Changes in smoking behavior after a myocardial infarction

Among 383 participants in a longitudinal study of myocardial infarction (MI) patients, 230 smoked at the time of the MI. Posthospital smoking status was based on self-report for the day of follow-up, whereas information about length of continuous cessation was not available. Six months after the heart attack, 40.6% of the smokers had resumed smoking, whereas 49.4% smoked at a 3- to 5-year (M = 43-month) follow-up. Resumption of smoking within 6 months after the heart attack was associated with an increase in anxiety and depression during the first weeks after discharge, less cardiac health knowledge, and a less severe MI. In patients who relapsed at a later point, resumption of smoking was associated with a subsequent decline in general cardiac health knowledge, as well as in correct understanding of smoking at a risk factor. Long-term changes in smoking status were also related to previous heart disease, premorbid work instability, age, and severity of the MI. The results indicate that antismoking counseling of MI patients should not be limited to the health risks associated with smoking and that training in coping with negative affects without smoking may be valuable in promoting smoking cessation.     

Attitudes, perceptions, and risk-taking behaviors of smokers, ex-smokers, and nonsmokers.

A sample of American adults completed questionnaires relevant to cigarette smoking. The questions were related to three areas: risk, perceptions of their or others' smoking, and satisfaction with life and health. The results revealed that smokers were greater risk-takers, that they perceived their smoking to be due to both physical and psychological addictions, and that they expressed less satisfaction and control. Results also indicated that smokers who saw their smoking as being addictive tended to be less satisfied with their health and felt less control over their lives. On the other hand, those smokers who were more likely to deny the health risks did not differ from either non- or ex-smokers on any of the satisfaction or control questions.     

Mental Health Research in Correctional Settings: Perceptions of Risk and Vulnerabilities

With more than half of individuals incarcerated having serious mental health concerns, correctional settings offer excellent opportunities for epidemiological, prevention, and intervention research. However, due to unique ethical and structural challenges, these settings create risks and vulnerabilities for participants not typically encountered in research populations. We surveyed 1,224 researchers, Institutional Review Board (IRB) members, and IRB prisoner representatives to assess their perceptions of risks and vulnerabilities associated with mental health research conducted in correctional settings. Highest ranked risks were related to privacy, stigma, and confidentiality; lowest ranked risks were related to prisoners’ loss of privileges or becoming targets of violence due to having participated in research. Cognitive impairment, mental illness, lack of autonomy, and limited access to services emerged as the greatest sources of vulnerability; being male, being female, being older than age 60, being a minority, and being pregnant were the lowest ranked sources of vulnerability. Researchers with corrections experience perceived lower risks and vulnerabilities than all other groups, raising the question whether these researchers accurately appraise risk and vulnerability based on experience, or if their lower risk and vulnerability perceptions reflect potential bias due to their vested interests. By identifying areas of particular risk and vulnerability, this study provides important information for researchers and research reviewers alike.     

Personality,risky health behaviour,and perceived susceptibility to health risks

We examined the relations between personality (Five‐Factor Model), risky health behaviours, and perceptions of susceptibility to health risks among 683 university students. The hypothesis was that personality would affect perceptions of susceptibility to health risks in two ways: directly, irrespective of risky health behaviours, and indirectly, through the effects of personality on risky health behaviours. The students were surveyed about smoking, being drunk, drunk driving, risky sexual behaviour, and perceptions of susceptibility to related health risks. In path‐analytical models we found the expected direct and indirect effects. The personality dimensions of Agreeableness and Conscientiousness had negative direct effects on perceptions of susceptibility as well as negative indirect effects through risky health behaviours. Neuroticism was the only personality dimension to show positive direct effects on perceptions of susceptibility as well as negative indirect effects. Copyright © 1999 John Wiley & Sons, Ltd.     

A randomized trial of a self-help smoking cessation intervention in a nonvolunteer female population: testing the limits of the public health model.

Reaching nonvolunteer female smokers with effective smoking cessation programs is a critical public health challenge. Smokers (N = 2,786) among 15,004 female members of a health maintenance organization who completed a routine needs assessment were invited into the "UCLA Preventive Health Behavior Study," consisting of five telephone interviews over 2 years assessing health practices. Participants (N = 1,396) were randomized into experimental or control conditions of an unsolicited, mailed, self-help smoking cessation program. Subjects were not alerted to the link between the program and the health study. Smoking status was assessed at 1, 6, 12, and 18 months. Across all subjects, point prevalence at 18 months was 18.62, and continuous abstinence was 2.71%. No difference was found between treatment and control groups regarding smoking status or readiness to stop smoking--raising questions about the value of mailing cessation materials to nonvolunteers. Quit rates increased over the 18-month follow-up; those still smoking at 18 months reported increased readiness to quit. Predictors at each follow-up point were examined multivariately.     

Long-term psychological sequelae of smoking cessation and relapse.

The authors examined whether smoking cessation and relapse were associated with changes in stress, negative affect, and smoking-related beliefs. Quitters showed decreasing stress, increasing negative health beliefs about smoking, and decreasing beliefs in smoking's psychological benefits. Quitters became indistinguishable from stable nonsmokers in stress and personalized health beliefs, but quitters maintained stronger beliefs in the psychological benefits of smoking than stable nonsmokers. Relapse was not associated with increases in stress or negative affect However, relapsers increased their positive beliefs about smoking and became indistinguishable from smokers in their beliefs. For quitters, decreased stress and negative beliefs about smoking may help maintain successful cessation. However, for relapsers, declining health risk perceptions may undermine future quit attempts.     

Personality traits, perceived risk, and risk-reduction behaviors: a further study of smoking and radon.

Personality traits and risk perceptions were examined as predictors of changes in smoking behavior. Participants (N = 697) were part of a randomized controlled trial of interventions to reduce exposure to the combined hazard of radon and cigarette smoke. Participants with higher perceived risk at baseline for the combination of smoking and radon were more likely to have a more restrictive household smoking ban in place at 12-month follow-up (p < .05). Risk perceptions also predicted reductions in the total number of cigarettes smoked in the home for participants in the video intervention who had high or moderate levels of extraversion (p < .01). Greater perceived risk predicted whether highly or moderately conscientious women quit smoking (p < .05). The moderating effects of personality traits should be considered when evaluating risk-reduction interventions.     

Extrinsic Life Goals and Health‐Risk Behaviors in Adolescents1

Guided by self‐determination theory (Deci & Ryan, 1985), two studies examined adolescents' risk behaviors as a function of their extrinsic aspirations for wealth, fame, and image relative to their intrinsic aspirations for growth, relationships, and community; and as a function of their perceptions of their parents' autonomy support. In the first study, adolescents who reported using cigarettes had significantly stronger relative extrinsic aspirations than did adolescents who reported not smoking. In the second study, a composite risk behavior index for adolescents' use of tobacco, alcohol, and marijuana, and their having had sexual intercourse was significantly predicted by their relative extrinsic life goals, and both students' health‐compromising behaviors and their relative extrinsic goals were significantly negatively predicted by their perceptions of their parents' autonomy support.     

The relationship of depression to health risk behaviors and health perceptions in Korean college students

The purpose of this study was to investigate the relationship of depression to health risk behaviors and health perceptions in Korean college students. The sample consisted of 434 students, ranging in age from 18 to 28 years, who were attending four universities in Korea. Data were collected using the Beck Depression Inventory, the Symptom Pattern Scale, and the Short Form Health Survey. Results indicate that the students were mildly depressed. The prevalence of alcohol consumption during the previous month was 84.6% and for smoking it was 33.6%. The majority of the students reported a low occurrence of symptoms of psychological distress and evaluated their health as either very good or good. The level of depression predicted alcohol consumption, symptom pattern, and physical health. Students who were more depressed reported more symptoms and perceived their health as worse compared with those who were less depressed. The students who were less depressed drank more alcohol. Depression did not predict smoking.     

Why it won't happen to me: perceptions of risk factors and susceptibility

Four studies were conducted with college student subjects to examine: (1) perceptions of susceptibility to health and safety risks; (2) factors that subjects see as important in determining their susceptibility; and (3) subjects' actual standing on objective risk factors. Subjects were generally unbiased about hereditary risk factors and were even somewhat pessimistic about environmental risk factors. Their views of their own actions and psychological attributes, however, were excessively optimistic. Few acknowledged actions or psychological attributes that increased their risk. This pattern of findings helps to explain why risks thought to be controllable (i.e., preventable by personal action) are likely to evoke unrealistic optimism about susceptibility. Family histories of health problems were incorporated into judgments of susceptibility, but, except for smoking, correlations between behavioral risk factors and judgments of susceptibility were surprisingly weak. Self-esteem enhancement is suggested as a motive that could explain many of the present findings. Several recommendations are offered for health campaigns that seek to produce more realistic perceptions of susceptibility to health and safety problems.     

THE COST-EFFECTIVENESS OF WORKSITE WELLNESS PROGRAMS FOR HYPERTENSION CONTROL, WEIGHT LOSS, SMOKING CESSATION, AND EXERCISE

The cost-effectiveness of three types of worksite wellness programs for reducing the cardiovascular disease risk factors of employees was examined at three manufacturing plants in terms of their incremental costs and effectiveness over a comparison site that used a simpler and cheaper program design. The risks targeted were hypertension, obesity, cigarette smoking, and lack of regular physical exercise. The annual direct cost per employee for post-screening interventions was $17.68 for Site A (the comparison site that offered health education classes), $39.28 for Site B (physical fitness facility), $30.96 for Site C (health education plus follow-up counseling), and $38.57 for Site D (health education, follow-up counseling, plus plant organization for health promotion). The addition of a physical fitness facility (Site B) did not produce any incremental benefit in reducing risks, as compared with health education classes (Site A), and Site B showed the lowest percentage of employees exercising regularly at the end of the 3-year study period. In contrast, the sites that used systematic outreach and follow-up counseling (Sites C and D) were more effective than both     

Different measures of risk perceptions and distress yield different patterns of results: the importance of specificity in measurement and theory

There is little consensus on how to conceptualize and measure both cognitive perceptions of risks and affective responses to risks. We report data on two measures of risk perceptions and affective responses, as well as attendance behaviour, for 226 women who received a normal test result and 180 women who received a first or non-consecutive inadequate cervical smear test result. Different measures of risk perceptions (cognition) and distress about test result (affect) were not always strongly associated, often yielding markedly different patterns of results. This highlights the need for more precise reporting of measures and greater specificity of theoretical predictions. Suggestions for further studies investigating cognitive and affective reactions to health risk information are outlined.     

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.     

Couples with Schizophrenia "Becoming like Others" in South Korea: Marriage as Part of a Recovery Process

Very little is known about the married life of couples with schizophrenia. In this paper, authors report perceptions and experiences of 5 married couples with schizophrenia on their strategies in forming and maintaining healthy marriage. Our data reveal that participants had realistic expectations of marriage, and recognized benefits as well as obstacles in their marriages with respect to their recovery. This paper examines the importance of extended family members, mental health professionals, and the larger society's attitudes toward marriage as a factor in the recovery process for persons with schizophrenia. The authors identify implications for mental health professionals regarding the respect of client dignity and the applicability of a strengths perspective when working with couples with schizophrenia. The authors argue that mental health professionals' decisions regarding the balance between respecting a client's self-determination and protecting a client from risks associated with cohabitation and marriage should no longer be a dilemma for those working with people with mental illness.     

Emotions,Risk Perceptions,and Precautionary Behavior Under the Threat of Terror Attacks: A Field Study Among Israeli College Students

The current study uses the unique data from a natural experiment conducted in a college located in southern Israel that was exposed to rocket attacks in 2008. The study examines the relationships between the negative emotions, the perceptions of risk to oneself, the precautionary actions, and the intentions of 290 students who were exposed to terror attacks while on campus. In addition, we compared the emotions, the risk perceptions, and the precautionary behavior between the two groups: those who lived within the range of the rockets and were also exposed to rocket attacks at home and those who lived outside the range of the rockets. The results show that the risk perceptions were affected mainly by the emotion of fear while the students were on campus. In particular, fearful people became more pessimistic about their general and personal risks from terror but not about routine risks. The results also reveal that those who lived outside the rocket area (and had less or no experience with terror attacks) were more likely to take precautionary actions during their stay in the campus and were more pessimistic about continuing their studies in college in the coming year than those living in the area, who had more experience with terror attacks. Copyright © 2011 John Wiley & Sons, Ltd.     

Suicide survivors' perceptions of the treating clinician

Seventy-one suicide survivors were surveyed about their perceptions of the clinicians who were treating their loved one at the time of death. Survivors provided information regarding their perceptions and attitudes toward clinician behaviors before and after the suicide and their perceptions of helpful and troubling aspects of clinician behaviors. Results indicated that survivors share a number of common opinions regarding the mental health care providers treating their loved ones. Several differences existed between survivors who consider lawsuits against mental health care providers versus those who do not. The implications of these findings for clinical practice, legal issues, surviving suicide, and future research are discussed.     

Long-term Evaluation of Genetic Counseling Following False-Positive Newborn Screen for Cystic Fibrosis

This cross-sectional mixed method study was a long-term follow-up evaluation of families who participated in an earlier survey of their understanding of cystic fibrosis (CF) genetics and their infants’ false-positive CF newborn screening (NBS) results. Thirty-seven of the original 138 parents participated in the follow-up telephone survey. Results showed parents who received genetic counseling at the time of their infants’ diagnostic sweat tests had significantly higher long-term retention of genetic knowledge than those without genetic counseling. However, both groups still had misconceptions and lacked accurate information about the actual risk associated with being a CF carrier. Most parents either had already informed (65%) or planned to inform (19%) their children about the child’s carrier status. Mean child age at the time of disclosure was 9.2 years. Situational prompts were the most common reasons for informing their children. Neither parental knowledge, medical literacy, nor parental education predicted whether parents informed their children about their carrier status. False-positive NBS results for CF were not associated with parental perceptions of child vulnerability 11–14 years after the testing. Although the sample from this study was small, these findings underscore the benefits of genetic counseling at the time of the diagnostic sweat test and offer information that can assist parents in talking with their children about the implications of having one CFTR mutation.     

Cognitive antecedents to adolescent health risk: Discriminating between behavioral intention and behavioral willingness

Abstract

A model of adolescent health risk behavior that is both cognitive and social-psychological in orientation is described, and an aspect of the model is tested empirically. The model suggests that health risk behaviors (e.g., smoking or drunk driving), especially among adolescents, are not always intended or premeditated, but instead are often reactions to risk-conducive circumstances. Because they are not entirely premeditated, such behaviors are not accurately predicted by “traditional” behavioral intention measures, but are predicted by a central construct in the model labeled behavioral willingness. Results of two studies indicate that both intention (expectation) and willingness measures predict future risk behaviors, and do so independent of one another. Additional analyses provide further evidence of discriminant validity between the two constructs by indicating that they relate differently to perceptions of personal vulnerability to the health risks associated with these behaviors.     

Using the Implicit Association Test to Assess Children's Implicit Attitudes toward Smoking

The development and psychometric properties of an Implicit Association Test (IAT) measuring implicit attitude toward smoking among fifth grade children were described. The IAT with "sweets" as the contrast category resulted in higher correlations with explicit attitudes than did the IAT with "healthy foods" as the contrast category. Children with family members who smoked (versus non-smoking) and children who were high in sensation seeking (versus low) had a significantly more favorable implicit attitude toward smoking. Further, implicit attitudes became less favorable after engaging in tobacco prevention activities targeting risk perceptions of addiction. Results support the reliability and validity of this version of the IAT and illustrate its usefulness in assessing young children's implicit attitude toward smoking.     

Quality of life after quitting smoking and initiating aerobic exercise

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