Showing papers in "Health Education & Behavior in 2010"

Photovoice: A Review of the Literature in Health and Public Health:

Abstract: Although a growing number of projects have been implemented using the community-based participatory research method known as photovoice, no known systematic review of the literature on this approach has been conducted to date. This review draws on the peer-reviewed literature on photovoice in public health and related disciplines conducted before January 2008 to determine (a) what defines the photovoice process, (b) the outcomes associated with photovoice, and (c) how the level of community participation is related to photovoice processes and outcomes. In all, 37 unduplicated articles were identified and reviewed using a descriptive coding scheme and Viswanathan et al.’s quality of participation tool. Findings reveal no relationship between group size and quality of participation but a direct relationship between the latter and project duration as well as with getting to action. More participatory projects also were associated with long-standing relationships between the community and outside researcher partners and an intensive training component. Although vague descriptions of project evaluation practices and a lack of consistent reporting precluded hard conclusions, 60% of projects reported an action component. Particularly among highly participatory projects, photovoice appears to contribute to an enhanced understanding of community assets and needs and to empowerment.

Parental Social Support and the Physical Activity-Related Behaviors of Youth: A Review

Abstract: Social support from parents serves as one of the primary influences of youth physical activity-related behaviors. A systematic review was conducted on the relationship of parental social support to the physical activity-related behaviors of youth. Four categories of social support were identified, falling under two distinct mechanisms-tangible and intangible. Tangible social support is divided into two categories: instrumental-purchasing equipment/payment of fees and transportation-and conditional-doing activity with and watching/supervision. Intangible social support is divided into the two categories of motivational- encouragement and praise-and informational-discussing benefits of. The majority of studies demonstrated positive associations among selected measures of parental tangible and intangible social support and youth activity. Overall, parental social support demonstrated positive effects. Many studies, however, combine social support categories and/or respondents into composite measures, making it difficult to disentangle the specific effects of parents and the type of support provided.

Health Behavior and Academic Achievement Among Adolescents: The Relative Contribution of Dietary Habits, Physical Activity, Body Mass Index, and Self-Esteem

Abstract: This study tested a structural equation model to estimate the relationship between health behaviors, body mass index (BMI), and self-esteem and the academic achievement of adolescents. The authors analyzed survey data from the 2000 study of Youth in Iceland , a population-based, cross-sectional sample of 6,346 adolescents in Iceland. The model demonstrated good fit with chi-square of 2685 (n = 5,810, df = 180), p < .001, Comparative Fit Index value of .94, and a root mean square error of approximation of .049. Lower BMI, physical activity, and good dietary habits were all associated with higher academic achievement; however, health behavior was positively and robustly associated with greater self-esteem. Self-esteem was positively influenced both through physical activity (beta = .16) and the consumption of fruits and vegetables (beta = .14). In contrast, poor dietary habits negatively influenced self-esteem and academic achievement, and self-esteem was negatively influenced by increasing levels of BMI (beta = -.05).

In the Dark: Young Men’s Stories of Sexual Initiation in the Absence of Relevant Sexual Health Information

Abstract: A growing body of research has investigated the effectiveness of abstinence-only sexual education. There remains a dearth of research on the relevant sexual health information available to young men who have sex with men (YMSM). Drawing on a mixed-methods study with 526 YMSM, this study explores how and where YMSM receive relevant information on sexual health/behavior. Findings indicate that information related to gay men's sexuality is not readily available from family, friends, or schools. At initiation of anal intercourse, respondents generally had limited information about HIV and sexually transmitted infections (STIs). In some cases, this resulted in the perception that activities such as unprotected sex were "low risk." Many mentioned they first learned about anal sex during their sexual debut, describing painful and/or unpleasant experiences. Some relied on older/more experienced partners, the Internet, and pornography for information. Findings are discussed in relation to how providers can help YMSM build solid foundations of sexual education to protect them from STI and HIV infection.

Exploring the Influence of a Social Ecological Model on School-Based Physical Activity:

Abstract: Among rising rates of overweight and obesity, schools have become essential settings to promote health behaviors, such as physical activity (PA). As schools exist within a broader environment, the social ecological model (SEM) provided a framework to consider how different levels interact and influence PA. The purpose of this study was to provide insight on school-based PA promotion by investigating the integration between different levels of Emmons’s SEM within one public school board in a large Canadian city. Interviews were conducted with participants from the government (n = 4), the public school board (n = 3), principals (n = 3), and teachers (n = 4) and analyzed to explore perspectives on the various levels of the model. The results suggested that higher level policies “trickled down” into the organizational level of the SEM but there was pivotal responsibility for schools to determine how to implement PA strategies. Furthermore, schools have difficulty implementing PA because of the continued prior...

An Urban Food Store Intervention Positively Affects Food-Related Psychosocial Variables and Food Behaviors:

Abstract: Obesity and other diet-related chronic diseases are more prevalent in low-income urban areas, which commonly have limited access to healthy foods. The authors implemented an intervention trial in nine food stores, including two supermarkets and seven corner stores, in a low-income, predominantly African American area of Baltimore City, with a comparison group of eight stores in another low-income area of the city. The intervention (Baltimore Healthy Stores; BHS) included an environmental component to increase stocks of more nutritious foods and provided point-of-purchase promotions including signage for healthy choices and interactive nutrition education sessions. Using pre- and postassessments, the authors evaluated the impact of the program on 84 respondents sampled from the intervention and comparison areas. Exposure to intervention materials was modest in the intervention area, and overall healthy food purchasing scores, food knowledge, and self-efficacy did not show significant improvements associated with intervention status. However, based on adjusted multivariate regression results, the BHS program had a positive impact on healthfulness of food preparation methods and showed a trend toward improved intentions to make healthy food choices. Respondents in the intervention areas were significantly more likely to report purchasing promoted foods because of the presence of a BHS shelf label. This is the first food store intervention trial in low-income urban communities to show positive impacts at the consumer level.

Testing Stage-Specific Effects of a Stage-Matched Intervention: A Randomized Controlled Trial Targeting Physical Exercise and Its Predictors

Abstract: Health education interventions can be tailored toward stages of change. This strategy is based on theories that predict at which stage which variables are indicative of subsequent behavior change processes. For example, planning is regarded as being effective in intenders. However, rather few studies have tested whether matched interventions are more successful for stage transitions than mismatched ones. Also very few previous studies have identified specific variables as targets of stage-matched interventions. A 2 (condition) x 2 (stages) experimental study tested the effects of stage-matched interventions for 226 participants. The stage-matched intervention moved significantly more individuals forward to action than did the control condition. Stage-specific effects were found to corroborate 78% of the assumptions. Multiple mediator analyses revealed stage-specific mechanisms, indicating that intention and planning facilitated behavior change in intenders. Thus, health behavior interventions should take stages of change into account.

Understanding Adolescent Caffeine Use: Connecting Use Patterns With Expectancies, Reasons, and Sleep

Abstract: Little is known about adolescents' caffeine use, yet caffeinated soda, and more recently coffee and energy drinks, are part of youth culture. This study examines adolescents' caffeine use and, using cluster analysis, identifies three groups of caffeine users who differed in their reasons for use, expectancies, and sleep behaviors. In this high school student sample (N = 197), 95% of participants reported recent caffeine use-most often soda-where typical first use of the day was in the evening. Results reveal that adolescents in the mixed use and high soda use groups consumed similar amounts of soda, reporting significantly more use than the low caffeine use group. In contrast with high soda users, mixed users drank more coffee, expected more dependence symptoms and energy enhancement from caffeine, and were more likely to report getting up early, daytime sleepiness, and using caffeine to get through the day.

A Meta-Analytic Review of School-Based Prevention for Cannabis Use

Abstract: This investigation used meta-analytic techniques to evaluate the effectiveness of school-based prevention programming in reducing cannabis use among youth aged 12 to 19. It summarized the results from 15 studies published in peer-reviewed journals since 1999 and identified features that influenced program effectiveness. The results from the set of 15 studies indicated that these school-based programs had a positive impact on reducing students' cannabis use (d = 0.58, CI: 0.55, 0.62) compared to control conditions. Findings revealed that programs incorporating elements of several prevention models were significantly more effective than were those based on only a social influence model. Programs that were longer in duration (≥15 sessions) and facilitated by individuals other than teachers in an interactive manner also yielded stronger effects. The results also suggested that programs targeting high school students were more effective than were those aimed at middle-school students. Implications for school-based prevention programming are discussed.

A Brief Culturally Tailored Intervention for Puerto Ricans With Type 2 Diabetes

Abstract: The information—motivation—behavioral skills (IMB) model of health behavior change informed the design of a brief, culturally tailored diabetes self-care intervention for Puerto Ricans with type 2 diabetes. Participants (n = 118) were recruited from an outpatient, primary care clinic at an urban hospital in the northeast United States. ANCOVA models evaluated intervention effects on food label reading, diet adherence, physical activity, and glycemic control (HbA1c). At follow-up, the intervention group was reading food labels and adhering to diet recommendations significantly more than the control group. Although the mean HbA1c values decreased in both groups (Intervention: 0.48% vs. Control: 0.27% absolute decrease), only the intervention group showed a significant improvement from baseline to follow-up (p < .008), corroborating improvements in diabetes self-care behaviors. Findings support the use of the IMB model to culturally tailor diabetes interventions and to enhance patients’ knowledge, motivation...

An Empirical Test of Ecodevelopmental Theory in Predicting HIV Risk Behaviors Among Hispanic Youth

Abstract: Ecodevelopmental theory is a theoretical framework used to explain the interplay among risk and protective processes associated with HIV risk behaviors among adolescents. Although ecodevelopmentally based interventions have been found to be efficacious in preventing HIV risk behaviors among Hispanic youth, this theory has not yet been directly empirically tested through a basic research study in this population. The purpose of this cross-sectional study was to empirically evaluate an ecodevelopmentally based model using structural equation modeling, with substance use and early sex initiation as the two outcomes of the ecodevelopmental chain of relationships. The sample consisted of 586 Hispanic youth (M age = 13.6; SD = 0.75) and their primary caregivers living in Miami, Florida. Adolescent, parent, and teacher reports were used. The results provided strong support for the theoretical model. More specifically, the parent–adolescent acculturation gap is indirectly related both to early sex initiation and to adolescent substance use through family functioning, academic functioning, perceived peer sexual behavior, and perceived peer substance use. Additionally, parent’s U.S. orientation is associated with adolescent substance use and adolescent sex initiation through social support for parents, parental stressors, family functioning, academic functioning, and perceived peer sexual behavior and substance use. These findings suggest that HIV risk behaviors may best be understood as associated with multiple and interrelated ecological determinants.

What Does the Public Know About Preventing Cancer? Results From the Health Information National Trends Survey (HINTS)

Abstract: This study provides information about the public's familiarity with cancer prevention strategies and examines the association between this familiarity and actual prevention behavior. Data from interviews with 5,589 adults included in the 2003 Health Information National Trends Survey (HINTS) were analyzed. Most respondents were able to cite one or two strategies for reducing the chances of cancer. On average, the fewest number of strategies were cited by Hispanics, respondents aged 65 years or older, and those with the lowest levels of education and income. Avoiding tobacco and eating a healthy diet were most commonly cited. People who cited the following strategies for preventing cancer were more likely to practice them: eating plenty of fruits and vegetables, exercising regularly, not smoking, and participating in cancer screening. Results indicate that efforts are needed to increase public familiarity with recommended strategies, especially among groups that are least familiar with recommendations for cancer prevention.

The Effectiveness of a School-Based Adolescent Depression Education Program

Abstract: In an effort to decrease the suicide rate in adolescents, many interventions have focused on school-based suicide prevention programs. Alternatively, depression education in schools might be effective in decreasing the morbidity, mortality, and stigma associated with adolescent depression. The Adolescent Depression Awareness Program (ADAP) developed a 3-hour curriculum to teach high school students about the illness of depression. The purpose of this study was to assess the effectiveness of the ADAP curriculum in improving high school students' knowledge about depression. From 2001 to 2005, 3,538 students were surveyed on their knowledge about depression before and after exposure to the ADAP curriculum. The number of students scoring 80% or higher on the assessment tool more than tripled from pretest to posttest (701 to 2,180), suggesting the effectiveness of the ADAP curriculum. Further study and replication are required to determine if improved knowledge translates into increased treatment-seeking behavior.

The Domestic Foodscapes of Young Low-Income Women in Montreal: Cooking Practices in the Context of an Increasingly Processed Food Supply

Abstract: Over the course of the past century, the quantity of prepackaged, pre-prepared foods available in the North American context has increased dramatically. This study examines the shifts in food practices that are taking place through an exploration of the day-to-day cooking practices of a group of young, low-income women in Montreal and considers how these contribute to health problems such as obesity and nutritional deficiencies in addition to health inequalities within populations. The participatory study uses data from five focus groups with a total of 22 participants to contribute to our understanding of how social and physical food environments (the "foodscape") shape daily food and cooking practices. Aspects of these environments that were discussed include household roles and responsibilities that require complex management, personal food choice and skill, as well as health, learning, and access to food.

Use (and Misuse) of the Responsible Drinking Message in Public Health and Alcohol Advertising: A Review:

Abstract: The objective is to present a comparative analysis examining the alcohol industry’s and scholarly researchers’ use of the concept “responsible drinking.” Electronic databases associated with health, education, sociology, psychology, and medicine were the date sources. Results were limited to English, peer-reviewed articles and commentaries specifically addressing “responsible drinking.” Search descriptors included responsible, responsibility, drinking, alcohol, brewer, and campaign. Eighteen articles constituted the final sample. The matrix method was utilized to organize and abstract pertinent information. Misunderstanding stemming from the inconsistency and counterintuitive nature of brewer-sponsored “responsible drinking” campaigns is further compounded by researchers’ use of the term and concept of “responsible drinking” in their scholarly reports. In articulating the definition of “responsible drinking,” researchers employ subjective notions and personal ideas, thus not differentiating the construct’...

Project ACTS: An Intervention to Increase Organ and Tissue Donation Intentions Among African Americans

Abstract: This study sought to evaluate the effectiveness of Project ACTS: About Choices in Transplantation and Sharing, which was developed to increase readiness for organ and tissue donation among African American adults. Nine churches (N = 425 participants) were randomly assigned to receive donation education materials currently available to consumers (control group) or Project ACTS educational materials (intervention group). The primary outcomes assessed at 1-year follow-up were readiness to express donation intentions via one's driver's license, donor card, and discussion with family. Results indicate a significant interaction between condition and time on readiness to talk to family such that participants in the intervention group were 1.64 times more likely to be in action or maintenance at follow-up than were participants in the control group (p = .04). There were no significant effects of condition or condition by time on readiness to be identified as a donor on one's driver's license and by carrying a donor card. Project ACTS may be an effective tool for stimulating family discussion of donation intentions among African Americans although additional research is needed to explore how to more effectively affect written intentions.

Promoting Elementary Physical Education: Results of a School-Based Evaluation Study

Abstract: Using a quasiexperimental design, the authors examine whether fourth- and fifth-grade students exposed to a developmental physical education (PE) curriculum, Michigan's Exemplary Physical Education Curriculum (EPEC), demonstrated stronger motor skill-specific self-efficacy and perceptions of physical activity competence, physical activity levels, motor skills, and physical fitness than did students exposed to existing PE curricula. The authors conducted a multilevel regression analysis with data from 1,464 students in the fourth and fifth grades. Data were collected using a student survey, an activity checklist, and motor and fitness assessments. Compared to students receiving standard PE, students exposed to EPEC showed significantly stronger results in motor skills but not fitness outcomes. The authors found significant positive intervention effects on indicators of motor skill self-efficacy and physical activity levels among the fourth-grade cohort. EPEC was more effective than standard PE curricula at improving motor skill performance (fourth- and fifth-grade cohorts) and at increasing self-reported motor skill-specific self-efficacy and physical activity (fourth-grade cohort).

Mediating Variables in a Transtheoretical Model Dietary Intervention Program

Abstract: This study identified mediators of a Transtheoretical Model (TTM) intervention to increase fruit and vegetable consumption among economically disadvantaged African American adolescents (N = 549). Single- and multiple-mediator models were used to determine whether pros, cons, self-efficacy, and stages of change satisfied four conclusions necessary for establishing mediation of intervention effects on youths' dietary behavior. All four conclusions were satisfied for stages of change and pros in the single-mediator models and for stages in the multiple-mediator model. Stages mediated 31% of the intervention effect, and pros mediated 7% of the intervention effect in the single-mediator models. In the multiple-mediator model, stages accounted for 72% of the intervention effect. Findings add to the limited data on mediating variables in TTM dietary intervention programs. Replication studies are needed before it can be concluded that stages of change and pros are consistent mediators of TTM intervention program effects.

Youth Assets and Sexual Risk Behavior: Differences Between Male and Female Adolescents

Abstract: Youth internal assets and external resources are protective factors that can help youth avoid potentially harmful behaviors This study investigates how the relationship between youth assets or resources and two sexual risk behaviors (ever had sex and birth control use) varied by gender Data were collected through in-home interviews from parent-adolescent dyads, including 1,219 females and 1,116 males Important differences exist between male and female adolescents Females with the nonparental role models or the family communication resource were more likely to report never having had sexual intercourse than were females without the resources Among males, the aspirations for the future and responsible choices assets were associated with never having had sexual intercourse Males and females had two assets or resources in common that were protective of never having had sex: peer role models and use of time (religion) Considering which youth assets and resources are more likely to positively influence sexual behaviors of males and females may be important when planning prevention programs with youth

Facilitators, Challenges, and Collaborative Activities in Faith and Health Partnerships to Address Health Disparities

Abstract: Interest in partnering with faith-based organizations (FBOs) to address health disparities has grown in recent years. Yet relatively little is known about these types of partnerships. As part of an evaluation of the Institute for Faith and Public Health Collaborations, representatives of 34 faith—health teams (n = 61) completed semi-structured interviews. Interviews were tape recorded, transcribed, and coded by two members of the evaluation team to identify themes. Major facilitators to faith—health collaborative work were passion and commitment, importance of FBOs in communities, favorable political climate, support from community and faith leaders, diversity of teams, and mutual trust and respect. Barriers unique to faith and health collaboration included discomfort with FBOs, distrust of either health agencies or FBOs, diversity within faith communities, different agendas, separation of church and state, and the lack of a common language. Findings suggest that faith—health partnerships face unique chal...

Impact of a Community-Based Prevention Marketing Intervention to Promote Physical Activity Among Middle-Aged Women

Abstract: A physical activity intervention applied principles of community-based participatory research, the community-based prevention marketing framework, and social cognitive theory. A nonrandomized design included women ages 35 to 54 in the southeastern United States. Women (n = 430 preprogram, n = 217 postprogram) enrolled in a 24-week behavioral intervention and were exposed to a media campaign. They were compared to cross-sectional survey samples at pre- (n = 245) and postprogram (n = 820) from the media exposed county and a no-intervention county (n = 234 pre, n = 822 post). Women in the behavioral intervention had statistically significant positive changes on physical activity minutes, walking, park and trail use, knowledge of mapped routes and exercise partner, and negative change on exercise self-efficacy. Media exposed women had statistically significant pre- to postprogram differences on knowledge of mapped routes. No-intervention women had significant pre- to postprogram differences on physical activi...

Attitudes and Beliefs Associated With Mammography in a Multiethnic Population in Israel

Abstract: This article highlights beliefs, attitudes, and barriers that are associated with mammography use in four distinct cultural and ethnic groups in Israel: veteran, ultra-orthodox, and immigrant Jewish and Arab women. A random telephone survey of 1,550 women was performed. Information from claims records concerning mammography use was obtained for each woman from Maccabi Health Services. Of the barriers studied, no one barrier was associated with mammography performance in all population groups. However, the combined measure was associated with mammography use in all groups. Subjective norms, fatalism, fear of breast cancer, and perceived effectiveness were associated with mammography in some of the population groups but not in others. Each population seems to have a unique set of variables predicting mammography use. It is not possible to generalize from one population to another and it implies that information concerning beliefs and attitudes should be studied in each subpopulation before planning interventions.

Challenges of Capacity Building in Multisector Community Health Alliances

Abstract: Capacity building is often described as fundamental to the success of health alliances, yet there are few evaluations that provide alliances with clear guidance on the challenges related to capacity building. This article attempts to identify potential challenges of capacity building in multistakeholder health alliances. The study uses a multiple case study design to identify potential challenges and trade-offs associated with capacity building in four community health alliances in the United States. Multiple challenges were found to be common across the four alliances, including specifying appropriate governance structures and decision-making frameworks, aligning stakeholder interests with the vision of the alliance, balancing short-term objectives with long-term goals, and securing resources to sustain the effort without compromising it. These challenges often involved trade-offs and choices that alliances need to prepare for if they are to approach capacity building in a planful rather than a reactive manner.

Project ÒRÉ: A Friendship-Based Intervention to Prevent HIV/STI in Urban African American Adolescent Females:

Abstract: There is an urgent need for continued innovation in the design of HIV/STI prevention interventions for African American females, a group at high risk for STIs and HIV. In particular, attention to social development and to culture is needed. The present study reports on a group randomized controlled trial of a friendship-based HIV/STI prevention intervention delivered at community-based centers in four San Francisco neighborhoods (n = 2, experimental; n = 2, control). This brief program focuses on youth and their friendship group (N = 264). Program outcomes vary by age at 3-month follow-up, evidencing decreases in risky sex in the oldest group (p ≤ .05), decreases in multiple partners in the middle age group (p ≤ .05), and increases in HIV testing in the youngest group (p = .05). Findings extend recent work on the efficacy of interventions to reduce sexual risk for racial and ethnic minority youth.

Future HIV Vaccine Acceptability Among Young Adults in South Africa

Abstract: Developing and disseminating a preventive HIV vaccine is a primary scientific and public health objective. However, little is known about HIV vaccine acceptability in the high-prevalence setting of South Africa— where young adults are likely to be targeted in early dissemination efforts. This study reports on six focus groups ( n = 42) conducted in 2007 with South Africans aged 18 to 24 years. A deductive framework approach is used to identify key motivators and barriers to future HIV vaccine uptake. Participants identify HIV testing, HIV stigma, mistrust of the health care system, and concerns about sexual disinhibition as barriers to vaccine uptake. For women, family members and friends are strong motivators for vaccine uptake, whereas men are more likely to see vaccines as an opportunity to stop using HIV prevention strategies such as condoms and partner reduction. Implications of these findings for developing HIV vaccine dissemination strategies and policy in South Africa are discussed.

Psychological Factors Associated With Weight Loss in Obese and Severely Obese Women in a Behavioral Physical Activity Intervention

Abstract: The behavioral processes of weight reduction are poorly understood, and responses to treatments based primarily on caloric restriction have been unfavorable. A theory-based path derived from proposed relations of physical activity, changes in psychological factors, and weight loss was separately tested with women with Class I and Class II obesity (body mass index [BMI] from 30 to 39.9 kg/m(2); n = 116), and Class III (BMI > or = 40.0 kg/m(2); n = 57) obesity. Participation in a cognitive-behavioral exercise support treatment along with nutrition education was significantly associated with changes in measures of self-efficacy, body satisfaction, and mood. Changes did not significantly differ by BMI group. Multiple regression analyses indicated that changes in the psychological factors explained 14% (Class I/II obesity group) and 22% (Class III obesity group) of the variance in exercise session attendance, and attendance was strongly related to weight loss. Implications for weight loss theory and treatment are discussed.

Voices From the Inside: African American Women’s Perspectives on Healthy Lifestyles

Abstract: The author of this study conducted focus groups with African American women to explore their perspectives on obesity, disease causation, and their ideas on the functionality of cultural, social, historical, environmental, and psychological forces in altering healthy eating habits. Reoccurring themes centered on four areas: (a) the definition of health as a mind, body, and spiritual construct; (b) conceptualizations of cultural norms regarding healthy foods versus unhealthy foods; (c) the importance of eating and social rituals on food choices; and (d) the impact of the environment in sustaining healthy initiatives. Structural constraints that uphold legacies of disenfranchisement, environmental injustice, and segregation influence the food choices available in low-wealth communities. These factors continue to operate and are vital issues to consider when designing culturally relevant wellness programs.

Children’s Sensitivity to External Food Cues: How Distance to Serving Bowl Influences Children’s Consumption

Abstract: Overweight is increasing in children, leading to negative health consequences. Children also lack appropriate levels of important vitamins and nutrients in their diets. Environmental cues, such as food proximity, have been shown to influence consumption rates in adults. The present study has tested whether proximity to either a nutrient-dense or caloric-dense food would influence children's snack consumption in a day care setting. Children (N = 46, age range 3.4-11) consumed more of both nutrient- and energy-dense foods when they are sitting closer to the food than if they are sitting farther away from the food, above and beyond the effects of age. The data indicate that it may be possible to increase the consumption of nutrient-dense foods or decrease the consumption of energy-dense foods, respectively, by modifying the proximity of such foods within a child's environment.

Evaluation of the Health Promotion Model to Predict Physical Activity in Iranian Adolescent Boys

Abstract: Promoting sustainable physical activity (PA) behavior change is challenging, and a number of theoretical models have been developed and applied to this problem. Pender's health promotion model (HPM) is a relatively new model that is based on Bandura's social cognitive theory but includes the additional construct of competing demands, which are viewed as alternative behaviors (e.g., watching television) that have powerful reinforcing properties. This study evaluates the HPM as a means to predict PA in a sample of Iranian adolescent boys. Participants were 515 boys from 100 junior high and high schools in Sanandaj, Iran. Participants' mean age was 14.33 years (SD = 1.6, range = 12-17). Participants completed questions assessing social cognitive variables, and structural equation modeling was used to fit the data to the HPM. The HPM accounted for 37% of the variance in PA but did not represent a good data fit (chi(2) = 913.85, df = 473, p < .001). There were significant pathways between PA and self-efficacy (beta = .25, p < .001), enjoyment (beta = .22, p < .01), and PA modeling (beta = -.13, p < .05). A revised model that included the indirect effects of competing demands explained 34% of the variance in PA and represented a good data fit (chi( 2) = 9.12, df = 4, p = .058). In the revised model, self-efficacy, commitment to planning, and enjoyment were associated with PA. According to the HPM, competing demands influence PA. In the study sample, competing demands were not related to PA but were inversely associated with commitment to planning.

Effects of a Mail and Telephone Intervention on Breast Health Behaviors

Abstract: This study evaluated a mail and telephone intervention to improve breast health behaviors while maintaining quality of life. Women recruited from the general public were randomized to a stepped-intensity intervention consisting of mailings, telephone calls, and counseling (if requested or appropriate given a woman's genetic risk for breast cancer) or to a delayed treatment control group. Outcomes (mammography screening and quality of life) were measured at baseline in a telephone survey and again at a 12-month follow-up period. Women in the intervention group significantly increased screening mammography uptake by 12% and quality of life by 5.3 scale points compared to control participants. Changes in knowledge of breast cancer, genetic testing, and cancer worry all significantly predicted intervention changes. This successful intervention can help women make better breast health choices without causing increased worry.