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

描述（申请人提供）：独立的功效试验表明，一个选择性的饮食失调预防计划，涉及不和谐的诱导活动，减少瘦理想的内化在高风险的女高中生和大学生与身体不满减少饮食失调的风险因素，饮食失调症状，以及相对于替代干预和仅评估对照条件的未来进食障碍和肥胖症发作风险，一些影响持续到3年随访。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提供干预措施时，通过2年的随访，这种干预措施相对于心理教育手册控制条件降低了风险因素和进食障碍症状。然而，后一项试验的效果略小于疗效试验，这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，因为他们通常有专门从事心理健康规划的工作人员，他们接受了团体干预培训，并获得了适当的设施。虽然我们对高中生进行了初步的有效性试验，但还没有经验支持的大学生饮食失调预防计划的有效性试验;这是一个重要的空白，因为大学与高中的环境，资源和内源性供应商非常不同，因为有超过100万美国女大学生患有阈值或亚阈值饮食失调。一项涉及多个地区、样本多样化的大型有效性试验也将允许对预测干预效应大小的促进者和参与者因素进行调查。我们建议进行3个站点的有效性试验，测试是否这种预防计划产生的影响时，大学辅导员，心理学家和护士招聘，筛选，并提供在生态有效的条件下的干预。我们将从俄勒冈州、宾夕法尼亚州和得克萨斯州的9所大学招募432名对身体不满意的高危年轻女性，随机分为失调项目组或心理教育手册对照组。我们将使用一个增强的辅导员培训程序和新出版的辅导员手册和参与者工作手册。参与者将完成一项调查，并在前测，后测，1年和2年的随访诊断采访。我们将测试（1）失调计划是否会导致风险因素、进食障碍症状、未来进食障碍和肥胖发作的风险、功能障碍和心理健康治疗相对于对照组的更大降低，（2）干预效果是否由瘦理想内化的变化介导，（3）某些因素是否会缓和计划效果（例如，初始身体不满意程度），（4）过程因素（例如，干预保真度）预测更大的效应量，（5）该干预产生的节省抵消了干预交付成本，以及（6）大学在完成该试验的1年干预交付阶段后继续提供预防计划（即，评估可持续性）。 公共卫生相关性：阈值和亚阈值饮食失调影响超过10%的青春期女孩，并与功能障碍，痛苦，医疗并发症，肥胖发作的风险，以及任何精神疾病的最高死亡率相关;因此，迫切的公共卫生优先事项是制定有效的预防计划。拟议的项目将是第一个有效性试验，以测试是否有来自功效试验的强有力的实证支持的饮食失调预防计划在高风险女大学生中的生态有效条件下产生影响，这是向广泛传播与NIH资助开发的计划迈出的重要一步。拟议的成本效益分析和检查的过程因素，预测较大的干预效果也将代表新的贡献的文献。

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). PUBLIC HEALTH RELEVANCE: Threshold and subthreshold eating disorders affect over 10% of adolescent girls and are associated with functional impairment, distress, medical complications, risk for obesity onset, and the highest mortality of any psychiatric condition; accordingly, a pressing public healthy priority is to develop effective prevention programs for eating pathology. The proposed project will be the first effectiveness trial to test whether an eating disorder prevention program with strong empirical support from efficacy trials produces effects under ecologically valid conditions among high-risk female college students, which is a vital step toward widespread dissemination of programs developed with NIH funding. The proposed cost-effectiveness analyses and examination of process factors that predict larger intervention effects will also represent novel contributions to the literature.