Chad D. Jensen

Effectiveness of Motivational Interviewing Interventions for Adolescent Substance Use Behavior Change: A Meta-Analytic Review

OBJECTIVE This study was designed to quantitatively evaluate the effectiveness of motivational interviewing (MI) interventions for adolescent substance use behavior change. METHOD Literature searches of electronic databases were undertaken in addition to manual reference searches of identified review articles. Databases searched include PsycINFO, PUBMED/MEDLINE, and Educational Resources Information Center. Twenty-one independent studies, representing 5,471 participants, were located and analyzed. RESULTS An omnibus weighted mean effect size for all identified MI interventions revealed a small, but significant, posttreatment effect size (mean d = .173, 95% CI [.094, .252], n = 21). Small, but significant, effect sizes were observed at follow-up suggesting that MI interventions for adolescent substance use retain their effect over time. MI interventions were effective across a variety of substance use behaviors, varying session lengths, and different settings, and for interventions that used clinicians with different levels of education. CONCLUSIONS The effectiveness of MI interventions for adolescent substance use behavior change is supported by this meta-analytic review. In consideration of these results, as well as the larger literature, MI should be considered as a treatment for adolescent substance use.

Meta-analysis of motivational interviewing for adolescent health behavior: efficacy beyond substance use.

OBJECTIVE We sought to systematically review and meta-analyze the literature comparing motivational interviewing (MI) with a control condition for adolescent health behavior change. In the current article, we reviewed only studies targeting health behaviors other than substance use (e.g., sexual risk behavior, physical activity, diet). METHOD Systematic literature searches of PsycINFO, PubMed/Medline, and ERIC were conducted through June 2013. Databases were combined, and studies were screened for inclusion or exclusion. To be included in the current review, studies were required to (a) compare the efficacy of at least 1 session of MI intervention with a control condition using a between-groups design and (b) examine a non-substance-use health behavior in adolescents. Fifteen studies met criteria for inclusion and were described qualitatively and quantitatively. RESULTS Using a fixed-effects model, we found that MI interventions produced a small, but significant, aggregate effect size for short-term postintervention effects-g = .16; 95% confidence interval (CI) [.05, .27]-compared with control conditions. Moreover, this effect was sustained at follow-up assessments averaging 33.6 weeks postintervention, n = 8, g = .18, 95% CI [.05, .32]. CONCLUSIONS MI interventions for adolescent health behavior appear to be effective. In addition, the magnitude of the aggregate effect size does not appear to differ meaningfully from reports of interventions targeting only substance use in adolescents. However, significant lack of clarity exists regarding interventionist training requirements necessary to ensure intervention effectiveness.

Predictors of attendance in a practical clinical trial of two pediatric weight management interventions.

The objective of this study was to evaluate demographic and psychosocial predictors of attendance in a family‐based behavioral weight management clinical trial. Ninety‐three children and adolescents aged 7–17 (Mean age = 11.59, s.d. = 2.6) who were either overweight or obese (Mean BMI percentile = 98.2) and their parents received either a 10‐session behavioral treatment or a three‐session brief family intervention in the context of a randomized clinical trial (10). Psychosocial and anthropometric measures were obtained before enrollment and at the end of 10 weeks for both treatment groups. Univariate linear regression and hierarchical multiple regression analyses were used to identify predictors of attendance to treatment from an a priori set of hypothesized predictors. Three variables demonstrated significant associations with the dependent variable, percent of treatment sessions attended. Specifically, distance from participants home to treatment site, lower gross family income, and youth self‐report of depressive symptoms were each associated with lower percent attendance (all Ps < 0.05). These results corroborate (i.e., income, depressive symptoms) and expand (i.e., distance from treatment site) previous reports in the literature of potential barriers to effective treatment for pediatric obesity, and suggest the need for research on treatment delivery methods that could increase participation among low‐income families (e.g., eHealth, mHealth options). Depressive symptoms could represent an additional barrier to treatment attendance, suggesting that assessment and treatment for these symptoms may be appropriate before commencing weight management treatment.

An Evaluation of a Personal Electronic Device to Enhance Self-Monitoring Adherence in a Pediatric Weight Management Program using a Multiple Baseline Design

OBJECTIVE To examine the effectiveness of a personal electronic device (PED) in order to improve adherence to self-monitoring of dietary intake and physical activity. METHOD The impact of a PED on adherence to self-monitoring goals was examined in a multiple baseline design across three overweight adolescents. During baseline, a traditional paper-and-pencil method of self-monitoring was utilized. The subsequent study phase introduced a PED for self-monitoring. Percent self-monitoring goal attainment was the outcome of interest. RESULTS During baseline, attainment of self-monitoring goals was low for all three participants (3-4%). Each subjects percent attainment of self-monitoring goal increased upon the introduction of the PED. For two of the three subjects this increase was stable (~75 and 100%) post-intervention. For the third subject the increase in percent attainment of self-monitoring goal was more variable but remained above baseline levels. CONCLUSION PEDs have potential for improving self-monitoring in the context of behavioral weight management treatment for adolescents.

Negative Attitudes Toward Physical Activity: Measurement and Role in Predicting Physical Activity Levels Among Preadolescents

OBJECTIVES To describe the development and validation of a measure of negative attitudes toward physical activity and examine the association between these attitudes and self-reported physical activity among preadolescents. METHOD A school-based sample of 382 fifth and sixth graders (mean age = 10.8) completed measures of attitudes toward physical activity and self-reported physical activity. Body mass index data for the participants was collected as a part of a standard school health assessment. Exploratory factor analysis, confirmatory factor analysis, and structural equation modeling were utilized to test the factor structure and predictive value of attitudes toward physical activity. RESULTS Results supported the reliability and concurrent validity of the negative attitudes measure and found a significant association between negative attitudes and physical activity. Negative attitudes was found to be a stronger predictor of physical activity than positive attitudes, which have been the focus of previous research in this area. CONCLUSIONS The results suggest that negative attitudes toward physical activity can be reliably measured and may be an important target for intervention efforts to increase physical activity among children and adolescents.

Weight-related Criticism and Self-perceptions among Preadolescents

OBJECTIVE To examine the relationships among weight-related criticism (WRC), body size perceptions, and body size dissatisfaction among a sample of preadolescent children. METHOD A community sample of 382 fifth and sixth graders (M age = 10.8) completed measures of WRC, nonweight-related criticism (NWRC), body size perceptions, body size dissatisfaction, and general self-esteem. Body mass index for each participant was collected during a standard school assessment. RESULTS WRC was a significant and unique predictor of body size perceptions and body size dissatisfaction, controlling for actual BMI percentile and NWRC. Weight status moderated these relationships, with significant effects for WRC found only in the overweight group. NWRC was a significant predictor of self-esteem. DISCUSSION The results suggest that WRC is specifically and uniquely associated with preadolescent childrens body self-perceptions beyond its association with general, nonweight-related victimization. Prevention efforts may be needed to limit WRC and its potentially harmful effects.

Functional brain response to food images in successful adolescent weight losers compared with normal‐weight and overweight controls

Research conducted with adults suggests that successful weight losers demonstrate greater activation in brain regions associated with executive control in response to viewing high‐energy foods. No previous studies have examined these associations in adolescents. Functional neuroimaging was used to assess brain response to food images among groups of overweight (OW), normal‐weight (NW), and successful weight‐losing (SWL) adolescents.

Parent- and Youth-Reported Illness Uncertainty: Associations With Distress and Psychosocial Functioning Among Recipients of Liver and Kidney Transplantations

The purpose of this study is to examine the associations between parent- and child-reported illness uncertainty and psychosocial functioning among solid organ transplant recipients. Youths who received liver or kidney transplantations and their caregivers completed measures of illness uncertainty, youth depressive symptoms, youth anxiety, and youth psychosocial functioning. Regression analyses indicated that youth-reported uncertainty was associated with both youth-reported depressive symptoms and anxiety and with parent-reported adaptive functioning and behavioral functioning. Parent-reported uncertainty was associated with parent-reported overall behavioral functioning, adaptive functioning, and internalizing problems. Results extend previous findings regarding illness uncertainty, and suggest that educational interventions to reduce uncertainty might be of benefit to families.

Longitudinal Associations Between Teasing and Health-related Quality of Life Among Treatment-seeking Overweight and Obese Youth

OBJECTIVES To examine concurrent and prospective associations between perceptions of teasing and health-related quality of life (HRQOL) over the course of a behavioral/educational intervention and the subsequent year in a sample of overweight and obese children and adolescents. METHOD A clinical sample of 93 overweight or obese youths (ages 7-17 years) and 1 parent/guardian completed measures of teasing and HRQOL at pre- and posttreatment and follow-up assessments. Structural equation modeling was used to examine the factor structure of the measures and to assess prospective associations over a 15-month period. RESULTS Results indicate that, concurrently, weight-related teasing is inversely associated with HRQOL and that, prospectively, HRQOL is inversely associated with subsequent teasing. CONCLUSIONS Study findings are suggestive of a directional relationship with lower quality of life predicting subsequent higher levels of teasing. Results suggest the potential for interventions designed to improve HRQOL to reduce teasing experiences for overweight and obese youth.

Validation of the Perceptions of Teasing Scale (POTS) in a Preadolescent Sample: Associations With Attitudes Toward Physical Activity

This study investigated the construct validity of the Perceptions of Teasing Scale (POTS) in a sample of 381 preadolescent children (mean age = 10.8 years). Children completed the POTS and self-report measures of attitudes toward physical activity (PA). Anthropometric data were collected as a part of a standard school health assessment. Confirmatory factor analysis and structural equation modeling supported the validity of the POTS. Children who experienced more teasing about abilities and competency reported increased negative attitudes and fewer positive attitudes toward PA. Children who reported more appearance-related teasing endorsed more negative attitudes about PA. Results indicate that the POTS is a valid measure of teasing among preadolescent children and that teasing may be an important target for prevention and intervention efforts to increase PA among children.