Online prevention of disordered eating in at-risk young-adult women: A two-country pragmatic randomised controlled trial

INTERVENTION: Participants were allocated to just one condition: Media Smart‐Targeted; Student Bodies; or, control. Media Smart‐Targeted and Student Bodies were both 9 modules long with 1 module released per week. Both programs featured a mixture of: reading material; images; videos; reflection tasks; and homework tasks that were generated specifically for the intervention (i.e., not publicly available). For both programs, modules took up to 30 minutes to complete, but often less than this. Adherence was measured through: website analytics of modules accessed and completed and qualitative feedback at the conclusion of each module. 1. Media Smart‐Targeted: 9 module online mobile website that is an adapted for high‐risk young‐adult women from the school‐based Media Smart program for universal classes of young‐adolescent girls and boys. 2. Student Bodies: 9 module online mobile website that is a highly regarded international eating disorder prevention program for young‐adult women CONDITION: alcohol use depressive symptoms disordered eating eating disorders substance use suicide risk PRIMARY OUTCOME: Disordered eating (dichotomous): this was measured by the Eating Disorder Examination ‐Questionnaire (EDE‐Q: Fairburn and Beglin, 1994) and was defined as having a global EDE‐Q score >= 1 SD of the community mean (i.e., 2.46: Mond et al., 2004), and the presence of one or more of the following in the previous 4‐week period: objective bulimic episode; fasting; vomiting or laxatives to control weight; or BMI <18.5. SECONDARY OUTCOME: Alcohol use was assessed using 3 items from the Alcohol Dependence section of the MINI International Schedule (Lecrubier, et al., 1997). The screening question was "In the past 12 months, have you drunk 3 or more alcoholic beverages in a 3‐hour period, on 3 or more occasions?" and this was followed‐up with a question about withdrawal effects and tolerance. Depressive symptoms were assessed using the Depression Scale from the Depression, Anxiety, Stress Scale (DASS‐21: Lovibond & Lovibond, 1995). Eating disorder diagnoses: this was measured by the diagnostic items from the (EDE‐Q) for: anorexia nervosa, bulimia nervosa, binge eating disorder, and other specific feeding and eating disorder. Whilst this variable has overlap with the disordered eating variable, it does provide more specific information about the type of eating disorder diagnosis and the requirements for diagnosis were greater than for disordered eating. Media Internalisation was assessed using the Sociocultural Attitudes Towards Appearance Questionnaire‐3 (Thompson et al., 2004) Quality of life ‐ Mental was assessed using the Medical Outcome Studies Short Form Scales – Mental Component Scale (Ware et al., 1993) Recreational drug use was assessed using 3 items from the Substance Dependence section of the MINI International Schedule (Lecrubier, et al., 1997). The screening question was "In the past 12 months, have you taken a recreational drug/s (not alcohol) more than once to get high, to feel elated, to get “a buzz” or to change your mood?" and this was followed‐up with a question about withdrawal effects and tolerance Suicidality was assessed using 6 items from the Suicidality section of the MINI International Schedule (Lecrubier, et al., 1997). INCLUSION CRITERIA: Participants were women aged 18‐25 years from Australia and New Zealand who wished to improve their body image.