Janet L. Johnson

A randomized clinical trial of a population- and transtheoretical model-based stress-management intervention

Stress has been associated with a variety of chronic and acute conditions and with higher use of health care services. This research reports on 18-month outcomes of a randomized clinical trial of a stress-management program based on the transtheoretical model (TTM; J. O. Prochaska & C. C. DiClemente, 1986). A national sample of 1,085 individuals participated (age range = 18-91 years, M = 55.33; 68.9% female, 31.1% male; 84.8% Caucasian; 15.2% non-Caucasian). Both the treatment and control groups received assessments at 0, 6, 12, and 18 months. In addition to the assessments, the treatment group received 3 individualized reports (0, 3, 6 months) and a manual. The 18-month assessment was completed by 778 individuals (72%). A random effects model indicated that participants completing the study in the treatment group had significantly more individuals reporting effective stress management at follow-up time points than did completers in the control group. Results also indicate that the intervention had significant effects on stress, depression, and specific stress-management behaviors. Results provide evidence for the effectiveness of this TTM population-based stress-management intervention.

Results of a multi-media multiple behavior obesity prevention program for adolescents.

BACKGROUND This study reports on effectiveness trial outcomes of Health in Motion, a computer tailored multiple behavior intervention for adolescents. METHODS Using school as level of assignment, students (n=1800) from eight high schools in four states (RI, TN, MA, and NY) were stratified and randomly assigned to no treatment or a multi-media intervention for physical activity, fruit and vegetable consumption, and limited TV viewing between 2006 and 2007. RESULTS Intervention effects on continuous outcomes, on movement to action and maintenance stages, and on stability within action and maintenance stages were evaluated using random effects modeling. Effects were most pronounced for fruit and vegetable consumption and for total risks across all time points and for each behavior immediately post intervention. Co-variation of behavior change occurred within the treatment group, where individuals progressing to action or maintenance for one behavior were 1.4-4.2 times more likely to make similar progress on another behavior. CONCLUSION Health in Motion is an innovative, multiple behavior obesity prevention intervention relevant for all adolescents that relies solely on interactive technology to deliver tailored feedback. The outcomes of the effectiveness trial demonstrate both an ability to initiate behavior change across multiple energy balance behaviors simultaneously and feasibility for ease of dissemination.

Transtheoretical-based bullying prevention effectiveness trials in middle schools and high schools

Background Bullying threatens the physical and mental well-being of students across a broad range of schools. Tailored interventions based on the Transtheoretical model and delivered over the Internet were designed to reduce participation in each of three roles related to bullying (bully, victim and passive bystander). Methods Effectiveness trials were completed in 12 middle schools and 13 high schools in the USA. A diverse sample of 1237 middle (6th–8th grade, with 45.1% in the 7th grade; ages 11–14) and 1215 high school (9th–11th grade, with 41.6% in the 9th grade; ages 14–17) students were available for analyses. Results Analyses showed significant treatment effects for both intervention groups when compared to control for both the middle and high school programs. Conclusions Given the relative ease of dissemination, these programs could be applied as stand-alone practices or as part of more intensive interventions.

Size, consistency, and stability of stage effects for smoking cessation.

In the transtheoretical model (TTM), the stage effect is one of the most important determinants of health behavior change. Randomly assigned to 1 of 11 treatment conditions were 4653 smokers. A total of 66 stage effects were possible with 6 for each of the 11 treatment groups. The results suggest that brief stage-matched interventions that help populations progress one stage could produce 75% more abstinence. Interventions that help populations progress two stages could produce 300% more abstinence. The results also support the importance of replicating the stage effects across treatment conditions and over time.

Enhancing Multiple Domains of Well-Being by Decreasing Multiple Health Risk Behaviors: A Randomized Clinical Trial

Tailored behavior change programs have proven effective at decreasing health risk factors, but the impact of such programs on participant well-being has not been tested. This randomized trial evaluated the impact of tailored telephone coaching and Internet interventions on health risk behaviors and individual well-being. Exercise and stress management were the primary health risks of interest; improvements in other health risk behaviors were secondary outcomes. A sample of 3391 individuals who reported health risk in the areas of exercise and stress management were randomly assigned to 3 groups: telephonic coaching that applied Transtheoretical Model (TTM) tailoring for exercise and minimal tailoring (stage of change) for stress management; an Internet program that applied TTM tailoring for stress management and minimal tailoring for exercise; or a control group that received an assessment only. Participants were administered the Well-Being Assessment and, at baseline, had relatively low well-being scores (mean, 60.9 out of 100 across all groups). At 6 months, a significantly higher percentage of both treatment groups progressed to the Action stage for exercise, stress management, healthy diet, and total number of health risks, compared to the control group. Both treatment groups also demonstrated significantly greater improvements on overall well-being and the domains of emotional health, physical health, life evaluation, and healthy behaviors. There were no differences between the groups for 2 well-being domains: basic access to needs and work environment. These results indicate that scalable, tailored behavior change programs can effectively reduce health risk and accrue to improved well-being for participants.

The Well-Being Assessment for Productivity A Well-Being Approach to Presenteeism

Objective: To develop a presenteeism assessment, the Well-Being Assessment for Productivity (WBA-P), that provides an informative evaluation of job performance loss due to well-being related barriers. Method: The WBA-P was developed using exploratory and confirmatory factor analysis using survey data from 1827 employed individuals. Evidence of criterion-related validity was established using multivariate analysis of variance across measures of health and well-being. Results: A hierarchical, two-factor model demonstrated good fit and included factors capturing productivity loss from personal reasons (WBA-PP) and work environment (WBA-PW). Significant interactions existed between these and previously validated presenteeism measures with respect to physical and emotional health, risk factors, and life evaluation. Conclusions: This initial psychometric evidence suggests that the WBA-P and its subscales are valid measures of presenteeism that capture actionable well-being–related performance barriers.

Efficacy and effectiveness trials: examples from smoking cessation and bullying prevention.

If health psychology is to maximize impacts on health, there will need to be a shift from relying primarily on efficacy trials to increasing reliance on effectiveness trials. Efficacy trials use homogeneous, highly motivated samples with minimal complications from a single setting receiving intensive treatments delivered under highly controlled conditions. Two effectiveness trials on bullying prevention illustrate the use of a heterogeneous population from multiple sites receiving a low intensity tailored treatment delivered under highly variable conditions. In spite of considerable noise the effectiveness trials produced robust results (odds ratios of about four) that bode well for population impacts under real-world dissemination.

Results of a Transtheoretical Model-Based Alcohol, Tobacco and Other Drug Intervention in Middle Schools

BACKGROUND Early use of alcohol, tobacco, and other drugs threatens the physical and mental well-being of students and continued use negatively affects many areas of development. An internet-based, tailored intervention based on the Transtheoretical Model of Behavior Change was delivered to middle school students to reduce alcohol, tobacco, and other drug use. This internet-based approach requires very little faculty and staff time, which is efficient given curricular demands. METHODS Twenty-two middle schools in the United States were matched and randomly assigned to either the intervention or control conditions (N=1590 students who had ever used substances). Participants received one pre-test assessment, three thirty-minute intervention sessions over three months, and two post-test assessments (3 and 14 months after pre-test, respectively). RESULTS Random effects logistic models showed significant treatment effects for the intervention group when compared to the control group at the 3-month post-test. CONCLUSIONS This program has the potential to be applied as stand-alone practice or as part of more intensive interventions to promote substance use cessation.

Development of an individual well-being scores assessment

BackgroundThis study describes the development and validation of an individual-level well-being assessment and scoring method (IWBS) adapted from the population-based Gallup-Healthways Well-being Index across six domains (physical health, emotional health, healthy behaviors, work environment, basic access and overall life-evaluation).MethodsExploratory analyses were conducted on half the sample (n = 2036) using principal component analyses (PCA) with varimax rotation and confirmatory factor analysis was conducted on the second half of the sample (n = 2100) using structural equation modeling to validate the measurement model found by the PCA.ResultsOptimal results in the exploratory sample were achieved for a seven-factor solution, accounting for 52.0% of the variance. All domains displayed adequate reliability, ranging from .42 to .79.ConclusionsThe IWBS met each of the criteria that were established for measurement development. Findings indicated that there was initial support for using the IWBS to assess well-being at the individual level. The IWBS has acceptable psychometrics of reliability, internal and external validity.

Testing stage effects in an ethnically diverse sample

The Transtheoretical Model (TTM) has been extensively validated in representative samples of adult smokers. Stage effects, i.e., the patterned relationships between Stage of Change (SOC) and other TTM variables, have been reported in a variety of samples. This study describes reliability data for the TTM variables and tests the stage effects with an ethnically diverse sample of 296 parents with young children. On the basis of theory and previous empirical evidence from a general population, it is possible to make quantitative predications about the magnitude of the expected effect sizes for the Decisional Balance, Situational Temptations, and Processes of Change subscales. For each variable, both a test of significance and a comparison with the expected effect sizes is reported. Results indicated significant stage differences for 8 of the 11 TTM subscales, and all quantitative predictions were confirmed. This study supports the use of TTM measures in an ethnically diverse sample.