Heather Patrick

Self-determination theory: its application to health behavior and complementarity with motivational interviewing

Mounting evidence implicates health behaviors (e.g., nutrition, physical activity, tobacco abstinence) in various health outcomes. As the science of behavior change has emerged, increasing emphasis has been placed on the use of theory in developing and testing interventions. Self-determination theory (SDT)-a theoretical perspective-and motivational interviewing (MI)-a set of clinical techniques-have both been used in health behavior intervention contexts. Although developed for somewhat different purposes and in relatively different domains, there is a good deal of conceptual overlap between SDT and MI. Accordingly, SDT may offer the theoretical backing that historically has been missing from MI, and MI may offer SDT some specific direction with respect to particular clinical techniques that have not been fully borne out within the confines of health related applications of SDT. Research is needed to empirically test the overlap and distinctions between SDT and MI and to determine the extent to which these two perspectives can be combined or co-exist as somewhat distinct approaches.

Parenting Styles and Practices in Children's Obesogenic Behaviors: Scientific Gaps and Future Research Directions

Given the emerging global childhood obesity epidemic and the specter of a generation of children who will have a shorter life expectancy than that of their parents, recent research has focused on factors that influence childrens weight status and obesogenic behaviors (i.e., eating, physical activity, and screen media use). Parents act as primary socializing agents for children, and thus growing evidence supports the role of parenting styles and practices in childrens obesity-related behaviors and weight. Studying these processes in children and adolescents is important for several reasons. First, diet and physical activity behaviors and weight status track from childhood and adolescence into adulthood. Furthermore, diet and physical activity behaviors and weight status confer significant risk for cancer, diabetes, cardiovascular disease, and other chronic diseases. The purpose of this article is to describe the scientific gaps that need to be addressed to develop a more informed literature on parenting styles and practices in the domains of weight status and obesogenic behaviors, as identified by an expert panel assembled by the National Cancer Institute.

The energization of health-behavior change: Examining the associations among autonomous self-regulation, subjective vitality, depressive symptoms, and tobacco abstinence

Most research on the psychological correlates of smoking behavior has focused on negative indices of wellness, but findings are mixed, contradictory, controversial, and, thus, inconclusive. This study, guided by self-determination theory, examined both positive (viz., vitality) and negative (viz., depressive symptoms) indices of psychological health as predictors of long-term tobacco abstinence in the context of a randomized clinical trial. It also examined autonomous self-regulation and cigarette use as predictors of psychological health. Results supported the proposed conditional indirect effect model in which change in cigarette use mediated the relation of change in autonomous self-regulation for smoking cessation to change in vitality, and this indirect effect was moderated by treatment condition. Further, change in vitality predicted long-term tobacco abstinence. Results for depressive symptoms were largely null. Discussion focuses on the importance of considering positive indices of psychological health for understanding the psychological correlates of smoking behavior.

Promoting family meals: a review of existing interventions and opportunities for future research

Evidence suggests that regular family meals protect against unhealthy eating and obesity during childhood and adolescence. However, there is limited information on ways to promote family meals as part of health promotion and obesity prevention efforts. The primary aim of this review was to synthesize the literature on strategies to promote family meals among families with school-aged children and adolescents. First, we reviewed interventions that assess family meals as an outcome and summarized strategies that have been used in these interventions. Second, we reviewed correlates and barriers to family meals to identify focal populations and target constructs for consideration in new interventions. During May 26–27, 2014, PubMed and PsycInfo databases were searched to identify literature on family meals published between January 1, 2000 and May 27, 2014. Two reviewers coded 2,115 titles/abstracts, yielding a sample of 139 articles for full-text review. Six interventions and 43 other studies presenting data on correlates of or barriers to family meals were included in the review. Four interventions resulted in greater family meal frequency. Although there were a small number of interventions, intervention settings were diverse and included the home, community, medical settings, the workplace, and the Internet. Common strategies were goal setting and interactive group activities, and intervention targets included cooking and food preparation, cost, shopping, and adolescent influence. Although methodological nuances may contribute to mixed findings, key correlates of family meals were employment, socioeconomic and demographic factors, family structure, and psychosocial constructs. Barriers to consider in future interventions include time and scheduling challenges, cost, and food preferences. Increasing youth involvement in mealtime, tailoring interventions to family characteristics, and providing support for families experiencing time-related barriers are suggested strategies for future research.

Obesity Prevention and National Food Security: A Food Systems Approach

Interventions that cultivate sustainable food systems to promote health, prevent obesity, and improve food security have the potential for many large-scale and long-lasting benefits including improvements in social, environmental, health, and economic outcomes. We briefly summarize findings from previous research examining associations between obesity and food insecurity and discuss the need for greater synergy between food insecurity initiatives and national obesity prevention public health goals in the United States. The common ground between these two nutrition-related public health issues is explored, and the transformation needed in research and advocacy communities around the shared goal of improving population health through individual, environmental, and policy level changes to promote healthy sustainable food systems is discussed. We propose an ecological framework to simultaneously consider food insecurity and obesity that identifies levers for change to promote sustainable food systems to improve food security and prevent obesity.

Lifestyle Change and Maintenance in Obesity Treatment and Prevention: A Self-determination Theory Perspective

Publisher Summary The key to obesity prevention is lifestyle change: improving dietary intake and increasing physical activity. To date, several interventions have been developed to target these behaviors and increase weight-loss success. Behavioral weight control, consisting of education about nutrition and physical activity and instruction in key behavioral techniques (e.g., self-monitoring and problem-solving), is the treatment of choice for overweight to moderately obese individuals (BMI 25–40 kg/m2). Self-determination theory (SDT) is a general theory of human motivation that addresses the importance of motivation in behavior change and its maintenance. This chapter aims to describe the general tenets of SDT, to discuss applications of SDT to the lifestyle changes relevant to weight loss, and to provide suggestions for future research and interventions to prevent obesity. One of the key assumptions of self-determination theory is that human beings are naturally oriented toward growth, health, and development. However, social-contextual circumstances may facilitate or impede this natural process of motivation and self-governance. Thus, self-determination theory offers an organismic dialectic perspective on human motivation, which acknowledges the interplay between the person and the situation in various behavioral contexts. SDT posits that all humans possess three basic psychological needs: competence, relatedness, and autonomy. The need for competence involves the need to feel optimally challenged in ones endeavors and to feel capable of achieving desired outcomes.

Brief report of virtual clinician research tools for tobacco dependence or dyslipidemia.

Health avatars were created to deliver previously tested live interventions for tobacco dependence and cholesterol management. The exploratory aims were to develop and test whether the avatar can be reliably assessed for autonomy supportiveness using the Health Care Climate Questionnaire and estimate the mean changes in motivation variables and correlate the avatars’ autonomy supportiveness with the motivation variables and health outcomes. The avatars were found to be reliably assessed for autonomy supportiveness on the Health Care Climate Questionnaire. Autonomy support was positively correlated with the change in motivations and reduction in low-density lipoprotein. These findings suggest that health avatars may be tested in clinical trials.

A Pilot Test of Self-Affirmations to Promote Smoking Cessation in a National Smoking Cessation Text Messaging Program

Background Although effective smoking cessation treatments, including mHealth interventions, have been empirically validated and are widely available, smoking relapse is likely. Self-affirmation, a process through which individuals focus on their strengths and behaviors, has been shown to reduce negative effects of self-threats and to promote engagement in healthier behavior. Objective To assess the feasibility of incorporating self-affirmations into an existing text messaging-based smoking cessation program (Smokefree TXT) and to determine whether self-affirmation led to greater engagement and higher cessation rates than the standard intervention. Methods Data were collected from smokers (n=1261) who subscribed to a free smoking cessation program and met eligibility criteria. The intervention lasted 42 days. The original design was a 2 (Baseline affirmation: 5-item questionnaire present vs absent) × 2 (Integrated affirmation: texts present vs absent) factorial design. Only 17 eligible users completed all baseline affirmation questions and these conditions did not influence any outcomes, so we collapsed across baseline affirmation conditions in analysis. In the integrated affirmation conditions, affirmations replaced approximately 20% of texts delivering motivational content. Results In all, 687 users remained enrolled throughout the 42-day intervention and 81 reported smoking status at day 42. Among initiators (n=1261), self-affirmation did not significantly improve (1) intervention completion, (2) days enrolled, (3) 1-week smoking status, or (4) 6-week smoking status (all Ps>.10); and among the 687 completers, there were no significant effects of affirmation on cessation (Ps>.25). However, among the 81 responders, those who received affirmations were more likely to report cessation at 6 weeks (97.5%; 39 of 40) than those not given affirmations (78.1%; 32 of 41; χ2(1)=7.08, P=.008). Conclusion This proof-of-concept study provides preliminary evidence that self-affirmation can be integrated into existing text-based cessation programs, as the affirmations did not lead to any adverse effects (ie, less engagement or lower rates of cessation). Among those who reported smoking status at the end of the intervention period (6.4% of eligible respondents), affirmations facilitated cessation. This study provides a “proof-of-concept” that brief, low-touch interventions may be integrated into a text messaging program with potential benefits, minimal disruption to the program or users, and little cost. Many questions remain regarding how self-affirmation and similar approaches can promote engagement in population interventions.

BMI and smoking: interrelated factors among cessation website users.

OBJECTIVE To investigate the relationship between body mass index (BMI) and smoking. METHODS Participants (N = 2243) provided demographic, height, weight, smoking information through a survey conducted on smokefree.gov and women.smokefree.gov websites. Analysis assessed associations among BMI, smoking status, and cigarettes smoked per day (CPD). RESULTS The average (SD) BMI of never, former, intermittent, and daily smokers was 26.3 (6.2), 27.9 (6.5), 27.4 (6.7) and 28.1 (6.8) respectively. Daily (31.2%) and former (32.3%) were more likely to be to be obese compared to never (22.0%) and intermittent (26.1%) smokers. Odds of being obese increased with number of CPD adjusting for potential confounders. CONCLUSIONS Smokers may currently have BMIs similar to the general population. BMI and CPD were positively correlated.