Later Stages Of Change Research Articles

Predicting and influencing PrEP use: the role of motivational and attitudinal factors

ABSTRACT This study examined PrEP attitude and HIV risk factors associated with PrEP motivation and evaluated the efficacy of a mock public health video that addresses both motivational and stigma issues for improving PrEP uptake over a standard educational video. Gay, bisexual, and other men who have sex with men (GBMSM; N = 604) were enrolled. One-way between subject analysis of variance (ANOVA) and post-hoc comparisons revealed that GBMSM in later stages of change had significantly higher endorsement of positive PrEP attitudes, PrEP stigma, objective and perceived HIV risk, HIV worry, and valued health benefits of PrEP more. Stepwise multiple regression revealed five significant predictors of PrEP motivation: HIV worry, objective HIV risk, anticipated PrEP stigma, positive PrEP attitudes, and perceived social consequences of PrEP use. Video conditions did not differ in their impact on PrEP attitudes or motivation; however, regardless of video condition, participants experienced a pre- to post-video increase in positive PrEP attitudes and motivation. Findings suggest HIV worry, objective HIV risk, positive PrEP attitudes, and perceived PrEP health benefits are important factors to optimize PrEP motivation, which can inform secondary prevention efforts. Further study is needed on promotional PrEP campaigns that disconfirm stigmatizing PrEP misconceptions.

Stage-emotion compatibility and the effectiveness of antismoking campaigns in South Korea: tailoring guilt and shame appeals to individuals in different stages of change

ABSTRACT In many domains of health risk prevention and management, tailoring messages specifically for different stages of change is critical. In the context of smoking cessation, this research represents an initial attempt to discover stage-specific affective profiles in terms of guilt versus shame. It then examines whether stage-congruent emotional appeals increase the persuasiveness of antismoking campaigns. Study 1 found that participants felt more negative self-conscious emotions as they entered the later stages of smoking cessation, showing more salient emotional states of guilt rather than shame. Study 2 found that stage-emotion compatibility, such as that exhibited by participants in the early stages of change, was not altered by emotional appeals regardless of the emotional type. In contrast, those in the later stages of change perceived guilt rather than shame appeals to be more effective and displayed greater smoking cessation intention. Through this, current research takes an important step toward theoretically identifying the affective states associated with different stages of change for smoking cessation and helps practitioners use emotional appeals effectively and appropriately in public health campaigns.

Primary care behavioral health patients' stage of change: Correlates and relation to follow-up session attendance.

In this study, we examined patients' readiness to change behavior (their stage of change) in a primary care behavioral health (PCBH) setting. We examined sociodemographic and health correlates of patients' stage of change and whether stage of change related to follow-up visit attendance. One-hundred eleven adult primary care patients completed self-report measures of psychiatric symptoms, hope, and stage of change at their initial behavioral health session. Demographic, health information, and follow-up visit attendance were gathered from patient electronic health records. Results suggest most patients referred to PCBH providers were in preparation and action stages of change. At the bivariate level, older age and non-Latinx ethnicity were associated with greater readiness to change. At the multivariate level, older age and higher levels of hope were associated with later stages of change. Patients in preparation, but not action, stages of change were significantly more likely to attend a follow-up behavioral health appointment than were patients in precontemplation/contemplation. Findings suggest most PCBH patients are prepared to take action or have already taken action to improve their behavioral health. Further, a single item assessing patients' stage of change is associated with continued retention in behavioral health treatment. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Urban and Rural Disparities in a WeChat-Based Smoking Cessation Intervention among Chinese Smokers.

Introduction: Tobacco use, which is directly responsible for 10% of total deaths per year globally, remains consistently high, with approximately 20% of the population reporting regular consumption globally. Moreover, health disparities regarding tobacco consumption and smoking cessation are growing between rural and urban populations worldwide. Social media interventions for tobacco cessation may effectively reach both groups. The objective of this study was to evaluate the efficacy of a WeChat-delivered smoking cessation intervention among rural and urban Chinese smokers, and to assess moderating variables that may contribute to differential intervention efficacy. Methods: WeChat was used to recruit smokers into this intervention study between 1 July and 5 August 2019. Participants were randomized to one of three intervention schedules: participants in the Standard Group and the Enhanced Group received 20 smoking-related messages over 2 weeks, whereas participants in the Enhanced Group received an extra 6 oral health-related messages for one week. Participants in the control group received 20 smoking-related messages after the post-intervention assessment. Participants completed questionnaires at baseline and at 4 weeks follow-up. Our primary outcome was smoking cessation stage of change and secondary outcome was 24-h point prevalence abstinence (PPA). Urban and rural areas were based on self-reported living areas. Chi-squared test, Fisher’s exact test, ANOVA test, linear regression, and logistic regression were used for analysis. Results: Overall, 403 participants completed the intervention (233 rural, 107 suburban, 63 urban). Compared to urban participants, rural participants were more likely to have progressed to a later stage of change (β = 0.40, 95% CI: 0.13, 0.67) and to report higher 24-h PPA rates at follow-up (aOR = 3.23, 95% CI: 1.36, 7.68). After stratification by living area, the intervention effects in stage of change and 24-h PPA rate at follow-up were only found in the urban subgroup. Discussion: Smokers who lived in rural areas reported better smoking cessation outcomes compared with urban smokers; however, the efficacy of a WeChat-based smoking cessation intervention was only found for participants living in an urban area. WeChat based smoking cessation interventions should be used to promote smoking cessation in urban, suburban, and rural areas.

Readiness to Change is Related to Real-World Walking and Depressive Symptoms in Chronic Stroke.

The transtheoretical model is a health behavior model used to understand an individual's readiness to change their behavior. This study aims to apply the transtheoretical model in understanding a person with stroke's readiness to change their activity level, as it relates to physical capacity, physical health, depressive symptoms, self-efficacy, and daily stepping activity. This was a cross-sectional analysis of baseline data from a clinical trial. Participants' readiness to change their activity levels was measured via self-report and daily stepping activity was measured using a step activity monitor. Robust regression (M-estimation with robust standard errors) was used to test the relationship between readiness to change and measures of physical capacity (6-minute walk test, self-selected walking speed), physical health (body mass index, age-adjusted Charlson Comorbidity Index), depressive symptoms (Patient Health Questionnaire-9), self-efficacy (Activities-Specific Balance Confidence Scale), and daily stepping (steps per day). A total of 274 individuals were included in the analysis. Adjusted for age, readiness to change was positively related to daily stepping (β = 0.29, P < 0.001) and negatively related to depressive symptoms (β = -0.13, P = 0.01). Readiness to change was not significantly associated with measures of physical capacity, physical health, or self-efficacy. These results suggest that individuals with stroke in the later stages of change may demonstrate greater daily stepping activity and lower depressive symptoms compared with those in earlier stages. Understanding the relationship between readiness to change, daily stepping, and depressive symptoms will help clinicians implement appropriate stage-specific intervention strategies and facilitate greater improvement in activity levels.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A333).

The Academic Performance Stages of Change Inventory (APSCI): An application of the Transtheoretical Model to academic performance

ABSTRACT The Transtheoretical Model (TTM) conceptualizes change as a process with five identifiable stages. Each stage has psychological characteristics that are manifestations of an underlying continuum of change. Surprisingly few studies have applied the TTM to understand the process involved with academic development. The objective of this study was to assess a new instrument designed to measure the stages of change in the development of academic performance: the Academic Performance Stages of Change Inventory (APSCI). High-school students (N = 564) were sampled from the 10th, 11th, and 12th grades of a secondary school in Portugal. Results showed that a correlated five-factor structure, corresponding to the five stages of change, had good empirical fit. The latent factors of this model (stages) were shown to have the same meaning across school grade and gender. We concluded that the five APSCI subscales had reasonable internal consistency considering the small number of items per factor. Students in the later stages of change tended to have better academic performances and to be more engaged in school than those in the earlier stages, particularly the pre-contemplation stage. This study provides good preliminary evidence that the APSCI is a suitable tool for assessing stages of change of academic performance.

Feasibility of Motivational Interviewing and Physical Activity Counseling Sessions for Improving Physical Activity Self-Management for Latina Women Either at Risk for or Diagnosed With Type 2 Diabetes Mellitus.

Introduction: Latinas have a greater chance of dying from diabetes than non-Latina Whites. As a population group, the literature has shown that Latinas do not meet physical activity (PA) guidelines. Motivational interviewing (MI) is a patient-centered counseling method that promotes self-efficacy for behavior change. The purpose of the study was to examine the feasibility of using MI/PA counseling for self-management of type 2 diabetes mellitus with Latinas. Methods: Latinas (n = 12) were recruited from an occupational program in Southern California. Two MI and PA sessions were conducted over 2 months. Feasibility measures included recruitment, retention, protocol adherence, and attrition. Impact outcomes included PA, PA stage of change, and waist circumference. Results: Participants attended all sessions and completed all questionnaires. Half progressed into a later stage of change for PA. Discussion: Results suggest MI and PA counseling is feasible for improving PA with Latinas at risk/diagnosed with type 2 diabetes mellitus.

Application of Transtheoretical (Stages of Change) Model in Studying Attitudes and Behaviors of Adults with Hearing Loss: A Descriptive Review.

Health Behavior Change (HBC) refers to facilitating changes to habits and/or behaviors related to health. There are a number of models/theories of HBC, which provide a structured framework to better understand the HBCs of individuals. The Transtheoretical Model (TTM, aka "the Stages of Change" model) is an integrative model used to conceptualize the process of intentional behavior change and is applied to a variety of behaviors, populations, and settings. In the last few years, use of TTM by the profession of audiology has been increasing. This descriptive literature review was aimed at identifying and presenting a summary of research studies, which use TTM to study the attitudes and behaviors of adults with hearing loss. A literature review was conducted. This review included 13 empirical studies. A literature review was conducted using the EBSCOhost and included the databases Cumulative Index to Nursing and Allied Health, MEDLINE, and PsycINFO. The review suggests TTM is useful in studying the attitudes and behaviors of adults with hearing loss. There are positive associations between stages of change and help-seeking, intervention uptake, and hearing rehabilitation outcome (i.e., benefit and satisfaction). However, associations with intervention decisions and intervention use were not evident. It appears help-seeking, intervention uptake, and successful outcomes are usually displayed in people in the later stages of change as those with greater hearing loss are often in the later stages of change. Understanding the readiness toward help-seeking and uptake of intervention in people with hearing loss based on TTM may help clinicians develop more focused management strategies. However, additional longitudinal and interventional studies are needed to further test the predictive validity of the stages of change model.

Motivational Interviewing: Its role in physiotherapy practice and changing exercise behaviour

International Journal of Therapy and RehabilitationVol. 24, No. 12 PracticeMotivational Interviewing: Its role in physiotherapy practice and changing exercise behaviourSuzanna BostockSuzanna BostockSearch for more papers by this authorSuzanna BostockPublished Online:15 Dec 2017https://doi.org/10.12968/ijtr.2017.24.12.539AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Alperstein D, Sharpe L. The efficacy of motivational interviewing in adults with chronic pain: A meta-analysis and systematic review. J Pain. 2016;17(4):393–403. https://doi.org/http://dx.doi.org/10.1016/j.jpain.2015.10.021 Crossref, Google ScholarArmstrong M, Mottershead T, Ronksley P, Sigal, R, Campbell T, Hemmelgarn B. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomised controlled trials. Obes Rev. 2011;12(9):709–723. http://dx.doi.org/10.1111/j.1467-789X.2011.00892.x. Google ScholarBarnes R, Ivezaj V. A systematic review of motivational interviewing for weight loss among adults in primary care. Obes Rev. 2015;16(4):304–318. https://doi.org/http://dx.doi.org/10.1111/obr.12264 Crossref, Google ScholarBasler H, Bertalanffy H, Quint S, Wilke A, Wolf U. (2007) TTM-based counselling in physiotherapy does not contribute to an increase in adherence to activity recommendations in older adults with chronic low back pain. Eur J Pain. 2007;11(1):31–37. https://doi.org/http://dx.doi.org/10.1016/j.ejpain.2005.12.009 Crossref, Google ScholarCritical Appraisal Skills Programme. CASP checklists [Internet]; 2017 [cited 2017 November 28]. Available from: http://www.casp-uk.net/casp-tools-checklists Google ScholarChristie D, Channon S. The potential for motivational interviewing to improve outcomes in the management of diabetes and obesity in paediatric and adult populations: a clinical review. Diabetes Obes Metab. 2014;16(5):381–387. https://doi.org/http://dx.doi.org/10.1111/dom.12195 Crossref, Google ScholarDanielsen K, Sundgot-Borgen J, Rugseth G. Severe obesity and the ambivalence of attending physical activity: exploring lived experiences. Qual Health Res. 2016;26(5):685–696.https://doi.org/http://dx.doi.org/10.1177/1049732315596152 Crossref, Google ScholarFallon E, Hausenblas H, Nigg C. The transtheoretical model and exercise adherence: examining construct associations in later stages of change. Psychol Sport Exercise. 2005;6(6):629–641. https://doi.org/https://doi.org/10.1016/j.psychsport.2005.01.003 Crossref, Google ScholarFrost H, Campbell P, Maxwell M, O'Carroll R, Dombrowski S, Cheyne H, et al.. Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: an overview of reviews. Physiotherapy. 2016;102(Suppl 1):59–60. https://doi.org/http://dx.doi.org/10.1016/j.physio.2016.10.382 Crossref, Google ScholarKennedy D, Apodaca T, Trowbridge K, Hafeman C, Roderick E, Modrcin A. Learning motivational interviewing: a pathway to caring and mindful patient encounters. J Pediatr Nurs. 2016;31(5):505–510. https://doi.org/http://dx.doi.org/10.1016/j.pedn.2015.12.011. Crossref, Google ScholarLambie D. Motivational interviewing to promote exercise behaviour change: a meta-ethnography using perspectives of patients and clinicians. Physiotherapy. 2016;102(Suppl 1):49–50. https://doi.org/http://dx.doi.org/10.1016/j.physio.2016.10.369 Crossref, Google ScholarMallisham S, Sherrod B. The spirit and intent of motivational interviewing. Perspect Psychiatr Care. 2017;53(4):226–233. https://doi.org/http://dx.doi.org/10.1111/ppc.12161 Crossref, Google ScholarMcGrane N, Galvin R, Cusack T, Stokes E. Addition of motivational interventions to exercise and traditional physiotherapy: a review and meta-analysis. Physiotherapy. 2015;101(1):1–12. https://doi.org/http://dx.doi.org/10.1016/j.physio.2014.04.009 Crossref, Google ScholarMiller W, Rose, G. Motivational interviewing and decisional balance: contrasting responses to client ambivalence. Behav Cogn Psychother. 2015;43(2):129–141. https://doi.org/http://dx.doi.org/10.1017/S1352465813000878 Crossref, Google ScholarMiller W, Rollnick S. Motivational interviewing. Helping people change. Third edition. New York, NY: Guilford Press; 2013. Google ScholarMorton K, Beauchamp M, Prothero A, Joyce L, Saunders L, Spencer-Bowdage S. The effectiveness of motivational interviewing for health behaviour change in primary care settings: a systematic review. Health Psychol Rev. 2015;9(2):205–223. https://doi.org/http://dx.doi.org/10.1080/17437199.2014.882006 Crossref, Google ScholarNational Institute for Health and Care Excellence. Obesity: identification, assessment and management [Internet]; 2014 [cited 2017 November 28]. Available from: https://www.nice.org.uk/guidance/cg189/chapter/1-Recommendations#physical-activity. Google ScholarNational Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management [Internet]; 2016 [cited 2017 November 28]. Available from: https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#non-invasive-treatments-for-low-back-pain-and-sciatica Google ScholarO'Halloran, P, Blackstock F, Shields N, Holland, A, Iles R, Kingsley M, Motivational interviewing to increase physical activity in people with chronic health conditions: a systematic review and meta-analysis. Clin Rehabil. 2014;28(12):1159–1171. https://doi.org/http://dx.doi.org/10.1177/0269215514536210 Crossref, Google ScholarPignataro R, Huddleston J. The use of motivational interviewing in physical therapy education and practice: empowering patients through effective self-management. J Phys Ther Edu. 2015;29(2):62–71. Google ScholarProchaska J, Di Clemente C. Transtheoretical therapy: toward a more intergrative model of change. Psychother Theory Res Pract. 1982;19(3):276–288. https://doi.org/http://dx.doi.org/10.1037/h0088437 Crossref, Google ScholarScottish Intercollegiate Guidelines Network. Management of chronic pain. A national clinical guideline [Internet]; 2013 [cited 2017 November 28]. Available from: http://www.sign.ac.uk/assets/sign136.pdf Google ScholarSimpson S, McNamara R, Shaw C, Kelson M, Moriarty Y, Randell E, et al.. A feasibility randomised controlled trial of a motivational interviewing-based intervention for weight loss maintenance in adults. Health Technol Assess. 2015;19(50):1–378. https://doi.org/http://dx.doi.org/10.3310/hta19500 Crossref, Google ScholarWest R. (2005) Time for a change: putting the transtheoretical (stages of change) model to rest. Addiction. 2005;100(8):1036–1039. https://doi.org/http://dx.doi.org/10.1111/j.1360-0443.2005.01139.x Crossref, Google ScholarWest RJ. Resources [Internet]; 2017 [cited 2017 November 28]. Available from: http://www.rjwest.co.uk/resources.php Google Scholar FiguresReferencesRelatedDetails 2 December 2017Volume 24Issue 12ISSN (online): 1759-779X Metrics History Published online 15 December 2017 Published in print 2 December 2017 Information© MA Healthcare LimitedPDF download

Mistaken perception of lipid intake and its effects: a randomized trial

BackgroundAlthough the Transtheoretical Model (TTM) is promising for behavioral interventions, it may be limited by an inability to understand perceptions of food consumption. The following questions and gaps presented by the scientific community prompted this study: What is the concordance between perceived and actual food consumption? What proportions of individuals are in the pseudo-maintenance (PM) stage (overly optimistic perception of fat consumption)? What is the proportion of individuals in the non-reflective action stages (adequate fat intake but do not recognize it)? Is it necessary to develop specific strategies for individuals in these stages? Therefore, the present study aimed to identify the proportion of “pseudo-respondents,” or those in the PM and non-reflective action stages, and to explore subgroup effects by PM classification.MethodsIn a previously conducted randomized controlled trial, participants in the usual care group (UCG) and the TTM-intervention group (TM-IG) were post-hoc classified as “true respondents” or “pseudo-respondents”; the latter included those in the PM (mistakenly perceived their lipid intake as adequate) or non-reflective action (did not recognize the adequacy of their lipid intake) stage. The 6-month TTM-based intervention for fat consumption was performed with a sample of Public Health Service users.ResultsSeventy-one women completed all of the phases. About half of the participants were in the PM stage (UCG: 14 of 31; TM-IG: 19 of 40), and only two were in the non-reflective action stage. Post-intervention, PM individuals in the TM-IG evolved differently, with greater progression to later stages of change and reduced calorie intake, weight, and body mass index (p < 0.05).ConclusionsOwing to the high proportion of participants in the PM stage and the differing performance, this stage is important. The intervention had a previously unreported differential effect on the progression of the stage of change and nutritional status by PM classification.Trial registrationRBR-5TDHZY (retrospectively registered in August 2017 in Brazilian Registry of Clinical Trials).

Improvements in stage of change correlate to changes in dietary intake and clinical outcomes in a 5-year lifestyle intervention in young high-risk Sri Lankans

The objectives of a stage-matched approach to lifestyle change are that individuals progress forward through the stages of change. It also posits that progression through the stages of change is associated with positive changes in lifestyle behaviours. Measuring the relationship between stage of change and food intake is challenging due to the plurality of dietary behaviours. Furthermore, it is not clear whether changes in behaviour are sustained long-term. In this study we assess the movement through stages of change in the intensive (visits every 3months) and control groups (visits annually) of a large-scale primary prevention study in cardiovascular disease, carried out in 2637 children and young adults in Sri Lanka between 2007 and 2012. We also examine their relationship to dietary behaviours and clinical outcomes. We demonstrate that individuals in both groups continue to progress through stages of change over the course of the study and that measures of dietary behaviours improved from baseline to final follow-up. We also demonstrate that stage of change positively correlates to dietary behaviours including the ratio of recommended:not-recommended items, unpolished:polished starches and low-fat:high-fat food items throughout each year of the study. Finally, participants in the later stages of change at Y2, Y3 and Y4, had a significantly attenuated increase in weight and waist circumference at the final visit in both groups. We therefore demonstrate the usefulness of stage-matched approach in modifying complex dietary behaviours, and that stage of change is a valid measure of dietary behaviours across a large population over time.

Attendance Behavior of Ex-members in Fitness Clubs

The transtheoretical model of behavior change (TTM) is often used to understand and predict health-related behavior. The objective of this study is to apply the TTM's stages of change to examine patterns of attendance behavior at fitness clubs. A retrospective study was performed to study the later stages of change, using attendance data of members who cancelled their membership in 2012 in two European fitness chains, including 259,355 ex-members of 267 clubs. A sample of 400 was selected at random for analyses, M age = 32.1 yr. (SD = 10.9; 64% males) and 34.7 yr. (SD = 11.0; 51% males) for BasicFit and HealthCity. Regular attendance behavior was defined by at least four visits per month. In the past, all ex-members had purchased a membership and by that were considered to have entered the preparation stage, but 19.5% had never attended the club in 24 months. Of the ex-members, 10% demonstrated regular attendance behavior for six months, and 2.3% had regular attendance for 24 months. 49% did not attend the club for one full month but started regular attendance again. Significant positive correlations were found in attendance behavior between the 6th and 12th months (r = .61), and the 12th and 24th months (r = .45), suggesting that ex-members who attended for more than six months were more likely to have maintained their attendance behavior. With only 10% of the members demonstrating regular attendance behavior, it is evident that appropriate strategies have to be developed to improve attendance behavior and facilitate exercise behavior in fitness clubs.

Stages of change in adults who have failed an online hearing screening.

Hearing screening has been proposed to promote help-seeking and rehabilitation in adults with hearing impairment. However, some longitudinal studies point to low help-seeking and subsequent rehabilitation after a failed hearing screening (positive screening result). Some barriers to help-seeking and rehabilitation could be intrinsic to the profiles and needs of people who have failed a hearing screening. Theories of health behavior change could help to understand this population. One of these theories is the transtheoretical (stages-of-change) model of health behavior change, which describes profiles and needs of people facing behavior changes such as seeking help and taking up rehabilitation. According to this model, people go through distinct stages toward health behavior change: precontemplation, contemplation, action, and finally, maintenance. The present study describes the psychometric properties (construct validity) of the stages of change in adults who have failed an online hearing screening. Stages of change were measured with the University of Rhode Island Change Assessment (URICA). Principal component analysis is presented, along with cluster analysis. Internal consistency was investigated. Finally, relationships between URICA scores and speech-in-noise recognition threshold, self-reported hearing disability, and self-reported duration of hearing disability are presented. In total, 224 adults who had failed a Swedish online hearing screening test (measure of speech-in-noise recognition) completed further questionnaires online, including the URICA. A principal component analysis identified the stages of precontemplation, contemplation, and action, plus an additional stage, termed preparation (between contemplation and action). According to the URICA, half (50%) of the participants were in the preparation stage of change. The contemplation stage was represented by 38% of participants, while 9% were in the precontemplation stage. Finally, the action stage was represented by approximately 3% of the participants. Cluster analysis identified four stages-of-change clusters: they were named decision making (44% of sample), participation (28% of sample), indecision (16% of sample), and reluctance (12% of sample). The construct validity of the model was good. Participants who reported a more advanced stage of change had significantly greater self-reported hearing disability. However, participants who reported a more advanced stage of change did not have a significantly worse speech-in-noise recognition threshold or reported a significantly longer duration of hearing impairment. The additional stage this study uncovered, and which other studies have also uncovered, preparation, highlights the need for adequate guidance for adults who are yet to seek help for their hearing. The fact that very few people were in the action stage (approximately 3% of the sample) signals that screening alone is unlikely to be enough to improve help-seeking and rehabilitation rates. As expected, people in the later stages of change reported significantly greater hearing disability. The lack of significant relationships between stages-of-change measures and speech-in-noise recognition threshold and self-reported duration of hearing disability highlights the complex interplay between impairment, disability, and behaviors in adults who have failed an online hearing screening and who are yet to seek help.

Effectiveness of the Treatment Readiness and Induction Program for increasing adolescent motivation for change

Success in substance abuse treatment is improved by problem recognition, desire to seek help, and readiness to engage in treatment, all of which are important aspects of motivation. Interventions that facilitate these at treatment induction for adolescents are especially needed. The purpose of this study is to assess the effectiveness of TRIP (Treatment Readiness and Induction Program) in promoting treatment motivation. Data represent 519 adolescents from 6 residential programs who completed assessments at treatment intake (time 1) and 35days after admission (time 2). The design consisted of a comparison sample (n=281) that had enrolled in treatment prior to implementation of TRIP (standard operating practice) and a sample of clients that had entered treatment after TRIP began and received standard operating practice enhanced by TRIP (n=238). Repeated measures ANCOVAs were conducted using each time 2 motivation scale as a dependent measure. Motivation scales were conceptualized as representing sequential stages of change. LISREL was used to test a structural model involving TRIP participation, gender, drug use severity, juvenile justice involvement, age, race–ethnicity, prior treatment, and urgency as predictors of the stages of treatment motivation. Compared to standard practice, adolescents receiving TRIP demonstrated greater gains in problem recognition, even after controlling for the other variables in the model. The model fit was adequate, with TRIP directly affecting problem recognition and indirectly affecting later stages of change (desire for help and treatment readiness). Future studies should examine which specific components of TRIP affect change in motivation.

P-18 * PATIENT'S TYPE FALLING UNDER THE CATEGORY OF ALCOHOL DEPENDENCE, HARMFUL USE OF ALCOHOL, AND HAZARDOUS DRINKING AND THE DIRECTION OF SUPPORT IN INPATIENTS OF GASTROENTEROLOGICAL MEDICINE DEPARTMENT

Introduction. In this investigation, 34.0% of 141 inpatients of gastroenterological medicine department with their consent had a score of 8 or higher in AUDIT. Types of those patients were investigated. Method. Alcohol abuse (diagnosed based on ICD-10) and hazardous drinking were analyzed for patients (n = 55) with an AUDIT score of 8 or higher. Patients were classified in a case-code matrix using age, gender, AUDIT score, diagnosis, presence/absence of alcohol abuse treatment, motivational stage by Prochaska, cognitive function, life expectancy as codes. This investigation was conducted with approval from the Ethical Committee of University of Tsukuba. There was no conflict of interest. Result. Types included patients with (1) alcohol abuse, in the preparation or later stage of change, with no previous treatment for alcohol abuse; (2) a history of alcohol abuse treatment and progressed physical disease due to relapse; (3) alcohol abuse and life expectancy of several months due to malignant disease; (4) alcohol abuse in the pre-contemplation stage of change, with impaired cognition function in some cases; and (5) harmful use of alcohol or hazardous drinking in the pre-contemplation stage of change. Conclusion. Support should be tailored by patients' type of alcohol abuse.

G-40 Free Communication/Poster - Aquatics

Research suggests that targeted mass media campaigns can be extremely effective at raising awareness and potentially improving short-term behavior change in areas such as nutrition and physical activity (Wakefield, Loke & Hornik, 2010; James & Cinelli, 2003). Current research links gestational overweight/obesity and adverse effects on offspring, including subsequent childhood obesity (Schack-Niesen et al 2010; Ludwig & Currie, 2010). Physical activity (PA) is considered to be a primary modifiable factor of weight gain during pregnancy with practitioners playing an instrumental role for perinatal women. PURPOSE: To evaluate the effectiveness of a physical activity media campaign among perinatal women to increase PA levels, intention, and knowledge. METHODS: The study employed a quantitative, quasi-experimental, control comparison research design at OBGYN offices, in which one office was exposed to a social media campaign (intervention, n=174) while another office served as a control (n=151). After six months, three measures were given to all participants: IPAQ for physical activity levels, Stages of Change Transtheoretical Model for behavioral intention, and an instrument to determine physical activity knowledge specific to maternal health. RESULTS: The majority of participants were Caucasian (n=207, 63.69%), pregnant (n=167, 51.38%) living in a rural area (n=121, 67.69%). ANOVA and Chi Square analyses determined significant differences of perinatal physical activity, behavioral intention, and PA knowledge by group. Perinatal women exposed to the social media campaign were statistically more likely to: participate in vigorous exercise and strength training (p<0.05), be in the later stages of change (p=0.006), and have more knowledgeable about physical activity (p=0.014). CONCLUSIONS:This study supported the hypothesis that a social media campaign targeting physical activity implemented within OBGYN offices can significantly increase exercise level, intention, and knowledge among perinatal women. Duplication of this campaign to other geographical areas to determine similar impact may be warranted. Support by Rural Health Research Institute, GSU Seed Grant.

Young adults who smoke cigarettes and marijuana: Analysis of thoughts and behaviors

IntroductionSmoking both cigarettes and marijuana is increasingly common among young adults, yet little is known about use patterns, motivations, or thoughts about abstinence. In a U.S. sample, this study explored young adults' severity of cigarette and marijuana co-use, quit attempts, and thoughts about use. MethodsYoung adults age 18-to-25 who had smoked at least one cigarette in the past 30days completed an anonymous online survey. ResultsOf 1987 completed surveys, 972 participants reported both past-month cigarette and marijuana use (68% male, 71% Caucasian, mean age 20.4years [SD=2.0]). Frequency of use, temptations to use, measures of dependence, decisional balance, and past-year quit attempts were associated across the two substances (all p<.05), but not motivation to quit. Relative to marijuana, participants reported greater desire and a later stage of change for quitting cigarettes and were more likely to endorse a cigarette abstinence goal, yet they had lower expectancy of success with quitting cigarettes and with staying quit (all p<.001). ConclusionsCigarette and marijuana use, temptations to use, and pros/cons of using were related in this young adult sample. Differences in motivation and thoughts about abstinence, however, suggest that young adults may be more receptive to interventions for tobacco than marijuana use. Use patterns and cognitions for both substances should be considered in prevention and intervention efforts.

Psychosocial predictors of four health‐promoting behaviors for cancer prevention using the stage of change of Transtheoretical Model

The present study aimed to examine whether demographic as well as psychosocial variables related to the five stages of change of the Transtheoretical Model can predict non-clinical adults' cancer preventive and health-promoting behaviors. This study specifically focused on cancer, one of the major chronic diseases, which is a serious threat of national health. A total of 1530 adults participated in the study and completed questionnaires. Collected data were analyzed by using multinominal logistic regression. The significant predictors of later stages varied among the types of health-promoting behaviors. Certain cancer preventive health-promoting behaviors such as well-balanced diet and exercise were significantly associated with psychosocial variables including cancer prevention-related self-efficacy, personality traits, psychosocial stress, and social support. On the other hand, smoking cessation and moderate or abstinence from drinking were more likely to be predicted by demographic variables including sex and age. The present study found that in addition to self-efficacy-a relatively well-studied psychological variable-other personality traits and psychological factors including introversion, neuroticism, psychosocial stress, and social support also significantly predicted later stages of change with respect to cancer preventive health-promoting behaviors. The implications of this study are also discussed.

Artifacts, identification and support for change after an acquisition

PurposeThis paper aims to investigate the extent to which individuals' identification with a changed organizational artifact is associated with their cognitive, behavioral, and affective support for change in the later stages of a change effort, and the role of contextual variables in mediating these relationships.Design/methodology/approachPrimarily quantitative with some qualitative data from an online organization that had acquired the non‐personnel assets of its competitor.FindingsThe paper finds that: artifacts can be an important part of employees' perceptions of their organizations; artifact identification is associated with cognitive and behavioral support in the later stages of a change effort; a positive perception of the change mediates between identification and cognitive and behavioral support, and also facilitates affective support; emotional exhaustion is a marginal mediator; and trust towards top managers does not play a mediating role.Research limitations/implicationsFuture research could study the factors that influence artifact identification. Studies of support for change must address its various dimensions to more accurately assess support.Practical implicationsDuring the later stages of change, managers can foster artifact identification, highlight the positives, and reduce emotional exhaustion to ensure support.Originality/valueThis study is one of the first to examine the relationship between artifact identification and support for change in the later stages of a change effort, and the mediating role of contextual factors. In addition, it investigates the multi‐dimensional aspects of support for change, an area that has received limited empirical research attention.

Tempering the Decline in College Student Physical Activity Using Informational Interventions: Moderating Effects of Stress and Stage of Change

An intervention was conducted to identify effective but feasible ways to combat the decline in physical activity (PA) among college students. One hundred forty-six first year college students were randomly assigned to one of three brief interventions: brochures, a classroom presentation, or an in-person demonstration. Benefiting from the study, having low perceived stress, and being in a later stage of change for PA were expected to protect against the typical decreases in PA outcomes. Declines in PA were slowed or reversed when students were influenced by the intervention, had lower stress, and were in earlier stages of change. Students may benefit from simple interventions such as one-time seminars and brochures explaining fitness guidelines, especially if combined with a stress management intervention.