How does stress affect health behaviors - preferences, beliefs, or constraints? The goal of this proposal is to identify a behavioral mechanism which might cause low adherence to medical regimens and other health behaviors. Low adherence is frequently associated with high levels of stress. Stress may affect adherence by increasing temporal discounting, i.e. a person's preferences for immediate relative to delayed outcomes; by decreasing self-efficacy, i.e. a person's beliefs about what they can achieve; or by impairing executive function, i.e. cognitive and behavioral constraints such as attention and working memory.
In Specific Aim 1, we identify appropriate measures for these targets. In Study 1A, we conduct a systematic literature review to identify measures; in Study 1B, we carefully test the psychometric properties of these measures.
In Specific Aim 2, we assess whether stress affects our targets through a laboratory experiment in which participants are exposed to mild stressors. We hypothesize that stress will increase temporal discounting, decrease self-efficacy, and impair executive control.
In Specific Aim 3, we identify and develop interventions to engage our targets of interest. In Study 3A, we identify candidate interventions, or develop new ones, that may affect our targets. Interventions are likely to include videos to raise aspirations, writing exercises for self-affirmation, computer games to increase the salience of future outcomes. We then test whether these interventions engage our targets using a laboratory study in which participants are first exposed to the interventions and then tested on the target measures. We hypothesize that the interventions will reduce discounting, increase self-efficacy, and improve executive control. Finally, in Specific Aim 4, we test whether engaging our targets improves medical regimen adherence using a field experiment in which randomly selected households will be exposed to one of our interventions. Our primary adherence behavior of interest is attendance of antenatal and postnatal care (ANC/PNC) visits by expecting and new mothers. We hypothesize that exposure to the interventions will engage our targets of interest and increase ANC/PNC adherence. Preliminary work: During SOBC-1, we have already tested the effect of stress on temporal discounting, and the effect of simple psychological interventions on psychological well-being; thus, the studies described above are a natural extension of our work in this area. Together, these proposed studies will contribute to establishing a more mechanistic understanding of the origin and failure of health behaviors such as medical regimen adherence.

Public Health Relevance

Poor health-related behaviors, such as low adherence to medical regimens, are strongly associated with stress. However, it is unclear whether and how stress causally affects health behavior. This proposal tests three potential mechanisms by which stress may affect health behavior: by increasing the focus on the present; by decreasing 'self-efficacy', i.e. the belief that one can influence one's own outcomes; and by impairing skills required for decision-making. The proposed research seeks to both demonstrate the relative importance of these channels, and test their role in influencing health behavior.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Exploratory/Developmental Cooperative Agreement Phase I (UH2)
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Special Emphasis Panel (ZRG1)
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Tully, Lois
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Princeton University
Schools of Arts and Sciences
United States
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Esopo, Kristina; Mellow, Daniel; Thomas, Catherine et al. (2018) Measuring self-efficacy, executive function, and temporal discounting in Kenya. Behav Res Ther 101:30-45