Protection Motivation Theory Constructs Research Articles

Effect of an Educational Intervention Based on Protection Motivation Theory on Preventing Cervical Cancer among Marginalized Women in West Iran

Objective:This study aimed to determine the effectiveness of an educational intervention to prevent cervical cancer among marginalized Iranianwomen based on the Protection Motivation Theory (PMT) as a theoretical framework.Methods:This quasi-experimental study was carried out on 143 women of Kermanshah City in western Iran during 2017. Participants were recruited through cluster and simple random sampling and randomly divided into experimental (n=72) and control groups (n=71). All completed a self-administered questionnaire including PMT constructs and demographic variables. An intervention over six sessions was then applied to the experimental group. Reassessment was conducted three months after the intervention, with data was analyzed with SPSS-16 using chi-square, McNemar, paired T- and independent T-tests.Results:The mean scores for the constructs of PMT, and cervical cancer screening behavior showed no significant differences between the two groups before the intervention (P>0.05). The educational manipulation had significant effects on the experimental groups’ average response for perceived vulnerability, perceived severity, perceived reward, self-efficacy, response efficacy, response cost and protection motivation (all p < 0.001). Also, the prevalence of regular Pap smear testing and referral to health centers were significantly increased after 3 months in the experimental (P=0.048), but notthe control group (P>0.05).Conclusions:The results show that applying an educational intervention based on PMT might help prevent cervical cancer and improve regular Pap smear testing.

Protection motivation theory in predicting intention to receive cervical cancer screening in rural Chinese women.

Despite the significance of cervical cancer screening, motivating more women to participate remains a challenge in resource-limited settings. In this study, we tested the protection motivation theory (PMT) in predicting screening intentions. Participants were women from Wufeng, a typical rural county in China. Participants (n=3000) with no cervical cancer history were recruited from 10 randomly selected villages. As mediating variables, 6 PMT constructs (Perceived Risk, Fear Arousal, Perceived Severity, Response Efficacy, Response Cost, and Self-Efficacy) were measured using the standardized questionnaire. Structural equation modeling (SEM) method was employed to test PMT-based prediction models. Of the total sample, 57.77% believed that regular screening may reduce cervical cancer risk, and 45.26% agreed that women should be screened regularly. Our data fit the PMT model well (GFI=0.95, AGFI=0.93, CFI=0.90, RMSEA=0.06, SRMR=0.04, Chi-square/df=2.47). Knowledge of screening was directly and positively associated with screening intention. Age, annual income, and awareness of and prior experience with screening were significantly associated with screening intention by enhancing cervical cancer risk perception and by reducing response cost (P<0.05 for both). PMT can be used as guidance to investigate cervical cancer screening intentions among rural women in China with focus on cancer knowledge, some demographic factors, and awareness of and previous experience with screening. These findings, if verified with longitudinal data, can be used for intervention program development.

Modifying attitude and intention toward regular physical activity using protection motivation theory: a randomized controlled trial

We were guided by the Protection Motivation Theory to test the motivational interviewing effects on attitude and intention of obese and overweight women to do regular physical activity. In a randomized controlled trial, we selected using convenience sampling 60 overweight and obese women attending health centres. The women were allocated to 2 groups of 30 receiving a standard weight-control programme or motivational interviewing. All constructs of the theory (perceived susceptibility, severity, self-efficacy and response efficacy) and all anthropometric characteristics (except body mass index) were significantly different between the groups at 3 study times. The strongest predictors of intention to do regular physical exercise were perceived response efficacy and attitude at 2- and 6-months follow-up. We showed that targeting motivational interviewing with an emphasis on Protection Motivation Theory constructs appeared to be beneficial for designing and developing appropriate intervention to improve physical activity status among women with overweight and obesity.

Predictors of Safety Behavior Among Jiroft-City Greenhouse Spray Workers Based on Protection Motivation Theory in 2016

Background: In recent decades, unsafe use of pesticides has caused different cancers in human beings as well as damages to environment and organisms. Objectives: The present study aimed to determine the predictors of safety behavior among greenhouses spray workers in Jiroft city based on Protection Motivation Theory (PMT). Methods: This cross-sectional study with descriptive-correlation approach was conducted in 2016 on 229 greenhouse spray workers in Jiroft city selected via proportional stratified random sampling using a researcher-made questionnaire. The questionnaire consisted of demographic variables and PMT constructs such as perceived vulnerability, perceived severity, costs, rewards, fear, self-efficacy, response-efficacy, and protection motivation, as well as safety behaviors. Results: All workers were male in the age range of 19 to 72 years, most of whom (47.6%) had previously been poisoned by pesticides. The mean scores of all the PMT constructs were in range of 50% to 75% except for perceived rewards that its mean score was between 75% and 100%. There was a significant correlation between response-efficacy and all the constructs at P < 0.01, except for the perceived rewards that was significant at P < 0.05. Moreover, a significant correlation was found between all the constructs other than perceived rewards and fear (P < 0.01). The predicted amount of spray workers’ preventive behaviors by protection motivation theory constructs was 41% and the role of perceived vulnerability (β = 0.310), perceived severity (β = 0.303), self-efficacy (β = 0.166), and response-efficacy (β = 0.140) was greater than the role of other constructs. Conclusions: Concerning predictive power of protection motivation theory constructs for safety behaviors related to spray workers’ health and due to the important role of perceived vulnerability, perceived severity, self-efficacy, and response-efficacy, educational interventions are necessary for training protective principles to prevent health problems resulted from exposure to pesticides in workers.

Avian influenza A/H7N9 risk perception, information trust and adoption of protective behaviours among poultry farmers in Jiangsu Province, China

BackgroundPoultry farmers are at high-risk from avian influenza A/H7N9 infection due to sustained occupational exposures to live poultry. This study examined factors associated with poultry farmers’ adoption of personal protective behaviours (PPBs) based on Protection Motivation Theory (PMT).MethodsTotally, 297 poultry farmers in three cities of Jiangsu Province, China were interviewed during November 2013-January 2014. Data on PMT constructs, perceived trustworthiness of A/H7N9 information from mass media (formal sources), friends and family (informal sources), intention to adopt and actual adoption of PPBs and respondents’ demographics were collected. Structural equation modeling (SEM) identified associations between demographic factors and PMT constructs associated with A/H7N9-oriented PPB intention. Moderated mediation analysis examined how demographics moderated the effects of information trust on PPB intention via risk perceptions of A/H7N9.ResultsRespondents generally perceived low vulnerability to A/H7N9 infection. The SEM found that male respondents perceived lower severity of (β = −0.23), and lower vulnerability to (β = -0.15) A/H7N9 infection; age was positively associated with both perceived personal vulnerability to (β = 0.21) and perceived self-efficacy (β = 0.24) in controlling A/H7N9; education was positively associated with perceived response efficacy (β = 0.40). Furthermore, perceived vulnerability (β = 0.16), perceived self-efficacy (β = 0.21) and response efficacy (β = 0.67) were positively associated with intention to adopt PPBs against A/H7N9. More trust in informal information (TII) was only significantly associated with greater PPB intention through its positive association with perceived response efficacy. Age significantly moderated the associations of TII with perceived Self-efficacy and perceived response efficacy, with younger farmers who had greater TII perceiving lower self-efficacy but higher response efficacy.ConclusionPoultry farmers perceive A/H7N9 as a personally-irrelevant risk. Interventions designed to enhance perceived response efficacy, particularly among lower educated respondents may effectively motivate adoption of PPBs. Informal information may be an important resource for enhancing response efficacy.

Adoption of personal health records by chronic disease patients: A research model and an empirical study

With the increasing prevalence of chronic disease throughout the world, electronic Personal Health Records (ePHRs) have been suggested as a way to improve chronic disease self-management. However, ePHRs are not yet widely used by consumers. Protection Motivation Theory (PMT) has been successfully used to explain health related behaviours among chronic disease patients. In addition, Information Systems (IS) theories such as Task Technology Fit (TTF) have been successfully used to explain information technology adoption. This study leverages these theories along with the health self-management readiness concept of the Patient Activation Measure (PAM) to propose a theoretical model of ePHR adoption by chronic disease patients for the task of self-management. The role of educational interventions on various elements of the proposed model is also examined. A survey-based study of 230 Type 2 Diabetes patients is used to empirically validate the proposed model via structural equation modeling techniques. Results reveal that the PMT, TTF and PAM constructs all have significant direct and indirect effects on the intention to adopt an ePHR. In addition, the educational intervention analysis indicates that the provision of advanced ePHR education positively influences various constructs in the model, while the use of fear appeals does not have an effect.

Knowledge of H7N9 avian influenza and intention to adopt preventive behaviours among Chinese poultry farmers: a cross-sectional study

BackgroundPoultry farmers are at high risk of H7N9 avian influenza infection. H7N9 influenza-related knowledge is the precondition motivating poultry farmers to adopt preventive behaviours against H7N9 infection. This study aimed to examine what elements of the knowledge were associated with poultry farmers' protection intention using the protection motivation theory (PMT). MethodsIn this cross-sectional study, using stratified random sampling method, we recruited poultry farmers from 36 villages of three cities (Suqian, Nantong, and Zhenjiang city) representing the northern, central, and southern Jiangsu Province, one of the major provinces affected by H7N9 outbreaks. We assessed H7N9 influenza-related knowledge with 25 dichotomous questions (ask for ‘know/don't know’ responses). Each element of PMT (perceived severity and vulnerability of H7N9 infection, perceived self-efficacy and response efficacy of adopting preventive behaviours) was measured using four items on a seven-point Likert scale ranging from “very strongly disagree” to “very strongly agree”. Exploratory Factor Analysis (EFA) was done to explore the types or elements of protective knowledge. We used structural equation modelling (SEM) to examine the associations between different types of knowledge and PMT constructs and protection intention. Ethical approval was given by local veterinary authorities and verbal consent was obtained from each participant before completing the survey. FindingsBetween Nov 5, 2013 and Jan 20, 2014, we recruited 297 poultry farmers (226 [76%] of whom were male; 112 farmers from Suqian, 96 from Nantong, and 89 from Zhenjiang). The EFA revealed four main knowledge types: symptoms, self-protection measures at work, basic preventive measures, and routine hygiene. The SEM showed that knowledge of symptoms (β=0·135, p=0·018) and self-protection measures at work (β=0·141, p=0·004) were positively associated with self-efficacy. Knowledge of symptoms (β=0·211, p<0·0001) and self-protection measures at work (β=0·343, p<0·0001) were also positively associated with response efficacy. Knowledge of basic preventive measures was negatively associated with perceived vulnerability (β=–0·165, p<0·001), while positively associated with self-efficacy (β=0·309, p<0·0001) and response efficacy (β=0·276, p<0·0001). Routine hygiene knowledge was positively associated with perceived vulnerability (β=0·120, p=0·013) and response efficacy (β=0·225, p<0·0001). Perceived vulnerability (β=0·312, p<0·0001), self-efficacy (β=0·129, p=0·034), and response efficacy (β=0·642, p<0·0001) were positively associated with protection intention. InterpretationDespite the limitation of small sample size from only one province, potentially under-representing the true knowledge level of poultry farmers in China, these findings reveal that different types of knowledge have various mechanisms influencing poultry farmers' intention to adopt preventive behaviours against H7N9 infection. These findings highlight the directions for intervention design for future avian influenza prevention. FundingNational Natural Science Foundation of China (71573221).

Investigation of the Role of Training Health Volunteers in Promoting Pap Smear Test Use among Iranian Women Based on the Protection Motivation Theory

Cervical cancer is known as one of the most prevalent types of cancers and a major public health problem in developing countries which can be detected by Pap test, prevented, and treated. Despite the effective role of Pap test in decreasing the incidence and mortality due to cervical cancer, it is still one the most common causes of cancer-related deaths among women, especially in developing countries. Thus, this study aimed to examine the effect of educational interventions implemented by health volunteers based on protection motivation theory (PMT) on promoting Pap test use among women. This quasi-experimental study was conducted on 60 health volunteers and 420 women. The study participants were divided into an intervention and a control group. Data were collected using a valid self-reported questionnaire including demographic variables and PMT constructs which was completed by both groups before and 2 months after the intervention. Then, the data were entered into the SPSS statistical software, version 19 and were analyzed using Chi-square test, independent T-test, and descriptive statistical methods. P<0.05 was considered as statistically significant. The findings of this study showed that the mean scores of PMT constructs (i.e. perceived vulnerability, perceived severity, fear, response-costs, self-efficacy, and intention) increased in the intervention group after the intervention (P<0.001). However, no significant difference was found between the two groups regarding response efficacy after the intervention (P=0.06). The rate of Pap test use also increased by about 62.9% among the study women. This study showed a significant positive relationship between PMT-based training and Pap test use. The results also revealed the successful contribution of health volunteers to training cervical cancer screening. Thus, training interventions based on PMT are suggested to be designed and implemented and health volunteers are recommended to be employed for educational purposes and promoting the community's, especially women's, health.

Risky electronic communication behaviors and cyberbullying victimization: An application of Protection Motivation Theory

The present study tested Protection Motivation Theory (PMT) as an explanation of electronic communication safe behavioral intentions and behaviors and cyberbullying victimization. We recruited 577 college students who completed a battery of surveys examining PMT-based constructs and cyberbullying victimization. We found that higher perceived susceptibility to cyberbullying victimization was associated with lower electronic communication safe behavioral intentions, higher electronic communication risky behaviors, and higher cyberbullying victimization. In addition, higher perceived severity of cyberbullying victimization was associated with higher electronic communication safe behavioral intentions and lower cyberbullying victimization. Furthermore, higher response efficacy and self-efficacy regarding electronic communication safe behaviors were predictive of higher electronic communication safe behavioral intentions. The PMT-based model accounted for over 30% of the variability in cyberbullying victimization. PMT constructs may be promising targets for interventions designed to decrease the incidence of cyberbullying victimization.

Determinants of Skin Cancer Preventive Behaviors Among Rural Farmers in Iran: an Application of Protection Motivation Theory.

Skin cancer is one of the most prevalent cancers, worldwide, which happens more among those with more sunlight exposure like farmers. The aim of this study was to explore the determinants of skin cancer preventive behaviors (SCPBs) among rural farmers using Protection Motivation Theory (PMT). In this cross-sectional study, multistage random sampling was employed to enroll 238 farmers referring to rural health houses (HH) in Chaldoran County, Iran. A valid and reliable instrument based on PMT variables was used. Significant correlations were found between all PMT variables with SCPBs (p < 0.05). Hierarchical multiple linear regressions were performed with Protection Motivation and SCPBs as outcome variables. Predictors for these two outcome variables were classified in two different blocks according to their natures. Demographic characteristics (p > 0.05) and PMT constructs (p < 0.001) explained 3 and 63.6% of the observed variance in Protection Motivation, respectively. Also, no significant effect was found on SCPBs by demographic variables, in the first block (∆R 2 = 0.025); however, in the second block, Perceived Susceptibility (p = 0.000), Rewards (p = 0.022), Self-efficacy (p = 0.000), and Response Cost (p = 0.001) were significant predictors of SCPBs (∆R 2 = 0.432). Health care providers may consider PMT as a framework for developing educational interventions aiming at improving SCPBs among rural farmers.

Women’s preferences for contralateral prophylactic mastectomy: An investigation using protection motivation theory

ObjectiveMost women diagnosed with unilateral breast cancer without BRCA1 or BRCA2 mutations are at low risk of contralateral breast cancer. Contralateral Prophylactic Mastectomy (CPM) decreases the relative risk of contralateral breast cancer, but may not increase life expectancy; yet international uptake is increasing. This study applied protection motivation theory (PMT) to determine factors associated with women’s intentions to undergo CPM. MethodsThree hundred eighty-eight women previously diagnosed with unilateral breast cancer and of negative or unknown BRCA1 or BRCA2 status were recruited from an advocacy group’s research database. Participants completed measures of PMT constructs based on a common hypothetical CPM decision-making scenario. ResultsPMT constructs explained 16% of variance in intentions to undergo CPM. Response efficacy (CPM’s advantages) and response costs (CPM’s disadvantages) were unique individual predictors of intentions. ConclusionDecision-making appears driven by considerations of the psychological, cosmetic and emotional advantages and disadvantages of CPM. Overestimations of threat to life from contralateral breast cancer and survival benefit from CPM also appear influential factors. Practice implicationsPatients require balanced and medically accurate information regarding the pros and cons of CPM, survival rates, and recurrence risks to ensure realistic and informed decision-making.

Educational intervention for reducing work-related musculoskeletal disorders and promoting productivity

Background and objectives. Work-related musculoskeletal disorders (WMSDs) are the main causes of pain, suffering, absenteeism, disability and reduction in productivity. This research aims to determine the role of training intervention based on protection motivation theory in reducing WMSDs and promoting productivity. Methodology. The conducted study was based on a quasi-experimental design (control) that was carried out on 158 employees of the Kabl Khodro factory which were divided into two groups of 79 people. After splitting the 158 workers, an experimental and control group was formed. The data collection instruments were made up of two questionnaires and were analysed using a quick exposure check (QEC) method. Result.Before intervention in both the experimental and control groups, there were no significant differences among the average protection motivation theory constructs, productivity and QEC scores (p < 0.05). However, following training intervention there was a significant increase in these factors within the investigated group apart from the perceived response costs and efficacy. Conclusion. The conducted study shows that ergonomic training based on the protection motivation theory is effective in reducing musculoskeletal risk factors and that increased knowledge of the subject can lead to an increase in productivity.

Protection motivation theory in predicting intention to engage in protective behaviors against schistosomiasis among middle school students in rural China.

BackgroundAmong millions of people who suffer from schistosomiasis in China, adolescents are at increased risk to be infected. However, there is a lack of theory-guided behavioral prevention intervention programs to protect these adolescents. This study attempted to apply the Protection Motivation Theory (PMT) in predicting intentions to engage in protective behaviors against schistosomiasis infection.MethodsThe participants were selected using the stratified cluster sampling method. Survey data were collected using anonymous self-reported questionnaire. The advanced structural equation modeling (SEM) method was utilized to assess the complex relationship among schistosomiasis knowledge, previous risk exposure and protective measures in predicting intentions to engage in protective behavior through the PMT constructs.Principal FindingsApproximately 70% of participants reported they were always aware of schistosomiasis before exposure to water with endemic schistosomiasis, 6% of the participants reported frequency of weekly or monthly prior exposure to snail-conditioned water. 74% of participants reported having always engaged in protective behaviors in the past three months. Approximately 7% were unlikely or very unlikely to avoid contact with snail-conditioned water, and to use protective behaviors before exposure. Results from SEM analysis indicated that both schistosomiasis knowledge and prior exposure to schistosomiasis were indirectly related to behavior intentions through intrinsic rewards and self-efficacy; prior protective behaviors were indirectly related to behavior intentions through severity, intrinsic rewards and self-efficacy, while awareness had an indirect relationship with behavior intentions through self-efficacy. Among the seven PMT constructs, severity, intrinsic rewards and self-efficacy were significantly associated with behavior intentions.ConclusionsThe PMT can be used to predict the intention to engage in protective behaviors against schistosomiasis. Schistosomiasis intervention programs should focus on the severity, intrinsic rewards and self-efficacy of protection motivation, and also increase the awareness of infection, and enrich the contents of schistosomiasis education.

Efficacy of theory-based HIV behavioral prevention among rural-to-urban migrants in China: a randomized controlled trial.

Our objective was to evaluate the efficacy of a cultural adaptation of a social cognitive theory-based HIV behavioral prevention program among young rural-to-urban migrants in China. The intervention design and assessment were guided by the Protection Motivation Theory (PMT). The intervention was evaluated through a randomized controlled trial with 6-month and 12-month follow-ups. The primary behavioral outcome was the use of condoms. Other outcome measures include HIV knowledge, condom use knowledge, HIV-related perceptions (PMT constructs), and intention to use condom. The mixed-effects regression models for condom use with regular partners indicated that overall frequency of condom use, condom use in last three sexual acts and proper condom use increased over time for the participants but the increases were significantly greater among the intervention group than the control group at 6-month and 12-month follow-ups. The mixed-effects models for HIV-related perceptions indicated that extrinsic rewards, intrinsic rewards, and response costs decreased while vulnerability, severity, response efficacy, and self-efficacy increased over time for the intervention group. The increases in HIV knowledge, condom use knowledge, and intention to use condom were also significantly greater among the intervention group than the control group. The data in the current study suggested efficacy of a social cognitive theory-based behavioral intervention in increasing condom use among young migrants in China. The intervention also increased protective perceptions and decreased risk perception posited by the theory (i.e., PMT).

Women's preferences for selective estrogen reuptake modulators: An investigation using protection motivation theory

ObjectiveSelective estrogen receptor modulators (SERMs) reduce breast cancer risk by 38%. However, uptake is low and the reasons are not well understood. This study applied protection motivation theory (PMT) to determine factors associated with intention to take SERMs. MethodsWomen at increased risk of breast cancer (N=107), recruited from two familial cancer clinics in Australia, completed a questionnaire containing measures of PMT constructs. Hierarchical multiple linear regression analysis was used to analyze the data. ResultsForty-five percent of women said they would be likely or very likely to take SERMs in the future. PMT components accounted for 40% of variance in intention to take SERMs. Perceived vulnerability, severity and response efficacy appeared the most influential in women's decisions to take or not take SERMs. ConclusionMany women are interested in SERMs as a risk management option. Accurate risk estimation and an understanding of the benefits of SERMs are critical to women's decision making. Practice implicationsHealth professionals need to explore women's perceptions of their risk and its consequences, as well as providing clear evidence-based information about the efficacy of SERMs. Exploring the source and strength of beliefs about SERMs may allow more effective, tailored counseling.

Getting the message: Framing food recall messages to increase consumer protection motivations

Previous research has shown that positive or negative message framing is a relevant factor in influencing behavioral intentions. Modifying recall message framing may be useful for increasing responses to high-risk food product recalls targeted to consumers. This study used a prospect theory message framing manipulation to discover the impact of positive, negative, and control condition messages on protection motivation theory constructs in an online experimental design. This study found that framing messages in a gain or control condition, and highlighting self-efficacy helps people feel capable of taking preventive action; alternatively, appealing to locus of control makes people feel as if they can make good choices to deal with the food recall. Proactive coping positively influences adaptive protection motivations in all three message frames tested. Once a recall message is broadcast, businesses should stress reactive coping or how to effectively deal with the stated risk. To avoid maladaptive protection motivations if a business uses a typical recall message (no gain-loss framing), it should stress the seriousness/severity of the recall because perceived severity makes it less likely that consumers will ignore the recall message. Emphasize self-efficacy in all message frames because people who demonstrate high self-efficacy are less likely to ignore recall messages.

Application of the Protection Motivation Theory in predicting cigarette smoking among adolescents in China

Reducing tobacco use among adolescents in China represents a significant challenge for global tobacco control. Existing behavioral theories developed in the West — such as the Protection Motivation Theory (PMT) — may be useful tools to help tackle this challenge. We examined the relationships between PMT factors and self-reported cigarette smoking behavior and intention among a random sample of vocational high school students (N=553) in Wuhan, China. Tobacco-related perceptions were assessed using the PMT Scale for Adolescent Smoking. Among the total sample, 45% had initiated cigarette smoking, and 25% smoked in the past month. Among those who never smoked, 15% indicated being likely or very likely to smoke in a year. Multiple regression modeling analysis indicated the significance of the seven PMT constructs, the four PMT perceptions and the two PMT pathways in predicting intention to smoke and actual smoking behavior. Overall, perceived rewards of smoking, especially intrinsic rewards, were consistently positively related to smoking intentions and behavior, and self-efficacy to avoid smoking was negatively related to smoking. The current study suggests the utility of PMT for further research examining adolescent smoking. PMT-based smoking prevention and clinical smoking cessation intervention programs should focus more on adolescents' perceived rewards from smoking and perceived efficacy of not smoking to reduce their intention to and actual use of tobacco.

Examining Information Disclosure Behavior on Social Network Sites Using Protection Motivation Theory, Trust and Risk

This paper reports on an empirical study that investigates the information disclosure behavior on Social Network Sites (SNS) focusing on undergraduate University students as our population. Although much have been reported on the issue of information privacy or privacy leakage on SNS, very few have employed the Protection Motivation Theory (PMT) as a framework to understand SNS user’s behavior related to information disclosure. In this study, the PMT incorporated with trust and risk factor, has revealed that trust on SNS and perceived benefits influenced information disclosure behaviour. Our findings showed that all PMT constructs are significantly related to privacy concern. However, privacy concern and perceived risk were found not related to information disclosure behaviour. Using self-administered questionnaire, 486 undergraduate students from five different universities in Malaysia were involved in this study.

Adolescents' protection motivation and smoking behaviour

The protection motivation theory (PMT) is a well-known theory of behaviour change. This study tested the applicability of the sub-constructs of threat and coping appraisal in predicting adolescents' smoking-related behavioural intentions and smoking behaviour longitudinally. Adolescents (N = 494) aged 11-16 years and not currently smoking at baseline participated in the study. Predictive validity of PMT constructs was tested in a path analysis model. Self-efficacy significantly predicted behavioural intention at baseline, which significantly predicted behavioural intention at follow-up, which in turn predicted smoking behaviour at follow-up. The effect of self-efficacy on behavioural intention at follow-up was mediated by behavioural intention at baseline and the effect of self-efficacy on smoking behaviour was mediated by behavioural intention at baseline and follow-up. In conclusion, we found support for one part of the PMT, namely for the predictive validity of the coping appraisal construct self-efficacy in predicting adolescents' smoking-related behavioural intention and smoking behaviour. These results fail to support the appropriateness of the PMT's construct threat appraisal in longitudinally predicting adolescents' smoking as well as the applicability of communicating fear and negative information as preventive interventions for this target group.

Correlates of unsupervised bathing of infants: a cross-sectional study.

Drowning represents the third leading cause of fatal unintentional injury in infants (0–1 years). The aim of this study is to investigate correlates of unsupervised bathing. This cross-sectional study included 1,410 parents with an infant. Parents completed a questionnaire regarding supervision during bathing, socio-demographic factors, and Protection Motivation Theory-constructs. To determine correlates of parents who leave their infant unsupervised, logistic regression analyses were performed. Of the parents, 6.2% left their child unsupervised in the bathtub. Parents with older children (OR 1.24; 95%CI 1.00–1.54) were more likely to leave their child unsupervised in the bathtub. First-time parents (OR 0.59; 95%CI 0.36–0.97) and non-Western migrant fathers (OR 0.18; 95%CI 0.05–0.63) were less likely to leave their child unsupervised in the bathtub. Furthermore, parents who perceived higher self-efficacy (OR 0.57; 95%CI 0.47–0.69), higher response efficacy (OR 0.34; 95%CI 0.24–0.48), and higher severity (OR 0.74; 95%CI 0.58–0.93) were less likely to leave their child unsupervised. Since young children are at great risk of drowning if supervision is absent, effective strategies for drowning prevention should be developed and evaluated. In the meantime, health care professionals should inform parents with regard to the importance of supervision during bathing.