Related Articles

Objective

To investigate the contribution of personal, social and environmental factors to mediating socioeconomic (educational) inequalities in women's leisure‐time walking and walking for transport.

Methods

A community sample of 1282 women provided survey data on walking for leisure and transport; educational level; enjoyment of, and self‐efficacy for, walking; physical activity barriers and intentions; social support for physical activity; sporting/recreational club membership; dog ownership; and perceived environmental aesthetics and safety. These data were linked with objective environmental data on the density of public open space and walking tracks in the women's local neighbourhood, coastal proximity and street connectivity.

Results

Multilevel modelling showed that different personal, social and environmental factors were associated with walking for leisure and walking for transport. Variables from all three domains explained (mediated) educational inequalities in leisure‐time walking, including neighbourhood walking tracks; coastal proximity; friends' social support; dog ownership; self‐efficacy, enjoyment and intentions. On the other hand, few of the variables examined explained educational variations in walking for transport, exceptions being neighbourhood, coastal proximity, street connectivity and social support from family.

Conclusions

Public health initiatives aimed at promoting, and reducing educational inequalities in, leisure‐time walking should incorporate a focus on environmental strategies, such as advocating for neighbourhood walking tracks, as well as personal and social factors. Further investigation is required to better understand the pathways by which education might influence walking for transport.

Background

Over half of kidney cancer survivors (KCS) are completely inactive and only a quarter are meeting physical activity (PA) guidelines. This highlights the need to identify and understand the determinants of PA in this understudied population. The purpose of this study is to determine the social cognitive correlates of PA intention and behavior in KCS using the Theory of Planned Behavior (TPB).

Methods

All 1,985 KCS diagnosed between 1996 and 2010 in Alberta, Canada were mailed a self-report survey that consisted of the Godin Leisure Time Exercise Questionnaire and standard TPB items for intention, planning, perceived behavioral control (PBC), affective and instrumental attitudes, and descriptive and injunctive norms. Standard demographic and medical variables were also collected.

Results

Completed surveys were received from 703 of 1,654 (43%) eligible KCS. The TPB was tested using structural equation modelling and demonstrated an adequate-to-good fit to the data [χ² = 256.88, p < .001; TLI = 0.97; CFI = 0.98; RMSEA = 0.06, 90% CI = 0.05-0.06].

There were significant pathways to PA from PBC (ß = 0.18, p = 0.02), planning (ß = 0.22, p < 0.01), and intention (ß = 0.31, p < 0.01); and to planning from intention (ß = 0.81, p < 0.01). In addition, there were significant model pathways to intention from instrumental attitude (ß = 0.28, p = 0.03), descriptive norm (ß = 0.09, p = 0.01), and PBC (ß = 0.52, p < 0.01). Overall, the TPB accounted for 69%, 63%, and 42% of the variance in intention, planning and PA, respectively.

Conclusion

The TPB appears to be a useful model for explaining PA in KCS. All TPB constructs except injunctive norm and affective attitude were useful for explaining intention with PBC emerging as the largest correlate. Developing PA interventions based on the TPB may be effective in promoting PA in KCS and may lead to important improvements in health.

Study objective: To examine the relation between adults' perceptions of the social and physical environment and their self reported walking behaviour.

Design: Cross sectional survey.

Setting: England.

Participants: A national sample of 4265 adults aged 16–74 years.

Main outcome measures: Self reported walking behaviour was categorised into two dichotomous variables: (a) any reported walking in past four weeks, (b) reported walking ⩾150 minutes per week in the past four weeks. Perceptions of the social environment covered safety of walking alone and social support for walking. Perceptions of the physical environment covered attractiveness of local area for walking, access to shops, leisure centres, parks, cycle paths, and traffic density.

Main results: In women, perceived safety of walking during the day (OR = 0.53; 95% CI: 0.31 to 0.88), and no shop within walking distance (OR = 0.72; 95% CI: 0.52 to 0.99) were associated with any reported walking occasions. Perceptions of the environment were not related to women walking ⩾150 min/week. In men, having a park within walking distance was associated with walking ⩾150 min/week (OR = 2.22; 95% CI: 1.18 to 4.35). No other significant associations were found.

Conclusions: Women seem to be more concerned about walking for utility and in safety. Men are more likely to walk ⩾150 min/week if they have access to a local park but their walking is not influenced by concerns about safety. Future research should focus on the relation between objective measures rather than perceptions of the environment and physical activity.

Background

Limited research has been conducted on gender differences in perceived environmental correlates of physical activity (PA). The purpose of this study was to explore the potential role of gender in the link between perceived environment and PA.

Methods

Using a telephone-administered survey, data was collected on leisure time physical activity (LTPA), perceptions of the neighbourhood environment, and self-efficacy in a representative sample of 1209 adults from the province of Alberta, Canada. LTPA was regressed on ten measures of perceived neighbourhood environment and self-efficacy in a series of logistic regressions.

Results

Women were more likely than men to perceive their neighbourhood as unsafe to go for walks at night (χ2 = 67.46, p < 0.001) and to report seeing people being active in their neighbourhood (χ2 = 6.73, p < 0.01). Conversely, women were less likely to perceive easy access to places for PA (χ2 = 11.50, p < 0.01) and availability of places to buy things within easy walking distance from home (χ2 = 4.30, p < 0.05). Adjusting for age, education, income, and place of residence, access to places for PA (OR = 2.49) and interesting things to look at in the neighbourhood (OR = 1.94), were associated with higher levels of LTPA in men. Access to places for PA (OR = 2.63) and reporting seeing people being active (OR = 1.50) were associated with increased LTPA among women. After controlling for sociodemographic variables and self-efficacy, the presence of shops and places to buy things within easy walking distance from home (OR = 1.73), interesting things to look at in the neighbourhood (OR = 1.65), and access to places for PA (OR = 1.82) were associated with higher levels of LTPA in men. Among women, no significant relationships were observed between perceived environment and LTPA after adjusting for self-efficacy.

Conclusion

The results provide additional support for the use of models in which gender is treated as a potential moderator of the link between the perceived environment and PA. Further, the results suggest the possibility of differential interventions to increase PA based on factors associated with gender.

Background

To facilitate access to the prevention of mother-to-child HIV transmission (PMTCT) services, HIV counselling and testing are offered routinely in antenatal care settings. Focusing a cohort of pregnant women attending public and private antenatal care facilities, this study applied an extended version of the Theory of Planned Behaviour (TPB) to explain intended- and actual HIV testing.

Methods

A sequential exploratory mixed methods study was conducted in Addis Ababa in 2009. The study involved first time antenatal attendees from public- and private health care facilities. Three Focus Group Discussions were conducted to inform the TPB questionnaire. A total of 3033 women completed the baseline TPB interviews, including attitudes, subjective norms, perceived behavioural control and intention with respect to HIV testing, whereas 2928 completed actual HIV testing at follow up. Data were analysed using descriptive statistics, Chi-square tests, Fisher's Exact tests, Internal consistency reliability, Pearson's correlation, Linear regression, Logistic regression and using Epidemiological indices. P-values < 0.05 was considered significant and 95% Confidence Interval (CI) was used for the odds ratio.

Results

The TPB explained 9.2% and 16.4% of the variance in intention among public- and private health facility attendees. Intention and perceived barriers explained 2.4% and external variables explained 7% of the total variance in HIV testing. Positive and negative predictive values of intention were 96% and 6% respectively. Across both groups, subjective norm explained a substantial amount of variance in intention, followed by attitudes. Women intended to test for HIV if they perceived social support and anticipated positive consequences following test performance. Type of counselling did not modify the link between intended and actual HIV testing.

Conclusion

The TPB explained substantial amount of variance in intention to test but was less sufficient in explaining actual HIV testing. This low explanatory power of TPB was mainly due to the large proportion of low intenders that ended up being tested contrary to their intention before entering the antenatal clinic. PMTCT programs should strengthen women's intention through social approval and information that testing will provide positive consequences for them. However, women's rights to opt-out should be emphasized in any attempt to improve the PMTCT programs.

Background

The predictive value of the psychosocial constructs of Theory of Planned Behaviour (TPB) on subsequent dietary habits has not been previously investigated in a multivariate approach that includes demographic factors and past dietary behaviour among adults. The aim of this study was to investigate to what extent TPB constructs, including intention, attitudes, subjective norms, perceived behavioural control, and perceived social norms, measured at age 25 predicted four eating behaviours (intake of fruits and vegetables, whole grains, total fat and added sugar) eight years later.

Methods

Two hundred and forty men and 279 women that participated in the Oslo Youth Study were followed from 1991 to 1999 (mean age 25 and 33 years, respectively). Questionnaires at baseline (1991) included the constructs of the TPB and dietary habits, and at follow-up (1999) questionnaires included demographic factors and diet. For the assessment of diet, a food frequency questionnaire (FFQ) with a few food items was used at baseline while an extensive semi-quantitative FFQ was used at follow-up.

Results

Among men, attitudes, subjective norms and previous eating behaviour were significant predictors of fruit and vegetable intake, while education and past eating behaviour were predictive of whole grain intake in multivariate analyses predicting dietary intake at follow-up. For women, perceived behavioural control, perceived social norms and past behaviour were predictive of fruit and vegetable intake, while subjective norms, education and past eating behaviour were predictive of whole grain intake. For total fat intake, intention was predictive for men and perceived behavioural control for women. Household income and past consumption of sugar-rich foods were significant predictors of added sugar intake among men, while past intake of sugar-rich foods was a significant predictor of added sugar intake among women.

Conclusion

After adjusting for potential confounding factors, all psychosocial factors assessed among young adults appeared predictive of one or more eating behaviours reported eight years later. Results point to the influence of psychosocial factors on future eating behaviours and the potential for interventions targeting such factors.

Despite research indicating that effective parenting plays an important protective role in adolescent risk behaviors, few studies have applied theory to examine this link with marijuana use, especially with national data. In the current study (N=2,141), we hypothesized that parental knowledge (of adolescent activities and whereabouts) and parental warmth are antecedents of adolescents’ marijuana beliefs—attitudes, subjective norms, and perceived behavioral control—as posited by the Theory of Planned Behavior (TPB; Ajzen 1991). These three types of beliefs were hypothesized to predict marijuana intention, which in turn was hypothesized to predict marijuana consumption. Results of confirmatory factor analyses corroborated the psychometric properties of the two-factor parenting structure as well as the five-factor structure of the TPB. Further, the proposed integrative predictive framework, estimated with a latent structural equation model, was largely supported. Parental knowledge inversely predicted pro-marijuana attitudes, subjective norms, and perceived behavioral control; parental warmth inversely predicted pro-marijuana attitudes and subjective norms, ps<.001. Marijuana intention (p<.001), but not perceived behavioral control, predicted marijuana use 1 year later. In households with high parental knowledge, parental warmth also was perceived to be high (r=.54, p<.001). Owing to the analysis of nationally representative data, results are generalizable to the United States population of adolescents 12–18 years of age.

Background

In Denmark, it has recently become mandatory for all dairy farmers with more than 100 cows to sign up for a herd health programme. Three herd health programmes are available. These differ in a number of aspects, including the frequency of veterinary visits and the farmer’s access to prescription drugs. The objective of this study was to investigate whether dairy farmers’ behavioural intentions, i.e. to call a veterinarian or start medical treatment on the day that they detect a cow with mild clinical mastitis (MCM), are different depending on the type of herd health programme.

Methods

A questionnaire survey based on the Theory of Planned Behaviour (TPB) was conducted. TPB proposes that a person’s behavioural intention is strongly correlated with his or her actual behaviour. Three behavioural factors determine the behavioural intention: attitude, subjective norm and perceived behavioural control. Each of these factors is decided by a set of beliefs, each of which in turn is weighted by an evaluation: 1) the expected outcomes of performing the behaviour, 2) what a person believes that others think of the behaviour, and 3) the person’s perceived power to influence the behaviour.

A set of statements about the treatment of MCM based on interviews with 38 dairy farmers were identified initially. The statements were rephrased as questions and the resulting questionnaire was distributed to 400 randomly selected Danish dairy farmers who use the two most restrictive herd health programmes, either Core or Module1, and to all 669 farmers with the least restrictive herd health programme, Module2. The association between intention and the herd health programme was modelled using logistic regression.

Results

The farmers with the Module2 herd health programme had a significantly higher behavioural intention to perform the behaviour, when compared to farmers with a more restrictive herd health programme (OR = 2.1, p < 0.0001).

Conclusion

Danish dairy farmers who participate in Module2 herd health programme had a higher intention to treat cases of MCM, compared to farmers who participate in a more restrictive herd health programme in which the veterinarian initiates treatments.

Greek-affiliated college students have been found to drink more heavily and frequently than other students. With female student drinking on the rise over the past decade, sorority women may be at particular risk for heavy consumption patterns. The current study is the first to apply the Theory of Planned Behavior (TPB) to examine drinking patterns among a sorority-only sample. Two-hundred and forty-seven sorority members completed questionnaires measuring TPB variables of attitudes, norms, perceived behavioral control, and intentions, with drinking behaviors measured one month later. Latent structural equation modeling examined the pathways of the TPB model. Intentions to drink mediated the relationship between attitudes and norms on drinking behavior. Subjective norms predicted intentions to drink more than attitudes or perceived behavioral control. Perceived behavioral control did not predict intentions but did predict drinking behaviors. Interpretation and suggestions from these findings are discussed.

Background

Intention is a key determinant of action. However, there is a gap between intention and behavioural performance that remains to be explained. Therefore, the aim of this study was to identify moderators of the intention-behaviour and perceived behavioural control (PBC)- behaviour relationships for leisure-time physical activity.

Method

This was tested in reference to Ajzen's Theory of Planned Behaviour. A sample of 300 volunteers, 192 women and 108 men, aged 18 to 55, participated in the study. At baseline, the participants completed a self-administrated psychosocial questionnaire assessing Ajzen's theory variables (i.e., intention and perceived behavioural control). The behavioural measure was obtained by mail three months later.

Results

Multiple hierarchical regression analyses indicated that age and annual income moderated the intention-behaviour and PBC-behaviour relationships. However, in the final model predicting behaviour (R2 = .46), only the interaction term of PBC by annual income (β = .24, p = 0.0003) significantly contributed to the prediction of behaviour along with intention (β = .49, p = 0.0009) and past behaviour (β = .44, p < 0.0001).

Conclusion

Physical activity promotion programs would benefit not only from focusing on increasing the intention of low intenders, but also from targeting factors that moderate the perceived behavioural control-behaviour relationships.

Objectives

To investigate the relation between perceived neighbourhood environment, social contact and support, and self efficacy, on the health of older people.

Design

British cross sectional population survey of people aged 65 and over.

Participants

999 people aged 65 plus living at home in Britain.

Results

Regression modelling showed that high self efficacy had a strong independent association with better self rated health status and physical functioning. Indicators of perceived neighbourhood environment that showed strong associations with both good health and functioning were: perceptions of good quality facilities in the area (social/leisure, facilities for people aged 65+, rubbish collection, health services, transport, closeness to shops, somewhere nice to walk), and high levels of neighbourliness (knows/trusts people). Perceptions of problems in the area (noise, crime, air quality, rubbish/litter, traffic, graffiti) were also predictive of poorer health. Measures of social contact and support did not show any independent associations with health or functioning.

Conclusions

The unique value of this paper is in the simultaneous analysis of associations between perceived neighbourhood, social contact and support, self efficacy, and health. The consistent strength of older people's perceptions of the quality of facilities in their neighbourhoods shows that responsive reinforcement of local infrastructures might have wider health benefits. Also of interest was the strength of self efficacy as a predictor of self rated health and physical functioning. The results have implications for both neighbourhood level interventions and self management programmes in chronic illness.

The authors investigated whether a causal-indicator model or an effect-indicator model of the theory of planned behavior (TPB) is more suitable for predicting behavioral intention and for which behaviors. No previous studies have evaluated this question using the same sample and same behavior. In this study, African American adolescents ages 12–17 participating in risk reduction classes were assessed on their initial attitudes, norms, perceived control, and intention regarding condom use. Second-order structural equation modeling indicated that the effect-indicator model exhibited superior fit above the causal-indicator model. Furthermore, modeling the behavioral antecedents in a causal way may not be as accurate due to the underlying uni-dimensional nature of attitudes, subjective norms, and control. The TPB was not disconfirmed as a suitable model for African American adolescents’ regarding condom use. Prevention programs may benefit by focusing on adolescent behavior change with regard to the global components in order to influence more specific concepts of these social cognitions. Editors’ Strategic Implications: Despite limitations including correlational data, this study yields implications for prevention programming and, more broadly, an important theoretical elaboration on effect-indicator and causal-indicator models of the TPB.

Background

The promotion of physical activity among an overweight/obese population is an important challenge for clinical practitioners and researchers. In this regard, completing a questionnaire on cognitions could be a simple and easy strategy to increase levels of physical activity. Thus, the aim of the present study was to test the effect of completing a questionnaire based on the Theory of Planned Behavior (TPB) on the level of physical activity.

Methods

Overall, 452 overweight/obese adults were recruited and randomized to the experimental or control group. At baseline, participants completed a questionnaire on cognitions regarding their participation in leisure-time physical activity (experimental condition) versus a questionnaire on fruit and vegetable consumption (control condition). The questionnaires assessed the TPB variables that are beliefs, attitude, norm, perception of control, intention and a few additional variables from other theories. At three-month follow-up, leisure-time physical activity was self-reported by means of a short questionnaire. An analysis of covariance with baseline physical activity level as covariate was used to verify the effect of the intervention.

Results

At follow-up, 373 participants completed the leisure-time physical activity questionnaire. The statistical analysis showed that physical activity participation was greater among participants in the experimental condition than those in the control condition (F(1,370) = 6.85, p = .009, d = 0.20).

Conclusions

Findings indicate that completing a TPB questionnaire has a significant positive impact on subsequent participation in physical activity. Consequently, asking individuals to complete such a questionnaire is a simple, inexpensive and easy strategy to increase the level of physical activity among overweight/obese adults.

Objective

To identify factors associated with intention to attend a hypothetical eye health test and provide an evidence base for developing an intervention to maximise attendance, for use in studies evaluating glaucoma screening programmes.

Design

Theory-based cross-sectional survey, based on an extended Theory of Planned Behaviour (TPB) and the Common Sense Self-Regulation Model, conducted in June 2010.

Participants

General population including oversampling from low socioeconomic areas.

Setting

Aberdeenshire and the London Boroughs of Lewisham and Southwark, UK.

Results

From 867 questionnaires posted, 327 completed questionnaires were returned (38%). In hierarchical regression analysis, the three theoretical predictors in the TPB (Attitude, Subjective norm and Perceived Behavioural Control) accounted for two-thirds of the variance in intention scores (adjusted R2=0.65). All three predictors contributed significantly to prediction. Adding ‘Anticipated regret’ as a factor in the TPB model resulted in a significant increase in prediction (adjusted R2=0.74). In the Common Sense Self-Regulation Model, only illness representations about the personal consequences of glaucoma (How much do you think glaucoma would affect your life?) and illness concern (How concerned are you about getting glaucoma?) significantly predicted. The final model explained 75% of the variance in intention scores, with ethnicity significantly contributing to prediction.

Conclusions

In this population-based sample (including over-representation of lower socioeconomic groupings), the main predictors of intention to attend a hypothetical eye health test were Attitude, Perceived control over attendance, Anticipated regret if did not attend and black ethnicity. This evidence informs the design of a behavioural intervention with intervention components targeting low intentions and predicted to influence health-related behaviours.

Article summary

Article focus

The current UK practice of opportunistic case finding during routine sight tests misses a majority of those with glaucoma. Early detection and treatment of glaucoma reduces the risk of blindness.

The feasibility and cost-effectiveness of screening programmes is largely determined by uptake by the target population.

This study identified empirical evidence, based on models of behaviour change, to inform the design of an intervention to maximise uptake.

Key messages

Intention to attend an eye health check to detect glaucoma is associated with positive Attitude, Perceived control over screening attendance, Anticipated regret if test is not attended, perceived consequences of glaucoma and black ethnicity. These factors can be targeted in an intervention to maximise uptake.

Strengths and limitations of this study

This study is the largest of its kind and uses a robust methodology based on plausible models of change to identify potential barriers to attendance for eye care.

The response rate was 38%, which is higher than generally achieved in similar population-based surveys.

There was evidence to suggest that this sample was representative of the target population (general population with over-representation of black ethnicity or of low socioeconomic status).

Background

Doing regular physical activity has positive effects on health. Several environmental factors are identified as important correlates of physical activity. However, there seems to be a difference between perceived and objective measures of the environment. This study examines the influence of physical activity, neighbourhood walkability, and socio-demographic characteristics on the correspondence between self-reported and objectively measured walking time to urban destinations of adults in the city of Ghent (Belgium).

Methods

Previously collected survey data was used from 1164 respondents in the city of Ghent who reported walking times to various closest destinations in the neighbourhood of residence. These were compared with corresponding walking times that were objectively measured through geographical information systems. Physical activity was recorded over a 7-day period using accelerometers. Neighbourhood walkability was assessed on the basis of residential density, connectivity, and land-use mix.

Results

We observed a relatively poor agreement between objective and perceived walking times. Stronger agreements were noted amongst the most physically active group, while low-level walkers tended to overestimate walking time. Surprisingly, however, people residing in a low-walkable neighbourhood underestimated walking times more frequently relative to those in high-walkable neighbourhoods.

Conclusions

Researchers investigating the influence of environmental attributes on physical activity behavior should thus be cautious when using only self-reported environmental data, since these are a priori influenced by physical activity levels and various socio-demographic factors.

Background

Walking is a popular form of physical activity and a convenient option to prevent chronic diseases. However, most of the evidence on this topic derives from high-income countries and little is known about walking patterns and its association with environmental features in low and middle income countries.

Objectives

To describe walking for leisure and to identify its association with perceived environment and personal factors among residents of three state capitals from different regions of Brazil

Methods

Cross sectional phone surveys were conducted in Recife, Curitiba and Vitória (n = 6,166) in 2007, 2008 and 2009 respectively. Physical activity was measured using the leisure-time sections of the long version of the International Physical Activity Questionnaire (IPAQ). Perceived environment characteristics were assessed using a modified version of the Neighborhood Environment Walkability Scale (NEWS). Multivariable analysis tested the associations between walking for leisure and perceived environment characteristics across the cities using logistic regression.

Results

The proportions of respondents meeting physical activity recommendations through walking for leisure were 9.6%, 16.0% and 8.8% in Curitiba, Recife and Vitoria, respectively. Engaging in 150 min/wk or more of walking for leisure was significantly associated with younger age, higher education, better self-rated health and with lack of sidewalks on nearby streets. We did not find positive associations between walking for leisure and traffic conditions and safety related to cycling/walking during the day or night.

Conclusion

Most environmental features were not associated with walking for leisure. Personal factors were stronger predictors of walking for leisure as compared with perceived environment factors.

Objectives

To investigate whether, and to what extent, perceived barriers to neighbourhood walking (BTNW) may be associated with physical activity levels.

Design

Prospective survey with 12‐month follow‐up.

Subjects and methods

750 people attending walking schemes throughout England and Scotland; 551 completed the follow‐up. independent variables were demographic characteristics, examples of possible “external” barriers to walking—for example, “worries about personal safety”, and one item concerning ill health. The main outcome measures were “metabolic equivalent” (MET) hours' walking and overall physical activity in the preceding week.

Results

Baseline and follow‐up demographic characteristics were similar and physical activity levels generally high. Leisure walking changed little over 12 months, while total physical activity levels reduced significantly from a mean (SD) of 71.26 (78.14) MET hours per week at baseline to 59.57 (181.40) at the 12‐month follow‐up (p<0.001). External BTNW cited between baseline and 12 months increased significantly from a mean (SD) of 1.24 (1.61) at baseline to 1.43 (1.72) at the 12‐month follow‐up (p<0.001); only “worries about personal safety” reduced. A significant association was found between citing a health‐related BTNW and the total number of external BTNW that were reported at baseline. The strength of this association increased over 12 months. Neither changes in reporting external BTNW that occurred over 12 months (increased vs decreased, vs unchanged) nor changes in the presence of a health‐related BTNW were significantly related to levels of leisure walking and overall physical activity (MET hours in the preceding week) over the same period.

Conclusion

Among older people who attended walking schemes, having a health problem that restricted walking had a detrimental influence on people's perceptions about external BTNW, which increased over time. Actual levels of walking and overall physical activity levels did not appear to be significantly affected by this.

Background

Despite strong support for predictive validity of the theory of planned behavior (TPB) substantial variance in both intention and behavior is unaccounted for by the model’s predictors. The present study tested the extent to which habit strength augments the predictive validity of the TPB in relation to a currently under-researched behavior that has important health implications, namely children’s active school travel.

Method

Participants (N = 126 children aged 8–9 years; 59 % males) were sampled from five elementary schools in the west of Scotland and completed questionnaire measures of all TPB constructs in relation to walking to school and both walking and car/bus use habit. Over the subsequent week, commuting steps on school journeys were measured objectively using an accelerometer. Hierarchical multiple regressions were used to test the predictive utility of the TPB and habit strength in relation to both intention and subsequent behavior.

Results

The TPB accounted for 41 % and 10 % of the variance in intention and objectively measured behavior, respectively. Together, walking habit and car/bus habit significantly increased the proportion of explained variance in both intention and behavior by 6 %. Perceived behavioral control and both walking and car/bus habit independently predicted intention. Intention and car/bus habit independently predicted behavior.

Conclusions

The TPB significantly predicts children’s active school travel. However, habit strength augments the predictive validity of the model. The results indicate that school travel is controlled by both intentional and habitual processes. In practice, interventions could usefully decrease the habitual use of motorized transport for travel to school and increase children’s intention to walk (via increases in perceived behavioral control and walking habit, and decreases in car/bus habit). Further research is needed to identify effective strategies for changing these antecedents of children’s active school travel.

Background

Several neighbourhood elements have been found to be related to leisure-time walking and cycling. However, the association with neighbourhood safety remains unclear. This study aimed to assess the association of neighbourhood-level safety with leisure-time walking and cycling among Dutch adults.

Methods

Data were derived from the national health survey (POLS) 2006–2009, with valid data on 20046 respondents residing in 2127 neighbourhoods. Multilevel logistic regression models were used to examine the association between neighbourhood-level safety (general safety and specific safety components: physical disorder, social disorder, crime-related fear, traffic safety) and residents’ engagement in outdoor leisure-time walking and cycling for at least 30 minutes per week.

Results

An increase in neighbourhood safety (both general safety and each of the safety components) was significantly associated with an increase in leisure-time cycling participation. Associations were strongest for general safety and among older women. In the general population, neighbourhood safety was not significantly associated with leisure-time walking. However, among younger and older adult men and lower educated individuals, an increase in general safety was associated with a decrease in leisure-time walking participation.

Conclusions

In the Netherlands, neighbourhood safety appears to be related to leisure-time cycling but not to walking. Leisure-time cycling may best be encouraged by improving different safety components at once, rather than focusing on one safety aspect such as traffic safety. Special attention is needed for older women.

Background

Despite evidence of the benefits of exercise in cancer survivors, exercise participation rates tend to decline after treatments. Few studies have examined the determinants of exercise in less common cancer sites. In this study, we examined medical, demographic, and social cognitive correlates of exercise in endometrial cancer survivors using the Theory of Planned Behavior (TPB).

Methods

A mailed survey was completed by 354 endometrial cancer survivors (1 to 10 years postdiagnosis) residing in Alberta, Canada. The study was cross-sectional. Exercise behavior was assessed using the Godin Leisure Time Exercise Questionnaire and the TPB constructs were assessed with standard self-report scales. Multiple regression analyses were used to determine the independent associations of the TPB constructs with intention and behavior.

Results

Chi-square analyses indicated that marital status (p = .003), income level (p = .013), and body mass index (BMI) (p = .020) were associated with exercise. The TPB explained 34.1% of the variance in exercise behavior with intention (β = .38, p < .001) and self-efficacy (β = .18, p = .029) being independent correlates. For intention, 38.3% of the variance was explained by the TPB with self-efficacy (β = .34, p < .001) and affective attitude (β = .30, p < .001) being the independent correlates. The TPB mediated the associations of marital status and BMI with exercise but not income level. Age and BMI moderated the associations of the TPB with intention and behavior.

Conclusion

The TPB may be a useful framework for understanding exercise in endometrial cancer survivors. Exercise behavior change interventions based on the TPB should be tested in this growing population.

Environmental effects on walking behavior have received attention in recent years because of the potential for policy interventions to increase population levels of walking. Most epidemiologic studies describe associations of walking behavior with environmental features. These analyses ignore the dynamic processes that shape walking behaviors. A spatial agent-based model (ABM) was developed to simulate peoples’ walking behaviors within a city. Each individual was assigned properties such as age, SES, walking ability, attitude toward walking and a home location. Individuals perform different activities on a regular basis such as traveling for work, for shopping, and for recreation. Whether an individual walks and the amount she or he walks is a function distance to different activities and her or his walking ability and attitude toward walking. An individual’s attitude toward walking evolves over time as a function of past experiences, walking of others along the walking route, limits on distances walked per day, and attitudes toward walking of the other individuals within her/his social network. The model was calibrated and used to examine the contributions of land use and safety to socioeconomic differences in walking. With further refinement and validation, ABMs may help to better understand the determinants of walking and identify the most promising interventions to increase walking.

Objective

To assess the relationship between adolescent perception of time to walk to neighborhood food retail outlets and purchasing of sugar sweetened beverages (SSB), fast and convenience food items and test for differences by urban versus suburban environment.

Design

Cross-sectional observational study.

Setting

Twin Cities Metropolitan Area, Minnesota.

Subjects

Adolescents from two studies completed survey-based measures on perceptions of time to walk to food retail outlets from home, purchasing patterns of SSB and fast and convenience store items, perceptions of personal safety and pedestrian infrastructure and demographic characteristics. Descriptive analysis, Spearman correlations and multivariate linear regression, accounting for clustering, were conducted using SAS.

Results

There were 634 adolescents, approximately half male, predominately white, with a middle-class background. Greater perceived time to food outlets were associated with less frequent purchasing of SSB, convenience store foods and fast food items. Multivariate models showed that a perceived shorter walking time (i.e. 1–5 versus 31+ minutes) was significantly associated with more SSB purchasing. SSB purchases were also significantly associated with the number of food outlets within a 10–minute walk (B=0.05, p=0.02).

Conclusions

A reduction in consumption of SSB and other energy dense snacks is an important obesity prevention approach. An approach offering alternatives or reducing exposure in addition to education to alter purchasing habits may contribute to improving dietary habits and reducing the obesity epidemic.

Background

This study examined the associations of the perceived and objective environment with adolescent engagement in sports activities and walking and cycling in leisure time. It also explored the degree of agreement between objective and perceived availability of physical activity (PA) facilities in neighborhoods.

Methods

Cross-sectional data on physical activity, the perceived availability of physical activity opportunities (perceived physical environment) was assessed through a questionnaire and the objective availability of PA opportunities (objective physical environment) was obtained through GIS data. The final sample included 654 adolescents with a mean age of 14.1 (SD = 1.2) years.

Results

Perceived availability of sports facilities and parks was significantly associated with engaging in sports (OR: 1.73; 95% CI: 1.16-2.56) and with walking and cycling in leisure time (OR: 1.66; 95% CI: 1.07-2.57) respectively. Agreement between objective and perceived environment was low to moderate with Kappa values ranging from -0.005 to 0.053.

Conclusion

The perceived environment was the stronger correlate of PA behavior among adolescents. There were substantial differences between assessments of objective and perceived physical environment.

Background

The results of randomised controlled trials can be usefully illuminated by studies of the processes by which they achieve their effects. The Theory of Planned Behaviour (TPB) offers a framework for conducting such studies. This study used TPB to explore the observed effects in a pragmatic cluster randomised controlled trial of a structured recall and prompting intervention to increase evidence-based diabetes care that was conducted in three Primary Care Trusts in England.

Methods

All general practitioners and nurses in practices involved in the trial were sent a postal questionnaire at the end of the intervention period, based on the TPB (predictor variables: attitude; subjective norm; perceived behavioural control, or PBC). It focussed on three clinical behaviours recommended in diabetes care: measuring blood pressure; inspecting feet; and prescribing statins. Multivariate analyses of variance and multiple regression analyses were used to explore changes in cognitions and thereby better understand trial effects.

Results

Fifty-nine general medical practitioners and 53 practice nurses (intervention: n = 55, 41.98% of trial participants; control: n = 57, 38.26% of trial participants) completed the questionnaire. There were no differences between groups in mean scores for attitudes, subjective norms, PBC or intentions. Control group clinicians had 'normatively-driven' intentions (i.e., related to subjective norm scores), whereas intervention group clinicians had 'attitudinally-driven' intentions (i.e., related to attitude scores) for foot inspection and statin prescription. After controlling for effects of the three predictor variables, this group difference was significant for foot inspection behaviour (trial group × attitude interaction, beta = 0.72, p < 0.05; trial group × subjective norm interaction, beta = -0.65, p < 0.05).

Conclusion

Attitudinally-driven intentions are proposed to be more consistently translated into action than normatively-driven intentions. This proposition was supported by the findings, thus offering an interpretation of the trial effects. This analytic approach demonstrates the potential of the TPB to explain trial effects in terms of different relationships between variables rather than differences in mean scores. This study illustrates the use of theory-based process evaluation to uncover processes underlying change in implementation trials.

Background

Supportive neighbourhood walking conditions are particularly important for older people as they age and who, as a group, prefer walking as a form of physical activity. Urban form and socio-economic status (SES) can influence neighbourhood walking behaviour. The objectives of this study were: a) to examine how urban form and neighbourhood SES inter-relate to affect the experiences of older people who walk in their neighbourhoods; b) to examine differences among neighbourhood stakeholder key informant perspectives on socio-political processes that shape the walkability of neighbourhood environments.

Methods

An embedded comparative case study examined differences among four Ottawa neighbourhoods that were purposefully selected to provide contrasts on urban form (inner-urban versus suburban) and SES (higher versus lower). Qualitative data collected from 75 older walkers and 19 neighbourhood key informants, as well as quantitative indicators were compared on the two axes of urban form and SES among the four neighbourhoods.

Results and discussion

Examining the inter-relationship of neighbourhood SES and urban form characteristics on older people's walking experiences indicated that urban form differences were accentuated positively in higher SES neighbourhoods and negatively in lower SES neighbourhoods. Older people in lower SES neighbourhoods were more affected by traffic hazards and more reliant on public transit compared to their higher SES counterparts. In higher SES neighbourhoods the disadvantages of traffic in the inner-urban neighbourhood and lack of commercial destinations in the suburban neighbourhood were partially offset by other factors including neighbourhood aesthetics. Key informant descriptions of the socio-political process highlighted how lower SES neighbourhoods may face greater challenges in creating walkable places. These differences pertained to the size of neighbourhood associations, relationships with political representatives, accessing information and salient neighbourhood association issues. Findings provide evidence of inequitable walking environments.

Conclusion

Future research on walking must consider urban form-SES inter-relationships and further examine the equitable distribution of walking conditions as well as the socio-political processes driving these conditions. There is a need for municipal governments to monitor differences in walking conditions among higher and lower SES neighbourhoods, to be receptive to the needs of lower SES neighbourhood and to ensure that policy decisions are taken to address inequitable walking conditions.