Intensive Behavioral Intervention Research Articles

Rationale and design of \u201cHearts & Parks\u201d: study protocol for a pragmatic randomized clinical trial of an integrated clinic-community intervention to treat pediatric obesity

BackgroundThe prevalence of child and adolescent obesity and severe obesity continues to increase despite decades of policy and research aimed at prevention. Obesity strongly predicts cardiovascular and metabolic disease risk; both begin in childhood. Children who receive intensive behavioral interventions can reduce body mass index (BMI) and reverse disease risk. However, delivering these interventions with fidelity at scale remains a challenge. Clinic-community partnerships offer a promising strategy to provide high-quality clinical care and deliver behavioral treatment in local park and recreation settings. The Hearts & Parks study has three broad objectives: (1) evaluate the effectiveness of the clinic-community model for the treatment of child obesity, (2) define microbiome and metabolomic signatures of obesity and response to lifestyle change, and (3) inform the implementation of similar models in clinical systems.MethodsMethods are designed for a pragmatic randomized, controlled clinical trial (n = 270) to test the effectiveness of an integrated clinic-community child obesity intervention as compared with usual care. We are powered to detect a difference in body mass index (BMI) between groups at 6 months, with follow up to 12 months. Secondary outcomes include changes in biomarkers for cardiovascular disease, psychosocial risk, and quality of life. Through collection of biospecimens (serum and stool), additional exploratory outcomes include microbiome and metabolomics biomarkers of response to lifestyle modification.DiscussionWe present the study design, enrollment strategy, and intervention details for a randomized clinical trial to measure the effectiveness of a clinic-community child obesity treatment intervention. This study will inform a critical area in child obesity and cardiovascular risk research—defining outcomes, implementation feasibility, and identifying potential molecular mechanisms of treatment response.Clinical trial registrationNCT03339440.

Evaluating dose delivered of a behavioral intervention for childhood obesity prevention: a secondary analysis

BackgroundCurrent recommendations for intensive behavioral interventions for childhood obesity treatment do not account for variable participant attendance, optimal duration of the intervention, mode of delivery (phone vs. face-to-face), or address obesity prevention among young children. A secondary analysis of an active one-year behavioral intervention for childhood obesity prevention was conducted to test how “dose delivered” was associated with body mass index z-score (BMI-Z) across 3 years of follow-up.MethodsParent-child pairs were eligible if they qualified for government assistance and spoke English or Spanish. Children were between three and 5 years old and were at risk for but not yet obese (BMI percentiles ≥50th and < 95th). The intended intervention dose was 18 h over 3-months via 12 face-to-face “intensive sessions” (90 min each) and 6.75 h over the next 9 months via 9 “maintenance phone calls” (45 min each). Ordinary least-squares multivariable regression was utilized to test for associations between dose delivered and child BMI-Z immediately after the 1-year intervention, and at 2-, and 3-year follow-up, including participants who were initially randomized to the control group as having “zero” dose.ResultsAmong 610 parent-child pairs (intervention n = 304, control n = 306), mean child age was 4.3 (SD = 0.9) years and 51.8% were female. Mean dose delivered was 10.9 (SD = 2.5) of 12 intensive sessions and 7.7 (SD = 2.4) of 9 maintenance calls. Multivariable linear regression models indicated statistically significant associations of intensive face-to-face contacts (B = -0.011; 95% CI [− 0.021, − 0.001]; p = 0.029) and maintenance calls (B = -0.015; 95% CI [− 0.026, − 0.004]; p = 0.006) with lower BMI-Z immediately following the 1-year intervention. Their interaction was also significant (p = 0.04), such that parent-child pairs who received higher numbers of both face-to-face intensive sessions (> 6) and maintenance calls (> 8) were predicted to have lower BMI-Z. Sustained impacts were not statistically significant at 2- or 3-year follow-up.ConclusionsIn a behavioral intervention for childhood obesity prevention, the combination of a modest dose of face-to-face sessions (> 6 h over 3 months) with sustained maintenance calls (> 8 calls over 9 months) was associated with improved BMI-Z at 1-year for underserved preschool aged children, but sustained impacts were not statistically significant at 2 or 3 year follow-up.Clinical trial registrationThe trial was registered on ClinicalTrials.gov (NCT01316653) on March 16, 2011, which was prior to participant enrollment.

Brief Report: Long-Term Follow-up of Smokers Living With HIV After an Intensive Behavioral Tobacco Treatment Intervention.

Cigarette smoking is extremely common among persons living with HIV (PLWH) in the United States, and it has emerged as a leading killer in this group. No tobacco treatment studied to date has demonstrated long-term efficacy. This was a follow-up study of PLWH adult smokers who completed a randomized controlled trial of positively Smoke Free group therapy from 2014 to 2017. Participants from 2 of the 3 trial sites were recalled to complete a long-term follow-up assessment, at least one year after initial enrollment. Of the 342 candidates for this follow-up study, 11 had died before our attempts to contact them, and 194 of the remaining 331 (58.6%) completed the late follow-up assessment. Most (91.2%) of the remaining candidates could not be contacted despite numerous attempts. At a mean of 38.1 months after initial study enrollment, using an intention-to-treat, lost to follow-up = still smoking (worst case scenario) strategy, 12.7% of group therapy vs. 6.6% of control participants had biochemically verified 7-day point-prevalence abstinence, odds ratio = 2.06 (95% CI: 0.96-4.41), P = 0.06, and 10.3% of group therapy vs. 4.2% of control participants had biochemically verified 12-month point-prevalence abstinence, odds ratio = 2.61 (95% CI: 1.05-6.47, P = 0.03). Improvements in abstinence self-efficacy in the positively Smoke Free group observed in the original study were sustained through late follow-up. Targeted group therapy for PLWH smokers was associated with increased cessation and sustained improvements in abstinence self-efficacy at a mean of more than 3 years of follow-up. This is the first trial to show long-term efficacy of tobacco treatment for PLWH.

Quality of Early Intensive Behavioral Intervention as a Predictor of Children's Outcome.

Research has directed surprisingly little attention to the quality of Early Intensive Behavioral Intervention (EIBI) in autism spectrum disorder (ASD) as a potential predictor of outcome. Therefore, using a preschool delivery model within a sample of 30 children, we examined the predictive power of EIBI quality on treatment outcome. EIBI quality was assessed at baseline by the York Measure of Quality of Intensive Behavioral Intervention (YMQI) and treatment outcome was evaluated after a period of 4 to 6 months using a battery of behavioral tests and scales to evaluate treatment success. Multinomial logistic regressions demonstrated that general EIBI quality predicted clinically significant change at follow-up. Particularly improvements in basic language and learning skills and global clinical impression were observed. Specific quality indicators that influenced overall treatment success were treatment organization, teaching level and differential reinforcement. In addition to previously examined predictors of EIBI treatment effects, such as child characteristics and intervention quantity, our findings highlight the importance of adequate EIBI quality assurance.

Implementing early intensive behavioral intervention in community settings.

Although research shows early intensive behavioral intervention can be very beneficial for children with autism spectrum disorder when delivered in university or private intervention centers, little is known about the best way to provide early intensive behavioral intervention within the broader community. The Michigan State University Early Learning Institute was developed to address challenges with providing early intensive behavioral intervention in community settings, with an emphasis on serving children and families on Medicaid. This short report describes the approach taken by the Early Learning Institute and reports data regarding enrollment and utilization among Medicaid families. Results suggest the model has potential to be used within community settings and that children on Medicaid are likely to consistently attend their treatment sessions.

Thinking in Pictures Educational Services (TIPES): A Preliminary Report of an Intensive Behavioral Intervention for Children with Moderate to Severe Autism Spectrum Disorder

Introduction: Autism spectrum disorder (ASD) is a potentially severely disabling exceptionality, and there is evidence of increasing incidence. In extreme cases major challenges can develop early in childhood for those individuals, their families and educational services. Social isolation, language problems, sensory and behavioural problems can all become entrenched if effective support is not provided. Interventions capable of delivering a recovery trajectory with transition to public/private education for children with moderate to severe ASD have been infrequently reported in the literature. Intensive behavioural intervention (IBI) as delivered within the Thinking in Pictures Educational Services (TIPES) has, as yet, not been tested as an intervention for children with moderate to severe autism. Methodology: IBI was delivered over a minimum of 12 months with 25-40 hours of individual therapy per week. Following a baseline memory paradigm assessment, a participant-specific IBI intervention was delivered. A combination of discrete trial training and ESDM, verbal behavior approach followed by direct instruction programs were used to improve language and social functioning. Baseline and end of intervention Assessment of Basic Language and Learning Skills-Revised (ABLLS-R) scores were recorded and compared to standard age adjusted mean childhood scores for educational ability. Each participant was assessed Assessment of Autism Treatment Evaluation Checklist (ATEC) in order to evaluate the impact of the intervention on the 4 domains of ASD (speech, sociability, sensory, behaviour performance). The primary end point was taken as the last score on the ATEC and ABLLS-R. The primary outcome was attendance in public and privately funded classroom settings. Results: All results within this study were significant. In terms of the primary outcome 9 out of 14 children with moderate to severe childhood ASD treated with IBI, using the TIPES method attended public/private funded sector education during the second year. There was an effect size (number needed to treat) of 2 indicating a very effective intervention. Basic language and learning skills as scored on the ABLLS-R significantly improved (p<0.000). Core characteristics of ASD as measured on the ATEC total scores significantly improved at end of treatment (p<0.012). All ATEC subscale scores significantly improved. Baseline mean speech scores significantly improved (p<0.006) as did sociability (p<0.005), sensory (p<0.078) and behaviour scores (p<0.041). Conclusion: This preliminary study indicated that educational attendance was possible for the majority of children with moderate to severe ASD who were accepted by TIPES and treated with an individualised combined IBI approach based on memory and learning capacity. If these results can be replicated this would be a highly cost-effective intervention.

The knowledge of Public Health Midwives on Autism Spectrum Disorder in two selected districts of the Western Province of Sri Lanka.

Early interventions are important for improving outcome in autism. However, the diagnosis of autism is often delayed for 3-4 years, which leads to missed opportunities to initiate early intensive behavioural interventions, thus jeopardizing its prognosis. The lack of knowledge among healthcare workers about the features of autism is postulated to be the main reason for this delay. A descriptive cross-sectional study was carried out among the PHMs in the Colombo and Kalutara districts of the Western Province, Sri Lanka. A specifically designed self-administered questionnaire was used to obtain information about the socio-demographic details. The knowledge about the signs and symptoms and common comorbidities of ASD were assessed using the "Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire". Out of 406 participants, 56.9 % (n = 231) were from the Colombo District. The mean knowledge of the participants on the "Knowledge about Childhood Autism among Health Workers (KCAHW) Questionnaire" was 13.23/19 (SD = 2.647). The knowledge was significantly higher in those who had participated in training programmes on autism (p < 0.01) and in those who have had contact with a child with autism (p < 0.05). Of the participants, 17.2 % (n = 70) believed that autism could be completely cured. 43.6 % and 42.2 % believed that poor attention from parents and parental conflicts during pregnancy and early childhood caused autism in children respectively. The knowledge of PHMs on autism is inadequate, with regard to the comorbidities, aetiology and treatment options. In service programmes are useful in improving the knowledge of PHMs on autism.

Incidence of large for gestational age and predictive values of third-trimester ultrasound among pregnant women with false-positive glucose challenge test

This cohort study aimed to determine the association between false-positive 50-g GCT and incidence of LGA and to evaluate predictive roles of third-trimester ultrasonographic examination. A total of 200 women with false-positive 50-g GCT and 188 women without GDM risks were enrolled. Third-trimester ultrasonographic examinations were offered. Rate of LGA during third trimester and at birth were compared between groups. Factors associated with LGA and diagnostic properties of third-trimester ultrasonography were evaluated. Incidence of LGA by third-trimester ultrasound and at birth were significantly higher in women with false-positive GCT (19.0% vs. 10.6%, p = .03 and 22% vs. 13.8%; p = .04). Factors associated with LGA included multiparity (adjusted OR 2.32, p = .01), excessive weight gain (adjusted OR 2.57, p = .01) and LGA by ultrasound (adjusted OR 9.79, p < .001). Third-trimester ultrasonography had 47.1% sensitivity, 92.1% specificity and LR + and LR- of 5.96 and 0.57 in identifying LGA infants. Impact statement What is already known on this subject? Women with abnormal GCT but normal OGTT (false positive GCT) might have some degree of glucose intolerance so that GDM-related outcomes could develop, including LGA, macrosomia, shoulder dystocia, and caesarean delivery. Roles of ultrasonography in the prediction of LGA and macrosomia has been reported with mixed results. What do the results of this study add? The results showed that the incidence of LGA, by third-trimester ultrasound and at birth, were significantly increased in women with false-positive GCT. Multiparity, excessive weight gain and LGA by third-trimester ultrasound significantly increased the risk of LGA. Third-trimester ultrasonography had 47.1% sensitivity, 92.1% specificity and LR + and LR- of 5.96 and 0.57 in identifying LGA infants. What are the implications of these findings for clinical practice and/or further research? More intensive behavioural and dietary interventions, together with weight gain control and monitoring, may be needed in women with false-positive GCT to minimise the risk of LGA. Third trimester ultrasonographic examination might be helpful to detect and predict LGA at birth and should be included into routine clinical practice. Further studies that are more widely generalisable are needed to elucidate the relationship between false-positive GCT and adverse pregnancy outcomes and to investigate the benefits of ultrasonographic examination in the prediction of LGA and macrosomia.

Effects of Remote Performance Feedback on Procedural Integrity of Early Intensive Behavioral Intervention Programs in China

In order to ensure the effects of early intensive behavioral interventions for children with autism, performance feedback is often used to improve procedural integrity. However, in areas where access to professionals is limited, onsite feedback may not be feasible. Researchers suggest that providing remote feedback may improve procedural integrity, but they often examined feedback along with other components. Thus, the purpose of this study is to investigate the effects of remote feedback alone on improving procedural integrity of discrete trial teaching (DTT) and incidental teaching (IT) of three interventionists in China. The interventionists received delayed remote feedback on either DTT or IT via video communication. Using an alternating treatment design, we directly compared the procedural integrity under the two conditions: with and without delayed remote feedback. Results showed that all interventionists improved procedural integrity only after feedback was introduced, suggesting that delayed remote feedback alone was effective in improving procedural integrity. The discussion addresses the practical and research implications of the findings.

Practical Functional Assessment: A Case Study Replication and Extension with a Child Diagnosed with Autism Spectrum Disorder

Recent literature has described the analysis and treatment of problem behavior that involves an open-ended interview to inform the conditions under which problem behavior is likely to occur, conducting a synthesized contingency analysis, and implementing treatment that includes functional communication training, delay and denial tolerance training, and increasing the amount of demands presented after a denial (e.g., Hanley et al. Journal of Applied Behavior Analysis, 47(1), 16–36, 2014). This process has been described as an Interview-Informed Synthesized Contingency Analysis (IISCA) or practical functional assessment. Much of the literature evaluating the practical functional assessment has originated from authors within the same research group. The purpose of the present study was to replicate and extend previous research on the practical functional assessment with a different group of researchers and in a different setting (i.e., an early intensive behavioral intervention clinic). This study sought to extend previous literature by including additional measures of social validity on the open-ended interview, contingency analysis, treatment, and pre-post measures on parental stress. The results were similar to previous research with an overall reduction in problem behavior and increases in functional communicative responses and compliance with demands.

EMERGENCE OF THE SKILLS THAT DEFINE NAMING IN CHILDREN WITH AUTISM

Individuals with autism lack flexibility to emit novel language. We explored the emergence of the skills that define the naming capacity in four young children with autism who received an early intensive behavioral intervention. They learned to tact objects or pictures (i.e., saying the name when seeing the object) then we probed, with no prompts or reinforcement, the emergence of selecting the same objects(pointing to the object or picture when hearing the name); they also learned to select a different set of items and we probed the emergence of tacts. Initially, two children did not demonstrate the emergence of any relation and the other two demonstrated the emergence of the selections. The procedure was repeated 15-21 months later. The first children demonstrated the emergence of the selections and the remaining children demonstrated the emergence of both selections and tacts. The results suggest that both selections and tacts can emerge in children with autism when they are taught with specific behavioral procedures.

Dishabituation of Operant Responding in Preschool-Aged Children

In applied settings, reinforcer satiation and the resulting response decrements may negatively affect otherwise effective treatments and can be difficult to avoid for some learners; previous research has suggested that a more precise explanation for these decrements may involve habituation to the sensory properties of repeatedly presented reinforcers, a process that carries with it different implications that may be useful in practice. One such implication is that habituated responding can undergo dishabituation, a recovery of habituated responding, following a brief stimulus change. The current study examined the effects of a dishabituation procedure on the operant responding of three children, all within the age range of children who typically receive early intensive behavioral intervention services. The participants engaged in an operant task in which they placed various task stimuli (e.g., pieces of foam, blocks, or poker chips) into a container in exchange for a small edible item or access to a toy. In each condition, once responding decreased to a predetermined level, the reinforcer (i.e., an edible) or an antecedent variable (i.e., the research assistant facilitating the task or the task stimulus) was changed for 2 min and then returned for an additional 2 min, whereas all other stimuli remained the same. Results indicated dishabituation patterns were observed in eight out of nine experimental conditions compared to control (no change) conditions in which responding did not recover, suggesting dishabituation procedures may provide options for at least temporarily reinstating the effectiveness of reinforcers.

Predictors of participant ‘no-shows’ for intensive behavioral tobacco cessation treatment: recruitment, demographics, and distance

AbstractIntroductionCognitive-behavioral therapy (CBT) for tobacco cessation is an evidence-based, yet underutilized intervention. More research is needed to understand why some treatment-seekers are ‘no-shows’ for the initial visit.AimExamine factors associated with participant no-shows among smokers scheduled for group CBT.MethodsTobacco smokers (N = 115) were recruited from the community, screened, and if eligible, scheduled to begin group-based CBT plus nicotine replacement therapy. At the screening, participants reported their recruitment source, demographics, smoking history, and contact information. We computed the distance to the study site using the address provided. Regression analyses tested predictors of participant no-shows for the initial visit.ResultsEligible participants were mostly recruited via flyers (56%), female (58%), African American (61%), middle-aged (Mage = 49 years), averaged 16 cigarettes per day, and resided 8 miles away from the study site. The overall initial visit no-show rate was 56%. Bivariate analyses indicated that respondents who were recruited online, younger, and lived further away from the site were more likely to be no-shows. Younger age significantly predicted failure to attend in the multivariable model.ConclusionsFindings highlight potential barriers to participation in a group-based intervention, and have implications for pre-intervention engagement strategies and modifications that may increase reach and uptake.

Lifestyle modification approaches for the treatment of obesity in adults.

The U.S. Preventive Services Task Force has recommended that primary care clinicians screen all adults for obesity and provide those affected intensive multicomponent behavioral interventions. Approximately 95 million U.S. adults qualify for such care, also referred to as lifestyle modification. Using the Guidelines (2013) for Managing Overweight and Obesity in Adults (hereafter, Obesity Guidelines) as a framework, this article reviews the principal components of comprehensive lifestyle modification, which include diet, physical activity, and behavior therapy. To lose weight, the Obesity Guidelines recommend participation for 6 months in high-intensity programs that provide 14 or more counseling sessions with a trained interventionist. When provided face-to-face individual or group treatment, participants lose up to 8 kg (8% of weight) in 6 months and experience improvements in cardiovascular disease risk factors and quality of life. To prevent weight regain, the Obesity Guidelines recommend participation for 1 year in weight-loss-maintenance programs that provide at least monthly counseling. High levels of physical activity, frequent monitoring of body weight, and consumption of a reduced-calorie diet are associated with long-term weight loss. Investigators currently are seeking to increase the availability of lifestyle modification by delivering it in community-based programs, as well as on digital platforms (e.g., Internet and Smartphone). Digitally delivered programs lower costs and expand treatment reach; their efficacy is likely to improve further with the addition of new technologies for monitoring food intake, activity, and weight. Ultimately, to improve long-term weight management, individual lifestyle counseling must be joined with collective and institutional efforts to improve the nation's eating and activity environments. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Interactive group-based orientation sessions: A method to improve adherence and retention in pragmatic clinical trials

BackgroundIntervention adherence and trial retention are challenging for clinical trials testing intensive behavioral interventions. Operational constraints or trial designs may preclude using effective retention strategies such as financial incentives. We examined whether implementing pre-enrollment orientation sessions was associated with higher intervention adherence and retention in a pragmatic clinical trial. MethodsThe trial tested an intensive behavioral intervention for patients with chronic pain on long-term opioids. Orientation sessions were implemented two years into trial recruitment at one site. Held before informed consent and randomization, these mandatory, group-based orientation sessions provided trial specifics, explained research methods principles, and leveraged motivational interviewing techniques. Using a pre-post design and multivariate models, we assessed adherence (number of intervention meetings attended) and retention (completed quarterly pain assessments over 12 months) before (04/2014–12/2015; n = 209) and after (01/2016–02/2017; n = 258) implementation. Also, we evaluated whether session implementation affected the proportion and characteristics of enrolled patients. ResultsAfter implementing orientation sessions, patients had higher intervention adherence than before (M = 7.6, SD = 3.8 vs. M = 5.6, SD = 4.5, respectively; mean difference = 2.0, 95% CI [0.9, 3.2], p = .001), and 2.8 times greater odds of completing quarterly assessments (95% CI [1.3, 5.8], p = .007). Fewer patients enrolled after implementing sessions than before (38.1% vs. 70.8%, 95% CI [26.4, 39.1], p < .001), with no differences in patient characteristics. ConclusionsImplementing orientation sessions during recruitment may be useful for promoting trial adherence and retention. To ensure enrollment goals are met, target population size and barriers affecting patients’ ability to attend orientation sessions should be considered, especially for patients with complex medical conditions. Clinical trials registration numberNCT02113592.

A didactic perspective on negotiations and collaborations between different actors within the Swedish support system: children with autism spectrum disorders included in community-based preschool settings

ABSTRACTIn the present study, a didactic perspective was used to examine collaborations and negotiations between preschools and habilitation centres concerning intensive behavioural interventions for children with autism spectrum disorders in inclusive settings in Swedish preschools. The didactic triangle was used as the theoretical tool to analyse information derived from a qualitative case-study in two preschools exemplifying ‘high quality practice’. Direct content analysis was used to analyse data with a focus on the child, the pedagogue, and the subject. Data were collected through multiple sources during a 12-month period, including observations and interviews. A model of aspects of the collaboration between preschools, habilitation centres, and families was conceptualized based on the didactic triangle: the ‘pedagogue cornerstone’ encompassed competence, attitudes, and collaborations; the ‘child cornerstone’ encompassed learning in relation to specific goals; the ‘subject cornerstone’ encompassed both subjects shared with typically developing peers and subjects related to the specific challenges. In addition, the preschool principals were described as important. Different factors in relation to tensions and collaborations between organizations concerning inclusive education were elaborated. Implications for preschools, inter-organizational collaboration, and future research are discussed.

How does hypnotherapy compare with behavioral treatments for promoting smoking cessation in adults?

Reviewers found no conclusive evidence from RCTs conducted in the 1970s and 1980s that hypnotherapy is more or less effective than behavioral treatments for smoking cessation. The effect of hypnotherapy on smoking cessation compared with behavioral treatments that involved the same duration of patient contact (including cognitive‐behavioral therapy, behavioral counseling, and relaxation), brief behavioral treatments (including health education or written cessation advice), or intensive behavioral treatments (including aversion therapy or behavioral modification) is uncertain. Much of the evidence is old (from the 1970s and 1980s), and the hypnosis regimens and behavioral treatments examined in these trials may not reflect current practice. Given the low and very low certainty of evidence, no firm conclusions about the effectiveness of hypnotherapy for smoking cessation can be drawn.

Associations between obesity severity and medical comorbidities for children with obesity in low intensity hospital intervention

BackgroundChildhood obesity has increased dramatically in the United States. Most available research has followed obesity prevalence with little attention to medical comorbidities, which could guide prevention and intervention. MethodsA retrospective chart review examined 2038 children referred to a Pediatric Weight Management Clinic providing low intensity (<26 contact hours) intervention. Linear regression examined associations between obesity severity level (I, II, III) and blood pressure percentile scores (systolic, diastolic) while controlling for gender, age group, and ethnicity. Logistical regression examined associations between obesity severity level and five medical diagnoses (hypertension, type 2 diabetes, elevated ALT, hyperlipidemia, obstructive sleep apnea), again controlling for demographics. ResultsResults revealed that children with Class III obesity severity had significantly greater risk for five of the seven medical conditions examined, with higher systolic and diastolic blood pressure scores, and higher odds for hypertension, type 2 diabetes, and obstructive sleep apnea. ConclusionThe US Preventive Services Task Force has documented the effectiveness of intensive behavioral interventions (>26 contact hours for changes in diet, exercise, screen time) for reducing obesity severity in children. Additional research is required to determine whether more intensive behavioral approaches should be added before a child’s obesity reaches the Class III level of severity in order to prevent medical comorbidities.

Community pharmacy personnel interventions for smoking cessation.

Community pharmacists could provide effective smoking cessation treatment because they offer easy access to members of the community. They are well placed to provide both advice on the correct use of smoking cessation products and behavioural support to aid smoking cessation. To assess the effectiveness of interventions delivered by community pharmacy personnel to assist people to stop smoking, with or without concurrent use of pharmacotherapy. We searched the Cochrane Tobacco Addiction Group Specialised Register, along with clinicaltrials.gov and the ICTRP, for smoking cessation studies conducted in a community pharmacy setting, using the search terms pharmacist* or pharmacy or pharmacies. Date of the most recent search: January 2019. Randomised controlled trials of interventions delivered by community pharmacy personnel to promote smoking cessation amongst their clients who were smokers, compared with usual pharmacy support or any less intensive programme. The main outcome measure was smoking cessation rates at six months or more after the start of the intervention. We used standard methodological procedures expected by Cochrane for study screening, data extraction and management. We conducted a meta-analysis using a Mantel-Haenszel random-effects model to generate risk ratios (RRs) and 95% confidence intervals (CIs). We identified seven studies including 1774 participants. We judged three studies to be at high risk of bias and four to be at unclear risk. Each study provided face-to-face behavioural support delivered by pharmacy staff, and required pharmacy personnel training. Typically such programmes comprised support starting before quit day and continuing with weekly appointments for several weeks afterwards. Comparators were either minimal or less intensive behavioural support for smoking cessation, typically comprising a few minutes of one-off advice on how to quit. Participants in both intervention and control arms received equivalent smoking cessation pharmacotherapy in all but one study. All studies took place in high-income countries, and recruited participants visiting pharmacies. We pooled six studies of 1614 participants and detected a benefit of more intensive behavioural smoking cessation interventions delivered by community pharmacy personnel compared with less intensive cessation interventions at longest follow-up (RR 2.30, 95% CI 1.33 to 3.97; I2 = 54%; low-certainty evidence). Community pharmacists can provide effective behavioural support to people trying to stop smoking. However, this conclusion is based on low-certainty evidence, limited by risk of bias and imprecision. Further research could change this conclusion.

Autism Beyond Early Intensive Behavioral Intervention

Autism spectrum disorder (ASD) affects many individuals worldwide. Researchers have identified effective interventions for teaching new skills and reducing challenging behaviors that have resulted in improvements in the lives of individuals with ASD and their families. Namely, assessments and interventions based on the science of behavior analysis have strong empirical support for improving the quality of life of individuals with ASD. Although beneficial, the majority of this research has involved young children, which is not always easily applied to adolescents and adults due to unique characteristics of this population. This special issue addresses the need for research with older individuals with ASD by presenting a variety of papers evaluating behavioral interventions for adolescents and adults and discussing the specific needs related to this population.