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Fried TR, Redding CA, Robbins ML, O'Leary JR, Iannone L. Agreement between older persons and their surrogate decision-makers regarding participation in advance care planning. J Am Geriatr Soc 2011; 59:1105-9. [PMID: 21649619 DOI: 10.1111/j.1532-5415.2011.03412.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine agreement between older persons and their surrogates regarding participation in advance care planning (ACP). DESIGN Observational cohort study. SETTING Community. PARTICIPANTS Persons aged 65 and older and the individual they identified as most likely to make treatment decisions on their behalf. MEASUREMENTS Older persons were asked about participation in four activities: completion of living will, completion of healthcare proxy, communication regarding views about life-sustaining treatment, and communication regarding views about quality versus quantity of life. Surrogates were asked whether they believed the older person had completed these activities. RESULTS Of 216 pairs, 81% agreed about whether a living will had been completed (κ=0.61, 95% confidence interval (CI) 0.51-0.72). Only 68% of pairs agreed about whether a healthcare proxy had been completed (κ=0.39, 95% CI 0.29-0.50), 64% agreed about whether they had communicated regarding life-sustaining treatment (κ=0.22, 95% CI 0.09-0.35), and 62% agreed about whether they had communicated regarding quality versus quantity of life (κ=0.23, 95% CI 0.11-0.35). CONCLUSION Although agreement between older persons and their surrogates regarding living will completion was good, agreement about participation in other aspects of ACP was fair to poor. Additional study is necessary to determine who is providing the most accurate report of objective ACP components and whether agreement regarding participation in ACP is associated with greater shared understanding of patient preferences.
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Noar SM, Webb EM, Van Stee SK, Redding CA, Feist-Price S, Crosby R, Troutman A. Using computer technology for HIV prevention among African-Americans: development of a tailored information program for safer sex (TIPSS). HEALTH EDUCATION RESEARCH 2011; 26:393-406. [PMID: 21257676 PMCID: PMC3099185 DOI: 10.1093/her/cyq079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2010] [Accepted: 10/05/2010] [Indexed: 05/28/2023]
Abstract
New prevention options are urgently needed for African-Americans in the United States given the disproportionate impact of HIV/AIDS on this group. This combined with recent evidence supporting the efficacy of computer technology-based interventions in HIV prevention led our research group to pursue the development of a computer-delivered individually tailored intervention for heterosexually active African-Americans--the tailored information program for safer sex (TIPSS). In the current article, we discuss the development of the TIPSS program, including (i) the targeted population and behavior, (ii) theoretical basis for the intervention, (iii) design of the intervention, (iv) formative research, (v) technical development and testing and (vi) intervention delivery and ongoing randomized controlled trial. Given the many advantages of computer-based interventions, including low-cost delivery once developed, they offer much promise for the future of HIV prevention among African-Americans and other at-risk groups.
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Redding CA, Brown-Peterside P, Noar SM, Rossi JS, Koblin BA. One session of TTM-tailored condom use feedback: a pilot study among at-risk women in the Bronx. AIDS Care 2011; 23:10-5. [PMID: 21218272 DOI: 10.1080/09540121.2010.498858] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
There is an urgent need to implement interventions to curb the spread of sexually transmitted infections (STIs), especially HIV. Consistent condom use is an effective preventive strategy, yet especially among those at highest risk, condom use remains too low. This paper describes changes in condom use and stages of condom use over two-three months time following a single session with an interactive multimedia computer-delivered Transtheoretical Model (TTM)-tailored expert system originally designed for at-risk adolescents. The intervention provided immediate TTM-tailored feedback to diverse urban women based on their stage of condom use and other TTM variables. Previous work found this system was acceptable. These data showed that 89% of women returned for a second session two-three months later, further supporting this system's utility. After just one feedback session, 21% of women not using condoms at baseline started using condoms consistently at follow-up, with a trend for a relationship to baseline stage of condom use. These results support further randomized controlled research on the reach and efficacy of computer-based TTM-tailored and individualized condom use interventions.
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Peipert JF, Zhao Q, Meints L, Peipert BJ, Redding CA, Allsworth JE. Adherence to dual-method contraceptive use. Contraception 2011; 84:252-8. [PMID: 21843690 DOI: 10.1016/j.contraception.2011.01.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/26/2011] [Accepted: 01/28/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patient characteristics associated with adherence to dual-method contraceptive use are not known. STUDY DESIGN Project PROTECT was a 24-month-long randomized trial designed to promote the use of dual methods of contraception using an individualized computer-based intervention or enhanced standard care counseling intervention. We analyzed 463 women with follow-up data and examined sustained dual-method use (reported at 2+ interviews). RESULTS While 32% initiated dual-method contraceptive use, only 9% reported sustained use. Education increased (RR(adj)=4.42; 95% confidence interval [CI] 1.19-16.42), substance abuse decreased (adjusted relative risk [RR(adj)]=0.49; 95% CI 0.24-0.97), no contraceptive use at baseline decreased (RR(adj)=0.32; 95% CI 0.11-0.92) and contraceptive stage of change increased (RR(adj)=5.04; 95% CI 1.09-23.4) adherence to dual-method use. CONCLUSION To effectively prevent sexually transmitted diseases and unplanned pregnancies, dual-method use must be consistent and sustained. Future interventions to promote dual-method use should focus on high-risk groups and additional dual-method combinations (e.g., barrier plus intrauterine devices or implants).
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Fried TR, Redding CA, Robbins ML, Paiva A, O'Leary JR, Iannone L. Stages of change for the component behaviors of advance care planning. J Am Geriatr Soc 2011; 58:2329-36. [PMID: 21143441 DOI: 10.1111/j.1532-5415.2010.03184.x] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To develop stages-of-change measures for advance care planning (ACP), conceptualized as a group of interrelated but separate behaviors, and to use these measures to characterize older persons' engagement in and factors associated with readiness to participate in ACP. DESIGN Observational cohort study. SETTING Community. PARTICIPANTS Persons aged 65 and older recruited from physician offices and a senior center. MEASUREMENTS Stages of change for six ACP behaviors: completion of a living will and healthcare proxy, communication with loved ones regarding use of life-sustaining treatments and quantity versus quality of life, and communication with physicians about these same issues. RESULTS Readiness to participate in ACP varied widely across behaviors. Whereas between approximately 50% and 60% of participants were in the action or maintenance stage for communicating with loved ones about life-sustaining treatment and completing a living will, 40% were in the precontemplation stage for communicating with loved ones about quantity versus quality of life, and 70% and 75% were in the precontemplation stage for communicating with physicians. Participants were frequently in different stages for different behaviors. Few sociodemographic, health, or psychosocial factors were associated with stages of change for completing a living will, but a broader range of factors was associated with stages of change for communication with loved ones about quantity versus quality of life. CONCLUSION Older persons show a range of readiness to engage in different aspects of ACP. Individualized assessment and interventions targeted to stage of behavior change for each component of ACP may be an effective strategy to increase participation in ACP.
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Redding CA, Prochaska JO, Paiva A, Rossi JS, Velicer W, Blissmer BJ, Greene GW, Robbins ML, Sun X. Baseline stage, severity, and effort effects differentiate stable smokers from maintainers and relapsers. Subst Use Misuse 2011; 46:1664-74. [PMID: 21449711 PMCID: PMC3184208 DOI: 10.3109/10826084.2011.565853] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This cross-sectional study (N = 4,144) compared three longitudinal dynatypes (Maintainers, Relapsers, and Stable Smokers) of smokers on baseline demographics, stage, addiction severity, and transtheoretical model effort effect variables. There were significant small-to-medium-sized differences between the Stable Smokers and the other two groups on stage, severity, and effort effect variables in both treatment and control groups. There were few significant, very small differences on baseline effort variables between Maintainers and Relapsers in the control, but not the treatment group. The ability to identify Stable Smokers at baseline could permit enhanced tailored treatments that could improve population cessation rates.
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Johnson BT, Redding CA, DiClemente RJ, Mustanski BS, Dodge B, Sheeran P, Warren MR, Zimmerman RS, Fisher WA, Conner MT, Carey MP, Fisher JD, Stall RD, Fishbein M. A network-individual-resource model for HIV prevention. AIDS Behav 2010; 14:204-21. [PMID: 20862606 PMCID: PMC4361779 DOI: 10.1007/s10461-010-9803-z] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
HIV is transmitted through dyadic exchanges of individuals linked in transitory or permanent networks of varying sizes. A theoretical perspective that bridges key individual level elements with important network elements can be a complementary foundation for developing and implementing HIV interventions with outcomes that are more sustainable over time and have greater dissemination potential. Toward that end, we introduce a Network-Individual-Resource (NIR) model for HIV prevention that recognizes how exchanges of resources between individuals and their networks underlies and sustains HIV-risk behaviors. Individual behavior change for HIV prevention, then, may be dependent on increasing the supportiveness of that individual's relevant networks for such change. Among other implications, an NIR model predicts that the success of prevention efforts depends on whether the prevention efforts (1) prompt behavior changes that can be sustained by the resources the individual or their networks possess; (2) meet individual and network needs and are consistent with the individual's current situation/developmental stage; (3) are trusted and valued; and (4) target high HIV-prevalence networks.
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Karney BR, Hops H, Redding CA, Reis HT, Rothman AJ, Simpson JA. A framework for incorporating dyads in models of HIV-prevention. AIDS Behav 2010; 14:189-203. [PMID: 20838872 PMCID: PMC4156876 DOI: 10.1007/s10461-010-9802-0] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although HIV is contracted by individuals, it is typically transmitted in dyads. Most efforts to promote safer sex practices, however, focus exclusively on individuals. The goal of this paper is to provide a theoretical framework that specifies how models of dyadic processes and relationships can inform models of HIV-prevention. At the center of the framework is the proposition that safer sex between two people requires a dyadic capacity for successful coordination. According to this framework, relational, individual, and structural variables that affect the enactment of safer sex do so through their direct and indirect effects on that dyadic capacity. This dyadic perspective does not require an ongoing relationship between two individuals; rather, it offers a way of distinguishing between dyads along a continuum from anonymous strangers (with minimal coordination of behavior) to long-term partners (with much greater coordination). Acknowledging the dyadic context of HIV-prevention offers new targets for interventions and suggests new approaches to tailoring interventions to specific populations.
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Blissmer B, Prochaska JO, Velicer WF, Redding CA, Rossi JS, Greene GW, Paiva A, Robbins M. Common factors predicting long-term changes in multiple health behaviors. J Health Psychol 2010; 15:205-14. [PMID: 20207664 DOI: 10.1177/1359105309345555] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study was designed to assess if there are consistent treatment, stage, severity, effort and demographic effects which predict long-term changes across the multiple behaviors of smoking, diet and sun exposure. A secondary data analysis integrated data from four studies on smoking cessation (N = 3927), three studies on diet (N = 4824) and four studies on sun exposure (N = 6465). Across all three behaviors, behavior change at 24 months was related to treatment, stage of change, problem severity and effort effects measured at baseline. There were no consistent demographic effects. Across multiple behaviors, long-term behavior changes are consistently related to four effects that are dynamic and open to change. Behavior changes were not consistently related to static demographic variables. Future intervention research can target the four effects to determine if breakthroughs can be produced in changing single and multiple behaviors.
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Santiago-Rivas M, Velicer WF, Redding CA, Prochaska JO, Paiva AL. Cluster Subtypes within the Preparation Stage of Change for Sun Protection Behavior. Appl Psychol Health Well Being 2010. [DOI: 10.1111/j.1758-0854.2009.01028.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Allsworth JE, Anand M, Redding CA, Peipert JF. Physical and sexual violence and incident sexually transmitted infections. J Womens Health (Larchmt) 2009; 18:529-34. [PMID: 19245303 DOI: 10.1089/jwh.2007.0757] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To investigate whether women aged 13-35 who were victims of interpersonal violence were more likely than nonvictims to experience incident sexually transmitted infections (STIs). METHODS We examined 542 women aged 13-35 enrolled in Project PROTECT, a randomized clinical trial that compared two different methods of computer-based intervention to promote the use of dual methods of contraception. Participants completed a baseline questionnaire that included questions about their history of interpersonal violence and were followed for incident STIs over the 2-year study period. We compared the incidence of STIs in women with and without a history of interpersonal violence using bivariate analyses and multiple logistic regression. RESULTS In the bivariate analyses, STI incidence was found to be significantly associated with African American race/ethnicity, a higher number of sexual partners in the past month, and a lower likelihood of avoidance of sexual partners who pressure to have sex without a condom. In both crude and adjusted regression analyses, time to STI incidence was faster among women who reported physical or sexual abuse in the year before study enrollment (HRR(adj) = 1.68, 95% CI 1.06, 2.65). CONCLUSIONS Women with a recent history of abuse are at significantly increased risk of STI incidence than are nonvictims.
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Morokoff PJ, Redding CA, Harlow LL, Cho S, Rossi JS, Meier KS, Mayer KH, Koblin B, Brown-Peterside P. Associations of Sexual Victimization, Depression, and Sexual Assertiveness with Unprotected Sex: A Test of the Multifaceted Model of HIV Risk Across Gender. JOURNAL OF APPLIED BIOBEHAVIORAL RESEARCH 2009; 14:30-54. [PMID: 25018617 PMCID: PMC4091996 DOI: 10.1111/j.1751-9861.2009.00039.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study examined whether the Multifaceted Model of HIV Risk (MMOHR) would predict unprotected sex based on predictors including gender, childhood sexual abuse (CSA), sexual victimization (SV), depression, and sexual assertiveness for condom use. A community-based sample of 473 heterosexually active men and women, aged 18-46 years completed survey measures of model variables. Gender predicted several variables significantly. A separate model for women demonstrated excellent fit, while the model for men demonstrated reasonable fit. Multiple sample model testing supported the use of MMOHR in both men and women, while simultaneously highlighting areas of gender difference. Prevention interventions should focus on sexual assertiveness, especially for CSA and SV survivors, as well as targeting depression, especially among men.
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Kuroki LM, Allsworth JE, Redding CA, Blume JD, Peipert JF. Is a previous unplanned pregnancy a risk factor for a subsequent unplanned pregnancy? Am J Obstet Gynecol 2008; 199:517.e1-7. [PMID: 18468575 DOI: 10.1016/j.ajog.2008.03.049] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Revised: 12/11/2007] [Accepted: 03/21/2008] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The objective of the study was to determine whether a history of unplanned pregnancy was a risk factor for a subsequent unplanned pregnancy. STUDY DESIGN We analyzed 542 women aged 14-35 years, enrolled in Project PROTECT, a randomized clinical trial to promote dual-method contraception use to prevent sexually transmitted diseases and unplanned pregnancy. Predictors of unplanned pregnancy were assessed by comparing women with and without a history of unplanned pregnancy. RESULTS More than 1 in 5 women (22.5%) experienced an unintended pregnancy. History of an unintended pregnancy was a predictor of unintended pregnancy (adjusted odds ratio, 1.91; 95% confidence interval, 1.09-3.34). Other factors that were significantly associated with unplanned pregnancy included young age and low educational status. CONCLUSIONS Future efforts should focus on bridging the gap between identifying risk factors for unplanned pregnancy and interventions aimed at reducing the incidence in high-risk groups.
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Peipert JF, Redding CA, Blume JD, Allsworth JE, Matteson KA, Lozowski F, Mayer KH, Morokoff PJ, Rossi JS. Tailored intervention to increase dual-contraceptive method use: a randomized trial to reduce unintended pregnancies and sexually transmitted infections. Am J Obstet Gynecol 2008; 198:630.e1-8. [PMID: 18395692 DOI: 10.1016/j.ajog.2008.01.038] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2007] [Revised: 10/03/2007] [Accepted: 01/23/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The objective of the study was to determine whether a transtheoretical model-tailored expert system intervention increases dual-method contraceptive use, compared with a nontailored educational intervention. STUDY DESIGN We performed a randomized clinical trial of 542 women at high risk for sexually transmitted infections (STIs) and unintended pregnancy. The intervention group received computer-based tailored feedback using a multimedia program. The control group received general contraceptive information and nontailored advice. RESULTS Participants in the intervention group were more likely to report use of dual contraceptive methods during follow-up (adjusted hazard rate ratio 1.70, 95% confidence interval 1.09, 2.66), compared with controls. However, there were no differences in the rates of incident STI or unintended pregnancy between the 2 groups. CONCLUSIONS The computer-based transtheoretical model-tailored intervention resulted in a 70% increase in reported dual-method contraceptive use in a group of women at high risk for STIs and unintended pregnancy. Inconsistent use of dual methods may explain the lack of effect on unintended pregnancy rates and incident STIs.
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DePue JD, Goldstein MG, Redding CA, Velicer WF, Sun X, Fava JL, Kazura A, Rakowski W. Cancer prevention in primary care: predictors of patient counseling across four risk behaviors over 24 months. Prev Med 2008; 46:252-9. [PMID: 18234324 PMCID: PMC2408758 DOI: 10.1016/j.ypmed.2007.11.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2007] [Revised: 10/17/2007] [Accepted: 11/14/2007] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Rates of preventive counseling remain below national guidelines. We explored physician and patient predictors of preventive counseling across multiple cancer risk behaviors in at-risk primary care patients. METHODS We surveyed 3557 patients, with at least one of four cancer risk behaviors: smoking, diet, sun exposure, and/or mammography screening, at baseline and 24 months. Patients reported receipt of 4A's (Ask, Advise, Assist, Arrange follow-up); responses were weighted and combined to reflect more thorough counseling (Ask=1, Advise=2, Assist=3, Arrange=4, score range 0-10) for each target behavior. A series of linear-regression models, controlling for office clustering, examined patient, physician and other situational predictors at 24 months. RESULTS Risk behavior topics were brought up more often for mammography (90%) and smoking (79%) than diet (56%) and sun protection (30%). Assisting and Arranging follow-up were reported at low frequencies across all behaviors. More thorough counseling for all behaviors was associated with multiple visits and higher satisfaction with care. Prior counseling predicted further counseling on all behaviors except smoking, which was already at high levels. Other predictors varied by risk behavior. CONCLUSIONS More thorough risk behavior counseling can be delivered opportunistically across multiple visits; doing so is associated with more satisfaction with care.
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Prochaska JO, Butterworth S, Redding CA, Burden V, Perrin N, Leo M, Flaherty-Robb M, Prochaska JM. Initial efficacy of MI, TTM tailoring and HRI's with multiple behaviors for employee health promotion. Prev Med 2008; 46:226-31. [PMID: 18155287 PMCID: PMC3384542 DOI: 10.1016/j.ypmed.2007.11.007] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2007] [Revised: 10/23/2007] [Accepted: 11/11/2007] [Indexed: 11/20/2022]
Abstract
OBJECTIVE This study was designed to compare the initial efficacy of Motivational Interviewing (MI), Online Transtheoretical Model (TTM)-tailored communications and a brief Health Risk Intervention (HRI) on four health risk factors (inactivity, BMI, stress and smoking) in a worksite sample. METHOD A randomized clinical trial assigned employees to one of three recruitment strategies and one of the three treatments. The treatment protocol included an HRI session for everyone and in addition either a recommended three TTM online sessions or three MI in person or telephone sessions over 6 months. At the initial post-treatment assessment at 6 months, groups were compared on the percentage who had progressed from at risk to taking effective action on each of the four risks. RESULTS Compared to the HRI only group, the MI and TTM groups had significantly more participants in the Action stage for exercise and effective stress management and significantly fewer risk behaviors at 6 months. MI and TTM group outcomes were not different. CONCLUSION This was the first study to demonstrate that MI and online TTM could produce significant multiple behavior changes. Future research will examine the long-term impacts of each treatment, their cost effectiveness, effects on productivity and quality of life and process variables mediating outcomes.
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Mauriello LM, Rossi JS, Fava JL, Redding CA, Robbins M, Prochaska JO, Meier KS. Assessment of the pros and cons of stress management among adolescents: development and validation of a decisional balance measure. Am J Health Promot 2007; 22:140-3. [PMID: 18019890 DOI: 10.4278/0890-1171-22.2.140] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE This article reports on the development of a decisional balance measure based on the transtheoretical model (TTM) for stress management among adolescents. DESIGN Measurement development was conducted with participants of a pilot survey. SETTING Surveys were completed in health and physical education classes. SUBJECTS Ninth and tenth graders (N=317) completed an assessment of TTM constructs. MEASURES The focus of this paper is the development of a decisional balance measure. ANALYSIS A split-half cross-validation procedure was implemented. RESULTS A brief reliable eight-item instrument was developed measuring the pros and cons of practicing stress management. A theoretically consistent pattern of pros and cons across the stages of change was obtained and indicated construct validity. Girls were more likely to practice and acknowledge benefits of stress management. CONCLUSION This instrument will aid future work on promoting stress management practices among adolescents, particularly when using the TTM to develop interventions.
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Peipert JF, Lapane KL, Allsworth JE, Redding CA, Blume JL, Lozowski F, Stein MD. Women at risk for sexually transmitted diseases: correlates of intercourse without barrier contraception. Am J Obstet Gynecol 2007; 197:474.e1-8. [PMID: 17714677 PMCID: PMC2175265 DOI: 10.1016/j.ajog.2007.03.032] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 12/06/2006] [Accepted: 03/12/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the correlates of vaginal intercourse without barrier contraception (unprotected intercourse). STUDY DESIGN Baseline data from a randomized trial were analyzed to evaluate factors that are associated with intercourse without barrier method use among women < 35 years old. Logistic regression models provided estimates of the association of demographic, reproductive, and sexual history variables with unprotected intercourse. RESULTS Intercourse without barrier contraception was common; 65% of participants had > or = 2 episodes of intercourse without barrier contraception use in the past month. Factors that were associated with increased odds of unprotected intercourse included the number of coital episodes, a male partner's unwillingness to use condoms (adjusted odds ratio, 4.1; 95% CI, 2.3-6.9), and, among women < 20 years old, low condom use self-efficacy score (adjusted odds ratio, 1.6; 95% CI, 1.0-2.9). CONCLUSION Risk factors for unprotected intercourse included coital frequency and the male partner's unwillingness to use condoms. Self-efficacy for condom use was especially important for women < 20 years old.
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Prochaska JJ, Hall SM, Tsoh JY, Eisendrath S, Rossi JS, Redding CA, Rosen AB, Meisner M, Humfleet GL, Gorecki JA. Treating tobacco dependence in clinically depressed smokers: effect of smoking cessation on mental health functioning. Am J Public Health 2007; 98:446-8. [PMID: 17600251 PMCID: PMC2253568 DOI: 10.2105/ajph.2006.101147] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We analyzed data from a randomized trial of 322 actively depressed smokers and examined the effect of smoking cessation on their mental health functioning. Only 1 of 10 measures at 4 follow-up time points was significant: participants who successfully stopped smoking reported less alcohol use than did participants who continued smoking. Depressive symptoms declined significantly over time for participants who stopped smoking and those who continued smoking; there were no group differences. Individuals in treatment for clinical depression can be helped to stop smoking without adversely affecting their mental health functioning.
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Norman GJ, Adams MA, Calfas KJ, Covin J, Sallis JF, Rossi JS, Redding CA, Cella J, Patrick K. A randomized trial of a multicomponent intervention for adolescent sun protection behaviors. ACTA ACUST UNITED AC 2007; 161:146-52. [PMID: 17283299 DOI: 10.1001/archpedi.161.2.146] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To evaluate a multicomponent primary care-based intervention to increase sun protection behaviors among adolescents. Excessive sun exposure in childhood increases the lifetime risk of melanomas and other forms of skin cancer. Interventions to improve sun protection behaviors in childhood have been based primarily in school and community settings, with little attention to the role of primary care physicians. DESIGN A 2-year randomized controlled trial. SETTING Primary care physician offices and participant homes. PARTICIPANTS Eight hundred nineteen adolescents aged 11 to 15 years. INTERVENTIONS At the study onset and the 12-month follow-up, the adolescents engaged in an office-based expert system assessment of sun protection behaviors followed by brief stage-based counseling from the primary care provider. Participants also received up to 6 expert system-generated feedback reports, a brief printed manual, and periodic mailed tip sheets. Participants randomized to the comparison condition received a physical activity and nutrition intervention. MAIN OUTCOME MEASURE A self-reported composite measure of sun protection behavior. RESULTS A random-effects repeated-measures model indicated a greater adoption of sun protection behaviors over time in the intervention group compared with the control group. The intervention effect corresponded to between-group differences at 24 months in avoiding the sun and limiting exposure during midday hours and using sunscreen with a sun protection factor of at least 15. Secondary analysis indicated that, by 24 months, more adolescents in the intervention group had moved to the action or the maintenance stage of change than those in the control group (25.1% vs 14.9%; odds ratio, 1.74; 95% confidence interval, 1.13-2.68). Sun protection behavior was also found to be positively associated with the completion of more intervention sessions (P = .002). CONCLUSION Primary care counseling coupled with a minimal-intensity expert system intervention can improve adolescents' sun protection behaviors.
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Peipert J, Redding CA, Blume J, Allsworth JE, Iannuccillo K, Lozowski F, Mayer K, Morokoff PJ, Rossi JS. Design of a stage-matched intervention trial to increase dual method contraceptive use (Project PROTECT). Contemp Clin Trials 2007; 28:626-37. [PMID: 17374567 DOI: 10.1016/j.cct.2007.01.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2006] [Revised: 12/12/2006] [Accepted: 01/30/2007] [Indexed: 11/23/2022]
Abstract
This manuscript describes the randomized clinical trial titled Stage-Matched Intervention to Increase Dual Method Use or Project PROTECT. Project PROTECT compared two approaches to promote the use of dual methods of contraception among high-risk women. The intervention arm received tailored individualized feedback based on the Transtheoretical Model of Behavior Change using a computer-based multimedia program. The control arm received general information on contraception. The primary outcomes of this trial were 1) self-reported use of dual methods of contraception and 2) the biological outcomes of an unintended pregnancy or an incident or recurrent sexually transmitted disease. In this report, we describe the significance and background of the problem, the specific aims of the study, study organization, patient selection, randomization, outcome variables, data collection, procedures used for follow-up and testing, primary and secondary outcomes, and statistical analyses. We also describe participant characteristics and procedures used to assure patient safety and trial monitoring.
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Velicer WF, Redding CA, Anatchkova MD, Fava JL, Prochaska JO. Identifying cluster subtypes for the prevention of adolescent smoking acquisition. Addict Behav 2007; 32:228-47. [PMID: 16697533 DOI: 10.1016/j.addbeh.2006.03.041] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2005] [Revised: 03/26/2006] [Accepted: 03/29/2006] [Indexed: 11/20/2022]
Abstract
School-based smoking prevention programs are typically identical for all students. Tailoring prevention materials to focus on individual needs with an emphasis on students at highest risk is a promising alternative. Recent prevention programs have tailored materials based on the Stages of Acquisition, an extension of the Stages of Change used to tailor smoking cessation materials effectively for adults. Three stages of acquisition have been identified: Acquisition Precontemplation (aPC), Acquisition Contemplation (aC) and Acquisition Preparation (aPR). However, about 90% of nonsmoking adolescents classify themselves in the aPC stage. A cluster analysis was performed, using the Decisional Balance and Situational Temptations scales, for three random subsamples of adolescents within the aPC stage (N(1)=N(2)=N(3)=514). Four distinct subtypes were identified in each subsample: High Risk, Protected, Ambivalent, and Risk Denial. External validity was established using family support for nonsmoking, peer variables, and stage classification at follow-up assessment (12, 24, and 36 months). Family support for nonsmoking was related to subtype much more strongly than peer interactions. Subjects in the Protected subgroup were the most likely to remain in the aPC stage at each follow-up assessment. Subtype membership, along with membership in the aC and aPR stages, provides important additional information for tailoring smoking prevention materials. Tailored interventions can focus on those adolescents at highest risk and limit or avoid expending resources on those at very low risk.
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Anatchkova MD, Redding CA, Rossi JS. Development and validation of transtheoretical model measures for Bulgarian adolescent non-smokers. Subst Use Misuse 2007; 42:23-41. [PMID: 17366124 DOI: 10.1080/10826080601094140] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of this study was to develop, translate, and evaluate measures for decisional balance and situational temptations for Bulgarian adolescent nonsmokers and to test the predicted relationships with stages of change. Students in the last grades of high school (15-19 years old) recruited in 12 randomly selected schools participated in the study. Data from the 369 nonsmokers (61.8% female, mean age 16.4 years, 97.1% Bulgarian) were used in the measurement development. A two-factor model for decisional balance (CFI=.94) and a hierarchical three-factor model for temptations (CFI=.90) demonstrated the best fit. The predicted crossover pattern for decisional balance and decreasing trend for temptations across the stages of change was verified. Both measures demonstrated tau-equivalent invariance across gender, in addition to good psychometric properties. These results, with the caveat of the noted limitations, support the cross-cultural validity of these transtheoretical model (TTM) constructs and indicate that they can be used as a basis for development of smoking prevention interventions.
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Velicer WF, Redding CA, Sun X, Prochaska JO. Demographic variables, smoking variables, and outcome across five studies. Health Psychol 2007; 26:278-87. [PMID: 17500614 DOI: 10.1037/0278-6133.26.3.278] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Intervention effectiveness can potentially be affected by membership in different demographic subgroups (race, ethnicity, gender, age, and education level) or smoking behavior variables (time to first cigarette, longest previous quit attempt, number of attempts in the past year, number of cigarettes, and stage of change). Previous research on these 2 sets of variables has produced mixed results. DESIGN This secondary data analysis combined data from 5 effectiveness trials (a random-digit-dial sample [N=1,358], members of an HMO [N=207], parents of students recruited for a school-based study [N=347], patients from an insurance provider list [N=535], and employees [N=175]) in which smokers were all proactively recruited from a defined population and all received the same expert system intervention. The intervention produced a consistent 22% to 26% point prevalence cessation rate across the 5 studies. MAIN OUTCOME MEASURES The main outcome measures were 24-hr point prevalence, 7-day point prevalence, 30-day prolonged abstinence, and 6-month prolonged abstinence. RESULTS There were no significant differences in outcome across gender, race, and ethnicity subgroups. There were significant differences and small effect sizes for age and education subgroups. There were significant differences and large effect sizes for all 5 smoking behavior variables. DISCUSSION Demographic variables are static variables, whereas the smoking variables are more dynamic, that is, open to change. Given the dynamic nature of the smoking variables and the large effect sizes, interventions tailored on the smoking variables should be more successful.
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Hall SM, Tsoh JY, Prochaska JJ, Eisendrath S, Rossi JS, Redding CA, Rosen AB, Meisner M, Humfleet GL, Gorecki JA. Treatment for cigarette smoking among depressed mental health outpatients: a randomized clinical trial. Am J Public Health 2006; 96:1808-14. [PMID: 17008577 PMCID: PMC1586139 DOI: 10.2105/ajph.2005.080382] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Using a brief contact control, we tested the efficacy of a staged care intervention to reduce cigarette smoking among psychiatric patients in outpatient treatment for depression. METHODS We conducted a randomized clinical trial that included assessments at baseline and at months 3, 6, 12, and 18. Three hundred twenty-two patients in mental health outpatient treatment who were diagnosed with depression and smoked > or =1 cigarette per day participated. The desire to quit smoking was not a prerequisite for participation. Staged care intervention participants received computerized motivational feedback at baseline and at 3, 6, and 12 months and were offered a 6-session psychological counseling and pharmacological cessation treatment program. Brief contact control participants received a self-help guide and referral list of local smoking-treatment providers. RESULTS As we hypothesized, abstinence rates among staged care intervention participants exceeded those of brief contact control participants at months 12 and 18. Significant differences favoring staged care intervention also were found in occurrence of a quit attempt and stringency of abstinence goal. CONCLUSION The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient settings.
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