Health Behavior: An Interlocking Personal and Social Task
Identifieur interne : 001515 ( Istex/Corpus ); précédent : 001514; suivant : 001516Health Behavior: An Interlocking Personal and Social Task
Auteurs : Elisabeth Kals ; Leo MontadaSource :
- Journal of Health Psychology [ 1359-1053 ] ; 2001-03.
Abstract
Traditional health behavior models comprise only person-centered motivational components such as personal vulnerability perceptions and specific internal control beliefs. However, such factors as social responsibility, perceived prevalence rates of illnesses, attribution of control to societal agencies, and the motivation to engage oneself for public health concerns are not unrelated to individual health protection. Therefore, an alternative model is proposed, which combines traditional self-centered and social variables. This alternative model was empirically confirmed in a questionnaire study exemplified by cancer preventive activities (N = 558), which embraced personal cancer prevention as well as efforts to reduce the cancer prevalence within the general population. The readiness to engage in personal cancer preventive measures appeared to be closely related to the readiness to engage oneself for public health programs. The motivational predictors of both categories of activities had significant overlap. Implications for model building and intervention strategies to promote individual as well as public health behavior are discussed.
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DOI: 10.1177/135910530100600204
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Health Behavior: An Interlocking Personal and Social Task</title><author wicri:is="90%"><name sortKey="Kals, Elisabeth" sort="Kals, Elisabeth" uniqKey="Kals E" first="Elisabeth" last="Kals">Elisabeth Kals</name></author><author wicri:is="90%"><name sortKey="Montada, Leo" sort="Montada, Leo" uniqKey="Montada L" first="Leo" last="Montada">Leo Montada</name><affiliation><mods:affiliation>University of Trier, Germany</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:5A13DDF99AF83EC4DF30F17662320A638B39BEDC</idno><date when="2001" year="2001">2001</date><idno type="doi">10.1177/135910530100600204</idno><idno type="url">https://api.istex.fr/document/5A13DDF99AF83EC4DF30F17662320A638B39BEDC/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001515</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">001515</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Health Behavior: An Interlocking Personal and Social Task</title><author wicri:is="90%"><name sortKey="Kals, Elisabeth" sort="Kals, Elisabeth" uniqKey="Kals E" first="Elisabeth" last="Kals">Elisabeth Kals</name></author><author wicri:is="90%"><name sortKey="Montada, Leo" sort="Montada, Leo" uniqKey="Montada L" first="Leo" last="Montada">Leo Montada</name><affiliation><mods:affiliation>University of Trier, Germany</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Health Psychology</title><idno type="ISSN">1359-1053</idno><idno type="eISSN">1461-7277</idno><imprint><publisher>SAGE Publications</publisher><pubPlace>London, Thousand Oaks and New Delhi</pubPlace><date type="published" when="2001-03">2001-03</date><biblScope unit="volume">6</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="131">131</biblScope><biblScope unit="page" to="148">148</biblScope></imprint><idno type="ISSN">1359-1053</idno></series><idno type="istex">5A13DDF99AF83EC4DF30F17662320A638B39BEDC</idno><idno type="DOI">10.1177/135910530100600204</idno><idno type="ArticleID">10.1177_135910530100600204</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">1359-1053</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Traditional health behavior models comprise only person-centered motivational components such as personal vulnerability perceptions and specific internal control beliefs. However, such factors as social responsibility, perceived prevalence rates of illnesses, attribution of control to societal agencies, and the motivation to engage oneself for public health concerns are not unrelated to individual health protection. Therefore, an alternative model is proposed, which combines traditional self-centered and social variables. This alternative model was empirically confirmed in a questionnaire study exemplified by cancer preventive activities (N = 558), which embraced personal cancer prevention as well as efforts to reduce the cancer prevalence within the general population. The readiness to engage in personal cancer preventive measures appeared to be closely related to the readiness to engage oneself for public health programs. The motivational predictors of both categories of activities had significant overlap. Implications for model building and intervention strategies to promote individual as well as public health behavior are discussed.</div></front></TEI><istex><corpusName>sage</corpusName><author><json:item><name>Elisabeth Kals</name></json:item><json:item><name>Leo Montada</name><affiliations><json:string>University of Trier, Germany</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>cancer preventive behaviors</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>health behavior models</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>individual health</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>public health</value></json:item></subject><articleId><json:string>10.1177_135910530100600204</json:string></articleId><language><json:string>eng</json:string></language><originalGenre><json:string>research-article</json:string></originalGenre><abstract>Traditional health behavior models comprise only person-centered motivational components such as personal vulnerability perceptions and specific internal control beliefs. However, such factors as social responsibility, perceived prevalence rates of illnesses, attribution of control to societal agencies, and the motivation to engage oneself for public health concerns are not unrelated to individual health protection. Therefore, an alternative model is proposed, which combines traditional self-centered and social variables. This alternative model was empirically confirmed in a questionnaire study exemplified by cancer preventive activities (N = 558), which embraced personal cancer prevention as well as efforts to reduce the cancer prevalence within the general population. The readiness to engage in personal cancer preventive measures appeared to be closely related to the readiness to engage oneself for public health programs. The motivational predictors of both categories of activities had significant overlap. Implications for model building and intervention strategies to promote individual as well as public health behavior are discussed.</abstract><qualityIndicators><score>6.86</score><pdfVersion>1.3</pdfVersion><pdfPageSize>481.96 x 696.76 pts</pdfPageSize><refBibsNative>true</refBibsNative><abstractCharCount>1154</abstractCharCount><pdfWordCount>8466</pdfWordCount><pdfCharCount>57902</pdfCharCount><pdfPageCount>18</pdfPageCount><abstractWordCount>155</abstractWordCount></qualityIndicators><title>Health Behavior: An Interlocking Personal and Social Task</title><refBibs><json:item><author><json:item><name>P. J. Anderson</name></json:item><json:item><name>J. B. Lowe</name></json:item><json:item><name>W. R. Stanton</name></json:item><json:item><name>K. P. Balanda</name></json:item></author><host><volume>18</volume><pages><last>420</last><first>417</first></pages><author></author><title>Australian Journal of Public Health</title></host><title>Skin cancer prevention: A link between primary prevention and early detection?</title></json:item><json:item><author><json:item><name>A. Bandura</name></json:item></author><host><volume>84</volume><pages><last>215</last><first>191</first></pages><author></author><title>Psychological Review</title></host><title>Self-efficacy: Toward a unifying theory of behavior change</title></json:item><json:item><author><json:item><name>M. H. Becker</name></json:item><json:item><name>I. M. Rosenstock</name></json:item><json:item><name> </name></json:item></author><host><pages><last>35</last><first>25</first></pages><author></author><title>The behavioral sciences and preventive medicine: Opportunities and dilemmas</title></host><title>Social-psychological research on determinants of preventive health behavior</title></json:item><json:item><author><json:item><name>P. Becker</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><pages><last>124</last><first>105</first></pages><author></author><title>Psychosoziale Prävention und Gesundheitsförderung</title></host><title>Diagnostik und Bedingungsanalyse des Gesundheitsverhaltens [Diagnostic and motivational analyses of health protective behavior]</title></json:item><json:item><author><json:item><name>R. J. Black</name></json:item><json:item><name>F. Bray</name></json:item><json:item><name>J. Ferlay</name></json:item><json:item><name>D. M. Parkin</name></json:item></author><host><volume>33</volume><pages><last>1107</last><first>1075</first></pages><author></author><title>European Journal of Cancer</title></host><title>Cancer incidence and mortality in the European Union: Cancer registry data and estimates of national incidence for 1990</title></json:item><json:item><author><json:item><name>L. G. Block</name></json:item><json:item><name>P. A. Keller</name></json:item></author><host><volume>28</volume><pages><last>1608</last><first>1584</first></pages><author></author><title>Journal of Applied Social Psychology</title></host><title>Beyond protection motivation: an integrative theory of health appeals</title></json:item><json:item><author><json:item><name>R. M. Bostick</name></json:item><json:item><name>J. Sprafka</name></json:item><json:item><name>B. A. Virnig</name></json:item><json:item><name>J. D. Potter</name></json:item></author><host><volume>23</volume><pages><last>826</last><first>816</first></pages><author></author><title>Preventive Medicine</title></host><title>Predictors of cancer prevention attitudes and participation in cancer screening examinations</title></json:item><json:item><author><json:item><name>M. Calnan</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><pages><last>307</last><first>290</first></pages><author></author><title>Psychosocial processes and health. A reader</title></host><title>The Health Belief Model and participation in programmes for the early detection of breast cancer: a comparative analysis</title></json:item><json:item><author><json:item><name>S. Carmel</name></json:item><json:item><name>E. Shani</name></json:item><json:item><name>L. Rosenberg</name></json:item></author><host><volume>22</volume><pages><last>688</last><first>651</first></pages><author></author><title>Educational Gerontology</title></host><title>Skin cancer protective behaviors among the elderly: Explaining their response to a health education program using the Health Belief Model</title></json:item><json:item><host><author></author><title>Principles of preventive psychiatry</title></host></json:item><json:item><author><json:item><name>G. A. Colditz</name></json:item><json:item><name>S. L. Gortmaker</name></json:item></author><host><volume>73</volume><pages><last>651</last><first>621</first></pages><author></author><title>Milbank Quarterly</title></host><title>Cancer prevention strategies for the future: Risk identification and preventive intervention</title></json:item><json:item><host><author></author><title>Predicting health behaviour: Research and practice with social cognition models</title></host></json:item><json:item><author><json:item><name>D. P. Crowne</name></json:item><json:item><name>D. Marlowe</name></json:item></author><host><volume>24</volume><pages><last>354</last><first>349</first></pages><author></author><title>Journal of Consulting Psychology</title></host><title>A new scale of social desirability independent of psychopathology</title></json:item><json:item><author><json:item><name>S. J. Curry</name></json:item><json:item><name>K. M. Emmons</name></json:item></author><host><volume>16</volume><pages><last>316</last><first>302</first></pages><author></author><title>Annals of Behavioral Medicine</title></host><title>Theoretical models for predicting and improving compliance with breast cancer screening</title></json:item><json:item><author><json:item><name>G. E. Dlugosch</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><pages><last>117</last><first>101</first></pages><author></author><title>Lehrbuch der Gesundheitspsychologie</title></host><title>Modelle in der Gesundheitspsychologie [Models in health psychology]</title></json:item><json:item><author><json:item><name>C. K. Ewart</name></json:item></author><host><volume>46</volume><pages><last>946</last><first>931</first></pages><author></author><title>American Psychologist</title></host><title>Social action theory for a public health psychology</title></json:item><json:item><author><json:item><name>L. L. Fahlberg</name></json:item><json:item><name>J. Wolfer</name></json:item></author><host><volume>8</volume><pages><last>352</last><first>352</first></pages><author></author><title>American Journal of Health Promotion</title></host><title>Dichotomy or integration? A response to McLeroy</title></json:item><json:item><author><json:item><name>S. D. Fischera</name></json:item><json:item><name>D. I. Frank</name></json:item></author><host><volume>18</volume><pages><last>9</last><first>3</first></pages><author></author><title>Health Values</title></host><title>The Health Belief Model as a predictor of mammography screening</title></json:item><json:item><host><author></author><title>Belief, attitude, intention, and behavior. An introduction to theory and research</title></host></json:item><json:item><author><json:item><name>L. C. Friedman</name></json:item><json:item><name>D. V. Nelson</name></json:item><json:item><name>J. A. Webb</name></json:item><json:item><name>L. P. Hoffman</name></json:item><json:item><name>P. E. Baer</name></json:item></author><host><volume>10</volume><pages><last>135</last><first>130</first></pages><author></author><title>American Journal of Preventive Medicine</title></host><title>Dispositional optimism, self-efficacy, and health beliefs as predictors of breast self-examination</title></json:item><json:item><author><json:item><name>K. Glanz</name></json:item></author><host><volume>16</volume><pages><last>346</last><first>334</first></pages><author></author><title>Annals of Behavioral Medicine</title></host><title>Reducing breast cancer risk through changes in diet and alcohol intake: From clinic to community</title></json:item><json:item><author><json:item><name>F. Gloor</name></json:item><json:item><name>F. Van der Linde</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><pages><last>29</last><first>18</first></pages><author></author><title>Onkologie für Krankenpflegeberufe</title></host><title>Epidemiologie und Ätiologie maligner Tumoren [Epidemiology and etiology of malignant tumors]</title></json:item><json:item><author><json:item><name>H. A. Hausenblas</name></json:item><json:item><name>A. V. Carron</name></json:item><json:item><name>D. E. Mack</name></json:item></author><host><volume>19</volume><pages><last>51</last><first>36</first></pages><author></author><title>Journal of Sport and Exercise Psychology</title></host><title>Application of the theories of reasoned action and planned behavior to exercise behavior: A meta-analysis</title></json:item><json:item><author><json:item><name>E. Heim</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><pages><last>342</last><first>278</first></pages><author></author><title>Psychosoziale Medizin</title></host><title>Medizinsoziologische Aspekte der Krankheit [Medical-sociological aspects of illness]</title></json:item><json:item><author><json:item><name>J. K. Hertog</name></json:item><json:item><name>J. R. Finnegan</name></json:item><json:item><name>B. Rooney</name></json:item><json:item><name>K. Viswanath</name></json:item><json:item><name>J. Potter</name></json:item></author><host><volume>5</volume><pages><last>40</last><first>21</first></pages><author></author><title>Health Communication</title></host><title>Self-efficacy as a target population segmentation strategy in a diet and cancer risk reduction campaign</title></json:item><json:item><host><author></author><title>Krebs: Wissen, Einstellungen und präventives Verhalten der Bevölkerung [Cancer: Knowledge, attitudes, and cancer preventive behavior within the population]</title></host></json:item><json:item><author><json:item><name>R. S. Houlston</name></json:item><json:item><name>L. Lemoine</name></json:item></author><host><volume>1</volume><pages><last>44</last><first>43</first></pages><author></author><title>Journal of Community and Applied Social Psychology</title></host><title>Medical and psychological perspectives on breast cancer screening: A comment on Pitts, McMaster and Wilson</title></json:item><json:item><author><json:item><name>E. Kals</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><pages><last>258</last><first>231</first></pages><author></author><title>Current societal concerns about justice</title></host><title>Are proenvironmental commitments motivated by health concerns or by perceived justice?</title></json:item><json:item><author><json:item><name>E. Kals</name></json:item></author><host><volume>24</volume><pages><last>391</last><first>384</first></pages><author></author><title>Gedrag & Gezondheid</title></host><title>Motieven voor preventief en riskant gezondheidsgedrag ten aanzien van kanker [Motives of cancer preventive and health risk behaviors]</title></json:item><json:item><host><author></author><title>Item- und Skalenanalyse umwelt- und gesundheitsbezogener Meßinstrumenten [Item- and scale analyses of environmentand health-related instruments]</title></host></json:item><json:item><author><json:item><name>E. Kals</name></json:item><json:item><name>E. Held</name></json:item><json:item><name>L. Montada</name></json:item></author><host><volume>7</volume><pages><last>20</last><first>1</first></pages><author></author><title>Zeitschrift für Gesundheitspsychologie</title></host><title>Persönlicher Fleischkonsum und gesellschaftspolitische Engagements mit Folgen für die allgemeine Fleischproduktion: Ein Vergleich ihrer motivationalen Grundlagen [Individual consumption of meat products and sociopolitical commitments with relevance for the general meat production: A comparison of their underlying motives]</title></json:item><json:item><author><json:item><name>E. Kals</name></json:item><json:item><name>L. Montada</name></json:item></author><host><volume>6</volume><pages><last>18</last><first>3</first></pages><author></author><title>Zeitschrift für Gesundheitspsychologie</title></host><title>Persönlicher Gesundheitsschutz im Spiegel sozialer Verantwortung [Individual health protection in the scope of social responsibility]</title></json:item><json:item><author><json:item><name>E. Kals</name></json:item><json:item><name>D. Odenthal</name></json:item></author><host><volume>4</volume><pages><last>54</last><first>37</first></pages><author></author><title>Zeitschrift für Gesundheitspsychologie</title></host><title>Über die Motive von Entscheidungen für konventionelle oder kontrolliert-biologische Nahrungsmittel [Motives underlying decisions for choosing products from alternative or conventional farming]</title></json:item><json:item><author><json:item><name>J. P. Kirscht</name></json:item><json:item><name> </name></json:item></author><host><pages><last>41</last><first>27</first></pages><author></author><title>Health behavior</title></host><title>The health belief model and predictions of health actions</title></json:item><json:item><author><json:item><name>A. R. Kristal</name></json:item><json:item><name>R. E. Patterson</name></json:item><json:item><name>K. Glanz</name></json:item><json:item><name>J. Heimendinger</name></json:item><json:item><name>J. R. Hebert</name></json:item><json:item><name>Z. Feng</name></json:item><json:item><name>C. Probart</name></json:item></author><host><volume>24</volume><pages><last>228</last><first>221</first></pages><author></author><title>Preventive Medicine</title></host><title>Psychosocial correlates of healthful diets: Baseline results from the Working Well Study</title></json:item><json:item><author><json:item><name>U. Laaser</name></json:item></author><host><volume>2</volume><pages><last>118</last><first>109</first></pages><author></author><title>Zeitschrift für Gesundheitswissenschaften</title></host><title>The contribution of the schools of Public Health to Public Health in Europe</title></json:item><json:item><author><json:item><name>D. Lauver</name></json:item></author><host><volume>24</volume><pages><last>287</last><first>281</first></pages><author></author><title>Journal of Nursing Scholarship</title></host><title>A theory of care-seeking behavior</title></json:item><json:item><author><json:item><name>H. E. Lück</name></json:item><json:item><name>E. Timaeus</name></json:item></author><host><volume>15</volume><pages><last>141</last><first>134</first></pages><author></author><title>Diagnostica</title></host><title>Skalen zur Messung Manifester Angst (MAS) und Sozialer Wünschbarkeit (SDS-E und SDS-CM) [Scales for the measurement of manifest fear (MAS) and social desirability (SDS-E and SDS-CM)]</title></json:item><json:item><author><json:item><name>J. E. Maddux</name></json:item><json:item><name>K. A. DuCharme</name></json:item><json:item><name> </name></json:item></author><host><pages><last>151</last><first>133</first></pages><author></author><title>Handbook of Health Behavior Research I: Personal and Social Determinants</title></host><title>Behavioral intensions in theories of health behavior</title></json:item><json:item><host><author></author><title>Topics in health psychology</title></host></json:item><json:item><author><json:item><name>C. M. Mansfield</name></json:item><json:item><name> </name></json:item></author><host><pages><last>227</last><first>221</first></pages><author></author><title>Approaches to breast cancer prevention</title></host><title>Motivating the public in cancer prevention</title></json:item><json:item><author><json:item><name>D. F. Marks</name></json:item></author><host><volume>1</volume><pages><last>21</last><first>7</first></pages><author></author><title>Journal of Health Psychology</title></host><title>Health psychology in context</title></json:item><json:item><author><json:item><name>J. D. Matarazzo</name></json:item></author><host><volume>35</volume><pages><last>817</last><first>807</first></pages><author></author><title>American Psychologist</title></host><title>Behavioral health and behavioral medicine: Frontiers for a new Health Psychology</title></json:item><json:item><author><json:item><name>R. J. Mermelstein</name></json:item><json:item><name>L. A. Riesenberg</name></json:item></author><host><volume>11</volume><pages><last>376</last><first>371</first></pages><author></author><title>Health Psychology</title></host><title>Changing knowledge and attitudes about skin cancer risk factors in adolescents</title></json:item><json:item><host><author></author><title>A theory of ‘willingness for continued responsible commitment’: Research examples from the fields of pollution control and health protection</title></host></json:item><json:item><author><json:item><name>F. Müller</name></json:item><json:item><name>S. Sacksofsky</name></json:item></author><host><volume>87</volume><pages><last>300</last><first>289</first></pages><author></author><title>Die Deutsche Schule</title></host><title>Gesundheitsförderung und Krebsprävention in der Schule [Health promotion and cancer prevention in school]</title></json:item><json:item><author><json:item><name>A. Oakley</name></json:item><json:item><name>G. Bendelow</name></json:item><json:item><name>J. Barnes</name></json:item><json:item><name>M. Buchanan</name></json:item><json:item><name>O. A. N. Husain</name></json:item></author><host><volume>310</volume><pages><last>1033</last><first>1029</first></pages><author></author><title>British Medical Journal</title></host><title>Health and cancer prevention: Knowledge and beliefs of children and young people</title></json:item><json:item><author><json:item><name>J. Ogden</name></json:item></author><host><volume>40</volume><pages><last>415</last><first>409</first></pages><author></author><title>Social Science and Medicine</title></host><title>Psychosocial theory and the creation of the risky self</title></json:item><json:item><author><json:item><name>S. Prentice-Dunn</name></json:item><json:item><name>R. W. Rogers</name></json:item></author><host><volume>1</volume><pages><last>161</last><first>153</first></pages><author></author><title>Health Education Research</title></host><title>Protection Motivation Theory and preventive health: Beyond the Health Belief Model</title></json:item><json:item><author><json:item><name>P. Reizenstein</name></json:item><json:item><name>B. Modan</name></json:item><json:item><name>L. H. Kuller</name></json:item></author><host><volume>47</volume><pages><last>581</last><first>575</first></pages><author></author><title>Journal of Clinical Epidemiology</title></host><title>The quandary of cancer prevention</title></json:item><json:item><author><json:item><name>J. K. Robinson</name></json:item><json:item><name>A. W. Rademaker</name></json:item></author><host><volume>24</volume><pages><last>341</last><first>333</first></pages><author></author><title>Preventive Medicine</title></host><title>Skin cancer risk and sun protection learning by helpers of patients with nonmelanoma skin cancer</title></json:item><json:item><author><json:item><name>I. M. Rosenstock</name></json:item></author><host><volume>44</volume><pages><last>124</last><first>94</first></pages><author></author><title>Millbank Memorial Fund Quarterly</title></host><title>Why people use health services</title></json:item><json:item><author><json:item><name>L. R. Schmidt</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><author></author><title>International Review of Health Psychology</title></host><title>A psychological look at public health: Contents and methodology</title></json:item><json:item><author><json:item><name>L. R. Schmidt</name></json:item><json:item><name>P. Schwenkmezger</name></json:item><json:item><name>G. E. Dlugosch</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><pages><last>27</last><first>3</first></pages><author></author><title>Theoretical and applied aspects of health psychology</title></host><title>The scope of health psychology</title></json:item><json:item><host><author></author><title>Theoretical and applied aspects of health psychology</title></host></json:item><json:item><author><json:item><name>R. Schwarzer</name></json:item><json:item><name>R. Fuchs</name></json:item><json:item><name> </name></json:item><json:item><name> </name></json:item></author><host><pages><last>196</last><first>163</first></pages><author></author><title>Predicting health behaviour: Research and practice with social cognition models</title></host><title>Self-efficacy and health behaviours</title></json:item><json:item><author><json:item><name>E. Seydel</name></json:item><json:item><name>E. Taal</name></json:item><json:item><name>O. Wiegman</name></json:item></author><host><volume>4</volume><pages><last>109</last><first>99</first></pages><author></author><title>Psychology and Health</title></host><title>Risk-appraisal, outcome and self-efficacy expectancies: Cognitive factors in preventive behavior related to cancer</title></json:item><json:item><author><json:item><name>D. Stokols</name></json:item></author><host><volume>47</volume><pages><last>22</last><first>6</first></pages><author></author><title>American Psychologist</title></host><title>Establishing and maintaining healthy environments</title></json:item><json:item><author><json:item><name>G. C. Stone</name></json:item></author><host><volume>4</volume><pages><last>17</last><first>3</first></pages><author></author><title>Psychology and Health</title></host><title>An international review of the emergence and development of Health Psychology</title></json:item><json:item><host><author></author><title>Social psychology and health</title></host></json:item><json:item><author><json:item><name>D. G. Taylor</name></json:item><json:item><name>L. A. Aday</name></json:item><json:item><name>R. Andersen</name></json:item></author><host><volume>16</volume><pages><last>49</last><first>39</first></pages><author></author><title>Journal of Health and Social Behavior</title></host><title>A social indicator of access to medical care</title></json:item><json:item><author><json:item><name>P. R. Taylore</name></json:item><json:item><name>S. Dawsey</name></json:item><json:item><name>D. Albanes</name></json:item></author><host><volume>1</volume><pages><last>203</last><first>195</first></pages><author></author><title>Annals of Epidemiology</title></host><title>Cancer prevention trials in China and Finland</title></json:item><json:item><author><json:item><name>P. Van Assema</name></json:item><json:item><name>M. Pieterse</name></json:item><json:item><name>G. Kok</name></json:item><json:item><name>M. Eriksen</name></json:item><json:item><name>H. de Vries</name></json:item></author><host><volume>8</volume><pages><last>472</last><first>461</first></pages><author></author><title>Health Education Research</title></host><title>The determinants of four cancer-related risk behaviours</title></json:item><json:item><author><json:item><name>P. Van Assema</name></json:item><json:item><name>M. Steenbakkers</name></json:item><json:item><name>G. Kok</name></json:item><json:item><name>M. Eriksen</name></json:item><json:item><name>H. de Vries</name></json:item></author><host><volume>23</volume><pages><last>401</last><first>394</first></pages><author></author><title>Preventive Medicine</title></host><title>Results of the Dutch community project ‘Healthy Bergeyk’</title></json:item><json:item><author><json:item><name>W. F. Velicer</name></json:item><json:item><name>C. C. Diclemente</name></json:item><json:item><name>J. S. Rossi</name></json:item><json:item><name>J. O. Prochaska</name></json:item></author><host><volume>15</volume><pages><last>283</last><first>271</first></pages><author></author><title>Addictive Behavior</title></host><title>Relapse situations and self-efficacy: An integrative model</title></json:item><json:item><host><author></author><title>Health psychology and public health. An integrative approach</title></host></json:item></refBibs><genre><json:string>research-article</json:string></genre><host><volume>6</volume><publisherId><json:string>HPQ</json:string></publisherId><pages><last>148</last><first>131</first></pages><issn><json:string>1359-1053</json:string></issn><issue>2</issue><genre><json:string>journal</json:string></genre><language><json:string>unknown</json:string></language><eissn><json:string>1461-7277</json:string></eissn><title>Journal of Health Psychology</title></host><categories><wos><json:string>social science</json:string><json:string>psychology, clinical</json:string></wos><scienceMetrix><json:string>health sciences</json:string><json:string>public health & health services</json:string><json:string>public health</json:string></scienceMetrix></categories><publicationDate>2001</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1177/135910530100600204</json:string></doi><id>5A13DDF99AF83EC4DF30F17662320A638B39BEDC</id><score>2.1223614</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/document/5A13DDF99AF83EC4DF30F17662320A638B39BEDC/fulltext/pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/document/5A13DDF99AF83EC4DF30F17662320A638B39BEDC/fulltext/zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/document/5A13DDF99AF83EC4DF30F17662320A638B39BEDC/fulltext/tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main" xml:lang="en">Health Behavior: An Interlocking Personal and Social Task</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>SAGE Publications</publisher><pubPlace>London, Thousand Oaks and New Delhi</pubPlace><availability><p>SAGE</p></availability><date>2001</date></publicationStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a" type="main" xml:lang="en">Health Behavior: An Interlocking Personal and Social Task</title><author xml:id="author-1"><persName><forename type="first">Elisabeth</forename><surname>Kals</surname></persName></author><author xml:id="author-2"><persName><forename type="first">Leo</forename><surname>Montada</surname></persName><affiliation>University of Trier, Germany</affiliation></author></analytic><monogr><title level="j">Journal of Health Psychology</title><idno type="pISSN">1359-1053</idno><idno type="eISSN">1461-7277</idno><imprint><publisher>SAGE Publications</publisher><pubPlace>London, Thousand Oaks and New Delhi</pubPlace><date type="published" when="2001-03"></date><biblScope unit="volume">6</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="131">131</biblScope><biblScope unit="page" to="148">148</biblScope></imprint></monogr><idno type="istex">5A13DDF99AF83EC4DF30F17662320A638B39BEDC</idno><idno type="DOI">10.1177/135910530100600204</idno><idno type="ArticleID">10.1177_135910530100600204</idno></biblStruct></sourceDesc></fileDesc><profileDesc><creation><date>2001</date></creation><langUsage><language ident="en">en</language></langUsage><abstract xml:lang="en"><p>Traditional health behavior models comprise only person-centered motivational components such as personal vulnerability perceptions and specific internal control beliefs. However, such factors as social responsibility, perceived prevalence rates of illnesses, attribution of control to societal agencies, and the motivation to engage oneself for public health concerns are not unrelated to individual health protection. Therefore, an alternative model is proposed, which combines traditional self-centered and social variables. This alternative model was empirically confirmed in a questionnaire study exemplified by cancer preventive activities (N = 558), which embraced personal cancer prevention as well as efforts to reduce the cancer prevalence within the general population. The readiness to engage in personal cancer preventive measures appeared to be closely related to the readiness to engage oneself for public health programs. The motivational predictors of both categories of activities had significant overlap. Implications for model building and intervention strategies to promote individual as well as public health behavior are discussed.</p></abstract><textClass><keywords scheme="keyword"><list><head>keywords</head><item><term>cancer preventive behaviors</term></item><item><term>health behavior models</term></item><item><term>individual health</term></item><item><term>public health</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2001-03">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/document/5A13DDF99AF83EC4DF30F17662320A638B39BEDC/fulltext/txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="corpus sage not found" wicri:toSee="no header"><istex:xmlDeclaration>version="1.0" encoding="UTF-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//NLM//DTD Journal Publishing DTD v2.3 20070202//EN" URI="journalpublishing.dtd" name="istex:docType"></istex:docType><istex:document><article article-type="research-article" dtd-version="2.3" xml:lang="EN"><front><journal-meta><journal-id journal-id-type="hwp">sphpq</journal-id><journal-id journal-id-type="publisher-id">HPQ</journal-id><journal-title>Journal of Health Psychology</journal-title><issn pub-type="ppub">1359-1053</issn><publisher><publisher-name>SAGE Publications</publisher-name><publisher-loc>London, Thousand Oaks and New Delhi</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.1177/135910530100600204</article-id><article-id pub-id-type="publisher-id">10.1177_135910530100600204</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group></article-categories><title-group><article-title>Health Behavior: An Interlocking Personal and Social Task</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Kals</surname><given-names>Elisabeth</given-names></name></contrib></contrib-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Montada</surname><given-names>Leo</given-names></name><aff>University of Trier, Germany</aff></contrib></contrib-group><pub-date pub-type="ppub"><month>03</month><year>2001</year></pub-date><volume>6</volume><issue>2</issue><fpage>131</fpage><lpage>148</lpage><abstract><p>Traditional health behavior models comprise only person-centered motivational components such as personal vulnerability perceptions and specific internal control beliefs. However, such factors as social responsibility, perceived prevalence rates of illnesses, attribution of control to societal agencies, and the motivation to engage oneself for public health concerns are not unrelated to individual health protection. Therefore, an alternative model is proposed, which combines traditional self-centered and social variables. This alternative model was empirically confirmed in a questionnaire study exemplified by cancer preventive activities (<italic>N</italic> = 558), which embraced personal cancer prevention as well as efforts to reduce the cancer prevalence within the general population. The readiness to engage in personal cancer preventive measures appeared to be closely related to the readiness to engage oneself for public health programs. The motivational predictors of both categories of activities had significant overlap. Implications for model building and intervention strategies to promote individual as well as public health behavior are discussed.</p></abstract><kwd-group><kwd>cancer preventive behaviors</kwd><kwd>health behavior models</kwd><kwd>individual health</kwd><kwd>public health</kwd></kwd-group><custom-meta-wrap><custom-meta xlink:type="simple"><meta-name>sagemeta-type</meta-name><meta-value>Journal Article</meta-value></custom-meta><custom-meta xlink:type="simple"><meta-name>search-text</meta-name><meta-value> 131 Health Behavior: An Interlocking Personal and Social Task ELISABETH KALS & LEO MONTADA University of Trier, Germany ELISABETH KALS is associate professor ('Hochschuldozentin') at the University of Trier, Germany, where she also earned her PhD and did post-doctoral research. Her main research interests include educational psychology with a focus on communication as well as the applied disciplines of health and environmental psychology where she is leading several research projects. LEO MONTADA is a full professor of psychology at the University of Trier, Germany. His current research fields embrace social emotions and their control, justice research, moral psychology, psychology of commitments, health and environmental psychology, and coping with losses. Journal of Health Psychology Copyright 2001 SAGE Publications London, Thousand Oaks and New Delhi, [13591053(200103)6:2] Vol 6(2) 131148; 015958 Abstract Traditional health behavior models comprise only person- centered motivational components such as personal vulnerability perceptions and specific internal control beliefs. However, such factors as social responsibility, perceived prevalence rates of illnesses, attribution of control to societal agencies, and the motivation to engage oneself for public health concerns are not unrelated to individual health protection. Therefore, an alternative model is proposed, which combines traditional self-centered and social variables. This alternative model was empirically confirmed in a questionnaire study exemplified by cancer preventive activities (N = 558), which embraced personal cancer prevention as well as efforts to reduce the cancer prevalence within the general population. The readiness to engage in personal cancer preventive measures appeared to be closely related to the readiness to engage oneself for public health programs. The motivational predictors of both categories of activities had significant overlap. Implications for model building and intervention strategies to promote individual as well as public health behavior are discussed. Keywords cancer preventive behaviors, health behavior models, individual health, public health COMPETING INTERESTS: None declared. ADDRESS. Correspondence should be directed to: DR ELISABETH KALS University of Trier, Department of Psychology, PO Box 3825, D-54286 Trier, Germany [Tel. (0651) 201 2054; Fax: (0651) 201 2961; email: Kals@uni-trier.de] 01 Kals (jr/d) 31/1/01 12:11 pm Page 131 HEALTH PSYCHOLOGICAL research focuses on the question of the explanation of health as well as risk behavior (Matarazzo, 1980; Schmidt, Schwenkmezger, Weinman, & Maes, 1990; Stone, 1990; Stroebe & Stroebe, 1995). If one reviews the bulky health psychological literature of the last few decades, which gives answers to this question, a dominant self-centered perspec- tive can be found: the target behavior, which is examined, as well the selection of motives that should explain these behaviors have nearly exclusive implications for one's own health. Accordingly, this self-centered perspective is also found in most models used to explain health and risk behavior (see Conner & Norman, 1996; Dlugosch, 1994; Lauver, 1992; Schmidt, Schwenkmezger, & Dlugosch, 1990, for an overview), such as in the traditional Health Belief Model (Becker & Rosenstock, 1974; Rosenstock, 1966), the Protection Moti- vation Theory (Prentice-Dunn & Rogers, 1986) or the Theory of Reasoned Action (Fishbein & Ajzen, 1975). The specific variables in all of these models vary, but they share some 'key theoretical con- structs' (Curry & Emmons, 1994, p. 302). These constructs, which we will refer to as 'traditional' in health psychology, are personal risk beliefs about the severity of the disease (also called 'vulnerability') self-efficacy beliefs various personal costbenefit balances that take subjective barriers against health protec- tive behavior into account (Seydel, Taal, & Wiegman, 1990). These constructs can be categorized as predis- posing factors, encompassing personal risk and self-efficacy beliefs, and enabling factors, e.g. possibilities to overcome barriers (Kristal et al., 1995). Self-efficacy is drawn from Bandura's model (1977) and has proved to have strong effects on various health behaviors (Hertog, Finnegan, Rooney, Viswanath, & Potter, 1993), for instance on healthy eating behavior (Schwarzer & Fuchs, 1996) or on the ability either to compensate given health risks or to avoid potential risks (e.g. Velicer, Diclemente, Rossi, & Prochaska, 1990). Although there is a long and in many parts successful tradition of applying these models to the explanation of various categories of health behaviors and risk decisions (Schmidt et al., 1990; Stroebe & Stroebe, 1995), there are at least three good reasons to doubt whether the limi- tation to self-centered criterion and predictor variables is adequate (Heim, 1986): (1) all indi- vidual behaviors are embedded in a social context, and might therefore be triggered by socially centered beliefs and motives such as perceived use of medical care by the public and individual access to it; (2) most health risks pose problems not only on the individual level, but also on a social and societal level. Other people than oneself might be affected, and feelings of responsibility for others or for society as well as other social respectively altruistic motives might trigger acts to reduce these health risks for others; and (3) measures on a societal level (e.g. public health campaigns, a well-structured health care system) help to establish traditional self-centered health behavior. Individual acts to promote those measures are assumed to be based on moral motives rather than on self- centered motives. The same is true for health policy measures, which reduce general health risks, such as ecological burdens. These arguments are well taken into account within public health (Schmidt, 1994). This research is 'inspired by the practice of viewing illnesses in a social context by relating the afflic- tions of individuals to the groups to which they belong or to the environment in which they work and live' (Ewart, 1991, p. 931). Ewart reflects that the focus lies upon the societal perspective of health and health behavior. As a consequence, structural factors, such as access to medical care (Taylor, Aday, & Ander- sen, 1975), as well as social interaction processes should be taken into account. Their effects are integrated in social-contextual models, and 'thinking in systems' has been applied in an effort to capture the dynamic interplay of factors from various levels (Ewart, 1991). This also includes ecological factors (like pollution of the natural environment) because they represent a more molar level of analysis that affects many health risks (Stokols, 1992). One kind of approach includes the analysis of general health risks and people's willingness to pay for measures that serve public and not only one's own individual health (Laaser, 1994; Schmidt, 1994). Such approaches attempt to transcend the borderline between health JOURNAL OF HEALTH PSYCHOLOGY 6(2) 132 01 Kals (jr/d) 31/1/01 12:11 pm Page 132 psychology and public health (Winett, King, & Altman, 1989) by integrating the self-centered level of analysis in health psychology and the social and societal level of analysis in public health, in which the self-centered perspective is not sufficiently taken into account (Fahlberg & Wolfer, 1994). In this article, our aim is to facilitate this inte- gration of a self- and societal-centered perspective by analyzing the underlying motives of cancer preventive behavior as an exemplary research field, thus following the proposal to put health psychology into a broader cultural, sociopoliti- cal, and community context (Marks, 1996). Cancer prevention as an exemplifying research field Using the term 'cancer prevention' we follow the suggestion of Caplan (1964) who requested that cancer prevention studies should include primary prevention and early detection efforts. In fact, medical measures for early detection (e.g. annual cancer check-ups) are often com- bined with counseling on primary prevention, and these two prevention strategies are closely correlated (Anderson, Lowe, Stanton, & Balanda, 1994). Why choose cancer prevention as an illustrative target behavior? The reason for this decision is threefold: 1. Cancer as an important research field for health psychologists In western countries, the cause of death of every fourth to fifth person over the last decade has been cancer, and scientific esti- mates even predict an increase in certain forms of cancer, such as skin cancer (Black, Bray, Ferlay, & Parkin, 1997). This high prevalence of cancer is well documented (Colditz & Gortmaker, 1995) and reflected in both a growing awareness for cancer risks within the population (Oakley, Bendelow, Barnes, Buchanan, & Husain, 1995) and a continuous growth of research on cancer. In nearly all current medical and psychological reference books on health, at least one chapter is designated to the etiology and pre- vention of cancer (e.g. Maes, Spielberger, Defares, & Sarason, 1988). Within this research the role of psychology is growing as behavioral determinants of cancers (e.g. eating habits and the ingestion of potentially chemopreventive substances, like complex carbohydrates) prove to be more and more important (Hornung, 1986; Reizenstein, Modan, & Kuller, 1994). 2. The necessity of offering knowledge on the underlying motives of cancer preventive behavior Within the population, the importance of cancer preventive behavior is increasingly recognized (Oakley et al., 1995), and the general belief is widely held that cancer is pre- ventable. For example, about 80 percent of a US random sample believed that they could influence the probability of falling ill with cancer (Bostick, Sprafka, Virnig, & Potter, 1994). Nevertheless, cancer risk behavior, such as smoking or sunbathing, is still wide- spread. Therefore, specific knowledge on the underlying motives of cancer preventive behavior is necessary to deduce strategies for its effective promotion. Studies on sociodemographic variables on the one hand are mainly used for adapting intervention programs for target groups. Such programs are available for nearly all relevant behavior and for many different settings (Mermelstein & Riesenberg, 1992; Mller & Sacksofsky, 1995; Robinson & Rademaker, 1995; Van Assema, Steenbakkers, Kok, Eriksen, & de Vries, 1994). This high differ- entiation is necessary as the demographic pre- dictors vary with different preventive behaviors (Bostick et al., 1994). Studies on psychological variables, on the other hand, are even more significant as they alone provide explanatory answers to the question of why people accept restrictions of time, money, or comfort for the sake of their own or other people's health. 3. The chance to refer to existing knowledge on behavioral determinants of cancer Within health psychology the need for research on cancer prevention is well recog- nized. This is reflected in the conduct of many empirical investigations, concerning, for instance, reducing smoking or the use of indoor tanning facilities (Oakley et al., 1995). Therefore, it is possible to extend this existing knowledge and to link new results to it. In reviewing this research one finds that all of the health behavior models cited above are KALS & MONTADA: HEALTH BEHAVIOR 133 01 Kals (jr/d) 31/1/01 12:11 pm Page 133 applied to cancer preventive behavior. In other words, most studies have only focused on self-centered motivation, like fear of disease. The possible impact of community- centered motivations, like responsibility for others, remained unconsidered with a few exceptions, mainly found in public health research. The existing data have largely confirmed the impact of self-centered constructs on behavior to reduce personal cancer risks (Carmel, Shani, & Rosenberg, 1996). There is a large amount of studies using the Health Belief Model, which may be due to the fact that this model was originally developed to explain preventive behavior only. The appli- cation of this model to early detection of breast cancer, e.g. by use of screening or by self-examination, might serve as an example. One study has confirmed the significance of subjects' belief in being able to reduce their cancer risk (Houlston & Lemoine, 1991). In another study subjective barriers and benefits turned out to be associated with using screen- ing procedures (Fischera & Frank, 1994). Many empirical investigations found that the models may be successfully applied to cancer-related behavior (Friedman, Nelson, Webb, Hoffmann, & Baer, 1994; Hornung, 1986; Kirscht, 1988) and other health-related behaviors such as fitness training (Hausen- blas, Carron, & Mack, 1997). However, the applicability of this family of models is not confirmed in all studies (Calnan, 1994). More- over there are some other criticisms. The pre- dictive power for actual behavior is normally lower than for 'intended' behavior. Models are restricted to 'intra-active' elements (Ogden, 1995). Their usefulness for develop- ing effective intervention strategies is also not fully accepted. Nevertheless, the overall acceptance of these models strengthened the self-centered perspective and the opinion that the most effective strategies to motivate people for cancer preventive actions are 'likely to be related to something close and personal' (Mansfield, 1991, p. 221). Despite the criticism of the models this overall conclusion by Mans- field still holds. In spite of this broad acceptance the re- striction to a self-centered perspective is questionable and also is criticized elsewhere (e.g. by Marks, 1996). All arguments support- ing this criticism, mentioned above, are also valid for cancer prevention. However, linking the personal and social perspectives on cancer prevention is not only necessary from a psychological point of view but also from a practical perspective: the high prevalence rate of cancer constitutes an important issue for the health care system in general (e.g. in the form of monetary costs). And this prevalence rate cannot only be reduced by individuals' preventive measures, but also--and perhaps even more efficiently--by measures on the social and on a more global societal level (e.g. through health promotion campaigns or pro- hibitive laws). For instance, the prevalence of many cancer illnesses is heightened by eco- logical risks due to the pollution of the natural environment (Colditz & Gortmaker, 1995). These ecological burdens cannot be reduced effectively by single individuals, but only by the multiple, long-term efforts of many indi- viduals, institutions, and states (Kals, 1996a). An integrative cancer preventive model of personal and public health As demanded, in our model of cancer preventive behavior we have integrated the self- and society-centered perspectives. In the first steps of testing this integrative model we did not differentiate between various forms of cancer, even though the etiology and preventability of various cancer illnesses are doubtless different (Black et al., 1997; Gloor & Van der Linde, 1982). Under the construct 'cancer prevention' we have subsumed both preventive behavior and the omission of risk behavior, which are conceptually intertwined. The proposed model is a psychological model of individual behavioral tendencies (Kals, 1996b; Kals & Montada, 1998), but the criteria as well as predictors include both self-centered variables and socially and society-centered variables (Fig. 1). The constructs of this model have already been successfully applied to the analysis of private versus public promotion of alternative farming (Kals & Odenthal, 1996) and to the analysis of individual consumption of meat products versus personal sociopolitical JOURNAL OF HEALTH PSYCHOLOGY 6(2) 134 01 Kals (jr/d) 31/1/01 12:11 pm Page 134 commitments related to meat production and cattle breeding (Kals, Held, & Montada, 1999). In the present study we have analyzed behav- ioral tendencies aiming to reduce personal cancer risks (e.g. using cancer screening tests) and commitments to measures to reduce cancer risks in general (e.g. supporting public health campaigns on screening tests). It makes sense to apply general cancer preventive measures at the level of individual acts as most general protec- tive measures depend on their acceptance and promotion through individuals because public health campaigns must be accepted by the popu- lation, the efficiency of modern early screening tests depends on their broad acceptance and use, smoking prohibitions must be supported by the majority of people, etc. The first group of behavioral tendencies cor- responds to those selected by traditional health behavior models and are called personal tenden- cies because they focus on the reduction of sub- jects' own cancer risks: I. the willingness to take preventive action against one's own cancer risks (e.g. the willingness to use cancer screening tests) II. the corresponding manifest cancer preven- tive behavior (e.g. the regular use of cancer screening tests) III. the willingness to get information about efficient cancer prevention measures for one's own benefit (e.g. to seek informat- ion about personal cancer prevention measures). The first two tendencies include a broad variety of cancer preventive activities like the intake of potential chemopreventive substances, the use of regular medical cancer screenings, the regular self-examination of one's body for indicators of cancer, etc. (e.g. Glanz, 1994; Taylore, Dawsey, & Albanes, 1990; Van Assema, Pieterse, Kok, Eriksen, & de Vries, 1993). The third dependent variable takes into account the fact that know- ledge about cancer prevention is constantly growing. As a consequence, people may want to update their information. Most psychological research on cancer KALS & MONTADA: HEALTH BEHAVIOR 135 Society-centred predictors perception of general cancer risks: awareness of general prevalence rate of cancer control beliefs (internal/external) to reduce the general prevalence rate of cancer barriers against general cancer preventive behavior (e.g. economic loss due to stricter cancer preventive laws) + + + + Willingness for commitment and behavioral tendencies towards personal cancer prevention ('personal health') general cancer prevention ('public health') + + + + Self-centred predictors perception of personal cancer risks: fear of cancer control belief (internal) to reduce one's own risk of cancer barriers against personal cancer preventive behavior (e.g. time and effort to attend Control variables: subjective current health/personal cancer experience Figure 1. Integrative cancer preventive model on personal and public health (section presented). 01 Kals (jr/d) 31/1/01 12:11 pm Page 135 prevention is limited to manifest behavioral decisions. We also include willingness to apply these behaviors (dependent variables I and III). Using 'willingness to do' variables is not unusual in health research. Behavioral intentions play a significant role in many social-cognitive health models, such as the Protection Motivation Theory or the Theory of Reasoned Action (Maddux & DuCharme, 1997). The 'willingness to do' dependent variables are similar to these intentions constructs, but in contrast to them they are not related to one specific single act or decision but to a category of acts or decisions (e.g. information-seeking behavior). The 'willingness to do' variables are used as criteria in the same manner as the self-reported actual decisions. This is allowed, as in an inde- pendent follow-up study this willingness for con- tinued commitment proved a valid predictor of corresponding behaviors assessed retrospec- tively two months later (Montada & Kals, 1998). This was even the case when no additional ques- tions on volition were assessed (e.g. fixing means and timing of the transference of the commit- ment into manifest behavior). As expected, the transference of the declared willingness into manifest behaviors is, however, moderated by contextual factors, which are neglected in this model. The second group of behavioral tendencies, called sociopolitical dependent variables, include in the same way willingness as well as manifest decisions related to the reduction of the cancer prevalence rate within the population: IV. the willingness to contribute to the pro- motion of cancer preventive laws (e.g. to the prohibition of advertising for alcohol and tobacco products) V. the willingness to pay for cancer preventive measures in general (e.g. to pay 'health taxes' for products like tobacco that increase the risk of cancer) VI. the willingness to actively support or promote cancer preventive programs (e.g. voluntary work in activity groups). These dependent variables are called 'socio- political', because no direct benefit for subjects' individual health can be expected but only long- term benefits for the health of the population. VII. We included an established questionnaire on health behavior (Becker, 1992), by which general health behavior--not specific cancer preventive behavior--is assessed. This standardized questionnaire should be used as a supplementary validation test of the depen- dent variables (I, IIIVI). The discriminatory validity of our cancer-specific behavioral scales should be tested by (a) joint factor analyses of general and cancer-specific health behavior items and (b) by testing the power of the cancer- specific variables to predict this general health behavior. For the prediction of the behavioral tenden- cies, half of the predictor variables were self- centered variables corresponding to the most powerful constructs of the traditional health behavior models (Fig. 1), discussed above (per- sonal risk beliefs, self-efficacy beliefs, and various personal costbenefit balances repre- senting predisposing respectively enabling factors). In our model these variables are called 1. perception of personal cancer risk (e.g. fear of falling ill with cancer) 2. internal control belief to reduce one's own cancer risk by specific behavioral strategies (e.g. by avoiding places polluted with ciga- rette smoke) 3. individual barriers against personal cancer preventive behaviors (e.g. time and effort to attend cancer screening tests). The society-centered predictors (Fig. 1) are con- structed in parallel to the personal predictors. They also include risk perceptions, locus of control, and barriers: 4. perception of general cancer risks (e.g. awareness of the prevalence and of conse- quences of cancer in general) 5. locus of control to reduce the general preva- lence rate of cancer: (5.1) internal control belief in the sense of having impact on the activities of powerful others (e.g. subjects' belief to contribute effectively by supporting public health campaigns on cancer preven- tion), and various external control beliefs, including the attribution of efficiency to (5.2) the industry (e.g. by avoiding exposure to carcinogens), (5.3) to medical staff and organizations (e.g. by improving medical cancer screening tests), and (5.4) to the state JOURNAL OF HEALTH PSYCHOLOGY 6(2) 136 01 Kals (jr/d) 31/1/01 12:11 pm Page 136 and its institutions (e.g. by enacting stricter prohibitive smoking laws) 6. barriers against general cancer preventive measures that require changes in society (e.g. personal losses of freedom by the establish- ment of smoking prohibition laws or econ- omic losses due to stricter standards for carcinogenic industrial emissions). The perception of personal as well as general cancer risks are considered as the motivational base for all cancer preventive activities. Experi- encing subjective cancer risks might motivate one to change one's personal behavior, e.g. to give up smoking, as well as moral activities to reduce such risks for others. The same is true for the experience of general cancer risks. Risk per- ception and objective risks are not identical but only risks that are subjectively represented have motivational impact. If, for example, a heavy smoker is objectively at risk for lung cancer but denies this risk for him- or herself with rhetori- cal arguments (like 'I fully compensate any poss- ible risks by my healthy nutrition, my sport activities, and my brilliant body constitution.), there is no perceived need to change. However, even if cancer risks are acknowledged and effec- tive strategies to reduce these risks are subjec- tively available, barriers still remain against adequate preventive activities, e.g. as effort, time or money required. Owing to differences between personal and societal cancer preventions some of the predic- tors could not be construed in a perfectly paral- lel way: The perception of personal cancer risks (pre- dictor 1) was operationalized more emotion- ally (fear of cancer) than the perception of general risks (predictor 4), which was opera- tionalized as a cognition. The control beliefs to reduce the cancer prevalence rate in general (predictor 5) include internal and external control beliefs because external agencies (medical organiz- ation, state, industry) are, in fact, more power- ful to affect the general cancer prevalence rate. Similarly, barriers against changes in society (predictor 6) include barriers against measures of external agencies to reduce the cancer prevalence rate. Predictors might be affected by subjects' own cancer experience and their subjective current health status. Therefore, we have included the following variables (7 and 8): 7. subjects' subjective current health status 8. personal cancer experience. 9. The tendency to answer in socially desirable ways was included as a control measure using an assessment scale of Lck and Timaeus (1969) based on the scale of Crowne & Marlowe (1960). 10. Demographic variables were also assessed. Research questions The general question of the present investi- gation was whether personal health care and care for public health are separate or inter- related concerns. This general question was dif- ferentiated as follows: Are the tendencies towards personal cancer prevention ('personal tendencies') and public cancer prevention ('sociopolitical tenden- cies') related? Are the self-related and the social predictors related? Are the predictor patterns for 'personal dependent variables' different from, or over- lapping with the predictor patterns for 'sociopolitical dependent variables'? These questions can be answered by the follow- ing analyses: analyses of the intercorrelations of the cancer specific behavioral variables (IVI) analyses of the intercorrelations of the predic- tor variables (16) multiple regression analyses of all cancer- specific dependent variables (IVI). The regression analyses include the following three subsets of predictor variables: set A, including all self-centered predictors (predictors 13); set B, including all society-centered pre- dictors (predictors 46); and set A & B com- bined, including all predictors of set A and B (predictors 16). This procedure allowed us to test whether the dependent variables are exclu- sively predicted by predictors of the same category (e.g. personal dependent variables by KALS & MONTADA: HEALTH BEHAVIOR 137 01 Kals (jr/d) 31/1/01 12:11 pm Page 137 self-centered predictors) or by a mix of predic- tors from both categories. In all regression analyses the effects of indi- vidual health status (7), of personal cancer experience (8), and of the tendency to exhibit socially desirable answering behavior (9) were controlled. Methods The questionnaire study was conducted in Germany with a total of 558 respondents (51.4 percent female, 45.2 percent male, 3.4 percent missing values). The average age of the partici- pants was 40.9 years with a standard deviation of 16.3 years. Their mean educational level was higher than in the general population. About one-fourth of the respondents were smokers. The sample was mainly recruited by calls in local newspapers. About 8 percent of the sample was drawn from health clubs (4.4 percent) and from indoor tanning clubs (3.9 percent) aiming to make the sample more heterogeneous with respect to cancer-related attitudes. Moreover, the members of the health clubs and indoor tanning clubs were needed as criterion groups. It was assumed that these members exhibit either especially high or respectively low health atti- tudes. Both criterion groups were used for the validation of the scales. The response rate to the questionnaires dis- tributed was 85 percent. Nevertheless, the sample remains a 'convenience sample'. This is acceptable because we want to answer the ques- tions derived from the model. We do not intend to make generalized descriptive statements about 'the German population'. Answers to all scales, except the social desir- ability scale, had to be given on 6-point Likert- type rating scales for each item (ranging from 1 = low agreement to 6 = high agreement with the statement; Kals, 1996a; Kals et al., 1999; Kals & Odenthal, 1996). All items used key words rep- resenting the constructs (cf. Kals & Becker, 1995). Positive and negative formulations of the items were intermixed in order to avoid biases. Item examples are given in Tables 1 and 2. All scales were factor analyzed with principle axis factor analyses and orthogonal varimax rotation. The factor analyses were successfully cross-validated by splitting the sample into halves for confirmation of the theoretical constructs of the model (Kals & Becker, 1995). Factor analyses were conducted in two ways. (1) The items of each scale were analyzed separ- ately. In these analyses, the empirical factors appeared to exactly match a priori attribution of items to the theoretical constructs described before. (2) The items of many predictor and cri- terion scales were simultaneously factor ana- lyzed. Again, the empirical factors appeared to match the a priori attribution of items to the theoretical constructs (one example of analysis is given at the end of this section). For all scales the internal consistency (Cron- bach's alpha), several split-half reliabilities, and all usual item statistics (mean value, standard deviation, corrected itemtotal correlation) were computed. Means, standard deviations, Cronbach's alphas, and number of items are pre- sented in Tables 1 and 2 for all scales. The validity of the predictor and criterion scales was successfully verified by comparisons of the criterion groups with groups from the same sample matched according to sociodemo- graphic variables (age, sex, and education). Members of indoor tanning clubs scored signifi- cantly lower on all scales of cancer preventive behavior and significantly higher on the cancer risk scales than the matched group of non- members from the main sample. The reverse is true for the group of members of health clubs. The validation test of the criterion scales using the established questionnaire on general health behavior (Becker, 1992) was also successful. When the whole pool of criterion items was factor analyzed, the items of Becker's question- naire clearly loaded on a separate factor, but-- as expected--their correlation coefficients were significant and high (between r = .44 with the sociopolitical willingness to pay for cancer pre- ventive measures in general, V and r = .69 with the manifest cancer preventive behavior for one's own sake, II). As assumed the cancer- specific predictor variables have only low impact on this general health behavior scale. Results First, the following statistical analyses were per- formed using the answers of the participants of the criterion groups. Next, all presented analyses were repeated with the main sample under exclusion of the criterion groups. The results JOURNAL OF HEALTH PSYCHOLOGY 6(2) 138 01 Kals (jr/d) 31/1/01 12:11 pm Page 138 showed, however, that the correlation co- efficients were not significantly lower, and in the regression analyses not a single predictor lost its significance. The expectation that sociopolitical and per- sonal cancer preventive behaviors are inter- related was empirically confirmed (Table 3). The more people are willing to promote societal measures to reduce general cancer risks, the more they tend to take cancer preventive measures on their own behalf and vice versa. The correlation coefficients of the three dependent variables of one category (that is per- sonal vs sociopolitical dependent variables) were not higher than the correlations between dependent variables of different categories. This showed that the two behavioral aims (protection of one's own health and of public health) are closely intertwined. Similar close interrelationships existed between self-centered and society-centered pre- dictor variables (Table 4). Again, the mean cor- relations between predictors of the same category (that is self-centered vs society-cen- tered) were not higher than the mean correla- tions between predictors of different categories. Non-significant correlation coefficients were found for the predictor 'individual barriers against personal cancer preventive behaviors' (predictor 3). The only significant correlation was with the corresponding predictor concern- ing societal barriers (predictor 6). The fact that the predictor variables are intercorrelated might cause the problem of KALS & MONTADA: HEALTH BEHAVIOR 139 Table 1. Dependent variables Construct Typical examples for each construct Number of Cronbachs M (SD)1 items alpha Personal dependent variables ('personal health') I. The willingness to take Generally, I am willing to change my 11 .88 4.80 preventive action against eating habits as recommended by some (.99) one's own cancer risks cancer experts to reduce my risk of cancer (e.g., to eat low-fat foods containing fiber) II. The manifest cancer Concerning my nutrition, I follow the 4 .63 3.78 preventive behavior for recommendation of cancer experts (e.g. (1.24) one's own benefit to eat low-fat foods containing fiber) III. The willingness to get Generally, I am willing to seek 3 .90 4.65 information about efficient information at the doctor's office or at (1.32) cancer preventive for one's health authorities about how to reduce own benefit my risk of cancer Sociopolitical dependent variables ('public health') IV. The willingness to The emission of carciogenic substances 10 .93 5.00 contribute to the promotion caused by traffic should be restricted by (1.09) of cancer preventive laws law V. The willingness to pay Generally, I am willing to donate money 5 .84 3.76 for cancer preventive to finance public information campaigns (1.35) measures in general about how to protect against cancer VI. The willingness to Generally, I am willing to actively 4 .88 4.27 actively support or promote promote public campaigns to take (1.29) cancer preventive programs precautions concerning cancer, e.g. programs where one can learn how to detect early cancer symptoms Validation of the dependent variables VII. Health behavior If I am ill, I will take all protective 9 .87 4.26 (Becker, 1992) behavior measures to cure my illness (1.15) 1Measured on a 6-point Likert-type rating scales with 1 = low agreement to 6 = high agreement 01 Kals (jr/d) 31/1/01 12:11 pm Page 139 JOURNAL OF HEALTH PSYCHOLOGY 6(2) 140 Table 2. Predictor variables Construct Typical examples for each construct Number of Cronbachs M (SD)1 items alpha Predictors with focus on oneself ('personal health') 1. Focus self: perception of I fear getting cancer myself, either for the 3 .81 4.35 personal cancer risk first time or even more affected (1.40) 2. Focus self: internal Personally I have efficient means to 7 .88 4.82 control belief to reduce reduce my risks of getting cancer by (1.07) one's own cancer risk changing my eating habits 3. Focus self: individual If I find that I don't take so much time and 3 .60 2.32 barriers against personal effort to behave cancer protectively, I (1.11) cancer preventive behaviors would be willing to do a lot more Predictors focused on society ('public health') 4. Focus society: Within recent decades, cancer and its 3 .81 4.72 perception of general consequences have become a growing (1.16) cancer risks problem in society 5.1. Focus society: internal Personally, I have efficient means to reduce 4 .92 3.33 control beliefs to reduce the the overall cancer rate by organizing or (1.51) general prevalence rate of helping to organize information cancer campaigns for cancer check-ups 5.2. Focus society: external Industrial companies (pharmaceutical, 4 .93 5.32 control belief to reduce the chemical, and other industries) have (1.04) general prevalence rate of efficient means to reduce the overall cancer (industry) cancer rate by abstaining from the production of goods that might contain carciogenic substances 5.3. Focus society: external Health insurance companies and 5 .87 4.84 control belief to reduce the physicians have efficient means to (1.06) general prevalence rate of reduce the cancer rate in general by cancer (medical staff and promoting scientific research so that organization) medical knowledge can advise even better about how to avoid cancer 5.4. Focus society: external Government, parliaments, and courts 3 .84 4.64 control belief to reduce the have efficient means to reduce the (1.31) general prevalence rate of cancer rate in general by applying cancer (state and its strictly existing laws for the protection institutions) against cancer, e.g. work protection regulations 6. Focus society: barriers I regard further cancer preventive 7 .91 2.28 against cancer preventive regulations for industrial companies as (1.12) measures that require unreasonable because certain risks for changes in society economic reasons have to be accepted Control variables: personal health 7. Focus self: subject's My health status is rather good at the 5 .77 2.29 perceived health status moment (1.02) 8. Focus self: personal Right now I am suffering from cancer 2 r = .50 1.38 experience with cancer myself (1.13) In the past I was suffering from cancer Control variables: social desirability 9. Social desirable I never said anything on purpose that 11 .77 4.02 answering behavior (Lck might hurt other people (.79) & Timaeus, 1969, based on Crowne & Marlowe, 1960) 1Measured on a 6-point Likert-type rating scales with 1 = low agreement (low social desirability) to 6 = high agreement (high social desirability) 01 Kals (jr/d) 31/1/01 12:11 pm Page 140 multicollinearity. We dealt with this problem by combining different subsets of predictors and by analyzing thoroughly the mutual effects by means of deleting an especially powerful predic- tor from the variable list. The standard package of analyses includes three subsets of predictors (set A: all self-centered predictors, set B: all society-centered predictors, set A&B: all predic- tors combined) on all dependent variables (IVI), which leads to 18 regression equations (Table 5). Due to the high number of analyses, not all of them can be discussed. Instead, the main pat- terns of results are summarized: All six dependent variables were best pre- dicted by a mix of self-centered and society- centered predictors. With the predictor set KALS & MONTADA: HEALTH BEHAVIOR 141 Table 3. Intercorrelations of the dependent variables II. III. IV. V. VI. Focus self: Focus self: the Focus society: Focus society: Focus society: manifest cancer willingness to get the willingness to the willingness to the willingness to preventive information contribute to the pay for cancer actively support behavior about efficient promotion of preventive or promote cancer preventive cancer measures in cancer for one's own preventive laws general preventive benefit programs I. Focus self: the .68** .69** .74** .62** .70** willingness to take preventive action against cancer for one's own benefit II. Focus self: manifest .56** .52** .49** .61** cancer preventive behavior III. Focus self: the .59** .64** .71** willingness to get information about efficient cancer preventive for one's own benefit IV. Focus society: the .54** .54** willingness to contribute to the promotion of cancer preventive laws V. Focus society: the .62** willingness to pay for cancer preventive measures in general **p < .01, *p < .05 01 Kals (jr/d) 31/1/01 12:11 pm Page 141 JOURNALOFHEALTHPSYCHOLOGY6(2) 142 Table 4. Intercorrelations of the predictor variables with focus on oneself and on society (2) (3) (4) (5.1) (5.2) (5.3) (5.4) (6) 1. Focus self: perception of personal cancer risk .39** .01 .45** .24** .30** .33** .28** .32** 2. Focus self: internal control belief to reduce one's own cancer risk .11** .55** .39** .60** .60** .62** .53** 3. Focus self: individual barriers against personal cancer preventive behaviors .02 .04 .16** .03 .06 .27** 4. Focus society: perception of general risks .36** .51** .56** .52** .39** 5.1. Focus society: internal control beliefs to reduce the general prevalence rate .35** .39** .39** .28** of cancer 5.2. Focus society: external control belief to reduce the general prevalence rate .64** .61** .57** of cancer (industry) 5.3. Focus society: external control belief to reduce general prevalence rate of .61** .43** cancer (medical staff and organization) 5.4. Focus society: external control belief to reduce the general prevalence rate .44** of cancer (state and its institutions) 6 Focus society: barriers against cancer preventive measures that require changes in society ** p < .01, * p < .05 01Kals(jr/d)31/1/0112:11pmPage142 KALS&MONTADA:HEALTHBEHAVIOR 143 Table 5. Three stepwise multiple regression analyses of all criteria (IVI) to predictors with focus on oneself (set A), focus on society (set B) and focus on oneself and on society (set A & B); the table embraces the non-standardized regression weight (b) of the significant predictors1) as well as the determinant coefficient (R2) Criteria 2 I II III IV V VI Predictors with focus on oneself (set A) 1. perception of personal cancer risk .11** .13** .20** . .17** .17** 2. internal control belief to reduce one's own cancer risk .59** .50** .55** .64** .48** .57** 3. individual barriers against personal cancer preventive behaviors . . . . .13** . R2 .50 .25 .32 .41 .25 .33 Predictors with focus on society (set B) 4. perception of general cancer risk .14** .23** .20** .13** .20** .21** 5. reduction of general prevalence rate of cancer: 5.1. internal control belief . .09** .12** . .21** .15** external control beliefs . . . 5.2. . . . industry .14** . . .32** . . 5.3. . . . medical staff and organization .23** .28** .21** .11** . .41** 5.4. . . . state and its institutions .19** .11* .18** .21** .22** .13** 6. barriers against general cancer preventive measures that require changes in society .11** . .15** .18** .23** . R2 .54 .29 .35 .63 .36 .44 Predictors with focus on oneself and on society (set A & B) 1. perception of personal cancer risk .08** . .17** . .09* .09** 2. internal control belief to reduce one's own cancer risk .31** .27** .29** .13** .24** 3. individual barriers against personal cancer preventive behaviors .05* . . . .11* . 4. perception of general cancer risk . .18** . .11** .18** .14** 5. reduction of general prevalence rate of cancer: 5.1. internal control belief . .08* .11** . .21** .14** external control beliefs . . . 5.2. . . . industry .11** . . .30** . . 5.3. . . . medical staff and organization .19** .23** .18** .09* .37** 5.4. . . . state and its institutions .14** . .15** .19** .22** . 6. barriers against general cancer preventive measures that require changes in society . . . .15** .18** . R2 .60 .32 .38 .63 .38 .46 ** p < .01, * p < .05 1 The regression weight of the most powerful predictor that qualifies in the first step is printed in bold numbers 2 Criteria: (I) the willingness to take preventive action against cancer for one's own benefit; (II) manifest cancer preventive behavior; (III) the willingness to get infor- mation about efficient cancer preventive for one's own benefit; (IV) the willingness to contribute to the promotion of cancer preventive laws; (V) the willingness to pay for cancer preventive measures in general; and (VI) the willingness to actively support or promote cancer preventive programs 01Kals(jr/d)31/1/0112:11pmPage143 A&B there was no analysis in which exclu- sively self- or society-centered predictors were significant. Moreover, the mixed predic- tor A&B was for five out of the six dependent variables the most powerful, for one depen- dent variable the mixed set explained exactly the same amount of variance as set B. It could be shown for all dependent variables that control beliefs were the most powerful predictors. In all equations one of the control beliefs qualified in the first regression step. In most cases this was a control belief that con- textually corresponded to the dependent vari- able. For personal behavior that reduces the personal cancer risks of subjects, the internal control belief to reduce the personal risk became, for example, the most powerful pre- dictor (Table 5). For sociopolitical behavioral tendencies (like willingness to promote cancer preventive laws), external control beliefs, e.g. 'Industry or state is able to reduce the cancer prevalence rate in general', became the most powerful predictor (Table 5). This makes sense: in the first case the participant has to make the adequate decisions; in the latter case it is the state that has to establish adequate laws to reduce the cancer prevalence rate. However, in subsequent regression steps control beliefs also became significant, which are related to a different aim from the one addressed in the dependent variable: control beliefs concerning one's personal cancer pre- vention became significant predictors of society-centered behavioral variables and vice versa. Similarly, both self-centered and society- centered risk perceptions became significant predictors of dependent variables corre- sponding or not corresponding in context. Society-centered barriers against cancer pre- ventive measures on the level of society (pre- dictor 6) became a significant predictor of four dependent variables, whereas individual bar- riers (predictor 3) only gained significance in two equations. For the prediction of all three personal cancer preventive dependent vari- ables this result is in perfect alignment with our hypothesis and reflects that barriers on a societal level can even explain personal behavioral variables better than self-centered barriers. It is striking that the subjective indi- vidual barriers have so little impact. The operationalization of the barriers of personal versus sociopolitical cancer prevention differs in context: on the sociopolitical level, argu- ments of interfering values (such as personal freedom and economy values) were assessed, whereas the operationalized barriers against personal cancer prevention were time restric- tions and effort, which do not explicitly touch the moral dimension and may in fact have less importance. Individuals reflecting on their lack of support for particular health behaviors may find it easier to convince themselves that broad societal and moral barriers prevent them from acting to prevent cancer more than personal barriers and restrictions do. Never- theless, the somewhat lower reliability of this scale (Cronbach's alpha is only .60) should also be taken into account as an alternative explanatory hypothesis. The explained criterion variance was high for all six dependent variables. It reached from about one-third for the manifest cancer pre- ventive behavior to nearly two-thirds for the willingness to contribute to the promotion of cancer prevention laws. It makes sense that manifest behavior can be less precisely pre- dicted with our model constructs than the willingness to commitment, because--as described above--the transference from willingness to commitment into manifest behavior is moderated by contextual factors (Montada & Kals, 1998). Again methodologi- cal effects of a lowered reliability of the mani- fest behavior scale have also to be considered (Cronbach's alpha = .63). Although the predictor variables are intercor- related, no suppressor effects were observed. This is even the case for the third set of pre- dictor variables that includes nine predictors. This confirms that the constructs reflect differ- ent psychological dimensions. The regression equations remain remarkably stable even when the most powerful predictors are deleted from the variable list. All regression analyses were repeated by includ- ing the health status, cancer experiences, and the tendency to exhibit socially desirable answering behavior (predictors 79). It could be confirmed that the tendency to socially desirable answering is, for nearly all dependent variables, not a sig- nificant predictor. The perceived current health JOURNAL OF HEALTH PSYCHOLOGY 6(2) 144 01 Kals (jr/d) 31/1/01 12:11 pm Page 144 status has no relevance for any criterion. Only the current and past experiences with a cancer illness qualifies for nearly all dependent vari- ables. This reflected that the experience of cancer does not only motivate to cancer preven- tive activities for one's own sake, but also to commit oneself to public cancer preventive measures. Discussion Taken together, the integration of a self- and a society-centered perspective to explain cancer preventive behavior as an exemplary research field is confirmed as it had been in earlier model applications (Kals et al., 1999; Kals & Odenthal, 1996). Individual health care and care for public health are not perfectly separated domains of behavior, but are intertwined and highly corre- lated in the same way as the underlying self- centered and society-centered motives are. Personal cancer prevention is predicted not only by self-centered variables--as traditional models of health psychology implicitly suggest-- but also by society-centered variables. Analo- gously, willingness to commit oneself to cancer prevention measures is predicted not only by society-centered but also by self-centered vari- ables. A closer look at the results of the regression analyses conveys plausible arguments why an integrative model is more powerful than a one- sided self-centered model: cancer risks are under the control not only of one individual but also of powerful others (like the industry that affects cancer risks by carcinogenic emissions). Measures on a societal level are therefore neces- sary for a sustainable reduction of the risks. The perception of this power and necessity motivates not only the moral support of general cancer preventive measures but also the reduction of personal risks. From these results the following theoretical conclusions can be drawn. It is important to direct the attention of health psychologists beyond a narrow, person-centered view of moti- vation. Cancer preventive behaviors as well as other categories of health behavior embrace self- and society-centered targets and motives (Seydel et al., 1990). Health behavior models (Becker & Rosenstock, 1974; Dlugosch, 1994; Prentice-Dunn & Rogers, 1986) should, therefore, be expanded by a society-oriented perspective as represented by public health research. This recommendation is in line with the conclusion drawn by Curry and Emmons (1994) that single theoretical models on health behavior have limitations, which calls for a more integrative view over various theoretical frame- works (see also Marks, 1996). Additional future tasks include further elabo- ration and testing of the model. The test of the hypotheses should be cross-validated by a larger sample with a lower mean educational level. It is expected that the strength of the described inter- relationships between the personal and the social domains will vary according to the popu- lation sampled and the specific category of cancer risks. This hypothesis still needs to be tested. Ideally this should be done using longi- tudinal instead of cross-sectional data, as only longitudinal data allow causal interpretations. Objective observational methods should be included to validate the dependent variables. Scales with low reliability (especially the mani- fested behavior scale and the scale on personal barriers) should be improved. Although, for our purpose, the inclusion of a 'convenience group' is acceptable, it would be interesting to test the model on a circumscribed population. Finally, it would be of great interest to find out whether or not the model can be generalized to other cat- egories of preventive behavior, for example, the prevention of a specific cancer (e.g. skin cancer) or of cardiovascular disease. This is especially important as the earlier model tests (Kals et al., 1999; Kals & Odenthal, 1996) only touch upon nutrition, but not preventive behavior in a nar- rower sense. One might criticize the model for its loss of economy in comparison with less complex one- sided models. The question is: what does 'economy' mean? If economy is reduced to a bare counting of the model variables, the presented model is definitely less efficient. However, competing criteria exist, such as: how well does the model represent the complex nature of health behavior? How precisely can health behavior be predicted? How many inter- vention strategies can be concluded from the result patterns, and how specific are they? A balance between efficiency and fidelity needs to be found. Future research might show that model variables might be omitted. KALS & MONTADA: HEALTH BEHAVIOR 145 01 Kals (jr/d) 31/1/01 12:11 pm Page 145 For the development of efficient intervention strategies on cancer prevention the presented model already offers very precise practical con- clusions. All significant predictors serve as a starting point to design such intervention pro- grams. There are few motivational differences between various behavioral categories to reduce personal or general cancer risks. This makes it possible to efficiently promote cancer preven- tive behavior and decrease cancer risk behavior on a personal and societal level within the same intervention program. For this purpose, an awareness of general cancer risks should be promoted in the same manner as an awareness for personal cancer risks. Awareness should primarily be presented as cognitive valuations and not as fear (Seydel et al., 1990). At the same time, knowledge of effec- tive internal and external strategies to reduce general and personal cancer risks should be offered in combination with discussions on bar- riers and arguments against cancer preventive measures. Competing norms that also have a moral base (like the freedom of choice) need to be presented and discussed as such (Mller & Sacksofsky, 1995). The role of positive social influences to give health norms priority might be utilized (Van Assema et al., 1993). All of these aims have to be shaped in accord- ance with the different stages of the various par- ticipants' readiness to change (Block & Keller, 1998), the specific target group, and the inter- vention setting (Colditz & Gortmaker, 1995; Hertog et al., 1993). A perception of personal risk, for example, can only be promoted when objective risks exist for this individual. The valuation of societal barriers might change with this personal affection. If the cancer affects only women, the societal barriers might rise, especi- ally when the costs for screening are, for example, charged to taxation or the health system instead of to recipients. This example shows how closely self-centered and altruistic motives are intertwined. It still needs to be tested how much purely altruistic motivation for public health can be promoted by psychological interventions. Long-term evaluation of such programs must prove the effectiveness of the target aims establishing cancer preventive behavior and reducing cancer risk behavior on both a personal and a social level. References Anderson, P. J., Lowe, J. B., Stanton, W. R., & Balanda, K. P. (1994). Skin cancer prevention: A link between primary prevention and early detec- tion? Australian Journal of Public Health, 18, 417420. Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavior change. Psychological Review, 84, 191215. Becker, M. H., & Rosenstock, I. M. (1974). Social- psychological research on determinants of preven- tive health behavior. In R. L. Kane (Ed.), The behavioral sciences and preventive medicine: Oppor- tunities and dilemmas (pp. 2535). Washington: DHEW Publication No. (NIH) 76878. Becker, P. (1992). Diagnostik und Bedingungsanalyse des Gesundheitsverhaltens [Diagnostic and moti- vational analyses of health protective behavior]. In H. Schrder & K. Reschke (Eds.), Psychosoziale Prvention und Gesundheitsfrderung (pp. 105124). Regensburg: Roderer. Black, R. J., Bray, F., Ferlay, J., & Parkin, D. M. (1997). Cancer incidence and mortality in the European Union: Cancer registry data and estimates of national incidence for 1990. European Journal of Cancer, 33, 10751107. Block, L. G., & Keller, P. A. (1998). Beyond protection motivation: an integrative theory of health appeals. Journal of Applied Social Psychology, 28, 15841608. Bostick, R. M., Sprafka, J., Virnig, B. A., & Potter, J. D. (1994). Predictors of cancer prevention attitudes and participation in cancer screening examinations. Preventive Medicine, 23, 816826. Calnan, M. (1994). The Health Belief Model and par- ticipation in programmes for the early detection of breast cancer: a comparative analysis. In A. Steptoe & J. Wardle (Eds.), Psychosocial processes and health. A reader (pp. 290307). Cambridge: Cam- bridge University Press. Carmel, S., Shani, E., & Rosenberg, L. (1996). Skin cancer protective behaviors among the elderly: Explaining their response to a health education program using the Health Belief Model. Edu- cational Gerontology, 22, 651688. Caplan, G. (1964). Principles of preventive psychiatry. New York: Basic Books. Colditz, G. A. & Gortmaker, S. L. (1995). Cancer pre- vention strategies for the future: Risk identification and preventive intervention. Milbank Quarterly, 73, 621651. Conner, M., & Norman, P. (Eds.). (1996). Predicting health behaviour: Research and practice with social cognition models. Buckingham: Open University Press. JOURNAL OF HEALTH PSYCHOLOGY 6(2) 146 01 Kals (jr/d) 31/1/01 12:11 pm Page 146 Crowne, D. P., & Marlowe, D. (1960). A new scale of social desirability independent of psychopathology. Journal of Consulting Psychology, 24, 349354. Curry, S. J., & Emmons, K. M. (1994). Theoretical models for predicting and improving compliance with breast cancer screening. Annals of Behavioral Medicine, 16, 302316. Dlugosch, G. E. (1994). Modelle in der Gesundheits- psychologie [Models in health psychology]. In P. Schwenkmezger & L. R. Schmidt (Eds.), Lehrbuch der Gesundheitspsychologie (pp. 101117). Stuttgart: Enke. Ewart, C. K. (1991). Social action theory for a public health psychology. American Psychologist, 46, 931946. Fahlberg, L. L., & Wolfer, J. (1994). Dichotomy or integration? A response to McLeroy. American Journal of Health Promotion, 8, 352. Fischera, S. D., & Frank, D. I. (1994). The Health Belief Model as a predictor of mammography screening. Health Values, 18, 39. Fishbein, M., & Ajzen, I. (1975). Belief, attitude, inten- tion, and behavior. An introduction to theory and research. Reading: Addison-Wesley. Friedman, L. C., Nelson, D. V., Webb, J. A., Hoffman, L. P., & Baer, P. E. (1994). Dispositional optimism, self-efficacy, and health beliefs as predictors of breast self-examination. American Journal of Pre- ventive Medicine, 10, 130135. Glanz, K. (1994). Reducing breast cancer risk through changes in diet and alcohol intake: From clinic to community. Annals of Behavioral Medicine, 16, 334346. Gloor, F., & Van der Linde, F. (1982). Epidemiologie und tiologie maligner Tumoren [Epidemiology and etiology of malignant tumors]. In A. Glaus, W. F. Junig, & H.-J. Senn (Eds.), Onkologie fr Krankenpflegeberufe (pp. 1829). Stuttgart: Thieme. Hausenblas, H. A., Carron, A. V., & Mack, D. E. (1997). Application of the theories of reasoned action and planned behavior to exercise behavior: A meta-analysis. Journal of Sport and Exercise Psy- chology, 19, 3651. Heim, E. (1986). Medizinsoziologische Aspekte der Krankheit [Medical-sociological aspects of illness]. In E. Heim & J. Willi (Eds.), Psychosoziale Medizin (Vol. 2, pp. 278342). Berlin: Springer. Hertog, J. K., Finnegan, J. R., Rooney, B., Viswanath, K., & Potter, J. (1993). Self-efficacy as a target popu- lation segmentation strategy in a diet and cancer risk reduction campaign. Health Communication, 5, 2140. Hornung, R. (1986). Krebs: Wissen, Einstellungen und prventives Verhalten der Bevlkerung [Cancer: Knowledge, attitudes, and cancer preventive behav- ior within the population]. Bern: Hans Huber. Houlston, R. S., & Lemoine, L. (1991). Medical and psychological perspectives on breast cancer screen- ing: A comment on Pitts, McMaster and Wilson. Journal of Community and Applied Social Psychol- ogy, 1, 4344. Kals, E. (1996a). Are proenvironmental commitments motivated by health concerns or by perceived justice? In L. Montada & M. Lerner (Eds.), Current societal concerns about justice (pp. 231258). New York: Plenum Press. Kals, E., (1996b). Motieven voor preventief en riskant gezondheidsgedrag ten aanzien van kanker [Motives of cancer preventive and health risk behaviors]. Gedrag & Gezondheid, 24, 384391. Kals, E., & Becker, R. (1995). Item- und Skalenanalyse umwelt- und gesundheitsbezogener Meinstru- menten [Item- and scale analyses of environment- and health-related instruments] (Berichte aus der Arbeitsgruppe 'Verantwortung, Gerechtigkeit, Moral' No. 89). Trier: Universitt Trier, Fachbereich I--Psychologie. Kals, E., Held, E., & Montada, L. (1999). Persnlicher Fleischkonsum und gesellschaftspolitische Engage- ments mit Folgen fr die allgemeine Fleischproduk- tion: Ein Vergleich ihrer motivationalen Grundlagen [Individual consumption of meat prod- ucts and sociopolitical commitments with relevance for the general meat production: A comparison of their underlying motives]. Zeitschrift fr Gesund- heitspsychologie, 7, 120. Kals, E., & Montada, L. (1998). Persnlicher Gesund- heitsschutz im Spiegel sozialer Verantwortung [Individual health protection in the scope of social responsibility]. Zeitschrift fr Gesundheitspsycholo- gie, 6, 318. Kals, E., & Odenthal, D. (1996). ber die Motive von Entscheidungen fr konventionelle oder kontrol- liert-biologische Nahrungsmittel [Motives under- lying decisions for choosing products from alternative or conventional farming]. Zeitschrift fr Gesundheitspsychologie, 4, 3754. Kirscht, J. P. (1988). The health belief model and pre- dictions of health actions. In D. S. Gochman (Ed.), Health behavior (pp. 2741). New York: Plenum Press. Kristal, A. R., Patterson, R. E., Glanz, K., Heimendinger, J., Hebert, J. R., Feng, Z., & Probart, C. (1995). Psychosocial correlates of healthful diets: Baseline results from the Working Well Study. Pre- ventive Medicine, 24, 221228. Laaser, U. (1994). The contribution of the schools of Public Health to Public Health in Europe. Zeitschrift fr Gesundheitswissenschaften, 2, 109118. Lauver, D. (1992). A theory of care-seeking behavior. Journal of Nursing Scholarship, 24, 281287. KALS & MONTADA: HEALTH BEHAVIOR 147 01 Kals (jr/d) 31/1/01 12:11 pm Page 147 Lck, H. E., & Timaeus, E. (1969). Skalen zur Messung Manifester Angst (MAS) und Sozialer Wnschbarkeit (SDS-E und SDS-CM) [Scales for the measurement of manifest fear (MAS) and social desirability (SDS-E and SDS-CM)]. Diagnostica, 15, 134141. Maddux, J. E., & DuCharme, K. A. (1997). Behavioral intensions in theories of health behavior. In D. S. Gochman (Ed.), Handbook of Health Behavior Research I: Personal and Social Determinants (pp. 133151). New York: Plenum Press. Maes, S., Spielberger, C. D., Defares, P. B., & Sarason, I. G. (Eds.). (1988). Topics in health psychology. Chichester: Wiley. Mansfield, C. M. (1991). Motivating the public in cancer prevention. In B. A. Stoll (Ed.), Approaches to breast cancer prevention (pp. 221227). Dor- drecht: Kluwer. Marks, D. F. (1996). Health psychology in context. Journal of Health Psychology, 1, 721. Matarazzo, J. D. (1980). Behavioral health and behav- ioral medicine: Frontiers for a new Health Psychol- ogy. American Psychologist, 35, 807817. Mermelstein, R. J., & Riesenberg, L. A. (1992). Changing knowledge and attitudes about skin cancer risk factors in adolescents. Health Psychol- ogy, 11, 371376. Montada, L., & Kals, E. (1998). A theory of 'willing- ness for continued responsible commitment': Research examples from the fields of pollution control and health protection (Berichte aus der Arbeitsgruppe 'Verantwortung, Gerechtigkeit, Moral' Nr. 114). Trier: Universitt Trier, Fachbere- ich I Psychologie. Mller, F., & Sacksofsky, S. (1995). Gesundheits- frderung und Krebsprvention in der Schule [Health promotion and cancer prevention in school]. Die Deutsche Schule, 87, 289300. Oakley, A., Bendelow, G., Barnes, J., Buchanan, M., & Husain, O. A. N. (1995). Health and cancer preven- tion: Knowledge and beliefs of children and young people. British Medical Journal, 310, 10291033. Ogden, J. (1995). Psychosocial theory and the creation of the risky self. Social Science and Medicine, 40, 409415. Prentice-Dunn, S., & Rogers, R. W. (1986). Protection Motivation Theory and preventive health: Beyond the Health Belief Model. Health Education Research, 1, 153161. Reizenstein, P., Modan, B., & Kuller, L. H. (1994). The quandary of cancer prevention. Journal of Clinical Epidemiology, 47, 575581. Robinson, J. K., & Rademaker, A. W. (1995) Skin cancer risk and sun protection learning by helpers of patients with nonmelanoma skin cancer. Preventive Medicine, 24, 333341. Rosenstock, I. M. (1966). Why people use health services. Millbank Memorial Fund Quarterly, 44, 94124. Schmidt, L. R. (1994). A psychological look at public health: Contents and methodology. In S. Maes, H. Leventhal, & M. Johnston (Eds.), International Review of Health Psychology (Vol. 3, pp. 336). Chichester: Wiley. Schmidt, L. R., Schwenkmezger, P., & Dlugosch, G. E. (1990). The scope of health psychology. In L. R. Schmidt, P. Schwenkmezger, J. Weinman, & S. Maes (Eds.), Theoretical and applied aspects of health psy- chology (pp. 327). Chur: Harwood Academic. Schmidt, L. R, Schwenkmezger, P. Weinman, J., & Maes, S. (Eds.). (1990). Theoretical and applied aspects of health psychology. Chur: Harwood Aca- demic. Schwarzer, R., & Fuchs, R. (1996). Self-efficacy and health behaviours. In M. Conner & P. Norman (Eds.), Predicting health behaviour: Research and practice with social cognition models (pp. 163196). Buckingham: Open University Press. Seydel, E., Taal, E., & Wiegman, O. (1990). Risk- appraisal, outcome and self-efficacy expectancies: Cognitive factors in preventive behavior related to cancer. Psychology and Health, 4, 99109. Stokols, D. (1992). Establishing and maintaining healthy environments. American Psychologist, 47, 622. Stone, G. C. (1990). An international review of the emergence and development of Health Psychology. Psychology and Health, 4, 317. Stroebe, W., & Stroebe, M. S. (1995). Social psychol- ogy and health. Buckingham: Open University Press. Taylor, D. G., Aday, L. A., & Andersen, R. (1975). A social indicator of access to medical care. Journal of Health and Social Behavior, 16, 3949. Taylore, P. R., Dawsey, S., & Albanes, D. (1990). Cancer prevention trials in China and Finland. Annals of Epidemiology, 1, 195203. Van Assema, P., Pieterse, M., Kok, G., Eriksen, M., & de Vries, H. (1993). The determinants of four cancer-related risk behaviours. Health Education Research, 8, 461472. Van Assema, P., Steenbakkers, M., Kok, G., Eriksen, M., & de Vries, H. (1994). Results of the Dutch community project 'Healthy Bergeyk'. Preventive Medicine, 23, 394401. Velicer, W. F., Diclemente, C. C., Rossi, J. S., & Pro- chaska, J. O. (1990). Relapse situations and self- efficacy: An integrative model. Addictive Behavior, 15, 271283. Winett, R. A., King, A. C., & Altman, D. G. (1989). Health psychology and public health. An integrative approach. New York: Pergamon. JOURNAL OF HEALTH PSYCHOLOGY 6(2) 148 01 Kals (jr/d) 31/1/01 12:11 pm Page 148 </meta-value></custom-meta></custom-meta-wrap></article-meta></front><back><ref-list><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Anderson, P. J.</surname></name>, <name name-style="western"><surname>Lowe, J. B.</surname></name>, <name name-style="western"><surname>Stanton, W. R.</surname></name>, & <name name-style="western"><surname>Balanda, K. P.</surname></name> (<year>1994</year>). <article-title>Skin cancer prevention: A link between primary prevention and early detection?</article-title><source>Australian Journal of Public Health</source>, <volume>18</volume>, <fpage>417</fpage>–<lpage>420</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Bandura, A.</surname></name> (<year>1977</year>). <article-title>Self-efficacy: Toward a unifying theory of behavior change</article-title>. <source>Psychological Review</source>, <volume>84</volume>, <fpage>191</fpage>–<lpage>215</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Becker, M. H.</surname></name>, & <name name-style="western"><surname>Rosenstock, I. M.</surname></name> (<year>1974</year>). <article-title>Social-psychological research on determinants of preventive health behavior</article-title>. In <name name-style="western"><surname>R. L. Kane</surname></name> (Ed.), <source>The behavioral sciences and preventive medicine: Opportunities and dilemmas</source> (pp. <fpage>25</fpage>–<lpage>35</lpage>). <publisher-loc>Washington</publisher-loc>: <publisher-name>DHEW</publisher-name> Publication No. (NIH) 76–878.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Becker, P.</surname></name> (<year>1992</year>). <article-title>Diagnostik und Bedingungsanalyse des Gesundheitsverhaltens [Diagnostic and motivational analyses of health protective behavior]</article-title>. In <name name-style="western"><surname>H. Schröder</surname></name> & <name name-style="western"><surname>K. Reschke</surname></name> (Eds.), <source>Psychosoziale Prävention und Gesundheitsförderung</source> (pp. <fpage>105</fpage>–<lpage>124</lpage>). <publisher-loc>Regensburg</publisher-loc>: <publisher-name>Roderer</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Black, R. J.</surname></name>, <name name-style="western"><surname>Bray, F.</surname></name>, <name name-style="western"><surname>Ferlay, J.</surname></name>, & <name name-style="western"><surname>Parkin, D. M.</surname></name> (<year>1997</year>). <article-title>Cancer incidence and mortality in the European Union: Cancer registry data and estimates of national incidence for 1990</article-title>. <source>European Journal of Cancer</source>, <volume>33</volume>, <fpage>1075</fpage>–<lpage>1107</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Block, L. G.</surname></name>, & <name name-style="western"><surname>Keller, P. A.</surname></name> (<year>1998</year>). <article-title>Beyond protection motivation: an integrative theory of health appeals</article-title>. <source>Journal of Applied Social Psychology</source>, <volume>28</volume>, <fpage>1584</fpage>–<lpage>1608</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Bostick, R. M.</surname></name>, <name name-style="western"><surname>Sprafka, J.</surname></name>, <name name-style="western"><surname>Virnig, B. A.</surname></name>, & <name name-style="western"><surname>Potter, J. D.</surname></name> (<year>1994</year>). <article-title>Predictors of cancer prevention attitudes and participation in cancer screening examinations</article-title>. <source>Preventive Medicine</source>, <volume>23</volume>, <fpage>816</fpage>–<lpage>826</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Calnan, M.</surname></name> (<year>1994</year>). <article-title>The Health Belief Model and participation in programmes for the early detection of breast cancer: a comparative analysis</article-title>. In <name name-style="western"><surname>A. Steptoe</surname></name> & <name name-style="western"><surname>J. Wardle</surname></name> (Eds.), <source>Psychosocial processes and health. A reader</source> (pp. <fpage>290</fpage>–<lpage>307</lpage>). <publisher-loc>Cambridge</publisher-loc>: <publisher-name>Cambridge University Press</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Carmel, S.</surname></name>, <name name-style="western"><surname>Shani, E.</surname></name>, & <name name-style="western"><surname>Rosenberg, L.</surname></name> (<year>1996</year>). <article-title>Skin cancer protective behaviors among the elderly: Explaining their response to a health education program using the Health Belief Model</article-title>. <source>Educational Gerontology</source>, <volume>22</volume>, <fpage>651</fpage>–<lpage>688</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Caplan, G.</surname></name> (<year>1964</year>). <source>Principles of preventive psychiatry</source>. <publisher-loc>New York</publisher-loc>: <publisher-name>Basic Books</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Colditz, G. A.</surname></name> & <name name-style="western"><surname>Gortmaker, S. L.</surname></name> (<year>1995</year>). <article-title>Cancer prevention strategies for the future: Risk identification and preventive intervention</article-title>. <source>Milbank Quarterly</source>, <volume>73</volume>, <fpage>621</fpage>–<lpage>651</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Conner, M.</surname></name>, & <name name-style="western"><surname>Norman, P.</surname></name> (Eds.). (<year>1996</year>). <source>Predicting health behaviour: Research and practice with social cognition models</source>. <publisher-loc>Buckingham</publisher-loc>: <publisher-name>Open University Press</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Crowne, D. P.</surname></name>, & <name name-style="western"><surname>Marlowe, D.</surname></name> (<year>1960</year>). <article-title>A new scale of social desirability independent of psychopathology</article-title>. <source>Journal of Consulting Psychology</source>, <volume>24</volume>, <fpage>349</fpage>–<lpage>354</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Curry, S. J.</surname></name>, & <name name-style="western"><surname>Emmons, K. M.</surname></name> (<year>1994</year>). <article-title>Theoretical models for predicting and improving compliance with breast cancer screening</article-title>. <source>Annals of Behavioral Medicine</source>, <volume>16</volume>, <fpage>302</fpage>–<lpage>316</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Dlugosch, G. E.</surname></name> (<year>1994</year>). <article-title>Modelle in der Gesundheitspsychologie [Models in health psychology]</article-title>. In <name name-style="western"><surname>P. Schwenkmezger</surname></name> & <name name-style="western"><surname>L. R. Schmidt</surname></name> (Eds.), <source>Lehrbuch der Gesundheitspsychologie</source> (pp. <fpage>101</fpage>–<lpage>117</lpage>). <publisher-loc>Stuttgart</publisher-loc>: <publisher-name>Enke</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Ewart, C. K.</surname></name> (<year>1991</year>). <article-title>Social action theory for a public health psychology</article-title>. <source>American Psychologist</source>, <volume>46</volume>, <fpage>931</fpage>–<lpage>946</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Fahlberg, L. L.</surname></name>, & <name name-style="western"><surname>Wolfer, J.</surname></name> (<year>1994</year>). <article-title>Dichotomy or integration? A response to McLeroy</article-title>. <source>American Journal of Health Promotion</source>, <volume>8</volume>, <fpage>352</fpage>-<lpage>352</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Fischera, S. D.</surname></name>, & <name name-style="western"><surname>Frank, D. I.</surname></name> (<year>1994</year>). <article-title>The Health Belief Model as a predictor of mammography screening</article-title>. <source>Health Values</source>, <volume>18</volume>, <fpage>3</fpage>–<lpage>9</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Fishbein, M.</surname></name>, & <name name-style="western"><surname>Ajzen, I.</surname></name> (<year>1975</year>). <source>Belief, attitude, intention, and behavior. An introduction to theory and research</source>. <publisher-loc>Reading</publisher-loc>: <publisher-name>Addison-Wesley</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Friedman, L. C.</surname></name>, <name name-style="western"><surname>Nelson, D. V.</surname></name>, <name name-style="western"><surname>Webb, J. A.</surname></name>, <name name-style="western"><surname>Hoffman, L. P.</surname></name>, & <name name-style="western"><surname>Baer, P. E.</surname></name> (<year>1994</year>). <article-title>Dispositional optimism, self-efficacy, and health beliefs as predictors of breast self-examination</article-title>. <source>American Journal of Preventive Medicine</source>, <volume>10</volume>, <fpage>130</fpage>–<lpage>135</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Glanz, K.</surname></name> (<year>1994</year>). <article-title>Reducing breast cancer risk through changes in diet and alcohol intake: From clinic to community</article-title>. <source>Annals of Behavioral Medicine</source>, <volume>16</volume>, <fpage>334</fpage>–<lpage>346</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Gloor, F.</surname></name>, & <name name-style="western"><surname>Van der Linde, F.</surname></name> (<year>1982</year>). <article-title>Epidemiologie und Ätiologie maligner Tumoren [Epidemiology and etiology of malignant tumors]</article-title>. In <name name-style="western"><surname>A. Glaus</surname></name>, <name name-style="western"><surname>W. F. Junig</surname></name>, & <name name-style="western"><surname>H.-J. Senn</surname></name> (Eds.), <source>Onkologie für Krankenpflegeberufe</source> (pp. <fpage>18</fpage>–<lpage>29</lpage>). <publisher-loc>Stuttgart</publisher-loc>: <publisher-name>Thieme</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Hausenblas, H. A.</surname></name>, <name name-style="western"><surname>Carron, A. V.</surname></name>, & <name name-style="western"><surname>Mack, D. E.</surname></name> (<year>1997</year>). <article-title>Application of the theories of reasoned action and planned behavior to exercise behavior: A meta-analysis</article-title>. <source>Journal of Sport and Exercise Psychology</source>, <volume>19</volume>, <fpage>36</fpage>–<lpage>51</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Heim, E.</surname></name> (<year>1986</year>). <article-title>Medizinsoziologische Aspekte der Krankheit [Medical-sociological aspects of illness]</article-title>. In <name name-style="western"><surname>E. Heim</surname></name> & <name name-style="western"><surname>J. Willi</surname></name> (Eds.), <source>Psychosoziale Medizin</source>(Vol. 2, pp. <fpage>278</fpage>–<lpage>342</lpage>). <publisher-loc>Berlin</publisher-loc>: <publisher-name>Springer</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Hertog, J. K.</surname></name>, <name name-style="western"><surname>Finnegan, J. R.</surname></name>, <name name-style="western"><surname>Rooney, B.</surname></name>, <name name-style="western"><surname>Viswanath, K.</surname></name>, & <name name-style="western"><surname>Potter, J.</surname></name> (<year>1993</year>). <article-title>Self-efficacy as a target population segmentation strategy in a diet and cancer risk reduction campaign</article-title>. <source>Health Communication</source>, <volume>5</volume>, <fpage>21</fpage>–<lpage>40</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Hornung, R.</surname></name> (<year>1986</year>). <source>Krebs: Wissen, Einstellungen und präventives Verhalten der Bevölkerung [Cancer: Knowledge, attitudes, and cancer preventive behavior within the population]</source>. <publisher-loc>Bern</publisher-loc>: <publisher-name>Hans Huber</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Houlston, R. S.</surname></name>, & <name name-style="western"><surname>Lemoine, L.</surname></name> (<year>1991</year>). <article-title>Medical and psychological perspectives on breast cancer screening: A comment on Pitts, McMaster and Wilson</article-title>. <source>Journal of Community and Applied Social Psychology</source>, <volume>1</volume>, <fpage>43</fpage>–<lpage>44</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Kals, E.</surname></name> (<year>1996a</year>). <article-title>Are proenvironmental commitments motivated by health concerns or by perceived justice?</article-title> In <name name-style="western"><surname>L. Montada</surname></name> & <name name-style="western"><surname>M. Lerner</surname></name> (Eds.), <source>Current societal concerns about justice</source> (pp. <fpage>231</fpage>–<lpage>258</lpage>). <publisher-loc>New York</publisher-loc>: <publisher-name>Plenum Press</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Kals, E.</surname></name>, (<year>1996b</year>). <article-title>Motieven voor preventief en riskant gezondheidsgedrag ten aanzien van kanker [Motives of cancer preventive and health risk behaviors]</article-title>. <source>Gedrag & Gezondheid</source>, <volume>24</volume>, <fpage>384</fpage>–<lpage>391</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Kals, E.</surname></name>, & <name name-style="western"><surname>Becker, R.</surname></name> (<year>1995</year>). <source>Item- und Skalenanalyse umwelt- und gesundheitsbezogener Meßinstrumenten [Item- and scale analyses of environmentand health-related instruments]</source> (Berichte aus der Arbeitsgruppe ‘Verantwortung, Gerechtigkeit, Moral’ No. 89). <publisher-loc>Trier</publisher-loc>: <publisher-name>Universität Trier, Fachbereich I—Psychologie</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Kals, E.</surname></name>, <name name-style="western"><surname>Held, E.</surname></name>, & <name name-style="western"><surname>Montada, L.</surname></name> (<year>1999</year>). <article-title>Persönlicher Fleischkonsum und gesellschaftspolitische Engagements mit Folgen für die allgemeine Fleischproduktion: Ein Vergleich ihrer motivationalen Grundlagen [Individual consumption of meat products and sociopolitical commitments with relevance for the general meat production: A comparison of their underlying motives]</article-title>. <source>Zeitschrift für Gesundheitspsychologie</source>, <volume>7</volume>, <fpage>1</fpage>–<lpage>20</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Kals, E.</surname></name>, & <name name-style="western"><surname>Montada, L.</surname></name> (<year>1998</year>). <article-title>Persönlicher Gesundheitsschutz im Spiegel sozialer Verantwortung [Individual health protection in the scope of social responsibility]</article-title>. <source>Zeitschrift für Gesundheitspsychologie</source>, <volume>6</volume>, <fpage>3</fpage>–<lpage>18</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Kals, E.</surname></name>, & <name name-style="western"><surname>Odenthal, D.</surname></name> (<year>1996</year>). <article-title>Über die Motive von Entscheidungen für konventionelle oder kontrolliert-biologische Nahrungsmittel [Motives underlying decisions for choosing products from alternative or conventional farming]</article-title>. <source>Zeitschrift für Gesundheitspsychologie</source>, <volume>4</volume>, <fpage>37</fpage>–<lpage>54</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Kirscht, J. P.</surname></name> (<year>1988</year>). <article-title>The health belief model and predictions of health actions</article-title>. In <name name-style="western"><surname>D. S. Gochman</surname></name> (Ed.), <source>Health behavior</source> (pp. <fpage>27</fpage>–<lpage>41</lpage>). <publisher-loc>New York</publisher-loc>: <publisher-name>Plenum Press</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Kristal, A. R.</surname></name>, <name name-style="western"><surname>Patterson, R. E.</surname></name>, <name name-style="western"><surname>Glanz, K.</surname></name>, <name name-style="western"><surname>Heimendinger, J.</surname></name>, <name name-style="western"><surname>Hebert, J. R.</surname></name>, <name name-style="western"><surname>Feng, Z.</surname></name>, & <name name-style="western"><surname>Probart, C.</surname></name> (<year>1995</year>). <article-title>Psychosocial correlates of healthful diets: Baseline results from the Working Well Study</article-title>. <source>Preventive Medicine</source>, <volume>24</volume>, <fpage>221</fpage>–<lpage>228</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Laaser, U.</surname></name> (<year>1994</year>). <article-title>The contribution of the schools of Public Health to Public Health in Europe</article-title>. <source>Zeitschrift für Gesundheitswissenschaften</source>, <volume>2</volume>, <fpage>109</fpage>–<lpage>118</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Lauver, D.</surname></name> (<year>1992</year>). <article-title>A theory of care-seeking behavior</article-title>. <source>Journal of Nursing Scholarship</source>, <volume>24</volume>, <fpage>281</fpage>–<lpage>287</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Lück, H. E.</surname></name>, & <name name-style="western"><surname>Timaeus, E.</surname></name> (<year>1969</year>). <article-title>Skalen zur Messung Manifester Angst (MAS) und Sozialer Wünschbarkeit (SDS-E und SDS-CM) [Scales for the measurement of manifest fear (MAS) and social desirability (SDS-E and SDS-CM)]</article-title>. <source>Diagnostica</source>, <volume>15</volume>, <fpage>134</fpage>–<lpage>141</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Maddux, J. E.</surname></name>, & <name name-style="western"><surname>DuCharme, K. A.</surname></name> (<year>1997</year>). <article-title>Behavioral intensions in theories of health behavior</article-title>. In <name name-style="western"><surname>D. S. Gochman</surname></name> (Ed.), <source>Handbook of Health Behavior Research I: Personal and Social Determinants</source> (pp. <fpage>133</fpage>–<lpage>151</lpage>). <publisher-loc>New York</publisher-loc>: <publisher-name>Plenum Press</publisher-name>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Maes, S.</surname></name>, <name name-style="western"><surname>Spielberger, C. D.</surname></name>, <name name-style="western"><surname>Defares, P. B.</surname></name>, & <name name-style="western"><surname>Sarason, I. G.</surname></name> (Eds.). (<year>1988</year>). <source>Topics in health psychology</source>.<publisher-loc>Chichester</publisher-loc>: <publisher-name>Wiley</publisher-name>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Mansfield, C. M.</surname></name> (<year>1991</year>). <article-title>Motivating the public in cancer prevention</article-title>. In <name name-style="western"><surname>B. A. Stoll</surname></name> (Ed.), <source>Approaches to breast cancer prevention</source> (pp. <fpage>221</fpage>–<lpage>227</lpage>). <publisher-loc>Dordrecht</publisher-loc>: <publisher-name>Kluwer</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Marks, D. F.</surname></name> (<year>1996</year>). <article-title>Health psychology in context</article-title>. <source>Journal of Health Psychology</source>, <volume>1</volume>, <fpage>7</fpage>–<lpage>21</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Matarazzo, J. D.</surname></name> (<year>1980</year>). <article-title>Behavioral health and behavioral medicine: Frontiers for a new Health Psychology</article-title>. <source>American Psychologist</source>, <volume>35</volume>, <fpage>807</fpage>–<lpage>817</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Mermelstein, R. J.</surname></name>, & <name name-style="western"><surname>Riesenberg, L. A.</surname></name> (<year>1992</year>). <article-title>Changing knowledge and attitudes about skin cancer risk factors in adolescents</article-title>. <source>Health Psychology</source>, <volume>11</volume>, <fpage>371</fpage>–<lpage>376</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Montada, L.</surname></name>, & <name name-style="western"><surname>Kals, E.</surname></name> (<year>1998</year>). <source>A theory of ‘willingness for continued responsible commitment’: Research examples from the fields of pollution control and health protection</source> (Berichte aus der Arbeitsgruppe ‘Verantwortung, Gerechtigkeit, Moral’ Nr. 114). <publisher-loc>Trier</publisher-loc>: <publisher-name>Universität Trier, Fachbereich I – Psychologie</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Müller, F.</surname></name>, & <name name-style="western"><surname>Sacksofsky, S.</surname></name> (<year>1995</year>). <article-title>Gesundheitsförderung und Krebsprävention in der Schule [Health promotion and cancer prevention in school]</article-title>. <source>Die Deutsche Schule</source>, <volume>87</volume>, <fpage>289</fpage>–<lpage>300</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Oakley, A.</surname></name>, <name name-style="western"><surname>Bendelow, G.</surname></name>, <name name-style="western"><surname>Barnes, J.</surname></name>, <name name-style="western"><surname>Buchanan, M.</surname></name>, & <name name-style="western"><surname>Husain, O. A. N.</surname></name> (<year>1995</year>). <article-title>Health and cancer prevention: Knowledge and beliefs of children and young people</article-title>. <source>British Medical Journal</source>, <volume>310</volume>, <fpage>1029</fpage>–<lpage>1033</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Ogden, J.</surname></name> (<year>1995</year>). <article-title>Psychosocial theory and the creation of the risky self</article-title>. <source>Social Science and Medicine</source>, <volume>40</volume>, <fpage>409</fpage>–<lpage>415</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Prentice-Dunn, S.</surname></name>, & <name name-style="western"><surname>Rogers, R. W.</surname></name> (<year>1986</year>). <article-title>Protection Motivation Theory and preventive health: Beyond the Health Belief Model</article-title>. <source>Health Education Research</source>, <volume>1</volume>, <fpage>153</fpage>–<lpage>161</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Reizenstein, P.</surname></name>, <name name-style="western"><surname>Modan, B.</surname></name>, & <name name-style="western"><surname>Kuller, L. H.</surname></name> (<year>1994</year>). <article-title>The quandary of cancer prevention</article-title>. <source>Journal of Clinical Epidemiology</source>, <volume>47</volume>, <fpage>575</fpage>–<lpage>581</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Robinson, J. K.</surname></name>, & <name name-style="western"><surname>Rademaker, A. W.</surname></name> (<year>1995</year>) <article-title>Skin cancer risk and sun protection learning by helpers of patients with nonmelanoma skin cancer</article-title>. <source>Preventive Medicine</source>, <volume>24</volume>, <fpage>333</fpage>–<lpage>341</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Rosenstock, I. M.</surname></name> (<year>1966</year>). <article-title>Why people use health services</article-title>. <source>Millbank Memorial Fund Quarterly</source>, <volume>44</volume>, <fpage>94</fpage>–<lpage>124</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Schmidt, L. R.</surname></name> (<year>1994</year>). <article-title>A psychological look at public health: Contents and methodology</article-title>. In <name name-style="western"><surname>S. Maes</surname></name>, <name name-style="western"><surname>H. Leventhal</surname></name>, & <name name-style="western"><surname>M. Johnston</surname></name> (Eds.), <source>International Review of Health Psychology</source> (Vol. 3, pp. 3–36). <publisher-loc>Chichester</publisher-loc>: <publisher-name>Wiley</publisher-name>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Schmidt, L. R.</surname></name>, <name name-style="western"><surname>Schwenkmezger, P.</surname></name>, & <name name-style="western"><surname>Dlugosch, G. E.</surname></name> (<year>1990</year>). <article-title>The scope of health psychology</article-title>. In <name name-style="western"><surname>L. R. Schmidt</surname></name>, <name name-style="western"><surname>P. Schwenkmezger</surname></name>, <name name-style="western"><surname>J. Weinman</surname></name>, & <name name-style="western"><surname>S. Maes</surname></name> (Eds.), <source>Theoretical and applied aspects of health psychology</source> (pp. <fpage>3</fpage>–<lpage>27</lpage>). <publisher-loc>Chur</publisher-loc>: <publisher-name>Harwood Academic</publisher-name>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Schmidt, L. R.</surname></name>, <name name-style="western"><surname>Schwenkmezger, P.</surname></name><name name-style="western"><surname>Weinman, J.</surname></name>, & <name name-style="western"><surname>Maes, S.</surname></name> (Eds.). (<year>1990</year>). <source>Theoretical and applied aspects of health psychology</source>. <publisher-loc>Chur</publisher-loc>: <publisher-name>Harwood Academic</publisher-name>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Schwarzer, R.</surname></name>, & <name name-style="western"><surname>Fuchs, R.</surname></name> (<year>1996</year>). <article-title>Self-efficacy and health behaviours</article-title>. In <name name-style="western"><surname>M. Conner</surname></name> & <name name-style="western"><surname>P. Norman</surname></name> (Eds.), <source>Predicting health behaviour: Research and practice with social cognition models</source> (pp. <fpage>163</fpage>–<lpage>196</lpage>). <publisher-loc>Buckingham</publisher-loc>: <publisher-name>Open University Press</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Seydel, E.</surname></name>, <name name-style="western"><surname>Taal, E.</surname></name>, & <name name-style="western"><surname>Wiegman, O.</surname></name> (<year>1990</year>). <article-title>Risk-appraisal, outcome and self-efficacy expectancies: Cognitive factors in preventive behavior related to cancer</article-title>. <source>Psychology and Health</source>, <volume>4</volume>, <fpage>99</fpage>–<lpage>109</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Stokols, D.</surname></name> (<year>1992</year>). <article-title>Establishing and maintaining healthy environments</article-title>. <source>American Psychologist</source>, <volume>47</volume>, <fpage>6</fpage>–<lpage>22</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Stone, G. C.</surname></name> (<year>1990</year>). <article-title>An international review of the emergence and development of Health Psychology</article-title>. <source>Psychology and Health</source>, <volume>4</volume>, <fpage>3</fpage>–<lpage>17</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Stroebe, W.</surname></name>, & <name name-style="western"><surname>Stroebe, M. S.</surname></name> (<year>1995</year>). <source>Social psychology and health</source>. <publisher-loc>Buckingham</publisher-loc>: <publisher-name>Open University Press</publisher-name>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Taylor, D. G.</surname></name>, <name name-style="western"><surname>Aday, L. A.</surname></name>, & <name name-style="western"><surname>Andersen, R.</surname></name> (<year>1975</year>). <article-title>A social indicator of access to medical care</article-title>. <source>Journal of Health and Social Behavior</source>, <volume>16</volume>, <fpage>39</fpage>–<lpage>49</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Taylore, P. R.</surname></name>, <name name-style="western"><surname>Dawsey, S.</surname></name>, & <name name-style="western"><surname>Albanes, D.</surname></name> (<year>1990</year>). <article-title>Cancer prevention trials in China and Finland</article-title>. <source>Annals of Epidemiology</source>, <volume>1</volume>, <fpage>195</fpage>–<lpage>203</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Van Assema, P.</surname></name>, <name name-style="western"><surname>Pieterse, M.</surname></name>, <name name-style="western"><surname>Kok, G.</surname></name>, <name name-style="western"><surname>Eriksen, M.</surname></name>, & <name name-style="western"><surname>de Vries, H.</surname></name> (<year>1993</year>). <article-title>The determinants of four cancer-related risk behaviours</article-title>. <source>Health Education Research</source>, <volume>8</volume>, <fpage>461</fpage>–<lpage>472</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Van Assema, P.</surname></name>, <name name-style="western"><surname>Steenbakkers, M.</surname></name>, <name name-style="western"><surname>Kok, G.</surname></name>, <name name-style="western"><surname>Eriksen, M.</surname></name>, & <name name-style="western"><surname>de Vries, H.</surname></name> (<year>1994</year>). <article-title>Results of the Dutch community project ‘Healthy Bergeyk’</article-title>. <source>Preventive Medicine</source>, <volume>23</volume>, <fpage>394</fpage>–<lpage>401</lpage>.</citation></ref><ref><citation citation-type="journal" xlink:type="simple"><name name-style="western"><surname>Velicer, W. F.</surname></name>, <name name-style="western"><surname>Diclemente, C. C.</surname></name>, <name name-style="western"><surname>Rossi, J. S.</surname></name>, & <name name-style="western"><surname>Prochaska, J. O.</surname></name> (<year>1990</year>). <article-title>Relapse situations and self-efficacy: An integrative model</article-title>. <source>Addictive Behavior</source>, <volume>15</volume>, <fpage>271</fpage>–<lpage>283</lpage>.</citation></ref><ref><citation citation-type="book" xlink:type="simple"><name name-style="western"><surname>Winett, R. A.</surname></name>, <name name-style="western"><surname>King, A. C.</surname></name>, & <name name-style="western"><surname>Altman, D. G.</surname></name> (<year>1989</year>). <source>Health psychology and public health. An integrative approach</source>. <publisher-loc>New York</publisher-loc>: <publisher-name>Pergamon</publisher-name>.</citation></ref></ref-list></back></article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Health Behavior: An Interlocking Personal and Social Task</title></titleInfo><titleInfo type="alternative" lang="en" contentType="CDATA"><title>Health Behavior: An Interlocking Personal and Social Task</title></titleInfo><name type="personal"><namePart type="given">Elisabeth</namePart><namePart type="family">Kals</namePart></name><name type="personal"><namePart type="given">Leo</namePart><namePart type="family">Montada</namePart><affiliation>University of Trier, Germany</affiliation></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="research-article"></genre><originInfo><publisher>SAGE Publications</publisher><place><placeTerm type="text">London, Thousand Oaks and New Delhi</placeTerm></place><dateIssued encoding="w3cdtf">2001-03</dateIssued><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><physicalDescription><internetMediaType>text/html</internetMediaType></physicalDescription><abstract lang="en">Traditional health behavior models comprise only person-centered motivational components such as personal vulnerability perceptions and specific internal control beliefs. However, such factors as social responsibility, perceived prevalence rates of illnesses, attribution of control to societal agencies, and the motivation to engage oneself for public health concerns are not unrelated to individual health protection. Therefore, an alternative model is proposed, which combines traditional self-centered and social variables. This alternative model was empirically confirmed in a questionnaire study exemplified by cancer preventive activities (N = 558), which embraced personal cancer prevention as well as efforts to reduce the cancer prevalence within the general population. The readiness to engage in personal cancer preventive measures appeared to be closely related to the readiness to engage oneself for public health programs. The motivational predictors of both categories of activities had significant overlap. Implications for model building and intervention strategies to promote individual as well as public health behavior are discussed.</abstract><subject><genre>keywords</genre><topic>cancer preventive behaviors</topic><topic>health behavior models</topic><topic>individual health</topic><topic>public health</topic></subject><relatedItem type="host"><titleInfo><title>Journal of Health Psychology</title></titleInfo><genre type="journal">journal</genre><identifier type="ISSN">1359-1053</identifier><identifier type="eISSN">1461-7277</identifier><identifier type="PublisherID">HPQ</identifier><identifier type="PublisherID-hwp">sphpq</identifier><part><date>2001</date><detail type="volume"><caption>vol.</caption><number>6</number></detail><detail type="issue"><caption>no.</caption><number>2</number></detail><extent unit="pages"><start>131</start><end>148</end></extent></part></relatedItem><identifier type="istex">5A13DDF99AF83EC4DF30F17662320A638B39BEDC</identifier><identifier type="DOI">10.1177/135910530100600204</identifier><identifier type="ArticleID">10.1177_135910530100600204</identifier><recordInfo><recordContentSource>SAGE</recordContentSource></recordInfo></mods></metadata><serie></serie></istex></record>Pour manipuler ce document sous Unix (Dilib)
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