A pilot investigation of a multidisciplinary quality of life intervention for men with biochemical recurrence of prostate cancer.

OBJECTIVE: This pilot project evaluated the acceptability and estimated the effect size of a tailored multidisciplinary quality of life (MQOL) intervention for men who have biochemical recurrence of prostate cancer. METHODS: Participants included 57 men with localized prostate cancer with biochemical recurrence (Median=76 years; 89% White). Participants were randomized to wait list control which offered the intervention upon conclusion of the study (n=27) or to an eight-session group-based, MQOL (n=30) intervention. Assessments were completed at baseline, end of treatment, and 6 months post-treatment. RESULTS: MQOL was acceptable as indicated by favorable participant retention (100% retained), treatment compliance (97% attended > 6 treatment sessions), and high ratings of helpfulness (80% rated helpfulness > 4 on 5-point scale). MQOL had a favorable impact on the mental health composite score of the Short Form-36 at the end of treatment but not at 6 months (effect size=0.52 and -0.04); health-related QOL as measured by the Functional Assessment of Cancer Therapy-Prostate at the end of treatment and 6 months (effect size=0.14 and 0.10); and prostate cancer specific anxiety as measured by the Memorial Anxiety Scale for Prostate Cancer at the end of treatment and 6 months (effect size=0.45 and 0.23). CONCLUSIONS: This pilot project provides preliminary data supporting the premise that a tailored behaviorally based MQOL intervention for men with biochemical recurrence of prostate cancer is acceptable to men and might reduce prostate cancer specific anxiety and enhance QOL. Further research examining the efficacy of this intervention in a larger randomized trial is warranted.

Brief integrative multiple behavior intervention effects and mediators for adolescents.

This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents. A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up. A total of 479 students attending two public high schools participated. Participants receiving the intervention showed a significant reduction in quantity × frequency of alcohol use, and increases in fruit and vegetable consumption and frequency of relaxation activities, compared to those receiving the control, P's = .01. No effects were found on cigarette and marijuana use, exercise and sleep. Effect sizes were small with alcohol use cessation effects reaching medium size. Intervention effects were mediated by changes in peer influenceability for alcohol use, and self-efficacy and self-image for health promoting behaviors. Findings suggest that the brief intervention resulted in health risk and promoting behavior improvements for adolescents, with outcomes mediated by several risk factors.

Integrated smoking cessation and binge drinking intervention for young adults: a pilot investigation.

BACKGROUND: Alcohol consumption is strongly associated with cigarette smoking in young adults. PURPOSE: The aim of this study was to evaluate the acceptability and estimate the magnitude of the effect of a novel-integrated smoking cessation and binge-drinking intervention for young adults compared with standard treatment control. METHODS: Participants were 41 young adult smokers (≥ 10 cigarettes per day) who regularly (≥ 2 times per month) binge drank who were randomly assigned to standard treatment (n = 19) involving eight individual treatment visits plus 8 weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge-drinking intervention (integrated intervention; n = 22). RESULTS: Participants rated integrated intervention as highly acceptable as indicated by 100% of participants rating helpfulness as 5 on 5-point scale. Using an intent-to-treat analysis for tobacco abstinence, at both week 12 end of treatment and week 24 follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment (36% vs. 21% at week 12; 23% vs. 11% at week 24). At week 24, change from baseline in binge-drinking episodes, drinks consumed, and drinking days between treatment groups were similar (intent-to-treat analysis was not used for alcohol data). CONCLUSIONS: Preliminary data support the intriguing possibility that integrated intervention may enhance smoking cessation and reduce binge drinking.

Are effects from a brief multiple behavior intervention for college students sustained over time?

OBJECTIVE: This study examined whether 3-month outcomes of a brief image-based multiple behavior intervention on health habits and health-related quality of life of college students were sustained at 12-month follow-up without further intervention. METHODS: A randomized control trial was conducted with 303 undergraduates attending a public university in southeastern US. Participants were randomized to receive either a brief intervention or usual care control, with baseline, 3-month, and 12-month data collected during fall of 2007. RESULTS: A significant omnibus MANOVA interaction effect was found for health-related quality of life, p=0.01, with univariate interaction effects showing fewer days of poor spiritual health, social health, and restricted recent activity, p's<0.05, for those receiving the brief intervention. Significant group by time interaction effects were found for driving after drinking, p=0.04, and moderate exercise, p=0.04, in favor of the brief intervention. Effect sizes typically increased over time and were small except for moderate size effects for social health-related quality of life. CONCLUSION: This study found that 3-month outcomes from a brief image-based multiple behavior intervention for college students were partially sustained at 12-month follow-up.

The association of alcohol consumption with tobacco use in Black and White college students.

This study explored the association of alcohol and tobacco use among college students. A survey was administered in 2004 to 2,189 Black and White students from the southeastern United States. The prevalence of alcohol and tobacco use, tobacco use characteristics according to level of alcohol consumed, and percentage of students using tobacco according to type of alcoholic beverages consumed were evaluated. The interaction of race and gender with alcohol and tobacco use was explored. Our findings extend prior investigations that have found alcohol use associated with smoking and suggest attention be paid to the relation of alcohol to other forms of tobacco. Racial and gender differences are highlighted. This study was funded by Mayo Clinic. The study's limitations were noted.

Health behavior insights: the transtheoretical/stages of change model: Carlo C. DiClemente, PhD.

Showcased in this article is an interview with Carlo C. DiClemente, PhD, an internationally renowned health behavior researcher and codeveloper of the Transtheoretical or Stages of Change Model. In this verbatim interview transcript, later edited by the authors and interviewee, Dr. DiClemente, he provides practical information and frank commentary on the steps to follow and pitfalls to avoid in developing, implementing, evaluating, and disseminating efficacious programs for affecting the health and well-being of individuals and populations. A concluding section summarizes key lessons learned from the professional experiences of Dr. DiClemente and discusses implications for advancing health behavior intervention practice and research.

Efficacy of a brief image-based multiple-behavior intervention for college students.

BACKGROUND: Epidemiologic data indicate most adolescents and adults experience multiple, simultaneous risk behaviors. PURPOSE: The purpose of this study is to examine the efficacy of a brief image-based multiple-behavior intervention (MBI) for college students. METHODS: A total of 303 college students were randomly assigned to: (1) a brief MBI or (2) a standard care control, with a 3-month postintervention follow-up. RESULTS: Omnibus treatment by time multivariate analysis of variance interactions were significant for three of six behavior groupings, with improvements for college students receiving the brief MBI on alcohol consumption behaviors, F(6, 261) = 2.73, p = 0.01, marijuana-use behaviors, F(4, 278) = 3.18, p = 0.01, and health-related quality of life, F(5, 277) = 2.80, p = 0.02, but not cigarette use, exercise, and nutrition behaviors. Participants receiving the brief MBI also got more sleep, F(1, 281) = 9.49, p = 0.00, than those in the standard care control. CONCLUSIONS: A brief image-based multiple-behavior intervention may be useful in influencing a number of critical health habits and health-related quality-of-life indicators of college students.

Brief multiple behavior health interventions for older adolescents.

PURPOSE: This study examined whether brief intervention strategies founded on the Behavior-Image Model and addressing positive images of college and career success could be potentially efficacious in impacting multiple health habits of high-risk adolescents transitioning into adulthood. DESIGN: Participants were stratified by grade level and drug use and individually randomized to one of the three Plan for Success interventions, with baseline and 1 month postintervention data collections. SETTING: A large, relatively diverse suburban school in northeast Florida. SUBJECTS: A total of 375 11th and 12th grade students participated during the spring semester 2006. INTERVENTION: Three interventions studied included: (1) Goal Survey, (2) Goal Survey plus Contract, or (3) Goal Survey plus Consult. MEASURES: Outcome measures included multiple health risk, health promotion, and personal development behaviors, as well as image and belief measures. ANALYSIS: Repeated-measures MANOVAs and ANOVAs were used to examine intervention effects. RESULTS: MANOVAs were significant for alcohol use, F(4,328) = 6.33, p = .001; marijuana use, F(4,317) = 3.72, p = .01; exercise, F(3,299 = 4.28, p = .01; college preparation, F(2,327) = 6.26, p = .001; and career preparation, F(2,329) = 6.17, p = .001, with most behaviors improving over time, whereas group-by-time interaction effects were found for nutrition habits, F(6,652) = 2.60, p = .02; and career preparation, F(4,658) = 3.26, p = .01, favoring the consultation. CONCLUSION: Brief interventions founded on the Behavior-Image Model may have potential to improve selected health and personal development habits among older adolescents.

Differences among Black and White young adults on prior attempts and motivation to help a smoker quit.

This study assessed differences between Black and White young adults on prior attempts and motivation to help a smoker quit. A total of 1,621 undergraduates (912 Black, 709 White; 63% female) ages 18-24 years completed a cross-sectional survey. Overall, 54% reported they had previously tried to help someone else stop smoking (52% among Blacks vs. 58% among Whites, p=0.016). Among nonsmokers who indicated they were close to a smoker whom they thought should quit, Blacks were most often concerned about a family member whereas Whites endorsed concern most often for a friend (p<0.001). Blacks were more likely than Whites to indicate interest in learning ways to help this smoker to quit (p<0.001) but there was no significant differences on motivation level (46% of Blacks and 42% of Whites reported they were "very" or "extremely" motivated to help this person quit). After adjusting for gender, the results remained unchanged. Tobacco control efforts could focus on optimizing these supportive behaviors as well as expressed motivation and interest in helping a smoker to quit among young adult nonsmokers.

Effect of expressive writing as a treatment adjunct for reducing smoking cessation related weight gain in young adult smokers.

This investigation evaluated the effect of expressive writing on weight gain in young adults being treated for smoking cessation. This study was conducted between July 2001 and June 2005. Participants (N = 196) ages 18-24 years (M = 20.8, SD = 2.0 years), who were recruited from a large city in the southeastern United States were randomized to brief office intervention or expressive writing plus brief office intervention. The sample was 56% female, 93% Caucasian, smoked a mean of 18.1 cigarettes per day (SD = 6.1), and had a mean body mass index of 24.9 (SD = 5.6). Participants who received the expressive writing plus brief office intervention gained significantly less weight than those receiving the brief office interventions from week 3 to 24, but did not significantly differ at week 52. A limitation of this investigation relates to the fact that the impact of expressive writing on weight was an unanticipated treatment effect that was evaluated in post-hoc analyses. Although the findings suggest that expressive writing holds promise as a treatment adjunct to decrease weight gain associated with smoking cessation, further research is warranted.

Alcohol-related fan behavior on college football game day.

UNLABELLED: High-risk drinking on game day represents a unique public health challenge. OBJECTIVE: The authors examined the drinking behavior of college football fans and assessed the support for related interventions. PARTICIPANTS: The authors randomly selected 762 football fans, including college students, alumni, and other college football fans, to complete an anonymous online game-day survey. METHODS: The authors collected data on participants' drinking behaviors and support for specific game-day interventions. RESULTS: Analysis revealed that, overall, fans drank significantly more on game day than they did the last time they partied or socialized. Nondrinkers were the most supportive of game-day interventions, followed by moderate drinkers, whereas heavy drinkers offered the least support. CONCLUSIONS: With the exception of limiting tailgating hours on game day, fans support game-day interventions, including alcohol-free alternatives, designating tailgating areas where open containers are permitted, and increasing law enforcement efforts.

Iatrogenic effects of alcohol and drug prevention programs.

OBJECTIVE: Understanding prevention program risks and the contextual factors associated with negative program outcomes is critical to assisting the development of public policy that is aimed at avoiding future prevention-related harm while maximizing prevention success. The purpose of this review was to systematically analyze published studies evaluating substance use prevention programs, to determine whether iatrogenic effects have occurred, and if so, what types of harmful effects resulted and under what circumstances. METHOD: A search of electronic bibliographic databases in allied health, education, medicine, psychology and general literature was conducted, spanning the years from 1980 to the present. RESULTS: Evidence of negative program effects was found in 17 evaluation studies for which 43 negative outcomes were documented. The most common type of negative outcome resulting from prevention programs was behavioral effects consisting primarily of increases in consumption, especially alcohol use. Drug prevention programs resulted in greater increases in alcohol use, cigarette use, marijuana use and multiple drug use than did alcohol prevention programs. Negative program outcomes appear to exist as three possible scenarios, described in this article. CONCLUSIONS: Researchers, publishers and practitioners should pay special attention to measuring, monitoring and reporting negative outcomes of prevention programs in the future, so that we might learn more about which program elements interact with which contextual factors to cause harm to which groups of youth.

Integrated smoking cessation and binge drinking intervention for young adults: a pilot efficacy trial.

Alcohol consumption is strongly associated with cigarette smoking in young adults. The primary aim of this investigation was to complete a pilot evaluation of the efficacy of an integrated intervention that targets both cigarette smoking and binge drinking on the cigarette smoking and binge behavior of young adults at 6-month follow-up. Participants were 95 young adult (M=24.3; SD=3.5 years) smokers (≥1 cigarettes per day) who binge drink (≥1 time per month) and who were randomly assigned to standard treatment (n=47) involving six individual treatment visits plus eight weeks of nicotine patch therapy or the identical smoking cessation treatment integrated with a binge drinking intervention (integrated intervention; n=48). Using an intent-to-treat analysis for tobacco abstinence, at both 3 month end of treatment and 6 month follow-up, more participants who received integrated intervention were biochemically confirmed abstinent from tobacco than those who received standard treatment at 3 months (19% vs. 9%, p=0.06) and 6 months (21% vs. 9%, p=0.05). At 6 months, participants who completed the study and who received integrated intervention consumed fewer drinks per month (p<0.05) and number of binge drinking episodes per month (p<0.05) than those who received standard treatment. Preliminary data supports that integrated intervention enhances smoking cessation and reduces binge drinking compared to standard treatment.

Pilot of a computer-based brief multiple-health behavior intervention for college students.

OBJECTIVE: Given the documented multiple health risks college students engage in, and the dearth of effective programs addressing them, the authors developed a computer-based brief multiple-health behavior intervention. This study reports immediate outcomes and feasibility of a pilot of this program. PARTICIPANTS: Two hundred students attending a midsized university participated. METHODS: Participants were randomly assigned to the intervention or control program, both delivered via computer. Immediate feedback was collected with the computer program. RESULTS: Results indicate that the intervention had an early positive impact on alcohol and cigarette use intentions, as well as related constructs underlying the Behavior-Image Model specific to each of the 3 substances measured. Based on the implementation process, the program proved to be feasible to use and acceptable to the population. CONCLUSION: Results support the potential efficacy of the intervention to positively impact behavioral intentions and linkages between health promoting and damaging behaviors among college students.

Relationship between frequency and intensity of physical activity and health behaviors of adolescents.

BACKGROUND: While studies have determined the importance of physical activity in advancing health outcomes, relatively few have explored the relationship between exercise and various health behaviors of adolescents. The purpose of this study is to examine the relationship between frequency and intensity of physical activity and both health risk and health promoting behaviors of adolescents. METHODS: Data were collected from 822 students attending a large, diverse suburban high school in northeast Florida using a self-administered survey. Multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA) tests examined differences on mean health behavior measures on 3 exercise frequency levels (low, medium, and high) and 2 intensity levels (vigorous physical activity [VPA] and moderate physical activity [MPA]). RESULTS: Results showed adolescents engaged in high levels of VPA used marijuana less frequently (p = .05) and reported heavy use of marijuana less frequently (p = .03); consumed greater numbers of healthy carbohydrates (p < .001) and healthy fats in their diets (p < .001); used stress management techniques more frequently (p < .001); and reported a higher quality of sleep (p = .01) than those engaged in low levels of VPA. Fewer differences were found on frequency of MPA and health behaviors of adolescents. CONCLUSIONS: These findings suggest that adolescents who frequently participate in VPA may be less likely to engage in drug use, and more likely to participate in a number of health promoting behaviors. Longitudinal and experimental studies are needed to determine what role frequent VPA may play in the onset and maintenance of health enhancing and protecting behaviors among adolescent populations.

A brief image-based prevention intervention for adolescents.

The authors evaluated the efficacy of a brief image-based prevention intervention and assessed current drug use as a moderator of intervention effects. In a clinical trial, 416 high school-age adolescents were randomized to either the brief intervention or usual care control, with data collected at baseline and 3-month follow-up. The brief intervention consisted of a tailored in-person communication and a series of parent/guardian print materials based on the behavior-image model. Health behavior goal setting increased for participants receiving the brief intervention, with an effect size in the small range (d = 0.33). Overall effect sizes for cigarette smoking frequency and quantity and alcohol use frequency and quantity were small (ds = 0.16-0.21) and in favor of the brief intervention. However, adolescents reporting current substance use who received the brief intervention reduced their frequency and heavy use of alcohol, frequency and quantity of cigarette smoking, and reported fewer alcohol/drug problems, with larger effects ranging from small to approaching medium in size (ds = 0.32-0.43, ps < .01). This study suggests that brief image-based messages may increase health behavior goal setting and reduce substance use, particularly among drug-using older adolescents.

Quality of life of men with biochemical recurrence of prostate cancer.

This investigation evaluated the psychological needs of men (n = 28) with biochemical recurrence of prostate cancer. A mixed qualitative-quantitative approach was employed. The qualitative component consisted of focus groups and the quantitative component included administration of standardized measures assessing quality of life (QOL), anxiety, and mood. Participants reported substantial anxiety and other negative moods secondary to prostate cancer. Responses form the quantitative instruments suggest participants experience significant health problems specific to prostate cancer, while their general QOL is superior to other chronically ill medical populations. In contrast to the qualitative data, participants rated their mood as favorable on the quantitative measures. Data were used to guide development of a novel QOL intervention.

Brief multiple behavior interventions in a college student health care clinic.

PURPOSE: This study examined the effects of brief image-based interventions, including a multiple behavior health contract, a one-on-one tailored consultation, and a combined consultation plus contract intervention, for impacting multiple health behaviors of students in a university health clinic. METHODS: A total of 155 college students attending a major southern university were recruited to participate in a study evaluating a health promotion program titled Project Fitness during the fall 2005 and spring 2006. Participants were randomly assigned to one of three treatments as they presented at the clinic: 1) a multiple behavior health contract, 2) a one-on-one tailored consultation, or 3) a combined consultation plus contract intervention. Baseline and 1-month post-intervention data were collected using computer-assisted questionnaires in a quiet office within the student health clinic. RESULTS: Omnibus repeated-measures analyses of variance were significant for drinking driving behaviors, F(2,136) = 4.43, p = .01, exercise behaviors, F(5,140) = 6.12, p = .00, nutrition habits, F(3,143) = 5.37, p = .00, sleep habits, F(2,144) = 5.03, p = .01, and health quality of life, F(5,140) = 3.09, p = .01, with improvements on each behavior across time. Analysis of group-by-time interaction effects showed an increase in the use of techniques to manage stress, F(2,144) = 5.48, p = .01, and the number of health behavior goals set in the last 30 days, F(2,143) = 5.35, p = .01, but only among adolescents receiving the consultation, or consultation plus contract. Effect sizes were consistently larger across health behaviors, and medium in size, when both consult and contract were used together. CONCLUSIONS: Brief interventions using a positive goal image of fitness, and addressing a number of health habits using a contract and consultation strategy alone, or in combination, have the potential to influence positive changes in multiple health behaviors of college students attending a university primary health care clinic.

Expressive writing as a smoking cessation treatment adjunct for young adult smokers.

This investigation evaluated the efficacy of expressive writing as a treatment adjunct to a brief office smoking cessation intervention plus nicotine patch therapy in young adults. Participants aged 18-24 years were randomized to a brief office intervention (n=99) or to an expressive writing plus brief office intervention (n=97). Both conditions received four individual visits plus 6 weeks of nicotine patch therapy, which began on the quit date following the week 2 visit. Participants in the expressive writing plus brief intervention condition wrote for 2 consecutive days before and 3 consecutive days after the quit date. The brief office intervention group completed a control writing assignment. At end of treatment (week 8), biochemically confirmed 7-day point-prevalence abstinence for the expressive writing plus brief office intervention condition was significantly greater than for the brief office condition (33% vs. 20%, p=.043, OR=2.0, 95% CI=1.0-3.7, from a logistic regression adjusting for gender). At 24 and 52 weeks, abstinence rates were similar for the brief office intervention versus expressive writing plus brief office intervention (12% vs. 11% at 24 weeks; 11% vs. 11% at 52 weeks). The results suggest that expressive writing has promise as a smoking cessation treatment adjunct for young adults. Lengthier interventions or the use of boosters should be tested to extend treatment effects. However, participants reported a low level of enthusiasm for the expressive writing, which may be a barrier to implementing it over a longer time frame. Therefore, other modes of delivering expressive writing to young adult cigarette smokers should be explored.