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BACKGROUND: This study aimed to promote competence, autonomy, and relatedness among first-time whole blood donors to enhance intrinsic motivation and increase retention. STUDY DESIGN AND METHODS: Using a full factorial design, first-time donors (N=2,002) were randomly assigned to a no-treatment control condition or to one of seven intervention conditions designed to promote donation competence, autonomy, relatedness, a combination of two (e.g., competence and autonomy), or all three constructs. Participants completed donor motivation measures before the intervention and six weeks later, and subsequent donation attempts were assessed for one year. RESULTS: There was no significant group difference in the frequency of donation attempts or in the number of days to return. Significant effects of group were observed for 10 of the 12 motivation measures, although follow-up analyses revealed significant differences from the control group were restricted to interventions that included an autonomy component. Path analyses confirmed direct associations between interventions involving autonomy and donor motivation, and indirect mediation of donation attempts via stronger donation intentions and lower donation anxiety. CONCLUSION: Among young, first-time, whole blood donors, brief interventions that include support for donor autonomy were associated with direct effects on donor motivation and indirect, but small, effects on subsequent donation behavior.

Background With growing awareness of the prevalence of nonanemic iron deficiency among blood donors, there is a need to explore the extent of potential negative consequences. This study examined the relationship between various measures of iron status, blood donation history, and neuropsychological and psychosocial functioning in healthy young women. Study design and methods Using a cross-sectional design, 160 female undergraduates completed neuropsychology tests and measures of sleep, fatigue, quality of life, and depression before providing a blood sample. Correlational analyses examined the relationship between iron status (ferritin, iron, hemoglobin, and zinc protoporphyrin) and cognitive and psychosocial functioning. Performance on these measures was also examined as a function of recent blood donation history (zero, one, more than one donation in the past year). Results Iron status (low ferritin, iron, or hemoglobin or high zinc protoporphyrin) was not associated with poorer performance on the cognitive tasks. Further, participants who reported donating once in the previous year performed better, rather than worse, than those with no recent donation history on several measures of executive function, even when controlling for ferritin levels. Although there was some evidence of greater fatigue among those who had donated more than once in the past year, this effect was not accounted for by ferritin levels. Conclusion The present findings are consistent with prior evidence that nonanemic iron deficiency is not associated with cognitive impairment or psychosocial dysfunction in healthy young females. Because these results are based on cross-sectional evidence, further study using longitudinal research is needed to confirm these findings.

BACKGROUND Prior studies have shown donation-related fear to be associated with decreased donor confidence and an increased risk for vasovagal reactions. This study examined the effects of a predonation intervention that provided fearful donors with suggestions for coping. STUDY DESIGN AND METHODS Using a tablet-based application, high school donors (49.4% female) answered a question regarding their fear of having blood drawn. Those who reported fear were randomly assigned to either a control (n = 930) or an intervention (n = 911) group. Donors in the control group rated their confidence in dealing with their fear and then donated as usual. Donors in the intervention group received a brief audiovisual presentation on coping strategies, rated their confidence, and then donated as usual. RESULTS A higher proportion of fearful versus nonfearful donors experienced a vasovagal reaction, even after controlling for other demographic and health predictors (OR, 2.3; 95% CI, 1.655-3.185, p

Background The potential for iron deficiency is a known blood donor health concern and suggests the need to inform donors about the potential risks of low iron levels as well as strategies to address these risks. Study design and methods Frequent (n = 904) and young (n = 629) donors were randomly assigned within risk group to either a control (n = 548) or an intervention (n = 985) group. The control group answered questions at baseline and 6-month follow-up regarding their awareness of the risk of donation-related iron depletion and whether they were taking actions to address their iron status. The intervention group answered the same questions at baseline and follow-up, but after completing the baseline survey, they received information regarding their risk of iron depletion and behaviors they could adopt to mitigate this risk. Intervention group participants were also offered the opportunity to develop an action plan to help them supplement their iron intake. Results The intervention enhanced overall awareness of donation-related iron loss (OR = 1.5, 95% CI 1.171-1.864, p = .001), with no negative impact on retention. Reported iron health behaviors (iron supplementation, speaking with a doctor) showed significant increases when action planning was paired with the educational information. Conclusion These findings suggest that it is possible to increase awareness of donation-related risk for iron depletion without negatively influencing retention, and combining education with encouragement to develop an action plan may increase the likelihood of both retention and behavioral changes to promote healthy iron levels.

BACKGROUND Elevated fear and anxiety regarding donation-related stimuli (e.g., needles, pain, blood, fainting) has been associated with reduced blood donor recruitment and retention. The present longitudinal study tests the notion that this inverse relationship may be accounted for by lower donation confidence and more negative donation attitudes among fearful first-time donors. STUDY DESIGN AND METHODS In a sample of 1479 first-time whole blood donors [67.9% female; mean age = 19.3 (standard deviation (SD) = 2.5) years], path analyses were conducted to examine relationships among donor ratings of fear of blood draw and donation anxiety obtained approximately 1 week after donation, donation confidence and attitudes assessed approximately 6 weeks later, and donation attempts over the 14 months following the original donation. RESULTS Path analyses indicated that both fear of blood draws and donation anxiety were associated with fewer attempted donations, and that these effects were indirectly mediated by a combination of lower donor confidence and more negative donation attitudes. CONCLUSION Because retention of new blood donors is essential to maintain a healthy blood supply, the results of the present study suggest that first-time donors should be assessed for fear and anxiety so that appropriate strategies can be provided to address their concerns, bolster their confidence and attitudes, and ultimately promote their long-term retention.

Background Extending existing research on the relationship between predonation fear of having blood drawn and risk for vasovagal reactions among young donors, this study assessed the predictive power of specific donation-related fears. Study design and methods After the health screening, high school whole blood donors (59.5% female) were randomly assigned into one of three groups. Group 1 (n = 881) answered a control question about their prior night's sleep. Group 2 (n = 911) answered the sleep question and a question about fear of having blood drawn. Group 3 (n = 924) answered the sleep question, the fear of having blood drawn question, and four questions about specific donation-related fears (seeing blood, needles, pain, and fainting). Results The proportion of vasovagal reactions did not differ significantly among the groups, indicating that asking one or more fear questions before donation did not promote reactions. Fearful donors were more likely to have a vasovagal reaction, even after controlling for other important demographic and health predictors, with odds ratios ranging from 2.17 (95% confidence interval [CI], 1.44-3.27) for fear of fainting to 3.50 (95% CI, 2.34-5.23) for fear of seeing blood. Hours of sleep was not significantly related to vasovagal reaction risk. Conclusion Predonation fear identifies donors who are more likely to experience a vasovagal reaction and does so without increasing the risk of such reactions. Accordingly, fear should be assessed during screening to identify those who could benefit from instruction in anxiety management and who might require greater attention to help prevent donor injury.

BACKGROUND Previous studies have reported a relationship between blood donation and decreased risk for cardiovascular events, and it has been proposed that this may be due to a lowering of blood pressure among hypertensive individuals who donate on a regular basis. STUDY DESIGN AND METHODS With the use of a retrospective longitudinal analysis, predonation blood pressure readings were examined across consecutive whole blood donations for New York Blood Center donors. With blood pressure levels recorded at the first, second, third, and fourth donations, the sample was divided into three subgroups including high (≥140 mmHg), intermediate (>100 and

BACKGROUND In contrast to standard donor retention strategies (e.g., mailings, phone calls, text messages), we developed a brief telephone interview, based on motivational interviewing principles, that encourages blood donors to reflect upon their unique motivators and barriers for giving. This study examined the effect of this motivational interview, combined with action and coping plan components, on blood donor motivations. STUDY DESIGN AND METHODS The design was to randomly assign blood donors to receive either a telephone-delivered motivational interview with action and coping plan components or a control call approximately 6 weeks after their most recent donation. Participants completed a series of surveys related to donation motivation approximately 3 weeks before telephone contact (precall baseline) and then repeated these surveys approximately 1 week after telephone contact (postcall). RESULTS The sample was 63% female, included a majority (52.6%) of first-time blood donors, and had a mean age of 30.0 years (SD, 11.7 years). A series of analyses of variance revealed that, relative to controls (n = 244), donors in the motivational interview group (n = 254) had significantly larger increases in motivational autonomy (p = 0.001), affective attitude (p = 0.004), self-efficacy (p = 0.03), anticipated regret (p = 0.001), and intention (p =

Background Blood is a valuable resource, but most people do not donate. One deterrent to blood donation is the anticipation of vasovagal symptoms (e.g., dizziness, nausea, and fainting), despite the fact that such symptoms typically affect a small proportion of donors. The current research examined norm perceptions regarding vasovagal symptom experiences and used a message-framing paradigm to communicate accurate norm information and increase future donation intentions. Study Design and Methods Three studies were conducted using young adult samples. In Study 1, donors and nondonors estimated the percentage of people who experience vasovagal symptoms. In Studies 2 and 3, nondonors and donors (respectively) were provided with accurate, positively framed, or negatively framed norm messages and indicated their intentions to donate. Results In Study 1 we found that participants vastly overestimated how normative it was to experience vasovagal symptoms and this overestimation was stronger among nondonors. In Studies 2 and 3, we showed that positively framed normative messages (“90% of donors do not experience vasovagal symptoms”) were generally more influential than negatively framed messages (“10% of donors do experience vasovagal symptoms”), except among past donors who had unfavorable donation experiences. Conclusion These findings suggest that targeting and correcting norm perception may be a critical step toward improving blood donation rates.

Background We previously demonstrated that fear of having blood drawn is one of the strongest known predictors of vasovagal reactions among high school blood donors. This report examines the combined effects of donor fear and experience of vasovagal reactions on repeat donation attempts among high school blood donors. Study Design and Methods Immediately after completing the blood donor health screening, 1715 high school students were asked about their fear of having blood drawn. The donor record was then used to collect information regarding their experience of vasovagal reactions at the time of donation as well as their subsequent donation attempts within the following year. Results Fear of having blood drawn and the experience of a vasovagal reaction each contributed to donor attrition, with only 33.2% of fearful donors who experienced a vasovagal reaction returning in the following year compared to 56.7% of nonfearful nonreactors. Path analyses demonstrated that fear has an indirect effect (through vasovagal reactions) on repeat donations among first-time donors and both direct and indirect effects on repeat donation attempts among experienced donors. Conclusion Among high school blood donors, fear of having blood drawn has both a direct negative effect on donor retention and an indirect negative effect by increasing the risk of vasovagal reactions. Accordingly, targeted efforts to reduce donor fear may be particularly efficient in promoting long-term donor loyalty among our youngest donors.

The Blood Donor Competency, Autonomy, and Relatedness Enhancement (Blood Donor CARE) project was designed as a practical application of self-determination theory to encourage retention of first-time donors. Self-determination theory proposes that people are more likely to persist with behaviors that are internally-motivated, and that externally-motivated behavior can evolve and become internalized given the appropriate socio-environmental conditions. According to self-determination theory, motivation to engage in blood donation may become increasingly self-determined if the behavior satisfies fundamental human needs for competence (a sense of self-efficacy to achieve specific goals), autonomy (a sense of volitional control over one's behavior), and relatedness (a sense of connection to a larger group). The primary aim of this randomized controlled trial is to examine the effect of competence, autonomy, and/or relatedness interventions on donor retention. Using a full factorial design, first-time donors will be assigned to a control condition or one of seven intervention conditions. Donation competence, autonomy, and relatedness, along with additional constructs associated with return donation, will be assessed before and after the intervention using online surveys, and donation attempts will be tracked for one-year using blood center donor databases. We hypothesize that, compared to the control condition, the interventions will increase the likelihood of a subsequent donation attempt. We will also examine intervention-specific increases in competence, autonomy, and relatedness as potential mediators of enhanced donor retention. By promoting first-time donor competence, autonomy, and relatedness our goal is to enhance internal motivation for giving and in so doing increase the likelihood of future donation.

BACKGROUND: We previously demonstrated in a group of mostly experienced blood donors that fear of blood draws was a significant predictor of vasovagal reactions. Importantly, being asked about one's fear immediately before donation did not increase reaction rates. This study further evaluates the relationship between fear and reactions among high school blood donors, who are known to be at a relatively greater risk for vasovagal reactions. STUDY DESIGN AND METHODS: Immediately after completing the blood donor health screening, 17- and 18-year-old high school students were asked about their fear of having blood drawn. Based on a random selection, the fear question was administered in approximately half of the schools, resulting in a final sample of 1715 donors who did and 1692 donors who did not answer the fear question. RESULTS: Fear was a significant predictor of donor reactions and remained a significant independent predictor (along with estimated blood volume and donor sex) in a logistic regression analysis. There was no difference in the proportion of reactions observed between those who did and did not answer the predonation fear question. CONCLUSION: Consistent with previous evidence in older and more experienced blood donors, these findings indicate that assessing fear of blood draws may help to identify those who are most likely to experience vasovagal reactions among young donors without increasing the frequency of such reactions.

BACKGROUND: Written and video approaches to donor education have been shown to enhance donation attitudes and intentions to give blood, particularly when the information provides specific coping suggestions for donation-related concerns. This study extends this work by comparing Web-based approaches to donor preparation among donors and nondonors. STUDY DESIGN AND METHODS: Young adults (62% female; mean [±SD] age, 19.3 [±1.5] years; mean [range] number of prior blood donations, 1.1 [0-26]; 60% nondonors) were randomly assigned to view 1) a study Web site designed to address common blood donor concerns and suggest specific coping strategies (n = 238), 2) a standard blood center Web site (n = 233), or 3) a control Web site where participants viewed videos of their choice (n = 202). Measures of donation attitude, anxiety, confidence, intention, anticipated regret, and moral norm were completed before and after the intervention. RESULTS: Among nondonors, the study Web site produced greater changes in donation attitude, confidence, intention, and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for moral norm and anxiety. Among donors, the study Web site produced greater changes in donation confidence and anticipated regret relative to both the standard and the control Web sites, but only differed significantly from the control Web site for donation attitude, anxiety, intention, and moral norm. CONCLUSION: Web-based donor preparation materials may provide a cost-effective way to enhance donation intentions and encourage donation behavior.

BACKGROUND: Fear is an important contributor to the risk of presyncopal reactions to blood donation. However, concern that asking donors about their fears may increase the risk of reactions is a potential impediment to incorporating fear assessment into donor screening. STUDY DESIGN AND METHODS: Before donation, participants responded to a series of questions that either did (n = 488) or did not (n = 494) include questions related to fear of seeing blood drawn. Immediately after donation all participants provided ratings of presyncopal reactions. RESULTS: Among those asked predonation fear questions, fear was most strongly related to presyncopal symptoms when compared against other donor characteristics (e.g., age, number of prior donations, body mass index, estimated blood volume, blood pressure, and pulse). However, Mann-Whitney U tests revealed that being asked about fear before donation was not associated with higher reports of presyncopal reactions for the sample as a whole, nor among novice donors. Further, regression analyses indicated that fear remained a significant predictor of presyncopal reactions in final models that included age and number of prior donations as significant predictors. CONCLUSION: Predonation assessment of fear of blood draws may help to identify donors who are most likely to benefit from brief interventions designed to enhance donor coping, reduce risk of presyncopal reactions, and increase donor retention. F or donor safety reasons, individual difference characteristics such as age and weight are routinely used to screen potential blood donors. Although the addition of new screening criteria can be a challenge to the blood collection process and the overall blood supply, recent findings regarding the positive relationship between estimated total blood volume and risk of syncopal and presyncopal reactions 1 has led many blood collection agencies to consider the combination of donor sex, height, and weight in determining eligibility to give blood. Interestingly, despite the fact that convincing reports of the relationship between donor fear or anxiety and the experience of syncopal reactions date back more than 50 years

BACKGROUND: Applied muscle tension (AMT), which involves rhythmic tensing of the muscles of the core and lower extremities, has been associated with attenuation of presyncopal reactions among whole blood donors. This study was designed to examine whether the salutary effects of AMT may be mediated by increases in cerebral oxygenation during blood donation. STUDY DESIGN AND METHODS: Seventy-two female blood donors were recruited at mobile blood drives in the American Red Cross Blood Services–Central Ohio Region. Participants were randomly assigned to engage in either AMT or repeated gentle foot flexions (i.e., distraction control) during whole blood donation. Cerebral oxygenation was monitored throughout the donation using near infrared spectroscopy. RESULTS: Participants who engaged in AMT were shown to have attenuated decreases in cerebral oxygenation across the three intervals of the blood draw relative to the distraction manipulation (F(1,70) = 8.144, p = 0.006). Whereas cerebral oxygenation decreased 1.42% (SD, 2.09%) for those in the distraction-control group, oxygenation levels increased 0.13% (SD, 2.56%) in the AMT group. CONCLUSION: AMT is associated with an attenuated decrease in cerebral oxygenation compared to a distraction-control group. Further studies are necessary to establish if the salutary effect of AMT during blood donation may be in part due to an increase in oxygen available to the brain.

BACKGROUND: Prior research has shown that education materials that directly address prospective donor concerns and provide specific coping suggestions are particularly effective at enhancing donation attitudes and intentions to give blood. This study compared the effect of donor coping materials, provided in written and audiovisual formats, as potential tools to enhance recruitment of prospective blood donors. The role of initial attitudes toward blood donation on responses to these materials was also considered. STUDY DESIGN AND METHODS: Young adults (62% female; mean [SD] age = 19.1 [1.4]; mean [range] prior blood donations = 1.32 [0-13]) were randomly assigned to 1) read a brochure addressing common blood donor concerns and suggesting specific coping strategies, 2) view a video addressing blood donor concerns and illustrating coping techniques, 3) read the brochure and view the video, or 4) read a control brochure on healthy eating and exercise. Measures of blood donation attitudes, anxiety, confidence, and intentions to give blood were completed before and after the intervention. RESULTS: Relative to the control brochure, all the intervention groups showed larger reductions in anxiety, more positive changes in attitude, and greater increases in donation confidence and intentions. The combination of the brochure and video outperformed either intervention alone in further improving donation attitudes among participants with high initial donation attitudes. CONCLUSION: Blood donation coping materials, presented in either written or audiovisual formats, significantly enhance willingness to donate blood among young adults regardless of their initial attitudes toward blood donation.

Background: Increasing repeat blood donation behavior is a critical public health goal. According to self-determination theory, the process of developing internal motivation to give blood and an associated self-identity as a blood donor may be promoted by feelings of “relatedness” or a connection to other donors, which may be enhanced through social relations and interactions. Objective: The purpose of this report it to describe the development and pilot testing of a social networking-based (Facebook) intervention condition designed to increase feelings of relatedness via virtual social interaction and support. Methods: To develop the intervention condition content, images, text, polls, and video content were assembled. Ohio University college students (N=127) rated the content (82 images/text) presented by computer in random order using a scale of one to five on various dimensions of relatedness. Mean ratings were calculated and analyses of variance were conducted to assess associations among the dimensions. Based on these results, the relatedness intervention was adapted and evaluated for feasibility, acceptability, and preliminary efficacy among 24 first-time donors, aged 18 to 24 years, in a 30-day pilot trial. Paired t-tests were conducted to examine change over time in relatedness and connectedness. Results: The intervention condition that was developed was acceptable and feasible. Results of the uncontrolled, preintervention, and postintervention evaluation revealed that feelings of individual-level relatedness increased significantly after the intervention. Conclusions: By promoting first-time blood donor relatedness, our goal is to enhance internal motivation for donating and the integration of the blood donor identity, thus increasing the likelihood of future repeat donation. Trial Registration: ClinicalTrials.gov NCT02717338; https://clinicaltrials.gov/ct2/show/NCT02717338 (Archived by WebCite at http://www.webcitation.org/6ymHRBCwu)

BACKGROUND: A randomized controlled trial was conducted to test the effects of hydration and applied muscle tensing on presyncopal reactions to blood donation. Both interventions are designed to prevent the decreases in blood pressure that can contribute to such reactions, but due to the distinct physiologic mechanisms underlying their pressor responses it was hypothesized that a combined intervention would yield the greatest benefit. STUDY DESIGN AND METHODS: Before blood donation, first- and second-time blood donors (mean age, 20.2 years; SD, 4.9) were randomly assigned to 1) standard donation, 2) placebo (leg exercise before venipuncture), 3) predonation water, or 4) predonation water and leg exercise during donation. RESULTS: Main effects of group were observed for phlebotomist classification of vasovagal reactions (χ2(3) = 8.38, p

BACKGROUND: Presyncopal reactions are among the most common systemic reactions experienced by blood donors, occur most frequently in novice donors, and can serve as a deterrent to future donation regardless of donation experience. This report describes the validation of a presyncopal reactions scale that can be used to standardize assessment of the donor's subjective experience. STUDY DESIGN AND METHODS: A psychometric analysis of the Blood Donation Reactions Inventory (BDRI), a measure of presyncopal reactions, was conducted using data obtained from two independent samples of volunteer blood donors. Based on these analyses, a new, brief version of the BDRI is proposed, and psychometric data regarding the reliability and construct validity of this instrument are presented. RESULTS: Results of confirmatory factor analyses indicate that a 4-item version of the BDRI can be used to assess subjective perception of mild, prefaint symptoms. Additional analyses indicate that the BDRI has good internal consistency and demonstrates concurrent validity relative to other indices of donor reactions (e.g., donor chair reclines and loss of consciousness). Construct validity is supported by factor analyses, expected score differences in different donor groups, and convergent validation against measures of donor satisfaction and likelihood of repeat donation. CONCLUSION: The BDRI provides an assessment of subjective ratings of presyncopal symptoms that is brief, easily understood by donors, and quick to administer and score. The BDRI yields important information about the donor's experience that can be used to predict satisfaction and likelihood of repeat donation.

BACKGROUND: Although little empiric evidence has been published concerning the efficacy of blood donor recruitment materials, research suggests that simple attempts to enhance knowledge may not be sufficient to motivate donation. In contrast, recent donor motivation studies highlight the importance of anxiety, attitudes, and perceived ability to cope with donation (i.e., self-efficacy) as crucial determinants of donation intention. Therefore, recruitment materials that specifically address these constructs have the potential to outperform traditional educational brochures. STUDY DESIGN AND METHODS: Participants were randomly assigned to read one of three brochures: 1) a new brochure addressing common donor concerns and suggesting specific coping strategies, 2) a standard blood center brochure, or 3) a control brochure on healthy eating and exercise. Standardized questionnaires were completed before and after the brochures to assess change in blood donation anxiety, attitude, self-efficacy, and intention. RESULTS: Although no significant changes were noted for the control brochure, after reading the new brochure participants reported significant improvements in attitude, anxiety, self-efficacy, and donation intention. The standard donation brochure had an intermediate effect. CONCLUSION: Efforts to address common donor fears and to provide useful coping suggestions may improve the effectiveness of blood donation recruitment materials.

First-time blood donors are essential to the US donor pool, providing nearly a third of all donations. Unfortunately, there are a wide variety of obstacles to repeat donation and new donors are extremely difficult to retain. Because each donor experiences a unique set of deterrents, we developed a post-donation interview based on motivational interview principles in order to flexibly address individual barriers. The primary aim of this randomized clinical trial is to examine retention of first-time, group O blood donors who are randomly assigned to receive either a telephone-delivered interview with motivational and action planning components or a standard-of-care control call approximately six weeks after their donation. Measures of donation attitude, perceived behavioral control, intention, and motivational autonomy will be measured before and after the telephone contact using online surveys, and donation attempts will be tracked for one year using blood center donor databases. We hypothesize that, compared to controls, donors who receive the telephone interview will be more likely to make a donation attempt over the following year. In addition, we will examine possible mechanisms of action of the interview using key predictors of donation behavior as described by Self Determination Theory (i.e., motivational autonomy) and the Theory of Planned Behavior (i.e., attitude, perceived behavioral control, and intention). Results of this intervention may help to support a novel strategy to enhance retention of selected blood donors in an effort to better meet the nation's blood supply needs.

The nociceptive flexion reflex (NFR) is a polysynaptic withdrawal reflex that occurs in response to painful stimulation. In human studies, NFR responsiveness has been used as a direct measure of nociception as well as an indirect measure of supraspinal modulation of nociceptive transmission. Previous studies have suggested that anxiety may influence NFR responding, and therefore it has been recommended that anxiety be reduced by familiarizing participants with assessment methodology prior to formal NFR assessment. The present study was designed to assess the influence of anxiety on NFR threshold. Using a repeated measures design, 40 men and women completed an NFR threshold assessment twice within session one, and twice again during a second session conducted 24 h later. Within each assessment session, state anxiety was measured at the beginning of the session and immediately following each NFR threshold assessment. Results indicated that although anxiety increased in response to NFR threshold assessment and was positively related to subjective pain reports, anxiety was not related to observed NFR threshold levels. These findings suggest that individual differences in anxiety do not significantly affect NFR threshold level determinations under standard testing conditions.

A growing body of evidence suggests that episodes of fainting can deter volunteer blood donors from returning to donate in the future. In contrast, relatively little is known about the effect of significantly more common mild reactions (e.g., faintness, dizziness, lightheadedness) on donor retention. In the present study, 1052 volunteer blood donors completed a standardized measure of subjective physiological reactions immediately after blood donation (Blood Donation Reactions Inventory), and individual scores were used to predict repeat donation behavior during a one-year follow-up. Results of a logistic regression analysis indicated that higher scores on the Blood Donation Reactions Inventory were associated with a significantly lower likelihood of repeat donation, and that novice donors who scored highest on the scale were less than half as likely to have returned to donate in the following year. These findings suggest that the Blood Donation Reactions Inventory is an effective method of assessing reactions that predict donor non-return, and therefore may be a useful addition to future studies aimed at enhancing donor satisfaction and retention.

Catastrophizing is reliably associated with increased reports of clinical and experimental pain. To test the hypothesis that catastrophizing may heighten pain experience by increasing nociceptive transmission through spinal gating mechanisms, the present study examined catastrophizing as a predictor of pain ratings and nociceptive flexion reflex (NFR) thresholds in 88 young adult men (n = 47) and women (n = 41). The NFR threshold was defined as the intensity of electrocutaneous sural nerve stimulation required to elicit a withdrawal response from the biceps femoris muscle of the ipsilateral leg. Participants completed an assessment of their NFR threshold and then provided pain ratings using both a numerical rating scale (NRS) and the short-form McGill pain questionnaire (SF-MPQ). Pain catastrophizing was assessed using the catastrophizing subscale of the coping strategies questionnaire (CSQ). Although catastrophizing was positively related to both NRS and SF-MPQ pain ratings, catastrophizing was not significantly related to NFR threshold. These findings suggest that differential modulation of spinal nociceptive input may not account for the relationship between catastrophizing and increased pain.

Therapeutic mechanisms hypothesized to underlie improvements in tension headache activity achieved with combined relaxation and electromyographic (EMG) biofeedback therapy were examined. These therapeutic mechanisms included (1) changes in EMG activity in frontal and trapezii muscles, (2) changes in central pain modulation as indexed by the duration of the second exteroceptive silent period (ES2), and (3) changes in headache locus of control and self-efficacy. Forty-four young adults with chronic tension-type headaches were assigned either to six sessions of relaxation and EMG biofeedback training (N = 30) or to an assessment only control group (N = 14) that required three assessment sessions. Measures of self-efficacy and locus of control were collected at pre- and posttreatment, and ES2 was evaluated at the beginning and end of the first, third, and last session. EMG was monitored before, during, and following training trials. Relaxation/EMG biofeedback training effectively reduced headache activity: 51.7% of subjects who received relaxation/biofeedback therapy recorded at least a 50% reduction in headache activity following treatment, while controls failed to improve on any measure. Improvements in headache activity in treated subjects were correlated with increases in self-efficacy induced by biofeedback training but not with changes in EMG activity or in ES2 durations. These results provide additional support for the hypothesis that cognitive changes underlie the effectiveness of relaxation and biofeedback therapies, at least in young adult tension-type headache sufferers.

Background and Objectives Although individual differences in fear of stimuli related to blood donation is a key determinant of donor recruitment and retention, a donation-specific fear measure has yet to be developed. Materials and Methods A donation-related fear measure was developed and tested on an initial sample of donors and non-donors, and then re-evaluated on a second sample to confirm the observed factor structure. Results Analyses supported a four-factor structure, with subscales related to fear of: (1) syncopal symptoms, (2) blood and needles, (3) social evaluation, and (4) health screen results. Conclusion The Blood Donation Fears Inventory is a novel measure to assess fears held by current and potential blood donors.

BACKGROUND: This study extends our prior assessment of a blood donation recruitment brochure by assessing persistence of observed changes in attitudes toward donation as well as the effects that such changes have on the behavior of registering to give blood. STUDY DESIGN AND METHODS: Participants were randomly assigned to read 1) a study brochure addressing common donor concerns and suggesting specific coping strategies, 2) a blood center brochure, or 3) a control brochure on healthy eating and exercise. Measures of blood donation attitudes, donation-related anxiety, confidence in ability to avert vasovagal reactions, and intentions to give blood in the near future were completed before and after reading the brochures and again approximately 1 week later. In addition, participants were given the opportunity to sign up for an upcoming blood drive immediately after reading the brochure. RESULTS: Relative to the control brochure, the study brochure was associated with improvements in donation attitude, anxiety, confidence, and intention, and all of these effects persisted at follow-up. Further, participants who read the study brochure were more likely to volunteer to give blood, an effect that was mediated by enhanced confidence in their ability to avoid vasovagal reactions. CONCLUSIONS: Exposure to a brief educational brochure can enhance prospective donor confidence and increase the likelihood that they will volunteer to give blood.

The effect of opioid blockade on nociceptive flexion reflex (NFR) activity and subjective pain ratings was examined in 151 healthy young men and women. Using a within-subjects design, NFR threshold was assessed on two days after administration of either placebo or a 50 mg dose of naltrexone. Electrocutaneous pain threshold and tolerance levels were measured after NFR threshold assessment on each day. Results indicated that administration of naltrexone was consistently associated with hypoalgesic responding. Specifically, participants exhibited lower levels of NFR activity and reported lower pain ratings for electrocutaneous stimulation delivered at pain threshold and tolerance levels following administration of naltrexone as compared to placebo. These findings indicate that opiate blockade using the current standard dose may elicit hypoalgesia. A potential moderating effect of dose of opiate blockade medication and level of endogenous opioid activation should be carefully examined in future research.

This double blind, placebo-controlled study examined the effects of an opiate antagonist, naltrexone, on nociceptive flexion reflex (NFR) thresholds and subjective pain in individuals with and without a parental history of hypertension. Using a repeated measures design, NFR threshold was repeatedly assessed on two testing days after administration of either placebo or naltrexone. Immediately after NFR threshold was determined, participants rated the level of pain experienced during the preceding NFR assessment, and at the end of each session participants' electrocutaneous pain threshold was assessed. Two primary findings were obtained. First, individuals with a parental history of hypertension exhibited attenuated pain sensitivity. Second, endogenous opioid blockade was associated with increased pain ratings in women but with increased pain threshold in men. In sum, the present study did not support a direct involvement of the endogenous opioid system in the attenuated pain sensitivity observed in individuals at increased risk for hypertension.

The present study examined relationships between pain coping, hormone replacement therapy, and laboratory and clinical pain reports in post-menopausal women and age-matched men with osteoarthritis. Assessment of nociceptive flexion reflex threshold was followed by an assessment of electrocutaneous pain threshold and tolerance. Participants rated their arthritis pain using the Arthritis Impact Measurement Scales. To assess pain coping, participants completed measures of emotion-focused coping, problem-focused coping, and pain catastrophizing. Results indicated that women were more likely than men to report using emotion-focused pain strategies, and that emotion-focused coping was associated with more arthritic pain and lower electrocutaneous pain tolerance. Correlations between coping measures and pain reports revealed that catastrophizing was associated with greater arthritis pain and lower pain threshold and tolerance levels. However, catastrophizing was not related to nociceptive flexion reflex threshold, suggesting that the observed relationship between catastrophizing and subjective pain does not rely on elevated nociceptive input. A comparison of men (n=58), post-menopausal women receiving hormone replacement therapy (n=32), and post-menopausal women not receiving hormone replacement therapy (n=42) revealed no significant group differences in arthritis pain, electrocutaneous pain threshold or tolerance, or nociceptive flexion reflex threshold. Thus, older adults with osteoarthritis do not exhibit the pattern of sex differences in response to experimental pain procedures observed in prior studies, possibly due to the development of disease-related changes in pain coping strategies. Accordingly, individual differences in clinical and experimental pain may be better predicted by pain coping than by sex or hormonal differences.

The finding that recurrent headache sufferers, particularly tension headache sufferers, obtain higher scores on psychological symptom measures than controls was replicated in 262 recurrent (tension, mixed, and migraine) headache sufferers and 26 controls. However, closer examination of the data revealed that psychological symptoms were elevated only in patients who experienced head pain at the time of assessment. This finding raises the possibility that previously reported elevations in psychological symptoms have resulted from uncontrolled differences in the pain state of respondents. Retrospective reports of headache activity also were related to pain state. In contrast, a measure of perceived control of factors affecting headaches was unrelated to pain state. As a result, locus of control (but not psychological symptoms) successfully differentiated recurrent headache sufferers from controls even when headache sufferers were tested when pain free. These results suggest that psychological symptom measures may yield misleading results when used with individuals with pain disorders.

Studies have documented the efficacy of coping skills training (CST) for managing pain, distress, and disability in persons with arthritis. However, no laboratory studies have examined the effects of CST on descending modulation of nociception. This study used the nociceptive flexion reflex (NFR) to document pain and nociceptive responding among 62 men and women with osteoarthritis of the knee (mean age=63.3±7.5 years). Before and after a 45-minute CST session, participants completed laboratory assessments of NFR threshold and questionnaires evaluating pain and state anxiety. Results indicated significantly increased NFR thresholds and decreased pain ratings following CST for men and women. A significant time by sex interaction was observed for state anxiety, with women reporting greater decreases in anxiety following CST than men. This is the first study to demonstrate effects of a CST protocol on a measure of descending inhibition of nociception among patients with osteoarthritic knee pain.