A Pilot Randomised Trial Investigating the Effects of Including Efficacy Messaging on Tobacco Warning Labels.

INTRODUCTION: Smokers can respond defensively to health risk communication such as on-pack warning labels, potentially reducing their effectiveness. Theory suggests that risk perception together with self-efficacy reduces defensive responses and predicts target behaviors. Currently, tobacco warning labels globally predominantly target risk and do not explicitly consider efficacy. AIMS: This study explores the effectiveness of combining Australian tobacco warning labels with efficacy content to increase quitting intentions. METHODS: RCT in 83 smokers over 3 weeks. After a seven-day baseline phase (smoking from usual tobacco packaging), participants were randomized to one of two adhesive labels groups for the remaining 14 days: Standard health warning labels (HWLs) featuring enhanced efficacy messages (experimental group) or unmodified standard HWLs (control group). Participants attached these labels to their tobacco packaging and recorded their cognitions and smoking behavior once daily using Smartphones. Multilevel structural equation modeling was used to test theorized effects of the labels on self-efficacy, risk perception, and intentions to quit. RESULTS: There was no effect of exposure to efficacy messages on either self-efficacy, risk perceptions, or intentions to quit. However, self-efficacy and risk perceptions were positively associated with quitting intentions at the within-person level. CONCLUSIONS: The predictive relationships between self-efficacy, risk perception, and intention to quit were supported, however, supplementing standard warning labels with efficacy messages had no effect on these cognitions. Whether this is due to conditioned avoidance of HWLS, characteristics of the messages, or limitations imposed by format are unclear. IMPLICATIONS: Self-efficacy and risk perception predict intentions to quit smoking. Adding efficacy content to tobacco health warnings may have the potential to bolster these cognitions but more research is required to determine the contexts in which this would be effective and who would be likely to benefit. The time course by which exposure to efficacy content might influence cessation self-efficacy and downstream quitting intentions also needs to be investigated.

[Occupational and Health Strains of Pensioners with Reduced Earning Capacity Due to Mental or Physical Illnesses - Implications for the Health Care System]. / Unterschiedliche berufliche und gesundheitliche Belastungen psychisch und körperlich erkrankter EM-Rentner*innen ­ Implikationen für das Gesundheitswesen.

OBJECTIVE: Demographic changes with an increasing number of people receiving pensions and a decreasing number of working people paying into the pension system represent major challenges for the German social security system. In particular, it is important to support people to continue working so that there is no (premature) reduction in their earning capacity and pensioners with reduced earning capacity (disability pensioners) should be helped to return to gainful employment. The aim of this study was to investigate the differing needs of two kinds of disability pensioners, namely those with mental illness and those who were physically ill. METHODS: A total of 453 persons receiving disability pension because of temporararily reduced earning capacity were interviewed over the telephone. Differences in demographic variables, occupational characteristics before applying for disability pension, and general resources were examined in descriptive analyses and multivariate analyses of variance with post-hoc tests. RESULTS: A third of the sample (33.1%) suffered from mental illness and the rest from somatic disorders. Those with mental illness reported higher perceived mental age, lower work-related self-efficacy, and lower quality of life concerning their mental health. Moreover, they reported higher levels of mental stressors at work. CONCLUSION: Mentally ill disability pensioners differ considerably from those with somatic illnesses. Accordingly, to promote a return to work, interventions need to target different factors in these two groups.

[Need for Action and Research in Psychosomatic and Orthopaedic Rehabilitation from the Point of View of Rehabilitants and Individuals who work in Rehabilitative Care]. / Handlungs- und Forschungsbedarf in der Psychosomatischen und Orthopädischen Rehabilitation aus der Sicht von Rehabilitand:innen und Mitarbeitenden in der Rehabilitation.

PURPOSE: The aim of this study was to assess the need for practical action and research in psychosomatic and orthopaedic rehabilitation from the perspective of rehabilitants and individuals who work in rehabilitative care. METHODS: The project was divided into an identification and a prioritization phase. In the identification phase, 3872 former rehabilitants, 235 employees from three rehabilitation clinics and 31 employees of the German Pension Insurance Oldenburg-Bremen (DRV OL-HB) were invited to participate in a written survey. The participants were asked to name relevant needs for action and research for psychosomatic and orthopaedic rehabilitation. The answers were evaluated qualitatively using an inductively developed coding system. Practical fields of action and research questions were formulated from the categories of the coding system. In the prioritization phase, the identified needs were ranked. For this purpose, 32 rehabilitants were invited to a prioritization workshop and 152 rehabilitants, 239 clinic employees and 37 employees of the DRV OL-HB to a two-round written Delphi survey. The resulting prioritized lists from both methods were combined into a top 10 list. RESULTS: In the identification phase, 217 rehabilitants, 32 clinic employees and 13 employees of the DRV OL-HB participated in the survey, in the prioritization phase, 75 rehabilitants, 33 clinic employees and 8 employees of the DRV OL-HB in both survey rounds of the Delphi survey, and 11 rehabilitants in the prioritization workshop. A need for practical action primarily in the implementation of holistic and individual rehabilitation, in quality assurance and in the education and participation of rehabilitants was identified, as also a need for research primarily on access to rehabilitation, structures in the rehabilitation setting (e. g., inter-agency cooperation), the design of rehabilitative interventions (more individualized, more suitable for everyday life), and the motivation of rehabilitants. CONCLUSION: The identified needs for action and research include many topics that have already been identified as problems in previous research projects and by various actors in rehabilitation. In the future, there needs to be increased focus on the development of strategies for dealing with and solving the identified needs, as well as on the implementation of these strategies.

[Subjective Financial Resources of Temporary Disability Pensioners: Interrelation with Loneliness and Life Satisfaction]. / Gesundheit und Lebenszufriedenheit bei Erwerbsminderungsrentnern und -rentnerinnen: Die Bedeutung von finanziellen Ressourcen und Einsamkeit.

AIM OF THE STUDY: In Germany, a disability that prevents a person from fully participating in the labor market can partly be compensated for financially with temporary disability pension. Due to fewer financial resources, this group is at a higher risk of poverty, which in conjunction with a worse health status might be related to other limitations such as lower social participation, loneliness and reduced life satisfaction. This study examined the relationships between household income, subjective financial resources, loneliness and life satisfaction. METHODOLOGY: 199 former employees with current reduced earning capacity status were interviewed at 2 points in time (T1; T2=T1+approx. 8 months) by means of structured telephone interviews. RESULTS: Income was not related to loneliness or life satisfaction. However, lower perceived financial resources were associated with higher levels of loneliness, which in turn was related to lower life satisfaction. Loneliness partially mediated this relationship. A lower health status was associated with more loneliness and lower life satisfaction. CONCLUSION: Rehabilitative measures that teach money management skills and aim to overcome loneliness could improve the life satisfaction of people with reduced earning capacity. This is highly relevant, as other studies have shown a connection between life satisfaction and return to work as well as social participation.

A systematic review of Indigenous caregiver functioning and interventions.

PURPOSE: There is a global increase in chronic, degenerative illnesses that require long-term intervention and support as a result of the aging population. The majority of support needs are met by informal family caregivers. While there have been three decades of research focusing on caregivers in general, the extent to which research has focused on Indigenous caregivers is unclear. Worldwide, Indigenous peoples face severe economic and health disadvantages that may make them even more vulnerable to the negative aspects of informal caregiving. The current systematic review aimed to synthesize the extant literature on Indigenous caregiver functioning and the interventions that are efficacious in alleviating Indigenous caregiver distress. METHODS: Systematic review Inclusion criteria were peer-reviewed quantitative studies examining Indigenous caregiver functioning or evaluating Indigenous caregiver interventions. RESULTS: 1172 unique records were located in the final search undertaken; only 7 articles, representing 6 unique studies, met the full inclusion criteria. Most studies contained numerous methodological weaknesses that compromised the reliability and validity of findings. Available studies suggest poor health and high burden among Indigenous relative to non-Indigenous caregivers. However, high levels of positive aspects of caregiving were reported in one study. A single intervention study suggests that poor health outcomes among Indigenous caregivers can be alleviated, though the quality and focus of this study was sub-optimal. CONCLUSIONS: Overall, there is very little quality evidence around Indigenous caregiver functioning. Future research in this area would benefit from greater adherence to the standards of research that contribute to a strong and reliable evidence base.

Illness representations, coping, and illness outcomes in people with cancer: a systematic review and meta-analysis.

OBJECTIVE: Cancer is associated with negative health and emotional outcomes in those affected by it, suggesting the need to better understand the psychosocial determinants of illness outcomes and coping. The common sense model is the leading psychological model of self-regulation in the face of illness and assumes that subjective illness representations explain how people attempt to cope with illness. This systematic review and meta-analysis examines the associations of the common sense model's illness representation dimensions with health and coping outcomes in people with cancer. METHODS: A systematic literature search located 54 studies fulfilling the inclusion criteria, with 38 providing sufficient data for meta-analysis. A narrative review of the remaining studies was also conducted. RESULTS: Random-effects models revealed small to moderate effect sizes (Fisher Z) for the relations between illness representations and coping behaviors (in particular between control perceptions, problem-focused coping, and cognitive reappraisal) and moderate to large effect sizes between illness representations and illness outcomes (in particular between identity, consequences, emotional representations, and psychological distress). The narrative review of studies with insufficient data provided similar results. CONCLUSIONS: The results indicate how illness representations relate to illness outcomes in people with cancer. However, more high-quality studies are needed to examine causal effects of illness representations on coping and outcomes. High heterogeneity indicates potential moderators of the relationships between illness representations and health and coping outcomes, including diagnostic, prognostic, and treatment-related variables. This review can inform the design of interventions to improve coping strategies and mental health outcomes in people with cancer.

Using Self-affirmation to Increase the Effects of Emotive Health Warnings on Smoking: A Randomized Exploratory Trial.

INTRODUCTION: Emotive health messages are widely used tools in tobacco control. However, under some circumstances, they can be less effective than desired by eliciting defensive responses in smokers. AIMS: This study tests whether enhancing a currently used emotive graphic smoking health warning with a self-affirmation component reduces cigarette consumption and whether potential effects are stronger in heavier smokers, as suggested by previous research. METHODS: Participants (n = 265) were randomly allocated to a self-affirmation (reflecting on personal values and positive traits using a questionnaire) or matched control condition before viewing an emotive graphic health message from a current Australian government public health campaign. The primary outcome (cigarettes per day [CPD]) was assessed both before and a week following the intervention. RESULTS: No main effect of self-affirmation on smoking, but as hypothesized, a significant interaction between baseline smoking and self-affirmation was found that showed that heavier smokers (>21 CPD) who self-affirmed significantly reduced CPD compared to nonaffirmed smokers. CONCLUSIONS: These findings support the use of self-affirmation to enhance smoking awareness campaigns in heavier smokers. IMPLICATIONS: This study shows that enhancing emotive graphic smoking health messages with self-affirmation (the act of reflecting on positive aspects of oneself) increases their effectiveness in heavier smokers. This suggests that self-affirmation might be a particularly useful tool for health promotion targeting heavier smokers. This study adds to previous research in that it is the first to test the add-on effects of self-affirmation to current graphic health messages on smoking rather than smoking-related cognitions.

Higher BMI is associated with stronger effects of social cues on everyday snacking behaviour.

Discretionary food choices (snacks) contribute up to a third of the daily energy intake and potentially contribute to energy imbalance and weight gain. Individual snack intake behaviour is guided by internal and external cues, with social cues (seeing others eat, being alone) consistently showing large effects. A wide body of (mainly laboratory-based) research suggests marked differences in people's response to eating cues based on BMI. Here, we show that these BMI differences in cue responsiveness also pertain to everyday snacking behaviour. In two combined ecological momentary assessment studies, 122 participants with BMIs ranging from 18.34 to 45.71 kg/m2 logged their everyday snacking behaviour in real-time over two weeks along with the presence or absence of social cues. Random-effects modelling showed that people with higher BMI were more likely to consume high-energy snacks when alone, and were more likely to consume low-energy snacks in the presence of others eating. This suggests BMI differences in cue responsiveness that are in line with impression management theory and underlines the importance of social cues for snacking behaviour and provides avenues for both theory and intervention development.

It's the power of food: individual differences in food cue responsiveness and snacking in everyday life.

BACKGROUND: Discretionary eating behaviour ("snacking") is dependent on internal and external cues. Individual differences in the effects of these cues suggest that some people are more or less likely to snack in certain situations than others. Previous research is limited to laboratory-based experiments or survey-based food recall. This study for the first time examines everyday snacking using real-time assessment, and examines whether individual differences in cue effects on snacking can be explained by the Power of Food scale (PFS). METHODS: Ecological Momentary Assessment (EMA) study with 53 non-clinical participants over an average of 10 days. Multiple daily assessments: Participants reported every snack and responded to randomly timed surveys during the day. Internal and external cues were measured during both types of assessment. Demographic data and PFS scores were assessed during a baseline lab visit. Data were analysed using multilevel linear and multilevel logistic regression with random intercepts and random slopes as well as cross-level interactions with PFS scores. RESULTS: Higher individual PFS scores were associated with more daily snacking on average (B = 0.05, 95% CI = 0.02,0.08, p < .001). More average daily snacking was associated with higher BMI (B = 1.42, 95% CI = 0.19,2.65, p = .02). Cue effects (negative affect, arousal, activities, company) on snacking were significantly moderated by PFS: People with higher PFS were more likely to snack when experiencing negative affect, high arousal, engaging in activities, and being alone compared to people with lower PFS scores. CONCLUSIONS: PFS scores moderate the effects of snacking cues on everyday discretionary food choices. This puts people with higher PFS at higher risk for potentially unhealthy and obesogenic eating behaviour.

Australian Smokers' and Nonsmokers' Exposure to Antismoking Warnings in Day-to-Day Life: A Pilot Study.

INTRODUCTION: Smokers and nonsmokers can encounter a variety of antismoking messages in their everyday life. Antismoking warnings often involve fear appeals to which particularly smokers may react in a defensive manner by avoiding or derogating the messages, or downplaying their personal risk. However, previous studies testing the effects of antismoking warnings have either been retrospective or lab-based, thus introducing potential recall biases and yielding limited ecological validity. We used ecological momentary assessment (EMA) to give an overview on the number, type, and locations where individuals encounter such messages and to examine their immediate reactions. METHODS: In an EMA study, 33 smokers and 37 never-smokers logged every encounter with antismoking warnings during 2.5 weeks (1,237 participant days of monitoring). After randomly selected encounters, several markers of defensiveness were assessed. RESULTS: On average, nonsmokers reported noticing significantly fewer warnings than smokers (M = 0.49/day vs. M = 2.14/day). Both groups saw the majority of warnings on cigarette packages. Smokers reported a significantly higher level of message derogation and a significantly lower level of message acceptance than nonsmokers. There were no differences in feelings of vulnerability between smokers and nonsmokers upon encountering the warnings. CONCLUSIONS: The overall number of encounters with antismoking warnings in people's everyday life is relatively low, particularly among smokers. Smokers are likely to avoid messages and respond defensively, thus limiting their potential effectiveness.

Examination of the mechanism of action of two pre-quit pharmacotherapies for smoking cessation.

BACKGROUND: There is substantial scope for improvement in the current arsenal of smoking cessation methods and techniques: even when front-line cessation treatments are utilized, smokers are still more likely to fail than to succeed. Studies testing the incremental benefit of using nicotine patch for 1-4 weeks prior to quitting have shown pre-quit nicotine patch use produces a robust incremental improvement over standard post-quit patch treatment. The primary objective of the current study is to test the mechanism of action of two pre-quit smoking cessation medications-varenicline and nicotine patch-in order to learn how best to optimize these pre-quit treatments. METHODS/DESIGN: The study is a three group, randomized, open-label controlled clinical trial. Participants (n = 216 interested quitters) will be randomized to receive standard patch treatment (10 weeks of patch starting from a designated quit day), pre-quit patch treatment (two weeks of patch treatment prior to a quit day, followed by 10 weeks post-quit treatment) or varenicline (starting two weeks prior to quit day followed by 10 weeks post-quit). Participants will use study-specific modified smart-phones to monitor their smoking, withdrawal symptoms, craving, mood and social situations in near real-time over four weeks; two weeks prior to an assigned quit date and two weeks after this date. Smoking and abstinence will be assessed at regular study visits and biochemically verified. DISCUSSION: Understanding how nicotine patches and varenicline influence abstinence may allow for better tailoring of these treatments to individual smokers. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12614000329662 (Registered: 27 March 2014).

Patient Anxiety and Depression Moderate the Effects of Increased Self-management Knowledge on Physical Activity: A Secondary Analysis of a Randomised Controlled Trial on Health-Mentoring in COPD.

OBJECTIVE: Anxiety and depression are common comorbidities in people with chronic obstructive pulmonary disease (COPD). While these comorbidities could potentially lead to a higher motivation to learn about self-management, they could also inhibit patients from translating this knowledge into appropriate self-management behaviours. This paper explores the moderating effects of anxiety and depression on a health-mentoring intervention, focusing on mechanisms of change (mediation). METHODS: 182 COPD patients participated in an RCT, with anxiety and depression assessed by the Hospital Anxiety and Depression Scale (HADS), self-management knowledge by the Partners in Health Scale, and spontaneous physical activity using accelerometers, all measured at baseline, 6 and 12 months. The moderated mediation model tested the intervention's effect on physical activity, mediated via changes in self-management knowledge, at different levels of anxiety and depression. RESULTS: Knowledge mediated the effect of the intervention on changes in physical activity only for participants reporting low levels of anxiety or depression. Both acted as moderators: Increased knowledge led to more physical activity among participants reporting low anxiety or depression and to less activity among highly anxious or depressed participants. CONCLUSION: Although health-mentoring interventions can be an effective tool to increase knowledge and physical activity among COPD patients, it is essential to take anxiety and depression into account, as increased knowledge may have detrimental effects in highly anxious or depressed participants. This suggests that patients with elevated anxiety or depression may need to be treated appropriately before engaging in chronic disease self-management interventions.

Compliance with an EMA monitoring protocol and its relationship with participant and smoking characteristics.

INTRODUCTION: Arguably, the greatest advantage of ecological momentary assessment (EMA) studies is that data are collected repeatedly in real-time and real-world situations, which reduces recall and situational biases and thus improves the accuracy and validity of the data collected. However, the validity of EMA data is contingent upon compliance rates. If participant characteristics are related to missing data, analyses should control for these factors, or they should be targeted in EMA training sessions. This study evaluates the impact of demographic and smoking-related participant characteristics on compliance to an EMA smoking study protocol. METHODS: Prequit-day data were taken from the control arm of an ongoing randomized controlled trial of a smoking-cessation program. After training, 119 participants were asked to carry a mobile device with them at all times for ~6 days and to log every cigarette they smoked in addition to completing randomly scheduled assessments. Different types of compliance were assessed: the percentage of completed random prompts (signal-contingent compliance), the percentage of logged cigarettes per day compared to a timeline follow-back measure, and the correlation between logged cigarettes and a carbon monoxide assessment 2 hr later (both event-contingent compliance). RESULTS: Overall compliance rates were 78.48% for event-contingent and 72.17% for signal-contingent compliance. None of the demographic or smoking-related participant characteristics predicted signal-contingent compliance; however, female participants showed higher event-contingent compliance than male participants, and Caucasian participants showed higher event-contingent compliance than non-Caucasian participants. CONCLUSIONS: Compliance did not depend on smoking-related characteristics. EMA is a valid method for assessing smoking behavior in real-time and real-world settings.

Beyond the usual suspects: target group- and behavior-specific factors add to a theory-based sun protection intervention for teenagers.

Sun protection standards among teenagers are low while sun exposure peaks in this age group. Study 1 explores predictors of adolescent protection intentions and exposure behavior. Study 2 tests the effectiveness of an intervention based on these predictors. Study 1(cross-sectional, N = 207, ages 15-18) and Study 2 (RCT, N = 253, ages 13-19) were conducted in schools. Path models were used to analyze data. Self-efficacy (ß = .26, p < .001) and time perspective (ß = .17, p = .014) were the strongest predictors of intentions; appearance motivation (ß = .54, p < .001) and intention (ß = -.18, p = .015) predicted behavior. The intervention effected changes in all predictors except self-efficacy. Changes in outcome expectancies (ß = .19, p < .001) and time perspective (ß = .09, p = .039) predicted changes in intention, while changes in intention (ß = -.17, p = .002) and appearance motivation (ß = .29, p < .001) predicted behavior changes. Target group- and behavior-specific intervention components are as important for changes in intentions and behavior as components derived from common health behavior theories.

Planning skills moderate the intention-planning cognitions-behaviour relation: a longitudinal study on physical activity in Chinese adolescents.

Our objective is to examine the role of planning skills for translating intentions into physical activity via planning cognitions. A study with 534 adolescents was conducted. Over 4 weeks, intention, planning cognitions (prospective anticipation of when, where, and how to perform activities), planning skills (successful past planning experiences), and physical activity were assessed. The results were that skills correlated with intention, planning cognitions, and subsequent physical activity. Planning cognitions were found to mediate the intention-behavior relation, whereas skills moderated the mediating role of planning cognitions: If students reported high skills, they were more likely to translate their intentions into plans and behavior. We conclude that having more skills makes it more likely that adolescents successfully translate their intentions into plans. Promotion of physical activity should improve planning cognitions but also planning skills. Only with planning cognitions and skills might adolescents better be able to act in accordance with their intentions and perform physical activity.

Enhancing planning strategies for sunscreen use at different stages of change.

To promote sun safety by implementing different plans for sunscreen use, different psychological interventions are compared. Self-regulatory strategies such as action planning and coping planning are seen as proximal predictors of actual behavior. The study compares a pure planning intervention with a broader resource communication and examines differential effects at different stages of change. A sun safety online study was designed with two intervention groups (resource communication versus planning) and one control group at two assessment points, 2 weeks apart. Participants (N = 292) were grouped post hoc according to their stage of change, resulting in 51 pre-intenders (no intention to use sunscreen), 102 intenders (high intention but no regular use of sunscreen) and 139 actors (sunscreen use on a regular basis). No overall treatment effects on planning, but an interaction between time, stage and intervention emerged. The resource communication was more effective for pre-intenders, whereas the planning intervention proved more effective for intenders. A planning treatment was more beneficial in motivated individuals, whereas a broader approach was better for unmotivated ones. Findings highlight the potential that stage-matched interventions might have in the context of sun safety promotion.

A mediator model of sunscreen use: a longitudinal analysis of social-cognitive predictors and mediators.

BACKGROUND: Sun safety behaviors to prevent skin cancer, such as sunscreen use, are difficult to adopt and maintain. PURPOSE: Most social-cognitive theories assume that the intention to change a behavior is the best predictor of actual change. But unforeseen barriers emerge, or people give in to temptations, such as getting a tan despite their initial good intentions. The Health Action Process Approach proposed by Schwarzer (Appl Psychol 57:1-29, 1) is used to explore the self-regulatory mechanisms of sunscreen use. METHOD: An international longitudinal survey was conducted with 524 individuals. Intentions, positive outcome expectancies, distal self-efficacy, and risk perception were assessed at time 1, whereas intention, planning, and proximal self-efficacy were measured 2 weeks later at time 2. Sunscreen use was reported at 3-month follow-up (time 3). RESULTS: A structural equation model fit the data well. Positive outcome expectancies, risk perception, and self-efficacy predicted the behavioral intention. Self-efficacy and planning predicted sunscreen use, and planning mediated the relation between intended and performed sunscreen use. CONCLUSION: The findings contribute to the understanding of psychological mechanisms in health behavior change. They also point to the particular role of mediator variables in the context of sun protection behaviors, which may have implications for designing skin cancer preventive interventions.

Translating intentions into sunscreen use: an interaction of self-efficacy and appearance norms.

The study examines whether self-efficacy mediates between intention and behavior, and whether appearance norms and self-efficacy are additive or synergistic predictors of sunscreen use. At two measurement points in time, 14 weeks apart, 154 individuals responded to an online questionnaire. Moderated mediation was tested by hierarchical regression analyses. Self-efficacy mediated the intention-behavior relationship, whereas appearance norms emerged as a moderator of the self-efficacy-sunscreen use relationship. The model accounted for 22% of the behavior variance at time 2. For individuals who believe that they would look more attractive with a tan, self-efficacy did not have a strong effect on behavior. Thus, for skin-protection motivation to become effective, self-efficacy is needed in conjunction with less positive appearance norms. Implications for public health promotion and mass media sunscreen use campaigns are discussed.

Risk perception moderates how intentions are translated into sunscreen use.

Planning is supposed to mediate between intention and behavior. The study examines whether such a mediation also exists in the context of sunscreen use. Moreover, the question is raised whether health risk perception might moderate such a mechanism. A longitudinal online study was conducted with three measurement points in time. Sunscreen use, intention, planning, and risk perception were assessed. A sample of 154 individuals was analyzed by hierarchical regression procedures in terms of moderated mediation. Planning partially mediated the intention-behavior relationship, and risk perception operated as a moderator. The moderator effect was negative, implying that low risk perception in conjunction with high intention was a prerequisite for planning, and, thus, for the mediation by planning. Low risk perception reflects health-specific optimism which can be a facilitator of health behavior change, in this case the change of sunscreen use from Time 1 to Time 3.