Stages of change for health-related behaviours in 18 year-old Australians

Abstract This study investigated the validity of a Stages of Change algorithm with respect to independent measures of physical activity and fitness. dietary intake and alcohol consumption in 18 year-old Ausmlian men (n = 301) and women (n = 282). Stage of Change categories were related to fat and fibre intakes in men and fibre intake in women as well as hit and vegetable intakes in men and women. Physical activity and fitness for men and women also showed significant linear associations with Stage of Change categories. Alcohol consumption was significantly associated with Stage of Change categories for men but not for women although recorded alcohol consumption was very variable for women. However, the algorithm was valid for both men and women when drinking alcohol consistent with national guidelines on safe drinking was used. In summary, with reference to actual health behaviours, the Stages of Change algorithm was valid for young men and women for diet. physical activity and alcohol drinking. Independent behavioural data were not available for smoking behaviours. Using the algorithm, there were significant associations in men between prccontemplation status for diet and drinking and diet and physical activity, in women between diet and smoking and in both men and women between drinking and smoking. Covariance between precontemplation status for different health behaviours therefore suggests the need for multimodal interventions.     

Are Religiosity and Spirituality Associated with Obesity Among African Americans in the Southeastern United States (the Jackson Heart Study)?

There are several lines of evidence that suggest religiosity and spirituality are protective factors for both physical and mental health, but the association with obesity is less clear. This study examined the associations between dimensions of religiosity and spirituality (religious attendance, daily spirituality, and private prayer), health behaviors and weight among African Americans in central Mississippi. Jackson Heart Study participants with complete data on religious attendance, private prayer, daily spirituality, caloric intake, physical activity, depression, and social support (n = 2,378) were included. Height, weight, and waist circumference were measured. We observed no significant association between religiosity, spirituality, and weight. The relationship between religiosity/spirituality and obesity was not moderated by demographic variables, psychosocial variables, or health behaviors. However, greater religiosity and spirituality were related to lower energy intake, less alcohol use, and less likelihood of lifetime smoking. Although religious participation and spirituality were not cross-sectionally related to weight among African Americans, religiosity and spirituality might promote certain health behaviors. The association between religion and spirituality and weight gain deserves further investigation in studies with a longitudinal study design.     

The impact of self-efficacy on behavior change and weight change among overweight participants in a weight loss trial.

Despite considerable clinical interest, attempts to link perceived self-efficacy with successful weight control have had mixed success. Definitive data on prospective associations between self-efficacy and weight loss are particularly sparse. This study examined relationships between self-efficacy beliefs, weight control behaviors, and weight change among individuals participating in a weight loss trial (N = 349, 87% women). Cross-sectionally, eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors. Self-efficacy beliefs prospectively predicted weight control behavior and weight change during active treatment but not during follow-up. Mediational models indicate that people's weight control behaviors mediate the impact of self-efficacy on weight change.     

Stages of change for health-related behaviours in 18 year-old Australians

Abstract

This study investigated the validity of a Stages of Change algorithm with respect to independent measures of physical activity and fitness. dietary intake and alcohol consumption in 18 year-old Ausmlian men (n = 301) and women (n = 282). Stage of Change categories were related to fat and fibre intakes in men and fibre intake in women as well as hit and vegetable intakes in men and women. Physical activity and fitness for men and women also showed significant linear associations with Stage of Change categories. Alcohol consumption was significantly associated with Stage of Change categories for men but not for women although recorded alcohol consumption was very variable for women. However, the algorithm was valid for both men and women when drinking alcohol consistent with national guidelines on safe drinking was used. In summary, with reference to actual health behaviours, the Stages of Change algorithm was valid for young men and women for diet. physical activity and alcohol drinking. Independent behavioural data were not available for smoking behaviours. Using the algorithm, there were significant associations in men between prccontemplation status for diet and drinking and diet and physical activity, in women between diet and smoking and in both men and women between drinking and smoking. Covariance between precontemplation status for different health behaviours therefore suggests the need for multimodal interventions.     

Concurrent drinking and smoking among college students: An event-level analysis

Cigarette smoking and drinking commonly co-occur among college students, a population that is at high risk for developing alcohol and nicotine use disorders. Several studies have been conducted that have examined predictors of drinking or smoking to gain a better understanding of the antecedents of engaging in these behaviors. Yet, few studies have examined specific factors that influence concurrent smoking and drinking in this population. The current study used data from a 21-day electronic diary-based study of college students (n=86) who engaged in concurrent drinking and smoking to examine event-level associations between alcohol use and cigarette smoking in the student's natural environment. We specifically focused on within-person analyses of contexts in which students reported smoking and drinking simultaneously in comparison to contexts in which students reporting drinking without smoking. Situational contexts included environmental setting, whether s/he was alone or with others, and changes in stress and urges to smoke before initiating drinking. Results indicated that students drank more while smoking and smoked three times as many cigarettes, on average, during drinking episodes. Being with others at a party or a bar was associated with increased odds of smoking while drinking. Likewise, increased stress since the prior assessment predicted a greater likelihood of smoking while drinking. Based on the findings from the present study, it is important for future prevention and intervention efforts to consider social settings and heightened stress among students as potential risk factors for engaging in concurrent drinking and smoking.     

Depressed mood and environmental mastery as potential pathways linking family relationship quality and disease self-management for African Americans with hypertension

African Americans are at significantly greater risk of hypertension and worse cardiovascular outcomes than other racialized groups, yet hypertension intervention effects remain limited. Thus, it is necessary to understand the potential mechanisms whereby interventions may be more effectively targeted to improve health. Supported by prior research evidence and guided by the Biobehavioral Family Model, this study examined associations between family relationship quality, psychological wellbeing, and self-management behaviors for African Americans with hypertension. Data were pooled from three Midlife Development in the U.S. projects, resulting in a sample of 317 African Americans (63.4% female, M_age = 53.32) with self-reported high blood pressure in the past 12 months. We tested four cross-sectional multiple mediator models, with depressed mood and environmental mastery mediating associations between family strain and exercise, smoking, problematic alcohol use, and stress-eating. Environmental mastery mediated the association between greater family strain and decreased odds of achieving recommended exercise levels; greater odds of reporting problematic alcohol use; and greater stress-eating. Though family strain was associated with depressed mood in each model, this variable did not serve as an indirect pathway to self-management behaviors. Family strain, and the potential pathway identified via environmental mastery, may be a meaningful predictor of disease self-management for African Americans with hypertension. Longitudinal studies are needed to examine directionality and to support intervention trials for improving self-management and hypertension outcomes.     

Stability and changes in health behaviours in young adults over a one year period

Abstract

Data concerning 19 health-related behaviours and associated beliefs were collected by questionnaire from 282 students in the Netherlands on two occasions over one year. While all behaviours showed moderate stability, there were variations in the degree of change. The highest stability was reported for sleep time, tooth brushing frequency, seat belt usage and health care service utilization. The least stable behaviours included regular exercise and various dietary measures. Predictors of changes in smoking, dietary fat intake, alcohol consumption and regular exercise were analysed in detail. Beliefs assessed at year 1 in the importance of these activities for health predicted changes in behaviour over the study year independently of prior behaviour levels. Awareness of the risks associated with behaviours, and explicit wishes to modify behaviour patterns (eg stop smoking, exercise more), did not predict change from year 1 to year 2. The results indicated that health behaviours vary in their stability, and that health beliefs may predict future health behaviour changes.     

Substance use, suicidal ideation and attempts in children and adolescents

Using data from a community sample of youth ( N = 1,458; ages 9-17), this study assessed the association between adolescent substance use/abuse and suicidal behaviors. Suicide attempts were strongly associated with alcohol abuse and dependence, followed by frequent cigarette smoking. The associations remained significant even after controlling for depression. The associations between substance use/abuse and suicidal ideation were no longer significant after controlling for depression. These findings highlight the important role that substance use plays in adolescent suicidal behaviors.     

Ethnic identity and risky health behaviors in school-age Mexican-American children

The study examined the relationship between ethnic identity and risky health behaviors in 1,892 Mexican-American students (M age= 14.6, SD= 1.35; 50.3% male) in South Texas. The Ethnic Identity Scale assessed ethnic identity and questions from the Youth Risk Behavior Survey measured risky health behaviors (mixed use of alcohol and drugs, heavy drinking, driving under the influence, regular marijuana use, regular cigarette smoking, lack of regular exercise, not eating breakfast regularly, and carrying a gun or knife to school). Logistic regression tested the relationships between ethnic identity and report of risky health behaviors controlling for potential confounders (sex, free school lunch status, grade, and self-reported school grade). Adjusted odds ratio (AOR) and confidence intervals were calculated. Results indicated that being associated with Mexican-American cultural identity was significantly associated with a decreased mixed use of alcohol and drugs (AOR= .97), heavy drinking (AOR= .98), and regular marijuana use (AOR= .97). A stronger ethnic identity was protective against engaging in risky health behaviors among these Mexican-American adolescents.     

Patterns of adolescent involvement in problem behaviors: Relationship to self-efficacy,social competence,and life events

Using a sample of 556 adolescents from a suburban community, patterns of various adolescent problem behaviors (e.g., delinquent behavior, smoking, use of alcohol or drugs) and their links to self-efficacy, social competence, and life events were examined. Cluster analysis was conducted to identify four subgroups of adolescents who showed distinct patterns of problem behaviors. These clusters were compared on the measures of self-efficacy, social competence, and life events. Overall results suggest there are meaningful links between adolescents’ problem behavior patterns and self-efficacy, the amount and quality of participation in various after school activities, and life events. For example, a subgroup of adolescents who showed uniformly low prevalence of all problem behaviors reported more positive academic self-efficacy, more active participation in sports and nonsports activities, more positive life events, and fewer negative events than adolescents who were involved in multiple problem behaviors. Implications for prevention and future research on adolescent problem behaviors are discussed.     

English language use as a risk factor for smoking initiation among Hispanic and Asian American adolescents: evidence for mediation by tobacco-related beliefs and social norms.

Acculturation increases the risk of smoking among Hispanic and Asian American adolescents, but the underlying mechanisms are not understood. This study examined associations between English language use and smoking among 4,167 Hispanic and 2,836 Asian American adolescents in California. Potential mediators were assessed, including access to cigarettes, perceived consequences, friends' smoking, cigarette offers, refusal self-efficacy, and prevalence estimates of peer smoking. English language use was associated with increased risk of lifetime smoking in both groups. This association became nonsignificant after access, perceived consequences, friends' smoking, and offers were controlled for. The acculturation process (as indicated by English language use) may be associated with smoking-related psychosocial variables, which may lead to an increased risk of experimentation with smoking.     

Prospective analysis of early lapse to drinking and smoking among individuals in concurrent alcohol and tobacco treatment

The aims of the current study were to examine, prospectively, (a) dynamic changes in affective state, self-efficacy, and urge in the hours before initial smoking and drinking lapses among individuals in concurrent alcohol and smoking treatment, and (b) the extent to which self-efficacy, urge to use, and/or the use of one substance predicted lapse to the other substance. Ninety-six men and women recruited for a clinical trial of concurrent alcohol and tobacco treatment were eligible for inclusion. Only data from those who experienced an initial lapse to drinking (n=29) or smoking (n=32) were included. Two outpatient substance abuse clinics provided concurrent alcohol and smoking treatment on a weekly basis for three months. Ecological Momentary Assessment (EMA) methods were employed over a 28-day monitoring period to assess antecedents to first drink, and a 14-day monitoring period was examined for initial smoking lapses. Baseline and EMA measures of positive and negative affect, alcohol/smoking urge, alcohol/smoking abstinence self-efficacy, nicotine withdrawal, and quantity/frequency of alcohol and tobacco use were examined as lapse predictors. Analyses of EMA ratings controlled for the corresponding baseline measure. Smoking lapse among individuals in concurrent alcohol and tobacco treatment was foreshadowed by higher urges to smoke, lower positive mood, and lower confidence to resist smoking. Drinking lapse was preceded by lower confidence to resist smoking, but only among individuals who reported recent smoking. Concurrent alcohol and smoking treatment should focus on the enhancement of abstinence self-efficacy, positive mood, and the curbing of urges in order to offset lapse risk.     

Antenatal determinants of early childhood talking delay and behavioural difficulties

The determinants of talking delay alone or its comorbidity with behavioural difficulties was examined in 5768 two-year-old members of the Growing Up in New Zealand longitudinal study. Using the MacArthur-Bates Communicative Development inventories and the total difficulties score from the preschool Strengths and Difficulties Questionnaire, a composite measure was created so that children were categorised as showing no language or behavioural concerns (72.5%), behavioural only difficulties (6.1%), language only difficulties (18.1%), and comorbid language and behavioural difficulties (3.3%). Analyses revealed that antenatal factors such as maternal perceived stress, inadequate folate intake, vitamin intake, alcohol consumption during the first trimester and maternal smoking all had a significant effect on child outcomes. In particular, low multivitamin intake and perceived stress during pregnancy were associated with coexisting language and behavioural difficulties. These findings support international research in showing that maternal factors during pregnancy are associated with developmental outcomes in the early childhood period, and demonstrate these associations within a NZ context. Interventions which address maternal stress management and health behaviours during pregnancy could be beneficial to offspring development.     

Implicit alcohol and smoking associations among young adult heavy drinkers: Associations with smoking status and alcohol-cigarette co-use

Implicit memory associations may play a role in motivation to use alcohol and cigarettes, but the relationship between implicit associations and co-use of alcohol and cigarettes is currently unknown. This study provided an initial examination of alcohol and smoking implicit associations among young adult drinkers who were either nonsmokers or relatively light smokers (i.e., 10 or fewer cigarettes per day) as a function of smoking frequency and daily-level alcohol-cigarette co-use. Drinkers (n?=?129) completed alcohol-arousal and smoking-valence variants of the implicit association test as well as a daily-level assessment of past 90-day alcohol and cigarette use. Smokers were grouped according to whether they reported daily or nondaily smoking frequency. Results showed that although implicit alcohol-arousal associations did not differ between smokers and nonsmokers, stronger implicit alcohol-arousal associations were observed for nondaily smokers relative to daily smokers after controlling for drinking frequency. Further, implicit positive-smoking associations were stronger for smokers relative to nonsmokers. Within the subgroup of nondaily smokers, more frequent co-use of alcohol and cigarettes was associated with stronger implicit positive-smoking associations when controlling for total drinking and smoking frequency. The findings suggest that implicit alcohol and smoking associations may be linked with smoking patterns (daily vs. nondaily) and co-use of alcohol and cigarettes among young adult drinkers who are not heavy smokers, highlighting the need for more research on the role of implicit associations in the co-use of cigarettes and alcohol.     

Childhood conduct problems,attention deficit behaviors,and adolescent alcohol,tobacco, and illicit drug use

The relationships between conduct problems and attention deficit behaviors at age 8 years and the use of alcohol, tobacco, and illicit drugs at 15 years were studied in a birth cohort of over 900 New Zealand children. The analysis showed that while early conduct problems were significantly associated with later substance use there were no significant associations between early attention deficit behaviors and later substance use once the correlations between conduct problems and attention deficit behaviors were taken into account. These associations persisted after control for a range of potentially confounding covariates. Children who showed tendencies to conduct problems at age 8 consumed 1.5 to 1.9 times more alcohol and had rates of alcohol-related problems, daily cigarette smoking, and illicit drug use that were 1.9 to 2.0 times higher than children with low conduct problem scores. It is concluded that attention deficit behaviors, in the absence of conduct problems, are not associated with later substance use. However, even when due allowance is made for social and contextual factors associated with both early conduct problems and later substance use, early conduct problems are a risk factor for later substance use.This research was funded by grants from the Health Research Council of New Zealand and the National Child Health Research foundation.     

A Contextual Model of Control Beliefs,Behavior, and Health: Latino and European Americans with Type 2 Diabetes

Sense of control is frequently found to be related to health. A model of control beliefs, disease-management behaviors, and health indicators was tested in a sample of 74 Latino Americans and 115 European Americans with Type 2 diabetes. Two measures of control beliefs, one diabetes-specific (diabetes self-efficacy) and one global (mastery), were examined for their effects on management behaviors (diet and exercise) and on health (Hb_A1C and general health). Results indicated that the relationship between control and management behaviors varied by measure of control and by group. For Latino participants, global mastery was related to management behaviors; whereas, self-efficacy was related to such behaviors among European Americans. The relationship between control and health did not appear to be mediated by management behaviors. This study provides support for a diversified approach to control, behavior, and health.     

Childhood Psychosocial Predictors of Adulthood Smoking,Alcohol Consumption,and Physical Activity1

This study prospectively addresses whether aspects of the childhood home environment (SES and parental divorce) and personality are predictive of smoking, alcohol consumption, and physical activity in middle adulthood. Subjects were 972 males and females who participated in the Terman Life-Cycle Study. Results of hierarchical regression analyses indicated that childhood unconscientiousness, cheerfulness, and parental divorce predicted adult smoking. Childhood unconscientiousness and sociability predicted adult alcohol consumption. Physical activity was predicted by a higher energy/activity level in childhood. Results suggest that the previously found associations between childhood characteristics and health-related behaviors over shorter periods are not simply reflective of early experimentation with such behaviors, but may be indicative of long-term lifestyle patterns.     

Comorbidity of substance dependence and depression: role of life stress and self-efficacy in sustaining abstinence.

The authors examined life stress and self-efficacy as predictors of time to relapse for 113 adults with comorbid major depressive disorder and alcohol and/or substance dependence in a randomized clinical trial comparing 2 psychotherapy interventions (integrated cognitive- behavioral therapy and 12-step facilitation therapy). Life stress, self-efficacy, and substance use were assessed at treatment entry, 12 weeks (mid-treatment), and 24 weeks (end of treatment). Time to relapse was defined as the number of days from treatment initiation until first alcohol and/or drug use. Half of the sample relapsed within the study period of 24 weeks. There was no significant difference between treatment groups. Individuals experiencing life stressors were more likely to relapse early than those not experiencing life stressors. Lower self-efficacy also predicted earlier relapse. Chronic stress levels and self-efficacy were stable across time for most individuals. In contrast, acute stress events occurred at differing times, and survival analyses provided evidence of heightened relapse risk in the month following acute stressors. The interaction of self-efficacy and life stress was not significant. The results highlight the significance of life stress and self-efficacy as predictors of early relapse.     

Parenting Perfectionism and Parental Adjustment

The parental role is expected to be one of the most gratifying and rewarding roles in life. As expectations of parenting become ever higher, the implications of parenting perfectionism for parental adjustment warrant investigation. Using longitudinal data from 182 couples, this study examined the associations between societal- and self-oriented parenting perfectionism and new mothers’ and fathers’ parenting self-efficacy, stress, and satisfaction. For mothers, societal-oriented parenting perfectionism was associated with lower parenting self-efficacy, but self-oriented parenting perfectionism was associated with higher parenting satisfaction. For fathers, societal-oriented parenting perfectionism was associated with higher parenting stress, whereas higher levels of self-oriented parenting perfectionism were associated with higher parenting self-efficacy, lower parenting stress, and greater parenting satisfaction. These findings support the distinction between societal- and self-oriented perfectionism, extend research on perfectionism to interpersonal adjustment in the parenting domain, and provide the first evidence for the potential consequences of holding excessively high standards for parenting.     

Personality and health habits

Abstract

Four hundred and fifty-five males and 523 females from a community sample participated in a study on the relationship between seven health practices (sleeping; breakfasting; snacking; being at good weight; smoking; alcohol consumption and physical activity) and seven personality factors (Neuroticism; Social Inadequacy; Rigidity; Hostility; Self-sufficiency; Dominance and Self-esteem).

It was found that the seven health habits did not constitute a homogeneous operationalization of a construct “positive lifestyle.” The intercorrelations between the different health practices were typically low. The results of MANOVAs and subsequent ANOVAs revealed small, but statistically significant differences between subjects reporting positive and those reporting poor health habits. The failure to find significant interactions with sex indicated that the results for males and females were generally similar. Neuroticism and hostility discriminated best between the groups with poor or good health behaviors. This held for sleeping, exercising, breakfasting daily and smoking. In addition, sporting people scored lower on social inadequacy and higher on self-esteem. Further, individuals who do not have a daily breakfast were more self-sufficient. Snacking individuals were generally less rigid and less dominant, but more hostile. In conclusion, most negative health habits were found to be associated with personality attributes which are intimately related to symptom reporting (neuroticism, hostility). Given the generally weak associations, it is concluded that, in order to obtain a more complete picture of the individual's psychosocial risk profile, lifestyle data should be collected together with information on the person's stress and his or her coping qualities.