Using motivational interviewing for smoking cessation in primary care.

OBJECTIVES: To compare the effects of resident physician motivational interviewing (MI), resident physician MI plus registered nurse (RN), and the standard of care counseling approach--ask, advise, assess, assist, and arrange follow-up (5 As)--on current smokers' behaviors (readiness to quit, cigarettes smoked per day, current smoking rates), self-efficacy to quit smoking, and nicotine dependence. METHODS: The study design was quasi-experimental pretest/posttest with a comparison group. Pencil/paper measures were completed in the clinic setting at baseline and via telephone approximately 1 and 2 months after the clinic visit. RESULTS: There were no differences among the three groups in the proportion of participants who quit smoking, and the stages of change did not differ among the groups or over time. There was a significant time effect and a decrease in the number of cigarettes smoked per day (F2,160 = 41.04, P < 0.001). Significant group × time interactions were present for self-efficacy (F4,140 = 8.20, P < 0.001), nicotine dependence (F4,140 = 6.22, P < 0.001) and satisfaction with clinician (F4,160 = 3.81, P = 0.006). Post hoc analyses showed that participants in the MI groups smoked fewer cigarettes, had higher self-efficacy, and had lower nicotine dependence scores. Only participants in the MD-plus-RN follow-up group had significant positive changes in satisfaction scores. CONCLUSIONS: Resident physicians who use MI techniques have a tremendous effect on patients' smoking behaviors. When the resident physician and the RN worked together, participants achieved better outcomes.

Promoting nurse interventionist fidelity to motivational interviewing in a diabetes self-care intervention.

We describe interventionist training procedures for a pilot intervention study that tested the effects of a nurse-delivered Motivational Interviewing (MI) intervention on diabetes self-care among adults diagnosed with type 2 diabetes mellitus. It reports on findings from MI fidelity assessments. Training consisted of didactic workshops plus practicum. Fidelity of MI was assessed using the MI Treatment Integrity (MITI) Scale. Fidelity assessments were conducted on 18 (25%) audiotaped MI sessions, which were randomly selected from a total of 72 sessions with 26 participants. Scores of the MITI were in the proficient and competent range. Results suggest that training strategies were sufficient to promote satisfactory interventionist fidelity to MI.

The co-occurrence of obesity, elevated blood pressure, and acanthosis nigricans among American Indian school children: identifying individual heritage and environment-level correlates.

OBJECTIVE: To estimate the prevalence and explore the social and cultural etiologic roots of weight status, blood pressure, and acanthosis nigricans among American Indian children on a reservation in South Dakota. METHODS: This observational study was conducted in 26 schools from 1998 to 2002 and included 5,422 observations representing 3,841 children, ages 3 to 19. Trained staff measured height, weight, blood pressure, and assessed the presence of acanthosis nigricans (AN). Percent Indian heritage (PIH) was abstracted from tribal records. Sociodemographic environment (SDE) was calculated using the 2000 Census at the city/town level. Descriptive analyses were conducted using one measurement time point, including tests for trend and co-occurrence of risk factors using the [kappa] statistic. Hierarchical, multivariate logistic regression estimated associations with overweight/obesity status, accounting for multiple measures on individuals and SDE. RESULTS: The overall prevalence of overweight/obesity was 46%, of hypertension 9%, and of AN 14%. The co-occurrence of risk factors was moderate to high. PIH and AN were positively associated in unadjusted analysis. Controlling for sex, age, and SDE, higher PIH was a significant correlate of overweight/obesity, although when hypertension (OR = 5.92, CI = 3.27-10.72), prehypertension (OR = 3.80, CI = 1.99-7.26), and AN (OR = 16.20, CI = 8.08-32.48) were included in the model PIH was no longer significant. SDE was not significantly associated with overweight/obesity. CONCLUSION: PIH appeared to be an important correlate of overweight and obesity, except when adjusted for the co-occurrence of high blood pressure and AN. Overall, the prevalence and co-occurrence of various risk factors in this population was high. Obesity prevention initiatives targeting families and communities are needed, as well as access to screening and treatment services.

Development of a Brief Abstinence Self-Efficacy Measure.

This study compared the 40-item Alcohol Abstinence Self-Efficacy (AASE) scale with domains of confidence and temptation to a new 12-item version developed by the authors consisting of the same domains. There were 126 participants who completed the survey. Psychometric analysis demonstrated high reliability and validity consisting of high correlations between domains of confidence (α = .92) and temptation (α = .88) in the 40-item version of the scale compared to the briefer version. The 12-item version appears to provide a clinically reliable and valid measure of AASE domains of confidence and temptation, providing a more efficient tool for clinical practice.

Concerns about dose and underutilization of twelve-step programs: models, scales, and theory that inform treatment planning.

Researchers have observed that a majority of addicted persons who are encouraged and facilitated by treatment providers to attend twelve-step (TS) programs either drop out or sporadically use twelve-step programs following treatment. This is troubling given considerable evidence of TS program benefits associated with regular weekly attendance and ubiquitous reliance by treatment professionals on these programs to provide important support services. This chapter reviews and advances theory of TS utilization and dose that is supported by prior research, multivariate models, and scales that predict risk of TS meeting underutilization. Advancing theory should organize and clarify the process of initial utilization, guide intervention development, and improve adherence of TS program referrals, all of which should lead to improved treatment planning and better outcomes. Three theories are integrated to explain processes that may influence TS program dose: the health belief model, self-determination theory (motivational theory), and a person-in-organization cultural fit theory. Four multidimensional scales developed specifically to predict participation are described. Implications for practice and future research are considered in a final discussion. Information contained in this chapter raises awareness of the need for TS-focused treatments to focus on achieving weekly attendance during and after treatment.

True porosity measurement of hair: a new way to study hair damage mechanisms.

This study employs a novel method, gas sorption (1), to quantify the porosity characteristics of hair by determining total pore volume, adsorption pore-size distribution, and the surface area of damaged hair. Damage mechanisms were studied by comparing the different pore volume and surface area resulting from two different types of damage: chemical and UV. Hair color measurement and tensile strength, both reflecting the changes in hair cortex, were also employed in this study. The results suggest that hair damage caused by oxidative bleach and UV oxidation follows different pathways. Chemical damage (oxidative bleach) nearly triples the hair surface area in the first minute of bleaching due to the increase in the number of pores, followed by a sudden drop after 10 min of bleaching from smaller pores breaking down into larger ones. In contrast, UV damage shows an immediate loss in surface area in the first 200 hr of exposure and a gradual increase as exposure time continues.

Motivational interviewing to improve diabetes outcomes in African Americans adults with diabetes.

The purpose of this study was to determine the effect of a motivational interviewing intervention (MII) on regimen adherence and diabetes markers among African Americans with diabetes. Sixty-two participants were assigned to the usual care (UC; n = 36) or MII (n = 26) groups. UC participants received the usual clinic care. MII participants received a maximum of six motivational interviewing (MI) sessions over 3 months. Outcome variables were obtained at baseline and 3-month follow-up. Data were obtained using medical records, self-reports, and glucose monitor and accelerometer print-outs. MII significantly increased the odds of participants adhering to recommended physical activity level (66.7% vs. 38.8%, odds ratio = 2.92, 95% confidence interval = [1.6, 14.3], p = .018) and significantly decreased glucose levels (p = .043) and body mass index (p = .046) over time when compared with UC. Findings support using MI as an intervention for improving health outcomes and regimen adherence rates among the study population.

Improving access to substance abuse treatment services for consumers with AIDS: a formative evaluation.

This paper presents the findings of a formative evaluation used to guide the implementation of programming funded by an HIV/Treatment Capacity Expansion grant received from Substance Abuse and Mental Health Administration. Data were gathered from programmatic records regarding access to treatment, individual interviews with persons with HIV referred to treatment that did not attend, and interviews with persons with HIV currently receiving substance abuse treatment. Findings connected to record review indicate that the program is functioning in accordance with current model standards, while interviews indicated several barriers to access. Suggestions are offered to improve the implementation of substance abuse treatment to persons living with HIV/AIDS.

What is Alcoholics Anonymous affiliation?

An increasing body of research evidence supports the use of 12-step program affiliation as an effective adjunct and aftercare for formal treatment. Recently, three brief (9- or 10-item) measures of affiliation have been developed. However, the brief scales are difficult to interpret, and the question of exactly what is affiliation (or disaffiliation) remains unclear. This analysis examines the question of what is the essence of affiliation vs. disaffiliation. Data from the Project MATCH 1-year posttreatment Alcoholics Anonymous Involvement (AAI) scale (N=1506) are used to identify the most salient items of Alcoholics Anonymous (AA) affiliation predicting 1-year posttreatment drinking outcomes. Analysis using stepwise regression suggests that a three-item solution can explain a similar amount of variance in the proportion of days abstinent in months 9 through 12 posttreatment, as does using the nine items. These three "core items predicting recovery" include AA attendance, sum of steps completed, and identifying self as an AA member. As an affiliation composite scale, these three items are easier to interpret and administer than the full AAI scale, and when combined, possess adequate reliability (alpha=0.72).