Dentist-Perceived Barriers and Attractors to Cognitive-Behavioral Treatment Provided by Mental Health Providers in Dental Practices.

Over 1 in 5 dental patients report moderate to severe dental fear. Although the efficacy of cognitive-behavioral treatment (CBT) for dental fear has been examined in over 20 randomized controlled trials-with 2 meta-analyses finding strong average effect sizes ( d > 1)-CBT has received almost no dissemination beyond the specialty clinics that tested it. The challenge, then, is not how to treat dental fear but how to disseminate and implement such an evidence-based treatment in a way that recognizes the rewards and barriers in the US health care system. This mixed-method study investigated the potential of disseminating CBT through care from a mental health provider from within the dental home, a practice known as evidence-based collaborative care (EBCC). Two preadoption studies were conducted with practicing dentists drawn from a self-organized Practice-Based Research Network in the New York City metropolitan area. The first comprised 3 focus groups ( N = 17), and the second involved the administration of a survey ( N = 46). Focus group participants agreed that CBT for dental fear is worthy of consideration but identified several concerns regarding its appeal, feasibility, and application in community dental practices. Survey participants indicated endorsement of factors promoting the use of EBCC as a mechanism for CBT dissemination, with no factors receiving less than 50% support. Taken together, these findings indicate that EBCC may be a useful framework through which an evidence-based treatment for dental fear treatment can be delivered.

The influence of significant others on attitudes, subjective norms and intentions regarding dietary supplement use among adolescent athletes.

Dietary supplement use has increased significantly over the past decade. The use of supplements among adolescents seems to be influenced by their beliefs and attitudes. The influence of coaches, parents, and athletic trainers also may be important. The purpose of this study was (1) to determine whether attitudes are a better predictor of adolescents' intentions to use dietary supplements than are subjective norms, and (2) to assess the influence of significant others (coaches, parents, and trainers) on attitudes, subjective norms, and intentions among adolescent athletes. Adolescents (N = 1,626) who were enrolled in grades six through twelve in nine public schools completed a self-report questionnaire that measured attitudes, subjective norms, and intentions regarding dietary supplement use. Results indicated that attitudes were a better predictor of intentions to use dietary supplements than were subjective norms. It was also found that trainers had more influence on the attitudes, subjective norms, and intentions of adolescents regarding supplement use than did parents and coaches. Implications for prevention are addressed.

Smoking acquisition: peer influence and self-selection.

The study examined and contrasted the extent that peer influence and self-selection for smoking peers may affect acquisition of smoking by adolescents. Data for a U.S. national cohort sample of adolescents (N = 4,444) who were nonsmokers in the 1989 Teenage Attitudes and Practices Surveys and were re-interviewed in 1993 were included. The information included measures of smoking behavior and smoking status of both boys' and girls' best friends. Analysis demonstrated that, although the effects of both peer influence and self-selection of smoking friends occurred, self-selection may play a greater role in adolescents' beginning to smoke. This implies that, while teaching adolescents to resist peer pressure may be necessary, it is perhaps more important to identify factors that influence adolescents' decisions in choosing friends who smoke. This could lead to more effective preventive strategies.

Detecting and describing preventive intervention effects in a universal school-based randomized trial targeting delinquent and violent behavior.

This study examined theoretical, methodological, and statistical problems involved in evaluating the outcome of aggression on the playground for a universal preventive intervention for conduct disorder. Moderately aggressive children were hypothesized most likely to benefit. Aggression was measured on the playground using observers blind to the group status of the children. Behavior was micro-coded in real time to minimize potential expectancy biases. The effectiveness of the intervention was strongly related to initial levels of aggressiveness. The most aggressive children improved the most. Models that incorporated corrections for low reliability (the ratio of variance due to true time-stable individual differences to total variance) and censoring (a floor effect in the rate data due to short periods of observation) obtained effect sizes 5 times larger than models without such corrections with respect to children who were initially 2 SDs above the mean on aggressiveness.

The veridicality of punitive childhood experiences reported by adolescents and young adults.

OBJECTIVE: The primary goal of the present research was to determine whether retrospective reports of childhood disciplinary experiences and perceptions of that discipline correspond to actual childhood events and whether the accuracy of that report was influenced by the affective state of the respondent. METHOD: Eighty-three adolescent and young adult males completed a retrospective measure of physical child maltreatment, Assessing Environments (AEIII), and the Brief Symptom Inventory (BSI). As children the participants had been observed naturalistically in their homes interacting with their parents an average of 10 years earlier. RESULTS: Analyses were consistent with the hypothesis that both current mood and actual observations of parent-child interactions during childhood predict self-reported recollections of childhood maltreatment by one's parents. Further the veridicality of such recollections appears to depend upon the objective specificity versus the perceptive nature of the questions used to elicit the recollections. CONCLUSIONS: The findings suggest that assessment instruments suitable for obtaining information regarding earlier childhood victimization must utilize behaviorally specific items. Thus, items that are either global or intimate a normative comparison should be avoided.

Description and immediate impacts of a preventive intervention for conduct problems.

A population-based randomized intervention trial for the prevention of conduct problems (i.e., oppositional defiant disorder and conduct disorder) is described. The LIFT (Linking the Interests of Families and Teachers) intervention was designed for all first- and fifth-grade elementary school boys and girls and their families living in at-risk neighborhoods characterized by high rates of juvenile delinquency. The 10-week intervention strategy was carefully targeted at proximal and malleable antecedents in three social domains that were identified by a developmental model of conduct problems. From 12 elementary schools, 671 first and fifth graders and their families participated either in the theory-based universal preventive intervention or in a control condition. The intervention consisted of parent training, a classroom-based social skills program, a playground behavioral program, and systematic communication between teachers and parents. A multiple measure assessment strategy was used to evaluate participant satisfaction and participation, fidelity of implementation, and the immediate impacts of the program on targeted antecedents.

Prospective social-psychological factors of adolescent smoking progression.

PURPOSE: To evaluate the ability of social-psychological risk factors to predict adolescent smoking behavior. METHODS: Nonsmoking adolescents (n = 4032) who participated in the 1989 and 1993 Teenage Attitudes and Practices Surveys (TAPS I) were selected for analyses. Four multivariate logistic models were used to examine (a) adolescents' smoking initiation, (b) adults' smoking initiation, (c) adolescents' progression to regular smoking, and (d) adults' progression to regular smoking. A series of social-psychological variables were measured. RESULTS: All four models were significant. However, no social-psychological factors were consistently significant in all four models, except white ethnicity. Data showed that social-psychological factors are less able to predict the transition from nonsmoking to experimental smoking than that from nonsmoking to regular smoking. CONCLUSIONS: Future prospective studies should measure both social-psychological and smoking acquisition factors at closer intervals to more accurately examine potential relationships.

Interpersonal skills training to reduce aggressive and delinquent behavior: limited evidence and the need for an evidence-based system of care.

The prevention of aggressive and delinquent behavior during childhood and adolescence is one of the highest priorities for public health and crime prevention. The most common approach to preventing or treating these conduct problems has been to provide interpersonal skills training to the affected youth. This paper reviews all randomized controlled trials evaluating interpersonal skills training programs as an intervention to reduce conduct problems. Research shows that such programs have weak empirical support as isolated interventions. An alternative evidence-based system of care is described. Such a system would include behavioral parent training and behavioral classroom-based interventions for young children at risk of developing problems, as well as multisystemic family therapy or multidimensional treatment foster care for chronic delinquents. Within such a network of services, interpersonal skills training could play an important supportive role. Such a system holds the greatest promise for reducing the prevalence of aggressive and delinquent behavior in communities.

School dropouts' attitudes and beliefs about smoking.

The purpose of this study was to examine the association of beliefs and attitude related to smoking and smoking behavior among school dropouts in a national sample (weighted N = 492,352). The self-reported smoking rate for school dropouts was 58.3%. Those who were most positive about smoking (such as smoking helps people reduce stress and relax, reduce boredom) were more likely to be smokers (p < .05). Smoking programs targeting this population should provide coping skills and an environment with options for relaxing, managing stress, and safe weight control.

The analysis of intervention change in children and families: methodological and conceptual issues embedded in intervention studies.

This article provides an overview of methodological and conceptual issues underlying the assessment of change during psychotherapy with children and families. Three central considerations are discussed: (1) What changes do we measure? (2) When do we measure change? (3) How do we measure change? The difficulties with the traditional methods of assessing change are highlighted, and suggestions for a new paradigm that calls for expansion of the nomological network relevant to the analysis of change, as well as the inclusion of more assessment points and more reliable and valid measures of the change process, are presented. Illustrations of key points are provided from the Adolescent Transitions Program, a theoretically based intervention program targeting high-risk youth.

The impact of worksite-based safety belt programs: a review of the literature.

PURPOSE: The purpose of this paper is to provide a literature review of the research that examines the effectiveness of worksite intervention programs designed to increase the use of safety belts by employees. SEARCH METHODS: The literature search, which identified 14 research studies on worksite safety belt programs conducted between 1968 and 1994, originated as part of a larger review on the health impact of worksite health promotion programs that was conducted by the Centers for Disease Control and Prevention (CDC). In addition, the authors conducted an additional search in an effort to validate the CDC search, but found no additional research articles. SUMMARY OF IMPORTANT FINDINGS: The literature specific to the effectiveness of safety belt programs is limited to only 14 studies. The safety belt intervention most commonly evaluated used behavioral modification principles involving incentives. These and other interventions demonstrated effective increases in seat belt utilization that, upon withdrawal of the intervention, achieved a recidivism rate above baseline levels. However, the vast majority of studies failed to incorporate control groups into their research design, which caused significant threats to internal validity. Thus, a summary of findings is only suggestive at best. MAJOR CONCLUSIONS: Based on the literature, there appears to be an insufficient number of quality research studies from which to derive a clear view of the impact of worksite safety belt programs. While the evidence is suggestive of a positive impact on safety belt use, there is a clear need for new, well-designed research initiatives on the effectiveness of theory-based safety belt intervention programs.

Interaction of asthmatics and their spouses: A preliminary study of individual differences.

Some asthmatics show evidence of airways reactivity triggered by strong emotions. Six case studies of married patients with severe asthma are reported. The videotaped interactions of the asthmatic and his/her spouse were coded for affect and behavior. Repeated measures of pulmonary function and affective state were recorded before and after two interaction tasks. Over the course of the experimental period, two patients' pulmonary function improved and four patients' deteriorated. In general, decreased pulmonary function was associated with more self-rated hostility and depression. The results are discussed in terms of their implications for the intra- and interpersonal factors that are important in asthma management.

Marital interaction coding system: revision and empirical evaluation.

Given the vast amount of codeable information in marital interactions, observational coding systems must emphasize particular classes of behavior. The most widely used marital coding scheme, the Marital Interaction Coding System (MICS), like many older behavioral coding systems, emphasizes verbal content over affect. Changes made to the MICS between versions III and IV are described; they were intended to increase the system's use of coded affect and to decrease autodependence in sequential analysis. We used an archival data set of 994 couples' videotaped conflict negotiations coded with the MICS. As intended, the MICS-IV, relative to the MICS-III, was found to have the advantage of capturing more non-verbal affect expressed during marital interactions, which resulted in stronger interactional contingencies (e.g. Wife Blame-->Husband Blame, Husband Facilitation-->Wife Facilitation). The MICS-IV also yielded significantly lower levels of spurious autodependence.

Family and peer influences on smoking behavior among American adolescents: an age trend.

PURPOSE: To study the age trend of family and peer influence on adolescent smoking behavior using a national sample. METHODS: Adolescents (N = 6,900), ages 14 through 18 years, from the 1988-89 Teenage Attitudes and Practices Survey, were selected for analyses. Data collected included measures for smoking status of the adolescent and their family and peers. RESULTS: Peer influence, such as the smoking status of best male/female friends, proved to be the most significant and consistent predictor across all ages, while parental influence had little effect on adolescent smoking status. Gender-specific effects were noted in the peer influence of adolescent smoking. CONCLUSIONS: The peer influence on adolescent smoking, across ages 14 through 18 years, confirmed previous literature. However, no differential effect of family and peer influence on adolescent smoking was evident.

Predicting smoking status by symptoms of depression for U.S. adolescents.

This study examined the predictive relationships between adolescents' smoking and symptoms of depression. A national sample of 6,900 adolescents, ages 14 to 18 years, were selected for analysis. Variables of interest included measures for smoking status and symptoms of depression. Odds ratio and adjusted odds ratio from logistic regression analyses indicated that more of the 885 smokers than of the 6,015 nonsmokers reported feelings of unhappiness, sadness, or depression, hopelessness about the future, and having trouble going to sleep.

Tobacco use among American adolescents: geographic and demographic variations.

A previous national study indicated that the South dominated other regions of the United States in tobacco use. Using the results of the Teenage Attitudes and Practices Survey conducted by the National Center for Health Statistics, we examined the geographic and demographic differences of tobacco use among US adolescents. The sample consisted of teenagers in grades 7 through 12 nationwide (N = 6,599). Data were collected through telephone interviewing. The variables included demographics and measures of smoking or use of smokeless tobacco (chewing tobacco/snuff). Results indicated that the overall prevalence rate for smokeless tobacco use was 4.44%, but in the South it was 6.38%. The overall smoking prevalence rate was 13.31%, with no substantial difference among regions. Demographic variables such as sex, ethnicity, education, and poverty levels were also related to tobacco use prevalence. These geographic and demographic variations in tobacco use help target specific regions and populations in greatest need of intervention programs.

The Midfield High School Safety Belt Incentive Program.

Motor vehicle accidents constitute the leading cause of death among children and youth ages 15-24. The Year 2000 Health Objectives for the Nation call for reduction in fatalities in this population through increasing occupant restraint measures. This article provides an overview of how one school district developed a school and community safety belt incentive program to increase safety belt use among high school students. The intervention program followed a seven-step process, involving community leaders, school officials, students, and local law enforcement personnel in its design, implementation, and evaluation. Local merchants and the Alabama Dept. of Health donated program incentives. Measurement of safety belt use among the target population revealed increased use throughout the program.

Impact of a physical fitness program in a blue-collar workforce.

The purpose of this study was to examine the impact of participation in the Wellness--Paths to Health Physical Fitness Program on selected physiological and personal health variables including blood pressure, pulse, body weight, trunk flexibility, cardiovascular endurance, abdominal strength, percent body fat and a cumulative fitness score. The subjects (N = 129) of this study were divided into four levels of adherence to this exercise-based health program. Data analysis examined relationships between adherence levels and changes in the selected physiological and personal health variables across two measures. In addition, data from high-risk participants were analyzed. The results of the study found statistical significant changes in the selected variables between repeated assessment measures. In addition, statistically significant relationships were found between levels of adherence to the program and six of the dependent variables.

Modification of a Nutritional Questionnaire for Older Adults and the ability of its knowledge and attitude evaluations to predict dietary adequacy.

This paper outlines the modification of the Nutritional Questionnaire for Older Adults (NQOA) to determine the extent to which knowledge and attitude can predict dietary adequacy. Aged adults (65 years or older) who participate in the Title III-C congregate meal program at a small community Senior Center in Alabama (n = 22) served as subjects for this study. Knowledge and attitude were shown to be weak predictors of dietary adequacy with regard to specific components, but were found to significantly predict adequate nutritional intake as measured by both RDA and by food group standards.