Association between stages of change regarding weight reduction in patients with cardiovascular risk factors: A randomized controlled trial

ABSTRACT Background: There is very low-quality evidence that the transtheoretical stages of change model combined with physical activity or diet, or both, can result in significant improvements in dietary and physical activity habits. Objective: To evaluate the association between stages of change on weight reduction, after a nutritional intervention, in patients with cardiovascular risk. Methods: In a randomized controlled clinical trial, patients >18 years old with body mass index ≥25 kg/m2 and at least two cardiovascular risk factors were distributed to an intervention or control group. The intervention group received, according to stage of change, a multidisciplinary intervention formed by a nutritionist, a psychologist, a chef and a physiotherapist to improve healthy eating, while the control group was given a nutritional prescription. Stage of change from the transtheoretical model, anthropometric variables, physical activity, and 24-hour recall of food intake were measured at baseline and 12 months postintervention. The main outcomes were change in weight, waist and hip circumferences. Results: We included 188 subjects (intervention group= 93, control group= 95), where 75% were female, 68.6% had obesity, and mean age 50.3±13. After 12-months, subjects in the intervention group that were ready to change showed a greater decrease in weight and energy intake, with differences between ready to change vs not ready to change subjects and an interaction between intervention group and ready to change. Conclusions: An intervention with a multidisciplinary team can be as effective as the current standard of care in promoting weight loss when taking into account baseline stage of change.

RESUMEN Introducción: existe poca evidencia sobre el efecto de la etapa de cambio del modelo transteórico en conjunto con actividad física, dieta, o ambas, en los hábitos dietéticos y de actividad física. Objetivo: evaluar el efecto de una intervención nutricional y la etapa de cambio inicial sobre la reducción de peso después de una intervención nutricional en pacientes con riesgo cardiovascular. Métodos: Ensayo clínico controlado aleatorizado. Pacientes >18 años con índice de masa corporal ≥25 kg/m2 y al menos 2 factores de riesgo cardiovascular fueron asignados a: grupo intervención o grupo control. El grupo de intervención recibió de acuerdo a la etapa de cambio una intervención multidisciplinaria formada por: nutricionista, psicólogo, chef y fisioterapeuta, mientras que el grupo control solo recibió prescripción nutricional habitual. Se evaluaron al inicio del estudio y 12 meses después de la intervención: etapa de cambio del modelo transteórico, variables antropométricas, actividad física y recordatorio de 24 horas. Resultados: se incluyeron 188 sujetos (grupo intervención 93, grupo control 95), 75% eran mujeres, 68,6% tenían obesidad, con promedio de 50.3±13. Después de 12 meses, los sujetos en el grupo de intervención que estaban listos para el cambio, mostraron una mayor disminución en el peso y en el consumo calórico, con diferencias estadísticamente significativas en la interacción grupo y etapa de cambio. Conclusiones: Una intervención con un equipo multidisciplinario puede ser tan eficaz como el tratamiento habitual para promover la pérdida de peso cuando se tiene en cuenta la etapa de cambio basal.

The study of college students’ physical exercise behavior phase and process of change based on the Transtheoretical model / 中华疾病控制杂志

Objective To analyze the stage characteristics in the exercise behavior improvement of college students and explore the role of Process in the exercise behavior change based on the transtheoretical model, providing basis for the stage-matched intervention for the exercise behavior of college students. Methods There were 932 students who completed the questionnaires, from 5 universities in Shanxi Province were selected by using a stratified random cluster sampling method. Descriptive analysis was used to describe the exercise behavior of college students. Variance analysis and multivariate Logistic regression model were used to analyze the difference of the process of with stage of change among college students’ physical exercise. Multivariate variance analysis was used to analyze how personal characteristics affect process of change. Results Among all participants, 89.4% students knew the importance of physical exercise, and 29.4% students were satisfied with their physical exercise condition. The distribution of students’ physical exercise stage showed an inverted U-shape with left-side peak, and there was a significant difference between gender( 2=54.657, P<0.001). There were significant stage characteristics in the process of students' exercise behavior, gender had a significant main effects on mutual aid relation(F=7.400, P=0.07)and conscious control (F=7.778, P=0.005), gender and grade had interaction effects on social release (F=3.614, P=0.013). Conclusions The college students' exercise behavior showed the characteristics of “knowing but not to do”, which conformed to the Transtheoretical model. It is essential to develop targeted phased exercise intervention strategies according to the relationship between change of phase and change of procedure.

Effects of Customized Nutritional Education 'Change 10 Habits' Program According to Stage of Behavior Change in Mildly Obese Adults

The prevalence of obesity is increasing worldwide and has become a serious epidemic health problem. We developed the 'Change 10 Habits' educational program based on obesity treatment and dietary guidelines and examined its effects on customized nutrition education in mildly obese adults. The study was approved by the Institutional Review Board. Study subjects were excluded if they had several major diseases, if had consumed an anti-obesity drug, or if they practiced an obesity-related program within 30 days. The subjects (n=87, 25< or = BMI<30) were each exposed to the customized nutrition education program with four lessons according to the stage of the transtheoretical model (TTM). The stage-matched program was administered for 12 weeks and was run by a clinical dietitian. Overall, subjects who were in the precontemplation/contemplation stage at baseline made progress in the preparation and action/maintenance stage after 12 weeks (P<0.05). For 'Alcohol is consumed, up to 2 drinks per day', the proportion of subjects who belonged in the action/maintenance stage increased from 34.5% to 49.4% at 12 weeks. In addition, scores of all items significantly increased after the program (P<0.05). 'Chew more than 10 times and eat slowly' score significantly increased from 3.9+/-2.4 to 5.8+/-2.3 (P<0.05). In conclusion, behavioral stage-matched nutrition education using the 'Change 10 Habits' program was effective in improving eating behaviors and enhancing healthy lifestyles in mildly obese adults.

Reliability and Validity of the Lam Assessment of Employment Readiness for Injured Workers / 中国康复理论与实践

@#Objective To measure the reliability and validity of the Lam Assessment of Stages of Employment Readiness (LASER) Putonghua version for injured workers, and observe the confidence of return to work on different preparation stages. Methods 85 injured workers with limb fractures were included. The data was obtained through face-to-face structured interview. The test-retest reliability and internal consistency were measured. Factor analysis was used to examine construct validity of the Putonghua version LASER. Results Principle component analysis extracted four factors, which was consistent with the original version of LASER. Intra- class correlation coefficient (ICC) of test-retest ranged 0.27~0.89, whereas the internal consistence among these 4 stages ranged 0.691~0.796. There were significantly differences in confident scores in different stages among 3 different confidence groups. Conclusion The structure validity of Putonghua version of LASER is useful for reflecting the readiness of injured workers' return to work. However, the reliability coefficient is rather low in some of the items, which could be resulted in incorrect judgment of readiness of return to work of injured workers. The further study on items correction and development is apparent.

Comparison of practice of dietary guidelines and health beliefs according to stage of weight loss behavior change among male workers / 한국영양학회지

This study compared levels of health and dietary behavior practices and health beliefs according to the stage of weight loss behavior change of Korean male workers. A self-administered survey questionnaire was collected from 411 male adult workers residing in Seoul, Kyeonggi, Chungcheong region. Practices of health related behavior, including smoking, drinking, exercise, work related physical activity, and dietary behavior according to dietary guidelines were evaluated. In addition, the levels of perceived benefit, perceived barrier, perceived susceptibility, perceived seriousness, and perceived cue to action from the health belief model were measured according to the stages of weight loss behavior change. Significant differences in BMI, level of daily exercise, and practices of dietary behavior according to dietary guidelines were observed among stages of weight loss behavior change. Subjects who were in action/maintenance stage showed a more desirable level of health behavior and health belief model variables, except perceived barrier. Based on the findings of this study, it is suggested that subjects with different stages of behavior change need an appropriate specific nutrition education method and material for improvement of nutrition education efficacy.

Study on the Eating Habits and Practicability of Guidelines for Reducing Sodium Intake according to the Stage of Change in Housewives / 대한지역사회영양학회지

This study was intended to investigate the sodium-related perception, dietary behavior, and practicability of methods for reducing sodium intake(RSI) according to the stage of change in consumers. The survey was conducted to 770 housewives, among them 553 subjects who answered the key questions for the stage of change were categorized into ''aintenance (M)' stage (maintaining reduced salt intake for more than 6 months; n = 287, 51.90%), 'Action (A)' stage (maintaining reduced salt intake for less than 6 months; n=139, 25.14%), and 'Pre-Action (P)'stage (not starting reduced salt intake; n = 127, 22.97%). The subjects in M and A were significantly older than those in P (p < 0.01). The scores of desirable dietary habit and dietary balance were the highest in M followed by A and P. When eating out, the subjects in P considered 'price' more and 'healthiness of food' less than those in M and A did. Among the guidelines for RSI, 'Avoid Processed Foods', 'Eat enough vegetables and fruits' and 'Add little amount of dipping sauce for fried food' were selected as the three easiest items to perform. With regard to the sodium-related perception, the subjects in M considered eating-out food to be more salty than homemade dishes, read nutrition labels more, avoided table salt or dipping sauce for fried food more, and had 'own low-sodium recipe' than those in P (p < 0.001). It is suggested that practicability of actions for RSI and the stage of change should be considered to develop effective personalized education program and nutrition guidance.

Reliability and Validity of the Korean Version of the Readiness to Change Questionnaire Treatment Version / 신경정신의학

OBJECTIVES: The purpose of this study was to evaluate the psychometric properties of the Korean version of the Readiness to Change Questionnaire-Treatment version (RCQTV-K). METHODS: The participants were 92 patients who were seeking treatment of alcoholism in two hospitals for alcoholism. A confirmatory factor analysis was performed to test whether the factor structure of the RCQTV-K was consistent with the English version. Convergent validity was assessed by correlating the scores on the RCQTV-K with those on other scales (Alcohol Abstinence Self-Efficacy Scale, Beck Depression Inventory, Korean Version of Alcohol Use Disorders Identification Test). RESULTS: The factor structure of the RCQTV-K was consistent with the three-factor structure established for the original RCQTV. Cronbach's alpha was high, indicating that the reliability of the items for each subscale was satisfactory. Allocated stage of change showed significant differences among the scores on the other scales. CONCLUSION: The results of the present study indicate that the RCQTV-K is an effective and valid scale for evaluating the stage of readiness to change in patients seeking treatment for alcoholism. The findings suggest that the RCQTV-K is a promising assessment tool for use in the treatment and study of alcoholism.

The Effect of Nutrition Education on the Improvement of Psychosocial Factors Related to Vegetable and Fruit Intake of Elementary School Children in Pre-Action Stages

This study investigates the change of level of psychosocial factors of decisional balance, processes of change, and self-efficacy after nutrition education on vegetable and fruit intake of children in pre-action stages. Forty-seven 5th grade elementary school children in Yeongi-Gun, Chungnam-Do were categorized into pre-action stages from a total of 71 children by four-stage questions, and then finally into two stages of precontemplation and contemplation & preparation. After 6 weeks nutrition education, recognition of both of pros and cons of vegetable intake were improved in the two groups of precontemplation and contemplation & preparation. In fruits intake, however, recognition of pros was not changed after nutrition education in either stage, but recognition of cons was improved only in the precontemplation stage. However, no difference in any psychosocial variables was found between precontemplation stage and contemplation & preparation stage. After the nutrition education, the score of consciousness raising of vegetable intake belonging to cognitive process of change increased in the subjects of the precontemplation stage, wheres the scores of dramatic relief, self-reevaluation, environment reevaluation and social liberation increased in the group of contemplation & preparation. In fruit intake, however, no change was found except in the environment reevaluation in the precontemplation group. The behavioral process of change of vegetable and fruit intake did not show any change in either group after nutrition education. Self-efficacy scores of vegetable intake of keeping the foods at hand, eating the recommended number of servings and making time to eat increased in the precontemplation group, while in the contemplation & preparation group, self efficacy scores of shopping for a variety of vegetables, instead of keeping the foods at hands, as well as the scores of the rest two items of eating the recommended number of servings and making time to eat increased after nutrition education. However, in case of fruits intake, no difference was shown in the precontemplation stage except an item of keeping the foods at hand. The results indicated that the stage of change was progressed in the pre-action stage after nutrition education and the scores of many psychosocial factors increased in both pre-action stages. It is suggested that the recognition of cons as well as the cognitive process of change and self-efficacy could be best used as indicators of the assessment of nutrition education program for vegetable intake.

Consumo de verduras y frutas en centros de salud y supermercados, de la Región Matropolitana de Chile: programa 5 al día / Vegetables and fruits consumption in health centres and supermarkets in the Chilean Metropolitan Region: 5 a day program

Objetivo: Evaluar la frecuencia de consumo de verduras y frutas y el conocimiento del mensaje "5 al día", en usuarios de Supermercados y de Centros de Salud Pública, para ser utilizados como línea base para planificar una intervención bimodal, controlada, para la promoción del consumo de frutas y verduras. Sujetos y métodos: a 1897 adultos entre 17 y 60 años, del área urbana de la Región Metropolitana, se les aplicó una encuesta de frecuencia de consumo, etapa de cambio de conducta y conocimiento del mensaje. Resultados: 58.8 por ciento señaló consumir entre 1-2 porciones/día y 33.5 por ciento entre 3-4. 91,2 por ciento indicó que ha mantenido este consumo por más de seis meses, 7,7 por ciento cumple con la recomendación "5 al día" sólo 9,4 por ciento conocía el mensaje. No hubo diferencias significativas entre los grupos de intervención salvo en el nivel educacional y en el número de porciones de consumo diario. Conclusiones: El consumo de verduras y frutas estuvo bajo la recomendación en todos los grupos estudiados y existe un desconocimiento del mensaje promocional 5 al día.

Objective: To evaluate the consumption frequency of vegetables and fruits and the knowledge of the 5 a day message in users of supermarkets and Public Health Centers to be utilized as a baseline to plan a bimodal controlled intervention for the promotion of fruits and vegetables consumption. Individuals and methods: A frequency consumption survey, the behavioral change stage and the message understanding was applied to 1.897 adults aged between 17 and 60 years in the urban area of the Metropolitan Region. Results: 58.8 percent stated that they ate between 1 -2 portions! day, 33.5 percent between 3-4,91.2 percent indicated that they had maintained this consumption for over six months and 7.7 percent complied with the recommendation of 5 a day; only 9.4 percent knew the message. There were no significant differences among the intervention groups except in the educational level and the number of daily consumption portions. Conclusions: The consumption of vegetables and fruits was under the recommendation in all the studied groups and there is a lack of knowledge regarding the 5 a day promotional message.

A Study on the Health Status, ADL, Depression and Life Satisfaction by Gender and Stage of Exercise Change among the Rural Elderly

PURPOSE: This study was conducted to find perceived health status, ADL, depression, and life satisfaction among the rural elderly and to explore differences according to gender and the stage of exercise change. METHODS: This is an exploratory survey study. The subjects were 365 elders consisting of 140 men (38.4%) and 225 women (61.6%) in a rural area in Korea. Data were collected from December, 2006 to January, 2007 using a structured questionnaire. The data were analyzed by Pearson's correlation, t-test, ANOVA, and Scheffe's test using the SPSS/WIN 10.0. RESULTS: The mean scores of perceived health status and ADL were lower and depression was higher in women than in men. There were statistically significant differences in perceived health status according to the stage of exercise change. Also there were significant differences in the scores of ADL, depression, and life satisfaction according to the stage of exercise change. CONCLUSION: The tailored exercise seems to decrease depression while promoting physical health status and life satisfaction among the rural elderly. We suggest considering the client's intention and motivation when developing exercise programs.

Analysis of the Factors Affecting to Youth Smoking Based on the Stage of Change

PURPOSE: This study was to analyse the factors affecting youth smoking, especially self-efficacy and perceived social norm, based on the stage of change. METHODS: A self-reported survey was conducted during the period from the 21st of April to the 17th of May, 2008. Data were collected from 10,707 students of 12 middle schools in Seoul, Gyeonggi-do, and Incheon. The data were analysed with SPSS/WIN 15.0. RESULT: The smoking possibility was 2.18 times higher in the male students than in female students, and 1.76 times higher in 8th-grade students and 2.48 times higher in 9th-grade students than in 7th-grade ones. Smoking possibility increased when students had more experience in alcohol, more friends who smoke, or worse relationship with their parents. Also this study showed that high-level self-efficacy and perceived social norm were acting as inhibiting factors of smoking. CONCLUSION: To reduce the youth's smoking rate, smoking prevention programs should provide educational chances to learn knowledge and skills on how to reject smoking temptation. Also, someone significant like parents should make it clear to the youth that they do not want their children to smoke.

Psychosocial Factors Related with the Intake of Vegetables and Fruits by Stage of Change of Elementary School Children in Chungnam Province

This study aims at investigating the psychosocial factors that influence on the intake of fruits and vegetables according to stage of change in rural children. Total 256 elementary school children, located in Yeongi-Gun, Chungnam-Do were surveyed from May 14 2007 to May 30 2007. Stage of change on the intake of fruits and vegetables of the students was categorized into three stages: precontemplation (PC), contemplation & preparation (CO&PR) and action (AC). Psychosocial factors consist of decisional balance based on pros and cons, process of change of cognitive and behavioral processes, and self-efficacy. The recognition of cons out of decisional balance showed the highest score in the subjects at the stage of PC and lowest score in those action stage. While, no difference was shown in the score of recognition of pros among the stages. Both levels of cognitive and behavioral process of change showed no difference between two pre-action stages, PC and CO&PR. However, the subjects of action stages got higher scores in more number of the variables in both of cognitive and behavioral process of change compared to those of pre-action stages with more remarkable in results vegetables than in fruits. The results of self-efficacy on fruits and vegetables intake showed that the higher stages of change, the higher the self-efficacy score. From the result, it is suggested that the items and level of psychosocial factors are different according to the stage of change and between fruits and vegetables in rural children.

Nutrition Knowledge, Dietary Self-Efficacy and Eating Habits According to Student's Stage of Regular Breakfast or Exercise / 대한지역사회영양학회지

This study has been performed to analyze nutrition knowledge, dietary self-efficacy and eating habits of the elementary- and middle- school students (n = 342) according to student's stage of regular breakfast or exercise. Middle school students had higher nutrition knowledge than primary school students. Total dietary self-efficacy and dietary habit scores were not different by school year and gender. Nutrition knowledge, dietary self-efficacy and dietary habit scores were positively correlated each other. By the stage of regular breakfast, the pre-contemplation stage comprised 13.6%, contemplation 2.1%, preparation 15.7%, action 11.5% and maintenance stage 59.1%. By the stage of regular exercise, the pre-contemplation stage comprised 20.9%, contemplation 7.3%, preparation 45.6%, action 9.8% and maintenance stage 16.4%. According to the stage of change, movement from the pre-contemplation and contemplation to upper stage increased the dietary self-efficacy score. Dietary habit score increased significantly across the five stages of changes. The results of this study indicate differences in stages of changes in breakfast intake and regular exercise and indicate the need for taking these phases of change into account in nutrition education.

Comparison of Mineral and Vitamin Intakes According to the Stage of Change in Fruit and Vegetable Intake for Elementary School Students in Chungnam Province

The purpose of this study was to compare the mineral and vitamin intake according to the stage of change in fruit and vegetable intake. The subjects consisted of 256 students, 122 males and 134 females, who are fourth, fifth and sixth grade in an elementary school located in Yeongi-Gun, Chungnam province. The dietary intake was examined by 24 hr dietary recall for 1 day and by food record for 2 days from April 19 to May 01, 2007. Stage of change of intake of fruits and vegetables of the students was categorized into three groups: precontemplation, contemplation and preparation, and action. The subjects at the stage of action took kimchi and vegetables more frequently, and also took more vitamin C as well. But the subjects at other two stages did not show any difference in the intake of any food group and nutrients. Percentage of the male subjects who took less than EAR did not show any significant difference by stage of change in all the nutrients. However, there was gradual decrease in the percentage of female taking less than EAR of vitamin C and vitamin B2. The result concludes that vitamin C intake significantly increase gradually as the stages of behavioral change of fruit and vegetable intake proceed although almost all vitamins and minerals tended to increase.

Evaluation of a theory-based community intervention to increase fruit and vegetable intakes of women with limited incomes

The study objectives were to increase both the stage of readiness to eat fruit and vegetables as well as the intakes of women who participated in the Expanded Food and Nutrition Education Program (EFNEP) for families with limited incomes. The intervention was to enhance the currently used curriculum, Eating Right Is Basic III (ERIB3), with stage-specific processes based on the Trans-Theoretical Model of readiness to change. Trained EFNEP community workers taught the enhanced curriculum to 90 mothers in the experimental county and to 53 mothers in the control county. Pre- and post-intervention measures included stages of readiness to eat fruit and vegetables and to intake as assessed by 24-hour dietary recalls and staging questions. Most women recruited into EFNEP were in Action and Preparation Stages (53.5%). Fruit and vegetable intakes showed a linear trend along with the Stage of Change for fruit and vegetable. After intervention, some combination of the ERIB3 and the fruit and vegetables-enhanced ERIB3 resulted in a reported 1/2 servings/day increase in fruits and vegetables in both the control and the experimental counties, although changes were not significant. EFNEP women also moved along the Stage of Change Continuum for fruits and vegetables in both counties. The percentage of people who ate 5 or more servings of fruit and vegetables was significant, however, only in the experimental group. We encourage health professionals to apply lessons learned from this intervention and to continue to pursue theoretically based interventions to change dietary behaviors.

A Study on the Stages of Change of Exercise and Its Related Factors in Patients with Diabetes Mellitus : Application of Transtheoretical Model / 성인간호학회지

PURPOSE: This study was conducted to compare the process of change, decisional balance, and self-efficacy according to the stages of change of exercise on the basis of the Transtheoretical Model in order to investigate factors associated with the change of exercise in adult diabetic patients. METHOD: Data were collected from January to April 2005. The subjects were 160 patients in the G university hospital and public health center in J city. RESULTS: The entire process of change showed the significant difference depending on the stage of change(F=20.007, p=.000). For each process of change, the Consciousness Raising(F=14.602, p=.000), Dramatic Relief(F=7.751, p=.000), Environmental Re-evaluation(F=11.843, p=.000), Self Re-evaluation(F=16.035, p=.000), Social Liberation(F=10.968, p=.000), Counter-conditioning (F=24.090, p=.000), Helping Relationships(F= 7.625, p=.000), Reinforcement Management(F= 16.693, p=.000), Self Liberation(F=11.990, p= .000) and Stimulus Control(F=4.020, p=.002) demonstrated significant differences depending on the stages of change of exercise. For the decisional balance, the Pros showed the significant difference depending on the stage of change(F=14.121, p=.000). For the self efficacy showed significant difference depending on the stage of change(F=17.137, p=.000). CONCLUSION: In order to proceed the stage of change of exercise in patients with Diabetes Mellitus, intensive use of a specific process of change, a stage of change matching is needed.

Process of Change, Decisional Balance, Self-efficacy and Depression across the Stages of Change for Exercise among Middle Aged Women in Korea / 간호학회지

PURPOSE: The purpose of this study was to differentiate the change in exercise behavior into different stages and to investigate differences in the process of change, self efficacy, decisional balances and depression according to the stages of exercise behavior change among middle aged women in Korea by using the transtheoretical Model. METHODS: A convenience sample of 434 middle aged women (40-64 years) completed measures of all transtheoretical model constructs involved in exercise behaviors (stages and processes of exercise behaviors change, self efficacy and decisional balance) and depression. The data were analyzed by using the SPSS 10.0 program including descriptive statistics, and one-way ANOVA. RESULTS: The subjects were distributed in each stage of change in exercise behaviors: pre-contemplation (n=106; 24.4%), contemplation (n=126; 29%), preparation (n=88; 20.3%), action (n=51; 11.8%), and maintenance (n=63; 14.5%). The processes of change, pros(advantages of behaviors), self-efficacy and depression were significantly differentiated across the stages of exercise behavior change. Cons(disadvantage of behaviors) was not significantly differentiated across the stages of exercise behavior change. CONCLUSIONS: Results of this study suggested that discriminating of processes of change, self-efficacy, decisional balance, and depression could provide positive information to people about the stages of change in exercise behavior. Therefore, in designing interventions, the stage of a client's exercise behaviors change needs to be assessed prior to application of intervention programs in order to increase and maintain exercise behavior in middle aged women.

Comparison of Nutrient Intakes Regarding Stages of Change in Dietary Fiber Increasing for College Students in Kyunggi-Do / 대한지역사회영양학회지

This study was conducted to compare nutrient intakes regarding stages of change in dietary fiber increasing behavior. Subjects were consisted of healthy 383 college students (250 females and 133 males) in Kyunggi-Do. Stages of change classified by an algorithim based on 6 items were designed each subjects into one of the 5 stages: precontemplation (PC), contemplation (CO), preparation (PR), action (AC), maintenance (MA). Nutrient intakes were assessed by 24-hr recall method. Regarding the 5 stages of changes, PR stage comprised the largest group (39.4%), followed by AC (33.7%), MA (14.6%), PC (7.6%), CO (4.7%). Female were more belong to either AC or MA. The higher stage of change in dietary fiber increasing behavior, the higher self-efficacy. In all male and female, there were no differences in energy, protein, monounsaturated fatty acids, polyunsaturated fatty acids and cholesterol intakes across the 5 stages. But, fiber, potassuim (K), vitamin A and vitamin C intakes of AC or MA were higer than those of PC, CO and PR. Energy% from fat of PR (25.4 - 26.5%) was higher than 20%, and those of AC and MA was lower than the other groups. Dietary P/S and omega6/omega3 ratios of AC and MA were similar to the recommended ratio. Female of PR had the most total saturated fat and palmitic acid and those of MA had the least. Male of PR had the least alpha-LNA (omega3) and total omega3 fatty acids and those of MA had the most. In male and female in AC or MA, fiber and K intakes from breakfast, dinner and snack and vitamin C intakes from all meals were higher than those of the other stages. These results of our study confirm differences in stages of change in fiber intake in terms of nutritional status. To have lower energy% from fat, higher intakes of K, fiber and vitamins, desirable ratio of dietary fatty acids, it needs consistent nutritional education leading to the AC or MA of fiber increasing behavior.

Effects of stage-matched repeated individual counseling on smoking cessation: A randomized controlled trial for the high-risk strategy by lifestyle modification (HISLIM) study

<p><b>OBJECTIVE</b>The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking.</p><p><b>METHODS</b>We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20-30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia.</p><p><b>RESULTS</b>The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia.</p><p><b>CONCLUSIONS</b>We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit.</p>

Effects of Stage-matched Repeated Individual Counseling on Smoking Cessation: A Randomized Controlled Trial for the High-risk Strategy by Lifestyle Modification (HISLIM) Study

Objective: The purpose of this study was to evaluate the effects of stage-matched repeated individual behavioral counseling as an intervention for the cessation of smoking. Methods: We conducted a multisite randomized controlled trial that enrolled smokers unselected for their readiness to quit. There were 979 smokers with hypertension or hypercholesterolemia recruited from 72 study sites and randomly allocated to the intervention or control group. Smokers in the intervention group received stage-matched individual counseling consisting of a 40 minute initial session and four 20-30 minute follow-up sessions. Smokers in the control group received individual behavioral counseling for hypertension or hypercholesterolemia. Results: The point prevalence abstinence rate at 6 months, validated by carbon monoxide testing, in the intervention group (13.6%) was 5.4 times higher (p<0.001) than that in the control group (2.5%). When the data were analyzed based on the baseline stage of change, there were significant differences in the abstinence rates at 6 months in smokers versus controls with each stage of change except in immotives. The odds ratio was 6.4 (p<0.001) in precontemplators, 6.7 (p<0.001) in contemplators, and 6.2 (p<0.01) in preparators. There was a positive, consistent effect of the intervention regardless of study site (worksite or community) or the presence of hypertension or hypercholesterolemia. Conclusions: We showed the effects of an intervention with repeated individual behavioral counseling on the cessation of smoking in smokers unselected for their readiness to quit. This result suggests that stage-matched individual counseling, based on the transtheoretical model, is effective in smokers with a lower motivation to quit as well as those ready to quit.