Correlates of colorectal cancer screening compliance and stage of adoption among siblings of individuals with early onset colorectal cancer.

Concepts from the health belief, transtheoretical, and dual process models were used to examine how siblings of individuals diagnosed with colorectal cancer (CRC) before age 56 made decisions about CRC screening. Siblings (N = 504) were assessed for CRC screening practices and intentions, pros, cons, processes-of-change, perceived risk of CRC, perceived severity of CRC, preventability of CRC, cancer-related distress, and sibling relationship closeness. Physician and family recommendation and knowledge were also assessed. Fifty-seven percent of participants (n = 287) were compliant with CRC screening. Logistic regression indicated that perceived pros and cons, perceived risk, commitment to screening, health care avoidance, and sibling closeness were associated with screening compliance. Physician and family recommendation were also strong correlates. A similar set of factors was associated with stage of adoption of CRC screening.     

Validation of scales measuring attitudes and norms related to mammography screening in women veterans.

Validation of psychosocial measures for use in mammography screening research has been given inadequate attention in the literature. The authors report on the validation of 5 measures examining 4 attitudinal constructs (i.e., pros, cons, outcome expectations, and cancer worries) and 1 social influence construct (i.e., subjective norms) in a 22-item inventory. The study participants consisted of a national, randomly sampled population of women veterans (n = 2,910). After minor revision of scales, the authors found independent measures for 4 constructs: pros, cons, cancer worries, and subjective norms. The authors concluded that these scales have acceptable psychometric properties; support construct validity; and provide brief, reliable, and valid measures of attitudes toward and norms regarding mammography screening. These scales may be useful for intervention research.     

Does the transtheoretical model need an attitude adjustment?: Integrating attitude with decisional balance as predictors of stage of change for exercise

Objectives. To compare conceptually similar decision-making components from the theory of planned behavior (attitude) and the transtheoretical model (pros and cons) to determine the extent to which attitude towards exercise adds to the prediction of stage of exercise behavior beyond that of pros and cons.Method. A sample of college undergraduates (N=223) were given stage of change, attitude and decisional balance measures regarding their exercise behavior. Structural equation modeling (SEM) was used to test the underlying measurement structure of the decision-making components, while a series of discriminant function analyses (DFAs) was performed using a combination of pros, cons, and cognitive and affective attitudes as predictors of membership in one of the five stages of change.Results. SEM determined that a correlated four-factor model, which included pros and cons and two attitude subscales, provided the best fit to the data. The DFAs revealed that the addition of attitude components to pros and cons significantly increased the overall explained variance across the stages of change from 32% to 56%, and improved the predictive ability of pros and cons from 31.2% to 48.2%.Conclusions. Although conceptually related, pros, cons and attitude were not closely linked at a construct-measurement level. Furthermore, the addition of attitude to pros and cons increased the overall explained variance across stages of change and improved the predictive ability of pros and cons alone. The measurement model and DFA results taken in combination strongly suggest that the addition of cognitive and affective attitudes may strengthen the decision-making aspect of the transtheoretical model.     

The pros and cons of temporally near and distant action

The present research demonstrated that in considering an action, considerations against (con) the action tend to be subordinate to considerations in favor of (pro) the action in that cons are considered only if the level of pros is sufficient, whereas pros are considered independent of the level of cons (Studies 1A and IB). The authors therefore concluded that pros constitute a higher construal level than cons and predict, on the basis of temporal construal processes (Y. Trope & N. Liberman. 2003). that pros would be more salient in making decisions for the more distant future, whereas the reverse should hold for cons. As predicted, participants generated more pros and fewer cons toward new exam procedures (Study 2), public policies (Study 3), and personal and interpersonal behaviors (Studies 4-6) that were expected to take place in the more distant future. This research also examined the limiting conditions and the evaluative consequences of these shifts.     

Advance Directives: Assessing Stage of Change and Decisional Balance in a Community-Based Educational Program

This study assessed the applicability of the transtheoretical model (TTM) to completing/revising advance directives (ADs). Participants in a community-based educational program completed pre- and post-program questionnaires concerning the completing/revising of ADs. Multiple-item scales were constructed to categorize participants into a stage of change: precontemplation (8%), contemplation (44%), preparation (4%), action (22%), and maintenance (19%). A decisional balance scale was constructed using 5 positive and 5 negative perceptions of ADs. The findings provided support for the applicability of the TTM to completing/revising ADs. The cons outweighed the pros among participants in the precontemplation stage, while the pros outweighed the cons among those in the action stage. One pro was that an AD would relieve family members of decision-making burdens.     

Predicting increases in readiness to quit smoking: A prospective analysis using the contemplation ladder

Abstract

Most smokers are not motivated to quit. The transtheoretical model posits mechanisms (processes of change and pros and cons) by which smokers might increase their stage of readiness to quit. While cross-sectional relationships among the stages of change, processes of change, and pros and cons are well established, there is little evidence that processes of change and pros and cons predict progressive stage movements. This study uses data from a large worksite-based cancer prevention study (the Working Well Trial) to test the hypothesis that processes of change and the pros and cons of smoking predict progressive movement up the contemplation ladder, which is an alternative measure of motivation to quit smoking based on social cognitive theory. The results indicate that experiential processes of change promote increases in readiness to quit smoking. This study provides further evidence for the predictive validity of the contemplation ladder and sheds light on how unmotivated, nonvolunteer smokers can be motivated to consider cessation.     

A 6-month investigation of exercise adoption from the contemplation stage of the transtheoretical model

Objectives: To investigate whether there are subtypes within the contemplation stage and to investigate whether self-efficacy and decisional balance changed in the manner predicted by the Transtheoretical Model (TTM) for individuals who adopted physical activity without intervention.Method: Participants were 118 adults (age range 18–66 years, MEAN=39.9 years) who were in contemplation at baseline. Participants completed two questionnaires assessing stage of exercise behaviour, self-efficacy and decisional balance 6 months apart.Results: Based on self-efficacy and pros and cons, three interpretable clusters were identified within the contemplation stage. Cluster membership influenced stage movement during the six months. Self-efficacy increased for those who adopted exercise and there was a significant increase in pros scores at 6 months for those who had recently adopted exercise.Conclusions: The existence of sub-stages indicates a true temporal order for the stages and has implications for closely tailoring interventions to the needs of the individual. Increasing self-efficacy and pros, and lowering cons is important in facilitating movement within the contemplation stage and from contemplation to action/maintenance.     

Family environment, affect, ambivalence and decisions about unplanned adolescent pregnancy

This study investigated the relationships among family environment, demographic measures, the decisions made by unintentionally pregnant adolescents regarding postdelivery plans and the certainty with which these decisions were made. Subjects were 175 pregnant adolescents, ages 14 through 22, who intended to carry their pregnancies to term. Greater uncertainty was associated with living with both natural parents or with mother only. Higher levels of negative affect were related to lower levels of perceived family cohesion, independence, expressiveness, and intellectual-cultural orientation. Age, trimester of pregnancy, and family constellation also were related to levels of negative affect. Discriminant analysis revealed that subjects choosing adoption were more likely to be older and to be white than were those choosing to keep the child. They also tended to perceive higher levels of expressiveness and independence in their families. The implications of these findings for the delivery of services and for future research efforts in this area are discussed.     

Do processes of change predict smoking stage movements? A prospective analysis of the transtheoretical model.

The transtheoretical model (TTM) posits that processes of change and the pros and cons of smoking predict progressive movement through the stages of change. This study provides both a cross-sectional replication and a prospective test of this hypothesis. As part of a larger study of worksite cancer prevention (the Working Well Trial), employees of 26 manufacturing worksites completed a baseline and 2 annual follow-up surveys. Of the 63% of employees completing baseline surveys, 27.7% were smokers (N = 1,535), and a cohort of these smokers completed the 2-year follow-up. Cross-sectional results replicated previous studies with virtually all the processes of change and the cons of smoking increasing in linear fashion from precontemplation to preparation (all ps < .00001), and the pros of smoking decreasing (p < .01). However, contrary to the hypothesis, the baseline processes of change and the pros and cons of smoking failed to predict progressive stage movements at either the 1- or the 2-year follow-ups. Possible explanations for these findings and concerns about the conceptual internal consistency of the TTM are discussed.     

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.     

Perceived Pros and Cons of Condom Use as Predictors of its Consistent Use with a Heterosexual Romantic Partner Among Young Adults

The present research examines the pros and cons of condom use as predictors of consistent condom use with a heterosexual romantic partner. Data from 619 undergraduate students (35.1 % males; mean of age?=?20.31) were collected using a voluntary and anonymous self-report survey. The pros and cons predicted consistent condom use during the last month among females, whereas only the pros were predictive of consistent condom use in men. Similarly, only the feelings of safety predicted consistent condom use among men. However, the reduction of pleasure for women, the side-effects of other contraceptive methods, the difficulty in asking for condom use when they were also using the pill and the fact that condom use interrupts and cools off foreplay were also predictors among women. Besides the superiority of the pros over the cons, in general, the present research identifies a number of important pros and cons that should be used to encourage condom use.     

Cluster subtypes within the precontemplation stage of change for sun protection behavior

The aim of this study is to identify replicable cluster subtypes within the precontemplation stage of change for sun protection. Secondary data analysis of baseline data from a sample of participants in a home-based expert system intervention was performed. Three random samples were selected from participants in the precontemplation stage (N = 570). Cluster analyses were performed using the scales of pros, cons, and self-efficacy. Interpretability of pattern, pseudo F-test, and dendograms were used to determine the number of clusters. A four-cluster solution replicated across subsamples. Significant differences between clusters on the nine processes of change and on behavioral measures were found. Cluster solutions were robust, interpretable and with good initial external validity. They replicated patterns found for other behaviors, demonstrating long-term predictability and providing basis for tailored interventions.     

THE PSYCHOLOGICAL WELL-BEING OF OLDER, RECENT WIDOWS

The impact of husband's death on the psychological well-being of 226 older widows was examined. Respondents were 60 to 89 years of age and had been widowed from 7 to 21 months at the time of interview. Using multiple regression analysis it was determined that 19 selected variables accounted for approximately 22% of the variance in positive affect and 18% of the variance in negative affect. Higher levels of positive affect were related to widows' religious involvement, number of siblings, and support from children and their families. Negative affect was more often associated with other deaths (in addition to that of husband), housing dissatisfaction, and a history of employment outside the home during marriage. Additional research is called for in light of the increasing numbers and potential vulnerabilities of older women who are recently widowed.     

Identifying and Correctly Labeling Sexual Prejudice,Discrimination, and Oppression

To effectively work with and advocate for lesbians, gay men, and their families, one has to be aware of the individual, relational, and societal forces that may negatively affect them. The focus of this article is to familiarize the reader with terminology used to identify and label sexual prejudice, discrimination, and oppression. The pros and cons of both historically used language and newer terminology are discussed.     

Health Beliefs and Illness Perceptions as Related to Mammography Uptake in Randomly Selected Women in Greece

Previous research has shown that, although routine mammography screening can reduce mortality from breast cancer, the use of annual mammography screening remains well under 65%. In an effort to determine the factors that are associated with women’s mammography behaviors, this study used the health belief model and the common-sense model of self-regulation as the theoretical frameworks to explore health beliefs, illness representations, and women’s mammography practice. Data were obtained from a nationally representative sample of 408 Greek women, 40 years of age or older, with no personal history of cancer. Three dependent variables were considered: recent mammography, repeat mammography, and no mammogram during lifetime. Predictors included socio-demographic and medical variables, perceived benefits of mammography screening, perceived barriers to mammography screening, self-efficacy, as well as illness perceptions. Multivariate analyzes indicated that never having had a mammogram was more likely for women who perceived fewer benefits and more barriers to mammography screening, had more negative emotional representations of breast cancer, and had no private health insurance coverage. Factors associated with recent mammography were younger age, a good knowledge of the recommended mammography screening interval, a family history of breast cancer, and use of patient reminders for next mammogram. Adequate knowledge about the recommended mammography screening interval and higher values for breast cancer worry were associated with an increased number of repeat lifetime mammograms. Implications of the results and suggestions for future research are outlined.     

Temporal distance and ease of retrieval

Construal Level Theory (CLT; Trope & Liberman, 2003) proposes that pro-arguments (pros) constitute high-level construals and counter-arguments (cons) low-level construals. Therefore, pros are more salient for distant-future actions than are cons and the reverse holds for near-future actions (Eyal, Liberman, Trope, & Walther, 2004). We further predicted and results from one experiment show that participants found it easier to generate pros if an action pertained to the distant rather than the near future. For cons the effect was reversed: participants found it more difficult to generate cons if the action pertained to the distant rather than the near future. Consequently, people were more in favor of the action if it pertained to the distant rather than the near future. Ease of retrieval mediated the effect of temporal distance on attitudes. The mutual relevance of the CLT framework and research on ease of retrieval is discussed.     

Structure of outcome beliefs in condom use. The Project RESPECT Study Group.

To study the structure of beliefs about condom use outcomes, the authors derived and tested 4 psychosocial hypothetical models: (a) a 2-factor model of the personal and social outcomes of condom use; (b) a 2-factor model of the pros and cons of the behavior; (c) a 3-factor model (i.e., physical, self-evaluative, and social) of outcome expectancies; and (d) a thematic 4-factor model of the protection, self-concept, pleasure, and interaction implications of the behavior. All 4 models were studied with a confirmatory factor analysis approach in a multisite study of 4,638 participants, and the thematic solution was consistently the most plausible. Self-concept and pleasure were most strongly associated with attitudes toward using condoms, intentions to use condoms, and actual condom use, whereas protection and interaction generally had little influence.     

Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice.     

Mediation analysis of decisional balance,sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection

Objective: Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant.

Design: Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention.

Main outcome measures: Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use.

Results: With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126–.614), and the pros predicted the outcomes (r = .181–.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes.

Conclusion: In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.     

Emotion regulation strategies in daily life: mindfulness,cognitive reappraisal and emotion suppression

Most empirical studies of emotion regulation have relied on retrospective trait measures, and have not examined the link between daily regulatory strategies and every day emotional well-being. We used a daily diary methodology with multilevel modelling data analyses (n = 187) to examine the influence of three emotion regulation strategies (mindfulness, cognitive reappraisal and emotion suppression) on the experience of daily negative and positive affect. Our results suggested that daily mindfulness was associated with lower negative and higher positive affect whereas the converse pattern was found for daily emotion suppression; cognitive reappraisal was related to daily positive, but not negative affect. When daily mindfulness, suppression and reappraisal were included in the same models, these strategies predicted unique variance in emotional well-being. Random slope analyses revealed substantial variability in the utility of these strategies. Indeed the presumably “adaptive” cognitive reappraisal strategy seemed to confer no benefit to the regulation of negative affect in approximately half the sample. Additional analyses revealed that age moderates the effect of cognitive reappraisal on daily negative affect: Higher use of reappraisal was associated with more negative affect for adolescents (aged 17 to 19) but became associated with less negative affect with increasing age. We interpret these results in line with a contextual view of emotion regulation where no strategy is inherently “good” or “bad”.