Psychosocial aspects of changes in cigarette-smoking behavior

Application of the Health Belief Model on the intention to stop smoking behavior among young adult women

Background: The smoking behavior among young adult women causes health issues and has effects on ethical norms, especially femininity and gender. A woman smoker usually has an intention to quit and several factors have been perceived to be related to this action according to the Health Belief Model (HBM).

Design and Methods: This study was conducted cross-sectionally to analyze the correlation between young adult women’s intention to stop smoking with perceived factors in the construction of HBM. A sample of 58 young adult women smokers and aged between 15-30 years were selected through the use of a purposive sampling technique in 2018.

Results: The results showed the intention to stop smoking has a significant correlation with perceived susceptibility (P=0.036), perceived severity (P=0.028), perceived benefits (P=0.011), perceived barriers (P=0.003), and perceived self-efficacy (P=0.005). This means there was a significant correlation between the intention of young adult smokers to quit smoking and the perceived factors of HBM.

Conclusions: The intention of stop smoking behavior among women smokers has a significant correlation with the perceived factors of the Health Belief Model construct, which includes perceived susceptibility, perceived severity, perceived benefits, perceived barriers, and perceived self-efficacy.

Do health warnings on cigarette sticks dissuade smokers and non-smokers? A focus group and interview study of Australian university students

Introduction: Young adults are a vulnerable population for experimentation with tobacco, which can lead to lifelong addiction. In an effort to ensure reductions in tobacco use through improved health promotion materials, we explored young adults' perceptions of current Australian packaging warnings, and novel health warnings on individual cigarette sticks. Methods: Focus groups and interviews were conducted with smoking and non-smoking first-year undergraduate university students at a regional Australian university. Semi-structured questions were used to gather participant perceptions. Sixteen students participated across three focus groups, and eleven students participated in the phone interviews. Data were analyzed using thematic analysis in NVivo. Results: Six emergent themes were identified. Current cigarette packaging warnings were seen as ineffective, being disregarded by current smokers (theme 1), and seen as irrelevant by young adult smokers and non-smokers (theme 2). Several cigarette stick warnings were perceived as engaging and effective, due to the novelty of the cigarette stick as a medium (theme 3), and the proximal nature of the warnings used (theme 4). The warning depicting the financial consequences of smoking was considered the most effective, followed by the impact of smoking on personal appearance, and the "minutes of life lost" warning. Social media (theme 5), and the use of more supportive messages to assist smokers (theme 6) were considered the best next steps as tobacco control interventions. Conclusions: Supplementing packaging warnings which were seen as minimally effective in this study, using cigarette stick warnings and social media may lead to further reductions in tobacco use. New and relatable warnings such as the financial consequences of smoking and impact on personal appearance may be the most effective in dissuading young adults from smoking, particularly within the university environment.

Understanding the Health Behaviors of Survivors of Childhood and Young-Adult Cancer: Preliminary Analysis and Model Development

The current study presents preliminary correlational data used to develop a model depicting the psychosocial pathways that lead to the health behaviors of survivors of childhood and young-adult cancer. Data collected from a sample of 18- to 30-year-old cancer survivors (n = 125) was used to examine the relations among interpersonal support and nonsupport, personal agency, avoidance, depressive symptoms and self-efficacy as they related to health behaviors. The outcome measures examined included tobacco and alcohol use, diet, exercise, sunscreen use, medication compliance and follow-up/screening practices. Correlational analyses revealed a number of significant associations among variables. Results are used to inform the development of a health behavior model. Implications for health promotion and survivorship programming are discussed, as well as directions for future research.

Relationships among factual and perceived knowledge of harms of waterpipe tobacco, perceived risk, and desire to quit among college users

Waterpipe tobacco smoking is increasing in the United States among college students. Through a web-based survey, we explored associations among factual and perceived knowledge, perceived risks and worry about harm and addiction, and desire to quit among 316 college waterpipe tobacco smoking users. Overall, factual knowledge of the harm of waterpipe tobacco smoking was poor, factual and perceived knowledge was weakly correlated, both forms of knowledge were related inconsistently to perceived risks and worry, and neither form of knowledge was associated with the desire to quit. Findings provide preliminary insights as to why knowledge gaps may not predict cessation among waterpipe users.

A preliminary exploration of college smokers' reactions to nicotine dependence genetic susceptibility feedback

INTRODUCTION

Many young smokers underestimate their risk for becoming addicted to cigarettes. We explored whether informing light college smokers (i.e., fewer than 5 cigarettes/day) of their genetic predisposition to nicotine dependence influenced their perceived risks and worry about becoming addicted, their ability to quit (i.e., self-efficacy), their desire to quit, and smoking cessation.

METHODS

College smokers (n = 142) received educational materials on mechanisms and consequences of nicotine addiction and were offered genetic susceptibility testing for nicotine dependence. Participants who accepted testing were randomized to receive feedback or no feedback (i.e., control). Tested participants learned they were above or not above average genetic risk for nicotine dependence. All participants responded to questions about perceived risks and worry about becoming addicted, efficacy to quit, and desire to quit. Cessation was assessed during a 1-month follow-up.

RESULTS

Efficacy beliefs, worry about becoming addicted, and desire to quit did not differ by study condition or feedback. Perceived risk for becoming addicted was highest among tested participants informed they were above average risk for nicotine dependence. Overall, self-reported 30- but not 7-day quit rate was higher among participants who underwent genetic testing compared with control participants.

CONCLUSIONS

This pilot study is the first to show that among light college smokers, receipt of genetic susceptibility feedback to nicotine dependence potentially curbs smoking without producing detrimental effects.

A before-after implementation trial of smoking cessation guidelines in hospitalized veterans

Background

Although most hospitalized smokers receive some form of cessation counseling during hospitalization, few receive outpatient cessation counseling and/or pharmacotherapy following discharge, which are key factors associated with long-term cessation. US Department of Veterans Affairs (VA) hospitals are challenged to find resources to implement and maintain the kind of high intensity cessation programs that have been shown to be effective in research studies. Few studies have applied the Chronic Care Model (CCM) to improve inpatient smoking cessation.

Specific objectives

The primary objective of this protocol is to determine the effect of a nurse-initiated intervention, which couples low-intensity inpatient counseling with sustained proactive telephone counseling, on smoking abstinence in hospitalized patients. Key secondary aims are to determine the impact of the intervention on staff nurses' attitudes toward providing smoking cessation counseling; to identify barriers and facilitators to implementation of smoking cessation guidelines in VA hospitals; and to determine the short-term cost-effectiveness of implementing the intervention.

Design

Pre-post study design in four VA hospitals

Participants

Hospitalized patients, aged 18 or older, who smoke at least one cigarette per day.

Intervention

The intervention will include: nurse training in delivery of bedside cessation counseling, electronic medical record tools (to streamline nursing assessment and documentation, to facilitate prescription of pharmacotherapy), computerized referral of motivated inpatients for proactive telephone counseling, and use of internal nursing facilitators to provide coaching to staff nurses practicing in non-critical care inpatient units.

Outcomes

The primary endpoint is seven-day point prevalence abstinence at six months following hospital admission and prolonged abstinence after a one-month grace period. To compare abstinence rates during the intervention and baseline periods, we will use random effects logistic regression models, which take the clustered nature of the data within nurses and hospitals into account. We will assess attitudes of staff nurses toward cessation counseling by questionnaire and will identify barriers and facilitators to implementation by using clinician focus groups. To determine the short-term incremental cost per quitter from the perspective of the VA health care system, we will calculate cessation-related costs incurred during the initial hospitalization and six-month follow-up period.

Trial number

NCT00816036

Self-efficacy and smoking cessation: a meta-analysis

According to relapse models, self-efficacy (SE), or confidence in one's ability to abstain, should predict the outcome of an attempt to quit smoking. We reviewed 54 studies that prospectively examined this relationship. The relationship between SE and future smoking depended upon the population studied and the timing of the SE assessment. The relationship between SE and future smoking was modest when SE was assessed prior to a quit attempt; SE scores were .21 standard deviation units (SD) higher for those not smoking at follow-up than for those who were smoking. The relationship was stronger (.47 SD) when SE was assessed post-quit. However, this effect was diminished when only abstainers at the time of the SE assessment were included in analysis (.28 SD). Controlling for smoking status at the time of SE assessment substantially reduced the relationship between SE and future smoking. Although SE has a reliable association with future abstinence, it is less robust than expected. Many studies may overestimate the relationship by failing to appropriately control for smoking behavior at the time of the SE assessment. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Overall self-rated health as an outcome indicator in primary care

RATIONALE, AIMS AND OBJECTIVES

The ultimate goal of health care systems is to improve overall health from the patient's point of view. However, overall self-rated health is not routinely monitored as a performance indicator. The purpose of this study was to investigate the feasibility of using a measure normally employed in community health surveys as a quality indicator in primary care clinics.

METHODS

In order to do so, we conducted a cross-sectional survey of community medicine patients treated in five clinics in Amarillo, Texas to test the theory that, in primary care patients, a single-item measure of self-rated health is significantly related to the usual risk factors found in community health surveys (environmental factors, demographic characteristics and health behaviours).

RESULTS

Multiple logistic regression analysis revealed that age, race, frequent mental distress, current smoking and health confidence were independently related to the odds of reporting good health.

CONCLUSION

Our results support using a single-item measure of self-rated health in primary care. Our data also suggest that encouragement of health confidence would appear to be in the best interests of patients.

Changes in Cancer-Related Risk Perception and Smoking Across Time in Newly-Diagnosed Cancer Patients

We examine the bidirectional relationships between cancer risk perceptions and smoking behavior among newly diagnosed cancer patients (N=188) during hospitalization for surgical resection, and at three and 12 months subsequently. Those with higher perceptions of risk for developing another cancer at three months were most likely to abstain from smoking by twelve months. Patients were relatively accurate in their cancer risk perceptions, with relapsers and continuous smokers reporting higher levels of risk perceptions at twelve months. Finally, those who quit smoking by 12 months felt at lower risk for developing cancer by 12 months. None of these relationships were significant between baseline and three months. Results indicate that perceived risk of cancer recurrence may be clinically useful in motivating smoking cessation after the acute cancer treatment phase is over. This study justifies an expanded theoretical framework attending to the distinct, prospective influences of illness risk perceptions on health behavior, and of health behavior on illness risk perceptions.

Overall self-rated health: a new quality indicator for primary care

RATIONALE, AIMS AND OBJECTIVES

Patient 'empowerment' gives patients choices about their own care and about the outcomes they would most prefer. Many patients can be presumed to regard overall self-rated health as an important outcome. Therefore, overall self-rated health can be considered a relevant and important outcome measure for a patient-centred medical clinic. The purpose of this study was to use this new outcome measure as a dependent variable and to test the hypothesis that patients who are confident about their ability to manage their health will have better health, in comparison to more dependent patients.

METHODS

We conducted a randomized cross-sectional postal survey of 500 veteran patients from the Panhandle of Texas and the surrounding areas; and 302 participated in the study. Multiple logistic regression analysis was used to test the hypothesis that health confidence is positively related to self-rated health, controlling for obesity, cigarette smoking and participation in recreational activities.

RESULTS

Veterans who strongly disagreed with the statement that they usually could overcome illnesses on their own were less likely to report good, very good or excellent self-rated health (adjusted odds ratio=0.25).

CONCLUSIONS

Overall self-rated health as measured by a single question proved to be significantly related to behavioural risk factors in this sample of primary care patients, attesting to its validity as an outcome indicator. Furthermore, health confidence was associated with better health. Most primary providers believe that they can, through good communication and providing self-care tools, increase healthy behaviours in their patients. If we are indeed able to increase health confidence in our patients, this study would suggest that self-rated health would improve.

The addition of social support to a community-based large-group behavioral smoking cessation intervention: improved cessation rates and gender differences

OBJECTIVE

To determine the effects on cessation rates of adding a partner support group component to a large-group community-based behavioral smoking cessation program.

METHODS

During the past eight smoking cessation programs at the Tom Baker Cancer Centre in Calgary, Alberta, Canada, separate support group sessions were offered for support persons of prospective quitters. Six hundred smokers brought 156 support people with them to the groups. Cessation rates were calculated at 3, 6, and 12 months postquit.

RESULTS

Those smokers who had support people attending at least one of the support group sessions had higher cessation rates at 3, 6, and 12 months (56%, 46%, and 43%) compared to those without a support person in attendance (36%, 35%, 32%). This effect was especially strong for men, with 3-, 6-, and 12-month cessation rates for those with support of 58%, 54%, and 56%, compared to 52%, 41%, and 36% in the women with support. For men without a support person, the rates were 34%, 35%, and 33%, compared to 38%, 35%, and 31% in women without support. This indicates that although support was initially effective for women, it had no effect on sustained abstinence.

CONCLUSIONS

The addition of a support person group to a large-group behavioral smoking cessation program was effective in improving 3-month cessation rates in both men and women, but over 1-year of follow-up support was only associated with greater sustained abstinence in men.

Testing a model of avoiding environmental tobacco smoke in young adults

PURPOSE

To test an explanatory model of gender, self-efficacy, situational influences, and other health-promoting behaviors on the avoidance of environmental tobacco smoke (ETS) in young adults. ETS is a cause of lung cancer, pulmonary disease, and cardiovascular disease. Although young adults are at increased risk for ETS exposure, there are few behavioral studies of ETS exposure and no reported studies of ETS exposure in young adults. Although college students are often exposed to ETS, the college environment offers a setting in which the opportunities for change are substantial.

DESIGN

Model-testing. Data are reported on a convenience sample of 136 nonsmoking 18- to 25-year old students in one mid-atlantic U.S. university. This sample of nonsmokers was drawn from a larger sample of 241 smokers and nonsmokers in 1995. Model constructs were based on Pender's health promotion model (HPM).

METHODS

The General Self-efficacy Scale, Health Promotion Lifestyle Profile, and ETS Avoidance Scale were used along with items measuring ETS-avoidance efficacy and Living with Smoke. Path analysis was used to test the model.

FINDINGS

The trimmed explanatory model showed that 26% of the variance in avoiding ETS was accounted for by gender, having self-efficacy, and ETS-avoidance efficacy, not living with people who smoke, and performing other healthy behaviors. Being female and general self-efficacy indirectly influenced ETS avoidance through their effects on related health promoting behaviors.

CONCLUSIONS

The explanatory model of ETS avoidance can provide useful information for the development of interventions to prevent exposure to passive smoke. Given the occurrence of ETS exposure in young adults, longitudinal research using this explanatory model is yielding promising results. Enhancing the self-efficacy of young adults and encouraging healthy lifestyle behaviors may be an important factor in their avoidance of ETS.

Self-management of cystic fibrosis: short-term outcomes of the Cystic Fibrosis Family Education Program

This study tested the efficacy of the Cystic Fibrosis Family Education Program, a cystic fibrosis self-management program, on improving participants' knowledge, self-efficacy, self-management behavior, health, and quality of life. A quasi-experimental pretest-posttest nonequivalent comparison group design was employed. Participants made up 104 patient-primary caregiver dyads from the intervention site cystic fibrosis center and 95 from the usual care comparison center. The intervention, a self-paced print curriculum based on social cognitive theory, targeted behavioral capability, self-efficacy, and outcome expectations and was implemented as an integral part of medical care. Parents, early childhood, middle childhood, and adolescents received separate materials on respiratory, nutrition and malabsorption, communication, and coping issues. Significant intervention effects were found on the knowledge scores for caregivers, adolescents, and children; caregiver and adolescent total self-management scores; Child Behavior Checklist total score; one parent coping scale score; the modified NIH score; NIH pulmonary factor 1; and the Brasfield total score. Significant interaction effects were evident in the self-efficacy scores for caregivers and children.

Gender differences in blue collar workers' use of hearing protection

In this study, the Health Promotion Model (HPM) was used as the basis for a structural equation model of male and female blue collar workers' self-reported use of hearing protection devices (HPDs). Overall use did not differ by gender; in addition, self-efficacy and barriers to use of HPDs were the two best predictors of this behavior for both men and women. Despite the similarities in HPD use and the most important predictors of that use between men and women, the predictive models differed by gender in several ways. Significant predictors of use among men also included age and value of use of HPDs. For women, ethnic status and plant site were additional significant predictors of use. Because the influences of plant site and gender on self-reported use of HPDs could not be separated in this study, further research should address worksite culture and assess differences by gender. Knowledge of these differences will aid development of more effective interventions and may increase the use of hearing protection.

A nurse-managed smoking cessation program for hospitalized smokers

OBJECTIVES

This study evaluated a nurse-managed smoking cessation program for smokers hospitalized for a variety of conditions.

METHODS

Hospitalized patients who smoked prior to hospitalization and who were motivated to quit (n = 660) were randomized to intervention or usual-care groups and followed for the next year. The intervention included a meeting with the nurse-case manager; the use of a videotape, workbook, relaxation audiotape, and nicotine replacement therapy; and nurse-initiated phone contacts after discharge.

RESULTS

The 12-month confirmed cessation rates were 21% and 31% for, respectively, the usual-care and intervention groups (odds ratio = 1.7; 95% confidence interval = 1.1, 2.3).

CONCLUSIONS

A nurse-managed smoking cessation intervention can significantly increase cessation rates for hospitalized patients.

Development of a scale to measure core beliefs and perceived self efficacy in adults with epilepsy

A scale based on underlying core beliefs generated by the experience of epilepsy was developed. The scale, with measures of coping, adaptability, and knowledge, was used to examine the commonly-reported differences in emotional adjustment between patients (EP) and a non-epileptic population (NEP). The EP had significantly lower perceived self efficacy and was more depressed and anxious than the NEP controls. The NEP showed greater knowledge of medical aspects of epilepsy than the EP. Positive correlations between scale values and measures of mastery, self esteem, affect balance, felt stigma and impact of epilepsy were found. Factor analysis produced a three factor solution of emotion, knowledge and anxiety which explained 61.6% of the variance in scores. Results are discussed in terms of Bandura's theory of self efficacy as the motivating and sustaining force in the ability to change behaviour. Core beliefs are central to both the development and maintenance of anxiety and depression in epilepsy patients and need to be addressed in any attempts at remedial intervention.

A community-based smoking-cessation program: self-care behaviors and success

Given the serious health consequences of smoking, nurses need to be well-informed on how to help various client populations with smoking cessation. Much recent research is focused upon effectiveness of various programs to enhance self-efficacy and self-management skills necessary to succeed in permanent smoking cessation. This study used a model based on Orem's Self-Care Deficit Theory to examine specific variables of importance in smoking cessation using descriptors relevant to understanding self-care actions. The model is used to examine the outcomes of a community-based smoking-cessation program. Results indicate that 15% of the final sample quit smoking and 42% reduced smoking while participating in the program. Additional findings are helpful in describing actions taken by subjects who were and were not successful in quitting. Remedies suggested by the American Lung Association booklet "Freedom from Smoking for You and Your Family" were reported by subjects to be helpful in dealing with the most common problems experienced during smoking cessation. Results are applied to public health nursing, emphasizing that smoking cessation is "a process" in which individuals learn strategies that work for them.

Predicting use of hearing protection: a preliminary study

The National Institute of Occupational Safety and Health targeted noise-induced hearing loss as one of the top 10 occupational hazards. Research has been directed toward reducing noise exposure rather than identifying the factors associated with workers' decision consistently to use hearing protection. The long-term goal of this program of research is to develop a causal model explaining workers' use of hearing protection to guide development of nursing interventions. This study was a preliminary one to prepare for testing Pender's health-promotion model (HPM) as a causal model. Ninety-eight skilled tradesmen completed written questionnaires at their work site. Although 98% indicated they were supposed to wear protection, their reported use averaged 50.3% of the time. Reported use significantly and positively correlated with workers' perceptions of the benefits and self-efficacy of use, value of outcomes regarding keeping out noise and increased well-being, and health-promoting behaviors in the areas of self-actualization and stress management. Perceptions of barriers of use were significantly and negatively related to use. In regression analyses of use of hearing protection on components of the HPM and dimensions of health behavior and lifestyle, one component of the HPM (benefits) and two dimensions of health behavior and lifestyle (self-actualization and interpersonal support) significantly predicted use, accounting for 24% of the variance in use of protection. Knowledge of the predictors of hearing protection use will ultimately aid nurses in implementing interventions, increasing use, and decreasing hearing losses.

Measuring self-efficacy expectations for the self-management of cystic fibrosis

This research developed and determined the psychometric characteristics of a measure of self-efficacy expectations (a social cognitive theory construct) for the self-management of cystic fibrosis (CF). Items for the original instrument were sampled from 150 self-management performance objectives for CF that represented behaviors in eight domains of CF care, including aspects of medical care, coping, and communication. The instrument was administered to 199 parents of children and adolescents with CF from two CF centers. The findings support a multidimensional structure for self-efficacy consistent with the multiple types of behavior required for the management of a chronic illness such as CF. An alpha-factor analysis yielded solutions clearly reflecting five theorized aspects of self-management: medical judgment and communication, coping, family communication, compliance, and acceptance. The first factor of the caretaker's scale most closely represents the underlying conceptualization of self-management as requiring self-monitoring of health status and collaboration with the health care provider in making judgments about treatment. The unit weighted factors exhibited high internal consistencies (Cronbach's alpha-factors ranging from 0.73 to 0.88).

Prediction of motivation and behavior change following health promotion: role of health beliefs, social support, and self-efficacy

Dimensions of health beliefs (perceived risk of behavior and benefit of behavior change), social support (family and others' support for change), and self-efficacy (magnitude and strength) were examined in 215 patients undergoing a prospective trial of health promotion in a primary care medical practice. Discriminant analyses were performed to evaluate how well these dimensions predicted motivation for change and lifestyle behavior change. These relationships were examined for six lifestyle areas: cigarette smoking, dealing with stress, amount and type of food eaten, use of seat belts, and exercise habits. The analyses demonstrated a statistically and clinically significant prediction of motivation by one or more health belief and self-efficacy dimensions for most lifestyle areas. The strongest single predictors were perceived benefits and self-efficacy strength, which were each significant predictors of motivation in four lifestyle areas (P less than 0.05). Support dimensions, as measured, were not shown to have predictive value in most areas. Behavior change was poorly predicted by beliefs, support, and self-efficacy for most lifestyle areas. However, adding motivation to the discriminant function equation resulted in significant predictions in all six lifestyle areas (P less than 0.05), with an average correct classification rate of 71%. This finding strongly suggests that motivation is a very important intervening variable when evaluating health promotion and resulting behavior change.

A hospital quit-smoking consult service: clinical report and intervention guidelines

A minimal-contact quit-smoking consult service was established to treat hospital inpatients and outpatients referred for behavioral smoking cessation treatment. Sixty-two consecutively referred patients were evaluated and triaged to one of three standardized quitting protocols: motivational counseling; standard behavioral abstinence counseling; or abstinence counseling plus nicotine fading. Consultations included personalized self-quit materials and planned telephone follow-up to enhance compliance. Triage differentiated patients with different levels of quitting readiness and nicotine dependence. Six months after treatment, 27% of patients had quit smoking (informant-verified). Predictors of quit attempts were shorter smoking history and lower nicotine dependence. Variables predicting cessation or substantial reductions in estimated daily nicotine intake included higher educational level, stronger beliefs in smoking health harms, higher trait anxiety, a greater desire to quit and quitting self-efficacy, and the recall of direct quitting advice from the referring physician. Results compare favorably with those of more intensive treatments with similar patient groups. Recommendations are presented for controlled follow-up research to explore promising findings in this clinical report.

Improving patient comprehension of literature on smoking

This study was designed to determine if simplification of smoking literature improved patient comprehension. Subjects (N = 129) were randomized in three groups: to receive no smoking booklet, receive one written at the 5th grade, or the 10th grade reading level. Subjects receiving the 5th grade booklet showed 13 percent better comprehension than those receiving the 10th grade booklet, and 18 percent better than the controls. Comprehension of written smoking materials can be improved by adjustment of the reading grade level.

Problems in understanding prescription labels

Reading prescription labels on medication bottles is often confusing. If medication is taken incorrectly, it may have deleterious effects. Questionnaires containing authentic prescription labels were administered to college students to interpret. Analysis suggests that less than half of those surveyed interpreted the labels correctly. Rated confidence in responding seemed to be a function of correctness.

Patient literacy and the readability of smoking education literature

This study was designed to determine if primary care clinic patients read at a level congruent to the reading grade level of available smoking literature. Reading estimates of smoking education literature (N = 49) ranged from grade 3 to college level (median = 9.5). Reading skills of 258 smoking patients were estimated by reported years of schooling (median = 10), and by scores on the Wide-Range Achievement Test (median = 6). A serious disparity existed between the reading estimates of smoking education literature and the literacy skills of patients in our sample.

The role of self-efficacy in achieving health behavior change

The concept of self-efficacy is receiving increasing recognition as a predictor of health behavior change and maintenance. The purpose of this article is to facilitate a clearer understanding of both the concept and its relevance for health education research and practice. Self-efficacy is first defined and distinguished from other related concepts. Next, studies of the self-efficacy concept as it relates to health practices are examined. This review focuses on cigarette smoking, weight control, contraception, alcohol abuse and exercise behaviors. The studies reviewed suggest strong relationships between self-efficacy and health behavior change and maintenance. Experimental manipulations of self-efficacy suggest that efficacy can be enhanced and that this enhancement is related to subsequent health behavior change. The findings from these studies also suggest methods for modifying health practices. These methods diverge from many of the current, traditional methods for changing health practices. Recommendations for incorporating the enhancement of self-efficacy into health behavior change programs are made in light of the reviewed findings.

Evaluation of a minimal-contact smoking cessation program in a health care setting

A controlled evaluation of a minimal-contact smoking cessation intervention was conducted with 213 inpatients and outpatients at a Veterans Administration Medical Center (VAMC). The intervention had three components: Brief consultation from a health practitioner; administration of a self-help smoking cessation manual; and provision of an incentive to adhere to recommendations in the manual. Enrollment procedures differed from those of many other smoking-intervention trials in that, instead of enrolling only smokers who were motivated to quit, all patients who smoked and who would normally be considered eligible for a smoking-cessation intervention were included. The evaluation examined acceptability of the program to patients who smoked, overall effectiveness of the intervention, and efficacy of the intervention for specific patient demographic, social status, and health status groups. The program had a high degree of acceptance by patients who smoked, with over 60% agreeing to participate and take home the self-help smoking-cessation manual. The program was effective in getting patients to reduce their daily smoking, and marginally effective in influencing smoking cessation, with some patient groups exhibiting higher cessation rates than others. Special problems to be considered when attempting to influence groups of smokers at high levels of psychological stress and with low levels of education and income--factors normally associated with high rates of smoking and failure in traditional smoking-cessation programs--are discussed in light of the results obtained.