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 (\u3c 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

Behavioral Couples Therapy for Smoking Cessation: A Pilot Randomized Clinical Trial

Introduction—Behavioral couples therapy (BCT) has been found to improve long-term abstinence rates in alcohol- and substance-dependent populations but has not been tested for smoking cessation. This pilot study examined the feasibility and acceptability of BCT for smoking-discordant couples. Methods—Forty-nine smokers (smoking \u3e10 cigarettes/day) with non-smoking partners were randomized to receive a couples social support (BCT-S) intervention, or an individually-delivered smoking cessation (ST) treatment. The couples were married or cohabiting for at least one year, with partners who had never smoked or had not used tobacco in one year. Both treatments included seven weekly sessions and 8-weeks of nicotine replacement therapy. Participants were followed for six months post-treatment. The Partner Interaction Questionnaire (PIQ) was used to measure perceived smoking-specific partner support. Results—Participants were 67% male and 88% White. Biochemically-verified cessation rates were 40.9%, 50% and 45% in BCT-S, and 59.1%, 50%, and 55% in ST, at end of treatment, 3-, and 6-months, respectively, and did not differ significantly between treatment conditions at any time point (all p’s \u3e .05). Perceived smoking-specific partner support at post-treatment did not significantly differ between treatment groups (M=2.45, SD .81 in BCT-S; M=2.27, SD .92 in ST; t(38) = .67, p = .51). Conclusions—Results of this pilot study do not provide support for the efficacy of BCT in smoking 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 vs. parents of healthy children (HC) and 2) whether greater intervention intensity (Enhanced-PAM) produces greater cessation than a previously tested intervention (Precaution Adoption Model; 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; 6 asthma education calls) or Enhanced-PAM (n=170; 6 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—were given at baseline, 2, 4, 6 and 12 months. Abstinence was bioverified. Outcomes were 7-day and 30-day 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 (OR=2.60, 95% CI = 1.22–5.54) and 7-day ppa (OR=2.26, 95% CI=1.13– 4.51) at 2 months (primary endpoint) 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 endpoint, 4-months (OR=2.12, 95% CI 1.09–4.12) and improved asthma outcomes vs. PAM. Conclusions—Smoking cessation interventions (Motivational Interviewing + 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

Organizational factors and therapist attitudes in the prediction of MI adoption.

Dissemination efforts occur within a context. It is important to determine the individual and organizational factors that promote MI adoption. The present study had three goals: 1) to examine the four-factor structure of the Evidence-Based Practice Attitudes Scale (EBPAS) in a sample of substance abuse providers, 2) to examine the organizational and therapist attitude variables that predicted study attrition, and 3) to examine the organizational and therapist attitude factors that predicted MI skill levels at each of the three time points and the factors that predicted skill growth over time. While the factor-structure of the EBPAS was similar in this sample to a sample of general mental health practitioners, the model fit the data only marginally well. More positive therapist attitudes about EBP and positive organizational climate predicted submission of a three-month follow-up session. Institutional resources and training exposure and utilization predicted both skill growth over time and skill level at baseline, immediately post-training, and three-months post-training. In order to more effectively adopt MI, an organization needs to be appropriately funded and devote more resources to exposing therapists to continuing education opportunities

Traumatic events, perceived stress, and health in women with fibromyalgia and healthy controls

This study examined the relationship between trauma, stress and health in 41 women with fibromyalgia (FM) and 44 women who were healthy controls (HC). The participants were assessed for traumatic events, perceived stress and mental and physical health. Perceived stress was related to worse mental and physical health in both groups. Traumatic events were related to worse mental and physical health in the FM group but were unrelated to health in the HC group. Perceived stress partially mediated the effect of traumatic events on mental and physical health in the FM group. Finally, adult abuse partially mediated the effects of child abuse on adult stress and health. Trauma may have lasting effects on stress and health in women with FM. Copyright © 2009 John Wiley & Sons, Ltd

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 is currently no published data on use of e-cigarettes among cardiac patients. The current study reports on the prevalence, reasons for use, and perceived risks of e-cigarettes among post-Acute Coronary Syndrome (ACS) patients. 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 focuses on 49 participants that completed e- cigarette questions at 24 weeks post-ACS. Results—51.0% of participants 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, 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 e-cigarettes only, significantly lower than perceived risk of recurrence if they were to regularly smoke only tobacco cigarettes (56.2%) and significantly higher than 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

The Role of Resilience and Purpose in Life in Habituation to Heat and Cold Pain

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. Re- silience, 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 pos- itively related to habituation to heat and cold pain while controlling for neuroticism. Multilevel mod- eling 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 charac- teristics, both resilience and purpose in life predicted greater habituation to heat and cold pain. Re- silience 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 re- silience, 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

Comparison of Secondhand Smoke Exposure in Minority and Non-minority Children with Asthma

Objective—Determine if secondhand smoke exposure (SHSE) is related to asthma-related functional morbidity by examining racial/ethnic differences in Non-Latino White (NLW), African American, and Latino families and whether racial/ethnic SHSE differences across families persist when accounting for smoking factors. Methods—Participants were 305 caregiver smokers of children with asthma. Two passive dosimeters measured SHS: one in the home and one worn by the child. Results—Higher SHSE was related to greater asthma-related functional morbidity. African Americans had higher levels of home SHSE than Latinos (p = .003) or NLWs (p = .021). SHSE as assessed by the child worn dosimeter did not differ across race/ethnicity. African American families were less likely to report a household smoking ban (46.4%) compared to Latinos (79.2%) and NLWs (67.9%; p \u3c .05). African Americans were less likely to report having two or more smokers in the home (37.2%) compared to NLWs (53.6%; p \u3c .05). NLWs reported the highest number of cigarettes smoked daily (Mdn = 15.00) compared to Latinos (Mdn = 10.00; p = .001) and African Americans (Mdn = 10.00; p \u3c .001). SHS home exposure levels were regressed on race/ethnicity and relevant covariates. Household smoking ban (p \u3c .001) and only one smoker in the home (p = .005) were associated with lower levels of SHS in the home; race/ethnicity was not significant. Conclusions—Differences in SHSE across race/ethnicity exist among children with asthma, possibly due to differential presence of a household smoking ban and number of smokers in the home

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 η2 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

Moringa Connect: Best Practices in Field Agent Management

This report responds to challenges MoringaConnect field officers face while working with farmers. We present insights of partner organizations to effectively organize field officers, expand the farmer networks, and increase the supply of moringa