Periconceptional smoking: an exploratory study of determinants of change in smoking behavior among women in the fertile age range.

How can women who are not yet pregnant be motivated to stop smoking before they become pregnant? Epidemiological studies have suggested that periconceptional smoking and smoking during the first trimester of the pregnancy may lead to congenital abnormalities. To motivate women to stop smoking before pregnancy, more insight is needed into the differences between 'smoking' women who want to have children and those who do not. A sample of 931 women (65% response rate) aged 15-45 years returned a questionnaire with questions about their smoking behavior, wish to have children, risk perceptions, attitude to smoking, personal efficacy and stage of readiness to change. In spite of some positive outcomes (e.g. negative attitude to smoking, relatively high risk perceptions of the relationship between congenital anomalies and smoking), one cannot automatically assume that these women will stop smoking before they get pregnant. (1) Beliefs, attitude and readiness to change were not well integrated and grounded cognitively. (2) Women who smoked were pessimistic about their ability to quit. Future campaigns need to 'invite' women to associate and to integrate risk information about the relationship between smoking and congenital abnormalities with other cognitions (attitude, intention). It is also important to instruct women in how to stop smoking and to remain non-smokers.

Can public campaigns effectively change psychological determinants of safer sex? An evaluation of three Dutch campaigns.

This study evaluated the 1994, 1995 and 1996 Dutch safer sex campaigns as to their effectiveness in terms of improved attitudes, perceived social norms, self-efficacy and intentions regarding safer sex. The hypotheses were tested that variables become more positive when campaigns are conducted and less positive when campaigns are discontinued. A comprehensive design, including a baseline-post-test/post-test-only group design and a longitudinal or multiple assessment group design, was employed to exclude testing effects, history effects, cultural changes and sample differences as alternative explanations. The results show that despite high baseline levels, the campaigns positively affected all variables. Importantly, levels of all variables decreased when no campaign was conducted. It is concluded that campaigns are needed to maintain high levels of determinants of safer sex and that future campaign goals should be formulated in terms of stabilization instead of growth.

Impact of group nutrition education and surplus value of Prochaska-based stage-matched information on health-related cognitions and on Mediterranean nutrition behavior.

This study compares the effect of two interventions focussed on the promotion of Mediterranean nutrition behavior. The target groups are persons with three risk factors for development of cardiovascular disease. The study region is a socio-economically deprived area in the Netherlands. The first intervention consisted of three meetings in which the positive health effects of a Mediterranean diet were discussed in group sessions. In the additional intervention stage-matched information based on the Transtheoretical Model of behavior change was given. Both intervention groups were compared with a control group, which received only a printed leaflet with the Dutch nutritional guidelines. At baseline the three subgroups were comparable and after 16 weeks both intervention strategies resulted in significant changes in comparison with the control condition. For fish consumption, both strategies resulted in more positive attitudes, social norms, stronger intentions, more progress in stage of change and better nutritional intake. For fruit/vegetables consumption, the effects of both strategies were limited to stage of change and nutritional intake. Additional individually stage-matched tailored letters did not result in more progress on any of the dependent variables. We conclude that substantial nutritional behavior change can be achieved by interactive group education in socio-economically deprived population groups.

Predictors of AIDS-preventive behavioral intentions among adult heterosexuals at risk for HIV-infection: extending current models and measures.

This study examined the predictors of the intention to use condoms with new sexual partners. A sample of heterosexual adult females and males (n = 711) was recruited through various channels. A substantial part of the sample had engaged in risky sexual behavior. Predictors were based on various theoretical models. Compared with men, women were in general more aware of the risks of AIDS and perceived fewer barriers to using condoms, but they also perceived less support for condom use among potential new partners. Among those with a risk factor for HIV infection (n = 514), various types of barriers, absolute and comparative self-efficacy, and three types of social norms were independently related to the intention to use condoms. When including all relevant predictors, self-efficacy, anticipated regret, and descriptive norms in the reference group, were independent predictors of condom use intention among men as well as among women. The implications for prevention are discussed.

[Condom use among heterosexuals: a comparison of the theory of planned behavior, the health belief model and protection motivation theory]. / Condoomgebruik door heteroseksuelen. Een vergelijking van de theorie van gepland gedrag, het health belief model en de protectie-motivatie theorie.

PIP: In the Netherlands, the theory of planned behavior (Ajzen, 1991), the health belief model (Janz and Becker, 1984), and the protection-motivation theory (Rogers, 1983) were compared for predicting condom use intentions because of AIDS. The 641 respondents were given two questionnaires: one for themselves and another one for a friend, partner, or acquaintance. 514 (80%) of them returned completed forms. 60% of these (307) persons were encouraged to answer and return another questionnaire, thus the final sample consisted of 821 responses. 711 individuals (481 women aged 15-91 years and 230 men aged 15-85 years) admitted having had heterosexual intercourse. 75% had had more than one sex partner in the previous 5 years. 45% had had sex at least once with someone other than their regular partner. Multivariance analysis of variance of promiscuity and condom use revealed that men exhibited more risky sex practices than women (p .001), had more sex partners in the previous 5 years than women (p .01), had more single sexual encounters with other persons than the regular sex partner than women (p .001), and they used condoms less often than women (p .01). 119 respondents had experienced sexually transmitted diseases and 165 had taken HIV tests. The difference between men and women also showed up in terms of their ideas, perceptions, and feelings about condom use when the three theoretical models were considered (p .001). The variables used in the theory of planned behavior explained the variance in intended condom use for 36% of women and 43% of men. The health belief model explained intended condom use only for 15% of women and 32% of men, while the cost-benefit analysis explained it for 9% of women and 18% of men. The protection-motivation theory explained intended condom use variance for 32% of women and 41% of men, but not all variables were included in the model. Fear from AIDS was correlated with inquisitive behavior and with seriousness (both p .001).^ieng