Cancer prevention as a source of exercise motivation: An experimental test using protection motivation theory

Impact of alternative terminology for depression on help-seeking intention: A randomized online trial

OBJECTIVE

People with depression experience barriers to seeking professional help. Different diagnostic terminology can influence people's treatment/management preferences. The aim of this study was to investigate how alternative depression diagnostic labels and recommendations impact help-seeking intentions and psychosocial outcomes.

METHODS

Participants (18-70 years) were recruited using an online panel (Australia) to complete a randomized controlled trial. They read a hypothetical scenario where they discussed experiencing depressive symptoms with their GP and were randomized to receive one of four diagnoses ("depression," "burnout," "functional impairment syndrome" [fictitious label], no label [control]), and one of two follow-up recommendations ("clinical psychologist," "mind coach").

PRIMARY OUTCOME

help-seeking intention (5-point scale, higher = greater intention); secondary outcomes: intention to speak to boss, self-stigma, worry, perceived severity, illness perceptions, and personal stigma.

RESULTS

A total of 676 participants completed the survey. There was no main effect of diagnostic label on help-seeking intention or stigma outcomes. Intention to speak to a boss was higher with the depression compared to burnout label (MD = 0.40, 95% CI: 0.14-0.66) and perceived severity was higher with the depression label compared to control (MD = 0.48, 95% CI: 0.22-0.74) and all other labels. Those who received the "clinical psychologist" recommendation reported higher help-seeking intention (MD = 0.43, 95% CI: 0.25-0.60) and treatment control (MD = 0.69, 95% CI: 0.29-1.10) compared to the "mind coach" recommendation.

CONCLUSION

Findings highlight the success of efforts to promote help-seeking from clinical psychologists for depression. If burnout is considered a separate diagnostic entity to depression, greater awareness around what such a diagnosis means may be needed. Future research should examine how different terminologies surrounding other mental health conditions impact help-seeking and stigma.

Diagnostic labels and advice for rotator cuff disease influence perceived need for shoulder surgery: an online randomised experiment

QUESTION

What are the effects of diagnostic labels and advice, and interactions between labels and advice, on perceived need for shoulder surgery for rotator cuff disease?

DESIGN

2×2 factorial online randomised experiment.

PARTICIPANTS

People with shoulder pain.

INTERVENTION

Participants read a scenario describing a patient with rotator cuff disease and were randomised to bursitis label plus guideline-based advice, bursitis label plus treatment recommendation, rotator cuff tear label plus guideline-based advice, and rotator cuff tear label plus treatment recommendation. Guideline-based advice included encouragement to stay active and positive prognostic information. Treatment recommendation stressed that treatment is needed for recovery.

OUTCOME MEASURES

Perceived need for surgery (primary outcome), imaging, an injection, a second opinion and to see a specialist; and perceived seriousness of the condition, recovery expectations, impact on work performance and need to avoid work.

RESULTS

A total of 2,024 responses (99.8% of 2,028 randomised) were analysed. Labelling as bursitis (versus rotator cuff tear) decreased perceived need for surgery (mean effect -0.5 on a 0-to-10 scale, 98.3% CI -0.7 to -0.2), imaging and to see a specialist, and perceived seriousness of the condition and need to avoid work. Guideline-based advice (versus treatment recommendation) decreased perceived need for surgery (mean effect -1.0, 98.3% CI -1.3 to -0.7), imaging, an injection, a second opinion and to see a specialist, and perceived seriousness of the condition and recovery expectations. There was little to no evidence of an advice label interaction for any outcome.

CONCLUSION

Labels and advice influenced perceived need for surgery and other secondary outcomes in people with rotator cuff disease, with larger effects for advice. There was evidence of little or no interaction between labels and advice for any outcome, but the additive effect of labels and advice appeared large for some outcomes (eg, perceived need for imaging and perceived seriousness of the condition).

TRIAL REGISTRATION

ACTRN12621001370897.

Associations of perceived role of exercise in cancer prevention with physical activity and sedentary behavior in older adults

This study examined whether the perceived importance of exercise in cancer prevention was related to physical activity and sedentary behavior in older adults, who are the most vulnerable to cancer and the least active among all age groups. A cross-sectional analysis was conducted with 1,308 respondents (≥ 50 years) from the cycle 2 of the 2018 Health Information National Trends Survey (HINTS). 70.23% of older adults acknowledged the protective role of exercise in cancer prevention. Logistic regression analysis revealed that the perceived role of exercise in cancer prevention was significantly and positively associated with physical activity (Odds Ratio = 1.58, p = .013), while multiple linear regression analysis revealed that the perceived role of exercise in cancer prevention was significantly and negatively associated with sedentary behavior (p < .001) in older adults. Findings from this study can guide efforts to develop interventions that could promote physical activity and reduce sedentary behavior in older adults.

The interdependent roles of the psychosocial predictors of human papillomavirus vaccination among Christian parents of unvaccinated adolescents

Despite the availability of the human papillomavirus (HPV) vaccine, uptake has been sub-optimal among certain religious groups. Psychosocial factors (threat appraisal, coping appraisal, and attitudes) have been identified as independent determinants of HPV vaccination. However, their interdependent effects have not been tested. We examined the interdependency of these psychosocial factors in predicting HPV vaccination intention among Christian parents of unvaccinated adolescents (using a theory-driven conceptual model). A cross-sectional study of 342 participants showed that perceived self-efficacy (β = 0.2, 0.11-0.29, p = <0.0001) and perceived response efficacy of HPV vaccine (β = 0.65, 0.53-0.77. p < .0001) were positively associated with vaccination intention. Our mediation analysis (using the Preachers and Hayes' approach) shows that attitudes toward HPV vaccination mediated 59% of the relationship between perceived self-efficacy to vaccinate child and HPV vaccination intention; and 61% of the relationship between perceived response efficacy of HPV vaccine and HPV vaccination intention. Attitudes may be the psychosocial factor that drives the effects of coping appraisal. Therefore, designing an attitude-based intervention to address religious barrier beliefs among Christian parents may nullify the impact of low self-efficacy and response efficacy on HPV vaccination.

Shared Determinants for Human Papillomavirus and COVID-19 Vaccination Intention: An Opportunity for Resource Consolidation

Purpose

This study aimed at targeting shared factors that influence the prevention of multiple diseases, which can help address various health problems simultaneously. We identified correlates of human papillomavirus (HPV) vaccination that overlap with COVID-19 vaccination.

Design

Cross-sectional survey data.

Setting

Online Qualtrics recruitment panel.

Subject

Religious parents of 342 adolescents who were unvaccinated for HPV (response rate was 68.1%).

Measures

Outcome variables were COVID-19 vaccination intention for (1) self, (2) child, and (3) HPV vaccination intention for child. Independent variables were psychological factors. Covariates were sociodemographic and socioeconomic factors.

Analysis

We conducted multivariate linear regressions on each outcome variable after controlling for covariates.

Result

Some psychological correlates of HPV overlapped as protective factors for all three outcomes. Higher perceived vulnerability of child to HPV was associated with higher vaccination intention against COVID-19 for self (β = .37, 95% confidence interval [CI] = .25–.48), child (β = .32, .21–.44), and HPV for child (β = .38, .27–.49). Higher perceived response efficacy of HPV vaccine was associated with greater vaccination intention against COVID-19 for self (β = .46, .33–.59), child (β = .41, .28–.53), and HPV for child (β = .75, .64–.85).

Conclusion

Given the overlap in HPV and COVID-19 vaccination correlates, interventions should target shared factors that address both diseases to maximize public health efforts. A major limitation of this study is the inability to measure the actual vaccination behavior.

Diagnostic Labels for Rotator Cuff Disease Can Increase People's Perceived Need for Shoulder Surgery: An Online Randomized Controlled Trial

OBJECTIVE

To investigate whether different labels for rotator cuff disease influence people's perceived need for surgery.

DESIGN

Randomized controlled experiment.

METHODS

Participants with and without shoulder pain read a vignette describing a patient with rotator cuff disease and were randomized to 1 of 6 terms describing rotator cuff disease: subacromial impingement syndrome, rotator cuff tear, bursitis, rotator cuff-related shoulder pain, shoulder sprain, and episode of shoulder pain. Perceived need for shoulder surgery was the primary outcome. Secondary outcomes included perceived need for imaging, an injection, a second opinion, and to see a specialist; perceived seriousness of the condition; recovery expectations; and perceived impact on work attendance. Using a Bonferroni correction (significance, P<.003), adjusted between-group mean differences and 99.67% confidence intervals (CIs) were obtained using a 1-way analysis of covariance.

RESULTS

One thousand three hundred eight (80% of 1626) responses were analyzed. Participants' mean ± SD age was 40.3 ± 16.0 years, and 59% were women. Mean perceived need for surgery (0-10 scale) was low and slightly higher among those assigned to the rotator cuff tear label compared to the bursitis label (2.6 versus 2.1; adjusted mean difference, 0.7; 99.67% CI: 0.0, 1.4). Mean perceived need for imaging (0-10) was moderate and slightly higher among those assigned to the rotator cuff tear (4.7 versus 3.7; adjusted mean difference, 1.0; 99.67% CI: 0.2, 1.9) and subacromial impingement syndrome labels (4.7 versus 3.7; adjusted mean difference, 1.0; 99.7% CI: 0.1, 1.9) compared to the bursitis label.

CONCLUSION

There were small differences in the perceived need for surgery and imaging between some labels, which could be important at the population level. J Orthop Sports Phys Ther 2021;51(8):401-411. Epub 31 Mar 2021. doi:10.2519/jospt.2021.10375.

What Best Predicts the Use of Hearing Protection Devices?

The use of protective devices to safeguard health in noisy environments is crucial. Intensive exposure to pop, rock, and jazz (PRJ) music leads to irreversible damage to the auditory system. This study analyzed the psychological variables that best predict the use of personal hearing protection devices (PHPD) in professional PRJ musicians and the relative importance of PHPD in general as well as in four different occupational contexts, after controlling for auditory measures and condition. Professional musicians’ attitudes toward PHPD and behavior were assessed. Analyses showed that the best predictor of current usage was the duration of previous use, followed by additional psychological factors that predict usage in the four occupational settings. Researchers can draw on the current findings to explore other psychological factors and mechanisms that may facilitate the use of PHPD. For example, the finding that custom-made PHPD predicts the use of PHPD could be explored further by identifying the underlying psychological mechanisms, such as perception of ownership or identification processes. Studies should examine the other barriers/inducements to the use of PHPD in addition to those examined here, including the social factors connected to particular musical ensembles. Overall, psychological approaches encouraging behavioral change should be implemented, such as reminding individuals about previous use of PHPD, drawing their attention to these devices and the occupational environment, and enforcing PHPD norms to augment occupational health and safety.

The questionnaire used in the experiment is available online at https://www.press.uillinois.edu/journals/ajp/media/redicts_the_use_of_hearing_protection/index.html

The effects of a physical inactivity-related health risk message intervention on changes in risk perceptions and physical activity in middle-aged women

The study investigated the effects of the physical inactivity-related health risk message intervention on changes in risk perception for diseases. Forty-one women participated in the 16-week intervention. During this period, the study participants' physical activity, risk perceptions, and objective risk factors were measured. Results indicated that the intervention had a significant effect on improving perceived health risk of heart disease and obesity. Moreover, changes in perceived risk showed significant effect on changes in physical activity over the 16-week intervention. The study provided both theoretical and practical implications for perceived health risk as a predictor of physical activity.

The associations between the response efficacy and objective and subjective change in physical activity and diet in the Information and Risk Modification trial

OBJECTIVES

Many health promotion campaigns and interventions focussing on improving health-related behaviours have been based on targeting response efficacy. This is based on the assumption that response efficacy is an important modifiable determinant of behaviour change. This study aimed to quantify the association between response efficacy and objective and subjective measures of physical activity and diet.

STUDY DESIGN

Prospective cohort analysis of data from a randomised controlled trial.

METHODS

A total of 953 participants were assessed for response efficacy at baseline and 12 weeks following randomisation to interventions to increase physical activity and improve diet. Subjective measures were collected via a self-report questionnaire that included two questions used to derive the Cambridge Index of physical activity and questions about daily or weekly fruit and vegetable, whole grain, meat and fish intake, based on the dietary guidelines to lower cardiovascular risk. Objective measures were quantified using accelerometers and plasma carotenoids.

RESULTS

The mean change in response efficacy for physical activity was +0.5 (standard deviation [SD] 2.0) and for diet was +0.5 (SD 2.1).There were no clinically or statistically significant associations between baseline or change in response efficacy and objective and subjective measures of physical activity or objective measures of diet. There was a small statistically significant association between baseline response efficacy and change in self-reported wholegrain consumption, but this is unlikely to be clinically significant.

CONCLUSIONS

Response efficacy is not a fundamental determinant of diet and physical activity and should not be the main focus of interventions targeting these behaviours.

Expectation for Physical Activity to Minimize Dementia Risk and Physical Activity Level Among Older Adults

This study aimed to examine whether the expectation for physical activity to minimize dementia risk was associated with physical activity level and whether this association was moderated by perceived high value of dementia prevention among older adults. Participants (n = 2,824) completed questionnaires and wore accelerometers to measure their average daily steps and levels of physical activity. The expectation for physical activity to minimize dementia risk, perceived value of dementia prevention, and potential covariates (expectation of other desirable outcomes, demographics, and health-related factors) were also measured. The main effects of the expectation and perceived value and their interaction were not significant for physical activity variables in generalized linear models. These findings indicate that expecting physical activity in minimizing dementia risk might not be sufficient to influence physical activity behavior regardless of perceived high value of dementia prevention among older adults.

Influence of the disease label 'polycystic ovary syndrome' on intention to have an ultrasound and psychosocial outcomes: a randomised online study in young women

Study question

Does the disease label 'polycystic ovary syndrome' (PCOS) have an impact on desire for medical testing and psychosocial outcomes?

Summary answer

When given the disease label PCOS in a hypothetical scenario, participants had higher intention to have an ultrasound, perceived the condition to be more severe and had lower self-esteem than those not given the disease label.

What is known already

Widening diagnostic criteria and improved imaging sensitivity have increased the number of reproductive-aged women diagnosed with PCOS from 4% to 8% to up to 21%. The uncertain clinical benefit of knowing this diagnosis needs to be weighed against the potential for poor psychological outcomes in women labelled with PCOS.

Study design, size, duration

This experimental online study randomised 181 young women to receive one of four hypothetical scenarios of a doctor's visit in a 2 (PCOS disease label versus no disease label) x 2 (information about unreliability of ultrasounds in clarifying diagnosis versus no information) design.

Participants/materials, setting, methods

Participants were university students (mean age: 19.4). After presenting the scenario, intention to have an ultrasound, negative affect, self-esteem, perceived severity of condition, credibility of the doctor and interest in a second opinion were measured. Participants were then presented with a second scenario, where the possibility of PCOS overdiagnosis was mentioned. Change in intention and perceived severity were then measured.

Main results and the role of chance

Participants given the PCOS label had significantly higher intention to have an ultrasound (mean = 6.62 versus mean = 5.76, P = 0.033, 95% CI(difference) = 0.069-1.599), perceived the condition to be more severe (17.17 versus 15.82, P = 0.019, 95% CI(difference) = 0.229-2.479) and had lower self-esteem (25.86 versus 27.56, P = 0.031, 95% CI(difference) = -3.187 to -0.157). After receiving overdiagnosis information, both intention and perceived severity decreased, regardless of condition (both P < 0.001).

Limitations, reasons for caution

This study used hypothetical scenarios; it is likely that for women facing a real diagnosis of PCOS, outcomes would be more affected than in the current study. The hypothetical design, however, allowed the symptoms and risks of PCOS to be held constant across conditions, the impact on intention and psychosocial outcomes directly attributable to the effect of the disease label.

Wider implications of the findings

These findings demonstrate the potential negative consequences of PCOS labelling. It is crucial we consider the impact of the label before diagnosing more women with PCOS when clinical benefit of this diagnosis is uncertain.

Study funding/competing interest(s)

This paper was written with support from a NHMRC grant awarded to the Screening and Test Evaluation Program. J.J. is supported by an NHMRC Early Career Fellowship. K.M. is supported by an NHMRC Career Development Fellowship. The authors declare that no competing interests exist.

Trial registration number

ACTRN12617000111370.

Trial registration date

20/01/2017.

Date of first patient's enrolment

01/06/2015.

Intention of college students to receive the human papillomavirus vaccine

Purpose

– The purpose of this paper is to better understand what influences the intentions of college students to receive the human papillomavirus (HPV) vaccine. HPV is the most common sexually transmitted infection in the USA and cancers related to HPV are on the rise.

Design/methodology/approach

– A 2×2 experimental design was used to predict the intentions. Messages were created that manipulated the level of severity and vulnerability to determine which would increase intentions to receive the HPV vaccine. Each of the 278 participants viewed a message that contained one severity message (high or low) and one vulnerability message (high or low).

Findings

– Regression was used to determine that elements of the protection motivation theory such as vulnerability and fear, along with norms, and information seeking explained a significant portion of the variance in intent to be vaccinated (R2=0.40, F(4, 268)=44.47, p < 0.001). Norms had the most influence on intention (β=0.42, p < 0.001), next was vulnerability (β=0.21, p < 0.001) then fear (β=0.16, p=0.002), and finally information seeking (β=0.10, p=0.01).

Originality/value

– The current college age population did not have the opportunity to be vaccinated early and the recent (2011) recommendation that males get vaccinated makes this research valuable to those designing vaccination messages. The current study shows that norms were the most influential variable in regards to increasing intent to get vaccinated. This means that if the participant believed their friends would support or endorse their intent to get vaccinated they were more likely to say they would follow through and get vaccinated. This finding should be highlighted in any future campaign.

The differential effects of presenting uncertainty around benefits and harms on treatment decision making

OBJECTIVE

The study aimed to determine the effects of presenting uncertainty of quantitative risk information about medication harms and benefits on intention to take medication and psychosocial outcomes.

METHODS

147 participants were randomized into four hypothetical scenarios: (1) harm/benefit presented as point-estimates, (2) harm as point/benefit as range, (3) harm as range/benefit as point, (4) harm/benefit as ranges. We assessed participants' intention to take medication, understanding, decisional conflict, and perceived benefit and harm. Participants viewed the scenario again with swapped range vs. point-estimate presentations; intention was re-assessed at time 2.

RESULTS

There were no significant differences in intention across arms (p=0.93). There was an increase in intention to take medication between time 1 and time 2 in arm 4 (both harm/benefit presented as ranges, then point estimates). Understanding was greater when information was presented as point estimates compared to ranges, for both benefit (all questions correct: 74% vs 42%; χ2=15.28, df=2, p<0.001) and harm (all questions correct: 70% vs 43%; χ2=11.19, df=2, p=0.004) CONCLUSION: Changes in benefit information appear to be more influential in changing intention to take medication than harm information. Presenting uncertainty decreases understanding of information.

PRACTICE IMPLICATION

The findings may help develop optimal ways to present uncertainty.

Psychosocial Predictors for Cancer Prevention Behaviors in Workplace Using Protection Motivation Theory

Backgrounds. The aim of this study was to describe the preventive behaviors of industrial workers and factors influencing occupational cancer prevention behaviors using protection motivation theory. Methods. A self-administered questionnaire was completed by 161 petrochemical workers in Iran in 2014 which consisted of three sections: background information, protection motivation theory measures, and occupational cancers preventive behaviors. Results. A statistically significant positive correlation was found between PM and self-efficacy, response efficacy, and the cancer preventive behaviors. Meanwhile, statistically significant negative correlations were found between PM, cost, and reward. Conclusions. Among available PMT constructs, only self-efficacy and cost were significant predictors of preventive behaviors. Protection motivation model based health promotion interventions with focus on self-efficacy and cost would be desirable in the case of occupational cancers prevention.

Awareness and correlates of the role of physical activity in breast cancer prevention among Japanese women: results from an internet-based cross-sectional survey

BACKGROUND

Although considerable evidence has demonstrated that physical activity is associated with breast cancer prevention, few studies have assessed the level of awareness of this association. Awareness is a key first step to successful of behavior change. Increasing awareness may contribute to promote physical activity and prevent breast cancer at the population level. The present study examined the prevalence and correlates of awareness about the role of physical activity in breast cancer prevention among Japanese women.

METHODS

1,000 Japanese women aged 20-69 years (mean age: 44.3 ± 13.4 years) who responded to an internet-based cross-sectional survey. Awareness of the role of physical activity in breast cancer prevention, knowledge of breast cancer (symptom, risk factor, screening), exposure to information about physical activity and cancer, a self-reported physical activity, and sociodemographic variables (age, marital status, having a child, education level, employment status, and household income) were obtained. Force-entry logistic regression analysis was used.

RESULTS

The prevalence of awareness was 31.5% (95% CI: 28.6-34.4). Factors significantly associated with awareness included sociodemographic variables, exposure to information, and knowledge of breast cancer. Being married (AOR, 95% CI: 1.75, 1.05-2.92) was positively related to awareness, while having children (0.65, 0.36-0.86) was negatively related. College graduates or those with higher levels of education (1.50, 1.01-2.22) were significantly more likely to be aware than those who had not graduated high school. Moreover, exposure to information (2.11, 1.51-2.95), and high knowledge of symptoms (2.43, 1.75-3.36) were positively associated with awareness. Finally, low knowledge of risk factors (0.30, 0.22-0.40) was negatively associated with awareness.

CONCLUSIONS

Japanese women through internet-based study were poorly aware of the role of physical activity in breast cancer prevention. Awareness was especially low among individuals with children and higher knowledge of risk factors whereas high in married women, those with higher educational level, exposure to information, and greater knowledge of symptoms. The findings suggest that strategies to increase the awareness about the preventive role of physical activity are needed for breast cancer prevention in consideration of subgroups with low awareness.

The influence of antiobesity media content on intention to eat healthily and exercise: a test of the ordered protection motivation theory

This study extended the ordered protection motivation framework to determine whether exposure and attention to antiobesity media content increases people's appraisals of threat and their ability to cope with it. It also assesses whether these cognitive processes, in turn, affected people's intention to abide by the practices recommended to prevent obesity. The results of a national online survey using a nonprobability sample indicate that attention to mediated obesity and related information significantly increased people's intention to exercise as well as their overall coping appraisals (the perceived effectiveness of the recommended behaviors and their ability to perform them). Likewise, increased threat and coping appraisals were both found to significantly influence people's intention to exercise and diet. Coping (rather than threat) appraisals more strongly predicted behavioral intent. Following the attitude-behavior literature, behavioral intention was used as the most proximate predictor of actual behavior (i.e., stronger intentions increase the likelihood of behavior change).

Can exergames impart health messages? Game play, framing, and drivers of physical activity among children

This study examines the effectiveness of incorporating exergaming into physical education lessons as a platform for imparting health education messages and influencing children's beliefs about and attitudes toward physical activity. The authors launched a 6-week intervention program using Nintendo Wii games coupled with protection motivation theory-based health messaging among 5th-grade school children in Singapore. Results indicated that when children who were exposed to threat-framed messages played Wii exergames during physical education lessons, they reported more positive physical activity attitude, self-efficacy, and perceived behavioral control than did those who underwent regular physical education lessons and were exposed to the same message. In addition, among children playing Wii, the threat and coping frames had similar effects on the degree of message influence on physical activity attitudes and beliefs. The implications for schools, parents, and health policy are discussed.

Protection motivation theory and physical activity in the general population: a systematic literature review

An appropriate theoretical framework may be useful for guiding the development of physical activity interventions. This review investigates the effectiveness of the protection motivation theory (PMT), a model based on the cognitive mediation processes of behavioral change, in the prediction and promotion of physical activity participation. A literature search was conducted using the databases MEDLINE, PsycINFO, PubMed, and Web of Science, and a manual search was conducted on relevant reference lists. Studies were included if they tested or applied the PMT, measured physical activity, and sampled from healthy populations. A total of 20 studies were reviewed, grouped into four design categories: prediction, stage discrimination, experimental manipulation, and intervention. The results indicated that the PMT's coping appraisal construct of self-efficacy generally appears to be the most effective in predicting and promoting physical activity participation. In conclusion, the PMT shows some promise, however, there are still substantial gaps in the evidence.

Determinants of human papillomavirus (HPV) vaccination intent among three Canadian target groups

To increase the uptake of the human papillomavirus (HPV) vaccine, understanding the determinants of vaccination intentions for various groups is important. Three studies examining theoretical determinants of college-aged women's (study 1: n = 286), parents' of daughters (study 2: n = 230) and parents' of sons (study 3: n = 137) HPV vaccination intentions were conducted. Participants completed questionnaires assessing constructs of protection motivation theory (PMT) and the theory of planned behaviour (TPB). Results indicate that both PMT and TPB constructs predict intentions for the different groups. Focusing on the response efficacy of the vaccine rather than the severity of contracting HPV may be an effective way to increase vaccination intentions among all groups. Focusing on vulnerability to HPV may only increase intentions among college-aged women and parents of sons, and increasing self-efficacy may only increase intentions among college-aged women and parents of daughters. Findings have implications for understanding differences among groups considering HPV vaccination and tailoring interventions.

Message framing and parents' intentions to have their children vaccinated against HPV

OBJECTIVE

Framing a message in terms of the benefits of engaging in the behavior (gain frame), the costs of failing to engage in the behavior (loss frame), or both the benefits and the costs (mixed frame) can impact parents' decisions about their childrens' and adolescents' health. This study, investigated the effect of framed messages on parents' intentions to have their children vaccinated against human papillomavirus (HPV).

DESIGN AND SAMPLE

The study employed a 2 (gender of the parent) × 2 (gender of the child) × 3 (message frame) between-groups, quasi-experimental design. A convenience sample of 367 parents with children in Grade 5, 6, or 7 who had at least one child who had not been vaccinated against HPV.

MEASURES

Social-cognitive variables relating to intentions to vaccinate a child were assessed.

INTERVENTION

Participants were randomly assigned to read one of three framed messages about the HPV vaccine (gain, loss, or mixed).

RESULTS

Gain-framed messages seemed to persuade mothers of sons to speak to a doctor about the vaccine (p < .05). Framing effects were not significant for other outcomes.

CONCLUSIONS

Findings provide preliminary evidence that certain vaccination messages may be more effective for different parent-child dyads.

Risky business: risk information and the moderating effect of message frame and past behaviour on women's perceptions of the Human Papillomavirus vaccine

The effect of response cost information, message framing and past behaviour on women's coping appraisal and motivation to be vaccinated against the Human Papillomavirus (HPV) were investigated using a 2 Frame × 2 Response Cost × 2 Pap Status design. Women (N = 286) read one of four messages about the vaccine. Women who received high-risk information perceived the vaccine as having higher response cost and were less motivated to be vaccinated compared to women who received low-risk information. The deleterious effects of risk information on specific aspects of women's coping appraisal may be mitigated by appropriately framed messages.

Examining predictors of physical activity among inactive middle-aged women: an application of the health action process approach

This study tested several relationships predicted by the Health Action Process Approach (HAPA) in a sample of 175 generally healthy, inactive, middle-aged women (40-65 yrs old) over a 12 week period. Participants' physical activity, risk perceptions, outcome expectancies, action self-efficacy and intention were measured at baseline. Planning and maintenance self-efficacy were measured 4 weeks later. Physical activity behaviour was measured 12 weeks after baseline. The HAPA relationships were examined using a structural equation model. The data fit the model well and revealed several significant relationships. Action self-efficacy was the best predictor of intention. Maintenance self-efficacy was the best predictor of planning and behaviour. Contrary to the tenets of HAPA and to past research, planning did not predict behaviour. Overall, HAPA provides a useful framework for identifying determinants of physical activity intentions and behaviour within a group of inactive, middle-aged women.

A Protection Motivation Theory application to date rape education

Date rape risk communication is a key component of education-based Date Rape Prevention Programs, common across colleges. In such programs, risk assessment in date rape is approached cautiously in order to avoid a tone of "victim blaming." Since it is important in the assessment of any risk to understand the surrounding social context of the risky situation and the individual's unique relationship with that social context, this study examines Protection Motivation Theory as it applies to handling the risk of date rape without victim blaming. The paper links individual personality and social contexts with risk communication. The study sample comprised 367 undergraduate women enrolled in a large Southern Public University. The study examines the relationships between dating activity, social competency, and type of information provided with the dependents variables of date rape related protection behavior (intent), belief, and knowledge. A factorial multiple analysis of covariance analysis found that the dependent variables had a significant relationship with aspects of social competency and dating activity. The exposure to varying information about date rape was not significantly related to the dependent variables of date rape-related protection behavior (intent), belief, and knowledge. The identification of social competency and dating activity status as protective factors in this study makes a significant contribution to the practice and research efforts in date rape education.

Protection motivation theory: is this a worthwhile theory for physical activity promotion?

This article reviews the published studies in the physical activity domain, which include novel hypothesis from our laboratory, that have tested Rogers' Protection Motivation Theory. Across the various population groups, the theory's coping appraisal is generally supported; however, there is limited support for the theory's threat components. Implications of these findings are discussed from both theoretical and practical perspectives.

The E2D2 model: a dynamic approach to cancer prevention interventions

The E2D2 model is a systematic, evidence-informed approach to designing comprehensive and strategic interventions focused on cancer prevention, with potential applications to the broader chronic disease community. The model was developed using an omnibus approach to account for multilevel influences and determinants of individual and population health, quality of life, and cancer risk. It is focused on the four pillars of health promotion and intervention practice (evidence, evaluation, development, and delivery) and moves through three fundamental phases: identification of risk factors and sensitizing concepts; mediating mechanisms and modifiable contexts; and program development, delivery, and evaluation. Distinguished from other models in the health promotion field, the E2D2 model is designed to be both sequential and feedback oriented, which allows for the emergence of new evidence, procedural revisions, and knowledge exchange to occur during any of its phases.

Health disparities in awareness of physical activity and cancer prevention: findings from the National Cancer Institute's 2007 Health Information National Trends Survey (HINTS)

This national study examines differences between racial/ethnic groups on awareness of physical activity and reduced cancer risk and explores correlates of awareness including trust, demographic, and health characteristics within racial/ethnic groups. The 2007 Health Information and National Trends Survey (HINTS) provided data for this study. After exclusions, 6,809 adults were included in analyses. Awareness of physical activity in reduced cancer risk was the main outcome. Logistic regression models tested relationships. Non-Hispanic Blacks had a 0.71 (0.54,0.93) lower odds of being aware of physical activity in reduced cancer risk than non-Hispanic Whites. Current attempts to lose weight were associated with greater odds for awareness among non-Hispanic Blacks and Hispanics (p < .01). Among non-Hispanic Blacks, trust in traditional and Internet media was associated with greater odds of awareness (p < .01). This study is the first national study to examine racial/ethnic disparities in awareness of physical activity and cancer risk. Comparisons between racial/ethnic groups found Black-White disparities in awareness. Variables associated with awareness within racial/ethnic groups identify potential subgroups to whom communication efforts to promote awareness may be targeted.

Protection motivation theory and the prediction of physical activity among adults with type 1 or type 2 diabetes in a large population sample

OBJECTIVES

To investigate the utility of the protection motivation theory (PMT) for explaining physical activity (PA) in an adult population with type 1 diabetes (T1D) and type 2 diabetes (T2D).

DESIGN

Cross-sectional and 6-month longitudinal analysis using PMT.

METHODS

Two thousand three hundred and eleven individuals with T1D (N=697) and T2D (N=1,614) completed self-report PMT constructs of vulnerability, severity, response efficacy, self-efficacy, and intention, and PA behaviour at baseline and 6-month follow-up. Multi-group structural equation modelling was conducted to: (1) test the fit of the PMT structure; (2) determine the similarities and differences in the PMT structure between the two types of diabetes; and (3) examine the explained variance and compare the strength of association of the PMT constructs in predicting PA intention and behaviour.

RESULTS

The findings provide evidence for the utility of the PMT in both diabetes samples (chi(2)/df=1.27-4.08, RMSEA=.02-.05). Self-efficacy was a stronger predictor of intention (beta=0.64-0.68) than response efficacy (beta=0.14-0.16) in individuals with T1D or T2D. Severity was significantly related to intention (beta=0.06) in T2D individuals only, whereas vulnerability was not significantly related to intention or PA behaviour. Self-efficacy (beta's=0.20-0.28) and intention (beta's=0.12-0.30) were significantly associated with PA behaviour.

CONCLUSIONS

Promotion of PA behaviour should primarily target self-efficacy to form intentions and to change behaviour. In addition, for individuals with T2D, severity information should be incorporated into PA intervention materials in this population.

Are current health behavioral change models helpful in guiding prevention of weight gain efforts?

Effective procedures are needed to prevent the substantial increases in adiposity that have been occurring among children and adults. Behavioral change may occur as a result of changes in variables that mediate interventions. These mediating variables have typically come from the theories or models used to understand behavior. Seven categories of theories and models are reviewed to define the concepts and to identify the motivational mechanism(s), the resources that a person needs for change, the processes by which behavioral change is likely to occur, and the procedures necessary to promote change. Although each model has something to offer obesity prevention, the early promise can be achieved only with substantial additional research in which these models are applied to diet and physical activity in regard to obesity. The most promising avenues for such research seem to be using the latest variants of the Theory of Planned Behavior and Social Ecology. Synergy may be achieved by taking the most promising concepts from each model and integrating them for use with specific populations. Biology-based steps in an eating or physical activity event are identified, and research issues are suggested to integrate behavioral and biological approaches to understanding eating and physical activity behaviors. Social marketing procedures have much to offer in terms of organizing and strategizing behavioral change programs to incorporate these theoretical ideas. More research is needed to assess the true potential for these models to contribute to our understanding of obesity-related diet and physical activity practices, and in turn, to obesity prevention.

Framework PEACE: an organizational model for examining physical exercise across the cancer experience

The primary purpose of this article is to provide a framework for organizing research on physical exercise and cancer control. A secondary purpose is to use this framework to provide an overview of the extant literature and to offer directions forr future research. The proposed framework, entitled Physical Exercise Across the Cancer Experience (PEACE), divides the cancer experience into 6 time periods: 2 prediagnosis (i.e., prescreening and screening/diagnosis) and 4 postdiagnosis (i.e., pretreatment, treatment, posttreatment, and resumption). Based on these time periods, 8 general cancer control outcomes are highlighted. Two cancer control outcomes occur prediagnosis (i.e., prevention and detection), and 6 occur postdiagnosis (i.e., buffering, coping, rehabilitation, health promotion, palliation, and survival). An overview of the physical exercise literature indicates that only I time period (i.e., prescreening) and cancer control outcome (i.e., prevention) has received significant research attention. Some time periods (i.e., treatment and resumption) and cancer control outcomes (i.e., coping and health promotion) have received modest research attention, whereas other time periods (i.e., screening/diagnosis, pretreatment, and posttreatment) and cancer control outcomes (i.e., detection, buffering, rehabilitation, palliation, and survival) have received only minimal attention. It is hoped that Framework PEACE will stimulate a more comprehensive and in-depth inquiry into the role of physical exercise in cancer control.