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Fried TR, Yang M, Martino S, Iannone L, Zenoni M, Blakley L, O’Leary JR, Redding CA, Paiva AL. Effect of Computer-Tailored Print Feedback, Motivational Interviewing, and Motivational Enhancement Therapy on Engagement in Advance Care Planning: A Randomized Clinical Trial. JAMA Intern Med 2022; 182:1298-1305. [PMID: 36342678 PMCID: PMC9641591 DOI: 10.1001/jamainternmed.2022.5074] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/17/2022] [Indexed: 11/09/2022]
Abstract
Importance There is a tension between clinician-led approaches to engagement in advance care planning (ACP), which are effective but resource-intensive, and self-administered tools, which are more easily disseminated but rely on ability and willingness to complete. Objective To examine the efficacy of computer-tailored print feedback (CTPF), motivational interviewing (MI), and motivational enhancement therapy (MET) on completion of a set of ACP activities, each as compared with usual care. Design, Setting, and Participants This randomized clinical trial was conducted from October 2017 to December 2020 via telephone contact with primary care patients at a single VA facility; 483 veterans aged 55 years or older were randomly selected from a list of patients with a primary care visit in the prior 12 months, with oversampling of women and people from minoritized racial and ethnic groups. Statistical analysis was performed from January to June 2022. Interventions Mailed CTPF generated in response to a brief telephone assessment of readiness to engage in and attitudes toward ACP; MI, an interview exploring ambivalence to change and developing a change plan; and MET, MI plus print feedback, delivered by telephone at baseline, 2, and 4 months. Main Outcome and Measures Self-reported completion of 4 ACP activities: communicating about views on quality vs quantity of life, assignment of a health care agent, completion of a living will, and submitting documents for inclusion in the electronic health record at 6 months. Results The study included 483 persons, mean (SD) age 68.3 (8.0) years, 18.2% women and 31.1% who were people from minoritized racial and ethnic groups. Adjusting for age, education, race, gender, and baseline stage of change for each ACP, predicted probabilities for completing the ACP activities were: usual care 5.7% (95% CI, 2.8%-11.1%) for usual care, 17.7% (95% CI, 11.8%-25.9%; P = .003) for MET, 15.8% (95% CI, 10.2%-23.6%; P = .01) for MI, P = .01, and 10.0% (95% CI, 5.9%-16.7%; P = .18) for CTPF. Conclusions and Relevance This randomized clinical trial found that a series of 3 MI and MET counseling sessions significantly increased the proportion of middle-aged and older veterans completing a set of ACP activities, while print feedback did not. These findings suggest the importance of clinical interaction for ACP engagement. Trial Registration ClinicalTrials.gov Identifier: NCT03103828.
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Affiliation(s)
- Terri R. Fried
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Manshu Yang
- Department of Psychology, College of Health Sciences, University of Rhode Island, South Kingstown
| | - Steve Martino
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Psychology Service, VA Connecticut Healthcare System, West Haven
| | - Lynne Iannone
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven
- Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Maria Zenoni
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven
- Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Laura Blakley
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
- Psychology Service, VA Connecticut Healthcare System, West Haven
| | - John R. O’Leary
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven
- Program on Aging, Yale School of Medicine, New Haven, Connecticut
| | - Colleen A. Redding
- Department of Psychology, College of Health Sciences, University of Rhode Island, South Kingstown
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, South Kingstown
| | - Andrea L. Paiva
- Department of Psychology, College of Health Sciences, University of Rhode Island, South Kingstown
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Fried TR, Paiva AL, Redding CA, Iannone L, O'Leary JR, Zenoni M, Risi MM, Mejnartowicz S, Rossi JS. Effect of the STAMP (Sharing and Talking About My Preferences) Intervention on Completing Multiple Advance Care Planning Activities in Ambulatory Care : A Cluster Randomized Controlled Trial. Ann Intern Med 2021; 174:1519-1527. [PMID: 34461035 PMCID: PMC8711627 DOI: 10.7326/m21-1007] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Interventions with the potential for broad reach in ambulatory settings are necessary to achieve a life course approach to advance care planning. OBJECTIVE To examine the effect of a computer-tailored, behavioral health model-based intervention on the engagement of adults in advance care planning recruited from ambulatory care settings. DESIGN Cluster randomized controlled trial with participant-level analysis. (ClinicalTrials.gov: NCT03137459). SETTING 10 pairs of primary and selected specialty care practices matched on patient sociodemographic information. PARTICIPANTS English-speaking adults aged 55 years or older; 454 adults at practices randomly assigned to usual care and 455 at practices randomly assigned to intervention. INTERVENTION Brief telephone or web-based assessment generating a mailed, individually tailored feedback report with a stage-matched brochure at baseline, 2 months, and 4 months. MEASUREMENTS The primary outcome was completion of the following 4 advance care planning activities at 6 months: identifying and communicating with a trusted person about views on quality versus quantity of life, assignment of a health care agent, completion of a living will, and ensuring that the documents are in the medical record-assessed by a blinded interviewer. Secondary outcomes were completion of individual advance care planning activities. RESULTS Participants were 64% women and 76% White. The mean age was 68.3 years (SD, 8.3). The predicted probability of completing all advance care planning activities in usual care sites was 8.2% (95% CI, 4.9% to 11.4%) versus 14.1% (CI, 11.0% to 17.2%) in intervention sites (adjusted risk difference, 5.2 percentage points [CI, 1.6 to 8.8 percentage points]). Prespecified subgroup analysis found no statistically significant interactions between the intervention and age, education, or race. LIMITATIONS The study was done in a single region and excluded non-English speaking participants. No information was collected about nonparticipants. CONCLUSION A brief, easily delivered, tailored print intervention increased participation in advance care planning in ambulatory care settings. PRIMARY FUNDING SOURCE National Institute of Nursing Research and National Institute of Aging.
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Affiliation(s)
- Terri R Fried
- Yale School of Medicine, New Haven, and Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut (T.R.F.)
| | - Andrea L Paiva
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island (A.L.P., C.A.R., J.S.R.)
| | - Colleen A Redding
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island (A.L.P., C.A.R., J.S.R.)
| | - Lynne Iannone
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, and Yale School of Medicine, New Haven, Connecticut (L.I., J.O., M.Z.)
| | - John R O'Leary
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, and Yale School of Medicine, New Haven, Connecticut (L.I., J.O., M.Z.)
| | - Maria Zenoni
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, and Yale School of Medicine, New Haven, Connecticut (L.I., J.O., M.Z.)
| | - Megan M Risi
- College of Health Sciences, University of Rhode Island, Kingston, Rhode Island (M.M.R.)
| | | | - Joseph S Rossi
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island (A.L.P., C.A.R., J.S.R.)
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van Dyck LI, Paiva A, Redding CA, Fried TR. Understanding the Role of Knowledge in Advance Care Planning Engagement. J Pain Symptom Manage 2021; 62:778-784. [PMID: 33587993 PMCID: PMC8361863 DOI: 10.1016/j.jpainsymman.2021.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 11/24/2022]
Abstract
CONTEXT Advance care planning remains underutilized. A better understanding of the role of education in promoting engagement is needed. OBJECTIVES To examine advance care planning knowledge and its relationship to engagement in middle-aged and older adults. METHODS This cross-sectional study utilized baseline data from 921 participants age ≥55 years enrolled in the STAMP randomized controlled trial, including a knowledge scale consisting of seven questions regarding the purpose and mechanisms of advance care planning and measures of participation. RESULTS Only 11.9% of participants answered all 7 questions correctly, and 25.6% of participants answered ≤3 correctly (defined as "low knowledge"). Low knowledge was independently associated with male gender (odds ratio [OR] 2.1, 95% confidence interval [CI]: 1.5, 3.0), non-white race (OR 1.5, 95% CI: 1.1, 2.2), older age (OR 2.2, 95% CI: 1.4, 3.4), lower income (OR 1.5, 95% CI: 1.1, 2.1), and lower education level (OR 2.9, 95% CI: 2.0, 4.1). Higher knowledge was independently associated with communicating with a loved one about quality versus quantity of life (OR 1.7, 95% CI: 1.2, 2.4) and with living will completion (OR 1.6, 95% CI: 1.0, 2.5), but not with healthcare agent assignment. Factors including race and education remained associated with engagement after accounting for knowledge. CONCLUSION Knowledge deficits regarding advance care planning are common and associated with the same sociodemographic factors linked to other healthcare disparities. While improving knowledge is an important component of intervention, it is unlikely sufficient in and of itself to increase engagement.
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Affiliation(s)
- Laura I van Dyck
- Department of Medicine, School of Medicine, Yale University (L.I.v.D., T.R.F.), New Haven, Connecticut, USA.
| | - Andrea Paiva
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island (A.P., C.A.R.), Kingston, Rhode Island, USA; Psychology Department, College of Health Sciences, University of Rhode Island (A.P., C.A.R.), Kingston, Rhode Island, USA
| | - Colleen A Redding
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island (A.P., C.A.R.), Kingston, Rhode Island, USA; Psychology Department, College of Health Sciences, University of Rhode Island (A.P., C.A.R.), Kingston, Rhode Island, USA
| | - Terri R Fried
- Department of Medicine, School of Medicine, Yale University (L.I.v.D., T.R.F.), New Haven, Connecticut, USA; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System (T.R.F.), West Haven, Connecticut, USA
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Tanzer JR, Redding CA, Mikhalyuk I, Bennett B, Lamoureux B, Achin D, Bassett S, Martin R, Stein LAR. Implementing Coordinated Specialty Care in CMHC Youth and Young Adults with Severe Mental Illness: Preliminary Outcome Assessment. Community Ment Health J 2021; 57:1348-1359. [PMID: 33438137 DOI: 10.1007/s10597-020-00763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
This study assessed impact of Coordinated Specialty Care (CSC), expanded to include both first episode psychosis (FEP) and severe mental health disorders (e.g., depression, bipolar disorder, trauma) in youths attending Community Mental Health Centers (CMHCs). Eligible youth and young adults (ages 16-26 years, N = 201) were recruited from two CMHCs and assessed every 6 months. Paired sample t-tests were performed comparing pre- and post-treatment observations. Statistically significant decreases from pre to post were found in sad and anxious feelings and in days hospitalized for psychiatric emergency and increases were found in subjective health ratings and employment status. This preliminary assessment supports the effectiveness of expanded inclusion criteria for participation in the CSC model.
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Affiliation(s)
- Joshua Ray Tanzer
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA.
| | - Colleen A Redding
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Irena Mikhalyuk
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | | | | | - Denise Achin
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, USA
| | - Shayna Bassett
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | | | - L A R Stein
- Psychology Department, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
- Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals, Cranston, USA
- Brown University School of Public Health, Providence, USA
- RI Training School, Cranston, USA
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Redding CA, Goldberg D, Weber KM, Yin HQ, Paiva AL, Burke-Miller J, Cohen MH, Rossi JS. Cross-validation of transtheoretical model smoking cessation measures in Chicago WIHS women smokers with and at risk for HIV. Transl Behav Med 2021; 10:457-468. [PMID: 30715533 DOI: 10.1093/tbm/ibz001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
People with and at risk for HIV have high rates of smoking, increasing their morbidity and mortality. Effective cessation interventions are needed for this group. Transtheoretical model (TTM)-tailored interventions have demonstrated efficacy, but measures need cross-validation in this population. TTM cessation measures were evaluated in women smokers with and at risk for HIV (N = 111) from Chicago Women's Interagency HIV Study (WIHS). Confirmatory factor analyses evaluated measurement models. MANOVAs examined relationships between constructs and stage subgroups. For decisional balance, the two-factor uncorrelated model was best (χ2(20) = 13.96; comparative fit index [CFI], 1.0; root mean square error of approximation [RMSEA] = .00), with good (pros α = .78) and fair (cons α = .55) four-item alphas. The one-factor temptations model (α = .90) showed reasonable fit (χ2(18) = 80.22; CFI = .89; RMSEA = .177). Processes of change subscales had fair to good two-item alphas (α = .49-.77) and fit a 10-factor fully correlated model (χ2(125) = 222.72; CFI = .88; RMSEA = .084). MANOVAs by stage of change replicated expected patterns for the pros, overall temptations, and two process subscales with medium-sized effects (η2 = .06-.18). Contrary to expectations, no differences by stage were found for cons or temptation negative affect subscales. The structures of these TTM measures replicated with good internal and external validity, except for the cons, which needs refinement. Negative affect temptations was structurally sound, but did not vary by stage group potentially reflecting this sample's moderate depression levels and/or their reliance on smoking to deal with negative affect. Results support the use of most TTM measures in research and tailored interventions to increase smoking cessation among women smokers with and at risk for HIV and highlight the importance of managing negative affect in cessation materials targeting this group.
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Affiliation(s)
- Colleen A Redding
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - David Goldberg
- Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL, USA
| | - Kathleen M Weber
- The CORE Center at Cook County Health and Hospital System, Chicago, IL, USA
| | - Hui-Qing Yin
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Andrea L Paiva
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Jane Burke-Miller
- The CORE Center at Cook County Health and Hospital System, Chicago, IL, USA
| | - Mardge H Cohen
- Department of Medicine, Cook County Health and Hospital System and Rush University, Chicago, IL, USA.,The CORE Center at Cook County Health and Hospital System, Chicago, IL, USA
| | - Joseph S Rossi
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
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6
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Sannes TS, Pirl WF, Rossi JS, Grebstein L, Redding CA, Ferszt GG, Prochaska JO, Braun IM, Yusufov M. Identifying patient-level factors associated with interest in psychosocial services during cancer: A brief report. J Psychosoc Oncol 2020; 39:686-693. [PMID: 33107411 DOI: 10.1080/07347332.2020.1837329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Uptake of psychosocial services during cancer treatment remains relatively low. To use these services efficiently, novel approaches - based on evidence-based theory - are needed to understand cancer patients' readiness to seek psychosocial services. Guided by the transtheoretical model (TTM), we investigated individuals' readiness to use psychosocial services by assessing decisional conflict (pros/cons) and self-efficacy, which are established as the most important constructs of predicting a specific behavior. METHODS In these secondary analyses, we examined demographic and treatment-related factors in a national sample of adult cancer patients and survivors in the United States as predictors of decisional balance (pros/cons) and self-efficacy (i.e., two core TTM constructs) of engaging in psychosocial services. Participants were recruited through an online survey. In addition to examining demographic factors (age, sex, race, and marital status) as independent variables using t tests and correlations, treatment-related variables, such as having multiple cancers, type of cancer, type of treatment, and treatment setting were included. RESULTS Four hundred and sixty-six participants completed the survey. The sample was primarily Caucasian (79%) and female (54.7%); average age was 47.9 (SD = 14.8). While no significant relationships emerged for self-efficacy, younger age and non-Caucasian race were significantly related to greater cons of seeking psychosocial care. Finally, those with multiple cancers versus reporting only one malignancy endorsed more cons of seeking psychosocial care. CONCLUSIONS These data highlight the importance of measuring the cons of seeking psychosocial care during cancer treatment, with younger age, non-Caucasian, and those reporting experience with multiple cancers endorsing greater cons. This may impact eventual uptake of available services. Future research should identify individuals at risk for declining services based on perceived cons of seeking psychosocial care during cancer.
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Affiliation(s)
- Timothy S Sannes
- Division of Adult Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, Massachusetts, USA
| | - William F Pirl
- Division of Adult Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph S Rossi
- Department of Psychology, The University of Rhode Island, Kingston, Rhode Island, USA
| | | | - Colleen A Redding
- Department of Psychology, The University of Rhode Island, Kingston, Rhode Island, USA
| | - Ginette G Ferszt
- Department of Psychology, The University of Rhode Island, Kingston, Rhode Island, USA
| | - James O Prochaska
- Department of Psychology, The University of Rhode Island, Kingston, Rhode Island, USA
| | - Ilana M Braun
- Division of Adult Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, Massachusetts, USA
| | - Miryam Yusufov
- Division of Adult Psychosocial Oncology and Palliative Care, Harvard Medical School, Boston, Massachusetts, USA
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Yusufov M, Grebstein L, Rossi JS, Redding CA, Ferszt GG, Prochaska JO. Development and Implementation of a Psychological Service for Patients With Cancer. Cognitive and Behavioral Practice 2020; 27:290-305. [DOI: 10.1016/j.cbpra.2020.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Paiva A, Redding CA, Iannone L, Zenoni M, O'Leary JR, Fried TR. Feasibility of Delivering a Tailored Intervention for Advance Care Planning in Primary Care Practice. J Am Geriatr Soc 2019; 67:1917-1921. [PMID: 31271654 DOI: 10.1111/jgs.16035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/11/2019] [Accepted: 05/21/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES To determine the feasibility of conducting a cluster randomized controlled trial providing individualized feedback reports to increase advance care planning (ACP) engagement in the primary care setting. DESIGN Pilot cluster randomized controlled trial. SETTING Two primary care practices selected for geographic colocation. PARTICIPANTS Adults aged 55 years and older. INTERVENTION Brief assessment of readiness to engage in (stage of change for) three ACP behaviors (healthcare agent assignment, communication with agent about quality vs quantity of life, and living will completion) generating an individualized feedback report, plus a stage-matched brochure. MEASURES Patient recruitment and retention, intervention delivery, baseline characteristics, and stage of change movement. RESULTS Recruitment rates differed by practice. Several baseline sociodemographic characteristics differed between the 38 intervention and 41 control participants, including employment status, education, and communication with healthcare agent. Feedback was successfully delivered to all intervention participants, and over 90% of participants completed a 2-month follow-up. More intervention participants demonstrated progression in readiness than did control participants, without testing for statistical significance. CONCLUSIONS This pilot demonstrates opportunities and challenges of performing a clustered randomized controlled trial in primary care practices. Differences in the two practice populations highlight the challenges of matching sites. There was a signal for behavior change in the intervention group. J Am Geriatr Soc 67:1917-1921, 2019.
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Affiliation(s)
- Andrea Paiva
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island.,Psychology Department, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island
| | - Colleen A Redding
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island.,Psychology Department, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island
| | - Lynne Iannone
- Program on Aging, Yale School of Medicine, New Haven, Connecticut.,Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Maria Zenoni
- Clinical Epidemiology Research Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut
| | - John R O'Leary
- Program on Aging, Yale School of Medicine, New Haven, Connecticut.,Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Terri R Fried
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut.,Clinical Epidemiology Research Center, Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut
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Rajotte JC, Hunter CE, Redding CA, Bassett SS. Initial Findings: Rhode Island's Community Health Teams Address Complex Physical, Behavioral, and Social Needs of Patient Populations. R I Med J (2013) 2019; 102:42-47. [PMID: 30943672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- James C Rajotte
- RI Department of Health, SIM Liaison and CHT Project Advisor
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Behrman P, Redding CA, Raja S, Newton T, Beharie N, Printz D. Society of Behavioral Medicine (SBM) position statement: restore CDC funding for firearms and gun violence prevention research. Transl Behav Med 2019; 8:958-961. [PMID: 29474678 DOI: 10.1093/tbm/ibx040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Society for Behavioral Medicine (SBM) urges restoration of Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research. Gun violence in the United States is an important and costly public health issue in need of research attention. Unfortunately, there have been no concerted CDC-funded research efforts in this area since 1996, due to the passage of the Dickey Amendment. To remedy the information-gathering restrictions caused by the Dickey Amendment bans, it is recommended that Congress remove 'policy riders' on federal appropriations bills that limit firearms research at the CDC; expand NVDRS firearms-related data collection efforts to include all fifty states; fund CDC research on the risk and protective factors of gun use and gun violence prevention; fund research on evidence-based primary, secondary, and tertiary prevention and treatment initiatives for communities that are seriously impacted by the effects of gun violence; and support the development of evidence-based policy and prevention recommendations for gun use and ownership.
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Affiliation(s)
- Pamela Behrman
- Department of Psychology, College of Mt. St. Vincent, Riverdale, NY, USA
| | - Colleen A Redding
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI, USA
| | - Sheela Raja
- Departments of Pediatric Dentistry and Medical Education, University of Illinois at Chicago, Chicago, IL, USA
| | - Tamara Newton
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
| | - Nisha Beharie
- Rory Meyers School of Nursing, New York University, New York, NY, USA
| | - Destiny Printz
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
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Yusufov M, Rossi JS, Grebstein L, Redding CA, Ferszt GG, Prochaska JO. Measures of psychosocial care utilization in a national sample of cancer patients. J Consult Clin Psychol 2018; 87:234-245. [PMID: 30589348 DOI: 10.1037/ccp0000369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Cancer is one of the most physically and emotionally debilitating diseases. Despite evidence that psychosocial care can improve psychological and physiological functioning, as few as 4.4% of patients are willing to engage in psychosocial treatment. Few studies explored drivers of psychosocial care underutilization. Therefore, treatment engagement strategies are needed, by identifying patients' barriers to psychosocial treatment. This study evaluated readiness to utilize psychosocial care by developing transtheoretical model (TTM) measures of stage of change, decisional balance, and self-efficacy. METHOD Online survey data was collected from a national sample of 475 adults (Mage = 47.89, SD = 14.77) with cancer diagnoses. A sequential process of measure development was used. Semistructured expert and research participant interviews were conducted for initial item development, followed by exploratory, confirmatory, and external validation analyses. RESULTS Principal components analyses (PCA) indicated two, 4-item factors (pros α = .874; cons α = .716) for decisional balance. Confirmatory factor analyses (CFA) supported a 2-factor correlated model, χ²(19) = 68.56, CFI = .962, RMSEA = .078. For self-efficacy, PCA indicated two, 3-item components (physical α = .892; social/emotional α = .708). CFA supported this structure χ²(8) = 23.72, CFI = .989, RMSEA = .067. Physical component items included fatigue, pain, and discomfort. Multivariate analyses indicated significant cross-stage differences for pros, cons, and self-efficacy. CONCLUSIONS Findings support the validity of the developed stage of change, 8-item decisional balance, and 6-item self-efficacy measures for psychosocial care. Clinicians could use these tools to address perceived cons of psychosocial care, including shame and self-efficacy (e.g., using psychosocial care despite pain). These scales may help treatment teams better address barriers to psychosocial care utilization. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Fried TR, Redding CA, Martino S, Paiva A, Iannone L, Zenoni M, Blakley LA, Rossi JS, O'Leary J. Increasing engagement in advance care planning using a behaviour change model: study protocol for the STAMP randomised controlled trials. BMJ Open 2018; 8:e025340. [PMID: 30099405 PMCID: PMC6089328 DOI: 10.1136/bmjopen-2018-025340] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/13/2018] [Accepted: 07/16/2018] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Advance care planning (ACP) is a key component of high-quality end-of-life care but is underused. Interventions based on models of behaviour change may fill an important gap in available programmes to increase ACP engagement. Such interventions are designed for broad outreach and flexibility in delivery. The purpose of the Sharing and Talking about My Preferences study is to examine the efficacy of three behaviour change approaches to increasing ACP engagement through two related randomised controlled trials being conducted in different settings (Veterans Affairs (VA) medical centre and community). METHODS AND ANALYSIS Eligible participants are 55 years or older. Participants in the community are being recruited in person in primary care and specialty outpatient practices and senior living sites, and participants in the VA are recruited by telephone. In the community, randomisation is at the level of the practice or site, with all persons at a given practice/site receiving either computer-tailored feedback with a behaviour stage-matched brochure (computer-tailored intervention (CTI)) or usual care. At the VA, randomisation is at the level of the participant and is stratified by the number of ACP behaviours completed at baseline. Participants are randomised to one of four groups: CTI, motivational interviewing, motivational enhancement therapy or usual care. The primary outcome is completion of four key ACP behaviours: identification of a surrogate decision maker, communication about goals, completing advance directives and ensuring documents are in the medical record. Analysis will be conducted using mixed effects models, taking into account the clustered randomisation for the community study. ETHICS AND RANDOMISATION The studies have been approved by the appropriate Institutional Review Boards and are being overseen by a Safety Monitoring Committee. The results of these studies will be disseminated to academic audiences and leadership in in the community and VA sites. TRIAL REGISTRATION NUMBERS NCT03137459 and NCT03103828.
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Affiliation(s)
- Terri R Fried
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Colleen A Redding
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
- Psychology Department, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Steven Martino
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Andrea Paiva
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
- Psychology Department, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - Lynne Iannone
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Program on Aging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Maria Zenoni
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Program on Aging, Yale School of Medicine, New Haven, Connecticut, USA
| | - Laura A Blakley
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Joseph S Rossi
- Cancer Prevention Research Center, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
- Psychology Department, College of Health Sciences, University of Rhode Island, Kingston, Rhode Island, USA
| | - John O'Leary
- Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Connecticut, USA
- Program on Aging, Yale School of Medicine, New Haven, Connecticut, USA
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Otterbach L, Mena NZ, Greene G, Redding CA, De Groot A, Tovar A. Community-based childhood obesity prevention intervention for parents improves health behaviors and food parenting practices among Hispanic, low-income parents. BMC Obes 2018; 5:11. [PMID: 29610670 PMCID: PMC5870387 DOI: 10.1186/s40608-018-0188-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/15/2018] [Indexed: 12/14/2022]
Abstract
Background Given the current prevalence of childhood obesity among Hispanic populations, and the importance of parental feeding behaviors, we aimed to assess the impact of the evidence-based Healthy Children, Healthy Families (HCHF) intervention on responsive food parenting practices (FPPs) in a low-income Hispanic population. Methods This community-based pilot study used a non-experimental pre/post within-subjects design. Parents (n = 94) of children aged 3-11 years old were recruited to participate in an 8-week, weekly group-based intervention. The intervention was delivered to nine groups of parents by trained paraprofessional educators over a two-year period. Children participated in a separate curriculum that covered topics similar to those covered in the parent intervention. Parents completed self-administered pre/post surveys, which included demographic questions, seven subscales from the Comprehensive Feeding Practices Questionnaire, and the 16-item HCHF Behavior Checklist. Descriptive statistics and paired samples t-tests were used to analyze data from parents that completed the intervention. Results Fifty-two, primarily Hispanic (93%) parents completed the intervention (39% attrition rate). For parents who completed the intervention, there was a significant increase in one of the feeding practice subscales: encouragement of balance and variety (p = 0.01). There were significant improvements in several parent and child diet and activity outcomes (p ≤ 0.01). Conclusions Although attrition rates were high, parents completing the study reported enjoying and being satisfied with the intervention. For parents who completed the intervention, reported 'encouragement of balance and variety', in addition to several health behaviors significantly improved. Larger studies utilizing an experimental design, should further explore the impact of the HCHF curriculum on improving certain FPPs and health behaviors that contribute to obesity.
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Affiliation(s)
- Laura Otterbach
- 1Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, 41 Lower College Rd, Kingston, RI 02881 USA
| | - Noereem Z Mena
- 1Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, 41 Lower College Rd, Kingston, RI 02881 USA
| | - Geoffrey Greene
- 1Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, 41 Lower College Rd, Kingston, RI 02881 USA
| | - Colleen A Redding
- 2Cancer Prevention Research Center and Department of Psychology, University of Rhode Island, Chafee Hall, 142 Flagg Road, Kingston, RI 02881 USA
| | - Annie De Groot
- 3Institute for Immunology and Informatics, University of Rhode Island, Shepard Building, 80 Washington Street, Providence, RI 02903 USA
| | - Alison Tovar
- 1Department of Nutrition and Food Sciences, University of Rhode Island, Fogarty Hall, 41 Lower College Rd, Kingston, RI 02881 USA
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Blaney CL, Redding CA, Paiva AL, Rossi JS, Prochaska JO, Blissmer B, Burditt CT, Nash JM, Bayley KD. Integrated Primary Care Readiness and Behaviors Scale: Development and validation in behavioral health professionals. Fam Syst Health 2018; 36:97-107. [PMID: 29608084 DOI: 10.1037/fsh0000310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Although integrated primary care (IPC) is growing, several barriers remain. Better understanding of behavioral health professionals' (BHPs') readiness for and engagement in IPC behaviors could improve IPC research and training. This study developed measures of IPC behaviors and stage of change. METHOD The sample included 319 licensed, practicing BHPs with a range of interests and experience with IPC. Sequential measurement development procedures, with split-half cross-validation were conducted. RESULTS Exploratory principal components analyses (N = 152) and confirmatory factor analyses (N = 167) yielded a 12-item scale with 2 factors: consultation/practice management (CPM) and intervention/knowledge (IK). A higher-order Integrated Primary Care Behavior Scale (IPCBS) model showed good fit to the data, and excellent internal consistencies. The multivariate analysis of variance (MANOVA) on the IPCBS demonstrated significant large-sized differences across stage and behavior groups. DISCUSSION The IPCBS demonstrated good psychometric properties and external validation, advancing research, education, and training for IPC practice. (PsycINFO Database Record
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Affiliation(s)
| | | | | | | | | | | | | | - Justin M Nash
- Department of Allied Health Sciences, University of Connecticut
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Mundorf N, Redding CA, Paiva AL. Sustainable Transportation Attitudes and Health Behavior Change: Evaluation of a Brief Stage-Targeted Video Intervention. Int J Environ Res Public Health 2018; 15:ijerph15010150. [PMID: 29346314 PMCID: PMC5800249 DOI: 10.3390/ijerph15010150] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/09/2018] [Accepted: 01/13/2018] [Indexed: 12/01/2022]
Abstract
Promoting physical activity and sustainable transportation is essential in the face of rising health care costs, obesity rates, and other public health threats resulting from lack of physical activity. Targeted communications can encourage distinct population segments to adopt active and sustainable transportation modes. Our work is designed to promote the health, social, and environmental benefits of sustainable/active transportation (ST) using the Transtheoretical Model of Change (TTM), which has been successfully applied to a range of health, and more recently, sustainability behaviors. Earlier, measurement development confirmed both the structure of ST pros and cons and efficacy measures as well as the relationship between these constructs and ST stages of change, replicating results found for many other behaviors. The present paper discusses a brief pre-post video pilot intervention study designed for precontemplators and contemplators (N = 604) that was well received, effective in moving respondents towards increased readiness for ST behavior change, and improving some ST attitudes, significantly reducing the cons of ST. This research program shows that a brief stage-targeted behavior change video can increase readiness and reduce the cons for healthy transportation choices.
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Affiliation(s)
- Norbert Mundorf
- Department of Communication Studies, Harrington School of Communication and Media, University of Rhode Island, Kingston, RI 02881, USA.
| | - Colleen A Redding
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA.
| | - Andrea L Paiva
- Cancer Prevention Research Center, Department of Psychology, College of Health Sciences, University of Rhode Island, Kingston, RI 02881, USA.
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Lipschitz JM, Paiva AL, Redding CA, Levesque D, Rossi JS, Weisberg RB, Prochaska JO. Development and Preliminary Psychometric Evaluation of Decisional Balance and Self-Efficacy Measures for Managing Anxiety in a National Sample of Clinically Anxious Adults. Am J Health Promot 2018; 32:215-223. [PMID: 27670270 DOI: 10.1177/0890117116669493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance from a transtheoretical model (TTM) perspective could facilitate tailored approaches for individuals with low readiness. This study developed and examined psychometric properties of TTM measures for addressing anxiety-based avoidance. DESIGN Cross-sectional survey. SETTING Community centers, online survey. PARTICIPANTS Five hundred ninety-four individuals aged 18 to 70 with clinically significant anxiety. MEASURES Overall Anxiety Severity Questionnaire, stages of change, decisional balance, and self-efficacy. ANALYSIS The sample was randomly split into halves for principal component analyses (PCAs) and confirmatory factor analyses (CFAs) to test measurement models. Further analyses examined relationships between constructs. RESULTS For decisional balance, PCA indicated two 5-item factors (pros and cons). Confirmatory factor analysis supported a 2-factor correlated model, Satorra-Bentler scaled chi-square [Formula: see text], comparative fit index (CFI = 0.94), root mean square error of approximation (RMSEA = 0.07), pros: α = 0.87, ρ = 0.87, cons: α = 0.75, and ρ = 0.75. For self-efficacy, PCA indicated one 6-item factor supported by CFA, [Formula: see text], P < .01, CFI = 0.98, RMSEA = 0.09, α = 0.90, ρ = 0.87. As hypothesized, significant cross-stage differences were observed for pros and self-efficacy, and significant relationships between anxiety severity and pros, cons, and self-efficacy were found. CONCLUSION Findings show strong psychometric properties and support the application of a readiness-based model to anxiety. In contrast to findings of other behaviors, cons remain high in action and maintenance. These measures provide a solid empirical foundation to develop TTM-tailored interventions to enhance engagement in treatment.
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Affiliation(s)
| | - Andrea L Paiva
- 2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Colleen A Redding
- 2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Deborah Levesque
- 2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Joseph S Rossi
- 2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | | | - James O Prochaska
- 2 Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
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Brick LA, Redding CA, Paiva AL, Velicer WF. Intervention effects on stage transitions for adolescent smoking and alcohol use acquisition. Psychology of Addictive Behaviors 2017; 31:614-624. [DOI: 10.1037/adb0000302] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brick LA, Redding CA, Paiva AL, Harlow LL, Velicer WF. Intervention Effects on Stage of Change Membership and Transitions among Adolescent Energy Balance Behaviors. Multivariate Behav Res 2017; 52:485-498. [PMID: 28426252 PMCID: PMC9795490 DOI: 10.1080/00273171.2017.1309518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The transition from childhood to adolescence is a crucial period for the development of healthy behaviors to be sustained later in life. With obesity a leading public health problem, the promotion of healthy behaviors has the potential to make a huge impact. The current study evaluated Stage of Change progression in a large (N = 4158) computer-delivered, Transtheoretical Model-tailored intervention focusing on physical activity and fruit and vegetable consumption (FV). Markov models were used to explore stage transitions and patterns of discrete change from sixth to ninth grade. Nested model comparisons examined the consistency of these patterns across time and intervention condition. Major findings supported models in which participants were free to transition forward and backward to any of the stages, but higher probabilities were observed for remaining in the same stage or for transitioning one or two stages forward. Participants in the intervention group had higher probabilities of transitioning toward Maintenance, with more change occurring relative to the comparison group during transitions from grades six to eight but not for grades eight to nine.
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Affiliation(s)
- Leslie A. Brick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
- University of Rhode Island, Cancer Prevention Research Center, Kingston, Rhode Island
- University of Rhode Island, Department of Psychology, Kingston, Rhode Island
| | - Colleen A. Redding
- University of Rhode Island, Cancer Prevention Research Center, Kingston, Rhode Island
- University of Rhode Island, Department of Psychology, Kingston, Rhode Island
| | - Andrea L. Paiva
- University of Rhode Island, Cancer Prevention Research Center, Kingston, Rhode Island
- University of Rhode Island, Department of Psychology, Kingston, Rhode Island
| | - Lisa L. Harlow
- University of Rhode Island, Department of Psychology, Kingston, Rhode Island
| | - Wayne F. Velicer
- University of Rhode Island, Cancer Prevention Research Center, Kingston, Rhode Island
- University of Rhode Island, Department of Psychology, Kingston, Rhode Island
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Sillice MA, Babbin SF, Paiva AL, Redding CA, Rossi JS, Velicer WF. Assessing demographic differences in decisional balance for smoking prevention and temptations to try smoking among adolescent subgroups. Tob Prev Cessat 2017; 3:14. [PMID: 32432188 PMCID: PMC7232824 DOI: 10.18332/tpc/70562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 04/10/2017] [Accepted: 04/19/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cigarette smoking initiation remains prevalent in adolescence. Effective prevention methods are needed to dissuade this behavior. Demographic factors are identified as important risk factors in the developmental nature of smoking in adolescence. The current study investigates potential demographic differences for two new trans-theoretical model measures, the Decisional Balance Inventory (pros and cons) for Smoking Prevention and the Temptations to Try Smoking Scale. METHODS A sample of 6th grade Rhode Island students from 20 middle schools (N = 4151) who were participating in a longitudinal and computer-delivered intervention for substance abuse prevention was assessed on these measures at baseline. Three MANOVA tests were conducted to assess the impact of race (White vs. Non-White), ethnicity (Hispanic vs. Non-Hispanic) and gender (male vs female). RESULTS Significant effects for race and ethnicity were found for Decisional Balance and Temptations to Try Smoking. For race, Whites reported lesser pros (p <.0001) and Non-Whites reported higher cons (p <.0001) and temptations to try smoking (p <.0001). Differences for ethnicity showed that Hispanics were higher on pros (p <.0001) and temptations to try smoking (p <.0001) than Non-Hispanics. Non-Hispanics reported higher cons (p <.0001). Gender differences were noted only for temptations to try smoking, and showed females were higher on this construct than males (p <.0001). The effect sizes were .01 or below. CONCLUSIONS The results did not demonstrate a strong association between these demographics and constructs, suggesting that tailored prevention methods based solely on these factors may not dissuade smoking in this group.
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Affiliation(s)
- Marie A. Sillice
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, United States
| | - Steven F. Babbin
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, United States
| | - Andrea L. Paiva
- Cancer Prevention Research Center and Department of Psychology, University of Rhode Island, Kingston, United States
| | - Colleen A. Redding
- Cancer Prevention Research Center and Department of Psychology, University of Rhode Island, Kingston, United States
| | - Joseph S. Rossi
- Cancer Prevention Research Center and Department of Psychology, University of Rhode Island, Kingston, United States
| | - Wayne F. Velicer
- Cancer Prevention Research Center and Department of Psychology, University of Rhode Island, Kingston, United States
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Abstract
The fourteen-factor Processes of Change Scale for Sun Protection assesses behavioral and experiential strategies that underlie the process of sun protection acquisition and maintenance. Variations of this measure have been used effectively in several randomized sun protection trials, both for evaluation and as a basis for intervention. However, there are no published studies, to date, that evaluate the psychometric properties of the scale. The present study evaluated factorial invariance and scale reliability in a national sample (N = 1360) of adults involved in a Transtheoretical model tailored intervention for exercise and sun protection, at baseline. Invariance testing ranged from least to most restrictive: Configural Invariance (constraints only factor structure and zero loadings); Pattern Identity Invariance (equal factor loadings across target groups); and Strong Factorial Invariance (equal factor loadings and measurement errors). Multi-sample structural equation modeling tested the invariance of the measurement model across seven subgroups: age, education, ethnicity, gender, race, skin tone, and Stage of Change for Sun Protection. Strong factorial invariance was found across all subgroups. Internal consistency coefficient Alpha and factor rho reliability, respectively, were .83 and .80 for behavioral processes, .91 and .89 for experiential processes, and .93 and .91 for the global scale. These results provide strong empirical evidence that the scale is consistent, has internal validity and can be used in research interventions with population-based adult samples.
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Affiliation(s)
- Marie A Sillice
- a Department of Psychiatry and Human Behavior , Alpert Medical School, Brown University, Centers for Behavioral and Preventive Medicine, The Miriam Hospital , Providence RI , USA
| | - Steven F Babbin
- b Cancer Prevention Research Center and Department of Psychology , University of Rhode Island , Kingston , RI , USA
| | - Colleen A Redding
- b Cancer Prevention Research Center and Department of Psychology , University of Rhode Island , Kingston , RI , USA
| | - Joseph S Rossi
- b Cancer Prevention Research Center and Department of Psychology , University of Rhode Island , Kingston , RI , USA
| | - Andrea L Paiva
- b Cancer Prevention Research Center and Department of Psychology , University of Rhode Island , Kingston , RI , USA
| | - Wayne F Velicer
- b Cancer Prevention Research Center and Department of Psychology , University of Rhode Island , Kingston , RI , USA
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Yang S, Harlow LL, Puggioni G, Redding CA. A comparison of different methods of zero-inflated data analysis and an application in health surveys. J Mod App Stat Meth 2017. [DOI: 10.22237/jmasm/1493598600] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Brick LAD, Yang S, Harlow LL, Redding CA, Prochaska JO. Longitudinal analysis of intervention effects on temptations and stages of change for dietary fat using parallel process latent growth modeling. J Health Psychol 2016; 24:572-585. [PMID: 27888255 DOI: 10.1177/1359105316679723] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Dietary Guidelines for Americans recommend a 20-35 percent daily intake of fat. Resisting the temptation to eat high-fat foods, in conjunction with stage of readiness to avoid these foods, has been shown to influence healthy behavior change. Data ( N = 6516) from three randomized controlled trials were pooled to examine the relationships among direct intervention effects on temptations and stage of change for limiting high-fat foods. Findings demonstrate separate simultaneous growth processes in which baseline level of temptations, but not the rate of change in temptations, was significantly related to the change in readiness to avoid high-fat foods.
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Affiliation(s)
- Leslie Ann D Brick
- 1 Rhode Island Hospital, USA.,2 Alpert Medical School at Brown University, USA
| | - Si Yang
- 3 University of Rhode Island, USA
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Weiss SM, Zulu R, Jones DL, Redding CA, Cook R, Chitalu N. The Spear and Shield intervention to increase the availability and acceptability of voluntary medical male circumcision in Zambia: a cluster randomised controlled trial. Lancet HIV 2016; 2:e181-9. [PMID: 26120594 PMCID: PMC4478609 DOI: 10.1016/s2352-3018(15)00042-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Widespread voluntary medical male circumcision (VMMC) in Africa could avert an estimated 3·436 million HIV infections and 300,000 deaths over the next 10 years. Most Zambian men, however, have expressed little interest in undergoing VMMC. This study tested the effect of an intervention designed to increase demand for VMMC among these “hard to reach” men. Methods This cluster randomized controlled trial was conducted from 2012 to 2014 in Lusaka, Zambia (HIV prevalence = 20·8%). 13 Community Health Centers (CHCs) were stratified by HIV voluntary counseling and testing (VCT) rates and patient census and randomly assigned (5:5:3) to Experimental, Control or Observation Only conditions. CHC health care providers at all 13 sites received VMMC training. Trial statisticians did not participate in randomization. 800 uncircumcised HIV-, post-VCT men, 400 per condition, were recruited; female partners were invited to participate. The primary outcome was the likelihood of VMMC by 12 months post-intervention. The trial registration is NCT 01688167. Findings 161 participants in the Experimental condition underwent VMMC as compared to 96 Control participants [adjusted odds ratio = 2·45, 95% CI = (1·24, 4·90) p = ·0166]. Post-VMMC condom use among Experimental condition participants increased compared to baseline, with no change among Control participants. No adverse events related to study participation were reported. Interpretation The Spear and Shield intervention combined with VMMC training was associated with a significant increase in the number of VMMCs performed as well as in condom use among “hard to reach” Zambian men. Results support the importance of comprehensive HIV prevention programs that increase supply of and demand for VMMC services. Funding NIH/NIMH R01MH095539.
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Yusufov M, Prochaska JO, Paiva AL, Rossi JS, Blissmer B, Redding CA, Velicer WF. Baseline Predictors of Singular Action Among Participants With Multiple Health Behavior Risks. Am J Health Promot 2016; 30:365-73. [PMID: 27404645 DOI: 10.1177/0890117116646341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Previous studies found that treatment effects can change two behaviors, but not one. This study examined baseline transtheoretical model constructs as three alternative predictors (stage of change, effort, and severity) of singular action among participants with co-occurring health behavior risks. DESIGN The study examined participants at risk for three pairs of behaviors (sun and smoking; smoking and diet; and diet and sun). Analyses were conducted with participants who changed only one behavior in a pair (singular action). SETTING School and home-based behavior change programs recruited participants via schools, worksites, and physician practices. School, worksite, medical, and home-based prevention programs were the study setting. SUBJECTS The sample (N = 3213) was age 44.6 years (SD, 11.1 years), 94.6% white, and 63.7% female. MEASURES Stages of change, effort, and severity variables were measured. ANALYSIS Pooled data were analyzed using logistic regressions from three randomized controlled trials. RESULTS Across all three behaviors, stage of change, effort, and severity effects were consistently related to behavior change at 24 months. Change efforts on one behavior were related to change on another behavior. Baseline sun severity (odds ratio, .97 [.94, 1.00]; p = .046) and smoking severity (odds ratio, .89 [.80, .98]; p = .019) were significant predictors of change on diet at final follow-up. CONCLUSION Stage of change was the biggest predictor. Problem severity was the smallest predictor of change at 2-year follow-up. Four of six predictors were within behaviors, whereas two were between.
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Affiliation(s)
- Miryam Yusufov
- Cancer Prevention Research Center and the Department of Psychology, University of Rhode Island, RI, USA
| | - James O Prochaska
- Cancer Prevention Research Center and the Department of Psychology, University of Rhode Island, RI, USA
| | - Andrea L Paiva
- Cancer Prevention Research Center and the Department of Psychology, University of Rhode Island, RI, USA
| | - Joseph S Rossi
- Cancer Prevention Research Center and the Department of Psychology, University of Rhode Island, RI, USA
| | - Bryan Blissmer
- Cancer Prevention Research Center and the Department of Kinesiology, University of Rhode Island, Kingston, RI, USA
| | - Colleen A Redding
- Cancer Prevention Research Center and the Department of Psychology, University of Rhode Island, RI, USA
| | - Wayne F Velicer
- Cancer Prevention Research Center and the Department of Psychology, University of Rhode Island, RI, USA Cancer Prevention Research Center and the Department of Kinesiology, University of Rhode Island, Kingston, RI, USA
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Redding CA, Jones D, Zulu R, Chitalu N, Cook R, Weiss SM. Stages of Change for Voluntary Medical Male Circumcision and Sexual Risk Behavior in Uncircumcised Zambian Men: The Spear and Shield Project. Int J Behav Med 2016; 22:799-806. [PMID: 25896876 DOI: 10.1007/s12529-015-9485-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dissemination and scale up of voluntary medical male circumcision (VMMC) programs is well supported by evidence that VMMC reduces HIV risk in populations with high HIV prevalence and low rates of circumcision, as is the case in Zambia. PURPOSE At both individual and population levels, it is important to understand what stages of change for VMMC are associated with, especially across cultures. This study evaluated VMMC knowledge, misinformation, and stages of change for VMMC of uncircumcised men and boys (over 18 years), as well as the concurrent relationship between VMMC stages of change and sexual risk behaviors. METHOD Uncircumcised (N = 800) adult men and boys (over 18) were screened and recruited from urban community health centers in Lusaka, Zambia, where they then completed baseline surveys assessing knowledge, attitudes, HIV risk behaviors, and stages of change for VMMC. A series of analyses explored cross-sectional relationships among these variables. RESULTS VMMC was culturally acceptable in half of the sample; younger, unmarried, and more educated men were more ready to undergo VMMC. Stage of change for VMMC was also related to knowledge, and those at greater HIV risk reported greater readiness to undergo VMMC. CONCLUSIONS Efforts to increase VMMC uptake should address the role of perceived HIV risk, risk behaviors, readiness, accurate knowledge, cultural acceptance, and understanding of the significant degree of HIV protection conferred as part of the VMMC decision making process. These results support incorporating comprehensive HIV risk reduction in VMMC promotion programs.
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Affiliation(s)
- Colleen A Redding
- University of Rhode Island, 130 Flagg Rd., Kingston, RI, 02881, USA.
| | - Deborah Jones
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Robert Zulu
- University of Zambia School of Medicine, Lusaka, Zambia
| | | | - Ryan Cook
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stephen M Weiss
- University of Miami Miller School of Medicine, Miami, FL, USA
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Fried TR, Redding CA, Robbins ML, Paiva AL, O'Leary JR, Iannone L. Development of Personalized Health Messages to Promote Engagement in Advance Care Planning. J Am Geriatr Soc 2016; 64:359-64. [PMID: 26804791 DOI: 10.1111/jgs.13934] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop and test the acceptability of personalized intervention materials to promote advance care planning (ACP) based on the Transtheoretical Model (TTM), in which readiness to change is a critical organizing construct. DESIGN Development study creating an expert system delivering TTM-personalized feedback reports and stage-matched brochures with more-general information on ACP and modifications based on participant reviews. SETTING Senior centers. PARTICIPANTS Community-living persons aged 65 and older (N = 77). MEASUREMENTS Participant ratings of length, attractiveness, and trustworthiness of and reactions to reports and brochures. RESULTS The expert system assessed participants' readiness to engage in each of four ACP behaviors: completion of a living will, naming a health care proxy, communication with loved ones about quality vs quantity of life, and communication with clinicians about quality vs quantity of life. The system also assessed pros and cons of engagement and values and beliefs that influence engagement. The system provided individualized feedback based on the assessment, with brochures providing additional general information. Initial participant review indicating unacceptable length led to revision of feedback reports from full-sentence paragraph format to bulleted format. After review, the majority of participants rated the materials as easy to read, trustworthy, providing new information, making them more comfortable reading about ACP, and increasing interest in participating in ACP. CONCLUSION Older adults found an expert system individualized feedback report and accompanying brochure to promote ACP engagement to highly acceptable and engaging. Additional research is necessary to examine the effects of these materials on behavior change.
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Affiliation(s)
- Terri R Fried
- Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut.,Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut
| | - Colleen A Redding
- Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island
| | - Mark L Robbins
- Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island
| | - Andrea L Paiva
- Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island
| | - John R O'Leary
- Program on Aging, School of Medicine, Yale University, New Haven, Connecticut
| | - Lynne Iannone
- Program on Aging, School of Medicine, Yale University, New Haven, Connecticut
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Lipschitz JM, Yusufov M, Paiva A, Redding CA, Rossi JS, Johnson S, Blissmer B, Gokbayrak NS, Velicer WF, Prochaska JO. Transtheoretical Principles and Processes for Adopting Physical Activity: A Longitudinal 24-Month Comparison of Maintainers, Relapsers, and Nonchangers. J Sport Exerc Psychol 2015; 37:592-606. [PMID: 26866767 DOI: 10.1123/jsep.2014-0329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This study examined longitudinal differences in use of transtheoretical model (TTM) behavior change constructs in maintainers (who reached and maintained exercise guidelines), relapsers (who reached guidelines, then regressed), and nonchangers (who did not reach guidelines). Data from two population-based TTM-tailored randomized trial intervention groups targeting exercise behavior (N = 1050) were pooled, and analyses assessed differences in TTM constructs between the three groups at baseline, 12 months, and 24 months. Findings indicated that relapsers tended to use TTM variables similarly to maintainers with the exception of self-efficacy, consciousness raising, and most behavioral processes of change, at 24 months. Nonchangers, however, used all TTM variables less than maintainers at nearly every time point. Findings suggest that relapsers remain more active than nonchangers in terms of use of change processes. Poor response to interventions (nonchangers) may be predicted by low baseline engagement in change processes. Although relapsers reverted to physical inactivity, their overall greater use of TTM constructs suggests that their efforts to change remain better than those of the stable nonchanger group. Future research can focus on treatment engagement strategies to help the stable nonchangers initiate change and to help relapsers to maintain treatment gains.
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Affiliation(s)
- Jessica M Lipschitz
- Department of Psychology and with the Cancer Prevention Research Center, University of Rhode Island, Kingston, Rhode Island
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Yusufov M, Paiva AL, Redding CA, Lipschitz JM, Gokbayrak NS, Greene G, Rossi JS, Blissmer B, Velicer WF, Prochaska JO. Fat Reduction Efforts. Health Promot Pract 2015; 17:116-26. [DOI: 10.1177/1524839915606423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This research examined dynamic transtheoretical model (TTM) constructs for dietary fat reduction. This secondary data analysis pooled three large population-based TTM-tailored school, worksite, medical, and home-based intervention studies and examined use of constructs across three groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. The criteria for successful change, at the time, were that less than 30% of calories came from fat. A total of 2,718 adults met criteria for an unhealthy diet at baseline. The majority of participants were female, White, married, and middle-aged. Demographics, Stage of Change, Processes of Change, Decisional Balance, and Temptations were measured. Dynatype groups were assessed with reliable and valid scales assessing constructs at baseline and 6, 12, and 24 months. Analyses included a multivariate analysis of variance followed by a series of analyses of variance, with Tukey follow-up tests assessing differences in use of TTM constructs across the three groups at each time point. Relapsers and Maintainers were similar in their use of all TTM Processes of Change at baseline, with the exception of Self-Liberation (η2 = 0.15, p < .001) and Reinforcement Management (η2 = 0.01, p < .001). Although Relapsers reverted to an unhealthy diet, their overall greater use of Processes of Change suggests that their behaviors and strategy use remain better than that of the Stable Non-Changer group. Results suggest that specific cognitive and behavioral constructs may contribute differentially to intervention outcomes.
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Abstract
BACKGROUND Traditional null hypothesis significance testing suffers many limitations and is poorly adapted to theory testing. PURPOSE A proposed alternative approach, called Testing Theory-based Quantitative Predictions, uses effect size estimates and confidence intervals to directly test predictions based on theory. METHOD This paper replicates findings from previous smoking studies and extends the approach to diet and sun protection behaviors using baseline data from a Transtheoretical Model behavioral intervention (N = 5407). Effect size predictions were developed using two methods: (1) applying refined effect size estimates from previous smoking research or (2) using predictions developed by an expert panel. RESULTS Thirteen of 15 predictions were confirmed for smoking. For diet, 7 of 14 predictions were confirmed using smoking predictions and 6 of 16 using expert panel predictions. For sun protection, 3 of 11 predictions were confirmed using smoking predictions and 5 of 19 using expert panel predictions. CONCLUSION Expert panel predictions and smoking-based predictions poorly predicted effect sizes for diet and sun protection constructs. Future studies should aim to use previous empirical data to generate predictions whenever possible. The best results occur when there have been several iterations of predictions for a behavior, such as with smoking, demonstrating that expected values begin to converge on the population effect size. Overall, the study supports necessity in strengthening and revising theory with empirical data.
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Affiliation(s)
- Leslie Ann D Brick
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, UK.
| | - Wayne F Velicer
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, UK
| | - Colleen A Redding
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, UK
| | - Joseph S Rossi
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, UK
| | - James O Prochaska
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, UK
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Yusufov M, Prochaska JO, Paiva AL, Rossi JS, Blissmer B, Redding CA, Velicer WF. Baseline Predictors of Singular Action Among Participants With Multiple Health Behavior Risks. Am J Health Promot 2015. [DOI: 10.4278/ajhp.140521-quan-220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Redding CA, Prochaska JO, Armstrong K, Rossi JS, Hoeppner BB, Sun X, Kobayashi H, Yin HQ, Coviello D, Evers K, Velicer WF. Randomized trial outcomes of a TTM-tailored condom use and smoking intervention in urban adolescent females. Health Educ Res 2015; 30:162-78. [PMID: 24794584 PMCID: PMC4296884 DOI: 10.1093/her/cyu015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 03/18/2014] [Indexed: 06/03/2023]
Abstract
Smoking and sexual risk behaviors in urban adolescent females are prevalent and problematic. Family planning clinics reach those who are at most risk. This randomized effectiveness trial evaluated a transtheoretical model (TTM)-tailored intervention to increase condom use and decrease smoking. At baseline, a total of 828 14- to 17-year-old females were recruited and randomized within four urban family planning clinics. Participants received TTM or standard care (SC) computerized feedback and stage-targeted or SC counseling at baseline, 3, 6 and 9 months. Blinded follow-up telephone surveys were conducted at 12 and 18 months. Analyses revealed significantly more consistent condom use in the TTM compared with the SC group at 6 and 12, but not at 18 months. In baseline consistent condom users (40%), significantly less relapse was found in the TTM compared with the SC group at 6 and 12, but not at 18 months. No significant effects for smoking prevention or cessation were found, although cessation rates matched those found previously. This TTM-tailored intervention demonstrated effectiveness for increasing consistent condom use at 6 and 12 months, but not at 18 months, in urban adolescent females. This intervention, if replicated, could be disseminated to promote consistent condom use and additional health behaviors in youth at risk.
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Affiliation(s)
- Colleen A Redding
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - James O Prochaska
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Kay Armstrong
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Joseph S Rossi
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Bettina B Hoeppner
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Xiaowu Sun
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Hisanori Kobayashi
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Hui-Qing Yin
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Donna Coviello
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Kerry Evers
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
| | - Wayne F Velicer
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Road, Kingston, RI 02881 and Family Planning Council of Pennsylvania, Philadelphia, PA 19103, USA
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Babbin SF, Velicer WF, Paiva AL, Brick LAD, Redding CA. Replicating cluster subtypes for the prevention of adolescent smoking and alcohol use. Addict Behav 2015; 40:57-65. [PMID: 25222849 DOI: 10.1016/j.addbeh.2014.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 08/29/2014] [Accepted: 09/01/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Substance abuse interventions tailored to the individual level have produced effective outcomes for a wide variety of behaviors. One approach to enhancing tailoring involves using cluster analysis to identify prevention subtypes that represent different attitudes about substance use. This study applied this approach to better understand tailored interventions for smoking and alcohol prevention. METHODS Analyses were performed on a sample of sixth graders from 20 New England middle schools involved in a 36-month tailored intervention study. Most adolescents reported being in the Acquisition Precontemplation (aPC) stage at baseline: not smoking or not drinking and not planning to start in the next six months. For smoking (N=4059) and alcohol (N=3973), each sample was randomly split into five subsamples. Cluster analysis was performed within each subsample based on three variables: Pros and Cons (from Decisional Balance Scales), and Situational Temptations. RESULTS Across all subsamples for both smoking and alcohol, the following four clusters were identified: (1) Most Protected (MP; low Pros, high Cons, low Temptations); (2) Ambivalent (AM; high Pros, average Cons and Temptations); (3) Risk Denial (RD; average Pros, low Cons, average Temptations); and (4) High Risk (HR; high Pros, low Cons, and very high Temptations). CONCLUSIONS Finding the same four clusters within aPC for both smoking and alcohol, replicating the results across the five subsamples, and demonstrating hypothesized relations among the clusters with additional external validity analyses provide strong evidence of the robustness of these results. These clusters demonstrate evidence of validity and can provide a basis for tailoring interventions.
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Affiliation(s)
- Steven F Babbin
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Wayne F Velicer
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA.
| | - Andrea L Paiva
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Leslie Ann D Brick
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Colleen A Redding
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
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Weller KE, Greene GW, Redding CA, Paiva AL, Lofgren I, Nash JT, Kobayashi H. Development and validation of green eating behaviors, stage of change, decisional balance, and self-efficacy scales in college students. J Nutr Educ Behav 2014; 46:324-333. [PMID: 24613445 DOI: 10.1016/j.jneb.2014.01.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Revised: 12/30/2013] [Accepted: 01/02/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To develop and validate an instrument to assess environmentally conscious eating (Green Eating [GE]) behavior (BEH) and GE Transtheoretical Model constructs including Stage of Change (SOC), Decisional Balance (DB), and Self-efficacy (SE). DESIGN Cross-sectional instrument development survey. SETTING/PARTICIPANTS Convenience sample (n = 954) of 18- to 24-year-old college students from a northeastern university. ANALYSIS The sample was randomly split: (N1) and (N2). N1 was used for exploratory factor analyses using principal components analyses; N2 was used for confirmatory analyses (structural modeling) and reliability analyses (coefficient α). The full sample was used for measurement invariance (multi-group confirmatory analyses) and convergent validity (BEH) and known group validation (DB and SE) by SOC using analysis of variance. RESULTS Reliable (α > .7), psychometrically sound, and stable measures included 2 correlated 5-item DB subscales (Pros and Cons), 2 correlated SE subscales (school [5 items] and home [3 items]), and a single 6-item BEH scale. Most students (66%) were in Precontemplation and Contemplation SOC. Behavior, DB, and SE scales differed significantly by SOC (P < .001) with moderate to large effect sizes, as predicted by the Transtheoretical Model, which supported the validity of these measures. CONCLUSIONS AND IMPLICATIONS Successful development and preliminary validation of this 25-item GE instrument provides a basis for assessment as well as development of tailored interventions for college students.
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Affiliation(s)
- Kathryn E Weller
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Geoffrey W Greene
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI.
| | - Colleen A Redding
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI
| | - Andrea L Paiva
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI
| | - Ingrid Lofgren
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Jessica T Nash
- Department of Nutrition and Food Sciences, University of Rhode Island, Kingston, RI
| | - Hisanori Kobayashi
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI
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Sillice MA, Paiva AL, Babbin SF, McGee HA, Rossi JS, Redding CA, Meier KS, Oatley K, Velicer WF. Testing demographic differences for alcohol use initiation among adolescents for the decisional balance and situational temptation prevention inventories. Addict Behav 2014; 39:1367-71. [PMID: 24916916 PMCID: PMC4089390 DOI: 10.1016/j.addbeh.2014.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 04/02/2014] [Accepted: 04/08/2014] [Indexed: 10/25/2022]
Abstract
Alcohol use by middle school-aged students is a public health concern because of the numerous adverse social, health and psychological outcomes. Prevention programs attempt to intervene before alcohol use begins. A tailored, computer-delivered program for the prevention of alcohol use and a series of new transtheoretical model measures were developed, including decisional balance (Pros and Cons) of alcohol use and Situational Temptations to Try Alcohol. This study investigated if there were any demographic differences on these measures in a sample of 6th grade middle school students from 20 schools (N=4151) at baseline. Three factorial analysis of variance tests were conducted to explore the impact of race (whites vs. non-whites), ethnicity (Hispanics vs. Non-Hispanics) and gender (males vs. females). A significant two-way interaction effect was found between gender and ethnicity for Pros of Alcohol Use. A significant three-way interaction effect was found between gender, race and ethnicity for Cons of Alcohol Use. Main effects were found for the three demographic factors for Situational Temptations to Try Alcohol. However, the effect sizes for the interaction effects and main effects were very small (all below η(2)=.01), suggesting that race/ethnicity and gender alone may not be highly influential factors in the Decisional Balance for the Prevention of Alcohol and Situational Temptations to Try Alcohol in adolescence. The implications for these results and alcohol use prevention among this group are discussed.
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Affiliation(s)
- Marie A Sillice
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Andrea L Paiva
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Steven F Babbin
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Heather A McGee
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Joseph S Rossi
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Colleen A Redding
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Kathryn S Meier
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Karin Oatley
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA
| | - Wayne F Velicer
- Cancer Prevention Research Center, University of Rhode Island, Kingston, RI, USA.
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Redding CA, Mundorf N, Kobayashi H, Brick L, Horiuchi S, Paiva AL, Prochaska JO. Sustainable transportation stage of change, decisional balance, and self-efficacy scale development and validation in two university samples. Int J Environ Health Res 2014; 25:241-253. [PMID: 25089023 DOI: 10.1080/09603123.2014.938025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Single occupancy vehicle (SOV) transportation is a key contributor to climate change and air pollution. Sustainable transportation (ST), commuting by any means other than SOV, could both slow climate change and enhance public health. The transtheoretical model (TTM) provides a useful framework for examining how people progress towards adopting ST. Short valid and reliable measures for ST decisional balance, self-efficacy, and climate change doubt were developed and their relationship with stages of change was examined. Two large university-based volunteer samples participated in measurement studies. Using multiple procedures, three brief internally consistent measures were developed: decisional balance, self-efficacy, and climate change doubt. The stages of change correctly discriminated both decisional balance and self-efficacy, as well as replicated hypothesized relationships. Climate change doubt did not vary by stages; however, it may prove useful in future studies. Results support the validation of these measures and the application of the TTM to ST.
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Affiliation(s)
- Colleen A Redding
- a CPRC/Psychology , University of Rhode Island , Kingston , NY , USA
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Fiske L, Fallon EA, Blissmer B, Redding CA. Prevalence of body dissatisfaction among United States adults: review and recommendations for future research. Eat Behav 2014; 15:357-65. [PMID: 25064281 DOI: 10.1016/j.eatbeh.2014.04.010] [Citation(s) in RCA: 124] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 03/12/2014] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
As the evidence supporting the role of body dissatisfaction (BD) in chronic disease risk factors and health behaviors increases, documenting the prevalence of BD is an essential first step in determining to what degree BD is a public health problem. Therefore, the primary purpose of this study is to critically evaluate research examining the population prevalence of BD among U.S. adults. Seven studies were located and provided estimates of prevalence of BD among U.S. adults that were extremely varied (11%-72% for women, and 8%-61% for men). While some of the variation may be due to increases in BD over time, the literature is also clouded by a lack of randomly selected samples, lack of consistency in measurement tools, lack of consistency in operational definitions of BD, and lack of standardized cut-off points for BD. Recommendations for improving BD prevalence research to enable public health research are provided.
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Affiliation(s)
- Lauren Fiske
- Interdisciplinary Health Studies Program, University of Rhode Island, 25 West Independence Way, Suite P, Kingston, RI 02881, United States
| | - Elizabeth A Fallon
- Interdisciplinary Health Studies Program, University of Rhode Island, 25 West Independence Way, Suite P, Kingston, RI 02881, United States; Department of Kinesiology & Health, Georgia State University, P.O. Box 3975, Atlanta, GA 30302, United States.
| | - Bryan Blissmer
- Department of Kinesiology, University of Rhode Island, 25 West Independence Way, Suite P, Kingston, RI 02881, United States
| | - Colleen A Redding
- Cancer Prevention Research Center, Department of Psychology, University of Rhode Island, Kingston, RI 02881, United States
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Yin HQ, Rossi JS, Redding CA. Abstract: Longitudinal Examination of Situational Temptations for Smoking in Adult Smokers. Multivariate Behav Res 2014; 49:302-303. [PMID: 26735208 DOI: 10.1080/00273171.2014.912932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Jones D, Cook R, Arheart K, Redding CA, Zulu R, Castro J, Weiss SM. Acceptability, knowledge, beliefs, and partners as determinants of Zambian men's readiness to undergo medical male circumcision. AIDS Behav 2014; 18:278-84. [PMID: 23757123 DOI: 10.1007/s10461-013-0530-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is limited information about the influence of partners on medical male circumcision (MMC) uptake. This study aimed to evaluate attitudes, knowledge, and preferences about MMC among men and their partners, and their relative impact on male readiness to undergo the MMC procedure. Male participants (n = 354) and their partners (n = 273) were recruited from community health centers in Lusaka, Zambia. Men reported their readiness to undergo MMC, and both men and women were assessed regarding their attitudes and knowledge regarding MMC. Men who had discussed MMC with their partners, those who endorsed MMC for HIV risk reduction, and those viewing MMC as culturally acceptable reported increased readiness to undergo MMC. Additionally, endorsement of MMC by female partners was associated with increased men's readiness. Results support promotion of cultural acceptability of MMC, and efforts to increase MMC uptake may benefit from incorporating partners in the decision making process.
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Affiliation(s)
- Deborah Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave. Suite 404A, Miami, FL, 33136, USA,
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Paiva AL, Lipschitz JM, Fernandez AC, Redding CA, Prochaska JO. Evaluation of the acceptability and feasibility of a computer-tailored intervention to increase human papillomavirus vaccination among young adult women. J Am Coll Health 2014; 62:32-38. [PMID: 24313694 DOI: 10.1080/07448481.2013.843534] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine acceptability and feasibility of a Transtheoretical Model (TTM)-based computer-tailored intervention (CTI) for increasing human papillomavirus (HPV) vaccination in college-aged women. PARTICIPANTS Two hundred forty-three women aged 18-26 were recruited between February and May of 2011. METHODS Participants completed the intervention and a 14-item evaluation of intervention content and delivery. RESULTS Most participants had heard of HPV (91%), but the majority (57%) of participants were in Precontemplation for getting vaccinated. Eighty-nine percent of participants rated the CTI positively across all acceptability items, and 91% endorsed intention to get vaccinated after intervention. Although average ratings in each demographic subgroup were positive, Hispanic women and participants in more advanced stages of change rated the program more favorably than non-Hispanic and earlier-stage participants. Additionally, HPV knowledge was higher among white/non-Hispanic participants. CONCLUSIONS Initial acceptability and feasibility data for this intervention are promising. Its computer-based, individually tailored format is state of the art and ideal for inexpensive dissemination.
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Affiliation(s)
- Andrea L Paiva
- a Cancer Prevention Research Center , University of Rhode Island , Kingston , Rhode Island
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Lipschitz JM, Paiva AL, Redding CA, Butterworth S, Prochaska JO. Co-occurrence and coaction of stress management with other health risk behaviors. J Health Psychol 2013; 20:1002-12. [PMID: 24165862 DOI: 10.1177/1359105313506026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study provides a preliminary investigation of the role of stress management in multiple behavior change. Risk status on stress management and five health behaviors (healthy eating, exercise, alcohol, smoking, and depression management) was assessed before and after a multiple behavior change intervention. Findings suggested a link between stress management and a worse health risk behavior profile at baseline. Results also showed relationships between improved stress management over 6 months and heightened odds of improving on specific behaviors as well as improving one's overall behavioral risk profile. Particularly strong links between stress management and energy balance and other affective behaviors were observed.
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Greene GW, Redding CA, Prochaska JO, Paiva AL, Rossi JS, Velicer WF, Blissmer B, Robbins ML. Baseline transtheoretical and dietary behavioral predictors of dietary fat moderation over 12 and 24 months. Eat Behav 2013; 14:255-62. [PMID: 23910762 PMCID: PMC4008122 DOI: 10.1016/j.eatbeh.2013.01.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 01/07/2013] [Accepted: 01/30/2013] [Indexed: 11/29/2022]
Abstract
Longitudinal predictors of dietary behavior change are important and in need of study. This secondary data analysis combined primary data across three randomized trials to examine transtheoretical model (TTM) and specific dietary predictors of successful dietary change at 12 and 24 months separately in treatment and control groups (N = 4178). The treatment group received three TTM-tailored print interventions over 12 months between 1995 and 2000. Chi-square and MANOVA analyses were used to examine baseline predictors of dietary outcome at 12 and 24 months. Last, a multivariable logistic regression was conducted with all baseline variables included. Across all analyses in both treatment and control groups, the most robust predictors of successful change were for TTM-tailored treatment group, preparation stage of change, and increased use of dietary behavior variables such as moderating fat intake, substitution of lower fat foods, and increasing intake of healthful foods. These results provide strong evidence for treatment, stage and behavioral dietary severity effects predicting dietary behavior change over time, and for targeting these variables with the strongest relationships to outcome in interventions, such as TTM-tailored dietary interventions.
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Yin HQ, Prochaska JO, Rossi JS, Redding CA, Paiva AL, Blissmer B, Velicer WF, Johnson SS, Kobayashi H. Treatment-enhanced paired action contributes substantially to change across multiple health behaviors: secondary analyses of five randomized trials. Transl Behav Med 2013; 3:62-71. [PMID: 23630546 PMCID: PMC3636993 DOI: 10.1007/s13142-013-0193-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The dominant paradigm of changing multiple health behaviors (MHBs) is based on treating, assessing, and studying each behavior separately. This study focused on individuals with co-occurring baseline health-risk behavior pairs and described whether they changed over time on both or only one of the behaviors within each pair. Data from five randomized trials of computer-tailored interventions (CTIs) that simultaneously treated MHBs were analyzed. The differences between treatment and control proportions that achieved paired action and singular action at 24 months follow-up, and the proportional contribution of paired action to overall change on each behavior, were assessed across 12 behavior pairs (including energy balance, addictive, and appearance-related behaviors). CTIs consistently produced more paired action across behavior pairs. Paired action contributed substantially more to the treatment-related outcomes than singular action. Studying concurrent changes on MHBs as demonstrated allows the effect of simultaneously treating MHBs to be assessed.
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Affiliation(s)
- Hui-Qing Yin
- />Cancer Prevention Research Center, University of Rhode Island, Kingston, RI USA
- />Department of Psychology, University of Rhode Island, Kingston, RI USA
| | - James O Prochaska
- />Cancer Prevention Research Center, University of Rhode Island, Kingston, RI USA
- />Department of Psychology, University of Rhode Island, Kingston, RI USA
| | - Joseph S Rossi
- />Cancer Prevention Research Center, University of Rhode Island, Kingston, RI USA
- />Department of Psychology, University of Rhode Island, Kingston, RI USA
| | - Colleen A Redding
- />Cancer Prevention Research Center, University of Rhode Island, Kingston, RI USA
- />Department of Psychology, University of Rhode Island, Kingston, RI USA
| | - Andrea L Paiva
- />Cancer Prevention Research Center, University of Rhode Island, Kingston, RI USA
- />Department of Psychology, University of Rhode Island, Kingston, RI USA
| | - Bryan Blissmer
- />Cancer Prevention Research Center, University of Rhode Island, Kingston, RI USA
- />Department of Kinesiology, University of Rhode Island, Kingston, RI USA
| | - Wayne F Velicer
- />Cancer Prevention Research Center, University of Rhode Island, Kingston, RI USA
- />Department of Psychology, University of Rhode Island, Kingston, RI USA
| | | | - Hisanori Kobayashi
- />Cancer Prevention Research Center, University of Rhode Island, Kingston, RI USA
- />Department of Psychology, University of Rhode Island, Kingston, RI USA
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Lipschitz JM, Fernandez AC, Larson HE, Blaney CL, Meier KS, Redding CA, Prochaska JO, Paiva AL. Validation of decisional balance and self-efficacy measures for HPV vaccination in college women. Am J Health Promot 2013; 27:299-307. [PMID: 23402229 DOI: 10.4278/ajhp.110606-quan-240] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Women younger than 25 years are at greatest risk for human papillomavirus (HPV) infection, including high-risk strains associated with 70% of cervical cancers. Effective model-based measures that can lead to intervention development to increase HPV vaccination rates are necessary. This study validated Transtheoretical Model measures of Decisional Balance and Self-Efficacy for seeking the HPV vaccine in a sample of female college students. DESIGN Cross-sectional measurement development. Setting. Online survey of undergraduate college students. SUBJECTS A total of 340 female students ages 18 to 26 years. MEASURES Stage of Change, Decisional Balance, and Self-Efficacy. ANALYSIS The sample was randomly split into halves for exploratory principal components analyses (PCAs), followed by confirmatory factor analyses (CFAs) to test measurement models. Multivariate analyses examined relationships between constructs. RESULTS For Decisional Balance, PCA indicated two 4-item factors (Pros -α = .90; and Cons -α = .66). CFA supported a two-factor correlated model, χ(2)(19) = 39.33; p < .01; comparative fit index (CFI) = .97; and average absolute standardized residual statistic (AASR) = .03; with Pros α = .90 and Cons α = .67. For Self-Efficacy, PCA indicated one 6-item factor (α = .84). CFA supported this structure, χ(2)(9) = 50.87; p < .05; CFI = .94; AASR = .03; and α = .90. Multivariate analyses indicated significant cross-stage differences on Pros, Cons, and Self-Efficacy in expected directions. CONCLUSION Findings support the internal and external validity of these measures and their use in Transtheoretical Model-tailored interventions. Stage-construct relationships suggest that reducing the Cons of vaccination may be more important for HPV than for behaviors with a true Maintenance stage.
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Affiliation(s)
- Jessica M Lipschitz
- Department of Psychology, Cancer PreventionResearch Center, University of Rhode Island, 2 Chafee Road, Kingston, RI 02881, USA.
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Velicer WF, Redding CA, Paiva AL, Mauriello LM, Blissmer B, Oatley K, Meier KS, Babbin SF, McGee H, Prochaska JO, Burditt C, Fernandez AC. Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students. Transl Behav Med 2013; 3:82-93. [PMID: 23585821 DOI: 10.1007/s13142-013-0197-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study examined the effectiveness of two transtheoretical model-tailored, computer-delivered interventions designed to impact multiple substance use or energy balance behaviors in a middle school population recruited in schools. Twenty middle schools in Rhode Island including sixth grade students (N=4,158) were stratified and randomly assigned by school to either a substance use prevention (decreasing smoking and alcohol) or an energy balance (increasing physical activity, fruit and vegetable consumption, and limiting TV time) intervention group in 2007. Each intervention involved five in-class contacts over a 3-year period with assessments at 12, 24, and 36 months. Main outcomes were analyzed using random effects modeling. In the full energy balance group and in subsamples at risk and not at risk at baseline, strong effects were found for physical activity, healthy diet, and reducing TV time, for both categorical and continuous outcomes. Despite no direct treatment, the energy balance group also showed significantly lower smoking and alcohol use over time than the substance use prevention group. The energy balance intervention demonstrated strong effects across all behaviors over 3 years among middle school students. The substance use prevention intervention was less effective than the energy balance intervention in preventing both smoking and alcohol use over 3 years in middle school students. The lack of a true control group and unrepresented secular trends suggest the need for further study.
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Affiliation(s)
- Wayne F Velicer
- Cancer Prevention Research Center, University of Rhode Island, 130 Flagg Rd, Kingston, RI 02881, USA
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Abstract
OBJECTIVE Predictive and external validity was studied among cluster profiles for sun protection behavior within stages from Transtheoretical Model of behavior change using follow-up data. METHODS Data from participants in a home-based expert system were analyzed. Longitudinal patterns of clusters on the precontemplation, contemplation, and preparation stages of change were assessed. Differences between clusters on membership in action/maintenance stages and scores on the Sun Protection Behavior Scale (SPBS) were measured at 12 and 24 months after intervention. RESULTS Differences between clusters on stage progression and on scores from the SPBS were found at 12 and 24 months after intervention at all stages. DISCUSSION Predictive and external validity of sun protection subtypes was established using sun protection variables after a stage-matched intervention. Results provide information to improve interventions for sun protection.
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Affiliation(s)
- Marimer Santiago-Rivas
- Cancer Prevention Research Center, University of Rhode Island, Kingston 02881-0808, USA.
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Hoeppner BB, Redding CA, Rossi JS, Pallonen UE, Prochaska JO, Velicer WF. Factor structure of decisional balance and temptations scales for smoking: cross-validation in urban female African-American adolescents. Int J Behav Med 2012; 19:217-27. [PMID: 21279493 DOI: 10.1007/s12529-011-9145-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The transtheoretical model is an influential theoretical model in health psychology, particularly in its application to smoking cessation research. Decisional Balance (DB) and Temptations are key constructs within this framework. PURPOSE This study examines the psychometric properties of the DB and Temptations scales for smoking in a predominantly African-American sample of urban adolescent girls. METHODS We used confirmatory factor analysis to compare the fit of previously published factor structures in smokers (n = 233) and nonsmokers (n = 598). External validity was tested by examining stages of change differences in the retained subscales. RESULTS Results supported the internal and external validity of the DB scale for smokers and nonsmokers. Notably, previously published three-factor (Social Pros, Coping Pros, Cons) and four-factor (Cons split into "Aesthetic Cons" and "Health Cons") models fit equally well, with Cons subscales correlating highly. For Temptations, a previously published three-factor (Negative Affect, Social, Weight Control) hierarchical model fit well in nonsmokers. In smokers, previously published subscales were reliably measured, but their structural relationship remained unclear. Stage difference tests showed medium to large effect sizes of DB and Temptation subscales in smokers and nonsmokers. CONCLUSIONS The use of DB was validated for both smokers and nonsmokers in this sample of primarily African-American adolescent females, where Cons can be combined or separated into "Aesthetic Cons" and "Health Cons" based on practical utility and preference. For Temptations, more research is needed but large stage differences in Temptations subscales underscore the importance of this concept in smoking acquisition and cessation.
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Affiliation(s)
- Bettina B Hoeppner
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA.
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Robbins ML, Levesque DA, Redding CA, Johnson JL, Prochaska JO, Rohr MS, Peters TG. Assessing family members' motivational readiness and decision making for consenting to cadaveric organ donation. J Health Psychol 2012; 6:523-35. [PMID: 22049451 DOI: 10.1177/135910530100600506] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study assessed the applicability of two important components of the transtheoretical model of behavior change (TTM) to family consent for cadaveric organ donation. Men and women (N = 169), who consented or refused to donate the organs of a family member, completed a telephone survey reflecting the stage of change and decisional balance constructs. Psychometric analyses resulted in a two-factor decisional balance scale: a seven-item scale representing negative perceptions of consent (cons), and a seven-item scale representing positive perceptions of consent (pros). The pros and cons were significantly associated with stage of readiness for donation consent and with the family consent decision. Research utilizing this measure has the potential to enhance intervention programs to increase donation consent rates.
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Affiliation(s)
- M L Robbins
- Cancer Prevention Research Center, University of Rhode Island, USA
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Blaney CL, Robbins ML, Paiva AL, Redding CA, Rossi JS, Blissmer B, Burditt C, Oatley K. Validation of the measures of the transtheoretical model for exercise in an adult African-American sample. Am J Health Promot 2012; 26:317-26. [PMID: 22548428 DOI: 10.4278/ajhp.091214-quan-393] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE African-Americans have high rates of physical inactivity-related morbidity and mortality, thus effective interventions to increase exercise are necessary. Tailored interventions show promise, but measures need validation in this population. This study validated transtheoretical model measures for exercise in an African-American sample. DESIGN Cross-sectional measure development. SETTING Telephone survey of individuals in North Carolina. SUBJECTS 521 African-American adults. MEASURES Stages of change, decisional balance (pros and cons), self-efficacy and processes of change (POC) for regular exercise. ANALYSIS Confirmatory factor analyses tested measurement models. Multivariate analyses examined relationships between each construct and stages of change. RESULTS For decisional balance, the two-factor uncorrelated model was the most parsimonious good-fitting model (χ(235) = 158.76; comparative fit index [CFI], .92; average absolute standardized residual [AASR], .04), and alphas were good (pros α = .85 and cons α = .74). The one-factor model for self-efficacy (α = .80) revealed an excellent fit (χ(29) = 45.51; CFI, .96; AASR, .03). For the POC subscales with good alphas (α = .62-.91), a 10-factor fully correlated model fit best (χ(2)[360] = 786.75; CFI, .91; AASR, .04). Multivariate analyses by stage of change replicated expected patterns for the pros, self-efficacy, and POC measures with medium-sized effects (η(2) = .05-.13). Results by stage of change did not replicate for the cons scale. CONCLUSIONS The structures of these measures replicated with good internal and external validity, except for the cons scale, which requires additional development. Results support the use of these measures in tailored interventions to increase exercise among African-Americans.
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Affiliation(s)
- Cerissa L Blaney
- Cancer Prevention Research Center, Department of Psychology, University of Rhode Island, Kingston, Rhode Island 02881, USA
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Fried TR, Redding CA, Robbins ML, Paiva A, O'Leary JR, Iannone L. Promoting advance care planning as health behavior change: development of scales to assess Decisional Balance, Medical and Religious Beliefs, and Processes of Change. Patient Educ Couns 2012; 86:25-32. [PMID: 21741194 PMCID: PMC3192927 DOI: 10.1016/j.pec.2011.04.035] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 03/22/2011] [Accepted: 04/27/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To develop measures representing key constructs of the Transtheoretical Model (TTM) of behavior change as applied to advance care planning (ACP) and to examine whether associations between these measures replicate the relationships posited by the TTM. METHODS Sequential scale development techniques were used to develop measures for Decisional Balance (Pros and Cons of behavior change), ACP Values/Beliefs (religious beliefs and medical misconceptions serving as barriers to participation), Processes of Change (behavioral and cognitive processes used to foster participation) based on responses of 304 persons age≥65 years. RESULTS Items for each scale/subscale demonstrated high factor loading (>.5) and good to excellent internal consistency (Cronbach α .76-.93). Results of MANOVA examining scores on the Pros, Cons, ACP Values/Beliefs, and POC subscales by stage of change for each of the six behaviors were significant, Wilks'λ=.555-.809, η(2)=.068-.178, p≤.001 for all models. CONCLUSION Core constructs of the TTM as applied to ACP can be measured with high reliability and validity. PRACTICE IMPLICATIONS Cross-sectional relationships between these constructs and stage of behavior change support the use of TTM-tailored interventions to change perceptions of the Pros and Cons of participation in ACP and promote the use of certain Processes of Change in order to promote older persons' engagement in ACP.
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Affiliation(s)
- Terri R Fried
- Department of Medicine, Yale University School of Medicine, New Haven, USA
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Santiago-Rivas M, Velicer WF, Redding CA, Prochaska JO, Paiva AL. Cluster subtypes within the precontemplation stage of change for sun protection behavior. PSYCHOL HEALTH MED 2011; 17:311-22. [PMID: 22175661 DOI: 10.1080/13548506.2011.630401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The aim of this study is to identify replicable cluster subtypes within the precontemplation stage of change for sun protection. Secondary data analysis of baseline data from a sample of participants in a home-based expert system intervention was performed. Three random samples were selected from participants in the precontemplation stage (N = 570). Cluster analyses were performed using the scales of pros, cons, and self-efficacy. Interpretability of pattern, pseudo F-test, and dendograms were used to determine the number of clusters. A four-cluster solution replicated across subsamples. Significant differences between clusters on the nine processes of change and on behavioral measures were found. Cluster solutions were robust, interpretable and with good initial external validity. They replicated patterns found for other behaviors, demonstrating long-term predictability and providing basis for tailored interventions.
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