The combination of economic and social costs associated with non-communicable diseases provide a compelling argument for developing strategies that can influence modifiable risk factors, such as ...discrete food choices. Models of behaviour, such as the Theory of Planned Behaviour (TPB) provide conceptual order that allows program designers and policy makers to identify the substantive elements that drive behaviour and design effective interventions. The primary aim of the current review was to examine the association between TPB variables and discrete food choice behaviours. A systematic literature search was conducted to identify relevant studies. Calculation of the pooled mean effect size (r(+)) was conducted using inverse-variance weighted, random effects meta-analysis. Heterogeneity across studies was assessed using the Q- and I(2)-statistics. Meta-regression was used to test the impact of moderator variables: type of food choice behaviour; participants' age and gender. A total of 42 journal articles and four unpublished dissertations met the inclusion criteria. TPB variables were found to have medium to large associations with both intention and behaviour. Attitudes had the strongest association with intention (r(+) = 0.54) followed by perceived behavioural control (PBC, r(+) = 0.42) and subjective norm (SN, r(+) = 0.37). The association between intention and behaviour was r(+) = 0.45 and between PBC and behaviour was r(+) = 0.27. Moderator analyses revealed the complex nature of dietary behaviour and the factors that underpin individual food choices. Significantly higher PBC-behaviour associations were found for choosing health compromising compared to health promoting foods. Significantly higher intention-behaviour and PBC-behaviour associations were found for choosing health promoting foods compared to avoiding health compromising foods. Participant characteristics were also found to moderate associations within the model. Higher intention-behaviour associations were found for older, compared to younger age groups. The variability in the association of the TPB with different food choice behaviours uncovered by the moderator analyses strongly suggest that researchers should carefully consider the nature of the behaviour being exhibited prior to selecting a theory.
Objective: Too much sitting is associated with an increased risk of chronic disease and premature death. This investigation aimed to systematically review the evidence for personality as a correlate ...of time spent in sedentary pursuits. Method: Electronic databases (PubMed; Science Direct; PsycINFO, PsycARTICLES, and SPORTDiscus via EBSCO; Web of Science; MEDLINE via Ovid; Scopus; ProQuest) were searched in December 2015 for studies reporting an association between at least 1 personality trait and time spent in at least 1 sedentary behavior. Pooled mean effect sizes were computed using inverse-variance weighted random effects meta-analysis. Results: Twenty-six studies (28 samples, 110 effect sizes) met inclusion criteria. Higher levels of sedentary behavior were associated with higher levels of neuroticism (r+ = .08, 95% confidence interval CI: .05, .10) and lower levels of conscientiousness (r+ = −.08, 95% CI −.11, −.06). Nonsignificant associations were observed for extraversion (r+ = .00, 95% CI −.07, .06), openness (r+ = −.02, 95% CI −.05, .02), and agreeableness (r+ = −.04, 95% CI −.09, .00). Effects for neuroticism and extraversion were moderated by measurement of sedentary behavior, and effects for openness and agreeableness were moderated by participant age and gender. Conclusions: Findings appear consistent with personality trait associations with other health-related behaviors. More objective measures of sedentary behavior are required to make more definitive conclusions about the contribution of personality to a sedentary lifestyle.
: To gauge the public health impact of new nicotine products, information is needed on use among different populations. Aims were to assess in adults who smoked, vaped, did both or had recently ...stopped: (1) awareness, ever and current use of heated tobacco products (HTPs) and nicotine pouches (NP), (2) characteristics associated with ever use, (3) reasons for use of and satisfaction with HTPs, (4) characteristics associated with interest in use of HTPs.
: Online survey in the UK in 2019,
= 3883. (1) Proportion aware, ever and current (≥monthly) use; (2) ever use regressed onto socio-demographics and smoking/vaping; (3) frequency of reasons for HTP use and satisfaction; (4) interest in trying HTPs regressed onto socio-demographics and smoking/vaping status.
: Awareness was 34.8% for HTP and 15.9% for NP; current use was 3.2% and 2.7%. Being <45 years, higher education, living in London and currently both smoking and vaping were associated with ever having used the products. Curiosity was the most common reason for HTP use (79.8%) and 72.0% of ever HTP users found them at least as satisfying as smoking. Among those not currently using HTPs, 48.5% expressed any interest-lower among those aged over 65 and higher among those smoking and vaping.
: In this sample of adults with a history of nicotine use, very few currently used heated tobacco products or nicotine pouches. Satisfaction with and interest in HTPs were substantial. The low level of use is unlikely to substantially reduce the public health impact of smoking.
Background and aims
Evidence on the effectiveness of electronic cigarettes (ECs) to facilitate abstinence from smoking is limited. The current study aimed to estimate the relative effectiveness of ...ECs and smoking cessation medication compared with using no help, accounting for frequency of use of ECs.
Design
Four consecutive wave‐to‐wave transitions (waves 1–2, 2–3, 3–4 or 4–5) of a longitudinal online survey collected between 2012 and 2017 were analysed. Time between waves ranged between 12 and 17 months. Cigarette smokers at the baseline wave who attempted to quit smoking between waves were included.
Setting
United Kingdom
Participants
A total of 1155 respondents (aged 18–81, 56.1% male, 64.6% in social grade C2DE, 93.8% white) provided 1580 pairs of observations for the primary analysis.
Measurements
Primary outcome: abstinence from smoking for at least 1 month at follow‐up; secondary outcome: at least 1 month's abstinence from smoking between baseline and follow‐up. The main predictor was stop smoking aid used (No help, nicotine replacement therapy only, smoking cessation medication only, disposable/cartridge EC, refill/modular EC, combination), adjusted for demographics.
Findings
Primary Compared with using no help, the odds of abstinence were increased by daily use of disposable/cartridge ECs (OR = 3.31 (1.32, 8.26), P = .010) and daily use of refill/modular ECs (OR = 5.47 (2.70, 11.11), P < .001). Odds were reduced by non‐daily use of disposable/cartridge ECs (OR = 0.23 (0.08–0.63), P = .005), and by use of disposable/cartridge ECs to quit and no longer using at follow‐up (OR = 0.10 (0.16–0.62), P < .013). Secondary Results were similar to the primary outcome; however, odds of abstinence were also increased by use of smoking cessation medication (OR = 4.15 (1.79, 9.62), P = .001).
Conclusions
When used daily, electronic cigarettes appear to facilitate abstinence from smoking when compared with using no help.
Purpose
The primary aim of this study was to review the evidence on the impact of a change in intention on behaviour and to identify (1) behaviour change techniques (BCTs) associated with changes in ...intention and (2) whether the same BCTs are also associated with changes in behaviour.
Methods
A systematic review was conducted to identify interventions that produced a significant change in intention and assessed the impact of this change on behaviour at a subsequent time point. Each intervention was coded using a taxonomy of BCTs targeting healthy eating and physical activity. A series of meta‐regression analyses were conducted to identify effective BCTs.
Results
In total, 25 reports were included. Interventions had a medium‐to‐large effect on intentions (d+ = 0.64) and a small‐to‐medium effect (d+ = 0.41) on behaviour. One BCT, ‘provide information on the consequences of behaviour in general’, was significantly associated with a positive change in intention. One BCT, ‘relapse prevention/coping planning’, was associated with a negative change in intention. No BCTs were found to have significant positive effects on behaviour. However, one BCT, ‘provide feedback on performance’, was found to have a significant negative effect. BCTs aligned with social cognitive theory were found to have significantly greater positive effects on intention (d+ = 0.83 vs. 0.56, p < .05), but not behaviour (d+ = 0.35 vs. 0.23, ns), than those aligned with the theory of planned behaviour.
Conclusions
Although the included studies support the notion that a change in intention is associated with a change in behaviour, this review failed to produce evidence on how to facilitate behaviour change through a change in intention. Larger meta‐analyses incorporating interventions targeting a broader range of behaviours may be warranted.
Statement of contribution
What is already known on this subject?
Prior research on the causal relationship between intention and behaviour has produced mixed findings.
Further experimental research to determine the precise nature of these variables is clearly warranted.
However, precise guidance on how to change intention is still lacking.
What does this study add?
This study aimed to identify behaviour change techniques associated with changes in intention and behaviour.
Techniques with positive effects on intention were identified; however, these did not have an impact on behaviour.
Larger meta‐analyses incorporating interventions targeting a broader range of behaviours may be warranted.
Background and Aims
People with mental ill health are more likely to smoke and experience smoking‐related harm than those without. Switching from combustible tobacco to lower‐risk nicotine‐containing ...products may be of benefit; however, misperceptions of harm may prevent their use. We aimed to assess, among adults with and without mental ill health, (1) perceptions of harm from nicotine and relative harm and addictiveness of different nicotine‐containing products and (2) sources of information associated with harm perceptions.
Design
Cross‐sectional study.
Setting and Participants
On‐line survey of adults (n = 3400) who smoke cigarettes and/or use e‐cigarettes, or have recently stopped, in the United Kingdom.
Measurements
Outcomes: harm perceptions of nicotine; relative perceived harm and addictiveness of different nicotine‐containing products; sources of information for harm perceptions of nicotine, cigarette smoking and e‐cigarettes. Demographics: sex, age, education, ethnic group and region. Other measures: self‐reported smoking, vaping and mental health status. Analyses: frequencies and logistic regressions adjusting for demographic/other measures.
Findings
Among those with serious mental distress (versus no/low mental distress): 9.6% 13.9%, adjusted odds ratio (aOR) = 0.69, 95% confidence interval (CI) = 0.50–0.97 correctly identified that none/a very small amount of the health risks of smoking cigarettes come from nicotine; 41.7% (53.5%, aOR = 0.67, 95% CI = 0.54–0.84) perceived e‐cigarettes and 53.2% (70.3%, aOR = 0.62, 95% CI = 0.50–0.77) perceived nicotine replacement therapy to be less harmful than cigarettes; and 42.1% (51.3%, aOR = 0.77, 95% CI = 0.62–0.95) perceived e‐cigarettes as being less likely than cigarettes to cause cancer, 35.4% (45.5%, aOR = 0.71, 95% CI = 0.57–0.88) heart attacks and 34.9% (42.3%, aOR = 0.80, 95% CI = 0.64–0.99) lung problems. The most popular sources of information for cigarette smoking, e‐cigarettes and nicotine were scientific experts’ opinions and media reports, with little variation by mental distress.
Conclusions
Among adults with a history of tobacco and/or e‐cigarette use, those with serious mental distress appear to have less accurate harm perceptions of nicotine and nicotine‐containing products than those with no/low distress, despite reporting similar sources of information.
The English network of stop-smoking services (SSSs) is among the best-value life-preserving clinical intervention in the UK NHS and is internationally renowned. However, success varies considerably ...across services, making it important to examine the factors that influence their effectiveness.
Data from 126,890 treatment episodes in 24 SSSs in 2009-10 were used to assess the association between intervention characteristics and success rates, adjusting for key smoker characteristics. Treatment characteristics examined were setting (eg, primary care, specialist clinics, pharmacy), type of support (eg, group, one-to-one) and medication (eg, varenicline, single nicotine replacement therapy (NRT), combination of two or more forms of NRT). The main outcome measure was abstinence from smoking 4 weeks after the target quit date, verified by carbon monoxide concentration in expired air.
There was substantial variation in success rates across intervention characteristics after adjusting for smoker characteristics. Single NRT was associated with higher success rates than no medication (OR 1.75, 95% CI 1.39 to 2.22); combination NRT and varenicline were more successful than single NRT (OR 1.42, 95% CI 1.06 to 1.91 and OR 1.78, 95% CI 1.57 to 2.02, respectively); group support was linked to higher success rates than one-to-one support (OR 1.43, 95% CI 1.16 to 1.76); primary care settings were less successful than specialist clinics (OR 0.80, 95% CI 0.66 to 0.99).
Routine clinic data support findings from randomised controlled trials that smokers receiving stop-smoking support from specialist clinics, treatment in groups and varenicline or combination NRT are more likely to succeed than those receiving treatment in primary care, one-to-one and single NRT. All smokers should have access to, and be encouraged to use, the most effective intervention options.
Pharmacological treatments for tobacco dependence, such as nicotine replacement therapy (NRT), have been shown to be safe and effective interventions for smoking cessation. Higher levels of adherence ...to these medications increase the likelihood of sustained smoking cessation, but many smokers use them at a lower dose and for less time than is optimal. It is therefore important to determine the effectiveness of interventions designed specifically to increase medication adherence. Such interventions may include further educating individuals about the value of taking medications and providing additional support to overcome problems with maintaining adherence.
The primary objective of this review was to assess the effectiveness of interventions to increase adherence to medications for smoking cessation, such as NRT, bupropion, nortriptyline and varenicline (and combination regimens). This was considered in comparison to a control group, typically representing standard care. Secondary objectives were to i) assess which intervention approaches are most effective; ii) determine the impact of interventions on potential precursors of adherence, such as understanding of the treatment and efficacy perceptions; and iii) evaluate key outcomes influenced by prior adherence, principally smoking cessation.
We searched the following databases using keywords and medical subject headings: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE (OVID SP) (1946 to July Week 3 2014), EMBASE (OVID SP) (1980 to Week 29 2014), and PsycINFO (OVID SP) (1806 to July Week 4 2014). The Cochrane Tobacco Addiction Group Specialized Register was searched on 9th July 2014. We conducted forward and backward citation searches.
Randomised, cluster-randomised or quasi-randomised studies in which participants using active pharmacological treatment for smoking cessation are allocated to an intervention arm or a control arm. Eligible participants were adult (18+) smokers. Eligible interventions comprised any intervention that differed from standard care, and where the intervention content had a clear principal focus on increasing adherence to medications for tobacco dependence. Acceptable comparison groups were those that provided standard care, which depending on setting may comprise minimal support or varying degrees of behavioural support. Included studies used a measure of adherence behaviour that allowed some assessment of the degree of adherence.
Two review authors searched for studies and independently extracted data for included studies. Risk of bias was assessed according to the Cochrane Handbook guidance. For continuous outcome measures, we report effect sizes as standardised mean differences (SMDs). For dichotomous outcome measures, we report effect sizes as relative risks (RRs). We obtained pooled effect sizes with 95% confidence intervals (CIs) using the fixed effects model.
Our search strategy retrieved 3165 unique references and we identified 31 studies as potentially eligible for inclusion. Of these, 23 studies were excluded at full-text screening stage or identified as studies awaiting classification subject to further information. We included eight studies involving 3336 randomised participants. The interventions were all additional to standard behavioural support and typically provided further information on the rationale for, and emphasised the importance of, adherence to medication, and supported the development of strategies to overcome problems with maintaining adherence.Five studies reported on whether or not participants achieved a specified satisfactory level of adherence to medication. There was evidence that adherence interventions led to modest improvements in adherence, with a relative risk (RR) of 1.14 (95% CI, 1.02 to 1.28, P = 0.02, n = 1630). Four studies reported continuous measures of adherence to medication. Although the standardised mean difference (SMD) favoured adherence interventions, the effect was small and not statistically significant (SMD 0.07, 95% CI, -0.03 to 0.17, n = 1529). Applying the GRADE system, the quality of evidence for these results was assessed as moderate and low, respectively.There was evidence that adherence interventions led to modest improvements in rates of cessation. The relative risk for achieving abstinence was similar to that for improved adherence. It was not significant in meta-analysis of four studies providing short-term abstinence: RR = 1.07 (95% CI 0.95 to 1.21, n = 1755), but there was statistically significant evidence of improved abstinence at six months or more from a different set of four studies: RR = 1.16 (95% CI, 1.01 to 1.34, P = 0.03, n = 3049). Applying the GRADE system, the quality of evidence for these results was assessed as low for both.As interventions were similar in nature and the number of studies was low, it was not possible to investigate whether different types of intervention approaches were more effective than others. Relevant outcomes other than adherence or cessation were not reported.There was no evidence that interventions to increase adherence to medication led to any adverse events. All included studies were assessed as at high or unclear risk of bias. This was often due to a lack of clarity in reporting - meaning assessments were unclear - rather than clear evidence of failing to sufficiently safeguard against the risk of bias.
There is some evidence that interventions that devote special attention to improving adherence to smoking cessation medication through providing information and facilitating problem-solving can improve adherence, though the evidence for this is not strong and is limited in both quality and quantity. There is some evidence that such interventions improve the chances of achieving abstinence but again the evidence for this is relatively weak.
Background and Aims
The presence and content of health warning labels (HWLs) on nicotine vaping products (NVPs), such as electronic cigarettes, varies by country and manufacturer. We compared ...proportions of people who report (i) noticing HWLs on NVPs and (ii) feeling concerned having noticed HWLs, by country and by smoking or vaping status. We also examined recall of HWL content and whether this varies by country.
Design
Cross‐sectional survey.
Setting
Australia (AU), Canada (CA), England (EN) and the United States (US). At the time of data collection, HWLs on NVPs were only mandatory in EN.
Participants
A total of 11 561 respondents from the following samples in the 2016 International Tobacco Control Four Country Project: (1) re‐contacted smokers and quitters who had participated in the previous wave of the project; (2) newly recruited current smokers and recent quitters; and (3) newly recruited current vapers from CA, EN and US.
Measurements
Outcomes included: (1) having noticed HWLs on NVPs, (2) feeling concerned having noticed HWLs, and (3) recall of HWL message content.
Findings
Compared with respondents in EN, respondents in CA were more likely to report having noticed HWLs odds ratio (OR) = 1.58, P = 0.02, whereas respondents in AU (OR = 0.76, P = 1.00) and the US (OR = 1.54, P = 0.09) were not significantly more or less likely to report having noticed HWLs. Compared with concurrent smokers and vapers, daily smokers, non‐daily smokers and quitters were less likely to report having noticed HWLs (ORs = 0.21, 0.33 and 0.19, respectively, all P < 0.001). There were no significant differences in reports of noticing HWLs when comparing concurrent smokers and vapers with daily (OR = 1.62, P = 0.91) or non‐daily (OR = 1.15, P = 1.00) vapers. There were no significant differences by country in reporting that HWLs made them concerned about using NVPs. Daily vapers were less likely to report feeling concerned than concurrent users (OR = 0.11, P = 0.017). Among those who reported reading HWLs (n = 688), there was little evidence of differences in recall of the HWL content.
Conclusions
Respondents in England, where health warning labels on nicotine vaping products are mandatory, were not significantly more likely to report having noticed such warnings than those in Australia, Canada and the United States where warnings are not mandatory.
The methods employed to measure behaviour in research testing the theories of reasoned action/planned behaviour (TRA/TPB) within the context of health behaviours have the potential to significantly ...bias findings. One bias yet to be examined in that literature is that due to common method variance (CMV). CMV introduces a variance in scores attributable to the method used to measure a construct, rather than the construct it represents. The primary aim of this study was to evaluate the impact of method bias on the associations of health behaviours with TRA/TPB variables. Data were sourced from four meta-analyses (177 studies). The method used to measure behaviour for each effect size was coded for susceptibility to bias. The moderating impact of method type was assessed using meta-regression. Method type significantly moderated the associations of intentions, attitudes and social norms with behaviour, but not that between perceived behavioural control and behaviour. The magnitude of the moderating effect of method type appeared consistent between cross-sectional and prospective studies, but varied across behaviours. The current findings strongly suggest that method bias significantly inflates associations in TRA/TPB research, and poses a potentially serious validity threat to the cumulative findings reported in that field.
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