RESUMEN
Grant proposal writing in the behavioral sciences is important for fiscal reasons and scientific reasons at many universities. This report describes a grant proposal-writing seminar series provided to University faculty (N = 20) and explores factors facilitating and impeding writing. Summary statistics are provided for quantitative data. Free responses were sorted by independent raters into meaningful categories. As a consequence of the training, 45% planned to submit within 18 months; 80% of grant proposals targeted NIH. At 1-year follow-up, 40% actually submitted grants. Factors impeding grant proposal writing included competing professional demands; factors facilitating writing included regularly scheduled feedback on written proposal sections and access to expert collaborators. Obtaining grants generates financial resources, facilitates training experiences, and vastly contributes to the growth and dissemination of the knowledge base in an area.
Asunto(s)
Medicina de la Conducta , Financiación Gubernamental , Conductas Relacionadas con la Salud , Apoyo a la Investigación como Asunto , Universidades , Escritura , Docentes , Femenino , Humanos , MasculinoRESUMEN
Patients with obstructive coronary artery disease (CAD) undergoing orthotopic liver transplantation (OLT) are at increased risk of poor outcomes. The accuracy of dobutamine stress echocardiography (DSE) to detect obstructive CAD is not well established in this population. We retrospectively identified patients with end-stage liver disease who underwent both DSE and coronary angiography as part of risk stratification prior to OLT. One hundred and five patients had both DSE and angiography, of whom 14 had known CAD and 27 failed to reach target heart rate during DSE. Among the remaining 64 patients (45 men; average age 61 +/- 8 years) DSE had a low sensitivity (13%), high specificity (85%), low positive predictive value (PPV) (22%) and intermediate negative predictive value (NPV) (75%) for obstructive CAD. DSE as a screening test for obstructive CAD in OLT candidates has a poor sensitivity. The frequent chronotropic incompetence and low sensitivity in patients who achieve target heart rate, even in those with multiple cardiovascular disease risk factors, suggest that alternative or additional methods of risk stratification are necessary.
Asunto(s)
Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Ecocardiografía de Estrés , Trasplante de Hígado , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Sensibilidad y EspecificidadRESUMEN
A short, reliable two-factor instrument measuring drinking-related negative consequences was developed from a previous measure using two samples of college students. In Study I, data on alcohol use and problems associated with alcohol use were collected on 382 introductory psychology students. The original College Alcohol Problems Scale (CAPS) was tested and found to fit the data poorly. Sequential methods were used to develop a revised instrument. Principal components analyses (PCA) on half of the sample were conducted on 20 items written to measure negative consequences related to college student drinking. Results indicated a two-factor solution measuring social and emotional problems. Confirmatory factor analyses (CFA) on the other half of the sample confirmed the two-factor structure. Further refinement of the instrument resulted in the revised CAPS (CAPS-r), an eight-item two-factor scale. In Study II, the response format was altered to coincide with the Young Adult Problem Screening Test. A total of 726 students completed the instrument as part of a university-wide random sample. CFA showed that the hypothesized model fit well across all measures of model fit and the factor structure was invariant across gender. Additional analyses revealed that the scale was internally consistent and externally valid. A short reliable and valid measure of alcohol-related problems is needed to enable low-cost data collection on college campuses across the nation, as well as to facilitate program evaluation and routine epidemiological surveillance and monitoring.
Asunto(s)
Consumo de Bebidas Alcohólicas/psicología , Trastornos Relacionados con Alcohol/psicología , Alcoholismo/psicología , Estudiantes/psicología , Adolescente , Adulto , Análisis de Varianza , Análisis Factorial , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Encuestas y CuestionariosRESUMEN
Developing interventions for reducing adolescent smoking rates based on the Transtheoretical Model (TTM) requires the development of quality measures of the key constructs of the model. The goal of this investigation was to evaluate the psychometric properties of measures of Stage of Change, Decisional Balance and Situational Temptation for both smokers and nonsmokers and to test if the predicted relationships between these constructs were confirmed in a large (N=2808) sample of adolescents. A correlated three factor model (Social Pros, Coping Pros and Cons) provided an excellent fit to the 12-item Decisional Balance inventory for both smokers (CFI=0.957) and nonsmokers (CFI=0.963). A hierarchical four factor model (negative affect, positive social, habit strength and weight control) provided an excellent fit to the eight-item Situational Temptations inventory for smokers (CFI=0.969). A hierarchical five-factor model (same four as smokers plus Curiosity) provided an excellent fit to the 10-item Situational Temptations inventory for nonsmokers (CFI=0.943). The relationships between both the Decisional Balance and temptation scales and the Stages of Change were verified for both smokers and nonsmokers. The measures for adolescents are similar to but not the same as the measures of these constructs for adults.
Asunto(s)
Conducta del Adolescente/psicología , Toma de Decisiones , Prevención del Hábito de Fumar , Fumar/psicología , Estudiantes/psicología , Adolescente , Análisis de Varianza , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Reproducibilidad de los Resultados , Cese del Hábito de FumarRESUMEN
A stage-matched expert system intervention was evaluated on 4144 smokers in a two-arm randomized control trial with four follow-ups over 24 months. Smokers were recruited by random digit-dial calls, and 80.0% of the eligible smokers were enrolled. Individualized and interactive expert system computer reports were sent at 0, 3, and 6 months. The reports provided feedback on 15 variables relevant for progressing through the stages. The primary outcomes were point prevalence and prolonged abstinence rates. At 24 months, the expert system resulted in 25.6% point prevalence and 12% prolonged abstinence, which were 30% and 56% greater than the control condition. Abstinence rates at each 6-month follow-up were significantly greater in the Expert System (ES) condition than in the comparison condition with the absolute difference increasing at each follow-up. A proactive home-based stage-matched expert system smoking cessation program can produce both high participation rates and relatively high abstinence rates.
Asunto(s)
Selección de Paciente , Cese del Hábito de Fumar/psicología , Fumar/psicología , Adulto , Análisis de Varianza , Sistemas Especialistas , Femenino , Estudios de Seguimiento , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Detección de Abuso de Sustancias , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate the effect of a 2-hour, multicomponent educational intervention on provider skin cancer control practices. DESIGN: Nonrandomized intervention study. The intervention was a 2-hour curriculum designed to augment provider skin cancer control practices through instruction in basic skin cancer triage (BSCT) and a brief summary of skin cancer epidemiology, prevention, and counseling. SETTING: Five staff-model health maintenance organizations in southeastern New England. PARTICIPANTS: Convenience sample of primary care providers. Providers older than age 75, individuals in practice for less than 1 year, or individuals planning to retire in the next 2 years were excluded from the study. Twenty-two of 28 participants completed the study. RESULTS: Providers completed preintervention and postintervention surveys asking them to rate their attitudes towards skin examination and skin cancer counseling and to rate the frequency of their skin cancer control practices, using 5-point Likert scales. We independently assessed provider behavior through surveys of their patients, eliciting information on provider practices before and after BSCT participation. Following participation in the curriculum, there was significant improvement in provider attitudes towards the total body skin examination but not towards skin cancer prevention counseling. Significant increases in provider self- reported skin cancer control practices during an initial visit with a new patient (2.17 to 3.21, P <.0001) and a routine visit with a patient at high risk for melanoma (2.15 to 3.00, P <.0001) were demonstrated. Analysis of the patient exit interviews independently confirmed these changes in practice patterns. CONCLUSIONS: The study results suggest that the BSCT curriculum may be a useful tool in increasing the practice of skin cancer control measures by primary care providers.
Asunto(s)
Curriculum , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/educación , Médicos de Familia/educación , Neoplasias Cutáneas/prevención & control , Triaje , Encuestas Epidemiológicas , Humanos , Modelos Lineales , Oportunidad Relativa , Atención Primaria de Salud/normas , Neoplasias Cutáneas/diagnóstico , Encuestas y CuestionariosRESUMEN
Power was calculated for 8,266 statistical tests in 187 journal articles published in the 1997 volumes of Health Psychology (HP), Addictive Behaviors (AB), and the Journal of Studies on Alcohol (JSA). Power to detect small, medium, and large effects was .34. .74. and .92 for HP; .34, .75, and .90 for AB; and .41, .81. and .92 for JSA. Mean power estimates are .36, .77, and .91, giving a good estimation for the field of health psychology. J. Cohen (1988) recommended that power to detect effects should be approximately .80. Using this criterion, the articles in these journals have adequate power to detect medium and large effects. Intervention studies have much less power to detect effects than nonintervention studies do. Results are encouraging for this field, although studies examining small effects are still very much underpowered. This issue is important, because most intervention effects in health psychology are small.
Asunto(s)
Medicina de la Conducta/estadística & datos numéricos , Conductas Relacionadas con la Salud , Publicaciones Periódicas como Asunto , Edición , Recuento de Colonia Microbiana , Humanos , Reproducibilidad de los Resultados , Estadística como AsuntoRESUMEN
BACKGROUND: Previous research has demonstrated the efficacy of an interactive expert system intervention for smoking cessation for a general population. The intervention provides individualized feedback that guides participants through the stages of change for cessation. Enhancing the expert system by adding proactive telephone counseling or a stimulus control computer designed to produce nicotine fading could produce preventive programs with greater population impacts. METHODS: Four interventions were compared: (a) the interactive expert system intervention; (b) the expert system intervention plus counselor calls; (c) the expert system intervention plus the stimulus control computer; and (d) an assessment only condition. A 4 (intervention) x 4 (occasions) (0,6,12, and 18 months) design was used. Smokers were contacted at home via telephone or mail. The initial subject pool was the 24,178 members of a managed care company. Screening was completed for 19,236 members (79.6%), of whom 4,653 were smokers; 85.3% of the smokers were enrolled. RESULTS: Thirty-eight percent were in the precontemplation stage, 45% in the contemplation stage, and only 17% in the preparation stage. At 18 months, the expert system resulted in 23.2% point prevalence abstinence, which was 33% greater than that of assessment only. The counselor enhancement produced increased cessation at 12 months but not at 18 months. The stimulus control computer produced no improvement, resulting in 20% worse cessation rates than the assessment only condition. CONCLUSIONS: The enhanced conditions failed to outperform the expert system alone. The study also demonstrated the ability of the interactive expert system to produce significantly greater cessation in a population of smokers than assessment alone.
Asunto(s)
Sistemas Especialistas , Cese del Hábito de Fumar/métodos , Adulto , Análisis de Varianza , Cotinina/sangre , Consejo/métodos , Femenino , Humanos , Masculino , Programas Controlados de Atención en Salud , New Hampshire , Análisis de Regresión , Rhode Island , Cese del Hábito de Fumar/psicología , Teléfono , Interfaz Usuario-ComputadorRESUMEN
Brief, validated, and reliable theory-based measures specifically designed for use in large survey research with adolescent populations are needed to assess attitudes and behaviors about dietary fat consumption. This study validated two transtheoretical model (TTM)-based instruments in 2639 ninth graders from 12 Rhode Island high schools. The Decisional Balance Questionnaire for Adolescent Dietary Fat Reduction (DBQA) measures the importance adolescents assign to the pros and cons of reducing dietary fat consumption, while the Situational Temptations Questionnaire for Adolescents (STQA) measures temptations to eat high-fat foods as both a global construct and across three categories of challenging situations. Four competing models were compared for each instrument. An eight-item, correlated two-factor Pros and Cons model was validated for the decisional balance measure and a nine-item, three-factor hierarchical model was validated for situational temptations. The theoretically predicted relationships between stage of change and the pros and cons, as well as stage and situational temptations were supported. These results demonstrate that both measures have sound psychometric properties and are externally valid.
RESUMEN
PURPOSE: A short form for situational temptations to drink scale was developed from an original 21-item inventory by Migneault. METHODS: The form measured four hypothesized subscales of temptations on a sample of 348 college drinkers (66% female). Peer pressure, social anxiety, negative affect, and positive/social situations subscales were replicated and reduced. RESULTS: Strong empirical support was found for a hierarchical model, indicating that the four subscales can be summed to provide a global measure of situational temptations. Confirmatory factor results, internal and external validity, and high correlations with the original measures indicate that the short form was as psychometrically valid as the original measure. IMPLICATIONS: Measures of external validity demonstrated the applicability of this measure to heavy drinking prevention programs.
Asunto(s)
Intoxicación Alcohólica/psicología , Alcoholismo/psicología , Motivación , Inventario de Personalidad/estadística & datos numéricos , Facilitación Social , Templanza/psicología , Adulto , Alcoholismo/rehabilitación , Femenino , Humanos , Masculino , Psicometría , Reproducibilidad de los Resultados , Factores de RiesgoRESUMEN
Sun exposure is the most important avoidable cause of skin cancers. We report characteristics of a representative sample (N = 2,324) of beachgoers in Southeastern New England during the summer of 1995. This sample was not employing adequate sun protection behaviors (83% did not often avoid the sun during midday and only 45% often used sunscreen). Important demographic and skin cancer risk factor differences in sun protective behaviors and stages of change for sun protection were found, especially differences based on age, gender, and degree of sun sensitivity. Consistent with previous research, increased age, female gender, and greater sun sensitivity were each independently associated with more sun protective behaviors. These findings underscore the need for interventions targeting high-risk populations, such as those receiving high-intensity sun exposures at the beach.
Asunto(s)
Playas/estadística & datos numéricos , Conductas Relacionadas con la Salud , Helioterapia/estadística & datos numéricos , Neoplasias Cutáneas/prevención & control , Quemadura Solar/prevención & control , Protectores Solares/uso terapéutico , Adolescente , Adulto , Anciano , Áreas de Influencia de Salud , Demografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rhode Island/epidemiología , Protectores Solares/administración & dosificación , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To develop an algorithm for determining the stage of change for dietary fat intake in African-American women. DESIGN: We examined the relationships between stage of change, dietary fat intake, and associated eating behaviors and developed an assessment tool for placing subjects in their appropriate stage of change. SUBJECTS: Working class and middle-income African-American women in Nashville, Tenn; 174 in study 1 and 208 in study 2. STATISTICAL ANALYSES: Fat and fiber intake by stage of change was examined using multivariate analysis of variance. Hierarchical cluster analysis was performed using Ward's method. RESULTS: A significant difference in fat intake was noted between women trying to change their intake and those not trying to change in study 1 (P < .001) and study 2 (P < .03). Of those trying to change, only 34% (study 1) and 9% (study 2) of subjects reported fat intakes below the Healthy People 2000 goal of 30% of energy from fat. In study 1, cluster analysis identified 14 groups of foods that significantly separated subjects into not trying, noncompliant, and compliant categories. Compliant subjects ate out less; ate fewer snack foods and less chicken, meat, and fat; and ate more fruits, vegetables, breakfast foods, and low-fat products. These results led to development of the Eating Styles Questionnaire (study 2), which facilitated more appropriate placement of the noncompliant group in stages of change for dietary fat intake. APPLICATIONS/CONCLUSIONS: These data support the stage construct of the Transtheoretical Model for dietary fat reduction in African-American women. Moreover, the Eating Styles Questionnaire (ESQ) can improve determination of stage of change for this group of women. The ESQ can be used to diagnose the eating styles that contribute to a high-fat intake and help in the design of interventions to lower fat intakes.
Asunto(s)
Negro o Afroamericano , Grasas de la Dieta/administración & dosificación , Ingestión de Alimentos/psicología , Conducta Alimentaria/psicología , Encuestas y Cuestionarios , Adulto , Negro o Afroamericano/psicología , Algoritmos , Análisis por Conglomerados , Fibras de la Dieta/administración & dosificación , Escolaridad , Femenino , Humanos , Persona de Mediana Edad , Modelos Biológicos , Análisis Multivariante , Clase SocialRESUMEN
Owing to the recent success of the Transtheoretical Model of behavior change and the possible relationships between health behaviors, this study investigated the stage distribution of 10 healthy behaviors (seatbelt use, avoidance of high fat food, eating a high-fiber diet, attempting to lose weight, exercising regularly, avoiding sun exposure, sunscreen use, attempting to reduce stress, stopping smoking, and conducting cancer self-exams) and their interrelationships in a representative sample of health maintenance organization (HMO) members. The majority of older adults were found to be in either precontemplation or maintenance, illustrating the need to target interventions to precontemplation. Most older individuals were in precontemplation for losing weight and/ or sunscreen use and exercise, making these behaviors a priority for intervention research. Possible gateway behaviors to general health could be identified; however, these results are preliminary and require longitudinal follow-up.
Asunto(s)
Conductas Relacionadas con la Salud , Modelos Psicológicos , Anciano , Distribución de Chi-Cuadrado , Femenino , Sistemas Prepagos de Salud , Humanos , Masculino , Persona de Mediana Edad , Asunción de RiesgosRESUMEN
Smoking is a serious health risk, particularly for people with diabetes. This study was designed to examine important aspects of smoking in a large group of individuals with diabetes. A survey was mailed to 2,056 individuals with diabetes. The variables examined were the stages of change for smoking, prevalence of quitting advice given by health care providers, and the patterns of readiness for change. The majority (57.8%) of current smokers were in the precontemplation stage. Comparisons on the stage of change indicated that more individuals with Type 2 diabetes have quit while there are more current smokers among those with Type 1 diabetes. Comparisons on current smokers indicated no differences on stage of change across the Type 1 and Type 2 groups, across three subgroups of individuals with Type 2 diabetes, or across duration of diabetes. Those who reported that they were given cessation advice were further along in the stages of change. These results suggest that the majority of individuals with diabetes who smoke are in the precontemplation stage of change and provider advice is important in moving smokers toward change. The current findings underscore the importance of assessing stage of change and providing stage-matched interventions when working with smokers with diabetes.
Asunto(s)
Actitud Frente a la Salud , Diabetes Mellitus/epidemiología , Cese del Hábito de Fumar/psicología , Fumar/epidemiología , Fumar/psicología , Adulto , Conducta Adictiva/epidemiología , Conducta Adictiva/psicología , Comorbilidad , Diabetes Mellitus/psicología , Diabetes Mellitus Tipo 1/epidemiología , Diabetes Mellitus Tipo 1/psicología , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Psicológicos , Aceptación de la Atención de SaludRESUMEN
BACKGROUND: Research on cognitive factors and motivational readiness for exercise is important for increasing our understanding of behavior change among those with sedentary lifestyles. This study examines stage of change for regular exercise and self-perceived quality of life. METHODS: Data are from 1,387 respondents to a random digit dial survey of health behaviors. Stage of change is assessed with a single item, and individuals are classified with respect to intention and exercise behavior. Quality of life is assessed with the SF-36, a multidimensional measure of health-related quality of life. RESULTS: Exercise stage is associated with self-perceived quality of life. The three areas most strongly related were physical functioning, general health perceptions, and vitality. Physical functioning scores were lowest in precontemplation and highest in maintenance. Vitality and mental health scales were related to exercise behavior, but not to intention. CONCLUSIONS: Cognitions about self-perceived quality of life vary across the stages of change, with those who are least prepared to adopt regular exercise reporting the lowest levels of quality of life. These findings suggest that cognitive-motivational messages designed to emphasize quality of life benefits associated with exercise may be useful intervention strategies for people who are less motivationally ready to change.
Asunto(s)
Ejercicio Físico , Estado de Salud , Estilo de Vida , Calidad de Vida , Adulto , Anciano , Análisis de Varianza , Ejercicio Físico/fisiología , Ejercicio Físico/psicología , Femenino , Conductas Relacionadas con la Salud , Encuestas Epidemiológicas , Humanos , Masculino , Salud Mental , Persona de Mediana Edad , Motivación , Aptitud Física , Rhode Island/epidemiología , Rol , Muestreo , Ajuste SocialRESUMEN
This study compared interactive and noninteractive smoking cessation interventions for a population of smokers who were all members of 1 division of a managed care company. In addition, it examined whether a dose-response relationship existed. Screening was completed for 19,236 members who were contacted by telephone or mail. Of the 4,653 who were identified as smokers, 85.3% were enrolled. A 2 Intervention (interactive or noninteractive) x 4 Contacts (1, 2, 3, or 6 contacts) x 4 Occasions (0, 6, 12, and 18 months) design was used. The interactive intervention was stage-matched expert-system reports plus manuals; the noninteractive intervention was stage-matched manuals. Contact occurred in 1 of 4 series (1, 2, 3 or 6 contacts) at 3-month intervals. The expert system outperformed the stage-matched manuals, but there was no clear dose-response relationship for either intervention.
Asunto(s)
Sistemas Especialistas , Manuales como Asunto/normas , Autocuidado , Cese del Hábito de Fumar/métodos , Terapia Asistida por Computador/normas , Adulto , Análisis de Varianza , Distribución de Chi-Cuadrado , Episodio de Atención , Retroalimentación , Femenino , Estudios de Seguimiento , Encuestas de Atención de la Salud , Humanos , Masculino , Programas Controlados de Atención en Salud/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Selección de Paciente , Vigilancia de la Población/métodos , Prevalencia , Autocuidado/métodos , Autocuidado/normas , Fumar/epidemiología , Prevención del Hábito de FumarRESUMEN
The Transtheoretical Model suggests that perception of pros and cons of smoking (decisional balance) is related to quitting. This study examined the underlying structure of decisional balance items to aid in development of a pregnancy-tailored measure. A sample of 281 low-income, pregnant women attending public maternity clinics who smoked or had recently quit smoking completed a decisional balance measure. The measure included items from the general decisional balance scale plus pregnancy-related decisional balance items. Confirmatory factor analysis examining the general-plus-pregnancy-related items suggested a four-factor solution, with factors representing general pros, pregnancy-related pros, cons related to disapproval from others, and health-related cons. Perceptions of pregnancy-related pros and disapproval-related cons differed significantly across stages of change. Findings suggest that inclusion of pregnancy-related items could provide additional information about concerns that are salient during pregnancy.