Brief Integrative Multiple Behavior Intervention Effects and Mediators for Adolescents

PubMed Central

(Chad) Werch, Chudley E.; Bian, Hui; Carlson, Joan; Moore, Michele J.; DiClemente, Carlo C.; Huang, I-Chan; Ames, Steven C.; Thombs, Dennis; Weiler, Robert M.; Pokorny, Steven B.

2015-01-01

This study evaluated the efficacy of a brief integrative multiple behavior intervention and assessed risk factors as mediators of behavioral outcomes among older adolescents. A randomized controlled trial was conducted with participants randomly assigned to either a brief intervention or standard care control with 3-month follow-up. A total of 479 students attending two public high schools participated. Participants receiving the intervention showed a significant reduction in quantity x frequency of alcohol use, and increases in fruit and vegetable consumption and frequency of relaxation activities, compared to those receiving the control, p’s =.01. No effects were found on cigarette and marijuana use, exercise and sleep. Effect sizes were small with alcohol use cessation effects reaching medium size. Intervention effects were mediated by changes in peer influenceability for alcohol use, and self-efficacy and self-image for health promoting behaviors. Findings suggest that the brief intervention resulted in health risk and promoting behavior improvements for adolescents, with outcomes mediated by several risk factors. PMID:20661637

Mediating mechanisms of a military Web-based alcohol intervention.

PubMed

Williams, Jason; Herman-Stahl, Mindy; Calvin, Sara L; Pemberton, Michael; Bradshaw, Michael

2009-03-01

This study explored the mediating mechanisms of two Web-based alcohol interventions in a sample of active duty United States military personnel. Personnel were recruited from eight bases and received the Drinker's Check-Up (N=1483), Alcohol Savvy (N=688), or served as controls (N=919). The interventions drew on motivational interviewing and social learning theory and targeted multiple mediators including social norms, perceived risks and benefits, readiness to change, and coping strategies. Baseline data were collected prior to the intervention and follow-up data on alcohol consumption were gathered 1 month and 6 months after program completion. Two mediation models were examined: (1) a longitudinal two-wave model with outcomes and mediators assessed concurrently at the 1-month follow-up; and (2) a three-wave model in which the causal chain was fully lagged. Results indicated strong support for the role of perceived descriptive norms in transmitting the effects of the Drinker's Check-Up, with consistent mediation across the majority of alcohol outcome measures for both the concurrent and fully lagged mediation models. These results suggest that web-based interventions that are effective in lowering perceived norms about the frequency and quantity of drinking may be a viable strategy for reducing alcohol consumption in military populations. The results did not support program mediation by the other targeted variables, indicating the need for future research on the effective components of alcohol interventions. The mediation models also suggest reasons why program effects were not found for some outcomes or were different across programs.

Mediators of improved child diet quality following a health promotion intervention: the Melbourne InFANT Program.

PubMed

Spence, Alison C; Campbell, Karen J; Crawford, David A; McNaughton, Sarah A; Hesketh, Kylie D

2014-11-04

Young children's diets are currently suboptimal. Given that mothers have a critical influence on children' diets, they are typically a target of interventions to improve early childhood nutrition. Understanding the maternal factors which mediate an intervention's effect on young children's diets is important, but has not been well investigated. This research aimed to test whether maternal feeding knowledge, maternal feeding practices, maternal self-efficacy, and maternal dietary intakes acted as mediators of the effect of an intervention to improve child diet quality. The Melbourne Infant Feeding Activity and Nutrition Trial (InFANT) Program was a cluster-randomized controlled trial, conducted from 2008-2010. This novel, low-dose, health promotion intervention was delivered quarterly over 15 months and involved educational activities, promotion of peer discussion, a DVD and written materials. Post-intervention, when children were approximately 18 months of age, child diets were assessed using multiple 24-hour recalls and a purpose-developed index of diet quality, the Obesity Protective Dietary Index. Maternal mediators were assessed using a combination of previously validated and purpose-deigned tools. Mediation analysis was conducted using the test of joint significance and difference of coefficients methods. Across 62 parents' groups in Melbourne, Australia, 542 parents were recruited. Post- intervention, higher maternal feeding knowledge and lower use of foods as rewards was found to mediate the direct intervention effect on child diet quality. While other aspects of maternal feeding practices, self-efficacy and dietary intakes did not act as mediators, they were associated with child diet quality. Mediation analysis of this novel health promotion intervention showed the importance of maternal feeding knowledge and use of foods as rewards in impacting child diet quality. The other maternal factors assessed were appropriate targets but further research on how to impact these in an intervention is important. This evidence of intervention efficacy and mediation provides important insights for planning future interventions. Current Controlled Trials ISRCTN81847050, registered 23 November 2007.

Testing mediators hypothesized to account for the effects of a dissonance-based eating disorder prevention program over longer term follow-up.

PubMed

Stice, Eric; Marti, C Nathan; Rohde, Paul; Shaw, Heather

2011-06-01

Test the hypothesis that reductions in thin-ideal internalization and body dissatisfaction mediate the effects of a dissonance-based eating disorder prevention program on reductions in eating disorder symptoms over 1-year follow-up. Data were drawn from a randomized effectiveness trial in which 306 female high school students (mean age = 15.7 years, SD = 1.1) with body image concerns were randomized to the 4-session dissonance-based prevention program or an educational brochure control condition, wherein school counselors and nurses were responsible for participant recruitment and intervention delivery. Dissonance-intervention participants showed greater reductions in thin-ideal internalization, body dissatisfaction, and eating disorder symptoms; change in thin-ideal internalization predicted change in body dissatisfaction and symptoms; change in body dissatisfaction predicted change in symptoms; and all indirect effects were significant. Change in thin-ideal internalization fully mediated the effects of intervention condition on change in body dissatisfaction and partially mediated the effects on symptoms; change in body dissatisfaction partially mediated the effect of intervention condition on change in symptoms. Findings provided support for the intervention theory of this eating disorder prevention program over longer term follow-up, extending the evidence base for this effective intervention. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Does understanding relational terminology mediate effects of intervention on compare word problems?

PubMed

Schumacher, Robin F; Fuchs, Lynn S

2012-04-01

The purpose of this study was to assess whether understanding relational terminology (i.e., more, less, and fewer) mediates the effects of intervention on compare word problems. Second-grade classrooms (N=31) were randomly assigned to one of three conditions: researcher-designed word-problem intervention, researcher-designed calculation intervention, or business-as-usual (teacher-designed) control. Students in word-problem intervention classrooms received instruction on the compare problem type, which included a focus on understanding relational terminology within compare word problems. Analyses, which accounted for variance associated with classroom clustering, indicated that (a) compared with the calculation intervention and business-as-usual conditions, word-problem intervention significantly increased performance on all three subtypes of compare problems and on understanding relational terminology, and (b) the intervention effect was fully mediated by students' understanding of relational terminology for one subtype of compare problems and partially mediated by students' understanding of relational terminology for the other two subtypes. Copyright © 2011 Elsevier Inc. All rights reserved.

Interventions based on self-management of well-being theory: pooling data to demonstrate mediation and ceiling effects, and to compare formats.

PubMed

Goedendorp, M M; Steverink, N

2017-09-01

Interventions based on self-management of well-being (SMW) theory have shown positive effects, but additional questions remain: (1) Are improvements in well-being, as induced by the interventions, mediated by improved self-management ability (SMA)? (2) Do the interventions show ceiling effects? (3) Is a particular format of SMW intervention (individual, group, or self-help) more effective? Data of three randomized controlled trials were pooled. The greater part of the sample (N = 445) consisted of single older females. A bootstrap analysis was performed to test for mediation. Regression analyses with interaction effects were performed to test for ceiling effects. Controlled and transformed effect sizes (proportion of maximum change) were calculated to compare formats. There was a full significant mediation of well-being by SMA. A significant interaction (ceiling) effect was found on well-being, but not on SMA. The controlled effect sizes of the raw scores were small to medium (.04-.49), and were small to large after transformation (.41-.73). None of the intervention formats was more effective. Support for SMW theory was found, i.e. increasing self-management ability lead to improved well-being. Some ceiling effect was found. We conclude that various SMW interventions formats can improve self-management abilities and well-being with medium effects.

Three-Dimensions vs. Two-Dimensions Intervention Programs: The Effect on the Mediation Level and Behavioural Aspects of Children with Intellectual Disability

ERIC Educational Resources Information Center

Eden, S.; Bezer, M.

2011-01-01

The research examined the effect of an intervention program employing 3D immersive virtual reality (IVR), which focused on the perception of sequential time, on the mediation level and behavioural aspects of children with intellectual disability (ID). The intervention is based on the mediated learning experience (MLE) theory, which refers the…

Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: Response expectancies and emotional distress

PubMed Central

Montgomery, Guy H.; Hallquist, Michael N.; Schnur, Julie B.; David, Daniel; Silverstein, Jeffrey H.; Bovbjerg, Dana H.

2010-01-01

Hypnosis is widely recognized as an empirically supported intervention to improve postsurgical outcomes. However, to date, no research has examined mediators of hypnotic benefit among surgery patients. The present study was designed to test the hypotheses that response expectancies and emotional distress would mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). In a sample of 200 women undergoing breast conserving surgery (mean age = 48.50 years), structural equation modeling revealed the following: 1) hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p< .0001), but not by distress (p=.12); 2) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p=.02), but not by nausea expectancy (p=.10); 3) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p=.0001) and presurgical distress (p=.02). These results improve understanding of the underlying mechanisms responsible for hypnotic phenomena in the surgical setting, and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery. PMID:20099953

Information processing versus social cognitive mediators of weight loss in a podcast-delivered health intervention.

PubMed

Ko, Linda K; Turner-McGrievy, Gabrielle M; Campbell, Marci K

2014-04-01

Podcasting is an emerging technology, and previous interventions have shown promising results using theory-based podcast for weight loss among overweight and obese individuals. This study investigated whether constructs of social cognitive theory and information processing theories (IPTs) mediate the effect of a podcast intervention on weight loss among overweight individuals. Data are from Pounds off Digitally, a study testing the efficacy of two weight loss podcast interventions (control podcast and theory-based podcast). Path models were constructed (n = 66). The IPTs, elaboration likelihood model, information control theory, and cognitive load theory mediated the effect of a theory-based podcast on weight loss. The intervention was significantly associated with all IPTs. Information control theory and cognitive load theory were related to elaboration, and elaboration was associated with weight loss. Social cognitive theory constructs did not mediate weight loss. Future podcast interventions grounded in theory may be effective in promoting weight loss.

Why and for Whom May Coping Planning Have Adverse Effects? A Moderated Mediation Analysis.

PubMed

Inauen, Jennifer; Stocker, Andrea; Scholz, Urte

2018-05-09

Coping planning, the formation of plans to overcome behavioral barriers is assumed to promote health behavior maintenance, but the literature on this is inconsistent. In this study, we aimed to investigate the mechanisms of a coping planning intervention that adversely affected maintained safe water consumption. We also explored perceived behavioral difficulty as a potential moderator of coping planning interventions. In the second phase of a cluster-randomised trial, households (N = 177 analyzed) were randomly allocated to a coping planning intervention or a comparison group (repetition of interventions from first intervention phase). Safe water consumption, the mechanisms of coping planning, and perceived difficulty were measured pre-post. The data were analyzed using mediation and moderated mediation analysis. Changes in behavioral intention mediated the intervention effects on behavioral maintenance (b = -0.36, 95% CI [-0.91, -0.03]). Changes in perceived coping planning (b = 0.08, 95% CI [-0.12, 0.34]), and maintenance self-efficacy (b = -0.13, 95% CI [-0.45, 0.01]) did not mediate the effects. Prior perceived difficulty moderated the coping planning intervention effects on maintenance via intention. Coping planning may decrease motivation for health behavior maintenance for persons who experienced few barriers prior to the planning intervention. © 2018 The International Association of Applied Psychology.

Randomized Trial of a Broad Preventive Intervention for Mexican American Adolescents

PubMed Central

Gonzales, N.A.; Dumka, L.E.; Millsap, R.E.; Gottschall, A.; McClain, D.B.; Wong, J.J.; Germán, M.; Mauricio, A.M.; Wheeler, L.; Carpentier, F.D.; Kim, S.Y.

2012-01-01

Objective This randomized trial of a family-focused preventive intervention for Mexican American (MA) adolescents evaluated intervention effects on adolescent substance use, internalizing and externalizing symptoms, and school discipline and grade records in 8th grade, one year after completion of the intervention. The study also examined hypothesized mediators and moderators of intervention effects. Method Stratified by language of program delivery (English vs. Spanish), the trial included a sample of 516 MA adolescents (50.8% female; M =12.3 years, SD=.54) and at least one caregiver that were randomized to receive a low dosage control group workshop or the 9-week group intervention that included parenting, adolescent coping, and conjoint family sessions. Results Positive program effects were found on all five outcomes at one-year posttest, but varied depending on whether adolescents, parents, or teachers reported on the outcome. Intervention effects were mediated by posttest changes in effective parenting, adolescent coping efficacy, adolescent school engagement, and family cohesion. The majority of direct and mediated effects were moderated by language, with a larger number of significant effects for families that participated in Spanish. Intervention effects also were moderated by baseline levels of mediators and outcomes, with the majority showing stronger effects for families with poorer functioning at baseline. Conclusion Findings support the efficacy of the intervention to decrease multiple problem outcomes for MA adolescents, but also demonstrate differential effects for parents and adolescents receiving the intervention in Spanish vs. English, and depending on their baseline levels of functioning. PMID:22103956

Mediation Analysis of the Efficacy of the Eban HIV/STD Risk-Reduction Intervention for African American HIV Serodiscordant Couples.

PubMed

El-Bassel, Nabila; Jemmott, John B; Bellamy, Scarlett L; Pequegnat, Willo; Wingood, Gina M; Wyatt, Gail E; Landis, J Richard; Remien, Robert H

2016-06-01

Targeting couples is a promising behavioral HIV risk-reduction strategy, but the mechanisms underlying the effects of such interventions are unknown. We report secondary analyses testing whether Social-Cognitive-Theory variables mediated the Eban HIV-risk-reduction intervention's effects on condom-use outcomes. In a multisite randomized controlled trial conducted in four US cities, 535 African American HIV-serodiscordant couples were randomized to the Eban HIV risk-reduction intervention or attention-matched control intervention. Outcomes were proportion condom-protected sex, consistent condom use, and frequency of unprotected sex measured pre-, immediately post-, and 6 and 12 months post-intervention. Potential mediators included Social-Cognitive-Theory variables: outcome expectancies and self-efficacy. Mediation analyses using the product-of-coefficients approach in a generalized-estimating-equations framework revealed that condom-use outcome expectancy, partner-reaction outcome expectancy, intention, self-efficacy, and safer-sex communication improved post-intervention and mediated intervention-induced improvements in condom-use outcomes. These findings underscore the importance of targeting outcome expectancies, self-efficacy, and safer-sex communication in couples-level HIV risk-reduction interventions.

A test of cognitive mediation in a 12-month physical activity workplace intervention: does it explain behaviour change in women?

PubMed

Plotnikoff, Ronald C; Pickering, Michael A; Rhodes, Ryan E; Courneya, Kerry S; Spence, John C

2010-05-03

Attempts to demonstrate the efficacy of interventions aimed at increasing physical activity (PA) have been mixed. Further, studies are seldom designed in a manner that facilitates the understanding of how or why a treatment is effective or ineffective and PA intervention designs should be guided by a heavier reliance upon behavioral theory. The use of a mediating variable framework offers a systematic methodological approach to testing the role of theory, and could also identify the effectiveness of specific intervention components. The primary purpose of this paper was to test the mediating role that cognitive constructs may have played in regards to the positive effect that a workplace behavioral intervention had on leisure-time PA for women. A subsidiary purpose was to examine the cross-sectional relationships of these cognitive constructs with PA behavior. The Physical Activity Workplace Study was a randomized controlled trial which compared the effects of stage-matched and standard print materials upon self-reported leisure-time PA, within a workplace sample at 6 and 12-months. In this secondary analysis we examined the mediation effects of 14 psychosocial constructs across 3 major social-cognitive theories which were operationalized for the intervention materials and measured at baseline, 6 and 12-months. We examined change in PA and change in the psychological constructs employing a mediation strategy proposed by Baron and Kenny for: (1) the first 6-months (i.e., initial change), (2) the second 6-months (i.e., delayed change), and (3) the entire 12-months (overall change) of the study on 323 women (n = 213 control/standard materials group; n = 110 stage-matched materials group). Of the 14 constructs and 42 tests (including initial, delayed and overall change) two positive results were identified (i.e., overall change in pros, initial change in experiential powerful intervention approaches processes), with very small effect sizes. However, these mediating results were eliminated after adjusting for the multiple statistical tests. The intervention did not change these mediators in any substantive way, and show a similar pattern to prior research where interventions generally do not result in a change in mediation of behavior change. It is important to report mediation results in randomized controlled trials whether the findings are null or positive. Future studies may wish to focus on more detailed dose-response issues between mediators and behavior, the inclusion of moderators that could affect individual change, or different mediator constructs at higher levels of measurement specificity. Continued work on innovative and more powerful PA intervention approaches are needed.

Estimation of Indirect Effects in the Presence of Unmeasured Confounding for the Mediator-Outcome Relationship in a Multilevel 2-1-1 Mediation Model

ERIC Educational Resources Information Center

Talloen, Wouter; Moerkerke, Beatrijs; Loeys, Tom; De Naeghel, Jessie; Van Keer, Hilde; Vansteelandt, Stijn

2016-01-01

To assess the direct and indirect effect of an intervention, multilevel 2-1-1 studies with intervention randomized at the upper (class) level and mediator and outcome measured at the lower (student) level are frequently used in educational research. In such studies, the mediation process may flow through the student-level mediator (the within…

Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions.

PubMed

Sairanen, Essi; Tolvanen, Asko; Karhunen, Leila; Kolehmainen, Marjukka; Järvelä-Reijonen, Elina; Lindroos, Sanni; Peuhkuri, Katri; Korpela, Riitta; Ermes, Miikka; Mattila, Elina; Lappalainen, Raimo

2017-06-01

Despite the promising results related to intuitive eating, few studies have attempted to explain the processes encouraging this adaptive eating behaviour. The focus of the present study was on exploring mechanisms of change in intuitive eating and weight in acceptance and commitment therapy (ACT) interventions. Mediation provides important information regarding the treatment processes and theoretical models related to specific treatment approaches. The study investigates whether psychological flexibility, mindfulness skills and sense of coherence mediated the interventions' effect on intuitive eating and weight. Secondary analysis of a randomized control trial. Mediation analysis compared two ACT interventions - face-to-face (in a group) and mobile (individually) - with a control group using a latent difference score model. Settings Data were collected in three Finnish towns. The participants were overweight or obese (n 219), reporting symptoms of perceived stress. The effect of the interventions on participants' (i) BMI, (ii) intuitive eating and its subscales, (iii) eating for physical rather than emotional reasons and (iv) reliance on internal hunger and satiety cues was mediated by changes in weight-related psychological flexibility in both ACT groups. These findings suggest that ACT interventions aiming for lifestyle changes mediate the intervention effects through the enhanced ability to continue with valued activities even when confronted with negative emotions and thoughts related to weight.

A meta-analysis of single-case research on the use of tablet-mediated interventions for persons with ASD.

PubMed

Hong, Ee Rea; Gong, Li-Yuan; Ninci, Jennifer; Morin, Kristi; Davis, John L; Kawaminami, Sawako; Shi, Yan-Qiu; Noro, Fumiyuki

2017-11-01

There is a growing amount of single-case research literature on the benefits of tablet-mediated interventions for individuals with autism spectrum disorder (ASD). With the development of tablet-based computers, tablet-mediated interventions have been widely utilized for education and treatment purposes; however, the overall quality and evidence of this literature-base are unknown. This article aims to present a quality review of the single-case experimental literature and aggregate results across studies involving the use of tablet-mediated interventions for individuals with ASD. Using the Tau nonoverlap effect size measure, the authors extracted data from single-case experimental studies and calculated effect sizes differentiated by moderator variables. The moderator variables included the ages of participants, participants' diagnoses, interventions, outcome measures, settings, and contexts. Results indicate that tablet-mediated interventions for individuals with ASD have moderate to large effect sizes across the variables evaluated. The majority of research in this review used tablets for video modeling and augmentative and alternative communication. To promote the usability of tablet-mediated interventions for individuals with ASD, this review indicates that more single-case experimental studies should be conducted with this population in naturalistic home, community, and employment settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

Applying Adult Behavior Change Theory to Support Mediator-Based Intervention Implementation

ERIC Educational Resources Information Center

Sanetti, Lisa M. H.; Kratochwill, Thomas R.; Long, Anna C. J.

2013-01-01

A majority of evidence-based interventions in schools are delivered through consultation models and are implemented by a mediator, such as a teacher. Research indicates that mediators do not always adequately implement adopted evidence-based interventions, limiting their effectiveness in transforming student outcomes. We propose that to transform…

Mediators of the effect of the JUMP-in intervention on physical activity and sedentary behavior in Dutch primary schoolchildren from disadvantaged neighborhoods

PubMed Central

2012-01-01

Background Important health benefits can be achieved when physical activity in children from low socio-economic status is promoted and sedentariness is limited. By specifying the mediating mechanisms of existing interventions one can improve future physical activity interventions. This study explored potential mediators of the long-term effect of the school-based multicomponent JUMP-in intervention on sport participation, outdoor play and screen time in Dutch primary schoolchildren from disadvantaged neighborhoods. Methods In total, 600 primary schoolchildren (aged 9.8 ± 0.7, 51% girls, 13% Dutch ethnicity, 35% overweight) from 9 intervention and 10 control schools were included in the analyses. JUMP-in was developed using Intervention Mapping, and targeted psychological and environmental determinants of physical activity. Outcome behaviors were self-reported sport participation, outdoor play, TV-viewing behavior and computer use. Potential mediators were self-reported psychological, social and physical environmental factors. Results JUMP-in was effective in improving sport participation after 20 months, but not in improving outdoor play, or reducing TV-viewing or computer time. JUMP-in was not effective in changing hypothesized mediators so no significant mediated effects could be identified. However, changes in self-efficacy, social support and habit strength were positively associated with changes in sport participation, and changes in social support, self-efficacy, perceived planning skills, enjoyment and habit strength were positively associated with changes in outdoor play. Changes in enjoyment was positively associated with changes in TV-viewing while parental rules were negatively associated. Having a computer in the bedroom and enjoyment were positively associated with changes in computer use, while changes in parental rules were negatively associated. Conclusions Besides a significant positive effect on sports participation, no significant intervention effect on outdoor play, screen time or any of the potential mediators was found. This suggest that other (unmeasured) factors operated as mediating mechanisms of the intervention, that we used unsuccessful intervention strategies, that the strategies were inappropriately implemented, or that children are unable to accurately recall past activities and cognitions. Additionally, the school setting might not be the sole channel to influence leisure time activities. Still, several personal and environmental constructs were found to be relevant in predicting change in sport participation, outdoor play and screen behavior and seem to be potential mediators. Future interventions are recommended including more effective strategies targeting these relevant constructs, addressing different constructs (e.g. pedagogic skills of parents), and focusing on different implementation settings. Trail registration ISRCTN17489378 PMID:23130806

Characteristics of the home food environment that mediate immediate and sustained increases in child fruit and vegetable consumption: mediation analysis from the Healthy Habits cluster randomised controlled trial.

PubMed

Wyse, Rebecca; Wolfenden, Luke; Bisquera, Alessandra

2015-09-17

The home food environment can influence the development of dietary behaviours in children, and interventions that modify characteristics of the home food environment have been shown to increase children's fruit and vegetable consumption. However to date, interventions to increase children's fruit and vegetable consumption have generally produced only modest effects. Mediation analysis can help in the design of more efficient and effective interventions by identifying the mechanisms through which interventions have an effect. This study aimed to identify characteristics of the home food environment that mediated immediate and sustained increases in children's fruit and vegetable consumption following the 4-week Healthy Habits telephone-based parent intervention. Analysis was conducted using 2-month (immediate) and 12-month (sustained) follow-up data from a cluster randomised control trial of a home food environment intervention to increase the fruit and vegetable consumption of preschool children. Using recursive path analysis, a series of mediation models were created to investigate the direct and indirect effects of immediate and sustained changes to characteristics of the home food environment (fruit and vegetable availability, accessibility, parent intake, parent providing behaviour, role-modelling, mealtime eating practices, child feeding strategies, and pressure to eat), on the change in children's fruit and vegetable consumption. Of the 394 participants in the randomised trial, 357 and 329 completed the 2- and 12-month follow-up respectively. The final mediation model suggests that the effect of the intervention on the children's fruit and vegetable consumption was mediated by parent fruit and vegetable intake and parent provision of these foods at both 2- and 12-month follow-up. Analysis of data from the Healthy Habits trial suggests that two environmental variables (parental intake and parent providing) mediate the immediate and sustained effect of the intervention, and it is recommended these variables be targeted in subsequent home food environment interventions to bring about immediate and sustained changes in child fruit and vegetable intake. ACTRN12609000820202 .

Causal mediation analysis with multiple mediators in the presence of treatment noncompliance.

PubMed

Park, Soojin; Kürüm, Esra

2018-05-20

Randomized experiments are often complicated because of treatment noncompliance. This challenge prevents researchers from identifying the mediated portion of the intention-to-treated (ITT) effect, which is the effect of the assigned treatment that is attributed to a mediator. One solution suggests identifying the mediated ITT effect on the basis of the average causal mediation effect among compliers when there is a single mediator. However, considering the complex nature of the mediating mechanisms, it is natural to assume that there are multiple variables that mediate through the causal path. Motivated by an empirical analysis of a data set collected in a randomized interventional study, we develop a method to estimate the mediated portion of the ITT effect when both multiple dependent mediators and treatment noncompliance exist. This enables researchers to make an informed decision on how to strengthen the intervention effect by identifying relevant mediators despite treatment noncompliance. We propose a nonparametric estimation procedure and provide a sensitivity analysis for key assumptions. We conduct a Monte Carlo simulation study to assess the finite sample performance of the proposed approach. The proposed method is illustrated by an empirical analysis of JOBS II data, in which a job training intervention was used to prevent mental health deterioration among unemployed individuals. Copyright © 2018 John Wiley & Sons, Ltd.

Testing Mediators Hypothesized to Account for the Effects of a Dissonance Eating Disorder Prevention Program Over Longer-Term Follow-Up

PubMed Central

Stice, Eric; Marti, C. Nathan; Rohde, Paul; Shaw, Heather

2011-01-01

Objective Test the hypothesis that reductions in thin-ideal internalization and body dissatisfaction mediate the effects of a dissonance-based eating disorder prevention program on reductions in eating disorder symptoms over 1-year follow-up. Method Data were drawn from a randomized effectiveness trial in which 306 female high school students (M age = 15.7 SD = 1.1) with body image concerns were randomized to the 4-session dissonance-based prevention program or an educational brochure control condition, wherein school counselors and nurses were responsible for participant recruitment and intervention delivery. Results Dissonance participants showed greater reductions in thin-ideal internalization, body dissatisfaction, and eating disorder symptoms; change in thin-ideal internalization predicted change in body dissatisfaction and symptoms; change in body dissatisfaction predicted change in symptoms; and all indirect effects were significant. Change in thin-ideal internalization fully mediated the effects of intervention condition on change in body dissatisfaction and partially mediated the effects on symptoms; change in body dissatisfaction partially mediated the effect of intervention condition on change in symptoms. Conclusions Findings provided support for the intervention theory of this eating disorder prevention program over longer-term follow-up, extending the evidence base for this effective intervention. PMID:21500884

The roles of health culture and physical environment in workplace health promotion: a two-year prospective intervention study in China.

PubMed

Jia, Yingnan; Fu, Hua; Gao, Junling; Dai, Junming; Zheng, Pinpin

2018-04-05

To understand the potential influencing factors on the effectiveness of workplace health promotion interventions and examine whether workplace health culture and physical environment can mediate the relationship between workplace health promotion and intervention effectiveness. A total of 719 participants from 10 Chinese government agencies were recruited for a prospective self-controlled trial. Questionnaires, qualitative interviews, and direct observation were used for the baseline evaluation, process evaluation, and effectiveness evaluation. Based on the results of the need assessment and risk assessment at each workplace, a two-year comprehensive health intervention was conducted by each workplace. Health outcomes including self-rated health (SRH) and mental health were measured at baseline and 24 months. Health culture was measured at 24 months. Physical environment and intervention implementation were measured at 12 months and 24 months. Compared with the baseline, the means of SRH and mental health increased significantly by 0.302 and 2.698, respectively. The SRH scores were different before and after intervention; furthermore, the differences varied by workplace. Health culture mediated the relationship between intervention implementation and intervention effectiveness, including SRH and mental health improvement, but physical environment did not. Physical environment quality was significantly negatively correlated with SRH improvement and mental health improvement. Under the relatively high-quality interventions with scores higher than 4.047 or 4.151 (out of 5), better health culture may led to greater SRH and mental health improvements. Health culture may mediate the relationship between intervention implementation and intervention effectiveness, whereas physical environment does not seem to mediate this relationship. Under relatively high-quality interventions, a better health culture may lead to more positive improvements in SRH and mental health. Future studies will need to examine the physical environment as a moderating effect rather than mediating effect. This study was retrospectively registered in Chinese Clinical Trial Registry. ChiCTR-OOC-16010059 . Date of registration: Dec 1, 2016.

Information Processing Versus Social Cognitive Mediators of Weight Loss in a Podcast-Delivered Health Intervention

PubMed Central

Ko, Linda K.; Turner-McGrievy, Gabrielle; Campbell, Marci K.

2016-01-01

Podcasting is an emerging technology, and previous interventions have shown promising results using theory-based podcast for weight loss among overweight and obese individuals. This study investigated whether constructs of social cognitive theory and information processing theories (IPTs) mediate the effect of a podcast intervention on weight loss among overweight individuals. Data are from Pounds off Digitally, a study testing the efficacy of two weight loss podcast interventions (control podcast and theory-based podcast). Path models were constructed (n = 66). The IPTs—elaboration likelihood model, information control theory, and cognitive load theory—mediated the effect of a theory-based podcast on weight loss. The intervention was significantly associated with all IPTs. Information control theory and cognitive load theory were related to elaboration, and elaboration was associated with weight loss. Social cognitive theory constructs did not mediate weight loss. Future podcast interventions grounded in theory may be effective in promoting weight loss. PMID:24082027

The Active for Life Year 5 (AFLY5) school-based cluster randomised controlled trial: effect on potential mediators.

PubMed

Lawlor, Debbie A; Howe, Laura D; Anderson, Emma L; Kipping, Ruth R; Campbell, Rona; Wells, Sian; Chittleborough, Catherine R; Peters, Tim J; Jago, Russell

2016-01-22

Active for life year 5 (AFLY5) is a school-based intervention, based on social cognitive theory, which aims to promote healthy levels of physical activity and healthy eating by improving a child's self-efficacy to make healthy choices, their knowledge of how to make such choices and prompting parents to support their children to make healthy choices. Previously published results showed no effect on the three primary outcomes and beneficial effects on three of nine secondary outcomes (time spent screen-viewing at weekends, consumption of snacks and of high energy drinks). This paper aims to determine the effect of the intervention on potential mediators. We conducted a cluster RCT of a school-based intervention, with allocation concealed by use of a remote system. The study was undertaken in the South West of England between 2011 and 2013. Participants were school children who were age 8-9 years at baseline assessment and 9-10 years during the intervention. Potential mediators were assessed at the end of the intervention. The intervention consisted of teacher training, provision of all materials required for lessons and homeworks and written materials for school newsletters and parents. The ten potential mediators were child-reported self-efficacy for physical activity and fruit and vegetable consumption, perceived parental logistic support and modelling for their child's physical activity, parental efforts to limit their child's sedentary behaviour and modelling of healthy fruit and vegetable consumption, together with a knowledge assessment. We successfully recruited 60 schools with over 2,221 children; valid data for the 10 mediators were available for 87 % to 96 % of participants. Three of the ten potential mediators were greater in the intervention, compared with the control group: fruit and vegetable self-efficacy 2.2 units (95 % CI: 0.7 to 3.8), assessed on a scale 26 to 130; child-reported maternal limitation of sedentary behaviour 0.5 (0.1 to 0.8), scale 4 to 16; and knowledge 0.5 (0.2, 0.7) scale 0 to 9. Reported maternal limitation of sedentary behaviour and the child's knowledge explained 23 % of the effect of the intervention on reducing time spent on sedentary behaviour at the weekend. There was no effect on other mediators. Our findings suggest that the effect of the AFLY5 intervention on reducing screen-viewing at weekends was partially mediated by an effect on mothers limiting their child's time spent sedentary and on increasing the child's knowledge about healthy behaviour. However, overall our findings suggest that theory driven interventions, like AFLY5, can fail to influence most potential mediators and this may explain the failure of the intervention to improve most primary and secondary outcomes. Current Controlled Trials ISRCTN50133740. Registered 17/03/2011.

Statistical grand rounds: understanding the mechanism: mediation analysis in randomized and nonrandomized studies.

PubMed

Mascha, Edward J; Dalton, Jarrod E; Kurz, Andrea; Saager, Leif

2013-10-01

In comparative clinical studies, a common goal is to assess whether an exposure, or intervention, affects the outcome of interest. However, just as important is to understand the mechanism(s) for how the intervention affects outcome. For example, if preoperative anemia was shown to increase the risk of postoperative complications by 15%, it would be important to quantify how much of that effect was due to patients receiving intraoperative transfusions. Mediation analysis attempts to quantify how much, if any, of the effect of an intervention on outcome goes though prespecified mediator, or "mechanism" variable(s), that is, variables sitting on the causal pathway between exposure and outcome. Effects of an exposure on outcome can thus be divided into direct and indirect, or mediated, effects. Mediation is claimed when 2 conditions are true: the exposure affects the mediator and the mediator (adjusting for the exposure) affects the outcome. Understanding how an intervention affects outcome can validate or invalidate one's original hypothesis and also facilitate further research to modify the responsible factors, and thus improve patient outcome. We discuss the proper design and analysis of studies investigating mediation, including the importance of distinguishing mediator variables from confounding variables, the challenge of identifying potential mediators when the exposure is chronic versus acute, and the requirements for claiming mediation. Simple designs are considered, as well as those containing multiple mediators, multiple outcomes, and mixed data types. Methods are illustrated with data collected by the National Surgical Quality Improvement Project (NSQIP) and utilized in a companion paper which assessed the effects of preoperative anemic status on postoperative outcomes.

Do Savings Mediate Changes in Adolescents' Future Orientation and Health-Related Outcomes? Findings From Randomized Experiment in Uganda.

PubMed

Karimli, Leyla; Ssewamala, Fred M

2015-10-01

This present study tests the proposition that an economic strengthening intervention for families caring for AIDS-orphaned adolescents would positively affect adolescent future orientation and psychosocial outcomes through increased asset accumulation (in this case, by increasing family savings). Using longitudinal data from the cluster-randomized experiment, we ran generalized estimating equation models with robust standard errors clustering on individual observations. To examine whether family savings mediate the effect of the intervention on adolescents' future orientation and psychosocial outcomes, analyses were conducted in three steps: (1) testing the effect of intervention on mediator; (2) testing the effect of mediator on outcomes, controlling for the intervention; and (3) testing the significance of mediating effect using Sobel-Goodman method. Asymmetric confidence intervals for mediated effect were obtained through bootstrapping-to address the assumption of normal distribution. Results indicate that participation in a matched Child Savings Account (CSA) program improved adolescents' future orientation and psychosocial outcomes by reducing hopelessness, enhancing self-concept, and improving adolescents' confidence about their educational plans. However, the positive intervention effect on adolescent future orientation and psychosocial outcomes was not transmitted through saving. In other words, participation in the matched CSA program improved adolescent future orientation and psychosocial outcomes regardless of its impact on reported savings. Further research is necessary to understand exactly how participation in economic strengthening interventions, for example, those that employ matched CSAs, shape adolescent future orientation and psychosocial outcomes: what, if not savings, transmits the treatment effect and how? Copyright © 2015 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Do savings mediate changes in adolescents’ future orientation and health-related outcomes? Findings from randomized experiment in Uganda

PubMed Central

Karimli, Leyla; Ssewamala, Fred M.

2015-01-01

Purpose This present study tests the proposition that an economic strengthening intervention for families caring for AIDS-orphaned adolescents would positively affect adolescent future orientation and psychosocial outcomes through increased asset-accumulation (in this case, by increasing family savings). Methods Using longitudinal data from the cluster-randomized experiment we ran generalized estimating equation (GEE) models with robust standard errors clustering on individual observations. To examine whether family savings mediate the effect of the intervention on adolescents’ future orientation and psychosocial outcomes, analyses were conducted in three steps: (1) testing the effect of intervention on mediator; (2) testing the effect of mediator on outcomes, controlling for the intervention; and (3) testing the significance of mediating effect using Sobel-Goodman method. Asymmetric confidence intervals for mediated effect were obtained through bootstrapping—to address the assumption of normal distribution. Results Results indicate that participation in a matched Child Savings Account program improved adolescents’ future orientation and psychosocial outcomes by reducing hopelessness, enhancing self-concept, and improving adolescents’ confidence about their educational plans. However, the positive intervention effect on adolescent future orientation and psychosocial outcomes was not transmitted through saving. In other words, participation in the matched Child Savings Account program improved adolescent future orientation and psychosocial outcomes regardless of its impact on reported savings. Conclusions Further research is necessary to understand exactly how participation in economic strengthening interventions, for example, those that employ matched Child Savings Accounts, shape adolescent future orientation and psychosocial outcomes: what, if not savings, transmits the treatment effect and how? PMID:26271162

Testing Mediators of Intervention Effects in Randomized Controlled Trials: An Evaluation of Three Depression Prevention Programs

ERIC Educational Resources Information Center

Stice, Eric; Rohde, Paul; Seeley, John R.; Gau, Jeff M.

2010-01-01

Objective: Evaluate a new 5-step method for testing mediators hypothesized to account for the effects of depression prevention programs. Method: In this indicated prevention trial, at-risk teens with elevated depressive symptoms were randomized to a group cognitive-behavioral (CB) intervention, group supportive expressive intervention, CB…

Reductions in Negative Parenting Practices Mediate the Effect of a Family-School Intervention for Children with Attention Deficit Hyperactivity Disorder

ERIC Educational Resources Information Center

Booster, Genery D.; Mautone, Jennifer A.; Nissley-Tsiopinis, Jenelle; Van Dyke, Devin; Power, Thomas J.

2016-01-01

Accumulating research has identified family behavioral interventions as an empirically supported psychosocial treatment for students with attention deficit hyperactivity disorder (ADHD). The mechanisms behind the effectiveness of these interventions, however, have been less well studied. The current study examined possible mediators of improvement…

Mediation of an efficacious HIV risk reduction intervention for South African men.

PubMed

O'Leary, Ann; Jemmott, John B; Jemmott, Loretta S; Bellamy, Scarlett; Icard, Larry D; Ngwane, Zolani

2015-10-01

"Men, Together Making a Difference!" is an HIV/STD risk-reduction intervention that significantly increased self-reported consistent condom use during vaginal intercourse compared with a health-promotion attention-control intervention among men (N = 1181) in Eastern Cape Province, South Africa. The present analyses were designed to identify mediators of the intervention's efficacy. The potential mediators were Social Cognitive Theory (SCT) constructs that the intervention targeted, including several aspects of condom-use self-efficacy, outcome expectancies, and knowledge. Mediation was assessed using a product-of-coefficients approach where an α path (the intervention's effect on the potential mediator) and a β path (the potential mediator's effect on the outcome of interest, adjusting for intervention) were estimated independently in a generalized estimating equations framework. Condom-use negotiation self-efficacy, technical-skill self-efficacy, and impulse-control self-efficacy were significant mediators. Although not mediators, descriptive norm and expected friends' approval of condom use predicted subsequent self-reported condom use, whereas the expected approval of sexual partner did not. The present results suggest that HIV/STD risk-reduction interventions that draw upon SCT and that address self-efficacy to negotiate condom use, to apply condoms correctly, and to exercise sufficient control when sexually aroused to use condoms may contribute to efforts to reduce sexual risk behavior among South African men. Future research must examine whether approaches that build normative support for condom use among men's friends are also efficacious.

A test of cognitive mediation in a 12-month physical activity workplace intervention: does it explain behaviour change in women?

PubMed Central

2010-01-01

Background Attempts to demonstrate the efficacy of interventions aimed at increasing physical activity (PA) have been mixed. Further, studies are seldom designed in a manner that facilitates the understanding of how or why a treatment is effective or ineffective and PA intervention designs should be guided by a heavier reliance upon behavioral theory. The use of a mediating variable framework offers a systematic methodological approach to testing the role of theory, and could also identify the effectiveness of specific intervention components. The primary purpose of this paper was to test the mediating role that cognitive constructs may have played in regards to the positive effect that a workplace behavioral intervention had on leisure-time PA for women. A subsidiary purpose was to examine the cross-sectional relationships of these cognitive constructs with PA behavior. Methods The Physical Activity Workplace Study was a randomized controlled trial which compared the effects of stage-matched and standard print materials upon self-reported leisure-time PA, within a workplace sample at 6 and 12-months. In this secondary analysis we examined the mediation effects of 14 psychosocial constructs across 3 major social-cognitive theories which were operationalized for the intervention materials and measured at baseline, 6 and 12-months. We examined change in PA and change in the psychological constructs employing a mediation strategy proposed by Baron and Kenny for: (1) the first 6-months (i.e., initial change), (2) the second 6-months (i.e., delayed change), and (3) the entire 12-months (overall change) of the study on 323 women (n = 213 control/standard materials group; n = 110 stage-matched materials group). Results Of the 14 constructs and 42 tests (including initial, delayed and overall change) two positive results were identified (i.e., overall change in pros, initial change in experiential powerful intervention approaches processes), with very small effect sizes. However, these mediating results were eliminated after adjusting for the multiple statistical tests. Conclusions The intervention did not change these mediators in any substantive way, and show a similar pattern to prior research where interventions generally do not result in a change in mediation of behavior change. It is important to report mediation results in randomized controlled trials whether the findings are null or positive. Future studies may wish to focus on more detailed dose-response issues between mediators and behavior, the inclusion of moderators that could affect individual change, or different mediator constructs at higher levels of measurement specificity. Continued work on innovative and more powerful PA intervention approaches are needed. PMID:20438632

Does self-efficacy mediate functional change in older adults participating in an exercise program after hip fracture? A randomized controlled trial.

PubMed

Chang, Feng-Hang; Latham, Nancy K; Ni, Pengsheng; Jette, Alan M

2015-06-01

To examine whether self-efficacy mediated the effect of the Home-based Post-Hip Fracture Rehabilitation program on activity limitations in older adults after hip fracture and whether the mediating effect was different between sex and age groups. Randomized controlled trial. Community. Participants with hip fracture (N=232; mean age ± SD, 79±9.4y) were randomly assigned to intervention (n=120, 51.7%) and attention control (n=112, 48.3%) groups. The 6-month intervention, the Home-based Post-Hip Fracture Rehabilitation, is a functionally oriented, home-based exercise program. Data were collected at baseline, postintervention (6mo), and follow-up (9mo). Activity Measure for Post-Acute Care. The mediating effect of the Home-based Post-Hip Fracture Rehabilitation program on Basic Mobility function through self-efficacy for exercise was significant at 9 months (βindirect=.21). Similarly, the mediating effect of the intervention on Daily Activity function through self-efficacy for exercise was significant at 9 months (βindirect=.49). In subgroup analyses, the mediating effect was significant at 9 months in the younger group (age, ≤79y) in comparison to the older group and was significant in women in comparison to men. Self-efficacy may play a partial mediating role in the effect on some longer-term functional outcomes in the Home-based Post-Hip Fracture Rehabilitation intervention. The results suggest that program components that target self-efficacy should be incorporated in future hip fracture rehabilitation interventions. Age and sex of the targeted participants may also need to be considered when developing interventions. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Reduced Reward-driven Eating Accounts for the Impact of a Mindfulness-Based Diet and Exercise Intervention on Weight Loss: Data from the SHINE Randomized Controlled Trial

PubMed Central

Mason, Ashley E.; Epel, Elissa S.; Aschbacher, Kirstin; Lustig, Robert H.; Acree, Michael; Kristeller, Jean; Cohn, Michael; Dallman, Mary; Moran, Patricia J.; Bacchetti, Peter; Laraia, Barbara; Hecht, Frederick M.; Daubenmier, Jennifer

2016-01-01

Many individuals with obesity report overeating despite intentions to maintain or lose weight. Two barriers to long-term weight loss are reward-driven eating, which is characterized by a lack of control over eating, a preoccupation with food, and a lack of satiety; and psychological stress. Mindfulness training may address these barriers by promoting awareness of hunger and satiety cues, self-regulatory control, and stress reduction. We examined these two barriers as potential mediators of weight loss in the Supporting Health by Integrating Nutrition and Exercise (SHINE) randomized controlled trial, which compared the effects of a 5.5-month diet and exercise intervention with or without mindfulness training on weight loss among adults with obesity. Intention-to-treat multiple mediation models tested whether post-intervention reward-driven eating and psychological stress mediated the impact of intervention arm on weight loss at 12-and 18-months post-baseline among 194 adults with obesity (BMI: 30–45). Mindfulness (relative to control) participants had significant reductions in reward-driven eating at 6 months (post-intervention), which, in turn, predicted weight loss at 12 months. Post-intervention reward-driven eating mediated 47.1% of the total intervention arm effect on weight loss at 12 months [β=-0.06, SE(β)=0.03, p=.030, 95% CI (−0.12, −0.01)]. This mediated effect was reduced when predicting weight loss at 18 months (p=.396), accounting for 23.0% of the total intervention effect, despite similar weight loss at 12 months. Psychological stress did not mediate the effect of intervention arm on weight loss at 12 or 18 months. In conclusion, reducing reward-driven eating, which can be achieved using a diet and exercise intervention that includes mindfulness training, may promote weight loss (clinicaltrials.gov registration: NCT00960414). PMID:26867697

Reduced reward-driven eating accounts for the impact of a mindfulness-based diet and exercise intervention on weight loss: Data from the SHINE randomized controlled trial.

PubMed

Mason, Ashley E; Epel, Elissa S; Aschbacher, Kirstin; Lustig, Robert H; Acree, Michael; Kristeller, Jean; Cohn, Michael; Dallman, Mary; Moran, Patricia J; Bacchetti, Peter; Laraia, Barbara; Hecht, Frederick M; Daubenmier, Jennifer

2016-05-01

Many individuals with obesity report over eating despite intentions to maintain or lose weight. Two barriers to long-term weight loss are reward-driven eating, which is characterized by a lack of control over eating, a preoccupation with food, and a lack of satiety; and psychological stress. Mindfulness training may address these barriers by promoting awareness of hunger and satiety cues, self-regulatory control, and stress reduction. We examined these two barriers as potential mediators of weight loss in the Supporting Health by Integrating Nutrition and Exercise (SHINE) randomized controlled trial, which compared the effects of a 5.5-month diet and exercise intervention with or without mindfulness training on weight loss among adults with obesity. Intention-to-treat multiple mediation models tested whether post-intervention reward-driven eating and psychological stress mediated the impact of intervention arm on weight loss at 12- and 18-months post-baseline among 194 adults with obesity (BMI: 30-45). Mindfulness (relative to control) participants had significant reductions in reward-driven eating at 6 months (post-intervention), which, in turn, predicted weight loss at 12 months. Post-intervention reward-driven eating mediated 47.1% of the total intervention arm effect on weight loss at 12 months [β = -0.06, SE(β) = 0.03, p = .030, 95% CI (-0.12, -0.01)]. This mediated effect was reduced when predicting weight loss at 18 months (p = .396), accounting for 23.0% of the total intervention effect, despite similar weight loss at 12 months. Psychological stress did not mediate the effect of intervention arm on weight loss at 12 or 18 months. In conclusion, reducing reward-driven eating, which can be achieved using a diet and exercise intervention that includes mindfulness training, may promote weight loss (clinicaltrials.gov registration: NCT00960414). Published by Elsevier Ltd.

A Review of Peer-Mediated Social Interaction Interventions for Students with Autism in Inclusive Settings

ERIC Educational Resources Information Center

Watkins, Laci; O'Reilly, Mark; Kuhn, Michelle; Gevarter, Cindy; Lancioni, Giulio E.; Sigafoos, Jeff; Lang, Russell

2015-01-01

This review addresses the use of peer-mediated interventions (PMI) to improve the social interaction skills of students with autism spectrum disorder (ASD) in inclusive settings. The purpose of this review is to (a) identify the characteristics and components of peer-mediated social interaction interventions, (b) evaluate the effectiveness of PMI…

Causal Models for Mediation Analysis: An Introduction to Structural Mean Models.

PubMed

Zheng, Cheng; Atkins, David C; Zhou, Xiao-Hua; Rhew, Isaac C

2015-01-01

Mediation analyses are critical to understanding why behavioral interventions work. To yield a causal interpretation, common mediation approaches must make an assumption of "sequential ignorability." The current article describes an alternative approach to causal mediation called structural mean models (SMMs). A specific SMM called a rank-preserving model (RPM) is introduced in the context of an applied example. Particular attention is given to the assumptions of both approaches to mediation. Applying both mediation approaches to the college student drinking data yield notable differences in the magnitude of effects. Simulated examples reveal instances in which the traditional approach can yield strongly biased results, whereas the RPM approach remains unbiased in these cases. At the same time, the RPM approach has its own assumptions that must be met for correct inference, such as the existence of a covariate that strongly moderates the effect of the intervention on the mediator and no unmeasured confounders that also serve as a moderator of the effect of the intervention or the mediator on the outcome. The RPM approach to mediation offers an alternative way to perform mediation analysis when there may be unmeasured confounders.

Mediators of a Culturally-Sensitive Intervention for Suicidal African American Women

PubMed Central

Zhang, Huaiyu; Neelarambam, Kiranmayi; Schwenke, Tomina J.; Rhodes, Miesha N.; Pittman, Delishia M.; Kaslow, Nadine J.

2013-01-01

This study explored intervention outcomes and mechanisms that could help explain why low-income, African American women with a history of intimate partner abuse and suicide attempt improve in response to a culturally-informed intervention, the Grady Nia Project. Specifically, the investigation examined whether or not the intervention had effects on the women and whether or not spiritual well-being and coping mediated the effects of the intervention on suicidal ideation and depressive symptoms. In this randomized controlled clinical trial, data from 89 women who completed both pre- and post-intervention assessments were analyzed. During the post-intervention follow-up, women in the active intervention group reported lower levels of suicidal ideation and depressive symptoms and higher levels of existential well-being and adaptive coping skills than those women randomized to the treatment as usual group. However, only existential well-being was found to mediate treatment effects on suicidal ideation and depressive symptoms. Religious well-being, as well as adaptive and maladaptive coping, did not serve a mediational function. These findings highlight the importance of designing and implementing culturally-sensitive and evidence-based strategies that enhance existential well-being in this population. PMID:23864403

Testing Mediators of Intervention Effects in Randomized Controlled Trials: An Evaluation of Two Eating Disorder Prevention Programs

ERIC Educational Resources Information Center

Stice, Eric; Presnell, Katherine; Gau, Jeff; Shaw, Heather

2007-01-01

The authors investigated mediators hypothesized to account for the effects of 2 eating disorder prevention programs using data from 355 adolescent girls who were randomized to a dissonance or a healthy weight intervention or an active control condition. The dissonance intervention produced significant reductions in outcomes (body…

Effectiveness of Parent-Child Mediation in Improving Family Functioning and Reducing Adolescent Problem Behavior: Results from a Pilot Randomized Controlled Trial.

PubMed

Tucker, Joan S; Edelen, Maria Orlando; Huang, Wenjing

2017-03-01

Parent-child mediation programs are intended to resolve or manage disputes and improve family functioning, but rigorous evaluations of their effectiveness are lacking. Families referred to a community-based mediation program (N = 111) were randomized to an intervention or wait-list control group, and completed three surveys over a 12-week period. With the exception of parent-reported child delinquency (which decreased more in the intervention group), this evaluation provides little support for the short-term effectiveness of parent-child mediation for improving family functioning and reducing child problem behaviors in general. Given that this is the first randomized controlled trial of a parent-child mediation program, additional evaluations involving larger samples and longer follow-ups are needed before firm conclusions can be drawn about the effectiveness of this intervention.

Effectiveness of Parent-Child Mediation in Improving Family Functioning and Reducing Adolescent Problem Behavior: Results from a Pilot Randomized Controlled Trial

PubMed Central

Tucker, Joan S.; Edelen, Maria Orlando; Huang, Wenjing

2016-01-01

Parent-child mediation programs are intended to resolve or manage disputes and improve family functioning, but rigorous evaluations of their effectiveness are lacking. Families referred to a community-based mediation program (N=111) were randomized to an intervention or wait-list control group, and completed three surveys over a 12-week period. With the exception of parent-reported child delinquency (which decreased more in the intervention group), this evaluation provides little support for the short-term effectiveness of parent-child mediation for improving family functioning and reducing child problem behaviors in general. Given that this is the first randomized controlled trial of a parent-child mediation program, additional evaluations involving larger samples and longer follow-ups are needed before firm conclusions can be drawn about the effectiveness of this intervention. PMID:26762375

Adolescents' Communication with Parents, Other Adult Family Members and Teachers on Sexuality: Effects of School-Based Interventions in South Africa and Tanzania.

PubMed

Namisi, Francis; Aarø, Leif Edvard; Kaaya, Sylvia; Kajula, Lusajo J; Kilonzo, Gad P; Onya, Hans; Wubs, Annegreet; Mathews, Catherine

2015-12-01

Cluster-randomized controlled trials were carried out to examine effects on sexual practices of school-based interventions among adolescents in three sites in sub-Saharan Africa. In this publication, effects on communication about sexuality with significant adults (including parents) and such communication as a mediator of other outcomes were examined. Belonging to the intervention group was significantly associated with fewer reported sexual debuts in Dar es Salaam only (OR 0.648). Effects on communication with adults about sexuality issues were stronger for Dar es Salaam than for the other sites. In Dar, increase in communication with adults proved to partially mediate associations between intervention and a number of social cognition outcomes. The hypothesized mediational effect of communication on sexual debut was not confirmed. Promoting intergenerational communication on sexuality issues is associated with several positive outcomes and therefore important. Future research should search for mediating factors influencing behavior beyond those examined in the present study.

Interventional Effects for Mediation Analysis with Multiple Mediators.

PubMed

Vansteelandt, Stijn; Daniel, Rhian M

2017-03-01

The mediation formula for the identification of natural (in)direct effects has facilitated mediation analyses that better respect the nature of the data, with greater consideration of the need for confounding control. The default assumptions on which it relies are strong, however. In particular, they are known to be violated when confounders of the mediator-outcome association are affected by the exposure. This complicates extensions of counterfactual-based mediation analysis to settings that involve repeatedly measured mediators, or multiple correlated mediators. VanderWeele, Vansteelandt, and Robins introduced so-called interventional (in)direct effects. These can be identified under much weaker conditions than natural (in)direct effects, but have the drawback of not adding up to the total effect. In this article, we adapt their proposal to achieve an exact decomposition of the total effect, and extend it to the multiple mediator setting. Interestingly, the proposed effects capture the path-specific effects of an exposure on an outcome that are mediated by distinct mediators, even when-as often-the structural dependence between the multiple mediators is unknown, for instance, when the direction of the causal effects between the mediators is unknown, or there may be unmeasured common causes of the mediators.

Effects of a combined parent-student alcohol prevention program on intermediate factors and adolescents' drinking behavior: A sequential mediation model.

PubMed

Koning, Ina M; Maric, Marija; MacKinnon, David; Vollebergh, Wilma A M

2015-08-01

Previous work revealed that the combined parent-student alcohol prevention program (PAS) effectively postponed alcohol initiation through its hypothesized intermediate factors: increase in strict parental rule setting and adolescents' self-control (Koning, van den Eijnden, Verdurmen, Engels, & Vollebergh, 2011). This study examines whether the parental strictness precedes an increase in adolescents' self-control by testing a sequential mediation model. A cluster randomized trial including 3,245 Dutch early adolescents (M age = 12.68, SD = 0.50) and their parents randomized over 4 conditions: (1) parent intervention, (2) student intervention, (3) combined intervention, and (4) control group. Outcome measure was amount of weekly drinking measured at age 12 to 15; baseline assessment (T0) and 3 follow-up assessments (T1-T3). Main effects of the combined and parent intervention on weekly drinking at T3 were found. The effect of the combined intervention on weekly drinking (T3) was mediated via an increase in strict rule setting (T1) and adolescents' subsequent self-control (T2). In addition, the indirect effect of the combined intervention via rule setting (T1) was significant. No reciprocal sequential mediation (self-control at T1 prior to rules at T2) was found. The current study is 1 of the few studies reporting sequential mediation effects of youth intervention outcomes. It underscores the need of involving parents in youth alcohol prevention programs, and the need to target both parents and adolescents, so that change in parents' behavior enables change in their offspring. (c) 2015 APA, all rights reserved).

Effects of The Coach Approach Intervention on Adherence to Exercise in Obese Women: Assessing Mediation of Social Cognitive Theory Factors

ERIC Educational Resources Information Center

Annesi, James J.; Unruh, Jennifer L.; Marti, C. Nathan; Gorjala, Srinivasa; Tennant, Gisele

2011-01-01

The link between physical activity and weight loss has precipitated interest in interventions to foster adherence to exercise. It has been suggested that treatment effects, when significant, should be analyzed to determine theory-based mediators. This research assessed possible mediation of changes in Physical Self-Concept, Exercise Self-Efficacy,…

The "Romsas in Motion" Community Intervention: Mediating Effects of Psychosocial Factors on Forward Transition in the Stages of Change in Physical Activity

ERIC Educational Resources Information Center

Lorentzen, Catherine; Ommundsen, Yngvar; Jenum, Anne Karen; Holme, Ingar

2009-01-01

This study examines whether a community-based physical activity intervention influenced movement in stages of change in physical activity in an adult population, whether any such effect was mediated by psychosocial influences, and whether any such mediations were moderated by sociodemographic or anthropometric factors. The 3-year-long…

Mediators of effects of a selective family-focused violence prevention approach for middle school students.

PubMed

2012-02-01

This study examined how parenting and family characteristics targeted in a selective prevention program mediated effects on key youth proximal outcomes related to violence perpetration. The selective intervention was evaluated within the context of a multi-site trial involving random assignment of 37 schools to four conditions: a universal intervention composed of a student social-cognitive curriculum and teacher training, a selective family-focused intervention with a subset of high-risk students, a condition combining these two interventions, and a no-intervention control condition. Two cohorts of sixth-grade students (total N = 1,062) exhibiting high levels of aggression and social influence were the sample for this study. Analyses of pre-post change compared to controls using intent-to-treat analyses found no significant effects. However, estimates incorporating participation of those assigned to the intervention and predicted participation among those not assigned revealed significant positive effects on student aggression, use of aggressive strategies for conflict management, and parental estimation of student's valuing of achievement. Findings also indicated intervention effects on two targeted family processes: discipline practices and family cohesion. Mediation analyses found evidence that change in these processes mediated effects on some outcomes, notably aggressive behavior and valuing of school achievement. Results support the notion that changing parenting practices and the quality of family relationships can prevent the escalation in aggression and maintain positive school engagement for high-risk youth.

The Moderated Mediating Effect of Self-Efficacy on Exercise Among Older Adults in an Online Bone Health Intervention Study: A Parallel Process Latent Growth Curve Model.

PubMed

Zhu, Shijun; Nahm, Eun-Shim; Resnick, Barbara; Friedmann, Erika; Brown, Clayton; Park, Jumin; Cheon, Jooyoung; Park, DoHwan

2017-07-01

This secondary data analyses of a longitudinal study assessed whether self-efficacy for exercise (SEE) mediated online intervention effects on exercise among older adults and whether age (50-64 vs. ≥65 years) moderated the mediation. Data were from an online bone health intervention study. Eight hundred sixty-six older adults (≥50 years) were randomized to three arms: Bone Power (n = 301), Bone Power Plus (n = 302), or Control (n = 263). Parallel process latent growth curve modeling (LGCM) was used to jointly model growths in SEE and in exercise and to assess the mediating effect of SEE on the effect of intervention on exercise. SEE was a significant mediator in 50- to 64-year-old adults (0.061, 95 BCI: 0.011, 0.163) but not in the ≥65 age group (-0.004, 95% BCI: -0.047, 0.025). Promotion of SEE is critical to improve exercise among 50- to 64-year-olds.

Direct and Mediated Effects of Two Theoretically Based Interventions to Increase Consumption of Fruits and Vegetables in the "Healthy Body Healthy Spirit" Trial

ERIC Educational Resources Information Center

Shaikh, Abdul R.; Vinokur, Amiram D.; Yaroch, Amy L.; Williams, Geoffrey C.; Resnicow, Ken

2011-01-01

This study tested the effects of two theory-based interventions to increase fruit and vegetable intake. Hypothesized intervention mediators included self-efficacy (SE), social support (SS), autonomous motivation (AM), and controlled motivation (CM). At baseline, 1,021 African American adults were recruited from 16 churches randomized to one…

The Effectiveness of a Cross-Setting Complementary Staff- and Parent-Mediated Early Intensive Behavioral Intervention for Young Children with ASD

ERIC Educational Resources Information Center

Fava, Leonardo; Strauss, Kristin; Valeri, Giovanni; D'Elia, Lidia; Arima, Serena; Vicari, Stefano

2011-01-01

We compared the effects of Early Intensive Behavioral Intervention (EIBI) and eclectic intervention in children with ASD on autism severity, developmental performance, adaptive behavior, language skills and challenging behaviors. Twelve children received cross-setting staff- and parent-mediated EIBI of centre-based one-to-one and play sessions as…

Interventional effects for mediation analysis with multiple mediators

PubMed Central

Vansteelandt, Stijn; Daniel, Rhian M.

2016-01-01

The mediation formula for the identification of natural (in)direct effects has facilitated mediation analyses that better respect the nature of the data, with greater consideration of the need for confounding control. The default assumptions on which it relies are strong, however. In particular, they are known to be violated when confounders of the mediator–outcome association are affected by the exposure. This complicates extensions of counterfactual-based mediation analysis to settings that involve repeatedly measured mediators, or multiple correlated mediators. VanderWeele, Vansteelandt, and Robins21 introduced so-called interventional (in)direct effects. These can be identified under much weaker conditions than natural (in)direct effects, but have the drawback of not adding up to the total effect. In this article, we adapt their proposal in order to achieve an exact decomposition of the total effect, and extend it to the multiple mediator setting. Interestingly, the proposed effects capture the path-specific effects of an exposure on an outcome that are mediated by distinct mediators, even when – as often – the structural dependence between the multiple mediators is unknown; for instance, when the direction of the causal effects between the mediators is unknown, or there may be unmeasured common causes of the mediators. PMID:27922534

Improved eating behaviours mediate weight gain prevention of young adults: moderation and mediation results of a randomised controlled trial of TXT2BFiT, mHealth program.

PubMed

Partridge, Stephanie R; McGeechan, Kevin; Bauman, Adrian; Phongsavan, Philayrath; Allman-Farinelli, Margaret

2016-04-02

Explanatory evaluation of interventions for prevention of weight gain is required beyond changes in weight, to determine for whom the intervention works and the underlying mechanisms of change. It was hypothesised that participant characteristics moderate intervention effect on weight change and improved eating and physical activity behaviours during the 3-month program mediate the relationship between intervention and weight. In our randomised controlled trial, young adults at risk of weight gain (n = 250) were assigned either to an intervention group that received a 3-month mHealth (TXT2BFiT) program with 6-month maintenance or to a control group. Data were collected via online self-report surveys. Hypothesised moderators and mediators of the intervention effect on weight were independently assessed in PROCESS macro models for 3 and 9-month weight change. Males (P = 0.01), mid-20s age group (P = 0.04), and higher income earners (P = 0.02) moderated intervention effects on weight change at 3-months and males only at 9-months (P = 0.02). Weight change at 3 (-1.12 kg) and 9-months (-1.38 kg) remained significant when 3-month nutrition and physical activity behaviours were specified as mediators (P <0.01 and P = 0.01 respectively). Indirect paths explained 39% (0.72/1.85 kg) and 40 % (0.92/2.3 kg) of total effect on weight change at 3 and 9-months respectively. Increased vegetable intake by intervention group at 3-months accounted for 19 and 17% and decreased sugar-sweetened beverages accounted for 8 and 13% of indirect weight change effects at 3 and 9-months respectively. TXT2BFiT was effective for both young men and women. Small sustained behavioural changes, including increased vegetable intake and decreased sugar-sweetened beverages consumption significantly mediated the intervention's effects on weight change. Improved eating behaviours and increased physical activity accounted for approximately 40% of the weight change. The trial is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12612000924853 ).

A combined planning and self-efficacy intervention to promote physical activity: a multiple mediation analysis.

PubMed

Koring, Milena; Richert, Jana; Parschau, Linda; Ernsting, Anna; Lippke, Sonia; Schwarzer, Ralf

2012-01-01

Many individuals are motivated to improve their physical activity levels, but often fail to act upon their intention. Interventions fostering volitional strategies, such as action planning, coping planning, and self-efficacy beliefs, can help to translate intentions into behavior. This study examines the effectiveness and the mechanisms of a combined planning and self-efficacy intervention to promote physical activity among motivated individuals. Participants (N = 883) were randomly assigned to the intervention or to a waiting-list control condition. Multivariate analysis of variance revealed that the intervention resulted in significantly more physical activity, higher levels of action planning, coping planning, and volitional self-efficacy beliefs (p < 0.01). In addition, multiple mediation analysis showed that action planning, coping planning, and volitional self-efficacy mediate between the intervention and physical activity. The study shows that the intervention successfully fostered physical activity and unfolds the underlying self-regulatory mechanisms of the intervention's effectiveness.

Improvements in maternal depression as a mediator of intervention effects on early childhood problem behavior

PubMed Central

Shaw, Daniel S.; Connell, Arin; Dishion, Thomas J.; Wilson, Melvin N.; Gardner, Frances

2009-01-01

Maternal depression has been consistently linked to the development of child problem behavior, particularly in early childhood, but few studies have examined whether reductions in maternal depression serve as a mediator in relation to changes associated with a family-based intervention. The current study addressed this issue with a sample of 731 families receiving services from a national food supplement and nutrition program. Families with toddlers between ages 2 and 3 were sereened and then randomized to a brief family intervention, the Family Check-Up, which included linked interventions that were tailored and adapted to the families needs. Follow-up intervention services were provided at age 3 and follow-up of child outcomes oecurred at ages 3 and 4. Latent growth models revealed intervention effects for early externalizing and internalizing problems from 2 to 4, and reductions in maternal depression from ages 2 to 3. In addition, reductions in maternal depression mediated improvements in both child externalizing and internalizing problem behavior after accounting for the potential mediating effects of improvements in positive parenting. The results are discussed with respect to targeting maternal depression in future intervention studies aimed at improving early child problem behavior. PMID:19338691

Sustaining self-regulatory efficacy and psychological outcome expectations for postnatal exercise: effects of a group-mediated cognitive behavioural intervention.

PubMed

Cramp, A G; Brawley, L R

2009-09-01

The objective of the current investigation was to examine if the effects of a group-mediated cognitive behavioural counselling plus exercise intervention were superior to the effects of a standard exercise care condition on postnatal mothers' self-regulatory efficacy (SRE), outcome expectations (OEs) and self-directed physical activity (PA). The design of the study consisted of two intervention conditions; group-mediated cognitive behavioural counselling plus exercise (GMCB) and standard exercise (SE). Each condition consisted of two phases; a 4-week supervised, centre-based intensive exercise training phase followed by a 4-week home-based phase. Participants were 57 postnatal women randomly assigned to conditions (SE: N=31; GMCB: N=26). Measures of SRE and OEs were assessed prior to and following the centre-based aspect of the intervention. Physical activity was measured following the intensive exercise training phase as well as the home-based phase. GMCB participants' SRE and OEs were sustained during the intervention whereas those of SE participants declined. GMCB participants also reported significantly greater time spent engaging in self-directed PA at the conclusion of the intensive and home-based phases. Mediation analysis revealed that SRE partially mediated the relationship between intervention condition and post home-based PA as confirmed by a significant sobel test. These findings suggest that a theory-based GMCB counselling plus exercise intervention is superior to the SE condition in sustaining SRE and OEs, and in promoting greater self-directed PA. SRE partially mediated the relationship between intervention condition and post home-based PA supporting the targeting of that variable for change as part of the intervention.

Testosterone reactivity to provocation mediates the effect of early intervention on aggressive behavior.

PubMed

Carré, Justin M; Iselin, Anne-Marie R; Welker, Keith M; Hariri, Ahmad R; Dodge, Kenneth A

2014-05-01

We tested the hypotheses that the Fast Track intervention program for high-risk children would reduce adult aggressive behavior and that this effect would be mediated by decreased testosterone responses to social provocation. Participants were a subsample of males from the full trial sample, who during kindergarten had been randomly assigned to the 10-year Fast Track intervention or to a control group. The Fast Track program attempted to develop children's social competencies through child social-cognitive and emotional-coping skills training, peer-relations coaching, academic tutoring, and classroom management, as well as training for parents to manage their child's behavior. At a mean age of 26 years, participants responded to laboratory provocations. Results indicated that, relative to control participants, men assigned to the intervention demonstrated reduced aggression and testosterone reactivity to social provocations. Moreover, reduced testosterone reactivity mediated the effect of intervention on aggressive behavior, which provides evidence for an enduring biological mechanism underlying the effect of early psychosocial intervention on aggressive behavior in adulthood.

BDNF mediates improvements in executive function following a 1-year exercise intervention

PubMed Central

Leckie, Regina L.; Oberlin, Lauren E.; Voss, Michelle W.; Prakash, Ruchika S.; Szabo-Reed, Amanda; Chaddock-Heyman, Laura; Phillips, Siobhan M.; Gothe, Neha P.; Mailey, Emily; Vieira-Potter, Victoria J.; Martin, Stephen A.; Pence, Brandt D.; Lin, Mingkuan; Parasuraman, Raja; Greenwood, Pamela M.; Fryxell, Karl J.; Woods, Jeffrey A.; McAuley, Edward; Kramer, Arthur F.; Erickson, Kirk I.

2014-01-01

Executive function declines with age, but engaging in aerobic exercise may attenuate decline. One mechanism by which aerobic exercise may preserve executive function is through the up-regulation of brain-derived neurotropic factor (BDNF), which also declines with age. The present study examined BDNF as a mediator of the effects of a 1-year walking intervention on executive function in 90 older adults (mean age = 66.82). Participants were randomized to a stretching and toning control group or a moderate intensity walking intervention group. BDNF serum levels and performance on a task-switching paradigm were collected at baseline and follow-up. We found that age moderated the effect of intervention group on changes in BDNF levels, with those in the highest age quartile showing the greatest increase in BDNF after 1-year of moderate intensity walking exercise (p = 0.036). The mediation analyses revealed that BDNF mediated the effect of the intervention on task-switch accuracy, but did so as a function of age, such that exercise-induced changes in BDNF mediated the effect of exercise on task-switch performance only for individuals over the age of 71. These results demonstrate that both age and BDNF serum levels are important factors to consider when investigating the mechanisms by which exercise interventions influence cognitive outcomes, particularly in elderly populations. PMID:25566019

Randomized comparative efficacy study of parent-mediated interventions for toddlers with autism.

PubMed

Kasari, Connie; Gulsrud, Amanda; Paparella, Tanya; Hellemann, Gerhard; Berry, Kathleen

2015-06-01

This study compared effects of two parent-mediated interventions on joint engagement outcomes as augmentations of an early intervention program for toddlers with autism spectrum disorder (ASD). Participants included 86 toddlers (range 22-36 months) with ASD and their primary caregiver. Caregiver-child dyads were randomized to receive 10 weeks of hands-on parent training in a naturalistic, developmental behavioral intervention (joint attention, symbolic play, engagement and regulation-JASPER) or a parent-only psychoeducational intervention (PEI). Dose was controlled in terms of researcher-parent contact and early intervention services received by the child. Results yielded significant effects of the JASPER intervention on the primary outcome of joint engagement. The treatment effect was large (Cohen's f² = .69) and maintained over the 6-month follow-up. JASPER effects were also found on secondary outcomes of play diversity, highest play level achieved, and generalization to the child's classroom for child-initiated joint engagement. The PEI intervention was found to be effective in reducing parenting stress associated with child characteristics. All secondary effects were generally small to moderate. These data highlight the benefit of a brief, targeted, parent-mediated intervention on child outcomes. Future studies may consider the combination of JASPER and PEI treatments for optimal parent and child outcomes. Trial registry no. NCT00999778. (c) 2015 APA, all rights reserved).

Exploring individual cognitions, self-regulation skills, and environmental-level factors as mediating variables of two versions of a Web-based computer-tailored nutrition education intervention aimed at adults: A randomized controlled trial.

PubMed

Springvloet, Linda; Lechner, Lilian; Candel, Math J J M; de Vries, Hein; Oenema, Anke

2016-03-01

This study explored whether the determinants that were targeted in two versions of a Web-based computer-tailored nutrition education intervention mediated the effects on fruit, high-energy snack, and saturated fat intake among adults who did not comply with dietary guidelines. A RCT was conducted with a basic (tailored intervention targeting individual cognitions and self-regulation), plus (additionally targeting environmental-level factors), and control group (generic nutrition information). Participants were recruited from the general Dutch adult population and randomly assigned to one of the study groups. Online self-reported questionnaires assessed dietary intake and potential mediating variables (behavior-specific cognitions, action- and coping planning, environmental-level factors) at baseline and one (T1) and four (T2) months post-intervention (i.e. four and seven months after baseline). The joint-significance test was used to establish mediating variables at different time points (T1-mediating variables - T2-intake; T1-mediating variables - T1-intake; T2-mediating variables - T2-intake). Educational differences were examined by testing interaction terms. The effect of the plus version on fruit intake was mediated (T2-T2) by intention and fruit availability at home and for high-educated participants also by attitude. Among low/moderate-educated participants, high-energy snack availability at home mediated (T1-T1) the effect of the basic version on high-energy snack intake. Subjective norm mediated (T1-T1) the effect of the basic version on fat intake among high-educated participants. Only some of the targeted determinants mediated the effects of both intervention versions on fruit, high-energy snack, and saturated fat intake. A possible reason for not finding a more pronounced pattern of mediating variables is that the educational content was tailored to individual characteristics and that participants only received feedback for relevant and not for all assessed mediating variables. Netherlands Trial Registry NTR3396. Copyright © 2015. Published by Elsevier Ltd.

Psychosocial constructs were not mediators of intervention effects for dietary and physical activity outcomes in a church-based lifestyle intervention: Delta Body and Soul III.

PubMed

Thomson, Jessica L; Tussing-Humphreys, Lisa M; Zoellner, Jamie M; Goodman, Melissa H

2016-08-01

Evaluating an intervention's theoretical basis can inform design modifications to produce more effective interventions. Hence the present study's purpose was to determine if effects from a multicomponent lifestyle intervention were mediated by changes in the psychosocial constructs decisional balance, self-efficacy and social support. Delta Body and Soul III, conducted from August 2011 to May 2012, was a 6-month, church-based, lifestyle intervention designed to improve diet quality and increase physical activity. Primary outcomes, diet quality and aerobic and strength/flexibility physical activity, as well as psychosocial constructs, were assessed via self-report, interviewer-administered surveys at baseline and post intervention. Mediation analyses were conducted using ordinary least squares (continuous outcomes) and maximum likelihood logistic (dichotomous outcomes) regression path analysis. Churches (five intervention and three control) were recruited from four counties in the Lower Mississippi Delta region of the USA. Rural, Southern, primarily African-American adults (n 321). Based upon results from the multiple mediation models, there was no evidence that treatment (intervention v. control) indirectly influenced changes in diet quality or physical activity through its effects on decisional balance, self-efficacy and social support. However, there was evidence for direct effects of social support for exercise on physical activity and of self-efficacy for sugar-sweetened beverages on diet quality. Results do not support the hypothesis that the psychosocial constructs decisional balance, self-efficacy and social support were the theoretical mechanisms by which the Delta Body and Soul III intervention influenced changes in diet quality and physical activity.

Executive Function, Behavioral Self-Regulation, and School Related Well-Being Did Not Mediate the Effect of School-Based Physical Activity on Academic Performance in Numeracy in 10-Year-Old Children. The Active Smarter Kids (ASK) Study.

PubMed

Aadland, Katrine N; Aadland, Eivind; Andersen, John R; Lervåg, Arne; Moe, Vegard F; Resaland, Geir K; Ommundsen, Yngvar

2018-01-01

Inconsistent findings exist for the effect of school-based physical activity interventions on academic performance. The Active Smarter Kids (ASK) study revealed a favorable intervention effect of school-based physical activity on academic performance in numeracy in a subsample of 10-year-old elementary schoolchildren performing poorer at baseline in numeracy. Aiming to explain this finding, we investigated the mediating effects of executive function, behavioral self-regulation, and school related well-being in the relation between the physical activity intervention and child's performance in numeracy. An ANCOVA model with latent variable structural equation modeling was estimated using data from 360 children (the lower third in academic performance in numeracy at baseline). The model consisted of the three latent factors as mediators; executive function, behavioral self-regulation, and school related well-being. We found no mediating effects of executive function, behavioral self-regulation or school related well-being in the relationship between the ASK intervention and academic performance in numeracy ( p ≥ 0.256). Our results suggest that the effect of the intervention on performance in numeracy in the present sample is not explained by change in executive function, behavioral self-regulation, or school related well-being. We suggest this finding mainly could be explained by the lack of effect of the intervention on the mediators, which might be due to an insufficient dose of physical activity. Trial registration: Clinicaltrials.gov registry, trial registration number: NCT02132494.

Executive Function, Behavioral Self-Regulation, and School Related Well-Being Did Not Mediate the Effect of School-Based Physical Activity on Academic Performance in Numeracy in 10-Year-Old Children. The Active Smarter Kids (ASK) Study

PubMed Central

Aadland, Katrine N.; Aadland, Eivind; Andersen, John R.; Lervåg, Arne; Moe, Vegard F.; Resaland, Geir K.; Ommundsen, Yngvar

2018-01-01

Inconsistent findings exist for the effect of school-based physical activity interventions on academic performance. The Active Smarter Kids (ASK) study revealed a favorable intervention effect of school-based physical activity on academic performance in numeracy in a subsample of 10-year-old elementary schoolchildren performing poorer at baseline in numeracy. Aiming to explain this finding, we investigated the mediating effects of executive function, behavioral self-regulation, and school related well-being in the relation between the physical activity intervention and child’s performance in numeracy. An ANCOVA model with latent variable structural equation modeling was estimated using data from 360 children (the lower third in academic performance in numeracy at baseline). The model consisted of the three latent factors as mediators; executive function, behavioral self-regulation, and school related well-being. We found no mediating effects of executive function, behavioral self-regulation or school related well-being in the relationship between the ASK intervention and academic performance in numeracy (p ≥ 0.256). Our results suggest that the effect of the intervention on performance in numeracy in the present sample is not explained by change in executive function, behavioral self-regulation, or school related well-being. We suggest this finding mainly could be explained by the lack of effect of the intervention on the mediators, which might be due to an insufficient dose of physical activity. Trial registration: Clinicaltrials.gov registry, trial registration number: NCT02132494. PMID:29541050

Moderation and Mediation of an Efficacious Sexual Risk-Reduction Intervention for South African Adolescents

PubMed Central

O’Leary, Ann; Jemmott, John B.; Jemmott, Loretta Sweet; Bellamy, Scarlett; Ngwane, Zolani; Icard, Larry

2015-01-01

Background “Let Us Protect Our Future” is a sexual risk-reduction intervention for sixth-grade adolescents in South Africa. Tested in a cluster-randomized controlled trial, the intervention significantly reduced self-reported intercourse and unprotected intercourse during a 12-month follow-up period. Purpose The present analyses were conducted to identify moderators of the intervention’s efficacy as well as which theory-based variables mediated the intervention’s effects. Methods: Intervention efficacy over the 3-, 6-, and 12-month follow-ups was tested using generalized estimating equation (GEE) models. Results Living with their father in the home, parental strictness, and religiosity moderated the efficacy of the intervention in reducing unprotected intercourse. Self-efficacy to avoid risky situations and expected parental disapproval of their having intercourse, derived from Social Cognitive Theory, significantly mediated the intervention’s effect on abstinence. Conclusions This is the first study to demonstrate that Social Cognitive variables mediate the efficacy of a sexual risk-reduction intervention among South African adolescents. PMID:22618963

Mediating Effects of Group Cohesion on Physical Activity and Diet in Women of Color: Health Is Power

PubMed Central

Lee, Rebecca E.; O’Connor, Daniel P.; Smith-Ray, Renae; Mama, Scherezade K.; Medina, Ashley V.; Reese-Smith, Jacqueline Y.; Banda, Jorge A.; Layne, Charles S.; Brosnan, Marcella; Cubbin, Catherine; McMillan, Tracy; Estabrooks, Paul A.

2015-01-01

Purpose To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention. Design Longitudinal design. Setting Harris County and Travis County, Texas. Participants Community-dwelling African-American and Hispanic or Latina women. Intervention Three hundred ten women were randomized to a PA (n = 204) or VF (n = 106) intervention group. Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption. Measures Women completed the International PA Questionnaire, National Cancer Institute VF and fat screeners, PA Group Environment Questionnaire, and 7-day accelerometer protocol at baseline and post-intervention. Analyses The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model, controlling for baseline values and covariates using path analysis. Results Women were middle aged (mean = 44.4 years) and overweight or obese (mean body mass index = 34.0 kg/m2). PA increased and fat consumption decreased for both groups, whereas VF consumption increased for women in VF group only (all p <.05). Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes. Conclusions Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women, but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid. PMID:22375580

A Successful Multifaceted Trial to Improve Hypertension Control in Primary Care: Why Did it Work?

PubMed

Margolis, Karen L; Asche, Stephen E; Bergdall, Anna R; Dehmer, Steven P; Maciosek, Michael V; Nyboer, Rachel A; O'Connor, Patrick J; Pawloski, Pamala A; Sperl-Hillen, JoAnn M; Trower, Nicole K; Tucker, Ann D; Green, Beverly B

2015-11-01

It is important to understand which components of successful multifaceted interventions are responsible for study outcomes, since some components may be more important contributors to the intervention effect than others. We conducted a mediation analysis to determine which of seven factors had the greatest effect on change in systolic blood pressure (BP) after 6 months in a trial to improve hypertension control. The study was a preplanned secondary analysis of a cluster-randomized clinical trial. Eight clinics in an integrated health system were randomized to provide usual care to their patients (n = 222), and eight were randomized to provide a telemonitoring intervention (n = 228). Four hundred three of 450 trial participants completing the 6-month follow-up visit were included. Intervention group participants received home BP telemonitors and transmitted measurements to pharmacists, who adjusted medications and provided advice to improve adherence to medications and lifestyle modification via telephone visits. Path analytic models estimated indirect effects of the seven potential mediators of intervention effect (defined as the difference between the intervention and usual care groups in change in systolic BP from baseline to 6 months). The potential mediators were change in home BP monitor use, number of BP medication classes, adherence to BP medications, physical activity, salt intake, alcohol use, and weight. The difference in change in systolic BP was 11.3 mmHg. The multivariable mediation model explained 47 % (5.3 mmHg) of the intervention effect. Nearly all of this was mediated by two factors: an increase in medication treatment intensity (24 %) and increased home BP monitor use (19 %). The other five factors were not significant mediators, although medication adherence and salt intake improved more in the intervention group than in the usual care group. Most of the explained intervention effect was attributable to the combination of self-monitoring and medication intensification. High adherence at baseline and the relatively low intensity of resources directed toward lifestyle change may explain why these factors did not contribute to the improvement in BP.

Peer-Mediated Intervention: Concept and Implications for Research and Pedagogical Practice of Teachers of Students with Autism

ERIC Educational Resources Information Center

Ramos, Fabiane dos Santos; de Bittencourt, Daniele F. C. Denardin; Carmargo, Síglia Pimentel Höher; Schmidt, Carlo

2018-01-01

Inclusion of students with autism has been a challenge for educators who indicate gaps in professional training, especially regarding interventions in the school context. The international literature shows evidence of the effectiveness of a type of intervention not found in the national literature, called peer-mediated intervention (PMI). This…

Mediating effects of resistance training skill competency on health-related fitness and physical activity: the ATLAS cluster randomised controlled trial.

PubMed

Smith, Jordan J; Morgan, Philip J; Plotnikoff, Ronald C; Stodden, David F; Lubans, David R

2016-01-01

The purpose of this study was to examine the mediating effect of resistance training skill competency on percentage of body fat, muscular fitness and physical activity among a sample of adolescent boys participating in a school-based obesity prevention intervention. Participants were 361 adolescent boys taking part in the Active Teen Leaders Avoiding Screen-time (ATLAS) cluster randomised controlled trial: a school-based program targeting the health behaviours of economically disadvantaged adolescent males considered "at-risk" of obesity. Body fat percentage (bioelectrical impedance), muscular fitness (hand grip dynamometry and push-ups), physical activity (accelerometry) and resistance training skill competency were assessed at baseline and post-intervention (i.e., 8 months). Three separate multi-level mediation models were analysed to investigate the potential mediating effects of resistance training skill competency on each of the study outcomes using a product-of-coefficients test. Analyses followed the intention-to-treat principle. The intervention had a significant impact on the resistance training skill competency of the boys, and improvements in skill competency significantly mediated the effect of the intervention on percentage of body fat and the combined muscular fitness score. No significant mediated effects were found for physical activity. Improving resistance training skill competency may be an effective strategy for achieving improvements in body composition and muscular fitness in adolescent boys.

Intervening to reduce workplace sitting: mediating role of social-cognitive constructs during a cluster randomised controlled trial.

PubMed

Hadgraft, Nyssa T; Winkler, Elisabeth A H; Healy, Genevieve N; Lynch, Brigid M; Neuhaus, Maike; Eakin, Elizabeth G; Dunstan, David W; Owen, Neville; Fjeldsoe, Brianna S

2017-03-06

The Stand Up Victoria multi-component intervention successfully reduced workplace sitting time in both the short (three months) and long (12 months) term. To further understand how this intervention worked, we aimed to assess the impact of the intervention on four social-cognitive constructs, and examined whether these constructs mediated intervention effects on workplace sitting time at 3 and 12 months post-baseline. Two hundred and thirty one office-based workers (14 worksites, single government employer) were randomised to intervention or control conditions by worksite. The intervention comprised organisational, environmental, and individual level elements. Participant characteristics and social-cognitive constructs (perceived behavioural control, barrier self-efficacy, perceived organisational norms and knowledge) were measured through a self-administered online survey at baseline, 3 months and 12 months. Workplace sitting time (min/8 h day) was measured with the activPAL3 device. Single multi-level mediation models were performed for each construct at both time points. There were significant intervention effects at 3 months on perceived behavioural control, barrier self-efficacy and perceived organisational norms. Effects on perceived organisational norms were not significant at 12 months. Perceived behavioural control significantly mediated intervention effects at 3 months, accounting for a small portion of the total effect (indirect effect: -8.6 min/8 h day, 95% CI: -18.5, -3.6 min; 7.5% of total effect). At 12 months, barrier self-efficacy significantly mediated the intervention effects on workplace sitting time (indirect effect: -10.3 min/8 h day, 95% CI: -27.3, -2.2; 13.9% of total effect). No significant effects were observed for knowledge at either time point. Strategies that aim to increase workers' perceived control and self-efficacy over their sitting time may be helpful components of sedentary behaviour interventions in the workplace. However, social-cognitive factors only partially explain variation in workplace sitting reduction. Understanding the importance of other levels of influence (particularly interpersonal and environmental) for initiating and maintaining workplace sedentary behaviour change will be informative for intervention development and refinement. This study was prospectively registered with the Australian New Zealand Clinical Trials register ( ACTRN12611000742976 ) on 15 July 2011.

Social cognitive theory mediators of physical activity in a lifestyle program for cancer survivors and carers: findings from the ENRICH randomized controlled trial.

PubMed

Stacey, F G; James, E L; Chapman, K; Lubans, D R

2016-04-14

Despite increasing numbers of cancer survivors and evidence that diet and physical activity improves the health of cancer survivors, most do not meet guidelines. Some social cognitive theory (SCT)-based interventions have increased physical activity behavior, however few have used objective physical activity measures. The Exercise and Nutrition Routine Improving Cancer Health (ENRICH) randomized controlled trial reported a significant intervention effect for the primary outcome of pedometer-assessed step counts at post-test (8-weeks) and follow-up (20-weeks). The aim of this study was to test whether the SCT constructs operationalized in the ENRICH intervention were mediators of physical activity behavior change. Randomized controlled trial with 174 cancer survivors and carers assessed at baseline, post-test (8-weeks), and follow-up (20-weeks). Participants were randomized to the ENRICH six session face-to-face healthy lifestyle program, or to a wait-list control. Hypothesized SCT mediators of physical activity behavior change (self-efficacy, behavioral goal, outcome expectations, impediments, and social expectations) were assessed using valid and reliable scales. Mediation was assessed using the Preacher and Hayes SPSS INDIRECT macro. At eight weeks, there was a significant intervention effect on behavioral goal (A = 9.12, p = 0.031) and outcome expectations (A = 0.25, p = 0.042). At 20 weeks, the intervention had a significant effect on self-efficacy (A = 0.31, p = 0.049) and behavioral goal (A = 13.15, p = 0.011). Only changes in social support were significantly associated with changes in step counts at eight weeks (B = 633.81, p = 0.023). Behavioral goal was the only SCT construct that had a significant mediating effect on step counts, and explained 22 % of the intervention effect at 20 weeks (AB = 397.9, 95 % CI 81.5-1025.5). SCT constructs had limited impact on objectively-assessed step counts in a multiple health behavior change intervention for cancer survivors and their carers. Behavioral goal measured post-intervention was a significant mediator of pedometer-assessed step counts at 3-months after intervention completion, and explained 22 % of the intervention effect. Future research should examine the separate impact of goals and planning, as well as examining mediators of behavior maintenance in physical activity interventions targeting cancer survivors. Australian and New Zealand Clinical Trials registry ANZCTRN1260901086257 .

Affective mediators of a physical activity intervention for depression in multiple sclerosis.

PubMed

Kratz, Anna L; Ehde, Dawn M; Bombardier, Charles H

2014-02-01

Previous analyses showed that a telephone-based intervention to increase physical activity in individuals with multiple sclerosis (MS) and depression resulted in significantly improved depressive symptoms compared to a wait-list control group. The aim of this study was to test positive affect and negative affect as mediators of the effect of the physical activity counseling on depressive symptoms. Ninety-two adults with MS, who met diagnostic criteria for either major depression or dysthymia and who reported low levels of physical activity, were randomized 1:1 to a 12-week telephone-based motivational interviewing (MI) intervention to improve physical activity (n = 44) or to a 12-week wait-list control group (n = 48). Self-reported positive and negative affect, physical activity, and depressive symptoms were gathered at baseline and postintervention. Path-analysis was used to test whether positive affect and negative affect mediated the positive effects of the intervention on depressive symptoms. Both positive and negative affect were significant mediators of the effects of the intervention on depressive symptoms; however, only positive affect mediated the association between changes in physical activity and improved depressive symptoms. Findings support physical activity and positive affect as key mediators of the MI treatment effect on improved mood. Decreases in negative affect were also evident in the treatment group, but were not related to improved physical activity. Findings may suggest the use of exercise-based interventions in conjunction with treatments that specifically target negative affective mechanisms for depression. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Can Computer-Mediated Interventions Change Theoretical Mediators of Safer Sex? A Meta-Analysis

ERIC Educational Resources Information Center

Noar, Seth M.; Pierce, Larson B.; Black, Hulda G.

2010-01-01

The purpose of this study was to conduct a meta-analysis of computer-mediated interventions (CMIs) aimed at changing theoretical mediators of safer sex. Meta-analytic aggregation of effect sizes from k = 20 studies indicated that CMIs significantly improved HIV/AIDS knowledge, d = 0.276, p less than 0.001, k = 15, N = 6,625; sexual/condom…

Mediators of Effects of a Selective Family-Focused Violence Prevention Approach for Middle School Students

PubMed Central

2013-01-01

This study examined how parenting and family characteristics targeted in a selective prevention program mediated effects on key youth proximal outcomes related to violence perpetration. The selective intervention was evaluated within the context of a multi-site trial involving random assignment of 37 schools to four conditions: a universal intervention composed of a student social-cognitive curriculum and teacher training, a selective family-focused intervention with a subset of high-risk students, a condition combining these two interventions, and a no-intervention control condition. Two cohorts of sixth-grade students (total N=1,062) exhibiting high levels of aggression and social influence were the sample for this study. Analyses of pre-post change compared to controls using intent-to-treat analyses found no significant effects. However, estimates incorporating participation of those assigned to the intervention and predicted participation among those not assigned revealed significant positive effects on student aggression, use of aggressive strategies for conflict management, and parental estimation of student’s valuing of achievement. Findings also indicated intervention effects on two targeted family processes: discipline practices and family cohesion. Mediation analyses found evidence that change in these processes mediated effects on some outcomes, notably aggressive behavior and valuing of school achievement. Results support the notion that changing parenting practices and the quality of family relationships can prevent the escalation in aggression and maintain positive school engagement for high-risk youth. PMID:21932067

Confounding in statistical mediation analysis: What it is and how to address it.

PubMed

Valente, Matthew J; Pelham, William E; Smyth, Heather; MacKinnon, David P

2017-11-01

Psychology researchers are often interested in mechanisms underlying how randomized interventions affect outcomes such as substance use and mental health. Mediation analysis is a common statistical method for investigating psychological mechanisms that has benefited from exciting new methodological improvements over the last 2 decades. One of the most important new developments is methodology for estimating causal mediated effects using the potential outcomes framework for causal inference. Potential outcomes-based methods developed in epidemiology and statistics have important implications for understanding psychological mechanisms. We aim to provide a concise introduction to and illustration of these new methods and emphasize the importance of confounder adjustment. First, we review the traditional regression approach for estimating mediated effects. Second, we describe the potential outcomes framework. Third, we define what a confounder is and how the presence of a confounder can provide misleading evidence regarding mechanisms of interventions. Fourth, we describe experimental designs that can help rule out confounder bias. Fifth, we describe new statistical approaches to adjust for measured confounders of the mediator-outcome relation and sensitivity analyses to probe effects of unmeasured confounders on the mediated effect. All approaches are illustrated with application to a real counseling intervention dataset. Counseling psychologists interested in understanding the causal mechanisms of their interventions can benefit from incorporating the most up-to-date techniques into their mediation analyses. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Behavioral and Nondirective Guided Self-Help for Parents of Children with Externalizing Behavior: Mediating Mechanisms in a Head-To-Head Comparison.

PubMed

Katzmann, Josepha; Hautmann, Christopher; Greimel, Lisa; Imort, Stephanie; Pinior, Julia; Scholz, Kristin; Döpfner, Manfred

2017-05-01

Parent training (PT) delivered as a guided self-help intervention may be a cost- and time-effective intervention in the treatment of children with externalizing disorders. In face-to-face PT, parenting strategies have repeatedly been identified as mediating mechanisms for the decrease of children's problem behavior. Few studies have examined possible mediating effects in guided self-help interventions for parents. The present study aimed to investigate possible mediating variables of a behaviorally oriented guided self-help program for parents of children with externalizing problems compared to a nondirective intervention in a clinical sample. A sample of 110 parents of children with externalizing disorders (80 % boys) were randomized to either a behaviorally oriented or a nondirective guided self-help program. Four putative mediating variables were examined simultaneously in a multiple mediation model using structural equation modelling. The outcomes were child symptoms of ADHD and ODD as well as child externalizing problems, assessed at posttreatment. Analyses showed a significant indirect effect for dysfunctional parental attributions in favor of the group receiving the behavioral program, and significant effects of the behavioral program on positive and negative parenting and parental self-efficacy, compared to the nondirective intervention. Our results indicate that a decrease of dysfunctional parental attributions leads to a decrease of child externalizing problems when parents take part in a behaviorally oriented guided self-help program. However, none of the putative mediating variables could explain the decrease in child externalizing behavior problems in the nondirective group. A change in dysfunctional parental attributions should be considered as a possible mediator in the context of PT.

Change in Self-efficacy Partially Mediates the Effects of the FRESH START Intervention on Cancer Survivors’ Dietary Outcomes

PubMed Central

Mosher, Catherine E.; Fuemmeler, Bernard F.; Sloane, Richard; Kraus, William E.; Lobach, David F.; Snyder, Denise Clutter; Demark-Wahnefried, Wendy

2013-01-01

This study examined change in self-efficacy as a mediator of the effects of a mailed print intervention on the dietary and exercise practices of newly diagnosed breast and prostate cancer survivors (N = 519). Results indicated that changes in self-efficacy for fat restriction and eating more fruits and vegetables were significant mediators of the intervention’s effects on dietary outcomes at 1-year follow-up. The intervention did not significantly affect self-efficacy for exercise; however, a significant, positive relationship was found between self-efficacy for exercise and exercise duration at follow-up. Findings are largely consistent with Social Cognitive Theory and support the use of strategies to increase self-efficacy in health promotion interventions for cancer survivors. PMID:18300337

Mediating processes of two communication interventions for breast cancer patients

PubMed Central

Hawkins, Robert P.; Pingree, Suzanne; Shaw, Bret; Serlin, Ronald C.; Swoboda, Chris; Han, Jeong-Yeob; Carmack, Cindy L.; Salner, Andrew

2012-01-01

Objective Test whether three mediating processes of Self-Determination Theory are involved in intervention effects on quality of life for breast cancer patients. Methods A randomized clinical trial recruited newly diagnosed breast cancer patients for 6 months of (1) Internet training and access, (2) access to an integrated eHealth system for breast cancer (CHESS), (3) a series of phone conversations with a Human Cancer Information Mentor, or (4) both (2) and (3). Results This paper reports results after the initial 6 weeks of intervention, at which point patients in the combined condition had higher quality of life scores than those in the other three conditions. All three Self-Determination Theory constructs (autonomy, competence, and relatedness) mediated that effect as hypothesized. In addition, the single-intervention groups were superior to the Internet-only group on relatedness, though perhaps this was too soon for that to carry through to quality of life as well. Conclusions The SDT constructs do mediate these interventions’ effects. Practice implications Intervention design can profitably focus on enhancing autonomy, competence and relatedness. PMID:21081261

Mother-child relationship quality and effective discipline as mediators of the 6-year effects of the New Beginnings Program for children from divorced families.

PubMed

Zhou, Qing; Sandler, Irwin N; Millsap, Roger E; Wolchik, Sharlene A; Dawson-McClure, Spring R

2008-08-01

This study examines whether program effects on mother-child relationship quality and effective discipline mediated the 6-year longitudinal effects of the New Beginnings Program (NBP) to improve mental health and competence outcomes in 218 adolescents from divorced families in a randomized experimental trial. The NBP is a theory-based and parenting-focused preventive intervention to help children adjust to divorce, and it has previously shown significant main and/or Program x Baseline Risk interaction effects to reduce adolescents' mental health and social adaptation problems and to promote competence. Mediation analyses were conducted using single- and two-group (high and low baseline risk) structural equation modeling. A multiple-methods and multiple-informants approach was used to assess the putative mediators and adolescents' outcomes. Results indicated that program-induced improvement in maternal effective discipline at posttest mediated the intervention effect on adolescents' GPA at the 6-year follow-up. Moreover, program-induced improvement in mother-child relationship quality mediated the intervention effect on adolescents' mental health problems for those with high baseline risk for maladjustment. The discussion focuses on the implications of the mediation findings for advancing the developmental theories that informed the design of the NBP and the implications for implementation of the NBP in community settings. Copyright 2008 APA, all rights reserved.

Psychosocial Factors Mediating the Effect of the CHoBI7 Intervention on Handwashing With Soap: A Randomized Controlled Trial.

PubMed

George, Christine Marie; Biswas, Shwapon; Jung, Danielle; Perin, Jamie; Parvin, Tahmina; Monira, Shirajum; Saif-Ur-Rahman, K M; Rashid, Mahamud-Ur; Bhuyian, Sazzadul Islam; Thomas, Elizabeth D; Dreibelbis, Robert; Begum, Farzana; Zohura, Fatema; Zhang, Xiaotong; Sack, David A; Alam, Munirul; Sack, R Bradley; Leontsini, Elli; Winch, Peter J

2017-08-01

Inadequate hand hygiene is estimated to result in nearly 300,000 deaths annually, with the majority of deaths being among children younger than 5 years. In an effort to promote handwashing with soap and water treatment behaviors among highly susceptible household members of cholera patients, we recently developed the Cholera-Hospital-Based Intervention-for-7-Days (CHoBI7); chobi means picture in Bengali. This 1-week handwashing with soap and water treatment intervention is delivered by a promoter in the hospital and the home to cholera patients and their household members. In our randomized controlled trial of this intervention, we observed a significant reduction in symptomatic cholera infections during the 1-week intervention period compared to the control arm and sustained high uptake of observed handwashing with soap behaviors up to 12 months postintervention. The aim of the present study was to assess the underlying mechanism of change that led to the high handwashing with soap behavior observed among participants who received the CHoBI7 intervention. Handwashing with soap was measured using 5-hour structured observation, and psychosocial factors were assessed using a structured questionnaire among 170 intervention and 174 control household members enrolled in the CHoBI7 trial. To investigate potential mediators of the CHoBI7 intervention effect, mediation models were performed. Response efficacy was found to mediate the intervention's effect on habit formation for handwashing with soap at the 1-week follow-up, and disgust, convenience, and cholera awareness were mediators of habit maintenance at the 6- to 12-month follow-up. These results support the use of theory-driven approaches for the development and implementation of handwashing with soap interventions.

Mediating effects of group cohesion on physical activity and diet in women of color: health is power.

PubMed

Lee, Rebecca E; O'Connor, Daniel P; Smith-Ray, Renae; Mama, Scherezade K; Medina, Ashley V; Reese-Smith, Jacqueline Y; Banda, Jorge A; Layne, Charles S; Brosnan, Marcella; Cubbin, Catherine; McMillan, Tracy; Estabrooks, Paul A

2012-01-01

To determine the effects and mediating factors of a physical activity (PA) or vegetable and fruit (VF) group cohesion intervention. Longitudinal design. Harris County and Travis County, Texas. Community-dwelling African-American and Hispanic or Latina women. Three hundred ten women were randomized to a PA (n  =  204) or VF (n  =  106) intervention group. Women met in groups six times over the course of 6 months and were exposed to a group cohesion intervention to promote walking or to increase VF consumption. Women completed the International PA Questionnaire, National Cancer Institute VF and fat screeners, PA Group Environment Questionnaire, and 7-day accelerometer protocol at baseline and post-intervention. The direct and mediated effects of the intervention on outcomes were evaluated using a mediational chain model, controlling for baseline values and covariates using path analysis. Women were middle aged (mean  =  44.4 years) and overweight or obese (mean body mass index  =  34.0 kg/m(2)). PA increased and fat consumption decreased for both groups, whereas VF consumption increased for women in VF group only (all p < .05). Increased task cohesion led to hypothesized increases in psychosocial factors in the PA group but not to behavioral changes. Group cohesion interventions may have psychological and physical health benefits for African-American and Hispanic or Latina women, but refinement of measures and intervention delivery is needed to determine whether hypothesized mediational pathways are valid.

Effect of a community-based diabetes self-management empowerment program on mental health-related quality of life: a causal mediation analysis from a randomized controlled trial.

PubMed

Sugiyama, Takehiro; Steers, William Neil; Wenger, Neil S; Duru, Obidiugwu Kenrik; Mangione, Carol M

2015-03-22

There is a paucity of evidence supporting the effectiveness of diabetes self-management education (DSME) in improving mental health-related quality of life (HRQoL) for African American and Latinos. Also, among studies supporting the favorable effects of DSME on mental HRQoL, the direct effect of DSME that is independent of improved glycemic control has never been investigated. The objectives of this study were to investigate the effect of community-based DSME intervention targeting empowerment on mental HRQoL and to determine whether the effect is direct or mediated by glycemic control. We conducted secondary analyses of data from the Diabetes Self-Care Study, a randomized controlled trial of a community-based DSME intervention. Study participants (n = 516) were African Americans and Latinos 55 years or older with poorly controlled diabetes (HbA1c ≥ 8.0%) recruited from senior centers and churches in Los Angeles. The intervention group received six weekly small-group self-care sessions based on the empowerment model. The control group received six lectures on unrelated geriatrics topics. The primary outcome variable in this secondary analysis was the change in Mental Component Summary score (MCS-12) from the SF-12 Health Survey between baseline and six-month follow-up. We used the change in HbA1c during the study period as the main mediator of interest in our causal mediation analysis. Additionally, possible mediations via social support and perceived empowerment attributable to the program were examined. MCS-12 increased by 1.4 points on average in the intervention group and decreased by 0.2 points in the control group (difference-in-change: 1.6 points, 95% CI: 0.1 to 3.2). In the causal mediation analysis, the intervention had a direct effect on MCS-12 improvement (1.7 points, 95% CI: 0.2 to 3.2) with no indirect effects mediated via HbA1c change (-0.1 points, 95% CI: -0.4 to 0.1), social support (0.1 points), and perception of empowerment (0.1 points). This Diabetes Self-Care Study empowerment intervention had a modest positive impact on mental HRQoL not mediated by the improvement in glycemic control, as well as social support and perception of empowerment. This favorable effect on mental HRQoL may be a separate clinical advantage of this DSME intervention. ClinicalTrial.gov NCT00263835.

Mediators of Psychological Well-being in Adolescent Boys.

PubMed

Lubans, David R; Smith, Jordan J; Morgan, Philip J; Beauchamp, Mark R; Miller, Andrew; Lonsdale, Chris; Parker, Philip; Dally, Kerry

2016-02-01

The aim of this study was to explore the effect of the Active Teen Leaders Avoiding Screen-time (ATLAS) intervention on psychological well-being in adolescent boys and to examine the potential mediating mechanisms that might explain this effect. ATLAS was evaluated using a cluster randomized controlled trial in 14 secondary schools located in low-income communities (N = 361 adolescent boys, mean age = 12.7 ± .5 years). The 20-week intervention was guided by self-determination theory and involved: professional development for teachers, provision of fitness equipment to schools, enhanced school sport sessions, researcher-led seminars, a smartphone application, and parental strategies for reducing screen time. Assessments were conducted at baseline and immediately post intervention (8 months). Psychological well-being was measured using the Flourishing Scale. Motivational regulations (intrinsic, identified, introjected, controlled, and amotivation) and basic psychological needs (autonomy, competence, and relatedness) in school sport, muscular fitness, resistance training skill competency, and recreational screen time were examined as potential mediating mechanisms of the intervention effect. The intervention effect on well-being was small but statistically significant. Within a multiple mediator model, changes in autonomy needs satisfaction, recreational screen time, and muscular fitness significantly mediated the effect of the intervention on psychological well-being. In addition to the physical health benefits, targeted physical activity programs for adolescent boys may have utility for mental health promotion through the mechanisms of increasing autonomy support and muscular fitness and reducing screen time. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Improving Collaborative Play Between Children with Autism Spectrum Disorders and Their Siblings: The Effectiveness of a Robot-Mediated Intervention Based on Lego® Therapy.

PubMed

Huskens, Bibi; Palmen, Annemiek; Van der Werff, Marije; Lourens, Tino; Barakova, Emilia

2015-11-01

The aim of the study was to investigate the effectiveness of a brief robot-mediated intervention based on Lego(®) therapy on improving collaborative behaviors (i.e., interaction initiations, responses, and play together) between children with ASD and their siblings during play sessions, in a therapeutic setting. A concurrent multiple baseline design across three child-sibling pairs was in effect. The robot-intervention resulted in no statistically significant changes in collaborative behaviors of the children with ASD. Despite limited effectiveness of the intervention, this study provides several practical implications and directions for future research.

Mediation and spillover effects in group-randomized trials: a case study of the 4Rs educational intervention

PubMed Central

VanderWeele, Tyler J.; Hong, Guanglei; Jones, Stephanie M.; Brown, Joshua L.

2013-01-01

Peer influence and social interactions can give rise to spillover effects in which the exposure of one individual may affect outcomes of other individuals. Even if the intervention under study occurs at the group or cluster level as in group-randomized trials, spillover effects can occur when the mediator of interest is measured at a lower level than the treatment. Evaluators who choose groups rather than individuals as experimental units in a randomized trial often anticipate that the desirable changes in targeted social behaviors will be reinforced through interference among individuals in a group exposed to the same treatment. In an empirical evaluation of the effect of a school-wide intervention on reducing individual students’ depressive symptoms, schools in matched pairs were randomly assigned to the 4Rs intervention or the control condition. Class quality was hypothesized as an important mediator assessed at the classroom level. We reason that the quality of one classroom may affect outcomes of children in another classroom because children interact not simply with their classmates but also with those from other classes in the hallways or on the playground. In investigating the role of class quality as a mediator, failure to account for such spillover effects of one classroom on the outcomes of children in other classrooms can potentially result in bias and problems with interpretation. Using a counterfactual conceptualization of direct, indirect and spillover effects, we provide a framework that can accommodate issues of mediation and spillover effects in group randomized trials. We show that the total effect can be decomposed into a natural direct effect, a within-classroom mediated effect and a spillover mediated effect. We give identification conditions for each of the causal effects of interest and provide results on the consequences of ignoring “interference” or “spillover effects” when they are in fact present. Our modeling approach disentangles these effects. The analysis examines whether the 4Rs intervention has an effect on children's depressive symptoms through changing the quality of other classes as well as through changing the quality of a child's own class. PMID:23997375

How does family intervention improve the outcome of people with schizophrenia?

PubMed

Girón, Manuel; Nova-Fernández, Francisco; Mañá-Alvarenga, Sonia; Nolasco, Andreu; Molina-Habas, Antonia; Fernández-Yañez, Antonio; Tabarés-Seisdedos, Rafael; Gómez-Beneyto, Manuel

2015-03-01

There is strong evidence of the efficacy of family psychosocial interventions for schizophrenia, but evidence of the role played by the attitudes of relatives in the therapeutic process is lacking. To study the effect of a family intervention on family attitudes and to analyse their mediating role in the therapeutic process 50 patients with schizophrenia and their key relatives undergoing a trial on the efficacy of a family psychosocial intervention were studied by means of the Affective Style Coding System, the Scale of Empathy, and the Relational Control Coding System. Specific statistical methods were used to determine the nature of the relationship of the relatives' attitudes to the outcome of family intervention. Family psychosocial intervention was associated with a reduction in relatives' guilt induction and dominance and an improvement in empathy. Empathy and lack of dominance were identified as independent mediators of the effect of family psychosocial intervention. The change in empathy and dominance during the first 9 months of the intervention predicted the outcome in the following 15 months. Relatives' empathy and lack of dominance are mediators of the beneficial effect of family psychosocial intervention on patient's outcome.

Information Processing Versus Social Cognitive Mediators of Weight Loss in a Podcast-Delivered Health Intervention

ERIC Educational Resources Information Center

Ko, Linda K.; Turner-McGrievy, Gabrielle M.; Campbell, Marci K.

2014-01-01

Podcasting is an emerging technology, and previous interventions have shown promising results using theory-based podcast for weight loss among overweight and obese individuals. This study investigated whether constructs of social cognitive theory and information processing theories (IPTs) mediate the effect of a podcast intervention on weight loss…

Behavioral Mediators of Weight Loss in Two Group-Based Behavioral Interventions in Older Adults

ERIC Educational Resources Information Center

Baruth, Meghan; Schlaff, Rebecca A.

2017-01-01

Background: Understanding the mechanisms by which behavioral interventions exert their effects is important. Purpose: To examine behavioral mediators of weight loss in a sample of older adults participating in an evidence-based physical activity (PA) or nutrition intervention. Methods: Participants (n = 46) were randomized to a 12-week,…

Preliminary Effectiveness of Project Impact: A Parent-Mediated Intervention for Children with Autism Spectrum Disorder Delivered in a Community Program

ERIC Educational Resources Information Center

Stadnick, Nicole A.; Stahmer, Aubyn; Brookman-Frazee, Lauren

2015-01-01

This is a pilot study of the effectiveness of Project ImPACT, a parent-mediated intervention for ASD delivered in a community program. The primary aim was to compare child and parent outcomes between the intervention group and a community comparison for 30 young children with ASD at baseline and 12 weeks. The secondary aim was to identify parent…

Mediating Effects of Home-Related Factors on Fat Intake from Snacks in a School-Based Nutrition Intervention among Adolescents

ERIC Educational Resources Information Center

Van Lippevelde, Wendy; van Stralen, Maartje; Verloigne, Maite; De Bourdeaudhuij, Ilse; Deforche, Benedicte; Brug, Johannes; Maes, Lea; Haerens, Leen

2012-01-01

The purpose of the present study was to investigate if the effects of the parental component of a school-based intervention on dietary fat intake from snacking were mediated by changes in home-related factors. A random sample of 10 schools with 2232 pupils aged 11-15 years was randomly assigned to one of two intervention groups [one with (n =…

Mediators of a Brief Hypnosis Intervention to Control Side Effects in Breast Surgery Patients: Response Expectancies and Emotional Distress

ERIC Educational Resources Information Center

Montgomery, Guy H.; Hallquist, Michael N.; Schnur, Julie B.; David, Daniel; Silverstein, Jeffrey H.; Bovbjerg, Dana H.

2010-01-01

Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years;…

Exploring How School Intra-Organizational Mechanisms Mediate the Effects of External Interventions on Improving Teaching and Learning

ERIC Educational Resources Information Center

Sun, Min

2011-01-01

This dissertation collects three independent but interrelated studies exploring how school intra-organizational mechanism may mediate the impact of external interventions on improving teaching and learning. This first study examines how high-quality professional development (PD) can promote the diffusion of effective teaching strategies among…

Social Cognitive Constructs Did Not Mediate the BEAT Cancer Intervention Effects on Objective Physical Activity Behavior Based on Multivariable Path Analysis.

PubMed

Rogers, Laura Q; Courneya, Kerry S; Anton, Phillip M; Hopkins-Price, Patricia; Verhulst, Steven; Robbs, Randall S; Vicari, Sandra K; McAuley, Edward

2017-04-01

Most breast cancer survivors do not meet physical activity recommendations. Understanding mediators of physical activity behavior change can improve interventions designed to increase physical activity in this at-risk population. Study aims were to determine the 3-month Better Exercise Adherence after Treatment for Cancer (BEAT Cancer) behavior change intervention effects on social cognitive theory constructs and the mediating role of any changes on the increase in accelerometer-measured physical activity previously reported. Post-treatment breast cancer survivors (N = 222) were randomized to BEAT Cancer or usual care. Assessments occurred at baseline, 3 months (M3), and 6 months (M6). Adjusted linear mixed model analysis of variance determined intervention effects on walking self-efficacy, outcome expectations, goal setting, and perceived barrier interference at M3. Path analysis determined mediation of intervention effects on physical activity at M6 by changes in social cognitive constructs during the intervention (i.e., baseline to M3). BEAT Cancer significantly improved self-efficacy, goals, negative outcome expectations, and barriers. Total path analysis model explained 24 % of the variance in M6 physical activity. There were significant paths from randomized intervention group to self-efficacy (β = 0.15, p < .05) and barriers (β = -0.22, p < .01). Barriers demonstrated a borderline significant association with M6 physical activity (β = -0.24, p = .05). No statistically significant indirect effects were found. Although BEAT Cancer significantly improved social cognitive constructs, no significant indirect effects on physical activity improvements 3 months post-intervention were observed (NCT00929617).

Coping and parenting: Mediators of 12-month outcomes of a family group cognitive-behavioral preventive intervention with families of depressed parents.

PubMed

Compas, Bruce E; Champion, Jennifer E; Forehand, Rex; Cole, David A; Reeslund, Kristen L; Fear, Jessica; Hardcastle, Emily J; Keller, Gary; Rakow, Aaron; Garai, Emily; Merchant, Mary Jane; Roberts, Lorinda

2010-10-01

In a randomized clinical trial with 111 families of parents with a history of major depressive disorder (86% mothers, 14% fathers; 86% Caucasian, 5% African-American, 3% Hispanic, 1% American Indian or Alaska Native, 4% mixed ethnicity), changes in adolescents' (mean age = 11 years; 42% female, 58% male) coping and parents' parenting skills were examined as mediators of the effects of a family group cognitive-behavioral preventive intervention on adolescents' internalizing and externalizing symptoms. Changes in hypothesized mediators were assessed at 6 months, and changes in adolescents' symptoms were measured at a 12-month follow-up. Significant differences favoring the family intervention compared with a written information comparison condition were found for changes in composite measures of parent-adolescent reports of adolescents' use of secondary control coping skills and direct observations of parents' positive parenting skills. Changes in adolescents' secondary control coping and positive parenting mediated the effects of the intervention on depressive, internalizing, and externalizing symptoms, accounting for approximately half of the effect of the intervention on the outcomes. Further, reciprocal relations between children's internalizing symptoms and parenting were found from baseline to 6-month follow-up. The present study provides the first evidence for specific mediators of a family group cognitive-behavioral preventive intervention for families of parents with a history of major depressive disorder. The identification of both coping and parenting as mediators of children's mental health outcomes suggests that these variables are important active ingredients in the prevention of mental health problems in children of depressed parents. Copyright 2010 APA, all rights reserved.

Paternal Lifestyle-Related Parenting Practices Mediate Changes in Children's Dietary and Physical Activity Behaviors: Findings From the Healthy Dads, Healthy Kids Community Randomized Controlled Trial.

PubMed

Lloyd, Adam B; Lubans, David R; Plotnikoff, Ronald C; Morgan, Philip J

2015-09-01

This study examined potential parenting-related mediators of children's physical activity and dietary behavior change in the Healthy Dads, Healthy Kids (HDHK) community program. A randomized controlled trial was conducted with 45 overweight/obese (mean [SD] age = 39.8 [5.4] years; BMI = 32.4 [3.8]) fathers and their children (n = 77; 58% boys; mean [SD] age = 7.7 [2.5] years). Families were randomized to either the HDHK program or wait-list control group. The program involved 7 sessions. Fathers and their children were assessed at baseline and at 14 weeks for physical activity (pedometery) and core food intake (Questionnaire). Fathers' lifestyle-related parenting practices included; self-efficacy, beliefs, modeling, logistic support, rules, cophysical activity, shared mealtime frequency and intentions. Significant intervention effects were found for cophysical activity and modeling physical activity. Cophysical activity mediated children's physical activity in the intervention ('mediated effect,' AB = 653, 95% CI = 4-2050) and was responsible for 59.5% of the intervention effect. Fathers' beliefs mediated children's percent energy from core foods (AB = 1.51, 95% CI = 0.05-5.55) and accounted for 72.9% of the intervention effect. Participation in the HDHK program positively impacted on fathers' cophysical activity with their child and beliefs about healthy eating which mediated changes in children's diet and physical activity behaviors.

Mediational Analyses of the Effects of Responsive Teaching on the Developmental Functioning of Preschool Children with Disabilities

ERIC Educational Resources Information Center

Karaaslan, Ozcan; Mahoney, Gerald

2015-01-01

Mediational analyses were conducted with data from two small randomized control trials of the Responsive Teaching (RT) parent-mediated developmental intervention which used nearly identical intervention and control procedures. The purpose of these analyses was to determine whether or how the changes in maternal responsiveness and children's…

A systematic review of pragmatic language interventions for children with autism spectrum disorder

PubMed Central

Cordier, Reinie; Munro, Natalie; Joosten, Annette; Speyer, Renée

2017-01-01

There is a need for evidence based interventions for children with autism spectrum disorder (ASD) to limit the life-long, psychosocial impact of pragmatic language impairments. This systematic review identified 22 studies reporting on 20 pragmatic language interventions for children with ASD aged 0–18 years. The characteristics of each study, components of the interventions, and the methodological quality of each study were reviewed. Meta-analysis was conducted to assess the effectiveness of 15 interventions. Results revealed some promising approaches, indicating that active inclusion of the child and parent in the intervention was a significant mediator of intervention effect. Participant age, therapy setting or modality were not significant mediators between the interventions and measures of pragmatic language. The long-term effects of these interventions and the generalisation of learning to new contexts is largely unknown. Implications for clinical practice and directions for future research are discussed. PMID:28426832

Mediation of Short and Longer Term Effects of an Intervention Program to Enhance Resilience in Immigrants from Mainland China to Hong Kong

PubMed Central

Yu, Nancy X.; Lam, T. H.; Liu, Iris K. F.; Stewart, Sunita M.

2015-01-01

Few clinical trials report on the active intervention components that result in outcome changes, although this is relevant to further improving efficacy and adapting effective programs to other populations. This paper presents follow-up analyses of a randomized controlled trial to enhance adaptation by increasing knowledge and personal resilience in two separate brief interventions with immigrants from Mainland China to Hong Kong (Yu et al., 2014b). The present paper extends our previous one by reporting on the longer term effect of the interventions on personal resilience, and examining whether the Resilience intervention worked as designed to enhance personal resilience. The four-session intervention targeted at self-efficacy, positive thinking, altruism, and goal setting. In this randomized controlled trial, 220 immigrants were randomly allocated to three arms: Resilience, Information (an active control arm), and Control arms. Participants completed measures of the four active components (self-efficacy, positive thinking, altruism, and goal setting) at baseline and immediately after the intervention. Personal resilience was assessed at baseline, post-intervention, and 3- and 6-month follow-ups. The results showed that the Resilience arm had greater increases in the four active components post-intervention. Changes in each of the four active components at the post-intervention assessment mediated enhanced personal resilience at the 3-month follow-up in the Resilience arm. Changes in self-efficacy and goal setting showed the largest effect size, and altruism showed the smallest. The arm effects of the Resilience intervention on enhanced personal resilience at the 6-month follow-up were mediated by increases of personal resilience post-intervention (Resilience vs. Control) and at the 3-month follow-up (Resilience vs. Information). These findings showed that these four active components were all mediators in this Resilience intervention. Our results of the effects of short term increases in personal resilience on longer term increase in personal resilience in some models suggest how changes in intervention outcomes might persist over time. PMID:26640446

Mediators of a Coping and Communication-Enhancing Intervention and a Supportive Counseling Intervention among Women Diagnosed with Gynecological Cancers

ERIC Educational Resources Information Center

Manne, Sharon L.; Winkel, Gary; Rubin, Stephen; Edelson, Mitchell; Rosenblum, Norman; Bergman, Cynthia; Hernandez, Enrique; Carlson, John; Rocereto, Thomas

2008-01-01

The authors evaluated mechanisms of change for a coping and communication-enhancing intervention (CCI) and supportive counseling (SC). They proposed that the effects of CCI on depressive symptoms would be mediated by psychological processes targeted by CCI, namely increases in the following: positive reappraisal, acceptance, planful problem…

Efficacy of Caregiver-Mediated Joint Engagement Intervention for Young Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Chiang, Chung-Hsin; Chu, Ching-Lin; Lee, Tsung-Chin

2016-01-01

Joint attention intervention for children with autism spectrum disorders was focused on improving joint engagement and joint attention skills. The purpose of this study was to develop a caregiver-mediated joint engagement intervention program combined with body movement play to investigate the effects of joint engagement/joint attention skills in…

Psychosocial constructs were not mediators of intervention effects for dietary and physical activity outcomes in a church-based,lifestyle intervention: Delta Body and Soul III

USDA-ARS?s Scientific Manuscript database

Background: While using theory-based methods when designing and implementing behavioral health interventions is essential, it also has become increasingly important to evaluate an intervention’s theoretical basis. Such evaluations can be accomplished through the use of mediation analysis which can ...

Academic Effects of Peer-Mediated Interventions with English Language Learners: A Research Synthesis

ERIC Educational Resources Information Center

Pyle, Daniel; Pyle, Nicole; Lignugaris/Kraft, Benjamin; Duran, Lillian; Akers, Jessica

2017-01-01

The purpose of this article is to synthesize the extant research on peer-mediated interventions (PMIs) with English language learners (ELLs) in kindergarten through Grade 12. Fourteen studies that were published in peer-reviewed journals from 1983 to 2013 were examined in terms of study characteristics, the effects on academic outcomes, study…

Mediating Parent Learning to Promote Social Communication for Toddlers with Autism: Effects from a Randomized Controlled Trial

ERIC Educational Resources Information Center

Schertz, Hannah H.; Odom, Samuel L.; Baggett, Kathleen M.; Sideris, John H.

2018-01-01

A randomized controlled trial was conducted to evaluate effects of the Joint Attention Mediated Learning (JAML) intervention. Toddlers with autism spectrum disorders (ASD) aged 16-30 months (n = 144) were randomized to intervention and community control conditions. Parents, who participated in 32 weekly home-based sessions, followed a mediated…

Improvements in fundamental movement skill competency mediate the effect of the SCORES intervention on physical activity and cardiorespiratory fitness in children.

PubMed

Cohen, Kristen E; Morgan, Philip J; Plotnikoff, Ronald C; Barnett, Lisa M; Lubans, David R

2015-01-01

Numerous studies have identified a positive association between fundamental movement skill (FMS) competency and physical activity in children; however, the causal pathways have not been established. The aim of this study is to determine if changes in FMS competency mediated the effect of the Supporting Children's Outcomes using Rewards, Exercise and Skills (SCORES) intervention on physical activity and cardiorespiratory fitness in children. Eight primary schools (25 classes) and 460 children (aged 8.5 ± 0.6, 54% girls) were randomised to the SCORES intervention or control group for the 12-month study. The outcomes were accelerometer-determined moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness. The hypothesised mediators were actual FMS competency and perceived sport competence. Mediation analyses were conducted using multilevel linear analysis in MPlus. From the original sample, 138 (30.0%) and 370 (80.4%) children provided useable physical activity and cardiorespiratory fitness data at post-test assessments. There were significant treatment effects for locomotor skills and overall FMSs. Changes in MVPA were associated with changes in object-control skills, overall FMSs and perceived competence. The overall FMSs had a significant mediating effect on MVPA (AB = 2.09, CI = 0.01-4.55). Overall FMSs (AB = 1.19, CI = 0.002-2.79) and locomotor skills (AB = 0.74, CI = 0.01-1.69) had a significant mediating effect on cardiorespiratory fitness. The results of this study conclude that actual but not perceived movement skill competency mediated the effect of the SCORES intervention on physical activity and cardiorespiratory fitness.

Nutrition interventions at point-of-sale to encourage healthier food purchasing: a systematic review.

PubMed

Liberato, Selma C; Bailie, Ross; Brimblecombe, Julie

2014-09-05

Point-of-sale is a potentially important opportunity to promote healthy eating through nutrition education and environment modification. The aim of this review was to describe and review the evidence of effectiveness of various types of interventions that have been used at point-of-sale to encourage purchase and/or eating of healthier food and to improve health outcomes, and the extent to which effectiveness was related to intensity, duration and intervention setting. Records from searches in databases were screened and assessed against inclusion criteria. Included studies had risk of bias assessed. Intervention effectiveness was assessed for two outcomes: i) purchase and/or intake of healthier food options and/or nutrient intake; and ii) mediating factors that might effect the primary outcome. The search identified 5635 references. Thirty-two papers met the inclusion criteria. Twelve studies had low risk of bias and were classified as strong, nine were moderate and 11 were weak. Six intervention types and a range of different outcome measures were described in these papers: i) nutrition education and promotion alone through supermarkets/stores; ii) nutrition education plus enhanced availability of healthy food; iii) monetary incentive alone; iv) nutrition education plus monetary incentives; v) nutrition intervention through vending machines; and vi) nutrition intervention through shopping online. The evidence of this review indicates that monetary incentives offered to customers for a short-term look promising in increasing purchase of healthier food options when the intervention is applied by itself in stores or supermarkets. There was a lack of good quality studies addressing all other types of relevant point-of-sale interventions examining change in purchase and/or intake of healthier food options. There were few studies that examined mediating factors that might mediate the effect on the primary outcomes of relevant interventions. A range of intervention types have been used at point-of-sale to encourage healthy purchasing and/or intake of healthier food options and to improve health outcomes. There is a need for more well designed studies on the effectiveness of a range of point-of-sale interventions to encourage healthier eating and improve health outcomes, and of the mediating factors that might impact these interventions.

Mediation of effects of a theory-based behavioral intervention on self-reported physical activity in South African men.

PubMed

Jemmott, John B; Stephens-Shields, Alisa; O'Leary, Ann; Jemmott, Loretta Sweet; Teitelman, Anne; Ngwane, Zolani; Mtose, Xoliswa

2015-03-01

Increasing physical activity is an important public-health goal worldwide, but there are few published mediation analyses of physical-activity interventions in low-to-middle-income countries like South Africa undergoing a health transition involving markedly increased mortality from non-communicable diseases. This article reports secondary analyses on the mediation of a theory-of-planned-behavior-based behavioral intervention that increased self-reported physical activity in a trial with 1181 men in Eastern Cape Province, South Africa. Twenty-two matched-pairs of neighborhoods were randomly selected. Within pairs, neighborhoods were randomized to a health-promotion intervention or an attention-matched control intervention with baseline, immediate-post, and 6- and 12-month post-intervention assessments. Theory-of-planned-behavior constructs measured immediately post-intervention were tested as potential mediators of the primary outcome, self-reported physical activity averaged over the 6- and 12-month post-intervention assessments, using a product-of-coefficients approach in a generalized-estimating-equations framework. Data were collected in 2007-2010. Attitude, subjective norm, self-efficacy, and intention were significant mediators of intervention-induced increases in self-reported physical activity. The descriptive norm, not affected by the intervention, was not a mediator, but predicted increased self-reported physical activity. The results suggest that interventions targeting theory-of-planned-behavior constructs may contribute to efforts to increase physical activity to reduce the burden of non-communicable diseases among South African men. Copyright © 2015 Elsevier Inc. All rights reserved.

Mediation of Effects of a Theory-Based Behavioral Intervention on Self-Reported Physical Activity in South African Men

PubMed Central

Jemmott, John B.; Stephens, Alisa; O’Leary, Ann; Jemmott, Loretta Sweet; Teitelman, Anne; Ngwane, Zolani; Mtose, Xoliswa

2015-01-01

Objective Increasing physical activity is an important public-health goal worldwide, but there are few published mediation analyses of physical-activity interventions in low-to-middle-income countries like South Africa undergoing a health transition involving markedly increased mortality from non-communicable diseases. This article reports secondary analyses on the mediation of a theory-of-planned-behavior-based behavioral intervention that increased self-reported physical activity in a trial with 1,181 men in Eastern Cape Province, South Africa. Method Twenty-two matched-pairs of neighborhoods were randomly selected. Within pairs, neighborhoods were randomized to a health-promotion intervention or an attention-matched control intervention with baseline, immediate-post, and 6- and 12-month post-intervention assessments. Theory-of-planned-behavior constructs measured immediately post-intervention were tested as potential mediators of the primary outcome, self-reported physical activity averaged over the 6- and 12-month post-intervention assessments, using a product-of-coefficients approach in a generalized-estimating-equations framework. Data were collected in 2007–2010. Results Attitude, subjective norm, self-efficacy, and intention were significant mediators of intervention-induced increases in self-reported physical activity. The descriptive norm, not affected by the intervention, was not a mediator, but predicted increased self-reported physical activity. Conclusion The results suggest that interventions targeting theory-of-planned-behavior constructs may contribute to efforts to increase physical activity to reduce the burden of non-communicable diseases among South African men. PMID:25565482

Mediation and moderation of treatment effects in randomised controlled trials of complex interventions.

PubMed

Emsley, Richard; Dunn, Graham; White, Ian R

2010-06-01

Complex intervention trials should be able to answer both pragmatic and explanatory questions in order to test the theories motivating the intervention and help understand the underlying nature of the clinical problem being tested. Key to this is the estimation of direct effects of treatment and indirect effects acting through intermediate variables which are measured post-randomisation. Using psychological treatment trials as an example of complex interventions, we review statistical methods which crucially evaluate both direct and indirect effects in the presence of hidden confounding between mediator and outcome. We review the historical literature on mediation and moderation of treatment effects. We introduce two methods from within the existing causal inference literature, principal stratification and structural mean models, and demonstrate how these can be applied in a mediation context before discussing approaches and assumptions necessary for attaining identifiability of key parameters of the basic causal model. Assuming that there is modification by baseline covariates of the effect of treatment (i.e. randomisation) on the mediator (i.e. covariate by treatment interactions), but no direct effect on the outcome of these treatment by covariate interactions leads to the use of instrumental variable methods. We describe how moderation can occur through post-randomisation variables, and extend the principal stratification approach to multiple group methods with explanatory models nested within the principal strata. We illustrate the new methodology with motivating examples of randomised trials from the mental health literature.

The Mediating Role of Partner Communication Frequency on Condom Use Among African-American Adolescent Females Participating in an HIV Prevention Intervention

PubMed Central

Sales, Jessica M.; Lang, Delia L.; DiClemente, Ralph J.; Latham, Teaniese P; Wingood, Gina M.; Hardin, James W.; Rose, Eve S.

2011-01-01

Objective Although effective HIV prevention interventions have been developed for adolescents, few interventions have explored whether components of the intervention are responsible for the observed changes in behaviors post-intervention. This study examined the mediating role of partner communication frequency on African-American adolescent females’ condom use post-participation in a demonstrated efficacious HIV risk-reduction intervention. Main Outcome Measures Percent condom use in the past 60 days and consistent condom use in the past 6o days across the 12-month follow-up period. Design As part of a randomized controlled trial of African-American adolescent females (N=715), 15-21 years, seeking sexual health services, completed a computerized interview at baseline (prior to intervention) and again 6- and 12-month follow-up post-intervention participation. The interview assessed adolescents’ sexual behavior and partner communication skills, among other variables, at each time point. Using generalized estimating equation (GEE) techniques, both logistic and linear regression models were employed to test mediation over the 12-month follow-up period. Additional tests were conducted to assess the significance of the mediated models. Results Mediation analyses observed that partner communication frequency was a significant partial mediator of both proportion condom-protected sex acts (p =.001) and consistent condom use (p = .001). Conclusion Partner communication frequency, an integral component of this HIV intervention, significantly increased as a function of participating in the intervention partially explaining the change in condom use observed 12-months post-intervention. Understanding what intervention components are associated with behavior change is important for future intervention development. PMID:21843001

Self-Efficacy, Planning, or a Combination of Both? A Longitudinal Experimental Study Comparing Effects of Three Interventions on Adolescents' Body Fat.

PubMed

Luszczynska, Aleksandra; Hagger, Martin S; Banik, Anna; Horodyska, Karolina; Knoll, Nina; Scholz, Urte

2016-01-01

The superiority of an intervention combining two sets of theory-based behavior change techniques targeting planning and self-efficacy over an intervention targeting planning only or self-efficacy only has rarely been investigated. We compared the influence of self-efficacy, planning, and self-efficacy+planning interventions with an education-based control condition on adolescents' body fat, assuming mediating effects of respective social cognitive variables and moderate-to-vigorous physical activity (MVPA). The moderating role of the built environment was examined. Participants (N = 1217, aged 14-18 years) were randomly assigned to four conditions: planning (n = 270), self-efficacy (n = 311), self-efficacy+planning (n = 351), and control (n = 285). The measurement was conducted at baseline (T1), two-month follow-up (T2), and fourteen-month follow-up (T3). Interventions/control group procedures were delivered at T1 and T2. Percent of body fat tissue (measured at T1 and T3) was the main outcome. Social cognitive mediators (self-efficacy and planning) were assessed at T1 and T2. The behavioral mediator (MVPA) and the presence of built MVPA facilities (the moderator) were evaluated at T1 and T3. Similar small increases of body fat were found across the three intervention groups, but the increment of body fat was significantly larger in the control group. On average, differences between control and intervention groups translated to approximately 1% of body fat. Effects of the interventions on body fat were mediated by relevant social cognitive variables and MVPA. A lower increase of body fat was found among intervention group participants who had access to newly-built MVPA facilities. We found no superiority of an intervention targeting two social cognitive variables over the intervention targeting one cognition only.

Teacher-Mediated Intervention after Disaster: A Controlled Three-Year Follow-Up of Children's Functioning

ERIC Educational Resources Information Center

Wolmer, Leo; Laor, Nathaniel; Dedeoglu, Ceyda; Siev, Joanna; Yazgan, Yanki

2005-01-01

Background: Child survivors of a catastrophic earthquake in Turkey were evaluated three and a half years after the event, and three years after a sub-group participated in a teacher-mediated intervention developed by the authors. The goal of this follow-up study was to determine the long-term effectiveness of the original intervention. Methods:…

Comparison of a Self-Directed and Therapist-Assisted Telehealth Parent-Mediated Intervention for Children with ASD: A Pilot RCT

ERIC Educational Resources Information Center

Ingersoll, Brooke; Wainer, Allison L.; Berger, Natalie I.; Pickard, Katherine E.; Bonter, Nicole

2016-01-01

This pilot RCT compared the effect of a self-directed and therapist-assisted telehealth-based parent-mediated intervention for young children with ASD. Families were randomly assigned to a self-directed or therapist-assisted program. Parents in both groups improved their intervention fidelity, self-efficacy, stress, and positive perceptions of…

Mediating Factors of a School-Based Multi-Component Smoking Prevention Intervention: The LdP Cluster Randomized Controlled Trial

ERIC Educational Resources Information Center

Carreras, G.; Bosi, S.; Angelini, P.; Gorini, G.

2016-01-01

The aim of this study was to investigate factors mediating the effects of Luoghi di Prevenzione (LdP) smoking prevention intervention based on social competence and social influence approaches, and characterized by peer-led school-based interventions, out-of-school workshops, school lessons, and by enforcing the school anti-smoking policy.…

Mediators of compassionate goal intervention effects on human neuroendocrine responses to the Trier Social Stress Test.

PubMed

Erickson, Thane M; Mayer, Stefanie E; Lopez-Duran, Nestor L; Scarsella, Gina M; McGuire, Adam P; Crocker, Jennifer; Abelson, James L

2017-11-01

The hypothalamic-pituitary-adrenal (HPA) axis is thought to mediate the effects of stress on illness. Research has identified a limited number of psychological variables that modulate human HPA responses to stressors (e.g. perceived control and social support). Prosocial goals can reduce subjective stress, but have not been carefully examined in experimental settings where pathways of impact on biological stress markers may be traced. Recent work demonstrated that coaching individuals to strive to help others reduced HPA responses to the Trier Social Stress Test (TSST) relative to other cognitive interventions. However, identification of mediational pathways, which were not examined in the original study, is necessary to determine whether the HPA buffering effects were due to helping motivations (compassionate goals; CGs) rather than via previously identified variables such as control or support. In this new analysis, we combined the original cortisol data with novel observer ratings of interpersonal behavior and psychological variables during the stress task, and conducted new, theory-driven analyses to determine psychological mediators for the intervention's effect on cortisol responses (N = 54; 21 females, 33 males; 486 cortisol samples). Control, support, and task ego-threat failed to account for the effects of the intervention. As hypothesized, self and observer-rated CGs, as well as observer-rated perceptions of participants' interpersonal behavior as morally desirable (but not as dominant or affiliative) were significant mediators of neuroendocrine responses. The findings suggest that stress-reduction interventions based on prosocial behavior should target particular motivational and interpersonal features.

Mediation analysis with multiple versions of the mediator.

PubMed

Vanderweele, Tyler J

2012-05-01

The causal inference literature has provided definitions of direct and indirect effects based on counterfactuals that generalize the approach found in the social science literature. However, these definitions presuppose well-defined hypothetical interventions on the mediator. In many settings, there may be multiple ways to fix the mediator to a particular value, and these various hypothetical interventions may have very different implications for the outcome of interest. In this paper, we consider mediation analysis when multiple versions of the mediator are present. Specifically, we consider the problem of attempting to decompose a total effect of an exposure on an outcome into the portion through the intermediate and the portion through other pathways. We consider the setting in which there are multiple versions of the mediator but the investigator has access only to data on the particular measurement, not information on which version of the mediator may have brought that value about. We show that the quantity that is estimated as a natural indirect effect using only the available data does indeed have an interpretation as a particular type of mediated effect; however, the quantity estimated as a natural direct effect, in fact, captures both a true direct effect and an effect of the exposure on the outcome mediated through the effect of the version of the mediator that is not captured by the mediator measurement. The results are illustrated using 2 examples from the literature, one in which the versions of the mediator are unknown and another in which the mediator itself has been dichotomized.

Mediation analysis with multiple versions of the mediator

PubMed Central

VanderWeele, Tyler J.

2013-01-01

The causal inference literature has provided definitions of direct and indirect effects based on counterfactuals that generalize the approach found in the social science literature. However, these definitions presuppose well defined hypothetical interventions on the mediator. In many settings there may be multiple ways to fix the mediator to a particular value and these different hypothetical interventions may have very different implications for the outcome of interest. In this paper we consider mediation analysis when multiple versions of the mediator are present. Specifically, we consider the problem of attempting to decompose a total effect of an exposure on an outcome into the portion through the intermediate and the portion through other pathways. We consider the setting in which there are multiple versions of the mediator but the investigator only has access to data on the particular measurement, not which version of the mediator may have brought that value about. We show that the quantity that is estimated as a natural indirect effect using only the available data does indeed have an interpretation as a particular type of mediated effect; however, the quantity estimated as a natural direct effect in fact captures both a true direct effect and an effect of the exposure on the outcome mediated through the effect of the version of the mediator that is not captured by the mediator measurement. The results are illustrated using two examples from the literature, one in which the versions of the mediator are unknown and another in which the mediator itself has been dichotomized. PMID:22475830

Mass Media Interventions to Reduce Youth Smoking Prevalence

PubMed Central

Flynn, Brian S.; Worden, John K.; Bunn, Janice Yanushka; Solomon, Laura J.; Ashikaga, Takamaru; Connolly, Scott W.; Ramirez, Amelie G.

2010-01-01

Background Mass media interventions for reduction of youth cigarette smoking have been recommended based on a broad array of evidence, although few randomized community trials have been reported. Design Four matched pairs of independent media markets were identified; one member of each pair was randomized to receive the intervention. School surveys were conducted in all markets, in 2001 before (n=19,966) and in 2005 after (n=23,246) the interventions were completed. Setting/Participants Grade 7–12 students from public schools in these eight medium sized metropolitan areas participated in the summative evaluations; grades 4–12 students were targeted to receive mass media interventions in four of these markets. Intervention Four simultaneous campaigns consisting of specially developed messages based on behavioral theory and targeted to defined age groups of racially and ethnically diverse young people were placed in popular TV, cable, and radio programming using purchased time for 4 years. Main Outcome Measures Prevalence of youth smoking and psychosocial mediators of smoking. Results No significant impacts of these interventions on smoking behaviors or mediators were found for the overall samples. A positive effect was found for one mediator in subgroups. Among Hispanic participants a marginally favorable effect on smoking prevalence, and significant effects on mediators were found. General awareness of smoking prevention TV messages was slightly higher over time in the intervention areas. Conclusions Mass media interventions alone were unable to induce an incremental difference in youth smoking prevalence, likely due to a relatively strong tobacco control environment that included a substantial national smoking prevention media campaign. PMID:20537841

School Engagement Mediates Long Term Prevention Effects for Mexican American Adolescents

PubMed Central

Gonzales, Nancy A.; Wong, Jessie J.; Toomey, Russell B.; Millsap, Roger; Dumka, Larry E.; Mauricio, Anne M.

2014-01-01

This five year follow-up of a randomized clinical trial evaluated the efficacy of a family-focused intervention delivered in middle school to increase school engagement following transition to high school (2 years posttest), and also evaluated mediated effects through school engagement on multiple problem outcomes in late adolescence (5 years posttest). The study sample included 516 Mexican American adolescents who participated in a randomized trial of the Bridges to High School Program (Bridges/ Puentes). Path models representing the direct and indirect effects of the program on four outcome variables were evaluated using school engagement measured in the 9th grade as a mediator. The program significantly increased school engagement, with school engagement mediating intervention effects on internalizing symptoms, adolescent substance use, and school dropout in late adolescence when most adolescents were in the 12th grade. Effects on substance use were stronger for youth at higher risk based on pretest report of substance use initiation. There were no direct or indirect intervention effects on externalizing symptoms. Findings support that school engagement is an important prevention target for Mexican American adolescents. PMID:24398825

The Effect of Peer-Assisted Mediation vs. Tutor-Intervention within Dynamic Assessment Framework on Writing Development of Iranian Intermediate EFL Learners

ERIC Educational Resources Information Center

Erfani, Shiva Seyed; Nikbin, Sareh

2015-01-01

Dynamic assessment originates in the Zone of Proximal Development (ZPD). Practicing dynamic assessment necessarily requires the development of ZPD. This study aimed to investigate the effect of peer-assisted mediation vs. tutor-intervention within dynamic assessment framework on writing development and the attitude of Iranian intermediate EFL…

Picture Exchange Communication System and Pals: A Peer-Mediated Augmentative and Alternative Communication Intervention for Minimally Verbal Preschoolers with Autism

ERIC Educational Resources Information Center

Thiemann-Bourque, Kathy; Brady, Nancy; McGuff, Sara; Strump, Keenan; Naylor, Amy

2016-01-01

Purpose: This study was conducted to investigate the effectiveness of a social intervention that integrates peer-mediated approaches and the Picture Exchange Communication System (PECS). Method: Effects were evaluated using a series of A-B designs replicated across 4 children with severe autism and limited verbal skills. Seven peers without…

The PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects) firefighter study: testing mediating mechanisms.

PubMed

Ranby, Krista W; MacKinnon, David P; Fairchild, Amanda J; Elliot, Diane L; Kuehl, Kerry S; Goldberg, Linn

2011-10-01

This paper examines the mechanisms by which PHLAME (Promoting Healthy Lifestyles: Alternative Models' Effects), a health promotion intervention, improved healthy eating and exercise behavior among firefighters, a population at high risk for health problems due to occupational hazards. In a randomized trial, 397 firefighters participated in either the PHLAME team intervention with their work shift or a control condition. Intervention sessions taught benefits of a healthy diet and regular exercise, and sought to improve social norms and social support from coworkers for healthy behavior. At posttest, team intervention participants had increased their fruit and vegetable consumption as compared to control participants. An increase in knowledge of fruit and vegetable benefits and improved dietary coworker norms partially mediated these effects. Exercise habits and VO2 max were related to targeted mediators but were not significantly changed by the team intervention. Partial support was found for both the action and conceptual theories underlying the intervention. Our findings illustrate how an effective program's process can be deconstructed to understand the underpinnings of behavior change and refine interventions. Further, fire stations may improve the health of firefighters by emphasizing the benefits of healthy diet and exercise behaviors while also encouraging behavior change by coworkers as a whole. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

How and for whom does web-based acceptance and commitment therapy work? Mediation and moderation analyses of web-based ACT for depressive symptoms.

PubMed

Pots, Wendy T M; Trompetter, Hester R; Schreurs, Karlein M G; Bohlmeijer, Ernst T

2016-05-23

Acceptance and Commitment Therapy (ACT) has been demonstrated to be effective in reducing depressive symptoms. However, little is known how and for whom therapeutic change occurs, specifically in web-based interventions. This study focuses on the mediators, moderators and predictors of change during a web-based ACT intervention. Data from 236 adults from the general population with mild to moderate depressive symptoms, randomized to either web-based ACT (n = 82) or one of two control conditions (web-based Expressive Writing (EW; n = 67) and a waiting list (n = 87)), were analysed. Single and multiple mediation analyses, and exploratory linear regression analyses were performed using PROCESS and linear regression analyses, to examine mediators, moderators and predictors on pre- to post- and follow-up treatment change of depressive symptoms. The treatment effect of ACT versus the waiting list was mediated by psychological flexibility and two mindfulness facets. The treatment effect of ACT versus EW was not significantly mediated. The moderator analyses demonstrated that the effects of web-based ACT did not vary according to baseline patient characteristics when compared to both control groups. However, higher baseline depressive symptoms and positive mental health and lower baseline anxiety were identified as predictors of outcome across all conditions. Similar results are found for follow-up. The findings of this study corroborate the evidence that psychological flexibility and mindfulness are distinct process mechanisms that mediate the effects of web-based ACT intervention. The results indicate that there are no restrictions to the allocation of web-based ACT intervention and that web-based ACT can work for different subpopulations. Netherlands Trial Register NTR2736 . Registered 6 February 2011.

Response expectancies, treatment credibility, and hypnotic suggestibility: mediator and moderator effects in hypnotic and cognitive-behavioral pain interventions.

PubMed

Milling, Leonard S; Shores, Jessica S; Coursen, Elizabeth L; Menario, Deanna J; Farris, Catherine D

2007-04-01

Several studies have shown that response expectancies are an important mechanism of popular psychological interventions for pain. However, there has been no research on whether response expectancies and treatment credibility independently mediate hypnotic and cognitive-behavioral pain interventions and whether the pattern of mediation is affected by experience with the interventions. Also, past research has indicated that hypnotic pain interventions may be moderated by hypnotic suggestibility. However, these studies have typically failed to measure the full range of suggestibility and have assessed pain reduction and suggestibility in the same experimental context, possibly inflating the association between these variables. To clarify the mediator role of response expectancies and treatment credibility, and the moderator role of hypnotic suggestibility in the hypnotic and cognitive-behavioral reduction of pain. Approximately 300 participants were assessed for suggestibility. Then, as part of an apparently unrelated experiment, 124 of these individuals received analogue cognitive-behavioral, hypnotic, or placebo control pain interventions. Response expectancies and credibility independently mediated treatment. The extent of mediation increased as participants gained more experience with the interventions. Suggestibility moderated treatment and was associated with relief only from the hypnotic intervention. Response expectancies and treatment credibility are unique mechanisms of hypnotic and cognitive-behavioral pain interventions. Hypnotic suggestibility predicts relief from hypnotic pain interventions and this association is not simply an artifact of measuring suggestibility and pain reduction in the same experimental context. The relationship between suggestibility and hypnotic pain reduction appears to be linear in nature.

The efficacy of teachers' responses to incidents of bullying and victimization: The mediational role of moral disengagement for bullying.

PubMed

Campaert, Kristel; Nocentini, Annalaura; Menesini, Ersilia

2017-09-01

Teachers respond differently to bullying and victimization. Socio-cognitive and moral domain theory suggest that students process teachers' behavior cognitively and that teachers' responses to incidents of bullying and victimization could affect students' level of moral disengagement. We examined the mediating effect of students' moral disengagement between types of teachers' responses to situations of bullying and victimization and individual bullying using multilevel mediation modelling. Participants were 609 students (50% boys, age M = 11.47, SD = 1.14) of central Italy, nested in 34 classes. Students rated the frequency of self-reported bullying and of teachers' responses to incidents of bullying and victimization on a 5-point Likert scale. Teachers' responses to bullying included non-intervention, mediation, group discussion, and sanctions. Teachers' responses to victimization included non-intervention, mediation, group discussion, and victim support. Results indicated that in the teachers' responses to incidents of bullying model, a significant indirect effect of non-intervention (β = .03; 95%CI [.01, .05]) and of sanctions (β = -.02; 95%CI [-.04, -.01]) on bullying through moral disengagement was found at the individual level. Similarly, in the model on teachers' responses toward victims there was a significant indirect effect through moral disengagement of non-intervention (β = .03; 95%CI [.02, .04]) and victim support (β = -.01; 95%CI [-.02, -.001]). At the class level there were no significant indirect effects. In sum, results indicated that moral disengagement is an important mediator at the individual level and suggest including teachers in anti-bullying interventions with a specific focus on their role for moral development. © 2017 Wiley Periodicals, Inc.

Modeling the Longitudinal Direct and Indirect Effects of Attitudes, Self-Efficacy, and Behavioral Intentions on Practice Behavior Outcomes of Suicide Intervention Training.

PubMed

Osteen, Philip; Frey, Jodi M; Woods, MaKenna N; Ko, Jungyai; Shipe, Stacey

2017-08-01

The purpose of this study was to use a longitudinal path analysis to test attitudes toward suicide prevention, self-efficacy, and behavioral intentions as mediators/moderators of clinical skill development over time following suicide intervention training. Results support a direct effect of attitudes on practice behaviors and self-efficacy, but no moderating effect. Self-efficacy performed as a mediator of practice behaviors over time. Behavioral intention had a direct effect on practice behaviors and mediated the relationship between attitudes and practice behaviors. Implications for research and practice are discussed. © 2016 The American Association of Suicidology.

Potential Mediators in Parenting and Family Intervention: Quality of Mediation Analyses

PubMed Central

Patel, Chandni C.; Fairchild, Amanda J.; Prinz, Ronald J.

2017-01-01

Parenting and family interventions have repeatedly shown effectiveness in preventing and treating a range of youth outcomes. Accordingly, investigators in this area have conducted a number of studies using statistical mediation to examine some of the potential mechanisms of action by which these interventions work. This review examined from a methodological perspective in what ways and how well the family-based intervention studies tested statistical mediation. A systematic search identified 73 published outcome studies that tested mediation for family-based interventions across a wide range of child and adolescent outcomes (i.e., externalizing, internalizing, and substance-abuse problems; high-risk sexual activity; and academic achievement), for putative mediators pertaining to positive and negative parenting, family functioning, youth beliefs and coping skills, and peer relationships. Taken as a whole, the studies used designs that adequately addressed temporal precedence. The majority of studies used the product of coefficients approach to mediation, which is preferred, and less limiting than the causal steps approach. Statistical significance testing did not always make use of the most recently developed approaches, which would better accommodate small sample sizes and more complex functions. Specific recommendations are offered for future mediation studies in this area with respect to full longitudinal design, mediation approach, significance testing method, documentation and reporting of statistics, testing of multiple mediators, and control for Type I error. PMID:28028654

Isolating active ingredients in a parent-mediated social communication intervention for toddlers with autism spectrum disorder.

PubMed

Gulsrud, Amanda C; Hellemann, Gerhard; Shire, Stephanie; Kasari, Connie

2016-05-01

Behavioral interventions are commonplace in the treatment of autism spectrum disorders, yet relatively little is known about how and why these interventions work. This study tests the relationship between isolated core components of a packaged social communication intervention and the primary outcome, joint engagement, to better understand how the intervention is affecting change in individuals. A total of 86 toddlers and their parents were enrolled in the study and randomized to one of two treatments, the joint attention, symbolic play, engagement, and regulation (JASPER) parent-mediated intervention or a psychoeducational intervention. Measures regarding the parent's use of intervention strategies were collected before and after the 10-week intervention. Additional measures of child and parent joint engagement were also collected. A significant effect of treatment was found for all four of the core strategies of the intervention, favoring a larger increase in the JASPER condition. A hierarchical linear regression revealed several individual predictors of joint engagement, including parent-rated buy-in, interventionist-rated parent involvement, and parental use of strategies. To complement the hierarchical analysis, we also tested the potential mediating effect the strategies may have on the relationship between treatment and joint engagement. Results showed that the strategy of mirrored pacing mediated the relationship between treatment and joint engagement in the positive direction. These results strongly suggest that the mirrored pacing strategy is an active ingredient of the JASPER treatment. © 2015 Association for Child and Adolescent Mental Health.

Consumer Acceptance of Population-Level Intervention Strategies for Healthy Food Choices: The Role of Perceived Effectiveness and Perceived Fairness.

PubMed

Bos, Colin; Lans, Ivo Van Der; Van Rijnsoever, Frank; Van Trijp, Hans

2015-09-15

The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers' freedom of choice (providing information, guiding choice through (dis)incentives, and restricting choice). We examine the mediating effects of perceived effectiveness and perceived fairness, and the moderating effects of barriers to choose low-calorie snacks and perceived responsibility for food choice. Data was collected through an online survey, involving three waves that were completed over a seven week timespan. Information was collected on barriers and perceived responsibility, and evaluations of a total of 128 intervention strategies with varying levels of intrusiveness that were further systematically varied in terms of source, location, approach/avoidance, type, and severity. A total of 1173 respondents completed all three waves. We found that the effect of intervention intrusiveness on acceptance was mediated by the perceived personal- and societal effectiveness, and the perceived fairness of interventions. For barriers and perceived responsibility, only main effects on intervention-specific beliefs were found. Government interventions were accepted less than interventions by food manufacturers. In conclusion, the present study shows that acceptance of interventions depends on perceptions of personal- and societal effectiveness and fairness, thereby providing novel starting points for increasing acceptance of both existing and new food choice interventions.

Technology-Mediated Interventions and Quality of Life for Persons Living with HIV/AIDS. A Systematic Review.

PubMed

Cho, Hwayoung; Iribarren, Sarah; Schnall, Rebecca

2017-04-12

As HIV/AIDS is considered a chronic disease; quality of life (QoL) has become an important focus for researchers and healthcare providers. Technology-mediated interventions have demonstrated improved clinical effectiveness in outcomes, such as viral suppression, for persons living with HIV/AIDS (PLWH). However, the evidence to support the impact of these interventions on QoL is lacking. The aim of this paper was to assess the impact of technology-mediated interventions on QoL and to identify the instruments used to measure the QoL of PLWH. For this review we followed the PRISMA guidelines. A literature search was conducted in PubMed, CINAHL, Cochrane, and EMBASE databases in April 2016. Inclusion criteria limited articles to those with technology-mediated interventions as compared to usual care; articles with the population defined as HIV-infected patients; and articles with QoL measured as a health outcome in randomized controlled trials. The Cochrane Collaboration Risk of Bias Tool was used to assess study quality. Of the 1,554 peer-reviewed articles returned in the searches, 10 met the inclusion criteria. This systematic review identified four types of technology-mediated interventions and two types of QoL instruments used to examine the impact of technology-mediated interventions on PLWH. Four studies of technology-mediated interventions resulted in improvement in QoL. Four studies considered QoL as a secondary outcome and resulted in a negative or neutral impact on QoL. Overall, four studies had a low risk of bias, one study had a moderate risk of bias, and the other five studies had a high risk of bias. The evidence to support the improvement of QoL using technology-mediated interventions is insufficient. This lack of research highlights the need for increased study of QoL as an outcome measure and the need for consistent measures to better understand the role of technology-mediated interventions in improving QoL for PLWH.

Exploring Mediators of Physical Activity in Young Adult Cancer Survivors: Evidence from a Randomized Trial of a Facebook-Based Physical Activity Intervention.

PubMed

Valle, Carmina G; Tate, Deborah F; Mayer, Deborah K; Allicock, Marlyn; Cai, Jianwen

2015-03-01

This study examined the effects of a physical activity (PA) intervention for young adult cancer survivors on changes in self-efficacy, social support, and self-monitoring and determined whether changes in these social cognitive theory constructs mediated the relationship between the intervention and changes in PA. A 12-week randomized trial compared a Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA to a Facebook-based self-help comparison group. Young adult cancer survivors (N=86, aged 21-39) were randomly assigned to one of the two groups. Self-report measures of PA and psychosocial variables were collected at baseline and after 12 weeks. The FITNET group reported lower self-efficacy for sticking to exercise (mean change=-0.38; 95% CI: -0.62 to -0.12; p=0.025) and social support from friends on social networking websites (mean change=-0.47; 95% CI: -1.45 to 0.65; p=0.039) relative to the self-help comparison group over time. Changes in social support from friends on social networking websites partially mediated the intervention effects on moderate-to-vigorous PA (mean indirect effect=-22.4; 95% CI: -62.0 to -2.8) in the unexpected direction. Across both groups, social support from friends and self-monitoring were positively associated with changes in moderate-to-vigorous PA. The proposed mediators did not explain the positive effects of the FITNET intervention on mild PA. The lack of significant improvements in psychosocial constructs among FITNET participants may partly explain why the intervention did not increase moderate-to-vigorous PA relative to the self-help comparison group. Future PA interventions with young adult cancer survivors should examine targeting social support from friends and self-monitoring.

Perceived social support mediates anxiety and depressive symptom changes following primary care intervention.

PubMed

Dour, Halina J; Wiley, Joshua F; Roy-Byrne, Peter; Stein, Murray B; Sullivan, Greer; Sherbourne, Cathy D; Bystritsky, Alexander; Rose, Raphael D; Craske, Michelle G

2014-05-01

The current study tested whether perceived social support serves as a mediator of anxiety and depressive symptom change following evidence-based anxiety treatment in the primary care setting. Gender, age, and race were tested as moderators. Data were obtained from 1004 adult patients (age M = 43, SD = 13; 71% female; 56% White, 20% Hispanic, 12% Black) who participated in a randomized effectiveness trial (coordinated anxiety learning and management [CALM] study) comparing evidence-based intervention (cognitive-behavioral therapy and/or psychopharmacology) to usual care in the primary care setting. Patients were assessed with a battery of questionnaires at baseline, as well as at 6, 12, and 18 months following baseline. Measures utilized in the mediation analyses included the Abbreviated Medical Outcomes (MOS) Social Support Survey, the Brief Symptom Index (BSI)-Somatic and Anxiety subscales, and the Patient Health Questionnaire (PHQ-9). There was a mediating effect over time of perceived social support on symptom change following treatment, with stronger effects for 18-month depression than anxiety. None of the mediating pathways were moderated by gender, age, or race. Perceived social support may be central to anxiety and depressive symptom changes over time with evidence-based intervention in the primary care setting. These findings possibly have important implications for development of anxiety interventions. © 2013 Wiley Periodicals, Inc.

Contextual Mediators influencing the Effectiveness of Behavioural Change Interventions: A Case of HIV/AIDS Prevention Behaviours

PubMed Central

Musiimenta, Angella

2012-01-01

Background: Although Uganda had recorded declines in HIV infection rates around 1990’s, it is argued that HIV/AIDS risk sexual behaviour, especially among the youth, started increasing again from early 2000. School-based computer-assisted HIV interventions can provide interactive ways of improving the youth’s HIV knowledge, attitudes and skills. However, these interventions have long been reported to have limited success in improving the youth’s sexual behaviours, which is always the major aim of implementing such interventions. This could be because the commonly used health promotion theories employed by these interventions have limited application in HIV prevention. These theories tend to lack sufficient attention to contextual mediators that influence ones sexual behaviours. Moreover, literature increasingly expresses dissatisfaction with the dominant prevailing descriptive survey-type HIV/AIDS-related research. Objective and Methods: The objective of this research was to identify contextual mediators that influence the youth’s decision to adopt and maintain the HIV/AIDS preventive behaviour advocated by a computer-assisted intervention. To achieve this objective, this research employed qualitative method, which provided in-depth understanding of how different contexts interact to influence the effectiveness of HIV/AIDS interventions. The research question was: What contextual mediators are influencing the youth’s decision to adopt and maintain the HIV/AIDS preventive behaviour advocated by a computer-assisted intervention? To answer this research question, 20 youth who had previously completed the WSWM intervention when they were still in secondary schools were telephone interviewed between Sept.08 and Dec.08. The collected data was then analysed, based on grounded theory’s coding scheme. Results: Findings demonstrate that although often ignored by HIV interventionists and researchers, variety of contextual mediators influence individual uptake of HIV preventives. These include relationship characteristics, familial mediators, peer influence, gender-based social norms, economic factors and religious beliefs. Conclusion: To generate concomitant mutual efforts, rather than exclusively focusing on individual level mediators, there is an urgent need to shift to integrative approaches, which combine individual level change strategies with contextual level change approaches in the design and implementation of interventional strategies to fight against HIV/AIDS. PMID:23569636

Maternal care mediates the effects of nutrition and responsive stimulation interventions on young children's growth.

PubMed

Brown, N; Finch, J E; Obradović, J; Yousafzai, A K

2017-07-01

Undernutrition contributes to at least half the estimated six million annual childhood deaths worldwide. Furthermore, one in three children fails to meet their developmental potential because of risks including stunting, illness, under-stimulation, poor responsive interactions and maternal depressive symptoms. Our study investigates the role of caregiving processes on children's height-for-age at 2 and 4 years. The Pakistan Early Child Development Scale-up study assessed the longitudinal effectiveness of early nutrition and responsive stimulation interventions on growth and development at 4 years of age. In total, 1302 children were followed up from birth to 4 years. We leveraged path analyses to explore potential mediators of early intervention effects on children's height-for-age at 4 years, including maternal depressive symptoms, mother-child interaction quality, diarrhoeal illness and height-for-age at 2 years. Our final model had excellent model fit (comparative fix index = 0.999, Tucker-Lewis index = 0.998, root mean square error of approximation = 0.008) and showed that mother-child interaction quality mediated the effects of both enhanced nutrition and responsive stimulation interventions on height-for-age at 4 years via its longitudinal stability from 2 years of age (β = 0.016, p = 0.005; β = 0.048, p < 0.001, respectively). Further, diarrhoeal illness mediated the effects of maternal depressive symptoms at 1 year post partum on children's height-for-age at 4 years via the longitudinal stability of height-for-age z-score from 2 years of age onwards (β = -0.007, p = 0.019). The quality of early caregiving experience mediated the association between both interventions and height-for-age. The effect of maternal depressive symptoms on growth was mediated by diarrhoeal illness. Programmatic approaches to child nutrition and growth must address all these potentially modifiable factors. © 2017 John Wiley & Sons Ltd.

Mass media interventions to reduce youth smoking prevalence.

PubMed

Flynn, Brian S; Worden, John K; Bunn, Janice Yanushka; Solomon, Laura J; Ashikaga, Takamaru; Connolly, Scott W; Ramirez, Amelie G

2010-07-01

Mass media interventions for reduction of youth cigarette smoking have been recommended based on a broad array of evidence, although few randomized community trials have been reported. Four matched pairs of independent media markets were identified; one member of each pair was randomized to receive the intervention. School surveys were conducted in all markets, in 2001 before (n=19,966) and in 2005 after (n=23,246) the interventions were completed. Grade 7-12 students from public schools in these eight medium-sized metropolitan areas participated in the summative evaluations; Grades 4-12 students were targeted to receive mass media interventions in four of these markets. Four simultaneous campaigns consisting of specially developed messages based on behavioral theory and targeted to defined age groups of racially and ethnically diverse young people were placed in popular TV, cable, and radio programming using purchased time for 4 years. Prevalence of youth smoking and psychosocial mediators of smoking. No significant impacts of these interventions on smoking behaviors or mediators were found for the overall samples. A positive effect was found for one mediator in subgroups. Among Hispanic participants a marginally favorable effect on smoking prevalence and significant effects on mediators were found. General awareness of smoking prevention TV messages was slightly higher over time in the intervention areas. Mass media interventions alone were unable to induce an incremental difference in youth smoking prevalence, probably because of a relatively strong tobacco control environment that included a substantial national smoking prevention media campaign. Copyright 2010 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Reconceptualizing decisional balance in an adolescent sun protection intervention: mediating effects and theoretical interpretations.

PubMed

Adams, Marc A; Norman, Gregory J; Hovell, Melbourne F; Sallis, James F; Patrick, Kevin

2009-03-01

The Transtheoretical model (TTM) integrates principles of operant learning, such as stimulus control and reinforcement, and psychological factors, such as decisional balance. Understanding interrelationships between decisions, behavior, and consequences from multiple-theoretical perspectives can advance theory and inform development of more effective interventions. This analysis examined the mediating effects of a special case of the decisional balance construct in which the pros of competing behaviors (i.e., sun protection vs. exposure) were measured rather than the pros and cons of the same behavior. Participants included 819 adolescents (10 to 16 years old, 53.5% girls, 58.4% White) randomized to a 24-month expert system intervention (SunSmart) or a physical activity and nutrition comparison group. Self-report measures included sun protection behaviors, pros for protection, and pros for exposure. Mediation analysis using latent growth curve models found both the treatment-to-mediator and mediator-to-behavior paths significant for decisional balance, producing an indirect effect of .323 (p < .01) and good model fit (CFI = .973, RMSEA = .055). Multiple strategies for conceptualizing and measuring decisional balance appear to be valid. Results are interpreted from the TTM and operant perspectives. (c) 2009 APA, all rights reserved

Family support as a mediator of change in sexual risk-taking attitudes among orphaned adolescents in rural Uganda

PubMed Central

Ismayilova, Leyla; Ssewamala, Fred M.; Karimli, Leyla

2011-01-01

Purpose Prior studies demonstrated that the effect of family-based economic empowerment intervention Suubi on reducing attitudes approving sexual risk taking among orphaned adolescents in Uganda. To understand mechanisms of change, the paper examines the effect of Suubi intervention on family support variables and their role in mediating the change in adolescents' attitudes toward sexual risk-taking. Methods The Suubi study utilized a cluster randomized experimental design with three waves and included 283 orphaned adolescents from 15 primary schools in Rakai, Uganda. First, using mixed effects models, the study tests for the effect of intervention on family support variables. Second, using mediation analysis, the study examines whether the change in sexual risk-taking attitudes was mediated by the change in family support. Results Compared to adolescents from the control group, at wave 2, adolescents in the treatment group reported higher levels of perceived support from caregivers, were more willing to talk to caregivers about their problems, and felt more comfortable talking about sexual risk behaviors with their caregivers. Mediation analysis demonstrated that the improvement in perceived support from caregivers at wave 2 accounted for 16.8% of the reduction in adolescents' attitudes toward sexual risk-taking at wave 3 (z = -2.21, p<.05). Conclusions A family-based economic empowerment intervention Suubi may have the potential to increase family support to orphaned adolescents. Interventions aimed at strengthening existing social networks and improving connectedness with surviving family members may be critical in preventing sexual risk-taking among orphaned adolescents in Uganda, which is characterized by low resources. PMID:22325127

Psychosocial Group Intervention Among War-Affected Children: An Analysis of Changes in Posttraumatic Cognitions.

PubMed

Kangaslampi, Samuli; Punamäki, Raija-Leena; Qouta, Samir; Diab, Marwan; Peltonen, Kirsi

2016-12-01

Cognitive theories point to reduction in dysfunctional posttraumatic cognitions (PTCs) as one mechanism involved in recovery from posttraumatic stress symptoms (PTSS), yet research findings have shown individual differences in the recovery process. We tested the cognitive mediation hypothesis above in a previously published psychosocial group intervention among war-affected children. We also examined heterogeneity in children's PTCs during the intervention. We used a cluster randomized trial of Smith et al.'s (2002) teaching recovery techniques (TRT) intervention among 482 Palestinians 10-13 years of age (n = 242 for intervention group, n = 240 for control group). Children reported PTSS, PTCs, and depressive symptoms at baseline, midpoint, postintervention, and at 6-month follow-up. Path analysis results showed that TRT was not effective in reducing dysfunctional PTCs, and the reductions did not mediate intervention effects on PTSS. Using latent class growth analysis, we chose the model with 3 differing trajectories in the intervention group: high, decreasing, moderate, downward trending, and severe, stable levels of PTCs. Higher PTSS and depressive symptoms at baseline were associated with membership in the severe, stable trajectory. The intervention did not produce the kind of beneficial cognitive change needed in the cognitive mediation conceptualization. Nevertheless, cognitive changes differed substantially across children during the intervention, and were associated with their preintervention mental health status. These findings call for more detailed examination of the process of cognitive mediation. Copyright © 2016 International Society for Traumatic Stress Studies.

Impact of a Technology-Mediated Reading Intervention on Adolescents' Reading Comprehension

ERIC Educational Resources Information Center

Fogarty, Melissa; Clemens, Nathan; Simmons, Deborah; Anderson, Leah; Davis, John; Smith, Ashley; Wang, Huan; Kwok, Oi-man; Simmons, Leslie E.; Oslund, Eric

2017-01-01

In this experimental study we examined the effects of a technology-mediated, multicomponent reading comprehension intervention, Comprehension Circuit Training (CCT), for middle school students, the majority of whom were struggling readers. The study was conducted in three schools, involving three teachers and 228 students. Using a within-teacher…

Within-Intervention Change: Mediators of Intervention Effects during Multisystemic Therapy

ERIC Educational Resources Information Center

Dekovic, Maja; Asscher, Jessica J.; Manders, Willeke A.; Prins, Pier J. M.; van der Laan, Peter

2012-01-01

Objective: The present study tested the hypothesis that improvements in parental sense of competence during multisystemic therapy (MST) lead to positive changes in parenting, which in turn lead to a decrease of adolescent externalizing problems. Mediational models were tested separately for 3 dimensions of parenting (positive discipline, inept…

The effects of an anxiety sensitivity intervention on anxiety, depression, and worry: mediation through affect tolerances.

PubMed

Norr, Aaron M; Allan, Nicholas P; Macatee, Richard J; Keough, Meghan E; Schmidt, Norman B

2014-08-01

Recently there has been increased interest in emotional and physical tolerance risk factors for mood and anxiety disorders. Three tolerance risk factors that have been shown to be related are anxiety sensitivity (AS), distress tolerance (DT), and discomfort intolerance (DI). Although previous research has demonstrated these constructs are malleable, no research has investigated the effects of an AS intervention on DT or DI. Further, no studies have investigated whether changes in DT or DI play a role in mood and anxiety symptom amelioration due to an AS intervention. Participants (N = 104), who were selected for elevated levels of AS, completed a single-session computer-assisted AS intervention or a control intervention and follow-up assessments at 1-week and 1-month post intervention. Results revealed that the intervention reduced AS and increased DT, but did not affect DI at the 1-week follow-up. Mediation analyses revealed that changes in AS and DT both mediated changes in symptoms (depression, anxiety, worry) due to the intervention at 1-month follow-up, however, when AS and DT were considered in the same model only the effect via AS remained significant. These results have important implications for the nature of the relationships between AS, DT, and DI as well as the specific mechanistic pathways through which an AS intervention ameliorates symptoms. Copyright © 2014 Elsevier Ltd. All rights reserved.

A randomized controlled trial to enhance coping and posttraumatic growth and decrease posttraumatic stress disorder in HIV-Infected men who have sex with men in Beijing, China.

PubMed

Ye, Zhi; Yu, Nancy Xiaonan; Zhu, Wanling; Chen, Lihua; Lin, Danhua

2018-06-01

Although HIV-infected men who have sex with men (MSM) constitute a newly emerged high-risk group in China, little research outside Western countries is available on effective intervention programs to enhance their well-being. The purpose of this randomized controlled trial was to evaluate the efficacy of a group intervention program designed to improve the well-being and adaptive coping strategies of 60 HIV-infected MSM in Beijing, China, randomly assigned either to the intervention group for participation in four weekly sessions or to the control group for placement on a waiting list. They all completed measurements at pre- and postintervention. Compared with the control group, the intervention group reported significantly increased problem-focused coping strategies and levels of posttraumatic growth (PTG) as well as decreased symptoms of posttraumatic stress disorder (PTSD) at the completion of the intervention. In addition, mediation analysis showed that changes in problem-focused coping strategies mediated the intervention effect on increases in PTG; however, the mediating effect of coping strategies on the association of intervention and PTSD was not significant. This study provides empirical evidence for conducting psychological intervention to promote the well-being of HIV-infected MSM. The findings also elucidate the mechanism through which intervention improved PTG.

Mediators of weight loss and weight loss maintenance in middle-aged women.

PubMed

Teixeira, Pedro J; Silva, Marlene N; Coutinho, Sílvia R; Palmeira, António L; Mata, Jutta; Vieira, Paulo N; Carraça, Eliana V; Santos, Teresa C; Sardinha, Luís B

2010-04-01

Long-term behavioral self-regulation is the hallmark of successful weight control. We tested mediators of weight loss and weight loss maintenance in middle-aged women who participated in a randomized controlled 12-month weight management intervention. Overweight and obese women (N = 225, BMI = 31.3 +/- 4.1 kg/m(2)) were randomly assigned to a control or a 1-year group intervention designed to promote autonomous self-regulation of body weight. Key exercise, eating behavior, and body image variables were assessed before and after the program, and tested as mediators of weight loss (12 months, 86% retention) and weight loss maintenance (24 months, 81% retention). Multiple mediation was employed and an intention-to-treat analysis conducted. Treatment effects were observed for all putative mediators (Effect size: 0.32-0.79, P < 0.01 vs. controls). Weight change was -7.3 +/- 5.9% (12-month) and -5.5 +/- 5.0% (24-month) in the intervention group and -1.7 +/- 5.0% and -2.2 +/- 7.5% in controls. Change in most psychosocial variables was associated with 12-month weight change, but only flexible cognitive restraint (P < 0.01), disinhibition (P < 0.05), exercise self-efficacy (P < 0.001), exercise intrinsic motivation (P < 0.01), and body dissatisfaction (P < 0.05) predicted 24-month weight change. Lower emotional eating, increased flexible cognitive restraint, and fewer exercise barriers mediated 12-month weight loss (R(2) = 0.31, P < 0.001; effect ratio: 0.37), but only flexible restraint and exercise self-efficacy mediated 24-month weight loss (R(2) = 0.17, P < 0.001; effect ratio: 0.89). This is the first study to evaluate self-regulation mediators of weight loss and 2-year weight loss maintenance, in a large sample of overweight women. Results show that lowering emotional eating and adopting a flexible dietary restraint pattern are critical for sustained weight loss. For long-term success, interventions must also be effective in promoting exercise intrinsic motivation and self-efficacy.

The interrelationship between sleep and depression: a secondary analysis of a randomized controlled trial on mind-body-spirit intervention.

PubMed

Ji, Xiao Wen; Chan, Celia H Y; Lau, Bobo H P; Chan, Jessie S M; Chan, Cecilia L W; Chung, Ka-Fai

2017-01-01

To conduct a secondary analysis of a randomized controlled trial (RCT) that aims to understand the mediating effects embedded in a mind-body-spirit intervention for sleep and mood disturbances. 126 adults with mild to moderate depression and subjective sleep disturbance, defined as Center for Epidemiologic Studies Depression Scale (CESD) scores from 10 to 34 and Pittsburgh Sleep Quality Index (PSQI) score > 5, participated in a waitlist-controlled RCT of an integrative mind-body-spirit intervention (I-BMS). Holistic well-being scale (HWS), a measure of the state of affliction and equanimity in mind, body and spirit, was included as a possible mediator. Data was collected at baseline and three-month follow-up. Mediation analyses were adopted to examine the pathways leading to sleep and mood improvements. After adjustments of baseline severities, changes in depressive symptoms partially mediated the effect of I-BMS on nighttime symptoms of insomnia (95% CI: 0.12-0.96), while exerting a full mediating effect on daytime symptoms of insomnia (95% CI: 0.14-0.64). The effect of I-BMS on mood was mediated by daytime symptoms of insomnia and spiritual orientation, but not by nighttime symptoms of insomnia (95% CI: 0.93-4.62). A bidirectional relationship was found between sleep disturbances and depressive symptoms following a mind-body-spirit intervention. The relationship between daytime symptoms and depressive symptoms was especially strong. Of the HWS variables, spiritual orientation was the only significant mediator of mood improvement following I-BMS. Our findings suggest that efforts to optimize the treatment of comorbid sleep disturbances and depression are needed, especially the treatment of daytime impairments along with sleep and mood disruptions. Copyright © 2016 Elsevier B.V. All rights reserved.

Readiness to Change as a Mediator of the Effect of a Brief Motivational Intervention on Posttreatment Alcohol-Related Consequences of Injured Emergency Department Hazardous Drinkers

PubMed Central

Stein, L. A. R.; Minugh, P. Allison; Longabaugh, Richard; Wirtz, Philip; Baird, Janette; Nirenberg, Ted D.; Woolard, Robert F.; Carty, Kathy; Lee, Christina; Mello, Michael; Becker, Bruce; Gogineni, Aruna

2009-01-01

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population. PMID:19586135

Early Educational Intervention, Early Cumulative Risk, and the Early Home Environment as Predictors of Young Adult Outcomes Within a High-Risk Sample

PubMed Central

Pungello, Elizabeth P.; Kainz, Kirsten; Burchinal, Margaret; Wasik, Barbara H.; Sparling, Joseph J.; Ramey, Craig T.; Campbell, Frances A.

2009-01-01

The extent to which early educational intervention, early cumulative risk, and the early home environment were associated with young adult outcomes was investigated in a sample of 139 young adults (age 21) from high-risk families enrolled in randomized trials of early intervention. Positive effects of treatment were found for education attainment, attending college, and skilled employment; negative effects of risk were found for education attainment, graduating high school, being employed and avoiding teen parenthood. The home mediated the effects of risk for graduating high school, but not being employed or teen parenthood. Evidence for moderated mediation was found for educational attainment; the home mediated the association between risk and educational attainment for the control group, but not the treated group. PMID:20331676

Testing the Causal Direction of Mediation Effects in Randomized Intervention Studies.

PubMed

Wiedermann, Wolfgang; Li, Xintong; von Eye, Alexander

2018-05-21

In a recent update of the standards for evidence in research on prevention interventions, the Society of Prevention Research emphasizes the importance of evaluating and testing the causal mechanism through which an intervention is expected to have an effect on an outcome. Mediation analysis is commonly applied to study such causal processes. However, these analytic tools are limited in their potential to fully understand the role of theorized mediators. For example, in a design where the treatment x is randomized and the mediator (m) and the outcome (y) are measured cross-sectionally, the causal direction of the hypothesized mediator-outcome relation is not uniquely identified. That is, both mediation models, x → m → y or x → y → m, may be plausible candidates to describe the underlying intervention theory. As a third explanation, unobserved confounders can still be responsible for the mediator-outcome association. The present study introduces principles of direction dependence which can be used to empirically evaluate these competing explanatory theories. We show that, under certain conditions, third higher moments of variables (i.e., skewness and co-skewness) can be used to uniquely identify the direction of a mediator-outcome relation. Significance procedures compatible with direction dependence are introduced and results of a simulation study are reported that demonstrate the performance of the tests. An empirical example is given for illustrative purposes and a software implementation of the proposed method is provided in SPSS.

Effect of a School-Based Intervention on Physical Activity and Quality of Life through Serial Mediation of Social Support and Exercise Motivation: The PESSOA Program

ERIC Educational Resources Information Center

Quaresma, A. M.; Palmeira, A. L.; Martins, S. S.; Minderico, C. S.; Sardinha, L. B.

2014-01-01

The aim of this study was to explore the effects of social support and behavioral regulation of exercise on physical activity (PA) and quality of life (QoL), in a Portuguese school-based intervention. We hypothesized that serial mediation effects would be present leading to greater levels of PA and QoL. The sample comprised 1042 students (549…

Improving Collaborative Play between Children with Autism Spectrum Disorders and Their Siblings: The Effectiveness of a Robot-Mediated Intervention Based on Lego® Therapy

ERIC Educational Resources Information Center

Huskens, Bibi; Palmen, Annemiek; Van der Werff, Marije; Lourens, Tino; Barakova, Emilia

2015-01-01

The aim of the study was to investigate the effectiveness of a brief robot-mediated intervention based on Lego® therapy on improving collaborative behaviors (i.e., interaction initiations, responses, and play together) between children with ASD and their siblings during play sessions, in a therapeutic setting. A concurrent multiple baseline design…

CAREGIVER-CHILD INTERACTION, CAREGIVER TRANSITIONS, AND GROUP SIZE AS MEDIATORS BETWEEN INTERVENTION CONDITION AND ATTACHMENT AND PHYSICAL GROWTH OUTCOMES IN INSTITUTIONALIZED CHILDREN.

PubMed

Warner, Hilary A; McCall, Robert B; Groark, Christina J; Kim, Kevin H; Muhamedrahimov, Rifkat J; Palmov, Oleg I; Nikiforova, Natalia V

2017-09-01

This report describes a secondary analysis of data from a comprehensive intervention project which included training and structural changes in three Baby Homes in St. Petersburg, Russian Federation. Multiple mediator models were tested according to the R.M. Baron and D.A. Kenny () causal-steps approach to examine whether caregiver-child interaction quality, number of caregiver transitions, and group size mediated the effects of the intervention on children's attachment behaviors and physical growth. The study utilized a subsample of 163 children from the original Russian Baby Home project, who were between 11 and 19 months at the time of assessment. Results from comparisons of the training and structural changes versus no intervention conditions are presented. Caregiver-child interaction quality and number of caregiver transitions fully mediated the association between intervention condition and attachment behavior. No other mediation was found. Results suggest that the quality of interaction between caregivers and children in institutional care is of primary importance to children's development, but relationship context may play a less direct mediational role, supporting caregiver-child interactions. © 2017 Michigan Association for Infant Mental Health.

Effects of an Alternative to Suspension Intervention in a Therapeutic High School

ERIC Educational Resources Information Center

Hernandez-Melis, Claudia; Fenning, Pamela; Lawrence, Elizabeth

2016-01-01

The purpose of the current study was to assess the effects of an alternative to suspension intervention on students' subsequent major referrals. The intervention included activities designed to teach social coping strategies as well as mediation to resolve interpersonal conflicts. The intervention was implemented in a therapeutic high school, and…

Consumer Acceptance of Population-Level Intervention Strategies for Healthy Food Choices: The Role of Perceived Effectiveness and Perceived Fairness

PubMed Central

Bos, Colin; Van Der Lans, Ivo; Van Rijnsoever, Frank; Van Trijp, Hans

2015-01-01

The present study investigates acceptance of intervention strategies for low-calorie snack choices that vary regarding the effect they have on consumers’ freedom of choice (providing information, guiding choice through (dis)incentives, and restricting choice). We examine the mediating effects of perceived effectiveness and perceived fairness, and the moderating effects of barriers to choose low-calorie snacks and perceived responsibility for food choice. Data was collected through an online survey, involving three waves that were completed over a seven week timespan. Information was collected on barriers and perceived responsibility, and evaluations of a total of 128 intervention strategies with varying levels of intrusiveness that were further systematically varied in terms of source, location, approach/avoidance, type, and severity. A total of 1173 respondents completed all three waves. We found that the effect of intervention intrusiveness on acceptance was mediated by the perceived personal- and societal effectiveness, and the perceived fairness of interventions. For barriers and perceived responsibility, only main effects on intervention-specific beliefs were found. Government interventions were accepted less than interventions by food manufacturers. In conclusion, the present study shows that acceptance of interventions depends on perceptions of personal- and societal effectiveness and fairness, thereby providing novel starting points for increasing acceptance of both existing and new food choice interventions. PMID:26389949

Associations of Early- and Later-Childhood Poverty With Child Cognitive Function in Indonesia: Effect Decomposition in the Presence of Exposure-Induced Mediator-Outcome Confounding.

PubMed

Maika, Amelia; Mittinty, Murthy N; Brinkman, Sally; Lynch, John

2017-05-15

The amount of family financial resources available in early life influences child health and development. Using data from the 2000 and 2007 waves of the Indonesian Family Life Survey, we estimated the associations of early-life poverty (at age <7 years) and poverty in later childhood (at age 7-14 years) with cognitive function at age 7-14 years. Our analysis provided little support for the idea that an early intervention to support household income has a larger effect than intervention later in childhood; both seemed equally important. We also decomposed the effect of poverty at age <7 years into direct and indirect effects mediated through poverty and schooling/home environment at age 7-14 years. For decomposing the effects, we used 3 approaches: 1) joint mediators, 2) path-specific, and 3) intervention analog. Being exposed to poverty before age 7 years had a larger direct effect (difference in cognitive function z score) on child cognitive function at age 7-14 years (i.e., joint mediators β = -0.07, 95% confidence interval: -0.12, -0.02) than the indirect effects mediated through later poverty at age 7-14 years (β = -0.01, 95% confidence interval: -0.04, 0.01) and school attendance/home environment at age 7-14 years. The effect of poverty on cognitive function was small; nevertheless, financial intervention may still benefit children's cognitive function. © The Author 2017. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Using Peer-Mediated LEGO® Play Intervention to Improve Social Interactions for Chinese Children with Autism in an Inclusive Setting.

PubMed

Hu, Xiaoyi; Zheng, Qunshan; Lee, Gabrielle T

2018-02-16

The purpose of this study was to examine the effects of a peer-mediated LEGO® play intervention on improving social skills for children with ASD in an inclusive preschool in China. Three boys with ASD and 13 typically developing children participated in this study. A multiple-probe across participants design was used. The intervention consisted of LEGO® construction activities incorporated with peer-mediated strategies for one child with ASD and two typically developing peers. The intervention sessions were conducted two sessions per week with a total of 28-31 sessions for each participant. Results indicated that all three children with ASD increased their social initiations and responses following the completion of the intervention. Social validity was also obtained.

Preventing Negative Behaviors Among Elementary-School Students Through Enhancing Students’ Social-Emotional and Character Development

PubMed Central

Snyder, Frank J.; Acock, Alan C.; Vuchinich, Samuel; Beets, Michael W.; Washburn, Isaac J.; Flay, Brian R.

2013-01-01

Purpose Examine the effects of a comprehensive, school-wide social-emotional and character development program using a positive youth development perspective. Specifically, we examined a mediation mechanism whereby positive academic-related behaviors mediated the intervention effects on substance use, violence, and sexual activity. Design Matched-pair, cluster-randomized, controlled design. Setting Twenty (10 intervention and 10 control) racially/ethnically diverse schools in Hawaii. Subjects Elementary-aged students (N = 1784) from grade 5. Intervention The Positive Action program. Measures Students self-reported their academic behaviors, together with their substance use, violence, and voluntary sexual activity; teachers rated students’ academic behaviors, substance use, and violence. Analysis Structural equation modeling. Results Students attending intervention schools reported significantly better academic behavior (B = .273, SE = .039, p < .001) and significantly less substance use (B = −.970, SE = .292, p < .01, incidence-rate ratio [IRR] = .379), violence (B = −1.410, SE = .296, p < .001, IRR= .244), and sexual activity (B = − 2.415, SE = .608, p < .001, odds ratio = .089); boys reported more negative behaviors than girls. Intervention effects on student-reported substance use, violence, and sexual activity were mediated by positive academic behavior. Teacher reports corroborated these results, with rated academic behavior partially mediating the effects of the intervention on rated negative behaviors. Conclusion This study (1) provides evidence that adds insight into one mechanism through which a social-emotional and character development program affects negative outcomes and (2) supports social-emotional and character development and positive youth development perspectives that posit that focusing on youths’ assets may reduce negative behaviors. PMID:23470183

Mechanism evaluation of a lifestyle intervention for patients with musculoskeletal pain who are overweight or obese: protocol for a causal mediation analysis

PubMed Central

Lee, Hopin; Wiggers, John; Kamper, Steven J; Williams, Amanda; O'Brien, Kate M; Hodder, Rebecca K; Yoong, Sze Lin; Campbell, Elizabeth; Haskins, Robin; Robson, Emma K; McAuley, James H; Williams, Christopher M

2017-01-01

Introduction Low back pain (LBP) and knee osteoarthritis (OA) are highly prevalent and disabling conditions that cause societal and economic impact worldwide. Two randomised controlled trials (RCTs) will evaluate the effectiveness of a multicomponent lifestyle intervention for patients with LBP and knee OA who are overweight or obese. The key targets of this intervention are to improve physical activity, modify diet and correct pain beliefs. These factors may explain how a lifestyle intervention exerts its effects on key patient-relevant outcomes: pain, disability and quality of life. The aim of this protocol is to describe a planned analysis of a mechanism evaluation for a lifestyle intervention for overweight or obese patients with LBP and knee OA. Methods and analysis Causal mediation analyses of 2 two-armed RCTs. Both trials are part of a cohort-multiple RCT, embedded in routine health service delivery. In each respective trial, 160 patients with LBP and 120 patients with knee OA waiting for orthopaedic consultation will be randomised to a lifestyle intervention, or to remain part of the original cohort. The intervention consists of education and advice about the benefits of weight loss and physical activity, and the Australian New South Wales Get Healthy Service. All outcome measures including patient characteristics, primary and alternative mediators, outcomes, and potential confounders will be measured at baseline (T0). The primary mediator, weight, will be measured at 6 months post randomisation; alternative mediators including diet, physical activity and pain beliefs will be measured at 6 weeks post randomisation. All outcomes (pain, disability and quality of life) will be measured at 6 months post randomisation. Data will be analysed using causal mediation analysis with sensitivity analyses for sequential ignorability. All mediation models were specified a priori before completing data collection and without prior knowledge about the effectiveness of the intervention. Ethics and dissemination The study is approved by the Hunter New England Health Human Research Ethics Committee (13/12/11/5.18) and the University of Newcastle Human Research Ethics Committee (H-2015–0043). The results will be disseminated in peer-reviewed journals and at scientific conferences. Trial registration number ACTRN12615000490572 and ACTRN12615000478516; Pre-results. PMID:28674135

Mechanism evaluation of a lifestyle intervention for patients with musculoskeletal pain who are overweight or obese: protocol for a causal mediation analysis.

PubMed

Lee, Hopin; Wiggers, John; Kamper, Steven J; Williams, Amanda; O'Brien, Kate M; Hodder, Rebecca K; Wolfenden, Luke; Yoong, Sze Lin; Campbell, Elizabeth; Haskins, Robin; Robson, Emma K; McAuley, James H; Williams, Christopher M

2017-07-03

Low back pain (LBP) and knee osteoarthritis (OA) are highly prevalent and disabling conditions that cause societal and economic impact worldwide. Two randomised controlled trials (RCTs) will evaluate the effectiveness of a multicomponent lifestyle intervention for patients with LBP and knee OA who are overweight or obese. The key targets of this intervention are to improve physical activity, modify diet and correct pain beliefs. These factors may explain how a lifestyle intervention exerts its effects on key patient-relevant outcomes: pain, disability and quality of life. The aim of this protocol is to describe a planned analysis of a mechanism evaluation for a lifestyle intervention for overweight or obese patients with LBP and knee OA. Causal mediation analyses of 2 two-armed RCTs. Both trials are part of a cohort-multiple RCT, embedded in routine health service delivery. In each respective trial, 160 patients with LBP and 120 patients with knee OA waiting for orthopaedic consultation will be randomised to a lifestyle intervention, or to remain part of the original cohort. The intervention consists of education and advice about the benefits of weight loss and physical activity, and the Australian New South Wales Get Healthy Service. All outcome measures including patient characteristics, primary and alternative mediators, outcomes, and potential confounders will be measured at baseline (T0). The primary mediator, weight, will be measured at 6 months post randomisation; alternative mediators including diet, physical activity and pain beliefs will be measured at 6 weeks post randomisation. All outcomes (pain, disability and quality of life) will be measured at 6 months post randomisation. Data will be analysed using causal mediation analysis with sensitivity analyses for sequential ignorability. All mediation models were specified a priori before completing data collection and without prior knowledge about the effectiveness of the intervention. The study is approved by the Hunter New England Health Human Research Ethics Committee (13/12/11/5.18) and the University of Newcastle Human Research Ethics Committee (H-2015-0043). The results will be disseminated in peer-reviewed journals and at scientific conferences. ACTRN12615000490572 and ACTRN12615000478516; Pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effects of early comprehensive interventions on child neurodevelopment in poor rural areas of China: a moderated mediation analysis.

PubMed

Liu, S; Wang, Z; Zhao, C; Huang, X; Liang, X; Wang, X; Lu, S; Scherpbier, R W

2018-06-01

To examine the effects of early comprehensive interventions on home environment and child neurodevelopment among children younger than 3 years in poor rural areas of China, as well as the underlying mediating and moderating mechanisms. Non-randomized intervention study was conducted among 216 children aged 0-3 years in Shanxi province of China. Based on a 2 × 2 factor design, children in Lin and Fenxi County were assigned to an intervention group with duration less than 1 year (n = 26) or an intervention group with duration longer than 1 year (n = 82), while children in Fangshan County served as a control group with duration less than 1 year (n = 30) or a control group with duration longer than 1 year (n = 78). The control group received national public health services (NPHS), while the intervention group received NPHS plus comprehensive interventions covering health, nutrition, early psychosocial stimulation, and child protection. Home environment (Infant-Toddler Home Observation for Measurement of the Environment [HOME]) and child neurodevelopment (Ages and Stages Questionnaire [ASQ]) were measured by observation and interview with mothers after the intervention program. The intervention group showed significantly higher overall HOME, organization, learning materials, and involvement than the control group, only for a duration longer than 1 year. Children in the intervention group performed better in overall ASQ, fine motor, problem-solving, and personal-social than children in the control group. Moderated mediation analyses indicated that there were significantly indirect effects of treatment on overall ASQ through overall HOME, organization, and involvement only when the duration was longer than 1 year. Early comprehensive interventions longer than 1 year improve home environment and promote child neurodevelopment among children younger than 3 years in poor rural areas. What is more, effects of early comprehensive interventions longer than 1 year on child neurodevelopment were mediated by home environment. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Peer-Mediated Intervention: An Effective, Inclusive Strategy for All Young Children

ERIC Educational Resources Information Center

Harris, Kathleen; Pretti-Frontczak, Kristie; Brown, Teresa

2009-01-01

The authors describe a teaching strategy that can support the development and learning of all children in inclusive learning environments. They give an overview of peer-mediated intervention and share useful information on how classroom teachers can use this tool to promote learning, particularly in the areas of social and communication…

Adolescent Attitudes toward Influenza Vaccination and Vaccine Uptake in a School-Based Influenza Vaccination Intervention: A Mediation Analysis

ERIC Educational Resources Information Center

Painter, Julia E.; Sales, Jessica M.; Pazol, Karen; Wingood, Gina M.; Windle, Michael; Orenstein, Walter A.; DiClemente, Ralph J.

2011-01-01

Background: School-based vaccination programs may provide an effective strategy to immunize adolescents against influenza. This study examined whether adolescent attitudes toward influenza vaccination mediated the relationship between receipt of a school-based influenza vaccination intervention and vaccine uptake. Methods: Participants were…

Perceived Self-Efficacy and Financial Incentives: Factors Affecting Health Behaviors and Weight Loss in a Workplace Weight Loss Intervention.

PubMed

Faghri, Pouran D; Simon, Julia; Huedo-Medina, Tania; Gorin, Amy

2017-05-01

To evaluate if self-efficacy (SE) and financial incentives (FI) mediate the effect of health behavior on weight loss in a group of overweight and obese nursing-home employees participating in a 16-week weight-loss intervention with 12-week follow-up. Ninety nine overweight/obese (body mass index [BMI] > 25) employees from four nursing-homes participated, with a mean age of 46.98 years and BMI of 35.33. Nursing-homes were randomized to receiving an incentive-based intervention (n = 51) and no incentive (n = 48). Participants' health behaviors and eating and exercise self-efficacy (Ex-SE) were assessed at week 1, 16, and 28 using a self-reported questionnaire. Mediation and moderated mediation analysis assessed relationships among these variables. Eating self-efficacy (Eat-SE) and Ex-SE were significant mediators between health behaviors and weight loss (P < 0.05). Incentives significantly moderated the effects of self-efficacy (P = 0.00) on weight loss. Self-efficacy and FI may affect weight loss and play a role in weight-loss interventions.

Self-Efficacy, Planning, or a Combination of Both? A Longitudinal Experimental Study Comparing Effects of Three Interventions on Adolescents’ Body Fat

PubMed Central

Luszczynska, Aleksandra; Hagger, Martin S.; Banik, Anna; Horodyska, Karolina; Knoll, Nina; Scholz, Urte

2016-01-01

Background The superiority of an intervention combining two sets of theory-based behavior change techniques targeting planning and self-efficacy over an intervention targeting planning only or self-efficacy only has rarely been investigated. Purpose We compared the influence of self-efficacy, planning, and self-efficacy+planning interventions with an education-based control condition on adolescents’ body fat, assuming mediating effects of respective social cognitive variables and moderate-to-vigorous physical activity (MVPA). The moderating role of the built environment was examined. Methods Participants (N = 1217, aged 14–18 years) were randomly assigned to four conditions: planning (n = 270), self-efficacy (n = 311), self-efficacy+planning (n = 351), and control (n = 285). The measurement was conducted at baseline (T1), two-month follow-up (T2), and fourteen-month follow-up (T3). Interventions/control group procedures were delivered at T1 and T2. Percent of body fat tissue (measured at T1 and T3) was the main outcome. Social cognitive mediators (self-efficacy and planning) were assessed at T1 and T2. The behavioral mediator (MVPA) and the presence of built MVPA facilities (the moderator) were evaluated at T1 and T3. Results Similar small increases of body fat were found across the three intervention groups, but the increment of body fat was significantly larger in the control group. On average, differences between control and intervention groups translated to approximately 1% of body fat. Effects of the interventions on body fat were mediated by relevant social cognitive variables and MVPA. A lower increase of body fat was found among intervention group participants who had access to newly-built MVPA facilities. Conclusions We found no superiority of an intervention targeting two social cognitive variables over the intervention targeting one cognition only. PMID:27410961

Behavioral Intervention Planning: Increasing Appropriate Behavior of a Socially Withdrawn Student

ERIC Educational Resources Information Center

Christensen, Lynnette; Young, K. Richard; Marchant, Michelle

2007-01-01

This study examined the effects of an assessment-based intervention plan on the appropriate classroom behavior of a socially withdrawn, Hispanic, learning disabled, third grade student. The study focused on (1) the effects of peer mediation as part of a behavioral intervention package of empirically validated components, (2) the effects of…

Integration of public health and primary care: A systematic review of the current literature in primary care physician mediated childhood obesity interventions.

PubMed

Bhuyan, Soumitra S; Chandak, Aastha; Smith, Patti; Carlton, Erik L; Duncan, Kenric; Gentry, Daniel

2015-01-01

Childhood obesity, with its growing prevalence, detrimental effects on population health and economic burden, is an important public health issue in the United States and worldwide. There is need for expansion of the role of primary care physicians in obesity interventions. The primary aim of this review is to explore primary care physician (PCP) mediated interventions targeting childhood obesity and assess the roles played by physicians in the interventions. A systematic review of the literature published between January 2007 and October 2014 was conducted using a combination of keywords like "childhood obesity", "paediatric obesity", "childhood overweight", "paediatric overweight", "primary care physician", "primary care settings", "healthcare teams", and "community resources" from MEDLINE and CINAHL during November 2014. Author name(s), publication year, sample size, patient's age, study and follow-up duration, intervention components, role of PCP, members of the healthcare team, and outcomes were extracted for this review. Nine studies were included in the review. PCP-mediated interventions were composed of behavioural, education and technological interventions or a combination of these. Most interventions led to positive changes in Body Mass Index (BMI), healthier lifestyles and increased satisfaction among parents. PCPs participated in screening and diagnosing, making referrals for intervention, providing nutrition counselling, and promoting physical activity. PCPs, Dietitians and nurses were often part of the healthcare team. PCP-mediated interventions have the potential to effectively curb childhood obesity. However, there is a further need for training of PCPs, and explain new types of interventions such as the use of technology. Copyright © 2015 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.

Family support as a mediator of change in sexual risk-taking attitudes among orphaned adolescents in rural Uganda.

PubMed

Ismayilova, Leyla; Ssewamala, Fred M; Karimli, Leyla

2012-03-01

Prior studies demonstrated the effect of family-based economic empowerment intervention Suubi on reducing attitudes approving sexual risk-taking behavior among orphaned adolescents in Uganda. To understand mechanisms of change, the article examines the effect of Suubi intervention on family support variables and their role in mediating the change in adolescents' attitudes toward sexual risk-taking. The Suubi study used a cluster-randomized experimental design with three waves, and included 283 orphaned adolescents from 15 primary schools in Rakai, Uganda. First, using mixed-effects models, the study tested for the effect of intervention on family support variables. Second, using mediation analysis, the study examined whether the change in sexual risk-taking attitudes was mediated by the change in family support. Compared with adolescents from the control group, at wave 2, adolescents in the treatment group reported higher levels of perceived support from caregivers, were more willing to talk to caregivers about their problems, and felt more comfortable talking about sexual risk behaviors with their caregivers. Mediation analysis demonstrated that the improvement in perceived support from caregivers at wave 2 accounted for 16.8% of the reduction in adolescents' attitudes toward sexual risk-taking behavior at wave 3 (z = -2.21, p < .05). A family-based economic empowerment intervention Suubi may have the potential to increase family support to orphaned adolescents. Interventions aimed at strengthening existing social networks and improving connectedness with surviving family members may be critical in preventing sexual risk-taking behavior among orphaned adolescents in Uganda, which is characterized by low resources. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Parenting intervention effects on parental depressive symptoms: examining the role of parenting and child behavior.

PubMed

Wong, Jessie J; Gonzales, Nancy A; Montaño, Zorash; Dumka, Larry; Millsap, Roger E

2014-06-01

Parental depression is a major risk factor in child development. Growing research suggests parenting programs can positively impact parental depressive symptoms, although the specific mechanisms that explain these effects are unknown. The current study examined parenting mediated effects of a parenting program on mothers' and fathers' depressive symptoms, as well as the role of child behavior in linking parenting to reductions in depressive symptoms. The study samples included 494 mothers and 288 fathers of Mexican origin adolescents who participated in a randomized trial of the Bridges to High School Program/Proyecto Puentes a la Secundaria, a universal prevention and promotion intervention that included parent training but did not directly target parental depressive symptoms. Parenting mediator models tested program effects on parental depressive symptoms through changes in harsh and supportive parenting. Results showed a significant indirect intervention effect on maternal depressive symptoms through changes in mothers' harsh parenting. Next, child behavior models revealed a partial mediation effect of harsh parenting and a full mediation effect of supportive parenting on maternal depressive symptoms through mothers' reports of child externalizing symptoms. Indirect effects of fathers' harsh and supportive parenting on paternal depressive symptoms were also found through fathers' reports of child behavior. PsycINFO Database Record (c) 2014 APA, all rights reserved.

Mediators and Moderators of a School-Based Cognitive-Behavioral Depression Prevention Program.

PubMed

Duong, Mylien T; Kelly, Brynn M; Haaland, Wren L; Matsumiya, Brandon; Huey, Stanley J; McCarty, Carolyn A

2016-10-01

This study tested potential moderators and mediators of an indicated depression prevention program for middle school students, Positive Thoughts and Actions (PTA). Participants were 120 students randomly assigned to PTA, or a brief, individually administered supportive intervention (Individual Support Program, or ISP). Youths completed measures of depressive symptoms at baseline, post-intervention, and 12-month follow-up. Hierarchical regression was used to test three moderators-ethnic minority status, gender, and baseline depressive symptoms-and three mediators representing functional outcomes targeted by PTA-parent-child communication, attitude towards school, and health behavior. Ethnic minority status did not moderate PTA effects at post-intervention but did moderate PTA effects at 12-month follow-up. At 12 months, PTA appeared to be more effective for White participants than ethnic minority youth. Follow-up analyses suggested this moderation effect was due to the tendency of ethnic minority youth, especially those with fewer symptoms at baseline, to drop out by 12 months. Neither gender nor baseline depressive symptoms moderated the effects of PTA. Although PTA improved health behavior and attitudes toward school, there was no evidence that any of these functional outcomes measured mediated the impact of PTA on depressive symptoms. Future directions are discussed.

Feelings and intervention judgments as mediators in the risk perception-intention relationship.

PubMed

Soureti, Anastasia; Hurling, Robert; Cobain, Mark R; van Mechelen, Willem; Chinapaw, Mai

2013-07-01

To explore the mediating role of measures of persuasion in the relationship between risk perceptions and intentions. The first study included 413 obese subjects (mean age = 45.3 years); the second study, 781 overweight subjects (mean age = 46.6 years). All measures were assessed by self-report. Feelings and intervention judgments were mediators in the relationship between risk perceptions and intention to eat healthier, do more physical activity (study 1) and intention to reduce saturated fat (study 2). Feelings was the only mediator in the relationship between risk perceptions and intention to stop smoking (study 1). Future interventions targeting risk perceptions to increase intentions are likely to be more effective if subjects find the information emotionally impactful, credible, and engaging.

A brief intervention changing oral self-care, self-efficacy, and self-monitoring.

PubMed

Schwarzer, Ralf; Antoniuk, Agata; Gholami, Maryam

2015-02-01

The roles of self-efficacy and self-monitoring as proximal predictors of dental flossing frequency are studied in the context of an oral health intervention. A study among 287 university students, aged 19 to 26 years, compared an intervention group that received a brief self-regulatory treatment, with a passive and an active control group. Dental flossing, self-efficacy, and self-monitoring were assessed at baseline and 3 weeks later. The intervention led to an increase in dental flossing regardless of experimental condition. However, treatment-specific gains were documented for self-efficacy and self-monitoring. Moreover, changes in the latter two served as mediators in a path model, linking the intervention with subsequent dental flossing and yielding significant indirect effects. Self-efficacy and self-monitoring play a mediating role in facilitating dental flossing. Interventions that aim at an improvement in oral self-care should consider using these constructs. Statement of contribution What is already known on this subject? The adoption and maintenance of oral self-care can be facilitated by a number of social-cognitive variables. Interventions that include planning, action control, or self-efficacy components have been shown to improve dental flossing. In one recent study on flossing in adolescent girls, planning intervention effects were mediated by self-efficacy. What does this study add? Self-monitoring is associated with better oral self-care. A 10-min intervention improves self-efficacy and self-monitoring. Self-efficacy and self-monitoring operate as mediators between treatment and flossing. © 2014 The British Psychological Society.

Psychological mediators related to clinical outcome in cognitive behavioural therapy for coronary heart disease: A sub-analysis from the SUPRIM trial.

PubMed

Norlund, Fredrika; Olsson, Erik Mg; Pingel, Ronnie; Held, Claes; Svärdsudd, Kurt; Gulliksson, Mats; Burell, Gunilla

2017-06-01

Background The Secondary Prevention in Uppsala Primary Healthcare Project (SUPRIM) was a randomized controlled trial of a group-based cognitive behavioural therapy stress management programme for patients with coronary heart disease. The project was successful in reducing the risk of fatal or non-fatal first recurrent cardiovascular events. The aim of this study was to analyse the effect of cognitive behavioural therapy on self-rated stress, somatic anxiety, vital exhaustion and depression and to study the associations of these factors with the reduction in cardiovascular events. Methods A total of 362 patients were randomly assigned to intervention or usual care groups. The psychological outcomes were assessed five times during 24 months and analysed using linear mixed models. The mediating roles of the outcomes were analysed using joint modelling of the longitudinal and time to event data. Results The intervention had a positive effect on somatic anxiety ( p < 0.05), reflecting a beneficial development over time compared with the controls. Stress, vital exhaustion and depression did not differ between the groups over time. Mediator analysis suggested that somatic anxiety may have mediated the effect of treatment on cardiovascular events. Conclusions The intervention had a small positive effect on somatic anxiety, but did not affect stress, vital exhaustion or depression in patients with coronary heart disease. Somatic anxiety was associated with an increased risk of cardiovascular events and might act as a partial mediator in the treatment effect on cardiovascular events. However, the mechanisms between the intervention and the protective cardiovascular outcome remain to be identified.

The role of tobacco outlet density in a smoking cessation intervention for urban youth.

PubMed

Mennis, Jeremy; Mason, Michael; Way, Thomas; Zaharakis, Nikola

2016-03-01

This study investigates the role of tobacco outlet density in a randomized controlled trial of a text messaging-based smoking cessation intervention conducted among a sample of 187 primarily African American youth in a midsize U.S. city. A moderated mediation model was used to test whether the indirect effect of residential tobacco outlet density on future smoking was mediated by the intention to smoke, and whether this indirect effect differed between adolescents who received the intervention and those who did not. Results indicated that tobacco outlet density is associated with intention to smoke, which predicts future smoking, and that the indirect effect of tobacco outlet density on future smoking is moderated by the intervention. Tobacco outlet density and the intervention can be viewed as competing forces on future smoking behavior, where higher tobacco outlet density acts to mitigate the sensitivity of an adolescent to the intervention's intended effect. Smoking cessation interventions applied to youth should consider tobacco outlet density as a contextual condition that can influence treatment outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

Effects of Peer-Mediated Implementation of Visual Scripts in Middle School

ERIC Educational Resources Information Center

Ganz, Jennifer B.; Heath, Amy K.; Lund, Emily M.; Camargo, Siglia P. H.; Rispoli, Mandy J.; Boles, Margot; Plaisance, Lauren

2012-01-01

Although research has investigated the impact of peer-mediated interventions and visual scripts on social and communication skills in children with autism spectrum disorders, no studies to date have investigated peer-mediated implementation of scripts. This study investigated the effects of peer-implemented scripts on a middle school student with…

Reducing Internalizing Symptoms among High-Risk, Hispanic Adolescents: Mediators of a Preventive Family Intervention

PubMed Central

Perrino, Tatiana; Brincks, Ahnalee; Howe, George; Brown, C. Hendricks; Prado, Guillermo; Pantin, Hilda

2016-01-01

Familias Unidas is a family-focused preventive intervention that has been found to reduce drug use and sexual risk behaviors among Hispanic adolescents. In some trials, Familias Unidas has also been found to be efficacious in reducing adolescent internalizing symptoms (i.e., depressive and anxiety symptoms), even though the intervention did not specifically target internalizing symptoms. This study examines potential mediators or mechanisms by which Familias Unidas influences internalizing symptoms, specifically the role of intervention-targeted improvements in parent-adolescent communication and reductions in youth externalizing behaviors. A total of 213 Hispanic eighth grade students with a history of externalizing behavior problems and their primary caregivers were recruited from the public school system. Participants, with a mean age of 13.8 years, were randomized into the Familias Unidas intervention or community practice control condition, and assessed at baseline, 6-months, 18-months, and 30-months post-baseline. A cascading mediation model was tested in which the Familias Unidas intervention was hypothesized to decrease adolescent internalizing symptoms through two mediators: improvements in parent-adolescent communication leading to decreases in externalizing behaviors. Findings show that the intervention had significant direct effects on youth internalizing symptoms at 30-months post-baseline. In addition, the cascading mediation model was supported in which the Familias Unidas intervention predicted significant improvements in parent-adolescent communication at 6-months, subsequently decreasing externalizing behaviors at 18-months, and ultimately reducing youth internalizing symptoms at 30-months post-baseline. Implications for prevention interventions are discussed. PMID:27154768

Mediation effects of a culturally generic substance use prevention program for Asian American adolescents

PubMed Central

Fang, Lin; Schinke, Steven P.

2014-01-01

In this paper, we examined the mediation effects of a family-based substance use prevention program on a sample of Asian American families. These families were randomized into an intervention arm or a non-intervention control arm. Using path models, we assessed the effect of the intervention on adolescent girls’ substance use outcomes at 2-year follow-up through family relationships and adolescent self-efficacy pathways. Bias-corrected bootstrapping strategy was employed to assess the significance of the mediation effect by evaluating the 95% confidence interval of the standardized coefficient. The results show that receiving the intervention exerted a positive effect on girls’ family relationships at 1-year follow-up. Such an improvement was associated with girls’ increased self-efficacy, which in turn led to girls’ decreased alcohol use, marijuana use, and future intention to use substances at 2-year follow-up. Considering the diverse cultural backgrounds, as well as languages, nationalities, and acculturation levels under the umbrella term “Asian Americans”, we demonstrate that a universal web-based intervention that tackles the theoretical- and empirical-based risk and protective factors can be effective for Asian Americans. Despite its generic nature, our program may provide relevant tools for Asian American parents in assisting their adolescent children to navigate through the developmental stage and ultimately, resist substance use. PMID:25505939

Effects of high-intensity interval training on fatigue and quality of life in testicular cancer survivors.

PubMed

Adams, Scott C; DeLorey, Darren S; Davenport, Margie H; Fairey, Adrian S; North, Scott; Courneya, Kerry S

2018-05-08

Testicular cancer survivors (TCS) are at increased risk of cancer-related fatigue (CRF), psychosocial impairment, and poor mental health-related quality of life (HRQoL). Here, we examine the effects of high-intensity interval training (HIIT) on patient-reported outcomes (PROs) in TCS. Secondarily, we explore cardiorespiratory fitness as a mediator of intervention effects and select baseline characteristics as moderators of intervention effects. TCS (n = 63) were randomly assigned to 12 weeks of supervised HIIT or usual care (UC). PROs included CRF, depression, anxiety, stress, self-esteem, sleep quality, and HRQoL assessed at baseline, post-intervention, and 3-month follow-up. TCS (median 7 years postdiagnosis) completed 99% of training sessions and achieved 98% of target training intensity. ANCOVA revealed that, compared to UC, HIIT significantly improved post-intervention CRF (p = 0.003), self-esteem (p = 0.029), and multiple HRQoL domains (ps ≤ 0.05). Effects on CRF (p = 0.031) and vitality (p = 0.015) persisted at 3-month follow-up. Cardiorespiratory fitness changes mediated CRF and HRQoL improvements. CRF effects were larger for TCS with an inactive lifestyle, lower fitness, higher testosterone, and clinical fatigue at baseline. HIIT significantly improves CRF and HRQoL in TCS. Mediation by cardiorespiratory fitness and moderation by clinical characteristics suggests opportunities for targeted exercise interventions to optimise PROs in TCS.

A Meta-Analysis of Peer-Mediated Interventions for Young Children with Autism Spectrum Disorders

ERIC Educational Resources Information Center

Zhang, Jie; Wheeler, John J.

2011-01-01

This meta-analysis investigated the efficacy of peer-mediated interventions for promoting social interactions among children from birth to eight years of age diagnosed with ASD. Forty-five single-subject design studies were analyzed and the effect sizes were calculated by the regression model developed by Allison and Gorman (1993). The overall…

A Systematic Review of Peer-Mediated Interventions on the Academic Achievement of Students with Emotional/Behavioral Disorders

ERIC Educational Resources Information Center

Dunn, Michelle E.; Shelnut, Jill; Ryan, Joseph B.; Katsiyannis, Antonis

2017-01-01

The purpose of this review is to report on the effectiveness of peer-mediated interventions on academic outcomes for students with emotional and behavioral disorders (EBD). CEC standards for evidence-based practices were used for determination of methodologically sound studies. Twenty-four studies involving 288 participants met inclusionary…

Patients' perceptions of sharing in decisions: a systematic review of interventions to enhance shared decision making in routine clinical practice.

PubMed

Légaré, France; Turcotte, Stéphane; Stacey, Dawn; Ratté, Stéphane; Kryworuchko, Jennifer; Graham, Ian D

2012-01-01

Shared decision making is the process in which a healthcare choice is made jointly by the health professional and the patient. Little is known about what patients view as effective or ineffective strategies to implement shared decision making in routine clinical practice. This systematic review evaluates the effectiveness of interventions to improve health professionals' adoption of shared decision making in routine clinical practice, as seen by patients. We searched electronic databases (PubMed, the Cochrane Library, EMBASE, CINAHL, and PsycINFO) from their inception to mid-March 2009. We found additional material by reviewing the reference lists of the studies found in the databases; systematic reviews of studies on shared decision making; the proceedings of various editions of the International Shared Decision Making Conference; and the transcripts of the Society for Medical Decision Making's meetings. In our study selection, we included randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series analyses in which patients evaluated interventions to improve health professionals' adoption of shared decision making. The interventions in question consisted of the distribution of printed educational material; educational meetings; audit and feedback; reminders; and patient-mediated initiatives (e.g. patient decision aids). Two reviewers independently screened the studies and extracted data. Statistical analyses considered categorical and continuous process measures. We computed the standardized effect size for each outcome at the 95% confidence interval. The primary outcome of interest was health professionals' adoption of shared decision making as reported by patients in a self-administered questionnaire. Of the 6764 search results, 21 studies reported 35 relevant comparisons. Overall, the quality of the studies ranged from 0% to 83%. Only three of the 21 studies reported a clinically significant effect for the primary outcome that favored the intervention. The first study compared an educational meeting and a patient-mediated intervention with another patient-mediated intervention (median improvement of 74%). The second compared an educational meeting, a patient-mediated intervention, and audit and feedback with an educational meeting on an alternative topic (improvement of 227%). The third compared an educational meeting and a patient-mediated intervention with usual care (p = 0.003). All three studies were limited to the patient-physician dyad. To reduce bias, future studies should improve methods and reporting, and should analyze costs and benefits, including those associated with training of health professionals. Multifaceted interventions that include educating health professionals about sharing decisions with patients and patient-mediated interventions, such as patient decision aids, appear promising for improving health professionals' adoption of shared decision making in routine clinical practice as seen by patients.

Processes of change in a school-based mindfulness programme: cognitive reactivity and self-coldness as mediators.

PubMed

Van der Gucht, Katleen; Takano, Keisuke; Raes, Filip; Kuppens, Peter

2018-05-01

The underlying mechanisms of the effectiveness of mindfulness-based interventions for emotional well-being remain poorly understood. Here, we examined the potential mediating effects of cognitive reactivity and self-compassion on symptoms of depression, anxiety and stress using data from an earlier randomised controlled school trial. A moderated time-lagged mediation model based on multilevel modelling was used to analyse the data. The findings showed that post-treatment changes in cognitive reactivity and self-coldness, an aspect of self-compassion, mediated subsequent changes in symptoms of depression, anxiety and stress. These results suggest that cognitive reactivity and self-coldness may be considered as transdiagnostic mechanisms of change of a mindfulness-based intervention programme for youth.

Exploring Mediators of Physical Activity in Young Adult Cancer Survivors: Evidence from a Randomized Trial of a Facebook-Based Physical Activity Intervention

PubMed Central

Tate, Deborah F.; Mayer, Deborah K.; Allicock, Marlyn; Cai, Jianwen

2015-01-01

Purpose: This study examined the effects of a physical activity (PA) intervention for young adult cancer survivors on changes in self-efficacy, social support, and self-monitoring and determined whether changes in these social cognitive theory constructs mediated the relationship between the intervention and changes in PA. Methods: A 12-week randomized trial compared a Facebook-based intervention (FITNET) aimed at increasing moderate-to-vigorous intensity PA to a Facebook-based self-help comparison group. Young adult cancer survivors (N=86, aged 21–39) were randomly assigned to one of the two groups. Self-report measures of PA and psychosocial variables were collected at baseline and after 12 weeks. Results: The FITNET group reported lower self-efficacy for sticking to exercise (mean change=−0.38; 95% CI: −0.62 to −0.12; p=0.025) and social support from friends on social networking websites (mean change=−0.47; 95% CI: −1.45 to 0.65; p=0.039) relative to the self-help comparison group over time. Changes in social support from friends on social networking websites partially mediated the intervention effects on moderate-to-vigorous PA (mean indirect effect=−22.4; 95% CI: −62.0 to −2.8) in the unexpected direction. Across both groups, social support from friends and self-monitoring were positively associated with changes in moderate-to-vigorous PA. Conclusion: The proposed mediators did not explain the positive effects of the FITNET intervention on mild PA. The lack of significant improvements in psychosocial constructs among FITNET participants may partly explain why the intervention did not increase moderate-to-vigorous PA relative to the self-help comparison group. Future PA interventions with young adult cancer survivors should examine targeting social support from friends and self-monitoring. PMID:25852972

Mediators and moderators in early intervention research.

PubMed

Breitborde, Nicholas J K; Srihari, Vinod H; Pollard, Jessica M; Addington, Donald N; Woods, Scott W

2010-05-01

The goal of this paper is to provide clarification with regard to the nature of mediator and moderator variables and the statistical methods used to test for the existence of these variables. Particular attention will be devoted to discussing the ways in which the identification of mediator and moderator variables may help to advance the field of early intervention in psychiatry. We completed a literature review of the methodological strategies used to test for mediator and moderator variables. Although several tests for mediator variables are currently available, recent evaluations suggest that tests which directly evaluate the indirect effect are superior. With regard to moderator variables, two approaches ('pick-a-point' and regions of significance) are available, and we provide guidelines with regard to how researchers can determine which approach may be most appropriate to use for their specific study. Finally, we discuss how to evaluate the clinical importance of mediator and moderator relationships as well as the methodology to calculate statistical power for tests of mediation and moderation. Further exploration of mediator and moderator variables may provide valuable information with regard to interventions provided early in the course of a psychiatric illness.

Effects of a randomized gratitude intervention on death-related fear of recurrence in breast cancer survivors.

PubMed

Otto, Amy K; Szczesny, Elana C; Soriano, Emily C; Laurenceau, Jean-Philippe; Siegel, Scott D

2016-12-01

Among the most prevalent and distressing concerns endorsed by breast cancer survivors is fear of cancer recurrence (FOR), and one of the most salient facets is the worry that a recurrence of cancer could cause one's death. The primary goal of the present study was to test the effects of a brief, low-cost gratitude intervention on overall FOR and death-related FOR, positing pursuit of meaningful goals as a theoretically driven putative mediator. To replicate published tests of similar gratitude-eliciting interventions, positive affect (PA) was also considered as an outcome. Sixty-seven women with early stage breast cancer were randomly assigned to either a 6-week online gratitude intervention or a 6-week online control condition. Outcomes were assessed at pre- and posttreatment, as well as 1 month and 3 months after the end of treatment. The mediator, meaningful goal pursuit, was measured via assessments over the 6-week intervention period. Results revealed that patients in the gratitude intervention experienced a significant decrease in death-related FOR compared to the control condition. Moreover, this effect was significantly mediated by meaningful goal pursuit (and not by PA). The gratitude intervention was also found to prevent declines in PA observed in the control condition. Overall, findings support the notion that a brief gratitude intervention can promote well-being and psychological adaptation to cancer by stimulating the pursuit of meaningful goals and subsequently reducing death-related FOR. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Empiric validation of a process for behavior change.

PubMed

Elliot, Diane L; Goldberg, Linn; MacKinnon, David P; Ranby, Krista W; Kuehl, Kerry S; Moe, Esther L

2016-09-01

Most behavior change trials focus on outcomes rather than deconstructing how those outcomes related to programmatic theoretical underpinnings and intervention components. In this report, the process of change is compared for three evidence-based programs' that shared theories, intervention elements and potential mediating variables. Each investigation was a randomized trial that assessed pre- and post- intervention variables using survey constructs with established reliability. Each also used mediation analyses to define relationships. The findings were combined using a pattern matching approach. Surprisingly, knowledge was a significant mediator in each program (a and b path effects [p<0.01]). Norms, perceived control abilities, and self-monitoring were confirmed in at least two studies (p<0.01 for each). Replication of findings across studies with a common design but varied populations provides a robust validation of the theory and processes of an effective intervention. Combined findings also demonstrate a means to substantiate process aspects and theoretical models to advance understanding of behavior change.

The Effects of a Peer-Mediated Reading Intervention on Juvenile Offenders' Main Idea Statements about Informational Text

ERIC Educational Resources Information Center

Wexler, Jade; Reed, Deborah K.; Barton, Erin E.; Mitchell, Marisa; Clancy, Erin

2018-01-01

Many youth in the juvenile justice system with or at risk for emotional and behavioral disorders struggle with reading. A multiple-baseline-across-participants single-case research design was used to examine the relationship between a supplemental peer-mediated reading intervention and juvenile offenders' generation of main idea statements about…

Mechanism of Developmental Change in the PLAY Project Home Consultation Program: Evidence from a Randomized Control Trial.

PubMed

Mahoney, Gerald; Solomon, Richard

2016-05-01

This investigation is a secondary analysis of data from a randomized control trial of the PLAY Home Consultation Intervention Program which was conducted with 112 preschool children with Autism Spectrum Disorders and their parents (Solomon et al. in J Dev Behav Pediatr 35:475-485, 2014). Subjects were randomly assigned to either a community standard (CS) treatment group or to the PLAY Project plus CS Treatment (PLAY). PLAY subjects received monthly parent-child intervention sessions for 1 year during which parents learned how to use the rationale and interactive strategies of the Developmental, Individual-differences, Relationship-based (DIR) intervention model (Greenspan and Weider in The child with special needs: encouraging intellectual and emotional growth. DeCapo Press, Cambridge, MA, 1998) to engage in more responsive, affective and less directive interactions with their children. This investigation examined whether PLAY intervention effects on parents' style of interacting with their children as well as on children's social engagement mediated the effects of PLAY on children's autism severity as measured by ADOS calibrated severity scores. Regression procedures were used to test for mediation. There were two main findings. First the effects of PLAY on children's social engagement were mediated by the increases in parental responsiveness and affect that were promoted by PLAY. Second, the effects of PLAY on the severity children's Social Affect disorders were mediated by changes in parental responsiveness and affect; however, the effects of Responsive/Affect were mediated by the impact these variables had on children's social engagement. Results are discussed in terms of contemporary models of developmental change including the developmental change model that is the foundation for DIR.

Designing Studies to Evaluate Parent-Mediated Interventions for Toddlers with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Siller, Michael; Morgan, Lindee; Turner-Brown, Lauren; Baggett, Kathleen M.; Baranek, Grace T.; Brian, Jessica; Bryson, Susan E.; Carter, Alice S.; Crais, Elizabeth R.; Estes, Annette; Kasari, Connie; Landa, Rebecca J.; Lord, Catherine; Messinger, Daniel S.; Mundy, Peter; Odom, Samuel L.; Reznick, J. Steven; Roberts, Wendy; Rogers, Sally J.; Schertz, Hannah H.; Smith, Isabel M.; Stone, Wendy L.; Watson, Linda R.; Wetherby, Amy M.; Yoder, Paul J.; Zwaigenbaum, Lonnie

2013-01-01

Given recent advances in science, policy, and practice of early identification in autism spectrum disorder (ASD), questions about the effectiveness of early intervention have far-reaching service and policy implications. However, rigorous research evaluating the efficacy and effectiveness of intervention programs for toddlers with ASD faces a…

Increasing Parent Limits on Novice Young Drivers: Cognitive Mediation of the Effect of Persuasive Messages

ERIC Educational Resources Information Center

Simons-Morton, Bruce G.; Hartos, Jessica L.; Leaf, William A.; Preusser, David F.

2006-01-01

This report describes intervention effects on parent-imposed driving limits on novice young drivers at licensure. Parent-adolescent dyads (4,344) completed baseline surveys at permit and were randomly assigned to intervention or comparison groups. Intervention families received persuasive communications related to protection motivation theory…

Systematic review of the effects of mirror therapy in children with cerebral palsy.

PubMed

Park, Eom-Ji; Baek, Soon-Hyung; Park, Soohee

2016-11-01

[Purpose] To provide data for systematic intervention plans in occupational therapy practice by objectivity showing the value of mirror therapy interventions in children with cerebral palsy. [Subjects and Methods] Medline and EMBASE databases were searched for the key words "cerebral palsy," "mirror movement," "mirror therapy," and "mirror visual feedback." Nine studies that met the inclusion and exclusion criteria were identified. The qualitatively determined level of evidence, period of research, comparisons and interventions, tools used to measure the intervention, and the effects were analyzed. [Results] According to the results analyzed, one (1/9, 11.1%) study showed the same result as the control group, one (1/9, 11.1%) showed a negative effect, and seven (7/9, 77.8%) showed positive effects of mirror-mediated therapy, with meaningful improvement in function, such as hand strength, movement speed, muscle activity, and accuracy of hand matching. [Conclusion] Through this study, the value of mirror-mediated therapeutic interventions in occupational therapy practice targeting cerebral palsy was confirmed. It is expected that this result will be useful in establishing mirror therapy as an interventional program.

The effect of a multi-component smoking cessation intervention in African American women residing in public housing.

PubMed

Andrews, Jeannette O; Felton, Gwen; Ellen Wewers, Mary; Waller, Jennifer; Tingen, Martha

2007-02-01

The purpose of this study was to test the effectiveness of a multi-component smoking cessation intervention in African American women residing in public housing. The intervention consisted of: (a) nurse led behavioral/empowerment counseling; (b) nicotine replacement therapy; and, (c) community health workers to enhance smoking self-efficacy, social support, and spiritual well-being. The results showed a 6-month continuous smoking abstinence of 27.5% and 5.7% in the intervention and comparison groups. Changes in social support and smoking self-efficacy over time predicted smoking abstinence, and self-efficacy mediated 6-month smoking abstinence outcomes. Spiritual well-being did not predict or mediate smoking abstinence outcomes. These findings support the use of a nurse/community health worker model to deliver culturally tailored behavioral interventions with marginalized communities.

Psychosocial mediators of change in physical activity in the Welsh national exercise referral scheme: secondary analysis of a randomised controlled trial.

PubMed

Littlecott, Hannah J; Moore, Graham F; Moore, Laurence; Murphy, Simon

2014-08-27

While an increasing number of randomised controlled trials report impacts of exercise referral schemes (ERS) on physical activity, few have investigated the mechanisms through which increases in physical activity are produced. This study examines whether a National Exercise Referral Scheme (NERS) in Wales is associated with improvements in autonomous motivation, self-efficacy and social support, and whether change in physical activity is mediated by change in these psychosocial processes. A pragmatic randomised controlled trial of NERS across 12 LHBs in Wales. Questionnaires measured demographic data and physical activity at baseline. Participants (N = 2160) with depression, anxiety or CHD risk factors were referred by health professionals and randomly assigned to control or intervention. At six months psychological process measures were collected by questionnaire. At 12 months physical activity was assessed by 7 Day PAR telephone interview. Regressions tested intervention effects on psychosocial variables, physical activity before and after adjusting for mediators and socio demographic patterning. Significant intervention effects were found for autonomous motivation and social support for exercise at 6 months. No intervention effect was observed for self-efficacy. The data are consistent with a hypothesis of partial mediation of the intervention effect by autonomous motivation. Analysis of moderators showed significant improvements in relative autonomy in all subgroups. The greatest improvements in autonomous motivation were observed among patients who were least active at baseline. The present study offered key insights into psychosocial processes of change in an exercise referral scheme, with effects on physical activity mediated by autonomous motivation. Findings support the use of self-determination theory as a framework for ERS. Further research is required to explain socio-demographic patterning in responses to ERS, with changes in motivation occurring among all sub-groups of participants, though not always leading to higher adherence or behavioural change. This highlights the importance of socio-ecological approaches to developing and evaluating behaviour change interventions, which consider factors beyond the individual, including conditions in which improved motivation does or does not produce behavioural change. ISRCTN47680448.

Identification of Indirect Effects in a Cognitive Patient Education (COPE) Intervention for Low Back Pain.

PubMed

Mansell, Gemma; Storheim, Kjersti; Løchting, Ida; Werner, Erik L; Grotle, Margreth

2017-12-01

Many interventions for the treatment of low back pain exist, but the mechanisms through which such treatments work are not always clear. This situation is especially true for biopsychosocial interventions that incorporate several different components and methods of delivery. The study objective was to examine the indirect effects of the Cognitive Patient Education (COPE) intervention via illness perceptions, back pain myths, and pain catastrophizing on disability outcome. This study was a secondary analysis of the COPE randomized controlled trial. Mediation analysis techniques were employed to examine the indirect effects of the COPE intervention via residualized change (baseline - posttreatment) in the 3 variables hypothesized to be targeted by the COPE intervention on posttreatment disability outcome. Pain intensity at baseline, pain duration, clinician type, and a treatment-mediator interaction term were controlled for in the analysis. Preliminary analyses confirmed that changes in pain catastrophizing and illness perceptions (not back pain myths) were related to both allocation to the intervention arm and posttreatment disability score. The treatment exerted statistically significant indirect effects via changes in illness perceptions and pain catastrophizing on posttreatment disability score (illness perceptions standardized indirect effect = 0.09 [95% CI = 0.03 to 0.16]; pain catastrophizing standardized indirect effect = 0.05 [95% CI = 0.01 to 0.12]). However, the inclusion of an interaction term led to the indirect effects being significantly reduced, with the effects no longer being statistically significant. This study presents a secondary analysis of variables not identified a priori as being potentially important treatment targets; other, unmeasured factors could also be important in explaining treatment effects. The finding that small indirect effects of the COPE intervention via changes in illness perceptions and pain catastrophizing on posttreatment disability could be estimated indicates that these variables may be viable treatment targets for biopsychosocial interventions; however, this finding must be viewed in light of the adjusted analyses, which showed that the indirect effects were significantly reduced through the inclusion of a treatment-mediator interaction term. © Crown copyright 2015

Self-Efficacy and Social Support as Mediators Between Culturally Specific Dance and Lifestyle Physical Activity

PubMed Central

Murrock, Carolyn J.; Madigan, Elizabeth

2013-01-01

Culturally specific dance has the potential to generate health benefits but is seldom used even among studies advocating culturally specific interventions. This study examined the components of self-efficacy and social support as mediators between culturally specific dance and lifestyle physical activity in African American women (N = 126). An experimental design compared intervention and control groups for mediating effects of self-efficacy and social support on lifestyle physical activity. Findings indicated that only outcome expectations and social support from friends mediated effects. Culturally specific dance is a first step in encouraging African American women to become more physically active and improve health outcomes. The implications are that culturally specific dance programs can improve health outcomes by including members of underserved populations. PMID:18763475

Self-efficacy and social support as mediators between culturally specific dance and lifestyle physical activity.

PubMed

Murrock, Carolyn J; Madigan, Elizabeth

2008-01-01

Culturally specific dance has the potential to generate health benefits but is seldom used even among studies advocating culturally specific interventions. This study examined the components of self-efficacy and social support as mediators between culturally specific dance and lifestyle physical activity in African American women (N = 126). An experimental design compared intervention and control groups for mediating effects of self-efficacy and social support on lifestyle physical activity. Findings indicated that only outcome expectations and social support from friends mediated effects. Culturally specific dance is a first step in encouraging African American women to become more physically active and improve health outcomes. The implications are that culturally specific dance programs can improve health outcomes by including members of underserved populations.

Improved confidence in performing nutrition and physical activity behaviours mediates behavioural change in young adults: Mediation results of a randomised controlled mHealth intervention.

PubMed

Partridge, Stephanie R; McGeechan, Kevin; Bauman, Adrian; Phongsavan, Philayrath; Allman-Farinelli, Margaret

2017-01-01

The burden of weight gain disproportionally affects young adults. Understanding the underlying behavioural mechanisms of change in mHealth nutrition and physical activity interventions designed for young adults is important for enhancing and translating effective interventions. First, we hypothesised that knowledge, self-efficacy and stage-of-change for nutrition and physical activity behaviours would improve, and second, that self-efficacy changes in nutrition and physical activity behaviours mediate the behaviour changes observed in an mHealth RCT for prevention of weight gain. Young adults, aged 18-35 years at risk of weight gain (n = 250) were randomly assigned to an mHealth-program, TXT2BFiT, consisting of a three-month intensive phase and six-month maintenance phase or to a control group. Self-reported online surveys at baseline, three- and nine-months assessed nutrition and physical activity behaviours, knowledge, self-efficacy and stage-of-change. The mediating effect of self-efficacy was assessed in multiple PROCESS macro-models for three- and nine-month nutrition and physical activity behaviour change. Young adults randomised to the intervention increased and maintained knowledge of fruit requirements (P = 0.029) compared to controls. Intervention participants' fruit and takeaway behaviours improved to meet recommendations at nine months, with a greater proportion progressing to action or maintenance stage-of-change (P < 0.001 and P = 0.012 respectively) compared to controls. Intervention participants' vegetable and physical activity behaviours did not meet recommendations, thereby halting progress to action or maintenance stage-of-change. Indirect effects of improved nutrition and physical activity behaviours at three- and nine-months in the intervention group were explained by changes in self-efficacy, accounting for 8%-37% of the total effect. This provides insights into how the mHealth intervention achieved part of its effects and the importance of improving self-efficacy to facilitate improved eating and physical activity behaviours in young adults. Copyright © 2016 Elsevier Ltd. All rights reserved.

Enhancing youth outcomes following parental divorce: a longitudinal study of the effects of the new beginnings program on educational and occupational goals.

PubMed

Sigal, Amanda B; Wolchik, Sharlene A; Tein, Jenn-Yun; Sandler, Irwin N

2012-01-01

This study examined whether the New Beginnings Program for divorced families led to improvements in youth's educational goals and job aspirations 6 years following participation and tested whether several parenting and youth variables mediated the program effects. Participants were 240 youth aged 9 to 12 years at the initial assessment, and data were part of a randomized, experimental trial of a parenting skills preventive intervention targeting children's postdivorce adjustment. The results revealed positive effects of the program on youth's educational goals and job aspirations 6 years after participation for those who were at high risk for developing later problems at program entry. Further, intervention-induced changes in mother-child relationship quality and youth externalizing problems, internalizing problems, self-esteem, and academic competence at the 6-year follow-up mediated the effects of the program on the educational expectations of high-risk youth. Intervention-induced changes in youth externalizing problems and academic competence at the 6-year follow-up mediated the effects of the program on the job aspirations of high-risk youth.

Use of tailored loading-dose clopidogrel in patients undergoing selected percutaneous coronary intervention based on adenosine diphosphate-mediated platelet aggregation.

PubMed

Meng, Kang; Lü, Shu-Zheng; Zhu, Hua-Gang; Chen, Xin; Ge, Chang-Jiang; Song, Xian-Tao

2010-12-01

Adenosine phosphate-mediated platelet aggregation is a prognostic factor for major adverse cardiac events in patients who have undergone selective percutaneous coronary interventions. This study aimed to assess whether an adjusted loading dose of clopidogrel could more effectively inhibit platelet aggregation in patients undergoing selected percutaneous coronary intervention. A total of 205 patients undergoing selected percutaneous coronary intervention were enrolled in this multicenter, prospective, randomized study. Patients receiving domestic clopidogrel (n = 104) served as the Talcom (Taijia) group; others (n = 101) received Plavix, the Plavix group. Patients received up to 3 additional 300-mg loading doses of clopidogrel to decrease the adenosine phosphate-mediated platelet aggregation index by more than 50% (the primary endpoint) compared with the baseline. The secondary endpoint was major adverse cardiovascular events at 12 months. Compared with the rational loading dosage, the tailored loading dosage better inhibited platelet aggregation based on a > 50% decrease in adenosine phosphate-mediated platelet aggregation (rational loading dosage vs. tailored loading dosage, 48% vs. 73%, P = 0.028). There was no significant difference in the eligible index between the Talcom and Plavix groups (47% vs. 49% at 300 mg; 62% vs. 59% at 600 mg; 74% vs. 72% at 900 mg; P > 0.05) based on a standard adenosine diphosphate-mediated platelet aggregation decrease of > 50%. After 12 months of follow-up, there were no significant differences in major adverse cardiac events (2.5% vs. 2.9%, P = 5.43). No acute or subacute stent thrombosis events occurred. An adjusted loading dose of clopidogrel could have significant effects on antiplatelet aggregation compared with a rational dose, decreasing 1-year major adverse cardiac events in patients undergoing percutaneous coronary interventions based on adenosine phosphate-mediated platelet aggregation with no increase in bleeding.

The Therapeutic Mechanisms of Check, Connect, and Expect

ERIC Educational Resources Information Center

Stage, Scott A.; Galanti, Sally B.

2017-01-01

Given the high prevalence of Tier 2 behavioral intervention use and calls to examine mediation and moderation effects on treatment for children, this study tested the mediation effect of the daily progress report and moderation effects of coach-student, teacher-student, and student-teacher relationships and their interactions for 95 elementary…

Long-term effects of a universal family intervention: mediation through parent-adolescent conflict.

PubMed

Jensen, Michaeline R; Wong, Jessie J; Gonzales, Nancy A; Dumka, Larry E; Millsap, Roger; Coxe, Stefany

2014-01-01

This randomized trial of a family-focused preventive intervention for Mexican American middle schoolers examined internalizing, externalizing, and substance use outcomes in late adolescence, 5 years after completing the intervention. Parent-adolescent conflict was tested as a mediator of these effects. The role of parent and adolescent acculturation in these pathways was also examined. There were 494 seventh-grade adolescents and their primary female caregivers randomized to receive either a 9-week multicomponent intervention or a brief workshop control group. Assessments were conducted at pretest, 2-year follow-up (9th grade), and 5-year follow-up (when most participants were in the 12th grade). The Bridges program significantly reduced mother-adolescent conflict measured in the 9th grade, with conflict mediating program effects on internalizing and externalizing symptoms, adolescent substance use, and diagnosed internalizing disorder in late adolescence. Mother and child acculturation were both significantly predictive of late adolescence outcomes. Contrary to hypotheses, neither mother nor child acculturation emerged as a significant predictor of mother-adolescent conflict, and the interaction of mother and adolescent acculturation was similarly not related to mother-adolescent conflict. Intervention effects were largely consistent across different levels of acculturation. These findings provide support for the efficacy of family-focused intervention during early adolescence, both in reducing mental health problems and substance use in the long term and in impacting parent-adolescent conflict processes that appear to play an important role in the development of later adjustment problems.

Does Perceived Social Support Mediate or Moderate the Relationship between Victimisation and Suicidal Ideation among Chinese Adolescents?

ERIC Educational Resources Information Center

Liu, Xiaoqun; Chen, Gui; Hu, Peng; Guo, Guipin; Xiao, Shuiyuan

2017-01-01

Bullying is a common problem in school. Engagement in bullying has been known to have many adverse effects, even including suicide. Examining which factor will moderate or mediate the pathway from victimisation to suicidal ideation is needed to develop effective intervention initiatives. This study aimed to examine the mediator and moderator roles…

Theories underlying health promotion interventions among cancer survivors.

PubMed

Pinto, Bernardine M; Floyd, Andrea

2008-08-01

To review the theories that have been the basis for randomized controlled trials (RCTs) promoting health behavior change among adults diagnosed and treated for cancer. Electronic databases and recent review papers. Several theories have been used in intervention development: Transtheoretical Model, Motivational Interviewing, Social Learning and Social Cognitive Theory, Theory of Planned Behavior, and Cognitive Behavioral Theory. There is support for the efficacy of some of these interventions. However, there has been limited assessment of theory-based constructs and examination of the mediational role of theoretical constructs in intervention efficacy. There is a need to apply theory in the development of interventions to assess the effects of the intervention on the constructs and to conduct mediational tests of these constructs.

Who Benefits and How Does It Work? Moderators and Mediators of Outcome in an Effectiveness Trial of a Parenting Intervention

ERIC Educational Resources Information Center

Gardner, Frances; Hutchings, Judy; Bywater, Tracey; Whitaker, Chris

2010-01-01

We examined mediators and moderators of change in conduct problems, in a multiagency randomized trial of the Incredible Years parenting program. Preschoolers (n = 153) at risk for conduct problems were randomly assigned to intervention (n = 104) and wait-list (n = 49) groups. Boys and younger children, and those with more depressed mothers, tended…

Mediators of weight loss in the 'Healthy Dads, Healthy Kids' pilot study for overweight fathers

PubMed Central

2012-01-01

Background A poor understanding of the specific lifestyle behaviors that result in weight loss has hindered the development of effective interventions. The aim of this paper was to identify potential behavioral mediators of weight loss in the Healthy Dads, Healthy Kids (HDHK) intervention for overweight fathers. Findings The three-month intervention was evaluated in a randomized controlled trial and conducted in Newcastle, New South Wales, Australia. Baseline, three month (immediate post-intervention) and six month assessments were conducted. Recruitment and follow-up occurred between October 2008 and May 2009. The study sample included 53 overweight/obese men [mean ( SD) age=40.6( 97.1) years; body mass index (BMI)=33.2 (3.9) kgm-2] and their primary school-aged children [n=71, 54% boys; age=8.2 (2.0) years] who were randomized to HDHK program or a wait-list control group. Physical activity (PA) was assessed using pedometers and dietary behaviors were measured using a validated food frequency questionnaire. The intervention resulted in significant weight loss (5.131.27kg, P<0.0001) and increased PA among fathers (2769750 steps/day, P<0.001) and their children (1486521 steps/day, P<0.01). Fathers PA mediated weight loss in the intervention (AB=2.31, 95% CI=4.63 to 0.67) and was responsible for 47% of the intervention effect. Changes in dietary behaviors were not statistically significant. Conclusions PA was an important mediator of weight loss in the HDHK intervention. Encouraging overweight fathers to be more active with their children appears to be a promising strategy for obesity treatment in men. PMID:22512861

Impact of Patient-centered eHealth Applications on Patient Outcomes: A Review on the Mediating Influence of Human Factor Issues.

PubMed

Wildenbos, G A; Peute, L W; Jaspers, M W M

2016-11-10

To examine the evidence of the impact of patient- centered eHealth applications on patient care and to analyze if and how reported human factor issues mediated the outcomes. We searched PubMed (2014-2015) for studies evaluating the impact of patient-centered eHealth applications on patient care (behavior change, self-efficacy, and patient health-related outcomes). The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) model was used as a guidance framework to identify the reported human factors possibly impacting the effectiveness of an eHealth intervention. Of the 348 potentially relevant papers, 10 papers were included for data analysis. None of the 10 papers reported a negative impact of the eHealth intervention. Seven papers involved a randomized controlled trial (RCT) study. Six of these RCTs reported a positive impact of the eHealth intervention on patient care. All 10 papers reported on human factor issues possibly mediating effects of patient-centered eHealth. Human factors involved patient characteristics, perceived social support, and (type of) interaction between patient and provider. While the amount of patient-centered eHealth interventions increases, many questions remain as to whether and to what extent human factors mediate their use and impact. Future research should adopt a formal theory-driven approach towards human factors when investigating those factors' influence on the effectiveness of these interventions. Insights could then be used to better tailor the content and design of eHealth solutions according to patient user profiles, so as to enhance eHealth interventions impact on patient behavior, self-efficacy, and health-related outcomes.

Toward the Design of Evidence-Based Mental Health Information Systems for People With Depression: A Systematic Literature Review and Meta-Analysis.

PubMed

Wahle, Fabian; Bollhalder, Lea; Kowatsch, Tobias; Fleisch, Elgar

2017-05-31

Existing research postulates a variety of components that show an impact on utilization of technology-mediated mental health information systems (MHIS) and treatment outcome. Although researchers assessed the effect of isolated design elements on the results of Web-based interventions and the associations between symptom reduction and use of components across computer and mobile phone platforms, there remains uncertainty with regard to which components of technology-mediated interventions for mental health exert the greatest therapeutic gain. Until now, no studies have presented results on the therapeutic benefit associated with specific service components of technology-mediated MHIS for depression. This systematic review aims at identifying components of technology-mediated MHIS for patients with depression. Consequently, all randomized controlled trials comparing technology-mediated treatments for depression to either waiting-list control, treatment as usual, or any other form of treatment for depression were reviewed. Updating prior reviews, this study aims to (1) assess the effectiveness of technology-supported interventions for the treatment of depression and (2) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be standard of care. Systematic searches in MEDLINE, PsycINFO, and the Cochrane Library were conducted. Effect sizes for each comparison between a technology-enabled intervention and a control condition were computed using the standard mean difference (SMD). Chi-square tests were used to test for heterogeneity. Using subgroup analysis, potential sources of heterogeneity were analyzed. Publication bias was examined using visual inspection of funnel plots and Begg's test. Qualitative data analysis was also used. In an explorative approach, a list of relevant components was extracted from the body of literature by consensus between two researchers. Of 6387 studies initially identified, 45 met all inclusion criteria. Programs analyzed showed a significant trend toward reduced depressive symptoms (SMD -0.58, 95% CI -0.71 to -0.45, P<.001). Heterogeneity was large (I2≥76). A total of 15 components were identified. Technology-mediated MHIS for the treatment of depression has a consistent positive overall effect compared to controls. A total of 15 components have been identified. Further studies are needed to quantify the impact of individual components on treatment effects and to identify further components that are relevant for the design of future technology-mediated interventions for the treatment of depression and other mental disorders. ©Fabian Wahle, Lea Bollhalder, Tobias Kowatsch, Elgar Fleisch. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 31.05.2017.

Toward the Design of Evidence-Based Mental Health Information Systems for People With Depression: A Systematic Literature Review and Meta-Analysis

PubMed Central

Fleisch, Elgar

2017-01-01

Background Existing research postulates a variety of components that show an impact on utilization of technology-mediated mental health information systems (MHIS) and treatment outcome. Although researchers assessed the effect of isolated design elements on the results of Web-based interventions and the associations between symptom reduction and use of components across computer and mobile phone platforms, there remains uncertainty with regard to which components of technology-mediated interventions for mental health exert the greatest therapeutic gain. Until now, no studies have presented results on the therapeutic benefit associated with specific service components of technology-mediated MHIS for depression. Objective This systematic review aims at identifying components of technology-mediated MHIS for patients with depression. Consequently, all randomized controlled trials comparing technology-mediated treatments for depression to either waiting-list control, treatment as usual, or any other form of treatment for depression were reviewed. Updating prior reviews, this study aims to (1) assess the effectiveness of technology-supported interventions for the treatment of depression and (2) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be standard of care. Methods Systematic searches in MEDLINE, PsycINFO, and the Cochrane Library were conducted. Effect sizes for each comparison between a technology-enabled intervention and a control condition were computed using the standard mean difference (SMD). Chi-square tests were used to test for heterogeneity. Using subgroup analysis, potential sources of heterogeneity were analyzed. Publication bias was examined using visual inspection of funnel plots and Begg’s test. Qualitative data analysis was also used. In an explorative approach, a list of relevant components was extracted from the body of literature by consensus between two researchers. Results Of 6387 studies initially identified, 45 met all inclusion criteria. Programs analyzed showed a significant trend toward reduced depressive symptoms (SMD –0.58, 95% CI –0.71 to –0.45, P<.001). Heterogeneity was large (I2≥76). A total of 15 components were identified. Conclusions Technology-mediated MHIS for the treatment of depression has a consistent positive overall effect compared to controls. A total of 15 components have been identified. Further studies are needed to quantify the impact of individual components on treatment effects and to identify further components that are relevant for the design of future technology-mediated interventions for the treatment of depression and other mental disorders. PMID:28566267

A Meta-Intervention to Increase Completion of an HIV-Prevention Intervention: Results from a Randomized Controlled Trial in the State of Florida

PubMed Central

Albarracín, Dolores; Wilson, Kristina; Durantini, Marta R.; Sunderrajan, Aashna; Livingood, William

2016-01-01

Objective A randomized control trial with 722 eligible clients from a health department in the State of Florida was conducted to identify a simple, effective meta-intervention to increase completion of an HIV-prevention counseling program. Method The overall design involved two factors representing an empowering and instrumental message, as well as an additional factor indicating presence or absence of expectations about the counseling. Completion of the three-session counseling was determined by recording attendance. Results A logistic regression analysis with the three factors of empowering message, instrumental message, and presence of mediator measures, as well as all interactions, revealed significant interactions between instrumental and empowering messages and between instrumental messages and presence of mediator measures. Results indicated that (a) the instrumental message alone produced most completion than any other message, and (b) when mediators were not measured, including the instrumental message led to greater completion. Conclusions The overall gains in completion as a result of the instrumental message were 16%, implying success in the intended facilitation of counseling completion. The measures of mediators did not detect any experimental effects, probably because the effects were happening without much conscious awareness. PMID:27786499

Cognitive mediators of treatment outcomes in pediatric functional abdominal pain.

PubMed

Levy, Rona L; Langer, Shelby L; Romano, Joan M; Labus, Jennifer; Walker, Lynn S; Murphy, Tasha B; Tilburg, Miranda A L van; Feld, Lauren D; Christie, Dennis L; Whitehead, William E

2014-12-01

Cognitive-behavioral (CB) interventions improve outcomes for many pediatric health conditions, but little is known about which mechanisms mediate these outcomes. The goal of this study was to identify whether changes in targeted process variables from baseline to 1 week posttreatment mediate improvement in outcomes in a randomized controlled trial of a brief CB intervention for idiopathic childhood abdominal pain. Two hundred children with persistent functional abdominal pain and their parents were randomly assigned to 1 of 2 conditions: a 3-session social learning and CB treatment (N=100), or a 3-session educational intervention controlling for time and attention (N=100). Outcomes were assessed at 3-, 6-, and 12-month follow-ups. The intervention focused on altering parental responses to pain and on increasing adaptive cognitions and coping strategies related to pain in both parents and children. Multiple mediation analyses were applied to examine the extent to which the effects of the social learning and CB treatment condition on child gastrointestinal (GI) symptom severity and pain as reported by children and their parents were mediated by changes in targeted cognitive process variables and parents' solicitous responses to their child's pain symptoms. Reductions in parents' perceived threat regarding their child's pain mediated reductions in both parent-reported and child-reported GI symptom severity and pain. Reductions in children's catastrophic cognitions mediated reductions in child-reported GI symptom severity but no other outcomes. Reductions in parental solicitousness did not mediate outcomes. Results suggest that reductions in reports of children's pain and GI symptoms after a social learning and CB intervention were mediated at least in part by decreasing maladaptive parent and child cognitions.

Cravings as a mediator and moderator of drinking outcomes in the COMBINE Study

PubMed Central

Lendle, Samuel; van der Laan, Mark; Kaskutas, Lee Ann; Ahern, Jennifer

2014-01-01

Aims Investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) Study examined whether combining medications with a behavioral intervention would improve outcomes over monotherapies. Unexpectedly, the combination did not offer any advantage over either treatment alone. This study aimed to explain the lack of incremental benefit offered by the combination over either monotherapy by assessing the role of cravings as a treatment mediator and moderator. Design Secondary mediation and moderation analyses of COMBINE study data. Setting Eleven United States academic sites. Participants 863 patients randomized to one of four treatment groups: naltrexone (100mg/d; n=209), the Combined Behavioral Intervention (CBI, n=236), naltrexone and CBI combined (n=213), and placebo naltrexone (n=205). Measurements Percent Days Abstinent (PDA) measured between 13 and 16 weeks post-baseline. Cravings, the potential mediator/moderator, was measured at baseline, week 4 and week 12 using the Obsessive-Compulsive Drinking Scale. Findings Compared to placebo, naltrexone, CBI, and the combination all increased PDA by an additional 6–10 percentage points for those with high cravings (p<0.05 for all three treatment groups). None had significant effects on PDA for those with low cravings. The effects of all three treatments were at least partially mediated by cravings; craving reduction explained 48–53% of treatment effects (p<0.05 for all three treatment groups). Furthermore, naltrexone appeared to reduce cravings at 4 weeks, while CBI did not reduce cravings until 12 weeks. Conclusions Naltrexone and the behavioral intervention both improved abstinence by reducing cravings and were no longer effective once cravings were low. Furthermore, naltrexone reduced cravings by 4 weeks, while the behavioral intervention took longer to affect cravings. The COMBINE naltrexone + CBI combination may not have been more beneficial than either monotherapy because craving reduction was a common mechanism of both, and neither worked when cravings were low. PMID:23668624

Mediators and moderators in early intervention research

PubMed Central

Breitborde, Nicholas J. K.; Srihari, Vinod H.; Pollard, Jessica M.; Addington, Donald N.; Woods, Scott W.

2015-01-01

Aim The goal of this paper is to provide clarification with regard to the nature of mediator and moderator variables and the statistical methods used to test for the existence of these variables. Particular attention will be devoted to discussing the ways in which the identification of mediator and moderator variables may help to advance the field of early intervention in psychiatry. Methods We completed a literature review of the methodological strategies used to test for mediator and moderator variables. Results Although several tests for mediator variables are currently available, recent evaluations suggest that tests which directly evaluate the indirect effect are superior. With regard to moderator variables, two approaches (‘pick-a-point’ and regions of significance) are available, and we provide guidelines with regard to how researchers can determine which approach may be most appropriate to use for their specific study. Finally, we discuss how to evaluate the clinical importance of mediator and moderator relationships as well as the methodology to calculate statistical power for tests of mediation and moderation. Conclusion Further exploration of mediator and moderator variables may provide valuable information with regard to interventions provided early in the course of a psychiatric illness. PMID:20536970

Life Satisfaction Moderates the Effectiveness of a Play-Based Parenting Intervention in Low-Income Mothers and Toddlers

PubMed Central

Brock, Rebecca L.; Kochanska, Grazyna; O'Hara, Michael W.; Grekin, Rebecca S.

2015-01-01

This multi-method multi-trait study examined moderators and mediators of change in the context of a parenting intervention. Low-income, diverse mothers of toddlers (average age 30 months; N=186, 90 girls) participated in a play-based intervention (Child-Oriented Play versus Play-as-Usual) aimed at increasing children's committed compliance and reducing opposition toward their mothers, observed in prohibition contexts, and at reducing mother-rated children's behavior problems 6 months after the intervention. Mothers’ subjective sense of life satisfaction and fulfillment during the intervention and objective ratings of psychosocial functioning by clinicians, obtained in a clinical interview were posed as moderators, and mothers’ observed power-assertive discipline immediately following the intervention was modeled as a mediator of its impact. We tested moderated mediation using structural equation modeling, with all baseline scores (prior to randomization) controlled. Mothers’ subjective sense of life satisfaction moderated the impact of the intervention, but clinicians’ ratings did not. For mothers highly satisfied with their lives, participating in Child-Oriented Play group, compared to Play-as-Usual group, led to a reduction in power-assertive discipline which, in turn, led to children's increased compliance and decreased opposition and externalizing problems. There were no effects for mothers who reported low life satisfaction. The study elucidates the causal sequence set in motion by the intervention, demonstrates the moderating role of mothers’ subjective life satisfaction, highlights limitations of clinicians’ ratings, and informs future prevention and intervention efforts to promote adaptive parenting. PMID:25860810

Life Satisfaction Moderates the Effectiveness of a Play-Based Parenting Intervention in Low-Income Mothers and Toddlers.

PubMed

Brock, Rebecca L; Kochanska, Grazyna; O'Hara, Michael W; Grekin, Rebecca S

2015-10-01

This multi-method multi-trait study examined moderators and mediators of change in the context of a parenting intervention. Low-income, diverse mothers of toddlers (average age 30 months; N = 186, 90 girls) participated in a play-based intervention (Child-Oriented Play versus Play-as-Usual) aimed at increasing children's committed compliance and reducing opposition toward their mothers, observed in prohibition contexts, and at reducing mother-rated children's behavior problems 6 months after the intervention. Mothers' subjective sense of life satisfaction and fulfillment during the intervention and objective ratings of psychosocial functioning by clinicians, obtained in a clinical interview were posed as moderators, and mothers' observed power-assertive discipline immediately following the intervention was modeled as a mediator of its impact. We tested moderated mediation using structural equation modeling, with all baseline scores (prior to randomization) controlled. Mothers' subjective sense of life satisfaction moderated the impact of the intervention, but clinicians' ratings did not. For mothers highly satisfied with their lives, participating in Child-Oriented Play group, compared to Play-as-Usual group, led to a reduction in power-assertive discipline which, in turn, led to children's increased compliance and decreased opposition and externalizing problems. There were no effects for mothers who reported low life satisfaction. The study elucidates the causal sequence set in motion by the intervention, demonstrates the moderating role of mothers' subjective life satisfaction, highlights limitations of clinicians' ratings, and informs future prevention and intervention efforts to promote adaptive parenting.

Mediation and the "Chilling" Effect of Med-Arb in a Simulated Labor-Management Dispute.

ERIC Educational Resources Information Center

Carnevale, Peter J. D.; Leatherwood, Marya L.

Mediation and mediation-arbitration (med-arb) are two forms of third-party conflict intervention that can affect integrative agreements in labor-management negotiation. In an attempt to evaluate the relative value of each of these two methods, 160 volunteers, almost all business students, were randomly placed into a mediation triad, a med-arb…

A Component Analysis of Positive Behaviour Support Plans

ERIC Educational Resources Information Center

McClean, Brian; Grey, Ian

2012-01-01

Background: Positive behaviour support (PBS) emphasises multi-component interventions by natural intervention agents to help people overcome challenging behaviours. This paper investigates which components are most effective and which factors might mediate effectiveness. Method: Sixty-one staff working with individuals with intellectual disability…

Predictors of self-perceived cultural competence among children's mental health providers.

PubMed

Keyser, Victoria; Gamst, Glenn; Meyers, Lawrence S; Der-Karabetian, Aghop; Morrow, Gloria

2014-07-01

Based on empirical research and predictions from the Multicultural Assessment-Intervention Process model, the racial attitudes, ethnic identity, and acculturation of a national sample of 371 child mental health service providers were assessed as possible predictors of practitioner self-perceived cultural competence. It was hypothesized that ethnic identity and racial attitudes would each directly affect self-perceived cultural competence and that acculturation and racial attitudes would mediate the effect of ethnic identity. The results indicated that ethnic identity exerted a direct effect on self-perceived cultural competence and that this effect was partially mediated by respondents' racial attitudes; however, acculturation had no significant role as a mediator. The results are discussed within the context of the Multicultural Assessment-Intervention Process model and implications for providing culturally competent services to children.

Prototype Willingness Model Drinking Cognitions Mediate Personalized Normative Feedback Efficacy.

PubMed

Lewis, Melissa A; Litt, Dana M; Tomkins, Mary; Neighbors, Clayton

2017-05-01

Personalized normative feedback (PNF) interventions have been shown to be efficacious at reducing college student drinking. Because descriptive norms have been shown to mediate PNF efficacy, the current study focused on examining additional prototype willingness model social reaction cognitions, namely, prototypes and willingness, as mediators of intervention efficacy. We expected the PNF interventions to be associated with increased prototype favorability of students who do not drink, which would in turn be associated with decreased willingness to drink and subsequently, less drinking. The current study included 622 college students (53.2% women; 62% Caucasian) who reported one or more heavy drinking episodes in the past month and completed baseline and three-month follow-up assessments. As posited by the framework of the prototype willingness model, sequential mediation analyses were conducted to evaluate increases in abstainer prototype favorability on willingness on drinking, and subsequently willingness to drink on drinking behavior. Mediation results revealed significant indirect effects of PNF on three-month drinking through three-month prototypes and willingness, indicating that the social reaction pathway of the prototype willingness model was supported. Findings have important implications for PNF interventions aiming to reduce high-risk drinking among college students. Study findings suggest that we should consider looking at additional socially-based mediators of PNF efficacy in addition to perceived descriptive norms.

Prototype Willingness Model Drinking Cognitions Mediate Personalized Normative Feedback Efficacy

PubMed Central

Litt, Dana M.; Tomkins, Mary; Neighbors, Clayton

2017-01-01

Personalized normative feedback (PNF) interventions have been shown to be efficacious at reducing college student drinking. Because descriptive norms have been shown to mediate PNF efficacy, the current study focused on examining additional prototype willingness model social reaction cognitions, namely, prototypes and willingness, as mediators of intervention efficacy. We expected the PNF interventions to be associated with increased prototype favorability of students who do not drink, which would in turn be associated with decreased willingness to drink and subsequently, less drinking. The current study included 622 college students (53.2% women; 62% Caucasian) who reported one or more heavy drinking episodes in the past month and completed baseline and three-month follow-up assessments. As posited by the framework of the prototype willingness model, sequential mediation analyses were conducted to evaluate increases in abstainer prototype favorability on willingness on drinking, and subsequently willingness to drink on drinking behavior. Mediation results revealed significant indirect effects of PNF on three-month drinking through three-month prototypes and willingness, indicating that the social reaction pathway of the prototype willingness model was supported. Findings have important implications for PNF interventions aiming to reduce high-risk drinking among college students. Study findings suggest that we should consider looking at additional socially-based mediators of PNF efficacy in addition to perceived descriptive norms. PMID:27995431

The Role of Theory in Increasing Adherence to Prescribed Practice

PubMed Central

Richardson, Julie; Wishart, Laurie; Hanna, Steven

2009-01-01

ABSTRACT Purpose: The purpose of this article is to apply theoretical frameworks to adherence behaviour and to guide the development of an intervention to increase adherence to prescribed home programmes. Summary of Key Points: Delivering an effective intervention requires establishing one that is evidence based and of adequate dosage. Two-thirds of patients who receive home exercise prescriptions do not adhere to their home programme, which may contribute to their physiotherapy's being ineffective. The mediating concepts of self-efficacy (SE) and outcome expectations (OE) are common to the five relevant theories used to explain adherence to exercise: the health belief model, protection motivation theory, theory of reasoned action, theory of planned behaviour, and social cognitive theory. Conclusion/Recommendations: Few intervention studies with any theoretical underpinning have examined adherence to exercise. Even fewer have been designed to affect and measure change in the theoretical mediators of SE and OE in patient populations. Physiotherapists must consider increasing adherence as a component of effective physiotherapy. Ongoing research is needed to increase our understanding of adherence to prescribed home programmes and to design interventions to affect theoretical mediators for increasing adherence. PMID:20190989

Robot-mediated Imitation Skill Training for Children with Autism

PubMed Central

Zheng, Zhi; Young, Eric M.; Swanson, Amy R.; Weitlauf, Amy S.; Warren, Zachary E.; Sarkar, Nilanjan

2016-01-01

Autism spectrum disorder (ASD) impacts 1 in 68 children in the US, with tremendous individual and societal costs. Technology-aided intervention, more specifically robotic intervention, has gained momentum in recent years due to the inherent affinity of many children with ASD towards technology. In this paper we present a novel robot-mediated intervention system for imitation skill learning, which is considered a core deficit area for children with ASD. The Robot-mediated Imitation Skill Training Architecture (RISTA) is designed in such a manner that it can operate either completely autonomously or in coordination with a human therapist depending on the intervention need. Experimental results are presented from small user studies validating system functionality, assessing user tolerance, and documenting subject performance. Preliminary results show that this novel robotic system draws more attention from the children with ASD and teaches gestures more effectively as compared to a human therapist. While no broad generalized conclusions can be made about the effectiveness of RISTA based on our small user studies, initial results are encouraging and justify further exploration in the future. PMID:26353376

Systematic review of the effects of mirror therapy in children with cerebral palsy

PubMed Central

Park, Eom-ji; Baek, Soon-hyung; Park, Soohee

2016-01-01

[Purpose] To provide data for systematic intervention plans in occupational therapy practice by objectivity showing the value of mirror therapy interventions in children with cerebral palsy. [Subjects and Methods] Medline and EMBASE databases were searched for the key words “cerebral palsy,” “mirror movement,” “mirror therapy,” and “mirror visual feedback.” Nine studies that met the inclusion and exclusion criteria were identified. The qualitatively determined level of evidence, period of research, comparisons and interventions, tools used to measure the intervention, and the effects were analyzed. [Results] According to the results analyzed, one (1/9, 11.1%) study showed the same result as the control group, one (1/9, 11.1%) showed a negative effect, and seven (7/9, 77.8%) showed positive effects of mirror-mediated therapy, with meaningful improvement in function, such as hand strength, movement speed, muscle activity, and accuracy of hand matching. [Conclusion] Through this study, the value of mirror-mediated therapeutic interventions in occupational therapy practice targeting cerebral palsy was confirmed. It is expected that this result will be useful in establishing mirror therapy as an interventional program. PMID:27942154

Meditation awareness training for the treatment of fibromyalgia syndrome: A randomized controlled trial.

PubMed

Van Gordon, William; Shonin, Edo; Dunn, Thomas J; Garcia-Campayo, Javier; Griffiths, Mark D

2017-02-01

The purpose of this study was to conduct the first randomized controlled trial (RCT) to evaluate the effectiveness of a second-generation mindfulness-based intervention (SG-MBI) for treating fibromyalgia syndrome (FMS). Compared to first-generation mindfulness-based interventions, SG-MBIs are more acknowledging of the spiritual aspect of mindfulness. A RCT employing intent-to-treat analysis. Adults with FMS received an 8-week SG-MBI known as meditation awareness training (MAT; n = 74) or an active control intervention known as cognitive behaviour theory for groups (n = 74). Assessments were performed at pre-, post-, and 6-month follow-up phases. Meditation awareness training participants demonstrated significant and sustained improvements over control group participants in FMS symptomatology, pain perception, sleep quality, psychological distress, non-attachment (to self, symptoms, and environment), and civic engagement. A mediation analysis found that (1) civic engagement partially mediated treatment effects for all outcome variables, (2) non-attachment partially mediated treatment effects for psychological distress and sleep quality, and (3) non-attachment almost fully mediated treatment effects for FMS symptomatology and pain perception. Average daily time spent in meditation was found to be a significant predictor of changes in all outcome variables. Meditation awareness training may be a suitable treatment for adults with FMS and appears to ameliorate FMS symptomatology and pain perception by reducing attachment to self. Statement of contribution What is already known on this subject? Designing interventions to treat fibromyalgia syndrome (FMS) continues to be a challenge. There is growing interest into the applications of mindfulness-based interventions for treating FMS. Second-generation mindfulness-based interventions (SG-MBIs) are a key new direction in mindfulness research. What does this study add? Meditation awareness training - an SG-MBI - resulted in significant reductions in FMS symptomatology. SG-MBIs recognize the spiritual aspect of mindfulness and may have a role in the treatment of FMS. © 2016 The British Psychological Society.

Long-Term Effects of a Universal Family Intervention: Mediation Through Parent-Adolescent Conflict

PubMed Central

Jensen, M.; Wong, J.J.; Gonzales, N.A.; Dumka, L.E.; Millsap, R.; Coxe, S.

2014-01-01

Objective This randomized trial of a family-focused preventive intervention for Mexican American middle schoolers examined internalizing, externalizing, and substance use outcomes in late adolescence, five years after completing the intervention. Parent-adolescent conflict was tested as a mediator of these effects. The role of parent and adolescent acculturation in these pathways was also examined. Method 498 7th grade adolescents and their primary female caregivers were randomized to receive either a 9-week, multi-component intervention or a brief workshop control group. Assessments were conducted at pre-test, two year follow-up (9th grade), and five year follow-up (when most participants were in the 12th grade). Results The Bridges program significantly reduced mother-adolescent conflict measured in the 9th grade, with conflict mediating program effects on internalizing and externalizing symptoms, adolescent substance use, and diagnosed internalizing disorder in late adolescence. Mother and child acculturation were both significantly predictive of late adolescence outcomes. Contrary to hypotheses, neither mother nor child acculturation emerged as a significant predictor of mother-adolescent conflict, and the interaction of mother and adolescent acculturation was similarly not related to mother-adolescent conflict. Intervention effects were largely consistent across different levels of acculturation. Conclusions These findings provide support for the efficacy of family-focused intervention during early adolescence, both in reducing mental health problems and substance use in the long term, as well as in impacting parent-adolescent conflict processes that appear to play an important role in the development of later adjustment problems. PMID:24730357

Brief Report: Mediation of Treatment Effect in a Communication Intervention for Pre-School Children with Autism

ERIC Educational Resources Information Center

Aldred, Catherine; Green, Jonathan; Emsley, Richard; McConachie, Helen

2012-01-01

Tests of mediation in treatment trials can illuminate processes of change and suggest causal influences in development. We conducted a mediation analysis of a previously published randomised controlled trial of parent-mediated communication-focused treatment for autism against ordinary care, with 28 children aged 2-5 years (Aldred et al. in J…

Protecting children from the consequences of divorce: A longitudinal study of the effects of parenting on children's coping processes

PubMed Central

Vélez, Clorinda E.; Wolchik, Sharlene A.; Tein, Jenn-Yun; Sandler, Irwin

2010-01-01

This study examined whether intervention-induced changes in mother-child relationship quality and discipline led to short-term (6 months) and long-term (6 years) changes in children's coping processes in a sample of 240 youth aged 9-12 years when assessed initially. Data were from a randomized, experimental trial of a parenting-focused preventive intervention designed to improve children's post-divorce adjustment. Three-wave prospective mediational analyses revealed that intervention-induced improvements in relationship quality led to increases in coping efficacy at 6 months and to increases in coping efficacy and active coping at 6 years. Tests of the mediated effects were significant for all 3 indirect paths. Results are discussed in terms of pathways to adaptive coping and implications for the implementation of preventive interventions targeting coping. PMID:21291440

Relative Effects of Interventions Supporting the Social Competence of Young Children with Disabilities.

ERIC Educational Resources Information Center

Odom, Samuel L.; McConnell, Scott R.; McEvoy, Mary A.; Peterson, Carla; Ostrosky, Michaelene; Chandler, Lynette K.; Spicuzza, Richard J.; Skellenger, Annette; Creighton, Michelle; Favazza, Paddy C.

1999-01-01

A study compared the effects of different intervention approaches designed to promote peer-related social competence of 83 preschool children with disabilities. Analyses indicated that the peer-mediated condition had the greatest and most sustained effect on children's participation in social interaction and on the quality of interaction.…

A Mediation Analysis of Mothers' Dietary Intake: The Entre Familia: Reflejos de Salud Randomized Controlled Trial.

PubMed

Horton, Lucy A; Ayala, Guadalupe X; Slymen, Donald J; Ibarra, Leticia; Hernandez, Erika; Parada, Humberto; Rock, Cheryl L; Arredondo, Elva M; Elder, John P

2017-12-01

Examine intervention effects among mothers involved in a healthy eating randomized controlled trial. Furthermore, examine the mediating roles of individual and familial influences on observed outcomes. Between 2009 and 2011, 361 families were recruited; half were assigned to an 11-session community health worker-delivered family-based intervention targeting Spanish-speaking Latino families in Imperial County, California. The intervention was delivered over a 4-month period. Home visits and telephone calls were delivered approximately weekly, with tapering near the end of the intervention to promote independence from the promotora. In this article, mothers' self-reported dietary intake was the primary outcome. Evaluation measures were taken at baseline, 4 months, and 10 months. Daily servings of fruits were higher among intervention versus control mothers (mean = 1.86 vs. mean = 1.47; effect size [ES] = 0.22) at 10 months post-baseline. Mothers in the intervention versus control condition also reported consuming a lower percent energy from fat (mean = 30.0% vs. 31.0%; ES = 0.30) and a higher diet quality (mean = 2.93 vs. mean = 2.67; ES = 0.29). Mediators of improvements were behavioral strategies to increase fiber and lower fat intake, family support for vegetable purchasing, and decreased unhealthy eating behaviors and perceived family barriers to healthy eating. Family-based behavioral interventions are effective for changing the skills and family system needed to improve diet among Latina mothers. Health care providers and other practitioners are encouraged to target skill development and fostering a socially supportive environment.

Short- and long-term effectiveness of a three-month individualized need-supportive physical activity counseling intervention at the workplace.

PubMed

Arrogi, Anass; Schotte, Astrid; Bogaerts, An; Boen, Filip; Seghers, Jan

2017-01-09

The objective of the present study was to evaluate the short- and long-term intervention and mediation effects of a 3-month individualized need-supportive physical activity (PA) counseling intervention on employees' PA and sedentary behavior. Insufficiently active employees (n = 300; mean age 42 ± 9 years; 78% female) were recruited from a large pharmaceutical company in Flanders, Belgium. A quasi-experimental design was used in which the intervention group (N = 246) was recruited separately from the reference group (N = 54). Intervention group participants received a 3-month behavioral support intervention, which consisted of two one-hour face-to-face counseling sessions and three follow-up counseling contacts by e-mail or telephone at weeks three, six and nine. PA counseling, delivered by qualified PA counselors, aimed to satisfy participants' basic psychological needs for autonomy, competence, and relatedness. Reference group participants did not receive individualized PA counseling. Outcome measures included objectively assessed and self-reported PA and sedentary time and psychological need satisfaction. Assessments were held at baseline, immediately after the intervention (short-term) and 6 months post-intervention (long-term). Mixed model analyses and bootstrapping analyses were used to determine intervention and mediation effects, respectively. The intervention group increased weekday daily steps both in the short- and long-term, while the reference group showed reductions in daily step count (ES = .65 and ES = .48 in the short- and long-term, respectively). In the short-term, weekday moderate-to-vigorous PA increased more pronouncedly in the intervention group compared to the reference group (ES = .34). Moreover, the intervention group demonstrated reductions in self-reported sitting time during weekends both in the short- and long-term, whereas the reference group reported increased sitting time (ES = .44 and ES = .32 in the short- and long-term, respectively). Changes in perceived autonomy and competence need satisfaction mediated the long-term intervention effects on daily step count. A 3-month individualized need-supportive PA counseling intervention among employees resulted in significant and sustained improvements in weekday daily step count and in decreased self-reported sitting during weekends. Our findings contribute to the growing evidence of the long-term effectiveness of need-supportive PA counseling. ClinicalTrials.gov NCT01759927 . Registered December 30, 2012.

Social Competence in Childhood Brain Tumor Survivors: Feasibility and Preliminary Outcomes of a Peer-Mediated Intervention

PubMed Central

Devine, Katie A.; Bukowski, William M.; Sahler, Olle Jane Z.; Ohman-Strickland, Pamela; Smith, Tristram H.; Lown, E. Anne; Patenaude, Andrea Farkas; Korones, David N.; Noll, Robert B.

2016-01-01

Objective Evaluate the acceptability, feasibility, and preliminary outcomes of a peer-mediated intervention to improve social competence of brain tumor survivors and classmates. Methods Twelve childhood brain tumor survivors and 217 classroom peers in intervention (n = 8) or comparison (n = 4) classrooms completed measures of social acceptance and reputation at two time points in the year. The intervention (5–8 sessions over 4–6 weeks) taught peer leaders skills for engaging classmates. Individual and classroom outcomes were analyzed with ANCOVA. Results Recruitment rates of families of brain tumor survivors (81%) and schools (100%) were adequate. Peer leaders reported satisfaction with the intervention. Preliminary outcome data trended toward some benefit in increasing the number of friend nominations for survivors of brain tumors but no changes in other peer-reported metrics. Preliminary results also suggested some positive effects on classroom levels of victimization and rejection. Conclusions A peer-mediated intervention was acceptable to families of brain tumor survivors and feasible to implement in schools. Findings warrant a larger trial to evaluate improvements for children with brain tumors and their peers. PMID:27355881

The effect of an Internet-based intervention designed to reduce HIV/AIDS sexual risk among Mexican adolescents.

PubMed

Castillo-Arcos, Lubia Del Carmen; Benavides-Torres, Raquel Alicia; López-Rosales, Fuensanta; Onofre-Rodríguez, Dora Julia; Valdez-Montero, Carolina; Maas-Góngora, Lucely

2016-01-01

The purpose of the study was to evaluate the effect of an Internet-based intervention to reduce sexual risk behaviors and increase resilience to sexual risk behaviors among Mexican adolescents, a key HIV/AIDS risk group. The study had a quasi-experimental design with single-stage cluster sampling. Participants ages 14-17 were stratified by gender and randomly assigned to either receive intervention "Connect" (which included face-to-face and Internet-based sessions designed to reduce sexual risk behaviors and increase resilience to sexual risk) or control (a general educational video on reducing health risks). A total of 9 survey instruments were administered online through SurveyMonkey pre- and post-intervention to assess changes in sexual risk and protective factors as well as two outcomes of interest: risky sexual behaviors and resilience. Pearson correlation assessed instrument reliability while multivariable linear regression models assessed two study hypotheses: (1) the effect of the intervention on sexual behavior and resilience is mediated by adolescent age, gender, and sexual experience and (2) risk and protective factors are mediators between the intervention and sexual behavior. The sample was composed of 193 adolescents between 14 and 17 years old (n = 96 in the control group and n = 97 in the experimental group). Survey instruments were reliable. Age was associated with pre-to-post test changes in sexual resilience (β = -6.10, p = .019), which partially mediated the effect of the intervention on sexual resilience (β = 5.70, p = .034). Social support was associated with pre-to-post test changes in risky sexual behavior (β = -0.17, p = .039). Intervention "Connect" was independently associated with improved self-reported resilience to risky sexual behaviors, though not with a reduction in those behaviors in multivariate analyses. This is the first Internet-based intervention designed to reduce HIV/AIDS sexual risk among Mexican adolescents.

A Randomised Controlled Trial of a Brief Online Mindfulness-Based Intervention on Paranoia in a Non-Clinical Sample.

PubMed

Shore, Robert; Strauss, Clara; Cavanagh, Kate; Hayward, Mark; Ellett, Lyn

2018-01-01

Paranoia is common and distressing in the general population and can impact on health, emotional well-being and social functioning, such that effective interventions are needed. Brief online mindfulness-based interventions (MBIs) have been shown to reduce symptoms of anxiety and depression in non-clinical samples; however, at present, there is no research investigating whether they can reduce paranoia. The current study explored whether a brief online MBI increased levels of mindfulness and reduced levels of paranoia in a non-clinical population. The mediating effect of mindfulness on any changes in paranoia was also investigated. One hundred and ten participants were randomly allocated to either a 2-week online MBI including 10 min of daily guided mindfulness practice or to a waitlist control condition. Measures of mindfulness and paranoia were administered at baseline, post-intervention and 1-week follow-up. Participants in the MBI group displayed significantly greater reductions in paranoia compared to the waitlist control group. Mediation analysis demonstrated that change in mindfulness skills (specifically the observe, describe and non-react facets of the FFMQ) mediated the relationship between intervention type and change in levels of paranoia. This study provides evidence that a brief online MBI can significantly reduce levels of paranoia in a non-clinical population. Furthermore, increases in mindfulness skills from this brief online MBI can mediate reductions in non-clinical paranoia. The limitations of the study are discussed.

Reduced substance use as a secondary benefit of an indicated cognitive-behavioral adolescent depression prevention program.

PubMed

Rohde, Paul; Stice, Eric; Gau, Jeff M; Marti, C Nathan

2012-09-01

Our first aim was to test whether a group cognitive-behavioral (CB) depression prevention program reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. Our second aim examined whether reductions in depressive symptoms mediate intervention effects, as posited by the affect-regulation model of substance use. In this indicated prevention trial, 341 high school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Group CB intervention, group supportive-expressive group intervention, CB bibliotherapy, or educational brochure control condition. Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Mediational analyses suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Group CB relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Results suggest that a secondary benefit of this CB group indicated depression prevention program is lower rates of long-term substance use. Findings supported the hypothesis that, relative to a nonactive comparison condition, reductions in depressive symptoms mediated the effects of Group CB prevention on substance use escalation. PsycINFO Database Record (c) 2012 APA, all rights reserved.

Mental Health Promotion as a New Goal in Public Mental Health Care: A Randomized Controlled Trial of an Intervention Enhancing Psychological Flexibility

PubMed Central

Bohlmeijer, Ernst T.; Smit, Filip; Westerhof, Gerben J.

2010-01-01

Objectives. We assessed whether an intervention based on acceptance and commitment therapy (ACT) and mindfulness was successful in promoting positive mental health by enhancing psychological flexibility. Methods. Participants were 93 adults with mild to moderate psychological distress. They were randomly assigned to the group intervention (n = 49) or to a waiting-list control group (n = 44). Participants completed measures before and after the intervention as well as 3 months later at follow-up to assess mental health in terms of emotional, psychological, and social well-being (Mental Health Continuum–Short Form) as well as psychological flexibility (i.e., acceptance of present experiences and value-based behavior, Acceptance and Action Questionnaire-II). Results. Regression analyses showed that compared with the participants on the waiting list, participants in the ACT and mindfulness intervention had greater emotional and psychological well-being after the intervention and also greater psychological flexibility at follow-up. Mediational analyses showed that the enhancement of psychological flexibility during the intervention mediated the effects of the intervention on positive mental health. Conclusions. The intervention is effective in improving positive mental health by stimulating skills of acceptance and value-based action. PMID:20966360

Mental health promotion as a new goal in public mental health care: a randomized controlled trial of an intervention enhancing psychological flexibility.

PubMed

Fledderus, Martine; Bohlmeijer, Ernst T; Smit, Filip; Westerhof, Gerben J

2010-12-01

We assessed whether an intervention based on acceptance and commitment therapy (ACT) and mindfulness was successful in promoting positive mental health by enhancing psychological flexibility. Participants were 93 adults with mild to moderate psychological distress. They were randomly assigned to the group intervention (n = 49) or to a waiting-list control group (n = 44). Participants completed measures before and after the intervention as well as 3 months later at follow-up to assess mental health in terms of emotional, psychological, and social well-being (Mental Health Continuum-Short Form) as well as psychological flexibility (i.e., acceptance of present experiences and value-based behavior, Acceptance and Action Questionnaire-II). Regression analyses showed that compared with the participants on the waiting list, participants in the ACT and mindfulness intervention had greater emotional and psychological well-being after the intervention and also greater psychological flexibility at follow-up. Mediational analyses showed that the enhancement of psychological flexibility during the intervention mediated the effects of the intervention on positive mental health. The intervention is effective in improving positive mental health by stimulating skills of acceptance and value-based action.

Mental Health Stress, Family Resources and Psychological Distress: A Longitudinal Mediation Analysis in African American Grandmothers Raising Grandchildren.

PubMed

Whitley, Deborah M; Lamis, Dorian A; Kelley, Susan J

2016-06-01

This study examines the effectiveness of a multidisciplinary intervention for African American grandmothers raising grandchildren on the relationship between dichotomized levels of mental health stress (low vs. high) and elevated levels of psychological distress, mediated by perceptions of family resources. A nonrandom sample of African American grandmothers (N = 679) was assessed to test the predictive relations among study constructs in the context of a prospective mediational model. Perception of family resources contributes to lower psychological distress among custodial grandmothers exhibiting low and high levels of mental health stress. There was no significant difference in the strength of the mediated effects between the 2 mental health stress groups. The findings suggest appropriate resource-focused interventions can enhance grandmothers' subjective assessments of family resources and reduce psychological distress. However, additional research is needed to ascertain the consistency and generalizability of findings. © 2016 Wiley Periodicals, Inc.

Examining mediators of child sexual abuse and sexually transmitted infections.

PubMed

Sutherland, Melissa A

2011-01-01

Interpersonal violence has increasingly been identified as a risk factor for sexually transmitted infections. Understanding the pathways between violence and sexually transmitted infections is essential to designing effective interventions. The aim of this study was to examine dissociative symptoms, alcohol use, and intimate partner physical violence and sexual coercion as mediators of child sexual abuse and lifetime sexually transmitted infection diagnosis among a sample of women. A convenience sample of 202 women was recruited from healthcare settings, with 189 complete cases for analysis. A multiple mediation model tested the proposed mediators of child sexual abuse and lifetime sexually transmitted infection diagnosis. Bootstrapping, a resampling method, was used to test for mediation. Key variables included child sexual abuse, dissociative symptoms, alcohol use, and intimate partner violence. Child sexual abuse was reported by 46% of the study participants (n = 93). Child sexual abuse was found to have an indirect effect on lifetime sexually transmitted infection diagnosis, with the effect occurring through dissociative symptoms (95% confidence interval = 0.0033-0.4714) and sexual coercion (95% confidence interval = 0.0359-0.7694). Alcohol use and physical violence were not found to be significant mediators. This study suggests that dissociation and intimate partner sexual coercion are important mediators of child sexual abuse and sexually transmitted infection diagnosis. Therefore, interventions that consider the roles of dissociative symptoms and interpersonal violence may be effective in preventing sexually transmitted infections among women.

AIDS Education for Tanzanian Youth: A Mediation Analysis

ERIC Educational Resources Information Center

Stigler, Melissa H.; Kugler, K. C.; Komro, K. A.; Leshabari, M. T.; Klepp, K. I.

2006-01-01

Mediation analysis is a statistical technique that can be used to identify mechanisms by which intervention programs achieve their effects. This paper presents the results of a mediation analysis of Ngao, an acquired immunodeficiency syndrome (AIDS) education program that was implemented with school children in Grades 6 and 7 in Tanzania in the…

Threat Reappraisal as a Mediator of Symptom Change in Cognitive-Behavioral Treatment of Anxiety Disorders: A Systematic Review

ERIC Educational Resources Information Center

Smits, Jasper A. J.; Julian, Kristin; Rosenfield, David; Powers, Mark B.

2012-01-01

Objective: Identifying mediators of therapeutic change is important to the development of interventions and augmentation strategies. Threat reappraisal is considered a key mediator underlying the effects of cognitive-behavioral therapy (CBT) for anxiety disorders. The present study systematically reviewed the evidence for the threat reappraisal…

Cravings as a mediator and moderator of drinking outcomes in the COMBINE study.

PubMed

Subbaraman, Meenakshi Sabina; Lendle, Samuel; van der Laan, Mark; Kaskutas, Lee Ann; Ahern, Jennifer

2013-10-01

Investigators of the COMBINE (Combining Medications and Behavioral Interventions for Alcoholism) study examined whether combining medications with a behavioral intervention would improve outcomes over monotherapies. Unexpectedly, the combination did not offer any advantage over either treatment alone. This study aimed to explain the lack of incremental benefit offered by the combination over either monotherapy by assessing the role of cravings as a treatment mediator and moderator. Secondary mediation and moderation analyses of COMBINE study data. Eleven United States academic sites. A total of 863 patients randomized to one of four treatment groups: naltrexone (100 mg/day; n = 209), the combined behavioral intervention (CBI, n = 236), naltrexone and CBI combined (n = 213) and placebo naltrexone (n = 205). Percentage of days abstinent (PDA) measured between 13 and 16 weeks post-baseline. Cravings, the potential mediator/moderator, were measured at baseline, weeks 4 and 12 using the Obsessive-Compulsive Drinking Scale. Compared with placebo, naltrexone, CBI and the combination all increased PDA by an additional 6-10 percentage points for those with high cravings (P < 0.05 for all three treatment groups). None had significant effects on PDA for those with low cravings. The effects of all three treatments were mediated at least partially by cravings; craving reduction explained 48-53% of treatment effects (P < 0.05 for all three treatment groups). Furthermore, naltrexone appeared to reduce cravings at 4 weeks, while CBI did not reduce cravings until 12 weeks. The Combining Medications and Behavioral Interventions for Alcoholism (COMBINE) naltrexone + CBI combination may not be more beneficial than either monotherapy because craving reduction is a common mechanism of both. © 2013 Society for the Study of Addiction.

Mediation of a Preventive Intervention’s Six-Year Effects on Health Risk Behaviors

PubMed Central

Soper, Ana C.; Wolchik, Sharlene A.; Tein, Jenn-Yun; Sandler, Irwin N.

2010-01-01

Using data from a 6-year longitudinal follow-up sample of 240 youth who participated in a randomized experimental trial of a preventive intervention for divorced families with children ages 9 -12, the current study tested mechanisms by which the intervention reduced substance use and risky sexual behavior in mid to late adolescence (15–19 years old). Mechanisms tested included parental monitoring, adaptive coping, and negative errors. Parental monitoring at 6-year follow-up mediated program effects to reduce alcohol and marijuana use, polydrug use, and other drug use for those with high pre-test risk for maladjustment. In the condition that included a program for mothers only, increases in youth adaptive coping at 6-year follow-up mediated program effects on risky sexual behavior for those with high pre-test risk for maladjustment. Contrary to expectation, program participation increased negative errors and decreased adaptive coping among low risk youth in some of the analyses. Ways in which this study furthers our understanding of pathways through which evidence-based preventive interventions affect health risk behaviors are discussed. PMID:20565156

Deliberate Play and Preparation Jointly Benefit Motor and Cognitive Development: Mediated and Moderated Effects

PubMed Central

Pesce, Caterina; Masci, Ilaria; Marchetti, Rosalba; Vazou, Spyridoula; Sääkslahti, Arja; Tomporowski, Phillip D.

2016-01-01

In light of the interrelation between motor and cognitive development and the predictive value of the former for the latter, the secular decline observed in motor coordination ability as early as preschool urges identification of interventions that may jointly impact motor and cognitive efficiency. The aim of this study was twofold. It (1) explored the outcomes of enriched physical education (PE), centered on deliberate play and cognitively challenging variability of practice, on motor coordination and cognitive processing; (2) examined whether motor coordination outcomes mediate intervention effects on children’s cognition, while controlling for moderation by lifestyle factors as outdoor play habits and weight status. Four hundred and sixty children aged 5–10 years participated in a 6-month group randomized intervention in PE, with or without playful coordinative and cognitive enrichment. The weight status and spontaneous outdoor play habits of children (parental report of outdoor play) were evaluated at baseline. Before and after the intervention, motor developmental level (Movement Assessment Battery for Children) was evaluated in all children, who were then assessed either with a test of working memory (Random Number Generation task), or with a test of attention (from the Cognitive Assessment System). Children assigned to the ‘enriched’ intervention showed more pronounced improvements in all motor coordination assessments (manual dexterity, ball skills, static/dynamic balance). The beneficial effect on ball skills was amplified by the level of spontaneous outdoor play and weight status. Among indices of executive function and attention, only that of inhibition showed a differential effect of intervention type. Moderated mediation showed that the better outcome of the enriched PE on ball skills mediated the better inhibition outcome, but only when the enrichment intervention was paralleled by a medium-to-high level of outdoor play. Results suggest that specifically tailored physical activity (PA) games provide a unique form of enrichment that impacts children’s cognitive development through motor coordination improvement, particularly object control skills, which are linked to children’s PA habits later in life. Outdoor play appears to offer the natural ground for the stimulation by designed PA games to take root in children’s mind. PMID:27014155

A psychological intervention reduces inflammatory markers by alleviating depressive symptoms: secondary analysis of a randomized controlled trial.

PubMed

Thornton, Lisa M; Andersen, Barbara L; Schuler, Tammy A; Carson, William E

2009-09-01

To test experimentally whether a psychological intervention reduces depression-related symptoms and markers of inflammation among cancer patients and to test one mechanism for the intervention effects. Depression and inflammation are common among cancer patients. Data suggest that inflammation can contribute to depressive symptoms, although the converse remains untested. As part of a randomized clinical trial, newly diagnosed breast cancer patients (n = 45) with clinically significant depressive symptoms were evaluated and randomized to psychological intervention with assessment or assessment only study arms. The intervention spanned 12 months, with assessments at baseline, 4, 8, and 12 months. Mixed-effects modeling tested the hypothesis that the intervention reduced self-reported depressive symptoms (Center for Epidemiological Studies Depression scale, Profile of Mood States Depression and Fatigue subscales, and Medical Outcomes Study-Short Form 36 Bodily Pain subscale) and immune cell numbers that are elevated in the presence of inflammation (white blood cell count, neutrophil count, and helper/suppressor ratio). Mediation analyses tested whether change in depressive symptoms, pain, or fatigue predicted change in white blood cell count, neutrophil count, or the helper/suppressor ratio. The intervention reduced significantly depressive symptoms, pain, fatigue, and inflammation markers. Moreover, the intervention effect on inflammation was mediated by its effect on depressive symptoms. This is the first experiment to test whether psychological treatment effective in reducing depressive symptoms would also reduce indicators of inflammation. Data show that the intervention reduced directly depressive symptoms and reduced indirectly inflammation. Psychological treatment may treat effectively depressive symptoms, pain, and fatigue among cancer patients.

Effect of a workplace design and training intervention on individual performance, group effectiveness and collaboration: the role of environmental control.

PubMed

Robertson, Michelle M; Huang, Yueng-Hsiang

2006-01-01

The effects of a workplace design and training intervention and the relationships between perceived satisfaction of office workplace design factors (layout and storage) and work performance measures (individual performance, group collaboration and effectiveness) were studied with 120 office workers using the Workplace Environment Questionnaire. Further, we examined whether environmental control had a direct effect on work performance, and then explored whether environmental control mediated or moderated the relationship between workplace design factors and work performance. Results showed a significant, positive impact of the intervention on environmental satisfaction for workstation layout. Satisfaction with workstation layout had a significant relationship with individual performance, group collaboration and effectiveness; and satisfaction with workstation storage had a significant relationship with individual performance and group collaboration. Environmental control had a direct impact on individual performance and group collaboration; whereas, the mediating and moderating effects of environmental control on the relationship between workplace design factors and outcome variables were not significant.

Intensive lifestyle intervention improves physical function among obese adults with knee pain: findings from the Look AHEAD trial.

PubMed

Foy, Capri G; Lewis, Cora E; Hairston, Kristen G; Miller, Gary D; Lang, Wei; Jakicic, John M; Rejeski, W Jack; Ribisl, Paul M; Walkup, Michael P; Wagenknecht, Lynne E

2011-01-01

Lifestyle interventions have resulted in weight loss or improved physical fitness among individuals with obesity, which may lead to improved physical function. This prospective investigation involved participants in the Action for Health in Diabetes (Look AHEAD) trial who reported knee pain at baseline (n = 2,203). The purposes of this investigation were to determine whether an Intensive Lifestyle Intervention (ILI) condition resulted in improvement in self-reported physical function from baseline to 12 months vs. a Diabetes Support and Education (DSE) condition, and whether changes in weight or fitness mediated the effect of the ILI. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and physical function subscales, and WOMAC summary score. ILI participants exhibited greater adjusted mean weight loss (s.e.) vs. DSE participants (-9.02 kg (0.48) vs. -0.78 kg (0.49); P < 0.001)). ILI participants also demonstrated more favorable change in WOMAC summary scores vs. DSE participants (β (s.e.) = -1.81 (0.63); P = 0.004). Multiple regression mediation analyses revealed that weight loss was a mediator of the effect of the ILI intervention on change in WOMAC pain, function, and summary scores (P < 0.001). In separate analyses, increased fitness also mediated the effect of the ILI intervention upon WOMAC summary score (P < 0.001). The ILI condition resulted in significant improvement in physical function among overweight and obese adults with diabetes and knee pain. The ILI condition also resulted in significant weight loss and improved fitness, which are possible mechanisms through which the ILI condition improved physical function.

A randomized clinical trial evaluating a combined alcohol intervention for high-risk college students.

PubMed

Turrisi, Rob; Larimer, Mary E; Mallett, Kimberly A; Kilmer, Jason R; Ray, Anne E; Mastroleo, Nadine R; Geisner, Irene Markman; Grossbard, Joel; Tollison, Sean; Lostutter, Ty W; Montoya, Heidi

2009-07-01

The current study is a multisite randomized alcohol prevention trial to evaluate the efficacy of both a parenting handbook intervention and the Brief Alcohol Screening and Intervention for College Students (BASICS) intervention, alone and in combination, in reducing alcohol use and consequences among a high-risk population of matriculating college students (i.e., former high school athletes). Students (n = 1,275) completed a series of Web-administered measures at baseline (in the summer before starting college) and follow-up (after 10 months). Students were randomized to one of four conditions: parent intervention only, BASICS only, combined (parent and BASICS), and assessment-only control. Intervention efficacy was tested on a number of outcome measures, including peak blood alcohol concentration, weekly and weekend drinking, and negative consequences. Hypothesized mediators and moderators of intervention effect were tested. The overall results revealed that the combined-intervention group had significantly lower alcohol consumption, high-risk drinking, and consequences at 10-month follow-up, compared with the control group, with changes in descriptive and injunctive peer norms mediating intervention effects. The findings of the present study suggest that the parent intervention delivered to students before they begin college serves to enhance the efficacy of the BASICS intervention, potentially priming students to respond to the subsequent BASICS session.

A Randomized Clinical Trial Evaluating a Combined Alcohol Intervention for High-Risk College Students*

PubMed Central

Turrisi, Rob; Larimer, Mary E.; Mallett, Kimberly A.; Kilmer, Jason R.; Ray, Anne E.; Mastroleo, Nadine R.; Geisner, Irene Markman; Grossbard, Joel; Tollison, Sean; Lostutter, Ty W.; Montoya, Heidi

2009-01-01

Objective: The current study is a multisite randomized alcohol prevention trial to evaluate the efficacy of both a parenting handbook intervention and the Brief Alcohol Screening and Intervention for College Students (BASICS) intervention, alone and in combination, in reducing alcohol use and consequences among a high-risk population of matriculating college students (i.e., former high school athletes). Method: Students (n = 1,275) completed a series of Web-administered measures at baseline (in the summer before starting college) and follow-up (after 10 months). Students were randomized to one of four conditions: parent intervention only, BASICS only, combined (parent and BASICS), and assessment-only control. Intervention efficacy was tested on a number of outcome measures, including peak blood alcohol concentration, weekly and weekend drinking, and negative consequences. Hypothesized mediators and moderators of intervention effect were tested. Results: The overall results revealed that the combined-intervention group had significantly lower alcohol consumption, high-risk drinking, and consequences at 10-month follow-up, compared with the control group, with changes in descriptive and injunctive peer norms mediating intervention effects. Conclusions: The findings of the present study suggest that the parent intervention delivered to students before they begin college serves to enhance the efficacy of the BASICS intervention, potentially priming students to respond to the subsequent BASICS session. PMID:19515296

A theory-informed approach to developing visually mediated interventions to change behaviour using an asthma and physical activity intervention exemplar.

PubMed

Murray, Jennifer; Williams, Brian; Hoskins, Gaylor; Skar, Silje; McGhee, John; Treweek, Shaun; Sniehotta, Falko F; Sheikh, Aziz; Brown, Gordon; Hagen, Suzanne; Cameron, Linda; Jones, Claire; Gauld, Dylan

2016-01-01

Visualisation techniques are used in a range of healthcare interventions. However, these frequently lack a coherent rationale or clear theoretical basis. This lack of definition and explicit targeting of the underlying mechanisms may impede the success of and evaluation of the intervention. We describe the theoretical development, deployment, and pilot evaluation, of a complex visually mediated behavioural intervention. The exemplar intervention focused on increasing physical activity among young people with asthma. We employed an explicit five-stage development model, which was actively supported by a consultative user group. The developmental stages involved establishing the theoretical basis, establishing a narrative structure, visual rendering, checking interpretation, and pilot testing. We conducted in-depth interviews and focus groups during early development and checking, followed by an online experiment for pilot testing. A total of 91 individuals, including young people with asthma, parents, teachers, and health professionals, were involved in development and testing. Our final intervention consisted of two components: (1) an interactive 3D computer animation to create intentions and (2) an action plan and volitional help sheet to promote the translation of intentions to behaviour. Theory was mediated throughout by visual and audio forms. The intervention was regarded as highly acceptable, engaging, and meaningful by all stakeholders. The perceived impact on asthma understanding and intentions was reported positively, with most individuals saying that the 3D computer animation had either clarified a range of issues or made them more real. Our five-stage model underpinned by extensive consultation worked well and is presented as a framework to support explicit decision-making for others developing theory informed visually mediated interventions. We have demonstrated the ability to develop theory-based visually mediated behavioural interventions. However, attention needs to be paid to the potential ambiguity associated with images and thus the concept of visual literacy among patients. Our revised model may be helpful as a guide to aid development, acceptability, and ultimately effectiveness.

Effects of compassion meditation on a psychological model of charitable donation.

PubMed

Ashar, Yoni K; Andrews-Hanna, Jessica R; Yarkoni, Tal; Sills, Jenifer; Halifax, Joan; Dimidjian, Sona; Wager, Tor D

2016-08-01

Compassion is critical for societal wellbeing. Yet, it remains unclear how specific thoughts and feelings motivate compassionate behavior, and we lack a scientific understanding of how to effectively cultivate compassion. Here, we conducted 2 studies designed to a) develop a psychological model predicting compassionate behavior, and b) test this model as a mediator of a Compassion Meditation (CM) intervention and identify the "active ingredients" of CM. In Study 1, we developed a model predicting compassionate behavior, operationalized as real-money charitable donation, from a linear combination of self-reported tenderness, personal distress, perceived blamelessness, and perceived instrumental value of helping with high cross-validated accuracy, r = .67, p < .0001. Perceived similarity to suffering others did not predict charitable donation when controlling for other feelings and attributions. In Study 2, a randomized controlled trial, we tested the Study 1 model as a mediator of CM and investigated active ingredients. We compared a smartphone-based CM program to 2 conditions-placebo oxytocin and a Familiarity intervention-to control for expectancy effects, demand characteristics, and familiarity effects. Relative to control conditions, CM increased charitable donations, and changes in the Study 1 model of feelings and attributions mediated this effect (pab = .002). The Familiarity intervention led to decreases in primary outcomes, while placebo oxytocin had no significant effects on primary outcomes. Overall, this work contributes a quantitative model of compassionate behavior, and informs our understanding of the change processes and intervention components of CM. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

The Effects of Technology-Mediated Dialogic Learning in Elementary Mathematics Instruction

ERIC Educational Resources Information Center

Working, Christopher

2018-01-01

The use of technology in elementary mathematics instruction tends to be low-level, despite its affordance of supporting the development of students' high-level reasoning ability. This study builds upon a sociocultural view of learning and was designed to determine what effect a technology-mediated dialogic learning intervention has on third-grade…

Social cognitive mediators of parent-child sexual communication.

PubMed

Evans, W Douglas; Blitstein, Jonathan L; Davis, Kevin C

2011-07-01

To test a social cognitive behavior change model and identify mediators of the effects of the Parents Speak Up National Campaign (PSUNC) on parent-child sexual communication. Investigators used 5 waves of data from an online randomized controlled trial. Latent variables were developed based on item response theory and confirmatory factor analysis. Structural equation modeling was used to test mediation. Outcome expectations mediated effects of social norms and self-efficacy on sexual communication. Other hypothesized mediators were not confirmed. Interventions to promote parent-child sexual communication should target outcome expectations. Future research should investigate parents' health information seeking.

Evaluation of the Dogs, Physical Activity, and Walking (Dogs PAW) Intervention: A Randomized Controlled Trial.

PubMed

Richards, Elizabeth A; Ogata, Niwako; Cheng, Ching-Wei

2016-01-01

To facilitate physical activity (PA) adoption and maintenance, promotion of innovative population-level strategies that focus on incorporating moderate-intensity lifestyle PAs are needed. The purpose of this randomized controlled trial was to evaluate the Dogs, Physical Activity, and Walking intervention, a 3-month, social cognitive theory (SCT), e-mail-based PA intervention. In a longitudinal, repeated-measures design, 49 dog owners were randomly assigned to a control (n = 25) or intervention group (n = 24). The intervention group received e-mail messages (twice weekly for 4 weeks and weekly for 8 weeks) designed to influence SCT constructs of self-efficacy, self-regulation, outcome expectations and expectancies, and social support. At baseline and every 3 months through 1 year, participants completed self-reported questionnaires of individual, interpersonal, and PA variables. Linear mixed models were used to assess for significant differences in weekly minutes of dog walking and theoretical constructs between groups (intervention and control) across time. To test self-efficacy as a mediator of social support for dog walking, tests for mediation were conducted using the bootstrapping technique. With the exception of Month 9, participants in the intervention group accumulated significantly more weekly minutes of dog walking than the control group. On average, the intervention group accumulated 58.4 more minutes (SD = 18.1) of weekly dog walking than the control group (p < .05). Self-efficacy partially mediated the effect of social support variables on dog walking. Results indicate that a simple SCT-based e-mail intervention is effective in increasing and maintaining an increase in dog walking among dog owners at 12-month follow-up. In light of these findings, it may be advantageous to design dog walking interventions that focus on increasing self-efficacy for dog walking by fostering social support.

A Culturally Adapted Smoking Cessation Intervention for Korean Americans: A Mediating Effect of Perceived Family Norm toward Quitting

PubMed Central

Kim, Sun S; Kim, Seong-Ho; Fang, Hua; Kwon, Simona; Shelley, Donna; Ziedonis, Douglas

2014-01-01

Background Korean men and women have the highest current smoking rates across all Asian ethnic subgroups in the United States. Methods This is a 2-arm randomized controlled study of a culturally adapted smoking cessation intervention. The experimental condition received eight weekly 40-minute individualized counseling sessions that incorporated Korean-specific cultural elements, whereas the control condition received eight weekly 10-minute individualized counseling sessions that were not culturally adapted. All participants also received nicotine patches for 8 weeks. Results One-hundred nine Korean immigrants (91 men and 18 women) participated in the study. The rate of biochemically verified 12-month prolonged abstinence was significantly higher for the experimental condition than the control condition (38.2% vs. 11.1%, χ2 = 10.7, p < 0.01). Perceived family norm significantly mediated the effect of cessation intervention on abstinence. Discussion Smoking cessation intervention for Korean Americans should be culturally adapted and involve family members to produce a long-term treatment effect. PMID:24878686

A Culturally Adapted Smoking Cessation Intervention for Korean Americans: A Mediating Effect of Perceived Family Norm Toward Quitting.

PubMed

Kim, Sun S; Kim, Seong-Ho; Fang, Hua; Kwon, Simona; Shelley, Donna; Ziedonis, Douglas

2015-08-01

Korean men and women have the highest current smoking rates across all Asian ethnic subgroups in the United States. This is a 2-arm randomized controlled study of a culturally adapted smoking cessation intervention. The experimental condition received eight weekly 40-min individualized counseling sessions that incorporated Korean-specific cultural elements, whereas the control condition received eight weekly 10-min individualized counseling sessions that were not culturally adapted. All participants also received nicotine patches for 8 weeks. One-hundred nine Korean immigrants (91 men and 18 women) participated in the study. The rate of biochemically verified 12-month prolonged abstinence was significantly higher for the experimental condition than the control condition (38.2 vs. 11.1 %, χ (2) = 10.7, p < 0.01). Perceived family norm significantly mediated the effect of cessation intervention on abstinence. Smoking cessation intervention for Korean Americans should be culturally adapted and involve family members to produce a long-term treatment effect.

Protecting children from the consequences of divorce: a longitudinal study of the effects of parenting on children's coping processes.

PubMed

Vélez, Clorinda E; Wolchik, Sharlene A; Tein, Jenn-Yun; Sandler, Irwin

2011-01-01

This study examines whether intervention-induced changes in mother-child relationship quality and discipline led to short-term (6 months) and long-term (6 years) changes in children's coping processes in a sample of 240 youth aged 9-12 years when assessed initially. Data were from a randomized, experimental trial of a parenting-focused preventive intervention designed to improve children's postdivorce adjustment. Three-wave prospective mediational analyses revealed that intervention-induced improvements in relationship quality led to increases in coping efficacy at 6 months and to increases in coping efficacy and active coping at 6 years. Tests of the mediated effects were significant for all 3 indirect paths. Results are discussed in terms of pathways to adaptive coping and implications for the implementation of preventive interventions targeting coping. © 2011 The Authors. Child Development © 2011 Society for Research in Child Development, Inc.

How stigma impacts on people with psychosis: The mediating effect of self-esteem and hopelessness on subjective recovery and psychotic experiences.

PubMed

Vass, Victoria; Morrison, Anthony P; Law, Heather; Dudley, James; Taylor, Pamela; Bennett, Kate M; Bentall, Richard P

2015-12-15

This study aimed to examine how stigma impacts on symptomatic and subjective recovery from psychosis, both concurrently and longitudinally. We also aimed to investigate whether self-esteem and hopelessness mediated the observed associations between stigma and outcomes. 80 service-users with psychosis completed symptom (Positive and Negative Syndrome Scale) and subjective recovery measures (Process of Recovery Questionnaire) at baseline and 6-months later, and also completed the King Stigma Scale, the Self-Esteem Rating Scale and the Beck Hopelessness Scale at baseline. In cross sectional regression and multiple mediation analyses of the baseline data, we found that stigma predicted both symptomatic and subjective recovery, and the effects of stigma on these outcomes were mediated by hopelessness and self-esteem. When the follow-up data were examined, stigma at baseline continued to predict recovery judgements and symptoms. However, self-esteem only mediated the effect of stigma on PANSS passive social withdrawal. Self-esteem and hopelessness should be considered in interventions to reduce the effects of stigma. Interventions that address the current and long-term effects of stigma may positively affect outcome for people being treated for psychosis. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Social cognitive mediators of the effect of the MobileMums intervention on physical activity.

PubMed

Fjeldsoe, Brianna S; Miller, Yvette D; Marshall, Alison L

2013-07-01

To explore whether improvements in physical activity following the MobileMums intervention were mediated by changes in Social Cognitive Theory (SCT) constructs targeted in the intervention (barrier self efficacy, goal setting skills, outcome expectancy, social support, and perceived environmental opportunity for exercise). This paper also examined if the mediating constructs differed between initial (baseline to 6 weeks) and overall (baseline to 13 weeks) changes in physical activity. Secondary analysis of data from a randomized controlled trial involving 88 postnatal women (<12 months postpartum). Participants were randomized to receive either the 12-week MobileMums intervention or a minimal-contact control condition. Physical activity and proposed mediators were assessed by self-report at baseline, 6 weeks, and 13 weeks. Walking for Exercise frequency was assessed using the Australian Women's Activity Survey and frequency of moderate-to-vigorous physical activity (MVPA) was assessed using a single-item question. Initial improvements in goal-setting skills mediated the relationship between experimental condition and initial changes in MVPA, αβ (95% CI) = 0.23(0.01, 0.59), and Walking for Exercise, αβ (95% CI) = 0.34(0.06, 0.73). Initial improvements in barrier self efficacy mediated the relationship between experimental condition and initial change in MVPA, αβ (95% CI) = 0.36(0.12, 0.65), but not Walking for Exercise. None of the SCT outcomes significantly mediated the relationship between experimental condition and overall (baseline to 13 weeks) change in frequency of MVPA or Walking for Exercise. Future interventions with postnatal women using SCT should target barrier self-efficacy and goal setting skills in order to increase physical activity. PsycINFO Database Record (c) 2013 APA, all rights reserved.

Mediators of Change in Psychosocial Interventions for Cancer Patients: A Systematic Review

PubMed Central

Moyer, Anne; Goldenberg, Matthew; Hall, Matthew A.; Knapp-Oliver, Sarah K.; Sohl, Stephanie J.; Sarma, Elizabeth A.; Schneider, Stefan

2012-01-01

Careful reviews and meta-analyses have made valuable contributions to understanding the efficacy of psychosocial interventions for cancer patients. An important next step is to determine the mediators that explain the influence of efficacious interventions on outcomes. This systematic review summarizes tests of mediating variables from twenty-two projects conducted from 1989–2010. Although all authors provided some type of rationale for considering particular mediating relationships, the investigations varied widely with respect to the extent to which formal theoretical constructs were tested, the type and goals of the interventions studied, and the broad types of outcomes and potential mediators examined. Although there was some evidence supporting selected mediating relationships, with positive findings often found when mediating variables represented behaviors targeted by an intervention, the findings were mixed. Expanding the focus of research to include mechanisms in psychosocial oncology intervention research is necessary for providing a unified picture of how mediating relationships may be operating in this field. PMID:22873734

Engagement With a Trauma Recovery Internet Intervention Explained With the Health Action Process Approach (HAPA): Longitudinal Study

PubMed Central

Shoji, Kotaro; Luszczynska, Aleksandra; Benight, Charles C

2018-01-01

Background There has been a growing trend in the delivery of mental health treatment via technology (ie, electronic health, eHealth). However, engagement with eHealth interventions is a concern, and theoretically based research in this area is sparse. Factors that influence engagement are poorly understood, especially in trauma survivors with symptoms of posttraumatic stress. Objective The aim of this study was to examine engagement with a trauma recovery eHealth intervention using the Health Action Process Approach theoretical model. Outcome expectancy, perceived need, pretreatment self-efficacy, and trauma symptoms influence the formation of intentions (motivational phase), followed by planning, which mediates the translation of intentions into engagement (volitional phase). We hypothesized the mediational effect of planning would be moderated by level of treatment self-efficacy. Methods Trauma survivors from around the United States used the eHealth intervention for 2 weeks. We collected baseline demographic, social cognitive predictors, and distress symptoms and measured engagement subjectively and objectively throughout the intervention. Results The motivational phase model explained 48% of the variance, and outcome expectations (beta=.36), perceived need (beta=.32), pretreatment self-efficacy (beta=.13), and trauma symptoms (beta=.21) were significant predictors of intention (N=440). In the volitional phase, results of the moderated mediation model indicated for low levels of treatment self-efficacy, planning mediated the effects of intention on levels of engagement (B=0.89, 95% CI 0.143-2.605; N=115). Conclusions Though many factors can affect engagement, these results offer a theoretical framework for understanding engagement with an eHealth intervention. This study highlighted the importance of perceived need, outcome expectations, self-efficacy, and baseline distress symptoms in the formation of intentions to use the intervention. For those low in treatment self-efficacy, planning may play an important role in the translation of intentions into engagement. Results of this study may help bring some clarification to the question of what makes eHealth interventions work. PMID:29636323

The Pathways from a Behavior Change Communication Intervention to Infant and Young Child Feeding in Bangladesh Are Mediated and Potentiated by Maternal Self-Efficacy.

PubMed

Zongrone, Amanda A; Menon, Purnima; Pelto, Gretel H; Habicht, Jean-Pierre; Rasmussen, Kathleen M; Constas, Mark A; Vermeylen, Francoise; Khaled, Adiba; Saha, Kuntal K; Stoltzfus, Rebecca J

2018-02-01

Although self-efficacy is a potential determinant of feeding and care behaviors, there is limited empirical analysis of the role of maternal self-efficacy in low- and middle-income countries. In the context of behavior change interventions (BCIs) addressing complementary feeding (CF), it is possible that maternal self-efficacy can mediate or enhance intervention impacts. In the context of a BCI in Bangladesh, we studied the role of maternal self-efficacy for CF (MSE-CF) for 2 CF behaviors with the use of a theoretically grounded empirical model of determinants to illustrate the potential roles of MSE-CF. We developed and tested a locally relevant scale for MSE-CF and included it in a survey (n = 457 mothers of children aged 6-24 mo) conducted as part of a cluster-randomized evaluation. Qualitative research was used to inform the selection of 2 intervention-targeted behaviors: feeding green leafy vegetables in the last 24 h (GLV) and on-time introduction of egg (EGG) between 6 and 8 mo of age. We then examined direct, mediated, and potentiated paths of MSE-CF in relation to the impacts of the BCI on these behaviors with the use of regression and structural equation modeling. GLV and EGG were higher in the intensive group than in the nonintensive control group (16.0 percentage points for GLV; P < 0.001; 11.2 percentage points for EGG; P = 0.037). For GLV, MSE-CF mediated (β = 0.345, P = 0.010) and potentiated (β = 0.390, P = 0.038) the effect of the intensive group. In contrast, MSE-CF did not mediate or potentiate the effect of the intervention on EGG. MSE-CF was a significant mediator and potentiator for GLV but not for EGG. The divergent findings highlight the complex determinants of individual specific infant and young child feeding behaviors. The study shows the value of measuring behavioral determinants, such as MSE-CF, that affect a caregiver's capability to adopt intervention-targeted behaviors.

Mediators effecting moderate-to-vigorous physical activity and inactivity for girls from an intervention program delivered in an organised youth sports setting.

PubMed

Guagliano, Justin M; Lonsdale, Chris; Rosenkranz, Richard R; Parker, Philip D; Agho, Kingsley E; Kolt, Gregory S

2015-11-01

The objective of this study was to test whether coaches' physical activity levels, contextual variables, and coaches' behavioural variables mediated the effect of an intervention on female basketball players' moderate-to-vigorous physical activity (MVPA) and inactivity in an organised youth sport (OYS) setting. Randomised controlled trial Data for the current study were derived from a two-armed, parallel-group randomised controlled trial. This study ran over the course of a 5-day OYS basketball program in 2 sports centres in Sydney, Australia. A convenience sample of 76 female players and 8 coaches were recruited. Coaches allocated to the intervention condition attended 2 coach education sessions, where strategies to increase MVPA and decrease inactivity were taught. There was a significant effect between changes in coach MVPA and player MVPA (unstandardised regression coefficient [B] = 0.26, 95% CI = 0.14 to 0.38) which coincided with a significant indirect effect (B = 1.80, 95% CI = 0.85 to 2.85). There was also a significant effect between changes in coach inactivity and player inactivity (B = -0.23, 95% CI = -0.14 to -0.31), which coincided with a significant indirect effect (B = -3.20, 95% CI = -0.14 to -0.31). No significant indirect effects were found for lesson context and coaches' behaviours variables. Coaches' MVPA and inactivity significantly mediated the effect of the intervention on player MVPA and inactivity, respectively. Consequently, coaches' physical activity levels appear to be important for influencing their players' physical activity levels. Published by Elsevier Ltd.

Psychosocial group rehabilitation for lonely older people: favourable processes and mediating factors of the intervention leading to alleviated loneliness.

PubMed

Savikko, Niina; Routasalo, Pirkko; Tilvis, Reijo; Pitkälä, Kaisu

2010-03-01

Loneliness among community-dwelling older people is a common problem, with serious health consequences. The favourable processes and mediating factors of a psychosocial group rehabilitation intervention in alleviating older people's loneliness were evaluated. Altogether, 117 lonely, home-dwelling individuals (aged ≥75 years) participated in a psychosocial group rehabilitation intervention. The content comprised (i) art and inspiring activities, (ii) group exercise and discussions or (iii) therapeutic writing and group therapy. The psychosocial group rehabilitation intervention was evaluated from the group leaders' diaries and by observing the groups. Experiences of loneliness and social participation were collected by postintervention questionnaires from the participants. Data were analysed using methodological triangulation. Doing things together and sharing experiences with their peers inspired lively discussions, created a feeling of togetherness and led to participants' empowerment and increased self-esteem. The intervention socially activated the participants, and their feelings of loneliness had been alleviated during the intervention. Several common favourable processes and mediating factors were identified in the psychosocial group rehabilitation intervention that led to alleviation of loneliness among older people. Relevance to clinical practice.  The psychosocial group rehabilitation intervention gives nurses an effective tool to support older people's psychosocial resources by activating them and alleviating their loneliness. © 2009 Blackwell Publishing Ltd.

Behavior change through automated e-mails: mediation analysis of self-help strategy use for depressive symptoms.

PubMed

Morgan, Amy J; Mackinnon, Andrew J; Jorm, Anthony F

2013-02-01

To evaluate whether automated e-mails promoting effective self-help strategies for depressive symptoms were effective in changing self-help behavior, and whether this improved depression outcomes. 568 adults with sub-threshold depression participated in a randomized controlled trial and provided complete data. A series of 12 e-mails promoting the use of evidence-based self-help strategies was compared with e-mails providing non-directive depression information. Depression symptoms were assessed with the Patient Health Questionnaire depression scale (PHQ-9) and use of self-help strategies was assessed at baseline and post-intervention. We hypothesized that those receiving the self-help e-mails would increase their use of evidence-based self-help and this would be associated with improvements in depression. Mediation analyses were conducted using a non-parametric bootstrapping procedure. Total use of the self-help strategies promoted in the e-mails significantly mediated the effect of the intervention on depressive symptoms (B = -0.75, SE = 0.16, 95% CI: -1.06 to -0.48). The direct effect of the intervention on depressive symptoms was much smaller and not significant when the mediation path was included. The majority of the individual strategies also had a significant indirect effect on depressive symptoms. In adults with sub-threshold depression, automated e-mails based on behavior change principles can successfully increase use of self-help strategies, leading to a reduction in depressive symptoms. Copyright © 2012 Elsevier Ltd. All rights reserved.

Developmental Mediation of Genetic Variation in Response to the Fast Track Prevention Program

PubMed Central

Albert, Dustin; Belsky, Daniel W.; Crowley, D. Max; Bates, John E.; Pettit, Gregory S.; Lansford, Jennifer E.; Dick, Danielle; Dodge, Kenneth A.

2015-01-01

We conducted a developmental analysis of genetic moderation of the effect of the Fast Track intervention on adult externalizing psychopathology. The Fast Track intervention enrolled 891 children at high risk to develop externalizing behavior problems when they were in kindergarten. Half of the enrolled children were randomly assigned to receive 10 years of treatment with a range of services and resources provided to the children and their families and the other half to usual care (controls). We previously showed that the effect of the Fast Track intervention on participants’ risk of externalizing psychopathology at age 25 years was moderated by a variant in the Glucocorticoid Receptor Gene (NR3C1). Children who carried copies of the A-allele of the single-nucleotide polymorphism rs10482672 had the highest risk of externalizing psychopathology if they were in the control arm of the trial and the lowest risk of externalizing psychopathology if they were in the treatment arm. In this study, we test a developmental hypothesis about the origins of this for-better-and-for-worse gene-by-intervention interaction (GxI): That the observed GxI effect on adult psychopathology is mediated by the proximal impact of intervention on childhood externalizing problems and adolescent substance use and delinquency. We analyzed longitudinal data tracking the 270 European-American children in the Fast Track RCT with available genetic information (129 intervention children and 141 control-group peers, 69% male) from kindergarten through age 25 years. Results show that the same pattern of “for-better-and-for-worse” susceptibility to intervention observed at the age-25 follow-up was evident already during childhood. At the elementary school follow-ups and at the middle/high-school follow-ups, rs10482672 predicted better adjustment among children receiving the Fast Track intervention, and worse adjustment among children in the control condition. In turn, these proximal GxI effects early in development mediated the ultimate GxI effect on externalizing psychopathology at age 25 years. We discuss the contribution of these findings to the growing literature on genetic susceptibility to environmental intervention. PMID:25640832

The Active for Life Year 5 (AFLY5) school-based cluster randomised controlled trial protocol: detailed statistical analysis plan.

PubMed

Lawlor, Debbie A; Peters, Tim J; Howe, Laura D; Noble, Sian M; Kipping, Ruth R; Jago, Russell

2013-07-24

The Active For Life Year 5 (AFLY5) randomised controlled trial protocol was published in this journal in 2011. It provided a summary analysis plan. This publication is an update of that protocol and provides a detailed analysis plan. This update provides a detailed analysis plan of the effectiveness and cost-effectiveness of the AFLY5 intervention. The plan includes details of how variables will be quality control checked and the criteria used to define derived variables. Details of four key analyses are provided: (a) effectiveness analysis 1 (the effect of the AFLY5 intervention on primary and secondary outcomes at the end of the school year in which the intervention is delivered); (b) mediation analyses (secondary analyses examining the extent to which any effects of the intervention are mediated via self-efficacy, parental support and knowledge, through which the intervention is theoretically believed to act); (c) effectiveness analysis 2 (the effect of the AFLY5 intervention on primary and secondary outcomes 12 months after the end of the intervention) and (d) cost effectiveness analysis (the cost-effectiveness of the AFLY5 intervention). The details include how the intention to treat and per-protocol analyses were defined and planned sensitivity analyses for dealing with missing data. A set of dummy tables are provided in Additional file 1. This detailed analysis plan was written prior to any analyst having access to any data and was approved by the AFLY5 Trial Steering Committee. Its publication will ensure that analyses are in accordance with an a priori plan related to the trial objectives and not driven by knowledge of the data. ISRCTN50133740.

Mass media and community interventions to reduce alcohol use by early adolescents.

PubMed

Flynn, Brian S; Worden, John K; Bunn, Janice Yanushka; Dorwaldt, Anne L; Dana, Greg S; Callas, Peter W

2006-01-01

Although early use of alcohol is an immediate and long-term risk for young people, proven prevention strategies are limited. Mass media interventions have been shown to be effective in reducing use of other substances by adolescents. This study tested the impact of a 4-year media campaign designed to reduce alcohol use by early adolescents. Theory-based television and radio messages promoting avoidance of alcohol were developed and delivered to an audience of young people as they matured from Grades 4-5 to Grades 7-8. A set of eight school districts was identified as the Media Area; eight matching districts served as the Comparison Area. Independent Grade 7-8 surveys were conducted in all districts at baseline (N= 2897) and after the interventions (N=2419). Unanticipated community coalitions working to reduce youth substance use were introduced into 10 of these 16 communities during the same time period. Exposure of the target audience to the media messages was lower than expected, and the unplanned community coalition interventions may have favored the Comparison Area. The main analyses indicated that the media interventions did not significantly affect alcohol use or its mediators. Supplementary analyses suggested a substantial impact of community coalitions on alcohol use and several key mediators. The mass media interventions provided by this study had no effect on adolescent alcohol use or its psychosocial mediators. Factors external to the study reduced chances of detecting media effects. Further work is needed to develop and test mass media strategies for alcohol use prevention among early adolescents.

Mediating processes in an effective life-review intervention.

PubMed

Korte, Jojanneke; Westerhof, Gerben J; Bohlmeijer, Ernst T

2012-12-01

Life review has been established as an evidence-based treatment for depression and anxiety. This paper addresses an important gap in the existing evidence of the working mechanisms of life review. We were able to longitudinally investigate possible mediators of a life-review intervention on depression and anxiety in the context of a large randomized controlled trial. A total of 202 older Dutch adults living in the community participated in this study. They were randomly assigned to either life review or care as usual. Participants were measured in terms of their depressive and anxiety symptoms, reminiscence functions, meaning in life, mastery and positive thoughts at study entry (t0), postintervention (t1; 3 months after study entry), and follow-up (t2; 3 months after the end of the intervention). Findings suggest that processes which have been theoretically and empirically proposed as important processes of change in life review therapy, that is, bitterness revival and boredom reduction reminiscence, mastery and positive thoughts, are indeed mediating the effects of life review on depression and anxiety. It is now recommended to measure these processes during the intervention in order to shed light on the exact process of change and direction of causality. 2013 APA, all rights reserved

Peer Inclusion in Interventions for Children with ADHD: A Systematic Review and Meta-Analysis

PubMed Central

Vilaysack, Brandon; Doma, Kenji; Wilkes-Gillan, Sarah; Speyer, Renée

2018-01-01

Objective To assess the effectiveness of peer inclusion in interventions to improve the social functioning of children with ADHD. Methods We searched four electronic databases for randomized controlled trials and controlled quasi-experimental studies that investigated peer inclusion interventions alone or combined with pharmacological treatment. Data were collected from the included studies and methodologically assessed. Meta-analyses were conducted using a random-effects model. Results Seventeen studies met eligibility criteria. Studies investigated interventions consisting of peer involvement and peer proximity; no study included peer mediation. Most included studies had an unclear or high risk of bias regarding inadequate reporting of randomization, blinding, and control for confounders. Meta-analyses indicated improvements in pre-post measures of social functioning for participants in peer-inclusive treatment groups. Peer inclusion was advantageous compared to treatment as usual. The benefits of peer inclusion over other therapies or medication only could not be determined. Using parents as raters for outcome measurement significantly mediated the intervention effect. Conclusions The evidence to support or contest the efficacy of peer inclusion interventions for children with ADHD is lacking. Future studies need to reduce risks of bias, use appropriate sample sizes, and provide detailed results to investigate the efficacy of peer inclusion interventions for children with ADHD. PMID:29744363

Assessment of Computer-Mediated Module Intervention in a Pharmacy Calculations Course

ERIC Educational Resources Information Center

Bell, Edward C.; Fike, David S.; Liang, Dong; Lockman, Paul R.; McCall, Kenneth L.

2017-01-01

Computer module intervention is the process of exposing students to a series of discrete exercises for the purpose of strengthening students' familiarity with conceptual material. The method has been suggested as a remedy to student under-preparedness. This study was conducted to determine the effectiveness of module intervention in improving and…

Antecedents and mediators of physical activity in endometrial cancer survivors: Increasing physical activity through Steps to Health

PubMed Central

Cox, Matthew; Carmack, Cindy; Hughes, Daniel; Baum, George; Brown, Jubilee; Jhingran, Anuja; Lu, Karen; Basen-Engquist, Karen

2015-01-01

OBJECTIVE Research shows that physical activity (PA) has a positive effect on cancer survivors including improving quality of life, improving physical fitness, and decreasing risk for cancer recurrence in some cancer types. Theory-based intervention approaches have identified self-efficacy as a potential mediator of PA interventions. This study examines the temporal relationships at four time points (T1–T4) between several social cognitive theory constructs and PA among a group of endometrial cancer survivors receiving a PA intervention. METHOD A sample of 98 sedentary women who were at least six months post treatment for endometrial cancer were given an intervention to increase their PA. The study tested whether modeling, physiological somatic sensations, and social support at previous time points predicted self-efficacy at later time points, which in turn predicted PA at later time points. RESULTS Results indicate that as physiological somatic sensations at T2 decrease, self-efficacy at T3 increases, which leads to an increase in PA at T4. This suggests that self-efficacy is a significant mediator between physiological somatic sensations and PA. Exploratory follow up models suggest model fit can be improved with the addition of contemporaneous effects between self-efficacy and PA at T3 and T4, changing the timing of the mediational relationships. CONCLUSIONS Physiological somatic sensations appear to be an important construct to target in order to increase PA in this population. While self-efficacy appeared to mediate the relationship between physiological somatic sensations and PA, the timing of this relationship is requires further study. PMID:25642840

Promoting action control and coping planning to improve hand hygiene.

PubMed

Reyes Fernández, Benjamín; Lippke, Sonia; Knoll, Nina; Blanca Moya, Emanuel; Schwarzer, Ralf

2015-09-25

We examined a brief educational intervention addressing hand hygiene self-regulatory mechanisms, and evaluated which psychological mechanisms may lead to hand hygiene behaviours. Two hundred forty two students (mean age = 21 years, SD = 3.9) received either an experimental (n = 149) or a control condition on action control and planning (n = 93). Hand hygiene, coping planning, and action control were measured at baseline and six weeks later. By applying repeated measures ANOVA, we compared the experimental condition addressing planning to perform hand hygiene with a control condition. Additionally, working mechanisms were evaluated by means of mediation analysis. The intervention had an effect on action control, as reflected by a time by treatment interaction. The direct effect of the intervention on behaviour was, however, non-significant. Changes in action control led to changes in coping planning. These social-cognitive changes mediated the effect of intervention on behaviour, after controlling for gender, baseline behaviour, and classroom membership. In spite of the associations between the intervention and self-regulatory strategies, no direct effect was found of the intervention on behaviour. Further research on how to increase hand sanitizing, involving enviromental characteristics, is required. The intervention led only indirectly to an improvement of hand hygiene via changes in self-regulatory factors. Results indicate the importance of promoting action control and coping planning to initiate changes in hand hygienic behaviours.

Mediation analysis with time varying exposures and mediators

PubMed Central

VanderWeele, Tyler J.; Tchetgen Tchetgen, Eric J.

2016-01-01

Summary In this paper we consider causal mediation analysis when exposures and mediators vary over time. We give non-parametric identification results, discuss parametric implementation, and also provide a weighting approach to direct and indirect effects based on combining the results of two marginal structural models. We also discuss how our results give rise to a causal interpretation of the effect estimates produced from longitudinal structural equation models. When there are time-varying confounders affected by prior exposure and mediator, natural direct and indirect effects are not identified. However, we define a randomized interventional analogue of natural direct and indirect effects that are identified in this setting. The formula that identifies these effects we refer to as the “mediational g-formula.” When there is no mediation, the mediational g-formula reduces to Robins’ regular g-formula for longitudinal data. When there are no time-varying confounders affected by prior exposure and mediator values, then the mediational g-formula reduces to a longitudinal version of Pearl’s mediation formula. However, the mediational g-formula itself can accommodate both mediation and time-varying confounders and constitutes a general approach to mediation analysis with time-varying exposures and mediators. PMID:28824285

Mediation analysis with time varying exposures and mediators.

PubMed

VanderWeele, Tyler J; Tchetgen Tchetgen, Eric J

2017-06-01

In this paper we consider causal mediation analysis when exposures and mediators vary over time. We give non-parametric identification results, discuss parametric implementation, and also provide a weighting approach to direct and indirect effects based on combining the results of two marginal structural models. We also discuss how our results give rise to a causal interpretation of the effect estimates produced from longitudinal structural equation models. When there are time-varying confounders affected by prior exposure and mediator, natural direct and indirect effects are not identified. However, we define a randomized interventional analogue of natural direct and indirect effects that are identified in this setting. The formula that identifies these effects we refer to as the "mediational g-formula." When there is no mediation, the mediational g-formula reduces to Robins' regular g-formula for longitudinal data. When there are no time-varying confounders affected by prior exposure and mediator values, then the mediational g-formula reduces to a longitudinal version of Pearl's mediation formula. However, the mediational g-formula itself can accommodate both mediation and time-varying confounders and constitutes a general approach to mediation analysis with time-varying exposures and mediators.

Enhancing youth outcomes following parental divorce: A longitudinal study of the effects of the New Beginnings Program on educational and occupational goals

PubMed Central

Sigal, Amanda B.; Wolchik, Sharlene A.; Tein, Jenn-Yun; Sandler, Irwin N.

2011-01-01

This study examined whether the New Beginnings Program for divorced families led to improvements in youth’s educational goals and job aspirations six years following participation and tested whether several parenting and youth variables mediated the program effects. Participants were 240 youth aged 9–12 years at the initial assessment, and data were part of a randomized, experimental trial of a parenting skills preventive intervention targeting children’s post-divorce adjustment. The results revealed positive effects of the program on youth’s educational goals and job aspirations six years after participation for those who were at high risk for developing later problems at program entry. Further, intervention-induced changes in mother-child relationship quality and youth externalizing problems, internalizing problems, self-esteem, and academic competence at the six-year follow-up mediated the effects of the program on the educational expectations of high-risk youth. Intervention-induced changes in youth externalizing problems and academic competence at the six-year follow-up mediated the effects of the program on the job aspirations of high-risk youth. Implications of the present findings for research with youth from divorced families and for the public health burden of divorce are discussed. PMID:22417189

Identifying potential working mechanisms behind the positive effects of exercise therapy on pain and function in osteoarthritis; a systematic review.

PubMed

Runhaar, J; Luijsterburg, P; Dekker, J; Bierma-Zeinstra, S M A

2015-07-01

Although physical exercise is the commonly recommended for osteoarthritis (OA) patients, the working mechanism behind the positive effects of physical exercise on pain and function is a black box phenomenon. In the present study we aimed to identify possible mediators in the relation between physical exercise and improvements of pain and function in OA patients. A systematic search for all studies evaluating the effects of physical exercise in OA patients and select those that additionally reported the change in any physiological factor from pre-to post-exercise. In total, 94 studies evaluating 112 intervention groups were included. Most included studies evaluated subjects with solely knee OA (96 out of 112 groups). Based on the measured physiological factors within the included studies, 12 categories of possible mediators were formed. Muscle strength and ROM/flexibility were the most measured categories of possible mediators with 61 and 21 intervention groups measuring one or more physiological factors within these categories, respectively. 60% (31 out of 52) of the studies showed a significant increase in knee extensor muscle strength and 71% (22 out of 31) in knee flexor muscle strength over the intervention period. All 5 studies evaluating extension impairments and 10 out of 12 studies (83%) measuring proprioception found a significant change from pre-to post-intervention. An increase of upper leg strength, a decrease of extension impairments and improvement in proprioception were identified as possible mediators in the positive association between physical exercise and OA symptoms. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Effects of a natural community intervention intensifying alcohol law enforcement combined with a restrictive alcohol policy on adolescent alcohol use.

PubMed

Schelleman-Offermans, Karen; Knibbe, Ronald A; Kuntsche, Emmanuel; Casswell, Sally

2012-12-01

Determining whether intensified inspections on alcohol retailers, combined with a policy withdrawing liquor licenses if retailers are fined twice per annum, is effective in reducing adolescents' odds to initiate weekly drinking and drunkenness. Causal pathways by which the intervention was assumed to work were tested. A longitudinal (2008, 2009, and 2010) quasi-experimental comparison group design including two Dutch communities, one intervention and one comparison, was used. Outcomes were assessed by following a cohort of 1,327 adolescents (aged 13-15 years at baseline). The intervention resulted in increased retail inspections but only seven sanctions and no repeated sanctions in 1 year. The intervention did not reduce adolescents' odds to initiate weekly drinking. Weekly drinking adolescents in the intervention community were at reduced risk to initiate drunkenness. This effect was not mediated by smaller increases in the frequency of adolescents' alcohol purchases or their perceived ease of purchasing alcohol. Intensified enforcement was effective in preventing adolescent drunkenness. No mediating causal pathways were detected. Effectiveness of enforcement could be increased by adopting enforcement methods with a high likelihood of apprehension, increasing social support for restrictive measures, and mobilizing the community to be more outspoken against adolescent (heavy) drinking. Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Influence of Teachers' Personal Health Behaviors on Operationalizing Obesity Prevention Policy in Head Start Preschools: A Project of the Children's Healthy Living Program (CHL).

PubMed

Esquivel, Monica Kazlausky; Nigg, Claudio R; Fialkowski, Marie K; Braun, Kathryn L; Li, Fenfang; Novotny, Rachel

2016-05-01

To quantify the Head Start (HS) teacher mediating and moderating influence on the effect of a wellness policy intervention. Intervention trial within a larger randomized community trial. HS preschools in Hawaii. Twenty-three HS classrooms located within 2 previously randomized communities. Seven-month multi-component intervention with policy changes to food served and service style, initiatives for employee wellness, classroom activities for preschoolers promoting physical activity (PA) and healthy eating, and training and technical assistance. The Environment and Policy Assessment and Observation (EPAO) classroom scores and teacher questionnaires assessing on knowledge, beliefs, priorities, and misconceptions around child nutrition and changes in personal health behaviors and status were the main outcome measures. Paired t tests and linear regression analysis tested the intervention effects on the classroom and mediating and moderating effects of the teacher variables on the classroom environment. General linear model test showed greater intervention effect on the EPAO score where teachers reported higher than average improvements in their own health status and behaviors (estimate [SE] = -2.47 (0.78), P < .05). Strategies to improve teacher health status and behaviors included in a multi-component policy intervention aimed at child obesity prevention may produce a greater effect on classroom environments. Copyright © 2016 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

Balancing competing needs mediates the association of caregiving demand with caregiver role strain and depressive symptoms of dementia caregivers: A cross-sectional study.

PubMed

Liu, Hsin-Yun; Yang, Ching-Tzu; Wang, Yu-Nu; Hsu, Wen-Chuin; Huang, Tzu-Hsin; Lin, Yueh-E; Liu, Chin-Yi; Shyu, Yea-Ing L

2017-12-01

To examine the role of balancing competing needs in the relationship between caregiving demand and caregiving outcomes (caregivers' role strain and depressive symptoms). Caregivers who do not balance competing needs are more likely to experience negative caregiving outcomes, suggesting that balance mediates between caregiving demand and caregiving outcomes. Identifying a mediator of negative caregiving effects may help in developing tailored interventions for family caregivers of persons with dementia. A cross-sectional, correlational design. Data were collected from family caregivers' self-completed questionnaires between March 2013 - April 2014. A convenience sample of 120 family caregivers and care receivers with dementia was enrolled. We examined whether balance mediated the relationship between caregiving demand and caregiving outcomes (caregivers' role strain and depressive symptoms) by multiple regression analysis. To evaluate the significance of the indirect effect of caregiver balance, we used the Sobel test and Monte Carlo method, an alternative approach to testing mediation. Balancing competing needs completely mediated the association of caregiving demand with depressive symptoms and partially mediated the association of caregiving demand with role strain. Assessing caregivers' self-perceived sense of balance may help to identify caregivers at high risk for role strain and depressive symptoms. Interventions to enhance caregivers' perceived sense of balance between competing needs may provide a strategy for reducing the negative effects of caregiving. © 2017 John Wiley & Sons Ltd.

Executive functions and school readiness intervention: Impact, moderation, and mediation in the Head Start REDI program

PubMed Central

BIERMAN, KAREN L.; NIX, ROBERT L.; GREENBERG, MARK T.; BLAIR, CLANCY; DOMITROVICH, CELENE E.

2011-01-01

Despite their potentially central role in fostering school readiness, executive function (EF) skills have received little explicit attention in the design and evaluation of school readiness interventions for socioeconomically disadvantaged children. The present study examined a set of five EF measures in the context of a randomized-controlled trial of a research-based intervention integrated into Head Start programs (Head Start REDI). Three hundred fifty-six 4-year-old children (17% Hispanic, 25% African American; 54% girls) were followed over the course of the prekindergarten year. Initial EF predicted gains in cognitive and social–emotional skills and moderated the impact of the Head Start REDI intervention on some outcomes. The REDI intervention promoted gains on two EF measures, which partially mediated intervention effects on school readiness. We discuss the importance of further study of the neurobiological bases of school readiness, the implications for intervention design, and the value of incorporating markers of neurobiological processes into school readiness interventions. PMID:18606033

Information-Motivation-Behavioral Skills (IMB) Model: testing direct and mediated treatment effects on condom use among women in low-income housing.

PubMed

Anderson, Eileen S; Wagstaff, David A; Heckman, Timothy G; Winett, Richard A; Roffman, Roger A; Solomon, Laura J; Cargill, Victoria; Kelly, Jeffrey A; Sikkema, Kathleen J

2006-02-01

The Information-Motivation-Behavioral Skills (IMB) model of HIV preventive behavior (1-4) specifies that treatment effects on behavior occur largely as the result of treatment effects on behavioral skills, which follow from effects on information and motivation. The objective was to determine whether the variables specified by the IMB model of HIV preventive behavior (1-4) accounted for the relation between an IMB-based treatment and resulting HIV preventive behavior (condom use). Women (n = 557) living in 18 low-income housing developments in 5 geographically dispersed cities were recruited to participate in an HIV-prevention study. Women (within housing developments) were randomly assigned to receive an IMB-based, HIV risk-avoidance intervention or a comparison intervention. Baseline and posttreatment (16 months after baseline) data were collected on condom use information, motivation (social norms, attitudes, intentions, and perceived risk), enactment of behavioral skills (condom negotiation and procurement), and rates of condom use in the past 2 months. The IMB intervention led to a 12% to 16% increase in condom use rates over the course, whereas the comparison intervention led to 2% decrease. In addition, the IMB treatment led to greater increases in condom use information, in the intentions and social norms components of motivation and the condom procurement and condom conversations components of behavioral skills. The IMB model provided an acceptable fit to the data (root mean square error of approximation < .05) and accounted for 50% of the variance in posttreatment condom use among the sample. Treatment effects on condom use were almost entirely mediated by the IMB variables; specifically, motivation and enactment of behavioral skills mediated the intervention's impact on condom use. These results provide supporting evidence as to how theoretical variables operate to effect change within a theory-based intervention and provide evidence as to the applicability of a prevailing theory of HIV risk behavior among low-income minority women.

The process through which an advocacy intervention resulted in positive change for battered women over time.

PubMed

Bybee, Deborah I; Sullivan, Cris M

2002-02-01

A prior experimental evaluation of a community-based advocacy program for women with abusive partners demonstrated positive change in the lives of women even 2 years postintervention (C M. Sullivan & D. I. Bybee, 1999). The current study explored the complex mediational process through which this change occurred, using longitudinal structural equation modeling and formal tests of mediation. As hypothesized, the advocacy intervention first resulted in women successfully obtaining desired community resources and increasing their social support, which enhanced their overall quality of life. This improvement in well-being appeared to serve as a protective factor from subsequent abuse, as women who received the intervention were significantly less likely to be abused at 2-year follow-up compared with women in the control condition. Increased quality of life completely mediated the impact of the advocacy intervention on later reabuse. Discussion places advocacy for women in the context of other efforts that are needed to build an effective community response to preventing intimate violence against women.

Cognitive Mechanisms of Change in Delusions: An Experimental Investigation Targeting Reasoning to Effect Change in Paranoia

PubMed Central

Garety, Philippa; Waller, Helen; Emsley, Richard; Jolley, Suzanne; Kuipers, Elizabeth; Bebbington, Paul; Dunn, Graham; Fowler, David; Hardy, Amy; Freeman, Daniel

2015-01-01

Background: Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. Methods: One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. Results: On an intention-to-treat analysis, there were significant improvements in state paranoia and reasoning in the experimental compared with the control condition. There was evidence that changes in reasoning mediated changes in paranoia, although this effect fell just outside the conventional level of significance after adjustment for baseline confounders. Working memory and negative symptoms significantly moderated the effects of the intervention on reasoning. Conclusion: The study demonstrated the effectiveness of a brief reasoning intervention in improving both reasoning processes and paranoia. It thereby provides proof-of-concept evidence that reasoning is a promising intermediary target in interventions to ameliorate delusions, and thus supports the value of developing this approach as a longer therapeutic intervention. PMID:25053650

Disentangling the effect of illness perceptions on health status in people with type 2 diabetes after an acute coronary event.

PubMed

Vos, Rimke Cathelijne; Kasteleyn, Marise Jeannine; Heijmans, Monique Johanna; de Leeuw, Elke; Schellevis, François Georges; Rijken, Mieke; Rutten, Guy Emile

2018-03-02

Chronically ill patients such as people with type 2 diabetes develop perceptions of their illness, which will influence their coping behaviour. Perceptions are formed once a health threat has been recognised. Many people with type 2 diabetes suffer from multimorbidity, for example the combination with cardiovascular disease. Perceptions of one illness may influence perceptions of the other condition. The aim of the current study was to evaluate the effect of an intervention in type 2 diabetes patients with a first acute coronary event on change in illness perceptions and whether this mediates the intervention effect on health status. The current study is a secondary data analysis of a RCT. Two hundred one participants were randomised (1:1 ratio) to the intervention (n = 101, three home visits) or control group (n = 100). Outcome variables were diabetes and acute coronary event perceptions, assessed with the two separate Brief Illness Perceptions Questionnaires (BIPQs); and health status (Euroqol Visual Analog Scale (EQ-VAS)). The intervention effect was analysed using ANCOVA. Linear regression analyses were used to assess whether illness perceptions mediated the intervention effect on health status. A positive intervention effect was found on the BIPQ diabetes items coherence and treatment control (F = 8.19, p = 0.005; F = 14.01, p < 0.001). No intervention effect was found on the other BIPQ diabetes items consequence, personal control, identity, illness concern and emotional representation. Regarding the acute coronary event, a positive intervention effect on treatment control was found (F = 7.81, p = 0.006). No intervention effect was found on the other items of the acute coronary event BIPQ. Better diabetes coherence was associated with improved health status, whereas perceiving more treatment control was not. The mediating effect of the diabetes perception 'coherence' on health status was not significant. Targeting illness perceptions of people with diabetes after an acute coronary event has no effect on most domains, but can improve the perceived understanding of their diabetes. Discussing perceptions prevents people with type 2 diabetes who recently experienced an acute coronary event from the perception that they will lose control of both their diabetes and the acute coronary event. Illness perceptions of diabetes patients should therefore be discussed in the dynamic period after an acute coronary event. Nederlands trial register; NTR3076 , Registered September 20 2011.

Blue-Collar Scholars?: Mediators and Moderators of University Attrition in First-Generation College Students

PubMed Central

Martinez, Julia A.; Sher, Kenneth J.; Krull, Jennifer L.; Wood, Phillip K.

2009-01-01

Many college entrants’ parents do not have college degrees. These entrants are at high risk for attrition, suggesting it is critical to understand mechanisms of attrition relative to parental education. Moderators and mediators of the effect of parental education on attrition were investigated in 3,290 students over 4 years. Low parental education was a risk for attrition; importantly, college GPAs both moderated and mediated this effect, and ACT scores, scholarships, loans, and full-time work mediated this effect. Drug use, psychological distress, and few reported academic challenges predicted attrition, independent of parental education. These findings might inform interventions to decrease attrition. PMID:19750141

The role of self-regulatory skills and automaticity on the effectiveness of a brief weight loss habit-based intervention: secondary analysis of the 10 top tips randomised trial.

PubMed

Kliemann, Nathalie; Vickerstaff, Victoria; Croker, Helen; Johnson, Fiona; Nazareth, Irwin; Beeken, Rebecca J

2017-09-05

Habit-interventions are designed to promote the automaticity of healthy behaviours and may also enhance self-regulatory skills during the habit-formation process. A recent trial of habit-based advice for weight loss (10 Top Tips; 10TT), found that patients allocated to 10TT lost significantly more weight over 3 months than those allocated to usual care, and reported greater increases in automaticity for the target behaviours. The current study aimed to test the hypothesis that i) 10TT increased self-regulatory skills more than usual care, and ii) that self-regulatory skills and automaticity changes mediated the effect of 10TT on weight loss. 537 obese patients from 14 primary care practices in the UK were randomized to receive 10TT or usual care. Patients in the 10TT group received a leaflet containing tips for weight loss and healthy habits formation, a self-monitoring log book and a wallet-sized shopping guide on how to read food labels. Patients were weighed and completed validated questionnaires for self-regulation and automaticity at baseline and 3-month follow-up. Within-group and Between-group effects were explored using Paired T-test and ANCOVA, respectively. Mediation was assessed using bootstrapping to estimate indirect effects and the sobel test. Over 3 months patients who were given 10TT reported greater increases in self-regulatory skills (Mean difference: .08; 95% CI .01; .15) than those who received usual care. Changes in self-regulatory skills and automaticity over 3 months mediated the effect of the intervention on weight loss (β = .52, 95% Bias Corrected CI .17; .91). As hypothesised, 10TT enhanced self-regulatory skills and changes in self-regulatory skills and automaticity mediated the effect of the intervention on weight loss. This supports the proposition that self-regulatory training and habit formation are important features of weight loss interventions. This study was prospectively registered with the International Standard Randomised Controlled Trials ( ISRCTN16347068 ) on 26 September 2011.

[Prevention of overweight and obesity in children and adolescents : Critical appraisal of the evidence base].

PubMed

Pigeot, Iris; Baranowski, Tom; Lytle, Leslie; Ahrens, Wolfgang

2016-11-01

Despite careful planning and implementation, overweight/obesity prevention interventions in children and adolescents typically show no, inconsistent or merely weak effects. Such programs usually aim at behavior changes, rarely also at environmental changes, that draw upon conventional wisdom regarding the commonly accepted determinants of childhood overweight/obesity. This paper evaluates the evidence base of the apparently overweight-/obesity-related determinants diet, physical activity and stress. The results of international intervention studies are discussed against this background. Based on the mediating-moderating variable model, we investigate the effect of theory specified mediating variables and how potential moderating variables may impact these relationships. Contrary to common beliefs, recent research has revealed inconsistent evidence regarding associations between potentially obesogenic behaviors and overweight/obesity in youth. Moreover, the evidence for strong and causal relationships between mediating variables and targeted behaviors seems to be inconsistent. In addition, inadequate attention is paid to moderating effects. The etiology of overweight/obesity in youth is likely the result of a complex interplay of multi-causal influences. Future prevention interventions would benefit from a more thorough understanding of the complex relationships that have been hypothesized and of the mechanisms of suspected behaviors for affecting overweight/obesity. Only if substantial change can be demonstrated in mediators with reasonable effort under real world circumstances, it will make sense to progress to community behavior change trials.

Peripheral Interventions Enhancing Brain Glutamate Homeostasis Relieve Amyloid β- and TNFα- Mediated Synaptic Plasticity Disruption in the Rat Hippocampus.

PubMed

Zhang, Dainan; Mably, Alexandra J; Walsh, Dominic M; Rowan, Michael J

2017-07-01

Dysregulation of glutamate homeostasis in the interstitial fluid of the brain is strongly implicated in causing synaptic dysfunction in many neurological and psychiatric illnesses. In the case of Alzheimer's disease (AD), amyloid β (Aβ)-mediated disruption of synaptic plasticity and memory can be alleviated by interventions that directly remove glutamate or block certain glutamate receptors. An alternative strategy is to facilitate the removal of excess glutamate from the nervous system by activating peripheral glutamate clearance systems. One such blood-based system, glutamate oxaloacetate transaminase (GOT), is activated by oxaloacetate, which acts as a co-substrate. We report here that synthetic and AD brain-derived Aβ-mediated inhibition of synaptic long-term potentiation in the hippocampus is alleviated by oxaloacetate. Moreover the effect of oxaloacetate was GOT-dependent. The disruptive effects of a general inhibitor of excitatory amino acid transport or TNFα, a pro-inflammatory mediator of Aβ action, were also reversed by oxaloacetate. Furthermore, another intervention that increases peripheral glutamate clearance, peritoneal dialysis, mimicked the beneficial effect of oxaloacetate. These findings lend support to the promotion of the peripheral clearance of glutamate as a means to alleviate synaptic dysfunction that is caused by impaired glutamate homeostasis in the brain. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Assessing a change mechanism in a randomized home-visiting trial: Reducing disrupted maternal communication decreases infant disorganization.

PubMed

Tereno, Susana; Madigan, Sheri; Lyons-Ruth, Karlen; Plamondon, Andre; Atkinson, Leslie; Guedeney, Nicole; Greacen, Tim; Dugravier, Romain; Saias, Thomas; Guedeney, Antoine

2017-05-01

Although randomized interventions trials have been shown to reduce the incidence of disorganized attachment, no studies to date have identified the mechanisms of change responsible for such reductions. Maternal sensitivity has been assessed in various studies and shown to change with intervention, but in the only study to formally assess mediation, changes in maternal sensitivity did not mediate changes in infant security of attachment (Cicchetti, Rogosch, & Toth, 2006). Primary aims of the current randomized controlled intervention trial in a high-risk population were to fill gaps in the literature by assessing whether the intervention (a) reduced disorganization, (b) reduced disrupted maternal communication, and (c) whether reductions in disrupted maternal communication mediated changes in infant disorganization. The results indicated that, compared to controls (n = 52), both infant disorganization and disrupted maternal communication were significantly reduced in the intervention group (n = 65) that received regular home-visiting during pregnancy and the first year of life. Furthermore, reductions in disrupted maternal communication partially accounted for the observed reductions in infant disorganization compared to randomized controls. The results are discussed in relation to the societal cost effectiveness of early attachment-informed interventions for mothers and infants, as well as the importance of formally assessing underlying mechanisms of change in order to improve and appropriately target preventive interventions.

The relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes.

PubMed

Marquez, Becky; Anderson, Andrea; Wing, Rena R; West, Delia S; Newton, Robert L; Meacham, Maria; Hazuda, Helen P; Peters, Anne; Montez, Maria G; Broyles, Stephanie T; Walker, Martha; Evans-Hudsnall, Gina

2016-03-01

Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss. Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year. Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss. Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos. © 2016 The Obesity Society.

The relationship of social support with treatment adherence and weight loss in Latinos with type 2 diabetes

PubMed Central

Marquez, Becky; Anderson, Andrea; Wing, Rena R.; West, Delia S.; Newton, Robert L.; Meacham, Maria; Hazuda, Helen P.; Peters, Anne; Montez, Maria G.; Broyles, Stephanie T.; Walker, Martha; Evans-Hudsnall, Gina

2016-01-01

Objective Little is known about the effects of social support on weight loss in Latinos. This study determined whether sex moderated and treatment adherence mediated the association between social support and weight loss. Methods Data from 278 Latino males and females with type 2 diabetes in the Intensive Lifestyle Intervention of the Look AHEAD trial were analyzed. Multivariable modeling tested for moderation and parallel multiple mediator modeling simultaneously tested the mediating effects of adherence to physical activity, diet, and session attendance on the relationship between baseline social support and percent weight loss at 1 year. Results Social support for physical activity (having family and friends join in physical activity) was related to weight loss. Adherence to physical activity was related to both social support for physical activity and weight loss. Sex did not moderate these relationships. Adherence to physical activity completely mediated the relationship between social support for physical activity and weight loss. Conclusion Increasing companionship for physical activity may be an effective intervention strategy to promote behaviors important for weight loss among Latinos. PMID:26833676

Single-Participant Assessment of Treatment Mediators: Strategy Description and Examples from a Behavioral Activation Intervention for Depressed Adolescents

ERIC Educational Resources Information Center

Gaynor, Scott T.; Harris, Amanda

2008-01-01

Determining the means by which effective psychotherapy works is critical. A generally recommended strategy for identifying the potential causal variables is to conduct group-level statistical tests of treatment mediators. Herein the case is made for also assessing mediators of treatment outcome at the level of the individual participant.…

Mediation and Spillover Effects in Group-Randomized Trials with Application to the 4Rs Evaluation

ERIC Educational Resources Information Center

VanderWeele, Tyler J.; Hong, Guanglei; Jones, Stephanie M.; Brown, Joshua L.

2011-01-01

In this paper the authors extend recent work on mediation in a multilevel setting and on causal inference under interference among units to develop a template for the mediation analysis of group randomized educational interventions. The present work will contribute to the literature on interference, in particular on interference in the context of…

Effects of Mindfulness-Based Stress Reduction Intervention on Psychological Well-being and Quality of Life: Is Increased Mindfulness Indeed the Mechanism?

PubMed Central

Kuijpers, Karlijn F.

2008-01-01

Background Although several studies have reported positive effects of mindfulness-based stress reduction (MBSR) intervention on psychological well-being, it is not known whether these effects are attributable to a change in mindfulness. Purpose The aim of this study is to compare the effects of MBSR to a waiting-list control condition in a randomized controlled trial while examining potentially mediating effects of mindfulness. Methods Forty women and 20 men from the community with symptoms of distress (mean age 43.6 years, SD = 10.1) were randomized into a group receiving MBSR or a waiting-list control group. Before and after the intervention period, questionnaires were completed on psychological well-being, quality of life, and mindfulness. Results Repeated measures multiple analysis of variance (MANCOVAs) showed that, compared with the control group, the intervention resulted in significantly stronger reductions of perceived stress (p = 0.016) and vital exhaustion (p = 0.001) and stronger elevations of positive affect (p = 0.006), quality of life (p = .009), as well as mindfulness (p = 0.001). When mindfulness was included as a covariate in the MANCOVA, the group effects on perceived stress and quality of life were reduced to nonsignificance. Conclusion Increased mindfulness may, at least partially, mediate the positive effects of mindfulness-based stress reduction intervention. PMID:18535870

Role of smoking intention in tobacco use reduction: A mediation analysis of an effective classroom-based prevention/cessation intervention for adolescents.

PubMed

Gonzálvez, María T; Morales, Alexandra; Orgilés, Mireia; Sussman, Steve; Espada, José P

2018-09-01

Although some school-based tobacco cessation and prevention programs have been proven to be effective, there remains a lack of understanding of how these programs succeed. This longitudinal study aimed to test smoking intention as a mediator of Project EX's intervention efficacy to reduce tobacco use. Using a computerized random number generator, six high schools located in the Mediterranean coast were randomly selected to participate in the program condition (Spanish version of Project EX) or the waiting-list control group with baseline, immediate-posttest, and 12-month follow-up assessments. At baseline, 685 adolescents aged 14-20 years (mean age: 14.87; SD = 0.92; 47.4% were females) were evaluated using self-administered tests of tobacco, and smoking intention. A biomarker of smoke inhalation, a measurement of exhaled carbon monoxide (ECM), was used. Mediation analyses were conducted using the PROCESS v2.12 macro for Windows. Project EX had a significant effect on smoking intention. Indirect effects indicated that Project EX reduced the ECM level, and number of cigarettes used. This is the first Spanish study that explored intention as a mediator of the long-term efficacy of Project EX to reduce tobacco use in adolescents. Results suggested that interventions that reduce consumption intention at short-term are more likely to be successful in decreasing tobacco use in the long-term. Copyright © 2018 Elsevier Ltd. All rights reserved.

Ecological pathways to prevention: How does the SASA! community mobilisation model work to prevent physical intimate partner violence against women?

PubMed

Abramsky, Tanya; Devries, Karen M; Michau, Lori; Nakuti, Janet; Musuya, Tina; Kiss, Ligia; Kyegombe, Nambusi; Watts, Charlotte

2016-04-16

Intimate partner violence (IPV) against women is a global public health concern. While community-level gender norms and attitudes to IPV are recognised drivers of IPV risk, there is little evidence on how interventions might tackle these drivers to prevent IPV at the community-level. This secondary analysis of data from the SASA! study explores the pathways through which SASA!, a community mobilisation intervention to prevent violence against women, achieved community-wide reductions in physical IPV. From 2007 to 2012 a cluster randomised controlled trial (CRT) was conducted in eight communities in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, aged 18-49, were undertaken at baseline (n = 1583) and 4 years post intervention implementation (n = 2532). We used cluster-level intention to treat analysis to estimate SASA!'s community-level impact on women's past year experience of physical IPV and men's past year perpetration of IPV. The mediating roles of community-, relationship- and individual-level factors in intervention effect on past year physical IPV experience (women)/perpetration (men) were explored using modified Poisson regression models. SASA! was associated with reductions in women's past year experience of physical IPV (0.48, 95 % CI 0.16-1.39), as well as men's perpetration of IPV (0.39, 95 % CI 0.20-0.73). Community-level normative attitudes were the most important mediators of intervention impact on physical IPV risk, with norms around the acceptability of IPV explaining 70 % of the intervention effect on women's experience of IPV and 95 % of the effect on men's perpetration. The strongest relationship-level mediators were men's reduced suspicion of partner infidelity (explaining 22 % of effect on men's perpetration), and improved communication around sex (explaining 16 % of effect on women's experience). Reduced acceptability of IPV among men was the most important individual-level mediator (explaining 42 % of effect on men's perpetration). These results highlight the important role of community-level norm-change in achieving community-wide reductions in IPV risk. They lend strong support for the more widespread adoption of community-level approaches to preventing violence. ClinicalTrials.gov, NCT00790959 . Registered 13th November 2008. The study protocol is available at: http://www.trialsjournal.com/content/13/1/96.

A systematic review investigating the behaviour change strategies in interventions to prevent misuse of anabolic steroids.

PubMed

Bates, Geoff; Begley, Emma; Tod, David; Jones, Lisa; Leavey, Conan; McVeigh, Jim

2017-10-01

We examined intervention effectiveness of strategies to prevent image- and performance-enhancing drug use. Comprehensive searches identified 14 interventions that met review inclusion criteria. Interventions were predominantly educational and delivered within school sport settings, but targeted a wide range of mediating factors. Identification of effective components was limited across studies by brief or imprecise descriptions of intervention content, lack of behavioural outcome measures and short-term follow-up times. However, studies with components in addition to information provision may be more promising. Interventions outside of sport settings are required to reflect the transition of this form of substance use to the general population.

Mother-Child Joint Writing and Storybook Reading and Their Effects on Kindergartners' Literacy: An Intervention Study

ERIC Educational Resources Information Center

Levin, Iris; Aram, Dorit

2012-01-01

This study assessed the effects of three different intervention programs on low-SES mother-child joint activities and on their kindergarten-age children's progress in early literacy and language. Parents in three groups (119 mothers, 5 fathers) were coached to mediate child learning, respectively, in: interactive storybook reading, writing, or…

Moderated Effects of Risky Behavior on Academic Performance among Adolescent Girls Living in Urban Slums of Kenya

ERIC Educational Resources Information Center

Ngware, Moses W.; Mahuro, Gerald M.; Hungi, Njora; Abuya, Benta; Nyariro, Milka P.; Mutisya, Maurice

2016-01-01

This paper examines effects of life-skills, mentoring, and counseling education intervention implemented among primary school attending girls aged between 10 and 19 years, living in Nairobi slums. We hypothesized that interaction between the intervention and aspiration, self-confidence and interest in schooling, mediates the impact of risky…

Using the Internet to promote physical activity: a randomized trial of intervention delivery modes.

PubMed

Steele, Rebekah; Mummery, W Kerry; Dwyer, Trudy

2007-07-01

A growing number of the population are using the Internet for health information, such as physical activity (PA). The aim of this study was to examine the effectiveness of delivery modes for a behavior change program targeting PA. A randomized trial was conducted with 192 subjects randomly allocated to either a face-to-face, Internet-mediated, or Internet-only arm of a 12-wk intervention. Subjects included inactive adults with Internet access. The primary outcome variable was self-reported PA, assessed at four time points. The results showed no group x time interaction for PA F(6, 567) = 1.64, p > 0.05, and no main effect for group F(2, 189) = 1.58, p > 0.05. However, a main effect for time F(3, 567) = 75.7, p < 0.01 was observed for each group. All groups were statistically equivalent immediately post-intervention (p < 0.05), but not at the follow-up time points (p > 0.05). The Internet-mediated and Internet-only groups showed similar increases in PA to the face-to-face group immediately post-intervention. This study provides evidence in support of the Internet in the delivery of PA interventions and highlights avenues for future research.

Evaluating guilt and shame in an expressive writing alcohol intervention.

PubMed

Rodriguez, Lindsey M; Young, Chelsie M; Neighbors, Clayton; Campbell, Michelle T; Lu, Qian

2015-08-01

Expressive writing interventions have shown positive physical and psychological health benefits over time, with the presumed mechanism being emotional disclosure. However, work utilizing expressive writing in behavior change has been minimal. The current research applied the expressive writing paradigm to reduce drinking intentions among college students, and evaluated the role of event-related guilt and shame in intervention effects. College students (N=429) completed a baseline survey and were randomly assigned to one of three conditions: Negative (write about a heavy drinking event that was negative); Positive (write about a heavy drinking event that was positive); or Neutral (write about their first day of college). After writing, readiness to change and future drinking intentions were assessed. Results revealed intervention effects on intended drinks per week and intended number of drinks during peak and typical drinking occasions. Participants in the negative condition also displayed higher levels of event-related guilt and shame. Results showed that guilt mediated intervention effects on readiness to change, which also mediated the association between guilt-reparative behavior and drinking intentions. Results provide initial support for an expressive writing intervention on alcohol use and underscore the importance of eliciting emotions associated with reparative behavior when considering negative past experiences and future behavior change. Copyright © 2015 Elsevier Inc. All rights reserved.

Evaluating guilt and shame in an expressive writing alcohol intervention

PubMed Central

Rodriguez, Lindsey M.; Young, Chelsie M.; Neighbors, Clayton; Campbell, Michelle T.; Lu, Qian

2016-01-01

Expressive writing interventions have shown positive physical and psychological health benefits over time, with the presumed mechanism being emotional disclosure. However, work utilizing expressive writing in behavior change has been minimal. The current research applied the expressive writing paradigm to reduce drinking intentions among college students, and evaluated the role of event-related guilt and shame in intervention effects. College students (N = 429) completed a baseline survey and were randomly assigned to one of three conditions: Negative (write about a heavy drinking event that was negative); Positive (write about a heavy drinking event that was positive); or Neutral (write about their first day of college). After writing, readiness to change and future drinking intentions were assessed. Results revealed intervention effects on intended drinks per week and intended number of drinks during peak and typical drinking occasions. Participants in the negative condition also displayed higher levels of event-related guilt and shame. Results showed that guilt mediated intervention effects on readiness to change, which also mediated the association between guilt-reparative behavior and drinking intentions. Results provide initial support for an expressive writing intervention on alcohol use and underscore the importance of eliciting emotions associated with reparative behavior when considering negative past experiences and future behavior change. PMID:26074424

What do we know about preventing school violence? A systematic review of systematic reviews.

PubMed

Lester, Soraya; Lawrence, Cayleigh; Ward, Catherine L

2017-03-01

Many children across the world are exposed to school violence, which undermines their right to education and adversely affects their development. Studies of interventions for school violence suggest that it can be prevented. However, this evidence base is challenging to navigate. We completed a systematic review of interventions to reduce four types of school violence: (a) peer violence; (b) corporal punishment; (c) student-on-teacher violence and (d) teacher-on-student violence. Reviewers independently searched databases and journals. Included studies were published between 2005 and 2015; in English; considered school-based interventions for children and measured violence as an outcome. Many systematic reviews were found, thus we completed a systematic review of systematic reviews. Only systematic reviews on interventions for intimate partner violence (IPV) and peer aggression were found. These reviews were generally of moderate quality. Research on both types of violence was largely completed in North America. Only a handful of programmes demonstrate promise in preventing IPV. Cognitive behavioral, social-emotional and peer mentoring/mediation programmes showed promise in reducing the levels of perpetration of peer aggression. Further research needs to determine the long-term effects of interventions, potential moderators and mediators of program effects, program effects across different contexts and key intervention components.

Effects of Joint Attention Mediated Learning for Toddlers with Autism Spectrum Disorders: An Initial Randomized Controlled Study

ERIC Educational Resources Information Center

Schertz, Hannah H.; Odom, Samuel L.; Baggett, Kathleen M.; Sideris, John H.

2013-01-01

The purpose of this study was to determine effects of the Joint Attention Mediated Learning (JAML) intervention on acquisition of joint attention and other early social communication competencies for toddlers with autism spectrum disorders (ASD). Twenty-three parents and their toddlers were randomly assigned to JAML or a control condition.…

Mediators of the Development and Prevention of Violent Behavior

PubMed Central

Morgan-Lopez, Antonio A.; Howard, Terry-Lee; Browne, Dorothy C.; Flay, Brian R.

2008-01-01

The purpose of this investigation was to determine if the Aban Aya Youth Project, a culturally grounded intervention, produced differences in changes over time in core intervening variables (i.e., communal value orientation, empathy, violence avoidance efficacy beliefs) and whether these variables mediated intervention effects on the development of youth violent behavior. Fifth grade cohorts at 12 schools were randomly assigned to one of two intervention conditions or an attention placebo control condition and followed longitudinally through eighth grade. A total of 668 students (49% male) participated in the study. Mediation analyses suggested that both program conditions (as compared to the control condition) led to steeper increases over time in empathy which, in turn were related to reductions in the likelihood of violent behavior over time. No other significant program effects were detected, although changes over time in violence avoidance efficacy were associated with reduced likelihood of violent behavior. Findings are discussed in terms of theory development, program development and points of refinement of the Aban Aya Youth Project and implications for future research. PMID:17558552

The role of family-related factors in the effects of the UP4FUN school-based family-focused intervention targeting screen time in 10- to 12-year-old children: the ENERGY project.

PubMed

Van Lippevelde, Wendy; Bere, Elling; Verloigne, Maïté; van Stralen, Maartje M; De Bourdeaudhuij, Ilse; Lien, Nanna; Vik, Frøydis Nordgård; Manios, Yannis; Grillenberger, Monika; Kovács, Eva; ChinAPaw, Mai J M; Brug, Johannes; Maes, Lea

2014-08-18

Screen-related behaviours are highly prevalent in schoolchildren. Considering the adverse health effects and the relation of obesity and screen time in childhood, efforts to affect screen use in children are warranted. Parents have been identified as an important influence on children's screen time and therefore should be involved in prevention programmes. The aim was to examine the mediating role of family-related factors on the effects of the school-based family-focused UP4FUN intervention aimed at screen time in 10- to 12-year-old European children (n child-parent dyads = 1940). A randomised controlled trial was conducted to test the six-week UP4FUN intervention in 10- to 12-year-old children and one of their parents in five European countries in 2011 (n child-parent dyads = 1940). Self-reported data of children were used to assess their TV and computer/game console time per day, and parents reported their physical activity, screen time and family-related factors associated with screen behaviours (availability, permissiveness, monitoring, negotiation, rules, avoiding negative role modeling, and frequency of physically active family excursions). Mediation analyses were performed using multi-level regression analyses (child-school-country). Almost all TV-specific and half of the computer-specific family-related factors were associated with children's screen time. However, the measured family-related factors did not mediate intervention effects on children's TV and computer/game console use, because the intervention was not successful in changing these family-related factors. Future screen-related interventions should aim to effectively target the home environment and parents' practices related to children's use of TV and computers to decrease children's screen time. The study is registered in the International Standard Randomised Controlled Trial Number Register (registration number: ISRCTN34562078).

Relationship between self-efficacy and physical activity among patients with type 2 diabetes.

PubMed

Dutton, Gareth R; Tan, Fei; Provost, Bridgette C; Sorenson, Jamie L; Allen, Brandon; Smith, Dawn

2009-06-01

While previous studies indicate a significant relationship between self-efficacy and physical activity, less research has focused on this relationship among patients with type 2 diabetes. The purpose of this investigation was to examine whether self-efficacy mediated the relationship between participation in a 1-month, print-based physical activity intervention and improvements in activity levels. Participants (N = 85; mean age = 57; 73% Caucasian; 69% female) were recruited from a community diabetes center. The intervention was individually-tailored based on theoretical constructs, including self-efficacy. After controlling for age, baseline activity, and baseline self-efficacy, the tailored intervention was associated with significant improvements in physical activity, 95% CI [23.01, 271.68] as well as self-efficacy, CI [0.02, 3.48]. There was an indirect effect of treatment on physical activity through self-efficacy, CI [0.77, 73.11], and the direct effect of treatment on physical activity was no longer significant, CI [-7.33, 253.40], after the influences of self-efficacy change were accounted for in the model. Results supported a mediation effect, such that the treatment effect on physical activity was completely mediated by changes in self-efficacy. Although replication is needed, results support the theoretical rationale for targeting self-efficacy to promote physical activity among patients with type 2 diabetes.

Cognitive and affective mechanisms of pain and fatigue in multiple sclerosis.

PubMed

Arewasikporn, Anne; Turner, Aaron P; Alschuler, Kevin N; Hughes, Abbey J; Ehde, Dawn M

2018-06-01

To examine the extent to which pain catastrophizing, fatigue catastrophizing, positive affect, and negative affect simultaneously mediated the associations between common symptoms of multiple sclerosis (MS; i.e., pain, fatigue) and impact on daily life, depressive symptoms, and resilience. Participants were community-dwelling adults with MS (N = 163) reporting chronic pain, fatigue, and/or moderate depressive symptoms. Multiple mediation path analysis was used to model potential mediators of pain and fatigue separately, using baseline data from a randomized controlled trial comparing two symptom self-management interventions. In the pain model, pain catastrophizing was a mediator of pain intensity with pain interference and depression. Negative affect was a mediator of pain intensity with depression and resilience. In the fatigue model, fatigue catastrophizing was a mediator of fatigue intensity with fatigue impact and depression. Positive affect was a mediator of fatigue intensity with depression and resilience. These findings provide preliminary support for the presence of differential effects of cognitive-affective mediators and suggest potential targets for psychological interventions based on an individual's clinical presentation. The differential mediating effects also support the inclusion of both positive and negative aspects of psychological health in models of pain and fatigue, which would not be otherwise apparent if negative constructs were examined in isolation. To our knowledge, this is the first study to utilize a multivariate path analysis approach to examine cognitive-affective mediators of pain and fatigue in MS, while also examining positive and negative constructs concurrently. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Healthy active living: a residence community-based intervention to increase physical activity and healthy eating during the transition to first-year university.

PubMed

Brown, Denver M Y; Bray, Steve R; Beatty, Kevin R; Kwan, Matthew Y W

2014-01-01

To examine the effects of a Healthy Active Living (HAL) community intervention on moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption (FVC), and psychosocial mediators of physical activity among students transitioning into university. Sixty undergraduate students were assigned to reside in either the HAL community or no-treatment control residence and completed questionnaire measures at the beginning and end of the academic year. Students living in the HAL community reported significantly more MVPA (F[1, 58]=19.93, p<.001, ηp2=.26) and greater FVC (F[1, 56]=3.12, p=.08, ηp2=.05) compared with controls. Participants in the HAL condition also scored significantly higher in action planning (F[1, 58]=4.79, p<.05, ηp2=.08), partially mediating the effect of the intervention on MVPA. A peer-delivered healthy lifestyles intervention targeting first-year university students appears to be effective in preserving or enhancing health behaviors and cognitions during their transition into university life.

Parent-mediated reading interventions with children up to four years old: a systematic review.

PubMed

Sloat, Elizabeth A; Letourneau, Nicole L; Joschko, Justin R; Schryer, Erin A; Colpitts, Jennifer E

2015-03-01

Research demonstrates that literacy and academic achievement are predicated on the emergent literacy knowledge and skills children acquire from birth up to 4 years of age. Parents are children's first and most important language and literacy teachers, yet not all parents have the capacity to establish an adequate early literacy foundation. Efforts to address this situation have resulted in numerous programs aimed at fostering emergent literacy development. This systematic review evaluates evidence on the effectiveness of parent-mediated interventions that increase the time parents spend reading with young children up to 4 years old. Four studies met inclusion criteria, reporting outcomes for 664 children. Three provided data for meta-analysis of effects on reading duration. The standardized mean difference in reading duration was 1.61 (95% CI, 1.03, 2.19 fixed-effect), favoring intervention over control. Results indicate that interventions aimed at increasing the amount of time parents spend reading interactively with their children yield positive results. Findings also demonstrate that pediatric primary care providers are well positioned to deliver reading promotion programs to parents and preschoolers.

Testing a multiple mediator model of the effect of childhood sexual abuse on adolescent sexual victimization.

PubMed

Bramsen, Rikke H; Lasgaard, Mathias; Koss, Mary P; Shevlin, Mark; Elklit, Ask; Banner, Jytte

2013-01-01

The present study modeled the direct relationship between child sexual abuse (CSA) and adolescent peer-to-peer sexual victimization (APSV) and the mediated effect via variables representing the number of sexual partners, sexual risk behavior, and signaling sexual boundaries. A cross-sectional study on the effect of CSA on APSV was conducted, utilizing a multiple mediator model. Mediated and direct effects in the model were estimated employing Mplus using bootstrapped percentile based confidence intervals to test for significance of mediated effects. The study employed 327 Danish female adolescents with a mean age of 14.9 years (SD = 0.5). The estimates from the mediational model indicated full mediation of the effect of CSA on APSV via number of sexual partners and sexual risk behavior. The current study suggests that the link between CSA and APSV was mediated by sexual behaviors specifically pertaining to situations of social peer interaction, rather than directly on prior experiences of sexual victimization. The present study identifies a modifiable target area for intervention to reduce adolescent sexual revictimization. © 2013 American Orthopsychiatric Association.

Effects of relationship education on couple communication and satisfaction: A randomized controlled trial with low-income couples.

PubMed

Williamson, Hannah C; Altman, Noemi; Hsueh, JoAnn; Bradbury, Thomas N

2016-02-01

Although preventive educational interventions for couples have been examined in more than 100 experimental studies, the value of this work is limited by reliance on economically advantaged populations and by an absence of data on proposed mediators and moderators. Data from the Supporting Healthy Marriage Project-a randomized, controlled trial of relationship education for couples living with low incomes-were therefore analyzed to test whether intervention effects on relationship satisfaction would be mediated by observational assessments of relationship communication and whether any such effects would be moderated by couples' pretreatment risk. Within the larger sample of Supporting Healthy Marriage Project couples randomized to a relationship education or no-treatment control condition, the present analyses focus on the 1,034 couples who provided (a) data on sociodemographic risk at baseline, (b) observational data on couple communication 12 months after randomization, and (c) reports of relationship satisfaction 30 months after randomization. Intervention couples reported higher satisfaction at 30 months than control couples, regardless of their level of pretreatment risk. Among higher risk couples, the intervention improved observed communication as well. Contrary to prediction, treatment effects on satisfaction were not mediated by improvements in communication, and improvements in communication did not translate into greater satisfaction. Relationship education programs produce small improvements in relationship satisfaction and communication, particularly for couples at elevated sociodemographic risk. The absence of behavioral effects on satisfaction indicates, however, that the mechanisms by which couples may benefit from relationship education are not yet well understood. (c) 2016 APA, all rights reserved).

Neighborhood Social Cohesion as a Mediator of Neighborhood Conditions on Mothers' Engagement in Physical Activity: Results From the Geographic Research on Wellbeing Study.

PubMed

Yuma-Guerrero, Paula J; Cubbin, Catherine; von Sternberg, Kirk

2017-12-01

The purpose of this study was to determine if social cohesion mediates the effects of neighborhood and household-level socioeconomic status (SES), perceptions of neighborhood safety, and access to parks on mothers' engagement in physical activity (PA). Secondary analyses were conducted on cross-sectional data from The Geographic Research on Wellbeing (GROW) study. GROW includes survey data from a diverse sample of 2,750 California mothers. Structural equation modeling was used to test a conceptual multilevel mediation model, proposing social cohesion as a mediator of known predictors of PA. Social cohesion fully mediated the pathway from perceived neighborhood safety to mothers' PA. Social cohesion also mediated the significant relationship between neighborhood SES and PA; however, this mediation finding was not practically significant when considered in the context of the full model. Household SES was significantly positively related to both social cohesion and PA. Park access contributed significantly to social cohesion but not directly to PA Social cohesion did not significantly mediate relationships between park access or household SES and PA. There is a need for public health interventions to improve engagement in PA among individuals and neighborhoods with lower levels of socioeconomic resources. Interventions that create social cohesion within neighborhoods may have positive effects on mothers' PA, particularly in neighborhoods perceived as unsafe.

The impact of patient and physician computer mediated communication skill training on reported communication and patient satisfaction.

PubMed

Roter, Debra L; Wexler, Randy; Naragon, Phyllis; Forrest, Brian; Dees, Jason; Almodovar, Astrid; Wood, Julie

2012-09-01

The objective was to evaluate parallel patient and physician computer-mediated communication skill training on participants' report of skill use and patient satisfaction. Separate patient and clinician web-tools comprised of over 500, 10-s video clips demonstrating patient-centered skills in various ways. Four clinician members of the American Academy of Family Physicians National Research Network participated by enrolling 194 patients into a randomized patient trial and 29 physicians into a non-randomized clinician trial of respective interventions. All participants completed baseline and follow-up self-report measures of visit communication and satisfaction. Intervention patients reported using more skills than controls in five of six skill areas, including identification of problems/concerns, information exchange, treatment adherence, shared decision-making and interpersonal rapport (all p<.05); post intervention, physicians reported using more skills in the same 5 areas (all p<.01). Intervention group patients reported higher levels of satisfaction than controls in five of six domains (all p<.05). Communication skill training delivered in a computer mediated format had a positive and parallel impact on both patient and clinician reported use of patient-centered communication and in patient satisfaction. Computer-mediated interventions are cost and time effective thereby increasing patient and clinician willingness to undertake training. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Comparing the Efficiency of Repeated Reading and Listening-While-Reading to Improve Fluency and Comprehension

ERIC Educational Resources Information Center

Hawkins, Renee O.; Marsicano, Richard; Schmitt, Ara J.; McCallum, Elizabeth; Musti-Rao, Shobana

2015-01-01

An alternating treatments design was used to compare the effects of two reading fluency interventions on the oral reading fluency and maze accuracy of four fourth-grade students. Also, by taking into account time spent in intervention, the efficiency of the two interventions was compared. In the adult-mediated repeated reading (RR) condition,…

Understanding How Sexual and Gender Minority Stigmas Influence Depression Among Trans Women and Men Who Have Sex with Men in India.

PubMed

Chakrapani, Venkatesan; Vijin, Pandara Purayil; Logie, Carmen H; Newman, Peter A; Shunmugam, Murali; Sivasubramanian, Murugesan; Samuel, Miriam

2017-06-01

Few studies have assessed how sexual and gender minority stigmas affect the mental health of trans women and self-identified men who have sex with men (MSM) in India, populations with a high HIV burden. We tested whether social support and resilient coping act as mediators of the effect of sexual and gender minority stigmas on depression as proposed by Hatzenbuehler's psychological mediation framework, or as moderators based on Meyer's minority stress theory. We conducted a cross-sectional survey among trans women (n = 300) and MSM (n = 300) recruited from urban and rural sites in India. Standardized scales were used to measure depression (outcome variable), transgender identity stigma/MSM stigma (predictor variables), and social support and resilient coping (tested as moderators and parallel mediators). The mediation and moderation models were tested separately for trans women and MSM, using Hayes' PROCESS macro in SPSS. Participants' mean age was 29.7 years (standard deviation 8.1). Transgender identity stigma and MSM stigma were significant predictors (significant total and direct effects) of depression, as were social support and resilient coping. Among trans women and MSM, social support and resilient coping mediated (i.e., significant specific indirect effects), but did not moderate, the effect of stigma on depression, supporting the psychological mediation framework. Sexual and gender minority stigmas are associated with depression, with social support and resilient coping as mediators. In addition to stigma reduction interventions at the societal level, future interventions should focus on improving social support and promoting resilience among trans women and MSM in India.

Short-term mediating factors of a school-based intervention to prevent youth substance use in Europe.

PubMed

Giannotta, Fabrizia; Vigna-Taglianti, Federica; Rosaria Galanti, Maria; Scatigna, Maria; Faggiano, Fabrizio

2014-05-01

To investigate factors mediating the effects of a European school-based intervention (Unplugged) based on a social influence approach to youths' substance use. Schools in seven European countries (n = 143, including 7,079 pupils) were randomly assigned to an experimental condition (Unplugged curriculum) or a control condition (usual health education). Data were collected before (pretest) and 3 months after the end of the program (posttest). Multilevel multiple mediation models were applied to the study of effect mediation separately for tobacco, alcohol, and cannabis use. Analyses were conducted on the whole sample, and separately on baseline users and nonusers of each substance. Compared with the control group, participants in the program endorsed less positive attitudes toward drugs; positive beliefs about cigarettes, alcohol, and cannabis; and the normative perception of peers using tobacco and cannabis. They also increased in knowledge about all substances and refusal skills toward tobacco. Decreased positive attitudes toward drugs, increase in refusal skills, and reappraisal of norms about peer using tobacco and cannabis appeared to mediate the effects of the program on the use of substances. However, mediating effects were generally weak and some of them were only marginally significant. This study lends some support to the notion that school-based programs based on a social influence model may prevent juvenile substance use through the modification of attitudes, refusal skills, and normative perceptions. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Socioeconomic, health, and psychosocial mediators of racial disparities in cognition in early, middle, and late adulthood

PubMed Central

Zahodne, Laura B.; Manly, Jennifer J.; Smith, Jacqui; Seeman, Teresa; Lachman, Margie

2017-01-01

Racial disparities in cognitive performance exist across the life course, but it is not known whether mediators of disparities differ by age. Understanding sources of cognitive disparities at different ages can inform policies and interventions. Data were obtained for non-Hispanic Black and White respondents to The National Survey of Midlife Development in the United States (MIDUS-II) from three age groups: 28–44 (N=1210; 20% Black); 45–64 (N=2693; 15% Black), 65–85 (N=1298; 11% Black). Moderated mediation models characterized direct and indirect effects of race on episodic memory and executive function composite scores through economic, health, and psychosocial variables as a function of age group. Education, income, chronic health conditions, and external locus of control mediated cognitive disparities across the life course, though income was a stronger mediator at younger ages. Perceived discrimination was a weaker mediator among young adults due to an absence of racial differences in perceived discrimination in that group. Despite multiple indirect effects, there were still significant unexplained effects of race on cognition that were not moderated by age group. Interventional work is needed to determine whether increasing educational attainment and income, and reducing chronic health conditions and perceived constraints among Blacks, reduce cognitive disparities. Targeting income inequality and discrimination (or buffering the impact of those variables) may be differently effective at reducing cognitive disparities at different stages of the adult life course. PMID:28287782

Stress self-management: an intervention for women with physical disabilities.

PubMed

Hughes, Rosemary B; Robinson-Whelen, Susan; Taylor, Heather B; Hall, John W

2006-01-01

We sought to develop and evaluate the efficacy of an innovative, theory-driven, group stress self-management intervention designed to ameliorate stress and promote health among women with physical disabilities such as spinal cord injury, multiple sclerosis, and arthritis. We recruited a voluntary sample of 78 community-living women with disabilities who were randomly assigned to either the group stress management intervention or the wait-listed control group, and we used a within- and between-groups pretest/posttest design with a 3-month follow-up. Group differences in changes over time on measures of perceived stress and mental health offer support for the efficacy of the intervention. At the 3-month follow-up assessment, the intervention group also showed greater improvement on measures of pain and role limitations owing to physical health when compared the wait-listed control group. Perceived stress was supported as a mediator of the effect of the intervention on mental health. We found support for social connectedness and self-efficacy as mediators of the relation between the intervention and perceived stress; however, there was relatively weak evidence for differential change over time in those proposed mediators. This study provides the first of its kind, that is, an evaluation of the efficacy of a stress self-management intervention designed specifically for women with physical disabilities. The results are consistent with a model in which the stress management intervention enhances self-efficacy and social connectedness, which leads to reduced stress, which then contributes to improved mental health.

Efficacy of Personalized Normative Feedback as a Brief Intervention for College Student Gambling: A Randomized Controlled Trial

PubMed Central

Neighbors, Clayton; Rodriguez, Lindsey M.; Rinker, Dipali V.; Agana, Maigen; Gonzales, Rubi G.; Tackett, Jennifer L.; Foster, Dawn W.

2016-01-01

Objective Social influences on gambling among adolescents and adults have been well documented and may be particularly evident among college students, who have higher rates of problem and pathological gambling relative to the general population. Personalized normative feedback (PNF) is a brief intervention designed to correct misperceptions regarding the prevalence of problematic behavior by showing individuals engaging in such behaviors that their own behavior is atypical with respect to actual norms. The current randomized controlled trial evaluated a computer-delivered PNF intervention for problem gambling college students. Method Following a baseline assessment, 252 college student gamblers scoring 2+ on the South Oaks Gambling Screen (SOGS) were randomly assigned to receive PNF or attention-control feedback. Follow-up assessments were completed 3 and 6 months postintervention. Results Results indicated significant intervention effects in reducing perceived norms for quantities lost and won, and in reducing actual quantity lost and gambling problems at the 3-month follow-up. All intervention effects except reduced gambling problems remained at the 6-month follow-up. Mediation results indicated that changes in perceived norms at 3 months mediated the intervention effects. Further, the intervention effects were moderated by self-identification with other student gamblers, suggesting that PNF worked better at reducing gambling for those who more strongly identified with other student gamblers. Conclusions Results support the use of PNF as a stand-alone brief intervention for at-risk gambling students. Extending this approach more broadly may provide an accessible, empirically supported gambling prevention option for universities and related institutions. PMID:26009785

Efficacy of personalized normative feedback as a brief intervention for college student gambling: a randomized controlled trial.

PubMed

Neighbors, Clayton; Rodriguez, Lindsey M; Rinker, Dipali V; Gonzales, Rubi G; Agana, Maigen; Tackett, Jennifer L; Foster, Dawn W

2015-06-01

Social influences on gambling among adolescents and adults have been well documented and may be particularly evident among college students, who have higher rates of problem and pathological gambling relative to the general population. Personalized normative feedback (PNF) is a brief intervention designed to correct misperceptions regarding the prevalence of problematic behavior by showing individuals engaging in such behaviors that their own behavior is atypical with respect to actual norms. The current randomized controlled trial evaluated a computer-delivered PNF intervention for problem gambling college students. Following a baseline assessment, 252 college student gamblers scoring 2+ on the South Oaks Gambling Screen (SOGS) were randomly assigned to receive PNF or attention-control feedback. Follow-up assessments were completed 3 and 6 months postintervention. Results indicated significant intervention effects in reducing perceived norms for quantities lost and won, and in reducing actual quantity lost and gambling problems at the 3-month follow-up. All intervention effects except reduced gambling problems remained at the 6-month follow-up. Mediation results indicated that changes in perceived norms at 3 months mediated the intervention effects. Further, the intervention effects were moderated by self-identification with other student gamblers, suggesting that PNF worked better at reducing gambling for those who more strongly identified with other student gamblers. Results support the use of PNF as a stand-alone brief intervention for at-risk gambling students. Extending this approach more broadly may provide an accessible, empirically supported gambling prevention option for universities and related institutions. (c) 2015 APA, all rights reserved).

Reporting the Effects of Interventions to the Tutor with Meta-Indicators

ERIC Educational Resources Information Center

Després, Christophe; Jacoboni, Pierre; Py, Dominique; Lekira, Aina

2016-01-01

In this paper, we study how to support a human tutor who regulates learners' activities, in a situation of mediated tutoring. Our goal is to provide the tutor with information about the effect of his/her interventions. To achieve this, we adopt an indicator-based approach and define the notion of meta-indicator. The distinguishing feature of…

Effects of an Automated Telephone Support System on Caregiver Burden and Anxiety: Findings from the REACH for TLC Intervention Study

ERIC Educational Resources Information Center

Mahoney, Diane Feeney; Tarlow, Barbara J.; Jones, Richard N.

2003-01-01

Purpose: We determine the main outcome effects of a 12-month computer-mediated automated interactive voice response (IVR) intervention designed to assist family caregivers managing persons with disruptive behaviors related to Alzheimer's disease (AD). Design and Methods: We conducted a randomized controlled study of 100 caregivers, 51 in the usual…

Cognitive mechanisms of change in delusions: an experimental investigation targeting reasoning to effect change in paranoia.

PubMed

Garety, Philippa; Waller, Helen; Emsley, Richard; Jolley, Suzanne; Kuipers, Elizabeth; Bebbington, Paul; Dunn, Graham; Fowler, David; Hardy, Amy; Freeman, Daniel

2015-03-01

Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. On an intention-to-treat analysis, there were significant improvements in state paranoia and reasoning in the experimental compared with the control condition. There was evidence that changes in reasoning mediated changes in paranoia, although this effect fell just outside the conventional level of significance after adjustment for baseline confounders. Working memory and negative symptoms significantly moderated the effects of the intervention on reasoning. The study demonstrated the effectiveness of a brief reasoning intervention in improving both reasoning processes and paranoia. It thereby provides proof-of-concept evidence that reasoning is a promising intermediary target in interventions to ameliorate delusions, and thus supports the value of developing this approach as a longer therapeutic intervention. © The Author 2014. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center.

Reciprocal effects among changes in weight, body image, and other psychological factors during behavioral obesity treatment: a mediation analysis.

PubMed

Palmeira, António L; Markland, David A; Silva, Marlene N; Branco, Teresa L; Martins, Sandra C; Minderico, Cláudia S; Vieira, Paulo N; Barata, José T; Serpa, Sidónio O; Sardinha, Luis B; Teixeira, Pedro J

2009-02-09

Changes in body image and subjective well-being variables (e.g. self-esteem) are often reported as outcomes of obesity treatment. However, they may, in turn, also influence behavioral adherence and success in weight loss. The present study examined associations among obesity treatment-related variables, i.e., change in weight, quality of life, body image, and subjective well-being, exploring their role as both mediators and outcomes, during a behavioral obesity treatment. Participants (BMI = 31.1 +/- 4.1 kg/m2; age = 38.4 +/- 6.7 y) were 144 women who attended a 12-month obesity treatment program and a comparison group (n = 49), who received a general health education program. The intervention included regular group meetings promoting lasting behavior changes in physical activity and dietary intake. Body image, quality of life, subjective well-being, and body weight were measured at baseline and treatment's end. Mediation was tested by multiple regression and a resampling approach to measure indirect effects. Treatment group assignment was the independent variable while changes in weight and in psychosocial variables were analyzed alternatively as mediators and as dependent variables. At 12 months, the intervention group had greater weight loss (-5.6 +/- 6.8% vs. -1.2 +/- 4.6%, p < .001) and larger decreases in body size dissatisfaction (effect size of 1.08 vs. .41, p < .001) than the comparison group. Significant improvements were observed in both groups for all other psychosocial variables (effect sizes ranging from .31-.75, p < .05). Mediation analysis showed that changes in body image and body weight were concurrently mediators and outcomes of treatment, suggesting reciprocal influences. Weight loss partially mediated the effect of treatment on quality of life and on self-esteem but the reciprocal effect was not observed. Changes in weight and body image may reciprocally affect each other during the course of behavioral obesity treatment. No evidence of reciprocal relationships was found for the other models under analysis; however, weight changes partially explained the effects of treatment on quality of life and self-esteem. Weight and psychosocial changes co-occur during treatment and will probably influence each other dynamically, in ways not yet adequately understood. Results from this study support the inclusion of intervention contents aimed at improving body image in weight management programs.

Causal mediation analysis with a binary outcome and multiple continuous or ordinal mediators: Simulations and application to an alcohol intervention.

PubMed

Nguyen, Trang Quynh; Webb-Vargas, Yenny; Koning, Ina M; Stuart, Elizabeth A

We investigate a method to estimate the combined effect of multiple continuous/ordinal mediators on a binary outcome: 1) fit a structural equation model with probit link for the outcome and identity/probit link for continuous/ordinal mediators, 2) predict potential outcome probabilities, and 3) compute natural direct and indirect effects. Step 2 involves rescaling the latent continuous variable underlying the outcome to address residual mediator variance/covariance. We evaluate the estimation of risk-difference- and risk-ratio-based effects (RDs, RRs) using the ML, WLSMV and Bayes estimators in Mplus. Across most variations in path-coefficient and mediator-residual-correlation signs and strengths, and confounding situations investigated, the method performs well with all estimators, but favors ML/WLSMV for RDs with continuous mediators, and Bayes for RRs with ordinal mediators. Bayes outperforms WLSMV/ML regardless of mediator type when estimating RRs with small potential outcome probabilities and in two other special cases. An adolescent alcohol prevention study is used for illustration.

78 FR 75997 - Provision of Early Intervention and Special Education Services to Eligible DoD Dependents

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-13

... individuals with disabilities; selecting, designing, fitting, customizing, adapting, applying, maintaining... specially designed services for an infant or toddler with a disability and the family of such infant or... impartial mediator who is trained in effective mediation techniques. Medical services. Those evaluative...

The mediated effects of maternal depression and infant temperament on maternal role.

PubMed

Rode, Jennifer L; Kiel, Elizabeth J

2016-02-01

We examined prenatal depression, postpartum depression, and infant temperament, respectively, in a mediated process model to predict maternal role. Using a prospective, observational design, we surveyed 168 women during pregnancy and then in postpartum. Data analyses supported the contribution of each variable in an ascending fashion (ab = -0.01, SE = 0.004, 95 % CI [-0.021, -0.004]), such that infant temperament had the strongest effects (sr(2) = .124, p < .001). Further, postpartum depression was found to influence maternal role with both direct effects and indirect effects via infant temperament. These results highlighted the significant impact postpartum depression may have on maternal role. Future interventions targeting mothers experiencing or who are at risk for depression may consider tools to improve mother-baby interactions. The effects of such intervention may subsequently improve both infant temperament and maternal role evaluation.

What are the combined effects of negative emotions and illness cognitions on self-care in people with type 2 diabetes? A longitudinal structural equation model.

PubMed

Hudson, Joanna L; Bundy, Christine; Coventry, Peter; Dickens, Chris; Wood, Alex; Reeves, David

2016-07-01

To explore whether negative emotions mediate the effect of diabetes cognitions on diabetes self-care and conversely whether diabetes cognitions mediate the effect of negative emotions on diabetes self-care. Longitudinal observational study in adults with type 2 diabetes. Self-reported depression and anxiety (Diabetes Wellbeing Questionnaire), cognitions (Illness Perceptions Questionnaire-Revised; Beliefs about Medicines Questionnaire), and diabetes self-care (Summary of Diabetes Self-Care Activities Scale) were completed at baseline and six months. Analyses used structural equation modelling. Baseline medication concerns were associated with elevated symptoms of depression and anxiety at follow-up, but emotions did not mediate medication concern's effect on diabetes self-care. Baseline depression and anxiety symptoms were associated with specific diabetes cognitions over time, but these cognition domains did not mediate emotion's effect on diabetes self-care. Personal control remained independent of emotions and was associated with diabetes self-care over time. Negative emotions did not act directly or alongside cognitions to influence diabetes self-care. The reciprocal relationship between diabetes cognitions and emotions suggests cognitive restructuring, in addition to other mood management intervention techniques would likely improve the emotional wellbeing of adults with type 2 diabetes. Likewise, personal control beliefs are likely important intervention targets for improving self-care.

Investing in communities: evaluating the added value of community mobilization on HIV prevention outcomes among FSWs in India.

PubMed

Kuhlmann, Anne Sebert; Galavotti, Christine; Hastings, Philip; Narayanan, Pradeep; Saggurti, Niranjan

2014-04-01

Community mobilization often requires greater time and resource investments than typical interventions, yet few evaluations exist to justify these investments. We evaluated the added benefit of community mobilization on HIV prevention outcomes among female sex workers (FSWs) using a composite measure of volunteer participation in program committees by FSWs. After adjusting for treatment propensity, we used multilevel structural equation modeling (MSEM) to test our program theory. We hypothesized that stronger community mobilization would be associated with increased levels of consistent condom use and with increased levels of perceived fairness, mediated by psychosocial processes. Community mobilization had an indirect effect on consistent condom use mediated through social cohesion and an indirect effect on perceived fairness mediated by collective efficacy. Our results suggest higher levels of community mobilization help improve condom use and reduce perceived discrimination beyond the effects of the core HIV intervention program. We recommend further testing of this model.

Early Intervention and Its Effects on Maternal and Child Development.

ERIC Educational Resources Information Center

Slaughter, Diana T.

1983-01-01

The longitudinal study reported used an intervention strategy to test the thesis that sociocultural background, mediated by maternal attitudes and behaviors, influences Black children's early development in educationally significant ways. Two models of parent education were contrasted: the Levenstein toy demonstration program and the…

Reducing Sibling Conflict in Maltreated Children Placed in Foster Homes

PubMed Central

Linares, L. Oriana; Jimenez, Jessica; Nesci, Cristina; Pearson, Eva; Beller, Sarah; Edwards, Nancy; Levin-Rector, Alison

2016-01-01

Sibling aggression among maltreated children placed in foster homes is linked to other externalizing problems and placement disruption. The reduction of sibling conflict and aggression may be achieved via a multicomponent ecologically focused intervention for families in the foster care system. The focus of the study is to evaluate the feasibility and short-term effectiveness of a transtheoretical intervention model targeting sibling pairs and their foster parent that integrates family systems, social learning theory, and a conflict mediation perspective. In this pilot study, sibling pairs (N=22) and their foster parent were randomized into a three-component intervention (n=13) or a comparison (n=9) group. Promoting Sibling Bonds (PSB) is an 8-week prevention intervention targeting maltreated sibling pairs ages 5–11 years placed together in a foster home. The Siblings, Parent, and Joint components were delivered in a program package at the foster agency by a trained two-clinician team. Average attendance across program components was 73%. Outcomes in four areas were gathered at pre-and post-intervention: observed sibling interaction quality (positive and negative) including conflict during play, and foster parent reports of mediation strategies and sibling aggression in the foster home. At post-intervention, adjusting for baseline scores and child age, intervention pairs showed higher positive (p<.001) and negative (p<.05) interaction quality, and lower sibling conflict during play (p <.01) than comparison pairs. Foster parents in the intervention group reported a higher number of conflict mediation strategies than those in the comparison group (p <.001). Foster parents in the intervention group reported lower sibling physical aggression from the older toward the younger child than those in the comparison group (p <.05). Data suggest that the PSB intervention is a promising approach to reduce conflict and promote parental mediation which together may reduce sibling aggression in the foster home. PMID:24585072

Moms in motion: a group-mediated cognitive-behavioral physical activity intervention.

PubMed

Cramp, Anita G; Brawley, Lawrence R

2006-08-22

When examining the prevalence of physical inactivity by gender and age, women over the age of 25 are at an increased risk for sedentary behavior. Childbearing and motherhood have been explored as one possible explanation for this increased risk. Post natal exercise studies to date demonstrate promising physical and psychological outcomes, however few physical activity interventions have been theory-driven and tailored to post natal exercise initiates. The purpose of this study was to compare the effects of a group-mediated cognitive behavioral intervention based upon social-cognitive theory and group dynamics (GMCB) to a standard care postnatal exercise program (SE). A randomized, two-arm intervention design was used. Fifty-seven post natal women were randomized to one of two conditions: (1) a standard exercise treatment (SE) and (2) a standard exercise treatment plus group-mediated cognitive behavioral intervention (GMCB). Participants in both conditions participated in a four-week intensive phase where participants received standard exercise training. In addition, GMCB participants received self-regulatory behavioral skills training via six group-mediated counseling sessions. Following the intensive phase, participants engaged in a four-week home-based phase of self-structured exercise. Measures of physical activity, barrier efficacy, and proximal outcome expectations were administered and data were analyzed using ANCOVA procedures. ANCOVA of change scores for frequency, minutes, and volume of physical activity revealed significant treatment effects over the intensive and home-based phases (p's < 0.01). In addition, ANCOVA of change in mean barrier efficacy and proximal outcome expectations at the conclusion of the intensive phase demonstrated that GMCB participants increased their initial level of barrier efficacy and outcome expectations while SE participants decreased (p < 0.05). While both exercise programs resulted in improvements to exercise participation, the GMCB intervention produced greater improvement in overall physical activity, barrier efficacy and proximal outcome expectations.

Social support from teachers mediates physical activity behavior change in children participating in the Fit-4-Fun intervention.

PubMed

Eather, Narelle; Morgan, Philip J; Lubans, David R

2013-05-28

Few studies have examined the mediators of behavior change in successful school-based physical activity interventions. The aim of this study was to explore potential mediators of physical activity in the Fit-4-Fun program for primary school children. Group randomized controlled trial. Four primary schools were recruited in April, 2011 and randomized by school into intervention or control conditions. Participants included 213 children (mean age = 10.7 years ± 0.6; 52.2% female) with the treatment group (n = 118) completing the 8-week multi-component Fit-4-Fun program. Participants were assessed at baseline, 3- and 6-months. Physical activity was measured using Yamax SW700 pedometers (mean steps/day) and questionnaires were used to assess constructs from Social Cognitive Theory and Competence Motivation Theory. Hypothesized mediators measured included social support from peers, parents and teachers; physical activity self-efficacy (barrier and task); enjoyment; and perceived school physical environment. Mediation was assessed using Preacher and Hayes' multiple mediation regression SPSS macro. Action theory (A), conceptual theory (B) and the significance of the product of coefficients (AB) are reported. The intervention had a significant effect on physical activity (p<0.001). The action theory test results revealed significant treatment effects at 3-months for perceived school environment (A=0.28, p<0.001); and at 6-month follow-up for perceived school environment (A=0.058, p<0.001), teacher social support (A=0.54, p<0.05) and enjoyment (A=-0.23, p<0.05). The conceptual theory test revealed a significant relationship between changes in teacher social support and changes in physical activity at 6-month follow-up (B=828, P<0.05). Teacher social support was shown to have a significant mediating effect on physical activity (AB = 445, CI = 77-1068 steps, proportion= 13%), and perceived school environment approached significance (AB = 434, CI= -415 to 1507 steps, proportion= 13%). The Fit-4-Fun program successfully targeted social support for physical activity provided by classroom teachers which contributed to improved physical activity in children. These results demonstrate that classroom teachers play a key role in influencing physical activity behavior outcomes in children.Trial Registration No: ACTRN12611000976987.

Social support from teachers mediates physical activity behavior change in children participating in the Fit-4-Fun intervention

PubMed Central

2013-01-01

Background Few studies have examined the mediators of behavior change in successful school-based physical activity interventions. The aim of this study was to explore potential mediators of physical activity in the Fit-4-Fun program for primary school children. Design Group randomized controlled trial. Methods Four primary schools were recruited in April, 2011 and randomized by school into intervention or control conditions. Participants included 213 children (mean age = 10.7 years ± 0.6; 52.2% female) with the treatment group (n = 118) completing the 8-week multi-component Fit-4-Fun program. Participants were assessed at baseline, 3- and 6-months. Physical activity was measured using Yamax SW700 pedometers (mean steps/day) and questionnaires were used to assess constructs from Social Cognitive Theory and Competence Motivation Theory. Hypothesized mediators measured included social support from peers, parents and teachers; physical activity self-efficacy (barrier and task); enjoyment; and perceived school physical environment. Mediation was assessed using Preacher and Hayes’ multiple mediation regression SPSS macro. Action theory (A), conceptual theory (B) and the significance of the product of coefficients (AB) are reported. Results The intervention had a significant effect on physical activity (p<0.001). The action theory test results revealed significant treatment effects at 3-months for perceived school environment (A=0.28, p<0.001); and at 6-month follow-up for perceived school environment (A=0.058, p<0.001), teacher social support (A=0.54, p<0.05) and enjoyment (A=-0.23, p<0.05). The conceptual theory test revealed a significant relationship between changes in teacher social support and changes in physical activity at 6-month follow-up (B=828, P<0.05). Teacher social support was shown to have a significant mediating effect on physical activity (AB = 445, CI = 77-1068 steps, proportion= 13%), and perceived school environment approached significance (AB = 434, CI= -415 to 1507 steps, proportion= 13%). Conclusions The Fit-4-Fun program successfully targeted social support for physical activity provided by classroom teachers which contributed to improved physical activity in children. These results demonstrate that classroom teachers play a key role in influencing physical activity behavior outcomes in children. Trial Registration No: ACTRN12611000976987 PMID:23714651

Personal Control and Service Connection as Paths to Improved Mental Health and Exiting Homelessness among Severely Marginalized Homeless Youth.

PubMed

Slesnick, Natasha; Zhang, Jing; Brakenhoff, Brittany

2017-02-01

Non-service connected, continuously homeless youth are arguably one of the most vulnerable populations in the U.S. These youth reside at society's margins experiencing an accumulation of risks over time. Research concludes that as vulnerabilities increase so do poor long-term outcomes. This study tested the mediating effects of service connection and personal control as mediators of cumulative risk and housing, health and mental health outcomes. By understanding the processes associated with therapeutic change among those with the most vulnerabilities, service providers and researchers can target those factors to enhance positive outcomes. Seventy-nine, non-service connected, substance using homeless youth were offered a strengths-based outreach and engagement intervention and were assessed at baseline 3, 6 and 9 months post-baseline. Personal control mediated the effects of cumulative risk on housing stability, and service utilization mediated the effects of cumulative risk on mental health. This study specifies important targets of intervention for a population at high risk for continuing homelessness. In particular, service providers should target youths' sense of personal control and link them to needed community-based services in order to help them exit street life and improve mental health outcomes.

An Internet-Mediated Pedometer-Based Program Improves Health-Related Quality-of-Life Domains and Daily Step Counts in COPD

PubMed Central

Moy, Marilyn L.; Collins, Riley J.; Martinez, Carlos H.; Kadri, Reema; Roman, Pia; Holleman, Robert G.; Kim, Hyungjin Myra; Nguyen, Huong Q.; Cohen, Miriam D.; Goodrich, David E.; Giardino, Nicholas D.

2015-01-01

BACKGROUND: Low levels of physical activity (PA) are associated with poor outcomes in people with COPD. Interventions to increase PA could improve outcomes. METHODS: We tested the efficacy of a novel Internet-mediated, pedometer-based exercise intervention. Veterans with COPD (N = 239) were randomized in a 2:1 ratio to the (1) intervention group (Omron HJ-720 ITC pedometer and Internet-mediated program) or (2) wait-list control group (pedometer). The primary outcome was health-related quality of life (HRQL), assessed by the St. George’s Respiratory Questionnaire (SGRQ), at 4 months. We examined the SGRQ total score (SGRQ-TS) and three domain scores: Symptoms, Activities, and Impact. The secondary outcome was daily step counts. Linear regression models assessed the effect of intervention on outcomes. RESULTS: Participants had a mean age of 67 ± 9 years, and 94% were men. There was no significant between-group difference in mean 4-month SGRQ-TS (2.3 units, P = .14). Nevertheless, a significantly greater proportion of intervention participants than control subjects had at least a 4-unit improvement in SGRQ-TS, the minimum clinically important difference (53% vs 39%, respectively, P = .05). For domain scores, the intervention group had a lower (reflecting better HRQL) mean than the control group by 4.6 units for Symptoms (P = .046) and by 3.3 units for Impact (P = .049). There was no significant difference in Activities score between the two groups. Compared with the control subjects, intervention participants walked 779 more steps per day at 4 months (P = .005). CONCLUSIONS: An Internet-mediated, pedometer-based walking program can improve domains of HRQL and daily step counts at 4 months in people with COPD. TRIAL REGISTRY: Clinical Trials.gov; No.: NCT01102777; URL: www.clinicaltrials.gov PMID:25811395

Effects of a school-based intensive intervention on systemic inflammation and disease risk in Mexican-American children

USDA-ARS?s Scientific Manuscript database

Childhood obesity is associated with an increased risk for cardiovascular disease and type 2 Diabetes mellitus. Systemic inflammation is thought to mediate this relationship. We have previously demonstrated that an intervention designed specifically for Mexican-American children that incorporates bo...

Steps in the design, development and formative evaluation of obesity prevention-related behavior change trials

USDA-ARS?s Scientific Manuscript database

Obesity prevention interventions through dietary and physical activity change have generally not been effective. This paper uses the Mediating Variable Model (MVM) as a conceptual framework for examining why obesity prevention interventions have not worked. Problems were identified in measurement of...

A Comprehensive Peer Network Intervention to Improve Social Communication of Children with Autism Spectrum Disorders: A Randomized Trial in Kindergarten and First Grade

ERIC Educational Resources Information Center

Kamps, Debra; Thiemann-Bourque, Kathy; Heitzman-Powell, Linda; Schwartz, Ilene; Rosenberg, Nancy; Mason, Rose; Cox, Suzanne

2015-01-01

The purpose of this randomized control group study was to examine the effects of a peer network intervention that included peer mediation and direct instruction for Kindergarten and First-grade children with autism spectrum disorders. Trained school staff members provided direct instruction for 56 children in the intervention group, and 39…

Increasing Responsive Parent–Child Interactions and Joint Engagement: Comparing the Influence of Parent-Mediated Intervention and Parent Psychoeducation

PubMed Central

Gulsrud, Amanda; Kasari, Connie

2016-01-01

Enhancing immediate and contingent responding by caregivers to children’s signals is an important strategy to support social interactions between caregivers and their children with autism. Yet, there has been limited examination of parents’ responsive behaviour in association with children’s social behaviour post caregiver-mediated intervention. Eighty-five dyads were randomized to one of two 10-week caregiver-training interventions. Parent–child play interactions were coded for parental responsivity and children’s joint engagement. Significant gains in responsivity and time jointly engaged were found post JASPER parent-mediated intervention over a psychoeducation intervention. Further, combining higher levels of responsive behaviour with greater adoption of intervention strategies was associated with greater time jointly engaged. Findings encourage a focus on enhancing responsive behaviour in parent-mediated intervention models. PMID:26797940

Mediators and Treatment Factors in Intervention for Children Exposed to Interparental Violence.

PubMed

Overbeek, Mathilde M; De Schipper, J Clasien; Willemen, Agnes M; Lamers-Winkelman, Francien; Schuengel, Carlo

2017-01-01

Changes in children's emotion differentiation, coping skills, parenting stress, parental psychopathology, and parent-child interaction were explored as mediators of treatment factors in two selective preventive group interventions for children exposed to interparental violence (IPV) and their parents. One hundred thirty-four IPV-exposed children (ages 6-12 years, 52% boys) and their parents were randomized to an IPV-focused or common factors community-based group intervention and completed baseline, posttest, and follow-up assessments for posttraumatic stress (PTS). A multilevel model tested mediators that included children's ability to differentiate emotions and coping skills, parenting stress, parental psychopathology, and parent-child interactions. In both conditions, exposure to nonspecific factors, specific factors unrelated to IPV and trauma-specific intervention factors was coded from videotaped child and parent sessions. Improved parental mental health mediated the link between greater exposure to nonspecific treatment factors and decreases in PTS symptoms. In addition, an increase in emotion differentiation and a decrease in parenting stress were associated with a decrease in PTS symptoms. Greater exposure to trauma-specific factors in child sessions was associated with a small decrease in emotion differentiation, an increase in coping skills, and a decrease in PTS symptoms over time. Greater exposure to nonspecific treatment factors in child and parent sessions was associated with more positive parent-child interaction. Parental mental health appears to be an important mechanism of change that can be promoted through exposure to nonspecific factors in parent intervention. For children, the effect of greater exposure to trauma-specific factors in intervention is less clear and may not have clear benefits.

MSL in the Digital Ages: Effects and Effectiveness of Computer-Mediated Intervention for FL Learners with Dyslexia

ERIC Educational Resources Information Center

Pfenninger, Simone E.

2015-01-01

The longitudinal intervention study reported here is the first to investigate the efficiency of computer learning software specifically designed for dyslexic Swiss German learners of Standard German as a second language (L2) and English as a third language (L3). A total of 40 subjects (20 of them dyslexics and 20 of them nondyslexics; 10 students…

Understanding Gender Differences in Anxiety: The Mediating Effects of Instrumentality and Mastery

ERIC Educational Resources Information Center

Zalta, Alyson K.; Chambless, Dianne L.

2012-01-01

Developing a better understanding of modifiable psychological factors that account for gender differences in anxiety may provide insight into interventions that can be used to target these risk processes. The authors developed a mediational model to examine the degree to which gender differences in anxiety are explained by instrumentality and…

Prevention System Mediation of Communities That Care Effects on Youth Outcomes

PubMed Central

Hawkins, J. David; Rhew, Isaac C.; Shapiro, Valerie B.; Abbott, Robert D.; Oesterle, Sabrina; Arthur, Michael W.; Briney, John S.; Catalano, Richard F.

2013-01-01

This study examined whether the significant intervention effects of the Communities That Care (CTC) prevention system on youth problem behaviors observed in a panel of eighth-grade students (Hawkins et al. Archives of Pediatrics and Adolescent Medicine 163:789–798 2009) were mediated by community-level prevention system constructs posited in the CTC theory of change. Potential prevention system constructs included the community’s degree of (a) adoption of a science-based approach to prevention, (b) collaboration on prevention activities, (c) support for prevention, and (d) norms against adolescent drug use as reported by key community leaders in 24 communities. Higher levels of community adoption of a science-based approach to prevention and support for prevention in 2004 predicted significantly lower levels of youth problem behaviors in 2007, and higher levels of community norms against adolescent drug use predicted lower levels of youth drug use in 2007. Effects of the CTC intervention on youth problem behaviors by the end of eighth grade were mediated fully by community adoption of a science-based approach to prevention. No other significant mediated effects were found. Results support CTC’s theory of change that encourages communities to adopt a science- based approach to prevention as a primary mechanism for improving youth outcomes. PMID:23828448

Tea-induced improvement of endothelial function in humans: No role for epigallocatechin gallate (EGCG).

PubMed

Lorenz, Mario; Rauhut, Franziska; Hofer, Christine; Gwosc, Stefanie; Müller, Eda; Praeger, Damaris; Zimmermann, Benno F; Wernecke, Klaus-Dieter; Baumann, Gert; Stangl, Karl; Stangl, Verena

2017-05-23

Consumption of tea is inversely associated with cardiovascular diseases. However, the active compound(s) responsible for the protective effects of tea are unknown. Although many favorable cardiovascular effects in vitro are mediated by epigallocatechin gallate (EGCG), its contribution to the beneficial effects of tea in vivo remains unresolved. In a randomised crossover study, a single dose of 200 mg EGCG was applied in three different formulas (as green tea beverage, green tea extract (GTE), and isolated EGCG) to 50 healthy men. Flow-mediated dilation (FMD) and endothelial-independent nitro-mediated dilation (NMD) was measured before and two hours after ingestion. Plasma levels of tea compounds were determined after each intervention and correlated with FMD. FMD significantly improved after consumption of green tea containing 200 mg EGCG (p < 0.01). However, GTE and EGCG had no significant effect on FMD. NMD did not significantly differ between interventions. EGCG plasma levels were highest after administration of EGCG and lowest after consumption of green tea. Plasma levels of caffeine increased after green tea consumption. The results show that EGCG is most likely not involved in improvement of flow-mediated dilation by green tea. Instead, other tea compounds, metabolites or combinations thereof may play a role.

Social Communication Effects of Peer-Mediated Recess Intervention for Children with Autism

PubMed Central

McFadden, Brandon; Kamps, Debra; Heitzman-Powell, Linda

2015-01-01

Children with ASD face enormous challenges in the area of social functioning. Research has shown that impairments in social functioning distinguish this population from both typically developing children and children with disabilities. This study incorporated several evidence-based social skills-teaching procedures (i.e., direct instruction, priming, prompting, peer-mediation, contingent reinforcement, and token economies) directly in the recess setting to increase appropriate social behaviors for four children with ASD (ages 6–8). Elements of Peer Networks and Pivotal Response Training (two types of social skills intervention packages in the literature) were included. Results showed significant increases in social communication between focus children and their peers, as well as generalization of skills to non-intervention recesses. PMID:26312064

eHealth Familias Unidas: Efficacy Trial of an Evidence-Based Intervention Adapted for Use on the Internet with Hispanic Families.

PubMed

Estrada, Yannine; Lee, Tae Kyoung; Wagstaff, Rachel; M Rojas, Lourdes; Tapia, Maria I; Velázquez, Maria Rosa; Sardinas, Krystal; Pantin, Hilda; Sutton, Madeline Y; Prado, Guillermo

2018-05-10

While substance use and sexual risk behaviors among Hispanic youth continue to be public health concerns, few evidence-based preventive interventions are developed for and implemented with Hispanic/Latino youth. The objective of this study was to evaluate the efficacy of eHealth Familias Unidas, an Internet adaptation of an evidence-based family intervention for Hispanics. A randomized controlled trial design (n = 230) was used to evaluate intervention effects on substance use and condomless sex among a sample of Hispanic eighth graders with behavioral problems. Participants were randomized to eHealth Familias Unidas (n = 113) or prevention as usual (n = 117) and assessed at baseline and 3 and 12 months post baseline. We trained mental health school personnel and community mental health professionals to recruit and deliver the Internet-based intervention with Hispanic families. It was hypothesized that, over time, eHealth Familias Unidas would be more efficacious than prevention as usual in reducing drug use (marijuana, cocaine, inhalants, and other drugs), prescription drug use, cigarette use, alcohol use, and condomless sex and that these changes would be mediated by family functioning. Significant intervention effects were found across time for drug use, prescription drug use, and cigarette use. While eHealth Familias Unidas positively affected family functioning, mediation effects were not found. This study demonstrated that family-based eHealth interventions can be efficacious among Hispanic populations when delivered in community settings.

Hypnotherapy to Reduce Hot Flashes: Examination of Response Expectancies as a Mediator of Outcomes

PubMed Central

Sliwinski, Jim R.; Elkins, Gary R.

2017-01-01

The mechanism of action responsible for hypnotherapy’s effect in reducing hot flashes is not yet known. The purpose of this study was to examine the role of response expectancies as a potential mediator. Hypnotizability was also tested as an effect moderator. Data were collected from a sample of 172 postmenopausal women, who had been randomized to receive either a 5-week hypnosis intervention or structured attention counseling. Measures of response expectancies were analyzed to determine if the relationship between group assignment and hot flashes frequency was mediated by expectancies for treatment efficacy. A series of simple mediation and conditional process analyses did not support mediation of the relationship between treatment condition and hot flash frequency through response expectancy. The effect of hypnotherapy in reducing hot flashes does not appear to be due to placebo effects as determined by response expectancies. Implications for clinical practice and future research are discussed. PMID:28528570

'Healthy Eating and Lifestyle in Pregnancy (HELP)' trial: Process evaluation framework.

PubMed

Simpson, Sharon A; Cassidy, Dunla; John, Elinor

2014-07-01

We developed and tested in a cluster RCT a theory-driven group-based intervention for obese pregnant women. It was designed to support women to moderate weight gain during pregnancy and reduce BMI one year after birth, in addition to targeting secondary health and wellbeing outcomes. In line with MRC guidance on developing and evaluating complex interventions in health, we conducted a process evaluation alongside the trial. This paper describes the development of the process evaluation framework. This cluster RCT recruited 598 pregnant women. Women in the intervention group were invited to attend a weekly weight-management group. Following a review of relevant literature, we developed a process evaluation framework which outlined key process indicators that we wanted to address and how we would measure these. Central to the process evaluation was to understand the mechanism of effect of the intervention. We utilised a logic-modelling approach to describe the intervention which helped us focus on what potential mediators of intervention effect to measure, and how. The resulting process evaluation framework was designed to address 9 core elements; context, reach, exposure, recruitment, fidelity, recruitment, retention, contamination and theory-testing. These were assessed using a variety of qualitative and quantitative approaches. The logic model explained the processes by which intervention components bring about change in target outcomes through various mediators and theoretical pathways including self-efficacy, social support, self-regulation and motivation. Process evaluation is a key element in assessing the effect of any RCT. We developed a process evaluation framework and logic model, and the results of analyses using these will offer insights into why the intervention is or is not effective. Copyright © 2014.

Effects of exercise on craving and cigarette smoking in the human laboratory.

PubMed

Kurti, Allison N; Dallery, Jesse

2014-06-01

Exercise is increasingly being pursued as a treatment to reduce cigarette smoking. The efficacy of clinical, exercise-based cessation interventions may be enhanced by conducting laboratory studies to determine maximally effective conditions for reducing smoking, and the mechanisms through which the effects on smoking are achieved. The main purpose of this study was to assess whether the effects of exercise on two components of craving (anticipated reward from smoking, anticipated relief from withdrawal) mediated the relationship between exercise and delay (in min) to ad libitum smoking. Experiment 1 (N=21) assessed the effects of exercise intensity (inactivity, low, moderate) on craving components up to 60 min post-exercise. Because moderate-intensity exercise most effectively reduced craving on the reward component, all participants exercised at a moderate intensity in Experiment 2. Using an ABAB within-subjects design, Experiment 2 (N=20) evaluated whether the effects of moderate-intensity exercise on reward and relief components of craving mediated the relationship between exercise and participants' delays (in min) to ad libitum smoking. Delays were significantly longer after exercise (M=21 min) versus inactivity (M=4 min), and the effects of exercise on delay were mediated through the reward component of craving. Future research should continue to explore the mechanisms through which exercise influences behavioral indices of smoking in the human laboratory. Additionally, given the benefits uniquely afforded by exercise-based cessation interventions (e.g., improving mood and other health outcomes), implementing these interventions in clinical settings may contribute substantially to improving public health. Copyright © 2014 Elsevier Ltd. All rights reserved.

Mediators of exposure therapy for youth obsessive-compulsive disorder: specificity and temporal sequence of client and treatment factors.

PubMed

Chu, Brian C; Colognori, Daniela B; Yang, Guang; Xie, Min-ge; Lindsey Bergman, R; Piacentini, John

2015-05-01

Behavioral engagement and cognitive coping have been hypothesized to mediate effectiveness of exposure-based therapies. Identifying which specific child factors mediate successful therapy and which therapist factors facilitate change can help make our evidence-based treatments more efficient and robust. The current study examines the specificity and temporal sequence of relations among hypothesized client and therapist mediators in exposure therapy for pediatric Obsessive Compulsive Disorder (OCD). Youth coping (cognitive, behavioral), youth safety behaviors (avoidance, escape, compulsive behaviors), therapist interventions (cognitive, exposure extensiveness), and youth anxiety were rated via observational ratings of therapy sessions of OCD youth (N=43; ages=8 - 17; 62.8% male) who had received Exposure and Response Prevention (ERP). Regression analysis using Generalized Estimation Equations and cross-lagged panel analysis (CLPA) were conducted to model anxiety change within and across sessions, to determine formal mediators of anxiety change, and to establish sequence of effects. Anxiety ratings decreased linearly across exposures within sessions. Youth coping and therapist interventions significantly mediated anxiety change across exposures, and youth-interfering behavior mediated anxiety change at the trend level. In CLPA, youth-interfering behaviors predicted, and were predicted by, changes in anxiety. Youth coping was predicted by prior anxiety change. The study provides a preliminary examination of specificity and temporal sequence among child and therapist behaviors in predicting youth anxiety. Results suggest that therapists should educate clients in the natural rebound effects of anxiety between sessions and should be aware of the negatively reinforcing properties of avoidance during exposure. Copyright © 2015. Published by Elsevier Ltd.

Putting theory to the test: Examining family context, caregiver motivation, and conflict in the Family Check-Up model

PubMed Central

Fosco, Gregory M.; Van Ryzin, Mark; Stormshak, Elizabeth A.; Dishion, Thomas J.

2014-01-01

This study examined contextual factors (caregiver depression, family resources, ethnicity, and initial levels of youth problem behavior) related to the effectiveness of the Family Check-Up (FCU) and evaluated family processes as a mediator of FCU intervention response and adolescent antisocial behavior. We followed a sample of 180 ethnically diverse youths of families who engaged in the FCU intervention. Family data were collected as part of the FCU assessment, and youth data were collected over 4 years, from sixth through ninth grade. Findings indicated that caregiver depression and minority status predicted greater caregiver motivation to change. In turn, caregiver motivation was the only direct predictor of FCU intervention response during a 1-year period. Growth in family conflict from sixth through eighth grade mediated the link between FCU response and ninth-grade antisocial behavior. This study explicitly tested core aspects of the FCU intervention model and demonstrated that caregiver motivation is a central factor that underlies family response to the FCU. The study also provided support for continued examination of family process mechanisms that account for enduring effects of the FCU and other family-centered interventions. PMID:24438894

Putting theory to the test: examining family context, caregiver motivation, and conflict in the Family Check-Up model.

PubMed

Fosco, Gregory M; Van Ryzin, Mark; Stormshak, Elizabeth A; Dishion, Thomas J

2014-05-01

This study examined contextual factors (caregiver depression, family resources, ethnicity, and initial levels of youth problem behavior) related to the effectiveness of the Family Check-Up (FCU) and evaluated family processes as a mediator of FCU intervention response and adolescent antisocial behavior. We followed a sample of 180 ethnically diverse youths of families who engaged in the FCU intervention. Family data were collected as part of the FCU assessment, and youth data were collected over 4 years, from sixth through ninth grade. Findings indicated that caregiver depression and minority status predicted greater caregiver motivation to change. In turn, caregiver motivation was the only direct predictor of FCU intervention response during a 1-year period. Growth in family conflict from sixth through eighth grade mediated the link between FCU response and ninth-grade antisocial behavior. This study explicitly tested core aspects of the FCU intervention model and demonstrated that caregiver motivation is a central factor that underlies family response to the FCU. The study also provided support for continued examination of family process mechanisms that account for enduring effects of the FCU and other family-centered interventions.

Mediator and moderator effects in developmental and behavioral pediatric research.

PubMed

Rose, Brigid M; Holmbeck, Grayson N; Coakley, Rachael Millstein; Franks, Elizabeth A

2004-02-01

The terms mediation and moderation are defined and clarified with particular emphasis on the role of mediational and moderational analyses in developmental and behavioral pediatric research. The article highlights the applicability of mediational and moderational analyses to longitudinal, intervention, and risk and protective factor research, and it provides basic information about how these analyses might be conducted. Also included is a discussion of various ways that both mediator and moderator variables can be incorporated into a single model. The article concludes with extended examples of both types of analyses using a longitudinal pediatric study for illustration. The article provides recommendations for applying mediational and moderational research in clinical practice.

Why and How to Promote Adolescents' Prosocial Behaviors: Direct, Mediated and Moderated Effects of the CEPIDEA School-Based Program.

PubMed

Caprara, Gian Vittorio; Luengo Kanacri, Bernadette Paula; Zuffianò, Antonio; Gerbino, Maria; Pastorelli, Concetta

2015-12-01

Prosocial behaviors are considered integral to intervention goals that seek to promote successful youth development. This study examines the effect of a school-based intervention program entirely designed to promote prosocial behaviors called Promoting Prosocial and Emotional Skills to Counteract Externalizing Problems in Adolescence (Italian acronym CEPIDEA). The CEPIDEA curriculum was incorporated into routine educational practices and included five major components that reflect the personal determinants of prosocial behavior during adolescence. The present study assessed 151 students (48.7% female; M(age) = 12.4) of the intervention school and 140 students (51.2% female; M(age) = 13.0) of the control school at three points. A multi-group latent curve analysis revealed that the intervention group, compared with the control group, showed an increase in prosocial behavior, interpersonal self-efficacy beliefs, and agreeableness along with a decrease in physical aggression above and beyond the normative developmental trend of the these variables. Participants of the intervention also obtained higher grades than the control group at the end of middle school. Moderation effects for prosocial behavior and agreeableness evidenced that those who benefited most from the intervention were those adolescents with lower normative development of prosocial behavior, low initial level of agreeableness, and high initial level of physical aggression. The results also showed that the increase of prosocial behaviors mediated the decline of verbal aggression in adolescents who had attended the intervention. These findings suggest that interventions aimed at promoting prosocial behaviors while having the potential to support positive outcomes may also counteract or redirect negative trajectories of functioning.

Does Size Impact Attention and Recall of Graphic Health Warnings?

PubMed

Klein, Elizabeth G; Shoben, Abigail B; Krygowski, Sarah; Ferketich, Amy; Berman, Micah; Peters, Ellen; Rao, Unnava; Wewers, Mary Ellen

2015-07-01

To evaluate the attention paid to larger sizes of graphic health warnings (GHWs) embedded within cigarette advertisements so as to assess their impacts on rural smokers. Daily smokers (N = 298) were randomly assigned to view a cigarette advertisement with 3 conditions: 2 intervention conditions with GHW comprising 20% or 33% of the ad area, or a text-only control. Eye-tracking software measured attention in milliseconds. Binary outcome mediation was conducted. Intervention participants spent 24% of their time viewing the GHWs, compared to 10% for control (p < .01). The odds of GHW recall in the combined (20% and 33%) intervention group were 3.3 times higher than controls. Total dwell time mediated 33% of the effect of the graphic condition on any recall. GHWs in 20% of cigarette advertisement space attracted significantly more attention than text-only warnings; larger GHWs did not increase attention. Attention was significantly associated with warning recall; total time viewing mediated warning recall. Tobacco ads should include GHWs to attract the attention of smokers.

The Effects of Two Influential Early Childhood Interventions on Health and Healthy Behaviour

PubMed Central

Conti, Gabriella; Heckman, James; Pinto, Rodrigo

2015-01-01

This paper examines the long-term impacts on health and healthy behaviors of two of the oldest and most widely cited U.S. early childhood interventions evaluated by the method of randomization with long-term follow-up: the Perry Preschool Project (PPP) and the Carolina Abecedarian Project (ABC). There are pronounced gender effects strongly favoring boys, although there are also effects for girls. Dynamic mediation analyses show a significant role played by improved childhood traits, above and beyond the effects of experimentally enhanced adult socioeconomic status. These results show the potential of early life interventions for promoting health. PMID:28260805

The effect of peer tutoring on interaction behaviors in inclusive physical education.

PubMed

Klavina, Aija; Block, Martin E

2008-04-01

This study assessed the effect of peer tutoring on physical, instructional, and social interaction behaviors between elementary school age students with severe and multiple disabilities (SMD) and peers without disabilities. Additional measures addressed the activity time of students with SMD. The study was conducted in inclusive general physical education settings under three instructional support conditions for students with SMD: (a) teacher-directed, (b) peer-mediated, and (c) voluntary peer support. During peer-mediated and voluntary peer support conditions, the instructional and physical interaction behaviors between students with SMD and their peers increased, while social interactions remained low. The activity engagement time data increased for all target students throughout intervention sessions. Interactions between students with SMD and teachers decreased toward the end of intervention.

Mindfulness-Based Cancer Recovery (MBCR) versus Supportive Expressive Group Therapy (SET) for distressed breast cancer survivors: evaluating mindfulness and social support as mediators.

PubMed

Schellekens, Melanie P J; Tamagawa, Rie; Labelle, Laura E; Speca, Michael; Stephen, Joanne; Drysdale, Elaine; Sample, Sarah; Pickering, Barbara; Dirkse, Dale; Savage, Linette Lawlor; Carlson, Linda E

2017-06-01

Despite growing evidence in support of mindfulness as an underlying mechanism of mindfulness-based interventions (MBIs), it has been suggested that nonspecific therapeutic factors, such as the experience of social support, may contribute to the positive effects of MBIs. In the present study, we examined whether change in mindfulness and/or social support mediated the effect of Mindfulness-Based Cancer Recovery (MBCR) compared to another active intervention (i.e. Supportive Expressive Group Therapy (SET)), on change in mood disturbance, stress symptoms and quality of life. A secondary analysis was conducted of a multi-site randomized clinical trial investigating the impacts of MBCR and SET on distressed breast cancer survivors (MINDSET). We applied the causal steps approach with bootstrapping to test mediation, using pre- and post-intervention questionnaire data of the participants who were randomised to MBCR (n = 69) or SET (n = 70). MBCR participants improved significantly more on mood disturbance, stress symptoms and social support, but not on quality of life or mindfulness, compared to SET participants. Increased social support partially mediated the impact of MBCR versus SET on mood disturbance and stress symptoms. Because no group differences on mindfulness and quality of life were observed, no mediation analyses were performed on these variables. Findings showed that increased social support was related to more improvement in mood and stress after MBCR compared to support groups, whereas changes in mindfulness were not. This suggests a more important role for social support in enhancing outcomes in MBCR than previously thought.

Unemployment and subsequent depression: A mediation analysis using the parametric G-formula.

PubMed

Bijlsma, Maarten J; Tarkiainen, Lasse; Myrskylä, Mikko; Martikainen, Pekka

2017-12-01

The effects of unemployment on depression are difficult to establish because of confounding and limited understanding of the mechanisms at the population level. In particular, due to longitudinal interdependencies between exposures, mediators and outcomes, intermediate confounding is an obstacle for mediation analyses. Using longitudinal Finnish register data on socio-economic characteristics and medication purchases, we extracted individuals who entered the labor market between ages 16 and 25 in the period 1996 to 2001 and followed them until the year 2007 (n = 42,172). With the parametric G-formula we estimated the population-averaged effect on first antidepressant purchase of a simulated intervention which set all unemployed person-years to employed. In the data, 74% of person-years were employed and 8% unemployed, the rest belonging to studying or other status. In the intervention scenario, employment rose to 85% and the hazard of first antidepressant purchase decreased by 7.6%. Of this reduction 61% was mediated, operating primarily through changes in income and household status, while mediation through other health conditions was negligible. These effects were negligible for women and particularly prominent among less educated men. By taking complex interdependencies into account in a framework of observed repeated measures data, we found that eradicating unemployment raises income levels, promotes family formation, and thereby reduces antidepressant consumption at the population-level. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

An Implicit Cognition Assessment Approach to Relapse, Secondary Prevention, and Media Effects

ERIC Educational Resources Information Center

Stacy, Alan W.; Ames, Susan L.; Leigh, Barbara C.

2004-01-01

We outline an implicit cognition, verbal, and nonverbal assessment approach that is feasible for a range of interventions in health behavior and addiction. This approach provides a way to assess whether interventions have an influence on the relatively spontaneous memories, thoughts, and evaluations that may mediate or precipitate health-related…

Effects of a Peer-Mediated Intervention on Social Interactions of Students with Low-Functioning Autism and Perceptions of Typical Peers

ERIC Educational Resources Information Center

Simpson, Lisa A.; Bui, Yvonne

2016-01-01

Students with autism display challenges acquiring friendships and participating in relationships with typical peers. Social interaction is further impacted in students with low-functioning autism, necessitating consideration of their unique characteristics when designing and implementing interventions. This single-subject study examined the…

Cognitive Modifiability of Children with Developmental Disabilities: A Multicentre Study Using Feuerstein's Instrumental Enrichment-Basic Program

ERIC Educational Resources Information Center

Kozulin, A.; Lebeer, J.; Madella-Noja, A.; Gonzalez, F.; Jeffrey, I.; Rosenthal, N.; Koslowsky, M.

2010-01-01

The study aimed at exploring the effectiveness of cognitive intervention with the new "Instrumental Enrichment Basic" program (IE-basic), based on Feuerstein's theory of structural cognitive modifiability that contends that a child's cognitive functioning can be significantly modified through mediated learning intervention. The IE-basic…

Power Analysis for Cross Level Mediation in CRTs

ERIC Educational Resources Information Center

Kelcey, Ben

2014-01-01

A common design in education research for interventions operating at a group or cluster level is a cluster randomized trial (CRT) (Bloom, 2005). In CRTs, intact clusters (e.g., schools) are assigned to treatment conditions rather than individuals (e.g., students) and are frequently an effective way to study interventions because they permit…

Understanding the behavioral linkages needed for designing effective interventions to increase fruit and vegetable intake in diverse populations

USDA-ARS?s Scientific Manuscript database

The design of interventions to increase fruit and vegetable consumption in a population (e.g. all men, all elementary school students) requires an underlying model that organizes the relevant literatures and provides an audience. The mediating-moderating variable model is a statistical analysis tech...

Mechanisms of Behavioral and Affective Treatment Outcomes in a Cognitive Behavioral Intervention for Boys.

PubMed

Burke, Jeffrey D; Loeber, Rolf

2016-01-01

Evidence for effective treatment for behavioral problems continues to grow, yet evidence about the effective mechanisms underlying those interventions has lagged behind. The Stop Now and Plan (SNAP) program is a multicomponent intervention for boys between 6 and 11. This study tested putative treatment mechanisms using data from 252 boys in a randomized controlled trial of SNAP versus treatment as usual. SNAP includes a 3 month group treatment period followed by individualized intervention, which persisted through the 15 month study period. Measures were administered in four waves: at baseline and at 3, 9 and 15 months after baseline. A hierarchical linear modeling strategy was used. SNAP was associated with improved problem-solving skills, prosocial behavior, emotion regulation skills, and reduced parental stress. Prosocial behavior, emotion regulation skills and reduced parental stress partially mediated improvements in child aggression. Improved emotion regulation skills partially mediated treatment-related child anxious-depressed outcomes. Improvements in parenting behaviors did not differ between treatment conditions. The results suggest that independent processes may drive affective and behavioral outcomes, with some specificity regarding the mechanisms related to differing treatment outcomes.

Causal mediation analysis with a binary outcome and multiple continuous or ordinal mediators: Simulations and application to an alcohol intervention

PubMed Central

Nguyen, Trang Quynh; Webb-Vargas, Yenny; Koning, Ina M.; Stuart, Elizabeth A.

2016-01-01

We investigate a method to estimate the combined effect of multiple continuous/ordinal mediators on a binary outcome: 1) fit a structural equation model with probit link for the outcome and identity/probit link for continuous/ordinal mediators, 2) predict potential outcome probabilities, and 3) compute natural direct and indirect effects. Step 2 involves rescaling the latent continuous variable underlying the outcome to address residual mediator variance/covariance. We evaluate the estimation of risk-difference- and risk-ratio-based effects (RDs, RRs) using the ML, WLSMV and Bayes estimators in Mplus. Across most variations in path-coefficient and mediator-residual-correlation signs and strengths, and confounding situations investigated, the method performs well with all estimators, but favors ML/WLSMV for RDs with continuous mediators, and Bayes for RRs with ordinal mediators. Bayes outperforms WLSMV/ML regardless of mediator type when estimating RRs with small potential outcome probabilities and in two other special cases. An adolescent alcohol prevention study is used for illustration. PMID:27158217

Testing the 4Rs and 2Ss Multiple Family Group intervention: study protocol for a randomized controlled trial.

PubMed

Acri, Mary; Hamovitch, Emily; Mini, Maria; Garay, Elene; Connolly, Claire; McKay, Mary

2017-12-04

Oppositional defiant disorder (ODD) is a major mental health concern and highly prevalent among children living in poverty-impacted communities. Despite that treatments for ODD are among the most effective, few children living in poverty receive these services due to substantial barriers to access, as well as difficulties in the uptake and sustained adoption of evidence-based practices (EBPs) in community settings. The purpose of this study is to examine implementation processes that impact uptake of an evidence-based practice for childhood ODD, and the impact of a Clinic Implementation Team (CIT)-driven structured adaptation to enhance its fit within the public mental health clinic setting. This study, a Hybrid Type II effectiveness-implementation research trial, blends clinical effectiveness and implementation research methods to examine the impact of the 4Rs and 2Ss Multiple Family Group (MFG) intervention, family level mediators of child outcomes, clinic/provider-level mediators of implementation, and the impact of CITs on uptake and long-term utilization of this model. All New York City public outpatient mental health clinics have been invited to participate. A sampling procedure that included randomization at the agency level and a sub-study to examine the impact of clinic choice upon outcomes yielded a distribution of clinics across three study conditions. Quantitative data measuring child outcomes, organizational factors and implementation fidelity will be collected from caregivers and providers at baseline, 8, and 16 weeks from baseline, and 6 months from treatment completion. The expected participation is 134 clinics, 268 providers, and 2688 caregiver/child dyads. We will use mediation analysis with a multi-level Structural Equation Modeling (SEM) (MSEM including family level variables, provider variables, and clinic variables), as well as mediation tests to examine study hypotheses. The aim of the study is to generate knowledge about effectiveness and mediating factors in the treatment of ODDs in children in the context of family functioning, and to propose an innovative approach to the adaptation and implementation of new treatment interventions within clinic settings. The proposed CIT adaptation and implementation model has the potential to enhance implementation and sustainability, and ultimately increase the extent to which effective interventions are available and can impact children and families in need of services for serious behavior problems. ClinicalTrials.gov, ID: NCT02715414 . Registered on 3 March 2016.

Effects of Internet-Based Self-Efficacy Intervention on Secondary Traumatic Stress and Secondary Posttraumatic Growth among Health and Human Services Professionals Exposed to Indirect Trauma

PubMed Central

Cieslak, Roman; Benight, Charles C.; Rogala, Anna; Smoktunowicz, Ewelina; Kowalska, Martyna; Zukowska, Katarzyna; Yeager, Carolyn; Luszczynska, Aleksandra

2016-01-01

Background: Although the evidence for the associations among self-efficacy, secondary traumatic stress (STS) and secondary posttraumatic growth (SPTG) is mounting, there is a lack of the experimental evidence for the influence of self-efficacy on positive and negative mental health outcomes among professionals indirectly exposed to trauma. Purpose: This study investigated the effects of an internet-based self-efficacy intervention (the experimental condition), compared to an education (the active control condition) on STS and SPTG among workers exposed to traumatic events indirectly, through their clients. We hypothesized that the group assignment (experimental vs. control) would affect STS and SPTG indirectly, with a mediating role of self-efficacy beliefs. Methods: Participants were 168 health and human services professionals (78% women), exposed indirectly to a traumatic event at work. They were randomly assigned to either a 4-session internet-based self-efficacy intervention (n = 87) or an education control group (n = 81) which received information about coping resources and consequences of stressors at work or at home. STS, SPTG, and self-efficacy were measured at the baseline (Time 1), 1-month follow-up (Time 2) and 2-month follow-up (Time 3). Results: Analysis of covariance showed that the group assignment had a significant effect on STS (Time 2) and self-efficacy (Time 2), with lower STS and higher self-efficacy reported by the self-efficacy intervention participants. Compared to the experimental group, the active control (education) group participants reported higher SPTG at Time 2. Mediation analyses indicated that the group assignment had indirect effects on STS and SPTG at Time 3. Workers who experienced increases in self-efficacy (Time 2) through the intervention were more likely to report lower STS and higher SPTG at Time 3. Conclusion: Elucidating the mediating processes that explain why an intervention for secondary trauma works is essential in order to develop more effective support systems that promote improved mental health outcomes among health and human services professionals. Prevention programs for workers exposed indirectly to traumatic events may target self-efficacy enhancement and education. PMID:27458407

Training Peer Partners to Use a Speech-Generating Device With Classmates With Autism Spectrum Disorder: Exploring Communication Outcomes Across Preschool Contexts.

PubMed

Thiemann-Bourque, Kathy S; McGuff, Sara; Goldstein, Howard

2017-09-18

This study examined effects of a peer-mediated intervention that provided training on the use of a speech-generating device for preschoolers with severe autism spectrum disorder (ASD) and peer partners. Effects were examined using a multiple probe design across 3 children with ASD and limited to no verbal skills. Three peers without disabilities were taught to Stay, Play, and Talk using a GoTalk 4+ (Attainment Company) and were then paired up with a classmate with ASD in classroom social activities. Measures included rates of communication acts, communication mode and function, reciprocity, and engagement with peers. Following peer training, intervention effects were replicated across 3 peers, who all demonstrated an increased level and upward trend in communication acts to their classmates with ASD. Outcomes also revealed moderate intervention effects and increased levels of peer-directed communication for 3 children with ASD in classroom centers. Additional analyses revealed higher rates of communication in the added context of preferred toys and snack. The children with ASD also demonstrated improved communication reciprocity and peer engagement. Results provide preliminary evidence on the benefits of combining peer-mediated and speech-generating device interventions to improve children's communication. Furthermore, it appears that preferred contexts are likely to facilitate greater communication and social engagement with peers.

[Effect of Adolescents' Abuse Experience on Suicidal Ideation: Focused on Moderated Mediation Effect of Self-esteem on Depression and Anxiety].

PubMed

Kim, Ji Young; Lee, Kyunghee

2015-10-01

The purpose of this study was to examine the moderating mediation effect of self-esteem on the relations among adolescents' abuse experiences, depression and anxiety, and suicidal ideation. The participants were selected using secondary data from a population in the 2012 Korea Welfare Panel Survey (KOWEPS). Data were analyzed using SPSS 15.0 and SPSS Macro, and bootstrapping and hierarchical regression analysis were performed to analyze multilevel models. First, analysis of the mediating effect of the adolescents' abuse showed that there was significant mediating influence between suicidal ideation and depression and anxiety. Second, hierarchical regression analysis showed that self-esteem had significant mediation effect on depression and anxiety in adolescents' suicidal ideation. Third, SPSS Macro showed that self-esteem also significantly moderated the mediating effect of adolescents' abuse experiences on suicidal ideation through depression and anxiety. The study results suggest that in future research on adolescent's abuse experience, the risk of suicide in depression and anxiety scores should be selected through evaluation of each individual's self-esteem scale. Coping strategies with immediate early intervention should be suggested.

Mediation and moderation of psychological pain treatments: response expectancies and hypnotic suggestibility.

PubMed

Milling, Leonard S; Reardon, John M; Carosella, Gina M

2006-04-01

The mediator role of response expectancies and the moderator role of hypnotic suggestibility were evaluated in the analogue treatment of pain. Approximately 1,000 participants were assessed for hypnotic suggestibility. Later, as part of a seemingly unrelated experiment, 188 of these individuals were randomly assigned to distraction, cognitive-behavioral package, hypnotic cognitive-behavioral package, hypnotic analgesia suggestion, placebo control, or no-treatment control conditions. Response expectancies partially mediated the effects of treatment on pain. Hypnotic suggestibility moderated treatment and was associated with the relief produced only by the hypnotic interventions. The results suggest that response expectancies are an important mechanism of hypnotic and cognitive-behavioral pain treatments and that hypnotic suggestibility is a trait variable that predicts hypnotic responding across situations, including hypnosis-based pain interventions. Copyright 2006 APA

Moderation and Mediation in Structural Equation Modeling: Applications for Early Intervention Research

ERIC Educational Resources Information Center

Hopwood, Christopher J.

2007-01-01

Second-generation early intervention research typically involves the specification of multivariate relations between interventions, outcomes, and other variables. Moderation and mediation involve variables or sets of variables that influence relations between interventions and outcomes. Following the framework of Baron and Kenny's (1986) seminal…

Meta-Analysis of Parent-Mediated Interventions for Young Children with Autism Spectrum Disorder

ERIC Educational Resources Information Center

Nevill, Rose E.; Lecavalier, Luc; Stratis, Elizabeth A.

2018-01-01

A number of studies of parent-mediated interventions in autism spectrum disorder have been published in the last 15 years. We reviewed 19 randomized clinical trials of parent-mediated interventions for children with autism spectrum disorder between the ages of 1 and 6 years and conducted a meta-analysis on their efficacy. Meta-analysis outcomes…

Self-Efficacy and Social Support Mediate the Relationship between Internal Health Locus of Control and Health Behaviors in College Students

ERIC Educational Resources Information Center

Marr, Joni; Wilcox, Sara

2015-01-01

Background: Internal health locus of control has been associated with positive health outcomes and behaviors. Understanding the mechanisms of this relationship are key to designing and implementing effective health behavior intervention programs. Purpose: The purpose was to examine whether self-efficacy and social support mediate the relationship…

Reducing sibling conflict in maltreated children placed in foster homes.

PubMed

Linares, L Oriana; Jimenez, Jessica; Nesci, Cristina; Pearson, Eva; Beller, Sarah; Edwards, Nancy; Levin-Rector, Alison

2015-02-01

Sibling aggression among maltreated children placed in foster homes is linked to other externalizing problems and placement disruption. The reduction of sibling conflict and aggression may be achieved via a multicomponent ecologically focused intervention for families in the foster care system. The focus of the study is to evaluate the feasibility and short-term effectiveness of a transtheoretical intervention model targeting sibling pairs and their foster parent that integrates family systems, social learning theory, and a conflict mediation perspective. In this pilot study, sibling pairs (N = 22) and their foster parent were randomized into a three-component intervention (n = 13) or a comparison (n = 9) group. Promoting Sibling Bonds (PSB) is an 8-week prevention intervention targeting maltreated sibling pairs ages 5-11 years placed together in a foster home. The siblings, parent, and joint components were delivered in a program package at the foster agency by a trained two-clinician team. Average attendance across program components was 73 %. Outcomes in four areas were gathered at pre- and postintervention: observed sibling interaction quality (positive and negative) including conflict during play, and foster parent reports of mediation strategies and sibling aggression in the foster home. At postintervention, adjusting for baseline scores and child age, intervention pairs showed higher positive (p < 0.001) and negative (p < 0.05) interaction quality and lower sibling conflict during play (p < 0.01) than comparison pairs. Foster parents in the intervention group reported a higher number of conflict mediation strategies than those in the comparison group (p < 0.001). Foster parents in the intervention group reported lower sibling physical aggression from the older toward the younger child than those in the comparison group (p < 0.05). Data suggest that the PSB intervention is a promising approach to reduce conflict and promote parental mediation, which together may reduce sibling aggression in the foster home.

Brief Motivational and Parent Interventions For College Students: A Randomized Factorial Study

PubMed Central

Wood, Mark D.; Fairlie, Anne M.; Fernandez, Anne C.; Borsari, Brian; Capone, Christy; Laforge, Robert; Carmona-Barros, Rosa

2010-01-01

Objective Using a randomized factorial design, we examined the efficacy of a Brief Motivational Intervention (BMI) and Parent-based Intervention (PBI) as universal preventive interventions to reduce alcohol use among incoming college students. Method Participants (N = 1,014) were assessed prior to matriculation and at 10-months and 22-months post-baseline. Two-part latent growth modeling was used to simultaneously examine initiation and growth in heavy episodic drinking and alcohol-related consequences. Results This study retained 90.8% (n = 921) of randomized students at the 10 month follow-up and 84.0% (n = 852) at the 22-month follow-up. BMI participants were significantly less likely than non-BMI participants to initiate heavy episodic drinking and to begin experiencing alcohol-related consequences. Effect sizes were minimal at 10-months (Cohen’s h ranged from 0.02–0.07) and small at 22-months (h’s from 0.15–0.22). A significant BMI X PBI interaction revealed that students receiving both the BMI and PBI were significantly less likely to report the onset of consequences beyond the sum of the individual intervention effects (h = 0.08 at 10-month and 0.21 at 22-month). Hypothesized direct BMI effects for reductions in heavy episodic drinking and consequences were not observed. Significant mediated effects via changes in descriptive norms were present for both growth and initiation of heavy episodic drinking and consequences. Conclusions To our knowledge, the current study is the first to provide support for BMI as a universal preventive intervention for incoming college students. While hypothesized PBI main effects were not found, mediation analyses suggest future refinements could enhance PBI effectiveness. PMID:20515210

Effects of peer-mediated implementation of visual scripts in middle school.

PubMed

Ganz, Jennifer B; Heath, Amy K; Lund, Emily M; Camargo, Siglia P H; Rispoli, Mandy J; Boles, Margot; Plaisance, Lauren

2012-05-01

Although research has investigated the impact of peer-mediated interventions and visual scripts on social and communication skills in children with autism spectrum disorders, no studies to date have investigated peer-mediated implementation of scripts. This study investigated the effects of peer-implemented scripts on a middle school student with autism, intellectual impairments, and speech-language impairment via a multiple baseline single-case research design across behaviors. The target student demonstrated improvements in three communicative behaviors when implemented by a trained peer; however, behaviors did not generalize to use with an untrained typically developing peer.

Personality and Alcohol-Related Outcomes among Mandated College Students: Descriptive Norms, Injunctive Norms, and College-Related Alcohol Beliefs as Mediators

PubMed Central

Pearson, Matthew R.; Hustad, John T. P.

2014-01-01

The present study examined three alcohol-perception variables (descriptive norms, injunctive norms, and college-related alcohol beliefs) as mediators of the predictive effects of four personality traits (impulsivity, sensation seeking, anxiety sensitivity, and hopelessness) on alcohol use and alcohol-related consequences in a sample of mandated college students (n = 875). Our findings replicated several findings of a previous study of incoming freshman college students (Hustad et al., in press) in that impulsivity and hopelessness had direct effects on alcohol-related problems, sensation seeking and impulsivity had indirect effects on alcohol-related outcomes via college-related alcohol beliefs, and college-related alcohol beliefs predicted both alcohol use and alcohol-related problems. We discuss the implications of our findings for global college student interventions as well as personality-targeted interventions. PMID:24589869

Effects of peer-mediated instruction to teach use of speech-generating devices to students with autism in social game routines.

PubMed

Trottier, Nadine; Kamp, Lorraine; Mirenda, Pat

2011-03-01

Supporting social interactions between students with autism spectrum disorders (ASDs) and their typically developing peers presents many challenges. The purpose of this study was to investigate the effects of a peer-mediated intervention designed to teach two students with ASD to use speech-generating devices (SGDs) to engage in interactions with peers in a social context at school. Six peer confederates (three from each student with ASD's general education classroom) were taught to support SGD use during game activities. A multiple baseline design was used to examine the relationship between peer-mediated instruction and an increase in total communicative acts (CAs) by the two students with ASD. Results provide evidence that the confederates acquired the skills needed to support SGD use by students with ASD. The results also suggest that the intervention was effective at increasing total appropriate CAs by students with ASD. In addition, social validity ratings by all of the confederates were positive. Results are discussed regarding educational implications, limitations, and future research.

Drinking water to reduce alcohol craving? A randomized controlled study on the impact of ghrelin in mediating the effects of forced water intake in alcohol addiction.

PubMed

Koopmann, Anne; Lippmann, Katharina; Schuster, Rilana; Reinhard, Iris; Bach, Patrick; Weil, Georg; Rietschel, Marcella; Witt, Stephanie H; Wiedemann, Klaus; Kiefer, Falk

2017-11-01

Recent data suggest that ghrelin is involved in the pathophysiology of alcohol use disorders, affecting alcohol self-administration and craving. Gastric ghrelin secretion is reduced by stomach distension. We now tested the hypothesis whether the clinically well-known effects of high-volume water intake on craving reduction in alcoholism is mediated by acute changes in ghrelin secretion. In this randomized human laboratory study, we included 23 alcohol-dependent male inpatient subjects who underwent alcohol cue exposure. Participants of the intervention group drank 1000ml of mineral water within 10min directly thereafter, compared to the participants of the control group who did not. Craving and plasma concentrations of acetylated ghrelin were measured ten times during the 120min following the alcohol cue exposure session. In the intervention group, a significant decrease in acetylated ghrelin in plasma compared to the control group was observed. This decrease was correlated to a reduction in patients' subjective level of craving. In the control group, no decrease of acetylated ghrelin in plasma and no association between alcohol craving and changes in plasma concentrations of acetylated ghrelin were observed. Our results present new evidence that the modulation in the ghrelin system by oral water intake mediates the effects of volume intake with craving reduction in alcohol use disorders. Hence, in addition to pharmacological interventions with ghrelin antagonists, the reduction of physiological ghrelin secretion might be a target for future interventions in the treatment of alcohol craving. Copyright © 2017 Elsevier Ltd. All rights reserved.

A Community-Based Intervention Program to Enhance Family Communication and Family Well-being: The Learning Families Project in Hong Kong.

PubMed

Shen, Chen; Wan, Alice; Kwok, Lit Tung; Pang, Sally; Wang, Xin; Stewart, Sunita M; Lam, Tai Hing; Chan, Sophia Siu Chee

2017-01-01

Family communication is important to maintain family relationships and family well-being. To enhance family communication and family well-being, a community-based "Learning Families Project," based on the social ecological model was developed in Kwun Tong in Hong Kong, a district with high prevalence of family problems. This quasi-experimental study included two nearby government subsidized low-rent housing estates separated by busy main roads, as the intervention [Tsui Ping (South) Estate] and control (Shun Tin Estate) estate. The main intervention was resident training programs, such as talks, day camps, and thematic activities. No program was implemented in the control estate. Participants in the intervention group received assessments before the intervention (T1), immediately after the intervention (T2), and 6 weeks after the intervention (T3). Control group participants were assessed at baseline (March to April 2011) and follow-up (December 2011 to March 2012). Assessments of family communication (time and perceived adequacy) and family well-being (harmony, happiness, and health) at T1 and T3 were obtained in the intervention group to examine within-group changes. In addition, these differences in outcomes in the intervention group were compared with those in the control group to examine the effectiveness of the intervention. Family communication time and perceived communication adequacy increased significantly in the intervention group ( n  = 515) with a small effect size (Cohen effect d : 0.10 and 0.24, respectively). Compared with the control group ( n  = 476), the improvements in family communication time and perceived communication adequacy (Cohen effect d : 0.13 and 0.14, respectively), and perceived family harmony and happiness (Cohen effect d : 0.12 and 0.12, respectively) were significantly greater in the intervention group, adjusting for age and education, suggesting the intervention was effective in improving family communication and family well-being. Mediation analysis showed that perceived communication adequacy mediated the effects of the intervention on family harmony [β = 0.10, 95% confidence interval (CI) 0.03, 0.18], happiness (β = 0.12, 95% CI 0.04, 0.20), and health (β = 0.10, 95% CI 0.02, 0.17), adjusting for age and education. This community intervention based on the social ecological model improved family well-being through improving family communication, which could be an effective target to promote family well-being in other communities. This study was registered under ClinicalTrials.gov, identifier NCT02851667. URL: https://clinicaltrials.gov/ct2/show/NCT02851667?term=02851667&rank=1.

Aging, the Central Nervous System, and Mobility in Older Adults: Interventions

PubMed Central

Hausdorff, Jeffrey M.; Studenski, Stephanie A.; Rosano, Caterina; Camicioli, Richard; Alexander, Neil B.; Chen, Wen G.; Lipsitz, Lewis A.; Carlson, Michelle C.

2016-01-01

Background: Research suggests that the central nervous system (CNS) and mobility are closely linked. CNS-mediated mobility impairment may represent a potentially new and prevalent syndrome within the older adult populations. Interventions targeting this group may have the potential to improve mobility and cognition and prevent disability. Methods: In 2012, the Gerontological Society of America (GSA) and the National Institute on Aging (NIA) sponsored a 3-year conference workshop series, “Aging, the CNS, and Mobility.” The goal of this third and final conference was to (i) report on the state of the science of interventions targeting CNS-mediated mobility impairment among community-dwelling older adults and (ii) partnering with the NIA, explore the future of research and intervention design focused on a potentially novel aging syndrome. Results: Evidence was presented in five main intervention areas: (i) pharmacology and diet; (ii) exercise; (iii) electrical stimulation; (iv) sensory stimulation/deprivation; and (v) a combined category of multimodal interventions. Workshop participants identified important gaps in knowledge and key recommendations for future interventions related to recruitment and sample selection, intervention design, and methods to measure effectiveness. Conclusions: In order to develop effective preventive interventions for this prevalent syndrome, multidisciplinary teams are essential particularly because of the complex nature of the syndrome. Additionally, integrating innovative methods into the design of interventions may help researchers better measure complex mechanisms, and finally, the value of understanding the link between the CNS and mobility should be conveyed to researchers across disciplines in order to incorporate cognitive and mobility measurements into study protocols. PMID:27154905

Mediating Effects of Global Negative Effect Expectancies on the Association between Problematic Cannabis Use and Social Anxiety.

PubMed

Di Blasi, Maria; Cavani, Paola; Pavia, Laura; Tosto, Crispino; La Grutta, Sabina; Lo Baido, Rosa; Giordano, Cecilia; Schimmenti, Adriano

2017-01-01

The relationship between social anxiety (SA) and cannabis use among adolescents and young adults is a highly debated topic. In this cross-sectional study, we tested whether cannabis use expectancies mediated the association between SA and cannabis use severity in a sample of 343 young adults (74.3% male) who used cannabis. They completed self-report measures for the screening of problematic cannabis use (Cannabis Use Problems Identification Test) and SA symptoms (Social Interaction Anxiety Scale and Social Phobia Scale). A multiple mediation analysis was used to test whether marijuana effect expectancies mediate SA effect on problematic cannabis use. SA was negatively associated with cannabis use severity in this sample, and we found evidence that cannabis use expectancies fully mediated this relationship. Specifically, global negative effect expectancies influence the relationship between SA and problematic cannabis use. These findings may inform current prevention strategies and clinical intervention for young adults who use cannabis.

Mediating Effects of Global Negative Effect Expectancies on the Association between Problematic Cannabis Use and Social Anxiety

PubMed Central

Di Blasi, Maria; Cavani, Paola; Pavia, Laura; Tosto, Crispino; La Grutta, Sabina; Lo Baido, Rosa; Giordano, Cecilia; Schimmenti, Adriano

2017-01-01

The relationship between social anxiety (SA) and cannabis use among adolescents and young adults is a highly debated topic. In this cross-sectional study, we tested whether cannabis use expectancies mediated the association between SA and cannabis use severity in a sample of 343 young adults (74.3% male) who used cannabis. They completed self-report measures for the screening of problematic cannabis use (Cannabis Use Problems Identification Test) and SA symptoms (Social Interaction Anxiety Scale and Social Phobia Scale). A multiple mediation analysis was used to test whether marijuana effect expectancies mediate SA effect on problematic cannabis use. SA was negatively associated with cannabis use severity in this sample, and we found evidence that cannabis use expectancies fully mediated this relationship. Specifically, global negative effect expectancies influence the relationship between SA and problematic cannabis use. These findings may inform current prevention strategies and clinical intervention for young adults who use cannabis. PMID:29213247

Competitive testing of health behavior theories: how do benefits, barriers, subjective norm, and intention influence mammography behavior?

PubMed Central

Murphy, Caitlin C.; Vernon, Sally W.; Diamond, Pamela M.; Tiro, Jasmin A.

2013-01-01

Background Competitive hypothesis testing may explain differences in predictive power across multiple health behavior theories. Purpose We tested competing hypotheses of the Health Belief Model (HBM) and Theory of Reasoned Action (TRA) to quantify pathways linking subjective norm, benefits, barriers, intention, and mammography behavior. Methods We analyzed longitudinal surveys of women veterans randomized to the control group of a mammography intervention trial (n=704). We compared direct, partial mediation, and full mediation models with Satorra-Bentler χ2 difference testing. Results Barriers had a direct and indirect negative effect on mammography behavior; intention only partially mediated barriers. Benefits had little to no effect on behavior and intention; however, it was negatively correlated with barriers. Subjective norm directly affected behavior and indirectly affected intention through barriers. Conclusions Our results provide empiric support for different assertions of HBM and TRA. Future interventions should test whether building subjective norm and reducing negative attitudes increases regular mammography. PMID:23868613

Decreasing Substance Use Risk Among African American Youth: Parent-based Mechanisms of Change

PubMed Central

Beach, Steven R. H.; Barton, Allen W.; Lei, Man Kit; Mandara, Jelani; Wells, Ashley C.; Kogan, Steven M.; Brody, Gene H.

2017-01-01

African American couples (N = 139; 67.7% married; with children between the ages of 9 and 14) were randomly assigned to (a) a culturally sensitive, couple- and parenting-focused program designed to prevent stress-spillover (n = 70) or (b) an information-only control condition in which couples received self-help materials (n = 69). Eight months after baseline, youth whose parents participated in the program, compared with control youth, reported increased parental monitoring, positive racial socialization, and positive self-concept, as well as decreased conduct problems and self-reported substance use. Changes in youth-reported parenting behavior partially mediated the effect of the intervention on conduct problems and fully mediated its impact on positive self-concept, but did not mediate effects on lifetime substance use initiation. Results suggest the potential for a culturally sensitive family-based intervention targeting adults’ couple and parenting processes to enhance multiple parenting behaviors as well as decrease youths’ substance use onset and vulnerability. PMID:27129477

Psychosocial Influences on Fruit and Vegetable Intake Following a NYC Supermarket Discount.

PubMed

Bernales-Korins, Maria; Ang, Ian Yi Han; Khan, Shamima; Geliebter, Allan

2017-08-01

To assess the effect of a 50% discount on fruits and vegetables (F&V) on the purchase and intake of F&V and on psychosocial determinants of F&V intake: self-efficacy (SE), stages of change (SOC), and perceived barriers (PB). This randomized controlled trial was conducted in local supermarkets over 16 weeks, including a 4-week baseline, 8-week discount intervention, and 4-week follow-up. Shoppers with overweight or obesity (BMI > 25) were randomized to receive a discount or no discount via their reward scan card after the baseline. Twenty-four-hour recalls and psychosocial measures were obtained for each study period. Purchases (P < 0.0005) and intakes (P = 0.019) of F&V increased significantly during the intervention, while only F&V intake was sustained at follow-up. The discount intervention increased SE (P < 0.01) and SOC (P < 0.05) and did not decrease PB (P = 0.057) during the intervention. SOC mediated the discount intervention effect on F&V intake (P < 0.05) during the intervention, explaining 43% of variance. A supermarket discount intervention led to increases in purchases and intakes of F&V and increases in the psychosocial factors SE and SOC and did not decrease PB. The discount intervention prompted participants to move from the preparation to action stage of SOC, which acted as a mediator for increased F&V intake. © 2017 The Obesity Society.

Aligning organizational priorities with ARC to improve youth mental health service outcomes.

PubMed

Glisson, Charles; Williams, Nathaniel J; Hemmelgarn, Anthony; Proctor, Enola; Green, Philip

2016-08-01

The Availability, Responsiveness, and Continuity (ARC) organizational intervention is designed to improve community-based youth mental health services by aligning organizational priorities with 5 principles of effective service organizations (i.e., mission driven, results oriented, improvement directed, relationship centered, participation based). This study assessed the effect of the ARC intervention on youth outcomes and the mediating role of organizational priorities as a mechanism linking the ARC intervention to outcomes. Fourteen community-based mental health agencies in a midwestern metropolis along with 475 clinicians and 605 youth (ages 5-18) served by those agencies were randomly assigned to the 3-year ARC intervention or control condition. The agencies' priorities were measured with the ARC Principles Questionnaire (APQ) completed by clinicians at the end of the intervention. Youth outcomes were measured as total problems in psychosocial functioning described by their caregivers using the Shortform Assessment for Children (SAC) at 6 monthly intervals. The rate of improvement in youths' psychosocial functioning in agencies assigned to the ARC condition was 1.6 times the rate of improvement in agencies assigned to the control condition, creating a standardized difference in functioning of d = .23 between the 2 groups at the 6-month follow-up. The effect on youth outcomes was fully mediated by the alignment of organizational priorities described in the 5 ARC principles (d = .21). The ARC organizational intervention improves youth outcomes by aligning organizational priorities with the 5 ARC principles. The findings suggest that organizational priorities explain why some community mental health agencies are more effective than others. (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Aligning Organizational Priorities with ARC to Improve Youth Mental Health Service Outcomes

PubMed Central

Glisson, Charles; Williams, Nathaniel J.; Hemmelgarn, Anthony; Procter, Enola; Green, Philip

2016-01-01

Objective The ARC organizational intervention was designed to improve community-based youth mental health services by aligning organizational priorities with five principles of effective service organizations (i.e., mission-driven, results-oriented, improvement-directed, relationship-centered, participation-based). This study assessed the effect of the ARC intervention on youth outcomes and the mediating role of organizational priorities as a mechanism linking the ARC intervention to outcomes. Methodology Fourteen community-based mental health agencies in a Midwestern metropolis along with 475 clinicians and 605 youth (aged 5–18) served by those agencies were randomly assigned to the three-year ARC intervention or control condition. The agencies’ priorities were measured with the ARC Principles Questionnaire (APQ) completed by clinicians at the end of the intervention. Youth outcomes were measured as total problems in psychosocial functioning described by their caregivers using the Shortform Assessment for Children (SAC) at six monthly intervals. Results The rate of improvement in youths’ psychosocial functioning in agencies assigned to the ARC condition was 1.6 times the rate of improvement in agencies assigned to the control condition, creating a standardized difference in functioning of d = .23 between the two groups at the six month follow-up. The effect on youth outcomes was fully mediated by the alignment of organizational priorities described in the five ARC principles (d = .21). Conclusions The ARC organizational intervention improves youth outcomes by aligning organizational priorities with the five ARC principles. The findings suggest that organizational priorities explain why some community mental health agencies are more effective than others. PMID:27253202

A pilot randomized controlled trial to decrease adaptation difficulties in chinese new immigrants to Hong Kong.

PubMed

Yu, Xiaonan; Stewart, Sunita M; Chui, Jolian P L; Ho, Joy L Y; Li, Anthony C H; Lam, Tai Hing

2014-01-01

Immigration occurs globally, and immigrants are vulnerable to the development of adaptation difficulties. Little evidence is available for effective programs to enhance immigrant adaptation outside of the West. This pilot randomized controlled trial tested the effectiveness of two interventions used to decrease adaptation difficulties by (a) providing knowledge of resources that are relevant to the Hong Kong context or (b) enhancing personal resilience in immigrants to Hong Kong from Mainland China. A total of 220 participants were randomly assigned to three conditions: information, resilience, or control arms. They completed measures on adaptation difficulties, knowledge, and personal resilience at baseline, immediately after the intervention (postintervention), and at a 3-month follow-up. The information intervention resulted in higher increases postintervention in knowledge than did the other two arms. The resilience intervention reported greater increases in personal resilience than did the control arm at both postintervention and 3 months later; it also reported greater increases than the information arm did at the 3-month follow-up. Although both interventions reported greater decreases in adaptation difficulties than the control arm did at postintervention and 3 months later, no significant differences were found when they were compared with each other at both time points. Both programs had high acceptability and were feasible to implement in the community. Change in knowledge had no significant mediation effect on adaption difficulties, but change in personal resilience from baseline to postintervention mediated the effect of the intervention on the outcome of adaptation difficulties at the 3-month follow-up. These findings indicate evidence for benefits of the information and resilience interventions, and they inform further development of our programs. Copyright © 2013. Published by Elsevier Ltd.

Explaining physical activity levels from a self-efficacy perspective: the physical activity counseling trial.

PubMed

Blanchard, Chris M; Fortier, Michelle; Sweet, Shane; O'Sullivan, Tracey; Hogg, William; Reid, Robert D; Sigal, Ronald J

2007-01-01

The Physical Activity Counseling (PAC) trial compared the effects of a 13-week primary care physical activity (PA) intervention that incorporated a PA counselor into a health care practice compared to a control condition on PA over a 25-week period and showed group differences in PA were present at 6 and 13 weeks. The main purpose was to examine the mediating effect of 6-week task and barrier self-efficacy on the intervention versus control group/13-week PA relationships. A secondary purpose was to determine whether task and barrier self-efficacy were significantly related to PA throughout the trial for both groups. Participants were primarily sedentary individuals who received a 2- to 4-min PA intervention from their primary care provider, after which they were randomly assigned to the intervention (n = 61) or control condition (n = 59). Self-reported PA and task (barrier) self-efficacy measures were obtained during (i.e., baseline, 6 and 13 weeks) and after (i.e., 19 and 25 weeks) the intervention in both groups. Six-week task and barrier self-efficacy had a small mediating effect. Furthermore, barrier self-efficacy had a significant relationship with PA throughout the trial, whereas the relationship between task self-efficacy and PA became significantly weaker as the trial progressed. PAC interventions among primarily sedentary individuals should be partly based on barrier and task self-efficacy. However, the stability of the task self-efficacy/PA relationship needs further examination.

Assessing natural direct and indirect effects through multiple pathways.

PubMed

Lange, Theis; Rasmussen, Mette; Thygesen, Lau Caspar

2014-02-15

Within the fields of epidemiology, interventions research and social sciences researchers are often faced with the challenge of decomposing the effect of an exposure into different causal pathways working through defined mediator variables. The goal of such analyses is often to understand the mechanisms of the system or to suggest possible interventions. The case of a single mediator, thus implying only 2 causal pathways (direct and indirect) from exposure to outcome, has been extensively studied. By using the framework of counterfactual variables, researchers have established theoretical properties and developed powerful tools. However, in practical problems, it is not uncommon to have several distinct causal pathways from exposure to outcome operating through different mediators. In this article, we suggest a widely applicable approach to quantifying and ranking different causal pathways. The approach is an extension of the natural effect models proposed by Lange et al. (Am J Epidemiol. 2012;176(3):190-195). By allowing the analysis of distinct multiple pathways, the suggested approach adds to the capabilities of modern mediation techniques. Furthermore, the approach can be implemented using standard software, and we have included with this article implementation examples using R (R Foundation for Statistical Computing, Vienna, Austria) and Stata software (StataCorp LP, College Station, Texas).

Prolonged tomato juice consumption has no effect on cell-mediated immunity of well-nourished elderly men and women.

PubMed

Watzl, B; Bub, A; Blockhaus, M; Herbert, B M; Lührmann, P M; Neuhäuser-Berthold, M; Rechkemmer, G

2000-07-01

The immunomodulatory potential of carotenoids has been investigated thoroughly only for beta-carotene. Data on the immunomodulatory activity of other carotenoids such as lycopene are scarce. The objective of this study was to investigate the effects of prolonged tomato juice consumption on cell-mediated immunity of well-nourished healthy elderly persons. In an intervention study, 33 female and 20 male subjects (aged 63-86 y) consumed 330 mL/d tomato juice (47.1 mg/d lycopene) or mineral water for 8 wk. Immune status was assessed by measuring number and lytic activity of natural killer (NK) cells, secretion of cytokines [interleukin (IL)-2, IL-4, tumor necrosis factor-alpha (TNF-alpha)] by activated peripheral blood mononuclear cells (PBMC), lymphocyte proliferation, and delayed-type hypersensitivity (DTH) skin responses. Tomato juice consumption resulted in significantly increased plasma lycopene and beta-carotene concentrations over time. In both treatment groups, TNF-alpha and IL-4 secretion were increased at the end of the intervention period, whereas IL-2 secretion was decreased. Tomato juice consumption had no effect on lymphocyte proliferation, DTH or the number of NK cells. Lytic activity of NK cells was increased in both groups at the end of the intervention period. In conclusion, these results show that prolonged tomato juice consumption increased plasma lycopene concentrations without significantly affecting cell-mediated immunity in well-nourished elderly subjects.

Longitudinal Mediation Analysis with Time-varying Mediators and Exposures, with Application to Survival Outcomes

PubMed Central

Zheng, Wenjing; van der Laan, Mark

2017-01-01

In this paper, we study the effect of a time-varying exposure mediated by a time-varying intermediate variable. We consider general longitudinal settings, including survival outcomes. At a given time point, the exposure and mediator of interest are influenced by past covariates, mediators and exposures, and affect future covariates, mediators and exposures. Right censoring, if present, occurs in response to past history. To address the challenges in mediation analysis that are unique to these settings, we propose a formulation in terms of random interventions based on conditional distributions for the mediator. This formulation, in particular, allows for well-defined natural direct and indirect effects in the survival setting, and natural decomposition of the standard total effect. Upon establishing identifiability and the corresponding statistical estimands, we derive the efficient influence curves and establish their robustness properties. Applying Targeted Maximum Likelihood Estimation, we use these efficient influence curves to construct multiply robust and efficient estimators. We also present an inverse probability weighted estimator and a nested non-targeted substitution estimator for these parameters. PMID:29387520

Stigma of persons with disabilities in Afghanistan: Examining the pathways from stereotyping to mental distress.

PubMed

Trani, Jean-Francois; Ballard, Ellis; Peña, Juan B

2016-03-01

Despite evidence that stigma of disability is frequently reflected through stereotyping and often results in mental distress, very limited literature demonstrates the pathways through which stereotyping has an impact on mental health. Drawing from a large sample of 1449 participants interviewed between December 2012 and September 2013 from an Afghan community-based rehabilitation program, we examined the structure of stigma associated with disability in Afghanistan. Labeling and negative stereotypes, associated with a specific cause of disability, result in social exclusion that in turn impacts mental health. Using structural equation modeling with latent variables, we examined the mediation effect of stereotypes associated with disability on mental distress and anxiety. We found a mediating role of social exclusion between stereotypes and mental distress but only in the case of persons with disabilities from birth. Comparing the total effect of 'disabled at birth' and mental distress 0.195 (95% CI: 0.018-0.367) the effect size of this mediation effect was 0.293 (95% CI: 0.173-0.415). There was no significant direct effect between 'disabled at birth' and mental distress once mediation effect was accounted for in our model. These findings suggest that a multipronged policy approach that recognizes the driving forces of stigma and promotes social participation directly alongside psychosocial interventions on mental distress of persons with disabilities is necessary to achieve wellbeing for a group that has been historically and systematically excluded from development interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Gambling-Related Problems as a Mediator Between Treatment and Mental Health with At-Risk College Student Gamblers.

PubMed

Geisner, Irene Markman; Bowen, Sarah; Lostutter, Ty W; Cronce, Jessica M; Granato, Hollie; Larimer, Mary E

2015-09-01

Disordered gambling has been linked to increased negative affect, and some promising treatments have been shown to be effective at reducing gambling behaviors and related problems (Larimer et al. in Addiction 107:1148-1158, 2012). The current study seeks to expand upon the findings of Larimer et al. (Addiction 107:1148-1158, 2012) by examining the relationship between gambling-related problems and mental health symptoms in college students. Specifically, the three-group design tested the effects of two brief interventions for gambling—an individual, in-person personalized feedback intervention (PFI) delivered using motivational interviewing and group-based cognitive behavioral therapy, versus assessment only on mood outcomes. The mediating effect of gambling-related problems on mood was also explored. Participants (N = 141; 65% men; 60% Caucasian, 28% Asian) were at-risk college student gamblers [South Oaks Gambling Screen (Lesieur and Blume in Am J Psychiatry 144:1184-1188, 1987) ≥3], assessed at baseline and 6-month follow-up. Gambling problems were assessed using the Gambling Problems Index (Neighbors et al. in J Gamb Stud 18:339-360, 2002). Mental health symptoms were assessed using the depression, anxiety, and hostility subscales of the Brief Symptom Inventory (Derogatis in Brief Symptom Inventory (BSI): administration, scoring, and procedures manual, National Computer Systems, Inc., Minneapolis, 1993). Results revealed that the PFI condition differentially reduced negative mood, and that reductions in gambling-related problems partially mediated this effect. Implications for intervention for comorbid mood and gambling disorders are discussed.

COMPASS for Hope: Evaluating the Effectiveness of a Parent Training and Support Program for Children with ASD

ERIC Educational Resources Information Center

Kuravackel, Grace M.; Ruble, Lisa A.; Reese, Robert J.; Ables, Amanda P.; Rodgers, Alexis D.; Toland, Michael D.

2018-01-01

Despite the growing number of studies that demonstrate the importance of empowering parents with knowledge and skills to act as intervention agents for their children with autism spectrum disorder (ASD), there are limited examples of parent-mediated interventions that focus on problem behaviors. Additionally, access to ASD-trained clinicians and…

Validating a Fidelity Scale to Understand Intervention Effects in Classroom-Based Studies

ERIC Educational Resources Information Center

Buckley, Pamela; Moore, Brooke; Boardman, Alison G.; Arya, Diana J.; Maul, Andrew

2017-01-01

K-12 intervention studies often include fidelity of implementation (FOI) as a mediating variable, though most do not report the validity of fidelity measures. This article discusses the critical need for validated FOI scales. To illustrate our point, we describe the development and validation of the Implementation Validity Checklist (IVC-R), an…

Peer-Mediated Intervention for Preschoolers with ASD Implemented in Early Childhood Education Settings

ERIC Educational Resources Information Center

Katz, Esther; Girolametto, Luigi

2013-01-01

The purpose of this study was to investigate the effects of peer intervention on the social interactions of children with autism spectrum disorder (ASD). In this model, a speech-language pathologist and three early childhood educators trained typically developing peers to engage children with ASD in play. Three preschool children with ASD and six…

Diabetes and Low-Health Literacy: A Preliminary Outcome Report of a Mediated Intervention to Enhance Patient-Physician Communication

ERIC Educational Resources Information Center

Shue, Carolyn K.; O'Hara, Laura L. S.; Marini, David; McKenzie, Jim; Schreiner, Melanie

2010-01-01

Patients with diabetes who experience low-health literacy often struggle in their roles as health consumers. A multi-disciplinary group of educators and researchers collaborated to develop a video intervention to help these patients better understand their disease and communicate more effectively with their physician. We describe the assessment…

Mediators and Moderators of the Effectiveness of a Community Health Worker Intervention That Improved Dietary Outcomes in Pregnant Latino Women

ERIC Educational Resources Information Center

Shah, Megha K.; Kieffer, Edith C.; Choi, Hwajung; Schumann, Christina; Heisler, Michele

2015-01-01

Background. Pregnancy is an opportune time to initiate diabetes prevention strategies for minority and underserved women, using culturally tailored interventions delivered by community health workers. A community-partnered randomized controlled trial (RCT) with pregnant Latino women resulted in significantly improved vegetable, fiber, added sugar,…

Maternal Scaffolding and Home Stimulation: Key Mediators of Early Intervention Effects on Children's Cognitive Development

ERIC Educational Resources Information Center

Obradovic, Jelena; Yousafzai, Aisha K.; Finch, Jenna E.; Rasheed, Muneera A.

2016-01-01

This study contributes to the understanding of how early parenting interventions implemented in low- and middle-income countries during the first 2 years of children's lives are sustained longitudinally to promote cognitive skills in preschoolers. We employed path analytic procedures to examine 2 family processes--the quality of home stimulation…

Reducing sickness absence from work due to low back pain: how well do intervention strategies match modifiable risk factors?

PubMed

Shaw, William S; Linton, Steven J; Pransky, Glenn

2006-12-01

To assess, from the review literature, the extent to which effective strategies for reducing work absence after acute low back pain (LBP) match empirical risk factors. From 17 recent review articles (2000-2005), disability risk factors and interventions were cross-tabulated to assess levels of relative concordance. Potentially modifiable risk factors included 23 variables describing 3 workplace and 3 personal domains. Effective interventions included 25 strategies that were personal (physical or behavioral), engineering, or administrative in nature. There was a strong risk factor concordance for workplace technical and organizational interventions, graded activity exposure, and cognitive restructuring of pain beliefs. There was less risk factor concordance for exercise, back education, and RTW coordination. Few interventions focused on relieving emotional distress or improving job dissatisfaction, two well-supported risk factors. Gaps between the epidemiological and intervention research of back disability prevention could be reduced by testing mediators of intervention effects or by stratifying outcomes according to pre-intervention risk factors.

Mediation and Moderation of an Efficacious Theory-Based Abstinence-Only Intervention for African American Adolescents

PubMed Central

Zhang, Jingwen; Jemmott, John B.; Jemmott, Loretta Sweet

2018-01-01

Objective This secondary data analysis sought to determine what mediated reductions in self-reported sexual initiation over the 24-month post-intervention period in early adolescents who received “Promoting Health among Teens,” a theory-based, abstinence-only intervention (Jemmott, Jemmott, & Fong, 2010). Methods African American grade 6 and 7 students at inner-city public middle schools were randomized to one of five interventions grounded in social cognitive theory and the theory of reasoned action: 8-hour abstinence-only targeting reduced sexual intercourse; 8-hour safer-sex-only targeting increased condom use; 8-hour and 12-hour comprehensive interventions targeting sexual intercourse and condom use; 8-hour control intervention targeting physical activity and diet. Primary outcome was self-report of vaginal intercourse by 24 months post-intervention. Potential mediators, assessed immediately post-intervention, were theory-of-reasoned-action variables, including behavioral beliefs about positive consequences of abstinence and negative consequences of sex, intention to have sex, normative beliefs about sex, and HIV/STI knowledge. We tested single and serial mediation models using the product-of-coefficients approach. Results Of 509 students reporting never having vaginal intercourse at baseline (324 girls and 185 boys; mean age = 11.8 years; SD = 0.8), 500 or 98.2% were included in serial mediation analyses. Consistent with the theory of reasoned action, the abstinence-only intervention increased positive behavioral beliefs about abstinence, which reduced intention to have sex, which in turn reduced sexual initiation. Negative behavioral beliefs about sex, normative beliefs about sex, and HIV/STI knowledge were not mediators. Conclusions Abstinence-only interventions should stress the gains to be realized from abstinence rather than the deleterious consequences of sexual involvement. PMID:26214076

34 CFR 303.431 - Mediation.

Code of Federal Regulations, 2012 CFR

2012-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH... who are qualified mediators and knowledgeable in laws and regulations relating to the provision of early intervention services. (ii) The lead agency must select mediators on a random, rotational, or...

34 CFR 303.431 - Mediation.

Code of Federal Regulations, 2013 CFR

2013-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH... who are qualified mediators and knowledgeable in laws and regulations relating to the provision of early intervention services. (ii) The lead agency must select mediators on a random, rotational, or...

34 CFR 303.431 - Mediation.

Code of Federal Regulations, 2014 CFR

2014-07-01

... REHABILITATIVE SERVICES, DEPARTMENT OF EDUCATION EARLY INTERVENTION PROGRAM FOR INFANTS AND TODDLERS WITH... who are qualified mediators and knowledgeable in laws and regulations relating to the provision of early intervention services. (ii) The lead agency must select mediators on a random, rotational, or...

Effect of trauma on quality of life as mediated by mental distress and moderated by coping and social support among postconflict displaced Ethiopians.

PubMed

Araya, Mesfin; Chotai, Jayanti; Komproe, Ivan H; de Jong, Joop T V M

2007-08-01

An understanding of how quality of life is affected by severe trauma and mental distress may facilitate better intervention strategies for postconflict internally displaced persons, by identifying mediators, moderators, and independent risk factors. We investigate the pathways involved in this process and also study the moderating roles of coping strategies and perceived social support. A random sample of 1193 (62% women) internally displaced Ethiopian adults living in shelters in Addis Ababa were interviewed with instruments capturing the relevant concepts, including SCL-90-R and WHOQOL-BREF. Path analysis was employed to elaborate the mediating and moderating effects. Self-reported living conditions were also assessed. Mental distress increased and quality of life decreased with age. Mental distress mediated the effects of trauma in reducing the quality of life, and some trauma also reduced quality of life directly. These effects remained after adjusting for living conditions. Living conditions were related to quality of life also on their own. Coping strategies and perceived social support influenced mental distress and quality of life directly as well as indirectly by moderation, in part gender specific. Intervention strategies aimed at reducing mental distress, modifying coping strategies, and encouraging social support may turn out to be useful in increasing the overall quality of life in postconflict situations, and are worth considering as complements to strategies that improve the living conditions.

Why is social network drinking associated with college students' alcohol use? Focus on psychological mediators.

PubMed

Reid, Allecia E; Carey, Kate B

2018-06-01

Level of drinking in the social network is strongly associated with college students' alcohol use. However, mechanisms through which networks are associated with personal drinking have been underexplored thus far. The present study examined theoretically derived constructs-sociability outcome expectancies, attitudes toward heavy drinking, self-efficacy for use of protective strategies, and descriptive norms-as potential mediators of the association between egocentric social network drinking and personal consumption. College students (N = 274) self-reported their social network's level of alcohol consumption, all mediators, drinks per week, and consequences at both baseline (Time 1) and a 1-month follow-up (Time 2). Autoregressive mediation models focused on the longitudinal associations between Time 1 network drinking and the Time 2 mediators and between the Time 1 mediators and the Time 2 outcomes. Consistent with hypotheses, Time 1 social network drinking was significantly associated with Time 2 drinks per week and consequences. Only attitudes significantly mediated social network associations with drinks per week and consequences, though the proportion of the total effects accounted for by attitudes was small. After accounting for the stability of constructs over time, social network drinking was generally un- or weakly related to sociability expectancies, self-efficacy, and descriptive norms. Results support reducing attitudes toward heavy drinking as a potential avenue for mitigating network effects, but also highlight the need to evaluate additional potential mechanisms of network effects. Intervention efforts that aim to address the social network have the potential to substantially reduce alcohol consumption, thereby enhancing the overall efficacy of alcohol risk-reduction interventions. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Co-Rumination Mediates Contagion of Internalizing Symptoms within Youths’ Friendships

PubMed Central

Schwartz-Mette, Rebecca A.; Rose, Amanda J.

2012-01-01

Peer contagion of internalizing symptoms was examined within youths’ friendships over six months. Children (grades 3 and 5) and adolescents (grades 7 and 9) paired in 274 reciprocal same-sex friendship dyads completed measures of depressive and anxiety symptoms, co-rumination, and self-disclosure. Depression contagion was present for all youth, and anxiety contagion was found in the sample of girls and older boys. Although normative self-disclosure did not mediate the contagion effects, co-rumination mediated the depression contagion effect for adolescents and the anxiety contagion effect in the sample of girls and older boys. Implications for interventions with youth at risk for developing internalizing symptoms are discussed. PMID:22369336

Remote ischemic preconditioning and endothelial function in patients with acute myocardial infarction and primary PCI.

PubMed

Manchurov, Vladimir; Ryazankina, Nadezda; Khmara, Tatyana; Skrypnik, Dmitry; Reztsov, Roman; Vasilieva, Elena; Shpektor, Alexander

2014-07-01

Remote ischemic preconditioning by transient limb ischemia reduces myocardial ischemia-reperfusion injury in patients undergoing percutaneous coronary intervention. The aim of the study we report here was to assess the effect of remote ischemic preconditioning on endothelial function in patients with acute myocardial infarction who underwent primary percutaneous coronary intervention. Forty-eight patients with acute myocardial infarction were enrolled. All participants were randomly divided into 2 groups. In Group I (n = 23), remote ischemic preconditioning was performed before primary percutaneous coronary intervention (intermittent arm ischemia-reperfusion through 4 cycles of 5-minute inflation and 5-minute deflation of a blood-pressure cuff to 200 mm Hg). In Group II (n = 25), standard percutaneous coronary intervention without preconditioning was performed. We assessed endothelial function using the flow-mediated dilation test on baseline, then within 1-3 hours after percutaneous coronary intervention, and again on days 2 and 7 after percutaneous coronary intervention. The brachial artery flow-mediated dilation results were significantly higher on the first day after primary percutaneous coronary intervention in the preconditioning group (Group I) than in the control group (Group II) (12.1% vs 0.0%, P = .03, and 11.1% vs 6.3%, P = .016, respectively), and this difference remained on the seventh day (12.3% vs 7.4%, P = .0005, respectively). We demonstrated for the first time that remote ischemic preconditioning before primary percutaneous coronary intervention significantly improves endothelial function in patients with acute myocardial infarction, and this effect remains constant for at least a week. We suppose that the improvement of endothelial function may be one of the possible explanations of the effect of remote ischemic preconditioning. Copyright © 2014 Elsevier Inc. All rights reserved.

Computer-Mediated Communication (CMC) in L2 Oral Proficiency Development: A Meta-Analysis

ERIC Educational Resources Information Center

Lin, Huifen

2015-01-01

The ever growing interest in the development of foreign or second (L2) oral proficiency in a computer-mediated communication (CMC) classroom has resulted in a large body of studies looking at both the direct and indirect effects of CMC interventions on the acquisition of oral competences. The present study employed a quantitative meta-analytic…

Performance of Fourth-Grade Students with Learning Disabilities on Multiplication Facts Comparing Teacher-Mediated and Technology-Mediated Interventions: A Preliminary Investigation

ERIC Educational Resources Information Center

Bryant, Brian R.; Ok, Minwook; Kang, Eun Young; Kim, Min Kyung; Lang, Russell; Bryant, Diane Pedrotty; Pfannestiel, Kathleen

2015-01-01

Instructional applications (apps) are educational software programs that can be accessed via mobile technologies (e.g., iPad, smartphone) and used to help students acquire various academic skills, including mathematics. Although research suggests that app-based instruction (AI) can be effective, there is a paucity of research comparing AI, to…

Unpacking the Black Box of the CSRP Intervention: The Mediating Roles of Teacher-child Relationship Quality and Self-regulation

PubMed Central

Jones, Stephanie M.; Bub, Kristen L.; Raver, C. Cybele

2014-01-01

This study examines the theory of change of the Chicago School Readiness Project (CSRP), testing a sequence of theory-derived mediating mechanisms including the quality of teacher-child relationships and children’s self-regulation. The CSRP is a multi-component teacher- and classroom-focused intervention, and its cluster-randomized efficacy trial was conducted in 35 Head Start-funded classrooms. A series of increasingly complex and conservative structural equation models indicate that the CSRP carries its effects on children’s academic and behavioral outcomes through changes in teacher-child relationship quality and children’s self-regulation. PMID:24729666

Building Kindergartners' Number Sense: A Randomized Controlled Study.

PubMed

Jordan, Nancy C; Glutting, Joseph; Dyson, Nancy; Hassinger-Das, Brenna; Irwin, Casey

2012-08-01

Math achievement in elementary school is mediated by performance and growth in number sense during kindergarten. The aim of the present study was to test the effectiveness of a targeted small group number sense intervention for high-risk kindergartners from low-income communities. Children were randomly assigned to one of three groups ( n = 44 in each group): a number sense intervention group, a language intervention group, or a business as usual control group. Accounting for initial skill level in mathematical knowledge, children who received the number sense intervention performed better than controls at immediate post test, with meaningful effects on measures of number competencies and general math achievement. Many of the effects held eight weeks after the intervention was completed, suggesting that children internalized what they had learned. There were no differences between the language and control groups on any math-related measures.

Effectiveness of the parent-mediated intervention for children with autism spectrum disorder in south Asia in India and Pakistan (PASS): a randomised controlled trial.

PubMed

Rahman, Atif; Divan, Gauri; Hamdani, Syed Usman; Vajaratkar, Vivek; Taylor, Carol; Leadbitter, Kathy; Aldred, Catherine; Minhas, Ayesha; Cardozo, Percy; Emsley, Richard; Patel, Vikram; Green, Jonathan

2016-02-01

Autism spectrum disorder affects more than 5 million children in south Asia. Although early interventions have been used for the treatment of children in high-income countries, no substantive trials have been done of the interventions adapted for use in low-income and middle-income countries (LMICs). We therefore assessed the feasibility and acceptability of the parent-mediated intervention for autism spectrum disorder in south Asia (PASS) in India and Pakistan. A single-blind randomised trial of the comparison of 12 sessions of PASS (plus treatment as usual) with treatment as usual alone delivered by non-specialist health workers was done at two centres in Goa, India, and Rawalpindi, Pakistan. Children aged 2-9 years with autism spectrum disorder were randomly assigned (1:1) by use of probabilistic minimisation, controlling for treatment centre (Goa or Rawalpindi), age (<6 years or ≥6 years), and functional impairment (Vineland Adaptive Behaviour Scale Composite score <65 or ≥65). The primary outcome was quality of parent-child interaction on the Dyadic Communication Measure for Autism at 8 months. Analysis was by intention to treat. The study is registered with ISRCTN, number ISRCTN79675498. From Jan 1 to July 30, 2013, 65 children were randomly allocated, 32 to the PASS group (15 in Goa and 17 in Rawalpindi) and 33 to the treatment-as-usual group (15 in Goa and 18 in Rawalpindi). 26 (81%) of 32 participants completed the intervention. After adjustment for minimisation factors and baseline outcome, the primary outcome showed a treatment effect in favour of PASS in parental synchrony (adjusted mean difference 0·25 [95% CI 0·14 to 0·36]; effect size 1·61 [95% CI 0·90 to 2·32]) and initiation of communication by the child with the parent (0·15 [0·04 to 0·26]; effect size 0·99 [0·29 to 1·68]), but time in mutual shared attention was reduced (-0·16 [-0·26 to -0·05]; effect size -0·70 [-1·16 to -0·23]). Our results show the feasibility of adapting and task-shifting an intervention used in a high-income context to LMICs. The findings also replicate the positive primary outcome treatment effects of a parent-mediated communication-focused intervention in the original UK Preschool Autism Communication Trial, with one negative effect not reported previously. Autism Speaks, USA. Copyright © 2016 Elsevier Ltd. All rights reserved.

The mediating effect of psychosocial factors on suicidal probability among adolescents.

PubMed

Hur, Ji-Won; Kim, Won-Joong; Kim, Yong-Ku

2011-01-01

Suicidal probability is an actual tendency including negative self-evaluation, hopelessness, suicidal ideation, and hostility. The purpose of this study was to examine the role of psychosocial variances in the suicidal probability of adolescents, especially the role of mediating variance. This study investigated the mediating effects of psychosocial factors such as depression, anxiety, self-esteem, stress, and social support on the suicidal probability among 1,586 adolescents attending middle and high schools in the Kyunggi Province area of South Korea. The relationship between depression and anxiety/suicidal probability was mediated by both social resources and self-esteem. Furthermore, the influence of social resources was mediated by interpersonal and achievement stress as well as self-esteem. This study suggests that suicidal probability in adolescents has various relationships, including mediating relations, with several psychosocial factors. The interventions on suicidal probability in adolescents should focus on social factors as well as clinical symptoms.

Mechanisms of motivational interviewing in health promotion: a Bayesian mediation analysis

PubMed Central

2012-01-01

Background Counselor behaviors that mediate the efficacy of motivational interviewing (MI) are not well understood, especially when applied to health behavior promotion. We hypothesized that client change talk mediates the relationship between counselor variables and subsequent client behavior change. Methods Purposeful sampling identified individuals from a prospective randomized worksite trial using an MI intervention to promote firefighters’ healthy diet and regular exercise that increased dietary intake of fruits and vegetables (n = 21) or did not increase intake of fruits and vegetables (n = 22). MI interactions were coded using the Motivational Interviewing Skill Code (MISC 2.1) to categorize counselor and firefighter verbal utterances. Both Bayesian and frequentist mediation analyses were used to investigate whether client change talk mediated the relationship between counselor skills and behavior change. Results Counselors’ global spirit, empathy, and direction and MI-consistent behavioral counts (e.g., reflections, open questions, affirmations, emphasize control) significantly correlated with firefighters’ total client change talk utterances (rs = 0.42, 0.40, 0.30, and 0.61, respectively), which correlated significantly with their fruit and vegetable intake increase (r = 0.33). Both Bayesian and frequentist mediation analyses demonstrated that findings were consistent with hypotheses, such that total client change talk mediated the relationship between counselor’s skills—MI-consistent behaviors [Bayesian mediated effect: αβ = .06 (.03), 95% CI = .02, .12] and MI spirit [Bayesian mediated effect: αβ = .06 (.03), 95% CI = .01, .13]—and increased fruit and vegetable consumption. Conclusion Motivational interviewing is a resource- and time-intensive intervention, and is currently being applied in many arenas. Previous research has identified the importance of counselor behaviors and client change talk in the treatment of substance use disorders. Our results indicate that similar mechanisms may underlie the effects of MI for dietary change. These results inform MI training and application by identifying those processes critical for MI success in health promotion domains. PMID:22681874

Does perceived neighborhood walkability and safety mediate the association between education and meeting physical activity guidelines?

PubMed

Pratt, Michael; Yin, Shaoman; Soler, Robin; Njai, Rashid; Siegel, Paul Z; Liao, Youlian

2015-04-09

The role of neighborhood walkability and safety in mediating the association between education and physical activity has not been quantified. We used data from the 2010 and 2012 Communities Putting Prevention to Work Behavioral Risk Factor Surveillance System and structural equation modeling to estimate how much of the effect of education level on physical activity was mediated by perceived neighborhood walkability and safety. Neighborhood walkability accounts for 11.3% and neighborhood safety accounts for 6.8% of the effect. A modest proportion of the important association between education and physical activity is mediated by perceived neighborhood walkability and safety, suggesting that interventions focused on enhancing walkability and safety could reduce the disparity in physical activity associated with education level.

Processes of behavior change and weight loss in a theory-based weight loss intervention program: a test of the process model for lifestyle behavior change.

PubMed

Gillison, Fiona; Stathi, Afroditi; Reddy, Prasuna; Perry, Rachel; Taylor, Gordon; Bennett, Paul; Dunbar, James; Greaves, Colin

2015-01-16

Process evaluation is important for improving theories of behavior change and behavioral intervention methods. The present study reports on the process outcomes of a pilot test of the theoretical model (the Process Model for Lifestyle Behavior Change; PMLBC) underpinning an evidence-informed, theory-driven, group-based intervention designed to promote healthy eating and physical activity for people with high cardiovascular risk. 108 people at high risk of diabetes or heart disease were randomized to a group-based weight management intervention targeting diet and physical activity plus usual care, or to usual care. The intervention comprised nine group based sessions designed to promote motivation, social support, self-regulation and understanding of the behavior change process. Weight loss, diet, physical activity and theoretically defined mediators of change were measured pre-intervention, and after four and 12 months. The intervention resulted in significant improvements in fiber intake (M between-group difference = 5.7 g/day, p < .001) but not fat consumption (-2.3 g/day, p = 0.13), that were predictive of weight loss at both four months (M between-group difference = -1.98 kg, p < .01; R(2) = 0.2, p < 0.005), and 12 months (M difference = -1.85 kg, p = 0.1; R(2) = 0.1, p < 0.01). The intervention was successful in improving the majority of specified mediators of behavior change, and the predicted mechanisms of change specified in the PMBLC were largely supported. Improvements in self-efficacy and understanding of the behavior change process were associated with engagement in coping planning and self-monitoring activities, and successful dietary change at four and 12 months. While participants reported improvements in motivational and social support variables, there was no effect of these, or of the intervention overall, on physical activity. The data broadly support the theoretical model for supporting some dietary changes, but not for physical activity. Systematic intervention design allowed us to identify where improvements to the intervention may be implemented to promote change in all proposed mediators. More work is needed to explore effective mechanisms within interventions to promote physical activity behavior.

Interventions to Improve Communication

PubMed Central

Paul, Rhea

2008-01-01

SYNOPSIS It is clear that children with autism benefit from intensive, early intervention that focuses on increasing the frequency, form, and function of communicative acts. Intervention methods that draw from a range of philosophies and make use of varying degrees of adult direction have been shown to be effective in increasing language and communicative behaviors, although direct comparisons among methods, controlled studies with random assignment to treatments, and long-term outcome studies are, as yet, lacking. Available evidence shows that highly structured behavioral methods have important positive consequences for these children, particularly in eliciting first words. However, the limitation of these methods in maintenance and generalization of skills suggests that many children with autism will need to have these methods supplemented with less adult-directed activities to increase communicative initiation and to carry over learned skills to new settings and communication partners. A review of programs aimed at language development in high functioning children with ASD points out the importance of thinking beyond words and sentences to the social functions of communication and language use when developing interventions. Although a range of adult-mediated programs are reviewed here, providing opportunities for mediated peer interactions with trained peers in natural settings appears to be especially important in maximizing the effects of this intervention. PMID:18775373

Importance of the nature of comparison conditions for testing theory-based interventions: reply.

PubMed

Michie, Susan; Prestwich, Andrew; de Bruin, Marijn

2010-09-01

The nature of comparison conditions is a much overlooked feature of designing and interpreting the results of randomized controlled trials, as outlined by Williams (see record 2010-18776-001). We agree that understanding the components and mechanisms of the comparison condition is necessary for making inferences about both intervention effectiveness (whether the intervention worked and which components may have contributed to such an effect) and about theoretical mediators (how it worked). The extent to which one can draw strong inferences regarding the efficacy and mechanisms of an intervention over the comparison is conditional upon a number of key points. (PsycINFO Database Record (c) 2010 APA, all rights reserved).

The effects of a lifestyle-focused text-messaging intervention on adherence to dietary guideline recommendations in patients with coronary heart disease: an analysis of the TEXT ME study.

PubMed

Santo, Karla; Hyun, Karice; de Keizer, Laura; Thiagalingam, Aravinda; Hillis, Graham S; Chalmers, John; Redfern, Julie; Chow, Clara K

2018-05-23

A healthy diet is an important component of secondary prevention of coronary heart disease (CHD). The TEXT ME study was a randomised clinical trial of people with CHD that were randomised into standard care or a text-message programme in addition to standard care. This analysis aimed to: 1) assess the effects of the intervention onadherence to the dietary guideline recommendations; 2) assess the consistency of effect across sub-groups; and 3) assess whether adherence to the dietary guideline recommendations mediated the improvements in objective clinical outcomes. Dietary data were collected using a self-report questionnaire to evaluate adherence to eight dietary guideline recommendations in Australia, including consumption of vegetables, fruits, fish, type of fat used for cooking and in spreads, takeaway food, salt and standard alcohol drinks. The primary outcome of this analysis was the proportion of patients adhering to ≥ 4 dietary guideline recommendations concomitantly and each recommendation was assessed individually as secondary outcomes. Data were analysed using log-binomial regression for categorical variables and analysis of covariance for continuous variables. Among 710 patients, 54% were adhering to ≥ 4 dietary guideline recommendations (intervention 53% vs control 56%, p = 0.376) at baseline. At six months, the intervention group had a significantly higher proportion of patients adhering to ≥ 4 recommendations (314, 93%) compared to the control group (264, 75%, RR 1.23, 95% CI 1.15-1.31, p < 0.001). In addition, the intervention patients reported consuming higher amounts of vegetables, fruits, and fish per week; less takeaway foods per week; and greater salt intake control. The intervention had a similar effect in all sub-groups tested. There were significant mediational effects of the increase in adherence to the recommendations for the association between the intervention and LDL-cholesterol (p < 0.001) and body mass index (BMI) at six months follow-up (p = 0.005). A lifestyle-focused text-message programme improved adherence to the dietary guideline recommendations, and specifically improved self-reported consumption of vegetables, fruits, fish, takeaway foods and salt intake. Importantly, these improvements partially mediated improvements in LDL-cholesterol and BMI. This simple and scalable text-messaging intervention could be used as a strategy to improve diet in people with CHD. Australia and New Zealand Clinical Trials Registry ACTRN12611000161921 . Registered on 10 February 2011.

The mediating effect of self-efficacy in the relationship between social support and post-traumatic stress disorder symptoms among patients with central system tumors in China: a cross-sectional study.

PubMed

Wang, Yang; Bao, Yijun; Liu, Li; Ramos, Aaron; Wang, Yunjie; Wang, Lie

2015-12-01

Post-traumatic stress disorder (PTSD) is a disorder that can affect people following the experience of a traumatic event. Few studies have researched on PTSD symptoms of patients with central nervous system tumors. In this study, we aim to examine the association between social support and PTSD symptoms and to explore the mediating effect of self-efficacy in this relationship among patients with central nervous system tumors in China. Questionnaires consisting of the Post-traumatic Stress Checklist-Civilian Version, the Duke-UNC Functional Social Support Questionnaire, the General Self-Efficacy Scale, as well as demographic and clinical factors were used to collect information of patients with central nervous system tumors in Liaoning Province, China. A total of 222 patients (effective response rate of 66.1%) became our subjects. Hierarchical linear regression analyses were performed to explore the association between social support and PTSD symptoms and the mediating effect of self-efficacy. After adjusting for demographic characteristics and tumor type, social support was negatively associated with the total score of PTSD symptoms (β = -0.342, P < 0.01). Social support explained 8.8% of the variance in PTSD symptoms. Self-efficacy was found to partially mediate the relationship between social support and PTSD symptoms. Self-efficacy partially mediated the relationship between social support and PTSD symptoms. Interventions focusing on both social support and self-efficacy might be more useful than interventions only targeting either of them. Copyright © 2015 John Wiley & Sons, Ltd.

Mechanisms of Partner Violence Reduction in a Group HIV-Risk Intervention for Hispanic Women.

PubMed

McCabe, Brian E; Gonzalez-Guarda, Rosa M; Peragallo, Nilda P; Mitrani, Victoria B

2016-08-01

The objective of this study was to test whether partner communication about HIV and/or alcohol intoxication mediated reductions in intimate partner violence (IPV) in SEPA (Salud [health], Educación [education], Promoción [promotion], y [and] Autocuidado [self-care]), a culturally specific, theoretically based group HIV-risk reduction intervention for Hispanic women. SEPA had five sessions covering sexually transmitted infection (STI)/HIV prevention, partner communication, condom negotiation and use, and IPV. SEPA reduced IPV and alcohol intoxication, and improved partner communication compared with controls in a randomized trial with adult U.S. Hispanic women (SEPA, n = 274; delayed intervention control, n = 274) who completed structured interviews at baseline and 3, 6, and 12 months post-baseline. Parallel process latent growth curve models indicated that partner communication about HIV mediated the reduction in male-to-female IPV in SEPA, B = -0.78, SE = 0.14, p< .001, but alcohol intoxication did not, B = -0.15, SE = 0.19, p = .431. Male-to-female IPV mediated the intervention effect on female-to-male IPV, B = -1.21, SE = 0.24, p< .001. Skills building strategies originally designed to enhance women's communication with their partners about sexual risk behaviors also worked to reduce male-to-female IPV, which in turn reduced female-to-male IPV. These strategies could be integrated into other types of health promotion interventions. © The Author(s) 2015.

Remembering Parents in Parent-Mediated Early Intervention: An Approach to Examining Impact on Parents and Families

ERIC Educational Resources Information Center

Wainer, Allison L.; Hepburn, Susan; McMahon Griffith, Elizabeth

2017-01-01

The goal of this review is to advance the discussion regarding meaningful outcomes of early intervention for children with autism spectrum disorder. The rapid growth in the development and evaluation of early intervention approaches for autism spectrum disorder includes both therapist-driven and parent-mediated interventions. The majority of…

Resistance Exercise and Inflammation in Breast Cancer Patients Undergoing Adjuvant Radiation Therapy: Mediation Analysis From a Randomized, Controlled Intervention Trial

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schmidt, Martina E., E-mail: m.schmidt@dkfz.de; Meynköhn, Anna; Habermann, Nina

Purpose: To explore the mediating role of inflammatory parameters in the development of fatigue, pain, and potentially related depressive symptoms during radiation therapy for breast cancer and its mitigation by resistance exercise. Methods and Materials: Breast cancer patients scheduled for adjuvant radiation therapy were randomized to 12-week progressive resistance exercise training (EX) or a relaxation control group. Interleukin-6 (IL-6) and interleukin-1 receptor antagonist (IL-1ra) were measured in serum samples collected before, at the end, and 6 weeks after radiation therapy from 103 chemotherapy-naïve participants. Fatigue was assessed with the multidimensional Fatigue Assessment Questionnaire, pain with the European Organization for Research andmore » Treatment of Cancer QLQ-C30, and depressive symptoms with the Center for Epidemiologic Studies Depression Scale. Analysis of covariance models, partial correlations, Freedman-Schatzkin tests, and R{sup 2} effect-size measures for mediation were calculated. Results: The analysis of covariance models revealed a significant intervention effect on IL-6 (P=.010) and the IL-6/IL-1ra ratio (P=.018), characterized by a marked increase during radiation therapy among controls, but no significant change in EX. Interleukin-1 receptor antagonist did not change significantly in either group (P=.88). Increased IL-6 and IL-6/IL-1ra levels at the end of radiation therapy were significantly associated with increased physical fatigue and pain 6 weeks after radiation. We observed significant partial mediation by IL-6 and IL-6/IL-1ra of the effect of resistance exercise on physical fatigue (Freedman-Schatzkin P=.023 and P<.001) and pain (both P<.001). Hereby IL-6 and IL-6/IL-1ra mediated between 15% and 24% of the variance of physical fatigue and pain explained by the intervention. Conclusions: This randomized, controlled trial showed a significantly increased proinflammatory cytokine level after adjuvant radiation therapy in breast cancer patients. This effect was counteracted by progressive resistance exercise training. Interleukin-6 and the IL-6/IL-1ra ratio seemed to mediate the beneficial effect of exercise on physical fatigue and pain but only to a small extent.« less

Posttraumatic stress symptoms as a mediating factor on the effects of exposure to community violence among children in Cape Town, South Africa.

PubMed

Shields, Nancy; Nadasen, Kathy; Pierce, Lois

2009-01-01

Research conducted over the past 20 years has linked exposure to violence to posttraumatic stress disorder (PTSD) in children both in the United States and South Africa, but very little research has investigated PTSD as a mediating variable between exposure to violence and other problems. The purpose of the current research was to determine if PTSD acts as a mediating variable between exposure to violence and depression, and exposure to violence and aggressive and violent behavior at school among a sample of 247 South African children. Regression analysis suggested that PTSD mediated the effects of exposure to violence on depression, whereas the effect of exposure to violence on aggression and violent behavior was only direct. The findings are discussed in terms of their implications for intervention and treatment.

Comparison of methods for the analysis of relatively simple mediation models.

PubMed

Rijnhart, Judith J M; Twisk, Jos W R; Chinapaw, Mai J M; de Boer, Michiel R; Heymans, Martijn W

2017-09-01

Statistical mediation analysis is an often used method in trials, to unravel the pathways underlying the effect of an intervention on a particular outcome variable. Throughout the years, several methods have been proposed, such as ordinary least square (OLS) regression, structural equation modeling (SEM), and the potential outcomes framework. Most applied researchers do not know that these methods are mathematically equivalent when applied to mediation models with a continuous mediator and outcome variable. Therefore, the aim of this paper was to demonstrate the similarities between OLS regression, SEM, and the potential outcomes framework in three mediation models: 1) a crude model, 2) a confounder-adjusted model, and 3) a model with an interaction term for exposure-mediator interaction. Secondary data analysis of a randomized controlled trial that included 546 schoolchildren. In our data example, the mediator and outcome variable were both continuous. We compared the estimates of the total, direct and indirect effects, proportion mediated, and 95% confidence intervals (CIs) for the indirect effect across OLS regression, SEM, and the potential outcomes framework. OLS regression, SEM, and the potential outcomes framework yielded the same effect estimates in the crude mediation model, the confounder-adjusted mediation model, and the mediation model with an interaction term for exposure-mediator interaction. Since OLS regression, SEM, and the potential outcomes framework yield the same results in three mediation models with a continuous mediator and outcome variable, researchers can continue using the method that is most convenient to them.

The Mediating Role of Loneliness in the Relation Between Social Engagement and Depressive Symptoms Among Older Korean Americans: Do Men and Women Differ?

PubMed Central

2013-01-01

Objectives. This study conceptualized loneliness as a mediator in the relation between social engagement and depressive symptoms and explored gender differences in the mediation model. Various indices of social engagement were considered including living arrangement, social network, and activity participation. Method. Using data from 674 community-dwelling Korean American older adults, we first examined the mediation effect of loneliness in the relation between each of 3 indices of social engagement (not living alone, social network, and activity participation) and depressive symptoms. Subsequently, gender differences in the mediation model were examined. Results. As hypothesized, loneliness was found to mediate the relation between each of the indices of social engagement and depressive symptoms in both men and women. We also observed gender differences in the strength of mediating effects; the effect of living alone was more likely to be mediated by loneliness among men, whereas women showed greater levels of mediation in the models with social network and activity participation. Discussion. Our findings suggest that loneliness may explain the mechanism by which deficits in social engagement exerts its effect on depressive symptoms and that gender differences should be considered in interventions targeting social engagement for mental health promotion. PMID:22929386

Dissociation mediates the relationship between peer victimization and hallucinatory experiences among early adolescents.

PubMed

Yamasaki, Syudo; Ando, Shuntaro; Koike, Shinsuke; Usami, Satoshi; Endo, Kaori; French, Paul; Sasaki, Tsukasa; Furukawa, Toshi A; Hasegawa-Hiraiwa, Mariko; Kasai, Kiyoto; Nishida, Atsushi

2016-06-01

Peer victimization increases the risk of experiencing psychotic symptoms among clinical and general populations, but the mechanism underlying this association remains unclear. Dissociation, which is related to peer victimization and hallucinatory experiences, has been demonstrated as a significant mediator in the relation between childhood victimization and hallucinatory experience among adult patients with psychosis. However, no studies have examined the mediating effect of dissociation in a general early adolescent population. We examined whether dissociation mediates the relationship between peer victimization and hallucinatory experiences among 10-year-old adolescents using a population-based cross-sectional survey of early adolescents and their main parent (Tokyo Early Adolescence Survey; N  = 4478). We examined the mediating effect of dissociation, as well as external locus of control and depressive symptoms, on the relationship between peer victimization and hallucinatory experiences using path analysis. The model assuming mediation effects indicated good model fit (comparative fit index = .999; root mean square error of approximation = .015). The mediation effect between peer victimization and hallucination via dissociation (standardized indirect effect = .038, p  < .001) was statistically significant, whereas the mediation effects of depressive symptoms (standardized indirect effect = -.0066, p  = 0.318) and external locus of control (standardized indirect effect = .0024, p  = 0.321) were not significant. These results suggest that dissociation is a mediator in the relation between peer victimization and hallucinatory experiences in early adolescence. For appropriate intervention strategies, assessing dissociation and peer victimization as they affect hallucinatory experiences is necessary.

Improving Participation Rates for Women of Color in Health Research: The Role of Group Cohesion

PubMed Central

Mama, Scherezade; Reese-Smith, Jacqueline Y.; Estabrooks, Paul A.; Lee, Rebecca E.

2015-01-01

Adherence to physical activity and dietary interventions is a common challenge. Interventions that use group cohesion strategies show promise for increasing adherence, but have not been tested among women of color. The purpose of this study was to determine whether dimensions of group cohesion mediate the association between intervention condition and attendance within a community physical activity program for women of color. African American and Hispanic or Latina women (N=310) completed measurements at baseline and post-intervention and participated in a social cohesion intervention to improve physical activity and dietary habits. Women were assigned to a physical activity or fruit and vegetable intervention group. Social and task cohesion was measured using the Physical Activity Group Environment Questionnaire (PAGE-Q). Attendance was recorded at each of six intervention sessions. Women were generally middle-age (M age = 46.4 years, SD=9.1) and obese (M BMI = 34.4 kg/m2, SD=7.7). The estimate of the mediated effect was significant for all group cohesion constructs, indicating both task constructs—attraction to the group’s task (SE=0.096, CI: −0.599 to −0.221) and group integration around the task (SE=0.060, CI: −0.092 to −0.328)—and social constructs—attraction to the group’s social aspects (SE=0.046, CI: −0.546 to −0.366) and group integration around social aspects (SE=0.046, CI: −0.546 to −0.366)—significantly mediated the association between group assignment and attendance. Both task and social constructs are important to improve attendance in health promotion interventions for women of color. PMID:21826476

Training Peer Partners to Use a Speech-Generating Device With Classmates With Autism Spectrum Disorder: Exploring Communication Outcomes Across Preschool Contexts

PubMed Central

McGuff, Sara; Goldstein, Howard

2017-01-01

Purpose This study examined effects of a peer-mediated intervention that provided training on the use of a speech-generating device for preschoolers with severe autism spectrum disorder (ASD) and peer partners. Method Effects were examined using a multiple probe design across 3 children with ASD and limited to no verbal skills. Three peers without disabilities were taught to Stay, Play, and Talk using a GoTalk 4+ (Attainment Company) and were then paired up with a classmate with ASD in classroom social activities. Measures included rates of communication acts, communication mode and function, reciprocity, and engagement with peers. Results Following peer training, intervention effects were replicated across 3 peers, who all demonstrated an increased level and upward trend in communication acts to their classmates with ASD. Outcomes also revealed moderate intervention effects and increased levels of peer-directed communication for 3 children with ASD in classroom centers. Additional analyses revealed higher rates of communication in the added context of preferred toys and snack. The children with ASD also demonstrated improved communication reciprocity and peer engagement. Conclusions Results provide preliminary evidence on the benefits of combining peer-mediated and speech-generating device interventions to improve children's communication. Furthermore, it appears that preferred contexts are likely to facilitate greater communication and social engagement with peers. PMID:28854313

Protocol: developing a conceptual framework of patient mediated knowledge translation, systematic review using a realist approach.

PubMed

Gagliardi, Anna R; Légaré, France; Brouwers, Melissa C; Webster, Fiona; Wiljer, David; Badley, Elizabeth; Straus, Sharon

2011-03-22

Patient involvement in healthcare represents the means by which to achieve a healthcare system that is responsive to patient needs and values. Characterization and evaluation of strategies for involving patients in their healthcare may benefit from a knowledge translation (KT) approach. The purpose of this knowledge synthesis is to develop a conceptual framework for patient-mediated KT interventions. A preliminary conceptual framework for patient-mediated KT interventions was compiled to describe intended purpose, recipients, delivery context, intervention, and outcomes. A realist review will be conducted in consultation with stakeholders from the arthritis and cancer fields to explore how these interventions work, for whom, and in what contexts. To identify patient-mediated KT interventions in these fields, we will search MEDLINE, the Cochrane Library, and EMBASE from 1995 to 2010; scan references of all eligible studies; and examine five years of tables of contents for journals likely to publish quantitative or qualitative studies that focus on developing, implementing, or evaluating patient-mediated KT interventions. Screening and data collection will be performed independently by two individuals. The conceptual framework of patient-mediated KT options and outcomes could be used by healthcare providers, managers, educationalists, patient advocates, and policy makers to guide program planning, service delivery, and quality improvement and by us and other researchers to evaluate existing interventions or develop new interventions. By raising awareness of options for involving patients in improving their own care, outcomes based on using a KT approach may lead to greater patient-centred care delivery and improved healthcare outcomes.

Protocol: developing a conceptual framework of patient mediated knowledge translation, systematic review using a realist approach

PubMed Central

2011-01-01

Background Patient involvement in healthcare represents the means by which to achieve a healthcare system that is responsive to patient needs and values. Characterization and evaluation of strategies for involving patients in their healthcare may benefit from a knowledge translation (KT) approach. The purpose of this knowledge synthesis is to develop a conceptual framework for patient-mediated KT interventions. Methods A preliminary conceptual framework for patient-mediated KT interventions was compiled to describe intended purpose, recipients, delivery context, intervention, and outcomes. A realist review will be conducted in consultation with stakeholders from the arthritis and cancer fields to explore how these interventions work, for whom, and in what contexts. To identify patient-mediated KT interventions in these fields, we will search MEDLINE, the Cochrane Library, and EMBASE from 1995 to 2010; scan references of all eligible studies; and examine five years of tables of contents for journals likely to publish quantitative or qualitative studies that focus on developing, implementing, or evaluating patient-mediated KT interventions. Screening and data collection will be performed independently by two individuals. Conclusions The conceptual framework of patient-mediated KT options and outcomes could be used by healthcare providers, managers, educationalists, patient advocates, and policy makers to guide program planning, service delivery, and quality improvement and by us and other researchers to evaluate existing interventions or develop new interventions. By raising awareness of options for involving patients in improving their own care, outcomes based on using a KT approach may lead to greater patient-centred care delivery and improved healthcare outcomes. PMID:21426573

Depression and anxiety mediate perceived social support to predict health-related quality of life in pregnant women living with HIV.

PubMed

Xiaowen, Wang; Guangping, Guo; Ling, Zhou; Jiarui, Zheng; Xiumin, Liang; Zhaoqin, Li; Hongzhuan, Luo; Yuyan, Yang; Liyuan, Yang; Lin, Lu

2018-04-01

Pregnant women living with HIV represent one of the most high-priority groups for HIV treatment and health assessment. Although social support has been shown to be a protective factor for improved health-related quality of life (HRQoL), and depression and anxiety have been identified as two major causes of psychological distress among people living with HIV, it is still unclear how social support, anxiety, and depression interact to influence HRQoL. The objective of our study was to demonstrate the nature of predictors, direct effects and mediator effects among social support, anxiety, depression symptoms and HRQoL in pregnant women living with HIV. We investigated a total of 101 pregnant women living with HIV in Yunnan province in China from April 2016 to June 2016. All participants completed the Social Support Rating Scale (SSRS), the Chinese version of the Hospital Anxiety and Depression Scales (HADS) and Quality of Life instruments (EuroQoL Five Dimensions Questionnaire, EQ-5D). The relationships between the variables were examined by Pearson's or Spearman's correlation analysis. Predictor effects were tested using separate multiple regressions, controlling for demographic variables and HIV diagnosis variables. Direct and mediation effects of social support on HRQoL were tested using a structural equation model (SEM). Anxiety and depression symptoms were negatively correlated with subjective social support, support utilization, social support and HRQoL. Social support significantly predicted better HRQoL, and anxiety and depression symptoms significantly predicted poorer HRQoL. Anxiety and depression symptoms partially mediated the associations between social support and HRQoL. Anxiety and depression symptoms completely mediated the associations of objective support and support utilization with HRQoL. Interventions to improve HRQoL in pregnant women living with HIV must consider the mediation effect of anxiety and depression symptoms on the association between social support and HRQoL. Social support interventions are valid only when anxiety and depression symptoms are managed effectively.

Investigating the Roles of Neighborhood Environments and Housing-based Social Support in the Relocation of Persons Made Homeless by Hurricane Katrina

PubMed Central

Kloos, Bret; Flory, Kate; Hankin, Benjamin L.; Cheely, Catherine A.; Segal, Michelle

2008-01-01

This study examined whether social support tied to relocation efforts and neighborhood social climate may mediate the effects of stressful life events on mental health outcomes following Hurricane Katrina. Participants were 108 adult persons made homeless by Hurricane Katrina and evacuated to Columbia, SC. Civic leaders developed an intervention model that emphasized (a) a one-stop point of entry, (b) living in hotels and apartments rather than shelters, and (c) matching hotels with volunteer “hosts” to assist in relocation efforts. Results revealed that perceived neighborhood factors and satisfaction with host relationship were related to several mental health outcomes. Neighborhood social climate partially mediated several mental health outcomes. Implications of this intervention model and the utility of social ecological perspectives on homelessness interventions are discussed. PMID:19363774

Effects of Parent Training on Callous-Unemotional Traits, Effortful Control, and Conduct Problems: Mediation by Parenting.

PubMed

Elizur, Yoel; Somech, Lior Y; Vinokur, Amiram D

2017-01-01

Callous-unemotional (CU) traits and effortful control (EC) are personality and temperament traits implicated in early-onset antisocial trajectories. This secondary analysis of Hitkashrut's randomized controlled trial first tested parent training's effects on EC and CU traits while controlling for more general treatment effects on conduct problems (CP), and subsequently tested mediation by parenting. Prekindergarten teachers in three Israeli cities identified 209 3-5 year-old (163 boys; 46 girls) preschoolers with subclinical-clinical range conduct problems. All participants were Jewish ranging from ultra-orthodox to secular. They were assigned to 14-session co-parent training groups (n = 140 couples), or to minimal intervention control groups with referral to local services as necessary (n = 69 couples). We employed averaged indices of pre- and post-intervention questionnaires completed by both parents. The testing of all hypothesized models controlled for treatment effects on CP in order to strengthen the robustness of the analyses. We found significant concurrent treatment effects on CP and on either CU traits or EC. All effects were mediated by ineffective parenting (IP): a latent variable that was indicated by negative/inconsistent practices and perceived parenting inefficacy. This is the first demonstration of parenting mediated treatment effects on both EC and CU traits in a randomized controlled study conducted in everyday practice contexts. This finding supports a disruption model of change: the reduction of IP facilitates a caregiving environment that affects children's behavior and developing personality. The changing of personality and temperament characteristics implicated in early-onset pathways suggests an innovative prevention strategy for disruptive behavior disorders.

Does Size Impact Attention and Recall of Graphic Health Warnings?

PubMed Central

Klein, Elizabeth G.; Shoben, Abigail B.; Krygowski, Sarah; Ferketich, Amy; Berman, Micah; Peters, Ellen; Rao, Unnava; Wewers, Mary Ellen

2015-01-01

Objective To evaluate the attention paid to larger sizes of graphic health warnings (GHWs) embedded within cigarette advertisements so as to assess their impacts on rural smokers. Methods Daily smokers (N = 298) were randomly assigned to view a cigarette advertisement with 3 conditions: 2 intervention conditions with GHW comprising 20% or 33% of the ad area, or a text-only control. Eye-tracking software measured attention in milliseconds. Binary outcome mediation was conducted. Results Intervention participants spent 24% of their time viewing the GHWs, compared to 10% for control (p < .01). The odds of GHW recall in the combined (20% and 33%) intervention group were 3.3 times higher than controls. Total dwell time mediated 33% of the effect of the graphic condition on any recall. Conclusions GHWs in 20% of cigarette advertisement space attracted significantly more attention than text-only warnings; larger GHWs did not increase attention. Attention was significantly associated with warning recall; total time viewing mediated warning recall. Tobacco ads should include GHWs to attract the attention of smokers. PMID:26550583

Cognitive cooperation groups mediated by computers and internet present significant improvement of cognitive status in older adults with memory complaints: a controlled prospective study.

PubMed

Krug, Rodrigo de Rosso; Silva, Anna Quialheiro Abreu da; Schneider, Ione Jayce Ceola; Ramos, Luiz Roberto; d'Orsi, Eleonora; Xavier, André Junqueira

2017-04-01

To estimate the effect of participating in cognitive cooperation groups, mediated by computers and the internet, on the Mini-Mental State Examination (MMSE) percent variation of outpatients with memory complaints attending two memory clinics. A prospective controlled intervention study carried out from 2006 to 2013 with 293 elders. The intervention group (n = 160) attended a cognitive cooperation group (20 sessions of 1.5 hours each). The control group (n = 133) received routine medical care. Outcome was the percent variation in the MMSE. Control variables included gender, age, marital status, schooling, hypertension, diabetes, dyslipidaemia, hypothyroidism, depression, vascular diseases, polymedication, use of benzodiazepines, exposure to tobacco, sedentary lifestyle, obesity and functional capacity. The final model was obtained by multivariate linear regression. The intervention group obtained an independent positive variation of 24.39% (CI 95% = 14.86/33.91) in the MMSE compared to the control group. The results suggested that cognitive cooperation groups, mediated by computers and the internet, are associated with cognitive status improvement of older adults in memory clinics.

Aging, the Central Nervous System, and Mobility in Older Adults: Interventions.

PubMed

Varma, Vijay R; Hausdorff, Jeffrey M; Studenski, Stephanie A; Rosano, Caterina; Camicioli, Richard; Alexander, Neil B; Chen, Wen G; Lipsitz, Lewis A; Carlson, Michelle C

2016-11-01

Research suggests that the central nervous system (CNS) and mobility are closely linked. CNS-mediated mobility impairment may represent a potentially new and prevalent syndrome within the older adult populations. Interventions targeting this group may have the potential to improve mobility and cognition and prevent disability. In 2012, the Gerontological Society of America (GSA) and the National Institute on Aging (NIA) sponsored a 3-year conference workshop series, "Aging, the CNS, and Mobility." The goal of this third and final conference was to (i) report on the state of the science of interventions targeting CNS-mediated mobility impairment among community-dwelling older adults and (ii) partnering with the NIA, explore the future of research and intervention design focused on a potentially novel aging syndrome. Evidence was presented in five main intervention areas: (i) pharmacology and diet; (ii) exercise; (iii) electrical stimulation; (iv) sensory stimulation/deprivation; and (v) a combined category of multimodal interventions. Workshop participants identified important gaps in knowledge and key recommendations for future interventions related to recruitment and sample selection, intervention design, and methods to measure effectiveness. In order to develop effective preventive interventions for this prevalent syndrome, multidisciplinary teams are essential particularly because of the complex nature of the syndrome. Additionally, integrating innovative methods into the design of interventions may help researchers better measure complex mechanisms, and finally, the value of understanding the link between the CNS and mobility should be conveyed to researchers across disciplines in order to incorporate cognitive and mobility measurements into study protocols. © The Author 2016. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

What Works for Whom, How and under What Circumstances? Testing Moderated Mediation of Intervention Effects on Externalizing Behavior in Children

ERIC Educational Resources Information Center

Stoltz, Sabine; Dekovic, Maja; van Londen, Monique; de Castro, Bram Orobio; Prinzie, Peter

2013-01-01

In this study, we investigate whether changes in child social cognitive functioning and parenting are the mechanisms through which an individually delivered real-world child intervention, Stay Cool Kids, aimed at preventing externalizing problem behavior in high-risk elementary school children, induces changes in child behavior. Moreover, we…

Healthy Active Living: A Residence Community-Based Intervention to Increase Physical Activity and Healthy Eating during the Transition to First-Year University

ERIC Educational Resources Information Center

Brown, Denver M. Y.; Bray, Steve R.; Beatty, Kevin R.; Kwan, Matthew Y. W.

2014-01-01

Objective: To examine the effects of a Healthy Active Living (HAL) community intervention on moderate-to-vigorous physical activity (MVPA), fruit and vegetable consumption (FVC), and psychosocial mediators of physical activity among students transitioning into university. Methods: Sixty undergraduate students were assigned to reside in either the…

The Role of Friends' Disruptive Behavior in the Development of Children's Tobacco Experimentation: Results from a Preventive Intervention Study

ERIC Educational Resources Information Center

van Lier, Pol A. C.; Huizink, Anja; Vuijk, Patricia

2011-01-01

Having friends who engage in disruptive behavior in childhood may be a risk factor for childhood tobacco experimentation. This study tested the role of friends' disruptive behavior as a mediator of the effects of a classroom based intervention on children's tobacco experimentation. 433 Children (52% males) were randomly assigned to the Good…

Creating a Common Table: Using Peer Mediated Intervention to Promote Social Communication Skills with At-Risk and Autism Spectrum Disorder Populations

ERIC Educational Resources Information Center

Craig-Unkefer, Lesley; Loncola Walberg, Jennifer

2015-01-01

Identifying an intervention that is effective for multiple populations can be a challenge. Given the potential range of students in an inclusive setting, the need to identify common strategies that promote skill development for multiple populations is essential. Professionals need to identify those strategies that promote skill development that…

Cross-site randomized control trial of the Social ABCs caregiver-mediated intervention for toddlers with autism spectrum disorder.

PubMed

Brian, Jessica A; Smith, Isabel M; Zwaigenbaum, Lonnie; Bryson, Susan E

2017-10-01

To evaluate the efficacy of the Social ABCs parent-mediated intervention for toddlers with suspected or confirmed autism spectrum disorder (ASD), through a cross-site randomized control trial, sixty-three parent-toddler dyads (toddler age: 16-30 months) were randomized into treatment (Social ABCs) or control (service-as-usual) conditions. Video data were obtained at three key time-points: Baseline; Post-training (PT; week 12); and Follow-Up (week 24). Analyses included 62 dyads. Treatment allocation significantly accounted for PT gains, all favouring the Treatment group, in (1) child functional vocal responsiveness to parent prompts (R 2  = 0.43, P < .001), (2) child vocal initiations (R 2  = 0.28, P < .001), (3) parent smiling (R 2  = 0.09, P = .017), and (4) fidelity of implementation (R 2  = 0.71, P < .001). A trend was observed for increased social orienting (R 2  = 0.06, P = 0.054); gains in parent smiling significantly predicted increases in child smiling and social orienting. Parents in the treatment condition reported significant gains in self-efficacy following the intervention (P = 0.009). No differential effects emerged for performance on standardized measures. The Social ABCs is a relatively low-resource, efficacious intervention, with potential to be a cost-effective means of intervening at the first signs of possible ASD. Autism Res 2017, 10: 1700-1711. © 2017 International Society for Autism Research, Wiley Periodicals, Inc. Clinical Trial Title: Social ABCs for Toddlers with Signs of Autism Spectrum Disorder: RCT of a Parent-Mediated Intervention http//ClinicalTrials.gov identifier: NCT02428452. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Safer Sex Media Messages and Adolescent Sexual Behavior: 3-Year Follow-Up Results From Project iMPPACS

PubMed Central

Romer, Daniel; Valois, Robert F.; Vanable, Peter; Carey, Michael P.; Stanton, Bonita; Brown, Larry; DiClemente, Ralph; Salazar, Laura F.

2013-01-01

Objectives. We estimated the long-term (36-month) effects of Project iMPPACS, a multisite randomized controlled trial of mass media and small-group intervention for African American adolescents. Methods. We collected 6 waves of longitudinal data on program participants aged 14 to 17 years (n = 1139) in Providence, Rhode Island; Syracuse, New York; Columbia, South Carolina; and Macon, Georgia, 36 months (December 2009–December 2010) after the intervention began (August 2006–January 2008). Seemingly unrelated regressions at each wave estimated the effects of 3 types of mass media messages (the thematic mediators: selection, pleasure, and negotiation) on condom use intention and self-reported unprotected vaginal sex events. Results. All 3 mediators of behavior change that were introduced during the media intervention were sustained at the follow-up assessments at least 18 months after the intervention ended, with intention having the largest correlation. Unprotected vaginal sex increased with each wave of the study, although cities receiving media exposure had smaller increases. Conclusions. Project iMPPACS demonstrates that mass media influence delivered over an extended period, when adolescents were beginning to learn patterns of behavior associated with sex, persisted after the media program ended. PMID:23153149

Aspiring to physical health: The role of aspirations for physical health in facilitating long-term tobacco abstinence

PubMed Central

Niemiec, Christopher P.; Ryan, Richard M.; Deci, Edward L.; Williams, Geoffrey C.

2009-01-01

Objective To assess aspirations for physical health over 18 months. To examine whether maintained importance of aspirations for physical health mediated and/or moderated the effect of an intensive intervention on long-term tobacco abstinence. Methods Participants were randomly assigned to an intervention based on self-determination theory or to community care, and provided data at baseline and at 18 and 30 months post-randomization. Results Aspirations for physical health were better maintained over 18 months among participants in the intervention (mean change = .05), relative to community care (mean change = -.13), t = 2.66, p < .01. Maintained importance of aspirations for physical health partially mediated the treatment condition effects on seven-day point prevalence tobacco abstinence (z′ = 1.68, p < .01) and the longest number of days not smoking (z′ = 2.16, p < .01), and interacted with treatment condition to facilitate the longest number of days not smoking (β = .08, p < .05). Conclusion Maintained importance of aspirations for physical health facilitated tobacco abstinence. Practice implications Smokers may benefit from discussing aspirations for physical health within autonomy-supportive interventions. Patients may benefit from discussing aspirations during counseling about therapeutic lifestyle change and medication use. PMID:18838243

Aspiring to physical health: the role of aspirations for physical health in facilitating long-term tobacco abstinence.

PubMed

Niemiec, Christopher P; Ryan, Richard M; Deci, Edward L; Williams, Geoffrey C

2009-02-01

To assess aspirations for physical health over 18 months. To examine whether maintained importance of aspirations for physical health mediated and/or moderated the effect of an intensive intervention on long-term tobacco abstinence. Participants were randomly assigned to an intervention based on self-determination theory or to community care, and provided data at baseline and at 18 and 30 months post-randomization. Aspirations for physical health were better maintained over 18 months among participants in the intervention (mean change=.05), relative to community care (mean change=-.13), t=2.66, p<.01. Maintained importance of aspirations for physical health partially mediated the treatment condition effects on seven-day point prevalence tobacco abstinence (z'=1.68, p<.01) and the longest number of days not smoking (z'=2.16, p<.01), and interacted with treatment condition to facilitate the longest number of days not smoking (beta=.08, p<.05). Maintained importance of aspirations for physical health facilitated tobacco abstinence. Smokers may benefit from discussing aspirations for physical health within autonomy-supportive interventions. Patients may benefit from discussing aspirations during counseling about therapeutic lifestyle change and medication use.

Masculinity and Bystander Attitudes: Moderating Effects of Masculine Gender Role Stress.

PubMed

Leone, Ruschelle M; Parrott, Dominic J; Swartout, Kevin M; Tharp, Andra Teten

2016-01-01

The purpose of the current study was to examine the bystander decision-making process as a mechanism by which men's adherence to various dimensions of traditional masculinity is associated with their confidence to intervene in sexually aggressive events. Further, this study examined the stress men experience from their attempts to adhere to traditional male gender roles as a moderator of this mediational path. Participants ( n = 252) completed measures of traditional masculinity, decisional balance (i.e., weighing the pros and cons) for intervening, masculine gender roles stress, and bystander efficacy. The belief that men must attain social status was associated with more confidence in men's ability to intervene. This effect was mediated by greater perceived positive consequences for intervention among men high, but not low, in masculine gender role stress. The belief that men should be tough and aggressive was associated with greater perceived negative consequences for intervention and less confidence to intervene. The belief that men should not act in stereotypically feminine ways was directly associated with less confidence for intervention. Findings highlight the importance of examining masculinity from a multidimensional perspective to better understand how adherence to various norms differentially influences bystander behavior. These findings may help to inform bystander intervention programming.

Safer sex media messages and adolescent sexual behavior: 3-year follow-up results from project iMPPACS.

PubMed

Hennessy, Michael; Romer, Daniel; Valois, Robert F; Vanable, Peter; Carey, Michael P; Stanton, Bonita; Brown, Larry; DiClemente, Ralph; Salazar, Laura F

2013-01-01

We estimated the long-term (36-month) effects of Project iMPPACS, a multisite randomized controlled trial of mass media and small-group intervention for African American adolescents. We collected 6 waves of longitudinal data on program participants aged 14 to 17 years (n = 1139) in Providence, Rhode Island; Syracuse, New York; Columbia, South Carolina; and Macon, Georgia, 36 months (December 2009-December 2010) after the intervention began (August 2006-January 2008). Seemingly unrelated regressions at each wave estimated the effects of 3 types of mass media messages (the thematic mediators: selection, pleasure, and negotiation) on condom use intention and self-reported unprotected vaginal sex events. All 3 mediators of behavior change that were introduced during the media intervention were sustained at the follow-up assessments at least 18 months after the intervention ended, with intention having the largest correlation. Unprotected vaginal sex increased with each wave of the study, although cities receiving media exposure had smaller increases. Project iMPPACS demonstrates that mass media influence delivered over an extended period, when adolescents were beginning to learn patterns of behavior associated with sex, persisted after the media program ended.

Mediating Variables in a Transtheoretical Model Dietary Intervention Program

ERIC Educational Resources Information Center

Di Noia, Jennifer; Prochaska, James O.

2010-01-01

This study identified mediators of a Transtheoretical Model (TTM) intervention to increase fruit and vegetable consumption among economically disadvantaged African American adolescents (N = 549). Single-and multiple-mediator models were used to determine whether pros, cons, self-efficacy, and stages of change satisfied four conclusions necessary…

Interventions to Promote Colorectal Cancer Screening: An Integrative Review

PubMed Central

Rawl, Susan M.; Menon, Usha; Burness, Allison; Breslau, Erica S.

2012-01-01

Behavior change interventions to promote colorectal cancer (CRC) screening have targeted people in community and primary care settings, health care providers, and health systems. Randomized controlled trials provide the strongest evidence of intervention efficacy. The purpose of this integrative review was to evaluate trials of CRC screening interventions published between 1997 and 2007 and to identify knowledge gaps and future directions for research. Thirty-three randomized trials that met inclusion criteria were evaluated using a modified version of the TREND criteria. Significant intervention effects were reported in six out of ten trials focused on increasing fecal occult blood testing, four of seven trials focused on sigmoidoscopy or colonoscopy completion, and nine of 16 focused on completion of any screening test. Several effective interventions to promote CRC screening were identified. Future trials need to use theory to guide interventions, examine moderators and mediators, consistently report results, and use comparable outcome measures. PMID:22261002

The Relationship Between Resilience and Internet Addiction: A Multiple Mediation Model Through Peer Relationship and Depression.

PubMed

Zhou, Pingyan; Zhang, Cai; Liu, Jian; Wang, Zhe

2017-10-01

Heavy use of the Internet may lead to profound academic problems in elementary students, such as poor grades, academic probation, and even expulsion from school. It is of great concern that Internet addiction problems in elementary school students have increased sharply in recent years. In this study, 58,756 elementary school students from the Henan province of China completed four questionnaires to explore the mechanisms of Internet addiction. The results showed that resilience was negatively correlated with Internet addiction. There were three mediational paths in the model: (a) the mediational path through peer relationship with an effect size of 50.0 percent, (b) the mediational path through depression with an effect size of 15.6 percent, (c) the mediational path through peer relationship and depression with an effect size of 13.7 percent. The total mediational effect size was 79.27 percent. The effect size through peer relationship was the strongest among the three mediation paths. The current findings suggest that resilience is a predictor of Internet addiction. Improving children's resilience (such as toughness, emotional control, and problem solving) can be an effective way to reduce Internet addiction behavior. The current findings provide useful information for early detection and intervention for Internet addiction.

Coping, subjective burden and anxiety among family caregivers of older dependents.

PubMed

del-Pino-Casado, Rafael; Pérez-Cruz, Margarita; Frías-Osuna, Antonio

2014-12-01

To investigate relationships between anxiety and stressors,coping and subjective burden and to contribute to defining factors related to anxiety among family caregivers of older dependents. Despite the studies analysing factors related to anxiety in caregivers, there is not enough evidence about this issue. Cross-sectional design. Data from 140 family caregivers (convenience sample) were analysed using descriptive statistics, correlation coefficients and path analysis. Socio-demographic data and several scales (Barthel Index, Short Portable Mental Status Questionnaire, Cummings Neuropsychiatric Inventory, Brief COPE, Caregiver Strain Index and Hamilton Anxiety Rating Scale) were used to collect data. Stressors (psychiatric and psychological symptoms and number of assisted activities of daily living), emotion-focused coping, dysfunctional coping and subjective burden were related to greater anxiety. Subjective burden mediated the effects of psychiatric and psychological symptoms on anxiety and partially mediated the effects of dysfunctional coping on anxiety. Stressors, dysfunctional coping and subjective burden were identified as factors related to anxiety. The mediating role of subjective burden in the relationship between dysfunctional coping and anxiety was supported. The effect of dysfunctional coping on anxiety was independent of the stressors. These conclusions justify several recommendations regarding nursing interventions for family caregivers of older dependents: (1) stressors,dysfunctional coping and subjective burden can be used in clinical practice for early detection of and early intervention for anxiety; (2) to prevent subjective burden and anxiety,approach-coping skills should be promoted through interventions such as problem-solving,positive reappraisal, assertiveness and control of negative thoughts; (3) these interventions for dysfunctional coping should be systematically developed for individuals with dysfunctional coping regardless of the level of stressors and/or the possibility of respite.

Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control.

PubMed

Hsu, Kean J; Beard, Courtney; Rifkin, Lara; Dillon, Daniel G; Pizzagalli, Diego A; Björgvinsson, Thröstur

2015-12-01

Deficits in attentional control have been hypothesized to cause rumination, suggesting that the relationships between attentional control and clinical symptoms may be mediated in part by rumination. However, to date, no clinical study has examined these constructs transdiagnostically in a path analysis model. Fifty-one adults presenting for treatment completed measures of self-reported attentional control, rumination, and depression and anxiety symptoms. A bias-corrected path analysis-based approach was employed to test whether indirect (i.e., mediating) effects of rumination were significantly associated with the direct effects of attentional control on depression and anxiety symptoms. Separate models for depression and anxiety symptoms were tested along with reverse models using attentional control as a proposed mediator. The relationship between attentional control and clinical symptomatology (i.e., both depression and anxiety symptoms) was mediated by rumination. Poor attentional control was associated with more rumination and consequently more severe symptoms of depression and anxiety. The reverse relationship (i.e., attentional control mediating the relationship between rumination and depression or anxiety symptoms) was not significant. Study design did not allow testing of temporal precedence for the mediation models. All constructs were assessed via self-report. Attentional control appears to impact depression and anxiety symptoms through rumination. The pathway between poor attentional control and emotion dysregulation via rumination suggests that interventions targeting attentional control may decrease maladaptive ruminative processes, leading to improved emotion regulation and reduced clinical symptomatology. Future studies should examine the stability of this mediational relationship over time (and in the face of targeted interventions). Copyright © 2015 Elsevier B.V. All rights reserved.

Translating Genetic Research into Preventive Intervention: The Baseline Target Moderated Mediator Design

PubMed Central

Howe, George W.; Beach, Steven R. H.; Brody, Gene H.; Wyman, Peter A.

2016-01-01

In this paper we present and discuss a novel research approach, the baseline target moderated mediation (BTMM) design, that holds substantial promise for advancing our understanding of how genetic research can inform prevention research. We first discuss how genetically informed research on developmental psychopathology can be used to identify potential intervention targets. We then describe the BTMM design, which employs moderated mediation within a longitudinal study to test whether baseline levels of intervention targets moderate the impact of the intervention on change in that target, and whether change in those targets mediates causal impact of preventive or treatment interventions on distal health outcomes. We next discuss how genetically informed BTMM designs can be applied to both microtrials and full-scale prevention trials. We use simulated data to illustrate a BTMM, and end with a discussion of some of the advantages and limitations of this approach. PMID:26779062

Translating Genetic Research into Preventive Intervention: The Baseline Target Moderated Mediator Design.

PubMed

Howe, George W; Beach, Steven R H; Brody, Gene H; Wyman, Peter A

2015-01-01

In this paper we present and discuss a novel research approach, the baseline target moderated mediation (BTMM) design, that holds substantial promise for advancing our understanding of how genetic research can inform prevention research. We first discuss how genetically informed research on developmental psychopathology can be used to identify potential intervention targets. We then describe the BTMM design, which employs moderated mediation within a longitudinal study to test whether baseline levels of intervention targets moderate the impact of the intervention on change in that target, and whether change in those targets mediates causal impact of preventive or treatment interventions on distal health outcomes. We next discuss how genetically informed BTMM designs can be applied to both microtrials and full-scale prevention trials. We use simulated data to illustrate a BTMM, and end with a discussion of some of the advantages and limitations of this approach.

Treatment seeking as a mechanism of change in a randomized controlled trial of a mobile health intervention to support recovery from alcohol use disorders.

PubMed

Glass, Joseph E; McKay, James R; Gustafson, David H; Kornfield, Rachel; Rathouz, Paul J; McTavish, Fiona M; Atwood, Amy K; Isham, Andrew; Quanbeck, Andrew; Shah, Dhavan

2017-06-01

We estimated the efficacy of the Addiction-Comprehensive Health Enhancement Support System (A-CHESS) in increasing the use of services for addiction and examined the extent to which this use of services mediated the effects of A-CHESS on risky drinking days and abstinence from drinking. We conducted secondary data analyses of the A-CHESS randomized controlled trial. Recruitment occurred in five residential treatment programs operated by two addiction treatment organizations. Participants were 349 adults with alcohol use disorders recruited two weeks before discharge from residential treatment. We provided intervention arm participants with a smartphone, the A-CHESS application, and an 8-month service plan. Control arm participants received treatment as usual. Telephone interviews at 4, 8, and 12-month follow-ups assessed past-month risky drinking days, past-month abstinence, and post-discharge service utilization (past-month outpatient addiction treatment and past-week mutual help including Alcoholics Anonymous and Narcotics Anonymous). Using mixed effects latent variable models, we estimated the indirect effects of A-CHESS on drinking outcomes, as mediated by post-discharge service utilization. Approximately 50.5% of participants reported outpatient addiction treatment and 75.5% reported mutual help at any follow-up interview in the year following randomization. Assignment to the A-CHESS intervention was associated with an increased odds of outpatient addiction treatment across follow-ups, but not mutual help. This use of outpatient addiction treatment mediated the effect of A-CHESS on risky drinking days, but not abstinence. The effect of A-CHESS through outpatient addiction treatment appeared to reduce the expected number of risky drinking days across follow-ups by 11%. The mobile health (mHealth) intervention promoted the use of outpatient addiction treatment, which appeared to contribute to its efficacy in reducing risky drinking. Future research should investigate how mHealth interventions could link patients to needed treatment services and promote the sustained use of these services. Copyright © 2017 Elsevier Inc. All rights reserved.

SPIRITUALITY AND RELIGION AMONG HIV-INFECTED INDIVIDUALS

PubMed Central

Szaflarski, Magdalena

2017-01-01

Spirituality and religion are important to many people living with HIV (PLWH). Recent research has focused on special populations (ethnic-minorities, women, and youth), spirituality/religion measurement, mediating/moderating mechanisms, and individual and community-level interventions. Spirituality/religion in PLWH has been refined as a multidimensional phenomenon which improves health/quality of life directly and through mediating factors (healthy behaviors, optimism, social support). Spirituality/religion helps people to cope with stressors, especially stigma/discrimination. Spiritual interventions utilizing the power of prayer and meditation and addressing spiritual struggle are under way. Faith-based community interventions have focused on stigma and could improve individual outcomes through access to spiritual/social support and care/treatment for PLWA. Community engagement is necessary to design/implement effective and sustainable programs. Future efforts should focus on vulnerable populations; utilize state-of the art methods (randomized clinical trials, community-based participatory research); and, address population-specific interventions at individual and community levels. Clinical and policy implications across geographic settings also need attention. PMID:23996649

Spirituality and religion among HIV-infected individuals.

PubMed

Szaflarski, Magdalena

2013-12-01

Spirituality and religion are important to many people living with HIV (PLWH). Recent research has focused on special populations (ethnic-minorities, women, and youth), spirituality/religion measurement, mediating/moderating mechanisms, and individual and community-level interventions. Spirituality/religion in PLWH has been refined as a multidimensional phenomenon, which improves health/quality of life directly and through mediating factors (healthy behaviors, optimism, social support). Spirituality/religion helps people to cope with stressors, especially stigma/discrimination. Spiritual interventions utilizing the power of prayer and meditation and addressing spiritual struggle are under way. Faith-based community interventions have focused on stigma and could improve individual outcomes through access to spiritual/social support and care/treatment for PLWA. Community engagement is necessary to design/implement effective and sustainable programs. Future efforts should focus on vulnerable populations; utilize state-of-the-art methods (randomized clinical trials, community-based participatory research); and, address population-specific interventions at individual and community levels. Clinical and policy implications across geographic settings also need attention.

Theory of Mind as a mediator variable between neurocognition and functioning in young individuals in treatment with secondary services for non-psychotic disorders.

PubMed

Francesconi, Marta; Minichino, Amedeo; Carrión, Ricardo E; Chiaie, Roberto Delle; Bevilacqua, Arturo; Parisi, Maurizio; Rullo, Santo; Bersani, Francesco Saverio; Biondi, Massimo; Cadenhead, Kristin

2016-12-30

A large body of studies provides evidence for a link between neurocognition, theory of mind (ToM) and functioning in psychotic spectrum disorders (PSDs), with ToM mediating the effect that neurocognition has on functioning. These three constructs and the related mediation effect may characterize different psychiatric syndromes other than PSDs. Structural equation modelling (SEM) was applied to baseline data from a longitudinal study of 138 young individuals with a recent-onset psychiatric disorder. Using SEM, we tested the hypothesis that ToM mediates the effect of neurocognition on functioning independent of the level of psychosis risk and the diagnostic category. In the mediation model the bootstrapping estimate revealed a significant indirect effect that was the association of social cognition with neurocognition and with functional outcome. ToM was significantly associated with neurocognition and the path from neurocognition to functioning was no longer significant as soon as the mediator (ToM) was entered into the mediation model consistent with a complete mediation effect through ToM. This mediation was independent of the psychosis-risk status and the psychiatric diagnoses. Our results provide useful information on a young psychiatric sample, in which specific therapeutic interventions have the potential to significantly limit functional disability. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The use of computer mediated communication in providing patient support: A review of the research literature.

PubMed

Wagg, Amanda J; Callanan, Margie M; Hassett, Alexander

2018-03-16

The aim of this study is to explore how computer mediated communication has been used by a variety of healthcare,professionals to support their patients and discuss the implication that this may have for future practice. A systematized review of the literature. A review of empirical studies within the literature was carried out in April 2016 in CINAHL, MEDLINE, ASSIA, BNI, Psychinfo, and Web of Science databases. The databases searched produced 2930 titles, of which 190 publications were considered relevant to the objectives. Titles and abstracts were then reviewed and duplicates removed producing 67 publications. Exclusion and inclusion criteria were applied. The inclusion criteria were (1) interventions that facilitate two-way communication between any healthcare professional and their patients via a computer; (2) Interventions aimed at providing any type of support e.g. emotional, tangible, informational, or esteem support; (3) English language; (4) Primary empirical studies. Data quality was assessed and thematic analysis applied. Thirty-one publications were included in this study. Intervention types included Email (n = 8), Videoconferencing (n = 7), Online Social Support Groups (n = 9) and multifaceted interventions (n = 7). Three themes emerged from the data including increasing access to healthcare, adding value to healthcare delivery and improving patient outcomes. Twenty-five (81%) of the studies found that computer mediated communication could produce positive effects. Computer mediated communication could be both what patients want and a way of delivering support to patients in a resource tight environment. This has implications for a range of health support needs and professionals including nurses, midwives and allied healthcare professionals. Reviewing the lessons learnt will ensure future interventions are tailored to the support needs of the patients, carefully planned and mindful of the risks. Copyright © 2018 Elsevier Ltd. All rights reserved.

Explaining Physical Activity Maintenance After a Theory-Based Intervention Among Patients With Rheumatoid Arthritis: Process Evaluation of a Randomized Controlled Trial.

PubMed

Knittle, Keegan; De Gucht, Véronique; Hurkmans, Emalie; Vlieland, Thea Vliet; Maes, Stan

2016-02-01

Regular physical activity (PA) benefits patients with rheumatoid arthritis (RA), particularly when maintained over time. Research in this area has largely focused on factors associated with initiating PA, while factors contributing to PA maintenance, particularly after lifestyle interventions, have received less attention. This study examined whether higher levels of autonomous motivation, self-efficacy for PA, and greater use of self-regulation skills mediated PA initiation and maintenance 6 months after a theory-based motivational interviewing and self-regulation coaching intervention. Seventy-eight individuals with RA were randomized to receive either a patient-education session (control group), or the patient-education session plus 1 motivational interview and 2 self-regulation coaching sessions (treatment group). Mediation analyses examined the effects of this intervention on PA initiation and maintenance through the intermediate variables autonomous motivation, self-efficacy for PA, and use of self-regulation skills. Analyses were controlled for age, sex, and previous levels of PA. The treatment group reported significantly higher autonomous motivation and greater use of self-regulation skills than controls at posttreatment. Increases in PA from baseline to posttreatment were not mediated by any intermediate variables. However, maintenance of PA from posttreatment to followup (6 months later) was mediated by greater autonomous motivation and use of self-regulation skills. Greater autonomous motivation and use of self-regulation skills predict maintenance of PA following a motivational interviewing and self-regulation coaching intervention. In promoting PA among patients with RA, supporting patient autonomy and teaching self-regulation skills, which focus attention on achieving PA goals, may improve long-term maintenance of PA. © 2016, American College of Rheumatology.

An Examination of Mediators of the Transfer of Cognitive Speed of Processing Training to Everyday Functional Performance

PubMed Central

Edwards, Jerri D.; Ruva, Christine L.; O’Brien, Jennifer L.; Haley, Christine B.; Lister, Jennifer J.

2013-01-01

The purpose of these analyses was to examine mediators of the transfer of cognitive speed of processing training to improved everyday functional performance (Edwards, Wadley, Vance, Roenker, & Ball, 2005). Cognitive speed of processing and visual attention (as measured by the Useful Field of View Test; UFOV) were examined as mediators of training transfer. Secondary data analyses were conducted from the Staying Keen in Later Life (SKILL) study, a randomized cohort study including 126 community dwelling adults 63 to 87 years of age. In the SKILL study, participants were randomized to an active control group or cognitive speed of processing training (SOPT), a non-verbal, computerized intervention involving perceptual practice of visual tasks. Prior analyses found significant effects of training as measured by the UFOV and Timed Instrumental Activities of Daily Living (TIADL) Tests. Results from the present analyses indicate that speed of processing for a divided attention task significantly mediated the effect of SOPT on everyday performance (e.g., TIADL) in a multiple mediation model accounting for 91% of the variance. These findings suggest that everyday functional improvements found from SOPT are directly attributable to improved UFOV performance, speed of processing for divided attention in particular. Targeting divided attention in cognitive interventions may be important to positively affect everyday functioning among older adults. PMID:23066808

Building Kindergartners’ Number Sense: A Randomized Controlled Study

PubMed Central

Jordan, Nancy C.; Glutting, Joseph; Dyson, Nancy; Hassinger-Das, Brenna; Irwin, Casey

2015-01-01

Math achievement in elementary school is mediated by performance and growth in number sense during kindergarten. The aim of the present study was to test the effectiveness of a targeted small group number sense intervention for high-risk kindergartners from low-income communities. Children were randomly assigned to one of three groups (n = 44 in each group): a number sense intervention group, a language intervention group, or a business as usual control group. Accounting for initial skill level in mathematical knowledge, children who received the number sense intervention performed better than controls at immediate post test, with meaningful effects on measures of number competencies and general math achievement. Many of the effects held eight weeks after the intervention was completed, suggesting that children internalized what they had learned. There were no differences between the language and control groups on any math-related measures. PMID:25866417

Adolescent survivors of childhood sexual abuse: the mediating role of attachment style and coping in psychological and interpersonal functioning.

PubMed

Shapiro, D L; Levendosky, A A

1999-11-01

To examine attachment style and coping strategies as potential mediating variables between childhood sexual abuse (CSA) and psychological and interpersonal functioning in an attempt to explain variability in extent of disorder and level of functioning. Eighty adolescent females, aged 14-16 years, answered questions regarding abuse history, attachment style, coping with an interpersonal stressor, depression and trauma symptomatology, and conflict with a best friend. Structural equation modeling analyses indicated that attachment style mediates the effects of CSA and child abuse and neglect on coping and psychological distress. The indirect effects of CSA and other abuse through attachment accounted for most of the effects on coping and psychological distress. Avoidant and cognitive coping strategies also served as mediators in the models, accounting for most of the effects of the other variables on interpersonal conflict. The findings indicate that attachment style and coping strategies influence psychological and interpersonal functioning, mediating the direct effects of CSA and other types of child abuse and neglect. These results have implications for therapeutic intervention with children and adolescents who have experienced child abuse.

Non-supportive Parenting Affects Telomere Length in Young Adulthood Among African Americans: Mediation through Substance Use

PubMed Central

Beach, Steven R. H.; Lei, Man Kit; Brody, Gene H.; Yu, Tianyi; Philibert, Robert A.

2015-01-01

Telomere length (TL) is an indicator of age related changes at the cellular level associated with heightened mortality risk. The effect of non-supportive parenting (NSP) during late adolescence and young adulthood on TL 5 years later was examined in a sample of N = 183 young adult African Americans to determine if effects of NSP on TL were mediated by substance use. Results indicated that the effect of caregiver reported NSP on diminished TL was mediated by escalation of drinking and smoking in young adulthood, even after controlling effects of socioeconomic status risk, gender, BMI, young adult stress, and intervention status. Results suggest that prevention of NSP may influence later physical health consequences by influencing substance use trajectory. PMID:25485673

I think therefore I om: cognitive distortions and coping style as mediators for the effects of mindfulness meditation on anxiety, positive and negative affect, and hope.

PubMed

Sears, Sharon; Kraus, Sue

2009-06-01

This study examined cognitive distortions and coping styles as potential mediators for the effects of mindfulness meditation on anxiety, negative affect, positive affect, and hope in college students. Our pre- and postintervention design had four conditions: control, brief meditation focused on attention, brief meditation focused on loving kindness, and longer meditation combining both attentional and loving kindness aspects of mindfulness. Each group met weekly over the course of a semester. Longer combined meditation significantly reduced anxiety and negative affect and increased hope. Changes in cognitive distortions mediated intervention effects for anxiety, negative affect, and hope. Further research is needed to determine differential effects of types of meditation. Copyright 2009 Wiley Periodicals, Inc.

Potential treatment mechanisms in a mindfulness-based intervention for people with progressive multiple sclerosis.

PubMed

Bogosian, Angeliki; Hughes, Alicia; Norton, Sam; Silber, Eli; Moss-Morris, Rona

2016-11-01

To explore putative mediators of a mindfulness-based intervention to decrease distress in people with multiple sclerosis (MS) and to explore the patients' perspectives on this intervention. We used an explanatory mixed methods design incorporating quantitative data from a pilot randomized control trial and a qualitative interview study with people who completed the mindfulness intervention. People with MS (n = 40) completed standardized measures of distress (outcome), and acceptance, decentring, self-compassion, and self-efficacy (potential mediators). Semi-structured interviews (n = 15) of patients' experiences of the mindfulness intervention were analysed deductively and inductively. Decentring post-intervention explained 13% of the 3-month change in distress and between 27% and 31% of concurrent changes in distress. Acceptance changed only slightly, and as a result, the indirect effect accounts for only 2% of future distress and between 3% and 11% of concurrent distress. Qualitative data showed that acceptance and self-compassion needed more time to develop, whereas decentring could be implemented readily after being introduced in the sessions. Self-efficacy also had a large mediating effect. Participants in their interviews talked about group dynamics and prior expectations as essential elements that determine their engagement with the course and their level of satisfaction. Mindfulness interventions for people with a chronic progressive condition may benefit from focusing on helping them to accept daily challenges and teach them to recognize their thoughts and feelings, allowing time for acceptance and self-compassion to develop. Group dynamics also play a fundamental role in the success of the mindfulness interventions. Statement of Contribution What is already known on this subject? Mindfulness courses improve psychological well-being for people with chronic conditions. Mindfulness courses have been successful in improving psychological well-being and symptom management for people with multiple sclerosis but we do not know how these courses work. What does this study add? Decentering and self-efficacy appear to be key mechanisms leading to reduced distress. Acceptance and self-compassion may need more time and practice to develop. Group dynamics and expectations of the mindfulness courses were also important elements of mindfulness. © 2016 The British Psychological Society.

Experienced HIV-Related Stigma in Health Care and Community Settings: Mediated Associations With Psychosocial and Health Outcomes.

PubMed

Kay, Emma S; Rice, Whitney S; Crockett, Kaylee B; Atkins, Ghislaine C; Batey, David Scott; Turan, Bulent

2018-03-01

There are multiple dimensions of HIV-related stigma that can compromise the mental and physical health of people living with HIV. We focused on the dimension of experienced stigma, defined as exposure to acts of discrimination, devaluation, and prejudice, and investigated its relationship with HIV health and psychosocial outcomes. We examined associations between experienced stigma in the community and health care settings and psychosocial and health outcomes for people living with HIV (N = 203) receiving care at an urban HIV clinic in the Southeastern United States. We also investigated whether those effects are unique to experienced stigma or are mediated by other dimensions of HIV-related stigma. Experienced stigma was associated with suboptimal clinical outcomes such as viral nonsuppression, as well as poor affective, cognitive, and mental health outcomes (self-esteem, depressive symptoms, avoidance coping, and blame coping) and interpersonal outcomes such as social support and physician trust. Furthermore, serial mediation models suggested significant indirect effects of experienced stigma through internalized stigma and anticipated stigma from various theoretically expected sources of stigma (eg, community members, friends and family, and health care workers), with varying effects depending on the source. These findings suggest nuanced mechanisms for the effects of experienced HIV-related stigma, especially in health care settings, and may be used to inform stigma-reduction interventions. Interventions designed to address experienced stigma in health care settings might be more tailored to specific outcomes, such as depression and physician trust, than interventions designed to address experienced stigma in the community.

Is Parenting the Mediator of Change in Behavioral Parent Training for Externalizing Problems of Youth?

PubMed Central

Forehand, Rex; Lafko, Nicole; Parent, Justin; Burt, Keith

2014-01-01

Change in parenting behavior is theorized to be the mediator accounting for change in child and adolescent externalizing problems in behavioral parent training (BPT). The purpose of this review is to examine this assumption in BPT prevention and intervention programs. Eight intervention and 17 prevention studies were identified as meeting all criteria or all but one criterion for testing mediation. Parenting behaviors were classified as positive, negative, discipline, monitoring/supervision, or a composite measure. Forty-five percent of the tests performed across studies to test mediation supported parenting as a mediator. A composite measure of parenting and discipline received the most support, whereas monitoring/supervision was rarely examined. More support for the mediating role of parenting emerged for prevention than intervention studies and when meeting all criteria for testing mediation was not required. Although the findings do not call BPT into question as an efficacious treatment, they do suggest more attention should be focused on examining parenting as a putative mediator in BPT. PMID:25455625

Drink refusal training as part of a combined behavioral intervention: Effectiveness and mechanisms of change

PubMed Central

Witkiewitz, Katie; Donovan, Dennis M.; Hartzler, Bryan

2012-01-01

Objective Many trials have demonstrated the effectiveness of cognitive behavioral interventions for alcohol dependence, yet few studies have examined why particular treatments are effective. This study was designed to evaluate whether drink refusal training was an effective component of a combined behavioral intervention (CBI) and whether change in self-efficacy was a mechanism of change following drink refusal training for individuals with alcohol dependence. Method The current study is a secondary analysis of data from the COMBINE study, a randomized clinical trial that combined pharmacotherapy with behavioral intervention in the treatment of alcohol dependence. The goal of the current study was to examine whether a drink refusal skills training module, administered as part of a 16-week CBI (n=776; 31% female, 23% non-White, average age=44) predicted changes in drinking frequency and self-efficacy during and following the CBI, and whether changes in self-efficacy following drink refusal training predicted changes in drinking frequency up to one year following treatment. Results Participants (n=302) who received drink refusal skills training had significantly fewer drinking days during treatment (d=0.50) and up to one year following treatment (d=0.23). In addition the effect of the drink refusal skills training module on drinking outcomes following treatment was significantly mediated by changes in self-efficacy, even after controlling for changes in drinking outcomes during treatment (proportion mediated = 0.47). Conclusions Drink refusal training is an effective component of CBI and some of the effectiveness may be attributed to changes in client self-efficacy. PMID:22289131

Social support and adaptation outcomes in children and adolescents with cerebral palsy.

PubMed

Carona, Carlos; Moreira, Helena; Silva, Neuza; Crespo, Carla; Canavarro, Maria Cristina

2014-01-01

This study had two main objectives: first, to describe the social support and psychological maladjustment of children and adolescents with cerebral palsy (CP); and second, to test a mediation model where psychological maladjustment was hypothesized to mediate the link between social support and health-related quality of life (HRQL). In addition, the moderating role of gender and age was examined for this mediation model. Self- and proxy-report questionnaires on the aforementioned variables were administered to a sample of 96 children/adolescents with CP and 118 healthy controls, as well as one of their parents. Univariate and multivariate analyses of covariance were conducted to examine differences in social support and psychological maladjustment, respectively. PROCESS computational tool was used for path analysis-based mediation, moderation and moderated mediation analyses. Children/adolescents with CP reported lower levels of social support than their healthy peers, but no significant differences emerged in terms of their psychological maladjustment. For children/adolescents with CP, internalizing and externalizing problems were found to mediate the link between social support and HRQL, and these indirect effects were not conditional upon age or gender. Children and adolescents with CP are likely have more negative perceptions of social support, but not necessarily more psychological adjustment problems than their healthy, able-bodied peers. Results further suggest that interventions targeting social support perceptions may positively affect HRQL outcomes in children/adolescents with CP, through the improvement of internalizing and externalizing dimensions of their psychological adjustment. Social support perceptions are important intervention targets in psychosocial rehabilitation with children and adolescents with CP. Children and adolescents with CP do not necessarily present increased psychological maladjustment. Interventions targeting these children and adolescents' social support may promote their psychological adjustment and health-related quality of life. Developmental specificities, such as age and gender differences, should be considered when planning and implementing psychosocial interventions.

Dyadic planning of health-behavior change after prostatectomy: a randomized-controlled planning intervention.

PubMed

Burkert, Silke; Scholz, Urte; Gralla, Oliver; Roigas, Jan; Knoll, Nina

2011-09-01

In this study, we investigated the role of dyadic planning for health-behavior change. Dyadic planning refers to planning health-behavior change together with a partner. We assumed that dyadic planning would affect the implementation of regular pelvic-floor exercise (PFE), with other indicators of social exchange and self-regulation strategies serving as mediators. In a randomized-controlled trial at a German University Medical Center, 112 prostatectomy-patients with partners were randomly assigned to a dyadic PFE-planning condition or one of three active control conditions. Questionnaire data were assessed at multiple time points within six months post-surgery, measuring self-reported dyadic PFE-planning and pelvic-floor exercise as primary outcomes and social exchange (support, control) and a self-regulation strategy (action control) as mediating mechanisms. There were no specific intervention effects with regard to dyadic PFE-planning or pelvic-floor exercise, as two active control groups also showed increases in either of these variables. However, results suggested that patients instructed to plan dyadically still benefited from self-reported dyadic PFE-planning regarding pelvic-floor exercise. Cross-sectionally, received negative control from partners was negatively related with PFE only in control groups and individual action control mediated between self-reported dyadic PFE-planning and PFE for participants instructed to plan PFE dyadically. Longitudinally, action control mediated between self-reported dyadic PFE-planning and pelvic-floor exercise for all groups. Findings provide support for further investigation of dyadic planning in health-behavior change with short-term mediating effects of behavior-specific social exchange and long-term mediating effects of better self-regulation. Copyright © 2011 Elsevier Ltd. All rights reserved.

How Does MBCT for Depression Work? Studying Cognitive and Affective Mediation Pathways

PubMed Central

Batink, Tim; Peeters, Frenk; Geschwind, Nicole; van Os, Jim; Wichers, Marieke

2013-01-01

Mindfulness based cognitive therapy (MBCT) is a non-pharmacological intervention to reduce current symptoms and to prevent recurrence of major depressive disorder. At present, it is not well understood which underlying mechanisms during MBCT are associated with its efficacy. The current study (n = 130) was designed to examine the roles of mindfulness skills, rumination, worry and affect, and the interplay between those factors, in the mechanisms of change in MBCT for residual depressive symptoms. An exploratory but systematic approach was chosen using Sobel-Goodman mediation analyses to identify mediators on the pathway from MBCT to reduction in depressive symptoms. We replicated earlier findings that therapeutic effects of MBCT are mediated by changes in mindfulness skills and worry. Second, results showed that changes in momentary positive and negative affect significantly mediated the efficacy of MBCT, and also mediated the effect of worry on depressive symptoms. Third, within the group of patients with a prior history of ≤ 2 episodes of MDD, predominantly changes in cognitive and to a lesser extent affective processes mediated the effect of MBCT. However, within the group of patients with a prior history of ≥ 3 episodes of MDD, only changes in affect were significant mediators for the effect of MBCT. Trail Registration: Nederlands Trial Register NTR1084 PMID:24009704

Individual and family factors associated with self-esteem in young people with epilepsy: A multiple mediation analysis.

PubMed

Chew, Judith; Haase, Anne M; Carpenter, John

2017-01-01

As young people experience added demands from living with epilepsy, which may lead to poor psychosocial adjustment, it is essential to examine mechanisms of change to provide practitioners with knowledge to develop effective interventions. The aim of this study was to examine individual and family-level factors - stress and illness perceptions, coping behaviors and family resilience - that promote or maintain young people's self-esteem. From November 2013 to August 2014, young people attending a neurology clinic in KK Women's and Children's Hospital, Singapore, participated in a cross-sectional survey (n=152; 13-16years old). Multiple mediation analyses were conducted to evaluate whether these variables mediated the relationship between illness severity (i.e., low, moderate, high) and self-esteem. Multiple mediation analyses demonstrated that illness severity had a direct effect on young people's self-esteem. Compared to those with moderate illness severity (reference group), young people with low severity had significantly higher self-esteem (c=3.42, p<0.05); while those with high severity had a more negative view of themselves (c=-3.93, p<0.001). Illness severity also had an indirect influence on self-esteem through its effects on mediators, such as perceived stress, illness perceptions and family resilience (D 1 : Total ab=3.46, 95% CI 1.13, 5.71; D 2 : Total ab=-2.80, 95% CI -4.35, -1.30). However, young people's coping levels did not predict their self-esteem, when accounting for the effects of other variables. The continued presence of seizure occurrences is likely to place greater demands on young people and their families: in turn, increased stress and negative illness perceptions negatively affected family processes that promote resilience. As the mediating effect of these modifiable factors were above and beyond the contributions of illness characteristics and young people's levels of coping, this has implications for developing individual and family interventions aimed to support young people living with epilepsy. Copyright © 2016 Elsevier Inc. All rights reserved.

Does Perceived Neighborhood Walkability and Safety Mediate the Association Between Education and Meeting Physical Activity Guidelines?

PubMed Central

Yin, Shaoman; Soler, Robin; Njai, Rashid; Siegel, Paul Z.; Liao, Youlian

2015-01-01

The role of neighborhood walkability and safety in mediating the association between education and physical activity has not been quantified. We used data from the 2010 and 2012 Communities Putting Prevention to Work Behavioral Risk Factor Surveillance System and structural equation modeling to estimate how much of the effect of education level on physical activity was mediated by perceived neighborhood walkability and safety. Neighborhood walkability accounts for 11.3% and neighborhood safety accounts for 6.8% of the effect. A modest proportion of the important association between education and physical activity is mediated by perceived neighborhood walkability and safety, suggesting that interventions focused on enhancing walkability and safety could reduce the disparity in physical activity associated with education level. PMID:25855989

Efficacy and Mediation of a Theory-Based Physical Activity Intervention for African American Men Who Have Sex with Men: A Randomized Controlled Trial.

PubMed

Zhang, Jingwen; Jemmott, John B; O'Leary, Ann; Stevens, Robin; Jemmott, Loretta Sweet; Icard, Larry D; Hsu, Janet; Rutledge, Scott E

2017-02-01

Few trials have tested physical-activity interventions among sexual minorities, including African American men who have sex with men (MSM). We examined the efficacy and mediation of the Being Responsible for Ourselves (BRO) physical-activity intervention among African American MSM. African American MSM were randomized to the physical-activity intervention consisting of three 90-min one-on-one sessions or an attention-matched control intervention and completed pre-intervention, immediately post-intervention, and 6- and 12-month post-intervention audio computer-based surveys. Of the 595 participants, 503 completed the 12-month follow-up. Generalized estimating equation models revealed that the intervention increased self-reported physical activity compared with the control intervention, adjusted for pre-intervention physical activity. Mediation analyses suggested that the intervention increased reasoned action approach variables, subjective norm and self-efficacy, increasing intention immediately post-intervention, which increased physical activity during the follow-up period. Interventions targeting reasoned action approach variables may contribute to efforts to increase African American MSM's physical activity. The trial was registered with the ClinicalTrials.gov Identifier NCT02561286 .

Effects of resource-building group intervention on career management and mental health in work organizations: randomized controlled field trial.

PubMed

Vuori, Jukka; Toppinen-Tanner, Salla; Mutanen, Pertti

2012-03-01

A resource-building group intervention was developed to enhance career management, mental health, and job retention in work organizations. The in-company training program provided employees with better preparedness to manage their own careers. The program activities were universally implemented using an organization-level, 2-trainer model with trainers from the human resources management and occupational health services. The study was a within-organizations, randomly assigned field experimental study; it investigated the impacts of the intervention on immediate career management preparedness and later mental health and intentions to retire early. A total of 718 eligible individuals returned a questionnaire in 17 organizations and became voluntary participants. The respondents were randomly assigned to either an intervention (N = 369) or a comparison group (N = 349). Those in the intervention group were invited to group intervention workshops, whereas those in the comparison group received printed information about career and health-related issues. The 7-month follow-up results showed that the program significantly decreased depressive symptoms and intentions to retire early and increased mental resources among the group participants compared to the others. The mediation analyses demonstrated that the increase in career management preparedness as a proximal impact of the intervention mediated the longer term mental health effects. Those who benefited most from the intervention as regards their mental health were employees with elevated levels of depression or exhaustion and younger employees, implying additional benefits of a more targeted use of the intervention. The results demonstrated the benefits of the enhancement of individual-level career management and resilience resources as career and health promotion practice in work organizations.

Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial

PubMed Central

Green, Jonathan; Charman, Tony; Pickles, Andrew; Wan, Ming W; Elsabbagh, Mayada; Slonims, Vicky; Taylor, Carol; McNally, Janet; Booth, Rhonda; Gliga, Teodora; Jones, Emily J H; Harrop, Clare; Bedford, Rachael; Johnson, Mark H

2015-01-01

Summary Background Risk markers for later autism identified in the first year of life present plausible intervention targets during early development. We aimed to assess the effect of a parent-mediated intervention for infants at high risk of autism on these markers. Methods We did a two-site, two-arm assessor-blinded randomised controlled trial of families with an infant at familial high risk of autism aged 7–10 months, testing the adapted Video Interaction to Promote Positive Parenting (iBASIS-VIPP) versus no intervention. Families were randomly assigned to intervention or no intervention groups using a permuted block approach stratified by centre. Assessors, but not families or therapists, were masked to group assignment. The primary outcome was infant attentiveness to parent. Regression analysis was done on an intention-to-treat basis. This trial is registered with ISCRTN Registry, number ISRCTN87373263. Findings We randomly assigned 54 families between April 11, 2011, and Dec 4, 2012 (28 to intervention, 26 to no intervention). Although CIs sometimes include the null, point estimates suggest that the intervention increased the primary outcome of infant attentiveness to parent (effect size 0·29, 95% CI −0·26 to 0·86, thus including possibilities ranging from a small negative treatment effect to a strongly positive treatment effect). For secondary outcomes, the intervention reduced autism-risk behaviours (0·50, CI −0·15 to 1·08), increased parental non-directiveness (0·81, 0·28 to 1·52), improved attention disengagement (0·48, −0·01 to 1·02), and improved parent-rated infant adaptive function (χ2[2] 15·39, p=0·0005). There was a possibility of nil or negative effect in language and responsivity to vowel change (P1: ES–0·62, CI −2·42 to 0·31; P2: −0·29, −1·55 to 0·71). Interpretation With the exception of the response to vowel change, our study showed positive estimates across a wide range of behavioural and brain function risk-markers and developmental outcomes that are consistent with a moderate intervention effect to reduce the risk for later autism. However, the estimates have wide CIs that include possible nil or small negative effects. The results are encouraging for development and prevention science, but need larger-scale replication to improve precision. Funding Autistica, Waterloo Foundation, Autism Speaks, and the UK Medical Research Council. PMID:26359749

Stress reduction at the work-family interface: positive parenting and self-efficacy as mechanisms of change in Workplace Triple P.

PubMed

Hartung, Doreen; Hahlweg, Kurt

2011-01-01

Workplace Triple P (WPTP) is a group-based parenting skills training specifically designed to meet the needs of employed parents. Several randomized controlled trials have demonstrated the training's efficacy. This study examined possible mechanisms of change that account for the stress reduction effects of this parenting skills training at the work-family interface. It was hypothesized that reductions in dysfunctional parenting (DP) behavior and increases in parental self-efficacy would mediate the stress-reducing effects of WPTP. The mediator effects were analyzed in a German pre- and postcompleter sample (N = 97 parents; 74 mothers and 23 fathers; treatment condition: n = 42 parents; waitlist-control condition n = 55 parents). The results indicate that individual stress- (IS) level reductions were mediated by decreased levels of DP. In addition, changes in IS levels mediated the effects of the training on work-related stress. The discussion focuses on the importance of understanding mechanisms of change to effectively implement interventions at the work-family interface.

[In vitro study of joint intervention of E-cad and Bmi-1 mediated by transcription activator-like effector nuclease in nasopharyngeal carcinoma].

PubMed

Luo, Tingting; Yan, Aifen; Liu, Lian; Jiang, Hong; Feng, Cuilan; Liu, Guannan; Liu, Fang; Tang, Dongsheng; Zhou, Tianhong

2018-03-28

To explore the effect of intervention of E-cadherin (E-cad) and B-lymphoma Moloney murine leukemia virus insertion region-1 (Bmi-1) mediated by transcription activator-like effector nuclease (TALEN) on the biological behaviors of nasopharyngeal carcinoma cells.
 Methods: Multi-locus gene targeting vectors pUC-DS1-CMV-E-cad-2A-Neo-DS2 and pUC-DS1-Bmi-1 shRNA-Zeo-DS2 were constructed, and the E-cad and Bmi-1 targeting vectors were transferred with TALEN plasmids to CNE-2 cells individually or simultaneously. The integration of target genes were detected by PCR, the expressions of E-cad and Bmi-1 were detected by Western blot. The changes of cell proliferation were detected by cell counting kit-8 (CCK-8) assay. The cell cycle and apoptosis were detected by flow cytometry. The cell migration and invasion were detected by Transwell assay.
 Results: The E-cad and Bmi-1 shRNA expression elements were successfully integrated into the genome of CNE-2 cells, the protein expression level of E-cad was up-regulated, and the protein expression level of Bmi-1 was down-regulated. The intervention of E-cad and Bmi-1 didn't affect the proliferation, cell cycle and apoptosis of CNE-2 cells, but it significantly inhibited the migration and invasion ability of CNE-2 cells. Furthermore, the intervention of E-cad and Bmi-1 together significantly inhibited the migration ability of nasopharyngeal carcinoma cells compared with the intervention of E-cad or Bmi-1 alone (all P<0.01).
 Conclusion: The joint intervention of E-cad and Bmi-1 mediated by TALEN can effectively inhibit the migration and invasion of nasopharyngeal carcinoma cells in vitro, which may lay the preliminary experimental basis for gene therapy of human cancer.

Impact of Study Skills and Parent Education on First-Year GPA Among College Students With and Without ADHD: A Moderated Mediation Model.

PubMed

Gormley, Matthew J; Pinho, Trevor; Pollack, Brittany; Puzino, Kristina; Franklin, Melanie K; Busch, Chelsea; DuPaul, George J; Weyandt, Lisa L; Anastopoulos, Arthur D

2018-02-01

To test if the relationship between ADHD and academic achievement is mediated by service utilization and/or study skills, and if these mediation effects are moderated by parental education level. A bootstrapping method within structural equation modeling was used with data from 355 first year college students meeting strict criteria for ADHD or clearly without ADHD to test the mediation and moderation effects. Study skills, but not service utilization, significantly mediated the relationship between ADHD status and GPA; however, this relationship was not significant among students with at least one parent holding a master's degree or higher. Among first year college students study skills may be a more salient predictor of educational outcomes relative to ADHD status. Additional research into support services for college students with ADHD is needed, however, results suggest interventions targeting study skills may hold particular promise for these students.

Mediation Analysis of an Adolescent HIV/STI/Pregnancy Prevention Intervention

ERIC Educational Resources Information Center

Glassman, Jill R.; Franks, Heather M.; Baumler, Elizabeth R.; Coyle, Karin K.

2014-01-01

Most interventions designed to prevent HIV/STI/pregnancy risk behaviours in young people have multiple components based on psychosocial theories (e.g. social cognitive theory) dictating sets of mediating variables to influence to achieve desired changes in behaviours. Mediation analysis is a method for investigating the extent to which a variable…

Effects of a recovery management intervention on Chinese heroin users' community recovery through the mediation effect of enhanced service utilization

PubMed Central

Wu, F.; Fu, L.M.; Hser, Y.H.

2015-01-01

Background This study investigates whether a recovery management intervention (RMI) can improve the utilization of community drug treatment and wraparound services among heroin users in China and subsequently lead to positive recovery outcomes. Methods Secondary analysis was conducted drawing data from a randomized controlled trial; 100 heroin users with no severe mental health problems were recruited in two Shanghai districts (Hongkou and Yangpu) upon their release from compulsory rehabilitation facilities. A latent variable modeling approach was utilized to test whether the RMI influences heroin users' perceived motivation and readiness for treatment, enhances treatment and wraparound service participation, and, in turn, predicts better recovery outcomes. Results Enrollment in drug treatment and other social service utilization increased significantly as a result of RMI rather than an individual drug user's motivation and readiness for treatment. Increased service utilization thus led to more positive individual recovery outcomes. In addition to this mediation effect through service utilization, the RMI also improved participants' community recovery directly. Conclusions Findings suggest that better drug treatment enrollment, community service utilization and recovery outcomes can be potentially achieved among heroin users in China with carefully designed case management interventions. PMID:24990956