C. Richard Hofstetter

Predictors of adoption and maintenance of vigorous physical activity in men and women.

BACKGROUND This study examined predictors of adoption and maintenance of vigorous physical activity over time in a sample of 1,719 randomly selected women and men. METHODS Based on reported frequency of vigorous exercise in a mail survey at baseline, subjects were classified as sedentary (zero sessions per week), intermediate (one to two sessions per week), or active (three or more sessions per week). RESULTS On the same survey subjects reported on 25 potential determinants of physical activity based on a comprehensive learning model. Twenty-four months later, 85% of subjects were resurveyed, and their physical activity levels were classified. Within each baseline category and gender subgroup, predictors of follow-up physical activity were identified. In multivariate analyses, adoption of vigorous exercise by sedentary men was predicted by self-efficacy, age (inverse), and neighborhood environment (inverse). Adoption by sedentary women was predicted by education, self-efficacy, and friend and family support for exercise. Maintenance of vigorous physical activity was predicted by self-efficacy and age (inverse) for initially active men and by education for initially active women. CONCLUSION These results suggest that factors influencing adoption are different for men and women, and there may be different factors influencing adoption versus maintenance of vigorous physical activity.

A multivariate study of determinants of vigorous exercise in a community sample

The purpose of this study was to explore the associations between several social learning theory variables and self-reported vigorous exercise and to consider the implications for exercise promotion. A random sample of adults in San Diego, California, was surveyed by mail. The 2,053 respondents (response rate, 43.4%) overrepresented Caucasian, affluent, and well-educated groups. A model of 24 variables accounted for 0.27 of the variance in exercise, and results strongly supported social learning theory. The strongest correlates were self-efficacy (i.e., confidence in the ability to exercise in specific situations), perceived barriers to exercise, modeling, dietary habits, support from friends, and age. Smoking was inversely associated with exercise in men only. We encourage researchers to conduct intervention trials to test the hypotheses generated in this study.

Explanation of vigorous physical activity during two years using social learning variables.

This study examined determinants of vigorous physical activity in a community sample of adults over a 24-month period. Social learning theory predicts that causal relationships between determinants and behavior are bidirectional, and both the behavior and its influences are subject to change over time. Thus, dynamic variables were expected to account for more variance in exercise change than static baseline variables. Over 86% of respondents to the baseline mail survey completed follow-up surveys 24 months later, yielding a final sample of 1739. Two physical activity change indices were constructed that were adjusted for baseline exercise and demographic variables, so that the effects of social learning variables could be isolated. In a two-step hierarchical regression analysis, physical activity measures were regressed onto 21 static and six dynamic independent variables. Baseline self-efficacy was a significant predictor of exercise change for both dependent variables. Four dynamic social learning variables were significantly associated with both exercise change measures: self-efficacy, perceived barriers, family support, and friend support. Social learning variables accounted for 12.3-15.5% of the variance in exercise change over 24 months. The results provide strong support for bidirectional causation between behavior and determinants and suggest hypotheses to be tested in experimental studies.

Reduction of environmental tobacco smoke exposure in asthmatic children. A 2-year follow-up.

STUDY OBJECTIVE To examine the long-term maintenance of a previously reported behavioral counseling intervention to reduce asthmatic childrens exposure to environmental tobacco smoke (ETS). PARTICIPANTS Families of asthmatic children (6 to 17 years), including at least one parent who smoked in the home, recruited from four pediatric allergy clinics. DESIGN Participants were randomized to one of three groups: behavioral counseling to reduce ETS exposure, self-monitoring control, and usual medical care control. Counseling concluded at month 6, and the original trial ended at month 12. Two follow-up interviews occurred at months 20 and 30. MEASUREMENTS AND RESULTS The originally reported analysis of baseline to 12 months was reanalyzed with a more robust restricted maximum likelihood procedure. The 2-year follow-up period was analyzed similarly. Significantly greater change occurred in the counseling group than the control groups and was sustained throughout the 2 years of follow-up. Further exploratory analyses suggested that printed counseling materials given to all participants at month 12 (conclusion of the original study) were associated with decreased exposure in the control groups. CONCLUSION Such long-term maintenance of behavior change is highly unusual in the general behavioral science literature, let alone for addictive behaviors. We conclude that ETS exposure can be reduced and that a clinician-delivered treatment may provide substantial benefit.

Clinical Features Distinguishing Large Cohorts with Possible AD, Probable AD, and Mixed Dementia

Objective: To determine whether clinical features and rate of cognitive and functional decline differed in cohorts of possible AD (poAD), probable AD (prAD), and mixed dementia (MIX) patients.

Tobacco use and acculturation among Californians of Korean descent: A behavioral epidemiological analysis

This study presents population estimates of cigarette use among adults of Korean descent residing in California. Data were drawn from telephone interviews with adults (N=2,830) developed from a random sampling of listed persons in California with Korean surnames. A total of 86% of attempted interviews were completed, and 85% of the interviews were conducted in Korean. Less acculturated men and more acculturated women reported higher present and predicted future rates of smoking after multivariate statistical controls were applied. Sharply divergent rates of cigarette use were found between the genders. Although men did not smoke their first cigarette or smoke cigarettes regularly earlier than women, both groups began smoking later than adults born in the United States. To be effective, tobacco intervention efforts must be tailored specifically to cultures of each minority. Results suggest that acculturation processes influence tobacco use differentially by gender, and future research is needed to identify the implications of processes in tobacco initiation and cessation.

Determinants of Hookah Use among High School Students

INTRODUCTION Hookah use is increasing among young people, but there are limited data on its use among high school-age populations. We examined hookah use initiation, prevalence, cessation, and psychosocial risk factors of hookah use among high school students. METHODS A cross-sectional survey of 689 students from three high schools in San Diego County was used to compare characteristics of hookah ever-users to nonusers and factors associated with current and former hookah use. RESULTS Hookah ever-use in the study population was 26.1%, previous month hookah use was 10.9%, and current hookah use was 10.3%. Most students first learned about hookah from friends (50.3%) or saw a hookah lounge (20.9%). Students believed hookah to be more socially acceptable than cigarettes and less harmful than cigarettes, cigars, and smokeless tobacco. Hookah ever-users were significantly more likely than nonusers to have smoked cigarettes, to know of a hookah lounge in their community, and to believe hookah is safer and more socially acceptable than cigarettes. In comparison to former users, current users were more likely to have recently smoked a cigarette, to know of a hookah lounge in their community, and to believe hookah is more socially acceptable than cigarettes. CONCLUSIONS Hookah use is becoming a commonly acceptable behavior among adolescents, and risk perception is a significant factor. Presence of hookah lounges are associated with increased hookah use among high school students and should be a target of further regulation.

Increasing Hookah Use in California

Hookah use is gaining popularity nationwide. We determined the correlates and trends for hookah use from the California Tobacco Survey. Between 2005 and 2008 hookah use increased more than 40%, and in 2008, 24.5% of young men reported ever using a hookah. Hookah use was more common among the young (18-24 years), the educated, the non-Hispanic Whites, and the cigarette smokers. Hookah use is increasing in California, especially among young adults, and in 2008 reached the highest prevalence ever reported for both genders.

Clinical Investigations: AsthmaReduction of Environmental Tobacco Smoke Exposure in Asthmatic Children: A 2-Year Follow-up

STUDY OBJECTIVE To examine the long-term maintenance of a previously reported behavioral counseling intervention to reduce asthmatic childrens exposure to environmental tobacco smoke (ETS). PARTICIPANTS Families of asthmatic children (6 to 17 years), including at least one parent who smoked in the home, recruited from four pediatric allergy clinics. DESIGN Participants were randomized to one of three groups: behavioral counseling to reduce ETS exposure, self-monitoring control, and usual medical care control. Counseling concluded at month 6, and the original trial ended at month 12. Two follow-up interviews occurred at months 20 and 30. MEASUREMENTS AND RESULTS The originally reported analysis of baseline to 12 months was reanalyzed with a more robust restricted maximum likelihood procedure. The 2-year follow-up period was analyzed similarly. Significantly greater change occurred in the counseling group than the control groups and was sustained throughout the 2 years of follow-up. Further exploratory analyses suggested that printed counseling materials given to all participants at month 12 (conclusion of the original study) were associated with decreased exposure in the control groups. CONCLUSION Such long-term maintenance of behavior change is highly unusual in the general behavioral science literature, let alone for addictive behaviors. We conclude that ETS exposure can be reduced and that a clinician-delivered treatment may provide substantial benefit.

E-Cigarette Use in the Past and Quitting Behavior in the Future: A Population-Based Study

OBJECTIVES We examined whether smokers who used e-cigarettes are more likely to quit after 1 year than smokers who had never used e-cigarettes. METHODS We surveyed California smokers (n = 1000) at 2 time points 1 year apart. We conducted logistic regression analyses to determine whether history of e-cigarette use at baseline predicted quitting behavior at follow-up, adjusting for demographics and smoking behavior at baseline. We limited analyses to smokers who reported consistent e-cigarette behavior at baseline and follow-up. RESULTS Compared with smokers who never used e-cigarettes, smokers who ever used e-cigarettes were significantly less likely to decrease cigarette consumption (odds ratio [OR] = 0.51; 95% confidence interval [CI] = 0.30, 0.87), and significantly less likely to quit for 30 days or more at follow-up (OR = 0.41; 95% CI = 0.18, 0.93). Ever-users of e-cigarettes were more likely to report a quit attempt, although this was not statistically significant (OR = 1.15; 95% CI = 0.67, 1.97). CONCLUSIONS Smokers who have used e-cigarettes may be at increased risk for not being able to quit smoking. These findings, which need to be confirmed by longer-term cohort studies, have important policy and regulation implications regarding the use of e-cigarettes among smokers.