The association between marijuana and e-cigarette use and exercise behavior among adults

Background

As the prevalence of marijuana and e-cigarette use among American adults rises and the perceived risk decreases, more information is needed on the potential costs and benefits of marijuana and e-cigarette use, including patterns of exercise. Prior studies have found mixed results, lacked data on types of exercise, and involved only adolescents and young adults. Thus, the current study explored whether marijuana and e-cigarette use are associated with strength training, walking for exercise, or general physical activity among adults in the United States.

Method

2,591 adults from Wave V of the National Longitudinal Study of Adolescent to Adult Health (2016-2018) comprised the sample. Separate one-way analyses of variance (ANOVAs) and post hoc tests examined whether participants' marijuana and e-cigarette use predicted their exercise, while follow-up analyses of covariance (ANCOVAs) probed significant effects.

Results

Results indicated that participants' marijuana and e-cigarette use predicted their walking for exercise, with marijuana users walking the highest number of times per week, followed by non-users, e-cigarette users, and dual users. However, this effect only approached significance after controlling for covariates. There were no significant differences in strength training or general exercise between groups.

Conclusion

These findings challenge the stereotype that marijuana and e-cigarette users are less active than non-users, and future research should examine the potential mechanisms of these findings.

A Professional Development Workshop: Applying the Race and Culture Guide to Reduce Bias in Medical Teaching Cases

Introduction

Clinical teaching cases are a cornerstone of health professions education programs, but cases historically have lacked diversity and have the potential to reinforce essentialism. In this article, we describe the creation, implementation, and feasibility assessment of a professional development workshop aimed at integrating an existing bias reduction tool into discussion and revision of teaching cases.

Methods

Six 60-minute workshops were held introducing "The Race and Culture Guide for Editors of Teaching Cases" to different health profession education programs wherein all participants worked in small groups to critique and edit two sample teaching cases. To assess initial feasibility, facilitators completed a facilitator evaluation survey to capture experiences after the first three workshops. Due to positive feedback, workshops were continued, and participants completed a participant evaluation survey to understand learner impact.

Results

Facilitators (n=6) identified the workshop as addressing an important need, highlighted the value in small-group format, and noted their ability to facilitate future sessions. Participants (n=18) rated the workshop as useful, effective at challenging biases, and would recommend the workshop to others.

Conclusion

The purpose of this study was to understand the feasibility of implementing a discussion-based workshop integrating a bias reduction tool. Initial feasibility and acceptability assessments demonstrate that this workshop.

Single and Combined Effects of Multiple Intensities of Behavioral Modification and Methylphenidate for Children with ADHD in the Home Setting

Behavioral treatment, stimulants, and their combination are the recommended treatments for childhood attention-deficit/hyperactivity disorder (ADHD). The current study utilizes within-subjects manipulations of multiple doses of methylphenidate (placebo, 0.15, 0.30, and 0.60 mg/kg/dose t.i.d.) and intensities of behavioral modification (no, low, and high intensity) in the summer treatment program (STP) and home settings. Outcomes are evaluated in the home setting. Participants were 153 children (ages 5-12) diagnosed with ADHD. In alignment with experimental conditions implemented during the STP day, parents implemented behavioral modification levels in three-week intervals, child medication status varied daily, and the orders were randomized. Parents provided daily reports of child behavior, impairment, and symptoms and self-reported parenting stress and self-efficacy. At the end of the study, parents reported treatment preferences. Stimulant medication led to significant improvements across all outcome variables with higher doses resulting in greater improvement. Behavioral treatment significantly improved child individualized goal attainment, symptoms, and impairment in the home setting and parenting stress and self-efficacy. Effect sizes indicate that behavioral treatment combined with a low-medium dose (0.15 or 0.30 mg/kg/dose) of medication results in equivalent or superior outcomes compared to a higher dose (0.60 mg/kg/dose) of medication alone. This pattern was seen across outcomes. Parents overwhelmingly reported preferring treatment with a behavioral component as a first-choice treatment (99%). Results underscore the need to consider dosing as well as parent preference when utilizing combined treatment approaches. This study provides further evidence that combining behavioral treatment and stimulant medication may reduce the stimulant dose needed for beneficial effects.

Preferences for Parenting Programs in Head Start: Using Conjoint Analysis to Understand Engagement in Parenting Health Promotion Programs

The impact of evidence-based parenting health promotion programs is threatened by limited enrollment and attendance. We used a discrete choice experiment (DCE) to examine how Early Head Start and Head Start parents prioritized key attributes of parenting programs when considering potential participation. Utility values and importance scores indicate that parents placed the highest priority on a program that optimized child academic outcomes, and after that, on a program that offered incentives and logistical supports, and maximized potential effects on friendship skills, behavioral skills, and the parent-child relationship. Next, we used simulations or forecasting tools to estimate parents' preferences for types of programs. Sixty-five percent of parents preferred Outcome-focused Programs that fostered parents' understanding and practice of skills, whereas 23% prioritized Enhanced Support Programs offering logistic support, such as incentives, followed by child outcomes. The remaining 12% of parents preferred Format-focused Programs that targeted positive outcomes via one 30-min meeting. Parents preferring Outcome-focused Programs reported higher child prosocial behaviors compared to parents preferring Enhanced Support and Format-focused Programs. Parents preferring Outcome-focused Programs were more likely to be those of 3- and 4-year-old children than of 2-year-olds. Findings challenge the one-size-fits-all approach to offering parenting programs and suggest ways to enhance accessibility and program reach.

Randomized Trial of First-Line Behavioral Intervention to Reduce Need for Medication in Children with ADHD

A study conducted in an analogue summer treatment setting showed that when concurrently receiving behavioral intervention, many children with Attention-Deficit Hyperactivity Disorder (ADHD) did not need medication or maximized responsiveness at very low doses. The present study followed participants in that summer study into the subsequent school year to investigate whether the same pattern would extend to the natural school and home settings. There were 127 unmedicated children with ADHD between the ages of 5 and 13 who were randomly assigned to receive or not receive behavioral consultation (BC) at the start of the school year. Children were evaluated by teachers and parents each week to determine if central nervous system stimulant treatment was needed. Children who received BC were approximately half as likely those who did not (NoBC) to initiate medication use each week at school or home and used lower doses when medicated at school. This produced a 40% reduction in total methylphenidate exposure over the course of the school year. BC and NoBC groups did not significantly differ on end-of-year teacher or parent ratings of behavior, which were positive. Moreover, BC and NoBC groups did not significantly differ in cost of treatment; although children in the BC condition accrued additional costs via the BC, these costs were offset by the associated delay and reduction in medication use. Results add to a growing literature suggesting that the use of low-intensity behavioral intervention as a first-line treatment reduces or eliminates the need for medication in children with ADHD.

A dose-ranging study of behavioral and pharmacological treatment in social settings for children with ADHD

Placebo and three doses of methylphenidate (MPH) were crossed with 3 levels of behavioral modification (no behavioral modification, NBM; low-intensity behavioral modification, LBM; and high-intensity behavior modification, HBM) in the context of a summer treatment program (STP). Participants were 48 children with ADHD, aged 5-12. Behavior was examined in a variety of social settings (sports activities, art class, lunch) that are typical of elementary school, neighborhood, and after-school settings. Children received each behavioral condition for 3 weeks, order counterbalanced across groups. Children concurrently received in random order placebo, 0.15 mg/kg/dose, 0.3 mg/kg/dose, or 0.6 mg/kg/dose MPH, 3 times daily with dose manipulated on a daily basis in random order for each child. Both behavioral and medication treatments produced highly significant and positive effects on children's behavior. The treatment modalities also interacted significantly. Whereas there was a linear dose-response curve for medication in NBM, the dose-response curves flattened considerably in LBM and HBM. Behavior modification produced effects as large as moderate doses, and on some measures, high doses of medication. These results replicate and extend to social-recreational settings previously reported results in a classroom setting from the same sample (Fabiano et al., School Psychology Review, 36, 195-216, 2007). Results illustrate the importance of taking dosage/intensity into account when evaluating combined treatments; there were no benefits of combined treatments when the dosage of either treatment was high but combination of the low-dose treatments produced substantial incremental improvement over unimodal treatment.

A comparison of behavioral parent training programs for fathers of children with attention-deficit/hyperactivity disorder

Few behavioral parent training (BPT) treatment studies for attention-deficit/hyperactivity disorder (ADHD) have included and measured outcomes with fathers. In this study, fathers were randomly assigned to attend a standard BPT program or the Coaching Our Acting-Out Children: Heightening Essential Skills (COACHES) program. The COACHES program included BPT plus sports skills training for the children and parent-child interactions in the context of a soccer game. Groups did not differ at baseline, and father ratings of treatment outcome indicated improvement at posttreatment for both groups on measures of child behavior. There was no significant difference between groups on ADHD-related measures of child outcome. However, at posttreatment, fathers who participated in the COACHES program rated children as more improved, and they were significantly more engaged in the treatment process (e.g., greater attendance and arrival on time at sessions, more homework completion, greater consumer satisfaction). The implications for these findings and father-related treatment efforts are discussed.