A Meta-Analysis of Brief Tobacco Interventions for Use in Integrated Primary Care.

Introduction: The integration of behavioral health services in primary care settings presents an opportunity to enhance the delivery of tobacco cessation interventions in the primary care setting, but guidance on evidence-based treatments for tobacco use disorder that fits the brief format of integrated primary care (IPC) is limited. This meta-analysis summarizes the outcomes of brief behavioral interventions targeting tobacco use that can be delivered in IPC settings. Methods: A literature search was conducted to locate empirical studies examining tobacco cessation interventions that could be implemented in an IPC setting. A random effects meta-analytic approach was utilized with odds ratios as the effect size. Subgroup analyses were conducted to determine the extent to which a number of study, participant, and intervention characteristics affected treatment outcome. Results: A total of 36 studies were included (n = 12975 patients). Patients in the intervention groups exhibited significantly greater odds of smoking cessation compared with those in the comparison groups (OR = 1.78, p < .001). Subgroup analyses did not reveal significant sources of heterogeneity attributable to moderators such as methodological quality, gender, bioverification, follow-up time period, or intervention characteristics (such as setting, type, or length of intervention). Conclusions: Brief tobacco cessation interventions that can be delivered in IPC settings were found to be effective. Future research in this area might evaluate ways to improve the dissemination and implementation of these types of interventions in IPC settings. Implications: The integration of behavioral health services into primary care presents a unique opportunity to increase the delivery of tobacco cessation interventions, as behavioral health providers in these settings are experts in behavior change interventions and may have more time to deliver these interventions than primary care providers. Results from the current meta-analysis demonstrate that brief tobacco cessation interventions that can be implemented in the IPC setting are effective. Future research in this area might examine ways to improve the dissemination and implementation of brief interventions for tobacco use in IPC settings.

Item-based analysis of delayed reward discounting decision making.

Delayed reward discounting (DRD) is a behavioral economic index of time preference, referring to how much an individual devalues a reward based on its delay in time, and has been linked to a wide array of health behaviors. It is commonly assessed using a task that asks participants to make dichotomous choices between two monetary rewards, one available immediately and the other after a delay. This study sought to shorten an extended iterative DRD assessment to increase its versatility and efficiency. Data were drawn from two young adult samples, an exploratory sample (N=130) and a confirmatory sample (N=247). In the exploratory sample, eight items were identified as predicting the majority of the variance in the full task area under the curve (AUC) (R(2)=.821; p<.001). In the confirmatory sample, the same eight items similarly predicted the majority of variance in the full task AUC (R(2)=.844, p<.001). These results provide initial support for the validity of a brief 8-item assessment of DRD. Priorities for further validation and potential applications are discussed.

Brief report: The Brief Alcohol Social Density Assessment (BASDA): convergent, criterion-related, and incremental validity.

OBJECTIVE: Alcohol misuse is substantially influenced by social factors, but systematic assessments of social network drinking are typically lengthy. The goal of the present study was to provide further validation of a brief measure of social network alcohol use, the Brief Alcohol Social Density Assessment (BASDA), in a sample of emerging adults. Specifically, the study sought to examine the BASDA's convergent, criterion, and incremental validity in relation to well-established measures of drinking motives and problematic drinking. METHOD: Participants were 354 undergraduates who were assessed using the BASDA, the Alcohol Use Disorders Identification Test (AUDIT), and the Drinking Motives Questionnaire. RESULTS: Significant associations were observed between the BASDA index of alcohol-related social density and alcohol misuse, social motives, and conformity motives, supporting convergent validity. Criterion-related validity was supported by evidence that significantly greater alcohol involvement was present in the social networks of individuals scoring at or above an AUDIT score of 8, a validated criterion for hazardous drinking. Finally, the BASDA index was significantly associated with alcohol misuse above and beyond drinking motives in relation to AUDIT scores, supporting incremental validity. CONCLUSIONS: Taken together, these findings provide further support for the BASDA as an efficient measure of drinking in an individual's social network. Methodological considerations as well as recommendations for future investigations in this area are discussed.