Health Education Research - Advance Access

Efficacy of a single computer-tailored e-mail for smoking cessation: results after 6 months

Te Poel, F., Bolman, C., Reubsaet, A., de Vries, H. — 2009-07-02

To date, few Internet-delivered smoking cessation interventions have been tested. This study tested the efficacy, understandability, credibility and personal relevance of an e-mail-delivered computer-tailored smoking cessation intervention. It included tailored action plan feedback, as recent studies have demonstrated the importance of planning in facilitating quitting smoking. Participants (Dutch adults) were randomly assigned to the intervention (computer-tailored e-mail; N = 224) or the control group (generic, non-tailored e-mail; N = 234). The results 6 months after baseline (N = 195) showed that significantly more participants in the intervention group reported not having smoked in the last 24 hours (21.5%) and 7 days (20.4%) in contrast with participants in the control group (9.8 and 7.8%, respectively). Intention-to-treat analyses revealed similar results, though overall lower quitting percentages. Furthermore, participants in the intervention group appreciated the computer-tailored e-mail significantly more in terms of understandability, credibility and personal relevance. Hence, the computer-tailored intervention is effective for the Dutch smoking population motivated to quit smoking. Further research is needed into the efficacy of the intervention for smokers who are not motivated to quit smoking and into the benefits of (multiple) e-mail-delivered tailored letters with tailored action plan feedback over and above tailoring without action plan feedback.

'My friends love to tan': examining sensation seeking and the mediating role of association with friends who use tanning beds on tanning bed use intentions

Banerjee, S. C., Greene, K., Bagdasarov, Z., Campo, S. — 2009-07-02

This paper explored how sensation seeking contributes to the likelihood of tanning bed use intentions both directly and indirectly through the way it shapes interaction with peers who use tanning beds and attitudes toward tanning bed. Eight hundred and ninety six (n = 896) male and female college students were recruited for the study. Measured variables included sensation seeking, association with friends who use tanning beds, attitudes toward tanning and tanning bed use intentions. Structural equation modeling was performed to test the hypotheses. In general, results supported the proposed hypotheses and documented that sensation seeking is indirectly associated with tanning bed use intentions through the mediation of association with peers who use tanning beds and attitudes toward tanning. The article discusses theoretical and methodological implications of the findings demonstrating the pathways of influence of sensation seeking on tanning bed use intentions.

Impact of a mass media campaign linking abdominal obesity and cancer: a natural exposure evaluation

Morley, B., Wakefield, M., Dunlop, S., Hill, D. — 2009-07-01

A mass media campaign aired in the Australian state of Victoria aimed to increase awareness and encourage identification of the abdominal circumference for men and women that placed them at increased risk of cancer. The evaluation assessed the extent to which ad exposure was associated with improvement in awareness, intentions and behaviours with respect to weight and cancer. Respondents were overweight or obese adults aged 30–69 years and exposure to the advertisement occurred via commercial television programmes in a natural setting. Questionnaire assessment occurred before, immediately after and 2 weeks following exposure to the advertising, and a comparison group who did not recall the ad completed the same interviews. For the main analyses, the exposure group was those who recalled the advertisement at post-exposure and follow-up (n = 101). Those who did not recall it at either stage comprised the unexposed group (n = 81). The campaign achieved its primary objective of increased awareness of the link between obesity and cancer and the specific waist sizes indicative of risk, as well as increased behavioural intentions with respect to weight and cancer. However, it did not have an effect on self-awareness of weight status, perceived personal risk of cancer or weight loss behaviour.

Discrepancies in households and other stakeholders viewpoints on the food security experience: a gap to address

Hamelin, A.-M., Mercier, C., Bedard, A. — 2009-06-29

This paper reports results from a case study on household food insecurity needs and the interventions that address them. It aimed at comparing households’ perceptions on food insecurity experience and vulnerability to those of other stakeholders: community workers, programme managers and representatives from donor agencies. Semi-structured interviews with 55 households and 59 other stakeholders were conducted. Content analysis was performed, using a framework encompassing food sufficiency, characterization of household food insecurity and vulnerability of households to food insecurity. Overall, the results draw attention to a gap between households and the other stakeholders, where the later do not seem always able to assess the realities of food-insecure households. Other areas of divergences include: characteristics of food insecurity, relative importance of various risk factors related to food insecurity and the effectiveness of the community assistance to enhance the households' ability to face food insecurity. These divergent perceptions may jeopardize the implementation of sustainable solutions to food insecurity. Training of stakeholders for a better assessment of households’ experience and needs, and systematic evaluation of interventions, appear urgent and highly relevant for an adequate response to households’ needs. Collaboration between all stakeholders should lead to knowledge sharing and advocacy for policies dedicated to poverty reduction.

Extra-team connections for knowledge transfer between staff teams

Ramanadhan, S., Wiecha, J. L., Emmons, K. M., Gortmaker, S. L., Viswanath, K. — 2009-06-15

As organizations implement novel health promotion programs across multiple sites, they face great challenges related to knowledge management. Staff social networks may be a useful medium for transferring program-related knowledge in multi-site implementation efforts. To study this potential, we focused on the role of extra-team connections (ties between staff members based in different site teams) as potential channels for knowledge sharing. Data come from a cross-sectional study of afterschool childcare staff implementing a health promotion program at 20 urban sites of the Young Men’s Christian Association of Greater Boston. We conducted a sociometric social network analysis and attempted a census of 91 program staff members. We surveyed 80 individuals, and included 73 coordinators and general staff, who lead and support implementation, respectively, in this study. A multiple linear regression model demonstrated a positive relationship between extra-team connections (β = 3.41, P < 0.0001) and skill receipt, a measure of knowledge transfer. We also found that intra-team connections (within-team ties between staff members) were also positively related to skill receipt. Connections between teams appear to support knowledge transfer in this network, but likely require greater active facilitation, perhaps via organizational changes. Further research on extra-team connections and knowledge transfer in low-resource, high turnover environments is needed.

Do we believe the tobacco industry lied to us? Association with smoking behavior in a military population

2009-06-15

Despite the dangers of smoking, tobacco companies continue to impede tobacco control efforts through deceptive marketing practices. Media campaigns that expose these practices have been effective in advancing anti-industry attitudes and reducing smoking initiation among young people, yet the association between knowledge of industry practices and smoking cessation and relapse has not been studied. In a large military sample entering Air Force Basic Military Training (BMT), where tobacco use is prohibited, we investigated (i) the prevalence of agreement with a statement that tobacco companies have misled the public about the health consequences of smoking and (ii) the association of this acknowledgement with smoking status upon entry into BMT (N = 36 013). At baseline, 56.6% agreed that tobacco companies have been deceptive, and agreement was a strong predictor of smoking status [smokers less likely to agree, odds ratio (OR) = 0.39, P < 0.01]. At 12-month follow-up, we examined the association between industry perception at baseline and current smoking status (N = 20 672). Recruits who had been smoking upon entry into BMT and who had acknowledged industry deception were less likely to report current smoking (OR = 0.84, P = 0.01). These findings suggest that anti-industry attitudes may affect smoking relapse following cessation.

Prevention of adolescents' music-induced hearing loss due to discotheque attendance: a Delphi study

Vogel, I., Brug, J., Van der Ploeg, C. P. B., Raat, H. — 2009-06-12

Noise-induced hearing loss is a significant social and public health problem, which is found in increasing numbers of adolescents. Young people are particularly likely to expose themselves to potentially damaging loud sounds during leisure activities. Visiting discotheques is one of the most popular leisure activities of young people. Only a few minutes exposure to the sound levels played in discotheques can cause permanent hearing loss. Since little is known about what constitutes effective prevention strategies, we explored the opinions and ideas of 30 experts in a qualitative study consisting of a three-round web-based Delphi study. The main parties involved in the prevention of music-induced hearing loss due to discotheque attendance are as follows: the adolescents themselves, followed by the government, discotheque owners, decorators of discotheques and disk jockeys (DJs). None of the identified protective behaviors of adolescents was considered to be feasible. Five environmental interventions were identified as being both relevant and feasible; of these, the most important were that loudspeakers must be placed further away from the visitors and that discotheques have attractive, low-volume and clearly indicated ‘chill-out rooms’. Effective prevention strategies to avoid music-induced hearing loss among adolescents due to discotheque attendance need to be taken primarily by discotheque owners and disk jockeys.

Disclosing donation decisions: the role of organ donor prototypes in an extended theory of planned behaviour

Hyde, M. K., White, K. M. — 2009-06-12

This study explored the role of donor prototype evaluations (perceptions of the typical organ donor) in organ donation communication decisions using an extended theory of planned behaviour (TPB) model. The model incorporated attitude, subjective norm, perceived behavioural control, moral norm, self-identity, and donor prototype evaluations to predict intentions to record consent on an organ donor register and discuss the organ donation decision with significant others. Participants completed surveys assessing the extended TPB constructs related to registering (n = 359) and discussing (n = 282). Results supported a role for donor prototype evaluations in predicting discussing intentions only. Both extended TPB structural equation models were a good fit to the data, accounting for 74 and 76% of the variance in registering and discussing intentions, respectively. Participants’ self-reported discussing behaviour (but not registering behaviour given low numbers of behavioural performers) was assessed 4 weeks later, with discussing intention as the only significant predictor of behaviour (Nagelkerke R² = 0.11). These findings highlight the impact of people's perceptions of a typical donor on their decisions to discuss their organ donation preference, assisting our understanding of the factors influencing individuals' communication processes in efforts to bridge the gap between organ supply and demand.

Cannabis and tobacco use: where are the boundaries? A qualitative study on cannabis consumption modes among adolescents

Akre, C., Michaud, P.-A., Berchtold, A., Suris, J.-C. — 2009-06-10

The purpose of this article is to identify tobacco and cannabis co-consumptions and consumers’ perceptions of each substance. A qualitative research including 22 youths (14 males) aged 15–21 years in seven individual interviews and five focus groups. Discussions were recorded, transcribed verbatim and transferred to Atlas.ti software for narrative analysis. The main consumption mode is cannabis cigarettes which always mix cannabis and tobacco. Participants perceive cannabis much more positively than tobacco, which is considered unnatural, harmful and addictive. Future consumption forecasts thus more often exclude tobacco smoking than cannabis consumption. A substitution phenomenon often takes place between both substances. Given the co-consumption of tobacco and cannabis, in helping youths quit or decrease their consumptions, both substances should be taken into account in a global approach. Cannabis consumers should be made aware of their tobacco use while consuming cannabis and the risk of inducing nicotine addiction through cannabis use, despite the perceived disconnect between the two substances. Prevention programs should correct made-up ideas about cannabis consumption and convey a clear message about its harmful consequences. Our findings support the growing evidence which suggests that nicotine dependence and cigarette smoking may be induced by cannabis consumption.

A review of undergraduate university tobacco control policy process in Canada

2009-05-18

The college years occur during the stage of life when many people develop permanent smoking habits, and approximately one-third go on to become addicted smokers. The 18–24 year demographic that makes up the majority of undergraduate attendees represents the earliest years that the tobacco industry now can legally attempt to lure new customers into smoking. This research investigated the ways in which university tobacco control policies are developed, introduced to students, faculty and staff and how they are implemented and enforced. Findings show that tobacco control initiatives at Canadian undergraduate universities face a wide range of challenges including a lack of dedicated and consistent tobacco control personnel, ownership issues, funding, enforcement and monitoring dilemmas. Participants also reported that the layout and geographic location of the campus can result in difficulties in implementation. Consequently, it appears that there may be a growing, although inadvertent, tolerance for smoking on Canadian campuses.

Early fatherhood: a mapping of the evidence base relating to pregnancy prevention and parenting support

Trivedi, D., Brooks, F., Bunn, F., Graham, M. — 2009-04-30

Teenage pregnancy prevention programmes targeted at young women have received considerable attention from researchers and programme developers. However, to date, relatively limited information is available on preventing teenage fatherhood or improving outcomes for young fathers. A notable gap is concerned with understanding the forms of sexual health programmes that are most effective from the perspective of young men. We conducted a systematic mapping to identify studies involving young men aimed at preventing teenage pregnancy, improving outcomes for teenage fathers or exploring the perspectives of young men around pregnancy and fatherhood. We searched a wide range of electronic databases from January 1996 to August 2008. Three quantitative and 15 qualitative studies were identified, of which nine were UK based. Key themes related to the inappropriateness of current sexual health promotion to respond to the needs of young men. While young men often possessed very similar ideals to young women, existing programmes were problematic when they negatively stereotyped young men and ineffectively addressed models of masculinity or the difficulties young men may have forming meaningful relationships. Further investigations are required on programme development for young men, particularly on sexual health promotion interventions for ‘looked-after’ young men and those from unstable childhoods.

Use of focus group data to develop recommendations for demographically segmented colorectal cancer educational strategies

2009-04-24

Screening is available and effective in colorectal cancer (CRC) control, but underutilized. The purpose of this study was to use focus group data to develop recommendations for the development of educational interventions to increase CRC screening, using an audience segmentation strategy. Demographic segments were based on urban–rural residence, race (African-American, White) and sex. One hundred and sixty-five participants age 50+, with no history of CRC participated in 17 focus groups in Alabama urban and rural communities. Transcripts were examined by independent coders. Knowledge among participants was limited regarding age to begin screening, insurance coverage and risk factors for CRC. Perceived barriers to screening included lack of physician recommendation, cost/lack of insurance coverage, pain/discomfort and embarrassment. African-American men reported postponement in seeing their physicians. White women were proactive at initiating discussion of CRC screening with their providers while African-American women felt that providers should drive the process. No urban–rural differences were identified. This study identified cultural and gender characteristics and perceptions that can be used in the development of demographically segmented health communication interventions to increase CRC awareness and screening.

Mobilizing men as partners: the results of an intervention to increase dual protection among Nigerian men

2009-04-09

This quasi-experimental, proof-of-concept study evaluated the effects of an intervention designed to help Nigerian men decrease risk for HIV/sexually transmitted infections and unintended pregnancy. The intervention was delivered in groups during two 5-hour workshops, with a monthly 2-hour check-in session. A comparison condition consisted of a group-based half-day didactic workshop. Based on recruitment area, 149 men were assigned to the intervention and 132 to the comparison. Men were evaluated at baseline and 3-month post-intervention. At follow-up, men assigned to the intervention were almost four times more likely than comparison men to report condom use at last intercourse (P < 0.001) and to report fewer unprotected vaginal sex occasions, greater self-efficacy for negotiation, a more egalitarian power dynamic in their primary relationship, more positive expectations for condom use and greater intention for future consistent condom use (all P values < 0.05). Findings suggest that this intervention is both feasible and effective.

Smoking among Dutch elementary schoolchildren: gender-specific predictors

Ausems, M., Mesters, I., van Breukelen, G., De Vries, H. — 2009-04-07

Higher rates of smoking initiation and continuation by female compared with male adolescents, as found in many developed countries, may call for gender-specific prevention programs. Risk factors of smoking initiation and continuation were examined prospectively (1997–2002) among 3205 Dutch elementary schoolchildren (mean age 11.64) in an intervention trial using written questionnaires and multilevel logistic regression. At baseline, smoking prevalence was lower among girls than among boys; at follow-up, smoking initiation was lower among girls than among boys. Concerning smoking initiation, girls and boys shared the following risk factors: age, modeling from parents and siblings (‘modeling nuclear’), modeling from other members in the social circle (‘modeling diffuse’) and perceived pro-tobacco pressure to smoke. The only gender-specific predictor of smoking initiation was parent origin; girls with non-Dutch parents could be targeted for prevention programs. Concerning continuation, girls and boys shared the following risk factors: older age, more modeling nuclear and diffuse, fewer smoking disadvantages and lower self-efficacy to refrain from smoking. This study confirms that social modeling, smoking attitude and self-efficacy information to refrain from smoking deserve a prominent place in smoking prevention programs for schoolchildren. Besides booster sessions, family-directed programs are suggested. No gender-specific predictors of later smoking initiation were found, apart from parent origin, which is not amenable to intervention.

Mass media campaign improves cervical screening across all socio-economic groups

Anderson, J. O., Mullins, R. M., Siahpush, M., Spittal, M. J., Wakefield, M. — 2009-04-02

Low socio-economic status (SES) has been associated with lower cervical screening rates. Mass media is one known strategy that can increase cervical screening participation. This study sought to determine whether a mass media campaign conducted in Victoria, Australia, in 2005 was effective in encouraging women across all SES groups to screen. Data were obtained from the Victorian Cervical Cytology Registry for each Pap test registered during 2005 and categorized into SES quintiles using the Index of Socio-Economic Advantage/Disadvantage. Negative binomial regression was used to determine the impact of the campaign on the weekly number of Pap tests and whether the media campaign had a differential effect by SES, after adjusting for the number of workdays per week, age group and time since previous test. Cervical screening increased 27% during the campaign period and was equally effective in encouraging screening across all SES groups, including low-SES women. Mass media campaigns can prompt increased rates of cervical screening among all women, not just those from more advantaged areas. Combining media with additional strategies targeted at low-SES women may help lessen the underlying differences in screening rates across SES.

Baseline survey of sun protection policies and practices in primary school settings in New Zealand

Reeder, A. I., Jopson, J. A., Gray, A. — 2009-04-02

The SunSmart Schools Accreditation Programme (SSAP) was launched as a national programme in October 2005 to help reduce the risk of excessive child exposure to ultraviolet radiation. As part of the need for evaluation, this paper reports the findings of a national survey of a randomly selected sample of approximately 12% of New Zealand primary schools prior to the national launch of the SSAP. Principals at 242 schools completed a mail survey (81% response rate) relating to school sun protection policies, practices, curriculum and environment. Survey responses were evaluated according to the 12 criteria of the SSAP, with schools assigned a score from 0 to 12. No school fully met all 12 accreditation criteria, although 2% of schools attained 11 criteria and another 2% attained 10. Nine per cent of schools attained three or fewer criteria. Overall, 7 was the most common score, achieved by 23%. School socio-economic decile rating and roll size were positively associated with higher scores (both P < 0.02). Continued support and resources are needed to encourage schools to address sun protection across the spectrum of curriculum, practices and environment and through commitment to written policy.

Secretos de la Buena Vida: processes of dietary change via a tailored nutrition communication intervention for Latinas

2009-04-01

Secretos de la Buena Vida was a successful tailored nutrition communication intervention delivered to Latinas living along the US–Mexico border in California. The intervention was delivered over a 14-week period and consisted of three intervention conditions: weekly home visits with promotoras + weekly tailored mailed newsletters in the first condition, weekly tailored mailed newsletters in the second condition and targeted materials in the attention control condition. The current study examined what elements of the promotora + tailored newsletter and tailored newsletter-only conditions were most effective for behavioral adoption and maintenance in a sample of 238 Latina women. Process evaluation measures assessed the implementation, fidelity and dose of these two intervention conditions. Results indicate that there was high fidelity to program implementation and delivery. Perceived effort, perceived support and intervention length predicted adoption of a lower fat diet at the 15-month follow-up. In the promotora + tailored newsletter condition, married women were four times more likely to be adopters of dietary fat changes than single women. These findings highlight the importance of process evaluation measures and help us understand the mechanism by which tailored print materials and interpersonal health communication via promotoras can facilitate health behavior change.

Daughter-initiated health advice to mothers: perceptions of African-American and Latina daughters

Mosavel, M., Thomas, T. — 2009-04-01

The prevailing paradigm of health exchange within the family is for health advice to flow from parent to child. Consistent with this pattern of exchange, most research has focused on the one-directional influence of the parent on the child and there is thus an absence of literature that explores the ability of adolescents to influence their parents' health behaviors. This qualitative study addressed this gap by exploring the feasibility of daughters providing health advice to their mothers. Twelve focus groups were conducted with 78 African–American and Latina daughters between the ages of 12 and 17 from low-income neighborhoods in a Mid-Western city in the United States. This study utilized a grounded theory approach to examine the focus group data. The findings indicate that many daughters report that they are already giving their mothers a wide spectrum of advice, including health advice. Differences were found in the reported willingness of African–American daughters when compared to Latina daughters to provide their mothers with specific cancer advice. These data suggest that some of these daughters have the potential to be valuable health education conveyers in the family.

Smoking cessation and diabetes control in Kerala, India: an urgent need for health education

Thresia, C.U., Thankappan, K.R., Nichter, M. — 2009-03-30

This study documented the tobacco use among male diabetes patients in a clinic-based population of urban India, patient reports of physician cessation messages and patients’ perception of tobacco use as a risk factor for diabetes complications. All the 444 male diabetes patients who attended three public sector hospitals in Thiruvananthapuram district, Kerala, were surveyed to ascertain their tobacco use as well as the frequency and content of quit messages received from health staff. A significant proportion (59%) of diabetes patients were tobacco users prior to diagnosis and more than half of them continued to use tobacco, many daily, even after diagnosis. Of the 100 current smokers, 75% were asked about their tobacco use at the time of diagnosis; of those, 52% were advised to quit. However, a lack of patient awareness existed regarding the linkages of smoking and diabetes complications. Notably, 52% of patients did not associate smoking with diabetes complications. Given the magnitude of tobacco use among diabetics, there is clearly a need for more proactive cessation efforts. The times of illness diagnosis, illness flare-ups and emerging illness complications are teachable moments when patients are primed to change their behavior and more motivated to quit tobacco.

Everybody's talking: using entertainment-education video to reduce barriers to discussion of cervical cancer screening among Thai women

Love, G. D., Mouttapa, M., Tanjasiri, S. P. — 2009-03-30

Although Southeast Asian women are at exceedingly high risk for cervical cancer, low rates of the Pap testing necessary for early detection and successful treatment continue among this group. Previous research suggests that discussions about Pap testing with important people in a woman's life, particularly her doctor, may increase the likelihood of screening; therefore increasing women's discussions about cancer screenings is an important step toward behavior change. The purpose of this study was to determine the effectiveness of a culturally sensitive, seven-minute video intervention in reducing barriers to discussions about Pap tests among Thai women. This unique video presented Thai actors, speaking in Thai, in a soap opera format. Participants completed a self-report questionnaire at baseline, immediately after the intervention and at 3-month follow-up. The comparison group received an educational pamphlet. Although the results indicated that both groups experienced reductions in barriers to communicating with others about Pap tests, the intervention group had significantly stronger outcomes than the comparison group for communicating about Pap tests in general as well as to doctors. These findings suggest that intermediate communication effects such as self-efficacy, collective efficacy and perhaps interpersonal communication may reduce barriers to discussion and positive decision making regarding Pap tests.

Results from the Active for Life process evaluation: program delivery fidelity and adaptations

2009-03-26

Active for Life® (AFL) was a large (n = 8159) translational initiative to increase physical activity (PA) in midlife and older adults. Translational research calls for a shift in emphasis from just understanding what works (efficacy) to also understanding how it works in more ‘real world’ settings. This article describes the process evaluation design and findings, discuss how these findings were used to better understand the translational process and provide a set of process evaluation recommendations with community-based translational research. AFL community organizations across the United States implemented one of two evidence-based PA programs (Active Living Every Day—The Cooper Institute; Human Kinetics Inc. or Active Choices—Stanford University). Both programs were based on the transtheoretical model and social cognitive theory. Overall, the process evaluation revealed high-dose delivery and implementation fidelity by quite varied community organizations serving diverse adult populations. Findings reveal most variation occurred for program elements requiring more participant engagement. Additionally, the results show how a collaborative process allowed the organizations to ‘fit’ the programs to their specific participant base while maintaining fidelity to essential program elements.

The compensatory health beliefs scale: psychometric properties of a cross-culturally adapted scale for use in The Netherlands

de Nooijer, J., Puijk-Hekman, S., van Assema, P. — 2009-03-24

This study assesses the psychometric properties of a measuring scale for compensatory health beliefs (CHBs), culturally adapted for use in the Dutch context. CHBs refer to the idea that people can compensate for unhealthy (mostly pleasant) behaviours with healthy behaviours, e.g. ‘It is OK to eat a chocolate bar, because I am going to the gym tonight’. We are critical towards such beliefs as they may also be an excuse to justify unhealthy behaviours. Before such effects can be studied, an appropriate tool to measure CHBs must be developed. We adapted a Canadian scale, consisting of four factors relating to beliefs about substance use, eating/sleeping habits, stress and weight regulation, translating it according to guidelines for cross-cultural adaptation and testing it among 145 Dutch students. Factor analysis showed that the structure was not entirely identical in the Dutch context, and the internal consistency of the four subscales was also low. The overall scale showed a high internal consistency ( = 0.78), indicating the existence of an underlying construct, and a high Pearson correlation between the first and second measurements (r = 0.82), showing good stability. We recommend using the overall scale and further studying its reliability among other subgroups as well as its validity.

Stages of mammography adoption in Asian American women

Wu, T.-Y., Hsieh, H. F., West, B. T. — 2009-03-24

Asian American women have the lowest mammography screening rate and are often diagnosed at later stages of breast cancer compared with other ethnic groups. This study applied the Transtheoretical Model and examined the relationships between stages of mammography adoption and mammography-related beliefs while controlling for socio-demographic factors. The study consisted of a convenience sample of 315 participants from four populous Asian ethnic groups in Michigan (109 Asian Indians, 51 Chinese, 36 Koreans and 119 Filipinos). In this relatively small sample, Koreans appeared to be more likely to be at the pre-contemplation stage and less likely to be at the maintenance stage. Perceived barriers and decisional balance scores differed by stage, with pre-contemplators reporting highest barriers and lowest scores in decisional balance. In terms of specific barrier items, pre-contemplators also displayed significantly greater agreement for most of the barrier items. Participants in the action stage have less favorable decisional balance than those in two earlier stages (i.e. contemplation and relapse). Common barriers for this sample of Asian participants included the items related to access and modesty issues. Overall, the study supports the notion that assessing differences in mammography-related beliefs by stage of screening behavior may facilitate the development of stage-matched interventions for Asian ethnic groups.

The effect of a handwashing intervention on preschool educator beliefs, attitudes, knowledge and self-efficacy

Rosen, L., Zucker, D., Brody, D., Engelhard, D., Manor, O. — 2009-03-24

This paper describes the effect of a preschool hygiene intervention program on psychosocial measures of educators regarding handwashing and communicable pediatric disease. A cluster-randomized trial, with randomization at the level of the preschool, was run in 40 Jerusalem preschool classrooms. Eighty preschool educators participated. The program used a multipronged approach which included elements aimed at staff, children, parents, school nurses and the classroom environment. Frontal lectures by medical, epidemiological and educational experts, along with printed materials and experiential learning, were provided to staff. Responses from a validated survey instrument were used to build four scales for each respondent regarding beliefs, attitudes, self-efficacy and knowledge. The scales were built on a Likert-type 1–7 scale (1 = minimum, 7 = maximum). The effect of the intervention was tested using mixed model analysis of variance. Response was received from 92.5% of educators. Educators believed that handwashing could affect health (mean = 5.5, SD = 1.1), had high levels of self-efficacy (mean = 6.1, SD = 0.9) and had positive attitudes toward handwashing (mean = 5.7, SD = 1.2). Knowledge was affected by the intervention (intervention: mean = 6.2, SD = 0.7; control: mean = 5.8, SD = 0.8). The combination of positive attitudes toward handwashing among educators and the program's effectiveness in imparting knowledge helped to create a sustained social norm of handwashing among many children in disparate locations.

Psychosocial correlates of leisure-time walking among Australian adults of lower and higher socio-economic status

Janssen, E., Sugiyama, T., Winkler, E., de Vries, H., te Poel, F., Owen, N. — 2009-03-23

Adults of lower socio-economic status (SES) participate less in physical activity than those of higher SES. Understanding the correlates of physical activity participation and how these may differ between socio-economic groups can inform policies and physical activity promotion strategies. The psychosocial correlates of leisure-time walking (the most common voluntary physical activity of adults) were assessed using a survey of 2488 randomly sampled Australian adults (response rate = 74.2%). Among respondents of higher SES, there were higher levels of positive cognitions towards physical activity, and walking for leisure was more prevalent than among those of lower SES. Relationships of psychosocial attributes with leisure-time walking differed by SES. The strongest correlate of leisure-time walking was perceived barriers for lower SES adults and enjoyment for those of higher SES. Social support from friends was associated with walking for both groups, while the effect of support from family was significant only for adults of lower SES. Strategies influencing leisure-time walking may have to target the specific needs of different socio-economic groups. For example, removing perceived barriers may be more appropriate to promote walking among lower SES adults. Interventions tailored for lower SES groups may help close the socio-economic gap in physical activity participation.

A qualitative exploration of the community partner experience in a faith-based breast cancer educational intervention

Rodriguez, E. M., Bowie, J. V., Frattaroli, S., Gielen, A. — 2009-03-23

Although community partner engagement is a key component in faith-based health promotion/disease prevention intervention research, the perspective of community partners on their experiences in the intervention process has been infrequently investigated. Semi-structured in-depth interviews were conducted with 12 African-American community partners [i.e. four pastors and eight lay health co-ordinators (LHCs)] from eight churches in greater Baltimore, MD, USA, that engaged in a breast cancer educational intervention that followed a community-based participatory research (CBPR) approach. Audiotaped interviews were transcribed, coded and content analysis was used to identify themes across the codes. Findings show that pastors support a holistic approach to health and that LHCs act as a link between the pastors, participants and academic researchers. In addition, pastors and LHCs emphasized that the religious and/or spiritual program elements should not overpower the importance of reaching participants with critical health information regardless of their religious or spiritual beliefs. Study findings suggest that faith-based educational intervention efforts that follow a CBPR approach are important in promoting cancer awareness in the African-American community. Including community partner assessment can further elucidate critical intervention impacts and helps to address health disparities in underserved communities.

African-American caregivers' breast health behavior

Inoue, M., Pickard, J. G., Welch-Saleeby, P., Johnson, S. — 2009-03-23

This study utilizes a stress and coping framework which includes cognitive appraisal, personal and environmental resources, coping and stress to examine factors related to African-American caregivers’ breast cancer screenings, including mammograms, clinical examinations and self-examinations. Using data from the Black Rural and Urban Caregivers Mental Health and Functioning Study, we performed separate logistic regressions for each type of breast cancer screening. Results reveal that having a regular doctor checkup (coping), care recipients having a cancer diagnosis (cognitive appraisal, and living in urban areas (environment resources) are associated with receiving a mammogram. Having greater income, having at least a high school degree (both personal resources) and having a regular doctor checkup (coping) are associated with receiving a clinical examination. Increased caregiver strain (stress), being 40 years old or older, social support (coping) and living in rural areas are associated with performing a self-examination. Targeting African-American caregivers, particularly in rural areas, for increased education on the importance of receiving breast cancer screenings is crucial to addressing health disparities. Making resources available, encouraging caregivers to get a clinical examination and a mammogram and directing public education toward caregivers are important points of intervention.

Which patient-related factors determine self-perceived patient adherence to prescribed dyspepsia medication?

2009-03-20

Patient adherence to medical treatment for dyspepsia is disappointing, whereas adherence is crucial for a proper evaluation of treatment. This prospective study used elements of the Integrated Change Model and Weiner's Attribution Theory to describe patients' important cognitions and their interrelationships regarding self-perceived adherence to short-term medical treatment for dyspepsia. Patient questionnaires measured the predictors before treatment and self-perceived adherence after treatment. Approximately one-quarter of the patients indicated that they were non-adherent (n = 347). Univariate and multiple linear regression analyses revealed several significant predictors that explained 44% of the variance in self-perceived adherence. Patients with a low educational level, patients who claimed to regularly forget their medication in general, patients with a low self-efficacy or a low intention were less likely to be adherent. These results may indicate targets for interventions designed to improve adherence to medical treatment for dyspepsia. For instance, asking about expected difficulties in taking acid suppressants (e.g. forgetfulness or medication use at weekends) and making action plans to overcome these difficulties (e.g. using reminders) may result in improved adherence rates. Such an approach may reach a substantial number of patients since one in five patients in our study experienced some difficulties in taking medication.

Process evaluation of a school-based weight gain prevention program: the Dutch Obesity Intervention in Teenagers (DOiT)

Singh, A. S., Chinapaw, M. J. M., Brug, J., van Mechelen, W. — 2009-03-20

Health promotion programs benefit from an accompanying process evaluation since it can provide more insight in the strengths and weaknesses of a program. A process evaluation was conducted to assess the reach, implementation, satisfaction and maintenance of a school-based program aimed at the prevention of excessive weight gain among Dutch adolescents [Dutch Obesity Intervention in Teenagers (DOiT)]. Our process evaluation involved data collections by means of questionnaires among students, teachers, school board and site staff. The results indicated immense difficulties in the recruitment phase and therefore a low reach at school level. However, among adolescents of the schools that participated, the reach was high (84%). Furthermore, the classroom intervention was implemented successfully based on the number of lessons taught. Most teachers rated the DOiT-intervention positively; students rated the intervention 6.6 on a scale of 1–10. The majority of the teachers planned to implement the DOiT-intervention program in the future, as they perceived DOiT feasible for pre-vocational education students.

The influence of tobacco marketing on adolescent smoking intentions via normative beliefs

Brown, A., Moodie, C. — 2009-03-13

Using cross-sectional data from three waves of the Youth Tobacco Policy Study, which examines the impact of the UK's Tobacco Advertising and Promotion Act (TAPA) on adolescent smoking behaviour, we examined normative pathways between tobacco marketing awareness and smoking intentions. The sample comprised 1121 adolescents in Wave 2 (pre-ban), 1123 in Wave 3 (mid-ban) and 1159 in Wave 4 (post-ban). Structural equation modelling was used to assess the direct effect of tobacco advertising and promotion on intentions at each wave, and also the indirect effect, mediated through normative influences. Pre-ban, higher levels of awareness of advertising and promotion were independently associated with higher levels of perceived sibling approval which, in turn, was positively related to intentions. Independent paths from perceived prevalence and benefits fully mediated the effects of advertising and promotion awareness on intentions mid- and post-ban. Advertising awareness indirectly affected intentions via the interaction between perceived prevalence and benefits pre-ban, whereas the indirect effect on intentions of advertising and promotion awareness was mediated by the interaction of perceived prevalence and benefits mid-ban. Our findings indicate that policy measures such as the TAPA can significantly reduce adolescents' smoking intentions by signifying smoking to be less normative and socially unacceptable.

Computer-tailored dietary behaviour change interventions: a systematic review

Neville, L. M., O'Hara, B., Milat, A. J. — 2009-03-13

Improving dietary behaviours such as increasing fruit and vegetable consumption and reducing saturated fat intake are important in the promotion of better health. Computer tailoring has shown promise as a strategy to promote such behaviours. A narrative systematic review was conducted to describe the available evidence on ‘second’-generation computer-tailored primary prevention interventions for dietary behaviour change and to determine their effectiveness and key characteristics of success. Systematic literature searches were conducted through five databases: Medline, Embase, PsycINFO, CINAHL and All EBM Reviews and by examining the reference lists of relevant articles to identify studies published in English from January 1996 to 2008. Randomized controlled trials or quasi-experimental designs with pre-test and post-test behavioural outcome data were included. A total of 13 articles were reviewed, describing the evaluation of 12 interventions, seven of which found significant positive effects of the computer-tailored interventions for dietary behaviour outcomes, one also for weight reduction outcomes. Although the evidence of short-term efficacy for computer-tailored dietary behaviour change interventions is fairly strong, the uncertainty lies in whether the reported effects are generalizable and sustained long term. Further research is required to address these limitations of the evidence.

Planned, motivated and habitual hygiene behaviour: an eleven country review

Curtis, V. A., Danquah, L. O., Aunger, R. V. — 2009-03-13

Handwashing with soap (HWWS) may be one of the most cost-effective means of preventing infection in developing countries. However, HWWS is rare in these settings. We reviewed the results of formative research studies from 11 countries so as to understand the planned, motivated and habitual factors involved in HWWS. On average, only 17% of child caretakers HWWS after the toilet. Handwash ‘habits’ were generally not inculcated at an early age. Key ‘motivations’ for handwashing were disgust, nurture, comfort and affiliation. Fear of disease generally did not motivate handwashing, except transiently in the case of epidemics such as cholera. ‘Plans’ involving handwashing included to improve family health and to teach children good manners. Environmental barriers were few as soap was available in almost every household, as was water. Because much handwashing is habitual, self-report of the factors determining it is unreliable. Candidate strategies for promoting HWWS include creating social norms, highlighting disgust of dirty hands and teaching children HWWS as good manners. Dividing the factors that determine health-related behaviour into planned, motivated and habitual categories provides a simple, but comprehensive conceptual model. The habitual aspects of many health-relevant behaviours require further study.

Understanding the role of self-identity in habitual risky behaviours: pedestrian road-crossing decisions across the lifespan

Holland, C. A., Hill, R., Cooke, R. — 2009-03-05

Self-identity as a careful pedestrian has not been fully considered in previous work on predicting intention to cross the road, or actual crossing behaviour, in non-optimal situations. Evidence suggests that self-identity may be a better predictor than attitudes in situations where decision-making styles have become habitual ways to respond. This study compared contributions of self-identity and attitudes to the prediction of intentions in two situations differing in level of habitual crossing expectation, and to crossing behaviour. Three hundred and sixty-two adults (17–92 years) completed a questionnaire measuring self-identity, attitudes, intentions, experience, social identity variables (e.g. age, gender) and personal limitations (mobility). Two hundred and five participants also completed a road-crossing simulation. Self-identity and attitude were both shown as significant independent predictors of intention in both situations. However, self-identity was less effective as a predictor in the higher risk scenario, where intention to perform the behaviour was lower, and for participants aged >75 years who had lower intention across scenarios. Self-identity strongly predicted intention to cross, which in turn predicted behaviour, but self-identity did not directly predict behaviour. Self-identity was strongly predicted by age. Implications for theories of compensation in older age and for design and targeting of pedestrian safety education are discussed.

Partners reducing effects of diabetes (PREDICT): a diabetes prevention physical activity and dietary intervention through African-American churches

2009-03-04

Type 2 diabetes is epidemic in the United States with greater incidence rates in African-American communities. Lifestyle interventions during the phase of insulin resistance mitigate cardiovascular risk and prevent diabetes. The primary aim of this study is to test the impact of a Community Health Advisor (CHA)-based diabetes prevention controlled intervention in urban African-American communities. In this controlled trial, church congregants in New Haven, CT, receiving a 1-year CHA-led diabetes prevention intervention were compared with church congregants in Bridgeport, CT, who did not receive an intervention. Outcome measures included physical activity, dietary pattern, anthropometric measure, social support, diabetes knowledge, nutrition and exercise self-efficacy. The results indicate that at the end of the 1-year intervention period, there were no significant differences observed between intervention and control groups. Possible explanations for the lack of change include difficulty in engaging the CHAs, variability in the CHA-led interventions, baseline discrepancies between the two sites which could not be fully controlled and loss to follow-up. The results indicate important obstacles which impeded the successful implementation of this intervention and lessons learned for future interventions.

The health impact of an online heart disease support group: a comparison of moderated versus unmoderated support

Lindsay, S., Smith, S., Bellaby, P., Baker, R. — 2009-02-27

The aim of this study was to assess whether our online closed community heart care support group and information resource could sustain changes in health behaviour after the moderators withdrew their support. Heart patients (n = 108) living in a deprived area of Greater Manchester were recruited from general practitioners’ coronary heart disease registries. The sample for this randomized controlled trial was divided in half at random where half of the participants received password-protected access to our health portal and the other half did not. At 6 months follow-up (based on the moderated phase), there was a significant difference between the experimental group and the controls in terms of self-reported diet (eating bad foods less often). This change in behaviour was not sustained during the 3-month unmoderated phase. During this unmoderated phase of the intervention, the experimental group had significantly more health care visits compared with the controls. There was no significant difference between the two phases for either group in terms of exercise, smoking or social support. This study offers insight into the potential implications for health changes of moderating arrangements for online health communities.

Health behavior interests of adolescents with unhealthy diet and exercise: implications for weight management

Thunfors, P., Collins, B. N., Hanlon, A. L. — 2009-01-30

This study sought to determine individual factors that may influence adolescents' interests in various health behaviors and, by extension, their potential interest in programs that promote healthy lifestyles and reduce obesity. The sample consisted of 737 rural Pennsylvania (United States) middle and high school students not involved in either healthy exercise or dietary behaviors (a target group for health-promoting interventions). Participants completed a self-report measure of their general health functioning, including their interests in sports programs, outdoor recreation programs, weightlifting, weight loss and healthy eating/cooking. Nurses measured body mass indices (BMIs). The vast majority of the sample endorsed self-efficacy in healthy eating and physical activity, and this self-efficacy was associated with interest in a healthy diet and outdoor recreation. Interest in healthy activities was consistently higher among 7th graders (age mean = 12.6 years) than 11th graders (age mean = 16.3 years). Females were more interested in weight loss and healthy eating/cooking, whereas males were more interested in weightlifting. Higher BMI only predicted interest in weight loss. These results indicate that adolescent health interests vary on the basis of their gender, grade level, BMI and self-efficacy. These trends are potentially important to consider when seeking to match intervention programs to adolescent interests.

Do intervention fidelity and dose influence outcomes? Results from the Move to Improve worksite physical activity program

2009-01-23

The purpose of this paper is to evaluate the implementation of the Move to Improve worksite physical activity program using a four step framework that includes the following: (i) defining the active ingredients, (ii) using good methods to measure implementation, (iii) monitoring implementation and (iv) relating implementation to outcomes. The intervention active ingredients consisted of a goal setting behavior change program, a team competition and environmental supports. Intervention fidelity and dose were measured by surveys administered to site co-ordinators, team captains and employees. Implementation was monitored by the use of biweekly assessments that tracked individual physical activity levels and through weekly reports of the project director and site co-ordinators. Latent growth modeling was conducted to determine whether intervention outcomes were affected by site implementation (i.e. fidelity) and/or participation by employees (i.e. dose). Results showed high levels of intervention fidelity, moderate to high levels of intervention dose delivered and moderate levels of the intervention dose received. Level of implementation affected the degree of change in vigorous physical activity (Mean = 5.4 versus 2.2; ² = 4.9, df = 1), otherwise outcome measures were unaffected by fidelity and dose. These findings suggest that practitioners should focus more energy assuring that the core components are fully implemented and be less concerned about the level of participation.

Measurement characteristics of dietary psychosocial scales in a Weight Gain Prevention Study with 8- to 10-year-old African-American girls

2008-12-15

Few measurement instruments for children's eating behaviors and beliefs have been specifically validated for African-American children. Validation within this population is important because of potential cultural and ethnic influences. Objectives were to evaluate established and newly developed or adapted dietary psychosocial measures in a sample of 303 preadolescent African-American girls and their caregivers. Acceptable internal consistency (Cronbach's ≥ 0.70) was found for measures of girls’ self-efficacy for healthy eating, outcome expectancies for healthy eating, positive family support for healthy eating and household availability of low-fat food and fruit, juice and vegetables (FJV). Evidence for concurrent validity was found with significant associations between self-efficacy for healthy eating and lower intake of energy (r = –0.17) and fat grams (r = –0.16). Greater FJV availability was associated with greater FJV intake (r = 0.14) and lower body mass index (BMI) in girls (r = –0.12). Positive family support for healthy eating was associated with higher BMI in girls (r = 0.41). These results contribute to the development of scales to evaluate prevention interventions related to dietary intake in African-American children.

Adolescents' impressions of antismoking media literacy education: qualitative results from a randomized controlled trial

Primack, B. A., Fine, D., Yang, C. K., Wickett, D., Zickmund, S. — 2008-12-03

Although media literacy represents an innovative venue for school-based antismoking programming, studies have not systematically compared student impressions of these and traditional programs. This study utilized data from a randomized trial comparing these two types of programs. After each program, students responded to three open-ended questions related to their assigned curriculum. Two coders, blinded to student assignments, independently coded these data. Coders had strong inter-rater agreement (kappa = 0.77). Our primary measures were spontaneously noted overall assessment, enjoyment/interest and the likelihood of changing smoking behavior. Of the 531 participants, 255 (48.0%) were randomized to the intervention (media literacy) group. Intervention participants had more net positive responses [rate ratio (RR) = 1.27, 95% confidence interval (CI) = 1.05, 1.54], more responses rating the program as compelling (RR = 1.63, 95% CI = 1.16, 2.29) and fewer responses rating the program as non-compelling (RR = 0.62, 95% CI = 0.39, 0.97). However, the intervention group was not more likely to suggest that the curriculum was likely to change behavior positively (RR = 0.57, 95% CI = 0.30, 1.06). Findings suggest that although media literacy provides a compelling format for the delivery of antitobacco programming, integration of components of traditional programming may help media literacy programs achieve maximal efficacy.

A Community Health Advisor Program to reduce cardiovascular risk among rural African-American women

2008-12-01

The Uniontown, Alabama Community Health Project trained and facilitated Community Health Advisors (CHAs) in conducting a theory-based intervention designed to reduce the risk for cardiovascular disease (CVD) among rural African-American women. The multiphased project included formative evaluation and community organization, CHA recruitment and training, community intervention and maintenance. Formative data collected to develop the training, intervention and evaluation methods and materials indicated the need for programs to increase knowledge, skills and resources for changing behaviors that increase the risk of CVD. CHAs worked in partnership with staff to develop, implement, evaluate and maintain strategies to reduce risk for CVD in women and to influence city officials, business owners and community coalitions to facilitate project activities. Process data documented sustained increases in social capital and community capacity to address health-related issues, as well as improvements in the community's physical infrastructure. This project is unique in that it documents that a comprehensive CHA-based intervention for CVD can facilitate wide-reaching changes in capacity to address health issues in a rural community that include improvements in community infrastructure and are sustained beyond the scope of the originally funded intervention.

Effective contraceptive use: an exploration of theory-based influences

Peyman, N., Oakley, D. — 2008-12-01

The purpose of this study was to explore factors that influence oral contraceptive (OC) use among women in Iran using the Theory of Planned Behavior (TPB) and concept of self-efficacy (SE). The study sample consisted of 360 married OC users, aged 18–49 years recruited at public health centers of Mashhad, 900 km east of Tehran. SE had the strongest association with the intent to use after the clinic visit (r = 0.784) and with actual use (r = 0.452). Family planning self-efficacy combined with TPB variables accounted for 65% of the variance for intent and 27% of the variance in behavior. The results provide support for a theory-based approach to improved family planning care that specifically addresses more effective use. Development and evaluation of culturally appropriate public education and changes in clinical efforts designed to enhance the sense of SE are discussed.

Prediction of stage transitions in fruit and vegetable intake

2008-11-28

Stage theories propose that individuals pass through different stages on their way toward behavior change. The present study examines stage-specific prediction patterns of social–cognitive variables (risk perception, outcome expectancies, perceived self-efficacy, action planning and social support) regarding transitions between the three stages of the Health Action Process Approach (HAPA; preintention, intention and action stage). In an online study (n = 494) on fruit and vegetable intake, social–cognitive variables and stages were assessed at baseline and stage transitions 4 weeks later. Transitions between the preintention, intention and action stage were predicted by social–cognitive variables using binary and multinomial logistic regression analyses. Stage-specific prediction patterns emerged for stage progression and stage regression. Outcome expectancies predicted progression from the preintention stage, whereas social support predicted progression to the action stage. Low levels of planning were associated with relapse to the preintention and the intention stage. Self-efficacy emerged as a universal predictor of stage transitions. Findings support not only the usefulness of the stage construct for describing health behavior change but also the validity of the HAPA variables as predictors of stage transitions. Stage-matched interventions targeting the variables identified as stage-specific predictors might support stage progression toward the goal behavior.

Transition in participation in sport and unstructured physical activity for rural living adolescent girls

Eime, R. M., Payne, W. R., Casey, M. M., Harvey, J. T. — 2008-11-27

Physical activity (PA) is important for lifelong health; however, participation is lower in rural compared with metropolitan areas and declines during adolescence, particularly for girls. It is likely that this decline is related to the number of life transitions that occur during adolescence. This qualitative study examined the views of active rural living girls regarding the factors affecting their sport and PA participation, using the socioecological model. Twenty-seven girls aged 16–17 from four schools participated in semi-structured focus group discussions. Content and thematic analysis was conducted from verbatim transcripts using NVivo. The girls enjoyed involvement in community club sport with friends and they reported living in communities where participation in sport was a major form of social interaction. However, the desire to succeed educationally was a critical factor affecting their participation in sport and PA and influenced their movement from structured club sport to more flexible, but socially isolated individual activities. It is recommended that future longitudinal research should track rural living adolescent females as they complete secondary school, in order to better understand the influence of educational priorities upon sport and PA participation and to identify practical strategies for both schools and community organizations to foster continuing participation throughout this crucial period of life transition.

Developing nutrition education resources for a multi-ethnic population in New Zealand

2008-11-10

In New Zealand, the burden of nutrition-related disease is greatest among vulnerable and disadvantaged groups, including Maori and Pacific peoples. However, little research is currently available on effective ways to improve nutrition in these communities. This paper describes the development of six paper-based nutrition education resources for multi-ethnic participants in a large supermarket intervention trial. Six focus groups involving 15 Maori, 13 Pacific and 16 non-Maori, non-Pacific participants were held. A general inductive approach was applied to identify common themes around participants' understanding and thoughts on relevance and usefulness of the draft resources. Feedback from focus groups was used to modify resources accordingly. Five themes emerged across all focus groups and guided modification of the resources: (i) perceived higher cost of healthy food, (ii) difficulty in changing food-purchasing habits, (iii) lack of knowledge, understanding and information about healthy food, (iv) desire for personally relevant information that uses ethnically appropriate language and (v) other barriers to healthy eating, including limited availability of healthy food. Many issues affect the likelihood of purchase and consumption of healthy food. These issues should be taken into account when developing nutritional materials for New Zealanders and possibly other multi-ethnic populations worldwide.

Evaluation of HIV/AIDS secondary school peer education in rural Nigeria

van der Maas, F., Otte, W. M. — 2008-11-05

In this study, we assessed whether peer education is an effective method of HIV/AIDS awareness, in terms of knowledge, misconception and behavior, among adolescents in the rural area of Nigeria. A comparative case series (n = 250), cross-sectional structured survey (n = 135) and focus group discussions (n = 80) were undertaken among adolescents. In both the case series and structured survey, a questionnaire was used which addresses the following issues: socio-demography, knowledge on transmission and prevention of HIV/AIDS, accessibility to different sources of HIV/AIDS information, stigmatization and sexual behavior. Binary logistic regression was applied to compare responses from the peer-educated and not peer-educated populations. The model was adjusted for confounders. We demonstrated increased knowledge and decreased misconception and sexual risk behavior in adolescents receiving peer education as compared to adolescents not receiving peer education. These differences are apparent both over time (2005–2007) and cross-sectional (2007). In conclusion, peer education in rural areas can be effective in HIV/AIDS prevention. Knowledge and behavior can be influenced positively.

Personal, social and environmental correlates of resilience to physical inactivity among women from socio-economically disadvantaged backgrounds

Cleland, V. J., Ball, K., Salmon, J., Timperio, A. F., Crawford, D. A. — 2008-10-29

While sex and socio-economic disparities in physical activity have been well documented, not all disadvantaged women are inactive. This study aimed to examine correlates of achieving recommended levels of physical activity among women of low socio-economic position. In 2005, a population-based sample of 291 women with low educational attainment provided survey data on leisure time physical activity (LTPA). Participants reported potential personal (enjoyment and self-efficacy; barriers; intentions; guilt and priorities; routines and scheduling; occupational physical activity; television viewing), social (support from family/friends; social participation; sport/recreation club membership; dog ownership) and environmental (aesthetics; safety; local access; footpaths; interesting walks; busy roads to cross; heavy traffic) correlates of physical activity. Nearly 40% of participants achieved recommended LTPA (150 min week^–1). Multivariable analyses revealed that higher levels of self-efficacy for walking [prevalence ratio (PR) 2.05, 95% confidence interval (CI) 1.19–3.53], higher enjoyment of walking (PR 1.48, 95% CI 1.04–2.12), greater intentions to be active (PR 1.97, 95% CI 1.12–3.45) and having set routines for physical activity (PR 1.91, 95% CI 1.18–3.09) were significantly associated with achieving recommended LTPA. Personal factors were the characteristics most strongly associated with achieving recommended levels of LTPA among women from socio-economically disadvantaged backgrounds.

Application of a social cognitive model in explaining physical activity in Iranian female adolescents

Taymoori, P., Rhodes, R. E., Berry, T. R. — 2008-10-20

Adolescent Iranian girls are at high risk for physical inactivity due to cultural barriers such as restrictions regarding exercising in public and research is needed to explore ethnic and gender-related factors associated with physical activity (PA) participation. Using social cognitive theory as the guiding model, the purpose of this study was to test the fit and strength of barriers self-efficacy, outcome expectations, self-regulation and social support in explaining PA in female Iranian adolescents (n = 558). Using path analysis, social support was modeled as an antecedent of self-efficacy and outcome expectations, while self-efficacy was modeled as an antecedent of outcome expectations, self-regulatory planning and PA. Outcome expectations and self-regulatory planning were subsequently modeled as additional antecedents of PA. The model explained 52% of the variance in PA. The two significant (P < 0.05) direct effects were from self-efficacy and outcome expectations. Social support from mothers, fathers and friends had significant indirect effects on PA through self-efficacy. These results will allow for future research and interventions not only for female Iranian adolescents but also for similar cultural and immigrant groups that have been neglected to date in the PA literature.

The characteristics of the outdoor school environment associated with physical activity

Haug, E., Torsheim, T., Sallis, J. F., Samdal, O. — 2008-10-20

The school is an important setting for physical activity. The purpose of the present study was to examine the association between physical environmental characteristics and participation in daily physical activity during school breaks. Data from 130 schools and 16 471 students (Grades 4–10) in Norway were obtained in 2004 through self-administered questionnaires to principals and students. Multilevel logistic regression models revealed that boys at secondary level with a larger number of outdoor facilities at school had 2.69 times [95% confidence interval (CI) = 1.21–5.98] and girls 2.90 times (95% CI = 1.32–6.37) higher odds of being physically active compared with students in schools with fewer facilities. Boys at secondary level with areas for hopscotch/skipping rope had 2.53 times (95% CI = 1.55–4.13), with a soccer field 1.68 times (95% CI = 1.15–2.45), with playground equipment 1.66 times (95% CI = 1.16–2.37) and with a sledding hill 1.70 times (95% CI = 1.23–2.35) higher odds to be physically active compared with students in schools without these facilities. A sledding hill was also associated with girls’ physical activity participation in secondary school (odds ratio = 1.58, 95% CI = 1.11–2.24). Outdoor facilities in secondary schools are associated with students’ daily physical activity participation during school breaks. Therefore, improving the outdoor environment should be considered in physical activity promotion school programs in secondary schools.

Determinants of awareness, initiation and maintenance of physical activity among the over-fifties: a Delphi study

van Stralen, M. M., Lechner, L., Mudde, A. N., de Vries, H., Bolman, C. — 2008-10-16

To develop effective interventions to stimulate physical activity (PA), insight into its underlying variables is needed. The aim of this study was to obtain an overview of the most relevant determinants of awareness, initiation and maintenance of PA among the over-fifties by means of a three-round Delphi study. In the first round, 17 key-experts outlined possible relevant determinants into an open-ended electronic questionnaire. In the second round, 118 experts completed a structured electronic questionnaire that was based on the first round results, in which they scored each determinant on its relevance. In the third round, experts were asked to re-rate the relevance of each determinant, after feedback was given about the group median relevance score. After three rounds, the experts agreed on 30 relevant determinants of the three phases of PA. When compared with longitudinal studies, the Delphi study pointed out new concepts, such as several post-motivational and social and environmental determinants as possible relevant determinants, suggesting that this method has the potential to trace new and promising determinants. The results further showed that next to similarities, much dissimilarity in relevant determinants of awareness, initiation and maintenance of PA was found, suggesting that most determinants could be phase specific.

A qualitative study of parental modeling and social support for physical activity in underserved adolescents

Wright, M. S., Wilson, D. K., Griffin, S., Evans, A. — 2008-08-14

This study obtained qualitative data to assess how parental role modeling and parental social support influence physical activity in underserved (minority, low-income) adolescents. Fifty-two adolescents (22 males, 30 females; ages 10–14 years, 85% African-American) participated in a focus group (6–10 per group, same gender). Focus groups were audiotaped, transcribed and coded by independent raters. Inter-rater reliabilities indicated adequate agreement [inter-rater reliability (r) = 0.84]. Themes were identified for parental role modeling and parental social support. Regarding parental role modeling, adolescents reported that parents engaged in a variety of different types of physical activities with their children such as walking, cycling and playing basketball; however, activity was infrequent. Sex differences were noted in parental social support indicating that female adolescents reported receiving more emotional and negative support for physical activity (being required to play outside with a sibling), while boys reported receiving more tangible types of support for physical activity. Adolescents also generated ideas on how to increase parental social support and in particular tangible support was highlighted as important by both males and females. This study suggests that future interventions should focus on improving parental engagement and tangible support that involve direct participation from parents in physical activities with their adolescents.

The role of collective efficacy in exercise adherence: a qualitative study of spousal support and Type 2 diabetes management

Beverly, E. A., Wray, L. A. — 2008-06-16

Adhering to increased exercise is often reported as one of the greatest challenges facing adults living with diabetes, a perception shared by the married middle-aged and older adults living with diabetes who participated in this study. Understanding how that challenge can best be met is both research and program relevant. Drawing on the social cognitive theory and social support literature, this qualitative study explored the powerful couple relationship in Type 2 diabetes management. The overarching goal of this paper was to illuminate the potentially key role of collective efficacy in exercise adherence in order to develop and test interventions that provide more effective supports for adults living with diabetes. Analyses revealed three core themes used by the couples to describe their perceived beliefs: ‘Collective support’, ‘Collective motivation’ and ‘Collective responsibility’. Our findings provide insights regarding how collective beliefs of spousal support may influence the adoption and maintenance of an exercise program. As health educators look for approaches to improve exercise adherence in diabetes management, it is important to understand how couples can be empowered to assume responsibility for their management.

Understanding children's sedentary behaviour: a qualitative study of the family home environment

Granich, J., Rosenberg, M., Knuiman, M., Timperio, A. — 2008-05-22

Electronic media (EM) (television, electronic games and computer) use has been associated with overweight and obesity among children. Little is known about the time spent in sedentary behaviour (SB) among children within the family context. The aim of this study was to explore how the family home environment may influence children's electronic-based SB. Focus groups and family interviews were conducted with 11- to 12-year old children (n = 54) and their parents (n = 38) using a semi-structured discussion guide. Transcripts were analysed using a thematic content approach. A brief self-completed questionnaire was also used to measure leisure behaviour and electronic devices at home. Children incorporated both sedentary and physical activities into their weekly routine. Factors influencing children's EM use included parent and sibling modelling and reinforcement, personal cognitions, the physical home environment and household EM use rules and restrictions. Participants were not concerned about the excessive time children spent with EM. This under-recognition emerged as a personal influencing factor and was viewed as a major barrier to modifying children's electronic-based SB. Efforts to reduce SB in children should focus on the influencing factors that reciprocally interact within the family home. An emphasis on increasing awareness about the risks associated with spending excessive time in screen-based activities should be a priority when developing intervention strategies aimed at modifying the time children spend in SB.