Motivational Interviewing Program Research Articles

Impact of pharmacist motivational interviewing on hepatitis B vaccination in adults with diabetes

BackgroundIn 2011, the Advisory Committee on Immunization Practices recommended hepatitis B (HepB) vaccination for previously unvaccinated adults (aged 19-59 years) with diabetes. Despite these recommendations, vaccination coverage for HepB vaccination for persons with diabetes remains low. ObjectivesThe primary objective was to determine the impact of a community pharmacist-led motivational interviewing (MI) intervention on HepB vaccination initiation among adults with diabetes who were previously unvaccinated against HepB. The secondary objective was to describe HepB vaccination series completion among adults with diabetes who initiated the first dose of a HepB vaccine. MethodsA prospective, nonrandomized, controlled cluster trial was conducted across 58 regional grocery store chain pharmacies: a total of 29 pharmacies in the MI group and 29 pharmacies in the control group. Pharmacy location-level baseline data were collected during a 12-month pre-program period. The MI program was delivered over 10 months. Alerts were generated during prescription processing throughout the study period for eligible patients at each MI pharmacy location. The MI consisted of a face-to-face conversation between the pharmacist and the patient at the time of prescription pick-up. The difference in the primary outcome of HepB vaccination series initiation between patients receiving MI and control patients was assessed using a difference-in-differences analysis. For series completion, patients who initiated the HepB vaccination series were followed up for over 12 months after their first HepB vaccine dose. ResultsThere was a statistically significant 3.711% increase in HepB vaccination when comparing eligible individuals who received the MI intervention (n = 1569) to eligible individuals in the control group (n = 3640). Of the patients in the MI group who initiated HepB vaccination, 40 of 65 patients (61.5%) completed the vaccination series. ConclusionA pharmacist-led MI intervention increased HepB vaccination rates among adult patients with diabetes. Community pharmacists can effectively provide vaccinations that require multiple doses to complete the vaccination series.

Mechanism of Changes within Motivational Interviewing in Relation to Dietary Behavior Outcome of Diabetics Patients in Thailand

Background: For diabetics, healthy eating or dietary management is essential. Motivational interviewing (MI) is found to be effective for facilitating Thai clients with diabetics to change their dietary behavior. At present, little is known about what therapeutic processes and mechanisms improvements occur within MI. Objective: To explain the mechanism within MI in relation to dietary behavior outcome. Materials and Methods: The present study was a qualitative study that explored mechanism of change within the MI program conducted in diabetic clients and use the self-determination theory (SDT) as a lens to explore the mechanism of change within MI. A qualitative approach was adopted in the present study. Results: The mechanisms that influenced the change in dietary control of the diabetic clients were the patient perception of competence, a sense of autonomy, and therapist-patient relationship. These three kinds of perceptions are found to be related to therapist’s skills and techniques used in the MI program. Conclusion: The present study result reveals the most promising mechanisms of MI is the patient perception of competence, sense of autonomy, and therapist-patient relationship. There is a need to ensure that a relational ingredient of MI focused on empathy and the interpersonal spirit of MI will be employed by MI counselor consistently. MI self-supervision tool might be a good option to assist MI counselors adhere to MI spirit. Keywords: Motivational interviewing program; Diabetes clients; Diet behavior

The Role of Motivational Interviewing in Improving Health State of Patients Undergoing Hemodialysis

Background: Hemodialysis patients frequently experience social, psychological, and physical issues. Motivational interviewing is one of the most crucial methods for patients’ health promotion .Patients undergoing hemodialysis need to more attention and care by educating about diseased condition and motivating them to adhere to treatment to reduce their suffering Aims of the study: To determine the role of motivational interviewing in improving the health status of patients undergoing hemodialysis. Methodology: A Single blind, randomized, clinical trial was conducted on patients on hemodialysis who were referred to Hemodialysis Unit of Al-Sadder Hospital, Missan, Iraq. for the period (first of February to 15th Maye, 2022). The participants were selected through purposive sampling method and were placed in two groups, each group contained (30) patients, one of these groups was intervened by motivational interviewing program and represented as an experimental group, while the other group acted as control group. The experimental group received five sessions of motivational interviewing. The General Health Questionnaire (GHQ) was completed by the participants before and after the intervention. Results: Results presented that there was a significant effect of the motivational interviewing on patients with hemodialysis of the experimental group at P = .000, while no significant difference (P = .083) appeared on control group who did not receive the motivational interviewing. motivational interviewing improved all aspects of general health status, based on general health questionnaire as a comparing between the pre and posttest time for the experimental group of all domains at P value less than .05. Conclusion: The program of motivational interviewing has a positive effect of on the treatment adherence in hemodialysis patients using both objective and subjective parameters as well as plays a significant role in the entire aspects covered by HPL-II including; physical activity, nutrition, spiritual growth, personal relationships, stress management, health responsibility Keywords: Motivational interviewing, health state, hemodialysis. ESRD, CKD

Using Anger Management Virtual Reality Cognitive Behavior Therapy to Treat Violent Offenders with Alcohol Dependence in South Korea: A Preliminary Investigation

Cognitive Behavior Therapy (CBT) effectively treats impulse/anger attacks and aggressive-impulsive behaviors, frequently conducted concerning domestic violence, among patients with alcohol dependence. CBT combined with virtual reality (VR) is a new and beneficial psychotherapeutic intervention for patients and violent offenders with impulse-anger control problems and alcohol dependence. This clinical study evaluated the effects of the “anger management virtual reality cognitive behavior therapy (AM-VR-CBT)” and motivational interviewing (MI) intervention program on quantitative electroencephalography (QEEG) mapping patterns among violent offenders with alcohol dependence (N = 29) in the National Probation Service. A clinical sample of twenty-nine violent offenders with alcohol dependence, who were evaluated and diagnosed with destructive and impulse-control disorders (DICD), underwent AM-VR-CBT combined with MI. The sessions lasted 150 minutes (AM-VR-CBT: 90 min; MI: 60 min) and were conducted twice a week for three weeks (six sessions). The intervention outcomes were measured using advanced QEEG brain mapping and standardized neurocognitive, emotional, and behavioral inventories, including the Alcohol Dependence Scale (ADS), the Obsessive Compulsive Drinking Scale (OCDS), the Readiness to Change Questionnaire (RTCQ), the Barratt Impulsiveness Scale-II (BIS-II), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-Second Edition (BDI-2), and the State-Trait Anger Expression Inventory-2 (STAXI-2), to identify neuro-psycho-physiological changes in violent offenders with alcohol dependence. The Wilcoxon signed-rank test was used at p < 0.05. The intervention showed significant improvements and healthy behavioral changes related to obsessive drinking thoughts, compulsive drinking behaviors, attentional control, intrinsic motivation, worry, anxiety, depression, impulse-anger control issues, aggressive behaviors, over-control, interpersonal relationships, self-efficacy, self-reflection, self-inhibition, creativity, mental navigation/imagery, and episodic memory retrieval among violent offenders with alcohol dependence. Therefore, the results demonstrate the efficacy of the novel and promising clinical evidence-based implementation of the AM-VR-CBT + MI program intervention for non-invasive neuromodulation and related neuro-psycho-physiological, neurocognitive, emotional, and behavioral changes among violent offenders demonstrating alcohol dependence, impulse-anger control, and aggressive behaviors.

Ameliorating Prediabetes With Healthy Lifestyles: A Stage-Tailored Motivational Interviewing Pilot

This study assessed the feasibility, acceptability, and preliminary efficacy of a nurse-led, 3-session, stage-tailored motivational interviewing (MI) program in modifying the lifestyles of 23 primarily African American (52%) females who were overweight/obese and had prediabetes. All participants attended all 3 MI sessions. More than 90% were satisfied with the program. The participants (baseline mean age = 45, BMI = 39.2, and A1C = 5.98) demonstrated significant decreases in waist circumferences and systolic/diastolic blood pressures, and improvements in exercise self-efficacy, readiness for behavioral changes, eating patterns, and moderate-intensity physical activity (PA). This pilot was well-accepted and efficacious in promoting healthy lifestyle among overweight/obese female adults with prediabetes.

A Journal Article Critique of “Motivational Interviewing and Exercise Program for Community-Dwelling Older Persons with Chronic Pain”

This article provides a critical review of a published article entitled “Motivational Interviewing and Exercise Program for Community-Dwelling Older Persons with Chronic Pain”. The reviewed article aimed to examine the effectiveness of an integrated motivational interviewing and physical exercise program (MIE) on pain, physical and psychological functions, quality of life, self-efficacy, and compliance with exercise. A randomized pretest-posttest with a control group experimental design was used in this study to attain its objectives. The researcher followed the conceptual framework of total pain to define chronic pain. Despite some threats that existed in the study design that might affect its empirical power and reputation, the study was worthwhile in testing Motivational Interviewing and Exercise Program. Health care providers need to consider its shortfalls while using the study findings and researchers should consider these threats when conducting future research.

Motivational Interviewing Adapted to Group Setting for the Treatment of Relapse in the Behavioral Therapy of Obesity. A Clinical Audit.

Motivational interviewing (MI) is devised to change unhealthy behaviors by increasing motivation. We adapted MI to a group format for the treatment of relapse during the behavioral treatment of obesity and performed a clinical audit to evaluate its effectiveness in stopping weight regain. The program was structured in seven weekly sessions, plus a 6-month follow-up. Patients (n = 86) completed a questionnaire on motivation to change in both healthy diet and physical activity, and a self-reported measurement of calorie intake and physical activity at baseline, at program end and at 6-month follow-up. The attendance to the program was high, with only 13 patients (15%) not completing the program and 24% not attending the 6-month follow-up. By the end of follow up, the prevalence of patients in either precontemplation or contemplation was reduced from over 60% at enrollment to approximately 20%, whereas the sum of patients in action or maintenance stages was increased from 9.5% in healthy diet and 14% in physical activity to 39.7% and 41.3%, respectively. These changes translated into significant behavioral changes (mean calorie intake, −13%; total physical activity, +125%; sedentary time, −8%) and finally into reduced body weight ( −3%). We conclude that MI programs adapted for groups may be used to stop relapse in individuals following a behavioral intervention for obesity.

Pilot Clinical Trial of a Website-Delivered Motivational Interviewing Program for Engaging Veterans in Paid Work

ABSTRACT: A web-based adaptation of a benefits counseling intervention was specifically developed to encourage veterans applying for service-connection to engage in work-related activities by explaining the limited risk of Veterans Administration (VA) benefit reduction if the beneficiary is employed. This study reports the efficacy of this web-based benefit counseling intervention. Altogether, 150 veterans applying for service-connection for a mental health condition were randomly assigned to a benefits counseling website or a control website. The benefits counseling website directed participants to a web-adapted benefits counseling program. The control website directed participants to a website with government links to general information about the service-connection process and VA benefits. Employment outcomes were assessed by phone at 4, 12, and 24 weeks after randomization. Three quarters ( n = 117, 78%) of veterans logged into their assigned website and were included in the analysis. Web-based benefits counseling had a modest impact on attitudes toward work and benefits, but there was no significant change in employment.

GPS: A Randomized Controlled Trial of Sexual Health Counseling for Gay and Bisexual Men Living With HIV

Gay, bisexual, and other men who have sex with men (GBM) continue to have high rates of HIV and sexually transmitted infections, including syphilis. GBM have therefore been identified by public health agencies as a high-priority population to reach with prevention initiatives. Despite the importance of mental health in preventing HIV and related infections, there is a shortage of credentialed mental health professionals to deliver behavioral Counseling interventions. The current study evaluated the efficacy of GPS, a community-based and peer-delivered sexual health promotion motivational interviewing–based intervention for HIV-positive GBM who engaged in condomless anal sex (CAS) in the past 2 months. GPS prevention counseling demonstrated a 43% relative reduction at 3-month follow-up in CAS with serodiscordant partners and significant reductions in sexual compulsivity. The study demonstrated that community-based counselors can administer an efficacious motivational interviewing program, and suggests a continued benefit of counseling methods to promote the sexual health of higher risk populations.

A Pharmacist-Led, Patient-Centered Program Incorporating Motivational Interviewing for Behavior Change to Improve Adherence Rates and Star Ratings in a Medicare Plan.

The Medicare 5-star quality rating system was designed to drive improvements in Medicare quality and to increase accountability among Medicare plans. Medicare star ratings provide significant bonuses for plans that improve medication adherence. Envolve's pharmacy division, Envolve Pharmacy Solutions, which provides services for Medicare Advantage Prescription Drug plans, developed an in-house medication therapy management (MTM) program to improve adherence rates and subsequent star ratings. As part of this program, Envolve invested in motivational interviewing (MI) as a means to improve adherence to antihypertensives, antihyperlipidemics, and antidiabetics but recognized the need for additional staff training to ensure pharmacist success with MI techniques. Thus, Envolve engaged a consultant to help train pharmacists and evaluate the program. This best practices article describes the implementation of an MI program and subsequent changes in patient adherence and star ratings. A pharmacist-led, patient-centered adherence program incorporating MI for behavior change was developed and implemented at Envolve. The program used didactic learning, coaching and skills assessments, and a train-the-trainer (TtT) intervention. This approach resulted in improved adherence rates in all 3 therapeutic classes immediately. In addition, a quality improvement process was incorporated to evaluate the improvements in adherence with this new program over 24 months. Key findings of the program are as follows: (a) the program increased adherence rates 5-9 percentage points (chi-square tests for all plans and drug classes measured, P < 0.05) over 5 years and improved Medicare star ratings by 1-2 stars; (b) there is a need for support of pharmacy MTM managers to ensure continued success of the program; and (c) there is value in a TtT program for managers that allows them to provide continuous evaluation and feedback to staff for improvement. Each year, as the Medicare star ratings system matures and plans are held more accountable for improving adherence measures, high star ratings become more difficult to attain. This MI TtT program for pharmacists allows for rapid cycle change in response to these challenges. Funding was provided by Envolve Pharmacy Solutions, which contracted with the University of California, San Francisco (UCSF), School of Pharmacy for the development and implementation of the motivational interviewing and train-the-trainer programs described in this best practices article. Spears, Erkens, and Misquitta are employees of Envolve Pharmacy Solutions. Stebbins and Cutler are faculty in the Department of Clinical Pharmacy at the UCSF School of Pharmacy, who were contracted through Envolve Pharmacy Solutions to provide consulting services for this best practice.

Motivating residents to change communication: the role of a brief motivational interviewing didactic.

Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents' knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home. Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up. The residents' knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up. The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents.

A Systematic Review of Patient- and Family-Level Inhaled Corticosteroid Adherence Interventions in Black/African Americans

Inhaled corticosteroid (ICS) adherence rates are suboptimal among adult black/African Americans. Comprehensive studies characterizing the effectiveness and the methodological approaches to the development of interventions to improve ICS adherence in adult black/African Americans have not been performed. Conduct a systematic review of patient/family-level interventions to improve ICS adherence in adult black/African Americans. We searched MEDLINE, EMBASE, Web of Science, and CINAHL from inception to August 2017 for English-language US studies enrolling at least 30% black/African Americans comparing patient/family-level ICS adherence interventions with any comparator. Two investigators independently selected, extracted data from, and rated risk of bias. We collected information on intervention characteristics and outcomes, and assessed whether studies were informed by behavior theory, stakeholder engagement, or both. Among 1661 abstracts identified, we reviewed 230 full-text articles and identified 4 randomized controlled trials (RCTs) and 1 quasi-experimental (pre-post design) study meeting criteria. Study participants (N range, 17-333) varied in mean age (22-47 years), proportion black/African Americans studied (71%-93%), and sex (69%-82% females). RCTs evaluated problem-solving classes, self-efficacy training, technology-based motivational interviewing program, and the use of patient advocates. The RCT testing self-efficacy training was the only intervention informed by both behavior theory and stakeholder engagement. All 4 RCTs compared interventions with active control and rated as medium risk of bias. No RCTs found a statistically significant improvement in adherence. Few studies assessing asthma adherence interventions focused on adult black/African-American populations. No RCTs demonstrated improved ICS adherence in participants. Future studies that are informed by behavior change theory and stakeholder engagement are needed.

Change talk when talk has changed: theoretical and practical insights into motivational interviewing in aphasia

Background: After stroke, people may need to make diet, smoking, physical activity or lifestyle adjustments. One method used widely in encouraging behaviour change is Motivational Interviewing (MI), a counselling approach that attends to people’s “change talk”, language that indicates their readiness to change (Rollnick, Miller & Butler, 2008). MI is collaborative and guiding, useful in contexts where there is ambivalence to change. Evidence from a range of health fields suggests that, where people are ambivalent, MI is more effective at changing behaviours than traditional approaches of advising and directing towards an expert’s solution to a problem. However, people with aphasia may not be offered MI in clinical contexts and tend to be excluded from studies using MI (for example, Krishnamurthi et al., 2014) because their language impairments are assumed to prevent participation in the interviewing process. This is unsatisfactory and denies them the same opportunities to make the lifestyle adjustments offered to people without aphasia. Aims: This presentation aims to show how MI can be adapted to be an accessible approach for people with aphasia using evidence from a single case where the goal was increased physical activity. It seeks to demonstrate how MI can be offered as an alternative option within rehabilitation goal setting, and beyond, for people who may be finding it hard to engage, and be a useful way for speech pathologists to support allied health colleagues working with people with aphasia. Methods and Procedures: This study draws on a single case of a 61-year old woman, J, who had suffered a left middle cerebral artery cerebrovascular accident 6 years before, resulting in a persisting moderate-severe non-fluent aphasia, apraxia of speech and a right hemiparesis. J had a complex previous medical history including longstanding schizophrenia, depression, epilepsy, osteoporosis with several previous fractures, hypothyroidism and gastro-oesphageal reflux. As part of a PhD study on increasing physical activity in people with neuromusculoskeletal conditions (carried out by the second author, an exercise physiologist (EP)), J attended the Adapted Physical Activity Program (APAP), a lifestyle intervention that includes MI. J attended sessions 3 times each week over a 15-week period at her local community rehabilitation service, and local gym, although several days were missed due to health issues. The data for this case study are based on qualitative analysis of field notes through the APAP, a video-recorded evaluation session, records of collaborative session planning between the EP and the speech pathologist, the subsequent adaptations made to implement MI for J, and outcomes of the APAP and MI program. Outcomes and results: Through a supported MI intervention, J was able to transition from reluctance to regular gym attendance during the APAP. MI adaptations allowed ways of judging and building on “change talk” through a range of ratings, visual timelines, values card-sorting, and supported conversation techniques. The EP supported J’s attitude change to the APAP, offering genuine, client-driven choices about attendance, exercise frequency, intensity, time and type. She demonstrated progress, and individualised the program sufficiently to keep J motivated. Conclusions: This case offers an innovative demonstration of interprofessional collaboration, of making MI accessible, and of resolving ambivalence in a person with aphasia. Moreover, despite MI being an accepted, evidence based counselling approach, this is one of the first examples of its use in aphasia. People with aphasia, judged as disengaged or unmotivated by health professionals, are at risk of being discharged or overlooked but this case highlights theoretical arguments and practical solutions to encourage lifestyle adjustment and behaviour change.

Motivational Interviewing Training Using Role Play in Dental Hygiene Students

The purpose of this study was to develop a motivational interviewing (MI) training program to improve competency in communication and to effect the evaluated changes that would occur in dental students’ counseling techniques as result of the training in the program. The study proceeded through the program via role-play practice, which was explained effectively during the MI program training process. A convenience sample of 43 fourth-year dental hygiene students was recruited. Twenty-two students were randomly assigned to the intervention group and 21 to the control group in the order of recruitment. The theoretical lecture was delivered over 3 hours and the practice was done in parallel by applying cases occurring in clinic settings. The practice was technical training, partner practice, and small group practice. The intervention group received three hour MI lecture while the control group received no lecture. Evaluation through role-play practice was separated according to “researcher’s viewpoint,” “counselor’s role viewpoint,” and “patient’s role viewpoint.” The results of the analysis showed that the intervention group had higher MI skills and ability than the control group. Furthermore, program participants showed positive impressions to the MI training program. The use of coaching sessions improved the MI techniques and counseling skills of dental hygiene students learning MI. The effect of the application of the MI training program was that the MI training improved counseling skills and interviewing abilities. Moreover, continuous training and feedback enhanced MI techniques and core skills. Training using lectures in parallel with practice rather than education through theory alone improved students’ techniques. Application of role play through the combined method of the MI program was confirmed by an effective training method.

A randomized trial of motivational interviewing and facilitated contraceptive access to prevent rapid repeat pregnancy among adolescent mothers

Most interventions designed to reduce teen pregnancy rates have not focused on pregnant and/or parenting adolescents. Therefore, a large randomized controlled trial was conducted regarding a motivational interviewing program entitled Teen Options to Prevent Pregnancy in a low-income sample of adolescent mothers. This program recommended monthly sessions between a participant and a registered nurse over 18 months. This program also featured facilitated birth controlaccess through transportation assistance and a part-time contraceptive clinic. The impact of this program on rapid repeat pregnancies at 18 months after enrollment was evaluated. Five hundred ninety-eight adolescent females were enrolled from 7 obstetrics-gynecology clinics and 5 postpartum units of a large hospital system in a Midwestern city. Each participant was enrolled at least 28 weeks pregnant or less than 9 weeks postpartum. Each participant was randomized to either the Teen Options to Prevent Pregnancy intervention or a usual-care control condition. Intervention participants averaged 4.5 hours of assistance. Participants were contacted by blinded research staff at 6 and 18 months to complete self-report surveys. Differences in outcomes between the intervention and control groups were assessed using ordinary least-squares regression. There was an 18.1% absolute reduction in self-reported repeat pregnancy in the intervention group relative to the control group (20.5% vs 38.6%%; P < .001). There was a 13.7% absolute increase in self-reported long-acting reversible contraception use in the intervention group relative to the control group (40.2% vs 26.5%, P= .002). There was no evidence of harmful effects of the intervention on sexual risk behaviors, such as having sexual intercourse without a condom or greater number of partners. The Teen Options to Prevent Pregnancy program represents one of the few evidence-based interventions to reduce rapid repeat teen pregnancy. This relatively brief intervention may be a viable alternative to more time-intensive programs that adolescent mothers may be unable or unwilling to receive.

The Effect of Motivational Interviewing Program on Self-Efficacy and Suicidal Ideation of Suicide Attempters

The Effect of Motivational Interviewing Program on Self-Efficacy and Suicidal Ideation of Suicide Attempters

Motivational Interviewing as an Adjunct to Hearing Rehabilitation for Patients with Tinnitus: A Randomized Controlled Pilot Trial.

To test the effects of a brief motivational interviewing (MI) program as an adjunct to hearing aid rehabilitation for patients with tinnitus and sensorineural hearing loss. This was a pilot randomized controlled trial. The sample consisted of 50 patients aged between 40 and 82 yr with both tinnitus and sensorineural hearing loss and a pure-tone average (0.5, 1, 2, and 4 kHz) < 70 dB HL. All patients were first-time hearing aid users. A brief MI program was used during hearing aid fitting in 25 patients, whereas the remainder received standard practice (SP), with conventional hearing rehabilitation. A total of 46 patients (N = 23 + 23) with tinnitus were included for further analysis. The Tinnitus Handicap Inventory (THI) and the International Outcome Inventory for Hearing Aids (IOI-HA) were administered before and after rehabilitation. THI was used to investigate changes in tinnitus annoyance, and the IOI-HA was used to determine the effect of hearing aid treatment. Self-reported tinnitus disability (THI) decreased significantly in the MI group (p < 0.001) and in the SP group (p < 0.006). However, there was greater improvement in the MI group (p < 0.013). Furthermore, the findings showed a significant improvement in patients' satisfaction concerning the hearing aids (IOI-HA, within both groups; MI group, p < 0.038; and SP group, p < 0.026), with no difference between the groups (p < 0.99). Tinnitus handicap scores decrease to a greater extent following brief MI than following SP. Future research on the value of incorporating MI into audiological rehabilitation using randomized controlled designs is required.

Pharmacotherapies for nicotine addiction in adults and adolescents

The prevalence of tobacco use has declined substantially in the past few decades, yet it remains the leading cause of preventable death globally. Smoking frequency in adolescents is also alarming and is often associated with greater susceptibility to health problems in their adult lives. Unlike the extensive body of literature that exists for adults, research on smoking cessation approaches for adolescents is scarce. This review discusses current pharmacological and psychosocial interventions available for both adults and adolescents. Anti-smoking medications approved for adult smokers are either nicotine based (i.e., nicotine patch, gum, inhaler, nasal spray and lozenges) or non-nicotine based (i.e., sustained-release bupropion and varenicline), all of which improve abstinence by acting on nicotinic acetylcholine receptors (nAChRs) in the brain. Non-pharmacological interventions targeting the psychosocial aspects of smoking addiction include brief counselling, cognitive-behavioural therapy, motivational interviewing, contingency management, relapse-prevention strategies, social influence and mobile phone-based programs.

Cost Analysis of Motivational Interviewing and Preschool Education for Secondhand Smoke Exposures.

This study determines if expenditures associated with implementing a combined motivational interviewing (MI) and Head Start-level education program (MI+Education), as compared to education alone, yield cost savings to society. Post hoc cost analyses were applied to a randomized controlled-trial of MI among predominantly African American, low-income caregivers of 330 Baltimore City Head Start students who reside with a smoker. The primary outcome was the cost savings of MI+Education from averted direct secondhand smoke exposure (SHSe)-related acute healthcare events and inferred indirect costs (work days lost, transportation and reduction in cigarettes smoked). The net direction of savings was defined by the sum of averted direct and indirect costs of the MI+Education intervention at 3, 6 and 12 months, benchmarked against the Education alone cohort at the equivalent time periods. The costs saved by the MI+Education intervention, relative to Education alone, resulted in savings at solely the 12-month follow-up time point. Significant savings were appreciated from averted emergency department (ED) visits at 12 months ($4410; 95% simulation interval [SI]: $2241, $6626) for the MI+Education group. The total savings at 12 months ($2274; 95% SI: -3916, $8442) could not overcome additional program costs of implementing MI to Head Start-level education ($13 695; 95% SI: $11 250, $16 034). This study is the first to examine the cost of either intervention on SHSe-attributed pediatric healthcare costs from a population level relevant for federal and community decision makers. Intervention costs could not be offset by short-term savings but a trend towards positive savings was appreciated 1 year after implementation. Behavioral interventions are effective in reducing SHSe in children. However, many of these interventions are not implemented in community settings due to lack of resources and money. Behavioral strategies may be a cost-saving addition to the national initiatives to create smoke-free home environments. The long-term benefits of MI, as evidenced from cost savings from averted ED visits, appeared to show MI+Education to be a robust long-term strategy. The decrease of acute healthcare services at 12 months may be informative for policy decision makers seeking to allocate limited resources to reduce the usage of costly ED services and hospital readmissions.

Feasibility of a pretrial diversion pilot in Kent County, Rhode Island

Background The U.S. correctional population is disproportionately burdened with chronic health conditions, particularly mental health and substance use disorders. Though inmates receive health care, linkages to care upon release are often poor or nonexistent. Further, the magnitude of the justiceinvolved population strains state and Federal finances. The annual cost per offender awaiting trial in Rhode Island is approximately $40,000. A diversion program (an alternative sentence diverting from incarceration and offering potential relief to courts and better outcomes for offenders) with linkages to health care has the potential to reduce costs by addressing the underlying physical, mental, and behavioral health issues keeping individuals in the justice system. We describe a diversion pilot program and our observations thus far. In partnership with Brown University and The Center for Prisoner Health and Human Rights, Justice Assistance, a nonprofit organization in Cranston, Rhode Island, received support from the Rhode Island General Assembly to develop a program to reduce the Rhode Island awaiting population by linking participants to community-based health care. The pilot program developed, Office of Community Alternatives (OCA), tests an intensive case management model. MAPIT (Motivational Assessment Program to Initiate Treatment) is an Internetbased motivational interviewing program piloted as a component of the OCA program.