Abstract Background The rising incidence and debilitating impact of lifestyle-related chronic kidney disease (CKD) are alarming. Although yoga has shown favorable results in end-stage CKD, its efficacy in earlier stages remains unexamined. Purpose This study assesses the efficacy and evaluates the mechanism of action of yoga on early stages of CKD. Methods The study followed a 2-armed randomized controlled trial design. The study was conducted at Father Muller Medical College & Hospital, Mangalore, India from January 2022 to September 2022. CKD patients (stages 3 and 4) with diabetic or hypertensive etiology, aged 35-60, were randomly allocated to the intervention (41) and control group (40). The intervention group received yoga practices for 12 weeks (5 hours/week) in addition to usual care; the control group received only usual care. Primary outcome measures included kidney function parameters, blood pressure, oxidative stress markers, antioxidant markers, and transforming growth factor-β1 (TGF-β1). Results Among the CKD participants (mean [SD], age, 54 [5.3] years; 61 [85%] males), yoga group showed significant improvement compared to the Control in serum creatinine (mean difference −0.42 (95% CI, −0.74 to −0.09); P = .013), estimated glomerular filtration rate (6.94 (95% CI, 1.76 to 12.11); P = .030), urine albumin-to-creatinine ratio (−464.2 (95% CI, −880.3 to −48.01); P = .029), and TGF-β1 (−218.2 (95% CI, −401.9 to −34.3); P = .021), along with blood pressure, oxidative-stress, and antioxidant markers. Mediation analysis demonstrates that reduced TGF-β1 levels, acting as a mediator, significantly convey the beneficial effects of yoga. Conclusion The study shows the beneficial effects of 12-week yoga practice on anthropometric, biochemical, and molecular markers in patients with stages 3 and 4 CKD. These findings may encourage the integration of yoga as a potent adjunct therapy alongside usual care in the management of earlier stages of CKD.

Abstract Background Sleep characteristics may be affected by daytime experiences, a fact that can be leveraged by nonpharmacological interventions to improve sleep. Purpose To investigate the effect of daily experiences on sleep in an ecologically valid within-participant design. Method We leverage the Budapest Sleep, Traits and Experiences Study, a large multiday observational study (N = 1901 nights in total) with extensive daily diaries and mobile electroencephalogram (EEG) recordings conducted for at least 7 days per participant to investigate how naturally occurring daily experiences such as social activity, emotional involvement, or mental strain affect sleep during the subsequent night. Results The strongest influence was on the timing of sleep onset: Even after controlling for day of the week, sleep onset occurred later after more experience-rich days and pleasurable activities (B = 0.05-0.89 hours, Pmax = .002). After statistically accounting for this extended wakefulness, we found limited evidence that daily experiences influence sleep characteristics. Only 4 effects survived correction for multiple comparisons: Sleep (B = 23 minutes, P = .002) and N3 duration (B = 6 minutes, P = .003) were longer after days with time at the workplace, rapid eye movement (REM) latency was increased after social activity (B = 8.6 minutes, P < .001), and sleep onset latency was reduced after alcohol consumption (B = −1.1 minute, P = .004). Conclusions Our work shows that, aside from homeostatic effects resulting from extended wakefulness, sleep is relatively resilient to and only affected by a few distinct daytime experiences. Nonpharmacological interventions seeking to change sleep may need to utilize behavioral modifications exceeding normal day-to-day variation.

Abstract Background In adaptive interventions, dynamic information about individuals is used to determine whether and how to intervene. Depending on the nature of the intervention (eg, human-delivered vs digitally delivered), adaptations may need to occur slowly or rapidly (eg, after a month vs daily). The optimization of adaptive interventions has been powered by 2 experimental designs, both employing sequential randomizations but on different timescales: the sequential multiple assignment randomized trial (SMART) on a slow timescale for standard adaptive interventions and the microrandomized trial (MRT) on a fast timescale for just-in-time adaptive interventions. Purpose This paper intends to help investigators who have research questions about the delivery and adaptation of intervention options at more than 1 time point, select and plan a trial design with the right form of sequential randomizations, on the appropriate timescale. Methods This is a conceptual paper discussing considerations related to designing trials with sequential randomizations. Results We clarify the differences and similarities between the SMART and the MRT, outline the types of questions that can be answered by the 2 experimental designs, and provide guidelines for selecting and planning the appropriate form of trial design based on the questions that need answers. Conclusions When designing a trial with sequential randomizations, it is essential to consider the need for sequential randomizations, the appropriate timescale for randomizations, whether to impose restrictions on randomizations, whether to randomize upfront or sequentially, the timing for measuring the primary outcome, and sample size planning.

Background: Thirdhand smoke (THS) contains toxic residues, including carcinogens, which persist on surfaces and clothes even after cigarette smoke dissipates. The public awareness of THS and its health effects remain low. Objective: This study examined beliefs about THS among Chinese-speaking former smokers and their non-smoking family members, before and after participating in a family-based THS education program. Methods: We implemented a 2-week THS education intervention delivered by lay health workers with 30 Chinese American dyads (N=60) residing in Northern California, consisting of former smokers who quit within the past 2 years and their family members. THS beliefs were assessed using the Beliefs About Thirdhand Smoke (BATHS) questionnaire administered at pre- and postintervention. Focus groups with 8 former smokers and 7 family participants were conducted. We used multivariable regression with Generalized Estimating Equations to account for time points and household correlations to assess changes in BATHS scores (Overall, Persistence and Health subscales). Focus group transcripts underwent independent coding by two researchers and thematic analysis. Results: The study sample included 30 male former smokers (37% with slight to mild craving for smoking), and 30 family members (97% female) who never smoked. A majority (82%) spoke English less than well, 83% were married, 58% lived with children and 27% with current smokers. All multivariable models showed a significant time x role (former smokers vs family) interaction (p < 0.05). Former smokers had lower BATHS scores than their family at preintervention (p < 0.01), but their scores became similar at post-intervention. Former smokers’ BATHS scores increased from pre- to post-intervention (Overall: p=0.02; Persistence: p=0.03; Health: p=0.04) while family had no significant change. Prominent themes from focus groups supported gaining new knowledge for both persistence and health effects of THS. Both former smokers and family members appreciated learning about cleaning methods and both shared increased family discussions and collaboration in household cleaning post intervention. Conclusion: THS education impacts former smokers and their non-smoking family members differently. Family-based interventions are promising to align beliefs and promote collaboration within households in addressing THS. Future randomized controlled trials should investigate broader impacts of the program on enhancing support for motivating quitting for current smokers, maintaining smoking abstinence, and in reducing THS exposure.

Despite the benefits of exercise, many individuals are unable or unwilling to adopt an exercise intervention. The purpose of this analysis was to identify putative genetic variants associated with dropout from exercise training interventions among individuals in the STRRIDE trials. We used a genome-wide association study approach to identify genetic variants in 603 participants initiating a supervised exercise intervention. Exercise intervention dropout occurred when a subject withdrew from further participation in the study or was otherwise lost to follow-up. Exercise intervention dropout was associated with a cluster of single-nucleotide polymorphisms with the top candidate being rs722069 (T/C, risk allele = C) (unadjusted p = 2.2 × 10-7, odds ratio = 2.23) contained within a linkage disequilibrium block on chromosome 16. In Genotype-Tissue Expression, rs722069 is an expression quantitative trait locus of the EARS2, COG7, and DCTN5 genes in skeletal muscle tissue. In subsets of the STRRIDE genetic cohort with available muscle gene expression (n = 37) and metabolic data (n = 82), at baseline the C allele was associated with lesser muscle expression of EARS2 (p < .002) and COG7 (p = .074) as well as lesser muscle concentrations of C2- and C3-acylcarnitines (p = .026). Our observations imply that exercise intervention dropout is genetically moderated through alterations in gene expression and metabolic pathways in skeletal muscle. Individual genetic traits may allow the development of a biomarker-based approach for identifying individuals who may benefit from more intensive counseling and other interventions to optimize exercise intervention adoption. STRRIDE I = NCT00200993; STRRIDE AT/RT = NCT00275145; STRRIDE-PD = NCT00962962.

The present research tests whether intention strength moderates intention-health behavior relations and the extent to which this is accounted for by the moderating effects of intention stability, goal priority, and goal conflict. In a prospective multi-behavior study, a representative sample of UK adults (N = 503) completed measures of past behavior, intention, intention strength, goal priority, and goal conflict in relation to eight Covid-19 protection behaviors at time 1. Intention and self-reported behavior were assessed at time 2 (2 months later). Intention stability was assessed over 2 months. Intention strength was a significant moderator of the intention-behavior relationship (controlling for past behavior). Controlling for the moderating effects of intention stability attenuated the moderating effect of intention strength, while also controlling for the moderating effects of goal priority and goal conflict reduced the moderating effects of intention strength to nonsignificance. The present findings indicate that intention strength is a significant moderator of the intention-health behavior relationship. They also suggest that the moderating effect of intention strength is explained by effects on intention stability, goal priority, and goal conflict. Tests of interventions to manipulate intention strength as a means to strengthen intention stability and intention-behavior relations are warranted.

Intersex individuals experience poor health due, in part, to healthcare avoidance. Nonconsensual intersex surgery may contribute to medical mistrust and avoidance among intersex populations. The purpose of this study was to explore the relationship between nonconsensual surgery and healthcare avoidance among intersex populations and to examine if medical mistrust mediates this relationship. Data for this cross-sectional study were collected in 2018 and analyzed in 2022. Participants completed a survey collecting information on demographics, medical mistrust, history of nonconsensual surgery, and history of postponing healthcare. One hundred nine participants with valid responses to all regression model variables were included in the study. Multivariable logistic regression models controlling for age, race, and income, examined the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. Mediation analyses of cross-sectional data examined whether medical mistrust mediated the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. Mean medical mistrust score was 2.8 (range = 1-4; standard deviation = 0.8), 49.7% of participants had nonconsensual surgery in their lifetime, 45.9% postponed emergency healthcare, and 61.5% postponed preventive healthcare in their lifetime. Nonconsensual surgery was associated with increased odds of delaying preventive (adjusted odds ratio [AOR] = 4.17; confidence interval [CI] = 1.76-9.88; p = .016) and emergency healthcare (AOR = 4.26; CI = 1.71-10.59; p = .002). Medical mistrust mediated the relationship between nonconsensual surgery and delaying preventive (indirect effect = 1.78; CI = 1.16-3.67) and emergency healthcare (indirect effect = 1.66; CI = 1.04-3.30). Nonconsensual surgery contributed to healthcare avoidance in this intersex population by increasing medical mistrust. To decrease healthcare avoidance, intersex health promotion interventions should restrict nonconsensual surgery and build trust through trauma-informed care.

To date, research investigating psychosocial correlates of COVID-19 vaccination has been cross-sectional, parochial, and/or reliant upon non-stratified international samples, resulting in difficulty in clarifying the contributions of various vaccination-related influences. The present study tested a novel integration of prospective and concurrent associations of demographic and dispositional tendencies, intervening illness and preventive beliefs, vaccine intention, illness experiences, and concurrent contextual vaccine-related influences with subsequent COVID-19 vaccination. The preregistered study used a stratified online U.S. sample (N = 500), with assessments aligned to (a) "15 days to slow the spread" in March 2020, (b) vaccine authorization and major case/mortality surge during December 2020 and January 2021, and (c) the period following full vaccine approval in August 2021 during the third major/case mortality surge during September and October 2021. Path modeling showed the absence of children in the household and greater education were prospective predictors of vaccination. Trait openness and less conservative political beliefs showed indirect prospective associations with vaccination via stronger intermediating vaccine intention. Contextual vaccine-related influences of vaccine-related information sources, employer mandates, and flu vaccine history also showed direct associations with vaccination. In contrast to expectations, lower conscientiousness showed a direct prospective association with vaccination. Controlling for interrelations among study variables, the results of the integrative psychosocial model clarified the unique contributions and pathways from antecedent characteristics to vaccination while accounting for vaccine-related contextual influences, providing further direction for refining the timing and content of public health messaging for vaccination.

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Most risk factors for cardiovascular disease (CVD) are modifiable, suggesting that the burden of CVD could be substantially reduced through cardiovascular screening and healthier lifestyle. People who have social support are more likely to adhere to cardiovascular prevention recommendations, but it is not clear whether the benefit of social support is equal for men and women. We investigated whether sex moderates the relationship between social support and adherence to cardiovascular prevention recommendations in a nationally representative sample. Participants were 17,287 adults (n = 10,264 middle-aged adults 40-64 years old and n = 7,023 older adults ≥ 65 years old) who participated in the National Health Survey of Spain in 2017. Social support was measured with the Functional Social Support Questionnaire of Duke-UNC. Adherence to cardiovascular screening recommendations was assessed based on self-reported testing of cholesterol, blood pressure, and blood sugar by a health professional in the past 12 months. Adherence to recommended health-related behaviors was assessed based on the guidelines of the European Society of Cardiology regarding diet, alcohol consumption, smoking, and physical activity. Multiple regression models adjusted for socio-demographic and cardiovascular history and risk variables showed that social support was more strongly associated with adherence to cardiovascular prevention recommendations in men than in women. In particular, low social support levels were especially detrimental for both middle-aged men (screening: B = 0.13, 95% CI [0.06-0.20], p < .001; behaviors: B = 0.33 [0.26-0.41], p < .001) and older men (screening: B = 0.10 [0.04-0.17], p = .001; behaviors: B = 0.16 [0.08-0.25], p < .001), whereas older women had comparatively high adherence, which was unrelated to social support (screening: B = 0.02 [-0.03 to 0.08], p = .433; behaviors: B = 0.03 [-0.03 to 0.10], p = .342). Social support is more strongly associated with cardiovascular prevention in men than in women, such that men who lack social support have the lowest adherence to cardiovascular screening and lifestyle recommendations.