Biomedical subjects

Wayne F Velicer

Publications and source records attributed to Wayne F Velicer.

At least 19 recordsLinked to original sources

PubMed2006

Binge drinking and health behavior in medical students.

OBJECTIVES: The objective of this study was to assess the prevalence of binge drinking and its relation to other health behaviors, drinking-related attitudes and perceived social norms among German medical students. METHODS: 271 first-year German medical students completed a cross-sectional, self-administered survey. A total of 252 (62% female and 38% male) students provided useable surveys. The mean age was 20.6years (S.D.=1.7). RESULTS: Most students reported heavy drinking with 24% having one episode in the past 2 weeks (Infrequent Bingers) and 28% having two or more episodes (Frequent Bingers). Men were more likely than women to have had a binge drinking episode. Frequent binge drinkers saw more pros of drinking and reported a higher temptation to drink than students in the other groups. Additionally, they were more likely to smoke, use cannabis, not exercise and not eat fruits and vegetables. All students overestimated their peers' alcohol intake and binge drinking frequency. CONCLUSIONS: Binge drinking was highly prevalent in this sample and clearly related to other health risk behaviors. Drinking rates were similar to college students in other Western countries. Future research needs to assess the consequences of this multiple risk behavior among medical students regarding academic and professional performance as well as personal health.

Adult↗

PubMed2006

Demographic differences in support for smoking policy interventions.

The Smoking Policy Inventory (SPI) is a 35-item scale, which measures attitudes towards tobacco control policies. The five dimensions of the SPI are advertising and promotion, public education, laws and penalties, taxes and fees, and restrictions on smoking. The SPI has been applied to different samples, both in the USA and internationally. However, no one has investigated if there is differential support for policy intervention among subgroups within the USA. This study investigated subgroup differences on five demographic variables (gender, age, race, ethnicity, and education) across the five dimensions of the SPI. A random digit dial sample of 506 adult participants from the United States was analyzed with five MANOVAs and follow-up ANOVAs. Men (N=188) had significantly (p<0.05) less favorable attitudes towards tobacco control policies than women (N=317) on all five scales. Blacks (N=52) had significantly (p<0.05) more favorable attitudes than whites (N=410) on increasing public education. There were no significant differences between Hispanics (N=21) and non-Hispanics (N=469). Older people were significantly (p<0.05) more supportive of restrictions on advertising and promotion, increasing public education, and increasing environmental restrictions. More educated people were significantly (p<0.05) more supportive of increasing taxes and fees and increasing environmental restrictions. These subgroup differences could be employed to guide the targeting of changes in policies and interventions to the specific concerns of the various groups.

Adolescent↗

PubMed2006

Identifying cluster subtypes for the prevention of adolescent smoking acquisition.

School-based smoking prevention programs are typically identical for all students. Tailoring prevention materials to focus on individual needs with an emphasis on students at highest risk is a promising alternative. Recent prevention programs have tailored materials based on the Stages of Acquisition, an extension of the Stages of Change used to tailor smoking cessation materials effectively for adults. Three stages of acquisition have been identified: Acquisition Precontemplation (aPC), Acquisition Contemplation (aC) and Acquisition Preparation (aPR). However, about 90% of nonsmoking adolescents classify themselves in the aPC stage. A cluster analysis was performed, using the Decisional Balance and Situational Temptations scales, for three random subsamples of adolescents within the aPC stage (N(1)=N(2)=N(3)=514). Four distinct subtypes were identified in each subsample: High Risk, Protected, Ambivalent, and Risk Denial. External validity was established using family support for nonsmoking, peer variables, and stage classification at follow-up assessment (12, 24, and 36 months). Family support for nonsmoking was related to subtype much more strongly than peer interactions. Subjects in the Protected subgroup were the most likely to remain in the aPC stage at each follow-up assessment. Subtype membership, along with membership in the aC and aPR stages, provides important additional information for tailoring smoking prevention materials. Tailored interventions can focus on those adolescents at highest risk and limit or avoid expending resources on those at very low risk.

Adolescent↗

PubMed2006

Psychometric evaluation of the smoking cessation Processes of Change scale in an adolescent sample.

The Processes of Change are the cognitions, behaviors, and emotions that people employ to change their behaviors. However, the processes of change remain the least studied dimension of the transtheoretical model. The present study presents a psychometric evaluation of the short form of the processes of change inventory for smoking cessation in an adolescent sample of 798 ninth-grade smokers from 22 Rhode Island high schools. The majority of the sample was white (87.2%), split approximately evenly as regards to gender (48.1% female), with an average age of 14.3 (SD=0.6) years of age. The same hierarchical model established on the adult sample was fit to the 20-item inventory. This model included 10 primary factors representing the processes of change and two second order factors that grouped the processes into five behavioral and five experiential processes of change. Model fit indices (RMSEA=0.08, CFI=0.92) supported the hypothesized structure. External validation was established by testing for stage differences in the use of the ten processes. A significant MANOVA (F(4,793)=18.517, p<0.001) and separate ANOVAs demonstrated that the use of all ten processes increased across the stages, as predicted by the transtheoretical model of behavior change. The processes of change help guide researchers, clinicians, and intervention program developers towards effective strategies to assist individuals at all stages of change progress towards healthier behaviors.

Adolescent↗

PubMed2006

Evaluating nicotine replacement therapy and stage-based therapies in a population-based effectiveness trial.

Pharmacological interventions for smoking cessation are typically evaluated using volunteer samples (efficacy trials) but should also be evaluated in population-based trials (effectiveness trials). Nicotine replacement therapy (NRT) alone and in combination with behavioral interventions was evaluated on a population of smokers from a New England Veterans Affairs Medical Center. Telephone interviews were completed with 3,239 smokers, and 2,054 agreed to participate (64%). Participants were randomly assigned to one of four conditions: stage-matched manuals (MAN); NRT plus manuals (NRT + MAN); expert system plus NRT and manuals (EXP + NRT + MAN); and automated counseling plus NRT, manuals, and expert system (TEL + EXP + NRT + MAN). Assessments were completed at baseline, 10, 20, and 30 months. The point prevalence cessation rates at final follow-up (30 months) were MAN, 20.3%; NRT + MAN, 19.3%; EXP + NRT + MAN, 17.6%; and TEL + EXP + NRT + MAN, 19.9%. Stage-matched manuals provided cessation rates comparable with previous studies. The addition of NRT, expert system interventions, and automated telephone counseling failed to produce a further increase in intervention effectiveness.

Adult↗

PubMed2006

Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks.

This study examined treatment outcomes among smokers with single versus multiple behavioral risks. Data were drawn from smokers (N = 2,326) participating in 3 population-based, multibehavioral studies targeting cigarette smoking, high-fat diets, and high-risk sun exposure. Outcomes were compared for participants at risk for smoking only (13%), smoking plus 1 additional risk factor (37%), and smoking plus 2 additional risk factors (50%). The smoking only group tended to be female, older, more educated, lighter smokers, in the preparation stage of change for smoking, with more previous quit attempts and longer periods of abstinence. At 12 and 24 months follow-up, treatment of 1 or 2 coexisting risk factors did not decrease the effectiveness of smoking cessation treatment, and treatment for the coexisting factors was effective.

Adult↗

PubMed2006

Tailored communications for smoking cessation: past successes and future directions.

Tailored communications are one of the most promising approaches to smoking cessation interventions for entire populations. Assessments based on the Transtheoretical Model are processed by computer-based expert systems that generate feedback reports tailored to each individual to accelerate their progress through the stages of change for smoking cessation. Seven studies are reviewed that range from a more traditional clinical trial to trials on entire populations of smokers to population trials designed to change multiple behaviours, including smoking. A series of three tailored communications was found to produce long-term point prevalence abstinence rates within the narrow range of 22-26% abstinence. This same range of abstinence was found even when two or three other behaviours (e.g. diet and sun protection) were treated in the population. These results point to a future in which health behaviour risk interventions will be assessed not solely by their efficacy but by their population impact.

Behavior Therapy↗

PubMed2005

Replication of subtypes for smoking cessation within the precontemplation stage of change.

The Transtheoretical Model constructs have been used in the development of effective tailored interventions for smoking cessation. Recent studies have suggested the existence of clusters within each stage of change, based on measures of the Pros, Cons and the Situational Temptations. The goal of this study is to replicate cluster subtypes within the Precontemplation stage of change in a secondary analysis of data from a sample of current smokers (N=3967). Four random samples ranging from 312 to 400 participants were selected from the Precontemplators subgroup. The cluster analyses were performed using Ward's Method on the standard scores from the three scales. Interpretability of the pattern, pseudo F test, and dendograms were used to determine the number of clusters. Four cluster subtypes were found and replicated across samples. The ten processes of change and two smoking behavior variables were used in the external validation of clusters. Statistically significant multivariate effects were found for the processes of change (p<.05) and the smoking behavior variables (p<.001) in all samples. The cluster patterns closely replicate earlier findings and provide evidence for the existence of clusters subtypes within the Precontemplation stage of change.

Adaptation, Psychological↗

PubMed2005

Replication of subtypes for smoking cessation within the Preparation stage of change.

OBJECTIVE: Recent cluster analyses based on the Pros and Cons and the Situational Temptations measures performed within the stages of change defined by the Transtheoretical Model have suggested the existence of distinct cluster subtypes. The goal of this study is to replicate cluster subtypes within the Preparation stage of change in a secondary analysis of data from a sample of current smokers (N=3967). Identification of stable cluster subtypes would permit the development of tailored interventions focusing on these subtypes. METHOD: Two random samples of approximately 340 subjects were selected from the 686 participants in the Preparation stage. The cluster analyses were performed using the Pros, Cons and Situational Temptations. Interpretability of the pattern, pseudo F test, and dendograms were used to determine the number of clusters. RESULTS: Four distinct cluster subtypes (Classic, Progressing, Early Preparation, and Disengaged) were found and replicated across samples. The clusters were externally validated using the ten processes of change and two smoking behavior variables. Statistically significant (p<0.05) multivariate effects were found for the ten processes of change and the smoking behavior variables (p<0.001) in the two samples. CONCLUSIONS: The cluster patterns replicate earlier findings and provide evidence for the existence of clusters subtypes within the Preparation stage of change.

Adaptation, Psychological↗

PubMed2005

Replication of subtypes for smoking cessation within the contemplation stage of change.

OBJECTIVE: Tailored interventions based on stage of change and other Transtheoretical Model constructs have been effective for promoting smoking cessation. Recent cluster analyses based on the Pros and Cons from the Decisional Balance and the Situational Temptations measures performed within the stages have suggested the existence of distinct cluster subtypes. Cluster subtypes would permit the development of tailored interventions focusing on these subtypes. This study attempts to replicate cluster subtypes within the Contemplation stage of change in a secondary analysis of data from a sample of current smokers (N=3967). METHOD: Four random samples of 400 were selected from the 1734 Contemplators. The cluster analyses were performed using the Pros, Cons, and Situational Temptations. Interpretability of the pattern, pseudo-F-test, and dendograms were used to determine the number of clusters. RESULTS: Four distinct cluster subtypes (Classic Contemplators, Progressing, Early Contemplators, and Disengaged) were found and replicated across samples. The clusters were externally validated using the 10 Processes of change and 2 smoking behavior variables (cigarettes per day and time before first morning cigarette). Statistically significant (p<0.05) multivariate effects were found for the 10 Processes of change in all four samples. The cluster groups differed on 7 or more of the processes in each sample. Significant multivariate effects were also found for the smoking behavior variables in all samples (p<0.001). CONCLUSIONS: The cluster patterns closely replicate earlier findings and provide evidence for the existence of clusters subtypes within the Contemplation stage of change.

Adolescent↗

PubMed2005

Stage-based expert systems to guide a population of primary care patients to quit smoking, eat healthier, prevent skin cancer, and receive regular mammograms.

BACKGROUND: Treating multiple health behavior risks on a population basis is one of the most promising approaches to enhancing health and reducing health care costs. Previous research demonstrated the efficacy of expert system interventions for three behaviors in a population of parents. The interventions provide individualized feedback that guides participants through the stages of change for each of their risk behaviors. This study extended that research to a more representative population of patients from primary care practice and to targeting of four rather than three behaviors. METHODS: Stage-based expert systems were applied to reduce smoking, improve diet, decrease sun exposure, and prevent relapse from regular mammography. A randomized clinical controlled trial recruited 69.2% of primary care patients (N = 5407) at home via telephone. Three intervention contacts were delivered for each risk factor at 0, 6, and 12 months. The primary outcome measures were the percentages of at-risk patients at baseline who progressed to the action or maintenance stages at 24-month follow-up for each of the risk behaviors. RESULTS: Significant treatment effects were found for each of the four behaviors, with 25.4% of intervention patients in action or maintenance for smoking, 28.8% for diet, and 23.4% for sun exposure. The treatment group had less relapse from regular mammography than the control group (6% vs. 10%). CONCLUSION: Proactive, home-based, and stage-matched expert systems can produce relatively high population impacts on multiple behavior risks for cancer and other chronic diseases.

Adult↗

PubMed2005

Comparing participants and nonparticipants recruited for an effectiveness study of nicotine replacement therapy.

BACKGROUND: Interventions for smoking cessation have been typically evaluated on reactively recruited samples in clinical trials (efficacy trials). However, to have an impact on smoking rates in a general population, the intervention should also be evaluated with proactively recruited representative samples (effectiveness trials). PURPOSE: The characteristics of participants and two groups of nonparticipants recruited for a population-based nicotine replacement therapy study were compared. METHODS: All members of a large New England Veterans' Administration Medical Center were contacted, and interviews were completed with 3,239 identified smokers (at least 10 cigarettes per day). At the end of the interview, all smokers were offered participation in a multiple intervention study. Of the interviewed smokers, 2,915 verbally agreed to participate in the study (90%). Of those who gave initial verbal consent, 2,054 returned the written informed consent form and became participants (70%). RESULTS: The participants (full consent group) differed significantly from both nonparticipant groups-that is, the smokers who were interviewed but declined participation by active refusal (survey only group) and those who gave verbal consent but passively refused participation by failing to return the written consent form (verbal consent only group). Participants were more likely to be married, younger, and female; to live with others; and to have previously used or considered using nicotine replacement therapy. The survey only group was also more likely to be in the precontemplation stage (54%), whereas the participants were more likely to be in the contemplation (46%) or preparation stage (35%). The verbal consent only group was intermediate of the other two groups in stage-of-change characteristics. CONCLUSIONS: An important finding was that it is possible to recruit a large proportion of a sample of identified smokers to an nicotine replacement therapy study. However, the participants are likely to differ in significant ways from those who either actively or passively decline participation.

Female↗

PubMed2005

Teen reach: outcomes from a randomized, controlled trial of a tobacco reduction program for teens seen in primary medical care.

OBJECTIVE: To test the long-term efficacy of brief counseling plus a computer-based tobacco intervention for teens being seen for routine medical care. METHODS: Both smoking and nonsmoking teens, 14 to 17 years of age, who were being seen for routine visits were eligible for this 2-arm controlled trial. Staff members approached teens in waiting rooms of 7 large pediatric and family practice departments within a group-practice health maintenance organization. Of 3747 teens invited at > or =1 visits, 2526 (67%) consented and were randomized to tobacco intervention or brief dietary advice. The tobacco intervention was individually tailored on the basis of smoking status and stage of change. It included a 30-second clinician advice message, a 10-minute interactive computer program, a 5-minute motivational interview, and up to two 10-minute telephone or in-person booster sessions. The control intervention was a 5-minute motivational intervention to promote increased consumption of fruits and vegetables. Follow-up smoking status was assessed after 1 and 2 years. RESULTS: Abstinence rates after 2 years were significantly higher for the tobacco intervention arm, relative to the control group, in the combined sample of baseline smokers and nonsmokers (odds ratio [OR]: 1.23; 95% confidence interval [CI]: 1.03-1.47). Treatment effects were particularly strong among baseline self-described smokers (OR: 2.42; 95% CI: 1.40-4.16) but were not significant for baseline nonsmokers (OR: 1.25; 95% CI: 0.97-1.61) or for those who had "experimented" in the past month at baseline (OR: 0.95; 95% CI: 0.45-1.98). CONCLUSIONS: Brief, computer-assisted, tobacco intervention during routine medical care increased the smoking cessation rate among self-described smokers but was less effective in preventing smoking onset.

Adolescent↗

PubMed2004

Factorial invariance and internal consistency for the decisional balance inventory--short form.

A crucial assumption for a measure is that it is factorially invariant; that is, the measurement model is the same in different subgroups and across different occasions. The invariance of the short form of the decisional balance inventory was investigated using data from a representative sample of smokers (N=4144). Separate analyses evaluated the invariance across two levels of gender (male and female), four levels of education (grade school, high school, college, and graduate school), two levels of race (white and black), four levels of age (18-25, 26-35, 36-50, and 50+), and across four assessment occasions. The results indicated that the decisional balance inventory demonstrated strong factorial invariance across the four demographic variables and across assessments.

Adolescent↗

PubMed2004

A comparison of four self-report smoking cessation outcome measures.

Interventions for smoking cessation have been developed by researchers in a number of distinct disciplines. As a result, a variety of different outcome measures have been developed and employed. This paper will report an analysis that compares four smoking cessation outcome measures on data gathered from three population-based studies: (1) 24-hour point prevalence abstinence, (2) 7-day point prevalence abstinence, (3) 30-day prolonged abstinence, and (4) 6-month prolonged abstinence. The three studies provided a total of 41 mean estimates for the first three measures but only 28 mean estimates for the 6-month prolonged abstinence measure. The data demonstrate an extremely high relationship between all four measures. The first three measures (24-hour point prevalence, 7-day point prevalence, and 30-day prolonged abstinence) all correlated in excess of.98 with each other. The only measure that did not demonstrate the same degree of almost perfect equivalence was 6-month prolonged abstinence, but even here the lowest correlation with the other three measures was.82. For practical purposes, the first three measures will result in the same conclusions when used as outcome measures in smoking cessation studies.

Data Collection↗

PubMed2004

Size, consistency, and stability of stage effects for smoking cessation.

In the transtheoretical model (TTM), the stage effect is one of the most important determinants of health behavior change. Randomly assigned to 1 of 11 treatment conditions were 4653 smokers. A total of 66 stage effects were possible with 6 for each of the 11 treatment groups. The results suggest that brief stage-matched interventions that help populations progress one stage could produce 75% more abstinence. Interventions that help populations progress two stages could produce 300% more abstinence. The results also support the importance of replicating the stage effects across treatment conditions and over time.

Adult↗

PubMed2004

Multiple risk expert systems interventions: impact of simultaneous stage-matched expert system interventions for smoking, high-fat diet, and sun exposure in a population of parents.

Three stage-based expert system interventions for smoking, high-fat diet, and unsafe sun exposure were evaluated in a sample of 2,460 parents of teenagers. Eighty-four percent of the eligible parents were enrolled in a 2-arm randomized control trial, with the treatment group receiving individualized feedback reports for each of their relevant behaviors at 0, 6, and 12 months as well as a multiple behavior manual. At 24 months, the expert system outperformed the comparison condition across all 3 risk behaviors, resulting in 22% of the participants in action or maintenance for smoking (vs. 16% for the comparison condition), 34% for diet (vs. 26%), and 30% for sun exposure (vs. 22%). Proactive, home-based, and stage-matched expert systems can produce significant multiple behavior changes in at-risk populations where the majority of participants are not prepared to change.

Adolescent↗

PubMed2003

Developing an empirical typology for regular exercise.

BACKGROUND: Tailored interventions require the identification of distinct homogenous subgroups that will benefit from different intervention materials. One way to identify such subgroups is to use cluster analysis to identify an empirical typology. METHODS: A sample of 346 adults completed surveys through a telephone interview that included questions related to participating in regular exercise. The three variables used in the cluster analysis were the Pros of Exercise, the Cons of Exercise, and Exercise Self-Efficacy. RESULTS: Six resulting clusters were labeled Disengaged, Immotive, Relapse Risk, Early Action, Maintainers, and Habituated. A series of analyses tested the internal and external validity of the typology. The internal validity test revealed that four of the clusters demonstrated high stability and replicability, while the Relapse Risk and Early Action clusters were less stable. Differences among clusters on self-reported exercise behavior and a strong association with stage of change for regular exercise provided external validity evidence of the typology. CONCLUSIONS: The resulting typology reflects a range of motivational patterns that are likely to be responsive to different types of messages and strategies regarding adoption and maintenance of regular exercise. The typology also generates a number of hypotheses about the identified clusters that can be empirically tested in further studies.

Adult↗