Individual, social environmental, and physical environmental influences on physical activity among black and white Adults: A Structural Equation Analysis

Background: Social ecological models suggest that conditions in the social and physical environment, in addition to individual factors, play important roles in health behavior change. Using structural equation modeling, this study tested a theoretically and empirically based explanatory model of physical activity to examine theorized direct and indirect effects of individual (e.g., motivation and self-efficacy), social environmental (e.g., social support), and physical environmental factors (e.g.), neighborhood quality and availability of facilities).Method: A community-based sample of adults (N = 910) was recruited from 2 public health centers (67% female, 43% African American, 43% < $20,000/year, M age = 33 years) and completed a self-administered survey assessing their current physical activity level, intrinsic and extrinsic motivation for physical activity, perceived social support, self-efficacy, and perceptions of the physical environment.Results: Results indicated that (a) perceptions of the physical environment had direct effects on physical activity, (b) both the social and physical environments had indirect effects on physical activity through motivation and self-efficacy, and (c) social support influenced physical activity indirectly through intrinsic and extrinsic motivation. For all forms of activity, self-efficacy was the strongest direct correlate of physical activity, and evidence of a positive dose-response relation emerged between self-efficacy and intensity of physical activity. Conclusions: Findings from this research highlight the interactive role of individual and environmental influences on physical activity. This research was supported by grant R06/CCR71721602 from the Centers for Disease Control and Prevention, and the CDC/ASPH Minority Fellowship Program (U48/CCU710806, Prevention Research Centers Program). We also thank Drs. Nancy Krieger and Karen Emmons for their review of early drafts of this article.     

Physical activity counseling in primary care and patient well-being: Do patients benefit?

Background: Promoting physical activity is an important public health strategy for long-term reductions in incidence or severity of clinical disease. Benefits to health-related quality of life (HRQL) and subjective well-being may be as important and take less time to accrue.Purpose:We examined the HRQL benefits of a social-cognitive-theory-based intervention of the Activity Counseling Trial (ACT), both directly in terms of changes in physical fitness and indirectly from increased self-efficacy associated with the intervention.Methods: In ACT, 395 female and 479 male inactive patients ages 35 to 75 years were randomized to one of: physician advice, advice plus behavioral counseling during primary care visits, or advice plus behavioral counseling that also included telephone contact and behavioral classes. Participants were assessed at baseline, 6 months, and 24 months. HRQL was assessed as perceived quality of life, perceived stress, depression, and general health. Satisfaction with function and appearance, self-efficacy, and social support were also assessed.Results: At 24 months women who received counseling or assistance had significant reductions in daily stress and improvements in satisfaction with body function compared to those receiving advice only. Men had reductions in daily stress across all treatment arms. These results mirrored V0₂max changes observed per group. Change in barriers self-efficacy was significantly associated with reductions in daily stress at 24 months.Conclusions: Patient benefit from ACT intervention was mediated by enhanced cardiorespiratory fitness and by barriers self-efficacy.     

Managing hindering self-focused attention in counseling sessions

Objective:This study examined the moderation effects of management strategies on the association between hindering self-focused attention and counseling self-efficacy. Method: Participants were 160 counselor trainees. A hierarchical regression was used to analyze the data, and a simple effect analysis was used to explore the nature of the interaction. Results: Results indicated that, for trainees who used more basic counseling techniques, counseling self-efficacy remained the same no matter their hindering self-focused attention experiences. However, for those who used less basic counseling techniques, their counseling self-efficacy dropped when they had more experiences of hindering self-focused attention. Similarly, for trainees who used more self-awareness to understand clients, these trainees reported a similar level of counseling self-efficacy no matter their hindering self-focused attention experiences. Conversely, for those who used less self-awareness as a tool to understand their clients during their sessions, their counseling self-efficacy decreased when they had more experiences of hindering self-focused attention. Conclusion: This is the first study that extends the literature on direct, linear relationships between hindering self-focused attention and counseling self-efficacy. Results suggested two strategies (i.e., use of basic counseling techniques and use of self-awareness to understand clients) significantly moderate the above association.     

Explaining physical activity levels from a self-efficacy perspective: the physical activity counseling trial

Background: The Physical Activity Counseling (PAC) trial compared the effects of a 13-week primary care physical activity (PA) intervention that incorporated a PA counselor into a health care practice compared to a control condition on PA over a 25-week period and showed group differences in PA were present at 6 and 13 weeks.Purpose: The main purpose was to examine the mediating effect of 6-week task and barrier self-efficacy on the intervention versus control group/13-week PA relationships. A secondary purpose was to determine whether task and barrier self-efficacy were significantly related to PA throughout the trial for both groups.Method: Participants were primarily sedentary individuals who received a 2- to 4-min PA intervention from their primary care provider, after which they were randomly assigned to the intervention (n=61) or control condition (n=59). Self-reported PA and task (barrier) self-efficacy measures were obtained during (i.e., baseline, 6 and 13 weeks) and after (i.e., 19 and 25 weeks) the intervention in both groups.Results: Six-week task and barrier self-efficacy had a small mediating effect. Furthermore, barrier self-efficacy had a significant relationship with PA throughout the trial, whereas the relationship between task self-efficacy and PA became significantly weaker as the trial progressed.Conclusions: PAC interventions among primarily sedentary individuals should be partly based on barrier and task self-efficacy. However, the stability of the task self-efficacy/PA relationship needs further examination. This study was supported by the Ontario Ministry of Health and Long — Term Care awarded to Dr. Michelle Fortier and Dr. William Hogg. Chris M. Blanchard is supported by the Canada Research Chairs Program.     

Physical activity and quality of life in older adults: Influence of health status and self-efficacy

Background: Physical activity has been positively linked to quality of life (QOL) in older adults. Measures of health status and global well-being represent common methods of assessing QOL outcomes, yet little has been done to determine the nature of the relationship of these outcomes with physical activity.Purpose: We examined the roles played by physical activity, health status, and self-efficacy in global QOL (satisfaction with life) in a sample of older Black and White women.Method: Participants (N = 249, M age = 68.12 years) completed multiple indicators of physical activity, self-efficacy, health status, and QOL at baseline of a 24-month prospective trial. Structural equation modeling examined the fit of 3 models of the physical activity and QOL relationship.Results: Analyses indicated that relationships between physical activity and QOL, self-efficacy and QOL were all indirect. Specifically, physical activity influenced self-efficacy and QOL through physical and mental health status, which in turn influenced global QOL.Conclusions: Our findings support a social cognitives model of physical activity’s relationship with QOL. Subsequent tests of hypothesized relationships across time are recommended. Funding for this study was provided by the National Institute on Aging (Grant AG 20118). We extend our sincere appreciation to April Bell for all of her efforts on this project.     

The California active aging community grant program: Translating science Into practice to promote physical activity in older adults

Background: Attempts to study the translation of evidence-based physical activity interventions in community settings are scarce.Purpose: This project was an investigation of whether 13 diverse local lead agencies could effectively implement a choice-based, telephone-assisted physical activity promotion program for older adults based on intervention models proven efficacious in research settings.Methods: At baseline, participants developed their own physical activity programs through an individualized planning session based on preference, health status, readiness to change, and available community resources. Thereafter, participants received regular telephone calls over a 1-year period from a trained staff member or volunteer support buddy. Additional program components consisted of health education workshops, newsletters, and group-based physical activities. Self-report data on caloric expenditure due to all and moderate or greater intensity physical activities were collected from 447 participants (M age = 68 ± 8.6 years).Results: A significant increase (p ≤ .0001) from baseline to midintervention and intervention endpoint was observed for total weekly caloric expenditure (Mdn change = 644–707 kcal/week) and moderate or greater weekly caloric expenditure (Mdn change = 149–265 kcal/week), as well as for weekly physical activity duration and frequency. These changes were observed in participants across all sites.Conclusions: The increases in weekly caloric expenditure were commensurate with findings from several previous randomized clinical trials. The utilization of community agency staff and volunteers receiving basic training to implement essential program components proved feasible. Very favorable levels of program satisfaction expressed by community staff, volunteer support buddies, and participants, combined with the significant increases in physical activity, warrant further dissemination of the intervention model. This project was supported by the Preventive Health and Health Services Block Grant from the Centers for Disease Control and Prevention, and the American Federation for Aging Research. We thank all of the local program staff and participants for their time and effort.     

Physical activity enhances long-term quality of life in older adults: Efficacy,esteem, and affective influences

Background: Physical activity has been effective in enhancing quality of life (QOL) of older adults over relatively short periods of time. However, little is known about the longterm effects of physical activity and even less about the possible mediators of this relationship.Purpose: We examined the mediating effects of psychological variables on the relationship between physical activity and global QOL (satisfaction with life) in older adults over a 4-year period.Methods: Participants (N = 174, M age = 66.7 years) completed a battery of psychosocial measures at 1 and 5 years following enrollment in a 6-month randomized controlled exercise trial.Results: Panel analysis conducted within a covariance modeling framework indicated that physical activity was related to self-efficacy, physical self-esteem, and positive affect at 1 year, and in turn, greater levels of self-efficacy and positive affect were associated with higher levels of QOL. Analyses indicated that changes in physical activity over the 4-year period were related to increases in physical self-esteem and positive affect, but only positive affect directly influenced improvements in QOL.Conclusions: The findings lend support to the position that physical activity effects on QOL are in part mediated by intermediate psychological outcomes and that physical activity can have long-term effects on well-being. Funding for this study was provided by the National Institute on Aging (AG 12113).     

Therapist correlates of attitudes toward sexual minority individuals,affirmative counseling self-efficacy,and beliefs about affirmative practice

Objective: The purpose of this study was to examine the influence of training in sexual minority issues, professional identification, and gender on attitudes toward lesbian, gay, and bisexual individuals, affirmative counseling self-efficacy, and beliefs about affirmative practice among mental health practitioners in the USA. Method: We used the Internet to recruit a nationwide sample of 443 heterosexual psychologists (n = 270), clinical social workers (n = 110), and marriage and family therapists (n = 63) residing in the USA. Results: When controlling for years of practice experience and age, results from structural equation modeling analysis showed that training was associated with more affirmative attitudes, higher levels of affirmative counseling self-efficacy, and more positive beliefs. Female therapists reported more affirmative attitudes and higher levels of affirmative counseling self-efficacy than male therapists. Professional identification did not predict any criterion variables, when controlling for years of practice experience and age. Conclusion: Findings suggest that it will be important for educational and training initiatives to consider the effect of gender role socialization on attitudes and affirmative counseling self-efficacy, especially among beginning male therapists.     

Efficacy of sequential or simultaneous interactive computer-tailored interventions for increasing physical activity and decreasing fat intake

Background: Little evidence exists about the effectiveness of “interactive” computer-tailored interventions and about the combined effectiveness of tailored interventions on physical activity and diet. Furthermore, it is unknown whether they should be executed sequentially or simultaneously.Purpose: The purpose of this study was to examine (a) the effectiveness of interactive computer-tailored interventions for increasing physical activity and decreasing fat intake and (b) which intervening mode, sequential or simultaneous, is most effective in behavior change.Methods: Participants (N = 771) were randomly assigned to receive (a) the physical activity and fat intake interventions simultaneously at baseline, (b) the physical activity intervention at baseline and the fat intake intervention 3 months later, (c) the fat intake intervention at baseline and the physical activity intervention 3 months later, or (d) a place in the control group.Results: Six months postbaseline, the results showed that the tailored interventions produced significantly higher physical activity scores, F(2, 573) = 11.4, p < .001, and lower fat intake scores, F(2, 565) = 31.4, p < .001, in the experimental groups when compared to the control group.Conclusions: For both behaviors, the sequential and simultaneous intervening modes showed to be effective; however, for the fat intake intervention and for the participants who did not meet the recommendation in the physical activity intervention, the simultaneous mode appeared to work better than the sequential mode. This study was financially supported by the Ghent University and the Flemish Fund for Scientific Research.We thank Katrien Bogaert, Griet Bonamie, Nele Callewaert, Hilde Decrop, Evelyn Vanbesien, and Els Van Cleemput for their cooperation in data gathering.     

Physical Activity, Self-Efficacy, and Quality of Life in Multiple Sclerosis

Background Quality of life (QOL) is compromised among individuals with multiple sclerosis (MS). Self-efficacy and physical activity have been positively associated with QOL in persons with MS, and based on a social cognitive perspective, the relationship between physical activity and QOL might be indirect and accounted for by self-efficacy. Purpose We tested the hypothesis that physical activity would be indirectly associated with QOL through a pathway that included self-efficacy. Methods Participants were 133 individuals with a definite diagnosis of MS who completed the Godin Leisure-Time Exercise Questionnaire, Multiple Sclerosis Self-Efficacy scale, and Multiple Sclerosis Impact Scale. Results Path analysis indicated that those with MS who were more physically active had greater self-efficacy for function and control, and self-efficacy for function and control were associated with greater physical and psychological components of QOL. Conclusions Our findings support physical activity as a possible modifiable behavior for mitigating reductions of QOL by improving self-efficacy in individuals with MS.     

Correlates of physical activity among individuals with multiple sclerosis

Background: There is accumulating evidence that individuals with multiple sclerosis (MS) are less physically active than nondiseased populations. One method for increasing the level of participation in physical activity among MS patients involves the identification of factors that correlate with physical activity and that are modifiable by a well-designed intervention.Purpose: This study adopts a social cognitive perspective and examines self-efficacy, enjoyment, social support, and disability as correlates of participation in physical activity among individuals with MS.Methods: We recruited 196 individuals with a diagnosis of MS from the Midwest region of the United States. The participants completed a battery of questionnaires and then wore a belt with an accelerometer for a 7-day period. The data were analyzed using covariance modeling.Results: Enjoyment (γ = .38, p > .001), social support (γ = .15, p > .05), and disability (γ =.18, p > .01) had statistically significant direct relations with self-efficacy, and self-efficacy (β = .29, p > .001) and enjoyment (γ = .28, p > .001) had statistically significant direct relations with physical activity.Conclusions: Future researchers should consider examining self-efficacy and enjoyment as possible components of an intervention that is designed to increase physical activity participation in MS patients.     

Perceived ease of activity (but not strategy use) mediates the relationship between self-efficacy and activity engagement in midlife and older adults

Abstract

Objectives: Activity participation is associated with a range of positive outcomes in older adults but tends to decline with age. Understanding protective factors is important to facilitate activity in later life. Social cognitive theory suggests that having high self-efficacy may promote activity because individuals with higher self-efficacy perceived their activities to be easier and use adaptive strategies to overcome barriers to activity. Despite considerable research linking self-efficacy and activity, limited research has examined the proposed mechanisms behind this association. This study therefore examined whether perceived ease of activity and use of adaptive strategies account for the association between self-efficacy and activity.

Method: Participants were 412 adults aged 50–93 years who completed a cross-sectional survey. Structural equation modelling was used to examine whether the effects of self-efficacy on activity were mediated by perceived ease of activity and use of adaptive strategies.

Results: Perceived ease of activity mediated the positive associations between self-efficacy and social (0.04 [0.02, 0.07]) and physical activity (0.16 [0.08, 0.25]), but not mental activity (0.01 [0.000, 0.03]). For physical activity, this effect was stronger for adults aged 70+ years than those aged 50–69 years (older a₂*b₂ - younger a₂*b₂ 0.13 [0.04, 0.24]). Use of adaptive strategies was not a significant mediator in any model.

Conclusion: This study suggests that self-efficacy may influence older adults' perception of activities and, in turn, the activities they choose to participate in. This has potential implications for the development of interventions aimed at promoting activity engagement in later life.     

Modifying physical activity in a multiethnic sample of low-income women: One-year results from the IMPACT (Increasing Motivation for Physical ACTivity) project

Background: Ethnic minorities or those with low socioeconomic status (SES) are at increased risk of cardiovascular disease, type 2 diabetes, and all-cause mortality, compared to higher SES Whites. National surveys also indicate that low-income, ethnic minority women have the highest rates of inactivity in the United States.Purpose: This study (the Increasing Motivation for Physical ACTivity or IMPACT study) promoted adoption and maintenance of physical activity (PA) in sedentary, low-income women participating in federally funded job training programs.Methods: The study consisted of 2 months of weekly 1-hr classes, then random assignment to 10 months of either home-based telephone counseling for PA plus information and feedback via mailed newsletters (Phone + Mail Counseling condition) or just the mailed newsletters (Mail Support condition). The IMPACT intervention included behavior change strategies for PA as well as discussions related to motivational readiness for PA change. Participants completed surveys and physiological assessments at baseline after the classes ended (i.e., at 10 weeks) and at 6 and 12 months postbaseline. Seventy-three percent of randomized participants (n = 72) were Latina, with a mean age of 32 ± 10 years. More than half the women had not completed high school, and 73% had an annual income less than $20,000.Results: After 10 months of a homebased intervention, women in the phone + mail counseling condition had significantly greater increases in estimated total energy expenditure compared to women in the mail support condition (p < .05).Conclusions: Regular PA counseling delivered via the telephone and through the mail appears effective for encouraging regular PA among low-income women transitioning from welfare or job training to the workforce. This research was supported by a grant HL58914 from the National This research was supported by a grant HL58914 from the National We gratefully acknowledge Helena Kraemer, Ph.D., for her insightful comments pertaining to the statistical analyses used; David Ahn for statistical programming; Karen Bolen and Toni Toledo for their assistance with the assessments and interventions; and Katherine Moore-Wines, Ernestine R. Howard, Isabelle Merle, Maria Buenrostro, Karen Enzensperger, Eve Visconti, Sally Hayden, Diane Hageman, and Gloria Duber for their assistance at the Adult Education Sites.     

Cancer-specific self-efficacy and psychosocial and functional adaptation to early stage breast cancer

Background: Although self-efficacy is considered a key psychological resource in adapting to chronic physical illness, this construct has received less attention among individuals coping with cancer.Purpose: To examine changes in cancer self-efficacy over time among women with early stage breast cancer and associations between task-specific domains of selfefficacy and specific psychological, relationship, and functional outcomes.Methods: Ninety-five women diagnosed with early stage breast cancer completed surveys postsurgery and 1 year later.Results: Cancer-related self-efficacy was relatively stable over 1 year, with only 2 domains of efficacy—(a) Activity Management and (b) Self-Satisfaction—evidencing significant increases over the 1-year time period. Cross-sectional findings were relatively consistent with predictions and suggested that specific domains of self-efficacy were more strongly related to relevant domains of adaptation. Longitudinal findings were not as consistent with the domain-specificity hypothesis but did suggest several predictive associations between self-efficacy and outcomes. Personal Management self-efficacy was associated with higher relationship satisfaction, higher Communication Self-Efficacy was associated with less functional impairment, and higher Affective Management self-efficacy was associated with higher self-esteem 1 year later.Conclusions: Specific domains of cancer-related self-efficacy are most closely related to relevant areas of adaptation when considered cross-sectionally, but further study is needed to clarify the nature of these relationships over time. We acknowledge Briana Floyd, Nicole Fasanella, Jenette Hosterman, ChristinaWeakland, and Jennifer Stillman for collection of study data; Sandra Corbett and Joseph Zike for project management; and Dorothy Weber for data management.We thank the oncologists who referred patients to this study as well as the patients who participated. This study was supported by grant CA 77857 from the National Cancer Institute.     

Lifestyle intervention can prevent weight gain during menopause: Results from a 5-year randomized clinical trial

Context: Menopausal-related weight gain and increased waist circumference have major cardiovascular health implications for older women. The efficacy of a dietary and physical activity lifestyle intervention to prevent weight gain and elevations in cardiovascular disease (CVD) risk factors from the peri- to postmenopause is unknown.Objective: To report the 54-month results of a lifestyle dietary and physical activity program on weight, body composition, physical activity, diet, and other CVD risk factors.Design: Data are from a 5-year randomized clinical trial known as the Women’s Healthy Lifestyle Project, conducted from 1992 to 1999.Participants: 535 healthy, premenopausal women ages 44 to 50 at study entry enrolled into the trial.Intervention: Participants were randomly assigned to either a lifestyle intervention group receiving a 5-year behavioral dietary and physical activity program or to an assessment-only control group. The lifestyle intervention group was given modest weight loss goals (5–15 lb, or approximately 2.3–6.8 kg) to prevent subsequent gain above baseline weight by the end of the trial. To achieve weight loss and lower low-density lipoprotein cholesterol levels, intervention participants followed an eating pattern consisting of 1,300 kcal/day (25% total fat, 7% saturated fat, 100 mg of dietary cholesterol) and increased their physical activity expenditure (1,000–1,500 kcal/week).Main Outcome Measures: Regarding weight gain prevention, 55% (136/246) of intervention participants were at or below baseline weight compared with 26% (68/261) of controls after 4.5 years, χ(2, N = 507) = 45.0, p < .001. The mean weight change in the intervention group was 0.1 kg below baseline (SD = 5.2 kg) compared with an average gain of 2.4 kg (SD = 4.9 kg) observed in the control group. Waist circumference also significantly decreased more in the intervention group compared with controls (M = −2.9 cm, SD = 5.3 vs. M = −0.5 cm, SD = 5.6, p < .001). Moreover, participants in the lifestyle intervention group were consistently more physically active and reported eating fewer calories and less fat than controls. Long-term adherence to physical activity and a low-fat eating pattern was associated with better weight maintenance.Conclusions: In healthy women, weight gain and increased waist circumference during the peri- to postmenopause can be prevented with a long-term lifestyle dietary and physical activity intervention. This research was supported through a grant from the National Heart, Lung, and Blood Institute, National Institutes of Health awarded to Lewis H. Kuller, M.D., Dr. PH. (HL 45167-03). We thank the participants of Women’s Healthy Lifestyle Project for their enduring dedication and the investigators and staff for their valuable contributions to the study (listed in alphabetical order): Michelle Berry, Alhaji Buhari, Michele Burnette, Jane Cauley, Yuefang Chang, David Chernew, DJ Conner-Beatty, Debbi Cusick, Aileen Faulkner, Shannon FitzGerald, Rich Foran, Sara Friel, Ed Gregg, Donna Hansen, Beth Hauth, Diane Ives, Ja Kielty, Mary Lou Klem, Andrea Kriska, Jean Lennon, Araxi Macaulay, Mehran Massoudi, Nancy Mazzei, Eileen McMahon, Elaine Meilahn, Marguerite Meyer, N. Carole Milas, Joann Naujelus, Pam Carter-Nolan, Mary Parker, Annette Rexroad, Loran Salamone, Danit Shahar, Siao Mei Shick, Maria Smith, Pam Vincent, Michelle Volansky, Charlene Walter, Marie Wilkerson, and Randi Wolf.     

Physician-based activity counseling: Intervention effects on mediators of motivational readiness for physical activity

In theory-based interventions for behavior change, there is a need to examine the effects of interventions on the underlying theoretical constructs and the mediating role of such constructs. These two questions are addressed in the Physically Active for Life study, a randomized trial of physician-based exercise counseling for older adults. Three hundred fifty-five patients participated (intervention n = 181, control n = 174; mean age = 65.6 years). The underlying theories used were the Transtheoretical Model, Social Cognitive Theory and the constructs of decisional balance (benefits and barriers), self-efficacy, and behavioral and cognitive processes of change. Motivational readiness for physical activity and related constructs were assessed at baseline, 6 weeks, and 8 months. Linear or logistic mixed effects models were used to examine intervention effects on the constructs, and logistic mixed effects models were used for mediator analyses. At 6 weeks, the intervention had significant effects on decisional balance, self-efficacy, and behavioral processes, but these effects were not maintained at 8 months. At 6 weeks, only decisional balance and behavioral processes were identified as mediators of motivational readiness outcomes. Results suggest that interventions of greater intensity and duration may be needed for sustained changes in mediators and motivational readiness for physical activity among older adults.     

Physical activity as a substitute for sedentary behavior in youth

Background: Youth may choose to be sedentary rather than physically active.Purpose: The purpose of this study was to use behavioral economics methods to investigate how experimental changes in the amount of sedentary behaviors influenced physical activity.Methods: Fifty-eight 8-to 16-year-old youth were studied in a within-subject crossover design with three 3-week phases: baseline, increasing, and decreasing targeted sedentary behaviors by 25% to 50%.Results: At baseline, boys were more active than girls (518.9 vs. 401.2 accelerometer counts/min, p = .02), and obese youth more sedentary than nonobese youth (240.5 vs. 174.4 min/day, p = .003). During the increase sedentary behavior phase, targeted sedentary behaviors increased by 52.1%, with girls increasing sedentary behaviors more than boys (114.7 vs. 79.8 min/day, p = .04). Physical activity decreased (−48.3 counts/min, p < .01) when sedentary behaviors increased, with obese youth decreasing total and moderate to vigorous physical activity (MVPA) more than nonobese youth (−110.4 vs. 8.9 counts/min, p < .001; −3.3 vs. −.03%MVPA, p = .013). During the decrease sedentary behavior phase, targeted sedentary behaviors decreased by 55.6% from baseline as nonobese youth increased physical activity, whereas obese youth decreased physical activity (55.8 vs. −48.0 counts/min, p = .042; 1.1 vs. −2.1 % MVPA, p = .021). Youth who substituted physical activity when sedentary behaviors were increased had greater standardized body mass index (z-body mass index = 1.4 vs. 0.4, p = .018), whereas youth who substituted physical activity when sedentary behaviors were decreased were less active at baseline (396.1 vs. 513.7 counts/min, p = .035).Conclusions: Behavioral economics provides a methodology to understand changes in physical activity when sedentary behaviors are modified and to identify factors associated with substitution of physically active for sedentary behaviors. This research was funded by Grant No. R01 HD 39778 to Dr. Leonard H. Epstein. Appreciation is expressed to Warren Bickel, Ph.D., Bonnie Spring, Ph.D., and Suzanne Wright, M.S., for comments on an earlier version of this article; to Jerry Richards, Ph.D., for ideas about substitutability; to Rekha Trivikram, B.A., for assistance in running the study; and to Steven Tallides, M.S., for preliminary data analyses.     

Online counseling: An exploratory survey of Italian psychologists’ attitudes towards new ways of interaction†

Objective: Online counseling may be defined as an interaction between users and mental health professionals that takes place through computer mediated communication technology. This study aimed to investigate the attitudes of Italian psychologists towards different aspects of online counseling provided via email, chat, forums, and videoconference. Method: An online questionnaire was administered to a sample of 289 licensed psychologists in the Veneto Region (Italy) in order to collect opinions, preferences, and intentions to use online modalities, along with prior knowledge and practice experiences. Results: Only 18.3% of the respondents had previous experience with online counseling. Overall, the majority of psychologists (62.6%) were favorable towards online counseling, but they also had several reservations about the provision of online diagnosis and therapeutic interventions. Results showed a consistent lack of clarity regarding ethical and penal issues concerning online modalities. Conclusions: More efforts must be directed to deepening the application of new technologies in the field of psychology in order to enable an ethical and professional practice of online counseling in Italy.