Steven P. Singleton

The Use of Behavioral Contracting to Increase Exercise Activity

A cardiovascular risk reduction program used a submaximal treadmill stress test to evaluate physical fitness. Of the 179 individuals who participated in the health education counseling activities which followed testing, 96 signed a behavioral contract to engage in a 12-week aerobic exercise program. Forty-one contractors fully met contract goals, and 21 reported increased activity levels. Analyses examined demographic, risk factor, and attitudinal predictors of contract signing and contract adherence. Contract signing was related to education, smoking, and womens mean body weight. Only womens body weight was related to contract adherence. Attitudes toward exercise were related to neither. Level of contract adherence was significantly related to a decrease in exercising heart rate at the six-month follow-up assessment. These data suggest that contract signing may be a useful device for assessing client motivation and predicting program participation and behavioral change outcomes.

Cholesterol Reduction among Volunteers in a Health Promotion Project

Behavioral contracting was used with moderate success as a primary intervention strategy in an urban clinic-based health promotion program designed to reduce serum cholesterol. Of the 223 adults screened, 144 had high serum cholesterol. One hundred and eighteen attended an interpretation/education session, and 51 participants agreed to sign a behavioral contract. Among those who signed contracts, adherence to American Heart Association dietary guidelines was significantly related to serum cholesterol changes. Eleven of the 46 adults who returned for the six-month clinical assessment reduced their cholesterol levels to recommended levels.

Attitudes of Employees for an On-Campus Health Promotion Program at a Large Urban University

This article describes the results of a survey among employees at Wayne State University that were designed to determine the desire for and willingness to participate in a campus wellness program. All 4,300 employees were mailed a questionnaire during the period March-June 1989. Among the 2,401 respondents (56% response rate), 81% felt a wellness program should be offered and 57% indicated an intention to participate. A significantly higherpercentage ofBlacks (77%) and women (62%) stated they would participate as compared to Whites (51%) and men (51%). There was an inverse relationship between desire for the program and income level; those who held commercial health club memberships and resided closerto campus showed higher interest. In the overall sample, lunchtime activities were the most requested. Types of services most requested included health screening (e.g., cholesterol testing and fitness assessment) and exercise classes.

Correlates of adherence to behavioral contracts for cholesterol reduction

There is considerable evidence that total serum cholesterol is related to coronary heart disease (CHD) (1-3). The Lipid Research Clinics Coronary Prevention Trial and the Multiple Risk Factor Intervention Trial (MRFIT) have both reported substantial reductions in CHD risk from lowering serum cholesterol (4-5). The American Heart Association (AHA) advocates reducing elevated serum cholesterol by follOWing a diet low in total fat, saturated fat and dietary cholesterol (6-8). However, dietary interventions for cholesterol reduction have had varying degrees of success (9-14), and the majority of studies which have employed long term follow-up measures of dietary change and serum cholesterol have not been encouraging (12, 15). Behavioral contracting is an intervention technique in which a client signs an agreement to make certain behavior changes within a specified time frame, in return for a desired reinforcement or reward. Contracting has been successfully employed to increase programmatic adherence in a variety of health behavior change programs (16, 17), but has not been widely used in cholesterol reduction interventions (18). This paper presents follow-up results from 52 individuals who signed behavioral contracts to adhere to the AHA dietary guidelines for cholesterol reduction. Data are presented to address the following questions: a) How do demographic variables and baseline body weight and serum cholesterol relate to initial contract signing and level of contract adherence? b) Do those individuals who successfully achieve their contract goals to adopt the AHA diet also experience a reduction in serum cholesterol? c) How well