of evidence suggests that, perhaps more importantly, people allocate their leisure-time to activities they find more enjoyable than PA. These findings underscore the need to devise physical activities that will be chosen over other enjoyable, but less healthy, behavioral alternatives. As a first step in this direction, we designed a group social PA play program for adults, known as PlayFit. The overarching philosophy of PlayFit is that fun and enjoyment are among the most important influences on PA adherence. In PlayFit, traditional sport games are modified to fulfill basic psychological needs, in a non-competitive, and non-contact environment. We will randomize 280 sedentary adults 18-50 years of age to 12-months of PlayFit or traditional group exercise, matching the groups on intensity, frequency, and duration. The primary outcomes include cardiorespiratory fitness (VO 2peak ), group adherence, and group enjoyment. We hypothesize that, at 6 months, cardiorespiratory fitness will have increased to the same extent in both groups, but at 12 months, only those randomized to PlayFit will have maintained their fitness through better adherence than Group Exercise - and this outcome will be mediated by enjoyment of the assigned group. Findings from this study could provide evidence that a focus on providing fun and enjoyable PA experiences for adults may be a viable route toward improving PA adherence. A simple, inexpensive PA intervention, such as PlayFit, may represent one such approach to do so., Competing Interests: Christopher Sciamanna has an investment, such as stock, in a company which has begun to investigate the possibility of creating a business that provides exercise programs. There are no further known conflicts of interest to declare., (© 2021 The Authors.)

Despite widespread interest in variance in affect, basic questions remain pertaining to the relative proportions of between-person and within-person variance, the contribution of days and moments, and the reliability of these estimates. We addressed these questions by decomposing negative affect and positive affect variance across three levels (person, day, moment), and calculating reliability using a coordinated analysis of seven daily diary, ecological momentary assessment (EMA), and diary-EMA hybrid studies (across studies age = 18-84 years, total N persons = 2,103, total N observations = 45,065). Across studies, within-person variance was sizeable (negative affect: 45% to 66%, positive affect: 25% to 74%); in EMA more within-person variance was attributable to momentary rather than daily level. Reliability was adequate to high at all levels of analysis (within-person: .73-.91; between-person: .96-1.00) despite different items and designs. We discuss the implications of these results for the design of future intensive studies of affect variance.

Incorporating technological supplements into existing group mindfulness-based interventions (MBIs), particularly for use with adolescents, is an important next step in the implementation of MBIs. Yet there is little available content. Herein we present the development and content of a technological supplement for MBIs, which incorporates multiple technological elements to support (a) skill transfer from the group MBI to daily life, (b) the establishment of a formal mindfulness practice, and (c) the use of mindfulness during periods of high stress. A mixed-methods approach was used to develop this multi-method adaptive supplement. Findings about the use of this supplement will be disseminated scientifically and/or publicly as appropriate., (Copyright © 2020 Lucas-Thompson, Rayburn, Seiter, Broderick, Smyth, Coatsworth and Henry.)

Background: Midlife women are at an elevated risk for cardiovascular disease (CVD) and associated mortality. Those who have additional risk conditions such as obesity or hypertension report specific barriers to engaging in cardioprotective behaviors such as physical activity (PA). Considerable effort has been devoted to understanding PA determinants and designing interventions for midlife women, although with suboptimal success, as increasing PA could meaningfully attenuate CVD risk. An updated approach to understanding PA among midlife women could improve upon existing resources by focusing on novel psychosocial influences on PA in this population (ie, body satisfaction, social interactions, social comparisons, mood state) and within-person relations between these influences and PA in the natural environment., Objective: The overarching goal of Project WHADE (Women's Health And Daily Experiences) is to use an ecological momentary assessment (EMA) approach to capture ecologically valid relations between midlife women's psychosocial experiences and PA as they engage in their normal daily activities. The primary aim of the study is to identify within-person psychosocial predictors of variability in PA (ie, experiences associated with higher vs lower PA for a given individual)., Methods: Midlife women (aged 40-60 years) with one or more additional risk markers for CVD (eg, hypertension) will be recruited from primary care clinics and the general community (target n=100). Eligible women will complete an initial survey and a face-to-face baseline session before engaging in a 10-day EMA protocol. Psychosocial experiences will be assessed using a brief self-report via a smartphone 5 times per day, and PA will be assessed throughout waking hours using a research-grade monitor. Participants will return for a brief exit interview at the end of 10 days. Multilevel models that address the nested structure of EMA data will be used to evaluate the study aims., Results: Recruitment and enrollment are ongoing, and a total of 75 women have completed the protocol to date. Data collection is expected to be completed in Fall 2020., Conclusions: Project WHADE is designed to identify naturally occurring psychosocial experiences that predict short-term variability in midlife women's PA. As such, the results of this study should advance the current understanding of PA among midlife women by providing further insight into within-person psychosocial influences on PA in this group. In the future, this information could help inform the design of interventions for this population., International Registered Report Identifier (irrid): DERR1-10.2196/19044., (©Danielle Arigo, Megan M Brown, Kristen Pasko, Matthew Cole Ainsworth, Laura Travers, Adarsh Gupta, Danielle Symons Downs, Joshua M Smyth. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 15.10.2020.)

Purpose: Social support (SS) has been shown to moderate the relationship between psychological distress and physical activity (PA) in adults, including those with no history of cancer and cancer survivors (CS). The purpose of this study was to explore the relationship between stress and leisure-time PA and test if SS is a moderator of this relationship in rural CS., Methods: CS were recruited to Partnering to Prevent and Control Cancer (PPCC) and completed questionnaires assessing sociodemographics, leisure-time PA, perceived stress, and SS. Hierarchical multivariable linear regression was used to assess the moderating role of SS on the association between stress and PA., Findings: Cancer survivors (N = 219) were in their mid-60s (M age = 64.3 ± 12.5 years) and overweight/obese (M BMI = 29.5 ± 6.8 kg/m 2 ); over half were women (60.7%) and insufficiently active (59.4%); and 42.1% reported moderate-to-high perceived stress. Perceived stress was negatively correlated with PA (r = -.183, P = .044) and SS (r = -.470, P < .001), and SS was positively correlated with PA (r = .205, P = .025). However, SS did not moderate the association between stress and PA., Conclusions: Rural CS reported higher stress and less PA than previously reported by urban CS, potentially contributing to rural cancer health disparities. Although previous studies have shown success in building SS to reduce stress and promote PA in CS, our results do not support the stress-buffering hypothesis in rural cancer survivors. Further research is needed to understand factors related to PA in rural CS and determine strategies to reduce psychological distress and promote healthy behaviors in an effort to improve cancer survivorship., (© 2020 National Rural Health Association.)

Churches are well positioned to promote better mental health outcomes in underserved populations, including rural adults. Mind-body (MB) practices improve psychological well-being yet are not widely adopted among faith-based groups due to conflicting religious or practice beliefs. Thus, "Harmony & Health" (HH) was developed as a culturally adapted MB intervention to improve psychosocial health in urban churchgoers and was adapted and implemented in a rural church. The purpose of this study was to explore the feasibility, acceptability, and efficacy of HH to reduce psychosocial distress in rural churchgoers. HH capitalized on an existing church partnership to recruit overweight or obese (body mass index [BMI] ≥25.0 kg/m2) and insufficiently active adults (≥18 years old). Eligible adults participated in an 8 week MB intervention and completed self-reported measures of perceived stress, depressive symptoms, anxiety, and positive and negative affect at baseline and postintervention. Participants (mean [M] age = 49.1 ± 14.0 years) were mostly women (84.8%), non-Hispanic white (47.8%) or African American (45.7%), high socioeconomic status (65.2% completed ≥bachelor degree and 37.2% reported an annual household income ≥$80,000), and obese (M BMI = 32.6 ± 5.8 kg/m2). Participants reported lower perceived stress (t = -2.399, p = .022), fewer depressive symptoms (t = -3.547, p = .001), and lower negative affect (t = -2.440, p = .020) at postintervention. Findings suggest that HH was feasible, acceptable, and effective at reducing psychosocial distress in rural churchgoers in the short-term. HH reflects an innovative approach to intertwining spirituality and MB practices to improve physical and psychological health in rural adults, and findings lend to our understanding of community-based approaches to improve mental health outcomes in underserved populations., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Despite evidence for effective integrated behavior therapy for treating comorbid obesity and depression, treatment response is highly variable and the underlying neurobiological mechanisms remain unknown. This hampers efforts to identify mechanistic targets in order to optimize treatment precision and potency. Funded within the NIH Science of Behavior Change (SOBC) Research Network, the 2-phased ENGAGE research project applies an experimental precision medicine approach to address this gap. The Phase 1 study focused on demonstrating technical feasibility, target engagement and potential neural mechanisms of responses to an integrated behavior therapy. This therapy combines a video-based behavioral weight loss program and problem-solving therapy for depression, with as-needed intensification of antidepressant medications, and its clinical effectiveness was demonstrated within a parent randomized clinical trial. Here, we describe the ENGAGE Phase 2 (ENGAGE-2) study protocol which builds on Phase 1 in 2 ways: (1) pilot testing of an motivational interviewing-enhanced, integrated behavior therapy in an independent, primarily minority patient sample, and (2) evaluation of a priori defined neural targets, specifically the negative affect (threat and sadness) circuits which demonstrated engagement and malleability in Phase 1, as mediators of therapeutic outcomes. Additionally, the Phase 2 study includes a conceptual and methodological extension to explore the role of microbiome-gut-brain and systemic immunological pathways in integrated behavioral treatment of obesity and depression. This protocol paper documents the conceptualization, design and the transdisciplinary methodologies in ENGAGE-2, which can inform future clinical and translational research in experimental precision medicine for behavior change and chronic disease management. Trial registration: ClinicalTrials.gov #NCT 03,841,682., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: Higher affect variability (the extent to which individuals vary in their affect over time) has been associated with poorer health indicators, but associations with inflammation are less well understood. The purpose of the present study was to examine whether affect variability was associated with inflammation in ways consistent with the stability theory or the fragile positive affect theory, and whether associations were linear or nonlinear., Method: In a racially diverse sample (N = 231; Aged 25-65; 65% female; 62% Black; 25% Hispanic), we examined whether positive affect (PA) and negative affect (NA) variability exhibited linear or quadratic associations with circulating inflammatory cytokines (a composite measure comprised of IL-1β, IL-4, IL-6, IL-8, IL-10, TNF-α, IFN-γ), and C-reactive protein (CRP) and whether person-mean affect moderated these associations. Affective states were assessed using ecological momentary assessments (EMAs) 5 times per day for 2 weeks, with a blood draw at the end of the EMA period. Individual standard deviations of affective states indexed affect variability., Results: A quadratic association indicated that moderate NA variability was associated with lower CRP. There was evidence of significant moderation by linear associations with PA only: For those with higher person-mean PA, PA variability was positively associated with the cytokine composite. Both person-mean PA and person-mean NA moderated quadratic associations, such that for those with high person-mean affect, both high and low affect variability was associated with systemic inflammation., Conclusion: Results are in line with fragile affect theory suggesting that associations between affect variability and health indicators may vary by person-mean affect. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Daily diary studies and experience sampling studies examine day-to-day variations in affect using different rating types: The former typically collect retrospective affect reports at the end of the day, whereas the latter collects multiple momentary assessments across the day. The present study examined the convergence of (aggregated) momentary assessments collected repeatedly within a day and retrospective assessments collected at the end of the day. Building on prior research on the memory-experience gap and the peak-and-end rule we predicted that participants would report more intense retrospective affect than aggregated momentary affect, and that retrospective affect would be biased toward the peak and the most recent affect of the day. Based on socioemotional selectivity theory and the strength and vulnerability integration model, age differences in these convergence indicators were expected. Findings from 2 age-heterogeneous ecological momentary assessment/daily diary hybrid studies ( N = 242, 25-65 years; and N = 175, 20-79 years) revealed (a) a memory-experience gap for negative affect (more intense retrospective ratings than aggregated momentary ratings) that is attenuated with advancing age; (b) only a small memory-experience gap for positive affect for very old adults (66-79 years), but not younger adults; (c) relatively high convergence of aggregated momentary ratings and retrospective ratings despite (d) small biases of retrospective negative affect ratings toward peak and most recent negative affect. Findings suggest that both rating types can discriminate "good days" from "bad days" and provide overlapping but not necessarily exchangeable information. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Recent work using naturalistic, repeated, ambulatory assessment approaches have uncovered a range of within-person mood- and body image-related dynamics (such as fluctuation of mood and body dissatisfaction) that can prospectively predict eating disorder behaviors (e.g., a binge episode following an increase in negative mood). The prognostic significance of these state-based dynamics for predicting trait-level eating disorder severity, however, remains largely unexplored. The present study uses within-person relationships among state levels of negative mood, body image, and dieting as predictors of baseline, trait-level eating pathology, captured prior to a period of state-based data capture. Two-hundred and sixty women from the general population completed baseline measures of trait eating pathology and demographics, followed by a 7 to 10-day ecological momentary assessment phase comprising items measuring state body dissatisfaction, negative mood, upward appearance comparisons, and dietary restraint administered 6 times daily. Regression-based analyses showed that, in combination, state-based dynamics accounted for 34-43% variance explained in trait eating pathology, contingent on eating disorder symptom severity. Present findings highlight the viability of within-person, state-based dynamics as predictors of baseline trait-level disordered eating severity. Longitudinal testing is needed to determine whether these dynamics account for changes in disordered eating over time.

Background: Emerging evidence suggests that higher circulating levels of inflammatory biomarkers in blood are associated with higher negative affect (NA) and lower positive affect (PA). To our knowledge, the unique associations between NA and PA in daily life and salivary biomarkers of inflammation have not been examined. This study examined these associations in young adults., Methods: Measures of NA and PA were created from aggregated daily measures of affect (morning and evening ratings averaged across 14 days). We investigated associations between these measures and salivary C-reactive protein (CRP) and interleukin (IL)-6 in a sample of 108 young adults (60% female, mean age = 20.45 ± 1.47), a subset of whom had self-reported chronic back pain (n = 49). CRP and IL-6 were determined from saliva obtained at the end of the daily diary period., Results: After covarying for age, gender, body mass index, chronic pain status, salivary flow rate, and NA, higher PA was associated with lower salivary CRP (β = - 0.02, 95% CI (- 0.03, - 0.00) sr 2  = .06, p = .01) but not IL-6; removing NA from this model did not change results. In a model with the same covariates (and PA), NA was not significantly related to CRP or IL-6. Chronic back pain status and gender did not moderate results., Conclusions: Findings suggest that higher PA may be associated with lower salivary CRP in young adults, even after accounting for NA and demographic characteristics. Findings highlight the utility of assessing emotional states in relation to salivary markers of inflammation in future biobehavioral research.

New technologies and innovations have often improved population well-being and societal function; however, these are also often initially accompanied by worry and fear. In some cases, such worries can impede, or even prevent entirely, the adoption of the technology. Mobile health (mHealth), a discipline broadly focused on employing ambulatory technologies to improve the affordability, reach, and effectiveness of health promotion and clinical intervention approaches, offers new innovations and opportunities. Despite emerging evidence supporting mHealth efficacy (eg, for improving health outcomes), some individuals have concerns about mHealth technology that may impede scalability, efficacy, and, ultimately, the public health benefits of mHealth. We present a review and conceptual framework to examine these issues, focusing on three overarching themes: biophysiological, psychological, and societal concerns. There are features of mHealth that lead to worries about the potential negative effects on an individual's health (eg, due to exposure to electromagnetic or radio waves), despite evidence supporting the safety of these technologies. When present, such beliefs can lead to worry that gives rise to the experience of unpleasant and concerning physical symptoms-the nocebo effect. This may represent an important implementational barrier because of apprehension toward beneficial mHealth products (or features thereof, such as wireless charging, wearable or implantable sensors, etc) and may also have broader ramifications (eg, leading to economic, governmental, and legislative actions). In addition to reviewing evidence on these points, we provide a broad three-step model of implementation research in mHealth that focuses on understanding and preventing health concerns to facilitate the safe and effective scalability of mHealth (and that may be generalizable and applied to similar technologies): (1) evaluating and better discerning public perceptions and misperceptions (and how these may differ between populations), (2) developing theory-based public health communication strategies regarding the safety of mHealth, and (3) disseminating this messaging using evidence-based methods. Collectively, these steps converge on reviewing evidence regarding the potential role of worry and nocebo in mHealth and providing a model for understanding and changing attitudes and preventing unfounded negative perceptions related to mHealth technology., (©Frank T Materia, Kate Faasse, Joshua M Smyth. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 25.05.2020.)

Background: Individuals' emotional responses to stressors in everyday life are associated with long-term physical and mental health. Among many possible risk factors, the stressor-related emotional responses may play an important role in future development of depressive symptoms., Purpose: The current study examined how individuals' positive and negative emotional responses to everyday stressors predicted their subsequent changes in depressive symptoms over 18 months., Methods: Using an ecological momentary assessment approach, participants (n = 176) reported stressor exposure, positive affect (PA), and negative affect (NA) five times a day for 1 week (n = 5,483 observations) and provided longitudinal reports of depressive symptoms over the subsequent 18 months. A multivariate multilevel latent growth curve model was used to directly link the fluctuations in emotions in response to momentary stressors in everyday life with the long-term trajectory of depressive symptoms., Results: Adults who demonstrated a greater difference in stressor-related PA (i.e., relatively lower PA on stressor vs. nonstressor moments) reported larger increases in depressive symptoms over 18 months. Those with greater NA responses to everyday stressors (i.e., relatively higher NA on stressor vs. nonstressor moments), however, did not exhibit differential long-term changes in depressive symptoms., Conclusions: Adults showed a pattern consistent with both PA and NA responses to stressors in everyday life, but only the stressor-related changes in PA (but not in NA) predicted the growth of depressive symptoms over time. These findings highlight the important-but often overlooked-role of positive emotional responses to everyday stressors in long-term mental health., (© Society of Behavioral Medicine 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Voice-based personal assistants using artificial intelligence (AI) have been widely adopted and used in home-based settings. Their success has created considerable interest for its use in healthcare applications; one area of prolific growth in AI is that of voice-based virtual counselors for mental health and well-being. However, in spite of its promise, building realistic virtual counselors to achieve higher-order maturity levels beyond task-based interactions presents considerable conceptual and pragmatic challenges. We describe one such conceptual challenge-cognitive plausibility, defined as the ability of virtual counselors to emulate the human cognitive system by simulating how a skill or function is accomplished. An important cognitive plausibility consideration for voice-based agents is its ability to engage in meaningful and seamless interactive communication. Drawing on a broad interdisciplinary research literature and based on our experiences with developing two voice-based (voice-only) prototypes that are in the early phases of testing, we articulate two conceptual considerations for their design and use-conceptualizing voice-based virtual counselors as communicative agents and establishing virtual co-presence. We discuss why these conceptual considerations are important and how it can lead to the development of voice-based counselors for real-world use., Competing Interests: Competing interestsJ.M. is a paid scientific consultant for Health Mentor, Inc. (San Jose, CA, USA)., (© The Author(s) 2020.)

Background: Adolescents diagnosed with persistent asthma commonly take less than 50% of their prescribed inhaled corticosteroids (ICS), placing them at risk for asthma-related morbidity. Adolescents' difficulties with adherence occur in the context of normative developmental changes (eg, increased responsibility for disease management) and rely upon still developing self-regulation and problem-solving skills that are integral for asthma self-management. We developed an adaptive mobile health system, Responsive Asthma Care for Teens (ReACT), that facilitates self-regulation and problem-solving skills during times when adolescents' objectively measured ICS adherence data indicate suboptimal rates of medication use., Objective: The current paper describes our user-centered and evidence-based design process in developing ReACT. We explain how we leveraged a combination of individual interviews, national crowdsourced feedback, and an advisory board comprised of target users to develop the intervention content., Methods: We developed ReACT over a 15-month period using one-on-one interviews with target ReACT users (n=20), national crowdsourcing (n=257), and an advisory board (n=4) to refine content. Participants included 13-17-year-olds with asthma and their caregivers. A total of 280 adolescents and their caregivers participated in at least one stage of ReACT development., Results: Consistent with self-regulation theory, adolescents identified a variety of salient intrapersonal (eg, forgetfulness, mood) and external (eg, changes in routine) barriers to ICS use during individual interviews. Adolescents viewed the majority of ReACT intervention content (514/555 messages, 93%) favorably during the crowdsourcing phase, and the advisory board helped to refine the content that did not receive favorable feedback during crowdsourcing. Additionally, the advisory board provided suggestions for improving additional components of ReACT (eg, videos, message flow)., Conclusions: ReACT involved stakeholders via qualitative approaches and crowdsourcing throughout the creation and refinement of intervention content. The feedback we received from participants largely supported ReACT's emphasis on providing adaptive and personalized intervention content to facilitate self-regulation and problem-solving skills, and the research team successfully completed the recommended refinements to the intervention content during the iterative development process., (©David A Fedele, Christopher C Cushing, Natalie Koskela-Staples, Susana R Patton, Elizabeth L McQuaid, Joshua M Smyth, Sreekala Prabhakaran, Selina Gierer, Arthur M Nezu. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 06.05.2020.)

Background: Mobile technology has increased the reach of health behavior interventions but raised new challenges in assessing the fidelity of treatment receipt. Fidelity can be compromised if participant fatigue or burden reduces engagement, leading to missed or delayed treatments for just-in-time interventions., Objective: This study aimed to investigate the temporal dynamics of text message receipt confirmations., Methods: Community-dwelling adults (N=10) were sent five text messages daily for 4 months (5598 messages sent in total), with a financial incentive to confirm receipt of 75% or more messages., Results: Overall, the message receipt confirmation rate was very high (5504/5598, 98.32%) and timely (eg, two-thirds of confirmations within 2 min). Confirmation times were slightly slower on weekends (vs weekdays) and as a function of the cumulative time in the study. Neither time of message delivery nor message content was associated with message confirmation latencies., Conclusions: Participants receiving financial incentives to confirm text message receipt exhibit extremely high and fast confirmation rates, although receipt confirmations were somewhat less timely on weekends (vs weekdays) and later in the intervention. The social calendar and treatment fatigue should be considered when planning text message-based interventions, especially if treatments are intended for a just-in-time delivery that requires extended engagement and precise timing., (©David E E Conroy, Chih-Hsiang Yang, Stephanie T Lanza, Joshua M Smyth, Constantino M Lagoa. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 22.04.2020.)

Introduction: The RAINBOW randomized clinical trial validated the efficacy of an integrated collaborative care intervention for obesity and depression in primary care, although the effect was modest. To inform intervention optimization, this study investigated within-treatment variability in participant engagement and progress., Methods: Data were collected in 2014-2017 and analyzed post hoc in 2018. Cluster analysis evaluated patterns of change in weekly self-monitored weight from week 6 up to week 52 and depression scores on the Patient Health Questionnaire-9 (PHQ-9) from up to 15 individual sessions during the 12-month intervention. Chi-square tests and ANOVA compared weight loss and depression outcomes objectively measured by blinded assessors to validate differences among categories of treatment engagement and progress defined based on cluster analysis results., Results: Among 204 intervention participants (50.9 [SD, 12.2] years, 71% female, 72% non-Hispanic White, BMI 36.7 [6.9], PHQ-9 14.1 [3.2]), 31% (n = 63) had poor engagement, on average completing self-monitored weight in <3 of 46 weeks and <5 of 15 sessions. Among them, 50 (79%) discontinued the intervention by session 6 (week 8). Engaged participants (n = 141; 69%) self-monitored weight for 11-22 weeks, attended almost all 15 sessions, but showed variable treatment progress based on patterns of change in self-monitored weight and PHQ-9 scores over 12 months. Three patterns of weight change (%) represented minimal weight loss (n = 50, linear β1 = -0.06, quadratic β2 = 0.001), moderate weight loss (n = 61, β1 = -0.28, β2 = 0.002), and substantial weight loss (n = 12, β1 = -0.53, β2 = 0.005). Three patterns of change in PHQ-9 scores represented moderate depression without treatment progress (n = 40, intercept β0 = 11.05, β1 = -0.11, β2 = 0.002), moderate depression with treatment progress (n = 20, β0 = 12.90, β1 = -0.42, β2 = 0.006), and milder depression with treatment progress (n = 81, β0 = 7.41, β1 = -0.23, β2 = 0.003). The patterns diverged within 6-8 weeks and persisted throughout the intervention. Objectively measured weight loss and depression outcomes were significantly worse among participants with poor engagement or poor progress on either weight or PHQ-9 than those showing progress on both., Conclusions: Participants demonstrating poor engagement or poor progress could be identified early during the intervention and were more likely to fail treatment at the end of the intervention. This insight could inform individualized and timely optimization to enhance treatment efficacy., Trial Registration: ClinicalTrials.gov# NCT02246413., Competing Interests: The authors declare that no competing interests existed for the research as reported. Dr. Lenard Lesser’s affiliation with 1Life Healthcare/One Medical constituted no competing interests. Dr. Lesser had originally supported on the NIH grant for his role as a study physician on this study while he was an employee at the Palo Alto Medical Foundation Research Institute (PAMFRI) where the study was conducted. Starting from 07/2016 till 10/2017, Dr. Lesser transitioned from PAMFRI to 1Life Healthcare, Inc/One Medical. At that time, his continuous involvement in the study was compensated through a research contract as an independent consultant with PAMFRI specifically for the NIH grant supporting the study. 1Life Healthcare/One Medical provided no support of any form for the study; and had no role in the study design, data collection/analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.”

This study examined reported post-traumatic stress disorder symptoms in adults with poorly controlled type 2 diabetes who had no history of psychiatric diagnosis or treatment ( n  = 184, M HbA1c  = 9.13%, standard deviation = 1.68). Participants reported moderate to severe intensity of post-traumatic stress disorder symptoms ( M  = 19.17, SD = 17.58). Together, depressive and post-traumatic stress disorder symptoms accounted for 10-40 percent of the variance in type 2 diabetes outcomes; post-traumatic stress disorder symptoms were associated with elevated diabetes distress and more frequent exercise and self-blood glucose testing (unique R 2  ~ 3%). Post-traumatic stress disorder symptoms may be overlooked in type 2 diabetes among patients without formal psychiatric diagnoses, and warrant increased attention.

Background: Affective experiences and movement-based behaviors form a system that has been shown to influence exercise adherence and mental health outcomes. Little is known about the naturalistic dynamics of the reciprocal associations in this system., Purpose: We examined the time intervals at which momentary affect precedes and follows movement-based behaviors in everyday life., Methods: A community sample of working adults (n = 111) completed ecological momentary assessments (EMA) asking about current affect states (sad, happy, tired, and interested) six times a day for three consecutive days. Ratings were used to generate scores for momentary affective arousal and valence. Participants also wore an activity monitor. Total activity counts and sedentary duration in the shorter to longer time intervals (5-120 min) before or after EMA were used as indicators of movement-based behaviors., Results: Multilevel modeling showed that current affective arousal predicted higher subsequent activity counts in the longer time intervals (120 min) and less subsequent sedentary behavior in the shorter to longer time intervals (5, 60, and 120 min). For the reversed sequence, neither movement-based behavior predicted subsequent momentary arousal or valence. Affective valence was unrelated to movement-based behaviors in either temporal direction., Conclusions: Some naturally occurring affective experiences (i.e., arousal) might precede, rather than follow, movement-based behaviors. Understanding affective arousal may contribute to improved management of subsequent movement-based behaviors in everyday life., (© Society of Behavioral Medicine 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Rates of cardiovascular disease and diabetes are rising in low- and middle-income countries (LMIC), but there is a dearth of research devoted to developing and evaluating chronic disease interventions in these settings, particularly in Africa. Lifestyle Africa is a novel, culturally adapted version of the Diabetes Prevention Program (DPP) being evaluated in an ongoing community-based cluster-randomized trial in an underresourced urban community in South Africa. The purpose of this study is to describe the adaptations and adaptation process used to develop the program and to report preliminary implementation findings from the first wave of groups (n = 11; 200 individuals) who participated in the intervention. The RE-AIM model and community advisory boards guided the adaptation process. The program was designed to be delivered by community health workers (CHWs) through video-assisted sessions and supplemented with text messages. Participants in the trial were overweight and obese members of existing chronic disease "support groups" served via CHWs. Implementation outcomes included completion of sessions, session attendance, fidelity of session delivery, and participant satisfaction. Results indicated that 10/11 intervention groups completed all 17 core sessions. Average attendance across all sessions and groups was 54% and the percentage who attended at least 75% of sessions across all groups was 35%. Fidelity monitoring indicated a mean of 84% of all required procedures were completed while overall communication skills were rated as "good" to "excellent". These preliminary results support the feasibility of culturally adapting the DPP for delivery by CHWs in underresourced settings in LMIC., (© Society of Behavioral Medicine 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Depressive symptoms are often linked with higher inflammation and inflammatory responses, although these associations are not always consistent. In a recent study (N=160, 25-65 years, 67% women), our group reported gender differences relevant to this association: In men higher depressive symptoms were related to heightened ex vivo inflammatory responses to lipopolysaccharide (LPS), whereas in women higher depressive symptoms were related to attenuated inflammatory responses. In the present manuscript, we investigate markers of endotoxemia - i.e., markers of the presence of endotoxin in the blood, presumably due to bacterial translocation from the gut - as factors that elicit gender-dependent immune responses that may be associated with links between depressive symptoms and inflammation. We examined ex vivo inflammatory responses in whole blood via a composite index of LPS-stimulated cytokines. The ratio of LPS-binding protein to soluble CD14 receptor (LBP:sCD14) was quantified as an index of endotoxemia that captures the relative reliance on pro-inflammatory versus non-inflammatory pathways for bacterial clearance. Levels of endotoxemia markers in blood were found to moderate gender differences in the link between depressive symptoms and stimulated inflammation (Gender × Depressive Symptoms × Endotoxemia: B = -0.039, 95%CI [-0.068, 0.009], p = 0.010). At lower LBP:sCD14 levels, depressive symptoms and stimulated inflammation were unrelated in both men and women. However, with higher levels of LBP:sCD14, men showed an increasingly positive correlation and women showed a negative correlation between depressive symptoms and stimulated inflammation. Hence, men and women exhibited similar associations between depressive symptoms and inflammatory responses at lower endotoxin marker levels, but these associations became divergent at higher levels of endotoxin markers. This information provides a novel perspective on risk factors for depression-linked alterations in inflammation, which may help to determine susceptibility to the downstream physical consequences of depressive symptomatology.

Background: Few adults in the United States obtain sufficient physical activity (PA) despite knowledge of the associated health benefits. The current feasibility study examined the feasibility of a novel modified sports intervention designed to promote enjoyment and sustained PA in sedentary adults., Methods: The US adults (N = 22, mean age 39.2 y, male/female percentage 54.5/45.5) in Central Pennsylvania participated in the PlayFit sports program for 60-minute sessions, 2 to 3 times per week, over the course of 10 weeks and 24 game sessions; completing 198 person sessions collectively. Primary outcomes were PA (accelerometry) and intervention satisfaction., Results: Percentage of time in moderate to vigorous activity ranged from 35.0% (volleyball) to 91.2% (ultimate frisbee). Percentage of time spent in vigorous activity ranged from 0.0% (volleyball) to 29.5% (team handball). Satisfaction, based on a 10-point scale with 10 being the most satisfied, ranged from 7.7 (kickball) to 8.7 (floor hockey and soccer). On average, all sports were rated highly, with the majority rated >8.5 and one rated <8.0. Percentage of time spent in the moderate to vigorous range was lower in men than in women (73.2% vs 80.0%, P = .01), but did not differ by age or body mass index., Conclusions: PlayFit is a promising first step in exploring the potential of modified sports programs to enhance population PA levels.

The experience of naturally-occurring stress in daily life has been linked with lower physical activity levels. However, most of this evidence comes from general and static reports of stress. Less is known how different temporal components of everyday stress interfere with physical activity. In a coordinated secondary analysis of data from two studies of adults, we used intensive, micro-longitudinal assessments (ecological momentary assessments, EMA) to investigate how distinct components of everyday stress, that is, reactivity to stressor events, recovery from stressor events, and pileup of stressor events and responses predict physical activity. Results showed that components of everyday stress predicted subsequent physical activity especially for indicators of stress pileup. In both studies, the accumulation of stress responses over the previous 12 h was more predictive of subsequent physical activity than current stress reactivity or recovery responses. Results are compared to the effects of general measures of perceived stress that showed an opposite pattern of results. The novel everyday stress approach used here may be fruitful for generating new insights into physical activity specifically and health behaviors in general.