BackgroundNonspecific low back pain (NLBP) is the diagnosis for individuals with back pain that has no underlying medical cause (eg, tumor, infection, fracture, herniated disc, spinal stenosis). The American College of Physicians (ACP) and American Pain Society (APS) recommend multidisciplinary treatments for NLBP that lasts more than 4 weeks. This approach, however, is impractical for many physicians to implement, and relatively few providers offer NLBP treatment that meets the joint ACP-APS guidelines.ObjectiveThis study evaluated the efficacy of a mobile-Web intervention called “FitBack” to help users implement self-tailored strategies to manage and prevent NLBP occurrences.MethodsA total of 597 adults were recruited, screened, consented, and assessed online at baseline, at 2 months (T2), and at 4 months (T3). After baseline assessments, participants were randomized into three groups: FitBack intervention, alternative care group that received 8 emails urging participants to link to six Internet resources for NLBP, and control group. The FitBack group also received weekly email reminder prompts for 8 weeks plus emails to do assessments. The control group was only contacted to do assessments.ResultsUsers of the FitBack program showed greater improvement compared to the control group in every comparison of the critical physical, behavioral, and worksite outcome measures at 4-month follow-up. In addition, users of the FitBack program performed better than the alternative care group on current back pain, behavioral, and worksite outcomes at 4-month follow-up. For example, subjects in the control group were 1.7 times more likely to report current back pain than subjects in the FitBack group; subjects in the alternative care group were 1.6 times more likely to report current back pain at 4-month follow-up. Further, the users of the FitBack program showed greater improvement compared to both the control and alternative care groups at 4-month follow-up on patient activation, constructs of the Theory of Planned Behavior, and attitudes toward pain.ConclusionsThis research demonstrated that a theoretically based stand-alone mobile-Web intervention that tailors content to users’ preferences and interests can be an effective tool in self-management of low back pain. When viewed from the RE-AIM perspective (ie, reach, efficacy/effectiveness, adoption, implementation fidelity, and maintenance), this study supports the notion that there is considerable value in this type of intervention as a potentially cost-effective tool that can reach large numbers of people. The results are promising considering that the FitBack intervention was neither supported by professional caregivers nor integrated within a health promotion campaign, which might have provided additional support for participants. Still, more research is needed on how self-guided mobile-Web interventions will be used over time and to understand factors associated with continuing user engagement.Trial RegistrationClinicaltrials.gov NCT01950091; http://clinicaltrials.gov...

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This 1-year prospective study of 173 families with two or more children examines the influence of parent, sibling, and peer modeling (i.e., use) and attitudes on adolescent use of alcohol. Independent questionnaire data were obtained from the adolescent, father, mother, and sibling(s). Structural equation modeling methods were employed to examine these relationships. Parent attitude toward youth alcohol use and parent modeling of alcohol use were strongly related to change in adolescent alcohol use, suggesting that parents can influence the future use of alcohol by their children. Peer and sibling modeling and peer attitudes also influenced adolescent alcohol use.

These evaluation results suggest that a smoking cessation programme, with at least short term efficacy, can be successfully delivered via the internet.

Relationships among risky sexual behaviors, other problem behaviors, and the family and peer context were examined for two samples of adolescents. Many adolescents reported behaviors (e.g., promiscuity or nonuse of condoms) which risked HIV or other sexually transmitted disease infection. Such risky behaviors were significantly intercorrelated. Consistent condom use was rare among those whose behavior otherwise entailed the greatest risk of infection. In both samples, an index of high-risk sexual behavior was significantly related to antisocial behavior, cigarette smoking, and illicit drug or alcohol use. Social context variables, including family structure, parenting practices, and friends' engagement in problem behaviors, were associated with high-risk sexual behavior. Finally, for sexually active adolescents, problem behaviors and social context variables were predictive of nonuse of condoms. Results were consistent across the two studies and regression weights held up well under cross-validation.

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Greater use of interrupted time-series experiments is advocated for community intervention research. Time-series designs enable the development of knowledge about the effects of community interventions and policies in circumstances in which randomized controlled trials are too expensive, premature, or simply impractical. The multiple baseline time-series design typically involves two or more communities that are repeatedly assessed, with the intervention introduced into one community at a time. It is particularly well suited to initial evaluations of community interventions and the refinement of those interventions. This paper describes the main features of multiple baseline designs and related repeated-measures time-series experiments, discusses the threats to internal validity in multiple baseline designs, and outlines techniques for statistical analyses of time-series data. Examples are given of the use of multiple baseline designs in evaluating community interventions and policy changes.

This study examined both the substance-specific and nonspecific, or generalized, effects of parent substance use, attitudes toward use, and behavior regarding use on adolescent initiation and maintenance of alcohol, cigarettes, and marijuana use. Data from 645 target adolescents and their parent(s) regarding their own use and parents' attitude, cautionary statements, and negative consequences were used to predict both the onset of using each substance and the transition from use to nonuse during the following year. Results indicated that not only did parents' influence specific to a given substance affect adolescent use of that same substance, but parents `nonspecific or generalized influence predicted the onset and maintenance of other substance use. Furthermore, parent modeling, attitude, cautionary statements, and consequences were all significant predictors of adolescent initiation and maintenance of substance use. Interactions of the parental influence variables with gender, age, and parents' marital status were found. Implications of these findings for intervention efforts are discussed.