Aart N. Mudde

Predicting stage transitions for smoking cessation applying the attitude-social influence-efficacy model

Abstract Cross-sectional studies integrating motivational stages with expectancy value models have suggested that contemplating smokers perceive more advantages of quitting and social support than precontemplators. Moreover, smokers preparing to quit were found to differ from precontemplators and contemplators by having higher self-efficacy expectations. Using the ASE model, the present study confirmed the findings of these cross-sectional studies. The longitudinal design of this study, however, facilitated prediction of transitions that smokers made during a 10-month follow-up. Smokers who progressed from precontemplation perceived more advantages of quitting than those who remained in precontemplation. Smokers regressed from contemplation perceived fewer advantages of quitting than those who did not regress. Finally, smokers who progressed from preparation had higher self-efficacy expectations than those who did not progress. In sum, the present study provided longitudinal support for the o-pattern, whi...

Determinants of physical activity among the older adults: a literature review.

Abstract Understanding the determinants of changing physical activity among older adults is crucial for effective intervention development. The aim of this study was to review and update the evidence relating to the determinants of physical activity initiation and maintenance among older adults, and to explore the main similarities and dissimilarities in determinants between the two phases. Only longitudinal and experimental studies were used to assess the level of evidence. Fifty-nine longitudinal observational and experimental studies were identified. Recent studies were identified that focused on some recently developed concepts, especially in the field of the post-motivational concepts and several environmental determinants in predicting physical activity initiation and maintenance. Furthermore, dissimilarities were found in determinants between physical activity initiation and maintenance. It can be concluded that determinants are to a large degree phase-specific, which should be taken into account during further investigation, theory development and intervention development. Further investigation is needed to study the importance of promising concepts, such as post-motivational and environmental determinants. Recommendations for further empirical research, theory development and intervention development are outlined in this review.

Subtypes within the precontemplation stage of adolescent smoking acquisition

The present study examined the existence of three possible subtypes within the precontemplation stage of smoking acquisition: committers, immotives, and progressives. The sample of the study included young people from six European countries (mean age = 13 years) who had never smoked regularly (n = 21 535). A cross-sectional design was used to assess cognitive determinants of smoking behavior: attitudes towards smoking, perceived social influences, and self-efficacy to remain a nonsmoker. Adolescents within the various stages of smoking acquisition were compared with regard to standardized T scores on these risk factors. The results showed that adolescents in the three subgroups of precontemplation differed from each other on every cognitive determinant tested, revealing a higher risk to start smoking among progressives than among immotives. Immotives revealed a higher risk to start smoking than committers. It is concluded that the use of subtypes within acquisition precontemplation in research on adolescent smoking may be a promising tool for investigating the initiation continuum and for improving the quality of both the implementation and evaluation of prevention programs.

Efficacy of Two Tailored Interventions Promoting Physical Activity in Older Adults

BACKGROUND Important health benefits can be obtained if effective low-cost interventions promoting physical activity, especially among older adults, are developed. DESIGN This RCT investigated the efficacy of two tailored physical activity interventions in promoting awareness, initiation, and maintenance of physical activity among older adults compared to a wait-list control group. Data were collected in 2007. Analyses were conducted in 2008. SETTING/PARTICIPANTS In total, 1971 Dutch older adults (mean age=64 years, 57% women) participated. INTERVENTION Two tailored physical activity interventions, consisting of three tailored letters delivered during 4 months, were systematically developed. The basic tailored intervention targeted psychosocial determinants alone, while the environmentally tailored intervention (intervention-plus) additionally targeted environmental determinants. MAIN OUTCOME MEASURES Awareness of personal physical activity behavior, self-reported level of physical activity, and compliance with the physical activity guideline were assessed at baseline, 3 months, and 6 months. RESULTS Intervention participants became more aware of their personal physical activity level at 6 months (OR(Ibasic)=1.7, OR(Iplus)=1.6) and were significantly more physically active at 3 (EffectSize[ES](Ibasic)=0.20, ES(Iplus)=0.20) and 6 months (ES(Ibasic)=0.30, ES(Iplus)=0.35) when compared to control participants. Moderation analyses showed that the interventions enhanced physical activity initiation at 3 (ES(Ibasic)=0.26, ES(Iplus)=0.21) and 6 months (ES(Ibasic)=0.32, ES(Iplus)=0.27) among participants insufficiently active at baseline, and induced maintenance at 6 months among participants sufficiently active at baseline (ES(Ibasic)=0.33, ES(Iplus)=0.34) when compared to the control condition. No differences between the intervention arms were found. CONCLUSIONS The results indicate that tailoring can be an effective tool in attaining and enhancing awareness, initiation, and maintenance of physical activity among older adults. Targeting environmental determinants in addition to psychosocial determinants, however, did not result in an additional increase in physical activity behavior. TRIAL REGISTRATION This study was registered with the Dutch Trial Register NTR 920.

The long-term efficacy of two computer-tailored physical activity interventions for older adults: main effects and mediators

OBJECTIVE Low-cost (e.g., computer-tailored) interventions with sustained effects are needed to increase and maintain physical activity in older adults. This study examined the long-term efficacy of 2 computer-tailored physical activity interventions for older adults and its psychosocial and environmental mediators. METHODS A clustered randomized controlled trial (N = 1,971) was conducted that included 3 research arms: (a) basic computer-tailored print intervention, targeting psychosocial mediators; (b) environmentally computer-tailored print intervention, targeting psychosocial and environmental mediators; and (c) no-intervention control group. Interventions were developed using the intervention mapping approach and consisted of 3 computer-tailored letters delivered over 4 months. Questionnaires assessed the study outcomes (i.e., total weekly days and total weekly minutes of physical activity) at baseline and 12 months. Potential mediators (i.e., awareness, attitude, self-efficacy, intention, social influence, intrinsic motivation, self-regulation, and perceived environment) were assessed at baseline and at 3 or 6 months. RESULTS Multilevel regression analyses revealed that both interventions significantly changed total weekly days of physical activity compared with the control group, but only the environmentally computer-tailored print intervention significantly changed weekly minutes of physical activity. Multiple mediation models showed that the effects of both interventions on weekly days of physical activity were mediated by changes in awareness and intention. CONCLUSIONS Computer-tailored interventions were effective in inducing long-term behavioral changes in physical activity behavior of older adults. Awareness and intention were found to be important mediators of changing daily physical activity and should be included in future computer-tailored intervention studies.

The active plus protocol: systematic development of two theory-and evidence-based tailored physical activity interventions for the over-fifties

BackgroundLimited data are available on the development, implementation and evaluation processes of physical activity promotion programmes among older adults. More integrative insights into interventions describing the planned systematic development, implementation and evaluation are needed.Methods and designThe purpose of this study is to give an integrative insight into the development of the Active plus programme applying the six-step Intervention Mapping protocol. The Active plus programme consisted of two theory- and evidence-based tailored physical activity promotion interventions, both comprising three tailored letters delivered over four months and aimed at raising awareness of insufficient physical activity, and stimulating physical activity initiation and maintenance among the over-fifties.The first intervention, the basic tailored intervention, provided tailored letters that intervened on the psychosocial determinants of physical activity. The second intervention, the intervention plus, provided the same tailored information but additionally provided tailored information about physical activity opportunities in the specific environment in which the older adults lived. This environment-based component also provided access to a forum and e-buddy system on a website. A plan for implementation and evaluation is also described.DiscussionThe planned development of the Active plus programme resulted in two theory- and evidence-based tailored physical activity interventions targeted at the over-fifties.Trial RegistrationDutch Trial Register NTR 920

The reach and effectiveness of a national mass media-led smoking cessation campaign in The Netherlands.

OBJECTIVES This study examined the reach, effectiveness, and cost-effectiveness of a mass media-led smoking cessation campaign including television shows, a television clinic, a quit line, local group programs, and a comprehensive publicity campaign. METHODS A random sample of baseline smokers (n = 1338) was interviewed before and after the campaign and at a 10-month follow-up. A nonpretested control group (n = 508) of baseline smokers was incorporated to control for test effects. RESULTS Most smokers were aware of the campaign, although active participation rates were low. Dose-response relations between exposure and quitting were found. The follow-up point prevalence abstinence rate attributable to the campaign was estimated to be 4.5% after control for test effects and secular trends. The cost per long-term quitter was about

Determinants of awareness, initiation and maintenance of physical activity among the over-fifties: a Delphi study

12. CONCLUSIONS In spite of a massive rise in tobacco promotion expenditures prior to the campaign and the absence of governmental control over the media, the campaign under study may have increased normal cessation rates substantially.

The working mechanisms of an environmentally tailored physical activity intervention for older adults: a randomized controlled trial

To develop effective interventions to stimulate physical activity (PA), insight into its underlying variables is needed. The aim of this study was to obtain an overview of the most relevant determinants of awareness, initiation and maintenance of PA among the over-fifties by means of a three-round Delphi study. In the first round, 17 key-experts outlined possible relevant determinants into an open-ended electronic questionnaire. In the second round, 118 experts completed a structured electronic questionnaire that was based on the first round results, in which they scored each determinant on its relevance. In the third round, experts were asked to re-rate the relevance of each determinant, after feedback was given about the group median relevance score. After three rounds, the experts agreed on 30 relevant determinants of the three phases of PA. When compared with longitudinal studies, the Delphi study pointed out new concepts, such as several post-motivational and social and environmental determinants as possible relevant determinants, suggesting that this method has the potential to trace new and promising determinants. The results further showed that next to similarities, much dissimilarity in relevant determinants of awareness, initiation and maintenance of PA was found, suggesting that most determinants could be phase specific.

Long-term efficacy of a printed or a Web-based tailored physical activity intervention among older adults

BackgroundThe aim of this study was to explore the working mechanisms of a computer tailored physical activity intervention for older adults with environmental information compared to a basic tailored intervention without environmental information.MethodA clustered randomized controlled trial with two computer tailored interventions and a no-intervention control group was conducted among 1971 adults aged ≥ 50. The two tailored interventions were developed using Intervention Mapping and consisted of three tailored letters delivered over a four-month period. The basic tailored intervention targeted psychosocial determinants alone, while the environmentally tailored intervention additionally targeted environmental determinants, by providing tailored environmental information. Study outcomes were collected with questionnaires at baseline, three and six months and comprised total physical activity (days/week), walking (min/week), cycling (min/week), sports (min/week), environmental perceptions and use and appreciation of the interventions.ResultsMediation analyses showed that changes in cycling, sports and total physical activity behaviour induced by the environmentally tailored intervention were mediated by changes in environmental perceptions. Changes in environmental perceptions did not mediate the effect of the basic tailored intervention on behaviour. Compared with the basic tailored intervention, the environmentally tailored intervention significantly improved cycling behaviour (τ = 30.2). Additionally, the tailored letters of the environmentally tailored intervention were better appreciated and used, although these differences did not mediate the intervention effect.DiscussionThis study gave some first indications of the relevance of environmental perceptions as a determinant of changing physical activity behaviours and the potential effectiveness of providing environmental information as an intervention strategy aimed at enhancing physical activity behaviour among older adults.