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Nour Amin Elsahoryi,1 Hadil Shafee Subih,2 Fadwa Hammouh,3 Fwziah Jammal Hammad2 1Department of Nutrition, Faculty of Pharmacy and Medical Sciences, The University of Petra, Jordan; 2Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, Irbid Jordan; 3Department of Nutrition and Dietetics, Faculty of Health Sciences, American University of Madaba, Madaba, JordanCorrespondence: Nour Amin Elsahoryi, Email nour.elsahoryi@uop.edu.joAim: This study aimed to determine the current stage of change (SOG) toward seven healthy eating behaviors and two healthy lifestyle behaviors related to blood pressure (BP) control. The lifestyle behaviors included smoking Behavior and practicing regular exercise, while the dietary behaviors included the DASH diet guidelines.Methods: A total of 1109 outpatients participated in this cross-sectional study that was conducted between 2021 and 2022 in Jordan. A staging algorithm assessed SOG for several BP control-related behaviors for diagnosed hypertension patients. Data were collected by a structured interview-based questionnaire.Results: There was a high degree of maintenance toward consuming diets with high grains, fruit, vegetables, meat, and poultry, less saturated fat, and more low-fat dairy products. More than half of the participants were in the pre-action stage for quitting smoking, practicing physical exercise, and consuming sweets and added sugars. Significant associations were observed between the degree of maintenance for several behaviors (p < 0.01). Age, income, education level, disease duration, and nutrition consultation availability were the most related factors to the SOG of the studied behaviors (p < 0.01).Conclusion: Patients with hypertension in Jordan are still in the pre-action stages for quitting smoking, practicing physical exercise, and consuming 5 servings of refined sweets and added sugars weekly. The current outcome suggests a need for nutritional counseling, education, and interventions to raise awareness of lifestyle factors influencing BP among hypertension patients.Keywords: hypertension, stage of change, SOG, health behavior

Background: Type 2 diabetes mellitus (T2DM) is increasing in China, with medication non-adherence being a significant contributor to uncontrolled T2DM. The Transtheoretical Model (TTM) has shown effectiveness in chronic disease management, but few studies have applied it in online interventions for T2DM medication adherence. Aim: The study aimed to develop and investigate the effects of a TTM-based online health education program on promoting positive stage of change (SOC) movement, improving self-efficacy and medication adherence, as well as reducing HbA1c levels in newly diagnosed patients with T2DM. Methods: This sequential mixed-method study was conducted from April 2023 to March 2024. Using the TTM framework, the study initially explored 32 participants' experiences with hypoglycemic medications, health information acquisition, and perspectives on online programs. Then, a quasi-experimental study design was conducted. Two communities were randomly assigned as the intervention (n = 91) and comparison (n = 98) groups, with 189 newly diagnosed middle-aged T2DM patients from various SOC. The intervention group received short videos health education and participated in WeChat group discussions, compared with usual care in the comparison group. Data were collected at baseline, 3-month, and 6-month follow-ups. Results: The intervention group was more likely to achieve positive SOC movement (P <.001, Adj OR = 13.69 95% CI = 6.76-27.71) compared to the comparison group. The intervention group also had significantly higher mean CDMSS-11 and MMAS-8 scores at 6 months (P =.03 and <.001, respectively) and more likely to achieve clinically significant glycated Hemoglobin (HbA1c) change at 3 months (P <.001, Adj OR = 3.91, 95% CI = 1.77-8.63) and at 6 months (P <.001, Adj OR = 5.62, 95% CI = 2.70-11.69) compared to the comparison group. Conclusion: These findings support that applying the TTM to develop an online program could promote behavior change, improve self-efficacy and medication adherence, and could lead to better glycemic control in newly diagnosed T2DM patients. [ABSTRACT FROM AUTHOR]

Background and objectives: Having children is one of the important factors in the development of society and country. This research was carried out with the aim of determining the effect of educational intervention based on the stages of change on the attitude and behavior of married women to have children. Materials and Methods: This Quasi experimental study was conducted on 80 married women (40 in the intervention group and 40 in the control group) under the cover of Saman Health Center Mashhad in 2022. Sampling was done by simple random method. In order to collect data, a researcher-made questionnaire was used whose validity and reliability were confirmed. Educational program was held in 4 sessions for one month for the intervention group and the participants in both groups answered the questionnaire questions before and 3 months after the intervention. The data was analyzed by SPSS 20. Results: The mean attitude scores of women in the intervention group before and 3 months after the intervention were 16.01±2.21, 17.85±2.06. Statistical tests showed a significant relationship between education and women's attitude towards having children (P<0.01). Also, the educational intervention had an effect on changing behavior of women for having children (P>0.05). Conclusion: The educational intervention in this study was able to significantly improve the attitude of married women in the field of childbearing. However, it is suggested that in the future programs of individuals, the stages of preparation and action in educational interventions should also be considered. [ABSTRACT FROM AUTHOR]

Motivational interviewing (MI)-based interventions can be effective for people living with HIV (PLWHIV) with medical follow-up problems. This study aimed to assess the stage of motivation to attend medical appointments of PLWHIV with medical follow-up problems and to evaluate a single telephone session MI intervention directed to engage them in care. The change in stage was evaluated before and after the intervention, and attending medical appointments was monitored for six months. Thirty-nine PLWHIV participated; 51.3% were in precontemplation/contemplation and 49.7% in preparation/action stage. Most (excluding those in the action stage from the beginning) (n = 22, 71.0%) advanced to another stage after the intervention (z = − 4.235, p <.001), and most did not miss the following appointments. Brief and remote MI interventions could be useful in low-resource settings, especially for those in the early stages of change, to explore motivations related with missing medical appointments. [ABSTRACT FROM AUTHOR]

Introduction: This pilot study will determine the recruitment feasibility, retention, and adhesion for a motivational interviewing program for weight loss. Materials and Methods: The singlearm pilot study will be a feasibility study of the Motivation to Lose Weight version 1 (MLW v.1). The study includes presential and online sessions. Participants will be recruited through advertisements on social media and selected according to the inclusion criteria. Participants will receive 8 sessions of approximately 30-45 minutes of motivational interviewing (MI) according to the processes of change in weight loss, as measured by the S-Weight scale. The results will be evaluated at the beginning and the end of the program, which will last 8 weeks. The primary outcome of the study is feasibility. The intervention will be feasible if adherence to the proposed activities in the sessions is greater than 70%, we can recruit 10 patients within 8 weeks, the proportion of interested people and registered participants is greater than 30%, and more than 75% of participants attend the final study visit. The secondary outcome is weight loss, fat mass percentage, muscle mass, waist and hip measurements, and the scores of behavioral scales. Ethics and discussion: This intervention aims to increase the participant's confidence level to implement actions that lead to the progression of behavior and, consequently, the action and maintenance of the lost weight. This study was approved by the Research Ethics Committee (REC) of the Hospital de Clínicas de Porto Alegre (HCPA) under number 20220209 CAAE 59573622300005327. [ABSTRACT FROM AUTHOR]

IntroductionOverconsumption of energy dense, nutrient poor foods and beverages is a major problem globally. This study describes what and how Australian adults consume and are willing to change their intake in terms of discretionary food and beverage categories.MethodsCross-sectional data were collected via the CSIRO Junk Food Analyser. This online tool contains short questions on discretionary food and beverage consumption, and items relating to stage of and willingness and strategies to reduce discretionary food and beverage intake. Analyses focussed on describing discretionary intake, adherence to guidelines and the prediction of willingness to change discretionary food intake amongst those exceeding guidelines.ResultsIn 2021, 41,109 Australian adults completed the CSIRO Junk Food Analyser. Participants were mostly female (73.1%) and aged 31–70 years (78.9%). Most participants exceeded dietary guidelines for discretionary food and beverage intake (67.4%, 27,694/41,109) with 40% reporting actively trying to reduce intake. Most people exceeding guidelines did so in categories of alcohol (39.3%) and cakes and biscuits (21.0%). Yet, willingness to change intake was lowest for alcohol (median, IQR of 3, 2:4 out of 5). Almost half of the participants were willing to try ‘having a few days off per week’ (46.0%), while only 13.4% were willing to try to ‘eliminate’ their highest ranked category.DiscussionAustralian adults are willing to reduce their discretionary food and beverage intake, but simply targeting the foods and beverages consumed most may not be the best place to start. Messages encouraging days off frequently consumed discretionary foods and beverages may be well received.

Naruemon Sawaengsri,1 Wantana Maneesriwongul,1 Erica N Schorr,2 Supichaya Wangpitipanit1 1Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 2School of Nursing, University of Minnesota, Minneapolis, MN, USACorrespondence: Wantana Maneesriwongul, Ramathibodi School of Nursing, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Thung Phaya Thai, Ratchathewi, Bangkok, 10400, Thailand, Tel +662 2011600, Fax +662 2012858, Email wantana.lim@mahidol.ac.thIntroduction: Owing to the increased prevalence of type 2 diabetes mellitus (T2DM) and the high proportion of patients with uncontrolled T2DM, effective interventions for disease management are needed.Objective: The study aim was to test the effects of brief motivational interviewing (MI) on patients’ self-management, medication adherence, and glycemic control.Methods: A single-group repeated measures trial was used to examine the effects of usual care only and usual care plus telephone-based brief MI. Participants were 29 patients with uncontrolled T2DM recruited from a rural primary care setting in Nakhon Sawan, Thailand. Participants received usual care during the first 4 weeks, followed by usual care plus brief MI during weeks 4– 8. Outcomes of self-management, medication adherence, fasting blood sugar (FBS) levels, and hemoglobin A1c (HbA1c) levels were assessed at baseline, 4 weeks, and 8 weeks. Data were analyzed using descriptive statistics, one-way repeated measures analysis of variance, and Friedman test.Results: Significant changes in self-management (p < 0.001), medication adherence (p < 0.001), and FBS (p < 0.05) were observed over the 8-week study. In multiple comparisons, self-management was the only parameter significantly different across baseline, 4, and 8 weeks (p < 0.05, < 0.001, and < 0.001, respectively); medication adherence was significantly different between 4 and 8 weeks (p < 0.05), and between baseline and 8 weeks (p < 0.001); and FBS was significantly different between 4 and 8 weeks (p < 0.05). HbA1c declined over the 8-week study, but not significantly.Conclusion: An intervention combining telephone-based brief MI with usual care significantly increased self-management, medication adherence, and glycemic control (ie, FBS) after 4 weeks, whereas usual care only significantly increased self-management. Phone-based brief MI may be an effective way for healthcare providers to remotely enhance patients’ self-management and glycemic control, thus reducing barriers related to time and geographic location.Keywords: motivational interviewing, tele-intervention, stage of change, medication adherence, glycemic control, diabetes, T2DM

Background: The Transtheoretical Model (TTM) which focuses on stage of change has been the main conceptual model used in understanding the lack of motivation to change in patients with Anorexia Nervosa (AN). Whilst there is evidence to support the prognostic value of the TTM in AN, this evidence base sufferers from limitations including limited studies in adults and none in outpatient populations. The primary aim of this study was to clarify whether readiness to change, as measured by the University Rhode Island Change Assessment Scale (URICA) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) could predict weight gain in adults with AN following treatment in an outpatient setting. Methods: This was a prospective cohort analysis, which selectively used data from an existing clinical database at an outpatient eating disorders service. 119 patients met eligibility criteria and were included in this study. This included all adult patients who had a diagnosis of AN and were assessed, but not necessarily treated at the outpatient eating disorders program (Group 1). A subgroup of 63 patients (Group 2) was also analysed which only included patients who had received treatment at the program. Baseline measures included the URICA score, the ANSOCQ score, the Eating Disorders Examination Questionnaire (EDE-Q) and body mass index (BMI). BMI was also measured on discharge. Results: The URICA scale had poor predictive validity for weight gain (r = 0.05, p = 0.725). The ANSOCQ had moderate predictive validity (Pearson's r = 0.57, p = 0.007), and accounted for 32.7% of variance in weight gain. The URICA and ANSOCQ were moderately correlated in both groups. The URICA was moderately predictive of symptom severity, measured by the EDE-Q in both groups. The ANSOCQ was moderately correlated with the EDE-Q scores in both Groups 1 and 2. Conclusions: To the authors' knowledge this is the only study evaluating stage of change, in an adult outpatient population with AN. The findings of this study suggest that while both the URICA and ANSOCQ were associated with eating disorder symptom severity, only the ANSOCQ was able to predict weight gain in outpatients with AN suggesting its greater utility in this context. [ABSTRACT FROM AUTHOR]

Persuasive systems motivate behaviour change using persuasive strategies (PS) which are often implemented in various ways. However, whether or not the effectiveness of PS varies depending on implementation choices is yet to be investigated via an empirical study. We conduct a large-scale study of 568 participants to investigate if and how individuals at different Stages of Change (SoC) respond to different implementations of each strategy in the same system. We also explore why the implementations motivate behaviour change using ARCS motivation model. Our results show that people's SoC plays a significant role in the perceived effectiveness of different implementations of the same strategy and that the implementations motivate for different reasons. For instance, people at the precontemplation stage are motivated by reward strategy implemented as badges because it increases their Confidence, while people in the preparation stage prefer reward implemented as points to build their Confidence. Our work links SoC theory with motivation theory and Persuasive Systems Design (PSD) model to offer practical guidelines for tailoring PS implementations to individuals to motivate behaviour change. [ABSTRACT FROM AUTHOR]

Lifestyle modifications after stroke are associated with better risk factor control and lower mortality. The primary objective of this study was to describe the knowledge of American Heart Association (AHA) recommendations for diet and exercise in survivors of stroke and transient ischemic attack (TIA). The secondary objectives were to describe their diet and exercise behaviors, self-efficacy (SE), behavioral intent (BI), stage of change, and barriers to change. Data are described from participants enrolled in a prospective educational intervention in mild stroke/TIA survivors. A multiple-choice questionnaire ascertained knowledge of AHA recommendations for diet and exercise, nutrition and physical activity behavior, SE, BI, stage of change, and barriers to change. Twenty-eight stroke/TIA survivors, with a mean age of 61.7 ± 11.8 years, completed questionnaires during their acute hospitalization. Participants underestimated the recommended intake of fruits, vegetables, whole grains, and participation in aerobic exercise and overestimated the recommended intake of sugar and salt. SE demonstrated a significant positive association with combined behavior scores (rs = 0.36, p = 0.043). Greater knowledge of the AHA recommendations was not associated with healthier behavior, greater SE, higher BI, or more advanced stage of change. The gaps between AHA recommendations and stroke/TIA patient knowledge identifies an area for potential intervention in stroke prevention and recovery. [ABSTRACT FROM AUTHOR]

Background: Hookah, as a traditional method of smoking, is widely used in Iran, especially in Bushehr province. It is essential to identify the most important determinants of modifying hookah smoking behavior. This study aimed to investigate the predictors of the stages of change in quitting hookah smoking in 15-60-year-old individuals in Bushehr province, southern Iran, based on the transtheoretical model (TTM). Methods: This descriptive-analytical study was conducted on 1173 Hookah smokers in Bushehr province. The samples were selected by two-stage random sampling from 10 cities. Data were collected using a valid and reliable questionnaire consisting of 5 sections (demographic characteristics, stages of change, processes of change, decisional balance, and self-efficacy). Data were analyzed by R version.3.3.1 using analysis of variance and ordinal logistic regression at a significant level of 0.05. Findings: The data revealed 82% of the participants were in the preparatory phase (55.3% in pre-contemplation and 26.7% in contemplation stages). Marital status, family members smoking hookah, cigarette smoking, level of education, number of family members, number of quitting attempts, self-efficacy, self-reevaluation, counter-conditioning, reinforcement management, and stimulus control were predictors of quitting hookah smoking. Conclusion: Given that most study participants were in the inactive stages of quitting hookah smoking, it seems necessary to design and implement behavioral interventions based on the predictive TTM constructs in this population.

Background: Hookah, as a traditional method of smoking, is widely used in Iran, especially in Bushehr province. It is essential to identify the most important determinants of modifying hookah smoking behavior. This study aimed to investigate the predictors of the stages of change in quitting hookah smoking in 15-60-year-old individuals in Bushehr province, southern Iran, based on the transtheoretical model (TTM). Methods: This descriptive-analytical study was conducted on 1173 Hookah smokers in Bushehr province. The samples were selected by two-stage random sampling from 10 cities. Data were collected using a valid and reliable questionnaire consisting of 5 sections (demographic characteristics, stages of change, processes of change, decisional balance, and self-efficacy). Data were analyzed by R version.3.3.1 using analysis of variance and ordinal logistic regression at a significant level of 0.05. Findings: The data revealed 82% of the participants were in the preparatory phase (55.3% in pre-contemplation and 26.7% in contemplation stages). Marital status, family members smoking hookah, cigarette smoking, level of education, number of family members, number of quitting attempts, self-efficacy, self-reevaluation, counter-conditioning, reinforcement management, and stimulus control were predictors of quitting hookah smoking. Conclusion: Given that most study participants were in the inactive stages of quitting hookah smoking, it seems necessary to design and implement behavioral interventions based on the predictive TTM constructs in this population. [ABSTRACT FROM AUTHOR]

Objective: To assess the meaning of a physical activity prescription (PAP) from the physician's point of view and to examine current PAP-related clinical practices and stage of change, including the factors that influence them. Methods: Mixed methodology was applied to obtain valid, high-quality data. During the qualitative phase, the "free-listing" technique was used to explore the "cultural domain" of a physician's perception of PAP, as well as the construction of culturally relevant items used during the last phase of the study. A survey was conducted to evaluate clinical practices, attitudes, and physician state of change regarding PAP. The convenience sample of 58 (qualitative phase) and 350 internists (quantitative phase) who attended the International Congress of Internal Medicine was interviewed. Results: A majority of internist reported having adequate knowledge, positive attitude, being in the maintenance phase with no barriers to prescribe physical activity (PA). Prescription was associated with physician training, their workplace, and experience. However, physicians do not satisfactorily evaluate the level of patient's PA nor recommend an adequate level of PA, which is necessary to achieve health goals. Conclusions: Physicians had great acceptance of PAP. However, there were low levels of knowledge of current PA guidelines, although most physicians thought they had sufficient knowledge. Training seems to be an excellent way to improve PAP. [ABSTRACT FROM AUTHOR]

Background: The transtheoretical model (TTM) is composed of the multiple stages according to patient’s consciousness and is believed to lead people to realize the importance of healthier behaviors. We examined the association of TTM stages with the decline of estimated glomerular filtration rate (eGFR). Methods: We used the annual health checkup data and health insurance claims data of the Japan Health Insurance Association in Kyoto Prefecture between April 2012 and March 2016. TTM stages of change obtained from questionnaires at the first health checkup and categorized into six groups. The primary outcome was defined as a more than 30% decline in eGFR from the first health checkup. We fitted multivariable Cox proportional-hazards model for time-to-event analyses adjusting for age, sex, eGFR, body mass index, blood pressure, blood sugar, dyslipidemia, uric acid, urinary protein, and existence of kidney diseases at first health checkup. Results: We analyzed 239,755 employees and the mean follow-up was 2.9 (standard deviation, 1.2) years. As compared with the stage 1 group, the risk of eGFR decline was significantly low in the stage 3 group (hazard ratio [HR] 0.77; 95% confidence interval [CI], 0.65–0.91); stage 4 group (HR 0.80; 95% CI, 0.65–0.98); and stage 5 group (HR 0.79; 95% CI, 0.66–0.95). Conclusion: Compared with the precontemplation stage (stage 1), the preparation, action and maintenance stages (stages 3, 4, and 5), were associated with a lower risk of eGFR decline.

Aim: This study evaluated the consistency between the International Classification of Diseases, 11th Edition (ICD-11) for gaming disorder (ICD-11-GD) and Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for internet gaming disorder (DSM-5-IGD). Moreover, the functional impairment of participants and their insight of their GD were evaluated. Methods: We recruited 60 participants with GD, 45 participants who engaged in hazardous gaming (HG), and 120 controls based on a diagnostic interview. Their operationalization of functional impairment and stage of change were evaluated by interviews and questionnaires, including the Brief Gaming Negative Consequence Scale (BGNCS). Results: We observed satisfactory consistency (kappa value 5 0.80) with a diagnostic accuracy of 91.5% between the ICD-11-GD and DSM-5-IGD criteria. Furthermore, 16 participants with IGD in DSM-5 were determined to have HG based on the ICD-11 criteria. Participants of GD group experienced impaired functioning in their health (96.7%), career (73.3%), social life (61.6%), academic performance (36.7%), and job performance (35%). Moreover, a proportion of them were in the pre-contemplation (25.0%), contemplation (61.7%), preparation (10%), and action stages (3.3%). Conclusion: There is a good consistency between ICD-11-GD and DSM-5-IGD criteria. The ICD-11 criteria have a high threshold for diagnosing GD. HG criteria could compensate for this high threshold and identify individuals with a gaming-related functional impairment who require help. Most of the participants with GD were in the early stage of change. Interventions to promote their insight are essential. The BGNCS can be used to examine the negative consequences of gaming and aid mental health professionals in assessing functional impairment. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This article presents a systematic review and meta-analysis of cross-sectional studies of physical activity (PA) behavioral changes in children and adolescents based on the trans-theoretical model (TTM). The main purpose is to test the rationality of TTM and the secondary purpose is to analyze whether PA can effectively identify the stages of change. MATERIALS AND METHODS: The databases CNKI, Wan-Fang, VIP, WOS, PubMed, and EBSCO were searched by computer. Two researchers independently reviewed the literature, extracted data, and evaluated the quality of the literature. Stata 23.0 software was used for statistical analysis. RESULTS: A total of 17 articles of medium and high quality were included in the meta-analysis. First, the behavior changes of PA of children and adolescents are related to the process of change (POC), self-efficacy (SEI), and decisional balance (DBL). The POC, SEI, and DBL have obvious stage characteristics. Second, with increasing intensity of PA, the degree of discrimination of stage of change (SOC) also improved, but PA could not still fully distinguish each stage. CONCLUSIONS: It is suggested that follow-up studies should compare the stages of change of different criteria by comprehensive behavioral data, exercise willingness, and exercise habits. Furthermore, it is recommended that more studies use longitudinal surveys or experimental interventions to test the rationality of TTM. It is suggested that the follow-up study design more standardized measurement tools to explore the change in PA behavior of children and adolescents. [ABSTRACT FROM AUTHOR]

Significant disruptive events have the potential to change travel behaviour in the long-term. COVID-19 has caused the most significant disruption of travel behaviour in living memory. One of the most notable changes has been the increase in working from home, which was forced upon many workers during lockdowns and 'stay at home' orders. But much is still unknown about the long-term impacts of those changes. This study explores the influence of the COVID-19 pandemic on changing work from behaviours using the Transtheoretical Model of behaviour change. The Transtheoretical Model has been widely used to study behaviour change in health, with some application to travel behaviour change. In this paper, we explore whether people's 'stage of change' before COVID-19 has an impact on their long-term intent to work from home. We found that only 12% of respondents had considered working from home more before COVID, yet those that had were far more likely to intend to work from home in the long term. In addition, we unpack the influence of 'process of change' factors, some of which point to a potential 're-norming' of attitudes toward working from home. Although self-efficacy (feeling capable to work from home) was an important factor, it was not as important as the attitudes of employers and colleagues toward working from home. Implications of the findings for research and practice are explored. • Transtheoretical Model explains intent to work from home (WFH) more 'after COVID'. • Most people (79%) hadn't considered increasing WFH before COVID. • Contemplating/preparing for change increases intent to WFH more 'after COVID'. • Process of change factors (helping relationships, social liberation) increase intent to WFH. • External constraints were more important than individual desire to WFH. [ABSTRACT FROM AUTHOR]

Objectives　This study aimed to longitudinally determine the eating behavior and food group intake of female students to examine the relationship between eating behaviors and intention to improve eating habits (change in eating habits stages) and help health education use the behavior change theory.Methods　This one-year longitudinal study included 130 female students from Japanese colleges. The stage at which eating habits and behaviors (skipping breakfast, eating out, instant food intake, and snacking) and intake of food groups rich in protein, calcium, vitamins, minerals, carbohydrates, and fats and oils were assessed. The stages were as follows; pre-contemplation or contemplation (lower group), preparation (middle group), and action or maintenance (upper group). A self-assessment questionnaire was administered to evaluate eating behaviors and food group intake frequencies using a 5-point Likert scale. P-values of <.05 were considered statistically significant.Results　A cross-sectional comparison of eating behaviors and food group intake scores demonstrated significant differences between the stages only in snacking behavior. The upper group consumed snacks significantly less frequently than the middle and lower groups. After one year, a longitudinal comparison of eating behaviors and food group intake scores revealed significant differences in the intake of food groups rich in vitamins and minerals (green and yellow vegetables), fats and oils in the pre-contemplation stage, intake of food groups rich in vitamins/minerals (green and yellow vegetables) and frequency of skipping breakfast in the preparation stage, and frequency of eating out and snacking in the action stage. Each stage demonstrated a decreasing trend in food intake and an increasing trend in the frequency of skipping breakfast, eating out, and snacking. The percentages of students whose eating habits stage dropped during the second year were 49.0%, 100%, and 77.8% in the preparation, action, and maintenance stages, respectively. This indicates that there are cases in which readiness reverses in stages with improved eating habits.Conclusion　In health education on eating habits, it is vital to understand the changes in eating habit stages for each eating behavior and details of actual eating behaviors and habits. Thus, health education should align to the needs of each individual to support them in transforming and maintaining a higher stage of change in their eating habits.

Se presenta una revisión sistemática sobre el uso del Modelo transteórico del cambio (MTC) como predictor de adherencia al ejercicio físico (EF) en supervivientes de cáncer de mama. La revisión sistemática de literatura se hizo siguiendo el método PRISMA, en las bases de datos: Scopus, Pubmed y Psycinfo. Tanto en inglés como en español. Se incluyeron 13 artículos publicados desde junio de 2005 hasta junio de 2020. Todos ellos utilizaron constructos del MTC en sus programas. Los resultados muestran que las variables del MTC que presentan asociación con el EF son los estadios de cambio y la autoeficacia. De este modo las intervenciones que siguen el MTC ayudan a comprender la utilización del ejercicio. Sin embargo, estos resultados están limitados por el escaso tamaño de la muestra, los sesgos de selección y la falta de mediciones a largo plazo de los seguimientos.

Introduction: There are several widely used theories of health behavior change, which mostly utilize the social cognitive approach. These theories tend to posit that intention is a direct predictor of behavior, do not include automatic influences on behavior, and propose a one-size-fits-all theory for both initiators and maintainers. However, the intention-behavior gap is a wellobserved phenomenon, researchers have highlighted that both automatic and reflective factors promote behavioral engagement, and predictors of behavior have been shown to differ between initiators and maintainers--three issues that necessitate theory advancement. To that end, the present research compares the utility of the Integrated Behavior Change Model (IBCM) - a social cognitive model that includes automatic factors involved in behavioral engagement and a moderator of the intention-behavior gap - to its theoretical predecessor, the Theory of Planned Behavior (TPB). Further, the relevance of the IBCM factors for predicting exercise behavior is compared in initiators versus maintainers. Method: Participants were 494 US undergraduates. Participants reported on variables from the IBCM (and TPB) at baseline and reported on their exercise behavior in two surveys at seven- and 14-days post-baseline. Results: Findings supported the first hypothesis that the IBCM would be more relevant for initiators in comparison with maintainers, using structural equation modeling. Specifically, only the paths between intrinsic motivation and affective attitude, affective attitude and intention, and intention and behavior were reliably found for maintainers. For initiators, the aforementioned paths were also reliably supported and the additional following paths were also supported: intrinsic motivation and perceived behavioral control, perceived behavioral control and intention, and intention and action planning. However, results did not support the second hypothesis that the IBCM would predict significantly more variance in behavior than its theoretical predecessor, the TPB. Specifically, the addition of action planning, implicit attitude, implicit motivation, and the interaction between intention and action planning only predicted an additional 0.3% (p < 0:05) of the variance in exercise behavior above and beyond intention. Conclusion: Results highlight the continued need for theoretical refinement in terms of delineating mechanisms of initiation and maintenance and the need for further development in terms of improving upon current predictions of behavior engagement and change. [ABSTRACT FROM AUTHOR]

Certain behaviors, especially when adopted by a majority, can help limit the magnitude of climate change. In this cross-sectional study, the stages of change from the Transtheoretical Model (TTM) are applied to environmentally-significant behavior. We develop and test a new scale – the Climate Change Stages of Change Questionnaire (CCSOCQ) – for measuring five discrete stages involved in changing behavior to address climate change (precontemplation, contemplation, preparation, action, and maintenance). In total, 3,469 middle-school students (Mage = 13.4) and 347 schoolteachers completed the CCSOCQ and a measure of engagement with sustainable development. Analyses indicated the CCSOCQ captured the five stages outlined by the TTM and had adequate psychometric properties. Further supporting predictions of the TTM, engagement with sustainable development was lowest in the precontemplation stage and highest in the action stage. We conclude the TTM has potential for describing how and why people alter their behavior to address climate change. Supplemental data for this article is available online at https://doi.org/10.1080/13504622.2021.1998382. [ABSTRACT FROM AUTHOR]

Various measures have been proposed and validated to assess environmental motivation and explain peoples' consumer behavior. However, most of the measures are rather complex, sometimes comprising dozens of items. In order to overcome the associated response burden, the goal of our research is to validate a much simpler measure of environmental motivation, namely the measure of Climate Change-Stage of Change. To do so we analyze data from a discrete choice experiment in which drivers decide to purchase a car with different levels of CO2 emissions and we also measure their environmental motivation with three alternative measures. The results show that environmental motivation assessed with Climate Change-Stage of Change explains the choices in the experiment as well as with more complex measures. Our findings have substantial implications for researchers as they may be able to assess climate-relevant motivation – a significant factor for many consumer choices – with a single question. [ABSTRACT FROM AUTHOR]

IntroductionThere are several widely used theories of health behavior change, which mostly utilize the social cognitive approach. These theories tend to posit that intention is a direct predictor of behavior, do not include automatic influences on behavior, and propose a one-size-fits-all theory for both initiators and maintainers. However, the intention-behavior gap is a well-observed phenomenon, researchers have highlighted that both automatic and reflective factors promote behavioral engagement, and predictors of behavior have been shown to differ between initiators and maintainers—three issues that necessitate theory advancement. To that end, the present research compares the utility of the Integrated Behavior Change Model (IBCM) – a social cognitive model that includes automatic factors involved in behavioral engagement and a moderator of the intention-behavior gap – to its theoretical predecessor, the Theory of Planned Behavior (TPB). Further, the relevance of the IBCM factors for predicting exercise behavior is compared in initiators versus maintainers.MethodParticipants were 494 US undergraduates. Participants reported on variables from the IBCM (and TPB) at baseline and reported on their exercise behavior in two surveys at seven- and 14-days post-baseline.ResultsFindings supported the first hypothesis that the IBCM would be more relevant for initiators in comparison with maintainers, using structural equation modeling. Specifically, only the paths between intrinsic motivation and affective attitude, affective attitude and intention, and intention and behavior were reliably found for maintainers. For initiators, the aforementioned paths were also reliably supported and the additional following paths were also supported: intrinsic motivation and perceived behavioral control, perceived behavioral control and intention, and intention and action planning. However, results did not support the second hypothesis that the IBCM would predict significantly more variance in behavior than its theoretical predecessor, the TPB. Specifically, the addition of action planning, implicit attitude, implicit motivation, and the interaction between intention and action planning only predicted an additional 0.3% (p < 0:05) of the variance in exercise behavior above and beyond intention.ConclusionResults highlight the continued need for theoretical refinement in terms of delineating mechanisms of initiation and maintenance and the need for further development in terms of improving upon current predictions of behavior engagement and change.

This study investigated the corresponding change between psycho-social predictors and physical activity (PA) behavior and if these relationships were dependent on the stages of change from the Transtheoretical Model in Minority American adolescents. We conducted a longitudinal field study with N = 357 students aged 13–18 years (M = 14.24 years, SD = 0.88); predominantly Filipino (61.2%) using a test–retest design assessing psycho-social PA predictors (enjoyment, self-efficacy, family support, friends' support, knowledge, stage of change) and moderate-to-vigorous physical activity (MVPA) at two time points over six months. Hierarchical regression results indicated that a positive change of enjoyment, knowledge about PA and family support predicted a change of MVPA, independently of stage. The time-varying covariation showed the importance of the current stage of change for enjoyment, self-efficacy and support of friends for a change of MVPA. Overall, our findings suggest that an individual's current stage of change should be considered to determine individually appropriate starting points and goals for designing interventions to promote PA among Minority American adolescents. [ABSTRACT FROM AUTHOR]

Background/Aim: The prognosis of colorectal cancer (CRC) is highly associated with its stage; therefore, it is important to determine the risk factors. Risk determination tools such as CRC-PRO are patientfriendly since they are non-invasive, and highly successful in predicting the cancer risk. This study aimed to determine the risks of getting CRC in individuals aged 50-70 years and the early diagnosis behaviors of individuals, who were deemed at high risk based on a Fecal Occult Blood Test (FOBT). Methods: This single-group quasi-experimental follow-up study was conducted in a family health center in Turkey between December 2016-December 2017. The data were collected using the "CRC Predicted Risk Online (CRC-PRO)" and "stages of change form." The patients were educated at the risk determination stage. Along with telephone counseling conducted with individuals in the first and sixth months, the changes in FOBT were noted. Results: The CRC-PRO mean risk scores of the males and females were 1.37 (0.74), and 0.79 (0.40), respectively. Among them, 33.5% of males and 25.8% of females had a risk of CRC. After they were educated for FOBT, their behaviors positively and significantly changed from the risk determination stage until the 6th-month follow-up. Conclusion: With the use of risk determination tools, individuals' lifestyle characteristics can be determined, and health education can be provided to change them. [ABSTRACT FROM AUTHOR]

Min Gao,1,2 Xueying Chen,1 Xin Sun,1 Fengbin Wang,1 Lishi Fan,1 Xinying Sun1 1School of Public Health, Peking University Health Science Center, Beijing, People’s Republic of China; 2Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKCorrespondence: Xinying SunSchool of Public Health, Peking University Health Science Center, 38, Xueyuan Road, Haidian District, Beijing 100191, People’s Republic of ChinaTel +86 136 9121 2050Email xysun@bjmu.edu.cnPurpose: This study aimed to predict stage of exercise among Chinese patients with type 2 diabetes by using an extended theory of planned behavior model (TPB) incorporating descriptive norm and self-identity.Patients and Methods: Participants (N=791) were included in a cross-sectional study. Structural equation modeling was used to explain how the extended TPB could predict the stage of exercise.Results: The model accounted for 41% of the variance in stage of exercise and 81.1% of the variance in intention. Intention (β=0.359, P< 0.01) and self-identity (β=0.236, P< 0.001) had a direct effect on stage of exercise. Self-identity (β=0.261, P< 0.001), descriptive norm (β=0.035, P< 0.05) and PBC (β=0.683, P< 0.001) were strong predicators of intention. The effects of self-identity and PBC on behavior were significantly mediated via intention. Age, BMI and stage of diet behavior were found to be significantly related to intention and behavior.Conclusion: This study has tested the usefulness of the extended TPB for explaining exercise in Chinese diabetic patients. To promote patients to start or continue exercising, interventions should target self-identity and controllability for physical activity.Keywords: theory of planned behavior, stage of change, exercise, descriptive norm, self-identity

The interaction of smoking and HIV has a substantially negative impact on multiple comorbidities, disease prognosis, and impaired adherence to HIV drugs. The health benefits of smoking cessation are well documented among HIV-positive individuals. However, there are no clinical practice guidelines to guide tobacco smoking cessation treatment in people living with HIV. Addressing the current stage of change for smokers may help provide appropriate and effective advice on smoking cessation. This cross-sectional study explored the prevalence of smoking and the stage of change in people living with HIV at an AIDS non-governmental organization in West Java, Indonesia. Convenience sampling was used to recruit 150 participants aged over 20 years old. Data were collected on demographic and clinical information, smoking status, willingness to quit smoking and using the instrument of stage of change based on the Transtheoretical Model. Results indicated that most respondents were males, 30 to 40 years old. More than half (53%) were currently smoking more than ten cigarettes per day (55%). Among smokers, 80% were willing to quit smoking, and more than half were in the preparation stage. The majority of respondents (65%) had never heard about a smoking cessation program, and 91% had never joined this program. We concluded that more than half of people living with HIV were currently smoking, and most smokers were only at the pre-contemplation stage. Systematic screening for smoking during routine HIV care using the Transtheoretical Model "stage of change" model may help to reduce the heavy burden of smoking and smoking-related morbidity and mortality within HIV populations. In addition, smoking cessation training for nurses or case managers who care for people living with HIV is required to help, assist, and support HIV smokers in quitting. [ABSTRACT FROM AUTHOR]

A systematic review on the use of the Transtheoretical Model of Change (TTM) as a predictor variable of adherence to Physical Exercise (PE) in breast cancer survivors is presented. The systematic literature review was carried out following the PRISMA method in Scopus, Pubmed, and Psycinfo databases. Both in English and Spanish. Thirteen articles published from June 2005 to June 2020 were included. All of them used TTM constructs in their programs. The results show that the TCM variables that demonstrated its association with PE were stages of change and self-efficacy. Therefore, TCM-based interventions help to understand the adoption of exercise behavior. However, these findings are limited by the small sample size, selection biases, and lack of long-term measurements of follow-ups. [ABSTRACT FROM AUTHOR]

Personalizing gameful applications is essential to account for interpersonal differences in the perception of gameful design elements. Considering that an increasing number of people lead sedentary lifestyles, using personalized gameful applications to encourage physical activity is a particularly relevant domain. In this article, we investigate behavior change intentions and Hexad user types as factors to personalize gameful fitness applications. We first explored the potential of these two factors by analyzing differences in the perceived persuasiveness of gameful design elements using a storyboards-based online study ( N = 178 ). Our results show several significant effects regarding both factors and thus support the usefulness of them in explaining perceptual differences. Based on these findings, we implemented "Endless Universe," a personalized gameful application encouraging physical activity on a treadmill. We used the system in a laboratory study ( N = 20 ) to study actual effects of personalization on the users' performance, enjoyment and affective experiences. While we did not find effects on the immediate performance of users, positive effects on user experience-related measures were found. The results of this study support the relevance of behavior change intentions and Hexad user types for personalizing gameful fitness systems further. [ABSTRACT FROM AUTHOR]

Physical activity rates have prevailed as a worldwide health concern. The WHO’s 'Global Action Plan on Physical Activity 2018–2030' articulated the need to test effective communication strategies that deliver information to enhance physical activity behaviors. The Comprehensive Messaging Strategy for Sustained Behavior Change (CMSSBC) is a promising approach that advocates tailoring messages to one’s stage of change and framing them intrinsically rather than extrinsically. This study examined adults’ decisions to read and engage with physical activity messages aligned with CMSSBC, considering the role of the message frame, stage of change of the message, stage of change of the participant, as well as the participants goal orientation. Participants ('nmale' = 91; 'nfemale' = 103) aged 25 to 65 ('x̅' = 39.53; 'SD' = 10.80) completed an online survey including; demographic questions, assessments of their physical activity goals and stage of change, decision to read eight messages, and a follow-up question providing the option to complete a behavior change task embedded within the messages they chose to read. Results indicated that participants were more likely to choose to read a message if it fit their goal orientation, and overall, they were significantly more likely to read intrinsic as opposed to extrinsic messages. Further, findings demonstrated that participants were more likely to complete the optional behavior change activity contained within the message if they had an intrinsic goal orientation. These findings demonstrate that physical activity information should be framed intrinsically and recognizes that one’s goal orientation may significantly influence how people respond to messages.

ObjectiveIndividuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs.MethodRecruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization.ResultsParticipants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence.ConclusionMost smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.

Parent involvement is important to help overweight children lose weight. However, parent readiness to make changes around child eating and physical activity (PA) behaviors can differ across domains. Using a cross-sectional design, our aim was to examine which factors were associated with parents being in the Action/Maintenance stage of change in each domain. From November 2008 to August 2009, parents of overweight/obese children (n=202) attending a tertiary care obesity clinic in Providence, RI, answered questions assessing their stage of change, beliefs about child health and weight, and provider behaviors. Separate multivariate logistic regression models were created to determine which factors were associated with parent readiness to make changes for child dietary and PA behaviors. Almost 62% of parents were in the Action stage of change for child dietary behaviors, but only 41% were in the Action stage of change for PA behaviors. Parents who believed their own weight was a health problem were less likely to be ready to make changes to their child's dietary behaviors. Physician discussion of strategies was related to readiness to make changes for child dietary behaviors, but not PA behaviors. In the PA domain, parents of younger children were more likely to be ready to make changes. Training health care providers to address PA readiness and be aware of factors influencing dietary and PA readiness may result in more effective conversations with parents and improve behavior change efforts for pediatric weight loss.

IntroductionPosttraumatic stress disorder (PTSD) is a risk factor for tobacco addiction. The majority of research on PTSD and smoking has been conducted with men, particularly combat veterans, and little is known about the association among women. In a clinical sample of women civilian smokers with serious mental illness (SMI), we examined the prevalence of PTSD symptomatology and associations with physical and mental health functioning, co-occurring substance use, nicotine dependence, and readiness to quit smoking.Methods376 adult women smokers aged 18-73 were recruited from 7 acute inpatient psychiatry units and screened by diagnostic interview for current PTSD symptomatology (PTSD(+)). In multiple regressions, we examined the associations of screening PTSD(+) with physical and mental health functioning; past-month drug use; past-year substance use disorders; nicotine dependence and readiness to quit smoking.ResultsNearly half the sample (43%) screened PTSD(+), which was significantly associated with the use of stimulants (OR=1.26) and opiates (OR=1.98), drug use disorders (OR=2.01), and poorer mental health (B=-2.78) but not physical health functioning. PTSD(+) status was unrelated to nicotine dependence, but predicted greater desire to quit smoking (B=2.13) and intention to stop smoking in the next month (OR=2.21). In multivariate models that adjusted for substance use disorders, physical and mental health functioning, and nicotine dependence, screening PTSD(+) remained predictive of greater desire and intention to quit smoking.ConclusionPTSD symptomatology was common in our sample of women smokers with SMI and associated with not only worse substance use and mental health, but also greater readiness to quit smoking, suggesting the need for and potential interest in integrative PTSD-addiction treatment among women.

Background: There is a strong association between chronic pain and unhelpful pain cognitions. Educating patients on pain neuroscience has been shown to reduce pain catastrophization, kinesiophobia, and self-perceived disability. This study investigated whether a group-based pain neuroscience education (PNE) session influenced pain-related outcomes, and whether readiness to change moderated these outcomes. Method: In a pragmatic pre-post-intervention study using a convenience sample, adults with chronic pain participated in one, 90–120 minute PNE session. Pain-related outcomes (i.e. pain catastrophization, kinesiophobia, disability, and pain neuroscience knowledge) and the Pain Stage of Change Questionnaire (PSOCQ) were assessed at baseline and immediately post-intervention. Paired t-tests evaluated pre-post changes in outcomes, and linear regression examined the impact of PSOCQ score changes on PNE-induced changes in clinical outcomes. Results: Sixty-five participants were recruited. All outcomes showed positive intervention effects (p <.01). Relationships between changes in PSOCQ subscale scores and change in post-intervention pain-related outcomes were found; 'Pre-Contemplation' was positively associated with pain catastrophization (p =.01), and 'Action' was negatively associated with kinesiophobia (p =.03). Conclusion: Consistent with previous research, there were improvements in outcomes associated with chronic pain after PNE. Some of these improvements were predicted by changes in PSOCQ scores, however, these findings are preliminary and require further investigation using controlled research designs. [ABSTRACT FROM AUTHOR]

Background: The purpose of the current study was to examine the association between the level of exercise behavior and individual and environmental factors related to exercise behavior among female Japanese undergraduate students. Methods: The participants were 2482 female Japanese undergraduate students. Participants' level of exercise behavior was measured by the stage of change to exercise in the transtheoretical model. Individual and environmental factors related to exercise behavior were assessed using body mass index, self-efficacy, social support, perceived positive and negative aspects of exercise, perceived neighborhood environment, attitude toward physical education lessons in childhood and puberty, and depression. Results: Scores for self-efficacy, social support, positive aspects of exercise, and perceived neighborhood environment were significantly higher among women who were more active compared with those who were inactive. On the other hand, scores for negative aspects of exercise and depression were greater among inactive women compared with those who were insufficiently active and/or active. In addition, past attitude toward exercise in primary school, junior high school, and high school was associated with current level of exercise behavior. Conclusions: This cross-sectional study confirmed that psychosocial and environmental factors were closely associated with level of exercise behavior among female Japanese undergraduate students. [ABSTRACT FROM AUTHOR]

Physical activity rates have prevailed as a worldwide health concern. The WHO's Global Action Plan on Physical Activity 2018-2030 articulated the need to test effective communication strategies that deliver information to enhance physical activity behaviors. The Comprehensive Messaging Strategy for Sustained Behavior Change (CMSSBC) is a promising approach that advocates tailoring messages to one's stage of change and framing them intrinsically rather than extrinsically. This study examined adults' decisions to read and engage with physical activity messages aligned with CMSSBC, considering the role of the message frame, stage of change of the message, stage of change of the participant, as well as the participants goal orientation. Participants (nmale = 91; nfemale = 103) aged 25 to 65 (x? = 39.53; SD = 10.80) completed an online survey including; demographic questions, assessments of their physical activity goals and stage of change, decision to read eight messages, and a follow-up question providing the option to complete a behavior change task embedded within the messages they chose to read. Results indicated that participants were more likely to choose to read a message if it fit their goal orientation, and overall, they were significantly more likely to read intrinsic as opposed to extrinsic messages. Further, findings demonstrated that participants were more likely to complete the optional behavior change activity contained within the message if they had an intrinsic goal orientation. These findings demonstrate that physical activity information should be framed intrinsically and recognizes that one's goal orientation may significantly influence how people respond to messages. [ABSTRACT FROM AUTHOR]

Introduction: Overconsumption of energy dense, nutrient poor foods and beverages is a major problem globally. This study describes what and how Australian adults consume and are willing to change their intake in terms of discretionary food and beverage categories., Methods: Cross-sectional data were collected via the CSIRO Junk Food Analyser. This online tool contains short questions on discretionary food and beverage consumption, and items relating to stage of and willingness and strategies to reduce discretionary food and beverage intake. Analyses focussed on describing discretionary intake, adherence to guidelines and the prediction of willingness to change discretionary food intake amongst those exceeding guidelines., Results: In 2021, 41,109 Australian adults completed the CSIRO Junk Food Analyser. Participants were mostly female (73.1%) and aged 31-70 years (78.9%). Most participants exceeded dietary guidelines for discretionary food and beverage intake (67.4%, 27,694/41,109) with 40% reporting actively trying to reduce intake. Most people exceeding guidelines did so in categories of alcohol (39.3%) and cakes and biscuits (21.0%). Yet, willingness to change intake was lowest for alcohol (median, IQR of 3, 2:4 out of 5). Almost half of the participants were willing to try 'having a few days off per week' (46.0%), while only 13.4% were willing to try to 'eliminate' their highest ranked category., Discussion: Australian adults are willing to reduce their discretionary food and beverage intake, but simply targeting the foods and beverages consumed most may not be the best place to start. Messages encouraging days off frequently consumed discretionary foods and beverages may be well received., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Mauch, Brindal and Hendrie.)

Purpose: Minority stress has been posited as a cause for sexual and gender minority (SGM) individuals to smoke as a coping mechanism. The purpose of this study was to elucidate the relationship between minority stress processes and nicotine dependence level and stage of change for SGM smokers living in the Deep South region of the United States. Methods: A one-time, cross-sectional online survey was administered to SGM smokers living in the Deep South. Survey measurements included demographics, minority stress processes (prejudice events, perceived stigma, and internalized queerphobia), and smoking cessation outcomes (nicotine dependence level and stage of change). Multivariable linear regression was used to assess the effect of each minority stress process on smoking outcomes, after adjusting for demographics and stratifying by gender and sexual identity. Results: Across all participants ( n  = 1296), lower levels of perceived stigma were significantly associated with further stage of change. Greater levels of internalized queerphobia were significantly associated with greater nicotine dependence level. After stratifying by gender and sexual identity, these significant associations were only maintained in cisgender males and gay individuals. An additional significant association between lower prejudice events and further stage of change for smoking cessation was found only for individuals whose sexual identity was labeled as "other." Conclusion: Addressing minority stress in smoking cessation and prevention programs has the potential to decrease nicotine dependence and further stage of change.

Background: The current food system is responsible for significant environmental damage therefore, encouraging consumers to adopt an environmentally sustainable diet is a key public health challenge. Dietary guidelines have been developed that outline recommendations for purchasing and consuming food in an environmentally sustainable manner, but they have not yet been incorporated in UK national dietary guidelines.Methods: Via an online survey of UK adults, we evaluated consumers' perceptions of the environmental benefit of various sustainable diet recommendations, their readiness to adopt these behaviours using the stage of change construct of the Transtheoretical Model, the factors that influenced their food choices, and their current consumption of plant- and animal-based sources of protein. Additionally, we investigated how demographic characteristics and food choice motives were associated with perceived environmental benefit of and readiness to adopt these sustainable diet recommendations.Results: The survey was completed by 442 participants (66% female, 80% aged 25-54 years, 85% with higher education). The majority of participants considered the recommendations to 'reduce consumption of air-freighted foods' (79%), 'reduce food waste' (75%), and 'buy locally grown produce' (78%) to have a high environmental benefit, whereas a smaller proportion of participants perceived 'prioritise plant-based proteins' (42%) and 'choose organic produce' (27%) to have a high environmental benefit. Differences in perceptions and readiness to adopt sustainable dietary behaviours were observed between demographic groups, with women significantly more likely than men to be in action/maintenance (A/M) stages of change for prioritising plant proteins (OR 0.54), and younger participants more likely to be in pre-contemplation/contemplation (PC/C) stages of change for 'choose organic produce' (OR 2.03) and 'choose sustainable fish' (OR 2.45). Health, cost, environmental sustainability and taste were the most commonly reported food choice motives. Reporting environmental sustainability as a food choice motive was associated with readiness to adopt sustainable diet recommendations.Conclusions: We found that consumers in the UK are engaged with some aspects of sustainable diets but remain resistant to others. The results of this study indicate that acceptable dietary guidelines could be developed to address environmental sustainability. Several behaviours were identified that consumers were willing to adopt, but there were barriers preventing them, highlighting that policy action is required to enable behaviour change to occur. Differences between demographic groups highlight potential targets for future campaigns promoting sustainable diets. [ABSTRACT FROM AUTHOR]

Background: Over the long term, people who have undergone bariatric surgery (BS) remain overly sedentary with inadequate physical activity (PA). The purpose of this study was to apply the transtheoretical model (TTM) to (1) explore in-depth how PA is experienced years after BS and (2) identify the barriers to and facilitators of PA involved at each stage of change (SOC). Methods: Seventeen women with a mean age of 32.5 ± 3.3 years and a percentage of total weight loss of 29.6 ± 12.4 were interviewed at a mean of 9.4 ± 3.6 years after BS. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. Results: The distribution of barriers to and facilitators of PA differed with the SOC. In progressing from the precontemplation and contemplation stages to the preparation stage, the women experienced changes in their decisional balance, supported by processes of self-reevaluation and environmental reevaluation. In shifting from preparation to the action and maintenance stages, they experienced intrinsic motivation and self-liberation processes. The relapse stage was associated with a decrease in self-efficacy to cope with life constraints. Conclusions: This study presents an in-depth theory-based exploration of the dynamics of long-term engagement in PA after BS in young women, with clinical implications for providing them with better guidance toward a more physically active lifestyle. [ABSTRACT FROM AUTHOR]

Abstract Background The Transtheoretical Model (TTM) which focuses on stage of change has been the main conceptual model used in understanding the lack of motivation to change in patients with Anorexia Nervosa (AN). Whilst there is evidence to support the prognostic value of the TTM in AN, this evidence base sufferers from limitations including limited studies in adults and none in outpatient populations. The primary aim of this study was to clarify whether readiness to change, as measured by the University Rhode Island Change Assessment Scale (URICA) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) could predict weight gain in adults with AN following treatment in an outpatient setting. Methods This was a prospective cohort analysis, which selectively used data from an existing clinical database at an outpatient eating disorders service. 119 patients met eligibility criteria and were included in this study. This included all adult patients who had a diagnosis of AN and were assessed, but not necessarily treated at the outpatient eating disorders program (Group 1). A subgroup of 63 patients (Group 2) was also analysed which only included patients who had received treatment at the program. Baseline measures included the URICA score, the ANSOCQ score, the Eating Disorders Examination Questionnaire (EDE-Q) and body mass index (BMI). BMI was also measured on discharge. Results The URICA scale had poor predictive validity for weight gain (r = 0.05, p = 0.725). The ANSOCQ had moderate predictive validity (Pearson’s r = 0.57, p = 0.007), and accounted for 32.7% of variance in weight gain. The URICA and ANSOCQ were moderately correlated in both groups. The URICA was moderately predictive of symptom severity, measured by the EDE-Q in both groups. The ANSOCQ was moderately correlated with the EDE-Q scores in both Groups 1 and 2. Conclusions To the authors’ knowledge this is the only study evaluating stage of change, in an adult outpatient population with AN. The findings of this study suggest that while both the URICA and ANSOCQ were associated with eating disorder symptom severity, only the ANSOCQ was able to predict weight gain in outpatients with AN suggesting its greater utility in this context.

Background and objective: Health care workers (HCWs) have a great background to promote their health – not only their professional knowledge on health but often also special equipment in their work environment. However, it is unclear if HCWs can use such infrastructure to promote their own health as well as what is their motivation to change their own lifestyles. Thus, the aim of the article was to describe workplace health promotion (WHP) situation in health care settings in Finland, Latvia, and Lithuania.Materials and methods: A questionnaire survey of 357 workers from health care sector in three European countries was conducted. Participants were asked to indicate various WHP activities/facilities/programs organized at their workplaces, WHP needs, opportunities to initiate changes related to the healthiness of their workplaces, and readiness to change their lifestyles.Results: Participants from three European countries differed in their WHP needs and in their responses on various activities/facilities/programs implemented at the institutions. Workers from Finnish institutions had the greatest opportunities to make initiatives relevant to their workplaces' healthiness, while Lithuanian workers were least provided with such opportunities. Furthermore, the results showed that there were differences of readiness to change among the workers from the three countries.Conclusions: HCWs recognized various WHP activities, facilities and programs organized at their workplaces; however, their needs were notably higher than the situation reported. WHP situation differed among the three European countries.