Objective Because no single report has examined risk factors that predict future onset each type of eating disorder and core symptom dimensions that crosscut disorders, we addressed these aims to advance knowledge regarding risk factor specificity. Method Data from 3 prevention trials that targeted young women with body dissatisfaction (N=1272; M age 18.5, SD 4.2) and collected annual diagnostic interview data over 3-year follow-up were combined to identify predictors of subthreshold/threshold anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and purging disorder (PD). Results Negative affect and functional impairment predicted onset of all eating disorders. Thin-ideal internalization, body dissatisfaction, dieting, overeating, and mental health care predicted onset of subthreshold/threshold BN, BED, and PD; positive thinness expectations, denial of cost of pursuing the thin ideal, and fasting predicted onset of 2 of these 3 disorders. Similar risk factors predicted core eating disorder symptom onset. Low BMI and dieting specifically predicted onset of subthreshold/threshold AN or low BMI. Only a subset of factors showed unique predictive effects in multivariate models, likely due to moderate correlations between the risk factors (M r = .14). Conclusions Results provide support for the theory that pursuit of the thin ideal and the resulting body dissatisfaction, dieting, and unhealthy weight control behaviors increase risk for binge/purge spectrum eating disorders, but suggest that youth who are inherently lean, rather than purposely pursuing the thin ideal, are at risk for AN. Impaired interpersonal functioning and negative affect are transdiagnostic risk factors, suggesting these factors should be targeted in prevention programs.

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...

In this depression prevention trial, 341 high-risk adolescents (M age = 15.6, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater reductions in depressive symptoms than supportiveexpressive, bibliotherapy, and assessment-only participants at posttest, though only the latter effect was significant at 6-month follow-up. CB participants showed significantly greater improvements in social adjustment and reductions in substance use at posttest and 6-month follow-up than participants in all three other conditions. Supportive-expressive and bibliotherapy participants showed greater reductions in depressive symptoms than assessment-only controls at certain followup assessments, but produced no effects for social adjustment and substance use. CB, supportiveexpressive, and bibliotherapy participants showed a significantly lower risk for major depression onset over the 6-month follow-up than assessment-only controls. The evidence that this brief CB intervention reduced risk for future depression onset and outperformed alternative interventions for certain ecologically important outcomes suggests that this intervention may have clinical utility. Keywords depression; prevention; high-risk; adolescent; alternative interventions Major depression in adolescents is a common, recurrent, and impairing condition that predicts future suicide attempts, academic failure, interpersonal problems, unemployment, substance abuse, and delinquency (Klein, Torpey, & Bufferd, 2008). Because less than one third of depressed youth receive treatment (Newman et al., 1996) it is crucial to develop prevention programs for this pernicious condition.Most depression prevention programs focus on reducing negative cognitions because a negative view towards oneself, one's experiences, and the future and a negative schema that biases the selection, encoding, and evaluation of information, theoretically increase risk for onset and persistence of depression (Beck, 1976). Negative cognitions predict future increases in depression among adolescents (Hankin, Abramson, & Siler, 2001;Lewinsohn et al., 1994; Correspondence should be addressed to Eric Stice, Oregon Research Institute, 1715 Franklin Blvd., Eugene, Oregon, 97403. Email: estice@ori.org. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at http://www.apa.org/journals/ccp/ NIH Public Access NIH-PA Author ManuscriptNIH-PA ...

This paper summarizes characteristics of major depressive disorder (MDD) in the Oregon Adolescent Depression Project, using data from 816 participants (56% female; 89% White). Contrasting four developmental periods (Childhood [5-12.9], Adolescence [13-17.9], Emerging Adulthood [18-23.9], Adulthood [24-30]), we examine MDD incidence/recurrence, gender, comorbidity, duration, and suicide attempts across periods. MDD first incidence was lower in Childhood compared to subsequent periods, and higher in Emerging Adulthood than Adulthood. Cumulative incidence was 51%. Recurrence was lower during Childhood than remaining periods, which were comparable. Female gender predicted first incident MDD in all four periods but was unassociated with recurrence. Comorbidity rates were comparable across periods. MDD duration was greater in Childhood than remaining periods. Suicide attempt rates were significantly higher during Adolescence than either Emerging Adulthood or Adulthood. Depression research should focus on MDD during Emerging Adulthood, adolescent suicidal behavior, the continuing role of gender into adulthood, and the ubiquity of MDD.

BackgroundPhysical activity (PA) for older adults has well-documented physical and cognitive benefits, but most seniors do not meet recommended guidelines for PA, and interventions are lacking.ObjectivesThis study evaluated the efficacy of a 12-week Internet intervention to help sedentary older adults over 55 years of age adopt and maintain an exercise regimen.MethodsA total of 368 sedentary men and women (M=60.3; SD 4.9) were recruited, screened, and assessed online. They were randomized into treatment and control groups and assessed at pretest, at 12 weeks, and at 6 months. After treatment group participants rated their fitness level, activity goals, and barriers to exercise, the Internet intervention program helped them select exercise activities in the areas of endurance, flexibility, strengthening, and balance enhancement. They returned to the program weekly for automated video and text support and education, with the option to change or increase their exercise plan. The program also included ongoing problem solving to overcome user-identified barriers to exercise.ResultsThe multivariate model indicated significant treatment effects at posttest (P=.001; large effect size) and at 6 months (P=.001; medium effect size). At posttest, intervention participation showed significant improvement on 13 of 14 outcome measures compared to the control participants. At 6 months, treatment participants maintained large gains compared to the control participants on all 14 outcome measures.ConclusionsThese results suggest that an online PA program has the potential to positively impact the physical activity of sedentary older adult participants. More research is needed to replicate the study results, which were based on self-report measures. Research is also needed on intervention effects with older populations.

Objective As independent trials have provided evidence for the efficacy and effectiveness of the dissonance-based Body Project eating disorder prevention program, the present trial tested whether clinicians produce the largest intervention effects, or whether delivery can be task-shifted to less expensive undergraduate peer educators or to Internet-delivery without effect size attenuation, focusing on acute effects. Method 680 young women (M age = 22.2, SD = 7.1) recruited at colleges in 2 states were randomized to clinician-led Body Project groups, peer-led Body Project groups, the Internet-based eBody Project or an educational video control condition. Results Participants in all three variants of the Body Project intervention showed significantly greater reductions in eating disorder risk factors and symptoms than educational video controls. Participants in clinician-led and peer-led Body Project groups showed significantly greater reductions in risk factors than eBody Project participants, but effects for the two types of groups were similar. Eating disorder onset over 7-month follow-up was significantly lower for peer-led Body Project group participants versus eBody Project participants (2.2% vs. 8.4%), but did not differ significantly between other conditions. Conclusions The evidence that all three dissonance-based prevention programs outperformed an educational video condition, that both group-based interventions outperformed the Internet-based intervention in risk factor reductions, and that the peer-led groups showed lower eating disorder onset over follow-up than the Internet-based intervention is novel. These acute-effects data suggest that both group-based interventions produce superior eating disorder prevention effects than the Internet-based intervention and that delivery can be task-shifted to peer leaders.

Efficacy trials indicate that an eating disorder prevention program involving dissonance-inducing activities that decrease thin-ideal internalization reduces risk for current and future eating pathology, yet it is unclear whether this program produces effects under real-world conditions. The present effectiveness trial tested whether this program produced effects when school staff recruit participants and deliver the intervention. Adolescent girls with body image concerns (N = 306; M age = 15.7 SD = 1.1) randomized to the dissonance intervention showed significantly greater decreases in thinideal internalization, body dissatisfaction, dieting attempts, and eating disorder symptoms from pretest to posttest than those assigned to a psychoeducational brochure control condition, with the effects for body dissatisfaction, dieting, and eating disorder symptoms persisting through 1-year follow-up. Effects were slightly smaller than those observed in a prior efficacy trial, suggesting that this program is effective under real-world conditions, but that facilitator selection, training, and supervision could be improved. Keywordsprevention; body dissatisfaction; eating disorders Almost 10% of adolescent girls and young women experience threshold or subthreshold anorexia nervosa, bulimia nervosa, or binge eating disorder (Lewinsohn, Streigel-Moore, & Seeley, 2000; Stice, Marti, Shaw, & Jaconis, 2009). These eating disorders are marked by functional impairment, medical complications, and mental health service utilization, and increase risk for future obesity, depression, suicide, anxiety disorders, substance abuse, and health problems (Johnson, Cohen, Kasen, & Brook, 2002;Lewinsohn et al., 2000;Stice, Cameron, Killen, Hayward, & Taylor, 1999; Stice et al., 2009;Wilson, Becker, & Heffernan, 2003).Although dozens of eating disorder prevention programs have been evaluated in randomized efficacy trials, a meta-analytic review (Stice, Shaw, & Marti, 2007b) found that only five have produced significant reductions in eating disorder symptoms relative to control participants that persisted through at least 6-month follow-up (McVey, Tweed, & Blackmore, 2007;Neumark-Sztainer, Butler, & Palti, 1995;Stewart, Carter, Drinkwater, Hainsworth, & Fairburn, 2001;Stice, Shaw, Burton, & Wade, 2006). Further, only the two programs evaluated Correspondence should be addressed to Eric Stice, Oregon Research Institute, 1715 Franklin Blvd., Eugene, Oregon, 97403. Email: estice@ori.org. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/ccp. NIH P...

A secondary analysis was conducted of the National Longitudinal Transition Study-2 to examine (a) main effects of parents' school and postschool outcome expectations on the actual outcomes achieved, (b) demographic moderators, and (c) adolescent autonomy as a mediator of parent expectations and outcomes. Parent expectations were found to significantly predict study outcomes. Moderator analysis indicated that disability type moderated the relationship between parent expectations and outcomes. Meditational analyses indicated that autonomy did not mediate the relationship between parent expectations and study outcomes. However, parent expectations significantly predicted levels of autonomy, and autonomy predicted a number of postschool outcomes. Together, these findings suggest a need for interventions that support and foster positive parent expectations and parental supports to promote autonomy development. Additional research is needed on the mechanisms by which parent expectations and autonomy affect the outcomes of adolescents with disabilities.