Using mHealth to Deliver Behavior Change Interventions Within Prenatal Care at Community Health Centers.

PURPOSE: To test an iPad-delivered multiple behavior tailored intervention (Healthy Pregnancy: Step by Step) for pregnant women that addresses smoking cessation, stress management, and fruit and vegetable consumption. DESIGN: A randomized 2 × 5 factorial repeated measures design was employed with randomization on the individual level stratified on behavior risk. Women completed three sessions during pregnancy and two postpartum at postdelivery months 1 and 4. SETTING: Women were recruited from six locations of federally funded health centers across three states. SUBJECTS: Participants (N = 335) were English- and Spanish-speaking women at up to 18 weeks gestation. INTERVENTION: The treatment group received three interactive sessions focused on two priority health behavior risks. The sessions offered individually tailored and stage-matched change strategies based on the transtheoretical model of behavior change. The usual care group received March of Dimes brochures. MEASURES: The primary outcome was the number of behavior risks. Stage of change and continuous measures for all behaviors also were assessed. ANALYSIS: Data were analyzed across all time points using generalized estimating equations examining repeated measures effects. RESULTS: Women in the treatment group reported significantly fewer risks than those in usual care at 1 month (.85 vs. 1.20, odds ratio [OR] = .70) and 4 months postpartum (.72 vs. .91, OR = .81). CONCLUSION: Healthy Pregnancy is an evidence-based and personalized program that assists pregnant women with reducing behavior risks and sustaining healthy lifestyle behaviors.

Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students.

This study examined the effectiveness of two transtheoretical model-tailored, computer-delivered interventions designed to impact multiple substance use or energy balance behaviors in a middle school population recruited in schools. Twenty middle schools in Rhode Island including sixth grade students (N=4,158) were stratified and randomly assigned by school to either a substance use prevention (decreasing smoking and alcohol) or an energy balance (increasing physical activity, fruit and vegetable consumption, and limiting TV time) intervention group in 2007. Each intervention involved five in-class contacts over a 3-year period with assessments at 12, 24, and 36 months. Main outcomes were analyzed using random effects modeling. In the full energy balance group and in subsamples at risk and not at risk at baseline, strong effects were found for physical activity, healthy diet, and reducing TV time, for both categorical and continuous outcomes. Despite no direct treatment, the energy balance group also showed significantly lower smoking and alcohol use over time than the substance use prevention group. The energy balance intervention demonstrated strong effects across all behaviors over 3 years among middle school students. The substance use prevention intervention was less effective than the energy balance intervention in preventing both smoking and alcohol use over 3 years in middle school students. The lack of a true control group and unrepresented secular trends suggest the need for further study.

An Internet-Based Computer-Tailored Intervention to Promote Responsible Drinking: Findings from a Pilot Test with Employed Adults.

This paper describes pilot test findings of an Internet-based, Transtheoretical Model-based, computer tailored intervention for adults who exceed national guidelines for low-risk drinking. In a pilot test, 166 adults recruited from worksites completed one session and evaluated the program. Pre and post assessments indicate intention to make behavioral changes. Importantly, 94.3% of participants indicated that they would recommend the program. Ratings were positive with the majority of participants 'agreeing' or 'strongly agreeing' with all 14 evaluation items. Feasibility was demonstrated by recruiting and engaging employed adults. This program is a cost-effective prevention program promoting responsible drinking to adults.

Results of a multi-media multiple behavior obesity prevention program for adolescents.

BACKGROUND: This study reports on effectiveness trial outcomes of Health in Motion, a computer tailored multiple behavior intervention for adolescents. METHODS: Using school as level of assignment, students (n=1800) from eight high schools in four states (RI, TN, MA, and NY) were stratified and randomly assigned to no treatment or a multi-media intervention for physical activity, fruit and vegetable consumption, and limited TV viewing between 2006 and 2007. RESULTS: Intervention effects on continuous outcomes, on movement to action and maintenance stages, and on stability within action and maintenance stages were evaluated using random effects modeling. Effects were most pronounced for fruit and vegetable consumption and for total risks across all time points and for each behavior immediately post intervention. Co-variation of behavior change occurred within the treatment group, where individuals progressing to action or maintenance for one behavior were 1.4-4.2 times more likely to make similar progress on another behavior. CONCLUSION: Health in Motion is an innovative, multiple behavior obesity prevention intervention relevant for all adolescents that relies solely on interactive technology to deliver tailored feedback. The outcomes of the effectiveness trial demonstrate both an ability to initiate behavior change across multiple energy balance behaviors simultaneously and feasibility for ease of dissemination.

Assessment of the pros and cons of stress management among adolescents: development and validation of a decisional balance measure.

PURPOSE: This article reports on the development of a decisional balance measure based on the transtheoretical model (TTM) for stress management among adolescents. DESIGN: Measurement development was conducted with participants of a pilot survey. SETTING: Surveys were completed in health and physical education classes. SUBJECTS: Ninth and tenth graders (N=317) completed an assessment of TTM constructs. MEASURES: The focus of this paper is the development of a decisional balance measure. ANALYSIS: A split-half cross-validation procedure was implemented. RESULTS: A brief reliable eight-item instrument was developed measuring the pros and cons of practicing stress management. A theoretically consistent pattern of pros and cons across the stages of change was obtained and indicated construct validity. Girls were more likely to practice and acknowledge benefits of stress management. CONCLUSION: This instrument will aid future work on promoting stress management practices among adolescents, particularly when using the TTM to develop interventions.

Using interactive behavior change technology to intervene on physical activity and nutrition with adolescents.

The use of interactive technologies to promote health behaviors is a rapidly expanding field. Yet, the integration of these technologies in the development of physical activity and nutrition interventions for adolescents is in its infancy. Health in Motion, a multimedia obesity-prevention program for adolescents, is described as a case example of a Web-based interactive program for promoting physical activity and fruit and vegetable consumption among high school students. Lessons gathered from existing programs are summarized and used to offer future direction for advancing the development of adolescent interventions in this field.

Acceptability of a school-based intervention for the prevention of adolescent obesity.

This article describes the development and pilot testing of a computer-based, multiple-behavior obesity prevention program for adolescents. Using the Transtheoretical Model as a framework, this intervention offers individualized feedback based on readiness to engage in physical activity, to consume fruits and vegetables, and to limit television viewing. Focus groups and interviews with students, teachers, school administrators, and experts guided the development. Forty-five students participated in a baseline intervention session and completed a 16-item acceptability measure. Ratings were positive, with item means ranging from 3.60-4.75 on a 5-point scale. Student responses to open-ended questions aided in the enhancement of the intervention, for which an effectiveness trial begins in September 2006. This formative work demonstrated the acceptability of this school-based intervention approach, which can be promoted and prescribed by school nurses. Further, if found effective, it can be disseminated as an efficient, low-cost, population-based approach designed to address the epidemic of obesity.

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention.

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.

Prevention profiles: Understanding youth who do not use substances.

This study replicates innovative profiles of prevention among students not using substances but who may be at different risks for acquisition. Using the Transtheoretical Model constructs of Decisional Balance and Temptations, cluster analyses were performed on four independent samples of students (n=1240) in the USA, England and Israel. For each sample, the same four distinct profiles emerged. ANOVAs indicated that the processes of prevention varied significantly across these profiles. The prevention profiles were extended to youth in Elementary, Middle, and High Schools and from a focus on single substances to multiple substances, including alcohol, tobacco, and illicit drugs. Implications for developing prevention programs are also discussed.