(2016) The impact of changing attitudes, norms, and self-efficacy on health-related intentions and behavior: a meta-analysis. Health Psychology, 35 (11). pp. 1178-1188 This version is available from Sussex Research Online: http://sro.sussex.ac.uk/58976/ This document is made available in accordance with publisher policies and may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the URL above for details on accessing the published version. Copyright and reuse:Sussex Research Online is a digital repository of the research output of the University.Copyright and all moral rights to the version of the paper presented here belong to the individual author(s) and/or other copyright owners. To the extent reasonable and practicable, the material made available in SRO has been checked for eligibility before being made available.Copies of full text items generally can be reproduced, displayed or performed and given to third parties in any format or medium for personal research or study, educational, or not-for-profit purposes without prior permission or charge, provided that the authors, title and full bibliographic details are credited, a hyperlink and/or URL is given for the original metadata page and the content is not changed in any way. CHANGING HEALTH BEHAVIORS 1The Impact of Changing Attitudes, Norms, and Self-Efficacy on Health-Related Intentions and Behavior: A Meta-Analysis CHANGING HEALTH BEHAVIORS 2 AbstractObjective: Several health behavior theories converge on the hypothesis that attitudes, norms, and self-efficacy are important determinants of intentions and behavior. Yet inferences regarding the relation between these cognitions and intention or behavior rest largely on correlational data that preclude causal inferences. To determine whether changing attitudes, norms, or self-efficacy leads to changes in intentions and behavior, investigators need to randomly assign participants to a treatment that significantly increases the respective cognition relative to a control condition, and test for differences in subsequent intentions or behavior. The present review analyzed findings from 204 experimental tests that met these criteria. Methods: Studies were located using computerized searches and informal sources and meta-analyzed using STATA Version 11.Results: Experimentally induced changes in attitudes, norms, and self-efficacy all led to mediumsized changes in intention (d+ = .48, .49, and .51, respectively), and engendered small to medium-sized changes in behavior (attitudes-d+ = .38; norms-d+ = .36; self-efficacy-d+ = .47).These effect sizes generally were not qualified by the moderator variables examined (e.g., study quality, theoretical basis of the intervention, methodological characteristics, features of the targeted behavior), although effects were larger for interventions designed to increase (vs. decrease) behavioral performance. Conclusion: The present review lends novel, experimental support...

Except for attitudes, the mediators that were successfully manipulated by the interventions (i.e., perceived susceptibility, perceived severity, and attitudes) were not the same constructs that predicted intentions (i.e., attitudes and condom use self-efficacy), and subsequently predicted behavior. This suggests that the constructs that explain behavior are not the same as those that produce behavior change.

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Because adolescence is a period of heightened exploration of new behaviors, there is a natural increase in risk taking including initial use of alcohol and marijuana. In order to better understand potential differences in neurocognitive functioning among adolescents who use drugs, the current study aimed to identify the neural substrates of risky decision making that differ among adolescents who are primary users of alcohol or marijuana, primary users of both alcohol and marijuana, and controls who report primary use of neither drug. Participants completed the Balloon Analogue Risk Task (BART) while undergoing functional magnetic resonance imaging. Comparison of brain activation during risky decisions versus non-risky decisions across all subjects revealed greater response to risky decisions in dorsal anterior cinguate cortex (dACC), anterior insula, ventral striatum, and lateral prefrontal cortex. Group comparisons across non-using controls, primary marijuana, primary alcohol, and alcohol and marijuana users revealed several notable differences in the recruitment of brain regions. Adolescents who use both alcohol and marijauna show decreased response during risky decision making compared to controls in insula, striatum, and thalamus, and reduced differentiation of increasing risk in dACC, insula, striatum, and superior parietal lobe compared to controls. These results provide evidence of differential engagement of risky decision making circuits among adolescents with varying levels of alcohol and marijuana use, and may provide useful targets for longitudinal studies that explicitly address causality of these differences.

BackgroundVideogame interventions are becoming increasingly popular as a means to engage people in behavioral interventions; however, strategies for examining data from such interventions have not been developed.ObjectiveThe objective of this study was to describe how a technology-based intervention can yield meaningful, objective evidence of intervention exposure within a behavioral intervention. This study demonstrates the analysis of automatic log files, created by software from a videogame intervention, that catalog game play and, as proof of concept, the association of these data with changes in substance use knowledge as documented with standardized assessments.MethodsWe analyzed 3- and 6-month follow-up data from 166 participants enrolled in a randomized controlled trial evaluating a videogame intervention, PlayForward: Elm City Stories (PlayForward). PlayForward is a videogame developed as a risk reduction and prevention program targeting HIV risk behaviors (substance use and sex) in young minority adolescents. Log files were analyzed to extract the total amount of time spent playing the videogame intervention and the total number of game levels completed and beaten by each player.ResultsCompleting and beating more of the game levels, and not total game play time, was related to higher substance use knowledge scores at the 3- (P=.001) and 6-month (P=.001) follow-ups.ConclusionsOur findings highlight the potential contributions a videogame intervention can make to the study of health behavior change. Specifically, the use of objective data collected during game play can address challenges in traditional human-delivered behavioral interventions.Trial RegistrationClinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6cV9fxsOg)