American Journal of Health Promotion

To investigate the relationships among self-efficacy, changes in self-efficacy, past exercise participation, future exercise adherence, and exercise program format.

Two-year randomized trial involving subjects (n = 63) participating in an aerobic exercise program. Subjects were randomly assigned to one of three exercise conditions: higher-intensity home-based exercise, higher-intensity class-based exercise, or lower-intensity home-based exercise.

Results indicated that baseline self-efficacy and exercise format had significant (p <.02), independent effects on adherence during the adoption and early maintenance phases of exercise behavior. In contrast, in predicting long-term exercise program maintenance, a significant (p <.05) self-efficacy X exercise format interaction indicated that self-efficacy predicted adherence only in the supervised home-based exercise conditions. Results also suggest that baseline self-efficacy, independent of the effect of past adherence, significantly (p <.03) predicted exercise adherence during the adoption phase, but not early maintenance phase, of exercise behavior. Finally, adherence change during the adoption phase of exercise behavior significantly (p <.04) predicted Year-one levels of self-efficacy even after adjusting far the effect of baseline self-efficacy.

These results suggest that exercise program format as well as an individual's initial cognitive and behavioral experiences in an exercise program play significant roles in determining exercise adherence.

This paper investigated whether stage of change for health behaviors was associated with the presence of chronic conditions.

A stratified cross-sectional survey by mail with telephone follow-up.

This study was conducted at a mixed-model HMO with 650,000 members based in Minnesota.

The sample consisted of a random sample of 8000 HMO members age 40 or over with systematic oversampling of members with hypertension, diabetes, dyslipidemia, or heart disease.

In addition to demographics, readiness to change for physical activity, fat intake, fruit and vegetable intake, and smoking were assessed.

The adjusted response rate was 82.4%. In a logistic regression analysis, members with one or more than one chronic condition had greater readiness to change for three out of four risk factors compared to members with no chronic conditions.

The stage-of-change distribution of HMO members with chronic conditions suggests that members at highest risk of adverse health outcomes have the greatest readiness to change behavioral risk factors. Based on these observations, targeted, stage-specific efforts to support behavior change are likely to be both acceptable and effective in HMO members with chronic conditions. Improving stage of change for behavioral risk factors for members with diabetes may present special problems and opportunities.

The purpose of this study was to assess the impact of prohibiting smoking in restaurants on total restaurant sales in Flagstaff, Arizona.

Flagstaff restaurant and retail sales data were collected for periods approximately 3.5 years prior to enactment of a no-smoking-in-restaurants ordinance and 1.5 years after enactment of the ordinance. Data were compared with six comparison areas utilizing four methods of analyses.

The city of Flagstaff Arizona, was the community in this study that prohibited smoking in restaurants.

Flagstaff restaurant and retail sales were compared to sales in two similar Arizona cities, three counties, and the entire state of Arizona.

A city ordinance that prohibited smoking in all Flagstaff, Arizona, restaurants.

Taxable restaurant sales were collected from Flagstaff and all comparison areas. Retail sales data were also collected to determine if changes occurred in the ratio of restaurant to retail sales.

All analyses resulted in the same conclusions: prohibiting smoking in restaurants did not affect restaurant sales.

Study findings indicate that prohibiting smoking in Flagstaff, Arizona, restaurants has had no effect on restaurant sales.

This study examined the relationship between stages of change, other psychosocial factors, and fruit and vegetable (F&V) consumption among rural African-Americans participating in a 5 a Day study.

The cross-sectional design assessed associations between F&V intake, stage of change, self-efficacy, beliefs, barriers, and social support.

Participants were surveyed by telephone.

Subjects were 3557 adult church members (response rate, 79.1%), aged 18 and over from 10 North Carolina counties.

A seven-item food frequency measured F&V intake. Stage of change was measured using four items; other psychosocial variables were measured using Likert scales. Chi-square tests and analysis of variance were used in statistical analyses.

The majority of participants (65 %) were in the preparation stage of change. Individuals in action/maintenance consumed an average of 6.5 daily F&V servings compared to 3.3 to 3.5 servings for those in precontemplation, contemplation, and preparation. Self-efficacy, social support, and belief about how many daily F&V servings are needed, were positively associated with stage. Barriers were most prevalent among precontemplators.

The findings support the applicability of the stages-of-change model to dietary change among rural African-Americans. The relationship between stage, self-efficacy, social support, and barriers supports using a multicomponent intervention strategy.

The objectives of this study were to develop a stage-of-change classification system and to determine the degree to which various adult subgroups have adopted the behavioral changes necessary to achieve a low-fat and/or high-fiber diet as recommended by the Dietary Guidelines for Americans.

The study used a mail survey randomly sent to 7110 adults.

The survey was conducted in 11 states and the District of Columbia.

The random sample included males and females over age 18. Of the eligible respondents, 3198 (51.5%) were included in this analysis, with 2004 and 2066 unambiguously classified into stages of change for fat and fiber, respectively.

Stage of change was defined by an algorithm based on self-reported intent and behaviors to limit fat and/or increase fiber.

45% of the respondents were classified as being in action/maintenance for fat and 38% for fiber. Women, older adults, individuals with advanced education, persons with diet-related chronic disease, people with higher levels of relevant nutrition knowledge and attitudes, and persons who indicated that health concerns were a primary influence on their diet were more likely to be in action/maintenance than other respondents.

The algorithm in this study presents a model that more closely reflects the proportions of the adult population that have achieved low-fat diets and classifies a greater proportion in the preparation stage than classification systems in previous studies.

This study was conducted to determine the extent of the relationship between obesity and absenteeism due to illness. A secondary objective was to ascertain the extent to which age, gender, family income, length of workweek, and cigarette smoking influenced the obesity-absenteeism association.

A cross-sectional design was used. Data regarding obesity, absenteeism, and the potential confounding factors were collected during the same time period.

Data were collected within workplaces throughout the U.S., and at the headquarters of Health Advancement Services, Inc. (HAS).

Subjects were 10,825 employed men and women who participated in an ongoing wellness screening program administered by HAS.

The three-site skinfold technique was used to estimate body fat percentage. Absenteeism due to illness and the potential confounding variables were assessed using a structured paper-pencil questionnaire.

Without controlling for any potential confounders, obese employees were more than twice as likely to experience high-level absenteeism (seven or more absences due to illness during the past 6 months), and 1.49 times more likely to suffer from moderate absenteeism (three to six absences due to illness during the last 6 months) than were lean employees. With all of the potential confounders controlled simultaneously, obese employees were 1.74 and 1.61 times more likely to experience high and moderate levels of absenteeism, respectively, than were lean individuals.

Obese employees tend to be absent from work due to illness substantially more than their counterparts.