B. van den Putte

Applying structural equation modeling in the context of the theory of reasoned action: Some problems and solutions

This study identifies and attempts to solve problems encountered in applications of structural equation modeling (SEM) to the theory of reasoned action. This theory is often used in social psychology and aims at explaining and predicting behavior. The few studies that test this theory with SEM have, in general, 2 methodological problems, which cast serious doubt on the validity of the conclusions. The first problem is that in most of the tests the data do not fit the model. The second problem is that part of the theory is formulated by multiplying 2 variables, which implies that the results are highly dependent on the arbitrarily chosen scale values. These problems are illustrated with a secondary analysis of survey data gathered by Burnkrant and Page (1988) and by new data presented in this study. In this article, an alternative model specification is proposed that strongly improves the fit of the data, but leaves intact the structural part of the model being tested. It is also advisable to omit 1 of the...

The interplay between affect and theory of planned behavior variables.

OBJECTIVES To assess whether affective evaluations of health behaviors moderate or mediate the influence of theory of planned behavior (TPB) variables on intention. METHODS For each of 20 health behaviors, respondents (N=300) completed questionnaire measures of affective evaluation, attitude, subjective norm, perceived behavioral control, and intention. RESULTS Analyses using path modeling revealed that affective evaluation of the behaviors did not moderate the influence of the TPB variables on intention, but it partially mediated the influence of attitude and perceived behavioral control on intention. CONCLUSIONS These results emphasize the importance of affective evaluation as a target for health communication.

Exercise promotion: an integration of exercise self-identity, beliefs, intention, and behaviour

Abstract We explored the role of exercise self-identity within the framework of the theory of planned behaviour (TPB). Participants were 538 undergraduate students who completed measures of exercise self-identity, exercise behaviour, TPB items, and behavioural and control beliefs. Regression analysis showed that self-identity was the second strongest predictor of exercise behaviour and interacted with exercise intention. Follow-up analysis showed that the intention–exercise relationship was more than three times stronger at high than at low levels of exercise self-identity. Results also showed that only a marginal part of the sample with strong exercise identities had a weak exercise intention, whereas a large part of the sample with a strong exercise intention also reported a strong exercise identity. Nevertheless, only a quarter of the sample that reported strong exercise identity and intention were sufficiently active. The results underline the notion that exercise self-identity may be a useful component for the theory of planned behaviour.Abstract We explored the role of exercise self-identity within the framework of the theory of planned behaviour (TPB). Participants were 538 undergraduate students who completed measures of exercise self-identity, exercise behaviour, TPB items, and behavioural and control beliefs. Regression analysis showed that self-identity was the second strongest predictor of exercise behaviour and interacted with exercise intention. Follow-up analysis showed that the intention–exercise relationship was more than three times stronger at high than at low levels of exercise self-identity. Results also showed that only a marginal part of the sample with strong exercise identities had a weak exercise intention, whereas a large part of the sample with a strong exercise intention also reported a strong exercise identity. Nevertheless, only a quarter of the sample that reported strong exercise identity and intention were sufficiently active. The results underline the notion that exercise self-identity may be a useful compone...

Trends and socioeconomic differences in roll-your-own tobacco use: findings from the ITC Europe Surveys

Objectives To examine if exclusive Roll-Your-Own (RYO) tobacco use relative to factory-made (FM) cigarette use has been rising over time, to determine the extent to which economic motives and perceptions that RYO cigarettes are less harmful act as primary motivations for use, and to examine the association of income and education with the level of RYO tobacco use among smokers in four European countries. Methods Data were obtained from the International Tobacco Control (ITC) Europe Surveys, and a cohort sample of 7070 smokers from the Netherlands, Germany, France and UK were interviewed between June 2006 and December 2012. Generalised estimating equations (GEE) were used to assess trends in RYO use, and whether RYO consumption varied by socioeconomic variables. Results Exclusive RYO use over the study period has increased significantly in the UK from 26.4% in 2007 to 32.7% in 2010 (p<0.001); France from 12.2% in 2006 to 19.1% in 2012 (p<0.001); and Germany from 12.7% in 2007 to 18.6% in 2011 (p=0.031), with increased borderline significantly in the Netherlands (31.7% to 34.3%, p=0.052), from 2008 to 2010. Over three-quarters of users in each of the study countries indicated that lower price was a reason why they smoked RYO. Just over a fourth of smokers in the UK, less than a fifth in France, and around a tenth in Germany and the Netherlands believed that RYO is healthier. Compared with exclusive FM users, exclusive RYO users were more likely to have lower incomes and lower education. Conclusions Effective tobacco tax regulation is needed in the European Union and elsewhere to eliminate or reduce the price advantage of RYO tobacco. Additional health messages are also required to correct the misperception that RYO tobacco is healthier than FM cigarettes.

Effects of issue involvement and framing of a responsible drinking message on attitudes, intentions, and behavior

To decrease the prevalence and the amount of alcohol consumption among students, health messages advocating responsible alcohol behavior can be used. However, it is unclear whether responsible drinking messages are most effective when they use a gain frame, presenting the advantages of responsible drinking, or a loss frame, presenting the disadvantages of irresponsible drinking. This study tests the effects of framing and the moderating role of involvement with the issue of responsible drinking. A three-wave, between-subjects, experimental study was conducted, in which participants (N = 90) were exposed to either a gain- or loss-framed message about responsible drinking behavior at Wave 2. At all three waves, attitudes, intentions and behavior toward responsible drinking were measured. Results showed that for participants with low issue- involvement, a gain frame led to more positive attitudes and intentions toward responsible alcohol use, whereas a loss frame did not have any effects for them. For participants with high issue involvement, a loss frame led to more positive attitudes and intentions toward responsible alcohol use, whereas a gain frame did not have an effect on attitude and only a delayed effect on intention. However, there were no effects of frame and issue involvement on adhering to the guideline of responsible alcohol use and average drinking behavior.

Effectiveness of a national reimbursement policy and accompanying media attention on use of cessation treatment and on smoking cessation: a real-world study in the Netherlands

Background In 2011, the Netherlands implemented a national policy that ensured that health insurance companies reimbursed behavioural counselling for smoking cessation or the combination of behavioural counselling with pharmacological therapy. Objective To examine the real-world impact of a national reimbursement policy and accompanying media attention on use of cessation treatment and on smoking cessation. Methods We used a four-wave longitudinal survey among 2763 adult smokers that started in September 2010 and was repeated at approximately 3 month intervals until June 2011. Two survey waves were conducted before the implementation of the policy and two survey waves after. Findings There were significant increases in quit attempts (among moderate-to-heavy smokers) and in quit success (among all smokers) following the implementation of the reimbursement policy and the media attention. Use of behavioural counselling did not increase, while use of pharmacological therapy without behavioural counselling (unreimbursed treatment) increased among moderate-to-heavy smokers. Attention to media about the reimbursement was significantly associated with more quit attempts and more quit success. Awareness of the policy was significantly associated with more use of reimbursed treatment among all smokers, while attention to the media coverage was only significantly associated with more use of reimbursed treatment among moderate-to-heavy smokers. Awareness/attention variables were not significantly associated with use of unreimbursed treatment. Conclusions It seems that a national reimbursement policy for smoking cessation treatment that is accompanied by media attention can increase cessation. Our findings suggest that this increase can (partly) be ascribed to the media attention that accompanied the policy implementation.

Educational differences in associations of noticing anti-tobacco information with smoking-related attitudes and quit intentions: findings from the International Tobacco Control Europe Surveys

This study examined educational differences in associations of noticing anti-tobacco information with smoking-related attitudes and quit intentions among adult smokers. Longitudinal data (N = 7571) from two waves of six countries of the International Tobacco Control (ITC) Europe Surveys were included. Generalized estimating equation analyses and multiple linear and logistic regression analyses were conducted. Higher educated smokers noticed anti-tobacco information slightly more often than lower educated smokers (F(2) = 25.78, P < 0.001). Noticing anti-tobacco information was associated with more negative smoking-related attitudes (β = 0.05, P < 0.001) and more quit intentions (OR = 1.08, P < 0.001). Among smokers without a quit intention at baseline, a positive association was found for noticing anti-tobacco information at baseline with follow-up quit intention (OR = 1.14, P = 0.003). No other longitudinal associations were found. No educational differences were found in the association of noticing anti-tobacco information with smoking-related attitudes but associations with quit intentions were found only among low (OR = 1.12, P = 0.001) and high educated respondents (OR = 1.11, P < 0.001) and not among moderate educated respondents (OR = 1.02, P = 0.43). Noticing anti-tobacco information may positively influence quit intentions and possibly smoking-related attitudes. Lower educated smokers were as likely to be influenced by anti-tobacco information as higher educated smokers but noticed anti-tobacco information less often; increasing reach of anti-tobacco information may increase impact in this group.

A longitudinal study into the reciprocal effects of identities and smoking behaviour: Findings from the ITC Netherlands Survey

OBJECTIVE Although it has been found that identity constructs related to smoking are associated with changes in smoking behaviour, the direction of causal associations is as yet unclear. This study aims to clarify the nature and direction of these associations. METHODS In this longitudinal study we examined the reciprocal relations between identity constructs (i.e., smoker self-identity, quitter self-identity and smoker group-identity), intention to quit and smoking and quitting behaviour among a sample of 1036 smokers and ex-smokers, using cross-lagged structural equation modelling. Moreover, we tested whether these relations differed by socio-economic status (SES). RESULTS Identity and smoking behaviour were reciprocally related in that in intention to quit and smoking behaviour consistently predicted identity change, and identity predicted (changes in) intentions to quit and smoking behaviour. Behaviour appears more important for identity change than identity for behaviour change. Furthermore, quitter self-identity appears more important than smoker self- and group-identity. Relationships did not differ significantly between SES-groups. The findings were replicated using a cross-validation sample. CONCLUSION Results imply that changing smoking behaviour may be a vehicle to change smoking-related identity. Moreover, strengthening identification with quitting is more crucial for quit success than decreasing smoker identities. The finding that behaviour may be more important for identity than vice versa, if replicated, may call for additions to identity theories.

Voorlichtingsmaterialen over alcohol voor vmbo- en praktijkscholieren

In this paper we present three studies that have been conducted amongst first year prevocational and special education students in which we examined whether narratives increase the effectiveness of health education materials. We compare various forms of narratives with standard expository materials. Results show short-term effects of exposure to health education materials on knowledge about the negative consequences of drinking alcohol. This effect is similar for materials with and without narratives. We did not find any effects on attitude or intention to drink alcohol.

The effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents

Objective: This study tests the effectiveness of narrative versus informational smoking education on smoking beliefs, attitudes and intentions of low-educated adolescents. Design: A field experiment with three waves of data collection was conducted. Participants (N = 256) were students who attend lower secondary education. At the first and third waves, they completed a questionnaire. At the second wave, 50.8% of the participants read a smoking education booklet in narrative form and 49.2% read a booklet in informational form. After reading, all participants also completed a questionnaire at wave 2. Main outcome measures: Beliefs about negative consequences of smoking, attitudes towards smoking and intentions to smoke were measured. Results: Repeated measures analyses with time as a within-subjects factor and condition as a between-subjects factor showed that beliefs about smoking were more negative at Wave 2 compared to Wave 1, irrespective of condition. However, attitudes towards smoking were more positive at Wave 3 compared to Wave 1 when participants had read the narrative version. Conclusion: These results show that narrative smoking education is not more effective than informational smoking education for low-educated adolescents and can even have an unintended effect for this target group by making attitudes towards smoking more positive.