Behaviour change among overweight and socially disadvantaged adults: a longitudinal study of the NHS Health Trainer Service

Social disadvantage is associated with being overweight, a poor diet and physical inactivity. The NHS Health Trainer Service (HTS) is a national initiative designed to promote behaviour change among socially disadvantaged people in England and Wales. This study reports pre-post changes in body mass index (BMI), associated behaviours and cognitions among service users who set dietary or physical activity goals during a 12-month period (2008-2009; N?=?4418). Sixty-nine percent of clients were from the two most deprived population quintiles and 94.7% were overweight or obese. Mean BMI decreased from 34.03 to 32.26, with overweight/obesity prevalence decreasing by 3.7%. There were increases in fruit and vegetable consumption, reductions in fried snack consumption, increases in frequency of moderate or intensive activity and gains in self-efficacy and perceived health and wellbeing. Clients with higher BMI, poorer diet or less activity at baseline achieved greater change. Findings suggest that the NHS HTS has the potential to improve population health and reduce health inequalities through behaviour change.     

Is dispositional optimism or dispositional pessimism predictive of ideal cardiovascular health? The Young Finns Study

Objective: We examined the independent association between dispositional optimism compared to dispositional pessimism and ideal cardiovascular health (defined by the American Heart Association).

Design: A prospective design with a study sample of 1113 participants aged 24–39 years from the longitudinal Young Finns Study.

Main outcome measures: Ideal cardiovascular health (comprised of seven ideal cardiovascular health metrics) was measured in 2001. The ideal cardiovascular health metrics were reassessed in 2007.

Results: Low pessimism rather than high optimism was a better predictor of ideal cardiovascular health in 2007. When examining the association between optimism and pessimism and the seven ideal cardiovascular health metrics in 2007 (BMI, diet, physical activity, smoking status, blood pressure, total cholesterol and plasma glucose), low pessimism predicted non-smoking status, ideal physical activity and eating a healthy diet, while high optimism was associated with eating a healthy diet.

Conclusion: Our findings suggest that low pessimism rather than high optimism is associated with ideal cardiovascular health, especially with health behaviours such as not smoking, being physically active and eating a healthy diet. Socio-economic status was the potential mediating or confounding factor. Future studies should examine the differential meaning of the optimism/pessimism concepts to further clarify their relation to health outcomes.     

Lifestyle Risk Factors for Breast Cancer in BRCA1/2-Mutation Carriers Around Childbearing Age

BRCA1/2-mutation carriers are at high risk of breast cancer (BC) and ovarian cancer. Physical inactivity, overweight (body mass index ≥25, BMI), smoking, and alcohol consumption are jointly responsible for about 1 in 4 postmenopausal BC cases in the general population. Limited evidence suggests physical activity also increases BC risk in BRCA1/2-mutation carriers. Women who have children often reduce physical activity and have weight gain, which increases BC risk. We assessed aforementioned lifestyle factors in a cohort of 268 BRCA1/2-mutation carriers around childbearing age (born between 1968 and 1983, median age 33 years, range 21–44). Furthermore, we evaluated the effect of having children on physical inactivity and overweight. Carriers were asked about lifestyle 4–6 weeks after genetic diagnosis at the Familial Cancer Clinic Nijmegen. Physical inactivity was defined as sports activity fewer than once a week. Carriers were categorized according to the age of their youngest child (no children, age 0–3 years and ≥4 years). In total, 48% of carriers were physically inactive, 41% were overweight, 27% smoked, and 70% consumed alcohol (3% ≥8 beverages/week). Physical inactivity was 4–5 times more likely in carriers with children. Overweight was not associated with having children. Carriers with children are a subgroup that may specifically benefit from lifestyle support to reduce BC risk.     

Clustering of diet,physical activity and smoking and a general willingness to change

Addressing multiple health behaviours are important in preventing disease and mortality. The present study investigated the clustering of health behaviours, cognitive determinants and stages of change in 2827 adults for the lifestyle factors of physical activity, fruit, vegetable and fat consumption and smoking. The results showed that only 3% of the total population met recommended guidelines for all of the five behaviours. Behaviours were found to be weakly associated. Behaviour-specific cognitions and stages of change for the behaviours clustered more strongly, however. With respect to diet and physical activity, respondents in the preparation stage for one behaviour were likely also to be preparing to change another behaviour. Possible mechanisms for the apparent general willingness to change multiple behaviours are discussed, as well as potential implications for health promotion practice.     

Self-efficacy for health-related behaviour change in patients with TIA or minor ischemic stroke

Abstract

Objective: To assess levels of self-efficacy for health-related behaviour change and its correlates in patients with TIA or ischemic stroke.

Methods: In this prospective cohort study, 92 patients with TIA or ischemic stroke completed questionnaires on self-efficacy for health-related behaviour change and fear, social support and depressive symptoms. Relations between fear, social support, depressive symptoms, cognitive impairment, vascular risk factors and history and demographic characteristics and low-self-efficacy were studied with univariable and multivariable logistic regression.

Results: Median total self-efficacy score at baseline was 4 (IQR 4–5). Older age (OR 1.05, 95% CI 1.01–1.09), depressive symptoms (OR 1.09, 95% CI 1.03–1.16), presence of vascular history (OR 2.42, 95% CI 0.97–6.03), higher BMI (OR 1.15, 95% CI 1.01–1.30), fear (OR 1.06, 95% CI 1.01–1.12) and low physical activity (OR 1.49, 95% CI 1.01–2.21) were significantly associated with low self-efficacy.

Conclusion: Patients with recent TIA or ischemic stroke report high self-efficacy scores for health-related behaviour change. Age, vascular history, more depressive symptoms, higher BMI, less physical activity and fear were correlates of low self-efficacy levels.

Practice implications: These correlates should be taken into account in the development of interventions to support patients in health behaviour change after TIA or ischemic stroke.     

Do increases in physical activity encourage positive beliefs about further change in the ProActive cohort?

Effects of behaviour change on cognitions are rarely examined within the Theory of Planned Behaviour. We tested whether increases in physical activity resulted in more positive beliefs about further change among a cohort of sedentary adults participating in a behavioural intervention trial (ProActive). At baseline, 6 and 12 months, 365 adults completed questionnaires assessing physical activity and cognitions about becoming more active over the coming year. Objective activity was assessed at baseline and 12 months. Participants reporting larger increases in activity were no more positive about making further increases than those reporting less behaviour change (p-values > 0.05). Participants with larger increases in objective activity reported weaker perceived control (β?=??0.342; p?=?0.001) and more negative instrumental attitudes (β?=??0.230; p?=?0.017) at 12 months. Participants may have felt that they had changed enough or measures of perceived success may be more sensitive to behaviour change. Alternatively, long measurement intervals may have missed immediate cognitive and affective consequences of behaviour change, or such effects may require participants to consistently self-monitor or receive feedback on performance. Future studies could test the effect of such techniques on physical activity and a wider range of cognitive, affective and physiological consequences, using more frequent measurement intervals.     

Does message framing affect changes in behavioural intentions in people with psoriasis? A randomized exploratory study examining health risk communication

Message framing is important in health communication research to encourage behaviour change. Psoriasis, a long-term inflammatory skin condition, has additional comorbidities including high levels of anxiety and cardiovascular disease (CVD), making message framing particularly important. This experimental study aimed to: (1) identify whether health messages about psoriasis presented as either gain- or loss-framed were more effective for prompting changes in behavioural intentions (BI), (2) examine whether BI were driven by a desire to improve psoriasis or reduce CVD risk; (3) examine emotional reactions to message frame; and (4) examine predictors of BI. A two by two experiment examined the effects on BI of message frame (loss vs. gain) and message focus (psoriasis symptom reduction vs. CVD risk reduction). Participants with psoriasis (n = 217) were randomly allocated to one of four evidence-based health messages related to either smoking, alcohol, diet or physical activity, using an online questionnaire. BI was the primary outcome. Analysis of variance tests and hierarchical multiple regression analyses were conducted. A significant frame by focus interaction was found for BI to reduce alcohol intake (p = .023); loss-framed messages were more effective for CVD risk reduction information, whilst gain-framed messages were more effective for psoriasis symptom reduction information. Message framing effects were not found for BI for increased physical activity and improving diet. High CVD risk was a significant predictor of increased BI for both alcohol reduction (β = .290, p < .01) and increased physical activity (β = ?.231, p < .001). Message framing may be an important factor to consider depending on the health benefit emphasised (disease symptom reduction or CVD risk reduction) and patient-stated priorities. Condition-specific health messages in psoriasis populations may increase the likelihood of message effectiveness for alcohol reduction.     

Mediating relationship between body mass index and the direct measures of the Theory of Planned Behaviour on physical activity intention

This research examines (a) the interrelationships between body mass index (BMI), the direct measures of the Theory of Planned Behaviour (TPB) and physical activity intention and (b) the potential mediation effects of the direct measures of the TPB in the relationship between BMI and physical activity intention in a sample of Australian adults. A total sample of 1,062 respondents participated in a computer-assisted telephone-interview (CATI) survey comprised of a standardised introduction; questions regarding TPB and physical activity; and standard demographic questions. BMI for each participant was calculated from self-reported height and weight. Separate regression analyses were performed to examine the mediating effects of each of the direct measures of the TPB on the predictive relationship between the BMI and physical activity intention, as proposed by Baron and Kenny (Journal of Personality and Social Psychology, 51(6), 1173 - 1182, 1986). Findings indicated that the direct measure of attitude and perceived behavioural control mediated the relationship between BMI and physical activity intention. However, the direct measure of subjective norm failed to act as a mediating mechanism. To date there has been no research that has examined the mechanism by which body mass may affect physical activity behaviour. Given the current focus for health promotion specialists on promoting physical activity as a strategy for reducing overweight and obesity, a theoretical understanding of weight-related barriers to physical activity may aid in the development of future interventions and community physical activity programs, particularly those targeting overweight and obese populations.     

The effect of autonomous and controlled motives on eating dysregulation: Implications for individuals classified as underweight,overweight or obese

IntroductionControlled and autonomous motivational factors from self-determination theory have previously been highlighted as key factors in eating regulation. The present study examined controlled motives as an overarching motivational factor in eating dysregulation and examined its effects on dieting behaviour for those who are underweight, overweight or obese.ObjectiveTo examine whether the influence of controlled motives on dieting behaviour would be moderated by body mass index (BMI). Specifically, it was hypothesised that controlled motives would be associated with high levels of dieting behaviour in underweight individuals and low levels of dieting behaviour in individuals classified as overweight or obese.MethodOne hundred and thirty-seven participants completed the measures of height, weight, and motivation and intentions towards watching their diet and subsequently completed a measure of dieting behaviour two weeks later.ResultsModerated regression and simple slopes analyses provided support for the hypothesised effects at underweight, overweight, and obese range BMIs.ConclusionThe effect of controlled motives on dieting behaviour is dependent upon BMI and therefore varies across underweight, overweight, and obese individuals. The implications of controlled motives and external pressures to watch one's diet are discussed.     

Body mass index and environmental supports for physical activity among active and inactive residents of a U. S. southeastern county.

OBJECTIVE: This study examined the associations between body mass index (BMI) and environmental supports for physical activity in active and inactive adults based on national recommendations for physical activity and walking. Residents of a southeastern community (N = 1,111; ages 18-75 years) were contacted using a random-digit-dial method and were asked about neighborhood and community social and environmental supports for physical activity. MAIN OUTCOME MEASURE: Physical activity was measured using the 2001 Behavioral Risk Factor Surveillance System (BRFSS) physical activity module. RESULTS: There was a positive association between higher physical activity and walking levels and lower BMI levels. Trusting neighborhoods, having recreational facilities present, and using trails were each associated with twice the odds of being overweight versus obese among those not meeting the national physical activity recommendations. Using trails was also associated with 2.7 times the odds of being overweight as opposed to obese among participants who were not regular walkers. CONCLUSION: Improving environmental supports for access and use of trails and recreational facilities may be important for future environmental interventions aimed at reducing obesity among inactive individuals.     

An exercise in nostalgia: Nostalgia promotes health optimism and physical activity

Objective: Previous research has shown that nostalgia, a sentimental longing for the past, leads to greater feelings of optimism, with other work demonstrating that optimistic thinking (general & health-orientated) is associated with better physical and psychological health. Integrating these two lines of research, the current studies examined whether nostalgia-induced health optimism promotes attitudes and behaviours associated with better physical well-being.

Methods: Participants, in three experiments, were randomly assigned to write about either a nostalgic or ordinary event. Following this, everyone completed a measure of health optimism (Studies 1–3), measures of health attitudes (Study 2) and had their physical activity monitored over the course of 2 weeks (Study 3).

Results: The results revealed that, in comparison to control conditions, nostalgic reverie led to greater health optimism (Studies 1–3). Further, heightened health optimism following nostalgic reflection led to more positive health attitudes (Study 2), and increased physical activity over a two-week period (i.e. Fitbit activity trackers; Study 3).

Conclusions: These findings highlight the importance of nostalgia on health attitudes and behaviours. Specifically, this work suggests that nostalgia can be used as a mechanism to increase the importance, perceived efficacy and behaviour associated with better physical health.     

State gratitude for one’s life and health after an acute coronary syndrome: Prospective associations with physical activity,medical adherence and re-hospitalizations

Abstract

Gratitude may be associated with beneficial health outcomes, but studies of this association have been mixed, and in these studies gratitude has often been conceptualized as a stable, unidimensional trait. We used four specific items to examine the prospective association of state- and domain-specific gratitude with medical outcomes among 152 patients with a recent acute coronary syndrome. State gratitude for one’s health 2 weeks post-event was associated with increased physical activity (measured via accelerometer) 6 months later, controlling for relevant demographic, social, medical and psychological factors (β = 340.9; 95% confidence interval = 53.4–628.4; p = .020). Gratitude for one’s life was associated with increased self-reported medical adherence at 6 months on the maximally adjusted model (β = .60; 95% confidence interval = .16–1.04; p = .008); no gratitude items were associated with rehospitalizations. In contrast, dispositional gratitude, measured by the Gratitude Questionnaire-6, was less dynamic and responsive to change over the 6-month period and was not associated with physical activity.     

Post-traumatic stress disorder and health risk behaviour among persons 15 years and older in South Africa

The aim of this study was to investigate the association between post-traumatic stress disorder (PTSD) and health risk behaviours among persons 15 years and older in South Africa. We analysed data from the South African National Health and Nutrition Examination Survey (SANHANES-1, 2012) (N = 15 201; mean age = 36.9 years, SD = 16.5; 2.1% with PSTD, 4.0% with partial PTSD). The survey included questions from validated measures of the following health risk behaviours: problem drinking, current tobacco use, physical activity, sedentary behaviour, vegetable consumption, and fast food and frequent soft drinks consumption. In adjusted logistic regression analysis, only self-reporting with PTSD was associated with problem drinking. The data did not yield significant association between PTSD status and any of the other health risk behaviours (tobacco use, low physical activity, and fast food consumption).     

‘I feel better when…’: An analysis of the memory-experience gap for peoples’ estimates of the relationship between health behaviours and experiences

Objective: People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as “my mood is better when I exercise”. This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour.

Design: Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments.

Main Outcome Measures: University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period.

Results: Correlations between experiences and behaviours (online data) were small (r = ?.12–.14), estimated correlations moderate (r = ?.35–.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity.

Conclusion: Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy.     

Resisting temptation: alcohol specific self-efficacy mediates the impacts of compensatory health beliefs and behaviours on alcohol consumption

Awareness of health risks linked with excessive alcohol consumption appears to have little influence on how much some people drink. Compensatory health beliefs (CHBs), in which the consequences of unhealthy behaviour are considered to be neutralised by additional healthy behaviours, are one way of justifying poor health choices. Currently, the role of CHBs within the context of drinking behaviour is not well understood. This research examined associations between alcohol specific compensatory health beliefs (ACH-Beliefs) and behaviours (ACH-Behaviours), alcohol consumption and alcohol specific self-efficacy (ASE), via an online survey completed by 249 participants, aged 18 + years (63.1% female; M age = 41.62 years; SD = 14.80). Higher ACH-Beliefs were associated with increases in ACH-Behaviours. While both predicted alcohol consumption, a greater proportion of variance was explained by ACH-Behaviours. ASE was a significant mediator of those relationships, suggesting that those with higher ASE may be better equipped to regulate drinking behaviour. Recommendations for future research include measuring both CHBs and behaviours within an experimental design, and further investigation of related cognitions such as compensatory behaviour intentions. Alcohol misuse interventions may wish to consider the potential roles of CHBs and behaviours in facilitating maladaptive coping strategies, and how addressing these may reduce harms.     

Predicting physical activity in adolescents: The role of compensatory health beliefs within the Health Action Process Approach

Objective: Compensatory health beliefs (CHBs), defined as beliefs that healthy behaviours can compensate for unhealthy behaviours, may be one possible factor hindering people in adopting a healthier lifestyle. This study examined the contribution of CHBs to the prediction of adolescents’ physical activity within the theoretical framework of the Health Action Process Approach (HAPA).

Design: The study followed a prospective survey design with assessments at baseline (T1) and two weeks later (T2).

Method: Questionnaire data on physical activity, HAPA variables and CHBs were obtained twice from 430 adolescents of four different Swiss schools. Multilevel modelling was applied.

Results: CHBs added significantly to the prediction of intentions and change in intentions, in that higher CHBs were associated with lower intentions to be physically active at T2 and a reduction in intentions from T1 to T2. No effect of CHBs emerged for the prediction of self-reported levels of physical activity at T2 and change in physical activity from T1 to T2.

Conclusion: Findings emphasise the relevance of examining CHBs in the context of an established health behaviour change model and suggest that CHBs are of particular importance in the process of intention formation.     

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.     

Religious Beliefs,Diet, and Physical Activity Among Jewish Adolescents

Despite a well‐documented connection between religion and mortality, the link between religion and obesity‐related outcomes and behaviors has not been adequately studied, particularly among adolescents. This study examines whether self‐reported religious beliefs influence decisions about physical activity and diet in a sample of Jewish adolescents (n = 351). The results show that reporting a stronger influence of religious beliefs on health behaviors is associated with behaviors related to physical activity, but not diet. In adjusted regression models, individuals who report that their religious beliefs influence decisions about being physically active “a lot” have significantly more active days per week than those who say their religious beliefs do not influence such decisions. Similar effects are seen with regard to the students’ overall amount of sedentary time. The results shed light on previously documented relationships between religion and health, provide practical implications for religious organizations and leaders, and suggest areas for future research.