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OBJECTIVE: Optimizing a self-persuasion intervention app for adolescent HPV vaccination requires investigating its hypothesized mechanisms. Guided by the experimental medicine approach, we tested whether (a) self-persuasion intervention components (verbalize vaccination reasons, choose HPV topics) changed putative mechanisms (memory, autonomous motivation) and (b) measures of the putative mechanisms were associated with HPV vaccination. METHODS: These are secondary analyses from a randomized 2 (cognitive processing: verbalize reasons vs. listen) × 2 (choice: choose HPV topics vs. assigned) factorial trial (Tiro et al., 2016). Undecided parents (N = 161) with an unvaccinated child (11–17 years old) used the self-persuasion app, recalled reasons for vaccination (memory measure), and completed an autonomous motivation measure. Adolescent vaccination status was extracted from electronic medical records 12 months post-intervention. RESULTS: The verbalize component resulted in greater recall accuracy of vaccination reasons (p < .001); however, the choose topics component did not increase autonomous motivation scores (p = .74). For associations with HPV vaccination, recall accuracy was not associated (ps > .51), but autonomous motivation scores significantly predicted vaccination (ps < .03), except when controlling for baseline motivation (p = .22). CONCLUSION: The intervention app engages parents in reasons for vaccination; however, memory may not be a viable mechanism of vaccination. Although the intervention did not affect autonomous motivation, associations with vaccination status suggest it is a viable intervention target for HPV vaccination but alternative strategies to change it are needed. Future testing of a refined app should examine implementation strategies to optimize delivery in clinical or community settings.

Purpose The purpose of this study is to examine the factor structure of the Risk Perception Survey for Developing Diabetes (RPS-DD) and test for factorial invariance by language (English, Spanish) and gender (males, females) in a clinically engaged, racially diverse, low-education population. Methods Adult patients seen in a safety-net health system (N = 641) answered an interviewer-administered survey via telephone in their preferred language (English: 42%, Spanish: 58%). Three constructs in the RPS-DD were assessed—personal control (2 items for internal control and 2 for external control), optimistic bias (2 items), and worry (2 items). Single and multigroup confirmatory factor analyses (CFAs) were performed using maximum-likelihood estimation to determine the factor structure and test for invariance. Results Contrary to previous psychometric analyses in white, educated populations, CFAs supported a 4-factor measurement model with internal and external control items loading onto separate factors. The 4-factor structure was equivalent between males and females. However, the structure varied by language, with the worry subscale items loading more strongly for English than Spanish speakers. Conclusions The RPS-DD can be used to investigate group differences across gender and language and to help understand if interventions have differential effects for subgroups at high risk for diabetes. Given the increasing prevalence of diabetes among Spanish speakers, researchers should continue to examine the psychometric properties of the RPS-DD, particularly the worry subscale, to improve its validity and clinical utility.

Experiential avoidance (also referred to as acceptance or psychological flexibility) is a core construct of third-wave behavior therapies. It is the tendency to avoid uncomfortable thoughts or feelings, even when doing so has negative long-term consequences. In order for developments in experiential avoidance and third-wave behavior therapies to continue, it is imperative to examine the construct validity of the most widely used measures of this construct, the Acceptance and Action Questionnaire–II (AAQ-II) and the Multidimensional Experiential Avoidance Questionnaire (MEAQ). In Amazon’s Mechanical Turk (N = 1,052) and college (N = 364) samples, we evaluated the construct validity of these measures. The AAQ-II demonstrated suboptimal patterns of convergent and discriminant validity with measures of neuroticism/negative affect (Big Five Inventory, Big Five Aspects Scale, Positive and Negative Affect Schedule), the MEAQ, and mindfulness (Five Factor Mindfulness Questionnaire). In contrast, the MEAQ demonstrated optimal convergent and discriminant validity. Factor analyses at the scale, subscale, and item levels demonstrated that the AAQ-II loads with indicators of neuroticism/negative affect and not with other constructs at the core of third-wave behavior therapies. In contrast, the MEAQ loads on factors with mindfulness or forms its own factors. These findings suggest the AAQ-II functions as a measure of neuroticism/negative affect, whereas the MEAQ functions as an indicator of experiential avoidance. These findings have substantial implications for research on experiential avoidance and third-wave behavior therapies. Therefore, in order to improve the theory, research, and practice of third-wave behavior therapies, we recommend using the MEAQ to assess experiential avoidance.

Mindfulness is defined as bringing one's attention to present-moment experience with acceptance, and is associated with engagement in various health behaviours. To synthesise and evaluate this literature, we conducted a comprehensive meta-analytic review and examined (a) the associations between trait mindfulness and health behaviours and (b) the extent to which these associations were moderated by study and individual differences. A total of 125 independent samples were included (

Affective judgments of physical activity have emerged as important predictors of physical activity and interventions targeting affective judgments are a promising approach to improving regular physical activity. Currently, measures assessing a variety of potentially distinct constructs are treated as interchangeable assessments of affective judgments of physical activity. Moreover, little is known about the construct validity of the purported measures of this construct. We review several components of construct validity; highlighting their importance for health psychology research. Then, we examine the construct validity of a wide variety of affective judgment of physical activity measures in MTurk and student samples. Cronbach's alpha for the included measures was uniformly high; however, several scales contained excessively redundant items that ultimately lessen their construct validity. Moreover, dependability estimates for the majority of measures was poor, indicating high levels of transient measurement error. The included measures significantly predicted levels of physical activity; however, their relative predictive power was strongly associated with their dependability. In general, the affective judgment measures demonstrated poor convergent validity suggesting they are not interchangeable and best viewed as assessing distinct, albeit related, constructs. Another important limitation of these measures is that they exhibited poor discriminant validity from exercise self-efficacy, which represents an important theoretical and empirical issue for the field of health behavior research. Overall, the current findings indicate the available affective judgments of physical activity measures are suboptimal, have considerable construct validity limitations, and thereby prevent the further advancement of science, theory, and intervention development in this promising area of research. (PsycINFO Database Record

Research on individual differences and the framing effect has focused primarily on how variability in rational processing influences choice. However, we propose that measuring only rational processing presents an incomplete picture of how participants are responding to framed options, as orthogonal individual differences in experiential processing might be relevant. In two studies, we utilize the Rational Experiential Inventory, which captures individual differences in rational and experiential processing, to investigate how both processing types influence decisions. Our results show that differences in experiential processing, but not rational processing, moderated the effect of frame on choice. We suggest that future research should more closely examine the influence of experiential processing on making decisions, to gain a broader understanding of the conditions that contribute to the framing effect.

Background. “I don’t know” (DK) responses are common in health behavior research. Yet analytic approaches to managing DK responses may undermine survey validity and researchers’ ability to interpret findings. Objective. Compare the usefulness of a methodological strategy for reducing DK responses to 3 analytic approaches: 1) excluding DKs as missing data, 2) recoding them to the neutral point of the response scale, and 3) recoding DKs with the mean. Methods. We used a 4-group design to compare a methodological strategy, which encourages use of the response scale after an initial DK response, to 3 methods of analytically treating DK responses. We examined 1) whether this methodological strategy reduced the frequency of DK responses, and 2) how the methodological strategy compared to common analytic treatments in terms of factor structure and strength of correlations between measures of constructs. Results. The prompt reduced DK response frequency (55.7% of 164 unprompted participants vs. 19.6% of 102 prompted participants). Factorial invariance analyses suggested equivalence in factor loadings for all constructs throughout the groups. Compared to excluding DKs, recoding strategies and use of the prompt improved the strength of correlations between constructs, with the prompt resulting in the strongest correlations (.589 for benefits and intentions, .446 for perceived susceptibility and intentions, and .329 for benefits and perceived susceptibility). Limitations. This study was not designed a priori to test methods for addressing DK responses. Our analysis was limited to an interviewer-administered survey, and interviewers did not probe about reasons for DK responses. Conclusion. Findings suggest that use of a prompt to reduce DK responses is preferable to analytic approaches to treating DK responses. Use of such prompts may improve the validity of health behavior survey research.

OBJECTIVES: To prevent human papillomavirus (HPV)–related cancers, providers must effectively communicate with HPV vaccine–hesitant parents. Here, we developed a typology characterizing parent-provider communication around HPV vaccine hesitancy. METHODS: We audio-recorded 43 visits with unvaccinated adolescents at 6 pediatric clinics in Dallas, Texas in which parents were undecided about HPV vaccination. We qualitatively coded how parents verbally expressed hesitancy (assertive response, asking a question, or expressing concern) and whether providers responded with acquiescence (agree to defer vaccination) and/or persistence (continue discussion). We described the frequency of parent and provider communication codes and same-day vaccination. RESULTS: Among the 43 visits, 37 parents expressed hesitancy ≥1 times in many ways. Assertive responses were most common (27 visits), followed by questions (16 visits), and concerns (12 visits). When the first expression of hesitancy was a question or concern, 71% and 75% of adolescents, respectively, received same-day vaccinations, whereas 33% of adolescents who received an initial assertive response were vaccinated. Providers responded with only persistence in 18 visits, a mix of acquiescence and persistence in 13 visits, and only acquiescence in 6 visits. When providers only used persistence, 17 of 18 adolescents were vaccinated; when providers responded with only acquiescence, no adolescents received the vaccine. CONCLUSIONS: Our exploratory analysis reveals that providers engaging hesitant parents and addressing their concerns can lead to same-day HPV vaccination. Data reveal that even parents making assertive statements are amenable to influence by providers. Our findings reveal an important missed opportunity when providers simply acquiesce to parental hesitation.

People have much to gain from regular exercise, such as improved sleep, increased cognitive function, and reduced risk for cardiovascular disease, and these benefits may be particularly important for people experiencing deficits in these areas due to depressive symptoms (Kubesch et al., 2003; Lett et al., 2004; Rethorst et al., 2013). Moreover, regular exercise can be an effective treatment for depression (Babyak et al., 2000; Dunn et al., 2005; Mather et al., 2002; Mota-Pereira et al., 2011; Rethorst, Wipfli, & Landers, 2009). Despite the myriad benefits of regular exercise, adults with depressive symptoms have lower exercise levels than other adults (Patten, Williams, Lavorato, & Eliasziw, 2009; Roshaneai-Moghaddam, Katon, & Russo, 2009) and those with depressive symptoms who initiate a regular exercise regimen are more likely than others to discontinue it (DiMatteo, Lepper, & Croghan, 2000; Teixeira et al., 2004). Therefore, it is important to understand the reasons why people with depressive symptoms have difficulty initiating and maintaining regular exercise. Models of health behavior change, such as the Health Action Process Approach, Theory of Planned Behavior, and Social Cognitive Theory, emphasize the role of self-efficacy in successful behavior change (Ajzen, 1991; Bandura, 1997; Schwarzer, 1992). Self-efficacy is a person’s belief in his or her own ability to execute a specific behavior (Bandura, 1997), and it is central to behavior change because it guides what behaviors people choose to engage in and how people respond to obstacles and challenges in changing their behaviors (Bandura, 1997). Self-efficacy is known to be a predictor of successful initiation and maintenance of regular exercise (Rodgers, Hall, Blanchard, McAuley, & Munroe, 2002; Williams et al., 2008). Low self-efficacy may be one reason why people with depressive symptoms have difficulties initiating and maintaining regular exercise. People with depressive symptoms report lower self-efficacy than people without depressive symptoms across various behaviors (Bandura, 1998; Robinson-Smith, Johnston & Allen, 2000; Sacco et al., 2005). However, to date, it is unclear how depressive symptoms affect people’s self-efficacy while they attempt to initiate regular exercise. Self-efficacy beliefs are based on perceptions of ability to execute the relevant behavior, as well as perceptions of specific task demands and situational circumstances. Self-efficacy is theorized to stem from four sources: personal experience, vicarious experience, social persuasion (e.g., verbal encouragement), and physiological factors (e.g., arousal such as increased heart rate can lead to perceived inefficacy). Among these different sources, personal experience in executing the relevant behavior is the strongest source of self-efficacy perceptions (Bandura, 1997). Consistent with the proposition that personal experience is the strongest source of self-efficacy, exercise self-efficacy has been shown to significantly increase following participation in exercise. This has been observed after individual bouts of exercise (McAuley, 1995; McAuley et al., 2011) and long-term interventions for regular exercise (Marcus, Selby, Niaura, & Rossi, 1992; McAuley, 1995). This pattern of self-efficacy increases following the execution of exercise is consistent across the literature among healthy adults (Keller, Fleury, Gregor-Holt, & Thompson, 1999). In contrast, self-efficacy has been shown to decrease when individuals do not adhere to regular exercise, especially during the initiation of regular exercise as a new behavior (Parschau, Richert, Koring, Lippke, & Schwarzer, 2012). These findings all demonstrate that perceptions of self-efficacy are sensitive to whether people are successfully engaging in exercise or not. However, Bandura (1997) emphasized that it is not simply objective task execution that influences self-efficacy, but also the subjective perceptions and interpretations associated with the behavior. Subjective perceptions can be influenced by personal factors, such as differences in affective and cognitive processing. Depressive symptoms may be a personal factor that moderates the path between personal experience with exercise and self-efficacy. Depression is characterized by negative interpretations of experiences that are influenced by rumination, negative cognitions, and negative recall bias (Beck, 1991). The result of these negative interpretations is a tendency to minimize successes and exaggerate failures (Bandura, 1997). There is evidence to suggest that depressive symptoms influence self-efficacy to exercise regularly, but the evidence does not specifically address how this occurs. For example, older adults with depressive symptoms who enrolled in a 10-week progressive resistance-training program did not report increases in self-efficacy despite regular participation in exercise and objective gains in physical capability (Singh et al., 1997). This finding suggests the possibility that people with depressive symptoms have difficulties deriving self-efficacy from successfully performing exercise. This would be consistent with evidence that depressive symptoms are associated with a tendency to minimize successes (Bandura, 1997; Beck, 1991). Alternatively, Conroy and colleagues (2007) analyzed cross-sectional data one year after an exercise intervention in order to understand lapses (i.e., two weeks of failed adherence) during the initiation of a regular exercise regimen. They found that participants with high depressive symptoms were more likely than other participants to never return to regular exercise after a lapse to inactivity. This suggests that not exercising for two weeks was more detrimental to regular exercise behavior for participants with high depressive symptoms than those with low symptoms. One possible explanation is that participants with depressive symptoms may have experienced greater decreases in self-efficacy when they did not exercise regularly. This would be consistent with evidence that depressive symptoms can also be associated with a tendency to exaggerate failures (Bandura, 1997; Beck, 1991). However, this possibility was not directly examined. If depressive symptoms moderate the relation between exercise and self-efficacy, the moderation effect could be manifest in two different ways. First, depressive symptoms may dampen an increase in self-efficacy when people exercise (e.g., self-efficacy is lower for people with high depressive symptoms than those with low symptoms on days they exercise). Second, depressive symptoms may amplify a decrease in self-efficacy when people do not exercise (e.g., self-efficacy is lower for people with high depressive symptoms than those with low symptoms on days they do not exercise). Current evidence is unclear as to whether either or both effects occur for people with depressive symptoms (Singh et al., 1997; Conroy et al., 2007). Elucidating how these effects unfold on a daily basis would help specify why people with depressive symptoms have difficulties initiating regular exercise. Self-efficacy and exercise both have unique features that would benefit from daily examination over time. First, self-efficacy is not a static construct; it varies according to a person’s experiences (Shiffman et al., 2000). Second, the first days and weeks of initiating regular exercise are a sensitive period in both the formation of self-efficacy (Bandura, 1997) and establishing regular exercise (Dishman, Ickes, & Morgan, 1980), thus it is likely that exercise self-efficacy will be particularly sensitive to daily influences during this critical phase. Third, regular exercise is a health behavior that does not necessitate daily adherence, unlike other health behaviors such as smoking cessation or medication adherence. Indeed, public health guidelines for physical activity recommend activity on most but not all days of the week (USDHHS, 2008). Consequently, for people initiating regular exercise, there will routinely be days on which they exercise and days on which they do not. Distinguishing between experiences that occur on days of exercise and days of no exercise is relevant to understanding the daily psychological processes that occur during the initiation phase of regular exercise.

OBJECTIVE Self-persuasion-generating one's own arguments for engaging in a specific behavior-can be an effective strategy to promote health behavior change, yet the causal processes that explain why it is effective are not well-specified. We sought to elucidate specific causal components and a mediating process of self-persuasion in two health behavior domains: physical activity and smoking. METHODS In two experiments, participants were randomized to write or read arguments about regular exercise (Study 1: N = 76; college students) or smoking cessation (Study 2: N = 107; daily smokers). In Study 2, we also manipulated the argument content (matched vs. mismatched participants' own concerns about smoking) to isolate its effect from the effect of argument source (self vs. other). Study outcomes included participants' reports of argument ratings, attitudes, behavioral intentions (Studies 1 & 2), and cessation attempts at 1 month (Study 2). RESULTS In Study 1, self-generated arguments about exercise were evaluated more positively than other arguments (p = .01, d = .63), and this biased processing mediated the self-generated argument effect on attitudes toward exercise (β = .08, 95% CI = .01, .18). In Study 2, the findings suggested that biased processing occurs because self-generated argument content matches people's own health concerns and not because of the argument source (self vs. other). In addition, self-generated arguments indirectly led to greater behavior change intentions (Studies 1 & 2) and a greater likelihood of a smoking cessation attempt (Study 2). CONCLUSIONS The findings elucidate a causal component and a mediating process that explain why self-persuasion and related behavior change interventions, such as motivational interviewing, are effective. Findings also suggest that self-generated arguments may be an efficient way to deliver message interventions aimed at changing health behaviors.

Objective Self-persuasion is an effective behavior change strategy, but has not been translated for low-income, less educated, uninsured populations attending safety-net clinics or to promote human papillomavirus (HPV) vaccination. We developed a tablet-based application (in English and Spanish) to elicit parental self-persuasion for adolescent HPV vaccination and evaluated its feasibility in a safety-net population. Methods Parents (N = 45) of age-eligible adolescents used the self-persuasion application. Then, during cognitive interviews, staff gathered quantitative and qualitative feedback on the self-persuasion tasks including parental decision stage. Results The self-persuasion tasks were rated as easy to complete and helpful. We identified six question prompts rated as uniformly helpful, not difficult to answer, and generated non-redundant responses from participants. Among the 33 parents with unvaccinated adolescents, 27 (81.8%) reported deciding to get their adolescent vaccinated after completing the self-persuasion tasks. Conclusions The self-persuasion application was feasible and resulted in a change in parents’ decision stage. Future studies can now test the efficacy of the tablet-based application on HPV vaccination. Practice implications The self-persuasion application facilitates verbalization of reasons for HPV vaccination in low literacy, safety-net settings. This self-administered application has the potential to be more easily incorporated into clinical practice than other patient education approaches.

According to Self-Determination Theory, the extent to which the motivation underlying behavior is self-determined or controlled influences its sustainability. This is particularly relevant for behaviors that must be repeated, such as completion of the human papillomavirus (HPV) vaccine series. To date, no measures of motivation for HPV vaccination have been developed.As part of a larger study, parents (N=223) whose adolescents receive care at safety-net clinics completed a telephone questionnaire about HPV and the vaccine. We modified the Treatment Self-Regulation Questionnaire to assess parents' motivation for HPV vaccination in both Spanish and English. We used confirmatory factor analysis to test a three-factor measurement model.The three-factor model fit the data well (RMSEA=0.04, CFI=0.98, TLI=0.96), and the scales' reliabilities were adequate (autonomous: α=0.87; introjected: α=0.72; external: α=0.72). The factor loading strength for one item was stronger for Spanish- than English-speaking participants (p0.05); all others were equivalent. The intercorrelations among the scales ranged from -0.17 to 0.32, suggesting discriminant factors. The scales displayed the expected pattern of correlations with other psychosocial determinants of behavior. Vaccination intentions showed a strong correlation with autonomous motivation (r=0.52), but no correlation with external motivation (r=0.02), suggesting autonomous motivation may be particularly important in vaccine decision-making.Findings support the use of three subscales to measure motivation in HPV vaccination and suggest possible cultural differences in motivation.

OBJECTIVE Researchers who study physical activity often use outcome variables that have a lower bound of zero and are positively skewed (e.g., minutes of physical activity in a day). Researchers also often use statistical methods that assume the outcome is normally distributed or transform the outcome as an attempt to make it more normal, both of which can be problematic. In this article, the authors describe multilevel 2-part models that use a mixture of logistic regression-to predict whether a person was active-and gamma regression-to predict amount of activity if there was activity. METHOD The authors contrast the 2-part models to a linear multilevel model using data from a longitudinal study of physical activity (N = 113; 2,305 observations). The dependent variable was minutes of moderate-to-vigorous activity in a day and the predictor variables were day, satisfaction, and gender. RESULTS The 2-part models outperform the linear model and provide researchers critical information that is conceptually relevant, such as distinguishing between predictors of whether activity occurred and of how much activity occurred. CONCLUSIONS Two-part models represent a flexible and useful addition to the analysis repertoire of health researchers. To assist researchers in learning these methods, the online supplemental materials provide additional technical information as well as annotated computer code for estimating these models. (PsycINFO Database Record

Objective Although provider recommendation is a key predictor of HPV vaccination, how providers verbalize recommendations particularly strong ones is unknown. We developed a tool to describe strength and content of provider recommendations. Methods We used electronic health records to identify unvaccinated adolescents with appointments at six safety-net clinics in Dallas, Texas. Clinic visit audio-recordings were qualitatively analyzed to identify provider recommendation types (presumptive vs. participatory introduction; strong vs. weak), describe content communicated, and explore patterns between recommendation type and vaccination. Results We analyzed 43 audio-recorded discussions between parents and 12 providers. Most providers used a participatory introduction (42 discussions) and made weak recommendations (24 discussions) by using passive voice or adding a qualification (e.g., not school required). Few providers (11 discussions) gave strong recommendations (clear, personally-owned endorsement). HPV vaccination was lowest for those receiving only weak recommendations and highest when providers coupled the recommendation with an adjacent rationale. Conclusion Our new tool provides initial evidence of how providers undercut their recommendations through qualifications or support them with a rationale. Most providers gave weak HPV vaccine recommendations and used a participatory introduction. Practice implications Providers would benefit from communication skills training on how to make explicit recommendations with an evidence-based rationale.

Objectives: Even after acute coronary syndrome (ACS) is ruled out, observational studies have suggested that many patients with nonspecific chest pain have a high burden of cardiovascular risk factors (CRFs) and are at increased long-term risk of ischemic heart disease (IHD)-related mortality. The aim of this study was to evaluate the premise that evaluation in an observation unit for symptoms of possible ACS is a “teachable moment” with regard to modification of CRFs. Methods: The authors conducted a baseline face-to-face interview and a 3-month telephone interview of 83 adult patients with at least one modifiable CRF who presented with symptoms of possible ACS to an academic medical center. Existing questionnaires were adapted to measure Health Belief Model (HBM) constructs for IHD. Stage of change and self-reported CRF-related behaviors (diet, exercise, and smoking) were assessed using previously validated measures. The paired t-test or signed rank test was used to compare baseline and 3-month measures of health behavior within the analysis sample. Results: Of the 83 study patients, 45 and 40% reported having received clinician advice regarding diet and physical activity during the observation unit encounter, respectively; 69% of current smokers received advice to quit smoking. Patients reported lower susceptibility to IHD (13.3 vs. 14.0, p = 0.06) and greater perceived benefit of healthy lifestyles (27.5 vs. 26.4, p = 0.0003) at 3-month follow-up compared to baseline. Patients also reported greater readiness to change and improved self-reported behaviors at follow-up (vs. baseline): decreased intake of saturated fat (10.1% vs. 10.5% of total calories, p = 0.005), increased fruit and vegetable intake (4.0 servings/day vs. 3.6 servings/day, p = 0.01), and fewer cigarettes (13 vs. 18, p = 0.002). Conclusions: Observed changes in IHD health beliefs and CRF-related behaviors during follow-up support the idea that observation unit admission is a teachable moment. Patients with modifiable risk factors may benefit from systematic interventions to deliver CRF-related counseling during observation unit evaluation.

We sought to determine whether different social, psychological, emotional, and physiological experiences associated with quitting smoking related to people’s satisfaction with cessation systematically, and whether the strength of the relations changes at different points during the cessation process and for different people (e.g., optimists). Using data from smokers enrolled in a cessation program, we used mixed models to assess the average longitudinal relation between people’s experiences and satisfaction measured at seven time points and whether the relations were moderated by key variables. Eight of nine experiences were related to people’s satisfaction (ps < 0.05) and the models accounted for 39–44% of the within-person variance in satisfaction. Current smoking behavior was more strongly related to people’s satisfaction during their early efforts to quit, whereas some experiences (e.g., feedback from others) had a stronger relation with satisfaction during people’s later efforts to quit or maintain abstinence (ps < 0.05). Individual differences in optimism and prior cessation experience moderated some of the relations (ps < 0.05). The findings mark the first evidence of factors that might influence how people determine their satisfaction with smoking cessation. The implications for tailoring interventions and potentially increasing the likelihood that people maintain abstinence are discussed.

Item does not contain fulltext Physical activity (PA) interventions have a clear role in promoting mental health. Current PA guidelines directed toward specific PA intensities may have negative effects on affective response to exercise, and affective response is an important determinant of PA adherence. In this randomized trial of 67 previously inactive adults, we compared the effects of a PA prescription emphasizing the maintenance of positive affect to one emphasizing a target heart rate, and tested the extent to which the effect of the affect-guided prescription on PA is moderated by cardiorespiratory fitness (CRF). We found the effect of an affect-guided prescription was significantly moderated by CRF. At one week, for participants with lower CRF (i.e. poor conditioning), the affect-guided prescription resulted in significantly greater change in PA minutes (M = 240.8) than the heart rate-guided prescription (M = 165.7), reflecting a moderate-sized effect (d = .55). For those with higher CRF (i.e. good conditioning), the means were in the opposite direction but not significantly different. At one month, the same pattern emerged but the interaction was not significant. We discuss the implications of these findings for the type of PA prescriptions offered to individuals in need. 13 p.

Using data from smokers (N = 591) who enrolled in an 8-week smoking cessation program and were then followed for 15 months, the authors tested the thesis that self-efficacy guides the decision to initiate smoking cessation but that satisfaction with the outcomes afforded by quitting guides the decision to maintain cessation. Measures of self-efficacy and satisfaction assessed at the end of the program, 2 months, and 9 months were used to predict quit status at 2, 9, and 15 months, respectively. At each point, participants were categorized as either initiators or maintainers on the basis of their pattern of cessation behavior. Across time, self-efficacy predicted future quit status for initiators, whereas satisfaction generally predicted future quit status for maintainers. Implications for models of behavior change and behavioral interventions are discussed.

Item does not contain fulltext Little is known about how outcome expectations change after physical activity initiation and whether changes are associated with physical activity experiences. In a diary study, physically inactive adults (N = 102) initiated an exercise regimen and reported their experiences daily (e.g. progress toward goals) and corresponding outcome expectations weekly (e.g. how much progress they expect this week). Average levels (between-person effects) for eight experiences (ps < .01) and deviations from the average levels (within-person effects) for three experiences (ps < .05) were associated with changes in outcome expectations. The findings demonstrate that outcome expectations for exercise vary over time and are associated with people’s subjective experiences. 11 p.

Satisfaction with physical activity is known to be an important factor in physical activity maintenance, but the factors that influence satisfaction are not well understood. The purpose of this study was to elucidate how ongoing experiences with recently initiated physical activity are associated with satisfaction. Participants (n = 116) included insufficiently active volunteers who initiated a self-directed physical activity regimen and completed daily diaries about their experiences for 28 days. We used multilevel models to examine the associations between experiences with physical activity and satisfaction. Significant between-person effects demonstrated that people reporting higher average levels of positive experiences and lower levels of thinking about the negative aspects of exercise were more likely to report higher levels of satisfaction (ps

Positive attitudes toward the use of corporal punishment (CP) predict subsequent spanking behavior. Given that CP has frequently been associated with behavior problems in children and child maltreatment, this prevention work was designed to test whether adults' attitudes could be changed by informing participants about the research findings on problematic behaviors associated with CP. Two random assignment studies are reported. In Study 1, we tested whether an active reading condition would result in more attitude change than a passive condition. With a sample of 118 non-parent adults, we found that after reading very brief research summaries on the problems associated with CP, there was a significant decrease in favorable attitudes toward CP. Contrary to expectations, the magnitude of the change was comparable for active and passive processing conditions. In Study 2, we extended our approach to a sample of 520 parents and included a control group. A significant decrease in positive attitudes toward spanking was observed in the intervention group, but no change for the control group. Parents who were unaware of the research showed more change after reading the summaries. Thus, these studies demonstrate that a brief and cost-effective approach to raise awareness of research findings can reduce positive attitudes toward CP. Implications for prevention and intervention are discussed.

We examined factors associated with information seeking about the human papillomavirus vaccine among mothers of adolescent girls by testing whether information seeking and vaccination intentions for their daughters are associated with perceived vulnerability, severity, and vaccine benefits in an ethnically diverse sample. Mothers ( N = 256) of unvaccinated girls living in Dallas, Texas, were surveyed (49% Black, 29% Hispanic, and 18% White). Perceived vulnerability to human papillomavirus was associated with talking with others (odds ratio = 1.71, 95% confidence interval = 1.09, 2.66) and talking with a doctor about the vaccine (odds ratio = 1.42, 95% confidence interval = 1.01, 1.99), and perceived vaccine benefits were associated with vaccination intentions (odds ratio = 2.96, 95% confidence interval = 1.98, 4.42), but the perceived severity was not associated with any dependent measure. Beliefs about human papillomavirus risk are associated with seeking information from a doctor and interpersonal sources, but ethnic minorities are less likely to talk with others about the vaccine.

Previous examinations of depression as a predictor of mortality in end-stage renal disease have yielded inconsistent findings. We sought to clarify the possible link with mortality by assessing depression at an earlier stage of renal impairment before the uremic disease state and depressive symptoms become highly confounded, and then following patients during the period of disease progression.Prospective design using an assessment of depression before initiation of renal replacement therapy to predict mortality status an average of 81 months later in patients in the early stages of chronic kidney disease.Mortality status.After controlling for relevant mortality risk factors (i.e., age, gender, presence of diabetes and cardiovascular disease, and potassium level), results of Cox regression analyses indicated that higher levels of nonsomatic depression symptoms were predictive of an increased mortality risk, χ²(1, N = 359) = 8.02, p = .005. Patients with nonsomatic depression scores 1 SD above the mean had an estimated mortality rate 21.4% higher than average scorers in this sample.Clinical implications of these findings point to the importance of assessment and treatment of depressive symptoms in patients with chronic kidney disease.

Recent research has shown that satisfaction with weight loss is predictive of weight loss maintenance, yet empirical evidence for how people derive satisfaction with weight loss is quite limited.To determine whether satisfaction with weight change systematically covaries with various weight-loss-related outcomes and experiences (e.g., improvement in physical appearance, amount of frustration experienced), which outcomes and experiences are the strongest longitudinal correlates of satisfaction, and whether the longitudinal covariations are due to between-person differences and/or within-person changes.We analyzed longitudinal data obtained from overweight or obese individuals enrolled in a weight-loss program who were followed for 18 months using random coefficient models.In univariate analyses controlling for the amount of weight people lost, nine of ten outcomes and experiences independently covaried with people's satisfaction, and the models accounted for 21-38% of the within-person variance in satisfaction. In a multivariate analysis, four outcomes and experiences remained as significant longitudinal covariates of satisfaction. In both sets of analyses, there were more significant relations due to within-person changes than to between-person differences.The results suggest that people's weight loss satisfaction systematically covaries with ongoing changes in weight-loss-related outcomes and experiences. The findings help elucidate how people derive satisfaction with weight loss.

Despite considerable clinical interest, attempts to link perceived self-efficacy with successful weight control have had mixed success. Definitive data on prospective associations between self-efficacy and weight loss are particularly sparse. This study examined relationships between self-efficacy beliefs, weight control behaviors, and weight change among individuals participating in a weight loss trial (N = 349, 87% women). Cross-sectionally, eating and exercise self-efficacy beliefs were strongly associated with corresponding weight loss behaviors. Self-efficacy beliefs prospectively predicted weight control behavior and weight change during active treatment but not during follow-up. Mediational models indicate that people's weight control behaviors mediate the impact of self-efficacy on weight change.