Stephen Lepore | Temple University (original) (raw)

Papers by Stephen Lepore

American Journal of Public Health, Mar 1, 2022

Objectives. To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel interv... more Objectives. To test the efficacy of Babies Living Safe and Smokefree (BLiSS), a multilevel intervention initiated in a citywide safety net health system to improve low-income maternal smokers’ abstinence and reduce child tobacco smoke exposure.Methods. This randomized controlled trial in Philadelphia, Pennsylvania (2015–2020), recruited low-income maternal smokers who received a brief smoking intervention (Ask, Advise, Refer [AAR]) from nutrition professionals in the Special Supplemental Nutrition Program for Women, Infants, and Children before randomization to (1) a multilevel intervention (AAR + multimodal behavioral intervention [MBI]; n = 199) or (2) an attention control intervention (AAR + control; n = 197).Results. AAR + MBI mothers had significantly higher 12-month bioverified abstinence rates than did AAR + control mothers (odds ratio [OR] = 9.55; 95% confidence interval [CI] = 1.54, 59.30; P = .015). There were significant effects of time (b = −0.15; SE = 0.04; P < .001) and condition by time (b = −0.19; SE = 0.06; P < .001) on reported child exposure favoring AAR + MBI, but no group difference in child cotinine. Presence of other residential smokers was related to higher exposure. Higher baseline nicotine dependence was related to higher child exposure and lower abstinence likelihood at follow-up.Conclusions. The multilevel BLiSS intervention was acceptable and efficacious in a population that experiences elevated challenges with cessation.Public Health Implications. BLiSS is a translatable intervention model that can successfully improve efforts to address the persistent tobacco-related burdens in low-income communities.Trial Registration. Clinical Trials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT02602288","term_id":"NCT02602288"}}NCT02602288. (Am J Public Health. 2022;112(3):472–481. https://doi.org/10.2105/AJPH.2021.306601)

BMC Public Health, Mar 14, 2017

Background: Addressing children's tobacco smoke exposure (TSE) remains a public health priority. ... more Background: Addressing children's tobacco smoke exposure (TSE) remains a public health priority. However, there is low uptake and ineffectiveness of treatment, particularly in low-income populations that face numerous challenges to smoking behavior change. A multilevel intervention combining system-level health messaging and advice about TSE delivered at community clinics that disseminate the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), combined with nicotine replacement and intensive multimodal, individual-level behavioral intervention may improve TSE control efforts in such high-risk populations. Methods/Design: This trial uses a randomized two-group design with three measurement points: baseline, 3-month and 12-month follow-up. The primary outcome is bioverified child TSE; the secondary outcome is bioverified maternal quit status. Smoking mothers of children less than 6 years old are recruited from WIC clinics. All participants receive WIC system-level intervention based on the "Ask, Advise, Refer (AAR)" best practices guidelines for pediatrics clinics. It includes training all WIC staff about the importance of maternal tobacco control; and detailing clinics with AAR intervention prompts in routine work flow to remind WIC nutrition counselors to ask all mothers about child TSE, advise about TSE harms and benefits of protection, and refer smokers to cessation services. After receiving the system intervention, mothers are randomized to receive 3 months of additional treatment or an attention control intervention: (1) The multimodal behavioral intervention (MBI) treatment includes telephone counseling sessions about child TSE reduction and smoking cessation, provision of nicotine replacement therapy, a mobile app to support cessation efforts, and multimedia text messages about TSE and smoking cessation; (2) The attention control intervention offers equivalent contact as the MBI and includes nutrition-focused telephone counseling, mobile app, and multimedia text messages about improving nutrition. The control condition also receives a referral to the state smoking cessation quitline. Discussion: This study tests an innovative community-based, multilevel and integrated multimodal approach to reducing child TSE in a vulnerable, low-income population. The approach is sustainable and has potential for wide reach because WIC can integrate the tobacco intervention prompts into routine workflow and refer smokers to free evidence-based behavioral counseling interventions, such as state quitlines. Trial registration: Clinicaltrials.gov NCT02602288. Registered 9 November 2015.

Tobacco Prevention & Cessation

INTRODUCTION Secondhand smoke (SHS) exposure creates health risks for nonsmokers and is especiall... more INTRODUCTION Secondhand smoke (SHS) exposure creates health risks for nonsmokers and is especially detrimental to children. This study evaluated whether immediate feedback in response to poor indoor air quality in children's bedrooms can reduce the potential for SHS exposure, as measured by adherence to a World Health Organization (WHO) indoor air standard. METHODS Homes that contained children and an adult who regularly smoked inside (n=298) had an air particle monitor installed in the child's bedroom. These devices measured the concentration of particulate matter (PM2.5) for approximately three months and, for half of the participants, immediately provided aversive feedback in response to elevated PM2.5. Hierarchical linear models were fit to the data to assess whether the intervention increased the probability that: 1) a given day was below the WHO guideline for daily exposure, and 2) a household established and maintained a smoke-free home (SFH), operationalized as achieving 30 consecutive days below the WHO guideline. The intervention's impact was calculated as groupby-time effects. RESULTS The likelihood that a child's bedroom met the WHO indoor air quality standard on a given day increased such that the baseline versus post-baseline odds ratio (OR) of maintaining indoor PM2.5 levels below the WHO guideline was 2.38 times larger for participants who received the intervention. Similarly, the baseline versus post-baseline OR associated with achieving an SFH was 3.49 times larger for participants in the intervention group. CONCLUSIONS The real-time intervention successfully drove clinically meaningful changes in smoking behavior that mitigated indoor PM2.5 levels in children's bedrooms and thereby reduced SHS exposure. These results demonstrate the effectiveness of targeting sensitive microenvironments by giving caregivers actionable information about children's SHS risks. Future extensions should examine additional microenvironments and focus on identifying the potential for SHS exposure before it occurs.

The European health psychologist, 2015

Introduction: Addressing child secondhand tobacco smoke (SHS) exposure is a public health priorit... more Introduction: Addressing child secondhand tobacco smoke (SHS) exposure is a public health priority (WHO). Our trial tests a multilevel intervention linking brief pediatric provider advice with individualized telebased counseling for parents focused on SHSe protections and smoking cessation. Methods: We modified pediatrics systems’ electronic assessments and trained providers throughout Philadelphia, PA, USA to educate smoking parents about SHS harms and the health benefits of protecting children from SHS. These providers referred parents to the trial. Parents are randomized to either 12 weeks of telebased smoking counseling or an attention control condition focused on nutrition education. Results: We have received >2900 referrals, enrolling over 300 parents (~90% retention). Over 80% of participants are women and African American, and over 75% are below the poverty line. Results suggest that relative to controls, the multilevel group: a) was less likely to smoke around their chil...

Pediatrics, 2018

BACKGROUND: In this study, we investigated trends in cannabis use among parents with children at ... more BACKGROUND: In this study, we investigated trends in cannabis use among parents with children at home in the United States and estimated changes in prevalence of any cannabis use and daily cannabis use among parents who identified as cigarette smokers and nonsmokers with children in the home from 2002 to 2015. METHODS: The National Survey on Drug Use and Health is an annual, nationally representative, cross-sectional study conducted in the United States. Using logistic regression models, associations between cigarette smoking and any past-month and daily past-month cannabis use among parents with children in the home from 2002 to 2015 were estimated. Moderation of these associations by demographics and trends over time was examined. RESULTS: Past-month cannabis use among parents with children in the home increased from 4.9% in 2002 to 6.8% in 2015, whereas cigarette smoking declined from 27.6% to 20.2%. Cannabis use increased from 11.0% in 2002 to 17.4% in 2015 among cigarette-smoki...

Journal of Clinical Oncology, Dec 20, 2014

Internet support group (ISG) members benefit from receiving social support and, according to the ... more Internet support group (ISG) members benefit from receiving social support and, according to the helper therapy principle, by providing support to others. To test the mental health benefits of providing support to others, this trial compared the efficacy of a standard ISG (S-ISG) and an enhanced prosocial ISG (P-ISG). Methods A two-armed randomized controlled trial with 1-month pretest and post-test assessments was conducted with women (N ϭ 184) diagnosed in the past 36 months with nonmetastatic breast cancer who reported elevated anxiety or depression. Women were randomly assigned to either the S-ISG or P-ISG condition. Both conditions included six professionally facilitated live chat sessions (90-minute weekly sessions) and access to an asynchronous discussion board; P-ISG also included structured opportunities to help and encourage others. Results Relative to the S-ISG, participants in the P-ISG condition exhibited more supportive behaviors (emotional, informational, and companionate support), posted more messages that were otherfocused and fewer that were self-focused, and expressed less negative emotion (P Ͻ .05). Relative to the S-ISG, participants in the P-ISG condition had a higher level of depression and anxiety symptoms after the intervention (P Ͻ .05). Conclusion Despite the successful manipulation of supportive behaviors, the P-ISG did not produce better mental health outcomes in distressed survivors of breast cancer relative to an S-ISG. The prosocial manipulation may have inadvertently constrained women from expressing their needs openly, and thus, they may not have had their needs fully met in the group. Helping others may not be beneficial as a treatment for distressed survivors of breast cancer.

Translational Behavioral Medicine

Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing ch... more Tobacco smoke exposure (TSE) adversely affects child health. Intervention research on reducing childhood TSE and uptake of evidence-based smoking cessation programs has had limited reach in high-risk communities. Intervening in clinics delivering the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) could address overlapping public health priorities essential for healthy child development—nutrition and smoke-free environments. The Babies Living Safe and Smokefree (BLiSS) trial addresses existing gaps by implementing and evaluating a WIC in-clinic evidence-based training based on Ask, Advise, and Refer (AAR) guidelines. WIC nutrition staff (n = 67) completed surveys pre- and post-training as part of the larger BLiSS trial. Staff sociodemographic data, knowledge, and attitudes about maternal smoking and child TSE prevention, and AAR practices in clinic were collected using self-administered surveys. Pre–post outcomes were assessed using bivariate statistics...

International Journal of Environmental Research and Public Health

Background: During quit attempts, smokers must overcome smoking urges triggered by environmental ... more Background: During quit attempts, smokers must overcome smoking urges triggered by environmental cues and nicotine withdrawal symptoms. This study investigates the psychometric properties of the 12-item Tobacco Urge Management Scale (TUMS), a new measure of smoking urge management behaviors. Methods: We analyzed secondary data (n = 327) from a behavioral smoking cessation intervention trial, Kids Safe and Smokefree (KiSS). Results: Confirmatory factor analysis of the TUMS indicated that a one-factor model and a correlated two-factor model had similar model fit indices, and a Chi-square difference test supported the one-factor model. Further study of the parsimonious one-factor scale provided evidence of reliability and construct validity. Known group validity was evidenced by significantly higher TUMS scores in the KiSS intervention arm receiving urge management skills training than in the control arm (p < 0.001). Concurrent validity was evidenced by TUMS’s inverse association wi...

Journal of Cancer Survivorship, 2014

Purpose-The term cancer survivor can refer to individuals from diagnosis through the rest of thei... more Purpose-The term cancer survivor can refer to individuals from diagnosis through the rest of their life. However, not all people with cancer identify as a survivor, and underlying factors and correlates are yet to be well-explored empirically. Methods-Study 1 surveyed men in a prostate cancer peer support network (n=514), exploring psychosocial variables related to adopting a survivor identity. Study 2 interviewed 160 women with breast cancer in an online support group and collected observational data, assessing how survivor identity relates to perceptions of and participation in online support groups. Results-For men, survivor identity (35 %) was related to lower levels of threat appraisal (p=. 000), more deliberate rumination (p=.042), gaining greater understanding of cancer experience through peers (p=.041) and a higher, though marginally significant, level of posttraumatic growth (p=.052). Women adopting a survivor identity (50 %) had higher rates of online support group

Lepore, S. J., & Revenson, T. A. (2006). Resilience & posttraumatic growth: Recov... more Lepore, S. J., & Revenson, T. A. (2006). Resilience & posttraumatic growth: Recovery, resistance, & reconfiguration. In L. G. Calhoun & R. G. Tedeschi (Eds.), Handbook of Posttraumatic Growth: Research and Practices, (pp. 24-46). Mahwah, NJ: Lawrence Erlbaum Associates, Inc., Publishers.

Cancer Nursing, 2017

Approximately 20% of men with a diagnosis of prostate cancer present with locally advanced or adv... more Approximately 20% of men with a diagnosis of prostate cancer present with locally advanced or advanced disease. Few studies consider longer-term impact of disease progression and treatment adverse effects on health-related quality of life (QoL) of these men. Describe changes in health-related QoL over 5 years for men with newly diagnosed locally advanced or advanced prostate cancer. Eighty-one men with locally advanced or advanced prostate cancer referred to the study by their treating urologist completed a self-administered questionnaire assessing distress, cancer-specific distress, decision regret, satisfaction with life, and global and disease-specific health-related QoL. Questionnaires were administered close to diagnosis (baseline), 2, 6, 12, 24, 36, 48, and 60 months' follow-up. Men were of mean age 68.3 (SD, 7.9) years and at mean of 31.9 (SD, 50.5) days postdiagnosis. The most common treatment received was androgen deprivation therapy (95.1%) or radiation therapy (79%). The proportion of men classified as distressed (Distress Thermometer) ranged from 46.3% (baseline) to 32.6% (60 months). Decrements in physical QoL were found at 2, 6, 12, 24, 36, and 48 months compared with baseline. Life satisfaction ratings were lower at 6 months compared with baseline. Sexual concerns were consistently high across the 5 years (Expanded Prostate Cancer Index Composite <30). In the context of advanced disease, results indicate that health-related QoL fluctuates from diagnosis to 5 years later. A substantial proportion remained distressed at 5-year follow-up. Care frameworks supporting ongoing assessment of health-related QoL concerns of men with advanced prostate cancer are needed with a particular focus on sexual adjustment.

Journal of Youth and Adolescence, 2016

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, Dec 17, 2016

To examine the extent to which mindfulness skills influence psychological distress and health-rel... more To examine the extent to which mindfulness skills influence psychological distress and health-related quality of life (HRQOL) in men with metastatic or castration-resistant biochemical progression of prostate cancer. A cross-sectional survey of 190 men (46 % response; mean age 71 years, SD = 8.7, range 40-91 years) with advanced prostate cancer, assessed psychological and cancer-specific distress, HRQOL. Mindfulness skills were assessed as potential predictors of adjustment outcomes. Overall, 39 % of men reported high psychological distress. One third had accessed psychological support previously although only 10 % were under current psychological care. One quarter had accessed a prostate cancer support group in the past six months. Higher HRQOL and lower cancer-specific and global psychological distress were related to non-judging of inner experience (p < 0.001). Higher HRQOL and lower psychological distress were related to acting with awareness (p < 0.001). Lower distress wa...

Patient Education and Counseling, 2016

This study investigates whether applying educational testing approaches to an informed consent vi... more This study investigates whether applying educational testing approaches to an informed consent video for a medical procedure can lead to greater recall of the information presented. Undergraduate students (n=120) were randomly assigned to watch a 20-min video on informed consent under one of three conditions: 1) tested using multiple-choice knowledge questions and provided with feedback on their answers after each 5-min segment; 2) tested with multiple choice knowledge questions but not provided feedback after each segment; or 3) watched the video without knowledge testing. Participants who were tested and provided feedback had significantly greater information recall compared to those who were tested but not provided feedback and to those not tested. The effect of condition was stronger for moderately difficult questions versus easy questions. Inserting knowledge tests and providing feedback about the responses at timed intervals in videos can be effective in improving recall of information. Providing informed consent information through a video not only standardizes the material, but using testing with feedback inserted within the video has the potential to increase recall and retention of this material.

Endocrine Practice, 2016

Objective-The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of ear... more Objective-The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy. Methods-We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed. Results-Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance. Conclusion-With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient's clinical status.

Coping with Chronic Stress, 1997

The social environment can facilitate or hamper one’s ability to cope with chronic stressors, but... more The social environment can facilitate or hamper one’s ability to cope with chronic stressors, but it can also be a direct source of chronic stress. This chapter examines three ways in which the social environment is implicated in chronic stress processes. First, it describes the variety of social sources of chronic stress. Second, it shows how the social environment can moderate, or alter, the impact of chronic stressors by mitigating or exacerbating people’s responses to them. Finally, it illustrates how enduring and undesirable changes in the social environment, which often result from stressful life events, can mediate, or explain, the effects of major life events on health and well-being.

Women & health, Jan 23, 2015

This study evaluated the psychometric properties of the Greek version of the Social Constraints S... more This study evaluated the psychometric properties of the Greek version of the Social Constraints Scale, developed in English by Lepore and Ituarte (1999). The scale was culturally adapted in Greek and was then administered, along with measures of psychological distress and intrusions, to a sample of 202 women with breast cancer, recruited from July 2012 to October 2013. Although the scale has usually been treated as a unidimensional measure, exploratory factor analysis revealed three underlying factors in the Greek Social Constraints Scale: unsupportive behaviors, avoidant behaviors, and suggestions for pretense and distraction. The three-factor solution explained 55% of the total variance. Subscale reliability was satisfactory,(Cronbach's alpha coefficients ranging from 0.77 to 0.88). All subscales were significantly related to intrusions and psychological distress. Thus, the Greek-Social Constraints Scale is a reliable and valid multidimensional instrument. The results of the p...