Brief Prevention

Interventions: Targeting

Multiple Health Risks

Using Positive Images

http://preventionpluswellness.com

Barriers to Using Brief

Prevention Interventions

1. Lack of knowledge of research & practice

2. Lack of knowledge of theory

3. Status quo

4. Inaccurate beliefs

5. History of using untested programs

Barriers to Using Brief

Prevention Interventions

6. Need for briefer prevention interventions

7. Need to save resources

8. Need for practical solutions

9. Need to have broader & greater impact

10. Reality check

Today’s Talk Objectives

1) The Problem: Describe the epidemic of multiple,

co-occurring health risks among American youth.

2) The Theory: Describe the two components of the

Behavior-Image Model for developing brief,

integrated programs.

3) The Research: Present research evaluating

multiple outcomes from brief integrated

programs.

4) The Practice: List the four steps for implementing

brief integrated programs.

1. 66% of adolescents tried and 35% currently drink alcohol

2. One in 10 currently drive after drinking, and 22% ride with a drinking driver

3. Over 1 in 5 (21%) currently binge drink alcohol

4. 40% tried and 23% currently use marijuana

5. 41% tried and 23% currently smoke cigarettes

6. 18% have taken prescription drugs without a doctors script, while…

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Epidemiology of Youth Risks:

ATOD Use (CDC, 2014)

1. Only 27% of adolescents were physically

active for 60 minutes every day last week

2. 41% used a computer three or more hours a

day that was not for school work

3. Only 38% ate breakfast every day last week

4. Only 16% ate vegetables, and 22% ate fruit 3 or

more times a day

5. Only 13% drank three or more glasses of milk

last week, while 27% drank soda every day last

week

6. Only 32% got 8 hours of sleep on school

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Epidemiology of Youth Risks:

Chronic Disease Related

1. The majority of US youth (53%) experience

two or more co-existing risk behaviors, and

over a third (36%) experience three or more

(Fox, et al, 2010).

2. Many risk behaviors are established during

adolescence and increase throughout early

adulthood.

3. Many risk behaviors are interrelated and

share underlying risk/protective factors.

Multiple Co-Existing Risks among

Youth

Number of Co-existing Risk Behaviors

Among Adolescents N=1242

(3) 27.5%

(2) 21.5%

(1) 12.6%

(0) 4.1%

(4) 19.5%

(5) 9.3%

(6) 4.2%(7) 1.2%

Alcohol Use

• Injury

• Disease

• Death

• Social

problems

• Sadness

Compounded Effects of Interacting

Multiple Health Risks

Phy. Inactivity

• Injury

• Disease

• Death

• Social

problems

• Sadness

= ?

• BIM is a road map for developing brief, integrated

resiliency-based interventions emphasizing

positive behavior and self-identity content.

• BIM consists of two key components:

1. Targeting positive (appealing) social and future

images to link health risk and health

promoting/protective behaviors, and

2. Developing self-regulation skills to set and

achieve multiple health behavior goals.

The Behavior-Image Model (BIM)

• Image has a conceptual foundation in:

1. Social Cognitive Theory (Bandura, 1986).

2. Prototype/Willingness Model (Gibbons,

Gerrard, & Lane, 2003).

3. Developmental Psychology of Self-concept (Harter, 1999).

• The use of appealing images has a practical foundation in marketing and advertising communications.

Image in Theory & Practice

Analytical Heuristic

•Deliberative

information

processing and

decision-making

•Logical

•Uses reason and

scientific deliberation

Dual Processing Theories of Thinking

Affect Heuristic

• Intuitive information

processing and

decision-making

• Automatic,

instinctive and

experiential

• Uses affective-laden

images, narratives

and metaphors

1. BIM-based interventions provide feedback on youths’ concrete health behaviors and relations to images.

2. The discrepancy between these behaviors and social and future images are highlighted as possible goals.

3. Public commitment to goal setting is offered to reduce discrepancy in health promoting behaviors/images, and increase discrepancy in risk behaviors/images.

BIM as a Self-regulation Model

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BIM evolved from developing and testing

brief integrated interventions linking

ATOD prevention with health promotion:

1. SPORT PPW for adolescents,

2. InShape PPW for college aged adults,

3. SPORT 2 PPW, and

4. In God’s Image (IGI).

BIM & Brief Integrated Programs

604 high school students, with 3 and

12-month follow-up, randomized to:

1) brief integrated consult with

mailed flyer, or

2) wellness brochure control.

Older Adolescent Trial: II (Werch, et al., 2005)

Trial II

Entire Sample Drug Users

3-Month 12-Month 3-Month 12-Month

n=584 n=514 n=118 n=104

Effect Size Effect Size Effect Size Effect Size

Measure d d d d

Alcohol Use

30-Day Alcohol Frequency 0.31 0.58

30-Day Alcohol Quantity 0.32 0.57

30-Day Heavy Drinking 0.29 0.70 0.32

Alcohol Initiation

Length of Alcohol Use 0.30 0.20

Alcohol Initiation 0.37

Drug Use

30-Day Cigarette Freq. 0.21 0.26 0.49 0.44

30-Day Marijuana Freq. 0.45 0.38

Drug Initiation

Cigarette Initiation 0.34

Exercise Behavior

Vigorous Physical Activity 0.34

Moderate Physical Activity 0.23 0.43

Trial II

Entire Sample Drug Users

3-Month 12-Month 3-Month 12-Month

n=584 n=514 n=118 n=104

Effect Size Effect Size Effect Size Effect Size

Measure d d d d

215 high school students in Istanbul,

Turkey, with 3-month follow-up, randomized

to:

1) brief integrated consultation

translated into Turkish, or

2) no treatment control.

Cultural Translation Trial: IV (Ilhan, et al., under review)

Trial IV

Consult Control

n = 103 n = 112

pretest posttest pretest posttest

Measures M M M M p-value

Health Responsibility 15.98 17.01 15.70 15.96 .03

Physical Activity 14.36 15.50 13.89 14.44 .04

Nutrition 18.75 19.48 18.35 18.57 .02

Moderate Physical Activity 2.68 3.68 3.05 2.99 .01

Fruits & Vegetables Eaten 4.58 4.94 4.86 4.18 .02

Exercise Self-Efficacy 38.46 45.71 32.96 34.95 .002

303 college students,

with 3-month follow-up,

randomized to:

1) brief integrated

consult, or

2) standard care

materials control.

Young Adult Trial: II (Werch, et al., 2008)

Frequency of drinking

Heavy drinking

Driving after drinking

Quantity of using marijuana

Heavy use of marijuana

30-day moderate exercise

Sleep

Spiritual Health

Social Health

YA Trial IIConsult Control

n = 140 n = 143

pretest posttest pretest posttest

M M M M

2.56

1.91

0.64

1.54

1.46

4.32

3.29

2.40

2.34

2.36

1.72

0.50

1.41

1.33

4.52

2.83

1.91

1.96

2.57

1.86

0.56

1.55

1.48

4.72

3.20

2.09

1.90

2.72

2.01

0.71

1.73

1.58

4.46

3.08

2.15

2.01

Implementers ask youth to answer

screening survey questions about

their health and fitness habits.

Screens can be implemented to

youth individually or in a group.

Step #1: Screen Youth Health

Behaviors

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Screening has 2 goals:

1) Cue desired behaviors & related

positive images, and

2) Provide data for tailoring feedback

on both health enhancing & risk

habits, and setting goals.

Screening Goals

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Implementers select the youth’s screen responses and then “reads” the brief one-on-one or group consultation feedback script.

Colorful slides highlight positive behaviors and positive image terms.

Step #2: Feedback and Positive

Image Communication

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• “Young people who engage in regular physical

activity tend to feel energetic, sleep better, and

look more active, fit and confident.”

Health Enhancing Behavior Gain

Framed (Benefits) Messages

“Alcohol use can get in the way of participating

in moderate exercise and achieving your fitness

goals of being in-shape, looking good, and

feeling fit and active.”

Health Risk Behavior Loss Framed

(Costs) Messages

“As your (Personal Trainer), I recommend

that you stay away from alcohol, cigarette

and drug use.

At the same time, get 30 minutes of

moderate physical on most days.

Together, these actions will help you to

be physically active, fit and in-shape.”

Recommendation Linking Health Enhancing

and Risk Behaviors with Positive Images

Youth set concrete goals for any of the

target health enhancing and risk behaviors

to achieve desired positive images

Youth make a public commitment to

achieving goals by signing a contract

The need to monitor goal attainment and

continue to revise goals over time is emphasized

Step #3: Setting Multiple Health

Behavior Goals

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Implementers can re-administer

the single-session program every

6-12 months as a booster.

Follow-up lessons can be

provided.

Step #4: Provide Follow-up or

Booster Strategies

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Summary

The Problem: Multiple, co-existing health

risks among the majority of youth

The Theory: The 2-component Behavior-

Image Model (i.e., images and goal setting)

The Research: Brief programs prevent

substance use while promoting healthy

habits

The Practice: 1) Screening, 2) Feedback, 3)

Multiple behavior goal setting, 4) Follow-

up

http://preventionpluswellness.com

info@preventionpluswellness.com

(904) 472-5022

For More Information

on how you can help solve the epidemic of multiple health risks among youth

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