Lori A. J. Scott-Sheldon

Computer-delivered interventions for health promotion and behavioral risk reduction: a meta-analysis of 75 randomized controlled trials, 1988-2007.

OBJECTIVEnThe use of computers to promote healthy behavior is increasing. To evaluate the efficacy of these computer-delivered interventions, we conducted a meta-analysis of the published literature.nnnMETHODnStudies examining health domains related to the leading health indicators outlined in Healthy People 2010 were selected. Data from 75 randomized controlled trials, published between 1988 and 2007, with 35,685 participants and 82 separate interventions were included. All studies were coded independently by two raters for study and participant characteristics, design and methodology, and intervention content. We calculated weighted mean effect sizes for theoretically-meaningful psychosocial and behavioral outcomes; moderator analyses determined the relation between study characteristics and the magnitude of effect sizes for heterogeneous outcomes.nnnRESULTSnCompared with controls, participants who received a computer-delivered intervention improved several hypothesized antecedents of health behavior (knowledge, attitudes, intentions); intervention recipients also improved health behaviors (nutrition, tobacco use, substance use, safer sexual behavior, binge/purge behaviors) and general health maintenance. Several sample, study and intervention characteristics moderated the psychosocial and behavioral outcomes.nnnCONCLUSIONnComputer-delivered interventions can lead to improved behavioral health outcomes at first post-intervention assessment. Interventions evaluating outcomes at extended assessment periods are needed to evaluate the longer-term efficacy of computer-delivered interventions.

Computer-delivered interventions to reduce college student drinking: a meta-analysis

AIMSnThis meta-analysis evaluates the efficacy of computer-delivered interventions (CDIs) to reduce alcohol use among college students.nnnMETHODSnWe included 35 manuscripts with 43 separate interventions, and calculated both between-group and within-group effect sizes for alcohol consumption and alcohol-related problems. Effects sizes were calculated for short-term (< or =5 weeks) and long-term (> or =6 weeks) intervals. All studies were coded for study descriptors, participant characteristics and intervention components.nnnRESULTSnThe effects of CDIs depended on the nature of the comparison condition: CDIs reduced quantity and frequency measures relative to assessment-only controls, but rarely differed from comparison conditions that included alcohol-relevant content. Small-to-medium within-group effect sizes can be expected for CDIs at short- and long-term follow-ups; these changes are less than or equivalent to the within-group effect sizes observed for more intensive interventions.nnnCONCLUSIONSnCDIs reduce the quantity and frequency of drinking among college students. CDIs are generally equivalent to alternative alcohol-related comparison interventions.

Interventions to reduce sexual risk for human immunodeficiency virus in adolescents: a meta-analysis of trials, 1985-2008.

OBJECTIVEnTo provide an updated review of the efficacy of behavioral interventions to reduce sexual risk of human immunodeficiency virus (HIV) among adolescents.nnnDESIGNnWe searched electronic databases, leading public health journals, and the document depository held by the Synthesis of HIV/AIDS Risk Reduction Project. Studies that fulfilled the selection criteria and were available as of December 31, 2008, were included.nnnSETTINGnStudies that investigated any behavioral intervention advocating sexual risk reduction for HIV prevention, sampled adolescents (age range, 11-19 years), measured a behavioral outcome relevant to sexual risk, and provided sufficient information to calculate effect sizes.nnnPARTICIPANTSnData from 98 interventions (51,240 participants) were derived from 67 studies, dividing for qualitatively different interventions and gender when reports permitted it.nnnMAIN OUTCOME MEASURESnCondom use, sexual frequency, condom use skills, interpersonal communication skills, condom acquisition, and incident sexually transmitted infections (STIs).nnnRESULTSnRelative to controls, interventions succeeded at reducing incident STIs, increasing condom use, reducing or delaying penetrative sex, and increasing skills to negotiate safer sex and to acquire prophylactic protection. Initial risk reduction varied depending on sample and intervention characteristics but did not decay over time.nnnCONCLUSIONSnComprehensive behavioral interventions reduce risky sexual behavior and prevent transmission of STIs. Interventions are most successful to the extent that they deliver intensive content.

Stress Management Interventions for HIV+ Adults: A Meta-Analysis of Randomized Controlled Trials, 1989 to 2006

OBJECTIVEnNumerous studies document that stress accelerates disease processes in a variety of diseases including HIV. As a result, investigators have developed and evaluated interventions to reduce stress as a means to improve health among persons living with HIV. Therefore, the current meta-analysis examines the impact of stress-management interventions at improving psychological, immunological, hormonal, and other behavioral health outcomes among HIV+ adults.nnnDESIGNnThis meta-analytic review integrated the results of 35 randomized controlled trials examining the efficacy of 46 separate stress management interventions for HIV+ adults (N=3,077).nnnMAIN OUTCOME MEASURESnEffect sizes were calculated for stress processes (coping and social support), psychological/psychosocial (anxiety, depression, distress, and quality of life), immunological (CD4+ counts and viral load), hormonal (cortisol, dehydroepiandrosterone sulfate [DHEA-S], cortisol/DHEA-S ratio, and testosterone) and other behavioral health outcomes (fatigue).nnnRESULTSnCompared to controls, stress-management interventions reduce anxiety, depression, distress, and fatigue and improve quality of life (d+s=0.16 to 0.38). Stress-management interventions do not appear to improve CD4+ counts, viral load, or hormonal outcomes compared with controls.nnnCONCLUSIONnOverall, stress-management interventions for HIV+ adults significantly improve mental health and quality of life but do not alter immunological or hormonal processes. The absence of immunological or hormonal benefits may reflect the studies limited assessment period (measured typically within 1-week postintervention), participants advanced stage of HIV (HIV+ status known for an average of 5 years), and/or sample characteristics (predominately male and White participants). Future research might test these hypotheses and refine our understanding of stress processes and their amelioration.

Face-to-face versus computer-delivered alcohol interventions for college drinkers: A meta-analytic review, 1998 to 2010

Alcohol misuse occurs commonly on college campuses, necessitating prevention programs to help college drinkers reduce consumption and minimize harmful consequences. Computer-delivered interventions (CDIs) have been widely used due to their low cost and ease of dissemination but whether CDIs are efficacious and whether they produce benefits equivalent to face-to-face interventions (FTFIs) remain unclear. Therefore, we identified controlled trials of both CDIs and FTFIs and used meta-analysis (a) to determine the relative efficacy of these two approaches and (b) to test predictors of intervention efficacy. We included studies examining FTFIs (N=5237; 56% female; 87% White) and CDIs (N=32,243; 51% female; 81% White). Independent raters coded participant characteristics, design and methodological features, intervention content, and calculated weighted mean effect sizes using fixed and random-effects models. Analyses indicated that, compared to controls, FTFI participants drank less, drank less frequently, and reported fewer problems at short-term follow-up (d(+)s=0.15-0.19); they continued to consume lower quantities at intermediate (d(+)=0.23) and long-term (d(+)=0.14) follow-ups. Compared to controls, CDI participants reported lower quantities, frequency, and peak intoxication at short-term follow-up (d(+)s=0.13-0.29), but these effects were not maintained. Direct comparisons between FTFI and CDIs were infrequent, but these trials favored the FTFIs on both quantity and problem measures (d(+)s=0.12-0.20). Moderator analyses identified participant and intervention characteristics that influence intervention efficacy. Overall, we conclude that FTFIs provide the most effective and enduring effects.

Alcohol and Risky Sexual Behavior among Heavy Drinking College Students

Multiple event-level methodology was used to examine the relation between risky sexual behavior and alcohol use among sexually active, heavy drinking college students (Nxa0=xa0221). Using a structured timeline followback interview, participants reported their sexual, alcohol, and drug use behaviors over a 3-month period. Over 2,700 vaginal or anal sexual events were reported from 177 participants. Overall, condom use was not associated with heavy or non-heavy alcohol consumption among those reporting both sexual events concurrent with heavy drinking and when no alcohol was consumed. Results from multilevel regression analyses revealed a more complex pattern. Among women, but not men, less condom use was associated with steady versus casual sexual partners, but partner type interacted with alcohol consumption such that less condom use occurred when heavy drinking preceded sex with steady partners. At the event-level, alcohol consumption among heavy drinking college students leads to risky sexual behavior but the relation differs by gender and partner type.

Health Behavior and College Students: Does Greek Affiliation Matter?

The college years offer an opportunity for new experiences, personal freedom, and identity development; however, this period is also noted for the emergence of risky health behaviors that place college students at risk for health problems. Affiliation with on-campus organizations such as fraternities or sororities may increase a students’ risk given the rituals and socially endorsed behaviors associated with Greek organizations. In this study, we examined alcohol and drug use, smoking, sexual behavior, eating, physical activity, and sleeping in 1,595 college students (nxa0=xa0265 Greek members, nxa0=xa01,330 non-Greek members). Results show Greek members engaged in more risky health behaviors (e.g., alcohol use, cigarette smoking, sexual partners, and sex under the influence of alcohol or drugs) than non-Greek members. Greek and non-Greek members did not differ in condom use, unprotected sex, eating, and physical activity behaviors. Implications for prevention and intervention strategies among Greek members are discussed.

Meta-Synthesis of Health Behavior Change Meta-Analyses

OBJECTIVESnWe integrated and compared meta-analytic findings across diverse behavioral interventions to characterize how well they have achieved change in health behavior.nnnMETHODSnOutcomes from 62 meta-analyses of interventions for change in health behavior were quantitatively synthesized, including 1011 primary-level investigations with 599,559 participants. Content coding suggested 6 behavioral domains: eating and physical activity, sexual behavior, addictive behaviors, stress management, female-specific screening and intervention behaviors, and behaviors involving use of health services.nnnRESULTSnBehavior change interventions were efficacious (mean effect sizes = 0.08-0.45). Behavior change was more evident in more recent meta-analyses; those that sampled older interventions and literatures or sampled more published articles; those that included studies that relied on self-report, used briefer interventions, or sampled fewer, older, or female participants; and in some domains (e.g., stress management) more than others (e.g., sexual behaviors).nnnCONCLUSIONSnInterventions improved health-related behaviors; however, efficacy varied as a function of participant and intervention characteristics. This meta-synthesis provides information about the efficacy of behavioral change interventions across health domains and populations; this knowledge can inform the design and development of public health interventions and future meta-analyses of these studies.

Behavioral Interventions for African-Americans to Reduce Sexual Risk of HIV: A Meta-Analysis of Randomized Controlled Trials

Context:African Americans constitute 13% of the US population yet account for nearly 50% of new HIV infections. Implementation of efficacious behavioral interventions can help reduce infections in this vulnerable population. Objectives:To examine the efficacy of behavioral interventions to reduce HIV for African Americans among 78 randomized controlled trials that sampled at least 50% African Americans (N = 48,585, 81% African American), measured condom use or number of sexual partners, and provided sufficient information to calculate effect sizes. Methods:Independent raters coded participant characteristics, design and methodological features, and intervention content. Weighted mean effect sizes, using both fixed- and random-effects models, were calculated; positive effect sizes indicated more condom use and fewer sexual partners. Results:Compared with controls, participants who received an HIV risk reduction intervention improved condom use at short-term, intermediate, and long-term assessments; change was better among men who have sex with men and people already infected with HIV, and when interventions provided intensive content across multiple sessions. Intervention participants reduced their number of sexual partners in interventions with intensive interpersonal skills training and in younger samples, especially at delayed intervals. Conclusions:Sexual risk reduction interventions for African Americans increased condom use without increasing the number of sexual partners. Translating these interventions and further enhancing them continue as a high priority.

Heart versus reason in condom use: implicit versus explicit attitudinal predictors of sexual behavior.

We test the hypothesis that explicit and implicit measures of attitudes would differentially predict deliberate versus spontaneous behavior in the domain of condom use. Students completed explicit attitudinal and thought-listing measures about using condoms and implicit measures using attitude priming and Implicit Association Test (IAT) procedures. An attitude IAT measured the association between condom images and affective images; a self-identity IAT measured association of condoms with the self. We predicted and found that condom use with main partners was predicted by explicit measures but not implicit measures; the opposite was true for condom use with casual partners. Although the attitude priming measure was not positively correlated with casual condom use, the IATs were. The patterns of relations, however, were unexpectedly complex, due to a strong decrease in IAT effects over time, and different IATs assessing unique attitudinal dimensions.