Melissa Tibbits

Sustaining Evidence-based Interventions Under Real-world Conditions: Results from a Large-scale Diffusion Project

This study examined factors associated with the predicted and actual post-funding sustainability of evidence-based interventions implemented as part of the Pennsylvania Commission on Crime and Delinquency’s Research-Based Delinquency and Violence Prevention Initiative. Correlates of predicted post-funding sustainability included program staff, overall school support, and school administrator support. Additionally, predicted post-funding sustainability was strongly associated with actual post-funding sustainability. Other correlates of actual post-funding sustainability included financial sustainability planning and aligning the intervention with the goals of the agency/school. Five years post-funding 33% of the interventions were no longer operating, 22% were operating at a reduced level, and 45% were operating at the same level or a higher level than the final year of funding. These findings are discussed in terms of implications for increasing intervention sustainability, as well as implications for future research on intervention sustainability.

It is better to be a fat ex-smoker than a thin smoker: findings from the 1997-2004 National Health Interview Survey-National Death Index linkage study.

Objective The aim of this research was to compare the risk of all-cause mortality and mortality from all cancers combined, lung cancer, respiratory diseases, cardiovascular diseases and diabetes mellitus between normal-weight smokers and overweight or obese ex-smokers. Methods Data were from 1997 to 2004 National Health Interview Survey (with response rates ranging from 70% to 80%) which were linked to records in the National Death Index. Mortality follow-up was through 31 December 2006. The sample was limited to normal-weight smokers and overweight/obese ex-smokers 25 years of age and older (n=52 819). HR from Cox regression was computed to represent mortality effect. Results Results showed that in both women and men, normal-weight smokers, relative to overweight or obese ex-smokers, had a higher risk of mortality from all causes combined, all cancers combined, lung cancer, cardiovascular and respiratory diseases. Among women, there was no difference in mortality risk from diabetes mellitus between normal-weight smokers and overweight or obese ex-smokers. Among men, there was some evidence that the risk of mortality was higher in obese ex-smokers than normal-weight smokers. Conclusions This article concludes that, overall, mortality risk is smaller in overweight or obese ex-smokers than normal-weight smokers. Smoking cessation interventions can tailor messages that highlight the greater reduction in mortality associated with quitting, compared with potential weight gain.

Association between duration of use of pharmacotherapy and smoking cessation: findings from a national survey

Objective To investigate the association of the duration of use of prescription medications and nicotine replacement therapy (NRT) with smoking cessation using a national sample of the general population in the USA, controlling for nicotine dependence and sociodemographic variables. Setting USA. Participants We used data from the 2010–2011 Tobacco Use Supplement to the US Current Population Survey. We limited the analysis to current daily smokers who made a quit attempt in the past year and former smokers who were a daily smoker 1 year prior to the survey (n=8263). Respondents were asked about duration of use of prescription medication (varenicline, bupropion, other) and NRT (nicotine patch, gum/lozenges, nasal spray and inhaler) for smoking cessation. Primary outcome measure Successful smoking cessation. Individuals who reported to have smoked at least 100 cigarettes in their lifetime but were not smoking at all at the time of the interview and were a daily smoker 1 year prior to the interview were considered to have successfully quit smoking. Results After adjusting for daily cigarette consumption and sociodemographic covariates, we found evidence for an association between duration of pharmacotherapy use and smoking cessation (p<0.001). Adjusted cessation rates for those who used prescription medication or NRT for 5+ weeks were 28.8% and 27.8%, respectively. Adjusted cessation rates for those who used prescription medication or NRT for less than 5 weeks varied from 6.2% to 14.5%. Adjusted cessation rates for those who used only behavioural counselling and those who attempted to quit smoking unassisted were 16.1% and 16.4%, respectively. Conclusions Use of pharmacotherapy for at least 5 weeks is associated with increased likelihood of successful smoking cessation. Results suggest that encouraging smokers who intend to quit to use pharmacotherapy and to adhere to treatment duration can help improve chances of successful cessation.

Prolonged financial stress predicts subsequent obesity: Results from a prospective study of an Australian national sample

The aim of this research was to assess the association of prolonged financial stress (FS) with subsequent obesity.

Profiles of Protection from Substance Use among Adolescents

The purpose of this study was to explore whether adolescents (N = 10,287) could be classified into homogeneous subgroups based on their protective factors and, if so, whether these constellations of protection differentially relate to adolescents’ lifetime and 30-day alcohol and tobacco use. Latent class analysis with eight protective factors—four internal and four external—were used to identify the underlying latent class structure. Five profiles of protection emerged: Adequate Protection (54%), Adequate External Protection (9%), Adequate Protection with Low Adult Communication (16%), Adequate Protection with Risky Friends (9%), and Inadequate Protection (12%). Lifetime alcohol use was associated with only a modest increase in odds of belonging to the Adequate External or Low Adult Communication latent classes, but an enormous increase in odds of having Inadequate Protection or Risky Friends. Similar effects were found for past month alcohol use. Unlike alcohol use, which was related most strongly with membership in the Risky Friends latent class (relative to Adequate Protection), cigarette use was most strongly related to membership in the Inadequate Protection latent class. Findings can be used to inform prevention programs as they illustrate the relationships that exist between adolescents’ profiles of protection and substance use.

Social Disparities in Unaided Quit Attempts Among Daily Current and Former Smokers: Results From the 2010-2011 Tobacco Use Supplement to the Current Population Survey.

INTRODUCTION There are well-documented inverse relationships between smoking and smoking cessation with measures of socioeconomic status. This study used nationally representative data to examine unaided quit attempts and their sociodemographic determinants among daily current and former smokers who made a quit attempt in the last 12 months. METHODS We used data from the 2010-2011 Tobacco Use Supplement to the Current Population Survey. We limited the analysis to current daily smokers who made a quit attempt in the past year and former smokers who were daily smokers 1 year prior to the survey (N = 8201). RESULTS Nearly 62% (n = 5078) of the sample made an unaided quit attempt. Adjusted results indicated unaided quit attempts were more likely among males compared to females (P < .001), younger age groups compared to older age groups (P < .001), non-Hispanic blacks compared to non-Hispanic whites (P < .001), among people with lower income compared to people with higher income (P < .001), and among people with lower nicotine dependence compared to those with higher nicotine dependence (P < .001). CONCLUSIONS Most quit attempts were unaided and there were significant sociodemographic disparities in unaided quit attempts. Considering that cessation aids enhance the likelihood of quitting, policies and programs should target populations which are more likely to attempt quitting without an aid and encourage them to use or provide subsidized cessation aids. Healthcare providers should advise their patients about approaches to quitting. IMPLICATIONS This study used the most recent nationally representative data for the United States to examine sociodemographic disparities in unaided quitting among current and former daily smokers who made a quit attempt in the last 12 months. Most quit attempts were unaided. People who were male, younger, non-Hispanic black, had lower nicotine dependence, and those who were low income were more likely to make an unaided quit attempt. These results could be used by policy makers and program planners to develop cessation interventions directed at specific populations to improve smoking cessation rates.

The Relation between Profiles of Leisure Activity Participation and Substance Use among South African Youth

Abstract A large body of research indicates that leisure activity participation is associated with substance use for American adolescents, and that leisure may be an important context of substance use prevention. It is important to begin to apply what we have learned with American youth and extend the knowledge base in other countries with significant adolescent risk behavior. The current study examined the association between leisure activity participation and substance use among a predominately Colored sample of 3497 South African 8th graders. Males’ activity participation was characterized by five leisure activity profiles (Uninvolved; Sports and Volunteer; Mixed, Recreation and Hobbies; Mixed, Artistic; Highly Involved), whereas females’ activity participation was characterized by four leisure activity profiles (Uninvolved; Uninvolved but Social; Mixed; Highly Involved). Leisure activity profiles were significantly associated with past-month alcohol, tobacco, and marijuana use.

Dieting Increases the Likelihood of Subsequent Obesity and BMI Gain: Results from a Prospective Study of an Australian National Sample

BackgroundDiet is a major determinant of obesity; however, findings from the studies examining how dieting to lose weight affects weight gain have been inconclusive.PurposeOur aim was to examine the longitudinal association of frequency of dieting for weight loss with (a) obesity status and (b) body mass index (BMI) change.MethodsWe used data from Waves 9 (2009) and 10 (2010) of the Household Income and Labour Dynamics in Australia (HILDA) survey. Binominal logistic regression estimated the association of frequency of dieting in 2009 on probability of obesity in 2010. Multinomial logistic regression estimated the association of frequency of dieting in 2009 on the probability of BMI gain versus BMI maintenance and BMI loss between 2009 and 2010. The analysis sample size was 8824.ResultsCompared to those who were never on a diet in the previous year, the odds of obesity were 1.9, 2.9, and 3.2 times higher among those who were on a diet once, more than once, and always, respectively. Similarly, the odds of BMI gain versus BMI maintenance and also versus BMI loss were higher among those who dieted than those who did not.ConclusionsDieting to lose weight can contribute to the risk of future obesity and weight gain. Losing weight requires a commitment to change one’s lifestyle and a sustained effort to maintain a healthy diet and engage in physical activity.

The role of alcohol use on recent trends in distracted driving

Distracted driving is now an increasingly deadly threat to road safety. We provide evidence that intoxicated driving is increasingly responsible for recent increases in fatalities from distracted driving crashes. This study describes trends in deaths on U.S. public roads caused by alcohol-involved and distracted drivers using the Fatality Analysis Reporting System (FARS)-a census of fatal crashes on U.S. public roads. Fatality rates per vehicle-miles traveled are calculated using data from the Federal Highway Administration. Alcohol-involved drivers who are simultaneously distracted were responsible for 1750 deaths in 2009, an increase of more than 63% from 2005 when there were 1072 deaths. Alcohol use while driving is increasingly responsible for a growing number of fatalities from distracted driving, accounting for 32% of deaths from distracted driving in 2009 versus 24% in 2005. The fatality rate from these crashes increased from 35.9 to 59.2 deaths per 100 billion vehicle-miles traveled after 2005. Alcohol use is quickly increasing as an important factor behind distracted driving fatalities. This has implications for policies combating distracted driving that do not address the role of alcohol use in distracted driving.

Neighbourhood exposure to point-of-sale price promotions for cigarettes is associated with financial stress among smokers: results from a population-based study

Aim To examine the association between neighbourhood exposure to point-of-sale (POS) cigarette price promotions and financial stress among smokers in a Midwestern metropolitan area in the USA. Methods Survey data from 888 smokers provided information on sociodemographic and smoking related variables. Financial stress was measured with the question: ‘In the last six months, because of lack of money, was there a time when you were unable to buy food or pay any important bills on time, such as electricity, telephone, credit card, rent or your mortgage? (Yes/No).’ Using audit data from 504 tobacco retailers, we estimated a score of POS price promotions for each respondent by summing the different types of promotion in each store in their neighbourhood, as defined by a 1-km roadway buffer. Results Adjusted results provided strong support for an association between higher scores of neighbourhood POS cigarette price promotions and a higher probability of financial stress (p=0.007). Conclusion Exposure to POS cigarette price promotions is associated with financial stress. This finding, coupled with previous reports that smokers with financial stress are less likely to attempt to quit or succeed in quitting smoking, suggests that POS cigarette price promotions may act as an impediment to smoking cessation.