THE RELATIONSHIP BETWEEN MALE PRISONERS' SELF-EFFICACY AND THEIR PARTICIPATION IN ADDICTION TREATMENT

The purpose of this study was to attempt to verify the existence of a relationship between internal resources (self-esteem and self-efficacy) and motivation (decisional balance) to undergo treatment in prisoners with alcohol addiction participating in a voluntary treatment as well as referred to obligatory addiction treatment based on a court decision. The study was carried out in penitentiary units in various parts of Poland in 2018-2019. Participants completed the Decision Balance Scale, Generalized Self-Efficacy Scale, and Multidimensional Self-Esteem Inventory twice - before and after addiction treatment. The study adopted the assumptions of the Transtheoretical Model developed by Prochaska and DiClemente. There were no statistically significant differences between the group of prisoners referred for obligatory treatment and those undergoing voluntary therapy. At the end of the 3-month treatment, there was a significantly smaller number of arguments "for" drinking and less identity integration in both groups studied. The results obtained may indicate that after undergoing the therapy, prisoners remain in a contemplation stage due to their inability to adapt therapeutic interactions to individual needs. It seems that changes in identity integration may be indicative of the crisis that is being experienced, which in effect may allow individuals with alcohol addiction to search for and achieve a potentially new, coherent image of themselves.

Validation and results of a novel survey assessing decisional balance for a whole food plant-based diet among US adults

Importance

Consuming a whole food plant-based diet (WFPBD) is a promising, low-risk strategy for reducing risk of prevalent chronic disease and certain cancers, with synergistic benefits for climate and environment. However, few US adults report consuming a WFPBD. Understanding the reasons for this inconsistency is important for developing and implementing interventions for promoting a WFPBD. However, no research to elucidate decisional balance driving current consumption patterns in the US exists.

Objective

This research aims to validate an online survey to assess decisional balance for the consumption of a WFPBD, describe attitudes and beliefs toward adopting a WFPBD, and evaluate socio-demographic differences in decisional balance for consuming a WFPBD among a convenience sample of US adults.

Design

Online cross-sectional data collection followed by confirmatory factor analysis (CFA), validation of internal consistency, and examination of invariance across socio-demographic variables. Sensitivity analysis of full vs. truncated survey to predict self-reported dietary patterns and consumption behaviors were evaluated. Results of the survey and significant differences by socio-demographics were assessed.

Setting

Online survey based on previous research, created via Qualtrics, and administered through MTurk.

Participants

A total of 412 US adults, majority female (66%), White (75%), 30-60 years old (54%), ≥ Bachelor's degree (85%), and earning ≥ $45K (68%).

Main outcomes and measures

Factor loadings, covariance of survey items, associations with self-reported dietary pattern and consumption measures, and differences in pros, cons, and decisional balance across socio-demographic variables.

Results

CFA reduced the survey from 49 to 12 items and demonstrated invariance across socio-demographic variables. Pros and cons varied inversely and significantly (cov = -0.59), as expected. Cronbach's α 's for subscales in the final, reduced model were high (>0.80). Pros, cons, and decisional balance in both the full and the reduced model were significantly (p < 0.05) associated with self-reported dietary pattern and consumption.

Conclusion and relevance

Our analyses indicate the WFPBD Survey is a parsimonious and psychometrically sound instrument for evaluation of decisional balance to consume a WFPBD diet among our sample of US adults. These results may be instrumental for development and deployment of interventions intended to promote consumption of a WFPBD in the US.

Understanding motives for and against hazardous drinking and change among returning veterans

The prevalence of hazardous drinking is elevated among returning veterans of Iraq and Afghanistan wars, particularly among returning veterans and those with co-occurring posttraumatic stress disorder (PTSD) symptoms. Understanding the reasons for drinking as well as motivations for change can tremendously improve intervention efforts. Unfortunately, little is currently known regarding the motivations that might facilitate or hinder change among returning veterans. In the current study, we examined returning veterans' reasons to change or not change drinking through analysis of responses to an open-ended decisional balance exercise. We included 366 returning veterans selected from a larger sample of returning veterans enrolled in a web-based randomized-controlled trial of an online intervention for alcohol use and PTSD. We used qualitative content analysis to systematically classify responses into categories through identification of common themes. Top reasons to change/reduce drinking included reducing negative physical effects, improve finances, and expected social/interpersonal benefits of reduction or abstaining. Top reasons to continue drinking/not change included facilitation of social interaction, promote sleep, and reduce tension. The current study adds to our phenomenological understanding of motivations for and against changing drinking among returning veterans. Whereas many motives were consistent with those of nonveteran samples, others appear to distinguish, and are uniquely salient among, returning veterans (e.g., to manage sleep and PTSD symptoms). These results provide insight into key assessment and intervention points regarding hazardous drinking among returning veterans. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Effects of Brain Breaks Video Intervention of Decisional Balance among Malaysians with Type 2 Diabetes Mellitus: A Randomised Controlled Trial

Brain Breaks^® are structured physical activity (PA) web-based videos designed to promote an interest in learning and health promotion. The objective of this study was to examine its effects on decision balance (DB) which consists of the perceived benefits (Pros) and perceived barriers (Cons) of exercise in people with type 2 diabetes mellitus (T2DM). A randomised controlled trial was conducted among people with T2DM at Hospital Universiti Sains Malaysia. The intervention group received Brain Breaks videos for a period of four months. The intervention and control groups completed the validated Malay version of DB questionnaire for five times, at pre-intervention, the first month, the second month, the third month, and post-intervention. Multivariate Repeated Measures Analysis of Variance was performed for data analysis. A total of 70 participants were included (male = 39; female = 31) with a mean age of 57.6 years (SD = 8.5). The intervention group showed a significant change in the Pros and Cons factors of DB scores over time. The intervention group showed significantly higher scores for the Pros (p-value < 0.001) and lower scores for the Cons (p-value = 0.008) factors than the control group. In conclusion, the Brain Breaks video is an effective intervention to improve decisional balance in patients with T2DM to help them in deciding on behaviour change to be more physically active.

Pathways of diabetes distress, decisional balance, self-efficacy and resilience to quality of life in insulin-treated patients with type 2 diabetes: A 9-month prospective study

AIMS AND OBJECTIVES

To construct a path model addressing influences of diabetes distress, self-efficacy of injecting insulin, resilience and decisional balance of injecting insulin to quality of life (QoL) in insulin-treated patients with type 2 diabetes (T2DM).

BACKGROUND

Insulin regimens more negatively impact QoL than oral medication treatments in patients with T2DM. Understanding the factors and influencing pathways associated with subsequent QoL will help nurses design timely interventions to improve QoL of insulin-treated T2DM patients.

DESIGN

A 9-month prospective design was employed in this study.

METHODS

Self-reported questionnaires were used to collect data from 185 insulin-treated T2DM patients. At baseline, diabetes distress and self-efficacy of injecting insulin were collected, while QoL, resilience and decisional balance of injecting insulin were collected 9 months later. Data were collected from February 2017 to February 2018. Structural equation modelling was used for analysis. This study was conducted based on the STROBE.

RESULTS

Low baseline diabetes distress and high 9-month decisional balance of injecting insulin directly associated with high 9-month QoL. High baseline self-efficacy of injecting insulin and high 9-month resilience directly associated with high 9-month decisional balance of insulin injection and indirectly associated with high 9-month QoL. High baseline diabetes distress directly and indirectly associated with poor 9-month QoL.

CONCLUSIONS

Diabetes distress, self-efficacy of injecting insulin, resilience and decisional balance of injecting insulin play different roles in associating with QoL in insulin-treated T2DM patients.

RELEVANCE TO CLINICAL PRACTICE

Nurses could provide educational programs focusing on enhancing decisional balance of injecting insulin to improve QoL in insulin-treated patients. Improving self-efficacy of injecting insulin and resilience could be promising strategies to improve the decisional balance of injecting insulin. More timely assessment of diabetes distress and intervention might be powerful strategies to improve subsequent QoL in these patients.

The Decisional Balance Toward Health Behaviors Among Patients With Hypertension

The decisional balance is related to the transtheoretical model, and involves weighting the pros and cons of performing a behavior. The study aimed to assess hypertensive patients' decisional balances about smoking, weight control, and physical exercise. A cross-section descriptive correlation design was used, and 110 patients were recruited using convenience sampling in outpatient clinics. The decisional balance was measured using "Decisional Balance Scales," which assess an individual's decisional balance related to smoking, weight control, and physical exercise behaviors. The results predicted that Jordanian hypertensive patients with higher physical exercise decisional balance and higher weight decisional balance had lower smoking decisional behaviors. Nurses can foster health promotion and behavioral change by employing interventions that improve decisional balances. Improving the decisional balance of one behavior would have a positive impact on other behaviors. Thus, designing multidimensional interventions might be effective for modifying different types of health behaviors, and fostering health promotion practices.

Outcome Expectations for Exercise and Decisional Balance Questionnaires Predict Adherence and Efficacy of Exercise Programs in Dialysis Patients

The purpose of this study was to define if Outcomes Expectations for Exercise (OEE) and Decisional Balance (DB) scales predict adherence to guided exercise programs and associate with the improvement in physical performance in the dialysis population. Participants (n = 40; age 63.6 ± 12.5 years) completed OEE and DB questionnaires before randomization to the experimental group (n = 20) and control group (n = 20) of a two-phased exercise program—the experimental group received eight weeks of supervised functional exercise and exercise counseling (1st phase) before commencing eight weeks of home-based exercise on non-dialysis days (2nd phase). Both groups performed intradialytic cycling on dialysis days during both study phases. Patients with above-median OEE and DB scores (>3.15 and >1.3, respectively) expressed significantly better adherence to intradialytic cycling (89% vs. 76%, 89% vs. 77%, respectively, p < 0.05). Experimental group patients with an above-median OEE (but not DB) score had significantly better adherence to supervised and home-based functional exercise (93% vs. 81% and 85% vs. 60%, respectively, p < 0.05). Baseline DB score predicted the final result in the hand-grip test and 6-min walk test. Low OEE and, to a lesser degree, low DB questionnaire scores associate with inferior adherence to dialysis bundled and home-based exercise programs and may help define patient subsets in need of intensified motivational input by exercise caregivers.

Temporal Sequencing of Physical Activity Change Constructs within the Transtheoretical Model

OBJECTIVE

Studies support the Transtheoretical Model's (TTM) ability to describe behavior change processes and guide interventions; however, the temporal sequencing of constructs is less understood. This cohort study tested five sequences to identify TTM construct changes related to physical activity.

METHODS

A random sample provided baseline data (n=689; 63% female; M _age (SD)=47(17); 37% white), with 401 participants providing 24-month data, at six-month intervals.

RESULTS

Structural equation models revealed processes to cognitions to stage (AIC=29313.093, BIC=29514.883, CFI=0.999, RMSEA=0.006, SRMR=0.026); processes to stage to cognitions (AIC=27788.651, BIC=27973.268, CFI=0.978, RMSEA=0.024, SRMR=0.038), self-efficacy/temptations to processes to decisional balance to stage (AIC=13914.771, BIC=14031.169, CFI=0.981, RMSEA=0.018, SRMR=0.034), and stage to processes to cognitions (AIC=22048.324, BIC=22212.986, CFI=0.976, RMSEA=0.026, SRMR=0.029) all fit well. However, cognitions to processes to stage did not fit the data well (AIC=10353.555, BIC=10444.179, CFI=0.937, RMSEA=0.038, SRMR=0.035).

CONCLUSIONS

Integrating results revealed a cyclical model so that intervention efforts should focus on processes to change cognitions related to barrier self-efficacy and decisional balance, which then lead to change in stage and then renew focus on the processes.

Characteristics in Stages of Change and Decisional Balance among Smokers: The Burden of Obstructive Lung Diseases (BOLD)-Australia Study

Smoking cessation remains a health promotion target. Applying the Transtheoretical Model to Australian Burden of Obstructive Lung Diseases (BOLD) data, we examined differences in stages of change (SoC) and readiness to quit decisional behaviours. Factors were identified likely to influence readiness of smokers, ≥40 years old, to quit. Analysis was restricted to current smokers classified to one of three stages: pre-contemplation (PC), contemplation (C) or preparation (P) to quit. Their ability to balance positive and negative consequences was measured using decisional balance. Among 314 smokers, 43.0% females and 60.8% overweight/obese, the distribution of SoC was: 38.1% PC, 38.3% C and 23.5% P. Overweight/obesity was associated with readiness to quit in stages C and P and there were more negative than positive attitudes towards smoking in those stages. Males were significantly heavier smokers in PC and C stages. Females used smoking cessation medication more frequently in PC stage, were more embarrassed about smoking and had greater negative reinforcements from smoking. Age started smoking and factors related to smoking history were associated with readiness to quit and increased the odds of being in stage C or P. An overweight/obese smoker was likely to be contemplating or preparing to quit. In these stages, smokers have more negative attitudes toward smoking. Starting smoking later, taking advice on cessation from health providers and using quit medications indicate increased readiness to quit. Evaluating these factors in smokers and developing cessation gain-framed messages may prove useful to healthcare providers.

Confirmatory Factor Analysis of the Malay-Language Transtheoretical Model of Physical Activity among Malaysian Primary School Children

Introduction

The transtheoretical model (TTM) is an integrative model of intentional change consisting of stages of change, processes of change, decisional balance and self-efficacy. This study aimed at validating the TTM questionnaires on physical activity for Malaysian children using confirmatory factor analysis.

Methods

The participants were 381 Malay students (188 male; 193 female), aged 10–12 years old, with a mean age of 10.94 (SD = 0.81). The original version of the TTM was translated into the Malay language using forward and backward translation. Certain phrases were adapted based on the local culture and vocabulary suitable for primary school students.

Results

The final measurement models and their fit indices were: processes of change (CFI = 0.939, TLI = 0.925, SRMR = 0.040, RMSEA = 0.030); decisional balance (CFI = 0.897, TLI = 0.864, SRMR = 0.045, RMSEA = 0.038); and self-efficacy (CFI = 0.934, TLI = 0.915, SRMR = 0.042, RMSEA = 0.032).

Conclusion

Care must be taken when using the TTM with children, as it has been prevalently validated with adults. The final version of the TTM questionnaire for Malay primary school children had 24 items for process of changes, 13 items for self-efficacy and 10 items for decisional balance.

Analyzing factors enabling colorectal cancer screening adherence in Korean Americans using the Andersen's Behavioral Model of Health Services Utilization

Purpose/objectives: Korean Americans (KAs) report suboptimal colorectal cancer (CRC) screening adherence. This study investigated factors that enable KAs to adhere to CRC screening guidelines using the Andersen's Behavioral Model of Health Services Utilization. Design: Cross-sectional survey using self-reported measures of CRC screening behaviors. Sample and methods: Purposive sampling was used to recruit 433 KAs aged 50-75 from the Atlanta metropolitan area who completed questionnaires measuring predisposing (i.e., gender, age, marital status, and educational attainment), enabling (income, health insurance, regular annual health checkups, doctor's recommendation English proficiency, CRC knowledge, self-efficacy for CRC screening, and decisional balance in CRC screening), and need (family cancer history and self-reported health status) factors associated with CRC screening. Findings: A multiple logistic regression model including all 14 predictor variables revealed that several enabling factors (i.e., income, regular annual health checkups, doctor's recommendation, self-efficacy, and decisional balance) independently predicted increased CRC screening adherence in KAs. No predisposing or need factors independently predicted CRC screening. Conclusions and implications for psychosocial providers or policy: To increase CRC screening adherence among KAs, psychosocial interventions should target on improving their self-efficacy and decisional balance regarding CRC screening, while policy interventions should focus on promoting health providers' CRC screening recommendations during routine health checkups.

Application of Transtheoretical Model on Behavioral Changes, and Amount of Physical Activity Among University's Students

This study's purpose was to examine the structural relationship of the transtheoretical model (TTM) and the amount of physical activity (PA) among undergraduate students in health and medicine at Universiti Sains Malaysia. A cross-sectional study was carried out among students who took part in the co-curricular program. Co-curricular program includes activities that take place outside of the regular lectures or tutorials in the University. Students recruited through purposive sampling were informed that their participation was entirely voluntarily. Those interested completed the self-administered questionnaire, which consisted of the decisional balance, processes of change, self-efficacy, stages of change scales, and Godin leisure-time exercise questionnaire. Data were analyzed using Mplus version 8 for descriptive statistics and structural equation modeling analysis for inferential statistics. A total of 562 students participated in the study. The majority of the students was female (79.0%) and Malay (73.3%) and average of exercise sessions per week was 2.62, with a mean of 43.37 min per exercise session. The final structural model fit the data well based on several fit indices (SRMR = 0.046, RMSEA (CI: 90%) = 0.061 (0.045, 0.078), RMSEA p = 0.130). The model showed that stages of change significantly affected self-efficacy (p < 0.001), pros (benefits of exercise; p < 0.001), cons (barriers to exercise; p = 0.022), and processes of change (p < 0.001). The model also showed significant inter-relationships among the TTM constructs and supported seven hypotheses. Among all the variables examined, only processes of change significantly affected PA (p < 0.001). However, stages of change (p < 0.001) and pros (p =< 0.001) had significant indirect effects on PA via processes of change. The findings support that individuals' stages of change affect their self-efficacy level, or the ability to make positive and negative decisions and perform behavior accordingly. The study confirms that making correct decisions and taking action accordingly can increase PA levels.

Weighing the Pros and Cons of Using Alcohol Protective Behavioral Strategies: A Qualitative Examination among College Students

BACKGROUND

Alcohol protective behavioral strategies (PBS) are behaviors engaged in immediately prior to, during, after, or instead of drinking with the explicit goal of reducing alcohol use, intoxication, and/or alcohol-related harms. Despite the quantitative support for alcohol PBS as a protective factor among college student drinkers, we know of no qualitative research aimed at determining college student drinkers' perceptions regarding the advantages and disadvantages of using PBS.

OBJECTIVES

In the style of a decisional balance exercise, we asked college student drinkers (analytic n = 113) to identify 5 reasons they would not use PBS (cons) and 5 reasons they would use PBS (pros).

METHOD

Participants (majority female, 77.0%) were recruited from a psychology department participant pool at a large, southeastern university in the United States. Within our analytic sample, participants on average consumed 6.38 (SD = 8.16) drinks per typical week of drinking and reported consuming alcohol on average 7.5 days (SD = 5.83) in the last 30 days.

RESULTS

Using a descriptive phenomenological approach, we identified 2 themes for pros (prevention of specific negative alcohol-related consequences and general safety) and 4 themes for cons (goal conflict, ineffectiveness, difficulty of implementation, and negative peer/social repercussions). Overall, participants reported more pros than cons and this discrepancy (i.e., number of PBS pros minus number of PBS cons) was positively related to self-reported frequency of PBS use. Conclusions/Importance: Taken together, we hope that clinicians/researchers will probe individual's reasons for choosing to use (or not use) PBS in order to tailor or improve existing PBS-based interventions.

Development and Preliminary Psychometric Evaluation of Decisional Balance and Self-Efficacy Measures for Managing Anxiety in a National Sample of Clinically Anxious Adults

PURPOSE

Anxiety is the most common and costly mental illness in the United States. Reducing avoidance is a core element of evidence-based treatments. Past research shows readiness to address avoidance affects outcomes. Investigating avoidance from a transtheoretical model (TTM) perspective could facilitate tailored approaches for individuals with low readiness. This study developed and examined psychometric properties of TTM measures for addressing anxiety-based avoidance.

DESIGN

Cross-sectional survey.

SETTING

Community centers, online survey.

PARTICIPANTS

Five hundred ninety-four individuals aged 18 to 70 with clinically significant anxiety.

MEASURES

Overall Anxiety Severity Questionnaire, stages of change, decisional balance, and self-efficacy.

ANALYSIS

The sample was randomly split into halves for principal component analyses (PCAs) and confirmatory factor analyses (CFAs) to test measurement models. Further analyses examined relationships between constructs.

RESULTS

For decisional balance, PCA indicated two 5-item factors (pros and cons). Confirmatory factor analysis supported a 2-factor correlated model, Satorra-Bentler scaled chi-square [Formula: see text], comparative fit index (CFI = 0.94), root mean square error of approximation (RMSEA = 0.07), pros: α = 0.87, ρ = 0.87, cons: α = 0.75, and ρ = 0.75. For self-efficacy, PCA indicated one 6-item factor supported by CFA, [Formula: see text], P < .01, CFI = 0.98, RMSEA = 0.09, α = 0.90, ρ = 0.87. As hypothesized, significant cross-stage differences were observed for pros and self-efficacy, and significant relationships between anxiety severity and pros, cons, and self-efficacy were found.

CONCLUSION

Findings show strong psychometric properties and support the application of a readiness-based model to anxiety. In contrast to findings of other behaviors, cons remain high in action and maintenance. These measures provide a solid empirical foundation to develop TTM-tailored interventions to enhance engagement in treatment.

Hitting rock bottom? Resource loss as a predictor of alcoholism treatment completion

Background Efforts to better understand the phenomenon of the 'bottom', the beginning of the process of turning away from alcohol, are important for both theoretical and practical goals. The conservation of resources theory by Hobfoll may represent a suitable framework to base these attempts around. Aim The aim of the study was to examine the role of resource loss in completing alcoholism treatment on the basis of Hobfoll's conservation of resources theory. Methods The study included 86 patients undergoing inpatient alcoholism treatment. An assessment of resource loss and gain during the previous year, as well as of the decisional balance regarding the pros and cons of drinking alcohol, took place at the beginning of therapy. Results The results of hierarchical binary logistic regression confirmed that resource loss was the only significant predictor of therapy completion, after adjustment for decisional balance, demographics and basic clinical data. Additionally, gender moderated the relationship between resource gain and therapy completion: while an increase in gain was related to a decreased chance of completing therapy in men, the opposite effect was noted in women. Conclusions Resource loss has more influence than decisional balance in predicting therapy completion, which can be translated into clinically valid recommendations based on gender differences.

Using the Transtheoretical Model of Change to Improve Lifestyle Behaviors in a Woman With Metabolic Syndrome

Purpose: To provide information on how the stages of change theory can be initiated using a case study of a 64-year-old African American woman with metabolic syndrome. A questionnaire on lifestyle modifications operationalizes the stages of change theory and the case patient illustrates the process of change using this questionnaire. Data Source: An exhaustive literature review was conducted on the stages of change theory. The questionnaire used in the clinical setting presented as part of this case study encapsulates the stages of change theory after being modified from a similar tool used by the Ohio Department of Health Fresh Start Program. Conclusion: Using an objective tool to assess progress made by this case patient demonstrates the value of being able to monitor lifestyle modifications for patients with chronic diseases. Significance for Practice: This questionnaire provides a means to assess change over time and can help both patient and provider identify outcomes of treatment.

Mediation analysis of decisional balance, sun avoidance and sunscreen use in the precontemplation and preparation stages for sun protection

OBJECTIVE

Mediation analyses of sun protection were conducted testing structural equation models using longitudinal data with three waves. An effect was said to be mediated if the standardised path between processes of change, decisional balance and sun protection outcomes was significant.

DESIGN

Longitudinal models of sun protection using data from individuals in the precontemplation (N = 964) and preparation (N = 463) stages who participated of an expert system intervention.

MAIN OUTCOME MEASURES

Nine processes of change for sun protection, decisional balance constructs of sun protection (pros and cons), sun avoidance behaviour and sunscreen use.

RESULTS

With the exception of two processes in the preparation stage, processes of change predicted the pros (r = .126-.614), and the pros predicted the outcomes (r = .181-.272). Three models with the cons as mediator in the preparation stage, and none in the precontemplation stage, showed a mediated relationship between processes and outcomes.

CONCLUSION

In general, mediation analyses found both the process of change-to-pros and pros-to-behaviour paths significant for both precontemplation and preparation stages, and for both sun avoidance and sunscreen use outcomes. Findings provide support for the importance of assessing the role of underlying risk cognitions in improving sun protection adherence.

Effects of readiness to change, quit history, and health perceptions on depressive symptoms among young adult smokers

BACKGROUND

The current study sought to evaluate the main and interactive effect of health perceptions, smoking quit attempt history, and readiness to change with respect to depressive symptoms among college student smokers.

METHOD

The present data came from baseline data from a randomized trial and included 495 undergraduate students (M_age = 23.84, SD = 4.92, 47.47% female) who reported smoking at least 1 cigarette per day.

RESULTS

A three-way interaction emerged between smoking quit attempt history, health perceptions, and readiness to change with respect to depressive symptoms. Quit attempt history was positively associated with depressive symptoms, particularly among individuals high in readiness to change if they perceived their health as poorer relative to peers; however, quit attempt history was negatively associated with depressive symptoms, particularly among individuals high in readiness to change if they perceived their health as comparable or better than that of their peers.

CONCLUSION

These findings support the assertion that readiness to change, quit history and perceived health interact in a dynamic way to confer greater risk for poor outcomes including smoking- (e.g., cessation failure) and psychological-related outcomes (e.g., increased depressive symptoms). As such, development of informed interventions and programs targeting readiness to change to improve quit history and perceptions of health may provide unique benefit.

Decisional Balance: Alcohol Decisional Balance Intervention for Heavy Drinking Undergraduates

BACKGROUND

This study evaluated a decisional balance intervention among heavy drinking undergraduates and compared a nonweighted decisional balance proportion (DBP; Collins, Carey, & Otto, 2009) to a participant-weighted DBP with weights based on relative importance of items. We expected: (1) the intervention to decrease drinking compared to control; (2) the weighted intervention to be more effective compared to the nonweighted or control in reducing drinking; and (3) intervention efficacy to be moderated by initial DBP.

METHOD

Participants (N = 162, Mean age = 24.37, SD = 6.81, 27% male) were randomly assigned to an alcohol intervention wherein they were either asked to assign weights of importance to pros and cons (weighted intervention), or not (nonweighted intervention), or to control. Participants completed web-based questionnaires at baseline and again during a one month follow-up assessment.

RESULTS

Consistent with expectations, the nonweighted intervention was associated with reduced follow-up weekly drinking, and the weighted intervention was associated with reductions in drinking frequency. Results further indicated that initial decisional balance did not moderate intervention efficacy.

DISCUSSION

Findings suggest that the decisional balance procedure can reduce drinking but there was not compelling evidence for the addition of weights. This study lays the groundwork for enhancing future interventions by increasing empirical knowledge of the role motivation plays in heavy alcohol use.

Partner distress in the context of adult anorexia nervosa: the role of patients' perceived negative consequences of AN and partner behaviors

OBJECTIVE

Romantic partners can play an important role in the recovery from anorexia nervosa (AN). It is important to understand partners' behaviors and variables associated with their own distress. The aim was to examine associations of patients' perceived negative consequences of AN, behavioral strategies employed by partners, and partner distress.

METHOD

We used a cross-sectional design to assess associations between self-reports of patients' perceived negative consequences of AN, partners' caregiver distress, negative affect, relationship satisfaction, and observational coding measures of partners' behavioral strategies of change promotion and acceptance/validation. Sixteen adult patient-partner dyads in committed relationships were assessed at baseline of a couple-based intervention for AN.

RESULTS

Partners' change promotion moderated the association between patients' perceived negative consequences of AN and partners' caregiver distress. Partners' acceptance/validation was associated with partners' negative affect.

DISCUSSION

This report represents the first description of specific partner behaviors in the context of AN. Partners who reported the least distress were those who were trying to promote changes in AN behaviors in patients who reported high negative consequences of AN, and partners who were trying to show understanding of the patients' experience. Future studies should examine the impact of partner behaviors on AN treatment outcome.

Sustainable transportation stage of change, decisional balance, and self-efficacy scale development and validation in two university samples

Single occupancy vehicle (SOV) transportation is a key contributor to climate change and air pollution. Sustainable transportation (ST), commuting by any means other than SOV, could both slow climate change and enhance public health. The transtheoretical model (TTM) provides a useful framework for examining how people progress towards adopting ST. Short valid and reliable measures for ST decisional balance, self-efficacy, and climate change doubt were developed and their relationship with stages of change was examined. Two large university-based volunteer samples participated in measurement studies. Using multiple procedures, three brief internally consistent measures were developed: decisional balance, self-efficacy, and climate change doubt. The stages of change correctly discriminated both decisional balance and self-efficacy, as well as replicated hypothesized relationships. Climate change doubt did not vary by stages; however, it may prove useful in future studies. Results support the validation of these measures and the application of the TTM to ST.

Development of a decisional balance scale for young adult marijuana use

This study describes the development and validation of a decisional balance scale for marijuana use in young adults. Scale development was accomplished in four phases. First, 53 participants (70% female, 68% freshman) provided qualitative data that yielded content for an initial set of 47 items. In the second phase, an exploratory factor analysis on the responses of 260 participants (52% female, 68% freshman) revealed two factors, corresponding to pros and cons. Items that did not load well on the factors were omitted, resulting in a reduced set of 36 items. In the third phase, 182 participants (49% female, 37% freshmen) completed the revised scale and an evaluation of factor structure led to scale revisions and model respecification to create a good-fitting model. The final scales consisted of 8 pros (α = 0.91) and 16 cons (α = 0.93), and showed evidence of validity. In the fourth phase (N = 248, 66% female, 70% freshman), we confirmed the factor structure, and provided further evidence for reliability and validity. The Marijuana Decisional Balance Scale enhances our ability to study motivational factors associated with marijuana use among young adults.

Young women's perspective of the pros and cons to seeking screening for chlamydia and gonorrhea: an exploratory study

STUDY OBJECTIVE

To identify young women's pros and cons (decisional balance) to seeking chlamydia (CT) and gonorrhea (NGC) screening.

DESIGN

Prospective, cross sectional study

SETTING

Community-based reproductive health clinic

PARTICIPANTS

192 young women (66% African American; mean age 18.9 years).

MAIN OUTCOME MEASURES

Content analysis of responses obtained during a decisional balance exercise (pros and cons) promoting CT and NGC screening was conducted. Thematic categories were developed through a coding process, and each response was assigned to one thematic category. The frequency of pros and cons responses for each category and the frequency of participants endorsing each category were calculated.

RESULTS

Ten thematic categories in relation to pros and cons of seeking CT and NGC screening were: being healthy; awareness of the body; systemic factors around the clinic visit and testing procedures; benefits and aversions around treatment; partner trust issues; confidentiality; prevention of long term adverse effects, protection of the body; concern for others; fear of results/aversion to testing; and logistical barriers. The three most often cited pros were awareness of the body, being healthy and treatment issues; and the three most often cited cons were logistical barriers (time/transportation), fear/aversion to testing, and systemic factors.

CONCLUSIONS

A variety of pros and cons to seeking CT and NGC screening were identified at a community-based clinic. Providers in clinical settings can utilize this information when encouraging patients to seek regular STI screening by elucidating and emphasizing those pros and cons that have the most influence on a young woman's decision-making to seek screening.

A brief decisional balance intervention increases motivation and behavior regarding condom use in high-risk heterosexual college men

Male college students constitute one of a number of at-risk populations susceptible to receiving and transferring sexually transmitted infections. Interventions designed to increase condom use have produced mixed results, but increasing motivation to use condoms may decrease risky sexual behavior. The current study examined the decisional balance, a component of Motivational Interviewing (MI), as an intervention to promote condom use. A total of 41 college men at-risk for negative outcomes from both unsafe sex and drinking participated. They reported both infrequent condom use and heavy drinking. Immediately following a decisional balance on condom use, three separate measures of motivation to change condom use increased. Further, participants reported increases in actual condom use at a 30-day follow-up. Participants did not alter their drinking behavior or their motivation to decrease problematic alcohol use. The findings provide preliminary support for the efficacy of a brief decisional balance intervention to increase safer-sex motivation and behaviors, but similar designs with true control groups receiving assessment only and larger numbers of participants are required before they can be generalized to the greater population of college students. College health professionals might adopt similar brief motivational enhancement interventions with the decisional balance to promote safer sex among at-risk college students.