Incorporating Prototyping and Iteration Into Intervention Development: A Case Study of a Dining Hall–Based Intervention

Abstract

Background: Previous research from the fields of computer science and engineering highlight the importance of an iterative design process (IDP) to create more creative and effective solutions. Objective: This study describes IDP as a new method for developing health behavior interventions and evaluates the effectiveness of a dining hall–based intervention developed using IDP on college students’ eating behavior and values. Participants: participants were 458 students (52.6% female, age = 19.6 ± 1.5 years [M ± SD]). Methods: The intervention was developed via an IDP parallel process. A cluster-randomized controlled study compared differences in eating behavior among students in 4 university dining halls (2 intervention, 2 control). Results: The final intervention was a multicomponent, point-of-selection marketing campaign. Students in the intervention dining halls consumed significantly less junk food and high-fat meat and increased their perceived importance of eating a healthful diet relative to the control group. Conclusion: IDP may be valuable for the development of behavior change interventions.     

Obesity and Food Choices Among Faculty and Staff at a Large Urban University

Abstract

Objective: In order to address increasing health care costs associated with obesity, this study sought to determine prevalence of overweight and obesity and examine eating behaviors, food choices, health beliefs, and attitudes of university employees. Participants and Methods: An online survey was distributed to > 3,800 faculty and staff at a large public metropolitan university in Winter 2008. Results: Almost half (48%) of 806 respondents were classified as overweight or obese. Compared to those with normal weights, overweight and obese respondents consumed fewer fruits and vegetables (p < .05), were less confident in making healthful food choices (p < .001), and were more influenced by food choices available in on-campus dining facilities (p < .05). Conclusions: Obesity among university employees warrants attention. Because these employees have less self-efficacy and consume less healthful diets than their normal weight colleagues, universities need to improve on-campus access to healthful foods.     

A Population-Wide Screening and Tailored Intervention Platform for Eating Disorders on College Campuses: The Healthy Body Image Program

Abstract

Objectives: This article presents a new approach to intervention for eating disorders and body image concerns on college campuses, using a model of integrated eating disorder screening and intervention. Formative data on implementation feasibility are presented. Participants: College students enrolled at 2 universities between 2011 and 2012. Methods: The Healthy Body Image program is an evidence-based screening and intervention platform, enacted via community and online resources. An online screen was used to identify students at varying levels of risk or eating disorder symptom status; responses were used to direct students to universal or targeted online interventions or further evaluation. Universal prevention programs to improve healthy weight regulation and body image culture were offered to all students. Results: Formative data from 1,551 students illustrates the application of this model. Conclusions: The Healthy Body Image program is feasible to deliver and provides a comprehensive system of screening, evidence-based intervention, and community culture change.     

Drunkorexia: Understanding the Co-occurrence of Alcohol Consumption and Eating/Exercise Weight Management Behaviors

Abstract

Objective: Examine the co-occurrence of alcohol consumption, physical activity, and disordered eating behaviors via a drunkorexia perspective. Participants: Nationally representative sample (n = 22,488) of college students completing the Fall 2008 National College Health Assessment. Methods: Hierarchical logistic regression was employed to determine if physical activity and disordered eating behaviors uniquely predicted binge drinking, while controlling for age, race, gender, year in college, Greek membership, and place of residence. Results: Physical activity and disordered eating made unique, statistically significant contributions. Moreover, including physical activity and disordered eating behaviors allowed for the correct classification of an additional 431 cases (ie, binge drinkers) over and above the predictive ability of the covariate-only model. Conclusions: Findings corroborate prior research indicating highly active college students are more likely to binge drink than their nonactive peers, and highlight the potential of a drunkorexia perspective in explaining the counterintuitive alcohol–activity association among college students.     

Examining the efficacy of an mHealth media literacy education program for sexual health promotion in older adolescents attending community college

Objective: To determine the feasibility of a mobile health (mHealth), media literacy education program, Media Aware, for improving sexual health outcomes in older adolescent community college students. Participants: 184 community college students (ages 18–19) participated in the study from April–December 2015. Methods: Eight community college campuses were randomly assigned to either the intervention or a wait-list control group. Student participants from each campus completed web-based pretest and posttest questionnaires. Intervention group students received Media Aware in between questionnaires. Results: Several intervention effects of the Media Aware program were significant, including reducing older adolescents' self-reported risky sexual behaviors; positively affecting knowledge, attitudes, normative beliefs, and intentions related to sexual health; and increasing media skepticism. Some gender differences in the findings were revealed. Conclusions: The results from this study suggest that Media Aware is a promising means of delivering comprehensive sexual health education to older adolescents attending community college.     

Predicting 1-Year Change in Body Mass Index Among College Students

Objective: Despite beliefs about weight gain in college, few researchers have evaluated this phenomenon. Participants: Participants were 18- to 31-year-old students at a midwestern university. The dependent variable was body mass index (BMI) change. Methods: The authors extracted predictor variables from a Health Risk Appraisal. These included clinical, medical history, medical usage, medications, pain or chronic conditions, perceptual measures, and behavioral factors. The authors performed an ordinal regression technique separately by gender. Results: No predictors were significant for men. Women in the BMI gain group were (1) more likely to consume alcohol, use maladaptive coping behaviors, eat foods low in fiber, and consume caffeine; and (2) less likely to be stress-free, to eat cruciferous vegetables, and to refrain from eating high-cholesterol foods. Conclusions: The lack of research on predictors of and interventions for reducing BMI gain among college students warrants more research.     

Patterns of Compensatory Behaviors and Disordered Eating in College Students

Abstract. Objective: The current study investigated rates of endorsement of eating-related compensatory behaviors within a college sample. Participants: This sample included male and female students (N = 1,158). Methods: Participants completed the Eating Disorder Examination Questionnaire (EDE-Q). The study defined 3 groups of students: those who did not endorse purging behaviors, those who endorsed only exercise, and those who endorsed laxative use or vomiting. Rates of related eating disorder risk variables were compared across the 3 groups. Results: Almost half of college students reported utilizing exercise as a compensatory strategy over the past 28 days. Those reporting compensatory exercise did not differ from other community and college samples on EDE-Q subscales. Conclusions: Findings suggest that college students report significant rates of compensatory exercise, and those who report exercise as their only compensatory behavior also report relatively low levels of eating disorder risk.     

Outcomes of a Technology-Based Social Norms Intervention to Deter Alcohol Use in Freshman Residence Halls

Objective: The authors tested a prototype intervention designed to deter alcohol use in residence halls. Participants: Approximately 384 freshmen participated in the study over a 2-year period. Methods: The authors devised a feedback method that assessed residents' blood alcohol concentration (BAC) at night and allowed the readings to be retrieved the next day via the Web. Residents in an intervention hall received their BAC readings as well as normative feedback. In a comparison hall, residents could retrieve only the BAC readings. Results: The authors found statistically significant hall differences, but they were small in size and not meaningful. Conclusions: Qualitative findings suggest the intervention had an overall positive impact, but the actions of a subgroup of rebellious drinkers might have obscured the effect. Social norms interventions could provoke some episodes of excessive drinking in students who find these messages objectionable. More research is needed to evaluate delayed BAC feedback.     

The impact of a health education intervention on health behaviors and mental health among Chinese college students

Abstract

Objective: This study aimed to assess the impact of a health education intervention on health behaviors, self-efficacy, and well-being among college students. Participants: Between March and October 2016, a total of 532 undergraduates participated. Methods: A theory-based intervention was conducted at Wuhan University, China. Participants were assigned to a control or intervention group (IG). The IG attended a 7-week health education class on knowledge, attitude, and practice of health behaviors. Results: Participants in the IG, compared with those in the control group (CG), reported significantly increased prevalence of high physical activity and regular breakfast, as well as lower screen time, sugar beverage intake, and Internet addiction tendency. Furthermore, intervention students improved in health behavior scores (p?=?0.040), compared with the CG, while the changes in subjective well-being and self-efficacy remained similar between the two groups. Conclusions: Health education may promote health behaviors among Chinese college students.     

Risk Factors Associated With Overweight and Obesity in College Students

College obesity is increasing, but to the authors' knowledge, no researchers to date have evaluated risk factors in this population. Objective: The authors assessed whether abnormal eating perceptions and behaviors were associated with overweight in college students. Participants and Methods: A sample of undergraduates (N = 4,201) completed an online survey containing demographic questions and the Eating Attitudes Test-26 (EAT-26) questionnaire. The authors stratified participants into normal-weight and overweight/obese groups and evaluated physical activity, EAT-26 score, purging behaviors, and answers to selected overweight screening questions on the basis of body mass index. A modified EAT-26 score of ≥ 11 was associated with overweight (p = .016). Results: Compared with normal-weight peers, overweight participants displayed an increased fear of bingeing, preoccupation with food, desire to be thinner, and engagement in dieting behavior. Mean body mass index also increased with age and physical inactivity (p < .001). Conclusions: Because physical inactivity, disordered eating perceptions, and disordered behaviors are associated with increased rates of overweight and obesity, identification of these risk factors in obese youths may increase understanding of weight loss barriers and facilitate the treatment of adolescent obesity.     

HPV Knowledge and Behaviors of Black College Students at a Historically Black University

College students are at high risk for human papillomavirus (HPV) infection, yet their knowledge and self-protective behaviors appear inadequate. Researchers who have measured HPV-related knowledge and behaviors in evaluating college intervention efforts pay secondary attention to black college students because this group generally represents only a small subset of samples of the broader college population. Objective and Participants The authors' purpose in this study was to examine HPV-related knowledge and behaviors in 351 black undergraduates attending a historically black southeastern university in the spring of 2003. Methods Voluntary and anonymous student participation was solicited in randomly selected undergraduate classes. Results Results indicated that most students lacked HPV awareness (64%), became aware of HPV largely after infection, and gained their HPV knowledge from a health-care provider or college class. The authors performed an analysis by gender and found that women were more knowledgeable about HPV than were men. Observed HPV-related knowledge and behaviors were similar to samples of the broader US college population. Conclusions Findings suggest a greater need for HPV intervention efforts for all college students, including those at black colleges.     

On Doing Research in a Clinical Setting

Abstract

Objective: To evaluate the efficacy of a stand-alone personalized normative feedback (PNF) intervention targeting misperceptions of gambling among college students. Participants: Undergraduates (N = 136; 55% male) who reported gambling in the past 30 days were recruited between September 2011 and March 2012. Methods: Using a randomized clinical trial design, participants were assigned to receive either PNF or an attention control task. In addition to self-report, this study used 2 computer-based risk tasks framed as “gambling opportunities” to assess cognitive and behavioral change at 1 week post intervention. Results: After 1 week, participants receiving PNF showed a marked decrease in perception of other students’ gambling, and evinced lower risk-taking performance on 2 analog measures of gambling. Conclusions: Changes in both self-reported perceived norms and analog gambling behavior suggest that a single, stand-alone PNF intervention may modify gambling among college students. Whether it can impact gambling outside of the laboratory remains untested.     

Transdiagnostic mechanisms involved in nonsuicidal self-injury,risky drinking and disordered eating: Impulsivity,emotion regulation and alexithymia

Abstract

Objective: The aim of the present study was to explore common and differential relationships between nonsuicidal self-injury (NSSI), risky drinking, and disordered eating attitudes and impulsivity, emotion dysregulation, and alexithymia. Methods: We investigated these associations in a sample of 951 college students (79.4% female, Mage = 21.86?years) by means of self-report questionnaires assessing the constructs of interest. Results: Overall, 28% of the students reported a history of NSSI, one third engaged in risky drinking, and less than 5% reported disordered eating symptoms. Negative urgency and difficulties in emotion regulation were both related to each of the three behaviors and can be considered as common transdiagnostic mechanisms. Conclusions: We discuss the implications of transdiagnostic mechanisms involved in these three dysregulated behaviors with respect to their assessment and treatment in college counseling settings.     

A Description of Disordered Eating Behaviors in Latino Males

Abstract

Objective: To explore disordered eating and eating disorders (EDs) in Latino males. Participants: Participants are 722 male college students from a larger prevalence study conducted in the University of Puerto Rico system. Methods: Participants were selected from a list of sections of required courses for first-year students on each campus. Self-report instruments were used to explore ED symptoms (the Eating Attitudes Test [EAT-26] and the Bulimia Test–Revised [BULIT-26-R] and the Beck Depression Inventory depression (BDI). Results: Overall, 2.26% scored above the cut-off point on the BULIT-R and 5.08% score above the cut-off point on the EAT-26. Of the males, 4.43% reported sufficient frequency and severity to approximate DSM-IV criteria for bulimia nervosa. Depression symptomatology was found in those who scored above the cut-off point on both instruments of EDs. Conclusion: College health practitioners should be aware of disordered eating in Latino males and include them in efforts to detect disordered eating behaviors in college students.     

Relationship Between Vigorous Exercise Frequency and Substance Use Among First-Year Drinking College Students

Objective: The authors explored the relationship between self-reported vigorous exercise frequency and alcohol, tobacco, and other drug (ATOD) use behaviors among first-year college students who self-identified as drinkers. Participants: The authors recruited 391 freshman college students in Northeast Florida to participate in an alcohol abuse prevention study. Methods: The authors conducted a multivariate analysis of variance to assess the relationship between vigorous exercise frequency and 6 measures of ATOD use at baseline. Results: Frequent exercisers drank significantly more often and a significantly greater quantity than did infrequent exercisers. However, frequent exercisers smoked cigarettes significantly less often than did infrequent exercisers. Conclusions: These findings suggest that vigorous exercise frequency is differentially associated with alcohol and cigarette consumption among college students. Researchers should further examine the reasons for these differences.     

Associations Between Past Bullying Experiences and Psychosocial and Academic Functioning Among College Students

Abstract. Objectives: This study examined whether childhood bullying victimization was associated with psychosocial and academic functioning at college. Participants: The sample consisted of 413 first-year students from a large northeastern university. Methods: Students completed an online survey in February 2012 that included items assessing past bullying involvement, current psychosocial and academic functioning, and victimization experiences since arriving at college. Results: Regression analyses indicated that reports of past bullying and other peer victimization were associated with lower mental health functioning and perceptions of physical and mental health, but were not associated with perceptions of social life at college, overall college experience, or academic performance. Conclusions: Childhood bullying victimization is associated with poorer mental and physical health among first-year college students. Colleges should consider assessing histories of bullying victimization, along with other past victimization exposures, in their service provision to students.     

Enforcing a Tobacco-Free Campus Through an Ambassador-Based Program: A Phenomenology

Abstract

Objective: The purpose of this study was to determine whether student awareness and attitudes about organic foods would predict their behaviors with regard to organic food consumption and other healthy lifestyle practices. A secondary purpose was to determine whether attitudes about similar eco-friendly practices would result in socially conscious behaviors. Participants: The sample was students (N = 443) enrolled in 1 of 2 core courses in a mid-sized Southern university. Method Summary: Students completed an anonymous 28-item survey about their awareness, attitudes, and behaviors. Linear regression and path analysis were used to test whether attitudes were related to purchase of organic foods and eco-friendly behaviors. Results: Many students (49%) possessed factual knowledge about organic foods. More (64%) felt positively about having organic food options available to them both on campus and elsewhere. Taste and price most influenced the purchase of such foods. Attitudes were significant predictors of consumption behaviors and healthy practices. Conclusions: Positive attitudes toward organic foods and other environmentally friendly practices significantly predicted similar behaviors. Student consumers seem to act upon their beliefs.     

Attention-deficit hyperactivity disorder symptomatology,binge eating disorder symptomatology,and body mass index among college students

Abstract

Objective: To explore the relationship between symptoms of attention-deficit hyperactivity disorder (ADHD), symptoms of binge eating disorder, and body mass index (BMI) among students at a southern university. Participants: Two hundred seventy-seven college students. Methods: Between January 31, 2013 and March 27, 2013, participants completed the Adult ADHD Self-Report Scale (ASRS) Screener and the Binge Eating Scale (BES) in addition to permitting researchers to measure their height and weight. Results: Higher ASRS scores, higher BMIs, and lower BES scores were observed among men. Among both men and women, BES scores were positively correlated with BMI and ASRS scores; however, the correlation between ASRS and BMI was not significant. Conclusion: Binge eating disorder symptomatology was associated with increased ADHD symptomatology and a higher BMI among both men and women. Among students presenting with obesity or ADHD, screening for binge eating may assist with the identification of problematic eating behaviors.     

Psychosocial and Environmental Determinants of Eating Behaviors,Physical Activity,and Weight Change Among College Students: A Qualitative Analysis

Abstract

Objective: The goal of this study was to identify factors that college students perceived as contributing to healthy and unhealthy eating patterns, physical activity (PA) levels, and weight change. Participants: Forty-nine 18- to 22-year-old students at a midwestern university participated. Methods: Six focus groups (3 with each gender) were conducted, and data were analyzed using qualitative software to code and categorize themes and then reduce these to clusters according to commonly practiced methods of qualitative analysis. Results: Eating and PA behaviors appear to be determined by a complex interplay between motivations and self-regulatory skills as well as the unique social and physical environment comprising college life. Moreover, there appear to be gender differences in how these determinants impact behavior. Conclusions: Future research should examine these interactions in the college context in order to further our understanding of potential interventions or environmental modifications that support healthy eating and PA.