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PubMed2004

Attitudes, perceived norms, and intentions: a needs assessment study of the influenza immunization intentions of elderly citizens in Vermont.

CONTEXT: Influenza and pneumonia rank among the 5 leading causes of death among persons aged 65 and over. Although immunization has been demonstrated to prevent influenza or reduce its incidence and associated complications among the elderly, it has been largely underutilized. PURPOSE: This study examined the association of attitudes, perceived norms, and intention to obtain influenza immunization among community-dwelling rural elderly. The goal was to design an effective intervention program to increase the rate of flu immunization among the rural elderly. METHODS: In spring 2000, random-digit dialing selected 1,239 households in 2 rural Vermont counties. Telephone interviews were conducted with 799 persons aged 60 or older, resulting in a response rate of 65%. FINDINGS: Factor analyses revealed 2 dimensions underlying attitudes and perceived norms. Subsequent regression analyses confirmed that 1 attitude construct--perceived benefits--and both normative indices were significant predictors of immunization intention, explaining 45% of its variation. CONCLUSIONS: An intervention program targeting rural elderly should emphasize the benefits and perceived side effects of immunization. The program should publicize that most elderly believe that the advantages of influenza immunization outweigh the disadvantages. These findings will inform an intervention program designed to increase immunization coverage among rural seniors in Vermont.

Aged↗
PubMed2001

Medical student career intentions at the Christchurch School of Medicine. The New Zealand Wellbeing, Intentions, Debt and Experiences (WIDE) survey of medical students pilot study. Results part II.

AIMS: To record career preferences for medical students at the Christchurch School of Medicine and Health Sciences and investigate factors, including student debt, that might influence career decisions. METHODS: A questionnaire, The New Zealand Wellbeing, Intentions, Debt, and Experiences (WIDE) Survey of Medical Students, was developed and administered to all 204 medical students at the Christchurch School of Medicine and Health Sciences. The survey included questions relating to preferred career intentions and factors influencing career decisions, including the decision to leave New Zealand to practise medicine. RESULTS: The response rate was 88%. 80% intend to practise medicine in New Zealand immediately after graduation, however 82% indicated that they would leave within two years of graduation. Financial opportunities overseas and level of debt were the strongest motivating factors to leave. Repayments towards student loans and increased salaries were factors that might retain people in New Zealand. Medical and surgical specialities were the most popular career choices. Personal interest was the strongest motivator for career choice. Practising in a rural community was not popular. CONCLUSION: Debt is one of a number of important factors influencing medical student career decisions including the decision to leave New Zealand. Initiatives addressing debt may be useful in retaining medical graduates in this country.

Adult↗
PubMed1992

Intentional behavior and intentional communication in young free-ranging orangutans.

The goal of this study was to describe the ontogeny of the manipulation of an animate object (i.e., the mother) by young free-ranging orangutans within the context of food sharing. The food-sharing context is an important one in the development of object manipulation skills and social communication. 5 orangutans, ranging in age from 1 month to 5 years, were videotaped with their biological mothers for 18 hours over the course of 9 months. Systematic coding of the videotapes revealed that even young orangutans, 1-6 months old, used intentional (i.e., goal-directed) behaviors. When young orangutans directed behavior toward the mother in addition to the goal object then maternal responses were positive, resulting in the infant obtaining the food. Intentional communication, evident in gestures and consisting of an abbreviated action directed toward the mother, was found in the 3 oldest orangutans (2 1/2, 3 1/2, and 5 years of age). Cognitive competence and behavioral performance are considered from the developmental perspectives of Piaget and prelinguistic communication. The ability to use a communicative gesture as an intermediate means in the coordination of actions on a social agent with actions on an object is evident in young orangutans.

Animal Communication↗
PubMed2004

Grasping the intentions of others: the perceived intentionality of an action influences activity in the superior temporal sulcus during social perception.

An explication of the neural substrates for social perception is an important component in the emerging field of social cognitive neuroscience and is relevant to the field of cognitive neuroscience as a whole. Prior studies from our laboratory have demonstrated that passive viewing of biological motion (Pelphrey, Mitchell, et al., 2003; Puce et al., 1998) activates the posterior superior temporal sulcus (STS ) region. Furthermore, recent evidence has shown that the perceived context of observed gaze shifts (Pelphrey, Singerman, et al., 2003; Pelphrey et al., 2004) modulates STS activity. Here, using event-related functional magnetic resonance imaging at 4 T, we investigated brain activity in response to passive viewing of goal- and nongoal-directed reaching-to-grasp movements. Participants viewed an animated character making reaching-to-grasp movements either toward (correct) or away (incorrect) from a blinking dial. Both conditions evoked significant posterior STS activity that was strongly right lateralized. By examining the time course of the blood oxygenation level-dependent response from areas of activation, we observed a functional dissociation. Incorrect trials evoked significantly greater activity in the STS than did correct trials, while an area posterior and inferior to the STS (likely corresponding to the MT/ V5 complex) responded equally to correct and incorrect movements. Parietal cortical regions, including the superior parietal lobule and the anterior intraparietal sulcus, also responded equally to correct and incorrect movements, but showed evidence for differential responding based on the hand and arm (left or right) of the animated character used to make the reaching-to-grasp movement. The results of this study further suggest that a region of the right posterior STS is involved in analyzing the intentions of other people's actions and that activity in this region is sensitive to the context of observed biological motions.

Adult↗
PubMed2006

Intentional and non-intentional non-adherence to medication amongst breast cancer patients.

This study aimed to investigate the prevalence of and factors associated with non-adherence to medication amongst a sample of breast cancer patients. 131 women with stable disease were interviewed and completed standardised psychological measures. 55% of women reported non-adherence to medication frequently or occasionally, with younger women and those who disliked taking their medication being significantly less adherent (P = 0.015, P = 0.001). Women who deliberately omitted taking their tablets occasionally or frequently had significantly lower scores, indicative of a weaker influence, on 'internal' and 'powerful others' dimensions of health locus of control (P = 0.032, P = 0.009). Despite a life-threatening diagnosis, patients may not adhere to medication representing a potential missed opportunity for health gain and waste of resources. Furthermore, interpretation of clinical trial data may be misleading without adherence information. More research is needed to identify those at risk for non-adherence. If other routes of administration are available these options should be discussed with patients to maximise efficacy of therapy.

Adult↗
PubMed1995

Physicians' intention to stay in or leave primary care specialties and variables associated with such intention.

A national mail survey of primary care physicians was conducted in 1993 to examine the differences between those who planned to leave and those who planned to stay in primary care disciplines. The physicians who planned to stay in primary care were those who, at the time of choosing primary care specialties, were more influenced by factors such as personal social values, religion, and the presence of a role model prior to medical school. Physicians' race, sex, workload, debt, place where they grew up, family income as a child, and timing when they made the decision to enter primary care disciplines are not associated with their plans to stay in or leave primary care disciplines. Findings indicated that personal social values, religious beliefs, and the presence of a role model prior to medical school not only influenced physicians' choice of primary care, but had a lasting effect on their commitment to such choice.

Career Mobility↗
PubMed1997

Medicare program; solvency standards for provider-sponsored organizations; intent to form negotiated rulemaking committee--HCFA. Intent to form negotiated rulemaking committee and notice of meetings.

The Balanced Budget Act of 1997 requires the Secretary to establish a Negotiated Rulemaking Committee under the Federal Advisory Committee Act (FACA). The Committee's purpose will be to negotiate the solvency standards for provider-sponsored organizations under part C of the Medicare program. The Committee will consist of representatives of interests that are likely to be significantly affected by the solvency rule. The Committee will be assisted by a neutral facilitator. We request public comment on whether--We have identified the key solvency issues to be negotiated by the Committee; We have identified the interests that will be affected by key issues listed below; The party we are proposing to serve as the neutral facilitator is acceptable. Additionally, comments are sought on several key definitions related to the negotiated rulemaking and the forthcoming rulemaking for Medicare+Choice organizations.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1998

Medicare program; coverage and administrative policies for clinical diagnostic laboratory tests; intent to form Negotiated Rulemaking Committee--HCFA. Notice of intent to form Negotiated Rulemaking Committee and notice of meetings.

The Balanced Budget Act of 1997 requires the Secretary to establish a Negotiated Rulemaking Committee under the Negotiated Rulemaking Act and the Federal Advisory Committee Act. The Negotiated Rulemaking Committee's (the Committee) purpose will be to negotiate national coverage and administrative policies for clinical diagnostic laboratory tests under Part B of the Medicare program as required by the Balanced Budget Act of 1997 (BBA). The Committee will consist of representatives of interested parties that are likely to be significantly affected by the proposed rule. The Committee will be assisted by a neutral facilitator. The BBA outlines the scope of issues to be negotiated by the Committee. We specifically request public comment as to whether we have identified the interests that will be affected by key issues listed below.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed2003

Intention to be screened over time for colorectal cancer in male automotive workers.

Intention is an important construct in health promotion research, yet very little is known about whether cross-sectional correlates of intention to be screened for colorectal cancer (CRC) also predict intention over time or intention change. We used survey data from The Next Step Trial, a worksite health promotion trial, to address the following questions: (1) What is the consistency over time of intention to be screened for CRC? (2) Are the patterns and magnitude of associations between intention to be screened and the Preventive Health Model variables consistent over time? (3) What are the predictors of improving weaker intention to be screened, i.e., changing to strong intention? (4) What are the predictors of no change in strong intention to be screened, i.e., maintaining strong intention? and (5) What is the predictive ability of the models to predict intention to be screened for CRC? The study population consisted of white male automotive employees who responded to baseline (1993) and follow-up (1994 and 1995) surveys and did not have CRC at baseline or develop it during the study period. Of 5042 eligible workers, 2903 (58%) returned a baseline survey, and 2556 (88% of survey responders) met eligibility criteria; 75% (1929 of 2556) returned the year 1 survey, and 74% (1892 of 2556) returned the year 2 survey. We fit logistic regression models separately for the Preventive Health Model variables measured at baseline and each outcome (intention at year 1, intention at year 2, improving weaker intention, and no change in strong intention). The prevalence of strong intention to be screened for CRC was approximately 60% on all three surveys. Overall, 66% maintained their baseline intention over time. The most consistent predictors of strong intention, improving weaker intention, and no change in strong intention were family support, belief in the salience and coherence of screening, prior screening, and lack of concern about screening-related discomfort. Intention measured at baseline predicted intention measured 1 and 2 years later. Perceived susceptibility and lack of fear and worry about a CRC diagnosis predicted improving weaker intention. Having a family history of CRC or polyps predicted maintaining strong intention. Plant factors, self-efficacy, and beliefs about polyp removal were not predictors beyond the baseline year. Basing intervention development on cross-sectional associations may miss important factors or may incorrectly assume that cross-sectional associations are stable over time. A more focused, tailored intervention may be developed using factors that consistently predict intention.

Attitude to Health↗
PubMed2005

Thinking about intentions.

In this fMRI study, we investigated the convergence of underlying neural networks in thinking about a scenario involving one's own intentional action and its consequences and setting up and holding in mind an intention to act. A factorial design was employed comprising two factors: i. Causality (intentional or physical events) and ii. Prospective Memory (present or absent). In each condition, subjects answered questions about various hypothetical scenarios, which related either to the link between the subject's own intentions and consequential actions (Intentional Causality) or to the link between a natural, physical event and its consequences (Physical Causality). A prospective memory task was embedded in half the blocks. In this task, subjects were required to keep in mind an intention (to press a key on seeing a red stimulus background) whilst carrying out the ongoing Causality task. Answering questions about intentional causality versus physical causality activated a network of regions that have traditionally been associated with Theory of Mind, including the medial prefrontal cortex (mPFC), the superior temporal sulcus and the temporal poles bilaterally. In addition, the precuneus bordering with posterior cingulate cortex, an area involved in self-awareness and self-related processing, was activated more when thinking about intentional causality. In the prospective memory task, activations were found in the right parietal cortex, frontopolar cortex (BA 10) and precuneus. Different subregions within the precuneus/posterior cingulate cortex were activated in both main effects of intentional causality and prospective memory. Therefore, the precuneus/posterior cingulate cortex subserves separately thinking about one's own intentions and consequent actions and bearing in mind an intention to make an action. Previous studies have shown that prospective memory, requiring the formation of an intention and the execution of a corresponding action, is associated with decreased activation in the dorsal mPFC, close to the region activated in Theory of Mind tasks. Here, we found that holding in mind an intention to act and at the same time thinking about an intentional action led to reduced activity in a dorsal section of the mPFC. This was a different region from a more anterior, inferior dorsal mPFC region that responded to intentional causality. This suggests that different regions of mPFC play different roles in thinking about intentions.

Adult↗
PubMed2006

Using past behaviour and spontaneous implementation intentions to enhance the utility of the theory of planned behaviour in predicting exercise.

OBJECTIVES: This study examined the utility of the theory of planned behaviour (TPB), past behaviour, and spontaneous implementation intentions in predicting exercise behaviour. The psychological correlates of spontaneous implementation intentions and the moderating effects of intention, perceived behavioural control, past behaviour, and implementation intentions at various time points were also examined. DESIGN: Data collection occurred over three phases with a 2- and 3-week interval. The attrition rate was 35.97% leaving a total of 162 participants (63 males, 99 females). In the first wave, participants completed measures of TPB, spontaneous implementation intentions, and past behaviour. Behaviour was assessed in the second and third waves, and a follow-up measure of spontaneous implementation intentions was completed in Phase 3. RESULTS: Several regression analyses were conducted. Attitude towards exercise and perceived behavioural control made a significant contribution to the prediction of intention. Intention made a significant contribution to the prediction of implementation intentions. Spontaneous implementation intentions reduced the effect of intention and past behaviour for behaviour at 2 weeks and when indexed over a 5-week period. When behaviour was measured for a 3-week period (following an initial 2-week period), the variance that intention and past behaviour accounted for in exercise behaviour decreased, and spontaneous implementation intentions were no longer a significant predictor of behaviour. Spontaneous implementation intentions were found to interact with past behaviour, such that implementation intentions predicted exercise behaviour only among participants who did not exercise frequently in the past. CONCLUSIONS: Implications and future research directions are discussed.

Adolescent↗
PubMed1998

Trends in intentional injury deaths in children and teenagers (1980-1995).

BACKGROUND: The aim of the study was to describe patterns and trends in intentional injury death rates in children and teenagers. METHODS: Analyses were carried out on data from the Office of National Statistics on all intentional injury deaths in people aged 0 to 19 years, in England and Wales, from 1980 to 1995. Trends in death rates were examined using Poisson regression modelling, and class-specific death rates were estimated using the Registrar General's Standard Classification of Occupations. RESULTS: Between 1980 and 1995, there has been a substantial fall in the unintentional injury death rate, but no reduction in the intentional injury death rate. Intentional injuries made up 13 per cent of injury and poisoning deaths in 1980, and 25 per cent of such deaths in 1995. Each year in England and Wales an average of 335 children and teenagers die as a result of homicide, suicide and injuries of undetermined intent. Older teenagers (15-19 years) account for 70 per cent of intentional injury deaths, children 0-4 years account for 18 per cent, and children 5-15 years account for 12 per cent. Of the 5361 intentional injury deaths, 45 per cent were classified as injury undetermined whether accidentally or purposely inflicted, 35 per cent were classified as suicide, and 20 per cent were classified as homicide. With the exception of suicide, there are steep social class gradients for each category of intentional injury. The homicide rate for children in social class V is 17 times that for children in social class I. For all intentional injury, homicide, suicide and injuries of undetermined intent, the relative risk of death for manual vs. non-manual was higher for the four year period 1992-1995 than in the four year period 1980-1983. CONCLUSIONS: Intentional injury is responsible for an average of 335 deaths of children and teenagers each year in England and Wales. Unlike for unintentional injury, there has been no reduction in death rates from intentional injury, which now accounts for 25 per cent of all injury deaths. There is a steep social class gradient in intentional injury death rates, which has widened over the period 1980-1995.

Adolescent↗
PubMed1999

Infant injury deaths with unknown intent: what else do we know?

OBJECTIVES: Strong evidence based on case record reviews indicates that the incidence of child homicide reported from death certificates is under ascertained. The characteristics of infant injury fatalities with undetermined, but suspicious, intent were compared for the probability that they should be considered homicides. METHODS: Using linked birth and death certificates for all birth cohorts in the US from 1983-91, 2345 injury fatalities reported as intentional, 7594 as unintentional, and 431 as undetermined intent were identified. Maternal and infant variables potentially predictive of injury fatalities were selected based on increased bivariate associations. Relative risks of injury death by intentional, unintentional, and undetermined intent were assessed for maternal and infant characteristics. RESULTS: Relative risks were consistently higher across all intent categories for infants of mothers with the least education, no prenatal care, young maternal age, and single marital status, as well as for infants who are second or later born, preterm, black, or American Indian. Fatalities with undetermined intent have larger relative risks in the highest risk categories than either intentional or unintentional injuries. Deaths with undetermined intent have risk profiles that more closely resemble profiles for intentional deaths than unintentional. CONCLUSIONS: Injury homicide rates would be almost 20% greater than official classifications indicate if deaths with undetermined intent were included. In analyses of infant homicide, excluding deaths of undetermined intent may lead to an underestimation of the magnitude of the public health problem of intentional injuries among infants. Other studies based on record reviews from multiple sources indicate that misclassification and under ascertainment of homicides may be even greater.

Adolescent↗