Intervention-control Differences Research Articles

Effects of mixed nuts as part of a Brazilian Cardioprotective diet on LDL-cholesterol in adult patients after myocardial infarction: a multicenter randomized controlled clinical trial

BackgroundNuts consumption is related to cardioprotective effects on primary cardiovascular prevention, but studies conducted in secondary prevention are small, scarce and controversial. The objective of this trial was to evaluate the effects of a regional and sustainable cardioprotective diet added or not with an affordable mixed nuts on cardiometabolic features in patients with previous myocardial infarction.MethodsDICA-NUTS study is a national, multi-center, and superiority-parallel randomized clinical trial. Males and females over 40 years old diagnosed with previous myocardial infarction in the last 2 to 6 months were included. Patients were allocated into two groups: the Brazilian Cardioprotective diet (DICA Br) supplemented with 30 g/day of mixed nuts (10 g of peanuts; 10 g of cashew; 10 g of Brazil nuts) (intervention group, n = 193); or only DICA Br prescription (control group, n = 195). The primary outcome was low-density lipoprotein cholesterol means (in mg/dL) after 16 weeks. Secondary outcomes were other lipid biomarkers, glycemic and anthropometric data and diet quality.ResultsAfter adjustment for baseline values, participating study site, time since myocardial infarction and statin treatment regimen (high potency, moderate and low potency/no statins), no significant difference was found between the groups in low-density lipoprotein cholesterol concentrations (intervention-control difference: 3.48 mg/dL [-3.45 to 10.41], P = 0.32). Both groups improved their overall diet quality at the end of the study without differences between them after 16 weeks (intervention-control difference: 1.05 (-0.9 to 2.99); P = 0.29). Other lipids, glycemic profile and anthropometrics were also not different between study groups at the end of the study.ConclusionAdding 30 g/day of mixed nuts to the DICA Br for 16 weeks did not change lipid, glycemic and anthropometric features in the post-myocardial infarction setting.Trial registrationThis study is registered on ClinicalTrials.gov website under number NCT03728127 and its World Health Organization Universal Trial Number (WHO-UTN) is U1111-1259–8105.

Effectiveness of a two-component nutritional strategy for blood pressure control in individuals with hypertension users of a public health system: a randomized controlled clinical trial.

To evaluate the effectiveness of a nutritional strategy based on two components and adapted for the public health system on blood pressure, cardiometabolic features, self-care, qualify of life and diet quality in individuals with hypertension. NUPRESS was an open-label, parallel-group, superiority randomized controlled clinical trial in which participants at least 21 years with hypertension and poorly controlled blood pressure were randomly assigned (1 : 1 allocation ratio) to either an individualized dietary prescription according to nutritional guidelines (control group, n = 205); or a two-component nutrition strategy, including a goal-directed nutritional counseling and mindfulness techniques (NUPRESS [intervention] group, n = 205). Primary outcomes were SBP (mmHg) after 24 weeks of follow up and blood pressure control, defined as either having SBP more than 140 mmHg at baseline and achieving 140 mmHg or less after follow-up or having SBP 140 mmHg or less at baseline and reducing the frequency of antihypertensive drugs in use after follow-up. In total, 410 participants were randomized and submitted to an intention-to-treat analysis regarding primary outcomes. Both groups decreased blood pressure, but after adjusting for baseline values, there was no significant difference between them on SBP [intervention-control difference: -0.03 (-3.01; 2.94); P = 0.98] nor blood pressure control [odds ratio 1.27 (0.82; 1.97); P = 0.28]. No differences between groups were also detected regarding secondary and tertiary outcomes. There was no difference between a two-component nutritional strategy and an established dietary intervention on blood pressure in participants with hypertension.

Supervised preoperative walking on increasing early postoperative stamina and mobility in older adults with frailty traits: A pilot and feasibility study.

Background and AimsFrail older adults are more than twice as likely to experience postoperative complications. Preoperative exercise may better prepare these patients through improved stamina and mobility experienced in the days following surgery. We measured the impact of a walking intervention using an activity tracker and coaching on postoperative stamina, and mobility in older adults with frailty traits.MethodsWe included patients aged 60+ and scoring 4+ on the Edmonton Frailty Scale. We then randomized patients to intervention versus control stratified by anticipated hospital stay (1 night vs. 2+ night) and baseline stamina (i.e., 6‐min walk distance [6MWD]). Intervention patients received an activity tracker and linked smart phone. An athletic trainer (AT) prescribed a daily step count goal and titrated this up after checking in with patients during weekly telephone calls. Controls received general walking recommendations. We then measured postoperative 6MWD 1–3 days after surgery. We also assessed postoperative mobility by measuring steps walked the day after surgery using a thigh‐worn monitor. Because many patients could not walk postoperatively, we compared intervention‐control difference in both 6MWD and steps using Wilcoxon rank testing and Tobit and ordinal logistic regression adjusting for several patient characteristics.ResultsWe randomized 104 eligible patients; 80 patients remained for final analysis. There was no difference in intervention versus control postoperative 6MWD (median 72 vs. 74 m Wilcoxon p = 0.54) or postoperative steps taken (median 128 vs. 51 steps Wilcoxon p = 0.76). Analysis adjusting for patient characteristics was consistent with these findings.ConclusionOur intervention consisting of goal setting with an activity tracker and telephonic coaching by an AT did not appear to improve stamina or mobility measured in the days after surgery. Small sample size limited our ability to examine this impact in subsets defined by surgical specialty or baseline stamina.

Abstract 19: Impacts of the Million Hearts® Cardiovascular Disease Risk Reduction Model on the Initiation or Intensification of Statins and Anti-hypertensive Medications: A Pragmatic, Cluster-randomized Trial

Introduction: The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model pays providers for measuring cardiovascular risk among their Medicare beneficiaries and for reducing risk among their high-risk patients. The Centers for Medicare and Medicaid Services (CMS) is testing whether this model can improve cardiovascular care and reduce the incidence of first-time heart attacks and strokes over 5 years. This study assesses whether, in its first 2 years, the model (1) increased use of CVD medications among those with elevated blood pressure or cholesterol, and (2) increased provider awareness of CVD risks among their patients. Methods: In this pragmatic, cluster-randomized trial, CMS enrolled 516 organizations (primary and specialty practices, health centers, and hospitals) throughout the country and assigned half to the intervention group. Organizations enrolled beneficiaries (age 40-79 without a prior CVD event) during routine office visits. We linked enrollment and clinical data with Medicare Part D claims and estimated impacts as intervention-control differences in outcomes. We surveyed one randomly selected provider in each organization about their use of risk CVD stratification (70% response rate). Results: The intervention and control organizations enrolled 300,550 Medicare beneficiaries. In both groups, 18% of enrollees were high risk per CMS definitions (≥30% or higher risk of a heart attack or stroke in the next 10 years), 40% were medium risk (15-30% risk), and the remainder were low risk (<15% risk). While almost all high-risk enrollees were taking anti-hypertensive medications or statins at baseline, most (90%) had elevated blood pressure, cholesterol, or both. High-risk enrollees in the intervention group were 4 percentage points more likely than control enrollees (28 vs 24%, p<0.001) to initiate or intensify statins or anti-hypertensive medications within 6 months of enrollment. When including the larger medium-risk group—for whom CMS does not separately pay for CVD risk reduction—rates of initiation or intensification were 3 percentage points higher in the intervention versus control groups (23 vs 20%, p<0.001). According to the survey, intervention group providers were much more likely than control group providers to risk assess at least half of their Medicare patients (71 vs 39%, p<0.001). Most intervention group providers (73%) said that their greater use of risk stratification helped them better identify beneficiaries at risk of CVD events. Conclusions: The Million Hearts model significantly improved use of CVD medications among high-risk enrollees, mainly through intensification, and had positive spillover to the much larger medium risk group. These improvements were likely driven, at least partly, by providers become more aware of their patients’ CVD risk through greater use of risk stratification.

Effects of Social Development Intervention in Childhood on Adult Life at Ages 30 to 39.

Elementary schools can be effective sites for universal preventive interventions. Less is known about how long effects of intervention in elementary grades last. Can they improve outcomes in adulthood? To test effects of a social developmental intervention in the elementary grades on adult life through the 30s, the Seattle Social Development Project, a nonrandomized controlled trial, followed all consenting 5th-grade students (N = 808) from 18 Seattle public elementary schools from age 10 (in 1985) to age 39 (in 2014), with 88% retention. The sample was gender balanced and ethnically and economically diverse. The full intervention, called Raising Healthy Children, continued from Grades 1 through 6 and consisted of teacher in-service training in classroom management and instructional methods; cognitive, social, and refusal skills training for children; and parent workshops in child behavior monitoring and management, academic support, and anticipatory guidance. Using structural equation modeling, we examined intervention effects from age 30 to age 39 across 9 constructs indicating 3 domains of adult life: health behavior, positive functioning, and adult health and success. An omnibus test across all 9 constructs indicated a significant positive overall intervention-control difference. Examined individually, significant intervention effects included better health maintenance behavior, mental health, and overall adult health and success. Significant effects were not found on substance use disorder symptoms, sex-risk behaviors, or healthy close relationships in the 30s. Results indicate that sustained, theory-based, multicomponent intervention in the elementary grades can produce lasting changes in health maintenance, mental health, and adult functioning through the 30s.

Long-term outcomes of an educational intervention to reduce antibiotic prescribing for childhood upper respiratory tract infections in rural China: Follow-up of a cluster-randomised controlled trial.

BackgroundInappropriate antibiotic prescribing causes widespread serious health problems. To reduce prescribing of antibiotics in Chinese primary care to children with upper respiratory tract infections (URTIs), we developed an intervention comprising clinical guidelines, monthly prescribing review meetings, doctor–patient communication skills training, and education materials for caregivers. We previously evaluated our intervention using an unblinded cluster-randomised controlled trial (cRCT) in 25 primary care facilities across two rural counties. When our trial ended at the 6-month follow-up period, we found that the intervention had reduced antibiotic prescribing for childhood URTIs by 29 percentage points (pp) (95% CI −42 to −16).Methods and findingsIn this long-term follow-up study, we collected our trial outcomes from the one county (14 facilities and 1:1 cluster randomisation ratio) that had electronic records available 12 months after the trial ended, at the 18-month follow-up period. Our primary outcome was the antibiotic prescription rate (APR)—the percentage of outpatient prescriptions containing any antibiotic(s) for children aged 2 to 14 years who had a primary diagnosis of a URTI and had no other illness requiring antibiotics. We also conducted 15 in-depth interviews to understand how interventions were sustained.In intervention facilities, the APR was 84% (1,171 out of 1,400) at baseline, 37% (515 out of 1,380) at 6 months, and 54% (2,748 out of 5,084) at 18 months, and in control facilities, it was 76% (1,063 out of 1,400), 77% (1,084 out of 1,400), and 75% (2,772 out of 3,685), respectively. After adjusting for patient and prescribing doctor covariates, compared to the baseline intervention-control difference, the difference at 6 months represented a 6-month intervention-arm reduction in the APR of −49 pp (95% CI −63 to −35; P < 0.0001), and compared to the baseline difference, the difference at 18 months represented an 18-month intervention-arm reduction in the APR of −36 pp (95% CI −55 to −17; P < 0.0001). Compared to the 6-month intervention-control difference, the difference at 18 months represented no change in the APR: 13 pp (95% CI −7 to 33; P = 0.21). Factors reported to sustain reductions in antibiotic prescribing included doctors’ improved knowledge and communication skills and focused prescription review meetings, whereas lack of supervision and monitoring may be associated with relapse. Key limitations were not including all clusters from the trial and not collecting returned visits or sepsis cases.ConclusionsOur intervention was associated with sustained and substantial reductions in antibiotic prescribing at the end of the intervention period and 12 months later. Our intervention may be adapted to similar resource-poor settings.Trial registrationISRCTN registry ISRCTN14340536.

PROSPER partnership delivery system: Effects on adolescent conduct problem behavior outcomes through 6.5 years past baseline

We report long-term effects of the PROSPER delivery system for universal evidence-based preventive interventions on adolescent conduct problem behaviors (CPBs). A cluster randomized trial included 28 school districts assigned to PROSPER or a control condition. Community-based teams in PROSPER condition school districts selected evidence-based interventions—a family-focused intervention in sixth grade and a school-based intervention the next year; follow-up assessments were conducted through 12th grade. CPBs were measured with 12 self-report items derived from the National Youth Survey. Intervention-control differences were tested via a multi-level Zero-Inflated Poisson (ZIP) model. Differences were significant from 9th through 12th grades; Relative Reduction Rates were between 10.1% and 14.5%. The intervention group was delayed in reaching a 10th grade reference level of CPBs by 10.7 months. Moderation analyses indicated stronger effects for early substance initiators. Findings suggest that the PROSPER delivery system has the potential to reduce CPBs in general populations.

Three-year follow-up of an early childhood intervention: what about physical activity and weight status?

Fundamental movement skills are a correlate of physical activity and weight status. Children who participated in a preschool intervention had greater movement skill proficiency and improved anthropometric measures (waist circumference and BMI z scores) post intervention. Three years later, intervention girls had retained their object control skill advantage. The study purpose was to assess whether at 3-year follow up a) intervention children were more physically active than controls and b) the intervention effect on anthropometrics was still present. Children were assessed at ages 4, 5, and 8 years for anthropometric measures and locomotor and object control proficiency (Test of Gross Motor Development-2). At age 8, children were also assessed for moderate to vigorous physical activity (MVPA) (using accelerometry). Several general linear models were run, the first with MVPA as the outcome, intervention/control, anthropometrics, object control and locomotor scores as predictors, and age and sex as covariates. The second and third models were similar, except baseline to follow-up anthropometric differences were the outcome. Overall follow-up rate was 29% (163/560), with 111 children having complete data. There were no intervention control differences in either MVPA or anthropometrics. Increased skill competence did not translate to increased physical activity.

Quasi-Experimental Pilot Study of Intervention to Increase Participant Retention and Completed Home Visits in the Nurse–Family Partnership

We evaluated an intervention to increase participant retention and engagement in community practice settings of the Nurse-Family Partnership (NFP), an evidence-based program of nurse home visiting for low-income, first-time parents. Using a quasi-experimental design (6 intervention and 11 control sites that delivered the NFP), we compared intervention and control sites on retention and number of completed home visits during a 10-month period after the intervention was initiated. Nurses at the five intervention sites were guided in tailoring the frequency, duration, and content of the visits to participants' needs. NFP nurses at the control sites delivered the program as usual. At the intervention sites, participant retention and completed home visits increased from the pre-intervention to intervention periods, while at the control sites, these outcomes decreased from the pre-intervention to intervention periods, leading to a significant intervention-control difference in change in participant retention (hazard ratio, 0.42; p = 0.015) and a 1.4 visit difference in change in completed home visits (p < 0.001, ES = 0.36). We conclude that training nurse home visitors to promote adaptation of program dosage and content to meet families' needs shows promise as a way to improve participant retention and completed home visits.

Scripted Messages Delivered by Nurses and Radio Changed Beliefs, Attitudes, Intentions, and Behaviors Regarding Infant and Young Child Feeding in Mexico

Scalable interventions are needed to improve infant and young child feeding (IYCF). We evaluated whether an IYCF nutrition communication strategy using radio and nurses changed beliefs, attitudes, social norms, intentions, and behaviors related to breastfeeding (BF), dietary diversity, and food consistency. Women with children 6–24 mo were randomly selected from 6 semi-urban, low-income communities in the Mexican state of Morelos (intervention, n = 266) and from 3 comparable communities in Puebla (control, n = 201). Nurses delivered only once 5 scripted messages: BF, food consistency, flesh-food and vegetable consumption, and feed again if food was rejected; these same messages aired 7 times each day on 3 radio stations for 21 d. The control communities were not exposed to scripted messages via nurse and radio. We used a pre-/post-test design to evaluate changes in beliefs, attitudes, norms, and intentions as well as change in behavior with 7-d food frequency questions. Mixed models were used to examine intervention-control differences in pre-/post changes. Coverage was 87% for the nurse component and 34% for radio. Beliefs, attitudes, and intention, but not social norms, about IYCF significantly improved in the intervention communities compared with control. Significant pre-/post changes in the intervention communities compared with control were reported for BF frequency (3.7 ± 0.6 times/d), and consumption of vegetables (0.6 ± 0.2 d) and beef (0.2 ± 0.1 d) and thicker consistency of chicken (0.6 ± 0.2 d) and vegetable broths (0.8 ± 0.4 d). This study provides evidence that a targeted communication strategy using a scalable model significantly improves IYCF.

Task-Shifting of Antiretroviral Delivery From Health Care Workers to Persons Living With HIV/AIDS: Clinical Outcomes of a Community-Based Program in Kenya

To assess whether community-based care delivered by people living with HIV/AIDS (PLWAs) could replace clinic-based HIV care. Prospective cluster randomized controlled clinical trial. Villages surrounding 1 rural clinic in western Kenya. HIV-infected adults clinically stable on antiretroviral therapy (ART). The intervention group received monthly Personal Digital Assistant supported home assessments by PLWAs with clinic appointments every 3 months. The control group received standard of care monthly clinic visits. Viral load, CD4 count, Karnofsky score, stability of ART regimen, opportunistic infections, pregnancies, and number of clinic visits. After 1 year, there were no significant intervention-control differences with regard to detectable viral load, mean CD4 count, decline in Karnofsky score, change in ART regimen, new opportunistic infection, or pregnancy rate. Intervention patients made half as many clinic visits as did controls (P < 0.001). Community-based care by PLWAs resulted in similar clinical outcomes as usual care but with half the number of clinic visits. This pilot study suggests that task-shifting and mobile technologies can deliver safe and effective community-based care to PLWAs, expediting ART rollout and increasing access to treatment while expanding the capacity of health care institutions in resource-constrained environments.

Universal intervention effects on substance use among young adults mediated by delayed adolescent substance initiation.

In this article, the authors examine whether delayed substance initiation during adolescence, achieved through universal family-focused interventions conducted in middle school, can reduce problematic substance use during young adulthood. Sixth-grade students enrolled in 33 rural midwestern schools and their families were randomly assigned to 3 experimental conditions. Self-report questionnaires provided data at 7 time points for the Iowa Strengthening Families Program (ISFP), Preparing for the Drug Free Years (PDFY), and control groups through young adulthood. Five young adult substance frequency measures (drunkenness, alcohol-related problems, cigarettes, illicit drugs, and polysubstance use) were modeled as distal outcomes affected by the average level and rate of increase in substance initiation across the adolescent years in latent growth curve analyses. Results show that the models fit the data and that they were robust across outcomes and interventions, with more robust effects found for ISFP. The addition of direct intervention effects on young adult outcomes was not supported, suggesting long-term effects were primarily indirect. Relative reduction rates were calculated to quantify intervention-control differences on the estimated proportion of young adults indicating problematic substance use; they ranged from 19% to 31% for ISFP and from 9% to 16% for PDFY.

A New Behavioral Program To Promote Physical Activity And Long-term Weight Control

Understanding and promoting physical activity (PA) among the overweight/obese are urgent research needs which are lacking in solid empirical evidence. Most existing findings are post-hoc and/or have limited theoretical support. PURPOSE: We aim to describe a new treatment for the overweight/obese, centered around PA and based on Self-Determination Theory (SDT) and Motivational Interviewing (MI), and report results from an ongoing 3-year RCT. METHOD: 257 overweight females (BMI: 31.7±4.1 kg/m2; age: 37.3±7.5 y) were randomized into intervention/control groups. The intervention includes 30 group meetings for 10-months covering PA, eating/nutrition, body image, and other cognitive-behavioral contents. MI techniques are used throughout the program, closely following SDT tenets. Autonomy, intrinsic motivation, and self-regulation for behavior change are central intervention targets. Additionally, autonomy-supportive treatment climate and internal causality orientations are hypothesized to enhance autonomous regulation, perceived competence, self-efficacy, and intrinsic motivation for PA. This is expected to result in lasting behavioral and body composition changes. Assessments include SDT-relevant putative psychosocial moderators/mediators (e.g. exercise intrinsic motivation, self-regulatory style), PA/exercise (accelerometry, 7-day PAR), diet (3-d food records, FFQ), and body weight/composition (DXA). All subjects are being followed for 3 years. RESULTS: One-year results (n=164, 78% retention) show the following intervention-control differences: +88±38 min/wk of walking (p=0.022), +133±69 min/wk of total PA(p=0.059);-5.1±1.1 % body weight (p<0.001); −6.9±3.8 kg body fat (p=0.073); +4.2±3.3 kg lean mass (p=0.210); +12.4±11.5 g/d of dietary fiber (p=0.285). Importantly, effect sizes for theoretical mediators were moderate to large (0.38 and 1.38, p<0.01), favoring intervention. CONCLUSION: Thus far, SDT and MI have not been experimentally evaluated for PA and weight management. Our findings indicate that they can be successfully implemented, resulting in meaningful changes, and that key SDT mediators can be strongly influenced, as predicted. Up-to-date results will be presented.

Randomized Study of Combined Universal Family and School Preventive Interventions: Patterns of Long-Term Effects on Initiation, Regular Use, and Weekly Drunkenness.

This study reports findings on a combined family and school-based competency-training intervention from an in-school assessment 2.5 years past baseline, as a follow-up to an earlier study of substance initiation. Increased rates of observed alcohol use and an additional wave of data allowed evaluation of regular alcohol use and weekly drunkenness, with both point-in-time and growth curve analyses. Thirty-six rural schools were randomly assigned to (a) a combined family and school intervention condition, (b) a school-only condition, or (c) a control condition. The earlier significant outcome on a substance initiation index was replicated, and positive point-in-time results for weekly drunkenness were observed, but there were no statistically significant outcomes for regular alcohol use. Discussion focuses on factors relevant to the mix of significant longitudinal results within a consistent general pattern of positive intervention-control differences.

Protecting children: reducing their environmental tobacco smoke exposure.

The present review examines the current status of efforts to reduce environmental tobacco smoke exposure (ETS) among infants and young children. Estimates of the number of children exposed vary, but it is probably over 20 million or about 35% of all U.S. children. Healthy People 2010 sets as an objective the reduction, to 10%, of the proportion of children regularly exposed to tobacco smoke at home. Children with ETS exposure are at higher risk for upper respiratory illnesses, asthma, otitis media, and sudden infant death syndrome. Eight experimental or quasi-experimental studies of attempts to reduce children' ETS exposure with sample sizes of greater than 100 were conducted in the United States and published between 1990 and 2003. Most of these studies showed a significant impact on maternal smoking and on the number of cigarettes smoked in the home, although intervention-control differences were relatively small. Despite support from professional organizations and federal government groups, many pediatricians and family physicians do not routinely engage in intensive efforts to reduce children's ETS exposure. Training in techniques for reducing tobacco dependence should be included in professional education programs. Public and private insurance should reimburse providers for efforts in this area. An overall strategy for reducing children's ETS exposure should combine individual counseling and education in offices, clinics, and homes with community education and regulatory and economic policies (i.e., smoking bans and excise taxes). Additional funding is needed for studies of provider knowledge, attitudes, and practices; of the effectiveness of various communication strategies; and of office- and community-based strategies to reduce ETS exposure.

Effects at age nine of maternal smoking in pregnancy: experimental and observational findings

Objectives To compare long term outcomes of a randomised controlled trial of anti-smoking education in pregnancy and to examine the same outcomes according to maternal pregnancy smoking behaviour. Design Follow up of the population included in the randomised controlled trial nine years later and of ex-smokers and non-smokers within the same hospital population. Setting A maternity hospital in Birmingham with follow up of children in schools and mothers at home. Population 1218 smokers recruited to the trial; also 191 ex-smokers at booking and 414 non-smokers throughout pregnancy. Methods Children were assessed individually by psychologists in schools, and mothers interviewed at home to obtain additional information relevant to cognitive development and growth. Information on smoking during pregnancy was obtained from mothers and obstetric data from computerised case-notes, both recorded immediately following delivery. Main outcome measures Height, weight, IQ and neurological soft signs at 9.4 years. Results Differences in birthweight and length between the intervention and control groups were confirmed but no intervention–control differences were found at age 9.4 for weight, height, IQ or neurological soft signs. Differences were found for height and IQ according to mothers pregnancy smoking behaviour, but smoking did not remain an independent predictor after taking account of confounding factors. Alternative classifications of smoking behaviour, taking account of the gestation at stopping and mean cigarette consumption throughout pregnancy likewise showed no effect. Conclusions The well established early hazards of smoking during pregnancy seem to be resolved by later childhood, with no evidence of direct long term effects on growth or cognitive functioning.

Reducing Adolescents' Aggressive and Hostile Behaviors

To examine the long-term effects of a brief family intervention on aggressive and hostile behaviors of adolescents in the general population. Randomized trial including 22 public schools assigned to the Iowa Strengthening Families Program or a control condition. Analyses supported sample representativeness and failed to show differential attrition effects 4 years after baseline. Seven-session intervention for parents and their sixth-grade children. The multi-informant, multimethod measures included independent observer ratings of adolescent aggressive and hostile behaviors in adolescent-parent interactions, family-member report of aggressive and hostile behaviors in those interactions, and adolescent self-report of aggressive and destructive conduct across settings. Data were collected during the 6th (preintervention and postintervention), 7th, 8th, and 10th grades. All measures showed a generally positive trend in intervention-control group differences over time. During 10th grade, significant intervention-control differences were found for adolescent self-report of aggressive and destructive conduct (P =. 01), with relative reduction rates ranging from 31.7% to 77.0%. Significant differences were shown for observer-rated aggressive and hostile behaviors in adolescent-parent interactions (P =.01); differences in family member reports of those behaviors were not significant. Supplemental analyses of both interactional behavior measures, specific to parent sex, indicated significant experimental group differences in interactions with mothers (P =.04 for both measures) but not with fathers. Brief family competency-training interventions designed for general populations can reduce aggressive and hostile behaviors in adolescents' interactions with parents and adolescent aggressive behaviors outside of the home setting. Thus, this type of intervention has important public health implications. Arch Pediatr Adolesc Med. 2000;154:1248-1257.

An evaluation of a theatre production to encourage non-smoking among elementary age children: 2 Smart 2 Smoke

OBJECTIVETo evaluate the impact of a theatre production on smoking-related attitudes, norms, and intentions of children in grades 1–6 (aged 6–12 years).DESIGNSeventeen schools were randomly selected among 160 that were...