Howard Tennen

Yale University, New Haven, CT, United States

Are you Howard Tennen?

Claim your profile

Publications (257)712.09 Total impact

  • Source
    [show abstract] [hide abstract]
    ABSTRACT: To test whether level of perceived stress and reductions in levels of perceived stress (i.e., "let-down") are associated with the onset of migraine attacks in persons with migraine. Patients with migraine from a tertiary headache center were invited to participate in a 3-month electronic diary study. Participants entered data daily regarding migraine attack experience, subjective stress ratings, and other data. Stress was assessed using 2 measures: the Perceived Stress Scale and the Self-Reported Stress Scale. Logit-normal, random-effects models were used to estimate the odds ratio for migraine occurrence as a function of level of stress over several time frames. Of 22 enrolled participants, 17 (median age 43.8 years) completed >30 days of diaries, yielding 2,011 diary entries including 110 eligible migraine attacks (median 5 attacks per person). Level of stress was not generally associated with migraine occurrence. However, decline in stress from one evening diary to the next was associated with increased migraine onset over the subsequent 6, 12, and 18 hours, with odds ratios ranging from 1.5 to 1.9 (all p values < 0.05) for the Perceived Stress Scale. Decline in stress was associated with migraine onset after controlling for level of stress for all time points. Findings were similar using the Self-Reported Stress Scale. Reduction in stress from one day to the next is associated with migraine onset the next day. Decline in stress may be a marker for an impending migraine attack and may create opportunities for preemptive pharmacologic or behavioral interventions.
    Neurology 03/2014; · 8.25 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Objective: Racial discrimination has been identified as an important predictor of alcohol-related outcomes for African Americans. The goal of the current study was to extend previously found links between lifetime discrimination, alcohol use, and alcohol problems as well as to elucidate the affective mechanisms underlying these associations, as moderated by gender. Method: A multiple-groups structural equation model was computed using survey data collected from 619 students from a historically Black college/university. Results: The final model provided excellent fit to the data, explaining 6% of the variance in alcohol consumption and 37% of the variance in alcohol problems. Discrimination was a significant predictor of alcohol-related problems but not, by and large, level of use. For men, anger-but not discrimination-specific anger-was a significant partial mediator of the link between discrimination and both alcohol use and alcohol problems. Depression partially mediated the link between discrimination and alcohol problems for both men and women. Conclusions: The results suggest that, for African Americans whose drinking leads to drinking-related problems, discrimination and poor affective self-regulation are highly relevant and predictive factors, especially for men. (J. Stud. Alcohol Drugs, 75, 228-234, 2014).
    Journal of studies on alcohol and drugs 03/2014; 75(2):228-34. · 1.68 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: We examined among college students the interactive effects of drinking to cope motivation, anxiety and depression symptoms, and drinking level in predicting drinking-related problems. Using an Internet-based survey, participants (N = 844, 53% women) first reported on their drinking motives and monthly for up to 3 months, they reported on their drinking level, anxiety, depression and DRPs. We found a 3-way interaction between drinking to cope motivation and average levels of drinking and anxiety (but not depression) in predicting drinking-related problems. Specifically, among individuals with stronger drinking to cope motives, higher mean levels of anxiety were associated with a stronger positive association between mean drinking levels and drinking-related problems. We did not find 3-way interactions in the models examining monthly changes in anxiety, depression and drinking in predicting monthly drinking-related problems. However, individuals high in drinking to cope motivation showed a stronger positive association between changes in drinking level and drinking-related problems. The results are discussed in terms of mechanisms related to attention-allocation and self-control resource depletion.
    Anxiety, stress, and coping 02/2014; · 1.55 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: OBJECTIVE Topiramate has been shown to reduce drinking and heavy drinking in individuals with alcohol dependence whose goal was to stop drinking. The authors evaluated the efficacy and tolerability of topiramate in heavy drinkers whose treatment goal was to reduce drinking to safe levels. METHOD A total of 138 individuals (62.3% men) were randomly assigned to receive 12 weeks of treatment with topiramate (N=67), at a maximal daily dose of 200 mg, or matching placebo (N=71). Both groups received brief counseling to reduce drinking and increase abstinent days. It was hypothesized that topiramate-treated patients would be better able to achieve these goals, and it was predicted that based on prior research, the effects would be moderated by a single nucleotide polymorphism (rs2832407) in GRIK1, encoding the kainate GluK1 receptor subunit. RESULTS The rate of treatment completion was 84.9% and equal by treatment group. Topiramate treatment significantly reduced heavy drinking days and increased abstinent days relative to placebo. Patients receiving topiramate also had lower concentrations of the liver enzyme γ-glutamyl transpeptidase and lower scores on a measure of alcohol-related problems than the placebo group. In a European American subsample (N=122), topiramate's effect on heavy drinking days was significantly greater than that for placebo only in rs2832407 C-allele homozygotes. CONCLUSIONS These findings support the use of topiramate at a daily dose of 200 mg to reduce heavy drinking in problem drinkers. The moderator effect of rs2832407, if validated, would facilitate the identification of heavy drinkers who are likely to respond well to topiramate treatment and provide an important personalized treatment option. The pharmacogenetic findings also implicate the kainate receptor in the mechanism of topiramate's effects on heavy drinking.
    American Journal of Psychiatry 02/2014; · 14.72 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: We investigated whether self-reported racial discrimination was associated with continuous glucose levels and variability in individuals with diabetes, and whether diabetes distress mediated these associations. Seventy-four Black and White women with type 2 diabetes completed the Experience of Discrimination scale, a measure of lifetime racial discrimination, and the Problem Areas in Diabetes, a measure of diabetes distress. Participants wore a continuous glucose monitor for 24 h after 8 h of fasting, a standard meal, and a 4-h run in period. Higher discrimination predicted higher continuous mean glucose and higher standard deviation of glucose. For both mean and standard deviation of glucose, a race × discrimination interaction indicated a stronger relationship between discrimination and glucose for Whites than for Blacks. Diabetes distress mediated the discrimination-mean glucose relationship. Whites who report discrimination may be uniquely sensitive to distress. These preliminary findings suggest that racial discrimination adversely affects glucose control in women with diabetes, and does so indirectly through diabetes distress. Diabetes distress may be an important therapeutic target to reduce the ill effects of racial discrimination in persons with diabetes.
    Journal of Immigrant and Minority Health 01/2014; · 1.16 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Young adults show the highest rates of escalating drinking, yet the neural risk mechanisms remain unclear. Heavy drinkers show variant functional magnetic resonance imaging (fMRI) blood oxygen level-dependent (BOLD) response to alcohol cues, which may presage increasing drinking. In this longitudinal study, we ascertained whether BOLD response to alcohol pictures predicted subsequent heavy drinking among college students. Participants were forty-three 18- to 21-year-olds in the United States who underwent BOLD scanning and completed monthly substance use surveys over the following year. Participants were categorized according to baseline and follow-up drinking into 13 continuously moderate drinkers, 16 continuously heavy drinkers, and 14 transitioners who drank moderately at baseline but heavily by follow-up. During fMRI scanning at baseline, participants viewed alcohol and matched non-alcohol beverage images. We observed group differences in alcohol cue-elicited BOLD response in bilateral caudate, orbitofrontal cortex, medial frontal cortex/anterior cingulate and left insula (clusters>2619ml, voxel-wise F(2,40)>3.23, p<.05, whole-brain corrected p<.05), where transitioners hyperactivated compared with moderate and heavy drinkers (all Tukey p<.05). Exploratory factor analysis revealed a single brain network differentiating those who subsequently increased drinking. Exploratory regressions showed that, compared with other risk factors (e.g., alcoholism family history, impulsivity), BOLD response best predicted escalating drinking amount and alcohol-related problems. Neural response to pictures of alcohol is substantially enhanced among United States college students who subsequently escalate drinking. Greater cue-reactivity is associated with larger increases in drinking and alcohol-related problems, regardless of other baseline factors. Thus, neural cue-reactivity could uniquely facilitate identifying individuals at greatest risk for future problematic drinking.
    Addiction 12/2013; · 4.58 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Multiple theories posit that people with a history of depression are at higher risk for a depressive episode than people who have never experienced depression, which may be partly due to differences in stress-reactivity. In addition, both the dynamic model of affect and the broaden-and-build theory suggest that stress and positive affect interact to predict negative affect, but this moderation has never been tested in the context of depression history. The current study used multilevel modeling to examine these issues among 1,549 college students with or without a history of depression. Students completed a 30-day online diary study in which they reported daily their perceived stress, positive affect, and negative affect (including depression, anxiety, and hostility). On days characterized by higher than usual stress, students with a history of depression reported greater decreases in positive affect and greater increases in depressed affect than students with no history. Furthermore, the relations between daily stress and both depressed and anxious affect were moderated by daily positive affect among students with remitted depression. These results indicate that students with a history of depression show greater stress-reactivity even when in remission, which may place them at greater risk for recurrence. These individuals may also benefit more from positive affect on higher stress days despite being less likely to experience positive affect on such days. The current findings have various implications both clinically and for research on stress, mood, and depression. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Emotion 11/2013; · 3.88 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Exposure to racial discrimination has been linked to physiological reactivity. This study investigated self-reported exposure to racial discrimination and parasympathetic [high-frequency heart rate variability (HF-HRV)] and sympathetic (norepinephrine and cortisol) activity at baseline and then again after acute laboratory stress. Lifetime exposure to racial discrimination was measured with the Schedule of Racist Events scale. Thirty-two women (16 Black and 16 White) with type 2 diabetes performed a public speaking stressor. Beat-to-beat intervals were recorded on electrocardiograph recorders, and HF-HRV was calculated using spectral analysis and natural log transformed. Norepinephrine and cortisol were measured in blood. Higher discrimination predicted lower stressor HF-HRV, even after controlling for baseline HF-HRV. When race, age, A1c and baseline systolic blood pressure were also controlled, racial discrimination remained a significant independent predictor of stressor HF-HRV. There was no association between lifetime discrimination and sympathetic markers. In conclusion, preliminary data suggest that among women with type 2 diabetes mellitus (T2DM), exposure to racial discrimination is adversely associated with parasympathetic, but not sympathetic, reactivity. Copyright © 2013 John Wiley & Sons, Ltd.
    Stress and Health 11/2013; · 1.04 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: A subset of patients with epilepsy successfully self-predicted seizures in a paper diary study. We conducted an e-diary study to ensure that prediction precedes seizures, and to characterize the prodromal features and time windows that underlie self-prediction. Subjects 18 or older with localization-related epilepsy (LRE) and ≥3 seizures per month maintained an e-diary, reporting a.m./p.m. data daily, including mood, premonitory symptoms, and all seizures. Self-prediction was rated by, "How likely are you to experience a seizure (time frame)?" Five choices ranged from almost certain (>95% chance) to very unlikely. Relative odds of seizure (odds ratio, OR) within time frames was examined using Poisson models with log normal random effects to adjust for multiple observations. Nineteen subjects reported 244 eligible seizures. OR for prediction choices within 6 h was as high as 9.31 (CI 1.92-45.23) for "almost certain." Prediction was most robust within 6 h of diary entry, and remained significant up to 12 h. For nine best predictors, average sensitivity was 50%. Older age contributed to successful self-prediction, and self-prediction appeared to be driven by mood and premonitory symptoms. In multivariate modeling of seizure occurrence, self-prediction (2.84; CI 1.68-4.81), favorable change in mood (0.82; CI 0.67-0.99), and number of premonitory symptoms (1.11; CI 1.00-1.24) were significant. Some persons with epilepsy can self-predict seizures. In these individuals, the odds of a seizure following a positive prediction are high. Predictions were robust, not attributable to recall bias, and were related to self-awareness of mood and premonitory features. The 6-h prediction window is suitable for the development of preemptive therapy.
    Epilepsia 09/2013; · 3.96 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: The current study used a person-centered approach (i.e. latent profile analysis) to identify distinct types of college student drinkers based on the predictions of motivational, social learning, and stress and coping theories of maladaptive drinking. A large sample (N=844; 53% female) of first-year undergraduates from two institutions, public and private, who reported consuming one or more drinks in the last three months completed measures of depressive and anxiety symptoms, positive alcohol-outcome expectancies, negative life events, social support, drinking motives, drinking level and drinking-related problems. Latent profile analysis revealed a small subgroup of individuals (n=81, 9%) who conformed to the anticipated high-risk profile; specifically, this group demonstrated high levels of negative affect, coping motives, drinks per week, and drinking-related problems. However, additional groups emerged that showed patterns inconsistent with the proposed vulnerability profile (e.g., high negative affect, positive expectancies, and negative life events, but relatively low drinking levels). Findings from our person-centered approach showing the presence of groups both consistent and inconsistent with the predictions of motivational, social learning, and stress and coping theories highlight the need to identify and target certain college students for prevention and intervention of negative affect-related drinking.
    Addictive behaviors 09/2013; 38(12):2937-2944. · 2.25 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Eighteen- to twenty-five-year-olds show the highest rates of alcohol use disorders (AUD) and heavy drinking, which may have critical neurocognitive implications. Regions subserving memory may be particularly susceptible to alcohol-related impairments. We used blood oxygen level-dependent (BOLD) functional magnetic resonance imaging (fMRI) to examine the neural correlates of visual encoding and recognition among heavy-drinking college students. We predicted that heavy drinkers would show worse memory performance, increased frontal/parietal activation, and decreased hippocampal response during encoding. Participants were 23 heavy drinkers and 33 demographically matched light drinkers, aged 18-20, characterized using quantity/frequency of drinking and AUD diagnosis. Participants performed a figural encoding and recognition task during fMRI. BOLD response during encoding was modeled based on whether each stimulus was subsequently recognized or forgotten (i.e., correct vs. incorrect encoding). There were no group differences in behavioral performance. Compared to light drinkers, heavy drinkers showed (1) greater BOLD response during correct encoding in the right hippocampus/medial temporal, right dorsolateral prefrontal, left inferior frontal, and bilateral posterior parietal cortices; (2) less left inferior frontal activation and greater bilateral precuneus deactivation during incorrect encoding; and (3) less bilateral insula response during correct recognition (clusters >10,233 μl, p < 0.05 whole brain). This is the first investigation of the neural substrates of figural memory among heavy-drinking older adolescents. Heavy drinkers demonstrated compensatory hyperactivation of memory-related areas during correct encoding, greater deactivation of default mode regions during incorrect encoding, and reduced recognition-related response. Results could suggest use of different encoding and recognition strategies among heavy drinkers.
    Psychopharmacology 08/2013; · 4.06 Impact Factor
  • Source
    [show abstract] [hide abstract]
    ABSTRACT: Impaired inhibition of prepotent motor responding may represent an important risk factor for alcoholism. Alcohol use also may increase impulsive behaviors, including impaired response inhibition. Little is known about brain function underlying response inhibition among college-age drinkers based on their drinking patterns, despite college-age drinkers demonstrating high rates of alcohol use disorders. Our major objective was to compare behavior and associated brain activity measured with fMRI during a response-inhibition task in matched heavy- and light-alcohol-drinking college students. Participants were light (N=36) and heavy (N=56) drinkers, aged 18-20 years. We characterized blood oxygen level-dependent (BOLD) responses while participants performed an fMRI Go/No-Go task to quantify inhibitory behavior and brain activity. Behaviorally, group performance differences were observed for Go correct-hit and No-Go false-alarm reaction times with increased reaction times in heavy compared to light drinkers. During fMRI No-Go correct rejections, light drinkers exhibited greater BOLD response than did heavy drinkers in left supplementary motor area, bilateral parietal lobule, right hippocampus, bilateral middle frontal gyrus, left superior temporal gyrus and cingulate gyrus/ACC (BA24). Group differences in Go/No-Go-related regional activations correlated with alcohol-and impulsivity-related measures. These findings suggest that heavy alcohol drinkers may have dysfunction in brain regions underlying attention and response inhibition, leading to diminished abilities to suppress prepotent responding. The extent to which these tendencies relate to impulsive decision-making and behaviors in real-life settings and may guide intervention development warrants additional investigation.Neuropsychopharmacology accepted article preview online, 14 May 2013; doi:10.1038/npp.2013.119.
    Neuropsychopharmacology: official publication of the American College of Neuropsychopharmacology 05/2013; · 6.99 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: Objective: Although home exercises are commonly prescribed following anterior cruciate ligament (ACL) reconstruction and are considered important in obtaining successful rehabilitation outcomes, little is known about factors associated with the completion of such exercises. Consequently, this study was designed to identify predictors of adherence to home rehabilitation exercises after ACL surgery. Method: Participants (33 women, 58 men) completed indices of athletic identity, neuroticism, optimism, and pessimism before ACL surgery and measures of daily pain, negative mood, stress, and home exercise completion for 42 days postoperatively. Results: Participants reported a high level of adherence to the prescribed regimen. Home exercise completion increased significantly over time as the number of sets of prescribed home exercises declined. Personal factors were not predictive of home exercise completion. Participants completed fewer home exercises on days when they experienced more stress or negative mood. Conclusions: Day-to-day variations in negative mood and stress may contribute to adherence to prescribed home exercises. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Rehabilitation Psychology 02/2013; 58(1):64-72. · 1.91 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: We investigated whether self-reported racial discrimination was associated with insulin resistance (IR) and glycosylated hemoglobin (A1c) in women with type 2 diabetes in the United States, after controlling for covariates. Seventy-seven Black and White women with type 2 diabetes completed the Experiences of Discrimination Scale, which assesses self-reported lifetime frequency of racially motivated discrimination. Participants provided fasting blood samples for assessment of glucose and insulin for determination of IR and A1c. Covariates included age, education, waist circumference, diabetes distress, and stressful life events. In unadjusted regression analysis discrimination was significantly associated with IR. There was a trend for a race by discrimination interaction, with a weaker effect for Blacks than Whites. Follow up analysis showed that discrimination was significantly associated with IR in both Blacks and Whites, even after adjustment, as was waist circumference. In unadjusted regression analysis, discrimination was significantly associated with A1c. There was a significant race by discrimination interaction. Follow up analysis showed that discrimination was not significantly associated with A1c among Blacks, but was among Whites, even after adjustment, as was diabetes distress and insulin use. Racial discrimination is associated with insulin resistance in Black and White women with diabetes, and with A1c in White women with diabetes.
    Ethnicity & disease 01/2013; 23(4):421-7. · 1.12 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: We previously reported moderating effects of age of onset of alcohol dependence (AD) and a functional polymorphism (5-HTTLPR) in the gene encoding the serotonin transporter protein in a sample of 134 individuals participating in a 12-week, placebo-controlled trial of sertraline. To understand more fully the effects seen in that study, we examined moderation by negative moods reported each evening, with nighttime drinking intensity (i.e. the number of standard drinks consumed at night) as the dependent variable. We found a daily anxiety × age of onset × 5-HTTLPR polymorphism × medication interaction, which reflected a daily anxiety × medication group effect for early-onset individuals homozygous for the high-expression (L') allele, but not others. Specifically, on days characterized by relatively high levels of anxiety, early-onset L' homozygotes receiving placebo reduced their drinking intensity significantly. In contrast, early-onset L' homozygotes treated with sertraline non-significantly increased their drinking intensity. These findings implicate anxiety as a key moderator of the observed pharmacogenetic effects. These findings have important implications because of the high prevalence of AD and the frequency with which SSRIs are prescribed to treat the disorders.
    Addiction Biology 11/2012; · 5.91 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: BACKGROUND: Heavy drinkers show altered functional magnetic resonance imaging (fMRI) response to alcohol cues. Little is known about alcohol cue reactivity among college age drinkers, who show the greatest rates of alcohol use disorders. Family history of alcoholism (family history positive [FHP]) is a risk factor for problematic drinking, but the impact on alcohol cue reactivity is unclear. We investigated the influence of heavy drinking and family history of alcoholism on alcohol cue-related fMRI response among college students. METHODS: Participants were 19 family history negative (FHN) light drinkers, 11 FHP light drinkers, 25 FHN heavy drinkers, and 10 FHP heavy drinkers, aged 18 to 21. During fMRI scanning, participants viewed alcohol images, nonalcohol beverage images, and degraded control images, with each beverage image presented twice. We characterized blood oxygen level-dependent (BOLD) contrast for alcohol versus nonalcohol images and examined BOLD response to repeated alcohol images to understand exposure effects. RESULTS: Heavy drinkers exhibited greater BOLD response than light drinkers in posterior visual association regions, anterior cingulate, medial frontal cortex, hippocampus, amygdala, and dorsal striatum, and hyperactivation to repeated alcohol images in temporo-parietal, frontal, and insular regions (clusters > 8,127 μl, p < 0.05). FHP individuals showed increased activation to repeated alcohol images in temporo-parietal regions, fusiform, and hippocampus. There were no interactions between family history and drinking group. CONCLUSIONS: Our results parallel findings of hyperactivation to alcohol cues among heavy drinkers in regions subserving visual attention, memory, motivation, and habit. Heavy drinkers demonstrated heightened activation to repeated alcohol images, which could influence continued drinking. Family history of alcoholism was associated with greater response to repeated alcohol images in regions underlying visual attention, recognition, and encoding, which could suggest aspects of alcohol cue reactivity that are independent of personal drinking. Heavy drinking and family history of alcoholism may have differential impacts on neural circuitry involved in cue reactivity.
    Alcoholism Clinical and Experimental Research 10/2012; · 3.42 Impact Factor
  • Nancy M. Petry, Howard Tennen, Glenn Affleck
    [show abstract] [hide abstract]
    ABSTRACT: For decades, researchers and clinicians have attempted to identify client characteristics that are associated with responses to psychotherapy. Despite thousands of empirical articles and hundreds of reviews examining the roles of these main and interaction effects, we are left with only a rudimentary understanding of pretreatment client characteristics that seem to affect the response to psychotherapy. The authors' objectives for this chapter are to: (1) provide a general overview of clients' characteristics thought to be associated with retention and outcomes, with a particular emphasis on personality; (2) critically evaluate the methods and findings from many of these reports; and (3) suggest areas for future investigation. Topics include: sociodemographic characteristics (socioeconomic status, race, gender, age, marital status, intelligence); nature, duration, and severity of disturbance and motivation to change (diagnosis, duration, and severity; motivation to change); personality characteristics; and a critique of retention and outcome studies. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
  • [show abstract] [hide abstract]
    ABSTRACT: This study investigated the effect of self-reported racial discrimination on endothelial responses to acute laboratory mental stress among post-menopausal women. One-hundred thirteen women (n = 94 self-identified as White and n = 19 self-identified as racial/ethnic minority), 43% with type 2 diabetes, reported lifetime experiences of racial/ethnic discrimination. Repeated assessments of flow-mediated dilation were performed at baseline, immediately after 5 min of mental arithmetic and at 20-min recovery. Both White and racial/ethnic minority women reported lifetime discrimination, with rates significantly higher among minorities. Self-reported lifetime discrimination was associated with attenuated flow-mediated dilation at recovery. Confounding variables, including clinical characteristics, mood, personality traits, other life stressors and general distress, did not better account for the effect of racial discrimination. Neither race/ethnicity nor diabetes status moderated the effect. The perceived stressfulness of the mental arithmetic was not associated with the endothelial response. In conclusion, self-reported lifetime discrimination is associated with attenuated endothelial recovery from acute mental stress. Elucidating the effects of discrimination and the biological mechanisms through which it affects the vasculature may suggest interventions to improve health. Copyright © 2012 John Wiley & Sons, Ltd.
    Stress and Health 09/2012; · 1.04 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: To evaluate the role of the functional Asn40Asp polymorphism in the mu-opioid receptor gene on drinking behavior and naltrexone's ability to attenuate drinking, we used a daily diary method in a 12-week, randomized clinical trial of naltrexone to reduce drinking. Participants (n = 158 problem drinkers) were assigned to receive either daily or targeted naltrexone 50 mg (n = 81) or matching placebo (n = 77). Patients reported by telephone each evening their current desire to drink and their drinking during the previous night and during the reporting day. We examined genotype, medication, desire to drink and their interactions as predictors of nighttime drinks consumed, controlling for drinking earlier in the day. Asp40 carriers showed a stronger positive association between evening desire (deviations from their mean levels) and later night drinking levels than Asn40 homozygotes (P = 0.019). The desire × genotype × medication condition interaction was also significant (P = 0.009), with a significant desire × genotype interaction for the placebo group ( P = 0.001) but not for the naltrexone group (P = 0.74). In summary, when the evening level of desire to drink was relatively high, Asp40 allele carriers were at greater risk than Asn40 homozygotes to drink more, which was attenuated by naltrexone. Although average measures across the study were not informative, daily reports helped to demonstrate the moderating effects of genetic variation on the relation between desire to drink and alcohol consumption and the effects of naltrexone on that phenotype.
    Addiction Biology 07/2012; · 5.91 Impact Factor
  • [show abstract] [hide abstract]
    ABSTRACT: The purpose of this study was to show the association between changes in clinician self-efficacy and readiness to change and implementation of an asthma management program (Easy Breathing). A 36 month randomized, controlled trial was conducted involving 24 pediatric practices (88 clinicians). Randomized clinicians received interventions designed to enhance clinician self-efficacy and readiness to change which were measured at baseline and 3 years. Interventions consisted of an educational toolbox, seminars, teleconferences, mini-fellowships, opinion leader visits, clinician-specific feedback, and pay for performance. The primary outcome was program utilization (number of children enrolled in Easy Breathing/year); secondary outcomes included development of a written treatment plan and severity-appropriate therapy. At baseline, clinicians enrolled 149 ± 147 (mean ± SD) children/clinician/year; 84% of children had a written treatment plan and 77% of plans used severity-appropriate therapy. At baseline, higher self-efficacy scores were associated with greater program utilization (relative rate [RR], 1.34; 95% confidence interval [CI], 1.04-1.72; P = .04) but not treatment plan development (RR, 0.63; 95% CI, 0.29-1.35; P = .23) or anti-inflammatory use (RR, 1.76; 95% CI, 0.92-3.35; P = .09). Intervention clinicians participated in 17 interventions over 36 months. At study end, self-efficacy scores increased in intervention clinicians compared to control clinicians (P = .01) and more clinicians were in an action stage of change (P = .001) but these changes were not associated with changes in primary or secondary outcomes. Self-efficacy scores correlated with program use at baseline and increased in the intervention arm, but these increases were not associated with greater program-related activities. Self-efficacy may be necessary but not sufficient for behavior change.
    Academic pediatrics 05/2012; 12(4):312-8.

Publication Stats

6k Citations
712.09 Total Impact Points


  • 1997–2013
    • Yale University
      • • Department of Psychiatry
      • • School of Medicine
      New Haven, CT, United States
  • 1985–2013
    • Trinity College
      • Psychology
      Hartford, Connecticut, United States
  • 2012
    • University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, PA, United States
  • 2010–2011
    • Hospital of the University of Pennsylvania
      • Department of Psychiatry
      Philadelphia, Pennsylvania, United States
    • Albert Einstein College of Medicine
      • Department of Epidemiology & Population Health
      New York City, NY, United States
  • 2001–2011
    • Community Health Center, Connecticut
      Middletown, Connecticut, United States
    • Arizona State University
      • Department of Psychology
      Mesa, AZ, United States
  • 1997–2011
    • UConn Health Center
      • • Division of Behavioral Sciences and Community Health
      • • Department of Community Medicine and Health Care
      Farmington, CT, United States
  • 2008–2010
    • Fairleigh Dickinson University
      Teaneck, New Jersey, United States
    • Portland State University
      Portland, Oregon, United States
  • 2009
    • University of Otago
      • Department of Psychology
      Dunedin, Otago, New Zealand
    • University of Minnesota Twin Cities
      • Department of Psychology
      Minneapolis, MN, United States
    • Rhode Island Hospital
      Providence, Rhode Island, United States
  • 2005–2009
    • Pacific Institute for Research and Evaluation
      • Prevention Research Center PRC
      Calverton, MD, United States
  • 2003–2008
    • University of Maine at Farmington
      Farmington, Maine, United States
  • 2007
    • University of California, Los Angeles
      • Department of Psychology
      Los Angeles, CA, United States
  • 2006
    • Pace University
      • Department of Psychology
      New York City, NY, United States
    • The University of Memphis
      Memphis, Tennessee, United States
    • State University of New York
      New York City, New York, United States
  • 1994–2004
    • University of Connecticut
      • • Department of Psychology
      • • Department of Psychiatry
      Storrs, CT, United States
  • 2000
    • University of Amsterdam
      • Amsterdam School of Economics Research Institute
      Amsterdam, North Holland, Netherlands
    • The Netherlands Institute for Addiction Healthcare
      Arnheim, Gelderland, Netherlands
  • 1997–2000
    • Duke University Medical Center
      • Department of Pediatrics
      Durham, NC, United States
  • 1999
    • Ohio University
      • Department of Psychology
      Athens, OH, United States
    • Fordham University
      • Department of Psychology
      New York City, NY, United States