Health locus of control and value for health in smokers and nonsmokers

The Use of E-Cigarettes among High School Students in Poland Is Associated with Health Locus of Control but Not with Health Literacy: A Cross-Sectional Study

Since their introduction, the use of electronic cigarettes has increased considerably in the population and among adolescents. Determinants of smoking conventional cigarettes were thoroughly studied in various social groups. However, we know less about the predictors of the use of e-cigarettes in younger generations. The main aim of this study was the assessment of the factors associated with the use of electronic cigarettes among high school students. Specifically, the roles of health literacy (HL) and health locus of control (HLC) were addressed. The analysis was based on the data from a 'pen-and-pencil' survey performed in a large sample of 2223 high school students from southern Poland. The tools used in the survey encompassed 133 items, including a 47-item European Health Literacy Survey questionnaire, an 18-item Multidimensional Health Locus of Control Scale, and a set of questions asking about the health behaviors, and sociodemographic and economic characteristics of respondents. In the study sample, 47.5% of the respondents had used e-cigarettes in the past, and 18.6% had used them in the last month. HL was not significantly associated with dependent variables reflecting the use of e-cigarettes. Two types of external HLC were associated with using e-cigarettes in the past, and 'Chance' HLC (CHLC) was also associated with their use in the last month. Males, students of schools providing vocational training, and students declaring more Internet use during the week showed a higher likelihood of ever using e-cigarettes or using them in the last month. Students smoking conventional cigarettes were also more prone to use e-cigarettes. To sum up, it was an unexpected result that HL is not associated with the use of e-cigarettes. A greater likelihood of using e-cigarettes was positively associated with higher CHLC scores, as in the case of smoking traditional cigarettes.

Factors Associated With Non-enrollment of Center-Based Cardiovascular Rehabilitation Program Among Transient Ischemic Attack or Mild Stroke Patients: A MIXED-METHOD RETROSPECTIVE STUDY

PURPOSE

Cardiovascular rehabilitation programs (CRPs) are effective in secondary stroke prevention, yet the enrollment rate is suboptimal. This study aims to identify demographic and clinical factors and patient-reported reasons for non-enrollment in a center-based outpatient CRP among patients with transient ischemic attack (TIA) or mild stroke.

METHODS

This mixed-method retrospective chart review was conducted in an outpatient CRP affiliated with a tertiary care hospital in Canada from January 2009 to October 2017. A total of 621 patients with TIA or mild stroke were included. Multiple logistic regression was used to determine the relationship between demographic and clinical predictors with non-enrollment. A thematic analysis of multidisciplinary progress notes was done for the non-enrollment subgroup of patients to understand the patient-reported reasons.

RESULTS

The non-enrollment rate was 42%. Travel distance to CRP (OR = 1.024; 95% CI, 1.010-1.038), age (OR = 1.023; 95% CI, 1.004-1.042), and current smoking status (OR = 1.935; 95% CI, 1.230-3.042) were associated with non-enrollment. The patient-reported reasons for non-enrollment were occurrence of new medical events and comorbidities, their perceptions of health and CRP, transportation, work/time conflict, and distance.

CONCLUSIONS

This study found that patients with TIA or mild stroke who were older, lived farther from the CRP center, or were current smokers were less likely to enroll in a CRP. The present findings may help clinicians identify patients unlikely to enroll in a CRP and allow the implementation of interventions focused on health education and physical activity to improve enrollment. Future research should validate these factors in multiple settings using prospective mixed methods so that interventions can be developed to address non-enrollment in the CRP.

Paradoxical Effects of Perceived Control on Survival

Objectives

Appraising health as controllable is typically thought to be adaptive, but recent evidence suggests the paradoxical possibility that perceived control (PC) can be detrimental. We considered the premise that high PC should have a survival benefit when it is part of an adaptive mindset involving high value (importance) for health, but it might be detrimental when it is part of a mindset comprised of low health value (HV). In addition, we examined whether the survival consequences of PC and HV vary with advancing age.

Method

Interviews were conducted with a heterogeneous sample of community-dwelling adults (n = 341; 72-99 years) to assess appraisals of control and value in the domain of health. Mortality data were obtained over 12 years from a provincial health registry.

Results

Both age and HV moderated the PC effect on mortality. The predicted beneficial and detrimental PC effects emerged at younger ages: higher PC predicted longer survival times when health was highly valued but shorter survival times when health was less highly valued.

Discussion

These findings deepen the knowledge regarding the conditions under which PC is or is not adaptive, suggesting the consequences depend on age and the extent to which health is valued.

Effectiveness of a complex intervention on smoking in adolescents: A cluster-randomized controlled trial

Tobacco smoking is a major preventable cause of death, and a significant public health problem worldwide. Most smokers begin in adolescence, age at which they are more susceptible to nicotine addiction. The prevalence of smoking in adolescence is considerable. Therefore, it would be convenient to incorporate smoking prevention programs in the school environment. It is necessary to provide evidence of its effectiveness. The primary objective of the study was to evaluate the effectiveness of a teacher-delivered school-based intervention on the initiation of smoking in adolescents (ITACA smoking prevention education program). A multi-center cluster randomized trial was designed. Twenty-two secondary schools from Spain were enrolled in 2 successive cohorts, from 2010 to 2011. The intervention consisted in the application of the ITACA smoking prevention education program. A 4-year cognitive-behavioral intervention that is based on the social-influences model and is integrated into schools' regular curricular activities. A total of 1055 students were surveyed before the intervention (age: 12-13 years-old), and at the third year of the intervention (age: 14-15 years-old) of a 4-year education program. The outcome measures were daily and weekly use of cigarettes, and initiation of smoking. There was no evidence that the intervention impacted the incidence of regular smoking (OR = 1.08; 95% CI: 0.50-2.33) or the initiation of smoking (OR = 1.09; 95% CI: 0.56-1.72). This trial provides evidence supporting the non-effectiveness of a complex educational smoking prevention program at 3 years after the intervention.

TRIAL REGISTRATION NUMBER

Current Controlled Trials: NCT01602796.

Momentary Associations Between Reported Craving and Valuing Health in Daily Smokers

Introduction

Research suggests that a blunted response to nondrug rewards, especially under conditions associated with strong cigarette cravings, is associated with reduced abstinence motivation in daily smokers. One limitation of previous studies is that they have largely focused on monetary rewards as broad representative of nondrug rewards. It remains unclear whether craving dampens responses to more abstract nondrug rewards, such as personal values. Personal values often have a positive valence and are frequently assumed to remain stable across time and situations. However, there may be time-varying and contextual influences on smokers' appraisal of values in daily life. Characterizing fluctuations in value importance in relation to relapse precipitants (eg, craving) may inform interventions that leverage personal values as motivation for cessation.

Methods

Daily smokers (n = 18) completed ecological momentary assessment surveys measuring the importance of specific personal values and smoking-related variables during 8 days of monetarily reinforced cigarette abstinence. We hypothesized that value ratings would demonstrate adequate within-person heterogeneity for multilevel modeling and that within-person fluctuations in craving would be negatively related to valuing personal health.

Results

All values demonstrated adequate within-person variability for multilevel modeling. Within-person craving was negatively related to health valuation (p = .012) and a cross-level interaction (p > .0001) suggested this effect is stronger for individuals who report greater overall craving.

Conclusions

Greater craving is associated with decreased importance of personal health in the moment, particularly for those with high average levels of craving. Timely interventions that bolster importance of health during moments of elevated craving can potentially improve cessation outcomes.

Implications

This study builds on research highlighting the positive influence of personal values in motivating behavior change. Values are an often used, but poorly studied, construct that has considerable utility in smoking cessation. Valuing personal health is frequently reported as a primary motivator for a quit attempt. Inasmuch as personal health is a distal nondrug reward used to motivate smoking abstinence, naturalistic evaluation of health importance, and motivators for continued smoking (ie, craving) could inform the timing and content of smoking treatment. This study is among the first to evaluate momentary assessment of personal values and craving within daily life.

Multidimensional Health Locus of Control: Comments on the Construct and its Measurement

In the present commentary, the theoretical construct of Multidimensional Health Locus of Control (MHLC) is described and evaluated in terms of its contributions to health psychology. This concept is compared to other control beliefs, in particular to perceived self-efficacy. It is argued that MHLC has supplied health psychology with essential insights and has offered a great deal of intellectual stimulation. Nevertheless, for some applications, different constructs might be more promising, in particular when it comes to predicting health behavior change. MHLC measurement, specifically its factorial structure, its proximity to health outcomes and health behaviors and its cultural sensitivity are addressed. Further refinement of the instrument is recommended, and the range of promising applications needs to be clearly defined.

The Paradoxical Role of Perceived Control in Late Life Health Behavior

Research has established the health benefits of psychological factors, including the way individuals appraise outcomes. Although many studies confirm that appraising outcomes as controllable is adaptive for health, a paradoxical possibility is largely ignored: Perceived control may be detrimental under some conditions. Our premise was that appraising health as controllable but at the same time ascribing little value to it might signal a dysfunctional psychological mindset that fosters a mistaken sense of invincibility. During face-to-face interviews with a representative sample of older adults (age range = 72–99), we identified individuals with such a potentially maladaptive “invincible” mindset (high perceived control and low health value) and compared them to their counterparts on several outcomes. The findings were consistent with our hypotheses. The invincibles denied future risks, they lacked the activating emotion of fear, and they visited their physicians less often over a subsequent five-year period. Moreover, in contrast to their counterparts, the invincibles did not appear strategic in their approach to seeking care: Even poor health did not prompt them to seek the counsel of a physician. The recognition that psychological appraisals are modifiable highlights the promise of remedial methods to alter maladaptive mindsets, potentially improving quality of life.

Identification of Barriers to Stroke Awareness and Risk Factor Management Unique to Hispanics

Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs). We performed a prospective study of stroke patients from an academic Stroke Center in Arizona and surveyed members of the general community. Questionnaires included: the Duke Social Support Index (DSSI), the Multidimensional Health Locus of Control (MHLC) Scale, a stroke barriers questionnaire, and a Stroke Awareness Test. Of 145 stroke patients surveyed (72 Hispanic; 73 NHW), Hispanics scored lower on the Stroke Awareness Test compared to NHWs (72.5% vs. 79.1%, p = 0.029). Hispanic stroke patients also reported greater barriers related to medical knowledge, medication adherence, and healthcare access (p < 0.05 for all). Hispanics scored higher on the "powerful others" sub-scale (11.3 vs. 10, p < 0.05) of the MHLC. Of 177 members of the general public surveyed, Hispanics had lower stroke awareness compared to NHWs and tended to have lower awareness than Hispanic stroke patients. These results suggest that Hispanic stroke patients perceive less control over their health, experience more healthcare barriers, and demonstrate lower rates of stroke literacy. Interventions for stroke prevention and education in Hispanics should address these racial/ethnic differences in stroke awareness and barriers to risk factor control.

Explaining selected health behaviors in a national sample of Taiwanese adults

Extant research provides little evidence about how health literacy, self-efficacy and health locus of control are related to each other in affecting health behaviors. The purposes of this study were to examine the associations among health literacy, self-efficacy and health locus of control and how the three factors are related to health behaviors using data from a national survey of Taiwanese adults. The analysis showed moderate correlations among health literacy, self-efficacy and locus of control, suggesting that they were independent, albeit correlated, factors. Moreover, we found in most cases that health literacy, self-efficacy and locus of control had independent associations with health behaviors. Of the three factors, self-efficacy had the most consistent and positive associations with health behaviors. Our findings suggest that efforts to promote and sustain health behaviors need to focus on improving individuals' emotional states and correcting their faulty self-beliefs and habits of thinking. Health education campaigns and enhancement of literacy skills alone may not achieve the desirable goal of behavioral change.

Health-related locus of control and health behaviour among university students in North Rhine Westphalia, Germany

Background

Health control beliefs were postulated to be associated with health behaviour. However, the results of studies assessing these associations suggest that they might not be universal. Among young adults associations have been reported, but the evidence is limited. The objective of this analysis was to re-examine these associations in a sample of university students in Germany.

Findings

Data from a multicentre cross-sectional study among university students in North Rhine-Westphalia, Germany was used (N=3,306). The Multidimensional Health Locus of Control Scale with three dimensions (one internal and two external) and six aspects of health behaviour (smoking habits, alcohol use, drug consumption, being over-/ or underweight, physical activity, and importance of healthy nutrition) were evaluated. Students with stronger internal locus of control paid more attention to healthy nutrition and displayed a higher level of physical activity. Individuals with a stronger belief in health professionals were less likely to use drugs and paid more attention to healthy nutrition. Furthermore, higher scores in the second external locus of control dimension (beliefs in luck or chance) were associated with a higher likelihood of current smoking, lower physical activity and less attention to healthy nutrition.

Conclusions

Students engaged more strongly in unhealthy behaviour if they believed that luck determines health. In contrast, believing in having control over one’s own health was associated with more healthy behaviour. These findings support the need to consider health control beliefs while designing preventive strategies in this specific population.

Public opinion about financial incentives for smoking cessation

OBJECTIVE

The aim of this study is to assess public support for a smoking cessation policy involving financial incentives.

METHODS

We conducted a randomized controlled trial using an experimental survey design. One of four questionnaire versions was distributed to participants. Each version described a smoking cessation treatment costing $750 per success, including an unspecified treatment, medication, or financial incentive paid to the smoker. Participants indicated whether they would support a $25 increase in their annual health insurance premium to pay for the treatment. Questionnaires were distributed to adults waiting at public transportation depots in Philadelphia between May and August 2010.

RESULTS

1010 individuals completed the questionnaires about willingness to support the policy: 53% female, 27% African-American, 18% current smokers, and 46% with a household income below $40,000. The response rate was greater than 50%. Overall support for all smoking cessation treatments was 41.6%. The financial incentive version received the lowest support (39.3%) but that support did not statistically differ from the treatment (45.8%, p=0.14) or medication (41.7%, p=0.58) versions.

CONCLUSIONS

Financial incentives were perceived no differently than currently used medications for smoking cessation. Most participants did not support any smoking cessation treatment options.

The management of blood safety in the presence of uncertain risk: a United kingdom perspective

Millions of patients in the UK benefit from the use of both plasma derivatives and blood components that are seen as critical interventions in current medicine. Measures are in place to significantly reduce the risks associated with blood transfusion and plasma derivatives; however, these measures themselves are not risk free. Over the past 20 years, advances in technology and regulation have seen major reductions in the risks associated with transfusion. International blood services, industry, and regulators strive to maintain safety levels through constant monitoring, assessment, and response to changing risk factors. Regulation of screening tests together with the development and introduction of nucleic acid technique tests for hepatitis B virus, hepatitis C virus, and human immunodeficiency virus has improved blood safety. However, other risks, including the changing epidemiology of transfusion-transmitted infections, bacterial contamination of platelets, incorrect blood component transfusion, and variant Creutzfeldt-Jakob disease, require further attention. Risks such as these are often complex, and there is a difficult balance to be struck between donors/recipients' benefit and adequacy of blood supply. The introduction of any new safety measure therefore requires robust, evidence-based evaluation of associated benefit, both clinical and economical. This review presents a UK perspective on how the safety of the blood supply is maintained in the face of uncertain risks.

Avoidance orientation moderates the effect of threatening messages

This study investigated the influence of individual differences in people's dispositional avoidance orientation on the persuasive effects of low- and high-threat messages promoting moderate drinking. First, participents (N = 99) individual differences in avoidance orientation were assessed, after which they were provided with either high- or low-threat messages about the consequences of drinking too much alcohol. The primary outcome measures were information acceptance, attitude and intention. Results showed that participants low in avoidance orientation were more likely to be persuaded by the low-threat message, whereas participants high in avoidance orientation were more likely to be persuaded by the high-threat message.

A comparison of tobacco-related risk factors between preadolescents with and without cancer

INTRODUCTION

To compare preadolescents with and without cancer on current smoking status, future intentions to smoke, and tobacco-related risk factors, as well as to explore the relationship between cancer status and tobacco-related variables with intentions.

PROCEDURE

Ninety-four preadolescents undergoing treatment for cancer and a matched comparison sample of 190 participants without cancer, ages 8 to 11 years, completed questionnaires about their smoking habits, intentions to smoke and tobacco-related psychosocial risk factors.

RESULTS

No preadolescents with cancer and only two preadolescents without cancer reported current smoking. Compared to healthy nonsmoking preadolescents, nonsmokers with cancer were approximately one-half as likely to report future intentions to smoke. Intention to smoke was better predicted by variables most proximal to smoking including older age, being male, not having cancer, having close friends who smoke, parental smoking, and lower perceived vulnerability for tobacco-related illnesses. In the model examining distal variables, preadolescents who were more rebellious, older, and without cancer were more likely to report future smoking intentions.

DISCUSSION/CONCLUSIONS

Although future intentions to smoke differed according to cancer status, the relationship between tobacco-related risk factors and future smoking intentions appeared to be similar among preadolescents with and without cancer.

IMPLICATIONS FOR CANCER SURVIVORS

Smoking prevention and tobacco-related health risk education should begin during the elementary years, a time prior to smoking initiation and the development of solidified smoking attitudes. The diagnosis and treatment of pediatric cancer may provide an excellent opportunity for health care providers to begin communicating anti-smoking messages and health risk counseling to their young patients and families.

Correlates of repeat and recent mammography for women ages 45 to 75 in the 2002 to 2003 Health Information National Trends Survey (HINTS 2003)

BACKGROUND

Most national-level mammography data are for ever-had and most-recent screening. There are few national-level data on rates of repeat, on-schedule mammography, and on the prevalence and correlates of repeat mammography. It is also important to investigate the similarity of correlates for repeat and recent mammography.

METHODS

Analyses were from data for women ages 45 to 75 in the 2002 to 2003 Health Information and National Trends Survey (HINTS 2003; N = 1,581). The two dependent variables were self-report of repeat mammography (two exams on schedule, based on an every-other-year interval) and recent mammography only (one mammogram within the past 2 years).

RESULTS

The prevalence of recent mammography was 81.6% (95% confidence interval, 79.1-84.1) and for repeat mammography was 72.2% (95% confidence interval, 69.0-75.4). An access to care variable combining insurance coverage and regular source of care was the strongest sociodemographic correlate of both mammography indicators. Most other sociodemographic variables were not associated with mammography status. Five psychosocial/behavioral variables were associated with both mammography indicators (smoking status, attention to health information, knowledge of screening interval, worry about breast cancer, and recent mood status). Correlates were very similar for repeat and recent mammography.

CONCLUSIONS

Although access to care had the strongest association with mammography, psychosocial and behavioral variables did better as a group than the sociodemographic variables. A standard set of such variables should be considered for all national surveys.

Elderly veterans' beliefs concerning life-sustaining treatment and the control of their end-of-life health and health care

OBJECTIVE

This study used qualitative methods to explore patients' beliefs about control of their end-of-life health and health care.

METHOD

The authors recruited 30 elderly patients from a large, urban Veterans Administration medical center in the United States and engaged them in semistructured interviews about end-of-life care concepts. Using grounded theory methods, they coded, categorized, and compared responses.

RESULTS

The authors discovered that patients' decisions about using life sustaining treatment were interconnected with their beliefs about their degree of control over circumstances and the role of external factors, including a higher power; institutions and individuals; medical interventions; medical conditions; and luck, chance, or fate.

DISCUSSION

The results shed light on why patients do or do not take active roles in advance decisions concerning the use of life-sustaining treatment.

Impact of computer-generated personalized goals on cholesterol lowering

OBJECTIVES

The National Cholesterol Education Program (NCEP) has enhanced public awareness of the importance of cholesterol in the development of heart disease, yet most patients with cardiovascular disease (CVD) do not know or achieve their low-density lipoprotein cholesterol (LDL-C) goals. This randomized, controlled trial was designed to evaluate the impact of a system that provides uniquely formatted laboratory results to patients with CVD on their changes in LDL-C levels.

METHODS

Eighty patients with CVD were randomized to receive standard care or the intervention inclusive of a computer-generated, 11''x17'' color poster depicting an individual's LDL-C status and goals along with personalized steps to aid in goal achievement. Cholesterol profiles were obtained at baseline and 6 months after enrollment. Physicians received standard laboratory reports and were blinded to the randomization.

RESULTS

There were no significant differences between patient groups in age, education level, race, baseline cholesterol levels, comorbidities, or percentage of patients in each group who met their NCEP goal at baseline. Patients receiving intervention tools had significant reductions in LDL-C from baseline compared with patients in the control group. Intervention patients who did not meet NCEP goals at baseline had the greatest reduction in LDL-C, with a mean change from baseline of -21.5 mg/dL (P<0.001) whereas standard care patients had no significant change in the LDL-C levels (-4.6 mg/dL, P=0.28). At study close, 73% of intervention patients reported that their posters remained displayed on their refrigerator.

CONCLUSION

This unique and personalized intervention resulted in the LDL-C lowering benefit among patients with CVD comparable to that of lipid lowering agents.

Smoking Status and Mammography Among Women Aged 50–75 in the 2002 Behavioral Risk Factor Surveillance System

BACKGROUND

Since the late 1980's, data show an association between smoking status and mammography. Women smokers reported 12-15% lower rates than non-smokers. This study investigated whether an association persists in a recent national-level database.

METHODS

The sample was women aged 50-75 years from the 2002 Behavioral Risk Factor Surveillance System (N = 52,300). Analyses used two definitions of recent mammography, one based on a one-year interval between exams, the other on a two-year interval. Smoking was classified as current, former, or never. Other covariates included sociodemographic variables, health practices, insurance status and usual source of care.

RESULTS

The rate of mammography for current smokers was 16% lower than for never smokers for the past-year interval, and 14.0% lower for the two-year interval. Multiple logistic regression supported the smoking/mammography association. Other covariates associated with lower mammography on both dependent variables were recent Pap test, health insurance/usual source of care, recent dental visit, seat belt use, marital status and age.

CONCLUSIONS

Reasons for the persistent association between smoking and mammography must be determined. These variables will inform interventions with women who smoke. A key question is whether to intervene on smoking directly or whether mediating variables are sufficient targets of intervention.

The impact of job strain on the predictive validity of the theory of planned behaviour: an investigation of exercise and healthy eating

OBJECTIVES

This study examined the impact of the job strain model on exercise and healthy eating within the framework of the Theory of Planned Behaviour.

DESIGN

Participants completed a questionnaire measuring the components of the Theory of Planned Behaviour and the job strain model. A follow-up questionnaire a week later measured behaviour.

METHOD

The questionnaires were completed by e-mail. The initial questionnaire was completed by 331 employees, and 286 follow-up questionnaires were returned.

RESULTS

Job demands affected exercise indirectly by lowering perceptions of behavioural control over exercise. However, variables from the job strain model were not related to exercise intentions or behaviour. In contrast, employees in passive jobs intended to eat more sweets and snack foods and employees in low strain jobs were more likely to realize their intentions to eat more sweets and snack foods. However, variables from the job strain model did not influence consumption of fruit and vegetables.

CONCLUSIONS

While people may consider the impact of job strain on exercise whilst making decisions about whether or not to exercise, job strain has a more direct impact on healthy eating. However, job strain may only affect consumption of so-called 'high density' foods, rather than foods such as fruit and vegetables.

Physical and psychosocial factors associated with health-promoting behaviors among elderly Chinese with type-2 diabetes

This study explored how physical and psychosocial factors influenced the practice of health-promoting behaviors among elderly Chinese patients with type-2 diabetes. Individual structured interviews were conducted with 191 elderly Chinese attending an outpatient clinic in Hong Kong. Results showed that demographic and illness characteristics were unrelated to health practices. Participants were more likely to engage in health-promoting behaviors when they were physically well, valued their health, were confident of practicing the behaviors and viewed their illness as controllable by both doctors and themselves. The above factors exerted their respective main effects, instead of interaction effects, in predicting health practices.

A Comparison of Tobacco-Related Risk Factors Between Adolescents With and Without Cancer

OBJECTIVE

To compare adolescents with and without cancer on current smoking status, intentions to smoke, and tobacco-related risk factors.

METHODS

Ninety adolescents undergoing treatment for cancer (median time since diagnosis was 2.4 months) and a comparison sample of 279 adolescents without cancer, ages 12 to 18 years, completed questionnaires that asked about their smoking habits, intentions to smoke, and tobacco-related psychosocial risk factors.

RESULTS

Approximately 2% of adolescents with cancer and 22% of adolescents without cancer reported current smoking. Compared to nonsmoking adolescents without cancer, nonsmoking adolescents with cancer were one third less likely to report intentions to smoke. No significant interactions were detected between group (having cancer or not) and each of the tobacco-specific and psychosocial variables tested in two separate multivariable models. Intentions to smoke were best predicted by variables most proximal to smoking. Adolescents who smoked in the past and who had lower tobacco knowledge and greater perceived instrumental value were more likely to report intentions to smoke. Adolescents who were less optimistic were also more likely to intend to smoke.

CONCLUSIONS

Tobacco-related risk factors for intentions to smoke appeared to be similar among adolescents with and without cancer. Implications of these findings for tobacco control among adolescents with cancer are discussed.

Locus de controle em uma população do nordeste brasileiro

Estabeleceu-se como objetivo principal desse trabalho realizar comparações inter e intragrupo com relação ao locus de controle em um setor da cultura nordestina (Paraíba) do Brasil e cotejar esses resultados com aqueles auferidos em uma cultura mexicana, mais especificamente do deserto de Sonora. Para tanto, definiu-se como objetivo específico analisar as propriedades psicométricas de um instrumento para avaliar locus de controle. Contou-se com uma amostra de 600 sujeitos divididos por quotas de idade e gênero, formando três grupos de idade (100 mulheres e 100 homens em cada um): 14-22; 23-35 e 36-70 anos. Foram realizadas estatísticas descritivas por cada item, teste T de Student para analisar o poder discriminativo de cada um, análises fatoriais, índices de consistência interna (correlação de Pearson). Utilizou-se a escala de locus de controle de Reyes (1995), validada com dados obtidos na população mexicana, composta de 78 itens, com sete opções de resposta apresentadas na forma tipo Likert pictórico. A análise fatorial indicou a presença de quatro fatores que conformam uma nova escala com 71 itens, que em seu conjunto explicam 36,2% da variância total, apresentando um alpha de 0,93. Os resultados permitem concluir pela validade da escala, cuja utilidade está assegurada para as situações em que foi avaliada.

Perceptions of risk factors for breast cancer and attitudes toward mammography among women who are current, ex- and non-smokers

Understanding risk perceptions for breast cancer among women smokers is important because smokers tend to underutilize breast cancer screening. Perceptions of the relative importance of a variety of factors which may increase breast cancer risk and the benefits/barriers of mammography, were examined among women who were current (n = 185), ex- (n = 632) and never (n = 623) smokers. Participants were a subset of women taking part in a project to increase mammography utilization among women aged 50 and over. Current smokers, but not ex-smokers, were significantly less likely than never smokers to agree that health risk behaviors most frequently seen in smokers (e.g., smoking cigarettes, high-fat diet, low intake of fruits and vegetables, physical inactivity, drinking alcohol) may increase risk for breast cancer. Current smokers, but not ex-smokers, perceived more barriers and fewer benefits of mammography, than never smokers.

Impact of computer-generated personalized goals on HbA(1c)

OBJECTIVE

The public is increasingly aware of the importance of HbA(1c) testing, yet the vast majority of patients with diabetes do not know their HbA(1c) status or goal. We set forth to evaluate the impact of a system that provides uniquely formatted and personalized reports of diabetes status and goals on changes in HbA(1c) levels.

RESEARCH DESIGN AND METHODS

A total of 150 patients with diabetes were randomized to receive either standard care or intervention inclusive of a computer-generated 11" x 17" color poster depicting an individual's HbA(1c) status and goals along with personalized steps to aid in goal achievement. All patients enrolled received diabetes education during the 3 months before enrollment. HbA(1c) was performed at baseline and 6 months.

RESULTS

At baseline, there were no significant differences between patient groups in terms of age, sex, education level, race, and HbA(1c) or lipid levels. Among patients with baseline HbA(1c) > or =7.0%, there was an 8.6% (0.77% absolute) reduction in HbA(1c) among control subjects compared with a 17.0% (1.69% absolute) decline in the intervention group (P = 0.032). There were no differences between the control and intervention groups with respect to the frequency of patients experiencing any decline in HbA(1c) (63 vs. 69%, P = 0.87); among these patients experiencing a decline, the most substantial reductions were seen with the control group, which had a 13.3% (1.15% absolute) decline compared with the intervention patients, who reduced their HbA(1c) by 24.2% (2.26% absolute reduction; P = 0.0048). At study close, 77% of the patients had their poster displayed on their refrigerator.

CONCLUSIONS

This unique and personalized computer-generated intervention resulted in HbA(1c) lowering comparable to that of hypoglycemic agents.

CHILDHOOD UNPREDICTABILITY, SCHEMAS FOR UNPREDICTABILITY, AND RISK TAKING

The present paper describes a conceptual model of possible antecedents, markers, and consequences of unpredictability schemas, and outlines empirical support for the model. Early experiences, especially those pertaining to one's family, are the basis for the development of an unpredictability schema. To date, an unpredictability schema has been measured indirectly with scales that tap a variety of interrelated beliefs. Measures of such beliefs show associations with risk taking. An unpredictability schema, thus, may be an overlooked factor in risk-taking behavior. The present model takes a multidisciplinary approach and makes two major contributions. First, it integrates psychological constructs that have not previously been linked. Second, it clarifies existing relationships among background characteristics and risk-related outcomes. Implications for prevention and intervention programming are discussed.

Protective role of health values in adolescents' future intentions to use condoms

PURPOSE

To examine the protective role of health values in adolescents' intentions to use condoms.

METHODS

Two hundred thirty-six sexually active adolescents who were attending a municipal sexually transmitted diseases clinic were interviewed, using standardized and constructed instruments, regarding their previous condom use, health values, condom attitudes, social norms regarding condoms, self-efficacy regarding condoms, and intentions to use condoms in the future. Correlations and hierarchical multiple regression analyses were conducted to examine the direct and indirect effects of health values on intentions to use condoms.

RESULTS

Health values were significantly correlated with intentions to use condoms with main and casual sexual partners, and accounted for a significant amount of variance in intentions to use condoms with casual sexual partners, after controlling for demographic variables, past condom use, and constructs from the Theory of Planned Behavior. Health values were also found to moderate the relationship between condom attitudes and intentions to use condoms with casual partners.

CONCLUSIONS

Efforts to include health values as a protective factor in health behavior theory and risk-reduction interventions are warranted.

Smoking status and psychosocial variables in type 1 diabetes mellitus

While depression, anxiety, and negative affect are associated with smoking and smoking cessation outcomes in healthy individuals, these associations have not been established in smokers with chronic diseases such as diabetes mellitus, a condition which greatly increases cardiovascular disease risk. Other psychosocial variables such as stress and locus of control may also be associated with smoking but are seldom reported. We examined stress, affect, and locus of control by smoking status in patients with type 1 diabetes mellitus. Results indicated that current smokers reported significantly higher levels of perceived stress, a more negative affect, and higher powerful others locus of control compared with nonsmokers. These findings indicate that those patients who have diabetes and who smoke are at greater risk for depressive symptoms. This knowledge may aid clinicians in their attempts to help these patients quit smoking.

Adolescents' use of tobacco, health locus of control, and self-monitoring

This study examined the association of the traits, health locus of control, and self-monitoring with adolescents' tobacco uptake. Participants were 112 rural adolescents (12 to 19 years old, M = 15.3). Of that sample, 33% used tobacco. Tobacco users were found to score lower on the dimension of Internality and higher on the dimension of Chance, as compared with nonusers of tobacco, indicating a more external Health Locus of Control. In addition, tobacco users were lower self-monitors than were nonusers. These results suggest that adolescents who use tobacco feel less in control of their lives in relation to nonusers, believe that chance plays a larger role in their health, and believe they may be unable to monitor and adapt their communication to achieve positive outcomes.

Locus of control for general health and STD acquisition among adolescent girls

PURPOSE

To examine adolescent girls' perception of control over general health and sexually transmitted disease (STD) acquisition.

METHODS

Adolescents participating in a longitudinal study were asked questions regarding their perception of their locus of control. These questions, adopted from a previous measure, focused on six loci: internal control, control by parents, partners, peers, and health care providers, and chance.

RESULTS

There were 128 girls (mean age, 17 years; range, 14.5 to 18.8); 82% were black and 18% white. Statistically significant associations were found between control of general health and STD acquisition for each locus of control subscale, with the exception of partner control. However, the girls reported significantly less control over STD acquisition than over general health for health care providers, parents, and by chance, and significantly more partner and internal control over STD acquisition than general health. The correlations between parental control over general health and over STD acquisition were inversely correlated with age. Partner control was positively related to current condom use, but internal control was not.

CONCLUSIONS

The degree of the locus of control was specific for STD acquisition. Girls who believe they should be able to control STD acquisition may not be using condoms. The view of partners as having control over STD acquisition may represent joint communication or coercion. However, in general these findings support the development of female-controlled methods for STD prevention, such as topical microbicides.