The power of habits: Unhealthy snacking behaviour is primarily predicted by habit strength

Objective. Although increasing evidence shows the importance of habits in explaining health behaviour, many studies still rely solely on predictors that emphasize the role of conscious intentions. The present study was designed to test the importance of habit strength in explaining unhealthy snacking behaviour in a large representative community sample (N= 1,103). To test our hypothesis that habits are crucial when explaining unhealthy snacking behaviour, their role was compared to the 'Power of Food', a related construct that addresses sensitivity to food cues in the environment. Moreover, the relation between Power of Food and unhealthy snacking habits was assessed. Design and Methods. A prospective design was used to determine the impact of habits in relation to intention, Power of Food and a number of demographic variables. One month after filling out the questionnaire, including measures of habit strength and Power of Food, participants reported their unhealthy snacking behaviour by means of a 7-day snack diary. Results. Results showed that habit strength was the most important predictor, outperforming all other variables in explaining unhealthy snack intake. Conclusions. The findings demonstrate that snacking habits provide a unique contribution in explaining unhealthy snacking behaviour, stressing the importance of addressing habit strength in further research and interventions concerning unhealthy snacking behaviour. STATEMENT OF CONTRIBUTION: WHAT IS ALREADY KNOWN ON THIS SUBJECT?: Although increasing evidence shows the importance of habits in predicting a variety of behaviours (e.g., Aarts, Verplanken, & Van Knippenberg, 1998), including health behaviours (e.g., De Bruijn, 2010), with regard to unhealthy snacking behaviour, only one study demonstrated that habit strength is the most important predictor of unhealthy snacking behaviour (Verplanken, 2006). However, as this study was conducted among a student sample, the role of habits in unhealthy snacking behaviour has as of yet not been examined in a community sample. In addition, the role of habits has not yet been compared to the 'Power of Food', a related construct that addresses sensitivity to food cues in the environment. WHAT DOES THIS STUDY ADD?: The present study was the first to examine unhealthy snacking behaviour among a large representative community sample (N = 1103), showing that the importance of habits in unhealthy snacking behaviour can be extended to the general population. In addition, the present study included the intention to eat more healthily, habit strength and the Power of Food, and demonstrated that habit strength is the most important predictor of unhealthy snacking behaviour, stressing the importance of addressing habits in further research and interventions concerning unhealthy snacking behaviour.     

Nurse prescribing of medicines in Western European and Anglo-Saxon countries: a survey on forces, conditions and jurisdictional control

BackgroundThe number of Western European and Anglo-Saxon countries where nurses are legally allowed to prescribe medicines is growing. As the prescribing of medicines has traditionally been the task of the medical profession, nurse prescribing is changing the relationship between the medical and nursing professions.ObjectivesTo gain more insight into the forces that led to the introduction of nurse prescribing of medicines in Western European and Anglo-Saxon countries, as well as into the legal, educational and organizational conditions under which nurses prescribe in these countries. Moreover, this study sought to determine which consequences nurse prescribing has for the division of jurisdictional control over prescribing between the nursing and medical professions.DesignInternational survey.ParticipantsAn email survey was sent to 60 stakeholders of professional nursing or medical associations or government bodies, at national, state or provincial level across ten Western European and Anglo-Saxon countries, namely Australia, Canada, Finland, Ireland, the Netherlands, New Zealand, Spain, Sweden, the United Kingdom and the United States of America.MethodsThe survey addressed the reasons for the introduction of nurse prescribing and the conditions under which nurses are or will be prescribing medicines.ResultsThe response rate was 65% (n = 39). It was shown that a diversity of forces led to the introduction of nurse prescribing, and respondents from nursing and medical associations and government bodies cited different forces as being important for the introduction of nurse prescribing. Representatives of nurses’ associations oftentimes emphasized the medication needs of patients living in remote geographical areas, while representatives of medical associations more often pointed to workforce shortages within the health care service. The conditions under which nurses prescribe medicines vary considerably, from countries where nurses prescribe independently to countries in which prescribing by nurses is only allowed under strict conditions and the supervision of physicians.ConclusionsCiting different forces as being important in the introduction of nurse prescribing can be conceived as a professional ‘problem construction’ in order to gain jurisdiction over the prescribing task. In most countries, nurses prescribe in a subordinate position and the jurisdiction over prescribing remains predominantly with the medical profession.     

Screening for Poststroke Depression Using the Patient Health Questionnaire

BACKGROUND:: Although poststroke depression has a significant impact on a patient's ability to recover after stroke, it is generally not recognized. Structured screening can help nurses identify symptoms of depression in stroke patients. In clinical practice, the utility of an instrument is as importantas its validity and reliability. OBJECTIVE:: To investigate the reliability, validity, and clinical utility of the nine-item and two-item patient health questionnaires (PHQ-9 and PHQ-2, respectively) in stroke patients in a clinical nursing setting. The results of these questionnaires will be compared against those from the Geriatric Depression Scale. METHODS:: The PHQ-9 was administered by 43 ward nurses in 55 patients with an intracerebral hemorrhage or ischemic infarction who were able to communicate adequately. The interrater reliability, test-retest reliability and internal consistency, concurrent validity, diagnostic accuracy, and clinical utility were evaluated. RESULTS:: The interrater reliability (intraclass correlation [ICC] = 0.98, 95% CI [0.96, 0.99]), test-retest reliability (ρSp = 0.75, p < .001), and internal consistency (Cronbach's α = 0.79) of the PHQ-9 were good. The concurrent validity was moderate for the PHQ-9, with a Pearson's correlation of .7 (p < .001) and acceptable for the PHQ-2 with a Pearson's correlation of .8 (p < .01). The optimum cutoff point of the PHQ-9 for major depression was 10 (sensitivity, 100%; specificity,86%; positive predicted value, 50%; and negative predicted value, 100%). For the PHQ-2, the optimum cutoff point was 2 (sensitivity, 100%; specificity, 77%; positive predicted value, 38%; and negative predicted value, 100%). DISCUSSION:: The PHQ is a brief and easy-to-use instrument for nursing practice. It shows good reliability, validity, and clinical utility when used in stroke patients who are able to communicate adequately.     

Infant Feeding and Ethnic Differences in Body Mass Index during Childhood: A Prospective Study

This study investigated ethnic differences in childhood body mass index (BMI) in children from Dutch and Turkish descent and the role of infant feeding factors (breastfeeding duration, milk feeding frequency, as well as the timing, frequency and variety of complementary feeding (CF)). We used data from 244 children (116 Dutch and 128 Turkish) participating in a prospective study in the Netherlands. BMI was measured at 2, 3 and 5 years and standard deviation scores (sds) were derived using WHO references. Using linear mixed regression analyses, we examined ethnic differences in BMI-sds between 2 and 5 years, and the role of infant feeding in separate models including milk or CF factors, or both (full model). Relative to Dutch children, Turkish children had higher BMI-sds at age 3 (mean difference: 0.26; 95%CI: 0.04, 0.48) and 5 (0.63; 0.39, 0.88), but not at 2 years (0.08; −0.16, 0.31). Ethnic differences in BMI-sds were somewhat attenuated by CF factors at age 3 (0.16; −0.07, 0.40) and 5 years (0.50; 0.24, 0.77), whereas milk feeding had a minor impact. Of all factors, only CF variety was associated with BMI-sds in the full model. CF factors, particularly CF variety, explain a small fraction of the BMI-sds differences between Dutch and Turkish children. The role of CF variety on childhood BMI requires further investigation.     

Smoking onset and the time-varying effects of self-efficacy, environmental smoking, and smoking-specific parenting by using discrete-time survival analysis

This study examined the timing of smoking onset during mid- or late adolescence and the time-varying effects of refusal self-efficacy, parental and sibling smoking behavior, smoking behavior of friends and best friend, and parental smoking-specific communication. We used data from five annual waves of the ‘Family and Health’ project. In total, 428 adolescents and their parents participated at baseline. Only never smokers were included at baseline (n = 272). A life table and Kaplan–Meier survival curve showed that 51% of all adolescents who did not smoke at baseline did not start smoking within 4 years. The risk for smoking onset during mid- or late adolescence is rather stable (hazard ratio between 16 and 19). Discrete-time survival analyses revealed that low refusal self-efficacy, high frequency of communication, and sibling smoking were associated with smoking onset one year later. No interaction effects were found. Conclusively, the findings revealed that refusal self-efficacy is an important predictor of smoking onset during mid- or late adolescence and is independent of smoking-specific communication and smoking behavior of parents, siblings, and (best) friend(s). Findings emphasize the importance of family prevention programs focusing on self-efficacy skills.     

Psychological and physical activity training for older persons: who does not attend?

BACKGROUND: Interventions to promote successful aging include psychological and physical activity programs. Identification of determinants of attendance of older persons may be useful to develop strategies to improve attendance. For physical activity programs determinants of attendance have been investigated extensively. For psychological programs hardly any knowledge is available. Determinants of attendance at psychological and physical activity programs have never been investigated simultaneously. OBJECTIVE: To identify demographic, physical and psychological determinants of attendance of older subjects following multifaceted psychological training - aimed at promoting active social participation - and physical activity training and to compare the variation of these determinants between the two training programs. METHOD: 118 subjects aged 65-92 years were randomized over psychological and physical activity training. Determinants of attendance were obtained at pretest with questionnaires and performance-based tests. RESULTS: Mean attendance was 62%. Attendance was not related to type of program. Having chronic diseases facilitated attendance in the psychological training group and limited attendance in the physical activity training group. Low and high levels of Activities of Daily Living performance (ADLs) and walking endurance were related to a high attendance in the psychological training group. A low level of activities of daily living (ADL) and a low walking endurance were related to a low attendance in the physical activity training group. For both training groups, persons living with a partner had higher attendance rates than persons living alone, and persons with a low level of anxiety had higher attendance rates than persons with a moderate or a high level of anxiety. CONCLUSION: Psychological training may be more suitable for frail older persons with chronic diseases, low ADL levels and low walking endurance than physical activity training, and may help to prepare such persons for physical activity.