Statistical Guideline #2: Report Appropriate Reliability for your Sample, Measure, and Design Abstract From the Editors: This is the second column from the Statistics Guru. The Statistics Guru will appear in every issue. In these columns, we briefly discuss appropriate ways to analyze and present data in the journal. As such, the Statistics Guru can be seen both as an editorial amuse bouche and a set of guidelines for reporting data in the International Journal of Behavioral Medicine. If you have ideas for a column, please email the Statistical Editor, Suzanne Segerstrom at segerstrom@uky.edu.

Daily Associations Between Sleep and Physical Activity Abstract Background Research has demonstrated a correlational relationship between sleep and physical activity, though this work has been largely cross sectional and fails to demonstrate temporal relationships. The purpose of this study was to test the daily, bidirectional relationships between sleep and physical activity, and whether this varied between weekdays and weekend days. Method Fifty-four healthy, young adults wore a Fitbit Flex to measure sleep and physical activity during a 6-day study period. Results Mixed linear models revealed that physical activity did not predict subsequent night’s sleep. However, on nights when participants had longer than their own average total sleep time, and greater than their own average wake after sleep onset, this predicted less physical activity the following day. Conclusion Results suggest that, in healthy young adults, physical activity may not promote healthier subsequent sleep, but sleep duration and continuity influence physical activity in their own way. Young adults may respond differently to health promotion efforts, and a greater understanding of these temporal associations can enhance the efficacy of these efforts.

The Role of Cohabitating Partner and Relationship Characteristics on Physical Activity among Individuals with Osteoarthritis Abstract Background Most individuals with knee or hip osteoarthritis do not meet recommendations for physical activity. The Social Cognitive Theory suggests that the social environment (e.g., spouses/partners) may influence the physical activity of individuals with osteoarthritis. The purpose of this study was to examine whether the physical activity of insufficiently active, coupled adults with osteoarthritis was associated with received partner support for physical activity, partner’s engagement in physical activity, and relationship satisfaction. Methods Cross-sectional data from 169 couples were collected. Accelerometers estimated moderate-to-vigorous physical activity and daily steps for participants with osteoarthritis and their partners. Participants with osteoarthritis reported total received partner support for physical activity and relationship satisfaction. Results Participants with osteoarthritis were on average 65 years old, 65% female, 86% non-Hispanic white, and 47% retired. Receiving total partner support more frequently was associated with more minutes of moderate-to-vigorous physical activity but not with steps. Relationship satisfaction moderated the association of partner’s physical activity on the daily steps of individuals with osteoarthritis such that having a partner who accomplished more daily steps was associated with participants with osteoarthritis accomplishing more daily steps themselves when they reported greater relationship satisfaction. Conclusions Partners and relationship satisfaction may play an important role in the physical activity of individuals with osteoarthritis. Interventions seeking to increase physical activity in this population may be enhanced by promoting partner support. Additional research is needed to further explain these associations within the context of relationship satisfaction.

The Interaction of Alcohol Use and Cannabis Use Problems in Relation to Opioid Misuse Among Adults with Chronic Pain Abstract Background The opioid epidemic is a significant public health crisis and prescription opioids are often used to manage chronic pain, despite questionable long-term efficacy. Furthermore, co-substance (mis)use is also common among individuals with chronic pain who use opioids. Alcohol has been consistently used to manage chronic pain, partly due to its acute analgesic properties. Cannabis has also recently garnered attention in the context of pain management, though research examining its efficacy for pain has produced mixed results. Nevertheless, there is accumulating evidence that concurrent substance co-use is positively associated with use and misuse of additional substances, particularly among individuals with chronic pain. Thus, the goal of this study was to examine the main and interactive effects of alcohol use problems and cannabis use problems in relation to opioid misuse among adults with chronic pain who use opioids. Methods The current sample was comprised of 440 adults with chronic pain using prescription opioids. Substance use problems were assessed using the ASSIST, Current Opioid Misuse Measure, and the Severity of Dependence Scale. Moderated regressions using the PROCESS macro were utilized. Results Results indicated that alcohol use problems and cannabis use problems each uniquely related to opioid dependence severity and opioid misuse. The interaction of alcohol and cannabis use problems was uniquely related to only opioid misuse, whereby alcohol use was most strongly associated to opioid misuse among those with higher levels of cannabis use problems. Conclusions Collectively, these findings suggest there may be utility in assessing and treating alcohol and cannabis use problems among persons with chronic pain who are using opioids for pain management.

Post-traumatic Stress Disorder, Cocaine Use, and HIV Persistence Abstract Background Post-traumatic stress disorder (PTSD) and stimulant use disorders are highly prevalent, commonly co-occur, and predict faster clinical HIV progression. However, scant research has examined if PTSD and cocaine use are associated with the HIV reservoir that persists in immune cells, lymphoid tissue, and organs of people living with HIV that are receiving effective treatment. Method This cross-sectional study enrolled 48 HIV-positive persons with sustained undetectable viral load (< 20 copies/mL) in the past year to examine the associations of PTSD and recent cocaine use with two measures of HIV persistence in immune cells: (1) proviral HIV DNA and (2) cell-associated (CA)-HIV RNA. Results Greater PTSD symptoms were significantly associated with lower proviral HIV DNA (r = − 0.30, p = 0.041) but not with CA-HIV RNA. Greater severity of PTSD symptom clusters for intrusions (Standardized Beta = − 0.30, p = 0.038) and hyperarousal (Standardized Beta = − 0.30, p = 0.047) were independently associated with lower proviral HIV DNA. Although participants with recent cocaine use had a significantly shorter duration of sustained undetectable HIV viral load (19.9 versus 26.9 months; p = 0.047), cocaine use was not significantly associated with proviral HIV DNA or CA-HIV RNA. Conclusion Further research is needed to examine the potentially bi-directional pathways linking PTSD symptom severity and HIV persistence.

“Finding my own motivation” — A Mixed Methods Study of Exercise and Behaviour Change Support During Oncological Treatment Abstract Background Exercising during oncological treatment is beneficial but challenging for persons with cancer and may require strategies to increase motivation. Behaviour change support, including specific behaviour change techniques (BCTs), have been used to facilitate exercise in persons undergoing oncological treatment, but more detailed knowledge from an individual perspective is needed to inform clinical practice. The aims were to explore the motivational experiences of exercise combined with behaviour change support, and to describe how specific BCTs were valued among persons exercising during oncological treatment. Methods A mixed-methods study was conducted using semi-structured interviews (n = 18) and a questionnaire (n = 229). Participants with breast, colorectal or prostate cancer who completed or dropped out of a six-month exercise programme during oncological treatment were included. The interviews were analysed with thematic analysis and the questionnaire with descriptive statistics (median and interquartile range). Results The participants underwent a motivational process through the exercise programme. By experiencing ‘Health gains and mastery’, ‘Learning’, ‘Affinity’, ‘Commitment’, and ‘Managing challenges’, they found incentives that fostered feelings of autonomy, competence and relatedness, leading to an increased motivation to exercise. Social support from coaches, structuring the physical environment with scheduled sessions, self-monitoring with resistance training log, and feedback based on heart rate monitor and fitness tests were the most valued BCTs. Conclusions The results indicate the importance of finding incentives and creating an environment that fosters autonomy, competence and relatedness to motivate persons to exercise during oncological treatment. Some BCTs appear particularly useful and may be used by health professionals to increase patients’ motivation to exercise.

Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model Abstract Background Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity. Method We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression. Results Women in MMT showed significant reductions in perceived stress (β = − 0.16) and depressive symptoms (β = − 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower glucose post-oral glucose tolerance test (β = − 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group. Conclusion A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population. Clinical Trials.gov #NCT01307683.

Illness Cognitions Among Adolescents and Young Adults Who Have a Parent with Cancer: a Qualitative Exploration Using the Common-Sense Model of Self-regulation as a Framework Abstract Background Individuals construct beliefs about an illness based on their own perceptions, interpretation, and understanding of the illness and its treatment. These beliefs (collectively referred to as “illness cognitions” or “representations”) can have implications for psychological outcomes in family members and carers of an individual with an illness. The aim of this study was to explore young people’s perceptions of their parent’s cancer using the Common-Sense Model of Self-Regulation as a theoretical framework. Methods Semi-structured, one-on-one interviews were conducted with young people who had a parent diagnosed with cancer. Interview transcripts were analysed using deductive thematic analysis techniques. Results Eleven young people aged 15–24 years participated in the study. Major themes aligned with the dimensions of the Common-Sense Model of Self-Regulation. Young people described their experiences with parental cancer with reference to cognitive representations (beliefs about the illness identity, their understanding or coherence of the illness, and consequences, curability or controllability, timeline, and cause of the illness) and emotional representations (emotional beliefs and subjective feelings about the illness). Conclusions Findings indicate that young people’s perceptions of their parent’s cancer can be usefully described within the framework of the Common-Sense Model of Self-Regulation. Future research should investigate the relationships between young people’s illness cognitions, coping strategies, and psychological adjustment following their parent’s cancer diagnosis. This will provide valuable insights for the development of interventions that target specific types of illness cognitions associated with maladaptive coping strategies and poor adjustment.

Motivation, Challenges and Self-Regulation in Heart Failure Self-Care: a Theory-Driven Qualitative Study Abstract Background Self-care behaviours are crucial in reducing chronic heart failure (HF) morbidity and mortality but performance remains poor worldwide. This study draws on Temporal Self-regulation Theory (TST) to explore participants’ motivations, challenges and personalised self-regulation strategies to enhance self-care. Method Seventeen HF patients were purposively sampled and recruited from outpatient and inpatient settings at a Singaporean tertiary hospital from December 2017 to March 2018. Unstructured face-to-face interviews were conducted. Data were analysed using thematic analysis with constant comparison. Results Five themes emerged. Self-care motivations were (1) consideration of family’s future and (2) consideration of own past, while demotivation was (3) fatalistic consideration of own future. Barriers of behaviour change were (4) difficulty adopting physical activity and (5) difficulty deviating from personal dietary habits and sociocultural dietary norms. Personalised strategies to overcome these challenges were described in the 12 subthemes that emerged. Themes were well-fitted into the TST—(1–3) corresponded to time perspective, (4–5) corresponds to behaviour prepotency and the subthemes corresponded to self-regulatory capacity. Motivation could be enhanced by stimulating considerations of one’s past regrets, family’s future well-being and real-life success stories to instil hope. Clinicians and case managers could enhance self-regulation by empowering patients with tactical and situational skills to develop personalised plans to improve lifestyle habits and strategies to resist temptations. Conclusion Future person-centred self-care interventions could be tailored according to the study findings. Better self-care could improve patient outcomes, reduce rehospitalisation and alleviate global healthcare burden. Findings could be generalised to healthy populations as primary prevention.

Survive or Thrive? Longitudinal Relation Between Chronic Pain and Well-Being Abstract Background The minimal literature on the relation between chronic pain and both eudaimonic (EWB) and hedonic well-being (HWB) examines the relation cross-sectionally, and most studies have examined chronic pain’s effect only on psychopathology. Methods Using a sample of 473 midlife and older adults with chronic pain, this study examined both the cross-sectional and longitudinal relations between chronic pain and EWB and HWB in addition to psychological distress. Results Multiple-group longitudinal structural equation modeling revealed that chronic pain was related significantly and negatively to EWB and HWB, and significantly and positively to distress among both men and women. When examined longitudinally, chronic pain at time 1 was associated significantly only with decreased EWB at time 2, suggesting chronic pain’s risk to psychological functioning, especially because of its long-term effects on future EWB. Conclusions Our study provides a comprehensive picture of the way chronic pain is associated both with EWB and HWB, in addition to psychological distress. Further, chronic pain may have a lasting influence on EWB, while it may have little predictive value for future HWB and psychological distress. Our study supports well-being’s relevance to chronic pain research and has the potential to guide prevention strategies and treatment for chronic pain using a positive psychological framework.