Assessing Specific Sexual Behavior: Instrument Development and Validation Techniques.

Through the use of multi-modal methods, the purpose of this study was to develop and assess measurement properties of an instrument evaluating specific sexual behaviors of college students and the role alcohol intoxication plays in one's intention to participate in these behaviors. A modified version of N. Krause's instrument development process was applied to create a behavior-specific instrument assessing oral, vaginal, and anal sex behaviors. The process included a review by expert scholars in relevant fields, cognitive interviews with the target population using screen-capture program Camtasia, piloting to assess measurement scales, and a formal investigation. The applied instrument development process employed screen capture software and web-based surveying in a cost-effective format suitable for mixed-method measurement development. The development and application of the instrument provides a clearer understanding of the relationship between alcohol use and sexual activity and aids in the development of effective public health interventions and policies.

Smoking cessation interventions among Hispanics in the United States: A systematic review and mini meta-analysis.

PURPOSE: The leading causes of mortality among Hispanics living in the United States are smoking related. This study sought to systematically review smoking cessation interventions targeting healthy Hispanic adults living in the United States, to conduct a "mini" meta-analysis of randomized controlled trials, and to offer recommendations for future research. DATA SOURCES: Studies were identified through computerized bibliographic databases (PsychINFO, PsycARTICLES, PsycFirst, MEDLINE, Science Direct, and Dissertation Abstracts Online), article reference lists, conference abstracts, and unpublished data through October 2008. STUDY INCLUSION AND EXCLUSION CRITERIA: Evaluation of a smoking cessation intervention among healthy U.S. Hispanic adults. Studies included in the meta-analysis were also required to be randomized controlled trials. DATA EXTRACTION: Twelve studies were eligible for the systematic review and five studies for the meta-analysis. Two independent raters coded each study. DATA SYNTHESIS: Interventions consisted of self-help, nicotine replacement therapy, and community-based interventions, as well as individual, group, and telephone counseling. There was evidence for the efficacy of smoking cessation interventions at the end of treatment (odds ratio, 1.54; 95% confidence interval, 1.09-2.16), which was attenuated in the longer term. CONCLUSIONS: Tobacco use among U.S. Hispanics is a growing public health concern. Smoking cessation interventions demonstrate promise among Hispanic adults living in the United States. More randomized trials evaluating tobacco interventions in this special population are warranted, with examination of the effect of cultural specificity and acculturation.

Effects of culturally specific cessation messages on theoretical antecedents of behavior among low-income african american smokers.

Previous research has highlighted the importance of cultural relevance in health risk communications, including tobacco interventions. However, few studies have examined the active components of smoking cessation messages targeting low-income African American smokers. This study tested the influence of message content and culturally specific framing in a sample of adult smokers. In a 2 x 2 factorial experiment, 243 African American smokers (M = 19 cigarettes/day) recruited from the community (55% women; mean age = 43 years) were randomly assigned to 1 of 4 conditions: culturally specific smoking messages, standard smoking messages, culturally specific exercise/weight messages, or standard exercise/weight messages. The primary outcome measures were theoretical antecedents to behavior change, including risk perceptions (general, personal, and culturally specific), readiness to quit smoking, and smoking-related knowledge. The results showed that the smoking messages produced greater culturally specific risk perceptions, readiness to quit smoking, and smoking-related knowledge. The culturally specific messages produced greater personal risk perceptions and intentions to quit. Culturally specific risk perceptions were most affected by culturally specific smoking messages. Findings support the roles of message content and culturally specific framing in the efficacy of brief written interventions for smoking cessation in this population. Future research is needed to examine the influence of these constructs on behavior change.

Cognitive-behavioral therapy to promote smoking cessation among African American smokers: a randomized clinical trial.

OBJECTIVE: The health consequences of tobacco smoking disproportionately affect African Americans, but research on whether efficacious interventions can be generalized to this population is limited. This study examined the efficacy of group-based cognitive-behavioral therapy (CBT) for smoking cessation among African Americans. METHOD: Participants (N = 154; 65% female, M = 44 years old, mean cigarettes/day = 13) were randomly assigned to either (a) group CBT or (b) group general health education (GHE). Participants in both conditions received 6 sessions of counseling and 8 weeks of transdermal nicotine patches. The primary outcome variable was 7-day point prevalence abstinence (ppa), assessed at the end of counseling (2 weeks) and at 3- and 6-month follow-ups. Secondary outcomes included 24-hr ppa and 28-day continuous abstinence (assessed at 3 and 6 months). RESULTS: Intent-to-treat analyses demonstrated the hypothesized effects, such that 7-day ppa was significantly greater in the CBT than the GHE condition at the end of counseling (51% vs. 27%), at 3 months (34% vs. 20%), and at 6 months (31% vs. 14%). Results of a generalized linear mixed model demonstrated a significant effect of CBT versus GHE on 7-day ppa (odds ratio = 2.57, 95% CI [1.40, 4.71] and also an effect of time (p < .002). The Condition x Time interaction was not significant. Similar patterns of results emerged for 24-hour ppa and 28-day continuous abstinence. Results from per protocol analyses (i.e., participants who completed all aspects of the study) corroborate the intent-to-treat findings. CONCLUSIONS: These results demonstrate that intensive, group CBT smoking cessation interventions are efficacious among African American smokers.

Culturally specific interventions for African American smokers: an efficacy experiment.

This pilot study sought to dismantle the efficacy of culturally specific print materials for smoking cessation. Two-hundred sixty-one African American smokers were randomized into 1 of 2 conditions: standard booklet or culturally specific booklet. The content and length of the interventions were identical yet varied in their degree of cultural specificity. Three-month follow-up assessments were completed by 70% (N = 183) of participants. Dependent variables included content evaluation, readiness to quit smoking, and actual behavior change. Evidence suggested that the culturally specific material was more effective at capturing attention, providing encouragement and gaining interest compared to standard materials; however, greater credibility was found for standard materials. In addition, greater readiness to quit and more 24-hour quit attempts were found in the standard condition. No differences were found in abstinence rates. In conclusion, culturally specific interventions may be preferred over standard approaches among African American smokers. Culturally specific approaches, however, may not result in greater behavior change. Implications for written interventions and cultural specificity are discussed.

Psychosocial factors associated with weight control expectancies in treatment-seeking African American smokers.

African Americans are disproportionately affected by tobacco smoking and obesity. As weight control expectancies can reinforce smoking maintenance, the purpose of this study was to explore psychosocial factors related to expectancies for weight control among African Americans seeking cessation treatment. African American smokers (N = 117) provided information on demographics, family medical history, personal risk factors, smoking, weight control expectancies and concerns, perceived stress, and acculturation. Multivariate analyses examined hypotheses regarding determinants of weight control expectancies. Fifty-one percent of participants were concerned about gaining weight upon cessation. Positive expectations for weight control through smoking were associated with older age, a family history of heart disease, greater perceived stress, and a lower level of acculturation. In conclusion, many African American smokers are concerned about postcessation weight gain: expectations for weight control through smoking are most evident those with elevated perceived stress, traditional African American cultural values, and a family history of chronic illness. Needed are culturally specific smoking cessation interventions that include weight management strategies as an adjunct to smoking cessation treatments.

Correlates of smoking quit attempts: Florida Tobacco Callback Survey, 2007.

OBJECTIVE: The public health burden of tobacco-associated diseases in the USA remains high, in part because many people's attempts to quit are unsuccessful. This study examined factors associated with having lifetime or recent attempts to quit smoking among current smokers, based on a telephone survey of Florida adults. METHODS: Data from the 2007 telephone-based Florida Behavioral Risk Factor Surveillance System (BRFSS) and its follow-up survey, the Tobacco Callback Survey, were used to assess determinants of having ever attempted to quit smoking and attempted to quit smoking in the past 12 months. All analyses were conducted using SAS. RESULTS: Among 3,560 current smokers, 41.5% reported having tried to quit smoking in the past 12 months while 83.4% reported having ever tried to quit. Having a history of a tobacco-related medical condition was significantly associated with both recent (Adjusted Odds Ratio (AOR) 1.41 [Confidence Interval 1.19-1.65]) and lifetime quit attempts (AOR 1.43 [1.15-1.79]). Greater nicotine dependence and being advised by a physician to quit smoking were also positively associated with lifetime quit attempts. Receipt of healthcare provider advice to quit smoking in the past 12 months and a strong belief that quitting following a long history of regular smoking would not result in health benefits and belief that there are health benefits to quitting smoking were associated with lifetime quit attempts. CONCLUSION: Targeted smoking cessation interventions are needed for smokers with selected medical conditions and with high nicotine dependence. The importance of physician advice in encouraging individuals to quit is further highlighted.

Medication adherence in HIV-infected smokers: the mediating role of depressive symptoms.

Strict medication adherence is integral to the success of highly active antiretroviral therapies (HAART) in patients with HIV. Research has examined several predictors of adherence, but few studies have examined the association between current smoking, which is highly prevalent among people living with HIV, and medication adherence; moreover, no study has examined the mediating role of depressive symptoms, which may influence both smoking and adherence. Therefore, we recruited 168 patients who were prescribed HAART and assessed viral load, CD4+ count, cigarette smoking, past week and 3-month medication adherence, and depressive symptoms. Results showed that 70% smoked at least one cigarette per day. As predicted, smoking was associated with poorer past week and 3-month adherence, and more depressive symptoms. Regression analyses provided partial support for the hypothesis that depressive symptoms mediated nonadherence among smokers. We conclude that future smoking cessation interventions with this population should target medical adherence and depression as intervention components.

The early health consequences of smoking: relationship with psychosocial factors among treatment-seeking Black smokers.

INTRODUCTION: Blacks suffer disproportionately from the long-term health effects of smoking. Little is known about the prevalence of the early health consequences of smoking in this population or whether psychosocial factors influence the frequency of symptoms. This study investigated the prevalence and psychosocial correlates of smoking-related physical symptoms in Black smokers. METHODS: Adult smokers (N = 117, 58% female, M(age) = 43.0 years) who smoked at least 5 cigarettes/day completed self-administered assessments of cigarettes smoked per day, smoking duration, alcohol use, perceived stress, depressive symptoms, and smoking-related symptoms. RESULTS: The most frequently occurring physical symptoms were shortness of breath (66%), coughing (50%), and headaches (49%). Multivariate analyses showed that smoking history, alcohol use, perceived stress, and depressive symptoms were independently related to smoking-related symptoms, even after controlling for sociodemographic variables and medical diagnoses. DISCUSSION: The early health consequences of smoking appear to be common among Black smokers and can serve as a cue to action for cessation efforts. Alcohol use, stress, and depression appear to negatively influence the early health consequences of smoking and should be assessed routinely in treatment-seeking Black smokers.

Recruiting African American smokers into intervention research: Relationships between recruitment strategies and participant characteristics.

The purposes of this study were to (a) to describe an 8-month recruitment campaign to enroll African American smokers (N = 249) into a randomized controlled trial and (b) examine characteristics of participants recruited through proactive (face-to-face), reactive (television, radio, or newspaper ads inviting participants), and combination (both reactive and proactive) approaches. Reactive recruitment was most successful (43%), followed by proactive (31%), and combination (26%) recruitment. Compared to proactive recruitment, reactive recruitment was associated with lower nicotine dependence, and greater readiness to quit, processes of change engagement, and acculturation. Combination recruitment was associated with lower nicotine dependence and greater readiness to quit. The differences according to recruitment strategy could be used to tailor recruitment strategies for African American smokers.

Does one size fit all African American smokers? The moderating role of acculturation in culturally specific interventions.

There is a consensus that interventions for ethnic minority populations should be culturally specific (CS). A previous study found that although African American smokers indicated a preference for CS self-help materials over standard materials, several outcomes were superior for the standard information (Webb, 2008). The current study reports on a priori analyses that tested level of acculturation as a moderating variable for the efficacy of CS interventions in a sample of low-income African Americans. Participants (N = 182) completed the African American Acculturation Scale-Revised before receiving a CS smoking cessation guide or a standard guide. As hypothesized, level of acculturation predicted evaluations of the intervention content, readiness to quit smoking, and 24-hr point prevalence abstinence at the 3-month follow-up. Lower levels of acculturation (i.e., more engagement in traditional African American culture) predicted a preference for CS materials and greater readiness to quit smoking after receiving the CS guide. Yet, among participants who were less acculturated, 24-hr abstinence was greater after receiving the standard guide. Overall, these findings emphasize that individual differences in levels of acculturation to the dominant culture affect receptivity to CS written interventions. Intragroup differences should be considered prior to the provision of CS interventions.

Treating tobacco dependence among African Americans: a meta-analytic review.

OBJECTIVE: African Americans suffer disproportionately from smoking-related morbidity and mortality; yet it is unclear whether existing treatments benefit this population. The purposes of this meta-analysis were to evaluate the overall efficacy of smoking cessation interventions (SCIs) among African American adults and to examine specific study characteristics and methods that influence treatment outcome. DESIGN: Twenty published and unpublished studies representing 32 hypothesis tests and 12,743 smokers compared SCIs to control conditions. MAIN OUTCOME MEASURES: (1) Smoking abstinence post-treatment; (2) abstinence at the first follow-up assessment; and (3) 11 potential moderators of treatment effects. RESULTS: Overall, SCIs increased the odds of cessation by 40% at posttest and 30% at follow-up. Treatment type, setting, cultural specificity, unit of analysis, outcome measure, nature of control group, and biochemical verification moderated the overall treatment effect size. CONCLUSION: SCIs are efficacious among African Americans. Theoretical, clinical, and future research implications are discussed.

Tobacco smoking among low-income Black women: demographic and psychosocial correlates in a community sample.

This study sought to identify demographic and psychosocial correlates of cigarette smoking among low-income U.S. Black females. A total of 263 women provided demographic information and completed measures of perceived stress, anger, and alcohol and tobacco use. The analyses examined smoking using two variables: (a) smoking status category (nonsmokers [0 cigarettes/day], light smokers [1-10 cigarettes/day], moderate smokers [11-19 cigarettes/day], and heavy smokers [> or =20 cigarettes/day]) and (b) a continuous measure of cigarettes smoked daily. Multinomial logistic (MLR) and hierarchical multiple regression (HMR) analyses were used to model demographic, psychological, and alcohol use correlates of smoking. Results indicated that 30% of the sample were nonsmokers, 44% reported light smoking, 6% were moderate smokers, and 20% were heavy smokers. Both regression models explained a significant proportion of the variance in smoking, accounting for 57% and 31%, respectively. Across smoking categories, the odds of smoking were greater for older women who had less education, lower income, greater perceived stress, and more frequent heavy alcohol use. Number of cigarettes smoked daily was associated with similar factors, including less education and income, and older age. Heavy smoking was predicted by having fewer children. Current drinking was associated with light and heavy smoking, and with the extent of daily smoking. Anger was not a predictor of smoking in either model. A more complete understanding of the demographic and psychosocial factors associated with smoking among Black women can inform prevention and cessation strategies aimed at this population.

Focus groups as an intervention for low-income African American smokers to promote participation in subsequent intervention studies.

African Americans are often underrepresented in smoking cessation research. Focus groups were examined as an intervention to increase readiness to quit smoking, the processes of change, and the odds of randomized clinical trial (RCT) participation of non-treatment-seeking, low-income African American smokers. Ten focus groups were conducted. Smokers completed baseline and/or post-group assessments of readiness to quit, the processes of change, and focus group quality. Significant increases were discerned in readiness to quit smoking and the processes of change. Seventy-six percent of participants enrolled in a self-help RCT, which was associated with readiness to quit smoking and plans to set a quit date. One-session focus groups among low-income African American smokers appear to facilitate cognitive changes and participation in RCTs.

Drink specials and the intoxication levels of patrons exiting college bars.

OBJECTIVES: To determine whether drink specials independently increase patrons' risk of achieving a high level of intoxication upon exiting drinking establishments. METHODS: In a campus community, data were collected from exiting patrons (N=291) via sidewalk interviews and breath tests on 6 nights of 2 consecutive semesters. RESULTS: A multivariate model revealed that taking advantage of a drink special was associated with a fourfold increase in risk of achieving a BAC >or= 80 mg/dl. CONCLUSIONS: These findings are the first to document that the drink discounting practices of college bars can be linked to higher intoxication levels among exiting patrons.

Health disparities and culturally specific treatment: perspectives and expectancies of African American smokers.

When the following article originally appeared in the Journal of clinical Psychology (Volume 63, number 6, june 2007), a number of author corrections were omitted. We regret this oversight and now reprint the article in full. Researchers suggest that culturally specific (CS) interventions are important in addressing smoking-related health disparities. Yet, little research has examined the perspectives of African American smokers regarding these efforts. This qualitative study sought to gain insight into perceptions related to (a) the smoking prevalence among African Americans, (b) smoking-related health disparities, (c) expectancies for CS interventions, (d) methods of recruiting research participants, and (e) key intervention components. Six focus groups were conducted with 41 African American smokers (aged 21-64) at a community health center. Content analyses revealed several themes, including the perception that smoking is normative among African Americans, limited knowledge of racial health disparities, mixed perceptions regarding race as a risk factor for illness, and mixed expectancies for the efficacy of CS interventions. In conclusion, individual differences, such as smoking norms, knowledge of health disparities, and intervention expectations may influence receptivity to CS treatments. Implications for tobacco interventions among African Americans are discussed.

Expectancy priming of smoking cessation messages enhances the placebo effect of tailored interventions.

OBJECTIVE: Previous research (Webb, Simmons, & Brandon, 2005) suggested that smokers' reactions to self-help materials were more positive if they believed that the materials had been personally tailored to their individual characteristics and if they held expectancies that tailored interventions are superior to standard, or generic, interventions. The authors' objective in the current study was to replicate and extend this research by testing the efficacy expectancy priming before intervention delivery. DESIGN: In a 2 x 2 factorial experiment, 210 smokers (M = 23 cigarettes/day) recruited from the community (62% female; 92% Caucasian; mean age = 49) were randomly assigned to 1 of 4 conditions: placebo-tailored intervention/no priming, placebo-tailored intervention/priming, standard intervention/no priming, or standard intervention/priming. The tailoring-related expectancies of participants' in the priming conditions were primed before they were presented with the respective intervention booklets. MAIN OUTCOME MEASURES: Content evaluations, readiness to quit smoking, cessation self-efficacy, smoking-related knowledge, and progress toward quitting (behavior changes). Assessments occurred by mail at baseline and at 1-month postintervention. RESULTS: Similar to the earlier study, the placebo-tailored booklets produced superior evaluations and smoking-related cognitive and behavioral changes. Moreover, the pretreatment expectancy priming successfully altered participants' tailoring-related expectancies and also produced superior evaluations and outcomes. CONCLUSION: Findings support a causal role of tailoring-related expectancies on the efficacy of tailored interventions and suggest that interventions can be enhanced via expectancy priming.

Cigarette smoking among HIV+ men and women: examining health, substance use, and psychosocial correlates across the smoking spectrum.

The prevalence of cigarette smoking among HIV+ individuals is greater than that found in the general population. However, factors related to smoking within this population are not well understood. This study examined the associations between smoking and demographic, medical, substance use, and psychosocial factors in a clinic-based sample of HIV+ men and women. Two hundred twelve participants completed self-report measures of tobacco use, HIV-related symptoms, viral load, CD4, alcohol and illicit drug use, depression, and social support. Multinomial logistic regression (MLR) analyses modeled the independent associations of the cross-sectional set of predictors with smoking status. Results indicated that 74% of the sample smoked at least one cigarette per day; using standard definitions, 23% of the sample were light smokers, 22% were moderate smokers, and 29% smoked heavily. Smoking was associated with more HIV-related symptoms, greater alcohol and marijuana use, and less social support. Light smoking was related to minority race/ethnicity and less income; moderate smoking was associated with less education; and heavy smoking was related to less education and younger age. Viral load, CD4 count, and depression were not associated with smoking status. Psychosocial interventions targeting this population should consider the relationships between biopsychosocial factors and smoking behavior.

Health disparities and culturally specific treatment: perspectives and expectancies of African American smokers.

Researchers suggest that culturally specific (CS) interventions are important in addressing smoking-related health disparities. Yet, little research has examined the perspectives of African American smokers regarding these efforts. This qualitative study sought to gain insight into perceptions related to (a) the smoking prevalence among African Americans, (b) smoking-related health disparities, (c) expectancies for CS interventions, (d) methods of recruiting research participants, and (e) key intervention components. Six focus groups were conducted with 41 African American smokers (aged 21-64) at a community health center. Content analyses revealed several themes, including the perception that smoking is normative among African Americans, limited knowledge of racial health disparities, mixed perceptions regarding race as a risk factor for illness, and mixed expectancies for the efficacy of CS interventions. In conclusion, individual differences, such as smoking norms, knowledge of health disparities, and intervention expectations may influence receptivity to CS treatments. Implications for tobacco interventions among African Americans are discussed.

The use of GEE for analyzing longitudinal binomial data: a primer using data from a tobacco intervention.

Longitudinal study designs in addictive behaviors research are common as researchers have focused increasingly on how various explanatory variables affect responses over time. In particular, such designs are used in intervention studies that have multiple follow-up points. These designs typically involve repeated measurement of participants' responses, and thus correlation within each participant is expected. Correct inferences can only be obtained by taking into account this within-participant correlation between repeated measurements, which can complicate the analysis of longitudinal data. In recent years, generalized estimating equations (GEE) has become a standard method for analyzing non-normal longitudinal data, yet it often is not utilized by addiction researchers. The goal of this article is to provide an overview of the GEE approach for analyzing correlated binary data for behavioral researchers, using data from an intervention study on the prevention of relapse to tobacco smoking.