[Show abstract][Hide abstract] ABSTRACT: This study examines the feasibility of recruiting and retaining adolescents and young adults with frequent cannabis use for a 2-week momentary sampling study of cannabis use. Participants responded to random signals on a handheld computer with reports of their use. Participants also initiated reports pre- and post-cannabis use. Participants had high rates of completion (93%) and response to signals (74%) and low study burden. Cannabis use influenced the validity of the data (p < .05). These findings highlight the feasibility of recruiting and retaining adolescent/young adult cannabis users in a momentary sampling study. Data validity may be affected by substance use.
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVE To assess the perceived effectiveness of tobacco cessation continuing education for pharmacists in face-to-face presentation versus live webinar modalities. METHODS A continuing pharmacy education (CPE) activity, Do Ask, Do Tell: A Practical Approach to Smoking Cessation, was offered in face-to-face and live webinar modalities. Following the activity, participants completed a brief questionnaire that assessed the anticipated impact of the activity on their smoking cessation counseling practices. RESULTS Of the 1,088 CPE participants, 819 (75%) attended a face-to-face presentation and 269 (25%) participated in a live webinar. Posttraining self-rated ability to address tobacco use was similar between groups ( P = 0.38), and both the face-to-face and live webinar groups reported a significant difference between pre- and posttraining abilities ( P < 0.05 for both groups). Attendees of the face-to-face presentation reported higher likelihoods of providing each of the individual tasks required to provide an effective, brief tobacco cessation intervention ( P < 0.05 for each task). CONCLUSION These data suggest that more value exists in face-to-face education than live webinars when personal and interactive skills are the focus of the activity.
Journal of the American Pharmacists Association 01/2014; 54(1):42-4. DOI:10.1331/JAPhA.2014.13001
[Show abstract][Hide abstract] ABSTRACT: The present investigation tested whether an enhanced smoking cessation program produced higher cessation rates for participants than for controls. Participants in the enhanced intervention condition received in-person motivational counseling with health feedback, a tailored internet-based program, and nicotine patch. Participants in the control group received a smoking cessation self-help manual and nicotine patch. This randomized controlled trial was conducted at a 4-year university with a student body of 32,000. Five hundred-nine students who smoked ≥1 cigarette daily were individually randomized into the enhanced intervention and control groups. Over a 3-month period, participants in the enhanced intervention condition attended two personal sessions with smoking cessation counselors. Participants in both conditions were reassessed for smoking status 12 months post-baseline. Multivariate logistic regression techniques were used to analyze the data using the intent to treat approach. Results indicated that the odds of smoking cessation were 2 times larger for the enhanced intervention group than controls (odds ratio = 2.3, 95%, confidence interval = 1.3, 3.9, 𝑃<.01). This study begins to fill research gaps regarding college students and smoking cessation. Suggestions for future advancements in smoking cessation interventions for college students are provided.
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Community pharmacies have the potential to reduce the prevalence of tobacco use, yet most pharmacies do not integrate cessation activities into routine practice. OBJECTIVES: The objective of this study was to describe the recruitment strategy and participant yield for a 2-state, randomized trial evaluating 2 intervention approaches for increasing pharmacy-based referrals to tobacco quitlines. METHODS: Detailed study recruitment tracking forms were used to document all contact attempts between the study investigators and each potential study site. These data were analyzed to characterize the overall recruitment and consent process for community pharmacies and pharmacy personnel (pharmacists, technicians). RESULTS: Achieving the target sample size of 64 study sites required contacting a total of 150 pharmacies (84 independent and 66 chain). Excluding 22 ineligible pharmacies, participation rates were 49% (32 of 65) for independent pharmacies and 51% (32 of 63) for chain pharmacies (50% overall). Across the 64 participating pharmacies, a total of 124 pharmacists (of 171; 73%) and 127 pharmacy technicians (of 215; 59%) were enrolled in the study. Pharmacies that chose not to participate most often cited time constraints as the primary reason. Overall, combining both the recruitment and consent process, a median of 5 contacts were made with each participating pharmacy (range, 2-19; interquartile range [IQR], 4-7), and the median overall duration of time elapsed from initial contact to consent was 25 days (range, 3-122 days; IQR, 12-47 days). CONCLUSIONS: Results from this study suggest that community pharmacy personnel are receptive to participation in multisite, tobacco cessation clinical research trials. However, execution of a representative sampling and recruitment scheme for a multistate study in this practice setting is a time- and labor-intensive process.
Research in Social and Administrative Pharmacy 07/2012; 9(4). DOI:10.1016/j.sapharm.2012.06.001 · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Antibiotics are frequently used to treat acute rhinosinusitis (ARS; acute sinusitis), although many episodes are viral. Because of community resistance concerns, current evidence provides limited support for the use of antibiotics in ARS. We conducted a retrospective comparative effectiveness outcomes assessment of the nasal steroid mometasone furoate nasal spray (MFNS) versus antibiotics among ARS patients in clinical practice.
Using the General Practice Research Database (United Kingdom), the earliest ARS event between January 1, 2005 and December 31, 2008 (index event) for patients aged 12-75 years and an antibiotic or MFNS prescription ±2 days was identified. Treatment cohorts were MFNS monotherapy (MM), MFNS + antibiotic (MAT), and antibiotic monotherapy (AM). Logistic regression adjusted for potential confounders and compared odds of rhinosinusitis-related medical encounters and related prescriptions in the 3- to 30-day postindex period.
There were 12,679 eligible patients (651 MM; 2285 MAT; 9743 AM). Compared with the reference cohort AM, during the 3- to 30-day postindex period, lower adjusted odds (p < 0.001) of having one or more rhinosinusitis-related medical encounters was observed for MM (odds ratio [OR] = 0.39; 95% CI, 0.26-0.58) and MAT (OR = 0.51; 95% CI, 0.42-0.62); having one or more rhinosinusitis-related prescriptions for MM (OR = 0.51; 95% CI, 0.42-0.63) and MAT (OR = 0.58; 95% CI, 0.52-0.65); having one or more antibiotic, nasal steroid, or oral steroid prescriptions for MM (OR = 0.36; 95% CI, 0.28-0.46) and MAT (OR = 0.51; 95% CI, 0.46-0.58); and having one or more antibiotic prescriptions for MM (OR = 0.43; 95% CI, 0.33-0.58) and MAT (OR = 0.63; 95% CI, (0.55-0.72).
Compared with AM, using MFNS for initial ARS treatment, alone or with an antibiotic, is associated with a decreased likelihood of both subsequent rhinosinusitis-related medical encounters and use of related prescriptions.
American Journal of Rhinology and Allergy 07/2012; 26(4):308-14. DOI:10.2500/ajra.2012.26.3781 · 2.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: BACKGROUND: Despite the fact that individuals who smoke are at an increased risk for disease and therefore require frequent visits to pharmacies for medications, most community pharmacies do not integrate tobacco cessation activities into routine practice. OBJECTIVE: The objective of this report is to describe the methods and baseline findings for a 2-state randomized trial evaluating 2 intervention approaches for increasing pharmacy-based referrals to their state's tobacco quitline. METHODS: Participating community pharmacies in Connecticut (n=32) and Washington (n=32) were randomized to receive either (1) on-site education with an academic detailer, describing methods for implementing brief interventions with patients and providing referrals to the tobacco quitline or (2) quitline materials delivered by mail. Both interventions advocated for pharmacy personnel to ask about tobacco use, advise patients who smoke to quit, and refer patients to the tobacco quitline for additional assistance with quitting. Study outcome measures include the number of quitline registrants who are referred by pharmacies (before and during the intervention period), the number of quitline materials distributed to patients, and self-reported behavior of cessation counseling and quitline referrals, assessed using written surveys completed by pharmacy personnel (pharmacists, technicians). RESULTS: Pharmacists (n=124) and pharmacy technicians (n=127), representing 64 participating pharmacies with equal numbers of retail chain and independently owned pharmacies, participated in the study. Most pharmacists (67%) and half of pharmacy technicians (50%) indicated that they were not at all familiar with the tobacco quitline. During the baseline (preintervention) monitoring period, the quitline registered 120 patients (18 in Connecticut and 102 in Washington) who reported that they heard about the quitline from a pharmacy. CONCLUSION: Novel tobacco intervention approaches are needed to capitalize on the community pharmacy's frequent interface with tobacco users, and these approaches need to be evaluated to estimate their effectiveness. Widespread implementation of brief, yet feasible, pharmacy-based tobacco cessation efforts that generate referrals to a tobacco quitline could have a substantial impact on the prevalence of tobacco use.
Research in Social and Administrative Pharmacy 05/2012; 9(1). DOI:10.1016/j.sapharm.2012.03.001 · 2.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study evaluates the effect of a program combing specialized medication packaging and telephonic medication therapy management on medication adherence, health care utilization, and costs among Medicaid patients.
A retrospective cohort design compared Medicaid participants who voluntarily enrolled in the program (n = 1007) compared with those who did not (n = 13,614). Main outcome measures were medication adherence at 12 months, hospital admissions and emergency department visits at 6 and 12 months, and total paid claim costs at 6 and 12 months. Multivariate regression models were used to adjust for the effect of age, sex, race, comorbidities, and 12-month preenrollment health care utilization.
Measures of medication adherence were significantly improved in the program cohort compared with the usual care cohort. At 6 months, adjusted all-cause hospitalization was marginally less in the program cohort compared with the usual care cohort [odds ratio = 0.73, 95% confidence interval (CI), 0.54-1.0, P = 0.05]. No statistically significant differences were observed between the 2 cohorts for any of the other adjusted utilization endpoints at 6 or 12 months. Adjusted total cost at 6 and 12 months were higher in the program cohort (6-month cost ratio = 1.76, 95% CI,1.65-1.89; 12-month cost ratio = 1.84, 95% CI,1.72-1.97), primarily because of an increase in prescription costs. Emergency department visits and hospitalization costs did not differ between groups.
: The program improved measures of medication adherence, but the effect on health care utilization and nonpharmacy costs at 6 and 12 months was not different from the usual care group. Reasons for these findings may reflect differences in the delivery of the specialized packaging and the medication therapy management program, health care behaviors in this Medicaid cohort, unadjusted confounding, or time required for the benefit of the intervention to manifest.
Medical care 04/2012; 50(6):485-93. DOI:10.1097/MLR.0b013e3182549d48 · 2.94 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The goal of this study was to pilot a randomized controlled trial of OROS methylphenidate (OROS-MPH) to treat attention deficit hyperactivity disorder (ADHD) plus epilepsy.
Thirty-three patients, 6-18years of age, taking antiepileptic drugs and with a last seizure 1-60months prior were assigned to a maximum daily dose of 18, 36, or 54mg of OROS-MPH in a double-blind placebo-controlled crossover trial.
There were no serious adverse events and no carryover effects in the crossover trial. OROS-MPH reduced ADHD symptoms more than did placebo treatment. There were too few seizures during the active (5) and placebo arms (3) to confidently assess seizure risk; however, considering exposure time, we observed an increased daily risk of seizures with increasing dose of OROS-MPH, suggesting that potential safety concerns require further study.
A larger study to assess the effect of OROS-MPH on seizure risk is needed. A crossover design including subjects with frequent seizures could maximize power and address high patient heterogeneity and recruitment difficulties.
[Show abstract][Hide abstract] ABSTRACT: A Smoking Prevention Interactive Experience (ASPIRE) is an innovative, computer-based smoking prevention and cessation intervention delivered to a culturally diverse population of high school students. Founded in the Transtheoretical Model of Change, five main and two "booster" sessions comprise the interactive intervention. Here we describe the intervention and the baseline characteristics from our study sample of 1,574 10th graders from 16 high schools in Houston, Texas. Environmental and behavioral smoking risk factors were assessed, and the two intervention groups were comparable with respect to most measured variables. The intervention program holds considerable promise in its ability to reduce smoking among teens.
[Show abstract][Hide abstract] ABSTRACT: Few studies have examined the long-term efficacy of computer-based smoking prevention and cessation programs. We analyzed the long-term impact of A Smoking Prevention Interactive Experience (ASPIRE), a theoretically sound computer-based smoking prevention and cessation curriculum for high school students. Sixteen predominantly minority, inner-city high schools were randomly assigned to receive the ASPIRE curriculum or standard care (receipt of the National Cancer Institute's Clearing the Air self-help booklet). A total of 1160 students, 1098 of whom were nonsmokers and 62 smokers at baseline, were included. At 18-month follow-up, among baseline nonsmokers, smoking initiation rates were significantly lower in the ASPIRE condition (1.9% vs. 5.8%, p < .05). Students receiving ASPIRE also demonstrated significantly higher decisional balance against smoking and decreased temptations to smoke. Differences between groups in self-efficacy and resistance skills were not significant. There was a nonsignificant trend toward improved smoking cessation with ASPIRE, but low recruitment of smokers precluded conclusions with respect to cessation. ASPIRE demonstrated the potential for an interactive multimedia program to promote smoking prevention. Further studies are required to determine ASPIRE's effects on cessation.
[Show abstract][Hide abstract] ABSTRACT: This study examined trajectories of positive and negative affect surrounding penile-vaginal sexual intercourse (sex) in adolescents and explored the influence of companionship on these trajectories. Using a handheld computer, sexually active adolescents (N = 67) reported momentary affect and sex events in response to several random signals each day for 1 week (1,777 reports, 266 sex events). Cubic spline regression analyses showed that positive affect began to increase before sex, peaked at the time sex was reported, and then returned to baseline. Negative affect did not differ from baseline before sex, but decreased following sex. Improvement in affect before and after sex varied according to companionship. Understanding the complex associations of affect, companionship, and sex has implications for interpreting and intervening on adolescent sexual behavior in social context.
Archives of Sexual Behavior 10/2008; 39(3):695-705. DOI:10.1007/s10508-008-9394-1 · 3.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined associations of psychological characteristics and sexual behavior with types of reasons for episodes of sexual intercourse among youth. After completing a baseline assessment, 62 adolescents (47 female) used a handheld computer to report when they had sex as soon as possible after the event as well as in response to random signals. Youth indicated for each sex event the main reason, categorized as intimacy/desire, external, affect management, and other; analyses were restricted to sex with a main partner (234 events). Baseline sexual behavior was not related to reasons for sex. Higher anxiety was associated with external reasons for sex; younger age and lower self-esteem were associated with affect management reasons. Female youth with higher impulsiveness reported more external reasons and fewer intimacy/desire reasons. Among male youth, lower self-esteem was associated with intimacy/desire reasons, but lower depression was associated with affect management reasons. These findings may aid health care providers and researchers in understanding the differences in young people's motivations for sex.
The Journal of Sex Research 08/2008; 45(3):225-32. DOI:10.1080/00224490801987457 · 2.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Community college students represent 44% of all students enrolled in U.S. higher education facilities. To our knowledge, no previous smoking cessation intervention has targeted community college students. Previous studies suggest that a motivational smoking cessation intervention could be successful for young adult smokers. Combining motivational interviewing sessions with personalized health feedback is likely to increase participants' motivation to quit and movement through the stages of change. The purpose of this study was to evaluate the impact of a smoking cessation program based on these premises. We designed a computer-assisted, counselor-delivered smoking cessation program that addresses personal health risks and readiness to change smoking behavior among community college students. A group-randomized, controlled trial was used to assess the intervention in a sample of 426 students (58.5% females; mean age, 22.8+/-4.7 years) from 15 pair-matched campuses. At the 10-month follow-up assessment, the cotinine-validated smoking cessation rates were 16.6% in the experimental condition and 10.1% in the standard care condition (p=0.07). Our results indicate that our computer-assisted intervention holds considerable promise in reducing smoking among community college students.
[Show abstract][Hide abstract] ABSTRACT: Mirtazapine is indicated for major depression and used for anxiety in adults; however, little is known about its application in pediatric populations. This is an 8-week open-label pilot study of mirtazapine in children with social phobia age 8-17 years. Primary outcomes were symptom improvement based on clinician rating and self-report, as well as tolerability based on rates of discontinuation due to adverse effects. Fifty-six percent (10/18) responded to treatment, 17% (3/18) achieved full remission. Social phobia symptoms improved significantly during the first 2 weeks of treatment, as did comorbid symptoms of depression and anxiety. Eleven patients (61%) did not complete all 8 weeks of treatment; four patients (22%) discontinued due to adverse effects including fatigue and irritability. The others discontinued due to study burden (28%), insufficient response (6%), or to pursue herbal treatment (6%). Significant weight gain was observed. Larger controlled trials are needed to further evaluate efficacy and safety.
[Show abstract][Hide abstract] ABSTRACT: The National Institutes of Health (NIH) Magnetic Resonance Imaging (MRI) Study of Normal Brain Development is a landmark study in which structural and metabolic brain development and behavior are followed longitudinally from birth to young adulthood in a population-based sample of healthy children. The neuropsychological assessment protocol for children aged 6 to 18 years is described and normative data are presented for participants in that age range (N = 385). For many measures, raw score performance improved steeply from 6 to 10 years, decelerating during adolescence. Sex differences were documented for Block Design (male advantage), CVLT, Pegboard and Coding (female advantage). Household income predicted IQ and achievement, as well as externalizing problems and social competence, but not the other cognitive or behavioral measures. Performance of this healthy sample was generally better than published norms. This linked imaging-clinical/behavioral database will be an invaluable public resource for researchers for many years to come.
Journal of the International Neuropsychological Society 10/2007; 13(5):729-46. DOI:10.1017/S1355617707070841 · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: As interest grows in creating computerized versions of established paper-and-pencil (P&P) questionnaires, it becomes increasingly important to explore whether changing the administration modes of questionnaires affects participants' responses. This study investigated whether mode effects exist when administering the Center for Epidemiologic Studies Depression (CES-D) scale by a personal digital assistant (PDA) versus the classic P&P mode. The Differential Functioning of Items and Tests (DFIT) procedure identified mode effects on the overall test and individual items. A mixed-effects regression model summarized the mode effects in terms of CES-D scores, and identified interactions with covariates. When the P&P questionnaire was administered first, scores were higher on average (2.4-2.8 points) than those of the other administrations (PDA second, PDA first, and P&P second), and all 20 questionnaire items exhibited a statistically significant mode effect. Highly educated people and younger people demonstrated a smaller difference in scores between the two modes. The mode-by-order effect influenced the interpretation of CES-D scores, especially when screening for depression using the established cut-off scores. These results underscore the importance of evaluating the cross-mode equivalence of psychosocial instruments before administering them in non-established modes.
Quality of Life Research 07/2007; 16(5):803-13. DOI:10.1007/s11136-006-9158-0 · 2.86 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This report presents the experimental approach and baseline findings from “Look at Your Health,” an ongoing study to develop and evaluate a computer-assisted, counselor-delivered smoking cessation program for community college students. It describes the expert system software program used for data collection and for provision of tailored feedback, individualized quitting strategies, and personalized newsletters. The transtheoretical model of change, the health belief model, and motivational interviewing provided the theoretical framework for the experimental cohort. Intervention participants received individual counseling, completed computerized questionnaires, performed measures of spirometric lung functioning and carbon monoxide levels, and were given a calculated lung age. At baseline, participants exhibited measurable tobacco-related health problems and an optimism bias. Addressing this optimism bias appropriately might lead smokers to progress through the stages of smoking cessation toward complete abstinence.