Transtheoretical Model: examining adolescent exercise 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.

A Validation and Reliability Study of the Physical Activity and Healthy Food Efficacy Scale for Children (PAHFE)

The purpose of this study was to obtain validity evidence for the Physical Activity and Healthy Food Efficacy Scale for Children (PAHFE). Construct validity evidence identifies four subscales: Goal-Setting for Physical Activity, Goal-Setting for Healthy Food Choices, Decision-Making for Physical Activity, and Decision-Making for Healthy Food Choices. The scores on each of these subscales show a moderate to high degree of internal consistency (0.59 ≤ α ≤ 0.87). The Decision-Making for Healthy Food Choice subscale and the Decision-Making for Physical Activity subscale scores show significant convergent validity evidence. These results provide support for using this self-efficacy scale to measure children's perceived confidence to make decisions about healthy eating and physical activity. The PAHFE may be considered to be a useful predictor of both physical activity and eating behaviors.

A cohort-sequential latent growth model of physical activity from ages 12 to 17 years

BACKGROUND

Despite serious public health implications of decreased physical activity during adolescence, few longitudinal studies have been conducted to determine the trajectory and important correlates of physical activity change during this period.

PURPOSE

This study examines change in physical activity from ages 12 to 17 years and the influences of personal, family, peer, and demographic factors on activity patterns.

METHODS

Data were from 371 youth. The sample was 50.1% female, 76% White, 12% African American, 4% Hispanic, 2% Asian, 2% American Indian, and 4% other or mixed races. Mean age was 12.05 years (SD = 1.63) at Time 1. Multivariate latent growth curve modeling (LGM), a cohort-sequential design, and a multiple-group design by sex were employed.

RESULTS

Youth physical activity declined significantly from ages 12 to 17. Boys had higher initial levels of physical activity than girls. Efficacy to overcome barriers, physically active friends, and friend social support all played roles in reducing the decline in physical activity. Early maturing boys, although more physically active initially, experienced a greater decline in physical activity compared to later maturing boys.

CONCLUSIONS

These findings encourage further research on the etiology and development of youth physical activity using procedures such as LGM to better understand the risk and protective factors associated with youth physical activity decline.

Understanding exercise behavior among korean adults: a test of the transtheoretical model

The purpose of this study was to examine the theorized association of Transtheoretical Model (TTM) of behavior change constructs by stage of change for exercise behavior among Korean adults. A total of 1,335 Korean adults were recruited and surveyed from the Nowon district, geographically located in northern Seoul. Four Korean-version questionnaires were used to identify the stage of exercise behavior and psychological attributes of adolescents. Data were analyzed by frequency analysis, MANOVA, correlation analysis, and discriminant analysis. Multivariate F tests indicated that behavioral and cognitive processes of change, exercise efficacy, and pros differentiated participants across the stages of exercise behavior. Furthermore, the findings revealed that adults' exercise behavior was significantly correlated with the TTM constructs and that overall classification accuracy across the stages of change was 50.6%. This study supports the internal and external validity of the TTM for explaining exercise behavior.

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.

Application of the transtheoretical model to identify psychological constructs influencing exercise behavior: a questionnaire survey

BACKGROUND

Current research on exercise behavior has largely been attempted to identify the relationship between psychological attributes and the initiation or adherence of exercise behavior based on psychological theories. A limited data are available on the psychological predictors of exercise behavior in public health.

OBJECTIVES

The present study examined the theorized association of TTM of behavior change constructs by stage of change for exercise behavior.

METHODS

A total of 228 college students selected from 2 universities in Seoul were surveyed. Four Korean-version questionnaires were used to identify the stage of exercise behavior and psychological attributes of adolescents. Data were analyzed by frequency analysis, MANOVA, correlation analysis, and discriminant function analysis.

RESULTS

Multivariate F-test indicated that behavioral and cognitive processes of change, exercise efficacy, and pros differentiated participants across the stages of exercise behavior. Furthermore, exercise behavior was significantly correlated with the TTM constructs, and that overall classification accuracy across the stages of change was 61.0%.

CONCLUSIONS

The present study supports the internal and external validity of the Transtheoretical Model for explaining exercise behavior. As this study highlights, dissemination must increase awareness but also influences perceptions regarding theoretically based and practically important exercise strategies for public health professionals.

Stages of change in adolescents: an examination of self-efficacy, decisional balance, and reasons for relapse

PURPOSE

The purpose of this study was to test selected constructs of the transtheoretical model (TTM) of behavior change in relation to exercise behavior with an adolescent sample. A further purpose was to examine reasons why adolescents stop physical activity and to relate these to stages of exercise change.

METHODS

Participants were 15 to 17 year old students at a private high school (N = 327). Participants completed a questionnaire consisting of an exercise measure, measures of the TTM variables, and an open-ended question that asked if they used to exercise in the past but currently did not, why they had stopped. The TTM data were analyzed using ANOVA F-tests with post-hoc Scheffe tests. To evaluate the ability of the TTM variables to discriminate between stages of exercise behavior, standard discriminant function analyses were performed. Open-ended answers to the relapse question were themed according to a model which categorizes barriers preventing youth's participation in recreational activities as infrastructural, superstructural, and procedural. The relationship of perceived barriers to stage of behavior change was assessed using cross-tabulation and chi-square analyses.

RESULTS

Moderate support for the TTM constructs were found, with the strongest discriminator between stages being strenuous exercise, and self-efficacy being the most supported construct. Infrastructural, superstructural, and procedural barriers were all evident.

CONCLUSION

Over 30% of previously active adolescents in this study reported barriers precluding extracurricular physical activity. Interventions should target the most often cited reasons for relapse: time and limits relating to the nature of the adolescent self.

Applying a transtheoretical behavioral change model to HIV/STD and pregnancy prevention in adolescent clinics

PURPOSE

To evaluate the application of a transtheoretical model (TTM) of behavioral change to adolescent reproductive health counseling.

METHODS

Family planning counselors in Boston Metro school-based and community health centers used a TTM for pregnancy and human immunodeficiency virus/sexually transmitted disease (HIV/STD) prevention. Data were collected from September 2000 through December 2001. Bivariate analyses using chi-square statistics and multivariate analyses using logistic regression were performed to identify the differences between stage of change (SOC) groups and the predictive variables for SOC movement.

RESULTS

Data on 539 sexually experienced clients were examined. Site, client's gender, race, proximity of sexual activity, sexual partner status, level of partner support, and target behavior were significantly associated with initial SOC for both pregnancy and disease prevention (p < .01). For clients meeting stage movement analysis criteria (n = 86 for pregnancy prevention; 128 for disease prevention), there was suggestive evidence that older ones were more likely to move forward for both pregnancy and disease prevention (p = .08 and p = .07, respectively) between their first and second visits. For disease prevention, those initially in the precontemplation/contemplation stages were more likely than those in the action/maintenance stages to be forward movers (odds ratio = 3.89, p = .06). Counselors/supervisors reported that the TTM helped structure an integrated message and increased client engagement.

CONCLUSIONS

Efforts to prevent teen pregnancy and HIV/STDs should acknowledge the roles of partner support and age in SOC. Adolescents in preparation may need specific skill-building for behavioral change. Overall, TTM represents a promising approach to promoting integrated pregnancy and disease prevention in family planning counseling.

Stages of change for physical activity in a community sample of adolescents

The aims of the present study were to investigate (1) the proportion of adolescents in each of the stages of change, (2) the differences in psychosocial factors and in physical activity between the stages, and (3) the classification accuracy using several reference criteria. A random sample of 38 schools from the Flemish community in Belgium resulted in a sample of 5931 adolescents (mean age=14.8, range 12-18, 61% females). All adolescents completed a computerized questionnaire assessing demographic variables, physical activity, physical activity determinants and stages of change. Distribution across the stages was: precontemplation, n=684 (11.5%); contemplation, n=948 (16.0%); preparation, n=818 (13.8%); action, n=492 (8.3%); and maintenance, n=2989 (50.4%). Analyses revealed gender and age differences (P<0.001), with girls and older adolescents being more prevalent in the first three stages. Differences between the stages of change were related to higher levels of physical activity of different intensity and within different contexts (P<0.001), together with more favorable psychosocial determinants related to physical activity (P<0.001). No differences between stages were found for sedentary activities. Three subgroups of adolescents were identified based on psychosocial determinants and physical activity levels. About 71% of the adolescents placed themselves in a stage which was in accordance with their self-reported level of physical activity.

Validation of a tool to measure processes of change for fruit and vegetable consumption among male college students

OBJECTIVE

To develop a valid tool to measure processes of change for fruit and vegetable consumption, and examine the relationship between stage and processes of change among several cultural groups.

DESIGN

Cross-sectional, using a self-report questionnaire.

SETTING

Convenience sample of male college students living in apartments.

PARTICIPANTS

105 US white, 53 international Latino, and 92 international Asian males.

MAIN OUTCOME MEASURES

Fruit and vegetable intake, stage and processes of change characterizations.

ANALYSIS

Analysis of covariance, with age as a covariate, was used to determine differences in processes of change scores among 3 cultural groups and stages of change. Two-way analysis of variance investigated relationships between stage of change and fruit and vegetable consumption. The pattern of differences across cultural groups was examined using chi-squared analysis.

RESULTS

Self-reported fruit and vegetable intake was higher (P < .01) in action and maintenance than in other stages. Participants in precontemplation/contemplation used significantly less of any process of change than those in preparation or action/maintenance. There were no significant interactions between stage of change and culture for any of the processes of change, but international Asians used significantly more dramatic relief and environmental reevaluation than did US whites and more stimulus control processes than US whites or international Latinos. At all stages, students used significantly more cognitive/experiential processes than behavioral processes.

CONCLUSIONS AND IMPLICATIONS

The use of processes increased within action-oriented stages, consistent with previous studies using the Transtheoretical Model in the nutritional area. The greater use of cognitive/experiential than behavioral processes at all stages was not consistent with predictions. Evidence of cultural differences in the use of processes of change was found.

What Older Adults Find Useful for Maintaining Healthy Eating and Exercise Habits

Four focus groups were conducted with a total of 29 adults 60 years of age and older enrolled in the SENIOR Project, a health promotion intervention study designed to increase fruit and vegetable consumption and exercise among community-dwelling older adults. The focus groups explored the motivations of older adults to eat five or more servings of fruits and vegetables and/or exercise and the strategies used to adopt or maintain these behaviors. Participants stated that maintaining health, remaining independent, and fearing illness provided the motivation needed to adhere to these behaviors. The strategies or the behavioral processes used to adopt or maintain these behaviors included counterconditioning, helping relationships, stimulus control, and self-liberation.

Cross-cultural comparison of American and Finnish college students' exercise behavior using transtheoretical model constructs

Although the benefits of exercise are well documented, an international problem of physical inactivity exists. More research, especially theory based, has been recommended. One promising approach for studying exercise behavior is that proposed in the Transtheoretical Model (TTM) of behavior change. This model, however, has received minimal cross-cultural attention and, relative to the current study, measurement instruments have only recently been translated into the Finnish language. The purpose of this study was to assess American and Finnish college students' exercise behaviors on the basis of TTM. Participants were American (n = 169) and Finnish (n = 168) college students who completed language-specific measures of exercise behavior, stage of change, processes of change, decisional balance, self-efficacy, and temptation. The only cultural difference observed was that the American participants rated themselves higher on barrier self-efficacy relative to the Finnish participants. Regardless of nationality orgender, participants classified by their stage of change differed on all the core constructs assessed. These results generally support the utility of TTM for understanding American and Finnish college students' exercise behavior.

Transtheoretical model: investigation of adolescentsʼ sunbathing behaviour

The incidence of malignant melanoma and non-melanoma skin cancers has increased rapidly in Sweden as well as in other western countries during the last 20 years. Adolescents are an important group in skin cancer prevention. Interventions targeting this group have been reported to affect knowledge and attitudes, but the effect on sun protection behaviour has been slight. The aim of this study was to investigate the applicability of the Transtheoretical Model (TTM) for skin cancer prevention for adolescents. A random sample of 1200 18-year-olds living in Stockholm County was selected from the national census registry. A questionnaire that included three of the major constructs of the TTM (i.e. stages of change, processes of change and decisional balance) was sent by mail. The majority of the teenagers were in the precontemplation stage for giving up intentional tanning. The relations between the stages of change and two other major constructs of the TTM, processes of change and decisional balance, were consistent with data on other health behaviours. The results may aid in developing successful skin cancer prevention programmes. The results give support for the stages of change measurement used in this study and that utilizing the TTM in skin cancer prevention may be appropriate.

Diet and exercise in low-income culturally diverse middle school students

It is important to understand constructs essential to low-fat-diet and physical-activity behaviors of low-income culturally diverse middle-school-age students, because ethnicity and socioeconomic status influence body weight status, and these groups are most at risk for obesity later in life. In this descriptive study, constructs important in low-fat diet and physical activity in low- to middle-income, culturally diverse middle school students were examined. Revised for cultural/developmental appropriateness and reading level, instruments incorporating constructs from the Health Promotion and Transtheoretical Models were tested with 221 youth. Results demonstrated that percentage of fat in diet, total number of strategies used for a low-fat diet, access to low-fat food, and total number of exercise processes varied significantly (p < 0.05) across stages of change for low-fat diet. We concluded that interventions should foster access to low-fat foods and processes for diet and activity change. Despite significantly lower income and higher grade level (both of which are risks for poor health behaviors), students in the private school demonstrated significantly lower fat in diet, higher perception of benefits, and better access to low-fat food. These findings warrant additional study.

Addressing health disparities in middle school students' nutrition and exercise

Those with low income, especially women of African American and Hispanic heritage have the greatest risk of inactivity and obesity. A 4-session (Internet and video) intervention with healthy snack and gym labs was tested in 2 (gym lab in 1) urban low-middle-income middle schools to improve low fat diet and moderate and vigorous physical activity.1 The gym lab was particularly beneficial (p =.002). Fat in diet decreased with each Internet session in which students participated. Percentage of fat in food was reduced significantly p =.018 for Black, White, and Black/Native American girls in the intervention group. Interventions delivered through Internet and video may enable reduction of health disparities in students by encouraging those most at risk to consume 30% or less calories from fat and to engage in moderate and vigorous physical activity.

The transtheoretical model of change in adolescents: implications for injury prevention

INTRODUCTION

Many injury prevention interventions require changes in human behavior to reduce self-risk or risk to others. Promising injury prevention interventions may be discarded if they lack power to create a significant difference in outcomes when judging their ability to "move a person from nonaction or negative action to positive action (safety)." The transtheoretical model of change (TMC) allows greater sensitivity in detecting along the change process where an intervention may be effective. The stages of change consist of precontemplation, contemplation, preparation, action, maintenance, and termination. Change is not viewed as an "all or none phenomenon."

METHOD

Use of the TMC was examined using a quasiexperimental, cross-over design involving high school agriculture students enrolled in 21 schools in Kentucky (n=9), Iowa (n=7), and Mississippi (n=5). A series of physical and narrative simulations (safety training exercises) were developed with a focus on preventing amputation, spinal cord injury, hypersensitivity pneumonitis, and noise-induced hearing loss. Contemplation and action, as part of the TMC, were measured using a 10-item, Likert-type, stages of change (SOC) instrument comprised of two subscales (reliability coefficients were.88 and.81, respectively). The final sample consisted of 790 students (373 treatment and 417 control).

RESULTS

There was a significant group effect for both contemplation, F(1,732)=197.4; p<.0001, and action, F(1,730)=106.1; p<.0001. A convenience sample of 29 of the participating students was selected for follow-up farm visits 1 year postparticipation. Of these students, 25 (86%) had made safety behavior changes in their farm work.

IMPACT ON INDUSTRY

The use of the TMC model can provide researchers with greater precision in examining intervention effectiveness in promoting change.

Exercise and older adults: changing behavior with the transtheoretical model

The loss of muscle strength, decreased flexibility and range of motion, and decreased sense of balance that frequently accompany aging contribute to falls and functional decline. Even in advanced old age, one can improve strength, decrease the risk of falls, improve cardiorespiratory fitness, and improve ability to live independently. The Transtheoretical Model (TTM) of behavior change is an internationally recognized model that holds much promise for health behavior changes of all types. This article outlines the effects of exercise on age-related changes in the musculoskeletal system and describes the TTM as a model useful to help older adults change their exercise behavior. Research studies are documented that support the effectiveness of the TTM in changing behavior. Application of the model is described with specific examples illustrated in two case studies.

Construct validity of the stages of change of exercise adoption for different intensities of physical activity in four samples of differing age groups

PURPOSE

To examine whether the stages of change of exercise adoption appropriately address strenuous, moderate, and mild intensities of physical activity.

DESIGN AND SETTING

Secondary analysis of four data sets investigating transtheoretical model (TTM) constructs for exercise adoption.

SUBJECTS

Four samples of differing age groups (adolescents, n = 400; college students, n = 240; adults, n = 346; seniors, n = 504).

MEASURES

Stage of change algorithm for exercise adoption and self-reported physical activity.

RESULTS

Multivariate analysis of variance (MANOVA) results showed that stages of change were distinguished by strenuous and moderate but not mild exercise in the adolescent, college student, and adult sample. In the senior sample, stage differences were found in the frequency of exercising (equivalent for moderate to strenuous exercise) and the frequency of walking (equivalent for mild exercise). Bivariate correlation coefficients as well as sensitivity, specificity, and related quality indices decreased respectively from strenuous to moderate to mild exercise and from exercising to walking.

CONCLUSIONS

Results provide additional support for the construct validity of the stages of change for strenuous and moderate intensities of physical activity. Development of a new stage assessment instrument for mild intensities of physical activity is recommended. Limitations include use of a different validation measure of exercise behavior in the senior sample.

The transtheoretical model of behavior change: a meta-analysis of applications to physical activity and exercise

The purpose of this study was to summarize findings from empirical applications of the transtheoretical model (TTM) (Prochaska & DiClemente, 1983) in the physical activity domain by using the quantitative method of meta-analysis. Ninety-one independent samples from 71 published reports were located that present empirical data on at least one core construct of the TTM applied to exercise and physical activity. In general, results support the application because core constructs differ across stages and most changes are in the direction predicted by the theory. Three general conclusions are offered. First, existing data are unable to confirm whether physical activity behavior change occurs in a series ofstages that are qualitatively different or along adjacent segments of an underlying continuum. Second, the growing number of studies that incorporate TTM concepts means that there is an increasing need to standardize and improve the reliability of measurement. Finally, the role ofprocesses of change needs reexamining because the higher order constructs are not apparent in the physical activity domain and stage-by-process interactions are not evident. There now are sufficient data to confirm that stage membership is associated with different levels of physical activity, self-efficacy, pros and cons, and processes of change. Further studies that simply stage participants or examine cross-sectional differences between core constructs of the TTM are of limited use. Future research should examine the moderators and mediators of stage transition.

Stages of change for perceived stress in a Swiss population sample: an explorative study

OBJECTIVES

Data from a cross-sectional survey of the Swiss general population were used in an explorative attempt to apply the transtheoretical model of behavioural change to perceived stress.

METHODS

The sample comprised 575 respondents who reported having experienced stressful situations in the previous month. Other variables assessed included gender, age, education, reported symptoms, and three constructs representing stages and processes of change as well as self-efficacy.

RESULTS

Findings indicated that (1) about one third of respondents appeared to cope successfully with the stressful situations they experienced, one third intended to do so, while one quarter appeared to have no intention of managing their stress more effectively. (2) There was no difference in stage of change distribution by gender or age, while those with higher education were more frequently represented in the latter stages than those with lower education. (3) Those in the maintenance stage reported significantly less symptoms than others.

CONCLUSIONS

We conclude that the assessment of readiness to change could be of valuable support in designing stage-specific interventions in the area of stress management.

Validating motivational readiness for exercise behavior with adolescents

The stages of motivational readiness as conceptualized by the Transtheoretical Model have been widely used among adult samples to assess readiness for adopting exercise behavior. To date, little research has been conducted using a staging framework with adolescent samples. There is a need for validation of the staging framework prior to a substantial amount of research with this age group. The current article presents two studies assessing stage and reported exercise behavior (Study 1: n = 819; M age = 15.0 years, SD = 1.2; 51% men; Study 2: n = 184; M age = 18.6 years, SD = .5; 45% men). As hypothesized in both studies, reported exercise consistently varied as a function of stage classification; those in earlier stages of readiness reported less exercise than those in later stages. Staging algorithms showed good sensitivity to detect reported exercise; however, specificity was distinctly better with the algorithm that used a specific activity criterion and immediate intention, as opposed to irregular behavior, in defining the preparation stage. Results support the validity of the staging framework for measuring motivational readiness for exercise behavior among North American adolescents.

Explaining adolescent exercise behavior change: a longitudinal application of the transtheoretical model

The developmental decline and benefits of exercise are documented, however, relatively little is known about the mechanisms and motivations underlying adolescent exercise behavior This project investigates which variables drive exercise or are a consequence thereof, within the Transtheoretical Model (TTM). Baseline questionnaires (N = 819) were collected through 5 Canadian high schools. For this longitudinal investigation, all baseline participants were approached for a 3-year follow up. Follow-up questionnaire completers (n = 400: mean baseline age = 14.89, SD = 1.15, mean follow-up age = 17.62 years, SD = 1.18) were not different from noncompleters (n = 419) on all baseline variables, except for sex (54. 75% and 43. 68% females, respectively; p <. 003). Stages, processes, self-efficacy, pros and cons of exercise from the TTM, and self-reported exercise were assessed. Panel analyses revealed that although the directions of the relations were as hypothesized, the processes did not significantly lead to exercise or vice versa. As hypothesized, exercise leads to self-efficacy and pros and cons, showing that the TTM can serve as a framework to understand adolescent exercise behavior Future research needs to incorporate shorter assessment intervals and use larger samples to be able to look at adjacent stage transitions.

Readiness to adopt adequate postural habits: an application of the Transtheoretical Model in the context of back pain prevention

Based on a biomechanical model, an adequate body posture can contribute to the prevention of back pain and back pain chronicity. This study examines the explanatory value of the Transtheoretical Model (TTM) for the adoption of adequate postural habits in a cross-sectional sample of 149 employees of a German administration unit (mean age 40.2 years, 50% female). Using newly developed instruments with satisfactory psychometric properties, basic assumptions of the TTM could be confirmed: self-efficacy and the perceived pros for maintaining a good body posture increased significantly across the stages, while the perceived cons decreased. Additionally, the use of preventive strategies for back pain prevention increased linearly and significantly across the stages of change. The study supports the applicability of the TTM for postural behavior. Considering stages of change as an intervening variable may contribute to clarifying the relationship between participation in low back schools and prevention of back pain chronicity. Longitudinal and intervention study data are needed to support these assumptions.

Characteristics of exercise behavior among college students: application of social cognitive theory to predicting stage of change

BACKGROUND

Young adulthood is characterized by a steep decline in the level of physical activity, but few theory-based studies have examined characteristics associated with regular exercise in this population. This study applied Social Cognitive Theory (SCT) and the Stages of Change Model (SCM) to determine personal, behavioral, and environmental characteristics associated with exercise behavior and intentions among undergraduate university students.

METHODS

A random sample of 937 undergraduate students (mean age 22.0 +/- 5.6 years; 84.7% ages 17-24 years) enrolled at a large Midwestern university completed a mailed questionnaire. Valid and reliable instruments were used to measure personal, behavioral, and environmental variables based on the SCT that were hypothesized to influence stage of exercise behavior change. Multivariate discriminant analysis was used to determine associations among these variables with stage of exercise behavior change.

RESULTS

Exercise self-efficacy, physical activity history, and nonexercise estimation of aerobic capacity were significant predictors of the stage of exercise behavior change for both males and females. Among females, exercise self-efficacy (P < 0.001) and family social support (P < 0. 001) for physical activity were the best predictors of stage of exercise behavior change. Friend social support (P < 0.001), physical activity history (P < 0.001), and exercise self-efficacy (P < 0.001) were significant predictors of stage of exercise behavior change among males.

CONCLUSIONS

The SCT framework predicted stage of exercise behavior change as defined by the SCM. Exercise self-efficacy was associated with exercise stage, but the source of significant social support (family versus friends) was different for males and females.

Changing health behaviors of older adults

1. Changing lifelong unhealthy habits can have a positive effect on health for older adults. 2. The Transtheoretical Model of behavior change proposes people move through a series of five stages and use a variety of processes as they attempt to change a behavior. 3. Research has shown that tailoring interventions to a individual's stage of change is most effective in promoting behavior change. 4. Specific stage-based strategies are recommended for nurses to use with both individuals and groups of older adults.

Self-efficacy, decisional balance and the stages of change for smoking cessation in a German sample

The Transtheoretical Model (TTM) has been shown to be a powerful basis for describing and explaining behavior change and designing effective interventions. Previous research has documented its usefulness in the context of smoking cessation as well as other areas but predominantly in US samples. The goal of this study was to provide further data on the applicability of the TTM and the relationship of some of its core constructs (stage of change, self-efficacy, decisional balance) in a German sample of smokers and ex-smokers. Participants (N = 401) were ever-smokers (age M = 47 years, range 35-65, 62% male) who participated in a health check-up for cardiovascular risk factors at their general practitioner's office. For current smokers, significant differences in the number of quit attempts across the stages of change supported the criterion validity of the staging algorithm; differences in number of cigarettes per day were non-significant. Self-efficacy for non-smoking behavior showed an almost linear increase across the stages of change, with significant differences between pre-action and action stages. The pros for smoking cessation also increased significantly across the stages, mainly due to a significantly lower perception of pros by participants in the Precontemplation stage. As expected, the cons for smoking cessation decreased significantly, being lower in Action and Maintenance than in earlier stages. Although the generalizability of the results for the stage distribution is limited by the selectivity of the sample, the results underline the applicability and replicability of these TTM core constructs for smoking cessation with newly developed instruments in a German sample.