A TPB-Based Smoking Intervention among Chinese High School Students.

OBJECTIVES: China is the world's largest tobacco consumer and its adolescent smoking rate is increasing. Smoking interventions among high school students are limited. The aim of this study was to deliver and evaluate a brief theory-based smoking intervention in China, with a focus on anti-smoking cognitions. METHODS: The intervention was based on the constructs of an extended theory of planned behavior and life skills training. Using class-level randomization sampling, 106 tenth graders from two high schools in Kunming, China received a four-session intervention; 101 students were assigned as control group members. Surveys were conducted at three time-points (1 week before the intervention, 1 week post-intervention, and 6 months post-intervention). MANOVA and latent class analysis were used to test the intervention's effectiveness and personal change trajectories over time. RESULTS: The intervention failed to change smoking behavior, intention or willingness, but improved anti-smoking attitudes and perceived control over smoking. Skills showed a general enhancement, consistent with participants' qualitative feedback. Trajectories of smoking behavior, intention, and willingness all assumed two distinct but constant latent classes independent of the intervention. CONCLUSIONS: This study suggests that addressing attitudinal and control beliefs among adolescents and building on assertiveness via additional strategies in life skills such as appropriate refusal skills may be beneficial. The absence of a successful change in subjective norm should be a focus for future anti-smoking programs in China.

Future Smoking Intentions at Critical Ages among Students in Two Chinese High Schools.

BACKGROUND: China is the world's largest tobacco consumer. Smoking initiation dramatically increases from teenage to adulthood. In this study, we investigated adolescents' future smoking intention at critical ages and its associated predictors. METHODS: Using a longitudinal design (3 waves) across 6 months in 2016, data from 156 10th graders in two high schools in China were examined. We used latent class growth modelling to explore the heterogeneous trajectories of smoking intentions for two future age groups. Logistic regression was then used to estimate the predictors of trajectories. RESULTS: Two trajectories and three trajectories were identified for future smoking intention in their twenties and forties, respectively. Gender, current smoking status, and mothers' and friends' smoking status all played distinct roles in future smoking intentions. CONCLUSIONS: Chinese adolescents' future intentions at critical ages are of concern. Future tobacco control should target the critical ages as well as incorporate social and cultural meanings of smoking in China. As important factors related to future smoking trajectories, gender and mothers' smoking status should also be considered in anti-smoking prevention efforts. Meanings associated with smoking status in the future should also be explored especially for female adolescents.

Effectiveness of a theory-based sun-safe randomised behavioural change trial among Australian adolescents.

OBJECTIVE: Sun safety is crucial for preventing skin cancer. This study evaluated a school-based intervention based on the theory of planned behaviour (TPB), which aimed to encourage sun-protective behaviour among adolescents. METHODS: Secondary school students (N = 382; 61.1% female; Mage  = 13.73 y) in Queensland, Australia, participated in the study. Schools were randomly allocated to an intervention or control group. The intervention focussed on fostering positive attitudes, increasing perceptions of normative support, and strengthening control perceptions. Participants completed questionnaires assessing the TPB variables and sun-protective behaviour (weekday and weekend) 1 week before intervention (time 1), 1 week after intervention (time 2), and 4 weeks after intervention (time 3). RESULTS: With baseline between-group differences in TPB variables matched, repeated-measures multivariate analysis of variance was used to evaluate the Time × Condition effects across time. Multigroup comparisons using path models traced the intervariable changes. From times 1 to 3, a significant improvement in weekend sun-protective behaviour was identified in the intervention group (but not the control group), whereas cognitions showed no significant changes across time for either conditions. Multigroup comparisons on path coefficients between the intervention and control group participants indicated that the intervention group members formed stronger positive associations between perceived behavioural control and intention at time 2 and between perceived control and behaviour at time 3. CONCLUSION: The significant behavioural change on weekends highlights the value of targeting control perceptions, which may encourage adolescents' sun-protective behaviour. Further studies are needed to understand the absence of significant changes in weekday sun-safe behaviour among this at-risk cohort.

Sun protection and young female beachgoers: A formative theory-based approach to identifying key sun safe beliefs.

ISSUE ADDRESSED: The prevalence of skin cancer remains at a high level in Australia. Young female Australian beachgoers are an at-risk population of skin cancer. Research on sun-protective beliefs held by this at-risk group is limited. METHODS: Based on the Theory of Planned Behaviour (TPB), we conducted a formative study to understand key sun safe messages among young female beachgoers in Queensland, including an elicitation study (Phase 1; N = 21, Mage  = 24.30 years) and a two-wave questionnaire survey (Phase 2; N = 140, Mage  = 23.96 years). RESULTS: Following content analysis and regression analyses, three key beliefs were identified: "be uncomfortable and/or unstylish" (behavioural belief), "friends and peers" (normative belief) and "lack of motivation to reapply sunscreen" (control belief). CONCLUSIONS: The results highlight the influences of friends and peers on beachgoers' sun-protective behaviour for this young female adult cohort. Compared to previous findings among the general population, discrepancies in beliefs suggest interventions targeting this cohort should specifically focus on fashionable sun safe images and motivation to reapply sunscreen. SO WHAT?: Future health promotion and public education should utilise various strategies according to specific groups given the discrepancies identified in beliefs. For female beachgoers, sun safe images and motivations should be the primary foci.

'I'm not a smoker yet': a qualitative study on perceptions of tobacco control in Chinese high schools.

OBJECTIVE: Chinese adolescents' perceptions about tobacco control at schools are rarely researched. We explored how current antismoking strategies work in middle school environments, as well as the attitudes towards these strategies held by students and teaching staff members. METHODS: Four focus groups (24 eleventh graders; Mage=16 years) and five indepth interviews (teaching staff members with tobacco control experience in schools) were conducted in Kunming, Yunnan Province, China. We used thematic analysis combining inductive and deductive processes, along with field observations and research group discussions, for data analysis. RESULTS: With educational approaches and practical strategies, antismoking education reported in the middle schools had limited effectiveness. Although smoking is banned in schools, students can circumvent schools' controls easily. Notably salient is the pessimistic attitude towards school-based antismoking strategies at school. Detrimental influences within (teachers' smoking) and beyond schools (high societal smoking prevalence) largely challenged the efforts to manage students' smoking. CONCLUSIONS: Current antismoking approaches in schools fail to curb smoking among Chinese high school students. Their effectiveness is undermined by both within-campus and off-campus influences. Students' perceptions of smoking should be valued as their knowledge of smoking is actively constructed. Future antismoking education at school should incorporate interactive sessions rather than merely didactic approaches about the harms of smoking. Although stricter rules for teachers' smoking are needed, complementary strategies such as population-level interventions and policy measures in wider society will assist in efforts within schools.

Emotional food cravings predicts poor short-term weight loss following laparoscopic sleeve gastrectomy.

OBJECTIVES: Laparoscopic sleeve gastrectomy (LSG) incidence has increased worldwide. However, a proportion of patients achieve inadequate weight loss and some experience weight regain. Little is known of the influence of eating beliefs and behaviours in response to cravings on early weight loss trajectory. This study aimed to identify the post-surgery eating cravings that predicted patients not achieving excess weight loss outcome (EWL) at 6-8 months post-LSG. DESIGN: A total of 106 (80.7% female) participants who underwent LSG from four sites completed the questionnaires at 4-6 weeks post-bariatric surgery and 6 months post-LSG. Achieving <40% EWL at 6-month follow-up was included as the outcome variable, and the nine subscales of the Food Cravings Questionnaire-Trait version (FCQ-T) were included as potential predictors of that change. METHODS: Logistic regression was used to examine the relationship between EWL and the nine subscales of the FCQ-T (intentions to eat, positive reinforcement, negative reinforcement, lack of control, preoccupation with food, feelings of hunger, negative affect, emotions experienced before or during food cravings or eating, and guilty feelings). RESULTS: Participants lost an average 64% EWL (SD = 21% EWL) 6-8 months after LSG surgery. Results indicated the overall model was significant and, of the nine variables, the emotional food craving subscale (adjusted OR = 4.19, p = .018) predicted a failure to achieve EWL. CONCLUSION: Emotional food cravings experienced 4-6 weeks following LSG may predict poor weight loss outcomes at 6 months. Statement of contribution What is already known on this subject? The prevalence of obesity has reached epidemic proportions worldwide. Bariatric surgery is currently the most viable and cost-effective treatment for obesity and shows sustainability. Laparoscopic sleeve gastrectomy (LSG) is now the most common procedure. Not all patients achieve excess weight loss outcome (EWL) following LSG. What does this study add? Emotional food cravings contribute to weight loss outcomes at 6 months' post-LSG surgery. Emotional food cravings may be a maladaptive coping mechanism that represents important area for early psychological intervention.

Smoking Beliefs Among Chinese Secondary School Students: A Theory-Based Qualitative Study.

Introduction: China has the world's greatest number of smokers but theory-based smoking interventions are rare. To develop an effective intervention, understanding the determinants of Chinese adolescent smoking is crucial. The Theory of Planned Behavior (TPB) is empirically supported to predict and assist in informing intervention strategies to change health-related behaviors. Based on the TPB, the elicitation of shared smoking beliefs among adolescents can inform future intervention designs among this at-risk population. Methods: We investigated the beliefs from six focus groups (N = 30) of one senior secondary school in Kunming, Yunnan Province, China. We used semi-structured questions based on the TPB framework, including prompts about behavioral (advantages and disadvantages), normative (important referents), and control (barriers and facilitators) beliefs. Following the Consensual Qualitative Research (CQR) methodology, data were discussed until consensus was reached. Auditing was undertaken by an external researcher. Results: Seven domains (advantages, disadvantages, approvers, disapprovers, facilitators, barriers, and smoker images) were examined. Smoking as a gendered behavior, smoking as influenced by cultural and environmental contexts, smoking as a strategy to cope with stress, and awareness of the harm of smoking, are highlighted themes across domains. Data suggested an extended-TPB framework as an appropriate approach to adopt when addressing smoking beliefs among the target population. Conclusions: These beliefs can be utilized to inform future school-based interventions and public health campaigns targeting smoking among Chinese adolescents. Implications: A modified TPB approach has potential for future smoking interventions among Chinese adolescents. Beliefs elicited in this study form a strong basis for designing a location- and population-specific antismoking programme.

Psychosocial presentation of female bariatric surgery patients after multiple revisional surgeries: A qualitative study.

Bariatric surgery is currently the most viable and cost-effective treatment for obesity. This study aimed to understand, from a female patient's perspective, what contributed to not achieving or maintaining excess weight loss from a primary laparoscopic adjustable gastric band surgery, leading to subsequent multiple revisional bariatric surgeries. The purposive sample of participants ( N = 17 females) were over 18 years, had a primary failed laparoscopic adjustable gastric band and had more than three revisional procedures. Participants were individually interviewed and data were analysed from a grounded theory methodology to build a causal model with the core category of unrealistic expectations of bariatric surgery and other important conceptual categories.

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.

Taste, Enjoyment, and Desire of Flavors Change After Sleeve Gastrectomy-Short Term Results.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) incidence continues to increase worldwide because of its efficacy and low surgical risks. This study aimed to investigate satisfaction with eating and the change in taste perception, desire, and enjoyment of flavor changes and associations with extent of percentage excess weight loss (%excess weight loss (EWL)) post-LSG. METHODS: One hundred six participants completed an online questionnaire 4 to 6 weeks as well as 6 to 8 months post-LSG bariatric surgery. The questionnaire included study-specific questions about changes in taste, desire, and enjoyment of eight major categories of flavor, as well as the Suter Quality of Alimentation Questionnaire to measure satisfaction with eating. RESULTS: The majority of participants reported a post-surgery increase in the intensity of the flavor of sweet (60, 55%) and fatty (57, 70%) at both time points, respectively. Participants also reported a decreased enjoyment for sweet (77, 61%) and fatty (77, 83%) flavors and decreased desire for fatty (83, 84%) and sweet (82, 68%) flavors at both time periods. This study found an increase in intensity of flavor of all eight taste modalities and a decrease in desire and enjoyment of all taste modalities except salty and savory flavors following surgery. Participants reported an increased acuity of spicy flavors and fatty tastes over time, and the desire and enjoyment of sweet, bitter, and metallic flavors increased over time. Changes in savory enjoyment over a 6- to 8-month period post-LSG were weakly associated with extent of % EWL at 6 months post-surgery. The participants reported average (40, 37%), good (33, 42%), and excellent (15, 11%) satisfaction with eating at both time points. CONCLUSION: This preliminary study indicates that subjective changes in taste, desire, and enjoyment of flavors of eight taste modalities are very common after LSG.

Predicting sun-protective intentions and behaviours using the theory of planned behaviour: a systematic review and meta-analysis.

OBJECTIVE: To synthesise theory of planned behaviour (TPB) relationships, using meta-analysis, and test the predictive utility of the model for sun protection behaviour. DESIGN: Thirty-eight samples were identified via database/manual searches and academic society posts based on the criteria: measuring sun-protective intentions and/or prospective behaviour; using the TPB/theory of reasoned action as a basis of measurement; and providing bivariate correlations for at least one relevant TPB association. MAIN OUTCOME MEASURES: Sun-protective intentions and behaviours. RESULTS: The sample-weighted average effects were moderate-to-strong with attitudes showing the strongest association with intention (r+ = 0.494), followed by perceived behavioural control (PBC; r+ = 0.451), and subjective norm (r+ = 0.419). Intentions showed a stronger association with prospective behaviour (r+ = 0.486) compared to PBC (r+ = 0.314). A total of 39% of variance in intentions and 25% of variance in behaviour were explained. Publication bias was not evident. Moderator analyses showed that TPB associations were stronger when measures specified the Target, Action, Context and Time; in non-student samples; and when follow-up exceeded two weeks. CONCLUSION: Despite recent criticism, this review shows that the TPB explains a large amount of variance in sun protection and that TPB associations are robust across different populations.

Keeping kids sun safe: exploring parents' beliefs about their young child's sun-protective behaviours.

OBJECTIVES: Melanoma of the skin is the third most commonly diagnosed cancer in Australia. Given the high incidence of sunburn in children and the level of sun protection provided by parents is often infrequent and/or insufficient, this research employed qualitative methodology to examine parents' beliefs about their young child's sun safe behaviour. METHODS: Parents (N = 21; n = 14 mothers, n = 7 fathers) of children aged 2-5 years participated in focus groups to identify commonly held beliefs about their decision to sun protect their child. Data were analysed using thematic content analysis. RESULTS: Parents generally had knowledge of the broad sun safe recommendations; however, the specific details of the recommendations were not always known. Parents reported adopting a range of sun-protective measures for their child, which depended on the time of year. A range of advantages (e.g. reducing the risk of skin cancer, developing good habits early and parental peace of mind), disadvantages (e.g. false sense of safety and preventing vitamin D absorption), barriers (e.g. child refusal) and facilitators (e.g. routine and accessibility) to performing sun safe practices were identified. Normative pressures and expectations also affected parents' motivation to be sun safe for their child. CONCLUSIONS: These identified beliefs can be used to inform interventions to improve sun safe behaviours in young children who reside in a region that has the highest skin cancer incidence in the world.

Negative experiences and donor return: an examination of the role of asking for something different.

BACKGROUND: Negative donation experiences, including vasovagal reactions, deter donor retention. However, whether this deterrence effect varies as a function of whole blood (WB) donation history and requests to donate the same or a different product remains unclear. STUDY DESIGN AND METHODS: The responses of 894 eligible WB donors who had been approached to convert to plasmapheresis and 954 eligible first-time plasmapheresis donors who had been surveyed on their last donation experience and their intention to donate plasma were considered. This information was matched with individual vasovagal reaction records, deferral category, WB donation history, and subsequent donation behavioral data obtained from the blood collection agency. RESULTS: Path analysis indicated that the application of a deferral and an officially recorded vasovagal reaction decreased donors' intentions to continue plasmapheresis donation, but had no effect on WB donors' intentions to convert to plasmapheresis. Consistent with past findings, vasovagal reactions occurred more frequently with female and inexperienced donors. CONCLUSION: Experiencing vasovagal reactions and deferrals may not universally deter donors from continuing to donate. Rather, the offer to convert to another form of donation-in this instance, plasmapheresis-after experiencing a negative donation event while donating WB may be sufficient to eliminate the deterrence effect on retention.

Predicting Australian adults' sun-safe behaviour: examining the role of personal and social norms.

OBJECTIVES: To address the scarcity of comprehensive, theory-based research in the Australian context, this study, using a theory of planned behaviour (TPB) framework, investigated the role of personal and social norms to identify the key predictors of adult Australians' sun-safe intentions and behaviour. DESIGN: The study used a prospective design with two waves of data collection, 1 week apart. METHODS: Participants were 816 adults (48.2% men) aged between 18 and 88 years recruited from urban, regional, and rural areas of Australia. At baseline, participants completed a questionnaire assessing the standard TPB predictors (attitude, subjective norm, and perceived behavioural control [PBC]), past behaviour, behavioural intention, and additional measures of group norm for the referent groups of friends and family, image norm, personal norm, personal choice/responsibility, and Australian identity. Seventy-one per cent of the participants (n = 577) reported on their sun-safe behaviour in the subsequent week. RESULTS: Via path modelling, past behaviour, attitude, group norm (friends), personal norm, and personal choice/responsibility emerged as independent predictors of intentions which, in turn, predicted sun-safe behaviour prospectively. Past behaviour, but not PBC, had direct effects on sun-safe behaviour. The model explained 61.6% and 43.9% of the variance in intention and behaviour, respectively. CONCLUSIONS: This study provides support for the use of a comprehensive theoretical decision-making model to explain Australian adults' sun-safe intentions and behaviours and identifies viable targets for health-promoting messages in this high-risk context. Statement of contribution What is already known on this subject? Identifying determinants of sun-safe behaviour is vital in high-risk cancer areas like Australia. For young Australians, friendship group norm is a key influence of intentions and behaviour. Little is known about drivers of sun safety, especially norms, among Australian adults in general. What does this study add? This study drew on qualitative data and reconceptualized norms for Australians' sun-safe decisions. Friendship group norm and personal norm, not family group norm, influence sun-safe intentions. Perceived responsibility and choice to be sun safe also impact on people's intentions.

Study protocol: a randomised controlled trial of a theory-based online intervention to improve sun safety among Australian adults.

BACKGROUND: The effects of exposure to ultraviolet radiation are a significant concern in Australia which has one of the highest incidences of skin cancer in the world. Despite most skin cancers being preventable by encouraging consistent adoption of sun-protective behaviours, incidence rates are not decreasing. There is a dearth of research examining the factors involved in engaging in sun-protective behaviours. Further, online multi-behavioural theory-based interventions have yet to be explored fully as a medium for improving sun-protective behaviour in adults. This paper presents the study protocol of a randomised controlled trial of an online intervention based on the Theory of Planned Behaviour (TPB) that aims to improve sun safety among Australian adults. METHODS/DESIGN: Approximately 420 adults aged 18 and over and predominantly from Queensland, Australia, will be recruited and randomised to the intervention (n = 200), information only (n = 200) or the control group (n = 20). The intervention focuses on encouraging supportive attitudes and beliefs toward sun-protective behaviour, fostering perceptions of normative support for sun protection, and increasing perceptions of control/self-efficacy over sun protection. The intervention will be delivered online over a single session. Data will be collected immediately prior to the intervention (Time 1), immediately following the intervention (Time 1b), and one week (Time 2) and one month (Time 3) post-intervention. Primary outcomes are intentions to sun protect and sun-protective behaviour. Secondary outcomes are the participants' attitudes toward sun protection, perceptions of normative support for sun protection (i.e. subjective norms, group norms, personal norms and image norms) and perceptions of control/self-efficacy toward sun protection. DISCUSSION: The study will contribute to an understanding of the effectiveness of a TPB-based online intervention to improve Australian adults' sun-protective behaviour. TRIALS REGISTRY: Australian and New Zealand Trials Registry number ACTRN12613000470796.

Identifying belief targets to increase bone marrow registry participation among students who have never donated blood.

New members on bone marrow registries worldwide are needed to allow sufficient diversity in the donor pool to meet patient needs. We used the theory of planned behaviour belief-basis and surveyed students who had not donated blood previously (i.e. non-donors) (N = 150) about the behavioural, normative, and control beliefs informing their intentions to join the Australian Bone Marrow Donor Registry. Key beliefs predicting non-donors' intentions included: viewing bone marrow donation as an invasion of the body (ß = -.35), normative support from parents (ß = .40), anticipating pain/side effects from giving blood (ß = -.27), and lack of knowledge about how to register (ß = -.30). Few non-donors endorsed these beliefs, suggesting they are ideal targets for change in strategies encouraging bone marrow donor registration.

Beliefs underlying the intention to donate again among first-time blood donors who experience a mild adverse event.

Using the belief basis of the theory of planned behavior (TPB), the current study explored the rate of mild reactions reported by donors in relation to their first donation and the intention and beliefs of those donors with regard to returning to donate again. A high proportion of first-time donors indicated that they had experienced a reaction to blood donation. Further, donors who reacted were less likely to intend to return to donate. Regression analyses suggested that targeting different beliefs for those donors who had and had not reacted would yield most benefit in bolstering donors' intentions to remain donating. The findings provide insight into those messages that could be communicated via the mass media or in targeted communications to retain first-time donors who have experienced a mild vasovagal reaction.

Identifying critical sun-protective beliefs among Australian adults.

We investigated critical beliefs to target in interventions aimed at improving sun-protective behaviours of Australian adults, a population at risk for skin cancer. Participants (N = 816) completed a Theory of Planned Behaviour belief-based questionnaire and a 1-week follow-up of sun-protective behaviour. A range of behavioural, normative and control beliefs correlated with sun-protective behaviour, with no and only minimal differences observed in correlations between beliefs and behaviour by gender and age, respectively. A range of key beliefs made independent contributions to behaviour; however, the behavioural belief about being less likely to tan (ß = 0.09); normative belief about friends (ß = 0.20); and control beliefs about forgetfulness (ß = -0.14), inconvenience (ß = -0.17), knowing I will be in the sun for a long time (ß = 0.16) and more fashionable sun-protective clothing (ß = 0.13) were significant critical beliefs guiding people's sun-protective behaviour. Our study fills a gap in the literature by investigating an at-risk population for skin cancer and using an established theoretical framework to identify critical beliefs that guide Australian adults' decisions to sun protect. Attention to these critical beliefs will assist health campaigns and interventions aimed at combating the increasing rates of skin cancer for adults.

Investigating mothers' decisions about their child's sun-protective behaviour using the Theory of Planned Behaviour.

This study tested the utility of the Theory of Planned Behaviour (TPB) to predict mothers' decisions to ensure their child engages in sun-protective behaviours. Mothers (N = 162) of children aged four or five years completed standard TPB items (attitude, subjective norm, perceived behavioural control, intention) and additional variables of role construction, mothers' own sun safe behaviour, planning and past behaviour. One week later, participants (N = 116) reported their behaviour. Results found support for the TPB constructs, role construction, past behaviour and the mediating role of planning. These findings can inform strategies to prevent skin cancer.