Principles for Designing Randomized Preventive Trials in Mental Health: An Emerging Developmental Epidemiology Paradigm

An emerging population-based paradigm is now being used to guide the design of preventive trials used to test developmental models. We discuss elements of the designs of several ongoing randomized preventive trials involving reduction of risk for children of divorce, for children who exhibit behavioral or learning problems, and for children whose parents are being treated for depression. To test developmental models using this paradigm, we introduce three classes of design issues: design for prerandomization, design for intervention, and design for postintervention. For each of these areas, we present quantitative results from power calculations. Both scientific and cost implications of these power calculations are discussed in terms of variation among subjects on preintervention measures, unit of intervention, assignment, balancing, number of pretest and posttest measures, and the examination of moderation effects.     

Evaluation of a sexual abuse prevention program for adults with mental retardation.

Programs to teach sexual abuse prevention skills to persons with mental retardation have rarely been evaluated empirically, and typical evaluations are limited to assessment of the participants' knowledge rather than their performance of specific skills. In the present study, 6 adult women with mental retardation were trained in sexual abuse prevention, and performance was assessed using four separate measures: pretests and posttests of knowledge, verbal report, role play, and naturalistic probes. All women learned the skills but failed to exhibit them to criterion during the probes. We discuss the implications for further training and assessment of sexual abuse prevention skills.     

Role of Secondary Stressors in the Parental Death–Child Distress Relation

This study examined the psychological consequences and secondary stressors associated with death of a parent. The sample (N = 116) consisted of 26 youths who had lost a parent to homicide, 45 youths who had lost a parent to natural death, and 45 nonbereaved youths. Youngsters completed face-to-face interviews, while their guardians completed measures assessing the children's functioning. Results based on both child and guardian reports indicated that parental death was associated with an increase in secondary stressors, regardless of the mode of death. Findings based on guardian reports also revealed that parental death was related to increased internalizing distress, and that parental death due to homicide was related to increased externalizing distress. Furthermore, secondary stressors mediated the parental death–child distress relation such that parental death led to an increase in stressors, which in turn led to increased child distress. Implications for secondary and tertiary preventive interventions are discussed.     

Teaching self-protection to young children

Self-protective behaviors were taught to three preschool children in order to prevent the opportunity for abduction. An analogue measure of self-protection was developed in which confederate adults approached and verbally attempted to lure each child from the setting, before, during, and after training. A multiple baseline design across subjects was used. During baseline, all the children displayed susceptibility to the lures. Training procedures included modeling, behavior rehearsal, and social reinforcement. Within 1 week after training began, all children displayed appropriate responses to all of the lures both in the training setting and in the community.     

BEHAVIORAL RESEARCH IN PREVENTIVE DENTISTRY: EDUCATIONAL AND CONTINGENCY MANAGEMENT APPROACHES TO THE PROBLEM OF PATIENT COMPLIANCE

This study examined the effects of reinforcement on compliance with an oral hygiene education program. Patients 18 years of age or older who enrolled in an ongoing program at a periodontal practice received 3–5 sessions of instruction in preventive dental care. Using a between-subjects design, patients who entered the program during alternating months also had a portion of their fees refunded contingent upon improvements in their dental plaque scores. Pre- and posttreatment data showed that all subjects exhibited lower plaque levels following the program, but that greater improvements were seen in patients who were exposed to the fee reduction contingency. Plaque scores taken at a 6-month follow-up revealed some relapse for the Fee Reduction subjects. However, their scores were still substantially better than pretreatment, and better than those of the Education only subjects, whose data differed little from untreated Controls. Methodological and practical issues related to behavioral research in preventive dentistry are discussed.     

ALTERING SHOPPERS' SUPERMARKET PURCHASES TO FIT NUTRITIONAL GUIDELINES: AN INTERACTIVE INFORMATION SYSTEM

This study reports the results of one effort to help supermarket shoppers alter food purchases to make purchases (and meals) that are lower in fat and higher in fiber. A prototype interactive information system using instructional video programs, feedback on purchases with specific goals for change, weekly programs, and the ability to track user interactions and intended purchases was evaluated. The major dependent measure was users' actual food purchases as derived from participants' highly detailed supermarket receipts. After a 5- to 7-week baseline phase, participants were randomly assigned to an experimental or control condition for the 7- to 8-week intervention phase. A follow-up phase began 5 to 8 weeks after participants completed the intervention and discontinued use of the system. The results indicated that experimental participants, when compared to control participants, decreased high fat purchases and increased high fiber purchases during intervention, with evidence for some maintenance of effect in follow-up. Plans for increasing the use and impact of the system are discussed.     

Alcohol problems and relapse: Can the clinic combat the community?

Despite over a decade of research and debate into the issue of relapse the majority of people in treatment for alcohol-related problems still relapse. In this paper the results of an innovative relapse prevention and management programme are reported. It was found that a cognitive-behavioural package of strategies reduced the likelihood of relapse. On average, clients receiving this experimental package took four times longer to return to any alcohol use and seven times longer to return to ‘heavy drinking’ than did a conventional treatment control group. However, notwithstanding these results, 60 per cent of the experimental group did return to harmful drinking. The authors question whether further refinement of these procedures is possible, and suggest that if relapse rates are to be further reduced then greater attention needs to be given by counsellors to clients' social environment.     

Police communication programmes aimed at burglary victims: A review of studies and an experimental evaluation

The effects and side-effects of a victim assistance project aimed at victims of burglary are experimentally evaluated. Key features of the programme included the provision of burglary prevention information by police officers during a personal interaction with the victim through a positive and limitative communication strategy. Results suggest that important programme goals (for example, stronger satisfaction with police performance, a more internal risk orientation concerning victimization, stronger preventive intentions) were met. One of the positive effects for which experimental support was found was an improvement in police-victim relations. As regards side-effects the programme led neither to response generalization, nor to increased fear of crime outside the home. However, the side-effects of increased fear in the home did occur in female victims and victims with an external risk-orientation. The implications for future victim assistance projects in this domain are finally discussed.     

Academic on a mission: Run and run and run

Challenges the distinctions we make between research/scholarship and practice. Recognizes and values the complimentarity of teaching, research, practice, and public policy. Tells how I have tried to approach creating opportunities to integrate those activities in my role as a community psychologist in an academic setting. Describes some of the lessons I have learned from my two decades of practice. This article is a very close approximation to my Distinguished Contribution to Practice in Community Psychology award address at APA in Toronto, August 1996. That talk included numerous overheads, which reason demands I omit. I thank Jim Sorenson and George Albee who, each in their own way, showed me that university professors can be passionate about their work and extend their reach beyond the perimeters of the campus. I thank Heather Barton, Krista Hopkins, Jennifer Heigel, and Anne Salassi for being such good ambassadors and for my most meaningful source of professional satisfaction: turning students on to careers as community psychologists and preventionists. I thank the Virginia prevention community for two decades of working together toward a common mission and the College of William and Mary for supporting my life’s work. Finally I thank John Morgan for his friendship and his affirming introduction, State Michaels for her help with the original talk, and Beverly Peterson for always being there. I am deeply honored.