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PubMed1992

Etiology and treatment of obesity: understanding a serious, prevalent, and refractory disorder.

Obesity remains a leading public health problem because of its complications, prevalence, and resistance to change, despite record rates of dieting. Risk factors exist at both population and individual levels, thus obesity has diverse etiologies and consequences. Dieting is often grounded in the notion that the body can be molded at will and that the rewards justify the effort, creating a drive for unrealistic goals. This article argues for establishing a "reasonable weight," which may differ from health and aesthetic ideals. Intervention is less a matter of finding a "best" treatment but of finding the approach with "best fit" for the individual. Advances in treatment are most likely when research is driven by theory on the etiology of weight gain, the relapse process, and methods for permanent behavior change. This article integrates information on etiology, social beliefs about body weight, theory, and treatment into a comprehensive and compassionate model for intervention.

Adaptation, Psychological↗

PubMedDate not supplied

Health behavior changes in the United States, the United Kingdom, and France.

OBJECTIVE: To determine changes in health behaviors in the United States, the United Kingdom, and France over the previous two years. DESIGN: Cross-sectional survey of nationally representative samples. SETTING/PARTICIPANTS: Surveys conducted between June and November 1988 on persons aged 16 to 50 years in the United States (n = 1,940), the United Kingdom (n = 1,833), and France (n = 2,294) regarding health behaviors, attitudes toward health, and changes in health practices during the previous two years. MEASUREMENTS AND MAIN RESULTS: Using Bonferroni's adjustment for multiple comparisons, residents of the United States had significantly (p < 0.05) higher Quetelet indices and reported higher egg and red meat consumption, but had lower alcohol consumption, than did residents of either the United Kingdom or France. Americans were also significantly more likely to report attitudes accepting personal responsibility for their health and much more often endorsed the role of health behaviors (e.g., exercise) for decreasing the risk of cardiovascular disease. Changes in health behavior over two years were consistently more likely in the United States for weight loss, decreased alcohol consumption, decreased red meat and egg consumption, and increased exercise. Americans were also much more likely to have changed at least three health behaviors in the previous two years (United States 41.5%, United Kingdom 25.5%, France 13.8%, p < 0.002). A multivariate linear model confirmed the high likelihood of health behavior changes in the United States compared with the United Kingdom or France. CONCLUSIONS: The findings confirm that changes in health behaviors are continuing to occur in the United States, but remain comparatively modest in the United Kingdom and France. These international variations in health behaviors parallel differential declines in mortality rates in ischemic heart disease.

Adolescent↗

PubMedDate not supplied

Readiness for smoking change among middle-aged Finnish men.

According to the transtheoretical model of change, smoking cessation attempts are preceded by three stages: precontemplation, contemplation, and preparation. These stages have shown great utility in predicting and impacting on behavior change. This cross-cultural study examined the distribution of the stages within a 33% random sample of middle-aged Finnish men. Of 490 regular smokers, 57.6% were in precontemplation, 29.4% in contemplation, and 13.0% in preparation. Five conceptual clusters were used to predict the stage membership. The number of lifetime quit attempts and the number of 24-h quit attempts in the past 12 months were found to be the best discriminators among the stages. The overall correct classification rate into stages using stepwise discriminant function analysis was 64.0%, substantially better than the chance rate. However, the analysis was successful for precontemplators only. Results showed that most smokers were precontemplators. Previous attempts to reduce smoking provided some predictive information concerning stage membership. Demographics, addiction to smoking, current smoking, smoking environment, and quit history were incomplete predictors of stage membership, as theoretically predicted.

Attitude↗

PubMed1992

Impact of HIV testing and counseling on subsequent sexual behavior.

To assess sexual behavior changes after voluntary HIV testing and routine counseling, we interviewed 235 persons at 2 anonymous test sites in North Carolina. Among the 57 (24%) persons returning for follow-up 1 year later, 70% were male; 44% were black, 37% were homosexual, 10% were bisexual; and 16% were HIV positive. Overall, 28% of returnees at the initial visit and 33% on the follow-up visit admitted to having 2 or more sexual partners in the past month. At the initial interview and at follow-up, 21% of returnees reported condom use in the past month. Homosexual men were significantly less likely to use condoms during anal sex over time (58% non-use initially vs. 74% non-use at follow-up, p = 0.04). No significant net change in high-risk sexual behaviors was found at follow-up. Overall findings indicate that the standard HIV testing and counseling provided by health departments anonymously and free of charge does not result in elimination of high-risk sexual behaviors or initiation of safer sex behaviors among those at high risk for HIV infection.

AIDS Serodiagnosis↗

PubMed1979

The variable natural history of subacute sclerosing panencephalitis: a study of 118 cases from the Middle East.

A variable natural history was found in a standardized follow-up study of 118 patients with subacute sclerosing panencephalitis (SSPE). Only 20% followed the sequence:behavior change, mental deterioration, periodic attacks, severe debility, and death within a year. Six stages were identified: 0, subtle psychointellectual symptoms; 1, obvious psychointellectual and neurological changes; 2, stereotyped attacks; 3, vegetative psychomotor condition; 4, improvement; 5, relapse. Illness began in stage 0 for 32%; 1, 36%; 2, 19%; 1 and 2 simultaneously, 13%. In early development, 77% were hyperactive, and 27% had psychointellectual difficulties one to five years prior to obvious illness. The average duration of each stage was as follows: stage 0, two years; 1, 2.5 months; 2, 7.5 months; 3, 5.5 months; 4, 3.5 years; 5, 1.5 years. Noteworthy improvements and plateaus occurred in more than half of the patients. In stage 4, improvement was long-term and substantial for 5% and modest for 18%. Survival followed an exponential curve with an average half-life of 1.8 years; 41% of the patients survived beyond two years. Half of the patients passed through neither stage 0 nor stage 4; their half-life was 0.7 years. The remainder had a half-life of 3.0 years.

Follow-Up Studies↗

PubMed1992

Behavioral changes in pediatric intensive care units.

OBJECTIVE: The purposes of this study were to compare the frequency and severity of manifestations of anxiety, depression, delirium, and withdrawal in pediatric patients hospitalized in intensive care unit vs ward settings and to evaluate the impact of preexisting psychopathologic disorders on the expression of these symptoms. RESEARCH DESIGN: Prospective patient series. SETTING: Tertiary care pediatric center. PATIENTS: Forty-three subjects aged 6 to 17 years hospitalized in either the pediatric or cardiovascular intensive care unit (n = 18) or on the general wards (n = 25) were recruited to participate. Subjects were excluded if their parents were unavailable for diagnostic interview or if they could not answer interview questions themselves. SELECTION PROCEDURES: Consecutive sample. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: The Hospital Observed Behavior Scale, developed for this study, was used to describe objectively subjects' manifestations of anxiety, depression, delirium, and withdrawal. The Diagnostic Interview for Children and Adolescents and Diagnostic Interview for Children and Adolescents-Parents were used to determine the presence of preexisting psychopathologic disorders. As measured by the Hospital Observed Behavior Scale, subjects in the intensive care unit exhibited apprehension, anxiety, detachment, sadness, and weeping more often than did patients in the ward. Behavior was also significantly influenced by severity of illness, duration of hospitalization, number of previous hospitalizations, and presence of a preexisting anxiety or mood disorder. We found the Hospital Observed Behavior Scale to have good interrater reliability. CONCLUSIONS: Our data indicate that critically ill children in the intensive care unit, children with prolonged or repeated hospitalizations, and children with preexisting anxiety and mood disorders are at greater risk than other hospitalized pediatric patients for psychological trauma and/or behavior problems that may warrant psychiatric intervention. The Hospital Observed Behavior Scale is a reliable tool to quantitate behaviors in hospitalized children.

Adolescent↗

PubMed1992

The why, when and whether of condom use among female and male drug users.

Eight focus groups consisting of all male, all female and mixed male and female drug users were conducted to gain an in-depth understanding of beliefs and behavior regarding the use of family planning services and contraceptives, particularly condom use in an effort to reduce the perinatal transmission of HIV. While participants often supported the use of condoms because of STDs and AIDS, their unplanned pregnancies and STD histories indicated in-consistent use, depending on the partner and the circumstances. The vast majority of both men and women did not like to use condoms because it interfered with the spontaneity and pleasure of sexual relations, though women seemed more willing to use condoms than their partners. Participants varied in their knowledge about the benefits of using a condom, in how and when to put it on, in the associations they made between condom use and trust and commitment, in the type of partner and conditions under which they would use condoms and in their willingness to consider condom use as an integral part of their lives. Issues of trust, commitment and condom use did not seem to have been resolved in the drug using community, particularly among younger people who appeared to have more difficulty in negotiating condom use. Promoting the use of condoms needs to be considered as part of a larger, multifaceted behavior change effort.

Condoms↗

PubMed1992

Time trends of smoking cessation: a micro-population computer simulation model.

The Micro-population model of Risk-group Dynamics (MRD) approaches smoking behavior at the level of the individual and integrates physiological and social factors to describe the evolution of behavior change in the population. MRD is innovative in several ways: (1) the model describes mathematically the interactions among these behavioral factors; (2) the model accounts for both the variability of these factors among different persons and the universality of basic rules describing these factors in all individuals; and (3) the model can be applied to various types of populations and a wide range of intervention strategies. MRD combines the physiological, psychological and social determinants into a hazard function for relapse to smoking. This hazard function is then organized into a three term expression incorporating: a baseline hazard characteristic to each individual, a decreasing term for the diminishing aspect of the initial hazard and an effect of external interventions. The model gives promising results when applied to the Multiple Risk Factors Intervention Trial (MRFIT) data using the assumptions of a Weibull distribution for the baseline hazard, a negative exponential for the decrease in the initial hazard and a constant intensity for the external intervention.

Algorithms↗

PubMed1992

Melanoma prevention: behavioral and nonbehavioral factors in sunburn among an Australian urban population.

BACKGROUND: To determine the independent contribution of behavioral factors to the occurrence of sunburn, sun protection behavior was assessed over 13 successive summer weekends in a total of 1,655 adults in Melbourne, Australia. METHODS: Telephone survey respondents provided detailed accounts of activities engaged in, time spent outside, and hat, clothing, and sunscreen coverage in the 4 hr around the solar midday on both weekend days, as well as skin type, sociodemographic descriptors, and degree of sunburn experienced. Independent measures of atmospheric temperature and ambient ultraviolet radiation (UVR) were added to individual records. RESULTS: The (mostly recreational) weekend sunburn in this urban sample was strongly associated with UVR, as expected. Temperature at 3 PM, sensitive skin type, youthfulness, and being male were also independently associated with sunburn. After all other predictors were controlled for, the body exposure index (which took into account time outside and hat, clothing, and sunscreen coverage) made a strong independent contribution to the explanation of sunburn (P < 0.001). CONCLUSION: It was concluded that behavior change strategies to prevent malignant melanoma of the skin are warranted.

Adolescent↗

PubMed2026

Use of wearable technologies for physical activity promotion in older adults: A systematic review.

This systematic review, conducted according to PRISMA guidelines and registered in PROSPERO (CRD420251055299), examined the use of wearable technologies for promoting physical activity (PA) in adults aged 60 years and older. Searches across five databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane) identified 2438 records, of which only six randomized controlled trials published between 2021 and 2025 met inclusion criteria, with sample sizes ranging from 36 to 551 participants and mean ages between 65 and 79 years. Given the small number of included studies, findings should be interpreted as preliminary. The studies ranged from the standalone use of commercial trackers (Fitbit, Polar, ActiGraph) to multicomponent interventions combining wearables with physiotherapist feedback, telephone counseling, web-based platforms, or interactive cognitive-motor training. Wearables used alone, as in the REACT trial, produced small or non-significant PA effects. In contrast, interventions integrating devices with personalized feedback, professional support, or digital platforms, such as PROMOTE and TASMANIA, were associated with more consistent improvements in PA, physical function, and cognitive outcomes. Multicomponent programs, such as PEER and ICMT, reported broader benefits, including cognition, balance, and reductions in sedentary behavior, though these findings derive from individual trials and require replication. Risk of bias, assessed with the Cochrane Risk of Bias tool version 2 (RoB 2.0), was rated as "some concerns" for five studies and low for only one, mainly due to gaps in randomization reporting, missing data, and lack of preregistration. Tentatively, and based on a very limited evidence base, wearables may have greater impact when embedded within broader behavioral systems, incorporating feedback, coaching, or interactive components, rather than when used in isolation as passive monitoring tools. Adherence and psychosocial outcomes appeared related to comfort and perceived usefulness among older adults, though larger and more robust trials are needed to confirm these patterns.

Humans↗

PubMed1992

High school students' perceptions of AIDS risk: realistic appraisal or motivated denial?

We examined perceptions of risk for acquired immunodeficiency syndrome (AIDS) in 296 high school students living in or near a major urban center. We hypothesized that students with a dispositional tendency to deny threat would be more likely to misperceive their risk of contracting AIDS. Results indicated that study participants, overall, used their behaviors as a basis for assessing personal risk in the sense that they perceived higher risk when their behavior was in fact riskier. However, this relation did not hold for those students classified as repressors on a repression-sensitization scale; repressors' perceptions of absolute (but not comparative) risk were negatively correlated with degree of behavioral risk. In a secondary analysis, perceived absolute risk was found to be a significant predictor of intention to change AIDS-risk behaviors. This study provides support for a motivational interpretation of perceived invulnerability and has implications for the development of models of health behavior change.

Acquired Immunodeficiency Syndrome↗

PubMed2026

Changes in sexual behavior among women in studies evaluating the dapivirine vaginal ring for HIV prevention.

BACKGROUND: Access to novel HIV prevention technologies often raise concerns of risk compensation. This analysis examined changes in the sexual behaviors of MTN 020/ASPIRE participants, a placebo controlled randomized control trial, who subsequently enrolled in MTN-025/HOPE, an open-label extension using the dapivirine vaginal ring. METHODS: Both studies enrolled healthy, sexually active, HIV-negative women from Malawi, South Africa, Uganda and Zimbabwe. Longitudinal data on participants' sexual behaviors, specifically sex with a nonprimary partner (past 3 months), and use of male or female condoms at the last vaginal sex act were compared between ASPIRE and HOPE. Conditional and mixed ordinal logistic regression models evaluated associations between study and sexual behaviors at enrollment, and quarterly over the first 12 months. RESULTS: Of the 2629 individuals enrolled in ASPIRE, 1456 (55%) participated in HOPE. At enrollment, the proportion of participants who reported sex with a nonprimary partner and condom use at last vaginal sex act did not differ by study. Across all quarterly follow-up visits, sex with a nonprimary partner was more common in HOPE (13.9-18.7%) than ASPIRE (10.7-12.6%); adjusted OR 1.47, 95% CI 1.24-1.75, P < 0.001. There was no difference in condom use at the last vaginal act across all quarterly follow-up visits between ASPIRE (36.5-42.7%) and HOPE (43.6-46.7%); adjusted OR 1.05, 95% CI 0.94-1.18. CONCLUSION: More women reported sex with nonprimary partners in HOPE, with little change in condom use over time between the two studies. Understanding behavior changes during PrEP use allows for tailored, holistic reproductive health programming.

Humans↗

PubMed1992

Longitudinal sexual behavior changes in injecting drug users.

OBJECTIVE: To determine whether injection drug users (IDU) maintained sexual behavior risk reduction over an 18-month period that had been noted previously over a 4-month period. DESIGN: A repeated measures design was utilized with IDU assessed initially at study enrollment and again 18 months later. METHODS: Sexual behaviors of a group of 220 IDU (148 men and 72 women) were assessed by a structured interview at the start of an AIDS prevention project and again 18 months later. RESULTS: Having multiple sex partners during the 12 months before initial assessment was reported by 42.6% of the men and 35.7% of the women. Significantly fewer had multiple sex partners during the 10 months before follow-up assessment (men, 20.9%; women, 14.3%). Condom use for vaginal intercourse increased from a mean of 11.9% initially to 27.8% at follow-up for men. The increase in condom use was greater for those with multiple sex partners. Women did not report significant increases in condom use. Continued involvement in unsafe sexual behaviors was associated with exchanging sex for money or drugs, using drugs to help meet sexual needs, alcohol use and drug use. CONCLUSIONS: Risk reductions noted previously were maintained over 18 months for the majority of the sample. Drug-use treatment and interventions that closely examine the interplay between drug use and sexuality for individual IDU are recommended as strategies to further reduce the sexual risk of HIV transmission among IDU.

Adult↗

PubMed1992

The application of motivational theory to cardiovascular risk reduction.

The level of motivation sustained by an individual has been identified as a primary predictor of success in sustained cardiovascular risk factor modification efforts. This article reviews the primary motivational theories that have been used to explain and predict cardiovascular risk reduction. Specifically, the application of the Health Belief Model, Health Promotion Model, Theory of Reasoned Action, Theory of Planned Behavior and Self-efficacy Theory to the initiation and maintenance of cardiovascular health behavior is addressed. The implication of these theories for the development of nursing interventions as well as new directions for nursing research and practice in the study of individual motivation in health behavior change are discussed.

Attitude to Health↗

PubMed1992

School-based programs to reduce sexual risk-taking behaviors.

This article reviews the major approaches implemented during the last two decades to reduce sexual risk-taking behaviors, examines their evidence for success, and provides several recommendations for effective programs and program evaluations. This article does not discuss more broad-based sexuality education programs which address sexuality in a broader context. Instead, this article focuses primarily on programs that educators believed would reduce unprotected sexual intercourse.

Adolescent↗

PubMed1992

Safe sex and women.

OBJECTIVE: Sexual behaviour, condom use, HIV knowledge and anxiety for women were examined to understand the range of sexual behaviours, predictors of safer sex and the extent of relapse. DESIGN: A cross sectional sample of women STD clinic attenders completed interviews and questionnaires. SETTING: Central London STD Clinic. SUBJECTS: 153 women drawn from consecutive attenders at a sexually transmitted disease (STD) clinic in inner London. RESULTS: A quarter of the sample had never responded to safe sex and a further 14% had been unable to maintain it over time. Anxiety and knowledge did not differ between safe and relapsed groups, but self efficacy and cognitive variables did. Those who maintained safe sex had significantly less sex. Ten percent of the sample had unprotected anal intercourse. Most women saw themselves in longer term relationships, yet a quarter had sex outside of the relationship and a fifth stated that their partners also did. HIV information gathering was passive and 74% felt they could not protect themselves against infection. High concern over HIV was monitored. Condom uptake was low and non-existent for anal intercourse. 25% had undergone HIV testing. These women did not differ significantly in terms of their behaviour from the untested women. CONCLUSIONS: HIV risks for women are a source of anxiety and tailored intervention is needed to reduce risk and promote dialogue and negotiation.

Acquired Immunodeficiency Syndrome↗

PubMed1992

Healthier lifestyles: how to motivate older patients to change.

A 1- to 3-minute clear discussion by the family physician of the risks of unhealthy lifestyles has been found to be quite successful in countering patients' denial of personal risk. Studies indicate that the physician's authority lends credibility to the need to make a change and is a strong motivator. An office-based physician counseling model has proven effective in motivating older patients to adopt healthier lifestyles. The model includes four basic steps: patient assessment, discussion of risk and delivery of a message to change, a prescription for change (planning and carrying out of a behavior change strategy), and prevention of relapse through a maintenance program.

Aged↗

PubMed1992

AIDS knowledge and attitudes among injection drug users: the issue of reliability.

Among injection drug users (IDUs), AIDS-related knowledge and attitudes have not consistently predicted AIDS risk behavior. This may be due in part to the limited reliability of indexes used to measure drug users' AIDS knowledge and attitudes. In addition, the substantive interpretation of findings is confounded if index reliability is lower for particular demographic groups (e.g., ethnic populations and women). This report is based on 8 measures of AIDS-related knowledge and attitudes in a sample of 332 injection drug users in Los Angeles. The reliability of knowledge and attitude indexes for the overall sample is generally acceptable for the purpose of group comparison (average alpha = .60). But reliability is consistently lower for respondents who are Hispanic (average alpha = .49) and respondents with less formal education (alpha = .56). The reliability of 2 measures of sex-related attitudes is lower for female respondents. It is therefore important that the reliability of knowledge and attitude indexes be assessed not just for drug-user samples as a whole, but also within demographic groups of substantive interest.

Acquired Immunodeficiency Syndrome↗