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Objective: The aim of this paper is to provide a guideline to a universal understanding of the analysis of co-occurrence of risk behaviors. The use of cluster analysis and factor analysis was clarified., Method: A theoretical introduction to cluster analysis and factor analysis and examples from literature were provided. A representative sample (N=4395) of the Dutch population, aged 16-40 and participating from fall 2005 to spring 2006, was used to illustrate the use of both techniques in assessing the co-occurrence of risk behaviors., Results: Whereas cluster analysis techniques serve to focus on particular clusters of individuals showing the same behavioral pattern, factor analysis techniques are used to assess possible groups of interrelated health-risk behaviors that can be explained by an unknown common source. Choice between the techniques partly depends on the research question and the aim of the research, and has different implications for inferences and policy., Conclusion: By integrating theory and results from an illustrative example, a guideline has been provided that contributes towards a systematic approach in the assessment of co-occurrence of risk behaviors. Following this guideline, a better comparison between outcomes from various studies is expected, leading to improved effectiveness of multiple behavior change interventions., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: Multiple studies have identified clusters of co-occurring health-related behaviours. Little is known, however, about factors associated with such clusters. This study aims to identify these factors and to assess whether their effects are in accordance with the Theory of Triadic Influence (TTI)., Design: A cross-sectional study using a representative sample (N = 3497) of the Dutch population aged 19-40., Main Outcome Measures: Our data concerned 18 health-related behaviours combined in three clusters (Health, Alcohol and Delinquency) and 30 non-behaviour-specific (i.e. ultimate or distal) cultural, social and intrapersonal factors. The three clusters were used as outcomes in regression analyses., Results: Descriptive Norms of Friends and Gender were associated with all three behaviour clusters. Furthermore, Having Parents who Smoke or Consume Alcohol was associated with, respectively, the Health and Alcohol clusters. Self-Control and past Parental Monitoring were associated with the Health and Delinquency clusters. Effect sizes were moderate to large (r²: 0.05 to 0.22)., Conclusion: Factors with a moderate to large association with several behaviour clusters were identified. These factors were located within the social and intrapersonal stream of the TTI, not within the cultural stream.

Background: The Dutch government recently added universal Human Papilloma Virus (HPV) vaccination for 12-year-old girls to the existing national immunization program. The participation rate for the initial catch-up campaign for girls aged 13 to 16 years in 2009 was lower (47%) than expected (70%). To inform future HPV information campaigns, this paper examines the social and psychological determinants of the HPV vaccination intentions of girls aged 13 to 16 years and their mothers who were targeted by the Dutch catch-up campaign of 2009., Methods: A random sample of girls and their mothers was chosen from the Dutch vaccination register and received a letter inviting them to participate (n = 5,998 mothers and daughters). In addition, a random sample was recruited via an online panel by a marketing research company (n = 650 mothers; n = 350 daughters). Both groups were asked to complete a web-based questionnaire with questions on social demographic characteristics, social-psychological factors and HPV vaccination intention. Backward linear regression analyses were conducted to examine which social-psychological factors were most dominantly associated with vaccination intention., Results: Data from 952 mothers (14%) and 642 daughters (10%) were available for the intended analyses. The contribution of social demographic variables to the explained variance of HPV vaccination intention was small but significant for mothers (ΔR² = .01; p = .007), but not significant for daughters (ΔR² = .02; p = .17) after controlling for HPV vaccination uptake and the sample. In addition, social-psychological determinants largely contributed to the explained variance of HPV vaccination intention of mothers (ΔR² = .35; p < .001) and daughters (ΔR² = .34; p < .001). Attitudes, beliefs, subjective norms and habit strength were significantly associated with participants' HPV vaccination intentions., Conclusions: Because of the large contribution of social-psychological variables to the explained variance of HPV vaccination intentions among the mothers and daughters, future communication strategies targeting HPV vaccination uptake should address attitudes, beliefs, subjective norms and habit strength. There is a need for longitudinal research to confirm the causality of the association between these determinants and HPV vaccination behavior indicated by this study.

Objective: To examine which factors determined the participation in HPV vaccination programme in 2009 and 2010., Design: Retrospective cross-sectional study., Method: Random samples of Dutch girls who had been invited for the HPV vaccination programme in 2009 and 2010, as well as their mothers, were drawn from an Internet panel. Data were gathered by means of a web-based questionnaire., Results: The questionnaire was filled out by 243 girls and 511 mothers from cohort 2009, and by 225 girls and 250 mothers from cohort 2010. In both cohorts, the following factors were related to HPV vaccination: perceived susceptibility for cervical cancer, general opinion about the vaccine, anticipated feelings of regret about the decision made, specific beliefs (e.g. about the protective effects of the vaccine), trust in responsible authorities, perceived opinion of others about the vaccination and their HPV vaccination participation, the degree to which vaccination is taken for granted and the extent to which the decision to have oneself vaccinated is unambiguously perceived. In both cohorts, these factors explained a large and significant part of the variation in HPV vaccination; namely, 89% and 81% of the girls and 94% and 82% of the mothers from the cohorts in 2009 and 2010, respectively., Conclusion: This study provides insight into the reasons behind the disappointing participation in the HPV vaccination programme. In order to increase HPV vaccination uptake, future communication should provide balanced information about facts and opinions, and advantages and disadvantages of the vaccination. There should also be room for uncertainty in the choice whether or not to have oneself vaccinated.

This paper describes the evaluation of an adoption strategy for the school-based healthy diet programme Krachtvoer. Health promotion (HP) professionals from five Regional Public Health Services (RPHSs) in The Netherlands were asked to recruit a total of 25 schools to adopt the Krachtvoer programme in accordance with this strategy. Afterwards, they were interviewed about their adherence to and subjective evaluation of the strategy. The adoption rate of the programme was calculated and 10 adopting and 9 rejecting teachers were interviewed about the reasons for their decision. The HP professionals' adherence to the strategy was good, as well as their appreciation and the perceived feasibility of the strategy. The person-to-person approach that characterized this strategy was considered important. The strategy led to an adoption rate of 53.2%. On average, adopters mentioned 4.4 reasons and rejecters mentioned 5.4 reasons for their decision. Most reasons were school related and programme related and in case of the adopters also teacher related. The diversity of reasons revealed the complexity of teachers' decision making. Although there is some room for improvement of the adoption strategy and the programme itself, especially socio-political conditions in schools and in RPHSs need change for a further increase in programme adoption.

Objective: This study investigates the clustering of a broad range of health-compromising and delinquent behaviors. We examine whether these behaviors belong to a single but broad cluster, 'risk-taking behavior', and whether the nature and degree of clustering in adolescents differs from that in adults., Method: A representative sample (N=4395) of the Dutch population aged 12 to 40 (overall response rate 67%), was asked about various health-compromising behaviors, such as alcohol consumption, smoking, illegal drug use, unsafe sexual behavior, physical inactivity, poor nutrition (such as skipping breakfast and not eating fruit and vegetables), poor sleep behavior, unlawful traffic behavior, and delinquent and aggressive behavior. Data were collected from fall 2005 to spring 2006 using internet questionnaires and face-to-face computer-assisted interviews., Results: No single broad cluster was found. Instead, there were several separate but interrelated clusters. The contents of these clusters differed between age groups. For young adolescents (12-15) two clusters were identified: Alcohol and Delinquency. For older adolescents (16-18) and adults (19-40) three clusters were identified: Alcohol, Delinquency and Health., Conclusion: The findings of this study support a more integrated approach to promoting healthier lifestyles, and suggest that the behavior targets of integrated prevention programs should be different for adolescents and adults.