Study Examines Add-On Interventions to CDC’s HORIZONS Program

WASHINGTON — In a study that aimed to address “spillover effects” of public health interventions, researchers examined two add-on interventions to the CDC’s HORIZONS program, which aims to encourage young black women to reduce risky sexual patterns.

For those randomized to HORIZONS plus group motivational enhancement therapy (GMET), increases in emotion dysregulation or depression were not associated with alcohol or cannabis use at 1 year, Alexander Denker, a PhD student at Emory University in Atlanta, reported here at the American Association for the Advancement of Science meeting.

However, for those in both an “enhanced standard-of-care” control and a group that received HORIZONS plus a general health promotion (GHP) program, increases in depression were associated with substance use at the 1-year follow-up point, according to the researchers. And in the control group alone, increases in emotion dysregulation were linked with substance use at follow-up.

Overall, substance use decreased over the course of the year among all three groups.

“The overall pattern of results suggests that the GMET intervention may result in a lower likelihood of emotional coping via substance use,” the researchers wrote in a presentation abstract.

“We confirmed that neither baseline marijuana nor baseline alcohol use was significantly associated with changes in emotion dysregulation or changes in depression over the course of the study, further supporting the influence of the intervention conditions on drug use,” they noted.

For their study, over 500 African-American teens and young women (mean age 24, range 17-24) from the Atlanta area were randomized to a control group that consisted of an “informational video, a question-and-answer session, and group discussion” over a 1-hour period, or one of two interventions. Both of these were add-on programs to HORIZONS, a 4-hour program that the CDC describes as “a group-level, gender- and culturally tailored STD/HIV intervention for African American adolescent females seeking sexual health services.”

In the first of the two add-ons, GMET, which was designed by the researchers, participants were exposed to an additional 4-hour session that “focused on alcohol-specific sexual risk-reduction,” Denker’s group reported. In the second, participants were exposed to the general health promotion (GHP), a 4-hour diabetes prevention program.

For inclusion in the study, participants had to have consumed alcohol at least 3 times in the 60 days before baseline. Participants either self-administered questionnaires or used a voice-recorded survey instrument.

“Our (previous) data indicated that alcohol use was a significant moderator, adversely impacting HORIZONS’ efficacy. For women who used alcohol more frequently (≥3 drinking occasions in the past 60 days) there were no treatment effects,” they added. “There is clear need to augment HORIZONS with an alcohol-specific module to enhance its applicability and efficacy for young African American women who drink alcohol more frequently.”

The researchers had hypothesized that level of emotion dysregulation and depression would predict substance use in the control and GHP groups, but not in the GMET group.

GMET was based on the Motivational Enhancement Therapy (MET) model, and aimed to evaluate the effects primarily of alcohol on sexual behavior. GMET “has demonstrated evidence of efficacy in influencing several alcohol-specific constructs (attitudes, norms, self-efficacy) and reducing sexual risk-taking,” the researchers wrote.

The researchers studied teens and young women because this age group is more likely to exhibit risky behavior, and young African-American women are an understudied group, they said, particularly when it comes to substance use.

This group uses alcohol and other substances less frequently than the general U.S. population, but are more likely to be depressed. When they do consume substances, negative effects can be more pronounced, according to the researchers. “Emotion dysregulation levels and depressive tendencies” significantly impact cannabis and alcohol consumption, but researchers do not understand this relationship to a high degree — especially among people who do not report high levels of substance use.

Denker’s and colleagues are working on follow-up studies, conducting linear modeling to examine treatment effects and rates of reduction, as well as parsing out differences between cannabis and alcohol consumption. The researchers hope their work can help tailor effective public health models to younger populations.