Co-occurrence and coaction of stress management with other health risk behaviors

"I'm an adult now": Health risk behaviors and identifying as an adult

Is identifying as an adult associated with lower rates of participation in risky behaviors? This study focuses on how identity affects health behaviors for young adults. We use an original sample of over 500 18- to 29-year-olds in the United States to explore how self-identification as an adult is associated with three clusters of health risk behaviors: substance use, risky sexual behavior, and risky driving behavior. Consistent with our predictions, we find that viewing oneself as an adult is associated with lower levels of participation in each of the health risk behavior outcomes.

Smoking cessation, metabolic risk behaviors, and stress management over time in a sample of young adult smokers

Smoking cessation may support changes in metabolic risk behaviors (e.g., high-fat diet, physical inactivity, poor sleep, low fruit and vegetable consumption [FVC]). We examined the association between smoking cessation and metabolic risk behavior profiles, mediated by readiness to change risk behaviors and moderated by stress management. Participants were young adult smokers in a randomized controlled trial of a Facebook smoking cessation intervention. Measures included stage of change for five metabolic risk behaviors: FVC, diet, physical activity, sleep hygiene, and stress management. Moderated mediation was used to examine relationships between smoking cessation at T1 (predictor), readiness to change metabolic risk behaviors at T2 (mediators), stress management at T3 (moderator), and metabolic risk behavior profile at T3 (outcome) over 9 months. T1 smoking abstinence was associated with greater readiness to increase FVC at T2, which predicted lower likelihood of T3 metabolic risk (β = -0.22, 95% confidence interval [CI] [-0.53, -0.03]). This indirect effect was moderated by stress management such that greater readiness to increase FVC at T2 was associated with lower T3 metabolic risk for participants with unmanaged stress (β = -0.90, 95% CI [-1.32, -0.49], p < .001), but not for participants with well-managed stress (β = -.22, 95% CI [-0.48, 0.04], p = .096). Young adults who quit smoking subsequently had lower metabolic risk behaviors. Among participants with unmanaged stress, those who quit smoking had greater readiness to increase FVC and lower likelihood of subsequent metabolic risk. Smoking cessation interventions could aim to teach broadly applicable behavior change skills and build confidence for decreasing metabolic risk.

Perceived Stress and Adherence to the Dietary Recommendations and Blood Glucose Levels in Type 1 Diabetes

Stress may negatively impact self-management of diabetes and thereby deteriorate glycaemic control. Eating is the most frequently reported stress-release method. In this study, we investigated the association between perceived stress (PS), dietary adherence, and glycaemic control. Data from participants in the FinnDiane Study with type 1 diabetes who had completed a diet questionnaire and Cohen's perceived stress scale (PSS) were included. In addition to using a continuous PSS score, participants were divided into three groups based on the PSS scores: the first PSS quartile, low levels of PS; second and third quartiles, moderate levels of PS; and fourth quartile, high levels of PS. A diet score reflecting the level of adherence to dietary recommendations was calculated. Analyses were conducted in the whole sample and in subgroups divided by body mass index (BMI < 25 kg/m² vs. BMI ≥ 25 kg/m²). In the whole sample, high PS and continuous stress score were negatively associated with the diet score and with adherence to fish, fresh vegetable, low-fat liquid milk product, and vegetable oil-based cooking fat recommendations. The stress score was negatively associated with the diet score both in lean and in those overweight or obese. However, fish and fresh vegetable recommendations were only affected in those with corpulence. PS was not associated with mean blood glucose concentrations in the whole sample. When divided by BMI status, worse glycaemic control was observed in lean subjects reporting stress. In individuals with overweight or obesity, instead, high glucose concentrations were observed regardless of the level of perceived stress. Interventions to improve stress management could improve dietary adherence and glycaemic control and could thereby have the potential to improve long-term health and well-being of individuals with type 1 diabetes.

Employee Stress, Reduced Productivity, and Interest in a Workplace Health Program: A Case Study from the Australian Mining Industry

The Australian mining sector has an elevated industry prevalence of stress and high stress related productivity impairment costs. This study surveyed 897 employees from an Australian mining company to identify characteristics associated with: (a) high stress related productivity impairment costs; and (b) likelihood of stressed employees wanting stress management assistance at work. Groups associated with average annual productivity impairment costs in excess of $50,000 per employee included: permanent day shift employees; employees who reported being stressed at work most of the time; employees who reported being stress at work all of the time; and employees who were contemplating better managing their stress in the next 6 months. Overall, 52% of employees who identified as being in the contemplation stage of change for stress management and 52% of employees who experienced stress most of the time reported wanting stress assistance with stress. However, only 33% of stressed permanent day shift employees and 36% of employees who experienced stress all the time reported wanting stress assistance. To achieve a high return on investment when implementing workplace stress management programs in the mining industry, practitioners need to strategically target health promotion to engage stressed employees with high productivity impairment costs and low desire for stress management assistance.

Associations between perceived stress, socioeconomic status, and health-risk behaviour in deprived neighbourhoods in Denmark: a cross-sectional study

Background

Previous studies have found that residents of deprived neighbourhoods have an increased risk of perceived stress compared to residents with similar sociodemographic and socioeconomic characteristics in non-deprived neighbourhoods. While stress may provide an explanatory pathway linking neighbourhood deprivation to health-risk behaviour, only limited research has been undertaken on whether perceived stress influences health-risk behaviour in deprived neighbourhoods. Moreover, it is uncertain whether perceived stress has a negative effect on the associations between socioeconomic status and health-risk behaviours in deprived neighbourhoods. The overall aim of this study was to compare perceived stress in deprived neighbourhood with that in the general population, and to examine whether perceived stress was associated with health-risk behaviours (including their co-occurrence) in deprived neighbourhoods. A further aim was to examine whether perceived stress modified the associations between socioeconomic status and health-risk behaviours.

Methods

Four questions from the Perceived Stress Scale were used as indicators of perceived stress. Multiple logistic regression analyses were applied to cross-sectional data from 5113 adults living in 12 deprived neighbourhoods in Denmark. Data from 14,868 individuals from the nationally representative Danish Health and Morbidity Survey 2010 were used as a comparison group with regard to perceived stress.

Results

Residents of deprived neighbourhoods had higher odds of perceived stress than the general population. Associations between disposable income, economic deprivation, strain, and perceived stress were found in deprived neighbourhoods. Perceived stress was significantly associated with higher odds of health-risk behaviour, including a low intake of fruit or vegetables, daily smoking, physical inactivity, and the co-occurrence of health-risk behaviours, even after adjustment for demographic and socioeconomic characteristics. Perceived stress was more strongly associated with physical inactivity and having two or more health-risk behaviours among residents with medium/high socioeconomic status compared to residents with low socioeconomic status.

Conclusions

Overall, the study showed a clear association between perceived stress and health-risk behaviour in deprived neighbourhoods. Future health promotion interventions targeting deprived neighbourhoods may benefit from incorporating stress reduction strategies to reduce health-risk behaviour. Further research is needed to fully understand the mechanism underlying the association between perceived stress and health-risk behaviour in deprived neighbourhoods.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5170-x) contains supplementary material, which is available to authorized users.

Factors Associated With Changes in Fruit Intake During Young Adulthood: A Classification and Regression Tree Analysis of Longitudinal Data

OBJECTIVE

To examine whether distinct participant groupings for changes in fruit intake (FI) levels between ages 23 and 31 years are identifiable based on both time-varying and time-invariant sociodemographic and behavioral variables.

METHODS

Data were derived from the National Longitudinal Survey of Youth-1997, US. Change in FI frequency constituted the dependent variable. For 21 variables, changes and averages in 2007-2011 were calculated. Classification and regression tree analysis was conducted using Generalized, Unbiased, Interaction Detection, and Estimation software.

RESULTS

Analysis isolated 5 variables (changes in smoking, drinking alcohol, and television viewing, plus 5-year mean of income-to-poverty ratio and computer use) and associated cutoff values to identify 7 groups of participants with differing degrees of FI change.

CONCLUSIONS AND IMPLICATIONS

Multiple groupings existed within upper social strata; a majority maintained healthy behaviors whereas some adopted substance use stress-coping mechanisms. Some low-income individuals demonstrated a capacity to adopt healthy behaviors. Dietary interventions could identify behavioral clustering, with emphasis on drinking, smoking, and screen time.

Combined treatment for at-risk drinking and smoking cessation among Puerto Ricans: A randomized clinical trial

Tobacco and alcohol use are linked behaviors that individually and synergistically increase the risk for negative health consequences. This study was a two-group, randomized clinical trial evaluating the efficacy of a behavioral intervention, "Motivation And Problem Solving Plus" (MAPS+), designed to concurrently address smoking cessation and the reduction of at-risk drinking. Targeted interventions may promote coaction, the likelihood that changing one behavior (smoking) increases the probability of changing another behavior (alcohol use). Puerto Ricans (N=202) who were smokers and at-risk drinkers were randomized to standard MAPS treatment focused exclusively on smoking cessation (S-MAPS), or MAPS+, focused on cessation and at-risk drinking reduction. Drinking outcomes included: number of at-risk drinking behaviors, heavy drinking, binge drinking, and drinking and driving. MAPS+ did not have a significant main effect on reducing at-risk drinking relative to S-MAPS. Among individuals who quit smoking, MAPS+ reduced the number of drinking behaviors, the likelihood of meeting criteria for heavy drinking relative to S-MAPS, and appeared promising for reducing binge drinking. MAPS+ did not improve drinking outcomes among individuals who were unsuccessful at quitting smoking. MAPS+ showed promise in reducing at-risk drinking among Puerto Rican smokers who successfully quit smoking, consistent with treatment enhanced coaction. Integrating an alcohol intervention into cessation treatment did not reduce engagement in treatment, or hinder cessation outcomes, and positively impacted at-risk drinking among individuals who quit smoking. Findings of coaction between smoking and drinking speak to the promise of multiple health behavior change interventions for substance use treatment and chronic disease prevention.