Measuring barriers of behavior change: How to better operationalize psychosocial constructs of control.

Researchers are generally interested in understanding barriers of behavior change, however current methods used to elicit such information may be confounded with other theoretical constructs such as motivation, and attitudes. The purpose of this study was to understand how distinct methodologies lead to potentially different results when eliciting barriers of physical activity among military spouses. Military spouses were recruited online (n = 253) and randomized into one of four conditions; a standard condition (standard elicitation of barriers); an impossible condition (elicitation using alternative words); an incentive condition (motivation held constant by the use of a hypothetical incentive); or a vignette condition (participants were primed with a vignette to interpret the literal meaning of prevent and enable). Responses were coded into categories and results showed participants reported significantly fewer barriers and enablers for physical activity for all treatment conditions compared to the standard condition. This study sheds light on how barriers of behavior change are studied, and potential problems that occur when attempting to elicit them in research and practice. Careful consideration should be given when eliciting barriers, to assure they are not convoluted with other psychosocial constructs.

The role of moral norms as a determinant of intentions to engage in bystander intervention to prevent sexual assault.

Bystander interventions (BIs) primarily focus on increasing a sense of community and responsibility among students. This study examined moral norms as a determinant of intentions towards BI, within the Theory of Planned Behavior (TPB). College students at two universities (n = 291) completed an online survey measuring TPB constructs (e.g., intentions, perceived norms) and moral norms. Results indicated that moral norms were significantly associated with intentions toward BI, and appeared to be a valuable addition to the overall perceived norms construct. In addition, the law, parents, peers, and religion were identified as significant determinants of moral norms. Promoting collective responsibility to engage in BI and including a moral imperative to act in message development could increase the impact of BI.

Defining Parenting Practices for Reducing Sugar-Sweetened Beverage Consumption Among Preschoolers.

While attempts have been made to organize parenting practices in a working system, there are problems that make it difficult to understand how parenting is related to children's eating behaviors. The purpose of this study was to evaluate the validity and reliability of a new instrument evaluating parenting practices toward sugar-sweetened beverages (SSBs) using the nine intervention functions of the Behavior Change Wheel. Each intervention function (education, persuasion, incentivization, coercion, training, restriction, environmental restructuring, modeling, and enablement) was applied to a parenting practice for having a preschooler consume no more than 8 oz of SSBs per week. A survey was developed to evaluate each practice. Forty-eight parents of preschoolers (2-5 years old) completed the survey, and the most utilized practices were modeling, creating a supportive home environment, persuading children, and restricting SSBs. The framework presented in this study can be useful for determining which parenting practices are acceptable and effective for promoting health behaviors among children.

Pastors' Perceptions of the Black Church's Role in Teen Pregnancy Prevention.

Objective. To identify pastors' perceptions of the Black Church's role in promoting adolescent sexual health and preventing teen pregnancy. The Black Church and pastor are important partners in addressing health disparities in the Black community, especially those addressing sensitive issues as teen pregnancy. Methods. Semistructured interviews (n = 31) were conducted with Black Church pastors in two southwestern U.S. cities from September 2014 to July 2015. The question path was developed based on interviews with local leaders, literature searches, and key informant pastor interviews. Questions included knowledge/beliefs about sexuality education, church's role in preventing teen pregnancy, and implementation obstacles. Interviews were transcribed and thematically analyzed. Results. (1) All pastors believed that the Black Church should address teen pregnancy with parents and congregants. (2) Two major obstacles emerged: (a) all pastors perceived social consequences, including resistant parents and (b) discomfort discussing contraceptives/condoms. (3) All pastors were willing to partner with organizations, but most had reservations based on conflicting missions/values. Conclusions. Black Church pastors support teen pregnancy prevention programs in the church; however, public health partners must be willing to address the church's unique needs and mission.

Associations Between Depressive Symptoms and Religiosity in Young Adults.

The purpose of this study was to evaluate the association between religiosity and depressive symptoms among young adults, as well as determine whether possession of parental assets influences the relationship between religiosity and depressive symptoms. Young adults (n = 775) from universities in the southwest were sent an online survey, evaluating depressive symptoms, religiosity beliefs, and the protective assets of the relationships with their mother and father. With regard to young adult depressive symptoms, results showed a significant inverse association with levels of organizational religious activities (OR range = 0.208-0.555), levels of non-organizational religious activities (OR range = 0.282-0.399), and intrinsic religiosity (OR range = 0.216-0.489). Overall, religiosity beliefs and practices appeared to be associated with fewer depressive symptoms. Inclusion of religious/spirituality-oriented strategies may be important for mental health interventions in emerging adulthood.

Home Food Environment Factors Associated With Hispanic Preschoolers' Intake of Fruits and Vegetables.

The purpose of this study was to evaluate the relationship of home fruit and vegetable (F&V) availability and maternal feeding practices with Hispanic preschoolers' F&V intake (N = 238). "Availability' of total fruit" (P < .0001) and "modeling" (P < .020) increased the odds of consuming 1 or more cups of fruit. "Pressure" (P < .009) and the child being female (P < .028) increased the odds of consuming 1 or more cups of vegetables, while having a greater number of children in the home (P < .037) reduced the odds of consuming 1 or more cups of vegetables. To increase preschoolers' intake of F&V, interventions should target specific environmental factors in the home and maternal monitoring practices.

Parents' beliefs of the Black Church's role in teen pregnancy prevention.

INTRODUCTION: Parents are important decision makers in black churches. The objective of this qualitative study was to identify African American parents' beliefs of the Black Church's role in preventing teen pregnancy and promoting healthy teen relationships. METHODS: Parent members (n = 36) of 27 predominately Black churches in two southwestern US cities participated in semi-structured interviews from February-June 2017. A question path was developed based on literature searches, key informant interviews, and a previous study with local pastors, and questions focused on parents' knowledge/beliefs about 1) sexuality education, 2) the church's role in preventing teen pregnancy, and 3) implementation obstacles. Interviews were transcribed verbatim, coded using NVivo, and open-coded for themes to investigate patterns across codes and participants. Transcripts were then reviewed for quotes to represent each theme. RESULTS: Five themes were identified, with multiple subthemes. Most parents said there should be no boundaries on the type of sexuality information shared by their church, but later changed their minds after reviewing a list of potential topics. Parents listed 'parent-child communication', 'goals and dreams', and 'relationships' as the most important topics for teen pregnancy prevention intervention. Parents said information shared during workshops should be judgement-free and realistic. Parents most often said pastors and/or youth pastors/directors should deliver sexual health information. Parents believed older adults and other parents may oppose sexual education. CONCLUSIONS: By understanding parents' beliefs of teen pregnancy prevention programs, public health practitioners can understand concerns, modify implementation strategies, and utilize parental support to gain buy-in before planning and implementing programs.

Differences in determinants of aerobic and muscle strengthening physical activity among college students: a reasoned action approach.

While there is a concerted effort to promote physical activity (PA) across United States government and non-governmental organizations, interventions typically focus on aerobic forms of PA, leaving out muscle strengthening PA. The purpose of this study was to operationalize the Reasoned Action Approach (RAA) to explain theory-based correlates of aerobic and muscle strengthening PA, which can provide targets for future public health interventions. Theory-based correlates of both PA behaviors were evaluated using logistic regression analyses, and intentions predicted a significant amount of aerobic PA (14.9%) and muscle strengthening PA (30.7%). Theory-based correlates of intentions to both PA behaviors were evaluated using linear regression analyses, and attitudes, perceived norms, and perceived behavioral control predicted a significant amount for aerobic PA (46.2% to 55.8%) and for muscle strengthening PA (53.9% to 59.8%). Finally, theory-based correlates of attitudes, injunctive norms, descriptive norms and perceived behavioral control were evaluated using salient beliefs, derived from an elicitation study. Results suggest that the RAA is a robust framework for predicting both types of PA behaviors. Belief-based measures also provides guidance for future public health promotion interventions and health communication strategies.

Behavior Change Techniques Used in Theory of Planned Behavior Physical Activity Interventions Among Older Adults: A Systematic Review.

Physical activity interventions among older adults vary widely in the techniques used to elicit behavior change. The purpose of this systematic review was to determine what behavior change techniques (BCTs) are used in interventions to increase physical activity among older adults using the theory of planned behavior and to make suggestions for BCTs that appear to be more effective. A database search identified peer-reviewed articles documenting interventions based on the theory of planned behavior. Seven articles (three randomized controlled trial, three quasi-experimental, and one n-of-1) from four countries (the United States, the United Kingdom, Australia, and the Netherlands) were included for review. Researchers independently coded BCTs using a hierarchical taxonomy of 93 BCTs. The most frequently coded BCTs included Goal Setting (n = 5 studies), Action Planning (n = 5 studies), and Credible Source (n = 5 studies). Of the 93 BCTs in the taxonomy, only 26 were used, indicating potential opportunities to implement and evaluate less commonly used techniques in future studies.

Using the Integrative Behavioral Model to Predict Monitoring of Fruit and Vegetable Consumption Among Hispanic Mothers.

The purpose of this study was to operationalize the Integrative Behavioral Model (IBM) to identify significant theory-based determinants of maternal monitoring of fruit and vegetables consumption among low-income, Hispanic mothers of 2- to 5-year-old children (N = 238). Mothers completed a survey evaluating each construct of the IBM. Path analysis showed that intentions significantly predicted maternal monitoring of fruit and vegetables consumption (5.3% of the variance explained) and autonomy significantly predicted intentions (33.1% of the variance explained). Results from this study help create foundational work to establish targets for future public health interventions for Hispanic mothers of preschoolers.

Utilizing a Social Determinant of Health Framework as Determinants of Perceived Behavioral Control.

Health disparities reflect inequalities in health outcomes among different populations. As a planning tool for researchers and practitioners to address health disparities, multiple frameworks utilizing social determinants of health have been proposed. Perceived behavioral control, a construct within the Integrative Behavioral Model, reflects how much control one feels over a health behavior and how easy or difficult the behavior is to enact under internal and external barriers. The purpose of this commentary is to suggest how a unified social determinant of health framework can be utilized as a predictor and determinant of the construct perceived behavioral control.

The association between environmental and psychosocial factors towards physical activity and screen time of children: an application of the Integrative Behavioural Model.

Physical activity is beneficial at all stages of life, and has been linked as a protective factor from obesity, and other chronic health conditions. Despite the benefits of physical activity, less than half of US children meet the current recommendations, and activity levels decline with age. When planning physical activity interventions, behavioural theories should be utilised, given the inherent benefits theory-based approaches possess. The purpose of this study was to investigate how constructs of the Integrative Theoretical Model (IM) are associated with physical activity and screen time among children (9 years ±1.2; n = 264). Using structural equation modeling, a final model proved to have a good fit (CFI = 0.989; TLI = 0.975; RMSEA = 0.043), and results indicated intentions and perceived behavioural control (PBC) explained 19.4% of the variance for physical activity, and attitudes, perceived norms, and PBC accounted for 62% of the variance of intentions. Furthermore, attitudes and perceived norms were negatively associated with total screen time, and accounted for 10% of the variance. Results suggest that IM is a useful framework for explaining physical activity and screen time among children.

The Use of the Internet for Prevention of Binge Drinking Among the College Population: A Systematic Review of Evidence.

AIMS: There are many consequences of binge drinking compared with light or moderate drinking behaviors. The prevalence rate and intensity of binge drinking is highest among the college-aged population. Given the popularity and high use of the Internet among college students, a novel approach for programming is through Internet-based interventions. The purpose of this study was to conduct a systematic review of Internet-based interventions targeting binge drinking among the college population. METHODS: Eligibility criteria included peer-reviewed articles evaluating Internet-based interventions for binge drinking prevention among college students published between 2000 and 2014. Only English language articles were included. Review articles and articles only explaining intervention pedagogies were not included. After a systematic screening process, a total of 14 articles were included for the final review. Each article was read thoroughly in order to extract the following variables: study design and sample size, average age of participants, underpinning theoretical framework, and intervention description and duration. This review also synthesized a methodological assessment with variables such as outcome measures, sample size justification, number of measurements and use of process evaluations. RESULTS: All studies but one reported a significant reduction in the frequency and quantity of alcohol consumption and problems related with heavy drinking. Furthermore, Internet-based interventions appeared to be more effective than traditional print-based interventions; however, face-to-face interventions were typically more effective. CONCLUSIONS: This review supports using the Internet as a brief intervention approach that can effectively support efforts to reduce binge drinking among college students.

Comparing the utility of the theory of planned behavior between boys and girls for predicting snack food consumption: implications for practice.

The purpose of this study was to use the theory of planned behavior to explain two types of snack food consumption among boys and girls (girls n = 98; boys n = 69), which may have implications for future theory-based health promotion interventions. Between genders, there was a significant difference for calorie-dense/nutrient-poor snacks (p = .002), but no difference for fruit and vegetable snacks. Using stepwise multiple regression, attitudes, perceived behavioral control, and subjective norms accounted for a large amount of the variance of intentions (girls = 43.3%; boys = 55.9%); however, for girls, subjective norms accounted for the most variance, whereas for boys, attitudes accounted for the most variance. Calories from calorie-dense/nutrient-poor snacks and fruit and vegetable snacks were also predicted by intentions. For boys, intentions predicted 6.4% of the variance for fruit and vegetable snacks (p = .03) but was not significant for calorie-dense/nutrient-poor snacks, whereas for girls, intentions predicted 6.0% of the variance for fruit and vegetable snacks (p = .007), and 7.2% of the variance for calorie-dense/nutrient-poor snacks (p = .004). Results suggest that the theory of planned behavior is a useful framework for predicting snack foods among children; however, there are important differences between genders that should be considered in future health promotion interventions.

Preventing Sexual Violence Within the Continuum: Differences in Bystander Intervention Engagement Among College Students.

Sexual violence is framed along a continuum that includes (but is not limited to) sexual harassment and sexual assault. While a few studies have evaluated students' predispositions and orientations around engaging in bystander intervention (BI) to prevent sexual assault, little has been done for preventing sexual harassment. The purpose of this study was to evaluate theory-based differences in college students' willingness to engage in BI for preventing either sexual assault or sexual harassment. Students were surveyed at two time points. At T1, intentions, attitudes, perceived norms, and perceived behavioral control (PBC) for BI to prevent sexual assault were evaluated, and the same variables were evaluated at T2 for sexual harassment. Independent t-tests evaluated differences between groups. Linear regression analyses were used to evaluate determinants of intentions for BI for both groups. Students' attitudes toward BI/sexual assault were significantly higher than students' attitudes toward BI/sexual harassment (p = .019; d = .22). Conversely, students' PBC toward BI/sexual harassment was significantly higher than students' PBC for BI/sexual assault (p ≤.001; d = .49). Attitudes (p < .001) and PBC (p < .001) explained 45.9% of the variance of intentions for BI/sexual assault, while perceived norms (p < .001) and attitudes (p < .001) explained 28.4% of the variance of intentions for BI/sexual harassment. Sexual violence, encompassing both sexual assault and sexual harassment, is a pervasive issue on college campuses. More attention should be focused on preventing sexual harassment, as it can create a downstream effect. Furthermore, specific BI practices should be investigated to understand which are more effective at preventing sexual harassment and sexual assault.

Assessment of factors that predict physical activity among Oklahoma clergy: a theory of planned behavior approach.

The purpose of this study was to examine predictors of physical activity among clergy members in Oklahoma, using the theory of planned behavior. A 51-item valid and reliable instrument, measuring theory of planned behavior constructs and physical activity, was developed and administered to 141 clergy members. Results indicated that the majority of those surveyed were white (93%), college educated (97%), and overweight or obese (84%). Stepwise multiple regression analysis found that intentions accounted for 13.8% of the variance of physical activity whereas attitudes, subjective norms, and perceived behavioral control accounted for 54.8% of the variance of intention. Implications for intervention development are discussed.

A true challenge for any superhero: an evaluation of a comic book obesity prevention program.

The purpose of this study was to pilot test the Comics for Health program, a theory-based nutrition and physical activity intervention for children. Twelve after-school programs were randomized to either a theory-based (n = 37) or a knowledge-based (n = 34 children) version of the intervention. Pretests, posttests, and 3-month follow-up tests were administered to evaluate the programmatic effects on body mass index percentile, obesity-related behaviors, and constructs of social cognitive theory. Both interventions found significant, yet modest effects for fruit and vegetable consumption (P < .005), physical activities (P < .004), and water and sugar-free beverage consumption (P < .001) and self-efficacy for fruit and vegetable consumption (P < .015) and physical activities (P < .009).

A process evaluation of a social cognitive theory-based childhood obesity prevention intervention: the Comics for Health program.

Process evaluations are an often overlooked yet essential component of health promotion interventions. This study reports the results of a comprehensive process evaluation for the "Comics for Health" program, a childhood obesity prevention intervention implemented at 12 after-school programs. Qualitative and quantitative process data were collected using surveys, field notes, and open-item questionnaires, which assessed program fidelity, dose delivered, dose received, reach, recruitment, and context. Triangulation of methods was also employed to better understand how the program was implemented and received by the facilitator, staff members, and children in the program. Results indicated that program implementation had an almost perfect rate of fidelity with most lessons recording 100% tasks completed. Lessons were implemented in their intended order and lasted approximately 30 minutes as planned. After-school staff members reported that the program was well received by children, and this program should be replicated in the future. Attendance records showed that a majority of the children attended each lesson on the initial day of delivery (70.4%) and informal make-up lessons were implemented to compensate for the other children. Finally, several known sources of contamination were found such as past and concurrent exposure to similar health promotion interventions, which could potentially influence study outcomes. These findings will be used to help explain the results of this intervention and make recommendations for future intervention efforts.

Evaluating the Association Between Artificial Sweetener Intake and Indicators of Stress and Anxiety.

The purpose of this study was to evaluate the association between non-nutritive sweetener (NNS) consumption and stress and anxiety, among a sample of college students. Two-hundred and twenty-seven students from a large mid-western university participated in this cross-sectional study. Students completed an online survey that evaluated NNS using a validated food frequency questionnaire. Stress and anxiety were evaluated using previously validated instruments. Most students reported very low/low/average concern for stress (63.9%), and had low/moderate anxiety (82.3%). Participants experiencing high and very high levels of stress had significantly higher NNS consumption compared to those with a very low and low risk, and concern for stress (p < .046; d = 0.28). There was no difference however for NNS intake and anxiety. Reduction of artificial sweetener intake may be associated with stress levels among college students. However, more research is needed to examine any causal relationship between artificial sweetener intake and stress.