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Since the implementation of China's open-door policy in 1978, the number, structure, and environmental conditions of rural settlements have changed dramatically. This study examined the changes in rural settlements and the factors behind rural change in Guangdong Province using land-use datasets from 1980, 1990, 1995, 2000, 2005, 2010, and 2015, a digital elevation model, and data for transport networks and physical characteristics. Different stages of change in the rural settlements became evident: there was expansion from 1980 to 2000 and rapid decline from 2000 to 2010. Urban growth was facilitated by converting high-production cropland. The density of rural settlements was highest in areas with medium-level development: the density was highest in eastern and western parts of the province, lower in the center, and lowest in the north. The patterns and changes in rural settlements were most strongly related to water sources and transport systems; however, some physical variables (terrain, precipitation, and temperature) were significantly associated with the probability of occurrence of rural settlements. We argue that comprehensive, systematic planning systems should be established for rural areas and that it is necessary to recognize the value of the cultural heritage of southern Guangdong. To ensure the success of a rural revitalization strategy, it is important to introduce regional development schemes that resolve inequalities between less and more economically developed areas.

Resume Buts de l’etude Plusieurs auteurs identifient la motivation au changement comme un aspect important de l’intervention aupres d’individus atteints d’anorexie mentale. Le Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) a ete developpe afin d’evaluer la motivation a changer specifiquement chez cette population. Cette etude visait a valider une version francophone du ANSOCQ. Patients et methode Quatre-vingt-deux adolescents atteints d’anorexie mentale, ou d’un trouble de la conduite alimentaire non specifie, ont rempli l’ANSOCQ, l’University of Rhode Island Change Assessment Scale, le Motivation Stages of Change for Adolescents Recovering from an Eating Disorder et l’Eating Disorder Inventory-3 au debut de leur hospitalisation. Cinquante-deux ont repondu aux memes questionnaires a la fin de leur hospitalisation. Resultats L’ANSOCQ a montre une excellente coherence interne et une grande convergence entre ses sous-echelles. Sa validite a ete soutenue par des associations a d’autres questionnaires portant sur la motivation au changement. De meme, les sous-echelles du ANSOCQ etaient associees differemment a l’intensite du trouble de la conduite alimentaire et des difficultes psychosociales associees. Conclusion Ces resultats appuient la qualite psychometrique de cette version francophone de l’ANSOCQ. La pertinence de distinguer les trois sous-echelles du test semble en outre prometteuse etant donne les differences observees entre celles-ci.

The aim of this study is to examine the structural relationship in the transtheoretical model (TTM) of behavioural change constructs among undergraduate students. A cross-sectional study was carried out by randomly selecting students participating in campus co-curricular activities. Questionnaires, comprising queries on the stages of change (SOC) — an 18-item self-efficacy (SE) scale, a 10-item decisional balance (DB) scale, and 30-item processes of change (PoC) scale — were distributed to the students. Their answers were analysed using Mplus 8 software for structural equation modelling. There were 562 participants comprising 118 males (21.0 %) and 444 females (79.0 %) with average age of 19.81±1.22 SD. Most of them were involved in sports (46.3 %) and non-sports (46.6 %) programmes, and exercised at least three times per week for approximately 43 minutes per session. Minority of the undergraduate students (7.1%) are involved in uniform group. The initial hypothesized structural equation modelling showed that the data fitted well. The fit indices were within recommended values (CFI= 0.967; TLI= 0.939; SRMR= 0.034; RMSEA (CI: 90%) = 0.049 (0.028, 0.070); RMSEA p= 0.495). There were three hypothesized path relationships in this model. From the final structural model, the SOC had significant direct effects on SE (p = 0.001), DB (p

Purpose The aim of this study was to discover whether a school-based sun protection program (SPP) developed in line with the transtheoretical model (TTM) had an impact on students in an intervention group in the stages of change of developing sun protection behavior, reducing the number of sunburns adolescents sustain, and in terms of their perceptions of pros and cons and self-efficacy, as compared to the control group. Design and methods This study was designed as pre−/posttest control group semi-experimental research. The research was carried out with 376 adolescents in two schools. One of the schools was randomly designated as the intervention group of students and the other represented the control group. The chi-square test and the two-way repeated measures analysis of variance were used in the analysis of the data. The SPP formed the basis for the program. Results The control group's sunscreen use and sun avoidance stages were behind and their self-efficacy mean scores significantly lower than the intervention group after the implementation of the SPP (p Conclusions The study showed that a SPP was effective in achieving progress in the TTM for sun protection. It can be suggested that school nurses will find it useful to make use of the sun protection program. Application to practice School nurses who provide protective healthcare services can play an effective role in reducing the exposure of children and adolescents to the sun and promoting the development of sun protection behavior in schools.

Dental caries and periodontal diseases are preventable. Nevertheless, they remain prevalent. Dental practices offer an ideal setting for educating patients about oral health-related behavior change. This article describes the motivational communication approach to changing behavior and applies it to a discussion of behavior change communication over the course of life. CONTENT considerations focus on on identifying high-priority behaviors for change; patient affect, behavior, and cognition related to these behaviors, and understanding in which stage of change the patient is. Process the four principles of the Motivational Interviewing approach by Miller & Rollnick to analyze oral health-related behavior change over the life course.

Objectives This study investigated the effects of messaging on physical activity (PA) motivation, and whether the effectiveness of messages aimed to promote either affective benefits, physical health benefits, or a combination of benefits varied based on one’s current PA status. Methods Adult participants (N = 188) completed an online survey assessing demographic information and current stage of change. They then viewed one of four randomly assigned promotional flyers for a campus PA program. The flyers mentioned either the: (a) affective benefits of participation, (b) physical health benefits, (c) a combination of affective and physical health benefits, or (d) a control message. Participants then responded to questions about the flyers, their perceived control for participating, followed by their interest, intention to participate, likelihood of participating, and whether they wanted to sign-up. Results A 2 (activity status) x 2 (affective message) x 2 (physical health message) between-subjects ANOVA found that the effectiveness of the promotional messages on overall cognitive motivation (i.e., a combination of interest, intention, and likelihood of participating) varied based on the respondents’ PA status. Simple effects showed that messages promoting affective benefits led to greater scores for those who are active. A logistic regression showed that PA status, message condition, and their interactions were non-significant predictors of participants’ agreeing to schedule a session in the program. Conclusion Using specific messages to sell PA may help increase motivation. However, the type of message that effectively promotes PA appears to vary depending on the message receiver’s current PA.

The purpose of this study was to examine the effects of a drinking-reduction program on drinking behavior, stages of change, drinking refusal self-efficacy, and resilience in Koreans with moderate alcohol use disorder. This study used a quasi-experimental nonequivalent control design. This study was performed from March 2015 to July 2015. The drinking-reduction program was conducted once per week for 11 weeks. This program improved drinking behavior, stages of change, drinking refusal self-efficacy, and resilience in the experimental group compared to the control group (p .05, n = 34). The drinking-reduction program can be used as a nursing intervention for people with moderate alcohol use disorder.

The potential of cycling for a sustainable city development has been widely recognised nowadays. However, as noticed in many of the studies on cycling behaviour, seeing the bicycle as an essential transport mode for the development of the city is not a universal belief. In that way, cycling is still neglected in urban transport planning in some cities, or ‘starter cycling cities’, where they can be found behind in promoting the mode, depicted in their residual cycling share and poor conditions offered. One such challenge is to anticipate a starting point for the future development towards soft transport modes instead of expecting an external after-effect. In response to that, policy makers and planner practitioners need to engage in implementing efficient pro-bike transport policies. Understanding that a resistance to the adoption of cycling solutions can be presented by individuals, as well as policymakers and planning practitioners, this research aims at building a conceptual method able to identify an attitude change of urban planners towards the cycling potential of their city under mediators of change techniques that in this case attempts to create awareness on the potential for cycling of a starter cycling city. Shaped on the Transtheoretical Model of Change and the principles of attitude change, professional attitudes towards cycling were assessed through belief-based surveys and classified into the following stages of change profiles: resistant, sceptic, interested, enthusiastic, and committed. For the application of the method, we involved a number of local practitioners from two Portuguese starter cycling cities in a series of workshops. Attitudinal surveys were implemented prior to the first workshop and after the last one. The method showed significant potential in assessing attitude change, when we found that previous attitudes corresponded to the expectations and that over half of planners involved showed more positive attitudes towards cycling after the workshops.

The working alliance is a key element to increase intimate partner violence (IPV) offenders' motivation, adherence to treatment, and active participation in batterer intervention programs (BIPs). The objective of the present study is to assess the psychometric properties and factor structure of the Working Alliance Inventory-Observer Short Version (WAI-O-S) with a sample of IPV offenders. The sample was 140 men convicted for IPV and court-mandated to a community-based BIP. Inter-rater agreement and reliability were evaluated by computing the intraclass correlation coefficient. To test the latent structure a Bayesian confirmatory factor analysis approach was used. To test criterion-related validity, the WAI-O-S factorial scores were correlated to protherapeutic behavior, stage of change and motivation to change. The WAI-O-S showed an adequate reliability. Results from Bayesian confirmatory factor analyses showed two first-order factors (La alianza terapéutica es clave para incrementar la motivación, adherencia al tratamiento y participación en los programas de intervención con maltratadores. El objetivo del presente estudio es evaluar las propiedades psicométricas y estructura factorial delSe utilizó una muestra de 140 hombres condenados por violencia de género y derivados a un programa de intervención con maltratadores. El acuerdo inter-jueces y la fiabilidad se evaluaron mediante el coeficiente de correlación intraclase. La estructura latente se obtuvo con un análisis factorial confirmatorio Bayesiano. Las puntuaciones del WAI-O-S se correlacionaron con la conducta proterapéutica, estadio y motivación para el cambio para analizar la validez.El WAI-O-S mostró una fiabilidad adecuada. El análisis factorial confirmatorio dio lugar a dos factores de primer orden (Vínculo y Acuerdo), y un factor de segundo orden (Alianza terapéutica general). Los resultados obtenidos también avalan la validez del instrumento.Una medida observacional fiable y válida de la alianza terapéutica, proporciona una herramienta útil para superar las limitaciones de las medidas basadas en auto-informes que se utilizan con población de hombres maltratadores, tales como la deseabilidad social, la negación y el engaño.

Objective To evaluate obesity counseling competence among residents in a primary care training program Methods We delivered a 3 h obesity curriculum to 28 Primary Care residents and administered a pre-curriculum and post curriculum survey looking specifically at self-assessed obesity counseling competence. Results Nineteen residents completed both the pre curriculum survey and the post curriculum survey. The curriculum had a positive impact on residents’ ability to ascertain patient’s stage of change, use different methods to obtain diet history (including 24 h recall, food record or food frequency questionnaire), respond to patient’s questions regarding treatment options, assist patients in setting realistic goals for weight loss based on making permanent lifestyle changes, and use of motivational interviewing to change behavior. When looking at the 5As domains, there was a significant improvement in the domains of Assess, Advise, and Assist. The proportion of residents with a lower level of self-assessed obesity counseling competence reduced from 75% before the curriculum to 37.5% (p = 0.04) after the curriculum. Conclusion Our curriculum addressing weight loss counseling using the 5As model increased obesity counseling competence among residents in a primary care internal medicine residency program.

Lower meat consumption benefits public health and the environment. This study examined public willingness to reduce meat consumption in Denmark, and the drivers and barriers involved. An online survey (n = 1005), representative of the Danish population, carried out in 2019 measured meat dietary habits and willingness to reduce meat intake using the Stages of Change model, and barriers to, and drivers of, reduction. Approximately 3.5% of those surveyed did not eat meat (vegetarians/vegans), 57% had no intention to reduce their meat intake (with 5% planning to increase it). About 11.5% intended to reduce, and 27.5% had already reduced their meat intake (a slightly higher share than previously observed). Importantly, those stating that they had already reduced also ate significantly fewer meals with meat than those with no intention or an intention only. Drivers of meat reduction included awareness of the climate impact of meat and social networks containing meat reducers and avoiders. Barriers included food neophobia, identity incongruence, habitual behavior and practical difficulties. Strategies should focus on meat reduction, not exclusion, as completely removing meat from the diet was unpopular. As barriers and drivers differed with stage, we call for specialized campaigns. Consumers not intending to reduce meat intake could potentially be persuaded by climate awareness campaigns, and by promotion of small adaptations to familiar meals. Consumers intending to reduce meat intake may be prompted to do so by health awareness campaigns, changes to the choice architecture and increased availability of meatless meals.

Sustainable transportation (ST) refers to any form of commuting other than single occupancy vehicle usage. This study prospectively examined the pros, cons, and self-efficacy for ST as predictors of stage transitions over a period of 6 months. Participants included 656 Chinese college students and workers. They completed a translated questionnaire on their ST stage (from Precontemplation to Maintenance), pros, cons, and self-efficacy. Six months later, the participants completed another questionnaire on their stage of change. The data on the participants in the pre-Action and post-Action stages were combined to predict forward transitions out of the pre-Action stages and backward transitions from the post-Action stages. Logistic regression analyses were conducted predicting 6-month stage transitions, either forward or backward, using baseline stage, pros, cons, and self-efficacy. Higher ST pros and, unexpectedly, lower ST self-efficacy predicted forward stage transitions among baseline participants who were not using ST. In contrast, lower ST pros and higher ST cons predicted backward stage transitions (regression) among those who at baseline were using ST. This study provides a preliminary understanding of predictive mechanisms of stage transitions for ST.

Stage-based theories of behavior change predict that people should have a different need for information in various stages. We tested this assumption in three studies on reduction of beef consumption on Norwegian samples. An information website was developed providing information on why and how to reduce beef consumption. In Study 1 (N=389), user behavior on this website was analyzed depending on the stage of change. It was found that people try to self-tailor the information, but do not fully succeed. In Study 2 (N=869) and Study 3 (N=3508) a randomized field experiment was conducted, comparing the effect of giving access to the section of the website matching the stage, to a control group with no access, a group with access to all information, and a group with a randomly selected stage-mismatched information. The tailored information outperformed the other conditions significantly. For reduction of beef consumption itself, the results were inconclusive. © 2017. This is the authors’ accepted and refereed manuscript to the article. LOCKED until 30.1.2019 due to copyright restrictions. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/

Self-regulation of driving has been proposed as an effective strategy to keep older adults driving safely for longer. Little is known of what influences older adults’ decision to adopt self-regulatory driving behaviours. Hassan et al. (2015) developed an initial model of self-regulation using the Precaution Adoption Process Model (PAPM) as a theoretical framework. The present study aims to build on the previous research by investigating whether a sample of older drivers can accurately be assigned to the PAPM stages of change. Further, the study aims to identify the psychosocial and environmental factors associated with different stages of the PAPM and those that predict the decision to adopt self-regulatory behaviour. Logistic regression analysis indicated that self-rated driving confidence, family feedback, self-rated quality of driving and driving relinquishment expectation were significant predictors of PAPM stages. Findings from this research have practical and theoretical applications for improving our understanding of the self-regulatory behaviours of older drivers.

Crossover youth have complex needs and can create difficulty for service providers who have to both provide effective services to the youth but also work with and navigate a system outside of their own. Professionals from the child welfare system and the juvenile justice system have recognized the need to work together to help crossover youth. A successful collaboration can be extremely beneficial to all those involved but certain barriers must be overcome. This study uses secondary qualitative analysis to examine the opinions of key professionals in both systems as they came together to create action plans to address issues facing crossover youth in their individual counties. Researchers identify common themes and discuss the importance of collaboration among systems and recognizing individual county's stages of change.

Background Protein choices are an important component of the environmental cost of the food system. It is important to consider the limited research done on protein choice decision making in college students. Students who are aware of their protein choices at the decision point in college may be more likely to practice sustainable food choices throughout their life. Objective To compare demographic, attitudinal and behavioral variables in college students between those who consistently think about the environmental impact of their protein choices (C) and those who are less concerned (L). Study Design, Setting, Participants Participants,18-24 years old, consenting to participate in this cross-sectional survey (n = 390), were recruited from introductory classes at a Northeastern university for extra credit. Participants were categorized by their response to “How often do you think about the impact of meat consumption on the environment?” with responses of “always” or “vegetarian” categorized as C and “sometimes” or “never” categorized as L. Measurable Outcome/Analysis Group (C and L) was compared using chi-square or t-test analysis for demographics, stage of change for environmentally conscious protein choice (EC), and green eating (GE), red meat consumption, and health consciousness. Results Participants were predominantly white (83%) females (80%); the mean age was 19.2 years old. C was more likely to include women (95%) (P Conclusions Students who consistently thought about the environmental impact of meat consumption differed from those who did not by sex, attitudes, and behavior, but future research is needed to determine if this is associated with a more sustainable lifestyle.

This paper presents results from a longitudinal study of the travel behaviour change associated with the London 2012 Olympic and Paralympic Games (the ‘Games’). The research examines commuter travel behaviour through a panel approach enabling an understanding of individual behaviour across three waves (before, during and after), with the study utilising unique access to a Transport for London panel study (n = 1132). The findings indicate that a substantial amount of change occurred during the Games (54% made at least one change), with reducing or re-timing journeys being the most likely adaptations made. A key objective of this work was to advance the discussion about the theoretical constructs that are most applicable in the study of behaviour change associated with disruptive events, which was done through the application and critical evaluation of the Transtheoretical Model. The insights from the stages of change element of the model were relatively limited but the analysis shows significant differences in the underlying factors explaining change according to the type of change made (reduce, re-time, re-mode and re-route). Whilst the long-term behavioural impacts of events like the Games appear small, the study has uncovered a need to consider these behavioural choices as distinct rather than under the collective term of “travel behaviour change”, as is current practice.

Objective: To measure change in patient activation and self-efficacy in individuals with phenylketonuria (PKU) before and after a 6-month phone-based motivational interviewing (MI) intervention and determine the feasibility of implementing dietary counseling for PKU using an MI approach. Methods: Participants (n = 31) included preadolescents (7–12 years), adolescents (13–17 years), and adults (18–35 years) with early-treated PKU. Participants completed online questionnaires assessing self-reported stage of change (SOC), patient activation, and self-efficacy for PKU self-management behaviors. The intervention included monthly phone-based dietary counseling using MI during which participants set monthly goals. Results: Patient activation and self-efficacy were significantly different by age group (both p

Background Stage of Change (SOC)-based interventions have been effective for behavior change but few have been developed to assess sustainable eating behavior. No algorithm assessing motivational readiness to make environmentally-conscious protein choices has been previously developed. Objective To develop a SOC algorithm for environmentally-conscious protein (ECP) choices. Study Design, Setting, Participants Development was initiated using a cross-sectional survey of participants (n = 400) enrolled in introductory classes. Participants ranged from 18-24 years old and received extra credit for completion. The ECP SOC algorithm was recoded for this study categorizing participants as pre- or post-action. Measurable Outcome/Analysis ECP groups were compared using chi-square and t-tests for animal protein (AP) consumption, attitude toward food and long-term health impact (LTH), green eating SOC (GE), attitude toward plant-based foods (PBF), and attitude toward the impact of meat on the environment (MOE). Results Participants were predominantly white (83%), female (80%) and averaged 19 ± 1.2 years. Most participants (70%) were in pre-action stages for ECP. Fifty-seven percent in pre-action consumed AP 4-6 days a week vs 41% of those in post-action (P Conclusions The ECP SOC algorithm successfully distinguished pre- and post-action stages by behavior and attitudes. The consistency of these results with previous research provides support for the continued development of the ECP SOC algorithm. Future research is needed to validate this algorithm and to determine if it can be used for interventions to facilitate behavior change.

In a motivational interviewing (MI) framework of decision-making, we consider potential outcomes for both a primary choice and an alternative choice (DiClemente & Velazquez, 2002). Thus, we would expect that motivation to quit smoking is related to expectancies for quitting smoking and expectancies for continuing to smoke. While smoking expectancies have been frequently studied, less attention has been paid to abstinence expectancies. The present study sought to clarify the predictive utility of smoking and abstinence expectancies together for smoking motivation and behavior, versus measuring smoking expectancies alone. Expectancies were measured at baseline; outcomes were measured at baseline and one-month follow-up. Smoking expectancies were assessed via the Smoking Consequences Questionnaire-Adult (Copeland, Brandon, & Quinn, 1995), and abstinence expectancies were assessed via the Perceived Risks and Benefits of Quitting scale (McKee, O’Malley, Salovey, Krishnan-Sarin, & Mazure, 2005). Outcomes included motivation to quit (Contemplation Ladder, Biener & Abrams, 1991; Stage of Change, DiClemente et al., 1991), and average daily smoking rate. Data was analyzed for 183 smokers at baseline and 166 at follow-up. Baseline smoking expectancies and abstinence expectancies were each uniquely associated with concurrent motivation to quit, but not concurrent smoking rate. Abstinence expectancies uniquely predicted changes in smoking rate over time. Smoking and abstinence outcome expectancies may relate differently to smoking behavior, motivation to quit, and changes in these constructs over time.

The purpose of the present research was to examine how self-determined and non-self-determined motivation for eating was related to healthy and unhealthy eating behaviors at different stages of change. In Study 1 (n = 360), the structure of a new scale designed to measure healthy and unhealthy eating behaviors based on recent recommendations of the Canadian Food Guide was examined through Principal Component Analysis. Study 2 (n = 711) retested the structure of the scale and also examined whether women reported different patterns of motivation and eating behaviors depending on their stage of change for eating regulation. In Study 3 (n = 264), moderated mediation models were used to examine if eating behaviors served to mediate the relationship between motivation and waist circumference, and whether stages of change moderated the link from motivation to eating behaviors. Overall, the studies provided evidence for the 2-factor structure of the scale, where the first factor represents healthy eating and the second factor represents unhealthy eating behaviors. It was also demonstrated that as women moved along the stages of change for eating regulation, they reported higher levels of self-determined motivation and lower levels of non-self-determined motivation, as well as a higher consumption of healthy foods and a lower consumption of unhealthy foods. Finally, findings indicated that healthy eating fully mediated the relationship between self-determined motivation and waist circumference, and that the relationship between self-determined motivation and healthy eating was moderated by stages of change. Together, these studies highlight the interactive roles of motivation and stages of change in their association with healthy and unhealthy eating behaviors, as well as the importance of healthy eating for a lower waist circumference.

Physical activity has been shown to help individuals with schizophrenia improve their physical and mental health. Despite these benefits, individuals with schizophrenia are less active than those in the general population. This mixed-methods study explored the feasibility of a theory-driven exercise counseling intervention on the psychological mediators of physical activity behaviors and levels of moderate and vigorous physical activity in obese adults with schizophrenia. A reversible A-B-A single-case experimental design was used to evaluate the effect of exercise counseling before, during, and after the intervention. Post-study interviews evaluated the acceptability of the intervention. Four obese adults with schizophrenia participated in the two-month study. Exercise counseling proved feasible with three participants progressing to the next stage of change. Increases in self-efficacy and perceived benefits of exercise were reported throughout the intervention. Accelerometry indicated moderate and vigorous physical activity levels did not change for three participants and decreased significantly for one. This study helped show that exercise counseling may be an effective way of strengthening the determinants of physical activity. Future research will need to address strategies to increase moderate and vigorous physical activity using exercise counseling.

To develop and validate an instrument to assess environmentally conscious eating (Green Eating [GE]) behavior (BEH) and GE Transtheoretical Model constructs including Stage of Change (SOC), Decisional Balance (DB), and Self-efficacy (SE).Cross-sectional instrument development survey.Convenience sample (n = 954) of 18- to 24-year-old college students from a northeastern university.The sample was randomly split: (N1) and (N2). N1 was used for exploratory factor analyses using principal components analyses; N2 was used for confirmatory analyses (structural modeling) and reliability analyses (coefficient α). The full sample was used for measurement invariance (multi-group confirmatory analyses) and convergent validity (BEH) and known group validation (DB and SE) by SOC using analysis of variance.Reliable (α.7), psychometrically sound, and stable measures included 2 correlated 5-item DB subscales (Pros and Cons), 2 correlated SE subscales (school [5 items] and home [3 items]), and a single 6-item BEH scale. Most students (66%) were in Precontemplation and Contemplation SOC. Behavior, DB, and SE scales differed significantly by SOC (P.001) with moderate to large effect sizes, as predicted by the Transtheoretical Model, which supported the validity of these measures.Successful development and preliminary validation of this 25-item GE instrument provides a basis for assessment as well as development of tailored interventions for college students.

Objective To assess the effects of an environmental intervention based on the transtheoretical model to increase access to nutritional information about vegetable consumption in workplace cafeterias. Design Nonrandomized controlled trial. Setting Sixteen workplaces with cafeterias in Niigata, Japan, were assigned to intervention (n = 8) or comparison sites (n = 8). Participants A total of 349 Japanese male workers aged 20–59 years, who visited the cafeterias ≥ 3 times/wk. Intervention For the intervention group, 12 types of table tents containing information on increasing vegetable consumption, based on the transtheoretical model stages and processes of change, were distributed to cafeterias for 24 weeks in 2009. Information was presented according to the sequence suggested by the stages of change. Main Outcome Measures Vegetable consumption in the cafeteria and per day and stage of change were assessed using self-administered questionnaires. Analysis Differences between groups were tested using a generalized linear model adjusted for age, work environment, and position. Results The difference in the stage of change was not statistically significantly different ( P = .05), but the intervention group (n = 181) had increased vegetable consumption in the cafeteria (+0.18 servings; P = .01) and per day (+0.32 servings; P = .01) vs the comparison group. Conclusions and Implications The findings suggest a beneficial effect of providing access to nutrition information about vegetable consumption as an environmental intervention in workplace cafeterias.

ispartof: Schizophrenia Research vol:197 pages:568-569 ispartof: location:Netherlands status: published

ResumenEl principal objetivo del presente trabajo es comprobar si el Programa Emocional para Presos por Violencia de Género (Rodríguez-Espartal, 2012) resulta más eficaz que el tratamiento cognitivo-conductual o la ausencia de tratamiento en hombres presos por violencia contra las mujeres. Participaron 36 presos por delitos de violencia de género que cumplen condena en la Prisión Provincial Jaén II, distribuidos en tres grupos en función del tratamiento: cognitivo-conductual (n=11), emocional (n=13) y control (n=12). La eficacia del tratamiento se midió por los resultados en una serie de variables cognitivo conductuales: pensamientos distorsionados sobre la mujer y sobre el uso de la violencia, expectativas de cambio, agresividad, ira, impulsividad y etapas de cambio. Los resultados muestran un mayor descenso de los pensamientos distorsionados sobre la mujer y sobre el uso de la violencia y unas mayores expectativas de cambio en aquellos hombres que han recibido el tratamiento emocional. Respecto al resto de variables, no se ha producido ningún cambio en los hombres que han recibido tratamiento, pero sí un aumento de resultados negativos en el grupo control. Los resultados subrayan la necesidad de realizar programas de intervención con maltratadores, así como de seleccionar el tratamiento más adecuado a las características de estos hombres.AbstractThe main objective of this research was to analyze whether the Program for Prisoners for Emotional Domestic Violence (Rodríguez-Espartal, 2012) is more effective than cognitive-behavioral treatment or no treatment in inmates imprisoned for violence against women. Participants were 36 male imprisoned for crimes related to violence against women in the Provincial Prison of Jaén II, divided into three groups according to treatment: cognitive-behavioral therapy (n=11), emotional (n=13), and control (n=12). The efficacy of treatment was measured by its influence on a series of cognitive behavioral variables: distorted thoughts about women and the use of violence, expectations about change, aggression, anger, impulsivity, and stages of change. There was a greater decrease in distorted thoughts about women and the use of violence and an increase in the expectations about change in inmates who received emotional treatment. No change was found in other variables among inmates receiving treatment but there was an increase in negative results in the control group. Our results highlight the need for batterer intervention programs and to select the treatment that best fits the characteristics of these men.

Purpose The current study focuses on the development and validation of the Decisional Balance Scale for Adolescent Offenders (DBS-AO). This measure was designed to systematically evaluate adolescent offenders’ motivation to end or maintain their criminal behaviors, a critical yet missing component for most assessment measures and treatment programs focused on adolescent offenders. Method Items based on the decisional balance theory were generated via focus groups and refined through confirmatory factor analyses (CFA) using 238 adolescent offenders from a maximum-security institution. Their results were compared to the stages of change and psychopathic characteristics. Results The CFA demonstrated a good fit for a three-factor model. The first scale, Cons, assesses the negative consequences of ending criminal behavior (e.g., monetary loss). In contrast, the Pros-Self evaluates the positive consequences for offenders when they terminate criminal activities (e.g., improved self-respect). Finally, the Pros-Others considers the positive consequences experienced by significant others when offenders stop engaging in crime (e.g., increased safety). The DBS-AO three scales demonstrated good scale homogeneity and initial evidence of construct validity with the Stages of Change scale. Conclusions The DBS-AO provides a theory-driven model for addressing motivational issues for adolescent-offender treatment, which is currently lacking in most interventions for adolescent offenders.

Objective To assess the construct validity of a milk consumption Stages of Change (SOC) algorithm among adolescent survivors of childhood cancer ages 11 to 21 years (n = 75). Methods Baseline data from a randomized controlled trial designed to evaluate a health behavior intervention were analyzed. Assessments included a milk consumption SOC algorithm and hypothesized theoretical and behavioral predictors of SOC. Results Compared with survivors who expressed no readiness to change, those expressing readiness to change behavior for both 2 and 4 daily servings of milk reported more frequent milk consumption ( P P = .006), and were more likely to meet age-specific recommendations for daily calcium intake ( P = .01). Conclusions and Implications Results provide support for the construct validity of the milk consumption SOC algorithm relative to behavioral criteria. Research is needed to further examine algorithm validity with respect to theoretical predictors of SOC.

This paper describes the stages of change in fruit and vegetable intake among patients with atherosclerotic disease, identifying demographic, socioeconomic, and health predictive factors for each stage of change. It is a cross-sectional study of 290 consecutive patients with atherosclerotic disease submitted to endovascular procedures in two referral hospitals. The staging algorithm included intentional and behavioral criteria, and patients were categorized into "pre-action" (pre-contemplation, contemplation, and preparation), or "action" (action, non-reflective action, and maintenance). Most of the patients were in action for the fruits intake (67.9%) and pre-action for the vegetables intake (69.1%). The logistic regression analysis for the stages of action change for fruits intake has identified as predictive factors, the higher level of education and consultation with a cardiologist. For the stages of action change for vegetable intake, absence of abdominal obesity, previous cardiac surgery, and consultation with dietitian have shown significant association. This study has shown differences in the distribution of stages of change for the fruits and vegetable intake among the patients with atherosclerotic disease. The different predictive factors for the stage of changes for fruits and vegetables suggest that approaches of nutritional orientation of the individuals must be distinct for each eating behavior.

The Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN) developed an evidence-based practice program, Setting Universal Cessation Counseling Education and Screening Standards (SUCCESS), to educate nurses and other health care practitioners about smoking cessation interventions, increase the number of practitioners providing smoking cessation interventions, and deliver a smoking cessation intervention program to childbearing women who smoke. The development, implementation, and outcomes of the SUCCESS program are described.

Individuals vary in the degree in which they are willing to make significant changes in areas of their daily life, especially after an illness or injury. Motivational interviewing (MI) has been used to predict a persons’ readiness to change and to build the necessary intrinsic motivation that is needed to make difficult changes. The article describes the stages of change model and strategies that can be applied to patients in different stages of change. Vignettes are provided to apply the various principles of MI and to assist hand therapists with an approach that supports the recovery efforts of their patients.

There are large disparities in cigarette smoking rates by socioeconomic status (SES) in many countries. There is mixed evidence about the relative effectiveness of smoking cessation media campaigns in promoting quitting between lower and higher SES populations, and studies suggest that some types of ad content may have differential effects by SES. We analyzed data from five waves of the New York Media Tracking Survey Online (MTSO), a web survey involving over 7000 adult smokers conducted between 2007 and 2009, to assess SES variation in response to smoking cessation ads. Smokers with low levels of education and income less often recalled ads focused on how to quit, and perceived them as less effective, than ads using graphic imagery or personal testimonials to convey why to quit. Contrary to predictions offered by the Stages of Change Model, we found no evidence that variation in readiness to quit smoking explained patterns of response by education. Results offer guidance for theorists and campaign planners in developing campaigns that are likely to promote cessation among less educated populations.

Summary Objective To determine the effectiveness of ergonomic training on postural habits and computer operators’ psychosocial mediating variables based on the transtheoretical model (TTM). Design A prospective randomized controlled trial. Setting Departments of two universities in Qazvin, Iran. Participants One hundred and thirty-four of operators, mean age 31.0 ± 7.2 years, who worked at a computer for a minimum of 20 h per week. The subjects were divided into intervention (n = 67) and control (n = 67) groups. Intervention The intervention group received a TTM-based intervention involving eight 2-h sessions, which included 45–60 min stage-matched ergonomic counseling, ergonomic behavior training, and a package of training materials comprising a facilitator's handbook and a handout regarding computer ergonomic guidelines (Ergo-Guidelines). Outcome measures Ergonomic knowledge, stage of change, self-efficacy, pros and cons, preventive behavior and rapid upper limb assessment (RULA) scores were measured at baseline, 3- and 6-month post-ergonomics training. Results Although both groups were homogeneous in all variables at baseline, the intervention group showed significant improvements in stages of change (P Conclusions Results from this study provide evidence that TTM-based ergonomic training among computer operators can improve postural risk factors for musculoskeletal disorders (MSDs).

Although patient education may promote motivation to change health behaviours, the most effective method has not yet been determined.This prospective, controlled trial compared an interactive, patient-oriented group program with lectures providing only information. We evaluated motivational stages of change and self-reported behaviours in three domains (sports, diet, relaxation) at four times up to one year (60% complete data) among 753 German rehabilitation inpatients (mean age 50 years, 52% male) with orthopaedic (59%) or cardiologic disorders (10%) or diabetes mellitus (31%).We found improvements between baseline and follow up regarding each outcome (p.001) in both groups. At the end of rehabilitation, participants of the interactive group, as compared to the lectures, showed more advanced motivation regarding diet (p.10) and sports (p=.006). Interactive group patients reported healthier diets both after 3 months (p=0.013) and 12 months (p=0.047), more relaxation behaviours (p=.029) after 3 months and higher motivation for sports after 12 months (p=.08).The superior effectiveness of the interactive group was only partly confirmed.This short, 5-session interactive program may not be superior to lectures to induce major sustainable changes in motivation.

Objectives To examine the relationships between stress events/intensity and exercise frequency, intensity, and duration, and to determine whether stage of change moderates these relationships. Design Prospective, 6-week longitudinal observational study. Method College-aged females ( N = 95) were recruited from undergraduate classes and completed a battery of questionnaires before a 6-week evaluation period. During this period, participants were asked to return a daily exercise log and to return a weekly stress events scale (Weekly Stress Inventory: Brantley, Jones, Boudreaux, & Catz, 1997 ). Results HLM analyses revealed that exercise stage of change interacted with stress (both event frequency and intensity) to effect: (1) the amount of exercise minutes/day reported per week, (2) the number of days of exercise/week, and, (3) mean RPE for exercise/week. For those in the maintenance stage, the number of stressful events were positively related to exercise frequency, intensity, and duration. This relationship was negative or nonexistent for all other stages combined. Likewise, stress intensity showed a positive relationship with exercise duration and a minimally positive relationship with exercise frequency for maintenance stage exercisers, compared to a negative relationship for all other stages combined. Conclusions These results suggest differential patterns of exercise engagement based on stage of change – with those in maintenance responding to stress with enhanced activity, while those in other stages were more likely to reduce physical activity. Implications for intervention design and theories of exercise behavior change are discussed.

Objective To explore the impact of coordinated statewide nutrition education on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) family behavior regarding fruits and vegetables, whole grains, and lower-fat milk. Design Survey of different cross-sectional samples of WIC families before and after education. Setting Intervention delivered at all WIC sites in California from April-September 2009. Participants Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,015 before and 3,004 after coordinated nutrition education. Intervention Education directed at families to eat more, and a greater variety of, fruits and vegetables; eat more whole grains; and drink lower-fat milk instead of whole milk. Main Outcome Measures Data collected by phone interview of women and caregivers on recognition of education messages, intention to consume, and change in family consumption of target food items. Analysis Means and frequencies computed. Chi-square and t tests used to compare responses before and after education and for Spanish and English subgroups. Results Following nutrition education, women and caregivers reported increased recognition of education messages, positive movement in stage of change for target food items, increased family consumption of fruits and whole grains, and replacement of whole milk with lower-fat milk. Impacts were similar for Spanish and English speakers. Conclusions and Implications Coordinated nutrition education in WIC can significantly influence consumption toward more healthful food choices.

Objective: Physical activity (PA) reduces cigarette cravings during smoking abstinence. However, little is known about quitters’ use of PA. This study aimed to: (1) determine the extent of quitters’ past and current use of PA as a cessation aid, while attempting to quit; (2) examine the relationship between use of PA and quitter characteristics and cognitions, within the Transtheoretical Model framework. \ud \ud Methods: Self-report surveys were completed by 181 smokers attending Stop Smoking Services in England and Scotland. \ud \ud Results: Twenty-two percent of quitters reported currently using PA to control their smoking, and 35% had used it during a previous quit attempt. Those in a more advanced stage of readiness for using PA as a cessation aid, held more positive beliefs regarding self-efficacy and outcome efficacy. \ud \ud Conclusion: Quitters were more likely to use PA to help them quit when they had greater belief in their own ability to use PA and in the efficacy of PA to help them to quit, and were also meeting weekly PA targets for health. \ud \ud Practice implications: Strategies by stop smoking advisors that aim to enhance client self-efficacy and outcome efficacy beliefs regarding PA as a cessation aid may help to increase the use of this behavioural strategy, since it seems that most quitters do not use PA.

Participation in regular physical activity has the potential to change the way we age. Evidence indicates that engaging in regular physical activity can provide dramatic physical, mental, and social benefits to older adults and decrease overall any-cause mortality. For older adults, the focus changes, and beside the promotion of health, maintenance of independent living becomes paramount. Nurse practitioners (NPs) must counsel older adults on the benefits of physical activity. The Stages of Change theory can be used to encourage older adults to change sedentary behavior and become more active.

The stages of change construct of the Transtheoretical Model have been successfully applied to examine physical activity adoption among adults. Thus far, little research on the stages of physical activity change has been focused on children. Therefore, the purpose of this study is to validate the stages of change with vigorous, moderate, and light physical activity, and sedentary behaviour among children. Two different samples (sample 1: n=513, 52% male; sample 2: n=258, 45% male) completed Godin's Leisure-Time Exercise Questionnaire and the physical activity stage questions. One-way ANOVAs revealed significant differences in both the samples between the stages of change for vigorous (sample 1: F=15.9, df=4508, p

We studied whether readiness to change predicts alcohol consumption (drinks per day) 3 months later in 267 medical inpatients with unhealthy alcohol use. We used 3 readiness to change measures: a 1 to 10 visual analog scale (VAS) and two factors of the Stages of Change Readiness and Treatment Eagerness Scale: Perception of Problems (PP) and Taking Action (TA). Subjects with the highest level of VAS-measured readiness consumed significantly fewer drinks 3 months later [Incidence rate ratio (IRR) and 95% confidence interval (CI): 0.57 (0.36, 0.91) highest vs. lowest tertile]. Greater PP was associated with more drinking [IRR (95%CI): 1.94 (1.02, 3.68) third vs. lowest quartile]. Greater TA scores were associated with less drinking [IRR (95%CI): 0.42 (0.23, 0.78) highest vs. lowest quartile]. Perception of Problems' association with more drinking may reflect severity rather than an aspect of readiness associated with ability to change; high levels of Taking Action appear to predict less drinking. Although assessing readiness to change may have clinical utility, assessing the patient's planned actions may have more predictive value for future improvement in alcohol consumption.

Patient education plays an important role in empowering patients who have allergic contact dermatitis. Having the knowledge about a disease process does not guarantee healthy behaviors. Through careful assessment of educational needs, awareness of stages of change that adults go through, and use of resources available to members of the American Contact Dermatology Society, nurses can provide patient education that completes the patch testing process.

An improved understanding of offenders' readiness to change would enhance our ability to assess and engage such readiness. This paper provides a critique of the Stages of Change Model (SCM) which is widely used to assess readiness to change with offenders. We argue that the SCM does not provide a sound theoretical basis for understanding offender readiness to change. We highlight problems measuring constructs with the SCM accurately and question the theoretical coherence and level of explanation of readiness to change offered by the model. The second section of the paper presents the Readiness to Change Framework (RCF) as an alternative theoretical framework for understanding readiness to change. The RCF has been designed as a generic framework for understanding readiness to change for multiple behaviors. The two models within the framework are described, and examples of how they may be useful to practitioners working in the area of readiness to change are presented. Finally, strengths, limitations, and potential further developments of the framework are discussed.

Longitudinal studies have been conducted to evaluate correlates of stage of change movement among adult smokers but no studies were found to be conducted among adolescent smokers. This study used longitudinal data to examine adolescents' abstinence self-efficacy over 10-week and six-month periods and determined whether stage transitions were associated with concomitant changes or baseline values in perceived abstinence self-efficacy, nicotine dependence and motivation to quit. From baseline to 10-weeks results showed a change in motivation to quit and baseline stage were significantly associated with stage progression and regression. Additionally, intervention school status was significantly associated with stage progression. On the other hand, baseline score for nicotine dependence predicted stage regression not progression. Adolescents' becoming more or less 'ready' to quit smoking are influenced by their nicotine dependence and motivation to quit.

Little is known about the relationship between motivational readiness for physical activity and quality of life (QOL) in long-term lung cancer survivors. Long-term survivors are considered those who are living 5 years or more following a cancer diagnosis. This project examined the relationship between a self-report measure of motivational readiness for physical activity and QOL in a sample of 272 long-term lung cancer survivors. Participants (54% male, average age 70 years old) completed the mailed survey an average of 6 years after being diagnosed with lung cancer. Survey measures included the stage of change for physical activity and a set of single item QOL and symptom scales. Thirty-seven percent of respondents reported they currently engaged in regular physical activity (a total of 30 min or more per day, at least 5 days per week). Kruskal-Wallis tests revealed that those who reported engaging in regular physical activity reported a better overall QOL, better QOL on all five domains of QOL functioning (mental, physical, social, emotional, and spiritual), and fewer symptoms compared to those with a sedentary lifestyle. Physical activity level may have important QOL and symptom management benefits for long-term lung cancer survivors.

Objectives This study examined differences in motives for and in barriers to physical activity participation in middle-aged Chinese women between activity levels and motivational styles. Design Cross-sectional study. Methods Chinese middle-aged women ( N =360) completed a battery of questionnaires about level of physical activity, reasons for and barriers to physical activity participation, and general motivational style. Results Eighty percent of the women were classified into precontemplation , contemplation , or preparation stages of physical activity, indicating the majority were not physically active enough to achieve health benefits. Fitness–health , enjoyment–interest and appearance were found to be the most important motives for, and lack of time , resources or skills and family or friend support the most important barriers to participation. Women in the later stages of physical activity behavior were more likely to exhibit greater motive strengths and to perceive fewer barriers compared to those in the earlier stages. Among a number of motivational style results, women in the later stages were found to be more arousal-seeking and to rate challenge of activities and improving competence higher than women in the earlier stages. Also, having a mastery motivational style and a higher income were strong predictors of physical activity participation in these middle-aged women. Conclusion The findings of the present study extend the literature by providing insights into how women's motives for and barriers to physical activity participation are related to their activity levels and motivational styles. The implications of the results for physical activity promotion and provision with regard to benefiting women's health are discussed.

Despite widespread use of dietary supplements, little is known about correlates and determinants of their use. Using a diverse sample from 7 interventions participating in the Behavior Change Consortium (n ¼ 2539), signal detection methodology (SDM) demonstrated a method for identifying subgroups with varying supplement use. An SDM model was explored with an exploratory half of the entire sample (n ¼ 1268) and used 5 variables to predict dietary supplement use: cigarette smoking, fruit and vegetable intake, dietary fat consumption, BMI, and stage of change for physical activity. A comparison of rates of supplement use between the exploratory model groups and comparably identified groups in the reserved, confirmatory sample (n ¼ 1271) indicates that these analyses may be generalizable. Significant indicators of any supplement use included smoking status, percentage of energy from fat, and fruit and vegetable consumption. Although higher supplement use was associated with healthy behaviors overall, many of the identified groups exhibited mixed combinations of healthy and unhealthy behaviors. The results of this study suggest that patterns of dietary supplement use are complex and support the use of SDM to identify possible population characteristics for targeted and tailored health communication interventions. J. Nutr. 138: 205S‐211S, 2008.

Up to 60% of ambulatory primary care patients have psychosocial factors contributing to their symptom presentation. Counseling, although helpful, is seen as requiring specialized training that most primary care physicians lack, as well as being complex and time-consuming. Several counseling methods have been developed that are brief, relatively easy for the physician to learn and implement, and patient-centered. These include the BATHE technique, the FRAMES strategy, the Stages of Change (Transtheoretical Model) approach, and Motivational Interviewing. Although limited, available research suggests that carefully targeted brief counseling in medical settings does produce meaningful change.

Objectives Two studies were conducted to evaluate the reliability and predictive validity of measures of intrinsic and extrinsic motivation for exercise, and to examine differences in motivation as a function of stage of motivational readiness for exercise. Design A cross-sectional design was employed in study one, and a longitudinal design was used in study two. Methods In study one, 184 healthy college students completed instruments to measure motivation and exercise stage. Intrinsic and extrinsic motivations were factor analyzed into subscales and validated in study two on a second sample of college students (n=220) by analyzing shifts in endorsement of motivation subscales from the beginning to end of the academic term. Results In both samples, intrinsic motivation for exercise was most highly endorsed in maintenance and lowest in contemplation stage. All extrinsic motivation subscales except tangible rewards were also most highly endorsed in maintenance compared to other stages. In study two, students in activity classes (n=72) endorsed both intrinsic and extrinsic motivation more than those in lecture classes (n=70). Relative to patterns of physical activity, intrinsic motivation was greater than extrinsic motivation for the continually active group, and decreased for the continually inactive group. Exercise maintenance was fostered by greater intrinsic relative to extrinsic motivation. Conclusion Intrinsic and extrinsic motivation can be decomposed into meaningful subfactors that are differentially related to exercise adoption and maintenance.