, Volume 3, Issue 1, pp 82-93
Date: 24 Jan 2013

Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students

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This study examined the effectiveness of two transtheoretical model-tailored, computer-delivered interventions designed to impact multiple substance use or energy balance behaviors in a middle school population recruited in schools. Twenty middle schools in Rhode Island including sixth grade students (N = 4,158) were stratified and randomly assigned by school to either a substance use prevention (decreasing smoking and alcohol) or an energy balance (increasing physical activity, fruit and vegetable consumption, and limiting TV time) intervention group in 2007. Each intervention involved five in-class contacts over a 3-year period with assessments at 12, 24, and 36 months. Main outcomes were analyzed using random effects modeling. In the full energy balance group and in subsamples at risk and not at risk at baseline, strong effects were found for physical activity, healthy diet, and reducing TV time, for both categorical and continuous outcomes. Despite no direct treatment, the energy balance group also showed significantly lower smoking and alcohol use over time than the substance use prevention group. The energy balance intervention demonstrated strong effects across all behaviors over 3 years among middle school students. The substance use prevention intervention was less effective than the energy balance intervention in preventing both smoking and alcohol use over 3 years in middle school students. The lack of a true control group and unrepresented secular trends suggest the need for further study.


Practice: The computer-tailored interactive interventions for increasing exercise, improving diet and reducing TV time can be easily disseminated to a general population of middle school students. The interventions can both increase the acquisition of desired behaviors for students not at criteria and prevent relapse for those students currently at criteria.
Policy: Resources should be directed to the further development, evaluation, and dissemination of computer-based lifestyle (physical activity, nutrition, decreased television time) interventions.
Research: Further investigation of computer-tailored interventions for smoking and alcohol interventions is needed, including improving the content of the interventions, determining optimal age for initiation of the interventions, and determining the number and timing of the contacts.