Leslie A. Robinson

Psychotherapy for the Treatment of Depression: A Comprehensive Review of Controlled Outcome Research

Previous quantitative reviews of research on the efficacy of psychotherapy for depression have included only a subset of the available research or limited their focus to a single outcome measure. The present review offers a more comprehensive quantitative integration of this literature. Using studies that compared psychotherapy with either no treatment or another form of treatment, this article assesses (a) the overall effectiveness of psychotherapy for depressed clients, (b) its effectiveness relative to pharmacotherapy, and (c) the clinical significance of treatment outcomes. Findings from the review confirm that depressed clients benefit substantially from psychotherapy, and these gains appear comparable to those observed with pharmacotherapy. Initial analysis suggested some differences in the efficacy of various types of treatment; however, once the influence of investigator allegiance was removed, there remained no evidence for the relative superiority of any 1 approach. In view of these results, the focus of future research should be less on differentiating among psychotherapies for depression than on identifying the factors responsible for improvement.

Predictors of risk for different stages of adolescent smoking in a biracial sample.

This investigation was designed to identify the risk factors associated with different stages of cigarette use in a large biracial adolescent sample. A questionnaire assessing smoking habits and variables thought to be related to smoking was administered to 6,967 7th graders. Analysis revealed that the best predictor of experimentation with cigarettes was the perception that they were easily available. Regular smoking appeared to be heavily influenced by cost. Social influences contributed to both experimental and regular smoking, but the impact of social models varied with ethnicity and gender. Analysis further revealed that weight-related variables were closely tied to regular smoking. Implications of the findings for smoking prevention programs are discussed.

Risk factors for smoking among adolescents with asthma

PURPOSE To examine the prevalence of smoking among youth with asthma and explore potential risk factors for smoking among these youth, compared with youth without asthma. METHODS In March 1997, a questionnaire assessing risk factors for smoking was administered to students attending public high school in Memphis, Tennessee. The sample (n = 3234) ranged from 15 to 18 years of age, was predominately African-American (76.7%), and 56.7% female. Based on a single self-reported item, 15.7% of youth reported having asthma. Logistic regression analyses assessed asthma status differences in current smoking and the association between risk factors and smoking. RESULTS Nearly 20% of youth reported current smoking. Adolescents with asthma (current or past) were nearly 1.5 times more likely to smoke than peers without asthma. The association between risk factors and current cigarette smoking was equivalent for youth regardless of whether they had asthma and did not differ for those youth with current vs. past asthma. CONCLUSIONS Results suggest that adolescents with or without asthma smoke for similar reasons. Research is needed to elucidate whether there are unique risk factors, not examined here, for smoking among adolescents with asthma. Smoking prevention and cessation programs are needed for youth with asthma.

What motivates adolescent smokers to make a quit attempt

A sample of 120 adolescent smokers (80 males, 40 females), most of whom were referred by school personnel after being caught with cigarettes at school (n=113), reported motivations for making a quit attempt during a smoking cessation project. Most students (n=76) were randomly assigned to a four session cessation program that included discussion of a number of motivational topics, and the remaining students were assigned to a self-help control group that received a pamphlet recommending strategies for quitting. Reported motivations for quitting did not differ significantly across the two treatment conditions. Concern about future health (73%) was the most popular reason given for making a quit attempt, followed by concern about current health (65%). Concerns about physical appearance (59%), the cost of cigarettes (52%), and athletic performance (51%) were also listed as motivators by a majority of the participants. Future health was the most popular choice for the most important motivator to quit (35%). Females and participants with fewer best friends smoking were more likely to report that the prevalence of non-smoking teenagers, the relationship between smoking and weight, and physical appearance concerns were motivators to quit. African Americans were more likely than Whites to list current health concern as the most important motivator.

ETHNIC AND GENDER DIFFERENCES IN RISK FACTORS FOR SMOKING ONSET

The purpose of this investigation was to explore gender and ethnic differences in the prevalence of risk factors for smoking onset. As part of a larger study, 6,967 seventh graders completed a questionnaire measuring variables shown in previous research to predict cigarette smoking. The results indicated that at this age level, risk factors for smoking initiation are less prevalent among African Americans than European American youth and among girls relative to boys. These findings are consistent with the lower incidence of smoking among African Americans and girls at this young age. Future research should examine changes in risk factors over time to determine whether such changes accompany the rising smoking rate typically observed among girls and African Americans later in adolescence.

“Start to stop”: results of a randomised controlled trial of a smoking cessation programme for teens

Objective:To examine the feasibility, acceptability, and effectiveness of a school based smoking cessation programme among students caught smoking at school. Design:A randomised controlled trial comparing cessation rates among students in a behavioural cessation programme and those receiving self help materials only. Setting:Eighteen schools in the Memphis, Tennessee area. Subjects:Two hundred and sixty one adolescent cigarette smokers (166 male, 95 female) averaging 15.8 years of age. Intervention:Students assigned to the intervention received a four session behavioural treatment programme administered individually by a health educator. In addition, these students received stage matched intervention in brief phone calls monthly until the one year follow up. Main outcome measure:Self reported and biochemically verified smoking cessation at post-test and 12 month follow up. Results:Recruiting students who were caught smoking at school proved to be highly successful. Participants rated the programme favourably, and retention rates were high. Although treated participants improved more in tobacco related knowledge relative to controls (p  =  0.002), there were no group differences in changes in attitudes toward smoking. In addition, treated and control participants demonstrated no significant differences in cessation rates both at post-test and follow up. Comparisons between self reported cessation rates and those obtained under bogus pipeline conditions or with biochemical verification suggested significant falsification of cessation among participants. Conclusions:Our results failed to demonstrate any significant effect of the cessation programme on smoking rates for treated adolescents compared with controls. Our findings also highlight the importance of utilising strong methodology in research on adolescent smoking cessation, including control groups and biochemical verification of smoking status.

Gender and ethnic differences in young adolescents’ sources of cigarettes

OBJECTIVE To identify the sources used by young adolescents to obtain cigarettes. DESIGN In early 1994 a survey assessing usual sources of cigarettes and characteristics of the respondents was administered in homeroom classes. SETTING A large urban, predominantly African American school system. SUBJECTS A population-based sample of 6967 seventh graders averaging 13 years of age. MAIN OUTCOME MEASURE Reports of usual sources of cigarettes. RESULTS At this age level, young smokers were more likely to get cigarettes from friends (31.2%) than buy them in stores (14.3%). However, the odds of purchasing varied for different groups of children. Regular smokers were much more likely (48.3%) to have purchased cigarettes than experimental smokers (9.6%), p<0.001. Girls were less likely to have bought their cigarettes than boys (p<0.001), and black smokers were less likely to have purchased cigarettes than white children (p<0.001). Results suggested that family members who smoke may constitute a more important source of tobacco products than previously recognised, particularly for young girls. CONCLUSIONS In this middle-school sample, peers provided the major point of cigarette distribution. However, even at this age, direct purchase was not uncommon. Sources of cigarettes varied significantly with gender, ethnicity, and smoking rate.

Ethnic differences in predictors of adolescent smoking onset and escalation : A longitudinal study from 7th to 12th grade

The present study sought to determine whether risk factors for cigarette smoking onset have a stronger influence on Black versus White children, and whether those patterns differ for nonsmokers versus experimental smokers. As part of a larger study, 5,213 seventh graders were surveyed annually for 5 years. The survey instrument assessed cigarette smoking, along with a variety of background variables thought to influence smoking. Results indicated that rebelliousness predicted smoking onset for Black nonsmokers; peer modeling was more influential for Whites. For both ethnicities, socially isolated children were at increased risk. The variables that predicted the shift from experimental to regular smoking were for the most part different from those that predicted smoking onset. Specifically, youths who lived with smokers, viewed smoking as a means to a goal, and experienced few adverse physiological effects of smoking were more likely to increase their cigarette consumption. Overall, we found that, contrary to previous research, risk factors for smoking differed across ethnicity. Further, smoking onset appears to be shaped by forces different from those that accelerate consumption.

Intraclass correlation among measures related to cigarette use by adolescents: estimates from an urban and largely African American cohort.

This paper presents the first estimates of school-level intraclass correlation (ICC) for smoking-related variables from an urban and largely African American population. Seventh graders (n = 6967) from 39 middle schools in Memphis, TN, were measured at baseline in 1994 and annually through 1997. Mixed model regression methods were used to estimate variance components for school and residual error. School-level ICCs were large enough, if ignored, to substantially inflate the Type I error rate in an analysis of treatment effects. We show how those correlations can be reduced using regression adjustments and used to determine sample size for future school-based smoking prevention studies.

A prospective evaluation of the relationships between smoking dosage and body mass index in an adolescent, biracial cohort.

Although there is clearly an inverse relationship between smoking and body weight, recent studies suggest that weight attenuation via smoking is slow and may take decades to accrue. This investigation prospectively evaluated the relationships between smoking dosage (or lack thereof) and relative weight change in 1697 adolescents followed over 4 years. A 4 (smoking groups: 0, 1, 2, or 3 or more years of smoking exposure)x2 (ethnicity: Caucasian or African American)x2 (gender: male or female) analysis of variance (ANOVA) was performed to assess weight gain attenuation associated with increasing exposure to smoking. The overall results revealed a significant three-way interaction between smoking dosage, gender, and ethnicity. Specifically, smoking initiation was associated with an increase in body mass index (BMI) for 2 years after initiation. For those youth smoking 3 or more years, body weights were almost identical compared to never-smokers. No significant reductions in body weight were observed in any gender or ethnic group for up to 3 years after smoking initiation. It is concluded that smoking initiation is not associated with adolescent body weight change for at least a 3-year period.