| Summary of Prior Research Findings
PICS, Inc. research and development is funded, in part, by Small
Business Innovation Research (SBIR) grants awarded by the National Institute on
Drug Abuse (NIDA) and the National Cancer Institute (NCI). Here are some of the
reports and published articles associated with these studies.
LifeSign Publications
Prue, D. M., Riley, A., W., Orlandi, M. A., & Jerome, A. (1990). Development
of a computer-assisted smoking cessation program: A preliminary report. Journal
of Advancement in Medicine, 3, 131-139.
The effectiveness of a self-help smoking cessation program implemented by a
hand-held micro computer was evaluated with 77 smokers. The computer implements
a gradual rate reduction protocol that targets both physiological dependence on
nicotine and conditioned stimuli that may elicit smoking. One-year post
treatment abstinence rates for two samples of smokers were 18.5% and 22%. The
results of this study suggest that a computer-based self-help program may meet
the needs of health care providers for an easily administered, effective tool
for assisting patients with smoking cessation.
Jerome, A., Perrone, R., & Kalfus, G. (1992). Computer-assisted smoking
treatment: A controlled evaluation and long-term follow-up. Journal of
Advancement in Medicine, 5, 29-41.
The present study provided a controlled outcome evaluation and long-term
follow-up assessment of a computer-assisted smoking treatment (CAST),
implemented by a credit card-sized, fully dedicated microcomputer. Seventy-one
smokers were randomly assigned to one of three groups: 1) CAST, 2) CAST plus
therapist assistance, or 3) waitlist control. Results indicated that subjects
complied with the computer treatment protocol and that daily cigarette
consumption and carbon monoxide levels decreased across treatment weeks in both
CAST groups. At 18-month follow-up, 24% of subjects in the CAST group and 36%
of subjects in the CAST plus therapist assistance group were abstinent. These
findings are comparable to outcomes reported for many clinic-based
interventions and thereby suggest that this CAST program can be utilized
effectively in either a self-help or therapist-assisted format.
Jerome, A., Fiero, P. L., & Behar, A. (2000). Computerized scheduled gradual
reduction for smokeless tobacco cessation: Development and preliminary
evaluation of a self-help program. Computers in Human Behavior, 16,
493-505.
The paper chronicles the development and feasibility testing of a computerized
scheduled gradual reduction program for smokeless tobacco cessation. During
Study 1, the LifeSign smoking cessation computer was adapted for use with
smokeless tobacco by pairing it with an electronic timer. The computer recorded
frequency of dips during a baseline phase and prompted for tobacco use during a
gradual reduction phase. The timer was used to track the length of dips during
baseline and to hold them to a fixed length during the reduction phase.
Abstinence rates among 60 male daily smokeless tobacco users who received the
program were 29% at 3-month follow-up (biochemically validated) and 19% at
12-month follow-up. Self-reported changes in topography of tobacco use were
consistent with the scheduled reduction protocol. Study 2 evaluated a prototype
computer that tracked both frequency and duration of dips during baseline and
gradually reduced both parameters during the reduction phase. Among 19 subjects
who received the program, self-reported abstinence was 56% at end of treatment
and 11% at 12-month follow-up. Results of these two studies demonstrate the
feasibility of computerized scheduled gradual reduction for smokeless tobacco
cessation and provide a basis for further product development.
Severson, H. H., Akers, L., Andrews, J. A., Lichtenstein, E., & Jerome, A.
(2000). Evaluating two self-help interventions for smokeless tobacco cessation. Addictive
Behaviors, 25, 465-470.
The need for effective, low-cost self-help treatment methods for smokeless
tobacco (ST) addiction becomes more evident as rates of product use and
associated morbidities increase. This study evaluated two self-help methods for
ST cessation. One hundred ninety-eight ST users were randomly assigned into two
conditions: half received LifeSign, a credit-card sized computer designed for
gradual ST cessation, and half received the Enough Snuff self-help manual and a
video. Subjects in both conditions received telephone support for their quit
effort. The study was conducted entirely through phone and mail, allowing the
delivery of the intervention to both rural and urban users. Self-reported rates
of sustained abstinence (no tobacco use at two months and six months) were
24.5% for the manual/video condition, and 18.4% for the LifeSign condition.
Riley, W., Jerome, A., Behar, A., & Zack, S. (2002). Feasibility of
computerized scheduled gradual reduction for adolescent smoking cessation. Substance
Use & Misuse, 37, 277-285.
The purpose of this project was to modify a smoking cessation program that uses
computerized scheduled gradual reduction for use with adolescent smokers and to
test the feasibility of this cessation approach in group support and minimal
contact modalities. Utilizing a lesson plan approach with high school marketing
students in five high schools and student survey feedback, the LifeSign program
was modified to be an acceptable smoking cessation program for adolescent
smokers. In the first study, 17 adolescent smokers used the modified program
with seven associated weekly group support sessions. At the end of treatment,
29% had quit smoking, and over half of those who continued to smoke reduced
their smoking rate by 50%. In the second study, the LifeSign for Teens program
was evaluated with 18 adolescent smokers in a minimal contact format. At the
end of treatment, 17% had quit smoking, and mean smoking rate reductions of 43%
were found among those who continued smoking. At 1-year follow-up, all subjects
who had quit at posttreatment reported continuous abstinence. The results of
these two small trials suggest that a computerized scheduled gradual reduction
approach may be an accepted and potentially efficacious approach for smoking
cessation among adolescent smokers.
Riley, W., Jerome, A., Behar, A., & Weil, J. (in press). Computer and manual
self-help behavioral strategies for smoking reduction: Initial feasibility and
one year follow-up. Nicotine and Tobacco Research.
This study sought to test the feasibility of two self-help behavioral
interventions to reduce and maintain a 50% reduction in those unable or
unwilling to quit, and to evaluate the impact of smoking reduction on
subsequent quit attempts. Ninety-three smokers who desired to reduce rather
than quit smoking were entered in the study and randomly assigned to either
computerized scheduled gradual reduction (CSGR) or to a manual-based selective
elimination reduction (SER). Both groups produced significant reductions in
smoking, approximately 10 cigarettes per day, during the seven week treatment
phase which were maintained over one year. Except for significantly greater
mean percent reductions in smoking from pre- to post-treatment (37% for CSGR,
20% for SER) and a greater percentage of subjects meeting the 50% reduction
goal (30% for CSGR, 16% for SER) which approached significance, the CSGR
intervention produced reductions in smoking comparable to the SER intervention,
particularly at the 6 and 12 month follow-up. Although subjects with a current
desire for smoking cessation were excluded from this study, one third of
subjects reported a 24 hr. quit attempt for the year following study
initiation, and 8.6% of subjects met seven-day point-prevalence criteria for
abstinence (CO validated) at the 12 month follow-up. The results of this study
lend support to the feasibility of self-help behavioral interventions to
produce sustained reductions in smoking rates without apparent negative impact
on subsequent quit attempts.
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LifeSign Reviews and Citations
The Behavior Therapist (Vol. 13, No. 3, March, 1990)
"I was very impressed with the program. It clearly incorporates sound behavioral
principles both the computerized cessation program itself, and in the
supporting materials provided in the manual."
"Existing data, most from small N studies, suggest that the program may be at
least as effective as other self-help smoking reduction programs, and perhaps
more so."
"The bland paragraphs above don’t communicate my intense excitement about the
program. Whatever the data ultimately suggest regarding the effectiveness of
the program in its current state, this is an important development in
behavioral self-help programming because of the potential that this technology
portends."
"I think LifeSign opens tremendously important doors to research and
applications in self-help behavioral programs."
Robert K. Klepac, Ph.D.
Wilford Hall Medical Center
SRNT Newsletter (Vol 6, No. 1, April, 2000)
"Robin Corelli and Karen Hudmon, in collaboration with the Pharmacy Partnership
of the California Medical Association Foundation, have orchestrated a project
whereby pharmacy faculty members and tobacco researchers have designed a
six-hour, comprehensive, tobacco curriculum program for pharmacy
students."
"The three hour workshop component includes role playing with case studies and
hands-on experience with pharmaceutical aids for smoking cessation and the
LifeSign hand-held computer for scheduled, gradual reduction of smoking."
Compliance in Health Care and Research (2001). Edited by Lora Burke and Ira
Ockene, American Heart Association Monograph Series, Futura Publishing, Armonk,
NY
"The LifeSign (PICS, Inc., Reston, VA) is a compact electronic recording device
approximately the size of a credit card and one-half inch thick. The individual
records each time a tobacco product is used by pushing one button."
"The primary advantage of using electronic recording devices is that data are
collected in real time, at the time of the symptoms or behavioral
performance."
Lora Burke, PhD, MPH, RN
Chapter 8, Electronic Measurement
Institute of Medicine (2001). Clearing the Smoke: Assessing the Science Base
for Tobacco Harm Reduction. Washington, DC. National Academy Press.
"More recent exploration of reduced smoking has used computerized devices to
gradually wean smokers from cigarettes as a means to achieve cessation. One
computerized program, LifeSign Computer Assisted Smoking Program, involves a
scheduled reduction by increasing the interval between cigarettes and informing
individuals when to smoke. The scheduled time-interval approach seems the most
promising of the behavioral treatment methods based on studies by Ciniciripini
and colleagues (Ciniciripini et al., 1995 and 1997) compared to abrupt
discontinuation or nonscheduled reduction of cigarettes. This behavioral method
systematically reduces the level of nicotine exposure, disrupts habitual
smoking patterns, and gives smokers the opportunity to develop new behaviors or
skills in response to cues associated with smoking."
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SleepKey Research
Association for Advancement in Behavior Therapy (AABT)
2002 Abstract
William Riley, Patti Mihm, and Albert Behar, PICS, Inc.,
Charles Morin, Universite Laval (2002). Initial Evaluation of a Computerized
Behavioral Intervention for Primary Insomnia. Poster presented
at the 2002 Annual Meeting of the Association for Advancement in Behavior
Therapy, November, 2002, Reno, NV.
Despite substantial evidence of the efficacy of behavioral interventions for
primary, chronic insomnia, these interventions remain largely unavailable to
those suffering from insomnia. Therefore, a number of self-help interventions
have been developed and evaluated in recent years to make these treatments
widely disseminable and more accessible. For this project, a
computerized behavioral intervention was developed, the Insomnia Assessment and
Treatment Program (IATP), which was prototyped on a small, specific purpose,
handheld computer. The program uses an active sampling procedure to assess
sleep or wake states (low volume auditory beep every 10 minutes). During a week
of baseline recording, the IATP calculates total sleep time, sleep onset
latency, sleep efficiency and other relevant variables. From these data,
the IATP devises a sleep restriction and stimulus control program, prompting
the user when to go to bed and get out of bed each night and continues to
record sleep behavior each night and adjusting the intervention accordingly.
Eighty six participants (60% female; 80% White, 10% Black,
10% Asian) meeting criteria for chronic primary insomnia were randomly assigned
to receive either the IATP or a similar device which monitored sleep only and a
manualized behavioral treatment (MBT). In addition to the data from the
monitoring units, the participants also keep sleep diaries each night. At the
initial and six week follow-up visit, participants also completed the
Pittsburgh Sleep Quality Index (PSQI). To assess concurrent validity, the
device monitoring data were compared to the sleep diary data for weekly means
of relevant variables. Sleep onset latency correlations for each week
ranged from .68 to .95. Lower but significant correlations also
were obtained for total sleep time (.30 to .75) and for sleep efficiency (.34
to .79). On treatment outcome, repeated measures ANOVAs revealed a
significantly greater improvements for the IATP than the MBT on the PSQI (F=
3.65, p < .05), sleep efficiency (F = 2.85, p < .05). Sleep
latency reduced in both groups but the time by group interaction was not
significant. An intent to treat analysis of those reaching 90% or greater sleep
efficiency at week 6 revealed that 35% of the IATP group but only 9% of the MBT
group met this criteria ( = 7.03, p <
.01). On a subjective rating of sleep improvement, 46% of the IATP group
rated their sleep as much or very much improved whereas none of the MBT did so.
The results of this project indicate that behavioral interventions for
insomnia can be delivered by a self-help computer device (the IATP) and that
the IATP produces greater improvement in sleep behavior than a manualized
treatment approach.
Insomnia Phase I
“Computerized Self-help Behavioral Treatment for Insomnia: Phase I Study
Results” by William T. Riley, Ph.D., PICS, Inc. You will need to allow popup
windows in order to view
the document (PDF)
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DietMate Publications
DietMate: Computerized Self-Management for Weight Control This paper
provides a conceptual overview and description of the DietMate Program (Albert
Jerome, Ph.D. & Lee W. Frederiksen, Ph.D. (1992). Behavior Therapist, 15
(10), 256-258.
DietMate Clinical Studies An overview of five important clinical studies
performed to evaluate the DietMate program and product for various applications
in health improvement. Detailed reports of these five studies follow.
Study 5.
Computerized Diet and Exercise Intervention for High Blood Pressure This
paper describes results of a Phase I SBIR study funded by NHLBI examining
DietMate as an intervention for High Blood Pressure (Albert Jerome, Ph.D.,
1996).
Study 4.
Phase II Study: Computer-Assisted Cholesterol Reduction The purpose of
this Phase II research study was to develop and evaluate a dietary and exercise
intervention for high blood cholesterol implemented via a hand-held
microcomputer. (Albert Jerome, Ph.D., 1996).
Study 3.
DietMate: A Computerized Intervention for Computer-Assisted Cholesterol Reduction
This paper describes results of a Phase I SBIR study funded by NHLBI examining
DietMate as an intervention for cholesterol reduction and weight loss (Albert
Jerome, Ph.D., 1992).
Study 2.
Computerized Self-Management for the Treatment of Obesity Presented at
the 25th Annual Convention of the Association for the Advancement of Behavior
Therapy, New York, N.Y., November, 1991. (Albert Jerome, Ph.D., Lee W.
Frederiksen, Ph.D., Candace B. Frederiksen, B.A. (1991).
Study 1.
DietMate: A Computerized Intervention for Weight Loss This paper
describes the initial DietMate validation study conducted with an early
prototype of the product (Albert Jerome, Ph.D., 1991.)
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Recent Presentations at
Scientific Meetings
William T. Riley, PH.D., Bradford W. Applegate, PH.D., Allison Sowell ,
M.S.; PICS, Inc. (2004) A Comparison Of Computer-Assisted Scheduled Gradual
Reduction VS. Self Help in Unmotivated Smokers.
Abstract:
Despite recent advances in treatment, many tobacco users are unwilling or unable
to quit. Harm reduction strategies have recently been proposed as an
alternative to current treatment approaches. The present data examines the
efficacy of a computerized scheduled reduction program (SGR) as compared to a
self-help manual (SH).
Participants who smoked > 15 cpd and had no intentions of quitting in the
next 30 days (N = 268) were randomly assigned to SGR or SH conditions. The SGR
condition monitored use for 7 days, followed by SGR to achieve a 50% reduction.
SH participants received information on reducing use. Smoking rates and
associated variables were measured at baseline, 9 weeks, and 6 months.
Participants smoked 27 cpd and were 46 years old, on average. The sample was
50% male and 59% Caucasian. There were no significant differences between
conditions at baseline. Treatment completion was 74% at 9 weeks and 61% at 6
months.
Repeated measures MANOVA indicated both main and interaction effects between
SGR and SH conditions, (both p’s < .05). SGR participants reduced intake
from 27 to 18.5 cpd at 9 weeks, compared to a reduction of 27 to 22 CPD in the
SH condition. Effects diminished at 6 months as SGR participants maintained
their rates and SH participants reduced smoking to comparable rates. Secondary
analyses revealed that a greater proportion of SGR participants achieved >
50% reduction in smoking than SH participants. Changes in health status and
motivation to quit were associated with reducing intake, but not sufficiently
to justify reduction as a harm reduction approach.
Beasley, J.M, Riley, W. T., & Jean-Mary, J. (2004) Sources of Error From
Palm-Based Food Records. Poster presented at the 3rd Annual Conference of the
International Society of Behavioral Nutrition and Physical Activity.
Washington, D.C.
Objective: The purpose of this study was to analyze the
potential sources of error from food records using a Palm-based program,
DietMatePro. After three days of using DietMatePro, subjects recorded an
observed, weighed lunch. Actual food portions were compared with estimates
recorded by the subjects using the DietMatePro. Thirty-nine healthy adults
participated in the trial. Observed lunch data were analyzed using the ESHA
Food Processor and compared to energy and nutrient values obtained from the
DietMatePro. Due to a malfunction on five Palms, data were available for
comparison with the observed lunch for 34 subjects. Over- and under-estimation
errors between actual and recorded food calories and macronutrients were
partialed into errors attributable to unrecorded foods, selecting similar but
not exact food matches, portion estimation errors, and nutrition analysis
database differences. Sixty-seven percent of the absolute error in caloric
estimation was due to portion size estimation error, 21 percent was due to
failing to report a food consumed, 10 percent to mismatches of similar foods,
and 2 percent to differences between the nutrient database values for the same
food. Differences between Palm-based food recording and observed, weighed foods
indicate that portion estimation error is the primary source of error in food
records. Concurrent validity of the DietMatePro is supported by the small error
due to differences between the DietMatePro and ESHA databases. To improve
dietary assessment, methods for increasing the accuracy of portion size
estimation are needed.
Supported by NINR #R44NR008443.
Riley, W. T., Sowell, A., & Behar, A. (2004) Feasibility of a palm-based
program to increase physical activity in sedentary individuals. Poster
presented at the 3rd Annual Conference of the International Society of
Behavioral Nutrition and Physical Activity. Washington, D.C.
Objective: The purpose of this study was to develop and assess
a palm-based exercise program.
Methods and Materials: Fifty-two healthy, sedentary adults were
provided with the palm-based program which designed a personalized exercise
program consistent with American College of Sports Medicine guidelines,
monitored progress, prompted exercise activity, and recommended gradually
increasing exercise durations. All subjects underwent simple physical fitness
tests and completed a standardized 7-day physical activity recall at baseline
and 12 week visits. Physical activity recall also was assessed via phone at
weeks 4 and 8.
Results: Repeated measures ANOVAs for exercise frequency per
week revealed a significant increase from 1.3 at week 0 to 3.4 at week 4 which
was maintained at week 8 (4.3) and at week 12 (4.1) (F = 6.72, p < .0001).
Weekly estimated MET expenditure at these time points also showed a similar but
less robust pattern (F = 3.49, p < .02). There was a significant improvement
in sit-and-reach flexibility from baseline to 12 weeks (15.7 to 17.3 in.; t =
-5.47, p < .0001) and a trend toward improved cardiovascular fitness on the
three-minute step test (heart rate change of 30.3 vs. 24.2 bpm; t = 1.82, p =
.08). Compliance to the program was not as high as anticipated (only 24%
reported using most or all days during the treatment period), but was strongly
associated with outcome on the fitness measures.
Significance: These results support the feasibility of a
palm-based exercise program to encourage exercise in sedentary individuals.
Supported by National Institute of Nursing Research (NR04370)
Jeannette M. Beasley*, M.P.H., William T. Riley, Ph.D., and Jersino
Jean-Mary, B.S., PICS, INC. This was presented at the Society For Behavioral
Medicine Conference: FEASIBILITY OF A PALM-BASED DIETARY ASSESSMENT PROGRAM
Objective: The purpose of this project was to
test the usability of a Palm-based food record, the Dietary Research Monitoring
System (DRMS).
Methods and Materials: The usability and validity
of the DRMS prototype was assessed during a three-day trial, validating the
DRMS nutrition data to a 24-hour dietary recall. At the follow-up visit,
subjects were timed recording a weighed lunch. Actual food portions compared
with estimates recorded in the DRMS. Thirty-nine healthy subjects (54% female,
46% male; 93% White, 7% African American; 3% Hispanic or Latino) participated
in the 3-day usability trial. Observed lunch and 24-hour dietary recall data
were analyzed using the ESHA Food Processor SQL and compared to energy and
nutrient values obtained from the Dietary Research Monitoring System. Due to a
DRMS program malfunction, subsets of the data were available for comparison
with the 24-hour recall (N=28) and the observed lunch (N=33).
Results: Pearson correlations of associations
between DRMS data and the comparison measure ranged from .549-.796 for the
24-hr recall and .549-.850 for the observed lunch, depending on the nutrient
measured. It took an average of 10 (SD=6.38) minutes for subjects to record the
observed lunch. Using 5 point Likert scales, subjects rated that the food
record accurately reflected food intake (4.05, SD 1.18), and that they would
use the program to track food intake (3.79, SD=1.34).
Significance: The results of this initial
usability trial indicate that the DRMS produces comparable measures of
association with other dietary assessment techniques. With revisions based on
feedback, the DRMS could be
a useful tool to automate measurement of food intake.
This study was conducted while the first author was at PICS. Supported by NHLBI
grant # R43HL67613.
William Riley, Allison Sowell, Albert Behar, and Jeannette Beasley.
PICS, Inc. Reston, VA. This was presented at the 5th International Food
Data Conference and 27th US National Nutrient Databank Conference in June 2003:
DEVELOPMENT AND INITIAL VALIDATION OF A PALM-BASED DIETARY ASSESSMENT PROGRAM
Objective: The purpose of this project was to develop
and test the feasibility of a Palm-based dietary research monitoring system
(DRMS).
Methods and Materials:
The validity of the DRMS prototype was assessed in a
within subjects, counterbalanced design comparing use of the DRMS with use of a
seven-day food diary, and comparing the nutritional data from these prospective
methods to 24 hr. dietary recall and food frequency questionnaires.
Fifty-nine healthy subjects (69% female, 31% male; 85% White, 10% African
American, and 5% Other) participated in and completed the 3-week assessment
trial. Subjects were randomly assigned to order of use (DRMS in week 1
and food diary in week 3 or vice versa with no recording during week 2).
Total calories and major macronutrient values obtained from the DRMS and the
food diary were compared to food frequency questionnaires and 24 hr. dietary
recalls obtained at the end of each week of prospective monitoring.
Results: In comparing DRMS data with other
dietary assessment measures, pearson correlations of associations ranged from
.322-.388 with the GSEL Food Frequency Questionnaire and .529-.635 with the
24-hour recall data, depending on the nutrient measured. Correlations of
calories (t=-3.44,p<.05)
and fat (t=-3.32, p<.05) between the food diary and the FFQ were
significantly greater than the correlations between DRMS and the FFQ. Using 5
point Likert scales, subjects rated the food diary as significantly more
accurate (4.11 vs 2.63) and easy to use (4.09 vs 2.55) than the DRMS. The mean
number of meals that subjects failed to record each week was less than one for
each meal type and not significantly different between recording methods.
Significance: The results of this initial validity trial
indicates that the DRMS produces comparable results to the standard food diary
monitoring approach and, with improvements, may be a useful tool to automate
the assessment of dietary intake.
William Riley, PhD, Allison Sowell, MA, Jeannette Beasley, MPH, PICS,
Reston, VA 20191. This was presented at the 2003 Society for Nutrition
Education 36th Annual Conference in July 2003: HOW MANY BYTES: A
WEB-BASED FOOD PORTION TUTORIAL EDUCATES CONSUMERS
A recent study by Smiciklas-Wright et al. (2002) comparing CSFII data trends in
portion sizes concluded that educating clients regarding appropriate portion
sizes would be a challenge to health care providers1. First quarter 2002 NHIS
data revealing 24.5% (95% CI = 23.1%-25.8%) of US adults are obese underscores
the importance of the issue. The objective of this study was to develop
and evaluate a web-based food portion tutorial to improve food portion
estimation. For initial development, 23 foods across the major food
groups were photographed, with portion sizes scaled based on USDA serving
sizes. A test module provided feedback to the user regarding accuracy of
portion size estimation. A feasibility trial with 76 subjects randomly
assigned participants to tutorial exposure before (pre-exposure) or after
(post-exposure) choosing and estimating portions among 15 food and beverage
selections. Estimated portions were compared to actual portion sizes as
measured by a portion control scale, and impact on caloric value was
measured. A significant difference was found between conditions on the
discrepancy between estimated and actual calories for the meal (t68.2)=3.07,
p=.003); however, the difference was primarily due to the overestimation of
calories for the pre-exposure group (271 kcal) versus the post-exposure group
(27 kcal). Users reported a mean overall usefulness of the tutorial as 4.1 (SD
0.8) based on a 5-point Likert scale. The tutorial had a
significant impact on food portion estimation among study participants, and
future design efforts will focus on eliminating the tendency towards
overestimation. This study was funded by NIH.
Smiciklas-Wright H, Mitchell DC, Mickle SJ, Goldman JD, Cook A. Foods commonly
eaten in the United States, 1989-1991 and 1994-1996: Are portion sizes
changing? J Am Diet Assoc. 2003 Jan;103(1):41-47
William T. Riley, PH.D., Melissa Pici, B.A., Valerie L. Forman, Ph.D.,
Albert Behar, M.S.; PICS, Inc. (2003) Computerized Dosing of Nicotine
Inhalers: Effects on Use and Quit Rates. Paper presented
at the 9th Annual Meeting of the Society For Research on Nicotine and
Tobacco. New Orleans, LA.
Abstract:
The purpose of this study was to develop and evaluate a computerized program to
encourage adequate dosing of nicotine inhalers. Two handheld computerized
dosing/prompting programs were developed. Both utilized a one week
smoking baseline to determmine the intitial inhaler prompting schedule but
differed in the length of the stable dosing period prior to tapering use (3
weeks vs. 12 weeks). These computer prompting programs were compared to
an inhaler only condition in a radomized trial of 462 smokers evaluated at 9
and 18 weeks (1 yr. follow-ups pending). At 9 weeks, 32% of the
computerized dosing groups has been quit for 7 days or longer (biochemically
validated) compared to 20% for the inhaler only condition (chi-square = 4.69, p
< .05). Continuous quit rates at 9 weeks were 21% for the computerized
dosing groups and 11% for the inhaler only group (chi-square = 5.76, p <
.02). At 18 weeks, 26% of the computerized dosing groups and 18% of the
inhaler only group met point prevalence criteria. Continuous quit rates
at 18 weeks were not significantly different (14% vs. 9%). Those in the
computerized dosing conditions also reported higher doses per day in the first
week of use than those in the inhaler only condition (9 vs. 7; t= 3.34, p <
.001). No signficant differences were found between the two computerized
programs. The results of this study indicate that computerized prompting
increases initial nicotine inhaler dosing and produces higher initial quit
rates than typical inhaler administration.
Valerie L. Forman, Ph.D., Melissa Pici, B.A., William T. Riley, Ph.D., PICS,
Inc. (2003) Impact of September 11th Tradegy on Smoking and Relapse
Rates. Paper presented at the 9th Annual Meeting of the Society
For Research on Nicotine and Tobacco. New Orleans, LA.
Abstract:
The September 11, 2001 terrorist attacks on the United States had widespread
behavioral and emotional impacts. Although one study found an increase in
smoking rates amoung Manhattan, New York residents following the tradegy
(Vlahov et al., 2002), no studies have examined the effect on individuals
trying to quit smoking at the time of the attacks. Local media in the
Washington, D.C. area was used to recruit 462 smokers into a study comparing
the effect of computerized-scheduled reduction to ad-lib dosing of nicotine
inhalers on quit rates. The terrorist attack was temporarily associated
with various stages of the study protocol. Mean smoking rates the week
before September 11th were slightly lower than mean smoking rates the week
after September 11th (11.8 cigarettes per day versus 12.6 cigarettes per day
respectively). Higher ratings on the Impact of Events (IES) scale,
completed retrospectively after all subjects had completed the 18-week
evaluation, were associated with increased cigarette use following the
terrorist attacks (Pearson's r=0.25 p<0.01). Among the 303
participants who completed smoking diaries, 43.9% did not change smoking rates,
23.1% decreased smoking, and 34.3% increased smoking the week following the
tradegy. Thirteen of the 82 subjects who had quit prior to September 11th
relapsed in the week following the attacks (15.9%); IES scores among those who
relapsed were moderately higher than subjects who remained quit (36.9 versus
29.8, respectively). Although the terrorist attacks were associated with
increases in smoking and relapse rates, the effect was relatively small and not
significant. Greater perceived impact of the events of September 11th,
however, predicted moderate increases in smoking and relapse rates.
Riley, W., Mihm, P., Behar, A., and Morin, C. (2002). Initial evaluation of
a computerized behavioral intervention for primary insomnia. Paper
presented at the 36th Annual Convention of the Association for the
Advancement of Behavior Therapy. Reno, NV.
Abstract:
Despite substantial evidence of the efficacy of behavioral interventions for
primary, chronic insomnia, these interventions remain largely unavailable to
those suffering from insomnia. Therefore, a number of self-help interventions
have been developed and evaluated in recent years to make these treatments
widely disseminable and more accessible. For this project, a computerized
behavioral intervention was developed, the Insomnia Assessment and Treatment
Program (IATP), which was prototyped on a small, specific purpose, handheld
computer. The program uses an active sampling procedure to assess sleep or wake
states (low volume auditory beep every 10 minutes). During a week of baseline
recording, the IATP calculates total sleep time, sleep onset latency, sleep
efficiency and other relevant variables. From these data, the IATP devises a
sleep restriction and stimulus control program, prompting the user when to go
to bed and get out of bed each night and continues to record sleep behavior
each night and adjusting the intervention accordingly. Eighty six participants
(60% female; 80% White, 10% Black, 10% Asian) meeting criteria for chronic
primary insomnia were randomly assigned to receive either the IATP or a similar
device which monitored sleep only and a manualized behavioral treatment (MBT).
In addition to the data from the monitoring units, the participants also keep
sleep diaries each night. At the initial and six week follow-up visit,
participants also completed the Pittsburgh Sleep Quality Index (PSQI). To
assess concurrent validity, the device monitoring data were compared to the
sleep diary data for weekly means of relevant variables. Sleep onset latency
correlations for each week ranged from .68 to .95. Lower but significant
correlations also were obtained for total sleep time (.30 to .75) and for sleep
efficiency (.34 to .79). On treatment outcome, repeated measures ANOVAs
revealed a significantly greater improvements for the IATP than the MBT on the
PSQI (F= 3.65, p < .05), sleep efficiency (F = 2.85, p <
.05). Sleep latency reduced in both groups but the time by group interaction
was not significant. An intent to treat analysis of those reaching 90% or
greater sleep efficiency at week 6 revealed that 35% of the IATP group but only
9% of the MBT group met this criteria (c 2 = 7.03, p <
.01). On a subjective rating of sleep improvement, 46% of the IATP group rated
their sleep as much or very much improved whereas none of the MBT did so. The
results of this project indicate that behavioral interventions for insomnia can
be delivered by a self-help computer device (the IATP) and that the IATP
produces greater improvement in sleep behavior than a manualized treatment
approach.
Obermayer, J., Riley, B., Asif, O., Jean-Mary, J. (2003). College
smoking cessation using wireless devices. Poster presented at the 2004
Society of Behavioral Medicine 25th Anniversary Annual Meeting & Scientific
Sessions on March 24-27, Baltimore Marriott Waterfront Hotel, Baltimore,
Maryland.
Objective: The purpose of this project was to develop and test the
feasibility of a smoking cessation program delivered in the form of text
messages via mobile phones.
Methodology: The usability of this prototype was assessed in a sample of
college students from local colleges and universities. Forty-six subjects (54%
male, 46% male; 72% White, 15% Asian, 7% African American, and 6% Other)
participated in and completed the 6-week assessment trial. Subjects registered
on the study website to personalize and initialize their smoking cessation
program. This allowed subjects to create a quitting plan, indicate situations
and times when they were at high risk for smoking, and input and track their
progress towards quitting. Pre-test and post-test measures included cigarette
logs, nicotine dependence scale, smoking and quitting documentation
questionnaire, and a program use questionnaire.
Results: During this study period, 20 subjects (43%) successfully
completed a 24-hour quit attempt. At the end of the six-week study period,
there were 10 subjects (22%) who met the 7-day point prevalence criterion for
quitting. Among subjects who had not quit, cigarette logs and nicotine
dependence scale scores indicated that these subjects substantially reduced
their mean cigarette counts of 77 cigarettes/week to 32 cigarettes/week (t
= 5.34, p < .001). These subjects also experienced lowered (-0.37 to
–1, t = 5.4, p < .001) nicotine dependence as measured by the
Nicotine Dependence Syndrome Scale (NDSS). All of the subjects rated the
program positively on usability, comparison to other methods tried, and overall
satisfaction.
Significance: The results of this initial study trial indicates that the
WICS program produces high quit rates in comparison to the overall 10% quit
rate for self-help smoking cessation programs, as well as resulting in positive
outcomes for non-abstinent subjects. Smoking on college campuses has increased
substantially in the last decade, yet programs have not targeted these smokers
who have unique patterns and causes of smoking. College students are early
adopters of communications technologies and may, therefore, readily adopt a
smoking cessation program delivered via these technologies.
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