title: Cognitive-behavioral mediators of changing multiple behaviors: smoking and a sedentary lifestyle.
abstract: BACKGROUND
  A significant percentage of the U.S. population has multiple poor health behaviors. Understanding the relationship among these behavioral risk factors is important for designing effective multiple risk factor interventions. While there is some evidence suggesting that participation in physical exercise may have a positive impact on smoking cessation, there is much to be learned about the relationships between cognitive-behavioral (self-efficacy, decisional-balance) and motivational mechanisms (stage of change) which have been shown to mediate changes in both exercise and smoking behavior.
  
  
  METHODS
  The sample comprised 332 smokers employed at two workplaces-a government agency and a medical center-recruited as part of a larger worksite health promotion project and who completed questionnaires on their smoking and exercise behaviors.
  
  
  RESULTS
  The results revealed significant relationships between smoking variables and exercise variables. Smokers who rated as important the positive benefits of smoking also rated as important the costs associated with increased physical activity. Similarly, the negative consequences of smoking were significantly associated with the positive benefits of physical activity. Self-efficacy for one behavior was significantly associated with self-efficacy for the other. Significant differences by exercise and smoking stage of change were found on the cross-behavior sets of variables (self-efficacy, pros, cons). Smokers who were contemplating a more active lifestyle reported the negative consequences of smoking to be significantly more important to them than smokers who were not considering adoption of a more active lifestyle. Smokers who were exercising regularly reported significantly more confidence in their ability to refrain from smoking than smokers not exercising regularly. Finally, smokers preparing for quitting reported less confidence in their ability to exercise than smokers who had already taken action to change their smoking behavior.
  
  
  CONCLUSIONS
  The cognitive mechanisms associated with changes in smoking behavior are related to the cognitive variables which have been shown to predict changes in exercise behavior. Significant relationships in mediating mechanisms including decisional balance and self-efficacy between smoking and exercise provide preliminary information on how change in one risk behavior may relate to change in another. These associations have implications for future intervention research and for methods research on multiple risk factors interactions.
authors.affiliation: Division of Behavioral and Preventive Medicine, Miriam Hospital, Providence, Rhode Island 02906, USA.
authors.forename: T K
authors.initials: TK
authors.lastname: King
authors.forename: B H
authors.initials: BH
authors.lastname: Marcus
authors.forename: B M
authors.initials: BM
authors.lastname: Pinto
authors.forename: K M
authors.initials: KM
authors.lastname: Emmons
authors.forename: D B
authors.initials: DB
authors.lastname: Abrams
mesh_terms: D000328:Adult; D015984:Causality; D016009:Chi-Square Distribution; D003657:Decision Making; D015444:Exercise / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006306:Health Surveys; D006801:Humans; D008019:Life Style; D008297:Male; D009042:Motivation; D015999:Multivariate Analysis; D016272:Occupational Health; D012647:Self-Assessment; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014836:Volition