Health Education Research - recent issues

Expanding the value of qualitative theories of illness experience in clinical practice: a grounded theory of secondary heart disease prevention

Ononeze, V., Murphy, A.W., MacFarlane, A., Byrne, M., Bradley, C. — 2009-05-14

Qualitative theories of illness experience are about the individual interpretations of the psychosocial and cultural aspects of living with illness. Thus, they contribute to a better understanding of health and health care provision. In this paper, we examine how a grounded theory (GT) of heart disease experience can inform secondary prevention. In-depth interviews of individual experience of heart disease were conducted with 26 patients, using GT iterative data collection and analysis framework. A GT was compiled from data and examined within a sociocultural framework to ascertain how experience influenced health behaviour. Despite individual contextual variations, the theory of ‘keeping it going’ describes the study sample’s common attitude to living with heart disease. The theory was adequate in explaining secondary cardiac behaviour, because it identified the aspects of patients’ beliefs and attitudes which are key to effective secondary prevention. The assessment of the impact of illness experience on health behaviour within a sociocultural framework helped to articulate the strong influence of social and contextual factors. The study offers an appropriate explanatory framework for encouraging health behaviour change. It emphasizes the importance of interventions being relevant to individual perceptions and interpretations. It provides a framework for designing and evaluating cardiac interventions and the theoretical principles which underpin them.

Effects of episodic variations in web-based avian influenza education: influence of fear and humor on perception, comprehension, retention and behavior

Kim, P., Sorcar, P., Um, S., Chung, H., Lee, Y. S. — 2009-05-14

In order to provide empirical evidence on the role of a web-based avian influenza (AI) education program for mass communication and also ultimately help young children learn and develop healthy behaviors against AI and all types of influenza, an education program with two episodic variations (i.e. fear and humor) has been developed and examined with 183 fifth-grade elementary students. A quasi-experimental design was employed to find potential differential effects on the context-specific risk perception, AI knowledge acquisition, retention and behavior. The study results reveal that the fear appealed AI web-based education program was much more effective than the humor-based program in improving risk perception and educating the students about healthy behaviors (i.e. against influenza infection). However, a significant behavior change or improvement of health practices was not apparent on the post-tests (i.e. 1 month after the treatment) in either episode of the program.

Developing the IDEFICS community-based intervention program to enhance eating behaviors in 2- to 8-year-old children: findings from focus groups with children and parents

2009-05-14

One purpose of ‘identification and prevention of dietary- and lifestyle-induced health effects in children and infants’ (IDEFICS) is to implement a standardized community-based multi-component healthy eating intervention for younger children in eight different countries. The present study describes important influencing factors for dietary behaviors among children aged 2–8 years old in order to determine the best approaches for developing the dietary components of the standardized intervention. Twenty focus groups with children (74 boys, 81 girls) and 36 focus groups with 189 parents (28 men, 161 women) were conducted. Only in two countries, children mentioned receiving nutrition education at school. Rules at home and at school ranged from not allowing the consumption of unhealthy products to allowing everything. The same diversity was found for availability of (un)healthy products at home and school. Parents mentioned personal (lack of time, financial constraints, preferences), socio-environmental (family, peer influences), institutional (school policies) and physical–environmental (availability of unhealthy products, price, season) barriers for healthy eating. This focus group research provided valuable information to guide the first phase in the IDEFICS intervention development. There was a large variability in findings within countries. Interventions should be tailored at the personal and environmental level to increase the likelihood of behavioral change.

Implementation fidelity: the experience of the Adolescent Substance Abuse Prevention Study

2009-05-14

While researchers have developed more effective programs and strategies to prevent the initiation of substance use and increasingly communities are delivering these interventions, determining the degree to which they are delivered as they were designed remains a significant research challenge. In the past several years, more attention has been given to implementation issues during the various stages of program development and diffusion. This paper presents the findings from a substudy of an evaluation of a newly designed middle and high school substance abuse prevention program, Take Charge of Your Life delivered by local Drug Abuse Resistance Education officer instructors. A key aspect of the study was to determine the extent to which implementation fidelity, using the measures of content coverage and appropriate instructional strategy, was associated with improvement in the program mediators of realistic normative beliefs, understanding the harmful effects of substance use and the acquisition of decision-making and resistance skills. Although it was found that higher fidelity was associated with better scores on some of the mediators, this was not a consistent finding. The mixed results are discussed within the context of the lesson activities themselves.

'Ready. Set. ACTION!' A theater-based obesity prevention program for children: a feasibility study

2009-05-14

This study examined the feasibility of implementing an innovative theater-based after-school program, ‘Ready. Set. ACTION!’, to reach ethnically diverse and low-income children and their parents with obesity prevention messages. The study population included 96 children and 61 parents. Children were in fourth to sixth grade and 41% were overweight at baseline. Program impact was evaluated with a pre/post-randomized controlled study design, but a major focus was placed on the process evaluation conducted in the intervention schools. Intervention children and parents reported high program satisfaction and that they had made changes or intended to make positive changes in their behaviors due to program participation. However, few meaningful differences between the intervention and control conditions were found at follow-up. Thus, the combined process and impact evaluation results suggest that the intervention was effective in leading to increased awareness of the need for behavioral change, but was not powerful enough on its own to lead to behavioral change. From this feasibility study, we concluded that Ready. Set. ACTION! offers promise as a creative intervention strategy. The next research step may be to incorporate theater-based programs into more comprehensive school-based interventions, with both educational and environmental components, and evaluate program impact.

There's alcohol in my soap: portrayal and effects of alcohol use in a popular television series

van Hoof, J. J., de Jong, M. D. T., Fennis, B. M., Gosselt, J. F. — 2009-05-14

Two studies are reported addressing the media influences on adolescents’ alcohol-related attitudes and behaviours. A content analysis was conducted to investigate the prevalence of alcohol portrayal in a Dutch soap series. The coding scheme covered the alcohol consumption per soap character, drinking situations and drinking times. Inter-coder reliability was satisfactory. The results showed that alcohol portrayal was prominent and that many instances of alcohol use reflected undesirable behaviours. To assess the influence of such alcohol cues on adolescents, a 2 x 2 experiment was conducted focusing on the separate and combined effects of alcohol portrayal in the soap series and surrounding alcohol commercials. Whereas the alcohol commercials had the expected effects on adolescents’ attitudes, the alcohol-related soap content only appeared to have unexpected effects. Adolescents who were exposed to the alcohol portrayal in the soap series had a less positive attitude towards alcohol and lower drinking intentions. Implications of these findings for health policy and future research are discussed.

Assessment of a national network: the case of the French teacher training colleges' health education network

Guevel, M.-R., Jourdan, D. — 2009-05-14

The French teacher training colleges’ health education (HE) network was set up in 2005 to encourage the inclusion of HE in courses for primary and secondary school teachers. A systematic process of monitoring the activity and the impact of this initiative was implemented. This analysis was systematically compared with the perceptions of teaching staff involved in the network. This paper assesses the network after 2 years using documents produced and interviews with 24 coordinators. Twenty-nine teacher training colleges out of a total of 31 are involved in the network. The network has helped to create links between teacher training colleges, extend HE training and encourage partnerships with other public health organizations. By 2007, HE was included in courses offered by 19 teacher training colleges as opposed to only 3 in 2005. This study not only showed the positive impact of the network but also revealed issues in its management and presented new challenges to ensure the effectiveness of the network. The network has succeeded in attracting and training trainers who were already providing or were interested in HE. Reaching other trainers who are not familiar with HE remains a challenge for the future.

Applying motivational interviewing to counselling overweight and obese children

Soderlund, L. L., Nordqvist, C., Angbratt, M., Nilsen, P. — 2009-05-14

The aim of this study was to identify barriers and facilitators to nurses’ application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group interviews concerning their experiences with applying MI to counselling overweight and obese children. Important barriers were nurses’ lack of recognition that overweight and obesity among children constitute a health problem, problem ambivalence among nurses who felt that children's weight might be a problem although there was no immediate motivation to do anything and parents who the nurses believed were unmotivated to deal with their children's weight problem. Facilitators included nurses’ recognition of the advantages of MI, parents who were cooperative and aware of the health problem and working with obese children rather than those who were overweight.

Gender factors associated with sexual abstinent behaviour of rural South African high school going youth in KwaZulu-Natal, South Africa

2009-05-14

The cross-sectional study investigated South African rural high school learners' choice of sexual abstinence in order to be able to develop tailored health education messages. All Grade 9 learners from one class at each of 10 randomly selected rural high schools participated. The Integrated Model for Motivational and Behavioural Change was used to elicit attitudes, social influences, self-efficacy and intentions towards sexual abstinence. Chi-square and t-tests were used for bivariate analysis. In total, 454 learners, mean age 16.7 years (standard deviation 1.41) range 14–20 years, participated, of whom 246 (54.2%) were female. When comparing learners reporting abstinence (n = 252) with those not abstinent (n = 202), abstinent learners were significantly more often females (P < 0.005), younger (16.5 years versus 17.1 years, P < 0.005) and drank less alcohol (P < 0.005). Abstaining girls believed that their friends and parents think that they should abstain from sex, that their friends abstained from sex and that abstinence helped them to mature emotionally. Abstinent boys expressed intentions to abstain from sex until marriage. Targeted intervention research is required to encourage South African rural high school learners to delay their sexual initiation to reduce their risk of human immunodeficiency virus infection. Different abstinent messages are needed for boys and girls to address the different patterns of behaviour observed.

Development and implementation of an integrated, multi-modality, user-centered interactive dietary change program

Glasgow, R. E., Christiansen, S., Smith, K. S., Stevens, V. J., Toobert, D. J. — 2009-05-14

Computer-tailored behavior change programs offer the potential for reaching large populations at a much lower cost than individual or group-based programs. However, few of these programs to date appear to integrate behavioral theory with user choice, or combine different electronic modalities. We describe the development of an integrated CD-ROM and interactive voice response dietary change intervention that combines behavioral problem-solving theory with a high degree of user choice. The program, WISE CHOICES, is being evaluated as part of an ongoing trial. This paper describes the program development, emphasizing how user preferences are accommodated, and presents implementation and user satisfaction data. The program was successfully implemented; the linkages among the central database, the CD-ROM and the automated telephone components were robust, and participants liked the program almost as well as a counselor-delivered dietary change condition. Multi-modality programs that emphasize the strengths of each approach appear to be feasible. Future research is needed to determine the program impact and cost-effectiveness compared with counselor-delivered intervention.

Body image, dieting and disordered eating and activity practices among teacher trainees: implications for school-based health education and obesity prevention programs

Yager, Z., O'Dea, J. — 2009-05-14

The aim was to investigate and compare body image, body dissatisfaction, dieting, disordered eating, exercise and eating disorders among trainee health education/physical education (H&PE) and non-H&PE teachers. Participants were 502 trainee teachers randomly selected from class groups at three Australian universities who completed the questionnaire. H&PE males and females had significantly poorer body image and higher levels of body dissatisfaction, dieting and disordered eating behaviors than non-H&PE participants. H&PE teachers were more likely to over-exercise and have exercise disorders, but very few self-identified problems with objectively assessed excessive exercise behaviors. Lifetime prevalence of eating disorders was 12.5% in H&PE males, 0% in non-H&PE males, 7.7% in H&PE females and 6% in non-H&PE females. Few participants had received any past or current treatment. Of particular concern is the likelihood of the teachers' inappropriate and dangerous attitudes and behaviors being intentionally or unintentionally conveyed to their school students. Those planning school health education, nutrition education and school-based obesity prevention programs should provide suitable training for the teachers involved. Screening and treatment services among teachers may also be helpful in order to detect, treat and educate young teachers about body image, dieting, disordered eating and physical activity practices.

Turning negative into positive: public health mass media campaigns and negative advertising

Apollonio, D. E., Malone, R. E. — 2009-05-14

Literature suggests that ‘negative advertising’ is an effective way to encourage behavioral changes, but it has enjoyed limited use in public health media campaigns. However, as public health increasingly focuses on non-communicable disease prevention, negative advertising could be more widely applied. This analysis considers an illustrative case from tobacco control. Relying on internal tobacco industry documents, surveys and experimental data and drawing from political advocacy literature, we describe tobacco industry and public health research on the American Legacy Foundation’s "truth" campaign, an example of effective negative advertising in the service of public health. The tobacco industry determined that the most effective advertisements run by Legacy’s "truth" campaign were negative advertisements. Although the tobacco industry’s own research suggested that these negative ads identified and effectively reframed the cigarette as a harmful consumer product rather than focusing solely on tobacco companies, Philip Morris accused Legacy of ‘vilifying’ it. Public health researchers have demonstrated the effectiveness of the "truth" campaign in reducing smoking initiation. Research on political advocacy demonstrating the value of negative advertising has rarely been used in the development of public health media campaigns, but negative advertising can effectively communicate certain public health messages and serve to counter corporate disease promotion.

Can social cognitive theory constructs explain socio-economic variations in adolescent eating behaviours? A mediation analysis

2009-05-14

Adolescents of low socio-economic position (SEP) are less likely than those of higher SEP to consume diets in line with current dietary recommendations. The reasons for these SEP variations remain poorly understood. We investigated the mechanisms underlying socio-economic variations in adolescents’ eating behaviours using a theoretically derived explanatory model. Data were obtained from a community-based sample of 2529 adolescents aged 12–15 years, from 37 secondary schools in Victoria, Australia. Adolescents completed a web-based survey assessing their eating behaviours, self-efficacy for healthy eating, perceived importance of nutrition and health, social modelling and support and the availability of foods in the home. Parents provided details of maternal education level, which was used as an indicator of SEP. All social cognitive constructs assessed mediated socio-economic variations in at least one indicator of adolescents’ diet. Cognitive factors were the strongest mediator of socio-economic variations in fruit intakes, while for energy-dense snack foods and fast foods, availability of energy-dense snacks at home tended to be strong mediators. Social cognitive theory provides a useful framework for understanding socio-economic variations in adolescent's diet and might guide public health programmes and policies focusing on improving adolescent nutrition among those experiencing socio-economic disadvantage.

A process evaluation of an injury prevention school-based programme for adolescents

Buckley, L., Sheehan, M. — 2009-05-14

A process evaluation provides critical information that can inform the design and implementation of a programme. This study sought to provide examples of how to operationalize a process evaluation of an effective programme (Skills for Preventing Injury in Youth). A comprehensive definition of process evaluation was used which included assessing dose, adherence, quality of process, participant responsiveness and programme differentiation. Dose was assessed through teacher and student ratings as well as independent observations. Reports from an observer were used to assess adherence to programme objectives, the quality of process including interactive delivery and programme differentiation. Participant responsiveness was assessed quantitatively and qualitatively with students providing greater depth to the findings. Findings regarding dose varied and suggested different sources of reports provided supplementary information. The findings also suggested that independent observations are an important tool for process evaluation and identified challenges for programme designers regarding interactive material. Overall, the research indicated that a comprehensive definition of process evaluation could be operationalized and provided an understanding of an application of a process evaluation to an injury prevention programme. Continued development of process evaluations will enable a better understanding of the conduct of interventions and maximize the likely effect of such interventions.

The relationship between the food environment and fruit and vegetable intake of adolescents living in Residential Children's Homes

Evans, A., Dowda, M., Saunders, R., Buck, J., Hastings, L., Kenison, K. — 2009-05-14

The purpose of this study was to examine the relationship between food environments and fruit and vegetable (FV) consumption of adolescents (n = 246) living in Residential Children's Homes (RCHs) in North and South Carolina, USA. Administrators of 21 RCHs completed the Physical Activity and Dietary Environmental Assessment (PADEA), an instrument assessing FV-related environmental variables of RCHs: (i) policies, (ii) availability, (iii) social environment, (iv) community collaboration and (v) administrative support. Two different approaches using mixed-effects regression models were used to compare FV consumption of adolescents living in RCHs with more conducive food environments compared with adolescents living in RCHs with less conducive environments. Using one approach, PADEA variables were analyzed as categorical data and in the second approach, PADEA variables were analyzed as continuous data. Results indicated greater FV consumption among adolescents residing in RCHs with more conducive food environments compared with less conducive RCHs. Specifically, adolescents living in RCHs with higher levels of administrative support and more FV policies reported greater FV intake compared with adolescents living in RCHs with less support and fewer policies. Food environments are related to adolescents’ dietary behaviors and interventions targeting FV consumption should include strategies to increase administrative support and the development of FV-related policies.

Attitudes and subjective norms: determinants of parents' intentions to reduce childhood fever with medications

Walsh, A., Edwards, H., Fraser, J. — 2009-05-14

Fever is a natural protective response of the host organism. Mild to moderate fevers, up to 40.0°C, have immunological benefits and do not need to be reduced. However, parents regularly reduce fever with medications to prevent perceived harmful outcomes. This study identified the determinants of parents’ intentions to reduce childhood fever with medications. A community-based cross-sectional survey was conducted with 391 Australian parents of children aged between 6 months and 5 years. Recruitment was through advertising, face-to-face and snowball methods. The survey targeted constructs of the Theory of Planned Behavior: attitudes, subjective norms, perceived behavioral control, intentions and previously identified background factors. Structural equation modeling identified 69% of the variance in intentions. The strongest influences were from non-scientifically based attitudes (phobic) (β = 0.55) and subjective norms (husband/partner and doctors) (β = 0.36). Attitudes (β = 0.69) and subjective norms (β = 0.52) were strongly determined by child medication behavior (whether the child took medications easily when febrile) which had a total effect on intentions of β = 0.66. Perceived control, education and number of children had minimal influence on intentions. There is an urgent need for (i) the education of both parents in the benefits of fever and (ii) for doctors to consistently provide parents with evidence-based information.

Psychosocial, environmental and behavioral factors associated with bone health in middle-school girls

Sharma, S. V., Hoelscher, D. M., Kelder, S. H., Day, R. S., Hergenroeder, A. — 2009-03-11

The purpose of this study was to identify the psychosocial, environmental and behavioral factors associated with calcium intake, physical activity and bone health in a cohort of adolescent girls. Baseline data (N = 718 girls, mean age: 11.6 ±0.4 years) from the Incorporating More Physical Activity and Calcium in Teens (IMPACT) study conducted in Texas, 2001–03, were utilized for the analyses. Hierarchical linear regression was used to examine the associations of interest. Confounders adjusted for included ethnicity, menarchal status, body mass index and lactose intolerance. Several psychosocial and behavioral factors were significantly associated with bone quality. These included knowledge of calcium content of foods (β = 0.08, P = 0.016), self-efficacy toward consuming calcium-rich foods (β = 0.16, P = 0.047), physical activity self-efficacy (β = 0.20, P = 0.002), physical activity outcome expectations (β = 0.5, P = 0.004), family encouragement to do physical activity (β = 0.96, P = 0.027), friend engagement in physical activity (β = 1.3, P = 0.001) and participation in sports teams (β = 1.7, P < 0.001). Self-efficacy, social support and participation in sports teams appear to be strongly associated with bone health in adolescent girls. Future health education/health promotion programs need to address these factors for effective primary prevention of osteoporosis in this population.

Evaluation of WebEase: an epilepsy self-management Web site

2009-03-11

People with epilepsy have various education needs and must adopt many self-management behaviors in order to control their condition. This study evaluates WebEase, an Internet-based, theory-driven, self-management program for adults with epilepsy. Thirty-five participants took part in a 6-week pilot implementation of WebEase. The main components of WebEase are My Log, a behavioral journal, and the Medication, Stress and Sleep Modules, which provide tailored information and feedback designed to prompt participants to assess their status with self-management behaviors, think about their behaviors and make a goal. In this article, we discuss the results of the feasibility, acceptability and usability assessments and the behavioral outcomes. The process results indicate that theoretical components that served as the program framework were successfully integrated into the program and that participants viewed WebEase as relevant, acceptable and easy to use. Additionally, participants showed some improvement in epilepsy self-management, adherence, sleep quality, self-efficacy and social support following the program. The initial results are encouraging and continued development of WebEase has the potential to facilitate education and self-management strategies among people with epilepsy.

A review of similarities between domain-specific determinants of four health behaviors among adolescents

2009-03-11

Schools are overloaded with health promotion programs that, altogether, focus on a broad array of behavioral domains, including substance abuse, sexuality and nutrition. Although the specific content of programs varies according to the domain focus, programs usually address similar concepts: knowledge, attitudinal beliefs, social influences and skills. This apparent conceptual overlap between behaviors and programs provides opportunities for a transfer-oriented approach which will stimulate students to apply the knowledge and skills they have learned in one domain (e.g. skills for resisting tobacco use) to other domains (e.g. alcohol, sex). A requirement for such an approach is that behaviors share at least some determinants. This review addresses this issue by examining similarities between domain-specific determinants of smoking, drinking, safe sex and healthy nutrition among adolescents. Recent empirical studies and reviews were examined. The results show that the following determinants are relevant to all four behaviors: beliefs about immediate gratification and social advantages, peer norms, peer and parental modeling and refusal self-efficacy. Several other determinants have been found to relate to at least two behaviors, e.g. health risk beliefs and parental norms. These results can be used for the development of a transfer-oriented school health promotion curriculum.

Testing the predictive power of the transtheoretical model of behavior change applied to dietary fat intake

Wright, J. A., Velicer, W. F., Prochaska, J. O. — 2009-03-11

This study evaluated how well predictions from the transtheoretical model (TTM) generalized from smoking to diet. Longitudinal data were used from a randomized control trial on reducing dietary fat consumption in adults (n =1207) recruited from primary care practices. Predictive power was evaluated by making a priori predictions of the magnitude of change expected in the TTM constructs of temptation, pros and cons, and 10 processes of change when an individual transitions between the stages of change. Generalizability was evaluated by testing predictions based on smoking data. Three sets of predictions were made for each stage: Precontemplation (PC), Contemplation (C) and Preparation (PR) based on stage transition categories of no progress, progress and regression determined by stage at baseline versus stage at the 12-month follow-up. Univariate analysis of variance between stage transition groups was used to calculate the effect size [omega squared (²)]. For diet predictions based on diet data, there was a high degree of confirmation: 92%, 95% and 92% for PC, C and PR, respectively. For diet predictions based on smoking data, 77%, 79% and 85% were confirmed, respectively, suggesting a moderate degree of generalizability. This study revised effect size estimates for future theory testing on the TTM applied to dietary fat.

Transtheoretical model-based dietary interventions in primary care: a review of the evidence in diabetes

Salmela, S., Poskiparta, M., Kasila, K., Vahasarja, K., Vanhala, M. — 2009-03-11

The objective of this study was to review the evidence concerning stage-based dietary interventions in primary care among persons with diabetes or an elevated diabetes risk. Search strategies were electronic databases and manual search. Selection criteria were randomized controlled studies with stage-based dietary intervention, conducted in primary care with at least 6 months of follow-up, and participants with either type 2 diabetes or with an elevated risk. The researchers evaluated trials for inclusion, extracted data and assessed study quality. Seven articles, based on five data sets, were included. These studies concentrated on cardiovascular diseases and being overweight, not diabetes. The quality of the studies was moderate to weak. Inadequacies in the reporting often involved unspecific information on the training of health care providers. Long-term positive outcomes (compared with controls) were found in total and monounsaturated fat intake, diastolic blood pressure, health status and well-being. The existing data are insufficient for drawing conclusions on the benefits of the transtheoretical model. More high-quality studies focusing on diabetes are needed, with greater attention to the training of providers and process evaluation. There is a need for a standardized appraisal tool for study evaluation, focusing separately on education interventions for patients and providers.

About evidence based and beyond: a discourse-analytic study of stakeholders' talk on involvement in the early development of personalized nutrition

Bouwman, L. I., te Molder, H. F. M. — 2009-03-11

This paper draws on discourse analysis to examine how Dutch stakeholders in health education, health care, health insurance, social science, the food industry and the media make sense of innovations in the field of ‘personalized nutrition’ and their own role and significance in an early stage of technology development. Previous research has focused on factors that help or hinder collaboration between stakeholders, and on the development, management and implementation of joint programs. However, no attention has been paid to how stakeholders themselves handle issues of responsibility and initiative in relation to early technology development and collaborative interactions. The present study shows how such stakeholders establish themselves as gatekeepers of innovation by displaying authority on what consumers ‘want’ and ‘cannot do’, while avoiding a proactive role. Uncertainty in scientific knowledge, fixed roles and responsibilities and dependency on incompetent or biased others are drawn upon to account for a wait-and-see policy.

Youths carrying a weapon or using a weapon in a fight: what makes the difference?

Thurnherr, J., Michaud, P.-A., Berchtold, A., Akre, C., Suris, J.-C. — 2009-03-11

The objective of this study was to characterize weapon-carrying adolescents and to assess whether weapon carriers differ from weapon users. Data were drawn from a cross-sectional school-based survey of 7548 adolescents aged 16–20 years in Switzerland. Youths carrying a weapon were compared with those who do not. Subsequently, weapon carriers were divided into those who had used it in a fight and those who had not. Individual, family, school and social factors were analyzed using bivariate and stepwise multivariate analysis. For both genders, delinquent behavior and being victim of physical violence were associated with weapon carrying. For males, quarreling while intoxicated, being an apprentice, being sensation seekers, having a tattoo, having a poor relationship with parents and practicing unsafe sex were also related to weapon carrying. Compared with weapon carriers, female weapon users were more likely to be regular smokers. Male weapon users were foreign born, urban and apprentices; had poor school connectedness; practiced unsafe sex and quarreled while intoxicated. Carrying a weapon is a relatively frequent behavior among youths in Switzerland and a sizeable proportion of weapon carriers have used it in a fight. Weapon carrying should be part of the clinical assessment and preventive counseling of adolescents. Preventive programs specific for at-risk youth groups need to be developed.

What is needed for informed decisions about prostate cancer screening: perspectives of African-American and Hispanic men

2009-03-11

Professional guidelines suggest that men should learn about risks and benefits of screening to make informed decisions consistent with their preferences. We used concept mapping to investigate views of informed decision making (IDM) of minority men. Statements about what men need for IDM about prostate cancer screening were sorted by similarity and rated for importance by 16 Hispanic and 15 African-American men. Multidimensional scaling and cluster analysis were used to develop a concept map for IDM. The 10-cluster solution was selected. The clusters rated most important were labeled Future Considerations, What to Know and Decision to Make. Clusters labeled Social Support and Sharing Perspectives depicted social aspects of the decision and were intermediate in importance. There was strong correlation in relative importance ratings of clusters by African-American and Hispanic men. However, African-American men gave higher importance ratings than Hispanic men. Concept mapping, a method with strong participatory elements, was useful in identifying conceptual frameworks for IDM of African-American and Hispanic men. Health education to support IDM requires some shifts in focus and strategy. It is important that interventions with minority men build upon a strong conceptual framework.

Using organization theory to understand the determinants of effective implementation of worksite health promotion programs

Weiner, B. J., Lewis, M. A., Linnan, L. A. — 2009-03-11

The field of worksite health promotion has moved toward the development and testing of comprehensive programs that target health behaviors with interventions operating at multiple levels of influence. Yet, observational and process evaluation studies indicate that such programs are challenging for worksites to implement effectively. Research has identified several organizational factors that promote or inhibit effective implementation of comprehensive worksite health promotion programs. However, no integrated theory of implementation has emerged from this research. This article describes a theory of the organizational determinants of effective implementation of comprehensive worksite health promotion programs. The model is adapted from theory and research on the implementation of complex innovations in manufacturing, education and health care settings. The article uses the Working Well Trial to illustrate the model's theoretical constructs. Although the article focuses on comprehensive worksite health promotion programs, the conceptual model may also apply to other types of complex health promotion programs. An organization-level theory of the determinants of effective implementation of worksite health promotion programs

Personal Social Capital Scale: an instrument for health and behavioral research

Chen, X., Stanton, B., Gong, J., Fang, X., Li, X. — 2009-03-11

The concept of social capital has drawn much attention in social and behavioral epidemiology and health education research. The purpose of this study is to develop the ‘Personal Social Capital Scale’ for quantitative survey studies of social factors that are related to health and behavior. The instrument contained 10 composite items based on 42 items for assessing personally owned social capital, including bonding and bridging capitals. The instrument was assessed using cross-sectional survey data collected among 128 participants (64 women) with a participation rate of 95%. Results from correlation and confirmatory factor analysis indicated adequate reliability and internal consistency. The mean score of the scale was 25.9 (SD = 5.2) for total social capital, 15.2 (SD = 3.0) for bonding social capital and 10.8 (SD = 3.4) for bridging social capital. The scale scores significantly predicted a number of theoretically related factors, including people skills, being sociable, social capital investment, informational support, instrumental support, emotional support and collective efficacy. This instrument provides a new tool for cross-cultural research to assess personally owned social capital.

Tailored lay health worker intervention improves breast cancer screening outcomes in non-adherent Korean-American women

Han, H.-R., Lee, H., Kim, M. T., Kim, K. B. — 2009-03-11

Despite rapidly increasing incidence rates of breast cancer, recent immigrants such as Korean-American (KA) women report disproportionately lower utilization of screening tests compared with other ethnic groups. Early screening of breast cancer for this population may be greatly facilitated by indigenous lay health workers (LHWs). We conducted an intervention trial with a 6-month follow-up. Trained LHWs recruited 100 KA women 40 years of age or older who had not had a mammogram during the past 2 years. Ninety-three completed follow-up questionnaires. A 120-min, in-class education combined with LHW follow-up counseling and navigation assistance through the health care system was provided. Rates of breast cancer screening behaviors significantly increased at 6 months (P < 0.001); changes between pre- and post-intervention were 31.9% for mammography, 23% for clinical breast examination and 36.2% for breast self-examination. Modesty toward screening significantly decreased over time, but we did not find any significant differences in breast cancer knowledge and beliefs before and after the intervention. Results support the efficacy of this neighborhood-based, culturally sensitive intervention. Further research should seek to replicate these findings and to incorporate more self-care skills such as health literacy when designing an intervention program for linguistically and culturally isolated immigrant women.

Effectiveness of community health agents' actions in situations of social vulnerability

2009-03-11

Moving from theory to practice: implementing the Kin KeeperSM Cancer Prevention Model

Williams, K. P., Mullan, P. B., Todem, D. — 2009-03-11

This paper presents the rationale and findings of a feasibility and process study of the Kin Keeper^SM Cancer Prevention Intervention. An observational cohort study design was implemented with African-American women in synergistic female family relationships. Community health workers (CHWs) from two Michigan public health programs recruited women to serve as ‘kin keepers’ who in turn recruited their female family members. In total, 161 kin keepers and female family members were sampled. Trained CHWs led kin keepers and family members in learning about breast cancer. Data methods included baseline and post-training administration of a breast cancer literacy assessment, post-training focus groups and review of personal action plans. To validate the feasibility of the process, a linear mixed-effects regression with 97% power was identified and differences in pre–post scores were detected at 5% significance level. Adjusting for family random effects, breast cancer literacy scores increased for all participants recruited (P-value = 0.0004) suggesting that the process was feasible. Analysis of focus groups and action plans indicated that participants valued the instruction and planned to act upon it. This experience with kin keepers and their families offers encouragement that the theoretical model and its community-based delivery can continue to enhance scholarship dedicated to ameliorating health care disparities.

Predictors of early first sexual intercourse among adolescents in Cape Town, South Africa

Mathews, C., Aaro, L. E., Flisher, A. J., Mukoma, W., Wubs, A. G., Schaalma, H. — 2009-01-07

Early coital debut is a risk factor for HIV. In this paper we investigate the predictors of young adolescents' transition to first intercourse using a social cognition theoretical framework. The analyses reported here were based on a longitudinal study of 2360 students in the schools allocated to the control arm of a cluster-randomized controlled trial to investigate the effect of a school-based HIV prevention programme among Grade 8 students in Cape Town. Structural equation modelling was performed with Mplus version 3.11. Of the 1440 students who were virgins at baseline, 1144 remained virgins 15 months later and 296 (20.6%) reported having had their first sexual intercourse. Transition to first sexual intercourse was more likely among males than females, among older students and among students with a lower socio-economic status. Transition to first sexual intercourse was significantly associated with intentions to have sexual intercourse, poor self-efficacy to negotiate delayed sex and intimate partner violence. The model predicted 35% of the variance in intentions and 16% of the variance in transition. These findings indicate some of the factors that influence young adolescent's transition to first intercourse and that need to be addressed when designing effective interventions.

'Imagine all that smoke in their lungs': parents' perceptions of young children's tolerance of tobacco smoke

Robinson, J., Kirkcaldy, A. J. — 2009-01-07

Despite knowing the risks to their children's health, parents continue to expose their children to tobacco smoke prior to and after their birth. This study explores the factors influencing parent's behaviour in preventing the exposure of their (unborn) children to environmental tobacco smoke (ETS) and any changes to their smoking behaviour in the home during the first years of their children's lives. Whether or not they stopped smoking during pregnancy, the women did not protect themselves from breathing in other people's smoke. Yet once the baby was born, parents actively protected the baby from environmental tobacco, believing that the lungs of newborn babies were too immature to tolerate smoke. This protection lasted only for a matter of weeks for some babies, or stopped when they were 6–12 months old, linked to their parent's belief that older babies could tolerate or avoid smoke. These findings suggest that changes made to smoking during the first weeks of a baby's life are unlikely to be sustained, and key messages about the risks if ETS exposure need to be delivered repeatedly over the first 2 years of life and re-enforced as the child gets older.

An examination of the association between seeing smoking in films and tobacco use in young adults in the west of Scotland: cross-sectional study

Hunt, K., Sweeting, H., Sargent, J., Lewars, H., Cin, S. D., Worth, K. — 2009-01-07

The objective is to examine the association between the amount of smoking seen in films and current smoking in young adults living in the west of Scotland in the UK. Cross-sectional analyses (using multivariable logistic regression) of data collected at age 19 (2002–04) from a longitudinal cohort originally surveyed at age 11 (1994–95) were conducted. The main outcome measure is smoking at age 19. No association was found between the number of occurrences of smoking estimated to have been seen in films (film smoking exposure) and current (or ever) smoking in young adults. This lack of association was unaffected by adjustment for predictors of smoking, including education, risk-taking orientation and smoking among peers. There was no association between film smoking exposure and smoking behaviour for any covariate-defined subgroup. Associations have been found between film smoking exposure and smoking initiation in younger adolescents in the United States. In this study, conducted in Scotland, no similar association was seen, suggesting that there may be age or cultural limitations on the effects of film smoking exposure on smoking. The lack of association could be due to methodological issues or greater sophistication of older adolescents and young adults in interpreting media images or the greater ubiquity of real-life smoking instances in Scotland. If the latter, film smoking exposure could become a more important risk factor for smoking uptake and maintenants in older adolescents following the recent ban on smoking in public places in Scotland.

Does targeting injury prevention towards families in disadvantaged areas reduce inequalities in safety practices?

Kendrick, D., Mulvaney, C., Watson, M. — 2009-01-07

Inequalities in childhood injury and safety practices exist, but there is little evidence that targeted interventions can reduce such inequalities. This study examines the effect of a home safety intervention on reducing inequalities in safety practices using a secondary analysis of data from a randomized controlled trial. Families with children <5 years from disadvantaged areas were randomized to receive a standardized health visitor safety consultation and free or low-cost safety equipment fitted in the home or to usual care. The impact of the intervention in terms of stair gate use and functioning smoke alarms was compared by ethnic group, maternal age, housing tenure, family type and receipt of state-provided means-tested benefits at 1-year follow-up. Marked inequalities were found for both safety practices by each socio-economic characteristic prior to the intervention. The intervention significantly reduced inequalities in stair gate use by housing tenure (P = 0.006) and receipt of benefits (P = 0.04), but did not reduce inequalities in functioning smoke alarms. We conclude that a home safety intervention targeted at deprived areas addressing the barriers of cost and needing help to fit equipment was only partially successful in reducing inequalities in safety practices. Other strategies will be required to reduce inequalities especially in relation to functioning smoke alarms.

Sustaining 'truth': changes in youth tobacco attitudes and smoking intentions after 3 years of a national antismoking campaign

Farrelly, M. C., Davis, K. C., Duke, J., Messeri, P. — 2009-01-07

This study examines how the American Legacy Foundation's ‘truth®’ campaign and Philip Morris's ‘Think. Don't Smoke’ (TDS) campaign have influenced youth's tobacco-related attitudes, beliefs and intentions during the first 3 years of the truth campaign. We use data from eight nationally representative cross-sectional telephone surveys of 35 074 12- to 17-year olds to estimate cross-sectional time series logistic regressions that assess the association between recall of truth and TDS and attitudes, beliefs, and intentions toward smoking. An alternative measure of exposure to TDS was also used. Findings indicate that exposure to truth advertisements (ads) was associated with steady positive changes in attitudes, beliefs and intentions to smoke, whereas exposure to Philip Morris ads was associated with more favorable beliefs and attitudes toward the tobacco industry. Our findings suggest that well-executed antismoking campaigns can positively and consistently change youth's beliefs and attitudes, whereas a tobacco industry-sponsored campaign can have a counterproductive influence.

Home and child safety on reality television

Manganello, J. A., McKenzie, L. B. — 2009-01-07

Injuries, many of which occur at home, are the leading cause of death for children. With such an extensive problem, it is natural to look for outlets such as mass media to reach large numbers of families with educational messages about safety and injury prevention. Mass media has been widely used to educate people about health issues. While studies have examined the portrayal of topics such as substance use and sexual behavior, no study has looked at media content about home and child safety practices. A pilot study with a sample of 10 television shows about home renovation, children or families was examined using content analysis for the presence or absence of home and child safety practices and products and discussion of injury topics. Most practices, like checking the water temperature when bathing a child or having smoke alarms, were never discussed or shown. Results suggest these shows provide information about home or family life, but few role models are shown offering information or examples of safe practices. Promoting safety information in these television programs may be a potentially important way to educate a large number of people, and feasibility of adding safety information to such shows should be explored.

Optimizing the efficacy of smoking cessation contests: an exploration of determinants of successful quitting

van Osch, L., Lechner, L., Reubsaet, A., Steenstra, M., Wigger, S., de Vries, H. — 2009-01-07

The present study describes the short- and long-term efficacy and program evaluation of a Quit and Win smoking cessation campaign, organized in The Netherlands. To be able to fine-tune smoking cessation contests to the needs of the target population, utilization, appreciation and efficacy of various contest elements were investigated. Data from 1551 Quit and Win participants and 244 control respondents were collected by web-based surveys at baseline (pre-contest) and 1 and 12 months after the contest. Demographic and contest predictors of successful quitting were determined by logistic regression analyses. Quit and Win proved to be an effective as well as highly appreciated program among participants. Conservative 1-month (35%) and continuous 12-month abstinence (12%) rates were significantly higher in Quit and Win participants than in the control group (1 month: 11%; continuous: 3%). Use of a supportive e-mail message service predicted short- and long-term abstinence. A buddy support system was the most used and highly appreciated cessation aid, and its use significantly predicted short-term abstinence. Radio commercials and Internet advertisements were the most effective recruitment channels. Although non-exhaustive, implementation of the results and recommendations discussed in this study could lead to an increased use, appreciation and efficacy of future smoking cessation campaigns.

Predicting transitions from preintentional, intentional and actional stages of change

Schuz, B., Sniehotta, F. F., Mallach, N., Wiedemann, A. U., Schwarzer, R. — 2009-01-07

Stage theories of health behavior change assume that individuals pass through qualitatively different stages on their way to the adoption of health behaviors. Three common stages (preintention, intention and action) can be defined by stage transitions included in current stage theories and supported by evidence. The present study examines whether transitions between these stages can be predicted by social cognition variables derived from prevailing health behavior theories. At two points in time, the motivation for interdental hygiene behaviors and oral self-care was assessed in 288 participants recruited in dental practices. Stage progression and regression over time were analyzed using discriminant function analysis. Progression from preintention to intention was predicted by action planning, whereas coping planning and self-efficacy predicted transitions from intention. Regression from action was predicted by self-efficacy. Results support the distinction of three common stages. Findings are discussed in terms of their contribution to health behavior theory.

Formative research on creating smoke-free homes in rural communities

Escoffery, C., Kegler, M. C., Butler, S. — 2009-01-07

The home is a significant place for exposure to secondhand smoke for children and non-smoking adults. This study explored factors that would convince families to adopt household smoking bans and actions to create and maintain smoke-free homes. Interviews were conducted with adults in 102 households in rural Georgia. Participating families had a young adolescent and included households with a mix of smokers and non-smokers and smoking ban status. Families reported they would consider a total ban to protect children from secondhand smoke and protect family members if they got sick. Few described difficulties in enforcement with over half of smokers accepting the rules. Situations that made it hard to enforce restrictions were if there was a visitor who smoked, a smoker who had cravings, and bad weather outside when the smoker desired to smoke. Smokers explained that family members could assist them in quitting by talking to them, not purchasing cigarettes for them, not smoking around them, and supporting them. Ideas for promoting smoke-free homes were having a no smoking sign, saying no to visitors who want to smoke, removing ashtrays, and creating a place outside for smokers. These findings can inform interventions designed to create and maintain smoke-free households.

Inequalities in toothbrushing among adolescents in Scotland 1998-2006

Levin, K. A., Currie, C. — 2009-01-07

The aim of this study was to examine trends in toothbrushing and inequalities in toothbrushing among girls and boys in Scotland between 1998 and 2006. A secondary aim was to investigate the association between the health promoting school (HPS) initiative and toothbrushing. Data from the Health Behaviour in School-aged Children 1998, 2002 and 2006 surveys were analysed using multilevel logistic regression for boys and girls aged 11, 13 and 15 years. Girls’ twice-a-day toothbrushing increased with age while that of boys’ remained stable. Toothbrushing increased significantly between 1998 and 2006 for all but 15-year-old girls. Family structure was significantly associated with toothbrushing for 11-year-old boys and 13-year-old boys and girls. Socio-economic inequalities in toothbrushing were significant for both boys and girls at all ages. Largest inequalities were seen among 13-year-old girls and 15-year-old boys. Inequalities persisted over time for all but 15-year-old boys who saw a significant reduction between 1998 and 2006. The HPS initiative in schools in deprived areas was associated with increased odds of twice-a day toothbrushing among 11-year-old boys and 15-year-old girls.

Obese girls differences in neighbourhood perceptions, screen time and socioeconomic status according to level of physical activity

Mota, J., Ribeiro, J. C., Santos, M. P. — 2009-01-07

The purpose of this study was to investigate perceptions of neighbourhood, amount of screen time and socioeconomic status (SES) in active and non-active ‘overweight/obese girls'. The sample comprised 162 girls aged 14.1 ± 1.5 years old. Girls were assigned as active obese (AO) and non-active obese (NAO). Environmental variables, screen time and SES were assessed by questionnaire. No statistically significant differences were found for screen time between AO and NAO groups. Educational status of father (r = 0.23; P = 0.003) and mother (r = 0.18; P = 0.02) was positively and significantly associated with AO. AO girls reported to more significantly (P < 0.05) agree with living in a neighbourhood with several public recreation facilities and that they see people being physically active in neighbourhood. Logistic regression analysis showed that social environment [odds ratio (OR) = 15.06; P = 0.037] and recreational facilities domain (OR = 11.16; P = 0.042) were associated to likelihood to be more active. Creating social support and providing PA facilities within neighbourhoods, particularly in low SES neighbourhoods, are desirable.

Psychosocial correlates of cigarette smoking among college students in China

Mao, R., Li, X., Stanton, B., Wang, J., Hong, Y., Zhang, H., Chen, X. — 2009-01-07

The objectives are to examine the smoking practice and intention among Chinese college students and to explore the association between cigarette smoking and individual and psychosocial factors. Cross-sectional data were collected from 1874 students from 19 college campuses in Jiangsu province, China. Both bivariate and multivariate analyses were performed to assess the associations of smoking practice and smoking intention with various individual and psychosocial factors. There was a significant gender difference in both smoking practice and smoking intention. Overall, 53% of the participants (70% male and 31% female) reported ever having smoked in their lifetime and 29% of the sample (49% male and 5% female) reported having smoked in the past 30 days. About one-fourth of the sample (44% male and 6% female) thought they were likely to smoke in the next 6 months. Male gender, low family socioeconomic status, perception of more peer smoking, more perceived benefits of smoking, higher level of pro-smoking attitude, higher level of perceived cost of non-smoking and more involvement in other health risk were positively associated with being a past or current smoker. Likewise, male gender, older age, more friends smoking, greater perceived benefits of smoking, higher pro-smoking attitudes and more health risk involvement were associated with the likelihood to smoke in the next 6 months. The data suggest a substantial smoking experimentation among college students in China, which presents both a challenge and an opportunity to prevent a large proportion of experimenters from progressing to regular smokers. The findings in the current study can be used to inform the development of effective smoking intervention prevention programs among college students in China.

Perceived condom norms and HIV risks among social and sexual networks of young African American men who have sex with men

Peterson, J. L., Rothenberg, R., Kraft, J. M., Beeker, C., Trotter, R. — 2009-01-07

The association between condom norms and unprotected sexual intercourse was examined within social and sexual networks of young African American men who have sex with men (MSM) in an HIV epicenter of the southern United States. We used a chain-link design to recruit 158 young African American men: 95 initial participants, 56 contacts of participants (alters) and 7 contacts of alters. Men in the high-risk group, compared with those in the no-risk group, perceived significantly lower approval concerning condom use in their social and sexual networks. Also, 100 participants could be connected to each other in 86 dyads of social and sexual networks. Within these dyads, men perceived that their friends and acquaintances approved for them to use condoms but that their friends and acquaintances did not use condoms themselves. Low HIV risk behavior appears associated with perceived social norms that support one's use of condoms, even when perceived norms do not support condom use by network members themselves.

Predicting changes in physical activity among adolescents: the role of self-efficacy, intention, action planning and coping planning

Araujo-Soares, V., McIntyre, T., Sniehotta, F. F. — 2009-01-07

This paper aims to test the direct predictors of the theory of planned behaviour (TPB), action planning and coping planning as predictors of changes in physical activity (PA) in 157 adolescents (mean age: 12). TPB measures, the Action Planning and Coping Planning Scales (APCPS) and the International Physical Activity Questionnaires were measured at baseline, 2- and 5-month follow-up. Hierarchical regression analyses were conducted regressing PA at Time 2 or Time 3 onto TPB and APCPS at baseline or Time 2, respectively. Past behaviour accounted for a significant 25–51% of the variance in PA in Step 1 of all three analyses. In Step 2, TPB accounted for an additional 3–10% with intention as a significant predictor. While no main effects for action planning or coping planning (Step 3) were found, all three analyses resulted in a significant amount of incremental variance accounted for by the interaction of action planning and coping planning (Step 4). Results suggest that the combination of high levels of action planning and coping planning is associated with increases in PA. Implications for theory of behaviour change in adolescents are discussed.

Validation of the worry about sexual outcomes scale for use in STI/HIV prevention interventions for adolescent females

2009-01-07

This study examined the psychometric properties of a new scale to measure adolescents’ worry regarding outcomes of risky sexual behavior (i.e. sexually transmitted infections, including HIV [STI/HIV], and unintended pregnancy). The 10-item worry about sexual outcomes (WASO) scale, resulting in two subscales STI/HIV worry and pregnancy worry, was administered to a sample of 522 African-American female adolescents ranging in age from 14 to 18, residing in the southeast United States and participating in a sexual risk reduction intervention. The WASO demonstrated internal consistency across multiple administrations and yielded satisfactory construct validity. Worry was found to negatively correlate with sexual communication self-efficacy (with a new male partner and a steady male partner), frequency of sexual communication with male partner, attitudes about condom use and social support; worry was positively correlated with perceived barriers to condom use, condom negotiation, locus of control and depression. Overall, the results indicate that the WASO is a reliable and valid measure of assessing adolescents’ worry about STIs, HIV and pregnancy. The WASO represents a brief self-administered instrument that can be easily integrated into sexual risk reduction assessments and interventions. Future studies employing the WASO might consider testing it with more diverse samples in terms of gender, race/ethnicity, age and sexual orientation.

Could pets be of help in achieving health literacy? A media analysis demonstration study

Rock, M., Lail, P. — 2009-01-07

This paper asks whether, when seeking to reach the public, interest in the health of pets merits consideration. Our data set consisted of 128 items from Canadian media coverage, 1996–2006, that dealt with bovine spongiform encephalopathy (BSE) as well as with cats, dogs or both. Three main messages regarding pet health and human health were identified: ‘do not worry’, ‘do worry’ and ‘be cautious’. A minority of articles did not convey a pet health message or a human health message (6%), and contradictory messages regarding human and animal health frequently occurred (32%). While we did not assess how members of the public actually received or interpreted these messages, media coverage dealing with pets does appear to have the potential to influence people. Media reports of British cats being harmed by BSE, in fact, may have influenced public views worldwide. Thus, professionals should give careful consideration to pets when conveying health information. Nevertheless, we do not suggest pet health information substitute for human health information. Rather, interest in pets may provide an opportunity to complement and to reinforce communication about human health.

Subjective attractiveness and perceived trendiness in smoking and snus use: a study among young Norwegians

Wiium, N., Aaro, L. E., Hetland, J. — 2009-01-07

In Norway, there has been a decline in smoking among adults and young people, but there has also been an increase in the use of snus, particularly among young males. Among females, snus use is less common. This study examines to what extent subjective attractiveness (SA) (the individual’s personal opinion regarding how attractive a person who smokes/uses snus is) and perceived trendiness (PT) (the individual’s impressions of how popular smoking/use of snus is) may contribute to explaining current trends in smoking and snus use among young people in Norway. Data were collected from a national representative sample of 2400 young people (age 16–20) by telephone interviews. Among males, regular smokers were also likely to be regular snus users and vice versa. SA and PT were significant predictors of their respective behaviours (smoking and snus use) and in some cases of the other behaviour. Smoking and snus use were perceived as unattractive, while snus use was perceived to be trendier than smoking. Males, more than females, perceived snus use to be attractive and trendy. This pattern is partly consistent with current changes in tobacco use in the Norwegian population.