Evidence for Discontinuity Patterns Across the Stages of Change: A Role for Attitudinal Ambivalence

Cross-sectional analyses of the transtheoretical ("stages of change") model (TTM) can provide valuable information concerning the variables that are likely to shift individuals from one stage to the next. The present study was designed to investigate the roles of theory of planned behaviour (TPB) variables and attitudinal ambivalence across the stages of change. Two samples derived from the general population completed measures of stage, TPB and attitudinal ambivalence with respect to consuming a low-fat diet (n = 148) and eating five portions of fruit and vegetables per day (n = 151). Consistent with previous research, the present study found linear increases in TPB variables across the stages of change. However, as predicted, attitudinal ambivalence showed discontinuity patterns, displaying a quadratic relationship with the stages of change, such that least ambivalence was experienced in the precontemplation and maintenance stages. Discussion of the findings focuses on implications for the development of theory-driven interventions.     

Coping and physical health outcomes: an overview

The aim of the present study was to investigate longitudinally the sensitivity of optimistic beliefs (positive outcome expectancies, efficacy expectancies, and optimistic bias) to disease-related stress (measured by disease duration, depressive symptoms, physical symptoms, physical impairment, and life-events) in Type 1 diabetes (n = 90) and multiple sclerosis (n = 90). First, we examined whether chronically ill patients were less optimistic than a healthy control group (n = 60), which showed that patients reported lower levels of optimistic bias but similar levels of the two other optimistic beliefs. Next, we analyzed the stability of the three types of optimistic beliefs across time (one year) for both disease groups, which demonstrated that optimistic bias in MS patients decreased. Finally, the impact of disease-related stressors on optimistic beliefs during a one-year period was determined, showing that all three optimistic beliefs decreased when patients reported depressive symptoms. Together, these findings show that positive outcome expectancies and efficacy expectancies were unaffected by being ill and fairly stable unless patients reported depressive symptoms while optimistic bias appeared to decrease as a result of being ill. Results are discussed in terms of the role of control and depression in optimistic bias.     

Recruiting Through the Stages: A Meta‐Analytic Test of Predictors of Applicant Attraction at Different Stages of the Recruiting Process

We used meta‐analysis and semipartial correlations to examine the relative strength and incremental variance accounted for by 7 categories of recruiting predictors across multiple recruitment stages on applicant attraction. Based on 232 studies (250 samples, 3,518 coefficients, n= 108,632), we found that characteristics of the job, organization, and recruitment process, recruiter behaviors, perceived fit, and hiring expectancies (but not perceived alternatives) accounted for unique variance in applicant attraction at multiple stages. Perceived fit was the strongest relative and unique variance predictor of applicant attraction albeit a nonsignificant predictor of job choice. Although not among the largest zero‐order predictors, recruiter behaviors accounted for substantial incremental variance at the first 2 stages. Organizational characteristics are more heavily weighed by applicants when maintaining applicant status as compared to the stage of application, and recruitment process characteristics are weighed progressively more as the recruitment stages advance. Job characteristics accounted for the greatest unique variance in job choice decisions. Job characteristics are more predictive in field studies, whereas recruiter behaviors, recruitment process characteristics, hiring expectancies, and perceived alternatives produced larger effect sizes in the laboratory. Results are discussed in terms of their theoretical and practical implications with future research suggestions.     

Relationships between stage of change for stress management behavior and perceived stress and coping

The main aim of this study was to examine the relationships between stage of change, which was guided by the transtheoretical model, for stress management behavior and perceived stress and coping. First, we developed the Korean version of the Rhode Island Stress and Coping Inventory (RISCI). Second, we related stage of change for stress management behavior to perceived stress and coping. Based on two surveys that we conducted (n = 530 for survey 1 and n = 299 for survey 2), we developed the Korean version of the RISCI with acceptable internal consistency and criterion‐related validity against the depressive level measured using the Korean Beck Depression Inventory II. The stress score of the Korean version of the RISCI was significantly lower in maintenance than in the other stages, while the coping score was significantly higher in action and maintenance than in the first three stages (n = 804), irrespective of sex. These results provided further empirical evidence to validate stage classification in the field of stress management behavior.     

Age and pre quit-day attrition during smoking cessation treatment

ABSTRACT

The present study aimed to replicate the finding that younger age predicts higher pre quit-day attrition. Our second aim was to explain this relation by examining empirically and theoretically informed age-related risk factors for low smoking cessation treatment engagement. 136 participants (M _age = 44.2 years, SD = 11.3 years; age = 22–64 years) were randomized to 15-weeks of either 1) an exercise intervention (n = 72) or 2) a wellness education control condition (n = 64). First, a logistic regression analysis was employed to test whether younger adults were more likely than older adults to drop prior to quit date. Next, we assessed whether smoking related health concerns, social expectancies, and/or perceived severity of craving affected the strength of the relation between age and attrition, by adding these three variables to the logistic regression along with age. The logistic regression model indicated that younger age and treatment condition were significantly related to the odds of dropping from treatment prior to the scheduled quit date. Further, health concerns, social expectancies, and/or perceived severity of cravings did not account for the effect of age on pre quit-day attrition. These findings highlight the importance of identifying empirically and theoretically informed variables associated with the pre quit-day attrition problem of young smokers.     

Health messages to promote fruit and vegetable consumption at different stages: A match-mismatch design

Objective: To examine the effectiveness of matching health messages promoting fruit and vegetable intake to the Health Action Process Approach stages of change.

Design: In a randomised controlled trial, 205 undergraduate students (non-intenders n = 123; intenders n = 82) were exposed to one of three health messages, targeted at non-intenders, intenders and controls.

Main outcome measures: Three longitudinal assessments of stage, fruit and vegetable intake, and social-cognitive determinants were obtained.

Results: Stage-specific effects of the interventions were confirmed. For self-efficacy, a stage by health message crossover interaction emerged, with both non-intenders and intenders in the matched conditions scoring higher in self-efficacy. Furthermore, in line with predictions, non-intenders in the matched condition showed higher risk perception, outcome expectancies, intention, and stage progression immediately after message exposure, and lower levels of action planning and coping planning a week later in the mismatched condition, but for these outcomes no differences across conditions were obtained among intenders. Multiple mediation analyses confirmed the facilitating role of self-efficacy and behavioural intention among non-intenders.

Conclusions: Stages should be considered when designing health messages, although more interactive interventions for intenders and extended measurement time frames may be required.     

A measure of perceived pain and tobacco smoking interrelations: pilot validation of the pain and smoking inventory

Mounting evidence indicates that pain can motivate cigarette smoking behavior, smokers have reliably endorsed the use of tobacco to cope with pain, and there is reason to suspect that pain may impede smoking cessation. Smoking-related outcome expectancies are among the best predictors of cigarette consumption and relapse, and the goal of this pilot study was to develop a standardized measure of how tobacco smokers perceive their pain and smoking behavior to be interrelated (i.e. pain as a motivator of smoking, expectancies for smoking as a means of coping with pain, and pain as a barrier to quitting). Participants (N = 75) completed an online survey that was designed to assess interrelations between pain and tobacco smoking. The nine-item Pain and Smoking Inventory (PSI) demonstrated excellent internal consistency (α = .95). As expected, PSI scores were higher among smokers with chronic pain (vs. no pain), and were positively associated with established indices of both pain and tobacco smoking dependence. These results corroborate the notion that smokers can effectively communicate perceptions of interrelations between their pain and smoking behavior. Future research is needed to establish reliability and validity of the PSI among larger, more diverse samples of smokers with varying levels of pain. Future work should also examine PSI scores as predictors of smoking cessation outcomes, and whether PSI data may usefully inform the development of tailored interventions for smokers in pain.     

Individual Variation in Psychological and Psychomotor Symptoms Following Smoking Cessation: The Implications for Treatment

Some commonly experienced signs and symptoms occur during abstinence from tobacco, but specific signs and symptoms and their intensity vary greatly from individual to individual. The aim of this study was to re-examine psychological and psychomotor symptoms in smokers in the general population, and to explore the individual variation in these. Quitting smokers (n = 123) reported their experiences pre- and post-cessation, on a questionnaire developed for the study. Analysis of variance and frequency analysis showed significant decreases between pre- and post-cessation on positive experiences (F = 9.81, p<0.0001) but no significant change on negative experiences, suggesting a loss of pleasure rather than increased negative affect upon quitting. The variance of the pre- to post-cessation difference score suggested wide variation in the reporting of withdrawal symptoms. These results lead us to consider the implications for treatment, using cognitive therapies and moderating the significant emphasis that is at present put on withdrawal.     

Social Discounting and Cigarette Smoking During Pregnancy

In this study, we examined the association between social discounting and smoking status in a cohort of pregnant cigarette smokers (n = 91), quitters (n = 27), or never‐smokers (n = 30). The smokers and quitters were participants in clinical trials on smoking cessation and relapse prevention, whereas the never‐smokers were controls in a study on nicotine withdrawal during pregnancy. Social discounting was assessed using a paper‐and‐pencil task that assesses the amount of hypothetical money a person is willing to forgo in order to share with individuals in their social network ranging from the person who is emotionally closest to them to a mere acquaintance. The amount that women were willing to forgo in order to share decreased hyperbolically as a function of social distance, with smokers exhibiting steeper discounting functions (i.e., less generosity) than quitters or never‐smokers; discounting functions of quitters and never‐smokers did not differ significantly. In multivariate analyses controlling for potential sociodemographic and other confounds, social discounting remained a significant predictor of smoking status among smokers versus quitters. Overall, these results suggest that individual differences in social discounting may be a factor influencing the choices that women make about quitting smoking upon learning of a pregnancy. Copyright © 2011 John Wiley & Sons, Ltd.     

Marijuana Use Among Daily Tobacco Smokers: Relationship to Anxiety-Related Factors

The present investigation evaluated the incremental validity of regular marijuana use and frequency of such use in relation to anxiety and depressive symptoms and perceived health among young adult tobacco smokers (n = 202). Approximately 72% of the sample were current marijuana smokers, using this drug on an average of 7.6 (SD = 9.2) times per week. As expected, after controlling for theoretically-relevant smoking (cigarettes per day), alcohol use, and affect factors (i.e., negative affectivity and anxiety sensitivity), marijuana use predicted anxiety symptoms and perceived general health, whereas frequency of marijuana use predicted only anxiety symptoms. These results are discussed in relation to better understanding the role of regular marijuana use in terms of anxiety-relevant emotional vulnerability and beliefs about physical health among regular smokers.     

The effectiveness of smoking cessation programs: Determinants and outcomes

Abstract

In this review, smoking cessation is discussed from a stress and coping perspective. Nicotine has been found to produce potentially reinforcing effects. Smoking cessation is best characterized as a process with various stages, of which the stage of relapse remains a major area for intervention research. Mood and expectancies appear to be major determinants of behavior in this stage. Social support apparently still needs conceptual refinement before it may be applied effectively in interventions. Effects of multicomponent treatment has been found to be increased when combined with nicotine replacement therapy. Notwithstanding the sometimes modest quit rates, smoking cessation has been found to be cost-effective among high-risk groups, both from an economical and health perspective. New research should focus on emotional and cognitive processes involved in cessation, in particularly self-efficacy expectations. While public policies may be most efficient in reducing the number of smokers in our society, an increasing number of smokers will be confronted with the addictive character of their smoking.     

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.     

Hypnosis versus relaxation: accuracy and confidence in dating international news events

This study compared participants who were administered either a hypnosis (n=50) or a relaxation (n=44) recall priming procedure in terms of the ability to estimate the dates of 20 relatively memorable (‘easy’) vs. less memorable (‘difficult’) international news events. The hypnosis and relaxation groups performed comparably in terms of the accuracy of estimates of when the events occurred, self‐reported confidence in estimates, and the memorability and emotionality of the events that were reported during hypnosis and relaxation. After these initial ratings, participants were informed that ‘at least one’ of their estimates was incorrect, and they were given the opportunity to change their estimates of the date of when one or more of the events occurred. Participants who generated their initial estimates during hypnosis were less likely to change their previous estimates of both easy and difficult events, than were participants in the relaxation condition. The measure of self‐reported confidence and a behavioural measure of willingness to change initial reports were largely dissociated from one another. Copyright © 2005 John Wiley & Sons, Ltd.     

Piagetian object permanence and its development in Eurasian jays (<Emphasis Type="Italic">Garrulus glandarius</Emphasis>)

Object permanence in Eurasian jays (Garrulus glandarius) was investigated using a complete version of the Uzgiris and Hunt scale 1. Nine hand-raised jays were studied, divided into two groups according to their different developmental stages (experiment 1, older jays: 2–3 months old, n = 4; experiment 2, younger jays: 15 days old, n = 5). In the first experiment, we investigated whether older jays could achieve piagetian stage 6 of object permanence. Tasks were administered in a fixed sequence (1–15) according to the protocols used in other avian species. The aim of the second experiment was to check whether testing very young jays before their development of “neophobia” could influence the achievement times of piagetian stages. Furthermore, in this experiment tasks were administered randomly to investigate whether the jays’ achievement of stage 6 follows a fixed sequence related to the development of specific cognitive abilities. All jays tested in experiments 1 and 2 fully achieved piagetian stage 6 and no “A not B” errors were observed. Performance on visible displacement tasks was better than performance on invisible ones. The results of experiment 2 show that “neophobia” affected the response of jays in terms of achievement times; the older jays in experiment 1 took longer to pass all the tasks when compared with the younger, less neophobic, jays in experiment 2. With regard to the achieving order, jays followed a fixed sequence of acquisition in experiment 2, even if tasks were administered randomly, with the exception of one subject. The results of these experiments support the idea that piagetian stages of cognitive development exist in avian species and that they progress through relatively fixed sequences. Electronic Supplementary Material Supplementary material is available in the online version of this article at and is accessible for authorized users.     

Effects of a Structured Camp Experience on Locus of Control Orientation

Summary

Inner-city teenagers (n = 261) experienced a structured camp program for a week. It was predicted and found that this experience led to a change toward internality, in the locus of control orientation of these youngsters. The trend toward internality continued in a group of youngsters (n = 27) who returned for an additional week. Item analyses revealed the specific items on which the changes occurred and indicated that a rather general change of orientation had occurred. The results were discussed in terms social learning theory and suggestions were made to improve future programs of this sort.     

Differentiating Cognitive Content between Depressed and Anxious Outpatients

Quantitative research suggests that depressed and anxious patients can be differentiated based on their cognitive content. This study used qualitative research methods to separate the specific components of open‐ended depressive and anxious thought content in 79 psychiatric outpatients. Patients with major depressive disorder (MDD; n = 36), generalized anxiety disorder (GAD; n = 10), and other psychiatric disorders (PC; n = 33) were instructed to (a) describe their most bothersome problem; (b) imagine the worst possible negative outcome followed by the best possible positive outcome; and (c) describe associated thoughts and emotions for each scenario. The content of patients' responses were coded to examine (a) the types and severity of problems; (b) the presence or absence of hopelessness, catastrophizing, hopefulness, and unrealistic positive expectations; and (c) the presence or absence of particular emotions associated with imagined worst and best outcomes. More GAD patients than MDD and PC patients indicated anticipated anxious emotions associated with imagined worst outcomes, and fewer MDD patients than GAD and PC patients indicated anticipated happiness associated with imagined best outcomes. No group differences emerged for the other variables considered. These findings suggest that depressed and anxious patients differ in their cognitive expectancies about future life events in terms of their own anticipated emotional reactions.     

The Measurement of Social Attitudes of College Students: I. Standardization of Tests and Results of a Survey

Summary

Two experiments indicated a decreased effect of discontinued performance expectancies (a) when nonvalued performance scores were given to subjects, and (b) when the modeling effects of the experimenter were reduced. According to the dependence interpretation advanced, the traditional use of valued performance scores increased the subjects' dependencies on the experimenter and, consequently, the likelihood of their imitating a change in his behavior; that is, disconfirmed performance expectancies may lead to dependence reduction and not necessarily to dissonance reduction.     

Dysphoria and the prediction and experience of emotion

Depression and dysphoria have been characterised by dampened positive emotional experiences. However, it remains unclear whether dysphoria is also characterised by dampened expectancies about positive emotional experiences. In the present study, participants with (dysphoric group; n=36) and without (non-dysphoric group; n=36) dysphoria reported on their expected and actual emotional responses to winning and losing money in a computer task. Results showed the dysphoric group predicted and experienced less happiness and contentment after winning money than the non-dysphoric group. Results also showed the dysphoric group predicted and experienced as much negative emotion after losing money as the non-dysphoric group. Moreover, the dysphoric group predicted they would experience more happiness after winning money than they actually did, whereas the non-dysphoric group experienced as much happiness as they had predicted. Results suggest that disturbances in positive emotional responding are characteristic of people experiencing dysphoria.     

The relationship of body image dissatisfaction to cigarette smoking in college students

This study examined the association of cigarette smoking status and body image dissatisfaction as measured by the Multidimensional Body-Self Relations Questionnaire (MBSRQ), in 1575 young adult college students, 18–24 years of age. Respondents were current cigarette smokers (N = 482) or never tobacco users (N = 1093). Smoking status was found to be significantly associated with 5 of the 10 MBSRQ subscales, with current smokers having lower scores on Fitness Orientation, Health Evaluation and Health Orientation (all p < 0.001) and higher scores on Appearance Orientation (p = 0.01) and Overweight Preoccupation (p = 0.03) compared with never tobacco users. Furthermore, among current smokers, a higher number of days smoked in the last 30 days were associated with lower scores on all MBSRQ subscales, except Self-Classified Weight. In terms of clinical implications, interventions for smoking cessation among college students might benefit from inclusion of components for addressing body image dissatisfaction and improving health beliefs.     

Construction of Smoking-Relevant Risk Perceptions Among College Students: The Influence of Need for Cognition and Message Content1

Changing smokers' health-risk perceptions has been difficult. This study tested whether need for cognition (NC)—a factor within Petty & Cacioppo's (1986) elaboration likelihood model that reflects the preference for effortful cognitive information processing—moderated responses to a smoking risk message intervention. College smokers (n=227) evaluated a fact-based or emotion-based smoking risk pamphlet or a control pamphlet. Among occasional but not daily smokers, NC interacted as hypothesized with type of message to moderate risk perceptions. Among participants with higher NC, the fact-based message produced the greatest increase in risk perception; whereas among participants with lower NC, the emotion-based message produced the greatest change. Findings demonstrate that individual differences in cognitive processing can influence the potency of health-risk messages.