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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2006.03.041 Byline: Wayne F. Velicer, Colleen A. Redding, Milena D. Anatchkova, Joseph L. Fava, James O. Prochaska Keywords: Stages of changes; Prevention; Cluster analysis; Smoking acquisition Abstract: School-based smoking prevention programs are typically identical for all students. Tailoring prevention materials to focus on individual needs with an emphasis on students at highest risk is a promising alternative. Recent prevention programs have tailored materials based on the Stages of Acquisition, an extension of the Stages of Change used to tailor smoking cessation materials effectively for adults. Three stages of acquisition have been identified: Acquisition Precontemplation (aPC), Acquisition Contemplation (aC) and Acquisition Preparation (aPR). However, about 90% of nonsmoking adolescents classify themselves in the aPC stage. A cluster analysis was performed, using the Decisional Balance and Situational Temptations scales, for three random subsamples of adolescents within the aPC stage (N.sub.1 = N.sub.2 = N.sub.3 =514). Four distinct subtypes were identified in each subsample: High Risk, Protected, Ambivalent, and Risk Denial. External validity was established using family support for nonsmoking, peer variables, and stage classification at follow-up assessment (12, 24, and 36 months). Family support for nonsmoking was related to subtype much more strongly than peer interactions. Subjects in the Protected subgroup were the most likely to remain in the aPC stage at each follow-up assessment. Subtype membership, along with membership in the aC and aPR stages, provides important additional information for tailoring smoking prevention materials. Tailored interventions can focus on those adolescents at highest risk and limit or avoid expending resources on those at very low risk. Author Affiliation: Cancer Prevention Research Center, 2 Chafee Rd., University of Rhode Island, Kingston, RI 02881, United States

This article evaluates the effectiveness of a smoking cessation intervention that uses an interactive expert system and a randomized recruitment method. Findings indicate that the expert system intervention resulted in high rates of participation and smoking abstinence.

Four distinct profiles were defined for smokers trying to quit using dynamic typology clustering. The study involved 2088 smokers in three stages of change, precontemplation, contemplation and preparation. From the 446 individual profiles patterns of a stable profile, a progressing profile, a vacillating profile and a regressing profile were defined. External validation was found to significantly affect the process of change, decisional balance and situational temptations.

A modified version of the Fagerstrom Tolerance Questionnaire (FTQ), suggests that high nicotine dependence levels among adolescents is possibly the reason for a high percentage of failure in adolescents smoking cessation programs. A study of vocational-technical students reveals a high FTQ mean score of 4.27, which is comparable to highly dependent adults. Since the use of FTQ is feasible among adolescents, it should be used to identify the possible subsets among adolescents who can benefit from nicotine replacement treatments. Smoking cessation treatment can be successful with a biopsychological approach.

A study applying Latent Transition Analysis (LTA) to assess the movement through the stages of change for smoking cessation indicates that the method of data analysis can be suitable for testing of alternate models of movement. LTA allows comparison of alternative theoretical models by depicting the pattern of change. It shows that the movement through the stages is not linear. The assessment of latent status membership on each occasion and transition probabilities between occasions is possible. It also helps in diagnosing the stability of individual stage membership.

The contemplation, preparation and action stages in smoking cessation behavior can be subdivided into four distinct subtypes and precontemplation stage can be divided into 3 subtypes. A significant difference between subtypes can be seen in the five experiential processes in the precontemplation stage. In the contemplation stage five experiential and two behavioral processes show significant difference. All the five experiential and three behavioral processes show significant difference in precontemplation stage. In the action stage significant differences occurred in several behavioral processes.

A study of the correlations among key constructs of the Transtheoretical Model, used to assess 4,144 smokers' behavior, revealed the utility of this model in providing information on smokers and their different stages of cessation. Of the sample, smokers in the Precontemplation Stage of Change were found to have the greatest degree of addiction and the least negative attitudes toward their smoking behavior.

Most patient-reported outcome measures (PROMs) used to assess outcomes after anatomic total shoulder arthroplasty (aTSA) focus on pain and function. Although strength is considered an important component of function, only the Constant-Murley score (CMS) includes an objective measurement of shoulder strength. The purpose of this study was to evaluate the relationship between shoulder elevation strength (SES) and PROMs after aTSA for the treatment of primary glenohumeral osteoarthritis (GHOA). This was a retrospective analysis of 605 patients enrolled in a multicenter clinical database who underwent aTSA to treat primary GHOA. Patients were evaluated preoperatively and at 24 months after surgery. Outcome was assessed with the CMS, American Shoulder and Elbow Surgeons score, Western Ontario Osteoarthritis of the Shoulder score, Single Assessment Numeric Evaluation score, and patient satisfaction. Relationships between SES and outcomes were investigated. The correlations between SES and the PROMs before and after treatment were very weak and weak, respectively (r ≤ 0.262 for all). The strength of the correlations between the absolute and adjusted CMS and the other PROMs varied from weak to moderate (r = 0.180 to r = 0.455), and the strength of the correlations was greater postoperatively. With the strength component removed from the CMS, the correlations between the CMS and other PROMs were stronger (r = 0.194 to r = 0.495). Although measurement of SES provides objective information about shoulder function and outcome related to the treatment of primary GHOA with aTSA, the actual relevance to patients is unclear as the correlations between SES and PROMs were weak. Furthermore, the variable correlations between the CMS and PROMs call into question the exclusive use of the CMS and support the use of other PROMs that may more accurately reflect patient perception of outcome. [ABSTRACT FROM AUTHOR]

The internal inconsistencies and factorial invariances in decisional balance inventory were analyzed using data from a representative sample of smokers. Decisional balance inventory reflected strong factorial invariances across the four demographic variables, namely gender, education, race, and age.

This article evaluates the validity of the Transtheoretical Model in measuring stage effects among ethnically diverse samples. The authors, focusing on a sample of adult smokers, maintain the Transtheoretical Model provided significant information for 8 out of 11 subscales regarding stage differences.

It has been possible to develop a theoretically based empirical topology of smokers using cluster analysis. This topology can potentially function as a significant level on which to match self-help behaviour change interventions to different groups of people. The theoretical structure for this research was supplied by the Transtheoretical Model of behaviour change. It was established that personal and emotional processes make the most significant contribution to distinguishing smokers in the early stages, followed by information from the environment. The next stage of this research will be to investigate how smokers in different subtypes change over time.

Pregnant smokers are similar to their nonpregnant counterparts with regard to their readiness to stop smoking. This research aimed to identify factors that may boost understanding of economically disadvantaged culturally diverse pregnant smokers and to play a role in the design of more effective interventions for pregnant smokers. It is clear that the majority of pregnant smokers are not highly motivated to stop smoking simply because of their pregnancy. Work with this group of low-income pregnant smokers must be stage-matched. There should be a particular focus on boosting motivation and willingness to stop smoking, rather than offering only action-oriented interventions for the small number of smokers ready to stop.

Awareness of the negative aspects of smoking is vital to forward stage movement from precontemplation to contemplation or preparation, according to research designed to assess movement through the stages of change from smoking to giving up smoking using the criterion measurement model constructs as dependent measures. This research involved making a series of 40 a priori predictions within the first three stages of change and testing a representative sample of smokers. It was established that the positive aspects of smoking do not begin to decrease until the transition from contemplation to preparation.

Background: Dietary variety is a factor that influences consumption but has received little attention in obesity treatment. Objective: This study examined the effect of limiting the variety of different non-nutrient-dense, energy-dense foods (NND-EDFs) (ie, chips, ice cream, cookies) on dietary intake and weight loss during an 18-mo lifestyle intervention. Design: Two hundred two adults aged 51.3 ± 9.5 y with a BMI (in kg/m2) 34.9 ± 4.3 (57.8% women, 92.2% white) were randomly assigned to 1 of 2 interventions: Lifestyle (1200-1500 kcal/d, ≤30% of energy as fat; n = 101) or Lifestyle + limited variety (LV) (limit variety of NND-EDFs, ie, 2 choices; n = 101). Both interventions involved 48 group sessions. Dietary intake, NND-EDF hedonics, NND-EDF variety in the home, and weight were assessed at 0, 6, 12, and 18 mo. Results: Intent-to-treat analyses showed that the Lifestyle+LV group consumed less variety (P < 0.01) and energy daily (P < 0.05) from NND-EDFs than did the Lifestyle group at 6, 12, and 18 mo. The Lifestyle+LV group consumed less total energy daily (P < 0.05) at 6 mo than did the Lifestyle group. The Lifestyle+LV group reported less (P < 0.05) NND-EDF variety in the home at 6 and 18 mo than did the Lifestyle group. The hedonics of one chosen NND-EDF decreased more (P < 0.05) in the Lifestyle+LV group. Despite these effects, no difference in percentage weight loss occurred at 18 mo (Lifestyle+LV: -9.9 ± 7.6%; Lifestyle: -9.6 ± 9.2%). Conclusions: Limitations in dietary variety decreased intakes in the targeted area but did not affect weight loss. Limiting variety in more areas may be needed to improve weight loss and weight-loss maintenance. This trial was registered at clinicaltrials.gov as NCT01096719. [ABSTRACT FROM AUTHOR]

Objective: Women are particularly prone to stress with respect to living with HIV. Stress management behaviors can mediate the stress response and improve health outcomes in HIV-positive individuals. The purpose of this descriptive cross-sectional study was to examine stress and Transtheoretical Model (TTM) indicators of stress management behaviors in HIV-positive women. Methods: 126 HIV-positive women recruited from diverse HIV-care clinics in northeast Ohio completed standardized self-report research instruments to measure stress, stress management behaviors, stage of change, self-efficacy, and decisional balance (pros and cons). Results: Women reported higher levels of stress in the later phase of HIV infection (P<.05). Highly stressed women in this study reported infrequently using stress management behaviors and a low level of perceived efficacy to manage stress although they perceived the pros of managing stress to be high (P<.01). Stress management behaviors were significantly related to stage of change (P<.01), self-efficacy (P<.01), and the cons of managing stress (P<.05). Graphed patterns of decisional balance examined by stage of change and stress management behavior were atypical in this sample. Conclusions: Clinicians and researchers can use the TTM to describe behavioral indicators of stress management in HIV+ women. However, further research is needed to more fully understand behavioral processes HIV+ women can use to adopt and maintain stress management behaviors. [Copyright &y& Elsevier]

Introduction: Cigarette smoking is associated with many adverse health effects and is an important public health concern. Increased understanding of smokers' behavior is central to developing effective interventions. Cigarette scavenging, a behavior that involves smoking shared or previously used cigarettes has thus far only been shown to be prevalent among homeless or incarcerated populations. The current study examines whether cigarette scavenging is prevalent in a more general population of adult smokers enrolling in a smoking cessation clinical trial, and whether engagement in this behavior is associated with demographic or smoking-related psychosocial factors.Methods: Baseline data was obtained from adult smokers (N=227) enrolling in a randomized clinical trial for smoking cessation. Cigarette scavenging was assessed using three items: a) sharing a cigarette with a stranger; b) smoking a "found" cigarette and c) smoking a previously used cigarette "butt". Participants who endorsed engaging in at least one of these three behaviors were categorized as a scavenger.Results: Approximately 32% of participants endorsed at least one cigarette scavenging behavior. A multiple logistic regression analysis found that scavengers were more likely to be: men (p<0.001), of younger age at smoking onset (p=0.012), unemployed (p=0.003), more likely to have used marijuana in the past 30days (p=0.005), single or living alone (p=0.003), and to have experienced higher withdrawal symptoms during previous quit attempts (p=0.044) as compared to non-scavengers.Conclusions: Scavenging is common among adult smokers. Interventions that address cigarette scavenging behaviors may better meet the needs of this unique smoking subgroup. [ABSTRACT FROM AUTHOR]

Introduction Smokers trying to quit encounter many challenges including nicotine withdrawal symptoms, cigarette craving, increased stress and negative mood and concern regarding weight gain. These phenomena make it difficult to successfully quit smoking. Studies in non-smoking populations show that yoga reduces stress and negative mood and improves weight control. By increasing mindfulness we anticipate that yoga may also improve smokers' ability to cope with the negative symptoms associated with quitting. Yoga may also improve cognitive deliberation which is needed to make effective choices and avoid smoking in tempting situations. Methods/design The BreathEasy study is a rigorous, randomized controlled clinical trial examining the efficacy of Iyengar yoga as a complementary therapy to cognitive-behavioral therapy for smoking cessation. All participants are given an 8-week program of smoking cessation classes, and are randomized to either twice weekly yoga (Yoga) or twice-weekly health and wellness classes which serve as a control for contact and participant burden (CTL). Assessments are conducted at baseline, 8 weeks, 3, 6, and 12 months of follow-up. The primary outcome is prolonged abstinence using an intention-to-treat approach. Multiple internal and external audits using blind data collection are employed to ensure treatment fidelity and reliability of study results. To understand why yoga may be more effective than CTL, we will examine the mechanisms of action (i.e., mediators) underlying intervention efficacy. We will examine the maintenance of yoga practice and smoking status at each follow-up. Focus groups and interviews will be used to enrich our understanding of the relationship of yoga practice and smoking abstinence. Conclusions This study will provide a stringent test of the relative efficacy of yoga compared to a condition that controls for contact time and attention. The use of mixed methodology also provides the opportunity to validate existing knowledge about yoga and helps to explore new themes for future mindfulness and yoga research. [ABSTRACT FROM AUTHOR]

Smoking cessation interventions delivered through mobile technologies offer promise as an effective intervention tool. However, most existing programs have not been empirically tested, were not developed with end-user participation, and/or do not address evidence-based cognitive and behavioral variables shown to enhance smoking cessation in clinical trials. In addition, many programs tested in research trials have required users to access the internet and/or a smartphone app to access all program features, limiting the potential reach of those programs. This study is a randomized controlled trial testing the efficacy of the TMQ intervention for smoking cessation. All participants are randomly assigned to receive 12 weeks of either; (1) a tailored smoking-cessation intervention delivered 100% through text messaging (TMQ), or (2) non-smoking-related text messages serving as a control for contact and subject burden (Mojo). Assessments are conducted at baseline, 3- and 6-month follow-up. The primary outcome is prolonged abstinence using an intent-to-treat approach. To understand why TMQ may be more effective than Mojo, we will test several posited mechanisms of action (i.e., mediators) that may underlie intervention efficacy and will examine use of the TMQ integrated social support (ISS) network. At the end of treatment, semi-structured interviews will be conducted with TMQ participants. This study will provide a rigorous test of an innovative smoking cessation program delivered 100% through text messages. Use of mixed methodologies will provide the opportunity to enhance our understanding of the user's experience with TMQ and identify areas for future enhancement and/or expansion. [ABSTRACT FROM AUTHOR]

Background: Students at community colleges comprise nearly half of all U.S. college students and show higher risk of heavy drinking and related consequences compared to students at 4-year colleges, but no alcohol safety programs currently target this population.Objective: To examine the feasibility, acceptability, and preliminary efficacy of an alcohol risk-reduction program delivered through text messaging designed for community college (CC) students.Methods: Heavy drinking adult CC students (N=60) were enrolled and randomly assigned to the six-week active intervention (Text Message Alcohol Program: TMAP) or a control condition of general motivational (not alcohol related) text messages. TMAP text messages consisted of alcohol facts, strategies to limit alcohol use and related risks, and motivational messages. Assessments were conducted at baseline, week 6 (end of treatment) and week 12 (follow up).Results: Most participants (87%) completed all follow up assessments. Intervention messages received an average rating of 6.8 (SD=1.5) on a 10-point scale. At week six, TMAP participants were less likely than controls to report heavy drinking and negative alcohol consequences. The TMAP group also showed significant increases in self-efficacy to resist drinking in high risk situations between baseline and week six, with no such increase among controls. Results were maintained through the week 12 follow up.Conclusions: The TMAP alcohol risk reduction program was feasible and highly acceptable indicated by high retention rates through the final follow up assessment and good ratings for the text message content. Reductions in multiple outcomes provide positive indications of intervention efficacy. [ABSTRACT FROM AUTHOR]

Abstract: The purpose of this study was to examine the predictive validity of the Eating Disorder Recovery Self-Efficacy Questionnaire (EDRSQ), an empirically-derived self-report instrument that assesses confidence to eat without engaging in eating disordered behavior or experiencing undue emotional distress (Normative Eating Self-Efficacy) and confidence to maintain a realistic body image that is not dominated by pursuit of thinness (Body Image Self-Efficacy). Participants were 104 female inpatients with anorexia nervosa (AN), subthreshold AN, or underweight bulimia nervosa who were treated at a specialized eating disorder clinic and completed the EDRSQ and Eating Disorder Inventory-2 (EDI-2) Drive for Thinness (DT) and Body Dissatisfaction (BD) subscales upon admission. A subset of patients completed the EDRSQ (n =81) and EDI-2 subscales (n =70) following inpatient treatment. Self-efficacy increased significantly during treatment. EDRSQ scores at admission were inversely related to length of hospital stay and posttreatment DT and BD subscales and positively related to partial hospital weight gain rate. The EDRSQ significantly predicted length of hospital stay and posttreatment BD above and beyond clinical indicators and eating disorder psychopathology at inpatient admission. Findings support the validity of the EDRSQ and suggest it is a useful predictor of short-term hospital treatment outcome in underweight eating disorder patients. [Copyright &y& Elsevier]

In the U.S., over 40% of 18–25 year olds meet criteria for overweight or obesity. Yet, no large-scale trials have targeted this age group for behavioral weight loss (BWL). Formative data revealed that existing BWL programs do not meet their unique needs and identified motivation as a fundamental barrier for weight management. The goal of the Richmond Emerging Adults Choosing Health (REACH) trial was to test the efficacy of two mHealth lifestyle interventions specifically focused on enhancing motivation, relative to adapted standard. Participants (N = 381, 18–25 years, body mass index 25–45 kg/m2) will be randomized to 1) adapted BWL (aBWL), 2) aBWL + self-determination theory (aBWL+SDT), or 3) aBWL + behavioral economics (aBWL+BE). All arms will receive a 6-month intervention, delivered via one group session and one individual session, followed by an mHealth platform. Assessments will occur at baseline, 3-months, 6-months (post-treatment) and 12-months (following a no-contact period). The primary aim is to compare weight loss outcomes at 6 months. Secondary aims include changes at 6-months in physical and behavioral cardiometabolic risk factors, as well as psychosocial measures. We will also explore weight loss maintenance, change in hypothesized mediators, and moderators of treatment response. REACH is the first large-scale BWL trial designed specifically for emerging adults. Further, it will be the first trial to compare a lifestyle intervention grounded in self-determination theory to one rooted in behavioral economics. If clinically significant reductions in adiposity are achieved, findings could inform a scalable treatment model to meet the needs of this vulnerable population. Trial Registration: NCT02736981 [ABSTRACT FROM AUTHOR]