Computeen: A Randomized Trial of a Preventive Computer and Psychosocial Skills Curriculum for At-Risk Adolescents

Computeen, a preventive technology and psychosocial skills development program for at-risk adolescents, was designed to improve computer skills, self-esteem, and school attitudes, and reduce behavior problems, by combining elements of community-based and empirically supported prevention programs. Fifty-five mostly Latino adolescents from 12 to 16 years old who were living in affordable housing communities participated in this randomized wait-list control study. Results showed considerable improvements in computer self-efficacy, decreases in internalizing behavior problems, and excellent attendance and consumer satisfaction. Self-esteem and school motivation results were mixed. Computer self-efficacy mediated the relationship between improved computer skills and self-esteem. Younger adolescents showed greater improvement than did older adolescents. Editors’ Strategic Implications: Although there are limitations to this study’s sample size and scope, Computeen appears promising as a developmentally appropriate, strengths-based prevention program.     

Treatment of morbid obesity in low-income adolescents: effects of parental self-monitoring

OBJECTIVE: This study examined the extent to which consistency of self-monitoring by participants and their parents was related to weight control over an initial period of 3 months within the context of a treatment program for morbidly obese low-income minority adolescents. RESEARCH METHODS AND PROCEDURES: Eighty-three obese adolescents (mean age, 13.0 years; 51% boys; 92% African American; mean BMI, 43.0 kg/m2; mean BMI z-score, 6.0) and at least one parent participated in a long-term treatment program that included a very-low-fat dietary focus, weekly group cognitive-behavior therapy, monthly nutrition education classes, a 12-week physical therapy class, and medical monitoring. RESULTS: Participants who self-monitored on the majority of days compared with those who did not self-monitor at all or who self-monitored infrequently attended more sessions and generally lost more weight over the first 3 months. Although parents signed behavioral contracts committing to self-monitor their own eating and exercising over the first month, only 12% did so. Nonetheless, participants whose parents self-monitored were much more likely to self-monitor consistently and lose weight during the first 3 months. DISCUSSION: These results indicate that self-monitoring is a cornerstone of successful weight control even for morbidly obese low-income minority adolescents; targeting consistency of self-monitoring among these high-risk weight controllers and their parents should be just as important as it is for more affluent and less overweight adolescents.     

Evaluating a Psychosocial Competence Program for Urban Adolescents

This study evaluated a primary prevention program called Going for the Goal [GOAL], designed by Danish and colleagues to teach life skills to at-risk urban adolescents. The 10-week program was administered to 350 middle school students by 55 trained high school leaders in a predominantly Hispanic school district. The program focused on setting positive, reachable goals, anticipating and responding to barriers to goal attainment, using social support, and building on one's strengths. Participants were randomly assigned to treatment or waiting-list control group conditions. Results demonstrated gains in knowledge of the skills being taught as well as attainment of goals set during the program. Leaders also showed an increase in their knowledge of life skills. The approach maximized both community resources and ecological validity while giving high school leaders the chance to benefit in their role as helpers.     

The Efficacy of an Intimate Partner Violence Prevention Program with High-Risk Adolescent Girls: A Preliminary Test

This study examined the efficacy of a brief (four session) intimate partner violence (IPV) prevention program (Building a Lasting Love, Langhinrichsen-Rohling et al. 2005) that was designed to reduce the relationship violence of predominantly African American inner-city adolescent girls (n?=?72) who were receiving teen pregnancy services. These high-risk girls were randomly assigned to the prevention program (n?=?39) or waitlist control (n?=?33) conditions. Implementation fidelity was documented. As predicted, girls who successfully completed the program (n?=?24) reported significant reductions in their perpetration of psychological abuse toward their baby??s father as compared to the control (n?=?23) participants. They also reported experiencing significantly less severe IPV victimization over the course of the program. Preliminary analyses indicated that avoidant attachment to one??s partner may be associated with less program-related change. These findings support the contention that brief IPV prevention programs can be targeted to selected groups of high-risk adolescents.     

Effects of an Occupation-Based Obesity Prevention Program for Children at Risk

ABSTRACT

Since the prevalence of obesity-related medical conditions in children and adolescents has increased over the past several years obesity prevention has become a vital need for our society and a focus of our professional practice. The primary aim of this pilot study was to increase children's experiences with physical activity and healthy foods to promote self-efficacy related to a healthy lifestyle. Using a pre- and posttest design, the Healthy Choices for Me program was evaluated for its efficacy. Intervention consisted of a 12-week after-school program implemented by occupational therapy students. Elementary-aged children from two lower social economic schools in an urban area participated in the program. Results demonstrated positive changes in food behavior, food self-efficacy, and vegetable consumption for the participants.     

Age and Sexual Orientation Moderated the Effects of a Bystander-Focused Interpersonal Violence Prevention Program for High School Students

The objective of the current paper was to identify moderating factors of a bystander-focused violence prevention program for adolescents, Bringing in the Bystander—High School Curriculum. Participants were 2,403 high school students from 25 schools in northern New England (M age?=?15.8 years; 50.9% female; 85.1% White, 84.5% heterosexual) who participated in a cluster-randomized controlled trial. We examined impact among different social groups (i.e., by race, gender, age, poverty, sexual orientation) using moderation analyses. The intervention effects for the past 12-month sexual harassment and stalking perpetration were stronger for younger participants and heterosexual participants; poverty, race, and gender did not moderate any program effects. Findings indicate that future prevention research should consider additional targets for older adolescents that may improve intervention program efficacy. An urgent need exists for interventions that are effective for sexual minority adolescents.

     

A Randomized Controlled Trial of an Online Relapse Prevention Program for Adolescents in Substance Abuse Treatment

Background

An Internet-based relapse prevention supplement to adolescent substance abuse treatment programming is a promising modality to reinforce treatment gains and enhance recovery; however, an evidence base is lacking.

Objective

To assess the efficacy of the online Navigating my Journey (NmJ) program.

Methods

129 adolescent-aged participants (ages 13–23) receiving substance abuse treatment participated in a randomized parallel group study comparing two conditions: experimental (NmJ) versus attention control (viewed wellness articles from the Nemours Foundation at their discretion). Participants in the experimental condition were asked to complete 12 core lessons over 3 months. Lesson content was developed to teach evidence-based relapse prevention skills. Data were collected at four time points: baseline, 1-month follow up, 3-month follow up, and 6-month follow up.

Results

We used a linear mixed modeling approach to test for differences between conditions on each outcome. Participants in the experimental condition reported a significantly greater increase in motivation to reduce or not misuse drugs from baseline to 3-month follow up and from baseline to 6-month follow up, compared to the control participants. Participants in the experimental condition also reported a greater decrease in drug use score from baseline to 3-month follow up, compared to the control participants. An analysis of age as a potential moderator suggested that the intervention may be more effective for older adolescents. Greater use of the program was associated with greater self-efficacy and lower self-reported substance use over time.

Conclusions

Relapse prevention treatment with adolescents may be facilitated by theory-based online interventions.

ClinicalTrials.gov Identifier

NCT02125539.

     

A Controlled Trial of Web-Based Feedback for Heavy Drinking College Students

Abstract Objective: Alcohol consumption has been a growing concern at U.S. colleges, particularly among first-year students, who are at increased risk for problems. This study tested the efficacy of the “electronic Check-Up to Go” (e-CHUG), a commercially-available internet program, at reducing drinking among a group of at-risk college freshman. Method: The design was a randomized controlled trial: 106 freshmen students who reported heavy episodic drinking were randomly assigned to receive feedback or to assessment only. Assessment measures were completed at baseline, 8 weeks, and 16 weeks. Results: At 8 weeks, the feedback group showed a significant decrease in drinks per week and peak BAC over control. By 16 weeks, the control group also declined to a point where there were no differences between groups. Changes in normative drinking estimates mediated the effect of the intervention. An additional 245 abstainers and light drinkers who were also randomized to condition did not show any intervention effect. Conclusions: This study provides preliminary support for the efficacy of this intervention at reducing short-term drinking among at-risk students.     

School-based drug prevention among at-risk adolescents: effects of ALERT plus.

In a recent randomized field trial, Ellickson et al. found the Project ALERT drug prevention curriculum curbed alcohol misuse and tobacco and marijuana use among eighth-grade adolescents. This article reports effects among ninth-grade at-risk adolescents. Comparisons between at-risk girls in ALERT Plus schools (basic curriculum extended to ninth grade with five booster lessons) and at-risk girls in control schools showed the program curbed weekly alcohol and marijuana use, at-risk drinking, alcohol use resulting in negative consequences, and attitudinal and perceptual factors conducive to drug use. Program-induced changes in perceived social influences, one's ability to resist those influences, and beliefs about the consequences of drug use mediated the ALERT Plus effects on drug use. No significant effects emerged for at-risk boys or at-risk adolescents in schools where the basic ALERT curriculum (covering seventh and eighth grades only) was delivered. Possible reasons for gender differences and implications for prevention programming are discussed.     

Sex in the Context of Substance Use: A Study of Perceived Benefits and Risks,Boundaries, and Behaviors among Adolescents Participating in an Internet-Based Intervention

Little research has examined adolescents’ perspectives of sex with substance use. This study examined (1) adolescents’ perceived benefits and risks of sex with substance use, as well as boundaries; (2) the potential for positive and negative social influences among adolescents when they discuss these topics; and (3) whether exposure to health-promoting content is associated with trajectories of sex with substance use over a 6-month period. To address the first two objectives, 176 comments were analyzed from 71 adolescents (90% female) aged 14–18 years who participated in an Internet-based sexual health promotion intervention and posted to at least one message board addressing sex with substance use. Adolescents’ perceived benefits and risks of sex with substance use primarily reflected concern for the experience of sex in the moment; perceived risks and boundaries primarily reflected concern for the ability to develop and maintain meaningful relationships. Comments of 63% and 22% of adolescents, respectively, were evaluated to have potential for health-promoting and risk-promoting social influence. To address the third objective, trajectories of self-reported sex with substance use were compared between 89 intervention and 54 control participants. No significant differences were observed. However, a dose–response effect was observed; intervention participants who completed less than one third of assigned tasks reported increases in sex with alcohol or marijuana use over time, while no marked changes or much smaller changes in sex with substance use were observed among intervention participants who completed one third or more tasks. Implications for prevention and intervention programs are discussed.

     

Reductions in HIV Risk Among Runaway Youth

Runaway youth are 6–12 times more likely to become infected with HIV than other youth. Using a quasi-experimental design, the efficacy of an HIV prevention program was evaluated over 2 years among 2 groups of runaways: (1) those at 2 shelters who received Street Smart, an intensive HIV intervention program, and (2) youth at 2 control shelters. Street Smart provided youth with access to health care and condoms and delivered a 10-session skill-focused prevention program based on social learning theory to youth. Prior to analysis of the intervention's outcomes, propensity scores were used to identify comparable subgroups of youth in the intervention (n = 101) and control conditions (n = 86). Compared to females in the control condition, females in the intervention condition significantly reduced their unprotected sexual acts at 2 years and alcohol use, marijuana use, and the number of drugs used over 12 months. Male adolescents in the intervention condition showed significant reductions in marijuana use over 6 months compared to control youth. Adolescent HIV prevention programs must proactively identify mechanisms for maintaining behavior change over the long-term, and innovative research designs are needed to allow examination of agency-level interventions.     

An evaluation of Safe Dates, an adolescent dating violence prevention program.

OBJECTIVES: This study assessed the effects of the Safe Dates program on the primary and secondary prevention of adolescent dating violence. METHODS: Fourteen schools were randomly allocated to treatment conditions. Eighty percent (n=1886) of the eighth and ninth graders in a rural county completed baseline questionnaires, and 1700 (90%) completed follow-up questionnaires. RESULTS: Treatment and control groups were comparable at baseline. In the full sample at follow-up, less psychological abuse, sexual violence, and violence perpetrated against the current dating partner were reported in treatment than in control schools. In a subsample of adolescents reporting no dating violence at baseline (a primary prevention subsample), there was less initiation of psychological abuse in treatment than in control schools. In a subsample of adolescents reporting dating violence at baseline (a secondary prevention subsample), there was less psychological abuse and sexual violence perpetration reported at follow-up in treatment than in control schools. Most program effects were explained by changes in dating violence norms, gender stereotyping, and awareness of services. CONCLUSIONS: The Safe Dates program shows promise for preventing dating violence among adolescents.     

When Should Programs for Teen Parents and Babies Begin? Longitudinal Evaluation of a Teen Parents and Babies Program

Confirmed child abuse and neglect rates were assessed for a group of 204 low-income, low-education adolescent mothers several years after identification of the teens either as low-risk or as high risk/low-support and eligible for 18 to 27 months of home-visitation by trained child development specialists. Three groups were studied: Low-risk Contrast Group, High-risk Program Graduates, and a Dropout Comparison Group—the last group being formed unintentionally when some participants dropped out of the high risk program. The major finding of this study is that acceptance of high-risk mothers into program prior to the infant's birth made a significant difference in preventing later child abuse/neglect. Child abuse/neglect rates and subsequent parity rates were not different between high-risk program graduates and low-risk contrast group members. Both of these groups differed significantly on these two rates with the Dropout Comparison Group. However, due to the unknown nature of this comparison group, more research is needed to understand this finding. Program costs were significantly lower than county foster care costs for children placed because of child abuse. Thus, prenatal initiation of program for high-risk pregnant adolescents may provide a cost-effective boost for family mental health and prevent child abuse and neglect by at-risk families.     

Effect of a Dissonance-Based Prevention Program on Risk for Eating Disorder Onset in the Context of Eating Disorder Risk Factors

Test (a) whether a dissonance-based eating disorder prevention program that reduces thin-ideal internalization mitigates the effects of risk factors for eating disorder onset and (b) whether the risk factors moderate the effects of this intervention on risk for eating disorder onset, to place the effects of this intervention within the context of established risk factors. Female adolescents (N = 481) with body image concerns were randomized to the dissonance-based program, healthy weight control program, expressive writing control condition, or assessment-only control condition. Denial of costs of pursuing the thin-ideal was the most potent risk factor for eating disorder onset during the 3-year follow-up (OR = 5.0). The dissonance program mitigated the effect of this risk factor. For participants who did not deny costs of pursuing the thin-ideal, emotional eating and externalizing symptoms increased risk for eating disorder onset. Negative affect attenuated the effects of each of the active interventions in this trial. Results imply that this brief prevention program offsets the risk conveyed by the most potent risk factor for eating disorder onset in this sample, implicate three vulnerability pathways to eating pathology involving thin-ideal pursuit, emotional eating, and externalizing symptoms, and suggest that negative affect mitigates the effects of eating disorder prevention programs.     

Testing the efficacy of an eating disorder prevention program.

OBJECTIVE: The efficacy of an eating disorder prevention program was tested in a group of preadolescent females. Improvements in self-esteem and eating behavior were predicted relative to a control group. METHOD: Two interventions lasting 5 weeks were designed and then administered to two groups of preadolescent females. Self-esteem, body esteem, dietary restraint, and eating pathology were measured before, immediately, and 6 months following an eating disorders prevention program (n = 16) and a similarly designed control program (n = 13) focusing on fruit and vegetable intake. RESULTS: Dietary restraint in both groups decreased following the interventions. Self-esteem improved in the experimental group, but this was only marginally significant. DISCUSSION: Eating disorder prevention programs may be most effective when targeted at older, more at-risk girls. However, encouraging healthy eating in both groups of preadolescent girls reduced dietary restraint, which may be an important step in the prevention of later eating disorders.     

Evaluation of an Online Relapse Prevention Program for Bipolar Disorder

Bipolar disorder is a chronic relapsing remitting illness affecting 1–2% of the general adult population. Awareness of the limitations of pharmacological treatment for this disorder has encouraged the development of psychological treatments and a large body of evidence now exists demonstrating the effectiveness of several types of psychosocial interventions in the treatment and prevention of relapse for bipolar disorder. Unfortunately, it is difficult for many individuals with bipolar disorder to access such programs due to financial constraints and restricted roll-out. One solution to this difficulty is to use Internet-based delivery of targeted psychoeducation, cognitive behavior management and online medication monitoring to improve relapse prevention for those with bipolar disorder.The focus of this article is to discuss the aims and methodology of this unique, collaborative randomized control trial that evaluates the effectiveness of an Internet-based disease management program (termed Recovery Road [RR]). The RR program incorporates both symptom monitoring with feedback, and targeted psychosocial treatment for adults with bipolar disorder delivered over a 12-month period. The overall aim was to determine whether this web-based adjunctive relapse prevention program can improve mental health outcomes. Upon successful enrolment, participants were automatically randomized into either the intervention (RR) or control group. The control group received some relevant information but did not include program components considered to be active parts of the experimental intervention.This article also describes a recruitment, enrolment and randomization process that maximizes the potential of the Internet for research and data collection purposes. At the time of writing full results were not yet available and, thus, were not reported in this article. Interim outcomes indicate that the online enrolment has been successful and participants are making full use of all online features of the active program included by the support facility. The difficulties with maintaining individuals on the control program are described and samples of typical anecdotal comments provided by participants to the research group via the support facility are presented.     

A community-based approach to preventing alcohol use among adolescents on an American Indian reservation.

This paper examines the effectiveness of a 5-year community-based health promotion program to reduce the rate of substance use, particularly alcohol, by adolescents on a Plains State American Indian reservation. The program was part of the Kaiser Family Foundation Community Health Promotion Grants Program. Since a reservation control group was not available, adolescents serving as control groups for other Community Health Promotion Grants Program communities, including a small sample of rural American Indians, were used as a basis for comparison. School-based surveys of 9th and 12th graders were carried out on the reservation and in five relevant California control communities--two suburban, three rural--in 1988, 1990, and 1992. The results showed that the use of both alcohol and marijuana declined substantially among American Indian adolescents living on the reservation. Binge drinking (five or more drinks on an occasion) declined from 46 percent to 30 percent, and marijuana use (in the past month) declined from 46 percent to 29 percent over the 4-year period. However, there were similar, if smaller, declines in alcohol use in the comparison groups. Since there was no evidence of a relative increase in exposure to alcohol and drug programs on the reservation, the authors are cautious in attributing the significant and heartening declines in substance use among adolescents on the reservation to the community-based program.     

Interpreting Outcomes: Using Focus Groups in Evaluation Research*

Although focus groups continue to gain popularity in marketing and social science research, their use in program evaluation has been limited. Here we demonstrate how focus groups can benefit evaluators, program staff, policy makers and administrators by providing an in‐depth understanding of program effectiveness from the perspective of participants as stakeholders in program outcomes. Using data from the Youth Action Program, a prevention program funded by the United States Air Force for military dependent adolescents at risk, our methodology included a narrative approach to data analysis, combining theme analysis with a systematic interpretive approach centering on how group members experienced the program within the contexts of their daily lives. We show that the parents benefited from the program beyond youth outcomes, and this was useful information for program improvement and expansion.