American Journal of Health Promotion

To evaluate the impact of the Long Beach AIDS Community Demonstration Project, a community-based HIV-prevention intervention incorporating principles from the Transtheoretical model in its design and evaluation.

Repeated cross-sectional sampling with matched intervention and comparison communities.

Neighborhoods in Long Beach, California, having a high prevalence of drug abuse and prostitution.

3081 injecting drug users who were sexually active and/or shared injection equipment.

Trained peer volunteers distributed fliers featuring role model stories targeted to the population's stage of change. Fliers were packaged with bleaching kits and/or condoms.

Primary outcome measures were exposure to the intervention, condom carrying, and stage of change for disinfecting injection equipment with bleach and for using condoms with main and other partners.

Toward the end of the study, 77% of injection drug users in the intervention area reported being exposed to the intervention. In the intervention area, rates of condom carrying increased from 10 to 27% (p <.001), and there was an increase from 2.32 to 3.11 in mean stage of change for using condoms with other partners, while stage of change decreased in the comparison area (p <.01). Mean stage of change for using condoms with a main partner also increased in the intervention area, but the difference was not significant after controlling for change in the comparison area. Subjects with recent project exposure had higher stage-of-change scores for using condoms with a main partner (p <.05) and other partners (p <.01) and for cleaning injection equipment with bleach (p <.05).

The results demonstrate the effectiveness of the AIDS Community Demonstration Project intervention for reaching injecting drug users in the community and for motivating the adoption of risk-reducing practices.

This study examined whether eating practices and psychosocial factors differed across stages of change for fruit and vegetables.

Data were collected using a self-administered written survey among a convenience sample of 739 Dutch adults. Response rate was 92%.

Data were collected as part of the baseline assessment for a nutrition intervention study.

Fruit and vegetable intake was measured as self-reported consumption with a validated eight-item food frequency questionnaire. Psychosocial variables were measured with six items on bipolar seven-point scales and stage-of-change classifications were based on separate four-item algorithms for fruits and vegetables. Differences in psychosocial factors and consumption were analyzed using one-way analysis of variance with Scheffé's multiple-comparison test.

Significant differences were found between stages of change in dietary intake, attitudes, self-efficacy, and judgment of one's own intake compared to others. Attitudes were most positive in preparation and action and least positive in precontemplation. Intake and self-efficacy were more positive in action/maintenance than in pre-action stages.

The findings suggest that nutrition education aimed at encouraging higher intake of fruits and vegetables might be most effective if it is stage-tailored. Messages to influence attitudes about fruits and vegetables are likely to affect people in precontemplation, and self-efficacy information to increase confidence in overcoming barriers to consumption is likely to be effective with persons in contemplation and preparation stages.

This study examined differences in decisional balance and self-efficacy scores across the five stages of change and across four health behaviors (exercise, protection from sun exposure, smoking, and dietary fat consumption), and explored the relationship between the frequency of subjects at each stage across four health behaviors.

Data for this study were collected as part of a health behavior survey of employees.

The study was conducted in a municipal government worksite in Arizona.

A total of 393 employees completed the survey. The sample was predominantly white (84.9%) and male (64.4%), with an average age of 42.2 years and a median annual household income of between $40,000 and $59,999.

Previously validated questions to measure stages of change, decisional balance, and self-efficacy were administered, along with questions about demographic variables.

Significant differences were found for decisional balance and self-efficacy scores across the five stages of change, but they were not significantly different between the four health behaviors. A minority of subjects (18.6%) were in the same stage of change for all four health behaviors.

This study provides preliminary evidence that there is considerable stage specificity across multiple health behaviors. Because employees at each stage of change possess differences in terms of their pros, cons, and self-efficacy, wellness programs need to focus on stage-specific interventions.

This study retrospectively compared subjects from three unrelated studies using eight algorithms to stage exercise behavior.

Study One included 936 employees involved in a smoking cessation study at four worksites—a medical center, retail store, manufacturing firm, and a government agency. Study Two included 19,212 members of a New England HMO; and Study Three included a convenience sample of 327 adult New Englanders.

The eight algorithms used different descriptions of stages based on the transtheoretical model, as well as different definitions of exercise and response formats.

Algorithms using longer, more precise definitions of exercise resulted in larger numbers of subjects being staged in precontemplation and contemplation in comparison to algorithms using shorter definitions, which tended to stage subjects in preparation and action. Maintenance was the most and preparation the least consistently described stage across algorithms.

Alteration of the descriptions of stage and the definition of exercise has consequences for the staging of subjects. Definitions need to be explicit, stating all parameters needed to meet criterion, and subjects must be able to assess themselves. Either a 5-Choice or a true/false response format is effective in assessing stage.

Previous research examining the transtheoretical model of behavior change within the exercise domain has been limited by use of self-report measures exclusively and inconsistent practices with regard to stage of exercise assessment. The present study was designed to partially circumvent these limitations and extend the current literature by determining the degree of association among stage of exercise and body mass index, cardiorespiratory fitness, exercise behavior, relapse, barriers, and self-efficacy, after controlling for several potential confounders.

A descriptive, cross-sectional study.

Two hundred thirty-five adults (M age = 34.7 years) volunteered to participate.

Participants were classified by stage of exercise and compared on two behavioral, two biometrical, and three psychological variables while statistically controlling for social desirability and demographic differences.

Significant between-stage differences were found for the overall set of dependent variables (p <.0001) and for each dependent variable separately (p <.01). The proportion of variance accounted for by the dependent variables ranged from .06 to .53.

This study offers objective support for the stage-of-change model within the exercise domain. By acknowledging and accurately assessing stage of exercise, researchers and clinicians may be able to improve physical activity promotion efforts.