Wellness program for anesthesiology residents: a randomized, controlled trial.

BACKGROUND: Multiple reports illustrate the deleterious effects of stress on physicians' mental and physical health, as well as on patient care. This study evaluates the effects of a wellness program on anesthesiology residents' well-being. METHODS: Sixty residents were randomly assigned to one of three groups: (1) wellness intervention group, (2) no-treatment control with release time, and (3) no-treatment control with routine duties. Coping, stressors, social support, psychological symptoms, and alcohol and tobacco use were measured using a pre-test-post-test design. RESULTS: Residents in the wellness program reported significantly fewer stressors in their role as parent, increased social support at work, greater problem-solving coping, and less anxiety as compared with one or both of the control groups. Findings related to reducing avoidance coping and alcohol consumption also were suggestive of positive intervention effects. CONCLUSIONS: An intervention to increase the use of active coping and social support, to reduce reliance on avoidance coping, and to decrease work and family stressors had an overall pattern of beneficial effects on residents' well-being. The importance of offering such programs during residency training, ways to strengthen intervention effectiveness, and areas for future research are discussed.

Impact of two social-cognitive interventions to prevent adolescent substance use: test of an amenability to treatment model.

An amenability to treatment model stipulates that interventions may be differentially effective for subgroups of individuals with similar characteristics. Using such a model, the present study tests the impact of two social-cognitive interventions implemented in the sixth (Intervention I) and eighth/ninth (Intervention II) grades on students' skill acquisition and on their ninth and tenth grade substance use. A randomized factorial design was used to examine main and interaction effects within the context of student family household status and gender. Positive program effects were found for Intervention II on skill acquisition and overall drug involvement. Interaction effects of Intervention II x Family Household Status provided support for the amenability to treatment model, but no support for the model was observed based on student gender. Possible explanations for the study findings are presented and future research directions are proposed to address why differences emerge in amenability to intervention and why such differences occur for specific subgroups.

Panel accretion and external validity in adolescent substance use research.

This study investigates the relationship of panel accretion to panel attrition and examines its impact on threats to external validity in adolescent substance use research. Panel accretion involves the addition of new participants to a panel design after initial baseline data has been obtained. Accretion occurs in longitudinal studies in which data is routinely gathered on all participants, as is often the case in prevention or epidemiological research on adolescent substance use. Accretion, attrition, and panel findings for three, 2-year panel samples in grades 7 through 9 are examined. The results indicate that accretion and attrition samples have an isomorphic relationship to one another on a range of dependent measures when drawn from the same population. The results are discussed in terms of their implications for adolescent substance use research, the examination of validity threats due to panel bias, and understanding the ecological validity of research findings.

Effects of a worksite coping skills intervention on the stress, social support, and health outcomes of working mothers.

This study examines the effectiveness of a 15-session worksite coping skills intervention aimed at modifying work- and family-related risk and protective factors and at reducing negative health outcomes among mothers employed in secretarial positions. A sample of 142 mothers employed at one of four corporate worksites was assessed at pretest, immediately following the intervention, and at 6-month follow-up using multiple self-report measures. Results showed that at immediate posttest, intervention participants reported significantly lower employee role stress, higher social support from work sources, and lower levels of alcohol and tobacco use. They also tended to report less use of avoidance coping and lower psychological symptomatology. At 6-month follow-up, intervention participants reported significantly lower work-family and work environment stress, higher social support from work sources, less avoidance coping, and lower psychological symptomatology. Attrition analyses provided support for the external and internal validity of the study findings. Results were discussed in relation to issues of longitudinal prevention research and worksite-based interventions.

Panel attrition and external validity in adolescent substance use research.

Panel attrition threatens external validity in adolescent substance use research. A 7-year adolescent panel was examined to determine whether attrition effects varied by (a) type of substance assessed and (b) method of measurement and type of statistical analysis. Chi-squares and multivariate analyses of variance revealed that study dropouts were more likely to use substances and reported higher mean use of substances at baseline than stayers; attrition effects varied by substance; and mean use comparisons were more likely to detect attrition effects than use-nonuse comparisons. Implications of these findings for adolescent substance use research are discussed.

Two-year follow-up of a social-cognitive intervention to prevent substance use.

This study presents two-year follow-up results of the Adolescent Decision-Making Program initially implemented when students were in their sixth grade. The intervention was found to maintain a positive effect on mean tobacco use, but no differences were observed for mean alcohol, marijuana, or hard drug use. In a test of the differential effectiveness of the intervention, program students living with married parents reported lower mean tobacco use than control students living with married parents and program and control students living with single parents. Logistic regression analyses examining the proportion of users at follow-up revealed a negative program effect for alcohol and no differences for the other substances. Subsequent attrition analyses strongly suggested that the positive effect for tobacco use at follow-up was most likely even stronger, and that the negative effect for alcohol was spurious. The importance of examining both program and attrition effects when evaluating the impact of longitudinal preventive interventions was emphasized, and the need to consider alternative models to guide the conceptualization and evaluation of adolescent substance use prevention programs was discussed.

Consultation and education in community mental health: a historical analysis.

A historical analysis of consultation and education services within community mental health centers is presented with a focus on the two major tasks that these services were intended to address:prevention andcommunity service system enhancement. This analysis begins with events that shaped the development of the initial community mental health center (CMHC) legislation, then examines key factors that influenced the nature and scope of consultation and education services as the federal CMHC program was implemented, and ends with a look at the changes that have occurred in these services since block grant funding was instituted. Throughout the analysis, central problems are discussed that have seriously hindered the development of viable consultation and education programs, and key policy, definitional and organizational issues are identified that must be addressed if these services are to become a meaningful component of the mental health service system.