The Effectiveness of Abstinence Education Programs in Reducing Sexual Activity among Youth. The Heritage Foundation Backgrounder.

ERIC Educational Resources Information Center

Rector, Robert

Teenage sexual activity is a major problem confronting the nation and has led to a rising incidence of sexually transmitted diseases, emotional and psychological injuries, and out-of-wedlock childbearing. Abstinence education programs for youth have proven effective in reducing early sexual activity. They can also provide the foundation for…

The Evaluation of Abstinence Education Programs Funded Under Title V Section 510: Interim Report.

ERIC Educational Resources Information Center

Devaney, Barbara; Johnson, Amy; Maynard, Rebecca; Trenholm, Chris

This report presents interim findings from an independent, federally funded evaluation of the abstinence education programs authorized under the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) and defined under Title V, Section 510 (b)(2)(A-H) of the Social Security Act. The report draws heavily on 4 years of…

Government Influence and Community Involvement on Abstinence-Only Programs in 1999 and 2003

ERIC Educational Resources Information Center

Gusrang, Jamie L.; Cheng, Simon

2010-01-01

In this study, we compare federal government influence on abstinence-only programs in 1999 and 2003 to better see how shifts in the federal government's sex education polices impacted other government and community actors. Using data from the Sex Education in America Surveys (SEAS), we find that changes in federal policy, particularly after the…

Comprehensive Sex Education: Research and Results

ERIC Educational Resources Information Center

Advocates for Youth, 2009

2009-01-01

Since 1997 the federal government has invested more than $1.5 billion dollars in abstinence-only programs--proven ineffective programs which censor or exclude important information that could help young people protect their health. In fact, until recently, programs which met a strict abstinence-only definition were the only type of sex education…

Implementing and Evaluating a Rural Community-Based Sexual Abstinence Program: Challenges and Solutions

ERIC Educational Resources Information Center

Stauss, Kimberly; Boyas, Javier; Murphy-Erby, Yvette

2012-01-01

Informing both program evaluation and practice research, this paper describes lessons learned during the planning, implementation, and pilot phases of an abstinence education program based in a rural community in a southern state in the USA. Although a number of challenges can emerge in successfully implementing and evaluating such a program in a…

An Abstinence Program's Impact on Cognitive Mediators and Sexual Initiation

ERIC Educational Resources Information Center

Weed, Stan E.; Ericksen, Irene H.; Lewis, Allen; Grant, Gale E.; Wibberly, Kathy H.

2008-01-01

Objectives: To evaluate the impact of an abstinence education program on sexual intercourse initiation and on possible cognitive mediators of sexual initiation for virgin seventh graders in suburban Virginia. Methods: Measures of sexual behavior and 6 mediating variables were compared at 3 time periods for program participants and a matched…

Sexual abstinence: What is the understanding and views of secondary school learners in a semi-rural area of North West Province, South Africa?

PubMed Central

Mokwena, Kebogile; Morabe, Mamaponesa

2016-01-01

Abstract Among strategies to prevent HIV, other sexually transmitted infections (STIs) and unwanted pregnancies, are programs that promote sexual abstinence among adolescents. However, literature suggests that there may be differences in the understanding of abstinence across adolescents, and this study sought to explore the understanding of sexual abstinence among both male and female learners in a secondary school in a semi-rural area of North West Province, South Africa. Focus group discussions were used to collect data from learners who were in grades 8–10 at the time of the study. The findings are that the learners in this area understand sexual abstinence as the decision not to have sex, and this was associated with prevention of HIV, STIs and unwanted pregnancies, which ensures a better future. Barriers to sexual abstinence include peer pressure, myths and wrong perceptions about sex, influence of drugs and alcohol and the influence of television. Based on how it is delivered, school-based sex education was viewed as both an enabler and barrier to sexual abstinence. It is recommended that programs to promote sexual abstinence be strengthened and such programs be community-based. PMID:27315574

Sexual abstinence: What is the understanding and views of secondary school learners in a semi-rural area of North West Province, South Africa?

PubMed

Mokwena, Kebogile; Morabe, Mamaponesa

2016-12-01

Among strategies to prevent HIV, other sexually transmitted infections (STIs) and unwanted pregnancies, are programs that promote sexual abstinence among adolescents. However, literature suggests that there may be differences in the understanding of abstinence across adolescents, and this study sought to explore the understanding of sexual abstinence among both male and female learners in a secondary school in a semi-rural area of North West Province, South Africa. Focus group discussions were used to collect data from learners who were in grades 8-10 at the time of the study. The findings are that the learners in this area understand sexual abstinence as the decision not to have sex, and this was associated with prevention of HIV, STIs and unwanted pregnancies, which ensures a better future. Barriers to sexual abstinence include peer pressure, myths and wrong perceptions about sex, influence of drugs and alcohol and the influence of television. Based on how it is delivered, school-based sex education was viewed as both an enabler and barrier to sexual abstinence. It is recommended that programs to promote sexual abstinence be strengthened and such programs be community-based.

Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S.

PubMed

Stanger-Hall, Kathrin F; Hall, David W

2011-01-01

The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.

Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S

PubMed Central

Stanger-Hall, Kathrin F.; Hall, David W.

2011-01-01

The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future. PMID:22022362

Exclusive purpose: abstinence-only proponents create federal entitlement in welfare reform.

PubMed

Daley, D

1997-01-01

Since 1981, the US government has funded a program promoting sexual abstinence among young people through its Office of Population's Adolescent Family Life Demonstration Grants program (AFLA). A 1983 court challenge which held that AFLA violated the separation of church and state by endorsing a particular religious viewpoint was settled out of court in 1993 with stipulations that AFLA-funded sexuality education must not include religious references, must be medically accurate, must respect the principle of self-determination of teenagers regarding contraceptive referrals, and must not be implemented on church property. Critics continue to charge that AFLA's abstinence-only programs have failed to receive proper evaluation. While AFLA has no broad-based support, it is backed by the same small group of Congressional proponents who are attempting to promote broad-scale, federally-funded abstinence-only programs. Thus, the August 1996 welfare reform legislation represents the broadest attack on the provision of comprehensive sexuality education in the US. While opponents of sexuality education could not restrict the content of education programs, they could restrict programs through health policy and funding mechanisms. Congress, thus, mandated $50 million a year for 1998-2002 to a matching grant with entitlement status, which was tagged on to final versions of the larger welfare reform bill. The intent of this action was to use federal law to change the social norm of premarital sexual activity. Funds will not go to programs which discuss contraception. Additional problems with the statute include misinformation, ambiguity, and a lack of evaluation requirements. It remains for states to decide whether to accept the restricted funds and for parties on both sides of the issue to continue to lobby for their positions.

The effectiveness of school-based sex education programs in the promotion of abstinent behavior: a meta-analysis.

PubMed

Silva, Mónica

2002-08-01

This review presents the findings from controlled school-based sex education interventions published in the last 15 years in the US. The effects of the interventions in promoting abstinent behavior reported in 12 controlled studies were included in the meta-analysis. The results of the analysis indicated a very small overall effect of the interventions in abstinent behavior. Moderator analysis could only be pursued partially because of limited information in primary research studies. Parental participation in the program, age of the participants, virgin-status of the sample, grade level, percentage of females, scope of the implementation and year of publication of the study were associated with variations in effect sizes for abstinent behavior in univariate tests. However, only parental participation and percentage of females were significant in the weighted least-squares regression analysis. The richness of a meta-analytic approach appears limited by the quality of the primary research. Unfortunately, most of the research does not employ designs to provide conclusive evidence of program effects. Suggestions to address this limitation are provided.

School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis.

PubMed

Fonner, Virginia A; Armstrong, Kevin S; Kennedy, Caitlin E; O'Reilly, Kevin R; Sweat, Michael D

2014-01-01

School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors. We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners. Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49-0.78, p<0.001), self-efficacy related to refusing sex or condom use (Hedges g = 0.25, 95% CI: 0.14-0.36, p<0.001), condom use (OR = 1.34, 95% CI: 1.18-1.52, p<0.001), fewer sexual partners (OR = 0.75, 95% CI:0.67-0.84, p<0.001) and less initiation of first sex during follow-up (OR = 0.66, 95% CI: 0.54-0.83, p<0.001). The paucity of abstinence-only or abstinence-plus interventions identified during the review made comparisons between the predominant comprehensive and less common abstinence-focused programs difficult. Comprehensive school-based sex education interventions adapted from effective programs and those involving a range of school-based and community-based components had the largest impact on changing HIV-related behaviors.

Impacts of Abstinence Education on Teen Sexual Activity, Risk of Pregnancy, and Risk of Sexually Transmitted Diseases

ERIC Educational Resources Information Center

Trenholm, Christopher; Devaney, Barbara; Fortson, Kenneth; Clark, Melissa; Bridgespan, Lisa Quay; Wheeler, Justin

2008-01-01

This paper examines the impacts of four abstinence-only education programs on adolescent sexual activity and risks of pregnancy and sexually transmitted diseases (STDs). Based on an experimental design, the impact analysis uses survey data collected in 2005 and early 2006 from more than 2,000 teens who had been randomly assigned to either a…

Evaluating a community saturation model of abstinence education: an application of social marketing strategies.

PubMed

Tanner, John F; Anne Raymond, Mary; Ladd, Stacey D

2009-01-01

This study examines a community saturation program, a social marketing strategy, promoting abstinence education and evaluates the effects of this strategy on adolescents' attitudes and sexual behaviors. The study also examines components of the strategy to determine which program element was most influential. The Worth the Wait program was implemented in five counties in Texas beginning in 1999 for the first county and in 2000 and 2001 for the other four counties. A total of 2007 students in grades 7 through 12 were tracked and answered an end-of-the-year post-program survey after varying time periods of school program participation. Results indicate that a saturation program can be effective in reducing teen pregnancy.

Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy.

PubMed

Kohler, Pamela K; Manhart, Lisa E; Lafferty, William E

2008-04-01

The role that sex education plays in the initiation of sexual activity and risk of teen pregnancy and sexually transmitted disease (STD) is controversial in the United States. Despite several systematic reviews, few epidemiologic evaluations of the effectiveness of these programs on a population level have been conducted. Among never-married heterosexual adolescents, aged 15-19 years, who participated in Cycle 6 (2002) of the National Survey of Family Growth and reported on formal sex education received before their first sexual intercourse (n = 1719), we compared the sexual health risks of adolescents who received abstinence-only and comprehensive sex education to those of adolescents who received no formal sex education. Weighted multivariate logistic regression generated population-based estimates. Adolescents who received comprehensive sex education were significantly less likely to report teen pregnancy (OR(adj) = .4, 95% CI = .22- .69, p = .001) than those who received no formal sex education, whereas there was no significant effect of abstinence-only education (OR(adj) = .7, 95% CI = .38-1.45, p = .38). Abstinence-only education did not reduce the likelihood of engaging in vaginal intercourse (OR(adj) = .8, 95% CI = .51-1.31, p = .40), but comprehensive sex education was marginally associated with a lower likelihood of reporting having engaged in vaginal intercourse (OR(adj) = .7, 95% CI = .49-1.02, p = .06). Neither abstinence-only nor comprehensive sex education significantly reduced the likelihood of reported STD diagnoses (OR(adj) = 1.7, 95% CI = .57-34.76, p = .36 and OR(adj) = 1.8, 95% CI = .67-5.00, p = .24 respectively). Teaching about contraception was not associated with increased risk of adolescent sexual activity or STD. Adolescents who received comprehensive sex education had a lower risk of pregnancy than adolescents who received abstinence-only or no sex education.

Utilizing Patient E-learning in an Intervention Study on Preoperative Smoking Cessation.

PubMed

Wong, Jean; Raveendran, Raviraj; Chuang, Junior; Friedman, Zeev; Singh, Mandeep; Patras, Jayadeep; Wong, David T; Chung, Frances

2018-05-01

Patients who smoke put themselves at increased risk for serious surgical complications, yet it is not currently routine practice to educate patients about the risk of complications due to smoking. Computer-based smoking cessation programs are increasingly being utilized in the general population and may overcome some of the barriers such as lack of time, knowledge, and training to provide interventions. Our objective was to develop and implement a patient e-learning program designed for surgical patients as part of a multifaceted program aimed at assisting them to quit smoking and to determine the factors cross-sectionally and longitudinally associated with abstinence. In this prospective multicenter study, smokers undergoing elective noncardiac surgery participated in a preoperative smoking cessation program consisting of a patient e-learning program, brief advice, educational pamphlet, tobacco quitline referral, letter to the primary care physician, and pharmacotherapy. The patient e-learning program described (1) the benefits of quitting smoking before surgery; (2) how to quit smoking; and (3) how to cope while quitting. The 7-day point prevalence (PP) abstinence on the day of surgery and at 1, 3 and 6 six months after surgery was separately assessed, and factors most associated with abstinence were identified using multivariable logistic regression analysis. Generalized estimating equation methods were used to estimate effect of the factors associated with abstinence longitudinally. The reach of the program was assessed with the number of smokers who participated in the program versus the number of patients who were referred to the program. A total of 459 patients (68.9% of eligible patients) participated. The 7-day PP abstinence at day of surgery, 1 month, 3 months, and 6 months was 22%, 29%, 25%, and 22%, respectively. The variables predicting abstinence at 6 months were use of pharmacotherapy (odds ratio [OR], 7.32; 95% confidence interval [CI], 3.71-14.44; P < .0001) and number of contacts with a tobacco quitline (OR, 1.60; 95% CI, 1.35-1.90; P < .0001). Presence of other smokers in the household (OR, 0.39; 95% CI, 0.21-0.72; P = .0030) and amount spent on cigarettes weekly at baseline (per $10 increase) (OR, 0.73; 95% CI, 0.61-0.87; P = .0004) were barriers to abstinence. Our preoperative smoking cessation program resulted in a 7-day PP abstinence of 22% at 6 months. A multifaceted intervention including a patient e-learning program may be a valuable tool to overcome some of the barriers to help surgical patients quit smoking.

Community-based abstinence education project: program outcomes.

PubMed

Bailey, Denise Nagle; Wolf, Zane Robinson

2015-01-01

Middle school and adolescent populations demonstrate high rates of unintended pregnancies and sexually transmitted infections, with young people in inner cities in the United States especially vulnerable. Teen births remain high, and youth are affected physically, mentally, socially, and economically. The Sex After Marriage primary prevention program, a federally funded, community-based abstinence education (CBAE) initiative, was implemented for 3 years in Philadelphia neighborhoods with vulnerable youth 12 to 18 years of age, supporting adults, healthcare professionals, and the general public. The three-tiered program offered a middle school curriculum, Sex Can Wait, at 16 different sites. The CBAE program delivered by the university's nursing center attempted to support vulnerable youths' decisions to postpone sexual activity by matching the interests of young people through an established curriculum, by holding workshops for supporting adults, and by creating a multimedia approach to supplement abstinence education initiatives including public service announcements and a website. Youth and college ambassadors and community colleagues were trained in the curriculum with a focus on healthy lifestyles. Youth and parents in experimental and control groups completed self-report surveys before and after program implementation. The project achieved most of its objectives on program evaluation. Youth (n = 1,428) 12 to 18 years of age received services, with most completing ≥75% of the program. Parents (n = 338) and other participating adults (n = 486) also received education or services. The need for risk reduction programs persists for youth in light of pregnancy, birth, and sexually transmitted disease statistics. Bailey Wolf. © 2014 Wiley Periodicals, Inc.

An evaluation of an abstinence-only sex education curriculum: an 18-month follow-up.

PubMed

Denny, George; Young, Michael

2006-10-01

The article examines the results from an 18-month follow-up evaluation of an abstinence education curriculum series. Participants were students from 15 school districts recruited to participate in the project. The intervention was the Sex Can Wait curriculum series, consisting of upper elementary, middle school, and high school components. The 5-week curriculum was implemented by teachers who had participated in a special teacher training workshop. Both intervention and comparison students were surveyed before and after the curriculum intervention and at 18-month follow-up. Results indicated short-term effects as follows. Upper elementary intervention students indicated higher level of knowledge, more hopefulness for the future, and greater self-efficacy than did the comparison group. Middle school intervention students did not differ from comparison students. High school intervention students reported lower participation rates than the comparison group students in sexual intercourse (ever and last month), a more positive attitude toward abstinence and a greater intent to remain abstinent. Long-term (18 month) benefits were noted as follows: upper elementary intervention students had greater knowledge and were less likely than comparison students to report participation in sexual intercourse in the last month. Middle school intervention students were less likely than comparison students to report participation in sexual intercourse ever and sexual intercourse in the last month. High school intervention students evidenced greater knowledge and greater intent to remain abstinent than did comparison students. Results indicate that the program did have some positive benefits that should be considered by those interested in abstinence education programming.

A Perioperative Smoking Cessation Intervention With Varenicline, Counseling, and Fax Referral to a Telephone Quitline Versus a Brief Intervention: A Randomized Controlled Trial.

PubMed

Wong, Jean; Abrishami, Amir; Riazi, Sheila; Siddiqui, Naveed; You-Ten, Eric; Korman, Jennifer; Islam, Sazzadul; Chen, Xin; Andrawes, Maged S M; Selby, Peter; Wong, David T; Chung, Frances

2017-08-01

The effectiveness of perioperative interventions to quit smoking with varenicline has not been compared with brief interventions. Our objective was to determine the efficacy of a comprehensive smoking cessation program versus a brief intervention for smoking cessation. In this prospective, multicenter study, 296 patients were randomized to participate in a smoking cessation program (one 10- to 15-minute counseling session, pharmacotherapy with varenicline, an educational pamphlet, and a fax referral to a telephone quitline); or brief advice and self-referral to a telephone quitline. The primary outcome was the 7-day point prevalence (PP) abstinence at 12 months after surgery. Secondary outcomes included abstinence at 1, 3, and 6 months. Multivariable generalized linear regression was used to identify independent variables related to abstinence. The 7-day PP abstinence for the smoking cessation program versus brief advice group was 42.4% vs 26.2% (relative risk [RR], 1.62; 95% confidence interval [CI], 1.16-2.25; P = .003) at 12 months. The 7-day PP abstinence at 1, 3, and 6 months was higher in the smoking cessation group versus the brief advice group: 45.7% vs 25.5% (RR, 1.79; 95% CI, 1.29-2.49; P < .001), 46.4% vs 26.9% (RR, 1.72; 95% CI, 1.25-2.37; P< .001), and 45.0% vs 26.2% (RR, 1.72; 95% CI, 1.24-2.38; P < .001), respectively. Participating in the smoking cessation group predicted abstinence at 12 months (RR, 1.58; 95% CI, 1.12-2.21; P = .0087). A perioperative smoking cessation program with counseling, pharmacotherapy with varenicline, an educational pamphlet, and a fax referral to a quitline increased abstinence from smoking 1, 3, 6, and 12 months after surgery versus a brief intervention.

HIV Education at the Secondary Level: An Urgent Necessity.

ERIC Educational Resources Information Center

Robenstine, Clark

1993-01-01

Regardless of sustained interest in abstinence-based sex education programs, a substantial portion of the teenage population engages in behaviors placing them at risk for HIV infection. At present, educating students and changing their unsafe voluntary behaviors is the only "cure" for AIDS. An effective education program is built around the peer…

Parents' perception, students' and teachers' attitude towards school sex education.

PubMed

Fentahun, Netsanet; Assefa, Tsion; Alemseged, Fessahaye; Ambaw, Fentie

2012-07-01

Sex education is described as education about human sexual anatomy, sexual reproduction, sexual intercourse, reproductive health, emotional relations, reproductive rights and responsibilities, abstinence, contraception, family planning, body image, sexual orientation, sexual pleasure, values, decision making, communication, dating, relationships, sexually transmitted infections (STIs) and how to avoid them, and birth control methods. This study was conducted to explore perception of parents about school sex education and assess the attitude of teachers and students towards school sex education. A cross-sectional quantitative and qualitative study was conducted on randomly selected 386 students, total census of 94 teachers and 10 parents in Merawi Town from March 13-27, 2011. Data were collected using self-administered structured questionnaire and in-depth interview guideline. Multiple linear regression analysis was performed using total score to determine the effect of the independent variables on the outcome variable and thematic analysis was used to analyze the qualitative data. All study participants have favourable attitude towards the importance of school sex education. They also agreed that the content of school sex education should include abstinence-only and abstinence-plus based on mental maturity of the students. That means at early age (Primary school) the content of school sex education should be abstinence-only and at later age (secondary school) the content of school sex education should be added abstinence-plus. The students and the teachers said that the minimum and maximum introduction time for school sex education is 5 year and 25 year with mean of 10.97(SD±4.3) and 12.36(SD±3.7) respectively. Teacher teaching experiences and field of studies have supportive idea about the starting of school sex education. Watching romantic movies, reading romantic materials and listening romantic radio programs appear to have a contribution on the predictor of students' attitude towards the starting time of school sex education. All study participants have a need to start sex education at school. All study participants said that at early age (Primary school) the content of school sex education is abstinence-only and at later age (secondary school) is added abstinence-plus. School Sex education should be under considers the need of students, teachers and parents.

Impacts of abstinence education on teen sexual activity, risk of pregnancy, and risk of sexually transmitted diseases.

PubMed

Trenholm, Christopher; Devaney, Barbara; Fortson, Kenneth; Clark, Melissa; Bridgespan, Lisa Quay; Wheeler, Justin

2008-01-01

This paper examines the impacts of four abstinence-only education programs on adolescent sexual activity and risks of pregnancy and sexually transmitted diseases (STDs). Based on an experimental design, the impact analysis uses survey data collected in 2005 and early 2006 from more than 2,000 teens who had been randomly assigned to either a program group that was eligible to participate in one of the four programs or a control group that was not. The findings show no significant impact on teen sexual activity, no differences in rates of unprotected sex, and some impacts on knowledge of STDs and perceived effectiveness of condoms and birth control pills

School Based Sex Education and HIV Prevention in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis

PubMed Central

Fonner, Virginia A.; Armstrong, Kevin S.; Kennedy, Caitlin E.; O'Reilly, Kevin R.; Sweat, Michael D.

2014-01-01

Objectives School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors. Methods We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners. Results Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49–0.78, p<0.001), self-efficacy related to refusing sex or condom use (Hedges g = 0.25, 95% CI: 0.14–0.36, p<0.001), condom use (OR = 1.34, 95% CI: 1.18–1.52, p<0.001), fewer sexual partners (OR = 0.75, 95% CI:0.67–0.84, p<0.001) and less initiation of first sex during follow-up (OR = 0.66, 95% CI: 0.54–0.83, p<0.001). Conclusions The paucity of abstinence-only or abstinence-plus interventions identified during the review made comparisons between the predominant comprehensive and less common abstinence-focused programs difficult. Comprehensive school-based sex education interventions adapted from effective programs and those involving a range of school-based and community-based components had the largest impact on changing HIV-related behaviors. PMID:24594648

Sexual abstinence behavior among never-married youths in a generalized HIV epidemic country: evidence from the 2005 Côte d'Ivoire AIDS indicator survey.

PubMed

Koffi, Alain K; Kawahara, Kazuo

2008-12-16

Sexual abstinence is the best available option for preventing both pregnancy and sexually transmitted infections, including HIV/AIDS. Identifying the factors associated with sexual abstinence among youths would have meaningful implications in a generalized HIV epidemic country such as the Côte d'Ivoire. Thus, we explored sexual abstinence behavior among never-married individuals aged 15 to 24 in Côte d'Ivoire and assessed factors that predict sexual abstinence. We obtained data from the nationally representative and population-based 2005 Côte d'Ivoire AIDS Indicator Survey, conducted from September 2004 to October 2005. Our sample included 3041 never-married people aged 15 to 24. Of these, 990 reported never having sexual intercourse (primary abstinence) and 137 reported sexual experience but not in the 12 months prior to the survey (secondary abstinence). In all, 1127 youths reported sexual abstinence practice. Of the 3041 never-married youths, 54.4% were male and 45.6% were female. About 33.0%, 6.7%, and 37.1% of them were practicing primary, secondary, and sexual abstinence behavior, respectively. Females of higher education level were significantly 11.14 times as likely as those of no education to practice either primary or secondary abstinence. Males who were animists, had no religion, or were practicing religions other than Christianity or Muslim were significantly less likely than other male youths to practice sexual abstinence (OR = 0.53, 95% CI = 0.30-0.95). Living in the north-west region of the country significantly decreased the odds of sexual abstinence among female youths. Similarly, female youths living in rural areas were significantly 0.42 times as likely as those in the urban zones to practice sexual abstinence. HIV/AIDS prevention program components could include media campaigns, educational intervention improvement, as well as promoting policies that shape female youth livelihoods. Likewise, youth involvement in initiatives to design appropriate messages, and activities to promote positive behaviors or to change negative perceptions could impact on youths' decision to exert abstinence behavior.

Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact.

PubMed

Santelli, John S; Kantor, Leslie M; Grilo, Stephanie A; Speizer, Ilene S; Lindberg, Laura D; Heitel, Jennifer; Schalet, Amy T; Lyon, Maureen E; Mason-Jones, Amanda J; McGovern, Terry; Heck, Craig J; Rogers, Jennifer; Ott, Mary A

2017-09-01

Adolescence is marked by the emergence of human sexuality, sexual identity, and the initiation of intimate relations; within this context, abstinence from sexual intercourse can be a healthy choice. However, programs that promote abstinence-only-until-marriage (AOUM) or sexual risk avoidance are scientifically and ethically problematic and-as such-have been widely rejected by medical and public health professionals. Although abstinence is theoretically effective, in actual practice, intentions to abstain from sexual activity often fail. Given a rising age at first marriage around the world, a rapidly declining percentage of young people remain abstinent until marriage. Promotion of AOUM policies by the U.S. government has undermined sexuality education in the United States and in U.S. foreign aid programs; funding for AOUM continues in the United States. The weight of scientific evidence finds that AOUM programs are not effective in delaying initiation of sexual intercourse or changing other sexual risk behaviors. AOUM programs, as defined by U.S. federal funding requirements, inherently withhold information about human sexuality and may provide medically inaccurate and stigmatizing information. Thus, AOUM programs threaten fundamental human rights to health, information, and life. Young people need access to accurate and comprehensive sexual health information to protect their health and lives. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Sex Can Wait: An Abstinence-Based Sexuality Curriculum for Middle School.

ERIC Educational Resources Information Center

Core-Gebhart, Pennie; And Others

This curriculum, directed primarily to students in grades seven and eight, is a five-week sexuality education program designed to promote sexual abstinence as the best decision young people can make for themselves. The guide is divided into three general areas of emphasis. These sections are divided into six units that focus the content of the…

Sex Can Wait: An Abstinence-Based Sexuality Curriculum for High School.

ERIC Educational Resources Information Center

Core-Gebhart, Pennie; And Others

This curriculum, directed primarily to students in grades nine and ten, is a 5-week sexuality education program designed to promote sexual abstinence as the best decision young people can make for themselves. The guide is divided into four general areas of emphasis. Section one, "Knowing Myself," helps students feel good about who they…

Sex Can Wait: An Abstinence-Based Sexuality Curriculum for Upper Elementary School.

ERIC Educational Resources Information Center

Young, Michael; Young, Tamera

This curriculum, directed primarily to students in grades five and six, is a 5-week sexuality education program designed to promote sexual abstinence as the best decision young people can make for themselves. The guide is divided into three general areas of emphasis: Knowing Myself, Reltating to Others, and Planning My Future. These sections are…

Advocates Call for a New Approach after the Era of "Abstinence-Only" Sex Education. Guttmacher Policy Review. Volume 12, Number 1, Winter 2009

ERIC Educational Resources Information Center

Boonstra, Heather D.

2009-01-01

In 1981, the first grants for what later came to be called "abstinence-only" programs were authorized under the Adolescent Family Life Act (AFLA). Sponsored by congressional family planning opponents, AFLA was promoted as a "family-centered" alternative to contraceptive counseling and services to teenagers; instead, this…

[Effects of TeenSTAR, an abstinence only sexual education program, on adolescent sexual behavior].

PubMed

Vigil, Pilar; Riquelme, Rosa; Rivadeneira, Rosario; Aranda, Waldo

2005-10-01

Urgent measures are required to stop the increase in the frequency of pregnancies and sexually transmitted diseases among teenagers. A means of facing this problem is promoting sexual abstinence among youngsters. There are studies that confirm the efficacy of this approach. To show the results of the application of a holistic sexuality program (TeenSTAR) among Chilean teenagers. Students attending basic or high school were divided into a control or study group. The control group (342 students) received the usual education on sexuality given by their schools and the study group (398 students) participated in twelve TeenSTAR sessions lasting 1.5 hours each, given by a trained professor. Assessment of achievements was made using an anonymous questionnaire answered at the start and end of the program. The rates of sexual initiation among control and study groups were 15 and 6.5%, respectively. Among sexually active students, 20% of those in the study group and 9% of those in the control group discontinued sexual activity. A higher proportion of students in the TeenSTAR program retarded their sexual initiation or discontinued sexual activity and found more reasons to maintain sexual abstinence than control students.

Hold the Sex, Please: The Discursive Politics between National and Local Abstinence Education Providers

ERIC Educational Resources Information Center

Hess, Amie

2010-01-01

There are many assumptions made about the beliefs behind abstinence-only until marriage (AOUM) sex education, yet comparatively little research examining the views of abstinence education providers. Drawing on in-depth interviews with 21 abstinence grantees throughout New York State, I examine how individuals working in abstinence organizations…

Texas Abstinence Educators' Self-Efficacy to Motivate Youth Sexual Abstinence

ERIC Educational Resources Information Center

Rasberry, Catherine N.; Goodson, Patricia; Buhi, Eric R.; Pruitt, B. E.; Wilson, Kelly; Suther, Sandra

2007-01-01

Authors examined self-efficacy to motivate abstinent behavior (among youth) in a sample of instructors teaching abstinence-only-until-marriage education in Texas (N = 104). Sixty-one percent of the sample had been trained/certified to teach abstinence education. Instructors (mostly female and White) were more confident motivating students to…

What Works Clearinghouse Quick Review of the Report "Efficacy of a Theory-Based Abstinence-Only Intervention Over 24 Months"

ERIC Educational Resources Information Center

What Works Clearinghouse, 2010

2010-01-01

The study examined whether a theory-based abstinence-only education program could reduce sexual behavior over a 24-month follow-up period. The study recruited sixth- and seventh-grade volunteers from four public middle schools serving low-income African-American communities in a city in the northeastern United States. The study authors randomly…

A Response to Teenage Pregnancy: Caring and Consistency.

ERIC Educational Resources Information Center

Hardebeck, Patience Lea

1987-01-01

Addresses the contributions Catholic educators can make to students' understanding of the conception and protection of life and of pregnancy. Suggests that educators present abstinence as the preferred form of birth control. Describes programs for improving prenatal care. (DMM)

The use of reconsent in a national evaluation of adolescent reproductive health programs.

PubMed

Palen, Lori-Ann; Ashley, Olivia Silber; Jones, Sarah B; Lyons, Jeffrey D; Derecho, Azucena A; Kan, Marni L; Richmond Scott, Alicia

2012-08-01

Reconsent involves asking research participants to reaffirm their consent for study participation when there have been significant changes in the study's procedures, risks, or benefits. We described the reconsent process, identified the reconsent rate, and examined the comparability of youths enrolled via consent and reconsent in a national evaluation of adolescent reproductive health programs. Evaluation participants from five abstinence education projects (N = 2,176) and nine projects serving pregnant or parenting adolescents (N = 878) provided either parent or youth consent or reconsent to participate in the national evaluation. Participants completed surveys that included demographic characteristics; sexual intentions, norms and behaviors; and pregnancy history. Multivariate logistic regression was used to examine associations between consent status, demographic characteristics, and risk indicators. The reconsent rates in the abstinence education and pregnant or parenting samples were 45% and 58%, respectively. Participant's age was positively associated with reconsent. Hispanic adolescents (and, for abstinence education, other racial/ethnic minorities) were underrepresented among youth with reconsent. Among abstinence education study participants, risk indicators were not associated with consent status. Among pregnant or parenting teens, those who had experienced repeat pregnancy were less likely than those who had experienced only one pregnancy to have been enrolled via reconsent. Reconsent can bolster sample size but may introduce bias by missing some racial/ethnic and age-groups. Among high-risk adolescents, reconsent may also yield a sample that differs from consented samples on risk characteristics, necessitating statistical adjustments when analyzing data. Copyright © 2012 Society for Adolescent Health and Medicine. All rights reserved.

Internet-delivered Treatment for Substance Abuse: A Multi-site Randomized Controlled Clinical Trial

PubMed Central

Campbell, Aimee N. C.; Nunes, Edward V.; Matthews, Abigail G.; Stitzer, Maxine; Miele, Gloria M.; Polsky, Daniel; Turrigiano, Eva; Walters, Scott; McClure, Erin A.; Kyle, Tiffany L.; Wahle, Aimee; Van Veldhuisen, Paul; Goldman, Bruce; Babcock, Dean; Stabile, Patricia Quinn; Winhusen, Theresa; Ghitza, Udi E.

2014-01-01

Objective Drug and alcohol abuse constitutes a major public health problem. Computer-delivered interventions have potential to improve access to quality care. The objective of this study was to evaluate the effectiveness of the Therapeutic Education System, an internet-delivered behavioral intervention that includes motivational incentives, as a clinician-extender in the treatment of substance use disorders. Method Adult men and women (N=507) entering 10 outpatient addiction treatment programs were randomly assigned to 12-weeks of treatment-as-usual (n=252) or treatment-as-usual + Therapeutic Education System, whereby the intervention substituted for 2 hours of standard care per week (n=255). Therapeutic Education System consists of 62 computer-interactive modules covering skills for achieving and maintaining abstinence, plus prize-based motivational incentives contingent on abstinence and treatment adherence. Treatment-as-usual consisted of individual and group counseling at the participating programs. Primary outcomes were (1) abstinence from drugs and heavy drinking measured by twice weekly urine drug screens and self-report, and (2) time to drop-out from treatment. Results Compared to treatment-as-usual, those receiving Therapeutic Education System reduced dropout from treatment (Hazard Ratio=0.72 [95% CI, 0.57-0.92], P=.010), and increased abstinence (Odds Ratio=1.62 [95% CI: 1.12-2.35], P=.010), an effect that was more pronounced among patients with a positive urine drug and/or breath alcohol screen at the point of study entry (n=228) (Odds Ratio=2.18 [95% CI: 1.30-3.68], P=.003). Conclusion Internet-delivered interventions, such as Therapeutic Education System, have the potential to expand access and improve addiction treatment outcomes; additional research is needed to assess effectiveness in non-specialty clinical systems and to differentiate the effect of Community Reinforcement Approach and Contingency Management. PMID:24700332

Reading and Writing; Adult Education in Comprehensive Combined Addiction Treatment: Needs, Problems, and Benefits.

ERIC Educational Resources Information Center

Schneider, Karl A.; And Others

This paper describes the results of the first year of the Eagleville Reading Academy and Satellite Program, a demonstration project funded by the U.S. Office of Education, Right to Read. Eagleville Hospital and Rehabilitation Center treats addicts and alcoholics in a combined abstinent therapeutic community program setting. The goals of the…

Abstinence-Only Sex Education: College Students' Evaluations and Responses

ERIC Educational Resources Information Center

Gardner, Emily A.

2015-01-01

This qualitative study explores the abstinence-only sex education experiences of a small group of young adults in the southeastern USA. Most participants felt that their abstinence-only sex education had mixed value and low overall impact in their lives. Perceptions about abstinence, virginity, and marriage varied significantly from those stressed…

Beyond Abstinence-Only: Relationships between Abstinence Education and Comprehensive Topic Instruction

ERIC Educational Resources Information Center

Jeffries, William L., IV; Dodge, Brian; Bandiera, Frank C.; Reece, Michael

2010-01-01

In the United States, a debate exists as to whether abstinence-only or comprehensive sexuality education strategies are most beneficial for school-age youth. Despite abstinence being a fundamental component of comprehensive education, the two are often characterized as polar opposites. Few studies have examined overlaps between the approaches. The…

Abstinence-related word associations and definitions of abstinence and virginity among missouri high school freshmen.

PubMed

Wilson, Kelly L; Smith, Matthew Lee; Menn, Mindy

2013-11-01

The ways in which adolescents define and view sex, abstinence, and virginity impact the efforts of sexuality educators and sexual health professionals. This study examined terminology used by nonsexually active high school students to define abstinence and virginity and identified words students associate with these terms. Purposes included (1) describing words/phrases associated with abstinence; (2) describing phrases for "being abstinent until marriage" and "being a virgin;" (3) assessing concordance between word dyads associated with abstinence; and (4) assessing concordance between phrases defining "abstinent until marriage" and "a virgin." In this study, 216 freshmen provided information about beliefs, behaviors, and perceptions. Pearson chi-square tests and Wilcoxon sign-rank tests assessed sex-based differences, definitions, and levels of concordance were conducted. Girls' friends took an abstinence pledge (p = .004) and their parents (p = .025) and best friends (p < .001) think they should abstain. Male counterparts reported being dissatisfied with current sex status (p = .002) and high acceptance of sex before marriage (p = .011). Boys were more likely to endorse "negative" words than girls. Professionals need to use relevant materials incorporating terminology that resonates with adolescents and programs that engage coherent participant discussions. © 2013, American School Health Association.

Evaluation of a School-Based Sex Education Program for Low Income Male High School Students in Chile.

ERIC Educational Resources Information Center

Silva, Monica; Ross, Ines

2003-01-01

Evaluated a 1-year sex education program for low income male high school students in Chile. Findings for 92 students in the baseline year, 1993, and 196 students in the 1998 cohort show a reduction in the percentage of students reporting having had sexual intercourse, changes attitudes toward abstinence, and differences in communication about…

A Health Education Program in Poland from the Perspective of Adolescent Mothers

ERIC Educational Resources Information Center

Kopacz, Marek S.

2008-01-01

Poland subscribes to an abstinence-only model of reproductive health education called "Education for Life in the Family." The aim of this study was to determine if the perceptions of adolescent mothers could be used to improve delivery of the Polish model of education. This study was conducted using focus group interviews with fourteen…

The Hot New Work in Sex Ed.

ERIC Educational Resources Information Center

Natale, Jo Anna

1995-01-01

Abstinence education is receiving increased attention as a way of preventing both teen pregnancy and risky sexual behavior. Effective sex education programs provide basic information about the risks of unprotected intercourse and also address the social influences on sexual behavior. Sidebars contain student comments. (MLF)

Nigerian secondary school adolescents' perspective on abstinence-only sexual education as an effective tool for promotion of sexual health.

PubMed

Inyang, Mfrekemfon P; Inyang, Obonganyie P

2013-01-01

The success of any type of sexual education programme depends on the knowledge and preparedness for practice by adolescents. A recent study has found that an 'abstinence-only' sexual education programme is effective in reducing sexual activity among adolescents. Knowledge of abstinence-only sexual education and preparedness for practice as an effective tool for promotion of sexual health among Nigerian secondary school adolescents was studied. An analytic descriptive survey design was used for the study. The research population comprised of all public secondary schools in three southern geopolitical zones of the Niger Delta Region of Nigeria. A multistage sampling technique was used to select 2020 senior secondary school (SS1-SS3) students as sample for the study. A partially self-designed and partially adapted questionnaire from an 'abstinence-only versus comprehensive sex education' debate, from debatepedia (http://wiki.idebate.org/), entitled 'Questionnaire on Nigerian Secondary School Adolescents' Perspective on Abstinence-Only Sexual Education (QNSSAPAOSE)' was used in eliciting information from respondents. Hypotheses were formulated and tested. Frequency counts, percentage and Pearson Product Moment Correlation were used in analysing data. A greater proportion of secondary school adolescents in this study lacked knowledge of sexual education. About 80% of the respondents could not define sexual education. The general perspective on abstinence-only sexual education was negative, as revealed by the larger number of respondents who demonstrated unwillingness to practice abstinence-only sexual education. Specifically, of those who responded in favour of abstinence-only sexual education, the youngest group of adolescents (11-13 years) and the male respondents were more likely to accept this type of education than the other groups. Poor knowledge of sexual education could be responsible for unwillingness to practice abstinence-only sexual education. Sexual education should, therefore, be introduced into the secondary school curriculum and taught by well-prepared teachers to enable an informed decision on practice.

Nigerian secondary school adolescents’ perspective on abstinence-only sexual education as an effective tool for promotion of sexual health

PubMed Central

Inyang, Mfrekemfon P; Inyang, Obonganyie P

2013-01-01

The success of any type of sexual education programme depends on the knowledge and preparedness for practice by adolescents. A recent study has found that an ‘abstinence-only’ sexual education programme is effective in reducing sexual activity among adolescents. Knowledge of abstinence-only sexual education and preparedness for practice as an effective tool for promotion of sexual health among Nigerian secondary school adolescents was studied. An analytic descriptive survey design was used for the study. The research population comprised of all public secondary schools in three southern geopolitical zones of the Niger Delta Region of Nigeria. A multistage sampling technique was used to select 2020 senior secondary school (SS1-SS3) students as sample for the study. A partially self-designed and partially adapted questionnaire from an 'abstinence-only versus comprehensive sex education' debate, from debatepedia (http://wiki.idebate.org/), entitled 'Questionnaire on Nigerian Secondary School Adolescents’ Perspective on Abstinence-Only Sexual Education (QNSSAPAOSE)' was used in eliciting information from respondents. Hypotheses were formulated and tested. Frequency counts, percentage and Pearson Product Moment Correlation were used in analysing data. A greater proportion of secondary school adolescents in this study lacked knowledge of sexual education. About 80% of the respondents could not define sexual education. The general perspective on abstinence-only sexual education was negative, as revealed by the larger number of respondents who demonstrated unwillingness to practice abstinence-only sexual education. Specifically, of those who responded in favour of abstinence-only sexual education, the youngest group of adolescents (11-13 years) and the male respondents were more likely to accept this type of education than the other groups. Poor knowledge of sexual education could be responsible for unwillingness to practice abstinence-only sexual education. Sexual education should, therefore, be introduced into the secondary school curriculum and taught by well-prepared teachers to enable an informed decision on practice. PMID:24627776

Sex education and the news: lessons from how journalists framed virginity pledges.

PubMed

Mebane, Felicia E; Yam, Eileen A; Rimer, Barbara K

2006-09-01

This analysis of newspaper articles about virginity pledges published from 1987 to 2001 describes prominent news frames on sex education. The articles focused on True Love Waits, a nationwide virginity pledge campaign encouraging abstinence, and results from Add Health (TLW), a longitudinal study that included questions to evaluate the effects of virginity pledges. Our results show how news frames and sources can vary for related events. Reporting on virginity pledges was often not grounded in science, and reporting on the science of pledges did not reflect a broader context. In this case, reporting may have encouraged support for abstinence-only programs.

Adolescent pregnancy prevention: An abstinence-centered randomized controlled intervention in a Chilean public high school.

PubMed

Cabezón, Carlos; Vigil, Pilar; Rojas, Iván; Leiva, M Eugenia; Riquelme, Rosa; Aranda, Waldo; García, Carlos

2005-01-01

To evaluate the efficacy of an abstinence-centered sex education program in adolescent pregnancy prevention, the TeenSTAR Program was applied in a high school in Santiago, Chile. A total of 1259 girls from a Santiago high school were divided into three cohorts depending on the year they started high school: the 1996 cohort of 425 students, which received no intervention; the 1997 cohort, in which 210 students received an intervention and 213 (control group) did not; and the 1998 cohort, in which 328 students received an intervention and 83 (control group) did not. Students were randomly assigned to control and intervention groups in these cohorts, before starting with the program. We conducted a prospective, randomized study using the application of the TeenSTAR sex education program during the first year of high school to the intervention groups in the 1997 and 1998 cohorts. All cohorts were followed up for 4 years; pregnancy rates were recorded and subsequently contrasted in the intervention and control groups. Pregnancy rates were measured and Risk Ratio with 95% confidence interval were calculated for intervention and control groups in each cohort. Pregnancy rates for the intervention and control groups in the 1997 cohort were 3.3% and 18.9%, respectively (RR: 0.176, CI: 0.076-0.408). Pregnancy rates for the intervention and control groups in the 1998 cohort were 4.4% and 22.6%, respectively (RR 0.195, CI: 0.099-0.384). The abstinence-centered TeenSTAR sex education intervention was effective in the prevention of unintended adolescent pregnancy.

Randomized Controlled Trial Comparing Exercise to Health Education for Stimulant Use Disorder: Results From the CTN-0037 STimulant Reduction Intervention Using Dosed Exercise (STRIDE) Study.

PubMed

Trivedi, Madhukar H; Greer, Tracy L; Rethorst, Chad D; Carmody, Thomas; Grannemann, Bruce D; Walker, Robrina; Warden, Diane; Shores-Wilson, Kathy; Stoutenberg, Mark; Oden, Neal; Silverstein, Meredith; Hodgkins, Candace; Love, Lee; Seamans, Cindy; Stotts, Angela; Causey, Trey; Szucs-Reed, Regina P; Rinaldi, Paul; Myrick, Hugh; Straus, Michele; Liu, David; Lindblad, Robert; Church, Timothy; Blair, Steven N; Nunes, Edward V

To evaluate exercise as a treatment for stimulant use disorders. The STimulant Reduction Intervention using Dosed Exercise (STRIDE) study was a randomized clinical trial conducted in 9 residential addiction treatment programs across the United States from July 2010 to February 2013. Of 497 adults referred to the study, 302 met all eligibility criteria, including DSM-IV criteria for stimulant abuse and/or dependence, and were randomized to either a dosed exercise intervention (Exercise) or a health education intervention (Health Education) control, both augmenting treatment as usual and conducted thrice weekly for 12 weeks. The primary outcome of percent stimulant abstinent days during study weeks 4 to 12 was estimated using a novel algorithm adjustment incorporating self-reported Timeline Followback (TLFB) stimulant use and urine drug screen (UDS) data. Mean percent of abstinent days based on TLFB was 90.8% (SD = 16.4%) for Exercise and 91.6% (SD = 14.7%) for Health Education participants. Percent of abstinent days using the eliminate contradiction (ELCON) algorithm was 75.6% (SD = 27.4%) for Exercise and 77.3% (SD = 25.1%) for Health Education. The primary intent-to-treat analysis, using a mixed model controlling for site and the ELCON algorithm, produced no treatment effect (P = .60). In post hoc analyses controlling for treatment adherence and baseline stimulant use, Exercise participants had a 4.8% higher abstinence rate (78.7%) compared to Health Education participants (73.9%) (P = .03, number needed to treat = 7.2). The primary analysis indicated no significant difference between exercise and health education. Adjustment for intervention adherence showed modestly but significantly higher percent of abstinent days in the exercise group, suggesting that exercise may improve outcomes for stimulant users who have better adherence to an exercise dose. ClinicalTrials.gov identifier: NCT01141608. © Copyright 2017 Physicians Postgraduate Press, Inc.

Behavioral Outcomes and Self-Concept Improvement Through Adult Education of Addicts & Alcoholics in a Combined Abstinent Therapeutic Community.

ERIC Educational Resources Information Center

Schneider, Karl A.; And Others

This paper describes the results of the Eagleville Reading Academy and Satellite Program, a demonstration project funded by the U.S. Office of Education. Eagleville is a private, nonprofit hospital devoted to treatment, research, education and training for alcoholism and drug addiction. The therapeutic community setting includes individual and…

Worth the Wait? The Consequences of Abstinence-Only Sex Education for Marginalized Students

ERIC Educational Resources Information Center

Hoefer, Sharon E.; Hoefer, Richard

2017-01-01

"Abstinence-only" sex education, which is still widely used across the United States, does not prepare students to engage in healthy adult relationships. Prior research evidence indicates that abstinence-only education is less effective at preventing pregnancy and sexually transmitted infections (STIs) than comprehensive sex education.…

Should We Be Teaching Sex Education or Sexual Abstinence?

ERIC Educational Resources Information Center

Stover, Del

2007-01-01

In this article, the author examines the controversial issue whether to teach sex education or sexual abstinence. Sex education has always been fraught with controversy. The discord in Westbrook, Maine, school district is noteworthy because of the vocal support for an abstinence-only curriculum approach to sex education that has reshaped the…

Resource List--Using Evidence-Based Programs as the Foundation of Comprehensive Sex Education

ERIC Educational Resources Information Center

Advocates for Youth, 2015

2015-01-01

Decades of research have identified dozens of programs that are effective in helping young people reduce their risk for pregnancy, HIV, and STDs. These evidence-based programs utilize strategies that include the provision of accurate, honest information about abstinence as well as contraception and can serve as the foundation for comprehensive sex…

Evaluating Knowledge, Attitudinal, and Behavioral Change Effects from a Multinational HIV/AIDS Education Program for Youth

ERIC Educational Resources Information Center

Hardre, Patricia L.; Garcia, Fe; Apamo, Peter; Mutheu, Lucy; Ndege, Monica; Bois, Iderle

2010-01-01

This project tracked the mid-term evaluation processes, practices, and products of a multinational program to reduce at-risk behaviors for HIV/AIDS among children in Kenya, Tanzania, and Haiti. It focused on participant and community perceptions; program effectiveness in promoting abstinence and monogamy decisions; and factors supporting ongoing…

Neoliberal Narratives and the Logic of Abstinence Only Education: Why Are We Still Having This Conversation?

ERIC Educational Resources Information Center

Clark, Lauren; Stitzlein, Sarah M.

2018-01-01

Given the lack of citizen or medical support for abstinence-only education, we ask how abstinence-education maintains such a stronghold in America and other Western democracies' public policy and consciousness. Our response has three parts. In the first, we outline the disproportionately negative health outcomes of sex education experienced by…

Comprehensive Sexuality Education or Abstinence-Only Education: Which Is More Effective?

ERIC Educational Resources Information Center

Pittman, Vicki; Gahungu, Athanase

2006-01-01

The purpose of this study was to examine the difference in effectiveness between comprehensive sexuality abstinence-based education and abstinence-only education. A survey was developed and distributed to over 140 individuals via a variety of sources such as: (1) the researcher's e-mail lists; (2) a group of City Core/City Year volunteers; (3) a…

Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence.

PubMed

Manlove, Jennifer; Fish, Heather; Moore, Kristin Anderson

2015-01-01

US adolescents have high rates of teen pregnancy, childbearing, and sexually transmitted infections (STIs), highlighting the need to identify and implement effective programs that will help improve teen sexual and reproductive health. This review identified 103 random-assignment evaluations of 85 programs that incorporated intent-to-treat analyses and assessed impacts on pregnancy, childbearing, STIs, and their key determinants - sexual activity, number of sexual partners, condom use, and other contraceptive use - among teens. This review describes the evidence base for five broad program approaches, including abstinence education, comprehensive sex education, clinic-based programs, youth development programs, and parent-youth relationship programs. We also describe programs with impacts on key outcomes, including pregnancy/childbearing, STIs, and those that found impacts on both sexual activity and contraceptive use. Our review identified 52 effective programs: 38 with consistent impacts on reproductive health outcomes, and 14 with mixed findings (across subpopulations, follow-ups, or multiple measures of a single outcome). We found that a variety of program approaches produced impacts on sexual and reproductive health outcomes. Parent-youth relationship programs and clinic-based program evaluations more frequently showed impacts than other program approaches, although we also identified a number of abstinence-education, comprehensive sex education, and youth-development programs with impacts on sexual and reproductive health outcomes. Overall, we identified nine program evaluations with impacts on teen pregnancies or births, five with impacts on reducing STIs, and 15 with impacts on both delaying/reducing sexual activity and increasing contraceptive use (including condom use). Future efforts should conduct replications of existing program evaluations, identify implementation components linked to impacts, rigorously evaluate programs that appear promising, and expand the evidence base on programs that impact hormonal and long-acting contraceptive method use.

Assessing sexuality attitudes and behaviors and correlates of alcohol and drugs.

PubMed

Donnelly, J; Goldfarb, E S; Ferraro, H; Eadie, C; Duncan, D F

2001-06-01

The association between sexual abstinence and use of alcohol, cigarettes, and marijuana was examined in data from questionnaires completed by 874 students in Grades 6 through 8 at six urban schools. These students participated in a program that implemented and evaluated an educational program on abstinence sexuality. It focused on raising self-esteem, improving communication skills, and learning to set life goals. The evaluation instrument contained items assessing sexuality and attitudes toward behaviors related to drug use. Use of each drug (alcohol, tobacco, and marijuana) was significantly (p < .00001) and positively associated with self-report of having experienced sexual intercourse and expectation of having intercourse during the next year.

Abstinence

MedlinePlus

... Jobs Sports Expert Answers (Q&A) Staying Safe Videos for Educators Search English Español Abstinence KidsHealth / For Teens / Abstinence Print en español La abstinencia sexual What Is It? Abstinence is not having sex. A person who decides to practice abstinence has ...

Going Too Far?: Sex, Sin and Social Policy

ERIC Educational Resources Information Center

Rose, Susan

2005-01-01

This paper examines the impact of the Religious Right on American social policy as it relates to family, sexuality and reproductive health. The article focuses on the current debates and practices of abstinence-until-marriage programs vs. comprehensive sex education programs--and the ways in which they reflect and affect cultural attitudes about…

A Qualitative Evaluation of the Students of Service (SOS) Program for Sexual Abstinence in Louisiana

ERIC Educational Resources Information Center

Yoo, Seunghyun; Johnson, Carolyn C.; Rice, Janet; Manuel, Powlin

2004-01-01

Abstinence-only programs for preventing teen pregnancy are the only options in some states but are the programs of choice in others. Effectiveness data, however, are lacking. The SOS Adolescent Family Life Program (SOS), an abstinence-only teen pregnancy prevention program, was implemented in south central Louisiana. Peer mentoring with an…

Measurement and Design Issues in the Study of Adolescent Sexual Behavior and the Evaluation of Adolescent Sexual Health Behavior Interventions

ERIC Educational Resources Information Center

Young, Michael; Palacios, Rebecca; Penhollow, Tina M.

2012-01-01

To improve the quality of research and commentary concerning adolescent sexuality and evaluation of both comprehensive sexuality education and abstinence education programs, this article aims to help readers (1) select appropriate measures to study adolescent sexual behavior, (2) develop appropriate study designs to evaluate adolescent sexual…

Sexuality education policies and sexually transmitted disease rates in the United States of America.

PubMed

Hogben, M; Chesson, H; Aral, S O

2010-04-01

The aim of the study was to test for relationships between state-level sex educational policies and sexually transmitted disease (STD) rates. We analysed US case reports of gonorrhoea and chlamydial infection for 2001-2005 against state policies for abstinence coverage in sexuality education, using the proportion of the population per state who identified as black (aged 15-24 years) as a covariate. We also tested for effects on 15-19 year olds versus 35-39 year olds and tuberculosis rates (the latter to ensure findings applied only to STD). States with no mandates for abstinence had the lowest mean rates of infection among the overall population and among adolescents. States with mandates emphasizing abstinence had the highest rates; states with mandates to cover (but not emphasize) abstinence fell in between. Rates in some states covering abstinence changed faster than in others, as reflected in sharper declines (gonorrhoea) or slower increases (chlamydial infection). These effects were not shown for tuberculosis or 35-39 year olds. Having no abstinence education policy has no apparent effect on STD rates for adolescents. For states with elevated rates, policies mandating coverage may be useful, although policies emphasizing abstinence show no benefit.

Feeling Abstinent? Feeling Comprehensive? Touching the Affects of Sexuality Curricula

ERIC Educational Resources Information Center

Lesko, Nancy

2010-01-01

This interpretive study draws on interdisciplinary scholarship on affect and knowledge to ask: toward what feelings do abstinence-only and comprehensive sexuality education curricula direct us? A methodology that is attuned to double exposures is discussed, and one abstinence-only sexuality education curriculum and one comprehensive sexuality…

Queer Youth Experiences with Abstinence-Only-until-Marriage Sexuality Education: "I Can't Get Married so where Does that Leave Me?"

ERIC Educational Resources Information Center

Fisher, Christopher Micheal

2009-01-01

Abstinence-only-until-marriage sexuality education has received increasing attention vis-a-vis policy, funding, and research. Despite large sums of federal money to develop, implement, and to some extent, assess abstinence-only education, virtually no studies have looked to assess the experiences of such a curriculum for gay and bisexual male…

The impact of exercise on depression and anxiety symptoms among abstinent methamphetamine-dependent individuals in a residential treatment setting

PubMed Central

Rawson, Richard A.; Chudzynski, Joy; Gonzales, Rachel; Mooney, Larissa; Dickerson, Daniel; Ang, Alfonso; Dolezal, Brett; Cooper, Christopher B.

2015-01-01

Background This paper reports data from a study designed to determine the impact of an 8-week exercise program on depression and anxiety symptoms among newly abstinent methamphetamine (MA)-dependent individuals in residential treatment. Methods One hundred thirty-five MA-dependent individuals, newly enrolled in residential treatment, were randomly assigned to receive either a 3-times-per-week, 60-minute structured exercise program for 8 weeks (24 sessions) or an equivalent number of health education sessions. Using mixed-modeling repeated-measures regression, we examined changes in weekly total depression and anxiety scores as measured by the Beck Depression Inventory and Beck Anxiety Inventory over the 8-week study period. Results Mean age of participants was 31.7 (SD = 6.9); 70.4% were male and 48% Latino. Analyses indicate a significant effect of exercise on reducing depression (β = −0.63, P = 0.001) and anxiety (β = −0.95, P = 0.001) symptoms (total scores) over the 8-week period compared to a health education control group. A significant dose interaction effect between session attendance and exercise was found as well on reducing depression (β = −0.61, P < 0.001) and anxiety symptoms (β = −0.22, P = 0.009) over time compared to the control group. Conclusions Results support the role of a structured exercise program as an effective intervention for improving symptoms of depression and anxiety associated with MA abstinence. PMID:25934458

The Impact of Exercise On Depression and Anxiety Symptoms Among Abstinent Methamphetamine-Dependent Individuals in A Residential Treatment Setting.

PubMed

Rawson, Richard A; Chudzynski, Joy; Gonzales, Rachel; Mooney, Larissa; Dickerson, Daniel; Ang, Alfonso; Dolezal, Brett; Cooper, Christopher B

2015-10-01

This paper reports data from a study designed to determine the impact of an 8-week exercise program on depression and anxiety symptoms among newly abstinent methamphetamine (MA)-dependent individuals in residential treatment. One hundred thirty-five MA-dependent individuals, newly enrolled in residential treatment, were randomly assigned to receive either a 3-times-per-week, 60-minute structured exercise program for 8 weeks (24 sessions) or an equivalent number of health education sessions. Using mixed-modeling repeated-measures regression, we examined changes in weekly total depression and anxiety scores as measured by the Beck Depression Inventory and Beck Anxiety Inventory over the 8-week study period. Mean age of participants was 31.7 (SD = 6.9); 70.4% were male and 48% Latino. Analyses indicate a significant effect of exercise on reducing depression (β = -0.63, P = 0.001) and anxiety (β = -0.95, P=0.001) symptoms (total scores) over the 8-week period compared to a health education control group. A significant dose interaction effect between session attendance and exercise was found as well on reducing depression (β = -0.61, P < 0.001) and anxiety symptoms (β = -0.22, P=0.009) over time compared to the control group. Results support the role of a structured exercise program as an effective intervention for improving symptoms of depression and anxiety associated with MA abstinence. Copyright © 2015 Elsevier Inc. All rights reserved.

Socioeconomic status and the reward value of smoking following tobacco abstinence: a laboratory study.

PubMed

Reitzel, Lorraine R; Leventhal, Adam M

2014-11-01

Socioeconomic status (SES) indicators are robustly associated with smoking behaviors. Yet, the psychological mechanisms underlying relations are unclear. This study merged the socioecological construct of SES with laboratory psychological science to investigate how income, education, and employment status predicted the reward value of smoking following tobacco abstinence among a diverse sample of adult daily smokers. We hypothesized that participants with lower SES (i.e., less education, lower income, and unemployed) would experience greater abstinence-induced enhancement of the reward value of smoking. Adult smokers (N = 240; 68.7% male; 51.7% Black, 33.8% White, 7.1% Latino, and 7.5% other) attended 2 laboratory sessions (1 nonabstinent and 1 following 16-hr tobacco abstinence) involving behavioral assessment of (a) latency to smoking when delaying smoking was monetarily rewarded and (b) purchasing individual cigarettes. Generalized estimating equations were used to test the interaction between each SES variable (education, income, and employment) and abstinence state to illustrate whether participants with certain SES characteristics were more sensitive to the abstinence-induced enhancement of the relative reward value of smoking. Participants who never attended college (vs. college attendees) exhibited greater abstinence-induced enhancement of the reward value of smoking, which was indicated by reduced willingness to delay smoking for money (ps = .03). Income and employment status did not moderate abstinence effects. Less-educated smokers were particularly motivated to smoke during acute abstinence. Observed educational disparities in smoking behaviors and smoking cessation might reflect a biased valuation of immediate drug-related (over less immediate alternative) rewards. Future research should explore potential mediators of this association. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Socioeconomic Status and the Reward Value of Smoking Following Tobacco Abstinence: A Laboratory Study

PubMed Central

Leventhal, Adam M.

2014-01-01

Introduction: Socioeconomic status (SES) indicators are robustly associated with smoking behaviors. Yet, the psychological mechanisms underlying relations are unclear. This study merged the socioecological construct of SES with laboratory psychological science to investigate how income, education, and employment status predicted the reward value of smoking following tobacco abstinence among a diverse sample of adult daily smokers. We hypothesized that participants with lower SES (i.e., less education, lower income, and unemployed) would experience greater abstinence-induced enhancement of the reward value of smoking. Methods: Adult smokers (N = 240; 68.7% male; 51.7% Black, 33.8% White, 7.1% Latino, and 7.5% other) attended 2 laboratory sessions (1 nonabstinent and 1 following 16-hr tobacco abstinence) involving behavioral assessment of (a) latency to smoking when delaying smoking was monetarily rewarded and (b) purchasing individual cigarettes. Generalized estimating equations were used to test the interaction between each SES variable (education, income, and employment) and abstinence state to illustrate whether participants with certain SES characteristics were more sensitive to the abstinence-induced enhancement of the relative reward value of smoking. Results: Participants who never attended college (vs. college attendees) exhibited greater abstinence-induced enhancement of the reward value of smoking, which was indicated by reduced willingness to delay smoking for money (ps = .03). Income and employment status did not moderate abstinence effects. Conclusions: Less-educated smokers were particularly motivated to smoke during acute abstinence. Observed educational disparities in smoking behaviors and smoking cessation might reflect a biased valuation of immediate drug-related (over less immediate alternative) rewards. Future research should explore potential mediators of this association. PMID:24935756

Posttreatment drug use abstinence: does the majority program clientele matter?

PubMed

Duncan, Alexandra; Melnick, Gerald; Ahmed, Rashid; Furr-Holden, C Debra

2014-01-01

The current study examines differences in organizational characteristics and client posttreatment drug use abstinence in residential substance abuse treatment programs serving clients with high or low levels of legal coercion to participate in treatment. The findings show that low legal coercion programs have higher counselor caseloads (Z = 59, p < .05) than high coercion programs. Although the results showed that programs with a large proportion of African American clients (β = 14.26, p < .0001) and high legal coercion programs (β = 19.99, p < .05) predicted longer abstinence posttreatment, the final models suggest organizational factors are the key predictors of client posttreatment abstinence.

The Impact of Peers and Social Disapproval on High-Risk Cannabis Use: Gender Differences and Implications for Drug Education

ERIC Educational Resources Information Center

Butters, Jennifer E.

2004-01-01

Drug education programs that rely on an abstinence based philosophy neglect, and may even contribute to, the potentially adverse consequences experienced by young people who already engage in this potentially health-compromising behaviour. A predominant focus of drug research during the initial wave of rising cannabis use by young people in the…

Students' experiences and perceived benefits of a sex education curriculum: a qualitative analysis.

PubMed

Smith, Peggy B; Realini, Janet P; Buzi, Ruth S; Martinez, Mario

2011-01-01

A qualitative evaluation explored the experiences and perceived benefits of students who participated in an abstinence-plus sex education program at enrollment and conclusion. The sample included 1130 inner-city high school students, 73.7% of whom were Hispanic. Thematic analysis was used to identify main themes in responses made by students to 3 open-ended questions. The most common preparticipation request was for information about sexually transmitted infections. At program conclusion, the most common response theme involved the quality of course delivery. Students indicated that they appreciated the facilitators who allowed open conversations. The implications of these findings to sex education programs are discussed.

Evaluation of an Abstinence Based Intervention for Middle School Students

ERIC Educational Resources Information Center

Rue, Lisa; Chandran, Raj; Pannu, Aman; Bruce, David; Singh, Rana; Traxler, Karen

2012-01-01

Outcomes associated with an abstinence education intervention were evaluated using a single group design with a 12-month longitudinal follow-up. The intervention group of adolescents ages 12-14 years (N = 427) were enrolled in an 11.5-hour abstinence education intervention offered during the school day. Significant differences were found in the…

Drug Courts and Adolescents.

ERIC Educational Resources Information Center

Schwebel, Robert

2002-01-01

The narrow preoccupation with abstinence causes many substance-abusing youth to react either with dishonesty or resistance. Drug education and treatment programs need to help youth rethink their use of drugs, rather than utilize harshly confrontational tactics. Drug courts can provide sanctions, while treatment interventions such as the Seven…

Programs to improve adolescent sexual and reproductive health in the US: a review of the evidence

PubMed Central

Manlove, Jennifer; Fish, Heather; Moore, Kristin Anderson

2015-01-01

Background US adolescents have high rates of teen pregnancy, childbearing, and sexually transmitted infections (STIs), highlighting the need to identify and implement effective programs that will help improve teen sexual and reproductive health. Materials and methods This review identified 103 random-assignment evaluations of 85 programs that incorporated intent-to-treat analyses and assessed impacts on pregnancy, childbearing, STIs, and their key determinants – sexual activity, number of sexual partners, condom use, and other contraceptive use – among teens. This review describes the evidence base for five broad program approaches, including abstinence education, comprehensive sex education, clinic-based programs, youth development programs, and parent–youth relationship programs. We also describe programs with impacts on key outcomes, including pregnancy/childbearing, STIs, and those that found impacts on both sexual activity and contraceptive use. Results Our review identified 52 effective programs: 38 with consistent impacts on reproductive health outcomes, and 14 with mixed findings (across subpopulations, follow-ups, or multiple measures of a single outcome). We found that a variety of program approaches produced impacts on sexual and reproductive health outcomes. Parent–youth relationship programs and clinic-based program evaluations more frequently showed impacts than other program approaches, although we also identified a number of abstinence-education, comprehensive sex education, and youth-development programs with impacts on sexual and reproductive health outcomes. Overall, we identified nine program evaluations with impacts on teen pregnancies or births, five with impacts on reducing STIs, and 15 with impacts on both delaying/reducing sexual activity and increasing contraceptive use (including condom use). Conclusion Future efforts should conduct replications of existing program evaluations, identify implementation components linked to impacts, rigorously evaluate programs that appear promising, and expand the evidence base on programs that impact hormonal and long-acting contraceptive method use. PMID:25897271

Parent opinion of sexuality education in a state with mandated abstinence education: does policy match parental preference?

PubMed

Ito, Kristin E; Gizlice, Ziya; Owen-O'Dowd, Judy; Foust, Evelyn; Leone, Peter A; Miller, William C

2006-11-01

Despite public debate about the content of sexuality education in schools, state and federal policy has increasingly financed and legislated abstinence-only education over the past decade. Although public schools strive to meet the needs of parents who, as taxpayers, fund the educational system, little is known about parental desires regarding sexuality education in states with mandated abstinence education. The objective of this study was to assess parental opinion about sexuality education in public schools in North Carolina, a state with mandated abstinence education. Computer-assisted, anonymous, cross-sectional telephone surveys were conducted among 1306 parents of North Carolina public school students in grades K-12. Parental support for sexuality education in public schools and 20 sexuality education topics was measured. We defined comprehensive sexuality education as education that includes a discussion of how to use and talk about contraception with partners. Parents in North Carolina overwhelmingly support sexuality education in public schools (91%). Of these respondents, the majority (89%) support comprehensive sexuality education. Less than a quarter of parents oppose teaching any specific topic, including those typically viewed as more controversial, such as discussions about sexual orientation, oral sex, and anal sex. Parents' level of education was inversely related to support for specific sexuality education topics and comprehensive education, although these differences were small in magnitude. More than 90% of respondents felt that parents and public health professionals should determine sexuality education content and opposed the involvement of politicians. Current state-mandated abstinence sexuality education does not match parental preference for comprehensive sexuality education in North Carolina public schools.

Adult Discrimination against Children: The Case of Abstinence-Only Education in Twenty-First-Century USA

ERIC Educational Resources Information Center

Greslé-Favier, Claire

2013-01-01

This paper analyses abstinence-only education programmes and discourses within the frame of theories of adult discrimination against children. To begin with, a definition of abstinence-only programmes and of the political context in which they were created will be provided. These programmes will then be analysed through the lens of children's…

Consequences of sex education on teen and young adult sexual behaviors and outcomes.

PubMed

Lindberg, Laura Duberstein; Maddow-Zimet, Isaac

2012-10-01

This study examined whether formal sex education is associated with sexual health behaviors and outcomes using recent nationally representative survey data. Data used were from 4,691 male and female individuals aged 15-24 years from the 2006-2008 National Survey of Family Growth. Weighted bivariate and multivariate analyses were conducted by gender, estimating the associations of sex education by type (only abstinence, abstinence and birth control, or neither) before first sexual intercourse, and sexual behaviors and outcomes. Receipt of sex education, regardless of type, was associated with delays in first sex for both genders, as compared with receiving no sex education. Respondents receiving instruction about abstinence and birth control were significantly more likely at first sex to use any contraception (odds ratio [OR] = 1.73, females; OR = 1.91, males) or a condom (OR = 1.69, females; OR = 1.90, males), and less likely to have an age-discrepant partner (OR = .67, females; OR = .48, males). Receipt of only abstinence education was not statistically distinguishable in most models from receipt of either both or neither topics. Among female subjects, condom use at first sex was significantly more likely among those receiving instruction in both topics as compared with only abstinence education. The associations between sex education and all longer-term outcomes were mediated by older age at first sex. Sex education about abstinence and birth control was associated with healthier sexual behaviors and outcomes as compared with no instruction. The protective influence of sex education is not limited to if or when to have sex, but extends to issues of contraception, partner selection, and reproductive health outcomes. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Health Education Curriculum Content--Abstinence

ERIC Educational Resources Information Center

North Dakota Department of Public Instruction, 2011

2011-01-01

As a result of House Bill 1229, introduced and passed during the 2011 North Dakota legislative session, every school district, both public and nonpublic, must expand health education to include abstinence education, if teaching sexuality education as part of the general health curriculum. This fact sheet provides guidance for districts in meeting…

Abstinence-Related Word Associations and Definitions of Abstinence and Virginity among Missouri High School Freshmen

ERIC Educational Resources Information Center

Wilson, Kelly L.; Smith, Matthew Lee; Menn, Mindy

2013-01-01

Background: The ways in which adolescents define and view sex, abstinence, and virginity impact the efforts of sexuality educators and sexual health professionals. This study examined terminology used by nonsexually active high school students to define abstinence and virginity and identified words students associate with these terms. Purposes…

Persistence of the effect of the Lung Health Study (LHS) smoking intervention over eleven years.

PubMed

Murray, Robert P; Connett, John E; Rand, Cynthia S; Pan, Wei; Anthonisen, Nicholas R

2002-10-01

Research on the long-term persistence of effects of interventions aimed at smoking cessation is limited. This paper examined the quitting behavior of individuals who were randomized to a smoking cessation intervention (SI) or to usual care (UC), at a point approximately 11 years later. The initial sample consisted of 5,887 adult smokers in 10 clinics who had evidence of airways obstruction. Two-thirds of the original participants were offered an intensive 12-week smoking cessation intervention. Of these, 4,517 were enrolled in the long-term follow-up study. Randomized group assignment was a strong predictor of smoking behavior after 11 years, in that 21.9% of SI participants and only 6.0% of UC participants maintained abstinence throughout the interval. Logistic regressions identified covariates associated with abstinence. A higher proportion of abstinence was observed in participants that had been assigned to SI (OR = 4.45), were older (OR = 1.11, increment 5 years), had more years of education (OR = 1.05), and fewer cigarettes/day at baseline (OR = 0.90, increment 10 cigarettes). Smokers exposed to an aggressive smoking intervention program and who sustain abstinence for a five-year period are very likely to still be abstinent after 11 years. Copyright 2002 American Health Foundation and Elsevier Science (USA)

Changes in formal sex education: 1995-2002.

PubMed

Lindberg, Laura Duberstein; Santelli, John S; Singh, Susheela

2006-12-01

Although comprehensive sex education is broadly supported by health professionals, funding for abstinence-only education has increased. Using data from the 1995 National Survey of Adolescent Males, the 1995 National Survey of Family Growth (NSFG) and the 2002 NSFG, changes in male and female adolescents' reports of the sex education they have received from formal sources were examined. Life-table methods were used to measure the timing of instruction, and t tests were used for changes over time. From 1995 to 2002, reports of formal instruction about birth control methods declined among both genders (males, from 81% to 66%; females, from 87% to 70%). This, combined with increases in reports of abstinence education among males (from 74% to 83%), resulted in a lower proportion of teenagers' overall receiving formal instruction about both abstinence and birth control methods (males, 65% to 59%; females, 84% to 65%), and a higher proportion of teenagers' receiving instruction only about abstinence (males, 9% to 24%; females, 8% to 21%). Teenagers in 2002 had received abstinence education about two years earlier (median age, 11.4 for males, 11.8 for females) than they had received birth control instruction (median age, 13.5 for both males and females). Among sexually experienced adolescents, 62% of females and 54% of males had received instruction about birth control methods prior to first sex. A substantial retreat from formal instruction about birth control methods has left increasing proportions of adolescents receiving only abstinence education. Efforts are needed to expand teenagers' access to medically accurate and comprehensive reproductive health information.

Medical accuracy in sexuality education: ideology and the scientific process.

PubMed

Santelli, John S

2008-10-01

Recently, many states have implemented requirements for scientific or medical accuracy in sexuality education and HIV prevention programs. Although seemingly uncontroversial, these requirements respond to the increasing injection of ideology into sexuality education, as represented by abstinence-only programs. I describe the process by which health professionals and government advisory groups within the United States reach scientific consensus and review the legal requirements and definitions for medical accuracy. Key elements of this scientific process include the weight of scientific evidence, the importance of scientific theory, peer review, and recognition by mainstream scientific and health organizations. I propose a concise definition of medical accuracy that may be useful to policymakers, health educators, and other health practitioners.

Effectiveness of a National Media Campaign to Promote Parent-Child Communication about Sex

ERIC Educational Resources Information Center

Davis, Kevin C.; Evans, W. Douglas; Kamyab, Kian

2013-01-01

Background: Although there is debate on the effectiveness of youth-focused abstinence education programs, research confirms that parents can influence their children’s decisions about sexual behavior. To leverage parent-based approaches to adolescent sexual health, the U.S. Department of Health and Human Services launched the "Parents Speak Up…

Whispers in the Walls: Unspoken Words in the Public School Fortress

ERIC Educational Resources Information Center

Barton, Colleen

2007-01-01

Teenage pregnancy is not a new issue, and though policymakers have made token efforts toward curtailing the problem, current preventative and support programs have little effect. Their failure can be attributed to an institutional refusal to acknowledge teenagers as sexual beings, thus limiting the scope of sex education curricula. Abstinence-only…

Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: a randomized controlled trial.

PubMed

DeFulio, Anthony; Donlin, Wendy D; Wong, Conrad J; Silverman, Kenneth

2009-09-01

Due to the chronic nature of cocaine dependence, long-term maintenance treatments may be required to sustain abstinence. Abstinence reinforcement is among the most effective means of initiating cocaine abstinence. Practical and effective means of maintaining abstinence reinforcement programs over time are needed. To determine whether employment-based abstinence reinforcement can be an effective long-term maintenance intervention for cocaine dependence. Participants (n = 128) were enrolled in a 6-month job skills training and abstinence initiation program. Participants who initiated abstinence, attended regularly and developed needed job skills during the first 6 months were hired as operators in a data entry business and assigned randomly to an employment-only (control, n = 24) or abstinence-contingent employment (n = 27) group. A non-profit data entry business. Participants Unemployed welfare recipients who used cocaine persistently while enrolled in methadone treatment in Baltimore. Abstinence-contingent employment participants received 1 year of employment-based contingency management, in which access to employment was contingent upon provision of drug-free urine samples under routine and then random drug testing. If a participant provided drug-positive urine or failed to provide a mandatory sample, then that participant received a temporary reduction in pay and could not work until urinalysis confirmed recent abstinence. Cocaine-negative urine samples at monthly assessments across 1 year of employment. During the 1 year of employment, abstinence-contingent employment participants provided significantly more cocaine-negative urine samples than employment-only participants [79.3% and 50.7%, respectively; P = 0.004, odds ratio (OR) = 3.73, 95% confidence interval (CI) = 1.60-8.69]. Conclusions Employment-based abstinence reinforcement that includes random drug testing is effective as a long-term maintenance intervention, and is among the most promising treatments for drug dependence. Work-places could serve as therapeutic agents in the treatment of drug dependence by arranging long-term employment-based contingency management programs.

Abstinence education.

PubMed

Zeiler, Alean

2014-11-01

The American College of Pediatricians strongly endorses abstinence-until-marriage sex education and recommends adoption by all school systems in lieu of "comprehensive sex education." This position is based on "the public health principle of primary prevention-risk avoidance in lieu of risk reduction," upholding the "human right to the highest attainable standard of health" (Freedman 1995).

A Review of 21 Curricula for Abstinence-Only-until-Marriage Programs.

ERIC Educational Resources Information Center

Wilson, Kelly L.; Goodson, Patricia; Pruitt, B.E.; Buhi, Eric; Davis-Gunnels, Emily

2005-01-01

The authors reviewed the content, methods, and overall quality of 21 curricula used in abstinence-only-until-marriage programs. Only materials designed for use in middle school grades (fifth to eighth) or with middle school-aged audiences (9-13 years of age), which presented the abstinence message in at least 40% of their content, were included. A…

Characterizing Durations of Heroin Abstinence in the California Civil Addict Program: Results From a 33-Year Observational Cohort Study

PubMed Central

Nosyk, Bohdan; Anglin, M. Douglas; Brecht, Mary-Lynn; Lima, Viviane Dias; Hser, Yih-Ing

2013-01-01

In accordance with the chronic disease model of opioid dependence, cessation is often observed as a longitudinal process rather than a discrete endpoint. We aimed to characterize and identify predictors of periods of heroin abstinence in the natural history of recovery from opioid dependence. Data were collected on participants from California who were enrolled in the Civil Addict Program from 1962 onward by use of a natural history interview. Multivariate regression using proportional hazards frailty models was applied to identify independent predictors and correlates of repeated abstinence episode durations. Among 471 heroin-dependent males, 387 (82.2%) reported 932 abstinence episodes, 60.3% of which lasted at least 1 year. Multivariate analysis revealed several important findings. First, demographic factors such as age and ethnicity did not explain variation in durations of abstinence episodes. However, employment and lower drug use severity predicted longer episodes. Second, abstinence durations were longer following sustained treatment versus incarceration. Third, individuals with multiple abstinence episodes remained abstinent for longer durations in successive episodes. Finally, abstinence episodes initiated >10 and ≤20 years after first use lasted longer than others. Public policy facilitating engagement of opioid-dependent individuals in maintenance-oriented drug treatment and employment is recommended to achieve and sustain opioid abstinence. PMID:23445901

Abstinence Self-Efficacy and Abstinence 1 Year After Substance Use Disorder Treatment

ERIC Educational Resources Information Center

Ilgen, Mark; McKellar, John; Tiet, Quyen

2005-01-01

To better understand the relationship between abstinence self-efficacy and treatment outcomes in substance use disorder patients, experts in the field need more information about the levels of abstinence self-efficacy most predictive of treatment outcomes. Participants (N = 2,967) from 15 residential substance use disorder treatment programs were…

Contingency Management Abstinence Incentives: Cost and Implications for Treatment Tailoring.

PubMed

Cunningham, Colin; Stitzer, Maxine; Campbell, Aimee N C; Pavlicova, Martina; Hu, Mei-Chen; Nunes, Edward V

2017-01-01

To examine prize-earning costs of contingency management (CM) incentives in relation to participants' pre-study enrollment drug use status (baseline (BL) positive vs. BL negative) and relate these to previously reported patterns of intervention effectiveness. Participants were 255 substance users entering outpatient treatment who received the therapeutic educational system (TES), in addition to usual care counseling. TES included a CM component such that participants could earn up to $600 in prizes on average over 12-weeks for providing drug negative urines and completing web-based cognitive behavior therapy modules. We examined distribution of prize draws and value of prizes earned for subgroups that were abstinent (BL negative; N=136) or not (BL positive; N=119) at study entry based on urine toxicology and breath alcohol screen. Distribution of draws earned (median=119 vs. 17; p<.0001) and prizes redeemed (median=54 vs. 9; p<.001) for drug abstinence differed significantly for BL negative compared to BL positive participants. BL negative earned on average twice as much in prizes as BL positive participants ($245 vs. $125). Median value of prizes earned was 5.4 times greater for BL negative compared to BL positive participants ($237 vs. $44; p<.001). Two-thirds of expenditures in an abstinence incentive program were paid to BL negative participants. These individuals had high rates of drug abstinence during treatment and did not show improved abstinence outcomes with TES versus usual care (Campbell et al., 2014). Effectiveness of the abstinence-focused CM intervention included in TES may be enhanced by tailoring delivery based on patients' drug use status at treatment entry. Copyright © 2015 Elsevier Inc. All rights reserved.

Public Opinion on School-Based Sex Education in South Carolina

ERIC Educational Resources Information Center

Alton, Forrest L.; Valois, Robert F.; Oldendick, Robert; Drane, J. Wanzer

2009-01-01

The purpose of this article was to determine opinions on the use of abstinence only versus comprehensive sex education by registered voters in South Carolina. A cross-sectional, random-digit dial sample was utilized. Approximately 81% of respondents indicated support for sex education that emphasizes abstinence but also teaches about the benefits…

Science Teachers' Decision-Making in Abstinence-Only-Until-Marriage (AOUM) Classrooms: Taboo Subjects and Discourses of Sex and Sexuality in Classroom Settings

ERIC Educational Resources Information Center

Gill, Puneet Singh

2015-01-01

Sex education, especially in the southeastern USA, remains steeped in an Abstinence-Only-Until-Marriage (AOUM) approach, which sets up barriers to the education of sexually active students. Research confirms that science education has the potential to facilitate discussion of controversial topics, including sex education. Science teachers in the…

Substance Use, Education, Employment, and Criminal Activity Outcomes of Adolescents in Outpatient Chemical Dependency Programs

PubMed Central

Balsa, Ana I.; Homer, Jenny F.; French, Michael T.; Weisner, Constance M.

2010-01-01

Although the primary outcome of interest in clinical evaluations of addiction treatment programs is usually abstinence, participation in these programs can have a wide range of consequences. This study evaluated the effects of treatment initiation on substance use, school attendance, employment, and involvement in criminal activity at 12 months post-admission for 419 adolescents (aged 12 to 18) enrolled in chemical dependency recovery programs in a large managed care health plan. Instrumental variables estimation methods were used to account for unobserved selection into treatment by jointly modeling the likelihood of participation in treatment and the odds of attaining a certain outcome or level of an outcome. Treatment initiation significantly increased the likelihood of attending school, promoted abstinence, and decreased the probability of adolescent employment, but it did not significantly affect participation in criminal activity at the 12-month follow-up. These findings highlight the need to address selection in a non-experimental study and demonstrate the importance of considering multiple outcomes when assessing the effectiveness of adolescent treatment. PMID:18064572

Abstinence education*

PubMed Central

Zeiler, Alean

2014-01-01

The American College of Pediatricians strongly endorses abstinence-until-marriage sex education and recommends adoption by all school systems in lieu of “comprehensive sex education.” This position is based on “the public health principle of primary prevention—risk avoidance in lieu of risk reduction,” upholding the “human right to the highest attainable standard of health” (Freedman 1995). PMID:25473134

Dangerous Omissions: Abstinence-Only-until-Marriage School-Based Sexuality Education and the Betrayal of LGBTQ Youth

ERIC Educational Resources Information Center

Elia, John P.; Eliason, Mickey J.

2010-01-01

To gain an understanding of how abstinence-only-until-marriage school-based sexuality education has been exclusionary, it is important to explore how heteronormativity has been endorsed, played out, and reproduced ever since school-based sexuality education has been offered in the United States. Such an exploration reveals glaring evidence that…

"Sex Respect": Abstinence Education and Other Deployments for Sexual "Freedom"

ERIC Educational Resources Information Center

Jackson, Liz

2006-01-01

Those who view the right to a religiously neutral, empirically-based public education as fundamental have been able to do little more than watch in terror as abstinence-only sex education, which excludes information on either safe sex or birth control, has come to prevail in United States (US) schools. Among causes for concern are abstinence…

Teacher Perspectives on Abstinence and Safe Sex Education in South Africa

ERIC Educational Resources Information Center

Francis, Dennis A.; DePalma, Renée

2014-01-01

The stakes are high for sex education in South Africa: it has been estimated that 8.7% of young people live with HIV. Within primarily US and UK contexts, there has been much debate over the relative merits of abstinence-only and comprehensive sexual education programmes. These perspectives have largely been presented as irreconcilable, but…

Abstinence, Sex, and Virginity: Do They Mean What We Think They Mean?

ERIC Educational Resources Information Center

Hans, Jason D.; Kimberly, Claire

2011-01-01

Ambiguous definitions concerning which behaviors constitute sex, abstinence, and virginity may lead to arbitrary interpretations of meaning or miscommunication, which could be particularly problematic in health care, educational, and research contexts. The purpose of this study was to examine and compare definitions of sex, abstinence, and…

Comparison of comprehensive and abstinence-only sexuality education in young African American adolescents.

PubMed

Shepherd, Lindsay M; Sly, Kaye F; Girard, Jeffrey M

2017-12-01

The purpose of this study was to identify predictors of sexual behavior and condom use in African American adolescents, as well as to evaluate the effectiveness of comprehensive sexuality and abstinence-only education to reduce adolescent sexual behavior and increase condom use. Participants included 450 adolescents aged 12-14 years in the southern United States. Regression analyses showed favorable attitudes toward sexual behavior and social norms significantly predicted recent sexual behavior, and favorable attitudes toward condoms significantly predicted condom usage. Self-efficacy was not found to be predictive of adolescents' sexual behavior or condom use. There were no significant differences in recent sexual behavior based on type of sexuality education. Adolescents who received abstinence-only education had reduced favorable attitudes toward condom use, and were more likely to have unprotected sex than the comparison group. Findings suggest that adolescents who receive abstinence-only education are at greater risk of engaging in unprotected sex. Copyright © 2017 The Foundation for Professionals in Services for Adolescents. Published by Elsevier Ltd. All rights reserved.

The Influence of Drug Testing and Benefit-Based Distribution of Opioid Substitution Therapy on Drug Abstinence.

PubMed

Gabrovec, Branko

2015-01-01

The objective of our research was to discover whether the new approach to urine drug testing has a positive effect on users' abstinence, users' treatment, and their cooperation, while remaining user-friendly, and whether this approach is more cost-effective. The centers are focused on providing high-quality treatment within a cost-efficient program. In this study, we focus on the influence of drug testing and benefit-based distribution of opioid substitution therapy (BBDOST) on drug abstinence. The purpose of this study was to find any possible positive effect of modified distribution of the therapy and illicit drug testing on the number of users who are abstinent from illicit drugs and users who are not abstinent from illicit drugs as well as the users' opinion on BBDOST and testing. We are also interested in a difference in abstinence rates between those on BBDOST and those not receiving BBDOST. In 2010, the method of drug testing at the center was changed (less frequent and random drug testing) to enable its users faster access to BBDOST (take-home therapy). It was found that the number of drug-abstinent program participants has increased from initial 44.5% (2010) to 54.1% (2014). According to the program participants, the new method allows them to achieve and maintain abstinence from drugs more easily. In addition, they are also satisfied with the modified way of drug testing. This opinion does not change with age, gender, and acquired benefits.

Changing emphases in sexuality education in U.S. public secondary schools, 1988-1999.

PubMed

Darroch, J E; Landry, D J; Singh, S

2000-01-01

Since the late 1980s, both the political context surrounding sexuality education and actual teaching approaches have changed considerably. However, little current national information has been available on the content of sexuality education to allow in-depth understanding of the breadth of these changes and their impact on current teaching. In 1999, a nationally representative survey collected data from 3,754 teachers in grades 7-12 in the five specialties most often responsible for sexuality education. Results from those teachers and from the subset of 1,767 who actually taught sexuality education are compared with the findings from a comparable national survey conducted in 1988. In 1999, 93% of all respondents reported that sexuality education was taught in their school at some point in grades 7-12; sexuality education covered a broad number of topics, including sexually transmitted diseases (STDs), abstinence, birth control, abortion and sexual orientation. Some topics--how HIV is transmitted, STDs, abstinence, how to resist peer pressure to have intercourse and the correct way to use a condom--were taught at lowergrades in 1999 than in 1988. In 1999, 23% of secondary school sexuality education teachers taught abstinence as the only way of preventing pregnancy and STDs, compared with 2% who did so in 1988. Teachers surveyed in 1999 were more likely than those in 1988 to cite abstinence as the most important message they wished to convey (41% vs. 25%). In addition, steep declines occurred between 1988 and 1999, overall and across grade levels, in the percentage of teachers who supported teaching about birth control, abortion and sexual orientation, as well as in the percentage actually covering those topics. However, 39% of 1999 respondents who presented abstinence as the only option also told students that both birth control and the condom can be effective. Sexuality education in secondary public schools is increasingly focused on abstinence and is less likely to present students with comprehensive teaching that includes necessary information on topics such as birth control, abortion and sexual orientation. Because of this, and in spite of some abstinence instruction that also covers birth control and condoms as effective methods of prevention, many students are not receiving accurate information on topics their teachers feel they need.

Condoms for sexually transmissible infection prevention: politics versus science.

PubMed

Mindel, Adrian; Sawleshwarkar, Shailendra

2008-03-01

The present review assesses the protection that condoms offer against sexually transmissible infections (STI) and the impact that social, political and religious opinion in the USA has had in the past 8 years on promoting condoms for safer sex. Condoms offer protection against most STI. However, the degree of protection depends on correct and consistent use, the type of sexual activity and the biological characteristics of different infections. Cross-sectional and case-control studies and other observational data provide the majority of evidence for STI prevention. Condoms provide a high level of protection against those infections that are transmitted mainly via infected secretions, including HIV, gonorrhoea, chlamydia and trichomoniasis. Protection against those infections transmitted via skin and mucous membrane contact, including Herpes simplex virus infection and human papilloma virus, appears to be less. The Bush administration, driven by conservative political, social and religious elements in the USA, has mounted a concerted campaign to undermine the role of the condom in health-promotion activities in the USA and overseas by undervaluing and misrepresenting scientific data, and through a sustained and well-funded promotion of abstinence-only education. However, this has lead to considerable controversy and disillusionment with abstinence-only education, both at home and abroad, and there is now incontrovertible evidence that abstinence-only programs are ineffectual.

New evidence: data documenting parental support for earlier sexuality education.

PubMed

Barr, Elissa M; Moore, Michele J; Johnson, Tammie; Forrest, Jamie; Jordan, Melissa

2014-01-01

Numerous studies document support for sexuality education to be taught in high school, and often, in middle school. However, little research has been conducted addressing support for sexuality education in elementary schools. As part of the state Behavioral Risk Factor Surveillance System (BRFSS) Survey administration, the Florida Department of Health conducted the Florida Child Health Survey (FCHS) by calling back parents who had children in their home and who agreed to participate (N = 1715). Most parents supported the following sexuality education topics being taught specifically in elementary school: communication skills (89%), human anatomy/reproductive information (65%), abstinence (61%), human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) (53%), and gender/sexual orientation issues (52%). Support was even greater in middle school (62-91%) and high school (72-91%) for these topics and for birth control and condom education. Most parents supported comprehensive sexuality education (40.4%), followed by abstinence-plus (36.4%) and abstinence-only (23.2%). Chi-square results showed significant differences in the type of sexuality education supported by almost all parent demographic variables analyzed including sex, race, marital status, and education. Results add substantial support for age-appropriate school-based sexuality education starting at the elementary school level, the new National Sexuality Education Standards, and funding to support evidence-based abstinence-plus or comprehensive sexuality education. © 2013, American School Health Association.

The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes.

PubMed

Carr, Jillian B; Packham, Analisa

2017-04-01

In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank, . In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000-2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

Controlling the Curriculum.

ERIC Educational Resources Information Center

Black, Susan

1995-01-01

Recent statistics concerning teen pregnancies and sexually transmitted diseases are compelling reasons for reaching kids before they become sexually active. Comprehensive K-12 programs are essential, despite conflicts over abstinence, "abstinence-but," and safer sex approaches. Adverse program criticism can be diffused if administrators…

Examining interest in secondary abstinence among young African American females at risk for HIV or STIs.

PubMed

Bradley, Erin L P; Sales, Jessica M; Murray, Colleen C; DiClemente, Ralph J

2012-12-01

Sexually active African American females are at increased risk for acquiring HIV or STIs. However, some reduce their risk by abstaining from sex for various periods of time following initiation, a practice known as secondary abstinence. Although this may be a valuable mechanism for reducing HIV or STI rates in this population, little is known about those interested in secondary abstinence. Baseline data were obtained from a sample of African American adolescent females, ages 14-20 years, prior to participation in an HIV-risk reduction intervention trial (N = 701). Differences in individual-level and interpersonal-level factors, as well as sociodemographic variables were examined between participants who reported strong interest in secondary abstinence and those who did not. 144 (20.5%) participants reported strong interest in secondary abstinence. Young women with strong interest in abstinence had higher odds of reporting a history of STIs and feeling negative emotions following sex because of their religious beliefs. They also had higher odds of believing their partner may be interested in abstaining and being less invested in their relationship with their main partner. Additionally, adolescents reported less interpersonal stress and more social support. African American females who are interested in practicing secondary abstinence and those who are not differ in their sexual health education needs. Findings from this study characterizing young women interested in secondary abstinence can help researchers provide more targeted health education by identifying those who may be more responsive to abstinence-promoting messages.

The Broad Effectiveness of Seventy-Four Field Instances of Abstinence-Based Programming

ERIC Educational Resources Information Center

Birch, Paul James; White, Joseph M.; Fellows, Kaylene

2017-01-01

Evaluations of a large federally funded sexual risk avoidance education (SRAE) efforts in the USA have not been widely reported in the wake of funding cuts. The purpose of this study is to report results from a broad set of programmes to demonstrate the breadth of field effectiveness of these programmes. Twenty-seven separate community-based SRAE…

Against Abstinence-Only Education Abroad: Viewing Internet Use during Study Abroad as a Possible Experience Enhancement

ERIC Educational Resources Information Center

Mikal, Jude P.; Grace, Kathryn

2012-01-01

As the old model of study abroad welcomes a new generation of student, administrators are forced to grapple with how and whether to adapt the old model to new communication technologies. Assumed in the traditional model of study abroad, and in the cultural and language learning theories around which those programs were constructed, is that…

[Previous abstinence time as a predictive factor at 12 months follow-up in a multi-component smoking cessation program].

PubMed

Moreno-Arnedillo, J J; Morante-Benadero, M E; Sánchez-Vegazo-Sánchez, E

2014-01-01

The objective of this study is to analyze the length of the longest period of previous abstinence time as a predictor of the results of a smoking cessation program at 12 months follow-up. A cross-sectional study was conducted on a sample of 475 smokers who had participated in a multi-component smoking cessation group therapy program. The independent variable is the longest abstinence time passed, measured in weeks, before the current treatment. Success was defined as self-reported abstinence. Bivariate analyses were applied to the independent variable and to other variables in order to determine the factors that would be part of a logistic regression model using contrasts Student t or χ(2) comparisons, as appropriate. Those that showed statistical significance were entered into a multivariate logistic regression model. Within the studied variables, previous abstinence time and sex were the only predictive variables of success at 12 month follow-up. The probability of being abstinent at 12 months follow-up was significantly associated with the length of the previous longest period of abstinence, and this is the best of the predictors considered. Successful cessation programs depend more on the relationship with the consumer biographical aspects than with biological factors. The history of previous attempts is a more valuable source of information for designing treatments than others traditionally considered. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

Sex and the Public Schools.

ERIC Educational Resources Information Center

Black, Susan

1995-01-01

Recent statistics concerning teen pregnancies and sexually transmitted diseases are compelling reasons for reaching kids before they become sexually active. Comprehensive K-12 programs are essential, despite conflicts over abstinence, abstinence-but, and safer-sex approaches. Adverse program criticism can be diffused if administrators examine…

Toward a Sexual Ethics Curriculum: Bringing Philosophy and Society to Bear on Individual Development

ERIC Educational Resources Information Center

Lamb, Sharon

2010-01-01

For over a decade, battles have raged between conservative Abstinence Only Until Marriage (AOUM) sexuality education advocates and liberal Comprehensive Sexuality Education (CSE) advocates. While these battles have focused on the inclusion of health information about contraception and whether or not a curriculum must advocate abstinence as the…

Abstinence at Successful Discharge in Publicly Funded Addiction Health Services

PubMed Central

Guerrero, Erick G.; Kong, Yinfei; Kim, Tina

2016-01-01

Abstinence at successful discharge in substance use disorder treatment is important to reducing relapse rates and increasing long-term recovery from substance use disorders. However, few studies have examined abstinence as an essential component of successful discharge. This study examined rates and correlates of reported abstinence (nonuse of drugs 30 days prior to successful discharge) among clients attending publicly funded treatment in Los Angeles County, California. Finding show that only 36% of clients who were successfully discharged reported abstinence. Black clients were less likely than non-Hispanic Whites to report abstinence at successful discharge. Clients in methadone treatment programs were less likely than outpatient clients to report abstinence, whereas clients referred to treatment through the legal system (Proposition 36) were more likely to report abstinence compared to self-referred clients. Findings underscore the importance of systematic assessment of abstinence in determining successful discharge and provide a basis for further examination of strategies to improve abstinence and reduce relapse. PMID:26882909

Abstinence at Successful Discharge in Publicly Funded Addiction Health Services.

PubMed

Frimpong, Jemima A; Guerrero, Erick G; Kong, Yinfei; Kim, Tina

2016-10-01

Abstinence at successful discharge in substance use disorder treatment is important to reducing relapse rates and increasing long-term recovery from substance use disorders. However, few studies have examined abstinence as an essential component of successful discharge. This study examined rates and correlates of reported abstinence (nonuse of drugs 30 days prior to successful discharge) among clients attending publicly funded treatment in Los Angeles County, California. Finding show that only 36% of clients who were successfully discharged reported abstinence. Black clients were less likely than non-Hispanic Whites to report abstinence at successful discharge. Clients in methadone treatment programs were less likely than outpatient clients to report abstinence, whereas clients referred to treatment through the legal system (Proposition 36) were more likely to report abstinence compared to self-referred clients. Findings underscore the importance of systematic assessment of abstinence in determining successful discharge and provide a basis for further examination of strategies to improve abstinence and reduce relapse.

Factors Associated with Intentions to Engage in Vaginal Intercourse among Sexually Abstinent Missouri High School Freshmen

ERIC Educational Resources Information Center

Watts, Timothy; Wilson, Kelly L.; McNeill, Elisa B.; Rosen, Brittany L.; Moore, Nancy Daley; Smith, Matthew L.

2016-01-01

Background: We examine personal characteristics, alcohol consumption, normative beliefs, household factors, and extracurricular engagement associated with intentions to have intercourse before marriage among abstinent students. Methods: Data were analyzed from 245 freshmen enrolled in a school-based abstinence-only-until-marriage program. Two…

The effectiveness of group-based comprehensive risk-reduction and abstinence education interventions to prevent or reduce the risk of adolescent pregnancy, human immunodeficiency virus, and sexually transmitted infections: two systematic reviews for the Guide to Community Preventive Services.

PubMed

Chin, Helen B; Sipe, Theresa Ann; Elder, Randy; Mercer, Shawna L; Chattopadhyay, Sajal K; Jacob, Verughese; Wethington, Holly R; Kirby, Doug; Elliston, Donna B; Griffith, Matt; Chuke, Stella O; Briss, Susan C; Ericksen, Irene; Galbraith, Jennifer S; Herbst, Jeffrey H; Johnson, Robert L; Kraft, Joan M; Noar, Seth M; Romero, Lisa M; Santelli, John

2012-03-01

Adolescent pregnancy, HIV, and other sexually transmitted infections (STIs) are major public health problems in the U.S. Implementing group-based interventions that address the sexual behavior of adolescents may reduce the incidence of pregnancy, HIV, and other STIs in this group. Methods for conducting systematic reviews from the Guide to Community Preventive Services were used to synthesize scientific evidence on the effectiveness of two strategies for group-based behavioral interventions for adolescents: (1) comprehensive risk reduction and (2) abstinence education on preventing pregnancy, HIV, and other STIs. Effectiveness of these interventions was determined by reductions in sexual risk behaviors, pregnancy, HIV, and other STIs and increases in protective sexual behaviors. The literature search identified 6579 citations for comprehensive risk reduction and abstinence education. Of these, 66 studies of comprehensive risk reduction and 23 studies of abstinence education assessed the effects of group-based interventions that address the sexual behavior of adolescents, and were included in the respective reviews. Meta-analyses were conducted for each strategy on the seven key outcomes identified by the coordination team-current sexual activity; frequency of sexual activity; number of sex partners; frequency of unprotected sexual activity; use of protection (condoms and/or hormonal contraception); pregnancy; and STIs. The results of these meta-analyses for comprehensive risk reduction showed favorable effects for all of the outcomes reviewed. For abstinence education, the meta-analysis showed a small number of studies, with inconsistent findings across studies that varied by study design and follow-up time, leading to considerable uncertainty around effect estimates. Based on these findings, group-based comprehensive risk reduction was found to be an effective strategy to reduce adolescent pregnancy, HIV, and STIs. No conclusions could be drawn on the effectiveness of group-based abstinence education. Published by Elsevier Inc.

Education, HIV, and Early Fertility: Experimental Evidence from Kenya

PubMed Central

Duflo, Esther; Dupas, Pascaline

2015-01-01

A seven-year randomized evaluation suggests education subsidies reduce adolescent girls’ dropout, pregnancy, and marriage but not sexually transmitted infection (STI). The government’s HIV curriculum, which stresses abstinence until marriage, does not reduce pregnancy or STI. Both programs combined reduce STI more, but cut dropout and pregnancy less, than education subsidies alone. These results are inconsistent with a model of schooling and sexual behavior in which both pregnancy and STI are determined by one factor (unprotected sex), but consistent with a two-factor model in which choices between committed and casual relationships also affect these outcomes. PMID:26523067

Education, HIV, and Early Fertility: Experimental Evidence from Kenya.

PubMed

Duflo, Esther; Dupas, Pascaline; Kremer, Michael

2015-09-01

A seven-year randomized evaluation suggests education subsidies reduce adolescent girls' dropout, pregnancy, and marriage but not sexually transmitted infection (STI). The government's HIV curriculum, which stresses abstinence until marriage, does not reduce pregnancy or STI. Both programs combined reduce STI more, but cut dropout and pregnancy less, than education subsidies alone. These results are inconsistent with a model of schooling and sexual behavior in which both pregnancy and STI are determined by one factor (unprotected sex), but consistent with a two-factor model in which choices between committed and casual relationships also affect these outcomes.

Results of a long-term community smoking cessation contest.

PubMed

Lando, H A; Hellerstedt, W L; Pirie, P L; Fruetel, J; Huttner, P

1991-01-01

Successive quit smoking contests undertaken as part of the Minnesota Heart Health Program had generated diminishing impact. The 1988 contest attempted to rejuvenate community interest and participation through a substantially extended enrollment period. Smokers were eligible for monthly prize drawings and a grand prize drawing by entering the contest at any point between June 1988 and January 1989 and remaining abstinent for at least one month. The contest was promoted through newspaper advertisements, contest flyers, schools, and a community-wide direct mail campaign. A total of 1,328 smokers returned initial interest cards and 918 (69.1%) of these smokers returned quit pledges. Self-reported abstinence for pledgers and nonpledgers was 16.7% and 9.2%, respectively. Survival analysis indicated significantly longer periods of abstinence for pledgers (p = .0001). The extended contest was successful in recruiting smokers (almost 7% of the entire Bloomington smoking population vs. 1% for a previous one-month contest), especially those with less than a high school education. The current contest required substantial expenditures. However, these costs could be dramatically reduced through innovative use of donated resources.

Patterns and correlates of parental and formal sexual and reproductive health communication for adolescent women in the United States, 2002-2008.

PubMed

Stidham-Hall, Kelli; Moreau, Caroline; Trussell, James

2012-04-01

To investigate patterns and correlates of sexual and reproductive health (SRH) communication among adolescent women in the United States between 2002 and 2008. We used data with regard to adolescent women (aged 15-19 years) from the National Survey of Family Growth (between 2002 and 2006-2008, n = 2,326). Multivariate analyses focused on sociodemographic characteristics and SRH communication from parental and formal sources. Seventy-five percent of adolescent women had received parental communication on abstinence (60%), contraception (56%), sexually transmitted infections (53%), and condoms (29%); 9% received abstinence-only communication. Formal communication (92%) included abstinence (87%) and contraceptive (71%) information; 66% received both, whereas 21% received abstinence-only. Between 2002 and 2006-2008, parental (not formal) communication increased (7%, p < .001), including the abstinence communication (4%, p = .03). Age, sexual experience, education, mother's education, and poverty were positively associated with SRH communication. Between 2002 and 2008, receipt of parental SRH communication, especially abstinence, was increasingly common among United States adolescents. Strategies to promote comprehensive communication may improve adolescents' SRH outcomes. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Evidence on the Effectiveness of Abstinence Education: An Update. No. 2372

ERIC Educational Resources Information Center

Kim, Christine C.; Rector, Robert

2010-01-01

Teen sexual activity is costly, not just for teens, but also for society. Teens who engage in sexual activity risk a host of negative outcomes including STD infection, emotional and psychological harm, and out-of-wedlock childbearing. Genuine abstinence education is therefore crucial to the physical and psycho-emotional well-being of the nation's…

An Evaluation of an Abstinence-Only Sex Education Curriculum: An 18-Month Follow-Up

ERIC Educational Resources Information Center

Denny, George; Young, Michael

2006-01-01

The article examines the results from an 18-month follow-up evaluation of an abstinence education curriculum series. Participants were students from 15 school districts recruited to participate in the project. The intervention was the Sex Can Wait curriculum series, consisting of upper elementary, middle school, and high school components. The…

The Knowledge Gap Versus the Belief Gap and Abstinence-Only Sex Education.

PubMed

Hindman, Douglas Blanks; Yan, Changmin

2015-08-01

The knowledge gap hypothesis predicts widening disparities in knowledge of heavily publicized public affairs issues among socioeconomic status groups. The belief gap hypothesis extends the knowledge gap hypothesis to account for knowledge and beliefs about politically contested issues based on empirically verifiable information. This analysis of 3 national surveys shows belief gaps developed between liberals and conservatives regarding abstinence-only sex education; socioeconomic status-based knowledge gaps did not widen. The findings partially support both belief gap and knowledge gap hypotheses. In addition, the unique contributions of exposure to Fox News, CNN, and MSNBC in this process were investigated. Only exposure to Fox News was linked to beliefs about abstinence-only sex education directly and indirectly through the cultivation of conservative ideology.

A Preliminary Exploration of Former Smokers Enrolled in an Internet Smoking Cessation Program

PubMed Central

Cohn, Amy M; Elmasry, Hoda; Graham, Amanda L

2016-01-01

Background Internet interventions may have an important role to play in helping self-quitters maintain an initial period of abstinence. Little is known about the characteristics and utilization patterns of former smokers who use Internet cessation programs. Objective The overarching aim of this preliminary study was to establish the feasibility of a subsequent randomized trial of the effectiveness of Internet interventions in preventing relapse. Specifically, this study sought to determine the number of former smokers that register on a smoking cessation website, the characteristics of former smokers and their website utilization patterns, and potential predictors of sustained abstinence. Methods Participants were self-identified former smokers who registered on a free smoking cessation website. Recruitment occurred immediately following site registration. Participants completed Web-based baseline and 1-month follow-up assessments. Website utilization metrics were extracted at 1 month. Descriptive statistics were used to characterize the full sample. Baseline differences were examined between recent quitters (≤7 days of abstinence at enrollment) and more established quitters (8+ days of abstinence at enrollment) using chi-square tests and t tests. Univariate logistic regression examined demographic, smoking, psychosocial characteristics, and website utilization metrics as predictors of 1-month abstinence. Results During the 10-month study period, 1141 former smokers were recruited to participate: 494 accepted the invitation, 395 were eligible, 377 provided informed consent, and 221 completed the baseline and fully enrolled (56% of those eligible). At 1 month, 55.7% (123/221) of participants completed the follow-up survey. Mean age was 44.25 years (SD 12.78) and the sample was primarily female (174/221, 78.7%), white (196/221, 88.7%), and had at least some college education (177/221, 80.1%). Slightly more than half of participants (123/221, 55.7%) reported quitting more than a week prior to website registration and 43.9% (97/221) had quit within 7 days of registration. The website features most likely to be used were an interactive Quit Date tool (166/221, 75.1%) and the Community (134/221, 60.6%). Univariate regression models showed that recent quitters, those with higher motivation to remain abstinent, and those who used cessation medication in the past year were more likely to use the Community. Older age, longer duration of abstinence at registration, better health status, and health care provider advice to quit were associated with 1-month abstinence. Website utilization metrics did not predict abstinence, though odds ratios suggested higher utilization was associated with greater odds of abstinence. Conclusions This exploratory study demonstrated the feasibility of recruiting former smokers to a research study and documented the uptake of an Internet cessation intervention among this group of self-quitters. Results also showed higher levels of website utilization and greater likelihood of community use among smokers early in their quit attempt compared to those with a longer period of abstinence at enrollment. Important areas for future research include identifying former smokers who may be more susceptible to relapse and determining which components of an Internet intervention are most helpful to prevent relapse in the early and later stages of a quit attempt. PMID:27302500

Ignorance Only: HIV/AIDS, Human Rights, and Federally Funded Abstinence-Only Programs in the United States. Texas: A Case Study.

ERIC Educational Resources Information Center

Schleifer, Rebecca

2002-01-01

This report contends that programs teaching teenagers to "just say no" to sex before marriage are threatening adolescent health by censoring basic information about how to prevent HIV/AIDS. The report focuses on federally funded "abstinence-only-until-marriage" programs in Texas, where advertising campaigns convey the message…

Long-term abstinent alcoholics have normal memory.

PubMed

Reed, R J; Grant, I; Rourke, S B

1992-08-01

It is generally believed that many non-Korsakoff alcoholics have subtle defects in memory. To determine whether such defects vary as a function of length of abstinence (LOA), we performed extensive memory testing with: (1) recently detoxified (n = 31; LOA-29 days); (2) intermediate-term abstinent (n = 28; LOA = 1.9 years); (3) long-term abstinent (n = 32; LOA-7.0 years) alcoholics; and (4) nonalcoholic controls (n = 37). All subjects were matched on age and education. Alcoholics were matched on years of alcoholic drinking. Memory measures were divided into the following domains: verbal learning, verbal recall, visual learning, visual recall, and paired associate learning. A series of MANOVAs were conducted that revealed a significant relationship between visual learning and length of abstinence, and a significant interaction between age and length of abstinence on visual recall. Long-term abstinent subjects were not significantly different from controls on any test. We conclude that memory disturbance demonstrable among recently detoxified alcoholics in the early weeks of their abstinence is not evident in demographically matched long-term abstinent alcoholics with similar drinking histories.

Achieving Drug and Alcohol Abstinence Among Recently Incarcerated Homeless Women: A Randomized Controlled Trial Comparing Dialectical Behavioral Therapy-Case Management With a Health Promotion Program.

PubMed

Nyamathi, Adeline M; Shin, Sanghyuk S; Smeltzer, Jolene; Salem, Benissa E; Yadav, Kartik; Ekstrand, Maria L; Turner, Susan F; Faucette, Mark

Homeless female ex-offenders (homeless female offenders) exiting jail and prison are at a critical juncture during reentry and transitioning into the community setting. The purpose of the study was to compare the effect of a dialectical behavioral therapy-case management (DBT-CM) program with a health promotion (HP) program on achieving drug and alcohol abstinence among female parolees/probationers residing in the community. We conducted a multicenter parallel randomized controlled trial with 130 female parolees/probationers (aged 19-64 years) residing in the community randomly assigned to either DBT-CM (n = 65) or HP (n = 65). The trial was conducted in four community-based partner sites in Los Angeles and Pomona, California, from February 2015 to November 2016. Treatment assignment was carried out using a computer-based urn randomization program. The primary outcome was drug and alcohol use abstinence at 6-month follow up. Analysis was based on data from 116 participants with complete outcome data. Multivariable logistic regression revealed that the DBT-CM program remained an independent positive predictor of decrease in drug use among the DBT-CM participants at 6 months (p = .01) as compared with the HP program participants. Being non-White (p < .05) and having higher depressive symptom scores (p < .05) were associated with lower odds of drug use abstinence (i.e., increased the odds of drug use) at 6 months. DBT-CM increased drug and alcohol abstinence at 6-month follow-up, compared to an HP program.

Internet-delivered treatment for substance abuse: a multisite randomized controlled trial.

PubMed

Campbell, Aimee N C; Nunes, Edward V; Matthews, Abigail G; Stitzer, Maxine; Miele, Gloria M; Polsky, Daniel; Turrigiano, Eva; Walters, Scott; McClure, Erin A; Kyle, Tiffany L; Wahle, Aimee; Van Veldhuisen, Paul; Goldman, Bruce; Babcock, Dean; Stabile, Patricia Quinn; Winhusen, Theresa; Ghitza, Udi E

2014-06-01

Computer-delivered interventions have the potential to improve access to quality addiction treatment care. The objective of this study was to evaluate the effectiveness of the Therapeutic Education System (TES), an Internet-delivered behavioral intervention that includes motivational incentives, as a clinician-extender in the treatment of substance use disorders. Adult men and women (N=507) entering 10 outpatient addiction treatment programs were randomly assigned to receive 12 weeks of either treatment as usual (N=252) or treatment as usual plus TES, with the intervention substituting for about 2 hours of standard care per week (N=255). TES consists of 62 computerized interactive modules covering skills for achieving and maintaining abstinence, plus prize-based motivational incentives contingent on abstinence and treatment adherence. Treatment as usual consisted of individual and group counseling at the participating programs. The primary outcome measures were abstinence from drugs and heavy drinking (measured by twice-weekly urine drug screens and self-report) and time to dropout from treatment. Compared with patients in the treatment-as-usual group, those in the TES group had a lower dropout rate (hazard ratio=0.72, 95% CI=0.57, 0.92) and a greater abstinence rate (odds ratio=1.62, 95% CI=1.12, 2.35). This effect was more pronounced among patients who had a positive urine drug or breath alcohol screen at study entry (N=228) (odds ratio=2.18, 95% CI=1.30, 3.68). Internet-delivered interventions such as TES have the potential to expand access and improve addiction treatment outcomes. Additional research is needed to assess effectiveness in non-specialty clinical settings and to differentiate the effects of the community reinforcement approach and contingency management components of TES.

Cessation Outcomes Among Quitline Callers in Three States During a National Tobacco Education Campaign.

PubMed

Vickerman, Katrina A; Zhang, Lei; Malarcher, Ann; Mowery, Paul; Nash, Chelsea

2015-07-16

Antismoking mass media campaigns, such as the Centers for Disease Control and Prevention's Tips from Former Smokers (Tips) campaign, increase the number of tobacco users calling tobacco quitlines. Few studies have investigated long-term tobacco use cessation for callers during antismoking media campaigns. Studies have suggested that callers during campaigns may be less committed to quitting and have lower quit rates. This study examines tobacco user cessation outcomes 7 months after quitline enrollment during the 2012 Tips campaign (March 19 through June 10, 2012). We analyzed data for 715 tobacco users who enrolled in the Nebraska, North Carolina, or Texas state quitline multiple-call programs during the 2012 Tips campaign and responded to a 7-month postenrollment survey (38.5% survey response rate). We used multivariable logistic regression analyses to determine whether 7-day and 30-day point prevalence abstinence rates 7 months after enrollment were related to level of exposure to the campaign. In multivariable models, only lower nicotine dependence and higher call completion were associated with higher odds of 7-day and 30-day abstinence 7 months after enrollment. Tips campaign exposure was not associated with abstinence. Once enrolled in quitline counseling, quitline callers achieved similar outcomes regardless of Tips campaign exposure levels. While the campaign did not appear to directly affect odds of tobacco abstinence through quitlines, antismoking mass media campaigns such as Tips are valuable in increasing tobacco users' exposure to quitlines and thus increasing their likelihood of making a quit attempt and eventually achieving tobacco abstinence.

Abstinence-What?: A Critical Look at the Language of Educational Approaches to Adolescent Sexual Risk Reduction

ERIC Educational Resources Information Center

Beshers, Sarah

2007-01-01

Twenty-six years ago, Ronald Reagan signed the Adolescent Family Life Act, and the abstinence education movement began its rapid ascendancy to political dominance, a process marked by increasingly generous federal funding, which reached a peak of $176 million in FY 2006. Throughout this period, a debate ensued over the appropriate approach to…

Better learning in schools to improve attitudes toward abstinence and intentions for safer sex among adolescents in urban Nepal.

PubMed

Shrestha, Rachana Manandhar; Otsuka, Keiko; Poudel, Krishna C; Yasuoka, Junko; Lamichhane, Medin; Jimba, Masamine

2013-03-20

School-based sex education is an effective medium to convey health information and skills about preventing sexually transmitted infections (STIs) and unwanted pregnancies among adolescents. However, research on school-based sex education is limited in many developing countries, including Nepal. This study thus had two main objectives: (1) to assess students' evaluation of school-based sex education, and (2) to examine the associations between students' evaluations of school-based sex education and their (a) attitudes toward abstinence and (b) intentions for safer sex. This cross-sectional study was conducted among 634 students from six schools in the Kathmandu Valley during May-June 2010. We used a self-administered questionnaire to assess students' evaluations of school-based sex education, attitudes toward abstinence, and intentions for safer sex. The data were then analyzed using multiple linear regression models. Regarding "information on HIV and sexual health", many students perceived that they received the least amount of information on HIV counseling and testing centers (mean 2.29, SD 1.00) through their schools. In terms of "support and involvement of teachers and parents" in sex education, parents' participation ranked as the lowest (mean 1.81, SD 1.01). Audiotapes were reported as the least used among the listed "teaching aids for sexual health education" (mean 1.54, SD 0.82). In multivariate analysis, receiving more "information on HIV and sexual health" was positively associated with more positive "attitudes toward abstinence" (β = 0.11, p = <0.018) and greater "intentions for safer sex" (β = 0.17, p = <0.001) among students. Similarly, increased "support and involvement from teachers and parents" was also positively associated with more positive "attitudes toward abstinence" (β = 0.16, p = <0.001) and greater "intentions for safer sex" (β = 0.15, p = <0.002). Our results suggest that students' needs and expectations regarding HIV and sexual health education are not being met through their schools. Moreover, comprehensive information on HIV and sexual health along with increased support and involvement of teachers and parents in sex education might help to improve adolescents' attitudes toward abstinence and intentions for safer sex. Adapting future school-based interventions to incorporate such elements may thus be an effective strategy to promote adolescent sexual health.

Exercise and Counseling for Smoking Cessation in Smokers With Depressive Symptoms: A Randomized Controlled Pilot Trial.

PubMed

Bernard, Paquito; Ninot, Gregory; Cyprien, Fabienne; Courtet, Philippe; Guillaume, Sebastien; Georgescu, Vera; Picot, Marie-Christine; Taylor, Adrian; Quantin, Xavier

2015-01-01

Despite various strategies to help smokers with depressive disorders to quit, the smoking relapse rate remains high. The purpose of this pilot study was to estimate the effects of adding an exercise and counseling intervention to standard smoking cessation treatment for smokers with depressive disorders. We hypothesized that the exercise and counseling intervention would lead to improved abstinence, reduced depressive symptoms, and increased physical activity. Seventy smokers with current depressive disorders were randomly assigned to standard smoking cessation treatment plus exercise and counseling (n = 35) or standard treatment plus a time-to-contact control intervention on health education (n = 35). Both programs involved 10 sessions over 8 weeks. The primary outcome was continuous abstinence since the quit date and was measured at week 8 (end of the intervention) and again at 12-, 24-, and 52-week follow-ups. Nearly 60% of participants were female (n = 41), 38 (52.3%) were single, 37 (52.9%) had education beyond high school, and 32 (45.7%) met criteria for major depressive disorder or dysthymia. Participants in the two treatment conditions differed at baseline only in marital status (χ(2) = 4.28, df = 1, p =.04); and smoking abstinence self-efficacy, t(66) = -2.04, p =.04). The dropout rate did not differ significantly between groups and participants attended 82% and 75% of the intervention and control sessions, respectively. Intention-to-treat analysis showed that, at 12 weeks after the beginning of the intervention, continuous abstinence did not vary significantly between the intervention and control groups: 48.5% versus 28.5%, respectively, ORadj = 0.40, 95% CI [0.12-1.29], p =.12. There were no group differences in depressive symptoms, but the intervention group did outperform the control group on the 6-minute walking test (Mint = 624.84, SD = 8.17, vs. Mcon = 594.13, SD = 8.96, p =.015) and perceived physical control (Mint = 2.84, SD = 0.16, vs. Mcon = 2.27, SD = 0.18, p =.028). The sample was not large enough to ensure adequate statistical power. This finding, while preliminary, suggests that an exercise and counseling intervention may yield better results than health education in improving smoking abstinence. This study is registered at www.clinincaltrials.gov under # NCT01401569.

Predictors of early versus late smoking abstinence within a 24-month disease management program.

PubMed

Cox, Lisa Sanderson; Wick, Jo A; Nazir, Niaman; Cupertino, A Paula; Mussulman, Laura M; Ahluwalia, Jasjit S; Ellerbeck, Edward F

2011-03-01

Standard smoking cessation treatment studies have been limited to 6- to 12-month follow-up, and examination of predictors of abstinence has been restricted to this timeframe. The KanQuit study enrolled 750 rural smokers across all stages of readiness to stop smoking and provided pharmacotherapy management and/or disease management, including motivational interviewing (MI) counseling every 6 months over 2 years. This paper examines differences in predictors of abstinence following initial (6-month) and extended (24-month) intervention. Baseline variables were analyzed as potential predictors of self-reported smoking abstinence at Month 6 and at Month 24. Chi-square tests, 2-sample t tests, and multiple logistic regression analyses were used to identify predictors of abstinence among 592 participants who completed assessment at baseline and Months 6 and 24. Controlling for treatment group, the final regression models showed that male gender and lower baseline cigarettes per day predicted abstinence at both 6 and 24 months. While remaining significant, the relative advantage of being male decreased over time. Global motivation to stop smoking, controlled motivation, and self-efficacy predicted abstinence at 6 months but did not predict abstinence at Month 24. In contrast, stage of change was strongly predictive of 24-month smoking status. While the importance of some predictors of successful smoking cessation appeared to diminish over time, initial lack of interest in cessation and number of cigarettes per day strongly predicted continued smoking following a 2-year program.

Randomized Trial of Four Financial-Incentive Programs for Smoking Cessation

PubMed Central

Halpern, Scott D.; French, Benjamin; Small, Dylan S.; Saulsgiver, Kathryn; Harhay, Michael O.; Audrain-McGovern, Janet; Loewenstein, George; Brennan, Troyen A.; Asch, David A.; Volpp, Kevin G.

2015-01-01

BACKGROUND Financial incentives promote many health behaviors, but effective ways to deliver health incentives remain uncertain. METHODS We randomly assigned CVS Caremark employees and their relatives and friends to one of four incentive programs or to usual care for smoking cessation. Two of the incentive programs targeted individuals, and two targeted groups of six participants. One of the individual-oriented programs and one of the group-oriented programs entailed rewards of approximately $800 for smoking cessation; the others entailed refundable deposits of $150 plus $650 in reward payments for successful participants. Usual care included informational resources and free smoking-cessation aids. RESULTS Overall, 2538 participants were enrolled. Of those assigned to reward-based programs, 90.0% accepted the assignment, as compared with 13.7% of those assigned to deposit-based programs (P<0.001). In intention-to-treat analyses, rates of sustained abstinence from smoking through 6 months were higher with each of the four incentive programs (range, 9.4 to 16.0%) than with usual care (6.0%) (P<0.05 for all comparisons); the superiority of reward-based programs was sustained through 12 months. Group-oriented and individual-oriented programs were associated with similar 6-month abstinence rates (13.7% and 12.1%, respectively; P = 0.29). Reward-based programs were associated with higher abstinence rates than deposit-based programs (15.7% vs. 10.2%, P<0.001). However, in instrumental-variable analyses that accounted for differential acceptance, the rate of abstinence at 6 months was 13.2 percentage points (95% confidence interval, 3.1 to 22.8) higher in the deposit-based programs than in the reward-based programs among the estimated 13.7% of the participants who would accept participation in either type of program. CONCLUSIONS Reward-based programs were much more commonly accepted than deposit-based programs, leading to higher rates of sustained abstinence from smoking. Group-oriented incentive programs were no more effective than individual-oriented programs. (Funded by the National Institutes of Health and CVS Caremark; ClinicalTrials.gov number, NCT01526265.) PMID:25970009

The Case for a New Approach to Sex Education Mounts; Will Policymakers Heed the Message? Guttmacher Policy Review. Volume 10, Number 2, Spring 2007

ERIC Educational Resources Information Center

Boonstra, Heather D.

2007-01-01

Abstinence-only-until-marriage education is a key component of social conservatives' global moral and religious agenda, and the cornerstone of the Bush administration's approach to reducing U.S. teen pregnancy and sexually transmitted infection (STI) rates. Fearful of being portrayed as anti-abstinence, policymakers have continued to support these…

Monetary incentives to reinforce engagement and achievement in a job-skills training program for homeless, unemployed adults.

PubMed

Koffarnus, Mikhail N; Wong, Conrad J; Fingerhood, Michael; Svikis, Dace S; Bigelow, George E; Silverman, Kenneth

2013-01-01

The current study examined whether monetary incentives could increase engagement and achievement in a job-skills training program for unemployed, homeless, alcohol-dependent adults. Participants (n=124) were randomized to a no-reinforcement group (n=39), during which access to the training program was provided but no incentives were given; a training reinforcement group (n=42), during which incentives were contingent on attendance and performance; or an abstinence and training reinforcement group (n=43), during which incentives were contingent on attendance and performance, but access was granted only if participants demonstrated abstinence from alcohol. abstinence and training reinforcement and training reinforcement participants advanced further in training and attended more hours than no-reinforcement participants. Monetary incentives were effective in promoting engagement and achievement in a job-skills training program for individuals who often do not take advantage of training programs. © Society for the Experimental Analysis of Behavior.

Adolescent Abstinence and Unprotected Sex in CyberSenga, an Internet-Based HIV Prevention Program: Randomized Clinical Trial of Efficacy

PubMed Central

Ybarra, Michele L.; Bull, Sheana S.; Prescott, Tonya L.; Korchmaros, Josephine D.; Bangsberg, David R.; Kiwanuka, Julius P.

2013-01-01

Context Cost-effective, scalable programs are urgently needed in countries deeply affected by HIV. Methods This parallel-group RCT was conducted in four secondary schools in Mbarara, Uganda. Participants were 12 years and older, reported past-year computer or Internet use, and provided informed caregiver permission and youth assent. The intervention, CyberSenga, was a five-hour online healthy sexuality program. Half of the intervention group was further randomized to receive a booster at four-months post-intervention. The control arm received ‘treatment as usual’ (i.e., school-delivered sexuality programming). The main outcome measures were: 1) condom use and 2) abstinence in the past three months at six-months' post-intervention. Secondary outcomes were: 1) condom use and 2) abstinence at three-month's post-intervention; and 6-month outcomes by booster exposure. Analyses were intention to treat. Results All 416 eligible youth were invited to participate, 88% (n = 366) of whom enrolled. Participants were randomized to the intervention (n = 183) or control (n = 183) arm; 91 intervention participants were further randomized to the booster. No statistically significant results were noted among the main outcomes. Among the secondary outcomes: At three-month follow-up, trends suggested that intervention participants (81%) were more likely to be abstinent than control participants (74%; p = 0.08), and this was particularly true among youth who were abstinent at baseline (88% vs. 77%; p = 0.02). At six-month follow-up, those in the booster group (80%) reported higher rates of abstinence than youth in the intervention, no booster (57%) and control (55%) groups (p = 0.15); they also reported lower rates of unprotected sex (5%) compared to youth in the intervention, no booster (24%) and control (21%) groups (p = 0.21) among youth sexually active at baseline. Conclusions The CyberSenga program may affect HIV preventive behavior among abstinent youth in the short term and, with the booster, may also promote HIV preventive behavior among sexually active youth in the longer term. Trial Registration NCT00906178. PMID:23967069

What schools teach our patients about sex: content, quality, and influences on sex education.

PubMed

Lindau, Stacy Tessler; Tetteh, Adjoa S; Kasza, Kristen; Gilliam, Melissa

2008-02-01

To identify predictors of comprehensive sex education in public schools. Using a three-stage design, 335 sex education teachers from a probability sample of 201 schools in 112 Illinois school districts were surveyed regarding the 2003-2004 school year. Coverage of at least all of the following topics constituted "comprehensiveness": abstinence, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS), other sexually transmitted diseases (STDs), and contraception. A logistic regression model identified predictors of comprehensiveness. Representing 91.3% of sampled schools, the teacher survey response rate was 62.4%. The most frequently taught topics included HIV/AIDS (97%), STDs (96%), and abstinence-until-marriage (89%). The least frequently taught topics were emergency contraception (31%), sexual orientation (33%), condom (34%) and other contraceptive (37%) use, and abortion (39%). Abstinence-only curricula were used by 74% of teachers, but 33% of these teachers supplemented with "other" curricula. Overall, two thirds met comprehensiveness criteria based on topics taught. Curricular material availability was most commonly cited as having a "great deal" of influence on topics taught. Thirty percent had no training in sex education; training was the only significant predictor of providing comprehensive sex education in multivariable analysis. Illinois public school-based sex education emphasizes abstinence and STDs and is heavily influenced by the available curricular materials. Nearly one in three sex education teachers were not trained. Obstetrician-gynecologists caring for adolescents may need to fill gaps in adolescent knowledge and skills due to deficits in content, quality, and teacher training in sex education. III.

The Use of Self-Directed Relapse Prevention Booklets to Assist in Maintaining Abstinence after a 6-Week Group Smoking Cessation Treatment Program: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Veldheer, Susan; Hrabovsky, Shari; Yingst, Jessica; Sciamanna, Chris; Berg, Arthur; Foulds, Jonathan

2018-01-01

Background: Identifying effective relapse prevention interventions is a vital step to help smokers maintain abstinence for the long term. Aims: The purpose of this study is to determine if providing recently quit smokers with self-directed relapse prevention booklets is effective at maintaining abstinence after intensive group smoking cessation…

Sex education attitudes and outcomes among North American women.

PubMed

Williams, Monnica T; Bonner, Laura

2006-01-01

Attitudes and outcomes of sex education received by North American women are examined via an Internet survey (N = 1,400). Mean age was 19.5, with 24% reporting one or more unplanned pregnancies. Women were more satisfied with sex education from informal sources than from parents, schools, and physicians. Those receiving sex education from parents or schools reported fewer pregnancies and abortions. In school, women receiving a combination of contraceptive and abstinence education and those receiving primarily abstinence education were least likely to experience unplanned pregnancy. Religious identification was significantly related to unplanned pregnancy and type of sex education received from parents. These factors seem to play a significant role in reducing unplanned pregnancy and abortion.

Factors associated with the content of sex education in U.S. public secondary schools.

PubMed

Landry, David J; Darroch, Jacqueline E; Singh, Susheela; Higgins, Jenny

2003-01-01

While sex education is almost universal in U.S. schools, its content varies considerably. Topics such as abstinence, and basic information on HIV and other sexually transmitted diseases (STDs), are commonly taught; birth control and how to access STD and contraceptive services are taught less often. Factors potentially associated with these variations need to be examined. Data on 1,657 respondents to a 1999 national survey of teachers providing sex education in grades 7-12 were assessed for variation in topics covered. Logistic regression was used to ascertain factors associated with instruction on selected topics. The content of sex education varied by region and by instructors' approach to teaching about abstinence and contraception. For example, teaching abstinence as the only means of pregnancy and STD prevention was more common in the South than in the Northeast (30% vs. 17%). Emphasizing the ineffectiveness of contraceptives was less common in the Northeast (17%) than in other regions (27-32%). Instructors teaching that methods are ineffective and presenting abstinence as teenagers' only option had significantly reduced odds of teaching various skills and topics (odds ratios, 0.1-0.5). Instructors' approach to teaching about methods is a very powerful indicator of the content of sex education. Given the well-documented relationship between what teenagers learn about safer sexual behavior and their use of methods when they initiate sexual activity, sex education in all U.S. high schools should include accurate information about condoms and other contraceptives.

Coping strategies as a mediator of internet-delivered psychosocial treatment: Secondary analysis from a NIDA CTN multisite effectiveness trial.

PubMed

Lévesque, Annie; Campbell, Aimee N C; Pavlicova, Martina; Hu, Mei-Chen; Walker, Robrina; McClure, Erin A; Ghitza, Udi E; Bailey, Genie; Stitzer, Maxine; Nunes, Edward V

2017-02-01

Coping strategies are a predictor of abstinence among patients with substance use disorders. However, little is known regarding the role of coping strategies in the effectiveness of the Community Reinforcement Approach (CRA). Using data from a 12week randomized control trial assessing the effectiveness of the Therapeutic Education System (TES), an internet-delivered version of the CRA combined with contingency management, we tested the role of coping strategies as a mediator of treatment effectiveness. 507 participants entering 10 outpatient addiction treatment programs received either treatment-as-usual (TAU), a counselor-delivered treatment (Arm 1), or reduced TAU plus TES wherein 2h of TAU per week were replaced by TES (Arm 2). Abstinence from drugs and alcohol was evaluated using urine toxicology and self-report. Coping strategies were measured using the Coping Strategies Scale-Brief Version. Mediation analyses were done following Baron and Kenny's and path analysis approaches. The average baseline coping strategies scores were not significantly different between the two treatment arms. Overall, TES intervention was significantly associated with higher coping strategies scores when accounting for baseline scores (F 1,1342 =8.3, p=0.004). Additionally, higher coping strategies scores at week 12 were associated with an increased likelihood of abstinence during the last 4weeks of the treatment, while accounting for treatment assignment and baseline abstinence. The effect of TES intervention on abstinence was no longer significant after controlling for coping strategies scores at week 12. Our results support the importance of coping skills as a partial mediator of the effectiveness of an internet-version of the CRA combined with contingency management. Copyright © 2016. Published by Elsevier Ltd.

Individual- and Area-level Unemployment Influence Smoking Cessation Among African Americans Participating in a Randomized Clinical Trial

PubMed Central

Kendzor, Darla E.; Reitzel, Lorraine R.; Mazas, Carlos A.; Cofta-Woerpel, Ludmila M.; Cao, Yumei; Ji, Lingyun; Costello, Tracy J.; Vidrine, Jennifer Irvin; Businelle, Michael S.; Li, Yisheng; Castro, Yessenia; Ahluwalia, Jasjit S.; Cinciripini, Paul M.; Wetter, David W.

2012-01-01

African Americans suffer disproportionately from the adverse health consequences of smoking, and also report substantially lower socioeconomic status than Whites and other racial/ethnic groups in the U.S. Although socioeconomic disadvantage is known to have a negative influence on smoking cessation rates and overall health, little is known about the influence of socioeconomic status on smoking cessation specifically among African Americans. Thus, the purpose of the current study was to characterize the impact of several individual- and area-level indicators of socioeconomic status on smoking cessation among African Americans. Data were collected as part of a smoking cessation intervention study for African American smokers (N = 379) recruited from the Houston, Texas, metropolitan area, who participated in the study between 2005 and 2007. The separate and combined influences of individual-level (insurance status, unemployment, education, and income) and area-level (neighborhood unemployment, education, income, and poverty) indicators of socioeconomic status on continuous smoking abstinence were examined across time intervals using continuation ratio logit modeling. Individual-level analyses indicated that unemployment was significantly associated with reduced odds of smoking abstinence, while higher income was associated with greater odds of abstinence. However, only unemployment remained a significant predictor of abstinence when unemployment and income were included in the model together. Area-level analyses indicated that greater neighborhood unemployment and poverty were associated with reduced odds of smoking abstinence, while greater neighborhood education was associated with higher odds of abstinence. However, only neighborhood unemployment remained significantly associated with abstinence status when individual-level income and unemployment were included in the model. Overall, findings suggest that individual- and area-level unemployment have a negative impact on smoking cessation among African Americans. Addressing unemployment through public policy and within smoking cessation interventions, and providing smoking cessation treatment for the unemployed may have a beneficial impact on tobacco-related health disparities. PMID:22405506

Individual- and area-level unemployment influence smoking cessation among African Americans participating in a randomized clinical trial.

PubMed

Kendzor, Darla E; Reitzel, Lorraine R; Mazas, Carlos A; Cofta-Woerpel, Ludmila M; Cao, Yumei; Ji, Lingyun; Costello, Tracy J; Vidrine, Jennifer Irvin; Businelle, Michael S; Li, Yisheng; Castro, Yessenia; Ahluwalia, Jasjit S; Cinciripini, Paul M; Wetter, David W

2012-05-01

African Americans suffer disproportionately from the adverse health consequences of smoking, and also report substantially lower socioeconomic status than Whites and other racial/ethnic groups in the U.S. Although socioeconomic disadvantage is known to have a negative influence on smoking cessation rates and overall health, little is known about the influence of socioeconomic status on smoking cessation specifically among African Americans. Thus, the purpose of the current study was to characterize the impact of several individual- and area-level indicators of socioeconomic status on smoking cessation among African Americans. Data were collected as part of a smoking cessation intervention study for African American smokers (N = 379) recruited from the Houston, Texas, metropolitan area, who participated in the study between 2005 and 2007. The separate and combined influences of individual-level (insurance status, unemployment, education, and income) and area-level (neighborhood unemployment, education, income, and poverty) indicators of socioeconomic status on continuous smoking abstinence were examined across time intervals using continuation ratio logit modeling. Individual-level analyses indicated that unemployment was significantly associated with reduced odds of smoking abstinence, while higher income was associated with greater odds of abstinence. However, only unemployment remained a significant predictor of abstinence when unemployment and income were included in the model together. Area-level analyses indicated that greater neighborhood unemployment and poverty were associated with reduced odds of smoking abstinence, while greater neighborhood education was associated with higher odds of abstinence. However, only neighborhood unemployment remained significantly associated with abstinence status when individual-level income and unemployment were included in the model. Overall, findings suggest that individual- and area-level unemployment have a negative impact on smoking cessation among African Americans. Addressing unemployment through public policy and within smoking cessation interventions, and providing smoking cessation treatment for the unemployed may have a beneficial impact on tobacco-related health disparities. Copyright © 2012 Elsevier Ltd. All rights reserved.

Accuracy of self-reported smoking abstinence in clinical trials of hospital-initiated smoking interventions.

PubMed

Scheuermann, Taneisha S; Richter, Kimber P; Rigotti, Nancy A; Cummins, Sharon E; Harrington, Kathleen F; Sherman, Scott E; Zhu, Shu-Hong; Tindle, Hilary A; Preacher, Kristopher J

2017-12-01

To estimate the prevalence and predictors of failed biochemical verification of self-reported abstinence among participants enrolled in trials of hospital-initiated smoking cessation interventions. Comparison of characteristics between participants who verified and those who failed to verify self-reported abstinence. Multi-site randomized clinical trials conducted between 2010 and 2014 in hospitals throughout the United States. Recently hospitalized smokers who reported tobacco abstinence 6 months post-randomization and provided a saliva sample for verification purposes (n = 822). Outcomes were salivary cotinine-verified smoking abstinence at 10 and 15 ng/ml cut-points. Predictors and correlates included participant demographics and tobacco use; hospital diagnoses and treatment; and study characteristics collected via surveys and electronic medical records. Usable samples were returned by 69.8% of the 1178 eligible trial participants who reported 7-day point prevalence abstinence. The proportion of participants verified as quit was 57.8% [95% confidence interval (CI) = 54.4, 61.2; 10 ng/ml cut-off] or 60.6% (95% CI = 57.2, 63.9; 15 ng/ml). Factors associated independently with verification at 10 ng/ml were education beyond high school education [odds ratio (OR) = 1.51; 95% CI = 1.07, 2.11], continuous abstinence since hospitalization (OR = 2.82; 95% CI = 2.02, 3.94), mailed versus in-person sample (OR = 3.20; 95% CI = 1.96, 5.21) and race. African American participants were less likely to verify abstinence than white participants (OR = 0.64; 95% CI = 0.44, 0.93). Findings were similar for verification at 15 ng/ml. Verification rates did not differ by treatment group. In the United States, high rates (40%) of recently hospitalized smokers enrolled in smoking cessation trials fail biochemical verification of their self-reported abstinence. © 2017 Society for the Study of Addiction.

Remaining Off Alcohol and Drugs: A Self-Management Skills Program for Abstinence.

ERIC Educational Resources Information Center

Dunphy, Peter Hughes

The Remaining Off Alcohol and Drugs Program (ROAD) was developed to teach newly abstinent chemical misusing clients how to remain alcohol and drug free. It provides its participants with a repertoire of knowledge, skills and behaviors that they can use in dealing with the most common problems caused by discontinuing chemical use and which can be…

Course of Psychiatric Symptoms and Abstinence among Methamphetamine-Dependent Persons in Sober Living Recovery Homes.

PubMed

Polcin, Douglas L; Witbrodt, Jane; Korcha, Rachael; Gupta, Shalika; Mericle, Amy A

2016-01-01

Although studies of co-occurring psychiatric disorders among methamphetamine (MA)-dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs). Residents entering SLHs (N = 243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past-year drug and alcohol dependence, and abstinence over six-month time periods. Overall, severity of psychiatric symptoms on the BSI was similar among MA-dependent and other dependent residents. Global psychiatric severity, depression, and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA-dependent residents but not for those dependent on other substances. The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA-dependent residents but not those dependent on other substances.

Course of Psychiatric Symptoms and Abstinence among Methamphetamine Dependent Persons in Sober Living Recovery Homes

PubMed Central

Polcin, Douglas; Witbrodt, Jane; Korcha, Rachael; Gupta, Shalika; Mericle, Amy A.

2016-01-01

Background Although studies of co-occurring psychiatric disorders among methamphetamine (MA) dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs). Methods Residents entering SLHs (N=243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past year drug and alcohol dependence, and abstinence over 6-month time periods. Results Overall, severity of psychiatric symptoms on the BSI were similar among MA dependent and other dependent residents. Global psychiatric severity, depression and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA dependent residents but not for those dependent on other substances. Conclusion The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA dependent residents but not those dependent on other substances. PMID:27184803

Interrelated effects of substance use diagnosis, race, and smoking severity on abstinence initiation in dually dependent male smokers: results of a retrospective chart review.

PubMed

Heffner, Jaimee L; Blom, Thomas J; Camerota, Elaine; Sansone, Linda E; Bodie, Linda; Smith, Joshua; Lin, Show; Drake, J Michael; Meyer, Corey; Anthenelli, Robert M

2007-12-01

: Study goals were 2-fold: 1) to examine differences in demographic and clinical characteristics of smokers who fell into 3 diagnostic groups: alcohol abuse/dependence only (ALC), cocaine abuse/dependence only (COC), and mixed alcohol and cocaine abuse/dependence (ALC + COC); and 2) to determine the degree to which diagnostic grouping predicted short-term abstinence from smoking. : Retrospective chart reviews were conducted by using the treatment records of male veterans (N = 175) who participated in a voluntary smoking cessation program during their stay in residential substance dependence treatment. : The ALC group smoked more heavily, had higher levels of nicotine dependence, and reported more emotional problems than the other 2 groups. Short-term abstinence rates were high across the 3 groups (38%, 58%, and 57% for the ALC, COC, and ALC + COC groups, respectively). Lighter smoking at treatment entry, non-white race, and a diagnosis of cocaine abuse/dependence (with or without alcohol abuse/dependence) predicted short-term abstinence in the program. : Substance misusers motivated to quit smoking can initiate smoking abstinence at relatively high rates with the aid of combined pharmacotherapy and intensive group counseling. White subjects who smoke more heavily and have a diagnosis of alcohol abuse/dependence only have lower success rates for abstinence initiation.

Abstinence Education. Hearing before a Subcommittee of the Committee on Appropriations, United States Senate, One Hundred Eighth Congress, Second Session (February 16, 2004). Senate Hearing 108-385

ERIC Educational Resources Information Center

US Senate, 2004

2004-01-01

The focus of this hearing was on funding for abstinence education. Following an opening statement by Subcommittee Chairman Senator Arlen Specter of Pennsylvania, witness testimonies were heard from: Dr. Wade F. Horn, Ph.D., Assistant Secretary for Children and Families, Department of Health and Human Services, Washington, D.C.; Rev. Kenneth Page,…

Psychosocial correlates of the motivation to abstain from sexual intercourse among Indonesian adolescents.

PubMed

Leerlooijer, Joanne N; Ruiter, Robert A C; Damayanti, Rita; Rijsdijk, Liesbeth E; Eiling, Ellen; Bos, Arjan E R; Kok, Gerjo

2014-01-01

Adolescents in Indonesia have limited access to sexuality education, resulting in increased risk of sexually transmitted infections and unplanned pregnancies. This study aimed to understand psychosocial correlates of sexual abstinence intentions to inform future sexuality education. Data were collected in 79 secondary schools among 2315 students, aged 14-20 years, in Jambi, Lampung, Jakarta and Bali. A self-completed questionnaire measured attitudes, risk perception, subjective norms, perceived behavioural control and intentions towards sexual abstinence. Significant associations with intention to abstain from sexual intercourse were found for experience with sexual intercourse, perceived behavioural control, attitude and subjective norms of peers and parents, explaining 31% of the variance in abstinence intention. To promote adolescents' informed sexual decision-making, sexuality education programmes in Indonesia may benefit from addressing past sexual behaviour and perceived behavioural control, subjective norms of peers and attitudes. © 2013 John Wiley & Sons Ltd.

Attendance rates in a workplace predict subsequent outcome of employment-based reinforcement of cocaine abstinence in methadone patients.

PubMed

Donlin, Wendy D; Knealing, Todd W; Needham, Mick; Wong, Conrad J; Silverman, Kenneth

2008-01-01

This study assessed whether attendance rates in a workplace predicted subsequent outcome of employment-based reinforcement of cocaine abstinence. Unemployed adults in Baltimore methadone programs who used cocaine (N=111) could work in a workplace for 4 hr every weekday and earn $10.00 per hour in vouchers for 26 weeks. During an induction period, participants provided urine samples but could work independent of their urinalysis results. After the induction period, participants had to provide urinalysis evidence of cocaine abstinence to work and maintain maximum pay. A multiple regression analysis showed that induction period attendance was independently associated with urinalysis evidence of cocaine abstinence under the employment-based abstinence reinforcement contingency. Induction period attendance may measure the reinforcing value of employment and could be used to guide the improvement of employment-based abstinence reinforcement.

The Primary Results of the Treating Adult Smokers at Risk for Weight Gain with Interactive Technology (TARGIT) Study.

PubMed

Johnson, Karen C; Thomas, Fridtjof; Richey, Phyllis; Tran, Quynh T; Tylavsky, Fran; Miro, Danielle; Coday, Mace

2017-10-01

To evaluate whether a behavioral weight management program combined with a smoking cessation program delivered via interactive technology could prevent postcessation weight gain. Three hundred and thirty young adult smokers, age 18 to 35 years, were randomized to a smoking cessation program alone (comparison group), which included behavioral counseling and nicotine replacement, or to a behavioral weight management program adapted from the Look AHEAD trial plus the same smoking cessation program (intervention group). The Treating Adult Smokers at Risk for Weight Gain with Interactive Technology study randomized 164 participants to the comparison group and 166 participants to the intervention group. On average, the participants gained 0.91 kg after 24 months in the trial (comparison group + 1.45 kg and intervention group + 0.32; P = 0.157). The only variable systematically affecting weight change over time was smoking abstinence, in which those who were abstinent, on average, gained 0.14 kg more per month compared with those who continued to smoke (P < 0.001). In exploratory analyses, the intervention participants who were abstinent at 6 months had numerically smaller weight gains compared with abstinent participants in the comparison group, but these differences were not statistically significant. Providing an intensive weight gain prevention program combined with a smoking cessation program via interactive technology was not associated with greater long-term weight gain prevention. © 2017 The Obesity Society.

Socioeconomic differences in adolescent substance abuse treatment participation and long-term outcomes.

PubMed

Lui, Camillia K; Sterling, Stacy A; Chi, Felicia W; Lu, Yun; Campbell, Cynthia I

2017-05-01

Socioeconomic status (SES) has been consistently linked to poorer access, utilization and outcomes of health care services, but this relationship has been understudied in adolescent substance abuse treatment research. This study examined SES differences in adolescent's treatment participation and long-term outcomes of abstinence and 12-step attendance over five years after treatment. Data are from 358 adolescents (ages 13-18) who were recruited at intake to substance abuse treatment between 2000 and 2002 at four Kaiser Permanente Northern California outpatient treatment programs. Follow-up interviews of adolescents and their parents were conducted at 1, 3, and 5years, with over 80% response rates across time points. Using parent SES as a proxy for adolescent SES, no socioeconomic differences were found in treatment initiation, treatment retention, or long-term abstinence from alcohol or drugs. Parent education, but not parent income, was significantly associated with 12-step attendance post-treatment such that adolescents with higher parent education were more likely to attend than those with lower parent education. Findings suggest a lack of socioeconomic disparities in substance abuse treatment participation in adolescence, but potential disparities in post-treatment 12-step attendance during the transition from adolescence to young adulthood. Copyright © 2017 Elsevier Ltd. All rights reserved.

Listening to youth: teen perspectives on pregnancy prevention.

PubMed

Hacker, K A; Amare, Y; Strunk, N; Horst, L

2000-04-01

To ascertain views of public high school students on preventing teen pregnancy. The authors hypothesized that students at varying risk for pregnancy (e.g., abstinent, consistent contraceptors, inconsistent contraceptors) would have differing views which would have implications for future pregnancy prevention programming. A 75-question anonymous survey designed for this study was administered in six Boston high schools. The sample consisted of 49% females and 51% males in 10th and 11th grades from diverse racial and ethnic backgrounds. One thousand surveys were received and analyzed using Chi-square tests to assess statistically significant differences in student responses. Sixty-three percent of the students had had sexual intercourse: 72% of males and 54% of females. Of these, 35% were consistent contraceptors and 65% were inconsistent. Students believed that having more information on pregnancy and birth control (52%), education about relationships (33%), parental communication (32%), improved contraceptive access (31%), and education about parenting realities (30%) would prevent teen pregnancy. Abstinent teens were more likely (58%) to say that information on pregnancy and birth control was important (p<.05), whereas consistently contracepting teens were more likely (40%) to identify greater access to birth control (p <.01). Males were more likely than females to prefer their information on contraception from parents (23% vs. 18%) and health education classes (16% vs. 7.5%), whereas females were more likely than males to prefer the health arena (51% vs. 27%) (p<.001). Teens using contraception were also more likely to be having frequent conversations with parents (49%) (p<.001). When asked why they had not used contraception, inconsistent contraceptors were more likely than others to say that they never thought of it (15%) (p<.001). Teens report that having more information from parents, school, and health arenas can prevent pregnancy. Abstinent, consistent contraceptors, and inconsistent contraceptors have different preferences regarding strategies. This information has important implications for educational content and policy discussions.

Effects of therapeutic goal management (TGM) on treatment attendance and drug abstinence among men with co-occurring substance use and axis I mental disorders who are homeless: results of the Birmingham EARTH program

PubMed Central

2013-01-01

Purpose This study describes the implementation and impact of Therapeutic Goal Management (TGM) in a Substance Abuse and Mental Health Services Administration (SAMHSA)-sponsored demonstration project entitled Enhanced Addiction Recovery through Housing (EARTH). Participants The sample included 28 male participants followed at six months who completed some treatment. Forty-three percent were Caucasian, and 57% were African American. The average age of participants was 42 years. Design The relationships between TGM goal achievement, treatment attendance, and drug abstinence outcomes were studied among EARTH program participants who were homeless and met criteria for co-occurring substance use and severe DSM-IV Axis I mental disorders. Results The results revealed an overall drug abstinence rate of 72.4% over six months and significant positive relationships between TGM goal achievement and drug abstinence (r = 0.693) and TGM goal achievement and treatment attendance (r = 0.843). Conclusions This research demonstrated the relationship and potential positive impact of systematically setting, monitoring, and reinforcing personalized goals in multiple life areas on drug abstinence and treatment attendance outcomes among persons who are homeless with co-occurring substance use and other Axis I disorders in a integrated community service delivery program. PMID:24499617

Does Early Adolescent Sex Cause Depressive Symptoms?

ERIC Educational Resources Information Center

Sabia, Joseph J.

2006-01-01

A recent study by the Heritage Foundation (Rector, Johnson, & Noyes, 2003) found evidence of a positive relationship between early sexual intercourse and depressive symptoms. This finding has been used to bolster support for funding abstinence only sex education. However, promoting abstinence will only yield mental health benefits if there is…

The Teachers' Lounge

ERIC Educational Resources Information Center

Barlow, Dudley

2005-01-01

In this article, the author critiques two current behavioral trends in society among the youth regarding sexuality, namely the abstinence-only viewpoint and hooking-up. He comments that abstinence-only sex education classes seem to focus on and amplify the very dangers that informed students know they can minimize. Moreover, if protecting students…

The Problematic Promotion of Abstinence: An Overview of Sex Respect.

ERIC Educational Resources Information Center

Goodson, Patricia; Edmundson, Elizabeth

1994-01-01

Presents the results of a content evaluation of the abstinence-based sexuality education curriculum, "Sex Respect," focusing on the curriculum's message and presentation. Results indicate Sex Respect omits basic content and includes misinformation, especially in the areas of human sexual response and reproductive health, and needs revision.…

A Systematic, Intensive Statistical Investigation of Data from the Comprehensive Analysis of Reported Drugs (CARD) for Compliance and Illicit Opioid Abstinence in Substance Addiction Treatment with Buprenorphine/naloxone.

PubMed

Blum, Kenneth; Han, David; Modestino, Edward J; Saunders, Scott; Roy, A Kennison; Jacobs, W; Inaba, Darryl S; Baron, David; Oscar-Berman, Marlene; Hauser, Mary; Badgaiyan, Rajendra D; Smith, David E; Femino, John; Gold, Mark S

2018-01-28

Buprenorphine and naloxone (bup/nal), a combination partial mu receptor agonist and low-dose delta mu antagonist, is presently recommended and used to treat opioid-use disorder. However, a literature review revealed a paucity of research involving data from urine drug tests that looked at compliance and abstinence in one sample. Statistical analysis of data from the Comprehensive Analysis of Reported Drugs (CARD) was used to assess compliance and abstinence during treatment in a large cohort of bup/nal patients attending chemical-dependency programs from eastern USA in 2010 and 2011. Part 1: Bup/nal was present in 93.4% of first (n = 1,282; p <.0001) and 92.4% of last (n = 1,268; p <.0001) urine samples. Concomitantly, unreported illicit drugs were present in 47.7% (n = 655, p =.0261) of samples. Patients who were compliant to the bup/nal prescription were more likely than noncompliant patients to be abstinent during treatment (p =.0012; odds ratio = 1.69 with 95% confidence interval (1.210, 2.354). Part 2: An analysis of all samples collected in 2011 revealed a significant improvement in both compliance (p < 2.2 × 10 -16 ) and abstinence (p < 2.2 × 10 -16 ) during treatment. Conclusion/Importance: While significant use of illicit opioids during treatment with bup/nal is present, improvements in abstinence and high compliance during maintenance-assisted therapy programs may ameliorate fears of diversion in comprehensive programs. Expanded clinical datasets, the treatment modality, location, and year of sampling are important covariates, for further studies. The potential for long-term antireward effects from bup/nal use requires consideration in future investigations.

Cost-Effectiveness and Cost-Utility of Internet-Based Computer Tailoring for Smoking Cessation

PubMed Central

Evers, Silvia MAA; de Vries, Hein; Hoving, Ciska

2013-01-01

Background Although effective smoking cessation interventions exist, information is limited about their cost-effectiveness and cost-utility. Objective To assess the cost-effectiveness and cost-utility of an Internet-based multiple computer-tailored smoking cessation program and tailored counseling by practice nurses working in Dutch general practices compared with an Internet-based multiple computer-tailored program only and care as usual. Methods The economic evaluation was embedded in a randomized controlled trial, for which 91 practice nurses recruited 414 eligible smokers. Smokers were randomized to receive multiple tailoring and counseling (n=163), multiple tailoring only (n=132), or usual care (n=119). Self-reported cost and quality of life were assessed during a 12-month follow-up period. Prolonged abstinence and 24-hour and 7-day point prevalence abstinence were assessed at 12-month follow-up. The trial-based economic evaluation was conducted from a societal perspective. Uncertainty was accounted for by bootstrapping (1000 times) and sensitivity analyses. Results No significant differences were found between the intervention arms with regard to baseline characteristics or effects on abstinence, quality of life, and addiction level. However, participants in the multiple tailoring and counseling group reported significantly more annual health care–related costs than participants in the usual care group. Cost-effectiveness analysis, using prolonged abstinence as the outcome measure, showed that the mere multiple computer-tailored program had the highest probability of being cost-effective. Compared with usual care, in this group €5100 had to be paid for each additional abstinent participant. With regard to cost-utility analyses, using quality of life as the outcome measure, usual care was probably most efficient. Conclusions To our knowledge, this was the first study to determine the cost-effectiveness and cost-utility of an Internet-based smoking cessation program with and without counseling by a practice nurse. Although the Internet-based multiple computer-tailored program seemed to be the most cost-effective treatment, the cost-utility was probably highest for care as usual. However, to ease the interpretation of cost-effectiveness results, future research should aim at identifying an acceptable cutoff point for the willingness to pay per abstinent participant. PMID:23491820

Back to Basics: How Young Mothers Learn about Sex and Sexuality

ERIC Educational Resources Information Center

Dudley, James; Crowder, Amanda; Montgomery, Tchernavia R.

2014-01-01

Adolescent pregnancy continues to be a major concern for policy-makers, programme developers, helping professionals and society generally in the USA, especially in light of the US federal government's legislative emphasis on abstinence-only sex education until recently. Studies have found that abstinence-only programmes do not succeed in…

Anxiety, depression and tobacco abstinence.

PubMed

Almadana Pacheco, Virginia; Gómez-Bastero Fernández, Ana Paulina; Valido Morales, Agustín; Luque Crespo, Estefanía; Monserrat, Soledad; Montemayor Rubio, Teodoro

2017-09-29

There is evidence of the relationship between mental illness and smoking and increased risk of depressive episodes after quitting smoking, even with specific treatments for abstinence. To assess the influence of a cessation program on the emotional state of patients by measuring levels of anxiety / depression and differences depending on the presence of psychiatric history. A prospective observational study of patients taking part in a combined program (pharmacological and cognitive-behavioral) for giving up smoking. Anxiety (A) and depression (D) were measured using the HADS questionnaire at baseline, first and third month of abstinence. Anxiety and depression showed significant and progressive improvement during treatment (A: baseline 9.2 ± 4.5, 5.9 ± 3.6 1 month, 3 months 4.5 ± 3.1, p.

Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high-sexually transmitted infection prevalence communities.

PubMed

Cummings, Teresa; Auerswald, Colette L; Ott, Mary A

2014-05-01

Abstinence is a core pregnancy and sexually transmitted infection (STI) prevention strategy. We explore the attitudinal, behavioral, and family contexts relating to abstinence and the decision to delay sex among adolescent boys. Adolescent boys ages 14-17 years were recruited from community sites using a venue-based sampling method. All eligible boys at venues were invited to participate in an electronic survey. Question items included sexual behaviors, attitudes related to sex, relationships, masculine values, and family contextual items. We enrolled 667 participants, mean age 15.7 years, of diverse ethnicity. A total of 252 were abstinent (38%). Abstinent participants were younger and less likely to report non-coital behaviors, and reported lower conventional masculine values. Among abstinent participants, 62% planned to delay sex, whereas 38% anticipated sex in the next year. Participants with lower conventional masculine values and more religious or moral motivations for abstinence were more likely to plan to delay sex. Abstinence among boys is common, even in high-STI risk communities. For these boys, abstinence appears to be a complex behavioral decision influenced by demographic, behavioral, attitudinal, and contextual factors such as age, race, non-coital sexual behaviors, and masculine values. Understanding the attitudes and contexts of abstinence, including plans to delay sex, can inform the development of public health programs for early fatherhood and STI prevention. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

University students' definitions of sexual abstinence and having sex.

PubMed

Byers, E Sandra; Henderson, Joel; Hobson, Kristina M

2009-10-01

We asked 298 heterosexual Canadian university students about their definitions of the terms abstinence and having sex. For both terms, students were provided with a list of 17 sexual behaviors and indicated whether they would include each in their definition. The majority of both male and female students included activities that did not involve genital stimulation in their definition of sexual abstinence and did not include these activities in their definition of having sex. Conversely, most students did not include bidirectional sexual stimulation (penile-vaginal intercourse or penile-anal intercourse) in their definitions of sexual abstinence but did include them in their definitions of having sex. Students were quite mixed in whether activities involving unidirectional genital stimulation (e.g., oral sex, genital fondling) constituted abstinence, having sex, or neither abstinence nor having sex. However, they were more likely to see these behaviors as abstinent than as having sex. Students were more likely to rate a behavior as abstinence if orgasm did not occur. A canonical correlation analysis was used to examine the patterns of association between a number of predictors and inclusions of behaviors involving no genital stimulation, unidirectional stimulation, and bidirectional genital stimulation in abstinence definitions. The results indicated that male participants who were more involved with their religion and sexually conservative, less sexually experienced, and who had not received sexual health education at home were more likely to define bidirectional genital stimulation and less likely to define no genital stimulation and unidirectional sexual stimulation as sexual abstinence. The research and health promotion implications of these results are discussed.

Feasibility and preliminary efficacy of a web-based smoking cessation intervention for HIV-infected smokers: a randomized controlled trial.

PubMed

Shuter, Jonathan; Morales, Daniela A; Considine-Dunn, Shannon E; An, Lawrence C; Stanton, Cassandra A

2014-09-01

To evaluate the feasibility and preliminary efficacy of a Web-based tobacco treatment for persons living with HIV (PLWH). Prospective, randomized controlled trial. HIV-care center in the Bronx, New York. Eligibility criteria included HIV infection, current tobacco usage, interest in quitting, and access to a computer with internet. One hundred thirty-eight subjects enrolled, and 134 completed the study. Positively Smoke Free on the Web (PSFW), an 8-session, 7-week targeted tobacco treatment program for PLWH, was compared with standard care (brief advice to quit and self-help brochure). All subjects were offered nicotine patches. The main feasibility outcomes were number of sessions logged into, number of Web pages visited, number of interactive clicks, and total time logged in. The main efficacy outcome was biochemically verified, 7-day point prevalence abstinence 3 months after intervention. PSFW subjects logged into a mean of 5.5 of 8 sessions and 26.2 of 41 pages. They executed a mean of 10 interactive clicks during a mean total of 59.8 minutes logged in. Most required reminder phone calls to complete the sessions. Educational level, anxiety score, and home access of the Web site were associated with Web site usage. Ten percent of the PSFW group vs. 4.3% of controls achieved the abstinence end point. Among those who completed all 8 sessions, 17.9% were abstinent, and among women completers, 30.8% were abstinent. Web-based treatment is a feasible strategy for PLWH smokers, and preliminary findings suggest therapeutic efficacy.

Employment-based abstinence reinforcement promotes opiate and cocaine abstinence in out-of-treatment injection drug users.

PubMed

Holtyn, August F; Koffarnus, Mikhail N; DeFulio, Anthony; Sigurdsson, Sigurdur O; Strain, Eric C; Schwartz, Robert P; Silverman, Kenneth

2014-01-01

We examined the use of employment-based abstinence reinforcement in out-of-treatment injection drug users, in this secondary analysis of a previously reported trial. Participants (N = 33) could work in the therapeutic workplace, a model employment-based program for drug addiction, for 30 weeks and could earn approximately $10 per hr. During a 4-week induction, participants only had to work to earn pay. After induction, access to the workplace was contingent on enrollment in methadone treatment. After participants met the methadone contingency for 3 weeks, they had to provide opiate-negative urine samples to maintain maximum pay. After participants met those contingencies for 3 weeks, they had to provide opiate- and cocaine-negative urine samples to maintain maximum pay. The percentage of drug-negative urine samples remained stable until the abstinence reinforcement contingency for each drug was applied. The percentage of opiate- and cocaine-negative urine samples increased abruptly and significantly after the opiate- and cocaine-abstinence contingencies, respectively, were applied. These results demonstrate that the sequential administration of employment-based abstinence reinforcement can increase opiate and cocaine abstinence among out-of-treatment injection drug users. © Society for the Experimental Analysis of Behavior.

EMPLOYMENT-BASED ABSTINENCE REINFORCEMENT PROMOTES OPIATE AND COCAINE ABSTINENCE IN OUT-OF-TREATMENT INJECTION DRUG USERS

PubMed Central

Holtyn, August F.; Koffarnus, Mikhail N.; DeFulio, Anthony; Sigurdsson, Sigurdur O.; Strain, Eric C.; Schwartz, Robert P.; Silverman, Kenneth

2016-01-01

We examined the use of employment-based abstinence reinforcement in out-of-treatment injection drug users, in this secondary analysis of a previously reported trial. Participants (N = 33) could work in the therapeutic workplace, a model employment-based program for drug addiction, for 30 weeks and could earn approximately $10 per hr. During a 4-week induction, participants only had to work to earn pay. After induction, access to the workplace was contingent on enrollment in methadone treatment. After participants met the methadone contingency for 3 weeks, they had to provide opiate-negative urine samples to maintain maximum pay. After participants met those contingencies for 3 weeks, they had to provide opiate- and cocaine-negative urine samples to maintain maximum pay. The percentage of drug-negative urine samples remained stable until the abstinence reinforcement contingency for each drug was applied. The percentage of opiate- and cocaine-negative urine samples increased abruptly and significantly after the opiate- and cocaine-abstinence contingencies, respectively, were applied. These results demonstrate that the sequential administration of employment-based abstinence reinforcement can increase opiate and cocaine abstinence among out-of-treatment injection drug users. PMID:25292399

Understanding Sexual Abstinence in Urban Adolescent Girls

PubMed Central

Morrison-Beedy, Dianne; Carey, Michael P.; Côté-Arsenault, Denise; Seibold-Simpson, Susan; Robinson, Kerry Anne

2008-01-01

Objectives To gain insight into the context of sexual abstinence and identify potential determinants of abstinence in this population. Design Four focus groups. Participants and Setting Twenty-four, predominantly African American (88%) girls aged 14 to 19 years were recruited from urban health centers and youth development programs in Rochester, New York, between September and December 2006. Data Analysis Content analysis was used to analyze the four verbatim transcripts. Using analytic induction, groups were compared and contrasted at the micro (within-group) and macro (between-group) levels to identify themes. Results Four themes were identified that provided insight into how and why these girls remain abstinent despite being in sexually active social climates. They focused on the following: self-respect (I'm worth it), impact of mothers (Mama says … think before you let it go), influence of boys and other peers (Boys will be boys), and potential negative consequences of sex (Hold on, there's a catch). Conclusions Developing interventions to maintain abstinence, delay onset of sexual activity, and promote protected first and subsequent sexual contact in abstinent girls are key to decreasing future sexual risk. These findings suggest opportunities to develop HIV prevention strategies tailored to the needs of abstinent girls. PMID:18336442

The impact of including incentives and competition in a workplace smoking cessation program on quit rates.

PubMed

Koffman, D M; Lee, J W; Hopp, J W; Emont, S L

1998-01-01

To determine the effectiveness of a multicomponent smoking cessation program supplemented by incentives and team competition. A quasi-experimental design was employed to compare the effectiveness of three different smoking cessation programs, each assigned to separate worksite. The study was conducted from 1990 to 1991 at three aerospace industry worksites in California. All employees who were current, regular tobacco users were eligible to participate in the program offered at their site. The multicomponent program included a self-help package, telephone counseling, and other elements. The incentive-competition program included the multicomponent program plus cash incentives and team competition for the first 5 months of the program. The traditional program offered a standard smoking cessation program. Self-reported questionnaires and carbon monoxide tests of tobacco use or abstinence were used over a 12-month period. The incentive-competition program had an abstinence rate of 41% at 6 months (n = 68), which was significantly better than the multicomponent program (23%, n = 81) or the traditional program (8%, n = 36). At 12 months, the quit rates for the incentive and multicomponent-programs were statistically indistinguishable (37% vs. 30%), but remained higher than the traditional program (11%). Chi-square tests, t-tests, and logistic regression were used to compare smoking abstinence across the three programs. Offering a multicomponent program with telephone counseling may be just as effective for long-term smoking cessation as such a program plus incentives and competition, and more effective than a traditional program.

Employment-based abstinence reinforcement as a maintenance intervention for the treatment of cocaine dependence: post-intervention outcomes.

PubMed

DeFulio, Anthony; Silverman, Kenneth

2011-05-01

Due to the chronicity of cocaine dependence, practical and effective maintenance interventions are needed to sustain long-term abstinence. We sought to assess the effects of long-term employment-based reinforcement of cocaine abstinence after discontinuation of the intervention. Participants who initiated sustained opiate and cocaine abstinence during a 6-month abstinence reinforcement and training program worked as data entry operators and were randomly assigned to a group that could work independently of drug use (control, n = 24), or an abstinence-contingent employment (n = 27) group that was required to provide cocaine- and opiate-negative urine samples to work and maintain maximum rate of pay. A non-profit data entry business. Unemployed welfare recipients who persistently used cocaine while in methadone treatment. Urine samples and self-reports were collected every 6 months for 30 months. During the employment year, abstinence-contingent employment participants provided significantly more cocaine-negative samples than controls (82.7% and 54.2%; P = 0.01, OR = 4.61). During the follow-up year, the groups had similar rates of cocaine-negative samples (44.2% and 50.0%; P = 0.93) and human immunodeficiency virus risk behaviors. Participants' social, employment, economic and legal conditions were similar in the two groups across all phases of the study. Employment-based reinforcement effectively maintains long-term cocaine abstinence, but many patients relapse to use when the abstinence contingency is discontinued, even after a year of abstinence-contingent employment. Relapse could be prevented in many patients by leaving employment-based abstinence reinforcement in place indefinitely, which could be facilitated by integrating it into typical workplaces. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Low effective organizational strategies in visual memory performance of unmedicated alcoholics during early abstinence.

PubMed

Daig, Isolde; Mahlberg, Richard; Schroeder, Franziska; Gudlowski, Yehonala; Wrase, Jana; Wertenauer, Florian; Bschor, Tom; Esser, Guenter; Heinz, Andreas; Kienast, Thorsten

2010-12-14

Alcohol-dependent patients in early abstinence show an impairment of cognitive functions which can be seen in poor implementation of newly learned skills for avoiding relapse. Executive dysfunction may persist during abstinence in alcohol-dependent persons, thus mitigating long-term abstinence. This study assessed visual memory function and choice of organizational strategies in alcoholics, as these are major factors necessary to implement ongoing behavior changes which are required for maintaining abstinence. We investigated 25 severely alcohol-dependent male patients between days 7 to 10 of abstinence, immediately after clinical withdrawal symptoms have ceased, compared to 15 healthy age, sex, and education matched controls. Pharmacological therapy had been terminated at least four half-lifes before inclusion into the study. Visual perceptual learning and organizational strategies were assessed with the Rey-Osterrieth Complex Figure Test (R-OCF). There were no group differences in copying or recalling the figure, but time differences occurred. Alcoholics and healthy controls performed worse in recalling than in copying. But, alcoholics used less effective organizational strategies. There was a deficit in choice of organizational strategy in newly abstinent and unmedicated alcohol-dependent patients. Due to the imperfect organizational strategies, alcoholics might need auxiliary therapeutic care to strengthen their cognitive ability.

Effectiveness of a Web-based multiple tailored smoking cessation program: a randomized controlled trial among Dutch adult smokers.

PubMed

Smit, Eline Suzanne; de Vries, Hein; Hoving, Ciska

2012-06-11

Distributing a multiple computer-tailored smoking cessation intervention through the Internet has several advantages for both provider and receiver. Most important, a large audience of smokers can be reached while a highly individualized and personal form of feedback can be maintained. However, such a smoking cessation program has yet to be developed and implemented in The Netherlands. To investigate the effects of a Web-based multiple computer-tailored smoking cessation program on smoking cessation outcomes in a sample of Dutch adult smokers. Smokers were recruited from December 2009 to June 2010 by advertising our study in the mass media and on the Internet. Those interested and motivated to quit smoking within 6 months (N = 1123) were randomly assigned to either the experimental (n = 552) or control group (n = 571). Respondents in the experimental group received the fully automated Web-based smoking cessation program, while respondents in the control group received no intervention. After 6 weeks and after 6 months, we assessed the effect of the intervention on self-reported 24-hour point prevalence abstinence, 7-day point prevalence abstinence, and prolonged abstinence using logistic regression analyses. Of the 1123 respondents, 449 (40.0%) completed the 6-week follow-up questionnaire and 291 (25.9%) completed the 6-month follow-up questionnaire. We used a negative scenario to replace missing values. That is, we considered respondents lost to follow-up to still be smoking. The computer-tailored program appeared to have significantly increased 24-hour point prevalence abstinence (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.30-2.65), 7-day point prevalence abstinence (OR 2.17, 95% CI 1.44-3.27), and prolonged abstinence (OR 1.99, 95% CI 1.28-3.09) rates reported after 6 weeks. After 6 months, however, no intervention effects could be identified. Results from complete-case analyses were similar. The results presented suggest that the Web-based computer-tailored smoking cessation program had a significant effect on abstinence reported after a 6-week period. At the 6-month follow-up, however, no intervention effects could be identified. This might be explained by the replacement of missing values on the primary outcome measures due to attrition using a negative scenario. While results were similar when using a less conservative scenario (ie, complete-case analyses), the results should still be interpreted with caution. Further research should aim at identifying strategies that will prevent high attrition in the first place and, subsequently, to identify the best strategies for dealing with missing data when studies have high attrition rates. Dutch Trial Register NTR1351; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1351 (Archived by WebCite at http://www.webcitation.org/67egSTWrz).

Employment characteristics and socioeconomic factors associated with disparities in smoking abstinence and former smoking among U.S. workers.

PubMed

Fagan, Pebbles; Shavers, Vickie L; Lawrence, Deirdre; Gibson, James Todd; O'Connell, Mary E

2007-11-01

This study examines the associations among employment and socioeconomic factors and the outcomes, current smoking, cigarette abstinence and former smoking among adult U.S. workers ages 18-64 (n=288,813). Multivariate logistic regression was used to examine the associations among the variables using cross-sectional data from the 1998-1999 and 2001-2002 Tobacco Use Supplements to the Current Population Survey. Lower odds of current smoking was observed among part-time workers compared to those working variable hours and multiple job holders compared to persons holding one job. The self-employed, part-time workers and multiple job holders had higher odds of former smoking than comparison groups. Employment factors were not associated with short-term abstinence or 12-month abstinence from smoking, but income, education, marital status, and duration of smoking were associated with 12-month abstinence. These data suggest that while employment factors are associated with current and former smoking, socioeconomic factors are associated with long-term quitting.

Outpatient Management of Neonatal Abstinence Syndrome: A Quality Improvement Project.

PubMed

Chau, Kim T; Nguyen, Jacqueline; Miladinovic, Branko; Lilly, Carol M; Ashmeade, Terri L; Balakrishnan, Maya

2016-11-01

An increasing number of infants are diagnosed with neonatal abstinence syndrome (NAS). The study's primary objectives were to describe an academic medical center's level IV neonatal ICU's (NICU's) comprehensive outpatient NAS management effort, measure guideline compliance, and assess its safety. Secondary objectives were to describe the duration and cumulative methadone exposure, and to improve parent and provider knowledge of NAS. The study included 22 infants having a gestational age of 35-41 weeks, diagnosed with NAS, and discharged for outpatient methadone management. Discharges spanned 10 months and included 3 improvement periods. The outpatient program includes comprehensive discharge planning, a focused electronic health record (EHR) template, management guidelines, and parent and provider education. Providers complied with using the outpatient management guideline and EHR template, and assessed weight, NAS symptoms, and methadone dose during appointments. Two infants required NAS-related hospital readmission in the study period. From improvement period 1 to period 3 there was no difference in total outpatient days on methadone (58, 53, 74 days, respectively) or cumulative methadone dose (2.7, 2.6, 3.1mg/kg, respectively). A downward trend pattern in cumulative methadone exposure was noted in improvement period 2. Pre- and postimplementation surveys revealed that after implementation, parents had better understanding of NAS before delivery (71% vs. 100%, p = 0.009), while providers had increased comfort with outpatient management (24% vs. 67%, p < 0.001) and educating parents (48% vs. 82%, p = 0.001). This preliminary study suggests that outpatient NAS management can be safe when a comprehensive management program is implemented and can result in provider compliance with the program. Copyright 2016 The Joint Commission.

Alcohol and drug treatment involvement, 12-step attendance and abstinence: 9-year cross-lagged analysis of adults in an integrated health plan.

PubMed

Witbrodt, Jane; Ye, Yu; Bond, Jason; Chi, Felicia; Weisner, Constance; Mertens, Jennifer

2014-04-01

This study explored causal relationships between post-treatment 12-step attendance and abstinence at multiple data waves and examined indirect paths leading from treatment initiation to abstinence 9-years later. Adults (N = 1945) seeking help for alcohol or drug use disorders from integrated healthcare organization outpatient treatment programs were followed at 1-, 5-, 7- and 9-years. Path modeling with cross-lagged partial regression coefficients was used to test causal relationships. Cross-lagged paths indicated greater 12-step attendance during years 1 and 5 and were casually related to past-30-day abstinence at years 5 and 7 respectfully, suggesting 12-step attendance leads to abstinence (but not vice versa) well into the post-treatment period. Some gender differences were found in these relationships. Three significant time-lagged, indirect paths emerged linking treatment duration to year-9 abstinence. Conclusions are discussed in the context of other studies using longitudinal designs. For outpatient clients, results reinforce the value of lengthier treatment duration and 12-step attendance in year 1. Copyright © 2014 Elsevier Inc. All rights reserved.

A Cognitive Behavioral Smoking Abstinence Intervention for Adults with Chronic Pain: A Randomized Controlled Pilot Trial

PubMed Central

Hooten, W. Michael; Townsend, Cynthia O.; Hays, J. Taylor; Ebnet, Kaye L.; Gauvin, Thomas R.; Gehin, Jessica M.; Laures, Heidi J.; Patten, Christi A.; Warner, David O.

2015-01-01

Current evidence suggests it may be difficult for patients with chronic pain to quit smoking and, based on previous formative work, a 7-session individual and group-based cognitive behavioral (CB) intervention was developed. The primary aim of this randomized controlled pilot trial was to test the hypothesis that abstinence at month 6 would be greater among patients with chronic pain who received the CB intervention compared to a control condition. Upon admission to a 3-week interdisciplinary pain treatment (IPT) program, patients were randomized to receive the CB intervention (n = 30) or the control condition (n = 30). The 7-day point prevalence of self-reported smoking status was assessed at week 3 (upon completion of the 3-week IPT program) and at month 6 in an intent-to-treat analysis. At week 3, 30% (n=9) of patients in the CB condition were abstinent from smoking compared to 10% (n=3) in the control group (P=.104). At month 6, 20% (n=6) of patients who received the CB intervention were abstinent compared to none in the control group (P=.024). At week 3, a significant group by time interaction effect was found where the CB patients experienced greater improvements in self-efficacy from baseline compared to the control group (P=.002). A greater proportion of patients randomized to the CB group completed the IPT program (P=.052). The findings of this pilot trial suggest that integration of a CB-based smoking abstinence intervention into ongoing pain therapy may be an effective treatment for smokers with chronic pain. PMID:24333035

Curriculum: Big Decisions--Making Healthy, Informed Choices about Sex

ERIC Educational Resources Information Center

Davis, Melanie

2009-01-01

Big Decisions is a 10-lesson abstinence-plus curriculum for ages 12-18 that emphasizes sex as a big decision, abstinence as the healthiest choice, and the mandate that sexually active teens use condoms and be tested for sexually transmitted diseases. This program can be implemented with limited resources and facilitator training when abstinence…

Costs and Effectiveness of Treating Homeless Persons with Cocaine Addiction with Alternative Contingency Management Strategies.

PubMed

Mennemeyer, Stephen T; Schumacher, Joseph E; Milby, Jesse B; Wallace, Dennis

2017-03-01

Between 1990 and 2006 in Birmingham, Alabama USA, 4 separate randomized controlled studies, called "Homeless 1" through "Homeless 4", treated cocaine substance abuse among chronically homeless adults, largely black men, many with non-psychotic mental health problems. The 4 studies had 9 treatment arms that used various counseling methods plus, in some arms, the provision of housing and work therapy usually with a contingent requirement of urine-test verified abstinence from substances. Participants in the abstinent-contingent arms who lapsed on abstinence were removed from housing and sent to an evening public shelter from which they were daily transported to day treatment until they returned to abstinence. This paper compares the cost effectiveness of the treatment arms. Societal cost per participant (in 2014 dollars) for each arm is defined as direct treatment cost plus cost of jail or hospital plus societal expense of public shelter use by lapsed participants. An untreated Base Case is defined as 5 percent abstinence with 95 percent usage of a public shelter. Incremental Cost Effectiveness Ratios (ICERs) for paired arms are defined as the change in cost per participant divided by the change in abstinence. Bootstrapping estimates confidence intervals. Average cost per participant at the end of 6 months of active treatment in 7 arms with comparable data ranged from USD 10,447 to USD 36,194 with corresponding average weeks abstinent ranging from 6.1 to 15.3 out of a possible 26 weeks. In contrast, the Base Case would cost USD 6,123 for 1.3 weeks of abstinence. Compared to the Base Case, the least expensive "DT2" treatment has an ICER of USD 901 (95% CI = USD 571 to USD 1,681) per additional week of abstinence and the most expensive "CMP4" has an ICER of USD 2,147 (95% CI = USD 1,701 to USD 2,848). Additionally, the Homeless 3 study found that the abstinent contingent housing (ACH3) treatment compared to the Non Abstinent Contingent Housing (NAC3), analogous to "Housing First", achieved better abstinence (12.1 v. 10 weeks) at higher average cost (USD 22,512 v. USD 17,541) yielding an ICER for this comparison of (USD 2,367, 95% CI=USD -10,587 to USD 12,467). Similar results are found at 12 months (6 months after active treatment). More intensive methods of counseling improved abstinence but 4 of the 7 treatments were inefficient ("dominated"). Bootstrapping shows that results are sensitive to which individuals were randomly assigned to each arm. A limitation of the analysis is that it does not consider the full societal cost of lost wages, crime costs beyond jail expenses and deterioration of neighborhood quality of life. Additionally, populations treated by Housing First programs may differ from the Birmingham Homeless studies in the severity of addiction or co-occuring psychological problems. The Homeless studies show that abstinent contingent safe housing with counseling can substantially improve abstinence for homeless cocaine abusers. Incremental costs rise sharply with more intensive counseling; modest programs of counseling may be more cost effective in a stepped treatment strategy.

Sex (Education) in the City: Singapore's Sexuality Education Curriculum

ERIC Educational Resources Information Center

Liew, Warren Mark

2014-01-01

This paper examines the Singapore Ministry of Education's sexuality education curriculum in relation to two leading approaches to sex education, namely, abstinence-only-until-marriage education (AOUME) and comprehensive sexuality education (CSE). Based on competing cultural, political, and religious beliefs, the arguments between the advocates of…

The importance of supporting autonomy and perceived competence in facilitating long-term tobacco abstinence

PubMed Central

Williams, Geoffrey C.; Niemiec, Christopher P.; Patrick, Heather; Ryan, Richard M.; Deci, Edward L.

2010-01-01

Background The Public Health Service (PHS) Guideline for Treating Tobacco Use and Dependence (1) recommends supporting autonomy and perceived competence to facilitate tobacco abstinence. Purpose To evaluate the effectiveness of an intensive tobacco-dependence intervention based on self-determination theory (SDT) and intended to support autonomy and perceived competence in facilitating long-term tobacco abstinence. Methods One thousand and six adult smokers were recruited into a randomized cessation-induction trial. Community care participants received cessation pamphlets and information on local treatment programs. Intervention participants received the same materials and were asked to meet four times with counselors over six months to discuss their health in a manner intended to support autonomy and perceived competence. The primary outcome was 24-month prolonged abstinence from tobacco. The secondary outcome was 7-day point prevalence tobacco abstinence at 24 months post-intervention. Results Smokers in the intervention were more likely to attain both tobacco abstinence outcomes and these effects were partially mediated by change in both autonomous self-regulation and perceived competence from baseline to six months. Structural equation modeling confirmed the SDT model of health-behavior change in facilitating long-term tobacco abstinence. Conclusions An intervention based on SDT and consistent with the PHS Guideline, which was intended to support autonomy and perceived competence, facilitated long-term tobacco abstinence. PMID:19373517

The importance of supporting autonomy and perceived competence in facilitating long-term tobacco abstinence.

PubMed

Williams, Geoffrey C; Niemiec, Christopher P; Patrick, Heather; Ryan, Richard M; Deci, Edward L

2009-06-01

The Public Health Service (PHS) Guideline for Treating Tobacco Use and Dependence (Fiore et al. 2000) recommends supporting autonomy and perceived competence to facilitate tobacco abstinence. The aim of the study was to evaluate the effectiveness of an intensive tobacco-dependence intervention based on self-determination theory (SDT) and intended to support autonomy and perceived competence in facilitating long-term tobacco abstinence. One thousand and six adult smokers were recruited into a randomized cessation-induction trial. Community care participants received cessation pamphlets and information on local treatment programs. Intervention participants received the same materials and were asked to meet four times with counselors over 6 months to discuss their health in a manner intended to support autonomy and perceived competence. The primary outcome was 24-month prolonged abstinence from tobacco. The secondary outcome was 7-day point prevalence tobacco abstinence at 24 months postintervention. Smokers in the intervention were more likely to attain both tobacco abstinence outcomes and these effects were partially mediated by change in both autonomous self-regulation and perceived competence from baseline to 6 months. Structural equation modeling confirmed the SDT model of health-behavior change in facilitating long-term tobacco abstinence. An intervention based on SDT and consistent with the PHS Guideline, which was intended to support autonomy and perceived competence, facilitated long-term tobacco abstinence.

Young People's Perceptions of Relationships and Sexual Practices in the Abstinence-Only Context of Uganda

ERIC Educational Resources Information Center

de Haas, Billie; Hutter, Inge; Timmerman, Greetje

2017-01-01

The Ugandan government has been criticised on several grounds for its abstinence-only policies on sexuality education directed towards young people. These grounds include the failure to recognise the multiple realities faced by young people, some of whom may already be sexually active. In the study reported on this paper, students' perceptions of…

A Randomized Trial of an Avatar-Hosted Multiple Behavior Change Intervention for Young Adult Smokers

PubMed Central

2013-01-01

Background Young adulthood is a critical transition period for the development of health behaviors. We present here the results of a randomized controlled trial of an online avatar-hosted personal health makeover program designed for young adult smokers. Methods We conducted a three-group randomized trial comparing delivery of general lifestyle content (Tx1), personally tailored health information (Tx2), and personally tailored health information plus online video–based peer coaching (Tx3) as part of a 6-week online health program. Participants were asked to set weekly goals around eating breakfast, exercise, alcohol use, and cigarette smoking. Eligibility criteria included age (18–30 years) and smoking status (any cigarette use in the previous 30 days). The primary outcome was self-reported 30-day abstinence measured 12 weeks postenrollment. Results Participant (n = 1698) characteristics were balanced across the groups (72% women, mean age 24, 26% nonwhite, 32% high school education or less, and 50% daily smokers). Considering intention to treat, 30-day smoking abstinence rates were statistically significantly higher in the intervention groups (Tx1 = 11%, Tx2 = 23%, Tx3 = 31%, P < .001). Participants in the intervention groups were also more likely to reduce their number of days spent on binge drinking and increase their number of days eating breakfast and exercising. Overall, intervention group participants were much more likely to make positive changes in at least three or four of the target behaviors (Tx1 = 19%, Tx2 = 39%, Tx3 = 41%, P < .001). Conclusions This online avatar-hosted personal health makeover “show” increased smoking abstinence and induced positive changes in multiple related health behaviors. Addition of the online video–based peer coaching further improved behavioral outcomes. PMID:24395994

A randomized trial of an avatar-hosted multiple behavior change intervention for young adult smokers.

PubMed

An, Lawrence C; Demers, Michele R S; Kirch, Matthias A; Considine-Dunn, Shannon; Nair, Vijay; Dasgupta, Kohinoor; Narisetty, Naveen; Resnicow, Ken; Ahluwalia, Jasjit

2013-12-01

Young adulthood is a critical transition period for the development of health behaviors. We present here the results of a randomized controlled trial of an online avatar-hosted personal health makeover program designed for young adult smokers. We conducted a three-group randomized trial comparing delivery of general lifestyle content (Tx1), personally tailored health information (Tx2), and personally tailored health information plus online video-based peer coaching (Tx3) as part of a 6-week online health program. Participants were asked to set weekly goals around eating breakfast, exercise, alcohol use, and cigarette smoking. Eligibility criteria included age (18-30 years) and smoking status (any cigarette use in the previous 30 days). The primary outcome was self-reported 30-day abstinence measured 12 weeks postenrollment. Participant (n = 1698) characteristics were balanced across the groups (72% women, mean age 24, 26% nonwhite, 32% high school education or less, and 50% daily smokers). Considering intention to treat, 30-day smoking abstinence rates were statistically significantly higher in the intervention groups (Tx1 = 11%, Tx2 = 23%, Tx3 = 31%, P < .001). Participants in the intervention groups were also more likely to reduce their number of days spent on binge drinking and increase their number of days eating breakfast and exercising. Overall, intervention group participants were much more likely to make positive changes in at least three or four of the target behaviors (Tx1 = 19%, Tx2 = 39%, Tx3 = 41%, P < .001). This online avatar-hosted personal health makeover "show" increased smoking abstinence and induced positive changes in multiple related health behaviors. Addition of the online video-based peer coaching further improved behavioral outcomes.

Cost-Effectiveness of an Internet-Delivered Treatment for Substance Abuse: Data from a Multisite Randomized Controlled Trial

PubMed Central

Murphy, Sean M.; Campbell, Aimee N. C.; Ghitza, Udi E.; Kyle, Tiffany L.; Bailey, Genie L.; Nunes, Edward V.; Polsky, Daniel

2016-01-01

Background Substance misuse and excessive alcohol consumption are major public health issues. Internet-based interventions for substance use disorders (SUDs) are a relatively new method for addressing barriers to access and supplementing existing care. This study examines cost-effectiveness in a multisite, randomized trial of an internet-based version of the community reinforcement approach (CRA) with contingency management (CM) known as the Therapeutic Education System (TES). Methods Economic evaluation of the 12-week trial with follow-up at 24 and 36 weeks. 507 individuals who were seeking therapy for alcohol or other substance use disorders at 10 outpatient community-based treatment programs were recruited and randomized to either treatment as usual (TAU) or TES+TAU. Sub-analyses were completed on participants with a poorer prognosis (i.e., those not abstinent at study entry). Results From the provider’s perspective, TES+TAU as it was implemented in this study costs $278 (SE=87) more than TAU alone after 12 weeks. The quality-adjusted life years gained by TES+TAU and TAU were similar; however, TES+TAU has at least a 95% chance of being considered cost-effective for providers and payers with willingness-to-pay thresholds as low as $20,000 per abstinent year. Findings for the subgroup not abstinent at study entry are slightly more favorable. Conclusions With regard to the clinical outcome of abstinence, our cost-effectiveness findings of TES+TAU compare favorably to those found elsewhere in the CM literature. The analyses performed here serve as an initial economic framework for future studies integrating technology into SUD therapy. Clinical trial registration NCT01104805. PMID:26880594

Cost-effectiveness of an internet-delivered treatment for substance abuse: Data from a multisite randomized controlled trial.

PubMed

Murphy, Sean M; Campbell, Aimee N C; Ghitza, Udi E; Kyle, Tiffany L; Bailey, Genie L; Nunes, Edward V; Polsky, Daniel

2016-04-01

Substance misuse and excessive alcohol consumption are major public health issues. Internet-based interventions for substance use disorders (SUDs) are a relatively new method for addressing barriers to access and supplementing existing care. This study examines cost-effectiveness in a multisite, randomized trial of an internet-based version of the community reinforcement approach (CRA) with contingency management (CM) known as the Therapeutic Education System (TES). Economic evaluation of the 12-week trial with follow-up at 24 and 36 weeks. 507 individuals who were seeking therapy for alcohol or other substance use disorders at 10 outpatient community-based treatment programs were recruited and randomized to either treatment as usual (TAU) or TES+TAU. Sub-analyses were completed on participants with a poorer prognosis (i.e., those not abstinent at study entry). From the provider's perspective, TES+TAU as it was implemented in this study costs $278 (SE=87) more than TAU alone after 12 weeks. The quality-adjusted life years gained by TES+TAU and TAU were similar; however, TES+TAU has at least a 95% chance of being considered cost-effective for providers and payers with willingness-to-pay thresholds as low as $20,000 per abstinent year. Findings for the subgroup not abstinent at study entry are slightly more favorable. With regard to the clinical outcome of abstinence, our cost-effectiveness findings of TES+TAU compare favorably to those found elsewhere in the CM literature. The analyses performed here serve as an initial economic framework for future studies integrating technology into SUD therapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Financial incentives for smoking cessation in low-income smokers: study protocol for a randomized controlled trial

PubMed Central

2012-01-01

Background Tobacco smoking is the leading avoidable cause of death in high-income countries. The smoking-related disease burden is borne primarily by the least educated and least affluent groups. Thus, there is a need for effective smoking cessation interventions that reach to, and are effective in this group. Research suggests that modest financial incentives are not very effective in helping smokers quit. What is not known is whether large financial incentives can enhance longer-term (1 year) smoking cessation rates, outside clinical and workplace settings. Trial design A randomized, parallel groups, controlled trial. Methods Participants: Eight hundred low-income smokers in Switzerland (the less affluent third of the population, based on fiscal taxation). Intervention: A smoking cessation program including: (a) financial incentives given during 6 months; and (b) Internet-based counseling. Financial rewards will be offered for biochemically verified smoking abstinence after 1, 2, and 3 weeks and 1, 3, and 6 months, for a maximum of 1,500 CHF (1,250 EUR, 1,500 USD) for those abstinent at all time-points. All participants, including controls, will receive Internet-based, individually-tailored, smoking cessation counseling and self-help booklets, but there will be no in-person or telephone counseling, and participants will not receive medications. The control group will not receive financial incentives. Objective: To increase smoking cessation rates. Outcome: Smoking abstinence after 6 and 18 months, not contradicted by biochemical tests. We will assess relapse after the end of the intervention, to test whether 6-month effects translate into sustained abstinence 12 months after the incentives are withdrawn. Randomization: Will be done using sealed envelopes drawn by participants. Blinding: Is not possible in this context. Discussion Smoking prevention policies and interventions have been least effective in the least educated, low-income groups. Combining financial incentives and Internet-based counseling is an innovative approach that, if proven acceptable and effective, could be later implemented on a large scale at a reasonable cost, decrease health disparities, and save many lives. Trial registration Current Controlled Trials ISRCTN04019434. PMID:22721577

Assessment of a Culturally-Tailored Sexual Health Education Program for African American Youth.

PubMed

Zellner Lawrence, Tiffany; Henry Akintobi, Tabia; Miller, Assia; Archie-Booker, Elaine; Johnson, Tarita; Evans, Donoria

2016-12-24

African American youth are affected disproportionately by sexually transmitted infections (STIs), human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS), and teenage pregnancy when compared to other racial groups. This paper evaluates the effectiveness of the To Help Young People Establish (2 HYPE) Abstinence Club, a behavioral intervention designed to promote delayed sexual activity among African American youth ages 12-18 in Atlanta, Georgia. The intervention included 20 h of curriculum and creative arts instruction. Pre- and post-intervention survey data collected from 2008-2010 were analyzed to determine the effectiveness of the intervention. Intervention ( n = 651) and comparison ( n = 112) groups were compared through analysis of variance and multivariate logistic regression models. There was a statistically significant increase in intervention youth who were thinking about being abstinent ( p = 0.0005). Those who had not been engaged in sexual activity were two times more likely to plan abstinence compared to participants that had been previously sexually active previously (odds ratio 2.41; 95% confidence interval 1.62, 3.60). Significant results hold implications for subsequent community-based participatory research and practice that broadens the understanding of the relevance of marriage, as just one among other life success milestones that may hold more importance to African American youth in positioning the value of delayed and responsible sexual activity towards effective STIs, HIV/AIDS, and teen pregnancy risk reduction interventions.

Brief psycho-education affects circadian variability in nicotine craving during cessation.

PubMed

Nosen, Elizabeth; Woody, Sheila R

2013-09-01

Nicotine cravings are a key target of smoking cessation interventions. Cravings demonstrate circadian variation during abstinence, often peaking during the morning and evening hours. Although some research has also shown diurnal variation in the efficacy of nicotine replacement medications, little research has examined how brief psychosocial interventions affect temporal patterns of craving during abstinence. The present study examined the impact of two brief psycho-education interventions on circadian variations in cravings during a 24-h period. 176 adult smokers interested in quitting participated in two lab sessions. During the first session, participants received (a) mindfulness psycho-education that encouraged acceptance of cravings as a normal, tolerable part of quitting that people should not expect to perfectly control, (b) standard cessation psycho-education, or (c) no psycho-education. Half the sample initiated a cessation attempt the following day. Dependent variables were assessed using ecological momentary assessment (24-h of monitoring, immediately after first lab session) and questionnaires four days later. Partially consistent with hypotheses, both forms of psycho-education were associated with differential diurnal variation in cravings during cessation. Relative to those receiving no psycho-education, standard smoking cessation psycho-education decreased morning cravings. Psycho-education encouraging acceptance of cravings was associated with lower craving in both the morning and evening, albeit only among successfully abstinent smokers. Results demonstrate that brief non-pharmacological interventions can affect circadian craving patterns during smoking cessation. Further investigation of mechanisms of change and of the impact of psycho-education on cessation outcomes is warranted. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Comparing School-Based Teen Pregnancy Prevention Programming: Mixed Outcomes in an At-Risk State.

PubMed

Oman, Roy F; Merritt, Breanca T; Fluhr, Janene; Williams, Jean M

2015-12-01

The purpose of this study is to compare the effectiveness of a national comprehensive teen pregnancy prevention (TPP) intervention to a national abstinence-only TPP intervention on middle school students' knowledge, attitudes, and behaviors related to teen sexual behaviors in a state with high teen birth rates. Pre- and post-intervention data were collected annually (2005-2010) from seventh-grade students to evaluate school-based TPP programs that implemented a comprehensive (N = 3244) or abstinence-only (N = 3172) intervention. Chi-square and t tests, logistic regressions, and hierarchical multiple regressions examined relationships between sexuality-related behavioral intentions, knowledge, and attitudes. Students in both interventions reported significant (p < .05) improvements post-intervention. Youth in the comprehensive TPP intervention were more likely (p < .05) to have significantly improved their attitudes (odds ratios [ORs] = 1.35, 1.83, 1.23) and behavior regarding abstinence decisions in the past 3 months (OR = 1.39). The interventions' improvements in attitudes were more explanatory for behavioral intentions for students in the abstinence-only intervention than for students in the comprehensive TPP intervention. The mixed results suggest the comprehensive TPP intervention was only slightly more effective than the abstinence intervention, but that changing student attitudes and perceptions may be a key component of more effective TPP interventions. © 2015, American School Health Association.

[Efficiency and risk factors in the cognitive-behavioural treatment for smoking cessation in pregnancy].

PubMed

Godá, Teresa; Marcos, Teodor; Corominas, Josep; Núñez, Laura; Salamero, Manel

2007-11-03

The aim of this study is to quantify the efficiency of the cognitive-behavioural treatment for smoking cessation in pregnancy and to evaluate the risk factors of success or failure for the abstinence before the childbirth. We studied 74 pregnant smoking women who, between January 2003 and January 2004, came to their obstetric regular control in the Hospital Casa Maternitat-Hospital Clínic i Provincial de Barcelona, and who voluntarily acceded to the cognitive-behavioural treatment without replacement of nicotine for the smoking cessation that they were offered. 44% of women who made the program of visits came abstinent to the childbirth, and of them, 93.1% was abstinent during the quarantine. 51.5% reduced the consumption and 4.5% didn't change or increased the consumption. The fact that someone smokes at home (p = 0.006), the degree of dependence to the nicotine (p = 0.015) and a consumption of coffee superior to 3 daily cups (p = 0.039), in an equation of logistic regression, classified both groups (abstinence/not abstinence). The efficiency of a program based on cognitive-behavioural therapy, without replacement of nicotine, for the smoking cessation in the pregnancy is confirmed in our sample. We propose to consider risk factors of treatment failure the fact that someone smokes at home and a daily high consumption of coffee.

78 FR 58310 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-23

... Security Act (42 U.S.C. 710(b)) with a focus on those groups that are most likely to bear children out-of..., and adult supervision to promote abstinence from sexual activity, with a focus on those groups which... Abstinence Program and PPR:50 States and 9 Territories, to include, District of Columbia, Puerto Rico, Virgin...

Long-Term Abstinence Following Holotropic Breathwork as Adjunctive Treatment of Substance Use Disorders and Related Psychiatric Comorbidity

ERIC Educational Resources Information Center

Brewerton, Timothy D.; Eyerman, James E.; Cappetta, Pamela; Mithoefer, Michael C.

2012-01-01

Addictions remain challenging conditions despite various promising traditional approaches. Although complete, long-term abstinence may be ideal, its attainment remains elusive. Many recovering addicts and clinicians stress the importance of spiritual issues in recovery, and 12-step programs such as AA are well-known approaches that embrace this…

Gender Factors Associated with Sexual Abstinent Behaviour of Rural South African High School Going Youth in KwaZulu-Natal, South Africa

ERIC Educational Resources Information Center

Dlamini, Siyabonga; Taylor, Myra; Mkhize, Nosipho; Huver, Rosemarie; Sathiparsad, Reshma; de Vries, Hein; Naidoo, Kala; Jinabhai, Champak

2009-01-01

The cross-sectional study investigated South African rural high school learners' choice of sexual abstinence in order to be able to develop tailored health education messages. All Grade 9 learners from one class at each of 10 randomly selected rural high schools participated. The Integrated Model for Motivational and Behavioural Change was used to…

Internet-Based Programs Incorporating Behavior Change Techniques Are Associated With Increased Smoking Cessation in the General Population: A Systematic Review and Meta-analysis.

PubMed

McCrabb, Sam; Baker, Amanda L; Attia, John; Skelton, Eliza; Twyman, Laura; Palazzi, Kerrin; McCarter, Kristen; Ku, Dominic; Bonevski, Billie

2018-05-10

This study aims to (i) examine the effectiveness of internet-based smoking cessation programs; (ii) describe the number and type of behavior change techniques (BCTs) employed; and (iii) explore whether BCTs included in internet-based smoking cessation programs are related to program effectiveness. MEDLINE, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched. Randomized controlled trials were included if they described the study of a smoking cessation program delivered via the internet; included current adult tobacco smokers from the general population; and were written in English. Random effects meta-analyses and meta-regressions were used to examine program effectiveness (pooled odds ratios, by outcome measure, i.e., 7 day point prevalence abstinence [PPA], 30 day PPA, other abstinence measure) in short- and long-term outcomes, and examine the associations between BCT number and type (individual BCTs and BCT domain) and program effectiveness. Results from 45 studies were included (n = 65,736). Intervention effectiveness was found in the short term for all outcome measures (OR = 1.29, 95% CI 1.12, 1.50, p = .001), for "prolonged abstinence" (OR = 1.43, 95% CI 1.09, 1.87, p = .009), and "30 day PPA" (OR = 1.75, 95% CI 1.13, 2.72, p = .013). Internet-based programs were effective in the long term for all outcome measures (OR = 1.19, 95% CI = 1.06, 1.35, p = .004) and for "prolonged abstinence" (OR = 1.40, 95% CI 1.19, 1.63, p < .001). On average, interventions used more BCTs than comparison groups (6.6 vs. 3.1, p = .0002). The impact of specific individual BCTs and BCT domains on effectiveness was examined and is reported. Internet-based smoking cessation interventions increased the odds of cessation by 29 per cent in the short term and by 19 per cent in the long term. Internet-based smoking cessation intervention development should incorporate BCTs to increase effectiveness. CRD42015014676.

Investigating Group Contingencies to Promote Brief Abstinence from Cigarette Smoking

PubMed Central

Meredith, Steven E.; Dallery, Jesse

2013-01-01

In contingency management (CM), monetary incentives are contingent on evidence of drug abstinence. Typically, incentives (e.g., “vouchers” exchangeable for goods or services) are contingent on individual performance. We programmed vouchers contingent on group performance to investigate whether these contingencies would promote brief abstinence from cigarette smoking. Thirty-two participants were divided into small teams (n = 3 per team). During three 5-day within-subject experimental conditions, participants submitted video recordings of breath carbon monoxide (CO) measures twice daily via Mōtiv8 Systems™, an Internet-based remote monitoring application. During the interdependent contingency condition, participants earned vouchers each time they and their teammates submitted breath CO samples indicative of abstinence (i.e., negative samples). During the independent contingency condition, participants earned vouchers each time they submitted negative samples, regardless of their teammates' performance. During the no vouchers condition, no monetary incentives were contingent on abstinence. In addition, half of the participants (n = 16) could communicate with their teammates through an online peer support forum. Although forum access did not appear to promote smoking abstinence, monetary incentives did promote brief abstinence. Significantly more negative samples were submitted when vouchers were contingent on individual performance (56%) or team performance (53%) relative to when no vouchers were available (35%; F = 6.9, p = 0.002). The results show that interdependent contingencies can promote brief abstinence from cigarette smoking. Moreover, the results suggest that these contingencies may help lower treatment costs and promote social support. PMID:23421358

Effectiveness of a Web-Based Multiple Tailored Smoking Cessation Program: A Randomized Controlled Trial Among Dutch Adult Smokers

PubMed Central

de Vries, Hein; Hoving, Ciska

2012-01-01

Background Distributing a multiple computer-tailored smoking cessation intervention through the Internet has several advantages for both provider and receiver. Most important, a large audience of smokers can be reached while a highly individualized and personal form of feedback can be maintained. However, such a smoking cessation program has yet to be developed and implemented in the Netherlands. Objective To investigate the effects of a Web-based multiple computer-tailored smoking cessation program on smoking cessation outcomes in a sample of Dutch adult smokers. Methods Smokers were recruited from December 2009 to June 2010 by advertising our study in the mass media and on the Internet. Those interested and motivated to quit smoking within 6 months (N = 1123) were randomly assigned to either the experimental (n = 552) or control group (n = 571). Respondents in the experimental group received the fully automated Web-based smoking cessation program, while respondents in the control group received no intervention. After 6 weeks and after 6 months, we assessed the effect of the intervention on self-reported 24-hour point prevalence abstinence, 7-day point prevalence abstinence, and prolonged abstinence using logistic regression analyses. Results Of the 1123 respondents, 449 (40.0%) completed the 6-week follow-up questionnaire and 291 (25.9%) completed the 6-month follow-up questionnaire. We used a negative scenario to replace missing values. That is, we considered respondents lost to follow-up to still be smoking. The computer-tailored program appeared to have significantly increased 24-hour point prevalence abstinence (odds ratio [OR] 1.85, 95% confidence interval [CI] 1.30–2.65), 7-day point prevalence abstinence (OR 2.17, 95% CI 1.44–3.27), and prolonged abstinence (OR 1.99, 95% CI 1.28–3.09) rates reported after 6 weeks. After 6 months, however, no intervention effects could be identified. Results from complete-case analyses were similar. Conclusions The results presented suggest that the Web-based computer-tailored smoking cessation program had a significant effect on abstinence reported after a 6-week period. At the 6-month follow-up, however, no intervention effects could be identified. This might be explained by the replacement of missing values on the primary outcome measures due to attrition using a negative scenario. While results were similar when using a less conservative scenario (ie, complete-case analyses), the results should still be interpreted with caution. Further research should aim at identifying strategies that will prevent high attrition in the first place and, subsequently, to identify the best strategies for dealing with missing data when studies have high attrition rates. Trial Registration Dutch Trial Register NTR1351; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1351 (Archived by WebCite at http://www.webcitation.org/67egSTWrz) PMID:22687887

MEDIATORS OF THE RELATIONSHIP BETWEEN NICOTINE REPLACEMENT THERAPY AND SMOKING ABSTINENCE AMONG PEOPLE LIVING WITH HIV/AIDS

PubMed Central

Stanton, Cassandra A.; Lloyd-Richardson, Elizabeth E.; Papandonatos, George D.; de Dios, Marcel A.; Niaura, Raymond

2012-01-01

Cigarette smoking is highly prevalent among people living with HIV/AIDS and poses unique health risks. Smoking cessation programs tailored to this population have documented improved smoking outcomes with nicotine replacement therapy (NRT). The current study examined 6-month abstinence rates from a randomized clinical trial targeting 412 HIV-positive adult current smokers (51% European American, 19% African American, and 17% Hispanic American) and tested whether psychosocial variables, such as self-efficacy and decisional balance, mediated the relationship between NRT and long-term abstinence. Meeting criteria for complete mediation, 6-month smoking abstinence rates improved significantly with increases in these mediators, and the association of NRT and smoking abstinence was no longer significant once changes in self-efficacy and decisional balance were taken into account. Failure to translate gains in self-efficacy among African Americans into improved abstinence rates accounted for racial/ ethnic differences among participants. Specific psychosocial factors, such as self-efficacy, may be particularly amenable to change in cessation interventions and should be addressed with greater awareness of how cultural and social contextual factors impact treatment response among people living with HIV/AIDS. PMID:19537955

An overview of clinical tools used to assess neonatal abstinence syndrome.

PubMed

Orlando, Susan

2014-01-01

Several clinical tools have been developed to quantify the severity of withdrawal signs and symptoms exhibited by infants born to substance-using mothers. Scores from the systematic assessments are used to guide treatment of infants with moderate to severe clinical signs. This article provides an overview of published assessment tools developed for infants with neonatal abstinence syndrome. Nurses caring for infants at risk for neonatal abstinence syndrome should be knowledgeable about the tools used to evaluate these infants and guide their treatment. The ideal assessment tool should be published and include item definitions and a protocol for administering the tool. Nurses need education and training to achieve competency and interobserver reliability in the use of a selected tool. Tool-specific materials should be used to standardize training and improve accuracy in assessments. Competent and knowledgeable nurses play a critical role in improving outcomes for infants with neonatal abstinence syndrome.

Sex education among Asian American college females: who is teaching them and what is being taught.

PubMed

Lee, Christine; Tran, Denise Yen; Thoi, Deanna; Chang, Melissa; Wu, Lisa; Trieu, Sang Leng

2013-04-01

Many parents are reluctant to educate their Asian American adolescents on sexual health topics because sexuality is taboo in most Asian cultures. A survey was conducted with Chinese, Filipina, Korean, and Vietnamese college females ages 18-25 to assess sources of abstinence and birth control education and age of sexual debut. Parents were the least reported source of sex education for all four ethnic groups, with the majority of respondents reporting school as their source of sex education. Respondents who reported family as their source of abstinence education had a sexual debut of 6 months later than those who did not. Females who reported family as their source of birth control education began having sex more than 7 months later than those who reported other sources. Disaggregation of data by Asian ethnic groups and examining differences in delivery of sex education among ethnic groups may improve school curricula and sexual health.

California parents' preferences and beliefs regarding school-based sex education policy.

PubMed

Constantine, Norman A; Jerman, Petra; Huang, Alice X

2007-09-01

Policy debates over the merits of abstinence-only versus comprehensive approaches to sex education are ongoing, despite well-documented public support for comprehensive sex education. Although parents are key stakeholders in the outcomes of these debates, their views have been less thoroughly considered. A random digit dial survey of 1,284 California parents was conducted in 2006. Parents were asked about their sex education policy preferences, the importance of teaching selected topics at different grade levels and reasons for their preferences. Cross-tabulations and odds ratios were used to assess regional and other subgroup differences. Overall, 89% of parents reported a preference for comprehensive sex education, and 11% for abstinence-only education. Support for comprehensive sex education was high in all regions (87-93%) and across all subgroup characteristics: race or ethnicity (79-92%), age (86-94%), education (84-93%), household income (87-92%), religious affiliation (86-91%), religious service attendance (69-96%) and ideological leaning (71-96%). Four types of reasons for preferences emerged: those focused on the consequences of actions, on the importance of providing complete information, on the inevitability of adolescents' engaging in sex and on religious or purity-based morality concerns. While 64% of abstinence-only supporters cited the last type (absolutist reasons), 94% of comprehensive sex education supporters cited one of the first three (pragmatic reasons). The high levels of support for comprehensive sex education across California's diverse regions and demographic subgroups suggest that such support may be generalizable to communities and school districts both in California and around the country. Furthermore, ideological differences might be less important to the sex education debates than the distinction between pragmatic and absolutist perspectives.

Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapy.

PubMed

Strecher, Victor J; Shiffman, Saul; West, Robert

2005-05-01

To assess the efficacy of World Wide Web-based tailored behavioral smoking cessation materials among nicotine patch users. Two-group randomized controlled trial. World Wide Web in England and Republic of Ireland. A total of 3971 subjects who purchased a particular brand of nicotine patch and logged-on to use a free web-based behavioral support program. Web-based tailored behavioral smoking cessation materials or web-based non-tailored materials. Twenty-eight-day continuous abstinence rates were assessed by internet-based survey at 6-week follow-up and 10-week continuous rates at 12-week follow-up. Using three approaches to the analyses of 6- and 12-week outcomes, participants in the tailored condition reported clinically and statistically significantly higher continuous abstinence rates than participants in the non-tailored condition. In our primary analyses using as a denominator all subjects who logged-on to the treatment site at least once, continuous abstinence rates at 6 weeks were 29.0% in the tailored condition versus 23.9% in the non-tailored condition (OR = 1.30; P = 0.0006); at 12 weeks continuous abstinence rates were 22.8% versus 18.1%, respectively (OR = 1.34; P = 0.0006). Moreover, satisfaction with the program was significantly higher in the tailored than in the non-tailored condition. The results of this study demonstrate a benefit of the web-based tailored behavioral support materials used in conjunction with nicotine replacement therapy. A web-based program that collects relevant information from users and tailors the intervention to their specific needs had significant advantages over a web-based non-tailored cessation program.

[Nevirapine induces abstinence symptoms in patients on a methadone maintenance program with HIV infection].

PubMed

Baño Rodrigo, M D; Agujetas Rodríguez, M; López García, M L; Guillén Llera, J L

2000-01-01

The objective of this study was to investigate the potential inductive effect of nevirapine (NVP) with methadone. Eight patients on the methadone maintenance programme with anti-retroviral therapy because of their infection with HIV, well maintained with methadone and without symptoms of abstinence were studied. All were included in a study of measurement of plasma levels of methadone. Anti-retroviral medication was changed, including NVP, and patients began with symptoms of abstinence 5 to 10 days later. Our results indicate an inductive effect of NVP on the methadone metabolism which caused symptoms of abstinence in all patients, which prompted an increase in the dose and plasma concentration of methadone was lost; patients continued with significantly low plasma levels (p < 0.01) after a therapy mean duration of 6.5 months, with no full recovery.

Smoking Prevention for Students: Findings From a Three-Year Program of Integrated Harm Minimization School Drug Education.

PubMed

Midford, Richard; Cahill, Helen; Lester, Leanne; Foxcroft, David R; Ramsden, Robyn; Venning, Lynne

2016-01-01

This study investigated the impact of the Drug Education in Victorian Schools (DEVS) program on tobacco smoking. The program taught about licit and illicit drugs in an integrated manner over 2 years, with follow up in the third year. It focused on minimizing harm, rather than achieving abstinence, and employed participatory, critical-thinking and skill-based teaching methods. A cluster-randomized, controlled trial of the program was conducted with a student cohort during years 8 (13 years), 9 (14 years), and 10 (15 years). Twenty-one schools were randomly allocated to the DEVS program (14 schools, n = 1163), or their usual drug education program (7 schools, n = 589). One intervention school withdrew in year two. There was a greater increase in the intervention students' knowledge about drugs, including tobacco, in all 3 years. Intervention students talked more with their parents about smoking at the end of the 3-year program. They recalled receiving more education on smoking in all 3 years. Their consumption of cigarettes had not increased to the same extent as controls at the end of the program. Their change in smoking harms, relative to controls, was positive in all 3 years. There was no difference between groups in the proportionate increase of smokers, or in attitudes towards smoking, at any time. These findings indicate that a school program that teaches about all drugs in an integrated fashion, and focuses on minimizing harm, does not increase initiation into smoking, while providing strategies for reducing consumption and harm to those who choose to smoke.

The ABCs of Sex Ed.

ERIC Educational Resources Information Center

Sroka, Stephen R.

2002-01-01

Cites statistics on extent of sexually transmitted diseases and pregnancies among adolescents; describes ideological dispute over how to teach sex education; advocates teaching the ABCs of sex education: Abstinence, Be Monogamous, and Condoms. (PKP)

The Legacy of Abstinence-Only Discourses and the Place of Pleasure in US Discourses on Teenage Sexuality

ERIC Educational Resources Information Center

Gresle-Favier, Claire

2010-01-01

This paper aims to examine the potential long-term legacy of abstinence-only discourses in the USA in order to consider the extent of the changes that might actually occur as a consequence of the 2009 presidential election. It first provides a brief overview of the history of discourses regarding youth sexuality and sex education over the past 30…

Determinants of 12-step group affiliation and moderators of the affiliation-abstinence relationship.

PubMed

Timko, Christine; Billow, Rachel; DeBenedetti, Anna

2006-06-28

This study examined characteristics of substance use disorder (SUD) outpatients at intake to treatment (N=345) that were associated with more 12-step group attendance and involvement, Steps worked, and acceptance of 12-step philosophy at a 6-month follow-up (N=281, 81.4%). Patient characteristics covered the domains of sociodemographics, SUD severity, personal functioning, and previous help received. Distinguishing baseline characteristics of patients who attended more 12-step group meetings during follow-up were being less-educated, more engaged in religious practices, and more extroverted and interpersonally competent, and having had more previous 12-step group exposure. These patient characteristics were generally similar to those associated with more 12-step meeting involvement and philosophy acceptance. More 12-step meeting attendance and involvement were related to abstinence at 6 months. Associations of attendance with abstinence were stronger among patients who were younger, white, less-educated, unstably employed, less religious, and less interpersonally skilled. These patients may have had fewer available social resources and so benefitted more from the fellowship and support for abstinence that 12-step group members often provide. We suggest methods by which treatment providers may encourage 12-step group affiliation among patients likely to benefit from it on substance use outcomes.

From Abstinence to Relapse: A Preliminary Qualitative Study of Drug Users in a Compulsory Drug Rehabilitation Center in Changsha, China

PubMed Central

Yang, Mei; Mamy, Jules; Gao, Pengcheng; Xiao, Shuiyuan

2015-01-01

Background Relapse among abstinent drug users is normal. Several factors are related to relapse, but it remains unclear what individuals’ actual life circumstances are during periods of abstinence, and how these circumstances facilitate or prevent relapse. Objective To illuminate drug users’ experiences during abstinence periods and explore the real-life catalysts and inhibitors contributing to drug use relapse. Method Qualitative in-depth interviews were conducted with 20 drug users recruited from a compulsory isolated drug rehabilitation center in Changsha. The interviews were guided by open-ended questions on individuals’ experiences in drug use initiation, getting addicted, treatment history, social environment, abstinence, and relapse. Participants were also encouraged to share their own stories. Interviews were digitally recorded and fully transcribed. The data of 18 participants who reported abstinence experiences before admission were included in the analyses. The data were analyzed using a thematic analysis with inductive hand coding to derive themes. Results Most drug users were able to successfully abstain from drugs. During abstinence, their lives were congested with challenges, such as adverse socioeconomic conditions, poor family/social support, interpersonal conflicts, and stigma and discrimination, all of which kept them excluded from mainstream society. Furthermore, the police’s system of ID card registration, which identifies individuals as drug users, worsened already grave situations. Relapse triggers reported by the participants focused mainly on negative feelings, interpersonal conflicts, and stressful events. Craving was experienced but not perceived as a relapse trigger by most participants. Conclusions This study of in-depth interview with drug users found evidence of situations and environments they live during abstinence appear rather disadvantaged, making it extremely difficult for them to remain abstinent. Comprehensive programs on relapse prevention that acknowledge these disadvantages are implicated. PMID:26107639

Changes in brain-derived neurotrophic factor (BDNF) during abstinence could be associated with relapse in cocaine-dependent patients.

PubMed

Corominas-Roso, Margarida; Roncero, Carlos; Daigre, Constanza; Grau-Lopez, Lara; Ros-Cucurull, Elena; Rodríguez-Cintas, Laia; Sanchez-Mora, Cristina; Lopez, Maria Victoria; Ribases, Marta; Casas, Miguel

2015-02-28

Brain-derived neurotrophic factor (BDNF) is involved in cocaine craving in humans and drug seeking in rodents. Based on this, the aim of this study was to explore the possible role of serum BDNF in cocaine relapse in abstinent addicts. Forty cocaine dependent subjects (DSM-IV criteria) were included in an inpatient 2 weeks abstinence program. Organic and psychiatric co-morbidities were excluded. Two serum samples were collected for each subject at baseline and at after 14 abstinence days. After discharge, all cocaine addicts underwent a 22 weeks follow-up, after which they were classified into early relapsers (ER) (resumed during the first 14 days after discharge,) or late relapsers (LR) (resumed beyond 14 days after discharge). The only clinical differences between groups were the number of consumption days during the last month before detoxification. Serum BDNF levels increased significantly across the 12 days of abstinence in the LR group (p=0.02), whereas in the ER group BDNF remained unchanged. In the ER group, the change of serum BDNF during abstinence negatively correlated with the improvement in depressive symptoms (p=0.02). These results suggest that BDNF has a role in relapse to cocaine consumption in abstinent addicts, although the underlying neurobiological mechanisms remain to be clarified. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Daily marijuana users with past alcohol problems increase alcohol consumption during marijuana abstinence.

PubMed

Peters, Erica N; Hughes, John R

2010-01-15

Drug abuse treatment programs typically recommend complete abstinence because of a fear that clients who stop use of one drug will substitute another. A within-subjects study investigated whether consumption of alcohol and other substances changes during marijuana abstinence. Twenty-eight daily marijuana users who were not trying to stop or reduce their marijuana consumption completed an 8-day baseline period in which they used marijuana and other drugs as usual, a 13-day marijuana abstinence period, and a 7-day return-to-baseline period. Participants provided self-report of substance use daily and submitted urine samples twice weekly to verify marijuana abstinence. A diagnosis of past alcohol abuse or dependence significantly moderated the alcohol increase from baseline to marijuana abstinence (p<0.01), such that individuals with this diagnosis significantly increased alcohol use (52% increase) but those without this history did not (3% increase). Increases in marijuana withdrawal discomfort scores and alcohol craving scores from baseline to marijuana abstinence significantly and positively correlated with increases in alcohol use. Increases in cigarettes, caffeine, and non-marijuana illicit drugs did not occur. This study provides empirical validation of drug substitution in a subgroup of daily marijuana users, but results need to be replicated in individuals who seek treatment for marijuana problems. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

Collecting outcome data of a text messaging smoking cessation intervention with in-program text assessments: How reliable are the results?

PubMed

Thrul, Johannes; Mendel, Judith A; Simmens, Samuel J; Abroms, Lorien C

2018-05-18

Text messaging interventions have shown promise in helping people quit smoking. Texting programs periodically survey participants about their smoking status. This study examined the consistency of participant self-reported smoking between external surveys and internal program text message assessments. Participants in Text2Quit program were surveyed about their past 7-day smoking at one, three, and six months post-enrollment using different survey modes (external surveys and internal program text message assessments) and responses were compared for consistency. The first set of analyses was conducted for participants responding on both modes (n = 45 at one month; n = 50 at three months; n = 42 at six months). Additional analyses, assuming missing = smoking, were conducted with the full sample of 262 smokers (68.7% female, mean age = 35.8 years) and compared to saliva-confirmed abstinence rates. Participants responding to both modes consistently reported smoking status at one (88.9%), three (88.0%) and six (88.1%) months post-enrollment, with fair to substantial levels of agreement (one month: κ = 0.24; three months: κ = 0.63; six months: κ = 0.66). Participants responding to both modes reported high rates of abstinence. In missing = smoking analyses, significant differences in abstinence rates reported across modes were detected at each timepoint (one month: external = 30.5%, internal = 16.4%; three months: external = 33.2%, internal = 16.0%; six months: external = 31.7%, internal = 12.2%; all p < .001). Moderate levels of agreement were found between the two modes. At 6 months, abstinence rates obtained via internal data were closer to those biochemically verified (15.7%) compared to external surveys. Results provide initial support for the use of internal program assessments in text messaging programs with missing = smoking assumptions in order to gather outcome data on smoking behavior. Copyright © 2018 Elsevier Ltd. All rights reserved.

Abstinence Education Reallocation Act of 2013

THOMAS, 113th Congress

Sen. Graham, Lindsey [R-SC

2013-02-26

Senate - 02/26/2013 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Abstinence Education Reallocation Act of 2012

THOMAS, 112th Congress

Sen. Graham, Lindsey [R-SC

2012-03-12

Senate - 03/12/2012 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Social stress, economic hardship, and psychological distress as predictors of sustained abstinence from substance use after treatment.

PubMed

Wahler, Elizabeth A; Otis, Melanie D

2014-11-01

Social characteristics associated with disadvantage, such as racial/ethnic minority status, female gender, and low socioeconomic status (SES), are often associated with increased psychological distress and substance use disorders. This project tests a conceptual model derived from Pearlin's social stress theory for predicting abstinence from substance use between baseline and 1-year follow-up in secondary data from a large statewide sample of Kentucky substance abuse treatment participants (N = 1,123). Racial minority status, employment, and higher education level were predictive of substance use at follow-up, while female gender was predictive of abstinence. Limitations, implications for practice, and suggestions for future research are discussed.

An evaluation of an abstinence education curriculum series: sex can wait.

PubMed

Denny, George; Young, Michael; Rausch, Susan; Spear, Caile

2002-01-01

To examine the effects of an abstinence education curriculum series on student outcomes. The series was taught at upper elementary, junior high, and high school levels. A questionnaire was administered to all intervention and comparison students before and after implementation of the curriculum. At the upper elementary level, the curriculum group had better outcomes on knowledge, self-efficacy, and a more hopeful outlook; at the middle school level no differences; at the high school level, findings favored the curriculum group on attitude, behavioral intent, and sexual behavior variables. Results are encouraging and should be considered by those interested in helping young people postpone sexual involvement.

Acute Effects of Aerobic Exercise on Affect and Smoking Craving in the Weeks Before and After a Cessation Attempt.

PubMed

Abrantes, Ana M; Farris, Samantha G; Minami, Haruka; Strong, David R; Riebe, Deborah; Brown, Richard A

2018-04-02

Aerobic exercise may improve smoking abstinence via reductions in craving and negative affect and increases in positive moods. Acute changes in craving and affect before and after structured exercise sessions have not been examined during the weeks prior to and following quit attempts nor has smoking status been examined in relation to these effects. Given that regular cigarette smoking can be perceived as affect enhancing and craving reducing, it is not known whether exercise could contribute additional affective benefit beyond these effects. Participants (N = 57; 68.4% women) were low-active daily smokers randomized to cessation treatments plus either group-based aerobic exercise (AE) or a health-education control (HEC). Mood, anxiety, and craving were assessed before and after each intervention session for each of the 12 weeks. Carbon monoxide (CO) breath samples ≤ 5ppm indicated smoking abstinence. During the prequit sessions, significantly greater decreases in anxiety following AE sessions relative to HEC sessions were observed. Changes in mood and craving were similar after AE and HEC sessions prior to quitting. Postquit attempt, significant reductions in craving and anxiety were observed after AE sessions but not following HEC. During the postquit period, positive mood increased following AE sessions relative to HEC only among individuals who were abstinence on that day. AE may be effective in acutely reducing anxiety prior to a quit attempt and both anxiety and craving following the quit attempt regardless of abstinence status. The mood-enhancing effects of AE may occur only in the context of smoking abstinence. The current findings underscore the importance of examining the acute effects of aerobic exercise prior to and after a cessation attempt and as a function of smoking status. Given the equivocal results from previous studies on the efficacy of exercise for smoking cessation, increasing our understanding of how aerobic exercise produces its reinforcing benefits for smokers attempting to quit could potentially inform the refinement (e.g., timing/sequencing) of exercise interventions within smoking cessation programs.

Public Opinion toward Sexuality Education: Findings among One South Florida County

ERIC Educational Resources Information Center

Howard-Barr, Elissa; Moore, Michele Johnson; Weiss, Josie A.; Jobli, Edessa

2011-01-01

As part of a community plan to implement abstinence-based sexuality education, this study assessed opinions toward sexuality education among residents. Respondents (N = 1,090) were selected by random digit dialing. The survey, adopted from previous national studies, assessed attitudes towards sexuality education. Chi-square tests of significance…

What Is Comprehensive Sexuality Education? Going WAAAAAY beyond Abstinence and Condoms

ERIC Educational Resources Information Center

Helmich, Joan

2009-01-01

In this article, the author expands our definition of "comprehensive sexuality education," broadening the discourse to something more ideal than what current rhetoric seems to suggest, and in the process presents the rationale for real comprehensive sexuality education. Current definitions of comprehensive sexuality education focus on prevention…

Attendance Rates in a Workplace Predict Subsequent Outcome of Employment-Based Reinforcement of Cocaine Abstinence in Methadone Patients

ERIC Educational Resources Information Center

Donlin, Wendy D.; Knealing, Todd W.; Needham, Mick; Wong, Conrad J.; Silverman, Kenneth

2008-01-01

This study assessed whether attendance rates in a workplace predicted subsequent outcome of employment-based reinforcement of cocaine abstinence. Unemployed adults in Baltimore methadone programs who used cocaine (N = 111) could work in a workplace for 4 hr every weekday and earn $10.00 per hour in vouchers for 26 weeks. During an induction…

Perceptions about sexual abstinence and knowledge of HIV/AIDS prevention among in-school adolescents in a western Nigerian city

PubMed Central

2011-01-01

Background Young people are becoming increasingly exposed to the risk of HIV infection. According to the 2008 HIV/Syphilis sentinel survey in Nigeria, 3.3% of young people aged 15-19 years are infected. Primary prevention especially abstinence, remains one of the most realistic interventions for reducing further spread of the virus. However, the adoption of sexual abstinence as a prevention strategy among adolescents remains low and factors influencing its practice among urban young people in Nigeria are relatively unknown. The aim of the study was to document the sexual abstinence behaviour of in-school adolescents, the factors influencing or obstructing abstinence, and knowledge of HIV and AIDS in Ibadan, South-West Nigeria. Methods The study was a descriptive cross-sectional survey of students in Ibadan South-West Local Government Area. A total of 420 respondents (52% males and 48% females), selected through a multistage sampling technique, completed a semi-structured questionnaire. This was supplemented with eight focus group discussions (FGDs) which had an average of 9 respondents within the 10 and 19 years age group. The data from the FGDs were transcribed and summarized manually while the quantitative data was analyzed using the Statistical Package for the Social Sciences to generate frequencies, cross tabulations of variables and logistic regression analysis. Results Twelve percent of the entire sample had ever had sex. Overall, knowledge of HIV transmission and prevention was high and most respondents favoured the promotion of abstinence as an HIV prevention strategy. A smaller proportion of male respondents (79%) abstained compared with the females (98%). Major predictors of sexual abstinence were being a female, not having a boyfriend or girl friend, not using alcohol and having a positive attitude towards abstinence (P < 0.05). Sexual abstinence was also significantly associated with perceived self efficacy to refuse sex and negative perception of peers who engage in sexual behaviours (P < 0.05). Majority of the FGD discussants suggested the involvement of parents, media, schools, faith-based institutions and non governmental organizations in promoting the adoption of abstinence. Conclusions The sexual abstinence behaviour of young persons is influenced by multiple factors and should be considered in determining the effectiveness of interventions targeting this behaviour. Coherent sexuality education interventions to promote the adoption of abstinence among young people are urgently needed. PMID:21569416

Preventing smoking relapse via Web-based computer-tailored feedback: a randomized controlled trial.

PubMed

Elfeddali, Iman; Bolman, Catherine; Candel, Math J J M; Wiers, Reinout W; de Vries, Hein

2012-08-20

Web-based computer-tailored approaches have the potential to be successful in supporting smoking cessation. However, the potential effects of such approaches for relapse prevention and the value of incorporating action planning strategies to effectively prevent smoking relapse have not been fully explored. The Stay Quit for You (SQ4U) study compared two Web-based computer-tailored smoking relapse prevention programs with different types of planning strategies versus a control group. To assess the efficacy of two Web-based computer-tailored programs in preventing smoking relapse compared with a control group. The action planning (AP) program provided tailored feedback at baseline and invited respondents to do 6 preparatory and coping planning assignments (the first 3 assignments prior to quit date and the final 3 assignments after quit date). The action planning plus (AP+) program was an extended version of the AP program that also provided tailored feedback at 11 time points after the quit attempt. Respondents in the control group only filled out questionnaires. The study also assessed possible dose-response relationships between abstinence and adherence to the programs. The study was a randomized controlled trial with three conditions: the control group, the AP program, and the AP+ program. Respondents were daily smokers (N = 2031), aged 18 to 65 years, who were motivated and willing to quit smoking within 1 month. The primary outcome was self-reported continued abstinence 12 months after baseline. Logistic regression analyses were conducted using three samples: (1) all respondents as randomly assigned, (2) a modified sample that excluded respondents who did not make a quit attempt in conformance with the program protocol, and (3) a minimum dose sample that also excluded respondents who did not adhere to at least one of the intervention elements. Observed case analyses and conservative analyses were conducted. In the observed case analysis of the randomized sample, abstinence rates were 22% (45/202) in the control group versus 33% (63/190) in the AP program and 31% (53/174) in the AP+ program. The AP program (odds ratio 1.95, P = .005) and the AP+ program (odds ratio 1.61, P = .049) were significantly more effective than the control condition. Abstinence rates and effects differed per sample. Finally, the results suggest a dose-response relationship between abstinence and the number of program elements completed by the respondents. Despite the differences in results caused by the variation in our analysis approaches, we can conclude that Web-based computer-tailored programs combined with planning strategy assignments and feedback after the quit attempt can be effective in preventing relapse 12 months after baseline. However, adherence to the intervention seems critical for effectiveness. Finally, our results also suggest that more research is needed to assess the optimum intervention dose. Dutch Trial Register: NTR1892; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1892 (Archived by WebCite at http://www.webcitation.org/693S6uuPM).

Forced smoking abstinence: not enough for smoking cessation.

PubMed

Clarke, Jennifer G; Stein, L A R; Martin, Rosemarie A; Martin, Stephen A; Parker, Donna; Lopes, Cheryl E; McGovern, Arthur R; Simon, Rachel; Roberts, Mary; Friedman, Peter; Bock, Beth

2013-05-13

Millions of Americans are forced to quit smoking as they enter tobacco-free prisons and jails, but most return to smoking within days of release. Interventions are needed to sustain tobacco abstinence after release from incarceration. To evaluate the extent to which the WISE intervention (Working Inside for Smoking Elimination), based on motivational interviewing (MI) and cognitive behavioral therapy (CBT), decreases relapse to smoking after release from a smoke-free prison. Participants were recruited approximately 8 weeks prior to their release from a smoke-free prison and randomized to 6 weekly sessions of either education videos (control) or the WISE intervention. A tobacco-free prison in the United States. A total of 262 inmates (35% female). Continued smoking abstinence was defined as 7-day point-prevalence abstinence validated by urine cotinine measurement. At the 3-week follow-up, 25% of participants in the WISE intervention (31 of 122) and 7% of the control participants (9 of 125) continued to be tobacco abstinent (odds ratio [OR], 4.4; 95% CI, 2.0-9.7). In addition to the intervention, Hispanic ethnicity, a plan to remain abstinent, and being incarcerated for more than 6 months were all associated with increased likelihood of remaining abstinent. In the logistic regression analysis, participants randomized to the WISE intervention were 6.6 times more likely to remain tobacco abstinent at the 3-week follow up than those randomized to the control condition (95% CI, 2.5-17.0). Nonsmokers at the 3-week follow-up had an additional follow-up 3 months after release, and overall 12% of the participants in the WISE intervention (14 of 122) and 2% of the control participants (3 of 125) were tobacco free at 3 months, as confirmed by urine cotinine measurement (OR, 5.3; 95% CI, 1.4-23.8). Forced tobacco abstinence alone during incarceration has little impact on postrelease smoking status. A behavioral intervention provided prior to release greatly improves cotinine-confirmed smoking cessation in the community. clinicaltrials.gov Identifier: NCT01122589.

Welfare, Liberty, and Security for All? U.S. Sex Education Policy and the 1996 Title V Section 510 of the Social Security Act.

PubMed

Lerner, Justin E; Hawkins, Robert L

2016-07-01

When adolescents delay (meaning they wait until after middle school) engaging in sexual intercourse, they use condoms at higher rates and have fewer sexual partners than those who have sex earlier, thus resulting in a lower risk for unintended pregnancies and sexually transmitted infections. The 1996 Section 510 of Title V of the Social Security Act (often referred to as A-H) is a policy that promotes abstinence-only-until-marriage education (AOE) within public schools. Using Stone's (2012) policy analysis framework, this article explores how A-H limits welfare, liberty, and security among adolescents due to the poor empirical outcomes of AOE policy. We recommend incorporating theory-informed comprehensive sex education in addition to theory-informed abstinence education that utilizes Fishbein and Ajzen's (2010) reasoned action model within schools in order to begin to address adolescent welfare, liberty, and security.

Differences in the verbal fluency, working memory and executive functions in alcoholics: Short-term vs. long-term abstainers.

PubMed

Nowakowska-Domagała, Katarzyna; Jabłkowska-Górecka, Karolina; Mokros, Łukasz; Koprowicz, Jacek; Pietras, Tadeusz

2017-03-01

The aim of the study was to assess differences in verbal fluency, working memory and executive functions in two subgroups of alcohol-dependent patients, those undergoing short-term abstinence (STA) and those undergoing long-term abstinence (LTA), and to compare the level of cognitive functions in patients after long-term abstinence with healthy subjects. The study group consisted of 106 alcohol-dependent patients (53 immediately after drinking at least 3 days and 53 after at least one-year abstinence). The control group comprised 53 subjects, whose age, sex and education levels matched those of the patients in the experimental group. The dependence intensity was assessed using SADD and MAST scales. The neuropsychological assessment was based on the FAS Test, Stroop Test and TMT A&B Test. The results obtained for alcohol-dependent patients revealed significant disturbances of cognitive functions. Such results indicate the presence of severe frontal cerebral cortex dysfunctions. Frontal cortex dysfunctions affecting the verbal fluency and working memory subsystems and the executive functions also persisted during long-term abstinence periods. No significant correlations between the duration of dependence, quantity of alcohol consumed and efficiency of the working memory and executive functions were observed in alcohol-dependent subjects after short-term or long-term abstinence. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

Florida Residents' Preferred Approach to Sexuality Education

ERIC Educational Resources Information Center

Howard-Barr, Elissa M.; Moore, Michele Johnson

2007-01-01

Although there is widespread support for sexuality education, whether to use an abstinence-only or comprehensive approach is hotly debated. This study assessed Florida residents preferred approach to school-based sexuality education. The 641 respondents were selected by random digit dialing, using methods to ensure ethnic and geographic…

Sex Education Knowledge Differences between Freshmen and Senior College Undergraduates

ERIC Educational Resources Information Center

Franklin, Ruth M.; Dotger, Sharon

2011-01-01

Abstinence sexuality education (sex ed) is the only federally funded sex ed in the United States. The strict curriculum of this education does not educate American adolescents about safer sex practices and leaves a knowledge gap in these adolescents that follows them into college. The Problem: This project aimed to identify sex knowledge…

Drug Craving Terminology among Opiate Dependents; A Mixed Method Study

PubMed Central

Maarefvand, Masoomeh; Ghiasvand, Hamid Reza

2013-01-01

Objective Drug craving is defined as an urge to continue substance abuse. Drug dependents use different terms to express their subjective feeling of craving. This study was an attempt to generate an understanding of craving terminology among different groups of Persian speaking Iranian opiate dependents. Method Terms used for the meaning of drug craving were listed by 36 ex-opiate dependents in focus group discussion meetings in the first phase of the study. These terms were composed from Craving Terms Questionnaire. In the second phase, 120 subjects in 3 groups of opiate dependents and a group of Current Opiate Abusers rated usage frequency of each term in the questionnaire under a Twelve-Step Program, Methadone Maintenance, and Other Abstinence-based Programs. Results Eighty nine terms were categorized in stimulation and triggering, attention bias and obsession, decision making difficulty, information processing impairment, withdrawal induction, drug euphoric experience, mental urge, motor control problem, negative valancing and stigmatizing. Terms for the three categories of mental urge, attention bias and obsession and motor control problem were used more than others. Patients in Methadone Maintenance Treatment (MMT) group used different categories of craving terms in comparison to other groups. Abstinent cases reported higher total score for craving terms in comparison to other groups in Twelve-Step Program and other abstinence-based programs. Conclusion Each craving-related term is associated with some aspects of the multidimensional concept of craving. A drug-craving thesaurus could provide a better understanding of craving nature from a drug dependent point of view. There are differences among abstinence vs. maintenance based treated opiate dependents in using craving terms. Addiction therapists will benefit from accessing drug dependents’ lexicon to assess and create therapeutic alliance with their clients. PMID:24130609

Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients With Chronic Liver Disease: A Systematic Review.

PubMed

Khan, Anam; Tansel, Aylin; White, Donna L; Kayani, Waleed Tallat; Bano, Shah; Lindsay, Jan; El-Serag, Hashem B; Kanwal, Fasiha

2016-02-01

We conducted a systematic review of efficacy of psychosocial interventions in inducing or maintaining alcohol abstinence in patients with chronic liver disease (CLD) and alcohol use disorder (AUD). We performed structured keyword searches in PubMed, PsychINFO, and MEDLINE for original research articles that were published from January 1983 through November 2014 that evaluated the use of psychosocial interventions to induce or maintain alcohol abstinence in patients with CLD and AUD. We identified 13 eligible studies that comprised 1945 patients; 5 were randomized controlled trials (RCTs). Delivered therapies included motivational enhancement therapy, cognitive behavioral therapy (CBT), motivational interviewing, supportive therapy, and psychoeducation either alone or in combination in the intervention group and general health education or treatment as usual in the control group. All studies of induction of abstinence (4 RCTs and 6 observational studies) reported an increase in abstinence among participants in the intervention and control groups. Only an integrated therapy that combined CBT and motivational enhancement therapy with comprehensive medical care, delivered during a period of 2 years, produced a significant increase in abstinence (74% increase in intervention group vs 48% increase in control group, P = .02), which was reported in 1 RCT. All studies of maintenance of abstinence (1 RCT and 2 observational studies) observed recidivism in the intervention and control groups. Only an integrated therapy that combined medical care with CBT produced a significantly smaller rate of recidivism (32.7% in integrated CBT group vs 75% in control group, P = .03), which was reported from 1 observational study. However, data were not collected for more than 2 years on outcomes of patients with CLD and AUD. In a systematic analysis of studies of interventions to induce or maintain alcohol abstinence in patients with CLD and AUD, integrated combination psychotherapy with CBT, motivational enhancement therapy, and comprehensive medical care increased alcohol abstinence. No psychosocial intervention was successful in maintaining abstinence, but an integrated therapy with CBT and medical care appears to reduce recidivism. Copyright © 2016 AGA Institute. Published by Elsevier Inc. All rights reserved.

Efficacy of Psychosocial Interventions in Inducing and Maintaining Alcohol Abstinence in Patients with Chronic Liver Disease – A Systematic Review

PubMed Central

Khan, Anam; Tansel, Aylin; White, Donna L.; Kayani, Waleed Tallat; Bano, Shah; Lindsay, Jan; El-Serag, Hashem B.; Kanwal, Fasiha

2016-01-01

Background & Aims We conducted a systematic review of efficacy of psychosocial interventions in inducing or maintaining alcohol abstinence in patients with chronic liver disease (CLD) and alcohol use disorder (AUD). Methods We performed structured keyword searches in PubMed, PsychINFO, and MEDLINE for original research articles, published from January 1983 through November 2014, that evaluated the use of psychosocial interventions to induce or maintain alcohol abstinence in patients with CLD and AUD. Results We identified 13 eligible studies, comprising 1945 patients; 5 were randomized controlled trials (RCTs). Delivered therapies included motivational enhancement therapy (MET), cognitive behavioral therapy (CBT), motivational interviewing (MI), supportive therapy and psychoeducation either alone or in combination in the intervention group and general health education or treatment as usual in the control group. All studies of induction of abstinence (4 RCTs and 6 observational studies) reported an increase in abstinence among participants in the intervention and control groups. Only an integrated therapy that combined CBT and MET with comprehensive medical care, delivered over 2 years, produced a significant increase in abstinence (74% increase in intervention group versus 48% increase in control group; P=.02), reported in 1 RCT. All studies of maintenance of abstinence (1 RCT and 2 observational studies) observed recidivism in the intervention and control groups. Only an integrated therapy that combined medical care with CBT produced a significantly smaller rate of recidivism (32.7% in integrated CBT group versus 75% decrease in control group, P=.03), reported from 1 observational study. However, data were not collected for more than 2 y on outcomes of patients with CLD and AUD. Conclusion In a systematic analysis of studies of interventions to induce or maintain alcohol abstinence in patients with CLD and AUD, integrated combination psychotherapy with CBT, motivational enhancement therapy, and comprehensive medical care increased alcohol abstinence. No psychosocial intervention was successful in maintaining abstinence, but an integrated therapy with CBT and medical care appears to reduce recidivism. PMID:26256464

Effects of lower-cost incentives on stimulant abstinence in methadone maintenance treatment: a National Drug Abuse Treatment Clinical Trials Network study.

PubMed

Peirce, Jessica M; Petry, Nancy M; Stitzer, Maxine L; Blaine, Jack; Kellogg, Scott; Satterfield, Frank; Schwartz, Marion; Krasnansky, Joe; Pencer, Eileen; Silva-Vazquez, Lolita; Kirby, Kimberly C; Royer-Malvestuto, Charlotte; Roll, John M; Cohen, Allan; Copersino, Marc L; Kolodner, Ken; Li, Rui

2006-02-01

Contingency management interventions that provide tangible incentives based on objective indicators of drug abstinence have improved treatment outcomes of substance abusers, but have not been widely implemented in community drug abuse treatment settings. To compare outcomes achieved when a lower-cost prize-based contingency management treatment is added to usual care in community methadone hydrochloride maintenance treatment settings. Random assignment to usual care with (n = 198) or without (n = 190) abstinence incentives during a 12-week trial. Six community-based methadone maintenance drug abuse treatment clinics in locations across the United States. Three hundred eighty-eight stimulant-abusing patients enrolled in methadone maintenance programs for at least 1 month and no more than 3 years. Participants submitting stimulant- and alcohol-negative samples earned draws for a chance to win prizes; the number of draws earned increased with continuous abstinence time. Total number of stimulant- and alcohol-negative samples provided, percentage of stimulant- and alcohol-negative samples provided, longest duration of abstinence, retention, and counseling attendance. Submission of stimulant- and alcohol-negative samples was twice as likely for incentive as for usual care group participants (odds ratio, 1.98; 95% confidence interval, 1.42-2.77). Achieving 4 or more, 8 or more, and 12 weeks of continuous abstinence was approximately 3, 9, and 11 times more likely, respectively, for incentive vs usual care participants. Groups did not differ on study retention or counseling attendance. The average cost of prizes was 120 dollars per participant. An abstinence incentive approach that paid 120 dollars in prizes per participant effectively increased stimulant abstinence in community-based methadone maintenance treatment clinics.

Employment-based abstinence reinforcement following inpatient detoxification in HIV-positive opioid and/or cocaine-dependent patients

PubMed Central

Dunn, Kelly; Fingerhood, Michael; Wong, Conrad J.; Svikis, Dace S.; Nuzzo, Paul; Silverman, Kenneth

2015-01-01

Employment-based reinforcement interventions have been used to promote abstinence from drugs among chronically unemployed injection drug users. The current study utilized an employment-based reinforcement intervention to promote opiate and cocaine abstinence among opioid-dependent, HIV-positive participants who had recently completed a brief inpatient detoxification. Participants (n=46) were randomly assigned to an Abstinence & Work group that was required to provide negative urine samples in order to enter the workplace and earn incentives for work (n=16), a Work Only group that was permitted to enter the workplace and earn incentives independent of drug use (n=15), and a No Voucher control group that did not receive any incentives for working (n=15) over a 26-week period. The primary outcome was urinalysis-confirmed opiate, cocaine, and combined opiate/cocaine abstinence. Participants were 78% male and 89% African American. Results showed no significant between-group differences in urinalysis-verified drug abstinence or HIV risk behaviors during the 6-month intervention. The Work Only group had significantly greater workplace attendance and worked more minutes per day when compared to the No Voucher group. Several features of the study design, including the lack of an induction period, setting the threshold for entering the workplace too high by requiring immediate abstinence from several drugs, and increasing the risk of relapse by providing a brief detoxification that was not supported by any continued pharmacological intervention, likely prevented the workplace from becoming established as a reinforcer that could be used to promote drug abstinence. However, increases in workplace attendance have important implications for adult training programs. PMID:24490712

Employment-based abstinence reinforcement following inpatient detoxification in HIV-positive opioid and/or cocaine-dependent patients.

PubMed

Dunn, Kelly E; Fingerhood, Michael; Wong, Conrad J; Svikis, Dace S; Nuzzo, Paul; Silverman, Kenneth

2014-02-01

Employment-based reinforcement interventions have been used to promote abstinence from drugs among chronically unemployed injection drug users. The current study used an employment-based reinforcement intervention to promote opioid and cocaine abstinence among opioid and/or cocaine-dependent, HIV-positive participants who had recently completed a brief inpatient detoxification. Participants (n = 46) were randomly assigned to an abstinence and work group that was required to provide negative urine samples in order to enter the workplace and to earn incentives for work (n = 16), a work-only group that was permitted to enter the workplace and to earn incentives independent of drug use (n = 15), and a no-voucher control group that did not receive any incentives for working (n = 15) over a 26-week period. The primary outcome was urinalysis-confirmed opioid, cocaine, and combined opioid/cocaine abstinence. Participants were 78% male and 89% African American. Results showed no significant between-groups differences in urinalysis-verified drug abstinence or HIV risk behaviors during the 6-month intervention. The work-only group had significantly greater workplace attendance, and worked more minutes per day when compared to the no-voucher group. Several features of the study design, including the lack of an induction period, setting the threshold for entering the workplace too high by requiring immediate abstinence from several drugs, and increasing the risk of relapse by providing a brief detoxification that was not supported by any continued pharmacological intervention, likely prevented the workplace from becoming established as a reinforcer that could be used to promote drug abstinence. However, increases in workplace attendance have important implications for adult training programs.

Long-term Follow-up of Psilocybin-facilitated Smoking Cessation

PubMed Central

Johnson, Matthew W.; Garcia-Romeu, Albert; Griffiths, Roland R.

2017-01-01

Background A recent open-label pilot study (N=15) found that two to three moderate to high doses (20 and 30 mg/70 kg) of the serotonin 2A receptor agonist psilocybin, in combination with cognitive behavioral therapy (CBT) for smoking cessation, resulted in substantially higher 6-month smoking abstinence rates than are typically observed with other medications or CBT alone. Objectives To assess long-term effects of a psilocybin-facilitated smoking cessation program at ≥12 months after psilocybin administration. Methods The present report describes biologically verified smoking abstinence outcomes of the previous pilot study at ≥12 months, and related data on subjective effects of psilocybin. Results All 15 participants completed a 12-month follow-up, and 12 (80%) returned for a long-term (≥16 months) follow-up, with a mean interval of 30 months (range = 16 – 57 months) between target-quit date (i.e., first psilocybin session) and long-term follow-up. At 12-month follow-up, 10 participants (67%) were confirmed as smoking abstinent. At long-term follow-up, nine participants (60%) were confirmed as smoking abstinent. At 12-month follow-up 13 participants (86.7%) rated their psilocybin experiences among the 5 most personally meaningful and spiritually significant experiences of their lives. Conclusion These results suggest that in the context of a structured treatment program, psilocybin holds considerable promise in promoting long-term smoking abstinence. The present study adds to recent and historical evidence suggesting high success rates when using classic psychedelics in the treatment of addiction. Further research investigating psilocybin-facilitated treatment of substance use disorders is warranted. PMID:27441452

Long-term follow-up of psilocybin-facilitated smoking cessation.

PubMed

Johnson, Matthew W; Garcia-Romeu, Albert; Griffiths, Roland R

2017-01-01

A recent open-label pilot study (N = 15) found that two to three moderate to high doses (20 and 30 mg/70 kg) of the serotonin 2A receptor agonist, psilocybin, in combination with cognitive behavioral therapy (CBT) for smoking cessation, resulted in substantially higher 6-month smoking abstinence rates than are typically observed with other medications or CBT alone. To assess long-term effects of a psilocybin-facilitated smoking cessation program at ≥12 months after psilocybin administration. The present report describes biologically verified smoking abstinence outcomes of the previous pilot study at ≥12 months, and related data on subjective effects of psilocybin. All 15 participants completed a 12-month follow-up, and 12 (80%) returned for a long-term (≥16 months) follow-up, with a mean interval of 30 months (range = 16-57 months) between target-quit date (i.e., first psilocybin session) and long-term follow-up. At 12-month follow-up, 10 participants (67%) were confirmed as smoking abstinent. At long-term follow-up, nine participants (60%) were confirmed as smoking abstinent. At 12-month follow-up 13 participants (86.7%) rated their psilocybin experiences among the five most personally meaningful and spiritually significant experiences of their lives. These results suggest that in the context of a structured treatment program, psilocybin holds considerable promise in promoting long-term smoking abstinence. The present study adds to recent and historical evidence suggesting high success rates when using classic psychedelics in the treatment of addiction. Further research investigating psilocybin-facilitated treatment of substance use disorders is warranted.

Adolescent pregnancy.

PubMed

Short, J D; Slusher, I L

1994-01-01

Kentucky has the fourth highest percentage of infants born to teenage mothers in the US. Risk factors for adolescent pregnancy are poor academic performance, family history of adolescent pregnancy, absence of one or both biological parents in the home, troubled family relationships, family violence, history of substance abuse, and poor self-concept. Pregnancy adds new developmental requirements to the continual developmental crisis of adolescence. Some of these developmental requirements are dealing with pregnancy and birth of a child and peer and family reactions and relationships. Pregnant teens are at high risk for anemia, preeclampsia, preterm delivery, and low birth weight infants. The health care team must assess the abilities, needs, practices, and priorities of teens. Nurses should promote health and positive health practices in teens. They should focus on prevention of adolescent pregnancy and on meeting the needs of pregnant teens. Adolescent pregnancy interventions include education and adolescent-centered special programs. Peer groups, role playing, videos, and computer games are individualized and effective education techniques for teens. Formal adolescent pregnancy prevention programs are abstinence education, knowledge-based programs, and clinic-focused or school-based programs. A combination of approaches is more effective than using just one approach. Adolescent pregnancy prevention interventions should promote the value of education, discourage substance abuse, and provide counseling for victims of child abuse. Pregnant teens should receive prenatal care as soon as possible. One health care agency should combine physical care, psychosocial support, and education for teens. Kentucky schools help pregnant teens continue their education and help them obtain information and support for care for themselves and their babies. Nurses can be effective at reducing the number of unwanted teen pregnancies.

Controversial Conversations in Science: Incorporating the Science "Sex Box"

ERIC Educational Resources Information Center

Gill, Puneet

2016-01-01

Science classrooms--and science textbooks--are proving to be challenging spaces for education that contradicts abstinence-only-until-marriage (AOUM) sex education. However, science educators can teach against this knowledge in a way that is critical of oppressive language. In fact, having explicit dialogue about gender identities and sexual…

Five Excellent Resources on Sexuality and Religious Education

ERIC Educational Resources Information Center

Kissel-Ito, Cindy L.

2007-01-01

A preliminary search of the Internet reveals the multiplicity of issues addressed under the topic of sexuality and education. Terms such as gender identity, sexual orientation, women's health, abuse, abstinence, education of children, teens, and parents, HIV/AIDS, morality and sexual ethics indicate the many different dimensions of contemporary…

Online Activities for Enhancing Sex Education Curricula: Preliminary Evidence on the Effectiveness of the Abstinence and Contraception Education Storehouse

PubMed Central

Raghupathy, Shobana; Klein, Charles; Card, Josefina

2013-01-01

The purpose of this research was to conduct a preliminary evaluation of the Abstinence and Contraception Education Storehouse (ACES), a digital, classroom-based resource designed to supplement existing sex education curricula with highly interactive materials such as video clips, multimedia polls and quizzes, and audiovisual demonstrations. 335 students ages 14–19 were randomly assigned to an ACES–based (treatment) or a standard (control) sex education curriculum. Data were collected at the onset of the intervention and 3-months after the completion of the intervention. Preliminary results were highly encouraging, with ACES participants who were sexually initiated at baseline reporting at the 3-month follow-up significant reductions in the number of times they had sex in the past four weeks. Both sexually initiated and non-sexually initiated youth who experienced the ACES curriculum also demonstrated greater intent to abstain from the sex during the follow-up period than those in the control group. PMID:24078799

Online Activities for Enhancing Sex Education Curricula: Preliminary Evidence on the Effectiveness of the Abstinence and Contraception Education Storehouse.

PubMed

Raghupathy, Shobana; Klein, Charles; Card, Josefina

2013-01-01

The purpose of this research was to conduct a preliminary evaluation of the Abstinence and Contraception Education Storehouse (ACES), a digital, classroom-based resource designed to supplement existing sex education curricula with highly interactive materials such as video clips, multimedia polls and quizzes, and audiovisual demonstrations. 335 students ages 14-19 were randomly assigned to an ACES-based (treatment) or a standard (control) sex education curriculum. Data were collected at the onset of the intervention and 3-months after the completion of the intervention. Preliminary results were highly encouraging, with ACES participants who were sexually initiated at baseline reporting at the 3-month follow-up significant reductions in the number of times they had sex in the past four weeks. Both sexually initiated and non-sexually initiated youth who experienced the ACES curriculum also demonstrated greater intent to abstain from the sex during the follow-up period than those in the control group.

Poly-substance use and antisocial personality traits at admission predict cumulative retention in a buprenorphine programme with mandatory work and high compliance profile.

PubMed

Öhlin, Leif; Hesse, Morten; Fridell, Mats; Tätting, Per

2011-05-12

Continuous abstinence and retention in treatment for alcohol and drug use disorders are central challenges for the treatment providers. The literature has failed to show consistent, strong predictors of retention. Predictors and treatment structure may differ across treatment modalities. In this study the structure was reinforced by the addition of supervised urine samples three times a week and mandatory daily work/structured education activities as a prerequisite of inclusion in the program. Of 128 patients consecutively admitted to buprenorphine maintenance treatment five patients dropped out within the first week. Of the remaining 123 demographic data and psychiatric assessment were used to predict involuntary discharge from treatment and corresponding cumulative abstinence probability. All subjects were administered the Structured Clinical Interview for DSM-IV-TR, and the Symptom Checklist 90 (SCL-90), the Alcohol Use Disorder Identification Test (AUDIT), the Swedish universities Scales of Personality (SSP) and the Sense of Coherence Scale (SOC), all self-report measures. Some measures were repeated every third month in addition to interviews. Of 123 patients admitted, 86 (70%) remained in treatment after six months and 61 (50%) remained in treatment after 12 months. Of those discharged involuntarily, 34/62 individuals were readmitted after a suspension period of three months. Younger age at intake, poly-substance abuse at intake (number of drugs in urine), and number of conduct disorder criteria on the SCID Screen were independently associated with an increased risk of involuntary discharge. There were no significant differences between dropouts and completers on SCL-90, SSP, SOC or AUDIT. Of the patients admitted to the programme 50% stayed for the first 12 months with continuous abstinence and daily work. Poly-substance use before intake into treatment, high levels of conduct disorder on SCID screen and younger age at intake had a negative impact on retention and abstinence.

Probability and predictors of relapse to smoking: Results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

PubMed Central

García-Rodríguez, Olaya; Secades-Villa, Roberto; Flórez-Salamanca, Ludwing; Okuda, Mayumi; Liu, Shang-Min; Blanco, Carlos

2013-01-01

Background The goal of this study was to estimate rates of relapse to smoking in the community and to identify predictors of relapse. Methods Data were drawn from the Waves 1 and 2 of the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC). Logistic regression analyses were used to estimate the probability of relapse at Wave 2 among individuals who were abstinent at Wave 1 given length of abstinence as well as the presence of several sociodemographic, psychopathologic and substance use-related variables at Wave 1. Results The risk for relapse among individuals who had been abstinent for 12 months or less at the baseline assessment was above 50%. Among individuals who had been abstinent for over a year, risk of relapse decreased hyperbolically as a function of time, and stabilized around 10% after 30 years of abstinence. Although several sociodemographic, psychopathologic and tobacco-related variables predicted relapse in univariate analyses, only younger age at cessation and shorter duration of abstinence independently predicted risk of relapse in multivariable analyses. Conclusions The first year after a quit attempt constitutes the period of highest risk for relapse. Although the risk for relapse decreases over time, it never fully disappears. Furthermore, younger age at smoking cessation also increases the risk for relapse. This information may help develop more targeted and effective relapse prevention programs. PMID:23570817

Implementing Community-Based Comprehensive Sexuality Education with High-Risk Youth in a Conservative Environment: Lessons Learned

ERIC Educational Resources Information Center

Secor-Turner, Molly; Randall, Brandy A.; Christensen, Katie; Jacobson, Amy; Loyola Meléndez, Migdalia

2017-01-01

Although comprehensive sexuality education programmes have the potential to improve the sexual health and well-being of young people, many socially conservative rural states in the USA have laws and policies restricting school-based comprehensive sexuality education and supporting abstinence-only education. This paper describes the process of…

Substance abuse treatment engagement, completion and short-term outcomes in the Western Cape province, South Africa: Findings from the Service Quality Measures Initiative.

PubMed

Myers, Bronwyn; Williams, Petal Petersen; Govender, Rajen; Manderscheid, Ron; Koch, J Randy

2018-04-01

Optimizing the effectiveness of substance use disorder (SUD) treatment is critical in low-and middle-income countries (LMICs) with limited opportunities for SUD treatment. This is the first study to identify targets for interventions to improve the quality of SUD treatment in a LMIC. We explored correlates of three indicators of treatment quality (treatment engagement, completion and abstinence at treatment exit) using data from a SUD performance measurement system implemented in the Western Cape Province of South Africa. The sample included data from 1094 adult treatment episodes representing 53% of the treatment episodes in 2016. Using multivariate logistic regression analyses, we modeled socio-demographic, substance use and program correlates of treatment engagement, completion, and abstinence at treatment exit. Overall, 59% of patients completed treatment (48% of patients from outpatient services). Treatment completion was associated with greater likelihood of abstinence at treatment exit. Patients were more likely to complete treatment if they engaged in treatment, were older, and had more severe drug problems (characterized by daily drug use and heroin problems) and attended programs of shorter duration. Residential treatment was associated with greater likelihood of treatment engagement, completion, and abstinence at treatment exit. Improving rates of outpatient treatment completion will enhance the effectiveness of South Africa's SUD treatment system. Interventions that promote engagement in treatment, particularly among younger patients; reduce program length through referral to step-down continuing care; and ensure better matching of drug problem to treatment level and type could improve rates of treatment completion. Copyright © 2018 Elsevier B.V. All rights reserved.

An ongoing process: a qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence.

PubMed

Yeh, Mei-Yu; Che, Hui-Lian; Wu, Shu-Mei

2009-11-24

Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs. In few cases do we know the full picture of how abstinence is achieved in Taiwan. We tracked processes of abstinence in alcohol-dependency disorders, based on study evidence and results. This research explores the process of recovery from the viewpoint of the alcohol-dependent. Semi-structured interviews were conducted in two different settings, using purpose sampling, during 2003-2004. The data were analyzed using content analysis. Participants were 32 adults, purposefully selected from an Alcoholics Anonymous group and a psychiatric hospital in North Taiwan. We found that the abstinence process is an ongoing process, in which the alcohol-dependent free themselves of addiction progressively. This process never ends or resolves in complete recovery. We have identified three stages in the struggle against alcoholism: the Indulgence, Ambivalence and Attempt (IAA) cycle, in which the sufferer is trapped in a cycle of attempting to give up and failing; the Turning Point, in which a Personal Nadir is reached, and the Ongoing Process of abstinence, in which a constant effort is made to remain sober through willpower and with the help of support groups. We also discuss Influencing Factors that can derail abstinence attempts, pushing the sufferer back into the IAA cycle. This study provides important points of reference for alcohol and drug service workers and community healthcare professionals in Taiwan, casting light on the abstinence process and providing a basis for intervention or rehabilitation services.

An ongoing process: A qualitative study of how the alcohol-dependent free themselves of addiction through progressive abstinence

PubMed Central

2009-01-01

Background Most people being treated for alcoholism are unable to successfully quit drinking within their treatment programs. In few cases do we know the full picture of how abstinence is achieved in Taiwan. We tracked processes of abstinence in alcohol-dependency disorders, based on study evidence and results. This research explores the process of recovery from the viewpoint of the alcohol-dependent. Methods Semi-structured interviews were conducted in two different settings, using purpose sampling, during 2003-2004. The data were analyzed using content analysis. Participants were 32 adults, purposefully selected from an Alcoholics Anonymous group and a psychiatric hospital in North Taiwan. Results We found that the abstinence process is an ongoing process, in which the alcohol-dependent free themselves of addiction progressively. This process never ends or resolves in complete recovery. We have identified three stages in the struggle against alcoholism: the Indulgence, Ambivalence and Attempt (IAA) cycle, in which the sufferer is trapped in a cycle of attempting to give up and failing; the Turning Point, in which a Personal Nadir is reached, and the Ongoing Process of abstinence, in which a constant effort is made to remain sober through willpower and with the help of support groups. We also discuss Influencing Factors that can derail abstinence attempts, pushing the sufferer back into the IAA cycle. Conclusion This study provides important points of reference for alcohol and drug service workers and community healthcare professionals in Taiwan, casting light on the abstinence process and providing a basis for intervention or rehabilitation services. PMID:19930698

Usage and Effectiveness of a Fully Automated, Open-Access, Spanish Web-Based Smoking Cessation Program: Randomized Controlled Trial

PubMed Central

2014-01-01

Background The Internet is an optimal setting to provide massive access to tobacco treatments. To evaluate open-access Web-based smoking cessation programs in a real-world setting, adherence and retention data should be taken into account as much as abstinence rate. Objective The objective was to analyze the usage and effectiveness of a fully automated, open-access, Web-based smoking cessation program by comparing interactive versus noninteractive versions. Methods Participants were randomly assigned either to the interactive or noninteractive version of the program, both with identical content divided into 4 interdependent modules. At baseline, we collected demographic, psychological, and smoking characteristics of the smokers self-enrolled in the Web-based program of Universidad Nacional de Educación a Distancia (National Distance Education University; UNED) in Madrid, Spain. The following questionnaires were administered: the anxiety and depression subscales from the Symptom Checklist-90-Revised, the 4-item Perceived Stress Scale, and the Heaviness of Smoking Index. At 3 months, we analyzed dropout rates, module completion, user satisfaction, follow-up response rate, and self-assessed smoking abstinence. Results A total of 23,213 smokers were registered, 50.06% (11,620/23,213) women and 49.94% (11,593/23,213) men, with a mean age of 39.5 years (SD 10.3). Of these, 46.10% (10,701/23,213) were married and 34.43% (7992/23,213) were single, 46.03% (10,686/23,213) had university education, and 78.73% (18,275/23,213) were employed. Participants smoked an average of 19.4 cigarettes per day (SD 10.3). Of the 11,861 smokers randomly assigned to the interactive version, 2720 (22.93%) completed the first module, 1052 (8.87%) the second, 624 (5.26%) the third, and 355 (2.99%) the fourth. Completion data was not available for the noninteractive version (no way to record it automatically). The 3-month follow-up questionnaire was completed by 1085 of 23,213 enrolled smokers (4.67%). Among them, 406 (37.42%) self-reported not smoking. No difference between groups was found. Assuming missing respondents continued to smoke, the abstinence rate was 1.74% (406/23,213), in which 22,678 were missing respondents. Among follow-up respondents, completing the 4 modules of the intervention increased the chances of smoking cessation (OR 1.95, 95% CI 1.27-2.97, P<.001), as did smoking 30 minutes (OR 1.58, 95% CI 1.04-2.39, P=.003) or 1 hour after waking (OR 1.93, 95% CI 1.27-2.93, P<.001) compared to smoking within the first 5 minutes after waking. Conclusions The findings suggest that the UNED Web-based smoking cessation program was very accessible, but a high level of attrition was confirmed. This could be related to the ease of enrollment, its free character, and the absence of direct contact with professionals. It is concluded that, in practice, the greater the accessibility to the program, the lower the adherence and retention. Professional support from health services and the payment of a reimbursable fee could prevent high rates of attrition. PMID:24760951

Breast feeding is associated with postpartum smoking abstinence among women who quit smoking due to pregnancy

PubMed Central

Businelle, Michael S.; Costello, Tracy J.; Castro, Yessenia; Reitzel, Lorraine R.; Vidrine, Jennifer I.; Mullen, Patricia Dolan; Velasquez, Mary M.; Cinciripini, Paul M.; Cofta-Woerpel, Ludmila M.; Wetter, David W.

2010-01-01

Introduction: The purpose of this study was to characterize the relationship between breast feeding and postpartum smoking abstinence among women who quit smoking due to pregnancy and who were participating in a randomized clinical trial of an intervention designed to prevent postpartum relapse. Methods: A total of 251 women were enrolled in the intervention between 30 and 33 weeks postpartum and were followed through 26 weeks postpartum. Participant characteristics were assessed at the prepartum baseline visit, any breast feeding was assessed at 8 weeks postpartum, and smoking abstinence was assessed at 8 and 26 weeks postpartum. Results: Although 79.1% of participants intended to breast feed, only 40.2% reported breast feeding at 8 weeks postpartum. Characteristics associated with breast feeding at 8 weeks postpartum included Caucasian race/ethnicity, greater education, higher household income, and being married/living with a significant other. Logistic regression analysis indicated that breast feeding at 8 weeks postpartum was significantly associated with smoking abstinence at 8 weeks postpartum, odds ratio (OR) = 7.27 (95% CI = 3.27, 16.13), p < .001. Breast feeding at 8 weeks postpartum was also associated with abstinence at 26 weeks postpartum after controlling for smoking status at 8 weeks postpartum, OR = 2.64 (95% CI = 1.14, 6.10), p = .02. Discussion: Encouraging breast feeding among women who quit smoking due to pregnancy may facilitate postpartum smoking abstinence while increasing adherence to current infant feeding guidelines. PMID:20713441

Is It O.K. for PPFA to Say "No Way"?

ERIC Educational Resources Information Center

Newcomer, Susan

Sexuality educators face a common dilemma in deciding whether it is best that teenagers not have babies, not get pregnant, or not have intercourse. Research findings suggest that sexuality educators and adolescents themselves are divided on the issue. The current political climate suggests that educators should promote abstinence. Some programs…

Educating for Character in the Sexual Domain

ERIC Educational Resources Information Center

Lickona, Thomas

2013-01-01

Changes in American sexual behavior brought about by the sexual revolution have been linked to the breakdown of the family and other social ills. Because sex has profound consequences for self, others, and society, sex education is an important part of character education. Sexual abstinence before marriage is associated with better physical and…

Contrasting outcomes of older versus middle-aged and younger adult chemical dependency patients in a managed care program.

PubMed

Satre, Derek D; Mertens, Jennifer; Areán, Patricia A; Weisner, Constance

2003-07-01

This study examined how well older chemical dependency patients succeed in treatment relative to middle-aged and younger patients in a mixed-age private HMO outpatient program. To predict successful outcome, we tested a model incorporating age group differences in individual, treatment and extratreatment factors. The sample included 89 patients aged 55 and over, 379 patients aged 40 to 54, and 736 patients aged 18-39 (N = 1,204). Baseline measures included DSM-IV substance misuse diagnoses, Addiction Severity Index (ASI), psychiatric symptom checklist, sources of suggestion to enter treatment, treatment history and motivation. Outcome measures were abstinence rates and ASI score 6 months posttreatment. At baseline, older adults showed higher levels of alcohol dependence, lower rates of drug dependence and lower psychiatric symptoms relative to younger individuals. Source of suggestions to enter treatment differed by age. Older and middle-aged patients were more likely to have an abstinence goal and to stay in treatment longer than younger adults. At 6 months posttreatment, 55% of older adults reported abstinence in the preceding 30 days, versus 59% of middle-aged adults and 50% of younger adults (p = .035). Lower rates of dependence and hostility, and greater abstinence motivation and length of stay in treatment--all of which were associated with greater age--positively affect prognosis of older adults in treatment.

Frontal Assessment Battery (FAB) is a simple tool for detecting executive deficits in chronic cannabis users.

PubMed

Fontes, Maria Alice; Bolla, Karen I; Cunha, Paulo Jannuzzi; Almeida, Priscila Previato; Jungerman, Flávia; Laranjeira, Ronaldo Ramos; Bressan, Rodrigo A; Lacerda, Acioly L T

2011-06-01

Cannabis is the most used illicit drug in the world, and its use has been associated with prefrontal cortex (PFC) dysfunction, including deficits in executive functions (EF). Considering that EF may influence treatment outcome, it would be interesting to have a brief neuropsychological battery to assess EF in chronic cannabis users (CCU). In the present study, the Frontal Assessment Battery (FAB), a brief, easy to use neuropsychological instrument aimed to evaluate EF, was used to evaluate cognitive functioning of CCU. We evaluated 107 abstinent CCU with the FAB and compared with 44 controls matched for age, estimated IQ, and years of education. CCU performed poorly as compared to controls (FAB total score = 16.53 vs. 17.09, p < .05). CCU had also a poor performance in the Motor Programming subtest (2.47 vs. 2.73, p < .05). This study examined effects of cannabis in executive functioning and showed evidence that the FAB is sensitive to detect EF deficits in early abstinent chronic cannabis users. Clinical significance of these findings remains to be investigated in further longitudinal studies. FAB may be useful as a screening instrument to evaluate the necessity for a complete neuropsychological assessment in this population.

Effectiveness of individually tailored smoking cessation advice letters as an adjunct to telephone counselling and generic self-help materials: randomized controlled trial.

PubMed

Sutton, Stephen; Gilbert, Hazel

2007-06-01

To evaluate the effectiveness of individually tailored smoking cessation advice letters as an adjunct to telephone counselling and generic self-help materials. Randomized controlled trial. The UK Quitline. A total of 1508 current smokers and recent ex-smokers. The control group received usual care (telephone counselling and an information pack sent through the post). The intervention group received in addition a computer-generated individually tailored advice letter. All outcomes were assessed at 6-month follow-up. The primary outcome measure was self-reported prolonged abstinence for at least 3 months. Secondary outcomes were self-reported prolonged abstinence for at least 1 month and 7-day and 24-hour point-prevalence abstinence. For the sample as a whole, quit rates did not differ significantly between the two conditions. However, among the majority (n = 1164) who were smokers at baseline, quit rates were consistently higher in the intervention group: prolonged abstinence for 3 months, 12.2% versus 9.0% [odds ratio (OR) = 1.40, 95% confidence interval (CI) = 0.96-2.04, P = 0.080); prolonged abstinence for 1 month, 16.4% versus 11.3% (OR = 1.53, 95% CI = 1.09-2.15, P = 0.013); 7-day point-prevalence abstinence, 18.9% versus 12.7% (OR = 1.59, 95% CI = 1.15-2.19, P = 0.004); 24-hour point-prevalence abstinence, 20.9% versus 15.4% (OR = 1.45, 95% CI = 1.07-1.96, P = 0.015). The results for the smokers are encouraging in showing a small but useful effect of the tailored letter on quit rate. Versions of the tailoring program could be used on the web and in general practices, pharmacies and primary care trusts.

Tobacco Treatment Outcomes in Patients With and Without a History of Depression, Czech Republic, 2005–2010

PubMed Central

Stepankova, Lenka; Kralikova, Eva; Zvolska, Kamila; Kmetova, Alexandra; Blaha, Milan; Bortlicek, Zbynek; Sticha, Michal; Anders, Martin; Schroeder, Darrell R.

2013-01-01

Introduction Higher prevalence of smoking among depressed patients, as well as the risk of depression in smokers, is well documented. The proportion of patients with a history of depression among those seeking intensive treatment of tobacco dependence is also high. In contrast, evidence of treatment success in this subgroup of patients is controversial. The aim of this study was to compare smoking abstinence rates after tobacco treatment in smokers with and without a history of depression. Methods We reviewed retrospective data from 1,730 smokers seeking treatment in Prague, Czech Republic. History of depression was defined as past diagnosis of depression or current treatment of depression. After a 1-year, self-reported smoking status was validated by expired-air carbon monoxide. We used logistic regression to analyze associations between abstinence rates, history of depression, and other factors (eg, age, sex, tobacco dependence). Results Of 1,730 smokers treated, 289 (16.7%) had a history of depression. The smoking abstinence rate at 1 year was 32.5% for smokers with a history of depression and 38.7% for those with no history (P = .048). Among women, abstinence did not differ between groups (35.0% vs 35.7%; P = .86). However, among men, those with a history of depression had lower rates of abstinence (27.4% vs 41.3%; P = .009). After adjustment for baseline covariates, history of depression was not significantly associated with smoking abstinence in men or women. Conclusion Intensive outpatient tobacco treatment programs can achieve abstinence rates among smokers with a history of depression similar to rates among the general population. PMID:24050528

The impact of adolescent binge drinking and sustained abstinence on affective state.

PubMed

Bekman, Nicole M; Winward, Jennifer L; Lau, Lily L; Wagner, Chase C; Brown, Sandra A

2013-08-01

While it is clear that affect is negatively impacted by heavy drinking in adulthood and that it improves with abstinence, little is known about effects of heavy drinking on mood during adolescence. This study examined negative mood states among 2 groups of 16- to 18-year-old high school students; youth with a history of recent heavy episodic drinking (HED; n = 39) and comparison youth with limited lifetime drinking experience (CON; n = 26). Affect was assessed at 3 time points during a 4- to 6-week period of monitored abstinence using the Hamilton Rating Scales for Anxiety and Depression; self-reports were obtained with the state portion of the State-Trait Anxiety Inventory, and experience sampling of current affect was assessed via daily text messages sent at randomly determined times in the morning, afternoon, and evening. Youth with a recent history of HED reported more negative affect compared with nondrinking youth during early stages of abstinence (days since last HED at assessment 1: M = 6.46; SD = 5.06); however, differences in affect were not observed after 4 to 6 weeks of abstinence. Sex differences were evident, with HED girls reporting greater depression and anxiety than HED male peers. Although not significant, response patterns indicated that boys may experience faster resolution of negative emotional states than girls with sustained abstinence. Findings suggest that high-dose drinking is associated with elevated negative affect for adolescents and that negative mood states may take longer to resolve for girls than for boys following heavy drinking episodes. Future research clarifying naturally occurring changes in affective response during early and sustained abstinence is necessary for improving programs designed to promote adolescent decision-making and to reduce risk for relapse. Copyright © 2013 by the Research Society on Alcoholism.

Invited commentary: broadening the evidence for adolescent sexual and reproductive health and education in the United States.

PubMed

Schalet, Amy T; Santelli, John S; Russell, Stephen T; Halpern, Carolyn T; Miller, Sarah A; Pickering, Sarah S; Goldberg, Shoshana K; Hoenig, Jennifer M

2014-10-01

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies-particularly sexuality health education policies and programs-have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the "tier 1" funding of the Office of Adolescent Health's Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as "evidence-based" interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.

Employment, gender, and smoking cessation outcomes in low-income smokers using nicotine replacement therapy.

PubMed

Burgess, Diana J; Fu, Steven S; Noorbaloochi, Siamak; Clothier, Barbara A; Ricards, Jennifer; Widome, Rachel; van Ryn, Michelle

2009-12-01

This study examines the presence and correlates of gender disparities in smoking cessation among lower income smokers prescribed nicotine replacement medication. We examined quit rates (7-day abstinence point prevalence) among a cohort of smokers who filled prescriptions for nicotine replacement (N = 1,782), using Minnesota Health Care Programs' (e.g., Medicaid) pharmacy claims databases (2005-2006) and mixed-mode survey protocols. A cohort of smokers who recently filled a prescription for nicotine replacement was stratified by race, and then subjects were selected by simple random sample from each race, oversampling the nonWhite groups (N = 1,782). The primary outcome was point prevalence of 7-day abstinence, and outcomes were assessed about 8 months after the nicotine replacement therapy (NRT) index prescription fill date using a mixed-mode survey protocol. Final interaction models were constructed using backward elimination. Abstinence rates were 11.4% among women and 19.2% among men (p = .02) and remained marginally significant after controlling for demographics, mental and physical health, period of cigarette abstinence, social environment, religious attendance, perceived stress, and NRT prescription type (p = .08). There was a significant Gender x Employment interaction (p = .02). Among men, quit rates were higher among the employed (26%) compared with the unemployed (16%); among women, quit rates were lower among those who were employed (8%) compared with those who were unemployed (14%). Results suggest the need for research on factors specific to women's work roles or workplaces that inhibit cessation as well as cessation programs tailored to low-income, employed female smokers. On-site workplace interventions and flexible counseling programs may be especially beneficial.

Comprehensive Sexuality Education: A Historical and Comparative Analysis of Public Opinion

ERIC Educational Resources Information Center

Herrman, Judith W.; Solano, Paul; Stotz, Lauren; McDuffie, Mary Joan

2013-01-01

This research clarifies the public support of comprehensive sexuality education (CSE) in terms of acceptance, content, timing, and effectiveness as it may inform practice in the United States. The historical context of public opinion, as well as a summary of the efficacy of abstinence only education (AOE) versus CSE in the scientific literature,…

Better learning in schools to improve attitudes toward abstinence and intentions for safer sex among adolescents in urban Nepal

PubMed Central

2013-01-01

Background School-based sex education is an effective medium to convey health information and skills about preventing sexually transmitted infections (STIs) and unwanted pregnancies among adolescents. However, research on school-based sex education is limited in many developing countries, including Nepal. This study thus had two main objectives: (1) to assess students’ evaluation of school-based sex education, and (2) to examine the associations between students’ evaluations of school-based sex education and their (a) attitudes toward abstinence and (b) intentions for safer sex. Methods This cross-sectional study was conducted among 634 students from six schools in the Kathmandu Valley during May–June 2010. We used a self-administered questionnaire to assess students’ evaluations of school-based sex education, attitudes toward abstinence, and intentions for safer sex. The data were then analyzed using multiple linear regression models. Results Regarding “information on HIV and sexual health”, many students perceived that they received the least amount of information on HIV counseling and testing centers (mean 2.29, SD 1.00) through their schools. In terms of “support and involvement of teachers and parents” in sex education, parents’ participation ranked as the lowest (mean 1.81, SD 1.01). Audiotapes were reported as the least used among the listed “teaching aids for sexual health education” (mean 1.54, SD 0.82). In multivariate analysis, receiving more “information on HIV and sexual health” was positively associated with more positive “attitudes toward abstinence” (β = 0.11, p = <0.018) and greater “intentions for safer sex” (β = 0.17, p = <0.001) among students. Similarly, increased “support and involvement from teachers and parents” was also positively associated with more positive “attitudes toward abstinence” (β = 0.16, p = <0.001) and greater “intentions for safer sex” (β = 0.15, p = <0.002). Conclusion Our results suggest that students’ needs and expectations regarding HIV and sexual health education are not being met through their schools. Moreover, comprehensive information on HIV and sexual health along with increased support and involvement of teachers and parents in sex education might help to improve adolescents’ attitudes toward abstinence and intentions for safer sex. Adapting future school-based interventions to incorporate such elements may thus be an effective strategy to promote adolescent sexual health. PMID:23509909

The enter-educate approach.

PubMed

Piotrow, P T; Coleman, P L

1992-03-01

This article describes how the Population Communication Services (PCS) has seized on the "enter-educate" approach, the blending of popular entertainment with social messages, to change reproductive health behavior. The enter-educate approach spreads its message through songs, soap operas, variety shows, and other types of popular entertainment mediums. Because they entertain, enter-educate projects can capture the attention of an audience -- such as young people -- who would otherwise scorn social messages. And the use of population mediums makes it possible to reach a variety of audiences. Funded by USAID, PCS began its first enter-educate project in response to the increasing number of teenage pregnancies in Latin America. PCS developed 2 songs and videos, which featured popular teenage singers to serve as role models, to urge abstinence. The songs became instant hits. Since then, PCS has mounted more then 80 major projects in some 40 countries. Highlights of programs range from a successful multi-media family planning campaign in Turkey to humorous television ads in Brazil promoting vasectomy. Recently, PCS initiated projects to teach AIDS awareness. At the core of the enter-educate approach is the social learning theory which holds that much behavior is learned through the observation of role-models. Health professionals work alongside entertainers to produce works that have audience appeal and factual social messages. The enter-educate approach works because it is popular, pervasive, personal, persuasive, and profitable. PCS has found that enter-educate programs pay for themselves through cost sharing and cost recovery.

A Health Belief Model-Social Learning Theory approach to adolescents' fertility control: findings from a controlled field trial.

PubMed

Eisen, M; Zellman, G L; McAlister, A L

1992-01-01

We evaluated an 8- to 12-hour Health Belief Model-Social Learning Theory (HBM-SLT)-based sex education program against several community- and school-based interventions in a controlled field experiment. Data on sexual and contraceptive behavior were collected from 1,444 adolescents unselected for gender, race/ethnicity, or virginity status in a pretest-posttest design. Over 60% completed the one-year follow-up. Multivariate analyses were conducted separately for each preintervention virginity status by gender grouping. The results revealed differential program impacts. First, for preintervention virgins, there were no gender or intervention differences in abstinence maintenance over the follow-up year. Second, female preintervention Comparison program virgins used effective contraceptive methods more consistently than those who attended the HBM-SLT program (p less than 0.01); among males, the intervention programs were equally effective. Third, both interventions significantly increased contraceptive efficiency for teenagers who were sexually active before attending the programs. For males, the HBM-SLT program led to significantly greater follow-up contraceptive efficiency than the Comparison program with preintervention contraceptive efficiency controlled (p less than 0.05); for females, the programs produced equivalent improvement. Implications for program planning and evaluation are discussed.

Empathy, and its relationship with cognitive and emotional functions in alcohol dependency.

PubMed

Erol, Almila; Akyalcin Kirdok, Asusinem; Zorlu, Nabi; Polat, Serap; Mete, Levent

2017-04-01

Empathy can be defined as the ability to understand the other's thoughts and feelings. It contains both cognitive and emotional components. The aim of this study was to investigate the empathy ability of patients with alcohol dependency in association with cognitive and emotional functions, after acute detoxification and during long-term abstinence. Thirty-three alcohol dependent inpatients that completed a detoxification process and stayed abstinent throughout the study, and 33 healthy comparison subjects that matched the patients for age, gender, and education level were included in the study. All the participants were administered the Facial Emotion Identification Test (FEIT), Facial Emotion Discrimination Test (FEDT), Trail Making Test (TMT), Digit Span Test (DST), Auditory Consonant Trigram Test (ACT), and Empathy Quotient Scale (EQS). All the tests were repeated after 3 months of abstinence. At the first evaluation conducted after detoxification, patients performed significantly worse than healthy comparisons in almost all tests. At the second evaluation, which was conducted after 3 months of abstinence, the patients improved significantly in all measures, and no significant differences were detected between the patient and comparison groups. There were significant correlations between the test scores and EQS score. Alcohol dependency has deleterious effects on empathy ability, and cognitive and emotional functions. Those impairments can improve with abstinence. Empathy ability has strong relationships with cognitive and emotional functions.

Animal Sex: Purity Education and the Naturalization of the Abstinence Agenda

ERIC Educational Resources Information Center

Sethna, Christabelle

2010-01-01

An early-twentieth-century movement for social purity in England, Canada and the United States aimed to eradicate prostitution, the double standard of sexual morals and their dreaded corollary, the venereal diseases. Social purists suggested that "purity education" for children was the best pedagogical prophylaxis against such…

[Referral to internal medicine for alcoholism: influence on follow-up care].

PubMed

Avila, P; Marcos, M; Avila, J J; Laso, F J

2008-11-01

The problem of high rates of patient drop-out in alcohol treatment programs is frequently reported in the literature. Our aim was to investigate if internal medicine referral could improve abstinence and retention rates in a cohort of alcoholic patients. A retrospective observational study was conducted comparing 200 alcoholic patients attending a psychiatric unit (group 1) with 100 patients attending both this unit and an internal medicine unit (group 2). We collected sociodemographic and clinical variables and analysed differences regarding abstinence and retention rates by means of univariate and multivariate analysis. At 3 and 12 months follow-up, group 2 patients had higher retention and abstinence rates than group 1 patients. Multivariate analysis including potential confounding variables showed that independent predictors of one-year retention were internal medicine referral and being married. Independent predictors of one-year abstinence were being married, age > 44 years and receipt of drug treatment. The higher retention rate found among patients referred to Internal Medicine specialists, a result that has not been previously reported to the best of our knowledge, emphasizes the importance of a multidisciplinary team approach in the treatment of alcoholism.

[Effectiveness of Varenicline with counseling programs on smoking cessation in a targeted clinical setting in China].

PubMed

Jiang, Bin; He, Yao; Zuo, Fang; Wu, Lei; Liu, Qinghui; Zhang, Li; Zhou, Changxi; Cheng, Kk; Chan, Sc; Lam, Th

2014-12-01

To evaluate the effectiveness of Varenicline for smoking cessation in a community-based smoking-cessation-clinic (SCC) in Chinese smokers. A prospective observational study was conducted in Beijing, China. 799 smokers (762 men and 37 women) were assessed on data gathered from structured questionnaires at baseline and follow up programs at 1, 3 and 6 months. Trained physician counselors provided free individual counseling and follow-up interviews with brief counseling for all the subjects. 272 subjects were additionally prescribed Varenicline according to their own choice and reported data were compared to those without Varenicline. Outcomes were self-reported, regarding the 7-day point prevalence on abstinence rate and continuous abstinence rates at 1, 3 and 6 month follow-up periods. At 6-month and by intention-to-treat, the 7-day point prevalence on abstinence rate with Varenicline and counseling, was significantly higher than the group with counseling only (34.6% versus 23.1%; OR = 1.75, 95% CI: 1.27-2.42;P < 0.001). The 3-month continuous abstinence rate at 6 month was higher in the group with Varenicline(31.3% versus 18.2% ;OR = 2.04, 95% CI:1.46-2.86;P < 0.001). Varenicline also showed better outcomes at 1 and 3 month follow-up. Varenicline prescription in the smoking cessation clinic appeared to be effective that doubled the rates of quitting among Chinese smokers in the practice at a community-based SCC.

I want to hold your hand: abstinence curricula, bioethics, and the silencing of desire.

PubMed

Wilkerson, Abby

2013-06-01

The abstinence approach to sex education remains influential despite its demonstrated ineffectiveness. One bill forbids the "promotion" of "gateway sexual activity," while requiring outright condemnation of "non-abstinence," defined so loosely as to plausibly include handholding. Bioethics seldom (if ever) contributes to sex-ed debates, yet exploring the pivotal role of medical discourse reveals the need for bioethical intervention. Sex-ed debates revolve around a theory of human flourishing based on heteronormative temporality, a developmental teleology ensuring the transmission of various supposed social goods through heterosexual marriage (Halberstam, 2005). Heteronormative temporality also constitutes a moralized discourse in which the values of health and presumed certainties of medicine serve to justify conservative religious dictates that otherwise would appear controversial as the basis for public policy. Overall, this analysis explores how moralized medical discourses compound existing injustices, while suggesting bioethics' potential contributions to moral and political analysis of sex-ed policies.

Effects of physician counseling on the smoking behavior of asbestos-exposed workers

DOE Office of Scientific and Technical Information (OSTI.GOV)

Li, V.C.; Kim, Y.J.; Ewart, C.K.

Physician antismoking advice has been shown to increase smoking cessation, particularly among patients who have medical problems or perceive themselves to be at risk. The present study tested three hypotheses: (a) providing 3 to 5 min of behavioral counseling regarding a cessation strategy would be more effective than simply warning the smoker to quit smoking; (b) smokers with abnormal pulmonary function would be more likely to comply with medical advice than would smokers with normal pulmonary function; and (c) that smokers with abnormal pulmonary function who receive behavioral counseling would be the group most likely to achieve prolonged abstinence. Asbestos-exposedmore » smoking men undergoing screening in a mandated program for naval shipyard workers were categorized as having normal or abnormal pulmonary status on the basis of chest X ray and pulmonary function tests (PFT). They were then randomly assigned within PFT categories to receive either a simple warning or 3 to 5 min of behavioral cessation counseling from the physician who gave them the results of their pulmonary tests. Subjects smoking status was evaluated at 3- and 11-month intervals following the physician intervention. Smokers who received behavioral counseling were more likely to quit and remain abstinent over the 11-month period (8.4% abstinent) than were smokers given a minimal warning (3.6% abstinent). Prolonged abstinence rates among abnormal PFT subjects (3.7%) did not differ from those of normals (5.9%). The group with normal PFT who received behavioral counseling achieved the highest level of abstinence (9.5%).« less

[Are competitions an appropriate instrument for youth smoking cessation? A 1-year follow-up of the Germany-wide "Smoke-free 2004" campaign].

PubMed

Schneider, Sven; Mohnen, Sigrid Mechthild; Tönges, Saskia; Pötschke-Langer, Martina; Schulze, Alexander

2006-09-15

In 2004, the German Cancer Research Center ("Deutsches Krebsforschungszentrum" [DKFZ]), collaborating with the Federal Center for Health Education ("Bundeszentrale für gesundheitliche Aufklärung" [BZgA]) and supported by the World Health Organization (WHO), carried out a population-related smoking cessation campaign entitled "Rauchfrei 2004" ("Smoke-free 2004"). Using mass-media communication, the campaign was intended to motivate as many smokers as possible to quit smoking for at least 4 weeks, so as to achieve, ideally, complete cessation of tobacco consumption. This prevention campaign explicitly included juvenile smokers. Within a 1-year follow-up survey, a 1/3 random sample was taken from a total of 4,358 juvenile participants whose smoking status by the end of the competition and 1 year later was evaluated according to international standards. 42% of juvenile participants named monetary reasons, 33% health-related reasons as their chief motivation for participating in the competition. 61% of young adults questioned stated that they were abstinent at the end of the competition, i.e., at least for 4 weeks. 1 year later, 19% of juvenile participants stated to be nonsmokers. 12% of them stated to have been continuously abstinent for 12 months after the start of the competition. This publication is the first scientific evaluation of juvenile participation in a competition-based smoking cessation campaign. Although some methodological restrictions need to be taken into account, abstinence rates determined according to internationally applied WHO evaluation guidelines are significantly higher than the secular trend. Thus, the prevention approach presented here appears to be similarly effective as alternative intervention programs that tend to be more expensive.

Recent Internet Use and Associations with Clinical Outcomes among Patients Entering Addiction Treatment Involved in a Web-Delivered Psychosocial Intervention Study.

PubMed

Tofighi, B; Campbell, A N C; Pavlicova, M; Hu, M C; Lee, J D; Nunes, E V

2016-10-01

The acceptability and clinical impact of a web-based intervention among patients entering addiction treatment who lack recent internet access are unclear. This secondary analysis of a national multisite treatment study (NIDA Clinical Trials Network-0044) assessed for acceptability and clinical impact of a web-based psychosocial intervention among participants enrolling in community-based, outpatient addiction treatment programs. Participants were randomly assigned to 12 weeks of a web-based therapeutic education system (TES) based on the community reinforcement approach plus contingency management versus treatment as usual (TAU). Demographic and clinical characteristics, and treatment outcomes were compared among participants with recent internet access in the 90 days preceding enrollment (N = 374) and without internet access (N = 133). Primary outcome variables included (1) acceptability of TES (i.e., module completion; acceptability of web-based intervention) and (2) clinical impact (i.e., self-reported abstinence confirmed by urine drug/breath alcohol tests; retention measured as time to dropout). Internet use was common (74 %) and was more likely among younger (18-49 years old) participants and those who completed high school (p < .001). Participants randomized to TES (n = 255) without baseline internet access rated the acceptability of TES modules significantly higher than those with internet access (t = 2.49, df = 218, p = .01). There was a near significant interaction between treatment, baseline abstinence, and internet access on time to dropout (χ 2 (1) = 3.8089, p = .051). TES was associated with better retention among participants not abstinent at baseline who had internet access (X 2 (1) = 6.69, p = .01). These findings demonstrate high acceptability of this web-based intervention among participants that lacked recent internet access.

Compassion Fatigue, Burnout, and Neonatal Abstinence Syndrome.

PubMed

Sweigart, Erin

2017-01-01

NICU nurses have seen a dramatic increase in cases of neonatal abstinence syndrome (NAS). The care needs of infants with NAS are highly demanding and can lead to feelings of frustration and emotional exhaustion among NICU nurses. Although studies have examined the experiences of nurses caring for NAS patients, none have specifically addressed the risk for compassion fatigue and burnout. Nurses need practical strategies to reduce their risk for compassion fatigue and burnout when caring for these patients. Improved education and implementation of self-care measures can help nurses more effectively manage stress and positively impact care of these infants and their families.

On the Aesthetic Difficulties of Research on Sex Education: Toward a Methodology of Affect

ERIC Educational Resources Information Center

Sandlos, Karyn

2010-01-01

This paper emerges from an ongoing, three-year qualitative study of how adolescents, teachers, and peer sexual health educators interpret the language of abstinence and represent the emotional meanings that enliven sexuality and sexual health. The paper demonstrates how conflicts of thinking and relationality emerge from aesthetic narratives about…

Community Attitudes toward School-Based Sexuality Education in a Conservative State

ERIC Educational Resources Information Center

Dunn, Michael S.; Thompson, Sharon H.; M'Cormack, Fredanna A. D.; Yannessa, John F.; Duffy, Jennifer L.

2014-01-01

The purpose of this study was to assess community attitudes toward school-based abstinence-plus sexuality education. A dual sampling approach of landlines and cell phones resulted in 988 adults from two counties completing "The South Carolina Survey of Public Opinion on Pregnancy Prevention." Among respondents, 87.1% supported…

Postpartum sexual abstinence, breastfeeding, and childspacing, among Yoruba women in urban Nigeria.

PubMed

Feyisetan, B J

1990-01-01

This paper examines the extent to which the traditional practice of sexual abstinence during lactation has broken down among Yoruba women residents in urban areas. The first major finding is that there is a gradual erosion of the tradition, and the dominant factors of modernization are education of the woman and the use of contraception. The second major finding is that the breakdown of postpartum sexual taboos has statistically significant negative consequences on duration of lactation, although the negative impact of woman's education is greater. The third major finding is that duration of breastfeeding reduces birth interval significantly only when it is less than 15 months, and that both durations of breastfeeding and birth intervals have declined over time. The first two findings suggest further reductions in the proportion of women who abstain from sexual relations during lactation and in durations of breastfeeding as more women become more educated. Significant declines in birth intervals may follow soon after.

Oral Health Promotion and Smoking Cessation Program Delivered via Tobacco Quitlines: The Oral Health 4 Life Trial.

PubMed

McClure, Jennifer B; Bush, Terry; Anderson, Melissa L; Blasi, Paula; Thompson, Ella; Nelson, Jennifer; Catz, Sheryl L

2018-05-01

To assess the effects of a novel oral health promotion program (Oral Health 4 Life; OH4L) delivered through state-funded tobacco quitlines. Using a semipragmatic design to balance experimental control and generalizability, we randomized US quitline callers (n = 718) to standard care or standard care plus OH4L. We followed participants for 6 months to assess effects on professional dental care and smoking abstinence. We collected data between 2015 and 2017. Participants were racially diverse (42% non-White) and socioeconomically disadvantaged. Most (71%) reported fair or poor oral health, and all were overdue for routine dental care. At 6 months, professional dental care and abstinence did not significantly differ between arms, but abstinence favored the experimental arm and was significantly higher among experimental participants at 2 months in a complete case sensitivity analysis. OH4L was not effective for promoting dental care, but integrating oral health counseling with quitline counseling may offer some advantage for smoking cessation. Public Health Implications. We offer a model for conducting semipragmatic trials and partnering with tobacco quitlines to evaluate population-level public health interventions.

Satisfaction with Sex Education in New Mexico High Schools: A Survey of College Students.

PubMed

Barlow, Meredith; Espey, Eve; Leeman, Lawrence; Scott, Ariel; Ogburn, Tony; Singh, Rameet

2016-01-01

To evaluate the perceived quality of and satisfaction with sex education among University of New Mexico (UNM) college students. Survey methods utilized with 18-21- year-old UNM freshmen and sophomores who graduated from a New Mexico high school. The survey included questions about type of sex education, satisfaction with sex education (on a 5-point Likert scale), and impact on sexual decision-making and was emailed to participants. A total of 9,866 surveys were emailed; 2,441 were returned (response rate = 24.7%); 415 did not attend high school in New Mexico, leaving 2,024 surveys in the analytic sample. Comprehensive sex education received higher ratings than abstinence-only or no sex education (3.29 ± 0.03 vs. 2.53 ± 0.07 vs. 1.87 ± 0.08, respectively, p<0.0001). More students receiving comprehensive sex education than abstinence-only education reported improved ability to make decisions about sexual initiation (66.6% vs. 54.0%; p = 0.0005), pregnancy prevention (92.7% vs. 72.9%; p < 0.0001), sexually transmitted, infection prevention (92.5% vs. 70.4%; p < 0.0001), and avoidance of unwanted sex (77.6% vs. 65.8%; p = 0.0003). New Mexico college students were more satisfied with comprehensive sex education in high school. New Mexico should consider establishing a state requirement for comprehensive sex education.

It Must Be True -- I Read It in "Seventeen" Magazine: US Popular Culture and Sexual Messages in an Era of Abstinence-Only Education

ERIC Educational Resources Information Center

Wegmann, Jennifer

2013-01-01

As discourse in sexual education classes across the USA in 1996 began to change, media outlets became important sources of education for teenage girls. Unaffected directly by government policy, one of the most popular teenage girls' magazines, "Seventeen," provided a plethora of information on sex. Several scholars have examined…

A randomized controlled evaluation of the tobacco status project, a Facebook intervention for young adults.

PubMed

Ramo, Danielle E; Thrul, Johannes; Delucchi, Kevin L; Hall, Sharon; Ling, Pamela M; Belohlavek, Alina; Prochaska, Judith J

2018-05-24

To test the efficacy of the Tobacco Status Project (TSP) Facebook smoking cessation intervention for young adults relative to referral to an on-line program on biochemically verified 7-day abstinence from smoking. Two-group parallel randomized controlled trial, comparing TSP (n = 251) to on-line control (n = 249) with follow-up to 12 months. On-line, throughout the United States. Young adult cigarette smokers (mean age 21 years; 73% white, 55% female, 87% daily smokers). TSP provided private Facebook groups tailored to stage of change to quit smoking, daily contacts, weekly live counseling sessions, and for those ready to quit, six cognitive behavioral therapy counseling sessions. Some TSP groups were assigned randomly to receive a monetary incentive for engagement. Control provided referral to the National Cancer Institute Smokefree.gov website. PRIMARY OUTCOME: Biochemically verified 7-day abstinence over 12 months. Post-treatment (3-month) abstinence; reported abstinence, quit attempt, reduction in smoking, readiness to quit smoking over 12 months. Verified 7-day abstinence was not significantly different for intervention compared with control over 1 year: month 3 (8.3 versus 3.2%), 6 (6.2 versus 6.0%), and 12 (5.9 versus 10.0%); odds ratio (OR) = 1.07; 95% confidence interval (CI) = 0.23, 4.97; retention = 71%. There was an effect at 3 months (OR = 2.52; CI = 1.56, 4.04; P < 0.0001). There were no 12-month treatment effects for reported abstinence (P = 0.746), reduction in smoking by 50% or more (P = 0.533), likelihood of having made a quit attempt (P = 0.387) or stage of change over time (0.968). Participants in TSP engaged more and rated the intervention more favorably than those in the control condition. Compared with referral to a smoking cessation website, a novel USA-focused Facebook smoking cessation intervention did not improve abstinence from smoking over 1 year, but increased abstinence at the end of treatment and was engaging to participants. © 2018 Society for the Study of Addiction.

Systematic Evaluation of “Compliance” to Prescribed Treatment Medications and “Abstinence” from Psychoactive Drug Abuse in Chemical Dependence Programs: Data from the Comprehensive Analysis of Reported Drugs

PubMed Central

2014-01-01

This is the first quantitative analysis of data from urine drug tests for compliance to treatment medications and abstinence from drug abuse across “levels of care” in six eastern states of America. Comprehensive Analysis of Reported Drugs (CARD) data was used in this post-hoc retrospective observational study from 10,570 patients, filtered to include a total of 2,919 patients prescribed at least one treatment medication during 2010 and 2011. The first and last urine samples (5,838 specimens) were analyzed; compliance to treatment medications and abstinence from drugs of abuse supported treatment effectiveness for many. Compared to non-compliant patients, compliant patients were marginally less likely to abuse opioids, cannabinoids, and ethanol during treatment although more likely to abuse benzodiazepines. Almost 17% of the non-abstinent patients used benzodiazepines, 15% used opiates, and 10% used cocaine during treatment. Compliance was significantly higher in residential than in the non-residential treatment facilities. Independent of level of care, 67.2% of the patients (n = 1963; P<.001) had every treatment medication found in both first and last urine specimens (compliance). In addition, 39.2% of the patients (n = 1143; P<.001) had no substance of abuse detected in either the first or last urine samples (abstinence). Moreover, in 2010, 16.9% of the patients (n = 57) were abstinent at first but not at last urine (deteriorating abstinence), the percentage dropped to 13.3% (n = 174) in 2011; this improvement over years was statistically significant. A longitudinal analysis for abstinence and compliance was studied in a randomized subset from 2011, (n = 511) representing 17.5% of the total cohort. A statistically significant upward trend (p = 2.353×10−8) of abstinence rates as well as a similar but stronger trend for compliance ((p = 2.200×10−16) was found. Being cognizant of the trend toward drug urine testing being linked to medical necessity eliminating abusive screening, the interpretation of these valuable results require further intensive investigation. PMID:25247439

Is smoking cessation associated with worse comorbid substance use outcomes among homeless adults?

PubMed

Reitzel, Lorraine R; Nguyen, Nga; Eischen, Sara; Thomas, Janet; Okuyemi, Kolawole S

2014-12-01

Smoking prevalence among homeless adults is exceedingly high, and high rates of comorbid substance use are among the barriers to abstinence experienced by this group. The extent to which smoking cessation might engender an escalation in comorbid substance use could be a concern prohibiting treatment provision and engagement. This study examined whether smoking abstinence status was associated with alcohol and substance use at 26 weeks post-randomization among homeless smokers in a smoking cessation trial. The current study was a secondary analysis of randomized smoking cessation intervention trial data. The parent study was conducted in the Minneapolis/St Paul area of Minnesota, USA. Participants were 427 homeless adult smokers interested in quitting smoking. Covariates collected at baseline included alcohol, cocaine, marijuana/hashish, heroin and 'any' drug use, age, sex, race/ethnicity, education, tobacco dependence, length of time homeless and treatment group. Biochemically verified smoking abstinence and self-reported alcohol and substance use were collected at 26 weeks post-randomization. Smoking abstinence was associated with fewer drinking days (P = 0.03), fewer drinks consumed on drinking days (P = 0.01), and lower odds of heavy drinking (P = 0.05), but not with differences in the number of days of cocaine, marijuana/hashish, heroin or any drug use. In homeless smokers, achieving smoking abstinence may be associated with a reduction in alcohol consumption but appears not to be associated with a substantial change in other drug use. © 2014 Society for the Study of Addiction.

Is Smoking Cessation Associated with Worse Comorbid Substance Use Outcomes among Homeless Adults?

PubMed Central

Reitzel, Lorraine R.; Nguyen, Nga; Eischen, Sara; Thomas, Janet; Okuyemi, Kolawole S.

2014-01-01

Background and Aims Smoking prevalence among homeless adults is exceedingly high, and high rates of comorbid substance use are among the barriers to abstinence experienced by this group. The extent to which smoking cessation might engender an escalation in comorbid substance use could be a concern prohibiting treatment provision and engagement. This study examined whether smoking abstinence status was associated with alcohol and substance use at 26 weeks post-randomization among homeless smokers in a smoking cessation trial. Design The current study was a secondary analysis of randomized smoking cessation intervention trial data. Setting The parent study was conducted in the Minneapolis/St. Paul area of Minnesota, USA. Participants Participants were 427 homeless adult smokers interested in quitting smoking. Measurements Covariates collected at baseline included alcohol, cocaine, marijuana/hashish, heroin, and “any” drug use, age, sex, race/ethnicity, education, tobacco dependence, length of time homeless, and treatment group. Biochemically-verified smoking abstinence and self-reported alcohol and substance use were collected at 26 weeks post-randomization. Findings Smoking abstinence was associated with fewer drinking days (p=.03), fewer drinks consumed on drinking days (p=.01), and lower odds of heavy drinking (p=.05), but not with differences in the number of days of cocaine, marijuana/hashish, heroin, or any drug use. Conclusions In homeless smokers, achieving smoking abstinence may be associated with a reduction in alcohol consumption but appears not to be associated with a substantial change in other drug use. PMID:25041459

The efficacy of mobile phone-based text message interventions ('Happy Quit') for smoking cessation in China.

PubMed

Liao, Yanhui; Wu, Qiuxia; Tang, Jinsong; Zhang, Fengyu; Wang, Xuyi; Qi, Chang; He, Haoyu; Long, Jiang; Kelly, Brian C; Cohen, Joanna

2016-08-19

Considering the extreme shortage of smoking cessation services in China, and the acceptability, feasibility and efficacy of mobile phone-based text message interventions for quitting smoking in other countries, here we propose a study of "the efficacy of mobile phone-based text message interventions ('Happy Quit') for smoking cessation in China". The primary objective of this proposed project is to assess whether a program of widely accessed mobile phone-based text message interventions ('Happy Quit') will be effective at helping people in China who smoke, to quit. Based on the efficacy of previous studies in smoking cessation, we hypothesize that 'Happy Quit' will be an effective, feasible and affordable smoking cessation program in China. In this single-blind, randomized trial, undertaken in China, about 2000 smokers willing to make a quit attempt will be randomly allocated, using an independent telephone randomization system that includes a minimization algorithm balancing for sex (male, female), age (19-34 or >34 years), educational level (≤ or >12 years), and Fagerstrom score for nicotine addiction (≤5, >5), to 'Happy Quit', comprising motivational messages and behavioral-change support, or to a control group that receives text messages unrelated to quitting. Messages will be developed to be suitable for Chinese. A pilot study will be conducted before the intervention to modify the library of messages and interventions. The primary outcome will be self-reported continuous smoking abstinence. A secondary outcome will be point prevalence of abstinence. Abstinence will be assessed at six time points (4, 8, 12, 16, 20 and 24 weeks post-intervention). A third outcome will be reductions in number of cigarettes smoked per day. The results will provide valuable insights into bridging the gap between need and services received for smoking cessation interventions and tobacco use prevention in China. It will also serve as mHealth model for extending the public health significance of other interventions, such as mental health interventions. NCT02693626 (Registration data April 11, 2016).

Association of State-Mandated Abstinence-only Sexuality Education with Rates of Adolescent HIV Infection and Teenage Pregnancy.

PubMed

Elliot, L M; Booth, M M; Patterson, G; Althoff, M; Bush, C K; Dery, M A

2017-01-01

Abstinence-only sexuality education (AOSE); is required in the public school systems of many states, raising public health concerns and perpetuating health disparities through school systems. This study aimed to determine the correlations between state-mandated AOSE and the rates of adolescent HIV and teen pregnancy. Using publicly available data on all 50 United States' laws and policies on AOSE, states were ranked according to their level of abstinence emphasis on sexuality education (Level 0 - Level 3);. We calculated the relative proportion of Black students in public schools and the proportion of families below the federal poverty line then ranked them by state. We compared the states' ranks to the incidence of adolescent HIV and teen pregnancy in those states to identify associations between variables. The majority of states (~44 percent ); have legally mandated AOSE policies (Level 3); and adolescent HIV and teen pregnancy rates were highest in these Level 3 states. There were significant, positive correlations between HIV incidence rates of 13-19 year olds, HIV rates of 20-24 year olds, teen pregnancy rates, and AOSE level, with the proportion of the population that lives below the federal poverty level, and whether they attended schools that had a greater than 50 percent of an African American population. These data show a clear association between state sexuality education policies and adolescent HIV and teen pregnancy rates not previously demonstrated. Our data further show that states that have higher proportions of at-risk populations, with higher adolescent HIV and teen pregnancy rates, are more likely to also have restrictive AOSE policies. These populations may be more likely to attend public schools where AOSE is taught, increasing their risk for HIV and teen pregnancy. The World Health Organization considers fact-based Comprehensive Sexuality Education a human right, and the authors believe it is past time to end harmful, discriminatory sexuality education policies in US public schools.

An Evaluation of an Adolescent Pregnancy Prevention Program: Is "Just Say No" Enough?

ERIC Educational Resources Information Center

Christopher, F. Scott; Roosa, Mark W.

1990-01-01

Evaluated impact of abstinence promotion program targeting sixth and seventh graders. After being exposed to 6 program sessions focusing on self-esteem, communication skills, peer pressure, and teaching value that sex should be confined to marriage, only change shown by 191 participants but not by 129 controls was increase in precoital sexual…

Evaluation of intrinsic and extrinsic motivation interventions with a self-help smoking cessation program.

PubMed

Curry, S J; Wagner, E H; Grothaus, L C

1991-04-01

Personalized feedback and a financial incentive, developed from an intrinsic/extrinsic motivation framework, were evaluated as adjuncts to self-help materials for smoking cessation. Ss (N = 1,217) were randomized to 4 treatment groups and were followed up at 3 and 12 months. Consistent with hypotheses derived from the motivation framework, the financial incentive increased the use of self-help materials, did not increase cessation rates among program users, and was associated with higher relapse rates among those who did manage to quit. The personalized feedback increased both smoking cessation and use of the materials 3 months after distribution of the materials. Continuous abstinence (abstinence at 3 and 12 months) in the group that received the personalized feedback alone was twice the rate of the other groups.

An mHealth App for Supporting Quitters to Manage Cigarette Cravings With Short Bouts of Physical Activity: A Randomized Pilot Feasibility and Acceptability Study

PubMed Central

Lintunen, Taru; Heikkinen, Risto; Vanhala, Mauno; Kettunen, Tarja

2017-01-01

Background While gains in reducing smoking rates in Finland have been made, prevalence rates are still substantial. Relapse rates among smokers engaged in quit-smoking programs are high. Physical activity has been proposed as one means to help smokers manage cravings. Software and apps on mobile phone and handheld devices offer an opportunity to communicate messages on how to use physical activity to manage cravings as part of quit-smoking programs. Objective We aimed to test the feasibility, acceptability, usability, and preliminary efficacy of an mHealth mobile phone app, Physical activity over Smoking (PhoS), to assist smokers in quitting smoking in a randomized controlled trial. The app was designed to prompt smokers to engage in physical activities to manage their smoking cravings. Methods Regular smokers (n=44) attended a group-based behavioral counselling program aimed at promoting physical activity as an additional aid to quit. After quit day, participants were randomly allocated to an intervention (n=25) or to a comparison (n=19) group. Participants in the intervention group were provided with the PhoS app and training on how to use it to assist with relapse prevention. Participants in the comparison condition were provided with generalized relapse prevention training. Results Some participants reported that the PhoS app was useful in assisting them to successfully manage their cigarette cravings, although compliance across the sample was modest and participants reported low levels of usability. Participants receiving the PhoS app did not report greater abstinence than those who did not receive the app. However, participants receiving the app were more likely to report greater abstinence if they did not use pharmacological support, while those who did not receive the app reported greater abstinence when using pharmacological support. Participants receiving the app reported greater levels of physical activity than those who did not. Results revealed that the app resulted in better retention. Conclusions The PhoS app showed some potential to reduce abstinence among participants not using pharmacological therapy and to increase physical activity. However, problems with usability and lack of effects on abstinence raise questions over the app’s long-term effectiveness. Future research should prioritize further development of the app to maximize usability and test effects of the intervention independent of quit-smoking programs. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI) PMID:28550004

Knowledge about smoking, reasons for smoking, and reasons for wishing to quit in inner-city African Americans.

PubMed

Ahluwalia, J S; Resnicow, K; Clark, W S

1998-01-01

To determine knowledge about smoking, reasons for smoking, and reasons for wishing to quit and the association of these variables with abstinence at ten weeks and six months. Descriptive study and longitudinal intervention. Inner-city public hospital clinics. 410 African-American cigarette smokers interested in quitting were surveyed at baseline and subsequently enrolled into a double-blind, placebo-controlled, randomized trial of the transdermal nicotine patch. Descriptive information about smoking knowledge, reasons for smoking, and reasons for wishing to quit, and association of these variables with abstinence at 10 weeks and 6 months. Among the 410 patients randomized, mean age was 48 years, 61% were female, 41% had less than a high school education, 51% had an annual household income less than $8,000, and the average number of cigarettes smoked a day was twenty. The average number of questions answered correctly was nine out of eleven (84%). The most cited reason for smoking was relaxation/tension reduction and the least cited were stimulation and handling of the cigarette. Ninety-nine percent of patients stated they wished to quit for health reasons. Knowledge, reasons for smoking, and reasons for wishing to quit were not significantly associated with 10-week or 6-month abstinence. In this group of inner-city African-American smokers, knowledge about cigarette smoking was high. Reasons for smoking were related to relaxation, craving, and pleasure, and reasons for wishing to quit were largely health-related. Knowledge, reasons for smoking, and reasons for wishing to quit were not associated with 10 week or 6 month abstinence. Since knowledge about smoking is already high, future efforts should be directed at promoting cessation through proven behavioral and pharmacological approaches, rather than didactic patient education.

Associations between Sexual Abstinence Ideals, Religiosity, and Alcohol Abstinence: A Longitudinal Study of Finnish Twins

PubMed Central

Winter, Torsten; Karvonen, Sakari; Rose, Richard J.

2016-01-01

We analyzed prevalence and stability of attitudes endorsing sexual abstinence ideals from late adolescence into early adulthood and studied associations of these attitudes with religiosity and alcohol abstinence in a sexually liberal Nordic society. Our population-based sample of Finnish twins permitted comparisons of co-twins concordant for religiosity but discordant for drinking to evaluate the association of sexual abstinence ideals with alcohol abstinence, controlling for household environment. From age 17 to 24, endorsement of sexual abstinence as a romantic ideal declined from 25% to 15%. Religiosity and alcohol abstinence correlated, both separately and together, with endorsing sexual abstinence. Abstinence ideals were associated with literal belief in fundamental tenets of the Bible. The association of sexual abstinence ideals with alcohol abstinence was confirmed in within-family comparisons of co-twins discordant for drinking but concordant for religiosity. Alcohol-abstinent twins were significantly more likely than their non-alcohol-abstinent twin siblings to endorse sexual abstinence ideals; that result suggests the association of sexual abstinence ideals with abstaining from alcohol is not explained by unmeasured confounds in familial background and structure. Our longitudinal results and analyses of discordant twins suggest that attitudes toward sexual abstinence ideals are embedded within other conservative attitudes and behaviors. PMID:23301620

Use of an online smoking cessation community promotes abstinence: Results of propensity score weighting.

PubMed

Graham, Amanda L; Papandonatos, George D; Erar, Bahar; Stanton, Cassandra A

2015-12-01

We estimated the causal effects of use of an online smoking cessation community on 30-day point prevalence abstinence at 3 months. Participants (N = 492) were adult current smokers in the enhanced Internet arm of The iQUITT Study, a randomized trial of Internet and telephone treatment for smoking cessation. All participants accessed a Web-based smoking-cessation program that included a large, established online community. Automated tracking metrics of passive (e.g., reading forum posts, viewing member profiles) and active (e.g., writing forum posts, sending private messages) community use were extracted from the site at 3 months. Self-selected community use defines the groups of interest: "None," "Passive," and "Both" (passive + active). Inverse probability of treatment weighting corrected for baseline imbalances on demographic, smoking, psychosocial, and medical history variables. Propensity weights estimated via generalized boosted models were used to calculate Average Treatment Effects (ATE) and Average Treatment effects on the Treated (ATT). Patterns of community use were: None = 198 (40.2%), Passive = 110 (22.4%), and Both = 184 (37.4%). ATE-weighted abstinence rates were: None = 4.2% (95% CI = 1.5-6.9); Passive = 15.1% (95% CI = 8.4-21.9); Both = 20.4% (95% CI = 13.9-26.8). ATT-weighted abstinence rates indicated even greater benefits of community use. Community users were more likely to quit smoking at 3 months than nonusers. The estimated benefit from use of online community resources was even larger among subjects with high propensity to use them. No differences in abstinence emerged between passive and passive/active users. Results suggest that lurking in online communities confers specific abstinence benefits. Implications of these findings for online cessation communities are discussed. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Social networks as mediators of the effect of Alcoholics Anonymous.

PubMed

Kaskutas, Lee Ann; Bond, Jason; Humphreys, Keith

2002-07-01

This study tested the hypothesis that the relationship between Alcoholics Anonymous (AA) involvement and reduced substance use is partially explained (or 'mediated') by changes in social networks. This is a naturalistic longitudinal study of the course of alcohol problems. Study sites were the 10 largest public and private alcohol treatment programs in a northern California county. Three hundred and seventy-seven men and 277 women were recruited upon seeking treatment at study sites. At baseline and 1-year follow-up, we assessed alcohol consequences and dependence symptoms, consumption, social support for abstinence, pro-drinking social influences and AA involvement. In the structural equation model, AA involvement was a significant predictor of lower alcohol consumption and fewer related problems. The size of this effect decreased by 36% when network size and support for drinking were included as mediators. In logistic regression models predicting abstinence at follow-up, AA remained highly significant after including social network variables but was again reduced in magnitude. Thirty-day abstinence was predicted by AA involvement (OR=2.9), not having pro-drinking influences in one's network (OR=0.7) and having support for reducing consumption from people met in AA (versus no support; OR=3.4). In contrast, having support from non-AA members was not a significant predictor of abstinence. For alcohol-related outcomes other than abstinence, significant relationships were found for both AA-based and non-AA-based support. The type of social support specifically given by AA members, such as 24-hour availability, role modeling and experientially based advice for staying sober, may help to explain AA's mechanism of action. Results highlight the value of focusing on outcomes reflective of AA's goals (such as abstinence) when studying how AA works.

Do women differ from men on Alcoholics Anonymous participation and abstinence? A multi-wave analysis of treatment seekers

PubMed Central

Delucchi, Kevin

2011-01-01

Background Given the widespread use of Alcoholics Anonymous (AA) and other similar groups in the US and the increasing membership of women, the present paper compares women to men on their meeting attendance and AA-prescribed behaviors, factors associated with that AA participation, and tests how these relate to women’s and men’s abstinence across time. Methods All consecutive new admissions (age ≥ 18) from county-wide public and private alcohol and drug treatment programs representing the larger population of treatment seekers were approached to be in the study at treatment entry. Those consenting at baseline (n = 926) were sought for follow-up interviews 1, 3, 5 and 7 years later. Generalized linear models were used to test whether various help-seeking factors associated with AA participation differentially by gender and, controlling for AA and other confounders, whether women differ from men on abstinence. Results At each follow-up interview, women and men attended AA at similar rates and similarly practiced specific AA-behaviors, and they were alike on most factors associated with AA participation and abstention across time including abstinence goal, drink volume, negative consequences, prior treatment, and encouragement to reduce drinking. Relative to men, women with higher ASI drug severity were less likely to participate in AA. Though higher AA participation was a predictor of abstinence for both genders, males were less likely to be abstinent across time. Men were also more likely to reduce their AA participation across time. Conclusion These findings add to an emerging literature on how women compare to men on factors related to AA participation and subsequent drinking outcomes across time. Findings have clinical implications for service providers referring clients to such groups. PMID:21689121

Effectiveness of Goal-Setting Telephone Follow-Up on Health Behaviors of Patients with Ischemic Stroke: A Randomized Controlled Trial.

PubMed

Wan, Li-Hong; Zhang, Xiao-Pei; Mo, Miao-Miao; Xiong, Xiao-Ni; Ou, Cui-Ling; You, Li-Ming; Chen, Shao-Xian; Zhang, Min

2016-09-01

Adopting healthy behaviors is critical for secondary stroke prevention, but many patients fail to follow national guidelines regarding diet, exercise, and abstinence from risk factors. Compliance often decreases with time after hospital discharge, yet few studies have examined programs promoting long-term adherence to health behaviors. Goal setting and telephone follow-up have been proven to be effective in other areas of medicine, so this study evaluated the effectiveness of a guideline-based, goal-setting telephone follow-up program for patients with ischemic stroke. This was a multicenter, assessor-blinded, parallel-group, randomized controlled trial. Ninety-one stroke patients were randomized to either a control group or an intervention group. Intervention consisted of predischarge education and 3 goal-setting follow-up sessions conducted by phone. Data were collected at baseline and during the third and sixth months after hospital discharge. Six months after discharge, patients in the intervention group exhibited significantly higher medication adherence than patients in the control group. There were no statistically significant differences in physical activity, nutrition, low-salt diet adherence, blood pressure monitoring, smoking abstinence, unhealthy use of alcohol, and modified Rankin Scale (mRS) scores between the 2 groups. Goal-setting telephone follow-up intervention for ischemic stroke patients is feasible and leads to improved medication adherence. However, the lack of group differences in other health behavior subcategories and in themRS score indicates a need for more effective intervention strategies to help patients reach guideline-recommended targets. Copyright © 2016 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Curricular Abstinence: Examining Human Sexuality Training in School Counselor Preparation Programs

ERIC Educational Resources Information Center

Behun, Richard Joseph; Cerrito, Julie A.; Delmonico, David L.; Campenni, Estelle

2017-01-01

Professional school counselors (PSCs; N = 486) rated their level of perceived preparedness acquired in their school counselor preparation program with respect to knowledge, skills, and self-awareness of five human sexuality domains (behavior, health, morality, identity, violence) across grade level (elementary vs. secondary) and three human…

A Randomized Trial of Motivational Interviewing

PubMed Central

Catley, Delwyn; Goggin, Kathy; Harris, Kari Jo; Richter, Kimber P.; Williams, Karen; Patten, Christi; Resnicow, Ken; Ellerbeck, Edward F.; Bradley-Ewing, Andrea; Lee, Hyoung S.; Moreno, Jose L.; Grobe, James E.

2015-01-01

Introduction Despite limitations in evidence, the current Clinical Practice Guideline advocates Motivational Interviewing for smokers not ready to quit. This study evaluated the efficacy of Motivational Interviewing (MI) for inducing cessation-related behaviors among smokers with low motivation to quit. Design Randomized clinical trial. Setting/participants Two-hundred fifty-five daily smokers reporting low desire to quit smoking were recruited from an urban community during 2010–2011 and randomly assigned to Motivational Interviewing, health education, or brief advice using a 2:2:1 allocation. Data were analyzed from 2012 to 2014. Intervention Four sessions of Motivational Interviewing utilized a patient-centered communication style that explored patients’ own reasons for change. Four sessions of health education provided education related to smoking cessation while excluding elements characteristic of Motivational Interviewing. A single session of brief advice consisted of brief, personalized advice to quit. Main outcomes measures Self-reported quit attempts, smoking abstinence (biochemically verified), use of cessation pharmacotherapies, motivation, and confidence to quit were assessed at baseline and 3- and 6-month follow-ups. Results Unexpectedly, no significant differences emerged between groups in the proportion who made a quit attempt by 6-month follow-up (Motivational Interviewing, 52.0%; health education, 60.8%; brief advice, 45.1%; p=0.157). Health education had significantly higher biochemically verified abstinence rates at 6 months (7.8%) than brief advice (0.0%) (8% difference, 95% CI=3%, 13%, p=0.003), with the Motivational Interviewing group falling in between (2.9% abstinent, 3% risk difference, 95% CI=0%, 6%, p=0.079). Both Motivational Interviewing and health education groups showed greater increases in cessation medication use, motivation, and confidence to quit relative to brief advice (all p<0.05), and health education showed greater increases in motivation relative to Motivational Interviewing (Cohen’s d=0.36, 95% CI=0.12, 0.60). Conclusions Although Motivational Interviewing was generally more efficacious than brief advice in inducing cessation behaviors, health education appeared the most efficacious. These results highlight the need to identify the contexts in which Motivational Interviewing may be most efficacious and question recommendations to use Motivational Interviewing rather than other less complex cessation induction interventions. PMID:26711164

Comprehensive Sexuality Education vs. Abstinence-Only Sexuality Education: The Need for Evidence-Based Research and Practice

ERIC Educational Resources Information Center

McCave, Emily L.

2007-01-01

Teen pregnancy has declined due to stagnating sexual activity rates and increases in contraceptive use. Still, between 800,000 and 900,000 adolescents become pregnant each year in America. Many who become parents during adolescence are unable to achieve positive health, economic, and social well-being outcomes, particularly around educational…

School-Based Sex Education and Neuroscience: What We Know about Sex, Romance, Marriage, and Adolescent Brain Development

ERIC Educational Resources Information Center

Ballonoff Suleiman, Ahna; Johnson, Megan; Shirtcliff, Elizabeth A.; Galván, Adriana

2015-01-01

Background: Many school-based abstinence-only sex education curricula state that sexual activity outside of marriage is likely to have harmful psychological effects. Recent advances in neuroscience have expanded our understanding of the neural underpinnings of romantic love, marriage, sexual desire, and sexual behavior and improved our…

Utilization of smoking cessation informational, interactive, and online community resources as predictors of abstinence: cohort study.

PubMed

An, Lawrence C; Schillo, Barbara A; Saul, Jessie E; Wendling, Ann H; Klatt, Colleen M; Berg, Carla J; Ahulwalia, Jasjit S; Kavanaugh, Annette M; Christenson, Matthew; Luxenberg, Michael G

2008-12-20

The association between greater utilization of Web-assisted tobacco interventions and increased abstinence rates is well recognized. However, there is little information on how utilization of specific website features influences quitting. To determine the association between utilization of informational, interactive, and online community resources (eg. bulletin boards) and abstinence rates, with the broader objective to identify potential strategies for improving outcomes for Web-assisted tobacco interventions. In Spring 2004, a cohort of 607 quitplan.com users consented to participate in an evaluation of quitplan.com, a Minnesota branded version of QuitNet.com. We developed utilization measures for different site features: general information, interactive diagnostic tools and quit planning tools, online expert counseling, passive (ie, reading of bulletin boards) and active (ie, public posting) online community engagement, and one-to-one messaging with other virtual community members. Using bivariate, multivariate, and path analyses, we examined the relationship between utilization of specific site features and 30-day abstinence at 6 months. The most commonly used resources were the interactive quit planning tools (used by 77% of site users). Other informational resources (ie, quitting guides) were used more commonly (60% of users) than passive (38%) or active (24%) community features. Online community engagement through one-to-one messaging was low (11%) as was use of online counseling (5%). The 30-day abstinence rate among study participants at 6 months was 9.7% (95% Confidence Interval [CI] 7.3% - 12.1%). In the logistic regression model, neither the demographic data (eg, age, gender, education level, employment, or insurance status) nor the smoking-related data (eg, cigarettes per day, time to first morning cigarette, baseline readiness to quit) nor use of smoking cessation medications entered the model as significant predictors of abstinence. Individuals who used the interactive quit planning tools once, two to three times, or four or more times had an odds of abstinence of 0.65 (95% Confidence Interval [CI] 0.22 - 1.94), 1.87 (95% CI 0.77 - 4.56), and 2.35 (95% CI 1.0 - 5.58), respectively. The use of one-to-one messages (reference = none vs 1 or more) entered the final model as potential predictor for abstinence, though the significance of this measure was marginal (OR = 1.91, 95% CI 0.92 - 3.97, P = .083). In the path analysis, an apparent association between active online community engagement and abstinence was accounted for in large part by increased use of interactive quitting tools and one-to-one messaging. Use of interactive quitting tools, and perhaps one-to-one messaging with other members of the online community, was associated with increased abstinence rates among quitplan.com users. Designs that facilitate use of these features should be considered.

Sex education and contraceptive use at coital debut in the United States: results from Cycle 6 of the National Survey of Family Growth.

PubMed

Isley, Michelle M; Edelman, Alison; Kaneshiro, Bliss; Peters, Dawn; Nichols, Mark D; Jensen, Jeffrey T

2010-09-01

The study was conducted to characterize the relationship between formal sex education and the use and type of contraceptive method used at coital debut among female adolescents. This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Contraceptive use and type used were compared among sex education groups [abstinence only (AO), birth control methods only (MO) and comprehensive (AM)]. Analyses also evaluated the association between demographic, socioeconomic, behavioral variables and sex education. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest. Of 1150 adolescent females aged 15-19 years, 91% reported formal sex education (AO 20.4%, MO 4.9%, AM 65.1%). The overall use of contraception at coitarche did not differ between groups. Compared to the AO and AM groups, the proportion who used a reliable method in the MO group (37%) was significantly higher (p=.03) (vs. 15.8% and 14.8%, respectively). Data from the 2002 NSFG do not support an association between type of formal sex education and contraceptive use at coitarche but do support an association between abstinence-only messaging and decreased reliable contraceptive method use at coitarche. Copyright 2010 Elsevier Inc. All rights reserved.

Biochemical Validation of Self-Reported Smokeless Tobacco Abstinence among Smokeless Tobacco Users: Results from a Clinical Trial of Varenicline in India.

PubMed

Jain, Raka; Jhanjee, Sonali; Jain, Veena; Gupta, Tina; Mittal, Swati; Chauhan, Prashant; Raghav, Rahul; Goelz, Patricia; Schnoll, Robert A

2015-01-01

The validity of self-reported tobacco use is often questioned given the potential for underestimation of use. This study used data from a double-blind, placebo-controlled clinical trial of varenicline for smokeless tobacco dependence in India to evaluate the accuracy of self-reported smokeless tobacco cessation using biochemical validation procedures and to evaluate correlates of reporting inaccuracy. Smokeless tobacco users attending a dental clinic at AIIMS were randomized to placebo or varenicline; all participants received counseling. Detailed smokeless tobacco use was recorded and abstinence was defined as cotinine-verified 7-day point prevalence cessation (cotinine < 50 ng/ml) and breath CO > 10 ppm at the end of 12 weeks of treatment. One-half of study completers (82/165) self-reported abstinence. Biochemical verification confirmed that (65.9%) subjects provided accurate self-reports while (34.1%) participants underreported tobacco use. These data indicate poor agreement between self-reported and biochemically confirmed abstinence (κ = -0.191). Underreporters of tobacco use had significantly higher baseline cotinine (p < 0.05), total craving (p < 0.012), and negative reinforcement craving (p < 0.001) vs. those whose self-reports were correctly verified. These findings provide evidence to support the need for biochemical validation of self-reported abstinence outcomes among smokeless tobacco users in cessation programs in India and identify high levels of pretreatment cotinine and craving levels as potential correlates of false reporting.

Recovery, relapse, or else? Treatment outcomes in gambling disorder from a multicenter follow-up study.

PubMed

Müller, K W; Wölfling, K; Dickenhorst, U; Beutel, M E; Medenwaldt, J; Koch, A

2017-06-01

Gambling disorder is associated with various adverse effects. While data on the immediate effectiveness of treatment programs are available, follow-up studies examining long-term effects are scarce and factors contributing to a stable therapy outcome versus relapse are under-researched. Patients (n=270) finishing inpatient treatment for gambling disorder regularly participated in a prospective multicenter follow-up study (pre-treatment, post-treatment, 12-month follow-up). Criteria for gambling disorder, psychopathology, functional impairment were defined as endpoints. Changes in personality were defined as an additional parameter. At follow-up, three groups were identified: subjects maintaining full abstinence (41.6%), patients still meeting criteria for gambling disorder (29.2%), and subjects still participating in gambling without meeting the diagnostic criteria for gambling disorder (29.2%). Every group had improvements in functional impairment, abstinent subjects showed the lowest psychopathology. Significant decreases in neuroticism and increases in both extraversion and conscientiousness were found among abstinent subjects but not in patients still meeting criteria for gambling disorder. One year after treatment, a considerable percentage of patients kept on gambling but not all of them were classified with gambling disorder leading to the question if abstinence is a necessary goal for every patient. The changes of personality in abstinent patients indicate that after surmounting gambling disorder a subsequent maturing of personality might be a protective factor against relapse. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Randomized Trial of Nicotine Lozenges and Phone Counseling for Smokeless Tobacco Cessation

PubMed Central

Danaher, Brian G.; Ebbert, Jon O.; van Meter, Nora; Lichtenstein, Edward; Widdop, Chris; Crowley, Ryann; Akers, Laura; Seeley, John R.

2015-01-01

Introduction: Relatively few treatment programs have been developed specifically for smokeless tobacco (ST) users who want to quit. Their results suggest that self-help materials, telephone counseling, and nicotine lozenges are efficacious. This study provides the first direct examination of the separate and combined effects of telephone counseling and lozenges. Methods: We recruited ST users online (N = 1067) and randomly assigned them to 1 of 3 conditions: (a) a lozenge group (n = 356), who were mailed 4-mg nicotine lozenges; (b) a coach calls group (n = 354), who were offered 3 coaching phone calls; or (c) a lozenge + coach calls group (N = 357), who received both lozenges and coaching calls. Additionally, all participants were mailed self-help materials. Self-reported tobacco abstinence was assessed at 3 and 6 months after randomization. Results: Complete-case and intention-to-treat (ITT) analyses for all tobacco abstinence were performed at 3 months, 6 months, and both 3 and 6 months (repeated point prevalence). ITT analyses revealed a highly similar result: the lozenge + coach calls condition was significantly more successful in encouraging tobacco abstinence than either the lozenge group or the coach calls group, which did not differ. Conclusions: Combining nicotine lozenges and phone counseling significantly increased tobacco abstinence rates compared with either intervention alone, whereas coach calls and lozenges were equivalent. The study confirms the high tobacco abstinence rates for self-help ST cessation interventions and offers guidance to providing tobacco treatment to ST users. PMID:25168034

A Randomized Trial of Contingency Management for Smoking Cessation During Intensive Outpatient Alcohol Treatment.

PubMed

Cooney, Judith L; Cooper, Sharon; Grant, Christoffer; Sevarino, Kevin; Krishnan-Sarin, Suchitra; Gutierrez, Ian A; Cooney, Ned L

2017-01-01

This randomized clinical trial was designed to evaluate the efficacy of contingency management (CM) for smoking cessation for smokers with alcohol abuse or dependence delivered concurrently with intensive outpatient alcohol treatment. The study also explored the indirect effects of CM smoking treatment and smoking cessation on alcohol and drug use outcomes. Alcohol abuse/dependent smokers were randomized to cognitive behavioral therapy plus nicotine replacement therapy plus contingency management (CBT+NRT+CM) or to cognitive behavior therapy plus nicotine replacement therapy (CBT+NRT) delivered concurrent with a three-week intensive outpatient alcohol treatment program. Participants in the CBT+NRT+CM condition were significantly more likely to be cigarette abstinent at the end of treatment (χ 2 (1)=8.48, p=.004) with approximately double the carbon monoxide confirmed quit rate (60%) compared with the CBT+NRT condition (29%). At the one-month and six-month time-points there were nonsignificant differences in smoking abstinence outcomes by condition. Smoking treatment condition did not directly affect alcohol abstinence outcomes, but we observed an indirect effect of smoking treatment on alcohol and drug abstinence at one-month follow-up that was mediated by smoking cessation at the end of treatment. Adding CM to an evidence-based smoking cessation treatment that included medication and behavioral counseling doubled the quit rate at the end of treatment. This finding provides strong evidence for the efficacy of CM for helping alcohol dependent smokers reach the milestone of initial smoking abstinence. Published by Elsevier Inc.

Evolving a model for integrated treatment in a residential setting for people with psychiatric and substance use disorders.

PubMed

Mayes, John; Handley, Samantha

2005-01-01

This paper discusses the implementation of a residential, integrated treatment program serving dually diagnosed people with histories of homelessness. Attention is focused on the program structure and how the program developed over time. Program modifications tended to relax program rules and embrace a motivational, stage-wise model using harm-reduction principles. Despite initial skepticism regarding these modifications, outcomes such as program retention, abstinence from substances, employment, and hospitalization improved.

Race moderates the effect of menthol cigarette use on short-term smoking abstinence.

PubMed

Reitzel, Lorraine R; Li, Yisheng; Stewart, Diana W; Cao, Yumei; Wetter, David W; Waters, Andrew J; Vidrine, Jennifer I

2013-05-01

The Food and Drug Administration is in the process of reviewing evidence of the impact of mentholated cigarettes on smoking behaviors and smoking cessation in order to determine if these products should be removed from the market. More empirical research is needed to inform those decisions. The goal of this study was to examine associations of menthol cigarette use with biochemically verified continuous short-term smoking abstinence, and potential moderation by race, among adult current smokers enrolled in a cohort study (N = 183; 57.4% female; 48.1% non-Hispanic Black, 51.9% non-Hispanic White). Continuation ratio logit models, adjusted for age, race, gender, total annual household income, educational level, employment status, and partner status, were used to examine associations of menthol use with smoking abstinence with and without an interaction term for race. Menthol cigarette use was not significantly associated with smoking abstinence in the sample as a whole; however, there was a significant interaction of menthol use with race (p = .03). Follow-up analyses stratified by race indicated that among White participants, menthol users had significantly lower odds of maintaining continuous abstinence than nonmenthol users (p = .05). Exploratory analyses suggested that tobacco dependence may lie along the causal pathway and partially explain this effect. White menthol smokers in this sample were at increased risk of smoking relapse relative to White nonmenthol smokers, at least partially due to greater tobacco dependence. Results should be replicated among other treatment-seeking samples with a greater representation of White menthol and Black nonmenthol smokers.

Contingency management for college student smokers: The role of drinking as a moderator and mediator of smoking abstinence during treatment.

PubMed

Cassidy, Rachel N; Jackson, Kristina M; Rohsenow, Damaris J; Tidey, Jennifer W; Tevyaw, Tracy O' L; Barnett, Nancy P; Monti, Peter M; Miller, Mollie E; Colby, Suzanne M

2018-05-01

Contingency management (CM) is effective for promoting smoking abstinence; however, moderators and mediators of CM treatment efficacy in young adult populations are under-explored. We leveraged fine-grained data from a large randomized controlled trial: 1) to determine whether early attainment of sustained abstinence mediated the effect of treatment on abstinence; 2) to test whether heavy drinking moderated the effect of treatment on abstinence; and 3) to test a serial mediation model of the effects of drinking during early treatment on sustained smoking abstinence. College student smokers (N=110) were randomized to receive either CM treatment or noncontingent reinforcement (NR) over a 21-day treatment period. All participants received $5 for providing twice-daily breath carbon monoxide (CO) samples. In CM, additional money was provided for samples that indicated smoking reduction (Initial Phase; first 7days), and for samples ≤5ppm (Abstinence Phase; following 14days). CM treatment led to greater sustained abstinence relative to NR. Longer sustained abstinence in the Initial Phase partially mediated the effect of treatment on sustained abstinence in the Abstinence Phase. Heavier pretreatment drinkers had shorter periods of sustained abstinence in the Abstinence Phase; this effect was greater in CM. A serial mediation model determined that increased drinking during the Initial Phase led to decreased sustained abstinence, which then led to decreased sustained abstinence in the Abstinence Phase. These data provide a greater understanding of how heavy drinking and early sustained abstinence may affect success during treatment in young adults undergoing contingency management treatment for smoking. Copyright © 2018. Published by Elsevier Ltd.

Exercise to Enhance Smoking Cessation: the Getting Physical on Cigarette Randomized Control Trial.

PubMed

Prapavessis, Harry; De Jesus, Stefanie; Fitzgeorge, Lindsay; Faulkner, Guy; Maddison, Ralph; Batten, Sandra

2016-06-01

Exercise has been proposed as a useful smoking cessation aid. The purpose of the present study is to determine the effect of an exercise-aided smoking cessation intervention program, with built-in maintenance components, on post-intervention 14-, 26- and 56-week cessation rates. Female cigarette smokers (n = 413) participating in a supervised exercise and nicotine replacement therapy (NRT) smoking cessation program were randomized to one of four conditions: exercise + smoking cessation maintenance, exercise maintenance + contact control, smoking cessation maintenance + contact control or contact control. The primary outcome was continuous smoking abstinence. Abstinence differences were found between the exercise and equal contact non-exercise maintenance groups at weeks 14 (57 vs 43 %), 26 (27 vs 21 %) and 56 (26 vs 23.5 %), respectively. Only the week 14 difference approached significance, p = 0.08. An exercise-aided NRT smoking cessation program with built-in maintenance components enhances post-intervention cessation rates at week 14 but not at weeks 26 and 56.

Patterns of use of a free nicotine patch program for Medicaid and uninsured patients.

PubMed Central

Jaén, C. R.; Cummings, K. M.; Shah, D.; Aungst, W.

1997-01-01

This study assessed the use and effectiveness of a free nicotine patch program among Medicaid and uninsured smokers. Patterns of patch use, associated behaviors with quit attempt, side effects, and self-reported abstinence from smoking for 6 months were evaluated prospectively among patients from five urban family practice offices and a nicotine dependence clinic located in a comprehensive cancer center in Western New York. Results indicated that the majority of participants used the program as intended, and 90% of the participants found the patch useful in their quit attempt. Fourteen percent of participants were abstinent for 6 months or more. We found no support for inappropriate use of transdermal nicotine patches among patients with no health insurance or those on Medicaid. Transdermal nicotine patches are an effective cessation aid for smokers. Given the tall of the consequences of smoking on health costs, barriers to access to effective treatment for smoking cessation among individuals covered by Medicaid for health insurance need to be eliminated. PMID:9170833

A prospective examination of online social network dynamics and smoking cessation

PubMed Central

Zhao, Kang; Papandonatos, George D.; Erar, Bahar; Wang, Xi; Amato, Michael S.; Cha, Sarah; Cohn, Amy M.; Pearson, Jennifer L.

2017-01-01

Introduction Use of online social networks for smoking cessation has been associated with abstinence. Little is known about the mechanisms through which the formation of social ties in an online network may influence smoking behavior. Using dynamic social network analysis, we investigated how temporal changes of an individual’s number of social network ties are prospectively related to abstinence in an online social network for cessation. In a network where quitting is normative and is the focus of communications among members, we predicted that an increasing number of ties would be positively associated with abstinence. Method Participants were N = 2,657 adult smokers recruited to a randomized cessation treatment trial following enrollment on BecomeAnEX.org, a longstanding Internet cessation program with a large and mature online social network. At 3-months post-randomization, 30-day point prevalence abstinence was assessed and website engagement metrics were extracted. The social network was constructed with clickstream data to capture the flow of information among members. Two network centrality metrics were calculated at weekly intervals over 3 months: 1) in-degree, defined as the number of members whose posts a participant read; and 2) out-degree-aware, defined as the number of members who read a participant’s post and commented, which was subsequently viewed by the participant. Three groups of users were identified based on social network engagement patterns: non-users (N = 1,362), passive users (N = 812), and active users (N = 483). Logistic regression modeled 3-month abstinence by group as a function of baseline variables, website utilization, and network centrality metrics. Results Abstinence rates varied by group (non-users = 7.7%, passive users = 10.7%, active users = 20.7%). Significant baseline predictors of abstinence were age, nicotine dependence, confidence to quit, and smoking temptations in social situations among passive users (ps < .05); age and confidence to quit among active users. Among centrality metrics, positive associations with abstinence were observed for in-degree increases from Week 2 to Week 12 among passive and active users, and for out-degree-aware increases from Week 2 to Week 12 among active users (ps < .05). Conclusions This study is the first to demonstrate that increased tie formation among members of an online social network for smoking cessation is prospectively associated with abstinence. It also highlights the value of using individuals’ activities in online social networks to predict their offline health behaviors. PMID:28832621

The Role of Recovery Capital in the Community Reentry of Prisoners with Substance Use Disorders

ERIC Educational Resources Information Center

Lyons, Thomas; Lurigio, Arthur J.

2010-01-01

This article examines the concept of recovery capital, which is based on a socioeconomic understanding of addiction. Substance abuse treatment programs, especially those in the criminal justice system, should recognize the important relationship between abstinence and recovery capital. A program is described which fosters recovery capital among…

Preliminary Examination of Adolescent Spending in a Contingency Management-Based Smoking-Cessation Program

ERIC Educational Resources Information Center

Cavallo, Dana A.; Nich, Charla; Schepis, Ty S.; Smith, Anne E.; Liss, Thomas B.; McFetridge, Amanda K.; Krishnan-Sarin, Suchitra

2010-01-01

Contingency management (CM) utilizing monetary incentives is efficacious in enhancing abstinence in an adolescent smoking-cessation program, but how adolescents spend their money has not been examined. We assessed spending habits of 38 adolescent smokers in a CM-based smoking-cessation project prior to quitting and during treatment using a…

A Web-Based Contingency Management Program with Adolescent Smokers

ERIC Educational Resources Information Center

Reynolds, Brady; Dallery, Jesse; Shroff, Palak; Patak, Michele; Leraas, Kristen

2008-01-01

The present study evaluated a new 30-day Web-based contingency management program for smoking abstinence with 4 daily-smoking adolescents. Participants made 3 daily video recordings of themselves giving breath carbon monoxide (CO) samples at home that were sent electronically to study personnel. Using a reversal design, participants could earn…

Evangelical Christian Parents' Attitudes towards Abstinence-Based Sex Education: "I Want My Kids to Have Great Sex!"

ERIC Educational Resources Information Center

Dent, Lauren; Maloney, Patricia

2017-01-01

While an overwhelming majority of people in the USA support some form of school-based sexual education, the specific content and context for that instruction varies widely, making it difficult to assess support for particular types of programmes. This is particularly the case for evangelical Christians, about whom there is a lack of scholarly…

A Teacher's Point of View on Family Life (Sex) Education

ERIC Educational Resources Information Center

Gawlinski, Judy R.

2007-01-01

As a Family and Consumer Science educator at Union City High School in Union City, Pennsylvania, I have heard and seen a great deal. I have been teaching for 24 years at this rural Pennsylvania Middle/High School where teen pregnancy has always been a problem. Teaching students abstinence as the only method of birth control has been a major…

Feasibility of a group cessation program for co-smokers of cannabis and tobacco.

PubMed

Becker, Julia; Haug, Severin; Kraemer, Thomas; Schaub, Michael P

2015-07-01

This study aims to evaluate the feasibility and effects of a group cessation program for cannabis and tobacco co-smokers. Using a repeated-measures design with pre-, post- and six months follow-up assessments, feasibility (intervention utilisation, safety and acceptability) and changes in substance use behaviour and mental health were evaluated. The intervention consisted of five to six group sessions and was based on current treatment techniques (e.g. motivational interviewing, cognitive-behavioural therapy, and self-control training). In total, 77 adults who used cannabis at least once weekly and cigarettes or similar products at least once daily participated in the study. Within nine months, the target sample size was reached. Treatment retention was 62.3%, and only three participants discontinued treatment due to severe problems (concentration problems, sleeping problems, depressive symptoms, and/or distorted perceptions). In total, 41.5% and 23.4% reported abstinence from cigarettes, cannabis or both at the end of treatment and the follow-up, respectively. The individual abstinence rates for cigarettes and cannabis were 32.5% and 23.4% (end of treatment) and 10.4% and 19.5% (follow-up), and 13% (end of treatment) and 5.2% (follow-up) achieved dual abstinence validated for tobacco abstinence. Over the study period, significant decreases in tobacco and cannabis use frequencies and significant improvements in additional outcomes (drinking problems, symptoms of cannabis use disorder, nicotine dependence, depression and anxiety) were achieved. The evaluated intervention for co-smokers is feasible regarding recruitment, intervention retention and safety. The promising results regarding substance use and mental health support a randomised controlled trial to evaluate effectiveness. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Teen pregnancy: a public health issue or political football?

PubMed

Clark, M P

1996-08-01

Politicians in the US have made adolescent parents the scapegoat of changing cultural patterns by suggesting punitive solutions to nonmarital births rather than addressing underlying causes of premature child-bearing. It is known that the percentages of young people of all races and all social classes reporting early, nonmarital sexual intercourse have increased dramatically, while adolescent fertility rates peaked in the 1950s. Improved access to contraception and abortion caused a decline in teen pregnancy and birth rates from 1970 to 1986. During 1986-91, service providers could not match growing demand, and the birth rate increased 25%. Increased rates of sexual activity have also led to increases in the incidence of sexually transmitted diseases (STDs) and HIV/AIDS among adolescents. This situation was exacerbated by Reagan and Bush policies, which reduced funding for services to adolescents and supported abstinence-only sex education courses. The concern voiced by policy-makers today centers on nonmarital childbearing by low-income adolescents who will rely on public assistance to survive. A proper response to this situation would involve the following policy actions: 1) mandating comprehensive sexuality education from kindergarten through high school, 2) funding mentoring programs, 3) improving economic and educational opportunities, 4) expanding STD and HIV/AIDS prevention programs, 5) increasing access to confidential health services (including mental health care and substance abuse treatment), 6) expanding child sexual abuse prevention and intervention programs, and 7) increasing access to and acceptability of teen contraceptive usage and abortion.

Racial Differences in Tobacco Cessation and Treatment Usage After Lung Screening: An Examination of the National Lung Screening Trial.

PubMed

Kumar, Pallavi; Gareen, Ilana F; Lathan, Christopher; Sicks, JoRean D; Perez, Giselle K; Hyland, Kelly A; Park, Elyse R

2016-01-01

Black smokers have demonstrated greater lung cancer disease burden and poorer smoking cessation outcomes compared with whites. Lung cancer screening represents a unique opportunity to promote cessation among smokers; however, little is known about the differential impact of screening on smoking behaviors among black and white smokers. Using data from the National Lung Screening Trial (NLST), we examined the racial differences in smoking behaviors after screening. We examined racial differences in smoking behavior and cessation activity among 6,316 white and 497 black (median age, 60 and 59 years, respectively) NLST participants who were current smokers at screening using a follow-up survey on 24-hour and 7-day quit attempts, 6-month continuous abstinence, and the use of smoking cessation programs and aids at 12 months after screening. Using multiple regression analyses, we examined the predictors of 24-hour and 7-day quit attempts and 6-month continuous abstinence. At 12 months after screening, blacks were more likely to report a 24-hour (52.7% vs. 41.2%, p < .0001) or 7-day (33.6% vs. 27.2%, p = .002) quit attempt. However, no significant racial differences were found in 6-month continuous abstinence (5.6% blacks vs. 7.2% whites). In multiple regression, black race was predictive of a higher likelihood of a 24-hour (odds ratio [OR], 1.6, 95% confidence interval [CI], 1.2-2.0) and 7-day (OR, 1.5, 95% CI, 1.1-1.8) quit attempt; however, race was not associated with 6-month continuous abstinence. Only a positive screening result for lung cancer was significantly predictive of successful 6-month continuous abstinence (OR, 2.3, 95% CI, 1.8-2.9). Although blacks were more likely than whites to have 24-hour and 7-day quit attempts, the rates of 6-month continuous abstinence did not differ. Targeted interventions are needed at the time of lung cancer screening to promote abstinence among all smokers. Among smokers undergoing screening for lung cancer, blacks were more likely than whites to have 24-hour and 7-day quit attempts; however, these attempts did not translate to increased rates of 6-month continuous abstinence among black smokers. Targeted interventions are needed at the time of lung cancer screening to convert quit attempts to sustained smoking cessation among all smokers. ©AlphaMed Press.

Population-level effects of automated smoking cessation help programs: a randomized controlled trial.

PubMed

Borland, Ron; Balmford, James; Benda, Peter

2013-03-01

To test the population impact of offering automated smoking cessation interventions via the internet and/or by mobile phone. Pragmatic randomized controlled trial with five conditions: offer of (i) minimal intervention control; (ii) QuitCoach personalized tailored internet-delivered advice program; (iii) onQ, an interactive automated text-messaging program; (iv) an integration of both QuitCoach and onQ; and (v) a choice of either alone or the combined program. Australia, via a mix of internet and telephone contacts. A total of 3530 smokers or recent quitters recruited from those interested in quitting, and seeking self-help resources (n = 1335) or cold-contacted from internet panels (n = 2195). The primary outcome was self-report of 6 months sustained abstinence at 7 months post-recruitment. Only 42.5% of those offered one of the interventions took it up to a minimal level. The intervention groups combined had a non-significantly higher 6-month sustained abstinence rate than the control [odds ratio (OR) = 1.48; 95% confidence interval (CI): 0.98-2.24] (missing cases treated as smokers), with no differences between the interventions. Among those who used an intervention, there was a significant overall increase in abstinence (OR = 1.95; CI: 1.04-3.67), but not clearly so when analysing only cases with reported outcomes. Success rates were greater among those recruited after seeking information compared to those cold-contacted. Smokers interested in quitting who were assigned randomly to an offer of either the QuitCoach internet-based support program and/or the interactive automated text-messaging program had non-significantly greater odds of quitting for at least 6 months than those randomized to an offer of a simple information website. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

A Randomized Trial of Employment-Based Reinforcement of Cocaine Abstinence in Injection Drug Users

ERIC Educational Resources Information Center

Silverman, Kenneth; Wong, Conrad J.; Needham, Mick; Diemer, Karly N.; Knealing, Todd; Crone-Todd, Darlene; Fingerhood, Michael; Nuzzo, Paul; Kolodner, Kenneth

2007-01-01

High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs…

Public health clinical demonstration project for smoking cessation in american veterans who served since september 11, 2001.

PubMed

Zaborowski, Daphne E; Dedert, Eric A; Straits-Troster, Kristy; Lee, Sherman; Wilson, Sarah M; Calhoun, Patrick S; Moore, Scott D; Acheson, Shawn; Hamlett-Berry, Kim W; Beckham, Jean C

2011-03-01

The purpose of this clinical demonstration project was to increase the reach of effective treatments, such as pharmacotherapy and telephone or web-based support, by offering these treatments in a low cost and convenient manner to a population of Veterans. Six hundred nine veteran smokers who had served in the military since September 11, 2001 were contacted by invitational letters. Veterans indicating interest in further contacts received telephone calls using standardized scripts that offered referral to the National Cancer Institute's Smoking QuitLine, web-based counseling, and local Department of Veteran Affairs pharmacologic treatment for smoking cessation. Seven percent of survey recipients participated in the clinical program. At follow-up, 23% of participants providing follow-up information reported maintaining smoking abstinence. This clinical demonstration project was associated with a reach of 8.6% (number of smokers who accessed the intervention/the number of targeted smokers), an efficacy of 26% (number of abstinent smokers at follow-up/number who accessed the intervention), and a 24-hour abstinence impact rate of 2.2% (number of smokers with 24-hour abstinence/number of targeted smokers). Results suggested that this project enhanced access to care and promoted short-term smoking cessation in Veterans who have served since September 11. 2001.

Family climate and expressed emotion in the course of alcoholism.

PubMed

Fichter, M M; Glynn, S M; Weyerer, S; Liberman, R P; Frick, U

1997-06-01

Family-based predictors of relapse were examined in 100 alcoholics who participated in a 12-week treatment program with 6-month and 18-month followups. "Expressed Emotion" (EE), or attitudes of relatives toward the alcoholic as measured by the Camberwell Family Interview, scales measuring rejection of the alcoholic by relatives, and self-reports of partner interaction were evaluated as possible predictors of abstinence. During therapy, partnership interactions showed a transient deterioration with increased temporary friction. Based on conservative criteria, the abstinence rate was 40% at 6-month followup and 30% at 18-month followup. An association with the relapse at followup could be obtained for the Patient Rejection Scale (PRS) and, using empirically derived classification rules, for the main three variables of the Camberwell Family Interview (CFI) conducted on admission: "Critical Comments," "Emotional Overinvolvement," and "Warmth." A low number of Critical Comments and a high score in Warmth were associated with a lower risk of relapse; however, contrary to expectations, Emotional Overinvolvement of the significant other was associated with more abstinence. In addition, the number of Critical Comments made by relatives about the alcoholic, a major component of high EE as measured by the CFI, had a statistically significant impact on the "survival function" of abstinence, and thus contributed to the prediction of the course of alcoholism in the expected direction.

Duration of detection of methamphetamine in hair after abstinence.

PubMed

Suwannachom, Natiprada; Thananchai, Thiwaphorn; Junkuy, Anongphan; O'Brien, Timothy E; Sribanditmongkol, Pongruk

2015-09-01

Researchers in the field of hair analysis have known for at least two decades that test results for many chemical compounds remain positive for a considerable period of time after subjects have reported cessation of use. These findings were generally based on small sample populations or individual case studies. Within the last decade, hair analyses of larger populations have investigated the phenomenon of residual positives in abstinent individuals in order to determine the period of time required for various compounds to present negative hair test results at internationally accepted cutoff levels. Such data has primarily been used to establish guidelines for retesting former abusers of illicit drugs in order to evaluate claims of abstinence. To date, research has focused on cocaine and opiates. The present study is the first to examine the duration of detection of methamphetamine (MA) and its metabolite amphetamine (AP) in the hair of chronic MA users who recently ceased their consumption of the drug. The study population (n=63) consisted of inpatients at a hospital drug rehabilitation program in Chiang Mai, Thailand. Drug taking behavior was collected by personal interview at the time of enrollment. Subjects provided hair samples at approximately monthly intervals for MA and AP analysis by gas chromatography-mass spectrometry at 0.2ng/mg cutoff levels. The correlation of baseline MA and AP concentrations in hair at the beginning of abstinence with corresponding duration of detection indicated great individual variability for the rate of clearance of MA and AP from hair. In regard to duration of detection, the majority of chronic MA users remained MA positive for up to about 90 days of reported abstinence, but by 120 days, the detection rate had fallen to about 16%. All subjects tested negative for MA after 153 days of abstinence. For AP, the limit of the duration of detection was reached at 106 days. With the adoption of a margin of safety to compensate for outlier individual variability, the present study affirmed that hair analysis of chronic MA abusers should test negative for MA after 6 months of claimed abstinence. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Evaluation of Three Adolescent Sexual Health Programs in Ha Noi and Khanh Hoa Province, Vietnam

PubMed Central

Pham, Van; Nguyen, Hoang; Tho, Le Huu; Minh, Truong Tan; Lerdboon, Porntip; Riel, Rosemary; Green, Mackenzie S.; Kaljee, Linda M.

2012-01-01

With an increase in sexual activity among young adults in Vietnam and associated risks, there is a need for evidence-based sexual health interventions. This evaluation of three sexual health programs based on the Protection Motivation Theory (PMT) was conducted in 12 communes in Ha Noi, Nha Trang City, and Ninh Hoa District. Inclusion criteria included unmarried youth 15–20 years residing in selected communes. Communes were randomly allocated to an intervention, and participants were randomly selected within each commune. The intervention programs included Vietnamese Focus on Kids (VFOK), the gender-based program Exploring the World of Adolescents (EWA), and EWA plus parental and health provider education (EWA+). Programs were delivered over a ten-week period in the communities by locally trained facilitators. The gender-based EWA program with parental involvement (EWA+) compared to VFOK showed significantly greater increase in knowledge. EWA+ in comparison to VFOK also showed significant decrease at immediate postintervention for intention to have sex. Sustained changes are observed in all three interventions for self-efficacy condom use, self-efficacy abstinence, response efficacy for condoms, extrinsic rewards, and perceived vulnerability for HIV. These findings suggest that theory-based community programs contribute to sustained changes in knowledge and attitudes regarding sexual risk among Vietnamese adolescents. PMID:22666565

Evaluation of three adolescent sexual health programs in ha noi and khanh hoa province, Vietnam.

PubMed

Pham, Van; Nguyen, Hoang; Tho, Le Huu; Minh, Truong Tan; Lerdboon, Porntip; Riel, Rosemary; Green, Mackenzie S; Kaljee, Linda M

2012-01-01

With an increase in sexual activity among young adults in Vietnam and associated risks, there is a need for evidence-based sexual health interventions. This evaluation of three sexual health programs based on the Protection Motivation Theory (PMT) was conducted in 12 communes in Ha Noi, Nha Trang City, and Ninh Hoa District. Inclusion criteria included unmarried youth 15-20 years residing in selected communes. Communes were randomly allocated to an intervention, and participants were randomly selected within each commune. The intervention programs included Vietnamese Focus on Kids (VFOK), the gender-based program Exploring the World of Adolescents (EWA), and EWA plus parental and health provider education (EWA+). Programs were delivered over a ten-week period in the communities by locally trained facilitators. The gender-based EWA program with parental involvement (EWA+) compared to VFOK showed significantly greater increase in knowledge. EWA+ in comparison to VFOK also showed significant decrease at immediate postintervention for intention to have sex. Sustained changes are observed in all three interventions for self-efficacy condom use, self-efficacy abstinence, response efficacy for condoms, extrinsic rewards, and perceived vulnerability for HIV. These findings suggest that theory-based community programs contribute to sustained changes in knowledge and attitudes regarding sexual risk among Vietnamese adolescents.

Gratitude, abstinence, and alcohol use disorders: Report of a preliminary finding.

PubMed

Krentzman, Amy R

2017-07-01

Gratitude is a central component of addiction recovery for many, yet it has received scant attention in addiction research. In a sample of 67 individuals entering abstinence-based alcohol-use-disorder treatment, this study employed gratitude and abstinence variables from sequential assessments (baseline, 6months, 12months) to model theorized causal relationships: gratitude would increase pre-post treatment and gratitude after treatment would predict greater percent days abstinent 6months later. Neither hypothesis was supported. This unexpected result led to the theory that gratitude for sobriety was the construct of interest; therefore, the association between gratitude and future abstinence would be positive among those already abstinent. Thus, post-treatment abstinence was tested as a moderator of the effect of gratitude on future abstinence: this effect was statistically significant. For those who were abstinent after treatment, the relationship between gratitude and future abstinence was positive; for those drinking most frequently after treatment, the relationship between gratitude and future abstinence was negative. In this preliminary study, dispositional tendency to affirm that there is much to be thankful for appeared to perpetuate the status quo-frequent drinkers with high gratitude were drinking frequently 6months later; abstinent individuals with high gratitude were abstinent 6months later. Gratitude exercises might be contraindicated for clients who are drinking frequently and have abstinence as their treatment goal. Copyright © 2017 Elsevier Inc. All rights reserved.

An mHealth App for Supporting Quitters to Manage Cigarette Cravings With Short Bouts of Physical Activity: A Randomized Pilot Feasibility and Acceptability Study.

PubMed

Hassandra, Mary; Lintunen, Taru; Hagger, Martin S; Heikkinen, Risto; Vanhala, Mauno; Kettunen, Tarja

2017-05-26

While gains in reducing smoking rates in Finland have been made, prevalence rates are still substantial. Relapse rates among smokers engaged in quit-smoking programs are high. Physical activity has been proposed as one means to help smokers manage cravings. Software and apps on mobile phone and handheld devices offer an opportunity to communicate messages on how to use physical activity to manage cravings as part of quit-smoking programs. We aimed to test the feasibility, acceptability, usability, and preliminary efficacy of an mHealth mobile phone app, Physical activity over Smoking (PhoS), to assist smokers in quitting smoking in a randomized controlled trial. The app was designed to prompt smokers to engage in physical activities to manage their smoking cravings. Regular smokers (n=44) attended a group-based behavioral counselling program aimed at promoting physical activity as an additional aid to quit. After quit day, participants were randomly allocated to an intervention (n=25) or to a comparison (n=19) group. Participants in the intervention group were provided with the PhoS app and training on how to use it to assist with relapse prevention. Participants in the comparison condition were provided with generalized relapse prevention training. Some participants reported that the PhoS app was useful in assisting them to successfully manage their cigarette cravings, although compliance across the sample was modest and participants reported low levels of usability. Participants receiving the PhoS app did not report greater abstinence than those who did not receive the app. However, participants receiving the app were more likely to report greater abstinence if they did not use pharmacological support, while those who did not receive the app reported greater abstinence when using pharmacological support. Participants receiving the app reported greater levels of physical activity than those who did not. Results revealed that the app resulted in better retention. The PhoS app showed some potential to reduce abstinence among participants not using pharmacological therapy and to increase physical activity. However, problems with usability and lack of effects on abstinence raise questions over the app's long-term effectiveness. Future research should prioritize further development of the app to maximize usability and test effects of the intervention independent of quit-smoking programs. International Standard Randomized Controlled Trial Number (ISRCTN): 55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI). ©Mary Hassandra, Taru Lintunen, Martin S Hagger, Risto Heikkinen, Mauno Vanhala, Tarja Kettunen. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 26.05.2017.

Treatment of cannabis dependence using escitalopram in combination with cognitive-behavior therapy: a double-blind placebo-controlled study.

PubMed

Weinstein, A M; Miller, H; Bluvstein, I; Rapoport, E; Schreiber, S; Bar-Hamburger, R; Bloch, M

2014-01-01

Cannabis is the most frequently used illegal substance in the United States and Europe. There is a dramatic increase in the demand for treatment for cannabis dependence. Cannabis users frequently have co-morbid mood symptoms, especially depression and anxiety, and regular cannabis users may self-medicate for such symptoms. We report a double-blind, placebo-controlled treatment study, for the prevention of cannabis use in cannabis-dependent individuals. Regular cannabis-dependent users (n = 52) were treated for 9 weeks with weekly cognitive-behavior and motivation-enhancement therapy sessions together with escitalopram 10 mg/day. Urine samples were collected to monitor delta-9 tetrahydrocannabinol (THC) during treatment and questionnaires were administered to assess anxiety and depression. We observed a high rate of dropout (50%) during the 9-week treatment program. Fifty-two patients were included in the intention-to-treat analysis. Of these, ten (19%) remained abstinent after 9 weeks of treatment as indicated by negative urine samples for THC. Escitalopram provided no advantage over placebo in either abstinence rates from cannabis or anxiety and depression scores during the withdrawal and abstinent periods. Escitalopram treatment does not provide an additional benefit either for achieving abstinence, or for the treatment of the cannabis withdrawal syndrome. Due to limitations of our study, namely, a high dropout rate and effects of low abstinence rates on measures of anxiety, depression and withdrawal, it is premature to conclude that selective serotonin reuptake inhibitors are not effective for treatment of the cannabis withdrawal syndrome.

Initial evaluation of a real-world Internet smoking cessation system

PubMed Central

Cobb, Nathan K.; Graham, Amanda L.; Bock, Beth C.; Papandonatos, George; Abrams, David B.

2010-01-01

To significantly reduce smoking prevalence, treatments must balance reach, efficacy, and cost. The Internet can reach millions of smokers cost-effectively. Many cessation Web sites exist, but few have been evaluated. As a result, the potential impact of the Internet on smoking prevalence remains unknown. The present study reports the results, challenges, and limitations of a preliminary, large-scale evaluation of a broadly disseminated smoking cessation Web site used worldwide (QuitNet). Consecutive registrants (N=1,501) were surveyed 3 months after they registered on the Web site to assess 7-day point prevalence abstinence. Results must be interpreted cautiously because this is an uncontrolled study with a 25.6% response rate. Approximately 30% of those surveyed indicated they had already quit smoking at registration. Excluding these participants, an intention-to-treat analysis yielded 7% point prevalence abstinence (for the responders only, abstinence was 30%). A range of plausible cessation outcomes (9.8%–13.1%) among various subgroups is presented to illustrate the strengths and limitations of conducting Web-based evaluations, and the tensions between clinical and dissemination research methods. Process-to-outcome analyses indicated that sustained use of QuitNet, especially the use of social support, was associated with more than three times greater point prevalence abstinence and more than four times greater continuous abstinence. Despite its limitations, the present study provides useful information about the potential efficacy, challenging design and methodological issues, process-to-outcome mechanisms of action, and potential public health impact of Internet-based behavior change programs for smoking cessation. PMID:16036277

[Personality pathological traits and brain metabolites as predictors of non-abstinence in addicts with personality disorders].

PubMed

Serrani Azcurra, Daniel

2013-01-01

Differences in pathological personality traits and disturbances in brain metabolites between non consumers, abstinent and non abstinent consumers were assessed. Participants (n=113) aged between 18-45 years with personality disorder (PD) were diagnosed with clinical interview and scales for depression, anxiety, impulsivity and dimensions of personality pathology. Brain metabolites were analyzed with magnetic resonance spectroscopy. Data were analyzed with ANOVA and multiple comparisons. Abstinent and non-abstinent differentiated from non-consumers in emotional deregulation, inhibition, and restricted expression; abstinent and non-abstinent differentiated from each other in self-aggression, dissocial behaviour, conduct disorder, stimulus seeking and intimacy problems. N-Acetyl Aspartate and creatine values were lower between non-abstinent in prefrontal, anterior cingulate cortex, cerebellar vermis and superior corona radiata. For abstinent, choline levels were greater in cerebellar vermis and n-acetyl aspartate were lower in dorso-lateral prefrontal and anterior cingulated cortex and insula. Regarding personality traits, insecure attachment, narcissism, lability, self-aggression and anxiety characterize consumers and abstinent, while suspiciousness, rejection and character hardness are found in consumers (non-abstinent and abstinent). Compulsive traits, unplanned body impulsiveness and lack of control in emotional regulation predominated in non-abstinent and participants with co-morbidities. Detachment and inhibition predominate in alcohol abuse disorder and narcissistic traits in substance abuse.

Emetic and Electric Shock Alcohol Aversion Therapy: Six- and Twelve-Month Follow-Up.

ERIC Educational Resources Information Center

Cannon, Dale S.; Baker, Timothy B.

1981-01-01

Follow-up data are presented for 6- and 12-months on male alcoholics (N=20) who received either a multifaceted inpatient alcoholism treatment program alone (controls) or emetic or shock aversion therapy in addition to that program. Both emetic and control subjects compiled more days of abstinence than shock subjects. (Author)

The Implementation of a Culturally Based HIV Sexual Risk Reduction Program for Latino Youth in a Denver Area High School

ERIC Educational Resources Information Center

Mueller, Trisha E.; Castaneda, Charlene Angel; Sainer, Shannon; Martinez, Donna; Herbst, Jeffrey H.; Wilkes, Aisha L.; Villarruel, Antonia M.

2009-01-01

In the United States, Latino youth experience disproportionately higher rates of teen pregnancy and sexually transmitted infections (STIs) than non-Latino Whites. As a result, organizations serving Latino youth seek culturally appropriate evidence-based prevention programs that promote sexual abstinence and condom use. "Cuidate" is an…

A randomized trial of employment-based reinforcement of cocaine abstinence in injection drug users.

PubMed

Silverman, Kenneth; Wong, Conrad J; Needham, Mick; Diemer, Karly N; Knealing, Todd; Crone-Todd, Darlene; Fingerhood, Michael; Nuzzo, Paul; Kolodner, Kenneth

2007-01-01

High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine-positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence-and-work (n = 28) or work-only (n = 28) group. Abstinence-and-work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work-only participants could work independent of their urinalysis results. Abstinence-and-work participants provided more (p = .004; OR = 5.80, 95% CI = 2.03-16.56) cocaine-negative urine samples (29%) than did work-only participants (10%). Employment-based abstinence reinforcement can increase cocaine abstinence.

Racial/ethnic subgroup differences in outcomes and acceptability of an Internet-delivered intervention for substance use disorders.

PubMed

Campbell, Aimee N C; Montgomery, L; Sanchez, Katherine; Pavlicova, M; Hu, M; Newville, H; Weaver, L; Nunes, E V

2017-01-01

The Therapeutic Education System (TES), an Internet version of the Community Reinforcement Approach plus prize-based motivational incentives, is one of few empirically supported technology-based interventions. To date, however, there has not been a study exploring differences in substance use outcomes or acceptability of TES among racial/ethnic subgroups. This study uses data from a multisite (N = 10) effectiveness study of TES to explore whether race/ethnicity subgroups (White [n = 267], Black/African American [n = 112], and Hispanic/Latino [n = 55])moderate the effect of TES. Generalized linear mixed models were used to test whether abstinence, retention, social functioning, coping, craving, or acceptability differed by racial/ethnic subgroup. Findings demonstrated that race/ethnicity did not moderate the effect of TES versus TAU on abstinence, retention, social functioning, or craving. A three-way interaction (treatment, race/ethnicity, and abstinence status at study entry) showed that TES was associated with greater coping scores among nonabstinent White participants (p = .008) and among abstinent Black participants (p < .001). Acceptability of the TES intervention, although high overall, was significantly different by race/ethnicity subgroup with White participants reporting lower acceptability of TES compared to Black (p = .006) and Hispanic/Latino (p = .008) participants. TES appears to be a good candidate treatment among a diverse population of treatment-seeking individuals with substance use disorders.

Anxiety and depressed mood decline following smoking abstinence in adult smokers with Attention Deficit Hyperactivity Disorder

PubMed Central

Covey, Lirio S.; Hu, Mei-Chen; Winhusen, Theresa; Lima, Jennifer; Berlin, Ivan; Nunes, Edward

2015-01-01

Introduction A preponderance of relevant research has indicated reduction in anxiety and depressive symptoms following smoking abstinence. This secondary analysis investigated whether the phenomenon extends to smokers with attention deficit hyperactivity disorder (ADHD). Methods The study setting was an 11-Week double-blind placebo-controlled randomized trial of osmotic release oral system methylphenidate (OROS-MPH) as a cessation aid when added to nicotine patch and counseling. Participants were 255 adult smokers with ADHD. The study outcomes are: anxiety (Beck Anxiety Inventory (BAI)) and depressed mood (Beck Depression Inventory II (BDI)) measured one Week and six Weeks after a target quit day (TQD). The main predictor is point - prevalence abstinence measured at Weeks 1 and 6 after TQD. Covariates are treatment (OROS-MPH vs placebo), past major depression, past anxiety disorder, number of cigarettes smoked daily, demographics (age, gender, education, marital status) and baseline scores on the BAI, BDI, and the DSM-IV ADHD Rating Scale. Results Abstinence was significantly associated with lower anxiety ratings throughout the post-quit period (p<0.001). Depressed mood was lower for abstainers than non-abstainers at Week 1 (p<0.05), but no longer at Week 6 (p=0.83). Treatment with OROS-MPH relative to placebo showed significant reductions at Week 6 after TQD for both anxiety (p<0.05) and depressed mood (p<0.001), but not at Week 1. Differential abstinence effects of gender were observed. Anxiety and depression ratings at baseline predicted increased ratings of corresponding measures during the post-quit period. Conclusion Stopping smoking yielded reductions in anxiety and depressed mood in smokers with ADHD treated with nicotine patch and counseling. Treatment with OROS-MPH yielded mood reductions in delayed manner. PMID:26272693

Gender-based Outcomes and Acceptability of a Computer-assisted Psychosocial Intervention for Substance Use Disorders.

PubMed

Campbell, Aimee N C; Nunes, Edward V; Pavlicova, Martina; Hatch-Maillette, Mary; Hu, Mei-Chen; Bailey, Genie L; Sugarman, Dawn E; Miele, Gloria M; Rieckmann, Traci; Shores-Wilson, Kathy; Turrigiano, Eva; Greenfield, Shelly F

2015-06-01

Digital technologies show promise for increasing treatment accessibility and improving quality of care, but little is known about gender differences. This secondary analysis uses data from a multi-site effectiveness trial of a computer-assisted behavioral intervention, conducted within NIDA's National Drug Abuse Clinical Trials Network, to explore gender differences in intervention acceptability and treatment outcomes. Men (n=314) and women (n=192) were randomly assigned to 12-weeks of treatment-as-usual (TAU) or modified TAU+Therapeutic Education System (TES), whereby TES substituted for 2hours of TAU per week. TES is composed of 62 Web-delivered, multimedia modules, covering skills for achieving and maintaining abstinence plus prize-based incentives contingent on abstinence and treatment adherence. Outcomes were: (1) abstinence from drugs and heavy drinking in the last 4weeks of treatment, (2) retention, (3) social functioning, and (4) drug and alcohol craving. Acceptability was the mean score across five indicators (i.e., interesting, useful, novel, easy to understand, and satisfaction). Gender did not moderate the effect of treatment on any outcome. Women reported higher acceptability scores at week 4 (p=.02), but no gender differences were detected at weeks 8 or 12. Acceptability was positively associated with abstinence, but only among women (p=.01). Findings suggest that men and women derive similar benefits from participating in a computer-assisted intervention, a promising outcome as technology-based treatments expand. Acceptability was associated with abstinence outcomes among women. Future research should explore characteristics of women who report less satisfaction with this modality of treatment and ways to improve overall acceptability. Copyright © 2015 Elsevier Inc. All rights reserved.

Smoker Characteristics and Smoking-Cessation Milestones

PubMed Central

Japuntich, Sandra J.; Leventhal, Adam M.; Piper, Megan E.; Bolt, Daniel M.; Roberts, Linda J.; Fiore, Michael C.; Baker, Timothy B.

2011-01-01

Background Contextual variables often predict long-term abstinence, but little is known about how these variables exert their effects. These variables could influence abstinence by affecting the ability to quit at all, or by altering risk of lapsing, or progressing from a lapse to relapse. Purpose To examine the effect of common predictors of smoking-cessation failure on smoking-cessation processes. Methods The current study (N = 1504, 58% female, 84% Caucasian; recruited from January 2005 to June 2007; data analyzed in 2009) uses the approach advocated by Shiffman et al., (2006), which measures cessation outcomes on three different cessation milestones (achieving initial abstinence, lapse risk, and the lapse-relapse transition) to examine relationships of smoker characteristics (dependence, contextual and demographic factors) with smoking-cessation process. Results High nicotine dependence strongly predicted all milestones: not achieving initial abstinence, and a higher risk of both lapse and transitioning from lapse to complete relapse. Numerous contextual and demographic variables were associated with higher initial cessation rates and/or decreased lapse risk at 6 months post-quit (e.g., ethnicity, gender, marital status, education, smoking in the workplace, number of smokers in the social network, and number of supportive others). However, aside from nicotine dependence, only gender significantly predicted the risk of transition from lapse to relapse. Conclusions These findings demonstrate that: (1) higher nicotine dependence predicted worse outcomes across every cessation milestone; (2) demographic and contextual variables are generally associated with initial abstinence rates and lapse risk and not the lapse-relapse transition. These results identify groups who are at risk for failure at specific stages of the smoking-cessation process, and this may have implications for treatment. PMID:21335259

Three-year chemical dependency and mental health treatment outcomes among adolescents: the role of continuing care.

PubMed

Sterling, Stacy; Chi, Felicia; Campbell, Cynthia; Weisner, Constance

2009-08-01

Few studies have examined the effects of treatment factors, including the types of services [chemical dependency (CD), psychiatric, or both], on long-term outcomes among adolescents following CD treatment, and whether receiving continuing care may contribute to better outcomes. This study examines the effect of the index CD and ongoing CD and psychiatric treatment episodes, 12-step participation, and individual characteristics such as CD and mental health (MH) severity and gender, age, and ethnicity, on 3-year CD and MH outcomes. Participants were 296 adolescents aged 13 to 18 seeking treatment at 4 CD programs of a nonprofit, managed care, integrated health system. We surveyed participants at intake, 1 year, and 3 years, and examined survey and administrative data, and CD and psychiatric utilization. At 3 years, 29.7% of the sample reported total abstinence from both alcohol and drugs (excluding tobacco). Compared with girls, boys had only half the odds of being abstinent (OR = 0.46, p = 0.0204). Gender also predicted Externalizing severity at 3 years (coefficients 18.42 vs. 14.77, p < 0.01). CD treatment readmission in the second and third follow-up years was related to abstinence at 3 years (OR = 0.24, p = 0.0066 and OR = 3.33, p = 0.0207, respectively). Abstinence at 1 year predicted abstinence at 3 years (OR = 4.11, p < 0.0001). Those who were abstinent at 1 year also had better MH outcomes (both lower Internalizing and Externalizing scores) than those who were not (11.75 vs. 15.55, p = 0.0012 and 15.13 vs. 18.06, p = 0.0179, respectively). A CD treatment episode resulting in good 1-year CD outcomes may contribute significantly to both CD and MH outcomes 3 years later. The findings also point to the value of providing a continuing care model of treatment for adolescents.

Effectiveness Trial of Community-Based I Choose Life-Africa Human Immunodeficiency Virus Prevention Program in Kenya

PubMed Central

Adam, Mary B.

2014-01-01

We measured the effectiveness of a human immunodeficiency virus (HIV) prevention program developed in Kenya and carried out among university students. A total of 182 student volunteers were randomized into an intervention group who received a 32-hour training course as HIV prevention peer educators and a control group who received no training. Repeated measures assessed HIV-related attitudes, intentions, knowledge, and behaviors four times over six months. Data were analyzed by using linear mixed models to compare the rate of change on 13 dependent variables that examined sexual risk behavior. Based on multi-level models, the slope coefficients for four variables showed reliable change in the hoped for direction: abstinence from oral, vaginal, or anal sex in the last two months, condom attitudes, HIV testing, and refusal skill. The intervention demonstrated evidence of non-zero slope coefficients in the hoped for direction on 12 of 13 dependent variables. The intervention reduced sexual risk behavior. PMID:24957544

Effectiveness trial of community-based I Choose Life-Africa human immunodeficiency virus prevention program in Kenya.

PubMed

Adam, Mary B

2014-09-01

We measured the effectiveness of a human immunodeficiency virus (HIV) prevention program developed in Kenya and carried out among university students. A total of 182 student volunteers were randomized into an intervention group who received a 32-hour training course as HIV prevention peer educators and a control group who received no training. Repeated measures assessed HIV-related attitudes, intentions, knowledge, and behaviors four times over six months. Data were analyzed by using linear mixed models to compare the rate of change on 13 dependent variables that examined sexual risk behavior. Based on multi-level models, the slope coefficients for four variables showed reliable change in the hoped for direction: abstinence from oral, vaginal, or anal sex in the last two months, condom attitudes, HIV testing, and refusal skill. The intervention demonstrated evidence of non-zero slope coefficients in the hoped for direction on 12 of 13 dependent variables. The intervention reduced sexual risk behavior. © The American Society of Tropical Medicine and Hygiene.

The role of prepartum motivation in the maintenance of postpartum smoking abstinence

PubMed Central

Heppner, Whitney L.; Ji, Lingyun; Reitzel, Lorraine R.; Castro, Yessenia; Correa-Fernandez, Virmarie; Vidrine, Jennifer Irvin; Li, Yisheng; Dolan-Mullen, Patricia; Velasquez, Mary M.; Cinciripini, Paul M.; Cofta-Woerpel, Ludmila; Greisinger, Anthony; Wetter, David W.

2011-01-01

Objective Motivation plays an important role in a variety of behaviors, including smoking cessation, and is integral to theory and treatment of smoking. For many women, pregnancy offers a motivational shift that helps them stop smoking and maintain abstinence during pregnancy. However, women's motivation to maintain smoking abstinence postpartum is not well-understood and may play a role in high postpartum relapse rates. The current study utilized multiple measures of prepartum motivation to maintain smoking abstinence to predict postpartum smoking abstinence. Design As part of a randomized clinical trial on postpartum smoking relapse prevention, pregnant women who quit smoking during pregnancy reported their motivation to continue smoking abstinence at a prepartum baseline session. Continued smoking abstinence was assessed at 8 and 26 weeks postpartum. Main Outcome Measure Biochemically verified continuous abstinence from smoking. Results Direct relationships among multiple measures of motivation were significant, and ranged in strength from weak to moderate. All motivation measures individually predicted continuous smoking abstinence, after controlling for treatment group, demographics, and pre-quit tobacco use. When tested simultaneously, a global motivation measure and parenthood motives for quitting remained significant predictors of abstinence. Backward selection modeling procedures resulted in a reduced model of prepartum predictors of postpartum abstinence including global motivation, parenthood motives, and stage of change. Conclusion Global motivation for smoking abstinence and parenthood motives for quitting are particularly important motivational constructs for pregnant women's continued smoking abstinence. PMID:21859215

A Randomized Trial of Motivational Interviewing: Cessation Induction Among Smokers With Low Desire to Quit.

PubMed

Catley, Delwyn; Goggin, Kathy; Harris, Kari Jo; Richter, Kimber P; Williams, Karen; Patten, Christi; Resnicow, Ken; Ellerbeck, Edward F; Bradley-Ewing, Andrea; Lee, Hyoung S; Moreno, Jose L; Grobe, James E

2016-05-01

Despite limitations in evidence, the current Clinical Practice Guideline advocates Motivational Interviewing for smokers not ready to quit. This study evaluated the efficacy of Motivational Interviewing for inducing cessation-related behaviors among smokers with low motivation to quit. Randomized clinical trial. Two-hundred fifty-five daily smokers reporting low desire to quit smoking were recruited from an urban community during 2010-2011 and randomly assigned to Motivational Interviewing, health education, or brief advice using a 2:2:1 allocation. Data were analyzed from 2012 to 2014. Four sessions of Motivational Interviewing utilized a patient-centered communication style that explored patients' own reasons for change. Four sessions of health education provided education related to smoking cessation while excluding elements characteristic of Motivational Interviewing. A single session of brief advice consisted of brief, personalized advice to quit. Self-reported quit attempts; smoking abstinence (biochemically verified); use of cessation pharmacotherapies; motivation; and confidence to quit were assessed at baseline and 3- and 6-month follow-ups. Unexpectedly, no significant differences emerged between groups in the proportion who made a quit attempt by 6-month follow-up (Motivational Interviewing, 52.0%; health education, 60.8%; brief advice, 45.1%; p=0.157). Health education had significantly higher biochemically verified abstinence rates at 6 months (7.8%) than brief advice (0.0%) (8% risk difference, 95% CI=3%, 13%, p=0.003), with the Motivational Interviewing group falling in between (2.9% abstinent, 3% risk difference, 95% CI=0%, 6%, p=0.079). Both Motivational Interviewing and health education groups showed greater increases in cessation medication use, motivation, and confidence to quit relative to brief advice (all p<0.05), and health education showed greater increases in motivation relative to Motivational Interviewing (Cohen's d=0.36, 95% CI=0.12, 0.60). Although Motivational Interviewing was generally more efficacious than brief advice in inducing cessation behaviors, health education appeared the most efficacious. These results highlight the need to identify the contexts in which Motivational Interviewing may be most efficacious and question recommendations to use Motivational Interviewing rather than other less complex cessation induction interventions. This study is registered at www.clinicaltrials.gov NCT01188018. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Outcomes from a patient-centered residential treatment plan for tobacco dependence.

PubMed

Hodgkin, John E; Sachs, David P L; Swan, Gary E; Jack, Lisa M; Titus, Betsy L; Waldron, Susan J S; Sachs, Bonnie L; Brigham, Janet

2013-09-01

St. Helena Hospital launched the first US residential stop-smoking program, The St. Helena Center for a Smoke-Free Life, in 1969. This observational report describes the center's treatment outcome rate for using a patient-centered approach to the use of tobacco dependence medications and behavioral treatment for patients who participated in the program from January 1, 2005 through December 31, 2007. A total of 284 patients used long-acting (nicotine patch, bupropion, and varenicline) and/or short-acting medications (nicotine nasal spray, nicotine gum, nicotine lozenge, and nicotine oral inhaler) alone or in combination during treatment and after discharge. Seven patients chose to use no medications. Patients using nicotine patch received a mean ± SD dose of 33.3±15.7 mg of nicotine in 16 hours (range, 5-90 mg). The 12-month 7-day point prevalence smoking abstinence rate after participation in the intensive, 1-week, residential program was 57.0%. Recommendations are discussed for future research and for implementing aspects of the St. Helena program in other treatment settings. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

A Randomized Trial of Employment-Based Reinforcement of Cocaine Abstinence in Injection Drug Users

PubMed Central

Silverman, Kenneth; Wong, Conrad J; Needham, Mick; Diemer, Karly N; Knealing, Todd; Crone-Todd, Darlene; Fingerhood, Michael; Nuzzo, Paul; Kolodner, Kenneth

2007-01-01

High-magnitude and long-duration abstinence reinforcement can promote drug abstinence but can be difficult to finance. Employment may be a vehicle for arranging high-magnitude and long-duration abstinence reinforcement. This study determined if employment-based abstinence reinforcement could increase cocaine abstinence in adults who inject drugs and use cocaine during methadone treatment. Participants could work 4 hr every weekday in a workplace where they could earn about $10.00 per hour in vouchers; they were required to provide routine urine samples. Participants who attended the workplace and provided cocaine-positive urine samples during the initial 4 weeks were invited to work 26 weeks and were randomly assigned to an abstinence-and-work (n  =  28) or work-only (n  =  28) group. Abstinence-and-work participants had to provide urine samples showing cocaine abstinence to work and maintain maximum pay. Work-only participants could work independent of their urinalysis results. Abstinence-and-work participants provided more (p  =  .004; OR  =  5.80, 95% CI  =  2.03–16.56) cocaine-negative urine samples (29%) than did work-only participants (10%). Employment-based abstinence reinforcement can increase cocaine abstinence. PMID:17970256

Comorbidity effects on cocaine dependence treatment and examination of reciprocal relationships between abstinence and depression.

PubMed

Milby, Jesse B; Conti, Kimberly; Wallace, Dennis; Mennemeyer, Stephen; Mrug, Sylvie; Schumacher, Joseph E

2015-02-01

We examined comorbid disorders' prevalence, their impact on abstinence, and the impact of depressive symptoms on abstinence and of abstinence on depressive symptoms. A randomized controlled trial's data on outcomes from treating cocaine dependence were used. It compared abstinence-contingent housing and work to contingency management plus behavioral day treatment. Regardless of original trial arm assignment, groups of participants with no additional Axis I disorders (n = 87) and 1 or more additional Axis I disorders (n = 113) were compared for abstinence. Changes in depression symptoms, measured by the Beck Depression Inventory, were analyzed as a function of 4 cohorts of increased consecutive weeks abstinent. An autoregressive cross-lagged path model examined reciprocal relationships between depression and abstinence. Most prevalent additional disorders were depressive disorders, followed by anxiety disorders. Additional disorders did not significantly affect abstinence. Cohorts with more abstinence were linearly related to lower depression symptoms. The cross-lagged model showed that longer abstinence predicted decreases in depressive symptoms at 6 months. However, depressive symptoms did not predict changes in abstinence. Our study adds to others that have found an effective treatment targeted at specific problems such as substance abuse, social anxiety disorder, and posttraumatic stress disorder that may have the side benefit of reducing depression. Additionally, we find that depression does not interfere with effective substance abuse treatment for cocaine dependency. This may be the 1st formal analysis comparing the ability of cocaine abstinence to predict future depressive symptoms versus depressive symptoms to predict future cocaine abstinence. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

Effects of a peer-led media literacy curriculum on adolescents' knowledge and attitudes toward sexual behavior and media portrayals of sex.

PubMed

Pinkleton, Bruce E; Austin, Erica Weintraub; Cohen, Marilyn; Chen, Yi-Chun Yvonnes; Fitzgerald, Erin

2008-09-01

The United States has the highest rates of teenage pregnancy and birth in the Western industrialized world, and research indicates that television and other mass media are important sources of sexual information for young people. The purpose of this study was to determine if a teen-led, media literacy curriculum focused on sexual portrayals in the media would increase adolescents' awareness of media myths concerning sex, decrease the allure of sexualized portrayals, and decrease positive expectancies for sexual activity. A posttest-only quasi-experiment with control groups was conducted at 22 school and community sites in Washington state (N = 532). The intervention, a 5-lesson media literacy curriculum targeted primarily to middle school students, encouraged sexual abstinence because of federal government funding requirements. Adolescents evaluated the program positively, with 85% rating it as better than other sex education programs. Compared to control-group participants, students were less likely to overestimate sexual activity among teens, more likely to think they could delay sexual activity, less likely to expect social benefits from sexual activity, more aware of myths about sex, and less likely to consider sexual media imagery desirable. The results showed that media literacy has promise as part of a sex education program by providing adolescents with a cognitive framework necessary to understand and resist the influence of media on their decision making concerning sex.

[Predictors of outcome of a smoking cessation treatment by gender].

PubMed

Marqueta, Adriana; Nerín, Isabel; Jiménez-Muro, Adriana; Gargallo, Pilar; Beamonte, Asunción

2013-01-01

To identify factors predictive of the outcome of a smoking cessation program by gender. A cross-sectional study of smokers starting treatment in a smoking cessation clinic from 2002 to 2007 was conducted. The variables consisted of data on sociodemographic factors, smoking habits, the social context of smoking and psychiatric comorbidity prior to or during the smoking cessation process. All patients received multicomponent treatment consisting of psychological and pharmacological interventions. Success was defined as self-reported continuous abstinence confirmed by cooximetry (CO ≤10 ppm). Logistic regression was used to analyze the factors predictive of success. A total of 1302 persons (52.1% men and 47.9% women), with a mean age of 43.4 (10.2) years, were included. The mean number of cigarettes smoked per day was 25.3 (10.4) and the mean Fagerström test score was 6.2 (2.2) points. The success rate was 41.3% (538) with no differences by gender. Positive predictors were lower nicotine dependence and having a non-smoking partner in men and older age, smoking fewer cigarettes per day, having fewer smoking friends and not experiencing depression or anxiety during the treatment in women. Men and women have similar tobacco abstinence outcomes although gender factors play a role in determining abstinence. The gender perspective should be incorporated in smoking prevention and cessation programs. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

Income Levels and Response to Contingency Management for Smoking Cessation.

PubMed

López-Núñez, Carla; Secades-Villa, Roberto; Peña-Suárez, Elsa; Fernández-Artamendi, Sergio; Weidberg, Sara

2017-06-07

Contingency management (CM) has demonstrated its efficacy in treating many drug addictions, including nicotine. However, one of the most commonly perceived limitations with regard to its dissemination into community settings is whether this protocol could be equally effective for treating patients across different income levels. This study aimed to examine whether individuals' income levels affect treatment success in a cognitive behavioral treatment (CBT) that included a voucher-based CM protocol for smoking cessation. A total of 92 treatment-seeking smokers in a community setting were randomly assigned to a CBT group (N = 49) or to a CBT plus CM group (N = 43). The CM procedure included a voucher program through which smoking abstinence was reinforced on a schedule of escalating magnitude of reinforcement with a reset contingency. We analyzed the impact of self-reported monthly income, alone and in combination with treatment condition, on short-term (treatment retention) and long-term (self-reported number of days of continuous smoking abstinence at 6-month follow-up) results. Income had no effect on treatment retention and continuous abstinence outcomes at 6-month follow-up in either treatment condition. Treatment modality emerged as the only significant predictor of treatment success. Our findings suggest that treatment-seeking smokers from the general population respond equally well to CM regardless of their income levels. The results of this randomized controlled trial support the generalizability of this evidenced-based program into community settings.

Qualitative evidence of a primary intervention point for elite athlete doping.

PubMed

Mazanov, Jason; Huybers, Twan; Connor, James

2011-03-01

Anti-doping activities in sport have shifted from secondary prevention (intervening after athletes have used) to educational strategies focused on primary prevention through promoting abstinence. There is no empirical evidence to guide targeting of anti-doping education initiatives. In this paper, a heuristic to guide education initiatives was derived by re-analysing a series of interviews (n=20) with athletes, coaches, sports managers, physiotherapists and sports nutritionists. The findings indicate primary prevention of doping may be enhanced by timing it around periods of career instability where athlete vulnerability to doping may increase as a function of winning or losing sponsorship. Sponsorship is broadly defined as financial (e.g. salary stipend) and non-financial support (e.g. training facilities). This provides a basis for targeting education interventions to promote abstinence. Two options are offered to mitigate the need to time prevention activity around career instability by lessening the effect of sponsorship on athlete doping. The first is liberalising access to legitimate performance enhancing technologies (e.g. training techniques or nutritional supplements). The second is to delay access to financial sponsorship (beyond living expenses) until retirement, with monetary gains (e.g. prize money) deposited into an account where penalties are debited if the athlete is caught doping. Copyright © 2010 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

Increased sexual abstinence among in-school adolescents as a result of school health education in Soroti district, Uganda.

PubMed

Shuey, D A; Babishangire, B B; Omiat, S; Bagarukayo, H

1999-06-01

A school health education programme in primary schools aimed at AIDS prevention in Soroti district of Uganda emphasized improved access to information, improved peer interaction and improved quality of performance of the existing school health education system. A cross-sectional sample of students, average age 14 years, in their final year of primary school was surveyed before and after 2 years of interventions. The percentage of students who stated they had been sexually active fell from 42.9% (123 of 287) to 11.1% (31 of 280) in the intervention group, while no significant change was recorded in a control group. The changes remained significant when segregated by gender or rural and urban location. Students in the intervention group tended to speak to peers and teachers more often about sexual matters. Increases in reasons given by students for abstaining from sex over the study period occurred in those reasons associated with a rational decision-making model rather than a punishment model. A primary school health education programme which emphasizes social interaction methods can be effective in increasing sexual abstinence among school-going adolescents in Uganda. The programme does not have to be expensive and can be implemented with staff present in most districts in the region.

Persistent alterations in mesolimbic gene expression with abstinence from cocaine self-administration

PubMed Central

Freeman, WM; Patel, KM; Brucklacher, RM; Lull, ME; Erwin, M; Morgan, D; Roberts, DCS; Vrana, KE

2010-01-01

Cocaine-responsive gene expression changes have been described after either no drug abstinence or short periods of abstinence. Little data exist on the persistence of these changes after long-term abstinence. Previously, we reported that after discrete-trial, cocaine self-administration and 10 days of forced abstinence, incubation of cocaine reinforcement was observable by a progressive ratio schedule. The present study used rat discrete-trial cocaine self-administration and long-term forced abstinence to examine: extinction responding, mRNA abundance of known cocaine-responsive genes, and chromatin remodeling. At 30 and 100 days of abstinence, extinction responding increased compared to 3-day abstinent rats. Decreases in both medial prefrontal cortex (mPFC) and nucleus accumbens (NAc) c-fos, Nr4a1, Arc, and EGR1 mRNA were observed, and in most cases persisted, for 100 days of abstinence. The signaling peptides CART and NPY transiently increased in the mPFC, but returned to baseline levels following 10 days of abstinence. To investigate a potential regulatory mechanism for these persistent mRNA changes, levels of histone H3 acetylation at promoters for genes with altered mRNA expression were examined. In the mPFC, histone H3 acetylation decreased after 1 and 10 days of abstinence at the promoter for EGR1. H3 acetylation increased for NPY after 1 day of abstinence and returned to control levels by 10 days of abstinence. Behaviorally, these results demonstrate incubation after discrete-trial cocaine self-administration and prolonged forced abstinence. This incubation is accompanied by changes in gene expression that persist long after cessation of drug administration and may be regulated by chromatin remodeling. PMID:17851536

Buprenorphine from detox and beyond: preliminary evaluation of a pilot program to increase heroin dependent individuals' engagement in a full continuum of care.

PubMed

Donovan, Dennis M; Knox, Patricia C; Skytta, Jenny A F; Blayney, Jessica A; DiCenzo, Jessica

2013-04-01

Absence of successful transition to post-detoxification treatment leads to high rates of relapse among detoxified heroin users. The present study evaluated a pilot buprenorphine treatment program (BTP). Heroin dependent individuals were inducted onto buprenorphine/naloxone in detox, maintained while transitioning through an intensive inpatient program (IIP), and gradually tapered off medication over 5 months of outpatient (OP) treatment. Compared to programmatic indicators of treatment engagement in the year prior to BTP implementation, referrals from detox to IIP, entry into and completion of IIP and subsequent OP, and days in OP treatment increased substantially. BTP completers, compared to non-completers, viewed abstinence as more difficult and as requiring more assistance to achieve, were less likely to be current cocaine and alcohol users or to have relapsed during the course of treatment. Although preliminary and in need of replication, initial adjunctive use of buprenorphine in an abstinence-based continuum of care may improve post-detoxification treatment entry, engagement, and completion. Copyright © 2013 Elsevier Inc. All rights reserved.

Forensic continuum of care with Assertive Community Treatment (ACT) for persons recovering from co-occurring disabilities: long-term outcomes.

PubMed

Smith, Ronald J; Jennings, Jerry L; Cimino, Anthony

2010-01-01

This study presents the long-term outcomes of a continuum of care program for co-occurring psychiatric disabilities and chemical dependency that has been recognized as a best practice model by the American Psychological Association's Committee for the Advancement of Professional Practice's Task Force on Serious Mental Illness and Severe Emotional Disturbance (APA/CAPP, 2007). Since publication of the initial positive outcomes for 18 men in 2002, this innovative recovery program continued to successfully reintegrate a total of 91 men and women with severe co-occurring disabilities who had been acquitted of violent crimes by reason of insanity (NGRI). This follow-up study showed continued positive outcomes for an additional 73 program graduates in terms of non-reoffending, psychiatric stability, substance abuse abstinence, stable housing and meaningful activity. In contrast to other studies that have applied Assertive Community Treatment and Intensive Case Management to populations with forensic issues and failed to reduce criminal recidivism, this continuum of care recovery model had strong results in preventing criminal recidivism in addition to achieving improved mental health, abstinence and quality of life.

Using Elite Athletes to Promote Drug Abstinence: Evaluation of a Single-Session School-Based Drug Use Prevention Program Delivered by Junior Hockey Players

ERIC Educational Resources Information Center

Wong, Jennifer

2016-01-01

School-based substance use prevention programs are a common method to approaching drug use in youths. Project SOS is a single-session drug prevention program developed by police officers and delivered by elite junior hockey players to students in grades 6 and 7. The current study evaluates the effects of Project SOS at achieving its objectives of…

Pharmacotherapy for Alcohol Dependence: The 2015 Recommendations of the French Alcohol Society, Issued in Partnership with the European Federation of Addiction Societies.

PubMed

Rolland, Benjamin; Paille, François; Gillet, Claudine; Rigaud, Alain; Moirand, Romain; Dano, Corine; Dematteis, Maurice; Mann, Karl; Aubin, Henri-Jean

2016-01-01

The latest French good practice recommendations (GPRs) for the screening, prevention, and treatment of alcohol misuse were recently published in partnership with the European Federation of Addiction Societies (EUFAS). This article aims to synthesize the GPRs focused on the pharmacotherapy of alcohol dependence. A four-member European steering committee defined the questions that were addressed to an 18-member multiprofessional working group (WG). The WG developed the GPRs based on a systematic, hierarchical, and structured literature search and submitted the document to two review processes involving 37 French members from multiple disciplines and 5 non-French EUFAS members. The final GPRs were graded A, B, or C, or expert consensus (EC) using a reference recommendation grading system. The treatment of alcohol dependence consists of either alcohol detoxification or abstinence maintenance programs or drinking reduction programs. The therapeutic objective is the result of a decision made jointly by the physician and the patient. For alcohol detoxification, benzodiazepines (BZDs) are recommended in first-line (grade A). BZD dosing should be guided by regular clinical monitoring (grade B). Residential detoxification is more appropriate for patients with a history of seizures, delirium tremens, unstable psychiatric comorbidity, or another associated substance use disorder (grade B). BZDs are only justified beyond a 1-week period in the case of persistent withdrawal symptoms, withdrawal events or associated BZD dependence (grade B). BZDs should not be continued for more than 4 weeks (grade C). The dosing and duration of thiamine (vitamin B1) during detoxification should be adapted to nutritional status (EC). For relapse prevention, acamprosate and naltrexone are recommended as first-line medications (grade A). Disulfiram can be proposed as second-line option in patients with sufficient information and supervision (EC). For reducing alcohol consumption, nalmefene is indicated in first line (grade A). The second-line prescription of baclofen, up to 300 mg/day, to prevent relapse or reduce drinking should be carried out according to the "temporary recommendation for use" measure issued by the French Health Agency (EC). During pregnancy, abstinence is recommended (EC). If alcohol detoxification is conducted during pregnancy, BZD use is recommended (grade B). No medication other than those for alcohol detoxification should be initiated in pregnant or breastfeeding women (EC). In a stabilized pregnant patient taking medication to support abstinence, the continuation of the drug should be considered on a case-by-case basis, weighing the benefit/risk ratio. Only disulfiram should be always stopped, given the unknown risks of the antabuse effect on the fetus (EC). First-line treatments to help maintain abstinence or reduce drinking are off-label for people under 18 years of age and should thus be considered on a case-by-case basis after the repeated failure of psychosocial measures alone (EC). Short half-life BZDs should be preferred for the detoxification of elderly patients (grade B). The initial doses of BZDs should be reduced by 30 to 50% in elderly patients (EC). In patients with chronic alcohol-related physical disorders, abstinence is recommended (EC). Any antidepressant or anxiolytic medication should be introduced after a psychiatric reassessment after 2-4 weeks of alcohol abstinence or low-risk use (grade B). A smoking cessation program should be offered to any smokers involved in an alcohol treatment program (grade B). © 2015 John Wiley & Sons Ltd.

Effectiveness of Abstinence-Based Sex Education Curricula: A Review.

ERIC Educational Resources Information Center

Toups, Melanie L.; Holmes, William R.

2002-01-01

Many attempts have been made to address the problem of teenage premarital sexual activity in order to reduce the number of pregnancies and sexually transmitted diseases. The authors review some of those efforts and attempt to identify effective approaches. Implications for research are also presented. (Author)

Is the internet filling the sexual health information gap for teens? An exploratory study.

PubMed

Jones, Rachel K; Biddlecom, Ann E

2011-02-01

At the same time that there was a decline in comprehensive school-based sex education, adolescents' use of the Internet became nearly universal. This study explores adolescents' use and evaluation of the Internet for sexual health information, with a focus on the issues of contraception and abstinence. The authors conducted 58 in-depth interviews with juniors and seniors in 3 public high schools in New York City and Indiana. Most of the adolescents used the Internet on a daily basis, but few considered it a main source of information about contraception or abstinence. Students were more likely to rely on and had greater trust in traditional sexuality education sources such as school, family members, and friends. Most of the adolescents the authors interviewed were wary of sexual health information on the Internet, and the authors describe strategies adolescents used to sort through the abundance of sex-related material. Formal and informal efforts to provide sexuality education to adolescents should include specific age- and content-appropriate Web sites because many teens are not actively searching on their own, and they express reservations about relying on the Internet as a source of sexual health information.

Exposure to and Views of Information about Sexual Abstinence among Older Teens

ERIC Educational Resources Information Center

Jones, Rachel K.; Biddlecom, Ann E.

2011-01-01

There is scant research of adolescents' understanding of abstinence. We conducted interviews with a sample of 58 teens to find out their exposure to abstinence information from a range of sources. Most teens had received abstinence information or messages from school, family members, and friends. For many teens, information about abstinence, or…

Health and economic effects from linking bedside and outpatient tobacco cessation services for hospitalized smokers in two large hospitals: study protocol for a randomized controlled trial.

PubMed

Fellows, Jeffrey L; Mularski, Richard; Waiwaiole, Lisa; Funkhouser, Kim; Mitchell, Julie; Arnold, Kathleen; Luke, Sabrina

2012-08-01

Extended smoking cessation follow-up after hospital discharge significantly increases abstinence. Hospital smoke-free policies create a period of 'forced abstinence' for smokers, thus providing an opportunity to integrate tobacco dependence treatment, and to support post-discharge maintenance of hospital-acquired abstinence. This study is funded by the National Heart, Lung, and Blood Institute (1U01HL1053231). The Inpatient Technology-Supported Assisted Referral study is a multi-center, randomized clinical effectiveness trial being conducted at Kaiser Permanente Northwest (KPNW) and at Oregon Health & Science University (OHSU) hospitals in Portland, Oregon. The study assesses the effectiveness and cost-effectiveness of linking a practical inpatient assisted referral to outpatient cessation services plus interactive voice recognition (AR + IVR) follow-up calls, compared to usual care inpatient counseling (UC). In November 2011, we began recruiting 900 hospital patients age ≥18 years who smoked ≥1 cigarettes in the past 30 days, willing to remain abstinent postdischarge, have a working phone, live within 50 miles of the hospital, speak English, and have no health-related barriers to participation. Each site will randomize 450 patients to AR + IVR or UC using a 2:1 assignment strategy. Participants in the AR + IVR arm will receive a brief inpatient cessation consult plus a referral to available outpatient cessation programs and medications, and four IVR follow-up calls over seven weeks postdischarge. Participants do not have to accept the referral. At KPNW, UC participants will receive brief inpatient counseling and encouragement to self-enroll in available outpatient services. The primary outcome is self-reported thirty-day smoking abstinence at six months postrandomization for AR + IVR participants compared to usual care. Additional outcomes include self-reported and biochemically confirmed seven-day abstinence at six months, self-reported seven-day, thirty-day, and continuous abstinence at twelve months, intervention dose response at six and twelve months for AR + IVR recipients, incremental cost-effectiveness of AR + IVR intervention compared to usual care at six and twelve months, and health-care utilization and expenditures at twelve months for AR + IVR recipients compared to UC. This study will provide important evidence for the effectiveness and cost-effectiveness of linking hospital-based tobacco treatment specialists' services with discharge follow-up care. ClinicalTrials.gov: NCT01236079.

Up Front: Students Are Chafing under "Test Stress."

ERIC Educational Resources Information Center

American School Board Journal, 2001

2001-01-01

Although President Bush favors continuous testing, headlines reflect an intense, growing antitesting sentiment. One standard does not fit all, current systems are malfunctioning, and kids are short-changed. A recent report says abstinence-only sex education is ineffective; high teen birth rates underline the need for comprehensive approaches. (MLH)

Practice and content of sex education among adolescents in a family setting in rural southwest Nigeria.

PubMed

Asekun-Olarinmoye, E O; Dairo, M D; Abodurin, O L; Asekun-Olarinmoye, I O

A descriptive cross-sectional study to assess adolescents' view of the practice and content of sex education within the family setting in a rural Nigerian community and explore whether there is any association between parental communication on sex and adolescents' sexual debut and habits. Simple random sampling was utilized, while a semi-structured questionnaire was used to collect data from 350 respondents. Data analysis was by the Statistical Package for Social Sciences (SPSS version 11). Majority of the respondents (48.8%) were late adolescents, 291 (85.1%) had had sex education, most (45.7%) of whom were exposed between ages 10 and 14 years. The main content of parental sex education was HIV/AIDS prevention (51.9%), avoidance of pregnancy (40.9%), abstinence (38.1%), and basic information about reproduction and biology (35.4%). Poor attitude to parental communication on sex was associated with a higher likelihood of pre-marital sex (p = 0.001). Curiosity was the most common major reason for sexual debut. This emphasizes the importance of early sex education within the family setting and its possible impact in delaying sexual initiation. Promotion of parent-child communication about sexual issues is vital in order to improve the reproductive health of the adolescents in this environment. Community-based health education intervention programs for parents are recommended.

[Alcohol dependence syndrome and before-discharge intervention method (BDIM)--Report 1. The process to develop the constructed BDIM].

PubMed

Ino, Aro

2004-02-01

Many alcoholics come to the hospital denying their own drinking problems. So, in the initial treatment stage for alcoholics, it is very important to bring patients' attention to their denial. In those days, there were many kinds of treatment method to help them aware of patients' denial. For example, psycho-educational therapy, Japanese Naikan therapy, attendance to self-help group meetings, and so on. But I don't think that these are effective enough to help them aware of their drinking problems, especially denial. The purpose of my study is to develop the therapeutic intervention method (Before discharge Intervention Method: BDIM). It is for being aware of patient's denial, stimulating his/her motivation for abstinence and attendance to medical follow-up sessions or self-help group meetings. To achieve these purposes, I apply Picard's initial intervention method that is a very useful therapy for alcohol dependence syndrome patients who reject consultation. The subjects of this study are 175 alcohol dependence syndrome inpatients and their family members. The period of BDIM practices is for about 1 week before discharge. BDIM's concrete programs are prepared by medical team under the therapist's guidance. Beforehand the therapist has to ask the patient whether he/she agree to practicing BDIM program or not. Then to obtain his/her family's approval of joining to BDIM, nurses talk by telephone or directly consult with the patient's family members. The therapists requires the patient's family members to write letters to him/her. In advance, the therapist has to take preliminary examination the letters not to be traumatic but spiritual. There are good memories about him/her and merits of the period without his/her drinking problems. Also, they write his/her drinking problems and their hope for abstinence and follow-up therapy after discharge and attendance of self-help group meetings. In BDIM session, the patients shall listen to his/her family members' messages by their letters with tears and receive their letters. Then the patient has an opportunity to talk his/her opinion about the letters and give his/her answer later. All the letters should be copied and kept with their medical file, because the therapists will talk about the letters with the patient and his/her family members in the follow-up session. Talking about letters after discharge helps him/her revive BDIM's memories and motivate abstinence, recovery and participation in self-help group. Even though alcohol dependence syndrome patient has some cognition and (or) memory disorders, I think that BDIM practices using some letters written by the patient and his/her family members are not only so useful for the patient to correct their cognition, but also helpful to be aware of denial and maintain motives to recovery. Owing to the deep emotion and warm heart from his/her family members, the patient can be aware of his/her family's sufferings and maintain abstinence for a long time.

Intolerance for withdrawal discomfort and motivation predict voucher-based smoking treatment outcomes for smokers with substance use disorders.

PubMed

Rohsenow, Damaris J; Tidey, Jennifer W; Kahler, Christopher W; Martin, Rosemarie A; Colby, Suzanne M; Sirota, Alan D

2015-04-01

Identifying predictors of abstinence with voucher-based treatment is important for improving its efficacy. Smokers with substance use disorders have very low smoking cessation rates so identifying predictors of smoking treatment response is particularly important for these difficult-to-treat smokers. Intolerance for Smoking Abstinence Discomfort (IDQ-S), motivation to quit smoking, nicotine dependence severity (FTND), and cigarettes per day were examined as predictors of smoking abstinence during and after voucher-based smoking treatment with motivational counseling. We also investigated the relationship between IDQ-S and motivation to quit smoking. Smokers in residential substance treatment (n=184) were provided 14days of vouchers for complete smoking abstinence (CV) after a 5-day smoking reduction lead-in period or vouchers not contingent on abstinence. Carbon monoxide readings indicated about 25% of days abstinent during the 14days of vouchers for abstinence in the CV group; only 3-4% of all participants were abstinent at follow-ups. The IDQ-S Withdrawal Intolerance scale and FTND each significantly predicted fewer abstinent days during voucher treatment; FTND was nonsignificant when controlling for variance shared with withdrawal intolerance. The one significant predictor of 1-month abstinence was pretreatment motivation to quit smoking, becoming marginal (p<.06) when controlling for FTND. Lower withdrawal intolerance significantly predicted 3month abstinence when controlling for FTND. Higher withdrawal intolerance pretreatment correlated with less motivation to quit smoking. Implications for voucher-based treatment include the importance of focusing on reducing these expectancies of anticipated smoking withdrawal discomfort, increasing tolerance for abstinence discomfort, and increasing motivation. Published by Elsevier Ltd.

75 FR 45123 - Agency Information Collection Activities: Proposed Collection; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-08-02

... proposed projects or to obtain a copy of the information collection plans, call the SAMHSA Reports... effectiveness, efficiency and sustainability of the GBHI project services for client abstinence, housing... the implementation and sustainability of project activities under the GBHI program. Each survey...

A Preliminary Trial: Double-Blind Comparison of Nefazodone, Bupropion-SR and Placebo in the Treatment of Cannabis Dependence

PubMed Central

Carpenter, Kenneth M.; McDowell, David; Brooks, Daniel J.; Cheng, Wendy; Levin, Frances R.

2009-01-01

The present study investigated the efficacy of nefazodone and bupropion-sustained release for treating cannabis dependence. A double blind, placebo controlled, piggy back design was employed to assess if nefazodone and bupropion-sustained release increased the probability of abstinence from cannabis and reduced the severity of cannabis dependence and cannabis withdrawal symptoms during a 13-week outpatient treatment program. One-hundred and six participants (M=32 years; Females n=25) were randomized to one of three medication conditions (nefazodone, bupropion-sustained release, or placebo) and participated in a weekly individually based coping skills therapy program. Results indicated a an increased probability of achieving abstinence over the course of treatment and a decrease in the severity of cannabis dependence and the withdrawal symptom of irritability. There were no significant effects demonstrated for nefazodone and bupropion-sustained release on cannabis use or cannabis withdrawal symptoms. The results indicate nefazodone and bupropion-sustained release may have limited efficacy in treating cannabis dependence. PMID:19219666

Community reinforcement approach plus vouchers for cocaine dependence in a community setting in Spain: six-month outcomes.

PubMed

Secades-Villa, Roberto; García-Rodríguez, Olaya; Higgins, Stephen T; Fernández-Hermida, José R; Carballo, José L

2008-03-01

The aim of this study was to assess the efficacy of the community reinforcement approach (CRA) plus vouchers treatment in achieving cocaine abstinence and treatment retention among patients enrolled in an outpatient program for cocaine dependence in Spain. Forty-three patients were randomly assigned to one of two treatment conditions in a community setting: CRA plus vouchers or standard care. Of the patients who received the CRA plus vouchers program, 73% completed 24 weeks of treatment, as compared with 42% of the patients who received standard care who did. In the CRA plus vouchers group, 40% of the patients achieved 24 weeks of continuous cocaine abstinence, as compared with 21% of the patients in the standard care group who did. These results support the effectiveness and generalizability of the CRA plus vouchers treatment in a community setting outside of the United States. Further follow-up is required to confirm the long-term maintenance of the results.

Withdrawal-Related Changes in Delay Discounting Predict Short-Term Smoking Abstinence.

PubMed

Miglin, Rickie; Kable, Joseph W; Bowers, Maureen E; Ashare, Rebecca L

2017-06-01

Impulsive decision making is associated with smoking behavior and reflects preferences for smaller, immediate rewards and intolerance of temporal delays. Nicotine withdrawal may alter impulsive decision making and time perception. However, little is known about whether withdrawal-related changes in decision making and time perception predict smoking relapse. Forty-five smokers (14 female) completed two laboratory sessions, one following 24-hour abstinence and one smoking-as-usual (order counterbalanced; biochemically verified abstinence). During each visit, participants completed measures of time perception, decision making (ie, discount rates), craving, and withdrawal. Following the second laboratory session, subjects underwent a well-validated model of short-term abstinence (quit week) with small monetary incentives for each day of biochemically confirmed abstinence. Smokers significantly overestimated time during abstinence, compared to smoking-as-usual (p = .021), but there were no abstinence effects on discount rates (p = .6). During the quit week, subjects were abstinent for 3.5 days (SD = 2.15) and smoked a total of 12.9 cigarettes (SD = 15.8). Importantly, higher discount rates (ie, preferences for immediate rewards) during abstinence (abstinence minus smoking difference score) predicted greater number of days abstinent (p = .01) and fewer cigarettes smoked during the quit week (p = .02). Withdrawal-related change in time reproduction did not predict relapse (p = .2). These data suggest that individuals who have a greater preference for immediate rewards during abstinence (vs. smoking-as-usual) may be more successful at maintaining short-term abstinence when provided with frequent (eg, daily) versus less frequent incentive schedules (eg, 1 month). Abstinence-induced changes in decision making may be important for identifying smokers who may benefit from interventions that incentivize abstinence such as contingency management (CM). The present results suggest that smokers who place greater subjective value on immediate rewards during withdrawal (compared to smoking-as-usual) may be less likely to relapse if offered small, frequent monetary incentives to maintain abstinence. Thus, the current findings may have important implications for identifying smokers most likely to benefit from particular interventions such as CM. Future research might evaluate whether withdrawal-related changes in delay discounting moderate treatment response to different incentive schedules with the goal of optimizing CM effectiveness to improve abstinence rates. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Maintenance of reinforcement to address the chronic nature of drug addiction

PubMed Central

Silverman, Kenneth; DeFulio, Anthony; Sigurdsson, Sigurdur O.

2012-01-01

Background Drug addiction can be a chronic problem. Abstinence reinforcement can initiate drug abstinence, but as with other treatments many patients relapse after the intervention ends. Abstinence reinforcement can be maintained to promote long-term drug abstinence, but practical means of implementing long-term abstinence reinforcement are needed. Methods We reviewed 8 clinical trials conducted in Baltimore, MD from 1996 through 2010 that evaluated the therapeutic workplace as a vehicle for maintaining reinforcement for the treatment of drug addiction. The therapeutic workplace uses employment-based reinforcement in which employees must provide objective evidence of drug abstinence or medication adherence to work and earn wages. Results Employment-based reinforcement can initiate (3 of 4 studies) and maintain (2 studies) cocaine abstinence in methadone patients, although relapse can occur even after long-term exposure to abstinence reinforcement (1 study). Employment-based reinforcement can also promote abstinence from alcohol in homeless alcohol dependent adults (1 study), and maintain adherence to extended-release naltrexone in opioid dependent adults (2 studies). Conclusion Treatments should seek to promote life-long effects in patients. Therapeutic reinforcement may need to be maintained indefinitely to prevent relapse. Workplaces could be effective vehicles for the maintenance of therapeutic reinforcement contingencies for drug abstinence and adherence to addiction medications. PMID:22668883

Relations between in-treatment and follow-up abstinence among cocaine-dependent homeless persons in three clinical trials.

PubMed

Vuchinich, Rudy; Wallace, Dennis; Milby, Jesse B; Schumacher, Joseph E; Mennemeyer, Stephen; Kertesz, Stefan

2009-06-01

Clinical trials with cocaine-dependent outpatients have found a strong relation between in-treatment and follow-up abstinence, and the strength of this relation is constant across treatment conditions with variable efficacy in generating abstinence. The authors conducted secondary analyses of data from 3 clinical trials to determine whether this relation generalizes to cocaine-dependent homeless persons. The 3 trials (total N = 543) were conducted in a community health care facility for homeless people. The 7 treatment arms across the 3 trials were combinations of day treatment, abstinence-contingent housing, and vocational training. Drug use was measured with urine toxicology testing. Consecutive weeks of abstinence during treatment were strongly related to abstinence at the 12-month follow-up, whether or not missing 12-month data were included in the analysis. The treatment arms differed in their efficacy in generating abstinence, but the relation between in-treatment and follow-up abstinence did not differ across treatment arms. These results replicate earlier reports of these relations and extend them to a population of homeless people. The lack of differences between treatment arms in the in-treatment-follow-up abstinence relation implies that that relation is independent of the treatment-specific intervention components that generate group differences in abstinence.

A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (happy ending): randomized controlled trial.

PubMed

Brendryen, Håvar; Drozd, Filip; Kraft, Pål

2008-11-28

Happy Ending (HE) is an intense 1-year smoking cessation program delivered via the Internet and cell phone. HE consists of more than 400 contacts by email, Web pages, interactive voice response, and short message service technology. HE includes a craving helpline and a relapse prevention system, providing just-in-time therapy. All the components of the program are fully automated. The objectives were to describe the rationale for the design of HE, to assess the 12-month efficacy of HE in a sample of smokers willing to attempt to quit without the use of nicotine replacement therapy, and to explore the potential effect of HE on coping planning and self-efficacy (prior to quitting) and whether coping planning and self-efficacy mediate treatment effect. A two-arm randomized controlled trial was used. Subjects were recruited via Internet advertisements and randomly assigned to condition. Inclusion criteria were willingness to quit on a prescribed day without using nicotine replacement and being aged 18 years or older. The intervention group received HE, and the control group received a 44-page self-help booklet. Abstinence was defined as "not even a puff of smoke, for the last seven days" and was assessed by means of Internet surveys or telephone interviews 1, 3, 6, and 12 months postcessation. The main outcome was repeated point abstinence (ie, abstinence at all four time points). Coping planning and self-efficacy were measured at baseline and at the end of the preparation phase (ie, after 2 weeks of treatment, but prior to cessation day). A total of 290 participants received either the HE intervention (n=144) or the control booklet (n=146). Using intent-to-treat analysis, participants in the intervention group reported clinically and statistically significantly higher repeated point abstinence rates than control participants (20% versus 7%, odds ratio [OR] = 3.43, 95% CI = 1.60-7.34, P = .002). Although no differences were observed at baseline, by the end of the preparation phase, significantly higher levels of coping planning (t(261) = 3.07, P = .002) and precessation self-efficacy (t(261) = 2.63, P = .01) were observed in the intervention group compared with the control group. However, neither coping planning nor self-efficacy mediated long-term treatment effect. For point abstinence 1 month after quitting, however, coping planning and self-efficacy showed a partial mediation of the treatment effect. This 12-month trial documents a long-term treatment effect of a fully automated smoking cessation intervention without the use of nicotine replacement therapy. The study adds to the promise of using digital media in supporting behavior change.

Predictors of Smokeless Tobacco Abstinence

ERIC Educational Resources Information Center

Ebbert, Jon O.; Glover, Elbert D.; Shinozaki, Eri; Schroeder, Darrell R.; Dale, Lowell C.

2008-01-01

Objectives: To investigate predictors of tobacco abstinence among smokeless tobacco (ST) users. Methods: Logistic regression analyses assessed characteristics associated with tobacco abstinence among ST users receiving bupropion SR. Results: Older age was associated with increased tobacco abstinence in both placebo and bupropion SR groups at end…

Factors Associated With Drinking Behavior Among Immigrant Women in Taiwan.

PubMed

Liu, Yi-Chun; Chen, Hung-Hui; Lee, Jia-Fu; Chu, Kuei-Hui; Chien, Li-Yin

2017-04-16

Transnational marriage-based immigrant women in Taiwan have moved to a country where alcohol use is prevalent and they face the challenge of adaptation into a new society, which could influence their drinking behavior. To describe the prevalence of alcohol drinking and examine factors associated with drinking patterns among immigrant women in Taiwan. This study was a cross-sectional questionnaire survey and data were collected from June through November in 2013. Convenience samples of 757 immigrant women were recruited across Taiwan. Alcohol use patterns during the past year were divided into abstinent, low-risk drinking, and hazardous drinking based on the Alcohol Use Disorder Identification Test. Measures included subject characteristics, exposure to cigarettes and alcohol, acculturation level, and perceived stress. The prevalence of drinking during the past year among immigrant women was 29.9% (low-risk drinking 27.6% and hazardous drinking: 2.3%). Multinomial logistic regression showed that women who were employed, who smoked, whose husbands drank, and who interacted with Taiwanese friends frequently were significantly more likely to be in the low-risk drinking group compared with the abstinent group. Women who were divorced/widowed, who had low education levels, who smoked, and whose husbands drank were significantly more likely to be in the hazardous drinking group compared with the abstinent group. More acculturation in immigrant women as indicated by working and frequently interacting with friends in mainstream society was related to low-risk drinking behavior; adversities as indicated by loss of marriage and low education level were related to hazardous drinking behavior.

[Factors Influencing Quality of Life of Alcoholics Anonymous Members in Korea].

PubMed

Yoo, Jae Soon; Lee, Jongeun; Park, Woo Young

2016-04-01

The purpose of this study was to determine quality of life (QOL) related factors in Alcoholics Anonymous (AA) members based on PRECEDE Model. A cross sectional survey was conducted with participants (N =203) from AA meeting in 11 alcohol counsel centers all over South Korea. Data were collected using a specially designed questionnaire based on the PRECEDE model and including QOL, epidemiological factors (including depression and perceived health status), behavioral factors (continuous abstinence and physical health status and practice), predisposing factors (abstinence self-efficacy and self-esteem), reinforcing factors (social capital and family functioning), and enabling factors. Data were analyzed using t-test, one way ANOVA, Tukey HSD test and hierarchical multiple regression analysis with SPSS (ver. 21.0). Of the educational diagnostic variables, self-esteem (β=.23), family functioning (β=.12), abstinence self-efficacy (β=.12) and social capital (β=.11) were strong influential factors in AA members' QOL. In addition, epidemiological diagnostic variables such as depression (β=-.44) and perceived health status (β=.35) were the main factors in QOL. Also, physical health status and practice (β=.106), one of behavioral diagnostic variables was a beneficial factor in QOL. Hierarchical multiple regression analysis showed the determinant variables accounted for 44.0% of the variation in QOL (F=25.76, p<.001). The finding of the study can be used as a framework for planning interventions in order to promote the quality of life of AA members. It is necessary to develop nursing intervention strategies for strengthening educational and epidemiological diagnostic variables in order to improve AA members' QOL.

Decreasing nonmarital births and strengthening marriage to reduce poverty.

PubMed

Amato, Paul R; Maynard, Rebecca A

2007-01-01

Since the 1970s, the share of U.S. children growing up in single-parent families has doubled, a trend that has disproportionately affected disadvantaged families. Paul Amato and Rebecca Maynard argue that reversing that trend would reduce poverty in the short-term and, perhaps more important, improve children's growth and development over the long term, thus reducing the likelihood that they would be poor when they grew up. The authors propose school and community programs to help prevent nonmarital births. They also propose to lower divorce rates by offering more educational programs to couples before and during marriage. Amato and Maynard recommend that all school systems offer health and sex education whose primary message is that parenthood is highly problematic for unmarried youth. They also recommend educating young people about methods to prevent unintended pregnancies. Ideally, the federal government would provide tested curriculum models that emphasize both abstinence and use of contraception. All youth should understand that unintended pregnancies are preventable and have enormous costs for the mother, the father, the child, and society. Strengthening marriage, argue the authors, is also potentially an effective strategy for fighting poverty. Researchers consistently find that premarital education improves marital quality and lowers the risk of divorce. About 40 percent of couples about to marry now participate in premarital education. Amato and Maynard recommend doubling that figure to 80 percent and making similar programs available for married couples. Increasing the number of couples receiving services could mean roughly 72,000 fewer divorces each year, or around 65,000 fewer children entering a single-parent family every year because of marital dissolution. After seven or eight years, half a million fewer children would have entered single-parent families through divorce. Efforts to decrease the share of children in single-parent households, say the authors, would almost certainly be cost effective in the long run and could reduce child poverty by 20 to 29 percent.

A Contingency Management Method for 30-Days Abstinence in Non-Treatment Seeking Young Adult Cannabis Users*

PubMed Central

Schuster, Randi Melissa; Hanly, Ailish; Gilman, Jodi; Budney, Alan; Vandrey, Ryan; Evins, A. Eden

2016-01-01

Background Rates of young adult cannabis use are rising, perceived harm is at its historical nadir, and most users do not want to quit. Most studies evaluating effects of cannabis use in young adults are cross-sectional, limiting causal inference. A method to reliably induce abstinence periods in cannabis users would allow assessment of the effects of abstinence and resumption of use on a variety of outcomes in a within subjects, repeated measure design. Methods We examined the efficacy and feasibility of a voucher-based contingency management procedure for incentivizing one month of continuous cannabis abstinence among young adults who reported at least weekly cannabis use, volunteered to participate in a laboratory study, and did not express desire to discontinue cannabis use long-term. Continuous cannabis abstinence was reinforced with an escalating incentive schedule, and self-report of abstinence was confirmed by frequent quantitative assays of urine cannabis metabolite (THCCOOH) concentration. New cannabis use during the abstinence period was determined using an established algorithm of change in creatinine-adjusted cannabis metabolite concentration between study visits. Results Thirty-eight young adults, aged 18–25, enrolled and 34 (89.5%) attained biochemically confirmed 30-day abstinence. Among those who attained abstinence, 93.9% resumed regular use within two-weeks of incentive discontinuation. Conclusion Findings support the feasibility and efficacy of contingency management to elicit short-term, continuous cannabis abstinence among young adult, non-treatment-seeking, regular cannabis users. Further work should test the effectiveness of this CM procedure for cannabis abstinence periods longer than one month, which may be required to evaluate some effects of abstinence. PMID:27590742

Effect of the Novel Positive Allosteric Modulator of Metabotropic Glutamate Receptor 2 AZD8529 on Incubation of Methamphetamine Craving After Prolonged Voluntary Abstinence in a Rat Model.

PubMed

Caprioli, Daniele; Venniro, Marco; Zeric, Tamara; Li, Xuan; Adhikary, Sweta; Madangopal, Rajtarun; Marchant, Nathan J; Lucantonio, Federica; Schoenbaum, Geoffrey; Bossert, Jennifer M; Shaham, Yavin

2015-10-01

Cue-induced methamphetamine craving increases after prolonged forced (experimenter-imposed) abstinence from the drug (incubation of methamphetamine craving). Here, we determined whether this incubation phenomenon would occur under conditions that promote voluntary (self-imposed) abstinence. We also determined the effect of the novel metabotropic glutamate receptor 2 positive allosteric modulator, AZD8529, on incubation of methamphetamine craving after forced or voluntary abstinence. We trained rats to self-administer palatable food (6 sessions) and then to self-administer methamphetamine under two conditions: 12 sessions (9 hours/day) or 50 sessions (3 hours/day). We then assessed cue-induced methamphetamine seeking in extinction tests after 1 or 21 abstinence days. Between tests, the rats underwent either forced abstinence (no access to the food- or drug-paired levers) or voluntary abstinence (achieved via a discrete choice procedure between methamphetamine and palatable food; 20 trials per day) for 19 days. We also determined the effect of subcutaneous injections of AZD8529 (20 and 40 mg/kg) on cue-induced methamphetamine seeking 1 day or 21 days after forced or voluntary abstinence. Under both training and abstinence conditions, cue-induced methamphetamine seeking in the extinction tests was higher after 21 abstinence days than after 1 day (incubation of methamphetamine craving). AZD8529 decreased cue-induced methamphetamine seeking on day 21 but not day 1 of forced or voluntary abstinence. We introduce a novel animal model to study incubation of drug craving and cue-induced drug seeking after prolonged voluntary abstinence, mimicking the human condition of relapse after successful contingency management treatment. Our data suggest that positive allosteric modulators of metabotropic glutamate receptor 2 should be considered for relapse prevention. Published by Elsevier Inc.

12-h abstinence-induced functional connectivity density changes and craving in young smokers: a resting-state study.

PubMed

Zhao, Shuzhi; Li, Yangding; Li, Min; Wang, Ruonan; Bi, Yanzhi; Zhang, Yajuan; Lu, Xiaoqi; Yu, Dahua; Yang, Likun; Yuan, Kai

2018-06-20

Studying the neural correlates of craving to smoke is of great importance to improve treatment outcomes in smoking addiction. According to previous studies, the critical roles of striatum and frontal brain regions had been revealed in addiction. However, few studies focused on the hub of brain regions in the 12 h abstinence induced craving in young smokers. Thirty-one young male smokers were enrolled in the present study. A within-subject experiment design was carried out to compare functional connectivity density between 12-h smoking abstinence and smoking satiety conditions during resting state in young adult smokers by using functional connectivity density mapping (FCDM). Then, the functional connectivity density changes during smoking abstinence versus satiety were further used to examine correlations with abstinence-induced changes in subjective craving. We found young adult smokers in abstinence state (vs satiety) had higher local functional connectivity density (lFCD) and global functional connectivity density (gFCD) in brain regions including striatal subregions (i.e., bilateral caudate and putamen), frontal regions (i.e., anterior cingulate cortex (ACC) and orbital frontal cortex (OFC)) and bilateral insula. We also found higher lFCD during smoking abstinence (vs satiety) in bilateral thalamus. Additionally, the lFCD changes of the left ACC, bilateral caudate and right OFC were positively correlated with the changes in craving induced by abstinence (i.e., abstinence minus satiety) in young adult smokers. The present findings improve the understanding of the effects of acute smoking abstinence on the hubs of brain gray matter in the abstinence-induces craving and may contribute new insights into the neural mechanism of abstinence-induced craving in young smokers in smoking addiction.

A contingency management method for 30-days abstinence in non-treatment seeking young adult cannabis users.

PubMed

Schuster, Randi Melissa; Hanly, Ailish; Gilman, Jodi; Budney, Alan; Vandrey, Ryan; Evins, A Eden

2016-10-01

Rates of young adult cannabis use are rising, perceived harm is at its historical nadir, and most users do not want to quit. Most studies evaluating effects of cannabis use in young adults are cross-sectional, limiting causal inference. A method to reliably induce abstinence periods in cannabis users would allow assessment of the effects of abstinence and resumption of use on a variety of outcomes in a within-subjects, repeated measures design. We examined the efficacy and feasibility of a voucher-based contingency management procedure for incentivizing one month of continuous cannabis abstinence among young adults who reported at least weekly cannabis use, volunteered to participate in a laboratory study, and did not express a desire to discontinue cannabis use long-term. Continuous cannabis abstinence was reinforced with an escalating incentive schedule, and self-report of abstinence was confirmed by frequent quantitative assays of urine cannabis metabolite (THCCOOH) concentration. New cannabis use during the abstinence period was determined using an established algorithm of change in creatinine-adjusted cannabis metabolite concentrations between study visits. Thirty-eight young adults, aged 18-25 years, enrolled and 34 (89.5%) attained biochemically confirmed 30-day abstinence. Among those who attained abstinence, 93.9% resumed regular use within two-weeks of incentive discontinuation. Findings support the feasibility and efficacy of contingency management to elicit short-term, continuous cannabis abstinence among young adult, non-treatment seeking, regular cannabis users. Further work should test the effectiveness of this contingency management procedure for cannabis abstinence in periods longer than one month, which may be required to evaluate some effects of abstinence. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Implementation of Cognitive-Behavioral Substance Abuse Treatment in Sub-Saharan Africa: Treatment Engagement and Abstinence at Treatment Exit.

PubMed

Gouse, Hetta; Magidson, Jessica F; Burnhams, Warren; Remmert, Jocelyn E; Myers, Bronwyn; Joska, John A; Carrico, Adam W

2016-01-01

This study documented the treatment cascade for engagement in care and abstinence at treatment exit as well as examined correlates of these outcomes for the first certified Matrix Model® substance abuse treatment site in Sub-Saharan Africa. This retrospective chart review conducted at a resource-limited community clinic in Cape Town, South Africa, assessed treatment readiness and substance use severity at treatment entry as correlates of the number of sessions attended and biologically confirmed abstinence at treatment exit among 986 clients who initiated treatment from 2009-2014. Sociodemographic and clinical correlates of treatment outcomes were examined using logistic regression, modeling treatment completion and abstinence at treatment exit separately. Of the 2,233 clients who completed screening, approximately 44% (n = 986) initiated treatment. Among those who initiated treatment, 45% completed at least four group sessions, 30% completed early recovery skills training (i.e., at least eight group sessions), and 13% completed the full 16-week program. Approximately half (54%) of clients who provided a urine sample had negative urine toxicology results for any substance at treatment exit. Higher motivation at treatment entry was independently associated with greater odds of treatment completion and negative urine toxicology results at treatment exit. Findings provide initial support for the successful implementation the Matrix Model in a resource-limited setting. Motivational enhancement interventions could support treatment initiation, promote sustained engagement in treatment, and achieve better treatment outcomes.

Alcohol expectancies pre-and post-alcohol use disorder treatment: Clinical implications.

PubMed

Coates, Jason M; Gullo, Matthew J; Feeney, Gerald F X; Young, Ross McD; Dingle, Genevieve A; Connor, Jason P

2018-05-01

Modification of elevated positive expectations of alcohol consumption (alcohol outcome expectancies; AOEs) is a key feature of Cognitive Behaviour Therapy (CBT) approaches to Alcohol Use Disorders (AUDs). Despite extensive research supporting the efficacy of CBT for AUD, few studies have examined AOE change. This study aimed to assess AOE change following completion of CBT for AUD and its association with drinking behaviour. One-hundred and seventy-five patients who completed a 12-week CBT program for AUD were administered the Drinking Expectancy Questionnaire (DEQ) at pre-treatment assessment and upon completion of treatment. Abstinence was achieved by 108 (61.7%) of completing patients. For patients who lapsed, the mean proportion of abstinent days was 93%. DEQ scales assessing expectations of positive alcohol effects on tension reduction, assertiveness, and cognitive enhancement were significantly lower post-treatment (p<0.001). Expectations of negative effects on mood were higher post-treatment (p<0.001). The largest AOE change occurred on the tension reduction scale. Greater percentage of abstinent days over treatment was associated with lower pre-and post-treatment tension reduction expectancy scores (p<0.05). Drinking during treatment was associated with smaller changes in expectations of negative effects of alcohol on mood (p<0.05). Individuals who completed CBT treatment for AUD showed significant AOE change. Tension reduction and affective change expectancies may be particularly important for abstinence and useful markers of lapse risk. Copyright © 2018 Elsevier Ltd. All rights reserved.

Partnering with public schools: a resident-driven reproductive health education initiative.

PubMed

Kuo, Kelly; Zhu, Tao Y; Raidoo, Shandhini; Zhao, Lulu X; Sammarco, Anne; Ashby, Karen

2014-02-01

To assess the impact of a resident-driven sexual health educational initiative in an inner-city Cleveland middle school. 10 resident physicians and 57 students in 7(th) and 8(th) grade participated in this prospective cohort study. Residents taught 3 sessions on the topics of basic anatomy and physiology, pregnancy, sexually transmitted infections (STI), contraception, and safe relationships. Outcome measures included the percentages of students able to name at least 3 different STIs and contraceptive methods; to name potential complications of STIs; and to correctly identify condoms and abstinence as the only contraceptive methods also protective against STI transmission. Significant improvements were noted in students' baseline knowledge of human anatomy, contraception, and safe sex practices after completion of the curriculum. The percentage of students able to name at least 3 forms of birth control increased from 1.7% to 70.7% (P < .0001). The percentage able to name at least 3 different STIs increased from 5.3% to 72.4% (P < .0001). Follow-up testing 4 months after completion of the curriculum demonstrated significant knowledge retention. All residents and medical students surveyed described a perceived need for comprehensive-rather than abstinence-based-reproductive health education in schools. The socioeconomic burden of teen pregnancy justifies comprehensive efforts to improve reproductive health education. Copyright © 2014 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Decreased cerebral blood flow of the right anterior cingulate cortex in long-term and short-term abstinent methamphetamine users.

PubMed

Hwang, Jaeuk; Lyoo, In Kyoon; Kim, Seog Ju; Sung, Young Hoon; Bae, Soojeong; Cho, Sung-Nam; Lee, Ho Young; Lee, Dong Soo; Renshaw, Perry F

2006-04-28

The aim of the current study was to explore changes of relative regional cerebral blood flow (rCBF) in short-term and long-term abstinent methamphetamine (MA) users. Relative rCBF in 40 abstinent MA users and 23 healthy comparison subjects was compared by the technetium-99m-hexamethyl-propylene amine oxime ((99m)Tc-HMPAO) single photon emission computed tomography (SPECT). Relative rCBF in areas that were found to differ significantly was also compared in groups of MA users with short-term (<6 months) and long-term (>or=6 months) abstinence. MA users showed decreased relative rCBF in the right anterior cingulate cortex (Brodmann area 32) relative to healthy comparison subjects. Long-term abstinent MA users had significantly greater rCBF than short-term abstinent MA users. We report that abstinent MA users have decreased rCBF in the anterior cingulate cortex with smaller relative decreases in subjects with prolonged abstinence.

Quasi-experimental evaluation of a national primary school HIV intervention in Kenya.

PubMed

Maticka-Tyndale, Eleanor; Wildish, Janet; Gichuru, Mary

2007-05-01

This study examined the impact of a primary-school HIV education initiative on the knowledge, self-efficacy and sexual and condom use activities of upper primary-school pupils in Kenya. A quasi-experimental mixed qualitative-quantitative pre- and 18-month post-design using 40 intervention and 40 matched control schools demonstrated significant program impact on targeted objectives of (1) adequate program delivery and, for standard 6 and 7 pupils (ages 11-16 years), (2) increased HIV-related knowledge; (3) increased communication with parents and teachers about HIV and sexuality; (4) increased assistance to fellow pupils to avoid sexual activity; (5) increased self-efficacy related to abstinence and condom use; (6) decreased exposure to HIV through delayed first intercourse, decreased sexual activity and increased condom. Results support the conclusions that the existing infrastructure is adequate for national roll-out of the program; that the program has its most beneficial effect on sexually inexperienced youth and should therefore be implemented with the youngest age groups possible; and that gains are gender specific, with boys reporting increased condom use while girls are more likely to decrease or delay sexual activity. Based on these results, the program began national roll-out to all primary schools in 2005. By June 2006, the program was operating in 11,000 of the country's nearly 19,000 schools.

A Contingency Management Intervention for Adolescent Marijuana Abuse and Conduct Problems.

ERIC Educational Resources Information Center

Kamon, Jody; Budney, Alan; Stanger, Catherine

2005-01-01

Objective: To describe an innovative treatment for adolescent marijuana abuse and provide initial information about its feasibility, acceptability, and potential efficacy. Method: Provided an intervention composed of (1) a clinic-administered, abstinence-based incentive program; (2) parent-directed contingency management targeting substance use…

Web-Based Aftercare for Women With Bulimia Nervosa Following Inpatient Treatment: Randomized Controlled Efficacy Trial.

PubMed

Jacobi, Corinna; Beintner, Ina; Fittig, Eike; Trockel, Mickey; Braks, Karsten; Schade-Brittinger, Carmen; Dempfle, Astrid

2017-09-22

Relapse rates in bulimia nervosa (BN) are high even after successful treatment, but patients often hesitate to take up further treatment. An easily accessible program might help maintain treatment gains. Encouraged by the effects of Web-based eating disorder prevention programs, we developed a manualized, Web-based aftercare program (IN@) for women with BN following inpatient treatment. The objective of this study was to determine the efficacy of the web-based guided, 9-month, cognitive-behavioral aftercare program IN@ for women with BN following inpatient treatment. We conducted a randomized controlled efficacy trial in 253 women with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) BN and compared the results of IN@ with treatment as usual (TAU). Assessments were carried out at hospital admission (T0), hospital discharge/baseline (T1), postintervention (T2; 9 months after baseline), 9-month follow-up (T3; 18 months after baseline). The primary outcome, abstinence from binge eating and compensatory behaviors during the 2 months preceding T2, was analyzed by intention to treat, using logistic regression analyses. Frequencies of binge eating and vomiting episodes, and episodes of all compensatory behaviors were analyzed using mixed effects models. At T2, data from 167 women were available. There were no significant differences in abstinence rates between the TAU group (n=24, 18.9%) and the IN@ group (n=27, 21.4%; odds ratio, OR=1.29; P=.44). The frequency of vomiting episodes in the IN@ group was significantly (46%) lower than in the TAU group (P=.003). Moderator analyses revealed that both at T2 and T3, women of the intervention group who still reported binge eating and compensatory behaviors after inpatient treatment benefited from IN@, whereas women who were already abstinent after the inpatient treatment did not (P=.004; P=.002). Additional treatment utilization was high in both groups between baseline and follow-up. Overall, data from this study suggest moderate effects of IN@. High rates of outpatient treatment utilization after inpatient treatment may have obscured potential intervention effects on abstinence. An aftercare intervention might be more beneficial as part of a stepped-care approach. International Standard Randomized Controlled Trial Number (ISRCTN): 08870215; http://www.isrctn.com/ISRCTN08870215 (Archived by WebCite at http://www.webcitation.org/6soA5bIit). ©Corinna Jacobi, Ina Beintner, Eike Fittig, Mickey Trockel, Karsten Braks, Carmen Schade-Brittinger, Astrid Dempfle. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 22.09.2017.

Web-Based Aftercare for Women With Bulimia Nervosa Following Inpatient Treatment: Randomized Controlled Efficacy Trial

PubMed Central

Fittig, Eike; Trockel, Mickey; Braks, Karsten; Schade-Brittinger, Carmen; Dempfle, Astrid

2017-01-01

Background Relapse rates in bulimia nervosa (BN) are high even after successful treatment, but patients often hesitate to take up further treatment. An easily accessible program might help maintain treatment gains. Encouraged by the effects of Web-based eating disorder prevention programs, we developed a manualized, Web-based aftercare program (IN@) for women with BN following inpatient treatment. Objective The objective of this study was to determine the efficacy of the web-based guided, 9-month, cognitive-behavioral aftercare program IN@ for women with BN following inpatient treatment. Methods We conducted a randomized controlled efficacy trial in 253 women with DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) BN and compared the results of IN@ with treatment as usual (TAU). Assessments were carried out at hospital admission (T0), hospital discharge/baseline (T1), postintervention (T2; 9 months after baseline), 9-month follow-up (T3; 18 months after baseline). The primary outcome, abstinence from binge eating and compensatory behaviors during the 2 months preceding T2, was analyzed by intention to treat, using logistic regression analyses. Frequencies of binge eating and vomiting episodes, and episodes of all compensatory behaviors were analyzed using mixed effects models. Results At T2, data from 167 women were available. There were no significant differences in abstinence rates between the TAU group (n=24, 18.9%) and the IN@ group (n=27, 21.4%; odds ratio, OR=1.29; P=.44). The frequency of vomiting episodes in the IN@ group was significantly (46%) lower than in the TAU group (P=.003). Moderator analyses revealed that both at T2 and T3, women of the intervention group who still reported binge eating and compensatory behaviors after inpatient treatment benefited from IN@, whereas women who were already abstinent after the inpatient treatment did not (P=.004; P=.002). Additional treatment utilization was high in both groups between baseline and follow-up. Conclusions Overall, data from this study suggest moderate effects of IN@. High rates of outpatient treatment utilization after inpatient treatment may have obscured potential intervention effects on abstinence. An aftercare intervention might be more beneficial as part of a stepped-care approach. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 08870215; http://www.isrctn.com/ISRCTN08870215 (Archived by WebCite at http://www.webcitation.org/6soA5bIit) PMID:28939544

Sex Ed for Caring Schools: Creating an Ethics-Based Curriculum

ERIC Educational Resources Information Center

Lamb, Sharon

2013-01-01

While arguments for and against teaching abstinence, the use of contraceptives, and sexual identity are becoming more and more polarized, most people agree that students must learn to navigate an increasingly sexual world. "Sex Ed for Caring Schools" presents a curriculum that goes beyond the typical health education most students receive today.…

Effects of an Intensive Depression-Focused Intervention for Smoking Cessation in Pregnancy

ERIC Educational Resources Information Center

Cinciripini, Paul M.; Blalock, Janice A.; Minnix, Jennifer A.; Robinson, Jason D.; Brown, Victoria L.; Lam, Cho; Wetter, David W.; Schreindorfer, Lisa; McCullough, James P., Jr.; Dolan-Mullen, Patricia; Stotts, Angela L.; Karam-Hage, Maher

2010-01-01

Objective: The objective of this study was to evaluate a depression-focused treatment for smoking cessation in pregnant women versus a time and contact health education control. We hypothesized that the depression-focused treatment would lead to improved abstinence and reduced depressive symptoms among women with high levels of depressive…

Heteronormativity in Online Information about Sex: A South Australian Case Study

ERIC Educational Resources Information Center

Riggs, Damien W.

2013-01-01

Whilst sex education in Australia has moved beyond a focus solely on abstinence, it is still in many instances shaped by what Silin refers to as the "silences" that accompany topics considered unspeakable to young people. The present article focuses specifically on one such silence, namely the representation of non-heterosexual…

Pathways to health: a cluster randomized trial of nicotine gum and motivational interviewing for smoking cessation in low-income housing.

PubMed

Okuyemi, Kolawole S; James, Aimee S; Mayo, Matthew S; Nollen, Nicole; Catley, Delwyn; Choi, Won S; Ahluwalia, Jasjit S

2007-02-01

Despite high smoking rates among those living in poverty, few cessation studies are conducted in these populations. This cluster-randomized trial tested nicotine gum plus motivational interviewing (MI) for smoking cessation in 20 low-income housing developments (HDs). Intervention participants (10 HDs, n = 66) received educational materials, 8 weeks of 4 mg nicotine gum, and 5 MI sessions on quitting smoking. Comparison participants (10 HDs, n = 107) received 5 MI sessions and educational materials addressing fruit and vegetable consumption. Participants had a mean age of 46.3 years and were predominantly female (70%) and African American (83%). Biochemically-verified 7-day abstinence rates at 8 weeks were 6.1% and 5.6% in the intervention and comparison arms, respectively (p = ns); and at 26 weeks were 7.6% and 9.3%, respectively (p = ns). Results suggest that nicotine gum plus MI were not effective for smoking cessation in low-income housing. Programs are needed to enhance the effectiveness of pharmacotherapy and counseling in underserved populations.

Breaking the habit: a retrospective analysis of desistance factors among formerly problematic heroin users.

PubMed

Best, David W; Ghufran, Safeena; Day, Ed; Ray, Rajashree; Loaring, Jessica

2008-11-01

The aim of this study was to examine heroin careers among former users to assess desistance factors and explanations for sustained abstinence. The study surveyed 107 former problematic heroin users who have achieved long-term abstinence about their experiences of achieving and sustaining abstinence. The cohort was recruited opportunistically from three sources, drawing heavily on former users working in the addictions field. On average, the group had heroin careers lasting for just under 10 years, punctuated by an average of 2.6 treatment episodes and 3.1 periods of abstinence, and had been heroin abstinent for an average of 10 years at the time of completing the survey. The most commonly expressed reason for finally achieving abstinence was 'tired of the lifestyle' followed by reasons relating to psychological health. In contrast, when asked to explain how abstinence was sustained, clients quoted both social network factors (moving away from drug-using friends and support from non-using friends) and practical factors (accommodation and employment) as well as religious or spiritual factors. Treatment was not mentioned widely either in achieving or sustaining abstinence, in contrast to 12-Step, which was endorsed widely. The study supports a careers perspective for examining heroin careers and indicates that, while achieving abstinence is possible for chronic opiate users, the path to sustained abstinence is complex and often reliant upon external support systems.

Effects of length of abstinence on decision-making and craving in methamphetamine abusers.

PubMed

Wang, Guibin; Shi, Jie; Chen, Na; Xu, Lingzhi; Li, Jiali; Li, Peng; Sun, Yan; Lu, Lin

2013-01-01

The majority of drug abusers are incapable of sustaining abstinence over any length of time. Accumulating evidence has linked intense and involuntary craving, Impulsive decision-making and mood disturbances to risk for relapse. However, little is known about temporal changes of these neuropsychological functions in methamphetamine (METH)-dependent individuals. To investigate the effect of length of abstinence on decision-making, craving (baseline and cue-induced), and emotional state in METH-addicted individuals. In this cross-sectional study, 183 adult METH-dependent patients at an addiction rehabilitation center who were abstinent for 6 days (n = 37), 14 days (n = 33), 1 month (n = 31), 3 months (n = 30), 6 months (n = 26), or 1 year (n = 30) and 39 healthy subjects were administered the Iowa Gambling Task (IGT) to assess decision-making performance. Depression, anxiety, and impulsivity were also examined. One hundred thirty-nine METH abusers who were abstinent for the aforementioned times then underwent a cue session, and subjective and physiological measures were assessed. METH dependent individuals who were abstinent for longer periods of time exhibited better decision-making than those who were abstinent for shorter periods of time. And self-reported emotional symptoms improved with abstinence. METH abusers' ratings of craving decreased with the duration of abstinence, while cue-induced craving increased until 3 months of abstinence and decreased at 6 months and 1 year of abstinence. We present time-dependent alterations in decision-making, emotional state, and the incubation of cue-induced craving in METH-dependent individuals, which might have significant clinical implications for the prevention of relapse.

Attentional Bias to Negative Affect Moderates Negative Affect’s Relationship with Smoking Abstinence

PubMed Central

Etcheverry, Paul E.; Waters, Andrew J.; Lam, Cho; Correa-Fernandez, Virmarie; Vidrine, Jennifer Irvin; Cinciripini, Paul M.; Wetter, David W.

2016-01-01

Objective To examine whether initial orienting (IO) and inability to disengage attention (ITD) from negative affective stimuli moderate the association of negative affect with smoking abstinence during a quit attempt. Methods Data were from a longitudinal cohort study of smoking cessation (N=424). A negative affect modified Stroop was administered one week before and on quit day to measure IO and ITD. Ecological Momentary Assessments were used to create negative affect intercepts and linear slopes for the week before quitting and on quit day. Quit day and long-term abstinence measures were collected. Results Continuation ratio (CR) logit model analyses found significant interactions of pre-quit negative affect slope with pre-quit ITD [OR = .738(.57, .96), p= .02] and quit day negative affect intercept with quit day ITD [OR = .62(.41, 950), p= .03] predicting abstinence. The interaction of pre-quit negative affect intercept and pre-quit IO predicting quit day abstinence was significant [OR = 1.42(1.06, 1.90), p= .02], as was the interaction of quit day negative affect slope and quit day IO predicting long-term abstinence [OR = 1.45(1.02, 2.08), p= .04]. Conclusions The hypothesis that the association of negative affect with smoking abstinence would be moderated by ITD was generally supported. Among individuals with high ITD, negative affect was inversely related to abstinence, but unrelated to abstinence among individuals with lower levels of ITD. Unexpectedly, among individuals with low IO negative affect was inversely related to abstinence, but unrelated to abstinence among individuals with higher levels of ITD. PMID:27505211

Incubation of Methamphetamine but not Heroin Craving After Voluntary Abstinence in Male and Female Rats.

PubMed

Venniro, Marco; Zhang, Michelle; Shaham, Yavin; Caprioli, Daniele

2017-04-01

We recently introduced an animal model of incubation of methamphetamine craving after choice-based voluntary abstinence in male rats. Here we studied the generality of this phenomenon to (1) female rats, and (2) male and female rats with a history of heroin self-administration. We first trained rats to self-administer palatable food pellets for 6 days (6 h per day) for either methamphetamine (0.1 mg/kg/infusion) or heroin (0.1 mg/kg/infusion) for 12 days (6 h/day). We then assessed relapse to drug seeking under extinction conditions after 1 and 21 abstinence days. Between tests, the rats underwent either voluntary abstinence (achieved via a discrete choice procedure between drug and palatable food; 20 trials/day) or home-cage forced abstinence. We found no sex differences in methamphetamine self-administration or in the strong preference for the palatable food over methamphetamine during the choice-based voluntary abstinence. In both sexes, methamphetamine seeking in the relapse tests was higher after 21 days of either voluntary or forced abstinence than after 1 day (incubation of methamphetamine craving). We also found no sex differences in heroin self-administration or the strong preference for the palatable food over heroin during the choice-based voluntary abstinence. However, male and female rats with a history of heroin self-administration showed incubation of heroin craving after forced but not voluntary abstinence. Our results show that incubation of methamphetamine craving after voluntary abstinence generalizes to female rats. Unexpectedly, prolonged voluntary abstinence prevented the emergence of incubation of heroin craving in both sexes.

Attentional bias to negative affect moderates negative affect's relationship with smoking abstinence.

PubMed

Etcheverry, Paul E; Waters, Andrew J; Lam, Cho; Correa-Fernandez, Virmarie; Vidrine, Jennifer Irvin; Cinciripini, Paul M; Wetter, David W

2016-08-01

To examine whether initial orienting (IO) and inability to disengage (ITD) attention from negative affective stimuli moderate the association of negative affect with smoking abstinence during a quit attempt. Data were from a longitudinal cohort study of smoking cessation (N = 424). A negative affect modified Stroop task was administered 1 week before and on quit day to measure IO and ITD. Ecological Momentary Assessments were used to create negative affect intercepts and linear slopes for the week before quitting and on quit day. Quit day and long-term abstinence measures were collected. Continuation ratio logit model analyses found significant interactions for prequit negative affect slope with prequit ITD, odds ratio (OR) = 0.738 (0.57, 0.96), p = .02, and for quit day negative affect intercept with quit day ITD, OR = 0.62 (0.41, 950), p = .03, predicting abstinence. The Prequit Negative Affect Intercept × Prequit IO interaction predicting quit day abstinence was significant, OR = 1.42 (1.06, 1.90), p = .02, as was the Quit Day Negative Affect Slope × Quit Day IO interaction predicting long-term abstinence, OR = 1.45 (1.02, 2.08), p = .04. The hypothesis that the association of negative affect with smoking abstinence would be moderated by ITD was generally supported. Among individuals with high ITD, negative affect was inversely related to abstinence, but unrelated to abstinence among individuals with lower levels of ITD. Unexpectedly, among individuals with low IO, negative affect was inversely related to abstinence, but unrelated to abstinence among individuals with higher levels of ITD. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Smoking Abstinence, Eating Style, and Food Intake.

ERIC Educational Resources Information Center

Duffy, Joanne; Hall, Sharon M.

1988-01-01

Administered the Eating Inventory and the Profile of Mood States (POMS) to smoking subjects assigned to cigarette abstinence or to continued smoking. Found abstinent smokers with high Disinhibition Scale scores overate more than did nonabstinent smokers or abstinent smokers with lower scores when participating in a subsequent ice cream tasting…

Ibudilast may improve attention during early abstinence from methamphetamine.

PubMed

Birath, J Brandon; Briones, Marisa; Amaya, Stephanie; Shoptaw, Steven; Swanson, Aimee-Noelle; Tsuang, John; Furst, Benjamin; Heinzerling, Keith; Obermeit, Lisa; Maes, Lauryn; McKay, Charles; Wright, Matthew J

2017-09-01

Inattention is a deficit related to instilling abstinence from methamphetamine (MA) dependence. This study aimed to determine whether ibudilast (IB; 50mg bid) improves attentional abilities compared to placebo during early abstinence from MA dependence. Attention was assessed in 11 MA-dependent non-treatment seeking participants in a phase IB safety-interaction trial. The Conners' Continuous Performance Test-II (CPT-II), a measure of sustained attention and response inhibition, was administered at baseline and on day 22, 48h post a MA challenge under placebo (P; n=6) or IB 50mg bid (n=5). Group differences were compared using Mann-Whitney U Tests. Groups were similar at baseline in premorbid intellectual functioning, attention deficit hyperactivity symptom scores, impulsivity ratings, and education level, but differed in age. Demographically corrected T-scores for CPT-II performances were utilized. Although no group differences in sustained attention existed at baseline, at follow-up, the IB group (Mdn=44.4) showed reduced variability in response times compared with the P group (Mdn=69.9), U=0.00, z=-2.74, p=.006, r=.83. The IB group (Mdn=45.8) also gave fewer perseverative responses than the P group (Mdn=67.0), U=2.00, z=-2.50, p=.01, r=.75. No other significant differences were observed. Findings suggest that IB may have a protective effect on sustained attention during early abstinence from MA dependence. This may guide thinking about mechanism of action should IB demonstrate efficacy as a treatment for MA dependence. Copyright © 2017 Elsevier B.V. All rights reserved.

Tobacco Cessation Among Low-Income Smokers: Motivational Enhancement and Nicotine Patch Treatment

PubMed Central

2014-01-01

Introduction: Despite decades of tobacco use decline among the general population in the United States, tobacco use among low-income populations continues to be a major public health concern. Smoking rates are higher among individuals with less than a high school education, those with no health insurance, and among individuals living below the federal poverty level. Despite these disparities, smoking cessation treatments for low-income populations have not been extensively tested. In the current study, the efficacy of 2 adjunctive smoking cessation interventions was evaluated among low-income smokers who were seen in a primary care setting. Methods: A total of 846 participants were randomly assigned either to motivational enhancement treatment plus brief physician advice and 8 weeks of nicotine replacement therapy (NRT) or to standard care, which consisted of brief physician advice and 8 weeks of NRT. Tobacco smoking abstinence was at 1, 2, 6, and 12 months following baseline. Results: The use of the nicotine patch, telephone counseling, and positive decisional balance were predictive of increased abstinence rates, and elevated stress levels and temptation to smoke in both social/habit and negative affect situations decreased abstinence rates across time. Analyses showed intervention effects on smoking temptations, length of patch use, and number of telephone contacts. Direct intervention effects on abstinence rates were not significant, after adjusting for model predictors and selection bias due to perirandomization attrition. Conclusions: Integrating therapeutic approaches that promote use of and adherence to medications for quitting smoking and that target stress management and reducing negative affect may enhance smoking cessation among low-income smokers. PMID:24174612

Tobacco cessation among low-income smokers: motivational enhancement and nicotine patch treatment.

PubMed

Bock, Beth C; Papandonatos, George D; de Dios, Marcel A; Abrams, David B; Azam, Munawar M; Fagan, Mark; Sweeney, Patrick J; Stein, Michael D; Niaura, Raymond

2014-04-01

Despite decades of tobacco use decline among the general population in the United States, tobacco use among low-income populations continues to be a major public health concern. Smoking rates are higher among individuals with less than a high school education, those with no health insurance, and among individuals living below the federal poverty level. Despite these disparities, smoking cessation treatments for low-income populations have not been extensively tested. In the current study, the efficacy of 2 adjunctive smoking cessation interventions was evaluated among low-income smokers who were seen in a primary care setting. A total of 846 participants were randomly assigned either to motivational enhancement treatment plus brief physician advice and 8 weeks of nicotine replacement therapy (NRT) or to standard care, which consisted of brief physician advice and 8 weeks of NRT. Tobacco smoking abstinence was at 1, 2, 6, and 12 months following baseline. The use of the nicotine patch, telephone counseling, and positive decisional balance were predictive of increased abstinence rates, and elevated stress levels and temptation to smoke in both social/habit and negative affect situations decreased abstinence rates across time. Analyses showed intervention effects on smoking temptations, length of patch use, and number of telephone contacts. Direct intervention effects on abstinence rates were not significant, after adjusting for model predictors and selection bias due to perirandomization attrition. Integrating therapeutic approaches that promote use of and adherence to medications for quitting smoking and that target stress management and reducing negative affect may enhance smoking cessation among low-income smokers.

Combined Quitline Counseling and Text Messaging for Smoking Cessation: A Quasi-Experimental Evaluation.

PubMed

Boal, Ashley L; Abroms, Lorien C; Simmens, Samuel; Graham, Amanda L; Carpenter, Kelly M

2016-05-01

This study seeks to determine whether comprehensive quitline services combined with text messaging improve smoking cessation rates beyond those achieved by offering comprehensive quitline services alone. The study sample consisted of callers to the Alere Wellbeing, Inc, commercial quitline in 2012. A quasi-experimental design was implemented using propensity score matching to create the intervention and control groups. The intervention group consisted of those who were offered and accepted a text message intervention in addition to usual quitline services, while the control group consisted of those who were not offered the text message intervention. Analyses utilized baseline data collected at intake, program use data (eg, call history and text message use), and reports of smoking behaviors and program satisfaction collected 6 months after intake. Similar rates of 7-day abstinence were reported regardless of whether participants received combined multi-call quitline services plus text messaging (25.3%) or multi-call quitline services in isolation (25.5%), though those who received combined services reported higher treatment satisfaction (P < .05). Among those who received combined services, the number of text messages sent to the text message program predicted 7-day abstinence such that those who sent more text messages were less likely to report 7-day abstinence. Text messaging may not confer additional benefits over and above those received through multi-modal, multi-call quitline programs. Future research should investigate whether text messaging programs improve quit rates when combined with less intensive services such as single-call phone counseling. While the impact of quitline and text messaging services for smoking cessation have been examined in isolation, no study has explored the impact of combined services on smoking outcomes. This study examines the role of text messaging in combination with comprehensive quitline services including multi-call phone counseling, access to an interactive website and nicotine replacement therapy. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

In college and in recovery: Reasons for joining a Collegiate Recovery Program

PubMed Central

Laudet, Alexandre B.; Harris, Kitty; Kimball, Thomas; Winters, Ken C.; Moberg, D. Paul

2016-01-01

Objective Collegiate Recovery Programs (CRPs), a campus-based peer support model for students recovering from substance abuse problems, grew exponentially in the past decade, yet remain unexplored. Methods This mixed methods study examines students’ reasons for CRP enrollment to guide academic institutions and referral sources. Students (N = 486) from the 29 CRPs nationwide operating in 2012 completed an online survey in 2013. Results Students were somewhat older than traditional age (mean age = 26). Now sober for three years (mean), they had experienced severe dependence on multiple substances. One third reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. Top reasons for joining a CRP was the need for same age peer recovery support, and wanting to ‘do college sober’ recognizing that college life challenges sobriety. Conclusions CRPs appear to meet their mission of allowing recovering students to pursue educational goals in ‘an abstinence hostile environment’ and emphasize the need for more institutions to address the support needs of students in recovery. PMID:26731130

Effects of Nicotine Fading and Relapse Prevention on Smoking Cessation.

ERIC Educational Resources Information Center

Brown, Richard A.; And Others

1984-01-01

Conducted a pilot study which combined nicotine-fading and relapse prevention with smokers (N=30) and compared this program to conditions where subjects (N=46) received nicotine-fading or relapse prevention only. Results showed no difference among groups in abstinence or rate at any follow-up point. (LLL)

Social Influences on Abstinence Self-Efficacy among Justice-Involved Persons

PubMed Central

Majer, John M.; Callahan, Sarah; Stevick, Kate; Jason, Leonard A.

2016-01-01

Social influences (social support for alcohol/drug use and social support for abstinence) were examined in relation to abstinence self-efficacy among a sample of 250 justice involved persons exiting inpatient treatment for substance use disorders. Hierarchical linear regression was used to examine social influences in relation to abstinence self-efficacy. Social influences were significantly related to abstinence self-efficacy when examined independently. However, only social support for alcohol/drug use was significant when both social influences were entered into the model. Findings suggest social support for alcohol/drug use compromises abstinence social support, particularly among justice involved persons who are early in their recovery from substance use disorders. PMID:27594810

Assessing God locus of control as a factor in college students' alcohol use and sexual behavior.

PubMed

Moore, Erin W

2014-01-01

This study explored God locus of control beliefs (i.e., God's control over behavior) regarding their influence on alcohol use and sexual behavior as an alternative religiosity measure to religious behaviors, which does not capture perceived influence of religiosity. Additionally, demographic differences in religious beliefs were explored. College students aged 18-24 (N = 324) completed a survey between April 2012 and March 2013. Principal components and multivariate analyses were conducted. Findings suggest that measures provide reliable, valid data from college students. God locus of control is linked to not consuming alcohol or engaging in sex. There were differences regarding relationship status and religious denomination. God locus of control beliefs are an appropriate construct for collecting data about college students' religiosity. Furthermore, health educators at faith-based institutions could incorporate this construct into their programming, encouraging abstinence but also behaving responsibly for those who do drink and are sexually experienced.

The therapeutic workplace to promote treatment engagement and drug abstinence in out-of-treatment injection drug users: a randomized controlled trial.

PubMed

Holtyn, August F; Koffarnus, Mikhail N; DeFulio, Anthony; Sigurdsson, Sigurdur O; Strain, Eric C; Schwartz, Robert P; Leoutsakos, Jeannie-Marie S; Silverman, Kenneth

2014-11-01

Determine if employment-based reinforcement can increase methadone treatment engagement and drug abstinence in out-of-treatment injection drug users. This study was conducted from 2008 to 2012 in a therapeutic workplace in Baltimore, MD. After a 4-week induction, participants (N=98) could work and earn pay for 26 weeks and were randomly assigned to Work Reinforcement, Methadone & Work Reinforcement, and Abstinence, Methadone & Work Reinforcement conditions. Work Reinforcement participants had to work to earn pay. Methadone & Work Reinforcement and Abstinence, Methadone, & Work Reinforcement participants had to enroll in methadone treatment to work and maximize pay. Abstinence, Methadone, & Work Reinforcement participants had to provide opiate- and cocaine-negative urine samples to maximize pay. Most participants (92%) enrolled in methadone treatment during induction. Drug abstinence increased as a graded function of the addition of the methadone and abstinence contingencies. Abstinence, Methadone & Work Reinforcement participants provided significantly more urine samples negative for opiates (75% versus 54%) and cocaine (57% versus 32%) than Work Reinforcement participants. Methadone & Work Reinforcement participants provided significantly more cocaine-negative samples than Work Reinforcement participants (55% versus 32%). The therapeutic workplace can promote drug abstinence in out-of-treatment injection drug users. Clinical trial registration number: NCT01416584. Copyright © 2014 Elsevier Inc. All rights reserved.

The Therapeutic Workplace to Promote Treatment Engagement and Drug Abstinence in Out-of-Treatment Injection Drug Users: A Randomized Controlled Trial

PubMed Central

Holtyn, August F.; Koffarnus, Mikhail N.; DeFulio, Anthony; Sigurdsson, Sigurdur O.; Strain, Eric C.; Schwartz, Robert P.; Leoutsakos, Jeannie-Marie S.; Silverman, Kenneth

2014-01-01

Objective Determine if employment-based reinforcement can increase methadone treatment engagement and drug abstinence in out-of-treatment injection drug users. Method This study was conducted from 2008–2012 in a therapeutic workplace in Baltimore, MD. After a 4-week induction, participants (N=98) could work and earn pay for 26 weeks and were randomly assigned to Work Reinforcement, Methadone & Work Reinforcement, and Abstinence, Methadone & Work Reinforcement conditions. Work Reinforcement participants had to work to earn pay. Methadone & Work Reinforcement, and Abstinence, Methadone, & Work Reinforcement participants had to enroll in methadone treatment to work and maximize pay. Abstinence, Methadone, & Work Reinforcement participants had to provide opiate- and cocaine-negative urine samples to maximize pay. Results Most participants (92%) enrolled in methadone treatment during induction. Drug abstinence increased as a graded function of the addition of the methadone and abstinence contingencies. Abstinence, Methadone & Work Reinforcement participants provided significantly more urine samples negative for opiates (75% versus 54%) and cocaine (57% versus 32%) than Work Reinforcement participants. Methadone & Work Reinforcement participants provided significantly more cocaine-negative samples than Work Reinforcement participants (55% versus 32%). Conclusion The therapeutic workplace can promote drug abstinence in out-of-treatment injection drug users. PMID:24607365

How treatment improvement in ADHD and cocaine dependence are related to one another: A secondary analysis.

PubMed

Levin, Frances R; Choi, C Jean; Pavlicova, Martina; Mariani, John J; Mahony, Amy; Brooks, Daniel J; Nunes, Edward V; Grabowski, John

2018-05-01

Attention-deficit hyperactivity disorder (ADHD) is overrepresented among individuals seeking treatment for substance use disorders. We previously reported that treatment with extended release mixed amphetamine salts (MAS-XR) increased abstinence, compared to placebo, among patients with co-occurring ADHD and cocaine dependence. This secondary analysis investigates the temporal relationship between ADHD improvement and cocaine abstinence in the first six weeks of the trial. The study was a three-arm, randomized, double-blinded, placebo-controlled, 14-week trial comparing MAS-XR (60 mg or 80 mg daily) versus placebo among 126 participants with ADHD and cocaine dependence. An autoregressive cross-lagged structural equation model was fit and evaluated weekly ADHD improvement (defined as ≥30% reduction in the Adult ADHD Investigator Symptom Rating Scale) and urine-confirmed abstinence over the first six weeks. The proportion of patients with each of the possible overall patterns of response was: ADHD improves before cocaine abstinence: 24%; Cocaine abstinence occurs before ADHD improvement: 12%; ADHD improvement and abstinence occur during the same week: 6%; ADHD improves but abstinence never achieved: 34%; Abstinence achieved but ADHD never improves: 6%; Neither ADHD improvement nor abstinence: 18%. A significant cross-lagged association was found; subjects with ADHD improvement at week 2 had significantly higher odds of cocaine abstinence at week 3 (p = .014). When treating co-occurring ADHD and cocaine dependence with stimulant medication, abstinence is most likely preceded by improvement in ADHD, which tends to occur early with medication treatment. Other observed temporal patterns suggest the potential complexity of the relationship between ADHD and cocaine dependence. Copyright © 2018. Published by Elsevier B.V.

Contingency management improves smoking cessation treatment outcomes among highly impulsive adolescent smokers relative to cognitive behavioral therapy.

PubMed

Morean, Meghan E; Kong, Grace; Camenga, Deepa R; Cavallo, Dana A; Carroll, Kathleen M; Pittman, Brian; Krishnan-Sarin, Suchitra

2015-03-01

Impulsive adolescents have difficulty quitting smoking. We examined if treatments that provide behavioral incentives for abstinence improve treatment outcomes among impulsive adolescent smokers, who have been shown to be highly sensitive to reward. We ran secondary data analyses on 64 teen smokers (mean age=16.36 [1.44]; cigarettes/day=13.97 [6.61]; 53.1% female; 90.6% Caucasian) who completed a four-week smoking cessation trial to determine whether impulsive adolescents differentially benefit from receiving cognitive behavioral therapy (CBT), contingency management (CM), or the combination of the two (CM/CBT). Indices of treatment efficacy included self-report percent days abstinent and end of treatment biochemically-confirmed 7-day point prevalence abstinence (EOT abstinence). We assessed self-reported impulsivity using the Brief Barratt Impulsiveness Scale. We used univariate Generalized Linear Modeling to examine main effects and interactions of impulsivity and treatment condition as predictors of self-reported abstinence, and exact logistic regression to examine EOT abstinence. CM/CBT and CM were comparably effective in promoting abstinence, so analyses were conducted comparing the efficacy of CBT to treatments with a CM component (i.e., CM and CM/CBT). CBT and deficient self-regulation predicted lower self-reported abstinence rates within the total analytic sample. Treatments containing CM were more effective than CBT in predicting 1) self-reported abstinence among behaviorally impulsive adolescents (% days abstinent: CM 77%; CM/CBT 81%; CBT 30%) and 2) EOT point prevalence abstinence among behaviorally impulsive adolescents and adolescents with significant deficits in self-regulation. CM-based interventions may improve the low smoking cessation rates previously observed among impulsive adolescent smokers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Plasma concentrations of oleoylethanolamide and other acylethanolamides are altered in alcohol-dependent patients: effect of length of abstinence.

PubMed

Garcia-Marchena, Nuria; Pavon, Francisco J; Pastor, Antoni; Araos, Pedro; Pedraz, Maria; Romero-Sanchiz, Pablo; Calado, Montserrat; Suarez, Juan; Castilla-Ortega, Estela; Orio, Laura; Boronat, Anna; Torrens, Marta; Rubio, Gabriel; de la Torre, Rafael; Rodriguez de Fonseca, Fernando; Serrano, Antonia

2017-09-01

Acylethanolamides are a family of endogenous lipid mediators that are involved in physiological and behavioral processes associated with addiction. Recently, oleoylethanolamide (OEA) has been reported to reduce alcohol intake and relapse in rodents but the contribution of OEA and other acylethanolamides in alcohol addiction in humans is unknown. The present study is aimed to characterize the plasma acylethanolamides in alcohol dependence. Seventy-nine abstinent alcohol-dependent subjects (27 women) recruited from outpatient treatment programs and age-/sex-/body mass-matched healthy volunteers (28 women) were clinically assessed with the diagnostic interview PRISM according to the DSM-IV-TR after blood extraction for quantification of acylethanolamide concentrations in the plasma. Our results indicate that all acylethanolamides were significantly increased in alcohol-dependent patients compared with control subjects (p < 0.001). A logistic model based on these acylethanolamides was developed to distinguish alcohol-dependent patients from controls and included OEA, arachidonoylethanolamide (AEA) and docosatetraenoylethanolamide (DEA), providing a high discriminatory power according to area under the curve [AUC = 0.92 (95%CI: 0.87-0.96), p < 0.001]. Additionally, we found a significant effect of the duration of alcohol abstinence on the concentrations of OEA, AEA and DEA using a regression model (p < 0.05, p < 0.01 and p < 0.001, respectively), which was confirmed by a negative correlation (rho = -0.31, -0.40 and -0.44, respectively). However, acylethanolamides were not influenced by the addiction alcohol severity, duration of problematic alcohol use or diagnosis of psychiatric comorbidity. Our results support the preclinical studies and suggest that OEA, AEA and DEA are altered in alcohol-dependence during abstinence and that might act as potential markers for predicting length of alcohol abstinence. © 2016 Society for the Study of Addiction.

Daily nicotine patch wear time predicts smoking abstinence in socioeconomically disadvantaged adults: An analysis of ecological momentary assessment data.

PubMed

Ma, Ping; Kendzor, Darla E; Poonawalla, Insiya B; Balis, David S; Businelle, Michael S

2016-12-01

Individuals who use the nicotine patch are more likely to quit smoking than those who receive placebo or no medication. However, studies have not yet examined the association between actual daily nicotine patch wear time during the early phase of a smoking cessation attempt and later smoking abstinence. The purpose of this study was to address this gap in the literature. Participants who enrolled in a safety-net hospital smoking cessation program were followed for 13 weeks (i.e., 1 week pre-quit through 12 weeks post-quit). Participants completed in-person assessments and daily ecological momentary assessments on study provided smartphones. Multivariate logistic regressions were used to determine if daily patch wear time during the first week post-quit predicted 7-day biochemically verified point prevalence smoking abstinence 4 and 12 weeks following the scheduled quit date. Demographic characteristics and smoking behaviors were adjusted as covariates. Participants (N=74) were primarily non-White (78.7%) and most (86%) had an annual household income of <$20,000. Greater average hours of daily nicotine patch wear time during the first week post-quit was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=2.22, 95% CI:1.17-4.23; aOR=2.24, 95% CI:1.00-5.03). Furthermore, more days of wearing the patch for ≥19h was associated with a greater likelihood of abstinence at the 4 and 12 week post-quit visits (aOR=1.81, 95% CI:1.01-3.22; aOR=2.18, 95% CI:1.03-4.63). Greater adherence to the nicotine patch early in a quit attempt may increase the likelihood of smoking cessation among socioeconomically disadvantaged adults. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Interventions to prevent HIV/AIDS among adolescents in less developed countries: are they effective?

PubMed

Magnussen, Lesley; Ehiri, John E; Ejere, Henry O D; Jolly, Pauline E

2004-01-01

The objective of this study was to summarize and critically assess the effects of interventions to prevent HIV/AIDS among adolescents in less developed countries. Reports of studies that evaluated interventions for preventing HIV/AIDS/STDs among persons aged 11-25 years were obtained from online computer databases, by searching conference proceedings and relevant journals, and by following up references cited in published reports. Studies were included if they investigated any educational, behavioral, psychosocial or other intervention that aimed to prevent or reduce HIV/AIDS/STD among persons aged 11-25 years in a less developed country. Only studies that included a control group, and which involved pre- and post-intervention assessments were included. Outcome measures included: (i) changes in safe sex practices (abstinence, condom use, limitation of sexual partners, avoidance of casual sex), (ii) knowledge about HIV/AIDS transmission and prevention methods, (iii) perception of HIV/AIDS/STD risks, (iv) self-efficacy with regard to condom negotiation and refusal of sex, (v) uptake of voluntary counseling and testing (VCT), and (vi) reduction in incidence of HIV/AIDS/STDs. Studies were assessed in terms of intervention format (e.g., education, role-play, video), duration, and setting (school or community). Reported improvements in outcome measures in intervention versus control groups were assessed. Sixteen studies met the inclusion criteria. Thirteen of these were conducted in Africa and three in Latin America. Twelve of the sixteen studies were school-based, and four were community-based. The interventions reviewed were not resoundingly successful in achieving their goals of increasing knowledge of HIV/AIDS, altering attitudes, improving negotiation and communication skills, or in influencing positive behavior evidenced through consistent condom use, abstinence, or reducing the number of partners. Considering the importance of HIV/AIDS prevention among adolescents, design of evaluation studies of programs in less developed countries need to be improved. The use of randomized controlled trials or other rigorous approaches for evaluating population-based behavioral interventions (e.g., Solomon Four design) is recommended.

Nicotine and Nicotine Abstinence Do Not Interfere with GABAA Receptor Neuroadaptations During Alcohol Abstinence.

PubMed

Hillmer, Ansel T; Kloczynski, Tracy; Sandiego, Christine M; Pittman, Brian; Anderson, Jon M; Labaree, David; Gao, Hong; Huang, Yiyun; Deluliis, Giuseppe; O'Malley, Stephanie S; Carson, Richard E; Cosgrove, Kelly P

2016-04-01

Alcohol dependence and tobacco smoking are highly comorbid, and treating both conditions simultaneously is controversial. Previously, we showed that tobacco smoking interferes with GABAA receptor neuroadaptations during alcohol withdrawal in humans, while this effect did not occur with continued nicotine use during alcohol abstinence in nonhuman primates. Here, we extend our previous work by measuring GABAA receptor availability with positron emission tomography (PET) during drug abstinence in nonhuman primates exposed to alcohol alone, nicotine and alcohol together, and alcohol abstinence with continued nicotine exposure. Twenty-four adolescent male rhesus macaques orally self-administered alcohol and nicotine, available separately in water and saccharin, over 20 weeks. The groups included alcohol alone (n = 8); nicotine and alcohol with simultaneous abstinence (n = 8); nicotine and alcohol with alcohol abstinence while nicotine was still available (n = 8); and a pilot group of animals consuming nicotine alone (n = 6). Animals were imaged with [(11)C]flumazenil PET to measure binding potential (BPND), an index of GABAA receptor availability. Imaging occurred at baseline (drug-naíve), and following alcohol and/or nicotine cessation at 1 day, 8 days, and 12 weeks of abstinence. Generalized linear mixed models were used to examine the time course of [(11)C]flumazenil BPND during alcohol abstinence across groups. Animals consumed 3.95 ± 1.22 g/kg/d alcohol and 55.4 ± 35.1 mg/kg/d nicotine. No significant group effects were observed in [(11)C]flumazenil BPND during alcohol abstinence; however, a main effect of time was detected. Post hoc analyses indicated that all groups abstaining from alcohol exhibited significantly increased GABAA receptor availability at 1 day and 8 days (but not 12 weeks) of abstinence relative to baseline, while no changes in [(11)C]flumazenil BPND during nicotine abstinence alone were observed. These data indicate that neither nicotine nor nicotine abstinence interferes with GABAA receptor neuroadaptations during alcohol withdrawal. This conclusion is consistent with our previous study and does not contradict the use of nicotine replacement therapies or non-nicotinic-acting pharmaceuticals to quit smoking during alcohol withdrawal from a GABAergic perspective. Copyright © 2016 by the Research Society on Alcoholism.

Factors associated with smoking cessation

PubMed Central

França, Samires Avelino de Souza; Neves, Ana Ligian Feitosa das; de Souza, Tatiane Andressa Santos; Martins, Nandara Celana Negreiros; Carneiro, Saul Rassy; Sarges, Edilene do Socorro Nascimento Falcão; de Souza, Maria de Fátima Amine Houat

2015-01-01

OBJECTIVE To analyze the prevalence and factors associated with smoking abstinence among patients who were treated in a reference unit for smoking cessation. METHODS This cross-sectional study examined the medical records of 532 patients treated in a reference unit for smoking cessation in Belém, PA, Northern Brazil, between January 2010 and June 2012. Sociodemographic variables and those related to smoking history and treatment were analyzed. Statistical significance was set at p < 0.05. RESULTS The mean age of the participants was 50 years; 57.0% of the patients were women. The mean tobacco load was 30 packs/year, and the mean smoking duration was approximately 32 years. Most patients remained in treatment for four months. The rate of smoking abstinence was 75.0%. Regression analysis indicated that maintenance therapy, absence of relapse triggers, and lower chemical dependence were significantly associated with smoking cessation. CONCLUSIONS The smoking abstinence rate observed was 75.0%. The cessation process was associated with several aspects, including the degree of chemical dependence, symptoms of withdrawal, and period of patient follow-up in a multidisciplinary treatment program. Studies of this nature contribute to the collection of consistent epidemiological data and are essential for the implementation of effective smoking prevention and cessation strategies. PMID:25741649

Exercise counseling to enhance smoking cessation outcomes: the Fit2Quit randomized controlled trial.

PubMed

Maddison, Ralph; Roberts, Vaughan; McRobbie, Hayden; Bullen, Christopher; Prapavessis, Harry; Glover, Marewa; Jiang, Yannan; Brown, Paul; Leung, William; Taylor, Sue; Tsai, Midi

2014-10-01

Regular exercise has been proposed as a potential smoking cessation aid. This study aimed to determine the effects of an exercise counseling program on cigarette smoking abstinence at 24 weeks. A parallel, two-arm, randomized controlled trial was conducted. Adult cigarette smokers (n = 906) who were insufficiently active and interested in quitting were randomized to receive the Fit2Quit intervention (10 exercise telephone counseling sessions over 6 months) plus usual care (behavioral counseling and nicotine replacement therapy) or usual care alone. There were no significant group differences in 7-day point-prevalence and continuous abstinence at 6 months. The more intervention calls successfully delivered, the lower the probability of smoking (OR, 0.88; 95 % CI 0.81-0.97, p = 0.01) in the intervention group. A significant difference was observed for leisure time physical activity (difference = 219.11 MET-minutes/week; 95 % CI 52.65-385.58; p = 0.01). Telephone-delivered exercise counseling may not be sufficient to improve smoking abstinence rates over and above existing smoking cessation services. (Australasian Clinical Trials Registry Number: ACTRN12609000637246.).

Bupropion for Smoking Cessation in African American Light Smokers: A Randomized Controlled Trial

PubMed Central

Nollen, Nicole L.; Mayo, Matthew S.; Choi, Won S.; Faseru, Babalola; Benowitz, Neal L.; Tyndale, Rachel F.; Okuyemi, Kolawole S.; Ahluwalia, Jasjit S.

2012-01-01

Background Previous research demonstrated the efficacy of sustained release bupropion (bupropion SR) for smoking cessation in whites as well as moderate to heavy (≥10 cigarettes per day [CPD]) African American smokers. We evaluated whether bupropion SR was effective for smoking cessation among African American light smokers (≤10 CPD). Methods A randomized, double-blind placebo-controlled trial was conducted from December 27, 2007, to May 13, 2010. All participants were African American light smokers (≤10 CPD), aged 18 years or older. Participants were randomly assigned to receive 300 mg bupropion SR (150 mg once daily for 3 days and then 150 mg twice daily) (n = 270 participants) or placebo (n = 270 participants) for 7 weeks, and up to six sessions of health education counseling. Serum cotinine was measured at baseline (week 0). The primary outcome was salivary cotinine–verified 7-day point prevalence smoking abstinence at week 26; a cut point of 15 ng/mL differentiated smokers from nonsmokers. Salivary cotinine–verified smoking abstinence at end of medication treatment at week 7 was also examined. Odds ratios (OR) for smoking abstinence and 95% confidence intervals (CIs) were calculated using logistic regression models. All statistical tests were two-sided. Results Participants at baseline visit (week 0) smoked an average of 8.0 CPD and had a mean serum cotinine level of 275.8 ng/mL (SD = 155.8 ng/mL); most used menthol cigarettes (83.7%) and smoked within 30 minutes of waking (72.2%). After imputing those lost to follow-up as smokers, no statistically significant difference in long-term smoking abstinence rates at week 26 was observed between bupropion SR and placebo groups (13.3% vs 10.0%, OR = 1.39, 95% CI = 0.82 to 2.35, P = .23). Cotinine-verified smoking abstinence rate at end of medication week 7 was higher in the bupropion SR vs placebo group (23.7% vs 9.6%, OR = 2.92, 95% CI = 1.78 to 4.77, P < .001). Conclusions Bupropion SR was effective in promoting smoking cessation during the medication phase of treatment but showed no effect on long-term smoking cessation among African American light smokers. More research is needed to identify strategies for sustaining abstinence among African American light smokers. PMID:22282543

Postpartum Smoking Relapse and Breast Feeding: Defining the Window of Opportunity for Intervention.

PubMed

Logan, Chad A; Rothenbacher, Dietrich; Genuneit, Jon

2017-03-01

Though many women spontaneously quit smoking during pregnancy, a large proportion relapse after delivery. Efforts aimed at reducing postpartum smoking relapse have been largely ineffective. Several studies have reported breast feeding as a primary factor influencing smoking abstinence duration. However, data on the potential role of breast feeding in smoking intervention efforts remain incomplete. The Ulm SPATZ Health Study cohort consists of 1006 newborns of 970 mothers recruited in the University Medical Center Ulm, Germany. Kaplan-Meier plots, log-rank tests, and Cox proportional hazards models were used to assess differences in predominant and total breast-feeding duration stratified by smoking abstinence at 2 years and relapse period (by 6 weeks, 6 months, and 2 years postdelivery). Chi-square and Kruskal-Wallis tests were performed to identify significant differences in demographic and lifestyle factors across smoking categories. Approximately 70% of previous smokers who initiated breast feeding relapsed within 2 years. Relapse by 6 months was significantly associated with noninitiation of predominant breast feeding. Total breast-feeding duration rates among abstaining mothers and those who relapsed after 6 weeks mirrored those of nonsmokers respectively up to 1 year and 3 months. Lower age and education were mostly associated with smoking by 6 weeks. First parity and having a nonsmoking partner were associated with abstinence up to 2 years. Interventions promoting breast feeding to incentivize continued smoking abstinence may be effective prior to weaning. Those promoting breast feeding longer than 6 months and partner smoking cessation may increase rates of long-term smoking abstinence lasting longer than 2 years postdelivery. Most mothers who quit smoking during pregnancy relapse within 6 months of delivery. Though interventions targeting new mothers have been largely unsuccessful, relapse is often delayed until after weaning and targeted breast-feeding promotion has been suggested to enhance smoking cessation interventions. In this study, we assess the relationship between breast-feeding duration and long-term smoking abstinence by longitudinally investigating predominant and total breast-feeding patterns among mothers with a recent history of smoking stratified by period of relapse up to 2 years after delivery. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Changing Neonatal Nurses' Perceptions of Caring for Infants Experiencing Neonatal Abstinence Syndrome and Their Mothers: An Evidenced-Based Practice Opportunity.

PubMed

Tobin, Kobi Brooke

2018-04-01

Neonatal intensive care units (NICUs) are caring for an increasing number of infants born with neonatal abstinence syndrome (NAS). The literature identifies the need for education for NICU nurses on NAS including skills for interacting with the mother with substance use disorder. An evidence-based practice project was developed to offer an educational presentation targeting these topics to 206 NICU participants (93% registered nurses, 1% licensed vocational nurses, and 6% nursing assistants) at a level IV NICU. A pretest/posttest was developed to assess knowledge of the participants prior to and after completion of the educational presentation. A posteducational questionnaire was developed to evaluate the skills learned for interacting with the mother with substance use disorder and the participant's professional readiness. The posttest demonstrated a statistically significant (P < .001) increase in knowledge of NAS. On the post-educational questionnaire, 96% of participants correctly identified 3 skills they would use clinically with mothers with substance use disorder and 84% of participants identified 2 personal strengths and 2 weaknesses that influence their care of infants with NAS and their families (professional readiness). These results demonstrate that this educational presentation was effective and should be replicated at other facilities to improve the knowledge and skills of NICU nurses to promote improved care for infants with NAS. Future studies should examine the impact on patient outcomes by preforming post-discharge interviews with the mothers of infants with NAS in the NICU pre- and post-educational intervention. Expanding the presentation into an interprofessional educational opportunity would promote increased knowledge and care by the entire multidisciplinary team.

Boys will be boys: are there gender differences in the effect of sexual abstinence on schooling?

PubMed

Sabia, Joseph J; Rees, Daniel I

2011-03-01

A recent study by Sabia and Rees (2009) found that delaying first intercourse leads to a substantial increase in the probability that female students graduate high school. However, it is unclear whether the effect of abstinence extends to male students. Here we identify exogenous variation in the timing of first intercourse using a physical development index available for both females and males. Two-stage least squares estimates suggest that abstaining from sexual intercourse increases the probability that females graduate from high school, but has little effect on the educational attainment of males. This pattern of results is consistent with evidence from previous studies that males are less likely than females to suffer adverse psychological consequences from engaging in sexual intercourse at an early age. Copyright © 2010 John Wiley & Sons, Ltd.

A Randomized Trial of Long-Term Reinforcement of Cocaine Abstinence in Methadone-Maintained Patients Who Inject Drugs

ERIC Educational Resources Information Center

Silverman, Kenneth; Robles, Elias; Mudric, Timothy; Bigelow, George E.; Stitzer, Maxine L.

2004-01-01

This study determined whether long-term abstinence reinforcement could maintain cocaine abstinence throughout a yearlong period. Patients who injected drugs and used cocaine during methadone treatment (n = 78) were randomly assigned to 1 of 2 abstinence-reinforcement groups or to a usual care control group. Participants in the 2…

Opiate v CNS depressant therapy in neonatal drug abstinence syndrome.

PubMed

Kandall, S R; Doberczak, T M; Mauer, K R; Strashun, R H; Korts, D C

1983-04-01

Paregoric and phenobarbital, administered randomly in 153 passively addicted neonates, initially appeared to control neonatal abstinence signs equally well. However, seven of the 62 phenobarbital-treated newborns had abstinence-associated seizures within the first month of life, while none of 49 paregoric-treated neonates had seizures. Forty-two neonates initially requiring no specific pharmacotherapy for abstinence signs were born to mothers taking less methadone hydrochloride just before delivery. Five of those 42 neonates, however, had seizures within the first 14 days of life. Seizure occurrence could not be predicted from analysis of early abstinence patterns. We consider paregoric to be the treatment of choice for the neonatal abstinence syndrome. Phenobarbital use should be monitored with serum drug levels and modification of recommended dosage regimens considered.

Neutrality, abstinence, and the therapeutic alliance.

PubMed

Meissner, W W

1998-01-01

Concepts of neutrality and abstinence are discussed in terms of the variant opinions about them, pro and con, with particular reference to efforts to dispense with them based on the unavoidable role of the analyst's personal influence and subjectivity in the analytic process. Stereotypes of both neutrality and abstinence are examined, and the therapeutic alliance established as the most appropriate context within which to articulate the essential and constructive role of effective analytic neutrality and abstinence. The alliance is not possible without the persistent exercise of both neutrality and abstinence; conversely, other components of the alliance are intended to facilitate and preserve neutrality and abstinence on the part of both analyst and analysand. These elements are essential factors in effective analytic practice.

Learning to Negotiate Sexual Relationships: A Girls' School in Tanzania as a Restrictive and Agentic Site

ERIC Educational Resources Information Center

Willemsen, Laura Wangsness; DeJaeghere, Joan

2015-01-01

Literature on schooling in Africa often frames sexual relationships as threatening girls' educational participation, health, and general well-being. Schooling practices aimed at sheltering girls reflect the prevalence of discourses emphasising danger and abstinence. This article presents the case of one all-girls school in Tanzania which provides…

Nationwide access to an Internet-based contingency management intervention to promote smoking cessation: A randomized controlled trial

PubMed Central

Dallery, Jesse; Raiff, Bethany R.; Kim, Sunny Jung; Marsch, Lisa A.; Stitzer, Maxine; Grabinski, Michael J.

2016-01-01

Background and aims Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of Internet-based CM relative to an Internet-based monitoring and goal setting control group in a nationwide sample of cigarette smokers. Design Randomized controlled trial with 3- and 6-month follow ups. Setting USA. Participants Smokers (n=94) from 26 states were enrolled (mean age 36, 56% female). Intervention and comparator Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n=48; Abstinent Contingent Group, AC), or based on submitting CO samples (n=46, Submission Contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings. Measures The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0–100mm visual analog scale. Findings Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups (odds ratio=4.4, 95% CI=1.6–12.3), but not at the 3- (29.2% AC and 19.6% SC, odds ratio=1.7, 95% CI=.6–4.4), or 6- (22.9% AC and 13.0% SC, odds ratio=2.0, 95% CI=.7–5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, odds ratio = 3.5, 95% CI=3.1–4.0; 43.4% AC and 24.6% SC, odds ratio = 2.3, 95% CI=1.6–3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = −10.3%–23.8%, x2=.75, p = .39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. Conclusions A contingency management/financial incentive program delivered via the Internet improved short-term abstinence rates compared with an internet program without the incentives. PMID:27923264

Nationwide access to an internet-based contingency management intervention to promote smoking cessation: a randomized controlled trial.

PubMed

Dallery, Jesse; Raiff, Bethany R; Kim, Sunny Jung; Marsch, Lisa A; Stitzer, Maxine; Grabinski, Michael J

2017-05-01

Contingency management (CM) is one of the most effective behavioral interventions to promote drug abstinence, but availability of this treatment is limited. We evaluated the efficacy and acceptability of internet-based CM relative to an internet-based monitoring and goal-setting control group in a nationwide sample of cigarette smokers. Randomized controlled trial with 3- and 6-month follow-ups. United States. Smokers (n = 94) from 26 states were enrolled (mean age 36, 56% female). Participants were randomized to earn financial incentives (up to $480 over 7 weeks) based on video-verified abstinence using breath carbon monoxide (CO) output (n = 48; abstinent contingent group, AC), or based on submitting CO samples (n = 46, submission contingent, SC). Both groups also received the same CO-based goals. A $50 deposit was required in both groups that could be recouped from initial earnings. The primary outcome was point prevalence at week 4. Secondary outcomes were point prevalence at the 3- and 6-month follow-ups, percentages of negative CO samples, adherence to the CO sampling protocol, and treatment acceptability ratings on a 0-100-mm visual analog scale. Abstinence rates differed at 4 weeks between the AC (39.6%) and SC (13.0%) groups [odds ratio (OR) = 4.4, 95% confidence interval (CI) = 1.6-12.3], but not at the 3- (29.2% AC and 19.6% SC, OR = 1.7, 95% CI = 0.6-4.4) or 6- (22.9% AC and 13.0% SC, OR = 2.0, 95% CI = 0.7-5.9) month follow-ups. During the two main treatment phases, there were significant differences in negative COs (53.9% AC and 24.8% SC, OR = 3.5, 95% CI = 3.1-4.0; 43.4% AC and 24.6% SC, OR = 2.3, 95% CI = 1.6-3.4). Adherence to the CO submission protocol was equivalent (78% AC and 85% SC, difference = 7.0%, 95% CI = -10.3 to 23.8 %, F < 1, P = 0.39). The lowest acceptability ratings were for the items assessing the deposit, whereas the highest ratings concerned the ease of the intervention, the graph of CO results, and earning money. A contingency management/financial incentive program delivered via the internet improved short-term abstinence rates compared with an internet program without the incentives. © 2016 Society for the Study of Addiction.

Front-Loaded Versus Weekly Counseling for Treatment of Tobacco Addiction

PubMed Central

Kalman, David; Hoskinson, Randall A.; Kinnunen, Taru; Wadler, Brianna M.; Thomson, Carey C.; Rosner, Bernard

2012-01-01

Introduction: Approximately 60%–70% of cigarette smokers who try to quit relapse by 2 weeks postcessation. We tested the efficacy of a front-loaded (FL) counseling intervention whose goal was to increase the likelihood of successful early abstinence and subsequent long-term abstinence. Methods: We randomized 278 adult smokers to an FL or weekly behavioral smoking cessation counseling schedule. The total number of sessions across treatment was the same for both groups. However, those assigned to the FL schedule received 6 counseling sessions in the first 2 weeks postcessation, while those in the weekly condition received 2 sessions. Participants in both groups also received standard nicotine patch treatment. Results: At 1 year postcessation, FL participants were significantly less likely to have relapsed when continuous abstinence was used as the definition of abstinence/relapse (11.7% abstinent vs. 6.3%, hazard ratio [HR] = 0.69, p = .007); and there were nonsignificant trends for FL subjects to have better outcomes when abstinence was defined as never smoking for 7 or more consecutive days nor for 7 or more consecutive episodes (18.4% abstinent vs. 14.8%, HR = 0.83, p = .20) and as point prevalence abstinence (15.6% abstinent vs. 12.9%, p = .11). The relationship between FL counseling treatment and continuous abstinence was partially mediated by higher postcessation levels of social support perceived from counseling and greater use of cessation-related coping strategies. Conclusions: We conclude that FL counseling is a promising treatment model that should be evaluated further, perhaps using modifications of the FL schedule used in this study. PMID:22058190

Extended findings of Brain Metabolite Normalization in MA-Dependent Subjects Across Sustained Abstinence: A Proton MRS Study

PubMed Central

Salo, Ruth; Buonocore, Michael H.; Leamon, Martin; Natsuaki, Yutaka; Waters, Christy; Moore, Charles D.; Galloway, Gantt P.; Nordahl, Thomas E.

2010-01-01

Objective The goal of the present study was to extend our previous findings on long-term methamphetamine (MA) use and drug abstinence on brain metabolite levels in an expanded group of MA-dependent individuals. Methods Seventeen MA abusers with sustained drug abstinence (1 year to 5 years), 30 MA abusers with short-term drug abstinence (1 month to 6 months) and 24 non-substance using controls were studied using MR spectroscopy (MRS). MRS measures of NAA/Cr, Cho/Cr and Cho/NAA were obtained in the anterior cingulate cortex (ACC) and in the primary visual cortex (PVC). Results ACC-Cho/NAA values were abnormally high in the short-term abstinent group compared to controls [F(1,52)=18.76, p<0.0001]. No differences were observed between controls and the long-term abstinent group [F(1,39)=0.97, p=0.97]. New evidence of lower ACC-NAA/Cr levels were observed in the short-term abstinent MA abusers compared to controls [F(1,52)=23.05, p<0.0001] and long-term abstinent MA abusers [F(1,45)=7.06, p=0.01]. No differences were observed between long-term abstinent MA abusers and controls [F(1,39)=0.48, p=0.49]. Conclusions The new findings of relative NAA/Cr normalization across periods of abstinence suggest that adaptive changes following cessation of MA abuse may be broader than initially thought. These changes may contribute to some degree of normalization of neuronal function in the ACC. PMID:20739127

Neural correlates of 12-h abstinence-induced craving in young adult smokers: a resting-state study.

PubMed

Li, Yangding; Yuan, Kai; Bi, Yanzhi; Guan, Yanyan; Cheng, Jiadong; Zhang, Yajuan; Shi, Sha; Lu, Xiaoqi; Yu, Dahua; Tian, Jie

2017-06-01

Studying the neural correlates of craving to smoke in young adulthood is of great importance to improve treatment outcomes in nicotine dependence. Previous nicotine dependence studies mainly focused on the neural substrates of craving elicited by smoking-related cues. More explicit attention to abstinence-induced craving during resting state in nicotine dependence has the potential to yield valuable information about craving, and characterizing this kind of craving is critical for developing effective interventions. Twenty-five young male smokers were enrolled in the present study. A within-subject experiment design was carried out to compare regional homogeneity (ReHo) between 12-h smoking abstinence and smoking satiety conditions during resting state in young adult smokers. Then, the ReHo changes associated with smoking abstinence (compared with satiety) were further examined for correlations with abstinence-induced changes in subjective craving. We found young adult smokers in abstinence state (compared with satiety) had higher ReHo in brain regions in fronto-striatal circuits including bilateral caudate, anterior cingulate cortex (ACC) and bilateral dorsal lateral prefrontal cortex (DLPFC), as well as brain regions in default mode network (DMN) including posterior cingulate cortex (PCC)/precuneus and angular gyrus. Additionally, we found the ReHo changes of the ACC and the bilateral caudate were positively correlated with the changes in craving induced by abstinence (i.e., abstinence minus satiety) in young adult smokers. The present findings improve the understanding of the effects of acute smoking abstinence on spontaneous brain activity and may contribute new insights into the neural mechanism of abstinence-induced craving in nicotine dependence.

Changes in Neuropsychological Status during the Initial Phase of Abstinence in Alcohol Use Disorder: Neurocognitive Impairment and Implications for Clinical Care.

PubMed

Mulhauser, Kyler; Weinstock, Jeremiah; Ruppert, Phillip; Benware, Jeffrey

2018-05-12

Neuropsychological deficits are common in individuals with alcohol use disorder (AUD) and impact daily functioning and AUD treatment outcomes. Longitudinal studies demonstrate that extended abstinence improves neuropsychological functioning. The effects of short-term abstinence are less clear. This study examined changes in neuropsychological functioning after acute detoxification over a 10-day period at the beginning of residential AUD treatment. Notably, this study evaluated cognitive functioning according to diagnostic classifications for neurocognitive disorder according to DSM-5. Using a within-subjects design, neuropsychological functioning of participants (N = 28) undergoing a 14-day residential AUD treatment program was assessed at two time points over 10 days (i.e., treatment entry, prior to treatment discharge). Tests of immediate memory, visuospatial abilities, attention, language abilities, delayed memory, and executive functioning were administered. After completing acute detoxification, almost all participants (93%) were clinically impaired in at least one of the five cognitive domains at residential treatment entry, with one third of the sample impaired on ≥3 domains. Ten days later, 71% remained clinically impaired in at least one of five cognitive domains, with 29% of the sample impaired on ≥3 domains. Significant improvement over the 10-day period was observed for immediate memory, visuospatial abilities, and overall cognitive functioning. Clinical significance of these changes is also reported. Conclusions/Importance: The results from this study help to characterize cognitive functioning in terms of neurocognitive impairment. A brief period of abstinence begins to ameliorate neuropsychological deficits, but many individuals remain cognitively impaired throughout treatment. Implications for treatment are discussed.

Differential behavioral and molecular alterations upon protracted abstinence from cocaine versus morphine, nicotine, THC and alcohol.

PubMed

Becker, Jérôme A J; Kieffer, Brigitte L; Le Merrer, Julie

2017-09-01

Unified theories of addiction are challenged by differing drug-seeking behaviors and neurobiological adaptations across drug classes, particularly for narcotics and psychostimulants. We previously showed that protracted abstinence to opiates leads to despair behavior and social withdrawal in mice, and we identified a transcriptional signature in the extended amygdala that was also present in animals abstinent from nicotine, Δ9-tetrahydrocannabinol (THC) and alcohol. Here we examined whether protracted abstinence to these four drugs would also share common behavioral features, and eventually differ from abstinence to the prototypic psychostimulant cocaine. We found similar reduced social recognition, increased motor stereotypies and increased anxiety with relevant c-fos response alterations in morphine, nicotine, THC and alcohol abstinent mice. Protracted abstinence to cocaine, however, led to strikingly distinct, mostly opposing adaptations at all levels, including behavioral responses, neuronal activation and gene expression. Together, these data further document the existence of common hallmarks for protracted abstinence to opiates, nicotine, THC and alcohol that develop within motivation/emotion brain circuits. In our model, however, these do not apply to cocaine, supporting the notion of unique mechanisms in psychostimulant abuse. © 2016 Society for the Study of Addiction.

Reducing sexual risk with practice of periodic secondary abstinence.

PubMed

Haglund, Kristin

2008-01-01

Test a novel intervention to help sexually experienced girls increase abstinence behaviors and attitudes. A quasi-experimental repeated measures design using qualitative and quantitative data. Two alternative public schools. Thirty-three females whose mean age was 16 and who were 79% African American participated. Most (79%) had experienced a pregnancy. A 6 session, weekly, interactive intervention was delivered. Data were collected at baseline, last session, and at 5 and 7 month follow-ups. Measured outcomes related to abstinence included participants' reasons, behaviors, stages of change, and attitudes. The most common reason for abstinence was not wanting to have sex. At each postintervention data collection point, most participants (greater than or equal to 74%) reported that they had purposefully avoided sex. Duration of consecutive days of abstinence increased although only significantly at 5 month follow-up. Abstinence behaviors increased with the largest change from first to last session. Stage of change advanced from preparation to action by 7 month follow-up. Attitudes toward abstinence became more favorable. Effective sexual risk reduction interventions are critically needed to promote safety. Nurses may assist young women to decrease their sexual risks by teaching them to practice periodic abstinence.

The comparative effectiveness of clinic, work-site, phone, and Web-based tobacco treatment programs.

PubMed

An, Lawrence C; Betzner, Anne; Schillo, Barbara; Luxenberg, Michael G; Christenson, Matthew; Wendling, Ann; Saul, Jessie E; Kavanaugh, Annette

2010-10-01

Tobacco treatment programs may be offered in clinical settings, at work-sites, via telephone helplines, or over the Internet. Little comparative data exist regarding the real-world effectiveness of these programs. This paper compares the reach, effectiveness, and costs of these different modes of cessation assistance. This is an observational study of cohorts of participants in Minnesota's QUITPLAN programs in 2004. Cessation assistance was provided in person at 9 treatment centers, using group counseling at 68 work-sites, via a telephone helpline, or via the Internet. The main outcomes of the study are enrollment by current smokers, self-reported 30-day abstinence, and cost per quit. Reach was calculated statewide for the helpline and Web site, regionally for the treatment centers, and for the employee population for work-site programs. Enrollment was greatest for the Web site (n = 4,698), followed by the helpline (n = 2,351), treatment centers (n = 616), and work-sites (n = 479). The Web site attracted younger smokers. Smokers at treatment centers had higher levels of nicotine dependence. The helpline reached more socially disadvantaged smokers. Responder 30-day abstinence rates were higher for the helpline (29.3%), treatment centers (25.8%), and work-sites (19.6%) compared with the online program (12.5%). These differences persisted after controlling for baseline differences in participant characteristics and use of pharmacological therapy. The cost per quit was lowest for the Web site program ($291 per quit, 95% CI = $229-$372). Treatment center, work-site, helpline, and Web site programs differ in their reach, effectiveness, and estimated cost per quit. Each program plays a part in assisting populations of tobacco users in quitting.

Exploring the Limits and Utility of Operant Conditioning in the Treatment of Drug Addiction

ERIC Educational Resources Information Center

Silverman, Kenneth

2004-01-01

This article describes a research program to develop an operant treatment for cocaine addiction in low-income, treatment-resistant methadone patients. The treatment's central feature is an abstinence reinforcement contingency in which patients earn monetary reinforcement for providing cocaine-free urine samples. Success and failure of this…

Financial incentives to promote extended smoking abstinence in opioid-maintained patients: a randomized trial.

PubMed

Sigmon, Stacey C; Miller, Mollie E; Meyer, Andrew C; Saulsgiver, Kathryn; Badger, Gary J; Heil, Sarah H; Higgins, Stephen T

2016-05-01

Prior studies by our group demonstrated the efficacy of a brief but intensive behavioral intervention for producing initial smoking abstinence among opioid-dependent patients. In the present study, our aim was to promote longer-duration abstinence in this population. Following an initial 2-week incentive intervention for smoking abstinence, we examined whether a 10-week maintenance arm involving continuation of contingent reinforcement will produce greater smoking abstinence than a similar duration of noncontingent reinforcement. Randomized, 12-week, parallel-group study. Out-patient research clinic in Burlington, Vermont, USA. Opioid-maintained smokers (n = 88) who provided breath carbon monoxide and urinary cotinine specimens and received contingent reinforcement for smoking abstinence during weeks 1-2 (phase 1), with 63 randomized on day 14 to an extended contingent (EC; n = 31) or extended noncontingent (EN; n = 32) experimental condition for weeks 3-12 (phase 2). The EC condition consisted of voucher values that escalated across consecutive negative samples until they reached $30, after which they remained at $30 per negative sample. A positive or a missing sample resulted in no vouchers for that day and reset the value of the next negative same to $9. Two consecutive negatives returned the schedule to the pre-reset value. The EN control condition consisted of vouchers delivered for providing scheduled samples, but independent of smoking status. The primary outcome was percentage of biochemically abstinent samples during phase 2. Secondary measures included abstinence status at final study visit, complete abstinence, participants' longest duration of continuous abstinence, cotinine and carbon monoxide (CO) levels and self-reported cigarettes per day. EC participants achieved greater smoking abstinence during phase 2 than EN participants [46.7 versus 23.5% negative samples, respectively; odds ratio (OR) = 2.98, 95% confidence interval (CI) = 1.16-7.65, χ(2) 1  (=)  5.0, P = 0.02]. When longest duration of continuous abstinence was compared between experimental groups, EC participants achieved twice the mean duration of continuous abstinence compared with EN participants (3.31 versus 1.68 weeks; t61  = 1.83, P = 0.07). An effect of experimental condition was also seen on mean cotinine levels (42.5 versus 210.6 ng/ml, respectively; F1,61 =5.9, P = 0.02). Among opioid-maintained smokers receiving an initial period of daily contingent incentives, a contingent reinforcement intervention appears to be more effective at extending smoking abstinence than noncontingent reinforcement over 10 weeks. © 2015 Society for the Study of Addiction.

Breastfeeding and abstinence among the Yoruba.

PubMed

Dow, T E

1977-08-01

Contemporary patterns of breastfeeding and postpartum abstinence among the Yoruba of Nigera are examined. Quite extensive periods of postpartum abstinence are still observed by most rural and poorer urban women to prolong breastfeeding and increase child survivorship. Differentials in duration of breastfeeding and abstinence relate to both socioeconomic factors and age, suggesting the likelihood of large future reductions. Implications for family planning prospects and policies are noted.

Financial strain and smoking cessation among men and women within a self-guided quit attempt.

PubMed

Reitzel, Lorraine R; Langdon, Kirsten J; Nguyen, Nga T; Zvolensky, Michael J

2015-08-01

Financial strain, defined as an unfavorable asset-to-needs ratio, has been associated with reduced odds of smoking cessation in the context of a structured clinical study providing cessation assistance. This study reports on a secondary data analysis that assessed the association of financial strain and biochemically-verified smoking abstinence within a structured clinical study of smokers making a self-guided cessation attempt. Participants (N=58; 65.5% men) were enrolled in a study about anxiety sensitivity and smoking cessation whereby they were instructed to initiate a self-guided quit attempt. Relations between financial strain and biochemically-verified smoking abstinence on the quit day and at Days 3, 7, 14, 28, and 90 post-quit were assessed using generalized estimating equations controlling for age, sex, race, education, partner status, pre-quit cigarettes smoked per day, and time. Associations between financial strain and abstinence in the whole sample were marginal (aOR=.94, 95% CI=.87-1.01, observations=293; p=.07). However, sex was a significant moderator: greater financial strain was associated with lower odds of abstinence for men (aOR=.90, 95% CI=.80-1.00, observations=201; p=.05), but not women (aOR=1.05, 95% CI=.91-1.21, observations=92; p=.48). Results indicated that financial strain was associated with lower odds of cessation among men undergoing a self-guided quit attempt in the context of a structured clinical study. These data suggest that financial strain may be an important socioeconomic determinant of smoking cessation and support its relevance for better understanding socioeconomic-based smoking-related health disparities. Future work may benefit by exploring sex-specific models of financial strain in the context of smoking cessation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Financial Strain and Smoking Cessation among Men and Women within a Self-Guided Quit Attempt

PubMed Central

Reitzel, Lorraine R.; Langdon, Kirsten J.; Nguyen, Nga T.; Zvolensky, Michael J.

2015-01-01

Financial strain, defined as an unfavorable asset-to-needs ratio, has been associated with reduced odds of smoking cessation in the context of a structured clinical study providing cessation assistance. This study reports on a secondary data analysis that assessed the association of financial strain and biochemically-verified smoking abstinence within a structured clinical study of smokers making a self-guided cessation attempt. Participants (N=58; 65.5% men) were enrolled in a study about anxiety sensitivity and smoking cessation whereby they were instructed to initiate a self-guided quit attempt. Relations between financial strain and biochemically-verified smoking abstinence on the quit day and at Days 3, 7, 14, 28, and 90 post-quit were assessed using generalized estimating equations controlling for age, sex, race, education, partner status, pre-quit cigarettes smoked per day, and time. Associations between financial strain and abstinence in the whole sample were marginal (aOR=.94, 95% CI=.87-1.01, observations=293; p=.07). However, sex was a significant moderator: greater financial strain was associated with lower odds of abstinence for men (aOR=.90, 95% CI= .80-1.00, observations=201; p=.05), but not women (aOR=1.05, 95% CI= .91-1.21, observations=92; p=.48). Results indicated that financial strain was associated with lower odds of cessation among men undergoing a self-guided quit attempt in the context of a structured clinical study. These data suggest financial strain may be an important socioeconomic determinant of smoking cessation and support its relevance for better understanding socioeconomic-based smoking-related health disparities. Future work may benefit by exploring sex-specific models of financial strain in the context of smoking cessation. PMID:25879712

Intolerance for smoking abstinence among nicotine-deprived, treatment-seeking smokers.

PubMed

Germeroth, Lisa J; Baker, Nathaniel L; Saladin, Michael E

2018-09-01

The Intolerance for Smoking Abstinence Discomfort Questionnaire (IDQ-S) assesses distress tolerance specific to nicotine withdrawal. Though developed to assess withdrawal-related distress, the IDQ-S has not been validated among nicotine-deprived, treatment-seeking smokers. The present study extended previous research by examining the predictive utility of the IDQ-S among abstinent, motivated-to-quit smokers. Abstinent, treatment-seeking smokers completed the IDQ-S Withdrawal Intolerance and Lack of Cognitive Coping scales, assessments of nicotine dependence and reinforcement, and smoking history at baseline. At baseline and at 24-h, 2-week, and 1-month follow-up, participants completed a smoking cue-reactivity task (collection of cue-elicited craving and negative affect), and assessments of cigarettes per day (CPD; daily diaries at follow-up), carbon monoxide (CO), and cotinine. Greater IDQ-S Withdrawal Intolerance was associated with younger age, higher nicotine dependence and reinforcement, and less smoking years (ps < .03). Greater IDQ-S Lack of Cognitive Coping was associated with less education, lower nicotine dependence and reinforcement, higher baseline CPD, and no prior quit attempts (ps < .04). IDQ-S scales did not significantly predict cue-elicited craving or negative affect, CPD, CO, or cotinine levels at follow-up (ps > .10). Withdrawal intolerance and lack of cognitive coping did not predict smoking outcomes among nicotine-deprived, treatment-seeking smokers, but were associated with smoking characteristics, including nicotine dependence and reinforcement. Withdrawal intolerance and lack of cognitive coping may not be especially useful in predicting craving and smoking behavior, but future studies should replicate the present study's findings and assess the stability of the IDQ-S before forming firm conclusions about its predictive utility. Copyright © 2018 Elsevier Ltd. All rights reserved.

The Impact of the Tobacco Retail Outlet Environment on Adult Cessation and Differences by Neighborhood Poverty

PubMed Central

Anesetti-Rothermel, Andrew; Pearson, Jennifer L.; Xiao, Haijun; Vallone, Donna; Kirchner, Thomas R.

2014-01-01

Aims This study examined the impact of tobacco retail outlets on cessation outcomes over time among non-treatment-seeking smokers and assessed differences by neighborhood poverty and individual factors. Design Observational longitudinal cohort study using geospatial data. We used generalized estimating equations to examine cessation outcomes in relation to the proximity and density of tobacco retail outlets near the home. Setting Eight large Designated Media Areas across the U.S. Participants A total of 2,377 baseline smokers followed over 3 waves from 2008 to 2010. Measurements Outlet addresses were identified through North American Industry Classification System codes and proximity and density measures were constructed for each participant at each wave. Outcomes included past 30-day abstinence and pro-cessation attitudes. Findings Smokers in high poverty census tracts living between 500 meters and 1.9 kilometers from an outlet were over 2 times more likely to be abstinent than those living fewer than 500 meters from an outlet (p<.05). Density within 500 meters of home was associated with reduced abstinence (OR: 0.94; CI: 0.90, 0.98) and lower pro-cessation attitudes (Coef: −0.07, CI: −0.10, −0.03) only in high poverty areas. In low poverty areas, density within 500 meters was associated with greater pro-cessation attitudes (OR: 0.06; CI: 0.01, 0.12). Gender, education and heaviness of smoking did not moderate the impact of outlet proximity and density on cessation outcomes. Conclusions In the US, density of tobacco outlets within 500 meters of the home residence appears to be negatively associated with smoking abstinence and pro-cessation attitudes only in poor areas. PMID:25171184

The impact of the tobacco retail outlet environment on adult cessation and differences by neighborhood poverty.

PubMed

Cantrell, Jennifer; Anesetti-Rothermel, Andrew; Pearson, Jennifer L; Xiao, Haijun; Vallone, Donna; Kirchner, Thomas R

2015-01-01

This study examined the impact of tobacco retail outlets on cessation outcomes over time among non-treatment-seeking smokers and assessed differences by neighborhood poverty and individual factors. Observational longitudinal cohort study using geospatial data. We used generalized estimating equations to examine cessation outcomes in relation to the proximity and density of tobacco retail outlets near the home. Eight large Designated Media Areas across the United States. A total of 2377 baseline smokers followed over three waves from 2008 to 2010. Outlet addresses were identified through North American Industry Classification System codes and proximity and density measures were constructed for each participant at each wave. Outcomes included past 30-day abstinence and pro-cessation attitudes. Smokers in high poverty census tracts living between 500 m and 1.9 km from an outlet were over two times more likely to be abstinent than those living fewer than 500 m from an outlet (P < 0.05). Density within 500 m of home was associated with reduced abstinence [odds ratio (OR) = 0.94; confidence interval (CI) = 0.90, 0.98) and lower pro-cessation attitudes (Coeff = -0.07, CI = -0.10, -0.03) only in high poverty areas. In low poverty areas, density within 500 m was associated with greater pro-cessation attitudes (OR = 0.06; CI = 0.01, 0.12). Gender, education and heaviness of smoking did not moderate the impact of outlet proximity and density on cessation outcomes. In the United States, density of tobacco outlets within 500 m of the home residence appears to be negatively associated with smoking abstinence and pro-cessation attitudes only in poor areas. © 2014 Society for the Study of Addiction.

Brain serotonin transporter density and aggression in abstinent methamphetamine abusers.

PubMed

Sekine, Yoshimoto; Ouchi, Yasuomi; Takei, Nori; Yoshikawa, Etsuji; Nakamura, Kazuhiko; Futatsubashi, Masami; Okada, Hiroyuki; Minabe, Yoshio; Suzuki, Katsuaki; Iwata, Yasuhide; Tsuchiya, Kenji J; Tsukada, Hideo; Iyo, Masaomi; Mori, Norio

2006-01-01

In animals, methamphetamine is known to have a neurotoxic effect on serotonin neurons, which have been implicated in the regulation of mood, anxiety, and aggression. It remains unknown whether methamphetamine damages serotonin neurons in humans. To investigate the status of brain serotonin neurons and their possible relationship with clinical characteristics in currently abstinent methamphetamine abusers. Case-control analysis. A hospital research center. Twelve currently abstinent former methamphetamine abusers (5 women and 7 men) and 12 age-, sex-, and education-matched control subjects recruited from the community. The brain regional density of the serotonin transporter, a structural component of serotonin neurons, was estimated using positron emission tomography and trans-1,2,3,5,6,10-beta-hexahydro-6-[4-(methylthio)phenyl]pyrrolo-[2,1-a]isoquinoline ([(11)C](+)McN-5652). Estimates were derived from region-of-interest and statistical parametric mapping methods, followed by within-case analysis using the measures of clinical variables. The duration of methamphetamine use, the magnitude of aggression and depressive symptoms, and changes in serotonin transporter density represented by the [(11)C](+)McN-5652 distribution volume. Methamphetamine abusers showed increased levels of aggression compared with controls. Region-of-interest and statistical parametric mapping analyses revealed that the serotonin transporter density in global brain regions (eg, the midbrain, thalamus, caudate, putamen, cerebral cortex, and cerebellum) was significantly lower in methamphetamine abusers than in control subjects, and this reduction was significantly inversely correlated with the duration of methamphetamine use. Furthermore, statistical parametric mapping analyses indicated that the density in the orbitofrontal, temporal, and anterior cingulate areas was closely associated with the magnitude of aggression in methamphetamine abusers. Protracted abuse of methamphetamine may reduce the density of the serotonin transporter in the brain, leading to elevated aggression, even in currently abstinent abusers.

The Efficacy of Vigorous-Intensity Exercise as an Aid to Smoking Cessation in Adults With High Anxiety Sensitivity: A Randomized Controlled Trial.

PubMed

Smits, Jasper A J; Zvolensky, Michael J; Davis, Michelle L; Rosenfield, David; Marcus, Bess H; Church, Timothy S; Powers, Mark B; Frierson, Georita M; Otto, Michael W; Hopkins, Lindsey B; Brown, Richard A; Baird, Scarlett O

2016-04-01

High anxiety sensitivity predicts poor smoking cessation outcomes. Aerobic exercise reduces anxiety sensitivity and aspects of the risk conferred by anxiety sensitivity. In the current study, we examined whether exercise can aid smoking cessation in adults with high anxiety sensitivity. Participants were sedentary and low-activity adult daily smokers (n = 136) with elevated prescreen anxiety sensitivity. Participants received 15 weeks of standard smoking cessation treatment (ST; cognitive behavioral therapy plus nicotine replacement therapy). In addition, participants were simultaneously randomized to 15 weeks of either an exercise intervention (ST + EX; n = 72) or a wellness education control condition (ST + CTRL; n = 64). Self-reported smoking abstinence was assessed weekly during the intervention, at the end of treatment (10 weeks after the target quit date), and at 4 and 6 months after the target quit date. Abstinence was verified by expired carbon monoxide readings and saliva cotinine. Results indicated that point prevalence abstinence (PPA) and prolonged abstinence (PA) rates were significantly higher for ST + EX than for ST + CTRL at each of the major end points among persons with high anxiety sensitivity (PPA: b = -0.91, standard error [SE] = 0.393, t(1171) = -2.33, p = .020; PA: b = -0.98, SE = 0.346, t(132) = -2.84, p = .005), but not among those with low anxiety sensitivity (PPA: b = -0.23, SE = 0.218, t(1171) = -1.06, p = .29; PA: b = -0.31, SE = 0.306, t(132) = -1.01, p = .32). The present results suggest that exercise facilitates the odds of quit success for smokers with high levels of anxiety sensitivity and therefore may be a useful therapeutic tactic for this high-risk segment of the smoking population. ClinicalTrials.gov, NCT01065506.

The Efficacy of Vigorous-Intensity Exercise as an Aid to Smoking Cessation in Adults with High Anxiety Sensitivity: A Randomized Controlled Trial

PubMed Central

Smits, Jasper A. J.; Zvolensky, Michael J.; Davis, Michelle L.; Rosenfield, David; Marcus, Bess H.; Church, Timothy S.; Powers, Mark B.; Frierson, Georita M.; Otto, Michael W.; Hopkins, Lindsey B.; Brown, Richard A.; Baird, Scarlett O.

2015-01-01

Objective High anxiety sensitivity predicts poor smoking cessation outcomes. Aerobic exercise reduces anxiety sensitivity and aspects of the risk conferred by anxiety sensitivity. In the current study, we examined whether exercise can aid smoking cessation in adults with high anxiety sensitivity. Method Participants were sedentary and low activity adult daily smokers (N = 136) with elevated prescreen anxiety sensitivity. Participants received 15 weeks of standard smoking cessation treatment (ST: cognitive behavioral therapy plus nicotine replacement therapy). Additionally, participants were simultaneously randomized to 15 weeks of either an exercise intervention (ST+EX; n = 72) or a wellness education control condition (ST+CTRL; n = 64). Self-reported smoking abstinence was assessed weekly during the intervention, at the end of treatment (10 weeks following the target quit date), and at 4 and 6 months following the target quit date. Abstinence was verified by expired carbon monoxide readings and saliva cotinine. Results Results indicated that point prevalence abstinence (PPA) and prolonged abstinence (PA) rates were significantly higher for ST+EX than for ST+CTRL at each of the major end points among persons with high anxiety sensitivity (PPA: b=−.91, SE=.393, t(1171)=−2.33, p=.020; PA: b=−.98, SE=.346, t(132)=−2.84, p=.005), but not among those with low anxiety sensitivity (PPA: b=−.23, SE=.218, t(1171)=−1.06, p=..29; PA: b=−.31, SE=.306, t(132)=−1.01, p=.32) Conclusions The present results suggest that exercise faciliates the odds of quit success for smokers with high levels of anxiety sensitivity, and therefore, may be a useful therapeutic tactic for this high-risk segment of the smoking population. PMID:26513517

Motivation and patch treatment for HIV+ smokers: a randomized controlled trial.

PubMed

Lloyd-Richardson, Elizabeth E; Stanton, Cassandra A; Papandonatos, George D; Shadel, William G; Stein, Michael; Tashima, Karen; Flanigan, Timothy; Morrow, Kathleen; Neighbors, Charles; Niaura, Raymond

2009-11-01

To test the efficacy of two smoking cessation interventions in a HIV positive (HIV+) sample: standard care (SC) treatment plus nicotine replacement therapy (NRT) versus more intensive motivationally enhanced (ME) treatment plus NRT. Randomized controlled trial. HIV+ smoker referrals from eight immunology clinics in the northeastern United States. A total of 444 participants enrolled in the study (mean age = 42.07 years; 63.28% male; 51.80% European American; mean cigarettes/day = 18.27). SC participants received two brief sessions with a health educator. Those setting a quit date received self-help quitting materials and NRT. ME participants received four sessions of motivational counseling and a quit-day counseling call. All ME intervention materials were tailored to the needs of HIV+ individuals. Biochemically verified 7-day abstinence rates at 2-month, 4-month and 6-month follow-ups. Intent-to-treat (ITT) abstinence rates at 2-month, 4-month and 6-month follow-ups were 12%, 9% and 9%, respectively, in the ME condition, and 13%, 10% and 10%, respectively, in the SC condition, indicating no between-group differences. Among 412 participants with treatment utilization data, 6-month ITT abstinence rates were associated positively with low nicotine dependence (P = 0.02), high motivation to quit (P = 0.04) and Hispanic American race/ethnicity (P = 0.02). Adjusting for these variables, each additional NRT contact improved the odds of smoking abstinence by a third (odds ratio = 1.32, 95% confidence interval = 0.99-1.75). Motivationally enhanced treatment plus NRT did not improve cessation rates over and above standard care treatment plus NRT in this HIV+ sample of smokers. Providers offering brief support and encouraging use of nicotine replacement may be able to help HIV+ patients to quit smoking.

How many individuals achieve symptom abstinence following psychological treatments for bulimia nervosa? A meta-analytic review.

PubMed

Linardon, Jake; Wade, Tracey D

2018-04-01

It is unclear how many patients with bulimia nervosa (BN) completely abstain from the core behavioral symptoms after receiving psychological treatment. The present meta-analysis of randomized controlled trials (RCTs) aimed to (a) estimate the prevalence of patients who abstain from binge eating and/or purging following all psychological treatments for BN, and (b) test whether these abstinence estimates are moderated by the type of treatment modality delivered, the definition of abstinence applied, and trial quality. Forty-five RCTs were included, with 78 psychotherapy conditions. Pooled event rates were calculated using random effects models. At post-treatment, the total weighted percentage of treatment-completers who achieved abstinence was 35.4% (95% CI = 29.6, 41.7), while the total weighted percentage of abstinence for all randomized patients (intention-to-treat) was 29.9% (95% CI = 25.7, 33.2). Abstinence estimates were highest in trials that used behavioral-based treatments (e.g., cognitive-behavioral therapy, behavior therapy). There was also evidence that guided self-help interventions produced the lowest post-treatment abstinence rates, but with no difference at follow-up from clinician-led treatments, and studies that used a shorter timeframe for defining abstinence (i.e., 14 days symptom-free compared to 28-days symptom-free) produced the highest abstinence rates. Abstinence estimates at follow-up for both the completer (34.6%; 95% CI = 29.3, 40.2) and intention-to-treat (28.6%; 95% CI = 25.1, 32.3) analyses were essentially the same as the post-treatment estimates. Over 60% of patients fail to fully abstain from core BN symptoms even after receiving our most empirically-supported treatments. The present findings highlight the urgency toward improving the effectiveness of psychological treatments for BN. © 2018 Wiley Periodicals, Inc.

Effects of naltrexone on post-abstinence alcohol drinking in C57BL/6NCRL and DBA/2J mice.

PubMed

Tomie, Arthur; Azogu, Idu; Yu, Lei

2013-07-01

The present experiment evaluated the effects of naltrexone, a non-selective opioid receptor antagonist, on post-abstinence alcohol drinking in C57BL/6NCRL and DBA/2J male mice. Home cage 2-bottle (alcohol vs. water) free-choice procedures were employed. During the pre-abstinence period, alcohol intake was much lower for the DBA/2J mice relative to the C57BL/6NCRL mice, and this strain difference was observed for groups receiving either 3% or 10% alcohol concentrations. The four-day abstinence period effectively reduced alcohol intakes (i.e., a negative alcohol deprivation effect, negative ADE) in both groups of DBA/2J mice, but had no effect on alcohol intakes in either group of C57BL/6NCRL mice. Both groups trained with 3% alcohol received the second four-day abstinence period, where the effects of acute administration of either naltrexone or saline on post-abstinence alcohol drinking were assessed. Naltrexone was more effective in reducing post-abstinence drinking of 3% alcohol in the DBA/2J mice than in the C57BL/6NCRL mice. In the DBA/2J mice, naltrexone further reduced, relative to saline-injected controls, the low levels of post-abstinence alcohol intake. Thus, the low baseline levels of alcohol drinking in DBA/2J mice were further diminished by the four-day abstinence period (negative ADE), and this suppressed post-abstinence level of alcohol drinking was still further reduced by acute administration of naltrexone. The results indicate that naltrexone is effective in reducing further the low levels of alcohol drinking induced by the negative ADE. Copyright © 2013 Elsevier Inc. All rights reserved.

Sex differences in negative affect and lapse behavior during acute tobacco abstinence: a laboratory study.

PubMed

Pang, Raina D; Leventhal, Adam M

2013-08-01

Heightened negative affect during acute tobacco abstinence in women relative to men could be an important factor underlying sex differences in smoking motivation. However, little controlled experimental work addresses this hypothesis. The current study investigated sex differences in withdrawal-related negative affect, time to start smoking on a lab analogue smoking lapse task, and the interrelation between sex, withdrawal-related negative affect, and smoking lapse behavior. Following a baseline session, current smokers (women: n = 68, men: n = 131) attended two counterbalanced lab sessions (16 hours smoking abstinence and ad libitum smoking) during which they completed self-report measures of mood and withdrawal symptoms followed by a laboratory analogue smoking lapse task. In this task participants are monetarily rewarded for delaying smoking. Performance on this task serves as an analogue model of smoking lapse behavior by measuring smoker's capability to resist temptation to smoke under conditions where abstinence is advantageous. Females showed greater abstinence induced increases in composite negative affect as well as several particular negative affect states (i.e., POMS Anger, Anxiety, Depression, and Confusion, ps < .05) but no differences in abstinence induced changes in other forms of affect or craving. Females also exhibited marginally greater abstinence induced decreases in their willingness to delay smoking for money (p = .10), which was mediated by abstinence induced increases in anger (p < .05). These results suggest that differential sensitivity to abstinence induced negative affect, particularly anger, could underlie sex specific smoking patterns. Negative affect during tobacco abstinence may be an important factor for understanding and treating nicotine addiction in women. PsycINFO Database Record (c) 2013 APA, all rights reserved

Revisiting The Relationship between The Ejaculatory Abstinence Period and Semen Characteristics

PubMed Central

Ayad, Bashir M; Van der Horst, Gerhard; S Du Plessis, Stefan

2018-01-01

Variation in the ejaculatory abstinence period suggested by different guidance bodies have resulted in a growing concern among researchers and clinicians over what the precise period of ejaculatory abstinence ought to be for an optimal semen sample. Several studies have thus been undertaken to examine the association between the length of sexual abstinence and semen characteristics. Not all studies, however, have arrived at the same conclusions. This study aims to review all existing literature published during the past few decades pertaining to the influence of ejaculatory abstinence on semen quality. For the purpose of this systematic review, all data related to sexual abstinence duration and seminal parameters were re-analysed to homogenize the current data. Thorough PubMed, MEDLINE and Google Scholar, a literature search was conducted using the keywords “sexual abstinence”, “ejaculatory abstinence”, “semen”, “spermatozoa”, “semen analysis”, “sperm parameters”, “motility”, “reactive oxygen species (ROS)” and “DNA fragmentation”. After carefully reviewing all the literature, 30 relevant papers, both written in English and published between January 1979 and December 2016, were included in this review. The weight of the evidence suggests that the decline in semen volume and sperm concentration with shorter abstinence periods is accompanied by a substantial improvement in sperm motility characteristics, especially progressive motility and velocity. Nevertheless, available data are insufficient to support definitive conclusions regarding the influence of the ejaculatory abstinence period on advanced semen parameters (ROS, DNA fragmentation and seminal plasma antioxidant capacity) and pregnancy rates. In conclusion, taking all data into account, shortening of the abstinence period may be beneficial to sperm quality. Furthermore, we recommend that the current guidelines regarding the prescribed abstinence period should be revisited. PMID:29043697

Perinatal Substance Use: A Prospective Evaluation of Abstinence and Relapse

PubMed Central

Forray, Ariadna; Merry, Brian; Lin, Haiqun; Ruger, Jennifer Prah; Yonkers, Kimberly A.

2015-01-01

Background Substance use decreases in pregnancy but little prospective data are available on the rates of abstinence and relapse for specific substances. This study compared rates of abstinence in pregnancy and relapse postpartum for nicotine cigarettes, alcohol, marijuana, and cocaine. Methods Data from 152 women drawn from a randomized controlled trial comparing psychological treatments for substance use in pregnancy were analyzed. Self-reports of substance use and urine for toxicology testing throughout pregnancy and 3-months, 12-months and 24-months post-delivery were collected. Multivariate Cox models were used to compare rates of abstinence and relapse across substances. Results In pregnancy, 83% of all women achieved abstinence to at least one substance. The mean (SE) days to abstinence was 145.81 (9.17), 132.01 (6.17), 151.52 (6.24), and 148.91 (7.68) for cigarettes, alcohol, marijuana and cocaine, respectively. Participants were more likely to achieve abstinence from alcohol (HR 7.24 (95% CI 4.47-11.72), marijuana (HR 4.06; 95% CI 1.87-6.22), and cocaine (HR 3.41; 95% CI 2.53-6.51), than cigarettes. Postpartum, 80% of women abstinent in the last month of pregnancy relapsed to at least one substance. The mean days to relapse was 109.67 (26.34), 127.73 (21.29), 138.35 (25.46), and 287.55 (95.85) for cigarettes, alcohol, marijuana and cocaine, respectively. Relapse to cocaine was only 34% (HR 0.34; 95% CI 0.15-0.77) that of cigarettes. Conclusions Pregnancy-related abstinence rates were high for all substances except cigarettes. Postpartum relapse was common, with cocaine using women being less likely to relapse after attaining abstinence compared to women using cigarettes, alcohol or marijuana. PMID:25772437

Self-concept mediate the relationship between childhood maltreatment and abstinence motivation as well as self-efficacy among drug addicts.

PubMed

Lu, Feng-Ying; Wen, Si; Deng, Gang; Tang, Yung-Lung

2017-05-01

Childhood maltreatment is widely accepted as a risk factor for drug addiction from adolescence to adulthood. However, the influence of childhood maltreatment on drug treatment related variables, such as drug abstinence motivation and self-concept, as well as self-efficacy, remains unclear. This study aims at exploring whether self-concept mediates the relationship between childhood maltreatment and abstinence motivation, as well as self-efficacy, among drug addicts. This study involves 816 (550 males, 226 females, mean age=34.59, range=16-58 years) drug addicts from compulsory detoxification units. Participants completed questionnaires, including the childhood trauma questionnaire 28 - item short form (CTQ - SF), Tennessee self-concept scale (TSCS), general self-efficacy scale (GSES), and drug abstinence motivation questionnaire (DAMQ). The structural equation model (SEM) analysis, including total and specific forms of maltreatment scores, showed that childhood maltreatment was negatively associated with self-concept, self-efficacy, and abstinence motivation. Self-concept was positively associated with self-efficacy and abstinence motivation. Conversely, significant association between self-efficacy and abstinence motivation did not exist. An indirect analysis showed that self-concept mediated the relationship between childhood maltreatment and self-efficacy. Critically, self-concept arbitrated the relationship between childhood maltreatment and abstinence motivation. The indirect effect of self-concept between childhood maltreatment and abstinence motivation still existed when the total scores of maltreatment were replaced by the scores of specific forms of maltreatment. These results demonstrated that self-concept is a critical factor in understanding the relationship between childhood maltreatment and abstinence motivation, as well as self-efficacy, among drug addicts. Improving the sense of self-worth may be an effective intervention therapy among drug addicts with childhood maltreatment history. Copyright © 2017 Elsevier Ltd. All rights reserved.

Maternal drug use and its effect on neonates: a population-based study in Washington State.

PubMed

Creanga, Andreea A; Sabel, Jennifer C; Ko, Jean Y; Wasserman, Cathy R; Shapiro-Mendoza, Carrie K; Taylor, Polly; Barfield, Wanda; Cawthon, Laurie; Paulozzi, Leonard J

2012-05-01

To estimate the effect of maternal illicit and prescription drug use on neonates in Washington State between 2000 and 2008. We used state-linked birth certificate and hospital discharge (mother and neonate) data to calculate prenatal drug exposure and neonatal abstinence syndrome rates, and compared state neonatal abstinence syndrome rates with national-level data from the Nationwide Inpatient Sample. We identified the drugs of exposure, examined predictors of drug exposure and neonatal abstinence syndrome, and assessed perinatal outcomes among drug-exposed and neonatal abstinence syndrome-diagnosed neonates compared with unexposed neonates. Drug exposure and neonatal abstinence syndrome rates increased significantly between 2000 and 2008, neonatal abstinence syndrome rates being consistently higher than national figures (3.3 compared with 2.8 per 1,000 births in 2008; P<.05). The proportion of neonatal abstinence syndrome-diagnosed neonates exposed prenatally to opioids increased from 26.4% in 2000 to 41.7% in 2008 (P<.05). Compared with unexposed neonates, drug-exposed and neonatal abstinence syndrome-diagnosed neonates had a lower mean birth weight, longer birth hospitalization, were more likely to be born preterm, experience feeding problems, and have respiratory conditions (all P<.001). Maternal use of illicit and prescription drugs was associated with considerable neonatal morbidity and significantly higher rates of drug exposure and neonatal abstinence syndrome in recent years. Data suggest that opioid analgesics contributed to the increase in prenatal drug exposure and neonatal abstinence syndrome in Washington State. In accordance with current guidelines, our findings emphasize the need for clinicians to screen pregnant women for illicit and prescription drug use and minimize use of opioid analgesics during pregnancy. II.

Postural Stability in Cigarette Smokers and During Abstinence from Alcohol

PubMed Central

Schmidt, Thomas Paul; Pennington, David Louis; Durazzo, Timothy Craig; Meyerhoff, Dieter Johannes

2014-01-01

Background Static postural instability is common in alcohol dependent individuals (ALC). Chronic alcohol consumption has deleterious effects on the neural and perceptual systems subserving postural stability. However, little is known about the effects of chronic cigarette smoking on postural stability and its changes during abstinence from alcohol. Methods A modified Fregly ataxia battery was administered to a total of 115 smoking (sALC) and non-smoking ALC (nsALC) and to 74 smoking (sCON) and non-smoking light/non-drinking controls (nsCON). Subgroups of abstinent ALC were assessed at 3 time points (approximately 1 week, 5 weeks, 34 weeks of abstinence from alcohol); a subset of nsCON was re-tested at 40 weeks. We tested if cigarette smoking affects postural stability in CON and in ALC during extended abstinence from alcohol, and we used linear mixed effects modeling to measure change across time points within ALC. Results Chronic smoking was associated with reduced performance on the Sharpened Romberg eyes-closed task in abstinent ALC at all three time points and in CON. The test performance of nsALC increased significantly between 1 and 32 weeks of abstinence, whereas the corresponding increases for sALC between 1 and 35 weeks was non-significant. With long-term abstinence from alcohol, nsALC recovered into the range of nsCON and sALC recovered into the range of sCON. Static postural stability decreased with age and correlated with smoking variables but not with drinking measures. Conclusions Chronic smoking was associated with reduced static postural stability with eyes closed and with lower increases of postural stability during abstinence from alcohol. Smoking cessation in alcohol dependence treatment may facilitate recovery from static postural instability during abstinence. PMID:24721012

Postural stability in cigarette smokers and during abstinence from alcohol.

PubMed

Schmidt, Thomas P; Pennington, David L; Durazzo, Timothy C; Meyerhoff, Dieter J

2014-06-01

Static postural instability is common in alcohol-dependent individuals (ALC). Chronic alcohol consumption has deleterious effects on the neural and perceptual systems subserving postural stability. However, little is known about the effects of chronic cigarette smoking on postural stability and its changes during abstinence from alcohol. A modified Fregly ataxia battery was administered to a total of 115 smoking (sALC) and nonsmoking ALC (nsALC) and to 71 smoking (sCON) and nonsmoking light/nondrinking controls (nsCON). Subgroups of abstinent ALC were assessed at 3 time points (TPs; approximately 1, 5, 34 weeks of abstinence from alcohol); a subset of nsCON was retested at 40 weeks. We tested whether cigarette smoking affects postural stability in CON and in ALC during extended abstinence from alcohol, and we used linear mixed effects modeling to measure change across TPs within ALC. Chronic smoking was associated with reduced performance on the Sharpened Romberg eyes-closed task in abstinent ALC at all 3 TPs and in CON. The test performance of nsALC increased significantly between 1 and 32 weeks of abstinence, whereas the corresponding increases for sALC between 1 and 35 weeks were nonsignificant. With long-term abstinence from alcohol, nsALC recovered into the range of nsCON and sALC recovered into the range of sCON. Static postural stability decreased with age and correlated with smoking variables but not with drinking measures. Chronic smoking was associated with reduced static postural stability with eyes closed and with lower increases of postural stability during abstinence from alcohol. Smoking cessation in alcohol dependence treatment may facilitate recovery from static postural instability during abstinence. Copyright © 2014 by the Research Society on Alcoholism.

Web-Based Smoking-Cessation Program

PubMed Central

Strecher, Victor J.; McClure, Jennifer B.; Alexander, Gwen L.; Chakraborty, Bibhas; Nair, Vijay N.; Konkel, Janine M.; Greene, Sarah M.; Collins, Linda M.; Carlier, Carola C.; Wiese, Cheryl J.; Little, Roderick J.; Pomerleau, Cynthia S.; Pomerleau, Ovide F.

2009-01-01

Background Initial trials of web-based smoking-cessation programs have generally been promising. The active components of these programs, however, are not well understood. This study aimed to (1) identify active psychosocial and communication components of a web-based smoking-cessation intervention and (2) examine the impact of increasing the tailoring depth on smoking cessation. Design Randomized fractional factorial design. Setting Two HMOs: Group Health in Washington State and Henry Ford Health System in Michigan. Participants 1866 smokers. Intervention A web-based smoking-cessation program plus nicotine patch. Five components of the intervention were randomized using a fractional factorial design: high- versus low-depth tailored success story, outcome expectation, and efficacy expectation messages; high- versus low-personalized source; and multiple versus single exposure to the intervention components. Measurements Primary outcome was 7 day point-prevalence abstinence at the 6-month follow-up. Findings Abstinence was most influenced by high-depth tailored success stories and a high-personalized message source. The cumulative assignment of the three tailoring depth factors also resulted in increasing the rates of 6-month cessation, demonstrating an effect of tailoring depth. Conclusions The study identified relevant components of smoking-cessation interventions that should be generalizable to other cessation interventions. The study also demonstrated the importance of higher-depth tailoring in smoking-cessation programs. Finally, the use of a novel fractional factorial design allowed efficient examination of the study aims. The rapidly changing interfaces, software, and capabilities of eHealth are likely to require such dynamic experimental approaches to intervention discovery. PMID:18407003

Assessing the outcomes of prolonged cessation-induction and aid-to-cessation trials: floating prolonged abstinence.

PubMed

Aveyard, Paul; Wang, Dechao; Connock, Martin; Fry-Smith, Anne; Barton, Pelham; Moore, David

2009-05-01

A Society for Research on Nicotine and Tobacco working group recommended outcome measures for cessation-induction trials and aid-to-cessation trials. Cessation-induction trials aim to motivate unwilling quitters to make a quit attempt. Aid-to-cessation trials give either medication or behavioral interventions to increase the rate at which willing quitters succeed in their attempts. Nicotine-assisted reduction programs combine features of both types of interventions by giving nicotine replacement to unwilling quitters. Treatment can be prolonged more than a year, quit attempts can occur and succeed early or late in the program, and renewed quit attempts are an inherent part of the program. Conventional outcome measures are tied to a fixed but arbitrary point in follow-up and cannot capture the true outcome: Prolonged cessation anchored to the point at which a person makes a successful quit attempt. We propose that the outcome should be counted from the successful quit attempt that began during the treatment period and continues for a defined period, ideally 6 months. In particular, if a trial compared a short reduction program with a long reduction program, it would not be possible to obtain an unbiased assessment of the outcome of such a trial using a measure tied to a fixed point in follow-up. Floating prolonged abstinence could provide such an assessment and is suitable for either prolonged cessation-induction trial or combined cessation-induction and aid-to-cessation trials.

Effects of prolonged abstinence from METH on the hippocampal BDNF levels, neuronal numbers and apoptosis in methamphetamine-sensitized rats.

PubMed

Hajheidari, Samira; Sameni, Hamid Reza; Bandegi, Ahmad Reza; Miladi-Gorji, Hossein

2017-04-03

Methamphetamine (METH) use is associated with neuronal damage in various regions of brain, while effects of prolonged abstinence on METH-induced damage are not quite clear. This study evaluated serum and hippocampal BDNF levels, neuronal numbers and apoptosis in METH-sensitized and abstinent rats. Rats were sensitized to METH (2mg/kg, daily/18 days, s.c.). All rats were evaluated for neuron counting, the TUNEL test and serum and hippocampal BDNF levels after 30 days of forced abstinence from METH. The results showed that increased BDNF levels in the hippocampus and serum of METH-sensitized rats returned to control level after 30 days of abstinence. The number of neurons in the DG and CA1 of hippocampus and also, the total hippocampal perimeter and area in METH-sensitized rats were significantly lower than the saline rats. While, the number of neurons was not significantly increased in the hippocampus after prolonged abstinence from METH. Also, METH-sensitized rats showed a significant increase in TUNEL-positive cells, whereas METH-abstinent rats showed a slight but significant decrease in TUNEL-positive cells in the DG and CA3 of hippocampus. These results suggest that despite the reduction in BDNF levels, reducing the number of neurons, perimeter and area of the hippocampus were stable after abstinence. Thus, the degenerative effects of METH have been sustained even after prolonged abstinence in the hippocampus. Copyright © 2017 Elsevier B.V. All rights reserved.

The Role of Public Schools in HIV Prevention: Perspectives from African Americans in the Rural South

ERIC Educational Resources Information Center

Lloyd, Stacey W.; Ferguson, Yvonne Owens; Corbie-Smith, Giselle; Ellison, Arlinda; Blumenthal, Connie; Council, Barbara J.; Youmans, Selena; Muhammad, Melvin R.; Wynn, Mysha; Adimora, Adaora; Akers, Aletha

2012-01-01

Though African-American youth in the South are at high risk for HIV infection, abstinence until marriage education continues to be the only option in some public schools. Using community-based participatory research methods, we conducted 11 focus groups with African-American adults and youth in a rural community in North Carolina with high rates…

[An attempt to explain fertility differentials in Upper Volta and in Ghana].

PubMed

Coulibaly, S P; Pool, I

1975-01-01

This study examines fertility differentials in Western Africa, notably in Upper Volta and in Ghana. The relationship between social and cultural transformation and fertility rate is usually seen as a matter of cause and effect. Direct variables caused by social transformation would be education, migration, and urbanization. This is not necessarily so, at least according to the Davis-Blake paradigm, which says that there are intermediate variables which intervene between fertility rate and the social system. For West Africa such variables are of 3 distinct types: 1) those which upset the normal flow of the family, such as separation due to migration, divorce, and marriage age; 2) those which influence conception itself, such as birth control, lactation and sexual abstinence; and, 3) cultural factors, such as poligamy and monogamy, type of conjugal union, and postpartum sexual abstinence. The central point of this study is that direct variables, i.e. migration, education and urbanization, do not directly influence fertility, but they influence the so-called intermediate variables, which, in turn, cause a change in fertility patterns. It must be remembered that birth control is still practically unknown in Western Africa.

A qualitative study of methamphetamine users' perspectives on barriers and facilitators of drug abstinence.

PubMed

Herbeck, Diane M; Brecht, Mary-Lynn; Christou, Dayna; Lovinger, Katherine

2014-01-01

To better understand methamphetamine (MA) use patterns and the process of recovery, qualitative interviews were conducted with adult MA users (n = 20), comparing a sample that received substance abuse treatment with those who had not received treatment. Respondents provided detailed information on why and how they changed from use to abstinence and factors they considered to be barriers to abstinence. Audio recordings and transcripts were reviewed for common themes. Participants reported a range of mild/moderate to intensely destructive problems, including loss of important relationships and profound changes to who they felt they were at their core; e.g., "I didn't realize how dark and mean I was … I was like a different person." Initial abstinence was often facilitated by multiple external forces (e.g., drug testing, child custody issues, prison, relocation), but sustained abstinence was attributed to shifts in thinking and salient realizations about using. The treatment group reported using more and different resources to maintain their abstinence than the no-treatment group. Findings indicate individualized interventions and multiple, simultaneous approaches and resources were essential in reaching stable abstinence. Understanding long-term users' experiences with MA use, addiction, and abstinence can inform strategies for engaging and sustaining MA users in treatment and recovery.

Predictors of Abstinence Self-Efficacy: Examining the role of HIV-risk Sexual Behavior.

PubMed

Majer, John M; Glantsman, Olya; Palmer, John S; Jason, Leonard A

Abstinence self-efficacy, or the confidence in ones' beliefs in one's ability to effectively engage in behaviors to maintain substance use abstinence, is a crucial recovery resource. However, little research has been conducted on what predicts increases in this recovery resource. Understanding predictors of abstinence self-efficacy could help social service practitioners in creating effective treatment plans/interventions while extending what is presently known in this small body of research. Predictors of abstinence self-efficacy were analyzed among a sample of ex-offenders (224 men and 46 women) who were completing inpatient treatment for substance use disorders. Hierarchical linear regression was conducted to examine changes in participants' abstinence self-efficacy in relation to factors directly related (HIV-risk drug use behaviors, substance use, 12-step meeting attendance) and indirectly related (HIV-risk sexual behaviors, incarceration histories) to substance use. HIV-risk sexual behaviors and substance use predicted significant decreases in abstinence self-efficacy whereas 12-step meeting attendance predicted significant increases. However, incarceration histories and HIV-risk drug use behaviors were not significant predictors of abstinence self-efficacy. Findings suggest HIV-risk sexual behavior should be considered when assessing relapse prevention for persons with substance use disorders, and that researchers should examine behaviors that are not directly related to substance use when investigating recovery resources.

The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips.

PubMed

Dawkins, Lynne; Acaster, Sarah; Powell, Jane H

2007-02-01

Incentive motivation theories of addiction suggest that behavioural concomitants of compromised mesocorticolimbic reward activity during abstinence might include decreased affective reactions to natural reinforcers. This study tested implications for hedonic reactions in abstinent smokers. It was hypothesised that positively valenced (pleasurable) film clips would elicit lower ratings of happiness in abstinent than satiated smokers. Twenty-nine smokers, randomly assigned to either an 'abstinent' or a 'satiated' condition, and 15 non-smokers took part in a single session in which they rated (i) signs and symptoms of nicotine withdrawal and (ii) affective responses to positively valenced, negatively valenced, and neutral film clips. Compared with satiated smokers, abstinent smokers rated positive clips as eliciting significantly lower levels of happiness, and this was independent of self-reported nicotine withdrawal symptoms; the scores of non-smokers fell between those of abstinent and satiated smokers, more closely approximating those of the latter. By contrast, sadness ratings in response to negative clips were not affected by smoking status, indicating that the effect on happiness was not simply due to general emotional blunting. These results suggest that, for regular smokers, stimuli that are motivationally salient for the general population may elicit reduced positive affective responses during periods of abstinence.

A Qualitative Study of Methamphetamine Users’ Perspectives on Barriers and Facilitators of Drug Abstinence

PubMed Central

Herbeck, Diane M.; Brecht, Mary-Lynn; Christou, Dayna; Lovinger, Katherine

2014-01-01

To better understand methamphetamine (MA) use patterns and the process of recovery, qualitative interviews were conducted with adult MA users (n=20), comparing a sample that received substance abuse treatment with those who had not received treatment. Respondents provided detailed information on why and how they changed from use to abstinence, and factors they considered to be barriers to abstinence. Audio recordings and transcripts were reviewed for common themes. Participants reported a range of mild/moderate to intensely destructive problems, including loss of important relationships and profound changes to who they felt they were at their core, e.g., “I didn’t realize how dark and mean I was... I was like a different person.” Initial abstinence was often facilitated by multiple external forces (e.g., drug testing, child custody issues, prison, relocation), but sustained abstinence was attributed to shifts in thinking and salient realizations about using. The treatment group reported using more and different resources to maintain their abstinence than the no treatment group. Findings indicate individualized interventions and multiple, simultaneous approaches and resources were essential in reaching stable abstinence. Understanding long-term users’ experiences with MA use, addiction and abstinence can inform strategies for engaging and sustaining MA users in treatment and recovery. PMID:25052880

[Postpartum risk factors in the development of children born to opiate-addicted mothers; comparison between mothers with and without methadone substitution].

PubMed

Ziegler, M; Poustka, F; von Loewenich, V; Englert, E

2000-09-01

In a retrospective case control study at the University of Frankfurt, Germany, 101 babies born to opiate-addicted mothers were identified from birth charts from 1988 to 1995. After birth, they developed a withdrawal syndrome (neonatal abstinence syndrome). Fifty control infants and their mothers were selected from neonatal wards. The group of opiate-exposed babies was subdivided into a group born to mothers without methadone treatment (n = 48) and a group born to mothers who were enrolled in a methadone program (n = 51). The methadone infants had a significantly higher mean birth weight (2822 g) than children in the group without methadone (2471 g). The abstinence syndrome was much more intense in the methadone group (convulsions 47.1%) than in heroin-exposed babies without methadone treatment (convulsions 27.1%). Women in methadone maintenance programs lived in more stable socioeconomic conditions than opiate-addicted women without methadone substitution. Moreover, they cared significantly better for their babies: 81.3% of the methadone mothers visited their children on a regular basis and 90.9% cared adequately. The data emphasize the need in future research to look more closely at the role of methadone treatment programs in the development of opiate-exposed babies.

Moderate intensity exercise as an adjunct to standard smoking cessation treatment for women: a pilot study.

PubMed

Williams, David M; Whiteley, Jessica A; Dunsiger, Shira; Jennings, Ernestine G; Albrecht, Anna E; Ussher, Michael H; Ciccolo, Joseph T; Parisi, Alfred F; Marcus, Bess H

2010-06-01

Previous randomized controlled trials have not supported moderate intensity exercise as an efficacious adjunct to smoking cessation treatments for women; however, compliance with exercise programs in these studies has been poor. The purpose of this pilot study was to estimate the effects of moderate intensity exercise on smoking cessation outcomes under optimal conditions for exercise program compliance. Sixty previously sedentary, healthy, female smokers were randomized to an 8-week program consisting of brief baseline smoking cessation counseling and the nicotine patch plus either 150 min/week of moderate intensity exercise or contact control. Participants attended a median of 86.4% and 95.5% of prescribed exercise/control sessions, respectively. There was a moderate, though statistically nonsignificant, effect of exercise at post-treatment for objectively verified 7-day point prevalence abstinence (48.3% vs. 23.3%; OR = 3.07, 95% CI: 0.89-11.07) and prolonged abstinence (34.5% vs. 20.0%; OR = 2.11, 95% CI: 0.56-8.32). Effects were attenuated when controlling for potential confounders, and after a 1-month, no-treatment period. The findings provide a preliminary indication that, given adequate compliance, moderate intensity exercise may enhance short-term smoking cessation outcomes for women; however, a larger trial is warranted. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

Contingency management in the 21st century: technological innovations to promote smoking cessation.

PubMed

Dallery, Jesse; Raiff, Bethany R

2011-01-01

Information technology represents an excellent medium to deliver contingencies of reinforcement to change behavior. Recently, we have linked the Internet with a science-based, behavioral treatment for cigarette smoking: abstinence reinforcement therapy. Under abstinence reinforcement interventions, incentives are provided for objective evidence of abstinence. Several studies suggest that the intervention is effective in initiating abstinence. The intervention addresses limitations (access, cost, sustainability, and dissemination potential) inherent in traditional abstinence reinforcement delivery models. It can also be applied to vulnerable, at-risk populations, and to other behavior to promote health. Information technologies offer unprecedented and rapidly expanding opportunities to facilitate behavior change.

Housing and abstinence self-efficacy in formerly incarcerated individuals

PubMed Central

Whipple, Christopher R.; Jason, Leonard A.; Robinson, W. LaVome

2016-01-01

To avoid recidivism, formerly-incarcerated individuals must successfully navigate barriers to re-entry, including finding adequate housing and avoiding substance use. This study examined the role that time in diverse housing situations affect abstinence self-efficacy in formerly-incarcerated individuals. Formerly-incarcerated individuals were surveyed about previous housing situations and abstinence self-efficacy after release from prison or inpatient substance use treatment. Models were estimated with both days spent in different housing situations in the past 180 and past 30 days. More time spent in recovery situations was associated with increased abstinence self-efficacy, while more time spent in precarious situations was associated with decreased abstinence self-efficacy. PMID:28603403

Predictors of Smokeless Tobacco Abstinence

PubMed Central

Ebbert, Jon O.; Glover, Elbert; Shinozaki, Eri; Schroeder, Darrell R.; Dale, Lowell C.

2010-01-01

Objectives To investigate predictors of tobacco abstinence among smokeless tobacco (ST) users. Methods Logistic regression analyses assessed characteristics associated with tobacco abstinence among ST users receiving bupropion SR. Results Older age was associated with increased tobacco abstinence in both placebo and bupropion SR groups at end of treatment and one year. Abstinence was lower at one year for subjects with a history of major depression. At end of treatment, a 2-way interaction was detected suggesting bupropion SR may be efficacious for subjects with other household tobacco users. Conclusions Younger ST users and those with a history of depression are less likely to quit ST use. PMID:18442352

American Academy of Pediatrics. Policy statement--sexuality, contraception, and the media.

PubMed

2010-09-01

From a health viewpoint, early sexual activity among US adolescents is a potential problem because of the risk of pregnancy and sexually transmitted infections. New evidence points to the media adolescents use frequently (television, music, movies, magazines, and the Internet) as important factors in the initiation of sexual intercourse. There is a major disconnect between what mainstream media portray-casual sex and sexuality with no consequences-and what children and teenagers need-straightforward information about human sexuality and the need for contraception when having sex. Television, film, music, and the Internet are all becoming increasingly sexually explicit, yet information on abstinence, sexual responsibility, and birth control remains rare. It is unwise to promote "abstinence-only" sex education when it has been shown to be ineffective and when the media have become such an important source of information about "nonabstinence." Recommendations are presented to help pediatricians address this important issue.

Environmental enrichment and abstinence attenuate ketamine-induced cardiac and renal toxicity

PubMed Central

Li, Xingxing; Li, Shuangyan; Zheng, Wenhui; Pan, Jian; Huang, Kunyu; Chen, Rong; Pan, Tonghe; Liao, Guorong; Chen, Zhongming; Zhou, Dongsheng; Shen, Wenwen; Zhou, Wenhua; Liu, Yu

2015-01-01

The current study was designed to investigate the effect of abstinence in combination with environmental enrichment (EE) on cardiac and renal toxicity induced by 2 weeks of ketamine self-administration (SA) in rodents. In Experiment 1, one group of rats underwent ketamine SA for 14 days. In Experiment 2, the animals completed 2 weeks of ketamine SA followed by 2 and 4 weeks of abstinence. In Experiment 3, animals underwent 14 days of ketamine SA and 4 weeks of abstinence in which isolated environment (IE) and EE was introduced. The corresponding control groups were included for each experiment. Two weeks of ketamine SA caused significant increases in organ weight, Apoptosis Stimulating Fragment/Kidney Injury Molecule-1, and apoptotic level of heart and kidney. The extended length of withdrawal from ketamine SA partially reduced toxicity on the heart and kidney. Finally, introduction of EE during the period of abstinence greatly promoted the effect of abstinence on ketamine-induced cardiac and renal toxicity. The interactive effect of EE and abstinence was promising to promote the recovery of cardiac and renal toxicity of ketamine. PMID:26112338

Investigating Social Support and Network Relationships in Substance Use Disorder Recovery.

PubMed

Stevens, Ed; Jason, Leonard A; Ram, Daphna; Light, John

2015-01-01

Social support and characteristics of one's social network have been shown to be beneficial for abstinence and substance use disorder recovery. The current study explores how specific sources of social support relate to general feelings of social support and abstinence-specific self-efficacy. Data were collected from 31 of 33 individuals residing in 5 recovery houses. Participants were asked to complete social support and social network measures, along with measures assessing abstinence from substance use, abstinence self-efficacy, and involvement in 12-step groups. A significant positive relationship was found between general social support and abstinence-specific self-efficacy. General social support was also significantly associated with the specific social support measures of sense of community and Alcoholics Anonymous (AA) affiliation. Social network size predicted abstinence-related factors such as AA affiliation and perceived stress. These results provide insight regarding individual feelings of social support and abstinence-specific self-efficacy by showing that one's social network-level characteristics are related to one's perceptions of social support. We also found preliminary evidence that individual Oxford Houses influence one's feelings of social support.

Training Lay Interventionists to Support Tobacco Cessation among Teachers in India.

PubMed

Aghi, Mira; Nagler, Eve; Lando, Harry; Pednekar, Mangesh; Gupta, Prakash; Sorensen, Glorian

2016-01-01

Despite the rapidly increasing burden of tobacco-related morbidity and mortality in low- and middle-income countries, tobacco control initiatives - especially cessation - receive little emphasis. This is true despite low-cost methods that have potential for widespread dissemination. The purpose of this paper is to provide a case study example of how lay interventionists may be trained and supported to facilitate tobacco use cessation, based on the successful Tobacco Free Teachers-Tobacco Free Society program (TFT-TFS) implemented in Bihar, India. This school-based program included multiple components, with lay interventionists having a crucial role. The lay interventionists included health educators and lead teachers, both of whom were selected based on formative research, underwent extensive training and received continuing support. We emphasized encouraging and supporting teachers to quit tobacco use and engaging both tobacco users and nonusers to create a supportive environment for cessation. We also stressed that neither the health educators nor lead teachers were being trained as counselors or as cessation experts. We focused on the importance of respecting teachers as individuals and identifying locally relevant methods of cessation. Although we cannot isolate the precise contribution of the lay interventionists to the successful TFT-TFS intervention, the abstinence findings in favor of the intervention at follow up are highly encouraging. Teachers have been neglected as lay interventionists for tobacco cessation despite the fact that they tend to be highly respected and credible. The approach used for TFT-TFS could be disseminable in multiple low- and middle-income country contexts through train-the-trainer programs targeted to teachers.

A cost-benefit analysis of the outpatient smoking cessation services in Taiwan from a societal viewpoint.

PubMed

Chen, Pei-Ching; Lee, Yue-Chune; Tsai, Shih-Tzu; Lai, Chih-Kuan

2012-05-01

This study applied a cost-benefit analysis from a societal viewpoint to evaluate the Outpatient Smoking Cessation Services (OSCS) program. The costs measured in this study include the cost to the health sector, non-health sectors, the patients and their family, as well as the loss of productivity as a result of smoking. The benefits measured the medical costs savings and the earnings due to the increased life expectancy of a person that has stopped smoking for 15 years. Data were obtained from the primary data of a telephone survey, the literatures and reports from the Outpatient Smoking Cessation Management Center and government. Sensitivity analyses were conducted to verify the robustness of the results. There were 169,761 cases that participated in the outpatient smoking cessation program in the years 2007 and 2008, of those cases, 8,282 successfully stopped smoking. The total cost of the OSCS program was 18 million USD. The total benefits of the program were 215 million USD with a 3% discount rate; the net benefit to society was 196 million USD. After conducting sensitivity analyses on the different abstinence, relapse, and discount rates, from a societal perspective, the benefits still far exceeded the costs, while from a health care perspective, there was only a net benefit when the respondent's abstinence rate was used. From a societal perspective, the OSCS program in Taiwan is cost-beneficial. This study provides partial support for the policy makers to increase the budget and expand the OSCS program.

Attributions for Long-Term Maintenance of Smoking Cessation or Relapse.

ERIC Educational Resources Information Center

Epstein, Jennifer A.; And Others

A previous study examined determinants of attributions for success or failure in stopping smoking in a self-help treatment program with and without a drug component. This follow-up study examined the attributions that successful quitters made after remaining abstinent through 12 months, or after they relapsed. Subjects (N=137) had been assigned to…

Comparing School-Based Teen Pregnancy Prevention Programming: Mixed Outcomes in an At-Risk State

ERIC Educational Resources Information Center

Oman, Roy F.; Merritt, Breanca T.; Fluhr, Janene; Williams, Jean M.

2015-01-01

Background: The purpose of this study is to compare the effectiveness of a national comprehensive teen pregnancy prevention (TPP) intervention to a national abstinence-only TPP intervention on middle school students' knowledge, attitudes, and behaviors related to teen sexual behaviors in a state with high teen birth rates. Methods: Pre- and…

Understanding the prevalence of lifetime abstinence from alcohol: An ecological study.

PubMed

Probst, Charlotte; Manthey, Jakob; Rehm, Jürgen

2017-09-01

The level of alcohol consumption and related burden in a country are strongly impacted by the prevalence of abstinence from alcohol use. The objective of this study was to characterize the association of lifetime abstinence from alcohol use with economic wealth (as measured in the gross domestic product [GDP]) and Muslim religion on a country level. An ecological study was performed using aggregate data of 183 countries for the year 2010. Lifetime abstinence among men and women was predicted using fractional response regression models with the natural logarithm of GDP-PPP (purchasing power parity) and the proportion of Muslim population as predictors. The models were further adjusted by the country's median age and World Health Organization region. Precision of prediction was investigated. Descriptive analyses showed a strong negative association between GDP-PPP and lifetime abstinence in countries without a Muslim majority and a GDP-PPP up to 20,000 international dollars. Regression models confirmed the negative association with GDP-PPP and showed a strong positive association between lifetime abstinence and the proportion of Muslim population. Stratified sensitivity analyses showed that in countries without a Muslim majority only GDP-PPP showed a statistically significant association whereas in Muslim majority countries only the proportion of Muslims was associated with the prevalence of lifetime abstinence. Particularly in countries with a lower GDP and without Muslim majority the prevalence of lifetime abstinence from alcohol use is strongly negatively associated with GDP-PPP. Future research should analyze the accordance in trends of GDP and lifetime abstinence over time. Copyright © 2017 Elsevier B.V. All rights reserved.

Effects of smoking abstinence on impulsive behavior among smokers high and low in ADHD-like symptoms

PubMed Central

Hawk, Larry W.

2011-01-01

Rationale Impulsivity, a multifaceted construct that includes inhibitory control and heightened preference for immediate reward, is central to models of drug use and abuse. Within a self-medication framework, abstinence from smoking may lead to an increase in impulsive behavior and the likelihood of relapse, particularly among persons with disorders (e.g., attention-deficit/hyperactivity disorder, ADHD) and personality traits (e.g., impulsivity) linked to impulsive behavior. Objectives This study aimed to examine the effects of smoking abstinence on multiple measures of impulsivity among a non-clinical sample of adult smokers selected for high and low levels of ADHD symptoms. Methods In a within-subjects design, participants selected for high or low levels of self-reported ADHD symptoms (N=56) completed sessions following overnight abstinence and when smoking as usual (order counterbalanced). Measures of impulsive behavior included response inhibition (i.e., stop signal task), interference control (i.e., attentional modification of prepulse inhibition (PPI) of startle), and impulsive choice (i.e., hypothetical delay discounting). Results As hypothesized, abstinence decreased response inhibition and PPI. Although ADHD symptoms moderated abstinence effects on impulsive choice and response inhibition, the pattern was opposite to our predictions: the low-ADHD group responded more impulsively when abstinent, whereas the high-ADHD group was relatively unaffected by abstinence. Conclusions These findings highlight the importance of utilizing multiple laboratory measures to examine a multifactorial construct such as impulsive behavior and raise questions about how best to assess symptoms of ADHD and impulsivity among non-abstinent smokers. PMID:21559802

Messages About Abstinence, Delaying Sexual Debut and Sexual Decision-Making in Conversations Between Mothers and Young Adolescents.

PubMed

Ramchandani, Kanika; Morrison, Penelope; Gold, Melanie A; Akers, Aletha Y

2018-04-01

Little is known about the information shared during family discussions about sexuality. From a public health perspective, abstinence is one of the most important sexuality topics parents can talk about with adolescents. We sought to characterize the messages mothers communicate to young adolescents regarding abstinence. Content analysis of dyadic discussions that occurred between June 2011-December 2012 between mothers and their 10- to 14-year-old adolescent sons and daughters. Discussions were audio-recorded, transcribed, and a grounded theory approach to content analysis performed. Urban city in Western Pennsylvania. Twenty-one dyads; 15 mother-daughter dyads and 6 mother-son dyads. None. None. Four key themes emerged reflecting the high priority mothers placed on abstinence, delaying their adolescent's sexual debut, and nurturing sexual decision-making skills. Theme 1 focused on ensuring that adolescents understand what abstinence means. In defining abstinence, only 1 mother explained what sex is. The 3 remaining themes emphasized sexual decision-making and emphasized when it is acceptable to stop being abstinent (theme 2), why abstinence is important (theme 3), and mothers' desire to engage in ongoing discussions, particularly when an adolescent was considering becoming sexually active (theme 4). Messages did not vary according to mothers' age or according to adolescent age, gender, or race. Mothers convey complex information about abstinence and sexual decision-making to young, non-sexually active adolescents. Message tailoring on the basis of the adolescents' age or sex was not observed. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

Measuring Outcome in the Treatment of Cocaine Dependence

PubMed Central

Crits-Christoph, Paul; Gallop, Robert; Gibbons, Mary Beth Connolly; Sadicario, Jaclyn S.; Woody, George

2015-01-01

Background Little in known about the extent to which outcome measures used in studies of the treatment of cocaine dependence are associated with longer-term use and with broader measures of clinical improvement. The current study examined reductions in use, and abstinence-oriented measures, in relation to functioning and longer-term clinical benefits in the treatment of cocaine dependence. Methods Overall drug use, cocaine use, and functioning in a number of addiction-related domains for 487 patients diagnosed with DSM-IV cocaine dependence and treated with one of four psychosocial interventions in the NIDA Cocaine Collaborative Treatment Study were assessed monthly during 6 months of treatment and at 9, 12, 15, and 18 month follow-up. Results Measures of during-treatment reduction in use were moderately correlated with drug and cocaine use measures 12 months, but showed non-significant or small correlations with measures of functioning at 12 months. Highest correlations were evident for abstinence measures (maximum consecutive days abstinence and completely abstinent) during treatment in relation to sustained (3 month) abstinence at 12 months. Latent class analysis of patterns of change over time revealed that most patients initially (months 1 to 4 of treatment) either became abstinent immediately or continued to use every month. Over the couse of follow-up, patients either maintained abstinence or used regularly – intermittent use was less common. Conclusions There were generally small associations between various measures of cocaine use and longer-term clinical benefits, other than abstinence was associated with continued abstinence. No one method of measuring outcome of treatment of cocaine dependence appears superior to others. PMID:26366427

A Control Theory Model of Smoking

PubMed Central

Bobashev, Georgiy; Holloway, John; Solano, Eric; Gutkin, Boris

2017-01-01

We present a heuristic control theory model that describes smoking under restricted and unrestricted access to cigarettes. The model is based on the allostasis theory and uses a formal representation of a multiscale opponent process. The model simulates smoking behavior of an individual and produces both short-term (“loading up” after not smoking for a while) and long-term smoking patterns (e.g., gradual transition from a few cigarettes to one pack a day). By introducing a formal representation of withdrawal- and craving-like processes, the model produces gradual increases over time in withdrawal- and craving-like signals associated with abstinence and shows that after 3 months of abstinence, craving disappears. The model was programmed as a computer application allowing users to select simulation scenarios. The application links images of brain regions that are activated during the binge/intoxication, withdrawal, or craving with corresponding simulated states. The model was calibrated to represent smoking patterns described in peer-reviewed literature; however, it is generic enough to be adapted to other drugs, including cocaine and opioids. Although the model does not mechanistically describe specific neurobiological processes, it can be useful in prevention and treatment practices as an illustration of drug-using behaviors and expected dynamics of withdrawal and craving during abstinence. PMID:28868531

Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs.

PubMed

Thylstrup, Birgitte; Schrøder, Sidsel; Fridell, Mats; Hesse, Morten

2017-01-09

People in treatment for substance use disorder commonly have comorbid personality disorders, including antisocial personality disorder. Little is known about treatments that specifically address comorbid antisocial personality disorder. Self-rated help received for antisocial personality disorder was assessed during follow-ups at 3, 9 and 15 months post-randomization of a randomized trial of psychoeducation for people with comorbid substance use and antisocial personality disorder (n = 175). Randomization to psychoeducation was associated with increased perceived help for antisocial personality disorder. Perceived help for antisocial personality disorder was in turn associated with more days abstinent and higher treatment satisfaction at the 3-month follow-up, and reduced risk of dropping out of treatment after the 3-month follow-up, and perceived help mediated the effects of random assignment on days abstinent at 3-month. Brief psychoeducation for antisocial personality disorder increased patients' self-rated help for antisocial personality disorder in substance abuse treatment, and reporting having received help for antisocial personality disorder was in turn associated with better short-term outcomes, e.g., days abstinent, dropout from treatment and treatment satisfaction. ISRCTN registry, ISRCTN67266318 , retrospectively registered 17/7/2012.

Factors Associated With Intentions to Engage in Vaginal Intercourse Among Sexually Abstinent Missouri High School Freshmen.

PubMed

Watts, Timothy; Wilson, Kelly L; McNeill, Elisa B; Rosen, Brittany L; Moore, Nancy Daley; Smith, Matthew L

2016-10-01

We examine personal characteristics, alcohol consumption, normative beliefs, household factors, and extracurricular engagement associated with intentions to have intercourse before marriage among abstinent students. Data were analyzed from 245 freshmen enrolled in a school-based abstinence-only-until-marriage program. Two binary logistic regression analyses identified factors associated with intentions to engage in intercourse before marriage and within the next year. Approximately 21% and 14% of participants reported intentions to have intercourse. Respondents participated in 2.2 (standard deviation [SD] = 1.2) extracurricular activities. Freshmen who were male, perceived their friends to approve of premarital sex, and consumed alcohol were more likely to report intentions to have intercourse. For every additional extracurricular activity in which freshmen participated, they were less likely to report intentions to have intercourse within the next year (odds ratio [OR] = 0.56). Factors such as extracurricular activities provide youth with opportunities to build supportive relationships, connect with peers and role models, and positively engage in schools and communities. Extracurricular activities typically already exist, have funding, and are generally well-supported. School-based strategies can increase teenagers' autonomy by providing a variety of activities to participate in and reduce unsupervised time. This, in turn, has the potential to decrease sexual risk taking behaviors. © 2016, American School Health Association.

Gender differences in negative affect during acute tobacco abstinence differ between African American and White adult cigarette smokers.

PubMed

Pang, Raina D; Bello, Mariel S; Liautaud, Madalyn M; Weinberger, Andrea H; Leventhal, Adam M

2018-06-15

Prior studies have found heightened negative affect following tobacco abstinence in women compared to men. However, experimental work addressing whether these findings generalize across racial groups is scarce. The current study investigated whether race (Non-Hispanic White vs. Non-Hispanic African American) moderated gender differences in abstinence-induced negative affect and smoking behavior. Data were collected from 2010 to 2017 from two separate laboratory studies investigating experimentally manipulated tobacco abstinence. Following a baseline session, adult daily smokers (10 cigarettes per day; women: n=297, 83.8% Non-Hispanic African American; men: n=492, 86.2% Non-Hispanic African American) attended two counterbalanced lab sessions (16 hours abstinent vs. non-abstinent) and completed self-report measures of negative affect followed by a laboratory analogue smoking reinstatement task. We found a gender race interaction for several negative affect states and composite negative affect (ßs=-.12 to -.16, ps<.05). Analyses stratified by race showed that Non-Hispanic White women compared to Non-Hispanic White men exhibited greater abstinence-induced increases in anger, anxiety, and composite negative affect (ßs=-.20 to -.29, ps<.05). No significant gender differences in abstinence-induced negative affect were found for Non-Hispanic African American smokers (ßs=.00 to -.04, ps>.05). These findings suggest that negative affect during acute tobacco abstinence may be a clinically important and intervenable factor that can inform cessation interventions specifically for Non-Hispanic White women smokers. Further empirical exploration of mechanisms underlying interactions of gender and race in tobacco addiction may benefit smoking cessation efforts in Non-Hispanic African American women smokers. The current study contributes to a scant body of research examining the intersectional influence of race and gender on abstinence-induced negative affect-a central, motivationally prepotent feature of tobacco withdrawal. Using a laboratory-based design to experimentally manipulate abstinence, we provide evidence of a gender race interaction on negative affect-related withdrawal. Our findings suggest that gender differences in abstinence-induced negative affect observed among Non-Hispanic White smokers may not generalize to Non-Hispanic African American smokers, highlighting the need for future work to address potential mechanisms underlying the racially discrepant impact of gender on affective tobacco withdrawal.

A pilot assessment of relapse prevention for heroin addicts in a Chinese rehabilitation center.

PubMed

Min, Zhao; Xu, Li; Chen, Hanhui; Ding, Xu; Yi, Zhang; Mingyuang, Zhang

2011-05-01

To conduct a pilot assessment of relapse prevention (RP) group therapy for heroin-dependent patients in a drug rehabilitation center in China. A randomized case-control study was conducted to assess the efficacy of RP delivered over a 2-month period to male heroin addicts (n = 50, RP group) in the Shanghai Labor Drug Rehabilitation Center (LDRC) compared with an equal number of participants (n = 50, labor rehabilitation (LR) group) in the LDRC program receiving standard-of-care treatment. Outcomes were assessed by the Beck Depression Inventory (BDI), the Self-Rating Anxiety Scale (SAS), the Self-Efficacy Scale (SE), and the Self-Esteem Scale (SES) after completion of RP, and by the Addiction Severity Index (ASI) and abstinence rates of heroin use at 3-month follow-up post release from the LDRC for both groups. Significant improvements in scores on SAS, SE, and SES were found in the RP group after completion of the 2-month RP group therapy compared with the LR group (SAS 7.85 ± 6.20 vs 1.07 ± 5.42, SE 3.88 ± 3.60 vs .08 ± 2.89, and SES 3.83 ± 3.31 vs .78 ± 2.55). At 3-month follow-up, the RP group participants had more improvements on ASI scores in most domains and had higher abstinence rates than that in the LR group (37.2% vs 16.7%). An RP component can be effective in increasing abstinence rates among post-program heroin-dependent individuals and may help reduce anxiety and improve self-esteem and self-efficacy during and following treatment. This study suggests RP as a potentially effective component of treatment for heroin addicts.

Hypnotherapy is more effective than nicotine replacement therapy for smoking cessation: results of a randomized controlled trial.

PubMed

Hasan, Faysal M; Zagarins, Sofija E; Pischke, Karen M; Saiyed, Shamila; Bettencourt, Ann Marie; Beal, Laura; Macys, Diane; Aurora, Sanjay; McCleary, Nancy

2014-02-01

The efficacy of pharmacotherapy for smoking cessation is well documented. However, due to relapse rates and side effects, hypnotherapy is gaining attention as an alternative treatment option. The aim of this one-center randomized study was to compare the efficacy of hypnotherapy alone, as well as hypnotherapy with nicotine replacement therapy (NRT), to conventional NRT in patients hospitalized with a cardiac or pulmonary illness. We evaluated self-reported and biochemically verified 7-day prevalence smoking abstinence rates at 12 and 26 weeks post-hospitalization. Patients (n=164) were randomized into one of three counseling-based treatment groups: NRT for 30 days (NRT; n=41), a 90-min hypnotherapy session (H; n=39), and NRT with hypnotherapy (HNRT; n=37). Treatment groups were compared to a "self-quit" group of 35 patients who refused intervention. Hypnotherapy patients were more likely than NRT patients to be nonsmokers at 12 weeks (43.9% vs. 28.2%; p=0.14) and 26 weeks after hospitalization (36.6% vs. 18.0%; p=0.06). Smoking abstinence rates in the HNRT group were similar to the H group. There was no difference in smoking abstinence rates at 26 weeks between "self quit" and participants in any of the treatment groups. In multivariable regression analysis adjusting for diagnosis and demographic characteristics, H and HNRT were over three times more likely than NRT participants to abstain at 26-weeks post-discharge (RR=3.6; p=0.03 and RR=3.2; p=0.04, respectively). Hypnotherapy is more effective than NRT in improving smoking abstinence in patients hospitalized for a smoking-related illness, and could be an asset to post-discharge smoking cessation programs. Copyright © 2014 Elsevier Ltd. All rights reserved.