An explanatory model of variables influencing health promotion behaviors in smoking and nonsmoking college students

Self-efficacy in health among university students: the role of social support and place

OBJECTIVE

The aim of this study was to better understand the role of students' living arrangements (on campus, off campus, with and without their parents) on their health self-efficacy.

PARTICIPANTS

A sample of undergraduate students (n = 216) were recruited by using word of mouth and visiting classrooms in a small Atlantic Canadian university.

METHODS

Participants completed a self-report questionnaire measuring health and sleep self-efficacy. Analyses of variance and covariance were used to compare the living arrangements of the students.

RESULTS

Differences between living arrangements were found. Students living on campus had higher health self-efficacy, particularly on the psychological well-being subscale, followed by those living off campus with their parents. Students living off campus without their parents had the lowest scores.

CONCLUSION

This study demonstrated that health self-efficacy varies according to students' living situations, thus illustrating the importance of keeping students' living arrangements in mind when designing health and well-being interventions.

Tobacco Dependence Among French University Students: A Cluster Analytic Approach to Identifying Distinct Psychological Profiles of Smokers

This study investigates the combination of several psychological factors related to tobacco smoking to identify smokers’ psychological profiles among French university students. A cluster analysis was performed on smoking motives, psychosocial variables, and the smoker identity ( N = 909). Five profiles were identified and then compared regarding tobacco dependence and motivations to quit. “Normative” and “sociohedonist smokers” are characterized by two distinct social factors (normative influences and social motives) and moderate dependence. “Dependent identified smokers” have higher levels of dependence motives, smoker identity and tobacco dependence associated with low motivations to quit. “Inconsistent smokers” have weak smoker identity and weak smoking motives, a strong perceived control over resisting smoking, low dependence and motivations to quit. “Coping smokers” have strong sedative and addictive motives and exhibit moderate dependence and motivations to quit. This research encourages prevention programs to consider the diversity of student smokers with strategies adapted to their psychological profiles.

Risk Perception & Risk-Reduction Behavior Model for Blue-Collar Workers: Adapted From the Health Promotion Model

This study examined the health promotion model (HPM) as a framework for assessing perceptions and health-related behaviors related to cardiovascular disease (CVD) risk among blue-collar workers. This was done with the aim of providing time-sensitive educational and training materials for workers while on the job or functioning in their communities. The revised HPM was evaluated in the above context using specific criteria developed by Chinn and Kramer (2008) and scoping literature review. Specifically, we assessed the model based on five criteria such as its clarity, simplicity, generality, accessibility, and importance. The revised HPM showed strengths in both accessibility and generality. That is, it applied to all populations and chronic illnesses through clearly defined and specified major concepts. However, there were several weaknesses in areas of clarity and consistency; the model included three new concepts (i.e., activity-related affect, commitment to a plan of action, and immediate competing demands and preference) that actually decreased these elements. In this context, situational influences require adequately reflected external variables. Nevertheless, the revised HPM showed predictive power among this study's target population. The HPM was modified to address deficiencies in regard to the concept of risk perception. Work-related situational influences were also restructured based on individual and environmental characteristics. The modified framework can be used to clarify health-related behaviors among blue-collar workers.

The psychometric properties of the Italian adaptation of the Health Orientation Scale (HOS)

Background

A novel approach suggested that cognitive and dispositional features may explain in depth the health behaviors adoption and the adherence to prevention programs. The Health Orientation Scale (HOS) has been extensively used to map the adoption of health and unhealthy behaviors according to cognitive and dispositional features. Coherently, the main aim of the current research was to assess the factor structure of the Italian version of the HOS using exploratory and confirmatory factor analysis and testing the construct validity of the scale by assessing differences in health orientations between tobacco cigarette smokers and nonsmokers.

Method

The research protocol was organized in two studies. Study 1 evaluated the dimensionality of the HOS in a sample of Northern Italian healthy people. Three hundred and twenty-one participants were enrolled; they were 229 women (71.3%) and 92 men (28.7%). In Study 2, the factor structure and construct validity of the HOS Italian version was assessed trough confirmatory factor analysis using a tobacco cigarette smokers and nonsmokers population. Two hundred and nineteen participants were enrolled; they were 164 women (75.2%) and 55 men (24.8%).

Results

In Study 1, a seven factors solution was obtained explaining 60% of cumulative variance instead of 10 factors solution of the original version of the HOS. In Study 2, the factor structure of the Italian version of the HOS was confirmed and applied to the smokers and nonsmokers; nonsmokers reported higher values than smokers in Factor 1 (MHPP) [t (208) = − 2.739 p < .007] (CI 95–4.96% to −.809), Factor 2 (HES) [t (209) = − 3.387 p < .001] (CI 95–3.93% to -. 1.03), Factor 3 (HIC) [t(213) = − 2.468 p < .014] (CI 95–2.56% to −.28) and Factor 7 (HEX) [t(217) = − 3.451 p < .001] (CI 95%- 1.45 to .39).

Conclusions

Results of the Italian adaptation of HOS lead to a partial redistribution of items and confirmed 7 subscales to distinguish psycho-cognitive dispositional dimensions involved in health orientation styles.

Design and implementation of an empowerment model to prevent elder abuse: a randomized controlled trial

Background

Older adults are more vulnerable to health risks than younger people and may get exposed to various dangers, including elder abuse. This study aimed to design and implement an empowerment educational intervention to prevent elder abuse.

Methods

This parallel randomized controlled trial was conducted in 2014–2016 for 18 months on 464 older adults aged above 60 years who visited health houses of 22 municipalities in Tehran. Data were collected using standard questionnaires, including the Elder Abuse-Knowledge Questionnaire, Health-Promoting Behavior Questionnaire, Health-Promoting Lifestyle Profile II, Barriers to Healthy Lifestyle, Perceived Social Support, Perceived Self-Efficacy, Loneliness Scale, Geriatric Depression Scale, Multidimensional Health Locus of Control Scale, and the SCARED (stress, coping, argument, resources, events, and dependence) tool. The intervention was done in twenty 45- to 60-minute training sessions over 6 months. Data analysis were performed using χ² tests, multiple linear and logistic regression, and structural equation modeling (SEM).

Results

The frequency of knowledge of elder abuse, self-efficacy, social support and health promoting lifestyle before the intervention was similar in the two groups. However, the frequency of high knowledge of elder abuse (94.8% in the intervention group and 46.6% in the control group), high self-efficacy (82.8% and 7.8%, respectively), high social support (97.0% and 10.3%, respectively) and high health promoting lifestyle (97.0% and 10.3%, respectively) was significantly higher (P<0.001) and the frequency of elder abuse risk (28.0% and 49.6%, respectively) was significantly less in the intervention group after the intervention. SEM standardized beta (Sβ) showed that the intervention had the highest impact on increase social support (Sβ=0.80, β=48.64, SE=1.70, P<0.05), self-efficacy (Sβ=0.76, β=13.32, SE=0.52, P<0.05) and health promoting behaviors (Sβ=0.48, β=33.08, SE=2.26, P<0.05), respectively. The effect of the intervention on decrease of elder abuse risk was indirect and significant (Sβ=−0.406, β=−0.340, SE=0.03, P<0.05), and through social support, self-efficacy, and health promoting behaviors.

Conclusion

Educational interventions can be effective in preventing elder abuse.

The Effect of Clinic-Based Health Promotion Education on Perceived Health Status and Health Promotion Behaviors of Adolescent and Young Adult Cancer Survivors

More than 70% of children/adolescents diagnosed with cancer are long-term survivors. Little is known about the health perceptions and practices of this population, and limited previous studies have come exclusively from a risk reduction/health protection model rather than a health promotion model. This study was conducted to describe the perceived health status and health-promoting behaviors of adolescent/young adult cancer survivors. This study used Pender’s revised health promotion model; perceived health status and health-promoting behaviors were measured using the General Health Index (GHRI) and the Health Promoting Lifestyle Profile II (HPLP-II). The sample consisted of 60 cancer survivors 2 years after completion of cancer treatment and attending a survivorship clinic. Mean baseline scores for the GHRI (76.66; SD, 10.41) indicate perceived health status is positive and similar to normative (noncancer survivor) adolescent/young adult samples. Surprisingly, there was no correlation between scores on the GHRI and the HPLP-II in this sample (r = 0.03).

Perceptions of Lung Cancer and Smoking Among College Students in Jordan

A descriptive, cross-sectional design was adopted to identify college students’ knowledge and perceptions of lung cancer and smoking. A random sample of 400 students at the Jordan University of Science and Technology in northern Jordan was subjected to the Lung Cancer and Smoking Survey, which is based on the Health Belief Model. The results show that the prevalence of current smoking is 16.5% and that the prevalence of former smoking is 10.0%. Most (75.3%) of the respondents were aware of the prevalence of lung cancer. Almost all (90.3%) were aware of the cancer risk from air pollution, but fewer (57.5%) were concerned about the risk caused by side-stream smoke. Most disagreed that lung cancer could be easily cured. Former smokers were more knowledgeable than current smokers about the health hazards of smoking, and those who never smoked were more knowledgeable than both. Engineering students were more likely to agree with the benefits of quitting smoking than were medical or science students. Addiction and friends were the reasons most frequently given for not quitting smoking.

THE MULTIDIMENSIONAL HEALTH LOCUS OF CONTROL SCALE: PSYCHOMETRIC PROPERTIES AND FORM EQUIVALENCE

This study examined the psychometric equivalence of Forms A and B of the Multidimensional Health Locus of Control Scale in a sample of college students (N = 370; M = 19.5 yr.; 318 Caucasians; 281 women). Given the dearth of studies that address the issue of form equivalence directly, this study sought to ascertain whether these forms could be used interchangeably by researchers. Subscales on the two forms had fairly high correlations (range of r = .77-.81), and similar alpha and omega reliability coefficients. Additionally, confirmatory factor analysis revealed both forms fit a three-factor model well. However, paired-sample t tests yielded significant mean differences for all three subscales. Furthermore, the two forms yielded inconsistent associations with relevant measures. Although the observed pattern of associations with social desirability and safe swimming behaviors were similar for Forms A and B, the pattern of differences was not identical for smoking groups and bicycle helmet use groups between forms. Overall, these results suggested that Forms A and B do not meet the strict criteria for parallel forms, but instead should be considered alternative forms.

The development of the Lifestyle and Habits Questionnaire-brief version: relationship to quality of life and stress in college students

The authors describe the development and preliminary evaluation of the Lifestyle and Habits Questionnaire-brief version (LHQ-B). Three hundred seventy-seven undergraduate students (ages 18-25) participated. Responses were collected through either a web-based or face-to-face survey. Data reductive procedures were used with a preexisting lifestyle inventory to create an abbreviated measure. The relationship between lifestyle domains and indicators of wellbeing (levels of stress and quality of life (QOL)) were also examined. Eight lifestyle domains, encompassing 42 items, were identified and found to have good psychometric properties. The resulting LHQ-B measure can be self-administered/scored and contains norm-referenced feedback. The domains of psychological health, physical health and exercise, and sense of purpose were the best predictors of QOL while psychological health, social concern, and the accident prevention domains predicted levels of stress. The results support the use of the LHQ-B in lifestyle research or as a self-administered measure promoting self-awareness of lifestyle behaviors/attitudes in young adults (18-25 years).

Health promotion and prevention strategies

Opiate dependency is a medical disorder that requires treatment intervention. Primary health care not only entails treatment of illness but also involves disease prevention and health promotion. Based on Pender's revised Health Promotion Model, a descriptive study comparing the health promoting behaviors/practices in abusing and recovering opiate-dependent drug users is analyzed. Using the Health Promoting Lifestyle Profile II, a comparative descriptive, exploratory, nonexperimental design study was conducted to identify key health-promoting behaviors in recovering opiate-dependent drug users. Prevention strategy recommendations are discussed, along with future research recommendations.

Impact of nursing care services on self-efficacy perceptions and healthy lifestyle behaviors of nursing home residents

The purpose of this study was to evaluate the impact of tailored individualized nursing care services on the self-efficacy perceptions and healthy lifestyle behaviors of older adults living in a nursing home in Turkey. This outcomes evaluation research used a quasi-experimental study design in which outcomes evaluations were repeated within time intervals in a single group. The study sample included 30 older adults. Nursing diagnoses and interventions were identified using the Omaha System. The impact of implemented nursing care services was evaluated using the Self-Efficacy Scale and Healthy Life-Style Behaviours Scale II. A total of 3,024 nursing interventions were performed, and self-efficacy perceptions and healthy lifestyle behaviors of older nursing home residents were significantly increased in a positive manner (p < 0.05). The results suggest that nurses should assess self-efficacy perceptions and healthy lifestyle behaviors of older adults and that nursing care services directed at health promotion of older adults should be maintained.

Cigarette smoking among Asian American and Pacific Islander college students: implications for college health promotion

Asian Americans (AA) and Pacific Islanders (PI) are an understudied population for health and tobacco use, which is alarming for a fast growing U.S. population. Research in smoking among AA and PI college students is limited, despite 50% of AA and 20% of PI having obtained a college degree. A cross-sectional tobacco survey was administered in a large racially diverse Southern California university (N = 490) that examined smoking behavior, psychosocial, and perceptual factors related to smoking among AA and PI compared with Caucasians. Overall, 19% of participants were smokers. The prevalence of current smoking by race was 26% PI, 19% AA, and 17% Caucasian. AA and PI are light, infrequent smokers who smoke mainly for social reasons and in social locations. Most AA and PI made quit attempts and reported intention to quit smoking. Low to moderate risk perceptions for addiction, disease and difficulty in quitting were observed. Social norms center on family influences, therefore it is recommended that cessation approaches target cigarette smoking norms within this social environment to increase perceptual risks of smoking. Smoking cessation should be placed in college health outreach programs based on culturally tailored approaches for AA and PI that target their unique smoking characteristics.

Prevalencia y factores de riesgo consumo de cigarrillo para estudiantes universitarios entre 18 a 25 años, durante el primer semestre académico del año 2013

El consumo de cigarrillo es un problema actual de salud pública, el cual es responsable de una parte importante de la carga de morbilidad y mortalidad en momentos actuales. Objetivo: Determinar la prevalencia de consumo diario, consumo no diario de cigarrillo, en estudiantes universitarios y factores asociados. Materiales y métodos: Se desarrolló un estudio descriptivos transversal, se tomó una muestra de 464 voluntarios adultos sanos entre 18 y 25 años, de ambos géneros. Siendo esta representativa de los estudiantes universitarios. Se establecieron asociaciones mediante la construcción de modelos de regresión simple y múltiples para los factores asociados. Resultados: La prevalencia para el consumo de cigarrillo diario fue de 5,4%, mientras que la de ser fumador esporádico fue de 13%, se encontraron asociación entre el consumo diario de cigarrillo y el género masculino O.R. 4,46 (I.C. 95% 1,5 – 13,27), practicar deporte O.R. 0,29 (I.C. 95% 0,11- 0,76); mientras que para el consumo esporádico de cigarrillo el género masculino presentó O.R. 4,04 (I.C. 95% 2,08 – 7,83) consumo de bebidas alcohólicos O.R. 4,76 (1,13 – 20,05) Conclusiones: El consumo de cigarrillo se asocia como factor de riesgo al género masculino, y como factor protector en las personas que practicas deportes.

Cigarette smoking among college students with disabilities: National College Health Assessment II, Fall 2008-Spring 2009

BACKGROUND

People with disabilities are 1.5 times more likely to smoke than their peers without disabilities, intensifying risk of health related disparities and further loss of function. When compared with the general population, college students also have a higher smoking prevalence. This study explores smoking rates among college students with disabilities.

OBJECTIVE/HYPOTHESIS

College students with disabilities have an increased likelihood of smoking, as compared with students without disabilities. Type of disability also influences smoking rates.

METHODS

This study explores the association between smoking and disability using multiple regression analyses and data from the National College Health Assessment II (NCHA II), Fall 2008-Spring 2009 (N = 79,915). People with disabilities comprised 15.6% of the total sample: 3.4% reported a physical disability, 8.3% reported a mental disability, 2.5% reported a sensory disability, and 3.7% reported a learning disability.

RESULTS

Smoking prevalence among those reporting disabilities was 23.1% versus 15% in those without disabilities. Those reporting mental disabilities had the highest rates (29.9%), followed by those with learning disabilities (23.7%), sensory disabilities (19.8%), and physical disabilities (16.4%). Students with disabilities were 1.23 times more likely to report current smoking than those without any disabilities, controlling for other factors (OR 1.23, 95% CI 1.16-1.30).

DISCUSSION

Results are consistent with previous research regarding the general adult population. Epidemiologic data demonstrating differences in risk behaviors for young adults with disabilities are important in allocation of resources. Findings of this study highlight the need for tailored smoking cessation programs for college students with disabilities.

Healthy lifestyle behaviour in university students and influential factors in eastern Turkey

This research was carried out to determine the healthy lifestyle behaviour of university students receiving education in central Erzincan. The population of this descriptive and cross-sectional research included a total of 4506 students receiving education at Erzincan University in the city centre, and the sampling included 981 students selected by a simple random sampling method from these schools. Data were collected between April and May 2008 by using an identification form and the Health Promotion Life-Style Profile (HPLP) Scale. Healthy lifestyle behaviour point averages of students were detected to be at medium level (118.41±20.90). It was established that student's grade, educational level of parents, economic status of the family and the student, the place where the student stays and smoking status of the student resulted in a significant difference in HPLP Scale total score average and the mean score of the majority of subscales.

Mexican American youths' and mothers' explanatory models of diabetes prevention

PURPOSE

To describe Mexican American mothers' and youths' explanatory models of promoting health and preventing diabetes in 12-14 year olds.

DESIGN AND METHODS

In this descriptive study, interviews produced mothers' (n= 21) and adolescents' (n= 20) explanatory models.

RESULTS

Mothers' and youths' views of causes of diabetes were mostly concordant with the biomedical model. They saw shared responsibility for health promotion and prevention.

PRACTICE IMPLICATIONS

Mothers and youths want help to promote health and prevent diabetes. Providers can apply explanatory models in interventions.

A cognitive-behavioral weight control program improves eating and smoking behaviors in weight-concerned female smokers

Many people use smoking as a weight control mechanism and are averse to quitting for fear of weight gain. These weight-concerned smokers tend to be women, are significantly less likely to stop smoking or to join smoking cessation programs, and will relapse more often than smokers who are not weight-concerned. Research suggests that a woman's motivation to quit smoking correlates positively with her confidence in her ability to control her weight after quitting. Likewise, success in smoking cessation has been associated with increased self-efficacy for weight control. This randomized controlled trial investigated the effects of a weight control program on eating and smoking behaviors in a group of female, weight-concerned smokers from July 2005 to June 2006. Two hundred sixteen subjects who wanted to lose weight but were not yet ready to quit smoking were recruited to participate in a 12-week, cognitive-behavioral weight control program consisting of 12 1-hour sessions. Subjects were randomly assigned to either the weight-control program (intervention group) or the control group. Differences between the intervention and control groups were evaluated using t tests for continuous variables, Wilcoxon rank-sum tests for ordinal variables and chi(2) tests for categorical variables. The intervention group had a 14% increase (P<0.001) in self-efficacy for weight control (Weight Efficacy Life-Style Questionnaire), which was associated with improved diet quality (Healthy Eating Index) (r=0.292, P<0.01), weight loss (r=0.582, P<0.001), increased self-efficacy for quitting smoking (Smoking Self-Efficacy Questionnaire) (r=0.291, P<0.014), a decrease in number of cigarettes smoked (r=0.331, P<0.005), and positive movement in stage of change toward smoking cessation (r=0.435, P<0.001). These findings suggest that for this group of weight-concerned smokers' success in changing eating behavior may trigger a positive change in smoking behavior.

Childhood healthcare experience, healthcare attitudes, and optimism as predictors of adolescents' healthcare behavior

Late adolescence and early adulthood is a time when people establish many of their life-style behaviors. Thus, in order to promote optimal health, it is important to identify factors predictive of young adults' healthcare behavior. This study evaluated the relationship between measures of childhood healthcare experience, healthcare attitudes, and optimism with young adults' healthcare behavior in a sample of college students (n = 100). Results suggested that prior healthcare experience, attitudes about healthcare, and optimism are associated with current healthcare behavior. In addition, the relation between childhood healthcare experience and current healthcare behavior was moderated by optimism, such that those who reported both more negative childhood healthcare experiences and low levels of optimism reported the least adaptive healthcare behaviors and those who reported the most positive childhood healthcare experience and the highest levels of optimism reported the most adaptive healthcare behavior.

Adolescents' avoidance of secondhand smoke exposure: model testing

More than half of young adolescents, 13 to 15 years old, suffer exposure to secondhand smoke (SHS) at home and in public places. Despite threats to adolescent health and well-being, little research has been done to identify factors that enable adolescents to avoid SHS. The objective of this study was to develop a model to predict SHS avoidance behavior among young adolescents. The impact of gender differences on predictor variances was investigated. Model testing was conducted using structural equation modeling on data from 1,291 nonsmoking Taiwanese middle school students. Attitude toward SHS is an important factor influencing the avoidance behavior of adolescents. The explanatory model of SHS avoidance behaviors provides useful information for program development aimed at decreasing adolescent exposure to SHS. Interventions focused on influencing adolescent attitudes toward SHS and supporting avoidance self-efficacy are needed.

Relations between physical activity and behavioral and perceptual correlates among midwestern college students

OBJECTIVE

Given the inconsistent findings in the literature, the authors' purpose in this study was to examine the associations between physical activity and behavioral and perceptional correlates, such as binge drinking, cigarette smoking, fruit or vegetable consumption, and weight perceptions, among midwestern college students.

PARTICIPANTS AND METHODS

The authors invited a convenience sample of 1,200 undergraduate college students enrolled in the 2004-2005 academic year in 4 different midwestern universities to participate in a survey. Of the 1,163 students who participated in the survey, a total of 1,134 usable surveys were received (response rate of 94.5%).

RESULTS

Hierarchical multiple logistic regression analyses indicated that smoking, perceived weight, and consumption of fruit were independent predictors of physical activity when controlling for other variables.

CONCLUSIONS

Physical activity promotion requires tailored approaches that are dependent on the target segment of the college student populations.

Health value, perceived social support, and health self-efficacy as factors in a health-promoting lifestyle

During their college years, students may adopt healthpromoting lifestyles that bring about long-term benefits.

OBJECTIVE AND PARTICIPANTS

The purpose of this study was to explore the roles of health value, family/friend social support, and health self-efficacy in the health-promoting lifestyles of a diverse sample of 162 college students.

METHODS

Participants completed an Assessment Battery consisting of the following instruments: (1) a demographic questionnaire, (2) the Multi-Dimensional Support, (3) the Value on Health Scale, (4) the Self-Rated Abilities for Health Practices, (5) the Health-Promoting Lifestyle Profile II, and (6) the Marlowe-Crowne Social Desirability Scale.

RESULTS

Correlational analyses indicated that health value, perceived family/friend social support, and health self-efficacy were significantly associated with engagement in a health-promoting lifestyle. An analysis of covariance (ANCOVA) revealed that health value and health self-efficacy significantly predicted the level of engagement in a health-promoting lifestyle. Perceived family/friend social support was not significant in the model. As age increased, level of perceived family/friend social support decreased.

CONCLUSION

Present findings suggest that health interventions programs focus on assessing and increasing health self-efficacy and health value of these youth. College health professionals can design and evaluate the effectiveness of such health-promoting interventions.

Smoking too young: students' decisions about tobacco use

PURPOSE

To describe college students' decisions related to tobacco use.

STUDY DESIGN AND METHODS

A sample of 49 smokers and 51 nonsmokers were asked about the smoking continuum of starting smoking, continuing to smoke, and tobacco cessation. An investigator-developed questionnaire was used to determine tobacco use and whether prevention and cessation messages were perceived as effective. Data were analyzed using descriptive statistics and qualitative descriptive analysis.

RESULTS

Peer pressure was the greatest influencing factor for beginning to smoke, and health was the major reason for not beginning to smoke. Addiction and stress maintained smoking. Both smokers and nonsmokers identified cessation strategies.

CLINICAL IMPLICATIONS

Every interaction with youth is another opportunity to assess smoking status. Recommendations from teens for cessation programs identified in this study may be more attractive to teens and young adults than the current standards related to strategies for adults.

The relationship between college class and cigarette smoking

Purpose

The purpose of this paper is to explore the relation between college class and cigarette‐smoking behavior in the USA.

Design/methodology/approach

National College Health Risk Behavior Survey (NCHRBS) data were employed. Five binary and two cumulative logit equations are estimated to explore the impact of college class on: having ever tried smoking cigarettes; having smoked in the past 30 days; having ever smoked on a daily basis; whether the student currently smoked daily; whether the student had quit entirely, that is, had not smoked for the past 30 days; the number of days smoked per month; and the number of cigarettes smoked per day.

Findings

The paper finds that second‐year students were more likely than other undergraduates to be current cigarette smokers. Among current smokers, first‐ and second‐year students smoked the most days per month and second‐year students smoked the most cigarettes per day. Of students who had ever smoked on a daily basis, third‐year students were least likely to have quit and fourth‐year students were most likely.

Research limitations/implications

The paper shows that since the NCHRBS was conducted only in 1995, there is no follow‐up data to determine whether the patterns have continued. It is also more difficult to disentangle college class effects from cohort and period effects.

Originality/value

This paper shows heterogeneity in college smoking and encourages efforts to better target anti‐smoking activities for greater effectiveness.

Factors related to cigarette smoking initiation and use among college students

The purpose of this cross-sectional study was to examine the impact of personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness), cognitive factors (sense of coherence and self-efficacy), coping resources (family and friend social support) and demographic factors (gender and ethnicity) on cigarette smoking behaviors (initiation, frequency, and amount of cigarette smoking) among college students. A total of 161 U.S. college students, aged 18-26, who enrolled in an introductory psychology course completed self-report questionnaires. The majority of the students had tried smoking (55%); among those who had tried, 42% were current smokers. The majority (77%) who had smoked a whole cigarette did so at age 16 years or younger. Students who reported lower levels of conscientiousness and self-efficacy had a greater likelihood to had tried cigarette smoking. Also, students who had lower levels of self-efficacy reported smoking more frequently and greater quantities of cigarettes than students with higher levels of self-efficacy. Self-efficacy was the most significant predictor of smoking behaviors. Health promotion programs focused on self-efficacy may be an effective tool for reducing the initiation, frequency, and amount of cigarette smoking among college students.

Predictors of health behaviours in college students

AIM

This paper reports a study examining the direct effects of perceived stress, perceived availability of and satisfaction with social support, and self-efficacy, and examines the intermediary roles of perceived threat (perceived susceptibility x perceived severity), benefits, and barriers on alcohol behaviour, smoking behaviour, physical activity and nutrition behaviour, general safety behaviour and sun-protective behaviour in college students.

BACKGROUND

Health behaviours formed during young adulthood may have a sustaining impact on health across later life. Entering college can be an exciting, yet stressful event for many adolescents and young adults as they face trying to adapt to changes in academic workloads, support networks, and their new environment. Coupled with these changes and new-found responsibilities, they have greater freedom and control over their lifestyles than ever before. However, researchers have shown globally that many college students engage in various risky health behaviours.

METHOD

A cross-sectional sample of 161 college students enrolled in an introductory psychology course completed self-report questionnaires regarding stress; social support; self-efficacy; and components of the Health Belief Model including perceived threat, perceived benefits, perceived barriers; and common health behaviours. Step-wise multiple regression analysis was conducted and significant predictors were retained as modifiers in the path analysis.

FINDINGS

Self-efficacy significantly predicted alcohol and smoking behaviour, physical activity and nutrition protective behaviour, general safety protective behaviour and sun-protective behaviour. Under high-perceived threat, self-efficacy was mediated by perceived barriers for binge drinking and moderated by perceived barriers for physical activity and nutrition behaviours. In addition, under high-perceived threat, self-efficacy was moderated by perceived threat for alcohol use at 30 days and 6 months. Under low threat, self-efficacy was mediated by perceived barriers for smoking behaviour and general safety protective behaviours.

CONCLUSIONS

Future health promotion programmes with college students must use interventions that maximize self-efficacy and ultimately reduce barriers to adopting a healthy lifestyle.

A review of interventions to reduce tobacco use in colleges and universities

BACKGROUND

Interventions have been designed to reduce the prevalence of smoking in college/university students. This review presents a summary and synthesis of the interventions published in English from 1980 to the present.

METHODS

Seven databases were searched for relevant published articles, and reference lists were examined for additional published studies. The studies were categorized as (1) individual approaches, such as on-campus cessation programs, and (2) institutional approaches, such as smoke-free policies. The studies were categorized by type of institution and geographic location, study design, sample demographics, and outcomes.

RESULTS

Fourteen studies were identified; only five received a "satisfactory" rating based on evaluation criteria. Most studies were based on convenience samples, and were conducted in 4-year institutions. Seven studies used comparison groups, and three were multi-institutional. Individual approaches included educational group sessions and/or individual counseling that were conducted on campus mostly by healthcare personnel. None used nicotine replacement or other medications for cessation. The quit rates for both smokeless tobacco and cigarette users varied, depending on definitions and duration of follow-up contact. Institutional interventions focused mainly on campus smoking restrictions, smoke-free policies, antitobacco messages, and cigarette pricing. Results indicated that interventions can have a positive influence on student behavior, specifically by reducing tobacco use (i.e., prevalence of cigarette smoking and use of smokeless products, amount smoked) among college students, and increasing acceptability of smoking policies and campus restrictions among both tobacco users and nonusers.

CONCLUSIONS

While some promising results have been noted, rigorous evaluations of a wider range of programs are needed, along with studies that address cultural and ethnic diversity on campuses.

Occurrence of exercise dependence in a college-aged population

Students (n = 257) were evaluated for scope and commitment to physical activity by use of self-reported data that assessed amount of activity per week and the obligatory or pathological nature of their activity patterns. Exhibiting atypical activity patterns, 21.8% of the students in the sample exercised 360 or more minutes per week and demonstrated at least one exercise "dependent" response pattern to queries about obligatory or pathological exercise. Although clinicians and educators should promote the many advantages of regular participation in physical activity, they should acknowledge that, for some, it may have undesirable consequences that occur at a frequency parallel to other age-related negative behaviors.

Cigarette smoking practices among American college students: review and future directions

Cigarette smoking among college students is a critical public health problem. In this article, the authors review available research on cigarette smoking practices among college students and suggest directions for future research. Studies show that smoking by college students is associated with being White, living in housing where smoking is permitted, using alcohol and other substances, and having a lower psychological sense of well-being. Depression, life satisfaction, and coping style are also related to college smoking, but the causal relationship remains unclear. Although a large proportion of college students have made an attempt to quit smoking, only a minority actually succeed. Most study designs examining college smoking have been cross-sectional, descriptive, or both. Thus, conclusions regarding predictors of smoking onset, maintenance, and cessation cannot be made. Future studies should use longitudinal designs that can identify psychological and socioenvironmental determinants of smoking among college students. Such information could inform the development of smoking prevention and cessation interventions targeted to the college student population.

Tobacco, depression, and lifestyle choices in the pivotal early college years

The author explored the correlates of tobacco use among 18- and 19-year-old students at a major midwestern university. A sample of 203 randomly selected freshmen and sophomore students completed a survey that included questions about tobacco use, other drug use, mental health issues, eating disorders, stress, smoking environment, and healthy lifestyles. The prevalence rate for tobacco use was 29% for the past year and 32% for the past month. Multivariate analyses suggested that students with a lifetime diagnosis of depression or treatment for depression were 7 times as likely as other students to use tobacco. In addition, marijuana and alcohol use and weekend exposure to smoke increased the likelihood of being a tobacco user. Stress and diet behaviors were found not to be significantly associated with tobacco use. Implications for health promotion among high school and college populations are drawn from the study findings.

Smoking on the rise among young adults: implications for research and policy

This paper investigates hypotheses regarding the cause of the recent apparent increase in young adult smoking, compares trends in smoking among young adults with trends in the use of other substances, and considers the implications for youth tobacco control research and policy. Time series analyses of national data suggest that the recent observed increase in smoking among young adults is primarily an artefact of the almost simultaneous increase in smoking among high school students. In addition, however, it also appears that there have been real changes in smoking patterns among young adults. While many questions remain regarding recent trends in tobacco and other drug use among adolescents and young adults, what is known leads to a clarion call for increased intervention and policy action for the prevention and control of tobacco use among young adults in the USA.

Concepts in health promotion. Perceived self-efficacy and barriers in older adults

Many older adults have reached later life in apparent good health while others' lack of self-care activities has greatly accelerated the process of aging. In this article, self-efficacy and perceived barriers are explored as significant concepts that influence the self-care activities of elderly individuals. A conceptual model is presented depicting perceived self-efficacy and barriers as determinants of self-care activities. This conceptual model differs from earlier health promotion models because it is specific for older adults. Based on empirical studies, this conceptual model demonstrates that the variables of perceived self-efficacy and barriers have a profound effect on an older adult's participation in self-care activities. Testing of this model is needed to provide a knowledge base for designing health promotion strategies, maximizing cost containment strategies, and contributing to Healthy People 2010 objectives of increasing quality of life for all older adults.

Tobacco use and baccalaureate nursing students: a study of their attitudes, beliefs and personal behaviours

AIM

To report findings about student nurses' attitudes, beliefs and personal behaviour in relation to tobacco issues.

RATIONALE

Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. However, a review of the literature suggests that this is not happening. Further understanding of nursing students' attitudes, beliefs and behaviours regarding tobacco use is needed in order to develop strategies which can positively impact on their future health promotion role.

METHODS

A cross-sectional survey of the total population of baccalaureate nursing students in one Canadian province was employed. Students were asked to complete a self-administered questionnaire, which included questions related to their smoking history; stage of behavioural change, and beliefs and attitudes towards tobacco. Students also completed the Health Promotion Lifestyle Profile (HPLP) and the Fagerström Nicotine Tolerance Scale.

FINDINGS

Two hundred and seventy-two students (61.9%) responded. Sixty (22.1%) indicated that they smoked daily or in social situations. These smokers were found to have a fairly low level of nicotine dependence and although 91.4% said they wanted to quit, few were actively engaged in the quitting process (16.9%). When comparing the beliefs and attitudes of smoking and non-smoking students, proportionally more of the non-smokers agreed that smokers will need close family/friends to help them quit; that the health of society should be protected by laws against smoking; and that nurses should set a non-smoking example. Non-smokers indicated more health promoting behaviours on items in the HPLP especially on the variables of physical activity, nutrition and stress management.

CONCLUSIONS

Nurses have the potential to influence clients' behaviours and public policy concerning tobacco use. Developing future nurses with the knowledge and skill to do so needs to be an important emphasis of nursing curricula.

Cervical cancer risk as a predictor of Pap smear use in rural North Carolina

Risk for invasive cervical cancer is reported to be higher in rural areas than urban ones, and cervical cancer-related mortality is higher in rural women due to poorer utilization of preventive services and subsequent presentation at late stages of the disease. This cross-sectional study examined the relationship between prevalence of risk factors for cervical cancer and the degree of compliance with risk-appropriate screening guidelines for cervical cancer. Secondary data were analyzed for 614 women from Robeson County, NC, aged 40 and older, and of mainly rural and low socioeconomic status. High-risk status was determined by the presence of any of the following five risk factors: a history of more than two sexual partners, age at first sexual intercourse under 18 years, history of sexually transmitted disease, history of sexually transmitted disease in sexual partner(s), and smoking. Low-risk status was the absence of all factors. A high-risk participant was considered compliant if she had had at least three Pap smears in the 3 years prior to the interview, while a low-risk participant was considered compliant if she had had at least one Pap smear within the previous 3 years. Overall, 82% of the participants were at high risk for cervical cancer. However, only 41% of all participants were compliant with the risk-appropriate screening guidelines. Low-risk status was significantly associated with compliance with cervical cancer screening guidelines (adjusted OR = 6.7; 95% CI = 3.7 to 11.1, p = .0001). Findings in this study population suggest rural women at high risk for cervical cancer are less likely to be compliant with appropriate Pap smear screening guidelines, indicating the need to target educational programs.

Self-efficacy perceptions in oral health behavior

The aim of this paper is to describe and understand people's views on dental self-efficacy and its formation. The qualitative data were collected by means of focused interviews with five patients selected on the basis of poor orientation to dental-care matters, measured using test scores from a previous questionnaire. The first stage of the analysis is a description of the background of the subjects from their own accounts; two proved to have internalized preventive dental beliefs and behavior deeply while two others had traumatic experiences as a reason for irregular dental appointments. One subject with poor oral health behavior seemed to have limited preventive action to his yearly dental appointment. The second stage of the analysis focuses on interpretation of the subjects' perception of self-efficacy and related comments. Among sources of self-efficacy that prove important in dental care are the cognitive, experiential, supportive and emotional dimensions, and beliefs and values learned in the family and at school. This qualitative research increases our understanding of the oral health behavior of patients and emphasizes the importance of patient-centered oral health education.