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1.  Barriers to Parent Support for Physical Activity in Appalachia 
Journal of physical activity & health  2016;13(10):1042-1048.
Background
Parent support for child physical activity is a consistent predictor of increased childhood activity. Little is known about factors that prevent or facilitate support. The purpose of this research was to identify barriers to parent support for child physical activity in Appalachian parents.
Methods
A cross-sectional study assessed parents whose children participated in CARDIAC screenings in a rural Appalachian state. Barriers to parental support for physical activity, demographics, geographic location, and parental support for activity were measured.
Results
A total of 475 parents completed surveys. The majority were mothers (86.7%), parents of kindergarteners (49.5%), white (89.3%) and living in a non-rural area (70.5%). Community-level factors were most frequently cited as barriers, particularly those related to the built environment. Rural and low-income parents reported significantly higher barriers. Community, interpersonal, and intrapersonal barriers were negatively correlated with parent support for child physical activity. Parents of girls reported a higher percentage of barriers related to safety.
Conclusion
Reported barriers in this sample differed from those reported elsewhere (Davison, 2009). Specific groups such as low–income and rural parents should be targeted in intervention efforts. Future research should explore gender differences in reported barriers to determine the influence of cultural stereotypes.
doi:10.1123/jpah.2015-0474
PMCID: PMC5093057  PMID: 27256544
Obesity; Obesogenic; Youth; Built Environment
2.  Understanding Genomic Knowledge in Rural Appalachia: The West Virginia Genome Community Project 
Purpose
Rural communities have limited knowledge about genetics and genomics and are also underrepresented in genomic education initiatives. The purpose of this project was to assess genomic and epigenetic knowledge and beliefs in rural West Virginia.
Sample
A total of 93 participants from three communities participated in focus groups and 68 participants completed a demographic survey. The age of the respondents ranged from 21 to 81 years. Most respondents had a household income of less than $40,000, were female and most were married, completed at least a HS/GED or some college education working either part-time or full-time.
Method
A Community Based Participatory Research process with focus groups and demographic questionnaires was used.
Findings
Most participants had a basic understanding of genetics and epigenetics, but not genomics. Participants reported not knowing much of their family history and that their elders did not discuss such information. If the conversations occurred, it was only during times of crisis or an illness event. Mental health and substance abuse are topics that are not discussed with family in this rural population.
Conclusions
Most of the efforts surrounding genetic/genomic understanding have focused on urban populations. This project is the first of its kind in West Virginia and has begun to lay the much needed infrastructure for developing educational initiatives and extending genomic research projects into our rural Appalachian communities. By empowering the public with education, regarding the influential role genetics, genomics, and epigenetics have on their health, we can begin to tackle the complex task of initiating behavior changes that will promote the health and well-being of individuals, families and communities.
PMCID: PMC4871272  PMID: 27212895
Rural; Genetics; Genomics; Focus groups; Community Based Participatory Research
3.  Parental influences on 7–9 year olds’ physical activity: A conceptual model 
Preventive medicine  2013;56(5):341-344.
Objective
Models characterizing parental influence on child and adolescent physical activity (PA) over time are limited. Preschool and Adolescent Models (PM and AM) of PA are available leaving the need to focus on elementary-aged children. We tested current models (PM and AM) with a sample of 7–9 year-olds, and then developed a model appropriate to this specific target population.
Methods
Parent–child dyads completed questionnaires in 2010–2011. All models were assessed using path analysis and model fit indices.
Results
For adequate power, 90 families were needed, with 174 dyads participating. PM and AM exhibited poor fit when applied to the study population. A gender-specific model was developed and demonstrated acceptable fit. To develop an acceptable model for this population, constructs from both the PM (i.e. parental perception of child competency) and AM (i.e., child-reported self-efficacy) were used. For boys, self-efficacy was a strong predictor of PA, which was influenced by various parental variables. For girls, parental PA demonstrated the greatest strength of association with child PA.
Conclusion
This new model can be used to promote PA and guide future research/interventions. Future studies, particularly longitudinal designs, are needed to confirm the utility of this model as a bridge between currently available models.
doi:10.1016/j.ypmed.2013.02.005
PMCID: PMC4888866  PMID: 23438761
Physical activity; Child health; Conceptual model; Parental influence; Self-efficacy; Role modeling
4.  Development and Validation of a Smoking Expectancies Measure for Adolescents Seeking to Quit Smoking 
Substance abuse  2015;36(1):119-126.
Background
A more comprehensive understanding of factors that affect smoking cessation outcomes among adolescents may help enhance treatment interventions. One promising but underexplored factor that may influence cessation success is teens’ specific expectancies or beliefs about smoking outcomes. The present study evaluated the validity and reliability of a new measure of expectancies and its association with cessation outcomes among 762 adolescent smokers participating in studies of the American Lung Association’s Not-On-Tobacco cessation program.
Methods
Self-report questionnaires were collected prior to and following participation in a smoking cessation program. Self-reported cigarette use was verified with expired-air carbon monoxide. A multi-step exploratory and confirmatory factor analysis and reliability and validity analyses were performed.
Results
Four theoretically-related yet empirically independent factors were identified by the Smoking Expectancies Questionnaire (SEQ): 1) Positive Reinforcement, 2) Negative Reinforcement / Emotional Regulation, 3) Negative Reinforcement / Addiction and Withdrawal, and 4) Negative Outcomes/Risk. These factors could be subsumed by a single SEQ factor that reflected an overall concept of smoking expectancies relevant for adolescent smoking cessation. An overall SEQ Function score reflecting the balance between positive and negative expectancies predicted both pre-intervention cigarettes per day and cessation outcomes.
Conclusions
A single, overall SEQ Function score may prove useful for understanding the associations among individual, social and contextual factors in predicting treatment outcomes. Additionally, study findings may assist with modifying smoking expectancies among cessation program participants thereby enhancing treatment outcomes with diverse youth smoking populations.
doi:10.1080/08897077.2014.897297
PMCID: PMC4562463  PMID: 24635745
Adolescent smoking; cessation; expectancies; beliefs
5.  Developing a Dissemination Model to Improve Intervention Reach among West Virginia Youth Smokers 
The not-on-tobacco program is an evidence-based teen smoking cessation program adopted by the American Lung Association (ALA). Although widely disseminated nationally via ALA Master Trainers, in recent years, adoption and implementation of the N-O-T program in West Virginia (WV) has slowed. WV, unfortunately, has one of the highest smoking rates in the US. Although it is a goal of public health science, dissemination of evidence-based interventions is woefully understudied. The present manuscript reviews a theoretical model of dissemination of the not-on-tobacco program in WV. Based on social marketing, diffusion of innovations, and social cognitive theories, the nine-phase model incorporates elements of infrastructure development, accountability, training, delivery, incentives, and communication. The model components as well as preliminary lessons learned from initial implementation are discussed.
doi:10.3389/fpubh.2014.00101
PMCID: PMC4117930  PMID: 25136547
dissemination; dissemination science; diffusion; teen smoking; teen smoking cessation; tobacco prevention; tobacco intervention
6.  Gender differences in cigarette smoking, social correlates and cessation among adolescents 
Addictive Behaviors  2012;37(6):739-742.
Background
Despite well-established gender differences in adult smoking behaviors, relatively little is known about gender discrepancies in smoking behaviors among adolescents, and even less is known about the role of gender in smoking cessation among teen populations.
Method
The present study examined gender differences in a population of 755 adolescents seeking to quit smoking through the American Lung Association’s Not-On-Tobacco (N-O-T) program. All participants enrolled in the N-O-T program between 1998 and 2009. All participants completed a series of questionnaires prior to and immediately following the cessation intervention. Analyses examined gender differences in a range of smoking variables, cessation success and direct and indirect effects on changes in smoking behaviors.
Results
Females were more likely to have a parents, siblings and romantic partners who smokes, perceive those around them will support a cessation effort, smoke more prior to intervention if they have friends who smoke, and to have lower cessation motivation and confidence if they have a parent who smokes. Conversely, males were more likely to have lower cessation motivation and confidence and be less likely to quit if they have a friend who smokes.
Conclusions
Gender plays an important role in adolescent smoking behavior and smoking cessation. Further research is needed to understand how these differences may be incorporated into intervention design to increase cessation success rates among this vulnerable population of smokers.
doi:10.1016/j.addbeh.2012.02.007
PMCID: PMC3334461  PMID: 22405835
7.  Beyond quitting: Predictors of teen smoking cessation, reduction and acceleration following a school-based intervention 
Drug and alcohol dependence  2008;99(1-3):160-168.
There remains a great need for effective, cost-efficient, and acceptable youth smoking cessation interventions. Unfortunately, only a few interventions have been demonstrated to increase quit rates among youth smokers, and little is known about how elements of cessation interventions and participants’ psychosocial characteristics and smoking histories interact to influence program outcomes. Additionally, few studies have examined how these variables lead to complete smoking abstinence, reduction or acceleration over the course of a structured cessation intervention. Data for the present investigation were drawn from a sample of teen smokers (n = 5892) who voluntarily participated in either a controlled study or field study (i.e., no control group) of the American Lung Association's Not On Tobacco (N-O-T) program between 1998 and 2006 in five states. Results suggest that those who reduce smoking (but do not achieve full abstinence) are similar to those who quit on most measures except stage of change. Furthermore, it was found that those who increased smoking were heavier smokers at baseline, more addicted, were more likely to have parents, siblings, and significant others who smoked and reported less confidence in and less motivation for quitting than did those who quit or reduced smoking. Finally, a path model demonstrated how peers, siblings and romantic partners affected tobacco use and cessation outcomes differently for males and females. Implications for interventions are discussed.
doi:10.1016/j.drugalcdep.2008.07.011
PMCID: PMC2683731  PMID: 18804924
Adolescent; Smoking; Cessation; Not On Tobacco; Path analysis
8.  A profile of teen smokers who volunteered to participate in school-based smoking intervention 
Objectives
Although a number of population-based studies have examined the characteristics of teens who attempt to quit smoking, few have identified the characteristics of youth who participate in structured cessation interventions, particularly those with demonstrated effectiveness. The purpose of the present study is to describe the sociodemographic and smoking-related characteristics of teen smokers who participated in the American Lung Association's Not On Tobacco (N-O-T) program, spanning eight years. N-O-T is the most widely used teen smoking cessation program in the nation.
Methods
Drawn from multiple statewide N-O-T studies, this investigation examined data from 5,892 teen smokers ages 14–19 who enrolled in N-O-T between 1998–2006. We demonstrate similarities and differences between N-O-T findings and existing data from representative samples of US teen smokers where available and relevant.
Results
N-O-T teens started smoking earlier, were more likely to be poly-tobacco users, were more dependent on nicotine, had made more previous attempts to quit, and were more deeply embedded in smoking contexts than comparative samples of teen smokers. Additionally, N-O-T teens were moderately ready to quit smoking, believed important people in their lives would support their quit efforts, yet had deficits in their confidence with quitting.
Conclusion
This profile of N-O-T teens can guide efforts for targeted recruitment strategies to enhance intervention reach for teen smoking cessation. Findings provide guidance for marketing and recruitment efforts of intensive, school-based cessation interventions among established teen smokers, particularly those who want to quit. Study results may shed light upon who is and is not enrolling in N-O-T.
doi:10.1186/1617-9625-4-6
PMCID: PMC2556032  PMID: 18822165
9.  School-based Programs: Lessons Learned from CATCH, Planet Health, and Not-On-Tobacco 
Preventing Chronic Disease  2007;4(2):A33.
Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools.
We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children — Coordinated Approach to Child Health (CATCH) and Planet Health — and one focused on smoking cessation among adolescents — Not-On-Tobacco (N-O-T).
Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.
PMCID: PMC1893131  PMID: 17362624
10.  Efficacy of an Emergency Department-based Motivational Teenage Smoking Intervention 
Preventing Chronic Disease  2006;4(1):A08.
Introduction
Motivational interviewing techniques have been minimally researched as a function of a teenage smoking intervention. The present study examined the efficacy of a theory-based motivational tobacco intervention (MTI).
Methods
A randomized two-group design was used to compare 6-month post-baseline quit and reduction rates among teenagers who received the MTI with those who received brief advice or care as usual. Participants were smokers aged 14 to 19 years (N = 75) who presented for treatment in a university-affiliated hospital emergency department (ED). Motivational interviewing techniques were used by trained providers to facilitate individual change; stage-based take-home materials also were provided.
Results
Similar to past clinic-based studies of motivational interviewing with teenage smokers, our study found negative results in terms of intervention efficacy for cessation. Six-month follow-up cessation rates were nonsignificant — two teenagers quit smoking. Among teenagers who were available at follow-up, a medium effect size (Cohen's h = .38) was found for reduction and a large effect size (Cohen's h = .69) was found for percentage reduction, although these results also were not statistically significant.
Conclusion
Although the major findings of this study were not significant, the reductions in tobacco use suggest that motivational interviewing may be a clinically relevant counseling model for use in teenage smoking interventions. However, many questions remain, and the current literature lacks studies on trials with significant outcomes using motivational interviewing in smoking cessation. Additionally, more research is needed to examine the suitability of the ED for MTI-type interventions.
PMCID: PMC1832131  PMID: 17173716
11.  Quit and Reduction Rates for a Pilot Study of the American Indian Not On Tobacco (N-O-T) Program 
Preventing Chronic Disease  2005;2(4):A13.
Introduction
American Indian youths smoke cigarettes at high rates, yet few smoking-cessation programs have been developed for them. The objective of this study, conducted during 2003 and 2004, was to determine the preliminary quit and reduction outcomes of the American Lung Association's newly adapted American Indian Not On Tobacco (N-O-T) program.
Methods
Seventy-four American Indian youths aged 14 to 19 years in North Carolina were enrolled in the American Indian N-O-T program or a brief 15-minute intervention. Quit and reduction rates were compared 3 months after baseline using compliant subsamples and intention-to-treat analyses.
Results
Among males in the American Indian N-O-T program, between 18% (intention-to-treat) and 29% (compliant subsample) quit smoking. Six males (28.6%) in the American Indian N-O-T program reported quitting smoking; one male (14.3%) in the brief intervention reported quitting. No females in either group quit smoking. More females in the American Indian N-O-T program reduced smoking than females in the brief intervention.
Conclusion
These pilot results suggest that the American Indian N-O-T program offers a useful and feasible cessation option for American Indian youths in North Carolina. Program modifications are necessary to improve outcomes for American Indian females, and recruitment issues require in-depth study. Further study is warranted to determine program efficacy.
PMCID: PMC1435710  PMID: 16164817

Results 1-11 (11)