Positive Outcome Expectancies Research Articles

Intensive care unit clinicians identify many barriers to, and facilitators of, early mobilisation: a qualitative study using the Theoretical Domains Framework.

From the perspective of intensive care unit (ICU) clinicians, what are the barriers to and facilitators of implementing early mobilisation? A qualitative study using focus groups, with analysis using the Theoretical Domains Framework. Physicians, nurses, respiratory therapists and physiotherapists from the ICUs of three university-affiliated hospitals in Montreal, Canada. Four focus group meetings were conducted with 33 participating ICU clinicians. Two researchers independently performed thematic content analysis on verbatim transcriptions of the audio recordings using the Theoretical Domains Framework. Data saturation was reached after the third focus group. Thirty-six barriers were categorised in 13 domains of the Theoretical Domains Framework. The key barriers to early mobilisation were: lack of conviction and knowledge regarding the available evidence about early mobilisation; lack of attention to the provision of optimal care; poor communication; the unpredictable nature of the ICU; and limited staffing, equipment, time and clinical knowledge. Twenty-five facilitators categorised in ten TDF domains were also identified. These included individual-level facilitators (intrinsic motivation, positive outcome expectations, conscious effort to mobilise early, good planning/coordination, the presence of ICU champions, and expert support by a physiotherapist) and organisational-level facilitators (reminder system, pro-early mobilisation culture, implementation of an early mobilisation protocol, and improved ICU organisation). A broad array of barriers to and facilitators of early mobilisation in the ICU were identified in this study. Clinicians can consider whether these barriers and facilitators are operating in their ICU. These may inform the design of tailored knowledge translation interventions to promote early mobilisation in the ICU.

Social Cognitions and Mental Health as Predictors of Adolescents\u2019 Mindfulness Practice

ObjectivesWhile practicing mindfulness can potentially mitigate and prevent mental health problems among adolescents, mindfulness programs delivered in schools do not uniformly lead to uptake of mindfulness practice. This low adherence threatens the internal validity of mindfulness trials and may hinder the alleviation of mental health problems in youth who fail to take up potentially effective techniques. Consequently, it is vital to investigate what predicts uptake of independent mindfulness practice in such interventions.MethodsUsing path analyses, this study investigates whether social cognitions from the Reasoned Action Approach and initial mental health predict mindfulness practice among 1646 adolescent recipients of the school-based Healthy Learning Mind mindfulness intervention.ResultsIn line with the Reasoned Action Approach, descriptive and injunctive norms, and positive and negative outcome expectations predicted intention to practice mindfulness (R2 = .37, p < .001), which in turn predicted different measures of mindfulness practice itself (R2 = .09–.17, p < .001). Neither perceived behavioral control nor mental health variables (depressive symptoms, internalization and externalization of difficulties, and resilience: R2 = .01, p > .05) were associated with mindfulness practice after the intervention.ConclusionSocial norms and outcome expectations are potential intervention targets to increase mindfulness practice motivation and behavior among adolescents.

Alcohol-related cognitive mechanisms underlying adolescent alcohol use and alcohol problems: Outcome expectancy, self-schema, and self-efficacy

The objective of this study was to empirically test a theoretical model to determine the cognitive mechanisms that are associated with adolescent alcohol use and alcohol problems. We posited that alcohol outcome expectancies would affect alcohol-refusal self-efficacy through the drinker self-schema. We also posited that alcohol outcome expectancies and the drinker self-schema would affect alcohol use and problems through alcohol-refusal self-efficacy. A survey was administered to 225 adolescents in a public junior high school in Taiwan at two-time points, six months apart. Path analysis was used to determine the mechanisms underlying the alcohol-related cognitive constructs on the alcohol use and alcohol problems separately, controlling for appropriate alcohol-related personal and environmental factors. Indirect effects were estimated using the bootstrapping method. Higher positive alcohol outcome expectancies and lower negative alcohol outcome expectancies predicted higher drinker self-schema scores. Higher positive alcohol outcome expectancies and drinker self-schema scores predicted lower alcohol-refusal self-efficacy. Lower alcohol-refusal self-efficacy was associated with a history of drinking and alcohol problems in the past six months. Effects of alcohol outcome expectancies on alcohol use and alcohol problems were partially mediated through the drinker self-schema and alcohol-refusal self-efficacy. Findings support the proposed theoretical cognitive mechanisms underlying alcohol use and alcohol problems in a sample of Taiwanese adolescents. Given that alcohol-related cognitive constructs are modifiable, the findings also provide a foundation to suggest that interventions to reduce positive alcohol outcome expectations and prevent the formation of a drinker self-schema may facilitate alcohol-refusal self-efficacy and mitigate drinking behaviors in this adolescent population.

Efficacy and Mediators of a Web-Based Media Literacy Intervention for Indoor Tanning Prevention

Extant media literacy interventions have been delivered in person, limiting their potential for large scale reach, implementation, and dissemination. Although emerging evidence suggests the interventions can impact behavior, the theoretical mediators that can explain the efficacy remain unknown. This study investigated the efficacy and mediators of a web-based media literacy intervention for reducing indoor tanning behavior among young women. Participants were randomly assigned to one of three conditions: a media literacy intervention with counter argument production, a media literacy intervention with counter story production, or an assessment-only control condition. The outcomes of indoor tanning behavior and intention were evaluated with 3- and 6-month follow-ups. Results indicated significant effects of the web-based intervention on reducing indoor tanning behavior at the follow-ups. Changes in perceived media realism completely mediated the intervention effects on behavior. Perceived media realism, positive and negative outcome expectancies, and collective efficacy partially mediated intervention effects on intention. This study demonstrates the efficacy of a web-based media literacy intervention and the theoretical mechanisms underlying the efficacy. It indicates that by altering perceived media realism, outcome expectancies, and collective efficacy, web-based media literacy interventions could generate behavioral effects.

An examination of the extent to which mood and context are associated with real-time alcohol consumption

AimTo assess the effects of mood, social and environmental contexts and alcohol-related beliefs on alcohol consumption. MethodParticipants (N = 69) recorded their positive and negative outcome expectancies and self-reported mood prior to drinking (Time 1 mood). A Smartphone App then enabled alcohol consumption (total number of drinks aggregated from reports throughout a drinking occasion, current mood (Time 2 mood), social context e.g., with friends and environmental location e.g., in a bar/pub to be documented in de facto real-time a total of 3009 data points. ResultsFeeling unhappy prior to consumption onset was associated with a significant increase in drinking. During a drinking occasion, feeling happy was a significant predictor of drinking larger quantities. Interestingly, however, an interaction between T1 and T2 mood suggested it is not mood prior to consumption which drives drinking, but rather that alcohol consumption elevates mood. Being with two or more friends (relative to being alone) also predicted increased consumption. Positive and negative expectancies were not found to be significant predictors within these models. ConclusionBy showing that both mood and social context may shape alcohol behaviors distinctly, the current study suggests that alcohol research and intervention efforts may benefit from greater consideration of the temporally-mediated contextual influences on alcohol consumption.

Contextual Effect of the Integrated Health Post and Social Capital on Completeness of Child Immunization in Pacitan, East Java

Background: Around 2-3 million deaths each yearwere caused by diseases that could be pre­vented by immunization. Immunization is an effort to actively increase a person's immunity against a disease. Basic immuniza­tion can pro­tect infants from diseases that can be prevented by immunization. This study aimed to analyze the factors at the individual level and the inte­grated health post level that affected the complete basic immunization status of infants. Subjects and Method: This was an observa­tional analytic study with a cross-sectional design. The study was conducted at 25 Inte­grated Health Posts (posyandu) in Pacitan, East Java. A sample of 200 infants aged 12-23 months was selected randomly. The dependent variable was complete basic immunization. The independent variables were knowledge, self-efficacy, outcome expectations, vicarious learn­ing, health workers support, social capital, and posyandu strata. The data were analyzed using a multiple multilevel logistic regression. Results: Complete basic immunization status increased with good knowledge (OR= 10.16; 95% CI= 1.48 to 69.98; p= 0.019), high self-efficacy (OR= 10.32; 95% CI= 2.01 to 53.13; p= 0.005), positive outcome expectations (OR= 20.40; 95% CI= 3.39 to 123; p= 0.001), vica­rious learning (OR= 4.35; 95% CI= 0.90 to 21.10; p= 0.068), strong health workers sup­port (OR= 14.54; 95% CI=2.63 to 80.65; p= 0.002), and strong social capital (OR= 6.54; 95% CI= 1.41 to 30.40; p= 0.017). Integrated Health Post strata had a contextual effect on the complete basic immunization status with Intra-Class Correlation (ICC)=34.15%. Conclusion: Complete basic immunization status increases with good knowledge, high self-efficacy, positive outcome expectations, had done vicarious learning, and strong social capital. Integrated Health Post strata have a contextual effect on the complete basic immunization status. Keywords: basic immunization, contextual effect, social cognitive theory, social capital Correspondence: Puspita Mayangsari Prabowo. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: mayangsari37.pm@gmail.com. Mobile: +6287859294881. Journal of Maternal and Child Health (2020), 05(05): 525-536 https://doi.org/10.26911/thejmch.2020.05.05.07

Theory of Planned Behavior and Social Cognitive Theory on the Effect of the Community Health Center Tertiary Preventive Behavior among Patients with Type 2 Diabetes Mellitus: A Multilevel Analysis

Background: Type 2 diabetes mellitus (DM) accounts for 90% to 95% of all diabetes cases. Complications of type 2 diabetes increase the risk of death for suf­ferers. Complications and deaths from type 2 dia­betes can be prevented by changes in behavior. This study aimed to determine the effect of health cen­­ters and other factors on the prevention of ter­­tiary diabetes type 2, using the theory of plan­ned behavior and social cognitive theory. Subjects and Method: This was an analytic ob­ser­­vational study with cross sectional de­sign, conducted at 25 community health centers, in Bantul Re­gen­cy, Yogyakarta, Indonesia. A sample of 200 type 2 DM patients was selected by exha­ustive samp­­ling. The dependent variable was type 2 DM tertiary prevention. The indepen­dent vari­ables at level 1 are intention, attitude, sub­jective norm, perceived behavior con­trol/ self-efficacy, experience, modelling, self-re­gu­­­­lation, and out­come expectation. Community health center was an independent variable at level 2. The data were col­­lected by questionnaire and analyzed by a mul­ti­level multiple linear regression. Results: Tertiary preventive behavior in type 2 DM patients increased with strong intention (b= 1.19; 95% CI= 0.62 to 1.76; p &lt;0.001), positive atti­tude (b= 1.19; 95% CI= 0.58 to 1.80; p &lt;0.001), supportive subjec­­tive norm (b= 0.79; 95% CI= 0.12 to 1.45; p= 0.019), perceived be­ha­vior control (b= 1.16; 95% CI= 0.60 to 1.72; p &lt;0.001), abundant experience (b= 0.65; 95% CI= 0.62 to 1.25; p&lt;0.001), strong modelling (b= 1.07; 95% CI= 0.53 to 1.67; p= 0.030), strong self-regulation (b= 0.87; 95% CI= 0.34 to 1.40; p= 0.001), and positive outcome expectation (b= 0.82; 95% CI= 0.25 to 1.38; p = 0.004). Commu­nity health center had con­textual effect on the tertiary pre­ventive behavior in type 2 DM patients with ICC= 19.18%. Conclusion: Tertiary preventive behavior in type 2 DM patients increases with strong intent­ion, positive atti­tude, supportive subjec­­tive norm, perceived be­ha­vior control, abundant experience, strong modelling, strong self-regula­tion, and positive outcome expectation. Commu­nity health center has con­textual effect on the tertiary pre­ventive behavior in type 2 DM patients. Keywords: tertiary prevention behavior, type 2 diabetes, TBP, SCT, multilevel analysis. Correspondence: Yudi Andriyaningtiyas. Masters Program in Pub­lic Health, Universitas Sebelas Maret, Jl. Ir. Su­tami No. 36A, Surakarta. Email: yudi.andriya­ning­­tiyas@gmail.com. Mobile: +6281392704899 Journal of Health Promotion and Behavior (2020), 05(01): 59-71 https://doi.org/10.26911/thejhpb.2020.05.01.08

Depression Outcome Expectancy in Primary Care in Singapore: Symptom Severity as a Mediating Determinant.

Background:Depression has been identified as the most common mental illness in Singapore. To address this growing concern, the current study focused on the population within the primary care setting since depression has been demonstrated to be highly prevalent in these patients. This study examined the possible predictors of outcome expectancy based on illness perception and depression severity.Methods:One hundred and one adult patients with depressive symptoms in primary care were recruited for a cross-sectional study. Positive outcome expectancy was measured using the Depression Change Expectancy Scale, and illness perception was measured using the Illness Perception Questionnaire Mental Health. Depression severity was derived from the Patient Health Questionnaire-9 scores extracted from the participants’ medical records. Regression and mediation analyses were applied to explore possible predictors of positive outcome expectancy.Results:Regression analysis demonstrated that symptom severity, and specific dimensions under illness perception (i.e., perception of chronicity, perception of personal control, and perception of treatment control) were the most significant predictors of positive outcome expectancy. Mediation analysis found that symptom severity partially mediated the relationship between perception of chronicity and positive outcome expectancy.Conclusions:Pharmacotherapy, interventions from allied health professionals, and psychotherapeutic interventions (e.g., strategies from positive psychology, solution-focused therapy, and strengths-based cognitive behavioral therapy) that aim to directly alleviate depressive symptoms as well as improve the perceptions of chronicity, personal control, and treatment control could potentially enhance treatment benefits in primary care patients with depression.

Temporary Disability Pension, RTW-Intentions, and RTW-Behavior: Expectations and Experiences of Disability Pensioners over 17 Months.

Purpose: Individuals receiving a temporary disability pension (TDP) should get the opportunity to return to work (RTW). The current study aims to determine the factors contributing to RTW. Methods: 453 individuals on TDP were interviewed at three measurement points (T1, T2 = T1 + approximately 7 months, T3 = T1 + approximately 17 months). Socio-demographics, psychological predictors, and current work status (maintained TDP, permanent disability pension, old-age pension, employed, or receipt of other benefits) were assessed. Results: Throughout the duration of the study, only four of the former temporary disability pensioners returned to work, and an additional seven made themselves available to the labor market. These were individuals who were younger, in TDP for a shorter period of time, and reported a higher RTW-intention. Higher RTW-intention was cross-sectionally associated with younger age, shorter TDP duration, and more positive outcome expectancies. Additionally, study participants who expected that medical rehabilitation would help them RTW were more motivated to RTW. An increase in RTW-intention over 17 months was related to younger age and better health. Conclusion: Personal factors such as self-efficacy and job-related variables appear less important for RTW than age and subjective health status. The observed RTW rates call for early support and tailored medical rehabilitation interventions that help individuals prevent functional limitations, overcome disability, and facilitate RTW.

An exploration of placement-related psychosocial influences on school engagement among adolescents in foster care

There is ample evidence that experiencing foster care in childhood often predicts grim outcomes in adulthood, including under-education and resulting poverty and dysfunction. However, little is known about the exact mechanisms through which foster care corrodes academic trajectories, specifically. The current study uses a nationally representative sample of adolescent foster youth (i.e., NSCAW II) to test a model of the influences of placement-related factors on school engagement – namely, foster youth’s perceptions of security in their foster placements, their reports of education-specific involvement by foster caregivers, and the mediating potential of adolescents’ expectations for their future. Results indicate that adolescents’ feelings of “placement security” were linked to their future expectations of positive life outcomes and, ultimately, school engagement. Results also suggest that while educational involvement by foster caregivers was not important for future expectations or social school engagement, it may be related to the more explicitly cognitive aspects of school engagement (i.e., assignment completion, effort, etc.). These findings offer insight into relations between foster care-specific factors and school engagement – a known predictor of academic achievement and eventual educational attainment. Implications for future research and practice are discussed.

Does Perceived Social Pressure Play a Vital Role in Emerging Adults’ Future Multiple Role Balance? Evidence From Sri Lanka

This study examines the role of perceived social pressure (PSP) in anticipated multiple role balance (AMRB) for emerging adults in Sri Lanka and variance across genders. Data were collected from a questionnaire with a sample size of 725 undergraduates at a major state university. Structural equation modeling with multigroup analysis was employed to investigate the relationships among constructs. The findings indicate that there is a positive and significant effect of PSP on AMRB both directly and indirectly through multiple role balance self-efficacy (SE) and positive outcome expectations (OE). Further, the results reveal that the effect of PSP on SE and anticipated multiple balance is statistically different across genders. This study contributes to the existing literature by applying social cognitive career theory’s self-management model to multiple role planning for the first time in Sri Lanka and filling the gaps in research on sources of SE and OE.

An Ecological Momentary Assessment Study Investigating Self-efficacy and Outcome Expectancy as Mediators of Affective and Physiological Responses and Exercise Among Endometrial Cancer Survivors.

Previous studies have shown affective and physiological states in response to exercise as predictors of daily exercise, yet little is known about the mechanism underlying such effects. To examine the mediating effects of self-efficacy and outcome expectancy on the relationships between affective and physiological responses to exercise and subsequent exercise levels in endometrial cancer survivors. Ecological momentary assessment (EMA) surveys were delivered up to eight 5- to 7-day periods over 6 months. Participants (n = 100) rated their affective and physiological states before and after each exercise session (predictors) and recorded their self-efficacy and outcome expectancy each morning (mediators). Exercise (outcome) was based on self-reported EMA surveys and accelerometer measures. A 1-1-1 multilevel mediation model was used to disaggregate the within-subject (WS) and between-subject (BS) effects. At the WS level, a more positive affective state after exercise was associated with higher self-efficacy and positive outcome expectation the next day, which in turn was associated with higher subsequent exercise levels (ps < .05). At the BS level, participants who typically had more positive affective and experienced less intense physiological sensation after exercise had higher average self-efficacy, which was associated with higher average exercise levels (ps < .05). In endometrial cancer survivors, affective experience after exercise, daily self-efficacy and positive outcome expectation help explain the day-to-day differences in exercise levels within-person. Findings from this study highlight potentials for behavioral interventions that target affective experience after exercise and daily behavioral cognitions to promote physical activity in cancer survivors' everyday lives.

Barriers to the safe use of chemical household products: A comparison across European countries

Chemical household products, such as cleaning and washing products or pest control and garden chemicals, are frequently involved in poisonings in private households. Consumer research has identified a number of barriers that impede the safe use of these products, ranging from unfamiliarity, to misconceptions and a lack of risk perception, to behavioural or situational barriers. This study aimed at investigating these barriers for consumers in eight European countries. Participants from eight European countries were recruited and asked to fill out an online questionnaire on their familiarity with hazard pictograms, perceptions and self-reported behaviour (Total: N = 5631, Austria: N = 731, Switzerland: N = 698, Germany: N = 711, France: N = 708, Italy: N = 695, Poland: N = 693, Sweden: N = 682, UK: N = 713). Across all countries, the lowest consumer familiarity was found for the meaning of the pictogram for “health hazard” (65% indicated having never seen it before). Small-sized differences between the eight countries were observed regarding people’s familiarity, perceptions and self-reported behaviour. The results suggest that people apply hazard-related as well as product- and marketing-related strategies to judge the dangerousness of a chemical household product. These findings suggest a number of starting points for risk regulation and communication regarding hazardous household chemical products. Further, the results suggest that positive outcome expectancies and rules of thumb for judging the risks of a chemical household product are particularly relevant for people’s self-reported safe use of chemical household products.

Gendered Career Choices: Paths Toward Studying a Degree in Physical Activity and Sport Science.

Drawing on Social Cognitive Career Theory (SCCT), we examined factors affecting interest in pursuing a degree in Physical Activity and Sport Science (PASS) among Spanish teenage students. Although women were awarded 55.1% of all bachelor degrees in Spain in 2017–2018, female enrollment in PASS degrees is decreasing and currently stands below 20% across the country. To better understand the under-representation of women in this field, 4146 students (50.2% girls; mean age = 16.82 years; SD = 0.837) participated in a survey designed to measure a series of SCCT constructs: interest in studying a PASS degree, career outcome expectations, goal representations, and perceived social supports. With these data, we tested a set of path analysis models to explain gender differences in interest in studying a degree in PASS. These models tested the assumption that interest in PASS would mediate the paths from outcome expectations and social supports to goal representations. Model 1 assumed that interest would partially mediate the path from outcome expectations to goal representations, Model 2 assumed complete mediation, and Model 3 assumed absence of mediation. All models were tested separately for boys and girls. Our results provide information on how male and female students set personal goals based on expected career outcomes and show that this process is affected by gender stereotypes. The lack of interest by young women in studying a degree in PASS (only 7.8% of girls expressed this interest compared with 19.0% of boys), together with the gender differences observed in perceived social supports, outcome expectations, and goal representations, have several important theoretical and practical implications. The present research suggests that interventions that foster positive outcome expectations and social support are necessary to increase interest in studying PASS among teenage girls.

Effects of Social and Outcome Expectancies on Hazardous Drinking among Chinese University Students: The Mediating Role of Drinking Motivations

Background and Objectives: Based on the theory of reasoned action, the present study investigated the relative effects of drinking outcome expectancies and parental norms, as well as the mediating effect of drinking motivations, on hazardous drinking in Chinese university students. Method: A sample of Chinese university students in Hong Kong and Macao (N = 973, M = 19.82, SD = 1.57, 48.9% males), who reported drinking in the past 3 months, voluntarily completed an anonymous questionnaire. Path analysis was used to test the effects of the variables on hazardous drinking. Results: All the psychosocial variables showed positive correlations with hazardous drinking. In the path model, controlling for sex, parental norms had both direct and indirect effects on hazardous drinking through social and enhancement motivations. Courage had the strongest indirect effect on drinking behavior through social, enhancement, and coping motivations, whereas the relationship between tension reduction and hazardous drinking was mediated by enhancement and coping motivations. Sociality and sexuality only had indirect effect through social and coping motivations respectively. Negative outcome expectancies had no direct nor indirect effects on hazardous drinking. Conclusions: Perceived approval from parents and positive alcohol outcome expectancies may enhance individuals’ tendency to engage in hazardous drinking by increasing their motivation to drink to be social, for enjoyment, and to cope with problems. Parents should explicitly show their disapproval of their children’s drinking, and education efforts should focus on decreasing positive outcome expectancies and associated motivations for drinking among Chinese university students.

Using the immediate blood pressure benefits of exercise to improve exercise adherence among adults with hypertension: a randomized clinical trial.

A single exercise session evokes immediate blood pressure (BP) reductions that persist for at least 24 h, termed postexercise hypotension (PEH). Self-monitoring of PEH may foster positive outcome expectations of exercise, and thus, enhance exercise adherence among adults with hypertension. To compare the efficacy of self-monitoring of exercise (EXERCISE) versus exercise and PEH (EXERCISE + PEH) to improve exercise adherence and BP control among adults with hypertension. Adults with high BP were randomized to EXERCISE (n = 12) or EXERCISE + PEH (n = 12). Participants underwent supervised, moderate intensity aerobic exercise training for 40-50 min/session, 3 days/week for 12 weeks and encouraged to exercise unsupervised at home at least 30 min/day, 1-2 days/week. EXERCISE + PEH also self-monitored BP before and after exercise. Adherence was calculated as [(no. of exercise sessions performed/no. of possible exercise sessions) × 100%]. BP was measured pre and posttraining. Healthy, middle-aged (52.3 ± 10.8 years) men (n = 11) and women (n = 13) with hypertension (136.2 ± 10.7/85.2 ± 8.9 mmHg) completed exercise training with 87.9 ± 12.1% adherence. EXERCISE + PEH demonstrated greater adherence to supervised training (94.3 ± 6.6%) than EXERCISE (81.6 ± 13.2%; P = 0.007). EXERCISE + PEH performed 32.6 ± 22.5 min/week more unsupervised home exercise than EXERCISE (P = 0.004), resulting in greater exercise adherence (107.3 ± 18.7%) than EXERCISE (82.7 ± 12.2%; P = 0.002). Post versus pretraining BP was reduced -7.4 ± 11.3/-4.9 ± 9.9 mmHg (P < 0.025) with no statistical difference between EXERCISE (-5.2 ± 13.3/-3.6 ± 6.1 mmHg) and EXERCISE + PEH (-9.9 ± 11.3/-6.1 ± 6.9 mmHg; P > 0.344). The current study is the first to demonstrate that PEH self-monitoring is an efficacious tool to improve exercise adherence among a small sample of adults with hypertension. Future research among a larger, more diverse sample is needed to confirm these novel findings and determine whether EXERCISE + PEH translates to better BP control relative to EXERCISE self-monitoring alone.

Can verbal suggestions strengthen the effects of a relaxation intervention?

Short stress management interventions such as relaxation therapy have demonstrated preliminary effectiveness in reducing stress-related problems. A promising tool to strengthen the effectiveness of relaxation-based interventions is the use of verbal suggestions, as previous research provided evidence that verbal suggestions can induce positive outcome expectancies, facilitate adaptive responses to stress and improve health outcomes. The present experimental proof-of-concept study aimed to investigate the effects of a brief relaxation intervention and specifically the role of verbal suggestions on stress-related outcomes assessed by self-report questionnaires and psychophysiological data. 120 participants (mean age = 22.1 years) were randomized to one of four intervention conditions: a brief relaxation intervention plus verbal suggestions condition, a brief relaxation intervention only condition, a verbal suggestions only condition, and a control condition. Afterwards, participants were subjected to a psychosocial stress challenge to assess reactivity to a stressful event. Immediately after both relaxation interventions (with and without verbal suggestions), lower self-reported state anxiety was found compared to the control condition, but no differences were observed in response to the stressor. The verbal suggestions only condition did not impact state anxiety. No significant effects were found for verbal suggestion interventions on cortisol, alpha amylase, heart rate and skin conductance. This is the first study investigating the role of verbal suggestions in the effectiveness of a brief relaxation intervention. Although this experimental proof-of-concept study provides support for the effectiveness of a brief relaxation intervention in lowering state anxiety directly after the intervention, the effects did not impact the response to a subsequent stressor and we did not observe any evidence for the add-on effectiveness of verbal suggestions. The effectiveness of brief relaxation interventions on stress responses should be investigated further in future research by incorporating interventions that are tailored to the specific stress challenge and various types of verbal suggestions.

Differential Effects of Anxiety Sensitivity on E-Cigarettes Processes: The Importance of E-Cigarette Quit Attempt History.

Electronic cigarettes (e-cigarettes) are recognized as a prevalent form of substance use among adults in the United States. The rise in e-cigarette use has motivated research to identify subgroups of the population that may be particularly vulnerable to e-cigarette use and its associated harm. Individuals with elevated psychological vulnerability are one such group more at risk for being a lifetime or current e-cigarette user. Yet, little is known about how factors of psychological vulnerability relate to perceptions of e-cigarette use within the context of e-cigarette quit attempts. The current study evaluated the differential relations of anxiety sensitivity (AS), a core affective vulnerability factor, on several relevant e-cigarette processes across those with and without a previous attempt to quit using e-cigarettes. Our sample consisted of 547 current e-cigarette users (51% female, Mage = 35.38 years, SD = 10.1). Results indicated that AS significantly related to greater perceived risks, benefits, and positive outcome expectancies of e-cigarette use among current e-cigarette users who reported at least one attempt to quit e-cigarettes but was unrelated among those who had never attempted to quit. Findings identify e-cigarette users who fail to quit as a potential vulnerable subgroup of users who experience more strongly held perceptions about e-cigarettes because of increased AS. This work provides initial evidence for a conceptual model in which levels of AS and e-cigarette processes are strengthened by and differ across e-cigarette quit attempt history. (Am J Addict 2019;28:390-397).

Working with Insulin, Carbohydrates, Ketones and Exercise to Manage Diabetes (WICKED): evaluation of a self-management course for young people with Type 1 diabetes.

To evaluate a 5-day self-management education course for young people with Type 1 diabetes and assess its effects on knowledge, self-efficacy, beliefs, distress, self-management behaviours and HbA1c . This is an evaluation of a structured education course. Young people (aged 16-24 years) with Type 1 diabetes were recruited from three diabetes centres. In the first centre, participants completed self-report measures of knowledge, self-efficacy, positive and negative outcome expectancies, and hypoglycaemic worries at baseline (n=47) and the end of the course (n=42). In two additional centres, participants completed these and other measures assessing self-management behaviours, cognitive adaptation to diabetes and diabetes distress at baseline (n=32), the end of the course (n=27) and 3-month follow-up (n = 27). HbA1c levels were recorded at baseline (n=79), 6 months (n=77) and 12 months (n=65). There were statistically significant increases in self-report knowledge, self-efficacy, positive outcome expectancies and self-management behaviours, and a statistically significant decrease in negative outcome expectances, between baseline and the end of the course. There were also statistically significant increases in self-report knowledge, self-efficacy, self-management behaviours and cognitive adaptation to diabetes between baseline and 3-month follow-up. Compared with baseline, HbA1c levels decreased by a mean (sd) of 5.44 (19.93) mmol/mol (0.48%) at 6 months (P=0.019), and by 5.98 (23.32) mmol/mol (0.54%) at 12 months (P =0.043). The results indicate the potential benefits of a self-management course designed to address the developmental needs and challenges faced by young people with Type 1 diabetes. Further studies with larger numbers and appropriate controls are required to confirm these initial findings.

Female Adolescents and Life Skills based on the Social Cognitive Theory: A Qualitative Study

Background: Adolescence is one of the most important periods of life for all people. This is a transition period from childhood to adulthood, through which individuals should learn to make the right decisions and apply the life skills. This study aimed to explain the life skills' experiences of 12-14 year-old female adolescents. Materials and Methods: In this qualitative content analysis study, adolescent girls aged 12-14 years were selected by the purposeful sampling method. The data were collected using individual interviews and focus group discussions. The recorded audio files were transcribed. Then, the information was compared and merged with the available literature in the field. A classification matrix was created according to the constructs of the social cognitive theory (SCT). Categories were derived from the constructs of SCT and themes were extracted from the analysis and interpretation of data. Results: The main extracted themes consisted of the environmental, behavioral, and personal factors. The theme of environmental factors included two categories of interpersonal relationships and influential role models as well as access to resources and facilities. The theme of behavioral factors included the categories of skills and the personal factors' theme contained the categories of personality traits, attitudes, perceived self-efficacy, knowledge, and outcome expectations. Conclusion: The use of life skills by adolescents is influenced by personal, environmental, and behavioral factors. Therefore, appropriate conditions should be provided for the adolescents to use the life skills. These conditions include acquisition of knowledge and skills, perception of positive outcome expectancies, existence of influential role models, existence of supportive systems, access to facilities, and positive attitudes.