Nina Knoll

Freie Universität Berlin, Berlín, Berlin, Germany

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Publications (97)201.96 Total impact

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    ABSTRACT: To evaluate a theory-guided intervention on oral self-care and examine the possible mechanisms among self-regulatory factors, two brief intervention arms were compared, an information-based education treatment and a self-regulation treatment focusing on planning and action control. Young adults (N = 284; aged 18-29 years) were assessed at baseline and 1 month later. The self-regulation intervention improved levels of oral self-care, dental planning and action control. Moreover, a moderated mediation model with planning as the mediator between experimental conditions and dental outcome, and self-efficacy as well as action control as moderators elucidated the mechanism of change. More self-efficacious participants in the self-regulation condition benefitted in terms of more planning, and those who monitored their actions yielded higher levels of oral hygiene. Dental self-efficacy, dental planning and action control are involved in the improvement of oral self-care. Their joint consideration may contribute to a better understanding of health behavior change. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.
    Health Education Research 08/2015; 30(4):671-81. DOI:10.1093/her/cyv032 · 1.66 Impact Factor
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    ABSTRACT: Objectives Dietary intentions are supposed to engender planning processes, which in turn stimulate dietary behaviour change. However, some studies failed to find such mediation effects, which suggest more complex and not yet unravelled relationships between these factors. One explanation may be that mediation works better under certain circumstances or only for specific subgroups. This study addresses this reasoning by examining autonomy beliefs and sex as putative moderators of the hypothesized mediation chain.Design and methodsIn a longitudinal design with three measurement points in time (1 week and 1 month apart), 912 women and 214 men were surveyed. Planning, intention, dietary autonomy beliefs, and sex were used to predict fruit and vegetable intake within a conditional process model designed to identify mechanisms of change.ResultsThe intention–planning–behaviour chain was qualified by a triple interaction involving autonomy beliefs and sex as moderators between intention and planning. Higher dietary autonomy resulted in higher levels of planning fruit and vegetable intake. For men, even in case of higher intention, at least medium levels of autonomy beliefs were necessary to facilitate planning processes. For women, already lower levels of autonomy beliefs can engender postintentional planning strategies and seem to even compensate lower intention.Conclusions Intention and planning are key predictors of dietary change. However, these variables work better under specific conditions (with a sufficient level of autonomy), and differently in subgroups (men vs. women). These results may explain the inconsistent findings of previous studies on the mediating effect of planning and allow for a better description of the mechanisms by which intentions may influence behaviour.Statement of contribution What is already known on this subject? The adoption of health-enhancing dietary behaviours can be facilitated by intentions and planning.Planning to eat more fruit and vegetable helps to translate intentions into actual consumption.Fruit and vegetable intake levels are higher in women than in men. What does this study add? Dietary intentions engender more likely planning processes when perceived autonomy concerning food consumption is high.Dietary autonomy beliefs and sex moderate the intention–planning–behaviour chain.Among men, dietary planning is highest when both intentions and autonomy are high.
    British Journal of Health Psychology 07/2015; DOI:10.1111/bjhp.12146 · 2.70 Impact Factor
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    ABSTRACT: This longitudinal experimental study compared effects of self-efficacy, planning, and education-based conditions, encouraging adolescents to eat fruit and vegetable in place of energy-dense foods. Data were collected among 506 adolescents (13-18 years old) who were randomly assigned to control (n = 181), planning (n = 153), or self-efficacy (n = 172) conditions. Measurements were taken at baseline (T1), at a 2-month follow-up (T2), and at a 14-month follow-up (T3). Interventions/control group procedures were delivered at T1 and T2. Self-reports of fruit and vegetable intake (FVI) and energy-dense foods intake were collected at three times. Cognitive mediators (self-efficacy and planning) were assessed at T1 and T2. Body weight and height were objectively measured at T1 and T3. Similar significant increases of FVI were found for planning and self-efficacy interventions (T3). The planning intervention did not influence energy-dense food intake (T3), but the self-efficacy intervention tended to result in stabilizing intake (compared to an increase found in the control group). There were no effects on body weight. Similar patterns were found for the total sample and for a subsample of adolescents with overweight/obesity. The effects of interventions on FVI were mediated by respective cognitions.
    Psychology & Health 07/2015; DOI:10.1080/08870446.2015.1070156 · 1.95 Impact Factor
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    ABSTRACT: Planning can bridge the gap between intentions and action, but what bridges the gap between planning and action? This study helps to answer the question by disentangling the interrelationships between self-efficacy, planning, and preparatory behaviors in predicting physical activity. Preparatory behaviors are tested as a working mechanism of planning. Moreover, it is tested whether the utility of preparatory behaviors depends on an individual's level of self-efficacy. A survey assessed planning, self-efficacy, and preparatory behaviors for physical activity. Adults (N = 166) provided data at two measurement points. In a longitudinal model, preparatory behaviors were specified as a mediator between planning and physical activity. Self-efficacy was specified as a possible moderator at two points in the model. Preparatory behaviors mediated the relationship between planning and physical activity. An interaction between self-efficacy and preparatory behaviors on physical activity was found, indicating that individuals with low self-efficacy beliefs were more active if they engaged more frequently in preparatory behaviors. Planning seems to stimulate preparatory behaviors, which in turn make future physical activity more likely. Furthermore, as performing preparatory behaviors represent a step forward towards the enactment of behavioral goals, preparatory behaviors may be particular beneficial for individuals afflicted by self-doubts regarding physical activity.
    Psychology & Health 07/2015; DOI:10.1080/08870446.2015.1070157 · 1.95 Impact Factor
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    ABSTRACT: Radical prostatectomy, a standard treatment for localized prostate cancer, is often followed by a recommendation to initiate and maintain pelvic floor exercise (PFE), to control postsurgery urinary incontinence. Previous studies showed that planning facilitated the uptake and maintenance of a new behavior. Whereas individual planning addresses the setting of plans by 1 person, dyadic planning refers to creating plans together with a partner on when, where, and how the individual target person will perform a behavior. Individual and dyadic planning of PFE, their development over time, and their associations with PFE were investigated. In a correlational study, 175 prostate-cancer patients provided data at 1, 3, 5, and 7 months following the onset of incontinence. Individual planning of PFE by patients and dyadic planning of PFE between patients and their partners, PFE, and incontinence were assessed by patients' self-reports. Two-level models with repeated assessments nested in individuals revealed stable levels of individual planning of PFE over time in patients with higher incontinence severity, whereas patients with receding incontinence showed decreases. Independent of incontinence severity, a curvilinear increase followed by a decrease of dyadic planning of PFE across time emerged. Sequential associations of both planning strategies with PFE were found. Whereas individual planning was steadily associated with PFE, associations between dyadic planning and PFE were nonsignificant in the beginning, but increased over time. Findings point to the importance of individual planning for the adoption and maintenance of PFE, with dyadic planning being relevant for PFE maintenance only. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Rehabilitation Psychology 07/2015; DOI:10.1037/rep0000047 · 1.91 Impact Factor
  • Ewa Gruszczyńska · Nina Knoll
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    ABSTRACT: The aim of the study was to investigate the relationship between affective state, pain, and coping in hospitalized women with rheumatoid arthritis, including both between- and within-person perspectives. Participants were 95 female patients between 24 and 82 years of age (M = 50.91; SD = 13.80). For three consecutive days, they rated each night their state affect (positive and negative), pain level, and coping strategies (emotion-, problem- and meaning-focused ones). Relations among variables were tested with a multilevel approach with time included as a covariate. Within-person meaning-focused coping suppressed the negative pain effect on emotional state, but only for positive affect (Sobel's z = 2.07, p = .04). Moderators of the pain-affect relationship were between-person differences in pain level (B = -.23, SE = .08, t = -2.884, p = .004) and in meaning-focused coping (B = -.63, SE = .20, t = -2.097, p = .04). Specifically, suppression was significant only for patients who reported lower than sample average pain levels and for patients who reported lower than sample average use of meaning-focused strategies. Findings indicated that meaning-focused coping can be a crucial strategy for keeping daily positive affect in the face of chronic pain and how this effect is modified by interindividual differences. Even if restricted to the specific context, it may inform an intervention for hospitalized women with rheumatoid arthritis.
    Quality of Life Research 06/2015; DOI:10.1007/s11136-015-1031-6 · 2.86 Impact Factor
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    ABSTRACT: Often, motivation to be physically active is a necessary precondition of action, but still does not suffice to initiate the target behavior. Instead, motivation needs to be translated into action by a self-regulatory process. Self-efficacy and planning are considered to be useful constructs that help to facilitate such translations. The aim is to examine the roles of motivation, planning, and self-efficacy as well as the mechanisms that operate in the change of physical activity levels. In a longitudinal observation study with 249 young adults, self-efficacy, planning, motivation, and physical activity were assessed at two points in time, three months apart. Planning served as a mediator between self-efficacy and physical activity, controlling for baseline activity. In addition to this indirect effect, a moderator effect was found between self-efficacy and stages of change on planning. The mediation operated only in motivated, but not in unmotivated students. Only when people are motivated to become more active, a mediation from self-efficacy via planning to physical activity seems to be likely.
    Journal of Physical Activity and Health 04/2015; DOI:10.1123/jpah.2014-0555 · 1.95 Impact Factor
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    ABSTRACT: When patients recover from disease-related functional limitations, support received from partners may not always match patients' changing independence goals. The lines of defense (LoD) model proposes a hierarchy of independence goals (LoDs), ranging from minimising discomfort by disengagement (lowest LoD) to protection of self-reliance (highest LoD). Prostate cancer patients' LoDs were examined as moderators of the association between partner support and patients' and partners' affect during patients' recovery from postsurgical functional limitations. Data from 169 couples were assessed four times within 7 months following patients' surgery. Patients reported on post-surgery functional limitations (i.e. incontinence), LoDs, affect, and received partner support. Partners reported on affect and support provided to patients. In patients endorsing lower LoDs, more received support was associated with less negative affect. Also, not endorsing high LoDs while receiving strong partner support was related to patients' lower negative and higher positive affect. Partners' support provision to patients tended to be associated with increases in partners' negative affect when patients had endorsed higher LoDs and with increases in positive affect when patients had endorsed lower LoDs. Matching patients' independence goals or LoDs with partners' support may be beneficial for patients' and partners' affect. © 2015 The International Association of Applied Psychology.
    Applied Psychology Health and Well-Being 03/2015; 7(2). DOI:10.1111/aphw.12043 · 1.75 Impact Factor
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    ABSTRACT: Globally, fruit and vegetable intake is lower than recommended despite being an important component to a healthy diet. Adopting or maintaining a sufficient amount of fruit and vegetables in one's diet may require not only motivation but also self-regulatory processes. Action control and action planning are two key volitional determinants that have been identified in the literature; however, it is not fully understood how these two factors operate between intention and behavior. Thus, the aim of the current study was to explore the roles of action control and action planning as mediators between intentions and dietary behavior. A longitudinal study with three points in time was conducted. Participants (N = 286) were undergraduate students and invited to participate in a health behavior survey. At baseline (Time 1), measures of intention and fruit and vegetable intake were assessed. Two weeks later (Time 2), action control and action planning were assessed as putative sequential mediators. At Time 3 (two weeks after Time 2), fruit and vegetable consumption was measured as the outcome. The results revealed action control and action planning to sequentially mediate between intention and subsequent fruit and vegetable intake, controlling for baseline behavior. Both self-regulatory constructs, action control and action planning, make a difference when moving from motivation to action. Our preliminary evidence, therefore, suggests that planning may be more proximal to fruit and vegetable intake than action control. Further research, however, needs to be undertaken to substantiate this conclusion. Copyright © 2015. Published by Elsevier Ltd.
    Appetite 03/2015; 91. DOI:10.1016/j.appet.2015.03.022 · 2.69 Impact Factor
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    ABSTRACT: To improve regular hand hygiene in adolescents, educational messages based on medical information have not been very successful. Therefore, a theory-guided self-regulatory intervention has been designed with a particular focus on planning strategies. A randomised controlled trial with 307 adolescents, aged 12-18 years, was conducted in high schools. The control group received educational hand hygiene leaflets, whereas the experimental group received a self-regulatory treatment which required them to generate specific action plans and coping plans. Three times during one month, both groups received verbal reminder messages about planning to wash their hands properly. At one-month follow-up, hand hygiene behaviour as well as planning to practise hand hygiene were higher in the self-regulation than in the education group (p < .01). Moreover, changes in planning levels operated as a mediator between experimental conditions and changes in behavioural outcomes. Teaching self-regulatory planning strategies may constitute a superior approach than educational messages to improve regular hand hygiene practice in adolescents.
    Psychology Health and Medicine 03/2015; 20(7):1-8. DOI:10.1080/13548506.2015.1024138 · 1.53 Impact Factor
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    ABSTRACT: Social support receipt from one's partner is assumed to be beneficial for successful smoking cessation. However, support receipt can have costs. Recent research suggests that the most effective support is unnoticed by the receiver (i.e., invisible). Therefore, this study examined the association between everyday levels of dyadic invisible emotional and instrumental support, daily negative affect, and daily smoking after a self-set quit attempt in smoker-non-smoker couples. Overall, 100 smokers (72.0% men, mean age M = 40.48, SD = 9.82) and their non-smoking partners completed electronic diaries from a self-set quit date on for 22 consecutive days, reporting daily invisible emotional and instrumental social support, daily negative affect, and daily smoking. Same-day multilevel analyses showed that at the between-person level, higher individual mean levels of invisible emotional and instrumental support were associated with less daily negative affect. In contrast to our assumption, more receipt of invisible emotional and instrumental support was related to more daily cigarettes smoked. The findings are in line with previous results, indicating invisible support to have beneficial relations with affect. However, results emphasize the need for further prospective daily diary approaches for understanding the dynamics of invisible support on smoking cessation. Statement of contribution What is already known on this subject? Social support receipt from a close other has proven to have emotional costs. According to current studies, the most effective social support is unnoticed by the receiver (i.e., invisible). There is empirical evidence for beneficial effects of invisible social support on affective well-being. What does this study add? Confirming benefits of invisible social support for negative affect in a health behaviour change setting Providing first evidence for detrimental effects of invisible social support on smoking. © 2015 The British Psychological Society.
    British Journal of Health Psychology 03/2015; DOI:10.1111/bjhp.12135 · 2.70 Impact Factor
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    ABSTRACT: Background Frequent handwashing can prevent infections, but non-compliance to hand hygiene is pervasive. Few theory- and evidence-based interventions to improve regular handwashing are available. Therefore, two intervention modules, a motivational and a self-regulatory one, were designed and evaluated.Methods In a longitudinal study, 205 young adults, aged 18 to 26 years, were randomized into two intervention groups. The Mot-SelfR group received first a motivational intervention (Mot; risk perception and outcome expectancies) followed by a self-regulatory intervention (SelfR; perceived self-efficacy and planning) 17 days later. The SelfR-Mot group received the same two intervention modules in the opposite order. Follow-up data were assessed 17 and 34 days after the baseline.ResultsBoth intervention sequences led to an increase in handwashing frequency, intention, self-efficacy, and planning. Also, overall gains were found for the self-regulatory module (increased planning and self-efficacy levels) and the motivational module (intention). Within groups, the self-regulatory module appeared to be more effective than the motivational module, independent of sequence.Conclusions Self-regulatory interventions can help individuals to exhibit more handwashing. Sequencing may be important as a motivation module (Mot) first helps to set the goal and a self-regulatory module (SelfR) then helps to translate this goal into actual behavior, but further research is needed to evaluate mechanisms.
    BMC Public Health 02/2015; 15(1):79. DOI:10.1186/s12889-015-1453-7 · 2.32 Impact Factor
  • Jochen P Ziegelmann · Nina Knoll
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    ABSTRACT: The study of health behaviors and fostering health-behavior change is an important endeavor even in old age. The aim of this viewpoint article is threefold. First, we use a broad perspective for the definition of health behaviors to capture all relevant aspects of health-behavior change in older adults. Particularly, we suggest a distinction between proximal (e.g., physical activity) and distal health behaviors (e.g., social participation). Second, we recommend a stronger orientation towards processes in order to study health behaviors and the design of health-behavior change interventions. Third, we review the advantages of a developmental perspective in health psychology. Future directions in the study of health behavior among older adults are discussed. © 2015 S. Karger AG, Basel.
    Gerontology 01/2015; DOI:10.1159/000369857 · 2.68 Impact Factor
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    ABSTRACT: Abstract Objectives. Maintaining physical exercise levels may not only require motivation and planning but also action control which is supposed to mediate between planning and exercise. Design. Behavioral intention, action planning, coping planning, and past behavior were assessed at baseline, and action control and concurrent exercise were measured one month later in 487 young adults. Method. Three nested structural models were specified to examine different mediation mechanisms. One model reflected the intention-planning-behavior chain, the other one focused on the intention-action control-behavior chain, and the third model comprised the full sequence. Results. Indirect effects from intentions on exercise involved either planning or action control as mediating variables. In model 3, all three constructs (action planning, coping planning, and action control) were sequential mediators between intentions and later physical exercise levels. Action and coping planning were not directly, but indirectly related to exercise via action control. Conclusions. Findings support the sequential mediation for planning and action control as antecedents of physical exercise. Action control is needed for exercise because planning in itself is not always sufficient. Maintaining exercise levels may be attributed to effective self-regulatory strategies such as action control in combination with planning.
    Psychology and Health 01/2015; 30(8):1-26. DOI:10.1080/08870446.2015.1006222 · 2.13 Impact Factor
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    ABSTRACT: Background: Self-efficacy and social support are considered relevant predictors of fruit and vegetable intake. This study examines whether the effect of self-efficacy on fruit and vegetable intake is mediated by intention and whether this motivational process is moderated by received dietary social support. Methods: A longitudinal study with two measurement points in time, four weeks apart, on fruit and vegetable intake was carried out with 473 students aged 19 years on average (52% women). In a conditional process analysis, dietary intention was specified as a mediator between self-efficacy and fruit and vegetable intake, whereas received dietary support was specified as a moderator of the self-efficacy-intention association, controlling for baseline fruit and vegetable intake. Results: Self-efficacy was positively associated with fruit and vegetable intake four weeks later, and intention mediated this process. Moreover, an interaction between received dietary support and self-efficacy on intention emerged. Conclusions: The effect of self-efficacy on fruit and vegetable intake was fully mediated by intention. Moreover, received support exhibited a moderating role within the motivational process: high dietary support appeared to accentuate the positive relationship between self-efficacy and dietary intention.
    Appetite 01/2015; 87. DOI:10.1016/j.appet.2014.12.223 · 2.69 Impact Factor
  • Maryam Gholami · Nina Knoll · Ralf Schwarzer
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    ABSTRACT: Oral diseases such as dental caries, periodontal disease, and tooth loss are a considerable public health problem. A review of the epidemiological data from many countries indicates that a global increase in dental caries prevalence affects children as well as adults. Despite the improvement in oral health of children in the last few decades, tooth decay remains one of the most common childhood diseases in both industrialized and developing countries. The study evaluates the effects of a self-regulatory intervention to increase dental flossing among adolescents and examines the mediating mechanisms underlying behavioral changes. A cluster randomized controlled trial compared a brief intervention arm with a control arm in 166 girls aged 11-15 years. Planning, self-efficacy, and behavioral intention were specified as mediators between treatment conditions and follow-up dental flossing frequency. At baseline, the intervention group received theory-guided materials on oral hygiene. Four weeks later, changes in behavior and social-cognitive variables were assessed. The brief self-regulatory intervention led to an increase in dental flossing and social-cognitive constructs. A sequential mediator model was identified in which first changes in intention and afterwards changes in self-efficacy mediated between treatment conditions and behavioral outcomes. Intention formation and self-efficacy seem to play an instrumental role in the mechanism that facilitates dental flossing among adolescent girls. Oral self-care interventions should consider the application of intention formation strategies combined with building confidence in one's ability to adhere to the regimen.
    International Journal of Behavioral Medicine 12/2014; DOI:10.1007/s12529-014-9459-6 · 2.63 Impact Factor
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    ABSTRACT: Background The effect of a self-regulatory intervention with its focus on planning sunscreen use is evaluated in comparison to a standard educational condition. Purpose This paper studied whether planning mediates between the experimental conditions and the behavioral outcome. Further, it is examined who benefits more: already motivated or unmotivated individuals. Method College students (N = 253) were randomly assigned to two groups: a self-regulatory and a standard-care condition. Sunscreen use, intention to use sunscreen, and planning were assessed at two points in time, 1 month apart. Results The self-regulatory intervention improved planning to use sunscreen but not the behavior directly. Planning emerged as the mediator between conditions and later sunscreen use, controlling for baseline behavior. Moreover, participants who were less motivated benefited more from the intervention. Conclusions Although it is generally assumed that planning interventions are best designed for already motivated persons, the present findings suggest that less prepared individuals might have more to gain from a brief self-regulatory intervention.
    International Journal of Behavioral Medicine 12/2014; DOI:10.1007/s12529-014-9458-7 · 2.63 Impact Factor
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    ABSTRACT: Following tumor surgery, urinary incontinence challenges prostate cancer patients' functional health. Adjustments of functional goals (lines of defense [LoDs]) were examined during rehabilitation from incontinence. A conceptual model proposing stepwise and distinct upward adjustments of LoDs, ranging from minimizing discomfort (lowest LoD) to protecting self-reliance (highest LoD), was investigated. Within 7 months following the onset of incontinence, 175 patients completed questionnaires at 4 occasions. A theory-based hierarchy was imposed on time-invariant latent classes of LoD-endorsements. As incontinence receded, patients transitioned upward through the hierarchy of LoD-classes, matched LoDs to concurrent incontinence levels, and thus promptly claimed independent functioning with physical improvements. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Psychology and Aging 12/2014; 29(4):787-92. DOI:10.1037/a0038311 · 2.73 Impact Factor
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    ABSTRACT: The Health Action Process Approach (HAPA) assumes that volitional processes are important for effective behavioral change. However, intraindividual associations have not yet been tested in the context of smoking cessation. This study examined the inter- and intraindividual associations between volitional HAPA variables and daily smoking before and after a quit attempt. Overall, 100 smokers completed daily surveys on mobile phones from 10 days before until 21 days after a self-set quit date, including self-efficacy, action planning, action control, and numbers of cigarettes smoked. Negative associations between volitional variables and daily numbers of cigarettes smoked emerged at the inter- and intraindividual level. Except for interindividual action planning, associations were stronger after the quit date than before the quit date. Self-efficacy, planning and action control were identified as critical inter- and intraindividual processes in smoking cessation, particularly after a self-set quit attempt when actual behavior change is performed.
    Journal of Behavioral Medicine 10/2014; 38(2). DOI:10.1007/s10865-014-9598-x · 3.10 Impact Factor
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    ABSTRACT: Background Social control and support have effects on smoking cessation, but are mostly examined separately. Purpose Interacting effects of social control and support are investigated, hypothesizing synergistic effects. Methods In 99 smokers, received social control and emotional support (both smoking specific) were assessed 2 weeks before a quit date (T1); objectively verified abstinence and self-reported numbers of cigarettes smoked daily were assessed 6 weeks after baseline (T2). Results For both outcomes, associations with control (T1) were moderated by support (T1), but beneficial synergistic effects (high control/high support) emerged for few participants only. Effects were mainly driven by constellations of low control/high support associated with more cigarettes smoked daily (T2) and low control/low support linked to higher likelihood of abstinence (T2). Conclusions Different constellations of levels of control and support may be beneficial for quitting smoking. Whereas synergies of high domain-specific control and support may be beneficial, they only rarely occur.
    Annals of Behavioral Medicine 09/2014; 49(1). DOI:10.1007/s12160-014-9635-6 · 4.20 Impact Factor

Publication Stats

931 Citations
201.96 Total Impact Points

Institutions

  • 2000–2015
    • Freie Universität Berlin
      • Division of Health Psychology
      Berlín, Berlin, Germany
  • 2006–2012
    • Charité Universitätsmedizin Berlin
      • • Institute of Medical Psychology
      • • Department of Urology
      Berlín, Berlin, Germany
  • 2008
    • University of Cologne
      • Department of Urology
      Köln, North Rhine-Westphalia, Germany