Eating Disorders Prevention: An Effectiveness Trial for At-Risk College Students

饮食失调预防：高危大学生的有效性试验

• 批准号: 7783649
• 负责人: Meghan Butryn
• 金额: $ 68.02万
• 依托单位: OREGON RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7783649
• 关键词: Affect; Body Image; Clinic; Competence; Cost Effectiveness Analysis; Diagnostic; Distress; Eating; Eating Disorders; Environment; Female; Female Adolescents; Funding; Future; Health; Intervention; Interview; Investigation; Literature; Manuals; Mediating; Mental Depression; Mental Health; Nurses; Obesity; Oregon; Pamphlets; Participant; Pennsylvania; Phase; Prevention program; Procedures; Process; Professional counselor; Provider; Psychologist; Public Health; Publishing; Randomized; Recruitment Activity; Relative (related person); Research Infrastructure; Resources; Risk; Risk Factors; Sampling; Savings; Screening procedure; Site; Students; Substance abuse problem; Suicide; Surveys; Symptoms; Testing; Texas; Training; United States National Institutes of Health; Woman; body dissatisfaction; college; cost; cost effectiveness; disorder prevention; disorder risk; eating pathology; effectiveness trial; efficacy trial; experience; follow-up; functional disability; group intervention; high risk; high school; improved; intervention effect; medical complication; mortality; novel; obesity risk; prevent; prevention effectiveness trial; programs; psychoeducational; public health relevance; university student

DESCRIPTION (provided by applicant): Independent efficacy trials indicate that a selective eating disorder prevention program involving dissonance- inducing activities that decrease thin-ideal internalization in high-risk female high school and college students with body dissatisfaction reduces eating disorder risk factors, eating disorder symptoms, and risk for onset of future eating disorders and obesity relative to alternative interventions and assessment-only control conditions, with some effects persisting through 3-year follow-up. A large effectiveness trial found that this intervention reduced risk factors and eating disorder symptoms relative to a psychoeducational brochure control condition through 2-year follow-up when high school counselors and nurses recruited participants and delivered the intervention. Yet the effects from this latter trial were slightly smaller than those in the efficacy trial, potentially due to limited infrastructure, funds, and staff to support prevention programs in high schools. It is thus possible that this intervention will produce larger effects in an effectiveness trial involving colleges, as they typically have staff devoted to mental health programming with group intervention training and access to appropriate facilities. Although we conducted our initial effectiveness trial with high school students, there have been no effectiveness trials of empirically supported eating disorder prevention programs for college students; this is an important lacuna because the environment, resources, and endogenous providers are very different for colleges versus high schools and because there are over 1 million US female college students with threshold or subthreshold eating disorders. A large effectiveness trial involving multiple regions with a diverse sample would also permit an investigation of facilitator and participant factors that predict intervention effect size. We propose to conduct a 3-site effectiveness trial that tests whether this prevention program produces effects when college counselors, psychologists, and nurses recruit, screen, and deliver the intervention under ecologically valid conditions. We will randomize 432 high-risk young women with body dissatisfaction recruited from 9 colleges in Oregon, Pennsylvania, and Texas to the dissonance program or a psychoeducational brochure control condition. We will use an enhanced facilitator training procedure and newly published facilitator manuals and participant workbooks. Participants will complete a survey and a diagnostic interview at pretest, posttest, and 1- and 2-year follow-ups. We will test whether (1) the dissonance program results in larger reductions in risk factors, eating disorder symptoms, risk for future eating disorder and obesity onset, functional impairment, and mental health treatment relative to controls, (2) intervention effects are mediated by change in thin-ideal internalization, (3) certain factors moderate program effects (e.g., initial body dissatisfaction level), (4) process factors (e.g., intervention fidelity) predict larger effect sizes, (5) the savings produced by this intervention offset intervention delivery costs, and (6) colleges continue to offer the prevention program after they complete the 1-year intervention-delivery phase of this trial (i.e., assess sustainability). PUBLIC HEALTH RELEVANCE: Threshold and subthreshold eating disorders affect over 10% of adolescent girls and are associated with functional impairment, distress, medical complications, risk for obesity onset, and the highest mortality of any psychiatric condition; accordingly, a pressing public healthy priority is to develop effective prevention programs for eating pathology. The proposed project will be the first effectiveness trial to test whether an eating disorder prevention program with strong empirical support from efficacy trials produces effects under ecologically valid conditions among high-risk female college students, which is a vital step toward widespread dissemination of programs developed with NIH funding. The proposed cost-effectiveness analyses and examination of process factors that predict larger intervention effects will also represent novel contributions to the literature.

描述（由申请人提供）：独立疗效试验表明，选择性饮食失调计划涉及不和谐的活动 - 降低高风险女性高中和患有身体不满的大学生的稀薄思想内在化，可减少饮食失调症的风险因素，饮食失调症状症状，饮食失调症状，并通过对未来的饮食障碍和肥胖症进行替代效果，并与一定的疗效相对效果，并以某种方式进行疗效。一项大型有效试验发现，这种干预措施减少了相对于心理教育手册控制条件的危险因素和饮食失调症状，当时高中辅导员和护士招募参与者并进行干预时，通过2年的随访。然而，后一种试验的影响略小于效力试验中的效果，这可能是由于基础设施，资金和员工有限，以支持高中的预防计划。因此，这种干预措施可能会在涉及大学的有效试验中产生更大的影响，因为他们通常会通过小组干预培训并获得适当的设施来致力于心理健康计划。尽管我们对高中生进行了初步有效性试验，但没有对大学生的经验支持预防饮食失调计划的有效试验。这是一个重要的空白，因为与高中相比，大学的环境，资源和内源性提供者截然不同，并且由于有超过100万的美国女大学生患有阈值或亚阈值饮食失调。一项涉及多种样本的多个区域的大型有效试验也将允许对预测干预效果大小的促进因子和参与者进行调查。我们建议进行三个站点的有效性试验，该试验测试该预防计划在大学辅导员，心理学家和护士招募，筛查和在生态上有效的条件下进行干预时是否产生影响。我们将从俄勒冈州，宾夕法尼亚州的9所大学和德克萨斯州的9所大学招募432名具有身体不满的高风险年轻妇女，以进行不和谐计划或心理教育手册控制条件。我们将使用增强的促进者培训程序以及新发布的主持人手册和参与者的工作簿。参与者将在预测试，后测和1年和2年的随访中完成调查和诊断访谈。 We will test whether (1) the dissonance program results in larger reductions in risk factors, eating disorder symptoms, risk for future eating disorder and obesity onset, functional impairment, and mental health treatment relative to controls, (2) intervention effects are mediated by change in thin-ideal internalization, (3) certain factors moderate program effects (e.g., initial body dissatisfaction level), (4) process factors (e.g., intervention fidelity) predict larger effect sizes, （5）此干预措施抵消干预交付成本所产生的储蓄，以及（6）在完成本试验的1年干预分娩阶段（即评估可持续性）后，大学继续提供预防计划。 公共卫生相关性：阈值和亚阈值饮食失调影响超过10％的青少年女孩，并且与功能障碍，遇险，医疗并发症，肥胖症的风险以及任何精神病患者的死亡率最高有关；因此，紧迫的公众健康优先事项是制定有效的预防饮食病理学计划。拟议的项目将是第一项有效性试验，用于测试预防饮食失调计划是否有效力试验的大力经验支持是否会在高风险女性大学生的生态有效条件下产生影响，这是朝着广泛传播NIH资助计划的广泛传播计划的重要一步。拟议的成本效益分析和对预测较大干预效果的过程因素的检查也将代表对文献的新贡献。