Relations between provider adherence to a tailored motivational intervention protocol and competence in motivational interviewing.

OBJECTIVES: To evaluate the association between provider adherence to Tailored Motivational Interviewing implementation strategy and motivational interviewing (MI) competence. METHODS: 156 youth-focused HIV providers enrolled in a parent implementation science trial completed: a) quarterly standardized patient assessments (SPI) during Baseline; b) a workshop, individual coaching sessions, and quarterly SPI plus feedback during Implementation; and c) quarterly SPI during Sustainment. Competence was measured using the MI-CRS and tracking data was used to assess adherence. We examined overall adherence as well as adherence to each implementation strategy in relation to MI competence. RESULTS: Overall adherence was not associated with overall MI competence. MI competence significantly increased from Baseline to Implementation and Baseline to Sustainment. Some individual implementation strategies were associated with change in competence and the probability of achieving Intermediate/Advanced competence. CONCLUSIONS: The results suggest that 100% percent adherence to all TMI implementation strategies may not be necessary. Completing some of the TMI implementation strategies yielded improvements in MI competence. The use of routine tracking data to measure adherence maybe more pragmatic than using observational coders and more objective than self-reports. PRACTICE IMPLICATIONS: In busy HIV clinics, MI training should focus on strategies most directly associated with increased provider competence.

Does preschool children's self-regulation moderate the impacts of instructional activities? Evidence from a randomized intervention study.

There is strong evidence linking children's self-regulation with their academic and behavioral outcomes. These relations have led to the development of interventions aimed at improving academic outcomes by promoting self-regulation, based in part on the idea that self-regulation promotes the development of academic skills. Although a considerable number of studies have examined the degree to which interventions designed to improve aspects of self-regulation have a positive impact on academic outcomes, only a few studies have examined the degree to which children's self-regulation moderates the effects of academic interventions. The goal of this study was to examine whether self-regulation, indexed by a direct assessment of executive function and teacher-rated attention, moderated the uptake of early literacy interventions for 184 children (average age = 58 months, SD = 3.38; 66% Black/African American, 28% White; 59% male) at risk for reading difficulties who participated in a randomized controlled trial examining the efficacy of Tier 2 interventions in preschool. Multilevel models were used to examine the degree to which children's self-regulation moderated the impacts of the interventions. The results of this study provided little evidence that self-regulation moderated the impacts of the interventions and call into question the likelihood of a causal relation between self-regulation and academic achievement.

Executive Function, Language Dominance and Literacy Skills in Spanish-speaking Language-minority Children: A Longitudinal Study.

In the U.S., children whose home language is Spanish are at increased risk for the development of reading difficulties. Studies have reported a link between executive function (EF) and reading; few studies have examined this linkage in Spanish-speaking language-minority (LM) children. This longitudinal study examined the association between preschool EF and kindergarten reading-related skills in 241 Spanish-speaking LM children (M-age in preschool = 54.23 months, SD = 6.17). In preschool, children completed measures of inhibitory control (IC) and working memory (WM) in their dominant language, and early literacy skills in Spanish and English. In the fall of their kindergarten year, children completed code- and language-related literacy measures in both languages. A two-factor model (IC and WM) accounted for children's preschool EF. Most zero-order correlations between EF factors and kindergarten outcomes in Spanish (rs = .03-.40) and English (rs = .05-.35) were statistically significant. For English-language outcomes, WM was more strongly associated with code-related skills and IC with language-related skills; for Spanish-language outcomes, WM was more strongly related to both code- and language- related skills than IC. There was little difference in the associations between EF and reading outcomes based on the language in which EF was measured (i.e., the child's dominant language). When controlling for early literacy skills in the same language as the kindergarten outcomes, EF contributed significant unique variance to kindergarten skills in English but not in Spanish. For Spanish language outcomes, early literacy skills appear to mediate the role of preschool EF. The results suggest that children's development in cognitive domains, such as EF, may have an important role in the acquisition of core early reading skills for Spanish-speaking LM children.

Examining the factors associated with past and present dermoscopy use among family physicians.

INTRODUCTION: Family physicians (FPs) play a critical role in the early detection of skin cancers. Dermoscopy can improve diagnostic accuracy but its use by FPs in the United States (US) remains understudied. OBJECTIVES: To examine dermoscopy use, factors associated with ever having used (Model 1) and currently using the dermascope (Model 2), and barriers. METHODS: We recruited 705 practicing FPs in-person at conferences and on-line to complete an anonymous, 46 item survey measuring: demographic factors, physician and practice characteristics; confidence in differentiating skin lesions; knowledge and use of dermoscopy; intentions to use; and barriers to use. We conducted bivariate analysis for each outcome and entered the significant predictors into two logistic regressions. RESULTS: Almost 20% had ever used a dermascope and 8.3% were currently using it. Ever having used a dermascope was associated with being 39 years of age or younger, practicing in academia or community centers, and having higher confidence differentiating skin lesions. Current use was associated with seeing more than 400 patients per month and being 60 years-of-age or older. CONCLUSION: Use of dermoscopy by FPs is low. This study is an initial step in understanding its use among US FPs.

Predictors of Sunburn Risk Among Florida Residents.

CONTEXT: The incidence of skin cancer, the most common type of cancer in the United States, is increasing. Sunburn is a major modifiable risk factor for skin cancer, and its prevalence among the US population is high. OBJECTIVES: To identify predictors of having had a red or painful sunburn in the past 12 months among people living in Florida. METHODS: Florida residents were recruited from public places and online. They were asked to complete an anonymous cross-sectional survey that assessed demographic information, dermatologic history, as well as knowledge, attitude, and behavior factors associated with sunburn. RESULTS: A total of 437 participants whose data were complete for all variables were included in the multivariate analysis. In multivariate logistic regression, younger age (18-29 years) was the most significant predictor of sunburn (OR, 15.26; 95% CI, 5.97-38.98; P<.001). Other significant predictors included identifying as nonwhite (OR, 0.51; 95% CI, 0.29-0.90; P<.02), having had a full-body skin examination by a physician (OR, 1.8; 95% CI, 1.03-3.14; P<.04), reporting higher levels of skin sensitivity to the sun (OR, 4.63; 95% CI, 2.07-10.34; P<.001), having a less favorable attitude toward sun protection (OR, 0.88; 95% CI, 0.81-0.94; P<.001), having high perceived vulnerability to skin cancer (OR, 1.21; 95% CI, 1.05-1.41; P<.009), and spending less than 1 hour outside between 10 am and 4 pm on weekends (OR, 0.46; 95% CI, 0.22-0.96; P<.04). The model was statistically significant at P<.001 and correctly classified 78% of participants. CONCLUSIONS: Sunburn prevention programs that osteopathic physicians can readily implement in clinical practice are urgently needed, particularly for young adult patients. This study identified 7 predictors of sunburn in Florida residents. With additional research findings, promoting attitude change toward sun protection may be a viable strategy.

Dermascope Use by Osteopathic Primary Care Physicians.

CONTEXT: Osteopathic physicians (ie, DOs) in primary care may play a critical role in the early detection of skin cancer. Dermoscopy improves diagnostic accuracy; however, its use among primary care DOs remains understudied. OBJECTIVES: To document dermascope use among DOs in primary care, to examine physician and practice characteristics associated with having used and having heard of a dermascope, and to examine the barriers to dermascope use. METHODS: Osteopathic physicians were recruited to complete an anonymous survey assessing demographic factors, physician and practice characteristics, confidence in differentiating skin lesions, knowledge and dermascope use, and barriers to dermascope use. Bivariate analyses were conducted, and the significant factors were entered into 2 separate logistic regressions. RESULTS: A total of 768 participants were included in the study. Four hundred ten (54%) had heard of a dermascope, and 123 (15%) had used one. The statistically significant multivariate predictors for having used a dermascope (model 1) were graduating from medical school after 1989 and having greater confidence in differentiating skin lesions (OR, 2.2; 95% CI, 1.66-2.79). Those who graduated after 2009 were 9.5 times more likely and those graduating between 2000 and 2009 were 4.3 times more likely to have used a dermascope than those graduating before 1990 (95% CI, 4.29-20.90 and 95% CI, 2.04-9.23, respectively). Ever having heard of a dermascope (model 2) was associated with being female (OR, 1.4; 95% CI, 1.02-1.87); practicing in a group (OR, 1.6; 95% CI, 1.05-2.36), academic (OR, 2.2; 95% CI, 1.26-3.86), or community center (OR, 2.2; 95% CI, 1.20-4.00); and having greater confidence in differentiating skin lesions (OR, 1.3; 95% CI, 1.15-1.55). Both models were statistically significant and correctly classified 605 (84.1%) (model 1) and 444 (58.4%) participants (model 2). CONCLUSION: Dermascope use could help primary care DOs improve their diagnostic accuracy for skin cancer and reduce unnecessary referrals to specialists. Efforts to disseminate knowledge about the benefits of using a dermascope to primary care DOs are needed.

A Randomized Controlled Trial of POWER: An Internet-Based HIV Prevention Intervention for Black Bisexual Men.

POWER is a theory-based, on-line HIV prevention intervention developed specifically for Black men who have sex with men and women (BMSMW), an understudied group significantly impacted by HIV. To test its efficacy, we recruited 224 BMSMW using chain referral methods and randomly assigned 108 to POWER and 103 to a health information comparison condition. Three months after the intervention, participants assigned to POWER had lower odds of reporting any condomless vaginal or condomless anal intercourse (CVAI) compared to those in the comparison group (aOR = 0.49; 95 % CI 0.25-0.98; p = 0.044). The intervention was associated with significantly lower odds of condomless anal intercourse with male partners (aOR = 0.55; 95 % CI 0.34-0.91; p = 0.020) but not with female partners and serodiscordant sex with male partners but not with female partners. Future studies are needed to replicate these findings in larger and more diverse samples of BMSMW and to understand the underlying mechanisms through which intervention efficacy was achieved.

Embedding HIV Mentoring Programs in HIV Research Networks.

Responding to the demands of the HIV/AIDS epidemic necessitates a diverse scientific and clinical workforce trained in applying interdisciplinary research approaches to address the epidemic domestically and internationally. Ensuring diversity in our workforce requires concerted efforts. Yet, the majority of graduate and post-graduate programs are ill-equipped to provide this type of training. Research networks, the HPTN, HVTN, CFAR and ATN, are uniquely positioned to implement interdisciplinary mentoring programs and all four have done so. We describe these programs, the nuts and bolts of program implementation and efforts to recruit and retain diversity scholars. We outline some inherent challenges such as competing demands for network resources or tension in aligning scholars' research agenda with that of the networks. We argue that the benefits to be gained from continuing these programs far outweigh their costs and that these programs are an essential component of a comprehensive strategy for developing the future HIV research workforce.

Project Stride: An Equine-Assisted Intervention to Reduce Symptoms of Social Anxiety in Young Women.

INTRODUCTION: Although there is evidence supporting the use of equine-assisted activities to treat mental disorders, its efficacy in reducing signs and symptoms of social anxiety in young women has not been examined. METHOD: We developed and pilot tested Project Stride, a brief, six-session intervention combining equine-assisted activities and cognitive-behavioral strategies to reduce symptoms of social anxiety. A total of 12 women, 18-29 years of age, were randomly assigned to Project Stride or a no-treatment control. Participants completed the Liebowitz Social Anxiety Scale at baseline, immediate-post, and 6 weeks after treatment. RESULTS: Project Stride was highly acceptable and feasible. Compared to control participants, those in Project Stride had significantly greater reductions in social anxiety scores from baseline to immediate-post [decrease of 24.8 points; t (9) = 3.40, P = .008)] and from baseline to follow-up [decrease of 31.8 points; t (9) = 4.12, P = .003)]. CONCLUSION: These findings support conducting a full-scale efficacy trial of Project Stride.