Goldstein, M., DePue, J. et al. (2005). Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer and receive regular mammograms.

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The transtheoretical model of health behavior change is described and supporting empirical work is presented that reviews the central constructs of the model: the stages of change, processes of change, decisional balance, confidence, and temptation. Model-based applications to a broad range of problem behaviors are summarized. Applications to human immunodeficiency virus (HIV) prevention behavior changes are highlighted for each variable. Finally, several questions about the area of sexual behavior change to reduce risk of HIV exposure are explored and future research ideas are described within the context of this model.

Four studies were conducted to develop and validate the Sexual Assertiveness Scale (SAS), a measure of sexual assertiveness in women that consists of factors measuring initiation, refusal, and pregnancysexually transmitted disease prevention assertiveness. A total of 1,613 women from both university and community populations were studied. Confirmatory factor analyses demonstrated that the 3 factors remained stable across samples of university and community women. A structural model was tested in 2 samples, indicating that sexual experience, anticipated negative partner response, and self-efficacy are consistent predictors of sexual assertiveness. Sexual assertiveness was found to be somewhat related to relationship satisfaction, power, and length. The community sample was retested after 6 months and 1 year to establish test-retest reliability. The SAS provides a reliable instrument for assessing and understanding women's sexual assertiveness. Sexual assertiveness is important for attainment of sexual goals and self-protection from unwanted or unsafe sexual activity. However, traditional gender roles include expectations for men to initiate sexual activity and for women to respond to men's attempts to initiate sexual behavior (Morokoff, 1990; Muehlenhard & McCoy, 1991). Specific problems are associated with women's compliance with gender-based norms for sexual behavior. One problem is that by adopting a sexually passive role, women do not have the opportunity to assert their own sexual interests by initiating sexual activity. Research has shown that although men may often be the first to directly express sexual interest, women indicate sexual interest indirectly, for example by smiling, touching, or gazing into a partner's eyes (Perper & Weis, 1987). Evidence

Throughout history, alcohol and other drugs have been used to provide relief in times of stress and frustration. Research has confirmed this association between disruptive life change events and substance use. It was hypothesized that two psychological constructs facilitate and mediate this relation between stress and substance use. Uncontrollable stress (negative life change events) was assumed to create a sense of loss of control, which in turn engendered a decreased level of meaning in life. This meaninglessness in life, experienced as distressful and uncomfortable, is then treated or medicated with various drug substances. This theoretical sequential model was tested in two separate studies with independent samples of adolescents (one sample collected by the Rutgers University and the other collected by the University of California, Los Angeles [UCLA]) using latent variable structural models. The Rutgers sample was cross-sectional, whereas the UCLA sample provided longitudinal data. Results supported the theoretical hypothesis that Perceived Loss of Control and Meaninglessness mediate the relation between Uncontrollable Stress and Substance Use. In the Rutgers data, the association between stress and drug use was clearly accounted for by the mediating constructs; in other words, no direct path was necessary to explain the relation between stress and general drug use. However, in the UCLA data there remained a direct influence of Uncontrollable Stress on Substance Use after accounting for the significant impact of the mediating constructs. Five other competing models were tested; four were rejected empirically, and the other was accepted, although it was less theoretically based than the mediational model.

A theoretical model of adolescent behavior is examined separately for males and females (N = 722). The model hypothesizes that depression and self‐derogation may lead to a lack of purpose in life, which, in turn, may lead to suicide ideation and substance use. Confirmatory factor analyses and structural equation procedures were used to examine the model, using Bentler's (1984) EQS computer program, which is available from BMDP. For both the men and women, the model adequately accounted for the data although there were some important differences between the sexes. In response to psychic discomfort (i.e., Depression and Self‐derogation), men are more apt to turn to drugs and alcohol, whereas women consider suicide. Conversely, the situation changes in response to feelings of meaninglessness or a lack of purpose in life. Here, the females appear to turn to substance use, whereas the males react with thoughts of suicide.

The purpose of this research was to test expansion of the Exercise and Self-Esteem Model (EXSEM) to include two levels of perceived physical competence as operationalized by the Physical Self-Perception Profile (PSPP). Female aerobic dancers (N = 216, age M = 38.4) were administered a Self-Esteem scale (SE), the PSPP to assess a general Physical Self-Worth (PSW), and more specific subdomains of perceived Sport Competence (Sport), Physical Condition (Cond), Attractive Body (Body), and Strength (Stren). Subjects also completed self-efficacy scales for jogging, sitting, and aerobic dancing. Confirmatory factor analysis supported model measurement as hypothesized, %2 = 1,154.88, df = 681, comparative fit index (CFI) = .913, root mean square residual (RMSR) = .047. Structural equation modeling (SEM) supported EXSEM component relationships as proposed. Further SEM associating two exercise self-reports with EXSEM again displayed satisfactory fit indices and explained up to 27.6% of exercise variance. It was concluded that exercise in adult female aerobic dancers is associated with positive evaluations of their physical condition and with negative evaluations of their bodies.

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