Rationale: Nicotine is the addictive component in cigarettes which maintains cigarette smoking that subsequently leads to morbidity and mortality. There are growing regulatory efforts to lower the nicotine content in cigarettes so that they are minimally addictive. Valid methods for assessing the abuse liability of cigarettes are essential to these efforts. While subjective effect measures and hypothetical purchase tasks are appealing because they are far easier to administer, it is unclear whether these methods can be used to evaluate acute relative reinforcing, a critical component of abuse liability. This secondary analysis sought to evaluate the utility of one subjective effects measure, the modified Cigarette Evaluation Questionnaire (mCEQ), and one hypothetical purchase task, the Cigarette Purchase Task (CPT), for predicting acute relative reinforcing efficacy as measured by concurrent choice Self-Administration (SA) Method: Current smokers (N=169) belonging to one of three vulnerable populations (socioeconomically disadvantaged women of childbearing age, opioid-maintained individuals, or individuals with affective disorders) participated in a multi-site, double blind study evaluating research cigarettes with varying levels of nicotine content (0.4, 2.4, 5.2, 15.8 mg/g). In Phase 1 (4 sessions, 1 research cigarette per session) participants completed the mCEQ and CPT following ad-lib smoking of the research cigarette. In Phase II (6 sessions) cigarette preference was assessed using two-dose concurrent choice tests. Difference scores were calculated for each of the five mCEQ subscales and five CPT indices for all six possible dose comparisons evaluated in Phase II. We evaluated the utility of the mCEQ subscale and CPT index difference scores for predicting preference for the higher dose in a given dose comparison using a mixed-model of repeated measures analysis of variance. Finally, we used stepwise regressions to determine which subscales and indices served as independent predictors of concurrent choice SA. Results: Among mCEQ subscales, higher Satisfaction and Enjoyment of Respiratory Tract Sensation were independently predictive of higher dose preference in the choice testing regardless of dose comparison. There was a significant Satisfaction X Vulnerable Population interaction where increases in Satisfaction difference scores corresponded to greater changes in higher dose preference among socioeconomically disadvantaged women of childbearing age compared to other Vulnerable Populations. Among CPT indices, Elasticity was the only independent predictor of choice. However, there was a significant Elasticity X Dose Comparison X Vulnerable Population interaction associated with its predictive utility where the relationship between elasticity and choice differed by dose among opioid-maintained individuals. In a final model, including all subscales and indices, Satisfaction and Enjoyment of Respiratory Tract Sensations remained the only significant predictors of choice. Discussion: Concurrent choice testing, subjective effects and hypothetical purchase tasks capture some common features of abuse liability. Concurrent choice testing and the Satisfaction subscale were the most concordant measures. The observation that CPT indices are not robust predictors of choice in a concurrent arrangement suggests this measure may have greater utility for capturing individual differences as opposed to isolating the acute relative reinforcing effects of nicotine. Nevertheless, all three measures can contribute to efforts to assess the abuse liability of cigarettes varying in nicotine dose and important work aimed at regulating these products to improve human health.

Indirect assessments are widely used to identify environmental factors that may be manipulated or integrated in the development of direct assessments and behavior interventions for individuals with developmental disabilities. To date, there are no indirect assessments that can be used to evaluate the extent to which children who engage in problem behavior wait to receive reinforcement. However, there are effective behavior interventions to increase waiting. A treatment package consisting of functional communication training (FCT) and schedule thinning (i.e., multiple schedules) has been identified as an effective intervention to increase waiting in children who engage in problem behavior maintained by social contingencies. Nonetheless, in studies in which a schedule thinning procedure has been used, the terminal waiting durations are typically selected arbitrarily. Therefore, we conducted three studies to evaluate the use of an indirect assessment to increase waiting within an FCT and schedule treatment package in children with developmental disabilities. The purpose of Study I was to develop the Waiting Assessment Interview Tool (WAIT) to obtain current waiting durations for subjects who engaged in problem behavior maintained by social contingencies. The purpose of Study II was to complete the WAIT with caregivers and behavior service providers and to compare their results to a latency functional analysis (FA) conducted with all children. Finally, the purpose of Study III was to use the WAIT completed by informants to systematically individualize the initial component durations used during the schedule thinning procedure. A second purpose was to use the informants’ preferred waiting times as final waiting targets for all subjects.

Children diagnosed with autism spectrum disorder (ASD) experience difficulties with social communication and restrictive, repetitive, and stereotyped behavior patterns that place them at an increased risk for developing challenging behaviors that warrant early intervention (American Psychiatric Association, 2013). These problems are unlikely to decrease without intervention. Research indicates that parents’ involvement in behaviorally based interventions improves the functioning of children with ASD (Horner, Carr, Strain, Todd, & Reid, 2002). . Parent-Child Interaction Therapy (Eyberg & Funderburk, 2011) is an empirically supported intervention for young children with disruptive behaviors. PCIT shares similarities with numerous proven ASD treatments including caregiver involvement, structure and predictable schedule, and the use of behavioral strategies (e.g., positive reinforcement, differential attention). As such, children with ASD are increasingly referred to PCIT. Researchers and clinicians have started to address the use of PCIT for targeting child compliance and social responsiveness in children with ASD. However, there is a need for research on the feasibility of PCIT for children with ASD and barriers to treatment participation for these families. The present study utilized a non-concurrent multiple baseline design with three parent-child dyads enrolled in PCIT to examine the degree of stability and immediacy of effect in caregivers parenting skill use and in patterns of challenging behaviors, ASD symptoms, and expressive communication exhibited by young children with ASD. Due to a significant attrition rate in the study, barriers to treatment participation were also examined. Findings suggested that PCIT improved children’s challenging behaviors and parent’s use of labeled praises.

Conduct problems describe behaviors that violate either age-appropriate societal norms or the rights of others. They include: physical or verbal aggression, theft, lying, arguing with authority, defiance, violation of rules, property destruction, fire setting, and truancy. Among youth with conduct problems, a subset display features known as callous-unemotional (CU) traits. CU traits, or interpersonal callousness, are exemplified in behaviors such as: (a) absence of remorse or guilt, (b) lack of empathy and, (c) callous use of others for personal gain (Frick & White, 2008). This study aims to fill the gap of examining these students in schools and which practices are currently being used to manage these students’ behaviors. Because students with callous unemotional traits are typically the students exhibiting the most extreme and aggressive forms of conduct problems, there is a need to discover effective ways to manage their behavior in order to maintain a safe and effective learning environment for all students. In this study, vignettes were used to make comparisons between youth with and without CU traits in the following areas: (RQ1) teachers’ attributive perceptions of conduct problems (i.e., Why do they think the child behaves this way?), (RQ2) teachers’ self-efficacy in addressing conduct problems in the classroom, (RQ3) the most appropriate educational setting for students with conduct problems, (RQ4) the type of behavior management strategies believed to be most effective, and (RQ5) the expected trajectory of the student. Teachers were most likely to attribute problem behavior of all students to home and within child factors but they were somewhat more likely to attribute home factors to the students with CU traits. Teachers additionally feel overall less efficacious in working with students with CU traits, had lower expectations of success, and were more likely to recommend ongoing home-school collaboration. Participants in this study showed overwhelming support for the fact that reinforcing interventions are more effective than punitive interventions and knowledge of a wide range of interventions. The discussion describes suggestions for future training to increase teacher competency in working with students with conduct problems in the general education setting.

This study evaluated Social StoriesTM (SS) with three at-risk preschool children in a high- need public elementary school. Specifically, this study examined the use of a multimedia SS designed to decrease problem behavior and increase prosocial behavior. A multiple baseline design across participants with an ABC sequence was used to assess the impact of the standard SS and multimedia SS on the children's target behaviors. The results of the study indicated that the standard SS was successful in reducing problem behavior and increasing prosocial behavior for all three participating children. The results also indicated that the multimedia SS had positive effects on the children, further increasing prosocial behavior during intervention. Although the problem behavior did not further decrease when the multimedia SS was introduced, the low levels of problem behavior were maintained at a 3-week follow-up for all three children. All three children demonstrated maintenance of improved prosocial behavior during follow-up. Overall, the multimedia SS demonstrated high levels of social validity.

Adults with mental illnesses are at an increased risk to be diagnosed with one or more comorbid physical illnesses compared to the general population. Much of the disparities faced by adults with serious mental illnesses (SMI) can be attributed to medication side effects, increased risk for metabolic diseases, inability to communicate about severity and monitor physical health symptoms, poor health behaviors, high rates of smoking, and poor quality health care. The rate of physical illnesses for adults with mental illnesses are even higher among those who have been involved with the criminal justice system. In order to understand the relationship between physical and mental illnesses, longitudinal study designs are needed. Longitudinal studies can provide greater understanding of the temporal relationship of physical and mental illnesses. Despite the benefits of longitudinal studies, there also are challenges, including missing data. The first manuscript of this dissertation explores the physical and mental health status of adults with mental illnesses. Secondary data were used from three different studies: a sample of adults with SMI enrolled in a mental health court jail diversion program (n=91); a sample of Medicaid enrollees with SMI in Florida (n=688) who were part of a larger Substance Abuse and Mental Health Services Administration (SAMHSA) study; and a sample of inpatient and outpatient adults with SMI from five different study sites (n=969). The samples were combined into two data sets, consisting of the jail diversion sample and the SAMHSA sample, and the jail diversion sample and the 5-site sample. Participants in these samples answered questions on the Short-Form Health Survey (SF-12), recent arrests, drug and alcohol use, socio-demographic information, and mental illness symptom severity (measured only in the criminal justice and 5-site samples). Overall, the mental and physical health status scores were significantly lower for all of the participants compared to the general population mean scores. The participants reporting a recent arrest had a higher physical health score compared to those who did not have a recent arrest, and in the jail diversion and 5-site sample, had a lower mental health status score than those without a recent arrest. After taking age, drug and alcohol use, and psychiatric symptom severity into account, arrest was no longer associated with the physical health status score in either of the data sets. In the jail diversion and 5-site data set, arrest was still significantly associated with mental health status score after controlling for age, drug and alcohol use, and psychiatric symptom severity. The second manuscript of this dissertation explores the analysis of missing data in a longitudinal study to determine the missing data mechanisms and missing data patterns, and subsequently, how to prepare the data for analysis by using multiple imputation or maximum likelihood estimation. Secondary data were drawn from the same jail diversion sample as in the first manuscript. Data were collected at baseline, three months, six months, and nine months. Only participants with the potential to have data collected at these time points were included (n=50). Analysis revealed missing data due to missing item-level information, missing participant data at one time point but complete data at a subsequent time point, and missing participant data for those who dropped out of the study completely. The missing data mechanism for the missing item-level data were missing completely at random, whereas the participant-level missing data were missing at random. Multiple imputation was used for the item-level data and for the participant-level missing data. Maximum likelihood estimation was also used for the participant-level missing data and compared to the multiple imputation results. Findings suggest that multiple imputation produced more accurate parameter estimates, possibly due to the small sample size. The findings from this study indicate that more research needs to be done to fully understand the physical illnesses experienced by adults with mental illnesses who are involved with the criminal justice system. Understanding mental and physical illness comorbidity is important in public health as it dictates appropriate treatments and training for behavioral health practitioners and staff. In addition, missing data in longitudinal studies cannot be ignored, as it can bias the results, and appropriate techniques for exploring the missing data must be used. When missing data is ignored in analyses, the subsequent results can be incorrect and unable to detect treatment effects, thereby preventing effective programs from receiving necessary funding. In addition, ignoring missing data can impact funding for behavioral health services by underestimating the prevalence and severity of mental illnesses. Future research should focus on exploring how mental and physical health are related in adults with a recent arrest compared to the general population, and ways to integrate services to address both mental and physical health.

Parental participation in parent training programs is necessary for success in behavioral parent training. Prior literature has demonstrated probabilistic reinforcement as an effective intervention for improving a wide variety of behaviors. In the present study, a probabilistic reinforcement program (i.e., lottery) was implemented in order to evaluate its efficacy as part of a behavioral parent training program. The behaviors targeted for increase included attendance, participation, homework completion, and performing role-plays or completing in-class assignments for two 10 week Tools for Positive Behavior Change courses. Participants earned lottery tickets for each of the dependent measures, and drawings took place at the end of each class. An alternating treatments design was employed to determine any differences in performance on the dependent measures between baseline and lottery sessions. Results showed that participants attended and participated more with parent training under the conditions of a lottery compared to baseline class sessions although the effect was minimal; furthermore, this effect was observed more clearly for one of the two classes. Further research is needed to explore the effect of a lottery intervention on parent participation in parent training programs.

Binge alcohol consumption is a rising concern in the United States, especially among adolescents as during this developmental period alcohol use is usually initiated and has been shown to cause detrimental effects on brain structure and function. These findings have been established through the use of binge models in animals, where animals are repeatedly administered high doses of ethanol typically over a period of three or four days. While such work has examined the effects of a four-day and repeated three-day binge, there has been almost no work conducted aimed at investigating the long-term behavioral and neurochemical and/or functional consequences of repeated binge pattern administration during adolescence relative to adulthood on later ethanol-induced behavior and neurochemistry in adulthood. The present set of experiments aimed to examine the dose-response and age-related differences induced by repeated binge pattern ethanol administration during adolescence or adulthood on voluntary ethanol consumption (Aim 1), changes in ethanol metabolism following ethanol pretreatment (Aim 2) and mesolimbic dopamine functionality (Aim 3) in adulthood. In both experiments, adolescent and adult male rats were intragastrically administered ethanol (0.5, 1.0 or 2.0 g/kg/ig) or isovolumetric water on postnatal days (PND) 28-31, PND 35-38 and PND 42-45 for adolescent rats and PND 60-64, PND 67-70 and PND 74-77 for adult rats. In both experiments all rats underwent fourteen days of abstinence (PND 46-59 or PND 78-91, respectively). Subsequently, in Experiment 1, all rats underwent voluntary ethanol consumption procedures, in which animals were exposed to 10% ethanol combined with decreasing saccharin concentrations across days from PND 60-82 for adolescent-exposed rats and PND 92-114 for adult-exposed rats. Finally, on PND 83 and PND 115, respectively, all animals were challenged with 2.0 g/kg ethanol and trunk blood samples were collected at 60 and 240 minutes post-injection. Results indicate there was a significant increase in voluntary ethanol intake in adolescent ethanol-exposed rats pretreated with 2.0 g/kg relative to their adult ethanol-pretreated counterparts. Faster ethanol metabolism was observed in adolescent rats pretreated with 2.0 g/kg during adolescence relative to adolescent-exposed rats pretreated with 0.5 g/kg and adults pretreated with 2.0 g/kg. For Experiment 2, all rats underwent surgery (PND 60 for adolescent-exposed and PND 92 for adult-exposed rats). From PND 61-64 for adolescent-exposed and PND 93-96 for adult exposed rats, all animals underwent recovery from surgery. Finally, all rats underwent in vivo microdialysis on PND 65 for adolescent-exposed and PND 97 for adult-exposed rats, with K+ (100 mM) infused into the ventral tegmental area and accumbal dopamine overflow assessed in the nucleus accumbens septi. The results from Experiment 2 indicate lasting changes in mesolimbic dopamine functionality with a trend for decreased potassium-stimulated dopamine overflow in the nucleus accumbens septi in adolescent-ethanol pretreated rats and a trend for increased potassium-stimulated dopamine overflow in adult ethanol-pretreated rats. The results from the present set of experiments show the dose-dependent impact of binge-pattern ethanol exposure during adolescence on subsequent ethanol consumption and ethanol metabolism in adulthood. These findings indeed determine adolescence as a period of vulnerability to the long-term changes in ethanol consumption relative to similarly-exposed adult male rats. Importantly, the results of Experiment 2 indicate an alteration in the functionality of the mesolimbic pathway in adulthood following adolescent binge pattern ethanol exposure, which demonstrates a long-term depression in mesolimbic dopamine functionality following adolescent binge pattern ethanol exposure.

D-cycloserine (DCS), a partial agonist that acts on the N-methyl-D-aspartate (NMDA) receptor of the glutamatergic receptor complex, may enhance fear extinction learning during exposure-based therapy. Clinical studies in adults with obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders - and a recent trial in pediatric OCD - have shown that DCS can improve treatment response to exposure therapy relative to placebo and exposure therapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS and homework compliance in a 10-week, double-blind, placebo controlled DCS+CBT treatment trial with 30 children and adolescents with a primary diagnosis of OCD. D-cycloserine was dosed 25 or 50mg (depending on weight) one hour before therapy sessions 4-10. Group status (DCS or placebo) did not predict improved homework compliance over the course of treatment. However, significant group differences in homework compliance were found at the first exposure session. Additionally, homework compliance mediated the relationship between DCS and treatment outcome. When groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that outside the context of DCS, homework compliance is an integral part of OCD treatment.

Disparities in behavioral outcomes for minority students are a decades-old problem. Recently, the systems-level approach of school-wide positive behavior support (SW-PBS) and its growing research base have garnered attention as a possible remedy. Although SW-PBS has been shown to be effective in reducing a school's overall level of office discipline referrals (ODRs) and suspensions (OSS), and its success has been replicated in schools with large populations of minority students, effective outcomes across all groups of students within a school are not guaranteed. Some reports document increases in the magnitude of disproportionality even when ODRs and OSS decrease for the school as a whole. However, studies of SW-PBS and disproportionality have overlooked the role of implementation fidelity as a potential mediator of student outcomes, allowing for the possibility that schools that fail to experience a reduction in ODRs and OSS across all groups of students are those in which few elements of SW-PBS have been implemented. The present study contributed to the current research base by investigating whether schools which implement SW-PBS with higher levels of fidelity were more likely to have lower levels of disproportionate ODRs and OSS for African American and Hispanic students. Drawing from online databases which record schools' implementation and ODR information, this study provided detailed school-level descriptive analyses of ODRs and OSS for African American, Hispanic, and White students. Additionally, risk ratios for receiving an ODR and for receiving an OSS were calculated for African American and Hispanic students, and then compared to each school's reported level of SW-PBS implementation as measured by their Benchmarks of Quality score. The descriptive analyses and follow-up Chi-Square analyses revealed that there was no significant relationship between a school's level of implementation fidelity and their magnitude of disproportionality for these groups of students. Implications for professional development, record keeping, and measuring disproportionality in schools are discussed.