Abstract
This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents. A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up. A total of 479 students attending two public high schools participated. Participants receiving the intervention showed a significant reduction in quantity × frequency of alcohol use, and increases in fruit and vegetable consumption and frequency of relaxation activities, compared to those receiving the control, P’s = .01. No effects were found on cigarette and marijuana use, exercise and sleep. Effect sizes were small with alcohol use cessation effects reaching medium size. Intervention effects were mediated by changes in peer influenceability for alcohol use, and self-efficacy and self-image for health promoting behaviors. Findings suggest that the brief intervention resulted in health risk and promoting behavior improvements for adolescents, with outcomes mediated by several risk factors.
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Atkins, D., & Clancy, C. (2004). Multiple risk factors interventions: Are we up to the challenge? American Journal of Preventive Medicine, 27(2 Suppl), 102–103.
Bachman, J. G., Johnston, L. D., & O’Malley, P. M. (2008). Monitoring the Future: Questionnaire responses from the nation’s high school seniors, 2006. Ann Arbor, MI: Institute for Social Research.
Bandura, A. (1986). Social foundations of thought and action: a social cognitive theory. Englewood Cliffs, NJ: Prentice-Hall.
Centers for Disease Control and Prevention. (2008). Youth risk behavior surveillance—United States, 2007. MMWR. Morbidity and Mortality Weekly Report, 57(SS-4), 1–131.
Channing Bete Company. (1992). What everyone should know ABOUT WELLNESS [Brochure]. South Deerfield, MA: Channing Bete Company, Inc.
Chen, M. Y., Wang, E. K., Yang, R. J., & Liou, Y. M. (2003). Adolescent health promotion scale: Development and psychometric testing. Public Health Nursing, 20(2), 104–110.
Dunn, C., Deroo, L., & Rivara, F. P. (2001). The use of brief interventions adapted from motivational interviewing across behavioral domains: A systematic review. Addiction, 96(12), 1725–1742.
Eaton, D. K., Kann, L., Kinchen, S., Hawkins, J., Harris, W. A., Lowry, R., et al. (2006). Youth risk behavior surveillance—United States, 2005. Journal of School Health, 76(7), 353–372.
Fordwood, S. R., Asarnow, J. R., Huizar, D. P., & Reise, S. P. (2007). Suicide attempts among depressed adolescents in primary care. Journal of Clinical Child and Adolescent Psychology, 36(3), 392–404.
Godin, G., & Shephard, R. J. (1985). A simple method to assess exercise behavior in the community. Canadian Journal of Applied Sport Sciences, 10(3), 141–146.
Groeger, J. A., Zijlstra, F. R., & Dijk, D. J. (2004). Sleep quantity, sleep difficulties and their perceived consequences in a representative sample of some 2000 British adults. Journal of Sleep Research, 13(4), 359–371.
Heather, N. (2002). Effectiveness of brief interventions proved beyond reasonable doubt. Addiction, 97(3), 293–294.
Kaner, E. F., Beyer, F., Dickinson, H. O., Pienaar, E., Campbell, F., Schlesinger, C., et al. (2007). Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database of Systematic Reviews, 2, CD004148.
Key, T. J., Schatzkin, A., Willett, W. C., Allen, N. E., Spencer, E. A., & Travis, R. C. (2004). Diet, nutrition and the prevention of cancer. Public Health Nutrition, 7(1A), 187–200.
Knai, C., Pomerleau, J., Lock, K., & McKee, M. (2006). Getting children to eat more fruit and vegetables: A systematic review. Preventive Medicine, 42(2), 85–95.
Kraag, G., Van Breukelen, G. J., Kok, G., & Hosman, C. (2009). ‘Learn Young, Learn Fair’, a stress management program for fifth and sixth graders: Longitudinal results from an experimental study. Journal of Child Psychology and Psychiatry and Allied Disciplines, 50(9), 1185–1195.
McMahon, S. D., Grant, K. E., Compas, B. E., Thurm, A. E., & Ey, S. (2003). Stress and psychopathology in children and adolescents: Is there evidence of specificity? Journal of Child Psychology and Psychiatry and Allied Disciplines, 44(1), 107–133.
Morris, S. B. (2008). Estimating effect sizes from pretest-posttest-control group design. Organizational Research Methods, 11(2), 364–386.
Ness, A. R., & Powles, J. W. (1997). Fruit and vegetables, and cardiovascular disease: A review. International Journal of Epidemiology, 26(1), 1–13.
Nigg, C. R., Allegrante, J. P., & Ory, M. (2002). Theory-comparison and multiple- behavior research: Common themes advancing health behavior research. Health Education Research, 17(5), 670–679.
Ohayon, M. M., Roberts, R. E., Zulley, J., Smirne, S., & Priest, R. G. (2000). Prevalence and patterns of problematic sleep among older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 39(12), 1549–1556.
Orleans, C. T. (2004). Addressing multiple behavioral health risks in primary care: Broadening the focus of health behavior change research and practice. American Journal of Preventive Medicine, 27(2 Suppl), 1–3.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40(3), 879–891.
Prochaska, J. J., Spring, B., & Nigg, C. R. (2008). Multiple health behavior change research: An introduction and overview. Preventive Medicine, 46(3), 181–188.
Rushton, J. L., Forcier, M., & Schectman, R. M. (2002). Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health. Journal of the American Academy of Child and Adolescent Psychiatry, 41(2), 199–205.
Scheier, M. F., & Carver, C. S. (2003). Goals and confidence as self-regulatory elements underlying health and illness behavior. In L. D. Cameron & H. Leventhal (Eds.), The self-regulation of health and illness behaviour (pp. 17–44). New York, NY: Routledge.
Solberg, L. I., Maciosek, M. V., & Edwards, N. M. (2008). Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness. American Journal of Preventive Medicine, 34(2), 143–152.
Stuart, H. (2006). Psychosocial risk clustering in high school students. Social Psychiatry and Psychiatric Epidemiology, 41(6), 498–507.
Substance Abuse and Mental Health Services Administration. (2007). 2008 National survey on drug use and health. Retrieved from http://www.oas.samhsa.gov/nsduh/2k8MRB/2k8Q.pdf.
Thompson, V. J., Bachman, C. M., Baranowski, T., & Cullen, K. W. (2007). Self-efficacy and norm measures for lunch fruit and vegetable consumption are reliable and valid among fifth grade students. Journal of Nutrition Education and Behavior, 39(1), 2–7.
U.S. Department of Health and Human Services. (2008). 2008 Physical Activity Guidelines for Americans. Retrieved from http://www.health.gov/paguidelines/pdf/paguide.pdf.
U.S. Department of Health and Human Services, U.S. Department of Agriculture. (2005). Dietary Guidelines for Americans, 2005. Retrieved from http://www.health.gov/dietaryguidelines/dga2005/document/pdf/DGA2005.pdf.
Werch, C. (2007). The Behavior-Image Model: A paradigm for integrating prevention and health promotion in brief interventions. Health Education Research, 22(5), 677–690.
Werch, C., Bian, H., Moore, M. J., Ames, S., DiClemente, C. C., Thombs, D., et al. (2008a). Brief multiple behavior health interventions for older adolescents. American Journal of Health Promotion, 23(2), 92–96.
Werch, C., Bian, H., Moore, M. J., Ames, S., DiClemente, C. C., & Weiler, R. M. (2007). Brief multiple behavior interventions in a college student health care clinic. Journal of Adolescent Health, 41(6), 577–585.
Werch, C., Moore, M., Bian, H., DiClemente, C. C., Ames, S. C., Weiler, R. M., et al. (2008b). Efficacy of a brief image-based multiple-behavior intervention for college students. Annals of Behavioral Medicine, 36(2), 149–157.
Werch, C., Moore, M., DiClemente, C. C., Bledsoe, R., & Jobli, E. (2005). A multihealth behavior intervention integrating physical activity and substance use prevention for adolescents. Prevention Science, 6(3), 213–226.
Werch, C., Moore, M., DiClemente, C. C., Owen, D. M., Jobli, E., & Bledsoe, R. (2003). A sport-based intervention for preventing alcohol use and promoting physical activity among adolescents. Journal of School Health, 73(10), 380–388.
Wolfson, A. R., Crowley, S. J., Anwer, U., & Bassett, J. L. (2003). Changes in sleep patterns and depressive symptoms in first-time mothers: Last trimester to 1-year postpartum. Behavioral Sleep Medicine, 1(1), 54–67.
Acknowledgments
This investigation and manuscript would not have been possible without the financial support from the National Institute on Alcohol Abuse and Alcoholism (Grant number: AA9283) and the National Institute on Drug Abuse (Grant numbers: DA018872 and DA019172). We also wish to thank the many school administrators, staff, teachers, parents, guardians, and students who made this project possible through their kind support and participation.
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Werch, C.E., Bian, H., Carlson, J.M. et al. Brief integrative multiple behavior intervention effects and mediators for adolescents. J Behav Med 34, 3–12 (2011). https://doi.org/10.1007/s10865-010-9281-9
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DOI: https://doi.org/10.1007/s10865-010-9281-9