Biomedical subjects

D V Ary

Publications and source records attributed to D V Ary.

At least 19 recordsLinked to original sources

PubMed2006

A randomised control study of a fully automated internet based smoking cessation programme.

OBJECTIVE: The objective of this project was to test the short term (90 days) efficacy of an automated behavioural intervention for smoking cessation, the "1-2-3 Smokefree" programme, delivered via an internet website. DESIGN: Randomised control trial. Subjects surveyed at baseline, immediately post-intervention, and 90 days later. SETTINGS: The study and the intervention occurred entirely via the internet site. Subjects were recruited primarily via worksites, which referred potential subjects to the website. SUBJECTS: The 351 qualifying subjects were notified of the study via their worksite and required to have internet access. Additionally, subjects were required to be over 18 years of age, smoke cigarettes, and be interested in quitting smoking in the next 30 days. Eligible subjects were randomly assigned individually to treatment or control condition by computer algorithm. INTERVENTION: The intervention consisted of a video based internet site that presented current strategies for smoking cessation and motivational materials tailored to the user's race/ethnicity, sex, and age. Control subjects received nothing for 90 days and were then allowed access to the programme. MAIN OUTCOME MEASURES: The primary outcome measure was abstinence from smoking at 90 day follow up. RESULTS: At follow up, the cessation rate at 90 days was 24.1% (n = 21) for the treatment group and 8.2% (n = 9) for the control group (p = 0.002). Using an intent-to-treat model, 12.3% (n = 21) of the treatment group were abstinent, compared to 5.0% (n = 9) in the control group (p = 0.015). CONCLUSIONS: These evaluation results suggest that a smoking cessation programme, with at least short term efficacy, can be successfully delivered via the internet.

Adolescent↗

PubMed2000

Development and evaluation of an interactive CD-ROM refusal skills program to prevent youth substance use: "refuse to use".

An interactive CD-ROM program designed to reduce adolescent substance use was developed and evaluated. The program uses video vignettes to teach refusal skills and socially acceptable responses to substance use situations, specifically offers of marijuana. In a randomized pretest-to-posttest experiment with 74 public school students from six classes in three high schools, significant changes were observed at posttest on (1) the adolescent's personal efficacy to refuse the offer of marijuana, (2) the adolescent's intention to refuse marijuana if offered, and (3) the adolescent's perceptions of the social norms associated with substance use and the importance of respecting another's decision to refuse a drug offer. In addition, adolescents in the treatment condition were able to recall approximately 50% of the portrayed refusal strategies. Findings are discussed with regard to the potential benefits of an interactive multimedia approach for conducting substance use interventions.

Adolescent↗

PubMed2000

A randomised controlled trial of a community intervention to prevent adolescent tobacco use.

OBJECTIVE: Experimental evaluation of comprehensive community wide programme to prevent adolescent tobacco use. DESIGN: Eight pairs of small Oregon communities (population 1700 to 13 500) were randomly assigned to receive a school based prevention programme or the school based programme plus a community programme. Effects were assessed through five annual surveys (time 1-5) of seventh and ninth grade (ages 12-15 years) students. INTERVENTION: The community programme included: (a) media advocacy, (b) youth anti-tobacco activities, (c) family communications about tobacco use, and (d) reduction of youth access to tobacco. MAIN OUTCOME MEASURE: The prevalence of self reported smoking and smokeless tobacco use in the week before assessment. RESULTS: The community programme had significant effects on the prevalence of weekly cigarette use at times 2 and 5 and the effect approached significance at time 4. An effect on the slope of prevalence across time points was evident only when time 2 data points were eliminated from the analysis. The intervention affected the prevalence of smokeless tobacco among grade 9 boys at time 2. There were also significant effects on the slope of alcohol use among ninth graders and the quadratic slope of marijuana for all students. CONCLUSION: The results suggest that comprehensive community wide interventions can improve on the preventive effect of school based tobacco prevention programmes and that effective tobacco prevention may prevent other substance use.

Adolescent↗

PubMed1999

The value of the Parenting Scale for measuring the discipline practices of parents of middle school children.

The psychometric properties of the Parenting Scale (Arnold, O'Leary, Wolff, and Acker, 1993), a 30-item instrument originally developed to assess the discipline practices of parents of preschool children, were examined for parents of middle school students. Subjects were 298 parents of middle school student identified as at-risk for problem behavior. An exploratory factor analysis identified two factors labeled 'Overreactivity' and 'Laxness', closely resembling two of the factors found by Arnold et al., but each of these factors contained only six items. Confirmatory factor analyses, using data from the first two assessments, replicated this factor structure. The factors were significantly correlated with measures of parents' behavior, with scales from the child Behavior Checklist and Parent Daily Reports, and with the Beck Depression Inventory. The Laxness factor was less robust than the Overreactivity factor.

Adolescent↗

PubMed1999

Adolescent problem behavior: the influence of parents and peers.

This paper presents evidence that the Patterson et al. (1992) model of development of antisocial behavior in children generalizes to the development of a wide array of problem behaviors during later adolescence and that youth antisocial behavior, high-risk sexual behavior, academic failure and substance use form a single problem behavior construct. Structural equation modeling methods were applied to 24-month longitudinal data from 204 adolescents and parents. The model fit the data well, accounting for 52% of the variance in adolescent problem behavior. Specifically, families experiencing high levels of conflict were more likely to have low levels of parent-child involvement. These family conditions were related to poor parental monitoring and association with deviant peers one year later. Poor parental monitoring and associations with deviant peers were strong proximal predictors of engagement in an array of problem behaviors at two-year follow-up.

Adolescent↗

PubMed1999

Development of adolescent problem behavior.

The developmental model of adolescent antisocial behavior advanced by Patterson and colleagues (e.g., Patterson, Reid, & Dishion, 1992) appears to generalize the development of a diverse set of problem behaviors. Structural equation modeling methods were applied to 18-month longitudinal data from 523 adolescents. The problem behavior construct included substance use, antisocial behavior, academic failure, and risky sexual behavior. Families with high levels of conflict were less likely to have high levels of parent-child involvement. Such family conditions resulted in less adequate parental monitoring of adolescent behavior, making associations with deviant peers more likely. Poor parental monitoring and associations with deviant peers were strong predictors of engagement in problem behavior. These constructs accounted for 46% of the variance in problem behavior. Although association with deviant peers was the most proximal social influence on problem behavior, parental monitoring and family factors (conflict and involvement) were key parenting practices that influenced this developmental process.

Achievement↗

PubMed1999

The effectiveness of a parenting skills program for parents of middle school students in small communities.

This study provides evidence of the effectiveness of behaviorally based parenting skills classes provided by carefully trained and supervised group leaders who were not mental health clinicians. A program for parents of at-risk middle school students was evaluated in a randomized controlled trial in 8 small Oregon communities. Parents (N = 303) were randomly assigned to immediate treatment or a wait-list condition. Data were analyzed using latent growth modeling. Participation in the program led to significant improvements in problem-solving interactions as indicated by parent reports and a Taped Situations Test. Parents' over-reactivity and laxness toward their children's behavior were reduced and their feelings toward their children improved significantly as a function of treatment. Parent-reported child antisocial behavior was also reduced.

Adolescent↗

PubMed1999

Parent-daughter discussions to discourage tobacco use: feasibility and content.

Parents engaged their 6th- and 8th-grade daughters in a conversation about tobacco. The parents were guided by a pamphlet designed to encourage effective family communication about tobacco. Conversations were audiotaped for later coding. Evidence is presented that such parent-daughter conversations about tobacco use can be successfully carried out in a nonaversive manner. Overall, the conversations were perceived to have gone well, with very little conflict reported. Further, the daughters reported that the parental advice was helpful and they did not resist receiving such advice. Among the topics suggested by the pamphlet, the following were most frequently discussed: consequences of smoking as experienced by friends and relatives, difficulty of quitting, promotional tactics of tobacco companies, making rules about tobacco use, and deciding on the consequences of rules adherence or violation. Other frequently discussed topics, which were not covered in the pamphlet, may also be appropriate for parent-daughter conversations: diminished physical attractiveness and body-image issues, how to resist peer pressure, and health risks.

Adolescent↗

PubMed1995

Peer and parental influences on adolescent tobacco use.

Longitudinal models of the development of adolescent smoking and smokeless tobacco (ST) use were tested for a sample of 643 adolescents, age 14 to 17. The sample was assessed at three time points. Smoking, smokeless tobacco, and other problem behaviors formed a single problem behavior factor. Structural equation modeling indicated that inadequate parental monitoring and association with deviant peers at Time 2 predicted tobacco use at Time 3. When parental and peer smoking at Time 2 were added to the model, each accounted for significant variance in predicting Time 3 smoking, but inadequate parental monitoring and association with deviant peers still accounted for some of the variance in Time 3 smoking. In predicting boys' smokeless tobacco use, monitoring at Time 2 predicted smokeless tobacco use, but only when parental approval of ST use was not included. Fathers approval of ST use at Time 2 predicted ST use at Time 3, while maternal disapproval predicted its use.

Adolescent↗

PubMed1994

Intraclass correlation among common measures of adolescent smoking: estimates, correlates, and applications in smoking prevention studies.

Most adolescent smoking prevention studies employ designs in which classrooms, schools, school districts, or sometimes whole communities are assigned to treatment conditions while observations are made on individual students. The critical design feature in such community trials is the nesting of intact social groups within treatment conditions. This combination requires that the treatment effect be assessed against the between-group variance; unfortunately, that variance is usually larger than for randomly constituted groups and its precision is usually less than that for the within-group variance. These factors often combine to reduce power so that it is almost impossible to detect important treatment effects in an otherwise well designed and properly executed study. To address these problems, investigators need good estimates of the intraclass correlation for the variables of interest, which together with the number of observations per unit determine the magnitude of the extra variation in the nested design. The purpose of this paper is to describe the methods and results from a study designed to generate estimates of intraclass correlation for common outcomes in adolescent smoking prevention studies and to discuss the use of these estimates in the planning of new studies.

Adolescent↗

PubMed1993

The influence of parent, sibling, and peer modeling and attitudes on adolescent use of alcohol.

This 1-year prospective study of 173 families with two or more children examines the influence of parent, sibling, and peer modeling (i.e., use) and attitudes on adolescent use of alcohol. Independent questionnaire data were obtained from the adolescent, father, mother, and sibling(s). Structural equation modeling methods were employed to examine these relationships. Parent attitude toward youth alcohol use and parent modeling of alcohol use were strongly related to change in adolescent alcohol use, suggesting that parents can influence the future use of alcohol by their children. Peer and sibling modeling and peer attitudes also influenced adolescent alcohol use.

Adolescent↗

PubMed1992

The context of smoking initiation and maintenance: findings from interviews with youths.

The characteristics of initial cigarette-smoking situations and subsequent situations in which adolescents received an offer to smoke were examined by means of interviews with 287 youths in grades 7 through 10. Initiation of smoking generally took place in a social context (89%), with small groups (2.7 people) of same-gender, older (2.1 years), peers (and siblings) who were smokers (60%). In one-third of these onset situations, another novice smoked for the first time. Most subjects (81%) reported that they smoked their first cigarette because they accepted an offer. The characteristics of the onset situation did not significantly differ between regular and experimental smokers. The situations for later offers to smoke were similar: small groups of same-gender, slightly older, cigarette-smoking peers (and siblings). Descriptive and comparative data also are presented on procurement, perceived prevalence, parental influence, cravings, quit attempts, beliefs about ease of quitting, and intention to smoke. These data suggest that school-based interventions may not be sufficient to address the broad social context surrounding adolescent tobacco use. Community-wide interventions are advocated.

Adolescent↗

PubMed1990

Employee and organizational factors associated with participation in an incentive-based worksite smoking cessation program.

This study investigated employee and worksite characteristics prospectively predictive of participation among 474 smokers in nine different worksites taking part in a year-long incentive-based smoking cessation program. Several different ways of defining participation (e.g., joining versus level of attendance, first 6 months versus entire program) were studied. A consistent pattern of results was observed across two of the participation indices, joining the program and participating in one or more monthly follow-up meetings. Both worksite (number of employees, previous health promotion history, degree of support from management) and employee (gender, motivation, previous quit attempts) variables were predictive of participation. Logistic regression analyses revealed that each set of variables, worksite and employee characteristics, was significantly related to participation after controlling for the effects of the other set. We were less able to predict level of attendance among participants who joined the program. Implications of these findings for future studies of participation in health promotion programs are discussed.

Employee Incentive Plans↗

PubMed1990

The efficacy of social-influence prevention programs versus "standard care": are new initiatives needed?

This study evaluates the effects of a school-based smoking prevention program after 1 year, using school (22 middle/elementary schools, 15 high schools) as both the unit of randomization and the unit of analysis. The multigrade level (grades 6 through 9) intervention was designed to address comprehensively the social influence factors that encourage smoking. Teacher survey data indicated that treatment schools had a median of 10 classroom sessions devoted to tobacco/drug use education, 5 of which were the sessions designed for this evaluation, and control schools had also dedicated a median of 10 classroom sessions to tobacco/drug education. Thus, the study evaluated the incremental effects of the social influence intervention compared to "standard-care" curricula. Among those who reported smoking one or more cigarettes in the month prior to the intervention, there was a significant treatment effect on rate of smoking at one year, but no grade level, gender, or interaction effects. The 1-year covariate-adjusted smoking rate among pretest smokers in the treatment schools was 76.6 cigarettes per month, compared to 111.6 cigarettes per month in control schools, a 31.4% difference. These effects were not accounted for by differential subject attrition. The analyses for nonsmokers, however, showed no significant effects, and the program did not affect self-reported alcohol or marijuana use. Taken together with the results of other prevention studies, these results point to the need for the development and evaluation of new initiatives to prevent substance use.

Adolescent↗

PubMed1989

An in-depth analysis of male adolescent smokeless tobacco users: interviews with users and their fathers.

Male adolescent smokeless tobacco (ST) users (N = 191) were extensively interviewed, then followed over a 6-month period with monthly telephone interviews. In addition, their fathers (N = 137) were interviewed by telephone. Based on these data, ST use appears similar to cigarette smoking with respect to onset, patterns of use, social influences, attempts to quit, and indications of addiction. Onset and continued use of ST largely occur in a social context. Parents are reportedly aware (73%) of their sons' ST use but appear tolerant. The great majority of S's (92%) believe that there is some health risk associated with ST use. Over half report noticing ST-related changes in their oral cavities, although their dentists generally had not discussed ST use with them. Over one-third of the current users report unsuccessful quit attempts. ST use appears to be part of a more general pattern of substance use, including marijuana and alcohol.

Adolescent↗

PubMed1989

Use of smokeless tobacco among male adolescents: concurrent and prospective relationships.

The concurrent and prospective correlates of the use of smokeless tobacco among 846 adolescent males were examined. There were 6- and 12-month follow-ups to the initial questionnaire. Substantial levels of tobacco, alcohol, and marijuana use were reported, with 21% reporting use of more than one drug in the last week. Daily smokeless tobacco users were more likely to initiate use of cigarettes, marijuana, and alcohol than were other males. In addition, the "having used" smokeless tobacco variable was related to increased use of cigarettes, marijuana, and alcohol at follow-up. Discriminant analysis of concurrent data identified peer use of smokeless tobacco and experience with cigarette smoking as the primary discriminating factors between males who had tried it and those who had not. Peer use of smokeless tobacco also discriminated between daily users and those who had tried it but had not gone on to become daily users. Thus peer influence seems to be an important factor not just in trial of smokeless tobacco but also in the development of a daily use pattern. Beginning use of smokeless tobacco was related to offers to use alcohol, cigarettes, and marijuana; peer use was the best predictor of continued daily use.

Adolescent↗

PubMed1988

Longitudinal changes in adolescent cigarette smoking behavior: onset and cessation.

Employing a 1-year longitudinal design, this study examined factors related to change in adolescent smoking. Predictors of smoking onset differed from predictors of continued smoking, underscoring the importance of studying factors related to adolescent smoking onset separately from mechanisms associated with changes in smoking among current smokers. Peer smoking predicted continuation of smoking after smoking initiation. Smokers received over 26 times more offers to smoke than did nonsmokers, suggesting that smokers attempting to quit need effective refusal skills to be successful. Habitual smoking was found to develop slowly, providing a substantial time window for refusal skill training and other prevention efforts. Predictors of smoking onset differed by developmental level. Peer smoking, and marijuana use were stronger predictors of smoking onset for high-school students, and number of cigarette offers predicted better among middle-school students. Parent variables were not significant predictors of later smoking. Intention to smoke was unrelated to onset and was redundant with pretest smoking behavior in predicting cessation.

Adolescent↗

PubMed1987

Smokeless tobacco use among male adolescents: patterns, correlates, predictors, and the use of other drugs.

Questionnaire data from a sample of 3,023 adolescents indicated that over 60% of boys have tried smokeless tobacco, and 7% use it daily. Daily users reported an average of 5.3 uses per day. Among boys the prevalence of smokeless tobacco use in the past 6 months (18.8%) was higher than that for cigarette use (10.4%). For 86% of boys, the initial use of smokeless tobacco occurred in a social setting with other boys. Split-sample discriminant analyses identified peer use of smokeless tobacco as a discriminator between users and nonusers. Male triers of smokeless tobacco were discriminated from those who had never tried it by whether they had also tried smoking, intended to smoke, or had peers who used smokeless tobacco. Nine-month longitudinal data indicated that onset of smokeless tobacco use was not well predicted. Among daily users, the initial rate of use was the best prospective predictor of rate of use at follow-up (r = 0.576). Smokeless tobacco use was related to the use of other drugs, with 83% of male daily users indicating concurrent use of alcohol, marijuana, and/or cigarettes (tau = 0.354, 0.210, and 0.284, respectively). The use of smokeless tobacco was a prospective risk factor for the onset or increased use of cigarettes, alcohol, or marijuana.

Adolescent↗