Conclusions: It is suggested that current skills-based communication programmes inadequately prepare future doctors for the growing task of facilitating weight loss. Findings are discussed in relation to the social cognitive basis of behaviour change and communication training needs for health professionals. Clinicians are increasingly confronted with illness associated with health behaviors (e.g. diet and exercise). Helping patients to adopt healthier behaviors therefore is an important component of medical management and disease prevention. Communication training is a core feature of medical and nursing training. However, recent research reveals that communication training inadequately equips new health professionals for this growing clinical challenge and practitioners remain unconfident about how to discuss behavior change usefully with patients. The study aims to explore how doctors and nurses manage behavior change and identify what barriers operate to prevent effective behavior change management. Semi-structured interviews were conducted with a purposive sample of 14 medical and 14 nursing practitioners at a range of stages during their training (undergraduate and postgraduate). Interviews were transcribed verbatim and analysed thematically using principles of constant comparison to categorise emergent and recurring themes within and between transcripts. Thematic categories arising in initial interviews were explored subsequently and disconfirmatory evidence was sought until thematic saturation arose. Findings reveal that trainees and practitioners consider behavior change to be a fundamental part of medical practice, yet one they are not formally trained in. Participants had developed a range of strategies to encourage behavior change through experiential learning, but were unconvinced of their efficacy. Further barriers to implementing behavior change included the uncertainty over whose responsibility it is, the influence of patient authority within consultations, and desire to protect the doctor-patient relationship. Evidently current communication training is inadequate to equip health practitioners to motivate behavior change. Barriers arise from clinician-patient interactions as well as the context of health care services and have important implications for medical education. Background: Lifestyle-related diseases are increasing worldwide, and it is important to address lifestyle issues in primary health care. In order to facilitate this, a tool for lifestyle intervention was developed and implemented in primary health care in Sweden. Implementing new methods, guidelines or tools into routine care, however, is a slow and unpredictable process, and the factors that play a role in the adoption process are not yet fully understood. Objective: To identify key factors influencing the adoption of a lifestyle intervention tool being introduced in primary health care (PHC) in Sweden. Methods: A computer-based test for lifestyle intervention was implemented at six PHC units in Sweden. Two different implementation strategies, implicit or explicit, were used. Contextual factors and organizational climate were measured prior to implementation. Outcome in terms of staff referral rates to the lifestyle test was measured after six months of operation. A qualitative study where staff at the units participated in focus group interviews was performed. Interviews were analyzed using the method qualitative content analysis. Results: A positive organizational climate combined with an explicit implementation strategy did predict a positive implementation outcome when a lifestyle intervention tool was introduced in PHC. Adoption was positively influenced by positive expectations among staff, perceptions of the tool being compatible with existing routines and perceived advantages of the new tool. Organizational changes and staff shortage coinciding with implementation seemed to be obstacles for the adoption process. Conclusion: Organizational climate and staff expectations should be assessed in advance when a new tool is to be introduced in PHC. Explicit implementation strategy is preferable, and coincidence with major organizational changes should be avoided. The cervical cancer vaccine provides a safe and effective means of reducing the incidence and mortality rate from this disease. Given that uptake is less than optimal, despite the availability of no cost vaccination, there is a need to identify psychosocial factors associated with this preventive behaviour. Applying the Common Sense Model, we first identified the illness representations associated with the acceptance and non-acceptance of the cervical cancer vaccine among young Australian women aged 18-26. We then assessed whether information regarding the link between the viral causes of cervical cancer and the effect of the preventive vaccine can function as a facilitator of future vaccination behaviours. Participants (N=132) initially completed measures of vaccination status, intentions to be vaccinated, illness representations, perceived risk, perceived vaccine effectiveness and cervical cancer knowledge. Then we experimentally manipulated illness coherence relating to links between the Human Papillomavirus, cervical cancer and the vaccine, by randomly assigning participants to receive either a brief or detailed information condition, to ascertain the effect of this manipulation on vaccination intentions for non-vaccinated women. Higher levels of illness coherence, identity, and perceived vaccine effectiveness, having had a Pap smear in the past, and lower beliefs in the treatment cure/ controllability of cervical cancer were associated with vaccination uptake. Higher intentions to be vaccinated among non-vaccinated women were associated with higher levels of illness coherence and perceived risk for cervical cancer. Post-manipulation measures indicated that the detailed condition of the experimental manipulation resulted in significant increases in illness coherence. The identification of illness cognitions and the role of illness coherence influencing the acceptance of this vaccine adds to the paucity of information available on this underrepresented sample and provides direction for the design of future intervention strategies aimed at modifying illness cognitions to increase vaccine uptake. Although levels of consumption of dietary fibre (DF) are high in Australia, recent evidence indicates the need for increased intakes of the lesser known fibre form, resistant starch (RS), which has been implicated in the reduction of risk of serious diet-related health conditions. The purpose of the present study was to identify the kinds of health messages and the kinds of foods likely to be most acceptable to consumers. Data were obtained by means of a nationwide postal survey (N=849). Ratings of the importance of various RS health and functional claims and receptiveness to different foods as RS delivery vehicles were analysed according to the respondents' level of fibre engagement, as classified under the Precaution Adoption Process Model (PAPM) of Health Behaviour (Weinstein & Sandman, 1992) . Significant gender differences were found, with women found to be more fibre engaged and also more receptive than men to RS and its potential benefits. The pattern of association between fibre engagement and self-perceived risk of serious health conditions was consistent with previous observations of changes in risk perception at different PAPM stages. Participants' ratings revealed a general preference for healthy staples over indulgences as foods for the delivery of RS, with the margin in preference increasing markedly with increased dietary fibre engagement. This application of the PAPM illustrates its potential usefulness as a segmentation tool for the exploitation of community engagement with a relatively familiar health concept or behaviour in the promotion of a novel, related concept or behaviour. Unhealthy diet and inactive lifestyle reflect prevalent, correlated behaviors that heighten chronic disease risk. Intervening on more than one risk behavior simultaneously could be efficient, but the optimal goal framing remains unknown. MBC was designed to test which combination of two behaviors (one dietary, one activity) and two goal frames (increase healthy, decrease unhealthy) maximizes healthy behavior change across all four risk behaviors. N = 200 participants with all four risk behaviors [high saturated fat intake (Fat), low fruit and vegetable intake (FV), low physical activity (PA), high sedentary leisure screen time (Sed)] were randomized to one of four goal prescriptions: ↑FV↑PA; ↓Fat↑PA; ↑FV↓Sed; ↓Fat↓Sed. They used handheld technology and coaching to change one diet and one activity behavior simultaneously, while change in untargeted (collateral) behavior was also measured. The Familiarity hypothesis predicted best outcome from usual dieting behaviors (↓Fat↑PA). The Optimal Substitution hypothesis, based on behavioral economic theory, predicted best outcome from substituting healthful for unhealthful behaviors (↑FV↓SED). The Low Inhibitory Demand hypothesis, based on Baumeister's self-regulatory strength model, predicted best outcome from minimizing demand on self-control resources (↑FV↑PA). To scale all behaviors to a common metric, the primary outcome was healthy lifestyle change expressed as a z score reflecting improvement relative to the sample baseline for each behavior and averaged to yield a composite score. As predicted by behavioral economic theory, mixed linear models showed that ↑FV↓Sed maximized healthy lifestyle change compared to alternative interventions [t(345) = 3.3, p=.001], producing a sustained 1 s.d. improvement in saturated fat intake as well as in both targeted behaviors. The untargeted decrease in saturated fat intake complemented the targeted reduction in recreational screen time (r=.29, p=.04). Paralleling observed behavior changes, ↑FV↓Sed improved self-efficacy for changing FV (p<.05), Sed (p<.01), and, marginally, Fat (p=.09). Conversely, the traditional dieting regimen (↓Fat↑PA) produced less healthy lifestyle change than alternative prescriptions [t (345) = − 2.09, p=.04], yielding sustained 1 s.d. improvement only in saturated fat. Relatedly, ↓Fat↑PA failed to increase self-efficacy for targeted behaviors and decreased efficacy for FV and Sed (both p<.05). Increasing healthy low-rate eating behavior and decreasing unhealthy high-rate physical activity produced greater and unexpectedly sustained healthy lifestyle change than alternative prescriptions. Background: Research has demonstrated a strong link between the built environment, health outcomes & inequalities. Environmental elements can negatively impact lifestyle choices. The 'My Health Matters' project was designed to build partnership with members of the health economy to meet the challenge of increasing physical activity & healthy eating in three deprived areas of Stoke-on-Trent, UK. The project aims to develop & evaluate an intervention to reduce health inequalities by increasing physical activity & healthier eating as defined by the community. Results from phase I of the project will be reported including baseline mapping of the built environment using Geographical Information Systems (GIS) & a community survey. Methods: Environmental factors including convenience & proximity of physical activity spaces, greenspace & leisure facilities, neighbourhood connectivity/walkability, land use mix & population density, traffic, safety & crime, food outlets & restaurants, were measured using GIS mapping (calculated around each residential address). A community postal survey of randomly selected addresses (n=343) across the three areas was undertaken. The Neighbourhood Walkability Scale was used to assess residents' perceptions of their neighbourhoods. Perceived health (SF12), social capital, fruit & vegetable intake & levels of physical activity (International Physical Activity Questionnaire) were also measured. Results: GIS mapping illustrated a lack of local access to fresh food outlets but easy access to fast food outlets. 76-96% of residents were within 300 m walking distance of green space, but these spaces were of poor quality e.g. not functional. Physical activity facilities were within walking distance for some neighbourhoods but not for others. The community survey demonstrated that self-reported health was lower than average compared to England. Negative perceived characteristics of the neighbourhood included; aesthetics (e.g. lack of trees), The worldwide increasing prevalence of overweight and obesity is a cause for concern as the overweight-related morbidity, mortality and health care costs concurrently increase. The objective of our meta-analytic review is to critically examine the effectiveness of workplace physical activity and dietary behavior interventions on weight outcomes. Six databases were searched for English-written studies published between 1980 and November 2009. Two authors independently selected 43 studies which met inclusion criteria. Data could be extracted from 22 studies for meta-analysis. Methodological quality was assessed using a predefined checklist. The GRADE approach was used to determine the level of evidence for each pooled outcome measure. Results show there is moderate quality of evidence that workplace physical activity Introduction: Risk perceptions are a key component in many health behavior theories. However, such theories often do not differentiate between cognitive and affective risk perceptions (or the way in which they interact), and it is generally assumed that any increased risk perceptions of either type are associated with preventive behaviors. The present study aims to differentiate between cognitive (perceived risk) and affective (worry) risk perceptions and explore their direct and interactive relationships with two health-related behaviors. Methods: Combined data from the 2003 and 2007 Health Information National Trends Surveys were analyzed using logistic regression with perceived cancer risk, cancer worry, and their interaction independently predicting two dichotomous variables: a) fulfilling the 5-a-day fruit /vegetable consumption guidelines (n=7966) and b) engaging in any exercise in the past month (n=8069). Results: Neither perceived risk nor worry was significantly related to fruit/ vegetable consumption. However, their interaction was significant such that those who had both the highest perceived risk and worry were the least likely to fulfill the guidelines (OR: .77, p<.05). With respect to exercise, worry (OR=1.77, p<.01), but not perceived risk, was associated with exercise. More importantly, the interaction was again significant, such that those high in both perceived risk and worry were the least likely to report exercise (OR=.77, p=.01). Conclusion: Counter-intuitively, reporting both high perceived risk and high worry is associated with less exercise and produce consumption. This research may have important implications for interventions, which often do not differentiate between targeting cognitive and affective risk perceptions and may even strive to heighten both types of risk perceptions in efforts to prompt behavior change. In addition, this research may inform communication of risk information; optimal changes in health behaviors may be achieved when cognitive risk perceptions are lower, and affective risk perceptions are higher. Behavioral interventions have not yet been firmly established as being efficacious for reducing nonfatal or fatal cancer or coronary disease recurrence. Three separate randomized clinical trials using group based cognitive behavior therapy (CBT) however, have recently observed positive changes in disease endpoints in patients who had experienced breast cancer or adverse coronary disease events. Group CBT included 20-26 two hour sessions over one year. The trials all used strategies to reduce stress, improve mood, alter health behaviors and maintain adherence to medical treatment. These three studies all included women, used intentto-treat analyses and adjusted for relevant covariates. Andersen and colleagues randomized 227 women who had been surgically treated for regional breast cancer and found after a median of 11 years follow-up, a reduced risk of breast cancer recurrence (HR=.55, p=.034), breast cancer mortality (HR=.44; p=.016) and all-cause-mortality (HR=.51; p=.028). Orth-Gomér and collaborators randomized 237 women with acute coronary syndrome and found after a median of 7 years, a reduced risk of mortality (HR=.31; p=.009). Burell and colleagues randomized 362 women and men with acute coronary syndrome and found after a median of 8 years, a reduced risk of recurrent myocardial infarction (HR=.55; p=.007). Discussion will focus upon the implications of these results and the need for conceptual replication in large multicenter trials. A randomized clinical trial was designed to test the hypothesis that cancer patients coping with a cancer diagnosis but receiving a psychological intervention would have reduced risk for disease progression (1994) . Patients (N= 227) surgically treated for regional breast cancer participated. Before beginning adjuvant cancer therapies, patients were assessed with psychological and behavioral measures, had a health evaluation, and a 60 mL blood sample was drawn. Patients were randomized to Psychological Intervention or Assessment only arms. The intervention was psychologist led, conducted in small groups, and included strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment. Earlier papers (2004, 2007) showed that, compared to the Assessment arm, the Intervention arm improved across all of the latter secondary outcomes. T cell blastogenesis was also enhanced. An interim paper (2007) clarified treatment mechanisms in the Intervention arm. First, patients were satisfied with the intervention, but it was group cohesion that related to better outcomes. Second, offering patients a stress conceptualization (Selye) and teaching them multiple coping strategies related to better health. Third, three relationships between treatment utilization and outcomes are noted: 1) Relaxation training was associated with both distress reduction and symptom lowering. 2) Patients' use of assertive communication with health care providers was associated with better health outcomes. 3) Intervention strategy use was also associated with fewer signs/symptoms and cancer treatment toxicities. After a median of 11 years follow-up, recurrence occurred for 62 of 212 (29%) women and death for 54 of 227 (24%). Intent to treat hazard analyses showed, as predicted, Intervention arm patients had a Psychosocial factors are independently associated with increased risk of cardiovascular disease (CVD) morbidity and mortality, but the outcome effect of intervention for these factors on these endpoints has so far been uncertain. 362 men and women, aged 75 or less, discharged from hospital after a coronary heart disease (CHD) event within the past 12 months, were randomized to cognitive behavioral therapy (CBT) focused on stress management during one year (n=192), or to usual care (n=170). Median attendance rate to the intervention program was 85%. Risk factor and quality of life data were measured at baseline and after 6, 12, 18, 24 months. Hospital admission data and survival data were obtained from national registers. During 8 years of follow-up the intervention group had 41% less fatal and non-fatal first recurrent CVD rate, and 45% less recurrent acute myocardial infarction (AMI) rate than the reference group. The study was powered to examine the combined endpoint of fatal and nonfatal recurrent coronary event rate and found a positive significant difference between groups (HR 0.59, 95% CI 0.42-0.83, p=0.003). Subsequent analyses found a significantly reduced nonfatal recurrent acute myocardial infarction rate (HR 0.55, 95% CI 0.36-0.85, p=0.007), but no significant difference in allcause-mortality (HR 0.72, 95% CI 0.40-1.30, p=0.28). During the first 2 years of follow-up there were no significant group differences in quality of life, but the intervention group had a significantly stronger optimism about the future. The CBT stress intervention decreased the risk of recurrent CVD and recurrent AMI. A dose-response relationship between therapy attendance rate and risk was observed. This has implications for targeting and strengthening of secondary preventive programs in CHD patients. Psychosocial stress may accelerate atherosclerosis progression and worsen prognosis in women with coronary heart disease (CHD). In Stockholm women, we found marital stress to be a stronger predictor than job stress, but behavioral interventions to reduce such psychosocial stressors in women had not been identified. Based on previous findings, we implemented a cognitive behavior therapy (CBT) program for women and investigated its ability to improve survival in women coronary patients. Consecutive women patients, aged 75 years or younger, hospitalized for acute myocardial infarction, coronary artery bypass grafting, or percutaneous coronary intervention were randomized to group-based CBT or to usual care. Intervention groups of 4 to 8 women met for a total of 20 sessions that were spread over a year. We provided education about risk factors, relaxation training techniques, methods for self-monitoring and cognitive restructuring, with an emphasis on coping with stress exposure from family and work, self-care and compliance with medical advice. From randomization until end of follow-up (mean duration, 7.1 years), 25 women (20%) in the usual care and 8 women (7%) in the CBT condition died, yielding an almost three fold protective effect of the intervention (HR = 0.33; 95% CI, 0.15 to 0.74; P= 0.007). Controlling for relevant demographic and medical prognostic factors in multivariate models, confirmed the unadjusted results. CBT improved survival independently of medication with statins. Additionally, an interactive effect of statins with behavioral intervention was suggested. In women who received both treatments, only one woman died, (1.5 %) as compared to 15 out of 70 (22 %) women who received none of the treatments(p=0.007). We concluded that a group-based CBT program for women with coronary disease may prolong their lives. This effect may be independent of clinical prognostic factors. To evaluate correlates of sexual risk behaviors associated with HIV/AIDS infection among adolescents participating in 2005 Colorado Youth Risk Behavioral Survey, since previous studies have produced mixed findings. The State mandates abstinenceonly program across all public schools. Multinomial logistic regression was used to evaluate relationships among dependent variables and independent variables. We found no significant effect of having received in-school HIV/AIDS education on all outcome measures. Compared with females, males were more likely to initiate sex at a relatively younger age, report unprotected sex with multiple partners, and to drink alcohol before sexual intercourse. Efforts to control the HIV/AIDS epidemic among adolescents may need to focus on targeted interventions aimed at addressing gender-and racial/ethnic-specific risk exposures among this population group, including risk behaviors linked with lifetime sexual abuse. The need to re-examine the role of in-school HIV prevention programs to build adequate competencies among students, parents and community leaders is recommended. Irritable bowel syndrome is a highly prevalent functional gastrointestinal disorder (FGD) in western countries. Often, the disorder occurs in comorbidity with additional functional symptoms like chronic pelvic pain, fatigue or psychiatric disorders like anxiety and depression. Females suffer at least twice as often from FGD than men. Irritable bowel syndrome (IBS) is the most prevalent FGD and research shows a strong association between chronic stress and trauma in these patients. Due to the increasing knowledge on psychobiological mechanisms regulating adaptive processes to stress, research focuses on functional syndromes, which seem to be associated with maladaption of biological stress regulatory systems. This symposium refers to the different biological factors contributing to the etiology and maintenance of IBS. Besides prevalence rates on the high number of females with IBS, naturally occurring variation of female life conditions like menstrual cycle will be discussed with respect to the occurrence of IBS symptoms. Additionally, data on different biological systems like the HPA axis, pain perception, serotonergic pathways will be presented with reference to IBS and possible treatment approaches. Background & Aims: Stress has been considered as an important etiological factor in IBS. The physiological mechanisms between stress and gut disturbances, however, are incompletely understood. The current studies aimed to investigate the association between different stressors and functional gastrointestinal (FGI) complaints in female IBS patients and healthy controls. Methods: In an Internet-based survey conducted in a large number of students, the prevalence of FGI symptoms and perceived stress (chronic stress, coping strategies, stress reactivity) were measured. In a second trial basal and stimulated HPA axis activity was assessed in 57 women with IBS and 20 matched controls. IBS diagnosis was made according the Rome III criteria and psychiatric comorbidity was assessed using a clinical interview. Salivary morning cortisol and diurnal profile were obtained and a standardized psychosocial stress test (TSST) was applied. Cortisol and ACTH were measured before and within one hour following the stressor. Results: Two third of the online study sample (n=668) reported FGI complaints which were significantly predicted by female gender, high levels of chronic stress, dispositional stress reactivity, and use of maladaptive coping. The biological results indicated that female IBS patients have intact circadian rhythmicity of the HPA axis. However, women with diarrhea predominant IBS (IBS-D) exhibited substantially heightened cortisol at awakening and nearly no morning increase. In response to the laboratory stressor significantly blunted cortisol (p< 0.05) and slightly attenuated ACTH secretion was observed in patients compared to controls. In the recovery period ACTH levels were significantly lower in patients than in healthy subjects (p<0.05). Women with IBS perceived higher general and situation specific stress susceptibility. Conclusions: FGI syndromes, including IBS, seem to be common in apparently healthy subjects whereas female gender is a predictor. Several naturally occurring stressors are associated with the presence of FGI symptoms. In both studies psychological stress measures were overall increased in the IBS group and propose heightened stress susceptibility. Biological data indicate an association between basal HPA axis activity and predominant bowel habit. Furthermore, the downregulated HPA axis reactivity in women with IBS following the laboratory stressor (TSST) suggests an attenuated sensitivity of the endocrine system. The strong relationship between stress experience and the occurrence of IBS indicates that stress-reducing interventions may be beneficial in such individuals. Inst. of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, Essen, Germany and 2 Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.