Social-contextual factors interact with masculinity to influence college men's HPV vaccination intentions: The role of descriptive norms, prototypes, and physician gender.

Men's low HPV vaccination uptake and HPV-related disease incidence are public health issues; gendered social-contextual factors likely play a role. In Study 1, college men (N = 130; Mage = 19.55; white = 58.1%) reported their social cognitions (male-referent descriptive norms and prototypes), self-reliance masculinity ideology, and vaccination intentions. In Study 2, college men (N = 106; Mage = 19.32; white = 61.3%) were randomly assigned to receive HPV vaccination information from a man or woman physician-avatar. Descriptive norms and favorable prototypes (bs ≥ .337; ps ≤ .016) were associated with higher HPV vaccination intentions. Men with higher self-reliance masculinity had higher HPV vaccination intentions with a man physician and when they perceived greater vaccination among men (ps ≤ .035). Men with higher self-reliance masculinity are more sensitive to gendered social-contextual effects in HPV vaccination decision-making. Gendered social-contextual factors should be integrated into public health interventions to increase college men's HPV vaccination uptake.

The interplay between cognitive and affective risks in predicting COVID-19 precautions: a longitudinal representative study of Americans.

OBJECTIVE: Cognitive risk figures prominently in models predicting health behaviors, but affective risk is also important. We examined the interplay between cognitive risk (personal likelihood of COVID-19 infection or death) and affective risk (worry about COVID-19) in predicting COVID-19 precautionary behaviors. We also examined how outbreak severity bias (overestimation of the severity of COVID-19 in one's community) predicted these outcomes. DESIGN: In a representative sample of U.S. adults (N = 738; Mage = 46.8; 52% women; 78% white), participants who had not had COVID-19 took two online surveys two weeks apart in April 2020. MAIN OUTCOME MEASURES: We assessed cognitive risk, affective risk, and outbreak severity bias at baseline and at follow-up two precaution variables: prevention behaviors (e.g. social distancing) and behavioral willingness (e.g. vaccinations). RESULTS: Overall, affective risk better predicted precautions than cognitive risk. Moreover, overestimating the severity of the outbreak predicted more affective risk (but not cognitive risk) and in turn more precautions. Additional analyses showed that when affective risk was lower (as opposed to higher) greater cognitive risk and outbreak severity bias both predicted more precautions. CONCLUSION: These findings illustrate the importance of affective risk and outbreak severity bias in understanding COVID-19 precautionary behavior.

Stress, coping, resilience, and sleep during the COVID-19 pandemic: A representative survey study of US adults.

INTRODUCTION: The COVID-19 pandemic is a global health emergency resulting in widespread death and substantial disruption to daily life. Previous research has shown that novel disease outbreaks are associated with high stress levels and sleep impairments that lead to neuropsychiatric consequences. Therefore, it is vital to study both stress and protective factors such as coping and resilience that may hinder or help sleep quality during the COVID-19 pandemic. Further, as gender disparities exist in sleep quality, it is important to understand the relationship between pandemic-related stress, coping strategies, resilience, and sleep in bothgenders during the COVID-19 pandemic. METHODS: Our study examined how gender, stress, coping, and resilience were associated with sleep cross-sectionally during the COVID-19 pandemic in a representative sample of US adults (N = 393). RESULTS: Consistent with many recent studies, we found that worsened sleep quality in women compared to men persisted during the COVID-19 pandemic. Interestingly, pandemic-related stress was not significantly associated with sleep quality, but pandemicrelated coping was associated with sleep independent of robust controls and trait resilience. CONCLUSIONS: Greater primary control engagement coping was associated with better sleep quality, while involuntary engagement coping was associated with poor sleep quality. Future research should extend the findings with actigraphy and explore ways to enhance beneficial coping and sleep health during pandemics.

Descriptive Norms and Prototypes Predict COVID-19 Prevention Cognitions and Behaviors in the United States: Applying the Prototype Willingness Model to Pandemic Mitigation.

BACKGROUND: Early in the COVID-19 pandemic, prevention behavior adoption occurred in a rapidly changing context. In contrast to expectancy-value theories, the Prototype Willingness Model (PWM) is well-suited for investigating novel and socially informed behaviors. PURPOSE: We explored whether PWM social cognitions predicted coronavirus prevention behaviors. METHOD: A representative sample of United States adults (N = 738; Mage = 46.8; 51.8% women; 78% white; April 2020) who had not had COVID-19 reported PWM predictor variables (perceived vulnerability, prevention descriptive norms, prototypes engaging in prevention behavior, and prevention behavioral intentions). Two weeks later, participants reported their prevention behaviors (handwashing, mask-wearing, social distancing, etc.) and future public health behavioral willingness (contact tracing, temperature checks, etc.). RESULTS: Controlling for putative demographic, past behavior, and coronavirus-contextual (e.g., local infection rates) covariates, mediation models indicated that higher norms and favorable prototypes were associated with greater prevention behavioral intentions, which in turn predicted increased prevention behavior, F(18, 705) = 92.20, p < .001, R2 = .70. Higher norms and favorable prototypes associated both directly and indirectly (through greater prevention behavioral intention) with greater willingness to engage in emerging public health behaviors, F(15, 715) = 21.49, p < .001, R2 = .31. CONCLUSIONS: Greater descriptive norms and favorable prototypes for prevention behavior predicted: (a) future prevention behaviors through increases in behavioral intentions and (b) willingness to participate in emerging public health behaviors. These results held across demographic groups, political affiliation, and severity of regional outbreaks. Public health efforts to curb pandemics should highlight normative prevention participation and enhance positive prototypes.

What Can We Learn From More Than 140,000 Moments of Ecological Momentary Assessment-Assessed Negative Emotion and Ambulatory Blood Pressure? A Systematic Review and Meta-Analysis.

OBJECTIVE: Two decades of research has examined within-person associations between negative emotion states and ambulatory blood pressure (ABP) using ecological momentary assessment (EMA), but no meta-analysis has been conducted. We conducted this systematic review and meta-analysis to quantify the magnitude of this association and identify moderators, review strengths and weaknesses in conceptual and measurement approaches, and provide recommendations. METHODS: We searched databases (PsycINFO, PubMed), identified 15 studies, and obtained data from 13 studies (n = 2511; 142,307 observations). RESULTS: Random-effects meta-analyses demonstrated small effect r values between momentary negative emotions and systolic ABP (r = 0.06) and diastolic ABP (r = 0.05; p values < .001). Meta-regressions found that effects were larger among studies focused on anxiety, multidimensional negative emotions, predominantly female samples, or less observations of each participant (p values from .003 to .049). A qualitative review found that few studies examined moderators contributing to the substantial interindividual differences in this association. CONCLUSIONS: The small association between momentary negative emotion and ABP extends laboratory findings on the association between the experiential and physiological aspects of emotion to the daily, natural emotional experiences of individuals. This literature could be strengthened by determining interindividual and intraindividual moderators of this association (e.g., trait negative emotion and state positive emotion), examining differential associations of different negative emotions with ABP, and standardizing EMA protocols. Although the effect is small, to the extent that repeated emotion-related cardiovascular reactivity may contribute to cardiovascular disease risk, identifying daily life triggers of emotion is important.

The double burden of racial discrimination in daily-life moments: Increases in negative emotions and depletion of psychosocial resources among emerging adult African Americans.

Objective: Racial discrimination is a common experience for African Americans, but no research has examined how discrimination reported in daily-life moments influences concurrent negative emotions and psychosocial resources. Method: Emerging adult African Americans (N = 54) reported hourly on momentary racial discrimination, negative emotions, and psychosocial resources across two days. Results: Controlling for past discrimination and trait emotion, momentary racial discrimination was associated with greater negative emotions and lower psychosocial resources (ps < .05). The relationship between momentary racial discrimination and negative emotions was stronger among individuals residing in areas with fewer African Americans (simple slope p < .0001). The relationship between momentary racial discrimination and psychosocial resources was stronger among individuals reporting greater past discrimination (simple slope p < .0001). Vicarious discrimination (exposure to discrimination experienced by another person) was associated with higher negative emotions (p < .01), but not with psychosocial resources. Conclusion: These results are the first to demonstrate that personal and vicarious racial discrimination are associated with negative emotions and lower coping resources in daily-life moments and that contextual factors modify these associations. Results refine our understanding of the immediate sequelae of discrimination in daily life and point to possible targets for ecological momentary interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Racial exclusion causes acute cortisol release among emerging-adult African Americans: The role of reduced perceived control.

Racial discrimination contributes to stress-related health disparities among African Americans, but less is known about the acute effects of racial exclusion on the hypo-pituitary-adrenocortical response and psychological mediators. Participants were 276 Black/African American emerging-adults (54% female; M age = 21.74, SD = 2.21) who were randomly assigned to be excluded or included by White peers via the game Cyberball. Racial exclusion (vs. inclusion) predicted: greater negative affect (F(1, 276) = 104.885, p < .0001), lower perceived control (F(1, 276) = 205.523, p < .0001), and greater cortisol release (F(1, 274) = 4.575, p = .033). Racial exclusion's impact on cortisol release was mediated by lower perceived control (95% CI: .027, .112), but not negative affect (-.041, .013). These findings suggest that racial exclusion contributes to acute cortisol release, and that reduced perceived control is a consequence of racial discrimination that has important implications for the health of those who experience discrimination.

Sleep duration partially accounts for race differences in diurnal cortisol dynamics.

OBJECTIVE: Emerging research demonstrates race differences in diurnal cortisol slope, an indicator of hypothalamic-pituitary-adrenocortical (HPA)-axis functioning associated with morbidity and mortality, with African Americans showing flatter diurnal slopes than their White counterparts. Sleep characteristics are associated with both race and with HPA-axis functioning. The present report examines whether sleep duration may account for race differences in cortisol dynamics. METHOD: Participants were 424 employed African American and White adults (mean age = 42.8 years, 84.2% White, 53.6% female) with no cardiovascular disease (Adult Health and Behavior Project-Phase 2 [AHAB-II] cohort, University of Pittsburgh). Cortisol slope was calculated using 4 salivary cortisol readings, averaged over each of 4 days. Demographic (age, sex), psychosocial (socioeconomic status [SES], affect, discrimination), and health behaviors (smoking, alcohol use, physical activity) variables were used as covariates, and sleep (self-report and accelerometry) was also assessed. RESULTS: African Americans had flatter slopes than Whites (F(1, 411) = 10.45, B = .02, p = .001) in models adjusting for demographic, psychosocial, and health behavior covariates. Shorter actigraphy-assessed total sleep time was a second significant predictor of flatter cortisol slopes (F(1, 411) = 25.27, B = -.0002, p < .0001). Total sleep time partially accounted for the relationship between race and diurnal slope [confidence interval = .05 (lower = .014, upper .04)]. CONCLUSIONS: African Americans have flatter diurnal cortisol slopes than their White counterparts, an effect that may be partially attributable to race differences in nightly sleep duration. Sleep parameters should be considered in further research on race and cortisol. (PsycINFO Database Record

Past racial discrimination exacerbates the effects of racial exclusion on negative affect, perceived control, and alcohol-risk cognitions among Black young adults.

Racial discrimination is associated with alcohol use and risky sex cognitions and behaviors, which are risk factors for negative health outcomes, including human immunodeficiency virus infection. The current study investigated the causal impact of racial discrimination on alcohol and sexual-risk cognitions while exploring potential mediators that might help explain this relation: negative affect, perceived control, and meaningful existence. We also examined if past discrimination impacts the strength of (moderates) these effects. Participants were 287 Black/African American young adults aged 18-25. They were randomly assigned to be excluded or included by White peers via the game Cyberball. Racial exclusion (vs. inclusion) predicted greater: perceived racial discrimination, negative affect, alcohol use willingness, and reduced perceived control and meaningful existence. Furthermore, excluded participants who experienced more past racial discrimination reported the lowest perceived control, and greatest negative affect and alcohol-risk cognitions. The findings suggest that past racial discrimination exacerbates the harmful health effects of immediate experiences of discrimination.

The relationship between cumulative unfair treatment and intima media thickness and adventitial diameter: The moderating role of race in the study of women's health across the nation.

OBJECTIVE: Unfair treatment may have a detrimental effect on cardiovascular health. However, little research on chronic health outcomes uses cumulative measures of unfair treatment. We tested whether cumulative unfair treatment was associated with greater subclinical cardiovascular disease in a diverse sample of African-American, Caucasian, Chinese, and Hispanic women. We also examined whether this relationship varied by race. METHOD: The Study of Women's Health Across the Nation is a longitudinal study of midlife women. Cumulative unfair treatment was calculated as the average of unfair treatment assessed over 10 years at 6 time points. Subclinical cardiovascular disease, specifically carotid intima media thickness and adventitial diameter, was assessed via carotid ultrasound conducted at study year 12 in 1,056 women. We tested whether cumulative unfair treatment was related to subclinical cardiovascular disease via linear regression, controlling for demographic factors including socioeconomic status and cardiovascular risk factors. RESULTS: The relation between unfair treatment and subclinical cardiovascular disease significantly varied by race (ps < .05), with unfair treatment related to higher intima media thickness (B = .03, SE = .01, p = .009) and adventitial diameter (B = .02, SE = .009, p = .013) only among Caucasian women. No significant relations between unfair treatment and subclinical cardiovascular disease outcomes were observed for African-American, Hispanic, and Chinese women. CONCLUSIONS: Our findings indicate that cumulative unfair treatment is related to worse subclinical cardiovascular disease among Caucasian women. These findings add to the growing literature showing that Caucasian women's experience of unfair treatment may have detrimental health implications. (PsycINFO Database Record

Trait positive and negative emotionality differentially associate with diurnal cortisol activity.

Inter-individual variability in metrics of hypothalamic-pituitary-adrenocortical (HPA) activity, such as the slope of the diurnal decline in cortisol, cortisol awakening response (CAR), and total cortisol output, have been found to associate inversely with trait ratings of extraversion and positive affect (E/PA) and positively with neuroticism and negative affect (N/NA) in some, but not all, investigations. These inconsistencies may partly reflect varied intensity of cortisol sampling among studies and reliance on self-rated traits, which are subject to reporting biases and limitations of introspection. Here, we further examined dispositional correlates of HPA activity in 490 healthy, employed midlife volunteers (M age=43 years; 54% Female; 86% white). Trait ratings were requested from participants and 2 participant-elected informants using the Positive and Negative Affect Schedule (PANAS) and Extraversion and Neuroticism dimensions of NEO personality inventories. CAR was assessed as percent increase in cortisol levels from awakening to 30min after awakening; and the diurnal slope and total output of cortisol [Area Under the Curve (AUC)] were determined from cortisol measurements taken at awakening, +4 and +9h later, and bedtime, across 3 workdays. Structural equation modeling was used to estimate multi-informant E/PA and N/NA factors. We used 3days of measurement as indicators to model each of the three latent cortisol factors (slope, CAR, and AUC). With the two latent emotionality and three latent cortisol indices included there was good fit to the data (χ(2)(200)=278.38, p=0.0002; RMSEA=0.028, 90% CI=0.02-0.04; CFI/TLI=0.97/0.96; SRMR=0.04). After controlling for covariates (age, sex, race), results showed higher latent E/PA associated with a steeper diurnal slope (Standardized ß=-0.19, p=0.02) and smaller CAR (Standardized ß=-0.26, p=0.004), whereas N/NA did not associate with any cortisol metric (Standardized ß's=-0.12 to 0.13, p's=0.10 to 0.53). These findings suggest that positive emotionality may be more closely associated with indices of diurnal cortisol release than negative emotionality.

The Relationship Between Young Adult Smokers' Beliefs About Nicotine Addiction and Smoking-Related Affect and Cognitions.

Risk beliefs and self-efficacy play important roles in explaining smoking-related outcomes and are important to target in tobacco control interventions. However, information is lacking about the underlying beliefs that drive these constructs. The present study investigated the interrelationships among young adult smokers' beliefs about the nature of nicotine addiction and smoking-related affect and cognitions (i.e., feelings of risk, worry about experiencing the harms of smoking, self-efficacy of quitting, and intentions to quit). Smokers (n = 333) were recruited from two large universities. Results showed that quit intentions were associated with feelings of risk, but not with worry or self-efficacy. Furthermore, higher feelings of risk were associated with lower beliefs that addiction is an inevitable consequence of smoking and with lower beliefs that the harms of smoking are delayed. This suggests that it is important for health messages to counter the possible negative effects of messages that strongly emphasize the addictiveness of nicotine, possibly by emphasizing the importance of quitting earlier rather than later. The findings also add to the evidence base that feelings of risk are powerful predictors of behavioral intentions. Furthermore, our results suggest that in some circumstances, feelings of risk predict quit intentions beyond that predicted by worry and self-efficacy. Gaining additional understanding of the tobacco-related beliefs that can increase feelings of risk and incorporating those beliefs into educational campaigns may improve the quality of such campaigns and reduce tobacco use.

Women's sun protection cognitions in response to UV photography: the role of age, cognition, and affect.

This study examined the impact of ultraviolet (UV) photography, cognition versus affect, and age on women's sun-related cognitions and a proxy measure of sun protection behavior. Participants (N = 114) were recruited via public advertisements and came to the lab to view a photo showing their UV damage. In addition, some participants received instructions to focus on either their thoughts (cognition) or feelings (affect) about their photograph before completing the survey. Women in the affect condition reported the lowest perceived vulnerability to skin cancer and highest absent/exempt beliefs (beliefs that one is unlikely to develop skin cancer if she hasn't already). Condition by age interactions showed that, among those in the cognition and control (no instructions) conditions, older women reported higher perceived vulnerability and lower absent/exempt beliefs, and took more sunscreen than younger women. However, older women reported higher absent/exempt beliefs and higher sun-risk willingness than younger women in the affect condition.

Concerns about unintended negative consequences of informing the public about multifactorial risks may be premature for young adult smokers.

BACKGROUND: Many health risks are associated with both genetic and behavioural factors. Concerns have been raised that learning about such multifactorial risks might have detrimental effects on health-related beliefs, cognitions, and affect. However, experimental evidence is sparse. OBJECTIVE: To explore the effects of reading an online news article about the discovery of a genetic basis for nicotine addiction. METHODS: Smokers (N = 333) were recruited from the psychology subject pools of two major universities. Participants were randomly assigned to read one of three news articles: one describing a genetic basis for nicotine addiction and lung cancer obtained from a national news source, one altered to indicate no genetic basis for nicotine addiction and lung cancer, or one unrelated attention control. Participants then completed an online questionnaire, which assessed smoking-related cognitions and affect, and beliefs about nicotine addiction, quitting smoking, and whether the harms of tobacco use are delayed. RESULTS: There was no statistically significant influence of experimental condition on smoking-related cognitions/affect (ps > .05, η(2)  < .002), beliefs about addiction and quitting (Wilks' λ = .98, p = .66, η(2)  = .01), or delayed harm (ps > .05, η(2)  < .002). CONCLUSION: Reading an online news article about the presence or absence of a genetic basis for nicotine addiction was not found to change smoking-related cognitions/affect or beliefs among young adult smokers. Concerns about negative effects of multifactorial risk information on health beliefs may be premature. Nevertheless, to effectively translate basic genomics research into effective public health practice, further research should investigate these issues in different populations, via different communication modalities, and for different health outcomes. STATEMENT OF CONTRIBUTION: What is already known on this subject? Information about the health implications of the interaction between genetics and behaviour is becoming prevalent. Learning about these interactions may reduce perceived risk and intentions to engage in health behaviours. What does this study add? Informing young adult smokers about the genetic basis for nicotine addiction does not affect health beliefs negatively. Responses are not moderated by endorsing the idea of genetic causation or current/experimenter smoking status.

The effects of racial discrimination on the HIV-risk cognitions and behaviors of Black adolescents and young adults.

OBJECTIVE: Two studies examined the impact of racial discrimination on HIV-risk (substance use and risky sex) behaviors (Study 1) and cognitions (Study 2) among African Americans. METHODS: Study 1 examined longer-term effects of cumulative discrimination on HIV-risk behaviors among 833 adolescents. In Study 2, Black young adults were excluded or included in an online game (Cyberball) by White peers. RESULTS: Study 1 revealed that discrimination was associated with greater HIV-risk behaviors contemporaneously, and with an increase in these behaviors over a 3-year period. In Study 2, excluded participants tended to attribute their exclusion to racial discrimination and reported greater risky sex and substance use willingness. In Study 1, the relation between discrimination and risky sex was mediated by substance use behavior. In Study 2, substance use willingness mediated the relation between perceived discrimination and risky sex willingness. CONCLUSIONS: Findings highlight the importance of examining the effects of discrimination on HIV risk among Black youth. The studies also demonstrate the utility of assessing social-psychological processes when examining the effects of discrimination on HIV-risk cognitions and behavior.

Influence of oral sex and oral cancer information on young adults' oral sexual-risk cognitions and likelihood of HPV vaccination.

Public health information and educational interventions regarding human papillomavirus (HPV) have focused on the link between vaginal sex and cervical cancer among women. Many people are unaware that HPV can be transmitted through oral sex or that HPV causes oral cancers. Given that HPV infections and unprotected oral sex are increasing, research on oral sex-related HPV risk is important. This study examined the effect of a brief informational intervention regarding HPV and oral sex on the sexual risk cognitions of young adults. College students (N = 238) read information on HPV, oral sex, and oral cancer or no information. Participants then completed measures of oral sex and HPV knowledge, oral sex willingness, HPV vaccination likelihood, and risk perceptions. Participants who read the information on HPV and oral sex and cancer (compared to those who did not) reported greater knowledge, perceived risk and concern, and lower willingness to engage in oral sex. These effects were only significant among women. However, men reported a higher likelihood of future HPV vaccination compared to women who had not yet received the vaccine. Focusing on oral sex and cancer, this study adds to research investigating ways to reduce HPV infections.

The prototype/willingness model, academic versus health-risk information, and risk cognitions associated with nonmedical prescription stimulant use among college students.

OBJECTIVES: Nonmedical prescription stimulant (NPS) use is an important problem among university students. The present studies applied the prototype-willingness model (Gibbons, Gerrard & Lane, 2003) to academic-based NPS use and examined the impact of academic versus health information on university students' NPS use cognitions. DESIGN AND METHODS: Study 1 used the prototype-willingness model to examine cognitions associated with academic-based willingness to use NPS. In Study 2, participants were randomly assigned to a control condition or to read information on the negative academic or negative health effects of NPS use. Beliefs, willingness, and expectation of engaging in future NPS use, prototypes of users, and perceived vulnerability were assessed. RESULTS: Students without a prescription for stimulants or a diagnosis of attention deficit hyperactivity disorder (ADHD) participated in each study (Ns = 555; 166). Twenty to thirty per cent reported NPS use, primarily for academic reasons. Controlling for past NPS, alcohol, and marijuana use: friends' NPS use, prototypes, perceived vulnerability, and negative health and positive academic beliefs were associated with willingness to use NPS in Study 1. Study 2 demonstrated that participants in the academic-information condition reported the lowest willingness and expectations as well as the least favourable prototypes of NPS users. Participants in the health-information condition reported the highest perceived vulnerability. CONCLUSIONS: These studies highlight: the utility of using a health model framework to examine NPS cognitions, the importance of examining beliefs about the behaviour, and the potential for academic and health information to reduce risky NPS use cognitions.

Heart attack risk perception biases among hypertension patients: the role of educational level and worry.

Risk biases such as comparative optimism (thinking one is better off than similar others) and risk inaccuracy (misestimating one's risk compared to one's calculated risk) for health outcomes are common. Little research has investigated racial or socioeconomic differences in these risk biases. Results from a survey of individuals with poorly controlled hypertension (N=813) indicated that participants showed (1) comparative optimism for heart attack risk by underestimating their heart attack risk compared to similar others, and (2) risk inaccuracy by overestimating their heart attack risk compared to their calculated heart attack risk. More highly educated participants were more comparatively optimistic because they rated their personal risk as lower; education was not related to risk inaccuracy. Neither race nor the federal poverty level was related to risk biases. Worry partially mediated the relationship between education and personal risk. Results are discussed as they relate to the existing literature on risk perception.