Factors Associated with Smoking Cessation and Risk of Smoking Initiation in Bulgarian Youth

The goal of this project was to explore the factors associated with smoking behavior among Bulgarian adolescents. A sample recruited from 12 high schools in Bulgaria (N = 673, mean age = 16.52, 65% female), was used for the analyses in this paper. A series of logistic regressions were performed to explore the factors associated with smoking cessation and increased risk of smoking initiation. Based on self-reported smoking status participants completed different sets of questionnaires and were included in separate models exploring smoking cessation and increased risk of smoking initiation. Variables consistently associated with smoking like stress, coping strategies, peer influence, family influence, exposure to tobacco related marketing were included as predictor variables in both models. In addition each of the two models included the relevant constructs of decisional balance and temptations from the Transtheoretical Model (TTM). The final logistic model differentiating smokers/ex-smokers included age, parental smoking status, Temptation to smoke, and support for smoking bans in public places as variables, correctly classifying 82.3% of the sample. The final model among nonsmokers differentiating higher risk/lower risk of smoking initiation included the strength of the belief that smoking is harmful, Temptations to try smoking, Pros of being smoke-free, and support for smoking bans in public places, correctly classifying 72.7% of the sample. These results provide better understanding of the factors associated with smoking behavior in Bulgarian adolescents that can guide the development of smoking cessation and prevention programs for this population

Mediation analysis of decisional balance, sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection

Objective: Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant. Design: Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention. Main outcome measures: Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use. Results: With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126–.614), and the pros predicted the outcomes (r = .181–.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes. Conclusion: In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence

Longitudinal analysis of intervention effects on temptations and stages of change for dietary fat using parallel process latent growth modeling

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

Exploring Sustainable Transportation Attitudes and Stages of Change Using Survey and Geospatial Data in New England Campus Commuters

This paper presents findings of a two-campus project designed to assess alternative/sustainable transportation (AT), which is defined as commuting via non-SOVs (single occupancy vehicles) such as transit, carpooling, walking, or biking. One of the objectives was to test the application of a well-known behavior change model, the Transtheoretical Model of Change (TTM), to transportation behaviors. Additionally, geospatial analysis and visualization were applied using the TTM measures. The survey results show that commuting distances, transit connectivity, and status (i.e., students, staff, and faculty) affected commute modes and stages of readiness to use AT. Another important finding was that the survey data for AT replicated TTM relationship predictions between constructs and stages of change

One session of TTM-tailored condom use feedback: a pilot study among at-risk women in the Bronx

There is an urgent need to implement interventions to curb the spread of sexually transmitted infections (STIs), especially HIV. Consistent condom use is an effective preventive strategy, yet especially among those at highest risk, condom use remains too low. This paper describes changes in condom use and stages of condom use over two–three months time following a single session with an interactive multimedia computer-delivered Transtheoretical Model (TTM)-tailored expert system originally designed for at-risk adolescents. The intervention provided immediate TTM-tailored feedback to diverse urban women based on their stage of condom use and other TTM variables. Previous work found this system was acceptable. These data showed that 89% of women returned for a second session two–three months later, further supporting this system\u27s utility. After just one feedback session, 21% of women not using condoms at baseline started using condoms consistently at follow-up, with a trend for a relationship to baseline stage of condom use. These results support further randomized controlled research on the reach and efficacy of computer-based TTM-tailored and individualized condom use interventions

Female Partner Acceptance as a Predictor of Men’s Readiness to Undergo Voluntary Medical Male Circumcision in Zambia: The Spear and Shield Project

The World Health Organization has recommended the scale-up of voluntary medical male circumcision (VMMC) for HIV prevention in sub-Saharan Africa; however, men are often uninterested in undergoing VMMC. The Spear & Shield project enrolled 668 men and female partners from ten Zambian community health centers into parallel interventions promoting VMMC for HIV prevention or time-matched control conditions. A mediation model was utilized to examine the relationships between changes in women’s acceptance of VMMC and men’s readiness to undergo the procedure. Results demonstrated that, at 12 months post-intervention, a 5.9 % increase in the likelihood of undergoing VMMC among men in the experimental condition could be attributed to increased women’s acceptance. From a public health perspective, involving women in VMMC promotion interventions such as the Spear & Shield project could significantly impact the demand for VMMC in Zambia

Stages of Change for Voluntary Medical Male Circumcision and Sexual Risk Behavior in Uncircumcised Zambian Men: The Spear and Shield Project

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

Outcomes of cluster profiles within stages of change for sun protection behavior

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

Evaluation of the acceptability and feasibility of a computer-tailored intervention to increase HPV vaccination among young adult women

Objective: To examine acceptability and feasibility of a Transtheoretical Model (TTM)-based computer-tailored intervention for increasing HPV vaccination in college-aged women. Participants: 243 women ages 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. While 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 is promising. Its computer-based, individually-tailored format is state of the art and ideal for inexpensive dissemination

Agreement Between Older Persons and Their Surrogate Decision‐Makers Regarding Participation in Advance Care Planning

Objectives: To examine agreement between older persons and their surrogates regarding participation in advance care planning (ACP). Design: Observational cohort study. Setting: Community. Participants: Persons aged 65 and older and the individual they identified as most likely to make treatment decisions on their behalf. Measurements: Older persons were asked about participation in four activities: completion of living will, completion of healthcare proxy, communication regarding views about life‐sustaining treatment, and communication regarding views about quality versus quantity of life. Surrogates were asked whether they believed the older person had completed these activities. Results: Of 216 pairs, 81% agreed about whether a living will had been completed (κ=0.61, 95% confidence interval (CI) 0.51–0.72). Only 68% of pairs agreed about whether a healthcare proxy had been completed (κ=0.39, 95% CI 0.29–0.50), 64% agreed about whether they had communicated regarding life‐sustaining treatment (κ=0.22, 95% CI 0.09–0.35), and 62% agreed about whether they had communicated regarding quality versus quantity of life (κ=0.23, 95% CI 0.11–0.35). Conclusion: Although agreement between older persons and their surrogates regarding living will completion was good, agreement about participation in other aspects of ACP was fair to poor. Additional study is necessary to determine who is providing the most accurate report of objective ACP components and whether agreement regarding participation in ACP is associated with greater shared understanding of patient preferences