Effectiveness of experimenter-provided and self-generated implementation intentions to reduce alcohol consumption in a sample of the general population: A randomized exploratory trial.

Objective: To test the effectiveness of implementation intentions to decrease alcohol consumption and control for possible demand characteristics by employing an active control condition and contrasting experimenter-provided with self-generated implementation intentions. Design: Two hundred forty-eight participants were randomly allocated to 1 of 4 conditions: questionnaire-only; questionnaire plus planning instruction; questionnaire, planning instruction plus experimenter-provided implementation intention; or questionnaire, planning instruction plus self-generated implementation intention. Main Outcome Measure: Alcohol intake. Results: There were clinically and statistically significant decreases in alcohol consumption in the 2 experimental conditions, but not in the 2 control conditions, F(3, 237) = 3.34, p p2 = .04. There were no significant differences between experimenter-provided and self-generated implementation intentions (p = .62). Compliance moderated the effects of self-generated implementation intentions only, such that alcohol intake only significantly decreased in participants who complied with the instructions, F(1, 52) = 4.20, p p2 = .07. However, simply choosing an experimenter-provided implementation intention was just as effective as writing it out in full, implying that implementation intentions work even with minimal information processing. Conclusion: The findings further support use of implementation intentions to protect against health risk behaviors and are congruent with laboratory research showing that implementation intentions are a case of strategic automaticity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of implementation intentions on the self-reported frequency of drivers' compliance with speed limits.

This study tested the efficacy of implementation intentions in the context of drivers' speeding behavior. Participants (N = 300) completed self-report measures of goal intention and behavior, and they were randomly assigned to an experimental condition, which required them to specify an implementation intention, or a control condition. One month postbaseline, self-reported compliance with speed limits significantly increased for experimental participants but not for control participants. The effects of specifying an implementation intention on behavior increased with the strength of drivers' goal intentions. Finally, analysis of participants' implementation intentions revealed that specifying more behavioral strategies increased the frequency with which participants reported complying with the speed limit. Implications of the findings are discussed in relation to enhancing road safety interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A volitional help sheet to encourage smoking cessation: A randomized exploratory trial.

Objective: The volitional help sheet draws on Gollwitzer's (1993) concept of implementation intentions by encouraging smokers to link temptations to smoke with appropriate behavioral responses derived from Prochaska and DiClemente's (1983) transtheoretical model. Design: There were 193 smokers who were randomly allocated to receive questionnaires, planning instruction, and a volitional help sheet or one of three control conditions: Questionnaire-only; questionnaire plus planning instruction; or questionnaire, planning instruction plus volitional help sheet without the explicit instruction to link temptations to smoke with appropriate behavioral responses. Main Outcome Measures: Nicotine dependence, number of cigarettes smoked and quit status. Results: Findings revealed significant decreases in nicotine dependence, number of cigarettes smoked, and increases in quitting in the volitional help sheet condition, relative to the control conditions, Fs(3, 189) = 7.48 to 10.78, ps ps = .11 to .15. This pattern of findings did not hold for social?cognitive variables, with few differences between the volitional help sheet (standard instructions) group and the other conditions. Conclusion: The findings provide support for the use of implementation intentions to protect against health risk behaviors and are congruent with laboratory research showing that implementation intentions are a case of strategic automaticity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of smoking self-identity and quitting self-identity on attempts to quit smoking.

Objective: To examine the effect of two types of self-identity on attempts to quit smoking: self-identity in terms of smoking and self-identity in terms of quitting. Design: A prospective survey among an initial sample of 3,411 smokers. Smoking history variables and psychosocial variables from the theory of planned behavior are also measured. Main Outcome Measures: Intention to quit smoking and smoking cessation attempts 4 months later. Results: Both smoking identity and quitting identity matter, but they appear to play different roles in explaining intention to quit and in predicting actual attempts to quit. Quitting identity is particularly important for intention to quit, whereas both quitting identity and smoking identity are important for actually trying to quit. Recent attempts to quit slightly attenuate the negative effect of smoking identity on attempts to quit. Conclusion: A broader interpretation of self-identity in terms of both current and aspired behavior offers a better understanding of when people might change health-relevant behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence that implementation intentions promote transitions between the stages of change.

A dietary change intervention based on Gollwitzer's (1993) concept of implementation intentions was used to see whether transitions between transtheoretical model stages could be induced in a field experiment. Participants (N = 554) were randomized to receive either questionnaire-only or questionnaire-plus-implementation intention. Results showed that, controlling for variables from the theory of planned behavior, implementation intentions helped a significantly greater number of people to progress through the stages of change than did receiving the questionnaire alone. However, the implementation intention intervention did not prevent regression from the stages of change. The discussion focuses on the importance of targeting implementation intention interventions and on the future use of health professional-led analyses of critical situations and precise identification of appropriate responses to prevent regression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social cognitive mediators of adolescent smoking cessation: Results from a large randomized intervention trial.

Only one prior study has examined why adolescent smoking cessation interventions are effective. To address this understudied and important issue, we examined whether a large adolescent smoking cessation intervention trial's outcomes were mediated by social cognitive theory processes. In a randomized trial (N = 2,151), counselors proactively delivered a telephone intervention to senior year high school smokers. Mediators and smoking status were self-reported at 12-months postintervention eligibility (88.8% retention). At least 6-months abstinence was the outcome. Among all enrolled smokers, increased self-efficacy to resist smoking in (a) social and (b) stressful situations together statistically mediated 55.6% of the intervention's effect on smoking cessation (p p     

Long-term effects of implementation intentions on prevention of smoking uptake among adolescents: A cluster randomized controlled trial.

Objective: To test the efficacy of implementation intentions in reducing smoking uptake in a sample of adolescents. Design: Classes of adolescents (aged 11–12 years) were randomly allocated to one of four conditions: implementation intention, self-efficacy, two control conditions. An implementation intention or a self-efficacy manipulation (both formed in relation to how to refuse offers of cigarettes) was completed by intervention condition participants at 0, 4, 8, 12, 16, 20, and 24 months. Main Outcome Measures: Long-term smoking behavior (self-report and objective) was assessed at 48 months post-baseline. Results: There were no differences between the two control conditions and the self-efficacy condition. Controlling for baseline smoking, sex, attitudes to smoking, friends and family smoking, and the multilevel nature of the data, intention-to-treat analyses indicated the implementation intention manipulation significantly reduced self-reported smoking compared to the other three conditions combined. Analyses on objectively assessed smoking (carbon monoxide breath measure) in a random subsample of participants also indicated that the implementation intention manipulation compared to the other three conditions significantly reduced smoking. Conclusion: Implementation intentions can reduce smoking in adolescent samples. Implications for using implementation intentions to reduce smoking in adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy of an implementation intention intervention for promoting physical activity among individuals with spinal cord injury: A randomized controlled trial.

Objective: To evaluate the efficacy of an 8-week implementation intention intervention for promoting physical activity among individuals with spinal cord injury. Study Design: Randomized clinical trial. Method: Participants were randomly assigned to an implementation intention intervention (n = 26) or control (n = 28) condition and were asked to engage in 30 min of moderate to heavy intensity physical activity 3 times per week. Results: Participants who formed implementation intentions followed through with their physical activity intentions, engaging in more physical activity than participants in the control condition. Participants in the intervention condition also experienced sustained motivation and greater confidence to schedule physical activity compared with participants in the control condition. Implications: These findings suggest a role for implementation intentions in health promotion programs for people with spinal cord injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The automatic component of habit in health behavior: Habit as cue-contingent automaticity.

Objective: Habit might be usefully characterized as a form of automaticity that involves the association of a cue and a response. Three studies examined habitual automaticity in regard to different aspects of the cue-response relationship characteristic of unhealthy and healthy habits. Design, Main Outcome Measures, and Results: In each study, habitual automaticity was assessed by the Self-Report Habit Index (SRHI). In Study 1 SRHI scores correlated with attentional bias to smoking cues in a Stroop task. Study 2 examined the ability of a habit cue to elicit an unwanted habit response. In a prospective field study, habitual automaticity in relation to smoking when drinking alcohol in a licensed public house (pub) predicted the likelihood of cigarette-related action slips 2 months later after smoking in pubs had become illegal. In Study 3 experimental group participants formed an implementation intention to floss in response to a specified situational cue. Habitual automaticity of dental flossing was rapidly enhanced compared to controls. Conclusion: The studies provided three different demonstrations of the importance of cues in the automatic operation of habits. Habitual automaticity assessed by the SRHI captured aspects of a habit that go beyond mere frequency or consistency of the behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Strategies to implement alcohol screening and brief intervention in primary care settings: A structured literature review.

Although alcohol screening and brief intervention (SBI) reduces drinking in primary care patients with unhealthy alcohol use, incorporating SBI into clinical settings has been challenging. We systematically reviewed the literature on implementation studies of alcohol SBI using a broad conceptual model of implementation, the Consolidated Framework for Implementation Research (CFIR), to identify domains addressed by programs that achieved high rates of screening and/or brief intervention (BI). Seventeen articles from 8 implementation programs were included; studies were conducted in 9 countries and represented 533,903 patients (127,304 patients screened), 2,001 providers, and 1,805 clinics. Rates of SBI varied across articles (2–93% for screening and 0.9–73.1% for BI). Implementation programs described use of 7–25 of the 39 CFIR elements. Most programs used strategies that spanned all 5 domains of the CFIR with varying emphases on particular domains and sub-domains. Comparison of SBI rates was limited by most studies' being conducted by 2 implementation programs and by different outcome measures, scopes, and durations. However, one implementation program reported a high rate of screening relative to other programs (93%) and could be distinguished by its use of strategies that related to the Inner Setting, Outer Setting, and Process of Implementation domains of the CFIR. Future studies could assess whether focusing on Inner Setting, Outer Setting, and Process of Implementation elements of the CFIR during implementation is associated with successful implementation of alcohol screening, as well as which elements may be associated with successful, sustained implementation of BI. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Social–cognitive beliefs, alcohol, and tobacco use: A prospective community study of change following a ban on smoking in public places.

Objective: To examine social–cognitive change associated with behavior change after the introduction of a smoke-free public places policy. Design: Adults (N = 583) who use public houses licensed to sell alcohol (pubs) completed questionnaires assessing alcohol and tobacco consumption and social–cognitive beliefs 2 months prior to the introduction of the smoking ban in England on July 1, 2007. Longitudinal follow-up (N = 272) was 3 months after the introduction of the ban. Main outcome measures: Social–cognitive beliefs, daily cigarette consumption, and weekly alcohol consumption. Results: Smokers consumed considerably more alcohol than did nonsmokers at both time points. However, a significant interaction of Smoking Status × Time showed that while smokers had consumed fewer units of alcohol after the ban, nonsmokers showed an increase over the same period. There was a significant reduction in number of cigarettes consumed after the ban. Subjective norms concerning not smoking, and perceived severity of smoking-related illness increased across time. Negative outcomes associated with not smoking were reduced among former smokers and increased across time among smokers. Regression analyses showed that changes in subjective norm and negative outcome expectancies accounted for significant variance in change in smoking across time. Conclusion: Results suggest that the smoking ban may have positive health benefits that are supported by social–cognitive change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Short-term effects of a brief motivational intervention to reduce alcohol and drug risk among homeless adolescents.

The short-term results of a randomized trial testing a brief feedback and motivational intervention for substance use among homeless adolescents are presented. Homeless adolescents ages 14-19 (N = 285) recruited from drop-in centers at agencies and from street intercept were randomly assigned to either a brief motivational enhancement (ME) group or 1 of 2 control groups. The 1-session motivational intervention presented personal feedback about patterns of risks related to alcohol or substance use in a style consistent with motivational interviewing. Follow-up interviews were conducted at 1 and 3 months postintervention. Youths who received the motivational intervention reported reduced illicit drug use other than marijuana at 1-month follow-up compared with youths in the control groups. Treatment effects were not found with respect to alcohol or marijuana. Post hoc analyses within the ME group suggested that those who were rated as more engaged and more likely to benefit showed greater drug use reduction than did those rated as less engaged. Limitations of the study are discussed as are implications for development of future substance use interventions for this high-risk group. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Secondary smoking prevention in a university setting: A randomized comparison of an experiential, theory-based intervention and a standard didactic intervention for increasing cessation motivation.

Objective: College may represent an untapped opportunity to reach the growing number of student smokers who are at risk of progressing toward regular smoking. The aim of this study was to test the efficacy of a theory-based experiential intervention for increasing motivation to quit smoking and reducing smoking behavior. Design: This study used a 3-arm, randomized design to examine the efficacy of an experiential secondary prevention intervention. The control groups included a traditional didactic smoking intervention and an experiential intervention on nutrition. Main Outcome Measures: The 2 primary dependent variables were change in self-reported intention to quit smoking, measured pre- and postintervention, and change in smoking behavior over the month following the intervention. Results: As hypothesized, the experiential smoking intervention was more effective than either control group in increasing immediate motivation to quit, but the effect was found only among female participants. At 1-month follow-up, both smoking interventions produced higher rates of smoking cessation and reduction than did the nutrition control condition. Conclusion: Findings support the potential efficacy of an intensive experiential intervention for female smokers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An ecological perspective on smoking among Asian American college students: The roles of social smoking and smoking motives.

Using electronic diaries, the present study examined the roles of social smoking and smoking motives in relation to cigarette use patterns among Asian American college smokers. Multilevel modeling results showed that participants smoked more cigarettes when smoking with peers than when smoking alone. Participants' coping (but not social) motives moderated the within-person associations between smoking with peers and the cigarettes smoked during a smoking episode. The findings support the utility of an ecological perspective in examining the dynamic interaction between smoking motives and the social settings of cigarette use, and call for further research on the social smoking behaviors in diverse populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Frequency and quality of parental communication as antecedents of adolescent smoking cognitions and smoking onset.

The present study examines whether aspects of parental communication about smoking function as antecedents of adolescent smoking cognitions. In this longitudinal full-family study (428 families), parent and adolescent reports were used to assess parental communication. Concepts of the Theory of Planned Behavior were measured among adolescents. Differences between older and younger siblings within the family were examined. Cross-sectionally, frequency and quality of communication were associated with smoking cognitions. Longitudinally, only quality of communication preceded smoking cognitions. This effect was mainly found for younger siblings. The results of this study emphasize the importance of quality of parental communication rather than frequency. Communication patterns based on mutual respect and equality help to prevent adolescent smoking onset. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Need for cognition as a predictor and a moderator of outcome in a tailored letters smoking cessation intervention.

Objective: To analyze whether baseline need for cognition (NFC) was a predictor or a moderator of treatment outcome in a tailored letters intervention for smoking cessation. Design: A total of 1,499 daily smokers were recruited from general medical practices in Germany within a quasi-randomized trial testing the efficacies of two brief interventions for smoking cessation: (a) computer-generated tailored letters and (b) physician-delivered brief counseling versus assessment-only. For this study, we used data from 1,097 daily smokers who were assigned to the tailored letters or the assessment-only condition. Main Outcome Measures: self-reported 6-month prolonged abstinence from tobacco smoking assessed at 12-, 18-, and 24-month follow-ups, and smoking cessation self-efficacy assessed at 6- and 24-month follow-ups. Results: Baseline NFC predicted 6-month prolonged smoking abstinence (p = .01) and smoking cessation self-efficacy (p .05) but on smoking cessation self-efficacy (p = .05). Tailored letters resulted in higher smoking cessation self-efficacy only for persons with higher NFC. Conclusion: Higher levels of NFC are required to increase smoking cessation self-efficacy in computer-tailored interventions for smoking cessation. Considering an individual's NFC might improve the efficacy of written interventions for smoking cessation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social cognitive theory and cancer patients' quality of life: A meta-analysis of psychosocial intervention components.

Social cognitive theory (SCT) provides a theoretical framework to evaluate improved quality-of-life (QOL) outcomes through interventions with cancer patients. To assess whether inclusion of SCT components predicted better outcomes, focused comparisons were used to integrate results from 38 randomized studies. Interventions with more SCT components had significantly larger effect sizes than studies with fewer or no SCT components for the overall analysis (Z = 3.72, p     

Timing of dietary change in response to a telephone counseling intervention: Evidence from the WHEL study.

Objective: Little is known about temporal patterns of diet change within interventions, nor about predictors of early and sustained successful change. Social-cognitive theory asserts that early successes in achieving behavior change increase self-efficacy, leading to longer-term success. Design: The authors conducted exploratory cluster analyses using dietary data from the first month of the telephone counseling intervention of the Women's Healthy Eating and Living (WHEL) Study. Main Outcome Measure: Change in dietary pattern at three early intervention timepoints. Results: Three clusters were identified: Cluster 1 (25%) was close to meeting study goals at baseline, but still made major changes; Cluster 2 (49%) and Cluster 3 (26%) were not achieving study goals at baseline, but Cluster 2 made substantial immediate changes, while Cluster 3 changed their diet more gradually. Baseline demographic and behavioral variables were associated with cluster membership; however, the strongest predictors of cluster were self-efficacy, motivation, and approaches to study goals. Cluster membership predicted dietary pattern at 12 months. Conclusion: These data suggest that a one-on-one telephone counseling intervention that is intensive in the early weeks may maximize the level of change achieved in a study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some problems with social cognition models: A pragmatic and conceptual analysis.

Empirical articles published between 1997 and 2001 from 4 health psychology journals that tested or applied 1 or more social cognition models (theory of reasoned action, theory of planned behavior, health belief model, and protection motivation theory; N=47) were scrutinized for their pragmatic and conceptual basis. In terms of their pragmatic basis, these 4 models were useful for guiding research. The analysis of their conceptual basis was less positive. First, these models do not enable the generation of hypotheses because their constructs are unspecific; they therefore cannot be tested. Second, they focus on analytic truths rather than synthetic ones, and the conclusions resulting from their application are often true by definition rather than by observation. Finally, they may create and change both cognitions and behavior rather than describe them. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cancer and the threat of death: The cognitive dynamics of death-thought suppression and its impact on behavioral health intentions.

Five studies examined the cognitive association between thoughts of cancer and thoughts of death and their implication for screening intentions. Study 1 found that explicit contemplation of cancer did not increase death-thought accessibility. In support of the hypothesis that this reflects suppression of death-related thoughts, Study 2 found that individuals who thought about cancer exhibited elevated death-thought accessibility under high cognitive load, and Study 3 demonstrated that subliminal primes of the word cancer led to increased death-thought accessibility. Study 4 revealed lower levels of death-thought accessibility when perceived vulnerability to cancer was high, once again suggesting suppression of death-related thoughts in response to conscious threats associated with cancer. Study 5 extended the analysis by finding that after cancer salience, high cognitive load, which presumably disrupts suppression of the association between cancer and death, decreased cancer-related self-exam intentions. Theoretical and practical implications for understanding terror management, priming and suppression, and responses to cancer are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)