Exercise Prescription Practices Among Mental Health Professionals on College Campuses: Testing the Information-Motivation-Behavioral Skills Model.

BACKGROUND: The co-occurrence of physical inactivity and poor mental health in the college student population can lead to chronic health issues that have negative short-term effects (e.g., academic success). Poor mental health is associated with long-term conditions (e.g., obesity, serious mental illness) that are linked to premature mortality. The purpose of this study was to examine the information-motivation-behavioral (IMB) skills model and evaluate its ability to explain the variance in the use of exercise prescription in mental health treatment. METHOD: Mental health professionals (MHPs) (n = 255) were recruited from college counseling centers in the USA. Structural equation modeling was used to examine the relationship between the predictor variables of information (exercise knowledge and benefits of exercise), motivation (personal beliefs, perceived barriers, and organizational support), and behavioral skills (self-efficacy), and the outcome variable of exercise prescription (i.e., brief counseling and referral for exercise). RESULTS: The predictors accounted for 23% of the variance in exercise prescription (p = .001). Organizational support had a significant direct effect on exercise prescription (ß = 0.27, p = .05). Personal beliefs (ß = 0.96, p = .05) and organizational support (ß = 0.31, p = .04) had significant direct effects on self-efficacy for prescribing exercise. MHP personal exercise behavior was associated with exercise prescription. CONCLUSION: MHPs may be willing to support physical activity promotion and exercise prescription, but organizational structures are critical to enhance and sustain the delivery of this adjunctive therapy. The personal exercise history of MHPs may be an important consideration for behavior change interventions. The development and validation of scales are important considerations for future intervention study design.

The development and preliminary evaluation of the Genetic Counseling Skills Checklist.

Genetic counseling (GC) relies on communication to help people understand and adapt to genetic contributions of disease, and there is need for a practical and reliable method of comprehensively documenting GC communication skills without intensive coding. To this end, we created a novel process measure called the Genetic Counseling Skills Checklist (GCSC), utilizing previously validated measures, communication/counseling frameworks, and prior research findings. A multistage iterative process was used to develop, evaluate, and modify the GCSC to improve its clarity, usability, and content validity. To assess interrater reliability, randomly assigned, untrained individuals (i.e., coders) used the GCSC version 3 to code multiple simulated GC sessions. Average measures intraclass correlation coefficients (ICCs) were calculated for each of the 8 GCSC process categories using one-way, random effects models. After relatively minor modifications to the GCSC, two pairs of experienced coders used GCSC version 4 to independently code additional GC sessions and Cohen's Kappa coefficients (κ) were calculated to assess interrater reliability for each process category. The GCSC contains five to eight items within each category and demonstrates good content validity given its ability to capture nearly all GC skills that genetic counselors reported using in a prior qualitative study. Interrater reliability of GCSC version 3 among coders with limited experience was moderate or good for 6 out of the 8 process categories as evidenced by ICCs ranging from 0.55 to 0.86. Average interrater reliability of GCSC version 4 among one pair of experienced coders was strong for all eight process categories (κ ranging from 0.82 to 0.94); among the second pair of experienced coders scores were strong for six categories (κ ranging from 0.80 to 0.87) and moderate for two categories (κ of 0.77 and 0.78). The results suggest the need for training and experience to assure adequate interrater reliability across GCSC coders. Future work is needed to create a formalized training program for coders, complete a larger study to further validate the measure, and use the GCSC to document variability in skills used across providers and sessions.

Masked analysis for small-scale cluster randomized controlled trials.

Researchers conducting small-scale cluster randomized controlled trials (RCTs) during the pilot testing of an intervention often look for evidence of promise to justify an efficacy trial. We developed a method to test for intervention effects that is adaptive (i.e., responsive to data exploration), requires few assumptions, and is statistically valid (i.e., controls the type I error rate), by adapting masked visual analysis techniques to cluster RCTs. We illustrate the creation of masked graphs and their analysis using data from a pilot study in which 15 high school programs were randomly assigned to either business as usual or an intervention developed to promote psychological and academic well-being in 9th grade students in accelerated coursework. We conclude that in small-scale cluster RCTs there can be benefits of testing for effects without a priori specification of a statistical model or test statistic.

A Motivational Interviewing Intervention for Adolescents in Accelerated High School Curricula: Applicability and Acceptability in a Second Sample.

The paper describes the applicability and acceptability of a selective intervention-Motivation, Assessment, and Planning (MAP)-for high school students that was developed based on the principles of motivational interviewing (MI) and tailored to the unique needs and strengths of students taking accelerated coursework, specifically Advanced Placement (AP) and International Baccalaureate (IB) classes. In addition to detailing the intervention in terms of MI spirit, processes, and relational and technical skills, we report applicability and acceptability data from a second iteration of MAP implementation in eight AP/IB programs in a Southeastern state during spring 2018. We analyzed quantitative and qualitative acceptability data from 121 high school freshmen (97 from AP and 24 from IB courses), as well as the seven MAP coaches who were trained using the Motivational Interview Training and Assessment System (Frey et al. 2017). To gain perspectives from the intended end users of the refined MAP, 12 school counselors and school psychologists who were not trained in MAP evaluated the intervention and provided qualitative and quantitative data on applicability and acceptability. All three stakeholder groups (students, coaches, and school mental health staff) rated and described the intervention as highly acceptable and appropriate for addressing the social-emotional needs of adolescents in AP/IB classes.

Depression, anxiety, and posttraumatic stress as predictors of immune functioning: differences between youth with behaviorally and perinatally acquired HIV.

Youth living with HIV (YLWH) face significant mental health problems, namely depression, anxiety, and PTSD with rates of these disorders higher than in the general population. This study explored the relationship between symptoms of depression, anxiety, and PTSD and biological markers among a sample of 145 YLWH ages 13-25 years. Participants completed the Center for Epidemiologic Studies Depression Scale (CES-D), Generalized Anxiety Disorder-7 Item Scale (GAD-7), and Primary Care-Posttraumatic Stress Disorder Screen (PC-PTSD). Biological markers included CD4 count and viral load (VL) abstracted from medical records. Findings revealed a relationship between depression and anxiety and CD4 count as well as anxiety and VL. The relationship between depression and anxiety and CD4 count and anxiety and VL was moderated by transmission mode (i.e., behavioral versus perinatal). For youth perinatally infected, greater psychological symptoms of depression and anxiety were associated with a decline in CD4 count and increase in VL, but this was not true for youth with behaviorally acquired HIV. These findings point to the need for individualized mental health prevention and intervention services for YLWH.

On the measurement of thin-ideal internalization: Implications for interpretation of risk factors and treatment outcome in eating disorders research.

OBJECTIVE: Although the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) and Ideal Body Stereotype Scale (IBSS) are used interchangeably to assess thin ideal internalization, limited work has examined the assumption that the two measures index the same construct. METHOD: The current study utilized confirmatory factor analysis to examine whether these measures capture a single construct (one-factor), two constructs (two-factor), or both shared and unique constructs (bifactor). The SATAQ-4R-Internalization: Thin/Low Body Fat subscale and IBSS-Revised were administered to 1,114 college females. RESULTS: A bifactor model provided the best fit to the data. Further, the SATAQ-4R was more strongly related to disordered eating and body satisfaction than the IBSS-R. DISCUSSION: Results indicate that the two most commonly used measures of internalization capture both shared and unique constructs. While both measures appear to contribute to the assessment of a global internalization factor, the SATAQ-4R may be better suited to assess personal acceptance of and desire to achieve a thin body, while the IBSS-R may be better suited to assess an awareness or acknowledgement of broader sociocultural ideals (e.g., toned, shapely bodies). Continued psychometric investigation of the scales is recommended in order to ensure targeted assessment of the intended constructs.

Multilevel Factor Analysis: Reporting Guidelines and a Review of Reporting Practices.

We provide reporting guidelines for multilevel factor analysis (MFA) and use these guidelines to systematically review 72 MFA applications in journals across a range of disciplines (e.g., education, health/nursing, management, and psychology) published between 1994 and 2014. Results are organized in terms of the (a) characteristics of the MFA application (e.g., construct measured), (b) purpose (e.g., measurement validation), (c) data source (e.g., number of cases at Level 1 and Level 2), (d) statistical approach (e.g., maximum likelihood), and (e) results reported (e.g., intraclass correlations for indicators and latent variables, standardized factor loadings, fit indices). Results from this review have implications for applied researchers interested in expanding their approaches to psychometric analyses and construct validation within a multilevel framework and for methodologists using Monte Carlo methods to explore technical and methodological issues grounded in realistic research design conditions.

Linking genetic counseling communication skills to patient outcomes and experiences using a community-engagement and provider-engagement approach: research protocol for the GC-PRO mixed methods sequential explanatory study.

INTRODUCTION: In over 50 years since the genetic counseling (GC) profession began, a systematic study of GC communication skills and patient-reported outcomes in actual sessions across multiple clinical specialties has never been conducted. To optimize GC quality and improve efficiency of care, the field must first be able to comprehensively measure GC skills and determine which skills are most critical to achieving positive patient experiences and outcomes. This study aims to characterise GC communication skills using a novel and pragmatic measure and link variations in communication skills to patient-reported outcomes, across clinical specialties and with patients from diverse backgrounds in the USA. Our community-engagement and provider-engagement approach is crucial to develop recommendations for quality, culturally informed GC care, which are greatly needed to improve GC practice. METHODS AND ANALYSIS: A mixed methods, sequential explanatory design will be used to collect and analyze: audio-recorded GC sessions in cancer, cardiac, and prenatal/reproductive genetic indications; pre-visit and post-visit quantitative surveys capturing patient experiences and outcomes and post-visit qualitative interview data. A novel, practical checklist will measure GC communication skills. Coincidence analysis will identify patterns of GC skills that are consistent with high scores on patient-reported measures. Two-level, multilevel models will be used to evaluate how GC communication skills and other session/patient characteristics predict patient-reported outcomes. Four community advisory boards (CABs) and a genetic counselor advisory board will inform the study design and analysis. ETHICS AND DISSEMINATION: This study has been approved by the single Institutional Review Board of the University of Minnesota. This research poses no greater than minimal risk to participants. Results from this study will be shared through national and international conferences and through community-based dissemination as guided by the study's CABs. A lay summary will also be disseminated to all participants.

Understanding the perceptions of sedentary college students' engagement in physical activity: application of the theory of planned behavior.

OBJECTIVE: To understand salient beliefs related to physical activity (PA) in sedentary college students. PARTICIPANTS: Thirty-seven students from a large research university participating in a larger research project were subsequently invited to participate in small focus groups. METHODS: Using the Theory of Planned Behavior as a framework, semi-structured focus groups were conducted to understand the perceptions of using mobile technology as a tool to increase PA. RESULTS: A grounded theory approach revealed that students generally had positive attitudes about PA and relied heavily on social support as a facilitator of PA behavior change. The structured exercise program delivered via the mobile app increased perceived behavioral control. Other key findings include academic barriers, desire to avoid chronic disease, and inconsistent efficacy of the mobile application among this population. CONCLUSIONS: Interventions designed to increase PA in this population should focus on structured activity, increased self-monitoring, positive outcome expectancies, and social support.

The Functional External Memory Aid Tool Version 2.0: A How-To Clinical Guide.

PURPOSE: Although compensatory cognitive rehabilitation is a common treatment approach for adults with cognitive-communication disorders, there are few assessment tools available to support clinicians in developing person-centered treatment plans. In addition to understanding a client's cognitive and functional abilities, it is also important to understand how they compensate for their weaknesses, specifically with external aids (e.g., calendars, notes), in everyday life. The Functional External Memory Aid Tool (FEMAT) is a performance-based measure that quantifies and describes external aid use during task completion. METHOD: The purpose of this clinical focus article is to educate and equip clinicians to administer and interpretate the FEMAT with adult clients with cognitive-communication disorders. This clinical focus article describes the theoretical motivation for the FEMAT as well as the administration, scoring, and interpretation procedures for Version 2.0 of the measure. A hypothetical case example is included to illustrate how to use the FEMAT to develop person-centered goals and treatment plans. CONCLUSIONS: The FEMAT is psychometrically sound, clinically relevant, free, easily accessible, and quick to administer and provides data that are complementary to data obtained from traditional performance-based and/or patient-reported measures. This clinical focus article describes new resources that are available to help clinicians administer and interpret Version 2.0 of the FEMAT when serving adults with cognitive-communication disorders. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21651311.

Second-first language acquisition: analysis of expressive language skills in a sample of girls adopted from China.

In this study we investigated adopted Chinese girls' expressive English language outcomes in relation to their age at adoption, chronological age, length of exposure to English and developmental risk status at the time of adoption. Vocabulary and phrase utterance data on 318 girls were collected from the adoptive mothers using the Language Development Survey (LDS) (Achenbach & Rescorla, 2000). The girls, aged 18-35 months (M=26·2 months, SD=4·9 months), were adopted at ages ranging from 6·8 to 24 months (M=12·6 months, SD=3·1 months), and had been exposed to English for periods ranging from 1·6 to 27·6 months (M=13·7, SD=5·7). Findings suggest that vocabulary and mean length of phrase scores were negatively correlated with age at adoption but positively correlated with chronological age and length of exposure to English. Developmental risk status at the time of adoption was not correlated with language outcomes. The gap between their expressive language and that of same-age girls from the US normative sample was wider for children aged 18-23 months but was closed for children aged 30-35 months. About 16% of the children met the LDS criteria for delays in vocabulary and 17% met the LDS criteria for delays in mean length of phrase. Speech/language interventions were received by 33·3% of the children with delays in vocabulary and 25% with delays in phrase.

Scheduling math practice: Students' underappreciation of spacing and interleaving.

Many randomized controlled experiments in the classroom have found that mathematics learning is improved dramatically when practice problems of one kind are distributed across multiple assignments (spaced) and mixed with other kinds of problems (interleaved). In two studies, we investigated students' knowledge of spacing and interleaving. In Study 1, 193 undergraduates designed learning schedules for a hypothetical math class. In Study 2, 175 undergraduates selected from among five hypothetical schedules in response to a variety of questions, provided reasons for their selections, and rated the utility of spacing and interleaving. In both studies, most participants incorrectly judged schedules with minimal degrees of spacing and interleaving to be most effective. Also, schedules with more spacing and interleaving were perceived as more difficult, less enjoyable, and less common. Participants' ratings of utility revealed mixed perspectives on spacing and an underappreciation of interleaving. Altogether, these findings demonstrate that most students fail to recognize the benefits of spaced and interleaved practice. Further, by identifying specific ways in which their beliefs about spacing and interleaving fall short, we reveal opportunities to reshape students' beliefs to foster these effective learning techniques. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Factor Structure and Measurement Invariance of the Irrational Beliefs Inventory for University Students in the United States and Iceland.

We used multigroup confirmatory factor analysis to evaluate the five-factor measurement model underlying the 50-item Irrational Beliefs Inventory (IBI) in samples of university students in the United States (n=827) and Iceland (n=720). Global model fit was marginally acceptable in each sample. Further analyses identified several sources of model misfit that included weak factor loadings, several item pairs with correlated errors, and items with loadings on more than one factor. Cronbach's alpha reliability estimates for the five factors were similar for the U.S. and Icelandic samples, and comparable to those reported by the developers of the IBI. Measurement invariance testing supported configural (same form) and metric invariance (equal loadings), but identified only 20 items that had invariant item intercepts across the U.S. and Icelandic groups. Given the finding of partial measurement invariance, we offer caution when using the IBI to make group comparisons for U.S. and Icelandic samples. Recommendations are proposed for ongoing psychometric evaluations of the IBI that would identify strengths of the IBI and items that, if revised or deleted, may improve the quality of the measure for research and clinical purposes.

Associations Between Multiple Health-Promoting Behaviors and Subjective Well-Being in High School Age Youth.

BACKGROUND: Conceptualizations of health have expanded to include indicators of adolescents' physical and mental wellness, rather than solely the absence of diseases or disorders. Although extensive research has identified links between mental and physical wellness, few studies have investigated the relationship between health promotion and happiness, particularly in adolescent populations who may be at particular risk for engaging in health-compromising behaviors, such as alcohol consumption. METHODS: This cross-sectional study examined the relationship between 12 health-promoting behaviors and subjective well-being in a sample of 450 high school students from 2 states. Participants reported on their diet, physical activity, sleep hygiene habits, as well as abstinence from tobacco and alcohol products, and completed a multidimensional assessment of subjective well-being. RESULTS: Findings demonstrated that 7 of the 12 health-promoting behaviors were significantly correlated with adolescents' subjective well-being. A sizeable portion of the variance in adolescents' subjective well-being (39.8%) was accounted for by the linear combination of the 12 health-promoting behaviors of interest. Increased physical activity, sleep hygiene cognitive/emotional factors, and bedtime routine all were identified as unique predictors of subjective well-being. CONCLUSIONS: These findings bring attention to the salience of daily physical activity and sleep hygiene and their associations with adolescents' happiness.

Allometric scaling of pegylated liposomal anticancer drugs.

Pegylated liposomal formulations contain lipid conjugated to polyethylene glycol. The disposition of encapsulated drug is dictated by the composition of the liposome, thus altering the pharmacokinetic (PK) profile of the drug. Allometric scaling is based on a power-log relationship between body weight (W) and drug clearance (CL) among mammals and has been used to compare the disposition of nonliposomal drugs across species. The objectives of this study were to use allometric scaling to: (1) compare the disposition of pegylated liposomal drugs across speciesand determine the best scaling model and (2) predict PK parameters of pegylated liposomal drugs in humans. The PK of pegylated liposomal CKD-602 (S-CKD602), doxorubicin (Doxil®), and cisplatin (SPI-077) were compared. PK studies ofS-CKD602, Doxil®, and SPI-077 were performed at the maximum tolerated dose (MTD) in male and female mice, rats, dogs and patients with refractory solid tumors. The allometric equation used to evaluate the relationship between W and CL in each species was CL = a(W)(m) (a = empirical coefficient; m = allometric exponent). Substitution of physiological variables other than body weight, such as factors representative of the mononuclear phagocyte system (MPS) were evaluated. Dedrick Plots and Maximum Life-Span Potential (MLP) were used to determine scaling feasibility. Standard allometry demonstrated a relationship between clearance of S-CKD602, Doxil®, and SPI-077 and body, spleen, liver, and kidney weights, total monocyte count, and spleen and liver blood flow. However, using scaling to predict CL of these agents in humans often resulted in differences >30%. Despite a strong correlation between body weight and MPS-associated variables with CL among preclinical species, the use of the equations did not predict CL. Thus, new methods of allometric scaling and measures of MPS function need to be developed.

Multilevel Confirmatory Factor Analysis of a Scale Measuring Interagency Collaboration of Children's Mental Health Agencies.

Multilevel confirmatory factor analysis was used to evaluate the factor structure underlying the 12-item, three-factor Interagency Collaboration Activities Scale (IACS) at the informant level and at the agency level. Results from 378 professionals (104 administrators, 201 service providers, and 73 case managers) from 32 children's mental health service agencies supported a correlated three-factor model at each level and indicated that the item loadings were not significantly (p < .05) different across levels. Reliability estimates of the three factors (Financial and Physical Resource Activities, Program Development and Evaluation Activities, and Collaborative Policy Activities) at the agency level were .81, .60, and .72, respectively, while these estimates were .79, .82, and .85 at the individual level. These multilevel results provide support for the construct validity of the scores from the IACS. When the IACS was examined in relation to level-1 and level-2 covariates, results showed that participants' characteristics (i.e., age, job role, gender, educational level, and number of months employed) and agency characteristics (i.e., state location and number of employees) were not significantly (p > .05) related to levels of interagency collaboration.

Speech-Language Pathologist Involvement in Multi-Tiered System of Supports Questionnaire: Advances in Interprofessional Practice.

Purpose This article describes the development and initial validation of the Speech-Language Pathologist (SLP) Involvement in Multi-Tiered System of Supports (MTSS) Questionnaire. It was developed to measure the extent to which SLPs are involved in MTSS at their school site(s). Method A total of 567 SLPs practicing in the United States responded to up to 39 Likert-type items meant to reflect six domains: scope of practice, professional development, leadership, consulting/collaborating, assessment and analysis, and intervention. Measurement quality was evaluated in terms of score reliability and validity. An exploratory factor analysis was conducted to evaluate the internal structure of the questionnaire responses. A three-factor model with the following dimensions of Carrying out Roles and Responsibilities, Leading, and Planning and Providing Interventions was supported. Loadings for retained factors ranged from .35 to .87. Internal consistency estimates ranged from .87 to .92. Descriptive statistics summarized the overall involvement of SLPs in MTSS, and responses to questions to assess the feasibility and acceptability of this questionnaire were analyzed. Results Questionnaire responses indicated that SLPs infrequently engage in MTSS activities. The item with the highest mean was related to SLPs collaborating with teachers to help them address students' speech and language disorders in their classrooms. Most of the SLPs who took the questionnaire found it easy to complete, but only some found the information to be useful. Conclusions The infrequent involvement of SLPs in MTSS indicates a need to disseminate information on the potentially valuable roles SLPs can play in MTSS implementation. This tool may be used by SLPs to better understand contributions they can make within an MTSS framework and self-reflect on their current levels of involvement. Supplemental Material https://doi.org/10.23641/asha.13874516.

Testing Measurement Invariance Across Unobserved Groups: The Role of Covariates in Factor Mixture Modeling.

Factor mixture modeling (FMM) has been increasingly used to investigate unobserved population heterogeneity. This study examined the issue of covariate effects with FMM in the context of measurement invariance testing. Specifically, the impact of excluding and misspecifying covariate effects on measurement invariance testing and class enumeration was investigated via Monte Carlo simulations. Data were generated based on FMM models with (1) a zero covariate effect, (2) a covariate effect on the latent class variable, and (3) covariate effects on both the latent class variable and the factor. For each population model, different analysis models that excluded or misspecified covariate effects were fitted. Results highlighted the importance of including proper covariates in measurement invariance testing and evidenced the utility of a model comparison approach in searching for the correct specification of covariate effects and the level of measurement invariance. This approach was demonstrated using an empirical data set. Implications for methodological and applied research are discussed.

Development and Initial Validation of the Functional External Memory Aid Tool.

Purpose The purpose of this study was to develop the item pool and investigate the structure and measurement properties of the Functional External Memory Aid Tool (FEMAT), a performance-based measure of everyday strategy use for persons with mild memory impairments. The FEMAT examines one's use of strategies to compensate for cognitive communication impairments that interfere with the completion of complex daily tasks. Method During Phase 1, six expert panel members reviewed the initial item pool and scoring rubric to assess item verification. Each item was developed to elicit strategy use and represent a complex daily task. During Phase 2, 99 participants with possible mild neurocognitive disorder (as determined by screening procedures) responded to 11 items. The factor structure of the data was analyzed using confirmatory factor analysis. Reliability and relationships between the FEMAT and additional factors were also examined. Results The process of development (Phase 1) resulted in 11 items distributed among three factors: (a) Medical Tasks, (b) Instrumental Daily Tasks, and (c) Retrieval-Based Tasks. Internal consistency (Phase 2), assessed with confirmatory factor analysis, confirmed the proposed three-factor model. Reliability analyses revealed at least 62%-84% of within-test score variance was due to true score variance. Correlation analyses indicated weak and strong relationships between the FEMAT and participant demographic variables and additional assessment measures. Conclusions The FEMAT provides reliable measurement of everyday external memory aid use in persons with possible mild neurocognitive disorder. The FEMAT was designed to be used in clinical settings and to provide better guidance to clinicians to design person-centered interventions than currently available cognitive communication measures.

Reexamination of the psychometric properties of the Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS) and exploration of alternative scoring.

OBJECTIVE: The primary aims of this paper were to reexamine the factor structure of the 21-item Compensatory Eating and Behaviors in Response to Alcohol Consumption Scale (CEBRACS), a measure of Food and Alcohol Disturbance (FAD), and investigate an alternative scoring structure. FAD is the use of disordered eating behaviors within an alcohol use episode to compensate for alcohol-related calories and/or increase effects of alcohol. The new scoring approach captures FAD behaviors based on whether they occurred before, during, or after alcohol use. METHOD: Participants were 586 young adults (18-30 years; 77.6% female; 55.8% non-Hispanic White) who completed online questionnaires on alcohol use, disordered eating behaviors, and FAD. RESULTS: Confirmatory factor analyses did not provide unequivocal evidence for any previously proposed factor structures of the CEBRACS. Exploratory factor analysis suggested items capturing FAD "Before" drinking had a two-factor structure (i.e., Alcohol Effects and Compensatory Behaviors), items capturing FAD "During" drinking had a three-factor structure (i.e., Alcohol Effects, Diet & Exercise, and Extreme Weight Control Behaviors [EWCB]), and items capturing FAD "After" drinking had a two-factor structure (i.e., Diet & Exercise & EWCB). DISCUSSION: The CEBRACS factor structure is not consistent across samples; however, despite suboptimal fit, the original structure remains the best approach to capture FAD behaviors. The alternative scoring reflects FAD behaviors based on when they occur relative to alcohol use. The two scoring approaches provide researchers and clinicians flexibility to describe FAD behaviors in multiple ways using the CEBRACS.