BACKGROUND:Interventions for smoking cessation have been typically evaluated on reactively recruited samples in clinical trials (efficacy trials). However, to have an impact on smoking rates in a general population, the intervention should also be evaluated with proactively recruited representative samples (effectiveness trials).PURPOSE:The characteristics of participants and two groups of nonparticipants recruited for a population-based nicotine replacement therapy study were compared.METHODS:All members of a large New England Veterans' Administration Medical Center were contacted, and interviews were completed with 3,239 identified smokers (at least 10 cigarettes per day). At the end of the interview, all smokers were offered participation in a multiple intervention study. Of the interviewed smokers, 2,915 verbally agreed to participate in the study (90%). Of those who gave initial verbal consent, 2,054 returned the written informed consent form and became participants (70%).RESULTS:The participants (full consent group) differed significantly from both nonparticipant groups-that is, the smokers who were interviewed but declined participation by active refusal (survey only group) and those who gave verbal consent but passively refused participation by failing to return the written consent form (verbal consent only group). Participants were more likely to be married, younger, and female; to live with others; and to have previously used or considered using nicotine replacement therapy. The survey only group was also more likely to be in the precontemplation stage (54%), whereas the participants were more likely to be in the contemplation (46%) or preparation stage (35%). The verbal consent only group was intermediate of the other two groups in stage-of-change characteristics.CONCLUSIONS:An important finding was that it is possible to recruit a large proportion of a sample of identified smokers to an nicotine replacement therapy study. However, the participants are likely to differ in significant ways from those who either actively or passively decline participation.

Background . Stress levels among Americans are considerable. This research examined Transtheoretical Model of Behavior Change (TTM) constructs for stress management in groups organized by longitudinal progress (dynatypes): Maintainers, Relapsers, and Stable Non-Changers. Methods . Secondary data analysis of a computer-tailored intervention group examined construct use over time across the three groups. Adults (n=427) meeting criteria for not engaging in stress management behaviors at baseline comprised the analytic sample. Participants received three TTM-tailored feedback interventions to help facilitate change at baseline, 3 and 6 months. Demographics, Stage of Change, 10 Processes of Change, Decisional Balance (Pros and Cons), and Self-Efficacy were assessed at baseline, 6, 12, and 18 months. Repeated measures MANOVA followed by ANOVAs, with Tukey follow-up tests assessed differences in use of TTM constructs longitudinally across dynatype groups. Results . Ten of the 13 TTM constructs differentiated between Successful Changers and Stable Non-Changers at baseline and over time. Relapsers were more similar to Successful Changers than to Stable Non-Changers in their use of all constructs, except Self-Efficacy. Conclusion . Findings suggest that baseline cognitive and behavioral constructs can improve prediction of different intervention outcomes 18 months later.

The understanding that immunity could be strengthened in the general population (e.g., through vaccine interventions) supported global advances upon acute infectious disease epidemics in the eighteenth, nineteenth, and twentieth centuries. However, in the twenty-first century, global populations face chronic disease epidemics. Research demonstrates that diseases largely emerge from health risk behavior. The understanding of how health behavior, like the biological immune system, can be strengthened in the general population, could support advances in the twenty-first century. To consider how health behavior can be strengthened in the general population, the authors present a theoretical model of population health behavior. The model operationalizes health behavior as a system of functions that, like the biological immune system, exists in each member of the population. Constructs are presented that operationalize the specific decisions and habits that drive health behavior and behavior change in the general population. The constructs allow the authors to present parallels (1) among existing behavior change theories and (2) between the proposed system and the biological immune system. Through these parallels, the authors introduce a model and a logic of population-level health behavior change. The Adaptive Behavioral Immune System is an integrative model of population health behavior.

Presents an obituary for Peter F. Merenda (1922-2019). Peter received his bachelor of science in math and physics and master of arts in education at Tufts, where he was also in the Navy Reserve Officers' Training Corps. He became an ensign and served in the Navy during World War II. After the war he served as director of research at the Naval Training Center and earned his PhD in counseling and statistics at the University of Wisconsin in 1957. In 1960, Peter cofounded the Departments of Psychology and Computer Science/Statistics at the University of Rhode Island. He was chair of psychology for 12 years at the University of Rhode Island and president of the New England Psychological Association (NEPA), the Rhode Island Psychological Association (RIPA), and the International Council of Psychologists (ICP) as well as chair of ICP conventions in Norway, East and West Germany, England, and Paris. And Peter was a captain in the Navy, a position of which he was particularly proud. Inspired, in part, by his Sicilian heritage, Peter served for 5 years as codirector of Project Talent in Sicily. This project informed national development plans for manpower and priority occupations. Peter's contributions were honored by awards from his community; state (RIPA); region (NEPA); APA Karl Heiser Presidential Award for Distinguished Scientific Contributions (Division 5); James McKeon Cattell Fellow Award; and awards from Portugal, the Republic of China, and Italy. Peter's contributions also included being influential in building an outstanding quantitative psychology specialty. Over the years, faculty like Wayne F. Velicer (1944 -2017), Lisa Harlow, and Joseph S. Rossi have been recognized as high-impact authors in quantitative and health psychology. Amazing it is that one person could accomplish so much and so well, while being so close to his wife, Rose, whom he met in elementary school when they were both 12. Rose (1922-2014) was a professor at Rhode Island College and an expert in early childhood education. Peter Francis Merenda was a remarkable individual who lived an extraordinary life, impacting people far and wide. In his 97-plus years, Peter accomplished much and gave back much to others- his family, friends, colleagues, students, community, country, and internationally. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Objective: The objective of this research is to provide the first empirical data to support the phenomenon of coprogression, which can be defined as the extent to which progressing toward healthy criteria on one behavior is associated with progressing toward healthy criteria on a second behavior at the same follow-up time point for individuals who met risk criteria for both behavior risks at baseline. Methods: Participants (N=9,461) were predominantly middle-aged (M= 43.9 years, SD=10.74), White (93.8%), and female (65.4%) adults from the United States who were proactively recruited by telephone. Each participant met criteria for both behavior risks at baseline and were assessed at 24-month follow-up for the following three behavior pairs: 1) smoking and diet, 2) smoking and unprotected sun exposure, and 3) unprotected sun exposure and diet. All participants were randomized to either the TTM-tailored treatment condition (N=4,800) or the assessment-only control (N=4,661). Results: Twenty-six out of 27 odds ratios (ORs) revealed that participants were more likely to progress toward healthy criteria on both behaviors in each behavior pair than progressing to criteria on only the second behavior in each behavior pair. Conclusion: The significant results and occurrence of 26/27 ORs being greater than 1.0 provide empirical support for including coprogression as a phenomenon in the emerging science of multiple health behavior change (MHBC).

Cancer patients frequently experience considerable distress during diagnosis and treatment. The aims of this study were to describe the development and utilization of a psychological service for cancer patients at a community hospital—and to provide preliminary results on clinical outcomes in a “real-world” clinical setting. This program was developed collaboratively by individuals from a university-based clinical psychology doctoral program and a community hospital. The psychological service was comprised of a licensed, PhD-level clinical psychologist and seven clinical psychology doctoral students. Patients were typically referred by their oncologists or nurses. Distress, depression, and anxiety were evaluated for a small subsample of participants. From the time the program was initiated, 238 patients between ages 18 and 95 (M = 66.4) were evaluated over a 3-year period. Most patients (77.8%) were offered psychosocial care. Although 49.8% declined treatment, 23.6% attended one session and 26.6% attended two or more. Average number of individual sessions was 2.77 (SD=8.31, range=0-96) and 0.06 (SD=0.43, range=0-4) for groups sessions. Patients referred through the Survivorship Training and Rehabilitation (STAR) Program® (i.e., a program providing multidisciplinary services) were more likely to engage in psychosocial care than those who found out about behavioral health in other ways. Patients experienced declines in depression (Wilks’ Λ=.580, F(2, 14)=5.08, p=.022), but not anxiety (Wilks’ Λ=.613, F(2, 12)=3.79, p=.053) across sessions. Two in-depth case descriptions are provided. Distress tracking may be improved if nurses, oncologists, and behavioral health providers administer measures. Partnerships between clinical psychology doctoral programs and hospitals may be mutually beneficial – and may advance the dissemination and implementation of evidence-based psychosocial interventions. Hospitals offering cancer treatment may benefit from generating referrals for comprehensive cancer care. These efforts can serve as a model for other hospitals seeking to integrate behavioral health into routine cancer treatment.

Objectives Uptake of psychosocial services during cancer treatment remains relatively low. To use these services efficiently, novel approaches - based on evidence-based theory - are needed to understand cancer patients' readiness to seek psychosocial services. Guided by the transtheoretical model (TTM), we investigated individuals' readiness to use psychosocial services by assessing decisional conflict (pros/cons) and self-efficacy, which are established as the most important constructs of predicting a specific behavior. Methods In these secondary analyses, we examined demographic and treatment-related factors in a national sample of adult cancer patients and survivors in the United States as predictors of decisional balance (pros/cons) and self-efficacy (i.e., two core TTM constructs) of engaging in psychosocial services. Participants were recruited through an online survey. In addition to examining demographic factors (age, sex, race, and marital status) as independent variables using t tests and correlations, treatment-related variables, such as having multiple cancers, type of cancer, type of treatment, and treatment setting were included. Results Four hundred and sixty-six participants completed the survey. The sample was primarily Caucasian (79%) and female (54.7%); average age was 47.9 (SD = 14.8). While no significant relationships emerged for self-efficacy, younger age and non-Caucasian race were significantly related to greater cons of seeking psychosocial care. Finally, those with multiple cancers versus reporting only one malignancy endorsed more cons of seeking psychosocial care. Conclusions These data highlight the importance of measuring the cons of seeking psychosocial care during cancer treatment, with younger age, non-Caucasian, and those reporting experience with multiple cancers endorsing greater cons. This may impact eventual uptake of available services. Future research should identify individuals at risk for declining services based on perceived cons of seeking psychosocial care during cancer.

Emphases on biomarkers (e.g. when making diagnoses) and pharmaceutical/ drug methods (e.g. when researching/disseminating population level interventions) in primary care evidence philosophies of health (and healthcare) that reduce health to the biological level. However, with chronic diseases being responsible for the majority of all cause deaths and being strongly linked to health behavior and lifestyle; predominantly biological views are becoming increasingly insufficient when discussing this health crisis. A philosophy that integrates biological, behavioral, and social determinants of health could benefit multidisciplinary discussions of healthy publics. This manuscript introduces a Philosophy of Health by presenting its first five principles of health. The philosophy creates parallels among biological immunity, health behavior change, social change by proposing that two general functions-precision and variation-impact population health at biological, behavioral, and social levels. This higher-level of abstraction is used to conclude that integrating functions, rather than separated (biological) structures drive healthy publics. A Philosophy of Health provides a framework that can integrate existing theories, models, concepts, and constructs.

To have a significant and sustainable impact on attaining and maintaining healthy behaviors, the Transtheoretical Model of Behavior Change addresses the needs of entire populations, not just the minority who are motivated to take immediate action for better health. The six stages of change are outlined as well as the 10 processes of change or strategies to progress from one stage to the next. Digitally assisted interventions tailored to specific stages of change allow programs supported by computer-based tools and methodologies to be interactive and individualized for treatment and prevention of entire populations with risk behaviors like smoking, inactivity, unhealthy diets, alcohol misuse, and ineffectively managed stress. Digitally assisted interventions include mobile phones, personal digital assistants, smartphones, portable media players, tablets, and smart books. The devices have a range of functions from mobile cellular communication using text messages, photos and videos, telephone, and worldwide web access to multimedia playback and software application support. They allow temporal synchronization of the intervention delivery and allow the intervention to engage people’s attention when it is most relevant. The chapter presents examples of transtheoretical, digitally assisted interventions for use by both clients and coaches. Evidence is presented that compares the effectiveness of the digital programs.

Over the past 40 years, few breakthroughs have dramatically increased the impacts of psychotherapy. There have been new and exciting therapies, but the research does not convincingly demonstrate that any recent or more established therapies produce greater impacts than 40 years ago. Seven strategies from the transtheoretical model that have produced breakthroughs in health psychology/population health are analyzed to illustrate how they can similarly generate breakthroughs in mental health outcomes. The first three strategies can enhance impacts by increasing the percentage of troubled populations entering and completing best-practice treatments: reach, recruit, and retain. The fourth strategy accords higher value to synergy than to specificity by generating more benefits from whole-health therapies that briefly treat the small number of behaviors that account for a large percentage of chronic disabilities and premature deaths. The fifth breakthrough strategy creates multiple synergistic changes within individuals; changing one problem behavior promotes the probabilities that individuals will change a second problem (coaction). The sixth strategy increases impacts by complementing psychologists with tailored technology that extends their influence into homes, schools, workplaces, and communities. The seventh strategy calls on researchers to test their innovations against best practices and to benchmark outcomes, like those found with depression. We conclude by advancing a framework that can generate more inclusive and effective psychotherapies by integrating individual health care with population health practices. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Objective: Cancer is one of the most physically and emotionally debilitating diseases. Despite evidence that psychosocial care can improve psychological and physiological functioning, as few as 4.4% of patients are willing to engage in psychosocial treatment. Few studies explored drivers of psychosocial care underutilization. Therefore, treatment engagement strategies are needed, by identifying patients' barriers to psychosocial treatment. This study evaluated readiness to utilize psychosocial care by developing transtheoretical model (TTM) measures of stage of change, decisional balance, and self-efficacy. Method: Online survey data was collected from a national sample of 475 adults (M-age = 47.89, SD = 14.77) with cancer diagnoses. A sequential process of measure development was used. Semistructured expert and research participant interviews were conducted for initial item development, followed by exploratory, confirmatory, and external validation analyses. Results: Principal components analyses (PCA) indicated two, 4-item factors (pros alpha = .874; cons alpha = .716) for decisional balance. Confirmatory factor analyses (CFA) supported a 2-factor correlated model, chi(2)(19) = 68.56, CFI = .962, RMSEA = .078. For self-efficacy, PCA indicated two, 3-item components (physical alpha = .892; social/emotional alpha = .708). CFA supported this structure chi(2)(8) = 23.72, CFI = .989, RMSEA = .067. Physical component items included fatigue, pain, and discomfort. Multivariate analyses indicated significant cross-stage differences for pros, cons, and self-efficacy. Conclusions: Findings support the validity of the developed stage of change, 8-item decisional balance, and 6-item self-efficacy measures for psychosocial care. Clinicians could use these tools to address perceived cons of psychosocial care, including shame and self-efficacy (e.g., using psychosocial care despite pain). These scales may help treatment teams better address barriers to psychosocial care utilization.

The transtheoretical model outlines important dimensions of intentional behavior change from an integrative perspective. Stages describe the motivational and temporal dimension and the critical multidimensional tasks involved in creating sustained change. Processes are an eclectic set of cognitive/experiential and behavioral coping activities that act as mechanisms or engines of change that drive completion of stage tasks. The chapter summarizes the origins of the approach, its applicability and structure, therapeutic relationship, and diversity considerations. A case example illustrates its assessment and treatment foundations. The transtheoretical approach has demonstrated utility in tailoring treatment and predicting outcomes across a variety of health, mental health, and addictive behaviors.

The Transtheoretical Model (TTM) postulates that change is a process that unfolds over time through a series of stages: Precontemplation, Contemplation, Preparation, Action, Maintenance, and Termination. The TTM is also based on critical assumptions about the nature of behavior change and population health interventions that can best facilitate such change. One potential is for TTM to treat multiple behaviors in a population since most populations have multiple behavior risks and are at risk for both chronic disease and premature death. Critics of the TTM have several core concerns. These include how well TTM constructs predict outcomes compared to non-TTM variables and whether TTM constructs predict progress across stages of change in the way that TTM should predict. Historically, studies conducted on multiple behavior changes have been limited by reliance on the action-oriented treatment and the lack of applying the most promising interventions, such as interactive and individualized TTM-tailored interventions.

The Dietary Guidelines for Americans recommend a 20–35 percent daily intake of fat. Resisting the temptation to eat high-fat foods, in conjunction with stage of readiness to avoid these foods, has been shown to influence healthy behavior change. Data ( N = 6516) from three randomized controlled trials were pooled to examine the relationships among direct intervention effects on temptations and stage of change for limiting high-fat foods. Findings demonstrate separate simultaneous growth processes in which baseline level of temptations, but not the rate of change in temptations, was significantly related to the change in readiness to avoid high-fat foods.