Assessing elements of women's decisions about mammography.

We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.     

Decisional balance measure for assessing and predicting smoking status

The Decisional Balance Sheet of Incentives has been proposed by Janis and Mann (1977) as a general schema for representing both the cognitive and motivational aspects of human decision making. In this study, a brief 24-item paper and pencil measure was constructed to study the decision-making process in smoking cessation. Two scales were identified and labeled the Pros of Smoking and the Cons of Smoking. These scales were successful in differentiating between five groups representing stages of change in the quitting process. The two scales were also successful when employed as predictors of smoking status at a 6-month follow-up. The Decisional Balance Scale appears to be a powerful construct of potentially wide application in behavior change.     

The stages and processes of exercise adoption and maintenance in a worksite sample.

We applied the model of the stages and processes of change to exercise adoption and maintenance. This model has shown promise in advancing theory and treatment of the addictions and other negative health behaviors, but there have been few systematic attempts to apply the model to positive health behaviors, such as exercise adoption. Questionnaires dealing with the stages and processes of exercise change were developed and administered to a sample of 1,172 participants in a worksite health promotion project. The sample was split randomly into halves for (a) initial model development and testing and (b) confirmatory measurement model testing. Additional model confirmation was obtained by examining the hierarchical structure of the processes of change and by conducting Stage x Process analyses. Results suggest that the underlying constructs derived from smoking cessation and other addictive behaviors can be generalized to exercise behavior. Understanding the stages and processes of exercise behavior change may yield important information for enhancing exercise adoption, adherence, and relapse prevention at both individual and public health levels.     

Reliability and validity of the Japanese language version of Pro‐Change's decisional balance measure for effective stress management1

This study aimed to develop the Japanese language version of Pro‐Change's decisional balance measure for effective stress management (PDSM). Effective stress management refers to activities that are practiced, for at least 20 min per day, to reduce a person's perceived stress. Six hundred and sixty‐five female and 456 male Japanese university and college students participated in this study, which consists of two surveys. Through exploratory and confirmatory factor analyses, the Japanese language version of the PDSM was developed, which contains 12 items and consists of two factors, the Pros and the Cons. The levels of internal consistency are acceptable (Pros = 0.78 and Cons = 0.64). The scores for the Pros and the Cons subscores were not affected by social desirability (Pros = ?0.04 and Cons = ?0.12). We confirmed the construct validity of the Japanese language version of PDSM with theoretically predicted relationships between the decisional balance and the stage of change for effective stress management. The Japanese language version of the PDSM with construct validity and reliability was developed.     

Is the sequencing of change processes by stage consistent across health problems? A meta-analysis.

Clinicians and researchers applying the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992) to health promotion often assume that relationships of processes and stages observed in smoking cessation can be generalized to other problems. A reanalysis of 47 cross-sectional studies determined that use of change processes varies by stage, but the sequencing of processes is not consistent across health problems. In smoking cessation, cognitive processes were used in earlier stages than were behavioral processes. In exercise adoption and diet change, use of behavioral and cognitive processes increased together. Results for substance abuse and psychotherapy were less consistent. Substituting new behaviors, making a commitment, considering consequences, seeking information, controlling cues, and using rewards varied most by stage. Future longitudinal studies should assess these processes as potential mediators of lifestyle change.     

Motivation is not enough: prediction of risk behavior following diagnosis of coronary heart disease from the theory of planned behavior.

Perceived behavioral control (PBC) and intention, the proximal predictors from the theory of planned behavior (TPB), were used to predict cardiovascular risk behaviors in 597 patients 1 year after diagnosis with coronary heart disease. The outcome measures were self-report measures of exercise plus objective measures of fitness (distance walked in 6 min) and cotinine-confirmed smoking cessation. In multivariate analyses incorporating both PBC and intention, PBC predicted exercise, distance walked, and smoking cessation, but intention was not a reliable independent predictor of any health behavior measured. Thus, the effective theoretical component of the TPB was PBC. Similar predictions could derive from social-cognitive theory. In coronary patients, behavioral change needs to address issues of action implementation rather than motivational factors alone.     

Testing the convergent and discriminant validity of the Decisional Balance Scale of the Transtheoretical Model using the Multi-Trait Multi-Method approach.

The authors extended research on the construct validity of the Decisional Balance Scale for smoking in adolescence by testing its convergent and discriminant validity. Hierarchical confirmatory factor analysis multi-trait multi-method approach (HCFA MTMM) was used with data from 2,334 UK adolescents, both smokers and non-smokers. They completed computerized and paper versions of the questionnaire on 3 occasions over 2 years. The results indicated a 3-factor solution; Social Pros, Coping Pros, and Cons fit the data best. The HCFA MTMM model fit the data well, with correlated methods and correlated trait factors. Subsequent testing confirmed discriminant validity between the factors and convergent validity of both methods of administering the questionnaire. There was, however, clear evidence of a method effect, which may have arisen due to different response formats or may be a function of the method of presentation. Taken with other data, there is strong evidence for construct validity of Decisional Balance for smoking in adolescence, but evidence of predictive validity is required.     

Psychological factors associated with maintenance of improved health behaviors in postcoronary patients

Multiple regression analyses of interview data determined whether certain behavioral, personality, and social support variables were associated with maintenance of changes in exercise, weight loss, and smoking cessation for a group of postcoronary patients. The results indicate that the psychological reactions to success or failure at one health behavior change, especially smoking, may affect the ability to maintain changes in other health behaviors. Also, the affective psychological sequelae to heart attacks may disrupt attempts to change health habits or may themselves be alleviated once successful health changes are achieved.     

Postpartum return to smoking: staging a "suspended" behavior.

Two hundred fifty-six pregnant women who had quit smoking were classified into the precontemplation (PC), contemplation (C), preparation (PA), or action (A) stages of change for postpartum smoking cessation based on a 3-item algorithm assessing personal goals, self-efficacy, and smoking behavior. Logistic regression and event history analyses indicated group differences in return to smoking at 6 weeks and 3, 6, and 12 months postpartum. The percentage of women who returned to postpartum smoking was highest in the precontemplation stage and decreased with each subsequent stage, that is, at 6 weeks 83% of PCs, 64% of Cs, 35% of PAs, and 24% of As had returned to smoking. Results lend support for the stages of change for postpartum smoking abstinence. Stage-based interventions may be developed to assist women in maintaining abstinence postpartum.     

Integrating stage and continuum models to explain processing of exercise messages and exercise initiation among sedentary college students.

Concepts from the transtheoretical model (J.O. Prochaska, C.C. DiClemente, & J.C. Norcross, 1992), theory of planned behavior (I. Ajzen, 1985), and the elaboration likelihood model (R.E. Petty & J.T. Cacioppo, 1986b) were used to examine how exercise readiness impacted processing of exercise messages and exercise initiation. Sedentary college students (n = 147) were assessed for exercise attitude, intent, behavior, and stage of change. Students also listed their thoughts after reading messages with either strong or weak arguments for exercise. Attitude predicted depth of message processing, but stage of change did not. Stage of change and intent at baseline predicted exercise adoption at 1- to 3-month follow-up (n = 134), with baseline activity moderating the effect of intent. Tailoring messages to recipients' depth of processing and interactive effects of intent and behavior on exercise adoption should be considered in future research.     

Quality of life after quitting smoking and initiating aerobic exercise

Quitting smoking and aerobic exercise each improve health. Although smokers may be concerned that quitting smoking will reduce their quality of life (QOL), recent research has shown that cessation is associated with QOL benefits. Elements of smoking cessation interventions, such as exercise, may contribute to changes in QOL. However, it is unknown whether initiating exercise in the context of smoking cessation is associated with greater or different effects on QOL than smoking cessation alone. The current study is a secondary analysis of data from a randomized trial (n = 61) of an exercise intervention for smoking cessation. We hypothesized that smoking abstinence and engagement in exercise would have positive, additive effects on QOL at end-of-treatment, 6- and, 12-month follow-ups. Sedentary adult smokers were randomized to the exercise intervention or a health education control (HEC) group. Additionally, all participants received smoking cessation counseling and nicotine patches. Data were analyzed using actual engagement in exercise, rather than group assignment as a proxy for exercise engagement, because some HEC participants also began exercising. Abstinence was positively associated with higher total and physical health QOL at follow-up. Exercise was not associated with total QOL and only marginally associated with physical health QOL, but was positively related to overall sense of well-being. Emphasizing that smoking cessation is associated with higher QOL may help motivate smokers to initiate quit attempts.     

Causal Models of Physical Exercise Participation: Testing the Predictive Power of the Construct "Pressure to Change"

This study examines 2 different causal models to predict physical exercise motivation and behavior under a longitudinal perspective. The first model includes 5 latent variables that were hypothesized to have an impact on exercise intention and behavior: behavior-specific social support, exercise self-efficacy, perceived health benefits, perceived barriers, and subjective vulnerability to cardiovascular disease. The second model was based on all variables of the first model, but additionally included the new variable "pressure to change." Pressure to change was defined as the extent to which a person feels the necessity that specific personal life circumstances (e.g., health status, social relations) may not remain as they are and ought to be changed. It was hypothesized that the inclusion of health-related pressure to change would result in a better prediction of exercise intention. The proposed causal models were tested separately at the stages of exercise adoption and maintenance. Covariance structure analyses (LISREL) confirmed that pressure to change may be an important factor in the motivational process that leads to the adoption of regular physical exercise. Adding this latent variable to the basic model improved the amount of explained variance in exercise intention by 6%. Furthermore, the results did not support the assumption that cognitive control is critical especially during the acquisition of exercise behaviors, but may be less influential once the behavioral routines have been established. Our data rather indicate that regular physical exercise, even if performed on a regular basis for years, always remains a behavior that requires a high level of cognitive guidance.     

Revisiting the factor structure of the questionnaire on smoking urges

This study assessed the factor structure of the Questionnaire on Smoking Urges (QSU), a commonly used assessment of cravings for cigarettes, with a sample of smokers presenting for treatment in a smoking cessation trial. On the basis of previous research, three confirmatory factor analytic models were tested. Model 1 hypothesized a 26-item, 2-factor model using the items reported in the original QSU analysis by S. T. Tiffany and D. J. Drobes (1991). Model 2 hypothesized a 12-item, 2-factor model comprised of the 6 most robust items found in each of the 2 factors of the original factor analysis. Using the 12 items from Model 2, Model 3 hypothesized a 12-item, 1-factor model. The 2nd model was found to fit the data best. Reliability was also tested using values obtained in this 2nd model, and these estimates were found to be reasonably good. Future research directions for the QSU are discussed.     

Specifying the determinants of the initiation and maintenance of behavior change: an examination of self-efficacy, satisfaction, and smoking cessation.

Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed.     

Predictors of smoking cessation in Taiwan: using the theory of planned behavior

This study aimed to explore the factors predicting the intention to quit smoking and the subsequent behavior 6 months later using the theory of planned behavior (TPB). Data were obtained from 145 smokers who attended a smoking cessation clinic in a community hospital. All participants completed a questionnaire which included demographic information, TPB-based items, perceived susceptibility and previous attempts to quit. The actual quitting behavior was obtained by follow-up phone calls 6 months later. The TPB constructs explained 34% of the variance in intention to quit smoking. By adding perceived susceptibility, the explained variance was significantly improved to 40%. The most important predictors were perceived behavior control and perceived susceptibility, followed by attitude. Subjective norm did not contribute to the prediction of intention. Attitude and perceived behavior control contributed to the prediction of actual quitting behavior, but intention, subjective norm and perceived susceptibility did not. Our findings support that the TPB is generally a useful framework to predict the intention to quit smoking in Taiwan. The inclusion of perceived susceptibility improved the prediction of intention. With regards to successfully quitting, attitude and perceived behavior control played more crucial roles than other TPB constructs. Smoking cessation promotion initiatives focusing on reinforcing cessation belief, enhancing a smoker’s perception of their capability to quit smoking, and persuading smokers that they can overcome cessation barriers to cessation could make subsequent interventions more effective.     

助推戒烟的行为干预策略

烟草危害是人类所面临的重大公共健康挑战之一。传统的控烟策略主要依赖健康宣教、烟草税和控烟条例等手段,但是较少考虑到吸烟行为的“非理性因素”及其心理机制,因此仍不能有效帮助吸烟者成功戒烟。行为科学的发展为助推吸烟者成功戒烟提供了新视角。以实施主体和干预的影响机制为划分标准,可将助推戒烟的行为干预策略分为由政府和公共健康服务部门执行的情境型干预策略和认知型干预策略以及吸烟者可自主执行的情境型和认知型干预策略,一方面便于吸烟者和相关部门选取可执行的戒烟行为干预策略,另一方面为进一步开发和验证助推戒烟的行为干预策略提供参考。虽然基于行为科学的助推干预策略已经取得了一定的进展,未来研究仍有必要进一步在真实世界中验证和评估戒烟助推干预策略的效果。未来也有必要进一步将行为改变技术融入到数字化的戒烟服务或应用小程序中去以提升其效果。未来也需要考察如何应用戒烟助推干预策略防止电子烟产品的负面影响并减少这类策略的误用和滥用。     

The energization of health-behavior change: Examining the associations among autonomous self-regulation,subjective vitality,depressive symptoms,and tobacco abstinence

Most research on the psychological correlates of smoking behavior has focused on negative indices of wellness, but findings are mixed, contradictory, controversial, and, thus, inconclusive. This study, guided by self-determination theory, examined both positive (viz., vitality) and negative (viz., depressive symptoms) indices of psychological health as predictors of long-term tobacco abstinence in the context of a randomized clinical trial. It also examined autonomous self-regulation and cigarette use as predictors of psychological health. Results supported the proposed conditional indirect effect model in which change in cigarette use mediated the relation of change in autonomous self-regulation for smoking cessation to change in vitality, and this indirect effect was moderated by treatment condition. Further, change in vitality predicted long-term tobacco abstinence. Results for depressive symptoms were largely null. Discussion focuses on the importance of considering positive indices of psychological health for understanding the psychological correlates of smoking behavior.     

Cigarette smoking and personality change across adulthood: Findings from five longitudinal samples

Personality traits are related to cigarette smoking. However, little is known about the link between smoking and change in personality. Therefore, the present study examined whether current cigarette smoking and smoking cessation are associated with personality change across adulthood. Participants (n = 15,572) aged from 20 to 92 years were drawn from five longitudinal cohorts with follow-ups that ranged from 4 to 20 years. Compared to non-smokers, current smokers were more likely to increase on neuroticism and to decline on extraversion, openness, agreeableness and conscientiousness over time. Compared to the persistent smokers, those who quit had a steeper decline in agreeableness. Cigarette smoking is related to detrimental personality changes across adulthood, and the pattern was not improved by smoking cessation.     

Testing a self-determination theory intervention for motivating tobacco cessation: supporting autonomy and competence in a clinical trial.

A longitudinal randomized trial tested the self-determination theory (SDT) intervention and process model of health behavior change for tobacco cessation (N = 1006). Adult smokers were recruited for a study of smokers' health and were assigned to intensive treatment or community care. Participants were relatively poor and undereducated. Intervention patients perceived greater autonomy support and reported greater autonomous and competence motivations than did control patients. They also reported greater medication use and significantly greater abstinence. Structural equation modeling analyses confirmed the SDT process model in which perceived autonomy support led to increases in autonomous and competence motivations, which in turn led to greater cessation. The causal role of autonomy support in the internalization of autonomous motivation, perceived competence, and smoking cessation was supported.