A randomised controlled feasibility trial of alcohol consumption and the ability to appropriately use a firearm.

OBJECTIVE: To show the feasibility of using a controlled trial to investigate the effect of alcohol on firearm use. METHODS: Randomised, blinded, placebo-controlled trial in the Firearm Usage and Safety Experiments (FUSE) Lab. Treatment subjects (male, 21-40-year-old, non-habitual drinkers, with no professional firearms training) received alcohol; control subjects received placebo alcohol. The AIS PRISim Firearm Simulator, including real pistols retrofitted to discharge compressed air cartridges that simulate firearm recoil and sound, was used to measure firearm performance. Accuracy and speed for target shooting, reaction time scenarios, and scenarios requiring judgement about when to use a gun were measured. RESULTS: 12 subjects enrolled in the trial, completing 160 training scenarios. All subjects in the alcohol arm reached target alcohol level. 33% of placebo subjects reported alcohol consumption. Mechanical malfunction of the simulator occurred in 9 of 160 (5.6%) scenarios. Intoxicated subjects were less accurate, slower to fire in reaction time scenarios, and quicker to fire in scenarios requiring judgement relative to controls. CONCLUSIONS: The feasibility of a randomised, controlled trial exploring the relationship between alcohol consumption and firearm use was shown. The hypothesis that alcohol consumption worsens accuracy and retards judgement about when to use a gun should be tested. Larger trials could inform policies regarding firearm use while intoxicated.

Determining objective injury prevention priorities.

BACKGROUND AND OBJECTIVE: Finite injury prevention resources make the establishment of prevention priorities essential. Toward this end, the US National Trauma Data Bank (NTDB) for 2000 to 2004 was accessed and four injury prevention priority scores (one previously defined and three new scores) were computed. METHODS: An injury prevention priority score (IPPS) was calculated based on the frequency of an injury mechanism and the median injury severity score. In addition, a mortality priority score (Mort-PS), a hospital charge priority score (Charge-PS), and a years of potential life lost (YPLL-PS) priority score were calculated for the 13 most common injury mechanisms. RESULTS: There was variability across the four scores, but motor vehicle traffic, firearm related, and fall injuries ranked high on all four of the priority criteria. Multiple criteria should be considered when assessing injury burden. CONCLUSIONS: The methods presented here can help prioritize injuries and support more objective public policies.

Social behaviour and illness information interact to influence the peer acceptance of children with chronic illness.

OBJECTIVES: Social behaviour was investigated as a contributor to the peer acceptance of children with chronic illness. We predicted that children with illness would receive less acceptance than children without illness, and that prosocial behaviour would improve acceptance, while aggressive behaviour would hamper it. Based upon attribution and cognitive bias theories, we also predicted that prosocial behaviour would be more beneficial and aggressive behaviour less damaging to the acceptance of children with illness compared to healthy children. DESIGN: A 3 (social behaviour: prosocial, aggressive, no information) x 2 (physical status: chronically ill, healthy) within-subjects analogue design was used. METHODS: Preadolescents (N = 149) indicated social acceptance of hypothetical children portrayed in vignettes as either chronically ill or healthy with prosocial, aggressive, or no social behaviour. A 13-item social intentions scale gauged acceptance. RESULTS: The hypotheses were supported. Although children described as ill received lower acceptance ratings than healthy children, prosocial/ill children were more accepted than aggressive/ill children. Social behaviour interacted with physical status to affect acceptance. CONCLUSIONS: Social behaviour influences the peer acceptance of hypothetical children with chronic illness. Prosocial behaviour enhances acceptance of children described with illness, while aggressive behaviour hampers it. Additionally, prosocial behaviour is more beneficial, and aggressive behaviour is less damaging for children described as ill versus healthy. The potential processes by which peers judge acceptance of children with illness are discussed.

Self-regulating interest: the moderating role of hardiness and conscientiousness.

Sansone, Weir, Harpster, and Morgan (1992) found that individuals intentionally regulated their interest in an activity when they had both the need (the task was boring) and a reason to exert the effort (an ostensible health benefit). The present study examined Hardiness and Conscientiousness as moderators of this self-regulatory process when individuals had the option of quitting in addition to the options of persisting and of engaging in interest-enhancing strategies. Undergraduates performed a boring copying activity under instructions to stop when they felt they could evaluate the task. Half were told that their evaluations would help researchers develop good jobs for others (Benefit). Results indicated high hardy individuals copied more letters when they were provided the additional Benefit information, and this effect was mediated through their attempt to make the task more interesting. High conscientious individuals persisted longer than individuals lower in conscientiousness independently of the benefit manipulation or strategy use. Implications of individual differences in self-regulation of motivation are discussed.

Neuroticism, symptom presentation, and medical decision making.

In 2 studies, the authors explored whether neuroticism influences illness descriptions in a manner that affects medical decisions. In Study 1, 80 participants presented an imagined illness that was high or low in severity to a confederate medical student. Neuroticism was associated with more elaborate symptom presentations and, among high-severity participants, with more disclosures of psychosocial information. In Study 2, representative videotapes from Study 1 were selected as stimuli to be evaluated by 14 family practice residents. Residents were able to discriminate between severity conditions for low- but not for high-neuroticism participants. Residents also viewed high-neuroticism participants as less credible, less in need of medical treatment, and more in need of mental health treatment than low-neuroticism participants. Correlations suggest the report of psychosocial concerns by high-neuroticism participants contributed to these effects.

Behavioral self-regulation in adolescents with type I diabetes: negative affectivity and blood glucose symptom perception.

The hypothesis that negative affectivity (NA) is associated with accuracy of blood glucose (BG) symptom perceptions and diabetes control was assessed. After completing measures of BG symptom beliefs and NA-related constructs (i.e., attentional focus and trait anxiety), 35 adolescents with insulin-dependent diabetes monitored their physical symptoms and their actual BG levels 3 times daily for 2 weeks. Each subject's actual BG symptoms were determined by correlating symptom ratings with BG levels and were then compared with symptom beliefs. Those who were more internally focused were more able to discern which symptoms actually covaried with BG fluctuations; those with higher trait anxiety tended to misattribute non-diabetes-related symptoms to BG levels. Finally, interactions suggested that those who both attend to internal physical sensations and experience-heightened anxiety display poorer metabolic control.

An analysis of response prevention and flooding procedures in the treatment of adolescent obsessive compulsive disorder.

Flooding and response prevention have been widely used in the treatment of adult obsessive compulsive disorder but have been overlooked in favor of less restrictive procedures when treating children. The present case investigates the utility of these procedures in an adolescent with severe compulsive handwashing. Treatments were introduced hierarchically to minimize subject distress; graded exposure decreased the frequency of handwashing, but flooding was required to eliminate the compulsion. Guidelines for the ethical use of flooding and exposure therapies with children are offered.

Coping processes as mediators of the relationship between hardiness and health.

Hardiness has been hypothesized to moderate the impact of stress on health by influencing coping responses, but little attention has been focused upon these associations. This study examined the relationship among hardiness, coping, and illness while attending to recent criticisms of the hardiness literature including the potential overlap with neuroticism, whether hardiness is a unitary construct, and the predominant use of male samples. Hardiness was found to be positively related to adaptive coping variables and negatively related to maladaptive coping variables. Problem-focused, support-seeking, and avoidant coping were found to mediate the hardiness-illness relationship. Although these hardiness-coping relationships were partially independent of the influence of neuroticism, the relationship of both coping and hardiness with self-reported illness appeared to result from the common influence of neuroticism. Consistent with previous research, the commitment and control components correlated most consistently with coping variables, and predicted hardiness effects were most consistently demonstrated for males.

Hardiness and stress moderation: a test of proposed mechanisms.

High and low hardy male and female undergraduates completed an evaluative threat task that was manipulated to influence appraisals of the task in a manner consistent with hardiness theory. High hardy subjects displayed higher frustration tolerance, appraised the task as less threatening, and responded to the task with more positive and less negative affect than did low hardy subjects. Although all subjects displayed increased heart rate (HR) in response to the experimental task, high hardy men displayed lower HR elevations during the task than did low hardy men. Hardiness did not influence HR responses among women. Manipulations of task appraisal revealed a similar pattern where men in the high hardiness appraisal conditions displayed lower levels of physiological arousal during the task than did men in the low hardiness appraisal conditions. Appraisal manipulations had either no effect or the opposite effect among women.

Stress and blood glucose in type II diabetes mellitus.

Six adults with non-insulin dependent diabetes mellitus participated in a laboratory procedure to determine the effects of an acute stressor, mental arithmetic, on blood glucose, cardiovascular, and subjective indices of stress. They then completed 12 days home monitoring of stressful events, subjective stress, and blood glucose. Diet and activity were controlled to evaluate the direct effects of stress on blood glucose in the natural environment. Laboratory results showed significant increases in blood glucose, cardiovascular (HR and SBP), and subjective stress ratings during the mental arithmetic task when compared to a resting condition. Home monitoring data were consistent with the laboratory findings; blood glucose range tended to be greater on high vs low stress days, especially when the difference between high and low stress was greatest. These findings suggest that the laboratory stress induction procedure was externally valid and that in the natural environment, stress has a hyperglycemic effect on blood glucose.

Life events, fitness, hardiness, and health: a simultaneous analysis of proposed stress-resistance effects.

The effects of exercise participation, self-perceived fitness level, and dispositional hardiness for promoting stress resistance were examined in a sample of 373 college students. Self-report measures of stressful life experience and recent physical illness were positively correlated, and fitness and hardiness were negatively correlated with illness as expected. Multiple regression analyses indicated that neither fitness nor hardiness provided a stress-moderator effect because neither was found to significantly interact with stress in the prediction of illness scores. Structural equation analyses suggested that hardiness may affect health indirectly by first influencing either the occurrence or subjective interpretation of stressful life events. No direct effect on health was found for exercise participation, although exercise may reduce illness indirectly by improving fitness. Implications for the multivariate modeling of proposed stress-resistance-enhancing effects are discussed.

Comparison of response formats for Multidimensional Health Locus of Control Scales: six levels versus two levels.

Two formats of the Multidimensional Health Locus of Control (MHLC) Scales were administered to 54 college students. Each subject completed the MHLC Scales in the standard 6-level response format (ranging from strongly disagree to strongly agree) and in a revised 2-level format (ranging from disagree to agree). Comparisons of internal consistency measures, principal components, and classification of subjects into groups indicate that the 2-level response format yields comparable data to those obtained with the 6-level format, particularly when classification of subjects is the goal.

Behavioral assessment of narcotic detoxification fear.

Recent data reveal that only a small number of opioid addicts who attempt to detoxify from methadone maintenance programs will be successful. An irrational fear of detoxification has been postulated to be one reason for detoxification not being more efficacious. The present investigation attempted to assess both self-report and psychophysiological responses to detoxification and neutral scenes in two groups of persons on methadone maintenance. The two groups (N = 8 each) were selected by two blind interviewers as either having or not having a detoxification fear. After imagery training, subjects were asked to imagine 10 scenes, alternating between neutral and detoxification scenes with random counterbalancing for order, while the psychophysiological dependent measures and self-report anxiety and clarity ratings were assessed. Some of the self-report and psychophysiological measures were significantly different for scene type, indicating a successful manipulation of scene imagery. Further, pulse volume measures indicated greater activation in the fear group than in the non-fear group to the detoxification scenes. The results are discussed in terms of providing evidence for greater activation, presumably due to greater anxiety, for the detoxification fear subjects than the non-fear subjects specific to the detoxification imagery and in terms of potential treatment implications.

Assessing pathological detoxification fear among methadone maintenance patients: the DFSS.

This study assessed the reliability, validity, discriminative accuracy, and factor structure of the Detoxification Fear Survey Schedule (DFSS). Prevalence of detoxification fear and its correlates also were assessed. Random samples from three geographically, culturally, and racially disparate populations (N = 271) of treated opioid addicts were used. The DFSS had a test-retest r = .935 and demonstrated several indicants of validity. A briefer version (DFSS-14) showed superior psychometric properties and could identify correctly 81% of the detox fear subjects while it excluded 55% of nonfear subjects. The DFSS-14 had a replicated three-factor structure that accounted for 62.1% of total item variance in the validation sample. Factor two, probably best named dose reduction fear, was replicated in all populations. A cut-off score set at the nonfear mean is recommended for clinical use. A brief clinical interview of positive scorers quickly should eliminate false positives and, thus, efficiently identify most of those with detoxification fear.

Prevalence and diagnostic reliability of methadone maintenance detoxification fear.

The authors identified a pathological fear of methadone detoxification in 22%, 25%, and 32% of random samples of patients in three disparate methadone maintenance programs. Patients with a pathological fear of detoxification had higher scores on the Detoxification Fear Survey Schedule, had longer histories of addiction, had been addicted for a larger percent of their life spans, and were older than patients without this fear. A greater proportion of the female patients had this fear, and a greater proportion of the patients with this fear had drug-free urinalyses. The authors recommend the use of the Detoxification Fear Survey Schedule as well as intervention to help rehabilitated opioid addicts initiate and complete detoxification.

Health practices and hardiness as mediators in the stress-illness relationship.

Two stress and illness models that include the joint mediating effects of health practices and hardiness were tested prospectively over a 2-month period. At the beginning of one academic quarter, 60 female and 26 male undergraduate students completed five subscales indexing hardiness. Stress, health practices, and illness for the prior month were assessed at this time as well as 1 and 2 months later. Stress was measured by the number of negatively rated stressors reported on the Life Experiences Survey. Health practices were measured by the Self Care Inventory. In the first model, illness was measured by the severity of physical symptoms reported on the Seriousness of Illness Rating Scale; in the second model, it was measured by the number of symptoms reported. Correlations between all measures of stress and illness were typical for life events research (r = .22 to .29). In both models, path analyses revealed that stress acted directly to affect illness as well as indirectly by changing health practices. Hardiness also had a direct effect on illness as well as in indirect effect through health practices. Hardiness did not appear to have a stress-buffering effect on illness; rather, its effects on illness appeared to be independent of its effects on stress. Implications for life events research are discussed.