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TRANSCRIPT
Brief Prevention
Interventions: Targeting
Multiple Health Risks
Using Positive Images
http://preventionpluswellness.com
Barriers to Using Brief
Prevention Interventions
1. Lack of knowledge of research & practice
2. Lack of knowledge of theory
3. Status quo
4. Inaccurate beliefs
5. History of using untested programs
Barriers to Using Brief
Prevention Interventions
6. Need for briefer prevention interventions
7. Need to save resources
8. Need for practical solutions
9. Need to have broader & greater impact
10. Reality check
Today’s Talk Objectives
1) The Problem: Describe the epidemic of multiple,
co-occurring health risks among American youth.
2) The Theory: Describe the two components of the
Behavior-Image Model for developing brief,
integrated programs.
3) The Research: Present research evaluating
multiple outcomes from brief integrated
programs.
4) The Practice: List the four steps for implementing
brief integrated programs.
1. 66% of adolescents tried and 35% currently drink alcohol
2. One in 10 currently drive after drinking, and 22% ride with a drinking driver
3. Over 1 in 5 (21%) currently binge drink alcohol
4. 40% tried and 23% currently use marijuana
5. 41% tried and 23% currently smoke cigarettes
6. 18% have taken prescription drugs without a doctors script, while…
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Epidemiology of Youth Risks:
ATOD Use (CDC, 2014)
1. Only 27% of adolescents were physically
active for 60 minutes every day last week
2. 41% used a computer three or more hours a
day that was not for school work
3. Only 38% ate breakfast every day last week
4. Only 16% ate vegetables, and 22% ate fruit 3 or
more times a day
5. Only 13% drank three or more glasses of milk
last week, while 27% drank soda every day last
week
6. Only 32% got 8 hours of sleep on school
nights 6
Epidemiology of Youth Risks:
Chronic Disease Related
1. The majority of US youth (53%) experience
two or more co-existing risk behaviors, and
over a third (36%) experience three or more
(Fox, et al, 2010).
2. Many risk behaviors are established during
adolescence and increase throughout early
adulthood.
3. Many risk behaviors are interrelated and
share underlying risk/protective factors.
Multiple Co-Existing Risks among
Youth
Number of Co-existing Risk Behaviors
Among Adolescents N=1242
(3) 27.5%
(2) 21.5%
(1) 12.6%
(0) 4.1%
(4) 19.5%
(5) 9.3%
(6) 4.2%(7) 1.2%
Alcohol Use
• Injury
• Disease
• Death
• Social
problems
• Sadness
Compounded Effects of Interacting
Multiple Health Risks
Phy. Inactivity
• Injury
• Disease
• Death
• Social
problems
• Sadness
= ?
• BIM is a road map for developing brief, integrated
resiliency-based interventions emphasizing
positive behavior and self-identity content.
• BIM consists of two key components:
1. Targeting positive (appealing) social and future
images to link health risk and health
promoting/protective behaviors, and
2. Developing self-regulation skills to set and
achieve multiple health behavior goals.
The Behavior-Image Model (BIM)
• Image has a conceptual foundation in:
1. Social Cognitive Theory (Bandura, 1986).
2. Prototype/Willingness Model (Gibbons,
Gerrard, & Lane, 2003).
3. Developmental Psychology of Self-concept (Harter, 1999).
• The use of appealing images has a practical foundation in marketing and advertising communications.
Image in Theory & Practice
Analytical Heuristic
•Deliberative
information
processing and
decision-making
•Logical
•Uses reason and
scientific deliberation
Dual Processing Theories of Thinking
Affect Heuristic
• Intuitive information
processing and
decision-making
• Automatic,
instinctive and
experiential
• Uses affective-laden
images, narratives
and metaphors
1. BIM-based interventions provide feedback on youths’ concrete health behaviors and relations to images.
2. The discrepancy between these behaviors and social and future images are highlighted as possible goals.
3. Public commitment to goal setting is offered to reduce discrepancy in health promoting behaviors/images, and increase discrepancy in risk behaviors/images.
BIM as a Self-regulation Model
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BIM evolved from developing and testing
brief integrated interventions linking
ATOD prevention with health promotion:
1. SPORT PPW for adolescents,
2. InShape PPW for college aged adults,
3. SPORT 2 PPW, and
4. In God’s Image (IGI).
BIM & Brief Integrated Programs
604 high school students, with 3 and
12-month follow-up, randomized to:
1) brief integrated consult with
mailed flyer, or
2) wellness brochure control.
Older Adolescent Trial: II (Werch, et al., 2005)
Trial II
Entire Sample Drug Users
3-Month 12-Month 3-Month 12-Month
n=584 n=514 n=118 n=104
Effect Size Effect Size Effect Size Effect Size
Measure d d d d
Alcohol Use
30-Day Alcohol Frequency 0.31 0.58
30-Day Alcohol Quantity 0.32 0.57
30-Day Heavy Drinking 0.29 0.70 0.32
Alcohol Initiation
Length of Alcohol Use 0.30 0.20
Alcohol Initiation 0.37
Drug Use
30-Day Cigarette Freq. 0.21 0.26 0.49 0.44
30-Day Marijuana Freq. 0.45 0.38
Drug Initiation
Cigarette Initiation 0.34
Exercise Behavior
Vigorous Physical Activity 0.34
Moderate Physical Activity 0.23 0.43
Trial II
Entire Sample Drug Users
3-Month 12-Month 3-Month 12-Month
n=584 n=514 n=118 n=104
Effect Size Effect Size Effect Size Effect Size
Measure d d d d
215 high school students in Istanbul,
Turkey, with 3-month follow-up, randomized
to:
1) brief integrated consultation
translated into Turkish, or
2) no treatment control.
Cultural Translation Trial: IV (Ilhan, et al., under review)
Trial IV
Consult Control
n = 103 n = 112
pretest posttest pretest posttest
Measures M M M M p-value
Health Responsibility 15.98 17.01 15.70 15.96 .03
Physical Activity 14.36 15.50 13.89 14.44 .04
Nutrition 18.75 19.48 18.35 18.57 .02
Moderate Physical Activity 2.68 3.68 3.05 2.99 .01
Fruits & Vegetables Eaten 4.58 4.94 4.86 4.18 .02
Exercise Self-Efficacy 38.46 45.71 32.96 34.95 .002
303 college students,
with 3-month follow-up,
randomized to:
1) brief integrated
consult, or
2) standard care
materials control.
Young Adult Trial: II (Werch, et al., 2008)
Frequency of drinking
Heavy drinking
Driving after drinking
Quantity of using marijuana
Heavy use of marijuana
30-day moderate exercise
Sleep
Spiritual Health
Social Health
YA Trial IIConsult Control
n = 140 n = 143
pretest posttest pretest posttest
M M M M
2.56
1.91
0.64
1.54
1.46
4.32
3.29
2.40
2.34
2.36
1.72
0.50
1.41
1.33
4.52
2.83
1.91
1.96
2.57
1.86
0.56
1.55
1.48
4.72
3.20
2.09
1.90
2.72
2.01
0.71
1.73
1.58
4.46
3.08
2.15
2.01
Implementers ask youth to answer
screening survey questions about
their health and fitness habits.
Screens can be implemented to
youth individually or in a group.
Step #1: Screen Youth Health
Behaviors
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Screening has 2 goals:
1) Cue desired behaviors & related
positive images, and
2) Provide data for tailoring feedback
on both health enhancing & risk
habits, and setting goals.
Screening Goals
Implementers select the youth’s screen responses and then “reads” the brief one-on-one or group consultation feedback script.
Colorful slides highlight positive behaviors and positive image terms.
Step #2: Feedback and Positive
Image Communication
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• “Young people who engage in regular physical
activity tend to feel energetic, sleep better, and
look more active, fit and confident.”
Health Enhancing Behavior Gain
Framed (Benefits) Messages
“Alcohol use can get in the way of participating
in moderate exercise and achieving your fitness
goals of being in-shape, looking good, and
feeling fit and active.”
Health Risk Behavior Loss Framed
(Costs) Messages
“As your (Personal Trainer), I recommend
that you stay away from alcohol, cigarette
and drug use.
At the same time, get 30 minutes of
moderate physical on most days.
Together, these actions will help you to
be physically active, fit and in-shape.”
Recommendation Linking Health Enhancing
and Risk Behaviors with Positive Images
Youth set concrete goals for any of the
target health enhancing and risk behaviors
to achieve desired positive images
Youth make a public commitment to
achieving goals by signing a contract
The need to monitor goal attainment and
continue to revise goals over time is emphasized
Step #3: Setting Multiple Health
Behavior Goals
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Implementers can re-administer
the single-session program every
6-12 months as a booster.
Follow-up lessons can be
provided.
Step #4: Provide Follow-up or
Booster Strategies
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Summary
The Problem: Multiple, co-existing health
risks among the majority of youth
The Theory: The 2-component Behavior-
Image Model (i.e., images and goal setting)
The Research: Brief programs prevent
substance use while promoting healthy
habits
The Practice: 1) Screening, 2) Feedback, 3)
Multiple behavior goal setting, 4) Follow-
up
http://preventionpluswellness.com
(904) 472-5022
For More Information
on how you can help solve the epidemic of multiple health risks among youth
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