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.

The relationship between drunkorexia, alcohol, and blackouts among college students: An exploratory study.

College drinkers commonly report blacking out (i.e., alcohol-induced amnesia), and those who drink with the intention to blackout are at risk for harmful consequences. Drunkorexia (i.e., restriction of calories on planned drinking days) is a high-risk behavior potentially associated with blacking out. Informed by the Theory of Planned Behavior (TPB), this study explores blackout experiences and intentions to blackout association with drunkorexia. College students (n = 2335) who primarily identified as female and White participated via an online survey. Participants received a $3 coupon for completion of the study. Consistent with the literature, 40% and 60.7% of participants reported experiencing blackouts and drunkorexia, respectively, in the last year. Informed by the TPB, a structural equation model assessed whether more frequent blackout experiences (IV) were related to drunkorexia behaviors (DV1) and alcohol behaviors (DV2), and whether there was a significant indirect effect through blackout intention. The model fit the data well (CFI = .98, TLI = .95), which suggests that more frequent blackout experiences relate to more drunkorexia experiences (R2 = .04) and higher levels of alcohol consumption (R2 = .44). In addition, the relationship between blackout experiences and drunkorexia flows through intentions to blackout (i.e., a significant indirect effect). Findings are consistent with TPB, which suggests that intentions predict health behavior. Future interventions should consider modifying intentions and other possible TPB constructs to minimize high-risk alcohol consumption and drunkorexia behaviors.

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.

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.

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.

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.

College students' patterns of electronic nicotine delivery system use and other substance use.

Objective: Electronic nicotine delivery system (ENDS) use on college campuses increased dramatically in recent years. Little is known about how ENDS use among college students relates to other substance use. Participants: Undergraduates (n = 3,917) at a mid-sized Midwestern public university in the United States. Methods: Cross-sectional survey data and latent class analysis of ENDS, cigarettes, alcohol, marijuana, and non-medical use of attention-deficit/hyperactivity disorder (ADHD) medication. Results: Over 95% of ENDS users fit into one of two classes comprising a minority of college students engaged in multiple and often problematic substance use behaviors. Only 4% of ENDS users were grouped into a class comprising 85% of the sample and characterized by either little/no substance use or moderate alcohol consumption. Conclusions: ENDS use in this sample was not indicative of general exploration with substances, nor was it indicative of isolated tobacco use, but rather more heavy and problematic substance use.

Pregnant Smokers' Intention to Switch From Cigarettes to E-Cigarettes: A Reasoned Action Approach.

INTRODUCTION: This study used the reasoned action approach (RAA) to examine 1) factors associated with pregnant smokers' intention to switch from cigarettes to e-cigarettes and 2) the influence that intention to switch had on future expectations to resume cigarette use postpartum. METHODS: U.S. pregnant women (N = 267) who reported past 30-day use of cigarettes completed an online cross-sectional survey between November and December 2019. A 30-item scale measured RAA constructs (intention, instrumental attitudes, experiential attitudes, injunctive norms, descriptive norms, perceived autonomy, and perceived capacity). A confirmatory factor analysis confirmed and structural equation modeling tested the RAA constructs' association with intention to switch and the relationship between intention to switch and future expectations to resume smoking after pregnancy. RESULTS: The confirmatory factor analysis confirmed the seven-factor measurement model. Structural equation modeling found instrumental attitudes (ß = 0.43; p < .001) and descriptive norms (ß = 0.53; p < .001) were associated with intention to switch from cigarettes to e-cigarettes. However, there were differences between the constructs' relationships with intention between those who did and did not use e-cigarettes in the past 30 days. Intention to switch was inversely related with future expectations to resume smoking postpartum (ß = -0.13; p < .001). CONCLUSIONS: This study examined multiple facets of behavioral decision-making that may influence pregnant smokers' intention to switch to e-cigarettes during pregnancy. In this sample, pregnant people who believed switching from cigarettes to e-cigarettes was important and that other smokers commonly switched during pregnancy reported greater intention to switch. Novel theories, such as the RAA, may provide an optimal lens to understand pregnant smokers' behavioral decision-making process as they consider switching from cigarettes to e-cigarettes.

Are current elicitation techniques for barriers and enablers confounded with motivation? How natural language may hinder theory-guided research.

OBJECTIVES: The objective of this study was to compare standard elicitation techniques for barriers and enablers for physical activity and sleep behaviours, to an alternative approach whereby participants were told to only consider the literal meanings of the words prevent/enable. DESIGN: Randomized controlled design. METHODS: College students were randomized to either a standard methods group (n = 177) (what prevents you from doing behaviour X) or a vignette group (n = 176) to encourage them to think of the literal meaning of the words prevent/enable. Responses were then codified by two blinded researchers. RESULTS: Students reported significantly different types of control beliefs between groups. Those in the standard group reported significantly more overall beliefs (p's < .05, except sleep/enable), suggesting poorer discrimination in interpreting what was meant by 'prevent' and 'enable'. CONCLUSIONS: This study demonstrates when self-efficacy-related control beliefs are elicited, natural language words such as 'prevent' and 'enable' have the potential to confuse people about the intent of the question.

Feasibility, Utility, and Limitations of a Rapid Community Behavioral Diagnosis for Social Distancing During the 2020 Coronavirus Pandemic.

PURPOSE: To evaluate the feasibility, utility, and limitations of a rapid community behavioral diagnosis (RCBD) for social distancing behaviors to prevent coronavirus transmission during a global coronavirus pandemic. DESIGN: Using social media for recruitment, we partnered with a local community task force to administer a brief online survey. SETTING: Residential urban community. SAMPLE: Eighty-four community members, the majority of whom were white, female, college educated completed the survey. MEASURES: Theory of planned behavior constructs: behavioral intentions, attitudes, perceived norms, and perceived behavioral control for 3 social distancing behaviors: maintaining a 6-foot distance, avoiding places people congregate, and staying home as much as possible. ANALYSIS: Path analyses were conducted to understand significant determinants of intentions for each behavior to guide the development of locally tailored health promotion messages. RESULTS: The RCBD was implemented, and results were communicated to the community within 1 week. Intentions were high across the 3 behaviors but lowest for staying home as much as possible. Younger participants had lower intentions of maintaining a 6-foot distance than older participants. For each behavior, specific recommendations for health promotion messaging emerged based on how attitudes, norms, and perceived behavioral control related to intentions. CONCLUSION: In a situation where local community action is paramount for reducing coronavirus transmission, this RCBD process is feasible and useful for informing local health promotion.

Developing and Validating an Instrument to Evaluate Theory-Based Behavioral Antecedents of Consuming a High-Fiber Diet.

Obesity is a major public health concern, with low consumption of fiber-rich foods (e.g., fruits and vegetables) commonly cited as a causal factor. The purpose of this study was to evaluate the validity of a survey measuring the constructs of the Reasoned Action Approach under the context of consuming a high-fiber diet. After an initial draft of the survey was developed, it was evaluated by a panel of six experts to establish face and content validity. Next, data were collected from an adult sample (n = 878), and psychometric data revealed indices of reliability (Cronbach's alpha) and validity (confirmatory factor analysis). The average age of adults was 51.5 years (±12.8), and a majority were Caucasian (81%), and women (93%). With regards to construct validity, the model structure had adequate fit (e.g., Comparative Fit Index = 0.960). In addition all items loaded significantly on its corresponding scale. For internal consistency reliability, all Cronbach's alpha scores were > 0.70. Overall the survey appears to be a promising tool for researchers and practitioners. Understanding the theoretical determinants of fiber consumption will help tie theory together with practice.

How Children Search for Health Information Online: An Observational Study.

OBJECTIVE: To evaluate whether children could find the correct answers to obesity-related health questions on the Internet and observe the search strategies children use when searching for such information. METHODS: Twenty-five parent-child dyads, from a southwestern US summer day camp, participated in this cross-sectional study. Parents' health literacy skills were evaluated. Children searched the Internet for 6 questions related to nutrition and physical activity. Search activities were recorded via Camtasia. Quantitative (ie, time spent per question) and qualitative data (ie, themes related to difficulties searching) were extracted by rewatching the recordings. RESULTS: All parents had either proficient or basic levels of health literacy. The question that had the highest rating for being correctly answered pertained to physical activity recommendations, whereas none of the children were able to find recommended servings of food groups. CONCLUSIONS AND IMPLICATIONS: Children were not successful in finding correct answers to most of the questions and used ineffective search strategies. Interventions that teach children effective search strategies for health information are needed.

Examining Determinants and Co-associations Between Fruit and Vegetable and Sugar-Sweetened Beverage Monitoring Practices Among a Sample of Low-Income Hispanic Mothers.

The etiology of obesity is complex, and a growing body of research suggests that changing two or more behaviors at the same time will likely have a stronger impact than changing one behavior in isolation. A lack of fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are two behaviors related to childhood obesity in the Hispanic community. The purpose of this study was to evaluate theory-based determinants of monitoring practices of FV and SSB among Hispanic mothers with young children using the reasoned action approach. The study also examined the co-associations among the theoretical antecedents for both behaviors. Surveys were distributed in several community settings to urban Hispanic mothers (n = 238) of 2-5-year-old children. Surveys assessed FV and SSB monitoring practices, attitudes, perceived norms, perceived behavioral control (PBC), and intentions. Two models were evaluated using structural equation modeling: attitudes, perceived norms, and PBC of both behaviors were associated with intentions for both behaviors, and PBC and intentions were associated with monitoring practices of FV and SSB. Both models had adequate fit (FV (CFI = 0.973; GFI = 0.980; RMSEA = 0.121); SSB (CFI = 0.994; GFI = 0.993; RMSEA = 0.066)). PBC for both FV and SSB monitoring was significantly associated with SSB monitoring, whereas FV intentions was only significantly associated with FV monitoring. Results from this study gives evidence that among Hispanic mothers, FV and SSB monitoring behaviors are interrelated. To promote SSB monitoring, more implementation strategies (i.e., skills-based interventions) are warranted, whereas to promote FV monitoring, motivational strategies are warranted.

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.

Determinants of Parenting Practices Related to Monitoring Sugar Sweetened Beverages Among Hispanic Mothers.

The purpose of this study was to evaluate Hispanic mothers (n = 238) of 2-5 year old children and determinants of their monitoring practices related to their preschooler's consumption of sugar-sweetened beverages (SSB). Hispanic mothers were recruited from numerous areas (i.e. churches, community agencies, and daycares) in southwest Oklahoma City. Constructs of the Reasoned Action Approach (RAA) were evaluated along with demographic questions. Most mothers (92%) were born outside the US, and a majority had been in the US ≥ 11 years (61%). The RAA constructs autonomy, capacity (or self-efficacy), and descriptive norms predicted a significant amount of the variance of SSB monitoring practices (14.7%). Results show that public health interventions that promote maternal monitoring practices related to SSB for Hispanic mothers should focus on promoting capacity, autonomy, and norms. Such interventions can take place in community centers, clinics, and day cares.

Do different factors predict the adoption and maintenance of healthy sleep behaviors? A reasoned action approach.

Sleep deprivation is a serious public health concern in the United States that often goes unnoticed, particularly among college students and young adults. Concerted efforts are needed to help those who are not engaging in healthy sleep behaviors, while also helping those who are already maintaining healthy sleep behaviors. The purpose of the study was to evaluate theory-based determinants of intentions toward healthy sleep behaviors among students currently not sleeping 7-9 hr per night, oriented toward initiating the behavior (to start sleeping 7-9 hr per night in the next 30 days; behavioral adoption), and students currently sleeping 7-9 hr per night, oriented toward maintaining the behavior (sleeping 7-9 hr per night for the next 6 months; behavioral maintenance). The theoretical framework for this study was the reasoned action approach (RAA). A valid and reliable survey was distributed online to university students (adopters = 310, maintainers = 300). Regression analyses revealed which latent constructs predicted variance of intentions, using a three-construct and a six-construct model. For the adoption group, attitudes, perceived norms, and perceived behavioral control (PBC) accounted for 29.3% of the variance of intentions, and perceived norms and PBC accounted for 32.6% of the variance of intentions for the maintenance group. Furthermore, PBC, stemming from capacity (self-efficacy), was found to have the strongest influence on intentions for both groups. Results from this study support the use of the RAA as a model for designing future sleep interventions. Implications and recommendations for future research and practice are presented.

Gender differences for theory-based determinants of muscle-strengthening physical activity in college-aged students: a moderation analysis.

Researchers and practitioners have primarily focused on understanding and promoting aerobic forms of physical activity (PA), while leaving muscle-strengthening forms of PA less understood. There are also stark gender disparities for muscle-strengthening PA but not aerobic PA. The purpose of this study was to apply the reasoned action approach (RAA) toward understanding theory-based determinants of muscle-strengthening PA and to explore gender differences. Female (n = 272) and male (n = 120) college students completed a valid and reliable survey evaluating their participation in muscle-strengthening PA and the constructs of the RAA (intentions, attitudes, perceived norms, and perceived behavioral control [PBC]). Results showed that attitudes, perceived norms, and PBC explained a substantial amount of the variance of intentions for both female (53.8%) and male (54.7%) participants; however, when predicting participation in muscle-strengthening PA, PBC moderated the relationship between intentions and muscle-strengthening PA participation for female participants but not for male participants. Results from this study showed that for women, implementational processes are likely needed for public health interventions to promote muscle-strengthening PA to build capability, skills, and self-efficacy, while for men, motivational interventions are warranted to create favorable attitudes.

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.