Stage of change, decisional balance, and temptations for smoking: measurement and validation in a large, school-based population of adolescents

Identifying Novel Motivation Phase-Specific Cessation Targets for Youth Experiencing Homelessness in the United States

INTRODUCTION

Of youth experiencing homelessness (YEH; 14-24 years old), 70%+ smoke combustible, commercial tobacco. Though many have tried to quit, most use ineffective methods. Drop-in centers for YEH are opportune places to link YEH to evidence-based treatment. Using the Phase-Based Model (PBM) for Cessation Research, the aim of this study was to identify "Motivation" phase-specific challenges impacting YEH's willingness to make a quit attempt-the goal of this cessation phase.

AIMS AND METHODS

Surveys were interview administered with 96 past-week combusted tobacco users accessing drop-in services. Regression models were fit to confirm hypothesized challenges impacting YEH's willingness to quit.

RESULTS

Moderate nicotine dependence was noted-a key Motivation phase cessation mechanism targeted-and was associated with population challenges including, but not limited to, replacing food with tobacco, accidental oxygen-deprivation events, and smoking to socialize. While 67.1% of participants made a past-year quit attempt, 45.8% expressed 30-day quit interest. Dimensions of coping with housing were associated with quit attempts and quit interest. Quit attempts were also associated with nicotine dependence, working, and smoking to socialize. Whereas, quit interest was associated with less endorsement of smoking to regulate affect and more endorsement to avoid danger.

CONCLUSIONS

Though common challenges targeted in Motivation phase cessation exist among YEH, other challenges may also need to be addressed to promote quitting.

IMPLICATIONS

Future research in optimizing evidence-based cessation access for YEH through drop-in centers may consider addressing the challenges of housing, food security, social context, violence, and neurotrauma sequela to bolster YEH willingness to make a quit attempt.

Development of transtheoretical model measures for assessing decisional balance and temptation to vape

Introduction: Vaping is common among young adults in the United States. The Transtheoretical Model (TTM) has demonstrated success in smoking cessation efforts; however, it has not been comprehensively applied to vaping cessation, and core TTM vaping measures have not been developed. Method: A cross-sectional survey including measures of stage of change (SOC), temptation to vape, and decisional balance (DCBL) was disseminated (n = 459). Items were adapted from TTM smoking scales. The sample was split for exploratory and confirmatory factor analyses (EFA/CFA). Analyses of variance assessed relationships between constructs and SOC. Results: EFA/CFA resulted in one Temptation scale (CFI = .95; α = .87) and two DCBL scales (CFI = .91; Pros α = .72; Cons α = .72). Temptation to vape and Pros of vaping decreased significantly across SOC, while Cons increased significantly. Conclusions: TTM vaping measures for two key TTM constructs were developed utilizing a college sample. Results suggest that the developed measures map well onto the TTM framework.

Psychometric properties of the Chinese version of the Exercise Self-Efficacy Scale for the Transtheoretical Model: a confirmatory analysis among Chinese children and adolescents

BACKGROUND

Self-efficacy has been recognized as a critical component in people's participation and maintenance of physical activity. This study aims to validate the Chinese version of the Exercise Self-Efficacy Scale (ESE) among Chinese children and adolescents using confirmatory factor analysis (CFA).

METHODS

A cross-sectional study was conducted on two primary and two secondary schools in central China. The ESE scale was translated into Chinese (ESE-C) using the standard forward-backward translation method. Data were analyzed using Mplus 8 for the CFA.

RESULTS

The final model showed a satisfactory level of goodness-of-fit (CFI = 0.918; TLI = 0.905; SRMR = 0.043; RMSEA = 0.066), indicating a good construct validity of the ESE-C for children and adolescents in mainland China. Furthermore, the final ESE-C model achieved composite reliability values of 0.963 and average variance extraction values of 0.597, indicating sufficient convergent and discriminant validity. Besides, the Cronbach's alpha value was 0.964, demonstrating excellent internal consistency of the ESE-C scale.

CONCLUSION

The ESE-C scale is a valid instrument for assessing exercise self-efficacy among children and adolescents in mainland China.

The reliability and validity of the Temptations to Try Smoking Scale in a group of Chinese adolescents

OBJECTIVE

To provide a scientifc tool, the Temptations to Try Smoking Scale (TTSS) is introduced to evaluate its reliability and validity in preventing and intervening Chinese adolescents from smoking temptations.

METHODS

A questionnaire, including the TTSS, the Chinese version of the Decisional Balance Scale (CDBS), the Adolescent Smoking Curiosity Scale (ASCOS), and the Sensation-Seeking Scale (SSS), is used to test 1195 Chinese adolescent volunteers (214 of them are retested after 1 month). If all six items in the TTSS are retained, the exploratory factor analysis (EFA) reveals that the TTSS exhibits a structure of two factors: positive social and curiosity/stress.

RESULTS

The confrmatory factor analysis (CFA) shows that the two-factor model of the TTSS has the ftting indices χ2/df = 2.35, RMSEA = 0.06, and CFI = 0.99, which are better than those of its single-factor model. The total scores of the TTSS, positive social, and curiosity/stress are positively correlated with the scores of Pros, ASCOS, TAS, and Dis of SSS but negatively correlated with the Cons, hereby exhibiting good criterion-related validity. The internal consistency coefcient of the TTSS is 0.89, and the retest reliability is 0.90.

CONCLUSION

Therefore, the TTSS has good reliability and validity for Chinese adolescents and can be used as an efective tool to evaluate adolescents' smoking temptations in China.

Validation and results of a novel survey assessing decisional balance for a whole food plant-based diet among US adults

Importance

Consuming a whole food plant-based diet (WFPBD) is a promising, low-risk strategy for reducing risk of prevalent chronic disease and certain cancers, with synergistic benefits for climate and environment. However, few US adults report consuming a WFPBD. Understanding the reasons for this inconsistency is important for developing and implementing interventions for promoting a WFPBD. However, no research to elucidate decisional balance driving current consumption patterns in the US exists.

Objective

This research aims to validate an online survey to assess decisional balance for the consumption of a WFPBD, describe attitudes and beliefs toward adopting a WFPBD, and evaluate socio-demographic differences in decisional balance for consuming a WFPBD among a convenience sample of US adults.

Design

Online cross-sectional data collection followed by confirmatory factor analysis (CFA), validation of internal consistency, and examination of invariance across socio-demographic variables. Sensitivity analysis of full vs. truncated survey to predict self-reported dietary patterns and consumption behaviors were evaluated. Results of the survey and significant differences by socio-demographics were assessed.

Setting

Online survey based on previous research, created via Qualtrics, and administered through MTurk.

Participants

A total of 412 US adults, majority female (66%), White (75%), 30-60 years old (54%), ≥ Bachelor's degree (85%), and earning ≥ $45K (68%).

Main outcomes and measures

Factor loadings, covariance of survey items, associations with self-reported dietary pattern and consumption measures, and differences in pros, cons, and decisional balance across socio-demographic variables.

Results

CFA reduced the survey from 49 to 12 items and demonstrated invariance across socio-demographic variables. Pros and cons varied inversely and significantly (cov = -0.59), as expected. Cronbach's α 's for subscales in the final, reduced model were high (>0.80). Pros, cons, and decisional balance in both the full and the reduced model were significantly (p < 0.05) associated with self-reported dietary pattern and consumption.

Conclusion and relevance

Our analyses indicate the WFPBD Survey is a parsimonious and psychometrically sound instrument for evaluation of decisional balance to consume a WFPBD diet among our sample of US adults. These results may be instrumental for development and deployment of interventions intended to promote consumption of a WFPBD in the US.

Characterizing tobacco and marijuana use among youth combustible tobacco users experiencing homelessness - considering product type, brand, flavor, frequency, and higher-risk use patterns and predictors

BACKGROUND

Cigarette smoking is three times more prevalent among youth experiencing homelessness compared with the general population. Co-use of tobacco and marijuana is also common. The aim of this study is to characterize tobacco and marijuana use among youth experiencing homelessness who use combustible tobacco in a Midwestern city to inform smoking cessation intervention.

METHODS

This study included 96 youth (ages 14-24 years; 52% male, 39% female, 5% transgender/non-binary) attending a homeless drop-in center who had used at least one combustible tobacco product in the past week. We assessed past-month use of tobacco products and marijuana, other product use characteristics (e.g., frequency, brand and flavor), and psychosocial predictors of more frequent (i.e., daily) use of combustible tobacco and marijuana.

RESULTS

Most youth experiencing homelessness with past-week combustible tobacco use had used cigarettes (n = 85, 88.5%), cigars (n = 89, 92.7%), and marijuana (n = 82, 85.4%) in the past month. One-third (n = 34) used electronic vapor products (EVPs), 19.8% (n = 19) smoked hookah, and 11.5% (n = 11) used smokeless tobacco (ST). Most marijuana users co-administered with tobacco (n = 67, 69.8%). Daily combustible tobacco smoking was associated with having a child and smoking out of boredom/habit. Daily marijuana use was associated with using substances to cope with one's housing situation. Newport (n = 66, 72.5%) and Black & Mild (n = 48, 51.1%) were the most popular brands of cigarettes and cigars among ever users. Most non-combustible tobacco ever users reported not having a usual brand (EVPs: n = 51, 73.9%; ST: n = 16, 57.1%). Cigar smokers reported the most varied selection of flavors.

CONCLUSIONS

Young combustible tobacco users experiencing homelessness engage in high-risk use patterns, including poly-tobacco use, co-use of tobacco with marijuana, and frequent combustible product use. Interventions that consider the full context of tobacco and marijuana use are needed to support smoking cessation in this population.

Applying the Transtheoretical Model to Stuttering Management Among Adolescents: Part I. Scale Development

Purpose This article is the first in a two-part series on the application of the Transtheoretical Model to stuttering management among adolescents. In this article, we describe the process of developing measures to assess stage of change (SOC) by defining behaviors of stuttering management, as well as the two primary cognitive constructs that underlie one's readiness to make behavioral change: decisional balance (DB) and situational self-efficacy (SSE). This work hinges on the ability to develop an operational definition of what it means to successfully manage or do something positive about one's stuttering. Method We used an iterative process to develop the three scales. Through qualitative analysis of key informant interview and focus group transcripts with 24 adolescents who stutter and 26 clinicians specializing in stuttering, we developed stuttering-specific SOC, DB, and SSE scales. The drafted scales were cognitively tested with nine adolescents who stutter. Results Thematic analysis yielded a three-part definition of successful stuttering management that formed the basis for the SOC scale: (a) learning and using strategies to modify speech or stuttering, (b) changing negative thoughts and attitudes regarding stuttering, and (c) talking without avoiding sounds, words, or situations. Results from this analysis support a broader view of successful stuttering management; that is, it is likely that doing so requires more than just behavior change, which has long been considered the main objective of stuttering treatment. Additional analyses yielded pros and cons of managing stuttering (62 items for the DB scale) and situations in which it is difficult to manage stuttering (39 items for the SSE scale). Conclusions Qualitative analyses provided a three-part definition of "stuttering management" and a comprehensive pool of items that would allow measurement of DB and SSE that underlie readiness to manage stuttering among adolescents. In the companion article in this two-part series, we describe the next step in scale development: exploratory scale validation of the drafted SOC, DB, and SSE scales.

Tobacco Use Status and Temptation to Try E-Cigarettes among a Sample of Appalachian Youth

E-cigarettes are commonly used tobacco products among youth populations, including Appalachian youth. However, knowledge of the extent to which tobacco use status relates to temptation to try e-cigarettes is limited. Data from the Youth Appalachian Tobacco Study (n = 1047) were used. Temptation to try e-cigarettes was derived from a 12-item situational inventory. Tobacco use status was defined as never, ever non-e-cigarette, and ever e-cigarette use. A factorial ANOVA was used to estimate the adjusted association between tobacco use status and the e-cigarette use temptation scale. Two-way interaction terms between tobacco use status and gender, and tobacco use status and race/ethnicity, were plotted to depict effect modification. Approximately 10% of youth were ever non-e-cigarette users and 24% were ever e-cigarette users. Never and ever non-e-cigarette user middle schoolers had higher temptation to try e-cigarettes than their high school counterparts. The same relationship was found among never and ever e-cigarette users living in households with tobacco users. The ANOVA results suggest a positive, monotonic relationship between tobacco use status and temptation to try e-cigarettes, and that the adjusted group means differ by gender and race/ethnicity. The findings can inform tobacco prevention interventions for youth at higher risk for e-cigarette use, especially youth who have not yet tried e-cigarettes.

The Effect of Peer Education on Decision-Making, Smoking-Promoting Factors, Self-Efficacy, Addiction, and Behavior Change in the Process of Quitting Smoking of Young People

Purpose

The study aims to examine the effect of peer education on the decision to quit smoking, factors that encourage smoking, self-efficacy, addiction, and behavior change in students who apply to the Youth Friendly Center to quit smoking.

Participants and Methods

This research is a Randomized Controlled Trials study. The experimental group consisted of students who were enrolled in the peer education course (n=759). The control group has consisted of students (n=1095) who did not enroll in this course.

Results

Participants in the experimental group to quit smoking, more than the control group (p>0,01). The addiction level of the participants in the experimental group, less than the participants in the control group (p>0,01). According to the scores of the participants in the control group of the participants in the experimental group, the factors that trigger smoking, and the benefit sub-dimension scores in the Decision Balance Scale were low. Loss sub-dimension scores, which show the losses from the harms of smoking, increased significantly in the Self-Efficacy Scale, Behavior Change Process Scale, and Decision Balance Scale (p>0,01).

Conclusion

Peer educators trained by the researcher and her team in the Youth Friendly Center Smoking Quit Program have an important effect in supporting/improving the cognitive and behavioral change processes of university students in smoking quit compared to those who do not receive an education. 94% success of the smoking quit program; Students’ voluntary application to receive professional support, students’ voluntary attendance of the treatment program for 6 months, strong communication and feedback, effective and functional professional counseling, and social support depend on strengthening the program with peer education. Especially with peer education, the development of leadership and role model characteristics made the smoking quit program preferred by students.

Factor Structure of the Smoking Temptation Scale: Cross-Validation in Iranian Men

Background

The transtheoretical model (TTM) is used as a framework to implement smoking cessation programs. This model has some subscales based on which the smoking temptation scale is proposed as stages movement factor. This study aimed to translate and validate the temptation subscales of the TTM questionnaire in the Iranian population.

Methods

This cross-sectional study was conducted on 387 smokers. The participants were selected using convenience sampling method. First, the smoking temptation scale designed by Velicer et al. was translated into Persian, and then, factorial validity of the hierarchical three-factor structure for this subscale was studied using factor analysis and measurement invariance (MI) methods. All analyses were performed using Mplus software.

Findings

It was observed that the hierarchical three-factor structure model had a good fit to the data [confirmatory fit index (CFI) = 0.944, Tucker-Lewis index (TLI) = 0.915, Root Mean Square Error of Approximation (RMSEA) = 0.067, standardized root mean square residual (SRMR) = 0.042]. This study showed that this factorial structure had an identical measurement and structural model in subgroups of the population such as rural and urban residence, highly educated and low educated, high income and low income, three stages of quitting, and across the three ethnicities.

Conclusion

Given the validity and reliability of the hierarchical three-factor structure for smoking temptation scale, this measure can be used in interventional programs for smoking cessation in the Iranian male population.

Prevalences of Stages of Change for Smoking Cessation in Adolescents and Associated Factors: Systematic Review and Meta-Analysis

PURPOSE

To synthesize evidence on the prevalences of stages of change (Transtheoretical Model) for smoking cessation in adolescents and associated factors.

METHODS

A systematic search of Web of Science (Thomson Reuters), SCOPUS (Elsevier), MEDLINE/PubMed, CINAHL (EBSCO) and PsycINFO (APA) was conducted to identify eligible studies. Two calibrated reviewers selected studies independently, extracted data, and appraised studies. A qualitative synthesis of the findings and meta-analysis of the prevalences of the stages of change for smoking cessation were carried out. A quality effects model was used to estimate the pooled prevalences.

RESULTS

Eleven studies (N = 6469 adolescents) from five middle- to high-income countries were included in the review. Precontemplators accounted for 41% of smokers in earlier stages of change (95%CI: 34%-49%). In such a group, a lowered decisional balance, the lowest self-efficacy, and highest nicotine dependence were found (p < .05).

CONCLUSIONS

A higher overall prevalence of adolescents in precontemplation stage for smoking cessation was observed. Such group displayed more unfavorable smoking-related behaviors and characteristics than adolescents in other stages. The evidence is limited due to the lack of studies in adolescents living in low-income countries.

Utilization of the Transtheoretical Model to Determine the Qualitative Impact of a Tribal FASD Prevention Program

Alcohol consumption during pregnancy can lead to damaging effects on an infant's health, including fetal alcohol spectrum disorders. Project Changing High-risk alcOhol use and Increasing Contraception Effectiveness Study (CHOICES), a program developed to reduce alcohol-exposed pregnancies through decreased alcohol consumption and increased birth control use, has been implemented with success in a variety of populations. The CHOICES program was structured to align with the transtheoretical model (Stages of Change), a popular public health model. Although studies have described the Stages of Change in the context of a variety of health behaviors, none have addressed the qualitatively distinct characteristics of each stage in the context of American Indian (AI) women's alcohol and birth control use. A framework analysis of 203 participants' written responses during their experience in the Oglala Sioux Tribe (OST) CHOICES Program was conducted. As a conceptual framework, the transtheoretical model of behavior change was applied to the participants' experiences, with two staff reading the open-ended responses and coding based on the stage of change. Participants' responses suggest qualitatively distinct stages as well as a progression through the stages for both behaviors during the course of the program. Many participants mentioned their children, education, and work as inspiration to decrease their unhealthy behaviors. Common barriers to behavior change were found across both behaviors. The open-ended responses uncover common themes in the experiences of the participants. These results can help inform future programs which hope to address the needs of AI communities.

Development and initial testing of the brief adolescent smoking curiosity scale (ASCOS)

BACKGROUND

Although the reasons behind tobacco smoking at young age are complex, research has identified curiosity as a potent driver of smoking among adolescents.

OBJECTIVE

The objective of the current study is to develop and provide initial evidence of reliability and validity of a short scale assessing smoking curiosity among adolescents (first measure of its kind). In particular, we developed and tested the adolescent smoking curiosity scale (ASCOS).

METHODS

After scale development, 101 adolescents completed a survey on smoking-related measures, including ASCOS (June to August 2014). We conducted exploratory factor analysis and Cronbach's alpha calculation to inspect factor-structure and reliability. We conducted multiple linear regression models to examine the scale's capacity to predict antecedents of smoking initiation.

RESULTS

Factor analysis supported a single-factor structure of smoking curiosity. ASCOS was internally reliable (Cronbach's alpha=0.83). Controlling for demographics, the measure correlated significantly with temptation to try smoking (β=0.41, p<0.01), number of friends who smoke (β=0.27, p<0.01), agreeing with the pros of smoking (β=0.41, p<0.001), sensation seeking (β=0.21, p<0.05), and depression (β=0.23, p<0.01). When controlling for a single-item measure for smoking curiosity, ASCOS significantly predicted susceptibility to smoke cigarettes (OR=3.40, p<0.05) and cigars (OR=6.66, p<0.01).

CONCLUSIONS

ASCOS presented good psychometric properties and passed initial validity-testing through associations with antecedents of smoking. ASCOS was a better predictor of susceptibility to smoke than did a traditional single-item measure used by previous research. As an implication, ASCOS can be crucial to the development of tailored interventions for smoking prevention that can reduce smoking curiosity.

The Short-term Effects of ASPIRA: A Web-based, Multimedia Smoking Prevention Program for Adolescents in Romania: A Cluster Randomized Trial

INTRODUCTION

Although web-based, multimedia smoking prevention programs have been tested in several high-income countries, their efficacy in Central and Eastern Europe is unknown. The aim of this trial was to assess the short-term effects of ASPIRA, among Romanian and Hungarian speaking ninth graders in Tirgu Mures, Romania. ASPIRA is the Romanian acronym for the translated and adapted version of ASPIRE, "A Smoking Prevention Interactive Experience," an evidence-based smoking prevention program originally developed to prevent tobacco use among high school students in the United States.

METHODS

Sixteen high schools in Tirgu Mures, Romania were randomized to receive five weekly sessions of the ASPIRA web-based, multimedia program or to a control condition. Socio-demographic data, psychosocial characteristics, and smoking behavior were collected from students at baseline and at 6 months. A hierarchical logistic regression analysis was conducted to test the efficacy of the intervention on smoking initiation and current smoking among 1369 students.

RESULTS

Never-smoker students in the intervention arm were 35% less likely to report smoking initiation 6 months after the baseline assessment (OR = 0.65, 95%CI: 0.44-0.97). Reduced smoking initiation was observed most notably among students who were exposed to at least 75% of the ASPIRA program. There was no statistically significant effect of the intervention on current tobacco use (OR = 0.80, 95%CI: 0.44-1.46).

CONCLUSIONS

ASPIRA, an adapted version of the evidence-based, multimedia ASPIRE program that was originally developed and tested in the United States may decrease smoking initiation among multi-ethnic adolescents in Central and Eastern Europe.

IMPLICATIONS

(1). Web-based, multimedia smoking prevention programs may be effective tools to prevent smoking initiation among multi-ethnic adolescent communities in Central and Eastern Europe. (2). The degree of exposure is critical, only high exposure to the multimedia smoking prevention program is associated with reduced smoking initiation.

Assessing demographic differences in decisional balance for smoking prevention and temptations to try smoking among adolescent subgroups

INTRODUCTION

Cigarette smoking initiation remains prevalent in adolescence. Effective prevention methods are needed to dissuade this behavior. Demographic factors are identified as important risk factors in the developmental nature of smoking in adolescence. The current study investigates potential demographic differences for two new trans-theoretical model measures, the Decisional Balance Inventory (pros and cons) for Smoking Prevention and the Temptations to Try Smoking Scale.

METHODS

A sample of 6th grade Rhode Island students from 20 middle schools (N = 4151) who were participating in a longitudinal and computer-delivered intervention for substance abuse prevention was assessed on these measures at baseline. Three MANOVA tests were conducted to assess the impact of race (White vs. Non-White), ethnicity (Hispanic vs. Non-Hispanic) and gender (male vs female).

RESULTS

Significant effects for race and ethnicity were found for Decisional Balance and Temptations to Try Smoking. For race, Whites reported lesser pros (p <.0001) and Non-Whites reported higher cons (p <.0001) and temptations to try smoking (p <.0001). Differences for ethnicity showed that Hispanics were higher on pros (p <.0001) and temptations to try smoking (p <.0001) than Non-Hispanics. Non-Hispanics reported higher cons (p <.0001). Gender differences were noted only for temptations to try smoking, and showed females were higher on this construct than males (p <.0001). The effect sizes were .01 or below.

CONCLUSIONS

The results did not demonstrate a strong association between these demographics and constructs, suggesting that tailored prevention methods based solely on these factors may not dissuade smoking in this group.

What is the impact of e-cigarette adverts on children's perceptions of tobacco smoking? An experimental study

OBJECTIVE

Exposure to e-cigarette adverts increases children's positive attitudes towards using them. Given the similarity in appearance between e-cigarettes and tobacco cigarettes, we examined whether exposure to e-cigarette adverts has a cross-product impact on perceptions and attitudes towards smoking tobacco cigarettes.

METHODS

Children aged 11-16 (n=564) were interviewed in their homes and randomised to one of three groups: two groups saw different sets of 10 images of e-cigarette adverts and one group saw no adverts. Of the 20 e-cigarette adverts, 10 depicted the product as glamorous and 10 depicted it as healthy. The children then self-completed a questionnaire assessing perceived appeal, harms and benefits of smoking tobacco cigarettes.

RESULTS

The analyses were conducted on 411 children who reported never having smoked tobacco cigarettes or used e-cigarettes. Exposure to the adverts had no impact on the appeal or perceived benefits of smoking tobacco cigarettes. While the perceived harm of smoking more than 10 cigarettes per day was similar across groups, those exposed to either set of adverts perceived the harms of smoking one or two tobacco cigarettes occasionally to be lower than those in the control group.

CONCLUSIONS

This study provides the first evidence that exposure to e-cigarette adverts might influence children's perceptions of smoking tobacco cigarettes, reducing their perceived harm of occasional smoking. These results suggest the potential for e-cigarette adverts to undermine tobacco control efforts by reducing a potential barrier (ie, beliefs about harm) to occasional smoking.

Determinants of Forward Stage Transition from Precontemplation and Contemplation for Fruit Consumption

Purpose.

To examine associations between decisional balance, self-efficacy, fruit intake, and stage of change transition from precontemplation and contemplation with cross-sectional and longitudinal methods.

Design.

A longitudinal cohort study with the use of electronic questionnaires was conducted. Three measurements were analyzed cross-sectionally, and the two intervals between the measurements were analyzed longitudinally.

Setting.

A random sample of 1500 individuals from an existing Dutch Internet panel resulted in a cohort of 735 individuals. Of the cohort, 648 (response rate 88%), 592 (response rate 81%), and 570 (response rate 78%) respondents completed questionnaires at the start of the present study (T1), 53 days after T1 (T2), and 106 days after T1 (T3), respectively.

Subjects.

Mean age was 37.5 years, 51% were women, and 57% ate less than the recommended intake of 250 g of fruit per day.

Measures.

Questionnaires included items measuring stage of change, factors favoring (pros) or working against (cons) behavior change, and self-efficacy. A food frequency questionnaire was used to assess fruit intake.

Results.

Logistic regression analyses showed that pros, fruit intake, and self-efficacy predicted forward stage transition from precontemplation. Self-efficacy predicted forward stage transition from contemplation. Cons did not predict stage transitions. Results from longitudinal analyses were similar to cross-sectional results, except for self-efficacy: no differences between early stages in self-efficacy were found, whereas self-efficacy predicted these early stage transitions.

Conclusions.

Within the limitations posed by the sampling frame, results provided support for the Transtheoretical Model, although determinants might not always be stage specific.

Applying the Transtheoretical Model to Tobacco Cessation and Prevention: A Review of Literature

Objective.

To comprehensively review all published, peer-reviewed research on the Transtheoretical Model (TTM) and tobacco cessation and prevention by exploring the validity of its constructs, the evidence for use of interventions based on the TTM, the description of populations using TTM constructs, and the identification of areas for further research. The three research questions answered were: “How is the validity of the TTM as applied to tobacco supported by research?” “How does the TTM describe special populations regarding tobacco use?” “What is the nature of evidence supporting the use of stage-matched tobacco interventions?”

Data Source.

Computer Database search (PsychInfo, Medline, Current Contents, ERIC, CINAHL-Allied Health, and Pro-Quest Nursing) and manual journal search.

Inclusion/Exclusion Criteria.

All English, original, research articles on the TTM as it relates to tobacco use published in peer-reviewed journals prior to March 1, 2001, were included. Commentaries, editorials, and books were not included.

Data Extraction and Synthesis.

Articles were categorized as TTM construct validation, population descriptions using TTM constructs, or intervention evaluation using TTM constructs. Summary tables including study design, research rating, purpose, methods, findings, and implications were created. Articles were further divided into groups according to their purpose. Considering both the findings and research quality of each, the three research questions were addressed.

Results.

The 148 articles reviewed included 54 validation studies, 73 population studies, and 37 interventions (some articles fit two categories). Overall, the evidence in support of the TTM as applied to tobacco use was strong, with supportive studies being more numerous and of a better design than nonsupportive studies. Using established criteria, we rated the construct validity of the entire body of literature as good; however, notable concerns exist about the staging construct. A majority of stage-matched intervention studies provided positive results and were of a better quality than those not supportive of stage-matched interventions; thus, we rated the body of literature using stage-matched tobacco interventions as acceptable and the body of literature using non–stage-matched interventions as suggestive. Population studies indicated that TTM constructs are applicable to a wide variety of general and special populations both in and outside of the United States, although a few exceptions exist.

Conclusions.

Evidence for the validity of the TTM as it applies to tobacco use is strong and growing; however, it is not conclusive. Eight different staging mechanisms were identified, raising the question of which are most valid and reliable. Interventions tailored to a smoker's stage were successful more often than nontailored interventions in promoting forward stage movement. Stage distribution is well-documented for U.S. populations; however, more research is needed for non-U.S. populations, for special populations, and on other TTM constructs.

Exploring socio-contextual factors associated with male smoker's intention to quit smoking

Background

Programs to encourage smokers to quit smoking tobacco have been implemented worldwide and are generally viewed as an effective public health intervention program. However, few studies have examined the social factors that influence a smoker’s intention to quit smoking. This study investigated the socio-contextual factors that are associated with the intention to quit smoking among male smokers in South Korea.

Methods

Data were obtained from a 2014 nationally representative panel that examined the influences of mass media on the health of the Korean population. Members of this panel were recruited using a mixed-method sampling and a combination of random digit dial and address-based sampling designs. Survey questions were based on those used in previous studies that assessed the effects of social context, including mass media and social capital, on health. Multivariate logistic regression analyses of the answers of 313 male smokers were undertaken.

Results

Male smokers who participated in community-based activities were 2.45 times more likely to intend to quit smoking compared to male smokers in general (95 % confidence interval [CI]: 1.25–6.82). In addition, male smokers who participated in informal social gathering networks were 2.38 times more likely to intend to quit smoking compared to male smokers in general (95 % CI: 1.11–5.10). Moreover, male smokers with high smartphone use were 1.93 times more likely than smokers with low smartphone use to intend to quit smoking within one year (95 % CI: 1.07–3.46).

Conclusions

A supportive environment that enables male smokers to access beneficial health information and that encourages them to quit smoking is necessary for a stop-smoking program to be effective. The result of this study contribute to establishing a new smoking control policy by identifying socio-contextual factors related to the intention to quit smoking.

Use of electronic cigarettes and alternative tobacco products among Romanian adolescents

OBJECTIVES

To assess socio-demographic and smoking-related correlates of e-cigarette and alternative tobacco products (ATPs) use in a multi-ethnic group of adolescents in Tîrgu Mures, Romania.

METHODS

The cross-sectional study included 1835 high school students from Tirgu Mures, Romania. Socio-demographic variables and data about smoking and e-cigarettes and ATP use were collected using an online questionnaire. Chi-square tests or one-way ANOVA were applied to compare never smokers, non-current smokers, and current smokers. Multiple logistic regression was conducted to determine the correlates of e-cigarettes and ATP use.

RESULTS

The most frequently tried non-cigarette nicotine and tobacco products were e-cigarette (38.5 %), cigar (31.4 %) and waterpipe (21.1 %). Ever trying and current use of cigarettes were the most important correlates of e-cigarette and ATPs use. Sex, ethnicity, sensation seeking and perceived peer smoking were correlates of several ATPs use.

CONCLUSIONS

The results of this study may inform the development of tailored tobacco control programs.

With others or alone? Adolescent individual differences in the context of smoking lapses

OBJECTIVE

Although a great deal of adolescent smoking research has investigated predictors of initiation, much less has focused on predictors of lapsing during a quit attempt. In particular, the role of social context may deserve greater attention in models of adolescent smoking cessation. Therefore, the present investigation aimed to use ecological momentary assessment (EMA) to examine individual differences in social lapsing--the extent to which lapses occur around others versus when alone.

METHODS

Analyses focused on 179 adolescent smokers (aged 14-18 years) engaged in an unassisted quit attempt. There were 2 general EMA assessment intervals: prequit (1 week) and postquit (2 weeks). Participants reported every time that they smoked a cigarette and at random, nonsmoking times; in each assessment, participants responded to questions about their current environment, behaviors, and psychological state. A 3-month follow-up assessed longer-term smoking-related outcomes.

RESULTS

Consistent with other adolescent research, the overall rate of lapsing was very high (93%). Social lapsing rates were likewise high (among those who lapsed, 73% reported their first lapse was social), but they also varied continuously across individuals. We computed a social lapsing coefficient for each youth and found that it related to smoking factors at baseline (e.g., lower smoking intensity and dependence) and follow-up (e.g., lower cotinine levels).

CONCLUSIONS

These results suggest that higher rates of social lapsing are associated with being a lighter, less dependent smoker and having better eventual cessation prospects. Findings provide evidence that accounting for variability in social lapsing may improve theory and treatment.

Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females

Smoking and sexual risk behaviors in urban adolescent females are prevalent and problematic. Family planning clinics reach those who are at most risk. This randomized effectiveness trial evaluated a transtheoretical model (TTM)-tailored intervention to increase condom use and decrease smoking. At baseline, a total of 828 14- to 17-year-old females were recruited and randomized within four urban family planning clinics. Participants received TTM or standard care (SC) computerized feedback and stage-targeted or SC counseling at baseline, 3, 6 and 9 months. Blinded follow-up telephone surveys were conducted at 12 and 18 months. Analyses revealed significantly more consistent condom use in the TTM compared with the SC group at 6 and 12, but not at 18 months. In baseline consistent condom users (40%), significantly less relapse was found in the TTM compared with the SC group at 6 and 12, but not at 18 months. No significant effects for smoking prevention or cessation were found, although cessation rates matched those found previously. This TTM-tailored intervention demonstrated effectiveness for increasing consistent condom use at 6 and 12 months, but not at 18 months, in urban adolescent females. This intervention, if replicated, could be disseminated to promote consistent condom use and additional health behaviors in youth at risk.

[Effect of school-based peer leader centered smoking prevention program]

PURPOSE

The purpose of this study was to develop and evaluate a school-based peer leader centered smoking prevention program.

METHODS

Non-equivalent control group with a pre/post-test design was used. Students (n=174) in two boys' junior high schools located in D city, Korea participated with 85 being selected for the experimental group and 89 for the control group. Five sessions were given to the experimental group and a 50 minute lecture to the control group. Knowledge, attitude, non-smoking intention, and non-smoking efficacy were measured for the both experimental and control group at two weeks before the program and one month after the program was completed. Data were analyzed using χ²-test, Fisher's exact test, independent t-test and paired t-test with the SPSS 21.0 program.

RESULTS

The experimental group showed higher overall knowledge, negative attitude toward smoking, and higher non-smoking intention and efficacy. After receiving the school based peer leader centered smoking prevention program scores for attitude toward smoking and non-smoking efficacy increased in the experimental group were higher than in the control group.

CONCLUSION

The school-based peer leader centered smoking prevention program needs longitudinal evaluation, but from this study, there is an indication that this program can be used with junior high school students and effectively change students' attitude toward smoking and promote non-smoking efficacy.

Replicating cluster subtypes for the prevention of adolescent smoking and alcohol use

INTRODUCTION

Substance abuse interventions tailored to the individual level have produced effective outcomes for a wide variety of behaviors. One approach to enhancing tailoring involves using cluster analysis to identify prevention subtypes that represent different attitudes about substance use. This study applied this approach to better understand tailored interventions for smoking and alcohol prevention.

METHODS

Analyses were performed on a sample of sixth graders from 20 New England middle schools involved in a 36-month tailored intervention study. Most adolescents reported being in the Acquisition Precontemplation (aPC) stage at baseline: not smoking or not drinking and not planning to start in the next six months. For smoking (N=4059) and alcohol (N=3973), each sample was randomly split into five subsamples. Cluster analysis was performed within each subsample based on three variables: Pros and Cons (from Decisional Balance Scales), and Situational Temptations.

RESULTS

Across all subsamples for both smoking and alcohol, the following four clusters were identified: (1) Most Protected (MP; low Pros, high Cons, low Temptations); (2) Ambivalent (AM; high Pros, average Cons and Temptations); (3) Risk Denial (RD; average Pros, low Cons, average Temptations); and (4) High Risk (HR; high Pros, low Cons, and very high Temptations).

CONCLUSIONS

Finding the same four clusters within aPC for both smoking and alcohol, replicating the results across the five subsamples, and demonstrating hypothesized relations among the clusters with additional external validity analyses provide strong evidence of the robustness of these results. These clusters demonstrate evidence of validity and can provide a basis for tailoring interventions.

The effectiveness of an integrated multicomponent program for adolescent smoking cessation in Taiwan

If adolescents do not receive appropriate assistance in quitting smoking, they are highly likely to become regular smokers when they enter adulthood. Thus, an effective smoking-cessation program is required. A program was designed based on both the smoking-cessation barriers reported by students and effective strategies derived from the literature. We assigned 143 student smokers from 6 vocational high schools to intervention (n=78) and comparison groups (n=65). Data were collected at the baseline, the end of the program, and 1- and 4-month follow-up time points. For the intervention group, the smoking-abstinence rates confirmed using the urine cotinine test were 22.73% at the end of the program and 20.75% at the 4-month follow-up point. Days smoked in the past month, number of cigarettes smoked per day, and the Fagerström Test for Nicotine Dependence score of the intervention group decreased at all of the time points. The group differences in these variables were statistically significant; the magnitude of effect sizes ranged from 0.44 to 0.95. Multicomponent programs addressing smoking-cessation barriers that students encounter can help adolescents quit smoking.

Testing demographic differences for alcohol use initiation among adolescents for the decisional balance and situational temptation prevention inventories

Alcohol use by middle school-aged students is a public health concern because of the numerous adverse social, health and psychological outcomes. Prevention programs attempt to intervene before alcohol use begins. A tailored, computer-delivered program for the prevention of alcohol use and a series of new transtheoretical model measures were developed, including decisional balance (Pros and Cons) of alcohol use and Situational Temptations to Try Alcohol. This study investigated if there were any demographic differences on these measures in a sample of 6th grade middle school students from 20 schools (N=4151) at baseline. Three factorial analysis of variance tests were conducted to explore the impact of race (whites vs. non-whites), ethnicity (Hispanics vs. Non-Hispanics) and gender (males vs. females). A significant two-way interaction effect was found between gender and ethnicity for Pros of Alcohol Use. A significant three-way interaction effect was found between gender, race and ethnicity for Cons of Alcohol Use. Main effects were found for the three demographic factors for Situational Temptations to Try Alcohol. However, the effect sizes for the interaction effects and main effects were very small (all below η(2)=.01), suggesting that race/ethnicity and gender alone may not be highly influential factors in the Decisional Balance for the Prevention of Alcohol and Situational Temptations to Try Alcohol in adolescence. The implications for these results and alcohol use prevention among this group are discussed.

Effects of student perceptions of social skills on their perception of smoking

BACKGROUND

This study was conducted as a descriptive-correlational exercise with the aim of determining the effect of student perceptions of social skills on their pro and con perceptions of smoking.

MATERIALS AND METHODS

The study sample comprised 106 students at 6th, 7th and 8th grades in three primary schools. The data were collected through socio-demographic data collection form, Social Skill Perception Form and Child Decisional Balance Scale. Data were evaluated by percentage calculation, Student t test and correlation analysis.

RESULTS

While the point average of pro perception of smoking of the students with a high point average of social skill perception, was 8.6±3.1, in those with a low social skill perception point average it was 10.7±4.2, the difference being significant(p=0.012). The respective point averages of con perceptions were 26.8±3.7 and 23.5±3.3, again significant (p=0.000). While a positive medium level (r=0.410) relationship was determined between the point average of social skill perception and con perception of smoking, a negative low level (r=0.281) relationship was determined with the pro perception of smoking.

CONCLUSIONS

As the social skill perception point average increases, children's con perceptions of smoking increase and their pro perceptions decrease.

Effects of self-concept levels and perceived academic achievements of Turkish students on smoking perceptions

BACKGROUND

The objective of this study was to examine the effect of self-concept levels and perceived academic achievements of sixth, seventh and eighth grade primary school students upon their perceptions about smoking.

METHOD

The data were collected with the Socio-Demographic Data Collection Form, Pier-Herris Self-Concept scale and Children's Decision Balance Scale. The study sample consisted of 374 students receiving education in the sixth, seventh and eighth grades of three primary schools, which were selected among primary schools of Izmir Provincial Directorate for National Education representing three socio-economic groups with a simple random sampling method. The data were collected in December 2012-January 2013. Percentages and the t test were used in the evaluation of the data.

RESULTS

While students with a positive self-concept had score averages of 7.12±2.18 regarding the lower dimension of smoking pros and 29.0±2.47 regarding the lower dimension of smoking cons, their counterparts with a negative self-concept had score averages of 8.61±3.76 (p=0.000) and 28.1±3.49 (p=0.004), respectively. According to self-perception, there was statistical difference between perceptions of students regarding smoking (p<0.01). While students perceiving themselves successful had score averages of 7.81±3.13 and 28.5±3.19 regarding the lower dimension of smoking benefit and harm, students perceiving themselves unsuccessful had score averages of 8.27±3.39 (p=0.333) and 29.01±2.05 (p=0.235), with no difference determined.

CONCLUSION

Students with a positive self-perception had a low perception of smoking pros and a high perception of smoking cons. Perception of academic achievement did not affect the pros and cons perceptions of children regarding smoking.

The transtheoretical model (TTM) questionnaire for smoking cessation: psychometric properties of the Iranian version

BACKGROUND

The transtheoretical model (TTM) is a common framework for studies of smoking cessation. Using the TTM, several instruments were developed to measure to what extent interventions could make changes in people's behavior. The current study aimed to test the validity and reliability of the Persian version of a TTM based questionnaire for smoking cessation in Iran.

METHODS

This was a cross-sectional validation study among adult male smokers using the TTM Questionnaire. Backward-forward procedure was applied to translate the questionnaire from English into Persian (the Iranian language). The confirmatory factor analyses were performed to test validity. The internal consistency and stability of the questionnaire was examined using Cronbach's alpha coefficient and Intraclass Correlation Coefficient (ICC).

RESULTS

In all 150 male smokers were entered into the study. The mean age of participants was 36.51 ± 7.94 years. The results obtained from confirmatory factor analysis revealed that the data was fit to the model: the goodness of fit index (GFI) = 0.92; the comparative fit index (CFI) = 0.91; the root mean square error of approximation (RMSEA) = 0.065 (95% CI = 0.063-0.067), and the relative chi-square (x²/df) = 1.87, p < 0.001. The Cronbach's alpha ranged from 0.60 to 0.84 indicating an acceptable result. Also Intraclass Correlation of Coefficient (ICC) ranged from 0.61 to 0.83 corresponding to a satisfactory finding.

CONCLUSION

The current study provided psychometric evidence for an appropriate, reliable, and valid tool to determine smoking behaviors among Iranian adult smokers. Indeed the findings from this study could be applied in designing smoking cessation interventions in Iran.

Effects of perceived parental attitudes on children's views of smoking

BACKGROUND

The aim of this study was to examine the effects of perceived parental attitudes on children's discernment of cigarettes.

MATERIALS AND METHODS

The study sample consisted of 250 children attending grades 6, 7 and 8. Data were collected via a socio-demographic survey questionnaire, the Parental Attitude Scale (PAS) and the Decisional Balance Scale (DBS). Data analysis covered percentages, medians, one-way analysis of variance (ANOVA) and post-hoc tests using a statistical package.

RESULTS

There were 250 participants; 117 were male, 133 were female. The mean age was 13.1 ± 0.98 for the females and 13.3 ± 0.88 for the males. A statistically significant difference was found in the children's mean scores for 'pros' subscale on the Decisional Balance Scale (DBS) according to perceived parental attitudes (F=3.172, p=0.025). There were no statistically significant differences in the DBS 'cons' subscale scores by perceived parental attitudes.

CONCLUSIONS

It was determined that while perceived parental attitudes affect children's views on advantages of smoking, they have no effect on children's views on its disadvantages.

Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students

This study examined the effectiveness of two transtheoretical model-tailored, computer-delivered interventions designed to impact multiple substance use or energy balance behaviors in a middle school population recruited in schools. Twenty middle schools in Rhode Island including sixth grade students (N=4,158) were stratified and randomly assigned by school to either a substance use prevention (decreasing smoking and alcohol) or an energy balance (increasing physical activity, fruit and vegetable consumption, and limiting TV time) intervention group in 2007. Each intervention involved five in-class contacts over a 3-year period with assessments at 12, 24, and 36 months. Main outcomes were analyzed using random effects modeling. In the full energy balance group and in subsamples at risk and not at risk at baseline, strong effects were found for physical activity, healthy diet, and reducing TV time, for both categorical and continuous outcomes. Despite no direct treatment, the energy balance group also showed significantly lower smoking and alcohol use over time than the substance use prevention group. The energy balance intervention demonstrated strong effects across all behaviors over 3 years among middle school students. The substance use prevention intervention was less effective than the energy balance intervention in preventing both smoking and alcohol use over 3 years in middle school students. The lack of a true control group and unrepresented secular trends suggest the need for further study.

Motivation for change and barriers to treatment among young cannabis users

BACKGROUND/AIMS

Despite cannabis use among adolescents has shown to be related to psychosocial and mental health problems, the demand from adolescents for professional help is very low, and determinants of motivation for change among nonclinical populations remain unknown. The purpose of this study was to assess motivation for change among young cannabis users and to identify determinants of intention to change and self-change, as well as perceived barriers to seeking professional help.

METHODS

261 cannabis users aged 16-21 participated in a computerized survey in Spain.

RESULTS

Data from this cross-sectional study indicated that few users intend to stop taking the drug. Determining factors of intention to change were the following: having more drug-related problems, paranoid symptomatology and greater concern about the consequences of use. Self-change was facilitated by lower use of cannabis, and could be hindered by tobacco smoking and cannabis dependence. Lack of awareness of the problems and the desire to solve one's problems alone constitute the main barriers to seeking professional help.

CONCLUSIONS

Adolescent cannabis users show low motivation for change though experiencing more problems associated with its use emerges as a determinant of increased motivation. Several barriers impede this motivation from turning into treatment demand.

Factor structure of decisional balance and temptations scales for smoking: cross-validation in urban female African-American adolescents

BACKGROUND

The transtheoretical model is an influential theoretical model in health psychology, particularly in its application to smoking cessation research. Decisional Balance (DB) and Temptations are key constructs within this framework.

PURPOSE

This study examines the psychometric properties of the DB and Temptations scales for smoking in a predominantly African-American sample of urban adolescent girls.

METHODS

We used confirmatory factor analysis to compare the fit of previously published factor structures in smokers (n = 233) and nonsmokers (n = 598). External validity was tested by examining stages of change differences in the retained subscales.

RESULTS

Results supported the internal and external validity of the DB scale for smokers and nonsmokers. Notably, previously published three-factor (Social Pros, Coping Pros, Cons) and four-factor (Cons split into "Aesthetic Cons" and "Health Cons") models fit equally well, with Cons subscales correlating highly. For Temptations, a previously published three-factor (Negative Affect, Social, Weight Control) hierarchical model fit well in nonsmokers. In smokers, previously published subscales were reliably measured, but their structural relationship remained unclear. Stage difference tests showed medium to large effect sizes of DB and Temptation subscales in smokers and nonsmokers.

CONCLUSIONS

The use of DB was validated for both smokers and nonsmokers in this sample of primarily African-American adolescent females, where Cons can be combined or separated into "Aesthetic Cons" and "Health Cons" based on practical utility and preference. For Temptations, more research is needed but large stage differences in Temptations subscales underscore the importance of this concept in smoking acquisition and cessation.

[Factors affecting preparation stage to quit smoking in men]

PURPOSE

This study was done to investigate factors affecting preparation stage to quit smoking in men.

METHODS

Based on data from the Community Health Survey conducted in Chungbuk Province in 2008, we estimated rates and odds ratio (OR) of smoking cessation intention for 2,639 men who were current smokers. Multivariate logistic regression analyses were used to identify factors affecting preparation stage to quit smoking.

RESULTS

Among current male smokers, the rate of smoking cessation intention was 17.1%. The OR of factors affecting smoking cessation was as follows: Compared to men with middle school education, the OR for rate of smoking cessation intention in men with high school education was 1.47 (p=.018), and for college or higher, 1.55 (p=.017). Compared to being single, the OR for cohabitation after marriage was 1.61 (p=.011) and living alone after marriage, 2.23 (p=.005). The OR for attempt to quit smoking, exposure to secondhand smoke and participation in smoking education were 6.80 (p<.001), 1.32 (p=.020) and 1.69 (p=.005), respectively.

CONCLUSION

Results of this study show that it is necessary to decrease exposure to secondhand smoke and to increase participation in smoking cessation education targeting current smokers to move them from precontemplation or contemplation stage to preparation stage.

Development and validation of the Decisional Balance Scale for problematic Prescription Drug use (DBS-PD)-20

The purpose of this study was to develop a Decisional Balance Scale (DBS) for Prescription Drugs (PD), the DBS-PD-20, to examine its factorial structure and test its reliability and external validity by comparison across Stages of Change. A sample of 126 general hospital inpatients with either regular use of PD (more than 60 days within the last three months) or abuse of or dependence on PD was recruited in a northern German city. Exploratory principal components analysis revealed a two-factor structure, the Pros and Cons of PD intake, as expected. While the DBS-PD-20 showed good reliability (Cronbach's alpha=0.91 for the Pros and=0.89 for the Cons), external validity could be proven for the Cons (significant increase from precontemplation to contemplation/action), whereas the Pros showed an insignificant increase. Although further validation is needed, the DBS-PD-20 may be helpful for interventions and research.

[Effectiveness of a motivational interviewing smoking cessation program on cessation change in adolescents]

PURPOSE

This study examined the effectiveness of an Adolescent Motivational Interviewing Cessation program on smoking cessation change. The study was done with a nonequivalent control group pretest-posttest design.

METHODS

The participants were 39 high school students from G city, who were in school from September 1 to October 30, 2009. The students were assigned to the experimental group (20) and participated in the motivational interviewing cessation program or to the control group (19) who did not participate. Data analyses involved χ²-test, independent t-test, Repeated Measures ANOVA, and utilized the SPSS program.

RESULTS

The experimental group had significantly less daily smoking, nicotine dependence and smoking temptation in comparison to the control group. The experimental group had significantly higher stage of change in comparison to the control group.

CONCLUSION

The results of the study indicate that a motivational interviewing cessation program delivered to adolescents who smoke is an effective method of encouraging cessation, and can be utilized as an effective nursing intervention for adolescents who smoke.

Cluster subtypes appropriate for preventing postpartum smoking relapse

OBJECTIVE

While the majority of women quit smoking either before or during pregnancy, 60 to 80% relapse in the postpartum period. The objective of this research was to examine postpartum women who quit smoking during their pregnancies and to determine the predictive factors for relapse in the postpartum period by identifying different subgroups that predict risk of relapse.

METHOD

One hundred forty four postpartum women who were abstinent at the time of delivery were recruited. Data regarding the Acquisition Stage of Change, Decisional Balance and Situational Temptations to Smoke were assessed in the immediate postpartum period. Based on their intention to remain abstinent, 121 women identified in the acquisition-Precontemplation (aPC) group comprised the study sample. Smoking status was assessed again at 2 months postpartum.

RESULTS

A cluster analysis was performed to identify subgroups of the acquisition-Precontemplation (aPC) group. Four subgroups were identified and were labeled Most Protected, Ambivalent, Risk Denial, and High Risk. Logistic regression was performed to establish external validity of the clusters. The clusters and exclusive breastfeeding were the only statistically significant variables associated with relapse at 2 months postpartum.

CONCLUSIONS

The results confirmed the clusters identified in previous prevention research with both adolescents and postpartum women, The cluster profiles can serve to guide the development of a tailored intervention program.

Dissonance-Based Interventions for Substance Using Alternative High-School Youth

This article describes an innovative new intervention tailored to older youth who are already abusing drugs, but who are not diagnostically ready for treatment. The basic tenet of this intervention is to utilize adolescents engaged in drug use as "experts" in the prevention curriculum adaptation activity. This activity then serves as a mechanism for their dissonance-based change. This process is designed to intervene with drug abusing youth prior to their development of substance dependence. The community-based design grew from a United States federally funded NIDA project (National Institute of Drug Abuse Mentored Research Scientist Award) which found that the youth who conduct program adaptations were effectively engaged, animatedly discussing the payoffs and downsides of drug and alcohol abuse. It is maintained through this research that dissonance between their role of "Preventionist" and their own substance abuse behaviors lead to shifts in attitudes and behaviors. Dissonance-based interventions (DBIs) have been successfully utilized for positive behavioral change with a variety of disorders, but have not yet been implemented with substance abusing youth. Findings of pilot research are shared along with implications for future research and interventions.

How Distinct are the Stages of Change for Smoking Cessation? A Comparison of the Stages of Change and the Contemplation Ladder Using an Adolescent Sample

The stage of change approach to smoking cessation posits that smokers can be divided into categories based on the extent to which they are motivated to quit smoking. Recent research, however, suggests that the stage of change algorithm systematically misclassifies smokers by underestimating motivation to quit. The hypothesis of the current study was that the systematic misclassification by the stages of change results in stages that blend together smokers varying widely in motivation to quit. We tested this hypothesis by contrasting the stages of change with the contemplation ladder (an alternative measure of motivation to quit smoking) using cross-sectional data on ten cessation-relevant variables. The sample consisted of 401 adolescent smokers. The results were consistent with the hypothesis. The cross-sectional analyses indicated that the contemplation ladder is a more discriminating measure of motivation to quit, and that the stage of change algorithm is an unnecessarily imprecise instrument.

Situational temptation for HIV medication adherence in high-risk youth

Abstract This study explored the role of situational temptation, a component of self-efficacy, in adolescent and young adult (ages 16-24) HIV medication adherence by assessing participants' perceptions of their temptation to miss medications in various situations (e.g., when medication causes physical side effects, when there is fear of disclosure of HIV status). Youth (n = 186; 83% African American) were participants in a multisite clinical trial examining the efficacy of a motivational intervention. Data were collected using computer-assisted personal interviewing. Youth believed the most tempting reasons or situations that might lead them to miss their HIV medications to be symptoms (if the medicine caused you to have other physical symptoms) and sick (if the medicine made you sick to your stomach or made you throw up or if it tasted bad), but these were not significantly associated with nonadherence. This suggests disconnection between youths' expectations of temptation and actual tempting situations associated with nonadherence. Situational temptations associated with nonadherence included lack of social support, needing a break from medications, and not seeing a need for medications. Interventions to improve adherence should consider perceptions of HIV medications, particularly the benefits of taking medications and expectations of physical symptoms. Interventionists and clinicians should consider situations that may tempt youth to miss doses of medication and help youth gain insight into these temptations. Emerging methods, such as Ecological Momentary Assessment (e.g., daily diaries, cell phone text messaging), may be useful in gaining insight into the day-to-day experience of youth living with HIV.

Kidney patients' intention to receive a deceased donor transplant: development of stage of change, decisional balance and self-efficacy measures

In order to sustain life, patients whose kidneys fail must receive dialysis or obtain a transplant. This study reports on the development and validation of measures of Stage of Change, Decisional Balance and Self-efficacy based on the Transtheoretical Model (TTM) to assess patients' readiness to receive a deceased donor transplant. We surveyed 293 transplant-eligible kidney patients about their deceased donation readiness. Exploratory and confirmatory analyses for all measures demonstrated factor structures similar to previous application of the TTM to other health behaviors, excellent model fit and good internal and external validity. These brief, reliable instruments with good psychometric properties can guide the development of improved, individually-tailored transplant education for patients.

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

OBJECTIVES

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

SUBJECTS AND SETTING

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

RESULTS

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

CONCLUSION

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

Mediating variables in a transtheoretical model dietary intervention program

This study identified mediators of a Transtheoretical Model (TTM) intervention to increase fruit and vegetable consumption among economically disadvantaged African American adolescents (N = 549). Single-and multiple-mediator models were used to determine whether pros, cons, self-efficacy, and stages of change satisfied four conclusions necessary for establishing mediation of intervention effects on youths' dietary behavior. All four conclusions were satisfied for stages of change and pros in the single-mediator models and for stages in the multiple-mediator model. Stages mediated 31% of the intervention effect, and pros mediated 7% of the intervention effect in the single-mediator models. In the multiple-mediator model, stages accounted for 72% of the intervention effect. Findings add to the limited data on mediating variables in TTM dietary intervention programs. Replication studies are needed before it can be concluded that stages of change and pros are consistent mediators of TTM intervention program effects.

Do the Transtheoretical Model processes of change, decisional balance and temptation predict stage movement? Evidence from smoking cessation in adolescents

AIMS

To examine the effects of processes of change (POC) on forward stage movement directly, indirectly through decisional balance and temptation, and total effects as a test of the key hypothesis of the Transtheoretical Model (TTM).

DESIGN

Prospective cohort study.

SETTING

United Kingdom.

PARTICIPANTS

A total of 1160 adolescents aged 13-14 years who were current or former smokers at baseline.

MEASUREMENTS

Stage was assessed with the standard algorithm three times, once every 3 months. On each occasion the POC, decisional balance and temptation were measured with the standard questionnaires. Path analysis was used to examine the direct, indirectly mediated and total contribution of POC and the other constructs to stage movement 3 months later.

FINDINGS

Four of the 24 analyses showed evidence that the theoretically appropriate POC predicted stage transition, with statistically significant total effects. Effect sizes were small. When the POC were summarized to experiential and behavioural process means, one transition from pre-contemplation was predicted by experiential processes and, contrary to the TTM, one transition predicted by behavioural processes. There was slightly more evidence that decisional balance (attitudes towards smoking) and temptation (ability to resist the urge to smoke) was associated with stage transition.

CONCLUSIONS

POC use was not associated generally with stage transition and evidence that effects, if missed, must be modest, giving no support to the central tenet of the TTM.