title: Reconceptualizing decisional balance in an adolescent sun protection intervention: mediating effects and theoretical interpretations.
abstract: OBJECTIVE
  The Transtheoretical model (TTM) integrates principles of operant learning, such as stimulus control and reinforcement, and psychological factors, such as decisional balance. Understanding interrelationships between decisions, behavior, and consequences from multiple-theoretical perspectives can advance theory and inform development of more effective interventions.
  
  
  METHODS
  This analysis examined the mediating effects of a special case of the decisional balance construct in which the pros of competing behaviors (i.e., sun protection vs. exposure) were measured rather than the pros and cons of the same behavior. Participants included 819 adolescents (10 to 16 years old, 53.5% girls, 58.4% White) randomized to a 24-month expert system intervention (SunSmart) or a physical activity and nutrition comparison group.
  
  
  METHODS
  Self-report measures included sun protection behaviors, pros for protection, and pros for exposure. Mediation analysis using latent growth curve models found both the treatment-to-mediator and mediator-to-behavior paths significant for decisional balance, producing an indirect effect of .323 (p < .01) and good model fit (CFI = .973, RMSEA = .055).
  
  
  RESULTS
  Multiple strategies for conceptualizing and measuring decisional balance appear to be valid. Results are interpreted from the TTM and operant perspectives.
authors.affiliation: Joint Doctoral Program in Public Health (Health Behavior Science), San Diego State University/University of California, La Jolla, CA 92093, USA. m1adams@ucsd.edu
authors.forename: Marc A
authors.initials: MA
authors.lastname: Adams
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Norman
authors.forename: Melbourne F
authors.initials: MF
authors.lastname: Hovell
authors.forename: James F
authors.initials: JF
authors.lastname: Sallis
authors.forename: Kevin
authors.initials: K
authors.lastname: Patrick
mesh_terms: D000293:Adolescent; D002648:Child; D003194:Computer-Assisted Instruction; D003657:Decision Making; D005103:Expert Systems; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008960:Models, Psychological; D009042:Motivation; D009381:Neoplasms, Radiation-Induced / Q000517:prevention & control* / Q000523:psychology*; D012878:Skin Neoplasms / Q000517:prevention & control* / Q000523:psychology*; D012984:Software; D055108:Sunbathing / Q000523:psychology*; D013472:Sunlight / Q000009:adverse effects*; D013473:Sunscreening Agents / Q000008:administration & dosage*; D011795:Surveys and Questionnaires
chemical_list: D013473:Sunscreening Agents