Jeffrey J. Milroy

Moving beyond the treatment package approach to developing behavioral interventions: addressing questions that arose during an application of the Multiphase Optimization Strategy (MOST)

ABSTRACTGiven current pressures to increase the public health contributions of behavioral interventions, intervention scientists may wish to consider moving beyond the classical treatment package approach that focuses primarily on achieving statistical significance. They may wish also to focus on goals directly related to optimizing public health impact. The Multiphase Optimization Strategy (MOST) is an innovative methodological framework that draws on engineering principles to achieve more potent behavioral interventions. MOST is increasingly being adopted by intervention scientists seeking a systematic framework to engineer an optimized intervention. As with any innovation, there are challenges that arise with early adoption. This article describes the solutions to several critical questions that we addressed during the first-ever iterative application of MOST. Specifically, we describe how we have applied MOST to optimize an online program (myPlaybook) for the prevention of substance use among college student-athletes. Our application of MOST can serve as a blueprint for other intervention scientists who wish to design optimized behavioral interventions. We believe using MOST is feasible and has the potential to dramatically improve program effectiveness thereby advancing the public health impact of behavioral interventions.

Developing a Web-Based Tool Using Information and Communication Technologies to Expand the Reach and Impact of Photovoice

Information and communication technologies are opening up vast new arenas for conducting the work of health promotion. Technology-based health promotions expand reach, standardize information and its delivery, provide opportunities for tailoring, create engaging interactivity within content delivery, provide for privacy and autonomy, improve portability, and lower delivery costs. This commentary describes the ongoing exploration and development of a web-based tool for enhancing the reach and impact of photovoice as a community change intervention. Features of the tool use information and communication technologies that integrate the use of an online learning management system, tailored messaging, gaming technology, interactive features, and the application of social medias power to increase the capacity of communities to employ comprehensive strategies to improve the health of their communities. It will enable individuals and groups to use photos and captions to assess the physical environment, social norms and behaviors of communities; raise community awareness of the factors contributing to ill-health in their communities, mobilize stakeholders, and inform environmental strategies and policy changes. We believe it will enhance the delivery of educational content about conducting photovoice projects, provide features unavailable without the application of information and communication technologies, and will be substantive advancement over existing photovoice resources.

Collaborative evaluation of a high school prevention curriculum: How methods of collaborative evaluation enhanced a randomized control trial to inform program improvement.

Blending high-quality and rigorous research with pure evaluation practice can often be best accomplished through thoughtful collaboration. The evaluation of a high school drug prevention program (All Stars Senior) is an example of how perceived competing purposes and methodologies can coexist to investigate formative and summative outcome variables that can be used for program improvement. Throughout this project there were many examples of client learning from evaluator and evaluator learning from client. This article presents convincing evidence that collaborative evaluation can improve the design, implementation, and findings of the randomized control trial. Throughout this paper, we discuss many examples of good science, good evaluation, and other practical benefits of practicing collaborative evaluation. Ultimately, the authors created the term pre-formative evaluation to describe the period prior to data collection and before program implementation, when collaborative evaluation can inform program improvement.

Synthetic Cannabinoid Use and Descriptive Norms among Collegiate Student-Athletes

ABSTRACT Synthetic cannabinoids have gained popularity over the past decade, especially among young adults, due to sharing similar psychoactive properties with Tetrahydrocannabinol (THC). A limited number of studies have examined synthetic cannabinoid use among college students but none have examined use exclusively by collegiate student-athletes. The objective of this study was to examine synthetic cannabinoid use among collegiate student-athletes. In the spring of 2013, 3,276 freshmen and transfer collegiate student-athletes from 47 NCAA Division I, II, and III institutions participated in a web-based survey on substance use. Bivariate logistic regression was used to analyze the relationship between collegiate student-athlete characteristics, substance use, and descriptive norms with lifetime use of synthetic cannabinoids. Sixty-two individuals (1.9%) reported lifetime use of synthetic cannabinoids, and 3 (0.1%) reported past-30-day use. Males, current drinkers, and athletes who used hookah and marijuana in the past 30 days were more likely to use synthetic cannabinoids. Peer use of synthetic cannabinoids was estimated to be higher than actual use, and such overestimation was positively associated with personal use of synthetic cannabinoids. Our findings suggest that campaigns addressing normative beliefs should be implemented on college campuses to prevent synthetic cannabinoid use among college students and collegiate student-athletes.

A University System-Wide Qualitative Investigation into Student Physical Activity Promotion Conducted on College Campuses:

Purpose. This study aimed to examine college student physical activity promotion. Design. A cross-sectional approach to qualitative research was used. Setting. Southeastern state university system. Participants. Fourteen of 15 (93%) universities recruited were included in this study; 22 university employees participated in a semistructured interview. Method. Nonprobabilistic purposive and snowball sampling strategies were used to recruit individuals who were likely to be engaged in physical activity promotion efforts on their respective campuses. Thematic analyses lead to the identification of emerging themes that were coded and analyzed using NVivo software. Results. Themes informed three main areas: key personnel responsible for promoting physical activity to students, actual physical activity promotion efforts implemented, and factors that influence student physical activity promotion. Results suggest that ecological approaches to promote physical activity on college campuses are underused, the targeting of mediators of physical activity in college students is limited, and values held by university administration influence campus physical activity promotion. Conclusion. Findings support recommendations for future research and practice. Practitioners should attempt to implement social ecological approaches that target scientifically established mediators of physical activity in college students. Replication of this study is needed to compare these findings with other types of universities, and to investigate the relationship between promotion activities (type and exposure) and physical activity behaviors of college students.

Going the Distance: Delivery of High School Drug Prevention via Distance Education.

Abstract The purpose of this project was to develop a technology that can be used in schools where there are insufficient resources to implement a quality drug prevention program. The specific technology—distance education via teleconferencing—allows a highly qualified teacher to deliver programs in such settings with increased quality. A promising high school drug prevention program, All Stars, Sr., was modified to be delivered using the latest technological advances in distance education. Student-level effects are reported across six mediating variables as well as past thirty-day and lifetime use of alcohol, tobacco, marijuana, ecstasy, and other illicit drugs.

Using the Multiphase Optimization Strategy (MOST) to Develop an Optimized Online STI Preventive Intervention Aimed at College Students: Description of Conceptual Model and Iterative Approach to Optimization

This chapter describes some aspects of an application of the multiphase optimization strategy (MOST) to optimize and evaluate itMatters, an online intervention that targets the intersection of alcohol use and sexual behaviors to reduce sexually transmitted infections (STIs) among college students. The chapter emphasizes two aspects of this application. First, we describe the development of a detailed conceptual model during the preparation phase of MOST. This conceptual model guided decisions such as the choice of outcome variables. Second, we describe an iterative approach to experimentation during the optimization phase of MOST. The objective of the iterative approach is to build a highly effective intervention by using repeated optimization trials to evaluate which intervention components meet a given criterion for effectiveness and which do not. Revisions are undertaken to improve the components that do not meet the criterion, and then a subsequent optimization trial is used to reevaluate the components. This iterative approach has the potential to enable the investigator to develop more effective, efficient, economical, and scalable interventions.

Implementing an Alcohol and Other Drug Use Prevention Program Using University–High School Partnerships: Challenges and Lessons Learned

Background: School-based alcohol and other drug use prevention remains an important national strategy. Collaborative partnerships between universities and high schools have the potential to enhance prevention programming; however, there are challenges to sustaining such partnerships. Purpose: The purpose of this commentary is to underscore challenges faced by health education practitioners when implementing and sustaining a university–high school partnership–based alcohol and other drug education program, emphasize strategies for addressing these challenges, and discuss implications for practice based on lessons learned. Three common themes emerged: (a) lack of regular face-to-face meetings, (b) novice implementation personnel, and (c) teacher turnover. Strategies for overcoming these challenges are presented in this commentary and discussed in detail. Translation to Health Education Practice: Program developers ought to consider lessons learned presented in this commentary to enhance and sustain university–high school partnerships in health promotion.

College Students' Perceived Wellness Among Online, Face-to-Face, and Hybrid Formats of a Lifetime Physical Activity and Wellness Course

Background: College students are vulnerable to risks associated with unhealthy behaviors. Considering the role that colleges play in facilitating lifelong health and wellness behaviors of college students, health-related fitness (HRF) courses are being offered using multiple delivery formats. Purpose: There is a need to better understand the relationship between course delivery format and perceived wellness; thus, the purpose of this study was to assess perceived wellness among college students who self-selected into various delivery formats of a required university HRF course. Methods: The Perceived Wellness Survey was used due to its previously established reliability and validity for college populations. Participants included 378 college students enrolled in a HRF course. Results: Students with higher perceived wellness were more likely to be enrolled in online and hybrid course formats rather than face to face. Discussion: The results of this study provide a better understanding of the perceived wellness of college students enrolled in various course delivery formats of a HRF course that go beyond that of demographic differences. Translation to Health Education Practice: With this information, those delivering HRF courses have the opportunity to capitalize on this trend by tailoring instructional activities accordingly.

Polysubstance Use Among First-Year NCAA College Student-Athletes

ABSTRACT The purpose of this article is to investigate polysubstance use among college student-athletes and determine whether use is independent of gender, race, season status, and athletic division. College student-athletes responded to questions related to their past-30-day use of alcohol, tobacco, marijuana, and prescription drugs. Findings suggest that polysubstance use differs significantly by gender, race, season status, and athletic division. Although a majority of college student-athletes do not engage in polysubstance use, it is reported more frequently for alcohol and tobacco, and alcohol and marijuana. Due to serious consequences associated with polysubstance use, practitioners should consider expanding prevention and treatment efforts to address polysubstance use.