"We're Not Patients. We're Inmates": Older Black Women's Experience of Aging, Health, and Illness During and After Incarceration

BACKGROUND AND OBJECTIVES

The incarcerated population is growing older and by the year 2030, more than one third of people incarcerated in the United States will be over the age of 55. This population shift will have a profound impact on correctional health care systems as older incarcerated people often have multiple chronic illnesses and correctional institutions were not designed with aging and disability in mind. Black women experience greater burdens of comorbid conditions and are disproportionately represented among incarcerated women.

RESEARCH DESIGN AND METHODS

We utilized Black Feminist Epistemological Methodology to explore the intersection of aging, chronic illness, and mass incarceration via in-depth interviews with 13 formerly incarcerated older Black women.

RESULTS

First, participants described needing to prove themselves to be trustworthy prior to becoming ill in order to be believed and granted access to care when they report symptoms. Next, participants report being treated, not as patients, but as "inmates." The punitive nature of prison health care disrupted the patient-provider relationship and complicated the ability of patients to maintain autonomy in health care interactions. Finally, I describe how carceral health extends beyond the walls of both the clinic and the institution.

DISCUSSION AND IMPLICATIONS

For older Black women, medical care and decision making inside prisons occur within a punitive context, which presents unique barriers when seeking care. Their experiences of health and illness while incarcerated may continue to influence if and how they seek care as they age in the community and thus must be interrogated when discussing aging in the Black community.

The Problem Is Not (Merely) Mass Incarceration: Incarceration as a Bioethical Crisis and Abolition as a Moral Obligation

Mass incarceration is an ethical crisis. Yet it is not only the magnitude of the system that is troubling. Mass incarceration has been created and sustained by racism, classism, and ableism, and the problems of the criminal legal system will not be solved without meaningfully intervening upon these forms of oppression. Beyond that, incarceration itself-whether of one person or 2 million-represents a moral failing. To punish and control, rather than invest in community and healing, is antithetical to the values of the field of bioethics. This commentary, which responds to the article "Fifty Years of U.S. Mass Incarceration and What It Means for Bioethics," by Sean Valles, considers abolition as a crucial form of justice that must be centered in the work of bioethics. Abolition is both an antiracist intervention and a means of considering the ways health care broadly and bioethics specifically have allowed for the perpetuation of carcerality in the United States.

The role of polygenic risk scores in breast cancer risk perception and decision-making

Polygenic risk scores (PRS) have the potential to improve the accuracy of clinical risk assessments, yet questions about their clinical validity and readiness for clinical implementation persist. Understanding how individuals integrate and act on the information provided by PRS is critical for their effective integration into routine clinical care, yet few studies have examined how individuals respond to the receipt of polygenic risk information. We conducted an embedded Ethical, Legal, and Social Implications (ELSI) study to examine if and how unaffected participants in a US population breast cancer screening trial understood and utilized PRS, as part of a multifactorial risk score combining traditional risk factors with a genetic risk assessment, to make screening and risk-reduction decisions. Semi-structured qualitative interviews were conducted with 24 trial participants who were designated at elevated risk for breast cancer due to their combined risk score. Interviews were analyzed using a grounded theory approach. Participants understood PRS conceptually and accepted it as one of many risk factors to consider, yet the value and meaning they ascribed to this risk estimate varied. Most participants reported financial and insurance barriers to enhanced screening with MRI and were not interested in taking risk-reducing medications. These findings contribute to our understanding of how PRS may be best translated from research to clinical care. Furthermore, they illuminate ethical concerns about identifying risk and making recommendations based on polygenic risk in a population screening context where many may have trouble accessing appropriate care.

A qualitative study of unaffected ATM and CHEK2 carriers: How participants make meaning of 'moderate risk' genetic results in a population breast cancer screening trial

Relatively little is known about experiences of individuals with a pathogenic variant in a moderately penetrant breast cancer gene, particularly those without a personal history of cancer. The WISDOM trial is testing a model of risk-based breast cancer screening that integrates genomic (nine genes and polygenic risk) and other risk factors. In the context of an embedded Ethical, Legal, and Social Implications (ELSI) study of WISDOM, we conducted qualitative interviews at two timepoints post-result disclosure with 22 ATM and CHEK2 carriers. Results disclosure and interview recordings were transcribed and analyzed using a grounded theory analysis framework. We found that participants minimized the significance of their results in comparison to BRCA; were surprised but not alarmed by the results in the absence of family history; did not fundamentally change their perception of their breast cancer risk despite the new genomic information; exhibited variable responses to WISDOM's screening and risk reduction recommendations; and shared test results with family but did not strongly encourage cascade testing. Participants viewed the results as having limited utility and responded accordingly. Our study offers important insights into how genetic test results for moderate-risk genes are received, understood, and acted upon in population screening context.

"It's personalized, but it's still bucket based": The promise of personalized medicine vs. the reality of genomic risk stratification in a breast cancer screening trial

Adaptive pragmatic clinical trials offer an innovative approach that integrates clinical care and research. Yet, blurring the boundaries between research and clinical care raises questions about how clinicians and investigators balance their caregiving and research roles and what types of knowledge and risk assessment are most valued. This paper presents findings from an ethnographic ELSI (Ethical, Legal, Social Implications) study of an innovative clinical trial of risk-based breast cancer screening that utilizes genomics to stratify risk and recommend a breast cancer screening commensurate with the assessed risk. We argue that the trial demonstrates a fundamental tension between the promissory ideals of personalized medicine, and the reality of implementing risk stratified care on a population scale. We examine the development of a Screening Assignment Review Board in response to this tension which allows clinician-investigators to negotiate, but never fully resolve, the inherent contradiction of 'precision population screening'.

Black Feminist Bioethics: Centering Community to Ask Better Questions

This commentary builds off the article "Is Trust Enough? Anti-Black Racism and the Perception of Black Vaccine 'Hesitancy,'" by Yolonda Wilson, and her assertion that the question, "Why don't Black people trust … ?" is insufficient. The commentary describes ways in which a Black feminist approach to knowledge production can facilitate centering community and can lead researchers, health care providers, and bioethicists to ask better questions. Instead of demanding that Black patients change to fit within biomedicine, people in these fields must radically reimagine biomedicine to better meet the needs of Black patients. For this to become a reality, bioethicists must work toward eliminating racism, and the field of bioethics should embrace Black feminist bioethics to work toward this goal.

The limits of personalization in precision medicine: Polygenic risk scores and racial categorization in a precision breast cancer screening trial

Population-based genomic screening is at the forefront of a new approach to disease prevention. Yet the lack of diversity in genome wide association studies and ongoing debates about the appropriate use of racial and ethnic categories in genomics raise key questions about the translation of genomic knowledge into clinical practice. This article reports on an ethnographic study of a large pragmatic clinical trial of breast cancer screening called WISDOM (Women Informed to Screen Depending On Measures of Risk). Our ethnography illuminates the challenges of using race or ethnicity as a risk factor in the implementation of precision breast cancer risk assessment. Our analysis provides critical insights into how categories of race, ethnicity and ancestry are being deployed in the production of genomic knowledge and medical practice, and key challenges in the development and implementation of novel Polygenic Risk Scores in the research and clinical applications of this emerging science. Specifically, we show how the conflation of social and biological categories of difference can influence risk prediction for individuals who exist at the boundaries of these categories, affecting the perceptions and practices of scientists, clinicians, and research participants themselves. Our research highlights the potential harms of practicing genomic medicine using under-theorized and ambiguous categories of race, ethnicity, and ancestry, particularly in an adaptive, pragmatic trial where research findings are applied in the clinic as they emerge. We contribute to the expanding literature on categories of difference in post-genomic science by closely examining the implementation of a large breast cancer screening study that aims to personalize breast cancer risk using both common and rare genomic markers.

In vitro exposure of preimplantation porcine embryos to porcine parvovirus

Early porcine embryos at the four- to eight-cell stage can be infected with either the virulent (NADL-8) or avirulent KBSH strain of porcine parvovirus (PPV) by microinjection or by incubation of embryos with virus. Treatment of embryos by microinjection of virus or incubation in media with virus did not significantly inhibit in vitro development of the embryos when compared with untreated controls. RNA-DNA hybridization was used to identify the presence of virus associated with embryos. It was found that PPV-DNA was present in viable embryos after microinjection of embryos with KBSH and NADL-8 strains of PPV and after incubation of embryos with KBSH strain. The data indicated the presence of replicative virus associated with viable porcine embryos.

Psychophysiological effects of habitual caffeine consumption

Caffeine is the most widely consumed pharmacologically active substance in the world, and a key issue concerning its possible implications for human health is whether it has persistent (i.e., chronic) physiological effects on habitual consumers. This study examined blood pressure, heart rate (HR), electromyogram (EMG), and skin conductance level (SCL) in 36 healthy men and women exposed to a pattern of moderate intake. A double-blind placebo-controlled crossover design with counterbalancing was used in which all subjects participated in four experimental conditions involving the ingestion of placebo or caffeine three times daily for 6 days followed by a seventh ("challenge") day of placebo or caffeine ingestion. Results confirmed that caffeine has significant pressor effects, and these were found to he additive to the pressor action of a laboratory stressor. Following habitual consumption of the drug. pressor effects were diminished (indicative of tolerance) but not eliminated. Effects of caffeine on other parameters were either modest (HR and EMG) or negligible (SCL). Considering (he near-universal use of caffeine. the persistent pressor effects observed in this study have important implications for clinical practice and public health.

Acute and chronic effects of caffeine on performance, mood, headache, and sleep

Despite being the most widely consumed psychoactive substance in the world, there is considerable confusion regarding the effects of caffeine. This study examined objective indices of performance, and self-reported mood, headache, and sleep in 36 healthy male and female habitual caffeine consumers exposed to a pattern of moderate intake. A double-blind placebo-controlled cross-over design with counterbalancing was employed in which all subjects participated in four experimental conditions involving the ingestion of placebo or caffeine 3 times daily for 6 days followed by a 7th (challenge) day of placebo or caffeine ingestion. No evidence was found that caffeine improved performance, either in the context of acute or habitual use. On the contrary, performance was found to be significantly impaired when caffeine was withdrawn abruptly following habitual use. Participants reported feeling more alert and less tired following acute ingestion of caffeine, but feeling less alert in conjunction with chronic exposure to the drug. In addition, caffeine withdrawal was associated with reported increases in frequency and severity of headache, and with reports of sleeping longer and more soundly.

Hemodynamic profile of stress-induced anticipation and recovery

Systolic and diastolic blood pressure, heart rate, stroke volume, cardiac output, and total peripheral resistance were measured in 100 healthy men and women with the aim of investigating hemodynamic profile during anticipation of, and recovery from, exposure to active and passive laboratory stressors. A 5-min anticipatory period preceded two tasks, both of which lasted 2.5 min. The tasks were mental arithmetic ('beta-adrenergic' stress) and the cold pressor test ('alpha-adrenergic' stress). Each task was followed by a 5-min recovery period. Blood pressure and heart rate were measured with a FinaPres 2300e, and stroke volume, cardiac output, and total peripheral resistance were computed from these parameters. Salivary cortisol was measured in relation to both tasks, and participants completed tests of state and trait anxiety, locus of control, and hostility. As expected, mental arithmetic and the cold pressor test elicited myocardial and vascular patterns of reactivity, respectively. However, contrary to expectations, anticipatory and recovery hemodynamic profile involved essentially vascular responding for both stressors. Salivary cortisol increased in response to both tasks but only weakly correlated with hemodynamic changes. None of the subjective measurements was a strong predictor of physiological reactivity. The findings suggest that stress-induced anticipatory and recovery reactivity may be generally vascular rather than myocardial. This could have important implications in light of suggestions that anticipatory and recovery responses may be better predictors of subsequent cardiovascular disease than direct stress-induced reactivity.

Effects of video-relayed social support on hemodynamic reactivity and salivary cortisol during laboratory-based behavioral challenge

The authors tested the effects of a laboratory analogue of social support on reactivity to laboratory-based behavioral challenge. Video-relayed supportive commentary was provided by a same-sex confederate while participants (40 healthy men and women assigned to support and no-support groups) performed a demanding computer task, and their heart rate, systolic and diastolic blood pressure, and salivary cortisol were measured. The authors found that heart rate and cortisol level (but not blood pressure) were attenuated in the support condition for both genders. Objective performance on the task was similar in both groups, but the social support group reported higher levels of perceived support and rated the task as easier than did participants in the no-support condition. Video presentation offers new opportunities for systematically examining social support and its effects.

Effects of video-relayed social support on hemodynamic reactivity and salivary cortisol during laboratory-based behavioral challenge

The authors tested the effects of a laboratory analogue of social support on reactivity to laboratory-based behavioral challenge. Video-relayed supportive commentary was provided by a same-sex confederate while participants (40 healthy men and women assigned to support and no-support groups) performed a demanding computer task, and their heart rate, systolic and diastolic blood pressure, and salivary cortisol were measured. The authors found that heart rate and cortisol level (but not blood pressure) were attenuated in the support condition for both genders. Objective performance on the task was similar in both groups, but the social support group reported higher levels of perceived support and rated the task as easier than did participants in the no-support condition. Video presentation offers new opportunities for systematically examining social support and its effects.

The psychological and emotional impact of living with an automatic internal cardioverter defibrillator (AICD): how can nurses help?

The introduction of the Automatic Internal Cardioverter Defibrillator (AICD) has greatly improved the mortality rates associated with sudden cardiac events (Moss et al 1996, McCarthy 1997, Trappe et al 1997). Little is known about the consequences of living with this device for patients and their families. Biomedical influences have resulted in the devices's success being measured on physical adaptation, with data on suitability, reliability, and efficiency of AICDs as a therapeutic measure. What seems to be of equal priority now is to obtain insights as to the emotional and psychological consequences of such treatment, and the effects these may have on outcomes and utilization of health-care resources. AICD patients have described many powerful emotions arising from receiving this device, which are often heightened at discharge, yet little is known of the reasons for this (James 1997a). It is essential that individuals' and their families' perceptions of their experiences are understood so that clinical staff can not only meet the technological and safety needs of this group, but also assist them to adjust to living with an AICD. Families of AICD patients report significant emotions arising from their support of AICD patients, and describe their own needs and problems. Nevertheless, the influence of, and the effects on the family are often underestimated within AICD patient care. A shift away from a purely individualistic approach towards a more family-centred approach is suggested, arguably enabling the role of family members to be recognized, supported and developed. Qualitative research in this area is needed to inform clinical nursing practice and assist in development of clinical expertise to address the important issues for patients and families. This should enable them to return to their everyday lives with appropriate support. Education of healthcare professionals in a wide variety of clinical areas is needed to ensure a sound body of knowledge, as a basis for development of a more holistic approach to care which encompasses and recognizes the feelings and emotions evoked from receiving this device.

A comparison of fluorescence versus chemiluminescence detection for analysis of the fluorescamine derivative of histamine by HPLC

Fluorescence and chemiluminescence detection were compared for HPLC analysis of the fluorescamine derivative of histamine. The kinetic behaviour of the chemiluminescent response for the derivative was characterized in a static system. An HPLC method was optimized for the derivative using fluorescence detection. Fluorescence detection was linear over the range of 166-1666 pg on column for the fluorescamine-histamine derivative with a limit of detection of 13 pg on column. Using a detector designed for optimal use with chemiluminescence, the chemiluminescence response of the fluorescamine derivative was linear over a range of 1.66-16.6 ng on column with a limit of detection of 1.0 ng on column. These results exemplify a case in which superior detectibility is provided by fluorescence over chemiluminescence, and contradicts many reports comparing fluorescence to chemiluminescence. The authors conclude that chemiluminescence should be considered when indicated by conditions established for separation that are favourable for the observation of chemiluminescence. These conditions include sufficiently low excitation energies corresponding to an excitation maximum greater than 400 nm, favourable dipole character of analytes, mobile phases of high organic content, and an appropriate pH of the mobile phase.

Chronic effects of habitual caffeine consumption on laboratory and ambulatory blood pressure levels

BACKGROUND

Uncertainty continues to surround the role of habitual caffeine consumption as a cardiovascular risk factor. The present study examined the effects of moderate caffeine intake on 24h blood pressure and heart rate in normotensive men and women.

METHODS

A double-blind, placebo-controlled, crossover design with counterbalancing was used, in which 36 healthy men and women participated in four experimental conditions involving the ingestion of placebo or caffeine three times daily for 6 days, followed by a seventh ('challenge') day of placebo or caffeine ingestion.

RESULTS

When caffeine was consumed on the challenge day, blood pressure was found to be elevated immediately after caffeine ingestion and was either unchanged or decreased (hypotensive effect) after a period of abstinence from the drug. Some diminution of the peak pressor effects was found when participants ingested caffeine after habitual use of the drug (6.0/5.2 mmHg) compared with when they had been abstinent before the challenge day (7.7/6.8 mmHg). This diminution in the reaction was comparatively small, however, and pressor effects persisted on caffeine-challenge days even when caffeine was consumed on preceding days.

CONCLUSION

Habitual consumption diminished, but did not eliminate, the pressor effects of caffeine. Considering the almost universal consumption of caffeine beverages, the persistent pressor effects of the drug could have important implications for cardiovascular health.

Pressor effects of caffeine and cigarette smoking

Pressor effects of caffeine and cigarette smoking were examined in 15 normotensive young men and women. A cross-over design was used in which all subjects participated in four separate conditions: placebo alone, caffeine alone, placebo plus smoking, and caffeine plus smoking. Caffeine and smoking produced independent increases in systolic and diastolic blood pressure, and these effects were additive in the caffeine-plus-smoking condition. Heart rate was significantly increased by smoking but was essentially unaffected by caffeine.

The influence of user status and anxious disposition on the hypertensive effects of caffeine

The present study examined the influence of consumer status and anxious disposition on the hypertensive effects of caffeine. A secondary aim of the study was to investigate possible gender differences in response to caffeine. Sixty normotensive subjects were assigned to 4 groups representing high and low scorers on the variables of habitual caffeine consumption and anxious disposition. A randomized double-blind crossover design was used in which all subjects received a placebo (lactose) at one of two 120-min laboratory sessions and caffeine (6 mg/kg) at the other. Systolic and diastolic blood pressure, heart rate, hand steadiness, and EMG were monitored before and after exposure to a psychological stressor. Caffeine produced significant elevations in systolic and diastolic blood pressure, and these effects were additive to the pressor effects of stress and anxiety. While the general pattern of results was similar for both sexes, reactions to caffeine were more pronounced in males than in females. Notwithstanding the need for clarification of the chronic effects of caffeine, present findings add further weight to current concerns about the acute hypertensive effects of the drug.

Virtue rewarded: reinforcement and punishment in an acute psychiatric admission ward

This study evaluated the naturally occurring behaviour of psychiatric patients in an acute psychiatric setting. Direct behavioural observations were carried out to determine the amount of time patients spent in interaction, with whom they interacted, and the nature of the interaction. Also examined were each respondent group's type and rate of interactive behavior. For much of the time no interactive behaviour was observed to occur, but much of the behaviour exhibited by patients was socially appropriate. When social interactions did occur, both fellow patients and staff tended to reinforce appropriate behaviour. However, nurses reinforced inappropriate crazy behaviour much less than did fellow-patients or non-nursing staff. Treatment implications are discussed.

Lumbar zygapophyseal joint meniscoids: evidence of their role in chronic intersegmental hypomobility

Meniscoid bodies of the zygapophyseal joints are considered by some to be a cause of the Acute-Locked Back Syndrome. These meniscoid bodies have been identified anatomically and histologically, but not yet in a formal clinical investigation. The authors provide a brief review of the zygapophyseal meniscoid-related literature, present new documentation of histological variations and offer some possible consequences of the presence of mechanically pathological meniscoids. It is herein proposed that an important sequela to the pathophysiology of these structures is that of chronic intersegmental hypomobility. We invite the scientific community to pursue further investigations of these meniscoids. Magnetic resonance imaging is one method suggested to investigate the meniscoid in vivo.

Relative efficacy of intensive and spaced behavioral treatment of stuttering

Twenty adult and adolescent stutterers were randomly assigned to two treatment formats consisting of either 16 two-hour sessions of fluency training administered within a concentrated period of four consecutive days (intensive treatment), or two two-hour sessions per week for eight weeks (spaced treatment). Frequency of stuttering and rate of speaking were repeatedly assessed from speech samples obtained in six different clinic and extra-clinic speech settings. The efficiency of treatment, subject compliance, and communication "attitudes" were also measured. Fluency training produced significant reductions in stuttering frequency, and significant improvements in speaking rate and communication attitudes for both treatment formats. Both formats were found equivalent on all measures. In addition, generalization of treatment effects was observed in all settings. However, maintenance of generalization effects was uneven across settings, suggesting the possible need for differential levels of training for different speaking situations.

Self-report reliability and symptomatology of habitual caffeine consumption

1. A large body of research on the demography of caffeine use and its potential health consequences has been undermined by the absence of empirical data on the reliability of retrospective self-reports of caffeine consumption. 2. The principal aim of the present study was to use standard bioanalytic method to assess the reliability of subjects' self-reported caffeine use. Saliva samples were obtained from 142 first-and second-year medical students and assayed for caffeine and paraxanthine. 3. Self-reported caffeine use was found to be significantly correlated with salivary caffeine (r = 0.31, P less than 0.001) and paraxanthine (r = 0.42, P less than 0.001), thereby providing qualified support for use of questionnaires to estimate patterns of caffeine consumption. 4. A secondary aim of the study was to extend previous research concerning the symptomatology of caffeine use by examining the association between caffeine exposure and a variety of measures of somatic and psychological health. Caffeine consumption was reliably associated with the self-reported occurrence of somatic symptoms, but not psychological well-being.

Biochemical validation of self-reported caffeine consumption during caffeine fading

Increasing concern about caffeine as a drug with potential for abuse has resulted in the development of procedures for effecting reductions in caffeine consumption among heavy users. However, the reliability of reported findings may be questioned, since previous studies have relied on subject self-report as the principal measure of caffeine use. The present study employed bioanalytic methods for assessing the reliability of self-reported caffeine intake during a caffeine-fading regime. Twelve subjects, each with a history of heavy caffeine use, provided baseline, treatment, and follow-up blood samples which were assayed for caffeine and its major metabolites. General support was provided for the reliability of self-report as a measure of caffeine consumption. The general efficacy of caffeine fading was also supported, although there were indications that maintenance effects may have been over-estimated in previous studies.

Desensitization treatment of agoraphobia

Clinical literature on desensitization treatment of agoraphobia is reviewed. The popular belief that in vivo desensitization is generally superior to imaginal exposure is critically examined. Studies which do not support this belief are reviewed, and the implications for clinical practice are considered.

Embryo transfer in swine

Embryo transfer is used to propagate genetically superior swine while minimizing disease risks. Embryos are harvested through a ventral midline incision in the anesthetized sow 4-6 days after estrus, using a glass tube or Foley catheter. Embryos are transferred to similarly prepared sows by injection directly into the uterus through a tomcat catheter or glass pipette. Embryos typically are transferred within a few hours of collection but may be stored in culture medium at 37 C for up to 30 hours.

The relative efficacy of imaginal and in vivo desensitization in the treatment of agoraphobia

Claims have often been made that in vivo procedures are generally superior to imaginal approaches in the clinical management of anxiety and avoidance behavior. Such claims seem unwarranted in that the relevant clinical research appears only to have involved either flooding or rapid exposure techniques. The aim of the present study was specifically to examine the relative efficacy of imaginal and in vivo desensitization in the clinical management of debilitating phobia. Six agoraphobic women participated in the study which employed a multiple-baseline single-subject methodology. Severity of phobia was repeatedly assessed on measures of avoidance behavior and subjective distress, and subjects self-monitored pulse rate. Significant reductions in phobic behavior were observed during both imaginal and in vivo desensitization, but neither treatment was found to be more effective than the other. Moreover, the same pattern of results was observed for both treatment and generalization settings. As such, the results do not support previous suggestions that in vivo exposure is necessarily superior to imaginal desensitization in the treatment of agoraphobia. Encouraging follow-up results provided some confirmation of previous findings indicating the effectiveness of self-management procedures in the long-term control of agoraphobia.

Embryo transfer for conserving valuable genetic material from swine herds with pseudorabies

Embryo transfer was used to conserve genetic material from 2 swine herds seropositive for pseudorabies virus (PRV). Embryos (n = 805) were recovered from 38 PRV-seropositive Duroc sows in Iowa and, after 4 to 10 hours' culture and shipment to Illinois, were transferred to 34 recipients from a herd seronegative for PRV. All recipients remained seronegative for PRV, and 22 of the recipients farrowed 208 pigs (189 alive) that also were seronegative for PRV. There was no evidence of PRV in the embryo recovery medium or in the uterine and oviductal cells recovered with the embryos. Transfer of morulae resulted in higher (P less than 0.02) farrowing rates than did transfer of 4- to 8-cell embryos, but litter size was not affected.

Parameters of the influence of self-initiated time-out from speaking on stuttering

The influence of two parameters of self-initiated time-out from speaking were investigated with 33 adolescent and adult stutterers. Subjects were assigned at random to one of three conditions which compared experimenter-administered time-out of fixed duration, experimenter-administered time-out of duration determined by the subject, and self-initiated time-out of fixed duration. When given the opportunity to determine time-out duration, subjects chose a relatively brief period. In addition, when given responsibility for self-initiating time-out contingent on stuttering, subjects were significantly less reliable than was the experimenter in administering the procedure. Nevertheless, significant improvements in fluency were observed during all three time-out conditions, and the improvements were comparable across the three conditions.

The modification of parent behavior. A review of generalization and maintenance

This article reviews the literature on the extratraining effects of behavioral family intervention relating to parent behavior. The review classifies generalization and maintenance into several distinct categories suggested by Drabman, Hammer, and Rosenbaum (1979). The authors conclude that only limited aspects of generalization and maintenance questions in parent training have been addressed and highlight several persisting methodological deficiencies that have hampered the development and evaluation of effective generalization programming technologies.

Punishment of stuttering: contingency and stimulus parameters

The influence of two major parameters of time out from speaking were investigated with 36 adolescent and adult stutterers. Subjects were assigned to four matched groups in an attempt to examine whether time out has to be contingent to be effective and whether simply signaling stuttering (no time out) produces response reduction. The major finding was that reliable reductions in stuttering frequency were produced only when tone presentations were contingent and signaled time out from speaking. Overall results are discussed in terms of their implications for the various major models used to account for the effects of response-contingent procedures on stuttering. Assigning a label of distraction, attention, or punishment is less important than identifying the parameters responsible for observed effects.

Behavioral self-control of stuttering using time-out from speaking

Research has shown that stuttering may be attenuated by a variety of response-contingent consequences. To date, however, few attempts have been made to develop comprehensive clinical procedures based on the operant manipulation of stuttering. The present research examined the efficacy of self-initiated response-contingent time-out from speaking in two experiments involving a single subject. Multiple baseline designs were used in which the subject's speech was monitored in a variety of laboratory and community settings. In Experiment 1, the time-out procedure produced reliable reductions in disfluency across all observational settings. Experiment 2 combined a response-cost contingency with time-out in an attempt to increase the reliability with which the subject timed himself out, and to increase further the effectiveness of the procedure. Increases in reliability were produced, and the associated improvements in fluency were maintained at 6- and 12-months' follow-up.

Personality changes in drinkers

A questionnaire survey of members of Mensa, all of whom have high IQs, found that perceptions of personality traits differed between social drinkers and alcoholics.

The influence of duration on the effects of time-out from speaking

The influence of the variable of duration on the effects of time-out from speaking was investigated. Forty-five adolescent and adult stutterers participated in a study which examined the relative effects of time-out of one, five, 10, and 30 seconds and no time-out. Response-contingent time-out from speaking of all four durations resulted in significant reductions in stuttering frequency while the no time-out control showed no change. Although longer durations tended to effect greater reductions in stuttering frequency, no reliable differences between time-out durations were found. It was concluded that the punishing effects of the time-out from speaking procedure were predominantly due to its involving contingent interruption of speaking, and that the actual duration of the period of silence was comparatively unimportant. Present findings seems to provide little support for the notion that time-out from speaking primarily represents time-out from positive reinforcement.

The influence of stutterer's expectancies of improvement upon response to time-out

The influence of the variable of stutterers' expectancies of improvement upon the efficacy of response-contingent time-out from speaking was investigated. Fourteen male stutterers were exposed to four conditions: base rate, time-out plus enhanced expectancies of improvement, base rate, and time-out plus allayed expectancies of improvement. Subjects' expectancies of improvement were manipulated by the administration of a placebo and instructions. Results indicated that time-out produced significant reductions in frequency of stuttering under both expectancy conditions, and that the efficacy of the procedure under one condition was not significantly different from its efficacy under the other. Other data collected allowed an independent check to be made of results obtained by previous investigators on the subjective effects of time-out. Discrepancies between the findings of other researchers ana those of the present study are discussed.