Improving Colorectal Cancer Screening Decision Making Processes

Introduction: Although shared decision making is recommended for cancer screening, it is not routinely completed in practice because of time constraints. We evaluated a process for improving decision making about colorectal cancer (CRC) screening using mailed decision aids (DA) with follow-up telephone support in primary care practices. Methods: We identified patients aged 50-75 who were not up to date with CRC screening in three primary care practices. DA were distributed via mail with telephone follow-up to eligible patients, and charts were reviewed six months later for CRC screening completion. Results: Among 1,064 eligible patients who received the mailed DA, 513 (48.2%) were reached by phone. During the six months after the intervention, 148/1064 (13.9%) patients were screened for CRC (4.8% underwent FIT, 9.1% underwent colonoscopy). Younger patients (aged 50-54) had higher rates of any screening (32.4%) compared with all other age groups (range 12.8%-19.6%), p=0.026, while Medicaid patients had the lowest rates of screening (4.0%), and insured patients had the highest rates (45.3%), p=0.003. Overall, 113/513 (22.0%) who were reached by phone went on to complete screening within 6 months, compared with 35/551 (6.4%) of patients who were not reached by phone (p Conclusion: A standard process for identifying patients unscreened for CRC and DA distribution via mail with telephone decision support modestly increased CRC screening and is consistent with the goal of providing preference-sensitive care and informed decision making. Improving care processes to include decision support outside of office visits is possible in primary care practices

Individual Differences in Preferences for Positive Psychology Interventions

Poster presented at the 23rd Annual Convention of the Association for Psychological Science, Washington D.C

Gender Effects on Self-Efficacy Expectations & Outcome Expectancy Values Regarding Positive Psychology Interventions

Poster presented at the 2010 meeting of the Maine Psychological Association, Augusta, ME

Predictors and Outcomes of Metacognitive Language Use Between Parents and Children

Paper presented at the 9th annual Thinking Matters Conference, Portland, ME

Evaluating adverse rural crash outcomes using the NHTSA State Data System.

INTRODUCTION: The population-based rate of motor vehicle crash mortality is consistently higher in rural locations, but it is unclear how much of this disparity might be due to geographic barriers or deficiencies in emergency medical services (EMS). We sought to analyze separately factors associated with the occurrence of a severe injury and those associated with death after injury had occurred. METHODS: Data from all police-reported crashes in 11 states from 2005-2007 were obtained through the National Highway Traffic Safety Administration (NHTSA) State Data System (SDS). Logistic regression was used to estimate factors associated with (1) death; (2) severe (incapacitating or fatal) injury; and (3) death given severe injury. Models included covariates related to the person, vehicle, and event; county location was specified using Rural-Urban Continuum Codes (RUCC). RESULTS: Older age, not wearing a belt, ejection, alcohol involvement, high speed, and early morning times were associated with increased risk of both severe injury and death. Controlling for these factors, and restricting analysis to persons who had suffered a severe injury, the adjusted odds ratio (aOR) associated with death was higher for counties classified rural (RUCC 6-7, aOR 1.23, 95% CI 1.16-1.31) or very rural (RUCC 8-9, aOR 1.31, 95% CI 1.18-1.46). CONCLUSIONS: Persons severely injured in crashes are more likely to die if they are in rural locations, possibly due to EMS constraints. As NHTSA-SDS data become more available and more uniform, they may be useful to explore specific factors contributing to this increased risk

Socioeconomic Status and Parent-Child Relationships Predict Metacognitive Scaffolding Language to Preschoolers

Poster presented at the 2011 Society for Research in Child Development Biennial Meeting, Montreal, Canada

The Effects of Low SES on Parents’ Scaffolding Questions to Preschoolers

Poster presented at the 2011 meeting of the Eastern Psychological Association, Cambridge, MA

Gender differences in the person-activity fit for positive psychology interventions.

Research on positive psychology interventions (PPIs) has established the value of activities such as acts of kindness, gratitude, and savoring life’s joys, for increasing individuals’ sense of well-being. Critical to the efficacy of PPIs isperson-activity fit– the degree activities stem from intrinsic motivation. Although person-activity fit effects are well documented, gaps remain in our understanding of how sociodemographic variables, particularly age and gender, play a role. We investigated how gender may affect self-reported person-activity fit across three PPIs: A gratitude journal; Acts of Kindness; and Savoring life’s joys. Age was explored since the subject sample ranged widely, from 18 to 51 years. Twenty-eight men and 82 women completed person-activity fit questionnaires. A multiple analysis of variance resulted in a main effect for gender, with women showing greater person-activity fit for all three PPIs. Among women only, age correlated significantly with person-activity fit for all three PPIs, suggesting greater maturational variability among men

Mapping the time course of overt emotion dysregulation, self-injurious behavior, and aggression in psychiatrically hospitalized autistic youth: A naturalistic study

Challenges with emotion dysregulation, self-injurious behavior (SIB), and aggression are common in autistic individuals. Prior research on the relationships between these behaviors is limited mainly to cross-sectional correlations of parent-report data. Understanding how emotion dysregulation, SIB, and aggression present and relate to one another in real-time could add to our understanding of the context and function of these behaviors. The present study examined the real-time occurrence and temporal relationships between these behaviors in 53 psychiatrically hospitalized autistic youth. Over 500 hours of behavioral observation occurred during everyday activities in the hospital. Start and stop times for instances of overt emotion dysregulation, SIB, and aggression were coded live using a custom mobile phone app. Results indicated large individual variability in the frequency and duration of these behaviors and their co-occurrence. Both SIB and aggression co-occurred with overt emotion dysregulation at above-chance levels, suggesting a role for emotional distress in the occurrence of these behaviors. However, there was substantial variability within and between individuals in co-occurrence, and SIB and aggression often (and for some individuals, almost always) occurred without overt emotion dysregulation. Relatedly, cross-recurrence quantitative analysis revealed that SIB and aggression preceded emotion dysregulation more often than emotion dysregulation preceded SIB and aggression. Future research, perhaps using ambulatory psychophysiological measures, is needed to understand whether emotion dysregulation may sometimes be present but not easily observed during SIB and aggression