Joseph P. Carbonari

Using transtheoretical model profiles to differentiate levels of alcohol abstinence success

Using data from 673 outpatient and 510 aftercare clients in Project MATCH, this study identified drinking-outcome-related differences in profiles across transtheoretical model (TTM) variables. Abstinent, moderate, and heavier drinking outcome groups were formed as a function of their 1-year posttreatment drinking behavior. Using profile analysis, group differences in the shapes of the mean profiles on TTM-related measures of stage and self-efficacy were found (a) for both the outpatient and aftercare populations and (b) at both the baseline and end-of-treatment time points. The use of cognitive and behavioral change processes during treatment was measured and the scores for each were included in the creation of the end of treatment profiles. The relation between number of TTM goals attained and probabilities of successful drinking outcome supports the usefulness of profile differences in predicting long-term drinking outcomes and can enable therapists to help clients set interim goals.

Pre-stimulus spectral EEG patterns and the visual evoked response

The relationship between the latencies and amplitudes of the N1 and P2 components of the visual evoked potential (VEP) and the psychophysiological state of the brain immediately preceding the time of the stimulus has been investigated in 7 male subjects. Power spectral measures in the delta, theta, alpha and beta bands of the 1 sec pre-stimulus EEG were used to assess the brain state, and low intensity flashes, delivered randomly between 2 and 6 whole seconds, were used as the stimuli. Trials were ranked separately according to the relative amounts of pre-stimulus power in each EEG band and were partitioned into groups by an equal pre-stimulus spectral power criterion. Averaged EPs were computed from these groups and multiple regression analysis was used to relate pre-stimulus spectral power values to EP features. Five of the 7 subjects displayed consistent increases in N1-P2 amplitude as a function of increasing pre-stimulus relative alpha power. The between-subjects effect of pre-stimulus EEG on N1 latency was small, but was moderate for P2 latency (both significant). Both N1 and P2 latency were found to decrease with increasing amounts of pre-stimulus relative delta and theta power.

Pregnancy smoking cessation: A case of mistaken identity☆

This study examined the process of change in pregnancy smoking cessation, using the stages and processes of change from the Transtheoretical Model, to compare women who stopped smoking during pregnancy with women who were in the process of smoking cessation, but were not pregnant. Differences in smoking cessation process activity and abstinence self-efficacy were hypothesized between the pregnant and nonpregnant groups of women. Study participants were 89 pregnant women who quit smoking, 28 nonpregnant women in the action stage of smoking cessation, and 92 nonpregnant women in the preparation stage. The Smoking Cessation Processes of Change Scale and the Smoking Abstinence Self-Efficacy Scale served as dependent measures. One-way MANOVA and follow-up Newman-Keuls comparisons indicated significant differences between pregnant and nonpregnant women in their levels of process activity and self-efficacy. Pregnancy smoking cessation differed dramatically from the process of nonpregnancy smoking cessation. Pregnant quitters were not engaging in experiential and behavioral processes at levels associated with the action stage of change. Low levels of process use and high efficacy indicated an externally (for the baby) motivated stopping rather than an internal, intentional process of change, which may account for high relapse rates postpartum.

Reducing Sexual Risk Behaviors and Alcohol Use Among HIV-Positive Men Who Have Sex With Men: A Randomized Clinical Trial

This randomized clinical trial (N = 253) evaluated the efficacy of a theory-based intervention designed to reduce both alcohol use and incidence of unprotected sexual behaviors among HIV-positive men who have sex with men with alcohol use disorders. An integrated, manualized intervention, using both individual counseling and peer group education/support, was compared with a control condition in which participants received resource referrals. The intervention was based on the transtheoretical models stages and processes of change, and motivational interviewing was used to enhance client readiness for change. Major findings include treatment effects for reduction in number of drinks per 30-day period, number of heavy drinking days per 30-day period, and number of days on which both heavy drinking and unprotected sex occurred. Practitioners employing this intervention may achieve enhanced client outcomes in reduction of both alcohol use and risky sexual behavior.

Postpartum return to smoking: staging a "suspended" behavior.

Two hundred fifty-six pregnant women who had quit smoking were classified into the precontemplation (PC), contemplation (C), preparation (PA), or action (A) stages of change for postpartum smoking cessation based on a 3-item algorithm assessing personal goals, self-efficacy, and smoking behavior. Logistic regression and event history analyses indicated group differences in return to smoking at 6 weeks and 3, 6, and 12 months postpartum. The percentage of women who returned to postpartum smoking was highest in the precontemplation stage and decreased with each subsequent stage, that is, at 6 weeks 83% of PCs, 64% of Cs, 35% of PAs, and 24% of As had returned to smoking. Results lend support for the stages of change for postpartum smoking abstinence. Stage-based interventions may be developed to assist women in maintaining abstinence postpartum.

Sexual risk behaviors and substance use among alcohol abusing HIV-positive men who have sex with men

Abstract An ethnically diverse sample (79.0% men of color) of HIV seropositive (HIV+) men who have sex with men (MSM) with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. Data were collected using quantitative assessments and calendar based techniques at the baseline assessment of a longitudinal study assessing the relationship between alcohol and substance use and sexual risk behaviors as well as alcohol use and HIV disease progression. Data were selected on a sample of 253 HIV+ MSM (mean age = 38.55, SD = 6.73). Of these, the majority of participants (80.2%, n = 203) reported engaging in sexual behaviors with casual partners. In terms of sexual behaviors that put partners at greatest risk for HIV transmission, unprotected anal insertive intercourse was most likely to occur with unknown status casual partners (46.8%, n = 95) than with either HIV negative casual partners (19.2%, n = 39) or with HIV+ casual partners (40.8%, n = 83). Further, bivariate analyses indicated significant relationships between the use of several substances and sexual behaviors that put partners at greatest risk for HIV transmission, as well as a significant positive relationship between drinks per drinking day and viral load.

Gender and smoking cessation: a factor structure comparison of processes of change.

This study examined gender differences in the pattern of process use for smoking cessation using the Processes of Change Questionnaire (J. O. Prochaska, W. F. Velicer, C. C. DiClemente, & J. Fava, 1988). The goals were (a) to determine the degree to which the covariance structure of the Processes of Change Questionnaire is invariant across gender, (b) to test the existence of the theoretical 2-factor process model using confirmatory factor analysis, and (c) to explore mean differences, if found, in the use of the 10 processes of change across 4 stages of change (precontemplation, contemplation, preparation, and action). The sample (N = 516) had an equal distribution of men and women across the stages of change. Results demonstrated that the structure of the measure for men and women was invariant at the level of the variance-covariance matrices and that the hypothesized 2-factor model fit the data. Only stage of change predicted the experiential and behavioral process factors.

Causal relationships of processes of change and decisional balance: Stage-specific models for smoking

This study, a secondary analysis of prospective data of smokers, tested whether the causal relationships between the processes of change and decisional balance of the transtheoretical model of change (TTM) are stage-specific. It was expected that for smokers in the contemplation stage, higher levels of experiential processing cause the cons of smoking to become more important and the pros of smoking to become less important. In other words, the level of experiential process use was expected to causally influence decisional balance (pros minus cons) for people in the contemplation stage. For ex-smokers in the action stage, when the cons outweigh the pros (cons become more important while pros become less important), they should increase their behavioral process use: decisional balance was expected to causally influence use of behavioral processes. Cross-lagged panels were analyzed using structural equation modeling. Results indicate that experiential process use has causal predominance over decisional balance for smokers in the contemplation stage. For those in the action stage, however, neither decisional balance nor behavioral process had apparent causal predominance. Mean-level invariance indicates that the contemplation and action stages are different. Further analysis investigated smokers who progressed from contemplation to either preparation or action or from preparation to action. For these smokers who had progressed toward action, decisional balance did causally influence use of behavioral processes. This evidence provides support for the use of the TTM as the basis for planning interventions that target specific stage-dependent causal mechanisms.

Ultrasound feedback and motivational interviewing targeting smoking cessation in the second and third trimesters of pregnancy

INTRODUCTION Cigarette smoking during pregnancy is associated with poor maternal and child health outcomes. Effective interventions to increase smoking cessation rates are needed particularly for pregnant women unable to quit in their first trimester. Real-time ultrasound feedback focused on potential effects of smoking on the fetus may be an effective treatment adjunct, improving smoking outcomes. METHODS A prospective randomized trial was conducted to evaluate the efficacy of a smoking cessation intervention consisting of personalized feedback during ultrasound plus motivational interviewing-based counseling sessions. Pregnant smokers (N = 360) between 16 and 26 weeks of gestation were randomly assigned to one of three groups: Best Practice (BP) only, Best Practice plus ultrasound feedback (BP+US), or Motivational Interviewing-based counseling plus ultrasound feedback (MI+US). Assessments were conducted at baseline and end of pregnancy (EOP). RESULTS Analyses of cotinine-verified self-reported smoking status at EOP indicated that 10.8% of the BP group was not smoking at EOP; 14.2% in the BP+US condition and 18.3% who received MI+US were abstinent, but differences were not statistically significant. Intervention effects were found conditional upon level of baseline smoking, however. Nearly 34% of light smokers (< or =10 cigarettes/day) in the MI+US condition were abstinent at EOP, followed by 25.8% and 15.6% in the BP+US and BP conditions, respectively. Heavy smokers (>10 cigarettes/day) were notably unaffected by the intervention. DISCUSSION Future research should confirm benefit of motivational interviewing plus ultrasound feedback for pregnant light smokers and explore mechanisms of action. Innovative interventions for pregnant women smoking at high levels are sorely needed.

Holland's personality constructs as predictors of stability of choice

Abstract It was the purpose of this study to test Hollands assertion that stability of vocational choice can be predicted from: (a) congruence of personality with chosen career, (b) differentiation of personality, and (c) internal consistency of personality characteristics. The relationship of each of the three constructs to stability of choice of college major was studied among 167 university students. It was hypothesized that prediction could be improved by combining congruence, differentiation, and consistency in a multiple relationship. The relative importance of the three constructs was examined. Findings supported Hollands contention that congruence and consistency are positively related to stability. No significant relationship was found between differentiation and stability. When combined, all three constructs predict stability, but the efficiency of prediction is not improved by adding differentiation and/or consistency to congruence. As hypothesized, congruence was found to be the most important predictor, followed in importance by differentiation and consistency, respectively.