PERCEPTIONS OF COSTS AND BENEFITS AS PREDICTORS OF POSITIVE OUTCOMES IN A BEHAVIORAL INTERVENTION FOR AFRICAN-AMERICAN TEENS

Purpose:   The objective of this analysis was to assess the impact of perceived costs and benefits on outcomes in a randomized trial of a substance use prevention intervention targeting rural African American teens.

Methods:   Participants were randomized to receive either the prevention intervention or an attention-control intervention. Perceived costs and benefits of the assigned intervention were self-reported by teens (N=157) on a Likert scale during the final intervention session attended, including satisfaction/usefulness of the program (perceived benefits) and the time/difficulty associated with attending the program (perceived costs). Two important outcomes for the group receiving the behavioral intervention were a reduction in substance use and improvements in mental health, compared to the attention-control group. Outcomes were measured prior to the first intervention session (baseline) and one-year after the final session (follow-up). Substance use was measured by ordinal variables representing episodes of alcohol use, binge drinking, marijuana use, and tobacco use. Three different instruments including the CES-D, SF-36, and EQ-5D measured depressive symptoms. To investigate the effects of perceived costs, perceived benefits, and the net perception of costs and benefits on the outcomes, data were analyzed with structural equation modeling. Separate models were tested for each of the outcomes.

Results:   Higher perceived benefits were associated with lower substance use and a lower risk of depressive symptoms. Perceived costs were not associated with either outcome. The perceived net benefits (perceived benefits less perceived costs) were also not significantly associated with either outcome.

Conclusions:   Despite the preliminary nature of these data, our results have important implications for behavioral interventions designed to reduce substance use and improve mental health (reduce depressive symptoms). Higher perceived benefits in the form of high satisfaction and a feeling of usefulness toward the intervention content are associated with improvements in substance use and mental health in a population of rural African American teens. Conversely, feelings of dissatisfaction with the time and difficulty related to the intervention are not associated with important outcomes. These results replicate similar research we have completed where higher perceived benefits were associated with a lower risk of intervention attrition in an African American population.