Mary Beth Miller

Personalized feedback interventions for college alcohol misuse: an update of Walters & Neighbors (2005).

Personalized drinking feedback is an evidence-based and increasingly common way of intervening with high-risk college drinking. This article extends an earlier review by Walters and Neighbors (S. T. Walters & C. Neighbors, 2005, Feedback interventions for college alcohol misuse: What, why, and for whom? Addictive Behaviors, 30, 1168-1182) by reviewing the literature of published studies using personalized feedback as an intervention for heavy drinking among college students. This article updates and extends the original review with a more comprehensive and recent set of 41 studies, most of which were not included in the original article. This article also examines within-subject effect sizes for personalized feedback interventions (PFIs) for high-risk alcohol use and examines the content of PFIs more closely to provide insight on the most essential components that will guide the future development of feedback-based interventions. In general, PFIs appear to be reliably effective at reducing harmful alcohol misuse among college students. Some components are almost universally included (i.e., drinking profile and normative comparison), precluding inferences regarding their unique contribution. Significantly larger effect sizes were observed for interventions that included decisional balance, practical costs, and strategies to limit risks. The present research provides an important empirical foundation for determining the relative contribution of individual components and facets in the efficacy of PFIs.

A systematic review of treatment fatigue among HIV-infected patients prescribed antiretroviral therapy

HIV treatment requires lifelong adherence to medication regimens that comprise inconvenient scheduling, adverse side effects, and lifestyle changes. Antiretroviral adherence and treatment fatigue have been inextricably linked. Adherence in HIV-infected populations has been well investigated; however, little is known about treatment fatigue. This review examines the current state of the literature on treatment fatigue among HIV populations and provides an overview of its etiology and potential consequences. Standard systematic research methods were used to gather published papers on treatment fatigue and HIV. Five databases were searched using PRISMA criteria. Of 1557 studies identified, 21 met the following inclusion criteria: (a) study participants were HIV-infected; (b) participants were prescribed antiretroviral medication; (c) the article referenced treatment fatigue; (d) the article was published in a peer-reviewed journal; and (e) text was available in English. Only seven articles operationally defined treatment fatigue, with three themes emerging throughout the definitions: (1) pill burden; (2) loss of desire to adhere to the regimen; and (3) nonadherence to regimens as a consequence of treatment fatigue. Based on these studies, treatment fatigue may be defined as “decreased desire and motivation to maintain vigilance in adhering to a treatment regimen among patients prescribed long-term protocols.” The cause and course of treatment fatigue appear to vary by developmental stage. To date, only structured treatment interruptions have been examined as an intervention to reduce treatment fatigue in children and adults. No behavioral interventions have been developed to reduce treatment fatigue. Further, only qualitative studies have examined treatment fatigue conceptually. Studies designed to systematically assess treatment fatigue are needed. Increased understanding of the course and duration of treatment fatigue is expected to improve adherence interventions, thereby improving clinical outcomes for individuals living with HIV.

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.

Changes in Smoking Prevalence, Attitudes, and Beliefs Over 4 Years Following a Campus-Wide Anti-tobacco Intervention

Abstract Objective: The current study examined the effectiveness of an institutional intervention aimed at decreasing prevalence of tobacco use and exposure to smoke on campus over a 4-year period. Participants: Participants were undergraduate students (N = 4,947) enrolled at a large Midwestern university between 2007 and 2010. Methods: In 2008, tobacco use was banned on campus. Additionally, campus-wide tobacco cessation services and information were provided to all students. A self-report measure assessing demographics, smoking prevalence, attitudes, and smoke exposure was administered at baseline and at 3 time points over the following 3 years. Results: The percentage of more frequent smokers and less frequent smokers decreased across assessment points. The program appeared to be less effective for female smokers than male smokers. Further, a significant change in attitudes and secondhand smoke exposure was observed. Conclusions: It appears that a campus-wide tobacco ban is a well-accepted and effective prevention method for smoking. This study lends considerable support for efforts towards smoke-free campuses.

Which Nicotine Products Are Gateways to Regular Use?: First-Tried Tobacco and Current Use in College Students

BACKGROUND The potential for emerging tobacco products (ETPs) to be gateway products for further tobacco use among youth is of significant concern. PURPOSE To examine use of various nicotine-containing products on a tobacco-free college campus and whether the first product tried predicts subsequent tobacco use. METHODS Undergraduate students (N=1,304) at a large university completed an online survey of past/current use of cigarettes; smokeless tobacco (SLT); hookah; ETPs (dissolvables, snus, and electronic cigarettes); and nicotine replacement therapy (NRT). Data were collected from September 2012 to May 2013 and analyses were conducted from June to September 2013. Students were classified as single, dual, or poly tobacco users. RESULTS The sample consisted of 79.5% non-users, 13.8% single, 4.4% dual, and 1.5% poly users. Overall, 49.4% of participants reported trying a tobacco product. Hookah was the most tried product (38%), but cigarettes were most often the first product ever tried (51%). First product tried did not predict current tobacco use and non-use, but individuals who first tried SLT or cigarettes (rather than hookah or ETPs) were more likely to be poly tobacco users. Current tobacco users who first tried ETPs or hookah were largely non-daily users of hookah; current tobacco users who first tried cigarettes or SLT were largely non-daily or daily users of cigarettes/SLT. CONCLUSIONS Hookah and ETPs are increasingly becoming the first tobacco product ever tried by youth; however, uptake of ETPs is poor, unlike cigarettes and SLT, and does not appear to lead to significant daily/non-daily use of cigarettes and SLT.

What do college student drinkers want to know? Student perceptions of alcohol-related feedback

Despite major advances and success in finding effective interventions for problematic drinking among college students, personalized feedback interventions (PFIs) continue to include a range of components that vary widely across intervention trials. To facilitate research regarding which feedback components may be most effective, the present research provides preliminary evidence regarding student perceptions of and preferences for different types of feedback components. Undergraduate student drinkers (n = 397, 41% male) rated their affinity for and skepticism of 14 feedback components and identified the feedback components that they most preferred. The majority of students preferred information regarding descriptive normative comparisons and the practical costs of drinking, whereas few reported a desire to learn behavioral strategies to limit risk or didactic information. High-risk drinkers (n = 228) reported lower ratings for all feedback components than did low-risk drinkers, and men (n = 162, 41%) provided significantly lower ratings for all feedback components than did women. This is the first study to document student preferences for the different feedback components included in PFIs. The current study generates hypotheses regarding components that may increase the efficacy of current feedback interventions for high-risk drinking.

Pilot study examining the efficacy of an electronic intervention to promote HIV medication adherence

Widespread dissemination of current interventions designed to improve HIV medication adherence is limited by several barriers, including additional time and expense burdens on the health care systems. Electronic interventions could aid in dissemination of interventions in the clinic setting. This study developed and tested the feasibility and acceptability of a computer-based adaption of an empirically supported face-to-face adherence promotion intervention. HIV-positive individuals (N = 92) on antiretroviral therapy with self-reported adherence <95% were randomized to the electronic intervention + treatment as usual (TAU) or TAU only. Study outcome variables which included treatment self-efficacy and self-reported medication adherence were assessed at baseline and follow-up. Time × condition interaction effects in mixed model analysis of variance (ANOVAs) examined the differences in patterns of change in the outcome variables over time between the two groups. Participants in the electronic intervention condition reported higher levels of self-efficacy to adhere to their medication at follow-up compared to the control condition. Although nonsignificant, levels of adherence tended to improve over time in the intervention condition, while TAU adherence remained constant. This was the first study to investigate a single-session, computer-based adherence intervention. Results suggest that electronic interventions are feasible and this method may be effective at increasing self-efficacy and adherence among patients reporting suboptimal adherence levels.

Student service members/veterans on campus: Challenges for reintegration.

Many returning OIF/OEF/OND Veterans are seeking higher education in an effort to develop a meaningful career and financial stability. Evidence suggests that student service members/veterans (SSM/Vs) are experiencing less academic success than other students. The purpose of this review is to identify the unique challenges of SSM/Vs and evaluate current campus efforts to facilitate their retention and academic performance. With a focus on SSM/Vs attending colleges and universities, we obtained 57 peer-reviewed and 73 gray literature records published between 2001 and 2015. The current SSM/V literature contains an abundance of gray literature, and the empirical research tends to be limited by cross-sectional design and small sample sizes. SSM/Vs encounter significant personal and environmental challenges when transitioning from the military to college campuses. A variety of services have been developed to address the needs of the SSM/V population, but the efficacy of these services remains largely unknown. In conclusion, there is a clear need to provide education to faculty, students, and staff regarding the experiences of SSM/Vs. Efforts to enhance screening for, availability of, and SSM/V engagement in mental health services would also be beneficial, as would improved availability of and SSM/V access to academic support. All future programs designed to address the unique challenges of SSM/Vs in the academic environment should also be systematically implemented and evaluated.

The Inability of Self-affirmations to Decrease Defensive Bias Toward an Alcohol-Related Risk Message Among High-Risk College Students.

Abstract Objective: To examine the efficacy of a self-affirmation task in deterring college alcohol misuse and the importance of preexisting beliefs in predicting subsequent behavior change. Participants: Heavy-drinking undergraduates (N = 110) participated during the 2011–2012 academic year. Methods: Participants were randomized to complete an affirmation or control task before reading an alcohol risk message. Alcohol-related beliefs and behaviors were assessed. Participants completed a 2-week online follow-up assessing alcohol-related behaviors. Results: Both groups reported increased perceived problem importance, but neither group displayed changes in personal risk. Follow-up assessment revealed similar, significant declines in peak consumption in both groups, with no significant between-group differences. Preexisting beliefs accounted for 5% to 10% of variance in drinking outcomes. Conclusions: An affirmation task does not seem to decrease defensive processing or alter high-risk drinking behaviors among college students and should not be utilized in lieu of more effective strategies.

Drinking Location and Pregaming as Predictors of Alcohol Intoxication Among Mandated College Students

ABSTRACT Background: Both drinking location and pregaming have been associated with heavy alcohol use among college students, yet the manner by which they uniquely contribute to alcohol intoxication remains unclear. Objective: The current study examined the unique utility of drinking location and pregaming in predicting alcohol intoxication among college students who violated campus alcohol policy. Method: Between 2011 and 2012, mandated college students who reported drinking prior to their referral events (N = 212, 41% female, 80% White, Mage = 19.4 y) completed a computerized assessment of drinking location and related behaviors as part of larger research trial. Chi-squared statistics, t-tests, one-way analyses of covariance, and regression were used to examine study aims. Results: Participants were most likely (44%) to report drinking in off-campus housing prior to the referral event, and approximately half (47%) reported pregaming. Alcohol intoxication on the night of the referral event differed significantly as a function of both drinking location and pregaming, but pregaming did not moderate the association between drinking location and alcohol intoxication among mandated students. Female birth sex, pregaming, and drinking at either fraternities or off-campus housing predicted greater levels of alcohol intoxication on the night of the referral incident, while drinking in a residence hall/dorm predicted lower intoxication. Conclusions/Importance: Drinking location and pregaming are distinct predictors of alcohol intoxication among mandated college students. Future interventions may benefit from targeting both where and how college students consume alcohol.