Efficacy for Dealing With Terrorism Precautionary Behavior: Laying the Groundwork for Communication Effectiveness.

In order to formulate effective communication and intervention strategies to respond to the widespread lack of preparedness for public health crises resulting from natural and human-made disasters, researchers have developed models describing the interrelationships between factors associated with emergency preparedness decisions. Empirical research has generally assumed that two key elements of most health behavior theories-self-efficacy and response efficacy-additively influence the decision to prepare, despite compelling theoretical rationale for an interactive relationship. The few studies that have investigated interactions in preparedness outcomes have not tested the Social Cognitive Theory prediction that non-zero levels of both efficacy types are required before individuals will engage in any preparedness behavior. Based on the responses of 3,101 participants in the National Survey of Disaster Experiences and Preparedness, this study tested additive, interactive, and conditional main effect hypotheses about the influence of self-efficacy and response efficacy for dealing with terrorism on preparedness due to terrorism six years after the September 11, 2001, terrorist attacks. A significant self-efficacy × response efficacy interaction effect on preparedness was found, in addition to a significant response efficacy effect when perceived self-efficacy was zero, contrary to the expectation from Social Cognitive Theory. These results offer insights into the cognitive processes underlying individuals' decisions to prepare for disasters such as terrorist attacks, and highlight the importance of considering more complex theory-based cognitive interaction models in designing effective communication strategies to facilitate individual emergency preparedness.

Perceived Threat of Disaster, Efficacy, and Psychological Distress Among Individuals with a Physical Disability: A Longitudinal Model.

OBJECTIVE: Individuals with physical disabilities experience distress when faced with the threat of human-made and natural disasters, yet little is known about how to reduce that distress. This study used Protection Motivation Theory to longitudinally test the relationships between psychological distress and disaster-related cognitive appraisals, including perceived threat, emergency preparedness self-efficacy, and response efficacy, in a sample of individuals with physical disabilities. METHODS: A nationwide convenience sample of 106 adults completed 2 surveys approximately 5 years apart. Structural equation modeling was used to assess effects of perceived threat, self-efficacy, and response efficacy on psychological distress across the 2 waves. RESULTS: Our results suggest that the associations of proximal perceived threat and self-efficacy with psychological distress remain stable across time, while the effect of response efficacy is variable and may be more context-specific. Importantly, individuals who reported an increase in self-efficacy over time also reported (on average) a decrease in psychological distress. CONCLUSIONS: In addition to broadening our understanding of factors related to psychological distress, these results have potentially important intervention implications; for example, to the extent that self-efficacy is a malleable construct, one way of reducing disaster-related psychological distress may be to increase an individual's self-efficacy.

The Effects of Implicit Theories on Body Weight Information Avoidance.

Regular self-weighing is associated with more effective weight control, yet many individuals avoid weight-related information. Implicit theories about weight, or perceptions of how malleable weight is, predict more effortful weight management and may also influence weight-related information avoidance. Participants (N = 209) were randomly assigned to read an article stressing an incremental theory of weight (i.e., weight is malleable), an article stressing an entity theory (i.e., weight is fixed), or to a control condition. We then examined their self-reported preference to avoid their body composition (i.e., body fat, weight, and muscle composition), their willingness to have their body composition measured during the lab visit, and their eating and exercise intentions. There were no notable differences across conditions, but higher self-reported incremental beliefs predicted less self-reported avoidance of body composition. The findings suggest that implicit theories may influence weight-related information avoidance, but a brief manipulation is not powerful enough to create meaningful change.

The reasons for nursing home entry in an adult day care population: caregiver reports versus regression results.

This article aims to compare reasons for nursing home entry determined through a regression of baseline predictors to relatives' perceptions of reasons for entry. Participants included 201 community-residing members of 5 senior day care centers in Maryland. Through a prospective design, statistical predictors using Cox regressions were compared to the relatives' reports of reasons for nursing home entry. These reports identified the most common reasons for nursing home entry as deterioration of independence and confusion. Behavior problems were also reported for almost half of the participants. In contrast, strong baseline statistical predictors of institutionalization were depressed affect, number of psychiatric diagnoses, a diagnosis of dementia, and age. Because of its strong significance within the baseline predictors, the meaning of depressed affect and why it was such a potent predictor of nursing home entry, yet still not reported by caregivers, should be studied further.

Readiness to change as a mediator of the effect of a brief motivational intervention on posttreatment alcohol-related consequences of injured emergency department hazardous drinkers.

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population.

Anxiety effects on disaster precautionary behaviors: A multi-path cognitive model.

Previous studies have revealed a negative relationship between anxiety and health-promoting behavior. This study identified three cognitive pathways through which anxiety operates on preparedness behaviors for terrorist attacks. Preparedness was regressed on trait anxiety, perceived threat, and self-efficacy based on data from 306 adults. Mediating paths through perceived threat (positive) and self-efficacy (negative) and an independent negative path were identified. Results suggest that the anxiety/precautionary behavior relationship is more complex than previously thought, involving multiple pathways of competing directionality. Interventions to improve disaster preparedness and thus reduce disaster-related morbidity/mortality would benefit by capitalizing on this multidimensionality.

The Importance of Self-Efficacy in Parental Emergency Preparedness: A Moderated Mediation Model.

OBJECTIVE: Disasters occur without warning and can have devastating consequences. Emergency preparedness can reduce negative effects. It is especially important that parents prepare, as children are particularly vulnerable after disasters. This study tested 2 hypotheses: (1) adults with more children are likely to be better prepared than those with fewer or no children because greater caretaking is linked to greater perceived threat of disaster leading to greater preparedness and (2) the strength of this mediational link varies as a function of parental self-efficacy. METHODS: Data from an online survey about human-made disasters (terrorism) with a community convenience sample were used to test the hypothesis that perceived threat mediates the relationship between parental status (number of children cared for) and preparedness behaviors, moderated by level of self-efficacy for emergency preparedness. RESULTS: A bootstrapping analysis with relevant covariates supported the hypothesized mediating effect of threat on the relationship between parental status and preparedness. This relationship was strengthened at higher levels of parental preparedness self-efficacy. CONCLUSIONS: The results of this study are particularly relevant for preparedness interventions. Because threat leads to preparedness, particularly for parents with high self-efficacy, it is important to focus attention on factors that can improve parents' sense of self-efficacy. (Disaster Med Public Health Preparedness. 2018; 12: 345-351).

Naltrexone's suppressant effects on drinking are limited to the first 3 months of treatment.

RATIONALE: Twelve weeks of naltrexone significantly improves drinking outcomes in alcoholics; however, the clinical benefits of naltrexone decline shortly after treatment is discontinued. OBJECTIVE: The present study investigated whether extended treatment with naltrexone significantly improved drinking outcomes. METHODS: One hundred forty-six alcohol-dependent patients received broad spectrum treatment or motivational enhancement therapy and either 12 or 24 weeks of naltrexone. The primary dependent variables were percent days abstinent and percent heavy drinking days. RESULTS: Using an intention-to-treat analysis, there were no significant differences in percent days abstinence or percent heavy drinking days at the end of phase 2 between patients who received 24 weeks of treatment with naltrexone (chi = 63.23) or patients who received 12 weeks of treatment with naltrexone followed by 12 weeks of treatment with placebo (chi = 65.82). Similarly, the average percent heavy drinking days was not significantly different at the end of phase 2 between the group that received 24 weeks of naltrexone (chi = 21.9) and the group that received 12 weeks of naltrexone followed by 12 weeks of placebo (chi = 22.14). Medication compliance was low in the second phase of the study. Drinking outcomes declined with declining compliance whether patients were taking naltrexone or placebo. CONCLUSIONS: The results of this study suggest that administering naltrexone beyond an initial 12 weeks of treatment may not be beneficial to all patients and should be administered along with close medical monitoring to insure compliance.

Characteristics of adult day care participants who enter a nursing home.

The authors sought to determine the characteristics of individuals enrolled in adult day care who are most likely to enter a nursing home. The status of 201 adult day care participants was assessed at baseline and at least 3 years after baseline evaluation. Risk factors for nursing home entry were identified on the basis of staff and family caregiver reports, participant testing, chart review, and physician evaluations. Cox regression analyses of baseline data such as medical diagnoses, affect, and demographic information were used to identify risk factors for institutionalization. Multivariate Cox regression analysis identified depressed affect of the care recipient as an important predictor of institutionalization; other predictors were low frequency of socializing with relatives and friends, higher number of psychiatric diagnoses, and increased age. The findings highlight the importance of socialization and suggest that a focus on successful and reinforcing socialization should be an important component of adult day care programming. The results also suggest that addressing patient mental health variables may be important in delaying institutionalization in this population.

Research fundamentals: follow-up of subjects in clinical trials: addressing subject attrition.

Many published clinical trials have less than adequate follow-up. When conducting a clinical trial, researchers attempt to minimize data loss; however, some data may not be collected, particularly when subjects are lost to follow-up. Careful planning of research protocols, including comprehensive initial data collection, identification of locators, flexible scheduling, systematic subject tracking, monitoring subject loss, and systematically approaching problem cases can ensure high follow-up rates. This article presents a compendium of techniques and procedures that researchers can use to enhance follow-up and address attrition in their studies. Finally, this article outlines statistical techniques that can be used to address the effects of missing data, particularly when patients are lost to follow-up.

Decomposing the relationships between pretreatment social network characteristics and alcohol treatment outcome.

OBJECTIVE: In Project MATCH a summary measure of network support for drinking identified matching and prognostic effects. The goals of the present analyses were (1) to determine which of the 11 component indexes are most predictive of treatment outcome regardless of treatment type and (2) to determine which of the indexes are most influential in the already demonstrated network support by treatment interaction effect. METHOD: This is a secondary data analysis of the outpatient arm of Project MATCH (N = 952), focusing primarily on the Important People and Activities instrument administered pretreatment. RESULTS: Patients with larger daily networks and patients with more abstainers/recovering alcoholics in their networks had a better prognosis. Patients with a higher network drinking frequency did better in Twelve Step Facilitation than in Motivational Enhancement Therapy. CONCLUSIONS: Three of the 11 indexes can be used to replicate the prognostic and matching effects found for an overall index of network support. These may be measured by a short form of the Important People and Activities instrument.

Biological background knowledge and learning from a drug and alcohol education program.

The authors asked whether having a base of relevant biological knowledge put school children in a better position to understand the effects of alcohol and cocaine and to learn about these effects when exposed to a curriculum presenting a physiological theory of drug action. Participants were 337 ethnically diverse 3rd- through 6th-grade students who were pretested, trained, and posttested. Multiple regression analyses revealed that knowledge of the basic functions of the heart, blood, and brain predicted certain drug-knowledge variables. Students with greater biological background knowledge also learned more from instruction, a finding with implications for enhancing drug and other health education programs.

Angular declination and the dynamic perception of egocentric distance.

The extraction of the distance between an object and an observer is fast when angular declination is informative, as it is with targets placed on the ground. To what extent does angular declination drive performance when viewing time is limited? Participants judged target distances in a real-world environment with viewing durations ranging from 36-220 ms. An important role for angular declination was supported by experiments showing that the cue provides information about egocentric distance even on the very first glimpse, and that it supports a sensitive response to distance in the absence of other useful cues. Performance was better at 220-ms viewing durations than for briefer glimpses, suggesting that the perception of distance is dynamic even within the time frame of a typical eye fixation. Critically, performance in limited viewing trials was better when preceded by a 15-s preview of the room without a designated target. The results indicate that the perception of distance is powerfully shaped by memory from prior visual experience with the scene. A theoretical framework for the dynamic perception of distance is presented.

Hyper-arousal decreases human visual thresholds.

Arousal has long been known to influence behavior and serves as an underlying component of cognition and consciousness. However, the consequences of hyper-arousal for visual perception remain unclear. The present study evaluates the impact of hyper-arousal on two aspects of visual sensitivity: visual stereoacuity and contrast thresholds. Sixty-eight participants participated in two experiments. Thirty-four participants were randomly divided into two groups in each experiment: Arousal Stimulation or Sham Control. The Arousal Stimulation group underwent a 50-second cold pressor stimulation (immersing the foot in 0-2° C water), a technique known to increase arousal. In contrast, the Sham Control group immersed their foot in room temperature water. Stereoacuity thresholds (Experiment 1) and contrast thresholds (Experiment 2) were measured before and after stimulation. The Arousal Stimulation groups demonstrated significantly lower stereoacuity and contrast thresholds following cold pressor stimulation, whereas the Sham Control groups showed no difference in thresholds. These results provide the first evidence that hyper-arousal from sensory stimulation can lower visual thresholds. Hyper-arousal's ability to decrease visual thresholds has important implications for survival, sports, and everyday life.

Predictors of entry to the nursing home: does length of follow-up matter?

This study examined the extent to which predictors of nursing home entry vary in their salience as a function of length of follow-up. Participants were 201 persons attending five senior day care centers. The impact of baseline assessment on nursing home entry was examined at one, two, and three-year follow-up periods. Analysis revealed that MMSE, IADL, physical non-aggressive agitated behavior, and 4 indicators of caregiver burden had significantly changing impacts on time to nursing home entry. Only depressed affect and age remained significant predictors at all three follow-up periods in the multivariate analysis. Physical and verbal aggressive agitation and declining caregiver health were significant predictors in the short term. Socializing and ethnicity became predictors at year three. We have demonstrated that while some predictors of nursing home placement are robust over varying follow-up times, the predictive value of others changes with length of the follow-up period. Length of follow-up needs to be taken into account in clarifying the processes that predict nursing home entry.

Network support as a prognostic indicator of drinking outcomes: the COMBINE Study.

OBJECTIVE: To increase understanding of the interrelationship between a patient's social network and patient drinking, the Important People and Activities (IPA) instrument was developed. To meet the aims of the COMBINE (Combining Medications and Behavioral Interventions) Study, the IPA was modified to create the Important People Inventory (IPI), which was used to measure the contextual influence of the patient's social network on patient outcomes and treatment effects. The aims of the present article were to describe the IPI and its differences from the IPA and to test the relationship of network support as measured by the IPI in predicting drinking during and following treatment. METHOD: Alcohol-dependent patients (N = 1,373) seeking outpatient treatment in the COMBINE randomized clinical trial were administered the IPI before treatment. Six network constructs were tested for predicting patient drinking. RESULTS: As unique effects, alcohol-specific support, as measured by network drinking and opposition to patient drinking, is predictive of patient abstinent days during and following treatment and heavy drinking days following treatment. Other measures of network support have variable relationships to patient drinking at different phases: Some are predictive of patient drinking during treatment but diminish, whereas others are unrelated to drinking during treatment but become increasingly predictive of drinking as time from treatment increases. CONCLUSIONS: The IPI is a useful instrument for describing network support of alcohol-use disorder patients entering treatment. Measures of alcohol-specific support are prognostic of drinking outcomes. The patient's network support should be systematically assessed prior to tailored treatment planning.

Extended naltrexone and broad spectrum treatment or motivational enhancement therapy.

BACKGROUND: Randomized clinical trials on the effectiveness of naltrexone (NTX) in the treatment of alcohol dependence have produced conflicting results. One possible explanation for these discrepancies may lie in the various psychosocial treatments for which NTX is an adjunct. The goal of this study was to examine the interplay between psychosocial treatment and duration of NTX. METHODS: One hundred and seventy-four alcohol-dependent outpatients participated in a double-blind trial where they were randomly assigned to 12 vs. 24 weeks NTX duration and to one of two psychosocial treatments: motivational enhancement therapy (MET) and broad spectrum treatment (BST), a cognitive behavioral therapy tailored to the patient's specific needs. After an initial 12-week period of NTX and psychosocial treatment, half of each psychotherapy condition was assigned to continue NTX for an additional 12 weeks while the other half was assigned to placebo. Patient drinking outcomes were measured for the year following treatment completion. It was hypothesized that the combination of extended duration of NTX and the moderate intensity of BST would be predictive of longer time to a first heavy drinking day than any of the three alternative combinations: MET with short or extended NTX administration or BST with short NTX administration. RESULTS: The median time to first drink and time to first heavy drinking day were found to be significantly longer for patients who received BST and extended NTX than for patients in the other three groups. CONCLUSIONS: These results may suggest that the kind of psychosocial treatment delivered in combination with duration of NTX administration may partially explain the inconsistent findings regarding the efficacy of NTX in the treatment of alcohol dependence.

Advances in causal chain development and testing in alcohol research: mediation, suppression, moderation, mediated moderation, and moderated mediation.

BACKGROUND: While causal modeling is generally well known to alcohol researchers, several causal structures (including suppression, mediated moderation, and moderated mediation) are often poorly understood and seldom employed when investigators seek to model the complex mechanisms of behavior change, despite their widespread applicability to the field. METHODS: This paper compares and contrasts five basic structures of causal modeling in the context of contemporary alcohol research and demonstrates how mechanisms of behavior change can be conceptualized and tested as parallel and serial sequences of these basic causal structures, forming causal chains. CONCLUSION: Recent methodological developments, while representing an important advancement for the field, fail to adequately address the complexities of alcohol dependence phenomena. A differentiation between frequently combined forms of these causal structures is proposed that would better address the needs of the field.

Building better cognitive-behavioral therapy: is broad-spectrum treatment more effective than motivational-enhancement therapy for alcohol-dependent patients treated with naltrexone?

OBJECTIVE: The current study investigated the treatment effectiveness, during treatment, of a second-generation cognitive-behavioral therapy for alcoholism--broad-spectrum treatment (BST)--compared with motivational-enhancement therapy (MET), when both were offered in conjunction with a therapeutic dose of naltrexone (Revia). METHOD: One hundred forty-nine alcohol-dependent patients completed a 3-month randomized, controlled trial of BST and naltrexone versus MET and naltrexone. RESULTS: Patients receiving BST had a significantly higher percentage of days abstinent than patients receiving MET. The superior effect of BST is particularly strong in interaction with support for drinking, suggesting that the advantage of BST is worth the additional cost for patients whose psychosocial networks are supportive of continued drinking. This effect remains significant when controlling for pretreatment percentage of days abstinent. CONCLUSIONS: In aggregate, these findings suggest that it is either the combination of naltrexone and BST or the unique properties of BST that account for BST's superiority to MET and naltrexone. The results of this initial phase of the trial suggest that a second-generation cognitive-behavioral therapy such as BST may have a meaningful clinical advantage over brief interventions such as MET, at least when combined with naltrexone.

Teaching a coherent theory of drug action to elementary school children.

This study examined whether two versions of a drug and alcohol curriculum explaining how substances affect behavior and health, one version more causally coherent than the other, were more effective than a control curriculum on disease in changing school-age children's (N=327) beliefs and attitudes regarding cocaine and alcohol. Few differences were found between the two drug and alcohol curricula. Compared to children receiving the control curriculum, however, both treatment groups demonstrated greater understanding of the circulation of alcohol and cocaine throughout the body, the true long-term effects of these substances, and the stimulant effects of cocaine. Moreover, they had less positive attitudes and intentions toward cocaine. Several differences were evident at both a 3-month post-test and a 1-year follow-up, pointing to the potential value of applying an intuitive theories perspective in designing drug prevention and other health education programs.