Cognitive-behavioral mediators of changing multiple behaviors: smoking and a sedentary lifestyle

Readiness to use physical activity as a smoking cessation aid: a multiple behaviour change application of the Transtheoretical Model among quitters attending Stop Smoking Clinics

OBJECTIVE

Physical activity (PA) reduces cravings during smoking abstinence. Little is known about quitters' use of PA. This study aimed to: (1) determine the extent of quitters' past and current use of PA as a cessation aid, while attempting to quit; (2) examine relationships between use of PA and quitter characteristics and cognitions.

METHODS

Self-report surveys were completed by 181 smokers attempting to quit.

RESULTS

Twenty-two percent of quitters reported currently using PA to control their smoking, and 35% had used it during a previous quit attempt. Those in later stages of readiness for using PA as a cessation aid held more positive beliefs regarding self-efficacy, outcome efficacy and did more vigorous PA.

CONCLUSION

Quitters were more likely to use PA to help them quit when they had greater belief in their own ability to use PA and in the efficacy of PA to help them to quit, and were also meeting weekly PA targets for health.

PRACTICE IMPLICATIONS

Strategies by stop smoking advisors aiming to enhance client self-efficacy and outcome efficacy beliefs regarding PA as a cessation aid may help to increase the use of this behavioural strategy, since it seems that most quitters do not use PA.

Improving physical activity and dietary behaviours with single or multiple health behaviour interventions? A synthesis of meta-analyses and reviews

Since multiple health behaviour interventions have gained popularity, it is important to investigate their effectiveness compared to single health behaviour interventions. This synthesis aims to determine whether single intervention (physical activity or dietary) or multiple interventions (physical activity and dietary) are more effective at increasing these behaviours by synthesizing reviews and meta-analyses. A sub-purpose also explored their impact on weight. Overall, reviews/meta-analyses showed that single health behaviour interventions were more effective at increasing the targeted behaviours, while multiple health behaviour interventions resulted in greater weight loss. This review may assist policies aiming at improving physical activity and nutrition and reversing the obesity epidemic.

Muscular fitness in relation to physical activity and television viewing among young adults

PURPOSE

To study how time spent in physical activity and that in television (TV) viewing are associated with muscular fitness among young adults.

METHODS

The study population consisted of a cross-sectional sample of 381 males and 493 females aged 19.1 yr (SD 0.3) from the Northern Finland Birth Cohort 1986. Muscular fitness was measured by trunk muscle strength tests (trunk extension, flexion, and rotation) and jumping height test. Time spent on moderate- to vigorous-intensity physical activity and on TV viewing was self-reported by a questionnaire.

RESULTS

The most physically active young adults performed significantly better in most trunk muscle strength tests and the jumping test than the least active subjects. The mean difference between the most and least active groups was at minimum 1.6 kg (95% confidence interval (CI) = -0.5 to 3.7) and at maximum 10.6 kg (95% CI = 4.7-16.5) for different trunk muscle strength tests and at minimum 4.4 cm (95% CI = 2.7-6.1) for the jumping height test. Males and females who watched TV for >or=2 h x d(-1) performed significantly worse in trunk extension and flexion tests and females also performed worse in the jumping test compared with those who watched TV <2 h x d(-1), independent of their physical activity level. The mean difference between low and high TV users was at minimum -3.8 kg (95% CI = -6.7 to -0.9) for trunk extension and flexion strength and -1.2 cm (95% CI = -2.0 to -0.4) for jumping height in females.

CONCLUSIONS

Among young adults, daily TV viewing for >or=2 h, irrespective of physical activity level, was associated with poorer muscular fitness.

Determinants of physical activity promotion by smoking cessation advisors as an aid for quitting: support for the Transtheoretical Model

OBJECTIVES

Physical activity (PA) can reduce cigarette cravings and aid quitting but little is known about its promotion by smoking cessation advisors. This study aimed to: (1) determine the extent to which smoking cessation advisors promote PA; and (2) examine the relationship between PA promotion as a cessation aid and advisor characteristics and cognitions, within the Transtheoretical Model (TM) framework.

METHODS

Self-report surveys assessing PA promotion, TM variables, advisors' own PA levels and demographics were completed by 170 advisors in England and Scotland.

RESULTS

Advisors reported spending 29min promoting PA over a 6/7-week clinic. Those in later stages of readiness for promoting PA as a cessation aid and those spending more time promoting PA held more positive beliefs regarding pros and cons, self-efficacy, outcome efficacy and importance of PA within smoking cessation. Time spent promoting PA and stage of readiness were strongly associated. There was a trend for the more physically active advisors to promote PA more often.

CONCLUSIONS

About half the advisors promoted PA and TM variables predicted this variability.

PRACTICE IMPLICATIONS

PA promotion among smoking cessation advisors may be facilitated by enhancing self-efficacy, outcome efficacy and pro- and con-beliefs related to PA promotion.

Getting beyond outcomes: a realist approach to help understand the impact of a nutritional intervention during smoking cessation

OBJECTIVES

This paper discusses the benefits that a 'realist' approach can bring to an outcome study using the example of a nutritional intervention offered as an adjunct to the existing smoking cessation programmes to limit post-cessation weight gain.

SUBJECTS AND SETTING

Participants of a smoking cessation programme in areas of deprivation in the north, south and west of Glasgow.

RESULTS

A realist approach enabled the development of a framework able to investigate both implementation and outcomes of the intervention. Drawing on theoretical and experiential knowledge, context-mechanism-outcome hypotheses were developed for further testing at later stages of evaluation. This will focus the further stages of evaluation on testing these specific hypotheses using outcome data collected at the end of the intervention.

CONCLUSION

Adopting such an evaluation approach enables integration of process and outcome data that will refine our understanding of contexts and mechanisms, which are associated with these behavioural changes. It can aid further policy decisions by identifying the type of participant and circumstances that are associated with positive outcomes and those subgroups of participants that can be targeted more effectively using other approaches.

Exercise interventions for smoking cessation

BACKGROUND

Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings, and by helping to manage weight gain.

OBJECTIVES

To determine whether exercise-based interventions alone or combined with a smoking cessation programme are more effective than a smoking cessation intervention alone.

SEARCH STRATEGY

In July 2008, we searched the Cochrane Tobacco Addiction Group Specialized Register for studies including the terms 'exercise' or 'physical activity'. We also searched MEDLINE, EMBASE, PsycINFO, Dissertation Abstracts and CINAHL.

SELECTION CRITERIA

We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme, recruiting smokers or recent quitters, and with a follow up of six months or more.

DATA COLLECTION AND ANALYSIS

We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis.

MAIN RESULTS

We identified 13 trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a significant benefit for exercise versus control on abstinence at the three-month follow up and a benefit for exercise of borderline significance (P = 0.05) at the 12-month follow up. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three-month follow up but not at the end of treatment or 12-month follow up. The other studies showed no significant effect for exercise on abstinence.

AUTHORS' CONCLUSIONS

Only one of the 13 trials offered evidence for exercise aiding smoking cessation at a 12-month follow up. All the other trials were too small to exclude reliably an effect of intervention, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense interventions, equal contact control conditions, measures of exercise adherence and change in physical activity in both exercise and comparison groups.

Physical activity as a strategy for maintaining tobacco abstinence: a randomized trial

OBJECTIVES

For smoking cessation, physical activity (PA) may help manage withdrawal symptoms, mood, stress, and weight; yet studies of PA as an aid for smoking cessation have been mixed. This study examined: (1) the impact of an extended relapse prevention program on increasing moderate to vigorous PA (MVPA) in adults enrolled in a tobacco cessation treatment trial; (2) whether changes in MVPA were associated with sustained abstinence from smoking; and (3) mechanisms by which MVPA may support sustained abstinence from smoking.

METHODS

In a randomized controlled trial conducted from 2003-2006 in San Francisco, California, 407 adult smokers received a 12 week group-based smoking cessation treatment with bupropion and nicotine patch with the quit date set at week 3. At week 12, participants were randomized to no further treatment or to 40 weeks of bupropion or placebo with or without an 11-session relapse prevention intervention of which 2 sessions (held at weeks 16 and 20) focused on PA. Participants receiving the PA intervention (n=163) received a pedometer, counseling to increase steps 10% biweekly towards a 10,000 steps/day goal, and personalized reports graphing progress with individualized goals. The International Physical Activity Questionnaire assessed weekly minutes of MVPA at baseline and weeks 12 and 24. Sustained abstinence from tobacco at week 24 was validated with expired carbon monoxide.

RESULTS

In a repeated mixed model analysis, intervention participants significantly increased their MVPA relative to control participants, F(1,475)=3.95, p=.047. Pedometer step counts also increased significantly, t(23)=2.36, p=.027, though only 15% of intervention participants provided 6 weeks of pedometer monitoring. Controlling for treatment condition, increased MVPA predicted sustained smoking abstinence at week 24, odds ratio=1.84 (95% CI: 1.07, 3.05). Among participants with sustained abstinence, increased MVPA was associated with increased vigor (r=0.23, p=.025) and decreased perceived difficulty with staying smoke-free (r=-0.21, p=.038).

CONCLUSION

PA promotion as an adjunct to tobacco treatment increases MVPA levels; changes in MVPA predict sustained abstinence, perhaps by improving mood and self-efficacy.

Effects of tailored feedback on multiple health behaviors

BACKGROUND

The effects of tailored intervention on multiple behaviors and possible moderators of tailoring effects have not yet been sufficiently demonstrated.

PURPOSE

The purpose of this study was to examine the effectiveness of a computer-tailored intervention on smoking; physical activity; and fruit, vegetable, and fat intake; and to test potential moderators of the effectiveness (BMI, age, SES, gender, motivation, and the number of behaviors for which respondents met the recommendations from national guidelines).

METHODS

Respondents were randomly assigned to a tailored intervention group, receiving one tailored letter on all of these behaviors, or a control intervention group, receiving one general information letter on all behaviors.

RESULTS

Three months after the baseline assessment, the tailored intervention group showed significantly better effects than the control group for all behaviors studied, except for smoking. Notably, the intervention did not enhance the health behaviors, but rather reduced a decline in these behaviors during the 3-month study interval. Effect sizes were small. No moderating factors were found, except for the number of behaviors for which recommendations were met in the tailoring intervention group on fruit consumption. The largest effects of the tailored intervention were found for fruit in respondents who did not meet the recommendations for any behavior (Cohen's d = 0.3).

CONCLUSIONS

A tailored intervention on multiple behaviors had significant, but limited effects when compared to generic information. The number of bad habits influenced the effects of the tailored intervention on fruit consumption.

Characteristics of physically active smokers and implications for harm reduction

OBJECTIVES

We sought to establish the prevalence of physical activity among smokers, whether or not physically active smokers were more likely to attempt cessation, and who these physically active smokers were.

METHODS

We used logistic regression to contrast physically active and inactive smokers in a secondary data analysis of the Canadian Community Health Survey Cycle 1.1.

RESULTS

Physically active smokers represented almost one quarter of the smoking population. Compared with physically inactive smokers, physically active smokers were more likely to have attempted cessation in the past year. Physically active smokers were more likely to be young, single, and men compared with their inactive counterparts. Income had no influence in distinguishing physically active and inactive smokers.

CONCLUSIONS

Skepticism persists regarding the practicality and potential risks of promoting physical activity as a harm-reduction strategy for tobacco use. We found that a modest proportion of the daily smoking population was physically active and that engagement in this behavior was related to greater cessation attempts. Interventions could be developed that target smokers who are likely to adopt physical activity.

Efficacy and use of an internet-delivered computer-tailored lifestyle intervention, targeting saturated fat intake, physical activity and smoking cessation: a randomized controlled trial

BACKGROUND

Although experts claim that computer-tailored interventions provided over the Internet have great potential to promote health behavior change, few studies have tested the efficacy of computer-tailored lifestyle interventions online-delivered over the Internet.

PURPOSE

To evaluate the short-term (1 month) efficacy of an Internet-delivered, computer-tailored lifestyle intervention targeting saturated fat intake, physical activity (PA), and smoking cessation, and to evaluate exposure to the intervention.

METHODS

A pretest-posttest randomized controlled trial with an intervention group and a no intervention waiting list control group was conducted. Self-reported behavior and determinants were assessed at baseline and 1 month follow-up. Exposure to the intervention was monitored through server registrations. The data were analyzed using multiple linear and logistic regression analysis.

RESULTS

The intervention resulted in a significantly lower self-reported saturated fat intake (b = -0.76, p < 0.01) and a higher likelihood of meeting the PA guidelines among respondents who were insufficiently active at baseline (OR = 1.34, 95%CI = 1.001-1.80). No significant intervention effects were found for self-reported smoking status. Of the participants, 81% actually visited the website.

CONCLUSIONS

The Internet-delivered, computer-tailored lifestyle intervention was effective in reducing self-reported saturated fat intake and in increasing self-reported PA among participants who completed the study.

Multiple health-risk behavior in a chronic disease population: what behaviors do people choose to change?

OBJECTIVE

To determine what health behaviors patients choose to change in response to medical advice when they are given the potential net-present value (reduction in biological age) of modifying a behavior.

METHODS

Baseline data for multiple health-risk behaviors that were recommended for change among 660 coronary angioplasty patients at the New York-Presbyterian Hospital-Weill-Cornell Medical Center who were enrolled during 2000--02 in one of two arms of a behavioral intervention trial designed to compare different approaches to communicating health risk (net-present vs. future value) were analyzed using multivariate statistical methods.

RESULTS

Although there was no difference between study arms, knowing the biological-age value of behaviors, stage of change, and the total number of behaviors recommended for change was associated with choosing several behaviors. Notably, stage of change was associated in both groups with strength training (intervention OR 2.82, 95% CI 1.85, 4.30; comparison OR 2.84, 95% CI 1.83, 4.43, p<.0001) and reducing weight (intervention OR 2.49, 95% CI 1.32, 4.67, p=.005; comparison OR 1.98, 95% CI 1.80, 3.31, p=.01).

CONCLUSION

Patients with coronary disease are more likely to choose strength training and reducing weight regardless of knowing the biological-age reduction of any given behavior.

Meta-analytic examination of the strong and weak principles across 48 health behaviors

OBJECTIVE

The strong and weak principles of change state that progress from the precontemplation to the action stage of change is associated with a one standard deviation increase in the pros and a one-half standard deviation decrease in the cons of change. In this study these relationships, originally developed by Prochaska [Prochaska, J.O., 1994. Strong and weak principles for progressing from precontemplation to action on the basis of 12 problem behaviors. Health Psychology, 13, 47-51] based on an examination of 12 studies of 12 different behaviors, were re-examined using many more datasets and much more rigorous statistical methods.

METHODS

The current study analyzes 120 datasets from studies conducted between 1984 and 2003 across and within 48 health behaviors, including nearly 50,000 participants from 10 countries. The datasets were primarily analyzed utilizing meta-analytic techniques.

RESULTS

Despite the range of behaviors and populations, the results were remarkably consistent with the original results (pros=1.00 standard deviation, cons=0.56 standard deviation). Few potential moderators showed any impact on effect size distributions.

CONCLUSIONS

This updated and enhanced examination of two important principles of behavior change is a significant contribution to the field of multiple health risk behaviors, as it clearly demonstrates the consistency of the theoretical principles across multiple behaviors, which has implications for developing multiple health risk behavior interventions.

Clusters of lifestyle behaviors: results from the Dutch SMILE study

OBJECTIVE

This study aimed to identify differences and similarities in health behavior clusters for respondents with different educational backgrounds.

METHODS

A total of 9449 respondents from the 2002 wave of the Dutch SMILE cohort study participated. Latent class analyses were used to identify clusters of people based on their adherence to Dutch recommendations for five important preventive health behaviors: non-smoking, alcohol use, fruit consumption, vegetable consumption and physical exercise.

RESULTS

The distribution of these groups of behaviors resulted in three clusters of people: a healthy, an unhealthy and poor nutrition cluster. This pattern was replicated in groups with low, moderate and high educational background. The high educational group scored much better on all health behaviors, whereas the lowest educational group scored the worst on the health behaviors.

CONCLUSION

The same three patterns of health behavior can be found in different educational groups (high, moderate, low). The high educational group scored much better on all health behaviors, whereas the lowest educational group scored the worst on the health behaviors. Tailoring health education messages using a cluster-based approach may be a promising new approach to address multiple behavior change more effectively.

Applying health behavior theory to multiple behavior change: considerations and approaches

BACKGROUND

There has been a dearth of theorizing in the area of multiple behavior change. The purpose of the current article was to examine how health behavior theory might be applied to the growing research terrain of multiple behavior change.

METHODS

Three approaches to applying health behavior theory to multiple behavior change are advanced, including searching the literature for potential examples of such applications.

RESULTS

These three approaches to multiple behavior change include (1) a behavior change principles approach; (2) a global health / behavioral category approach, and (3) a multiple behavioral approach. Each approach is discussed and explicated and examples from this emerging literature are provided.

CONCLUSIONS

Further study in this area has the potential to broaden our understanding of multiple behaviors and multiple behavior change. Implications for additional theory-testing and application of theory to interventions are discussed.

Motivation and the stages of change among individuals with severe mental illness and substance abuse disorders

A complicating factor affecting the treatment of individuals with coexisting substance use problems and serious mental illness is their motivation for change and how these interacting, chronic conditions affect the entire process of intentional behavior change. This selective review explores conceptual and assessment issues related to readiness to modify substance use and readiness to initiate behaviors helpful for managing mental illness in the search for a better understanding of patient motivation for change. The recent but limited research on motivation and stages of change among dually diagnosed patients indicates that these individuals appear to access and use an intentional behavior change process. However, it is not completely clear how this process works and what precise adaptations are needed to assess and to access motivation to change to encourage sustained behavior change in this population. Nevertheless, motivation and readiness to change are important dimensions that need to be addressed in treatment and research with dually diagnosed populations.

Smoking patterns, beliefs, and the practice of healthy behaviors in abstinent, relapsed, and recalcitrant smokers

The purpose of this study was to perform a secondary analysis of smoking patterns and beliefs related to healthy behaviors in adult smokers (N = 71). Data for the secondary analysis were obtained from an original study that examined guided health imagery as a smoking cessation intervention. The imagery intervention resulted in significantly higher 2-year smoking abstinence rates for the intervention group of participants (26% vs. 12% for the control group). In this study, discriminant function analysis demonstrated that "well-established smoking patterns" accounted for 42% of the variance in those smokers who relapsed or never made any attempt to quit smoking. Higher baseline smoking rates, longer lifetime smoking histories, younger age at initiation of smoking, more positive beliefs about smoking (pros), and fewer healthy behaviors differentiated abstinent smokers from those who relapsed or were considered recalcitrant. Smoking patterns, belief systems related to smoking, and the practice of healthy behaviors need to be assessed as smokers enroll in cessation programs. Knowledge about relapsed and recalcitrant smokers will assist in the development of future interventions to meet smokers' unique needs and demands for cessation.

The effects of exercise and nicotine replacement therapy on smoking rates in women

PURPOSE

To examine the individual effects of supervised and intensive exercise as well as the combined effects of exercise and nicotine replacement therapy (NRT) on (a) smoking cessation and reduction rates and (b) psychological and physiological processes during withdrawal.

METHODS

One-hundred and forty-two inactive female smokers were randomised into the following four groups: exercise+nicotine patch; exercise+no nicotine patch; cognitive behavior therapy (CBT)+nicotine patch and CBT+no nicotine patch. Smoking abstinence (verified by saliva cotinine and expired carbon monoxide), cessation self-efficacy, and physical fitness and body weight were assessed at baseline (week 1), quit date (week 6), program termination (week 12), and 3- and 12-month follow-up.

RESULTS

There were significant differences in a 7-day point prevalence but not continuous abstinence rates between treatment groups across targeted end points. Consistently higher cessation rates were seen when NRT was added to both treatment programs. Compared with CBT participants, exercise participants had significantly increased functional exercise capacity and had gained significantly less weight during program end points but these differences did not hold at a 12-month follow-up. Compared with exercise participants, CBT participants felt greater cessation efficacy and reported greater knowledge, coping and support resources across all end points.

CONCLUSIONS

Exercise combined with NRT facilitates smoking cessation, improves functional exercise capacity, and delays weight gain in women smokers. We recommend that physicians and health care professionals recommend exercise and NRT together for highly motivated women interested in quitting smoking.

How does dialectical behavior therapy facilitate treatment retention among individuals with comorbid borderline personality disorder and substance use disorders?

For individuals presenting with comorbid borderline personality disorder (BPD) and substance use disorders (SUD), rates of treatment dropout from combined mental health and substance abuse treatment centers approach 80%, rendering dropout the rule rather than the exception. Several studies indicate that utilizing a more comprehensive treatment such as Dialectical Behavior Therapy (DBT) may be useful for client retention; however, given the scope and effort required to conduct this treatment, it may be more practical to determine which specific components within DBT are useful in retaining clients in substance use treatment. Thus, the purpose of the current paper is first to determine what exact deficits underlie treatment dropout among the BPD-SUD comorbidity. Second, we review and evaluate effectiveness of DBT retention-enhancing strategies by assembling work from other samples and literatures that also tests retention-enhancing strategies discussed in DBT. As a last step, the paper will conclude with a discussion on methodological limitations and potential future directions in this line of research.

Smoking patterns, beliefs, and the practice of healthy behaviors in abstinent, relapsed, and recalcitrant smokers

The purpose of this study was to perform a secondary analysis of smoking patterns and beliefs related to healthy behaviors in adult smokers (N = 71). Data for the secondary analysis were obtained from an original study that examined guided health imagery as a smoking cessation intervention. The imagery intervention resulted in significantly higher 2-year smoking abstinence rates for the intervention group of participants (26% vs. 12% for the control group). In this study, discriminant function analysis demonstrated that "well-established smoking patterns" accounted for 42% of the variance in those smokers who relapsed or never made any attempt to quit smoking. Higher baseline smoking rates, longer lifetime smoking histories, younger age at initiation of smoking, more positive beliefs about smoking (pros), and fewer healthy behaviors differentiated abstinent smokers from those who relapsed or were considered recalcitrant. Smoking patterns, belief systems related to smoking, and the practice of healthy behaviors need to be assessed as smokers enroll in cessation programs. Knowledge about relapsed and recalcitrant smokers will assist in the development of future interventions to meet smokers' unique needs and demands for cessation.

Applying the transtheoretical model to exercise: a systematic and comprehensive review of the literature

Three questions guided a literature review of the transtheoretical model (TTM) as applied to exercise to address the evidence for stage-matched interventions, the description of priority populations, and the identification of valid TTM measurement tools. One-hundredand-fifty studies were reviewed. Results indicate preliminary support for the use of stage-matched exercise interventions. Most studies have focused on White, middle-class, female populations, limiting the generalizability of their findings. Valid and reliable measures exist for stage of change, decisional balance, processes of change, self-efficacy, and temptations to not exercise; however, more research is needed to refine these measures. Evidence for the construct validity of the TTM as applied to exercise is mixed. When designing and implementing TTM-based exercise interventions, practitioners and policy makers are encouraged to clearly define the term exercise, choose a valid and reliable staging tool, and employ all TTM constructs and not just stage membership.

Cross-cultural adaptation of the diabetes management self-efficacy scale for patients with type 2 diabetes mellitus: Scale development

BACKGROUND

As a profession, nurses are particularly concerned with cross-cultural influences that affect the health practices of populations. Although the international literature describes questionnaires and specific scales in health and disease behaviours, adequate Turkish-language instruments are scarce. Therefore, suitable Turkish-language instruments need to be developed or adapted for the Turkish population.

OBJECTIVES

Study aim was to adapt a Dutch/English version of the diabetes management self-efficacy (SE) scale for use with a Turkish population and evaluate its psychometric properties.

DESIGN

Methodological research design.

SETTINGS

Attendants of an outpatient clinic of a university hospital in Turkey.

PARTICIPANTS

A convenience sample of 110 patients with type 2 diabetes mellitus (DM).

METHODS

Translation and back-translation of the original English instrument and content validation through a expert panel were the first two steps of the study. Third step was the psychometric testing of the adapted instrument by establishing internal consistency (Cronbach's alpha), stability (test-retest reliability), and construct validity (factor analysis).

RESULTS

Content validity procedure resulted in a final scale that consisted of 20 items. Internal consistency of the total scale was coefficient alpha=0.88, and test-retest reliability with a 4-week time interval was r=0.91 (p<0.001). Factor analysis yielded three factors related to diet, exercise and medical treatment. Two relevant items of the scale, weight control and blood sugar control, however, had low reliability and validity scores.

CONCLUSIONS

Although acceptable levels of reliability and validity of the Turkish version of the diabetes management SE scale for people with type 2 DM were reached, cultural factors appeared to play a role in the applicability of some items of the scale.

The Transtheoretical model for fruit, vegetable and fish consumption: associations between intakes, stages of change and stage transition determinants

Background

Cardiovascular diseases are caused by multiple behavioral factors, including different dietary factors. We examined to what extent fruit, vegetable and fish consumption are related, and whether behavioral determinants vary across these dietary behaviors from a Transtheoretical model perspective.

Methods

Data were collected among 1142 participants (T0; response rate 46%) selected from an Internet panel, who were followed-up one-week later (T1; N = 1055, response rate 92%). Mean age was 35.4 (SD = 11.9) years, 35% was male, and most respondents were of Dutch origin (90%). Of the respondents, 13%, 44% and 43% had a low, medium or high level of education, respectively. Electronic questionnaires assessed fruit, vegetable and fish intake (food frequency questionnaires), stages of change, decisional balance and self-efficacy, for each of these three behaviors.

Results

Stages of change and (changes in) fruit, vegetable and fish intake were only weakly associated; decisional balance and self-efficacy were more strongly associated. Some presumed predictors of stage transitions were similar for fruit, vegetable, and fish intake, i.e., strong pros predicted progress out of precontemplators and low self-efficacy predicted relapse from action/maintenance for all behaviors. However, progress out of contemplation and out of preparation showed different patterns for fruit, vegetable and fish intake.

Conclusion

The weak associations between intakes and potential determinants for fruit, vegetable, and fish consumption do not warrant an integrated dietary change approach targeting the same determinants for each behavior.

Tobacco harm reduction strategies: The case for physical activity

Since the effects of tobacco smoke are so detrimental to health, growing consideration has been given to the development of harm reduction strategies for those smokers who are unable or unwilling to stop using tobacco. The term harm reduction refers to a policy, strategy, or particular intervention that assumes continued use of an undesired behavior and aspires to lower the risk of adverse consequences associated with the continuation of this addictive behavior. Up to this point, tobacco harm reduction interventions have focused on reducing tobacco-related harm through the utilization of innovative tobacco products, reduced tobacco consumption, and pharmaceutical medications. With the possible exception of medicinal nicotine products, these strategies remain unproven and thus far no scientific or medical literature exists to suggest these harm reduction strategies reduce tobacco-related exposure, morbidity, or mortality. Consequently, a need exists for broadening the range of potentially effective harm reduction strategies. This preliminary review suggests that physical activity has the potential to become one such strategy. Of the eight principles that characterize a harm reduction strategy, all are at least partially satisfied by physical activity. Further, emerging evidence indicates that physical activity may delay the occurrence of disease and premature death initiated by tobacco consumption. Significant concerns remain regarding the practicality of physical activity as a harm reduction strategy and the extent to which participation in physical activity may be used to justify continued smoking.

Health behaviors during and after a cancer diagnosis

With improvements in cancer survival rates, more patients with cancer are living longer, and hence, cancer is becoming viewed as a chronic illness requiring long-term management. An important aspect of patient care during and after cancer treatment is patient health behaviors. For example, sequelae from various cancer treatments, such as chemotherapy and radiotherapy (RT), can compromise health in a variety ways, including decreased immune functioning, cardiotoxic effects of chemotherapy and/or RT, and weight gain. In addition, the stress caused by a cancer diagnosis and its treatment can disrupt existing health behaviors or exacerbate unhealthy behaviors. Continued smoking or alcohol use can complicate treatment and increase risk for further malignancy. Furthermore, decreased physical activity and poor nutrition can cause weight gain, which may contribute to secondary health problems such as cardiovascular disease and diabetes. The authors reviewed the extant literature on four key health behaviors among patients with cancer and survivors: healthy diet, reduced tobacco use, reduced alcohol use, and increased physical activity. They described the prevalence of these behaviors, reviewed the effects of interventions designed to alter unhealthy behaviors, and discussed the implications and future directions for this emerging area of research.

Evidence that implementation intentions promote transitions between the stages of change

A dietary change intervention based on Gollwitzer's (1993) concept of implementation intentions was used to see whether transitions between transtheoretical model stages could be induced in a field experiment. Participants (N=554) were randomized to receive either questionnaire-only or questionnaire-plus-implementation intention. Results showed that, controlling for variables from the theory of planned behavior, implementation intentions helped a significantly greater number of people to progress through the stages of change than did receiving the questionnaire alone. However, the implementation intention intervention did not prevent regression from the stages of change. The discussion focuses on the importance of targeting implementation intention interventions and on the future use of health professional-led analyses of critical situations and precise identification of appropriate responses to prevent regression.

Cardiovascular risk behavior among sedentary female smokers and smoking cessation outcomes

Background

We examined female sedentary smokers' additional cardiovascular disease (CVD) risk behaviors and their associations to smoking cessation.

Methods

This study was part of a randomized controlled trial testing the effectiveness of exercise and nicotine gum in smoking cessation. Included in the analyses were 148 participants. Dietary habits and alcohol consumption were measured as additional CVD risk behaviors. High-fat diet and heavy alcohol use were considered those risk behaviors. Nicotine dependence, length of the longest quit attempt, depressive symptoms, self-efficacy, and education were examined as other baseline variables. Abstinence from tobacco was recorded through 12 months.

Results

Diet was related to depressive symptoms at baseline. Alcohol use was related to nicotine dependence and education level. Heavy alcohol use alone and accumulation of two added risk behaviors predicted poorer smoking cessation outcome. Although diet alone was not associated with cessation outcome the high-fat diet interacted with depressive symptoms, such that the depressed women with high-fat diet were significantly more likely to relapse in their quit attempt compared to other subgroups.

Conclusion

Non-moderate alcohol use alone and accumulation of multiple CVD risk behaviors seem to be associated with lower success in smoking cessation.

Commitment to Health Scale

The Commitment to Health Scale (CHS) was developed to predict likelihood of clients being able to permanently adopt new health-promoting behaviors. Commitment is based on the association between starting new health behaviors and long-term performance of those behaviors. The CHS evolved from an examination of Prochaska and DiClemente’s Stages of Change Algorithm, Decisional Balance Scale, and Strong and Weak Principle (Velicer, Rossi, Prochaska, & DiClemente, 1996). Scale items were assessed by classical and Rasch measurement methods. The research was performed in three separate studies at various locations in the United States and included approximately 1,100 subjects. A new unidimensional variable was identified called Commitment to Health. Internal consistency reliability of the scale was .94 (Cronbach’s alpha). External validity and reliability were assessed based on expected and observed ordering and between known groups. Scale scores predicted self-reported health behaviors and body mass index.

A randomized trial assessing the Five-Day Plan for smoking cessation

AIM

To evaluate the effectiveness of the Five-Day Plan (FDP) in helping smokers to stop smoking.

DESIGN

Randomized controlled trial comparing intervention and control groups. The primary outcome measure was 12 months continuous abstinence verified by expired air carbon monoxide concentration. Secondary outcome measures were self-reported abstinence at end of treatment, at 3 and 6 months.

SETTING

Six towns in France.

PARTICIPANTS

228 smokers, recruited by newspaper and radio advertisement, aged 18 years or over and willing to make an attempt to quit smoking.

INTERVENTION

The Intervention group (119 participants) received the FDP, which is a behavioural group-based treatment programme that has been in operation in France since 1965. It involves five consecutive evening behavioural therapy sessions. The Control group (109 participants) received a single session discussing the health effects of smoking.

FINDINGS

In the Intervention group, 67 participants (56%) quit smoking at the end of the FDP. After three months this number had been reduced to 30 (25%) and to 19 (16%) by the end of one year. In the Control group these numbers were 14 (13%) and 12 (11%), respectively, after three and 12 months. When considering the rate of cessation without lapse after one year a significant difference was observed with a 13% rate in the Intervention group and 3% in the Control group (P = 0.004).

CONCLUSIONS

The FDP may be considered as an aid for smokers who want to quit.

Psychosocial characteristics associated with sun protection practices among parents of young children

Despite the importance of sun protection during childhood, many parents fail to adequately protect their children from the sun. The current study assessed sun-related knowledge, stage of change, and psychosocial characteristics of parents of young children. We examined how knowledge and psychosocial characteristics differed by stage of change, and tested a model of the relationship among demographics, knowledge, psychosocial variables, and child sun protection. Surveys were completed by 391 parents of preschool-aged children. Parent knowledge about skin cancer was relatively high and did not vary by stage of change. Parents in earlier stages of change perceived more barriers to child sun protection, had more positive beliefs about children's sun exposure, perceived their child to be less susceptible to sun damage, and had lower self-efficacy for child sun protection than did parents in later stages of change. In a path model, the strongest predictors of child sun protection were parents' own sun protection habits, perceived barriers, and self-efficacy. Results highlight the importance of parent psychosocial characteristics in predicting child sun protection.

Relationships between smoking behavior and readiness to change physical activity patterns in a community in Japan

PURPOSE

To examine the relationship between readiness to change exercise behavior and smoking behavior; stratified by gender.

METHODS

A cross-sectional survey of those inhabitants of Hikami, Japan, who were 30 years of age or older (n = 11,708). The response rate was 82.1%. Chi-squared tests and analysis of variance were used to evaluate differences in characteristics by smoking behavior, and the odds ratio (OR) was calculated to examine the relationship while controlling for possible confounding factors such as age, body mass index, and health consciousness.

RESULTS

Even when controlling for confounding factors, the relationship between the two behaviors differed according to gender Among males, ex-smokers were more likely to be motivated to exercise (OR, 1.14; 95% confidence interval [CI], .95-1.36), whereas among females, smokers were more likely to be motivated to exercise (OR, .40; 95% CI, .34-.48).

DISCUSSION

Despite some limitations, the findings suggest that gender should be used as a stratification variable when discussing the relationship between smoking and exercise behaviors.

Project PREVENT: A Randomized Trial to Reduce Multiple Behavioral Risk Factors for Colon Cancer

BACKGROUND

This report examines the outcome data for Project PREVENT, a two-site randomized control trial designed to reduce behavioral risk factors for colorectal cancer among individuals who have been diagnosed with adenomatous colon polyps.

METHODS

The study sample included 1,247 patients with recent diagnosis of adenomatous colorectal polyps. Within 4 weeks following the polypectomy, participants completed a baseline survey by telephone, and were randomized to either Usual Care (UC) or the PREVENT intervention, which was designed to target multiple risk factors. The intervention consisted of a telephone-delivered intervention plus tailored materials, and focused on the six primary behavioral risk factors for colorectal cancer, including red meat consumption, fruit and vegetable intake, multivitamin intake, alcohol, smoking, and physical inactivity.

RESULTS

Participation in the PREVENT intervention was associated with a significantly greater reduction in prevalence of multiple risk factors for colorectal cancer compared with UC. Only about one third of UC participants dropped any risk factors during the study period, compared with almost half of the PREVENT participants. PREVENT participants were also significantly more likely to change more than one behavior than UC participants.

CONCLUSIONS

The PREVENT intervention was effective in helping patients change multiple risk factors. These results provide further support that more comprehensive interventions that move beyond emphasis on a single risk factor are acceptable to patient populations, can result in improvements, and are cost effective.

Getting to the heart of social support: a qualitative analysis of the types of instrumental support that are most helpful in motivating cardiac risk factor modification

PURPOSE

This study evaluates the types of instrumental social support that are perceived by patients with coronary artery disease as being most helpful to health behavior modification.

METHODS

A purposive sample of 63 patients with coronary artery disease were enrolled in this qualitative study. Patients described lifestyle changes that they made in an effort to stay healthy and the types of instrumental supports provided by their social networks that helped them make these changes.

RESULTS

The most frequently cited lifestyle changes reported were making dietary changes, reducing responsibilities, keeping doctors' appointments, taking medications, and exercising more. The types of instrumental support that were perceived as being most helpful in making these changes were those that (1) made it easier and practical to engage in healthy behaviors, (2) alleviated stressful situations, and (3) facilitated the process of receiving medical care.

CONCLUSIONS

These findings identify practical ways in which social networks can promote risk factor modification and ultimately contribute to improving coronary artery disease outcomes.

Prevalence and predictors of multiple behavioral risk factors for colon cancer

OBJECTIVES

This paper examines the prevalence of behavioral risk factors for colorectal cancer (CRC) (e.g., red meat consumption, fruit and vegetable intake, multivitamin intake, alcohol, smoking, and physical inactivity), co-occurrence among these behaviors, and motivation for change among patients at increased risk.

METHODS

The study sample included 1,247 patients with recent diagnosis of adenomatous colorectal polyps. Within 4 weeks following the polypectomy, participants completed a baseline survey by telephone.

RESULTS

Sixty-six percent of participants had not been diagnosed with polyps before. Fifty-eight percent of the sample had red meat as a risk factor, 63% had fruit and vegetable consumption as a risk factor, 54% did not take a daily multivitamin, and 44% had physical activity as a risk factor. In contrast, only 9% of the sample had alcohol consumption as a risk factor and only 14% were current smokers. The prevalence of the six individual risk factors was combined into an overall multiple risk factor score (MRF). The average number of risk factors was 2.43. Men, those with a high school education or below, those reporting fair or poor health status, and those with less self-efficacy about risk factor change had more risk factors.

CONCLUSIONS

There is a need for multiple risk factor interventions that capitalize on natural intersections among intra- and interpersonal factors that maintain them.

Exercise interventions for smoking cessation

BACKGROUND

Taking regular exercise may help people give up smoking by moderating nicotine withdrawal and cravings.

OBJECTIVES

To determine whether exercise-based interventions alone or combined with a smoking cessation programme are more effective than a smoking cessation intervention alone.

SEARCH STRATEGY

We searched the Cochrane Tobacco Addiction Group specialized register for studies including the terms 'exercise' or 'physical activity' in July 2004. In August 2004 we searched MEDLINE, EMBASE, PsycINFO, CINAHL, Dissertation Abstracts and SPORTDiscus.

SELECTION CRITERIA

We included randomized trials which compared an exercise programme alone, or an exercise programme as an adjunct to a cessation programme, with a cessation programme, recruiting smokers or recent quitters, and with a follow up of six months or more.

DATA COLLECTION AND ANALYSIS

We extracted data on study characteristics and smoking outcomes. Because of differences in studies we summarized the results narratively, making no attempt at meta-analysis.

MAIN RESULTS

We identified 11 trials, six of which had fewer than 25 people in each treatment arm. They varied in the timing and intensity of the smoking cessation and exercise programmes. Three studies showed significantly higher abstinence rates in a physically active group versus a control group at end of treatment. One of these studies also showed a benefit for exercise versus control on abstinence at both the three month and 12 month follow-up points. One study showed significantly higher abstinence rates for the exercise group versus a control group at the three month follow up but not at the end of treatment or at 12 month follow up. The other studies showed no significant effect for exercise on abstinence.

AUTHORS' CONCLUSIONS

Only one of the 11 trials offered evidence for exercise aiding smoking cessation. All but one of the other trials were too small to conclude that the intervention was ineffective, or included an exercise intervention which was insufficiently intense to achieve the desired level of exercise. Trials are needed with larger sample sizes, sufficiently intense exercise interventions, equal contact control conditions and measures of exercise adherence.

Decisional balance for exercise: Adaptation of an instrument for older Mexican American women

The purpose of this study was to adapt and test an instrument to measure decisional balance for exercise with older Mexican American women. Items were derived from a Decisional Balance Scale (DBS) developed by Marcus, Rakowski, and Rossi (1992) and a focus group with Mexican American women aged 60 to 86 years. The adapted Spanish-English DBS was administered to 75 Mexican American women (38 exercisers and 37 non-exercisers). A factor analysis yielded a positive and a negative factor. Alpha coefficients were .95 for the positive factor and .79 for the negative factor. Decisional balance for exercise was significantly more positive for the exercisers than for the non-exercisers and was positively related to exercise readiness and habitual activity. The findings suggest that the adapted Spanish-English DBS can be used in exercise and activity research with older Mexican American women.

Readiness to change physical activity and dietary practices and willingness to consult healthcare providers

Background

Complementary or discrepant stages of change for multiple risk behaviors can guide the development of effective risk reduction interventions for multiple risk factors. The objectives of this study were to assess readiness to change physical activity and dietary practices and the relationships among readiness scores for physical activity and dietary practices. In an underserved population, the readiness scores were analyzed in relationship to the patient's interest in communicating with healthcare providers about health behavior change. Healthcare providers are important contributors in promoting behavior change in community health centers.

Methods

Patients completed questionnaires about communicating with healthcare providers and readiness to change physical activity, intake of fruits and vegetables, dietary fat, calories and weight management. Frequency distributions, correlations, and analysis of variance were computed.

Results

Readiness to change physical activity was not related to readiness to change dietary practices. Readiness to change fruit and vegetable intake and readiness to change dietary fat intake were significantly related. Readiness to change and interest in communicating with healthcare providers were significantly related for physical activity but not for dietary practices.

Conclusions

Readiness to change behavior and interest in talking to healthcare providers were distinct dimensions; for physical activity, the dimensions were congruent and for dietary practices, the dimensions were unrelated. Readiness to change physical activity and dietary practices were not related (discrepant stages of readiness). Therefore, among underserved populations, sequential rather than simultaneous interventions may be appropriate when intervening on multiple risk behaviors, particularly physical activity and dietary practices.

Characteristics of highly physically active smokers in a population of young adult military recruits

A substantial number of cigarette smokers are thought to engage in regular exercise. It is unclear why individuals who engage in a health-promoting activity such as exercising would simultaneously engage in a health-damaging behavior like smoking. Two possibilities are that (1) exercise serves as a "harm reduction" strategy to lessen the negative effects of smoking, or (2) that among weight conscious individuals, exercise and smoking are both used as weight control strategies. To examine these issues, smoking status, physical activity level, weight concerns, and several additional health behaviors and attitudes were assessed by questionnaire in a population of United States Air Force recruits (n=32,144). Multiple logistic regression analyses were used to compare characteristics of highly physically active smokers with both highly physically active never-smokers, and less active smokers. A substantial proportion of smokers reported being highly physically active (15.8%), although this proportion was significantly higher for never-smokers (22.7%). Active smokers were similar to active never-smokers across several health behaviors and attitudes, including diet, seatbelt use, and attitudes toward illegal drugs and condom use. Compared to less active smokers, active smokers consumed more fruits and vegetables, worried less about their weight, were less nicotine dependent, and had greater previous success at quitting smoking. These findings indicate that a substantial proportion of highly physically active young adults are regular cigarette smokers. Based on findings regarding general health behaviors and smoking history, this group may be particularly amenable to smoking cessation efforts.

Exercise interventions for smokers with a history of alcoholism: exercise adherence rates and effect of depression on adherence

This study examined the adherence rates and the effect of depression on adherence in two studies conducted among smokers with a past history of alcoholism. In both studies, subjects participated in a 12-session group-based exercise intervention for smoking cessation. The target quit date (TQD) was Session 8. Participants in Study 1 were 73 smokers (43% female). Exercise instructions began at Session 8 and continued through Session 12. Mean frequency and number of minutes of exercise decreased during the 4 weeks of exercise treatment (P<.001). Study 2, conducted with 18 smokers (50% female), examined the feasibility of commencing exercise at Session 1, well before the TQD. The mean number of minutes exercised increased from Sessions 1 to 12 (P=.013). In both studies, average session attendance was high (82%). Combining subjects from both studies, depressed smokers at baseline reported greater mean frequency of exercise per week than nondepressed smokers (P=.05). The results suggest that depressed smokers can be engaged in an exercise program. Further research is needed to determine if commencing exercise early during treatment, prior to the TQD, improves adherence.

Health and performance related reasons for wanting to quit: gender differences among teen smokers

Adolescents frequently state health as a broad-ranging reason for wanting to quit smoking. Much less is known regarding performance-related reasons. We hypothesized that more male than female smokers want to quit for performance-related reasons (e.g., to improve athletic performance). As part of a telephone screen to determine eligibility for participation in a cessation trial in Baltimore, Maryland, 1999-2001, 509 teenage smokers [mean age 15.78 +/- 1.65 years (range 11-21), 60.9% female, 32.6% African-American] were asked the open-ended question: "Why do you want to quit?" Responses were subsequently grouped into categories that included health, performance, cost, social influences, setting an example for others, self-efficacy, cosmetics, no perceived positive reinforcement, or unknown reasons. Health was the most commonly stated primary and overall reason for wanting to quit among both boys and girls. Sixty-five percent of teen smokers endorsing health reasons were girls, and 51% of those endorsing performance-related reasons were boys (chi2(2) = 7.78, p = 0.02). Recognizing the greater concern for performance-related issues among boys is important for designing and engaging young smokers into cessation interventions.

Congruence of readiness to change, self-efficacy, and decisional balance for physical activity and dietary fat reduction

PURPOSE

The current study examines the relations between decisional balance and self-efficacy variables on stage of change between the behaviors of avoiding dietary fat and increasing exercise.

DESIGN

A cross-sectional design was used.

SETTING

The current study took place in public primary care clinics from four sites across Louisiana. Clinics were associated with teaching hospitals and located in urban and rural areas.

SUBJECTS

Subjects included 515 adult outpatients, 60% African-American, 81% women, and 43% married. The age ranged from 18 to 87 years old, and the mean age was 45 (SD = 14). Patients were predominantly low-income (mean household income of $490 per month) and uninsured (71%).

MEASURES

Standard questionnaires were given to asses stage of change, decisional balance, and self-efficacy for exercise and dietary fat reduction.

RESULTS

Although the chi 2 analysis revealed that dietary fat and exercise stage of change were significantly related, Pearson chi 2 (df = 16) = 74.30, p < .001, 35% of the sample was stage incongruent between behaviors (e.g., a significant percentage of exercise maintainers were precontemplators for reducing dietary fat). Only 27% of the sample was in the same stage for both behaviors. Correlations and multivariate analyses of variance (MANOVAs) indicated that relationships between behaviors were similar to those found previously within behaviors; however, the effect sizes were markedly attenuated.

CONCLUSIONS

These results have implications for healthcare providers working with weight management. Accurate assessment of readiness for change for both exercise and dietary fat consumption is critical. For many patients, readiness for change differs dramatically between the two behaviors, and interventions may need to be tailored more precisely. Providers may need to use more active, behaviorally focused interventions for the more advanced behavior while simultaneously implementing more cognitively focused interventions for the less advanced one.

Changing multiple health behaviors: smoking and exercise

BACKGROUND

Previous stage of change research examining health behaviors has tended to examine one behavior at a time. However, one recent study by King et al. (1996) examined the relationship between smoking and exercise across cognitive-behavioral mediators (i.e., decisional balance and self-efficacy) shown to be important in predicting readiness to change. In this study, we seek to replicate the study of King et al. (1996) in a low-income sample, the majority of whom are women, with at least one chronic illness who are attending primary care clinics.

METHODS

Data were obtained from 270 adult outpatients attending four public primary care clinics in Louisiana.

RESULTS

Smoking and exercise stage of change were not related. Significant relationships existed between the cognitive variables of smoking and exercise. No significant differences existed within exercise stage of change on the cognitive variables of smoking, and vice versa, no significant differences were noted within smoking stage of change on the cognitive variables of exercise.

CONCLUSIONS

Smoking and exercise appear to be specific health behaviors that are independent constructs in this particular sample. However, caution should be taken when interpreting the findings since 75% of the sample had at least one chronic illness.

Leading the Way in Exercise and Diet (Project LEAD): intervening to improve function among older breast and prostate cancer survivors

The U.S. population is aging, bringing with it an increased prevalence of chronic disease and concomitant declines in physical function. The risk of developing cancer increases significantly with age, and functional decline is much more likely once a cancer diagnosis is rendered. Thus, functional status in later life is a key concern, one that is heightened among elders who have been diagnosed with cancer. To date, however, there have been few trials that have exclusively addressed issues related to cancer survivorship among older cancer patients, and to our knowledge, none has focused on preserving or enhancing physical functioning. This paper describes the study design and methodological considerations of a randomized controlled trial to determine if a personally tailored workbook and telephone counseling program can positively affect physical activity and dietary behaviors and ultimately the physical functioning of up to 420 older men and women newly diagnosed with breast or prostate cancer. This trial is unique because the cancer diagnosis is used not only as a marker of risk for functional decline, but also as a "teachable moment" - an opportune time when elders may be more receptive to making beneficial lifestyle changes. Undoubtedly, as cure rates for cancer increase and intersect with ever-growing numbers of elderly, there will be numerous opportunities to provide and test interventions within this vulnerable population and to target functional status as a primary outcome. In reporting our methods, we hope to give others "a leg up," so that they can hurdle with greater ease the barriers we experienced, and thus advance the field more rapidly.

Health perceptions and risk behaviors of lung cancer survivors

BACKGROUND

Lung cancer survivors are at an increased risk for recurrence and the development of secondary tumors and other comorbid conditions. However, little is known about lung cancer survivors' risk behaviors and the effect of these behaviors on overall health perceptions.

OBJECTIVE

The purpose of this study was to describe the prevalence of health risk behaviors among non-small cell lung cancer survivors and their relationship perception to overall health.

METHODS

One hundred forty-two survivors of non-small cell lung cancer with a minimum of 5 years disease free completed a battery of questionnaires to assess perception of health status and self-reported risk behaviors (smoking, exposure to secondhand smoke, alcohol use) and weight before and after diagnosis. Urinary cotinine level was used to verify smoking status, and actual height and weight were obtained to determine overweight status (body mass index, >/=25). Descriptive statistics and logistic regression were used to analyze the data.

RESULTS

Seventy percent of participants reported their health as good to excellent. Although 81% quit smoking after diagnosis, 13.4% continued to smoke and 28% reported exposure to secondhand smoke. Approximately half the sample (58%) drank alcohol (16.3% quit after diagnosis) and was overweight (51%). A strong agreement between current smoking and exposure to secondhand smoke was observed. In a multivariate analysis, smoking (odds ratio [OR], 7.02; CI, 2.45 to 20.13), exposure to secondhand smoke (OR, 5.37; CI, 2.42 to 11.95), alcohol use (OR, 9.04; CI, 3.28 to 24.92), and overweight (OR, 8.51; CI, 3.44 to 21.10) were independent predictors of perceived poor health status.

CONCLUSION

Although most lung cancer survivors have made healthy lifestyle changes, a substantial proportion has not. Our findings suggest the need for multiple risk factor interventions to decrease risk behaviors and improve overall health after a cancer diagnosis.

Smoking among participants in the childhood cancer survivors cohort: the Partnership for Health Study

PURPOSE

This article describes baseline data collection and the intervention design of Partnership for Health, a smoking cessation intervention for smokers in the Childhood Cancer Survivors Study. The purpose of this article is to evaluate demographic, psychosocial, and cancer-related factors that are associated with smoking behavior and mediators of smoking cessation.

PATIENTS AND METHODS

This study includes 796 smokers from the Childhood Cancer Survivors Study database who were diagnosed with cancer before the age of 21, had survived at least 5 years, and were at least 18 years of age at the time of the baseline survey. Correlates of smoking behaviors included smoking rate, number of recent quit attempts, and nicotine dependence; two key mediators of smoking cessation, readiness to quit smoking and self-efficacy, were also assessed.

RESULTS

Participants smoked, on average, 14 cigarettes/day; 53.2% were nicotine dependent, and 58% had made at least one quit attempt in the past year. Smoking behaviors were primarily associated with demographic variables; mediators of cessation were primarily associated with age at cancer diagnosis and perceived vulnerability to smoking-related illnesses. Severity of psychologic symptoms was associated with increased smoking rate, high nicotine dependence, and low self-efficacy. Support for quitting was related to smoking rate, number of quit attempts, readiness to quit smoking, and self-efficacy.

CONCLUSION

These findings indicate that many cancer survivors who smoke are receptive to smoking cessation interventions. Factors related to mediators of smoking cessation might be particularly good targets for intervention.