Reflections on the Continued Popularity of the Transtheoretical Model

Sometimes in health behavior research, purportedly novel theoretical models are offered that may help move thinking about behavior change forward, and may be well-received by clinicians, but over time end up being a subject of continual scientific disconfirmation. The transtheoretical model is one rather popular example. The five stages of change and associated 10 processes of change are well-known (e.g., DiClemente et al., 2008; DiClemente et al., 2004). Yet, the model has been discredited to a large extent by several in the health behavior research community. In the present editorial, we briefly summarize the transtheoretical model, mention its current ongoing popularity, identify the critiques of this model, and suggest how one might best consider the model in future health behavior research and practice

Menthol Cigarette Smoking and Obesity in Young Adult Daily Smokers in Hawaii

This study investigates 1) the relationship between menthol cigarette smoking and obesity and 2) the association of body mass index with the nicotine metabolite ratio among menthol and non-menthol daily smokers aged 18–35 (n = 175). A brief survey on smoking and measures of height and weight, carbon monoxide, and saliva samples were collected from participants from May to December 2013 in Honolulu, Hawaii. Multiple regression was used to estimate differences in body mass index among menthol and non-menthol smokers and the association of menthol smoking with obesity. We calculated the log of the nicotine metabolite ratio to examine differences in the nicotine metabolite ratio among normal, overweight, and obese smokers. Sixty-eight percent of smokers used menthol cigarettes. Results showed that 62% of normal, 54% of overweight, and 91% of obese smokers used menthol cigarettes (p = .000). The mean body mass index was significantly higher among menthol compared with non-menthol smokers (29.4 versus 24.5, p = .000). After controlling for gender, marital status, educational attainment, employment status, and race/ethnicity, menthol smokers were more than 3 times as likely as non-menthol smokers to be obese (p = .04). The nicotine metabolite ratio was significantly lower for overweight menthol smokers compared with non-menthol smokers (.16 versus .26, p = .02) in the unadjusted model, but was not significant after adjusting for the covariates. Consistent with prior studies, our data show that menthol smokers are more likely to be obese compared with non-menthol smokers. Future studies are needed to determine how flavored tobacco products influence obesity among smokers

Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial

Background: Semaglutide, a GLP-1 receptor agonist, reduces the risk of major adverse cardiovascular events (MACE) in people with overweight or obesity, but the effects of this drug on outcomes in patients with atherosclerotic cardiovascular disease and heart failure are unknown. We report a prespecified analysis of the effect of once-weekly subcutaneous semaglutide 2·4 mg on ischaemic and heart failure cardiovascular outcomes. We aimed to investigate if semaglutide was beneficial in patients with atherosclerotic cardiovascular disease with a history of heart failure compared with placebo; if there was a difference in outcome in patients designated as having heart failure with preserved ejection fraction compared with heart failure with reduced ejection fraction; and if the efficacy and safety of semaglutide in patients with heart failure was related to baseline characteristics or subtype of heart failure. Methods: The SELECT trial was a randomised, double-blind, multicentre, placebo-controlled, event-driven phase 3 trial in 41 countries. Adults aged 45 years and older, with a BMI of 27 kg/m2 or greater and established cardiovascular disease were eligible for the study. Patients were randomly assigned (1:1) with a block size of four using an interactive web response system in a double-blind manner to escalating doses of once-weekly subcutaneous semaglutide over 16 weeks to a target dose of 2·4 mg, or placebo. In a prespecified analysis, we examined the effect of semaglutide compared with placebo in patients with and without a history of heart failure at enrolment, subclassified as heart failure with preserved ejection fraction, heart failure with reduced ejection fraction, or unclassified heart failure. Endpoints comprised MACE (a composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death); a composite heart failure outcome (cardiovascular death or hospitalisation or urgent hospital visit for heart failure); cardiovascular death; and all-cause death. The study is registered with ClinicalTrials.gov, NCT03574597. Findings: Between Oct 31, 2018, and March 31, 2021, 17 604 patients with a mean age of 61·6 years (SD 8·9) and a mean BMI of 33·4 kg/m2 (5·0) were randomly assigned to receive semaglutide (8803 [50·0%] patients) or placebo (8801 [50·0%] patients). 4286 (24·3%) of 17 604 patients had a history of investigator-defined heart failure at enrolment: 2273 (53·0%) of 4286 patients had heart failure with preserved ejection fraction, 1347 (31·4%) had heart failure with reduced ejection fraction, and 666 (15·5%) had unclassified heart failure. Baseline characteristics were similar between patients with and without heart failure. Patients with heart failure had a higher incidence of clinical events. Semaglutide improved all outcome measures in patients with heart failure at random assignment compared with those without heart failure (hazard ratio [HR] 0·72, 95% CI 0·60-0·87 for MACE; 0·79, 0·64-0·98 for the heart failure composite endpoint; 0·76, 0·59-0·97 for cardiovascular death; and 0·81, 0·66-1·00 for all-cause death; all pinteraction>0·19). Treatment with semaglutide resulted in improved outcomes in both the heart failure with reduced ejection fraction (HR 0·65, 95% CI 0·49-0·87 for MACE; 0·79, 0·58-1·08 for the composite heart failure endpoint) and heart failure with preserved ejection fraction groups (0·69, 0·51-0·91 for MACE; 0·75, 0·52-1·07 for the composite heart failure endpoint), although patients with heart failure with reduced ejection fraction had higher absolute event rates than those with heart failure with preserved ejection fraction. For MACE and the heart failure composite, there were no significant differences in benefits across baseline age, sex, BMI, New York Heart Association status, and diuretic use. Serious adverse events were less frequent with semaglutide versus placebo, regardless of heart failure subtype. Interpretation: In patients with atherosclerotic cardiovascular diease and overweight or obesity, treatment with semaglutide 2·4 mg reduced MACE and composite heart failure endpoints compared with placebo in those with and without clinical heart failure, regardless of heart failure subtype. Our findings could facilitate prescribing and result in improved clinical outcomes for this patient group. Funding: Novo Nordisk

Ethnic Differences in Smoking Rate, Nicotine Dependence, and Cessation-Related Variables Among Adult Smokers in Hawaii

Magnetosomes in magnetotactic bacteria (MTB) are among the most intriguing examples of subcellular structures in prokaryotes. The magnetosome particles consist of the magnetic iron mineral magnetite (or rarely greigite), which is enclosed within membrane vesicles.So far, the biomineralization process is poorly understood, but the magnetosome membrane (MM) seemed to be crucial in the biological control of magnetite formation.This work displays the first comprehensive biochemical and molecular investigations of the magnetosomes in Magnetospirillum gryphiswaldense. The biochemical characteristics of the MM were investigated by using various proteomic approaches to analyze the protein composition. In total, a number of 17 magnetosome membrane-associated proteins were found to constitute the magnetosome subproteome, and most of these proteins are novel for Magnetospirillum gryphiswaldense. Except of one, all MMPs were encoded by open reading frames in the mms6-cluster, mamGFDC-cluster and mamAB-cluster. These three gene clusters are arranged within the magnetosome island, which comprises approximately 150 genes. At least 25 of the genes are involved in magnetosome formation. Most of the mam-genes were found to be conserved, in respect of nucleotide sequence and gene arrangement, in different magnetotactic strains. Based on the amino acid sequences of the identified MMPs, special functions in magnetosome formation like in iron accumulation, nucleation, crystal growth and in the arrangement and shape of the magnetosome particles within the cell are discussed.Initial deletion experiments of the mamGFDC-cluster revealed an effect on size and shape of single magnetosome particles.This is the first time GFP-fusions of MMPs were employed to study protein localization in Magnetospirillum gryphiswaldense. Preliminary results indicate that the most abundant MMP (MamC) is localized exclusively in the MM

Explaining Real-Life Events: How Culture and Domain Shape Attributions

Several lines of experimental research have shown that attributional styles are affected by the attributor's culture, inferential goals, and level of cognitive processing. Can these findings be replicated in natural settings? This study compared the attributions made in two domains (sports articles and editorials) of newspapers published in two culturally distinct countries (Hong Kong and the United States). Consistent with the cross-cultural research, attributions were less dispositional in the East than in the West. This cultural difference was weaker in editorials than in sports articles. The authors argue that the higher level of complexity, accountability, and uncertainty in editorials increased the cognitive effort expended to make attributions, which, in turn, attenuated their extremity. Implications for the mixed model of social inference are discussed.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69096/2/10.1177_0146167296227007.pd

It ain't over till it's over: the case for offering relapse-prevention interventions to former smokers

Most people who attempt to quit tobacco smoking eventually relapse. Although treatment strategies have been developed to prevent smoking relapse, they tend to be available only to the small proportion of smokers who enroll in intensive smoking cessation treatments. It is argued that freestanding relapse-prevention interventions could be offered to persons who recently ceased smoking, whether they used a formal treatment program or quit on their own. A line of research is described demonstrating that a series of relapse-prevention booklets mailed to recent quitters significantly reduces smoking relapse. Moreover, the intervention seems to be highly cost-effective. If disseminated widely, such an approach has the potential to make a significant public health impact