Objectives. To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel interv... more Objectives. To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel intervention initiated in a citywide safety net health system to improve low-income maternal smokers’ abstinence and reduce child tobacco smoke exposure.Methods. This randomized controlled trial in Philadelphia, Pennsylvania (2015–2020), recruited low-income maternal smokers who received a brief smoking intervention (Ask, Advise, Refer [AAR]) from nutrition professionals in the Special Supplemental Nutrition Program for Women, Infants, and Children before randomization to (1) a multilevel intervention (AAR + multimodal behavioral intervention [MBI]; n = 199) or (2) an attention control intervention (AAR + control; n = 197).Results. AAR + MBI mothers had significantly higher 12-month bioverified abstinence rates than did AAR + control mothers (odds ratio [OR] = 9.55; 95% confidence interval [CI] = 1.54, 59.30; P = .015). There were significant effects of time (b = −0.15; SE = 0.04; P < .001) and condition by time (b = −0.19; SE = 0.06; P < .001) on reported child exposure favoring AAR + MBI, but no group difference in child cotinine. Presence of other residential smokers was related to higher exposure. Higher baseline nicotine dependence was related to higher child exposure and lower abstinence likelihood at follow-up.Conclusions. The multilevel BLiSS intervention was acceptable and efficacious in a population that experiences elevated challenges with cessation.Public Health Implications. BLiSS is a translatable intervention model that can successfully improve efforts to address the persistent tobacco-related burdens in low-income communities.Trial Registration. Clinical Trials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT02602288","term_id":"NCT02602288"}}NCT02602288. (Am J Public Health. 2022;112(3):472–481. https://doi.org/10.2105/AJPH.2021.306601)
Introduction: Addressing child secondhand tobacco smoke (SHS) exposure is a public health priorit... more Introduction: Addressing child secondhand tobacco smoke (SHS) exposure is a public health priority (WHO). Our trial tests a multilevel intervention linking brief pediatric provider advice with individualized telebased counseling for parents focused on SHSe protections and smoking cessation. Methods: We modified pediatrics systems’ electronic assessments and trained providers throughout Philadelphia, PA, USA to educate smoking parents about SHS harms and the health benefits of protecting children from SHS. These providers referred parents to the trial. Parents are randomized to either 12 weeks of telebased smoking counseling or an attention control condition focused on nutrition education. Results: We have received >2900 referrals, enrolling over 300 parents (~90% retention). Over 80% of participants are women and African American, and over 75% are below the poverty line. Results suggest that relative to controls, the multilevel group: a) was less likely to smoke around their chil...
BACKGROUND: In this study, we investigated trends in cannabis use among parents with children at ... more BACKGROUND: In this study, we investigated trends in cannabis use among parents with children at home in the United States and estimated changes in prevalence of any cannabis use and daily cannabis use among parents who identified as cigarette smokers and nonsmokers with children in the home from 2002 to 2015. METHODS: The National Survey on Drug Use and Health is an annual, nationally representative, cross-sectional study conducted in the United States. Using logistic regression models, associations between cigarette smoking and any past-month and daily past-month cannabis use among parents with children in the home from 2002 to 2015 were estimated. Moderation of these associations by demographics and trends over time was examined. RESULTS: Past-month cannabis use among parents with children in the home increased from 4.9% in 2002 to 6.8% in 2015, whereas cigarette smoking declined from 27.6% to 20.2%. Cannabis use increased from 11.0% in 2002 to 17.4% in 2015 among cigarette-smoki...
Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing ch... more Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development—nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre–post outcomes were assessed using bivariate statistics...
International Journal of Environmental Research and Public Health
Background: During quit attempts, smokers must overcome smoking urges triggered by environmental ... more Background: During quit attempts, smokers must overcome smoking urges triggered by environmental cues and nicotine withdrawal symptoms. This study investigates the psychometric properties of the 12-item Tobacco Urge Management Scale (TUMS), a new measure of smoking urge management behaviors. Methods: We analyzed secondary data (n = 327) from a behavioral smoking cessation intervention trial, Kids Safe and Smokefree (KiSS). Results: Confirmatory factor analysis of the TUMS indicated that a one-factor model and a correlated two-factor model had similar model fit indices, and a Chi-square difference test supported the one-factor model. Further study of the parsimonious one-factor scale provided evidence of reliability and construct validity. Known group validity was evidenced by significantly higher TUMS scores in the KiSS intervention arm receiving urge management skills training than in the control arm (p < 0.001). Concurrent validity was evidenced by TUMS’s inverse association wi...
Lepore, S. J., &amp; Revenson, T. A. (2006). Resilience &amp; posttraumatic growth: Recov... more Lepore, S. J., &amp; Revenson, T. A. (2006). Resilience &amp; posttraumatic growth: Recovery, resistance, &amp; reconfiguration. In L. G. Calhoun &amp; R. G. Tedeschi (Eds.), Handbook of Posttraumatic Growth: Research and Practices, (pp. 24-46). Mahwah, NJ: Lawrence Erlbaum Associates, Inc., Publishers.
Approximately 20% of men with a diagnosis of prostate cancer present with locally advanced or adv... more Approximately 20% of men with a diagnosis of prostate cancer present with locally advanced or advanced disease. Few studies consider longer-term impact of disease progression and treatment adverse effects on health-related quality of life (QoL) of these men. Describe changes in health-related QoL over 5 years for men with newly diagnosed locally advanced or advanced prostate cancer. Eighty-one men with locally advanced or advanced prostate cancer referred to the study by their treating urologist completed a self-administered questionnaire assessing distress, cancer-specific distress, decision regret, satisfaction with life, and global and disease-specific health-related QoL. Questionnaires were administered close to diagnosis (baseline), 2, 6, 12, 24, 36, 48, and 60 months&#39; follow-up. Men were of mean age 68.3 (SD, 7.9) years and at mean of 31.9 (SD, 50.5) days postdiagnosis. The most common treatment received was androgen deprivation therapy (95.1%) or radiation therapy (79%). The proportion of men classified as distressed (Distress Thermometer) ranged from 46.3% (baseline) to 32.6% (60 months). Decrements in physical QoL were found at 2, 6, 12, 24, 36, and 48 months compared with baseline. Life satisfaction ratings were lower at 6 months compared with baseline. Sexual concerns were consistently high across the 5 years (Expanded Prostate Cancer Index Composite &lt;30). In the context of advanced disease, results indicate that health-related QoL fluctuates from diagnosis to 5 years later. A substantial proportion remained distressed at 5-year follow-up. Care frameworks supporting ongoing assessment of health-related QoL concerns of men with advanced prostate cancer are needed with a particular focus on sexual adjustment.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Dec 17, 2016
To examine the extent to which mindfulness skills influence psychological distress and health-rel... more To examine the extent to which mindfulness skills influence psychological distress and health-related quality of life (HRQOL) in men with metastatic or castration-resistant biochemical progression of prostate cancer. A cross-sectional survey of 190 men (46 % response; mean age 71 years, SD = 8.7, range 40-91 years) with advanced prostate cancer, assessed psychological and cancer-specific distress, HRQOL. Mindfulness skills were assessed as potential predictors of adjustment outcomes. Overall, 39 % of men reported high psychological distress. One third had accessed psychological support previously although only 10 % were under current psychological care. One quarter had accessed a prostate cancer support group in the past six months. Higher HRQOL and lower cancer-specific and global psychological distress were related to non-judging of inner experience (p < 0.001). Higher HRQOL and lower psychological distress were related to acting with awareness (p < 0.001). Lower distress wa...
This study investigates whether applying educational testing approaches to an informed consent vi... more This study investigates whether applying educational testing approaches to an informed consent video for a medical procedure can lead to greater recall of the information presented. Undergraduate students (n=120) were randomly assigned to watch a 20-min video on informed consent under one of three conditions: 1) tested using multiple-choice knowledge questions and provided with feedback on their answers after each 5-min segment; 2) tested with multiple choice knowledge questions but not provided feedback after each segment; or 3) watched the video without knowledge testing. Participants who were tested and provided feedback had significantly greater information recall compared to those who were tested but not provided feedback and to those not tested. The effect of condition was stronger for moderately difficult questions versus easy questions. Inserting knowledge tests and providing feedback about the responses at timed intervals in videos can be effective in improving recall of information. Providing informed consent information through a video not only standardizes the material, but using testing with feedback inserted within the video has the potential to increase recall and retention of this material.
The social environment can facilitate or hamper one’s ability to cope with chronic stressors, but... more The social environment can facilitate or hamper one’s ability to cope with chronic stressors, but it can also be a direct source of chronic stress. This chapter examines three ways in which the social environment is implicated in chronic stress processes. First, it describes the variety of social sources of chronic stress. Second, it shows how the social environment can moderate, or alter, the impact of chronic stressors by mitigating or exacerbating people’s responses to them. Finally, it illustrates how enduring and undesirable changes in the social environment, which often result from stressful life events, can mediate, or explain, the effects of major life events on health and well-being.
This study evaluated the psychometric properties of the Greek version of the Social Constraints S... more This study evaluated the psychometric properties of the Greek version of the Social Constraints Scale, developed in English by Lepore and Ituarte (1999). The scale was culturally adapted in Greek and was then administered, along with measures of psychological distress and intrusions, to a sample of 202 women with breast cancer, recruited from July 2012 to October 2013. Although the scale has usually been treated as a unidimensional measure, exploratory factor analysis revealed three underlying factors in the Greek Social Constraints Scale: unsupportive behaviors, avoidant behaviors, and suggestions for pretense and distraction. The three-factor solution explained 55% of the total variance. Subscale reliability was satisfactory,(Cronbach's alpha coefficients ranging from 0.77 to 0.88). All subscales were significantly related to intrusions and psychological distress. Thus, the Greek-Social Constraints Scale is a reliable and valid multidimensional instrument. The results of the p...
Objectives. To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel interv... more Objectives. To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel intervention initiated in a citywide safety net health system to improve low-income maternal smokers’ abstinence and reduce child tobacco smoke exposure.Methods. This randomized controlled trial in Philadelphia, Pennsylvania (2015–2020), recruited low-income maternal smokers who received a brief smoking intervention (Ask, Advise, Refer [AAR]) from nutrition professionals in the Special Supplemental Nutrition Program for Women, Infants, and Children before randomization to (1) a multilevel intervention (AAR + multimodal behavioral intervention [MBI]; n = 199) or (2) an attention control intervention (AAR + control; n = 197).Results. AAR + MBI mothers had significantly higher 12-month bioverified abstinence rates than did AAR + control mothers (odds ratio [OR] = 9.55; 95% confidence interval [CI] = 1.54, 59.30; P = .015). There were significant effects of time (b = −0.15; SE = 0.04; P < .001) and condition by time (b = −0.19; SE = 0.06; P < .001) on reported child exposure favoring AAR + MBI, but no group difference in child cotinine. Presence of other residential smokers was related to higher exposure. Higher baseline nicotine dependence was related to higher child exposure and lower abstinence likelihood at follow-up.Conclusions. The multilevel BLiSS intervention was acceptable and efficacious in a population that experiences elevated challenges with cessation.Public Health Implications. BLiSS is a translatable intervention model that can successfully improve efforts to address the persistent tobacco-related burdens in low-income communities.Trial Registration. Clinical Trials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT02602288","term_id":"NCT02602288"}}NCT02602288. (Am J Public Health. 2022;112(3):472–481. https://doi.org/10.2105/AJPH.2021.306601)
Introduction: Addressing child secondhand tobacco smoke (SHS) exposure is a public health priorit... more Introduction: Addressing child secondhand tobacco smoke (SHS) exposure is a public health priority (WHO). Our trial tests a multilevel intervention linking brief pediatric provider advice with individualized telebased counseling for parents focused on SHSe protections and smoking cessation. Methods: We modified pediatrics systems’ electronic assessments and trained providers throughout Philadelphia, PA, USA to educate smoking parents about SHS harms and the health benefits of protecting children from SHS. These providers referred parents to the trial. Parents are randomized to either 12 weeks of telebased smoking counseling or an attention control condition focused on nutrition education. Results: We have received >2900 referrals, enrolling over 300 parents (~90% retention). Over 80% of participants are women and African American, and over 75% are below the poverty line. Results suggest that relative to controls, the multilevel group: a) was less likely to smoke around their chil...
BACKGROUND: In this study, we investigated trends in cannabis use among parents with children at ... more BACKGROUND: In this study, we investigated trends in cannabis use among parents with children at home in the United States and estimated changes in prevalence of any cannabis use and daily cannabis use among parents who identified as cigarette smokers and nonsmokers with children in the home from 2002 to 2015. METHODS: The National Survey on Drug Use and Health is an annual, nationally representative, cross-sectional study conducted in the United States. Using logistic regression models, associations between cigarette smoking and any past-month and daily past-month cannabis use among parents with children in the home from 2002 to 2015 were estimated. Moderation of these associations by demographics and trends over time was examined. RESULTS: Past-month cannabis use among parents with children in the home increased from 4.9% in 2002 to 6.8% in 2015, whereas cigarette smoking declined from 27.6% to 20.2%. Cannabis use increased from 11.0% in 2002 to 17.4% in 2015 among cigarette-smoki...
Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing ch... more Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development—nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre–post outcomes were assessed using bivariate statistics...
International Journal of Environmental Research and Public Health
Background: During quit attempts, smokers must overcome smoking urges triggered by environmental ... more Background: During quit attempts, smokers must overcome smoking urges triggered by environmental cues and nicotine withdrawal symptoms. This study investigates the psychometric properties of the 12-item Tobacco Urge Management Scale (TUMS), a new measure of smoking urge management behaviors. Methods: We analyzed secondary data (n = 327) from a behavioral smoking cessation intervention trial, Kids Safe and Smokefree (KiSS). Results: Confirmatory factor analysis of the TUMS indicated that a one-factor model and a correlated two-factor model had similar model fit indices, and a Chi-square difference test supported the one-factor model. Further study of the parsimonious one-factor scale provided evidence of reliability and construct validity. Known group validity was evidenced by significantly higher TUMS scores in the KiSS intervention arm receiving urge management skills training than in the control arm (p < 0.001). Concurrent validity was evidenced by TUMS’s inverse association wi...
Lepore, S. J., &amp; Revenson, T. A. (2006). Resilience &amp; posttraumatic growth: Recov... more Lepore, S. J., &amp; Revenson, T. A. (2006). Resilience &amp; posttraumatic growth: Recovery, resistance, &amp; reconfiguration. In L. G. Calhoun &amp; R. G. Tedeschi (Eds.), Handbook of Posttraumatic Growth: Research and Practices, (pp. 24-46). Mahwah, NJ: Lawrence Erlbaum Associates, Inc., Publishers.
Approximately 20% of men with a diagnosis of prostate cancer present with locally advanced or adv... more Approximately 20% of men with a diagnosis of prostate cancer present with locally advanced or advanced disease. Few studies consider longer-term impact of disease progression and treatment adverse effects on health-related quality of life (QoL) of these men. Describe changes in health-related QoL over 5 years for men with newly diagnosed locally advanced or advanced prostate cancer. Eighty-one men with locally advanced or advanced prostate cancer referred to the study by their treating urologist completed a self-administered questionnaire assessing distress, cancer-specific distress, decision regret, satisfaction with life, and global and disease-specific health-related QoL. Questionnaires were administered close to diagnosis (baseline), 2, 6, 12, 24, 36, 48, and 60 months&#39; follow-up. Men were of mean age 68.3 (SD, 7.9) years and at mean of 31.9 (SD, 50.5) days postdiagnosis. The most common treatment received was androgen deprivation therapy (95.1%) or radiation therapy (79%). The proportion of men classified as distressed (Distress Thermometer) ranged from 46.3% (baseline) to 32.6% (60 months). Decrements in physical QoL were found at 2, 6, 12, 24, 36, and 48 months compared with baseline. Life satisfaction ratings were lower at 6 months compared with baseline. Sexual concerns were consistently high across the 5 years (Expanded Prostate Cancer Index Composite &lt;30). In the context of advanced disease, results indicate that health-related QoL fluctuates from diagnosis to 5 years later. A substantial proportion remained distressed at 5-year follow-up. Care frameworks supporting ongoing assessment of health-related QoL concerns of men with advanced prostate cancer are needed with a particular focus on sexual adjustment.
Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Dec 17, 2016
To examine the extent to which mindfulness skills influence psychological distress and health-rel... more To examine the extent to which mindfulness skills influence psychological distress and health-related quality of life (HRQOL) in men with metastatic or castration-resistant biochemical progression of prostate cancer. A cross-sectional survey of 190 men (46 % response; mean age 71 years, SD = 8.7, range 40-91 years) with advanced prostate cancer, assessed psychological and cancer-specific distress, HRQOL. Mindfulness skills were assessed as potential predictors of adjustment outcomes. Overall, 39 % of men reported high psychological distress. One third had accessed psychological support previously although only 10 % were under current psychological care. One quarter had accessed a prostate cancer support group in the past six months. Higher HRQOL and lower cancer-specific and global psychological distress were related to non-judging of inner experience (p < 0.001). Higher HRQOL and lower psychological distress were related to acting with awareness (p < 0.001). Lower distress wa...
This study investigates whether applying educational testing approaches to an informed consent vi... more This study investigates whether applying educational testing approaches to an informed consent video for a medical procedure can lead to greater recall of the information presented. Undergraduate students (n=120) were randomly assigned to watch a 20-min video on informed consent under one of three conditions: 1) tested using multiple-choice knowledge questions and provided with feedback on their answers after each 5-min segment; 2) tested with multiple choice knowledge questions but not provided feedback after each segment; or 3) watched the video without knowledge testing. Participants who were tested and provided feedback had significantly greater information recall compared to those who were tested but not provided feedback and to those not tested. The effect of condition was stronger for moderately difficult questions versus easy questions. Inserting knowledge tests and providing feedback about the responses at timed intervals in videos can be effective in improving recall of information. Providing informed consent information through a video not only standardizes the material, but using testing with feedback inserted within the video has the potential to increase recall and retention of this material.
The social environment can facilitate or hamper one’s ability to cope with chronic stressors, but... more The social environment can facilitate or hamper one’s ability to cope with chronic stressors, but it can also be a direct source of chronic stress. This chapter examines three ways in which the social environment is implicated in chronic stress processes. First, it describes the variety of social sources of chronic stress. Second, it shows how the social environment can moderate, or alter, the impact of chronic stressors by mitigating or exacerbating people’s responses to them. Finally, it illustrates how enduring and undesirable changes in the social environment, which often result from stressful life events, can mediate, or explain, the effects of major life events on health and well-being.
This study evaluated the psychometric properties of the Greek version of the Social Constraints S... more This study evaluated the psychometric properties of the Greek version of the Social Constraints Scale, developed in English by Lepore and Ituarte (1999). The scale was culturally adapted in Greek and was then administered, along with measures of psychological distress and intrusions, to a sample of 202 women with breast cancer, recruited from July 2012 to October 2013. Although the scale has usually been treated as a unidimensional measure, exploratory factor analysis revealed three underlying factors in the Greek Social Constraints Scale: unsupportive behaviors, avoidant behaviors, and suggestions for pretense and distraction. The three-factor solution explained 55% of the total variance. Subscale reliability was satisfactory,(Cronbach's alpha coefficients ranging from 0.77 to 0.88). All subscales were significantly related to intrusions and psychological distress. Thus, the Greek-Social Constraints Scale is a reliable and valid multidimensional instrument. The results of the p...
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Papers by Stephen Lepore