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Theory-comparison and multiple-behavior research: common themes advancing health behavior research.

Research that seeks to compare and contrast theories of behavior change and assess the utility of a particular theoretical model for changing two or more health-related behaviors is critical to advancing health behavior research. Theory-comparison can help us learn more about the processes by which people change and maintain health behaviors than does study of any single theory alone and thus has the potential to better guide the development of intervention. Multiple-behavior interventions promise to have much greater impact on public health than single-behavior interventions. However, theory-comparison and multiple-behavior research presents several emerging challenges. These include finding new ways to enhance recruitment and retention, especially among diverse populations; improving treatment fidelity; developing common metrics across behaviors that can be used to advance the measurement and assessment of behavioral change; and expanding the reach and translation of intervention approaches that have demonstrated efficacy. This paper discusses the rationale for conducting theory-comparison and multiple-behavior research and presents several common themes that have emerged from the work of the National Institutes of Health Behavior Change Consortium (BCC). The activities of each BCC workgroup and the potential contribution of each to these common themes to advance health behavior research are also described.

Health Behavior↗

The theory of planned behavior as related to intention to exercise and exercise behavior.

In a previously reported study we sought to assess the usefulness of the theory of planned behavior in explaining the exercise behavior of 73 adults enrolled in an exercise program over a 5-mo. period. The correlation between scores on Intention to Exercise and Exercise Behavior was moderate and inverse, conflicting with a primary tenet of the Theory of Planned Behavior. In this analysis of the data we sought to explain that finding by partitioning participants into groups based on a median split of their scores on Intention to Exercise and Exercise Behavior. Using the four Intention by Behavior groups as independent variables and scale scores as dependent variables, post hoc tests for Fitness Attitude showed significant differences only when High Intention conflicted with Low Intention, irrespective of Exercise Behavior. Perceived Behavioral Control showed opposite tendencies, i.e., differences were significant when High Behavior conflicted with Low Behavior, irrespective of Intention to Exercise. We conclude that Perceived Behavioral Control defines one's ultimate Exercise Behavior over a 5-mo. period while scores on Fitness Attitude define Intentions to Exercise.

Adult↗

Adolescent health behavior and conventionality-unconventionality: an extension of problem-behavior theory.

Examined the relation of psychosocial and behavioral conventionality-unconventionality to health-related behavior in cross-sectional data from 1,588 male and female 7th to 12th graders. Conventionality-unconventionality was represented by personality, perceived social environment, and behavior variables selected from the social-psychological framework of problem-behavior theory (R. Jessor & S. L. Jessor, 1977). Greater psychosocial conventionality correlates with more regular involvement in health-related behavior (regular physical activity, adequate sleep, safety belt use, attention to healthy diet). Greater behavioral conventionality (less involvement in problem behaviors such as marijuana use, problem drinking, delinquent-type behavior, and greater involvement in conventional behaviors such as church attendance) was also associated with greater involvement in health-maintaining behavior. The overall findings provide support for the extension of problem-behavior theory to the domain of adolescent health behavior and for the relevance of the dimension of conventionality-unconventionality.

Adolescent↗

[Evaluation of disruptive behavioral disorders: how situation specific and temporally accurate are behavior observations?].

The stability of expert behavior ratings was analyzed in an unselected inpatient sample of 49 children admitted for disruptive behavior disorders. Expert behavior ratings were obtained for two highly standardized situations (play behavior on ward, on-task behavior during tests) at two time points (T1: 1 week and T2: 4 weeks after admission). These scores were compared with initial diagnostic assessments (clinical judgement) and objective behavior data (actometer) in the test situation. A comparison of the standardized behavior ratings over time showed that in both settings problem behavior was more pronounced at T2 than at T1. Actometer data indicating a higher activity level at T2 were significantly correlated with behavior ratings. There was only a weak association between expert behavior ratings and an initial diagnosis of conduct disorder; the correlation between an initial diagnosis of attention-deficit hyperactivity disorder and the behavior ratings was statistically significant. In general, T2 behavior ratings corresponded better to the initial clinical judgement. Implications for the use of multiple sources of information and of repeated measurements are discussed.

Attention Deficit Disorder with Hyperactivity↗

Is adjunctive behavior a third class of behavior?

Research during the past 20 years has revealed that intermittent food presentation to a variety of organisms results in an inordinately excessive consumption of water as well as other behaviors including attack, pica, escape, and alcohol consumption. Such behavior has not been thought to be either respondent or operant behavior, but instead has been regarded as a new behavioral category termed "adjunctive behavior." This paper reexamines the rejection of adjunctive behavior as either operant or respondent behavior and concludes that the rejection was premature. This paper also reexamines the argument that there is a unique class of adjunctive behavior and concludes that there is not. It is recommended that given the growing difficulties in maintaining an operant-respondent dichotomy, rather than admitting adjunctive behavior into either of these categories, research efforts should de-emphasize preconceived and outdated notions about categories of behavior and how such behaviors should behave and instead focus on mapping functional relationships between behavior and various procedures for presenting non-contingent stimuli.

Animals↗

Order is needed to promote linear or quantum changes in nutrition and physical activity behaviors: a reaction to 'A chaotic view of behavior change' by Resnicow and Vaughan.

Recently, Drs. Ken Resnicow and Roger Vaughan published a thought-provoking paper in the International Journal of Behavioral Nutrition and Physical Activity (IJBNPA). They argue that the most often used social-cognition theories in behavioral nutrition and physical activity are of limited use. These models describe behavior change as a linear event, while Resnicow and Vaughan posit that behavior change is more likely to occur in quantum leaps that are impossible to predict. They introduce Chaos Theory into the behavioral nutrition and physical activity domain as a more valid framework to study the complex process of health behavior change. The present paper is a commentary on Resnicow and Vaughan's article by Resnicow's opponent in a recent debate-session at the annual meeting of the International Society of Behavioral Nutrition and Physical Activity. The chair of that meeting, Prof. Tom Baranowski, provides a separate commentary on Resnicow and Vaughan's paper also published recently in the IJBNPA. In the present commentary I relate Resnicow and Vaughan's paper to the other contributions to the Theory debate in the IJBNPA. I recognize the limited success of social cognition models, and, next to a better application of these models and more thorough research to test these model, also support research to further test the quantum and chaotic character of health behavior change. However, if such research supports the chaotic and quantum nature of health behavior change, the implications for behavioral nutrition and physical activity interventions may be limited, because even if behavior change is quantum rather than linear, the social cognition models are still relevant to inform interventions to promote quantum leaps in behavior change.

Comment↗

Genetic and environmental influences on cross-gender behavior and relation to behavior problems: a study of Dutch twins at ages 7 and 10 years.

The aim of this study was to investigate the prevalence of cross-gender behavior during childhood, to estimate the influence of genotype and environment on variation in cross-gender behavior, and to explore the association of cross-gender behavior with maternal ratings of behavior problems as indexed by the Internalizing and Externalizing scales of the Child Behavior Checklist (CBCL). Cross-gender behavior was assessed by two items from the CBCL: "behaves like opposite sex" and "wishes to be of opposite sex." As part of an ongoing longitudinal study of the Netherlands Twin Registry, mothers were asked to complete the CBCL for their twins when they were 7 (n approximately 14,000 twins) and 10 years old (n approximately 8,500 twins). The prevalence of cross-gender behavior (as measured by maternal report of behaving like or wishing to be the opposite sex) was 3.2% and 5.2% for 7-year-old boys and girls, respectively, and decreased to 2.4% and 3.3% for 10-year-old boys and girls. Surprisingly, the prevalence rate of cross-gender behavior of girls with a male co-twin was lower than of girls with a female co-twin. At both ages, the similarity for cross-gender behavior was greater in monozygotic than in dizygotic twins pairs. Genetic structural equation modeling showed that 70% of the variance in the liability of cross-gender behavior could be explained by genetic factors, at both ages and for both sexes. Cross-gender behavior was associated with higher scores on Internalizing and Externalizing problems, both in boys and in girls.

Child↗

Lead and behavioral development: parental compensation for behaviorally impaired chicks.

Lead is ubiquitous in nature, and can affect behavioral, physiological, and intellectual development in humans and other animals. We used lead-induced behavioral deficits to examine the behavior of parents and young herring gulls in the Captree, NY, gull colony. Our objectives were to determine: a) If there were differences in the behavior, weight, and survival of chicks as a function of treatment; b) if parental behavior varied as a function of treatment; and 3) if there were differences in sibling competition and parent-young conflict between experimental nests (with lead-impaired chicks and control chicks) and control nests. We injected one chick in each of 22 nests (1-2 days of age) with lead acetate (100 mg/kg in sterile water) and injected its sibling with sterile saline, and compared behavior of parents and young (from 1-21 days postinjection). We also observed behavior of parents and chicks in 12 control nests in which chicks were handled similarly but were not injected. There were significant lead-induced differences in righting response, locomotion, thermoregulation, begging, and feeding behavior in the chicks; corroborating observations from the laboratory. Lead-injected chicks were less able to compete for food with their siblings, with a resultant significant difference by weight at 16 days of age. For experimental nests in which the weight difference was great, parents engaged in divided feeding of the brood. After one parent initiated feeding, the other parent walked a short distance away and began to call to and then feed the second, smaller chick. The extra parental care resulted in increased survival for the lead-injected chicks, and in their catching up to their siblings in weight by fledging. The results of this experiment indicate that lead induces behavioral deficits and growth retardation in gulls in nature, decreases survival at young ages, and that parents compensate for these behavioral and growth deficits by brood division for feeding chicks such that by fledging the chicks are no longer at a weight and size disadvantage. Parents are, thus, able to perceive a difference in body size and/or vigor of their offspring, and to behaviorally compensate partially for the lead-induced deficits.

Animals↗

Sleep and daytime behavior in children with obstructive sleep apnea and behavioral sleep disorders.

OBJECTIVE: The purpose of this study was: 1) to examine both bedtime sleep behaviors and daytime behaviors associated with daytime sleepiness in a group of children with a primary medical sleep disorder (obstructive sleep apnea syndrome [OSAS]) compared with a group of children with a primary behavioral sleep disorder (BSD) (limit setting sleep disorder or sleep onset association disorder); and 2) to investigate the impact of a comorbid BSD on sleep and daytime behavioral consequences of OSAS. METHODS: Children referred to a pediatric sleep disorders clinic during a 3-year period with a primary diagnosis of either polysomnographically-confirmed OSAS (n = 100) or a BSD (n = 52) were compared on several parent report measures assessing the following domains: symptoms of sleep disordered breathing, other sleep behaviors (primarily parasomnias), bedtime behaviors, and externalizing daytime behavior problems. The OSAS sample was then divided into a pure OSAS group (n = 78) and an OSAS plus a behavioral sleep diagnosis group (n = 22) based on the presence or absence of delayed sleep onset and/or prolonged nightwakings and compared on the parent-report symptom domains. RESULTS: Almost one-quarter of the OSAS group had clinically significant behavioral sleep problems, primarily bedtime resistance, in addition to OSAS. Bedtime resistance was associated with a significantly shortened sleep duration in both the BSD and OSAS-BSD groups. Although the OSAS-BSD group had less severe disease, as defined by polysomnographic variables, than the pure OSAS group, they were rated by their parents as having more daytime externalizing behavior problems associated with daytime sleepiness. CONCLUSIONS: The results of this study suggest that evaluation for comorbid BSD should be done in all children presenting with symptoms of OSAS. The coexistence of such BSDs may contribute significantly to sleep deprivation, and thus to behavioral manifestations of daytime sleepiness in these children.

Child↗

Decreasing aggressive, agitated, or disruptive behavior: perticipation in a behavior management unit.

A 32-bed Behavior Management Unit was opened in a long-term care facility to care for dementia patients who exhibit aggressive, agitated, or disruptive (AAD) behaviors. The purpose of the study was to evaluate the effectiveness of the Behavior Management Program (BMP) in decreasing such behaviors. The sample consisted of all patients (N = 32) who resided in the unit for at least 3 months. The Nursing Home Behavior Problem Scale (NHBPS) was used to collect data. Hypothesis 1, predicting participation in the BMP would decrease the total number of AAD behaviors was supported, with a significant decrease from the baseline to 6-month measurements. Hypothesis 2, predicting participation in the BMP would decrease the frequency of occurrence of specific AAD behaviors was supported, with 7 behaviors being significantly reduced by 6 months. Nurses in long-term care often treat patients with AAD behavior. Because staff members on general long-term care units and even in dementia units may not be experts in caring for patients with AAD behaviors, the implications of this study might be helpful. The interventions that were effective in reducing AAD behaviors included verbal distraction, time-outs, activity diversion, getting to know the patient well, and managing the environment.

Adult↗

Effects of castration on problem behaviors in male dogs with reference to age and duration of behavior.

OBJECTIVE: To determine whether 9 problem behaviors in adult male dogs were affected by castration and to examine the influence of age and duration of problem behavior on behavioral effects of castration. DESIGN: Cohort study. ANIMALS: 57 male dogs > 2 years old at the time of castration that had > or = 1 of the targeted problem behaviors. PROCEDURE: Data were collected by telephone contact with owners to identify dogs that had > or = 1 problem behavior before castration and to estimate the improvement (ie, decrease) in the objectionable behaviors after castration. Problem behaviors of interest included urine marking in the house, mounting, roaming, fear of inanimate stimuli, aggression toward human family members, aggression toward unfamiliar people, aggression toward other dogs in the household, aggression toward unfamiliar dogs, and aggression toward human territorial intruders. RESULTS: Effects of castration on fear of inanimate stimuli or aggression toward unfamiliar people were not significant. For urine marking, mounting, and roaming, castration resulted in an improvement of > or = 50% in > or = 60% of dogs and an improvement of > or = 90% in 25 to 40% of dogs. For remaining behaviors, castration resulted in an improvement of > or = 50% in < 35% of dogs. Significant correlations were not found between the percentage of improvement and age of the dog or duration of the problem behavior at the time of castration. CLINICAL IMPLICATIONS: Castration was most effective in altering objectionable urine making, mounting, and roaming. With various types of aggressive behavior, including aggression toward human family members, castration may be effective in decreasing aggression in some dogs, but fewer than a third can be expected to have marked improvement. Age of the dog or duration of the problem behavior does not have value in predicting whether castration will have a beneficial effect.

Aggression↗

Social and behavioral factors associated with high-risk sexual behavior among adolescents.

Relationships among risky sexual behaviors, other problem behaviors, and the family and peer context were examined for two samples of adolescents. Many adolescents reported behaviors (e.g., promiscuity or nonuse of condoms) which risked HIV or other sexually transmitted disease infection. Such risky behaviors were significantly intercorrelated. Consistent condom use was rare among those whose behavior otherwise entailed the greatest risk of infection. In both samples, an index of high-risk sexual behavior was significantly related to antisocial behavior, cigarette smoking, and illicit drug or alcohol use. Social context variables, including family structure, parenting practices, and friends' engagement in problem behaviors, were associated with high-risk sexual behavior. Finally, for sexually active adolescents, problem behaviors and social context variables were predictive of nonuse of condoms. Results were consistent across the two studies and regression weights held up well under cross-validation.

Adolescent↗

Individual differences in biobehavioral organization during problem-solving in toddlers: the influence of maternal behavior, infant-mother attachment, and behavioral inhibition on the attachment-exploration balance.

The aim of the study was to investigate the influence of maternal behavior, infant-mother attachment, and behavioral inhibition on the biobehavioral organization of toddlers during a primary non-attachment-related challenging context. In a sample of 76 toddlers, quality of attachment (secure, avoidant, ambivalent, disorganized) was assessed at 12 months. At 22 months, the subjects were observed in a challenging task according to [Matas et al. (1978) Child Development 49: 547-556], and salivary cortisol was assessed before and afterwards. Behavioral analyses included child task orientation and exploration, help seeking, proximity seeking, and attachment-exploration-balance as well as maternal supportive presence and quality of assistance. Behavioral inhibition was assessed from maternal reports. Findings from concurrent analyses indicate relations between toddler behavior and adrenocortical function and the importance of concurrent maternal support for toddler behavior. Longitudinal analyses showed that quality of attachment predicted task orientation, help seeking behavior, and the quality of the attachment-exploration-balance, while behavioral inhibition was related to approach to the task. In line with previous findings, adrenocortical activation was found only in insecure infants with high behavioral inhibition indicating the function of attachment security as a social buffer against less adaptive temperamental dispositions. Finally, within-group analyses indicated a social regulation pattern in secure toddlers while the behavior of insecure ones was additionally linked to behavioral inhibition and physiological reactivity.

Adaptation, Psychological↗

Anxiety behavior, exploratory behavior, and activity in NZB x NZW F1 hybrid mice: role of genotype and autoimmune disease progression.

Behavioral changes often accompany the autoimmune disease systemic lupus erythematosus (SLE) in humans and animals. In a mouse model of SLE, the NZB x NZW F1 (B/W) hybrid, 12-week-old mice display more anxiety behavior, less activity, and less exploratory behavior than non-autoimmune female NZW mice. To determine whether these behaviors result from the autoimmune disease or genetic differences between B/W and NZW mice, they were assessed prior to and during disease emergence (6 and 12 weeks of age, respectively). B/W mice were less active at both ages, suggesting a genetic component to this behavioral difference. Anxiety behavior and exploratory behavior did not differ between B/W and NZW mice at 6 weeks; however, at 12 weeks B/W mice displayed more anxiety behavior and less exploratory behavior, indicating that these behaviors were related with the development of autoimmune disease. Prior experience with these tasks increased anxiety behavior in B/W but not NZW mice, suggesting that B/W mice may be more sensitive to anxiogenic experiences.

Aging↗

Cognitive-behavioral mediators of changing multiple behaviors: smoking and a sedentary lifestyle.

BACKGROUND: A significant percentage of the U.S. population has multiple poor health behaviors. Understanding the relationship among these behavioral risk factors is important for designing effective multiple risk factor interventions. While there is some evidence suggesting that participation in physical exercise may have a positive impact on smoking cessation, there is much to be learned about the relationships between cognitive-behavioral (self-efficacy, decisional-balance) and motivational mechanisms (stage of change) which have been shown to mediate changes in both exercise and smoking behavior. METHODS: The sample comprised 332 smokers employed at two workplaces-a government agency and a medical center-recruited as part of a larger worksite health promotion project and who completed questionnaires on their smoking and exercise behaviors. RESULTS: The results revealed significant relationships between smoking variables and exercise variables. Smokers who rated as important the positive benefits of smoking also rated as important the costs associated with increased physical activity. Similarly, the negative consequences of smoking were significantly associated with the positive benefits of physical activity. Self-efficacy for one behavior was significantly associated with self-efficacy for the other. Significant differences by exercise and smoking stage of change were found on the cross-behavior sets of variables (self-efficacy, pros, cons). Smokers who were contemplating a more active lifestyle reported the negative consequences of smoking to be significantly more important to them than smokers who were not considering adoption of a more active lifestyle. Smokers who were exercising regularly reported significantly more confidence in their ability to refrain from smoking than smokers not exercising regularly. Finally, smokers preparing for quitting reported less confidence in their ability to exercise than smokers who had already taken action to change their smoking behavior. CONCLUSIONS: The cognitive mechanisms associated with changes in smoking behavior are related to the cognitive variables which have been shown to predict changes in exercise behavior. Significant relationships in mediating mechanisms including decisional balance and self-efficacy between smoking and exercise provide preliminary information on how change in one risk behavior may relate to change in another. These associations have implications for future intervention research and for methods research on multiple risk factors interactions.

Adult↗

Effect of first-grade classroom environment on shy behavior, aggressive behavior, and concentration problems.

Investigates the effect of the first-grade classroom environment on the shy behavior, aggressive behavior, and concentration problems of 609 children in 19 East Baltimore public schools. First-grade classroom environment was assessed in terms of dominant pattern of classroom achievement and behavior. Structured teacher ratings assessed child shy behavior, aggressive behavior, and concentration problems at the end of first grade. Children in low-achieving classroom environments had significantly higher teacher ratings of shy behavior and aggressive behavior than children in mixed-achieving or high-achieving environments, even after controlling for potentially confounding child characteristics and classroom behavior environment effects. Analyses controlling for child characteristics and classroom achievement environment effects indicated that children in poor-behaving classroom environments also had significantly higher teacher ratings of shy behavior than children who were not in poor-behaving environments. Subgroup analyses indicated that repeaters in mixed-achieving environments had significantly higher levels of shy behavior compared with nonrepeaters, and repeaters in poor-behaving environments had significantly higher levels of aggressive behavior compared with nonrepeaters. Implications for prevention research are discussed.

Achievement↗

Has behavior therapy drifted from its experimental roots? A survey of publication trends in mainstream behavioral journals.

In recent years it has been suggested that behavior therapy, characterized in part by single-subject designs and an idiographic approach to addressing practical problems, is drifting from its experimental roots. To examine trends in behavior therapy, and to provide an objective index of drift, two archival studies were conducted to identify publication trends in the use of single-subject designs vs. group designs, as well as citations to select basic behavioral science journals. In Study 1, articles appearing in Behavior Therapy from 1970 through 1996 were reviewed and categorized in terms of type of article, design, and citations to experimental journals. Findings from Study 1 suggest declining publication trends in single-subject designs and citations to experimental journals in Behavior Therapy, with a modest increase in the use of group designs over the period. Study 2 was designed to replicate and extend our initial findings by surveying three behavioral journals in addition to Behavior Therapy using the PsychLit database and years covering 1974 through 1996: Behaviour Research and Therapy, Journal of Behavior Therapy and Experimental Psychiatry, and Behavior Modification. Consistent with Study 1, results of Study 2 showed declining trends in single-subject designs for all mainstream behavioral journals. The significance of these findings in light of the argument that behavior therapy has drifted from its experimental roots is discussed, with emphasis on contingencies that may be responsible for the trends observed.

Behavior Therapy↗

Central lactogenic regulation of maternal behavior in rats: steroid dependence, hormone specificity, and behavioral potencies of rat prolactin and rat placental lactogen I.

Adult virgin female rats display maternal behavior when continuously exposed to foster young for 5-6 days. Central infusions of PRL or placental lactogens (PLs) together with systemic treatment of progesterone (P) and estradiol (E2) stimulate maternal behavior in 1-2 days. In the present set of studies, it was asked whether the actions of lactogenic hormones are dependent upon both E2 and P and specific to lactogenic molecules. Moreover, we wanted to know whether central infusions of rat (r) PRL and PLs were equally effective in inducing maternal behavior. In the first study, adult virgin rats were ovariectomized (ovx) and stereotaxically fitted with bilateral cannulas directed at the medial preoptic area (MPOA). Rats were then assigned to one of four groups: P plus E2, blank (B) plus E2, P plus B, and B plus B. P-filled or B capsules were implanted sc on treatment day 1 and removed on day 11, whereas E2 or B capsules were implanted on day 11. All groups were infused with rPRL (40 ng/side) five times from days 11-13 and injected with bromocriptine (CB-154) sc (days 11-17) to suppress endogenous PRL release. Behavioral testing was conducted daily from days 12-17. It was found that exposure to both P and E2 was necessary to induce a fast onset of maternal behavior in PRL-infused females; priming with P or E2 alone in PRL-treated rats failed to stimulate a fast onset of behavior relative to that in nonsteroid-treated controls. In the second experiment to determine the biochemical specificity of PRL's action, adult nulliparous rats were ovx, implanted with bilateral cannulas directed at the MPOA, treated with both P and E2, injected with CB-154, and infused centrally (five times) with 40 ng (per side) of bovine GH, ovine LH, or vehicle. Central infusions of either bovine GH or ovine LH failed to stimulate maternal behavior, suggesting that the stimulatory actions of PRL are related to its lactogenic properties. In the final study, rats were ovx, fitted with bilateral cannulas directed at the MPOA; treated with P, E2, and CB-154; and given a single set of bilateral infusions of rPL-I or rPRL (40 ng/side.infusion) on day 11, three sets of infusions of rPL-I or rPRL (days 11 and 12), or vehicle infusions. Rats given three infusions of rPL-I and rPRL responded faster than controls, although the effect was not as robust as that in animals given five infusions in the initial study. rPL-I and rPRL groups did not differ from one another. Together these studies indicate that 1) both P and E2 are required for lactogenic stimulation of maternal behavior; 2) the stimulatory actions of PRL and rPLs on maternal behavior are related to their lactogenic properties; 3) extended treatment of females with lactogenic hormones is more effective in stimulating the onset of maternal behavior; and 4) the neural potencies of rPRL and rPL-I are similar. These findings provide support for the idea that the induction of maternal behavior is stimulated by the central actions of lactogenic hormones.

Animals↗