1. Established Truths of the Science of Health Behavior Change that are Not True
James O. Prochaska, Ph.D.
Director and Professor
Cancer Prevention Research Center
University of Rhode Island
Founder
Pro-Change Behavior Systems, Inc. 1

2. 1. Behavior Science and Behavior Change Science are synonyms

3. Stages of Change 10

4. Precontemplation: Not Ready
Have no intention to start taking action in next 6 months 43

5. Efficacy: Clinical Guidelines for Treating Tobacco Use
Fiore et al., 1996: studies on tobacco
Fiore et al., 2008: 6000 studies
Many evidence-based treatments for motivated smokers (i.e. those in preparation stage)
No evidence-based treatments for unmotivated smokers
A. > 80% of all U.S. smokers
Fiore et al., 1996: studies on tobacco. Fiore et al., 2008: 6000 studies

6. 2. There is a hierarchy of methodologies that have increasing impacts on the science and practice of health behavior change (e.g., qualitative < cross-sectional < longitudinal < RCTs)

7. The pros and cons of changing across stages of change for 48 behaviors
Stage Transitions C
The pros and cons of changing across stages of change for 48 behaviors
Hall, K. L. & Rossi, J. S. (2008). Meta-analytic examination of the strong and weak principles across 48 health behaviors. Preventive Medicine, 46,

8. Stages by Processes Precontemplation Contemplation Preparation
Consciousness Raising
Dramatic Relief
Environmental Reevaluation
Self Reevaluation
Prochaska, JO & DiClemente, CC. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 29

9. Stages by Processes Preparation Action Maintenance Self Liberation
Reinforcement Management
Helping Relationships
Counter conditioning
Stimulus Control
Prochaska, JO & DiClemente, CC. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 30

10. 3. Behavior change imaging is not feasible because change happens over time

11. The pros and cons of changing across stages of change for 48 behaviors
Stage Transitions C
The pros and cons of changing across stages of change for 48 behaviors
Hall, K. L. & Rossi, J. S. (2008). Meta-analytic examination of the strong and weak principles across 48 health behaviors. Preventive Medicine, 46,

12. 4. Specificity of causality (e. g
4. Specificity of causality (e.g., a specific germ or gene causes a specific disease) is a hallmark of advanced health sciences

13. 5. Individualized and interactive health counseling is the most effective treatment modality

17. Treatment Groups 1. Action-oriented Manuals 2. Stage-Matched Manuals
3. Tailored Computerized Programs &
Manuals
4. Counselors & Tailored Computerized
Programs 33

18. Assessment Months Months Months Months
Prochaska, JO, DiClemente, CC, Velicer, WF & Rossi, JS. (1993). Standardized, individualized, interactive and personalized self-help programs for smoking cessation. Health Psychology, 12, 34

19. 6. People of different age, gender, race, ethnicity and mental health status have different success rates

20. Age
Velicer, WF, Redding, CA, Sun, X, & Prochaska, JO. (2007). Demographic variables, smoking variables, and outcome across five studies. Health Psychology, 26,

21. Proactive Cessation With Adolescents in Primary Care
Tailored Intervention
Assessment Only
23.9%
11.4%
Hollis, JF, Polen, MR, Whitlock, EP; Lichtenstein, E., Mullooly, JP, Velicer, W.F., & Redding, C.A. (2005). TEEN REACH: Outcomes from a randomized controlled trial of a tobacco reduction program among teens seen in primary medical care. Pediatrics, 115,

22. Race
Velicer, WF, Redding, CA, Sun, X, & Prochaska, JO. (2007). Demographic variables, smoking variables, and outcome across five studies. Health Psychology, 26,

23. Hispanic
Velicer, WF, Redding, CA, Sun, X, & Prochaska, JO. (2007). Demographic variables, smoking variables, and outcome across five studies. Health Psychology, 26,

24. Proactive Cessation with Depressed Patients: Abstinence at 18 Months
Tailored Intervention +
Assessment Only
24.6%
19.1%
Hall, S. M., Tsoh, J. V., Prochaska, J. J., Eisendrath, S., Humfleet, G. L., Gorecki, J. A. et al. (2006). Treatment for Cigarette Smoking Among Depressed Mental Health Outpatients: A Randomized Clinical Trial. American Journal of Public Health, 96,

25. Proactive Cessation with Patients Hospitalized for Mental Illness
Tailored
Assessment
20% 8%
Prochaska, J.J., Hall, S., Delucchi, K., & Hall, S.M. (2014). Efficacy of initiating tobacco dependence treatment in inpatient psychiatry: A randomized controlled trial. American Journal of Public Health, 104(8),

26. 7. Treating one behavior produces greater efficacy on that behavior than treating multiple behaviors

27. Smoking Point Prevalence
% Quit
12-Month 24-Month
Treatment % %
Control % %
Prochaska, JO, Velicer, WF, Redding, CA, Rossi, JS, Goldstein, M, DePue, J, Greene, GW, Rossi, SR & Sun, X. (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. Preventive Medicine, 41,

28. Diet Point Prevalence % Movement to Action or Maintenance
12-Month 24-Month
Treatment % %
Control % %
Prochaska, JO, Velicer, WF, Redding, CA, Rossi, JS, Goldstein, M, DePue, J, Greene, GW, Rossi, SR & Sun, X. (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. Preventive Medicine, 41,

29. Sun Point Prevalence % Movement to Action or Maintenance
12-Month 24-Month
Treatment % %
Control % %
Prochaska, JO, Velicer, WF, Redding, CA, Rossi, JS, Goldstein, M, DePue, J, Greene, GW, Rossi, SR & Sun, X. (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. Preventive Medicine, 41,

30. Two Years of Primary Care Counseling
I. No effects on any of the four target behaviors
II. No increased effect on four behaviors treated effectively with TTM-tailored interventions

31. 8. Comparative outcomes between treatment and control groups can predict outcomes within individuals

32. Coaction: The increased probability of progressing to Action on a second behavior (e.g. diet) when individuals have progressed to Action on an initial behavior (e.g. smoking).
Coaction in Odds Ratio
Control Group
TTM Intervention Group
Johnson SS1, Paiva AL2, Mauriello L1, Prochaska JO2, Redding C2, Velicer WF. (2014). Coaction in multiple behavior change interventions: consistency across multiple studies on weight management and obesity prevention. Health Psychol, 33(5): doi: /a Epub 2013 Nov 25.

33. CoAction at 6 months Odds Ratios PA & FV PA & TV FV & TV Treatment
Control
(N=471)
(N=233)
(N=304)
(N=163)
(N=364)
(N=238)
3.36***
1.04
(2.14, 5.28)
2.08**
0.498
(1.23, 3.52)
1.99**
0.906
(1.26, 3.15)

34. 9. Behavior change treatments don’t produce long term success

35. Comparative Outcomes of Interventions
(arms from RCTs/Case Studies)
(26 arms from RCTs)
Johnson, J.L., Prochaska, J.O., Paiva, A.L., Fernandez, A.C., DeWees, S.L., and Prochaska, J.M. (2013) Advancing Bodies of Evidence for Population-based Health Promotion Programs: Randomized Controlled Trials and Case Studies. Population Health Management, 16(6),

36. 10. Reducing negative behaviors does not increase positive ones

37. Well-being RCT
Determine the effects on multiple risks and multiple domains of well-being of Pro-Change’s effective LifeStyle Programs:
Online program for stress management
Telephonic coaching program for exercise management
3 group design
Prochaska, J.O., Evers, K.E., Castle, P.H., Johnson, J.L., Prochaska, J.M., Rula, E.Y., Coberley, C., & Pope, J.E. (2012). Enhancing Multiple Domains
of Well-being by Decreasing Multiple Health Risk Behaviors: A Randomized Clinical Trial. Population Health Management, 15 (5),
second set

38. Baseline Demographics
39 States represented
59% female
52% currently employed
5.2% full time student
42.7% never smoke
20% reported no depression
Age:
Mean = (13.53)
Range = 18-86
Chronic conditions:
Mean = 3.74 (3.09)
Range = 0-34
Behavior risks:
Mean = 4.14 (1.44)
Range = 0-9
second set

39. Baseline Stage of Change
Regular Exercise
PC 30.2% (1250)
C 32.7% (1354)
PR 27.4% (1132)
A 5.8% (239)
  M 3.9% (161)
Stress Management
PC 31.0% (1282)
C 26.3% (1089)
PR 22.8% (941)
A 8.1% (336)
  M 11.8% (488)
James O. Prochaska, Kerry E. Evers, Patricia H. Castle, Janet L. Johnson, Janice M. Prochaska, Elizabeth Y. Rula, Carter Coberley, and James E. Pope. (2012). Population Health Management, 15(5): doi: /pop
second set

40. Exercise: Movement to A/M at T2 Group Exercise Coach 57.3%
Stress Online
46.6%
Control
37.3%
second set

41. Stress Management: Movement to A/M at T2 Group Exercise Coach 74.9%
Stress Online
64.7%
Control
53.1%
second set

42. IWBS: Emotional Health Mean Differences (T1-T2)
Group 
Exercise Coach
14.54
Stress Online
12.03
Control
7.75
second set

43. Life Evaluation Categories:T1
James O. Prochaska, Kerry E. Evers, Patricia H. Castle, Janet L. Johnson, Janice M. Prochaska, Elizabeth Y. Rula, Carter Coberley, and James E. Pope. (2012). Population Health Management, 15(5): doi: /pop
second set

44. Life Evaluation Categories:T2
James O. Prochaska, Kerry E. Evers, Patricia H. Castle, Janet L. Johnson, Janice M. Prochaska, Elizabeth Y. Rula, Carter Coberley, and James E. Pope. (2012). Population Health Management, 15(5): doi: /pop
second set