Introduction: Unhealthy alcohol use is a substantial problem among college students and can lead to a variety of negative consequences. Commercially available web-based brief alcohol intervention (WBI) programs have demonstrated efficacy in a range of student groups and have been widely disseminated to colleges to address this issue. However, the majority of published WBI studies required participants to complete baseline research assessments (RA) about their alcohol use before the WBI and reactivity to the RA may have inflated WBI efficacy estimates in these studies. The present study tested whether there was an additive effect of RA administered online plus a WBI on alcohol consumption, alcohol consequences, and protective behaviors related to alcohol used in the past month compared to the effects of only a WBI. It was hypothesized that participants randomized to the RA+WBI condition would have significantly lower alcohol consumption in the past month, fewer alcohol-related problems, and use more protective behaviors related to alcohol consumption in the past month than participants randomized to the WBI only condition. Methods: Undergraduate students (n= 856) from universities in the United States and Canada were recruited for this online study. Seventy percent of the sample was female and 82% were Caucasian. The sample had a mean age was 20.0. Sixty four percent (n= 547) of participants who were randomized completed the WBI. Sixty-eight percent completed the one month follow up questionnaire. Results: Multiple regression analyses using 20 multiply imputed datasets revealed that there were no significant differences in groups at follow up on alcohol use measures, alcohol related problems, or protective behaviors used when controlling for variables with theoretical and statistical relevance to the models. A repeated measures analysis of covariance indicated that there was a significant decrease in peak estimated blood alcohol concentration from baseline to follow up, but no differential effect by randomization group. The results suggested there was a moderate effect of the WBI consistent with studies of WBI efficacy in the literature and that there were no substantial assessment reactivity effects. Discussion: The current study contributes to the literature by identifying an experimental condition under which assessment reactivity may not be present and does not appear to cloud the detection of WBI efficacy when measured within subjects. The results indicate that WBI researchers may be justified in conducting brief pretreatment research assessments online to collect information about participant alcohol use without biasing within subjects estimates of WBI efficacy. Universities using these programs may likely observe similar effect sizes to those reported in the literature, however effectiveness studies are warranted.

Master of Public Health / Public Health Interdepartmental Program / Emily Mailey / BACKGROUND: The high prevalence of physical inactivity in America is associated with the development of multiple chronic health conditions and a growing burden on the healthcare system, causing a public health crisis. An ineffective communication strategy regarding how and why people can be physically active may be partially to blame for this crisis. Messages coming from various sources, including physicians, the federal government, professional organizations, and the media, promote physical activity in a way that does not support the three key psychological needs of autonomy, competence, and relatedness described by the Self-Determination Theory (SDT). To address these deficiencies, the present study sought to compare the impact of brief online modules utilizing SDT-supportive strategies to promote autonomy and competence to information-based modules on participant levels of autonomous motivation, attitude, perceived behavioral control (PBC), and physical activity behavior. METHOD: Four online modules were developed for inactive adults ages 22-45 and were delivered over the course of four weeks via Qualtrics. Participants were randomized into the intervention (n=66) or control (n=66) condition, with the intervention modules including more autonomy-supportive content and recommendations to re-frame physical activity as a more feasible activity that one can benefit from immediately. Both groups completed modules relating to similar topics, including the benefits of physical activity, physical activity recommendations, barriers, and external influences. Repeated measures ANOVAs were utilized to examine changes in autonomous motivation, attitude, PBC, and physical activity behavior from pre-post intervention between groups. RESULTS: Participants from both groups reported an increase in autonomous motivation [F(1,66)=16.207, p=<.001], overall attitude towards physical activity [F(1,65)=4.726, p=.033], and PBC [F(1,66)=9.191, p=.002]. There was no significant change in physical activity behavior [F(1,68)=.122, p=.728] during the four-week pre-post assessment, and there were no significant differences detected between groups. CONCLUSION: A four-week online intervention positively impacted autonomous motivation, attitude, and perceived behavioral control regarding individual physical activity behavior. These findings suggest that implementing recommendations to re-frame physical activity through brief interactive and information-based modules could be an effective strategy to increase the psychological precursors of physical activity behavior. However, additional strategies may be necessary to translate psychological changes to physical activity behavior. Future interventions could benefit from identifying ways to increase the reach of the program and incorporating a longer follow-up to assess if the psychological changes are translated to behavior.

Background: Family-centered web-based lifestyle interventions have the potential to be a scalable and cost-effective strategy to promote physical activity for children. However, program engagement and attrition are key challenges facing self-guided web-based interventions. Human email-mediated support may be a solution to these challenges. Currently, there is a lack of research examining whether the addition of human email-mediated support to self-guided family-centered physical activity interventions can improve engagement and intervention effectiveness. Thus, a feasibility study is needed to further understand ways to enhance web-based intervention delivery. Objective: (i) Evaluate the feasibility (recruitment, attrition, engagement, satisfaction) of a human email-mediated support compared to a self-guided web-based intervention (ii) examine the potential efficacy of a human-supported versus self-guided web-based intervention in improving children’s physical activity and parental support behaviours. Methods: Children aged 8-12 years old who did not meet the Canadian physical activity guidelines were recruited. Families were allocated to either 10-week human email-mediated support or self-guided program. The programs were developed using the multi-process action control (M-PAC) framework. The programs provided information and interactive online activities targeting healthier lifestyle behaviours. The human support group received multiple weekly support emails as needed. The self-guided only received one generic email per week. Both parents and children completed validated questionnaires assessing physical activity and parental support behaviours pre- and post- 10-week intervention. Descriptive statistics were used to analyze recruitment rate, attrition and website engagement. Repeated measures analysis of variance (ANOVA) were used to evaluate intervention effectiveness. Post-program interviews were added to further explore program satisfaction. Results: Fifty-one families contacted the researcher and eighteen families completed follow-up measures. The overall recruitment rate over a 16-month period was 41% (21/51). The attrition for human email-mediated support and the self-guided group was 10% and 18.2%, respectively. The attrition for both groups was 14% (3/21). The human email-mediated support group showed a significantly higher login frequency (4.7±2.1 vs. 2.3±1.4, respectively; p = 0.02), percentage of core pages accessed (35.8±19.6 vs. 13.1±18.2, respectively; p = 0.02), and total time spent in minutes (180.6±110.6 vs. 108.8±88.1, respectively; p = 0.01). The human email-mediated support group was more satisfied with the program compared to the self-guided group (p < 0.05). Both human support and self-guided groups improved their informational and appraisal-emotional support (p < 0.01; ηp2 = 0.9), parent self-efficacy to support their child’s physical activity (p = 0.03; ηp2 = 0.27), and child physical activity confidence (p = 0.04; ηp2 = 0.26). Children in the human email-mediated group showed a greater increase in the children’s physical activity intrinsic motivation (p = 0.02; ηp2 = 0.34) than self-guided group following the intervention. Conclusions: Study recruitment was a challenge. The human email-mediated support group had a lower attrition rate and a higher engagement than the self-guided group. Both interventions showed potential efficacy in improving physical activity measures. A full-scale study is recommended to confirm findings. / Graduate

Since Web-based interventions have a significantly high rate of attrition ranging from 99.5% to 77.5%, the researcher employed an instrumental case study approach to understand compliance in a Web-portal. The specific issue for this study was attrition rates and how SCT constructs affected eating competence. Qualitative data provided ground zero insight to a complex issue that was further understood. To better understand the phenomenon, participants that registered for the 30-day study and the software developer were interviewed. All interviews (n=6) were transcribed and data from the transcriptions were transformed from dialogues, into categories, then themes, and finally into concepts. Five guidelines to keep attrition rates low was the outcome of the data analysis. Having a nation interested in the Internet and at the same time faced with an obesity epidemic seemed to be a good fit for researching a method to promote eating competence with interactive technology. Eating competence intertwines four components: (1) attitudes about eating and the enjoyment of food (2) accepting new food to add variety to your diet (3) being able to eat the right amount of food and (4) being able to manage food through proper planning, storing, preparing, and offering. With the above information extracted from the literature, it was determined, a serious enough problem existed to justify spending time, money and other resources to develop and implement an intervention. The theoretical framework supporting the development of the web portal is the social cognitive theory (SCT). In health promotion, the purpose of the SCT is to help people stay healthy through good self-management of health habits. This dissertation focused on four constructs: self-efficacy, behavioral capabilities, observational learning, and reinforcement to better understand how eating competence skills were enhanced and attrition rates lowered.

abstract: School bullying is a serious problem for children and adolescents, associated with a multitude of psychological and behavioral problems. Interventions at the individual level have primarily been social skills training for victims of bullying. However, investigators have had mixed results; finding little change in victimization rates. It has been suggested victims of school bullying have the social skills necessary to be effective in a bullying situation; however they experience intense emotional arousal and negative thoughts leading to an inability to use social skills. One intervention that has been getting increasing acknowledgement for its utility in the intervention literature in psychology is mindfulness. However, there has been no research conducted examining the effects of mindfulness meditation on victims of bullying. Therefore, the purpose of this study was to develop an online intervention for victims of bullying that utilizes the cutting-edge technique of mindfulness and to determine the efficacy of this intervention in the context of bullying victimization. Participants were 32 adolescents ages 11 to 14 identified by their school facilitators as victims of bullying. Repeated measures ANOVAs were used to assess the efficacy of the NMT program versus a treatment as usual (TAU) social skills program. Results revealed significant decreases in victimization and increases in mindfulness among both treatment groups from pre-test to follow-up and post-test to follow-up assessments. There were no differences found between the two treatment groups for mean victimization or mindfulness scores. Overall, the NMT program appears to be a promising online intervention for bullied teens. Directions for future research and limitations of this study were also discussed. / Dissertation/Thesis / Ph.D. Counseling Psychology 2013

Heavy/at-risk alcohol use among young adults is an important public health problem given its association with health risk behavior and negative consequences. Dual process models of self-control characterize heavy/at-risk alcohol use as a function of (1) automatic appetitive processes and (2) conscious control processes. While existing interventions typically focus on individuals’ conscious control processes, recent research has focused on targeting automatic appetitive processes directly through strategies such as Cognitive Bias Modification (CBM). Although there is some evidence that CBM may improve outcomes for patients in treatment for alcohol use disorder, there is less evidence for its efficacy among young adults. This has been attributed to utilizing CBM as a stand-alone intervention and recruiting samples with low motivation to change drinking in prior studies. To address these limitations, this study examined the efficacy of CBM as an adjunct to brief web-based motivational intervention among young adults interested in changing their drinking. Heavy drinkers, ages 18-34, were recruited through social media platforms and completed an online screener. Eligible participants (N = 81) completed baseline assessment and a web-based motivational intervention (NIAAA- Rethinking Drinking). Participants were randomized to one of two adjunct intervention conditions—CBM or SHAM (control)—that was completed following the motivational intervention and over 4 sessions in the ensuing week. Weekly number of drinks, weekend drinking, alcohol-related consequences, readiness to change, and implicit biases toward alcohol were measured at baseline, 1-week and 1-month follow-up. Intervention condition did not significantly predict the primary outcomes of weekly drinking or consequences at 1-month, controlling for sex. In addition, intervention condition was not associated with implicit bias toward alcohol at 1-week or 1-month follow-up, controlling for sex. Post-hoc analyses revealed the intervention may be differentially efficacious for individuals high, versus low, in readiness to change. Overall, this web based CBM intervention did not reduce drinking behavior, consequences, or implicit biases compared to SHAM. Future work should focus on alternative strategies to modify automatic processes to enhance motivational web-based interventions, particularly among individuals highly motivated to change their behavior.

Youthful indoor tanning as few as ten sessions can increase the risk of melanoma by two to four times with each additional session adding another 2 % to the risk. Recent research estimates that indoor tanning can be linked to approximately 450,000 cases of skin cancer annually in the USA, Europe, and Australia. Despite these risks, indoor tanning remains popular with adolescents. This study tested the efficacy of a web-based skin cancer prevention intervention designed to reduce indoor tanning motivations in adolescent females. A nationally representative sample of 443 female teens was enrolled from an online panel into a two-arm, parallel group design, randomized controlled trial. Treatment participants received an appearance-focused intervention grounded in established health behavior change models. Controls viewed a teen alcohol prevention website. Outcome variables included willingness and intentions to indoor tan, willingness to sunless tan, and measures of indoor tanning attitudes and beliefs. The intervention decreased willingness and intentions to indoor tan and increased sunless tanning willingness relative to controls. We also examined indirect mechanisms of change through intervening variables (e.g., indoor tanning attitudes, norms, positive and negative expectancies) using the product of coefficient approach. The web-based intervention demonstrated efficacy in changing adolescent indoor tanning motivations and improving their orientation toward healthier alternatives. Results from the intervening variable analyses give guidance to future adolescent skin cancer prevention interventions.

No description available.

BACKGROUND: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. OBJECTIVE: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. METHODS: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. RESULTS: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. CONCLUSIONS: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers. TRIAL REGISTRATION: ClinicalTrials.gov NCT04004260; https://clinicaltrials.gov/ct2/show/NCT04004260.