Astrid Reubsaet

Efficacy of a single computer-tailored e-mail for smoking cessation: results after 6 months

To date, few Internet-delivered smoking cessation interventions have been tested. This study tested the efficacy, understandability, credibility and personal relevance of an e-mail-delivered computer-tailored smoking cessation intervention. It included tailored action plan feedback, as recent studies have demonstrated the importance of planning in facilitating quitting smoking. Participants (Dutch adults) were randomly assigned to the intervention (computer-tailored e-mail; N = 224) or the control group (generic, non-tailored e-mail; N = 234). The results 6 months after baseline (N = 195) showed that significantly more participants in the intervention group reported not having smoked in the last 24 hours (21.5%) and 7 days (20.4%) in contrast with participants in the control group (9.8 and 7.8%, respectively). Intention-to-treat analyses revealed similar results, though overall lower quitting percentages. Furthermore, participants in the intervention group appreciated the computer-tailored e-mail significantly more in terms of understandability, credibility and personal relevance. Hence, the computer-tailored intervention is effective for the Dutch smoking population motivated to quit smoking. Further research is needed into the efficacy of the intervention for smokers who are not motivated to quit smoking and into the benefits of (multiple) e-mail-delivered tailored letters with tailored action plan feedback over and above tailoring without action plan feedback.

Motives of Belgian Adolescents for Using Sunscreen: The Role of Action Plans

The first objective of this study was to analyze the differences between adolescents who use sunscreen frequently and those who do not. The second objective was to explore the importance of specific action plans when planning sunscreen use. Data was gathered among 602 Belgian secondary school students. Frequent and infrequent users of sunscreen were compared on several determinants related with sunscreen use, and a regression analysis on sunscreen use was done. Frequent users of sunscreen measures had significantly higher scores on attitudes, social influence, self-efficacy, some awareness factors, intention, and action plans. The integrated model for exploring motivational and behavioral change (I-Change model) explained 57% of the total variance of using sunscreen every 2 hours. Frequent sunscreen use was most strongly predicted by action plans, followed by positive intentions to use sunscreen, wearing protective clothing, seeking shade, attitude toward sunscreen use, education, social influence, and exposure to the sun. Our results suggest that skin cancer prevention programs aimed at promoting sunscreen use need to emphasize the advantages of sunscreen to infrequent users and to increase feelings of self-efficacy. Moreover, support by friends and parents should be stimulated. Finally, developing specific action plans for the use of sunscreen should be promoted to more effectively translate general intentions into actual sunscreen use. (Cancer Epidemiol Biomarkers Prev 2006;15(7):1360–6)

Systematic prevention of overweight and obesity in adults: a qualitative and quantitative literature analysis

To date, most interventions aimed at preventing obesity have underemphasized the application of systematic intervention development, implementation and evaluation. The present review provides a thorough insight in factors promoting implementation and/or effectiveness in interventions aimed at preventing overweight/obesity among adults. A total of 46 studies evaluating interventions aimed at preventing obesity were reviewed, followed by both qualitative and quantitative analyses. The Intervention Mapping protocol and the Environmental Research framework for weight Gain prevention (EnRG) were applied to analyse and classify the included studies. The interventions were categorized by setting (workplace, community, health care) and target group (ethnic minorities, pregnant women, [pre]menopausal women, smokers, people with intellectual disabilities). Generally, interventions were found to have potential in changing energy balance‐related behaviours and anthropometric outcomes. Effect sizes for changes in body mass index ranged between −0.09 and 0.45. When the programme goal specifically aimed at weight management, the intervention was found to be more successful than interventions with programme goals that were aimed at preventing cardiovascular disease or improving general health status. Although a considerable part of studies included motivational interventions, only some actually assessed the effects on potential cognitive mediators. A general lack of reporting underlying theoretical models for behaviour change was observed as well as the inclusion of linkage groups and strategies to promote empowerment.

Determinants of the intention of Dutch adolescents to register as organ donors

This article identifies relevant predictors of willingness among Dutch adolescents to register as posthumous organ and tissue donors. A cross-sectional survey was conducted among 1836 Dutch adolescents between 16 and 18 years of age who had not yet been approached for registration. Sixty-seven percent of the participants indicated that they were willing to register as organ donors. In order of greatest association, negative outcome beliefs, anxiety, social outcome expectations, involvement with organ donation issues, positive outcome beliefs, knowledge about organ donation registration, past behaviour, and sex were significant predictors of the willingness to register as organ donor. Religion and level of education had a significant bi-variate correlation with intention, but were not significant predictors after controlling for other variables. The results give clear suggestions for tailoring organ donation registration interventions to specific characteristics, beliefs and misconceptions of adolescents.

Clustering of diet, physical activity and smoking and a general willingness to change

Addressing multiple health behaviours are important in preventing disease and mortality. The present study investigated the clustering of health behaviours, cognitive determinants and stages of change in 2827 adults for the lifestyle factors of physical activity, fruit, vegetable and fat consumption and smoking. The results showed that only 3% of the total population met recommended guidelines for all of the five behaviours. Behaviours were found to be weakly associated. Behaviour-specific cognitions and stages of change for the behaviours clustered more strongly, however. With respect to diet and physical activity, respondents in the preparation stage for one behaviour were likely also to be preparing to change another behaviour. Possible mechanisms for the apparent general willingness to change multiple behaviours are discussed, as well as potential implications for health promotion practice.

From theory to practice: An explorative study into the instrumentality and specificity of implementation intentions

Objective: The present study explores the behavioural impact of instrumentality and specificity of implementation intentions. Method: At baseline, 764 participants in a smoking cessation contest were asked to formulate three implementation intentions on how they planned to cope with difficult situations. Two independent researchers evaluated all formulated plans and rated them according to their instrumentality (instrumental and non-instrumental) and specificity (non-specific, medium and highly specific). Point prevalence and continuous smoking abstinence rates were measured 7 months after baseline. Results: One in four participants (23%) made at least one non-instrumental implementation intention. On average, participants made medium to highly specific plans. The mere instrumentality of plans did not significantly affect smoking abstinence. Plan specificity positively predicted point prevalence abstinence; medium to highly specific planning resulted in higher abstinence rates than less specific planning. Smoking abstinence rates did not differ between respondents with medium and highly specific planning. Women, higher educated participants, and experienced quitters were more likely to formulate instrumental implementation intentions. Women and highly motivated participants were more specific in their planning. Conclusion: By encouraging participants to furnish goal-directed actions with sufficient detail the efficacy of implementation intention formation can be increased. Implications for future studies and interventions are discussed.

Predicting parental sunscreen use: Disentangling the role of action planning in the intention–behavior relationship

Structural equation modeling was used to examine antecedents of parental sunscreen use (N = 436) in a longitudinal design. The influence of a volitional planning cognition was assessed in several path models, investigating potential mediation and moderation of the intention–behavior relationship. Premotivational and motivational variables accounted for 55.1% of the variance in intention to use sunscreen. Intention emerged as the most powerful predictor of behavior, followed by action planning and self-efficacy expectations, together explaining 35.4% of parental sunscreen use after five months. Strong support was found for both mediating and moderating influences of action planning on the intention–behavior relationship. Action planning also partially mediated the impact of self-efficacy on behavior. The results support theoretical considerations to add postintentional cognitions to current health behavior models. Although action planning is an important component in the transition from intention to behavior, the impact of intention and of other premotivational and motivational variables should not be overlooked when developing health educational interventions.

Predictors Of Organ Donation Registration Among Dutch Adolescents

BACKGROUND In 1998, a new organ donor registration scheme was implemented in the Netherlands in order to increase the number of potential donors and to facilitate decisions and procedures concerning organ donation. However, registration rate and registration choices failed to meet the expectations. METHODS A cross-sectional survey among a random sample of 1,731 Dutch adolescents of 18 and 19 years was conducted to study potential determinants of organ donor registration choices. RESULTS Almost one fifth of the adolescents indicated that they did not return their organ donation registration form. Among subjects who registered, 57% were willing to donate their organs or tissues posthumously. More positive social influences, fewer negative outcome beliefs, and a low level of organ donation anxiety were significant predictors of returning a completed registration form and registration as an organ donor. In addition, religion was a significant predictor of returning a completed registration form, and positive outcome beliefs contributed to the prediction of registration as an organ donor. CONCLUSIONS The results give clear suggestions for tailoring organ donation registration interventions to specific characteristics, beliefs, and misconceptions of adolescents. The results also suggest that it is important to encourage adolescents to discuss issues related to organ donation with their parents and friends in order to increase donor registration.

Smoking Status and Peer Support as the Main Predictors of Smoking Cessation in Adolescents from Six European Countries

We compared 1,335 adolescent smokers and quitters from six European countries with regard to attitudes toward smoking, self-efficacy, social influences, and intentions to quit smoking. At 6-month follow-up, occasional, weekly, and daily smokers who had quit indicated less social influence of friends and siblings toward smoking, acknowledged more disadvantages of smoking, and expressed more confidence that they would be able not to smoke in various tempting situations. Logistic regression analyses revealed that smoking status at baseline and social influence of peers were the main predictors of cessation. Although no large cultural differences were found, the pattern of predictors was not similar for all six countries. As adolescents who smoke regularly are less likely to quit, strategies to prevent them from taking up the habit are important. The influence of peers calls for inclusion of peer groups in cessation strategies.

Passive cancer detection and medical help seeking for cancer symptoms: (in)adequate behavior and psychosocial determinants.

The present study explored the performance and psychosocial determinants of passive cancer detection behavior, that is, attentiveness to cancer symptoms, and medical help seeking, and investigated potential dependency between these two behaviors. A detailed telephone survey was conducted among 459 respondents, aged 55 years or older. The survey assessed passive detection behavior and appropriately timed medical help seeking, regarding 14 cancer symptoms. Knowledge of cancer symptoms and various other psychosocial determinants were also measured. Knowledge of cancer symptoms and adequate passive detection behavior was low to moderate. Timely medical help-seeking behavior was low to moderate for urgent symptoms but relatively high for prolonged symptoms. Overall, women had higher knowledge levels, paid more attention to cancer symptoms, and performed more timely help seeking than men. Passive detection behavior was positively associated with premotivational awareness factors (knowledge and awareness), female gender, and perceived advantages. Timely medical help seeking was positively related to cognitive motivational factors (perceived advantages, self-efficacy expectations, and intention) and negatively related to educational level and perceived susceptibility to cancer. Furthermore, a strong positive association was found between the performance of passive detection behavior and timely medical help seeking. The suboptimal levels of knowledge and performance of early cancer detection behaviors found in this study emphasize a need for educational efforts in the area of early cancer detection. The effectiveness of these efforts may benefit from considering the distinct sets of determinants of passive detection behavior and medical help seeking.