Measurement Models for Reasoned Action Theory.

Quantitative researchers distinguish between causal and effect indicators. What are the analytic problems when both types of measures are present in a quantitative reasoned action analysis? To answer this question, we use data from a longitudinal study to estimate the association between two constructs central to reasoned action theory: behavioral beliefs and attitudes toward the behavior. The belief items are causal indicators that define a latent variable index while the attitude items are effect indicators that reflect the operation of a latent variable scale. We identify the issues when effect and causal indicators are present in a single analysis and conclude that both types of indicators can be incorporated in the analysis of data based on the reasoned action approach.

Using the Integrative Model to explain how exposure to sexual media content influences adolescent sexual behavior.

Published research demonstrates an association between exposure to media sexual content and a variety of sex-related outcomes for adolescents. What is not known is the mechanism through which sexual content produces this "media effect" on adolescent beliefs, attitudes, and behavior. Using the Integrative Model of Behavioral Prediction, this article uses data from a longitudinal study of adolescents ages 16 to 18 (N = 460) to determine how exposure to sexual media content influences sexual behavior. Path analysis and structural equation modeling demonstrated that intention to engage in sexual intercourse is determined by a combination of attitudes, normative pressure, and self-efficacy but that exposure to sexual media content only affects normative pressure beliefs. By applying the Integrative Model, we are able to identify which beliefs are influenced by exposure to media sex and improve the ability of health educators, researchers, and others to design effective messages for health communication campaigns and messages pertaining to adolescents' engaging in sexual intercourse.

Psychosocial determinants of cancer-related information seeking among cancer patients.

This study explores the utility of using the Integrative Model of Behavioral Prediction as a framework for predicting cancer patients' intentions to seek information about their cancer from sources other than a physician, and to examine the relation between patients' baseline intentions to seek information and their actual seeking behavior at follow-up. Within 1 year of their diagnosis with colon, breast, or prostate cancer, 1,641 patients responded to a mailed questionnaire assessing intentions to seek cancer-related information from a source other than their doctor, as well as their attitudes, perceived normative pressure, and perceived behavioral control with respect to this behavior. In addition, the survey assessed their cancer-related information seeking. One year later, 1,049 of these patients responded to a follow-up survey assessing cancer-related information seeking during the previous year. Attitudes, perceived normative pressure, and perceived behavioral control were predictive of information-seeking intentions, although attitudes emerged as the primary predictor. Intentions to seek information, perceived normative pressure regarding information seeking, baseline information-seeking behavior, and being diagnosed with stage 4 cancer were predictive of actual information-seeking behavior at follow-up. Practical implications are discussed.

Identifying the causal pathways from religiosity to delayed adolescent sexual behavior.

This study used the Integrative Model as a framework to examine whether religiosity delays onset of coitus among a longitudinal sample of virgins, and investigated the causal pathways of this relationship. In addition, this study examined the behavioral beliefs about the consequences of engaging in sex, which distinguishes between youth who vary in level of religiosity. A further analysis was also conducted to examine whether religiosity offers protective effects in terms of progression toward sexual intercourse on a sexual behavior index. The sexual behavior index assumes a progressive nature of sexual behaviors, and includes the following seven behaviors: kissing, having breasts touched (touching for boys), genital touching, receiving oral sex, vaginal intercourse, giving oral sex, and receiving (or giving) anal sex. Religiosity at baseline was negatively associated with sexual debut one year later. This relationship was mediated through attitudes toward personally engaging in sexual intercourse. Religiosity at baseline was also negatively associated with scores on the sexual behavior index one year later. These results suggest that religiosity offers protective effects for both coital and noncoital sexual behaviors.

A Measure of Perceived Argument Strength: Reliability and Validity.

Studies of the content of persuasive messages in which the central arguments of the message are scrutinized have traditionally relied on the technique of thought-listing to assess argument strength. Although the validity of the thought-listing procedure is well documented, its utility can be limited in situations involving non-adult populations and sensitive topics. In this paper we present a self-reported scale that can be used to assess perceived argument strength in contexts where thought-listing may be less appropriate. This scale taps into perceived argument strength from multiple points of view, including but also extending beyond the potential of the argument to elicit positive and negative thoughts. Reliability and validity of this scale were assessed in health communication contexts involving anti-drug PSAs directed at adolescents and anti-smoking PSAs targeting adults. Evidence of convergence between this scale and the thought-listing technique was also obtained using the classical comprehensive exam arguments.

A model of adolescents' seeking of sexual content in their media choices.

This article reports on the extent to which adolescents report actively seeking sexual content in media, identifies from which media they report seeking, estimates the association between seeking sexual information and romantic and sexual behavior, and shows that active seeking of sexual content in media sources is explained by an intention to seek such content using the Integrative Model of Behavioral Prediction, a reasoned action approach. The data are a national sample of 810 adolescents aged 13 to 18 years. Results show that 50% of adolescents reported actively seeking sexual content in their media choices, which included movies, television, music, Internet pornography sites, and magazines. Males sought sex content more than females, and gender differences were greatest for seeking from Internet pornography sites, movies, and television. Path analysis demonstrate that seeking sexual content is well-predicted by intentions to seek, and intentions are primarily driven by perceived normative pressure to seek sexual content.

A randomized trial of a nursing intervention for HIV disease management among persons with serious mental illness.

OBJECTIVE: The heightened risk of persons with serious mental illness to contract and transmit HIV is recognized as a public health problem. Persons with HIV and mental illness may be at risk for poor treatment adherence, development of treatment-resistant virus, and worse outcomes. The objective of this study was to test the effectiveness of a community-based advanced practice nurse (APN) intervention (PATH, Preventing AIDS Through Health) to promote adherence to HIV and psychiatric treatment regimens. METHODS: Community-dwelling HIV-positive participants with co-occurring serious mental illnesses (N=238) were recruited from community HIV provider agencies from 2004 to 2008 to participate in the randomized controlled trial. Participants in the intervention group (N=128) were assigned an APN who provided community-based care management at a minimum of one visit per week and coordinated clients' medical and mental health care for one year. Viral load and CD4 cell count were evaluated at baseline and 12 months. RESULTS: Longitudinal models for continuous log viral load showed that compared with the control group, the intervention group exhibited a significantly greater reduction in log viral load at 12 months (d=-.361 log 10 copies per milliliter, p<.001). Differences in CD4 counts from baseline to 12 months were not statistically significant. CONCLUSIONS: This project demonstrated the effectiveness of community-based APNs in delivering a tailored intervention to improve outcomes of individuals with HIV and co-occurring serious mental illnesses. Persons with these co-occurring conditions can be successfully treated; with appropriate supportive services, their viral loads can be reduced.

Cancer information scanning and seeking in the general population.

The amount of cancer-related information available in the media and other sources continues to increase each year. We wondered how people make use of such content in making specific health decisions. We studied both the information they actively seek ("seeking") and that which they encounter in a less purposive way ("scanning") through a nationally representative survey of adults aged 40-70 years (n = 2,489) focused on information use around three prevention behaviors (dieting, fruit and vegetable consumption, and exercising) and three screening test behaviors (prostate-specific antigen, colonoscopy, mammogram). Overall, respondents reported a great deal of scanning and somewhat less seeking (on average 62% versus 28% for each behavior), and they used a range of sources including mass media, interpersonal conversations, and the Internet, alongside physicians. Seeking was predicted by female gender, age of 55-64 vs. 40-44, higher education, Black race and Hispanic ethnicity, and being married. Scanning was predicted by older age, female gender, and education. Respondents were fairly consistent in their place on a typology of scanning and seeking across behaviors. Seeking was associated with all six behaviors, and scanning was associated with three of six behaviors.

A network-individual-resource model for HIV prevention.

HIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual's relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual's current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks.

The Role of Communication with Friends in Sexual Initiation.

This study identifies a theoretical mechanism through which communication with friends about sex influences sexual initiation in a sample of adolescents. The Integrative Model was used to assess the effect of attitudes, normative pressure and self efficacy on intentions to have sex in a sample of virgin adolescents. Results show that the constructs of the theory partially mediated the effect of communication with friends on subsequent sexual initiation. The effect of communication with friends on sexual initiation was not different for males and females. Overall, the results suggest how conversations with friends about sex influence adolescents' intentions to initiate sexual intercourse, which in turn influence subsequent sexual initiation.

Adolescent judgment of sexual content on television: implications for future content analysis research.

Many studies of sexual messages in media utilize content analysis methods. At times, this research assumes that researchers and trained coders using content analysis methods and the intended audience view and interpret media content similarly. This article compares adolescents' perceptions of the presence or absence of sexual content on television to those of researchers using three different coding schemes. Results from this formative research study suggest that participants and researchers are most likely to agree with content categories assessing manifest content, and that differences exist among adolescents who view sexual messages on television. Researchers using content analysis methods to examine sexual content in media and media effects on sexual behavior should consider identifying how audience characteristics may affect interpretation of content and account for audience perspectives in content analysis study protocols when appropriate for study goals.

Differentiating between precursor and control variables when analyzing reasoned action theories.

This paper highlights the distinction between precursor and control variables in the context of reasoned action theory. Here the theory is combined with structural equation modeling to demonstrate how age and past sexual behavior should be situated in a reasoned action analysis. A two wave longitudinal survey sample of African-American adolescents is analyzed where the target behavior is having vaginal sex. Results differ when age and past behavior are used as control variables and when they are correctly used as precursors. Because control variables do not appear in any form of reasoned action theory, this approach to including background variables is not correct when analyzing data sets based on the theoretical axioms of the Theory of Reasoned Action, the Theory of Planned Behavior, or the Integrative Model.

Adjuncts or adversaries to shared decision-making? Applying the Integrative Model of behavior to the role and design of decision support interventions in healthcare interactions.

BACKGROUND: A growing body of literature documents the efficacy of decision support interventions (DESI) in helping patients make informed clinical decisions. DESIs are frequently described as an adjunct to shared decision-making between a patient and healthcare provider, however little is known about the effects of DESIs on patients' interactional behaviors-whether or not they promote the involvement of patients in decisions. DISCUSSION: Shared decision-making requires not only a cognitive understanding of the medical problem and deliberation about the potential options to address it, but also a number of communicative behaviors that the patient and physician need to engage in to reach the goal of making a shared decision. Theoretical models of behavior can guide both the identification of constructs that will predict the performance or non-performance of specific behaviors relevant to shared decision-making, as well as inform the development of interventions to promote these specific behaviors. We describe how Fishbein's Integrative Model (IM) of behavior can be applied to the development and evaluation of DESIs. There are several ways in which the IM could be used in research on the behavioral effects of DESIs. An investigator could measure the effects of an intervention on the central constructs of the IM - attitudes, normative pressure, self-efficacy, and intentions related to communication behaviors relevant to shared decision-making. However, if one were interested in the determinants of these domains, formative qualitative research would be necessary to elicit the salient beliefs underlying each of the central constructs. Formative research can help identify potential targets for a theory-based intervention to maximize the likelihood that it will influence the behavior of interest or to develop a more fine-grained understanding of intervention effects. SUMMARY: Behavioral theory can guide the development and evaluation of DESIs to increase the likelihood that these will prepare patients to play a more active role in the decision-making process. Self-reported behavioral measures can reduce the measurement burden for investigators and create a standardized method for examining and reporting the determinants of communication behaviors necessary for shared decision-making.

The effect of marijuana scenes in anti-marijuana public service announcements on adolescents' evaluation of ad effectiveness.

This study explored the possible negative impact of a specific ad feature-marijuana scenes-on adolescents' perceptions of ad effectiveness. A secondary data analysis was conducted on adolescents' evaluations of 60 anti-marijuana public service announcements that were a part of national and state anti-drug campaigns directed at adolescents. The major finding of the study was that marijuana scenes in anti-marijuana public service announcements negatively affected ad liking and thought valence toward the ads among adolescents who were at higher levels of risk for marijuana use. This negative impact was not reversed in the presence of strong anti-marijuana arguments. The results may be used to partially explain the lack of effectiveness of the anti-drug media campaign. It may also help researchers design more effective anti-marijuana ads by isolating adverse elements in the ads that may elicit boomerang effects in the target population.

Elicitation of cognitions related to HIV risk behaviors in persons with mental illnesses: implications for prevention.

OBJECTIVE: An important step in research using the Theory of Reasoned Action and Theory of Planned Behavior (TRA/TPB) is conducting an elicitation process to identify topic and population specific cognitions. This study explored HIV risk behaviors in persons with mental illnesses and introduces findings from focus groups conducted during the development phase of an HIV primary and secondary prevention intervention study. METHODS: Researchers held four focus groups with persons with mental illnesses focused on HIV risks and condom use. RESULTS: Participants discussed sexual side effects of psychotropic medications as a potential cause of both medication non-adherence and HIV risk behaviors. The intersection of these two issues is specific to this population. CONCLUSIONS: We conclude with the recommendation that HIV primary and secondary prevention intervention for persons with mental illnesses must incorporate the promotion of healthy sexuality, including attention to sexual side effects of psychotropic medications.

Estimating the longitudinal association between adolescent sexual behavior and exposure to sexual media content.

The purpose of this study is to estimate the association between adolescent sexual behavior and exposure to sexual media content. A three-wave, longitudinal survey sample (N = 506) of 14- to 16-year-olds at baseline is analyzed using growth curves. Growth trajectories are linear for sexual behavior but not for exposure to sexual media content. The signs of the exposure slopes are not uniformly positive: Hispanic and African American respondents show declines of exposure to sexual media content over the age range investigated here. Although changes in exposure to sex content are highly associated with changes in sexual behavior among Whites, there is little or no association between changes in these variables among Blacks.

Experimental evaluation of antitobacco PSAs: effects of message content and format on physiological and behavioral outcomes.

INTRODUCTION: Antitobacco media campaigns using public service announcements (PSAs) have shown promise in reducing smoking initiation and increasing intentions to quit. Research on what makes an effective PSA has had mixed outcomes. The present study tested the effects of specific message features in antitobacco PSAs, using theory-based physiological and self-report outcomes. METHODS: PSAs were categorized as high or low in message sensation value (MSV) and strength of argument and presented to 200 current smokers in a 2 x 2 factorial design. Physiological responses-specifically, heart rate, skin conductance, zygomaticus major, and corrugator supercilii-were assessed while participants viewed the PSAs. Beliefs, attitudes, efficacy, norms, and intentions to quit were assessed immediately following viewing. RESULTS: Corrugator activity was significantly greater in the high MSV condition. Among those low in sensation seeking, low MSV PSAs elicited higher self-efficacy, whereas the reverse was true for high sensation seekers. High MSV PSAs elicited higher negative beliefs in low sensation seekers. Adding physiological measures to a model predicting intention to quit did not improve the explained variance. DISCUSSION: The present study represents the first comprehensive theory-based experimental investigation of the effects of different features of antitobacco PSAs and provides a framework for future research in identifying effective features of such PSAs. Results illustrate the importance of considering individual differences, characterizing both PSA content and format, and outcome and response measures when evaluating antitobacco PSAs.

Predicting intentions to engage in cancer prevention and detection behaviors: examining differences between Black and White adults.

Reducing cancer-related mortality rates can be achieved by increasing cancer screening rates and by increasing the number of people who engage in healthy lifestyle behaviors. This study uses the Integrative Model of Behavioral Prediction (IM; Fishbein, 2000) to examine differences between Blacks and Whites in the US in the degree to which attitudes, perceived behavioral control (PBC) and normative pressure contribute to predicting intentions to engage in three cancer screening behaviors (mammogram, colonoscopy and PSA test) and three healthy lifestyle behaviors (controlling ones diet to lose weight, eating fruits and vegetables and exercising regularly). Prior research has demonstrated that these behaviors are effective at reducing incidence and mortality rates for some cancers. Results indicated that for Blacks intentions to engage in all behaviors were driven by PBC. Patterns were more varied for Whites and indicated that normative pressure was a particularly important determinant of screening intentions whereas attitudes were most strongly associated with dieting intentions. Results suggest that interventions targeting these behaviors should be tailored by behavior and by ethnicity.

How sources of sexual information relate to adolescents' beliefs about sex.

OBJECTIVES: To examine how sources of sexual information are associated with adolescents' behavioral, normative, and control beliefs about having sexual intercourse using the integrative model of behavior change. METHODS: Survey data from a quota sample of 459 youth. RESULTS: The most frequently reported sources were friends, teachers, mothers, and media. Regression analyses indicated that learning about sex from parents, grandparents, and religious leaders was associated with beliefs likely to delay sex; friends, cousins, and media were associated with beliefs that increase the likelihood of having sexual intercourse. CONCLUSIONS: Different sexual information sources were associated with different underlying beliefs.

A reasoned action approach to health promotion.

This article describes the integrative model of behavioral prediction (IM), the latest formulation of a reasoned action approach. The IM attempts to identify a limited set of variables that can account for a considerable proportion of the variance in any given behavior. More specifically, consistent with the original theory of reasoned action, the IM assumes that intentions are the immediate antecedents of behavior, but in addition, the IM recognizes that environmental factors and skills and abilities can moderate the intention-behavior relationship. Similar to the theory of planned behavior, the IM also assumes that intentions are a function of attitudes, perceived normative pressure and self-efficacy, but it views perceived normative pressure as a function of descriptive as well as of injunctive (i.e., subjective) norms. After describing the theory and addressing some of the criticisms directed at a reasoned action approach, the paper illustrates how the theory can be applied to understanding and changing health related behaviors.