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Health and behavioral predictors of success in an intensive smoking cessation program for women.

Cigarette smoking is the major addiction of women, the leading cause of women's death, and maternal smoking has substantial negative health effects on children. The majority of smokers quit on their own, but women are more likely than men to seek help, and some prefer women-only programs. Multi-component programs combining cessation techniques with counselling, skills training, and emotional support show the highest quit rates. In this clinical study of a multi-component, eight week cessation program for women, sixty-two percent completed the program and stopped smoking. Over half of these were abstinent six months later, which compares favorably with other women's-only programs in Canada. Based on the literature, we hypothesized that factors related to personal health status, family drug history, current lifestyle and social environment would be the best predictors of program outcome: dropping out of the program, completing the program and quitting smoking, and being abstinent at six months. Over 400 measures of personal and family history, health status, health behavior and social environment were gathered. A multiple regression model using four variables with additive variance and stable parameters explained 48% of the variance in program outcome. These were client's history of asthma, smoking status of the mother when the client was a child, weekly consumption of chocolate and candy, and the number of children the client had. These results identify issues that need to be taken into account when assisting women to quit smoking.

Asthma↗

Markets and childhood obesity policy.

In examining the childhood obesity epidemic from the perspective of economics, John Cawley looks at both possible causes and possible policy solutions that work through markets. The operation of markets, says Cawley, has contributed to the recent increase in childhood overweight in three main ways. First, the real price of food fell. In particular, energy-dense foods, such as those containing fats and sugars, became relatively cheaper than less energy-dense foods, such as fresh fruits and vegetables. Second, rising wages increased the "opportunity costs" of food preparation for college graduates, encouraging them to spend less time preparing meals. Third, technological changes created incentives to use prepackaged food rather than to prepare foods. Several economic rationales justify government intervention in markets to address these problems. First, because free markets generally under-provide information, the government may intervene to provide consumers with nutrition information they need. Second, because society bears the soaring costs of obesity, the government may intervene to lower the costs to taxpayers. Third, because children are not what economists call "rational consumers"--they cannot evaluate information critically and weigh the future consequences of their actions-the government may step in to help them make better choices. The government can easily disseminate information to consumers directly, but formulating policies to address the other two rationales is more difficult. In the absence of ideal policies to combat obesity, the government must turn to "second-best" policies. For example, it could protect children from advertisements for "junk food." It could implement taxes and subsidies that discourage the consumption of unhealthful foods or encourage physical activity. It could require schools to remove vending machines for soda and candy. From the economic perspective, policymakers should evaluate these options on the basis of cost-effectiveness studies. Researchers, however, have as yet undertaken few such studies of obesity-related policy options. Such analyses, once available, will help policymakers achieve the greatest benefit from a fixed budget.

Child↗

Methamphetamine and amphetamine pharmacokinetics in oral fluid and plasma after controlled oral methamphetamine administration to human volunteers.

BACKGROUND: Methamphetamine (METH) and amphetamine (AMP) concentrations in 200 plasma and 590 oral fluid specimens were used to evaluate METH pharmacokinetics and pharmacodynamics after oral administration of sustained-release METH. METHODS: Eight participants received four oral 10-mg S-(+)-METH hydrochloride sustained-release tablets within 7 days. Three weeks later, five participants received four oral 20-mg doses. Blood samples were collected for up to 24 h and oral fluid for up to 72 h after drug administration. RESULTS: After the first oral dose, initial plasma METH detection was within 0.25-2 h; c(max) was 14.5-33.8 micro g/L (10 mg) and 26.2-44.3 micro g/L (20 mg) within 2-12 h. In oral fluid, METH was detected as early as 0.08-2 h; c(max) was 24.7-312.2 micro g/L (10 mg) and 75.3-321.7 micro g/L (20 mg) and occurred at 2-12 h. The median oral fluid-plasma METH concentration ratio was 2.0 across 24 h and was highly variable. Neutral cotton swab collection yielded significantly higher METH and AMP concentrations than citric acid candy-stimulated expectoration. Mean (SD) areas under the curve for AMP were 21% +/- 25% and 24% +/- 11% of those observed for METH in plasma and oral fluid, respectively. After a single low or high dose, plasma METH was >2.5 micro g/L for up to 24 h in 9 of 12 individuals (mean, 7.3 +/- 5.5 micro g/L at 24 h); in oral fluid the detection window was at least 24 h (mean, 18.8 +/- 18.0 micro g/L at 24 h). The plasma and oral fluid 24-h METH detection rates were 54% and 60%, respectively. After four administrations, METH was measurable for 36-72 h (mean, 58.3 +/- 14.5 h). CONCLUSIONS: Perceived advantages of oral fluid for verifying METH exposure compared with urine include simpler specimen collection and reduced potential for adulteration, but urine offers higher analyte concentrations and a greater window of detection.

Administration, Oral↗

Sensitivity and specificity of the Cozart microplate EIA cocaine oral fluid at proposed screening and confirmation cutoffs.

BACKGROUND: Oral fluid is currently being evaluated as an alternative matrix for monitoring illicit drugs in federally mandated workplace drug testing, for addiction treatment programs, and for driving under the influence testing. The sensitivity, specificity, and efficiency of the Cozart Microplate EIA Cocaine Oral Fluid Kit (COC ELISA) were determined by comparison with gas chromatography-mass spectrometry (GC/MS) results at screening and confirmation cutoffs proposed in the US and UK. METHOD: Oral fluid was collected by expectoration after citric acid candy stimulation or with Salivette neutral cotton swabs or Salivette citric acid-treated cotton swabs before and after cocaine (COC) administration. Specimens (n = 1468) were analyzed with the COC ELISA for screening and with solid-phase extraction followed by GC/MS for confirmation. Three screening cutoffs (10, 20, and 30 microg/L) and four GC/MS cutoffs (2.5, 8, 10, and 15 microg/L COC, benzoylecgonine, and/or ecgonine methyl ester) were evaluated. GC/MS limit of quantification was 2.5 micro g/L for all analytes. RESULTS: COC ELISA interassay imprecision (CV; n = 19) was 16% at 16.7 microg/L and 12% at 81.8 microg/L. With the 2.5, 8, 10, and 15 microg/L GC/MS cutoffs, 59.0%, 54.7%, 52.7%, and 48.7% of the oral fluid specimens were positive, respectively. Sensitivity, specificity, and efficiency were 92.2%, 84.7%, and 88.8%, respectively, for the suggested Substance Abuse and Mental Health Services Administration (SAMHSA) cutoffs and 90.2%, 89.2%, and 89.7% for cutoffs currently used in the UK. CONCLUSIONS: COC ELISA had suitable sensitivity, specificity, and efficiency for identifying COC exposure at both the proposed SAMHSA and UK cutoffs. Sensitivity, specificity, and efficiency were >84% for both cutoffs, but 92 additional true-positive samples were identified with the SAMHSA cutoffs.

Adult↗

Biochemical, microbiologic, and clinical comparisons between two dentifrices that contain different mixtures of sugar alcohols.

It has been customary to think that in a dentifrice only a few of its ingredients would be active and have clinically significant effects on dental caries, oral hygiene, and the levels of caries-inducive microorganisms or harmful plaque metabolic products. Therefore, most of the emphasis has been placed on the type of fluorine compounds, abrasives, or similar dentifrice ingredients. This study shows that such common dentifrice components as the humectants, which contribute to the texture, rheologic characteristics, and shelf life of the product, also may affect the type of dental plaque grown on the tooth surfaces between toothbrushings or during long-term neglect of toothbrushing or of oral hygiene. Commonly used humectants include sorbitol, a sugar alcohol of the hexitol type, which is used often in sugarless candies. This study showed that when sorbitol in a dentifrice was replaced by xylitol, a sugar alcohol of the pentitol type, the dental plaque of human subjects contained more ammonia and significantly less bacterial polysaccharides. It is accepted generally that ammonia neutralizes plaque acids and that bacterial polysaccharides are involved in promoting caries. Xylitol-containing dentifrice also reduced the saliva levels of S mutans. The results further indicated that if sorbitol and xylitol could be compared in a short-term dentifrice study that relied on subjective and coarse plaque determinations only, no differences between those dentifrices would be found necessarily. To demonstrate the differences between the experimental dentifrices used in this study, it was necessary to analyze specific plaque components and the salivary levels of S mutans.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

Chewing gum bezoars of the gastrointestinal tract.

Children have chewed gum since the Stone Age. Black lumps of prehistoric tar with human tooth impressions have been found in Northern Europe dating from approximately 7000 BC (Middle Stone Age) to 2000 BC (Bronze Age). The bite impressions suggest that most chewers were between 6 and 15 years of age. The Greeks chewed resin from the mastic tree (mastic gum). North American Indians chewed spruce gum. The first manufacturing patent for chewing gum was issued in 1869 for a natural gum, chicle, derived from the Sopadilla tree, indigenous to Central America. Chewing gum sold today is a mixture of natural and synthetic gums and resins, with added color and flavor sweetened with corn syrup and sugar. Chewing gum is big business. A significant amount of the $21 billion US candy industry sales is from chewing gums, many of which appeal almost exclusively to children. Despite the history and prevalence of gum chewing, the medical literature contains very little information about the adverse effects of chewing gum. In the present report, we briefly review gum-chewing complications and describe three children who developed intestinal tract and esophageal obstruction as a consequence of swallowing gum.

Bezoars↗

[Severity of dental caries in children and relationship with social and behavioral aspects].

OBJECTIVE: To identify social and behavioral conditions that could act as risk factors to the severity of dental caries in 12-year-old children. METHODS: Based on the oral health survey data obtained in Florianópolis, Brazil, in 1995, social and behavior conditions were compared between two 12-year-old children groups with dental caries with different severity: high and very high severity, and very low severity. In the interview, there were questions about each family were part of the interview, besides social-economic conditions and behavior aspects. RESULTS/CONCLUSIONS: The multivariate logistic regression analysis showed that the risk factors for dental caries with high severity were candy intake and family income. Children who consumes cariogenic products 2 or 3 times a day on a daily basis has 4.41 more chance of having dental caries with high severity when compared to children who consumes these same products only once a day - CI (OR) = [1.18; 16.43] ). Family income was the most important socialeconomic factor. Children whose family income is lower than five minimum wages has 4.18 more chance of having high severity dental caries when compared to children whose family income is higher than five minimum wages - CI (OR) = [1.16; 15.03]. The purpose of this study was to have a a better knowledge of dental caries occurrence in 12-year-old children who, in most cases, have a complete permanent dentition that showed the illness history.

Brazil↗

Attractancy and toxicity of an attracticide for Indianmeal moth, Plodia interpunctella (Lepidoptera: Pyralidae).

Plodia interpunctella (Hübner) is a serious and widespread postharvest pest on cereal products, dried fruits, candy, and pet food. Due to the strong positive anemotactic flight response of P. interpunctella males to the main component of the female-produced pheromone [(Z,E)-9,12-tetradecadienyl acetate, herein referred to as ZETA], we evaluated the potential of an attracticide for this pest, in which ZETA as attractant was combined with permethrin as the killing agent. Two concentrations of ZETA [0.16 and 0.32% (wt:wt)] and five concentrations of permethrin [0, 3, 6, 12, and 18% (wt:wt)] were incorporated into Last Call gel (10 different permethrin:ZETA combinations). All attracticide gels were evaluated in a toxicity test, in which either the tip of a leg or an antenna of a virgin P. interpunctella male was touched < 3 s into a dot of attracticide gel. These males were subsequently transferred to jars with virgin females. The toxicity test showed that a brief and gentle contact of P. interpunctella males with attracticide gel containing 3-18% permethrin caused a significant reduction in mating and killed males moths within 24 h. A wind tunnel test was conducted to evaluate the flight responses of P. interpunctella males to the same 10 attracticide gels. Male moths displayed significantly higher levels of positive anemotactic flight and more males made contact with the attracticide gel when the ZETA concentration was 0.16% compared with 0.32%. P. interpunctella males showed no signs of repellency to permethrin concentrations within a range of 0-18% in the attracticide gel. Three densities of P. interpunctella pairs were released into small warehouse rooms, and we found that the attracticide gel suppressed oviposition when the moth density was at a low level, but it was ineffective when the moth density exceeded one male-female pair per 11.3 m3.

Animals↗

Clinical effects and plasma concentrations of fentanyl after transmucosal administration in three species of great ape.

Fentanyl is approved for transmucosal use in the United States as a preanesthetic agent in human pediatric patients and in adults for breakthrough cancer pain. Using this formulation in three species of great ape, including eight orangutans (Pongo pygmaeus), nine chimpanzees (Pan troglodytes), and two gorillas (Gorilla gorilla), fentanyl was offered transmucosally at an intended dose of 10-15 microg/kg based on estimated body weight. The animals were trained to accept and suck slowly on a piece of placebo candy, given as a treat, after an overnight fast. On the day of the study, the animals were given the lollipop formulation of fentanyl. The resulting plasma concentrations of fentanyl supported transmucosal absorption, similar to that reported in humans. This study provides an alternative sedative regimen and yielded half-life data of transmucosal fentanyl in great apes. Although transmucosal fentanyl was a useful adjunct for sedating orangutans and gorillas, its acceptance by chimpanzees before chemical immobilization was suboptimal and unpredictable.

Adjuvants, Anesthesia↗

A token reinforcement program in a public school: a replication and systematic analysis.

A base rate of disruptive behavior was obtained for seven children in a second-grade class of 21 children. Rules, Educational Structure, and Praising Appropriate Behavior while Ignoring Disruptive Behavior were introduced successively; none of these procedures consistently reduced disruptive behavior. However, a combination of Rules, Educational Structure, and Praise and Ignoring nearly eliminated disruptive behavior of one child. When the Token Reinforcement Program was introduced, the frequency of disruptive behavior declined in five of the six remaining children. Withdrawal of the Token Reinforcement Program increased disruptive behavior in these five children, and reinstatement of the Token Reinforcement Program reduced disruptive behavior in four of these five. Follow-up data indicated that the teacher was able to transfer control from the token and back-up reinforcers to the reinforcers existing within the educational setting, such as stars and occasional pieces of candy. Improvements in academic achievement during the year may have been related to the Token Program, and attendance records appeared to be enhanced during the Token phases. The Token Program was utilized only in the afternoon, and the data did not indicate any generalization of appropriate behavior from the afternoon to the morning.

Journal Article↗

Inappropriate speech in a severely retarded child: a case study in language conditioning and generalization.

The modification of inappropriate speech, a class of behaviors rather than a limited number of specific examples, is little known in the severely retarded. In this study, operant techniques were used to modify the strikingly bizarre and inappropriate speech of a severely retarded boy. The boy's appropriate verbal responses to questions about magazine pictures were reinforced with candy. When he responded inappropriately, the magazine was withdrawn, and social interaction was discontinued for a 10-sec timeout period. Negative responses were ignored, the next picture displayed, and the next question asked immediately. In 10 sessions, appropriate responses increased from 26% to 86% of all responses. A reversal of reinforcement was then introduced, in which inappropriate responses were reinforced, appropriate responses resulted in timeout, and negative responses were treated as before. This reduced the percentage of appropriate responses to 24%. Subsequent sessions of reinforcement for appropriate responses increased appropriate responses to 96% of all responses. At significant stages in the experiment, a measure of possible generalization was attempted. Although some generalization was recorded, it was minimal: some explanations are discussed.

Journal Article↗

Reduction of dangerously aggressive behavior in a severely retarded resident through a combination of positive reinforcement procedures.

A severely retarded resident was released from a timeout chair only occasionally for brief periods of time. Under the timeout contingency alone, the subject made a choke response within minutes of being released. Attention, such as hugs, smiles, and candy was then increased, first by providing it non-contingently and continuously as long as there were no aggressive responses and then, by making it contingent upon incompatible responses. Under conditions of timeout plus increased attention, choking decreased aburptly. Grabbing responses, which increased when choking was reduced, were also reduced under conditions of timeout plus attention. Unrestrained time was gradually increased and all extra attention, i.e., more scheduled attention than provided other residents, was gradually withdrawn. When the resident was unrestrained all day and all extra attention was withdrawn, grabs and, to a lesser extent, chokes increased. Both were again reduced to a manageable level by scheduling several brief periods of attention each day. Hence, the program resulted in quick reductions that endured when the program was largely withdrawn. The changes in aggressive responding as a function of the presence and absence of extra attention suggest the importance of extra "positive reinforcement" in programs based upon positive reinforcement procedures and dealing with retarded residents for whom positive reinforcers may be scarce.

Journal Article↗

The modification of sentence structure and its relationship to subjective judgements of creativity in writing.

The present study objectively defined and manipulated some compositional variables in 10-sentence stories written by fourth-, fifth-, and sixth-grade students, and related these operationally defined variables to subjective judgements of creativity. Points, exchangeable for candy and extra recess, were given to members of two teams contingent upon their using different adjectives, different action verbs, and different sentence beginnings. The students' use of these selected parts of speech was modified and the independent subjective ratings indicated that stories written during contingency conditions were generally rated as more creative than those written during baseline conditions. Operational definitions that specify non-repetition or variety of responses, and contingencies that require response diversity may provide a beginning basis for defining writing creativity and the conditions that maximize its occurrence.

Journal Article↗

Increasing rural Head Start children's consumption of middle-class meals.

Rural black, economically impoverished Head Start children, whose normal diets were deficient in nutritional requirements, were not consuming the nutritional breakfasts of, to them, unfamiliar foods provided by the county school system. This study investigated a positive simple method to increase the amount of food consumed and thereby ensure proper nutrition. Teachers dispensed sugar-coated cereal and small candies paired with praise contingent on eating behaviors and rewarded children who finished the entire meal with additional treats and praise. Substantial increases were produced in the proportion of meals consumed and in the number of children observed engaged in eating behaviors. These simple traditional behavioral procedures are readily available for any staff working with economically impoverished children as one method of increasing their sampling and consumption of unfamiliar nutritious foods.

Black or African American↗

Reducing aggressive and self-injurious behavior of institutionalized retarded children through reinforcement of other behaviors.

Aggressive and self-injurious behaviors of four retarded children were reduced by combining various techniques with the differential reinforcement of other behaviors (DRO). In one study, aggressive responses of a severely retarded child were reduced when DRO was combined with a 30-sec timeout. In a second study, various aggressive classroom behaviors were reduced when the child was told "no" for an inappropriate response but earned puzzle pieces for periods of time when inappropriate responses resulted did not occur. Exchangeable tokens were given to a third subject for every 15 min in which aggressive responding did not occur, while each inappropriate response resulted in the loss of all tokens accrued. Responding was decreased to a level far below baseline. For a fourth child, self-injurious responses were followed by "no", and intervals of time in which no self-injurious responding occurred earned candy. The rate of this behavior reduced significantly. In each case, the DRO procedure combined with the other techniques proved to be manageable for the teacher and successful in reducing the inappropriate behavior.

Adolescent↗

The development and functional control of reading-comprehension behavior.

Reading comprehension, indicated by motor behavior and multiple-choice picture selection called for in written instructions, was taught to an autistic child using verbal prompts, modelling, and physical guidance. The child was rewarded for correct behaviors to training items; nonrewarded probes were used to assess generalization. Probable maintaining events were assessed through their sequential removal in a reversal design. Results showed: (a) following acquisition, performance was maintained at a near-100% level when candy, praise, attention, and training were removed, (b) absence of other persons was correlated with a marked decrease in performance, whereas their presence was associated with performance at near 100%, and (c) performance generalized to probes and across experimenters. Rewards, which may have been reinforcing during acquisition, did not appear necessary to maintain later performance. Instead, presence of others (a setting event) was demonstrated to have control over maintained performance.

Autistic Disorder↗

Instructions, feedback, and reinforcement in reducing activity levels in the classroom.

The biomotometer, an electronic device which simultaneously measures motor activity and provides auditory feedback, was used in combination with material reinforcers in an experiment to reduce children's activity level in a classroom setting. Subjects were nine boys and two girls, aged 9--13, from a day hospital program for emotionally disturbed children. After five baseline trials, each child had five contingent reinforcement trials in which he/she received feedback "beeps" from the biomotometer and was given toy or candy rewards after each trial in which activity fell at least 20% below mean baseline level. Then five noncontingent reinforcement trials were run in which children received rewards for wearing the apparatus without the feedback attachment. Results indicated that the intervention "package," including instructions, feedback, and contingent reinforcement, was successful in all five trials for 8 of 11 children. Activity levels increased during the final noncontingent phase.

Acoustic Stimulation↗

[Oral health in pregnancy].

INTRODUCTION: Good oral health care during pregnancy is essential but often overlooked factor of dental growth as well as of other structures of oral cavity. Pregnancy is the time when conscious approach to preventive oral care should increase. PREVENTIVE MEASURES DURING PREGNANCY: Preventive measures during pregnancy mean usage of fluorides, special dietary measures and increased oral hygiene habits. Preventive measures in pregnant women have one goal: providing conditions for development of fetal teeth as well as preventing tooth decay in pregnant women. The optimal period for introducing preventive measures is the first trimester of pregnancy. ALTERATIONS OF ORAL HEALTH DURING PREGNANCY: Because of hormonal alterations there is an increased incidence of dental diseases: gingivitis and low salivary pH (inflammation and bleeding gums). IMPACT OF NUTRITION DURING PREGNANCY ON ORAL HEALTH: Eating habits of pregnant women may lead to frequent snacking on candy or other decay-promoting foods, thereby increasing the risk of caries. However, very poor oral health, possible dental complications and their consequences to the health as well as emotional status represent very strong reasons for activation of dental health care in this period.

Dental Care↗