Abstract Overview The Client Language Assessment – Proximal/Distal (CLA-PD) is a language rating system for measuring client decision-making in interventions that target a specified behavior change ...(e.g., alcohol or other drug use). In the CLA-PD, there are five dimensions of change language (Reason, Ability, Commitment, Taking Steps, Other) adapted from the client portion of the Motivational Interviewing Skill Code (MISC). For the CLA-PD, language codes are sub-divided to discriminate statements regarding the primary, or target behavior change ( distal change ) from the intermediate coping activities ( proximal change ) that are prescribed to facilitate that target behavior change. The goal of the CLA-PD is to allow for higher specificity than existing client language measures, when process studies consider interventions that are multi-session and skill-based (e.g., cognitive behavioral therapy). Method Three raters received 40 hours of training on the use of the CLA-PD. The data were a sample of therapy session audio-files from a completed clinical trial ( N = 126), which enabled examination of client language across four sessions (i.e., first three and final attended) of three evidence-based alcohol interventions (cognitive behavioral therapy, twelve-step facilitation therapy, motivational enhancement therapy). Results Inter-rater reliability results for summary scores showed “excellent” reliability for the measure. Specifically, two-way mixed intraclass coefficients ranged from .83 to .95. Internal consistency reliability showed alphas across sessions that ranged from “fair” to “good” (α = .74–.84). In convergent and discriminant validity analyses using data independently measured with MISC-based ratings, the pattern of results was as would be expected. Specifically, convergent correlations, by valence (i.e., change and sustain talk), between CLA-PD Distal and MISC-based language scores were moderate ( r = .46–.55, p < .001) while discriminant correlations by valence for CLA-PD Proximal and MISC-based language scores were small ( r = .22–.24, p < .05). Finally, proportion Change Talk Proximal predicted subsequent session coping behaviors (i.e., processes of change) as well as 3-month Alcoholics Anonymous involvement and attendance ( p s < .05–.005), but not 3-month alcohol abstinence self-efficacy. Further, analyses of criterion predictive validity showed that proportion Change Talk Distal predicted 3- and 12-month drinking frequency and quantity measures ( p s < .05–.005). Conclusions When behavior change treatments are multi-session and/or skill-based, the present analyses suggest the CLA-PD is a promising, psychometrically sound observational rating measure of client verbalized decision-making.
Abstract Study Objective To examine a computer-assisted, counselor-guided motivational intervention (CAMI) aimed at reducing the risk of unprotected sexual intercourse. Design, Setting, Participants, ...Interventions, and Main Outcome Measures We conducted a 9-month, longitudinal randomized controlled trial with a multisite recruitment strategy including clinic, university, and social referrals, and compared the CAMI with didactic educational counseling in 572 female adolescents with a mean age of 17 years (SD = 2.2 years; range = 13-21 years; 59% African American) who were at risk for pregnancy and sexually transmitted diseases. The primary outcome was the acceptability of the CAMI according to self-reported rating scales. The secondary outcome was the reduction of pregnancy and sexually transmitted disease risk using a 9-month, self-report timeline follow-back calendar of unprotected sex. Results The CAMI was rated easy to use. Compared with the didactic educational counseling, there was a significant effect of the intervention which suggested that the CAMI helped reduce unprotected sex among participants who completed the study. However, because of the high attrition rate, the intent to treat analysis did not demonstrate a significant effect of the CAMI on reducing the rate of unprotected sex. Conclusion Among those who completed the intervention, the CAMI reduced unprotected sex among an at-risk, predominantly minority sample of female adolescents. Modification of the CAMI to address methodological issues that contributed to a high drop-out rate are needed to make the intervention more acceptable and feasible for use among sexually active predominantly minority, at-risk, female adolescents.
Individuals with schizophrenia and severe mental illness smoke cigarettes at rates that well exceed the general population. Little is known about the correlates and sequelae of increased smoking ...severity on persons with severe mental illness. A total of 304 smokers from six community mental health centers were assessed for smoking history, psychiatric symptoms, co-occurring disorders, subjective quality of life, and expired carbon monoxide (CO). Statistical analyses identified correlates of smoking severity, as assessed by number of cigarettes smoked per week. The average number of cigarettes smoked per week was 136±83. Increased smoking was associated with higher levels of expired CO and being Caucasian, and with a greater likelihood of a current diagnosis of hypertension and oral gum disease. Greater smoking severity was also associated with greater perceived stress, poorer overall subjective quality of life, and lower satisfaction with finances, health, leisure activities, and social relationships. This study confirms high rates of heavy smoking among persons with severe mental illness. The association of increased quantity of cigarettes smoked with being Caucasian is consistent with previous reports in mentally ill and non-mentally ill populations. The linkage of heavy smoking with poorer quality of life and co-occurring medical disorders suggests the importance of smoking reduction and cessation strategies to reduce smoking and decrease patients' total pack years of smoking. (Am J Addict 2007;16:101-110)
Abstract Study Objective To determine associations between religiosity and female adolescents' sexual and contraceptive behaviors. Design We conducted a secondary analysis on data from a randomized ...controlled trial comparing interventions designed to prevent pregnancy and sexually transmitted diseases (STDs). Multivariable modeling assessed the association between a religiosity index consisting of items related to religious behaviors and impact of religious beliefs on decisions and sexual outcomes. Participants 572 female adolescents aged 13 to 21, recruited via a hospital-based adolescent clinic and community-wide advertisements. Main Outcome Measures Sexual experience, pregnancy, STDs, number of lifetime partners, frequency of sexual activity, previous contraceptive use, and planned contraceptive use. Results Mean participant age was 17.4 ± 2.2 years and 68% had been sexually active. Most (74.1%) had a religious affiliation and over half (52.8%) reported that their religious beliefs impact their decision to have sex at least “somewhat.” Multivariate analyses showed that, compared with those with low religiosity, those with high religiosity were less likely to have had sexual intercourse (OR = 0.23, 95% CI = 0.14, 0.39). Among sexually active participants, those with high religiosity were less likely to have been pregnant (OR = 0.46, 95% CI = 0.22, 0.97), to have had an STD (OR = 0.42, 95% CI = 0.22, 0.81), or to have had multiple (≥4) lifetime partners (OR = 0.38, 95% CI = 0.21, 0.68) compared to those with low religiosity. Levels of religiosity were not significantly associated with frequency of intercourse, contraception use at last intercourse, or planned contraceptive use. Conclusion In this cohort, religiosity appeared to be a protective factor rather than a risk factor with regard to sexual behavior and was not associated with contraception use.
When disasters and other broad-scale public health emergencies occur in the United States, they often reveal flaws in the pre-event preparedness of those individuals and agencies charged with ...responsibility for emergency response and recovery activities. A significant contributor to this problem is the unwillingness of some public health workers to participate in the requisite planning, training, and response activities to ensure quality preparedness. The thesis of this article is that there are numerous, empirically supported models of behavior change that hold potential for motivating role-appropriate behavior in public health professionals. The models that are highlighted here for consideration and prospective adaptation to the public health emergency preparedness system (PHEPS) are the Transtheoretical Model of Intentional Behavior Change (TTM) and Motivational Interviewing (MI). Core concepts in TTM and MI are described, and specific examples are offered to illustrate the relevance of the frameworks for understanding and ameliorating PHEPS-based workforce problems. Finally, the requisite steps are described to ensure the readiness of organizations to support the implementation of the ideas proposed.
The Journey to the End of Smoking DiClemente, Carlo C., PhD; Delahanty, Janine C., PhD; Fiedler, Robert M., JD
American journal of preventive medicine,
2010, Letnik:
38, Številka:
3
Journal Article
Recenzirano
Background Smoking cessation is best represented as a journey and not a single event. This article chronicles the path of change for the population of smokers in Maryland. Purpose This study compared ...the population of ever-smokers in Maryland over three time points (2000, 2002, and 2006) examining how the population of ever-smokers shifted over time. Methods Analysis of process of change and social influence variables conducted using data from the Maryland Adult Tobacco Surveys (MATS) administered in 2000, 2002, and 2006. Results Analyses indicated an increasing percentage of ever-smokers (100 lifetime cigarettes) who have successfully quit and maintained cessation for more than 5 years. By 2006, the population of current adult smokers (aged ≥18 years) was smaller but seemed less interested in and able to quit. More 2006 smokers were in earlier stages of change for cessation and not interested in or planning to quit in the near term. Many had unsuccessfully tried to quit, with a substantial minority finding that cessation products found effective in research were not effective for them. Despite past failures, the vast majority expects to quit, has considered quitting, and believes that they will likely succeed eventually. Larger percentages of 2006 smokers are being advised to quit by medical professionals, are accessing empirically supported quit-smoking aids, and have multiple quit attempts. They also smoked every day for more years, smoked as many cigarettes per day, and had environments as filled with smoking as their 2000 and 2002 counterparts. Conclusions Increasing successful cessation would require not only appropriate use of effective products but also successful negotiation of important tasks in the cessation journey. Health literacy and a consumer perspective can help to bridge gaps in the dissemination and effective use of empirically supported treatments.
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