Motivational Interviewing (MI) is a widely-used approach for addressing adolescent substance use. Recent meta-analytic findings show small but consistent effect sizes. However, differences in intervention format and intervention design, as well as possible mediators of change, have never been reviewed. This review of the literature summarizes the most up-to-date MI interventions with adolescents, looks at differences between intervention format and design, and discusses possible theory-based mechanisms of change. Of the 39 studies included in this review, 67% reported statistically significant improved substance use outcomes. Chi square results show no significant difference between interventions using feedback or not, or interventions combined with other treatment versus MI alone. The need for systematic investigation in theory-based mechanisms of change is presented.

Client language about change, or change talk, is hypothesized to mediate the relationship between counselor fidelity in Motivational Interviewing (MI) and drug use outcomes. To investigate this causal chain, this study used data from a MI booster delivered to alternative high school students immediately after a universal classroom-based drug abuse prevention program. One hundred and seventy audio-recorded MI sessions about substance use were coded using the Motivational Interviewing Skill Code 2.5. Structural equation modeling showed that percentage of change talk on the part of the client mediated three of the four relationships between MI quality indicators and marijuana outcomes, while percentage of reflections of change talk showed a main effect of counselor skill on marijuana outcomes. Findings support change talk as an active ingredient of MI and provide new empirical support for the micro-skills of MI.

We examined whether a bidirectional, longitudinal relationship exists between future time perspective (FTP), measured with the Zimbardo Time Perspective Inventory, and any past 30-day use of alcohol, tobacco, marijuana, or hard drugs among continuation high school students (N = 1,310, mean age 16.8 years) in a large urban area. We found increased FTP to be protective against drug use for all substances except alcohol. While any baseline use of substances did not predict changes in FTP 1 year later. The discussion explores why alcohol findings may differ from other substances. Future consideration of FTP as a mediator of program effects is explored.

In the study of Motivational Interviewing (MI), counselor skill has been posited to influence client language about change or “change talk”. This study investigates the relationship between a specific counselor behavior, valenced reflective listening, and client change talk in a MI intervention with substance using adolescents. A combination of recorded in-person and telephone (n = 223) sessions were sequentially coded using the Motivational Interviewing Skill Code 2.5. Reflections were categorized by valence, meaning they included content that was either moving toward (i.e. positive reflection) or away from change (i.e. negative reflection). Client language was coded as either moving toward change, away from change or neutral about change. Probability analyses showed positive reflections were 11 times more likely to be followed by change talk and 71% less likely to be followed by counter change talk. Negative reflections were 19 times more likely to be followed by counter change talk and 65% less likely to be followed by change talk. Client language was also predictive of counselor reflections, such that positive reflections were 10 times more likely to occur after client change talk and negative reflections were 19 times more likely to follow counter change talk. Since the percentage of change talk expressed in a session has been shown to be positively related to improved behavioral outcomes, counselors should avoid unintentional reflections of counter change talk and use reframing techniques to change the valence of client change language. Implications for MI practice and training are discussed.

Background: The Move Your Way campaign, developed by the Office of Disease Prevention and Health Promotion, aims to improve Americans’ adherence to the Physical Activity Guidelines for Americans. This article describes the research that informed the campaign’s products, messaging, and strategy. Methods: A mixed-methods approach was used to understand participants’ preferences for physical activity messages and information seeking. Two rounds (round 1 [n = 95] and round 2 [n = 73]) of focus groups and an online survey (n = 2050) were conducted with adult physical activity contemplators. A third round (n = 84) of focus groups was conducted with children, teens, and parents of young children. Results: Adults, parents, teens, and children preferred messages that reflected diverse examples of activities; most participants disliked “one-size-fits-all” recommendations. Adults and parents preferred messages that emphasized specific health benefits over generic messages about overall health. Although some participants preferred getting physical activity information from digital search tools and social media platforms, many preferred getting this information from family members and friends. Conclusion: The Office of Disease Prevention and Health Promotion translated these findings into 3 themes used for Move Your Way implementation: (1) leverage social and community connections, (2) emphasize representation through inclusion and diversity, and (3) customize physical activity recommendations to make them more achievable.