Christina S. Lee

A culturally adapted physical activity intervention for Latinas: a randomized controlled trial.

BACKGROUND In the U.S., Latinos report particularly high levels of inactivity and related chronic illnesses and are in need of intervention. Thus, the purpose of the current study was to culturally and linguistically adapt an empirically supported, individually tailored physical activity print intervention for Latinos and then conduct an RCT of the modified program. DESIGN An RCT was conducted. SETTING/PARTICIPANTS The sample included 93 overweight/obese (80%) Latinas with low income and acculturation. INTERVENTION Data were collected in 2007-2008 and analyzed by intent-to-treat in 2009. Participants were randomly assigned to either (1) a culturally and linguistically adapted physical activity intervention (Seamos Activas) or (2) a wellness contact control condition. MAIN OUTCOME MEASURES Self-report physical activity, as measured pre- and post-intervention (6 months, 87% retention) by the 7-Day Physical Activity Recall. RESULTS Moderate-intensity (or greater) physical activity increased from an average of 16.56 minutes/week (SD=25.76) at baseline to 147.27 (SD=241.55) at 6 months in the intervention arm (n=45), and from 11.88 minutes/week (SD=21.99) to 96.79 (SD=118.49) in the wellness contact control arm (n=48). No between-group differences were seen in overall physical activity. Intervention participants reported significantly greater increases in cognitive (F[1, 91]=9.53, p=0.003) and behavioral processes of change (F[1, 91]=8.37, p=0.005) and available physical activity supplies and equipment at home (F[1, 91]=4.17, p=0.04) than control participants. CONCLUSIONS Results supported the hypothesized feasibility, acceptability, and preliminary efficacy of individually tailored physical activity print interventions among Latinas. Although more research is needed to corroborate these findings, such high-reach, low-cost approaches have great potential to positively affect public health. TRIAL REGISTRATION NCT00724165.

Readiness to change as a mediator of the effect of a brief motivational intervention on posttreatment alcohol-related consequences of injured emergency department hazardous drinkers.

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population.

Project Reduce: Reducing alcohol and marijuana misuse: Effects of a brief intervention in the emergency department

STUDY OBJECTIVE Brief interventions (BI) for alcohol misuse and recently for marijuana use for emergency department patients have demonstrated effectiveness. We report a 12-month outcome data of a randomized controlled trial of emergency department (ED) patients using a novel model of BI that addresses both alcohol and marijuana use. METHODS ED research assistants recruited adult patients who admitted alcohol use in the last month, and marijuana use in the last year. In the ED, patients received an assessment of alcohol and marijuana use and were randomized to treatment (n=249) or standard care (n=266). Treatment consisted of two sessions of BI. At 3 and 12months, both groups had an assessment of alcohol and marijuana use and negative consequences of use. RESULTS 515 patients were randomized. We completed a 12-month follow-up assessments on 83% of those randomized. Measures of binge drinking and conjoint marijuana and alcohol use significantly decreased for the treatment group compared to the standard care group. At 12-month binge alcohol use days per month in the treatment group were (M=0.72:95% CI=0.36-1.12) compared to standard care group (M=1.77:95% CI=1.19-1.57) Conjoint use days in the treatment group (M=1.25.1:95% CI=0.81-1.54) compared to standard care group (M=2.16:95% CI=1.56-2.86). No differences in negative consequences or injuries were seen between the treatment and standard care groups. CONCLUSIONS BI for alcohol and marijuana decreased binge drinking and conjoint use in our treatment group. BI appears to offer a mechanism to reduce risky alcohol and marijuana use among ED patients but expected reductions in consequences of use such as injury were not found 12months after the ED visit.

DIAL: a randomised trial of a telephone brief intervention for alcohol.

Background Decreasing Injuries from ALcohol (DIAL) is a randomised control trial of a telephone brief intervention (BI) with injured emergency department (ED) patients with high-risk alcohol use. Here the authors examine 12-month outcomes of the interventions effect on alcohol use, alcohol-related injuries and alcohol-related negative consequences. Methods ED research assistants recruited adult injured patients who screened positive for high-risk alcohol use and were to be discharged home. After discharge, all participants received by telephone an assessment of their alcohol use, alcohol-related injuries, and alcohol-related negative consequences and then were randomised to treatment or standard care. Treatment consisted of two telephone sessions of BI focusing on risky alcohol use. Both groups were reassessed after 12 months. Results At 12 months, 249 (89%) participants completed follow-up assessments. After using a log transformation, the difference in alcohol-related injuries between baseline and 12-month follow-up was greater in the BI group than the standard care group (p=0.04); this is an effect size of Cohens d=0.21. No difference between groups was found when comparing change in alcohol consumption and other alcohol-related negative consequences at 12 months. Conclusions These findings suggest that a telephone BI with injured ED patients may decrease alcohol-related injuries. Identifying patients with risky alcohol use in the ED and then subsequently delivering the intervention by telephone after discharge has promise as a model for BI and deserves further study.

Rationale, design, and baseline findings from Seamos Saludables: A randomized controlled trial testing the efficacy of a culturally and linguistically adapted, computer- tailored physical activity intervention for Latinas

BACKGROUND Latinos are now the largest (and fastest growing) ethnic minority group in the United States. Latinas report high rates of physical inactivity and suffer disproportionately from obesity, diabetes, and other conditions that are associated with sedentary lifestyles. Effective physical activity interventions are urgently needed to address these health disparities. METHOD/DESIGN An ongoing randomized controlled trial will test the efficacy of a home-based, individually tailored physical activity print intervention for Latinas (1R01NR011295). This program was culturally and linguistically adapted for the target population through extensive formative research (6 focus groups, 25 cognitive interviews, iterative translation process). This participant feedback was used to inform intervention development. Then, 268 sedentary Latinas were randomly assigned to receive either the Tailored Intervention or the Wellness Contact Control arm. The intervention, based on Social Cognitive Theory and the Transtheoretical Model, consists of six months of regular mailings of motivation-matched physical activity manuals and tip sheets and individually tailored feedback reports generated by a computer expert system, followed by a tapered dose of mailings during the second six months (maintenance phase). The main outcome is change in minutes/week of physical activity at six months and one year as measured by the 7-Day Physical Activity Recall (7-Day PAR). To validate these findings, accelerometer data will be collected at the same time points. DISCUSSION High reach, low cost, culturally relevant interventions to encourage physical activity among Latinas could help reduce health disparities and thus have a substantial positive impact on public health.

Acculturation Stress and Drinking Problems Among Urban Heavy Drinking Latinos in the Northeast

This study investigates the relationship between the level of acculturation and acculturation stress and the extent to which each predicts problems related to drinking. Hispanics who met criteria for hazardous drinking completed measures of acculturation, acculturation stress, and drinking problems. Sequential multiple regression was used to determine whether the levels of self-reported acculturation stress predicted concurrent alcohol problems after controlling for the predictive value of the acculturation level. Acculturation stress accounted for a significant variance in drinking problems, while adjusting for acculturation, income, and education. Choosing to drink in response to acculturation stress should be an intervention target with Hispanic heavy drinkers.

Translation of alcohol screening and brief intervention guidelines to pediatric trauma centers.

BACKGROUND As part of the American College of Surgeons verification to be a Level 1 trauma center, centers are required to have the capacity to identify trauma patients with risky alcohol use and provide an intervention. Despite supporting scientific evidence and national policy statements encouraging alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT), barriers still exist, which prevent the integration of SBIRT into clinical care. Study objectives of this multisite translational research study were to identify best practices for integrating SBIRT services into routine care for pediatric trauma patients, to measure changes in practice with adoption and implementation of a SBIRT policy, and to define barriers and opportunities for adoption and implementation of SBIRT services at pediatric trauma centers. METHODS This translational research study was conducted at seven US pediatric trauma centers during a 3-year period. Changes in SBIRT practice were measured through self-report and medical record review at three different study phases, namely, adoption, implementation, and maintenance phases. RESULTS According to medical record review, at baseline, 11% of eligible patients were screened and received a brief intervention (if necessary) across all sites. After completion of the SBIRT technical assistance activities, all seven participating trauma centers had effectively developed, adopted, and implemented SBIRT policies for injured adolescent inpatients. Furthermore, across all sites, 73% of eligible patients received SBIRT services after both the implementation and maintenance phases. Opportunities and barriers for successful integration were identified. CONCLUSION This model may serve as method for translating SBIRT services into practice within pediatric trauma centers. LEVEL OF EVIDENCE Therapeutic/prevention study, leve IV.

Differences in smoking behavior and attitudes among Puerto Rican, Dominican, and non-Latino white caregivers of children with asthma

Purpose. No studies have examined the differences in smoking attitudes and behavior between Dominicans (DRs) and Puerto Ricans (PRs). Identification of pretreatment differences is important for cultural adaptation of evidenced-based smoking cessation treatments. Design. Secondary analysis. Setting/Intervention. Three home visits for asthma education and smoking cessation. Subjects. Caregivers who smoke and have a child with asthma: DRs (n = 30), PRs (n = 67), and non-Latino whites (n = 128; NLWs). Measures. Baseline assessment of psychosocial variables. Analyses. Controlled for age, education, and acculturation. Results. Compared with DRs, PRs were more acculturated, more nicotine dependent, less motivated and confident to quit, and identified more pros of smoking (all p < .05). Compared with NLWs, PRs were less likely to be employed, smoked fewer cigarettes per day, and had lower education, greater depressed mood, greater pros and cons of smoking, less social support, and higher child asthma morbidity (all p < .05). Compared with NLWs, DRs were less nicotine dependent, more confident to quit, and less likely to live with a smoker; reported greater cons of smoking and greater stress; and were more likely to have a household smoking ban (DRs 60% vs. NLWs 33.6%). Only 3.3% of DRs were precontemplators vs. 16.4% (PRs) and 10.9% (NLWs). Conclusions. PRs appear to have more factors associated with risk of smoking treatment failure; DRs appear to have more protective factors. Examination of the role of these smoking attitudes as potential moderators and mediators of smoking behavior are needed to guide the cultural adaptation of evidenced-based treatments. (Am J Health Promot 2011;25[5 Supplement]:S91—S95.)

Injuries, negative consequences, and risk behaviors among both injured and uninjured emergency department patients who report using alcohol and marijuana

Background: Brief intervention (BI) to reduce hazardous drinking and negative consequences such as injury has been effective when given in the emergency department (ED). The effectiveness and effect of BI has varied between injured and uninjured ED patients. This study compares injured and uninjured ED patients who admit to alcohol and marijuana use to determine their need and their readiness for BI. Patients and Methods: Participants volunteered to enter a randomized controlled trial of BI to reduce hazardous alcohol and marijuana use. Adult ED patients who had had alcohol in the last month and smoked marijuana in the last year were recruited. Those patients who were admitted to hospital, were under police custody, or were seeking treatment for substance use or psychiatric disorder were excluded. Research assistants interviewed participants using a validated questionnaire. Data were analyzed using SAS (version 9.1). Binominal tests of proportions, t-test analyses, and transformations were conducted as appropriate. Results: Injured (n = 249) and uninjured (n = 266) study participants reported very high, statistically equivalent (P > 0.05), rates of binge drinking (4–5 days/month), marijuana use (13 days/month), driving under the influence of marijuana or alcohol (>49% in the last 3 months), injury (>83% in the last year), and other negative consequences (>64% in the last 3 months) prior to their ED visit. These behaviors and the consequences demonstrate a need for change. Both injured and uninjured subjects were ready to change (>56%) and confident they could change (>91%) alcohol and marijuana use. Discussion: ED patients who admit to alcohol and marijuana use also use other hazardous substances and participate in high-risk behaviors. In both injured and uninjured patients who admit using alcohol and marijuana, the ED visit is an opportunity to deliver BI to reduce alcohol and marijuana use and associated risk behaviors and the subsequent injury and negative consequences. Given their risk behaviors and experience of negative consequences, members of both injured and uninjured groups have an equal need for BI. Fortunately, in both groups, a high number of members express motivation to change.

Social processes underlying acculturation: a study of drinking behavior among immigrant Latinos in the Northeast United States

Study Goals To identify social processes that underlie the relationship of acculturation and heavy drinking behavior among Latinos who have immigrated to the Northeast United States of America (USA). Method Community-based recruitment strategies were used to identify 36 Latinos who reported heavy drinking. Participants were 48% female, 23 to 56 years of age, and were from South or Central America (39%) and the Caribbean (24%). Six focus groups were audiotaped and transcribed. Results Content analyses indicated that the social context of drinking is different in the participants’ countries of origin and in the United States. In Latin America, alcohol consumption was part of everyday living (being with friends and family). Nostalgia and isolation reflected some of the reasons for drinking in the USA. Results suggest that drinking in the Northeastern United States (US) is related to Latinos’ adaptation to a new sociocultural environment. Knowledge of the shifting social contexts of drinking can inform health interventions.