Bio

Academic Appointments


Honors & Awards


  • Jarvik-Russell New Investigator Award, Society for Research on Nicotine and Tobacco (2007)
  • Outstanding Early Career Investigator Award, NIDA's Division of Clinical Neuroscience & Behavioral Research (2009)
  • Mentor of the Year, Bay Area Clinical Research Symposium (2011)

Professional Education


  • BA, Duke University, Psychology (1995)
  • MPH, SDSU, Health Promotion (2001)
  • PhD, UCSD/SDSU, Clinical Psychology (2002)

Community and International Work


  • Evaluating the efficacy of an integrated smoking cessation intervention for mental health patients, Newcastle, New South Wales, Australia

    Topic

    Tobacco Treatment Clinical Trial

    Partnering Organization(s)

    University of Newcastle, NSW Australia

    Populations Served

    smokers with serious mental illness

    Location

    International

    Ongoing Project

    Yes

    Opportunities for Student Involvement

    Yes

Research & Scholarship

Current Research and Scholarly Interests


My research program focuses on developing effective treatments for tobacco dependence and other leading risk factors (e.g., sedentary behavior, obesity, stress and distress), with a focus on complex and multi-problem groups including people with serious mental illness, alcohol and drug problems, and heart disease, the unemployed, and homeless.

Publications

Journal Articles


  • Tobacco use among the job-seeking unemployed in California. Preventive medicine Prochaska, J. J., Shi, Y., Rogers, A. 2013; 56 (5): 329-332

    Abstract

    Given the current economic climate, with 8.1% unemployment nationally and 10.6% among the Californian labor force in August 2012, employers can be more selective in their hiring decisions, and individuals who smoke may be at a serious economic disadvantage. The current study examined the association between cigarette smoking and employment status among adults in California, a state with strong antitobacco sentiment.Cross-sectional data were analyzed from the 2007 and 2009 California Health Interview Survey on 68,501 noninstitutionalized adults age 20-65.The job-seeking unemployed had the highest smoking prevalence (20.9%) relative to the non-job-seeking unemployed (15.9%) and employed (14.8%). In a multivariate multinomial logistic regression that controlled for demographic factors and other risk characteristics (obesity, binge drinking), current (adjusted odds ratio [AOR]=1.23, 95% CI=1.01-1.49) but not former smoking status (AOR=0.95, 95% CI=0.76-1.19) was significantly associated with being unemployed and job-seeking.Smokers in California were more likely than never and former smokers to be unemployed. Employment service agencies may be well placed for reaching smokers and treating tobacco dependence.

    View details for DOI 10.1016/j.ypmed.2013.01.021

    View details for PubMedID 23415765

  • Tobacco Use and Its Treatment Among Young People in Mental Health Settings: A Qualitative Analysis. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco Prochaska, J. J., Fromont, S. C., Wa, C., Matlow, R., Ramo, D. E., Hall, S. M. 2013

    Abstract

    BACKGROUND: Youth with psychiatric disorders are at increased risk of tobacco use. Outpatient mental health settings have received little investigation for delivering tobacco treatment. This study obtained formative data to guide development of a tobacco cessation program for transitional age youth with co-occurring psychiatric disorders with a focus on outpatient mental health settings. METHODS: Applying qualitative methods, we analyzed transcripts from interviews with 14 mental health clients (aged 16-23) and 8 mental health providers. RESULTS: The youth identified internal (nicotine addiction and mood), social, parental, and media influences to their use of tobacco. Providers' viewed youth tobacco use as a normative developmental process, closely tied to management of psychiatric symptoms, supported by parents, and of lower priority relative to youth alcohol and illicit drug use. Youth and providers believed that clinicians can do more to address tobacco use in practice and emphasized nonjudgmental support and nondirective approaches. Top recommended quitting strategies, however, differed notably for the youth (cold turkey, support from friends, physical activity, hobbies) and providers (cessation pharmacotherapy, cessation groups, treatment referrals). CONCLUSIONS: Mental health providers' greater prioritization of other substances and view of youth smoking as developmentally normative and a coping strategy for psychopathology are likely contributing to the general lack of attention to tobacco use currently. Integrating care within mental health settings would serve to reach youth in an arena where clinical rapport is already established, and study findings suggest receptivity for system improvements. Of consideration, however, is the apparent disconnect between provider and youth recommended strategies for supporting cessation.

    View details for PubMedID 23322765

  • Twitter=quitter? An analysis of Twitter quit smoking social networks TOBACCO CONTROL Prochaska, J. J., Pechmann, C., Kim, R., Leonhardt, J. M. 2012; 21 (4): 447-449

    Abstract

    Widely popular, Twitter, a free social networking and micro-blogging service, offers potential for health promotion. This study examined the activity of Twitter quit smoking social network accounts.A cross-sectional analysis identified 153 activated Twitter quit smoking accounts dating back to 2007 and examined recent account activity for the month of August 2010.The accounts had a median of 155 followers and 82 total tweets per account; 49% of accounts had >100 tweets. Posted content was largely inconsistent with clinical guidelines; 48% linked to commercial sites for quitting smoking and 43% had tweets on e-cigarettes. In August 2010, 81 of the accounts (53%) were still active.Though popular for building quit smoking social networks, many of the Twitter accounts were no longer active, and tweet content was largely inconsistent with clinical guidelines. Future research is needed to examine the effectiveness of Twitter for supporting smoking cessation.

    View details for DOI 10.1136/tc.2010.042507

    View details for Web of Science ID 000305799600026

    View details for PubMedID 21730101

  • Medical Students' Attention to Multiple Risk Behaviors: A Standardized Patient Examination JOURNAL OF GENERAL INTERNAL MEDICINE Prochaska, J. J., Gali, K., Miller, B., Hauer, K. E. 2012; 27 (6): 700-707

    Abstract

    Risk behaviors tend to cluster, particularly among smokers, with negative health effects. To optimize patients' health and wellbeing, health care providers ideally would assess and intervene upon the multiple risks with which patients may present.This study examined medical students' skills in assessing and treating multiple risk behaviors.Using a randomized experimental design, medical students' counseling interactions were evaluated with a standardized patient presenting with sexual health concerns and current tobacco use with varied problematic drinking status (alcohol-positive or alcohol-negative).One hundred and fifty-six third-year medical students.Student and standardized patient completed measures evaluated student knowledge, attitudes, and clinical performance.Overall, most students assessed tobacco use (85%); fewer assessed alcohol use (54%). Relative to the alcohol-negative case, students seeing the alcohol-positive case were less likely to assess sexually transmitted disease history (80% vs. 91%, p?=?0.042), or patients' readiness to quit smoking (41% vs. 60%, p?=?0.025), and endorsed greater attitudinal barriers to tobacco treatment (p?=?0.030). Patient satisfaction was significantly lower for the alcohol-positive than the alcohol-negative case; clinical performance ratings moderated this relationship.When presented with a case of multiple risks, medical students performed less effectively and received lower patient satisfaction ratings. Findings were moderated by students' overall clinical performance. Paradigm shifts are needed in medical education that emphasize assessment of multiple risks, new models of conceptualizing behavior change as a generalized process, and treatment of the whole patient for optimizing health outcomes.

    View details for DOI 10.1007/s11606-011-1953-9

    View details for Web of Science ID 000304402900015

    View details for PubMedID 22215267

  • Risk of cardiovascular serious adverse events associated with varenicline use for tobacco cessation: systematic review and meta-analysis BRITISH MEDICAL JOURNAL Prochaska, J. J., Hilton, J. F. 2012; 344

    Abstract

    To examine the risk of treatment emergent, cardiovascular serious adverse events associated with varenicline use for tobacco cessation.Meta-analysis comparing study effects using four summary estimates.Medline, Cochrane Library, online clinical trials registries, and reference lists of identified articles.We included randomised controlled trials of current tobacco users of adult age comparing use of varenicline with an inactive control and reporting adverse events. We defined treatment emergent, cardiovascular serious adverse events as occurring during drug treatment or within 30 days of discontinuation, and included any ischaemic or arrhythmic adverse cardiovascular event (myocardial infarction, unstable angina, coronary revascularisation, coronary artery disease, arrhythmias, transient ischaemic attacks, stroke, sudden death or cardiovascular related death, or congestive heart failure).We identified 22 trials; all were double blinded and placebo controlled; two included participants with active cardiovascular disease and 11 enrolled participants with a history of cardiovascular disease. Rates of treatment emergent, cardiovascular serious adverse events were 0.63% (34/5431) in the varenicline groups and 0.47% (18/3801) in the placebo groups. The summary estimate for the risk difference, 0.27% (95% confidence interval -0.10 to 0.63; P = 0.15), based on all 22 trials, was neither clinically nor statistically significant. For comparison, the relative risk (1.40, 0.82 to 2.39; P = 0.22), Mantel-Haenszel odds ratio (1.41, 0.82 to 2.42; P = 0.22), and Peto odds ratio (1.58, 0.90 to 2.76; P = 0.11), all based on 14 trials with at least one event, also indicated a non-significant difference between varenicline and placebo groups.This meta--analysis--which included all trials published to date, focused on events occurring during drug exposure, and analysed findings using four summary estimates-found no significant increase in cardiovascular serious adverse events associated with varenicline use. For rare outcomes, summary estimates based on absolute effects are recommended and estimates based on the Peto odds ratio should be avoided.

    View details for DOI 10.1136/bmj.e2856

    View details for Web of Science ID 000303818500002

    View details for PubMedID 22563098

  • Cardiology Rx for Change: Improving Clinical Attention to Tobacco Use and Secondhand Smoke Exposure in Cardiology CLINICAL CARDIOLOGY Prochaska, J. J., Benowitz, N. L., Glantz, S. A., Hudmon, K. S., Grossman, W. 2011; 34 (12): 738-743

    Abstract

    Heart disease is the leading cause of tobacco-related death in smokers and of deaths due to secondhand smoke (SHS) exposure in nonsmokers. This study centers on the development and evaluation of an evidence-based model curriculum for improving clinical attention to tobacco use and SHS exposure in cardiology.We hypothesized that the curriculum would be associated with improvements in clinician tobacco-related knowledge, attitudes, confidence, and counseling behaviors from pre-to post-training and at the 3-month follow-up.The 1-hour Cardiology Rx for Change curriculum was evaluated with 22 cardiology fellows and 77 medical residents with consistent training effects observed between the 2 groups.Trainees' tobacco treatment knowledge increased significantly from pre- to post-training (t[81] = 6.51, P<0.001), and perceived barriers to providing cessation treatment decreased significantly (t[81] = -3.97, P<0.001). The changes, however, were not sustained at the 3-month follow-up, suggesting the need for booster training efforts. From pretraining to 3-month follow-up, the training was associated with significant sustained gains in clinician confidence for treating tobacco dependence (t[61] = 3.69, P = 0.001) and with improvements in clinicians assessing patients' readiness to quit smoking (from 61% to 79%, t[59] = 3.69,P<0.001) and providing assistance with quitting (from 47% to 59%, t[59] = 2.12, P = 0.038). Asking patients about tobacco use, advising cessation, and arranging follow-up also increased over time, but not significantly. All participants (100%) recommended the curriculum for dissemination to other training programs.Available online via http://rxforchange.ucsf.edu, Cardiology Rx for Change offers a packaged training tool for improving treatment of tobacco use and SHS exposure in cardiology care.

    View details for DOI 10.1002/clc.20982

    View details for Web of Science ID 000297632500003

    View details for PubMedID 21987417

  • An online survey of tobacco use, intentions to quit, and cessation strategies among people living with bipolar disorder BIPOLAR DISORDERS Prochaska, J. J., Reyes, R. S., Schroeder, S. A., Daniels, A. S., Doederlein, A., Bergeson, B. 2011; 13 (5-6): 466-473

    Abstract

    Tobacco use is prevalent among people living with bipolar disorder. We examined tobacco use, attempts to quit, and tobacco-related attitudes and intentions among 685 individuals with bipolar disorder who smoked ? 100 cigarettes in their lifetime.? Data were collected online through the website of the Depression and Bipolar Support Alliance, a mood disorder peer-support network.? The sample was 67% female, 67% aged 26 to 50, and 89% Caucasian; 87% were current smokers; 92% of current smokers smoked daily, averaging 19 cigarettes/day (SD=11). The sample began smoking at a mean age of 17 years (SD=6) and smoked a median of 7 years prior to bipolar disorder diagnosis. Among current smokers, 74% expressed a desire to quit; intent to quit smoking was unrelated to current mental health symptoms [?(2) (3)=5.50, p=0.139]. Only 33% were advised to quit smoking by a mental health provider, 48% reported smoking to treat their mental illness, and 96% believed being mentally healthy was important for quitting. Ex-smokers (13% of sample) had not smoked for a median of 2.7 years; 48% quit 'cold turkey.' Most ex-smokers (64%) were in poor or fair mental health when they quit smoking. At the time of the survey, however, more ex-smokers described their mental health as in recovery than current smokers [57% versus 40%; ?(2) (3)=11.12, p=0.011].? Most smokers living with bipolar disorder are interested in quitting. The Internet may be a useful cessation tool for recruiting and potentially treating smokers with bipolar disorder who face special challenges when trying to quit and rarely receive cessation treatment from their mental health providers.

    View details for DOI 10.1111/j.1399-5618.2011.00944.x

    View details for Web of Science ID 000297029600003

    View details for PubMedID 22017216

  • Smoking and Mental Illness - Breaking the Link NEW ENGLAND JOURNAL OF MEDICINE Prochaska, J. J. 2011; 365 (3): 196-198

    View details for Web of Science ID 000292915500002

    View details for PubMedID 21774707

  • Treating tobacco dependence in clinically depressed smokers: Effect of smoking cessation on mental health functioning AMERICAN JOURNAL OF PUBLIC HEALTH Prochaska, J. J., Hall, S. M., Tsoh, J. Y., Eisendrath, S., Rossi, J. S., Redding, C. A., Rosen, A. B., Meisner, M., Humfleet, G. L., Gorecki, J. A. 2008; 98 (3): 446-448

    Abstract

    We analyzed data from a randomized trial of 322 actively depressed smokers and examined the effect of smoking cessation on their mental health functioning. Only 1 of 10 measures at 4 follow-up time points was significant: participants who successfully stopped smoking reported less alcohol use than did participants who continued smoking. Depressive symptoms declined significantly over time for participants who stopped smoking and those who continued smoking; there were no group differences. Individuals in treatment for clinical depression can be helped to stop smoking without adversely affecting their mental health functioning.

    View details for DOI 10.2105/AJPH.2006.101147

    View details for Web of Science ID 000253742500014

    View details for PubMedID 17600251

  • A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery JOURNAL OF CONSULTING AND CLINICAL PSYCHOLOGY Prochaska, J. J., Delucchi, K., Hall, S. A. 2004; 72 (6): 1144-1156

    Abstract

    This meta-analysis examined outcomes of smoking cessation interventions evaluated in 19 randomized controlled trials with individuals in current addictions treatment or recovery. Smoking and substance use outcomes at posttreatment and long-term follow-up (> or = 6 months) were summarized with random effects models. Intervention effects for smoking cessation were significant at posttreatment and comparable for participants in addictions treatment and recovery; however, intervention effects for smoking cessation were nonsignificant at long-term follow-up. Smoking cessation interventions provided during addictions treatment were associated with a 25% increased likelihood of long-term abstinence from alcohol and illicit drugs. Short-term smoking cessation effects look promising, but innovative strategies are needed for long-term cessation. Contrary to previous concerns, smoking cessation interventions during addictions treatment appeared to enhance rather than compromise long-term sobriety.

    View details for DOI 10.1037/0022-006X.72.6.1144

    View details for Web of Science ID 000225801700021

    View details for PubMedID 15612860

  • Counseling Nondaily Smokers about Secondhand Smoke as a Cessation Message: A Pilot Randomized Trial NICOTINE & TOBACCO RESEARCH Schane, R. E., Prochaska, J. J., Glantz, S. A. 2013; 15 (2): 334-342

    Abstract

    Nondaily smoking represents a substantial and growing fraction of smokers, many of whom do not consider themselves smokers or at risk of tobacco-related diseases and, so, may be less responsive to counseling content contained in traditional cessation interventions. This study compares the effects brief counseling interventions (<20 min) focused on the harm smoking does to themselves (harm to self, HTS) versus the harm their secondhand smoke (SHS) does to others (harm to others, HTO) among nondaily smokers.Randomized trial of 52 nondaily smokers (smoked in the past week, but not daily) recruited between September 2009 and June 2010; 40 completed the study. We measured changes in motivation and smoking status at 3 months postintervention.There was a difference in quitting between the two groups, with 9.5% (2 out of 21) for HTS and 36.8% (7 out of 19) for HTO subjects reporting not smoking any cigarettes in the prior week (p = .06 by Fisher exact test and .035 by likelihood-ratio chi-square). Motivation and self-efficacy increased from baseline to 3-month follow-up, but not differentially by intervention group.Consistent with findings from research conducted by the tobacco industry as early as the 1970s that concluded that social smokers feel immune from the personal health effects of tobacco but are concerned about the consequences of their SHS on others, educating nondaily smokers about the dangers of SHS to others appears to be a more powerful cessation message than traditional smoking cessation counseling that emphasizes the harmful consequences to the smoker.

    View details for DOI 10.1093/ntr/nts126

    View details for Web of Science ID 000313826600004

    View details for PubMedID 22592447

  • Reliability and Validity of Young Adults' Anonymous Online Reports of Marijuana Use and Thoughts About Use PSYCHOLOGY OF ADDICTIVE BEHAVIORS Ramo, D. E., Liu, H., Prochaska, J. J. 2012; 26 (4): 801-811

    Abstract

    With growing interest in online assessment of substance abuse behaviors, there is a need to formally evaluate the validity of the data gathered. The current investigation evaluated the reliability and validity of anonymous, online reports of young adults' marijuana use and related cognitions. Young adults age 18 to 25 who had smoked at least one cigarette in the past 30 days were recruited over 14 months to complete an anonymous online survey. Of 3,106 eligible cases, 1,617 (52%) completed the entire survey. Of those, 54% (n = 884) reported past-month marijuana use (65% male, 70% Caucasian, mean age was 20.4 years [SD = 2.0]). Prevalence of marijuana use was reported reliably across three similar items, and interitem correlations ranged from fair to excellent for measures of marijuana dependence symptoms and thoughts about marijuana use. Marijuana use frequency demonstrated good construct validity through expected correlations with marijuana use constructs, and nonsignificant correlations with thoughts about tobacco use. Marijuana frequency distinguished among stages of change for marijuana use and goals for use, but not among gender, ethnicity, or employment groups. Marijuana use and thoughts about use differed by stage of change in the hypothesized directions. Self-reported marijuana use and associated cognitions reported anonymously online from young adults are generally reliable and valid. Online assessments of substance use broaden the reach of addictions research.

    View details for DOI 10.1037/a0026201

    View details for Web of Science ID 000312682000013

    View details for PubMedID 22082344

  • Correlates of tobacco dependence and motivation to quit among young people receiving mental health treatment DRUG AND ALCOHOL DEPENDENCE Grana, R. A., Ramo, D. E., Fromont, S. C., Hall, S. M., Prochaska, J. J. 2012; 125 (1-2): 127-131

    Abstract

    Young people with mental health concerns are at high-risk for initiation and continuation of tobacco use. To inform treatment needs, the current study sought to describe tobacco dependence, motivations to quit and associated sociodemographic factors among young people seen in mental health settings.Sixty adolescent and young adult smokers (age mean=19.5 years, range 13-25) receiving outpatient mental health treatment completed measures of tobacco dependence, motivation to quit smoking, mental health, and social environmental factors.Participants averaged 8.0 cigarettes per day (SD=6.6) and moderate nicotine dependence (mFTQ M=4.8, SD=1.6). Participants' mean rating (10-point scales) of perceived difficulty with avoiding relapse during a quit attempt was significantly higher (M=6.7, SD=2.6), than ratings of desire (M=5.1, SD=2.6) and perceived success (M=4.6, SD=2.6) with quitting. Over half (52%) did not intend to quit smoking in the next 6 months, and few (11%) were prepared to quit in the next 30 days. Mental health treatment and symptomatology measures were unrelated to level of dependence or motivation to quit. Among the social environmental factors, having close friends who smoke was associated with greater perceived difficulty with avoiding relapse during a quit attempt (r=0.25, p<0.01).In this sample of adolescent and young adult smokers in mental health treatment, moderate levels of tobacco dependence and motivation to quit were observed and found to be unrelated to mental health measures. Over half of the sample was not intending to quit smoking in the near future, supporting the need for treatment strategies aimed at increasing motivation.

    View details for DOI 10.1016/j.drugalcdep.2012.04.005

    View details for Web of Science ID 000308720700017

    View details for PubMedID 22560677

  • Validity study of the K6 scale as a measure of moderate mental distress based on mental health treatment need and utilization INTERNATIONAL JOURNAL OF METHODS IN PSYCHIATRIC RESEARCH Prochaska, J. J., Sung, H., Max, W., Shi, Y., Ong, M. 2012; 21 (2): 88-97

    Abstract

    The widely-used Kessler K6 non-specific distress scale screens for severe mental illness defined as a K6 score ? 13, estimated to afflict about 6% of US adults. The K6, as currently used, fails to capture individuals struggling with more moderate mental distress that nonetheless warrants mental health intervention. The current study determined a cutoff criterion on the K6 scale indicative of moderate mental distress based on mental health treatment need and assessed the validity of this criterion by comparing participants with identified moderate and severe mental distress on relevant clinical, impairment, and risk behavior measures. Data were analyzed from 50,880 adult participants in the 2007 California Health Interview Survey. Receiver operating characteristic curve analysis identified K6 ? 5 as the optimal lower threshold cut-point indicative of moderate mental distress. Based on the K6, 8.6% of California adults had serious mental distress and another 27.9% had moderate mental distress. Correlates of moderate and serious mental distress were similar. Respondents with moderate mental distress had rates of mental health care utilization, impairment, substance use and other risks lower than respondents with serious mental distress and greater than respondents with none/low mental distress. The findings support expanded use and analysis of the K6 scale in quantifying and examining correlates of mental distress at a moderate, yet still clinically relevant, level.

    View details for DOI 10.1002/mpr.1349

    View details for Web of Science ID 000304833500003

    View details for PubMedID 22351472

  • Tobacco and marijuana use among adolescents and young adults: A systematic review of their co-use CLINICAL PSYCHOLOGY REVIEW Ramo, D. E., Liu, H., Prochaska, J. J. 2012; 32 (2): 105-121

    Abstract

    Tobacco (TOB) and marijuana (MJ) are the most widely used drugs among adolescents and young adults. The literature on their co-use, however, has not been systematically reviewed. We identified 163 English language articles published from 1999 to 2009 examining TOB and MJ co-use, correlates or consequences of co-use, or interventions for prevention or cessation of co-use with participants aging 13-25 years. Most studies (n=114, 70%) examined TOB and MJ co-use, and 85% of relationships studied indicated a significant association. Fifty-nine studies (36%) examined correlates or consequences of co-use. Factors consistently associated with increased likelihood of co-use, defined as significant associations in at least four studies, were African-American ethnicity, mental and physical health characteristics (e.g., high-intensity pleasure temperament), and school characteristics (e.g., good grades). The only consistent consequence of co-use was exacerbation of mental health symptoms. Few studies examined prevention (n=3) or cessation (n=2) interventions for TOB and MJ co-use, and the findings were stronger for prevention efforts. A sufficient literature base has documented that TOB and MJ use are strongly related in young people, yet few consistent correlates and consequences of co-use have been identified to inform intervention targets.

    View details for DOI 10.1016/j.cpr.2011.12.002

    View details for Web of Science ID 000300033800003

    View details for PubMedID 22245559

  • A Test of Positive Affect Induction for Countering Self-Control Depletion in Cigarette Smokers PSYCHOLOGY OF ADDICTIVE BEHAVIORS Shmueli, D., Prochaska, J. J. 2012; 26 (1): 157-161

    Abstract

    The self-control strength model posits that exerting self-control on one task, such as resisting temptations, will deplete self-control and impair subsequent self-regulatory performance, such as controlling smoking. The current study examined interventions designed to replenish depleted self-control strength to prevent tobacco use by inducing positive affect. In a 2 × 2 design, 200 participants were randomized to either (1) resist eating from a plate of desserts (high temptation) or from a plate of raw vegetables (low temptation) and then (2) undergo a positive or neutral affect induction. Two inductions were compared (video vs. writing technique). Participants were then given a 10-min recess. Whether or not participants smoked during the recess, assessed by self-report and biochemical verification, served as the primary dependent variable. The interaction between depletion and exposure group was significant, Wald's ?˛ = 9.66, df = 3, p < .05. Among those assigned to resist desserts, 65.5% to 85% smoked if they were in the neutral video or writing conditions versus 10.5% in the positive affect video group. Positive affect elicited with a video was able to counteract the detrimental effects of self-control depletion on smoking behavior, while writing exercises were associated with smoking. Implications for tobacco cessation intervention are discussed.

    View details for DOI 10.1037/a0023706

    View details for Web of Science ID 000301556200018

    View details for PubMedID 21553949

  • Broad Reach and Targeted Recruitment Using Facebook for an Online Survey of Young Adult Substance Use JOURNAL OF MEDICAL INTERNET RESEARCH Ramo, D. E., Prochaska, J. J. 2012; 14 (1)

    Abstract

    Studies of tobacco use and other health behaviors have reported great challenges in recruiting young adults. Social media is widely used by young adults in the United States and represents a potentially fast, affordable method of recruiting study participants for survey research.The present study examined Facebook as a mechanism to reach and survey young adults about tobacco and other substance use.Participants were cigarette users, age 18-25 years old, living throughout the United States and recruited through Facebook to complete a survey about tobacco and other substance use. Paid advertising using Facebook's Ad program over 13 months from 2010 Feb 28 to 2011 Apr 4 targeted by age (18-25), location (United States or California), language (English), and tobacco- and/or marijuana-related keywords. Facebook approved all ads.The campaign used 20 ads, which generated 28,683,151 impressions, yielding 14,808 clicks (0.7% of targeted Facebook members), at an overall cost of $6,628.24. The average cost per click on an ad was $0.45. The success of individual ads varied widely. There was a rise in both clicks and impressions as the campaign grew. However, the peak for clicks was 3 months before the peak for ad impressions. Of the 69,937,080 accounts for those age 18-25 in the United States, Facebook estimated that 2.8% (n = 1,980,240) were reached through tobacco and marijuana keywords. Our campaign yielded 5237 signed consents (35.4% of clicks), of which 3093 (59%) met criteria, and 1548 (50% of those who met criteria) completed the survey. The final cost per valid completed survey was $4.28. The majority of completed surveys came from whites (69%) and males (72%). The sample averaged 8.9 cigarettes per day (SD 7.5), 3.8 years of smoking (SD 2.9), with a median of 1 lifetime quit attempts; 48% did not intend to quit smoking in the next 6 months.Despite wide variety in the success of individual ads and potential concerns about sample representativeness, Facebook was a useful, cost-effective recruitment source for young-adult smokers to complete a survey about the use of tobacco and other substances. The current findings support Facebook as a viable recruitment option for assessment of health behavior in young adults.

    View details for DOI 10.2196/jmir.1878

    View details for Web of Science ID 000301925700020

    View details for PubMedID 22360969

  • Cigarette Smoking and Serious Psychological Distress: A Population-Based Study of California Adults NICOTINE & TOBACCO RESEARCH Sung, H., Prochaska, J. J., Ong, M. K., Shi, Y., Max, W. 2011; 13 (12): 1183-1192

    Abstract

    This study examines differences in smoking behaviors between adults with and without serious psychological distress (SPD) in California, which has the longest running comprehensive tobacco control program in the world.Cross-sectional data from the 2007 California Health Interview Survey on 50,880 noninstitutionalized adults were used to analyze smoking prevalence, cigarette consumption, and quit ratio. Persons with SPD were identified using the K6 scale, a clinically validated psychological screening instrument.About 3.8% of California adults screened positive for SPD in the past 30 days (acute SPD) and an additional 4.8% screened positive for SPD in the past 2-12 months (recent SPD). Persons with SPD were more likely to be current smokers than those without SPD (adjusted odds ratios [AOR] = 2.54, 95% CI = 2.02-3.19 for acute SPD and AOR = 2.20, 95% CI = 1.79-2.71 for recent SPD). Current smokers with acute SPD were more likely to smoke ?20 cigarettes daily than those without SPD (AOR = 1.59, 95% CI = 1.06-2.39). The quit rate was lower among ever-smokers with acute (AOR = 0.46, 95% CI = 0.35-0.62) or recent SPD (AOR = 0.55, 95% CI = 0.42-0.71) than those without SPD. While persons with acute or recent SPD comprised 8.6% of adults, they consumed 19.2% of all cigarettes in California.In California, adults with SPD were more likely to be current smokers and to smoke heavily and less likely to quit than those without SPD. The findings underscore the need for effective smoking cessation strategies targeting this group.

    View details for DOI 10.1093/ntr/ntr148

    View details for Web of Science ID 000297376400003

    View details for PubMedID 21849411

  • Using Extended Cognitive Behavioral Treatment and Medication to Treat Dependent Smokers AMERICAN JOURNAL OF PUBLIC HEALTH Hall, S. M., Humfleet, G. L., Munoz, R. F., Reus, V. I., Prochaska, J. J., Robbins, J. A. 2011; 101 (12): 2349-2356

    Abstract

    We evaluated smoking-cessation efficacy of an extended course of sustained-release bupropion (bupropion SR) and cognitive-behavioral treatment (CBT).Participants who smoked at least 10 cigarettes per day and who smoked within 30 minutes of arising (n = 406) completed a 12-week smoking-cessation treatment including group counseling, nicotine-replacement therapy, and bupropion SR. Participants were then randomly assigned to 1 of 5 conditions: (1) no further treatment, (2) active bupropion SR for 40 weeks, (3) placebo for 40 weeks, (4) active bupropion SR and 11 sessions of CBT for 40 weeks (A-CBT), or (5) placebo and 11 sessions of CBT for 40 weeks. Participants were assessed at baseline and at weeks 12, 24, 52, 64, and 104.A-CBT was not superior to the other 3 extended treatments. From weeks 12 through 104, all extended treatment conditions were superior to standard treatment. At weeks 64 and 104, the 2 CBT conditions produced significantly higher abstinence rates than did the other 3 conditions.Brief contact with providers can increase abstinence during treatment. CBT may increase long-term abstinence after extended treatment is terminated.

    View details for DOI 10.2105/AJPH.2010.300084

    View details for Web of Science ID 000297140900029

    View details for PubMedID 21653904

  • Reliability and Validity of Self-Reported Smoking in an Anonymous Online Survey With Young Adults HEALTH PSYCHOLOGY Ramo, D. E., Hall, S. M., Prochaska, J. J. 2011; 30 (6): 693-701

    Abstract

    The Internet offers many potential benefits to conducting smoking and other health behavior research with young adults. Questions, however, remain regarding the psychometric properties of online self-reported smoking behaviors. The purpose of this study was to examine the reliability and validity of self-reported smoking and smoking-related cognitions obtained from an online survey.Young adults (N = 248) age 18 to 25 who had smoked at least 1 cigarette in the past 30 days were recruited online and completed a survey of tobacco and other substance use.Measures of smoking behavior (quantity and frequency) and smoking-related expectancies demonstrated high internal consistency reliability. Measures of smoking behavior and smoking stage of change demonstrated strong concurrent criterion and divergent validity. Results for convergent validity varied by specific constructs measured. Estimates of smoking quantity, but not frequency, were comparable to those obtained from a nationally representative household interview among young adults.These findings generally support the reliability and validity of online surveys of young adult smokers. Identified limitations may reflect issues specific to the measures rather than the online data collection methodology. Strategies to maximize the psychometric properties of online surveys with young adult smokers are discussed.

    View details for DOI 10.1037/a0023443

    View details for Web of Science ID 000297029200004

    View details for PubMedID 21574709

  • SCREENING FOR UNDERSTANDING OF RESEARCH IN THE INPATIENT PSYCHIATRY SETTING JOURNAL OF EMPIRICAL RESEARCH ON HUMAN RESEARCH ETHICS Hickman, N. J., Prochaska, J. J., Dunn, L. B. 2011; 6 (3): 65-72

    Abstract

    People with mental illness constitute a substantial proportion of smokers and an important population for smoking cessation research. Obtaining informed consent in this population is a critical ethical endeavor. We examined performance on a three-item instrument (3Q) designed to screen for understanding of several key elements of research: study purpose, risks, and benefits. Patients were clinically diagnosed with primary unipolar depression (n = 40), a primary psychotic disorder (n = 32), both mood and psychotic disorders (n = 17), and primary bipolar disorder (n = 14). Among an ethnically diverse sample of 124 psychiatric inpatients approached for a smoking cessation trial, 107 (86%) performed adequately on the 3Q (i.e., obtained a score of at least 3 out of a possible 6). Patients were better able to identify the study risks and benefits than to describe the study purpose. The 3Q appears to be a useful tool for researchers working with vulnerable psychiatric patients.

    View details for DOI 10.1525/jer.2011.6.3.65

    View details for Web of Science ID 000295878900008

    View details for PubMedID 21931239

  • Integrating Tobacco Treatment Into Mental Health Settings JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION Prochaska, J. J. 2010; 304 (22): 2534-2535

    View details for Web of Science ID 000285053300030

    View details for PubMedID 21139117

  • A Population-Based Examination of Cigarette Smoking and Mental Illness in Black Americans NICOTINE & TOBACCO RESEARCH Hickman, N. J., Delucchi, K. L., Prochaska, J. J. 2010; 12 (11): 1125-1132

    Abstract

    This study examines the relation between tobacco use and cessation with lifetime and past year mental illness in a nationally representative sample of Blacks.This cross-sectional study analyzed nationally representative data from 3,411 adult Blacks participating in the 2001-2003 National Survey of American Life. Smoking prevalence and quit rates according to lifetime and past year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition mental disorders were assessed by a modified version of the Composite International Diagnostic Interview.Compared with those without mental illness, respondents with a lifetime, past year, or past month mental illness had a higher smoking prevalence (20.6%, 35.6%, 36.0%, and 45.4%, respectively) and lower quit rate (40.5%, 31.2%, and 26.2%, respectively). The odds of being a current smoker among Blacks with mental illness in their lifetime, past year, and past month, after adjusting for age, gender, education, poverty, and marital status were 1.76 (95% CI = 1.39-2.22), 1.57 (95% CI = 1.22-2.03), and 2.20 (95% CI = 1.56-3.12), respectively. Mental illness also was associated with heavier smoking. Blacks with past year mental illness represented 18.1% of the sample, yet consumed 23.9% of cigarettes smoked by Black smokers. Past year (odds ratio [OR] = 0.72, 95% CI = 0.53-0.97) and past month (OR = 0.54, 95% CI = 0.29-0.98) mental illness were associated with a lower odds of quitting for at least 1 year.Findings indicate that mental illness is significantly associated with tobacco use in Blacks. Tobacco cessation interventions that address mental illness as a barrier to cessation are needed.

    View details for DOI 10.1093/ntr/ntq160

    View details for Web of Science ID 000283677600008

    View details for PubMedID 20855413

  • Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? DRUG AND ALCOHOL DEPENDENCE Prochaska, J. J. 2010; 110 (3): 177-182

    Abstract

    In mental health and addiction treatment settings, failure to treat tobacco dependence has been rationalized by some as a clinical approach to harm reduction. That is, tobacco use is viewed as a less harmful alternative to alcohol or illicit drug use and/or other self-harm behaviors. This paper examines the impact of providers' failure to treat tobacco use on patients' alcohol and illicit drug use and associated high-risk behaviors. The weight of the evidence in the literature indicates: (1) tobacco use is a leading cause of death in patients with psychiatric illness or addictive disorders; (2) tobacco use is associated with worsened substance abuse treatment outcomes, whereas treatment of tobacco dependence supports long-term sobriety; (3) tobacco use is associated with increased (not decreased) depressive symptoms and suicidal risk behavior; (4) tobacco use adversely impacts psychiatric treatment; (5) tobacco use is a lethal and ineffective long-term coping strategy for managing stress, and (6) treatment of tobacco use does not harm mental health recovery. Failure to treat tobacco dependence in mental health and addiction treatment settings is not consistent with a harm reduction model. In contrast, emerging evidence indicates treatment of tobacco dependence may even improve addiction treatment and mental health outcomes. Providers in mental health and addiction treatment settings have an ethical duty to intervene on patients' tobacco use and provide available evidence-based treatments.

    View details for DOI 10.1016/j.drugalcdep.2010.03.002

    View details for Web of Science ID 000280626200001

    View details for PubMedID 20378281

  • Reaching young adult smokers through the Internet: Comparison of three recruitment mechanisms NICOTINE & TOBACCO RESEARCH Ramo, D. E., Hall, S. M., Prochaska, J. J. 2010; 12 (7): 768-775

    Abstract

    While young adults have the highest prevalence of cigarette smoking of any adult age group, studies of tobacco and other substance use have reported challenges in recruiting this age group. The Internet may be a useful tool for reaching young adult smokers. The present study compared three Internet-based recruitment methods for young adult smokers to complete a survey about tobacco and other substance use: Craigslist advertisements, other Internet advertisements, and E-mail invitations through a survey sampling service.Recruitment campaigns invited young adults aged 18-25 years who had smoked at least one cigarette in the past 30 days to complete an online survey. Recruitment methods were compared across recruitment numbers, costeffectiveness, and demographic and smoking characteristics of recruited participants.In 6 months, 920 people gave online consent to determine eligibility to complete the survey, of which 336 (36.5%) were eligible, and 201 (59.8%) completed the survey. While Internet advertisements yielded the largest proportion of recruited participants and completed surveys overall, Craigslist and sampling strategies were more successful at targeting young adult smokers who went on to complete the survey and were more costeffective. Participants differed in demographic and substance use characteristics across the three recruitment mechanisms.We identified success at reaching young adults who have smoked cigarettes recently through the Internet, though costs, participant eligibility, proportion of completed surveys, and respondent characteristics differed among the three methods. A multipronged approach to Internet recruitment is most likely to generate a broad diverse sample of young adult smokers.

    View details for DOI 10.1093/ntr/ntq086

    View details for Web of Science ID 000279485400011

    View details for PubMedID 20530194

  • Effect of Smoking Scenes in Films on Immediate Smoking A Randomized Controlled Study AMERICAN JOURNAL OF PREVENTIVE MEDICINE Shmueli, D., Prochaska, J. J., Glantz, S. A. 2010; 38 (4): 351-358

    Abstract

    The National Cancer Institute has concluded that exposure to smoking in movies causes adolescent smoking and there are similar results for young adults.This study investigated whether exposure of young adult smokers to images of smoking in films stimulated smoking behavior.100 cigarette smokers aged 18-25 years were randomly assigned to watch a movie montage composed with or without smoking scenes and paraphernalia followed by a 10-minute recess. The outcome was whether or not participants smoked during the recess. Data were collected and analyzed in 2008 and 2009.Smokers who watched the smoking scenes were more likely to smoke during the break (OR=3.06, 95% CI=1.01, 9.29). In addition to this acute effect of exposure, smokers who had seen more smoking in movies before the day of the experiment were more likely to smoke during the break (OR=6.73, 95% CI=1.00, 45.25, comparing the top to bottom 5th percentiles of exposure). Level of nicotine dependence (OR=1.71, 95% CI=1.27, 2.32 per point on the Fagerström Test for Nicotine Dependence scale); contemplation (OR=9.07, 95% CI=1.71, 47.99) and precontemplation (OR=7.30, 95% CI=1.39, 38.36) stages of change; and impulsivity (OR=1.21, 95% CI=1.03, 1.43) were also associated with smoking during the break. Participants who watched the montage with smoking scenes and those with a higher level of nicotine dependence were also more likely to have smoked within 30 minutes after the study.There is a direct link between viewing smoking scenes and immediate subsequent smoking behavior. This finding suggests that individuals attempting to limit or quit smoking should be advised to refrain from or reduce their exposure to movies that contain smoking.

    View details for DOI 10.1016/j.amepre.2009.12.025

    View details for Web of Science ID 000276419500001

    View details for PubMedID 20307802

  • Cigarette Smoking is a Risk Factor for Alzheimer's Disease: An Analysis Controlling for Tobacco Industry Affiliation JOURNAL OF ALZHEIMERS DISEASE Cataldo, J. K., Prochaska, J. J., Glantz, S. A. 2010; 19 (2): 465-480

    Abstract

    To examine the relationship between smoking and Alzheimer's disease (AD) after controlling for study design, quality, secular trend, and tobacco industry affiliation of the authors, electronic databases were searched; 43 individual studies met the inclusion criteria. For evidence of tobacco industry affiliation, http://legacy.library.ucsf.edu was searched. One fourth (11/43) of individual studies had tobacco-affiliated authors. Using random effects meta-analysis, 18 case control studies without tobacco industry affiliation yielded a non-significant pooled odds ratio of 0.91 (95% CI, 0.75-1.10), while 8 case control studies with tobacco industry affiliation yielded a significant pooled odds ratio of 0.86 (95% CI, 0.75-0.98) suggesting that smoking protects against AD. In contrast, 14 cohort studies without tobacco-industry affiliation yielded a significantly increased relative risk of AD of 1.45 (95% CI, 1.16-1.80) associated with smoking and the three cohort studies with tobacco industry affiliation yielded a non-significant pooled relative risk of 0.60 (95% CI 0.27-1.32). A multiple regression analysis showed that case-control studies tended to yield lower average risk estimates than cohort studies (by -0.27 +/- 0.15, P=0.075), lower risk estimates for studies done by authors affiliated with the tobacco industry (by -0.37 +/- 0.13, P=0.008), no effect of the quality of the journal in which the study was published (measured by impact factor, P=0.828), and increasing secular trend in risk estimates (0.031/year +/- 0.013, P=0.02). The average risk of AD for cohort studies without tobacco industry affiliation of average quality published in 2007 was estimated to be 1.72 +/- 0.19 (P< 0.0005). The available data indicate that smoking is a significant risk factor for AD.

    View details for DOI 10.3233/JAD-2010-1240

    View details for Web of Science ID 000276616000008

    View details for PubMedID 20110594

  • Smoking Cessation: An Integral Part of Lung Cancer Treatment ONCOLOGY Cataldo, J. K., Dubey, S., Prochaska, J. J. 2010; 78 (5-6): 289-301

    Abstract

    Lung cancer is the leading cause of cancer death in the US. About 50% of lung cancer patients are current smokers at the time of diagnosis and up to 83% continue to smoke after diagnosis. A recent study suggests that people who continue to smoke after a diagnosis of early-stage lung cancer almost double their risk of dying. Despite a growing body of evidence that continued smoking by patients after a lung cancer diagnosis is linked with less effective treatment and a poorer prognosis, the belief prevails that treating tobacco dependence is useless. With improved cancer treatments and survival rates, smoking cessation among lung cancer patients has become increasingly important. There is a pressing need to clarify the role of smoking cessation in the care of lung cancer patients.This paper will report on the benefits of smoking cessation for lung cancer patients and the elements of smoking cessation treatment, with consideration of tailoring to the needs of lung cancer patients.Given the significant benefits of smoking cessation and that tobacco dependence remains a challenge for many lung cancer patients, cancer care providers need to offer full support and intensive treatment with a smoking cessation program that is tailored to lung cancer patients' specific needs.A tobacco dependence treatment plan for lung cancer patients is provided.

    View details for DOI 10.1159/000319937

    View details for Web of Science ID 000281517800001

    View details for PubMedID 20699622

  • Intentions to quit smoking among youth in substance abuse treatment DRUG AND ALCOHOL DEPENDENCE Ramo, D. E., Prochaska, J. J., Myers, M. G. 2010; 106 (1): 48-51

    Abstract

    Smoking cessation interventions for adolescents in substance abuse treatment have shown promise. However, a better understanding of the correlates of substance use disordered (SUD) youths' intentions toward smoking cessation will help tailor cessation interventions to this population. The current study examined tobacco use, smoking-related self-efficacy, substance use and intentions to quit using alcohol and illicit drugs as correlates of intentions to quit smoking among youth in SUD treatment.Participants were 178 adolescents who were in inpatient (n=90) or outpatient (n=88) SUD treatment and had smoked at least once in the past 30 days. The sample was 44% female, 72% non-Hispanic Caucasian, with a mean age of 16.2 years (SD=1.2). Participants rated the likelihood that they would be nonsmokers in the next year (9-point scale).SUD youth intention to quit smoking averaged 4.9 out of 10 (SD=3.2), comparable to intention to quit drinking (M=5.3, SD=3.6), but lower than their intention to quit using drugs (M=6.0, SD=3.4). Teens' intentions to quit smoking were associated with nicotine dependence (r=-.30, p<.01) and smoking cessation related self-efficacy (r=.36, p<.01), but not with pretreatment substance use severity (r=-.15). Controlling for nicotine dependence, teens' intentions to quit smoking were positively related to smoking cessation self-efficacy (pr=.26, p<.01) and intention to quit using illicit drugs (pr=.15, p<.05), but unrelated to intention to quit drinking.Findings highlight the appropriateness of addressing adolescent tobacco use during SUD treatment, but emphasize the importance of assessing intention and other cognitions for each substance, as they may differ markedly.

    View details for DOI 10.1016/j.drugalcdep.2009.07.004

    View details for Web of Science ID 000273935800007

    View details for PubMedID 19699041

  • The benefits and challenges of multiple health behavior change in research and in practice PREVENTIVE MEDICINE Prochaska, J. J., Nigg, C. R., Spring, B., Velicer, W. F., Prochaska, J. O. 2010; 50 (1-2): 26-29

    Abstract

    The major chronic diseases are caused by multiple risks, yet the science of multiple health behavior change (MHBC) is at an early stage, and factors that facilitate or impede scientists' involvement in MHBC research are unknown. Benefits and challenges of MHBC interventions were investigated to strengthen researchers' commitment and prepare them for challenges.An online anonymous survey was e-mailed to listservs of the Society of Behavioral Medicine between May 2006 and 2007. Respondents (N=69) were 83% female; 94% held a doctoral degree; 64% were psychologists, 24% were in public health; and 83% targeted MHBC in their work.A sample majority rated 23 of the 24 benefits, but only 1 of 31 challenge items, as very to extremely important. Those engaged in MHBC rated the total benefits significantly higher than respondents focused on single behaviors, F(1,69)=4.21, p<.05, and rated the benefits significantly higher than the challenges: paired t(57)=7.50, p<.001. The two groups did not differ in ratings of challenges.It appears that individuals focused solely on single behaviors do not fully appreciate the benefits that impress MHBC researchers; it is not that substantial barriers are holding them back. Benefits of MHBC interventions need emphasizing more broadly to advance this research area.

    View details for DOI 10.1016/j.ypmed.2009.11.009

    View details for Web of Science ID 000275278700005

    View details for PubMedID 19948184

  • Ten critical reasons for treating tobacco dependence in inpatient psychiatry. Journal of the American Psychiatric Nurses Association Prochaska, J. J. 2009; 15 (6): 404-409

    View details for DOI 10.1177/1078390309355318

    View details for PubMedID 20336177

  • Extended treatment of older cigarette smokers ADDICTION Hall, S. M., Humfleet, G. L., Munoz, R. F., Reus, V. I., Robbins, J. A., Prochaska, J. J. 2009; 104 (6): 1043-1052

    Abstract

    Tobacco dependence treatments achieve abstinence rates of 25-30% at 1 year. Low rates may reflect failure to conceptualize tobacco dependence as a chronic disorder. The aims of the present study were to determine the efficacy of extended cognitive behavioral and pharmacological interventions in smokers > or = 50 years of age, and to determine if gender differences in efficacy existed.Open randomized clinical trial.A free-standing, smoking treatment research clinic.A total of 402 smokers of > or = 10 cigarettes per day, all 50 years of age or older.Participants completed a 12-week treatment that included group counseling, nicotine replacement therapy (NRT) and bupropion. Participants, independent of smoking status, were then assigned randomly to follow-up conditions: (i) standard treatment (ST; no further treatment); (ii) extended NRT (E-NRT; 40 weeks of nicotine gum availability); (iii) extended cognitive behavioral therapy (E-CBT; 11 cognitive behavioral sessions over a 40-week period); or (iv) E-CBT plus E-NRT (E-combined; 11 cognitive behavioral sessions plus 40 weeks nicotine gum availability).Primary outcome variable was 7-day point prevalence cigarette abstinence verified biochemically at weeks 24, 52, 64 and 104.The most clinically important findings were significant main effects for treatment condition, time and the treatment x time interaction. The E-CBT condition produced high cigarette abstinence rates that were maintained throughout the 2-year study period [(week 24 (58%), 52 (55%), 64 (55%) and 104 (55%)], and was significantly more effective than E-NRT and ST across that period. No other treatment condition was significantly different to ST. No effects for gender were found.Extended cognitive behavioral treatments can produce high and stable cigarette abstinence rates for both men and women. NRT does not add to the efficacy of extended CBT, and may hamper its efficacy. Research is needed to determine if these results can be replicated in a sample with a greater range of ages, and improved upon with the addition of medications other than NRT.

    View details for DOI 10.1111/j.1360-0443.2009.02548.x

    View details for Web of Science ID 000265882800024

    View details for PubMedID 19392908

  • Stage-Tailored Tobacco Cessation Treatment in Inpatient Psychiatry PSYCHIATRIC SERVICES Prochaska, J. J., Hall, S. E., Hall, S. M. 2009; 60 (6): 848-848

    View details for Web of Science ID 000266493800020

    View details for PubMedID 19487360

  • Resisting Tempting Foods and Smoking Behavior: Implications From a Self-Control Theory Perspective HEALTH PSYCHOLOGY Shmueli, D., Prochaska, J. J. 2009; 28 (3): 300-306

    Abstract

    Individuals may desire to diet or restrain from eating certain foods while attempting to quit smoking out of concern for weight gain. However, previous research and clinical tobacco treatment guidelines suggest that concurrent dieting may undermine attempts to quit smoking. The current study applied the self-control strength model, which posits that self-regulation relies on a limited strength that is consumed with use, to test whether resisting tempting sweets would lead to a greater likelihood of subsequent smoking.Participants were 101 cigarette smokers randomly assigned to resist eating either from a tempting plate of sweets or from a plate of less tempting vegetables. All participants were then given a 10-min recess.Whether participants smoked during the break, measured with a breath carbon monoxide sample, served as the primary dependent variable.As predicted, participants who resisted sweets were more likely to smoke during the break (53.2%) than those who resisted vegetables (34.0%), chi2(1, N = 101) = 3.65 p < .05.The findings support the tenets of the self-control strength model and suggest the mechanism by which dietary restraint may harm efforts at quitting smoking.

    View details for DOI 10.1037/a0013826

    View details for Web of Science ID 000266084800005

    View details for PubMedID 19450035

  • Designing for dissemination: development of an evidence-based tobacco treatment curriculum for psychiatry training programs. Journal of the American Psychiatric Nurses Association Prochaska, J. J., Fromont, S. C., Hudmon, K. S., Cataldo, J. K. 2009; 15 (1): 24-31

    Abstract

    Psychiatry training programs provide a unique arena for affecting professional norms and increasing access to tobacco cessation services among smokers with mental illness. Psychiatry Rx for Change emphasizes evidence-based patient-oriented tobacco treatments relevant for tobacco users with psychiatric disorders. Following Diffusion of Innovations theory and the RE-AIM framework, the curriculum is being disseminated to psychiatry residency and graduate psychiatric nursing programs in the Western United States with plans to study curriculum adoption, implementation, and maintenance on a broad scale. Psychiatry Rx for Change aims to increase the likelihood that smokers with co-occurring disorders will receive evidence-based cessation treatment.

    View details for DOI 10.1177/1078390308329536

    View details for PubMedID 19587844

  • Treatment of Smokers with Co-Occurring Disorders: Emphasis on Integration in Mental Health and Addiction Treatment Settings ANNUAL REVIEW OF CLINICAL PSYCHOLOGY Hall, S. M., Prochaska, J. J. 2009; 5: 409-431

    Abstract

    This article reviews the research on the treatment of cigarette smoking in individuals who have comorbid mental illnesses or non-nicotinic addictions. The prevalence of smoking in mentally ill and substance-abusing populations is presented, as well as reasons for this high prevalence. The historical role of cigarettes and tobacco in mental illness and addiction is reviewed to help the reader better understand the pervasiveness of smoking in these disorders and the relative absence of intervention efforts in mental heath and addiction treatment settings. The article then discusses the several reasons for integrating smoking treatment into mental health and addiction settings. The outcome research for adult and adolescent comorbid smokers is reviewed, and barriers to treatment are discussed. The review closes with a brief discussion of models of integration and thoughts about prevention.

    View details for DOI 10.1146/annurev.clinpsy.032408.153614

    View details for Web of Science ID 000268072000019

    View details for PubMedID 19327035

  • Evaluation of an Evidence-Based Tobacco Treatment Curriculum for Psychiatry Residency Training Programs ACADEMIC PSYCHIATRY Prochaska, J. J., Fromont, S. C., Leek, D., Hudmon, K. S., Louie, A. K., Jacobs, M. H., Hall, S. M. 2008; 32 (6): 484-492

    Abstract

    Smokers with mental illness and addictive disorders account for nearly one in two cigarettes sold in the United States and are at high risk for smoking-related deaths and disability. Psychiatry residency programs provide a unique arena for disseminating tobacco treatment guidelines, influencing professional norms, and increasing access to tobacco cessation services among smokers with mental illness. The current study evaluated the Rx for Change in Psychiatry curriculum, developed for psychiatry residency programs and focused on identifying and treating tobacco dependence among individuals with mental illness.The 4-hour curriculum emphasized evidence-based, patient-oriented cessation treatments relevant for all tobacco users, including those not yet ready to quit. The curriculum was informed by comprehensive literature review, consultation with an expert advisory group, faculty interviews, and a focus group with psychiatry residents. This study reports on evaluation of the curriculum in 2005-2006, using a quasi-experimental design, with 55 residents in three psychiatry residency training programs in Northern California.The curriculum was associated with improvements in psychiatry residents' knowledge, attitudes, confidence, and counseling behaviors for treating tobacco use among their patients, with initial changes from pre- to posttraining sustained at 3-months' follow-up. Residents' self-reported changes in treating patients' tobacco use were substantiated through systematic chart review.The evidence-based Rx for Change in Psychiatry curriculum is offered as a model tobacco treatment curriculum that can be implemented in psychiatry residency training programs and disseminated widely, thereby effectively reaching a vulnerable and costly population of smokers.

    View details for Web of Science ID 000262780000007

    View details for PubMedID 19190293

  • Physical activity as a strategy for maintaining tobacco abstinence: A randomized trial PREVENTIVE MEDICINE Prochaska, J. J., Hall, S. M., Humfleet, G., Munoz, R. F., Reus, V., Gorecki, J., Hu, D. 2008; 47 (2): 215-220

    Abstract

    For smoking cessation, physical activity (PA) may help manage withdrawal symptoms, mood, stress, and weight; yet studies of PA as an aid for smoking cessation have been mixed. This study examined: (1) the impact of an extended relapse prevention program on increasing moderate to vigorous PA (MVPA) in adults enrolled in a tobacco cessation treatment trial; (2) whether changes in MVPA were associated with sustained abstinence from smoking; and (3) mechanisms by which MVPA may support sustained abstinence from smoking.In a randomized controlled trial conducted from 2003-2006 in San Francisco, California, 407 adult smokers received a 12 week group-based smoking cessation treatment with bupropion and nicotine patch with the quit date set at week 3. At week 12, participants were randomized to no further treatment or to 40 weeks of bupropion or placebo with or without an 11-session relapse prevention intervention of which 2 sessions (held at weeks 16 and 20) focused on PA. Participants receiving the PA intervention (n=163) received a pedometer, counseling to increase steps 10% biweekly towards a 10,000 steps/day goal, and personalized reports graphing progress with individualized goals. The International Physical Activity Questionnaire assessed weekly minutes of MVPA at baseline and weeks 12 and 24. Sustained abstinence from tobacco at week 24 was validated with expired carbon monoxide.In a repeated mixed model analysis, intervention participants significantly increased their MVPA relative to control participants, F(1,475)=3.95, p=.047. Pedometer step counts also increased significantly, t(23)=2.36, p=.027, though only 15% of intervention participants provided 6 weeks of pedometer monitoring. Controlling for treatment condition, increased MVPA predicted sustained smoking abstinence at week 24, odds ratio=1.84 (95% CI: 1.07, 3.05). Among participants with sustained abstinence, increased MVPA was associated with increased vigor (r=0.23, p=.025) and decreased perceived difficulty with staying smoke-free (r=-0.21, p=.038).PA promotion as an adjunct to tobacco treatment increases MVPA levels; changes in MVPA predict sustained abstinence, perhaps by improving mood and self-efficacy.

    View details for DOI 10.1016/j.ypmed.2008.05.006

    View details for Web of Science ID 000258560300013

    View details for PubMedID 18572233

  • Evaluating the validities of different DSM-IV-based conceptual constructs of tobacco dependence ADDICTION Hendricks, P. S., Prochaska, J. J., Humfleet, G. L., Hall, S. M. 2008; 103 (7): 1215-1223

    Abstract

    To compare the concurrent and predictive validities of two subsets of DSM-IV criteria for nicotine dependence (tolerance and withdrawal; withdrawal; difficulty controlling use; and use despite harm) to the concurrent and predictive validity of the full DSM-IV criteria.Analysis of baseline and outcome data from three randomized clinical trials of cigarette smoking treatment.San Francisco, California.Two samples of cigarette smokers (n = 810 and 322), differing with regard to baseline characteristics and treatment received, derived from three randomized clinical trials.DSM-IV nicotine dependence criteria were measured at baseline with a computerized version of the Diagnostic Interview Schedule for DSM-IV (DIS-IV). Additional baseline measures included the Fagerström Test of Nicotine Dependence (FTND), number of cigarettes smoked per day, breath carbon monoxide (CO) level, the Minnesota Nicotine Withdrawal Scale (MNWS), the Michigan Nicotine Reinforcement Questionnaire (M-NRQ) and the Profile of Mood States (POMS). Seven-day point-prevalence abstinence was assessed at week 12.Full DSM-IV criteria displayed greater concurrent validity than either of the two subsets of criteria. However, DSM-IV symptoms accounted for only a nominal amount of the variance in baseline smoking-related characteristics and were unrelated to smoking abstinence at week 12. Cigarettes smoked per day was the only significant predictor of abstinence at week 12.Although the findings do not provide a compelling alternative to the full set of DSM-IV nicotine dependence criteria, its poor psychometric properties and low predictive power limit its clinical and research utility.

    View details for DOI 10.1111/j.1360-0443.2008.02232.x

    View details for Web of Science ID 000256684400024

    View details for PubMedID 18554351

  • Tobacco use among individuals with schizophrenia: What role has the tobacco industry played? SCHIZOPHRENIA BULLETIN Prochaska, J. J., Hall, S. M., Bero, L. A. 2008; 34 (3): 555-567

    Abstract

    Rates of tobacco use among individuals diagnosed with schizophrenia have been estimated as high as 80%. A variety of hypotheses have been proposed to explain the high rate of tobacco use among this vulnerable group. This study examined the tobacco industry's efforts to establish and promulgate beliefs about schizophrenic individuals' need to smoke and the hazards of quitting. The current study analyzed previously secret tobacco industry documents. The initial search was conducted during January-July 2005 in the Legacy Tobacco Documents Library. The search yielded 280 records dating from 1955 to 2004. Documents indicate the tobacco industry monitored or directly funded research supporting the idea that individuals with schizophrenia were less susceptible to the harms of tobacco and that they needed tobacco as self-medication. The tobacco industry promoted smoking in psychiatric settings by providing cigarettes and supporting efforts to block hospital smoking bans. The tobacco industry engaged in a variety of direct and indirect efforts that likely contributed to the slowed decline in smoking prevalence in schizophrenia via slowing nicotine dependence treatment development for this population and slowing the rate of policy implementation vis-ā-vis smoking bans on psychiatric units.

    View details for DOI 10.1093/schbul/sbm117

    View details for Web of Science ID 000255156500019

    View details for PubMedID 17984298

  • Changes in psychiatric patients' thoughts about quitting smoking during a smoke-free hospitalization NICOTINE & TOBACCO RESEARCH Shmueli, D., Fletcher, L., Hall, S. E., Hall, S. M., Prochaska, J. J. 2008; 10 (5): 875-881

    Abstract

    Though exempted from national bans of tobacco smoking in hospitals, some psychiatric facilities have voluntarily gone 100% smoke free with little reported difficulty in clinical management. The impact of smoking restrictions on psychiatric patients' thoughts about quitting smoking, however, is not known. This study investigates changes in thoughts about quitting smoking for patients hospitalized in a smoke-free psychiatric inpatient facility. Participants were 100 smokers recruited from a university-based adult inpatient psychiatry unit. The present study focused on participants' reported desire to quit smoking, their expectancy of success and anticipated difficulty with quitting, and their smoking abstinence goal. Assessments were conducted at hospital intake and shortly before hospital discharge. Follow-up assessments were conducted by phone at 1 week, 1 month, and 3 months post-hospitalization to measure smoking behavior. Although no cessation treatment was provided in this observational study, from admission to discharge, participants reported an increased expectancy of success with quitting and a decreased expectancy of difficulty with staying quit. They also were more likely to endorse a smoking-related goal. Psychiatric diagnosis was not related to thoughts about abstinence. Furthermore, participants' thoughts about abstinence at discharge were significantly related to their subsequent smoking behavior. Hospitalization in a smoke-free environment is associated with increases in patients' expectancies about quitting and staying smoke free.

    View details for DOI 10.1080/14622200802027198

    View details for Web of Science ID 000256055900014

    View details for PubMedID 18569762

  • Investigation into the cause of death of a 56-year-old man with serious mental illness AMERICAN JOURNAL OF PSYCHIATRY Prochaska, J. J., Schane, R., Leek, D., Hall, S. E., Hall, S. M. 2008; 165 (4): 453-456
  • Methods of quantifying change in multiple risk factor interventions PREVENTIVE MEDICINE Prochaska, J. J., Velicer, W. F., Nigg, C. R., Prochaska, J. O. 2008; 46 (3): 260-265

    Abstract

    Risky behaviors such as smoking, alcohol abuse, physical inactivity, and poor diet are detrimental to health, costly, and often co-occur. Greater efforts are being targeted at changing multiple risk behaviors to more comprehensively address the health needs of individuals and populations. With increased interest in multiple risk factor interventions, the field will need ways to conceptualize the issue of overall behavior change.Analyzing data from over 8000 participants in four multibehavioral interventions, we present five different methods for quantifying and reporting changes in multiple risk behaviors.The methods are: (a) the traditional approach of reporting changes in individual risk behaviors; (b) creating a combined statistical index of overall behavior change, standardizing scores across behaviors on different metrics; (c) using a behavioral index; (d) calculating an overall impact factor; and (e) using overarching outcome measures such as quality of life, related biometrics, or cost outcomes. We discuss the methods' interpretations, strengths, and limitations.Given the lack of consensus in the field on how to examine change in multiple risk behaviors, we recommend researchers employ and compare multiple methods in their publications. A dialogue is needed to work toward developing a consensus for optimal ways of conceptualizing and reporting changes in multibehavioral interventions.

    View details for DOI 10.1016/j.ypmed.2007.07.035

    View details for Web of Science ID 000255668000013

    View details for PubMedID 18319099

  • Multiple health behavior change research: An introduction and overview PREVENTIVE MEDICINE Prochaska, J. J., Spring, B., Nigg, C. R. 2008; 46 (3): 181-188

    Abstract

    In 2002, the Society of Behavioral Medicine's special interest group on Multiple Health Behavior Change was formed. The group focuses on the interrelationships among health behaviors and interventions designed to promote change in more than one health behavior at a time. Growing evidence suggests the potential for multiple-behavior interventions to have a greater impact on public health than single-behavior interventions. However, there exists surprisingly little understanding of some very basic principles concerning multiple health behavior change (MHBC) research. This paper presents the rationale and need for MHBC research and interventions, briefly reviews the research base, and identifies core conceptual and methodological issues unique to this growing area. The prospects of MHBC for the health of individuals and populations are considerable.

    View details for DOI 10.1016/j.ypmed.2008.02.001

    View details for Web of Science ID 000255668000001

    View details for PubMedID 18319098

  • Does Smoking Intervention Influence Adolescent Substance Use Disorder Treatment Outcomes? SUBSTANCE ABUSE Myers, M. G., Prochaska, J. J. 2008; 29 (2): 81-88

    Abstract

    Although tobacco use is reported by the majority of substance use disordered (SUD) youth, little work has examined tobacco focused interventions with this population. The present study is an initial investigation of the effect of a tobacco use intervention on adolescent SUD treatment outcomes. Participants were adolescents in SUD treatment taking part in a cigarette smoking intervention efficacy study, assessed at baseline and followed up at 3- and 6-months post-intervention. Analyses compared treatment and control groups on days using alcohol and drugs and proportion abstinent from substance use at follow up assessments. Adolescents in the treatment condition reported significantly fewer days of substance use and were somewhat more likely to be abstinent at 3-month follow up. These findings suggest that tobacco focused intervention may enhance SUD treatment outcome. The present study provides further evidence for the value of addressing tobacco use in the context of treatment for adolescent SUD's.

    View details for DOI 10.1080/08897070802093361

    View details for Web of Science ID 000207708200009

    View details for PubMedID 19042327

  • Older versus younger treatment-seeking smokers: Differences in smoking behavior, drug and alcohol use, and psychosocial and physical functioning NICOTINE & TOBACCO RESEARCH Hall, S. M., Humfleet, G. L., Gorecki, J. A., Munoz, R. F., Reus, V. I., Prochaska, J. J. 2008; 10 (3): 463-470

    Abstract

    Quitting smoking benefits older individuals, yet few recent studies have described older smokers. The goal of this paper was to test a series of hypotheses about differences between smokers aged 50 years or older (50+) and those younger than age 50 (<50) presenting to the same treatment facility during 2002-2004 for participation in two randomized clinical trials: one exclusively for smokers aged 50+, and a second open to smokers aged 18 or older. As predicted, smokers aged 50+ were more tobacco dependent, had better psychological functioning, and had poorer physical functioning than those aged <50. Contrary to predictions, we found no differences in motivation to quit cigarette smoking or in alcohol use. Women aged 50+ were less likely to report marijuana use than women aged <50, and less likely than men to receive a positive diagnosis for alcohol abuse. Despite higher scores on measures of tobacco dependence, older smokers were less likely to be diagnosed as tobacco dependent or as having tobacco withdrawal using DSM-IV criteria. Rates of DSM-IV alcohol abuse and dependence were high in both age groups but were higher for smokers aged <50. We found no striking differences between studies in reasons for exclusion, but in both the proportion of individuals excluded due to current antidepressant use was high. Implications for the assessment and treatment of older adults are discussed.

    View details for DOI 10.1080/14622200801901922

    View details for Web of Science ID 000253763400010

    View details for PubMedID 18324565

  • Cognitive interviews for measurement evaluation of the Fagerstrom Test for Nicotine Dependence (FTND) in smokers with schizophrenia spectrum disorders ADDICTIVE BEHAVIORS Prochaska, J. J., Leek, D. N., Hall, S. E., Hall, S. M. 2007; 32 (4): 793-802

    Abstract

    People diagnosed with schizophrenia have among the highest known rates of tobacco use. While the Fagerström Test for Nicotine Dependence (FTND) is the most widely used measure of nicotine dependence, recent research has questioned its applicability for individuals with schizophrenia. The current study employed cognitive interviews to evaluate the FTND with smokers diagnosed with schizophrenia spectrum disorders, recruited from an acute inpatient psychiatry setting, and a comparison group of smokers recruited from the community. The groups were comparable on tobacco use variables and FTND scores. Detailed qualitative cognitive interviews indicated all subjects understood the FTND items. For both groups, the FTND missed nocturnal smoking, reported as weekly by 80% of patients and 47% of controls. Finishing other people's cigarettes also was under-reported on the FTND. Restrictions to smoking were common across groups. The cognitive interview methodology proved useful for understanding how individuals interpreted and answered the FTND items. Overall, the qualitative findings identified limitations in the FTND for both groups, with the limitations generally more pronounced among patients with schizophrenia.

    View details for DOI 10.1016/j.addbeh.2006.06.016

    View details for Web of Science ID 000244399000011

    View details for PubMedID 16839695

  • Medical students' use of the Stages of Change Model in tobacco cessation counseling JOURNAL OF GENERAL INTERNAL MEDICINE Prochaska, J. J., Teherani, A., Hauer, K. E. 2007; 22 (2): 223-227

    Abstract

    Many medical schools have incorporated the Stages of Change Model into their curricula with specific application to tobacco cessation.This study examined the extent to which medical students were prepared to provide stage-based interventions to treat nicotine dependence.Using a quasi-experimental design, medical students' counseling interactions were evaluated with a standardized patient portraying a smoker in either the precontemplation or preparation stage of change.Participants were 147 third-year medical students at the University of California, San Francisco.Checklists completed by standardized patients evaluated students' clinical performance. Surveys administered before and after the encounters assessed students' knowledge, attitudes, confidence and previous experience with treating smoking.Most students asked about tobacco use (89%), advised patients of the health benefits of quitting (74%), and assessed the patient's readiness to quit (76%). The students were more likely to prescribe medications and offer referrals to patients in the preparation than in the precontemplation stage of change (P < 0.001); however, many students had difficulty identifying patients ready to quit, and few encouraged patients to set a quit date or arranged follow-up to assess progress. Students' tobacco-related knowledge, but not their attitudes, confidence, or previous experience predicted their clinical performance.The findings indicated evidence of students tailoring their counseling strategies to the patients' stage of change; however, they still could do more to assist their patients in quitting. Additional training and integration of cessation counseling into clinical rotations are needed.

    View details for DOI 10.1007/s11606-006-0040-0

    View details for Web of Science ID 000244521900010

    View details for PubMedID 17356990

  • Addressing nicotine dependence in psychodynamic psychotherapy: Perspectives from residency training ACADEMIC PSYCHIATRY Prochaska, J. J., Fromont, S. C., Banys, P., Eisendrath, S. J., Horowitz, M. J., Jacobs, M. H., Hall, S. M. 2007; 31 (1): 8-14

    Abstract

    According to APA treatment recommendations, psychiatrists should assess and intervene in tobacco use with all of their patients who smoke. The ease with which this occurs may vary by treatment model. This study examined perspectives in residency training to identify a framework for addressing nicotine dependence within psychodynamic psychotherapy.The authors collected data from a focus group of psychiatry residents and interviews with psychiatry residency faculty with expertise in psychodynamic psychotherapy. The transcribed interviews were analyzed for key themes and synthesized.Though the residents reported hesitancy to address patients' tobacco use, specifically in psychodynamic psychotherapy, the consensus from the expert faculty consultants was that tobacco interventions can and should be incorporated. The faculty provided suggestions, consistent with a psychodynamic formulation, for assessing patients' tobacco use and their interest in quitting, providing cessation treatment and/or referrals, and following up with patients to address relapse.The findings provide a useful framework, consistent with a psychodynamic model, for assessing and treating tobacco use with patients. Additional training and supervision likely are needed to increase residents' confidence and comfort with implementing these strategies.

    View details for Web of Science ID 000243600000003

    View details for PubMedID 17242046

  • Treatment for cigarette smoking among depressed mental health outpatients: A randomized clinical trial AMERICAN JOURNAL OF PUBLIC HEALTH Hall, S. M., Tsoh, J. Y., Prochaska, J. J., Eisendrath, S., Rossi, J. S., Redding, C. A., Rosen, A. B., Meisner, M., Humfleet, G. L., Gorecki, J. A. 2006; 96 (10): 1808-1814

    Abstract

    Using a brief contact control, we tested the efficacy of a staged care intervention to reduce cigarette smoking among psychiatric patients in outpatient treatment for depression.We conducted a randomized clinical trial that included assessments at baseline and at months 3, 6, 12, and 18. Three hundred twenty-two patients in mental health outpatient treatment who were diagnosed with depression and smoked > or =1 cigarette per day participated. The desire to quit smoking was not a prerequisite for participation. Staged care intervention participants received computerized motivational feedback at baseline and at 3, 6, and 12 months and were offered a 6-session psychological counseling and pharmacological cessation treatment program. Brief contact control participants received a self-help guide and referral list of local smoking-treatment providers.As we hypothesized, abstinence rates among staged care intervention participants exceeded those of brief contact control participants at months 12 and 18. Significant differences favoring staged care intervention also were found in occurrence of a quit attempt and stringency of abstinence goal.The data suggest that individuals in psychiatric treatment for depression can be aided in quitting smoking through use of staged care interventions and that smoking cessation interventions used in the general population can be implemented in psychiatric outpatient settings.

    View details for DOI 10.2105/AJPH.2005.080382

    View details for Web of Science ID 000240891200023

    View details for PubMedID 17008577

  • Training in tobacco treatments in psychiatry: A national survey of psychiatry residency training directors ACADEMIC PSYCHIATRY Prochaska, J. J., Fromont, S. C., Louie, A. K., Jacobs, M. H., Hall, S. M. 2006; 30 (5): 372-378

    Abstract

    Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and is a leading cause of death and disability. This study examines training in tobacco treatment in psychiatry residency programs across the United States.The authors recruited training directors to complete a survey of their program's curriculum related to tobacco treatment, attitudes related to treating tobacco in psychiatry, and perceptions of residents' skills for addressing nicotine dependence in psychiatric patients.Respondents were representative of the national pool. Half of the programs provided training in tobacco treatments for a median duration of 1 hour. Content areas covered varied greatly. Programs with tobacco-related training expressed more favorable attitudes toward addressing tobacco in psychiatry and were more likely to report confidence in their residents' skills for treating nicotine dependence. Programs without tobacco training reported a lack of faculty expertise on tobacco treatments. Most training directors reported moderate to high interest in evaluating a model tobacco curriculum for psychiatry and stated they would dedicate an average of 4 hours of curriculum time.The findings demonstrate the need for and interest in a model tobacco treatment curriculum for psychiatry residency training. Training psychiatrists offers the potential of delivering treatment to one of the largest remaining groups of smokers: patients with mental disorders.

    View details for Web of Science ID 000241026900003

    View details for PubMedID 17021144

  • Comparing intervention outcomes in smokers treated for single versus multiple behavioral risks HEALTH PSYCHOLOGY Prochaska, J. J., Velicer, W. F., Prochaska, J. O., Delucchi, K., Hall, S. M. 2006; 25 (3): 380-388

    Abstract

    This study examined treatment outcomes among smokers with single versus multiple behavioral risks. Data were drawn from smokers (N = 2,326) participating in 3 population-based, multibehavioral studies targeting cigarette smoking, high-fat diets, and high-risk sun exposure. Outcomes were compared for participants at risk for smoking only (13%), smoking plus 1 additional risk factor (37%), and smoking plus 2 additional risk factors (50%). The smoking only group tended to be female, older, more educated, lighter smokers, in the preparation stage of change for smoking, with more previous quit attempts and longer periods of abstinence. At 12 and 24 months follow-up, treatment of 1 or 2 coexisting risk factors did not decrease the effectiveness of smoking cessation treatment, and treatment for the coexisting factors was effective.

    View details for DOI 10.1037/0278-6133.25.3.380

    View details for Web of Science ID 000237761300015

    View details for PubMedID 16719610

  • Return to smoking following a smoke-free psychiatric hospitalization AMERICAN JOURNAL ON ADDICTIONS Prochaska, J. J., Fletcher, L., Hall, S. E., Hall, S. M. 2006; 15 (1): 15-22

    Abstract

    This study examined the smoking behaviors and motivations of 100 patients hospitalized in a smoke-free psychiatry unit. The sample averaged nineteen cigarettes per day and had a history of repeated failed quit attempts, yet 65% expressed interest in quitting. During hospitalization, nicotine replacement was provided to 70% of smokers to manage nicotine withdrawal. Provider counseling for smoking cessation, however, was rare, and all patients returned to smoking within five weeks of hospital discharge. The inpatient setting provides a potential site for initiating tobacco dependence treatment; however to maintain abstinence following hospital discharge, greater support is needed.

    View details for DOI 10.1080/10550490500419011

    View details for Web of Science ID 000234991900004

    View details for PubMedID 16449089

  • How prepared are psychiatry residents for treating nicotine dependence? ACADEMIC PSYCHIATRY Prochaska, J. J., Fromont, S. C., Hall, S. M. 2005; 29 (3): 256-261

    Abstract

    Nicotine dependence is the most prevalent substance abuse disorder among adult psychiatric patients and a leading cause of death and disability. The authors examined the extent to which psychiatry residents are prepared to treat nicotine dependence in clinical practice.Residents from five psychiatry residency programs in northern California completed an anonymous survey of their knowledge, attitudes, and behaviors regarding treating nicotine dependence among their patients.Respondents (N = 105, 60% female) represented all 4 years of residency training. Residents' smoking status was 11% current, 17% former, and 72% never. Knowledge scores averaged 54% correct. Confidence ratings averaged 3 (SD = 0.6) on a 5-point scale. Seventy six percent rated their overall ability to help patients quit using tobacco as fair or poor. The percent reporting often or always engaging in the National Cancer Institute's 5-A intervention for smoking cessation was: 58% ask; 29% advise; 17% assess; 18% assist; and 13% arrange follow up. Most residents reported none or inadequate tobacco cessation training during medical school (74%) or residency (79%), and nearly all (94%) reported moderate to high interest in learning more about helping patients quit smoking.Psychiatry residents appear unprepared to treat nicotine dependence, but report considerable interest in this area. The findings demonstrate the need for and interest in tobacco cessation curricula in psychiatry residency training.

    View details for Web of Science ID 000231596700005

    View details for PubMedID 16141120

  • Preliminary evidence of the association between the history of childhood attention-deficit/hyperactivity disorder and smoking treatment failure NICOTINE & TOBACCO RESEARCH Humfleet, G. L., Prochaska, J. J., Mengis, M., Cullen, J., MUNOZ, R., Reus, V., Hall, S. M. 2005; 7 (3): 453-460

    Abstract

    Smoking rates are elevated among individuals with attention-deficit/hyperactivity disorder (ADHD). The association of ADHD diagnosis and smoking treatment outcome has not been examined. The present study examined abstinence rates among 428 adult smokers participating in two randomized controlled trials. Treatments included nicotine replacement, antidepressants, and psychological interventions. Childhood ADHD was assessed retrospectively by diagnostic interview. In a survival analysis, ADHD status predicted time to relapse after controlling for gender, history of depression, and baseline smoking variables. Only 1 of 47 participants with a history of childhood ADHD remained abstinent by week 52, compared with 18% of those who had no history of childhood ADHD (adjusted OR=0.36, 95% CI=0.28-0.45). The current findings provide preliminary evidence for an association between childhood ADHD and smoking cessation treatment failure. Further investigation is warranted.

    View details for DOI 10.1081/14622200500125310

    View details for Web of Science ID 000232105700015

    View details for PubMedID 16085513

  • Predictors of health functioning in two high-risk groups of smokers DRUG AND ALCOHOL DEPENDENCE Prochaska, J. J., Sorensen, J. L., Hall, S. M., Rossi, J. S., Redding, C. A., Rosen, A. B., Eisendrath, S. J., Meisner, M. R. 2005; 78 (2): 169-175

    Abstract

    The relative and combined health effects of cigarette smoking, heroin use, and depression were examined in 322 clinically depressed smokers and 117 opioid-dependent smokers participating in two studies of the San Francisco Treatment Research Center. Opioid-dependent smokers averaged 16 years (S.D.=9) of heroin use; 3% of depressed smokers used opiates in the past 6 months. Cigarettes per day (M=15, S.D.=10) and Beck Depression (BDI-II) scores (M=21, S.D.=11) were comparable between the two groups. Health functioning was assessed using the Medical Outcomes Study Short Form (SF-36). Adjusting for demographic differences, depressed smokers reported better physical but poorer emotional health relative to opioid-dependent smokers. Both groups scored significantly lower than published norms (p<.05). Within groups, severity of depressive symptoms, tobacco use, and opiate use were independent predictors of lower health functioning (p<.05). Examining risk-related subgroups based on depression scores (BDI-II> or =20), cigarettes per day (> or =1 pack), and opiate use, number of risk factors was monotonically related to health functioning in both samples. Individuals with two or more risk factors scored the lowest (p<.05). Severity of depressive symptoms, tobacco use, and opiate use contributed individually and collectively to lower health functioning. Blended treatments that target multiple risk factors are needed to improve health outcomes.

    View details for DOI 10.1016/j.drugalcdep.2004.10.012

    View details for Web of Science ID 000229049300008

    View details for PubMedID 15845320

  • Acceptance of nicotine dependence treatment among currently depressed smokers NICOTINE & TOBACCO RESEARCH Haug, N. A., Hall, S. M., Prochaska, J. J., Rosen, A. B., Tsoh, J. Y., Humfleet, G., Delucchi, K., Rossi, J. S., Redding, C. A., Eisendrath, S. 2005; 7 (2): 217-224

    Abstract

    This study reports on baseline characteristics associated with acceptance and refusal of available smoking treatment among currently depressed smokers in a psychiatric outpatient clinic who were enrolled in a larger clinical trial. The sample (N=154) was 68% female and 72% White, with a mean age of 41.4 years and average smoking rate of 17 cigarettes/day. All participants were assigned to a repeated contact experimental condition; received a stage-based expert system program to facilitate treatment acceptance; and were then offered smoking treatment, consisting of behavioral counseling, nicotine patch, and bupropion. Acceptors (n=53) were defined as those accepting behavioral counseling and pharmacological treatment at some point during the 18-month study, whereas refusers (n=101) received only the expert system. The number of days to treatment acceptance was significantly predicted by stage of change, with those in preparation entering treatment more quickly than contemplators or precontemplators. In a logistic regression, the variables most strongly associated with accepting treatment were current use of psychiatric medication and perceived success for quitting. Severity of depressive symptoms, duration of depression history, and history of recurrent depression were not related to treatment acceptance. Findings have implications for the psychiatric assessment and treatment of smokers in clinical settings. Psychiatric medication may play a significant role in smoking cessation treatment acceptance by currently depressed smokers.

    View details for Web of Science ID 000229117300005

    View details for PubMedID 16036278

  • Identification and treatment of substance misuse on an inpatient psychiatry unit PSYCHIATRIC SERVICES Prochaska, J. J., Gill, P., Hall, S. E., Hall, S. M. 2005; 56 (3): 347-349

    Abstract

    This chart review study examined identification and treatment of substance misuse on an inpatient psychiatry ward before and after the hospital's administration made changes to increase attention to patients' substance misuse. Before the ward changes, 113 of 250 inpatients (45 percent) were identified as misusing substances. Misusers were significantly more likely to be younger, male, single, and cigarette smokers. After the ward changes, substance misuse was more than twice as likely to be addressed in treatment planning and discharge diagnoses, and referrals to substance abuse treatment were nearly twice as likely to be made. Changes in assessment of and treatment planning for psychiatric inpatients may increase attention to substance misuse.

    View details for Web of Science ID 000227538000016

    View details for PubMedID 15746511

  • Coeducational and single-sex physical education in middle schools: impact on physical activity. Research quarterly for exercise and sport McKenzie, T. L., Prochaska, J. J., Sallis, J. F., LaMaster, K. J. 2004; 75 (4): 446-449

    View details for PubMedID 15673045

  • Depressed smokers and stage of change: implications for treatment interventions DRUG AND ALCOHOL DEPENDENCE Prochaska, J. J., Rossi, J. S., Redding, C. A., Rosen, A. B., Tsoh, J. Y., Humfleet, G. L., Eisendrath, S. J., Meisner, M. R., Hall, S. M. 2004; 76 (2): 143-151

    Abstract

    Tobacco Dependence among smokers with psychiatric disorders has been under-addressed by the mental health, addictions, and tobacco control communities. This study examined depressed smokers' readiness to quit and the applicability of the Stages of Change framework to a psychiatric sample. Currently depressed smokers (N=322) were recruited from four outpatient psychiatric clinics. Participants averaged 16 cigarettes per day (S.D.=10) and 24 years (S.D.=13) of smoking. The majority (79%) reported intention to quit smoking with 24% ready to take action in the next 30 days. Individuals in the preparation stage reported more prior quit attempts, a greater commitment to abstinence, increased recognition of the cons of smoking, and greater use of the processes of change. Precontemplators were least likely to identify a goal related to their smoking behavior. Depressive symptom severity and history of recurrent depressive episodes were unrelated to readiness to quit. This study is one of the first to examine the smoking behaviors of currently depressed psychiatric outpatients. The level and longevity of their tobacco use underscore the need for cessation interventions. The consistency in hypothesized patterns among theoretical constructs of the Stages of Change model supports the transfer of stage-tailored interventions to this clinical population.

    View details for DOI 10.1016/j.drugalcdep.2004.04.017

    View details for Web of Science ID 000225056900004

    View details for PubMedID 15488338

  • Treatment of tobacco use in an inpatient psychiatric setting PSYCHIATRIC SERVICES Prochaska, J., Gill, P., Hall, S. M. 2004; 55 (11): 1265-1270

    Abstract

    Despite high rates of tobacco use among psychiatric patients, such patients are one of the least studied groups of smokers, and little is known about their access to cessation treatment. This study examined delivery of tobacco cessation services in a smoke-free inpatient psychiatric setting.Medical records of 250 psychiatric inpatients who were admitted from 1998 to 2001 were randomly selected and systematically reviewed.A total of 105 patients (42 percent) were identified as current smokers; the mean+/-SD number of cigarettes that they smoked per day was 21+/-15. Smokers evidenced statistically greater agitation and irritability compared with nonsmokers. None of the smokers received a diagnosis of nicotine dependence or withdrawal, and smoking status was not included in treatment planning for any patient. Nicotine replacement therapy was prescribed for 59 smokers (56 percent); of these patients, 54 (92 percent) used it. Smokers who were not given a prescription for nicotine replacement therapy were more than twice as likely as nonsmokers and smokers who were given a prescription for this therapy to be discharged from the hospital against medical advice. Only one smoker was encouraged to quit smoking, referred for cessation treatment, or provided with nicotine replacement therapy on discharge.Psychiatric inpatients smoke at high rates, yet interventions to treat this deadly addiction are rare. Furthermore, nicotine withdrawal left unaddressed may compromise psychiatric care.

    View details for Web of Science ID 000224778600010

    View details for PubMedID 15534015

  • Viability of parks and recreation centers as sites for youth physical activity promotion. Health promotion practice Moody, J. S., Prochaska, J. J., Sallis, J. F., McKenzie, T. L., Brown, M., Conway, T. L. 2004; 5 (4): 438-443

    Abstract

    This descriptive study explored the potential for public parks and recreation centers as intervention sites for promoting physical activity among youth. Directors (55% women) of 44 recreation centers in San Diego County completed a survey of their centers' physical activity programming for youths ages 3 to 17 years (response rate = 60%). On an average weekday, 373 (SD = 782) youths participated in physical activity at a center. More boys attended than girls (p <.05). Some centers sponsored after-school programs at elementary (41%) and middle (11%) schools but not at high schools (0%). Primary barriers to providing physical activity programs were inadequate staffing (54%), funding (39%), and facilities (32%). Girls and low-income youth were identified as the most difficult populations to reach. Directors reported considerable interest in collaborating on interventions to improve youth activity programs. Public parks and recreation centers are understudied settings with the potential for substantial involvement in efforts to promote youth physical activity.

    View details for PubMedID 15358916

  • Evaluation of a two-year middle-school physical education intervention: M-SPAN MEDICINE AND SCIENCE IN SPORTS AND EXERCISE McKenzie, T. L., Sallis, J. F., Prochaska, J. J., Conway, T. L., Marshall, S. J., Rosengard, P. 2004; 36 (8): 1382-1388

    Abstract

    School physical education (PE) is highly recommended as a means of promoting physical activity, and randomized studies of health-related PE interventions in middle schools have not been reported. We developed, implemented, and assessed an intervention to increase physical activity during middle-school PE classes.Twenty-four middle schools (approximately 25,000 students, 45% nonwhite) in Southern California participated in a randomized trial. Schools were assigned to intervention (N = 12) or control (N = 12) conditions, and school was the unit of analysis. A major component of the intervention was a 2-yr PE program, which consisted of curricular materials, staff development, and on-site follow-up. Control schools continued usual programs. Student activity and lesson context were observed in 1849 PE lessons using a validated instrument during baseline and intervention years 1 and 2.The intervention significantly (P = 0.02) improved student moderate to vigorous physical activity (MVPA) in PE, by approximately 3 min per lesson. Effects were cumulative; by year 2 intervention schools increased MVPA by 18%. Effect sizes were greater for boys (d = 0.98; large) than girls (d = 0.68; medium).A standardized program increased MVPA in middle schools without requiring an increase in frequency or duration of PE lessons. Program components were well received by teachers and have the potential for generalization to other schools. Additional strategies may be needed for girls.

    View details for DOI 10.1249/MSS.0000135792.20353.4D

    View details for Web of Science ID 000223119300017

    View details for PubMedID 15292747

  • A randomized controlled trial of single versus multiple health behavior change: Promoting physical activity and nutrition among adolescents HEALTH PSYCHOLOGY Prochaska, J. J., Sallis, J. F. 2004; 23 (3): 314-318

    Abstract

    Targeting multiple behaviors for change may provide significant health benefits. This study compared interventions targeting physical activity and nutrition (PAN) concurrently versus physical activity (PA) alone. Adolescents (N=138) were randomized to the PAN or PA intervention or control condition (n=46 per group). Primary outcomes were change in PA accelerometer and 3-day dietary recording from baseline to 3-month follow-up. The PAN and PA interventions were efficacious in supporting boys' (p<.001) but not girls' (p=.663) PA relative to the control condition. Dietary change was minimal. Although the findings do not reveal a decrement to PA promotion when a nutrition intervention was added, neither do they reveal any additional benefit. More studies comparing single versus multibehavioral interventions are needed.

    View details for DOI 10.1037/0278-6133.23.3.314

    View details for Web of Science ID 000221120800012

    View details for PubMedID 15099173

  • Reliability and validity of a fruit and vegetable screening measure for adolescents JOURNAL OF ADOLESCENT HEALTH Prochaska, J. J., Sallis, J. F. 2004; 34 (3): 163-165

    Abstract

    We developed and evaluated a brief measure of fruit and vegetable consumption for adolescents. The measure was reliable and significantly correlated with 3-day food record data. Correct classification rate (63%) and specificity (63%) were good. Sensitivity (33%) was lower. The measure is recommended, although improvements in classification are still needed.

    View details for DOI 10.1016/j.jadohealth.2003.07.001

    View details for Web of Science ID 000189118800003

    View details for PubMedID 14967337

  • Environmental interventions for eating and physical activity - A randomized controlled trial in middle schools AMERICAN JOURNAL OF PREVENTIVE MEDICINE Sallis, J. F., McKenzie, T. L., Conway, T. L., Elder, J. P., Prochaska, J. J., Brown, M., Zive, M. M., Marshall, S. J., Alcaraz, J. E. 2003; 24 (3): 209-217

    Abstract

    Our objective was to evaluate the effects of environmental, policy, and social marketing interventions on physical activity and fat intake of middle school students on campus.Twenty-four middle schools were randomly assigned to intervention or control conditions. Baseline measures were collected in spring 1997, and interventions were conducted during the 1997-1998 and 1998-1999 school years SETTING/PARTICIPATION: The schools had mean enrollments of 1109, with 44.5% nonwhite students. Over 2 years, physical activity interventions were designed to increase physical activity in physical education classes and throughout the school day. Nutrition interventions were designed to provide and market low-fat foods at all school food sources, including cafeteria breakfasts and lunches, a la carte sources, school stores, and bag lunches. School staff and students were engaged in policy change efforts, but there was no classroom health education.Primary outcomes were measured by direct observation and existing records.Randomized regression models (N =24 schools) revealed a significant intervention effect for physical activity for the total group (p <0.009) and boys (p <0.001), but not girls (p <0.40). The intervention was not effective for total fat (p <0.91) or saturated fat (p <0.79). Survey data indicated that the interventions reduced reported body mass index for boys (p <0.05).Environmental and policy interventions were effective in increasing physical activity at school among boys but not girls. The interventions were not effective in reducing fat intake at school. School environmental and policy interventions have the potential to improve health behavior of the student population, but barriers to full implementation need to be better understood and overcome.

    View details for DOI 10.1016/S0749-3797(02)00646-3

    View details for Web of Science ID 000182213700001

    View details for PubMedID 12657338

  • Sources of dietary fat in middle schools PREVENTIVE MEDICINE Zive, M. M., Elder, J. P., Prochaska, J. J., Conway, T. L., Pelletier, R. L., Marshall, S., Sallis, J. F. 2002; 35 (4): 376-382

    Abstract

    The current study uses an ecological approach to describe the food environment at 24 middle schools and multiple food sources' dietary fat contribution.Five consecutive days were sampled for collection of school meals, a la carte, and student store data. Bag lunch contents were observed on 3 days. Measurement included grams of saturated and total fat plus sales or participation data.Average total fat grams per meal were 21 g (SD = 2) for bag lunches, 14 g (SD = 5) for Type A breakfast, and 31 g (SD = 8) for Type A lunches. Average fat grams per item were 13 g (SD = 3) for a la carte and 6 g (SD = 2) for student stores. Students purchased or brought to school a mean of 26 g (SD = 3) of total and 8 g (SD = 1) of saturated fat. Contributions to total fat grams were 42% by Type A lunches, 27% by a la carte foods, 25% by bag lunches, 3% by Type A breakfast, and 2% by student stores. Findings for saturated fat were similar.Middle school students eat excessive amounts of fat at school, and multiple sources of food must be considered to understand the school food environment.

    View details for DOI 10.1006/pmed.2002.1089

    View details for Web of Science ID 000178188300011

    View details for PubMedID 12453715

  • Association of parent and peer support with adolescent physical activity RESEARCH QUARTERLY FOR EXERCISE AND SPORT Prochaska, J. J., Rodgers, M. W., Sallis, J. F. 2002; 73 (2): 206-210

    View details for Web of Science ID 000176240200011

    View details for PubMedID 12092896

  • Preliminary evaluation of a multicomponent program for nutrition and physical activity change in primary care: PACE+ for adults PREVENTIVE MEDICINE Calfas, K. J., Sallis, J. F., Zabinski, M. F., Wilfley, D. E., Rupp, J., Prochaska, J. J., Thompson, S., Pratt, M., Patrick, K. 2002; 34 (2): 153-161

    Abstract

    Patient-centered Assessment and Counseling on Exercise plus nutrition (PACE+) is an intervention based in primary care settings to help patients change physical activity and dietary behaviors.One hundred seventy-three adults were assessed before and after a 4-month intervention. All patients completed a computerized assessment and created tailored "action plans" to change one physical activity and one nutrition behavior that they then discussed with their provider. After the visit, subjects were randomized to one of four extended intervention conditions: control, mail only, infrequent phone and mail, and frequent phone and mail. Self-report of five target behaviors (moderate and vigorous physical activity stage of change, dietary fat, fruit/vegetable intake, and overeating behaviors) was collected at baseline and 4 months. Acceptability measures were also taken.Participants in all conditions improved on all behaviors over time, supporting the utility of the computer and provider counseling components. The extended intervention did not produce differential results with respect to mode (phone or mail) or intensity (frequent or infrequent). However, for each behavior, participants who targeted the behavior to change improved significantly more than those who did not target the behavior. Acceptability of the intervention was high.Primary care-based, interactive health communication to improve physical activity and dietary behavior is feasible and has promising initial results.

    View details for DOI 10.1006/pmed.2001.0964

    View details for Web of Science ID 000173788200007

    View details for PubMedID 11817910

  • Physical activity levels of Barbadian youth and comparison to a US sample INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE Prochaska, J. J., Sallis, J. F., Griffith, B., Douglas, J. 2002; 9 (4): 360-372

    Abstract

    This is the first study to report on physical activity levels of young people in Barbados. The Self-Administered Physical Activity Checklist was administered to 1,579 children aged 8 to 18 years. The majority of youth (69%) reported at least 60 min of physical activity on the previous school day. Boys and younger students reported greater physical activity than girls and older students (p < .001). Participation in physical education was low among primary (30%) and secondary (18%) school students, and youth reported the majority of their physical activity took place after school (58%). Physical activity levels and patterns were similar to those of U.S. youth. Gender and grade differences in physical activity could put girls and older youth at higher risk for health problems such as obesity. Policy recommendations to support youth physical activity in Barbados include mandatory daily physical education and after-school physical activity programs.

    View details for Web of Science ID 000179479400005

    View details for PubMedID 12508670

  • Screening measure for assessing dietary fat intake among adolescents PREVENTIVE MEDICINE Prochaska, J. J., Sallis, J. F., Rupp, J. 2001; 33 (6): 699-706

    Abstract

    Clinical preventive guidelines recommend that health care providers counsel adolescents on nutrition. Brief, accurate, and reproducible dietary assessments are needed. The purpose of the current pair of studies was to develop a dietary fat screening measure for use with adolescents.Two measures were developed-a 21-item and a 4-category measure. The measures differed in the level at which fat consumption was assessed (food item vs food group). Study 1 (N = 231, age M = 15 years, 57% female, 41% Euro-American) evaluated reliability. Study 2 (N = 59, age M = 14 years, 63% female, 37% Euro-American) evaluated construct validity and correct classification rates.Internal consistencies (alpha > 0.70) and test-retest reliabilities (ICC > 0.60) were adequate for both measures. Neither measure correlated with total fat assessed by a 3-day food record (P > 0.05). The 21-item measure correlated significantly with percentage of calories from fat (r = 0.36, P <.01). Correct classification rate (71%) and sensitivity (81%) of the 21-item measure were good. Specificity (47%) was lower, indicating some subjects with a low-fat diet were misclassified by the screening measure.The 21-item measure is quick to complete and score, is inexpensive to reproduce, and has demonstrated reliability and validity. The measure could be clinically useful, but further improvements should be attempted to improve specificity.

    View details for DOI 10.1006/pmed.2001.0951

    View details for Web of Science ID 000173102800025

    View details for PubMedID 11716669

  • A multicomponent program for nutrition and physical activity change in primary care - PACE+ for adolescents ARCHIVES OF PEDIATRICS & ADOLESCENT MEDICINE Patrick, K., Sallis, J. F., Prochaska, J. J., Lydston, D. D., Calfas, K. J., Zabinski, M. F., Wilfley, D. E., Saelens, B. E., Brown, D. R. 2001; 155 (8): 940-946

    Abstract

    Most adolescents do not meet national recommendations for nutrition and physical activity. However, no studies of physical activity and nutrition interventions for adolescents conducted in health care settings have been published. The present study was an initial evaluation of the PACE+ (Patient-centered Assessment and Counseling for Exercise plus Nutrition) program, delivered in primary care settings.Adolescents aged 11 to 18 years (N = 117) were recruited from 4 pediatric and adolescent medicine outpatient clinics. Participants' mean (SD) age was 14.1 (2.0) years, 37% were girls, and 43% were ethnic minorities.Behavioral targets were moderate physical activity, vigorous physical activity, fat intake, and fruit and vegetable intake. All patients completed a computerized assessment, created tailored action plans to change behavior, and discussed the plans with their health care provider. Patients were then randomly assigned to receive no further contact or 1 of 3 extended interventions: mail only, infrequent telephone and mail, or frequent telephone and mail.Brief, validated, self-report measures of target behaviors were collected at baseline and 4 months later.All outcomes except vigorous physical activity improved over time, but adolescents who received the extended interventions did not have better 4-month outcomes than those who received only the computer and provider counseling components. Adolescents who targeted a behavior tended to improve more than those who did not target the behavior, except for those who targeted vigorous physical activity.A primary care-based interactive health communication intervention to improve physical activity and dietary behaviors among adolescents is feasible. Controlled experimental research is needed to determine whether this intervention is efficacious in changing behaviors in the short- and long-term.

    View details for Web of Science ID 000170237100013

    View details for PubMedID 11483123

  • The association of school environments with youth physical activity AMERICAN JOURNAL OF PUBLIC HEALTH Sallis, J. F., Conway, T. L., Prochaska, J. J., McKenzie, T. L., Marshall, S. J., Brown, M. 2001; 91 (4): 618-620

    Abstract

    This study assessed the association of school environmental characteristics with student physical activity on campus.Physical activity areas (n = 137) at 24 public middle schools were assessed for area type, size, and improvements (e.g., basketball courts). Student physical activity and the presence of equipment and supervision were directly observed before school, after lunch, and after school.Environmental characteristics explained 42% of the variance in the proportion of girls who were physically active and 59% of the variance for boys.School environments with high levels of supervision and improvements stimulated girls and boys to be more physically active.

    View details for Web of Science ID 000170345100015

    View details for PubMedID 11291375

  • PACE+ - Interactive communication technology for behavior change in clinical settings AMERICAN JOURNAL OF PREVENTIVE MEDICINE Prochaska, J. J., Zabinski, M. F., Calfas, K. J., Sallis, J. F., Patrick, K. 2000; 19 (2): 127-131

    Abstract

    Interactive health communication technologies have the potential to eliminate or greatly reduce many of the barriers to delivery of preventive services. This paper describes the process of developing and evaluating interactive health communication programs for primary care settings. We present as examples the Patient-centered Assessment and Counseling for Exercise plus Nutrition (PACE+) programs, designed to promote physical activity and healthy nutrition with adolescents and adults.The PACE+ programs use interactive communication technology to screen multiple behaviors, prioritize areas for intervention, and initiate intervention. Patient information is synthesized for ease of use by clinicians. The patient completes the program on a computer in the clinic waiting room before the provider encounter. Acceptability of the program was evaluated with adolescents (n=252), adults (n=285), and their health care providers.The PACE+ programs were developed, evaluated, modified, and re-evaluated. Feasibility testing indicated that a diverse group of adolescents and adults found the PACE+ computer programs acceptable. Modifications to shorten and refine the programs were identified.Development of interactive health technologies is an iterative process dependent on feedback from intended users and systems of care. Interactive health communication technologies can be incorporated into clinical settings.

    View details for Web of Science ID 000088449800010

    View details for PubMedID 10913904

  • Examination of the factor structure of physical activity behaviors JOURNAL OF CLINICAL EPIDEMIOLOGY Prochaska, J. J., Sallis, J. F., Sarkin, J. A., Calfas, K. J. 2000; 53 (8): 866-874

    Abstract

    Multiple physical activity recommendations exist for behaviors that vary in type and intensity (e.g., vigorous physical activity, strengthening exercises, moderate physical activity). The present study examined underlying dimensions of physical activity behaviors and determined the extent to which factors correspond to national health recommendations. Fifteen variables were drawn from six self-report measures and subjected to factor analysis with quartimax rotation. Participants were 547 university seniors (56% female; 60% Caucasian; mean age = 25 years). TV watching, the only index of sedentary behavior, did not load highly with other items, and was analyzed separately. Three interpretable factors were found: variables related to vigorous physical activity loaded highly on Factor 1; flexibility and strengthening items loaded highly on Factor 2; and moderate and housework activity loaded highly on Factor 3. Factors corresponded closely to national recommendations. Unweighted factor scores and TV watching correlated significantly with physiological indicators of fitness, supporting construct validity.

    View details for Web of Science ID 000088908400014

    View details for PubMedID 10942871

  • A review of correlates of physical activity of children and adolescents MEDICINE AND SCIENCE IN SPORTS AND EXERCISE Sallis, J. F., Prochaska, J. J., Taylor, W. C. 2000; 32 (5): 963-975

    Abstract

    Understanding the factors that influence physical activity can aid the design of more effective interventions. Previous reviews of correlates of youth physical activity have produced conflicting results.A comprehensive review of correlates of physical activity was conducted, and semiquantitative results were summarized separately for children (ages 3-12) and adolescents (ages 13-18). The 108 studies evaluated 40 variables for children and 48 variables for adolescents.About 60% of all reported associations with physical activity were statistically significant. Variables that were consistently associated with children's physical activity were sex (male), parental overweight status, physical activity preferences, intention to be active, perceived barriers (inverse), previous physical activity, healthy diet, program/facility access, and time spent outdoors. Variables that were consistently associated with adolescents' physical activity were sex (male), ethnicity (white), age (inverse), perceived activity competence, intentions, depression (inverse), previous physical activity, community sports, sensation seeking, sedentary after school and on weekends (inverse), parent support, support from others, sibling physical activity, direct help from parents, and opportunities to exercise.These consistently related variables should be confirmed in prospective studies, and interventions to improve the modifiable variables should be developed and evaluated.

    View details for Web of Science ID 000086723700014

    View details for PubMedID 10795788

  • Correlates of physical activity in a national sample of girls and boys in Grades 4 through 12 HEALTH PSYCHOLOGY Sallis, J. F., Prochaska, J. J., Taylor, W. C., Hill, J. O., Geraci, J. C. 1999; 18 (4): 410-415

    Abstract

    Psychological, biological, social, and physical environmental variables were examined for their association with physical activity of young people. A national sample of 1,504 parents and children in Grades 4-12 were interviewed by telephone. Twenty-two potential determinants were assessed along with an 11-item child physical activity index (alpha = .76). Hierarchical multiple regressions were conducted separately for 6 age-sex subgroups. Percentage of variance explained ranged from 18% for boys in Grades 4-6 to 59% for girls in Grades 10-12. Three variables had strong and consistent associations with the child physical activity index that generalized across subgroups: use of afternoon time for sports and physical activity, enjoyment of physical education, and family support for physical activity. These 3 variables should be targeted for change to promote physical activity in all groups of young people.

    View details for Web of Science ID 000081525500012

    View details for PubMedID 10431943

Conference Proceedings


  • Depression and stages of change for smoking in psychiatric outpatients Acton, G. S., Prochaska, J. J., Kaplan, A. S., Small, T., Hall, S. M. PERGAMON-ELSEVIER SCIENCE LTD. 2001: 621-631

    Abstract

    This article reports on the relations between depression and stages of change for smoking cessation. A convenience sample of 205 psychiatric outpatients (68% female, mean age 41) completed measures of depression Primary Care Evaluation of Mental Disorders [PRIME-MD] and Beck Depression Inventory-II [BDI-II]), all transtheoretical model constructs related to smoking (stages and processes of change, pros and cons of smoking, and situational temptations), and thoughts about abstinence. As hypothesized, patients who had never smoked showed substantially lower rates of currently diagnosed major depressive disorder (MDD) than those who had ever smoked. Patients in early stages of change did not show more MDD or depressive symptoms but, as hypothesized, showed more negative thoughts about abstinence. Findings are consistent with the documented association between smoking and depression and suggest the appropriateness of building smoking cessation interventions based on the transtheoretical model of change for use with psychiatric populations.

    View details for Web of Science ID 000171105700001

    View details for PubMedID 11676374

  • A physical activity screening measure for use with adolescents in primary care Prochaska, J. J., Sallis, J. F., Long, B. AMER MEDICAL ASSOC. 2001: 554-559

    Abstract

    To develop a reliable and valid physical activity screening measure for use with adolescents in primary care settings.We conducted 2 studies to evaluate the test-retest reliability and concurrent validity of 6 single-item and 3 composite measures of physical activity. Modifications were based on the findings of the 2 studies, and a best measure was evaluated in study 3. Accelerometer data served as the criterion standard for tests of validity.In study 1 (N = 250; mean age, 15 years; 56% female; 36% white), reports on the composite measures were most reliable. In study 2 (N = 57; mean age, 14 years; 65% female; 37% white), 6 of the 9 screening measures correlated significantly with accelerometer data. Subjects, however, had great difficulty reporting bouts of activity and distinguishing between intensity levels. Instead, we developed a single measure assessing accumulation of 60 minutes of moderate to vigorous physical activity. Evaluated in study 3 (N = 148; mean age, 12 years; 65% female; 27% white), the measure was reliable (intraclass correlation, 0.77) and correlated significantly (r = 0.40, P<.001) with accelerometer data. Correct classification (63%), sensitivity (71%), and false-positive rates (40%) were reasonable.The "moderate to vigorous physical activity" screening measure is recommended for clinical practice with adolescents.

    View details for Web of Science ID 000168417000005

    View details for PubMedID 11343497

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