Russell E. Glasgow

Barriers to regimen adherence among persons with insulin-dependent diabetes

The present study was designed to assess the frequency of different barriers to adherence among persons with insulin-dependent diabetes mellitus (IDDM) and to determine the relationship between such barriers and adherence to insulin injection, glucose testing, and dietary and exercise components of the regimen. The behavior analytic model was used to develop a Barriers to Adherence Scale for adults and adolescents with IDDM. Sixty-five outpatient subjects were then interviewed in their home and reassessed 6 months later. Subjects reported the greatest number of barriers to dietary and exercise adherence and the fewest barriers to insulin injections. Females reported more barriers than males, but age was not associated with barriers scores. Self-report measures of adherence revealed consistent relationships between barriers and all areas of regimen adherence assessed. Adherence indices based on self-monitoring and dietary recall data correlated less consistently with barriers scores. We conclude that the behavior analytic model has great potential for use in the development of psychosocial assessment procedures for diabetes.

Self-efficacy and outcome expectations as predictors of controlled smoking status

Two studies were conducted to develop and evaluate the usefulness of self-efficacy and outcome expectation measures in predicting smoking status. Subjects were chronic smokers participating in controlled smoking treatment programs. In Study 1, Self-Efficacy and Outcome Expectancy Scales were developed and used to concurrently predict nicotine content, amount of each cigarette smoked, number of cigarettes smoked, and carbon monoxide levels. Both congruence microanalyses and correlational analyses revealed a strong relationship between self-efficacy and the dependent variables. Study 2, a larger prospective study, found strong correlations between our revised Self-Efficacy Scale and smoking behavior at a 6-month follow-up. In neither study did outcome expectancy significantly correlate with the dependent variables, nor did it significantly increment the proportion of variance explained when combined with self-efficacy.

Parental characteristics and interactional dysfunction in families with child behavior problems: a preliminary investigation

Thirty-six families with a preteenage behavior problem child were assessed on measures of marital discord, parental psychopathology, and three parental cognitive factors: knowledge of behavioral principles, tolerance for child deviancy, and expectations regarding their childs behavior. Nine nonproblem families with demographic characteristics similar to the problem families were also assessed. Correlational analyses across all families revealed a strong association between marital discord and the parental index of child behavior problems. While a number of significant associations were discovered between the various measures of marital discord, parental psychopathology, and parental cognitive factors, no other measure besides marital discord was associated with parental perception of child behavior problems. The nonproblem families and 15 of the problem families also participated in home observations obtained through random audio recordings during high interaction periods. These observational data indicated a significant relationship between parental perception of child behavior problems and parental negative behavior toward the child, but no significant relationship between parental perception of child behavior problems and child behavior, even when child behavior was weighted by parents reactions to that behavior. Through sequential analysis, several contingent relations between parent and child behavior were discovered. Findings are discussed in relation to family systems theory.

Preventing adolescent smoking: what have we learned about treatment construct validity?

In recent years, numerous programs introduced to prevent adolescent smoking have demonstrated some success. This paper reviews the treatment construct validity of such programs; that is, we seek to determine how and why programs reduce adolescent smoking. The review leads to the conclusion that little is presently known about the construct validity of successful programs, a problem that results primarily from the neglect of process assessment and analyses. The advantages and disadvantages of several future research approaches are discussed, including: (a) utilization of process measures within large scale treatment/no-treatment designs, (b) small-scale studies to test the effects of prevention components on process measures (e.g., attitudes, intentions to smoke), and (c) combinations of these two approaches.

Increasing the adherence of diabetic adolescents

This study examined the effects of sequentially introducing self-monitoring, goal setting, and behavioral contracting procedures on increasing the regimen compliance of nonadherent adolescent diabetics. For each of three insulin-dependent subjects, a multiple-baseline across-behaviors design was used to study three of the following target behaviors: urine testing, insulin injections, exercise, wearing diabetic identification, and home blood glucose testing. In addition to self-monitoring of adherence, measures of metabolic control of diabetes were collected before and after an 8-week treatment and at a 2-month follow-up. Adherence increased and was maintained at desired levels for two of the subjects following introduction of goal setting procedures. Metabolic control measures also showed substantial improvement for these subjects. The third subject, whose family was experiencing a variety of severe problems, did not show reliable improvement. The data suggest that graduated goal setting is a promising approach for improving adherence to diabetic regimens.

Cost effectiveness in behavioral family therapy

This report presents a multiple assessment exploration of cost effectiveness in behavioral family therapy. Thirty-six families with problem children between the ages of 4 and 12 were randomly assigned within stratified blocks to individual treatment, group treatment, or minimal contact bibliotherapy. All conditions received similar information about the behavioral management of children; only the format for therapy and the amount of therapist contact were different. Dependent variables consisted of parent attitude measures, parent-collected data on defined problems, and observational data from audio recordings made in the homes of the families. Analysis of both the parent-collected data and the home-observation data indicated the superiority of group and individual treatment conditions over the minimal contact bibliotherapy condition. Although it required less than half the amount of professional time, the group condition performed as well as the individual therapy condition. Parents in all three conditions rated the focus child as significantly improved with no differences between conditions.

Long-term effects of a controlled smoking program: A 2 1/2 year follow-up

A 2 1/2 year follow-up was conducted on 48 subjects who had participated in acontrolled smoking program. Although some relapse from posttest smoking levels was observed, subjects were still smoking less than at pretest on all dependent variables. Nine percent of the subjects became totally abstinent between posttest and follow-up and an additional 9–36% of participants showed further reductions on measures of nicotine content, number of cigarettes, percentage of the cigarette smoked, and carbon monoxide levels. Consistent with earlier findings, there were no differences between subjects assigned to feedback versus no feedback conditions.

Controlled smoking, with or without carbon monoxide feedback, as an alternative for chronic smokers

Sixty chronic cigarette smokers were randomly assigned to one of three treatment conditions: controlled smoking, controlled smoking plus weekly carbon monoxide feedback, or delayed treatment control. The controlled smoking treatments lasted 5 weeks and sequentially focused on making 50% reductions in nicotine content of brand smoked, number of cigarettes smoked per day, and percentage of each cigarette smoked. Self-monitoring records indicated that subjects in the two controlled smoking conditions were successful in making reductions in each of the target behaviors and that the timing of these changes immediately followed the initiation of treatment within the multiple baseline across behaviors design. There were few differences between the two treatment conditions, and both treatments produced greater change than the control condition on all targeted behaviors. Carbon monoxide levels were also reduced significantly more in the treatment conditions than in the control condition. The carbon monoxide, as well as smoking behavior, reductions were maintained at 3- and 6-month follow-ups. The results suggest that controlled smoking can be successfully implemented in a group context with long-term, heavy smokers and that carbon monoxide feedback, at least as implemented in the present study, is not essential to treatment success.

Controlled smoking for chronic smokers: An extension and replication

Nine long-term cigarette smokers participated in a seven session controlled smoking program. Employing a multiple baseline across behaviors design, the program focused on making sequential reductions in nicotine content of the cigarette brand smoked, percent of each cigarette smoked and, finally, number of cigarettes smoked per day. Self-monitoring records indicated that subjects were successful in making reductions in each of the three target behaviors and that the timing of these changes closely followed the initiation of treatment for each specific behavior. The magnitude of change was greatest for nicotine content (49% reduction) and somewhat less for number of cigarettes (28% reduction) and amount smoked (24% reduction). Carbon monoxide levels were also reduced and these reductions, as well as the smoking behavior changes, were generally maintained at a 6-month follow-up. This study provides a systematic replication of an earlier study and illustrates the usefulness of single subject designs for studying cigarette smoking. It is concluded that controlled smoking can be achieved by chronic smokers without significant relapse or compensation for at least six months following treatment. Limitations of the study and directions for future research are also discussed.

Self-help manuals for the control of nervous habits: A comparative investigation

This study evaluated the effectiveness of two commercially published manuals for the control of fingernail biting ( Azrin & Nunn, 1977 ; Perkins & Perkins, 1976 ) against a self-observation control condition. The three treatments were crossed with two conditions of administration (self-administered and therapist administered) in a 3×2 factorial design. Forty-one adults from the community, with an average nailbiting history of 21 years participated in 3-week treatment programs and a 6-week follow-up. Subjects in all conditions were able to modify their naibiting habit substantially, as indicated by nail length, nail appearance, and self-monitored frequency of nailbiting measures. Posttreatment improvements were maintained during the follow-up period. There were no differential effects of either type of treatment or condition of administration; thus the self-administered conditions proved to be more cost-effective.