Goldstein, M., DePue, J. et al. (2005). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer and receive regular mammograms.

The transtheoretical model of health behavior change is described and supporting empirical work is presented that reviews the central constructs of the model: the stages of change, processes of change, decisional balance, confidence, and temptation. Model-based applications to a broad range of problem behaviors are summarized. Applications to human immunodeficiency virus (HIV) prevention behavior changes are highlighted for each variable. Finally, several questions about the area of sexual behavior change to reduce risk of HIV exposure are explored and future research ideas are described within the context of this model.

No abstract

Objective-This study was designed to compare the initial efficacy of Motivational Interviewing (MI), Online Transtheoretical Model (TTM) Tailored communications and a brief Health Risk Intervention (HRI) on four health risk factors (inactivity, BMI, stress and smoking) in a worksite sample.Method-A randomized clinical trial assigned employees to one of three recruitment strategies and one of the three treatments. The treatment protocol included an HRI session for everyone and in addition either a recommended three TTM online sessions or three MI in person or telephone sessions over 6 months. At the initial post-treatment assessment at six months, groups were compared on the percentage who had progressed from at-risk to taking effective action on each of the four risks.Results-Compared to the HRI only group, the MI and TTM groups had significantly more participants in the Action stage for exercise and effective stress management and significantly fewer risk behaviors at 6 months. MI and TTM group outcomes were not different. Conclusion: This was the first study to demonstrate that MI and online TTM could produce significant multiple behavior changes. Future research will examine the long-term impacts of each treatment, their cost effectiveness, effects on productivity and quality of life, and process variables mediating outcomes. KeywordsMultiple behavior change; Motivational Interviewing; TTM Tailoring; exercise; stress; smoking; BMI Increasingly it is recognized that a major barrier to dissemination of evidence-based health promotion programs is that most programs were not designed or developed to reach at-risk populations (Glasgow et al., 2003). They were designed for and evaluated on self-selected samples of at-risk individuals. For example, in the United States Public Health Services Corresponding Author: James O. Prochaska, Ph.D., Cancer Prevention Research Center, 2 Chafee Road, University of Rhode Island, Kingston, RI 02881, Tel: 401-874-2830, Fax: 401-874-5562, jop@uri.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. 1996 Clinical Guidelines for the Treatment of Tobacco, over 3,000 studies on tobacco were identified. The Guidelines were able to recommend a broad range of evidence-based interventions for motivated smokers; i.e., those prepared to quit in the next month (Fiore et al., 1996). There were no evidence-based interventions recommended for unmotivated smokers, even though they make up more than 80% of all U.S. smokers (Velicer et al., 1995) and more than 90% of daily smokers (Wewers et al., 2003). In the second edition of the Guidelines there w...

The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient settings.