Andrea L. Paiva - SBMAndrea L. Paiva Velicer, WF, Redding, CA, Meier K, Oatley K, Babbin S, McGee H,...
Transcript of Andrea L. Paiva - SBMAndrea L. Paiva Velicer, WF, Redding, CA, Meier K, Oatley K, Babbin S, McGee H,...
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Project BEST: Tailored Interventions for Multiple Risk Factor Prevention
for Adolescents
Project BEST: Tailored Interventions for Multiple Risk Factor Prevention
for Adolescents
Andrea L. PaivaVelicer, WF, Redding, CA, Meier K, Oatley K,
Babbin S, McGee H, & Prochaska JO
Research supported by:
NIDA Grant # DA 020112 (PI: Velicer)
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BackgroundBackground• Individually tailored interventions have demonstrated
efficacy:– Across theoretical models– Across behaviors– For both adults & adolescents
• Transtheoretical model (TTM) tailoring advantages:– Theoretical foundation + empirical tailoring rules– Efficacy data– Population-based
• Prevention programs have shown limited efficacy -could be enhanced by integrating these strengths
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Group – Same for all
Targeted
Precontemplation Contemplation Preparation Action Maintenance
Moderate Tailoring
Full TTM-Tailoring - Expert system
Different Levels of Tailoring
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TTM-Tailored Prevention ProgramsTTM-Tailored Prevention Programs• TTM-tailored behavior change interventions
have been successful.• But, TTM-tailored prevention programs for
smoking & alcohol produced very small or no effects in high school students.
• Is high school too late for prevention?• How do we make substance prevention
relevant for most kids (who are not even thinking about it)?
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Stages of Substance AcquisitionStages of Substance Acquisition
• Precontemplation for Acquisition (aPC):
– Not considering trying it
• Contemplation for Acquisition (aC):
– Thinking about trying it within the next 6 months
• Preparation for Acquisition (aPR):
– Planning to try it within next 30 days
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ProblemProblem
• 90% of high school adolescents are in aPC – not intending to try substance in next 6 mos.
• So how does acquisition occur?
– aC + aPR kids do start using at highest rates
– ~ 50% of aPC will experiment
• How to identify the 50% who are at risk?
• Cluster analyses on Pros, Cons + Temptations identified 4 replicable clusters that predicted uptake over 3 years.
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Example of Cluster Results: Smoking, Subsample 1 (N = 702)
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HS Student aPC Baseline Clusters & Smoking Rates over 3 yrs
HS Student aPC Baseline Clusters & Smoking Rates over 3 yrs
(Velicer, Redding et al., Addict Behav, 2007)
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Stages + Clusters - ContinuumStages + Clusters - Continuum
• Maintenance*
• Action*
• Preparation*
• Contemplation*
• Precontemplation*
• Acquisition Preparation
• Acquisition Contemplation
• Acquisition PC: High Risk
• Acquisition PC: Risk Denial
• Acquisition PC: Ambivalent
• Acquisition PC: Most Protected
*Part of cessation system
Quitting
Regular
Smoking
Trying it
Nonsmoking
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BEST Baseline SampleBEST Baseline SampleN=4153 - 6th Grade Students
• Age = 11.4 years (sd=0.69)• 52.7% Male
– 62% White NH– 14.3% Mixed race/ethnicity – 12.5% Hispanic – 4% Black NH
• 97.8% Nondrinkers + 2.1% Drinkers
• 98.6% Nonsmokers + 1.4% Smokers
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Baseline Stages of Acquisition
among Nonusers
Baseline Stages of Acquisition Baseline Stages of Acquisition
among Nonusersamong Nonusers
Acquisition Stage Smoking(n=4101)
Alcohol(n=4019)
Acq. Precontemplation 99.0% 95.6%
Acq. Contemplation 0.4% 1.3%
Acq. Preparation 0.6% 0.9%
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Baseline Cluster Membership within Acquisition Precontemplation
Baseline Cluster Membership within Acquisition Precontemplation
Alcohol
Most Protected - 47.2%Ambivalent - 27.4%Risk Denial - 23.4%
High Risk - 2.0%
Smoking
Most Protected – 73.9%Ambivalent - 14.4%Risk Denial – 9.0%
High Risk - 2.7%
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RetentionRetention
• N = 4158 at baseline• N = 3438 (82.7%) at 12 months (7th grade)• N = 3184 (76.6%) at 24 months (8th grade)• N = 2983 (71.7%) at 36 months (9th grade)
• No baseline or retention differences between randomized groups
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AnalysesAnalyses
• Randomized Effect Modeling – 7th,8th, 9th grade data– All available data– Random intercept & random slope multilevel modeling – School controlled for as unit of assignment
• Outcomes assessed separately for each behavior
• No cessation outcomes yet – sample sizes too small
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Smoking Acquisition by GroupAll Non-Smokers at Baseline
Smoking Acquisition by GroupAll Non-Smokers at Baseline
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Alcohol Acquisition by GroupAll Non-Drinkers at Baseline
Alcohol Acquisition by GroupAll Non-Drinkers at Baseline
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2009 RI Middle School Health Risk Summary
2009 RI Middle School Health Risk Summary
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2009 RI Middle School Health Risks By Grade2009 RI Middle School Health Risks By Grade
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Summary: Addictive BehaviorsSummary: Addictive Behaviors
• In baseline nonusers, low rate of acquisition at 36
months (9th grade) for smoking (5.7-9.2%) and slightly
higher rates for alcohol (10.1%-14.4%).
• Appear to improve upon secular trends, but without a
no treatment group, interpretation is problematic.
• Addictive behavior initiation rates were better in
Energy Balance group compared to the Addictive
Behavior Prevention group at all followup timepoints.
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DiscussionDiscussion
• Unexpectedly, the TTM-tailored Energy Balance behavior intervention had better addictive behavior outcomes (which were not treated directly) at 7th, 8th, & 9th grades than the TTM-tailored cluster-based Addictive Behavior prevention intervention.
• Interesting follow up studies…