Christopher C. Cushing

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.

A Meta-Analytic Review of eHealth Interventions for Pediatric Health Promoting and Maintaining Behaviors

OBJECTIVE The current study quantitatively evaluated the impact of eHealth interventions on pediatric health promoting and maintaining behaviors believed to impact the development or worsening of a physical disease and their associated outcomes. METHOD PsycINFO, PUBMED/MEDLINE, Educational Resources Information Center (ERIC), and reference sections of identified articles were searched. RESULTS An omnibus weighted mean effect size for all identified eHealth interventions revealed a small, but significant, effect (mean d = .118, 95% confidence interval [CI] = .066-.171). However, when considered independently, educational interventions demonstrated no significant effect on pediatric health behavior or health outcomes. Behavioral eHealth interventions produced relatively homogeneous effects that were small but significantly different from zero (mean d = .354, 95% CI = .232-.475). CONCLUSION eHealth interventions that incorporate behavioral methods (e.g., self-monitoring, goal setting, immediate feedback, contingency management) produce larger effect sizes for health behaviors and their associated outcomes than interventions that rely solely on education.

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.

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.

A Systematic Review: Is There an App for That? Translational Science of Pediatric Behavior Change for Physical Activity and Dietary Interventions

OBJECTIVE Systematically review and meta-analyze the pediatric literature on behavior-change techniques (BCT) as defined by Abraham & Michie (Health Psychology, 27, 379-387, 2008), and describe whether the most effective BCTs are incorporated in physical activity (PA) and dietary mobile apps. METHODS Randomized controlled trials (n = 74) targeting diet or PA were meta-analyzed. Metaregressions were used to determine which BCTs predict aggregate effect size (ES). iTunes™ apps were coded for presence/absence of BCTs that produce larger ES. RESULTS Modeling was the only predictor of PA ES in children (aged 6-13 years). Consequences for behavior, others approval, self-monitoring, intention formation, and behavioral contracting significantly predicted PA for adolescents. Modeling and social support predicted dietary ES in adolescents and children, respectively. Practice was also a significant predictor for children. A majority of effective strategies for children were not widely incorporated in apps; however, the picture is more optimistic for adolescents. CONCLUSIONS More collaboration is needed between pediatric psychologists and technologists to incorporate evidence-based BCTs into developmentally appropriate mobile apps.

Mobile Health Interventions for Improving Health Outcomes in Youth: A Meta-analysis

Importance Mobile health interventions are increasingly popular in pediatrics; however, it is unclear how effective these interventions are in changing health outcomes. Objective To determine the effectiveness of mobile health interventions for improving health outcomes in youth 18 years or younger. Data Sources Studies published through November 30, 2016, were collected through PubMed, Cumulative Index to Nursing and Allied Health Literature, Educational Resources Information Center, and PsychINFO. Backward and forward literature searches were conducted on articles meeting study inclusion criteria. Search terms included telemedicine, eHealth, mobile health, mHealth, app, and mobile application. Study Selection Search results were limited to infants, children, adolescents, or young adults when possible. Studies were included if quantitative methods were used to evaluate an application of mobile intervention technology in a primary or secondary capacity to promote or modify health behavior in youth 18 years or younger. Studies were excluded if the article was an unpublished dissertation or thesis, the mean age of participants was older than 18 years, the study did not assess a health behavior and disease outcome, or the article did not include sufficient statistics. Inclusion and exclusion criteria were applied by 2 independent coders with 20% overlap. Of 9773 unique articles, 36 articles (containing 37 unique studies with a total of 29 822 participants) met the inclusion criteria. Data Extraction and Synthesis Of 9773 unique articles, 36 articles (containing 37 unique studies) with a total of 29 822 participants met the inclusion criteria. Effect sizes were calculated from statistical tests that could be converted to standardized mean differences. All aggregate effect sizes and moderator variables were tested using random-effects models. Main Outcomes and Measures Change in health behavior or disease control. Results A total of 29 822 participants were included in the studies. In studies that reported sex, the total number of females was 11 226 (53.2%). Of those reporting age, the average was 11.35 years. The random effects aggregate effect size of mobile health interventions was significant (n = 37; Cohen d = 0.22; 95% CI, 0.14-0.29). The random effects model indicated that providing mobile health intervention to a caregiver increased the strength of the intervention effect. Studies that involved caregivers in the intervention produced effect sizes (n = 16; Cohen d = 0.28; 95% CI, 0.18-0.39) larger than those that did not include caregivers (n = 21; Cohen d = 0.13; 95% CI, 0.02-0.25). Other coded variables did not moderate study effect size. Conclusions and Relevance Mobile health interventions appear to be a viable health behavior change intervention modality for youth. Given the ubiquity of mobile phones, mobile health interventions offer promise in improving public health.

Quality of life assessment between laparoscopic appendectomy at presentation and interval appendectomy for perforated appendicitis with abscess: analysis of a prospective randomized trial

PURPOSE The current study examined the impact of immediate laparoscopic surgery vs nonoperative initial management followed by interval appendectomy for appendicitis with abscess on child and family psychosocial well-being. METHODS After obtaining Internal Review Board approval, 40 patients presenting with a perforated appendicitis and a well-formed abscess were randomized to surgical condition. Parents were asked to complete child quality of life and parenting stress ratings at presentation, at 2 weeks postadmission, and at approximately 12 weeks postadmission (2 weeks postoperation for the interval appendectomy group). RESULTS Children in the interval arm experienced trends toward poorer quality of life at 2 and 12 weeks postadmission. However, no group differences in parenting stress were observed at 2 weeks postoperation. At 12 weeks postadmission, participants in the interval condition demonstrated significant impairment in both frequency and difficulty of problems contributing to parenting distress. CONCLUSION Families experience significant parenting distress related to the childs functioning and disruption in the childs quality of life that may be because of the delay in fully resolving the childs medical condition. In addition, parents experience negative consequences to their own stress as a result of the delay before the childs appendectomy.

Aggregated N-of-1 Randomized Controlled Trials: Modern Data Analytics Applied to a Clinically Valid Method of Intervention Effectiveness

OBJECTIVE Aggregated N-of-1 randomized controlled trials (RCTs) combined with multilevel modeling represent a methodological advancement that may help bridge science and practice in pediatric psychology. The purpose of this article is to offer a primer for pediatric psychologists interested in conducting aggregated N-of-1 RCTs. METHODS An overview of N-of-1 RCT methodology is provided and 2 simulated data sets are analyzed to demonstrate the clinical and research potential of the methodology. RESULTS The simulated data example demonstrates the utility of aggregated N-of-1 RCTs for understanding the clinical impact of an intervention for a given individual and the modeling of covariates to explain why an intervention worked for one patient and not another. CONCLUSIONS Aggregated N-of-1 RCTs hold potential for improving the science and practice of pediatric psychology.

Systematic Review and Meta-Analysis of Health Promotion Interventions for Children and Adolescents Using an Ecological Framework

OBJECTIVE To evaluate and quantify the evidence for health promotion interventions in children and adolescents. METHOD 96 independent samples of smoking, physical activity, and diet studies were included. Outcomes included both objective and self-reports of health behavior, as well as proxy measures such as fitness. RESULTS The aggregated effect was significant (g = .20, 95% confidence interval [CI] = 0.08-0.32, n = 96). A significant effect of intervention was observed at approximately 1-year follow-up (g = .07, 95% CI = 0.02-0.14, n = 20). The greatest risk of bias was failure to blind outcome assessment, which occurred in 21% of studies. Most studies lacked sufficient detail to determine the quality of their randomization sequence (58%). Additional concerns about risk of bias for individual studies were minimal. Overall, the quality of this finding was moderate using the Grading of Recommendations Assessment, Development, and Evaluation criteria. CONCLUSION Health promotion interventions are effective for modifying health behavior; however, effect sizes are small.

Volitional and Accidental Nonadherence to Pediatric Inflammatory Bowel Disease Treatment Plans: Initial Investigation of Associations with Quality of Life and Disease Activity

OBJECTIVE To examine rates of volitional and accidental nonadherence, and explore potential differential associations of each with disease activity and quality of life (QOL), in pediatric patients with inflammatory bowel disease (IBD). METHODS One hundred families (100 parents, 78 adolescents) recruited from a large Midwestern childrens hospital reported on the childs medication nonadherence and QOL. Healthcare providers supplied disease activity ratings. RESULTS Most adolescents (73.1%) and parents (70.1%) reported engaging in accidental nonadherence, whereas a smaller group (35 and 30%, respectively) reported engaging in volitional nonadherence to the childs prescribed medication regimen. Frequency of accidental nonadherence was unrelated to disease activity or any specific QOL area examined, whereas greater frequency of volitional nonadherence was associated with greater disease activity and poorer parent reported psychosocial QOL. CONCLUSIONS Nonadherence and the relationship with disease severity and QOL may be more complex for children with IBD than understood through previous work.