Stephen B. Hotz

Predicting exercise stage transitions over two consecutive 6-month periods : A test of the theory of planned behaviour in a population-based sample

OBJECTIVES To predict exercise stage transitions over two consecutive 6-month periods using the theory of planned behaviour (TPB). It was hypothesized that different social cognitive constructs would predict different stage transitions. DESIGN Prospective and longitudinal in order to predict multiple stage transitions over time. Assessments were made at baseline, 6 months and 1 year. METHOD Participants were a randomly selected population-based sample of 683 adults who completed two telephone interviews (baseline and 6 months) that assessed exercise stage, intention, perceived behavioural control, attitude, subjective norm, and social support, and a mailed survey (1 year) that assessed exercise stage. RESULTS Progression from pre-contemplation was predicted by intention, attitude and subjective norm; progression/regression from contemplation was predicted by intention, perceived behavioural control, attitude, and social support; progression/regression from preparation was predicted by intention and attitude; and regression from action/maintenance was predicted by intention, attitude and social support. CONCLUSIONS Different social cognitive constructs predicted different stage transitions, which indicates that exercise behaviour change may be represented by a series of stage transitions. Moreover, the TPB may be a useful model for highlighting the key social cognitive constructs that are important for exercise stage transitions.

Validation of the Decisional Balance Scales in the Exercise Domain From the Transtheoretical Model: A Longitudinal Test

This study examined the validity and reliability of decisional balance scales for exercise (i.e., pros and cons) in a large longitudinal population-based randomized sample of Canadian adults ages 18 to 65 years (N = 703). Assessments were taken over 3 time points with 6-month intervals between testing. Content, factorial, concurrent, and construct validity along with internal consistency and test-retest reliability were established for the decisional balance scales. The developed measures have utility for researchers and practitioners who test and apply the exercise decisional balance constructs of the Transtheoretical Model.

Exercise Behavior in a Community Sample With Diabetes: Understanding the Determinants of Exercise Behavioral Change

PURPOSE The purpose of this study was to investigate the factors associated with exercise behavior among adults with diabetes. METHODS Exercise behavior (stage of exercise readiness and energy expenditure) and potential determinants were measured on a subsample (n=46) of adults with type 1 or type 2 diabetes from a randomized population-based telephone survey. Participants were assessed at baseline and at a 6-month follow-up. RESULTS Sociodemographic and biomedical characteristics did not significantly differ between the stages of exercise behavior. Scores on the psychosocial constructs of self-efficacy, behavioral processes, self-concept, and social support were significantly higher for those in the action stage than those in the preaction stage of exercise readiness. Self-efficacy and behavioral process of change were significantly associated with energy expenditure; self-efficacy was the strongest predictor in the longitudinal analysis. CONCLUSIONS These findings may generate direction for theory development and guide health and medical practitioners when intervening on the specific constructs. Populationand community-based surveys have utility for assessing diabetes health-related behavior (eg, exercise behavior).

Readiness to Shop for Low-Fat Foods: A Population Study

BACKGROUND Stages of change are related to dietary fat consumption. Few studies have examined stage occupation within the context of purchasing low-fat foods. OBJECTIVE To determine the stage-prevalence of individuals for purchasing low-fat foods; identify the frequency of misclassification into action and maintenance (A/M) stages for purchasing for low-fat foods; and explain the demographic and cognitive-variable differences between pseudo (or false positive) A/M and true A/M individuals. DESIGN Data were collected using a self-administered questionnaire among English-speaking adults (n=1,001) who were randomly sampled by mail. STATISTICAL ANALYSES PERFORMED Descriptive statistics were used to compare the characteristics of the stage groups. Groups were compared using chi(2) tests and Student t test. RESULTS Of those who reported being in A/M stages, 32% were misclassified by the staging algorithm and were not true A/M low-fat food purchasers. CONCLUSIONS Individuals who are in A/M stages for buying low-fat foods still purchase high-fat foods. Stage misclassification may be a persistent problem in studies of dietary change using the Transtheoretical Model.

Applying the stages of change to multiple low-fat dietary behavioral contexts. An examination of stage occupation and discontinuity.

Consuming a diet lower in total fat is important for the prevention of many chronic diseases. Individual and population-based programs targeting this behavior must be theoretically grounded and consider the context within which dietary behavior change may be attempted. To identify the factors differentiating stage of readiness to follow a low-fat diet, a sample (N=1216) of adults was surveyed using 4 different staging algorithms to assess stages of change and associated social-cognitive variables (pros, cons, and temptation). Approximately 75% of the sample occupied the Action/Maintenance stages for all staging algorithms. In general, pros increased and cons decreased with higher stage occupation. Temptation decreased from the early pre-action to the action stages for the different staging algorithms. When developing programs to decrease dietary-fat intake, social-cognitive variables associated with stage transition for behaviors related to consuming a low-fat diet may have relevance to researchers and clinicians.

Is Stress Management Training a Useful Addition to Physician Advice and Nicotine Replacement Therapy during Smoking Cessation in Women? Results of a Randomized Trial:

Purpose. To determine whether a stress management (SM) program could improve cessation rates when added to usual care (UC) among women attempting to quit smoking. Design. Randomized controlled trial conducted during a 12-month period. Setting. Smoking cessation clinics located within two tertiary care centers in Ottawa, Ontario. Subjects. A total of 332 women smokers 19 years or older who smoked 10 or more cigarettes per day were recruited via advertisements. Intervention. Either UC (physician advice and nicotine replacement therapy) or UC plus an eight-session group SM training program (coping skills development relevant to smoking-specific and generic stressors). Measures. Point prevalence abstinence 2 and 12 months after study intake. A secondary outcome of interest was change in perceived stress during the intervention period. Results. On an intent-to-treat basis, the addition of SM to UC had no incremental effect on 2-or 12-month abstinence rates. Abstinence rates at 2 months were 26.2% vs. 31.7% in the UC and SM groups, respectively (p = .59). At 12 months, the rates were 18.5% vs. 20.7% (p = .86). When quit rates were compared including only participants who demonstrated adequate adherence to the intervention protocol, there was a significant difference between the UC and SM groups at 2 months (34.9% vs. 48.7%; adjusted odds ratio, 1.88; 95% confidence interval, 1.04–3.42; p = .04) but not at 12 months (23.0% vs. 28.2%; adjusted odds ratio, 1.24; 95% confidence interval, .64–2.41; p = .53). There was a significant reduction in perceived stress from preintervention to postintervention; however, this decrease was not moderated by group assignment. Conclusion. The addition of SM in our setting neither increased abstinence rates nor reduced perceived stress over and above UC in women motivated to quit smoking. Poor attendance at the SM intervention undermined its effectiveness.