Motivating Behavioral Change.

Motivational interviewing (MI) allows medical providers and patients to have more productive conversations about changing health behaviors. MI helps patients talk themselves into changing by evoking discussion around change, thus resolving natural ambivalence. MI practitioners cultivate a spirit of MI and use specific skills and strategies to develop discrepancy between the patient's current behavior and their goals or values. This article discusses the flow of MI, the spirit and method of MI including specific skills and strategies, and important considerations in implementing MI.

Adolescent Emotion Regulation and Parent-Child Discussions about Sexual Behaviors.

Risky sexual behavior can lead to negative outcomes (e.g., pregnancy, sexually transmitted infections). Adolescents may engage in risky sex less often if families talk about sexual safety or if adolescents engage in emotion regulation (ER) skills, however research is lacking on how ER may be a barrier to sexual health communication. This exploratory study was a secondary analysis of baseline information from 420 American adolescents referred for mental health symptoms and their parents regarding ER and sexual health communication. Significant differences emerged on adolescent ER between families that talk about sexual health and those that do not.

Behavioral activation for smoking cessation and mood management following a cardiac event: results of a pilot randomized controlled trial.

BACKGROUND: Smoking cessation following hospitalization for Acute Coronary Syndrome (ACS) significantly reduces subsequent mortality. Depressed mood is a major barrier to cessation post-ACS. Although existing counseling treatments address smoking and depression independently in ACS patients, no integrated treatment addresses both. We developed an integrated treatment combining gold standard cessation counseling with behavioral activation-based mood management; Behavioral Activation Treatment for Cardiac Smokers (BAT-CS). The purpose of this pilot randomized controlled trial was to test feasibility, acceptability, and preliminary efficacy of BAT-CS vs. Standard of Care (SC). METHODS: Participants were recruited during hospitalization for ACS and were randomly assigned to BAT-CS or SC. The nicotine patch was offered in both conditions. Smoking, mood, and stress outcomes were collected at end-of-treatment and 24-week follow-up. RESULTS: Fifty-nine participants (28 BAT-CS, 31 SC) were recruited over 42 weeks, and assessment completion was above 80% in both conditions. Treatment acceptability and fidelity were high. At 24 week follow-up adjusted odds ratios favoring BAT-CS were 1.27 (95% CI: 0.41-3.93) for 7-day point prevalence abstinence and 1.27 (95% CI: 0.42-3.82) for continuous abstinence. Time to first smoking lapse was significantly longer in BAT-CS (62.4 vs. 31.8 days, p = 0.03). At 24-weeks, effect sizes for mood and stress outcomes ranged from η2partial of.07-.11, with significant between treatment effects for positive affect, negative affect, and stress. CONCLUSIONS: The design of this study proved feasible and acceptable. Results provide preliminary evidence that combining behavioral activation with standard smoking cessation counseling could be efficacious for this high risk population. A larger trial with longer follow-up is warranted. TRIAL REGISTRATION: NCT01964898 . First received by clinicaltrials.gov October 15, 2013.

Characteristics of Cigarette Smoking in Individuals in Smoking Concordant and Smoking Discordant Couples.

INTRODUCTION: Partner smoking status may impact smoking cessation outcomes. The purpose of this study is to compare smokers in smoking concordant couples (both partners smoke) to smokers in smoking discordant couples (one partner smokes) on variables that have been shown to be important for quitting smoking. METHODS: Participants were 123 cigarette smokers with cohabitating romantic partners (smoking discordant: n=60, smoking concordant: n=63, 63.9% females). We used one-way MANCOVA, controlling for age and number of cigarettes smoked/day, to examine differences between groups on smoking outcome expectancies, motivation to quit smoking, and dyadic efficacy to quit smoking. We examined smoking behavior in a series of exploratory analyses. RESULTS: We found a significant multivariate difference between individuals in smoking concordant and discordant couples (p < .05) such that 20.3% of the variation in the linear combination of dependent variables was accounted for by group membership. Follow-up univariate ANCOVA analyses indicated that those in smoking discordant couples reported greater positive outcome expectancies for cigarettes with regard to facilitating social situations and reducing boredom than those in the smoking concordant group. Participants in smoking concordant couples smoked more cigarettes when their partners were present, fewer cigarettes without their partners present, and were more likely to prefer that their partner be involved in their smoking cessation treatment than those in smoking discordant couples. DISCUSSION: The results of this study may guide the development of smoking cessation interventions that attend to the unique needs of smoking concordant and discordant couples.

Motivating parents of kids with asthma to quit smoking: the effect of the teachable moment and increasing intervention intensity using a longitudinal randomized trial design.

AIMS: We tested two aims: (1) the teachable moment (TM): whether second-hand smoke exposure (SHSe) feedback motivates cessation in parents of children with asthma versus parents of healthy children (HC); and (2) whether greater intervention intensity [enhanced-precaution adoption model (PAM)] produces greater cessation than a previously tested intervention (PAM). DESIGN AND INTERVENTIONS: Aim 1: two home visits (asthma education or child wellness), and cessation induction using motivational interviewing and SHSe feedback. Aim 2: post-home-visits, parents with asthmatic children were randomized to PAM (n = 171; six asthma education calls) or enhanced-PAM (n = 170; six asthma education/smoking cessation calls + repeat SHSe feedback). SETTING: Rhode Island, USA. PARTICIPANTS: Parents of asthmatic (n = 341) or healthy (n = 219) children who did not have to want to quit smoking to enroll. MEASUREMENTS: Measurements were given at baseline, 2, 4, 6 and 12 months. Abstinence was bioverified. Outcomes were 7-day and 30-day point prevalence abstinence (ppa) and SHSe (primary) and asthma morbidity (secondary). FINDINGS: Aim 1: the TM was supported: parents of asthmatic children were more than twice as likely to achieve 30-day [odds ratio (OR) = 2.60, 95% confidence interval (CI) = 1.22-5.54] and 7-day ppa (OR = 2.26, 95% CI = 1.13-4.51) at 2 months (primary end-point) and have non-detectable levels of SHSe than HCs. Greater treatment intensity yielded stronger TM effects (OR = 3.60; 95% CI = 1.72-7.55). Aim 2: enhanced-PAM was more likely to achieve 30-day ppa at the primary end-point, 4 months (OR = 2.12, 95% CI 1.09-4.12) and improved asthma outcomes versus PAM. CONCLUSIONS: Smoking cessation intervention (Motivational Interviewing plus biomarker feedback) appear to motivate smoking cessation more strongly among parents of asthmatic children than among parents of healthy children. Increased intervention intensity yields greater smoking cessation among parents of asthmatic children and better asthma outcomes.

Prevalence, Reasons for Use, and Risk Perception of Electronic Cigarettes Among Post-Acute Coronary Syndrome Smokers.

PURPOSE: The use of electronic cigarettes (e-cigarettes) has risen dramatically in recent years. However, there are currently no published data on the use of e-cigarettes among cardiac patients. The current study reports on the prevalence, reasons for use, and perceived risks of e-cigarettes among patients with post-acute coronary syndrome (ACS). The relationship between e-cigarette use and post-ACS tobacco smoking cessation is also explored. METHODS: Participants were drawn from a randomized trial of smoking cessation treatments following hospitalization for ACS. The current study focused on 49 participants who completed e-cigarette questions at 24 weeks post-ACS. RESULTS: Of the 49 of participants, 51.0% reported ever use of an e-cigarette and 26.5% reported using an e-cigarette at some time during the 24 weeks post-ACS. Ever use and post-ACS use were both significantly associated with lower rates of abstinence from tobacco cigarettes. Participants perceived e-cigarettes as less harmful to cardiac health than tobacco use and Chantix (varenicline), and similarly harmful as nicotine replacement therapy. Participant perceived likelihood of experiencing a heart attack in the next year was 34.6% if they were to regularly use only e-cigarettes, significantly lower than the perceived risk of recurrence if they were to regularly smoke only tobacco cigarettes (56.2%) and significantly higher than the perceived risk of recurrence if they were to use no nicotine (15.2%). CONCLUSIONS: A significant minority of patients are using e-cigarettes post-ACS. Providers should be prepared to discuss potential discrepancies between patient beliefs about the safety of e-cigarettes and the current state of the science.

Motivational Interviewing for Parent-child Health Interventions: A Systematic Review and Meta-Analysis.

PURPOSE: Motivational interviewing (MI) is a patient-centered approach focusing on building intrinsic motivation for change. This paper presents a meta-analysis of parent-involved MI to improve pediatric health behavior and health outcomes. METHODS: Study inclusion criteria: (1) examined modifiable pediatric health behaviors (< 18 years old); (2) used MI or motivational enhancement; (3) conducted a randomized controlled trial with a comparison group (non-MI control or active treatment group); (4) conducted the intervention with only a parent or both a parent and child; and (5) were written in English. Twenty-five studies (with 5,130 participants) were included and independently rated. Weighted mean effect sizes, using random-effects assumptions, were calculated. RESULTS: Relative to comparison groups, MI was associated with significant improvements in health behaviors (e.g., oral health, diet, physical activity, reduced screen time, smoking cessation, reduced second hand smoke) and reduction in body mass index. Results suggest that MI may also outperform comparison groups in terms of dental caries, but more studies are needed. MI interventions were more successful at improving diets for Caucasians and when the intervention included more MI components. CONCLUSIONS: Our findings provide support for providing motivational interviewing to parents and children to improve pediatric health behaviors.

Structural and Functional Support in the Prediction of Smoking Cessation in Caregivers of Children with Asthma.

Caregivers of children with asthma smoke at rates similar to the general population. Research on the relative importance of structural or functional social support in smoking cessation has been mixed. Participants were smokers (N = 154) who were caregivers of children with asthma. Both functional (Interpersonal Support Evaluation List) and structural social support (living with another smoker, partner status, and the proportion of smoking friends) were measured at baseline. Participants received an asthma-education and smoking cessation intervention based on Motivational Interviewing. Biochemically-verified abstinence was assessed at six months post treatment. Results indicated that functional support predicted smoking abstinence even when controlling for relevant covariates and structural support (OR = .896, p = .025). Exploratory analyses revealed that this effect was driven primarily by the self-esteem ISEL subscale. Smoking cessation that focuses on building general functional support, particularly self-esteem support, may be beneficial for smoking cessation in caregivers of children with asthma.

Mindfulness is associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems in urban firefighters.

OBJECTIVE: This study investigated the association between mindfulness, other resilience resources, and several measures of health in 124 urban firefighters. METHOD: Participants completed health measures of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, physical symptoms, and alcohol problems and measures of resilience resources including mindfulness, optimism, personal mastery, and social support. The Mindful Awareness and Attention Scale (MAAS; Brown & Ryan, 2003) was used to assess mindfulness. Participants also completed measures of firefighter stress, number of calls, and years as a firefighter as control variables. Hierarchical multiple regressions were conducted with the health measures as the dependent variables with 3 levels of independent variables: (a) demographic characteristics, (b) firefighter variables, and (c) resilience resources. RESULTS: The results showed that mindfulness was associated with fewer PTSD symptoms, depressive symptoms, physical symptoms, and alcohol problems when controlling for the other study variables. Personal mastery and social support were also related to fewer depressive symptoms, firefighter stress was related to more PTSD symptoms and alcohol problems, and years as a firefighter were related to fewer alcohol problems. CONCLUSIONS: Mindfulness may be important to consider and include in models of stress, coping, and resilience in firefighters. Future studies should examine the prospective relationship between mindfulness and health in firefighters and others in high-stress occupations.

The role of resilience and purpose in life in habituation to heat and cold pain.

UNLABELLED: This study examined the role of resilience in habituation to heat and cold pain in healthy women (n = 47). Heat and cold pain thresholds were each assessed across 5 equally spaced trials. Resilience, purpose in life, optimism, social support, and neuroticism were assessed using self-report measures. The hypothesis was that the resilience and the associated resilience factors would be positively related to habituation to heat and cold pain while controlling for neuroticism. Multilevel modeling was used to test the hypothesis. When considering each characteristic separately, resilience and purpose in life predicted greater habituation to heat pain while resilience, purpose in life, optimism, and social support predicted greater habituation to cold pain. When controlling for the other characteristics, both resilience and purpose in life predicted greater habituation to heat and cold pain. Resilience and associated characteristics such as a sense of purpose in life may be related to enhanced habituation to painful stimuli. Future research should further examine the relationship between resilience, purpose in life, and habituation to pain and determine whether psychosocial interventions that target resilience and purpose in life improve habituation and reduce vulnerability to chronic pain. PERSPECTIVE: This article showed that resilience and a sense of purpose in life were both related to the ability to habituate to heat and cold pain in healthy women. These personal characteristics may enhance habituation to pain by providing the confidence and motivation to persist in the face of painful stimuli.

Habituation and sensitization to heat and cold pain in women with fibromyalgia and healthy controls.

The purpose of this study was to examine differences in habituation to heat and cold pain in women with fibromyalgia (FM; n=33) and in women who were healthy controls (HC; n=44). Quantitative sensory testing (QST) was used to assess pain thresholds during five consecutive trials of ascending heat and descending cold stimulation. Anxiety, depression, fatigue, and pain during the previous week were assessed using self-report measures. The overall hypotheses were that there would be differences between groups in pain thresholds and in the rate of habituation to heat and cold pain stimuli. Multilevel modeling was used to test the hypotheses. There were large overall differences in pain thresholds, with the FM group showing greater sensitivity to heat and cold pain stimuli compared with the HC group. While habituation occurred in both of the groups for heat pain, the HC group had stronger habituation across trials than the FM group. Conversely, while the HC group habituated to cold pain stimuli, the FM group showed sensitization and had decreased cold pain thresholds across trials (they felt cold pain at higher temperatures). In addition, anxiety, depression, fatigue, and pain were related to decreased heat and cold pain thresholds in the overall sample. However, when group was controlled, none of these variables were related to thresholds or rates of habituation or sensitization. The differences between women with FM and healthy women in habituation and sensitization may have important implications for the etiology, diagnosis, and treatment of FM and other chronic pain conditions.