Jeffrey A. Smith

Behavioral economic analysis of activity choice in obese children.

Evaluated childrens choice for sedentary versus vigorous activity. Experiment 1 assessed the influence of percent overweight (less than 20%, 20% to 80%, greater than 80%) on choice of a moderately liked vigorous activity at a constant variable ratio (VR) 2 reinforcement schedule versus a highly liked sedentary activity with the schedule varied from VR2 to VR32. All children chose the sedentary choice when the schedules were VR2. As the cost for sedentary activity increased, lean and moderately obese children switched to the vigorous activity, but the very obese children still chose the sedentary activity. Experiment 2 compared moderately obese childrens choice between easily accessible, highly or least liked vigorous activities (VR2) and highly liked sedentary activity with the schedule varied from VR2 through VR16. When the reinforcement schedules were equal, and sedentary activity and vigorous activity were rated as equally linked, children chose the sedentary activity. All subjects switched from the sedentary to the vigorous activity, but there were no differences in choice as a function of liking for vigorous activities.

Randomized Prospective Study of Self-Management Training With Newly Diagnosed Diabetic Children

This study was designed to evaluate the effects of a self-management training (SMT) program on metabolic control of children with insulin-dependent diabetes mellitus (IDDM) in the first 2 yr after diagnosis. After standard in-hospital diabetes education, 36 children (mean age 9.3 yr, range 3–16 yr) were randomized to conventional follow-up, conventional and supportive counseling (SC), or conventional and SMT, which emphasized use of data obtained from self-monitoring of blood glucose. SC and SMT interventions consisted of seven outpatient sessions with a medical social worker during the first 4 mo after diagnosis and booster sessions at 6 and 12 mo postdiagnosis. Groups were similar with respect to age, sex, body mass index, socioeconomic status, C-peptide, and severity of illness at diagnosis. Metabolic control, measured quarterly by glycosylated hemoglobin (HbA1), improved substantially in all three treatment groups during the first 6 mo. SMT patients had significantly lower HbA1 levels than conventional patients at 1 yr (P < 0.01) and 2 yr (P < 0.05) postdiagnosis. SMT patients also had lower HbA1 levels than SC patients, but this did not reach statistical significance. The lower HbA1 levels of SMT patients were not explained by severity of illness at diagnosis, or insulin dose, body mass index, and C-peptide levels at 2 yr. These results suggest that an SMT program during the first few months after diagnosis helps avoid the deterioration in metabolic control often seen in children with IDDM between 6 and 24 mo after diagnosis.

Suicidal Ideation and Behavior and Noncompliance With the Medical Regimen Among Diabetic Adolescents

OBJECTIVE To examine (1) the 1-year and lifetime prevalence of suicidal thoughts and behavior among adolescents with insulin-dependent diabetes mellitus (IDDM), (2) the relationship between suicidal thoughts and serious noncompliance with the medical regimen, and (3) factors including psychiatric disorder, self-efficacy expectations, and hopelessness that might mediate the relationship between suicidal thoughts and noncompliance. METHOD Semistructured and structured interview instruments and self-report questionnaires were used to determine history of suicidal thoughts and behavior, serious noncompliance with the medical regimen, current psychiatric disorder, hopelessness, and self-efficacy expectations among 91 adolescents attending outpatient clinic appointments. RESULTS The rate of suicidal ideation among the diabetic adolescents was higher than expected, but the rate of suicide attempts was comparable with that reported for the general population. Suicidal thoughts were strongly associated with serious noncompliance with the medical regimen. Duration of IDDM and psychiatric diagnosis were related to both suicidal ideation within the previous year and lifetime suicidal ideation. Diagnosable psychiatric disorder and not living in a two-parent home were related to noncompliance with medical treatment. CONCLUSIONS Suicidal thoughts and serious noncompliance with the medical regimen are strongly associated among diabetic teenagers, and psychiatric disorder is a common correlate of both.

Psychiatric status of intrafamilial child sexual abuse victims

The initial psychiatric profile of a large sample of sexually abused children who presented at an outpatient child psychiatry clinic was assessed. The results identified a wide diversity in victim responses to incest. The older the victim, the closer the relationship of the offender to the child, the greater the frequency of abuse incidents, the longer the duration of the abuse, the offender having a history of alcohol abuse, and the victim being a victim of physical abuse as well as sexual abuse were all related to the presence of a DSM-III axis I clinical disorder.

Behavioral economic analysis of food choice in obese children

Behavioral economic analysis has shown food choice in normal weight adults is influenced by both liking and constraints on access to food. The present study assessed the contributions of food liking and environmental constraints to choice of moderately liked, low-calorie foods or highly liked high-calorie foods in obese children. Access to the moderately liked food remained on a VR2 schedule, while response requirements for the highly liked food ranged from VR2 to VR32. Subjects chose to work for the higher-rated food at comparisons up to VR2/VR4, showed no preference at VR2/VR8 and their choice shifted to the lower rated food when response requirements for the highly liked food were increased to VR16. These results show that both subjective and environmental factors contribute to childrens choice of foods.

Coping with sports injuries: an examination of the adolescent athlete ☆

Forty-eight injured adolescent athletes completed questionnaires over 3 months after injury to assess psychosocial outcomes. Depressive symptoms decreased over time, and the lack of positive stress and high athletic identity were associated with early depressive symptoms after accounting for injury severity. Increased social support was associated with lower initial depressive symptoms.

Conditioned tolerance to the heart rate effects of smoking.

This study extended our findings that behavioral tolerance to nicotine in animals can be influenced by conditioning to cardiovascular tolerance in humans. Subjects smoked one-half a cigarette during each of five trials. In the ten-minute intersmoking interval the contexts that preceded smoking were varied. Smokers in the Changing group attended to a different five-minute segment of a Sherlock Holmes radio mystery before each trial, while those in the Repeated group listened to the same segment of the tape. Presmoking heart rates were stable across the groups from trials 1 to 5. As predicted, heart rate for subjects who smoked in the same context showed tolerance to smoking from trials 1 to 5 (84.5 to 78 bpm), while subjects who smoked in in the same context showed tolerance to 83.9 bpm). COa levels increased equally for both groups over the five trials. The results of this study suggest tolerance to smoking can be influenced by learning.

Adolescent tobacco use and cessation.

Over one third of high school students in the United States smoke cigarettes, and close to 10% use spit tobacco. Tobacco use clusters with alcohol use, other substance abuse, and other health risk behaviors among teenagers. Public health and law enforcement policy changes, combined with effective substance use prevention programs in both elementary and middle school, are needed to prevent the early age of onset of tobacco use by youth. Primary care providers can play a key role in identifying children and adolescents who smoke or use spit tobacco and helping them discontinue their tobacco use.

Dietary Skills and Adherence in Children With Type I Diabetes Mellitus

This study was designed to objectively measure dietary skills of diabetic children and their mothers and to assess dietary adherence in specific situations. Subjects were 34 children with Type I diabetes mellitus and their mothers. Recall of diet prescriptions and performance on skills tests averaged around 50% for both children and mothers. Adherence problems were most frequent during afternoon snack, while at school, with friends, and at restaurants. Significant relationships between glycosylated hemoglobin values and adherence at school and with friends were observed. Older children had more adherence problems with afternoon snack, while alone, and while with parents. Dietary skills were unrelated to adherence. These findings demonstrate that children with diabetes and their mothers have substantial dietary skills deficits and situationally related dietary adherence problems.

American College of Emergency Physicians Ethics Manual

Ethical concerns are a major part of the clinical practice of emergency medicine. The emergency physician must make hard choices, not only with regard to the scientific/technical aspects but also with regard to the moral aspects of caring for emergency patients. By the nature of the specialty, emergency physicians face ethical dilemmas often requiring prompt decisions with limited information. This manual identifies important moral principles and values in emergency medicine. The underlying assumption is that a knowledge of moral principles and ethical values helps the emergency physician make responsible moral choices. Neither the scientific nor the moral aspects of clinical decision making can be reduced to simple formulas. Nevertheless, decisions must be made. Emergency physicians should, therefore, be cognizant of the ethical principles that are important for emergency medicine, understand the process of ethical reasoning, and be capable of making rational moral decisions based on a stable framework of values.