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Background Insomnia is frequently comorbid with chronic migraine, and small trials suggest that cognitive-behavioral treatment of insomnia (CBTi) may reduce migraine frequency. This study endeavored to provide a quantitative synthesis of existing CBTi trials for adults with chronic migraine using Bayesian statistical methods, given their utility in combining prior knowledge with sequentially gathered data. Methods Completer analyses of 2 randomized trials comparing CBTi to a sham control intervention (Calhoun and Ford, 2007; Smitherman et al, 2016) were used to quantify the effects of a brief course of treatment on headache frequency. Change in headache frequency from baseline to the primary endpoint (6-8 weeks posttreatment) was regressed on group status using a Gaussian linear model with each study specified in the order of completion. To estimate the combined effect, posterior distributions from the Calhoun and Ford study were used as informative priors for conditioning on the Smitherman et al data. Results In a combined analysis of these prior studies, monthly headache frequency of the treatment group decreased by 6.2 days (95%CrI: -9.7 to -2.7) more than the control group, supporting an interpretation that there is a 97.5% chance that the treatment intervention is at least 2.7 days better than the control intervention. The analysis supports the hypothesis that at least for those who complete treatment, there is high probability that individuals who receive CBTi experience greater headache reduction than those who receive a control intervention equated for therapist time and out-of-session skills practice. Conclusion Cognitive-behavioral interventions for comorbid insomnia hold promise for reducing headache frequency among those with chronic migraine. These findings add to a small but growing body of literature that migraineurs with comorbid conditions often respond well to behavioral interventions, and that targeting comorbidities may improve migraine itself.

Postmenopausal women have substantial concerns about weight gain when quitting smoking, which may contribute smoking relapse. There is a need for smoking cessation and weight gain prevention programs effective in this population.Two formats of a smoking cessation/weight gain prevention follow-up intervention in postmenopausal weight concerned women were compared: a minimally-tailored group format and a highly tailored, multidisciplinary individual format. Effects on sustained abstinence and postcessation weight gain were assessed. Postmenopausal smokers received 6 sessions of behavioral counseling over a 2-week period, 8weeks of the nicotine transdermal patch, and subsequent random assignment to receive follow-up relapse prevention sessions at 1, 3, 8, and 16weeks postcessation in either group or individual format.The sample (N=98) was 67% Caucasian and 33% African-American. Age: m=52.3 (7.8) years, follicle stimulating hormone: m=42.6 (25.7), body mass index (BMI): m=27.4 (6.2), daily smoking rate: m=20.3 (11.5), for m=29.4 (10.7) years, Fagerström Test for Nicotine Dependence (FTND): m=6.4 (2.1), and carbon monoxide: m=23.8 (13.0) ppm. Abstinence rates in the group condition were significantly higher at 8weeks posttreatment. Group format significantly predicted abstinence rates at 8 and 16weeks posttreatment, even while controlling for age, race, BMI, CPD, years smoking, FTND, and weight concern. Weight concern predicted postcessation weight gain at 8 and 16weeks posttreatment.Results indicate that smoking cessation programs for postmenopausal women may best be delivered in a group format and that postcessation weight concerns be dealt with prior to a quit date.

Rationale Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke. Aims and/or hypothesis The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke. Design Recruitment of 430 first-ever stroke participants will occur in the Auckland and Waikato regions. Randomization will be to intervention or usual care groups. Participants randomized to intervention will receive four motivational interviews and five follow-up assessments over 12 months. Nonintervention participants will be assessed at the same time points. Study outcomes Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke. Secondary outcomes include self-reported adherence and barriers to prescribed medications, new cardiovascular events (including stroke), changes in quality of life, and mood. Discussion The results of the motivational interviewing in stroke trial will add to our understanding of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant.

Objective To determine whether a tailored weight management program, addressing the needs of obese, low-income African-American women, would produce greater weight loss than standard medical care. Research methods and procedures A randomized, controlled trial was conducted between 1999 and 2003 with 144 overweight or obese women (predominantly African-American) enrolled at two primary care clinics. Four physicians at each clinic were randomly assigned to provide either tailored weight management interventions or standard care. The tailored condition consisted of six monthly outpatient visits lasting approximately 15 minutes each, which included personalized materials and messages. The main outcome was body weight change. Results The intervention group lost more weight than the standard care group (p = 0.03). The tailored group lost a mean (standard deviation) of 2.0 (3.2) kg by Month 6. The standard care group gained 0.2 (2.9) kg. More participants in the tailored group lost weight (79% vs. 47%; p = 0.04). Discussion Obese, low-income, African-American women provided with 90 minutes of physician-delivered, tailored weight management instruction over 6 months achieved greater weight loss than those receiving standard medical care. The primary care physician can be effective in delivering weight loss interventions, and the primary care clinic may be a useful setting to implement weight management interventions.

This study evaluated changes in depression, anxiety, and stress during Army basic training. During week 1 of training, 139 soldiers from two companies volunteered for participation. In week 8, 93 soldiers were available for retesting. Self-reports of depressive symptoms and perceptions of stressfulness at both assessments fell within the normative range for nonclinical samples, whereas endorsement of anxiety symptoms remained slightly elevated, in the mild range. Women endorsed higher levels of anxiety (F = 8.87, p0.01) than did men. No gender or ethnicity differences were noted for changes in psychological distress over time. Regression analyses showed that subjects with the highest levels of initial distress on the anxiety, depression, and stress measures had the most change at the end of 8 weeks of training (r values between 0.61 and 0.39; all p0.01). Results suggest that initial levels of psychological distress are slightly elevated for anxiety but most individuals adapt to the stress of basic training, with normal levels of distress by the last week.

Objective: This randomized controlled trial tested the efficacy of an internetbased lifestyle behavior modification program for weight management in African-American girls. Design: African-American girls were randomly assigned to an interactive behavioral internet program or an internet health education program, the control condition. The behavioral intervention included internet counseling and was highly interactive. The control intervention was a passive (non-interactive) educational program. Parents were also participants in the study. Participants in both treatment groups met in face-to-face sessions on four occasions over the first 12 weeks of a 6-month intervention. Subjects: The study enrolled 57 African-American adolescent girls (ages 11 to 15 years) who were overweight or obese and had at least one biological parent who was obese [body mass index (BMI) >30 kg/m2]. Of the 57 participants, 50 (88%) completed the 6-month trial. Measurements: Outcome data, including BMI, body weight, body composition, dietary intake, and weight loss behaviors were collected at baseline and 6-months later. A computer server tracked utilization of the websites. Participation in the program was measured by number of “hits” on the website. Results: Compared to the control condition, adolescents in the behavioral treatment lost more body fat (group difference =1.6% body fat) and parents lost significantly more body weight (group difference =2.1 kg). Utilization of the behavioral website by adolescents and parents was associated with positive outcome. Dietary fat intake was lowered for adolescents and parents in the behavioral treatment group. Conclusion: An internet-based behavioral intervention was superior to internet-based health education and yielded decreased body fat for adolescent girls and decreased body weight for parents.

Background: Computer technologies hold promise for implementing alcohol screening, brief intervention, and referral to treatment (SBIRT). Questions concerning the most effective and appropriate SBIRT model remain. Objective: The aim of this study was to evaluate the impact of a computerized SBIRT system called the Health Evaluation and Referral Assistant (HERA) on risky alcohol use treatment initiation. Methods: Alcohol users (N=319) presenting to an emergency department (ED) were considered for enrollment. Those enrolled (n=212) were randomly assigned to the HERA, to complete a patient-administered assessment using a tablet computer, or a minimal-treatment control, and were followed for 3 months. Analyses compared alcohol treatment provider contact, treatment initiation, treatment completion, and alcohol use across condition using univariate comparisons, generalized estimating equations (GEEs), and post hoc chi-square analyses. Results: HERA participants (n=212; control=115; intervention=97) did not differ between conditions on initial contact with an alcohol treatment provider, treatment initiation, treatment completion, or change in risky alcohol use behavior. Subanalyses indicated that HERA participants, who accepted a faxed referral, were more likely to initiate contact with a treatment provider and initiate treatment for risky alcohol use, but were not more likely to continue engaging in treatment, or to complete treatment and change risky alcohol use behavior over the 3-month period following the ED visit. Conclusions: The HERA promoted initial contact with an alcohol treatment provider and initiation of treatment for those who accepted the faxed referral, but it did not lead to reduced risky alcohol use behavior. Factors which may have limited the HERA’s impact include lack of support for the intervention by clinical staff, the low intensity of the brief and stand-alone design of the intervention, and barriers related to patient follow-through, (eg, a lack of transportation or childcare, fees for services, or schedule conflicts). Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): NCT01153373; https://clinicaltrials.gov/ct2/show/NCT01153373 (Archived by WebCite at http://www.webcitation.org/6pHQEpuIF) [J Med Internet Res 2017;19(5):e119]

Although the primary care setting offers an innovative option for weight loss interventions, there is minimal research examining this type of intervention with low-income minority women. Further, there is a lack of research on the long-term effects of these programs. The purpose of this investigation was to examine the weight loss maintenance of low-income African-American women participating in a primary care weight management intervention. A randomized controlled trial was conducted with overweight and obese women (N = 144) enrolled at two primary care clinics. Women received a 6-month tailored weight loss intervention delivered by their primary care physician and completed follow-up assessments 9, 12, and 18 months following randomization. The weight loss maintenance of the tailored intervention was compared to a standard care comparison group. The weight loss of intervention participants (-1.52 +/- 3.72 kg) was significantly greater than that of standard care participants (0.61 +/- 3.37 kg) at month 9 (P = 0.01). However, there was no difference between the groups at the 12-month or 18-month follow-ups. Participants receiving a tailored weight loss intervention from their physician were able to maintain their modest weight loss up to 3-6 months following treatment. Women demonstrated weight regain at the 18-month follow-up assessment, suggesting that more intensive follow-up in the primary care setting may be needed to obtain successful long-term weight loss maintenance.

To examine the effects of a primary-care weight management intervention on physical activity (PA) among overweight/obese women.This randomized controlled trial included 139 women (92% African American). The effects of a physician-delivered tailored intervention were compared with standard care. Repeated measures analyses of variance (ANOVA) were used to examine changes in PA (measured by a 7-day physical activity recall) and physical fitness (measured by heart rate recovery following exercise).Although the intervention group demonstrated an increase in PA, this did not differ significantly from standard care. A significantly greater proportion of intervention participants (90%) achieved current PA recommendations compared with standard care (77%), P.03.These results provide novel information suggesting that a physician-delivered intervention may have limited effectiveness for increasing PA among this at-risk population.

The present study sought to determine whether postcessation weight gain concerns influenced pretreatment attrition differently for pre- versus postmenopausal women smokers. Participants were pre- and postmenopausal women smokers drawn from two clinical trials for smoking cessation and weight gain prevention [the Smoking Treatment/Obesity Prevention (STOP) studies]. Predictors of attrition from baseline assessment visits prior to entering smoking cessation treatment were identified among these women. Pretreatment attrition was significantly higher among the premenopausal women. The premenopausal women had significantly higher weight concern but lower restraint and disinhibition than the postmenopausal women. Weight concern explained variance in treatment attrition from the programs, while controlling for variables such as Body Mass Index (BMI), smoking rate, number of years smoking, nicotine dependence level, dietary restraint, disinhibition, and hunger, such that the higher the weight concern, the more likely women were to drop out of treatment programs prior to a quitting attempt.

Postcessation weight gain is of concern to many female cigarette smokers. A multidisciplinary treatment combining psychological, dietary, and exercise components followed a 2-week smoking cessation program. Participants were randomly assigned to receive six follow-up relapse prevention sessions (in a group format or in an individually tailored format) directed by trained representatives from clinical psychology, dietary counseling, and exercise physiology. As predicted, abstinence rates were significantly higher among the individually tailored follow-up participants than among those assigned to the group follow-up condition at 3 and 6 months posttreatment. Differences between conditions in postcessation weight gain were not significant. However, the postcessation weight gain that did occur was significantly associated with subsequent smoking relapse in the group follow-up condition only.

WHITE, MARNEY A., PAMELA DAVIS MARTIN,ROBERT L. NEWTON, HEATHER M. WALDEN,EMILY E. YORK-CROWE, STEWART T. GORDON,DONNA H. RYAN, AND DONALD A. WILLIAMSON.Mediators of weight loss in a family-based interventionpresented over the Internet. Obes Res. 2004;12:1050–1059.Objective: To assess the process variables involved in aweight loss program for African-American adolescent girls.Several process variables have been identified as affectingsuccess in in vivo weight loss programs for adults andchildren, including program adherence, self-efficacy, andsocial support. The current study sought to broaden theunderstanding of these process variables as they pertain toan intervention program that is presented using the Internet.It was hypothesized that variables such as program adher-ence, dietary self-efficacy, psychological factors, and fam-ily environment factors would mediate the effect of theexperimental condition on weight loss.Research Methods and Procedures: Participants were 57adolescent African-American girls who joined the programwith one obese parent; family pairs were randomized toeither a behavioral or control condition in an Internet-basedweight loss program. Outcome data (weight loss) are re-ported for the first 6 months of the intervention.Results: Results partially supported the hypotheses. Forweight loss among adolescents, parent variables pertainingto life and family satisfaction were the strongest mediatingvariables. For parental weight loss, changes in dietary prac-tices over the course of 6 months were the strongest medi-ators.Discussion: The identification of factors that enhance orimpede weight loss for adolescents is an important step inimproving weight loss programs for this group. The currentfindings suggest that family/parental variables exert a stronginfluence on weight loss efforts for adolescents and shouldbe considered in developing future programs.Key words: adolescents, African American, Internet,telehealth, family-based interventions

MARTIN, PAMELA D., GARETH R. DUTTON, AND PHILLIP J. BRANTLEY. Self-efficacy as a predictor of weight change in African-American women. Obes Res. 2004;12:646-651. Objective: Although self-efficacy has received increasing attention for its role in weight loss, there is less research examining this relationship in minority samples. The purpose of this study was to determine whether self-efficacy for weight loss was predictive of weight change in a sample of African-American women. Research Methods and Procedures: Subjects were 106 overweight or obese, low-income African-American women participating in a weight management intervention that involved either personalized monthly sessions with their primary care physician or standard care. Weight and self-efficacy for weight loss were assessed at baseline and at the end of the 6-month treatment. Results: For subjects in the personalized intervention, baseline self-efficacy was predictive of subsequent weight change, such that higher levels of self-efficacy before treatment were associated with less weight loss. In contrast, improvements in self-efficacy during treatment were associated with greater weight loss for the personalized intervention group. Discussion: Results suggest high self-efficacy for weight loss before treatment may be detrimental to success, whereas treatments that improve participants' self-efficacy may result in greater weight loss. High pretreatment self-efficacy may be indicative of overconfidence or lack of experience with the difficulties associated with weight loss efforts. Whereas replication is needed, our results suggest that self-efficacy is an important variable to consider when implementing weight loss interventions.

While the Weight Efficacy Lifestyle Questionnaire (WEL) shows promise as a measure of self-efficacy for eating control, there is a lack of research examining the psychometric properties of this measure with ethnic minorities. The current study examined the WEL with a sample of 144 overweight and obese African American females. Analyses indicated similar self-efficacy levels compared to predominantly Caucasian samples. Supporting the validity of the WEL, participants undergoing obesity treatment demonstrated modest improvement in WEL scores, while standard care participants showed no changes in self-efficacy over time. Factor analysis indicated a four-factor structure rather than the five factors previously found. The four-factor structure accounted for 61.85% of the variance. Results indicate the WEL may be a valid measure of self-efficacy for overweight and obese African American women, although researchers should be mindful of the variation in scale properties when using the WEL with this population.

This paper examines the use of the Guide to Clinical Preventive Services for behavioral counseling for overweight patients in the primary care setting.Study 1 assessed counseling practices of family physicians with a 13-item physician questionnaire based on the Guide to Clinical Preventive Services. Study 2 assessed the perception of weight loss recommendations made to obese primary care patients attending a family practice clinic.46% of the family physicians responded. The most common referrals were made to dieticians and exercise programs. The patient survey indicated that 80.3% had received weight loss recommendations, and 68.9% had received counseling on diet change or exercise.This study found adequate rates of compliance with the Guide to Clinical Preventive Services. However, these results have highlighted the need to expand the guidelines to counsel patients more specifically with regard to weight loss recommendations and to focus on improving patient compliance and motivation.

This research project evaluated changes in food selections, food intake, and body weight during 8 weeks of basic combat training (BCT). During the first week of BCT, 139 soldiers from two companies volunteered for participation in the study. In the eighth week of BCT, 92 soldiers were available for retesting. A digital photography method for measuring food selections and food intake was developed for this study. Fruit intake of soldiers was very low at the beginning and end of BCT. Food intake for grains and milk products was low during the first week of BCT but improved by the end of BCT. Average body weight decreased during the 8 weeks of BCT, but heavier soldiers tended to lose weight and thinner soldiers tended to gain weight. These findings suggest that the overall effect of BCT was a trend toward improvement of healthy eating and healthy body weight.

To determine if families of long-term critical care patients have needs different from those of families of short-term critical care patients.Ex post facto, descriptive, convenience sample.Southeastern community-based medical centers.Twenty-six family members of patients in surgical intensive care units (SICU) for a minimum of 2 weeks. Age range was 20 to 73 years with a median of 48.19 years.Molter's Critical Care Family Needs Instrument administered to a relative of a patient in the SICU for 2 weeks or more.The needs of families were very similar to the previously reported needs of families who had members in critical care units for short periods of time (3 to 4 days). The desire for information remained the number one need.These findings suggest that family needs remain constant and continue in a crisis mode regardless of the length of time a family member may be a patient in the SICU. Recognition of these continuing needs will assist nurses in relating to the families of long-term critical care patients.