Joseph L. Fava
Miriam Hospital
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Featured researches published by Joseph L. Fava.
Hepatology | 2010
Kittichai Promrat; David E. Kleiner; Heather M. Niemeier; Elizabeth Jackvony; Marie Kearns; Jack R. Wands; Joseph L. Fava; Rena R. Wing
Nonalcoholic steatohepatitis (NASH) is a chronic progressive liver disease that is strongly associated with obesity. Currently, there is no approved therapy for NASH. Weight reduction is typically recommended, but efficacy data are lacking. We performed a randomized controlled trial to examine the effects of lifestyle intervention using a combination of diet, exercise, and behavior modification, with a goal of 7% to 10% weight reduction, on clinical parameters of NASH. The primary outcome measure was the change in NASH histological activity score (NAS) after 48 weeks of intervention. Thirty‐one overweight or obese individuals (body mass index [BMI], 25–40 kg/m2) with biopsy‐proven NASH were randomized in a 2:1 ratio to receive intensive lifestyle intervention (LS) or structured education (control). After 48 weeks of intervention, participants assigned to LS lost an average of 9.3% of their weight versus 0.2% in the control group (P = 0.003). A higher proportion of participants in the LS group had a reduction of NAS of at least 3 points or had posttreatment NAS of 2 or less as compared with the control group (72% versus 30%, P = 0.03). NAS improved significantly in the LS group (from 4.4 to 2.0) in comparison with the control group (from 4.9 to 3.5) (P = 0.05). Percent weight reduction correlated significantly with improvement in NAS (r = 0.497, P = 0.007). Participants who achieved the study weight loss goal (≥7%), compared with those who lost less than 7%, had significant improvements in steatosis (−1.36 versus −0.41, P < 0.001), lobular inflammation (−0.82 versus −0.24, P = 0.03), ballooning injury (−1.27 versus −0.53, P = 0.03) and NAS (−3.45 versus −1.18, P < 0.001). Conclusion: Weight reduction achieved through lifestyle intervention leads to improvements in liver histology in NASH. (HEPATOLOGY 2009.)
Archive | 2000
Wayne F. Velicer; Cheryl A. Eaton; Joseph L. Fava
The concept of a construct is central to many of the advances in the behavioral sciences during the second half of this century. Constructs serve to summarize, organize, and facilitate the interpretation of data. The concept of a construct also permits us to move directly from data analysis to theory development and testing. Factor analysis and component analysis are two very similar methods that facilitate the transition from dealing with a large number of observed variables to a smaller number of constructed or latent variables. Douglas Jackson employed factor or component analysis as an integral part of his sequential approach to the development of psychological measures (Jackson, 1970, 1971). It has become a standard part of measure development and is one of the most employed statistical procedures in the behavioral sciences.
Addictive Behaviors | 2001
James O. Prochaska; Wayne F. Velicer; Joseph L. Fava; Joseph S. Rossi; Janice Y. Tsoh
A stage-matched expert system intervention was evaluated on 4144 smokers in a two-arm randomized control trial with four follow-ups over 24 months. Smokers were recruited by random digit-dial calls, and 80.0% of the eligible smokers were enrolled. Individualized and interactive expert system computer reports were sent at 0, 3, and 6 months. The reports provided feedback on 15 variables relevant for progressing through the stages. The primary outcomes were point prevalence and prolonged abstinence rates. At 24 months, the expert system resulted in 25.6% point prevalence and 12% prolonged abstinence, which were 30% and 56% greater than the control condition. Abstinence rates at each 6-month follow-up were significantly greater in the Expert System (ES) condition than in the comparison condition with the absolute difference increasing at each follow-up. A proactive home-based stage-matched expert system smoking cessation program can produce both high participation rates and relatively high abstinence rates.
Addictive Behaviors | 1996
Alexander V. Prokhorov; Unto E. Pallonen; Joseph L. Fava; Lin Ding; Raymond Niaura
In the present study we tested our hypothesis that because of the higher prevalence and greater intensity of cigarette smoking among vocational-technical students (N = 110; 51.8% males; mean age 17 years), adolescents might demonstrate the nicotine dependence patterns comparable to those measured in a similar fashion in a group of adult smokers (N = 173; 50% males; mean age 42 years). A modified version of the Fagerström Tolerance Questionnaire (FTQ) utilized in the adolescent sample was coded to make it comparable to the original FTQ used in the adult sample. The tests of item structure and internal consistency of the modified FTQ for adolescents were satisfactory; the overall mean FTQ score correlated significantly with the intensity and duration of smoking. Although the FTQ values were generally lower in the adolescent sample, 20% of students had an overall FTQ score of 6 and above, indicating substantial nicotine dependence (compared to 49% in adults). Reasons for failure of the existing adolescent smoking cessation programs as well as the rationale for adding a nicotine replacement option to the behavioral smoking cessation treatment for a subset of high-risk nicotine-dependent adolescents are discussed.
Addictive Behaviors | 1995
Joseph L. Fava; Wayne F. Velicer; James O. Prochaska
Interrelationships among key constructs of the Transtheoretical Model are examined for the first time on a large (N = 4,144) representative sample of smokers. The posited relationships between the early Stages of Change (Precontemplation, Contemplation, Preparation) and the Processes of Change, Decisional Balance, and Situational Temptation are generally supported. Precontemplators are found to use the Processes of Change the least and those in Preparation use them the most. Precontemplators also have the least negative attitudes toward their smoking behavior. Precontemplators and Contemplators are tempted to smoke in more situations than those in Preparation. Precontemplators are also the most addicted to smoking, followed by those in Contemplation and Preparation, respectively, when examined on traditional measures of smoking behavior. The implications for smoking cessation efforts are also discussed.
Health Psychology | 1999
Wayne F. Velicer; James O. Prochaska; Joseph L. Fava; Robert G. Laforge; Joseph S. Rossi
This study compared interactive and noninteractive smoking cessation interventions for a population of smokers who were all members of 1 division of a managed care company. In addition, it examined whether a dose-response relationship existed. Screening was completed for 19,236 members who were contacted by telephone or mail. Of the 4,653 who were identified as smokers, 85.3% were enrolled. A 2 Intervention (interactive or noninteractive) x 4 Contacts (1, 2, 3, or 6 contacts) x 4 Occasions (0, 6, 12, and 18 months) design was used. The interactive intervention was stage-matched expert-system reports plus manuals; the noninteractive intervention was stage-matched manuals. Contact occurred in 1 of 4 series (1, 2, 3 or 6 contacts) at 3-month intervals. The expert system outperformed the stage-matched manuals, but there was no clear dose-response relationship for either intervention.
Health Psychology | 2004
James O. Prochaska; Wayne F. Velicer; Joseph S. Rossi; Colleen A. Redding; Geoffrey W. Greene; Susan R. Rossi; Xiaowu Sun; Joseph L. Fava; Robert G. Laforge; Brett A. Plummer
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.
Addictive Behaviors | 1999
Wayne F. Velicer; Gregory J. Norman; Joseph L. Fava; James O. Prochaska
Sensitive measurement of behavior change requires dependent measures that are sensitive to the whole spectrum of change, not just a single aspect of change. Traditional outcome variables such as point prevalence for smoking cessation focus on a single discrete event and ignore all other progress. Alternatively, the criterion measurement model (CMM) is an approach that posits a three-construct outcome model (habit strength, positive evaluation strength, and negative evaluation strength), where different constructs are sensitive to change for different aspects of the temporal domain. In this article, a series of 40 differential a priori predictions were tested using a large representative sample of smokers. The focus was on the prediction of specific effect sizes rather than statistical significance. A series of comparisons involving stage transitions was examined using five variables representing the three CMM constructs. The predictions involved movement from one of three initial stages (precontemplation, contemplation, and preparation) to stage membership 12 months later. Thirty-six of the 40 predictions were confirmed, indicating that the outcome model has strong construct validity and accurately reflects movement between the stages of change.
Addictive Behaviors | 1995
Wayne F. Velicer; Stanley L. Hughes; Joseph L. Fava; James O. Prochaska; Carlo C. DiClemente
The transtheoretical model of behavior change postulates five distinct, well-defined stages of change: Precontemplation, Contemplation, Preparation, Action, and Maintenance. Each stage has been regarded as reflecting a motivational posture and treated as if it is homogenous with respect to membership. This paper reports the results of four cluster analytic studies, one within each of the first four stages of change. The cluster analysis was based on three constructs of the model. Four distinct subtypes were found within Contemplation, Preparation, and Action, and three subtypes were found within Precontemplation. External validation for the clusters was provided using the 10 Processes of Change and 8 behavioral measures as dependent measures. At least one subtype corresponded to the existing stage definition but the other subtypes suggested alternative intervention strategies.
Preventive Medicine | 2009
Elizabeth E. Lloyd-Richardson; Steffani Bailey; Joseph L. Fava; Rena R. Wing
OBJECTIVE To assess the prevalence of weight gain among male and female college freshmen. METHODS Study 1 examined weight change over freshman and sophomore years among 904 students attending a state university in Indiana, from 2002-2004. Study 2 examined weight and BMI change over the freshman year among 382 students attending a private university in Rhode Island, from 2004-2006. RESULTS 77% of Study 1 participants and 70% of Study 2 participants gained weight during their freshman year, largely during the first semester. In Study 1, weight gain averaged 3.5 kg in females and males; in Study 2, weight gain averaged 1.6 kg for females and 2.5 kg for males. Students continued to gain weight their sophomore year, with females 4.2 kg and males 4.3 kg heavier than at start of college. Overweight/obesity rates increased from baseline to end of freshman year for Study 1 (21.6% to 36%) and Study 2 participants (14.7% to 17.8%). CONCLUSION The first years of college may be a critical developmental window for establishing weight gain prevention efforts.