Elissa Sarah Epel

Background: Metabolic disease, including type 2 diabetes, is a major public health concern. Reducing sugar-sweetened beverage (SSB) consumption is a critical target for disease prevention and lifestyle modification. Workplace interventions offer a promising opportunity to address barriers to behavior change while strengthening motivation and self-efficacy. Objective: The authors describe the intervention protocol, fidelity, and feasibility of a theory-informed brief intervention based on motivational interviewing principles to support reductions in SSB consumption among health care workers. The authors also explore changes over time in proposed mechanisms of behavior change. Methods: Participants (N=314) allocated to the intervention arm of a multicenter randomized controlled trial received a 4-dose intervention consisting of an introductory phone call, a brief counseling session, and 2 booster calls, supplemented by at-home tools targeting stress and craving management. We assessed fidelity to motivational interviewing principles (competence scores) and described feasibility via session adherence. Finally, we explored changes over time in motivation for change and perceived self-efficacy. Results: More than 60% of enrolled participants completed all 4 sessions, suggesting feasibility and high retention in the context of a remotely delivered workplace intervention. Health coaches achieved basic levels of proficiency in 2 of 4 competency scores: technical (mean 3.23, SD 0.48) and complex reflections (mean 41.91%, SD 15.17%). Preliminary exploratory findings indicate improvements in motivation for change and self-efficacy over time. Finally, we found that the use of brief mindfulness practices were associated with acute reductions in stress and cravings. Conclusions: This theory-grounded brief motivational intervention may offer a cost-effective and accessible approach for employers to support behavior change related to SSB consumption. Findings from the fully powered randomized controlled trial are needed to determine if the brief intervention can effectively change behavior. This paper establishes the intervention and its framework to inform future implementation.

Background/Objectives: The present investigation examined whether perceived stress statistically mediated the association between food insecurity and diet quality, as well as maladaptive eating behaviors (i.e., reward-based eating, comfort eating). Methods: Study 1 used cross-sectional data from the National Heart, Lung, and Blood Institute Growth and Health Study (N = 624), in which Black and white women completed self-report measures of food security, perceived stress, diet quality, and reward-based eating. Study 2 used cross-sectional data from a census-matched U.S. sample by age, gender, income, race/ethnicity, and census region (N = 1993), with self-report measures of food security, perceived stress, and comfort eating. Mediation analyses tested the indirect effect of perceived stress on associations between food insecurity and diet quality, reward-based eating, and comfort eating, controlling for sociodemographic factors. Results: In Study 1, food insecurity was positively correlated with perceived stress (r = 0.30) and negatively correlated with diet quality (r = −0.11). Perceived stress mediated the relationship between food insecurity and higher reward-based eating (indirect effect = 0.14, 95% CI [0.08, 0.22]) but did not mediate the association between food insecurity and diet quality (indirect effect = −0.04, 95% CI [−0.11, 0.03]). In Study 2, food insecurity was positively correlated with perceived stress (r = 0.42) and comfort eating (r = 0.19). Using a two-part mediation model, perceived stress mediated the association between food insecurity and the frequency of comfort eating among individuals who reported at least one day of comfort eating, with the strongest indirect effect observed among food-insecure individuals (conditional indirect effect = 0.75, 95% CI [0.49, 1.13]). Conclusions: Across two cross-sectional studies, higher perceived stress statistically mediated the relationship between food insecurity and two forms of maladaptive eating behaviors, suggesting that perceived stress is an important correlate of these relationships. Future work is needed to further evaluate the causal relationships between these constructs.

Leukocyte telomere length (LTL) is a biomarker of replicative history of cells and has been posited to be an indicator of biological aging. LTL may yield insight into immunomodulatory disorders, including systemic lupus erythematosus (SLE), an immune-mediated inflammatory disease that disproportionately affects Black/African American women. This study examined the association between LTL and mortality among 422 Black/African American women in the Black Women's Experiences Living with Lupus (BeWELL) Study. Participants were recruited from metropolitan Atlanta, Georgia, between April 2015 and May 2017 and followed for a mean of 1.98 years (SD = 0.38). LTL was measured as the telomere-to-single copy gene ratio (T/S). Mortality was assessed prospectively. Cox proportional hazards regression models adjusting for sociodemographic, health, and disease characteristics were specified. A total of 19 participants died during the follow-up period. Adjusting for demographic, socioeconomic, and health-related covariates, longer LTL was associated with lower risk of mortality (hazard ratio = 0.13, 95% confidence interval = 0.02, 0.83, P = 0.03). This study is the first to report an association between LTL and subsequent mortality among Black/African American women with SLE. Findings may be particularly relevant for this population, which has been shown to experience severe disease consequences. Future research may further explore LTL in mechanistic studies of SLE and assess the utility of LTL for monitoring disease progression and outcomes.

To survive and thrive, living organisms must monitor and regulate cell-level energy supply, demand, and transformation. They do so through a brain-directed interoceptive process we refer to as “metaboception.” Here, we describe a specific metaboceptive signaling cascade mediated by the metabokine/cytokine growth differentiation factor 15 (GDF15), which we name “mitoception.” Mitoception involves an afferent signaling arm initiated by the integrative stress response (ISR), and an efferent signaling arm that simultaneously promotes energy conservation and fuel mobilization. Afferent mitoceptive signaling is mediated by GDF15 released when cells face energy demand in excess of their energy transformation capacity, creating an “energy gap”. Efferent mitoceptive signaling arises when GDF15 receptors in the brainstem receive the signal and initiate psychological experiences including fatigue and anxiety, together with neuroendocrine stress responses. Mitoceptive outputs thus reprioritize systemic energy metabolism to promote allostasis, survival, and long-term health. The proposed GDF15-driven mitoception cascade makes predictions about modifiable processes that shape disease risk, mental health, mood, resilience, well-being, and aging.

Background: Emotional well-being interventions lead to better mental and physical health. However, most of these interventions have been tested on relatively homogeneous samples, with few interventions large enough to examine whether key sociodemographic factors impact outcomes. In addition, barriers to engagement include access and high participant burden. We developed a brief web-based intervention to address these barriers and tested the effects across sociodemographic groups. Objective: The study aims to examine the effectiveness of a brief, low-burden digital well-being intervention in improving emotional well-being and health-related outcomes across a diverse global sample. It investigates how key sociodemographic factors, such as age, sex, race and ethnicity, education, financial strain, and subjective social status, moderate intervention effects. The goal is to identify which groups benefit most, informing the scalability and public health potential of digital well-being interventions. Methods: We conducted a single-group pre-post study spanning from 2022 to 2024 using a web-based, multicomponent, week-long well-being intervention requiring 5 to 10 minutes of daily activity (the Big Joy Project). Using a global convenience sample recruited via open web-based enrollment, we assessed pre-post changes in emotional well-being, positive emotions, happiness agency, perceived stress, self-reported health, and sleep quality. At baseline, participants also reported sociodemographic characteristics. We used mixed-effects linear models to examine pre-post changes in the outcomes and sociodemographic moderators. Results: The sample (N=17,598) consisted of individuals from 169 countries and territories, with broad representation across sociodemographic groups; however, the sample was predominantly White, female, and had at least a high school or college education. Following the intervention, participants showed significant within-subjects effect size increases in emotional well-being (dz=0.48; P<.001), positive emotions (dz=0.45; P<.001), and happiness agency (dz=0.44; P<.001). Furthermore, participants showed a decrease in perceived stress (dz=–0.35; P<.001) and an increase in self-reported health (dz=0.07; P<.001) and sleep quality (dz=0.15; P<.001). There was a clear dose-response pattern across outcomes: participants who engaged in more daily practices showed greater improvements. There was a strong pattern of social disadvantage moderating these effects, with groups experiencing greater social disadvantage showing larger benefits across most outcomes. For example, those with lower education, greater financial strain, or lower subjective social status and those identifying as individuals from racial or ethnic minority groups (Black or Hispanic) all showed larger improvements across well-being outcomes. Furthermore, younger people had greater increases in emotional well-being and greater decreases in perceived stress compared to older people. Conclusions: A brief, low-intensity intervention showed meaningful improvements in well-being and stress, comparable to those seen in longer, more intensive digital well-being interventions. Sociodemographic groups that are at higher risk of poor mental health benefited more from the intervention, highlighting its potential for scalable public health impact. Testing this intervention with a randomized controlled trial design will be important.

The climate crisis poses the largest threat to human health and survival and has been a public health emergency for many years. It is causing harmful consequences for physical and mental health and is amplifying existing health inequities. In this call to action, we highlight the relevance of the health psychology and behavioral medicine communities in addressing the health impacts of climate change. We identify mitigation and adaptation climate health behaviors and social changes needed that underlie the three essential objectives to address climate change and its associated health consequences: (a) rapid decarbonization, (b) drawdown of atmospheric heat-trapping gases (sequestration), and (c) adaptation. To advance the behavioral and systemic changes necessary to protect health, we propose a 1-2-3 Transformational Model in which the larger field of health psychology and behavioral medicine promotes (1) One Health, human and planetary health by (2) targeting climate health behaviors, and (3) social change across major professional areas, including research, interventions, and education/advocacy. We urge the adoption of the social quantum change paradigm, a systems approach to understanding the process of social change, where systemic change is viewed as local to global, and the individual has an influential role. These shifts in views, priorities, and methods will bolster hope, collective efficacy, and action to support the next generation of health psychology and behavioral medicine professionals. With these changes, the health psychology and behavioral medicine communities can have a more immediate and meaningful impact on the climate crisis and its associated health consequences. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Objective: The climate crisis poses the largest threat to human health and survival and has been a public health emergency for many years. It is causing harmful consequences for physical and mental health and is amplifying existing health inequities. In this call to action, we highlight the relevance of the health psychology and behavioral medicine communities in addressing the health impacts of climate change. Method: We identify mitigation and adaptation climate health behaviors and social changes needed that underlie the three essential objectives to address climate change and its associated health consequences: (a) rapid decarbonization, (b) drawdown of atmospheric heat-trapping gases (sequestration), and (c) adaptation. Results: To advance the behavioral and systemic changes necessary to protect health, we propose a 1–2–3 Transformational Model in which the larger field of health psychology and behavioral medicine promotes (1) One Health, human and planetary health by (2) targeting climate health behaviors, and (3) social change across major professional areas, including research, interventions, and education/advocacy. We urge the adoption of the social quantum change paradigm, a systems approach to understanding the process of social change, where systemic change is viewed as local to global, and the individual has an influential role. Discussion: These shifts in views, priorities, and methods will bolster hope, collective efficacy, and action to support the next generation of health psychology and behavioral medicine professionals. With these changes, the health psychology and behavioral medicine communities can have a more immediate and meaningful impact on the climate crisis and its associated health consequences.