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)

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

Group – Same for all

Targeted

Precontemplation Contemplation Preparation Action Maintenance

Moderate Tailoring

Full TTM-Tailoring - Expert system

Different Levels of Tailoring

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)?

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)

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)

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

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

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%

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%

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

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

Smoking Acquisition by GroupAll Non-Smokers at Baseline

Smoking Acquisition by GroupAll Non-Smokers at Baseline

Alcohol Acquisition by GroupAll Non-Drinkers at Baseline

Alcohol Acquisition by GroupAll Non-Drinkers at Baseline

2009 RI Middle School Health Risk Summary

2009 RI Middle School Health Risk Summary

2009 RI Middle School Health Risks By Grade2009 RI Middle School Health Risks By Grade

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…