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

描述（由申请人提供）：独立的疗效试验表明，选择性饮食失调预防项目涉及不和谐诱导活动，可减少身材不满意的高风险女高中生和大学生的瘦理想内化，减少饮食失调风险因素，饮食失调症状，以及未来饮食失调和肥胖发病的风险，相对于替代干预和仅评估的对照条件。一些影响会持续3年。一项大规模的有效性试验发现，当高中辅导员和护士招募参与者并实施干预时，通过2年的随访，这种干预减少了风险因素和饮食失调症状，而不是心理教育手册控制条件。然而，后一项试验的效果略小于有效性试验，这可能是由于支持高中预防项目的基础设施、资金和人员有限。因此，在涉及大学的有效性试验中，这种干预可能会产生更大的效果，因为大学通常有专门从事心理健康规划的工作人员，并提供团体干预培训和适当的设施。虽然我们对高中生进行了初步的有效性试验，但还没有针对大学生的经验支持的饮食失调预防项目的有效性试验；这是一个重要的空白，因为大学和高中的环境、资源和内生提供者非常不同，因为有超过100万的美国女大学生患有阈值或亚阈值饮食失调症。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因素和参与者因素进行调查。我们建议进行一项3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所大学中随机招募432名对身体不满意的高危年轻女性参加失调项目或心理教育手册控制条件。我们将采用改进的引导者培训程序和新出版的引导者手册和参与者工作手册。参与者将在测试前、测试后以及1年和2年的随访中完成一项调查和诊断性访谈。我们将检验(1)与对照组相比，失调项目是否导致风险因素、饮食失调症状、未来饮食失调和肥胖发病风险、功能障碍和心理健康治疗的更大减少，(2)干预效果是由瘦理想内化的变化介导的，(3)某些因素适度的项目效果（如初始身体不满意水平），(4)过程因素（如干预保真度）预测更大的效应，(5)这种干预所产生的节省抵消了干预交付的成本，(6)大学在完成这项试验的1年干预交付阶段（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).