Rigorous theory-based intervention research is the bold action needed to address oral health disparities and inequities.

The Consensus Statement about behavioral and social sciences in oral health encourages future research to draw on testable theories that specify causal pathways that reflect the complex nature of oral health. In this commentary, we amplify the importance of explicit and well-specified theory in oral health intervention research, acknowledging that problematic use of theory has limited its utility in developing effective public health interventions. Also, we affirm the need to focus on determinants of oral health-and health inequities-most likely to drive meaningful change, and to understand the causal pathways that connect drivers of change from the individual to the global level. We view theory-based, causal mechanisms research as a powerful approach to building successful public health interventions, and suggest resources to inspire such research, including exemplary studies, methodologies, and collaborative initiatives that facilitate strong theory-based public health research.

HIV-Related Stigma Research as a Priority at the National Institutes of Health.

The National Institutes of Health (NIH) recognizes that, despite HIV scientific advances, stigma and discrimination continue to be critical barriers to the uptake of evidence-based HIV interventions. Achieving the Ending the HIV Epidemic: A Plan for America (EHE) goals will require eliminating HIV-related stigma. NIH has a significant history of supporting HIV stigma research across its Institutes, Centers, and Offices (ICOs) as a research priority. This article provides an overview of NIH HIV stigma research efforts. Each ICO articulates how their mission shapes their interest in HIV stigma research and provides a summary of ICO-relevant scientific findings. Research gaps and/or future opportunities are identified throughout, with key research themes and approaches noted. Taken together, the collective actions on the part of the NIH, in tandem with a whole of government and whole of society approach, will contribute to achieving EHE's milestones.

RESUMEN: Los Institutos de Salud Nacional (NIH, siglas en inglés) reconocen que, a pesar de los avances en la prevención y el tratamiento, el estigma y la discriminación continúan siendo barreras críticas a la adopción de la prevención y el cuido basados en la evidencia. Las metas de Logrando el Fin de la Epidemia de VIH: Plan para América (EHE, siglas en inglés) requerirán la eliminación del estigma relacionado al VIH. Los NIH tienen una historia significativa apoyando la investigación del estigma relacionado al VIH a través de sus Institutos, Centros, y Oficinas (ICOs, siglas en inglés). Esta investigación es una prioridad fundamental y entrelazada para los ICOs. En este artículo, los autores de los NIH proveen una reseña sobre la investigación del estigma relacionado al VIH a través de los ICOs selectos. Cada ICO articula como su misión y prioridad dan forma a su interés en la investigación del estigma al VIH y provee una breve reseña de los hallazgos científicos pertinentes al ICO. Lagunas en la investigación relacionada a la misión, prioridades, y/o áreas de investigación futuras se identifican a través del artículo. También se apuntan en el resumen los temas de investigación claves y sus estrategias. En conjunto, las acciones colectivas de parte de los NIH, junto a la estrategia necesaria de parte del gobierno en su totalidad y de la sociedad en su totalidad, contribuirán al logro de las metas del EHE.

Skin Cancer and UV Exposure-Related Behaviors Among Appalachian and Non-Appalachian Adults.

Introduction: Appalachian communities experience elevated rates of cancer incidence and mortality relative to other regions in the U.S. Specifically, melanoma mortality rates are higher in Appalachia compared to the national average, despite comparable incidence rates. Purpose: To examine differences in self-reported history of skin cancer and prevalence of two UV exposure behaviors between Appalachian and non-Appalachian adults in a nationally representative sample. Methods: Data are from four cross-sectional cycles of the Health Information National Trends Survey (2011-2014) (N=14,451). We examined sunscreen use and tanning bed use, and self-reported history of melanoma and non-melanoma skin cancer. Descriptive and weighted multivariable analyses were conducted to examine sunscreen and tanning bed use, controlling for sociodemographic characteristics. Results: Approximately 8% of the study sample resided in Appalachia (n=1,015). Self-reported melanoma (0.6%) and non-melanoma (3.2%) skin cancer histories were low among Appalachians and did not differ statistically from non-Appalachians (p>0.05). Only 21.2% of Appalachians reported using sunscreen often or always when going outside for more than one hour on a warm, sunny day compared to 27.4% of non-Appalachians (pp=0.04), but there were no regional differences in tanning bed use (OR=1.48, p=0.23) when controlling for sociodemographics and general health status. Implications: Appalachians had comparable histories of self-reported melanoma and non-melanoma skin cancer but were less likely to report sunscreen use than non-Appalachians. Enhanced communication efforts to promote sunscreen use and other UV protection behaviors in Appalachia may be valuable.

Perceived social integration predicts future physical activity through positive affect and spontaneous thoughts.

The present research evaluated the social, affective, and cognitive processes underlying sustained patterns of health behavior as articulated by the upward spiral theory of lifestyle change. Specifically, we tested whether positive affect experienced during physical activity changes over time in tandem with perceived social integration (PSI), and whether PSI is associated with future activity indirectly through sociality during physical activity, positive affect during physical activity, and positive spontaneous thoughts about physical activity. Adult participants (N = 226) reported daily on their PSI, physical activity behavior, and affect during physical activity for 11 weeks. Once every 2 weeks, they also reported on features of a specific bout of physical activity, including how social it was, positive affect during the activity, and positivity of spontaneous thoughts about physical activity. Multilevel modeling of daily reports over the 11 weeks revealed that as participants' PSI increased, so did their positive affect during physical activity. Further, structural equation modeling of specific reports revealed a significant indirect effect of PSI on future activity through sociality during an intervening instance of physical activity, positive affect experienced during that activity, and positive spontaneous thoughts about physical activity. The findings reported herein provide evidence consistent with the upward spiral theory of lifestyle change and reveal affective and cognitive mechanisms by which social processes may contribute to positive health behavior change and maintenance: namely, positive affect during physical activity and spontaneous thoughts about physical activity. Beyond its utility for evaluating theory, the present study may inform subsequent research aimed at developing sustainable behavior-change interventions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Consensus-Building efforts to identify best tools for screening and assessment for supportive services in oncology.

Purpose: To build consensus around an optimal patient-reported outcome measure of cancer symptoms and patient needs to facilitate patient-provider communication and trigger referrals to supportive services.Methods and materials: The Grid-Enabled Measures platform was used to crowdsource and facilitate collaboration to achieve consensus. Respondents were invited to nominate and independently rate the usefulness of measures that: (1) have been actively used at a healthcare institution, (2) have a multiple choice or yes/no type format, (3) are applicable to adults with cancer, (4) are patient-reported, and 5) have psychometric data if possible. Discussion boards within the GEM workspace allowed respondents to identify barriers to implementing patient assessment and referral systems.Results: 166 individuals from various disciplines from 25 organizations participated. Six instruments were nominated, and 553 rating surveys were submitted. The three most highly-rated overall instruments were the Distress Thermometer, the James Supportive Case Screening, and the Functional Assessment of Cancer Therapy-General. Participants noted that wide-scale implementation of this process requires both identifying problems and providing clinicians with algorithms to facilitate appropriate referrals.Conclusions: Consensus reported three most highly-related measures as optimal for comprehensive screening and identification for referral by assessing multiple domains of functioning and quality of life.Implications for RehabilitationGaining consensus on the best patient reported outcome measures is an important step towards improving access to cancer rehabilitation services.A consensus agreed on several measures to use for cancer rehabilitation screening. Functional Assessment of Cancer Therapy-General, National Comprehensive Cancer. Network Distress Thermometer and the James Instrument.The selected measures do not put undue burden on clinicians and patients.

Implicit theories of smoking and association with interest in quitting among current smokers.

Many cigarette smokers make multiple attempts to quit before they are successful. Implicit theories of smoking (ITS)-beliefs about whether smoking behavior is something that is changeable (incremental belief) or fixed (entity belief)-may play a role in quitting. Four iterations of the cross-sectional, nationally-representative Health Information National Trends Survey (HINTS) were used in logistic regression analyses to examine how smokers' ITS relates to (1) attempts to quit in the past 12 months; (2) considering quitting in the next 6 months; and (3) the interaction between ITS and past quit attempts on considering quitting. Greater incremental beliefs were not significantly associated with having tried to quit in the past year (ß = .27, p = .055); however, greater incremental beliefs were associated with greater likelihood of considering quitting in the next 6 months (ß = .22, p = .04). Past quit attempts did not moderate the association between ITS and considering quitting (ß = .59, p = .10). Results suggest that incremental beliefs are associated with increased intentions to quit.

Interactions among perceived norms and attitudes about health-related behaviors in U.S. adolescents.

OBJECTIVE: Prior research has documented the influence of social norms on health-related behaviors, though social norms may affect behaviors in more complex ways than have conventionally been modeled. The present research evaluates parent norms and teens' own attitudes as moderators of associations between perceived peer norms and diet and physical activity behaviors (both health-promoting and health-impairing) in a national sample of U.S. adolescents. METHODS: Adolescent participants (N = 1,859; ages 12-17) from the 2014 Family Life, Activity, Sun, Health, and Eating study reported on the extent to which their friends eat fruits and vegetables; eat junk food or drink sugary drinks; exercise; and watch TV, play on the computer, or play electronic games most days of the week. They also reported on their own attitudes and behaviors as well as their parents' corresponding behaviors and rules. RESULTS: Perceived peer norms were associated with teens' own health-promoting behaviors such as fruit and vegetable consumption and physical activity as well as health-impairing behaviors such as junk food consumption and sedentary habits. Teens who reported liking fruits and vegetables or physical activity or perceiving congruent descriptive parental norms demonstrated the strongest positive associations between peer norms and their own behavior. CONCLUSIONS: Perceived social norms may play a significant role in both health-impairing and health-promoting behaviors, particularly when congruent with attitudes or descriptive parental norms about those behaviors. The findings may inform interventions such as social norms marketing campaigns that aim to change perceptions of peer norms for health-promoting behavior. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The ecology of multilevel intervention research.

Behavior change research to promote health and prevent disease increasingly relies on a complex set of interacting characteristics across levels of influence such as biological, psychological, behavioral, interpersonal, and environmental. How to best develop health-related interventions that incorporate the individual, the macro-environment, and their interactions remains a challenge. This article considers a set of key dimensions that constitute what we refer to as the ecology of research across a broad context of multilevel research (MLR), spanning fundamental multilevel research (FMLR), multilevel intervention research (MLIR), and multilevel implementation science (MIS). With the goal of promoting improvements in MLIR, we describe the inherent interdependencies among aspects of research and consider how the growth and development of evidence and resources influence the cross-talk among researchers from different perspectives (e.g., disciplines and domains). We propose a framework that highlights opportunities to reduce barriers and address gaps in areas critical to generating an evidence base through MLR, MLIR, and MIS. Overall, we aim to support strategic decisions that can accelerate our understanding of ML health outcomes and interactions among factors within and across levels, with the goal of strengthening the effectiveness of ML interventions across health-related outcomes.

Beliefs About Behavioral Determinants of Obesity in Appalachia, 2011-2014.

The populations of many Appalachian communities have high rates of unhealthy body weight. This study aimed to identify differences in beliefs about obesity between Appalachians and non-Appalachians. Our analyses explored health beliefs and behaviors among US adults aged ≥18 (n = 14 451) who responded to the Health Information National Trends Survey (2011-2014), of whom 1015 (8%) resided within the 420 counties recognized as Appalachian by the Appalachian Regional Commission. Using weighted regression analyses and controlling for sociodemographic characteristics and general health, we determined that self-reported body mass index was higher among Appalachians than among non-Appalachians ( B = 0.75, P = .03, 95% confidence interval, 0.08-1.47) and that Appalachians were less likely than non-Appalachians to believe that lifestyle factors were related to obesity ( B = -0.37, P = .03, 95% confidence interval, -0.04 to -0.71). Results suggest that Appalachians may regard behavioral prevention differently from non-Appalachians, perhaps with less confidence in the effectiveness of certain behaviors to reduce obesity risk. Future research may determine whether such beliefs could complicate efforts to encourage healthy lifestyles throughout the region.

The science of team science: A review of the empirical evidence and research gaps on collaboration in science.

Collaborations among researchers and across disciplinary, organizational, and cultural boundaries are vital to address increasingly complex challenges and opportunities in science and society. In addition, unprecedented technological advances create new opportunities to capitalize on a broader range of expertise and information in scientific collaborations. Yet rapid increases in the demand for scientific collaborations have outpaced changes in the factors needed to support teams in science, such as institutional structures and policies, scientific culture, and funding opportunities. The Science of Team Science (SciTS) field arose with the goal of empirically addressing questions from funding agencies, administrators, and scientists regarding the value of team science (TS) and strategies for successfully leading, engaging in, facilitating, and supporting science teams. Closely related fields have rich histories studying teams, groups, organizations, and management and have built a body of evidence for effective teaming in contexts such as industry and the military. Yet few studies had focused on science teams. Unique contextual factors within the scientific enterprise create an imperative to study these teams in context, and provide opportunities to advance understanding of other complex forms of collaboration. This review summarizes the empirical findings from the SciTS literature, which center around five key themes: the value of TS, team composition and its influence on TS performance, formation of science teams, team processes central to effective team functioning, and institutional influences on TS. Cross-cutting issues are discussed in the context of new research opportunities to further advance SciTS evidence and better inform policies and practices for effective TS. (PsycINFO Database Record

The Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures Project: Rationale and Approach.

BACKGROUND: Individual variability in response to multiple modalities of obesity treatment is well documented, yet our understanding of why some individuals respond while others do not is limited. The etiology of this variability is multifactorial; however, at present, we lack a comprehensive evidence base to identify which factors or combination of factors influence treatment response. OBJECTIVES: This paper provides an overview and rationale of the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, which aims to advance the understanding of individual variability in response to adult obesity treatment. This project provides an integrated model for how factors in the behavioral, biological, environmental, and psychosocial domains may influence obesity treatment responses and identify a core set of measures to be used consistently across adult weight-loss trials. This paper provides the foundation for four companion papers that describe the core measures in detail. SIGNIFICANCE: The accumulation of data on factors across the four ADOPT domains can inform the design and delivery of effective, tailored obesity treatments. ADOPT provides a framework for how obesity researchers can collectively generate this evidence base and is a first step in an ongoing process that can be refined as the science advances.

Accumulating Data to Optimally Predict Obesity Treatment (ADOPT) Core Measures: Psychosocial Domain.

BACKGROUND: Within the Accumulating Data to Optimally Predict obesity Treatment (ADOPT) Core Measures Project, the psychosocial domain addresses how psychosocial processes underlie the influence of obesity treatment strategies on weight loss and weight maintenance. The subgroup for the psychosocial domain identified an initial list of high-priority constructs and measures that ranged from relatively stable characteristics about the person (cognitive function, personality) to dynamic characteristics that may change over time (motivation, affect). OBJECTIVES: This paper describes (a) how the psychosocial domain fits into the broader model of weight loss and weight maintenance as conceptualized by ADOPT; (b) the guiding principles used to select constructs and measures for recommendation; (c) the high-priority constructs recommended for inclusion; (d) domain-specific issues for advancing the science; and (e) recommendations for future research. SIGNIFICANCE: The inclusion of similar measures across trials will help to better identify how psychosocial factors mediate and moderate the weight loss and weight maintenance process, facilitate research into dynamic interactions with factors in the other ADOPT domains, and ultimately improve the design and delivery of effective interventions.

Positive affective processes underlie positive health behaviour change.

Positive health behaviours such as physical activity can prevent or reverse many chronic conditions, yet a majority of people fall short of leading a healthy lifestyle. Recent discoveries in affective science point to promising approaches to circumvent barriers to lifestyle change. Here, we present a new theoretical framework that integrates scientific knowledge about positive affect with that on implicit processes. The upward spiral theory of lifestyle change explains how positive affect can facilitate long-term adherence to positive health behaviours. The inner loop of this spiral model identifies nonconscious motives as a central mechanism of behavioural maintenance. Positive affect experienced during health behaviours increases incentive salience for cues associated with those behaviours, which in turn, implicitly guides attention and the everyday decisions to repeat those behaviours. The outer loop represents the evidence-backed claim, based on Fredrickson's broaden-and-build theory, that positive affect builds a suite of endogenous resources, which may in turn amplify the positive affect experienced during positive health behaviours and strengthen the nonconscious motives. We offer published and preliminary evidence in favour of the theory, contrast it to other dominant theories of health behaviour change, and highlight attendant implications for interventions that merit testing.

Do positive spontaneous thoughts function as incentive salience?

The present work explores the theoretical relationship between positive spontaneous thoughts and incentive salience-a psychological property thought to energize wanting and approach motivation by rendering cues that are associated with enjoyment more likely to stand out to the individual when subsequently encountered in the environment (Berridge, 2007). We reasoned that positive spontaneous thoughts may at least be concomitants of incentive salience, and as such, they might likewise mediate the effect of liking on wanting. In Study 1, 103 adults recruited via Amazon's Mechanical Turk reported on key aspects of 10 everyday activities. As predicted, positive spontaneous thoughts mediated the relationship between liking an activity in the past and wanting to engage in it in the future. In Study 2, 99 undergraduate students viewed amusing and humorless cartoons and completed a thought-listing task, providing experimental evidence for the causal effect of liking on positive spontaneous thoughts. In Study 3, we tested whether positive spontaneous thoughts play an active role in energizing wanting rather than merely co-occurring with (inferred) incentive salience. In that experiment involving 80 undergraduates, participants who were led to believe that their spontaneous thoughts about a target activity were especially positive planned to devote more time to that activity over the coming week than participants who received no such information about their spontaneous thoughts. Collectively, these findings suggest that positive spontaneous thoughts may play an important role in shaping approach motivation. Broader implications and future directions in the study of positive spontaneous thoughts are discussed. (PsycINFO Database Record

Of passions and positive spontaneous thoughts.

Despite the abundance of research on negative intrusive thoughts, far less is known about their positive counterparts. In two studies, we explored how positive spontaneous thoughts are related to people's favorite activities (i.e., their passions, Vallerand et al., 2003), and how passions and associated thoughts contribute to mental health. In Study 1, 170 participants reported on the valence and frequency of the spontaneous thoughts they tend to have about several activities. Harmonious and obsessive passion both predicted more frequent spontaneous thoughts, but only harmonious passion predicted thought positivity. In Study 2, 232 participants completed measures pertaining to physical activity, spontaneous thoughts, and mental health. As predicted, positivity of spontaneous thoughts about physical activity predicted frequency of physical activity. Further, positivity of spontaneous thoughts about physical activity mediated the relationship between harmonious passion and indices of mental well-being.