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

描述(由申请人提供)：独立疗效试验表明，与替代干预和仅评估控制条件相比，一项包括不和谐诱导活动的选择性饮食障碍预防计划减少了身体不满意的高危女高中生和大学生的瘦理想内化，降低了饮食障碍风险因素、饮食障碍症状以及未来发生饮食障碍和肥胖的风险，一些效果持续了3年。一项大型有效性试验发现，当高中辅导员和护士招募参与者并实施干预时，这种干预措施通过两年的跟踪调查，相对于心理教育手册控制条件，减少了危险因素和饮食障碍症状。然而，后一项试验的影响略小于有效性试验中的效果，可能是由于支持高中预防计划的基础设施、资金和工作人员有限。因此，这种干预可能会在涉及大学的有效性试验中产生更大的影响，因为大学通常有专门从事心理健康规划的工作人员，接受团体干预培训并获得适当的设施。尽管我们对高中生进行了初步的有效性试验，但还没有针对大学生的经验性饮食障碍预防计划的有效性试验；这是一个重要的空白，因为大学和高中的环境、资源和内源性提供者非常不同，而且美国有100多万女大学生患有门槛或门槛以下的饮食障碍。一项涉及多个地区和不同样本的大型有效性试验也将允许对预测干预效果大小的促进者和参与者因素进行调查。我们建议进行一项三点有效性试验，以测试当大学辅导员、心理学家和护士在生态有效的条件下招募、筛选和提供干预措施时，该预防计划是否产生效果。我们将从俄勒冈州、宾夕法尼亚州和德克萨斯州的9所大学招募432名对身体不满意的高危年轻女性，并将其随机分配到不和谐项目或心理教育手册控制条件下。我们将使用经过改进的主持人培训程序以及新出版的主持人手册和参与者练习册。参与者将在前测、后测以及一年和两年的随访中完成调查和诊断性访谈。我们将测试(1)与对照组相比，不和谐计划是否导致风险因素、饮食失调症状、未来饮食失调和肥胖症、功能障碍和心理健康治疗的风险更大的降低，(2)干预效果是由瘦-理想内化的变化调节的，(3)某些因素缓和计划效果(例如，初始身体不满意程度)，(4)过程因素(例如，干预保真度)预测更大的效果大小，(5)这种干预产生的节省抵消了干预交付成本，(6)大学在完成为期一年的干预-交付阶段(即评估可持续性)后，继续提供预防计划。

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