6-month Post-intervention Follow-up Research Articles

Outcomes From a Randomized Trial of a Bilingual mHealth Social Media Intervention to Increase Care Engagement Among Young Gay, Bisexual, and Other Men Who Have Sex With Men and Transgender Women With HIV.

The North Carolina Community Research Partnership developed, implemented, and tested weCare, a 12-month bilingual mHealth social media intervention designed to reduce missed HIV care appointments and increase viral suppression among racially/ethnically diverse gay, bisexual, and other men who have sex with men (GBMSM) and transgender women living with HIV by harnessing established social media platforms (i.e., Facebook, texting, and dating apps). We randomized 198 GBMSM and transgender women (mean age = 26) living with HIV to the weCare intervention (n = 100) or usual-care (n = 98) group. Inclusion criteria included being newly diagnosed or not in care. Participants completed structured assessments at baseline and 6-month postintervention follow-up (18 months after baseline data collection). HIV care appointment and viral load data were abstracted from each participant's electronic health record at baseline and follow-up. Follow-up retention was 85.5%. Among participants, 94% self-identified as cisgender men, 6% as transgender, 64% as African American/Black, and 13% as Latine. Participants in both groups significantly reduced missed HIV care appointments and increased viral suppression at follow-up compared with baseline. However, there were no significant differences between weCare and usual-care participants for either outcome at follow-up. An intervention effect was not identified for our two primary outcomes. Several factors may have influenced the lack of significant differences between weCare and usual-care participants at follow-up, including intervention implementation (e.g., staffing changes and lack of fidelity to the intervention as originally designed by the partnership), data collection (e.g., data collection time points and retention strategies), and clinical (e.g., contamination) factors.

The Possibilities of Physical Training Methods in the Recovering of Cognitive Functions After Cardiac Surgery

To assess the duration of benefits on back pain and back extensor strength in women with osteoporosis who had previously participated in a randomized controlled trial (RCT) involving either exercise or wearing a spinal orthosis.A 6-month postintervention follow-up of women who were involved in the interventions in the RCT.The study was conducted in a primary health care center in Stockholm, Sweden.In this follow-up study 31 women participated in the spinal orthosis group, and 31 women participated in the exercise group, with a median age of 76 years in both groups (N=62). All women were diagnosed as having osteoporosis, had back pain with or without vertebral fracture, and were 60 years or older, which were the inclusion criteria in the RCT.The participants received no controlled supervision. The spinal orthosis group was asked to wear the orthosis, and the training group was asked to follow an exercise program for another 6 months voluntarily.Back extensor strength was measured with a computerized device; back pain was estimated by the visual analog scale and by Borg CR-10.After 6 months there were no significant differences between the groups in back extensor strength or back pain. Analyses within the groups showed that achieved results during 6 months intervention in the RCT were maintained after 6 months of voluntary use of the spinal orthosis and training. In the spinal orthosis group, back extensor strength mean was 81.7 N, and back pain median was 3 mm. In the training group back extensor strength mean was 72.8 N, and back pain median was 3 mm. There were no changes for any other measurements performed.Voluntary use of the spinal orthosis or exercise during a 6-month follow-up period maintained the increase in back extensor muscle strength obtained during the RCT. Estimation of back pain was not influenced. This indicates that the women had continued to use the spinal orthosis and exercise.

Wearing an Activating Spinal Orthosis and Physical Training in Women With Osteoporosis and Back Pain: A Postintervention Follow-Up Study

ObjectiveTo assess the duration of benefits on back pain and back extensor strength in women with osteoporosis who had previously participated in a randomized controlled trial (RCT) involving either exercise or wearing a spinal orthosis. DesignA 6-month postintervention follow-up of women who were involved in the interventions in the RCT. SettingThe study was conducted in a primary health care center in Stockholm, Sweden. ParticipantsIn this follow-up study 31 women participated in the spinal orthosis group, and 31 women participated in the exercise group, with a median age of 76 years in both groups (N=62). All women were diagnosed as having osteoporosis, had back pain with or without vertebral fracture, and were 60 years or older, which were the inclusion criteria in the RCT. InterventionsThe participants received no controlled supervision. The spinal orthosis group was asked to wear the orthosis, and the training group was asked to follow an exercise program for another 6 months voluntarily. Main Outcome MeasuresBack extensor strength was measured with a computerized device; back pain was estimated by the visual analog scale and by Borg CR-10. ResultsAfter 6 months there were no significant differences between the groups in back extensor strength or back pain. Analyses within the groups showed that achieved results during 6 months intervention in the RCT were maintained after 6 months of voluntary use of the spinal orthosis and training. In the spinal orthosis group, back extensor strength mean was 81.7 N, and back pain median was 3 mm. In the training group back extensor strength mean was 72.8 N, and back pain median was 3 mm. There were no changes for any other measurements performed. ConclusionsVoluntary use of the spinal orthosis or exercise during a 6-month follow-up period maintained the increase in back extensor muscle strength obtained during the RCT. Estimation of back pain was not influenced. This indicates that the women had continued to use the spinal orthosis and exercise.

Effect of the OPTIMAL programme on self-management of multimorbidity in primary care: a randomised controlled trial.

BackgroundEffective primary care interventions for multimorbidity are needed.AimTo evaluate the effectiveness of a group-based, 6-week, occupational therapy-led self-management support programme (OPTIMAL) for patients with multimorbidity.Design and settingA pragmatic parallel randomised controlled trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity, from November 2015 to December 2018. Intervention was OPTIMAL with a usual care comparison.MethodPrimary outcomes were health-related quality of life (EQ-5D-3L) and frequency of activity participation (Frenchay Activities Index [FAI]). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy, and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/≥65 years) and the number of chronic conditions (<4/≥4) were explored further.ResultsA total of 124 (83.2%) and 121 (81.2%) participants had complete data at immediate and 6-month post-intervention follow-up, respectively. Intervention participants had significant improvement in EQ-VAS (visual analogue scale) at immediate follow-up (adjusted mean difference [aMD] = 7.86; 95% confidence interval [CI] = 0.92 to 14.80) but no difference in index score (aMD = 0.04; 95% CI = −0.06 to 0.13) or FAI (aMD = 1.22; 95% CI = −0.84 to 3.29). At 6-month follow-up there were no differences in primary outcomes and mixed results for secondary outcomes. Pre-planned subgroup analyses suggested participants aged <65 years were more likely to benefit.ConclusionOPTIMAL was found to be ineffective in improving health-related quality of life or activity participation at 6-month follow-up. Existing multimorbidity interventions tend to focus on older adults; preplanned subgroup analyses results in the present study suggest that future research should target younger adults (<65 years) with multimorbidity.

230-OR: Personalized Nutrition for Prediabetes by Prediction of Glycemic Responses

Prediabetes is a leading risk factor for the development of type 2 diabetes mellitus (T2DM) and its metabolic complications. Current practice for prevention of diabetes includes weight loss-targeting dietary and lifestyle modifications but has had limited success. Alternative approaches, such as dietary interventions that directly target blood glucose levels for prevention of T2DM, are not well established and have been much less studied. In particular, postprandial (post-meal) glucose responses (PPGR) are a major determinant of glycemic control, but dietary methods for controlling PPGRs are rare and show limited efficacy. We previously recruited a population-based cohort of 900 people in which we continuously tracked blood glucose and obtained clinical and gut microbiota measurements. Our data of ∼50,000 PPGRs revealed that different people have vastly different responses to the same meal. We devised a machine learning algorithm based on clinical and microbiome features that accurately predicted personalized PPGRs to any food combination. Here, we sought to evaluate the long-term clinical efficacy of a dietary intervention based on our algorithm in prediabetes, and test the hypothesis that a dietary treatment that targets meal PPGR can lead to long-term improvements in glycemic control and other metabolic outcomes, as compared to a standard Mediterranean-style diet. To this end, we conducted a 6-month randomized controlled diet intervention trial (RCT) followed by a 6-month post-intervention follow-up program, and randomly assigned 225 adults with prediabetes to receive a Mediterranean-style (Med) diet or a Personalized Postprandial-targeting (PPT) diet. At 6 months, mean daily time of glucose levels above 140 mg/dl changed by -29% and -65% in the Med diet and PPT diet, respectively (p=3.4x10-10). Mean HbA1c% levels changed by -0.08% and -0.16% in the Med diet and PPT diet, respectively (p=6.9x10-3). The favorable effects of the ’PPT diet’ on glycemic control persisted also at one year follow up. Disclosure O. Ben-Yacov: None. A. Godneva: None. E. Segal: Consultant; Self; DayTwo.

Effect of a pedometer-based walking intervention on body composition in patients with ESRD: a randomized controlled trial

BackgroundA randomized trial of a pedometer-based intervention with weekly activity goals led to a modest increase in step count among dialysis patients. In a secondary analysis, we investigated the effect of this intervention on body composition.MethodsSixty dialysis patients were randomized to standard care or a 6-month program consisting of 3 months of pedometers and weekly step count targets and 3 months of post-intervention follow-up. We obtained bioelectrical impedance spectroscopy (BIS) data on 54 of these patients (28 control, 26 intervention) and used linear mixed-modeling (adjusted for sex and dialysis modality) to estimate differences in change in total-body muscle mass (TBMM) adjusted for height2, fat mass (kg), and body mass index (BMI) (kg/m2) between control and intervention groups.ResultsThe median age of participants was 57.5 years (53–66), and 76% were men. At baseline, there was no significant difference between groups in age, BMI, race, or body composition, but there were more men in the intervention group. After 3 months, patients in the intervention group increased their average daily steps by 2414 (95% CI 1047, 3782) more than controls (p < 0.001), but there were no significant differences in body composition. However, at 6 months, participants in the intervention had a significantly greater increase from baseline in TBMM of 0.7 kg/m2 (95% CI 0.3, 1.13), decrease in fat mass (− 4.3 kg [95% CI -7.1, − 1.5]) and decrease in BMI (− 1.0 kg/m2 [95% CI -1.8, − 0.2]) relative to controls. In post-hoc analysis, each increase of 1000 steps from 0 to 3 months was associated with a 0.3 kg decrease in fat mass (95% CI 0.05, 0.5) from 0 to 6 months, but there was no dose-response relationship with TBMM/ht2 or BMI.ConclusionA pedometer-based intervention resulted in greater decreases in fat mass with relative preservation of muscle mass, leading to a greater decrease in BMI over time compared with patients not in the intervention. These differences were driven as much by worsening in the control group as by improvement in the intervention group. Step counts had a dose-response relationship with decrease in fat mass.Trial registrationClinicalTrials.gov (NCT02623348). 02 December 2015.

A developmental cascade perspective of paediatric obesity: A systematic review of preventive interventions from infancy through late adolescence.

The goals of this systematic review were to identify and describe paediatric obesity prevention interventions from infancy to late adolescence and to provide recommendations for future intervention research in light of a recently proposed developmental cascade (DC) model of paediatric obesity. We conducted an electronic search of randomized controlled trials with a minimum 6-month postintervention follow-up published between 1995 and 2019. We included 74 interventions: prenatal/infancy (n = 4), early childhood (n = 11), childhood (n = 38), early to mid-adolescence (n = 18), and late adolescence (n = 3). Infancy and early childhood trials targeted early feeding and positive parenting skills. Half of the childhood and adolescence trials were school based and used universal prevention strategies; those classified as selective or indicated prevention tended to involve the family for more intensive lifestyle modification. Less than 10% of studies followed participants over long periods of time (greater than or equal to 5 years), and only 16% and 31% of studies assessed intervention mediators and moderators, respectively. We recommend that future interventions focus on early prevention, assess long-term intervention effects, use a standardized taxonomy for defining intervention behavioural strategies, assess underlying mechanisms of action and intervention moderators, target parent and family management strategies across development, and increase scientific equity. We also provide specific recommendations regarding intervention targets for each developmental stage.

Functional ability is associated with higher adherence to behavioral interventions in mild cognitive impairment

Objective: Behavioral interventions during early memory decline hold promise in delaying the development of dementia. In the present study, participants in a multimodal behavioral intervention study were assessed for post-intervention adherence and predictors of adherence.Methods: Participants (N = 272, mean age = 75.04 ± 7.54) diagnosed with amnestic Mild Cognitive Impairment (aMCI) were assigned to intervention groups receiving four out of five behavioral intervention components, including yoga, memory compensation training, computerized cognitive training, support groups, and/or wellness education. Length of the intervention was 10 days, 4 h per day, with post-intervention follow-up at 6, 12, and 18 months.Results: Two-hundred and thirty-seven participants completed the 6-month post-intervention follow-up measures, 228 participants completed the 12-month measures, and 218 participants completed the 18-month measures. Participants fully adhered to a mean of 2 out of the 4 taught intervention components. Eighty-nine percent of participants were at least partially adherent to one or more taught intervention components at 6-, 12-, and 18-month post-intervention follow-up. Physical activity was the most adhered to intervention while group support was the least adhered to intervention across all three follow-up time-points. Higher educational level, higher baseline depressive symptoms, higher baseline global cognitive functioning, and better baseline and concurrent functional abilities were associated post-intervention adherence.Conclusion: Changes in functional abilities are associated with disease progression among persons with aMCI. In the present study, individuals with aMCI who have higher education, higher depressive symptoms, and better baseline functioning abilities are more likely to adhere to behavioral intervention components over time. Post-intervention adherence also associates with concurrent daily function.

Exercise-Based Interventions to Enhance Long-Term Sustainability of Physical Activity in Older Adults: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Exercise is a form of physical activity (PA). PA is an important marker of health and quality of life in older adults. The purpose of this study was to conduct a systematic review of the literature to assess the effect of exercise-based interventions on an at least six-month follow up PA measure, and to describe the specific strategies implemented during the intervention to strengthen the sustainability of PA in community-dwelling 65+ year-old adults. We registered and conducted a systematic review and meta-analysis (PROSPERO: CRD42017070892) of randomized clinical trials (RCT). We searched three electronic databases during January 2018 to identify RCT assessing any type of exercise-based intervention. Studies had to report a pre-, post-, and at least 6-month post-intervention follow-up. To be included, at least one PA outcome had to be assessed. The effect of exercise-based interventions was assessed compared to active (e.g., a low-intensity type of exercise, such as stretching or toning activities) and non-active (e.g., usual care) control interventions at several time points. Secondary analyses were conducted, restricted to studies that reported specific strategies to enhance the sustainability of PA. The intervention effect was measured on self-reported and objective measures of time spent in PA, by means of standardized mean differences. Standardized mean differences of PA level were pooled. Pooled estimates of effect were computed with the DerSimonian–Laird method, applying a random effects model. The risk of bias was also assessed. We included 12 studies, comparing 18 exercise intervention groups to four active and nine non-active control groups. Nine studies reported specific strategies to enhance the long-term sustainability of PA. The strategies were mostly related to the self-efficacy, self-control, and behavior capability principles based on the social cognitive theory. Exercise interventions compared to active control showed inconclusive and heterogeneous results. When compared to non-active control, exercise interventions improved PA time at the six-months follow up (standardized mean difference (SMD) 0.30; 95%CI 0.15 to 0.44; four studies; 724 participants; I2 0%), but not at the one- or two-years follow-ups. No data were available on the mid- and long-term effect of adding strategies to enhance the sustainability of PA. Exercise interventions have small clinical benefits on PA levels in community-dwelling older adults, with a decline in the observed improvement after six months of the intervention cessation.

Effect of Controlled Substance Use Management on Prescribing Patterns and Health Outcomes Among High-Risk Users.

The misuse of prescription drugs is a serious public health problem. Although controlled substance (CS) prescribing, in particular, opioid analgesics, has recently declined, the volume of prescriptions in 2015 was still 3 times higher than in 1999. To curb the high volume of CS prescribing, a national health plan has implemented a controlled substance utilization management (CSUM) program, a prescriber-focused educational intervention regarding patients at risk for CS misuse. To characterize the effect of the CSUM program on CS prescribing volumes, number of prescribers and other health outcomes (opioid overdoses, all-cause emergency department visits, and all-cause hospitalizations). The CSUM program identified patients who received ≥10 CS prescriptions within any 3-month window for noncancer pain as being high risk for CS misuse and mailed patient medication profiles to their CS prescribers. This retrospective study was conducted on patients whose prescribers were contacted by the CSUM program from January 2014 to December 2015. The reference group included patients with carved-out pharmacy benefits who were 1:1 propensity score matched to the program group. CS prescribing volumes, number of CS prescribers, and other health care utilization measures were assessed in the 6-month pre-intervention (baseline) period and 6-month post-intervention (follow-up) period using difference-in-difference (DID) analysis. After matching, each group had 17,295 patients, and there were no differences in baseline demographic and clinical characteristics. During the follow-up period, the CSUM group had 1.1 fewer prescriptions for CS (mean difference [MD] within group -3.2 vs. -2.1 prescriptions), 21 fewer days of supply (MD -27 vs. -6 days), and 0.2 fewer number of CS prescribers (MD -0.8 vs. -0.6 prescribers) per patient when compared with the reference group; all P values were < 0.001. The reductions in CS prescribing volumes and number of prescribers within the CSUM group were mainly driven by opioid analgesics, with minimal differences in benzodiazepines and stimulants between the 2 groups. The CSUM program had no significant effect on the opioid dosage strength but was associated with a lower rate of all-cause emergency department visits. The CSUM program had a moderate positive effect on reducing CS prescribing volumes and number of CS prescribers compared with a reference group. Beside the focus on patients who have already received 10+ CS prescriptions, there remains a need for more intensive approaches for accelerating targeted declines in CS in general and opioids in particular. Funding for this study was provided by Anthem, which had no role in study design, data interpretation, manuscript development, or the decision to publish. Chen, Ma, Barron, DeVries, and Agiro are employees of HealthCore, a wholly owned subsidiary of Anthem. Horn is an employee of Anthem.

Sustained impact of the "Healthy Habits, Healthy Girls - Brazil" school-based randomized controlled trial for adolescents living in low-income communities.

Pediatric obesity is a major public health concern in low- and middle-income countries, such as Brazil. There is an urgent need for preventive programs for adolescents and, the assessment of their sustained impact. This paper reports the longer-term (6-month post intervention) effects of the “H3G-Brazil” obesity prevention program on weight status and weight-related behaviors. A cluster randomized controlled trial starting with 10 public schools in the city of São Paulo, Brazil involved 253 adolescent girls [mean (se) age = 15.6 (0.87) years]. Body mass index (BMI), waist circumference (WC), dietary intake, physical activity (PA) and sedentary behaviors (SB) were assessed at baseline, immediate post-intervention and 6-month post-intervention (follow-up). ANCOVA was performed using intention to treat principles. There was no effect on BMI, the primary outcome. Although, meaningful increases occurred in waist circumference for both groups, the intervention group presented a lower increase (F = 3.31, p = 0.04). This effect size, however, was lower than the criterion for small (d = 0.102). Unfortunately, significant results favored the control group for time spent on TV/weekdays (F = 5.13, p = 0.01), TV/weekends (F = 5.46, p = 0.01) and sedentary behaviors/weekdays (F = 5.32, p = 0.04). No other significant results were found. This obesity prevention intervention among Brazilian adolescent girls did not have the desire effect on BMI. The significantly lower increase in waist circumference in the intervention groups is inconsistent with the adverse changes detected in sedentary time.

Effects of mental health interventions for students in higher education are sustainable over time: a systematic review and meta-analysis of randomized controlled trials.

BackgroundSymptoms of depression, anxiety, and distress are more common in undergraduates compared to age-matched peers. Mental ill health among students is associated with impaired academic achievement, worse occupational preparedness, and lower future occupational performance. Research on mental health promoting and mental ill health preventing interventions has shown promising short-term effects, though the sustainability of intervention benefits deserve closer attention. We aimed to identify, appraise and summarize existing data from randomized control trials (RCTs) reporting on whether the effects of mental health promoting and mental ill health preventing interventions were sustained at least three months post-intervention, and to analyze how the effects vary for different outcomes in relation to follow-up length. Further, we aimed to assess whether the effect sustainability varied by intervention type, study-level determinants and of participant characteristics.Material and MethodsA systematic search in MEDLINE, PsycInfo, ERIC, and Scopus was performed for RCTs published in 1995–2015 reporting an assessment of mental ill health and positive mental health outcomes for, at least, three months of post-intervention follow-up. Random-effect modeling was utilized for quantitative synthesis of the existing evidence with standardized mean difference (Hedges’ g) used to estimate an aggregated effect size. Sustainability of the effects of interventions was analyzed separately for 3–6 months, 7–12 months, and 13–18 months of post-intervention follow-up.ResultsAbout 26 studies were eligible after reviewing 6,571 citations. The pooled effects were mainly small, but significant for several categories of outcomes. Thus, for the combined mental ill health outcomes, symptom-reduction sustained up to 7–12 months post-intervention (standardized mean difference (Hedges’ g) effect size (ES) = −0.28 (95% CI [−0.49, −0.08])). Further, sustainability of symptom-reductions were evident for depression with intervention effect lasting up to 13–18 months (ES = −0.30 (95% CI [−0.51, −0.08])), for anxiety up to 7–12 months (ES = −0.27 (95% CI [−0.54, −0.01])), and for stress up to 3–6 months (ES = −0.30 (95% CI [−0.58, −0.03])). The effects of interventions to enhance positive mental health were sustained up to 3–6 months for the combined positive mental health outcomes (ES = 0.32 (95% CI [0.05, 0.59])). For enhanced active coping, sustainability up to 3–6 months was observed with a medium and significant effect (ES = 0.75 (95% CI [0.19, 1.30])).DiscussionThe evidence suggests long-term effect sustainability for mental ill health preventive interventions, especially for interventions to reduce the symptoms of depression and symptoms of anxiety. Interventions to promote positive mental health offer promising, but shorter-lasting effects. Future research should focus on mental health organizational interventions to examine their potential for students in tertiary education.

Using a single-case experimental design to evaluate a cognitive-behavioural self-management counselling intervention

ABSTRACTArguably one of the most important components of cognitive-behavioural counselling occurs after the client has finished a counselling session when they attempt to convert their goals identified in the clinic into positive behaviour change. However, clients often struggle to implement and complete treatment plans because of difficulties with self-management. Motivated by the increasing demand for evidence of the effectiveness for therapeutic interventions, this study aimed to evaluate a collaboratively designed self-management program using a single-case experimental design with baseline, intervention and 6-month post-intervention follow-up to help a mature-aged individual begin and maintain a higher intensity fitness regime. The dependent variables were distance and time with the goal being able to run 5km non-stop within 30 minutes. After the intervention phase the participant was able to increase his running distance from a baseline mean of 1.36km to the 5km goal in 30 minutes, remaining injury free. Setting targets and making them public appeared to play a role in motivating the participant to complete goals. The explanatory force for adherence to the self-directed program may provide insights in other areas of behaviour, such as compliance with pharmaceutical and dietary regimes.

Implementing an Evidence-Based Fall Prevention Intervention in Community Senior Centers.

To evaluate the impact of implementing an evidence-based fall prevention intervention in community senior centers. We used a single-group design to evaluate the Tai Ji Quan: Moving for Better Balance (TJQMBB) program's adoption, population reach, implementation, effectiveness, and maintenance among 36 senior centers in 4 Oregon counties between 2012 and 2016. The primary outcome measure, as part of the effectiveness evaluation, was number of falls as ascertained by self-report. Trained TJQMBB instructors delivered the program to community-dwelling older adults for 48 weeks, with a 6-month postintervention follow-up. TJQMBB was adopted by 89% of the senior centers approached and reached 90% of the target population. The program resulted in a 49% reduction in the total number of falls and improved physical performance. Participation was well maintained after the program's completion. The average cost-effectiveness ratio for the 48-week program implementation was $917 per fall prevented and $676 per fall prevented for multiple falls. TJQMBB is an effective public health program that can be broadly implemented in community senior centers for primary prevention of falls among community-dwelling older adults.

Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Youth Internalizing Symptoms.

This study examined the secondary effects of Behavioral Couples Treatment (BCT) for parents with substance use disorder on youth reports of internalizing symptoms (i.e., depressive and anxiety symptoms). Participants were 59 triads (father, mothers, and youth; 32 girls, 27 boys) in which one or both parents met criteria for drug or alcohol use disorder (or both). Mothers, fathers, and youth completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Two piecewise latent growth models examined whether number of sessions attended was associated with parents' relationship satisfaction or its growth over time, and in turn if parents' relationship satisfaction was uniquely associated with youth depressive/anxiety symptoms or their growth over time. A significant indirect effect at post-intervention revealed the number of sessions attended contributed to decreases in youth depressive symptoms via increases in mothers' and fathers' relationship satisfaction. Mothers' relationship satisfaction uniquely mediated the relationship between number of sessions attended and youth depressive symptoms at post-intervention. With regards to fathers, there was a non-significant trend such that increases in sessions attended was associated with decreases in youth depressive symptoms post- intervention via increasing relationship satisfaction among fathers. Findings suggest that BCT may have protective secondary effects in reducing youth reports of depressive symptoms among couples in which one or both parents have substance use disorder.

Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Risk for Child Abuse

Risk for child abuse was examined prior to and after behavioral couples treatment (BCT) among 61 couples in which one or both parents were diagnosed with substance use disorder (SUD). All couples were residing with one or more school-age children. Mothers and fathers completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Results of piecewise latent growth models tested whether the number of BCT sessions attended and number of days abstinent from drugs and alcohol influenced relationship satisfaction and its growth over time, and in turn if relationship satisfaction and change in relationship satisfaction influenced risk for child abuse. For both mothers and fathers, attending more BCT sessions lead to a direct increase in relationship satisfaction, which in turn led to stronger reductions in risk for child abuse. This effect was maintained from the post-intervention through the 6-month post-intervention follow-up. For fathers, number of days abstinent significantly influenced reduction in child abuse potential at post-intervention via relationship satisfaction. This indirect effect was not present for mothers. The overall benefits of BCT on mothers' and fathers' risk for child abuse suggest that BCT may have promise in reducing risk for child abuse among couples in which one or both parents have SUD.

Trajectories of alcohol use and consequences in college women with and without depressed mood

College students with depressed mood face heightened risk for experiencing drinking-related negative consequences. However, few studies have examined prospective patterns of alcohol consequences among depressed students. In the present investigation, we assessed how first-year college women's trajectories of heavy episodic drinking (HED) and alcohol consequences differed as a function of depressed mood at college entry. Participants were 233 heavy drinking incoming first-year college females (61% White) at a mid-sized West Coast University. Participants completed an online baseline survey, attended a single brief group intervention session, and completed 1- and 6-month post-intervention follow-up surveys. Depressed mood, alcohol consumption, and alcohol consequences were assessed at each time point. We employed latent growth curve analyses. Females with depressed mood, versus without depressed mood, experienced greater levels of alcohol consequences overall, particularly during transitions to college. However, contrary to hypotheses, participants with depressed mood (vs. without) exhibited significantly steeper declining trends in consequences, controlling for treatment condition, age, race, and ethnicity, and despite stable drinking levels, depressed mood, and use of protective behaviors over time. Potential explanations and suggestions for future research are discussed.

Does a community-based stress management intervention affect psychological adaptation among underserved black breast cancer survivors?

In this randomized trial, Project CARE, we examined whether participation in a cognitive-behavioral stress management and breast cancer wellness and education program improved psychological outcomes among a sample of underserved black breast cancer survivors. Both complementary medicine interventions were 10-sessions, manualized, group-based, and were culturally adapted for black women in the community from evidence-based interventions. Participants were 114 black women (mean age = 51.1, 27-77 years) who had completed breast cancer treatment 0-12 months before enrollment (stages 0-IV, mean time since cancer diagnosis = 14.1 months). Women were enrolled upon completion of curative treatment (ie, surgical, chemotherapy, radiation oncology) and randomized to receive cognitive-behavioral stress management or cancer wellness and education program. There was a remarkable 95% retention rate from baseline to 6-month follow-up. Participants in both conditions showed statistically significant improvement on indices of psychological well-being, including overall quality of life (Functional Assessment of Cancer Therapy-Breast), intrusive thoughts (Impact of Event Scale-Revised), depressive symptoms (Center for Epidemiologic Studies-Depression), and stress levels (Perceived Stress Scale) over the 6-month postintervention follow-up (all repeated measures analysis of variance within-subjects time effects: P < .05, except for overall mood; Profile of Mood States-Short Version). Contrary to hypotheses, however, condition × time effects were not statistically significant. Findings suggest that improvements in multiple measures over time may have been due to intensive training in stress management, extensive provision of breast cancer information, or participation in an ongoing supportive group of individuals from a similar racial background. Implications bear on decisions about appropriate control groups, the timing of intervention delivery during the treatment trajectory, and perceived support from the research team.

Evaluation of the making sense of brain tumor program: a randomized controlled trial of a home-based psychosocial intervention.

Despite significant psychosocial morbidity, there are few controlled trials of psychological support for people with brain tumor. This study evaluated the efficacy of the Making Sense of Brain Tumor (MSoBT) program, a home-based psychosocial intervention. A randomized controlled trial with a wait list condition Fifty participants aged 17-82 years with brain tumor (54% benign) were randomly allocated to immediate treatment (n = 27) or a waitlist (n = 23). Measures included Montgomery-Asberg Depression Rating Scale (MADRS), McGill Quality of Life (MQOL) Questionnaire, Depression Anxiety Stress Scales (DASS) and Functional Assessment of Cancer Therapy-Brain (FACT-Br). The immediate treatment group received the 10-session MSoBT program, while the waitlist group received usual care for 10 weeks and were then re-assessed before receiving the MSoBT program. A 6-month post-intervention follow-up was conducted. Analysis of covariance adjusting for baseline functioning identified that the immediate treatment group reported significantly lower levels of depression on the MADRS (η(p)(2) = .19) and higher levels of existential well-being on the MQOL (η(p)(2) = .13) and functional well-being (η(p)(2) = .21) and global quality of life on the FACT-Br (η(p)(2) = .12) at post-assessment than the waitlist group. At 6-month follow-up participants reported significantly lower levels of depression and stress and higher existential well-being and quality of life relative to pre-intervention. The MSoBT program appears to have efficacy for enhancing psychological well-being and quality of life after brain tumor.

A systematic review of physical activity interventions among African American adults: evidence from 2009 to 2013.

This review extends findings from four previous reviews of physical activity (PA) interventions among African Americans (AA) and includes papers published between January 2009 and August 2013. Eligible papers were retrieved using strategies employed in previous reviews. Overall, 16 relevant papers were identified, including four pilot studies and 12 full trials. Interventions were based on a variety of behavioural sciences theories. The most common setting for interventions was churches. Most interventions lasted >6 months; few interventions included >6 months of post-intervention follow-up. Overall, studies identified within-group differences showing positive improvements in PA, and most studies showed statistically significant between-group differences in at least one measure of PA. A quality score was used to rate various elements of the studies and provide a numerical assessment of each paper; scores ranged from 3 to 10 out of 13 possible points. The current review indicates a continued need for studies that use objective PA measures, assess long-term intervention impact, provide specific PA goals for interventions, include more attention to strategies that can increase retention and adherence among AA study participants, include AA men and determine the independent and synergistic effects of individual and environmental (socio-cultural and built) change strategies.