Increasing driver yielding and pedestrian signaling with prompting, feedback, and enforcement

The effects of an intervention package on drivers' yielding to pedestrians and on pedestrians' signaling their intention to cross the street were assessed using a multiple baseline design. The intervention, which consisted of publicly posted feedback on the percentage of motorists yielding to pedestrians, small signs prompting pedestrians to engage in appropriate crossing behavior, and an enforcement program involving the use of warning tickets and feedback fliers, was sequentially introduced on two streets. The intervention more than doubled the percentage of motorists yielding to pedestrians and increased the percentage of pedestrians signaling their intention to cross the street to over 13% from a baseline level of less than 1%. Near misses involving pedestrians decreased by more than 50% on the narrower of the two streets.     

INTERVENTIONS TO REDUCE HIGH-VOLUME PORTABLE HEADSETS: “TURN DOWN THE SOUND!”

Two studies examined effects of interventions to reduce noise levels from portable stereo headphones. Study 1 examined the effectiveness of warning signs posted in and nearby public elevators with 567 passengers possessing a portable headphone (total N = 7,811). During a 9-day baseline, the mean percentage of headphones played at an observer-audible level was 85%. During a subsequent 6-day warning sign phase, the mean percentage of audible headphones declined to 59%, which increased to a mean of 76% during a second baseline phase (5 days). Study 2 assessed the impact of a student confederate who lowered his or her observer-audible headphone volume at the polite request of a second student confederate. Of the 4,069 elevator passengers, 433 possessed a portable headset. The mean percentage of observer-audible headphones during a 4-day baseline was 85%. Subsequently, a 5-day modeling intervention reduced audible volumes to a mean of 46%. During a second baseline phase of 4 days, the mean level was 77%, and during reintroduction of the modeling phase (9 days) the mean level was 42%. The modeling intervention was significantly more effective with women (53% compliance) than men (29% compliance).     

Comparison of health promotion and deterrent prompts in increasing use of stairs over escalators

This study compared the effectiveness of two point-of-decision prompts within the same environmental setting. The effects of a health promotion sign were compared with activity change resulting from a deterrent sign. Individuals were observed using the upward stairs or upward escalator at a midwest regional air port during a 5-week period in which intervention signs were compared with no sign conditions on activity choice. During Weeks 1, 3, and 5 behaviors were assessed without any prompts. During Week 2, a health promotion sign was posted at the behavioral choice point which read "Keep your heart healthy, use the stairs." During Week 4, a deterrent sign which read "Please limit escalator use to staff and those unable to use the stairs" was posted at the same behavioral choice point. Younger (<40) women (14.8%) and men (10.8%) used the stairs more frequently, followed by older women (9.3%) and older men (6.9%). A hierarchical log linear analysis showed that stair use increased during both interventions, which was significantly moderated by age. Point-of-decision prompts appear to be effective environmental interventions for promoting increases in physical activity.     

PROMOTING AUTOMOBILE SAFETY BELT USE BY YOUNG CHILDREN

A program using behavioral practice, assertiveness training, and social and contrived reinforcers was developed to establish and maintain automobile safety belt use by young children. Sixteen children (ages 4.8 to 7 years) who never used their safety belts during a 5-day preexperimental observation period were randomly assigned to two groups of eight each. A multiple baseline design across groups was used to evaluate the effectiveness of the training program. During the 8-day baseline period for Group 1, no children used their safety belts when unobtrusively observed while being driven from school. During the 26-day intervention period, the children were buckled up on 96% of the observations. Follow-up probes conducted 2–3 months after program discontinuance found safety belt use to range from 86% to 100%. For Group 2, the 14-day baseline safety belt use averaged 6% and increased to a mean of 81% during the 20-day training and maintenance program. Follow-up probes 2–3 months later found safety belt use to occur during 75% to 96% of the observations. Parent questionnaires indicated the generalizability and social validity of the program.     

Increasing Vegetable Consumption in Students with Autism Spectrum Disorder Using Pre-meal Presentation: A Preliminary Analysis

This study examined the effect of pre-meal presentation on the consumption of vegetables in a sample of 16 students with autism spectrum disorder (ASD). These 16 students (75% male; mean age?=?13 years; age range 8–18 years) were enrolled in a private school serving children with autism. School staff offered participants 10 small pieces of two vegetables during lunch (baseline) or prior to lunch (pre-meal presentation). Observers recorded the number of bites students consumed. We used an A–B–A–B design to examine the effects of pre-meal presentation. Results were evaluated using a mixed-method, individual- and group-level, analysis. Pre-meal presentation resulted in increased vegetable consumption for 9 of the 16 participants. A reversal to baseline demonstrated expected decreases in bites consumed, and the subsequent return to intervention demonstrated expected increases in bites consumed. One-way repeated measures ANOVA compared bites consumed per session across 10 four-session study blocks and found significant differences between these two conditions. Paired comparisons revealed no change in bites consumed per session from baseline to intervention block #1, but significant increases from baseline to intervention #2 and all subsequent intervention blocks. Our results suggested pre-meal presentation can serve as a low-cost, low-effort intervention for increasing vegetable consumption for some children with ASD.

     

PARTICIPATIVE EDUCATION FOR CHILDREN: AN EFFECTIVE APPROACH TO INCREASE SAFETY BELT USE

Vehicle license plate numbers and the shoulder belt use of front-seat occupants were recorded unobtrusively when parents delivered and picked up their children at a Montessori school during 5-day baseline, intervention, and follow-up phases. Practicing and presenting a 15-min safety belt skit increased the safety belt use of those 6 kindergarten children who were not consistent belt users 82% above their preintervention baseline belt use mean of 47%. The belt use of these children's parents (who watched the skit) increased to 56% above their baseline mean of 36%. Also, mean safety belt use of 11 primary school children who watched the skit increased to 70% above their baseline of 28%. Mean safety belt use of the older children's parents (who didn't watch the skit) remained at approximately 31% for each phase, regardless of whether children were vehicle occupants. The follow-up observations, taken 3 months after the intervention, revealed 60% belt use for the kindergartners, 48% for the primary school children, and 71% for the kindergartners' parents when the children were vehicle occupants but only 30% when the parents were driving alone.     

Increasing recycling in office environments: The effects of specific, informative cues

We investigated the effects of prompts on the recycling behavior of approximately 217 faculty, staff, and graduate students in two academic departments of a large university. During the intervention, two signs were posted in each department. One sign prompted recycling (posted above the recycling receptacle), and the other sign prompted proper disposal of trash (posted above the trash receptacle). Results of a multiple baseline design across the two departments indicated that the sign prompt increased recycling behavior. Installation of the sign prompts in close proximity to receptacles in Department A resulted in a 54% improvement over baseline. Posting of sign prompts over containers 4 m apart in Department B resulted in a 17% improvement, whereas positioning the signs and receptacles in close proximity resulted in a 29% improvement over baseline.     

Improving the driving practices of pizza deliverers: Response generalization and moderating effects of driving history

A practical intervention program, targeting the safety belt use of pizza deliverers at two stores, increased significantly the use of both safety belts (143% above baseline) and turn signals (25% above baseline). Control subjects (i.e., pizza deliverers at a third no-intervention store and patrons driving to the pizza stores) showed no changes in belt or turn signal use over the course of 7-month study. The intervention program was staggered across two pizza stores and consisted of a group meeting wherein employees discussed the value of safety belts, received feedback regarding their low safety belt use, offered suggestions for increasing their belt use, and made a personal commitment to buckle up by signing buckle-up promise cards. Subsequently, employee-designed buckle-up reminder signs were placed in the pizza stores. By linking license plate numbers to individual driving records, we examined certain aspects of driving history as moderators of pre- and postintervention belt use. Although baseline belt use was significantly lower for drivers with one or more driving demerits or accidents in the previous 5 years, after the intervention these risk groups increased their belt use significantly and at the same rate as drivers with no demerits or accidents. Whereas baseline belt use was similar for younger (under 25) and older (25 or older) drivers, younger drivers were markedly more influenced by the intervention than were older drivers. Individual variation in belt use during baseline, intervention, and follow-up phases indicated that some drivers require more effective and costly intervention programs to motivate their safe driving practices.     

The use of brief restraint plus reinforcement to treat self-injurious behavior

This study evaluated the use of brief arm restraint plus differential reinforcement of alternative behavior to treat the self-injurious behavior of two residents with multiple handicaps and profound mental retardation. The study took place in a nursing home and sessions were conducted for 15 minutes, Monday through Friday. The design contained both multiple baseline and reversal components. Mean levels of self-injurious behavior and stripping for one client were reduced from 92 to 16% and 81 to 2%, respectively, by the treatment. Her appropriate behavior increased from a mean of 18% in baseline to 100% in treatment. The second client's self-injurious behavior averaged 39% in baseline, but was reduced to a mean of 9% in treatment. His throwing decreased from a mean of 54% prior to treatment to a mean of 2%, while appropriate object manipulation increased from 26 to 99%. These data support the use of brief restraint plus reinforcement for decelerating severe self-injurious behaviors and accelerating appropriate behaviors in adults with profound mental retardation. The advantages of this treatment are that it appears to be less intrusive and to offer more educational benefits than other commonly used techniques.     

Motivating safety belt use at a community hospital: An effective integration of incentive and commitment strategies

An effective hospital-based safety-belt program incorporated several advantages over prior attempts to increase safety belt use, including (a) the use of indigenous staff as program sponsors, coordinators, and delivery agents; (b) a yearlong program evaluation; and (c) a combination of extrinsic incentives and intrinsic commitment. To be eligible for a weekly $5, employees met the following contingencies: (a) signed a pledge card; (b) displayed the signed pledge card in their vehicle; and (c) wore a safety belt. Overall, belt use increased from a 2-week baseline mean of 15.6% to 34.7% during the 6-month intervention, and decreased to 25.6% at withdrawal. For the pledge card signers (n = 188) and the nonsigners (n = 533), belt use increased from baseline means of 29.4% and 11.8% to intervention use rates of 75.1 and 17.7%, respectively. Withdrawal and 4-month follow-up use rates were 56.0% and 44.9% for the Pledge group, and 17.2% and 22.1% for the Nonpledge group.     

Directed Rehearsal and Preservice Teachers' Performance of Instructional Behaviors

This investigation evaluated the use of directed rehearsal to improve the teaching behaviors of four preservice elementary physical education teachers during a teaching practicum. Directed rehearsal consisted of two phases: (a) initial feedback following baseline, review of teaching behaviors, and rehearsal; and (b) rehearsal contingent upon errors made during each lesson. Three teaching behaviors were assessed using a multiple baseline design across behaviors for each teacher. Social validity in the form of the acceptability of directed rehearsal as a teacher training intervention also was assessed using a questionnaire. Results indicate that directed rehearsal was effective in improving the teaching behaviors of the four teachers in this study to 100% correct implementation. In addition, the intervention was acceptable to the teachers and the class instructor.     

Effects of peer social initiations on the behavior of withdrawn preschool children

Social approach to peers was evaluated as an intervention for isolate preschoolers. During baseline, confederate peers made few social approaches to the target subjects. Confederates greatly increased their rate of social approaches during the first intervention, decreased social approaches during a second baseline, and increased social approaches again in a second intervention phase. Increases in confederate social initiations immediately increased the frequency of subjects' positive social behavior. Additionally, five of six subjects showed an increase in their own positive social initiations during intervention periods. The results suggest that: (a) peers may be programmed to increase the positive social behaviors of their isolate classmates, and (b) remediating social deficits requires assessment and intervention specifically tailored to the individual child.     

Husbands' and wives' alcohol use disorders and marital interactions as longitudinal predictors of marital adjustment

In this longitudinal study, the relationships among wives' and husbands' lifetime alcoholism status, marital behaviors, and marital adjustment were tested. Participants were 105 couples from the Michigan Longitudinal Study (MLS), an ongoing multimethod investigation of substance use in a community-based sample of alcoholics, nonalcoholics, and their families. At baseline (T1), husbands and wives completed a series of diagnostic measures, and lifetime diagnosis of alcohol use disorder (AUD, as defined in the Diagnostic and Statistical Manual of Mental Disorders, 4th ed.), was assessed. Couples completed a problem-solving marital interaction task 3 years later at T2, which was coded for the ratio of positive to negative behaviors. Couples also completed a measure of marital adjustment at T4 (9 years after T1 and 6 years after T2). Results showed that husbands' lifetime AUD predicted lower levels of their wife's positive marital behaviors 3 years later but was not related to their own or their wife's marital adjustment 9 years from baseline. By contrast, wives' lifetime AUD had direct negative associations with their own and their husband's marital satisfaction 9 years later, and wives' marital behaviors during the problem-solving task predicted their own and their husband's marital satisfaction 6 years later. Findings indicate that marital adjustment in alcoholic couples may be driven more by the wives' than the husbands' AUD and marital behavior. Implications for intervention with alcoholic couples were discussed.     

Evaluating increased effort for item disposal to improve recycling at a university

An evaluation of increased response effort to dispose of items was conducted to improve recycling at a university. Signs prompting individuals to recycle and notifying them of the location of trash and recycling receptacles were posted in each phase. During the intervention, trashcans were removed from the classrooms, and one large trashcan was available in the hallway next to the recycling receptacles. Results showed that correct recycling increased, and trash left in classrooms increased initially during the second intervention phase before returning to baseline levels.     

Effects of teacher greetings on student on-task behavior

A multiple baseline design across participants was used to determine how teacher greetings affected on-task behavior of 3 middle school students with problem behaviors. Momentary time sampling was used to measure on-task behavior during the first 10 min of class. Teacher greetings produced increases in students' on-task behavior from a mean of 45% in baseline to a mean of 72% during the intervention phase. Teacher greetings represent an antecedent manipulation that can easily be implemented in classrooms to improve students' on-task behavior.     

An experimental analysis of peer social initiations on the behavior of withdrawn preschool children: Some training and generalization effects

In this study, positive social initiations by an age-peer was evaluated as an intervention for isolate preschool children in training and generalization sessions. During baseline, the confederate made few social approaches to the target subjects. The confederate greatly increased his rate of positive social initations during the first intervention, decreased social approaches during a second baseline, and increased social approaches again in a second intervention phase. Increases in confederate initiations resulted in an immediate acceleration in the frequency of subjects' positive social behavior during training sessions. Additionally, for two of the three subjects, positive social behaviors were also observed to increase during generalization sessions. The results suggest that (a) peers may be trained successfully to set the occasion for positive social behaviors by withdrawn classmates, (b) increased social responding by withdrawn children in the presence of frequent peer social initiations may also generalize beyond the training setting, and (c) the magnitude of direct and generalization effects appears to be related to the entry-level repertoire of target children.     

Early Identification and Intervention for Behavior Problems in Primary Care: A Comparison of Two Abbreviated Versions of Parent-Child Interaction Therapy

Behavioral screening and preventive intervention were implemented for 3- to 6-year-olds in pediatric primary care with subclinical behavior problems. One hundred eleven children were screened with the Eyberg Child Behavior Inventory. Thirty children who scored within one standard deviation of the normative mean whose mothers indicated wanting help for their child's behavior were randomized to one of two abbreviated versions of Parent-Child Interaction Therapy (PCIT) for use in pediatric primary care: (a) a 4-session group preventive intervention called Primary Care PCIT (PC-PCIT); or (b) written materials describing basic steps of PCIT and guidelines for practice, called PCIT Anticipatory Guidance (PCIT-AG). Decreases in child problem behaviors and ineffective parenting strategies, and increases in parental feelings of control were not significantly different between versions at post-intervention or 6-month follow-up. Changes during intervention were significantly larger for both groups than changes during pretreatment baseline, with moderate to large effect sizes. These brief versions of PCIT are both promising primary care preventive interventions that deserve further study.     

Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

This study tested whether a new training tool, the Exposure Guide (EG), improved in-session therapist behaviors (i.e., indicators of quality) that have been associated with youth outcomes in prior clinical trials of exposure therapy. Six therapists at a community mental health agency (CMHA) provided exposure therapy for 8 youth with obsessive–compulsive disorder (OCD). Using a nonconcurrent multiple baseline design with random assignment to baseline lengths of 6 to 16 weeks, therapists received gold-standard exposure therapy training with weekly consultation (baseline phase) followed by addition of EG training and feedback (intervention phase). The primary outcome was therapist behavior during in-session exposures, observed weekly using a validated coding system. Therapist behavior was evaluated in relation to a priori benchmarks derived from clinical trials. Additional outcomes included training feasibility/acceptability, therapist response to case vignettes and beliefs about exposure, and independent evaluator-rated clinical outcomes. Three therapists reached behavior benchmarks only during the EG (intervention) phase. Two therapists met benchmarks during the baseline phase; one of these subsequently moved away from benchmarks but met them again after starting the EG phase. Across all therapists, the percentage of weeks meeting benchmarks was significantly higher during the EG phase (86.4%) vs. the baseline phase (53.2%). Youth participants experienced significant improvement in OCD symptoms and global illness severity from pre- to posttreatment. Results provide initial evidence that adding the EG to gold-standard training can change in-session therapist behaviors in a CMHA setting.     

Promoting safety belt use among state employees: the effects of prompting and a stimulus-control intervention.

This study assessed the effects of dashboard stickers and signature sheets on safety belt use among occupants of state-owned vehicles in three Florida agencies. The stickers and signature sheets contained information regarding a regulation requiring safety belt use and a consequence of a 25% reduction in benefits for noncompliance if the driver were to become involved in an accident. Safety belt use significantly increased during the intervention phase in all three agencies and maintained variable but high levels for 5 months. In Agency 1 and Agency 2 (stickers plus signature sheets) safety belt use increased from averages of 10.8% and 9.4% during baseline to 57.4% and 47.0%, respectively, during intervention. In Agency 3 (stickers only) the rates of safety belt use averaged 9.7% during baseline and 38.0% during intervention. Some increases in private vehicle use were observed. A substantial reduction in workers'' compensation claim costs was shown for the target agencies with some reductions also shown in the nontarget agencies.     

The effects of two AIDS risk-reduction interventions on heterosexual college women's AIDS-related knowledge,attitudes and condom use

An intervention combining AIDS information with condom eroticization, condom normalization, and communication skills training was found to increase both AIDS-related knowledge and condom use among Canadian college students. 112 unmarried female undergraduates (mean age, 18 years) were randomly assigned to this combination intervention (n = 49), an information-only intervention (n = 44), or a pre-test/post-test control group (n = 19). 80% of students had engaged in vaginal intercourse and 14% in anal intercourse. 84% of coitally active women had engaged in unprotected intercourse in the past year and 48% had not used condoms consistently with any sexual partner. Condom use in the pre-intervention period was associated with positive attitudes toward the method and the perception that condom use was normative among peers. One month after the interventions, both the combination and information groups, but not controls, showed an increase over baseline in AIDS-related knowledge. However, among the 36 students who were coitally active in the 1-month periods before and after the intervention, only the combination intervention was associated with increased condom use. In the combination group, the percentage of episodes of intercourse protected by condoms increased from an average of 21.8% in the month preceding the study to 50% during the 4-week follow-up period. Due to the small sample size and design of the study, it was not possible to determine which component of the multifaceted educational intervention was most responsible for this change.