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Suijkerbuijk Y, Nieuwenhuijsen K. Identification of the return-to-work mode in unemployed workers with mental health issues: A focus group study among occupational health professionals. Work 2022; 74:891-906. [PMID: 35527604 DOI: 10.3233/wor-210434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND: Return-to-work (RTW) perceptions and attitudes are predictive for future work participation in workers with mental health issues. OBJECTIVE: To identify what RTW perceptions and attitudes occupational health professionals recognize in sick-listed unemployed workers with mental health issues and how these perceptions and attitudes can be systematically assessed. METHODS: Four focus group sessions, each involving five-six different occupational health professionals, were held. The audio records were transcribed verbatim and coded by two researchers independently. A thematic analysis was conducted. RESULTS: Professionals recognized RTW perceptions and attitudes in sick-listed unemployed workers with mental health issues. These perceptions and attitudes were described as characteristics of three modes in a process regarding RTW: the passive, ambivalent and active RTW mode. A passive RTW mode includes perceptions about not being able to work and an expectant attitude. The ambivalent RTW mode is characterized by uncertainty and ambivalence regarding RTW with a desire for occupational support. Workers in an active RTW mode have positive RTW perceptions and show job search behavior. A main theme was the flexible nature of RTW attitudes and perceptions, with workers switching between the passive, ambivalent and active RTW modes. For the assessment of the RTW mode, the professionals preferred personal contact, possibly with support of a tool. This enables them to ask specific questions and to observe non-verbal signs. CONCLUSIONS: Recurring assessments of the RTW mode can be helpful in identifying unemployed workers with mental health issues at risk of long-term sickness absence and for starting targeted RTW interventions.
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Affiliation(s)
- Yvonne Suijkerbuijk
- Amsterdam UMC, Location University of Amsterdam, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Research Center for Insurance Medicine, Meibergdreef 9, Amsterdam, The Netherlands
| | - Karen Nieuwenhuijsen
- Amsterdam UMC, Location University of Amsterdam, Department of Public and Occupational Health, Coronel Institute of Occupational Health, Research Center for Insurance Medicine, Meibergdreef 9, Amsterdam, The Netherlands
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Wilson M, Orgass H, Dearborn-Tomazos J. Stages and Processes of Change for Weight Loss in Acute Stroke or TIA Patients Living with Obesity. Cerebrovasc Dis Extra 2021; 12:1-6. [PMID: 34915499 PMCID: PMC8958604 DOI: 10.1159/000521387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/28/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity is associated with an increased prevalence of vascular risk factors and incidence of stroke. As such weight loss is recommended for patients living with obesity in the secondary prevention of stroke. Few studies, however, have examined the stages and processes of change for weight loss in stroke patients living with obesity. OBJECTIVE To evaluate the stages and processes of change for weight loss in patients living with obesity who have had a recent stroke or TIA. METHODS Using a validated questionnaire, we assessed each patient's stage of behavioral change according to the Transtheoretical Model (precontemplation, contemplation, preparation, action and maintenance). We also examined four processes of behavioral change, which quantify activities and experiences that patients undergo on the way to behavioral change: emotional re-evaluation (EMR), weight management action (WMA), weight consequence evaluation (WCE), and supporting relationships (SR). Processes scores were compared between patients in the action and maintenance stages and those in the precontemplation, contemplation and preparation stages. RESULTS Out of 49 patients who provided informed consent, 44 met the inclusion/exclusion criteria. Of these 44 patients, 6 (14%) were in the precontemplation stage of change, 7 (16%) were in contemplation, 2 (5%) were in preparation, 13 (30%) were in action, and 16 (36%) were in maintenance. Those in the action and maintenance stages accounted for the majority of participants (n=29, 66%). Patients in the action and maintenance stages (N=29) had higher EMR scores (mean 79, SD 13 vs mean 68, SD 19, t=2.0, p=0.03) and WMA scores (mean 69, SD 13 vs mean 59, SD 19, t=2.0, p=0.03) as compared to those in the precontemplation, contemplation and preparation stages (N=15). CONCLUSIONS Our results suggest that without counseling or specific intervention, approximately two-thirds of stroke/TIA patients living with obesity are in the action or maintenance stage of behavior change with respect to weight loss and therefore more likely to succeed in intensive lifestyle-based interventions targeted towards weight loss. Patients who score higher in EMR and WMA are more likely to be in the action or maintenance stage of change.
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Affiliation(s)
- Mitch Wilson
- Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
- *Mitch Wilson,
| | - Hailey Orgass
- Department of Neurology, Yale New Haven Hospital/Yale School of Medicine, New Haven, Connecticut, USA
| | - Jennifer Dearborn-Tomazos
- Division of Vascular Neurology, Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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Natural antioxidants enhance the power of physical and mental activities versus risk factors inducing progression of Alzheimer's disease in rats. Int Immunopharmacol 2021; 96:107729. [PMID: 33971493 DOI: 10.1016/j.intimp.2021.107729] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 04/02/2021] [Accepted: 04/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Alzheimer's disease (AD) is a progressive neurodegenerative disease that is exacerbated by social isolation (SI) and protein malnutrition (PM). Antioxidants, physical and mental activities (Ph&M) can maintain cognitive functions and protect against dementia. OBJECTIVE To investigate the impact of Epigallocatechin-3-gallate (EGCG), Vitamin E (VE), Vitamin C (VC), and Selenium (Se), in enhancing the potential effect of Ph&M versus SI&PM as risk factors in the progression of AD in rats. METHODS Aluminum chloride (70 mg/kg, I.P for 5 weeks) was used to induce AD in rats that either normally fed or socially isolated and protein malnourished (SI&PM). Simultaneously, rats were weekly exposed to Ph&M either alone or in combination with EGCG (10 mg/kg, I.P), VC (400 mg/kg, P.O), VE (100 mg/kg, P.O), and Se (1 mg/kg, P.O). RESULTS The combination protocol of EGCG, VE, VC, and Se together with Ph&M significantly increased brain monoamines, superoxide dismutase (SOD), total antioxidant capacity (TAC) and brain-derived neurotrophic factor (BDNF) in AD, SI&PM and SI&PM/AD groups. Additionally, this regimen significantly mitigated brain acetylcholine esterase (ACHE), β-amyloid (Aβ), Tau protein, β-secretase, malondialdehyde (MDA), tumor necrosis factor-alpha (TNF-α), and Interleukin 1β (IL-1β) as well as DNA fragmentation. These biochemical findings were supported by the histopathological examinations of brain tissue. CONCLUSION The combination protocol of antioxidants with Ph&M activities mitigated SI&PM-induced progressive risk of AD.
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Hayotte M, Nègre V, Gray L, Sadoul JL, d'Arripe-Longueville F. The transtheoretical model (TTM) to gain insight into young women's long-term physical activity after bariatric surgery: a qualitative study. Obes Surg 2021; 30:595-602. [PMID: 31654341 DOI: 10.1007/s11695-019-04220-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Over the long term, people who have undergone bariatric surgery (BS) remain overly sedentary with inadequate physical activity (PA). The purpose of this study was to apply the transtheoretical model (TTM) to (1) explore in-depth how PA is experienced years after BS and (2) identify the barriers to and facilitators of PA involved at each stage of change (SOC). METHODS Seventeen women with a mean age of 32.5 ± 3.3 years and a percentage of total weight loss of 29.6 ± 12.4 were interviewed at a mean of 9.4 ± 3.6 years after BS. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS The distribution of barriers to and facilitators of PA differed with the SOC. In progressing from the precontemplation and contemplation stages to the preparation stage, the women experienced changes in their decisional balance, supported by processes of self-reevaluation and environmental reevaluation. In shifting from preparation to the action and maintenance stages, they experienced intrinsic motivation and self-liberation processes. The relapse stage was associated with a decrease in self-efficacy to cope with life constraints. CONCLUSIONS This study presents an in-depth theory-based exploration of the dynamics of long-term engagement in PA after BS in young women, with clinical implications for providing them with better guidance toward a more physically active lifestyle.
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Affiliation(s)
| | - Véronique Nègre
- Centre Spécialisé Obésité PACA Est, Pôle DARE, Centre Hospitalier Universitaire de Nice membre de l'Université Côte d'Azur, Nice, France
| | - Laura Gray
- Université Côte d'Azur, LAMHESS, Nice, France
| | - Jean-Louis Sadoul
- Centre Spécialisé Obésité PACA Est, Pôle DARE, Centre Hospitalier Universitaire de Nice membre de l'Université Côte d'Azur, Nice, France
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Tessaro VCZ, Silva AMR, Loch MR. Stages of change for leisure time physical activity in Brazilian adults: longitudinal study. CIENCIA & SAUDE COLETIVA 2020; 26:2969-2980. [PMID: 34378690 DOI: 10.1590/1413-81232021268.18022020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/12/2020] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to analyze the maintenance of and movement between stages of change for leisure time physical activity (LTPA) after four years and the association with sociodemographic characteristics. A cross-sectional population-based study was conducted with 1,180 individuals aged 40 years or over in 2011. In 2015, 885 participants were reinterviewed. The dependent variables were the maintenance of and movement between stages of change for LTPA behavior. The data was analyzed using adjusted Poisson regression. We found that around 40% of the study participants were still at the same stage they were at in the first assessment, while 31.6% had relapsed and 27% had advanced at least one stage. The stages that showed the highest frequencies were remained in precontemplation and maintenance. The risk of remaining at the precontemplation stage was higher among men (RR=1.59; 95%CI:1.21-2.11), respondents aged ≥60 years (RR=1.35; 95%CI:1.03-1.78), those with a lower level of education (RR=1.24; 95%CI:1.04-2.33), and those from economic classes C and D/E (RR=1.71; 95%CI:1.17-2.49 and RR=1.88; 95%CI:1.12-3.18, respectively). The frequency of individuals who remained at the maintenance stage was significantly lower in economic classes D/E than in classes A/B (RR=0.35; 95%CI:0.14-0.87).
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Affiliation(s)
- Valéria Cristina Zamataro Tessaro
- Programa de Pós-Graduação em Fisioterapia, Universidade Estadual de Londrina. Av. Robert Koch 60 Caixa Postal 791, Bairro Cervejaria. 86038-440 Londrina PR Brasil.
| | - Ana Maria Rigo Silva
- Departamento de Saúde Coletiva, Centro de Ciências da Saúde, Universidade Estadual de Londrina. Londrina PR Brasil
| | - Mathias Roberto Loch
- Departamento de Fundamentos da Educação Física, Centro de Educação Física e Desportos, Universidade Estadual de Londrina. Londrina PR Brasil
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Assessing Motivational Stages and Processes of Change for Weight Management Around Bariatric Surgery: a Multicenter Study. Obes Surg 2020; 29:3348-3356. [PMID: 31209830 DOI: 10.1007/s11695-019-04001-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION/PURPOSE The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. MATERIALS/METHODS A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. RESULTS A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. CONCLUSION Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge.
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Rizal H, Hajar MS, Kueh YC, Muhamad AS, Kuan G. Confirmatory Factor Analysis of the Malay-Language Transtheoretical Model of Physical Activity among Malaysian Primary School Children. Malays J Med Sci 2019; 26:99-113. [PMID: 31447613 PMCID: PMC6687211 DOI: 10.21315/mjms2019.26.2.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 01/20/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction The transtheoretical model (TTM) is an integrative model of intentional change consisting of stages of change, processes of change, decisional balance and self-efficacy. This study aimed at validating the TTM questionnaires on physical activity for Malaysian children using confirmatory factor analysis. Methods The participants were 381 Malay students (188 male; 193 female), aged 10–12 years old, with a mean age of 10.94 (SD = 0.81). The original version of the TTM was translated into the Malay language using forward and backward translation. Certain phrases were adapted based on the local culture and vocabulary suitable for primary school students. Results The final measurement models and their fit indices were: processes of change (CFI = 0.939, TLI = 0.925, SRMR = 0.040, RMSEA = 0.030); decisional balance (CFI = 0.897, TLI = 0.864, SRMR = 0.045, RMSEA = 0.038); and self-efficacy (CFI = 0.934, TLI = 0.915, SRMR = 0.042, RMSEA = 0.032). Conclusion Care must be taken when using the TTM with children, as it has been prevalently validated with adults. The final version of the TTM questionnaire for Malay primary school children had 24 items for process of changes, 13 items for self-efficacy and 10 items for decisional balance.
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Affiliation(s)
- Hussein Rizal
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mawar Siti Hajar
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Yee Cheng Kueh
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Ayu Suzailiana Muhamad
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Garry Kuan
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Batsis JA, Gilbert-Diamond D, McClure AC, Weintraub A, Sette D, Mecchella JN, Rotenberg S, Cook SB, Rothstein RI. Prevalence of Sarcopenia Obesity in Patients Treated at a Rural, Multidisciplinary Weight and Wellness Center. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119862288. [PMID: 31384133 PMCID: PMC6651666 DOI: 10.1177/1179544119862288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 06/18/2019] [Indexed: 12/21/2022]
Abstract
Sarcopenic obesity portends poor outcomes, yet it is under-recognized in practice. We collected baseline clinical data including data on body composition (total and segmental muscle mass and total body fat), grip strength, and 5-times sit-to-stand. We defined sarcopenia using cut-points for appendicular lean mass (ALM) and obesity using body-fat cut-points. A total of 599 clinic patients (78.5% female; mean age was 51.3 ± 14.2 years) had bioelectrical impedance analysis (BIA) data (83.8%). Mean body mass index (BMI) and waist circumference were 43.1 ± 8.9 kg/m2 and 132.3 ± 70.7 cm, respectively. All patients had elevated body fat. There were 284 (47.4%) individuals fulfilling criteria for ALM-defined sarcopenia. Sarcopenic obese persons had a lower BMI (38.2 ± 6.4 vs 47.6 ± 8.6; P < 0.001), fat-free mass (113.0 kg ± 16.1 vs 152.1 kg ± 29.4; P < 0.001), fat mass (48.4% ± 5.9 vs 49.5% ± 6.2; P = 0.03), and visceral adipose tissue (216.8 ± 106.3 vs 242.7 ± 133.6 cm3; P = 0.009) than those without sarcopenic obesity. Grip strength was lower in those with sarcopenic obesity (25.1 ± 8.0 vs 30.5 ± 11.3 kg; P < 0.001) and sit-to-stand times were longer (12.4 ± 4.4 vs 10.8 second ± 4.6; P = 0.03). Sarcopenic obesity was highly prevalent in a rural, tertiary care weight and wellness center.
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Affiliation(s)
- John A Batsis
- Geisel School of Medicine at Dartmouth, Hanover, NH, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA
| | - Diane Gilbert-Diamond
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Auden C McClure
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
| | - Aaron Weintraub
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
| | - Diane Sette
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
| | - John N Mecchella
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
| | - Sivan Rotenberg
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
| | - Summer B Cook
- Department of Kinesiology, University of New Hampshire, Durham, NH, USA
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Romain AJ, Abdel-Baki A. Using the transtheoretical model to predict physical activity level of overweight adults with serious mental illness. Psychiatry Res 2017; 258:476-480. [PMID: 28890227 DOI: 10.1016/j.psychres.2017.08.093] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 12/13/2022]
Abstract
Although physical activity (PA) is recommended for individuals with serious mental illness (ISMI), most of them are inactive or insufficiently active. The transtheoretical model (TTM) has been proposed to explain the motivational factors associated with PA however, there is little evidence of its applicability to ISMI. So, the objective was to analyse whether TTM components are related to PA in overweight ISMI. In this cross-sectional study, participants completed the Global Physical Activity Questionnaire to assess their PA level and TTM components: stages of change (SOC), decisional balance (pros and cons), self-efficacy and processes of change (POC; experiential and behavioural). 43 overweight ISMI (27 males, mean age 29.0 ± 6.64, mean BMI 31.91 ± 5.10kg/m2, 30% with schizophrenia, and 44% inactive), referred to a PA programme were recruited. PA was positively correlated with POC and perceived pros, with TTM constructs accounting for 14.5% of PA variance. Mean level of behavioural POC and perceived pros were higher in physically active than in inactive participants. So, this study confirms that TTM components are associated with PA in overweight ISMI. Therefore, the TTM should be considered when planning PA interventions for ISMI.
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Affiliation(s)
- Ahmed Jérôme Romain
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, Québec, Canada.
| | - Amal Abdel-Baki
- University of Montreal Hospital Research Centre (CRCHUM), Montréal, Québec, Canada; Department of Psychiatry, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Clinique des Jeunes Adultes Psychotiques, University Hospital of Montreal (CHUM) -Notre-Dame Hospital, Montréal, Québec, Canada
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Dol KS. Weight control behaviors among Koreans. J Phys Ther Sci 2017; 29:910-913. [PMID: 28603370 PMCID: PMC5462697 DOI: 10.1589/jpts.29.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 02/20/2017] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study was performed to investigate the weight control behaviors among
Koreans. [Subjects and Methods] The study is a secondary analysis. Data were extracted
from the Korea National Health and Nutrition Examination Survey from 2010 through 2014.
[Results] The weight control behaviors were exhibited by more than half of the
participants each year. The weight control behavior that was most prevalent among Koreans
was exercise. The types of exercise included walking, muscle strengthening, flexibility
exercises, etc. [Conclusion] These findings indicate that exercise was confirmed as the
preferred method for weight control among Koreans.
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Affiliation(s)
- Kim Sang Dol
- Department of Nursing, College of Health Science, Kangwon National University: 346 Hwangjo-gil, Dogye-eup, Samcheok-si, Gangwon-do 245-907, Republic of Korea
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Santiago-Rivas M, Velicer WF, Redding C. Mediation analysis of decisional balance, sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection. Psychol Health 2015; 30:1433-49. [PMID: 26040293 DOI: 10.1080/08870446.2015.1056791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant. DESIGN Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention. MAIN OUTCOME MEASURES Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use. RESULTS With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126-.614), and the pros predicted the outcomes (r = .181-.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes. CONCLUSION In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.
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Affiliation(s)
- Marimer Santiago-Rivas
- a Department of Oncological Sciences , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - Wayne F Velicer
- b Cancer Prevention Research Center , University of Rhode Island , Kingston , RI , USA
| | - Colleen Redding
- b Cancer Prevention Research Center , University of Rhode Island , Kingston , RI , USA
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