Predicting substance abuse treatment completion using a new scale based on the theory of planned behavior

Exploring the Acute Effects of Immersive Virtual Reality Biking on Self-Efficacy and Attention of Individuals in the Treatment of Substance Use Disorders: A Feasibility Study

BACKGROUND

The role of exercise programs during substance use disorder (SUD) treatment is considered particularly supportive in fostering positive psychological and behavioral changes. The treatment of SUD is a challenging and demanding process. Therefore, it is crucial to discover innovative methods to enhance and facilitate it. Integrating exercise into a virtual environment is an innovative approach for drug rehabilitation, offering multiple benefits to individuals undergoing treatment. The aim of this feasibility study was to explore the acute effects of cycling exercise in an immersive virtual reality (VR) environment on attentional control and self-efficacy expectations of individuals undergoing SUD treatment.

METHODS

A total of 20 individuals (mean age of 37.75 years) enrolled in a SUD treatment program participated in the study. They were instructed to complete a single session of cycling with a self-selected duration within the VR system.

RESULTS

Following the cycling session, pre-post measures indicated a statistically significant improvement in self-efficacy expectations and attentional control measured with the Stroop test. The results revealed that participants expressed high levels of intention for future use, interest/enjoyment, and positive attitudes toward the VR exercise system. Qualitative data indicated that participants found the VR exercise system enjoyable, expressed a strong intention to use it, and did not encounter technical difficulties or negative emotions.

CONCLUSIONS

In conclusion, it seems that engaging in a brief period of self-selected exercise within a virtual environment can result in temporary activation of cognitive changes, heightened self-efficacy expectations, and a motivating approach to increasing physical activity participation among individuals with SUD, thus suggesting the feasibility of this approach.

Enhancing Substance Use Disorder Recovery through Integrated Physical Activity and Behavioral Interventions: A Comprehensive Approach to Treatment and Prevention

The global issue of substance abuse demands ongoing initiatives aligned with the United Nations Sustainable Development Goals. With drug use remaining prevalent worldwide, interventions are critical to addressing the associated health challenges and societal implications. Exercise and physical activities have emerged as integral components of substance use disorder (SUD) treatment, offering promising avenues for prevention, intervention, and recovery. Recent research underscores the efficacy of exercise in reducing substance cravings, promoting abstinence, and improving overall well-being. However, integrating exercise into SUD recovery programs presents challenges such as dropout rates and cultural considerations. This paper synthesizes existing literature on exercise integration into SUD recovery, highlighting strategies for enhancing treatment outcomes and addressing barriers to exercise adherence. Drawing on cognitive-behavioral therapy, experiential learning, motivational interviewing, and goal-setting techniques, the holistic approach outlined in this paper aims to empower individuals both mentally and physically, fostering resilience and supporting long-term recovery. In conclusion, new initiatives need to be taken by advocating for inclusive policies, promoting community engagement, and fostering collaborations across sectors. By doing so, stakeholders can optimize the effectiveness of exercise programs and contribute to sustainable rehabilitation efforts for individuals with SUD.

The factors affecting substance abuse relapse based on theory of planned behavior in male addicts covered by addiction treatment centers in Southern Iran

BACKGROUND

Given the destructive nature of addiction and its relapse after quitting, the present study aimed to investigate the factors affecting substance abuse relapse based on the Theory of Planned Behavior (TPB) in male addicts covered by addiction treatment centers in Shiraz, Iran.

METHODS

This cross-sectional study was conducted on 400 male addicts covered by addiction treatment centers in Shiraz, Iran, in 2021-2022. The data collection tool was a researcher-made questionnaire. Data were analyzed using SPSS-22 software through descriptive statistical methods, linear regression, and binary logistic regression.

RESULTS

190 people (47.50%) were aged 31-40 years, 265 people (66.25%) were married, 224 people (56%) lived with their spouses, and 192 people (48 percent) had their first use at the age of 16-20. The substance respondents used were methamphetamine (59.5%), heroin (53%), opium (48%), and alcohol (40%). 138 people (34.5%) had their first place of consumption at friends' houses (Tables 1 and 2). 342 people (85.5%) had a history of relapse, and 172 people (50.29%) had 1-5 relapses. Marital status, occupation, and income were among the demographic risk factors, and addicted friends and close relatives were among the behavioral risk factors for drug relapse among people with a history of relapse. Personal desire and the insistence of friends were also among the individual and interpersonal factors of drug use among participants. The regression results showed that the constructs of awareness, attitude, subjective norms, perceived behavioral control, and behavioral intention were predictors of drug relapse among addicts (P < 0.05).

CONCLUSION

The current study's findings indicate that among the behavioral risk factors for drug relapse in individuals with a history of relapse are addicted friends and close relatives, while marital status, occupation, and income are among the demographic risk variables. Among the individual and interpersonal factors influencing drug usage among participants were personal desire and friends' insistence. Furthermore, the findings indicated that the TPB's structures might be used to predict drug relapse in addicts.

Understanding physical exercise among individuals with substance use disorders using an integrated theoretical perspective of the health action process approach and theory of planned behavior

Introduction

Physical exercise is considered a useful non-pharmacological adjunctive treatment for promoting recovery from substance use disorders (SUD). However, adherence to physical exercise treatments is low, and little is known about what factors are associated with the initiation and maintenance of physical exercise behaviors. The aim of this study was to explore the psychosocial factors underlying these behaviors in individuals with SUD using an integrated theoretical model based on the health action process approach (HAPA) and the theory of planned behavior (TPB).

Methods

A total of 1,197 individuals with SUDs (aged 37.20 ± 8.62 years) were recruited from 10 compulsory isolation drug rehabilitation centers in Zhejiang Province via convenience sampling according to a set of inclusion criteria. Self-reported data were collected to assess task self-efficacy (TSE), maintenance self-efficacy (MSE), recovery self-efficacy (RSE), outcome expectations (OE), action planning (AP), coping planning (CP), social support (SS), subjective norms (SN), attitude behavior (AB), behavioral intention (BI), perceived behavioral control (PBC), risk perception (RP), exercise stage, and exercise behavior in this integrated model. ANOVA and structural equation modeling (SEM) were used to evaluate this model.

Results

One-way ANOVA revealed that the majority of the moderating variables were significantly different in the exercise phase. Further SEM showed that the model fit the data and revealed several important relationships. TSE, RP, SS, AB, and SN were indirectly associated with physical exercise behavior in individuals with SUD through the BI in the SUD initiation stage. In addition, PBC was directly related to physical exercise behavior in individuals with SUD. In the maintenance stage, MSE, AP, CP and exercise behavior were significantly related. Moreover, AP and CP were mediators of BI and MSE.

Conclusion

This study is the first attempt to integrate patterns of physical exercise behavior in individuals with SUD. The HAPA-TPB integration model provides a useful framework for identifying determinants of physical exercise behavioral intentions and behaviors in individuals with SUD and for explaining and predicting the initiation and maintenance of physical exercise behaviors in these individuals. Moreover, the model provides scientific guidance for the enhancement of physical exercise adherence in individuals with SUD.

Attitudes and Intentions toward Use of HIV Pre-Exposure Prophylaxis (PrEP) among Adults Receiving Treatment for Opioid Use

Background: Although pre-exposure prophylaxis (PrEP) prevents HIV, little is known about PrEP awareness and factors associated with intention to take PrEP among people with opioid use disorder (OUD). Methods: HIV-negative adults recruited from an outpatient treatment program in Cincinnati, Ohio completed self-administered surveys. Items derived from literature and health behavioral theory included demographics, sexual and drug use behaviors, HIV prevention practices, PrEP knowledge, and attitudes toward PrEP. Primary outcomes were 1) intention to ask a clinician about PrEP and 2) intention to accept PrEP if recommended by a clinician. Outcomes were dichotomized into higher vs. lower intention for analyses in logistic regression models. Results: Among 198 participants, 60.3% reported past injection drug use. Among 58 participants (29.3%) meeting criteria for PrEP, 24% were aware of PrEP, 15.5% had discussed it with a clinician, and 5% had taken it. Factors associated with intention to ask a clinician about PrEP included being somewhat confident about consistent condom use (p < 0.01), motivation to comply with normative beliefs (p < 0.01), and reporting that PrEP fits very well (p < 0.01) and is easy to fit (p < 0.01) into current prevention practices. Factors associated with intention to accept PrEP if recommended by a clinician included motivation to comply with normative beliefs (p < 0.01) and PrEP being easy to fit into current prevention practices (p < 0.01). Conclusion: Among participants meeting indications for PrEP, only 24% were aware of it and few had taken it. Interventions that normalize PrEP and target incorporating PrEP into current prevention practices may improve uptake among individuals with OUD.

Examining the Moderating Role of Reasons in Masstige Luxury Buying Behavior

This study proposes a new model derived from Behavioral Reasoning Theory (BRT) to examine the purchasing behavior of masstige jewelry consumers. The suggested model provides a more comprehensive understanding of the determinants of purchasing masstige products by considering values and reasons in addition to the global motives and intention. The study also examines, for the first time, the moderating role of reasons. It explores how reasons may strengthen or weaken the impact of perceived values on global motives. The proposed model was empirically tested using partial least squares-structural equation modeling (PLS-SEM) with survey data on the consumption of masstige jewelry brands in Türkiye. To provide a more complete understanding of the moderating role of reasons, submodels were constructed for different value-reason combinations. The results demonstrate notable differences in the goodness-of-fit measures between the moderated and non-moderated models. Specifically, reasons contributed to enhanced explanations of global motives and intention, both directly and indirectly. However, not all submodels yielded significant results in terms of the moderator effect. Thus, the empirical tests supported the hypotheses regarding the moderating effect only partially. Overall, the current findings further extend the existing frameworks and provide valuable insights into masstige jewelry purchasing behavior, which can be used by marketers to develop more effective strategies.

The theory of planned behavior and alcohol protective behavioral strategies: a prospective study examining the role of habit and gender invariance

OBJECTIVES

Alcohol Protective Behavioral Strategies (PBS) have consistently shown to be effective in reducing alcohol use and its associated consequences. We aimed to examine the explanatory value of the Theory of Planned Behavior (TPB) for using five PBS, studying the role of habit, and its potential variation across genders.

METHODS

Targeted sampling was used to recruit 339 young adults in the community (women = 50.7%; mean age = 2.21[SD = 2.21]), who completed baseline and 2-month follow-up questionnaires.

RESULTS

The explained variance of the TPB ranged from 58-68% for intention to use PBS, and 18-50% for behavior. The inclusion of habit produced increases of 17-26% in explained variance in intention, while explained variance in behavior remained similar. Habit was the strongest predictor of intention to use PBS, followed by attitude. Except for one behavior (drinking slowly), habits did not moderate the intention-behavior relationship, and the explanatory value of the TPB did not differ across genders.

CONCLUSIONS

Our findings support the utility of the TPB as an explanatory model of alcohol PBS, along with the need to include habits within the framework of dual-process models. Interventions aimed at promoting alcohol PBS could be optimized by targeting attitudes towards PBS and habits.

Studying environmental and economic considerations on tourism activities in achieving sustainable development goals: implications for sustainability

The study aims to extend the understanding of environmental and economic considerations on tourism activities in achieving sustainable development goals. The motivation of the study is to provide the empirical inference of variables based on study topicality and the implications to achieve SDG 8 and SDG 9 specifically. The study used panel data from 2000 to 2021 to check for cross-sectional dependency and performed various panel unit root tests to verify the unit root properties of the variables. With the help of Pedroni and Kao's statistical results, we confirm variables are integrated. The results from OLS modified and dynamic demonstrate the correlation between transformation, measured by patents and publications, and higher economic performance and lower environmental hazard, emphasizing the role of transformation. The results also show that tourism arrivals have a significant positive effect on reducing pollution hazards and increasing economic performance, which shows progress toward sustainable development. Based on the study, it was determined that the contribution of asylum seekers did not positively impact the host countries' economic conditions or environmental improvement initiatives. It was found that higher levels of education play a crucial role in promoting sustainable development through economic growth and mitigating environmental risks. To achieve sustainable development in the G20 economies, promoting tourism, undertaking transformational measures, and enhancing higher education are recommended. These results have significant implications for policymakers, firms, and an agenda of the United Nations sustainable development program.

Applying the theory of planned behavior to predict online addiction treatment intention

METHODS

This descriptive-analytical study included a self-report questionnaire based on the TPB model, and was distributed to a sample of 115 people recovering from SUD, aged 18-69, 62% of whom were men.

RESULTS

Attitude, Subjective Norms (SN), and Perceived Behavioral Control (PBC) toward online addiction treatment was significantly positive in relation to intention and past behavior of participants in online addiction treatment. Attitude and PBC were found to be significant predictors, and the TPB model was found to be significant {F (3,111) = 47.29, p < 0.01}, explaining 56% of the variance of intention for participants in online addiction treatment.

CONCLUSION

As online treatment is a relatively new tool in addiction treatment, professionals and treatment providers should encourage beliefs, attitudes, moral norms, and perceived behavior control to increase intentions among future participants in online addiction treatment.

Improving assessment of alcohol treatment barriers among Latino and White adults with an alcohol use disorder: Development of the barriers to specialty alcohol treatment scale

INTRODUCTION

The present study's aims were two-fold. First, we sought to validate a novel measure to assess barriers to specialty alcohol treatment among White and Latino individuals with an alcohol use disorder (AUD): The Barriers to Specialty Alcohol Treatment (BSAT) scale. Second, we sought to demonstrate that the BSAT scale could be used to explain Latino-White disparities in barriers to alcohol treatment.

METHODS

In 2021, we recruited an online national sample of 1200 White and Latino adults with a recent AUD. Participants completed an online questionnaire that included the BSAT items. Confirmatory and exploratory factor analyses were conducted to validate the BSAT. Multiple group analyses across race/ethnicity and language were also performed using the final model.

RESULTS

The final model consisted of 36 items across 7 factors that reflect barriers related to low problem recognition, recovery goals, low perceived treatment efficacy, cultural factors, immigration-related concerns, low perceived social support, and logistical barriers. The final model's factor structure and factor loadings held up across race/ethnicity and language. The top endorsed barriers were low problem recognition, recovery goals, low perceived social support, logistical issues, and low perceived treatment efficacy. Compared to Whites, Latinos were more likely to report perceived lack of social support, logistical barriers, low perceived treatment efficacy, cultural barriers, and immigration-related concerns as barriers.

CONCLUSION

Findings provide empirical support for the validity of the BSAT scale, which offers improved measurement of specialty alcohol treatment barriers and can be used to explore Latino-White disparities in a future study.

Predicting factors affecting the intention to use a 3PL during the COVID-19 pandemic: A machine learning ensemble approach

The COVID-19 pandemic had brought changes to individuals, especially in consumer behavior. As the government of different countries has been implementing safety protocols to mitigate the spread of the virus, people became apprehensive about traveling and going out. This paved way for the emergence of third-party logistics (3PL). Statistics have proven the rapid escalation regarding the use of 3PL in various countries. This study utilized Artificial Neural Network and Random Forest Classifier to validate and justify the factors that affect consumer intention in selecting a 3PL service provider during the COVID-19 pandemic integrating the Service Quality Dimensions and Pro-Environmental Theory of Planned Behavior. The findings of this study revealed that attitude is the most significant factor that affects the consumers' behavioral intention. Other factors such as customer satisfaction, customer perceived value, perceived environmental concern, assurance, responsiveness, empathy, reliability, tangibility, perceived behavioral control, subjective norm, and perceived authority support, are all contributing factors that affect behavioral intention. Machine learning algorithms, specifically ANN and RFC, resulted to be reliable in predicting factors as they obtained accuracy rates of 98.56% and 93%. Results presented that consumers’ attitude, satisfaction, perceived value, assurance by the 3PL, and perceived environmental concerns were highly influential in choosing a 3PL package carrier. It was seen that people would be encouraged to use 3PL service providers if they demonstrate availability and environmental concerns in catering to the customers' needs. Subsequently, 3PL providers must assure safety and convenience before, during, and after providing the service to ensure continuous patronage of consumers. This is considered to be the first study that utilized a machine learning ensemble to measure behavioral intention for the logistic sector. The framework, analysis tools, and findings of this study could be extended and applied among other behavioral intentions regarding transportation worldwide. Managerial insights among service providers are discussed.

Sustainable Consumption: Will They Buy It Again? Factors Influencing the Intention to Repurchase Organic Food Grain

Global consumption trends point to rising demand for organic food as people become more health-conscious. The factors that people consider while making initial organic purchases have been discussed at length. However, the published research is scant about the factors that affect consumers’ propensity to repurchase organic goods. The present research fills this gap by focusing on what influences consumers’ decisions to repurchase organic grain. The Stimulus-Organism-Response (S-O-R) theory and the Theory of Planned Behaviour are the theoretical foundations of the present investigation. The consumer’s attitude toward organic grains and their desire to repurchase organic grains are influenced by health consciousness and previous experience. The repurchase intent was determined to be controlled by the buyer’s willingness to pay and their level of trust in the organic grain. This cross-sectional study collected the necessary data from five chosen urban centres in India. Smart PLS 3.2.9 was used to analyse the gathered data from 463 respondents. According to the findings, health consciousness and past experience favourably influence attitudes and repurchase intent. The trust that consumers have built up in organic grain as a result of past experiences is what drives their desire to make more purchases. Willingness to pay significantly controls and impacts the inclination to repurchase. The association between health consciousness and repurchase intention is partially mediated by attitude, as is the relationship between past experience and repurchase intention. The relationship between health consciousness and the desire to repurchase is partially mediated by the willingness to pay.

Environmental, Health or Social Impacts? Investigating Ethical Food Consumption Behavior in the Case of Palm Oil-Free Foods

Environmental consciousness, health consciousness, social consciousness—today, all three terms have become buzzwords that influence food consumer behavior and reach many consumers. A number of consumer trends have emerged, which manufacturers have responded to, giving consumers the opportunity to make purchasing decisions that reflect any or all of these three buzzwords. In the context of palm oil, all three of these buzzwords may be associated with a consumer-perceived problem. They may be aware of the social (e.g., child labor), environmental (e.g., burning of rainforests) or potential health impacts communicated by the media. Today, more and more products claim to be palm oil free. Related to this the main question of the research is “why do consumers choose palm oil-free foods?” The results of our model using the theory of planned behavior show that the factor most influencing purchase intention is consumer attitude towards palm oil. The only significant effect on this factor is the environmental impact. Neither the perceived health-, nor the social effect had a significant effect on shaping attitudes among the respondents. A further result of the model is that perceived behavioral control only directly affects actual behavior, but does not influence intention, indicating that although there is a possibility for respondents to purchase palm oil-free products, it was not necessarily a conscious, intentional purchase.

“Intervention Program Based on Self”: A Proposal for Improving the Addiction Prevention Program “Unplugged” through Self-Concept

The “Intervention Program based on Self” (IPSELF) project was created to address the gap between the acquisition of life skills during prevention programs and their application with a session for developing one’s self-concept included in the European program “Unplugged”. The present study evaluated its effectiveness. A total of 157 middle school students (94 girls, 63 boys, M_AGE= 12.89, SD = 0.45) from three schools in France participated in this study. The participants attended one of two programs (Unplugged/IPSELF). The effectiveness of the IPSELF add-on session was measured with the Self-Concept Clarity Scale, and the differences between the two programs was measured with the prototype willingness model. Adolescents in IPSELF rated the typical nonsmoker and cannabis nonsmoker more favorably, and the typical drinker less favorably. They felt more different from the typical smoker and drinker after participation in IPSELF. More alcohol experimenters were observed in Unplugged. The knowledge gained in IPSELF appeared to help adolescents more than that gained in Unplugged to change their smoking behavior. Furthermore, IPSELF had a more beneficial effect for girls, who felt that they had gained more control over their alcohol and cannabis use than boys, whereas Unplugged had a more positive effect on boys, who gained better control over their consumption. Moreover, the girls felt that they had gained more knowledge about the substances discussed in IPSELF than in Unplugged. We therefore recommend the use of IPSELF especially with female audiences.

Associations between heavy drinker’s alcohol-related social media exposures and personal beliefs and attitudes regarding alcohol treatment

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Social media exposures were associated with alcohol treatment-seeking intentions.

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Exposure to peer pro-drinking posts was negatively associated with intentions.

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Exposure to peer treatment/recovery posts was positively associated with intentions.

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Associations explained partially by attitudes toward treatment effectiveness and stigma.

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Social media-based recovery narratives may promote treatment and recovery seeking.

Objective

Social media use among American adults is ubiquitous. Alcohol-related social media posts often glamorize heavy drinking, with increased exposure to such content associated with greater alcohol use. Comparatively less is known, however, about how social media promotes alcohol-related health behavior change. Greater scientific knowledge in this area may enhance our understanding of the relationship between social media and alcohol behaviors, helping to inform clinical and public health recommendations. We examined the relationship between exposure to peer alcohol-related social media posts (pro-drinking, negative consequences, and pro-treatment/recovery) and treatment-seeking intentions among heavy drinkers, as well as potential mediators of the relationship (e.g., attitudes toward treatment effectiveness).

Method

Hazardous drinking adults (aged 18–55 years) who use social media (N = 499) completed an online questionnaire. Linear regression analysis examined the association between alcohol-related social media exposures and treatment-seeking intentions. Mediation was tested using structural equation modelling

Results

Exposure to peer pro-drinking posts was negatively associated with intentions to seek treatment (β = -0.67, p < 0.01), whereas exposures to peer alcohol-related negative consequences posts and peer posts about positive experiences with treatment/recovery were positively associated with treatment-seeking intentions (β = 0.69, p < 0.01; β = 1.23, p < 0.001, respectively). Mediation analysis concluded the effect of exposures on intentions was explained partially by attitudes toward treatment effectiveness (25.5%) and alcohol treatment stigma (6.1%). Conclusions: Findings suggest peers’ alcohol-related social media posts may both promote and hinder health behavior change depending on the nature of the post. Future research that develops and tests social media-delivered interventions to promote treatment and recovery seeking is warranted.

An agent-based model of the dual causality between individual and collective behaviors in an epidemic

The evolution of an epidemic is strongly related to the behavior of individuals, and the consideration of cause and effect of social phenomena can extend epidemiological models and allow for better identification, prediction and control of the impacts of containment and mitigation measures. This work proposes an agent-based model to simulate the double causality that exists between individual behaviors, influenced by the cultural orientation of a population, and the evolution of an epidemic, focusing on recent studies on the COVID-19 pandemic. To do this, concepts from the social sciences are used, such as the theory of planned behavior, as well as Bayesian inference to abstract the decision-making processes involved in human behavior. A set of simulation experiments with different populations was developed to demonstrate the role that the cultural orientation of a population plays in the management of an epidemic. The results agree with the revised theory, showing that in populations that have a greater inclination towards collectivism, epidemiological indicators evolve in a better way than in those populations where the culture is individualistic. This work contributes to the field of computational epidemiology by providing a new way of including the social aspects of studied populations in agent-based models to help develop better interventions.

Predicting Substance Use Treatment Failure with Transfer Learning

Transfer learning, which involves repurposing a trained model on a related task, may allow for better predictions with substance use data than models that are trained using the target data alone. This approach may also be useful for small clinical datasets. The current study examined a method of classifying substance use treatment success using transfer learning. Transfer learning was used to classify data from a nationwide database. We trained a convolutional neural network on a heroin use treatment dataset, then trained and tested on a smaller opioid use treatment dataset. We compared this model with a baseline model that did not benefit from transfer learning, and a tuned random forest (RF). The goal was to see if model weights transfer across related substances and from large to small datasets. The transfer model outperformed the RF model and baseline model. These findings suggest leveraging the power of large datasets for transfer learning may be an effective approach in predicting substance use disorder (SUD) treatment outcomes. It is possible to achieve a score that performs better than RF using transfer learning.

An integrated dual process simulation model of alcohol use behaviours in individuals, with application to US population-level consumption, 1984-2012

INTRODUCTION

The Theory of Planned Behaviour (TPB) describes how attitudes, norms and perceived behavioural control guide health behaviour, including alcohol consumption. Dual Process Theories (DPT) suggest that alongside these reasoned pathways, behaviour is influenced by automatic processes that are determined by the frequency of engagement in the health behaviour in the past. We present a computational model integrating TPB and DPT to determine drinking decisions for simulated individuals. We explore whether this model can reproduce historical patterns in US population alcohol use and simulate a hypothetical scenario, "Dry January", to demonstrate the utility of the model for appraising the impact of policy interventions on population alcohol use.

METHOD

Constructs from the TPB pathway were computed using equations from an existing individual-level dynamic simulation model of alcohol use. The DPT pathway was initialised by simulating individuals' past drinking using data from a large US survey. Individuals in the model were from a US population microsimulation that accounts for births, deaths and migration (1984-2015). On each modelled day, for each individual, we calculated standard drinks consumed using the TPB or DPT pathway. In each year we computed total population alcohol use prevalence, frequency and quantity. The model was calibrated to alcohol use data from the Behavioral Risk Factor Surveillance System (1984-2004).

RESULTS

The model was a good fit to prevalence and frequency but a poorer fit to quantity of alcohol consumption, particularly in males. Simulating Dry January in each year led to a small to moderate reduction in annual population drinking.

CONCLUSION

This study provides further evidence, at the whole population level, that a combination of reasoned and implicit processes are important for alcohol use. Alcohol misuse interventions should target both processes. The integrated TPB-DPT simulation model is a useful tool for estimating changes in alcohol consumption following hypothetical population interventions.

Barriers to retention in substance use treatment: Validation of a new, theory-based scale

PURPOSE

Few studies and no theory-based scales have addressed specific barriers to substance use disorder (SUD) treatment retention. The current study, building on the Theory of Planned Behavior (TPB), sought to (a) identify those barriers that are most strongly associated with treatment retention, and most common, and (b) develop and validate a new scale of retention barriers, focusing on TPB attitude and perceived control components.

METHODS

The study administered surveys to 200 participants initiating SUD treatment at a public, outpatient program in Northern California; the analytic sample (N = 156) included only those not strongly coerced into treatment. Surveys included TPB-based measures of treatment barriers; other motivational readiness measures; treatment coercion and social desirability measures; and clinical severity variables and demographics. Discharge status was collected from program records.

RESULTS

Item and scale analyses identified three dimensions of attitudinal barriers (i.e., Low Perceived Treatment Need/Value, Social Concerns, and Concerns about Missing Substances) and two dimensions of perceived control barriers (i.e., Personal Limitations and Basic Logistic Barriers). Results informed creation of a 19-item Barriers to Retention Scale (BRS) with 5 subscales and very good internal reliability (alpha = 0.88). While all subscale scores were correlated with treatment completion, only Concerns about Missing Substances and total BRS scores predicted treatment completion in multivariate analyses.

CONCLUSIONS

The present study identified core dimensions of treatment retention barriers and developed a new scale predictive of treatment completion and potentially useful as a screener and in future research. Results suggest that interventions to improve retention should focus strongly on concerns about the negative impacts of abstaining from alcohol and drugs on craving and quality of life.

Understanding the Antecedents of Knowledge Sharing Behavior From the Theory of Planned Behavior Model: Cross-Cultural Comparisons Between Mainland China and Malaysia

Affected by coronavirus disease (COVID-19), in addition to keeping away the impact of the pandemic on their business practices, many enterprises have proposed relevant measures to protect their employees' job safety and security. Especially for enterprises with high dependence on knowledge resources, employees' innovation and knowledge sharing play a vital role. In the context of global economic austerity, how to put forward the corresponding plan of knowledge sharing intention to improve the knowledge sharing behavior of employees for enterprises is worth discussing. Mainland China and Malaysia have different quarantine policies and similar industrial structures. This study examines the awareness of Mainland China vs. Malaysian employees, and evaluates the relationship among self-efficacy, job security, market orientation, knowledge sharing intention, and knowledge sharing behavior from the theory of planned behavior. In this study, a total of 627 Mainland China and 434 Malaysian participants were collected to compare both groups in the development of employees' knowledge sharing behavior. In this study, a variance-based partial least squares structural equation modeling (PLS-SEM) was performed to test the proposed hypothesis and conduct comparative analysis. The results in both the samples show that self-efficacy, job security, and market orientation have positive and significant effects on knowledge sharing intention; self-efficacy has positive and significant effects on job security; knowledge sharing intention has positive and significant effects on knowledge sharing behavior. Moreover, there are several significant differences between Mainland China and Malaysia in the examinations of path comparisons.

Analysis of Influencing Factors of College Students’ Intention to Repeated Blood Donation Based on Structural Equation Modeling

To research the influencing factors of college students' blood donation behavior intention and propose intervention strategies to improve the repeated blood donation rate of college students. Questionnaire survey was used to research and analyze the influencing factors of behavior intention. Amos 21.0 software was used to establish structural equation modeling and perform confirmatory factor analysis. SPSS 20.0 was used for statistic. The model was proved with highly adaptability, with χ2/df = 2.956 < 3. Factors influencing college students' intention of repeat blood donation behavior can be summarized into four: attitude, external motivation, advice-taking, and perceived behavioral control. Among them, attitude and perceived behavioral control have a great direct impact on behavioral intention, while the external motivation and recommendation acceptance have an indirect impact by influencing the other two factors. In view of those evaluation items with high path coefficient in each factor, we can develop recruitment strategies to influence college students’ repeated blood donation behavior and provide scientific suggestions for improving their repeated blood donation rate.

Application of the theory of planned behavior to predict smoking intentions: cross-cultural comparison of Kenyan and American young adults

Despite well-established research on the applications of the theory of planned behavior (TPB) in the American culture, TPB has not been fully tested in the Kenyan culture. This study compared the applications of TPB in predicting smoking intentions (i.e., future and weekend smoking intentions) of Kenyan and American young adults. Data were collected from 252 Kenyans and 227 Americans. The Kenyan participants consisted of 41.7% females with a mean age of 25 years (SD = 4.81). The American participants (49.3% females) had an average age of 19 years (SD = 1.30). Multi-group path analysis was performed to test the equivalence of a TPB-based mediation model in Kenyans and Americans. Significant differences of TPB application were detected. In the American model, smoking consequence beliefs were indirectly associated with smoking intentions through attitudes whereas neither direct nor indirect effects of smoking consequence beliefs were detected in the Kenyan model. Instead, normative beliefs indirectly associated with future and weekend smoking intentions through attitudes and subjective norms in the Kenyan model. Despite some overlapping paths, there were cultural variations on specific associations among TPB constructs between Kenyans and Americans. Cultural adaptations may be needed when applying TPB in the Kenyan cultural context.

Perceived need for drug treatment among African American male drug-using prisoners

Since 2016, African Americans have experienced the largest increase in cocaine-related drug overdose deaths compared to other racial/ethnic groups. African American male prisoners who used drugs prior to incarceration are at an increased risk for relapse and overdose upon community re-entry. Using the Theory of Planned Behavior as a guiding framework, this study examined correlates of perceived need for treatment among 193 drug-using incarcerated African American men nearing release. Linear regression analyses revealed that the number of lifetime drug overdoses, severity of legal problems, and previous drug treatment significantly predicted a need for treatment. Further, more frequent drug use, specifically crack cocaine, in the month prior to incarceration predicted a higher perceived need for drug treatment. Implications suggest this population demonstrates a need for treatment, which may be exacerbated by re-entry stressors. Preventative measures, including culturally tailored treatment and transitional care from prison to community-based services, are necessary to reduce risk of relapse and overdose among this group.

Private health insurance coverage of drug use disorder treatment: 2005-2018

Many privately insured adults with drug use disorders in the United States do not have health care coverage for drug use treatment. The Affordable Care Act sought to redress this gap by including substance use treatments as essential health benefits under new plans offered. This study used data from 11,732 privately insured adult participants of the 2005-2018 National Survey on Drug Use and Health with drug use disorders to examine trends in drug use treatment coverage and the association of coverage with receiving treatment. 37.6% of the participants with drug use disorders did not know whether their plan covered drug use treatment, with little change over time. Among those who knew, coverage increased modestly between the 2005-2013 and 2014-2018 periods (73.5% vs. 77.5%, respectively, p = .015). Coverage was associated with receiving drug use treatment (adjusted odds ratio = 2.09, 95% confidence interval = 1.61-2.72, p < .001). However, even among participants with coverage, only 13.4% received treatment. Broader coverage of drug use treatment could potentially improve treatment rates.

Employers’ Intent to Hire People Who Are Blind or Visually Impaired: A Test of the Theory of Planned Behavior

The purpose of this study was to examine the utility of the theory of planned behavior (TPB) in explaining employers’ hiring intentions of people who are blind or visually impaired (B/VI). Participants were 388 hiring managers who completed an online survey that included the four TPB construct measures (attitudes, subjective norms, behavioral control, and intent to hire). Confirmatory factor analysis (CFA) was used to determine the suitability of the measurement model, and structural equation modeling was used to test the structural model. The proposed TPB structural model provided good data fit; attitudes about productivity, subjective norms, and perceived behavioral control accounted for more than 61% of the variance in intent to hire people who are blind. Attitudes about productivity of a blind employee had the strongest relationship with intent to hire, followed by subjective norms and perceived behavioral control. Rehabilitation professionals who work with B/VI individuals should educate employers about how this population can perform the employers’ jobs to improve attitudes about productivity. They should consider employers’ subjective norms and perceived behavioral control, which could be influenced by providing disability awareness presentations to company employees and maintaining a relationship with employers, thus enabling employers to have access to qualified applicants.

Until I get off parole … then I can swim in it if I want to: Facilitators of and barriers to drug use among formerly incarcerated Black drug offenders

Black Americans are overrepresented among those incarcerated for drug-related offenses. Drug use, postincarceration, is associated with high risk of recidivism and overdose deaths. We explored factors influencing drug use among former Black drug offenders. Qualitative interviews with 30 Black Americans released from prison within the past year explored drug behavior as well as institutional, environmental, and social factors that influence drug use. Findings show participants reentered drug-enticing environments and social networks. Being on parole, drug programs, and social support influenced abating drug use. Drug interventions postincarceration should consider the environment and social networks as leverage points for behavior change.

Motivation and adherence to psychosocial treatment for alcohol and drug use-related problems

Abstract This is a prospective cohort study of 150 individuals attending a specialized health service for substance-related disorders. The study investigated the association between motivation to remain in treatment and treatment adherence. All service users were interviewed soon after admission to the treatment program and were followed-up during the first two months of treatment. A Cox Regression Model was used to estimate the hazard ratios for dropout during the two months following the admission interview. The results indicated that individuals with a primary-school education, lack of income, and low motivation toward treatment at the admission interview presented a higher risk of treatment dropout. This study showed the importance of motivation in changing addictive behavior and in adherence to treatment as essential factors for recovery.

Barriers to Mindfulness: a Path Analytic Model Exploring the Role of Rumination and Worry in Predicting Psychological and Physical Engagement in an Online Mindfulness-Based Intervention

Little is known about the factors associated with engagement in mindfulness-based interventions (MBIs). Moreover, engagement in MBIs is usually defined in terms of class attendance (‘physical engagement’) only. However, in the psychotherapy literature, there is increasing emphasis on measuring participants’ involvement with interventions (‘psychological engagement’). This study tests a model that rumination and worry act as barriers to physical and psychological engagement in MBIs and that this in turn impedes learning mindfulness. One hundred and twenty-four participants were given access to a 2-week online mindfulness-based self-help (MBSH) intervention. Self-report measures of mindfulness, rumination, worry, positive beliefs about rumination, positive beliefs about worry and physical and psychological engagement were administered. A path analysis was used to test the linear relationships between the variables. Physical and psychological engagement were identified as two distinct constructs. Findings were that rumination and worry both predicted psychological disengagement in MBSH. Psychological engagement predicted change in the describe, act with awareness, non-judge and non-react facets of mindfulness while physical engagement only predicted changes in the non-react facet of mindfulness. Thus, rumination and worry may increase risk of psychological disengagement from MBSH which may in turn hinder cultivating mindfulness. Future suggestions for practice are discussed.

Feasibility and acceptability of shared decision-making to promote alcohol behavior change among women Veterans: Results from focus groups

BACKGROUND

Although rates of unhealthy drinking are high among women Veterans with mental health comorbidities, most women Veterans with mental comorbidities who present to primary care with unhealthy drinking do not receive alcohol-related care. Barriers to alcohol-related treatment could be reduced through patient-centered approaches to care, such as shared decision-making.

AIMS

We assessed the feasibility and acceptability of a telephone-delivered shared decision-making intervention for promoting alcohol behavior change in women Veterans with unhealthy drinking and co-morbid depression and/or probable post-traumatic stress disorder.

METHODS

We used 3, 2-hour focus group discussions with 19 women Veterans to identify barriers and solicit recommendations for using the intervention with women Veterans who present to primary care with unhealthy drinking and mental health comorbidities. Transcripts from the focus groups were qualitatively analyzed using template analysis.

RESULTS

Although participants perceived that the intervention was feasible and acceptable for the targeted patient population, they identified the treatment delivery modality, length of telephone sessions, and some of the option grid content as potential barriers. Facilitators included strategies for enhancing the telephone-delivered shared decision-making sessions and diversifying the treatment options contained in the option grids. Focus group feedback resulted in preliminary adaptations to the intervention that are mindful of women Veterans' individual preferences for care and realistic in the everyday context of their busy lives.

Factors associated with physicians' choice of a career in research: a retrospective report 15 years after medical school graduation

Relatively little is known regarding factors associated with the choice of a research career among practicing physicians, and most investigations of this issue have been conducted in the absence of a theoretical/conceptual model. Therefore we designed a survey to identify the determinants of decisions to pursue a biomedical research career based upon the Theory of Planned Behavior and the concept of stereotype threat. From October 2012 through January 2014 electronic surveys were sent to four consecutive Harvard Medical School graduating classes, 1996-1999. Respondents provided demographic information, indicated their current research involvement, and provided retrospective reports of their experiences and attitudes when they were making career choices as they completed medical school. Multivariable ordinal regression was used to identify factors independently associated with current research involvement. Completed questionnaires were received from 358 respondents (response rate 65 %). In unadjusted analyses, variables associated with more extensive research involvement included non-minority status, male gender, lower debt at graduation, strong attitudes toward research at time of graduation, and greater social pressures to pursue research (all P < .001). These associations remained significant in multivariable regression analysis (all P < 0.01). However, an interaction between sex and prior research publications was also detected, indicating that more extensive research involvement during medical school doubled the likelihood of a research career for women (OR 2.53, 95 % CI 1.00-6.40; P = 0.05). Most of the factors predicting research career choice involve factors that are potentially modifiable, suggesting that appropriately designed behavioral interventions may help to expand the size and diversity of the biomedical research community.

Mental health stigma: Impact on mental health treatment attitudes and physical health

The purpose of this study was to test two models of the impact of mental health stigma on both attitudes toward seeking psychological help and physical health. General self-efficacy, self-esteem, and anxiety were tested as potential mediators of these two relationships. A sample of adults ( N = 423) aged 18-72 years was surveyed using the participant pool of a large, distance learning university. Structural equation modeling results indicated that mental health stigma directly and indirectly influenced treatment attitudes and physical health. Internal self-variables mediated the relationship between mental health stigma and both study outcomes.

Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders

Background

Perceived coercion is a sense of pressure related to the experience of being referred to treatment. The sense of pressure arises from the patient’s internal perception of coercion. The sources of coercion may be the legal system, the family, the health system, or self-criticism (internal sources). Here, we studied patients diagnosed with substance use disorders that were involuntarily admitted to hospital, pursuant to a social services act. We sought to determine whether these patients perceived coercion differently than patients that were admitted voluntarily.

Methods

This study included patients admitted to combined substance use disorder and psychiatry wards in three publicly funded treatment centres in Norway in the period 2009–2011. Participants included 63 patients that were admitted involuntarily, pursuant to the Norwegian Public Health Act, and 129 patients that were admitted voluntarily. All participants completed the Perceived Coercion Questionnaire. Sociodemographic variables were determined with the European Addiction Severity Index. The range of psychopathological symptoms was evaluated with the Symptom Checklist-90-R. Independent sample t-tests, the chi-squared test, and Fisher’s exact test were used to detect statistically significant differences between groups.

Results

Scores on the Perceived Coercion Questionnaire showed that patients admitted voluntarily and those admitted involuntarily experienced similar levels of perceived coercion. Those admitted voluntarily reported higher levels of perceived coercion from internal sources, and those admitted involuntarily perceived significantly higher coercion from legal sources. No differences between groups were found with the other tests.

Conclusions

Our results suggested that assumptions about involuntary admissions should be evaluated carefully to determine how best to alleviate counterproductive feelings of coercion when a coerced admission is planned. Informing and collaborating with the patient will most likely facilitate a better experience during admission and treatment. Moreover, the patient is more likely to experience a better recovery process.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1906-4) contains supplementary material, which is available to authorized users.

Motivation Among Ex-Offenders Exiting Treatment: The Role of Abstinence Self-Efficacy

The relationships between motivation, treatment readiness, and abstinence self-efficacy were examined among a sample of ex-offenders exiting inpatient treatment for substance use disorders. Hierarchical linear regression was conducted to examine changes in participants' motivation levels in relation to abstinence self-efficacy beyond what would be expected from treatment readiness and substance use. Abstinence self-efficacy predicted significant decreases in motivation whereas treatment readiness and substance use predicted significant increases. However, there was not a significant relationship between abstinence self-efficacy and treatment readiness. Findings suggest that motivation for change among persons with substance use disorders is related to their self-efficacy for ongoing abstinence.

The Survey of Treatment Entry Pressures (STEP): identifying client's reasons for entering substance abuse treatment

OBJECTIVE

Systematically identifying reasons that clients enter substance abuse treatment may allow clinicians to immediately focus on issues of greatest relevance to the individual and enhance treatment engagement. We developed the Survey of Treatment Entry Pressures (STEP) to identify the specific factors that precipitated an individual's treatment entry. The instrument contains 121 items from 6 psychosocial domains (i.e., family, financial, social, medical, psychiatric, legal). The current study examined the STEP's psychometric properties.

METHOD

A total of 761 participants from various treatment settings and modalities completed the STEP prior to treatment admission and 4-7 days later. Analyses were performed to examine the instrument's psychometric properties including item response rates, test-retest reliability, internal consistency, and factor structure.

RESULTS

The items displayed adequate test-retest reliability and internal consistency within each psychosocial domain. Generally, results from exploratory and confirmatory factor analyses support a 2-factor structure reflecting type of reinforcement schedule.

CONCLUSION

The study provides preliminary support for the psychometric properties of the STEP. The STEP may provide a reliable way for clinicians to characterize and capitalize on a client's treatment motivation early on which may serve to improve treatment retention and therapeutic outcomes.