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Educational differences in the intention to stop smoking: explanations based on the Theory of Planned Behaviour.

BACKGROUND: At this time, the mechanisms by which socioeconomic differences in smoking develop are not completely understood. In this paper the Theory of Planned Behaviour as a potential explanatory framework for socioeconomic differences in smoking is tested. It was hypothesized that components of the Theory of Planned Behaviour may be unequally distributed over educational groups and therefore contribute to the explanation of socioeconomic differences in smoking. Educational differences in the intention to quit smoking are described and attempts are made to understand these in the light of educational patterns in attitude towards smoking cessation, perceived subjective norm concerning quitting smoking, and self-efficacy. METHODS: This cross-sectional study was part of the longitudinal GLOBE study on socioeconomic differences in The Netherlands. Components of the Theory of Planned Behaviour were measured in 1997 among 602 Dutch daily smokers. RESULTS: No educational differences in the intention to quit smoking were found. Persons with a more positive attitude towards smoking cessation and a high subjective norm significantly more often intended to quit smoking. But, positive attitude and high subjective norm were not related to education, which explains the lack of educational differences in intention to quit smoking. Higher educated respondents reported significantly higher self-efficacy to refrain from smoking, which, however, was not related to the intention to quit smoking. CONCLUSION: It is anticipated that, from all components of the Theory of Planned Behaviour, only the direct effect of self-efficacy on behaviour may contribute to educational differences in smoking cessation.

Adolescent↗

Comparing stage of change and behavioral intention to understand fruit intake.

We explored if the pre-action Transtheoretical stages of change are indeed discrete stages for fruit intakes. In a longitudinal design, a cohort of 735 adults completed electronic questionnaires assessing fruit intake, stages of change and intention to increase fruit intake at baseline and 35 and 67 days follow-up. A dichotomization of a continuous intention measure ('pseudostages') was compared with precontemplation and contemplation stages. The results showed (i) that pseudostages and stages of change were strongly associated; (ii) that for most respondents, stability and transitions in stages of change resembled transitions in pseudostage, while test-retest reliabilities for both measures were similar and (iii) that pseudostages and the continuous intention measure were stronger predictors of fruit intake than stage of change. We conclude that pre-action stages of change for fruit are not different from a mere categorization of a continuous intention measure.

Adult↗

The epidemiology of intentional burns.

We sought to present the epidemiology of intentional burns, both deliberate self-inflicted burns and assault burns. Patient records from the University of Alabama at Birmingham Burn Center were reviewed retrospectively. Information pertaining to demographic and injury characteristics were obtained. Ninety-six patients with intentional burns were identified. Patients sustaining intentional burn injury had larger mean TBSA burned (26.1% vs 13.8%), longer mean hospital length of stay (19.9 days vs 13.2 days), higher incidence of inhalational injury (20.8% vs 8.7%), higher rate of mortality (20.0% vs 9.8%), and were more likely to have an elevated blood alcohol content (14.6% vs 7%) when compared with all other burn patients. Patients with deliberate self-burns were more likely to be men (85.7% vs 55.7%) and more likely to have a positive drug screen test than assault burn patients (11.4% vs 0%). Patients who suffer intentional burns tend to have more severe burns and experience worse outcomes.

Adult↗

Factors explaining the intention to give blood among the general population.

BACKGROUND AND OBJECTIVES: The aim of this study was to identify factors explaining the intention to donate blood. MATERIALS AND METHODS: A random sample of 4000 respondents drawn from the general population received a questionnaire by mail. This questionnaire assessed variables as defined by the most prominent social cognitive theories. RESULTS: Overall, the respondents expressed a neutral mean level of intention to give blood in the next 6 months (2.84 on a five-point scale); 56.2% had never given blood in the past. The variables explaining 74% of the variance of intention were: perceived behavioural control (beta = 0.39; P < 0.001); factors facilitating taking action (beta = 0.25; P < 0.001); anticipated regret (beta = 0.16; P < 0.001); moral norm (beta = 0.11; P < 0.001); attitude (beta = 0.08; P < 0.01); level of education (beta = -0.03; P < 0.05); and past experience in giving blood (beta = 0.09; P < 0.001). Nonetheless, the predictive power of perceived behavioural control and moral norm was higher among the ever donors (both at P < 0.01) compared to the never donors, whereas the reverse was observed for attitude (P < 0.05). CONCLUSIONS: People's intentions are mainly determined by perceived barriers and obstacles regarding blood donations. This suggests that promotional strategies should focus on the elimination of barriers to action as well as the development of a higher perception of control. Also, messages should be adapted to the targeted population, based on their previous blood donation behaviour (i.e. never donors vs. ever donors).

Adolescent↗

Shared intentionality.

We argue for the importance of processes of shared intentionality in children's early cognitive development. We look briefly at four important social-cognitive skills and how they are transformed by shared intentionality. In each case, we look first at a kind of individualistic version of the skill -- as exemplified most clearly in the behavior of chimpanzees -- and then at a version based on shared intentionality -- as exemplified most clearly in the behavior of human 1- and 2-year-olds. We thus see the following transformations: gaze following into joint attention, social manipulation into cooperative communication, group activity into collaboration, and social learning into instructed learning. We conclude by highlighting the role that shared intentionality may play in integrating more biologically based and more culturally based theories of human development.

Animals↗

Prevalence of influenza vaccination and correlates of intention to be vaccinated among Hong Kong Chinese.

OBJECTIVES: To explore influenza vaccination rates and investigate correlates of intention to be vaccinated among adults attending a Hong Kong outpatient clinic. DESIGN: Descriptive cross-sectional survey. SAMPLE: Convenience sample of adults attending outpatient clinic (452 participants). METHOD: Self-administered written questionnaire including socio-demographic items, health items, influenza vaccination history, and questions based on the Health Belief Model and Predisposing, Reinforcing, and Enabling Causes in Educational Diagnosis and Evaluation framework. RESULTS: The response rate was 78.9%. Of the participants, 27% had been vaccinated in the past year; 51% reported intention to be vaccinated this year. Intention to be vaccinated did not vary according to gender, marital status, occupation, or household income. In adjusted logistic regression analysis, intention to be vaccinated was significantly associated with chronic disease, having received the flu shot in the previous year, perceived susceptibility ("I am likely to get the flu if I do not get a yearly flu shot"), and reinforcing factors ("My family encouraged me to get a flu shot last year" and "My doctor encouraged me to get a flu shot last year"). CONCLUSIONS: The government can successfully promote vaccination by educating the public about susceptibility to flu and the benefits of vaccination, by publicizing locations where vaccinations are available, and by having family and physicians encourage patients to be vaccinated.

Adolescent↗

Why don't young people volunteer to give blood? An investigation of the correlates of donation intentions among young nondonors.

BACKGROUND: In the past decade, the number of blood donors has steadily declined in the Netherlands, and young adults are underrepresented among registered donors. An understanding of the correlates of donation intentions among nondonors could facilitate targeting psychological prerequisites of donation decisions in recruitment campaigns. STUDY DESIGN AND METHODS. A cross-sectional study with self-administered questionnaires based on an extension of the Theory of Planned Behavior (TPB; a social cognition model to study the determinants of volitional behavior) was conducted to assess potential cognitive determinants of willingness to donate blood in a student sample. A response rate of 50.5 percent yielded a sample of 311. RESULTS: Just over 7 percent of participants were registered blood donors but most (61.7%) had never seriously considered becoming donors. Self-efficacy (confidence in performing the behavior), attitude (the overall evaluation of the behavior), and personal moral norm (the perceived personal responsibility to perform the behavior) regarding blood donation were the most important correlates of the intention to become a blood donor. In total, 43 percent of the variance in the intentions toward blood donation could be explained by a TPB-based model. CONCLUSION: Among students, determinants of the intention to become a blood donor include self-efficacy, attitude, personal moral norm regarding blood donation, and subjective norm (perceived social support). Future research could establish whether campaigns targeting these psychological prerequisites would be more effective than current strategies.

Adolescent↗

The impact of the family planning supply environment on contraceptive intentions and use in Morocco.

Although the extent to which organized family planning programs influence reproductive preferences remains a subject of debate, most observers would grant that such programs play a key role in helping individuals to realize their contraceptive and reproductive intentions. However, few prior studies have quantified the magnitude of this facilitating or enabling effect of family planning services, given existing demand for contraception. This study takes advantage of panel survey data and linked information on the supply environment for family planning services in Morocco in order to bridge this research gap. In the analysis, contraceptive use during the 1992-95 period is related to contraceptive intentions in 1992; individual-, household-, and community-level determinants of contraceptive behavior; and family planning supply factors. Estimation procedures are used that control for unobserved joint determinants of contraceptive intentions and use. Evidence of a significant enabling or facilitating role of family planning services is found, and the results also suggest that family planning program factors influence contraceptive intentions in important ways.

Adolescent↗

Correlates of the intention to remain sexually inactive among underserved Hispanic and African American high school students.

The objective of this study was to apply the Information-Motivation-Behavior (IMB) theoretical framework to examine the correlates of the intention to remain sexually inactive among Hispanic and African American high school students. This study utilized a cross-sectional survey of high school students. The setting was the unified school districts in the County of Los Angeles, California. The participants comprised a geographically defined convenience sample of 502 Hispanic and African American high school students. This study found that only 50% of this sample reported that they plan to remain sexually abstinent until they graduate from high school. Another 21% rejected the notion of remaining abstinent, and 29% were uncertain about their intention to engage in sexual activities before they graduate from high school. Male and African American students were less likely than their female and Latino counterparts to report an intention to remain sexually inactive. Using multinomial logistic regression and controlling for demographic characteristics, this study documented that students with (1) a higher level of perceived peer pressure, (2) a lower level of behavioral and refusal skills for avoiding sexual activity, (3) a more positive attitude toward practicing safe sex, and (4) a lower level of perceived pregnancy repercussions were less likely to claim to remain sexually inactive. The data from this study support the IMB model, which suggests that intervention programs focusing on knowledge alone are inconsequential in altering the intentions of adolescents with respect to their decision to engage in sexual activity. Intervention programs should focus on encouraging youth to postpone sexual activity by reducing peer pressure and building self-efficacy through enhancing motivations and culturally appropriate behavioral skills.

Adolescent↗

Attention to intention.

Intention is central to the concept of voluntary action. Using functional magnetic resonance imaging, we compared conditions in which participants made self-paced actions and attended either to their intention to move or to the actual movement. When they attended to their intention rather than their movement, there was an enhancement of activity in the pre-supplementary motor area (pre-SMA). We also found activations in the right dorsal prefrontal cortex and left intraparietal cortex. Prefrontal activity, but not parietal activity, was more strongly coupled with activity in the pre-SMA. We conclude that activity in the pre-SMA reflects the representation of intention.

Attention↗

Do children's intentions to risk take relate to actual risk taking?

OBJECTIVES: Concerns about safety and rigorous ethic standards can make it very difficult to study children's risk taking. The goal of this study was to determine how closely intentions to risk take relate to actual risk taking among boys and girls 6-11 years of age. METHODS: Children initially completed an "intentions to risk take" task. Following administration of several questionnaires they later participated in an actual risk taking task. RESULTS: At all ages, for both boys and girls, intentions to risk take was highly positively correlated with actual risk taking. When discrepancies occurred these were usually of minimal magnitude. CONCLUSIONS: Tasks that tap children's intentions to risk take can serve as proxy indicators of children's actual risk taking.

Age Factors↗

Smoking cessation among Hong Kong Chinese smokers attending hospital as outpatients: impact of doctors' advice, successful quitting and intention to quit.

To identify factors affecting current smokers' intention to quit smoking and factors associated with successful quitting among ex-smokers in Hong Kong. A cross-sectional survey of Chinese patients attending medical and surgical Specialist Outpatient Clinics (SOPCs) of public hospitals in Hong Kong, using a structured questionnaire. Results of the 642 respondents, 21% were current smokers, 9% were ex-smokers and 69% were non-smokers. 74% of the smokers reportedly received quitting advice from doctors. Among the current smokers, past quitting attempts, receiving information from sources other than doctors, believing that doctor's advice was useful, believing that all smokers should quit smoking and a positive attitude towards quitting were associated with intention to quit. Among those who had attempted to quit, being older (aged 50 or above), being retired/unemployed and consuming more than 10 cigarettes per day were associated with successful quitting. We found that advice from doctors on quitting smoking did not have any impact on Chinese smokers quitting or future intention to quit and reflect the inadequacy of advice given by Hong Kong doctors. The predictors of intention to quit and successful quitting identified in the study could be used to design future smoking cessation services.

Adult↗

Harm, intent, and the nature of aggressive behavior: measuring naturally occurring aggression in barroom settings.

The research goals were to use the constructs of harm and intent to quantify the severity of aggression in the real-world setting of the bar/club, to describe the range of aggressive behaviors and their relationship to harm and intent, and to examine gender differences in the form and severity of aggression. Systematic observations were conducted by trained observers on 1,334 nights in 118 bars/clubs. Observers documented a range of aggressive acts by 1,754 patrons in 1,052 incidents, with many forms of aggression occurring at more than one harm and intent level. Women used different forms of aggression, inflicted less harm, and were more likely to have defensive intent compared with men. Implications of the findings for research and measurement of aggression and applications to preventing aggression and violence are discussed.

Aggression↗

Intention or experience? Predictors of continued breastfeeding.

Despite the known benefits of breastfeeding, many women do not breastfeed their infants or stop breastfeeding early. This study examines the effects of prenatal intention and initial breastfeeding experiences on breast-feeding initiation and duration among 1,665 U.S. women completing questionnaires on infant feeding practices. Outcomes included no initiation of breastfeeding at birth and termination at <10 weeks, 10 to <20 weeks, or 20 to <30 weeks. Predictor variables included intended breast feeding duration and early breast feeding experiences with analyses controlling for demographic characteristics, previous breastfeeding experience, and prenatal intentions to work after delivery. Prenatal intentions to never initiate or to stop breastfeeding early were significant risk factors for all breastfeeding outcomes. Initial breastfeeding experiences were significant risk factors for early termination. This study supports using the intention construct from the theory of reasoned action to predict initiation of behavior but suggests the need to include initial experience when predicting maintenance of behavior.

Adolescent↗

Predicting willingness to engage in unsafe sex and intention to perform sexual protective behaviors among adolescents.

This article examines the sociocognitive processes contributing to intention to use contraception and willingness to engage in unsafe sex, using extended versions of the theory of planned behavior (TPB) and the Prototype/Willingness model (Gibbons & Gerrard, 1995, 1997). Data were obtained from a questionnaire delivered to all the pupils in ninth grade (N = 196) at three schools in Oslo. Hierarchical multiple regression analysis was used to predict intention and willingness. The results showed that subjective norm was the most important predictor of intentions for girls, whereas moral norm was most important for boys' intentions and willingness. Prototypes were the most important predictor for girls' willingness. Implications of the findings are discussed.

Adolescent↗

Level of suicidal intent predicts overall mortality and suicide after attempted suicide: a 12-year follow-up study.

BACKGROUND: The aim of this study was to comprehensively examine clinical risk factors, including suicide intent and hopelessness, for suicide and risk of death from all causes after attempted suicide over a 12-year follow-up period. METHODS: A systematic sample of 224 patients from consecutive cases of attempted suicide referred to health care in four Finnish cities between 1 January and 31 July 1990 was interviewed. RESULTS: After 12 years of follow-up 22% of these patients had died, 8% by committing suicide. The only statistically significant risk factor for eventual suicide was high scores on Beck's Suicidal Intention Scale. Male gender, older age, physical illness or disability and high scores on Beck's Suicidal Intention Scale predicted death overall. CONCLUSIONS: Following attempted suicide, high intention to kill oneself is a significant risk factor for both death from all causes and suicide.

Adolescent↗

Independent predictors of breastfeeding intention in a disadvantaged population of pregnant women.

BACKGROUND: Breastfeeding rates in Scotland are very low, particularly in the more disadvantaged areas. Despite a number of interventions to promote breastfeeding very few women actually intend to breastfeed their baby. The aim of this study was to identify personal and social factors independently associated with intention to breastfeed. METHODS: Nine hundred and ninety seven women from two socio-economically disadvantaged housing estates located on the outskirts of Glasgow participated in a study that aimed to increase the prevalence of breastfeeding. Self-administered questionnaires completed by each participant collected information in early pregnancy, prior to exposure to the study intervention, on feeding intention, previous feeding experience and socio-demographic data. RESULTS: Five factors were independently predictive of breastfeeding intention. These were previous breastfeeding experience, living with a partner, smoking, parity and maternal age. After adjusting for these five factors, neither deprivation nor receipt of milk tokens provided useful additional predictive information. CONCLUSION: In this population of socially disadvantaged pregnant women we identified five variables that were independently predictive of breastfeeding intention. These variables could be useful in identifying women at greatest risk of choosing not to breastfeed. Appropriate promotional efforts could then be designed to give due consideration to individual circumstances.

Adult↗

Factors associated with intentions to adhere to colorectal cancer screening follow-up exams.

BACKGROUND: To increase adherence rate to recommendations for follow-up after abnormal colorectal cancer (CRC) screening results, factors that inhibit and facilitate follow-up must be identified. The purpose of this study was to identify the factors associated with intention to adhere to CRC screening follow-up exams. METHODS: During a 4-week period in October 2003, this survey was conducted with 426 subjects participating in a community-based CRC screening program in Nagano, Japan. Study measures included intention to adhere to recommendation for clinical follow-up in the event of an abnormal fecal occult blood test (FOBT) result, perceived susceptibility and severity of CRC, perceived benefits and barriers related to undergoing follow-up examination, social support, knowledge of CRC risk factors, health status, previous CRC screening, personality and social demographic characteristics. Univariate and multivariate logistic regression analyses on intention to adhere to recommendations for follow-up were performed. RESULTS: Among the 288 individuals analyzed, approximately 74.7% indicated that they would definitely adhere to recommendations for follow-up. After controlling for age, gender, marital status, education, economic status, trait anxiety, bowel symptoms, family history of CRC, and previous screening FOBT, analyses revealed that lower levels of perceived barriers, higher levers of perceived benefits and knowledge of CRC risk factors were significantly associated with high intention respectively. CONCLUSION: The results of this study suggest that future interventions should focus on reducing modifiable barriers by clarifying misperceptions about follow-up, promoting the acceptance of complete diagnostic evaluations, addressing psychological distress, and making follow-up testing more convenient and accessible. Moreover, educating the public regarding the risk factors of CRC and increasing understanding of the benefits of follow-up is also important.

Adult↗