Anne C. Fernandez

Measuring Mindfulness and Examining its Relationship with Alcohol Use and Negative Consequences

Mindfulness has been proposed as a useful adjunct to alcohol abuse treatment. However, very little research has examined the basic relationship between alcohol use and mindfulness. Inconsistency in definition and measurement of mindfulness across studies makes such research difficult to interpret and conduct. Therefore, the current research sought to validate an emerging mindfulness measure, the Five Facet Mindfulness Questionnaire (FFMQ), and examine its relationship with alcohol use and alcohol-related negative consequences among a sample of 316 college-aged adults. The purported factor structure of the FFMQ was examined using confirmatory factor analysis. Structural equation modeling was used to examine relations among mindfulness, alcohol use, and alcohol-related negative consequences. Consistent with past research, results supported the five-factor structure of the FFMQ. Structural equation modeling analyses revealed that two awareness-based factors of mindfulness were negatively related to alcohol use. After controlling for alcohol use, one acceptance-based factor (nonjudging of thoughts and feelings) was negatively related to alcohol-related consequences, and one awareness-based factor was positively related to consequences (all ps < .05). Effect sizes were small-medium. The results reported here inform the burgeoning development of mindfulness-based addiction treatment and provide additional psychometric validation of the FFMQ.

Brief motivational and parent interventions for college students: A randomized factorial study

OBJECTIVE Using a randomized factorial design, we examined the efficacy of a brief motivational intervention (BMI) and a parent-based intervention (PBI) as universal preventive interventions to reduce alcohol use among incoming college students. METHOD Participants (N = 1,014) were assessed prior to matriculation and at 10 months and 22 months postbaseline. Two-part latent growth modeling was used to simultaneously examine initiation and growth in heavy episodic drinking and alcohol-related consequences. RESULTS This study retained 90.8% (n = 921) of randomized students at the 10-month follow-up and 84.0% (n = 852) of randomized students at the 22-month follow-up. BMI participants were significantly less likely than non-BMI participants to initiate heavy episodic drinking and to begin experiencing alcohol-related consequences. Effect sizes were minimal at 10 months (Cohens h ranged from 0.02 to 0.07) and were small at 22 months (hs ranged from 0.15 to 0.22). A significant BMI x PBI interaction revealed that students receiving both the BMI and the PBI were significantly less likely to report the onset of consequences beyond the sum of the individual intervention effects (h = 0.08 at 10 months, and h = 0.21 at 22 months). Hypothesized direct BMI effects for reductions in heavy episodic drinking and consequences were not observed. Significant mediated effects via changes in descriptive norms were present for both growth and initiation of heavy episodic drinking and consequences. CONCLUSIONS To our knowledge, the current study is the first to provide support for BMI as a universal preventive intervention for incoming college students. Although hypothesized PBI main effects were not found, mediation analyses suggest future refinements could enhance PBI effectiveness.

Treated individuals who progress to action or maintenance for one behavior are more likely to make similar progress on another behavior: Coaction results of a pooled data analysis of three trials

OBJECTIVE This study compared, in treatment and control groups, the phenomena of coaction, which is the probability that taking effective action on one behavior is related to taking effective action on a second behavior. METHODS Pooled data from three randomized trials of Transtheoretical Model (TTM) tailored interventions (n=9461), completed in the U.S. in 1999, were analyzed to assess coaction in three behavior pairs (diet and sun protection, diet and smoking, and sun protection and smoking). Odds ratios (ORs) compared the likelihood of taking action on a second behavior compared to taking action on only one behavior. RESULTS Across behavior pairs, at 12 and 24 months, the ORs for the treatment group were greater on an absolute basis than for the control group, with two being significant. The combined ORs at 12 and 24 months, respectively, were 1.63 and 1.85 for treatment and 1.20 and 1.10 for control. CONCLUSIONS The results of this study with addictive, energy balance and appearance-related behaviors were consistent with results found in three studies applying TTM tailoring to energy balance behaviors. Across studies, there was more coaction within the treatment group. Future research should identify predictors of coaction in more multiple behavior change interventions.

Family and peer interventions for adults : Past approaches and future directions

Through the use of published literature and empirical research, the authors explore the differing conceptual frameworks, techniques, and effectiveness of various family interventions for change-resistant, substance-abusing adults. The 2 dominant programs in place to help families and friends deal with the addiction of an adult loved one are the Johnson Intervention and Al-Anon. Research on these 2 programs is presented, followed by an outline of promising alternative approaches. These include A Relational Intervention Sequence for Engagement, Community Reinforcement Training, Community Reinforcement and Family Training, Unilateral Family Therapy, and Pressures to Change. The effectiveness and appropriateness of these approaches in different situations are discussed. In addition, areas in need of further study are pointed out.

Computer-based HIV adherence promotion interventions: a systematic review: Translation Behavioral Medicine.

Researchers have instituted a range of methodologies to increase access to HIV adherence interventions. This article reviews studies published through January 2014 utilizing computer-based delivery of such interventions to persons living with HIV. A systematic review of five databases identified ten studies (three RCTs, three pilot studies, three feasibility studies, and one single-group trial) that met the inclusion criteria. Descriptions of the interventions’ content and characteristics are included. Interventions varied widely in terms of program structure, theoretical framework, and content. Only six studies reported medication adherence outcomes. Of these, four (five RCTS and one single group pre-post test) reported significant improvement in adherence using various measures, and two approached significance. Results suggest that computer-delivered adherence interventions are feasible and acceptable among both HIV-positive adolescents and adults. Definitive conclusions regarding clinical impact cannot be drawn due to the small number of adequately powered randomized trials in this review. Additional randomized controlled research is needed to draw inferences regarding intervention efficacy.

Evaluation of the Acceptability and Feasibility of a Computer-Tailored Intervention to Increase Human Papillomavirus Vaccination Among Young Adult Women

Abstract Objective: To examine acceptability and feasibility of a Transtheoretical Model (TTM)–based computer-tailored intervention (CTI) for increasing human papillomavirus (HPV) vaccination in college-aged women. Participants: Two hundred forty-three women aged 18–26 were recruited between February and May of 2011. Methods: Participants completed the intervention and a 14-item evaluation of intervention content and delivery. Results: Most participants had heard of HPV (91%), but the majority (57%) of participants were in Precontemplation for getting vaccinated. Eighty-nine percent of participants rated the CTI positively across all acceptability items, and 91% endorsed intention to get vaccinated after intervention. Although average ratings in each demographic subgroup were positive, Hispanic women and participants in more advanced stages of change rated the program more favorably than non-Hispanic and earlier-stage participants. Additionally, HPV knowledge was higher among white/non-Hispanic participants. Conclusions: Initial acceptability and feasibility data for this intervention are promising. Its computer-based, individually tailored format is state of the art and ideal for inexpensive dissemination.

Resilience in Organ Transplantation: An Application of the Connor-Davidson Resilience Scale (CD-RISC) With Liver Transplant Candidates.

End-stage liver disease (ESLD) is a chronic and debilitating condition associated with substantial psychological stress, morbidity, and mortality. The Connor–Davidson Resilience Scale (CD–RISC; Connor & Davidson, 2003) is a commonly used resilience measure. This research examined the validity of the CD–RISC among ESLD patients (N = 120) using exploratory factor analysis. Results supported a single-factor solution after removing poorly loading items. The CD–RISC also was correlated with measures of depression, anxiety, quality of life, social support, age, and cognitive ability, thus providing evidence to support its construct validity. Future research should confirm this factor structure and examine its predictive validity prior to widespread use among ESLD patients. This research represents the first step in this process and proposes an alternative version of the CD–RISC for this population.

Validation of Decisional Balance and Self-Efficacy Measures for HPV Vaccination in College Women

Purpose. Women younger than 25 years are at greatest risk for human papillomavirus (HPV) infection, including high-risk strains associated with 70% of cervical cancers. Effective model-based measures that can lead to intervention development to increase HPV vaccination rates are necessary. This study validated Transtheoretical Model measures of Decisional Balance and Self-Efficacy for seeking the HPV vaccine in a sample of female college students. Design. Cross-sectional measurement development. Setting. Online survey of undergraduate college students. Subjects. A total of 340 female students ages 18 to 26 years. Measures. Stage of Change, Decisional Balance, and Self-Efficacy. Analysis. The sample was randomly split into halves for exploratory principal components analyses (PCAs), followed by confirmatory factor analyses (CFAs) to test measurement models. Multivariate analyses examined relationships between constructs. Results. For Decisional Balance, PCA indicated two 4-item factors (Pros –α = .90; and Cons –α = .66). CFA supported a two-factor correlated model, χ2(19) = 39.33; p < .01; comparative fit index (CFI) = .97; and average absolute standardized residual statistic (AASR) = .03; with Pros α = .90 and Cons α = .67. For Self-Efficacy, PCA indicated one 6-item factor (α = .84). CFA supported this structure, χ2(9) = 50.87; p < .05; CFI = .94; AASR = .03; and α = .90. Multivariate analyses indicated significant cross-stage differences on Pros, Cons, and Self-Efficacy in expected directions. Conclusion. Findings support the internal and external validity of these measures and their use in Transtheoretical Model–tailored interventions. Stage-construct relationships suggest that reducing the Cons of vaccination may be more important for HPV than for behaviors with a true Maintenance stage.

Drinking Location and Pregaming as Predictors of Alcohol Intoxication Among Mandated College Students

ABSTRACT Background: Both drinking location and pregaming have been associated with heavy alcohol use among college students, yet the manner by which they uniquely contribute to alcohol intoxication remains unclear. Objective: The current study examined the unique utility of drinking location and pregaming in predicting alcohol intoxication among college students who violated campus alcohol policy. Method: Between 2011 and 2012, mandated college students who reported drinking prior to their referral events (N = 212, 41% female, 80% White, Mage = 19.4 y) completed a computerized assessment of drinking location and related behaviors as part of larger research trial. Chi-squared statistics, t-tests, one-way analyses of covariance, and regression were used to examine study aims. Results: Participants were most likely (44%) to report drinking in off-campus housing prior to the referral event, and approximately half (47%) reported pregaming. Alcohol intoxication on the night of the referral event differed significantly as a function of both drinking location and pregaming, but pregaming did not moderate the association between drinking location and alcohol intoxication among mandated students. Female birth sex, pregaming, and drinking at either fraternities or off-campus housing predicted greater levels of alcohol intoxication on the night of the referral incident, while drinking in a residence hall/dorm predicted lower intoxication. Conclusions/Importance: Drinking location and pregaming are distinct predictors of alcohol intoxication among mandated college students. Future interventions may benefit from targeting both where and how college students consume alcohol.

Latent growth classes of alcohol-related blackouts over the first 2 years of college.

Alcohol-related blackouts are common among college student drinkers. The present study extends prior work by examining latent growth classes of blackouts and several predictors of class membership. Participants (N = 709 college drinkers) completed a baseline survey at college entry and biweekly online assessments throughout freshman and sophomore years. Results revealed 5 latent growth class trajectories, reflecting varying experiences of blackouts at the beginning of college and differential change in blackouts over time. The largest class represented a relatively low-risk group (low decrease; 47.3%) characterized by endorsement of no or very low likelihood of blackouts, and decreasing likelihood of blackouts over time. Another decreasing risk group (high decrease; 11.1%) initially reported a high proportion of blackouts and had the steepest decrease in blackout risk over time. A small percentage showed consistently high likelihood of blackouts over time (high stable; 4.1%). The remaining 2 groups were distinguished by relatively moderate (moderate stable; 14.9%) and lower (low stable; 22.6%) likelihood of blackouts, which remained stable over time. Comparisons between classes revealed that students with greater perceived peer drinking, perceived peer approval of drinking, and enhancement motives upon entry to college tended to be in higher risk groups with consistent experiences of blackouts over time, whereas blackout likelihood decreased over time for students with greater conformity motives. Findings suggest that precollege preventive interventions may be strengthened by considering not only factors related to current risk for blackouts and other alcohol-related consequences, but also those factors related to persistence of these behaviors over time. (PsycINFO Database Record