Multiple Risk Expert Systems Interventions: Impact of Simultaneous Stage-Matched Expert System Interventions for Smoking, High-Fat Diet, and Sun Exposure in a Population of Parents.

Abstract

Three stage-based expert system interventions for smoking, high-fat diet, and unsafe sun exposure were evaluated in a sample of 2,460 parents of teenagers. Eighty-four percent of the eligible parents were enrolled in a 2-arm randomized control trial, with the treatment group receiving individualized feedback reports for each of their relevant behaviors at 0, 6, and 12 months as well as a multiple behavior manual. At 24 months, the expert system outperformed the comparison condition across all 3 risk behaviors, resulting in 22% of the participants in action or maintenance for smoking (vs. 16% for the comparison condition), 34% for diet (vs. 26%), and 30% for sun exposure (vs. 22%). Proactive, home-based, and stage-matched expert systems can produce significant multiple behavior changes in at-risk populations where the majority of participants are not prepared to change.

Initial efficacy of MI, TTM tailoring and HRI’s with multiple behaviors for employee health promotion

“…It is also worthy to note that there were only three coaching sessions that were time limited. These results suggest that MI counselors can be more ambitious and simultaneously target multiple and not just single behavior risks in a population.Secondly, the results replicated the multiple behavior changes within a target population that have been generated by TTM tailored interventions (Johnson et al, in press;Jones et al, 2003;Prochaska et al, 2004Prochaska et al, , 2005. More innovatively, this is the first study with adults to demonstrate such results when the TTM tailoring was delivered online.…”

“…Across a growing range of population trials, the control groups attained abstinence rates of 16% to 19%, while the TTM Tailoring produced 22% to 26% abstinence at longer term follow-up (Prochaska et al, 1993(Prochaska et al, , 2001a(Prochaska et al, , 2001b(Prochaska et al, , 2004(Prochaska et al, , 2005. The abstinence rates with MI (34.6%) were higher than the 24% found with MI by Carpenter et al (2004), but that study limited their sample only to unmotivated smokers in the precontemplation or contemplation stages.…”

“…For smoking cessation, a three item algorithm was used with precontemplation defined as not intending to quit smoking in the next six months; contemplation defined as intending to quit in the next 6 months; and preparation defined as intending to quit in the next month and having made a quit attempt in the past 12 months. This cessation algorithm has been found to have strong predictive validity over 6 months (DiClemente et al, 1991), 12, 18 and 24 months (Prochaska et al, 2004;Velicer et al, 2007). For exercise, the items and algorithm recommended by Sarkin and colleagues (2001) were adapted to reflect the 30 minutes/day X 5 days/week criterion.…”

“…To date, the two most common trajectories with TTM tailoring have been either stable (e.g., with stress effects at six months remaining stable at 12 and 18 months, (Evers et al, 2006)) or increasing (e.g., with smoking cessation in the treatment group increasing over 18 months compared to the assessment only condition (Prochaska et al, 2001a(Prochaska et al, , 2001b(Prochaska et al, , 2004(Prochaska et al, , 2005.…”

“…TTM tailored print feedback has also been found effective when treating: 1) three health behaviors in a population of parents whose teens were participating in health promotion at school (Prochaska et al, 2004); 2) four behaviors in a population of primary care patients (Prochaska et al, 2005); 3) three behaviors in a population of patients with diabetes (Jones et al, 2003) and 4) three behaviors in a population of overweight individuals (Johnson et al, in press). Comparable TTM tailored feedback has also been presented in a multimedia format (Redding et al, 1999), but not yet online.…”