1. “Change is a process, not an event.” Prochaska Change Consultants
6/23/2018
“Change is a process, not an event.”
Multiple Behavior Interventions to Prevent Substance Use and Increase Energy Balance in Middle School Students
Janice M. Prochaska, Ph.D.
Prochaska Change Consultants

2. High School Study Authors
Mauriello LM, Ciavatta MM, Paiva AL, Sherman KJ, Castle PH,  Johnson JL, Prochaska JM. (2010). Results of a Multi-Media Multiple Behavior Obesity Prevention Program for Adolescents. Preventive Medicine, 51,
Funded by National Heart, Lung, and Blood Institute: Grant # R43 HL074482

3. Middle School Study Authors
Wayne F Velicer, PhD, Colleen A Redding, PhD, Andrea L Paiva, PhD, Leanne M Mauriello, PhD, Bryan Blissmer, PhD., Karin Oakley, MA, Kathryn S Meier, MPH, CHES, Steven F Babbin, MA, Heather McGee, MA, James O Prochaska, PhD, Caitlin Burditt, MCHES, Anne C Fernandez, MA. (2013). Multiple behavior interventions to prevent substance abuse and increase energy balance behaviors in middle school students. Translational Behavioral Medicine, online, January 24, 1-12.
Funded by NIDA grant DA

4. Transtheoretical Model (TTM)
Model of Intentional Behavior Change
Basis for developing interventions to promote health behavior change, to either:
Prevent risky behaviors
Acquire healthy behaviors 4

5. Integrated Approach to Multiple Behavior Change
One unifying theme ties health behaviors together throughout intervention
Participants get intervention on all 3 behaviors:
Increasing Physical Activity
Increasing Intake of Fruits + Vegetables
Limiting TV Time
Participants get interventions on 2 behaviors: smoking and alcohol

6. Integrated Multiple Behavior Change: Preventing Overweight & Obesity with Energy Balance
Early prevention on population-basis is key
Healthy lifestyle messages are important for everyone
Regardless of weight or Body Mass Index
Regardless of current behavior or health habits
Goal to help all youth either adopt or maintain healthier energy balance behaviors and prevent substance use
Stage-matched guidance + TTM tailoring increases relevance + acceptability

7. Target Behaviors
Physical Activity – getting at least 60 minutes of activity on at least 5 days/week
Fruit & Vegetable Intake – eating at least 5 servings of F & V each day
Limiting TV Time – watching no more than 2 hours of TV each day
No Smoking
No Alcohol Use

8. Tailored Feedback Messages Different Degrees of Tailoring
Combined different degrees of tailoring to fit sessions into classroom time available
Full TTM Tailoring (Physical Activity)
Feedback on ALL TTM constructs by Stage
Stage of Change
Pros & Cons
Self-efficacy
Processes of Change
Moderate TTM Tailoring (Fruit & Vegetable/TV Time)
Stage-Based Feedback (Fruit & Vegetable/TV Time)
Stage feedback ONLY
Optimal tailoring is an innovative approach to tailoring that includes tailoring on the most important TTM constructs for a particular stage, based on empirical decision making.
Reduces response burden while maximizing the potential effect of the feedback by addressing the behavior change constructs that account for the most variance.
Optimal tailoring allows participants to be treated for all three behaviors within a single class period.

17. Project BEST: Overview
Involving 20 Middle Schools throughout Rhode Island
Tracking the same students from 6th to 9th grade
A Multi-Media Individually-Tailored Computerized Laptop Intervention
Each session takes approximately minutes to complete
Addresses the National Health Standards for 6-8 Grades

18. Project BEST: Timeline
Year 1 – 6th Grade ( )
1 computerized assessment & 1 multimedia intervention
Year 2 – 7th Grade ( )
1 computerized assessment & 3 multimedia interventions
Year 3 – 8th Grade ( )
Year 4 – 9th Grade ( )
1 computerized assessment

19. Project BEST: Goals (Tobacco & Alcohol) 2. Energy Balance Promotion
1. Addictive Behavior Prevention
(Tobacco & Alcohol)
2. Energy Balance Promotion
(healthy diet, physical exercise & reduced TV time)

20. Retention N = 4151 at baseline
N = 3650 (87.9%) at 12 months (7th grade)
N = 2972 (71.6%) at 36 months (9th grade)
No differences between randomized groups

21. Middle Schools Baseline Behavioral Risks (% Pre-Action)
No differences between randomized groups at baseline
43.5% % %

22. Middle School Physical Activity (in P, C, PR): % Success – % A, M
*** EB group had > % than ABP group moving to AM at:
24 months (48.6% versus 36.1%; t(4122)=3.59, p<.001,d=.41), and
36 months (49.3% versus 37.3%; t (4122) = 3.39, p < .001,d = .39).

23. Middle School Fruit & Vegetable (in P,C, PR): % Success – % A, M
EB group >% than ABP moving to AM at:
12 months (27.7% versus 19.2%; t(6687)=3.46, p<.001, d=.38),
24 months (28.3% versus 18.0%; t (6687) = 4.15, p < .001,d = .46) and
36 months (24.9% versus 17.2%; t (6687) = 3.23, p < .01,d = .37).

24. Middle School TV Time (in P, C, PR): % Success – % A, M
EB group had > % than ABP group moving to AM at:
-12 months (38.3% versus 30.6%; t (5137) = 2.56, p < .05, d = .27)
-24 months (47.6% versus 37.2%; t (5137) = 3.20, p < .01, d = .34), and
-36 months (47.7% versus 39.1%; t (5137) = 2.60, p < .01, d = .28)

25. Middle School Physical Activity (in A, M): Stability
EB group > % than ABP group staying at AM at 36 months (73.4% versus 65.8%; t (5434) = 3.13, p < .01, d = .28).

26. Middle School TV Time (in A, M): Stability
EB group had > % than ABP group staying at AM at:
12 months (79.2% versus 70.0%; t (4383) = 2.70, p < .01, d = .39) and
36 months (77.6% versus 65.8%; t (4383) = 3.22, p < .01, d = .47).

27. Middle School Fruit & Vegetable (in A, M): Stability
EB group had > % than the ABP group staying at AM at:
12 months (57.9% versus 43.5%; t (2870) = 3.85, p < .001, d = .46),
24 months (58.3% versus 34.6%; t (2870) = 6.18, p < .001, d = .78), and
36 months(48.6% versus 34.8%; t (2870) = 3.55, p < .001, d = .45)

28. Middle School Multiple Behavior Impact
Evaluated Coaction between pairs of energy balance behaviors
Progress on one behavior led to progress on a second behavior
Significant Coaction between energy balance behavior pairs (PA + FV, FV + TV, PA + TV) at all timepoints for Energy Balance Behavior group only.

29. Middle School Treat multiple health behaviors
Impressive synergy in Treatment group
On average, Treatment group showed about 3.5 times more Coaction (progress to A/M on both behaviors) compared to other group

30. Baseline Stages of Acquisition among Nonusers
Acquisition Stage
Smoking
(n=4094)
Alcohol
(n=4018)
Acq. Precontemplation
99.0%
97.6%
Acq. Contemplation
0.4%
1.3%
Acq. Preparation
0.6%
0.9%

31. Baseline Cluster Membership within Acquisition Precontemplation
Alcohol
Most Protected %
Ambivalent %
Risk Denial %
High Risk - 2.0%
Smoking
Most Protected – 73.9%
Ambivalent %
Risk Denial - 8.9%
High Risk - 2.7%
Did replicate clusters, although distributions were less spread out in middle school compared to HS students (50% MP, 24% AM, 10% RD, 6% HR)

32. Alcohol Acquisition by Group
(aPC at BL -- n=3972)
Baseline
12 Months
24 Months
36 Months
BEST Treatment
0.00%
3.56%
7.03%
14.4%
Energy Balance
2.24%
4.31%
10.1%

33. Smoking Acquisition by Group
(aPC at Baseline -- n=4045)
Baseline
12 Months
24 Months
36 Months
BEST Treatment
0.00%
2.70%
6.13%
9.2%
Energy Balance
1.15%
3.86%
5.7%

35. Tailored to individuals…scaled to populations…driven by science and technology
For over 20 years, our mission has been to create evidence-based behavior change solutions that optimize population health and well-being.
For more information:
Kerry E. Evers, Ph.D.