Habit Facilitates Actioning Sun Protective Behavior Intentions.

Skin cancer is highly burdensome, but preventable with regular engagement in sun protective behaviors. Despite modest effectiveness of sun-protective behavior promotional efforts thus far, rates of engagement in sun-protective behaviors remain low. More is needed to understand motivation for using sunscreen, wearing sun-protective clothing, and seeking shade. This study tested whether the links of intention and habit strength with behavior differed between sun-protective behaviors. It was hypothesized that sun protective behaviors would be predicted by both habit and intention and that intention-behavior associations would be weaker for people with stronger habits. Participants residing in Queensland, Australia (N = 203; 75.96% female; M age = 37.16 years, SD = 14.67) self-reported their intentions and habit strength about sun-protective behavior for the next 7 days. Participants were followed-up 7 days later to self-report their sun-protective behavior. Multilevel modeling, accounting for nesting of multiple behaviors within-person, revealed that habit moderated the intention strength - behavior association and this moderation effect did not differ as a function of which behavior was being predicted. People with strong or moderate habit strength tended to act in line with their intentions; however, for people with very weak habits (2 SD < M), there was less alignment between their intention and behavior. These findings suggest that habit plays a facilitative role in the implementation of strong sun protective behavior intentions. Interventions should consider how to encourage intention and habit to enhance sun-protective behaviors and reduce the burden of skin cancer from sun exposure.Supplemental data for this article is available online at https://doi.org/10.1080/08964289.2021.1903380 .

Evolution of physical activity habits after a context change: The case of COVID-19 lockdown.

OBJECTIVE: Habits, defined as well-learned associations between cues and behaviours, are essential for health-related behaviours, including physical activity (PA). Despite the sensitivity of habits to context changes, little remains known about the influence of a context change on the interplay between PA habits and behaviours. We investigated the evolution of PA habits amidst the spring COVID-19 lockdown, a major context change. Moreover, we examined the association of PA behaviours and autonomous motivation with this evolution. DESIGN: Three-wave observational longitudinal design. METHODS: PA habits, behaviours, and autonomous motivation were collected through online surveys in 283 French and Swiss participants. Variables were self-reported with reference to three time-points: before-, mid-, and end-lockdown. RESULTS: Mixed effect modelling revealed a decrease in PA habits from before- to mid-lockdown, especially among individuals with strong before-lockdown habits. Path analysis showed that before-lockdown PA habits were not associated with mid-lockdown PA behaviours (ß = -.02, p = .837), while mid-lockdown PA habits were positively related to end-lockdown PA behaviours (ß = .23, p = .021). Autonomous motivation was directly associated with PA habits (ps < .001) and withto before- and mid-lockdown PA behaviours (ps < .001) (but not with end-lockdown PA behaviours) and did not moderate the relations between PA behaviours and habits (ps > .072). CONCLUSION: PA habits were altered, and their influence on PA behaviours was impeded during the COVID-19 lockdown. Engagement in PA behaviours and autonomous motivation helped in counteracting PA habits disruption.

How we are misinterpreting physical activity intention - behavior relations and what to do about it.

BACKGROUND: Studies of the physical activity intention-behavior gap, and factors that may moderate the gap (e.g., habit, perceived behavioral control), can inform physical activity promotion efforts. Yet, these studies typically apply linear modeling procedures, and so conclusions rely on linearity and homoscedasticity assumptions, which may not hold. METHODS: We modelled and plotted physical activity intention-behavior associations and the moderation effects of habit using simulated data based on (a) normal distributions with no shared variance, (b) correlated parameters with normal distribution, and (c) realistically correlated and non-normally distributed parameters. RESULTS: In the uncorrelated and correlated normal distribution datasets, no violations were unmet, and the moderation effects applied across the entire data range. However, because in the realistic dataset, few people who engaged in physical activity behavior had low intention scores, the intention-behavior association was non-linear, resulting in inflated linear moderation estimations of habit. This finding was replicated when tested with intention-behavior moderation of perceived behavioral control. CONCLUSIONS: Comparisons of the three scenarios illustrated how an identical correlation coefficient may mask different types of intention-behavior association and moderation effects. These findings highlight the risk of misinterpreting tests of the intention-behavior gap and its moderators for physical activity due to unfounded statistical assumptions. The previously well-documented moderating effects of habit, whereby the impact of intention on behavior weakens as habit strength increases, may be based on statistical byproducts of unmet model assumptions.

Prevalence of Chronic Health Conditions in Australian Adults with Depression and/or Anxiety.

The association between psychotic illness and poor physical health is now clearly articulated in the literature. By contrast the impact of depression and/or anxiety on physical health is considerably less understood, despite depression being the leading cause of disability worldwide and is associated with significantly higher prevalence of physical comorbidities than found in the general population. An Australia national cross-sectional population-based survey was conducted to ascertain the prevalence of chronic physical health conditions in persons with, and without depression and/or anxiety, allowing for demographic characteristics and lifestyle factors. The telephone-based survey was conducted using trained interviewers. Survey questions included those eliciting information about demographics, health status, and health behaviours. Independent t-tests and chi square tests showed demographic, health behaviours, and physical illness differed between those with and without depression and/or anxiety. Heart disease, high blood pressure, stroke, cancer, arthritis, chronic neck and/or back pain, and asthma were significantly higher in participants diagnosed with depression and/or anxiety. Binary logistic regression showed the strongest predictor of chronic illness was having a diagnosis of depression and/or anxiety. Depression and anxiety present major health problems impacting a considerable proportion of the population. A greater understanding of the associated physical health issues should provide impetus to broaden the physical health and mental illness research agenda to include these diagnoses.

Health behaviours of Australian fly-in, fly-out workers and partners during on-shift and off-shift days: an ecological momentary assessment study.

OBJECTIVES: Fly-in, fly-out (FIFO) work involves long commutes, living on-site for consecutive days and returning home between shifts. This unique type of work requires constant transitioning between the roles and routines of on-shift versus off-shift days. This study aims to examine health behaviour patterns of FIFO workers and FIFO partners during on-shift and off-shift time frames. DESIGN: This study used ecological momentary assessment and multilevel modelling to examine daily health behaviours. SETTING: FIFO workers and FIFO partners from across Australia responded to daily online surveys for up to 7 days of on-shift and up to 7 days of off-shift time frames. PARTICIPANTS: Participants included 64 FIFO workers and 42 FIFO worker partners. RESULTS: Workers and partners reported poorer sleep and nutrition quality for on-shift compared with off-shift days. Both workers and partners exercised less, smoked more cigarettes, took more physical health medication and drank less alcohol during on-shift compared with off-shift days. CONCLUSIONS: FIFO organisations should consider infrastructure changes and support services to enhance opportunities for quality sleep and nutrition, sufficient exercise, moderate alcohol consumption and cigarette cessation for workers on-site and their partners at home.

Do singles or couples live healthier lifestyles? Trends in Queensland between 2005-2014.

OBJECTIVES: To compare the frequency of and trends in healthy lifestyle factors between singles and couples. METHODS: Cross-sectional data from annual surveys conducted from 2005-2014 were used. The pooled sample included 15,001 Australian adults (mean age: 52.9 years, 50% male, 74% couples) who participated in the annual Queensland Social Survey via computer-assisted telephone interviews. Relationship status was dichotomised into single and couple. Binary logistic regression was used to assess associations between relationship status, and the frequency of and trends in healthy lifestyle factors. RESULTS: Compared to singles, couples were significantly more likely to be a non-smoker (OR = 1.82), and meet recommendations for limited fast food (OR = 1.12), alcohol consumption (OR = 1.27) and fruit and vegetable intake (OR = 1.24). Fruit and vegetable intake was not significantly associated with relationship status after adjusting for the other healthy lifestyle factors. Conversely, couples were significantly less likely to be within a normal weight range (OR = 0.81). In both singles and couples, the trend data revealed significant declines in the rates of normal weight (singles: OR = 0.97, couples: OR = 0.97) and viewing TV for less than 14 hours per week (singles: OR = 0.85, couples: OR = 0.84), whilst non-smoking rates significantly increased (singles: OR = 1.12, couples: OR = 1.03). The BMI trend was no longer significant when adjusting for health behaviours. Further, in couples, rates of meeting recommendations for physical activity and fruit/vegetable consumption significantly decreased (OR = 0.97 and OR = 0.95, respectively), as did rates of eating no fast food (OR = 0.96). These trends were not significant when adjusting for the other healthy lifestyle factors. In singles, rates of meeting alcohol recommendations significantly increased (OR = 1.08). CONCLUSIONS: Health behaviour interventions are needed in both singles and couples, but relationship status needs to be considered in interventions targeting alcohol, fast food, smoking and BMI. Further research is needed to understand why health behaviours differ by relationship status in order to further improve interventions.

Child sun safety: Application of an Integrated Behavior Change model.

OBJECTIVE: Childhood sun exposure increases risk of skin cancer in later life. Parents of young children play an important role in minimizing childhood sun exposure. The aim of the current study was to identify the motivational, volitional, and implicit antecedents of parents' sun-protective behaviors based on an Integrated Behavior Change model. METHOD: Parents (N = 373) of 2- to 5-year-old children self-reported their intentions, attitudes, subjective norm, perceived behavioral control, autonomous and controlled motivation, action plans, habit, and past behaviors with respect to sun-protective behaviors for their children. Two weeks later (n = 273), the parents self-reported their participation in sun-protective behaviors for their child. RESULTS: Data were analyzed using variance-based structural equation modeling. Results showed significant direct effects of attitudes, subjective norm, perceived behavioral control, and past behavior on intentions, and significant direct effects of autonomous motivation, perceived behavioral control, intentions, action planning, habit, and past behavior on parents' participation in sun-protective behaviors for their child. There were also significant total indirect effects of autonomous motivation on intentions mediated by attitudes and subjective norm. CONCLUSIONS: Current results indicate that parents' sun-protective behaviors toward their children are a function of motivational (autonomous motivation, intentions), volitional (action planning), and implicit (habit) factors. The findings from the current study provide formative data to inform the development of behavior change interventions to increase parents' participation in sun-protective behaviors for their children. (PsycINFO Database Record

Apps to improve diet, physical activity and sedentary behaviour in children and adolescents: a review of quality, features and behaviour change techniques.

BACKGROUND: The number of commercial apps to improve health behaviours in children is growing rapidly. While this provides opportunities for promoting health, the content and quality of apps targeting children and adolescents is largely unexplored. This review systematically evaluated the content and quality of apps to improve diet, physical activity and sedentary behaviour in children and adolescents, and examined relationships of app quality ratings with number of app features and behaviour change techniques (BCTs) used. METHODS: Systematic literature searches were conducted in iTunes and Google Play stores between May-November 2016. Apps were included if they targeted children or adolescents, focused on improving diet, physical activity and/or sedentary behaviour, had a user rating of at least 4+ based on at least 20 ratings, and were available in English. App inclusion, downloading and user-testing for quality assessment and content analysis were conducted independently by two reviewers. Spearman correlations were used to examine relationships between app quality, and number of technical app features and BCTs included. RESULTS: Twenty-five apps were included targeting diet (n = 12), physical activity (n = 18) and sedentary behaviour (n = 7). On a 5-point Mobile App Rating Scale (MARS), overall app quality was moderate (total MARS score: 3.6). Functionality was the highest scoring domain (mean: 4.1, SD: 0.6), followed by aesthetics (mean: 3.8, SD: 0.8), and lower scoring for engagement (mean: 3.6, SD: 0.7) and information quality (mean: 2.8, SD: 0.8). On average, 6 BCTs were identified per app (range: 1-14); the most frequently used BCTs were providing 'instructions' (n = 19), 'general encouragement' (n = 18), 'contingent rewards' (n = 17), and 'feedback on performance' (n = 13). App quality ratings correlated positively with numbers of technical app features (rho = 0.42, p < 0.05) and BCTs included (rho = 0.54, p < 0.01). CONCLUSIONS: Popular commercial apps to improve diet, physical activity and sedentary behaviour in children and adolescents had moderate quality overall, scored higher in terms of functionality. Most apps incorporated some BCTs and higher quality apps included more app features and BCTs. Future app development should identify factors that promote users' app engagement, be tailored to specific population groups, and be informed by health behaviour theories.

Protecting young children against skin cancer: Parental beliefs, roles, and regret.

OBJECTIVE: To examine the role of parental beliefs, roles, and anticipated regret toward performing childhood sun-protective behaviours. METHODS: Parents (N = 230; 174 mothers, 56 fathers), recruited using a nonrandom convenience sample, of at least 1 child aged between 2 and 5 years completed an initial questionnaire assessing demographics and past behaviour as well as theory of planned behaviour global (attitude, subjective norm, and perceived behavioural control) and belief-based (behavioural, normative, and control beliefs) measures, role construction, and anticipated regret regarding their intention and behaviour to protect their child from the sun. Two weeks later, participants completed a follow-up questionnaire assessing their sun protection of their child during the previous 2 weeks. RESULTS: Hierarchical multiple regression analysis identified attitude, perceived behavioural control, role construction, anticipated regret, past behaviour, and a normative belief ("current partner/other family members") as significant predictors of parents' intention to participate in sun-protective behaviour for their child. Intention and past behaviour were significant predictors of parents' follow-up sun-protective behaviour. The regression models explained 64% and 36% of the variance in intention and behaviour, respectively. CONCLUSIONS: The findings of this study highlight the importance of anticipated regret and role-related beliefs alongside personal, normative, and control beliefs in determining parents' intentional sun-protective behaviour for their children. Findings may inform the development of parent- and community-based sun protection intervention programs to promote parents' sun-safety behaviours for their children to prevent future skin cancer incidence.

8-year trends in physical activity, nutrition, TV viewing time, smoking, alcohol and BMI: A comparison of younger and older Queensland adults.

Lifestyle behaviours significantly contribute to high levels of chronic disease in older adults. The aims of the study were to compare the prevalence and the prevalence trends of health behaviours (physical activity, fruit and vegetable consumption, fast food consumption, TV viewing, smoking and alcohol consumption), BMI and a summary health behaviour indicator score in older (65+ years) versus younger adults (18-65 years). The self-report outcomes were assessed through the Queensland Social Survey annually between 2007-2014 (n = 12,552). Regression analyses were conducted to compare the proportion of older versus younger adults engaging in health behaviours and of healthy weight in all years combined and examine trends in the proportion of younger and older adults engaging in health behaviours and of healthy weight over time. Older adults were more likely to meet recommended intakes of fruit and vegetable (OR = 1.43, 95%CI = 1.23-1.67), not consume fast food (OR = 2.54, 95%CI = 2.25-2.86) and be non-smokers (OR = 3.02, 95%CI = 2.53-3.60) in comparison to younger adults. Conversely, older adults were less likely to meet the physical activity recommendations (OR = 0.86, 95%CI = 0.78-0.95) and watch less than 14 hours of TV per week (OR = 0.65, 95%CI = 0.58-0.74). Overall, older adults were more likely to report engaging in 3, or at least 4 out of 5 healthy behaviours. The proportion of both older and younger adults meeting the physical activity recommendations (OR = 0.97, 95%CI = 0.95-0.98 and OR = 0.94, 95%CI = 0.91-0.97 respectively), watching less than 14 hours of TV per week (OR = 0.96, 95%CI = 0.94-0.99 and OR = 0.94, 95%CI = 0.90-0.99 respectively) and who were a healthy weight (OR = 0.95, 95%CI = 0.92-0.99 and OR = 0.96, 95%CI = 0.94-0.98 respectively) decreased over time. The proportion of older adults meeting the fruit and vegetable recommendations (OR = 0.90, 95%CI = 0.84-0.96) and not consuming fast food (OR = 0.94, 95%CI = 0.88-0.99) decreased over time. Although older adults meet more health behaviours than younger adults, the decreasing prevalence of healthy nutrition behaviours in this age group needs to be addressed.

Do personalised e-mail invitations increase the response rates of breast cancer survivors invited to participate in a web-based behaviour change intervention? A quasi-randomised 2-arm controlled trial.

BACKGROUND: Previous research has shown that the personalisation of study invitations improves response rates in survey-based research. To examine if this finding extends to experimental studies, we examined the impact of personalised study invitation e-mails on the response rates of potentially eligible breast cancer survivors for participation in a 6 month randomised controlled trial testing the efficacy of a physical activity intervention. METHODS: Potential participants (n = 344) were sent either a personalised email or a generic email. RESULTS: Those sent the personalised email were 1.5 times (95 % CI = 1.18-1.93) more likely to respond than those sent the generic email. CONCLUSION: These findings suggest that personalisation may be a useful and potentially powerful tool that can be utilised when recruiting participants into experimental studies in order to boost response rates.

Examining the use of evidence-based and social media supported tools in freely accessible physical activity intervention websites.

BACKGROUND: It has been shown that physical activity is more likely to increase if web-based interventions apply evidence-based components (e.g. self-monitoring) and incorporate interactive social media applications (e.g. social networking), but it is unclear to what extent these are being utilized in the publicly available web-based physical activity interventions. The purpose of this study was to evaluate whether freely accessible websites delivering physical activity interventions use evidence-based behavior change techniques and provide social media applications. METHODS: In 2013, a systematic search strategy examined 750 websites. Data was extracted on a wide range of variables (e.g. self-monitoring, goal setting, and social media applications). To evaluate website quality a new tool, comprising three sub-scores (Behavioral Components, Interactivity and User Generated Content), was developed to assess implementation of behavior change techniques and social media applications. An overall website quality scored was obtained by summing the three sub-scores. RESULTS: Forty-six publicly available websites were included in the study. The use of self-monitoring (54.3%), goal setting (41.3%) and provision of feedback (46%) was relatively low given the amount of evidence supporting these features. Whereas the presence of features allowing users to generate content (73.9%), and social media components (Facebook (65.2%), Twitter (47.8%), YouTube (48.7%), smartphone applications (34.8%)) was relatively high considering their innovative and untested nature. Nearly all websites applied some behavioral and social media applications. The average Behavioral Components score was 3.45 (±2.53) out of 10. The average Interactivity score was 3.57 (±2.16) out of 10. The average User Generated Content Score was 4.02 (±2.77) out of 10. The average overall website quality score was 11.04 (±6.92) out of 30. Four websites (8.7%) were classified as high quality, 12 websites (26.1%) were classified as moderate quality, and 30 websites (65.2%) were classified as low quality. CONCLUSIONS: Despite large developments in Internet technology and growth in the knowledge of how to develop more effective web-based interventions, overall website quality was low and the majority of freely available physical activity websites lack the components associated with behavior change. However, the results show that website quality can be improved by taking a number of simple steps, and the presence of social media applications in most websites is encouraging.

Correlates of resistance training in post-treatment breast cancer survivors.

PURPOSE: To explore demographic, health, social-cognitive and behavioural correlates of resistance training among post-treatment breast cancer survivors. METHODS: A sample of 330 post-treatment breast cancer survivors recruited from across Australia completed a mailed questionnaire. A multivariate logistical regression model was used to test associations between independent variables and meeting the resistance training guidelines. RESULTS: Less than a quarter of the participants were meeting the resistance training guidelines of at least two sessions of resistance training per week. Higher task self-efficacy for resistance training (p < 0.01) and greater goal-setting behaviour (p < 0.05) were identified as significant predictors of meeting the resistance training guidelines, with a one unit increase in task self-efficacy and goal setting, increasing the odds of meeting the resistance training guidelines by a factor of approximately 1.2 (odds ratio (OR) task self-efficacy = 1.23, 95 % confidence interval (CI) = 1.05-1.43; goal-setting OR = 1.20, 95 % CI = 1.04-1.38). No other variables significantly predicted meeting the resistance training guidelines in the multivariate analysis. CONCLUSIONS: Strategies targeting task self-efficacy and goal-setting behaviours are likely to be important intervention components in resistance training interventions for breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: The findings of this study will be useful for informing the development of evidence-based interventions aiming to promote resistance training among this group.