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To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.addbeh.2005.05.003 Byline: Zeena Harakeh (a), Ron H.J. Scholte (a), Hein de Vries (b), Rutger C.M.E. Engels (a) Keywords: Personality types; Personality dimensions; Adolescent smoking; Smoking onset; Birth order Abstract: The present study examined the association between adolescents' personality traits and smoking, and tested whether this association was moderated by birth order or gender. Participants were 832 Dutch siblings aged 13 to 17 years participating at baseline assessment (T1) and at follow-up 12 months later (T2). Personality was assessed by applying a variable-centered approach including five personality dimensions (Extraversion, Agreeableness, Conscientiousness, Emotional Stability and Openness to Experience), and a person-oriented approach using three personality types (i.e., Resilients, Overcontrollers and Undercontrollers). Cross-sectional findings indicated that Extraversion (at T1 and T2), Agreeableness (at T2), Conscientiousness (at T2), and Emotional Stability (at T2) were related to adolescent smoking. Longitudinal findings indicated that only Extraversion and Emotional Stability were related to onset of adolescent smoking. Using a person-oriented approach, Overcontrollers and Undercontrollers did not differ from Resilients on smoking onset. No indication was found for a moderating effect of birth order on the association between personality and smoking. Additional findings showed that gender moderated the effect of Agreeableness on adolescents' smoking onset. Implications for prevention are also addressed. Author Affiliation: (a) Institute of Family and Child Care Studies, Radboud University Nijmegen, PO Box 9104, 6500 HE Nijmegen, The Netherlands (b) Department of Health Education, Maastricht University, The Netherlands

A study on smoking cessation interventions was conducted to investigate a stage model that categorizes smokers into four groups with increasing readiness to change, which includes immotives, precontemplators, contemplators and preparers. Anticipated positive and negative outcomes of quitting, perceived self-efficacy and smoking behavior were assessed and follow-up measurements were done three and 14 months after. Results showed that smokers in the four stages differed from each other on the factors pertaining to the positive outcomes and perceived self-efficacy.

The effect of intervention aimed at changing smoking behavior is determined by several factors. The effectiveness of intervention for smokers in precontemplation stage is lower than for smokers in the contemplation and preparation stages. The goal of intervention in precontemplating smokers is a positive stage transition and not a smoking cessation. The study shows that the effectiveness of an intervention is partly determined by the motivational stage that the smoker is in.

The anti-depressive benefits of physical activity are well-evidenced; however little is known about whether people with more frequent depressive symptoms have different psychological correlates of physical activity than people with less frequent symptoms, or whether special consideration is needed in targeting web-based physical activity interventions toward people with frequent depressive symptoms. An online cross-sectional survey was used to collect data from 511 adults (age = 45.99 ± 14.73 years). Two multiple regression analyses were conducted to test the relationship between frequency of depressive symptoms and (1) psychological correlates of physical activity (i.e., intentions, perceived behavioral control, affective attitudes, instrumental attitudes, and perceived physical activity effectiveness), and (2) perceived helpfulness of a variety of web-based physical activity intervention features. People with more frequent depressive symptoms had lower perceived behavioral control of physical activity ( β = −0.19), were more likely to report that goal-setting intervention tools ( β = 0.10) and personally-relevant information ( β = 0.09) would be helpful, and were less likely to report intervention features portraying information about how similar people are being regularly active as helpful ( β = −0.10) than those with less frequent symptoms. These findings highlight key components for designing web-based physical activity intervention content for people with depressive symptoms. [ABSTRACT FROM AUTHOR]

Objective: two studies aimed to explore the advice Dutch midwives give and the information Dutch pregnant women and partners of pregnant women receive about alcohol consumption in pregnancy. Design: study 1 included individual semi-structured interviews with midwives. Study 2 involved focus groups and individual semi-structured interviews with pregnant women and partners. Interview content was based on the I-Change Model. Setting: study 1 was conducted nation-wide; Study 2 was conducted in the central and southern regions of the Netherlands. Participants: 10 midwives in Study 1; 25 pregnant women and nine partners in Study 2. Measurements and findings: study 1 showed that midwives intended to advise complete abstinence, although this advice was mostly given when women indicated to consume alcohol. Midwives reported to lack good screening skills and sufficient knowledge about the mechanisms and consequences of antenatal alcohol use and did not involve partners in their alcohol advice. In Study 2, the views of pregnant women and partners were congruent to the findings reported in Study 1. In addition, pregnant women and partners considered midwives as an important source of information on alcohol in pregnancy. Partners were interested in the subject, had a liberal view on antenatal alcohol use and felt ignored by midwives and websites. Pregnant women indicated to receive conflicting alcohol advice from their health professionals. Key conclusions: midwives' alcohol advice requires improvement with regard to screening, knowledge about mechanisms and consequences of antenatal alcohol use and the involvement of the partners in alcohol advice during pregnancy. Implications for practice: training should be given to Dutch midwives to increase their screening skills and their alcohol related knowledge to pregnant women. Research is needed to determine how the midwife's alcohol advice to the partner should be framed in order to optimise the partner's involvement concerning alcohol abstinence in pregnancy. More attention to the topic at a national level, for example via mass media campaigns, should also be considered to change views about alcohol use during pregnancy in all stakeholders. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: We sought to identify risk groups among smoking cardiac patients from their social cognitive profiles, and to assess predictors of smoking abstinence shortly after discharge. Methods: Smoking cardiac patients (n = 133) completed questionnaires at hospital admission and 1 month after discharge. Hierarchical cluster analysis was used to detect risk groups of smokers, based on baseline scores for smoking-related social cognitions. Regression analyses were used to identify predictors of the intention to abstain from smoking and smoking abstinence 1 month after discharge. Results: Three groups of smokers were distinguished that differed significantly on the pros of nonsmoking, self-efficacy expectancies toward nonsmoking, social support, social modeling, and smoking behavior. Abstinence from smoking 1 month after discharge was predicted by group membership and a stronger intention to quit. A previous hospital admission because of a cardiac event significantly decreased the likelihood of abstinence. Conclusions: One third of cardiac patients are at high risk of continuing smoking after hospital discharge because of an unfavorable smoking and disease history and a poor social cognitive profile. Interventions for cardiac patients should address risk profiles to achieve long-term abstinence. The implications of nursing practices in smoking cessation treatments are discussed. [Copyright &y& Elsevier]

Abstract: Background: PAS (Personal Advice in Stopping smoking) combines two of the most effective smoking cessation interventions: multiple computer tailoring and tailored counselling by a practice nurse in the general practice. Methods/design: Since May 2009, practice nurses are recruiting smoking patients. Each practice nurse is asked to recruit 15 adult smokers who are willing to quit within 6months and have access to the Internet. Smokers can sign up for PAS through the PAS website and are then randomized into one of three groups receiving multiple tailoring and counselling (MTC), multiple tailoring (MT) or usual care (UC), respectively. All groups receive questionnaires at baseline, 2days after a set quit date and at 6weeks, 6months and 12months follow-up. The MT group receives tailored, iterative feedback letters at the first four measurements points. At 12months follow-up biochemical validation will take place amongst respondents reporting to have quit. The three groups will be compared with regard to quit attempt rate, point prevalence abstinence and continued abstinence by means of logistic multilevel regression analyses. Linear multilevel regression analyses will be used to compare the three groups regarding smoking related beliefs. Discussion: The present paper provides an extensive description of the development of PAS and of the design of the study towards its effectiveness. This might provide insight into PAS’ potentially effective working mechanisms. The results concerning effectiveness may contribute to knowledge about the effectiveness of smoking cessation interventions aimed at smoking adults. Trial registration: Dutch Trial Register NTR1351 [Copyright &y& Elsevier]

Background: Important health benefits can be obtained if effective low-cost interventions promoting physical activity, especially among older adults, are developed. Design: This RCT investigated the efficacy of two tailored physical activity interventions in promoting awareness, initiation, and maintenance of physical activity among older adults compared to a wait-list control group. Data were collected in 2007. Analyses were conducted in 2008. Setting/participants: In total, 1971 Dutch older adults (mean age=64 years, 57% women) participated. Intervention: Two tailored physical activity interventions, consisting of three tailored letters delivered during 4 months, were systematically developed. The basic tailored intervention targeted psychosocial determinants alone, while the environmentally tailored intervention (intervention-plus) additionally targeted environmental determinants. Main outcome measures: Awareness of personal physical activity behavior, self-reported level of physical activity, and compliance with the physical activity guideline were assessed at baseline, 3 months, and 6 months. Results: Intervention participants became more aware of their personal physical activity level at 6 months (ORIbasic=1.7, ORIplus=1.6) and were significantly more physically active at 3 (EffectSize[ES]Ibasic=0.20, ESIplus=0.20) and 6 months (ESIbasic=0.30, ESIplus=0.35) when compared to control participants. Moderation analyses showed that the interventions enhanced physical activity initiation at 3 (ESIbasic=0.26, ESIplus=0.21) and 6 months (ESIbasic=0.32, ESIplus=0.27) among participants insufficiently active at baseline, and induced maintenance at 6 months among participants sufficiently active at baseline (ESIbasic=0.33, ESIplus=0.34) when compared to the control condition. No differences between the intervention arms were found. Conclusions: The results indicate that tailoring can be an effective tool in attaining and enhancing awareness, initiation, and maintenance of physical activity among older adults. Targeting environmental determinants in addition to psychosocial determinants, however, did not result in an additional increase in physical activity behavior. Trial registration: This study was registered with the Dutch Trial Register NTR 920. [Copyright &y& Elsevier]

Abstract: Objective: Smoking during pregnancy is an important problem in the Netherlands. We tested the effectiveness of a health counseling method by midwives using a RCT. Methods: Four provinces with 42 practices including 118 midwives were randomly assigned to the experimental or control condition. Midwives in the experimental group provided brief health counseling, self-help materials on smoking cessation during pregnancy and early postpartum, and a partner booklet. Controls received routine care. The main outcome measures were 7-day abstinence, continuous abstinence, and partner smoking at 6 weeks post-intervention (T1) and 6 weeks postpartum (T2). Results: Multi-level analysis revealed significant differences between both conditions at T1 and T2 using intention-to-treat analysis. Nineteen percent of the experimental group reported 7-day abstinence compared to 7% of the control group at T1, and 21 and 12%, respectively, at T2. For continuous abstinence these percentages were 12% in the experimental group and 3% in the control group. The partner intervention was not successful. Conclusion: The intervention resulted in significant effects on smoking behavior for pregnant women, but not for partner smoking. Practice implications: The program realized short-term effects. An important precondition is that midwives need a proper training. [Copyright &y& Elsevier]

The development of underground spaces serves a range of common urban functions, including workspaces. However, underground workplaces, work-related factors and the indoor environmental quality (IEQ) parameters within them may negatively affect worker's mental health. This study assessed the prevalence of psychological distress with repeated measures over time in aboveground and underground workspaces, and assessed the association between perceived IEQ parameters and work-related factors with psychological distress. A total of 329 workers in similar aboveground and underground workspaces were followed-up in three assessments over 12 months in Singapore. Psychological distress was assessed using the 12-item General Health Questionnaire (GHQ-12) and defined as a GHQ-12 score ≥2. Perceived IEQ (air quality, temperature, noise, light) in the workplace were collected using the OFFICAIR questionnaire. We used generalised estimating equation models to assess the association between working underground, perceived IEQ, and work-related factors with psychological distress. The overall prevalence of psychological distress was 21.9%, 26.1% and 21.9%, at baseline, 3- and 12-months follow-up, respectively. The fully-adjusted multivariable analysis did not show any association between working underground and psychological distress, however, perceived IEQ parameters and longer working hours were significantly associated with psychological distress. Regardless of working in under or aboveground workplaces, perceived IEQ was associated with psychological distress. Future studies are needed in order to examine the relationship between objective measures of IEQ and psychological distress and the impact of healthy building policies and improved IEQ on psychological distress. • There was no association between working underground and psychological distress. • Perceived IEQ in the workplace was associated with psychological distress. • Stress at work and longer working hours were associated with psychological distress. [ABSTRACT FROM AUTHOR]

Abstract: Background: The present study examined the effects of the campaign “early detection of cancer” on knowledge, attitudes, awareness, and intention to perform passive detection and timely seeking medical help. Further, the campaign was evaluated on recall and recognition and the various campaign components were evaluated. Methods: A longitudinal study using a Solomon four-group design among 784 Dutch adults aged 55 years and older was conducted. Data was gathered by means of telephone interviews. Results: The results showed moderate levels of campaign awareness. After the campaign, solely respondents who received a pre-test questionnaire and were aware of the campaign had significant higher cancer knowledge levels regarding passive detection. Respondents who were only aware of the campaign were significantly more willing to perform passive detection behavior and to timely seek medical help in the future. Further, they were more aware that paying attention to cancer warning signs can lead to early detection of cancer. Conclusions: It can be concluded that solely the combination of the pre-test questionnaire and exposure to the campaign had a significant positive impact on respondents’ cancer knowledge levels. The effects of the campaign on intention and awareness are indistinct and could be a consequence of (the results of) a self-selection bias. It seems that the dose, frequency, and duration of the campaign should be increased in order to substantiate the effects of the campaign. [Copyright &y& Elsevier]

Abstract: Objective: This study aims to determine differences in samples of adult smokers recruited by passive or active recruitment in community pharmacy (PP and AP) or passive recruitment in general practice setting (PG), then comparing these samples to an unrecruited cohort of Dutch smokers. Methods: The three recruited samples were compared on demographics, smoking behaviour, motivational determinants, stage of change and intention to use specific action plans when quitting using multinomial logistic regression analyses; this method was also used to assess whether recruitment affected the acquired samples concerning demographic variables compared with the cohort. PP, AP and PG response rates were compared with Tukey post hoc tests. Results: Significant differences were found for both AP and PG smokers, compared with PP smokers. Most important results include a higher rate of pre-contemplators in the AP sample and a lower educational level in the PG sample. All recruited samples appeared to be significantly different from the cohort sample. Conclusion: Recruitment method and primary care setting does influence the sample recruited, this should be taken into consideration when recruiting a specific sub-sample. Practice implications: These results are valuable for researchers contemplating recruitment in a primary care setting. [Copyright &y& Elsevier]

Social psychological correlates of two main aspects of the process of cancer detection, viz. passive detection (i.e., paying attention to cancer symptoms) and help-seeking intention, were studied among a-symptomatic Dutch adults. Two written questionnaires, with a six-week interval, identified correlates of both variables, using a determinant model based on the theory of planned behavior. Knowledge, advantages, self-efficacy, being female and being more highly educated were associated with passive detection. Knowledge, advantages, moral obligation, anticipated regret, social norm, and self-efficacy were correlated with the intention to seek help. We suggest that educational programs need to address the two variables separately and also need to tailor their content to the various social psychological correlates of these two aspects. [Copyright &y& Elsevier]

A cross-sectional design was used to asses whether Dutch midwives trained to use a smoking cessation counseling protocol appreciated it and could implement it in routine care. Midwives received a questionnaire after the implementation period of the effectiveness study was finished. In total, 118 midwives from 42 practices participated in the study, 69 midwives (58.5%) returned the questionnaire. To validate the results collected among midwives, clients who participated in the study were also questioned about the information they received about smoking cessation from their midwife.Experimental midwives more often reported giving the advice to quit (B=0.50, S.E.=0.24, P<0.05), setting a quit date with clients who indicated to be motivated to quit (B=1.69, S.E.=0.28, P<0.001) and discussing aftercare (B=1.10, S.E.=0.25, P<0.001). These results were confirmed by data collected among clients.This easy-to-implement program is recommended for broad dissemination. Further investigation is needed to improve the partner and postpartum component. [Copyright &y& Elsevier]

This paper reports on knowledge and behavior among Dutch adults (n=1530) regarding early detection of cancer (passive detection, active detection and help-seeking behavior). Written questionnaires assessed knowledge of detection methods and cancer symptoms, symptom recognition, detection behaviors, and help-seeking behaviors. Respondents did not have much general knowledge of detection methods and cancer symptoms, but recognized most cancer symptoms. More women than men paid attention to cancer symptoms. For most symptoms, medical help would be sought within the appropriate time by the majority of the respondents. Principal component analyses revealed relations between symptoms pertaining to the ‘interior’ body and those pertaining to the ‘exterior’ body. Correlations between symptom recognition, detection behavior and help-seeking behavior were low. Differences in demographic groups and differences in knowledge and behavior require adaptation of future health education on early detection of cancer to different groups. [ABSTRACT FROM AUTHOR]

Objective: To broadly synthesize literature regarding decision aids (DAs) supporting decision making about diet, physical activity, sleeping and substance use a scoping review was performed.Methods: Multiple sources were used: (1) Scientific literature searches, (2) excluded references from a Cochrane review regarding DAs for treatments and screenings, and (3) results from additional searches. Interventions had to (1) support informed decision making and (2) provide information and help to choose between at least two options. Two researchers screened titles and abstracts. Relevant information was extracted descriptively.Results: Thirty-five scientific articles and four DAs (grey literature) were included. Results were heterogeneous. Twenty-nine (94%) studies described substance use DAs. All DAs offered information and value and/or preference clarification. Many other elements were included (e.g., goal-setting). DA's effects were mixed. Few studies used standardized measures, e.g., decisional conflict (n = 4, 13%). Some positive behavioral effects were reported: e.g., smoking abstinence (n = 1).Conclusions: This research shows only some positive behavioral effects of DAs. However, studies reported heterogeneous results/outcomes, impeding knowledge synthesis. Areas of improvement were identified, e.g., establishing which intervention elements are effective regarding health behavior decision making.Practice Implications: DAs can potentially be beneficial in supporting people to change health behaviors - especially regarding smoking. [ABSTRACT FROM AUTHOR]

Background: Our study evaluated the short-term impact of introducing European Union's tobacco pictorial health warnings (PHWs).Methods: Longitudinal data were collected at two time-points from adult smokers, participating in the International Tobacco Control (ITC) surveys, conducted in the Netherlands, Australia, Canada, the United Kingdom and the United States. In the Netherlands, textual health warnings (THWs) were replaced by PHWs between both time-points. Health warning policies did not change in the other countries. Data from continuing smokers were used (N = 3,487) and analyzed using Generalized Estimating Equations.Results: Between both time-points, only Dutch smokers showed increases in noticing health warnings (β = 0.712, p < 0.001), self-reports of health warnings leading to a cognitive response such as thinking about smoking health-risks (SHRs) (OR = 1.834, p < 0.001), knowledge about SHRs (β = 0.369, p < 0.001), and avoiding health warnings (OR = 9.869, p < 0.001). However, Dutch smokers showed no changes in attitude towards smoking (β = 0.035, p = 0.518), intention to quit smoking (OR = 0.791, p = 0.157), self-efficacy to quit smoking (β=-0.072, p = 0.286), or reporting that health warnings helped them to resist having a cigarette (OR = 1.091, p = 0.714).Conclusions: Results suggest that introducing the European PHWs was effective in provoking changes closely related to health warnings, but there was no direct impact on variables more closely related to smoking cessation. [ABSTRACT FROM AUTHOR]

Objective: To conduct an economic evaluation of a tailored e-learning program, which successfully improved practice nurses' smoking cessation guideline adherence.Methods: The economic evaluation was embedded in a randomized controlled trial, in which 269 practice nurses recruited 388 smoking patients. Cost-effectiveness was assessed using guideline adherence as effect measure on practice nurse level, and continued smoking abstinence on patient level. Cost-utility was assessed on patient level, using patients' Quality Adjusted Life Years (QALYs) as effect measure.Results: The e-learning program was likely to be cost-effective on practice nurse level, as adherence to an additional guideline step cost €1,586. On patient level, cost-effectiveness was slightly likely after six months (cost per additional quitter: €7,126), but not after twelve months. The cost-utility analysis revealed slight cost-effectiveness (cost per QALY gained: €18,431) on patient level.Conclusion: Providing practice nurses with a tailored e-learning program is cost-effective to improve their smoking cessation counseling. Though, cost-effectiveness on patient level was not found after twelve months, potentially resulting from smoking relapse.Practice Implications: Widespread implementation of the e-learning program can improve the quality of smoking cessation care in general practice. Strategies to prevent patients' smoking relapse should be further explored to improve patients' long-term abstinence. [ABSTRACT FROM AUTHOR]

• Childhood vaccination is perceived as a self-evident decision among acceptors. • Refusers rely on anecdotal evidence to make a decision about childhood vaccination. • Partial acceptors deliberate the pros and cons of each vaccine and VPD individually. • Elaborate dialogues are necessary to strengthen and support decision-making. In light of the decline in childhood vaccination coverage, the question rises concerning what factors play a role in informed decision-making about childhood vaccination. Insight into factors related to this decision helps us to support parents' informed decision-making about childhood vaccination. We conducted 12 semi-structured focus group interviews across the Netherlands based on a definition of informed decision-making: three with acceptors, three with refusers, and six with partial acceptors to ask about knowledge, attitudes, deliberation, and information needs. We performed a thematic analysis of the transcripts. Acceptors viewed the decision to participate in the National Immunization Program (NIP) as self-evident. Refusers and partial acceptors, however, reported to extensively deliberate the pros and cons of accepting or refusing the NIP in much detail. Their answers indicated that their knowledge was not always evidence-based. In addition, refusers and partial acceptors perceived fewer risks of vaccine-preventable diseases (VPDs), more risks of side-effects of vaccines, less social support from their environment, less trust in child welfare centers (CWCs), and information provided than acceptors. We observed distinct differences in factors related to decision-making about childhood vaccination between acceptors, refusers, and partial acceptors. Acceptors in the current study perceived accepting childhood vaccinations as self-evident, refusers relied mostly on anecdotal information rather than evidence-based information to weigh up the pros and cons vaccines and the VPDs, and partial acceptors elaborately deliberated the pros and cons of each vaccine and VPD individually, which was time-consuming and difficult. To strengthen and support decision-making among parents, more elaborate dialogues are needed between Child Vaccine Providers (CVPs) and parents. These discussions could build trust between parents and CVPs, be used to discuss the evidence-based advantages of childhood vaccinations, and to decrease parents' susceptibility to anecdotal information and misperceptions about childhood vaccinations shared by other parents. [ABSTRACT FROM AUTHOR]

Objectives Physical activity is associated with many health benefits that are important for older adults. These health benefits can only be obtained and preserved when physical activity is maintained over a long period of time. Habit formation has been proposed as a way to ensure long-term maintenance of physical activity. Intention, action planning, and physical activity are suggested to be determinants of physical activity habits. However, how they determine physical activity habits in older adults is largely unknown. This study examined whether the relationship between intention and habit is mediated by action planning and/or physical activity. Design A four-wave prospective design was used. Methods Two independent studies were conducted in 469 (Study 1; M age = 63.07, SD age = 7.61) and 322 (Study 2; M age = 64.31, SD age = 9.39) older adults. Study 2 was conducted with the aim of replicating findings of Study 1. In both studies the older adults completed questionnaires on intention, physical activity, and habit at baseline, action planning at three months, physical activity at six months, and habit at twelve months. Results Structural equation modeling analyses showed significant intention-physical activity-habit paths, nonsignificant intention-action planning-habit paths, and nonsignificant intention-action planning-physical activity-habit paths in both studies. Conclusions The relationship between physical activity habit and intention was mediated by physical activity. Intention was neither associated with habit via action planning as a single mediator, nor via action planning and physical activity as sequential mediators. Possible conditions under which intention-action planning-habit paths and intention-action planning-physical activity-habit paths exist are discussed. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the current study is to investigate trends and socioeconomic differences in policy triggers for thinking about quitting in six European countries.Methods: Data were derived from all available survey waves of the International Tobacco Control (ITC) Europe Surveys (2003-2013). France conducted three survey waves (n=1420-1735), Germany three waves (n=515-1515), The Netherlands seven waves (n=1420-1668), Ireland three waves (n=582-1071), Scotland two waves (n=461-507), and the rest of the United Kingdom conducted seven survey waves (n=861-1737). Smokers were asked whether four different policies (cigarette price, smoking restrictions in public places, free or lower cost medication, and warning labels on cigarette packs) influenced them to think about quitting. Generalized Estimating Equation (GEE) models were estimated for each country.Results: Cigarette price was mentioned most often in all countries and across all waves as trigger for thinking about quitting. Mentioning cigarette price and warning labels increased after the implementation of price increases and warning labels in some countries, while mentioning smoking restrictions decreased after their implementation in four countries. All studied policy triggers were mentioned more often by smokers with low and/or moderate education and income than smokers with high education and income. The education and income differences did not change significantly over time for most policies and in most countries.Conclusions: Tobacco control policies work as a trigger to increase thoughts about quitting, particularly in smokers with low education and low income and therefore have the potential to reduce health inequalities in smoking. [ABSTRACT FROM AUTHOR]

Objectives Habit has been proposed as an explanation of why prior behavior is a good predictor of later behavior. This study examined whether habit mediates the relationship between prior and later physical activity (PA), within the framework of the attitude-social influences-efficacy (ASE) model and the theory of planned behavior (TPB). Design A longitudinal design was used. Methods A total of 1976 older adults completed questionnaires on ASE/TPB constructs and PA at baseline, intention at three months, habit at six months, and PA at twelve months. Results Path analyses showed that habit significantly mediates the relationship between prior and later PA, after ASE/TPB variables were taken into account. Conclusions Habit is a partial solution to the question why prior PA is a good predictor of later PA. It is recommended to incorporate habit into the ASE/TPB model. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: Despite their positive motivation to quit, many smokers do not attempt to quit or relapse soon after their quit attempt. This study investigated the predictors of successful and unsuccessful quit attempts among smokers motivated to quit smoking. Methods: We conducted secondary data analysis among respondents motivated to quit within 6months, randomized to the control group (N =570) of a Web-based smoking cessation intervention study. Using chi-square tests and ANOVA with Tukey post hoc comparisons, we investigated baseline differences by smoking status (successful quitter/relapse/persistent smoker) assessed after 6weeks (N =214). To identify independent predictors of smoking status, multivariate multinomial logistic regression analyses were conducted. Results: Successful quitters at 6-week follow-up (26%) had reported significantly higher baseline levels of self-efficacy than relapsers (45%) and persistent smokers (29%). Furthermore, both successful quitters and relapsers had reported a significantly higher baseline intention to quit than persistent smokers and successful quitters had reported significantly more preparatory planning at baseline than persistent smokers. Results from regression analyses showed that smokers' baseline intention to quit positively predicted quit attempts reported after 6weeks, while self-efficacy positively predicted quit attempt success. Conclusions: Different factors appear to play a role in predicting quit attempts and their success. Whereas intention to quit only appeared to play a role in predicting quit attempts, self-efficacy was the main factor predicting quit attempt success. More research is needed to determine the role of preparatory planning and plan enactment and to investigate whether these findings can be replicated on the long term. [Copyright &y& Elsevier]

Abstract: Background: This study examined possible income differences in the impact of a national reimbursement policy for smoking cessation treatment and accompanying media attention in the Netherlands in 2011. Methods: We used three waves of the International Tobacco Control (ITC) Netherlands Survey, a nationally representative longitudinal sample of smokers aged 15 years and older (n =1912). The main analyses tested trends and income differences in outcome measures (smokers’ quit attempt rates, use of behavioral counseling, use of cessation medications, and quit success) and awareness variables (awareness of reimbursement possibilities, the media campaign, medications advertisements and other media attention) with generalized estimating equations analyses. Results: In the first half of 2011, there was a significant increase in quit attempts (odds ratio (OR)=2.02, p <0.001) and quit success (OR=1.47, p <0.001). Use of counseling and medications remained stable at 3% of all smokers in this period. Awareness of reimbursement possibilities increased from 11% to 42% (OR=6.38, p <0.001). Only awareness of the media campaign was associated with more quit attempts at the follow-up survey (OR=1.95, p <0.001). Results were not different according to smokers’ income level. Conclusions: The Dutch reimbursement policy with accompanying media attention was followed by an increase in quit attempts and quit success, but use of cessation treatment remained stable. The impact of the policy and media attention did not seem to have decreased or increased socioeconomic inequalities in quit attempts, use of cessation treatment, or quit success. [Copyright &y& Elsevier]

Abstract: The present study investigated the persuasiveness of gain- and loss-framed information recommending healthier choices in fast-food restaurants. Visitors of two fast-food restaurants (N =235) filled in a questionnaire concerning their fast food choices and received gain-or loss-framed nutrition information. The data revealed that gain- and loss-framed nutrition information were not differently persuasive, but that participants’ self-efficacy to choose healthy products influenced the effect of framing. Specifically, for participants high in self-efficacy, the gain-framed message resulted in more positive attitudes towards healthy eating and stronger healthy eating intentions than the loss-framed message. However, for participants low in self-efficacy, the loss framed message resulted in stronger intentions than the gain-framed message. The study thus provides evidence for the role of self-efficacy as a potential moderator of the effects of framed nutrition information in a field setting. [Copyright &y& Elsevier]

Abstract: This study examined whether smokers'' perceived level of stigmatization changed after the implementation of smoke-free hospitality industry legislation and whether smokers who smoked outside bars reported more perceived stigmatization. Longitudinal data from the International Tobacco Control (ITC) Netherlands Survey was used, involving a nationally representative sample of 1447 smokers aged 15 years and older. Whether smoke-free legislation increases smokers'' perceived stigmatization depends on how smokers feel about smoking outside. The level of perceived stigmatization did not change after the implementation of smoke-free hospitality industry legislation in the Netherlands, possibly because most Dutch smokers do not feel negatively judged when smoking outside. [Copyright &y& Elsevier]

Abstract: National level smoke-free legislation is implemented to protect the public from exposure to second-hand tobacco smoke (SHS). The first aim of this study was to investigate how successful the smoke-free hospitality industry legislation in Ireland (March 2004), France (January 2008), the Netherlands (July 2008), and Germany (between August 2007 and July 2008) was in reducing smoking in bars. The second aim was to assess individual smokers’ predictors of smoking in bars post-ban. The third aim was to examine country differences in predictors and the fourth aim was to examine differences between educational levels (as an indicator of socioeconomic status). This study used nationally representative samples of 3147 adult smokers from the International Tobacco Control (ITC) Europe Surveys who were surveyed pre- and post-ban. The results reveal that while the partial smoke-free legislation in the Netherlands and Germany was effective in reducing smoking in bars (from 88% to 34% and from 87% to 44%, respectively), the effectiveness was much lower than the comprehensive legislation in Ireland and France which almost completely eliminated smoking in bars (from 97% to 3% and from 84% to 3% respectively). Smokers who were more supportive of the ban, were more aware of the harm of SHS, and who had negative opinions of smoking were less likely to smoke in bars post-ban. Support for the ban was a stronger predictor in Germany. SHS harm awareness was a stronger predictor among less educated smokers in the Netherlands and Germany. The results indicate the need for strong comprehensive smoke-free legislation without exceptions. This should be accompanied by educational campaigns in which the public health rationale for the legislation is clearly explained. [ABSTRACT FROM AUTHOR]

Objective: To evaluate two counseling programs in general practice to help smokers with chronic obstructive pulmonary disease (COPD) to quit smoking. Methods: Cluster randomized controlled trial including 68 general practices (667 patients) using a randomly assigned intervention program with counseling and advice about nicotine replacement therapy (and additional bupropion-SR in one of the programs) or usual care. Usual care consisted of periodic regular check-ups and COPD information. The main outcome measure was biochemically verified point prevalence at 12months. Results: The two intervention groups were treated as one in the analysis because they were equally effective. The intervention resulted in a significantly self-reported higher success rate (14.5%) compared to usual care (7.4%); odds ratio=2.1, 95% confidence interval=1.1–4.1. Biochemically verified quit rates were 7.5% (intervention) and 3.4% (usual care); odds ratio=2.3, 95% confidence interval=0.9–6.0. Conclusion: The program doubled the cessation rates (statistically nonsignificant). Too few participants used the additional bupropion-SR to prove its effectiveness. Practice implications: The protocols can be used for COPD patients in general practice, but expectations should be modest. If quitting is unsuccessful, a stepped care approach should be considered. [Copyright &y& Elsevier]

Objective: Physical activity (PA) and fruit and vegetable consumption may prevent or delay the development of hypertension and cardiovascular diseases. We examined adherence rates to single and combinations of Dutch public health guidelines for these behaviors by comparing and combining two self-report measurements.Study Design and Setting: The behaviors of 2,568 Dutch participants aged 45-70 years were measured using one item and multiple items. Patients were classified as meeting or not meeting a guideline using both measurements separately and combined.Results: Substantially more participants met guidelines when measured with multiple items than when measured with one item, with differences of 21-39%. Combined measurements resulted in fewer participants meeting guidelines than multiple-item measurements used alone. Combined measurements showed that 17%, 12%, and 34% of participants met the guidelines for fruit and vegetable consumption and PA, respectively; only 3% met all three guidelines. Sociodemographic variables explained less than 4% of the variance of congruency between single- and multiple-item measurements.Conclusion: When assessing adherence rates, the level appears dependent on the method of self-report chosen. Hence, more research must analyze which adherence measurement will result in valid responses and which variables are associated with congruency between single- and multiple-item measurements. [ABSTRACT FROM AUTHOR]

Abstract: The co-evolution of adolescents'' friendship networks and their smoking behavior is examined in a large sample across six European countries. Selection and influence processes are disentangled using new methods of social network analysis that enable alternative selection mechanisms to be controlled for. The sample consisted of 7704 adolescents participating in the control group of the ESFA (European Smoking prevention Framework Approach) study. The design was longitudinal with four observations. The main measurements were friendship ties, adolescents smoking behavior, parental smoking behavior, and sibling smoking behavior. Results indicated that in each country adolescents preferred selecting friends based on similar smoking behavior. Support for the influence of friends was found in only two countries. A similarity in smoking behavior between friends was explained more strongly by smoking-based selection processes than by the influence of friends in each of the six countries. Prevention programs need to address aspects that drive peer selection, and reinforce non-smoking attitudes in adolescents. [Copyright &y& Elsevier]

Abstract: Objective: Early detection of melanomas might increase survival chance. Patients can usually see primary lesions while inspecting their skin. Skin self-examination (SSE) is therefore the recommended pre-screening method. To maximize the likelihood that SSE will be performed, it is important to distinguish those factors that increase the chance of performance. The aim is to examine motivational differences between (a) melanoma-prone persons who perform SSE once every 2–3 months, and (b) melanoma-prone persons with a lower SSE frequency. Methods: A survey to assess socio-demographic factors, attitude, social influence, self-efficacy and intention to perform SSE. Results: Members (n =71) of 18 familial atypical multiple mole melanoma (FAMMM) families participated; 70% performed SSE at least once every 2–3 months. Adequate performers were more likely to have a partner, had a more positive attitude toward SSE, perceived SSE as less difficult to perform and had a stronger intention to perform SSE compared to poor performers. Logistic regression indicated attitude as the only reliable predictor of SSE performance. Conclusion: We found that about one third of our genetically predisposed population did not report an adequate frequency of performing SSE. Practice implications: Deficiencies in SSE practices in a genetically predisposed population are indicated. [Copyright &y& Elsevier]

Abstract: This study examined whether global parenting style can be regarded as a context in which smoking-specific parenting practices relate to adolescent smoking cognitions and behaviors. Data were gathered through self-administered questionnaires from 482 adolescents aged 12–19 years, who participated in the Study of Medical Information and Lifestyles in Eindhoven (SMILE). We assessed parenting style dimensions (support, strict control, psychological control), smoking-specific parenting practices (parent-child communication about smoking, anti-smoking house rules, availability of tobacco products, non-smoking agreement), smoking-related cognitions according to the I-Change Model (attitude, social norm, self-efficacy, intention), and smoking behavior. Structural equation models were computed and compared for adolescents in different parenting climates. Results showed that communication and availability were related to adolescents’ attitude towards smoking. Availability was additionally associated with reduced self-efficacy to refrain from smoking. Attitude and self-efficacy were subsequently related to intention to smoke, which in turn was related to smoking behavior. No direct relations were found between anti-smoking parenting practices and adolescent smoking behavior. These results were not dependent on the parenting climate. Parenting style thus did not serve as a context for smoking-specific parenting practices, indicating that these facets of parenting operate independently, and that anti-smoking parenting practices may be effective regardless of parenting climate. [Copyright &y& Elsevier]

Background: Recent calls have been made to consider both environmental factors and individual-level factors in the explanation of physical activity (PA). The present study tested a conceptual model that integrated past PA, relevant environmental-level and individual-level factors and their associations with adolescent PA, using the tenets of the Theory of Planned Behavior (TPB). Methods: Data were gathered in an adolescent sample (n=221; 60% girls) using questionnaires. PA was assessed in May 2003 and November 2003. Theory of Planned Behavior cognitions regarding PA and the environmental factors under study were assessed in November 2003. Confirmatory factor analyses and path analyses were performed using AMOS software. Results: The initial structural model did not provide an acceptable fit to the data. Including a direct path from past PA to current PA significantly improved model fit to an acceptable fit. Including a direct path from past PA to environmental perceptions did not significantly improve model fit. Including a direct path from the environmental variables to current PA did not significantly improve model fit. Current PA was most strongly influenced by past PA, while environmental aesthetics and distance to PA opportunities were indirectly related to adolescents’ intention to be physically active. Significant standardized path coefficients ranged from 0.14 to 0.34 and explained 17% variance in current PA. Conclusions: Combining past PA, Theory of Planned Behavior cognitions, and environmental factors increased our understanding of their relative influences on adolescent PA. Implications for future research on physical activity are discussed. [Copyright &y& Elsevier]

Abstract: Despite intensive efforts, most smoking prevention interventions have had disappointing results. In the present paper, the assumption underlying these efforts that smoking initiation is the result of a rational decision or plan, is questioned. The process of adolescent smoking initiation is described, based on a recently conducted series of studies. It is argued that smoking initiation among adolescents is unplanned behaviour. Therefore, interventions regarding smoking initiation should not only include a focus on smoking-specific cognitions. Models that incorporate both conscious and unconscious processes need to be used in mapping smoking prevention efforts. Further, programmes that help adolescents to quit smoking need more attention. Finally, it is argued that smoking prevention interventions should aim at influencing the image of nonsmoking by using mass media interventions and restrictive policies. [Copyright &y& Elsevier]

Objectives: Many tobacco and related products (TRPs) are less strictly regulated and marketed as less harmful than cigarettes. Little is known about their awareness, use, user profile, use behavior, reasons for use and risk perception, especially for the newest products. In an exploratory survey study among Dutch adolescents and adults, we have investigated three examples of non-cigarette TRPs available on the worldwide market.Methods: In a two-step web-based design, data on cigarillos, heated tobacco products (HTPs) and nicotine pouches were collected. In the first step (N = 5805), a representative sample (≥13 years) was studied to quantify their awareness, ever and current use in the Dutch population. In the second step (N = 526), in-depth data regarding use behavior, reasons for use and risk perception were collected among users and non-users.Results: Awareness (<50%) and use (<15% ever use and <2% current use) is relatively low for all three products, but overall higher among men, (e-)cigarette users and respondents with higher education and social economic status. Most participants became aware of the products through people they knew. Reasons for use were mainly curiosity, pleasant taste, flavour variety, and lower harmfulness. All products were perceived as (slightly) less harmful and addictive than cigarettes.Conclusions: This study is one of the first to investigate awareness and use of cigarillos, HTPs and nicotine pouches. To prevent increased use, we recommend regulators to extend flavour and smoking bans to these products. In addition, public information may discourage use by increasing awareness of health risks. [ABSTRACT FROM AUTHOR]

Although information and communication technologies have become an integral part of contemporary societies, substantial proportions of the older population remain distant from these digital tools. This stresses the importance of identifying age-specific factors that facilitate or prevent technology adoption among older age groups. Despite being powerful determinants of behavior and health in late adulthood, little is known about the role of stereotypical perceptions about age and aging in the behavioral engagement with technological devices. Across two longitudinal studies, we examined the relationship between self-perceptions of aging and computer use behavior, as well as the mediating role of cognitive functioning. Study 1 was based on the 2010, 2014, and 2018 waves of the Health and Retirement Study (n = 3404). Study 2 was based on the 2014 and 2017 waves of the German Ageing Survey (n = 4871). Both studies revealed that more positive self-perceptions of aging were associated with more frequent computer use behavior. Moreover, this relationship was partially mediated by cognitive functioning. This suggests that perceptions about their aging experience can influence how individuals behave towards computer technology by impacting important predictors of use behavior. Interventions promoting positive self-perceptions of aging may thus contribute to the digital inclusion of middle-aged and older adults. • Positive self-perceptions of aging were associated with greater computer use behavior. • Cognitive functioning mediated this relationship across two longitudinal studies. • This was found among middle-aged and older adults from the United States and Germany. • These findings were consistent across different cognitive domains and use measures. [ABSTRACT FROM AUTHOR]