The Pullout Program Day a Week School for Gifted Children: Effects on Social–Emotional and Academic Functioning

Background

Gifted children learn differently compared to their peers in several ways. However, their educational needs are often not met in regular schools, which may result in underachievement and social–emotional and behavioral problems. A pullout program, the “Day a Week School” (DWS), was offered to gifted children in 25 elementary schools from neighborhoods of higher and lower SES in Amsterdam.

Objective

To investigate whether DWS decreases children’s social–emotional and behavior problems and parents’ stress, and improves children’s self-concept, enjoyment at school, and academic achievement.

Methods

Gifted children (grades 3–5) were selected through a standardized identification procedure assessing “out-of-the box”, logical, and creative thinking and motivation (n = 89). Children, as well as both their parents and teachers, completed questionnaires before the start of DWS and after 2,5 months. Results were analyzed for all children and for at-risk children with higher levels of psychopathology before starting DWS.

Results

Analyses on the total group showed small positive effects on children’s self-reported self-concept dimensions, scholastic competence and behavioral conduct, as well as on fathers’ reported child prosocial behavior. In the at-risk group, children reported medium positive effects on scholastic competence and behavioral conduct, and on sleep problems and worry, and small improvements on enjoyment at school. Parents of at-risk children reported decreased child’s somatic complaints and decreased social–emotional and behavioral problems. Finally, teachers reported higher academic achievement and medium positive effects on inattention-hyperactivity in the at-risk group.

Conclusions

Day a Week School appears to be a promising pullout program for gifted children, particularly for children at-risk for psychopathology.     

Personal and Professional Emotional Characteristics of Early Childhood Teachers and Their Proneness to Communicate with Parents and Colleagues About Children’s Emotions

Background

Early childhood teachers represent important socializers of children’s emotions providing professional practices, such as communication about children’s emotions, influencing children’s development. According to an ecological framework, early childhood teachers’ emotional practices are guided by both their personal and professional emotional abilities.

Objective

In this study, we addictively took into account both teachers’ personal (i.e., level of education, years of experience, parenthood status, personal emotional self-efficacy) and professional emotional characteristics (i.e., self-efficacy as emotional socializers, and coaching style) in their contribution to teacher–parent/colleague communication about children’s emotions.

Methods

382 early childhood teachers from Center and South of Italy took part to this study (mean years of professional experience = 15.07, SD 10.29 years).

Results

Results showed a positive association between proneness to communicate with parents about children’s emotions and having one’s own children, self-efficacy as emotional socializer, and coaching style. As for communication with colleagues about children’s emotions, we found positive associations with years of experience, personal emotional self-efficacy, and coaching style.

Conclusions

These findings reinforce the need for preservice and in-service programs to promote a reflective orientation to professional practice focusing on early childhood teachers’ personal and professional emotional competence.

     

Psychosocial determinants of quality of life in parents of obese children seeking inpatient treatment

Purpose

To examine and identify predictors of parental health-related quality of life (HRQoL) in a sample of obese and very obese children participating in an inpatient program for treating obesity.

Methods

Data are part of a prospective multicenter randomized-controlled intervention trial. Parents (n = 463) of obese and very obese children (7–13 years) completed standardized questionnaires assessing their own and their child’s HRQoL, psychosocial functioning, demographics and parental weight-specific self-efficacy on the child’s admission to an inpatient pediatric weight management program. Weight and height of the children were measured by trained personnel; parental weight was assessed via self-report.

Results

Parents reported lower mental HRQoL compared to healthy adults and even lower than reference values for acute or chronic illness. With respect to physical HRQoL, parents of obese children reported higher scores than both groups. Effect sizes were small to medium. Overweight parents reported a lower physical HRQoL. Mental HRQoL was higher for married parents with a higher educational level and a higher self-efficacy and for those whose children depicted fewer behavioral problems and reported a higher HRQoL. Hierarchical regression analyses revealed that weight-specific self-efficacy explained 3 % of variance in mental HRQoL in addition to the demographic and child psychosocial variables. Parental self-efficacy also partially mediated the association between the child’s HRQoL and parental mental HRQoL.

Conclusion

Childhood obesity is associated with reduced parental HRQoL. Interventions for obesity in children should consider the parents’ psychosocial situation as well. Enhancing parental self-efficacy may be a promising approach.     

Preliminary Study of Resilience-Based Group Therapy for Improving the Functioning of Anxious Children

Background

There is a lack of research examining the feasibility of group psychotherapy interventions for anxious children in private clinical service settings. Furthermore, no research to date has examined the effectiveness of resilience-based interventions for helping children with anxiety disorders.

Objective

The present study aims to examine the effectiveness of a resilience-based cognitive behavioral therapy (CBT) group psychotherapy, the Resilience Builder Program^® (RBP), for improving the social, emotional, and family functioning of anxious children in a private clinical setting.

Methods

Participants consisted of 22 children with an anxiety disorder aged 7–12 (81.8 % generalized anxiety disorder; M age = 9.93; 63 % male) enrolled at a private psychotherapy practice in RBP, a 12-week manualized group treatment that targets social competence using resilience skills (i.e., affect and behavior regulation, flexibility/adaptability, social problem-solving, proactive orientation)

Results

Following the completion of RBP, results showed that parents and teachers reported significant decreases in problem behavior. In addition, parents reported significant decreases in depressive symptoms and improved family functioning domains of problem behaviors and communication. Teachers reported reduced internalizing symptoms, somatic problems, and socially odd behaviors, as well as improvements in communication skills and resilience. Moreover, children reported significant improvement in their positive and negative emotions, as well as their emotional control.

Conclusions

Findings from the present study suggest preliminary support for the effectiveness of RBP for improving anxious children’s social, emotional, and family functioning.     

Effectiveness of a school-based physical activity-related injury prevention program on risk behavior and neuromotor fitness a cluster randomized controlled trial

Background

To investigate the effects of a school-based physical activity-related injury prevention program, called 'iPlay', on risk behavior and neuromotor fitness.

Methods

In this cluster randomized controlled trial 40 primary schools throughout the Netherlands were randomly assigned in an intervention (n = 20) or control group (n = 20). The study includes 2,210 children aged 10-12 years. The iPlay-intervention takes one school year and consists of a teacher manual, informative newsletters and posters, a website, and simple exercises to be carried out during physical education classes. Outcomes measures were self-reported injury preventing behavior, self-reported behavioral determinants (knowledge, attitude, social-influence, self-efficacy, and intention), and neuromotor fitness.

Results

The iPlay-program was not able to significantly improve injury-preventing behavior. The program did significantly improve knowledge and attitude, two determinants of behavior. The effect of the intervention-program on behavior appeared to be significantly mediated by knowledge and attitude. Improved scores on attitude, social norm, self-efficacy and intention were significantly related to changes in injury preventing behavior. Furthermore, iPlay resulted in small non-significant improvements in neuromotor fitness in favor of the intervention group.

Conclusion

This cluster randomized controlled trial showed that the iPlay-program did significantly improved behavioral determinants. However, this effect on knowledge and attitude was not strong enough to improve injury preventing behavior. Furthermore, the results confirm the hypothetical model that injury preventing behavior is determined by intention, attitude, social norm and self-efficacy.

Trial number

ISRCTN78846684     

Observations of Group Care Worker-Child Interaction in Residential Youth Care: Pedagogical Interventions and Child Behavior

Background

The work of group care workers in residential youth care is often described as professional parenting. Pedagogical interventions of group care workers influence the quality of care for looked-after children.

Objective

The aim of the current study was to observe the pedagogical interventions of group care workers within residential youth care and their associations with child behaviors.

Methods

Group care worker interventions and child behaviors were videotaped during structured observations. Participants included 95 children (64 % boys, M _age = 9.19) and 53 group care workers (74 % female, M _age = 33.79 years). A coding system was developed to code pedagogical interventions and child behaviors.

Results

It showed that group care workers mainly used positive pedagogical interventions (warmth/support and positive control) and seldom used negative pedagogical interventions (permissiveness and negative control). Frustration and anger of children was associated with positive controlling interventions and permissiveness of group care workers. The hypothesis that child anxiety and nervousness is associated with warm and supportive interventions could not be confirmed.

Conclusions

Pedagogical interventions should be part of education, training, and supervision of group care workers.     

Emotional demands and the risks of depression among homecare workers in the USA

Purpose

Homecare workers’ diversity of emotional demands and their relation to mental health problems have not yet been fully explored. The purpose of this study is to investigate the types of emotional demands on homecare workers and the association of these demands with depression.

Method

Data were collected from two surveys of a random sample of 1,599 homecare workers (June 2003–September 2003 and December 2003–February 2004). Depression was assessed using a 20-item RCES-D screening scale.

Results

Homecare workers appeared to have a variety of emotional demands: unfair treatment, client’s family abuse, unmet care needs, client health, and emotional suppression. In general, homecare workers were more likely to be exposed to their client health and emotional suppression (mean scores = 1.46–3.07) than to be exposed to unmet care needs, unfair treatment, and client’s family abuse (mean scores = 1.02–1.38). After adjusting for potential confounders, four emotional-demand factors (excluding the client health factor) were significantly associated with a high risk of subthreshold depression at Wave 1. In particular, the factor “unmet care needs” was an essential predictor of 6-month subthreshold depression at Wave 2.

Conclusion

This study illustrated the diversity of emotional demands among homecare workers and their association with depression. Our mixed findings regarding the cross-sectional and longitudinal analyses suggested that further research should refine the measurement of emotional demands and their relationship with mental health among homecare workers.     

Anxiety and Response to Reading Intervention among First Grade Students

Background

For school-aged children with reading difficulties, an emerging and important area of investigation concerns determining predictors of intervention response. Previous studies have focused exclusively on cognitive and broadly defined behavioral variables. What has been missing, however, are studies examining anxiety, which is among the most commonly experienced difficulty for youth.

Objective

The present study examined anxiety among children classified as typically achieving or showing inadequate/adequate response following an intervention for reading problems.

Methods

Participants were 153 ethnically-diverse children (84 male, 69 female) evaluated in the winter and spring of their first-grade academic year. Children completed several standardized measures of reading achievement involving decoding and fluency along with a multidimensional anxiety rating scale.

Results

Repeated measures ANOVA revealed significant main effects for time and scale and significant interactions for time × scale and group × scale. Logistic regression examined whether anxiety predicted response to intervention (Y/N) at the end of the school-year.

Conclusions

Results showed overall decreases in anxiety over time, with the exception of the harm avoidance area which increased and also interacted with group (children with decoding/fluency difficulties reported less harm avoidance than typically achieving children). The harm avoidance area was most pertinent across analyses highlighting the potential importance of targeting this area; however, none of the anxiety scales predicted response group at the end of the intervention. Ongoing research is needed in this area in order to identify characteristics of inadequate responders to reading intervention programs and/or inform interventions that incorporate these socioemotional factors.     

School Reintegration Following Psychiatric Hospitalization: An Ecological Perspective

Background

School reintegration following psychiatric hospitalization can be challenging for children, their families, and school personnel. While school reintegration of children with physical illness has received considerable professional attention, our knowledge about the needs of children returning to school after psychiatric hospitalization is still limited.

Objective

This paper delineates an ecological perspective on school reintegration of children after hospitalization for mental health reasons. This perspective takes into account the multiple social systems in which children are embedded and focuses on both individual and environmental factors that may contribute to a child’s well-being or, conversely, trigger emotional and behavioral difficulties.

Methods

This is a theoretical paper based on the systematic review of empirical literature related to psychiatric hospitalization of children, post discharge adjustment, school reintegration following hospitalization, mental health stigma in children, and cross-agency collaboration.

Results

Several ecological factors that may affect school reintegration after psychiatric hospitalization were identified, including: (1) child/youth experiences with and perceptions of having a mental health condition, being hospitalized, and subsequent school reentry; (2) parental experiences and perceptions of child/youth psychiatric condition and hospitalization; (3) attitudes and reactions from members of the child/youth school ecology including teachers and peers; and (4) inter-disciplinary collaboration. The paper proposes ecologically informed guidelines to facilitate successful school reintegration and discusses the roles of the school-based mental health professionals in this process.

Conclusions

While complex and challenging, a successful reintegration may be the key step in reducing inpatient recidivism rates and improving a child’s future academic and behavioral success.     

A Challenging Job: Physical and Sexual Violence Towards Group Workers in Youth Residential Care

Background

Residential or group care social workers appear to be at increased risk for experiencing physical violence at work. However, little is known about sexual harassment in addition to physical victimization of social workers in youth residential or group care.

Objective

We investigated the prevalence of physical and sexual victimization of youth care workers in residential care and tested whether characteristics of the group care workers and the type of care facility influenced this prevalence.

Methods

One hundred seventy-eight participants reported whether they had experienced verbal threat, physical threat, physical violence, verbal sexual harassment, and physical sexual harassment by one or more of the youth they worked with in a 1-year period.

Results

Eighty-one percent of the group workers experienced violence. Most incidents were verbal threats, but about half of the participants experienced physical violence. Youth care workers from secure care were most at risk for experiencing physical and verbal violence and workers from juvenile detention facilities were most at risk for experiencing sexual harassment. Rates of violence were increased for participants working with children with a mild intellectual disability. Gender of the youth care workers was not related to the rate of victimization, but age was: younger group workers reported more incidents than older group workers.

Conclusions

The high levels of violence in residential youth care indicate that residential care is not the best workplace for professionals nor the best rearing setting for youth. Alternative care settings, such as treatment in a family-type environment, should be explored.     

Preschool Teachers’ Professional Training,Observational Feedback,Child-Centered Beliefs and Motivation: Direct and Indirect Associations with Social and Emotional Responsiveness

Background

Young children’s social and emotional competence is a key predictor of their current and future academic and social success. Although preschool teachers are critical socializing agent of children’s social and emotional development, we know little about factors associated with preschool teachers’ social and emotional responsiveness.

Objective

This study examined how preschool teachers’ educational training and regularity of receiving observational feedback were associated with teachers’ social and emotional responsiveness, as mediated by more personal characteristics such as teachers’ child-centered beliefs and motivation for professional development.

Method

We investigated direct and indirect associations using a national survey of 1129 preschool teachers in the United States.

Results

We found that teachers with an associate degree, compared to those without, were more likely to respond negatively to children’s emotional displays. Taking child development or early education coursework was associated with less negative social guidance. Receiving regular observational feedback was associated with greater encouragement of expressing emotion and with less negative social guidance. We also found significant indirect associations. For example, teachers who received regular observational feedback had greater motivation for professional development, which in turn, predicted more positive social guidance and emotional responsiveness.

Conclusions

More stringent educational criteria for preschool educators and ongoing observational feedback may support teachers’ optimal social and emotional responsiveness. In addition, educational training should incorporate child-centered theory and practices and observational feedback should include information specific to professional development resources.

     

Ten-year quality of life outcomes among patients with schizophrenia and schizoaffective disorder II. Predictive value of psychosocial factors

Purpose

To identify psychosocial predictors of change in health-related quality of life among patients with schizophrenia (SZ) and schizoaffective (SA) disorders over a 10-year period.

Methods

In a naturalistic longitudinal design, 108 patients with SZ/SA disorders completed a comprehensive rating scale battery including self-reported quality of life, emotional distress symptoms, coping styles, sense of self-efficacy, and social support, as well as observer-rated psychopathology, medication side effects, and general functioning at 2?time points, baseline and 10?years later.

Results

Regression models revealed that reduction in self-reported symptoms of depression, sensitivity or anxiety along with increase in self-efficacy, social support, and emotion-oriented coping scores predicted improvement in domain-specific perceived quality of life. Adjustment of the psychosocial models for the effects of disorder-related factors (psychopathology, functioning, and medication side effects) confirmed the above findings and amplified their statistical power.

Conclusions

In the long-term course of severe mental disorders (SZ/SA), changes in the psychosocial factors are stronger predictors of subjective quality of life outcome than disorder-related changes. The findings enable better understanding of the combined effects of psychopathology and psychosocial factors on quality of life outcome over a 10-year period.     

Long-term efficacy of an attachment-based parental training program for single mothers and their children: a randomized controlled trial

Objective

Single mothers suffer more frequently from chronic diseases, depression, and elevated stress level. Their children display adaptation and behavior problems more often than children of dual-parent families. To prevent these risks, a parental training program (PALME) for single mothers and their preschool children was developed. The concept of PALME is based on attachment theory and psychodynamic-interactional approaches.

Subject and methods

The efficacy of the program was evaluated in a randomized control intervention study with 58 single mothers. Outcomes from the revised version of the Symptom Checklist SCL-90-R, SF-12 Health Survey, Psychogenic Impairment Score (BSS), Scales on the Experience of Emotions (SEE) and Strengths and Difficulties Questionnaire SDQ were compared at baseline (t1), post-treatment (t2), and 6 months follow-up (t3) for statistical and clinical significance. Per-protocol analyses of variance were used to examine intervention effects.

Results

Statistically significant group x time interaction effects in favor of the intervention group indicated intervention effects on the mothers’ psychological symptom load GSI score of SCL-90 R, depression, psychological well-being and psychogenic impairment. Some aspects of maternal emotional competence and behavioral problems of their children improved only in the short term.

Conclusion

The results suggest that PALME is an effective prevention program for the reduction of maternal depression and psychological symptom load and the improvement of well-being among single mothers.     

Impact of economic crisis on mental health of migrant workers: what happened with migrants who came to Spain to work?

Objectives

To assess changes in mental health in a sample of migrant workers after the eruption of the economic crisis in Spain.

Methods

318 migrant workers were interviewed. Mental health, sociodemographic, and economic crisis related variables were obtained through face-to-face (2008) and phone (2011) interviews. Prevalence of poor mental health (PMH) was compared (2011–2008) and multivariate logistic regression models were fitted.

Results

Change in prevalence of PMH was higher in men (aOR 4.63; 95 % CI 2.11–10.16). Subgroups of men showing the largest detrimental mental health effects were: unemployed, with low salaries (≤1,200 euros) and those reporting family burden. An increase of PMH was found in women, without significant associations.

Conclusions

Mental health of migrant workers in Spain has worsened during the economic crisis.     

Overweight and obesity in primary school: native children versus migrant children

Aim

To compare the means of body mass index (BMI) and the prevalences of overweight and obesity between native Dutch and migrant primary school children and to assess to what degree differences between these children could be explained by socioeconomic position and BMI of the mother and the father.

Subjects and methods

A cross-sectional survey was performed among children at the age of 8–9 years old. Subjects were a total of 1,943 children and their primary caregiver. Outcome measures were BMIs and the prevalence of overweight, including obesity. Main independent variables were migrant background, based on country of birth of the parents, socioeconomic status, as indicated by educational level, and parental BMI. Other independent variables were the age and sex of the child.

Results

Overall, our findings show that overweight and obesity are significantly more prevalent among migrant children of non-Western descent as compared to native children and children of Western descent.

Conclusion

Parental BMI is an important predictor of a child’s BMI. However, socioeconomic position is not. Because children of non-Western migrant origin are at higher risk for overweight and obesity, insight into differences in both physical activity and energy intake as well as how these behaviors relate to cultural contrasts in parental beliefs and practices is needed.     

The Effect of Wilderness Therapy on Adolescents’ Cognitive Autonomy and Self-efficacy: Results of a Non-randomized Trial

Background

Adolescents participate in decision-making processes involving risky behaviors. Management of these important decisions may be promoted by enhancing adolescents’ self-efficacy beliefs and cognitive autonomy.

Objective

In order to elucidate the value of wilderness therapy to the successful management of decision making processes among adolescents at risk, this study aims to examine the effect of wilderness therapy participation on cognitive autonomy and self-efficacy.

Methods

The sample consisted of 93 male adolescents at-risk aged 14–16 who study at boarding schools in Israel. Participants took part in a full wilderness therapy intervention, a partial one, or a control condition. Allocation was not randomized. Assessments included the cognitive autonomy and self evaluation inventory and the potency scale and were administered in 3 waves: pre-intervention, post-intervention, and at 5-month follow-up.

Results

The intervention group showed a significant increase in cognitive autonomy following wilderness therapy participation when compared to controls in wave 2 and wave 3. Partial wilderness therapy participation engendered a significant increase in cognitive autonomy when compared to no participation. An identical pattern of findings was found for self-efficacy.

Conclusion

This is the first report of significant cognitive autonomy benefits among male adolescents following wilderness therapy participation. Findings suggest that wilderness therapy may provide adolescents with the capacity to tackle decision-making dilemmas in a successful, constructive manner.     

“I can’t do this,it’s too much”: building social inclusion in cancer diagnosis and treatment experiences of Aboriginal people,their carers and health workers

Objectives

Social inclusion theory has been used to understand how people at the margins of society engage with service provision. The aim of this paper was to explore the cancer care experiences of Aboriginal people in NSW using a social inclusion lens.

Methods

Qualitative interviews were conducted with 22 Aboriginal people with cancer, 18 carers of Aboriginal people and 16 health care workers.

Results

Participants’ narratives described experiences that could be considered to be situational factors in social inclusion such as difficulties in managing the practical and logistic aspects of accessing cancer care. Three factors were identified as processes of social inclusion that tied these experiences together including socio-economic security, trust (or mistrust arising from historic and current experience of discrimination), and difficulties in knowing the system of cancer treatment.

Conclusions

These three factors may act as barriers to the social inclusion of Aboriginal people in cancer treatment. This challenges the cancer care system to work to acknowledge these forces and create practical and symbolic responses, in partnership with Aboriginal people, communities and health organisations.     

Work-life balance among shift workers: results from an intervention study about self-rostering

Purpose

The aims of the study were to explore the effects of the implementation of IT-based tools for planning of rosters among shift workers on work-family-related outcomes and to interpret the results in light of the different implementation processes.

Methods

A quasi-experimental intervention study was conducted with 12-month follow-up at 14 intervention and 14 reference worksites in Denmark. Workplaces planning to introduce IT-supported self-rostering were recruited, and three different kinds of interventions were implemented. Intervention A and B aimed at increasing workers satisfaction and well-being, while intervention C was designed to optimize the personnel resources. Questionnaire data were collected from 840 employees at baseline and 784 at follow-up. Process evaluation encompassed interviews with about 25 employees and 15 managers at baseline and follow-up. Work-family-related outcomes were work-life conflicts, work-life facilitation, marital conflicts and time with children.

Results

An overall decline in work-family conflicts and increase in work-family facilitation were found in the total intervention group. More specifically, in group B, work-family conflicts and marital conflicts decreased while work-family facilitation increased. In group C, work-family conflicts increased while work-family facilitation and time spend with children decreased, and no significant changes were observed in the reference group and in group A.

Conclusion

An overall positive effect of the implementation of self-rostering was found on the balance between work and private life. However, results from the process evaluation suggested that the organizational aim with the intervention was crucial for the effect.     

A randomised controlled trial of a school-based intervention to prevent tobacco use among children and adolescents in Italy

Aim

A randomised field trial was conducted to evaluate a school-based programme to prevent tobacco use in children and adolescents.

Subject and methods

The trial included 534 children and 308 adolescents who were randomly selected to receive or not to receive the prevention programme. The prevention programme included: (a) health facts and the effect of smoking, (b) analysis of the mechanisms underlying intiation of smoking and (c) refusal skills training to deal with the social pressures to smoke. A questionnaire was administered before the intervention programme and 2 years later.

Results

The prevalence rates of smoking in both groups of children and adolescents were increased at the end of the study. Anyway, the difference of smoking prevalence between the intervention and control groups was statistically significant only for the children’s group (from 18.3 to 18.8% for the intervention group and from 17.8 to 26.9% in the control group) (p?=?0.035). As regards reasons that induced the start of smoking, there was a significant increase of the issue “because smokers are fools” (p?=?0.004 for children; p?<?0.001 for adolescents) and “because smokers are irresponsible” (p?≤?0.001 for both children and adolescents) in the experimental groups.

Conclusion

The results suggest that a school-based intervention programme addressing tobacco use among children and adolescents, based on the development of cognitive and behavioural aspects, can be effective. After 1 year of intervention, smoking prevalence was significantly lower in children belonging to the intervention group than in children not randomised to intervention. Targeting young children before they begin to smoke can be a successful way of prevention.     

Smokers’ compliance with smoke-free policies, and non-smokers’ assertiveness for smoke-free air in the workplace: a study from the Balkans

Objective

Identify the psychosocial variables that predict smokers’ compliance with smoke-free policies at work, and non-smokers’ assertiveness for smoke-free rights in Greek and Bulgarian workplaces.

Methods

Data were collected from employees in Greece and Bulgaria. The main outcome measures were smokers’ compliance with smoke-free policies, and non-smokers’ assertiveness intentions. Demographic variables, tobacco use and dependence, as well as beliefs about second-hand smoke (SHS) exposure and smoking at work were also assessed.

Results

Regression analyses showed that smokers’ compliance with smoke-free policies was predicted by age, perceived health risks of smoking, and beliefs related to the benefits of smoking at work. Non-smokers’ assertiveness was predicted by annoyance from exposure to SHS at work, and assertiveness-related social cognitions (e.g., attitudes, social norms, and self-efficacy).

Conclusions

Interventions to promote support for tobacco control policies at work in Greece and Bulgaria may benefit from targeting smokers’ beliefs about the actual effects of tobacco use on health and job performance. Accordingly, efforts to promote non-smokers assertiveness should build stronger assertiveness-related attitudes, convey anti-smoking normative messages, and strengthen self-efficacy skills.