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,...
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…