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This study compares the problem-focused emotion regulation strategies used by 200 female survivors of intimate partner violence (age: M = 40.16, SD = 11.27, 18 – 66 years) to cope with violence throughout various stages of change (SOC). It examines the relationship between problem-focused coping strategies and positive and negative affect, and the impact of these variables on the different SOC. Results suggest that victims differ and are flexible in the use of strategies throughout the various SOC. During the initial stages, victims tend to use passive/maladaptive behaviors that hamper change, while in the later stages they use more active/adaptive strategies to leave the abusive relationship.

Tobacco smoking is the leading cause of death in the world, accounting for more than eight million casualties. To reduce the prevalence of smoking, government and nongovernment players use interventions to reduce smoking and/or incite smoking cessation. These interventions are based on behavior change models. Foremost among those models is the Transtheoretical Model of Behavior Change developed by Dr Prochaska. The transtheoretical model theorizes that smoking cessation is a stage-wise change. This change is enabled by a set of processes of change. The current study identifies the relationship between two basic constructs of the model: processes of change and stages of change. The study also identifies the relative importance of different processes of change in different stages of change. Data analysis from this study shows that different processes of change have a differing influence on various stages of change. Experiential processes have a significant influence on the precessation stages and lack significant influence on the postcessation stages. On the contrary, behavioral processes have a significant influence on the postcessation stages and lack significant influence on the precessation stages.

Background: Despite evidence of the protective effects of a diet high in fruits and vegetables, intake among Ohio adults remains low. A health communication campaign is an attractive behavior change intervention due to its potential to reach a large audience. Focus of the Article: This study aims to examine the development of a state-level health communication campaign and to assess outcome measures relative to fruit and vegetable intake. Research Question: Two research questions were evaluated: (1) How did Ohio State University Extension use formative research to inform the campaign’s development? and (2) Was campaign exposure associated with increased fruit and vegetable consumption or readiness to increase fruit and vegetable consumption among the target audience comprising Ohio adults eligible for the Supplemental Nutrition Assistance Program (SNAP)? Program Design/Approach: Ohio State University Extension conducted extensive formative evaluation prior to developing the Celebrate Your Plate health communication campaign. The campaign was designed to increase the target audiences’ fruit and vegetable consumption, reinforce messages taught in nutrition education classes, and reach a larger segment of the population with messages promoting healthy behaviors. The campaign was implemented statewide through a multi-year phased rollout and comprised a mix of printed and digital communication channels and an accompanying website. Supportive individual- and community-level programming was also implemented by Ohio State University Extension as part of a multilevel approach to increasing fruit and vegetable intake. Importance to the Social Marketing Field: The limited existing research on the effectiveness of health communication campaigns to increase consumption of healthy foods largely focuses on national campaigns and this study examines effectiveness of a locally tailored campaign. Methods: This study comprised a mixed-methods multi-stage evaluation: qualitative data were collected in four pilot counties to assess the target audience’s awareness and reception of the campaign and recommendations for future efforts. Cross-sectional post-implementation outcome evaluation data were collected and analyzed to assess campaign exposure and behaviors of the target audience. Results: During the pilot evaluation, the target audience responded positively to campaign materials and identified the perceived cost of healthy recipes as a main barrier to changing eating patterns. After the campaign was rolled out statewide, approximately 18% of the target audience indicated exposure to Celebrate Your Plate in aided recall. Campaign exposure was significantly associated with higher fruit ( p < .001) and vegetable ( p < .001) consumption. The Stages of Change model was used to conceptualize readiness to increase fruit and vegetable consumption; campaign exposure was significantly associated with readiness to increase fruit ( p = .001) and vegetable ( p = .027) consumption. Recommendations for Research or Practice: Results of this study show that campaign exposure is significantly associated with higher fruit and vegetable consumption and readiness to consume more fruits and vegetables among the target audience, though more rigorous evaluation is needed to determine causality. Limitations: This study included cross-sectional data and lacked a control group and consequently cannot be used to determine if behavioral observations resulted from campaign exposure. Additionally, this study relied on self-reported data and is susceptible to response biases.

The Transtheoretical Model (TTM) of behavior change predicts that patients go through different stages of change prior to changing their problematic behavior. This study aims to evaluate the utility and validity of this model in a sample of 549 court-ordered partner violent men. Three types of perpetrators with respect to their readiness to change were revealed. Those in more advantage stage of change use more processes to change their problem and present with higher levels of intimate partner violence (IPV). Low readiness to change levels and treatment drop-out predict short-term criminal justice recidivism, while treatment drop-out predicts medium and long-term recidivism. Results highlight the applicability of the TTM in IPV and its usefulness in designing behavioral interventions with this population.

The experience of transitioning into adulthood is a critical phase in life. The navigation of government benefits adds further complexity that can affect employment outcomes for youth with disabilities. Some individuals hesitate to work out of fear to losing access to monetary, disability, and related health care benefits. However, using available work incentives while pursuing employment and career paths can provide opportunities to work and address poverty without forgoing needed services. The Wisconsin Promoting Readiness of Minors in Supplemental Security Income (PROMISE) research grant aimed to positively change youth readiness to work through the use of Motivational Interviewing, work incentive benefits counseling, financial capability building, shifting expectations, and help in navigating transition resources. To measure the impact on readiness to work, 126 transition-age youth receiving supplemental security income (SSI), 188 of their family members, and 411 Division of Vocational Rehabilitation (DVR) counselors working with the youth and families completed a modified Stages of Change Scale survey. Results indicated that youths’ work readiness and positive feelings about work significantly increased from baseline to follow-up, along with an increase in employment rates. The implications of these findings highlight the utility of incorporating the stages of change theory into the design and implementation of services and supports to increase work readiness for youth with disabilities in transition.

This exploratory study investigates how emerging adults (EAs) experience catching feelings. Applying the Stages of Change Model and Relational Receptivity Theory, this study investigates how EAs understand the cognitive and behavior changes leading up to commitment and how they process precontemplation surrounding catching feelings. Using focus group interviews, collegiate EAs ( N = 17) define catching feelings as the unintentional, unexpected, and surprisingly desirable development of romantic feelings for another person (commonly beginning face-to-face). When confronted with catching feelings, EAs must delineate their preconditions for catching feelings and work through decision-making processes. Implications for relationship readiness, communication, and commitment are discussed.

Objective: This study evaluated the effect of a community-wide walking intervention (involving walking maps and events) on older residents’ walking and environmental perceptions. Method: In this nonrandomized quasi-panel study, older adults living in an intervention and control site were recruited at baseline and follow-up. All households in the intervention site received maps and were invited to participate in a walking event monthly. The intervention lasted for 21 months. The outcomes were walking frequency, duration, and perceptions of local environments. Results: We did not find a significant improvement in walking frequency or duration in the intervention site relative to the control site. However, there was a significant increase in the awareness of others being active and a marginal increase in the perception of aesthetics in the intervention site. Discussion: The increased awareness of others being active may be a positive step in the stages of change toward engagement in physical activity.

The health status and health behaviors among support staff providing daily support for people with intellectual and developmental disabilities (IDD-SS) in community-based organizations (CBOs) have not been systematically studied. This study examined the health impact of IDD-SS workers who participated in a HealthMatters Program: Train-the-Trainer Certified Instructor Workshop followed by implementing a 12-week HealthMatters Program for people with intellectual and developmental disabilities (IDD) that they care for as part of their employment. A total of 48 IDD-SS were enrolled into either an intervention ( n = 28) or control group ( n = 20). IDD-SS in the intervention group received an 8-hour HealthMatters Program: Train-the-Trainer Workshop immediately prior to teaching a 12-week HealthMatters Program for people with IDD. Assessments were conducted with IDD-SS before and after completing the 12-week HealthMatters Program to evaluate whether IDD-SS experienced any benefit of the training and teaching the program on their own health and health behaviors. Relative to the control group, the IDD-SS in the intervention group showed significant improvements in social/environmental supports for nutrition ( F = 4.92, p = .032), exercise outcome expectations ( F = 6.58, p = .014), nutrition outcome expectations ( F = 8.87, p = .005), fruit and vegetable intake ( F = 13.62, p = .001), knowledge of fruit and vegetable intake recommendations ( F = 11.25, p = .002), and stages of change for eating fruits and vegetables ( F = 6.86, p = .012). Results demonstrated that IDD-SS benefited from the health education programming. Findings support the need to develop programs and organizational policies for health promotion activities for direct care staff.

This article presents a single case study investigating the role of change communication in the early stages of change implementation at a European government agency. It adopts a multimethod approach, relying on quantitative methods and adding qualitative components to clarify core assumptions. The quantitative part of the research relies on a survey of 718 staff members, based on existing instruments—the ICA audit, the Organizational Change Recipients’ Belief scale, and the Cynicism about Organizational Change scale. The qualitative part of the research relies on 18 semistructured in-depth interviews. The findings demonstrate how a lack of clear, unambiguous communication proves a major obstacle for succeeding in unfreezing employees; it leads them to mainly think about their own self-interest, maintain the status quo and avoid needless risks.

This study explored the process of exiting and recovery from commercial sexual exploitation beginning in childhood, utilizing semistructured interviews with 11 adult female survivors who had been out of the commercial sex industry for at least six months. The narratives were analyzed using consensual qualitative research. Participants described a complex interface of internal motivation and external resources in the exiting process. They identified a need for comprehensive, nonjudgmental services across all stages of change, in order to support a profound reconstruction of identity and community. Subgroup comparisons revealed that women who were exploited at younger ages were more vulnerable to coercive and dehumanizing exploitation and required especially intensive services. These results support the methods of many survivor-led programs for sexually exploited youth. Implications of survivors’ perspectives for counseling, research, and advocacy are discussed.

Despite enormous social-psychological and economic consequences of substance abuse in youth and young adults, too little is known about effective interventions among substance users, both with and without ADHD. This special issue reports on four linked investigations that employed a novel research strategy when the Multimodal Treatment Children with ADHD Study (MTA) participants were between ages 21.7 and 27.3 years old (14-16 years after initial assessments). Using combination of in-depth qualitative narrative interviews and quantitative analyses (“mixed methods”) of 183 participants from four to six original MTA sites, investigators sought to obtain a more complete understanding of factors contributing to youths’ substance use (SU) initiation, maintenance, and desistence, (both among youth with ADHD and control participants). The articles in this special issue illuminate important new insights about possible influences contributing to SU, particularly persistent use/abuse. Findings also illustrate the benefits of mixed-methods studies, not only to better understand the linkages between ADHD and SU, but also to understand other areas of child/adult psychopathology.

The Dietary Guidelines for Americans recommend a 20–35 percent daily intake of fat. Resisting the temptation to eat high-fat foods, in conjunction with stage of readiness to avoid these foods, has been shown to influence healthy behavior change. Data ( N = 6516) from three randomized controlled trials were pooled to examine the relationships among direct intervention effects on temptations and stage of change for limiting high-fat foods. Findings demonstrate separate simultaneous growth processes in which baseline level of temptations, but not the rate of change in temptations, was significantly related to the change in readiness to avoid high-fat foods.

Electronic nicotine products remain popular among college students. These products contain heavy metals, carcinogens and the addictive substance nicotine. By understanding where students are in their behavior change can help to determine and focus messages and campaigns. The aim of this study was to assess predictors of the Transtheoretical model in college-aged vaping. This study consisted of an online/Ipad delivery of a voluntary survey to 1249 young adults/college students at 5 universities (International and within the U.S.). Data was analyzed using Stata. Regression analysis was performed to assess predictors of the stages in the Transtheoretical Model of behavior change. Our study found that women tended to be further along in the stages of change as compared to their male counterparts. Additionally, the older students were more likely to be in maintenance stage as compared to the younger students. The students who vaped longer tended to not have advance into any of the stages of change besides precontemplation. Understanding where students are in the stages of change can help to inform behavioral message campaigns enabling more focused targeting of messages and efforts to reduce consumption. Electronic nicotine products are highly prevalent on college campuses, both nationally and internationally. The nicotine is addictive and may result in less of a desire or ability to quit as young adults age.

Through routine screenings for sexually transmitted infections (STIs) and HIV, medical providers are able to motivate behavior change. Although established models rely on quantitative measures, doing so requires time and ability to score each. Listening for verbal cues, however, could simplify the process of suggesting HIV screenings. Using mixed methods to identify verbal indicators for readiness to change, this article conducted two phases of study. First using quantitative means of identifying participant’s knowledge of HIV, perceptions of safer sex, and readiness to change safer sex behaviors ( N = 487). Interviews were then conducted exploring the possibility of verbal markers for one’s readiness to change ( n = 25). Results confirmed the use of verbal markers when discussing perceptions of risk. Identification of verbal markers, at three stages of change, provides new possibilities for medical providers’ such as providing time saving and effective tools when seeking to motivate HIV and STI testing, and other safer sex behaviors.

This study examined self-efficacy (confidence to exercise), pros (exercise’s advantages), and cons (exercise’s disadvantages) as variables associated across the transtheoretical model’s six stages of change in 403 Japanese college students. A series of logistic regression analyses were conducted. Results showed that higher pros and lower cons were associated with being in contemplation compared to precontemplation. Lower cons were associated with being in preparation compared to contemplation. Higher self-efficacy was associated with being in action compared to preparation as well as being in maintenance compared to action. Lower cons were associated with being in termination compared to maintenance.

Motivational interviewing (MI) is an evidence-based, client-centered approach that provides a framework for the change process. Careful attention is given within MI to understand and meet clients across a continuum of readiness for change. While less readily applied to family counseling, MI facilitates therapeutic alliance, evokes motivation for change, and provides useful guidelines for conceptualizing and implementing family counseling services. This article (a) provides a brief overview of MI’s major tenets, (b) examines systems-level applications of MI principles, and (c) describes five counseling interventions developed by the authors that illustrate how MI may be integrated into family counseling practice.

Patients with lung cancer report more disease burden and lower spiritual well-being (SWB) compared with other cancer patients. Understanding variables that lessen disease burden and improve SWB is essential. The aim of this study was to explore the relationship between motivational level for physical activity and SWB in patients with lung cancer. Linear regression showed increased SWB as stage of change for physical activity increased (p

The CORFIS ( Community-Based Cardiovascular Risk Factors Intervention Strategies) program was piloted in community clinics in Malaysia to address the lack of health education in chronic disease management. The stages of change model was applied in a multicenter quasi-experimental design to evaluate adherence to advocated behaviors in CORFIS patients with hypertension. Based on submitted diet and exercise records ( n = 209), adherence to sodium reduction, regular exercise, and increasing fruit and vegetable intake behaviors were quantified against weight, waist circumference (WC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) changes. Patients were categorized at 6 months into nonadherent/N-A (Precontemplation, Contemplation, and Preparation), newly adherent/NA (Action) and totally adherent/TA (Maintenance) groups. Self-reported adherence records did not meet recommended targets for healthful behaviors, but clinical benefits were achieved by adherent groups as indicated by effect size (Cohen’s d) comparisons. SBP reduction was associated with adherence to sodium reduction in NA ( d = 0.60, p < .001) and TA ( d = 0.45, p < .001) compared to N-A ( d = 0.13, p > .05). Marginally increasing fruit and vegetable consumption (Δ = 0.41 servings) resulted in sizeable reductions in weight for NA ( d = 0.81, p < .001) > TA ( d = 0.54, p < .001) > N-A ( d = 0.21, p > .05) and in WC for NA ( d = 0.68, p < .00) > TA ( d = 0.53, p < .001) > N-A ( d = 0.52, p > .05). Exercise behavior was least successful as pedometer counting was below 10,000 steps but sizeable weight and WC reductions were largest for NA ( d = 0.71 and 0.79, respectively) > TA ( d = 0.60 and 0.53, respectively) > N-A ( d = 0.33 and 0.35, respectively). Patients reporting a shift to positive stages of change behaviors enjoyed clinically beneficial reductions in SBP, DBP, weight, and WC.

Nonsuicidal self-injury (NSSI) is a pervasive and potentially lethal behavior that affects many youth and adolescents. Effective treatment and prevention efforts are critical but often lack a nuanced understanding of the behavior change process. To address this gap, this research employs a stage of change model to identify and understand the most salient and widespread processes that facilitate NSSI behavior change. Thirty-one semi-structured interviews were conducted with individuals with current or past self-injury. Individuals were recruited to represent all stages of change including those who have not thought about changing behavior to those who have been NSSI-free for years. We employ a directed content analysis to code for dimensions derived from the model and an inductive approach to surface more nuanced change levers. Four organizing dimensions emerged: relational, behavioral, self-knowledge, and barriers. Common change levers of value in clinical practice or in intervention modalities are discussed.

High attrition often limits the efficacy of weight management programs, particularly those that serve primary care patients. We investigated stage of change and other predictors of retention in a behavioral intervention program that enrolled adult obese patients at three primary care sites. The program included practice improvements and provider training, as well as individual lifestyle counseling and educational group classes for participants. We analyzed predictors of whether participants returned for counseling visits and whether they attended group classes. The 461 participants were mainly women (84%) and minorities (87%), and most of them were in the preparation stage for dietary and physical activity changes. A total of 134 (29%) participants returned for at least one follow-up visit with their counselor and 85 (18%) attended at least one class. Baseline stage of change was not significantly associated with either return visits or class attendance (p = .875 and .182, respectively). Men and participants with children in the household were less likely to return for subsequent counseling sessions (p = .012 and .027, respectively). Age and employment were associated with class attendance (p = .099 and .034, respectively). Focus groups with participants confirmed that reasons for dropout included physical limitations or health issues, family issues, stress, and lack of social support. We conclude that prescreening of patients for readiness to participate and attention to personal barriers related to family and work might improve program retention. More frequent contacts between visits and stronger provider engagement might also strengthen the intervention.

We examined the validity of ‘Transtheoretical Model of Behavior Change’ six stages in exercise domain. A paper-pencil survey was completed by 457 workers. Self-efficacy tended to increase from Precontemplation to Action, did not change from Action to Maintenance, and then increase from Maintenance to Termination. Pros tended to increase and cons decrease only from Precontemplation to Action. A follow-up survey was completed by 331 workers. More preparers (25.4%) moved to Action compared to precontemplator (3.8%) and contemplators (6.5%). Relapse rates were lower among those in Termination (17.0%) than those in Action (43.8%) and Maintenance (38.1%). These results partially supported the validity.

The main objective of this study was to determine whether motivational and volitional variables identified in the health action process approach (HAPA) model can be used to successfully differentiate people with multiple sclerosis (MS) in different stages of change for exercise and physical activity. Ex-post-facto design using multiple discriminant analysis was used. Participants were 215 individuals with MS. The outcome variable was measured by the Physical Activity Stages of Change Instrument, along with motivational and volitional measures (severity, action self-efficacy, outcome expectancy, risk perception, perceived barriers, intention, maintenance self-efficacy, action and coping planning, and recovery self-efficacy). Participants in the precontemplation, contemplation, and action groups can be maximally separated by two significant canonical discriminant functions, volition and motivation. The action group can be differentiated from other groups based on high group mean (centroid) score on the volition function, and the precontemplation group can be differentiated based on low group means on both the motivation and volition functions. The contemplation group can be differentiated based on high centroid score on the motivation function. Research findings of this study support the concept of stage-matching exercise and physical activity intervention. The HAPA framework can be used to design health promotion behavioral interventions for people with MS in vocational rehabilitation.

The stage of change approach to smoking cessation posits that smokers can be divided into categories based on the extent to which they are motivated to quit smoking. Recent research, however, suggests that the stage of change algorithm systematically misclassifies smokers by underestimating motivation to quit. The hypothesis of the current study was that the systematic misclassification by the stages of change results in stages that blend together smokers varying widely in motivation to quit. We tested this hypothesis by contrasting the stages of change with the contemplation ladder (an alternative measure of motivation to quit smoking) using cross-sectional data on ten cessation-relevant variables. The sample consisted of 401 adolescent smokers. The results were consistent with the hypothesis. The cross-sectional analyses indicated that the contemplation ladder is a more discriminating measure of motivation to quit, and that the stage of change algorithm is an unnecessarily imprecise instrument.

The objective of this study was to assess the relationship between stage of change (SOC) and behavioral outcomes among African American women entering obesity treatment in two settings. Fifty-five overweight/obese (body mass index = 26.50-48.13), but otherwise healthy African American women, 23 to 56 years old, attended a 13-week weight loss–treatment program that took place at churches ( n = 36) or a university ( n = 19). Participants were weighed, completed SOC measures, and had a physical fitness test at pre- and posttreatment. Pretreatment measures of SOC placed 47% of the participants as actors, 31% as contemplators, and 22% as maintainers. Of the 45 women who reported posttreatment SOC, 7% regressed, 44% did not change, and 31% progressed in SOC. Pretreatment SOC predicted posttreatment weight loss in the church setting but not in the university setting. At churches, contemplators lost more weight than actors and maintainers. The church may be a more conducive setting for weight change behaviors for African American women who are categorized as contemplators in the SOC model.

A classification and regression tree (CART) analysis was applied to data for 237 male participants ( M = 31.93 years, SD = 7.64) in a prison-based substance abuse treatment program to study the integrity of the Stages of Change model of treatment readiness. Using the Stages of Change Questionnaire (STOCQ), participants were assigned to Contemplation (102), Action (118), or Maintenance (17) groups. A CART analysis then examined differences in the overall group profiles on the basis of scores on the Psychological Inventory of Criminal Thinking, the Situational Confidence Questionnaire, and the Carlson Psychological Survey. The assumption of discrete stages of change was not supported. Alternative models are suggested: one based on states of change and one on personality characteristics. A focus on equal attention to both cognitive and behavioral aspects of substance abuse treatment readiness is suggested.

Both the Stages of Change Model (transtheoretical model [TTM]) and solution focused brief therapy (SFBT) are widely used when counseling substance abusing clients, and there is broad support in the literature to document their effectiveness. Likewise, SFBT has also been applied in the martial and family counseling setting with good results. The authors found no documentation in the literature integrating the TTM and SFBT as a therapeutic technique. As both models are widely used, accepted, and have been empirically validated, after reviewing the pertinent literature, the authors propose a methodology incorporating both the TTM and the SFBT when working with non-substance abusing clients and their families.

This study examined the usefulness of the stage of change model and protection motivation theory (PMT) in creating brief persuasive appeals to promote healthy sun-behavior. College women ( N = 254) read one of four essays that manipulated the level of threat and coping appraisal. The transition from the precontemplation to contemplation stage was promoted by threat appraisal information, but transition from contemplation to the preparation stage occurred only when individuals were provided with both high threat and high coping information. Thus, brief communications based on PMT may create attitudes leading to behavior change when later, more intensive, interventions are introduced.

Purpose. An audience-centered approach was used to develop valid and reliable scales to measure adult self-efficacy to eat fruit and vegetables. Design. Cross-sectional survey of a national population. Setting. New Zealand. Subjects. A sample of 350 adults ages 25 to 60 years was randomly selected from a nationally representative sampling frame. Overall, 231 questionnaires were returned, producing a 72% response rate. The mean age of subjects was 42.7 years; 58% were female; 80% were of European descent; 11% were indigenous Maori. Measures. The 76–item, self-administered questionnaire collected data on demographics, fruit and vegetable intakes, stages of change, decisional balance, and self-efficacy (24 items). Analysis. Principal components analysis with oblimin rotation was performed. Results. Principal components analysis yielded three distinct and reliable scales for self-efficacy to eat “vegetables, ” “fruit, ”and “fruit and vegetables” (Cronbach α = .80, .85, and .73, respectively). These scales were correlated, but only the “vegetable” scale was positively correlated with the “fruit and vegetable” scale (Kendall tau r = 0.30, −0.26 [fruit, “fruit and vegetables”], −0.38 [fruit, vegetable]). As predicted, self-efficacy was associated with intake (r = 0.30 [fruit], 0.34 [vegetables]). Conclusion. Assuming the factor structure is confirmed in independent samples, these brief, psychometrically sound scales may be used to assess adult self-efficacy to eat fruit and to eat vegetables but not self-efficacy to eat “fruit and vegetables. ”

This study assessed whether college students in various stages of change relative to exercise adherence would rate self-efficacy and barriers to exercise differently. A total of 198 participants (49 men, 149 women) ranging in age from 17 to 38 years ( M = 20.4, SD = 2.3) completed surveys measuring exercise behavior, barriers to exercise, and both task and coping self-efficacy. Multivariate tests yielded significant differences in means on task self-efficacy, coping self-efficacy, and perceived barriers to exercise. Implications are that people who do not exercise or exercise sporadically perceive more barriers to exercise than those who exercise regularly. Also, people who exercise regularly rate their confidence higher (i.e., self-efficacy) to overcome obstacles to exercise. Health practitioners may find useful assessments of baseline self-efficacy and perceived barriers before implementing exercise programs.

The purpose of this study was to identify the stages and processes of change related to smoking cessation among vocational technical high school students to provide baseline data for smoking cessation programs. Cross-sectional data were collected in April and May, 2004, from 300 male students at three vocational technical high schools in Korean metropolitan areas. The survey instruments included: decisional balance; self-efficacy; nicotine dependence; stages and processes of change; and knowledge related to smoking. The results indicated that 31.7%, 39.2%, and 29.1% of current smokers were in the precontemplation, contemplation, and preparation stages, respectively, and that 42.6% and 57.4% of former smokers were in the action and maintenance stages, respectively. Decisional balance, self-efficacy, and nicotine dependence were significantly associated with the stages of change. Regarding the processes of change, only behavioral processes were significantly associated with the stages of change, with experiential processes showing no significant relationship. The study results suggest that smoking cessation programs should emphasize behavioral strategies to help students progress through the stages.

Objective. To conduct a rapid scoping review to explore the hypothesis that socioeconomic affluence is associated with a more advanced stage of change for health behaviors. Data Source. Key-word searches of MEDline, Embase, PyschINFO, and www.google.com were conducted. Study Inclusion and Exclusion Criteria. Studies identified by the searches were included if they were published between 1982 and September 2003, written in English, and reported information on the distribution of the stages of change for any health behavior according to a marker of socioeconomic position (SEP). Data Extraction. Data on the behavior studied, the sample studied, the measure of SEP used, the definitions of the stages of change used, and the distribution of the stages of change according SEP were extracted by a single reviewer. Data Synthesis. As far as possible, data were reanalyzed by the chi-square test to determine if there was evidence that the distribution of the stages of change varied according to SEP. A formal meta-analysis was not appropriate. Results. Twenty-one studies reporting data on 30 samples and 188,850 individuals were included. Significant variations in the distribution of the stages of change were found according to SEP, in the expected direction, in 16 (53%) samples representing 171,183 (91%) individuals. Conclusions. There is substantial published evidence that more-affluent people tend to be in more-advanced stages of change than are more-deprived people.

Interest has grown in the positive youth development (PYD) approach and its application to youth in a variety of settings. When using the PYD approach, workers focus on youth assets rather than deficits, collaborate with youth in planning the youth's future, build youth competencies rather than doing tasks for the youth, adopt a holistic perspective of healthy personal growth, and engage in long-range planning rather than short-term solutions. This approach has not typically been applied to youth who demonstrate problem behavior such as substance abuse or psychiatric symptoms. Building on three theories–-strengths, coping, and stages of change–- we offer practice guidelines for applying the PYD approach to problem-oriented youth behavior, with substance abuse as an example.

Edentulous denture-wearers eat fewer fruits and vegetables than do comparable dentate individuals. Improved chewing ability with new dentures has resulted in little dietary improvement, suggesting that dietary intervention is necessary. The objective of this randomized controlled trial was to have a positive impact upon dietary behavior of patients receiving replacement complete dentures through a tailored dietary intervention. Readiness to change diet (Stage of Change), intake of fruits, vegetables, and nutrients, and chewing ability were assessed pre-and 6 weeks post-intervention. The intervention group (n = 30) received two dietary counseling sessions; the control group (n = 28) received current standard care. Perceived chewing ability significantly increased in both groups. There was significantly more movement from pre-action into action Stages of Change in the intervention group, who had a greater increase in fruit/vegetable consumption (+209 g/d) than did the control group (+26 g/d) (P = 0.001). Tailored dietary intervention contemporaneous with replacement dentures can positively change dietary behavior.

Undergraduate ( n = 561) and graduate ( n = 104) students at a large mid-Atlantic university were surveyed to determine their usage patterns and beliefs about the climate of a newly constructed student recreation center (SRC) on their campus. Analyses attempted to identify differences between those students who used the facility ( n = 547) and those who did not ( n = 118) in relation to gender, age, year on campus, stage of change for exercise, and motivational orientation. Results revealed that SRC users were at higher stages along the transtheoretical model (Prochaska & DiClemente, 1983) and were significantly more likely to have participated in high school athletics than non-users. Non-users were significantly more likely to live off-campus, smoke, and be female than SRC users. The discussion offers suggestions for enticing non-users to exercise and use the facility, and feel more comfortable while doing so.

Purpose. To examine the application of the transtheoretical model (TTM) to fruit and vegetable consumption among economically disadvantaged African-American adolescents. Methods. Scales for measuring decisional balance, situational self-efficacy, and processes of change for fruit and vegetable consumption were developed and pretested with 57 economically disadvantaged African-American adolescents. The scales and measures for assessing stages of change, demographic variables, and fruit and vegetable consumption were administered to a separate sample of 262 participants. t-tests for independent samples and analysis of variance were used to examine differences in TTM variables and fruit and vegetable consumption across stages of change. Results. Two-factor solutions for decisional balance and processes of change and a three-factor solution for situational self-efficacy provided the best fit to the data. Alpha coefficients of reliability for the scales ranged from .77 (experiential change processes) to .91 (pros). Participants in action-maintenance stages evidenced higher pros, self-efficacy, and fruit and vegetable consumption and significantly lower cons than did participants in precontemplation and contemplation-preparation stages. Also, participants in action-maintenance stages used processes of change more frequently than did those in precontemplation-contemplation-preparation stages. The use of experiential and behavioral processes within these stages did not differ significantly, as posited. Discussion. Observed differences in TTM variables and fruit and vegetable consumption by stage of change in this sample of economically disadvantaged African-American adolescents were consistent with theory and previous applications of the model to fruit and vegetable consumption in adults. With replication studies, the TTM may be appropriate for designing interventions to increase fruit and vegetable consumption among this population.

Objective To use the stages of change model to examine six health-related behaviours. Design and Setting This pilot study collected data using an anonymous questionnaire. Non-probability sampling recruited community service group members and students in Palmerston North, New Zealand. Four hundred and sixty responses were received (response rate 53 per cent). Method The questionnaire investigated stage of change distributions for six health-related behaviours. These behaviours were avoidance of a high- fat diet, eating a high-fibre diet, attempting to lose weight, undertaking exercise, stress reduction, and conducting cancer self-examinations. Parametric statistics were used to identify gender and age differences in the stage distributions. Results For all behaviours, except losing weight, approximately two-thirds of the sample reported performing the behaviour, 10 per cent reported thinking about behaviour change; the remainder reported being at precontemplation or contemplation. Significant gender differences were found for all behaviours, except eating fibre. Significant age differences were found for the behaviours of avoiding fat, eating fibre, reducing stress, and conducting cancer self-examinations. The behaviours showing the most extensive between-behaviour associations were avoiding fat, eating fibre, and conducting cancer self-examinations. Conclusions Support was found for a continuum of change from 'ignoring', to 'thinking about' to 'performing' healthy behaviour. Age and gender differences were identified within these distributions and between behaviour analyses highlighted potential gateway behaviours. The stage of change concept coupled with age and gender tailoring has potential to improve both the design and evaluation of public health programmes.

Presented are the basic design, methods, and baseline data analyses for the Study of Exercise and Nutrition in Older Rhode Islanders (SENIOR Project) an experimental study to investigate the relative effectiveness of a 12-month, stage of readiness to change-based multiple-behavior intervention (exercise and nutrition) compared to single-behavior interventions in a community-dwelling population of 1,277 older adults. Relationships between stage of readiness to change in the two target behaviors, as well as the relationship between stage of readiness and self-reported exercise levels and fruit and vegetable consumption, were examined using a combination of Pearson chi-squares, analyses of variance (ANOVA), and Spearman’s rank order correlations. Stage of change (SOC) for fruit and vegetable consumption was significantly associated with the dietary measure, and SOC for exercise was associated with both the three physical activity measures and servings of fruits and vegetables per day. Overall, individual older adult's readiness to change seems largely to be behavior-specific.

Prochaska and colleagues' transtheoretical model (TTM) describes a sequential progression of six stages individuals advance through as they commence the self-change process of altering behaviors. Mezirow and his associates offer 10 phases of perspective transformation from their theory of transformative learning, known as transformational learning theory (TLT). This theory explains how adults interpret life experiences, make meaning, and change a belief, an attitude, or an entire perspective. A change in perspective is personally emancipating in that one is freed from previously held beliefs, attitudes, values, and feelings that have constricted and distorted one's life. Both theories offer schemes of learning, changing, and growing for people seeking to make meaningful, life-transforming changes. This article provides a brief overview of each model and attempts to integrate these models to explain the process of transformational, or emancipatory, change.

Purpose. Explore whether adults' physical activity behavior or their use of physical activity behavior-change strategies, as derived from the Transtheoretical Model, differed by handedness. Methods. A cross-sectional survey of 151 adults' hand preference (i.e., handedness: right, left, ambidextrous) and their use of the behavioral and cognitive processes of change, decisional balance scores (i.e., pros minus cons), self-efficacy, and their stage of change for physical activity involvement. Results. Left-handers showed significantly less use of the behavioral and cognitive processes of change compared to right-handers (M = 46.9 vs. M = 40.5 and M = 46.9 vs. M = 40.5, respectively). Left-handers were also significantly more likely to be in the earlier (i.e., inactive or irregularly active) stages of change relative to right-handers (84.6% vs. 48.1%, respectively). Discussion. Handedness may be a previously unrecognized, heritable correlate of physical activity behavior and the use of physical activity behavior-change strategies.

Addictive behaviors are major causes of chronic disease, premature death, and high health care costs. Such behaviors have not been treated seriously by health care systems, and this is a major reason why such systems face an unhealthy future. Treating addictions seriously requires complementing a traditional individual-patient paradigm with a population paradigm, an action paradigm with a stage paradigm, clinic practices with home-based practices, a clinician paradigm with a computer paradigm, and programs that focus on changing single behaviors with programs that focus on changing multiple behaviors.

Purpose. In this study, we examined the influence of self-efficacy in predicting stage of change (SOC) movement, without intervention, over a 1-month period for smoking cessation, exercise adoption, and dietary fat reduction. Design. The design of this study was longitudinal. Patients' stage of change and self-efficacy were assessed at baseline, and stage of change was reassessed at a 1-month follow-up. Patients were categorized as (1) Regressors (moved backward at least one stage), (2) Stables (no change), or (3) Progressors (moved forward at least one stage). Chi-square analyses were used to determine the ability of self-efficacy to predict stage movement at 1-month follow-up. Setting. The data were collected at a large, inner city, academic hospital in the southeastern United States. Patients were attending primary care clinics. Subjects. Five hundred fifty-four low income, predominantly African-American, individuals attending primary care clinics were participants in the study. Measures. Previously validated scales of stage of change and self-efficacy from Prochaska's laboratory were used in this study. Results. Results showed statistically significant differences between predicted and actual SOC movement for smoking cessation, exercise adoption, and dietary fat intake reduction. Baseline self-efficacy ratings were significantly related to stage progression, regression, and stability of stage of change for all three health behaviors. Thirty-seven percent of smokers who were predicted to progress on the basis of their self-efficacy scores progressed. For exercise adoption and dietary fat reduction, 50% and 44%, respectively, of individuals expected to progress at least one stage on the basis of self-efficacy scores progressed. Conclusion. Self-efficacy influences SOC movement for smoking cessation, dietary fat reduction, and exercise adoption.

Purpose. To evaluate the acceptability and feasibility of a lifestyle physical activity program for people with spinal cord injury (SCI). Methods. Sixteen nonexercising adult volunteers with SCI participated in a single group pre-post–test of the “Be Active in Life Program” comprising stage-matched educational materials, home visit by a nurse, construction of a personal plan to increase activity, and four follow-up phone calls. Program acceptability, stage of change, barriers to health-promoting activities, abilities for health practices, health, depression, and muscle strength were rated. Physical activity was monitored using actigraphy and a self-report record. Results. Participants rated the program positively, although some preferred a structured exercise approach. Eighty-one percent of participants progressed in stage of change and 60% increased physical activity. There were significant changes in motivational barriers, exercise self-efficacy, self-rated health, and muscle strength. Discussion. Lifestyle physical activity is feasible and acceptable and could be effective in promoting greater physical activity among people with SCI.

The Stage of Change construct from the Transtheoretical Model of behavioral change has been widely utilized in the assessment of various health behaviors. The majority of these tests measure the Stage of Change construct using the single-item, multiple-choice format. This study validated the use of a single-item measure in measuring readiness to comply with taking a prescribed medication. A sample of 161 subjects tested the multiple-item Stage of Change measure, then a refined multiple-item survey was tested with 59 subjects. With the latter survey, discriminating subjects at the differing stages of change dimensions was difficult. A correlation of .91 was found for stage classifications between ratings on the single-item and multiple-item scales. The use of the single-item measure seems reasonable when assessing stage of change in compliance with prescribed medication.

The application of theory to practice can be challenging. This article describes the experiences of one organization in applying the Transtheoretical Model (TTM) to a health promotion program for older adults, Health Stages. The concepts of the model, especially stage of change, were successfully used for program planning, curriculum development, and program evaluation. A Programming Grid was developed to guide curriculum development and evaluate if programs were reaching out to people at all stages of readiness to make healthy changes. Other TTM constructs, including self-efficacy, decisional balance, and processes of change were incorporated into the Health Stages curriculum. Evaluation showed that the pilot sites increased their offering of action- and maintenance-oriented programs, filling in the gaps in current programming. Older adults were receptive and interested in the model. The TTM enhanced the program by providing a framework for design and a method for reaching a wider audience of older adults with important health information.

The Stages of Change Scale—Substance Abuse (SCS-SA) was developed to measure readiness to change among individuals in treatment for substance abuse and was field tested with 457 participants in 7 therapeutic community programs in 4 different states. Factor analysis on SCS-SA items defined 4 subscales: Precontemplation, Determination, Participation, and Relapse. Using cluster analysis, 4 clusters of participants were identified, based on their profiles of SCS-SA subscale scores: (a) Indifferent, (b) Active Participation—Realistic, (c) Active Participation—Optimistic, and (d) Conforming. Finally, a discriminant analysis indicated significant differentiation among the clusters on the basis of sense of coherence scores. With continuing research to document reliability and validity, the SCS-SA appears to have potential in facilitating treatment planning and research to better understand readiness to change.

Purpose. The current study examines the relations between decisional balance and self-efficacy variables on stage of change between the behaviors of avoiding dietary fat and increasing exercise. Design. A cross-sectional design was used. Setting. The current study took place in public primary care clinics from four sites across Louisiana. Clinics were associated with teaching hospitals and located in urban and rural areas. Subjects. Subjects included 515 adult outpatients, 60% African-American, 81% women, and 43% married. The age ranged from 18 to 87 years old, and the mean age was 45 (SD = 14). Patients were predominantly low-income (mean household income of $490 per month) and uninsured (71%). Measures. Standard questionnaires were given to assess stage of change, decisional balance, and self-efficacy for exercise and dietary fat reduction. Results. Although the χ2 analysis revealed that dietary fat and exercise stage of change were significantly related, Pearson χ2 (df = 16) = 74.30, p < .001, 35% of the sample was stage incongruent between behaviors (e.g., a significant percentage of exercise maintainers were precon-templators for reducing dietary fat). Only 27% of the sample was in the same stage for both behaviors. Correlations and multivariate analyses of variance (MANOVAs) indicated that relationships between behaviors were similar to those found previously within behaviors; however, the effect sizes were markedly attenuated. Conclusions. These results have implications for healthcare providers working with weight management. Accurate assessment of readiness for change for both exercise and dietary fat consumption is critical. For many patients, readiness for change differs dramatically between the two behaviors, and interventions may need to be tailored more precisely. Providers may need to use more active, behaviorally focused interventions for the more advanced behavior while simultaneously implementing more cognitively focused interventions for the less advanced one.

Objective To examine the application of key constructs of the Transtheoretical Model (stages of change and decisional balance) to attendance at dental checkups with a student sample. Method A questionnaire was completed by 224 students from the University of Derby. They were asked to report their intention and behaviour in relation to dental checkups (reflecting the stage framework) as well as rating 31 statements representing the Pros and Cons of dental checkups. Results Thirty (13.7 per cent) participants were classified into precontemplation, 69 (31.5 per cent) contemplation, 18 (8.2 per cent) preparation, 86 (39.3 per cent) action and 16 (7.3 per cent) maintenance. Support for the application of the stages of change model to dental checkups was found. The decisional balance measure (Pros and Cons) reflected hypothesised differences across the stages of change. Conclusion The findings suggest that applying the stages of change construct to dental checkup attendance can assist us in designing interventions that are more appropriately targeted by stage of change. For the large proportion of students not attending, we suggest minimising the Cons and maximising the Pros of dental checkups.

This is the first of an occasional series of articles that will feature in full exclusively in Promotion & Education as part of the formal link between IUHPE and Health Education Research. Each article will review key issues raised by papers published recently in Health Education Research on a topic or theme of current relevance to health promotion. A brief summary will also appear in Euronews, the IUHPE Regional Newsletter for Europe.

Sixty-five college-student smokers were randomly assigned to a four-week computer-administered, stage-based smoking control program or a four-week computer-administered general health education control condition. At post-test, the percentage of students advancing to a higher stage of readiness to change was slightly higher among those in the stage-based program compared to the control condition. At seven month follow-up, both groups reported abstinence rates of approximately 30%. Continuous abstinence for 6 months was 19% for the stage-based group and 14% for the control group at the final follow-up.