@Article{info:doi/10.2196/16207,
author="Evans, William
and Andrade, Elizabeth
and Pratt, Michaela
and Mottern, Alexandra
and Chavez, Sergio
and Calzetta-Raymond, Anthony
and Gu, Jiayan",
title="Peer-to-Peer Social Media as an Effective Prevention Strategy: Quasi-Experimental Evaluation",
journal="JMIR Mhealth Uhealth",
year="2020",
month="May",
day="6",
volume="8",
number="5",
pages="e16207",
keywords="social media; substance use; prevention; marijuana; opioids; adolescent health",
abstract="Background: Substance use by adolescents remains to be at unacceptably high levels, and there is evidence that teens' social norms are becoming more favorable toward recreational use and perceived safety of substances such as marijuana and prescription opioids. Social media offer a low-cost, potentially high-impact approach to disseminate prevention messages. Objective: Living the Example (LTE) is a program that trains adolescent youth ambassadors to develop and disseminate prevention messages within their own social media networks and through in-school activities. This study aimed to evaluate the effects of exposure to LTE-based social media on students in the youth ambassadors' networks. Methods: The George Washington (GW) University designed and implemented a quasi-experimental evaluation of the LTE program in 3 Maryland high schools. Before program launch, a sample of 826 students (wave 1) at the 3 schools, drawn from a census of freshmen enrolled in a class attended by all students at the grade level, completed a survey. A total of 584 students were surveyed at the wave 2 program midpoint and 542 at the wave 3 endpoint. The survey contained questions on drug use--related attitudes, beliefs, intentions, and behaviors, all based on validated measures. We evaluated the effects of LTE on the intended next 30-day drug use, and controlling for LTE self-reported exposure, age, and gender from waves 2 and 3 was appended into a single dataset. We first conducted ordinal logistic regressions for each drug use intention in wave 3 (ie, sell or distribute illegal drugs, smoke cigarettes, drink beer/wine/hard liquor when parents do not know about it, use marijuana, use lysergic acid diethylamide, cocaine, amphetamines or other illegal drugs, use heroin, use synthetic drugs, and use any prescription pills without a prescription) to examine the association between LTE exposure and drug use intentions. We included an interaction term for the study wave to examine intervention effects. Results: We found a significant positive effect of LTE exposure on all 8 measured drug use intentions: sell/distribute illegal drugs; smoke cigarettes; drink beer, wine, or liquor when my parents do not know about it; use marijuana; use cocaine, amphetamines, or other illegal drug; use heroin; use synthetic drugs; use any prescription pills without a prescription (all P<.05; odds ratios ranging from 2.12 to 3.71). We also found that boys were more likely than girls to exhibit reduced drug use intentions. We also found reductions in 30-day intentions between the second and third survey waves for all 8 measured drug use variables. Conclusions: Overall, the results are consistent with and indicate a stronger LTE effect in this study compared with a previous pilot study. LTE appears to offer a protective effect, with exposure to program messages leading to reduced/improved drug use intentions. ",
doi="10.2196/16207",
url="https://mhealth.jmir.org/2020/5/e16207",
url="https://doi.org/10.2196/16207",
url="http://www.ncbi.nlm.nih.gov/pubmed/32374270"
}


@Article{info:doi/10.2196/15282,
author="Hsiang, Elaine
and Offer, Claudine
and Prescott, Maximo
and Rodriguez, Amy
and Behar, Emily
and Matheson, Tim
and Santa Maria, Diane
and Santos, Glenn-Milo",
title="Bridging the Digital Divide Among Racial and Ethnic Minority Men Who Have Sex With Men to Reduce Substance Use and HIV Risk: Mixed Methods Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="29",
volume="8",
number="4",
pages="e15282",
keywords="ecological momentary assessment; men who have sex with men; text messaging; substance use; HIV; digital divide; focus group",
abstract="Background: Ecological momentary assessment (EMA) is a promising data collection tool for mobile health interventions targeting episodic health behaviors. For substance-using men who have sex with men (SUMSM), EMA is becoming more widely utilized in efforts to characterize substance use and sexual risk factors for HIV transmission. However, recent literature demonstrates emerging concerns over compliance and lower EMA engagement and data concordance among racial and ethnic minority SUMSM. Objective: This study aimed to provide a qualitative evaluation of the barriers and facilitators of EMA as a data collection tool among racial and ethnic minority SUMSM. Methods: Between October and November 2017, 45 racial and ethnic minority SUMSM were recruited from a list of prior research participants at the San Francisco Department of Public Health to participate in daily EMA surveys on their substance use and sexual health behaviors for 1 week, followed by in-person focus groups (FGs). A total of 4 FGs explored the participants' experiences with the surveys, issues regarding privacy and confidentiality, and suggestions for improvement. Qualitative analysis was performed using content analysis. Descriptive statistics and Fisher exact tests were used to assess the associations between demographics or substance use behaviors and EMA completion. Results: Overall, 93.9{\%} (295/314) of all delivered surveys were initiated, and of those, 98.0{\%} (289/295) were completed. Neither participant demographics, including race (P=.65) or age (P=.43), nor substance use behaviors, including the frequency of alcohol (P=.40) or methamphetamine (P=.91) use or any cocaine (P=.28), crack (P=.99), or polysubstance use (P=.24), were found to be associated with survey completion. Overall, participants were receptive to the text message--based EMA surveys. Facilitators included survey timing, user-friendly survey design, survey-stimulated self-reflection, coding of sensitive phrases, and other privacy benefits of a mobile survey. Barriers included an inability to correct texting errors and participants' perception of judgment or stigmatization related to questions about condomless sex. To improve EMA compliance and uptake, participants suggested adding response confirmations, clarifying survey language, and continuing to diversify the study audience. Conclusions: EMA appears to be feasible and acceptable among this sample of racial and ethnic minority SUMSM. Close attention to EMA study design and the development of nonjudgmental, contextualized questions regarding stigmatized health behaviors may be critical to further improve EMA compliance. ",
doi="10.2196/15282",
url="http://mhealth.jmir.org/2020/4/e15282/",
url="https://doi.org/10.2196/15282",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347807"
}


@Article{info:doi/10.2196/17688,
author="Tomazic, Tina
and Jerkovic, Olivera Stanojevic",
title="Online Interventions for the Selective Prevention of Illicit Drug Use in Young Drug Users: Exploratory Study",
journal="J Med Internet Res",
year="2020",
month="Apr",
day="22",
volume="22",
number="4",
pages="e17688",
keywords="web-based; intervention; prevention; internet",
abstract="Background: Digital technologies have a major impact on the daily lives of young people and are also used to seek information on and help with drug-related issues online. Objective: The aim of this article was to analyze current online interventions for young drug users in Slovenia, with the purpose of contributing to the development of guidelines and key recommendations for effective online interventions. Methods: This study was part of the project Click for Support. We performed a keyword search, received input from national experts in the field of drug prevention, and conducted an assessment of recognized national online interventions through workshop-based discussions with the target group of 20 young drug users. Results: The current online intervention services in Slovenia are satisfactory but are still not sufficiently recognized. The most important issues for young drug users were the design and functionality of the online intervention, presence of a clear structure, possibility of using it on smartphones, comprehensive and quick professional feedback, and data security. Playful elements and the ability to share (experiences) with other or former users were also recognized as important. Conclusions: With effective online interventions, we can include more young drug users, facilitate access to a more affordable service, provide quick professional feedback on patterns of consumption, increase knowledge about the effects and consequences of drugs, and support the reduction or cessation of drug use. From the public health perspective, it is challenging to provide drug interventions broadly to the target group and, hence, decrease inequities. ",
doi="10.2196/17688",
url="http://www.jmir.org/2020/4/e17688/",
url="https://doi.org/10.2196/17688",
url="http://www.ncbi.nlm.nih.gov/pubmed/32319962"
}


@Article{info:doi/10.2196/16199,
author="Slovis, Benjamin H
and Kairys, John
and Babula, Bracken
and Girondo, Melanie
and Martino, Cara
and Roke, Lindsey M
and Riggio, Jeffrey",
title="Discrepancies in Written Versus Calculated Durations in Opioid Prescriptions: Pre-Post Study",
journal="JMIR Med Inform",
year="2020",
month="Mar",
day="31",
volume="8",
number="3",
pages="e16199",
keywords="informatics; electronic health record; opioids; prescription; duration",
abstract="Background: The United States is in the midst of an opioid epidemic. Long-term use of opioid medications is associated with an increased risk of dependence. The US Centers for Disease Control and Prevention makes specific recommendations regarding opioid prescribing, including that prescription quantities should not exceed the intended duration of treatment. Objective: The purpose of this study was to determine if opioid prescription quantities written at our institution exceed intended duration of treatment and whether enhancements to our electronic health record system improved any discrepancies. Methods: We examined the opioid prescriptions written at our institution for a 22-month period. We examined the duration of treatment documented in the prescription itself and calculated a duration based on the quantity of tablets and doses per day. We determined whether requiring documentation of the prescription duration affected these outcomes. Results: We reviewed 72,314 opioid prescriptions, of which 16.96{\%} had a calculated duration that was greater than what was documented in the prescription. Making the duration a required field significantly reduced this discrepancy (17.95{\%} vs 16.21{\%}, P<.001) but did not eliminate it. Conclusions: Health information technology vendors should develop tools that, by default, accurately represent prescription durations and/or modify doses and quantities dispensed based on provider-entered durations. This would potentially reduce unintended prolonged opioid use and reduce the potential for long-term dependence. ",
doi="10.2196/16199",
url="https://medinform.jmir.org/2020/3/e16199",
url="https://doi.org/10.2196/16199",
url="http://www.ncbi.nlm.nih.gov/pubmed/32229472"
}


@Article{info:doi/10.2196/16191,
author="Stevens, Robin C
and Brawner, Bridgette M
and Kranzler, Elissa
and Giorgi, Salvatore
and Lazarus, Elizabeth
and Abera, Maramawit
and Huang, Sarah
and Ungar, Lyle",
title="Exploring Substance Use Tweets of Youth in the United States: Mixed Methods Study",
journal="JMIR Public Health Surveill",
year="2020",
month="Mar",
day="26",
volume="6",
number="1",
pages="e16191",
keywords="social media; illicit drug; youth; adolescent",
abstract="Background: Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use--related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use. Objective: This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths' drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content. Methods: We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sample by age (13-24 years), yielding approximately 23 million tweets from 20,112 users. We developed a list of drug-related keywords and phrases and selected a random sample of tweets with the most commonly used keywords to identify themes (n=249). Results: We identified two broad classes of emergent themes: functional themes and relational themes. Functional themes included posts that explicated a function of drugs in one's life, with subthemes indicative of pride, longing, coping, and reminiscing as they relate to drug use and effects. Relational themes emphasized a relational nature of substance use, capturing substance use as a part of social relationships, with subthemes indicative of drug-related identity and companionship. We also identified topical areas in tweets related to drug use, including reference to polysubstance use, pop culture, and antidrug content. Across the tweets, the themes of pride (63/249, 25.3{\%}) and longing (39/249, 15.7{\%}) were the most popular. Most tweets that expressed pride (46/63, 73{\%}) were explicitly related to marijuana. Nearly half of the tweets on coping (17/36, 47{\%}) were related to prescription drugs. Very few of the tweets contained antidrug content (9/249, 3.6{\%}). Conclusions: Data integration indicates that drugs are typically discussed in a positive manner, with content largely reflective of functional and relational patterns of use. The dissemination of this information, coupled with the relative absence of antidrug content, may influence youth such that they perceive drug use as normative and justified. Strategies to address the underlying causes of drug use (eg, coping with stressors) and engage antidrug messaging on social media may reduce normative perceptions and associated behaviors among youth. The findings of this study warrant research to further examine the effects of this content on beliefs and behaviors and to identify ways to leverage social media to decrease substance use in this population. ",
doi="10.2196/16191",
url="http://publichealth.jmir.org/2020/1/e16191/",
url="https://doi.org/10.2196/16191",
url="http://www.ncbi.nlm.nih.gov/pubmed/32213472"
}


@Article{info:doi/10.2196/16038,
author="Butler, Stephen F
and Oyedele, Natasha K
and Dailey Govoni, Taryn
and Green, Jody L",
title="How Motivations for Using Buprenorphine Products Differ From Using Opioid Analgesics: Evidence from an Observational Study of Internet Discussions Among Recreational Users",
journal="JMIR Public Health Surveill",
year="2020",
month="Mar",
day="25",
volume="6",
number="1",
pages="e16038",
keywords="buprenorphine-naloxone combination; buprenorphine; motivation; controlled substance diversion; addiction, opioid; opioid medication-assisted treatment",
abstract="Background: Opioid use disorder (OUD) poses medical and societal concerns. Although most individuals with OUD in the United States are not in drug abuse treatment, buprenorphine is considered a safe and effective OUD treatment, which reduces illicit opioid use, mortality, and other drug-related harms. However, as buprenorphine prescriptions increase, so does evidence of misused, abused, or diverted buprenorphine. Users' motivations for extratreatment use of buprenorphine (ie, misuse or abuse of one's own prescription or use of diverted medication) may be different from the motivations involved in analgesic opioid products. Previous research is based on small sample sizes and use surveys, and none directly compare the motivations for using buprenorphine products (ie, tablet or film) with other opioid products having known abuse potential. Objective: The aim of the study was to describe and compare the motivation-to-use buprenorphine products, including buprenorphine/naloxone (BNX) sublingual film and oxycodone extended-release (ER), as discussed in online forums. Methods: Web-based posts from 2012 to 2016 were collected from online forums using the Web Informed Services internet monitoring archive. A random sample of posts was coded for motivation to use. These posts were coded into the following motivation categories: (1) use to avoid withdrawal, (2) pain relief, (3) tapering from other drugs, (4) opioid addiction treatment, (5) recreational use (ie, to get high), and (6) other use. Oxycodone ER, an opioid analgesic with known abuse potential, was selected as a comparator. Results: Among all posts, 0.81{\%} (30,576/3,788,922) discussed motivation to use one of the target products. The examination of query-selected posts revealed significantly greater discussion of buprenorphine products than oxycodone ER (P<.001). The posts mentioning buprenorphine products were more likely than oxycodone ER to discuss treatment for OUD, tapering down use, and/or withdrawal management (P<.001). Buprenorphine-related posts discussed recreational use (375/1020, 36.76{\%}), although much less often than in oxycodone ER posts (425/508, 83.7{\%}). Despite some differences, the overall pattern of motivation to use was similar for BNX sublingual film and other buprenorphine products. Conclusions: An analysis of spontaneous, Web-based discussion among recreational substance users who post on online drug forums supports the contention that motivation-to-use patterns associated with buprenorphine products are different from those reported for oxycodone ER. Although the findings presented here are not expected to reflect the actual use of the target products, they may represent the interests and motivations of those posting on the online forums. Buprenorphine-related posts were more likely to discuss treatment for OUD, tapering, and withdrawal management than oxycodone ER. Although the findings are consistent with a purported link between the limited availability of medication-assisted therapies for substance use disorders and use of diverted buprenorphine products for self-treatment, recreational use was a motivation expressed in more than one-third of buprenorphine posts. ",
doi="10.2196/16038",
url="http://publichealth.jmir.org/2020/1/e16038/",
url="https://doi.org/10.2196/16038",
url="http://www.ncbi.nlm.nih.gov/pubmed/32209533"
}


@Article{info:doi/10.2196/17046,
author="Milne-Ives, Madison
and Lam, Ching
and De Cock, Caroline
and Van Velthoven, Michelle Helena
and Meinert, Edward",
title="Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use, and Mental Health: Systematic Review",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="18",
volume="8",
number="3",
pages="e17046",
keywords="telemedicine; evidence-based medicine; mobile health; digital health; mobile applications; app; cell phone; smartphone; mobile phone; health behavior; intervention; behavior change; systematic review",
abstract="Background: With a growing focus on patient interaction with health management, mobile apps are increasingly used to deliver behavioral health interventions. The large variation in these mobile health apps---their target patient group, health behavior, and behavioral change strategies---has resulted in a large but incohesive body of literature. Objective: This systematic review aimed to assess the effectiveness of mobile apps in improving health behaviors and outcomes and to examine the inclusion and effectiveness of behavior change techniques (BCTs) in mobile health apps. Methods: PubMed, EMBASE, CINAHL, and Web of Science were systematically searched for articles published between 2014 and 2019 that evaluated mobile apps for health behavior change. Two authors independently screened and selected studies according to the eligibility criteria. Data were extracted and the risk of bias was assessed by one reviewer and validated by a second reviewer. Results: A total of 52 randomized controlled trials met the inclusion criteria and were included in the analysis---37 studies focused on physical activity, diet, or a combination of both, 11 on drug and alcohol use, and 4 on mental health. Participant perceptions were generally positive---only one app was rated as less helpful and satisfactory than the control---and the studies that measured engagement and usability found relatively high study completion rates (mean 83{\%}; n=18, N=39) and ease-of-use ratings (3 significantly better than control, 9/15 rated >70{\%}). However, there was little evidence of changed behavior or health outcomes. Conclusions: There was no strong evidence in support of the effectiveness of mobile apps in improving health behaviors or outcomes because few studies found significant differences between the app and control groups. Further research is needed to identify the BCTs that are most effective at promoting behavior change. Improved reporting is necessary to accurately evaluate the mobile health app effectiveness and risk of bias. ",
doi="10.2196/17046",
url="http://mhealth.jmir.org/2020/3/e17046/",
url="https://doi.org/10.2196/17046",
url="http://www.ncbi.nlm.nih.gov/pubmed/32186518"
}


@Article{info:doi/10.2196/16251,
author="Cordova, David
and Munoz-Velazquez, Jaime
and Mendoza Lua, Frania
and Fessler, Kathryn
and Warner, Sydni
and Delva, Jorge
and Adelman, Nicole
and Fernandez, Angela
and Bauermeister, Jose",
title="Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="17",
volume="8",
number="3",
pages="e16251",
keywords="youth; mHealth; illicit drugs; sex behavior; HIV; primary care",
abstract="Background: Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings. Objective: This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing. Methods: Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV. Results: Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (∆ score mean 0.36, SD 0.51) and self-efficacy (∆ score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95{\%} CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95{\%} CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95{\%} CI −0.39 to 0.73), and drug use (Cohen h=1.28, 95{\%} CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95{\%} CI −0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95{\%} CI −0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95{\%} CI −0.39 to 0.72). Conclusions: The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted. Trial Registration: ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410. ",
doi="10.2196/16251",
url="https://mhealth.jmir.org/2020/3/e16251",
url="https://doi.org/10.2196/16251",
url="http://www.ncbi.nlm.nih.gov/pubmed/32181747"
}


@Article{info:doi/10.2196/16240,
author="Chung, Tammy
and Bae, Sang Won
and Mun, Eun-Young
and Suffoletto, Brian
and Nishiyama, Yuuki
and Jang, Serim
and Dey, Anind K",
title="Mobile Assessment of Acute Effects of Marijuana on Cognitive Functioning in Young Adults: Observational Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="10",
volume="8",
number="3",
pages="e16240",
keywords="marijuana; cannabis; cell phone; memory, short-term; cognition",
abstract="Background: Mobile assessment of the effects of acute marijuana on cognitive functioning in the natural environment would provide an ecologically valid measure of the impacts of marijuana use on daily functioning. Objective: This study aimed to examine the association of reported acute subjective marijuana high (rated 0-10) with performance on 3 mobile cognitive tasks measuring visuospatial working memory (Flowers task), attentional bias to marijuana-related cues (marijuana Stroop), and information processing and psychomotor speed (digit symbol substitution task [DSST]). The effect of distraction as a moderator of the association between the rating of subjective marijuana high and task performance (ie, reaction time and number of correct responses) was explored. Methods: Young adults (aged 18-25 years; 37/60, 62{\%} female) who reported marijuana use at least twice per week were recruited through advertisements and a participant registry in Pittsburgh, Pennsylvania. Phone surveys and mobile cognitive tasks were delivered 3 times per day and were self-initiated when starting marijuana use. Completion of phone surveys triggered the delivery of cognitive tasks. Participants completed up to 30 days of daily data collection. Multilevel models examined associations between ratings of subjective marijuana high (rated 0-10) and performance on each cognitive task (reaction time and number of correct responses) and tested the number of distractions (rated 0-4) during the mobile task session as a moderator of the association between ratings of subjective marijuana high and task performance. Results: Participants provided 2703 data points, representing 451 reports (451/2703, 16.7{\%}) of marijuana use. Consistent with slight impairing effects of acute marijuana use, an increase in the average rating of subjective marijuana high was associated with slower average reaction time on all 3 tasks---Flowers (B=2.29; SE 0.86; P=.008), marijuana Stroop (B=2.74; SE 1.09; P=.01), and DSST (B=3.08; SE 1.41; P=.03)---and with fewer correct responses for Flowers (B=−0.03; SE 0.01; P=.01) and DSST (B=−0.18; SE 0.07; P=.01), but not marijuana Stroop (P=.45). Results for distraction as a moderator were statistically significant only for certain cognitive tasks and outcomes. Specifically, as hypothesized, a person's average number of reported distractions moderated the association of the average rating of subjective marijuana high (over and above a session's rating) with the reaction time for marijuana Stroop (B=−52.93; SE 19.38; P=.006) and DSST (B=−109.72; SE 42.50; P=.01) and the number of correct responses for marijuana Stroop (B=−0.22; SE 0.10; P=.02) and DSST (B=4.62; SE 1.81; P=.01). Conclusions: Young adults' performance on mobile cognitive tasks in the natural environment was associated with ratings of acute subjective marijuana high, consistent with slight decreases in cognitive functioning. Monitoring cognitive functioning in real time in the natural environment holds promise for providing immediate feedback to guide personal decision making. ",
doi="10.2196/16240",
url="http://mhealth.jmir.org/2020/3/e16240/",
url="https://doi.org/10.2196/16240",
url="http://www.ncbi.nlm.nih.gov/pubmed/32154789"
}


@Article{info:doi/10.2196/16853,
author="Pedersen, Eric R
and Firth, Caislin
and Parker, Jennifer
and Shih, Regina A
and Davenport, Steven
and Rodriguez, Anthony
and Dunbar, Michael S
and Kraus, Lisa
and Tucker, Joan S
and D'Amico, Elizabeth J",
title="Locating Medical and Recreational Cannabis Outlets for Research Purposes: Online Methods and Observational Study",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="26",
volume="22",
number="2",
pages="e16853",
keywords="marijuana; cannabis; dispensaries; retailers; Los Angeles; tobacco",
abstract="Background: An increasing number of states have laws for the legal sale of recreational and medical cannabis out of brick-and-mortar storefront locations. Given the proliferation of cannabis outlets and their potential for impact on local economies, neighborhood structures, and individual patterns of cannabis use, it is essential to create practical and thorough methods to capture the location of such outlets for research purposes. However, methods used by researchers vary greatly between studies and often do not include important information about the retailer's license status and storefront signage. Objective: The aim of this study was to find methods for locating and observing cannabis outlets in Los Angeles County after the period when recreational cannabis retailers were granted licenses and allowed to be open for business. Methods: The procedures included searches of online cannabis outlet databases, followed by methods to verify each outlet's name, address, license information, and open status. These procedures, conducted solely online, resulted in a database of 531 outlets. To further verify each outlet's information and collect signage data, we conducted direct observations of the 531 identified outlets. Results: We found that 80.9{\%} (430/531) of these outlets were open for business, of which 37.6{\%} (162/430) were licensed to sell cannabis. Unlicensed outlets were less likely to have signage indicating the store sold cannabis, such as a green cross, which was the most prevalent form of observed signage. Co-use of cannabis and tobacco/nicotine has been found to be a substantial health concern, and we observed that 40.6{\%} (175/430) of cannabis outlets had a tobacco/nicotine outlet within sight of the cannabis outlet. Most (350/430, 81.4{\%}) cannabis outlets were located within the City of Los Angeles, and these outlets were more likely to be licensed than outlets outside the city. Conclusions: The findings of this study suggest that online searches and observational methods are both necessary to best capture accurate and detailed information about cannabis outlets. The methods described here can be applied to other metropolitan areas to more accurately capture the availability of cannabis in an area. ",
doi="10.2196/16853",
url="https://www.jmir.org/2020/2/e16853",
url="https://doi.org/10.2196/16853",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130141"
}


@Article{info:doi/10.2196/15861,
author="O'Connor, Karen
and Sarker, Abeed
and Perrone, Jeanmarie
and Gonzalez Hernandez, Graciela",
title="Promoting Reproducible Research for Characterizing Nonmedical Use of Medications Through Data Annotation: Description of a Twitter Corpus and Guidelines",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="26",
volume="22",
number="2",
pages="e15861",
keywords="prescription drug misuse; social media; substance abuse detection; natural language processing; machine learning; infodemiology; infoveillance",
abstract="Background: Social media data are being increasingly used for population-level health research because it provides near real-time access to large volumes of consumer-generated data. Recently, a number of studies have explored the possibility of using social media data, such as from Twitter, for monitoring prescription medication abuse. However, there is a paucity of annotated data or guidelines for data characterization that discuss how information related to abuse-prone medications is presented on Twitter. Objective: This study discusses the creation of an annotated corpus suitable for training supervised classification algorithms for the automatic classification of medication abuse--related chatter. The annotation strategies used for improving interannotator agreement (IAA), a detailed annotation guideline, and machine learning experiments that illustrate the utility of the annotated corpus are also described. Methods: We employed an iterative annotation strategy, with interannotator discussions held and updates made to the annotation guidelines at each iteration to improve IAA for the manual annotation task. Using the grounded theory approach, we first characterized tweets into fine-grained categories and then grouped them into 4 broad classes---abuse or misuse, personal consumption, mention, and unrelated. After the completion of manual annotations, we experimented with several machine learning algorithms to illustrate the utility of the corpus and generate baseline performance metrics for automatic classification on these data. Results: Our final annotated set consisted of 16,443 tweets mentioning at least 20 abuse-prone medications including opioids, benzodiazepines, atypical antipsychotics, central nervous system stimulants, and gamma-aminobutyric acid analogs. Our final overall IAA was 0.86 (Cohen kappa), which represents high agreement. The manual annotation process revealed the variety of ways in which prescription medication misuse or abuse is discussed on Twitter, including expressions indicating coingestion, nonmedical use, nonstandard route of intake, and consumption above the prescribed doses. Among machine learning classifiers, support vector machines obtained the highest automatic classification accuracy of 73.00{\%} (95{\%} CI 71.4-74.5) over the test set (n=3271). Conclusions: Our manual analysis and annotations of a large number of tweets have revealed types of information posted on Twitter about a set of abuse-prone prescription medications and their distributions. In the interests of reproducible and community-driven research, we have made our detailed annotation guidelines and the training data for the classification experiments publicly available, and the test data will be used in future shared tasks. ",
doi="10.2196/15861",
url="http://www.jmir.org/2020/2/e15861/",
url="https://doi.org/10.2196/15861",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130117"
}


@Article{info:doi/10.2196/16751,
author="Budney, Alan J
and Marsch, Lisa A
and Aklin, Will M
and Borodovsky, Jacob T
and Brunette, Mary F
and Campbell, Andrew T
and Dallery, Jesse
and Kotz, David
and Knapp, Ashley A
and Lord, Sarah E
and Nunes, Edward V
and Scherer, Emily A
and Stanger, Catherine
and Torrey, William C",
title="Workshop on the Development and Evaluation of Digital Therapeutics for Health Behavior Change: Science, Methods, and Projects",
journal="JMIR Ment Health",
year="2020",
month="Feb",
day="26",
volume="7",
number="2",
pages="e16751",
keywords="digital health; behavioral health; mobile technology; mHealth; digital interventions; behavior change; behavioral science; addiction; mental health",
doi="10.2196/16751",
url="http://mental.jmir.org/2020/2/e16751/",
url="https://doi.org/10.2196/16751",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130155"
}


@Article{info:doi/10.2196/16919,
author="Aupperle, Robin Leora
and Paulus, Martin P
and Kuplicki, Rayus
and Touthang, James
and Victor, Teresa
and Yeh, Hung-Wen
and Khalsa, Sahib S",
title="Web-Based Graphic Representation of the Life Course of Mental Health: Cross-Sectional Study Across the Spectrum of Mood, Anxiety, Eating, and Substance Use Disorders",
journal="JMIR Ment Health",
year="2020",
month="Jan",
day="28",
volume="7",
number="1",
pages="e16919",
keywords="mental health; life history; psychosocial factors; depression; anxiety; substance use disorders; eating disorders",
abstract="Background: Although patient history is essential for informing mental health assessment, diagnosis, and prognosis, there is a dearth of standardized instruments measuring time-dependent factors relevant to psychiatric disorders. Previous research has demonstrated the potential utility of graphical representations, termed life charts, for depicting the complexity of the course of mental illness. However, the implementation of these assessments is limited by the exclusive focus on specific mental illnesses (ie, bipolar disorder) and the lack of intuitive graphical interfaces for data collection and visualization. Objective: This study aimed to develop and test the utility of the Tulsa Life Chart (TLC) as a Web-based, structured approach for obtaining and graphically representing historical information on psychosocial and mental health events relevant across a spectrum of psychiatric disorders. Methods: The TLC interview was completed at baseline by 499 participants of the Tulsa 1000, a longitudinal study of individuals with depressive, anxiety, substance use, or eating disorders and healthy comparisons (HCs). All data were entered electronically, and a 1-page electronic and interactive graphical representation was developed using the Google Visualization Application Programming Interface. For 8 distinct life epochs (periods of approximately 5-10 years), the TLC assessed the following factors: school attendance, hobbies, jobs, social support, substance use, mental health treatment, family structure changes, negative and positive events, and epoch and event-related mood ratings. We used generalized linear mixed models (GLMMs) to evaluate trajectories of each domain over time and by sex, age, and diagnosis, using case examples and Web-based interactive graphs to visualize data. Results: GLMM analyses revealed main or interaction effects of epoch and diagnosis for all domains. Epoch by diagnosis interactions were identified for mood ratings and the number of negative-versus-positive events (all P values <.001), with all psychiatric groups reporting worse mood and greater negative-versus-positive events than HCs. These differences were most robust at different epochs, depending on diagnosis. There were also diagnosis and epoch main effects for substance use, mental health treatment received, social support, and hobbies (P<.001). User experience ratings (each on a 1-5 scale) revealed that participants found the TLC pleasant to complete (mean 3.07, SD 1.26) and useful for understanding their mental health (mean 3.07, SD 1.26), and that they were likely to recommend it to others (mean 3.42, SD 0.85). Conclusions: The TLC provides a structured, Web-based transdiagnostic assessment of psychosocial history relevant for the diagnosis and treatment of psychiatric disorders. Interactive, 1-page graphical representations of the TLC allow for the efficient communication of historical life information that would be useful for clinicians, patients, and family members. ",
doi="10.2196/16919",
url="http://mental.jmir.org/2020/1/e16919/",
url="https://doi.org/10.2196/16919",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012081"
}


@Article{info:doi/10.2196/15188,
author="Goodday, Sarah M
and Atkinson, Lauren
and Goodwin, Guy
and Saunders, Kate
and South, Matthew
and Mackay, Clare
and Denis, Mike
and Hinds, Chris
and Attenburrow, Mary-Jane
and Davies, Jim
and Welch, James
and Stevens, William
and Mansfield, Karen
and Suvilehto, Juulia
and Geddes, John",
title="The True Colours Remote Symptom Monitoring System: A Decade of Evolution",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="15",
volume="22",
number="1",
pages="e15188",
keywords="symptom assessment; signs and symptoms; digital health; ecological momentary assessment; mood disorders",
doi="10.2196/15188",
url="https://www.jmir.org/2020/1/e15188",
url="https://doi.org/10.2196/15188",
url="http://www.ncbi.nlm.nih.gov/pubmed/31939746"
}


@Article{info:doi/10.2196/15645,
author="Prieto, Jos{\'e} Tom{\'a}s
and Scott, Kenneth
and McEwen, Dean
and Podewils, Laura J
and Al-Tayyib, Alia
and Robinson, James
and Edwards, David
and Foldy, Seth
and Shlay, Judith C
and Davidson, Arthur J",
title="The Detection of Opioid Misuse and Heroin Use From Paramedic Response Documentation: Machine Learning for Improved Surveillance",
journal="J Med Internet Res",
year="2020",
month="Jan",
day="3",
volume="22",
number="1",
pages="e15645",
keywords="naloxone; emergency medical services; natural language processing; heroin; substance-related disorders; opioid crisis; artificial intelligence",
abstract="Background: Timely, precise, and localized surveillance of nonfatal events is needed to improve response and prevention of opioid-related problems in an evolving opioid crisis in the United States. Records of naloxone administration found in prehospital emergency medical services (EMS) data have helped estimate opioid overdose incidence, including nonhospital, field-treated cases. However, as naloxone is often used by EMS personnel in unconsciousness of unknown cause, attributing naloxone administration to opioid misuse and heroin use (OM) may misclassify events. Better methods are needed to identify OM. Objective: This study aimed to develop and test a natural language processing method that would improve identification of potential OM from paramedic documentation. Methods: First, we searched Denver Health paramedic trip reports from August 2017 to April 2018 for keywords naloxone, heroin, and both combined, and we reviewed narratives of identified reports to determine whether they constituted true cases of OM. Then, we used this human classification as reference standard and trained 4 machine learning models (random forest, k-nearest neighbors, support vector machines, and L1-regularized logistic regression). We selected the algorithm that produced the highest area under the receiver operating curve (AUC) for model assessment. Finally, we compared positive predictive value (PPV) of the highest performing machine learning algorithm with PPV of searches of keywords naloxone, heroin, and combination of both in the binary classification of OM in unseen September 2018 data. Results: In total, 54,359 trip reports were filed from August 2017 to April 2018. Approximately 1.09{\%} (594/54,359) indicated naloxone administration. Among trip reports with reviewer agreement regarding OM in the narrative, 57.6{\%} (292/516) were considered to include information revealing OM. Approximately 1.63{\%} (884/54,359) of all trip reports mentioned heroin in the narrative. Among trip reports with reviewer agreement, 95.5{\%} (784/821) were considered to include information revealing OM. Combined results accounted for 2.39{\%} (1298/54,359) of trip reports. Among trip reports with reviewer agreement, 77.79{\%} (907/1166) were considered to include information consistent with OM. The reference standard used to train and test machine learning models included details of 1166 trip reports. L1-regularized logistic regression was the highest performing algorithm (AUC=0.94; 95{\%} CI 0.91-0.97) in identifying OM. Tested on 5983 unseen reports from September 2018, the keyword naloxone inaccurately identified and underestimated probable OM trip report cases (63 cases; PPV=0.68). The keyword heroin yielded more cases with improved performance (129 cases; PPV=0.99). Combined keyword and L1-regularized logistic regression classifier further improved performance (146 cases; PPV=0.99). Conclusions: A machine learning application enhanced the effectiveness of finding OM among documented paramedic field responses. This approach to refining OM surveillance may lead to improved first-responder and public health responses toward prevention of overdoses and other opioid-related problems in US communities. ",
doi="10.2196/15645",
url="https://www.jmir.org/2020/1/e15645",
url="https://doi.org/10.2196/15645",
url="http://www.ncbi.nlm.nih.gov/pubmed/31899451"
}


@Article{info:doi/10.2196/14035,
author="Savolainen, Iina
and Oksanen, Atte
and Kaakinen, Markus
and Sirola, Anu
and Paek, Hye-Jin",
title="The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study",
journal="JMIR Ment Health",
year="2020",
month="Jan",
day="2",
volume="7",
number="1",
pages="e14035",
keywords="youth; problem behavior; excessive alcohol consumption; internet; gambling; loneliness",
abstract="Background: In the ever-growing and technologically advancing world, an increasing amount of social interaction takes place through the Web. With this change, loneliness is becoming an unprecedented societal issue, making youth more susceptible to various physical and mental health problems. This societal change also influences the dynamics of addiction. Objective: Employing the cognitive discrepancy loneliness model, this study aimed to provide a social psychological perspective on youth addictions. Methods: A comprehensive survey was used to collect data from American (N=1212; mean 20.05, SD 3.19; 608/1212, 50.17{\%} women), South Korean (N=1192; mean 20.61, SD 3.24; 601/1192, 50.42{\%} women), and Finnish (N=1200; mean 21.29, SD 2.85; 600/1200, 50.00{\%} women) youths aged 15 to 25 years. Perceived loneliness was assessed with the 3-item Loneliness Scale. A total of 3 addictive behaviors were measured, including excessive alcohol use, compulsive internet use, and problem gambling. A total of 2 separate models using linear regression analyses were estimated for each country to examine the association between perceived loneliness and addiction. Results: Loneliness was significantly related to only compulsive internet use among the youth in all 3 countries (P<.001 in the United States, South Korea, and Finland). In the South Korean sample, the association remained significant with excessive alcohol use (P<.001) and problem gambling (P<.001), even after controlling for potentially confounding psychological variables. Conclusions: The findings reveal existing differences between youths who spend excessive amounts of time online and those who engage in other types of addictive behaviors. Experiencing loneliness is consistently linked to compulsive internet use across countries, although different underlying factors may explain other forms of addiction. These findings provide a deeper understanding in the mechanisms of youth addiction and can help improve prevention and intervention work, especially in terms of compulsive internet use. ",
doi="10.2196/14035",
url="https://mental.jmir.org/2020/1/e14035",
url="https://doi.org/10.2196/14035",
url="http://www.ncbi.nlm.nih.gov/pubmed/31895044"
}


@Article{info:doi/10.2196/13911,
author="Thabrew, Hiran
and D'Silva, Simona
and Darragh, Margot
and Goldfinch, Mary
and Meads, Jake
and Goodyear-Smith, Felicity",
title="Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial",
journal="J Med Internet Res",
year="2019",
month="Dec",
day="3",
volume="21",
number="12",
pages="e13911",
keywords="mass screening; adolescents; anxiety; depression; substance-related disorders; primary health care; school health services; eHealth",
abstract="Background: Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet--based composite screener for identifying similar psychosocial issues to HEEADSSS Objective: This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. Methods: A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly M{\={a}}ori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. Results: YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6{\%} vs 25/110, 22.7{\%}; P<.01), sexual health (24/110, 21.8{\%} vs 10/110, 9.1{\%}; P=.01), safety (65/110, 59.1{\%} vs 17/110, 15.5{\%}; P<.01), and physical inactivity (43/110, 39.1{\%} vs 21/110, 19.1{\%}; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27{\%}) than YouthCHAT (11/110, 10{\%}; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. Conclusions: This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check. Trial Registration: Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422. ",
doi="10.2196/13911",
url="https://www.jmir.org/2019/12/e13911",
url="https://doi.org/10.2196/13911",
url="http://www.ncbi.nlm.nih.gov/pubmed/31793890"
}


@Article{info:doi/10.2196/14751,
author="Kumpfer, Karol Linda
and Brown, Jaynie Litster",
title="A Parenting Behavior Intervention (the Strengthening Families Program) for Families: Noninferiority Trial of Different Program Delivery Methods",
journal="JMIR Pediatr Parent",
year="2019",
month="Nov",
day="18",
volume="2",
number="2",
pages="e14751",
keywords="parenting; youth drug prevention; family skills; DVD; Strengthening Families Program; internet; noninferiority trial",
abstract="Background: The Strengthening Families Program (SFP) is an evidence-based parent training and youth life skills and drug prevention program traditionally delivered in group settings. Families attend parent and youth classes conducted by trained facilitators. Recently, a 2-disk home-use DVD series was created with the same SFP skills as the group classes for parents and the youth to watch together at home. Additional lesson material was added that included healthy brain development, school success, anger management, dangers of alcohol and drugs, and mindfulness. The SFP DVD reduces SFP delivery costs for agencies and logistic burdens to families. Creative applications of the DVD include holding SFP DVD family discussion groups of multiple families and using SFP DVD video clips as part of a shorter 10-week group class version for parents and the youth. Objective: This study aimed to examine three different DVD implementation scenarios using a noninferiority trial, contrasting target outcomes with an age-matched sample culled from a national norm database of families who completed a standard SFP 14-week class. Methods: The partial eta-square was used to compare effect sizes between the different delivery modalities for relevant programmatic outcomes. We adjusted the effect sizes by demographic measures to determine whether there were site-specific features influencing program outcomes. Results: For the unadjusted effect size comparisons, 13 of the 15 indicated that the home-use DVD outperformed group norms with an average 0.13 effect size estimate difference across the comparisons (28{\%} improvement in the effect size for DVD condition). Comparisons of the home-use DVD condition with the mixed DVD use conditions showed no discernable pattern where one condition consistently outperformed another. Adjusted effect sizes still reinforced the superiority of the DVD conditions; however, there was some shrinkage in the effect sizes as expected with the inclusion of relevant covariates. Conclusions: The home-use DVD shows that it is possible to effectively deliver an affordable family-based intervention using alternative technology outside of the traditional group-based class format. In almost all of the comparisons, the DVD conditions outperformed the group norms, underscoring that low-cost DVDs or viewing the videos on the Web may provide a useful surrogate for costly group-based formats. Future studies may want to improve on the quasi-experimental design by examining programmatic differences based on delivery format using a randomized controlled trial, thus strengthening the causal framework regarding program effects. In addition, the assessment protocol relied on retrospective reporting, which, although this can limit response shift bias, does not separate data collection in time as with a true pre- and posttest design. ",
doi="10.2196/14751",
url="http://pediatrics.jmir.org/2019/2/e14751/",
url="https://doi.org/10.2196/14751",
url="http://www.ncbi.nlm.nih.gov/pubmed/31738176"
}


@Article{info:doi/10.2196/16325,
author="Zhang, Melvyn
and Ying, Jiangbo
and Amron, Syidda B
and Mahreen, Zaakira
and Song, Guo
and Fung, Daniel SS
and Smith, Helen E",
title="Making Sense of Negative Findings from Mobile Attention Bias Modification Interventions for Individuals with Addictive Disorders: Quantitative Feasibility Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Nov",
day="12",
volume="7",
number="11",
pages="e16325",
keywords="attention bias; cognitive bias; psychiatry",
abstract="Background: Advances in experimental psychology have led to a better understanding of unconscious, automatic processes that result in individuals relapsing into their substance-using habits. While some reviews have demonstrated the effectiveness of bias retraining of these unconscious biases, there have been other reviews that have highlighted that bias retraining is not always effective. Other studies have revealed there was no baseline biases among some participants. An examination of mobile bias retraining interventions has also revealed mixed results, with some reporting effectiveness and others null findings. A recent feasibility and acceptability study, done by the authors, revealed that 53{\%} of participants have had no baseline biases and 21{\%} of those with positive baseline biases did not have a positive change in magnitude following intervention. Objective: The aim of this paper was to explore potential variables (demographic and clinical) that could account for the negative baseline biases in the prior feasibility and acceptability study, and to discuss some of the factors that could account for the absence of baseline biases. We also explored potential reasons for why there was no reduction in the magnitude of attentional biases among individuals with baseline biases. Methods: Participants who were in the rehabilitation phase of their treatment were invited to participate. During the study they had to complete a set of baseline questionnaires, and on each day that they were on the ward they had to complete an attention bias assessment and modification task and rate their cravings using a visual analogue scale. Attention bias was deemed to be present if individuals had a positive score. Results: In our study, 53{\%} (16/30) of individuals did not present with baseline attentional biases, and among those with positive baseline biases a total of 21{\%} (3/14) of participants did not have a reduction in the overall magnitude of attentional biases. Chi-square analyses undertaken to compare the demographic characteristics of participants with and without baseline biases did not reveal any significant findings. However, with respect to clinical characteristics, those who had positive baseline biases had experimented with more substances. Conclusions: Our study is one of the first to have explored negative findings in attention bias modification interventions for individuals with addictive disorders. We postulate that several factors could account for the absence of baseline biases and there being no changes following bias retraining. Future research ought to take into consideration these factors. ",
doi="10.2196/16325",
url="http://mhealth.jmir.org/2019/11/e16325/",
url="https://doi.org/10.2196/16325",
url="http://www.ncbi.nlm.nih.gov/pubmed/31714248"
}


@Article{info:doi/10.2196/15794,
author="Chartash, David
and Paek, Hyung
and Dziura, James D
and Ross, Bill K
and Nogee, Daniel P
and Boccio, Eric
and Hines, Cory
and Schott, Aaron M
and Jeffery, Molly M
and Patel, Mehul D
and Platts-Mills, Timothy F
and Ahmed, Osama
and Brandt, Cynthia
and Couturier, Katherine
and Melnick, Edward",
title="Identifying Opioid Use Disorder in the Emergency Department: Multi-System Electronic Health Record--Based Computable Phenotype Derivation and Validation Study",
journal="JMIR Med Inform",
year="2019",
month="Oct",
day="31",
volume="7",
number="4",
pages="e15794",
keywords="electronic health records; emergency medicine; algorithms; phenotype; opioid-related disorders",
abstract="Background: Deploying accurate computable phenotypes in pragmatic trials requires a trade-off between precise and clinically sensical variable selection. In particular, evaluating the medical encounter to assess a pattern leading to clinically significant impairment or distress indicative of disease is a difficult modeling challenge for the emergency department. Objective: This study aimed to derive and validate an electronic health record--based computable phenotype to identify emergency department patients with opioid use disorder using physician chart review as a reference standard. Methods: A two-algorithm computable phenotype was developed and evaluated using structured clinical data across 13 emergency departments in two large health care systems. Algorithm 1 combined clinician and billing codes. Algorithm 2 used chief complaint structured data suggestive of opioid use disorder. To evaluate the algorithms in both internal and external validation phases, two emergency medicine physicians, with a third acting as adjudicator, reviewed a pragmatic sample of 231 charts: 125 internal validation (75 positive and 50 negative), 106 external validation (56 positive and 50 negative). Results: Cohen kappa, measuring agreement between reviewers, for the internal and external validation cohorts was 0.95 and 0.93, respectively. In the internal validation phase, Algorithm 1 had a positive predictive value (PPV) of 0.96 (95{\%} CI 0.863-0.995) and a negative predictive value (NPV) of 0.98 (95{\%} CI 0.893-0.999), and Algorithm 2 had a PPV of 0.8 (95{\%} CI 0.593-0.932) and an NPV of 1.0 (one-sided 97.5{\%} CI 0.863-1). In the external validation phase, the phenotype had a PPV of 0.95 (95{\%} CI 0.851-0.989) and an NPV of 0.92 (95{\%} CI 0.807-0.978). Conclusions: This phenotype detected emergency department patients with opioid use disorder with high predictive values and reliability. Its algorithms were transportable across health care systems and have potential value for both clinical and research purposes. ",
doi="10.2196/15794",
url="http://medinform.jmir.org/2019/4/e15794/",
url="https://doi.org/10.2196/15794",
url="http://www.ncbi.nlm.nih.gov/pubmed/31674913"
}


@Article{info:doi/10.2196/11841,
author="Zhang, Melvyn
and Ying, Jiangbo
and Song, Guo
and Fung, Daniel S S
and Smith, Helen",
title="Web-Based Cognitive Bias Modification Interventions for Psychiatric Disorders: Scoping Review",
journal="JMIR Ment Health",
year="2019",
month="Oct",
day="24",
volume="6",
number="10",
pages="e11841",
keywords="cognitive bias; attention bias; psychiatry; eHealth",
abstract="Background: Cognitive biases refer to automatic attentional or interpretational tendencies, which result in individuals with addictive disorders to automatically attend to substance-related stimuli and those with anxiety disorders to attend to threatening stimuli. To date, several studies have examined the efficacy of cognitive bias modification, and meta-analytical studies have synthesized the evidence for overall efficacy. The clinical utility of cognitive bias modification interventions has previously been limited to the confines of a laboratory, but recent advances in Web technologies can change this. Objective: This scoping review aimed to determine the scope of Web-based cognitive bias interventions and highlight their effectiveness. Methods: Databases (PubMed and MEDLINE, EMBASE, PsycINFO, ScienceDirect, and Cochrane Central) were searched from inception to December 5, 2017. The following search terminologies were used: (``attention bias'' OR ``cognitive bias'' OR ``approach bias'' OR ``avoidance bias'' OR ``interpretative bias'') AND (``Internet'' OR ``Web'' OR ``Online''). The methods for this scoping review are based on the previously published protocol. For the synthesis of the evidence, a narrative synthesis was undertaken, as a meta-analysis was not appropriate, given the lack of reported effect sizes and the heterogeneity in the outcomes reported. Results: Of the 2674 unique articles identified, we identified 22 randomized controlled studies that met our inclusion criteria: alcohol use disorder (n=2), tobacco use disorder (n=2), depressive disorder (n=3), anxiety and depressive symptoms in adolescents (n=3), obsessive-compulsive disorder (OCD; n=2), social anxiety disorder (n=9), and anxiety disorder (n=1). The sample sizes of these studies ranged from 16 to 434 participants. There is preliminary evidence to suggest that Web-based interventions could reduce biases among adolescents with heightened symptoms of anxiety and depression and among individuals with OCD. Conclusions: This is the first scoping review that mapped out the scope of cognitive bias modification interventions for psychiatric disorders. Web-based interventions have been applied predominantly for social anxiety and addictive disorders. Larger cohorts must be used in future studies to better determine the effectiveness of Web-based cognitive bias interventions. International Registered Report Identifier (IRRID): RR1-10.2196/10427 ",
doi="10.2196/11841",
url="http://mental.jmir.org/2019/10/e11841/",
url="https://doi.org/10.2196/11841",
url="http://www.ncbi.nlm.nih.gov/pubmed/31651410"
}


@Article{info:doi/10.2196/13593,
author="Cooper, Hannah Luke Fenimore
and Crawford, Natalie D
and Haard{\"o}rfer, Regine
and Prood, Nadya
and Jones-Harrell, Carla
and Ibragimov, Umedjon
and Ballard, April M
and Young, April M",
title="Using Web-Based Pin-Drop Maps to Capture Activity Spaces Among Young Adults Who Use Drugs in Rural Areas: Cross-Sectional Survey",
journal="JMIR Public Health Surveill",
year="2019",
month="Oct",
day="18",
volume="5",
number="4",
pages="e13593",
keywords="rural; substance use disorder; Web-based data collection; geospatial methods; risk environment; activity spaces",
abstract="Background: Epicenters of harmful drug use are expanding to US rural areas, with rural young adults bearing a disproportionate burden. A large body of work suggests that place characteristics (eg, spatial access to health services) shape vulnerability to drug-related harms among urban residents. Research on the role of place characteristics in shaping these harms among rural residents is nascent, as are methods of gathering place-based data. Objective: We (1) analyzed whether young rural adults who used drugs answered self-administered Web-based mapping items about locations where they engaged in risk behaviors and (2) determined the precision of mapped locations. Methods: Eligible individuals had to report recently using opioids to get high; be aged between 18 and 35 years; and live in the 5-county rural Appalachian Kentucky study area. We used targeted outreach and peer-referral methods to recruit participants. The survey asked participants to drop a pin in interactive maps to mark where they completed the survey, and where they had slept most; used drugs most; and had sex most in the past 6 months. Precision was assessed by (1) determining whether mapped locations were within 100 m of a structure and (2) calculating the Euclidean distance between the pin-drop home location and the street address where participants reported sleeping most often. Measures of central tendency and dispersion were calculated for all variables; distributions of missingness for mapping items and for the Euclidean distance variable were explored across participant characteristics. Results: Of the 151 participants, 88.7{\%} (134/151) completed all mapping items, and ≥92.1{\%} (>139/151) dropped a pin at each of the 4 locations queried. Missingness did not vary across most participant characteristics, except that lower percentages of full-time workers and peer-recruited participants mapped some locations. Two-thirds of the pin-drop sex and drug use locations were less than 100 m from a structure, as were 92.1{\%} (139/151) of pin-drop home locations. The median distance between the pin-drop and street-address home locations was 2.0 miles (25th percentile=0.8 miles; 75th percentile=5.5 miles); distances were shorter for high-school graduates, staff-recruited participants, and participants reporting no technical difficulties completing the survey. Conclusions: Missingness for mapping items was low and unlikely to introduce bias, given that it varied across few participant characteristics. Precision results were mixed. In a rural study area of 1378 square miles, most pin-drop home addresses were near a structure; it is unsurprising that fewer drug and sex locations were near structures because most participants reported engaging in these activities outside at times. The error in pin-drop home locations, however, might be too large for some purposes. We offer several recommendations to strengthen future research, including gathering metadata on the extent to which participants zoom in on each map and recruiting participants via trusted staff. ",
doi="10.2196/13593",
url="https://publichealth.jmir.org/2019/4/e13593",
url="https://doi.org/10.2196/13593",
url="http://www.ncbi.nlm.nih.gov/pubmed/31628787"
}


@Article{info:doi/10.2196/13691,
author="Bagot, Kara
and Hodgdon, Elizabeth
and Sidhu, Natasha
and Patrick, Kevin
and Kelly, Mikaela
and Lu, Yang
and Bath, Eraka",
title="End User--Informed Mobile Health Intervention Development for Adolescent Cannabis Use Disorder: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="4",
volume="7",
number="10",
pages="e13691",
keywords="adolescent; cannabis; mobile health; treatment; smartphone",
abstract="Background: The rates of cannabis use continue to increase among adolescents and the current interventions have modest effects and high rates of relapse following treatment. There is increasing evidence for the efficacy of mobile technology--based interventions for adults with substance use disorders, but there is limited study of this technology in adolescents who use cannabis. Objective: The goal of our study was to elucidate elements of an app-based adjunctive intervention for cannabis cessation that resonate with adolescents who use cannabis. Methods: Adolescents, aged between 14 and 17 years, who used cannabis were recruited from San Diego County high schools. Semistructured focus groups (6 total; N=37) were conducted to examine the ways in which participants used smartphones, including the use of any health behavior change apps, as well as to elicit opinions about elements that would promote engagement with an app-based intervention for adolescent cannabis cessation. An iterative coding structure was used with first cycle structural coding, followed by pattern coding. Results: Themes that emerged from the analysis included (1) youth valued rewards to incentivize the progressive reduction of cannabis use, which included both nontangible rewards that mimic those obtained on social media platforms and prosocial activity-related rewards, (2) having the ability to self-monitor progression, (3) peer social support, (4) privacy and confidentiality discrete logo and name and usernames within the app, and (5) individualizing frequency and content of notifications and reminders. Conclusions: Integrating content, language, interfaces, delivery systems, and rewards with which adolescents who use cannabis are familiar, engage with on a day-to-day basis, and identify as relevant, may increase treatment engagement and retention for adolescents in substance use treatment. We may increase treatment effectiveness by adapting and individualizing current evidence-based interventions, so that they target the needs of adolescents and are more easily incorporated into their everyday routines. ",
doi="10.2196/13691",
url="https://mhealth.jmir.org/2019/10/e13691",
url="https://doi.org/10.2196/13691",
url="http://www.ncbi.nlm.nih.gov/pubmed/31588909"
}


@Article{info:doi/10.2196/15871,
author="Zhang, Melvyn
and Heng, Sandor
and Song, Guo
and Fung, Daniel SS
and Smith, Helen E",
title="Co-designing a Mobile Gamified Attention Bias Modification Intervention for Substance Use Disorders: Participatory Research Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Oct",
day="3",
volume="7",
number="10",
pages="e15871",
keywords="attention bias; cognitive bias; gamification; participatory design research; psychiatry; apps; mobile intervention",
abstract="Background: Advances in experimental psychology have highlighted the need to modify underlying automatic cognitive biases, such as attentional biases. The effectiveness of bias modification has been well studied for substance use disorders. With recent advances in technology, it is now possible to work outside the laboratory with Web-based and mobile-based attention bias interventions. Gamification technologies might also help diminish the repetitiveness of the task and increase the intrinsic motivation to train. The inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. Objective: The aim of this study was to involve patients, together with health care professionals, in the design of a gamified mobile attention bias modification intervention for substance use disorders. Methods: The participatory design research method adopted is that of a user-oriented design approach in the form of a future workshop. In the first phase of the workshop, participants shared their critique of an attention bias modification intervention. In the second phase of the workshop, participants were asked to brainstorm features. Participants were also shown gamification approaches and asked to consider if gaming elements could enhance the existing app. In the last phase, participants were asked to sketch a new prototype. Results: Three co-design workshops were conducted with health care professionals, inpatients, and outpatients. There were 20 participants, consisting of 10 health care professionals and 10 patients. When asked to identify the limitations in the existing app, common issues identified were those of the design, visual probe task, and the included images. Outpatients were also concerned with the safety of administration of the intervention. In the brainstorming sessions, health care professionals made recommendations as to how the stimulus, the mechanism of responding, and the presentation of the scores could be enhanced. Inpatient participants recommended the addition of functionalities, such as information on the harms associated with the substance use, and for there to be enhancements in the design, images, and task. Outpatient participants perceived a need to improve the images and presentation of the results and recommended the inclusion of gaming features. There were differences in opinion on the inclusion of gaming features, as only health care professionals endorsed their inclusion. In the last phase of the workshop, participants were tasked with the conceptualization of prototypes, and the commonality in the design was for a gradual shortening of the interval for stimulus/image presentation. Conclusions: The results from this research will guide the development of an app that meets the specific needs of patients and is still based on a pre-existing validated task paradigm. {\emspace} ",
doi="10.2196/15871",
url="https://mhealth.jmir.org/2019/10/e15871",
url="https://doi.org/10.2196/15871",
url="http://www.ncbi.nlm.nih.gov/pubmed/31584003"
}


@Article{info:doi/10.2196/14011,
author="Ellway, Daniel
and Reilly, Rachel
and Le Couteur, Amanda
and Ward, James",
title="Exploring How People Affected by Methamphetamine Exchange Social Support Through Online Interactions on Facebook: Content Analysis",
journal="JMIR Ment Health",
year="2019",
month="Oct",
day="1",
volume="6",
number="10",
pages="e14011",
keywords="methamphetamine; social media; social support",
abstract="Background: Methamphetamine is an illicit and addictive psychostimulant that remains to be a significant cause of economic burden in Australia. Social media is increasingly being used by nongovernment organizations and health services to encourage the growth of social support networks among people with health-related issues. Several studies have investigated the utility of social media in providing social support to groups of people with health-related issues. However, limited research exists that explores how people who have been directly or indirectly affected by methamphetamine use social media for social support. Objective: This study aimed to determine the types of social support being sought and provided by people affected by methamphetamine when interacting with others on a Facebook page. Methods: A total of 14,777 posts were collected from a Facebook page and transferred into an Excel document for content analysis. The posts were manually coded into categories of social support using an adapted version of Cutrona and Suhr's Social Support Behavior Code. Posts could be coded into more than one category. Saturation was reached at 2000 posts, which were used to draw inferences. Results: Emotional support was the most offered support type, with 42.05{\%} (841/2000) of posts providing this form of support. This is followed by esteem support, which was provided in 40.40{\%} (808/2000) of posts. Overall, 24.20{\%} (484/2000) of posts offered informational support. Network support and tangible support were the least offered support types, with 2.25{\%} (45/2000) and 1.70{\%} (34/2000) of posts offering these types of support, respectively. Conclusions: This study suggests that online social support groups can be effective in challenging stigma by encouraging people affected by methamphetamine to connect with each other and talk about their struggles. This in turn represents an important step toward successful rehabilitation. ",
doi="10.2196/14011",
url="https://mental.jmir.org/2019/10/e14011",
url="https://doi.org/10.2196/14011",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573926"
}


@Article{info:doi/10.2196/12407,
author="Ryan-Pettes, Stacy R
and Lange, Lindsay L
and Magnuson, Katherine I",
title="Mobile Phone Access and Preference for Technology-Assisted Aftercare Among Low-Income Caregivers of Teens Enrolled in Outpatient Substance Use Treatment: Questionnaire Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Sep",
day="26",
volume="7",
number="9",
pages="e12407",
keywords="mobile phones; text messaging; substance use treatment; mhealth; parenting; aftercare",
abstract="Background: Improvements in parenting practices can positively mediate the outcomes of treatment for adolescent substance use disorder. Given the high rates of release among adolescents (ie, 60{\%} within three months and 85{\%} within  one year), there is a critical need for interventions focused on helping parents achieve and maintain effective parenting practices posttreatment. Yet, research suggests that engaging parents in aftercare services is difficult, partly due to systemic-structural and personal barriers. One way to increase parent use of aftercare services may be to offer mobile health interventions, given the potential for wide availability and on-demand access. However, it remains unclear whether mobile phone--based aftercare support for caregivers of substance-using teens is feasible or desired. Therefore, formative work in this area is needed. Objective: This study aims to determine the feasibility and acceptability of mobile phone--based aftercare support in a population of caregivers with teens in treatment for substance use. Methods: Upon enrollment in a treatment program, 103 caregivers completed a mobile phone use survey, providing information about mobile phone ownership, access, and use. Caregivers also provided a response to items assessing desire for aftercare services, in general; desire for mobile phone--based aftercare services specifically; and desire for parenting specific content as part of aftercare services. Research assistants also monitored clinic calls made to caregivers' mobile phones to provide an objective measure of the reliability of phone service. Results: Most participants were mothers (76.7{\%}) and self-identified as Hispanic (73.8{\%}). The average age was 42.60 (SD 9.28) years. A total of 94{\%} of caregivers owned a mobile phone. Most had pay-as-you-go phone service (67{\%}), and objective data suggest this did not impede accessibility. Older caregivers more frequently had a yearly mobile contract. Further, older caregivers and caregivers of adolescent girls had fewer disconnections. Bilingual caregivers used text messaging less often; however, caregivers of adolescent girls used text messaging more often. Although 72{\%} of caregivers reported that aftercare was needed, 91{\%} of caregivers endorsed a desire for mobile phone--based aftercare support in parenting areas that are targets of evidence-based treatments. Conclusions: The results suggest that mobile phones are feasible and desired to deliver treatments that provide support to caregivers of teens discharged from substance use treatment. Consideration should be given to the age of caregivers when designing these programs. Additional research is needed to better understand mobile phone use patterns based on a child's gender and among bilingual caregivers. ",
doi="10.2196/12407",
url="https://mhealth.jmir.org/2019/9/e12407",
url="https://doi.org/10.2196/12407",
url="http://www.ncbi.nlm.nih.gov/pubmed/31573920"
}


@Article{info:doi/10.2196/15465,
author="Zhang, Melvyn
and Ying, Jiangbo
and Amron, Syidda B
and Mahreen, Zaakira
and Song, Guo
and Fung, Daniel S S
and Smith, Helen Elizabeth",
title="A Smartphone Attention Bias App for Individuals With Addictive Disorders: Feasibility and Acceptability Study",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Sep",
day="12",
volume="7",
number="9",
pages="e15465",
keywords="attention bias; cognitive bias; psychiatry; substance abuse; alcohol abuse; opioid abuse; cannabis abuse; addiction; digital health; mhealth",
abstract="Background: Conventional psychology therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psychology have led to a better understanding of attention and approach biases and methods to modify these biases. Several studies have demonstrated the effectiveness of bias modification among clinical cohorts. The advances in mobile health technologies have allowed remote delivery of these interventions. To date, there is a lack of studies examining bias modification in a substance-using non-Western sample. Objective: This study was designed to determine the feasibility of an attention bias modification intervention and an attention bias modification smartphone app for the reduction of attention biases among treatment-seeking individuals. The secondary aim is to determine the acceptability of the intervention. Methods: A feasibility study was conducted among inpatients who were in their rehabilitation phase at the National Addictions Management Service. Participants were to complete a set of baseline questionnaires, and on each day that they are in the study, undertake an attention bias assessment and modification task while completing a visual analogue scale to assess their craving. Feasibility was determined by the acceptance rate of participation and participants' adherence to the interventions. Acceptability was assessed by a perception questionnaire. Descriptive statistical analyses were performed using SPSS version 22. A thematic analysis approach was used in the qualitative synthesis of users' perceptions. Results: Of the 40 participants invited to participate in the feasibility study, 10 declined, yielding an acceptance rate of 75{\%}. Of the recruited participants, 6 participants were diagnosed with alcohol dependence; 17, with opioid dependence; 2, with cannabis dependence; and 5, with stimulant dependence. In addition, of the final 30 participants, 11 (37{\%}) failed to complete all the planned interventions and 22 (73{\%}) completed the perspective questionnaires; of these 22 participants, 100{\%} rated the app as extremely and very easy, 77{\%} rated it as extremely or very interactive, 54{\%} rated it as extremely or very motivating, and 33{\%} reported a change in their confidence levels. Conclusions: Our results highlight the feasibility of recruiting participants to undertake attention bias modification interventions. Participants generally accept use of a mobile version of such an intervention. Nevertheless, our acceptability data indicate that there could be improvements in the existing app, and a participatory design approach might be helpful in its future conceptualization. International Registered Report Identifier (IRRID): RR2-10.2196/11822 ",
doi="10.2196/15465",
url="http://mhealth.jmir.org/2019/9/e15465/",
url="https://doi.org/10.2196/15465",
url="http://www.ncbi.nlm.nih.gov/pubmed/31586359"
}


@Article{info:doi/10.2196/15298,
author="Gassman, Ruth Ann
and Dutta, Tapati
and Agley, Jon
and Jayawardene, Wasantha
and Jun, Mikyoung",
title="Social Media Outrage in Response to a School-Based Substance Use Survey: Qualitative Analysis",
journal="J Med Internet Res",
year="2019",
month="Sep",
day="12",
volume="21",
number="9",
pages="e15298",
keywords="social media; ATOD; survey; firestorm; digital",
abstract="Background: School-based alcohol, tobacco, and other drug use (ATOD) surveys are a common epidemiological means of understanding youth risk behaviors. They can be used to monitor national trends and provide data, in aggregate, to schools, communities, and states for the purposes of funding allocation, prevention programming, and other supportive infrastructure. However, such surveys sometimes are targeted by public criticism, and even legal action, often in response to a lack of perceived appropriateness. The ubiquity of social media has added the risk of potential online firestorms, or digital outrage events, to the hazards to be considered when administering such a survey. Little research has investigated the influence of online firestorms on public health survey administration, and no research has analyzed the content of such an occurrence. Analyzing this content will facilitate insights as to how practitioners can minimize the risk of generating outrage when conducting such surveys. Objective: This study aimed to identify common themes within social media comments comprising an online firestorm that erupted in response to a school-based ATOD survey in order to inform risk-reduction strategies. Methods: Data were collected by archiving all public comments made in response to a news study about a school-based ATOD survey that was featured on a common social networking platform. Using the general inductive approach and elements of thematic analysis, two researchers followed a multi-step protocol to clean, categorize, and consolidate data, generating codes for all 207 responses. Results: In total, 133 comments were coded as oppositional to the survey and 74 were coded as supportive. Among the former, comments tended to reflect government-related concerns, conspiratorial or irrational thinking, issues of parental autonomy and privacy, fear of child protective services or police, issues with survey mechanisms, and reasoned disagreement. Among the latter, responses showed that posters perceived the ability to prevent abuse and neglect and support holistic health, surmised that opponents were hiding something, expressed reasoned support, or made factual statements about the survey. Consistent with research on moral outrage and digital firestorms, few comments (<10{\%}) contained factual information about the survey; nearly half of the comments, both supportive and oppositional, were coded in categories that presupposed misinformation. Conclusions: The components of even a small online firestorm targeting a school-based ATOD survey are nuanced and complex. It is likely impossible to be fully insulated against the risk of outrage in response to this type of public health work; however, careful articulation of procedures, anticipating specific concerns, and two-way community-based interaction may reduce risk. ",
doi="10.2196/15298",
url="http://www.jmir.org/2019/9/e15298/",
url="https://doi.org/10.2196/15298",
url="http://www.ncbi.nlm.nih.gov/pubmed/31516129"
}


@Article{info:doi/10.2196/13352,
author="Curtis, Brenda
and Bergman, Brandon
and Brown, Austin
and McDaniel, Jessica
and Harper, Kristen
and Eisenhart, Emily
and Hufnagel, Mariel
and Heller, Anne Thompson
and Ashford, Robert",
title="Characterizing Participation and Perceived Engagement Benefits in an Integrated Digital Behavioral Health Recovery Community for Women: A Cross-Sectional Survey",
journal="JMIR Ment Health",
year="2019",
month="Aug",
day="26",
volume="6",
number="8",
pages="e13352",
keywords="substance use disorder; mHealth; mental health; substance addiction; rehabilitation",
abstract="Background: Research suggests that digital recovery support services (D-RSSs) may help support individual recovery and augment the availability of in-person supports. Previous studies highlight the use of D-RSSs in supporting individuals in recovery from substance use but have yet to examine the use of D-RSSs in supporting a combination of behavioral health disorders, including substance use, mental health, and trauma. Similarly, few studies on D-RSSs have evaluated gender-specific supports or integrated communities, which may be helpful to women and individuals recovering from behavioral health disorders. Objective: The goal of this study was to evaluate the SHE RECOVERS (SR) recovery community, with the following 3 aims: (1) to characterize the women who engage in SR (including demographics and recovery-related characteristics), (2) describe the ways and frequency in which participants engage with SR, and (3) examine the perception of benefit derived from engagement with SR. Methods: This study used a cross-sectional survey to examine the characteristics of SR participants. Analysis of variance and chi-square tests, as well as univariate logistic regressions, were used to explore each aim. Results: Participants (N=729, mean age 46.83 years; 685/729, 94{\%} Caucasian) reported being in recovery from a variety of conditions, although the most frequent nonexclusive disorder was substance use (86.40{\%}, n=630). Participants had an average length in recovery (LIR) of 6.14 years (SD 7.87), with most having between 1 and 5 years (n=300). The most frequently reported recovery pathway was abstinence-based 12-step mutual aid (38.40{\%}). Participants reported positive perceptions of benefit from SR participation, which did not vary by LIR or recovery pathway. Participants also had high rates of agreement, with SR having a positive impact on their lives, although this too did vary by recovery length and recovery pathway. Participants with 1 to 5 years of recovery used SR to connect with other women in recovery at higher rates, whereas those with less than 1 year used SR to ask for resources at higher rates, and those with 5 or more years used SR to provide support at higher rates. Lifetime engagement with specific supports of SR was also associated with LIR and recovery pathway. Conclusions: Gender-specific and integrated D-RSSs are feasible and beneficial from the perspective of participants. D-RSSs also appear to provide support to a range of recovery typologies and pathways in an effective manner and may be a vital tool for expanding recovery supports for those lacking in access and availability because of geography, social determinants, or other barriers. ",
doi="10.2196/13352",
url="http://mental.jmir.org/2019/8/e13352/",
url="https://doi.org/10.2196/13352",
url="http://www.ncbi.nlm.nih.gov/pubmed/31452520"
}


@Article{info:doi/10.2196/12620,
author="Hochstatter, Karli R
and Gustafson Sr, David H
and Landucci, Gina
and Pe-Romashko, Klaren
and Maus, Adam
and Shah, Dhavan V
and Taylor, Quinton A
and Gill, Emma K
and Miller, Rebecca
and Krechel, Sarah
and Westergaard, Ryan P",
title="A Mobile Health Intervention to Improve Hepatitis C Outcomes Among People With Opioid Use Disorder: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2019",
month="Aug",
day="01",
volume="8",
number="8",
pages="e12620",
keywords="mHealth; eHealth; hepatitis C virus; substance use; continuum of care",
abstract="Background: People who inject drugs are at a disproportionate risk for contracting hepatitis C virus (HCV). However, use of HCV prevention and treatment services remains suboptimal among people with substance use disorders due to various health system, societal, and individual barriers. Mobile health applications offer promising strategies to support people in recovery from substance use disorders. We sought to determine whether the Addiction-Comprehensive Health Enhancement Support System (A-CHESS), an existing mobile health application for opioid use disorder, could be adapted to improve HCV screening and treatment. Objective: The goals of this paper are to describe: (1) the components and functionality of an HCV intervention incorporated into the existing A-CHESS system; and (2) how data are collected and will be used to evaluate HCV testing, linkage to care, and treatment. Methods: People with recent opioid use were enrolled in a randomized controlled trial to test whether A-CHESS reduced relapse. We developed and implemented HCV intervention content within the A-CHESS platform to simultaneously evaluate whether A-CHESS improved secondary outcomes related to HCV care. All A-CHESS users received the HCV intervention content, which includes educational information, private messages tailored to an individual's stage of HCV care, and a public discussion forum. Data on patients' HCV risk behaviors and stage of care were collected through quarterly telephone interviews and weekly surveys delivered through A-CHESS. The proportion of people with opioid use disorder who are HCV untested, HCV-negative, HCV antibody-positive, or HCV RNA--positive, as well as linked to care, treated and cured at baseline is described here. The 24-month follow-up is ongoing and will be completed in April 2020. Survey data will then be used to assess whether individuals who received the HCV-enhanced A-CHESS intervention were more likely to reduce risky injection behaviors, receive HCV testing, link to medical care, initiate treatment, and be cured of HCV compared to the control group. Results: Between April 2016 and April 2018, 416 individuals were enrolled and completed the baseline interview. Of these individuals, 207 were then randomly assigned to the control arm and 209 were assigned to the intervention arm. At baseline, 202 individuals (49{\%}) self-reported ever testing HCV antibody-positive. Of those, 179 (89{\%}) reported receiving HCV RNA confirmatory testing, 134 (66{\%}) tested HCV RNA--positive, 125 (62{\%}) were linked to medical care and 27 (13{\%}) were treated and cured of HCV. Of the remaining 214 individuals who had never tested HCV antibody--positive, 129 (31{\%}) had tested HCV antibody--negative within the past year and 85 (20{\%}) had not been tested within the past year. Conclusions: The A-CHESS mobile health system allows for the implementation of a bundle of services as well as the collection of longitudinal data related to drug use and HCV care among people with opioid use disorders. This study will provide preliminary evidence to determine whether HCV-specific services embedded into the A-CHESS program can improve HCV outcomes for people engaged in addiction treatment. Trial Registration: ClinicalTrials.gov NCT02712034; https://clinicaltrials.gov/ct2/show/NCT02712034 International Registered Report Identifier (IRRID): DERR1-10.2196/12620 ",
doi="10.2196/12620",
url="https://www.researchprotocols.org/2019/8/e12620/",
url="https://doi.org/10.2196/12620",
url="http://www.ncbi.nlm.nih.gov/pubmed/31373273"
}


@Article{info:doi/10.2196/12389,
author="Moore, Sarah K
and Grabinski, Michael
and Bessen, Sarah
and Borodovsky, Jacob T
and Marsch, Lisa A",
title="Web-Based Prescription Opioid Abuse Prevention for Adolescents: Program Development and Formative Evaluation",
journal="JMIR Form Res",
year="2019",
month="Jul",
day="19",
volume="3",
number="3",
pages="e12389",
keywords="opioids; prevention and control; adolescent; randomized controlled trial; internet",
abstract="Background: The unprecedented number of youths engaged in nonmedical use of prescription opioids (POs), as well as the myriad negative consequences of such misuse, emphasizes the importance of prevention efforts targeting this public health crisis. Although there are several science-based, interactive drug abuse prevention programs focused on preventing the use of nonprescription drugs in youths, to our knowledge, there are no science-based interactive programs that focus on the prevention of PO abuse among adolescents. Objective: The aim of this study was to develop and conduct a formative evaluation of a science-based interactive Web-based program focused on the prevention of PO abuse among adolescents aged 12 to 17 years (Pop4Teens). This study was conducted to prepare for a randomized controlled trial designed to evaluate the effectiveness of Pop4Teens compared with an active control website, JustThinkTwice.com (Drug Enforcement Administration), in impacting knowledge and attitudes about POs and perceptions of risk associated with the abuse of POs, as well as intentions to use and actual use of POs. Methods: We conducted 6 focus groups with 30 youths (a mean of 5 per group: the eligibility being aged 12-19 years) along a continuum of exposure to POs (in treatment for opioid use disorder, in general treatment for other substance use disorder, prescribed an opioid, and opioid-na{\"i}ve) and writing sessions with 30 youths in treatment for opioid use disorder (12-19 years) to inform the development of the Web-based prevention tool. Feasibility and acceptability of a prototype of the Web-based intervention were then assessed through individual feedback sessions with 57 youths (drawn from the same populations as the focus groups). Results: We successfully completed the development of a Web-based PO abuse prevention program (Pop4Teens). Analyses of focus group transcripts informed the development of the program (eg, quiz content/format, script writing, and story editing). Selected writing session narratives anchored the planned scientific content by lending credibility and informing the development of compelling storylines intended to motivate the youth to engage with the program. Feedback session data indicated that the Web-based tool could be potentially useful and acceptable. In addition, feedback session participants demonstrated significant increases in their knowledge of key topics related to the prevention of PO abuse after the exposure to sections of the Web-based program. Conclusions: The opioid crisis is predicted to get worse before it gets better. An effective response will likely require a multipronged strategy inclusive of effective evidence-based prevention programs acceptable to, and accessible by, a majority of youths. ",
doi="10.2196/12389",
url="http://formative.jmir.org/2019/3/e12389/",
url="https://doi.org/10.2196/12389",
url="http://www.ncbi.nlm.nih.gov/pubmed/31325289"
}


@Article{info:doi/10.2196/13015,
author="Starks, Tyrel J
and Robles, Gabriel
and Pawson, Mark
and Jimenez, Ruben H
and Gandhi, Monica
and Parsons, Jeffrey T
and Millar, Brett M",
title="Motivational Interviewing to Reduce Drug Use and HIV Incidence Among Young Men Who Have Sex With Men in Relationships and Are High Priority for Pre-Exposure Prophylaxis (Project PARTNER): Randomized Controlled Trial Protocol",
journal="JMIR Res Protoc",
year="2019",
month="Jul",
day="04",
volume="8",
number="7",
pages="e13015",
keywords="HIV; pre-exposure prophylaxis; substance-related disorders; sexual behavior; sexual partners",
abstract="Background: Men who have sex with men (MSM) currently account for more than two-thirds of new HIV diagnoses in the United States and, among young MSM (YMSM) aged 20 to 29 years, as many as 79{\%} to 84{\%} of new infections occur between primary partners. Contributing to HIV risk, YMSM use drugs at comparatively high rates. To date, no interventions have been developed that specifically address the unique needs of partnered YMSM or incorporate a focus on relationship factors in addressing personal motivation for change. Objective: The study's primary aim is to evaluate the efficacy of the PARTNER intervention and evaluate potential moderators or mediators of intervention effects. The study's secondary aims were to gather ideographic data to inform a future effectiveness implementation study and develop a novel biomarker for pre-exposure prophylaxis (PrEP) adherence by analyzing PrEP drug levels in fingernails. Methods: PARTNER is a 4-session motivational interviewing--based intervention that integrates video-based communication training to address drug use and HIV prevention among partnered YMSM. This study utilizes a randomized controlled trial design to compare the PARTNER intervention with an attention-matched psychoeducation control arm that provides information about HIV-risk reduction, PrEP, and substance use. Participants are randomized in a 1-to-1 ratio stratified on age disparity between partners, racial composition of the couple, and relationship length. Follow-up assessments are conducted at 3-, 6-, 9-, and 12-months postbaseline. The study recruits and enrolls 240 partnered YMSM aged between 18 to 29 years at a research center in New York City. Participants will be HIV-negative and report recent (past 30-day) drug use and condomless anal sex with casual partners; a nonmonogamous primary partner (regardless of HIV status); or a serodiscordant primary partner (regardless of sexual agreement). Primary outcomes (drug use and HIV sexual transmission risk behavior) are assessed via a Timeline Follow-back interview. Biological markers of outcomes are collected for drug use (fingernail assay), sexual HIV transmission risk (rectal and urethral gonorrhea and chlamydia testing), and PrEP adherence (dried blood spots and fingernails for a novel PrEP drug level assay). Results: The study opened for enrollment in February 2018. Anticipated completion of enrollment is October 2021. Primary outcome analyses will begin after final follow-up completion. Conclusions: Existing research on partnered YMSM within the framework of Couples Interdependence Theory (CIT) has suggested that relationship factors (eg, dyadic functioning and sexual agreements) are meaningfully related to drug use and HIV transmission risk. Results pertaining to the efficacy of the proposed intervention and the identification of putative moderators and mediators will substantially inform the tailoring of interventions for YMSM in relationships and contribute to a growing body of relationship science focused on enhancing health outcomes. Trial Registration: ClinicalTrials.gov NCT03396367; https://clinicaltrials.gov/ct2/show/NCT03396367 (Archived by WebCite at http://www.webcitation.org/78ti7esTc. International Registered Report Identifier (IRRID): DERR1-10.2196/13015 ",
doi="10.2196/13015",
url="https://www.researchprotocols.org/2019/7/e13015/",
url="https://doi.org/10.2196/13015",
url="http://www.ncbi.nlm.nih.gov/pubmed/31274114"
}


@Article{info:doi/10.2196/12984,
author="Ballard, April M
and Cooper, Hannah LF
and Young, April M",
title="Web-Based Eligibility Quizzes to Verify Opioid Use and County Residence Among Rural Young Adults: Eligibility Screening Results from a Feasibility Study",
journal="JMIR Res Protoc",
year="2019",
month="Jun",
day="18",
volume="8",
number="6",
pages="e12984",
keywords="Web-based methods; eligibility determination; rural health; substance-related disorders; opioid use; surveys and questionnaires; internet; confidentiality; sampling methods; recruitment",
abstract="Background: Web-based methods can be used to collect data from hidden populations, including people who use drugs (PWUD). These methods might be especially advantageous among PWUD in rural areas, where transportation barriers are prevalent, stigma may heighten concerns about confidentiality, and internet access is improving. However, Web-based research with PWUD can be challenging, especially in verifying eligibility. Administering quizzes to verify residential and substance use eligibility could prove valuable in online research among PWUD, yet the utility of this approach is currently unknown. Objective: This study describes the implementation of online eligibility quizzes about the local community to verify residence in the target study area along with drug dose, appearance, and price to verify opioid misuse. Methods: To be eligible, individuals had to live in 1 of 5 eastern Kentucky counties, report using opioids to get high in the past 30 days, and be 18 to 35 years old. Participants recruited from August 2017 to July 2018 were asked questions about their opioid use followed by a quiz about drug dose, appearance, and price to verify substance use eligibility. Residential eligibility was verified with 5-question quizzes assessing knowledge of the county where they reported living. Questions tested knowledge about towns, festivals, and landmarks; local school mascots and colors; and presence of certain retail stores, restaurants, and facilities (eg, jails). A subsample that reported using opioids in the past 24 hours was randomly selected to complete urine drug testing (UDT). Nonparametric tests were performed to explore differences across demographic subgroups. Results: Of the 410 entries assessed for eligibility, 39.3{\%} (161/410) were ineligible as they reported no substance use, being outside the age range, or living outside the study area. Of the remaining 249 who met the eligibility criteria based on age, residency, and opioid misuse, 94.0{\%} (234/249) passed the eligibility quizzes. Among those who passed the heroin quiz, 99.4{\%} (167/168) recognized the image of powdered heroin, 94.6{\%} (159/168) answered the cap size (ie, the purchase unit) question correctly, and 97.0{\%} (163/168) answered the street price question correctly. Among those who passed the drug quiz for prescription opioids, 95{\%} (36/38) answered the dose question correctly, and 82{\%} (31/38) selected the correct image. In a random sample of participants who completed UDT within 3 days of their online screening, 74{\%} (25/34) tested positive for an opioid. Conclusions: This study demonstrated the utility of using online eligibility screening quizzes to verify opioid misuse and residence. Participants accurately recognized heroin and prescription opioid doses, prices, and images and correctly answered questions about features of their county. Online quizzes to screen and enroll PWUD hold promise for future research as an alternative to more time- and resource-intensive approaches that could offset the advantages of Web-based methods. ",
doi="10.2196/12984",
url="http://www.researchprotocols.org/2019/6/e12984/",
url="https://doi.org/10.2196/12984",
url="http://www.ncbi.nlm.nih.gov/pubmed/31215520"
}


@Article{info:doi/10.2196/12110,
author="Basak, Arinjoy
and Cadena, Jose
and Marathe, Achla
and Vullikanti, Anil",
title="Detection of Spatiotemporal Prescription Opioid Hot Spots With Network Scan Statistics: Multistate Analysis",
journal="JMIR Public Health Surveill",
year="2019",
month="Jun",
day="17",
volume="5",
number="2",
pages="e12110",
keywords="opiate dependence; spatial temporal analysis; network scan statistics; medical specialty",
abstract="Background: Overuse and misuse of prescription opioids have become significant public health burdens in the United States. About 11.5 million people are estimated to have misused prescription opioids for nonmedical purposes in 2016. This has led to a significant number of drug overdose deaths in the United States. Previous studies have examined spatiotemporal clusters of opioid misuse, but they have been restricted to circular shaped regions. Objective: The goal of this study was to identify spatiotemporal hot spots of opioid users and opioid prescription claims using Medicare data. Methods: We examined spatiotemporal clusters with significantly higher number of beneficiaries and rate of prescriptions for opioids using Medicare payment data from the Centers for Medicare {\&} Medicaid Services. We used network scan statistics to detect significant clusters with arbitrary shapes, the Kulldorff scan statistic to examine the significant clusters for each year (2013, 2014, and 2015) and an expectation-based version to examine the significant clusters relative to past years. Regression analysis was used to characterize the demographics of the counties that are a part of any significant cluster, and data mining techniques were used to discover the specialties of the anomalous providers. Results: We examined anomalous spatial clusters with respect to opioid prescription claims and beneficiary counts and found some common patterns across states: the counties in the most anomalous clusters were fairly stable in 2014 and 2015, but they have shrunk from 2013. In Virginia, a higher percentage of African Americans in a county lower the odds of the county being anomalous in terms of opioid beneficiary counts to about 0.96 in 2015. For opioid prescription claim counts, the odds were 0.92. This pattern was consistent across the 3 states and across the 3 years. A higher number of people in the county with access to Medicaid increased the odds of the county being in the anomalous cluster to 1.16 in both types of counts in Virginia. A higher number of people with access to direct purchase of insurance plans decreased the odds of a county being in an anomalous cluster to 0.85. The expectation-based scan statistic, which captures change over time, revealed different clusters than the Kulldorff statistic. Providers with an unusually high number of opioid beneficiaries and opioid claims include specialties such as physician's assistant, nurse practitioner, and family practice. Conclusions: Our analysis of the Medicare claims data provides characteristics of the counties and provider specialties that have higher odds of being anomalous. The empirical analysis identifies highly refined spatial hot spots that are likely to encounter prescription opioid misuse and overdose. The methodology is generic and can be applied to monitor providers and their prescription behaviors in regions that are at a high risk of abuse. ",
doi="10.2196/12110",
url="http://publichealth.jmir.org/2019/2/e12110/",
url="https://doi.org/10.2196/12110",
url="http://www.ncbi.nlm.nih.gov/pubmed/31210142"
}


@Article{info:doi/10.2196/13803,
author="Li, Jiawei
and Xu, Qing
and Shah, Neal
and Mackey, Tim K",
title="A Machine Learning Approach for the Detection and Characterization of Illicit Drug Dealers on Instagram: Model Evaluation Study",
journal="J Med Internet Res",
year="2019",
month="Jun",
day="15",
volume="21",
number="6",
pages="e13803",
keywords="opioids; social media; narcotics; substance abuse; machine learning; internet; prescription drug abuse; artificial intelligence",
abstract="Background: Social media use is now ubiquitous, but the growth in social media communications has also made it a convenient digital platform for drug dealers selling controlled substances, opioids, and other illicit drugs. Previous studies and news investigations have reported the use of popular social media platforms as conduits for opioid sales. This study uses deep learning to detect illicit drug dealing on the image and video sharing platform Instagram. Objective: The aim of this study was to develop and evaluate a machine learning approach to detect Instagram posts related to illegal internet drug dealing. Methods: In this paper, we describe an approach to detect drug dealers by using a deep learning model on Instagram. We collected Instagram posts using a Web scraper between July 2018 and October 2018 and then compared our deep learning model against 3 different machine learning models (eg, random forest, decision tree, and support vector machine) to assess the performance and accuracy of the model. For our deep learning model, we used the long short-term memory unit in the recurrent neural network to learn the pattern of the text of drug dealing posts. We also manually annotated all posts collected to evaluate our model performance and to characterize drug selling conversations. Results: From the 12,857 posts we collected, we detected 1228 drug dealer posts comprising 267 unique users. We used cross-validation to evaluate the 4 models, with our deep learning model reaching 95{\%} on F1 score and performing better than the other 3 models. We also found that by removing the hashtags in the text, the model had better performance. Detected posts contained hashtags related to several drugs, including the controlled substance Xanax (1078/1228, 87.78{\%}), oxycodone/OxyContin (321/1228, 26.14{\%}), and illicit drugs lysergic acid diethylamide (213/1228, 17.34{\%}) and 3,4-methylenedioxy-methamphetamine (94/1228, 7.65{\%}). We also observed the use of communication applications for suspected drug trading through user comments. Conclusions: Our approach using a combination of Web scraping and deep learning was able to detect illegal online drug sellers on Instagram, with high accuracy. Despite increased scrutiny by regulators and policymakers, the Instagram platform continues to host posts from drug dealers, in violation of federal law. Further action needs to be taken to ensure the safety of social media communities and help put an end to this illicit digital channel of sourcing. ",
doi="10.2196/13803",
url="http://www.jmir.org/2019/6/e13803/",
url="https://doi.org/10.2196/13803",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199298"
}


@Article{info:doi/10.2196/11716,
author="Abroms, Lorien C
and Fishman, Marc
and Vo, Hoa
and Chiang, Shawn C
and Somerville, Victoria
and Rakhmanov, Lawrence
and Ruggiero, Michael
and Greenberg, Daniel",
title="A Motion-Activated Video Game for Prevention of Substance Use Disorder Relapse in Youth: Pilot Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2019",
month="May",
day="23",
volume="7",
number="2",
pages="e11716",
keywords="youth; addiction treatment; opioid; marijuana; video game; technology",
abstract="Background: Body motion-activated video games are a promising strategy for promoting engagement in and adherence to addiction treatment among youth. Objective: This pilot randomized trial (N=80) investigated the feasibility of a body motion--activated video game prototype, Recovery Warrior 2.0, targeting relapse prevention in the context of a community inpatient care program for youth. Methods: Participants aged 15-25 years were recruited from an inpatient drug treatment program and randomized to receive treatment as usual (control) or game play with treatment as usual (intervention). Assessments were conducted at baseline, prior to discharge, and at 4 and 8 weeks postdischarge. Results: The provision of the game play intervention was found to be feasible in the inpatient setting. On an average, participants in the intervention group played for 36.6 minutes and on 3.6 different days. Participants in the intervention group mostly agreed that they would use the refusal skills taught by the game. Participants in the intervention group reported attending more outpatient counseling sessions than those in the control group (10.8 versus 4.8), but the difference was not significant (P=.32). The game had no effect on drug use at 4 or 8 weeks postdischarge, with the exception of a benefit reported at the 4-week follow-up among participants receiving treatment for marijuana addiction (P=.04). Conclusions: Preliminary evidence indicates that a motion-activated video game for addiction recovery appears to be feasible and acceptable for youth within the context of inpatient treatment, but not outpatient treatment. With further development, such games hold promise as a tool for the treatment of youth substance use disorder. Trial Registration: ClinicalTrials.gov NCT03957798; https://clinicaltrials.gov/show/NCT03957798 (Archived by WebCite at http://www.webcitation.org/78XU6ENB4) ",
doi="10.2196/11716",
url="http://games.jmir.org/2019/2/e11716/",
url="https://doi.org/10.2196/11716",
url="http://www.ncbi.nlm.nih.gov/pubmed/31124471"
}


@Article{info:doi/10.2196/12354,
author="Lee, Eleanor
and Cooper, Richard J",
title="Codeine Addiction and Internet Forum Use and Support: Qualitative Netnographic Study",
journal="JMIR Ment Health",
year="2019",
month="Apr",
day="25",
volume="6",
number="4",
pages="e12354",
keywords="codeine; addiction; abuse; opioid; internet; prescription; over-the-counter",
abstract="Background: The use of codeine as an analgesic is well-recognized, but there are increasing concerns that for some individuals continued use may lead to misuse, dependence, and fatalities. Research suggests that those affected may represent a hard-to-reach group who do not engage with formal treatment services. Objective: This study sought to explore the experiences of people with self-reported addiction to codeine and, specifically, how a social media forum is used to communicate with others about this issue. Methods: Using a qualitative netnographic methodology, the social media forum Mumsnet was used, with permission, and searches were undertaken in 2016 of any posts that related to codeine and addiction. A total of 95 relevant posts were identified; a purposive sample of 25 posts was selected to undertake subsequent six-stage thematic analysis and development of emerging themes. These 25 posts were posted between 2003 and 2016 and comprised 757 individual posts. Results: Individuals created posts to actively request help in relation to usually their own, but occasionally their partner's or relative's, problems relating to codeine use and self-reported ``addiction.'' Varying levels of detail were provided in narratives of problematic codeine use. There were both positive and negative descriptions of side effects emerging, problems experiencing withdrawal, and failed attempts to discontinue codeine use. Mainly positive and supportive responses to posts were identified from those with either self-reported health profession experience or lay respondents, who often drew on their own experiences of similar problems. Treatment advice emerged in two main ways, either as signposting to formal health services or to informal approaches and often anecdotal advice about how to taper or use cold turkey techniques. Some posts were more critical of the original poster, and arguments and challenges to advice were not uncommon. Shame and stigma were often associated with users' posts and, while there was a desire to receive support and treatment advice in this forum, users often wanted to keep their codeine use hidden in other aspects of their lives. Distinctly different views emerged as to whether responsibility lay with prescribers or patients. Some users expressed anger toward doctors and their prescribing practices. Conclusions: This study provides a unique insight into how a public internet forum is used by individuals to confirm and seek support about problematic codeine use and of the ways others respond. The pseudonymous use of internet forums for such information and variation in treatment options suggested by often lay respondents suggest that increased formal support and awareness about codeine addiction are needed. There may be opportunities for providing further support directly on such online forums. Improvements in prescribing codeine and in the over-the-counter supply of codeine are required to prevent problematic use from occurring. ",
doi="10.2196/12354",
url="http://mental.jmir.org/2019/4/e12354/",
url="https://doi.org/10.2196/12354",
url="http://www.ncbi.nlm.nih.gov/pubmed/31021328"
}


@Article{info:doi/10.2196/11831,
author="Tofighi, Babak
and Chemi, Chemi
and Ruiz-Valcarcel, Jose
and Hein, Paul
and Hu, Lu",
title="Smartphone Apps Targeting Alcohol and Illicit Substance Use: Systematic Search in  in Commercial App Stores and Critical Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Apr",
day="22",
volume="7",
number="4",
pages="e11831",
keywords="mHealth; substance use disorder; mobile health; alcohol abuse",
abstract="Background: Smartphone apps promise to enhance the reach of evidence-based interventions (cognitive behavior therapy, contingency management and therapeutic education system) for populations with substance use disorders, with minimal disruption to health systems. However, further studies are needed to systematically evaluate smartphone apps targeting alcohol and illicit substances. Objective: The aim of this study was to evaluate the functionality, aesthetics, and quality of information of free or low-cost apps claiming to target alcohol, benzodiazepine, cocaine, crack/cocaine, crystal methamphetamine, and heroin use using the validated Mobile App Rating Scale (MARS) and critical content analysis. Methods: A systematic search of iTunes and Google Play app stores for free or low-cost apps facilitating recovery was conducted in March 2018 and yielded 904 apps using the keywords described in previous studies (eg, recovery, sobriety, sober, alcohol, and heroin). An interdisciplinary team of clinicians, behavioral informatics, and public health reviewers trained in substance use disorders conducted a descriptive analysis of 74 apps categorized as reducing use. In addition to the MARS scale, a descriptive analysis of relevant apps was conducted by the study team to assess for quality indicators emphasized by expert guidelines and review articles. Results: Most apps (n=74) claimed to reduce use or promote abstinence and yielded an overall low median MARS score of 2.82 (0.55) and a wide range of scores (1.64, 4.20). Ratings were also low for engagement (2.75 (0.72)), functionality (3.64 (0.78)), aesthetics (3.03 (0.87)), information (2.82 (0.62)), and satisfaction (1.76 (0.67)) subdomains. Innovative design and content features elicited in the review included initial assessments of substance use following app download, tracking substance use, and related consequences (eg, cost or calorie intake), remote and proximate peer support per geospatial positioning, and allowing users and family members of individuals with substance use disorders to locate 12-step meetings, treatment programs, and mental health services. Few apps integrated evidence-based psychotherapeutic (eg, cognitive behavioral therapy [CBT] or motivational interviewing) and pharmacologic interventions (eg, naloxone or buprenorphine). Conclusions: Few commercially available apps yielded in our search integrated evidence-based interventions (eg, extended-release naltrexone, buprenorphine, naloxone, Self-Management and Recovery Training recovery, or CBT), and a concerning number of apps promoted harmful drinking and illicit substance use. ",
doi="10.2196/11831",
url="https://mhealth.jmir.org/2019/4/e11831/",
url="https://doi.org/10.2196/11831",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008713"
}


@Article{info:doi/10.2196/13050,
author="Curtis, Brenda L
and Ashford, Robert D
and Magnuson, Katherine I
and Ryan-Pettes, Stacy R",
title="Comparison of Smartphone Ownership, Social Media Use, and Willingness to Use Digital Interventions Between Generation Z and Millennials in the Treatment of Substance Use: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="17",
volume="21",
number="4",
pages="e13050",
keywords="social media, mHealth, substance use treatment, digital health, recovery; social networking sites; substance use disorder",
abstract="Background: Problematic substance use in adolescence and emerging adulthood is a significant public health concern in the United States due to high recurrence of use rates and unmet treatment needs coupled with increased use. Consequently, there is a need for both improved service utilization and availability of recovery supports. Given the ubiquitous use of the internet and social media via smartphones, a viable option is to design digital treatments and recovery support services to include internet and social media platforms. Objective: Although digital treatments delivered through social media and the internet are a possibility, it is unclear how interventions using these tools should be tailored for groups with problematic substance use. There is limited research comparing consumer trends of use of social media platforms, use of platform features, and vulnerability of exposure to drug cues online. The goal of this study was to compare digital platforms used among adolescents (Generation Zs, age 13-17) and emerging adults (Millennials, age 18-35) attending outpatient substance use treatment and to examine receptiveness toward these platforms in order to support substance use treatment and recovery. Methods: Generation Zs and Millennials enrolled in outpatient substance use treatment (n=164) completed a survey examining social media use, digital intervention acceptability, frequency of substance exposure, and substance use experiences. Generation Zs (n=53) completed the survey in July 2018. Millennials (n=111) completed the survey in May 2016. Results: Generation Zs had an average age of 15.66 (SD 1.18) years and primarily identified as male (50.9{\%}). Millennials had an average age of 27.66 (SD 5.12) years and also primarily identified as male (75.7{\%}). Most participants owned a social media account (Millennials: 82.0{\%}, Generation Zs: 94.3{\%}) and used it daily (Millennials: 67.6{\%}, Generation Zs: 79.2{\%}); however, Generation Zs were more likely to use Instagram and Snapchat, whereas Millennials were more likely to use Facebook. Further, Generation Zs were more likely to use the features within social media platforms (eg, instant messaging: Millennials: 55.0{\%}, Generation Zs: 79.2{\%}; watching videos: Millennials: 56.8{\%}, Generation Zs: 81.1{\%}). Many participants observed drug cues on social media (Millennials: 67.5{\%}, Generation Zs: 71.7{\%}). However, fewer observed recovery information on social media (Millennials: 30.6{\%}, Generation Zs: 34.0{\%}). Participants felt that social media (Millennials: 55.0{\%}, Generation Zs: 49.1{\%}), a mobile phone app (Millennials: 36.9{\%}, Generation Zs: 45.3{\%}), texting (Millennials: 28.8{\%}, Generation Zs: 45.3{\%}), or a website (Millennials: 39.6{\%}, Generation Zs: 32.1{\%}) would be useful in delivering recovery support. Conclusions: Given the high rates of exposure to drug cues on social media, disseminating recovery support within a social media platform may be the ideal just-in-time intervention needed to decrease the rates of recurrent drug use. However, our results suggest that cross-platform solutions capable of transcending generational preferences are necessary and one-size-fits-all digital interventions should be avoided. ",
doi="10.2196/13050",
url="http://www.jmir.org/2019/4/e13050/",
url="https://doi.org/10.2196/13050",
url="http://www.ncbi.nlm.nih.gov/pubmed/30994464"
}


@Article{info:doi/10.2196/11297,
author="Pradhan, Apoorva Milind
and Park, Leah
and Shaya, Fadia T
and Finkelstein, Joseph",
title="Consumer Health Information Technology in the Prevention of Substance Abuse: Scoping Review",
journal="J Med Internet Res",
year="2019",
month="Jan",
day="30",
volume="21",
number="1",
pages="e11297",
keywords="consumer health information technology; primary prevention; substance abuse; review",
abstract="Background: Addiction is one of the most rapidly growing epidemics that currently plagues nations around the world. In the United States, it has cost the government more than US {\$}700 billion a year in terms of health care and other associated costs and is also associated with serious social, physical, and mental consequences. Increasing efforts have been made to tackle this issue at different levels, from primary prevention to rehabilitation across the globe. With the use of digital technology rapidly increasing, an effort to leverage the consumer health information technologies (CHITs) to combat the rising substance abuse epidemic has been underway. CHITs are identified as patient-focused technological platforms aimed to improve patient engagement in health care and aid them in navigating the complex health care system. Objective: This review aimed to provide a holistic and overarching view of the breadth of research on primary prevention of substance abuse using CHIT conducted over nearly past five decades. It also aimed to map out the changing landscape of CHIT over this period. Methods: We conducted a scoping review using the Arksey and O'Malley's modified methodological framework. We searched 4 electronic databases (PubMed, Cochrane, Scopus, and EMBASE). Papers were included if the studies addressed the use of CHIT for primary prevention of substance abuse and were published in English between 1809 and 2018. Studies that did not focus solely on primary prevention or assessed additional comorbid conditions were eliminated. Results: Forty-two papers that met our inclusion criteria were included in the review. These studies were published between 1970 and 2018 and were not restricted by geography, age, race, or sex. The review mapped studies using the most commonly used CHIT platforms for substance abuse prevention from mass media in the 1970s to mobile and social media in 2018. Moreover, 191 studies that were exclusively focused on alcohol prevention were excluded and will be addressed in a separate paper. The studies included had diverse research designs although the majority were randomized controlled trials (RCT) or review papers. Many of the RCTs used interventions based on different behavioral theories such as family interactions, social cognitive theories, and harm-minimization framework. Conclusions: This review found CHIT platforms to be efficacious and cost-effective in the real-world settings. We also observed a gradual shift in the types and use of CHIT platforms over the past few decades and mapped out their progression. In addition, the review detected a shift in consumer preferences and behaviors from face-to-face interactions to technology-based platforms. However, the studies included in this review only focused on the aspect of primary prevention. Future reviews could assess the effectiveness of platforms for secondary prevention and for prevention of substance abuse among comorbid populations. ",
doi="10.2196/11297",
url="http://www.jmir.org/2019/1/e11297/",
url="https://doi.org/10.2196/11297",
url="http://www.ncbi.nlm.nih.gov/pubmed/30698526"
}


@Article{info:doi/10.2196/11107,
author="Birrell, Louise
and Deen, Hannah
and Champion, Katrina Elizabeth
and Newton, Nicola C
and Stapinski, Lexine A
and Kay-Lambkin, Frances
and Teesson, Maree
and Chapman, Cath",
title="A Mobile App to Provide Evidence-Based Information About Crystal Methamphetamine (Ice) to the Community (Cracks in the Ice): Co-Design and Beta Testing",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Dec",
day="20",
volume="6",
number="12",
pages="e11107",
keywords="internet; methamphetamine; mobile apps; mobile phone; substance-related disorder",
abstract="Background: Despite evidence of increasing harms and community concern related to the drug crystal methamphetamine (``ice''), there is a lack of easily accessible, evidence-based information for community members affected by its use, and to date, no evidence-based mobile apps have specifically focused on crystal methamphetamine. Objective: This study aims to describe the co-design and beta testing of a mobile app to provide evidence-based, up-to-date information about crystal methamphetamine to the general community. Methods: A mobile app about crystal methamphetamine was developed in 2017. The development process involved multiple stakeholders (n=12), including technology and drug and alcohol experts, researchers, app developers, a consumer expert with lived experience, and community members. Beta testing was conducted with Australian general community members (n=34), largely recruited by the Web through Facebook advertising. Participants were invited to use a beta version of the app and provide feedback about the content, visual appeal, usability, engagement, features, and functions. In addition, participants were asked about their perceptions of the app's influence on awareness, understanding, and help-seeking behavior related to crystal methamphetamine, and about their knowledge about crystal methamphetamine before and after using the app. Results: The vast majority of participants reported the app was likely to increase awareness and understanding and encourage help-seeking. The app received positive ratings overall and was well received. Specifically, participants responded positively to the high-quality information provided, usability, and visual appeal. Areas suggested for improvement included reducing the amount of text, increasing engagement, removing a profile picture, and improving navigation through the addition of a ``back'' button. Suggested improvements were incorporated prior to the app's public release. App use was associated with an increase in perceived knowledge about crystal methamphetamine; however, this result was not statistically significant. Conclusions: The Cracks in the Ice mobile app provides evidence-based information about the drug crystal methamphetamine for the general community. The app is regularly updated, available via the Web and offline, and was developed in collaboration with experts and end users. Initial results indicate that it is easy to use and acceptable to the target group. ",
doi="10.2196/11107",
url="https://mhealth.jmir.org/2018/12/e11107/",
url="https://doi.org/10.2196/11107",
url="http://www.ncbi.nlm.nih.gov/pubmed/30573443"
}


@Article{info:doi/10.2196/10313,
author="Murtagh, Ross
and Swan, Davina
and O'Connor, Eileen
and McCombe, Geoff
and Lambert, John S
and Avramovic, Gordana
and Cullen, Walter",
title="Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study",
journal="Interact J Med Res",
year="2018",
month="Dec",
day="19",
volume="7",
number="2",
pages="e10313",
keywords="hepatitis C; integrated HCV care; people who inject drugs; primary care",
abstract="Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Injection drug use is now one of the main routes of transmission of HCV in Ireland and globally with an estimated 80{\%} new infections occurring among people who inject drugs (PWID). Objective: We aimed to examine whether patients receiving opioid substitution therapy in primary care practices in Ireland were receiving guideline-adherent care regarding HCV screening. Ireland has developed a model of care for delivering opioid substitution treatment in the primary care setting. We conducted this study given the shift of providing care for PWID from secondary to primary care settings, in light of current guidelines aimed at scaling up interventions to reduce chronic HCV infection and associated mortality. Methods: We included baseline data from the Dublin site of the Heplink study, a feasibility study focusing on developing complex interventions to enhance community-based HCV treatment and improve the HCV care pathway between primary and secondary care. We recruited 14 opioid substitution treatment-prescribing general practices that employed the administration of opioid substitution therapy from the professional networks and databases of members of the research consortium. A standardized nonprobability sampling framework was used to identify 10 patients from each practice to participate in the study. Patients were eligible if aged ≥18 years, on opioid substitution treatment, and attending the practice for any reason during the recruitment period. The baseline data were collected from the clinical records of participating patients. We collected and analyzed data on demographic characteristics, care processes and outcomes regarding HCV and other blood-borne viruses, urinalysis test results, alcohol use disorders, chronic illness, and health service utilization. We examined whether patients received care concordant with guidelines related to HCV screening and care. Results: The baseline data were collected from clinical records of 134 patients; 72.2{\%} (96/134) were males; (mean age 43, SD 7.6; range 27-71 years); 94.8{\%} (127/134) of patients had been tested for anti-HCV antibody in their lifetime; of those, 77.9{\%} (99/127) tested positive. Then, 83.6{\%} (112/134) of patients had received an HIV antibody test in their lifetime; of those, 6.3{\%} (7/112) tested HIV positive. Moreover, 66.4{\%} (89/134) of patients had been tested for hepatitis B virus in their lifetime and 8{\%} (7/89) of those were positive. In the 12 months before the study, 30.6{\%} (41/134) of patients were asked about their alcohol use by their general practitioner, 6.0{\%} (8/134) received a brief intervention, and 2.2{\%} (3/134) were referred to a specialist addiction or alcohol treatment service. Conclusions: With general practice and primary care playing an increased role in HCV care, this study highlights the importance of prioritizing the development and evaluation of real-world clinical solutions that support patients from diagnosis to treatment completion. ",
doi="10.2196/10313",
url="http://www.i-jmr.org/2018/2/e10313/",
url="https://doi.org/10.2196/10313",
url="http://www.ncbi.nlm.nih.gov/pubmed/30567692"
}


@Article{info:doi/10.2196/10845,
author="Fielenbach, Sandra
and Donkers, Franc CL
and Spreen, Marinus
and Bogaerts, Stefan",
title="Effects of a Theta/Sensorimotor Rhythm Neurofeedback Training Protocol on Measures of Impulsivity, Drug Craving, and Substance Abuse in Forensic Psychiatric Patients With Substance Abuse: Randomized Controlled Trial",
journal="JMIR Ment Health",
year="2018",
month="Dec",
day="11",
volume="5",
number="4",
pages="e10845",
keywords="neurofeedback; impulsivity; substance use disorder; offenders; drug craving",
abstract="Background: Forensic psychiatric patients are often diagnosed with psychiatric disorders characterized by high levels of impulsivity as well as comorbid substance use disorders (SUD). The combination of psychiatric disorders and SUD increases the risk of future violence. Chronic substance abuse can lead to a structural state of disinhibition, resulting in more drug taking and eventually loss of control over drug intake. When treating SUD, it is crucial to address high levels of impulsivity and lack of inhibitory control. Objective: This study set out to investigate the effects of a theta/sensorimotor rhythm (SMR) neurofeedback training protocol on levels of impulsivity, levels of drug craving, and actual drug intake in a population of forensic psychiatric patients with a diagnosis of SUD. Methods: A total of 21 participants received 20 sessions of theta/SMR neurofeedback training in combination with treatment-as-usual (TAU). Results of the intervention were compared with results from 21 participants who received TAU only. Results: SMR magnitude showed a significant (P=.02) increase post training for patients in the neurofeedback training group, whereas theta magnitude did not change (P=.71). Levels of drug craving as well as scores on the motor subscale of the Barratt Impulsivity Scale-11 decreased equally for patients in the neurofeedback training group and the TAU group. Other measures of impulsivity as well as drug intake did not change posttreatment (P>.05). Therefore, neurofeedback+TAU was not more effective than TAU only. Conclusions: This study demonstrated evidence that forensic psychiatric patients are able to increase SMR magnitude over the course of neurofeedback training. However, at the group level, the increase in SMR activity was not related to any of the included impulsivity or drug craving measures. Further research should focus on which patients will be able to benefit from neurofeedback training at an early stage of the employed training sessions. Trial Registration: Dutch National Trial Register: NTR5386; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386 (Archived by WebCite at http://www.webcitation.org/6nXLQuoLl). ",
doi="10.2196/10845",
url="http://mental.jmir.org/2018/4/e10845/",
url="https://doi.org/10.2196/10845",
url="http://www.ncbi.nlm.nih.gov/pubmed/30538087"
}


@Article{info:doi/10.2196/games.9944,
author="Kapit{\'a}ny-F{\"o}v{\'e}ny, M{\'a}t{\'e}
and Vagdalt, Eszter
and Ruttkay, Zs{\'o}fia
and Urb{\'a}n, R{\'o}bert
and Richman, Mara J
and Demetrovics, Zsolt",
title="Potential of an Interactive Drug Prevention Mobile Phone App (Once Upon a High): Questionnaire Study Among Students",
journal="JMIR Serious Games",
year="2018",
month="Dec",
day="04",
volume="6",
number="4",
pages="e19",
keywords="secondary prevention; adolescent; mHealth; energy drinks; substance use; alcohol abuse; cannabis",
abstract="Background: In recent years, drug prevention networks and drug education programs have started using Web-based or mobile phone apps as novel prevention tools, testing their efficacy compared with face-to-face prevention. Objective: The aim of this study was to assess the potential of an interactive app called Once Upon a High (VoltEgySzer). Methods: The app approaches drug prevention from 6 different aspects, and it addresses youngsters with 6different modules: (1) interactive comics/cartoons, telling stories of recovery; (2) quiz game; (3) roleplay game; (4) introduction of psychoactive drugs; (5) information on the somatic and psychologicaleffects of psychoactive substances; (6) list of available treatment units, rehabs, and self-support groups in Hungary. Students of 2 vocational schools and 2 high schools filled out a questionnaire at a baseline (T0) and a 2-month follow-up (T1) data collection session. Students of 1 vocational school and 1 high school downloaded the Once Upon a High app (app group), whereas students from the other vocational school and high school did not (nonapp group). The time points of T0 and T1 questionnaires contained demographic variables, items with regard to substance use characteristics for both legal and illegal substances, including novel psychoactive substance, exercise habits, knowledge about psychoactive substances, attitudes toward substance users and validated instruments measuring the severity of tobacco (Fagerstr{\"o}m Test for Nicotine Dependence), alcohol (Alcohol Use Disorder Identification Test), cannabis (Cannabis Abuse Screening Test), and synthetic cannabinoid consumption. Beliefs about substance use (Beliefs About Substance Abuse) and perceived self-efficacy (General Perceived Self-Efficacy) were also measured. At T1, members of the app group provided additional evaluation of the app. Results: There were 386 students who participated in the T0 session. After dropout, 246 students took part in T1 data collection procedure. Alcohol was the most frequently consumed psychoactive substance (334/364, 91.8{\%} lifetime use), followed by tobacco (252/386, 65.3{\%}, lifetime use) and cannabis (43/323, 13.3{\%} lifetime use). Decreased self-efficacy (beta=−.29, P=.04) and increased daily physical exercise frequencies (beta=.04, P<.001) predicted higher frequencies of past month energy drink consumption, whereas elevated past month alcohol consumption was mainly predicted by a decrease in negative attitudes toward substance users (beta=−.13, P=.04) in the regression models. Once Upon a High was found to be effective only in reducing energy drink consumption (beta=−1.13, P=.04) after controlling for design effect, whereas perceived utility of the app showed correlation with a decreasing alcohol use (rS(44)=.32, P=.03). The roleplay module of the app was found to be the most preferred aspect of the app by the respondents. Conclusions: The Once Upon a High app can be a useful tool to assist preventive intervention programs by increasing knowledge and self-efficacy; however, its efficacy in reducing or preventing substance use needs to be improved and further studied. Additional potential impacts of the app need further testing. ",
doi="10.2196/games.9944",
url="http://games.jmir.org/2018/4/e19/",
url="https://doi.org/10.2196/games.9944",
url="http://www.ncbi.nlm.nih.gov/pubmed/30514697"
}


@Article{info:doi/10.2196/10442,
author="Chapman, Cath
and Champion, Katrina Elizabeth
and Birrell, Louise
and Deen, Hannah
and Brierley, Mary-Ellen
and Stapinski, Lexine A
and Kay-Lambkin, Frances
and Newton, Nicola C
and Teesson, Maree",
title="Smartphone Apps About Crystal Methamphetamine (``Ice''): Systematic Search in App Stores and Assessment of Composition and Quality",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Nov",
day="21",
volume="6",
number="11",
pages="e10442",
keywords="internet; methamphetamine; mobile phone; review; substance-related disorder",
abstract="Background: Amid considerable community concern about the prevalence and harms associated with the use of crystal methamphetamine (``ice''), the increased use of smartphones to access health information and a growing number of available smartphone apps related to crystal methamphetamine, no previous reviews have examined the content and quality of these apps. Objective: This study aims to systematically review existing apps in the iTunes and Google Play Stores to determine the existence, composition, and quality of educational smartphone apps about methamphetamines, including ice. Methods: The iTunes and Google Play Stores were systematically searched in April 2017 for iOS Apple and Android apps, respectively. English-language apps that provided educational content or information about methamphetamine were eligible for inclusion. Eligible apps were downloaded and independently evaluated for quality by 2 reviewers using the Mobile Application Rating Scale (MARS). Results: A total of 2205 apps were initially identified, of which 18 were eligible and rated using the MARS. The mean MARS quality total score for all rated apps was 3.0 (SD 0.6), indicating poor to acceptable quality. Overall, mean scores were the highest for functionality (mean 4.0, SD 0.5) and lowest for engagement (mean 2.3, SD 0.7). Conclusions: This study demonstrates a shortage of high-quality educational and engaging smartphone apps specifically related to methamphetamine. The findings from this review highlight a need for further development of engaging and evidence-based apps that provide educational information about crystal methamphetamine. ",
doi="10.2196/10442",
url="http://mhealth.jmir.org/2018/11/e10442/",
url="https://doi.org/10.2196/10442",
url="http://www.ncbi.nlm.nih.gov/pubmed/30463834"
}


@Article{info:doi/10.2196/11822,
author="Zhang, Melvyn
and Ying, Jiangbo
and Amron, Syidda B
and Mahreen, Zaakira
and Song, Guo
and Fung, Daniel SS
and Smith, Helen",
title="A Smartphone Attention Bias Intervention for Individuals With Addictive Disorders: Protocol for a Feasibility Study",
journal="JMIR Res Protoc",
year="2018",
month="Nov",
day="19",
volume="7",
number="11",
pages="e11822",
keywords="addiction; approach bias; attention bias; bias modification; feasibility; pilot; psychiatry; mobile phone; mHealth; eHealth",
abstract="Background: Substance use disorders are highly prevalent globally. Relapse rates following conventional psychological interventions for substance use disorders remain high. Recent reviews have highlighted attentional and approach or avoidance biases to be responsible for multiple relapses. Other studies have reported the efficacy of interventions to modify biases. With advances in technologies, there are now mobile versions of conventional bias modification interventions. However, to date, no study has evaluated bias modification in a substance-using, non-Western sample. Existing evaluations of mobile technologies for the delivery of bias interventions are also limited to alcohol or tobacco use disorders. Objective: This study aims to examine the feasibility of mobile-based attention bias modification intervention among treatment-seeking individuals with substance use and alcohol use disorders. Methods: This is a feasibility study, in which inpatients who are in their rehabilitation phase of clinical management will be recruited. On each day that they are in the study, they will be required to complete a craving visual analogue scale and undertake both a visual probe-based assessment and and modification task in a smartphone app . Reaction time data will be collated for the computation of baseline attentional biases and to determine whether there is a reduction of attentional bias across the interventions. Feasibility will be determined by the number of participants recruited and participants' adherence to the planned interventions up until the completion of their rehabilitation program and by the ability of the app in detecting baseline biases and changes in biases. Acceptability of the intervention will be assessed by a short questionnaire of users' perceptions of the intervention. Statistical analyses will be performed using SPSS version 22.0, while qualitative analysis of the perspectives will be performed using NVivo version 10.0. Results: This study was approved by the National Healthcare Group Domain Specific Research Board, with approval number (2018/00316). Results will be disseminated by means of conferences and publications.Currently, we are in the process of recruitment for this study. Conclusions: To the best of our knowledge, this is the first study to evaluate the feasibility and acceptability of a mobile attention bias modification intervention for individuals with substance use disorders. The data pertaining to the feasibility and acceptability are undoubtedly crucial because they imply the potential use of mobile technologies in retraining attentional biases among inpatients admitted for medical-assisted detoxification and rehabilitation. Participants' feedback pertaining to the ease of use, interactivity, and motivation to continue using the app is crucial because it will determine whether a codesign approach might be warranted to design an app that is acceptable for participants and that participants themselves would be motivated to use. International Registered Report Identifier (IRRID): PRR1-10.2196/11822 ",
doi="10.2196/11822",
url="http://www.researchprotocols.org/2018/11/e11822/",
url="https://doi.org/10.2196/11822",
url="http://www.ncbi.nlm.nih.gov/pubmed/30455170"
}


@Article{info:doi/10.2196/jmir.9873,
author="Nesv{\aa}g, Sverre
and McKay, James R",
title="Feasibility and Effects of Digital Interventions to Support People in Recovery From Substance Use Disorders: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Aug",
day="23",
volume="20",
number="8",
pages="e255",
keywords="digital interventions; substance use disorders; recovery support; feasibility; effects",
abstract="Background: The development and evaluation of digital interventions aimed at preventing or treating substance use--related problems and disorders is a rapidly growing field. Previous reviews of such interventions reveal a large and complex picture with regard to targeted users, use, and efficacy. Objective: The objective of this review was to investigate the feasibility and effects of interventions developed specifically for digital platforms. These interventions are focused on supporting people in recovery from substance use disorders by helping them achieve their substance use goals and develop a more satisfying life situation. Methods: The review is based on a systematic search in MEDLINE, Embase, PsycInfo, and Cochrane Library databases. Of the 1149 identified articles, 722 were excluded as obviously not relevant. Of the remaining articles, 21 were found to be previous reviews, 269 were on interventions aimed at reducing hazardous alcohol or cannabis use, and 94 were on digitized versions of standard treatment methods. The remaining 43 articles were all read in full and systematically scored by both authors. Results: The 43 articles cover 28 unique interventions, of which 33 have been published after 2013. The interventions are aimed at different target groups (defined by age, substance, or comorbidity). Based on the number of features or modules, the interventions can be categorized as simple or complex. Fourteen of the 18 simple interventions and 9 of the 10 complex interventions have been studied with quantitative controlled methodologies. Thirteen of the 18 simple interventions are integrated in other treatment or support systems, mainly delivered as mobile phone apps, while 6 of the 10 complex interventions are designed as stand-alone interventions, most often delivered on a platform combining desktop/Web and mobile phone technologies. The interventions were generally easy to implement, but in most cases the implementation of the complex interventions was found to be dependent on sustained organizational support. Between 70{\%} and 90{\%} of the participants found the interventions to be useful and easy to use. The rates of sustained use were also generally high, except for simple interventions with an open internet-based recruitment and some information and education modules of the complex interventions. Across all interventions, slightly more than half (55{\%}) of the studies with control groups generated positive findings on 1 or more substance use outcomes, with 57{\%} of the interventions also found to be efficacious in 1 or more studies. In the positive studies, effects were typically in the small to moderate range, with a few studies yielding larger effects. Largely due to the inclusion of stronger control conditions, studies of simple interventions were less likely to produce positive effects. Conclusions: The digital interventions included in this review are in general feasible but are not consistently effective in helping people in recovery from substance use disorder reduce their substance use or achieving other recovery goals. ",
doi="10.2196/jmir.9873",
url="http://www.jmir.org/2018/8/e255/",
url="https://doi.org/10.2196/jmir.9873",
url="http://www.ncbi.nlm.nih.gov/pubmed/30139724"
}


@Article{info:doi/10.2196/10849,
author="Newton, Nicola Clare
and Chapman, Cath
and Slade, Tim
and Conroy, Chloe
and Thornton, Louise
and Champion, Katrina Elizabeth
and Stapinski, Lexine
and Koning, Ina
and Teesson, Maree",
title="Internet-Based Universal Prevention for Students and Parents to Prevent Alcohol and Cannabis Use Among Adolescents: Protocol for the Randomized Controlled Trial of Climate Schools Plus ",
journal="JMIR Res Protoc",
year="2018",
month="Aug",
day="17",
volume="7",
number="8",
pages="e10849",
keywords="alcohol; Australia; cannabis; parents; prevention; school; internet-based intervention",
abstract="Background: Early initiation of alcohol and cannabis use markedly increases the risk of harms associated with use, including the development of substance use and mental health disorders. To interrupt this trajectory, effective prevention during the adolescent period is critical. Despite evidence showing that parents can play a critical role in delaying substance use initiation, the majority of prevention programs focus on adolescents only. Accordingly, the Climate Schools Plus (CSP) program was developed to address this gap. Objective: This paper outlines the protocol for a cluster randomized controlled trial (RCT) of the CSP program, a novel internet-based program for parents and students to prevent adolescent substance use and related harms. The CSP program builds on the success of the Climate Schools student programs, with the addition of a newly developed parenting component, which allows parents to access the internet-based content to equip them with knowledge and skills to help prevent substance use in their adolescents. Methods: A cluster RCT is being conducted with year 8 students (aged 12-14 years) and their parents from 12 Australian secondary schools between 2018 and 2020. Using blocked randomization, schools are assigned to one of the two groups to receive either the CSP program (intervention) or health education as usual (control). The primary outcomes of the trial will be any student alcohol use (≥1 standard alcoholic drink/s) and any student drinking to excess (≥5 standard alcoholic drinks). Secondary outcomes will include alcohol- and cannabis-related knowledge, alcohol use-related harms, frequency of alcohol consumption, frequency of drinking to excess, student cannabis use, parents' self-efficacy to stop their children using alcohol, parental supply of alcohol, and parent-adolescent communication. All students and their parents will complete assessments on three occasions---baseline and 12 and 24 months postbaseline. In addition, students and parents in the intervention group will be asked to complete program evaluations on two occasions---immediately following the year 8 program and immediately following the year 9 program. Results: Analyses will be conducted using multilevel, mixed-effects models within an intention-to-treat framework. It is expected that students in the intervention group will have less uptake and excessive use of alcohol compared with the students in the control group. Conclusions: This study will provide the first evaluation of a combined internet-based program for students and their parents to prevent alcohol and cannabis use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000153213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374178 (Archived by WebCite at http://www.webcitation.org/71E0prqfQ) Registered Report Identifier: RR1-10.2196/10849 ",
doi="10.2196/10849",
url="http://www.researchprotocols.org/2018/8/e10849/",
url="https://doi.org/10.2196/10849",
url="http://www.ncbi.nlm.nih.gov/pubmed/30120084"
}


@Article{info:doi/10.2196/mental.9903,
author="Hammond, Alexis S
and Paul, Michael J
and Hobelmann, Joseph
and Koratana, Animesh R
and Dredze, Mark
and Chisolm, Margaret S",
title="Perceived Attitudes About Substance Use in Anonymous Social Media Posts Near College Campuses: Observational Study",
journal="JMIR Ment Health",
year="2018",
month="Aug",
day="02",
volume="5",
number="3",
pages="e52",
keywords="Yik Yak; college; social media; substance; drugs; alcohol",
abstract="Background: Substance use is a major issue for adolescents and young adults, particularly college students. With the importance of peer influence and the ubiquitous use of social media among these age groups, it is important to assess what is discussed on various social media sites regarding substance use. One particular mobile app (Yik Yak) allowed users to post any message anonymously to nearby persons, often in areas with close proximity to major colleges and universities. Objective: This study describes the content, including attitude toward substances, of social media discussions that occurred near college campuses and involved substances. Methods: A total of 493 posts about drugs and alcohol on Yik Yak were reviewed and coded for their content, as well as the poster's attitude toward the substance(s) mentioned. Results: Alcohol (226/493, 45.8{\%}), marijuana (206/493, 41.8{\%}), and tobacco (67/493, 13{\%}) were the most frequently mentioned substances. Posts about use (442/493) were generally positive toward the substance mentioned (262/442, 59.3{\%}), unless the post was about abstinence from the substance. Additionally, posts that commented on the substance use of others tended to be less positive (18/92, 19.6{\%} positive) compared to posts about one's own use (132/202, 65.3{\%} positive). Conclusions: This study provides a description of anonymous discussions on or near college campuses about drugs and alcohol, which serves as an example of data that can be examined from social media sites for further research and prevention campaigns. ",
doi="10.2196/mental.9903",
url="http://mental.jmir.org/2018/3/e52/",
url="https://doi.org/10.2196/mental.9903",
url="http://www.ncbi.nlm.nih.gov/pubmed/30072359"
}


@Article{info:doi/10.2196/resprot.9850,
author="Rabbi, Mashfiqui
and Philyaw Kotov, Meredith
and Cunningham, Rebecca
and Bonar, Erin E
and Nahum-Shani, Inbal
and Klasnja, Predrag
and Walton, Maureen
and Murphy, Susan",
title="Toward Increasing Engagement in Substance Use Data Collection: Development of the Substance Abuse Research Assistant App and Protocol for a Microrandomized Trial Using Adolescents and Emerging Adults",
journal="JMIR Res Protoc",
year="2018",
month="Jul",
day="18",
volume="7",
number="7",
pages="e166",
keywords="engagement; microrandomized trial; just-in-time adaptive intervention",
abstract="Background: Substance use is an alarming public health issue associated with significant morbidity and mortality. Adolescents and emerging adults are at particularly high risk because substance use typically initiates and peaks during this developmental period. Mobile health apps are a promising data collection and intervention delivery tool for substance-using youth as most teens and young adults own a mobile phone. However, engagement with data collection for most mobile health applications is low, and often, large fractions of users stop providing data after a week of use. Objective: Substance Abuse Research Assistant (SARA) is a mobile application to increase or sustain engagement of substance data collection overtime. SARA provides a variety of engagement strategies to incentivize data collection: a virtual aquarium in the app grows with fish and aquatic resources; occasionally, funny or inspirational contents (eg, memes or text messages) are provided to generate positive emotions. We plan to assess the efficacy of SARA's engagement strategies over time by conducting a micro-randomized trial, where the engagement strategies will be sequentially manipulated. Methods: We aim to recruit participants (aged 14-24 years), who report any binge drinking or marijuana use in the past month. Participants are instructed to use SARA for 1 month. During this period, participants are asked to complete one survey and two active tasks every day between 6 pm and midnight. Through the survey, we assess participants' daily mood, stress levels, loneliness, and hopefulness, while through the active tasks, we measure reaction time and spatial memory. To incentivize and support the data collection, a variety of engagement strategies are used. First, predata collection strategies include the following: (1) at 4 pm, a push notification may be issued with an inspirational message from a contemporary celebrity; or (2) at 6 pm, a push notification may be issued reminding about data collection and incentives. Second, postdata collection strategies include various rewards such as points which can be used to grow a virtual aquarium with fishes and other treasures and modest monetary rewards (up to US {\$}12; US {\$}1 for each 3-day streak); also, participants may receive funny or inspirational content as memes or gifs or visualizations of prior data. During the study, the participants will be randomized every day to receive different engagement strategies. In the primary analysis, we will assess whether issuing 4 pm push-notifications or memes or gifs, respectively, increases self-reporting on the current or the following day. Results: The microrandomized trial started on August 21, 2017 and the trial ended on February 28, 2018. Seventy-three participants were recruited. Data analysis is currently underway. Conclusions: To the best of our knowledge, SARA is the first mobile phone app that systematically manipulates engagement strategies in order to identify the best sequence of strategies that keep participants engaged in data collection. Once the optimal strategies to collect data are identified, future versions of SARA will use this data to provide just-in-time adaptive interventions to reduce substance use among youth. Trial Registration: ClinicalTrials.gov NCT03255317; https://clinicaltrials.gov/show/NCT03255317 (Archived by WebCite at http://www.webcitation.org/70raGWV0e) Registered Report Identifier: RR1-10.2196/9850 ",
doi="10.2196/resprot.9850",
url="http://www.researchprotocols.org/2018/7/e166/",
url="https://doi.org/10.2196/resprot.9850",
url="http://www.ncbi.nlm.nih.gov/pubmed/30021714"
}


@Article{info:doi/10.2196/10292,
author="Zhu, Youwei
and Jiang, Haifeng
and Su, Hang
and Zhong, Na
and Li, Runji
and Li, Xiaotong
and Chen, Tianzhen
and Tan, Haoye
and Du, Jiang
and Xu, Ding
and Yan, Huan
and Xu, Dawen
and Zhao, Min",
title="A Newly Designed Mobile-Based Computerized Cognitive Addiction Therapy App for the Improvement of Cognition Impairments and Risk Decision Making in Methamphetamine Use Disorder: Randomized Controlled Trial",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="20",
volume="6",
number="6",
pages="e10292",
keywords="methamphetamine; methamphetamine use disorder; cognitive function; impulse control; risk decision making; attention bias",
abstract="Background: Cognitive rehabilitation therapy has been found to improve cognitive deficits and impulse control problems in methamphetamine use disorder (MUD). However, there is limited research regarding this therapy's feasibility when using mobile-based health technologies in supporting recovery from MUD in China. Objective: The main aim of this study was to test whether 4 weeks of a newly designed computerized cognitive addiction therapy (CCAT) app can improve cognitive impairments, eliminate drug-related attention bias, and attenuate risk decision-making behaviors in participants with MUD. Methods: Forty MUD participants were assigned randomly to either the CCAT group (n=20), who received 4 weeks of CCAT plus regular detoxification treatment as usual, or the control group (n=20), who only received the regular detoxification treatment as usual, in drug rehabilitation centers in Shanghai. The CCAT was designed by combine methamphetamine use-related picture stimuli with cognitive training with the aim of improving cognitive function and eliminating drug-related attention bias. The CogState Battery, Delay Discounting Task (DDT), Iowa Gambling Task (IGT), and Balloon Analog Risk Task (BART) were administered face-to-face to all participants before and after CCAT interventions. Results: Forty male patients were recruited. The mean age was 32.70 (SD 5.27) years in the CCAT group and mean 35.05 (SD 8.02) years in the control group. Compared to the control group, CCAT improved working memory in the CCAT group (P=.01). Group{\texttimes}time interactions were observed among DDT, IGT, and BART tasks, with rates of discounting delayed rewards, IGT, and BART scores (P<.001) being reduced among those who received CCAT, whereas no changes were found in the control group. Conclusions: The newly designed CCAT can help to improve cognitive impairment and impulsive control in MUD. Further study is needed to understand the underlying brain mechanisms of the cognitive therapy. Trial Registration: ClinicalTrials.gov NCT03318081; https://clinicaltrials.gov/ct2/show/NCT03318081 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT03318081) ",
doi="10.2196/10292",
url="http://mhealth.jmir.org/2018/6/e10292/",
url="https://doi.org/10.2196/10292",
url="http://www.ncbi.nlm.nih.gov/pubmed/29925497"
}


@Article{info:doi/10.2196/resprot.9589,
author="Kotz, David
and Lord, Sarah E
and O'Malley, A James
and Stark, Luke
and Marsch, Lisa A",
title="Workshop on Emerging Technology and Data Analytics for Behavioral Health",
journal="JMIR Res Protoc",
year="2018",
month="Jun",
day="20",
volume="7",
number="6",
pages="e158",
keywords="behavioral health; mobile technology; wearable devices; data analytics; mHealth",
doi="10.2196/resprot.9589",
url="http://www.researchprotocols.org/2018/6/e158/",
url="https://doi.org/10.2196/resprot.9589",
url="http://www.ncbi.nlm.nih.gov/pubmed/29925493"
}


@Article{info:doi/10.2196/10136,
author="Kornfield, Rachel
and Sarma, Prathusha K
and Shah, Dhavan V
and McTavish, Fiona
and Landucci, Gina
and Pe-Romashko, Klaren
and Gustafson, David H",
title="Detecting Recovery Problems Just in Time: Application of Automated Linguistic Analysis and Supervised Machine Learning to an Online Substance Abuse Forum",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="12",
volume="20",
number="6",
pages="e10136",
keywords="self-help groups; substance-related disorders; supervised machine learning; social support; health communication",
abstract="Background: Online discussion forums allow those in addiction recovery to seek help through text-based messages, including when facing triggers to drink or use drugs. Trained staff (or ``moderators'') may participate within these forums to offer guidance and support when participants are struggling but must expend considerable effort to continually review new content. Demands on moderators limit the scalability of evidence-based digital health interventions. Objective: Automated identification of recovery problems could allow moderators to engage in more timely and efficient ways with participants who are struggling. This paper aimed to investigate whether computational linguistics and supervised machine learning can be applied to successfully flag, in real time, those discussion forum messages that moderators find most concerning. Methods: Training data came from a trial of a mobile phone-based health intervention for individuals in recovery from alcohol use disorder, with human coders labeling discussion forum messages according to whether or not authors mentioned problems in their recovery process. Linguistic features of these messages were extracted via several computational techniques: (1) a Bag-of-Words approach, (2) the dictionary-based Linguistic Inquiry and Word Count program, and (3) a hybrid approach combining the most important features from both Bag-of-Words and Linguistic Inquiry and Word Count. These features were applied within binary classifiers leveraging several methods of supervised machine learning: support vector machines, decision trees, and boosted decision trees. Classifiers were evaluated in data from a later deployment of the recovery support intervention. Results: To distinguish recovery problem disclosures, the Bag-of-Words approach relied on domain-specific language, including words explicitly linked to substance use and mental health (``drink,'' ``relapse,'' ``depression,'' and so on), whereas the Linguistic Inquiry and Word Count approach relied on language characteristics such as tone, affect, insight, and presence of quantifiers and time references, as well as pronouns. A boosted decision tree classifier, utilizing features from both Bag-of-Words and Linguistic Inquiry and Word Count performed best in identifying problems disclosed within the discussion forum, achieving 88{\%} sensitivity and 82{\%} specificity in a separate cohort of patients in recovery. Conclusions: Differences in language use can distinguish messages disclosing recovery problems from other message types. Incorporating machine learning models based on language use allows real-time flagging of concerning content such that trained staff may engage more efficiently and focus their attention on time-sensitive issues. ",
doi="10.2196/10136",
url="http://www.jmir.org/2018/6/e10136/",
url="https://doi.org/10.2196/10136",
url="http://www.ncbi.nlm.nih.gov/pubmed/29895517"
}


@Article{info:doi/10.2196/mhealth.9783,
author="Hsu, Kuo-Yao
and Tsai, Yun-Fang
and Huang, Chu-Ching
and Yeh, Wen-Ling
and Chang, Kai-Ping
and Lin, Chen-Chun
and Chen, Ching-Yen
and Lee, Hsiu-Lan",
title="Tobacco-Smoking, Alcohol-Drinking, and Betel-Quid-Chewing Behaviors: Development and Use of a Web-Based Survey System",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jun",
day="11",
volume="6",
number="6",
pages="e142",
keywords="tobacco smoking; alcohol drinking; betel-quid chewing; Web-based survey system",
abstract="Background: Smoking tobacco, drinking alcohol, and chewing betel quid are health-risk behaviors for several diseases, such as cancer, cardiovascular disease, and diabetes, with severe impacts on health. However, health care providers often have limited time to assess clients' behaviors regarding smoking tobacco, drinking alcohol, and chewing betel quid and intervene, if needed. Objective: The objective of this study was to develop a Web-based survey system; determine the rates of tobacco-smoking, alcohol-drinking, and betel-quid-chewing behaviors; and estimate the efficiency of the system (time to complete the survey). Methods: Patients and their family members or friends were recruited from gastrointestinal medical--surgical, otolaryngology, orthopedics, and rehabilitation clinics or wards at a medical center in northern Taiwan. Data for this descriptive, cross-sectional study were extracted from a large series of research studies. A Web-based survey system was developed using a Linux, Apache, MySQL, PHP stack solution. The Web survey was set up to include four questionnaires: the Chinese-version Fagerstrom Tolerance Questionnaire, the Chinese-version Alcohol Use Disorders Identification Test, the Betel Nut Dependency Scale, and a sociodemographic form with several chronic diseases. After the participants completed the survey, the system automatically calculated their score, categorized their risk level for each behavior, and immediately presented and explained their results. The system also recorded the time each participant took to complete the survey. Results: Of 782 patient participants, 29.6{\%} were addicted to nicotine, 13.3{\%} were hazardous, harmful, or dependent alcohol drinkers, and 1.5{\%} were dependent on chewing betel quid. Of 425 family or friend participants, 19.8{\%} were addicted to nicotine, 5.6{\%} were hazardous, harmful, or dependent alcohol drinkers, and 0.9{\%} were dependent on chewing betel quid. Regarding the mean time to complete the survey, patients took 7.9 minutes (SD 3.0; range 3-20) and family members or friends took 7.7 minutes (SD 2.8; range 3-18). Most of the participants completed the survey within 5-10 minutes. Conclusions: The Web-based survey was easy to self-administer. Health care providers can use this Web-based survey system to save time in assessing these risk behaviors in clinical settings. All smokers had mild-to-severe nicotine addiction, and 5.6{\%}-12.3{\%} of patients and their family members or friends were at risk of alcohol dependence. Considering that these three behaviors, particularly in combination, dramatically increase the risk of esophageal cancer, appropriate and convenient interventions are necessary for preserving public health in Taiwan. ",
doi="10.2196/mhealth.9783",
url="http://mhealth.jmir.org/2018/6/e142/",
url="https://doi.org/10.2196/mhealth.9783",
url="http://www.ncbi.nlm.nih.gov/pubmed/29891467"
}


@Article{info:doi/10.2196/resprot.9532,
author="Ti, Lianping
and Parent, Stephanie
and Soc{\'i}as, Mar{\'i}a Eugenia",
title="Integrated Models of Care for People Living with Hepatitis C Virus and a Substance Use Disorder: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2018",
month="May",
day="09",
volume="7",
number="5",
pages="e122",
keywords="hepatitis C virus; substance use disorder; integrated care; protocol; systematic review",
abstract="Background: People living with a substance use disorder (SUD) are a key population within the hepatitis C virus (HCV) epidemic. While integrated and community-based models of care have shown positive outcomes among this population, the literature has been primarily focused on the HIV context. This paper outlines a systematic review protocol on the impact of various integrated models of care, which includes HCV and SUD services, on various treatment, and health-related outcomes among this population. Objective: The objective of this review is to determine the impact of integrated models of care on HCV and addiction treatment and health-related outcomes for adults living with HCV and an SUD. Methods: We will search 5 databases, article reference lists, and abstracts from relevant conferences that investigate the impact of integrated models of care on treatment and health-related outcomes among people living with HCV and an SUD. Database searches will be conducted and titles, abstracts, and the full-text of the relevant studies will be independently reviewed in separate stages. The methodological quality of included studies will be assessed using a validated tool. Data from included articles will be extracted using a standardized form and synthesized in a narrative account. Results: For this project, we have received funding from the Canadian Institute of Health Research. To date, we have completed the search strategy, reviewed the titles, abstracts, and full-texts. Grading the selected studies and qualitative synthesis of the results are currently under way, and we expect the final results to be submitted for publication in the fall of 2018. Conclusions: The systematic review will describe different integrated models of care that could be effective in improving the health and well-being of people living with HCV and an SUD. Results of this review could also identify quality improvement strategies to minimize the health and cost burden imposed on patients, healthcare professionals, and the healthcare system. Trial Registration: PROSPERO CRD42017078445; https://www.crd.york.ac.uk/prospero/display{\_}record.php?RecordID=78445 (Archived by WebCite at http://www.webcitation.org/6z4YnkE9G) ",
doi="10.2196/resprot.9532",
url="http://www.researchprotocols.org/2018/5/e122/",
url="https://doi.org/10.2196/resprot.9532",
url="http://www.ncbi.nlm.nih.gov/pubmed/29743153"
}


@Article{info:doi/10.2196/jmir.9579,
author="Jonas, Benjamin
and Tensil, Marc-Dennan
and Tossmann, Peter
and Str{\"u}ber, Evelin",
title="Effects of Treatment Length and Chat-Based Counseling in a Web-Based Intervention for Cannabis Users: Randomized Factorial Trial",
journal="J Med Internet Res",
year="2018",
month="May",
day="08",
volume="20",
number="5",
pages="e166",
keywords="cannabis; Internet; counseling; random allocation",
abstract="Background: Digital interventions show promise in reducing problematic cannabis use. However, little is known about the effect of moderators in such interventions. The therapist-guided internet intervention Quit the Shit provides 50 days of chat-based (synchronous) and time-lagged (asynchronous) counseling. Objective: In the study, we examined whether the effectiveness of Quit the Shit is reduced by shortening the program or by removing the chat-based counseling option. Methods: We conducted a purely Web-based randomized experimental trial using a two-factorial design (factor 1: real-time-counseling via text-chat: yes vs no; factor 2: intervention duration: 50 days vs 28 days). Participants were recruited on the Quit the Shit website. Follow-ups were conducted 3, 6, and 12 months after randomization. Primary outcome was cannabis-use days during the past 30 days using a Timeline Followback procedure. Secondary outcomes were cannabis quantity, cannabis-use events, cannabis dependency (Severity of Dependence Scale), treatment satisfaction (Client Satisfaction Questionnaire), and working alliance (Working Alliance Inventory-short revised). Results: In total, 534 participants were included in the trial. Follow-up rates were 47.2{\%} (252/534) after 3 months, 38.2{\%} (204/534) after 6 months, and 25.3{\%} (135/534) after 12 months. Provision of real-time counseling (factor 1) was not significantly associated with any cannabis-related outcome but with higher treatment satisfaction (P=.001, d=0.34) and stronger working alliance (P=.008, d=0.22). In factor 2, no significant differences were found in any outcome. The reduction of cannabis use among all study participants was strong (P<.001, d≥1.13). Conclusions: The reduction of program length and the waiver of synchronous communication have no meaningful impact on the effectiveness of Quit the Shit. It therefore seems tenable to abbreviate the program and to offer a self-guided start into Quit the Shit. Due to its positive impact on treatment satisfaction and working alliance, chat-based counseling nevertheless should be provided in Quit the Shit. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN99818059; http://www.isrctn.com/ISRCTN99818059 (Archived by WebCite at http://www.webcitation.org/6uVDeJjfD) ",
doi="10.2196/jmir.9579",
url="http://www.jmir.org/2018/5/e166/",
url="https://doi.org/10.2196/jmir.9579",
url="http://www.ncbi.nlm.nih.gov/pubmed/29739738"
}


@Article{info:doi/10.2196/publichealth.9408,
author="Borodovsky, Jacob T
and Marsch, Lisa A
and Budney, Alan J",
title="Studying Cannabis Use Behaviors With Facebook and Web Surveys: Methods and Insights",
journal="JMIR Public Health Surveill",
year="2018",
month="May",
day="02",
volume="4",
number="2",
pages="e48",
keywords="epidemiology; cross-sectional studies; sampling studies; social media; data collection; cannabis; surveys",
doi="10.2196/publichealth.9408",
url="http://publichealth.jmir.org/2018/2/e48/",
url="https://doi.org/10.2196/publichealth.9408",
url="http://www.ncbi.nlm.nih.gov/pubmed/29720366"
}


@Article{info:doi/10.2196/resprot.9414,
author="Stephenson, Rob
and Bonar, Erin E
and Carrico, Adam
and Hunter, Alexis
and Connochie, Daniel
and Himmelstein, Rebecca
and Bauermeister, Jose",
title="Intervention to Increase HIV Testing Among Substance-Using Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Apr",
day="30",
volume="7",
number="4",
pages="e114",
keywords="HIV; men who have sex with men; drug abuse; substance use disorders; motivational interviewing",
abstract="Background: Young men who have sex with men (YMSM) and transgender people in the Detroit Metro Area are the only risk group for whom the incidence of HIV and sexually transmitted infections (STI) has increased since 2000, with HIV incidence nearly doubling among youth. Substance use (including alcohol), which is relatively frequent among YMSM and transgender people, creates barriers to the optimal delivery of HIV prevention and care services. Standard HIV counseling, testing, and referral (CTR) is limited in providing strategies to identify and address substance use. Hence, in its current form, CTR may not be serving the prevention needs of substance-using YMSM and transgender people. Brief counseling interventions, grounded in principles of motivational interviewing, may offer a mechanism to meet the HIV prevention and care needs of substance-using YMSM and transgender people. Objective: This prospective, 4-arm, factorial randomized controlled trial aims to examine the efficacy of an motivational interviewing--based substance use brief intervention (SUBI) on participants' substance use and engagement in HIV prevention. Methods: The research implements a prospective randomized controlled trial (Project Swerve) of 600 YMSM and transgender people recruited both online and in person. Eligibility criteria include participants who (1) are between the ages of 15 to 29 years, (2) live in the Detroit Metro Area, (3) self-identify as a man or transgender man or woman, (4) have had sexual contact with a man in the 6 months before enrollment, (5) self-report binge drinking or any substance use in the 3 months before enrollment, and (6) self-report an unknown or negative HIV status upon enrollment. Participants are randomized to receive, 3-months apart starting at baseline, 2 individual sessions. Sessions are CTR-only, SUBI-only, CTR followed by SUBI, or SUBI followed by CTR. Results: Project Swerve was launched in April 2017 and enrollment is ongoing. Conclusions: Incorporating a SUBI that utilizes the principles of motivational interviewing into HIV CTR provides an opportunity to tailor counseling services for YMSM and transgender people to address additional client barriers to HIV and STI testing. Trial Registration: ClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436 (Archived by WebCite at http://www.webcitation.org/6yFyOK57w) ",
doi="10.2196/resprot.9414",
url="http://www.researchprotocols.org/2018/4/e114/",
url="https://doi.org/10.2196/resprot.9414",
url="http://www.ncbi.nlm.nih.gov/pubmed/29712625"
}


@Article{info:doi/10.2196/10029,
author="Mackey, Tim
and Kalyanam, Janani
and Klugman, Josh
and Kuzmenko, Ella
and Gupta, Rashmi",
title="Solution to Detect, Classify, and Report Illicit Online Marketing and Sales of Controlled Substances via Twitter: Using Machine Learning and Web Forensics to Combat Digital Opioid Access",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="27",
volume="20",
number="4",
pages="e10029",
keywords="online pharmacies; drug abuse; opioid abuse; machine learning; unsupervised machine learning; prescription drug misuse",
abstract="Background: On December 6 and 7, 2017, the US Department of Health and Human Services (HHS) hosted its first Code-a-Thon event aimed at leveraging technology and data-driven solutions to help combat the opioid epidemic. The authors---an interdisciplinary team from academia, the private sector, and the US Centers for Disease Control and Prevention---participated in the Code-a-Thon as part of the prevention track. Objective: The aim of this study was to develop and deploy a methodology using machine learning to accurately detect the marketing and sale of opioids by illicit online sellers via Twitter as part of participation at the HHS Opioid Code-a-Thon event. Methods: Tweets were collected from the Twitter public application programming interface stream filtered for common prescription opioid keywords in conjunction with participation in the Code-a-Thon from November 15, 2017 to December 5, 2017. An unsupervised machine learning--based approach was developed and used during the Code-a-Thon competition (24 hours) to obtain a summary of the content of the tweets to isolate those clusters associated with illegal online marketing and sale using a biterm topic model (BTM). After isolating relevant tweets, hyperlinks associated with these tweets were reviewed to assess the characteristics of illegal online sellers. Results: We collected and analyzed 213,041 tweets over the course of the Code-a-Thon containing keywords codeine, percocet, vicodin, oxycontin, oxycodone, fentanyl, and hydrocodone. Using BTM, 0.32{\%} (692/213,041) tweets were identified as being associated with illegal online marketing and sale of prescription opioids. After removing duplicates and dead links, we identified 34 unique ``live'' tweets, with 44{\%} (15/34) directing consumers to illicit online pharmacies, 32{\%} (11/34) linked to individual drug sellers, and 21{\%} (7/34) used by marketing affiliates. In addition to offering the ``no prescription'' sale of opioids, many of these vendors also sold other controlled substances and illicit drugs. Conclusions: The results of this study are in line with prior studies that have identified social media platforms, including Twitter, as a potential conduit for supply and sale of illicit opioids. To translate these results into action, authors also developed a prototype wireframe for the purposes of detecting, classifying, and reporting illicit online pharmacy tweets selling controlled substances illegally to the US Food and Drug Administration and the US Drug Enforcement Agency. Further development of solutions based on these methods has the potential to proactively alert regulators and law enforcement agencies of illegal opioid sales, while also making the online environment safer for the public. ",
doi="10.2196/10029",
url="http://www.jmir.org/2018/4/e10029/",
url="https://doi.org/10.2196/10029",
url="http://www.ncbi.nlm.nih.gov/pubmed/29613851"
}


@Article{info:doi/10.2196/games.9231,
author="Metcalf, Mary
and Rossie, Karen
and Stokes, Katie
and Tallman, Christina
and Tanner, Bradley",
title="Virtual Reality Cue Refusal Video Game for Alcohol and Cigarette Recovery Support: Summative Study",
journal="JMIR Serious Games",
year="2018",
month="Apr",
day="16",
volume="6",
number="2",
pages="e7",
keywords="addiction treatment; Kinect; serious games; motion control games; virtual reality",
abstract="Background: New technologies such as virtual reality, augmented reality, and video games hold promise to support and enhance individuals in addiction treatment and recovery. Quitting or decreasing cigarette or alcohol use can lead to significant health improvements for individuals, decreasing heart disease risk and cancer risks (for both nicotine and alcohol use), among others. However, remaining in recovery from use is a significant challenge for most individuals. Objective: We developed and assessed the Take Control game, a partially immersive Kinect for Windows platform game that allows users to counter substance cues through active movements (hitting, kicking, etc). Methods: Formative analysis during phase I and phase II guided development. We conducted a small wait-list control trial using a quasi-random sampling technique (systematic) with 61 participants in recovery from addiction to alcohol or tobacco. Participants used the game 3 times and reported on substance use, cravings, satisfaction with the game experience, self-efficacy related to recovery, and side effects from exposure to a virtual reality intervention and substance cues. Results: Participants found the game engaging and fun and felt playing the game would support recovery efforts. On average, reported substance use decreased for participants during the intervention period. Participants in recovery for alcohol use saw more benefit than those in recovery for tobacco use, with a statistically significant increase in self-efficacy, attitude, and behavior during the intervention. Side effects from the use of a virtual reality intervention were minor and decreased over time; cravings and side effects also decreased during the study. Conclusions: The preliminary results suggest the intervention holds promise as an adjunct to standard treatment for those in recovery, particularly from alcohol use. ",
doi="10.2196/games.9231",
url="http://games.jmir.org/2018/2/e7/",
url="https://doi.org/10.2196/games.9231",
url="http://www.ncbi.nlm.nih.gov/pubmed/29661748"
}


@Article{info:doi/10.2196/mental.8891,
author="Champion, Katrina Elizabeth
and Chapman, Cath
and Newton, Nicola Clare
and Brierley, Mary-Ellen
and Stapinski, Lexine
and Kay-Lambkin, Frances
and Nagle, Jack
and Teesson, Maree",
title="A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice",
journal="JMIR Ment Health",
year="2018",
month="Mar",
day="20",
volume="5",
number="1",
pages="e21",
keywords="methamphetamine; substance-related disorders; internet; preventive psychiatry; health education",
abstract="Background: The use of crystal methamphetamine (ice) and the associated harms for individuals, families, and communities across Australia has been the subject of growing concern in recent years. The provision of easily accessible, evidence-based, and up-to-date information and resources about crystal methamphetamine for the community is a critical component of an effective public health response. Objective: This paper aims to describe the codevelopment process of the Web-based Cracks in the Ice Community Toolkit, which was developed to improve access to evidence-based information and resources about crystal methamphetamine for the Australian community. Methods: Development of the Cracks in the Ice Community Toolkit was conducted in collaboration with community members across Australia and with experts working in the addiction field. The iterative process involved the following: (1) consultation with end users, including community members, crystal methamphetamine users, families and friends of someone using crystal methamphetamine, health professionals, and teachers (n=451) via a cross-sectional Web-based survey to understand information needs; (2) content and Web development; and (3) user testing of a beta version of the Web-based toolkit among end users (n=41) and experts (n=10) to evaluate the toolkit's acceptability, relevance, and appeal. Results: Initial end user consultation indicated that the most commonly endorsed reasons for visiting a website about crystal methamphetamine were ``to get information for myself'' (185/451, 41.0{\%}) and ``to find out how to help a friend or a family member'' (136/451, 30.2{\%}). Community consultation also revealed the need for simple information about crystal methamphetamine, including what it is, its effects, and when and where to seek help or support. Feedback on a beta version of the toolkit was positive in terms of content, readability, layout, look, and feel. Commonly identified areas for improvement related to increasing the level of engagement and personal connection, improving the ease of navigation, and balancing a ``low prevalence of use, yet high impact'' message. A total of 9138 users visited the website in the 3 months immediately post launch, and over 25,000 hard-copy Cracks in the Ice booklets and flyers were distributed across Australia. Of these resources, 60.93{\%} (15,525/25,480) were distributed to relevant organizations and mailing list subscribers, and 39.07{\%} (9955/25,480) were ordered directly by individuals, services, and community groups via the Cracks in the Ice website. Conclusions: The codevelopment process resulted in an engaging Web-based resource for the Australian community to access up-to-date and evidence-based resources about crystal methamphetamine. The Cracks in the Ice Community Toolkit provides much-needed information and support for individuals, families, and communities. ",
doi="10.2196/mental.8891",
url="http://mental.jmir.org/2018/1/e21/",
url="https://doi.org/10.2196/mental.8891",
url="http://www.ncbi.nlm.nih.gov/pubmed/29559427"
}


@Article{info:doi/10.2196/publichealth.8144,
author="Cherian, Roy
and Westbrook, Marisa
and Ramo, Danielle
and Sarkar, Urmimala",
title="Representations of Codeine Misuse on Instagram: Content Analysis",
journal="JMIR Public Health Surveill",
year="2018",
month="Mar",
day="20",
volume="4",
number="1",
pages="e22",
keywords="prescription opioid misuse; social media; poly-substance use; Instagram",
abstract="Background: Prescription opioid misuse has doubled over the past 10 years and is now a public health epidemic. Analysis of social media data may provide additional insights into opioid misuse to supplement the traditional approaches of data collection (eg, self-report on surveys). Objective: The aim of this study was to characterize representations of codeine misuse through analysis of public posts on Instagram to understand text phrases related to misuse. Methods: We identified hashtags and searchable text phrases associated with codeine misuse by analyzing 1156 sequential Instagram posts over the course of 2 weeks from May 2016 to July 2016. Content analysis of posts associated with these hashtags identified the most common themes arising in images, as well as culture around misuse, including how misuse is happening and being perpetuated through social media. Results: A majority of images (50/100; 50.0{\%}) depicted codeine in its commonly misused form, combined with soda (lean). Codeine misuse was commonly represented with the ingestion of alcohol, cannabis, and benzodiazepines. Some images highlighted the previously noted affinity between codeine misuse and hip-hop culture or mainstream popular culture images. Conclusions: The prevalence of codeine misuse images, glamorizing of ingestion with soda and alcohol, and their integration with mainstream, popular culture imagery holds the potential to normalize and increase codeine misuse and overdose. To reduce harm and prevent misuse, immediate public health efforts are needed to better understand the relationship between the potential normalization, ritualization, and commercialization of codeine misuse. ",
doi="10.2196/publichealth.8144",
url="http://publichealth.jmir.org/2018/1/e22/",
url="https://doi.org/10.2196/publichealth.8144",
url="http://www.ncbi.nlm.nih.gov/pubmed/29559422"
}


@Article{info:doi/10.2196/jmir.9172,
author="Ashford, Robert D
and Lynch, Kevin
and Curtis, Brenda",
title="Technology and Social Media Use Among Patients Enrolled in Outpatient Addiction Treatment Programs: Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2018",
month="Mar",
day="06",
volume="20",
number="3",
pages="e84",
keywords="digital divide; behavioral health; social media; addiction; recovery; relapse",
abstract="Background: Substance use disorder research and practice have not yet taken advantage of emerging changes in communication patterns. While internet and social media use is widespread in the general population, little is known about how these mediums are used in substance use disorder treatment. Objective: The aims of this paper were to provide data on patients' with substance use disorders mobile phone ownership rates, usage patterns on multiple digital platforms (social media, internet, computer, and mobile apps), and their interest in the use of these platforms to monitor personal recovery. Methods: We conducted a cross-sectional survey of patients in 4 intensive outpatient substance use disorder treatment facilities in Philadelphia, PA, USA. Logistic regressions were used to examine associations among variables. Results: Survey participants (N=259) were mostly male (72.9{\%}, 188/259), African American (62.9{\%}, 163/259), with annual incomes less than US {\$}10,000 (62.5{\%}, 161/259), and averaged 39 (SD 12.24) years of age. The vast majority of participants (93.8{\%}, 243/259) owned a mobile phone and about 64.1{\%} (166/259) owned a mobile phone with app capabilities, of which 85.1{\%} (207/243) accessed the internet mainly through their mobile phone. There were no significant differences in age, gender, ethnicity, or socio-economic status by computer usage, internet usage, number of times participants changed their phone, type of mobile phone contract, or whether participants had unlimited calling plans. The sample was grouped into 3 age groups (Millennials, Generation Xers, and Baby Boomers). The rates of having a social media account differed across these 3 age groups with significant differences between Baby Boomers and both Generation Xers and Millennials (P<.001 in each case). Among participants with a social media account (73.6{\%}, 190/259), most (76.1{\%}, 144/190) reported using it daily and nearly all (98.2{\%}, 186/190) used Facebook. Nearly half of participants (47.4{\%}, 90/190) reported viewing content on social media that triggered substance cravings and an equal percentage reported being exposed to recovery information on social media. There was a significant difference in rates of reporting viewing recovery information on social media across the 3 age groups with Baby Boomers reporting higher rates than Millennials (P<.001). The majority of respondents (70.1{\%}, 181/259) said they would prefer to use a relapse prevention app on their phone or receive SMS (short message service) relapse prevention text messages (72.3{\%}, 186/259), and nearly half (49.1{\%}, 127/259) expressed an interest in receiving support by allowing social media accounts to be monitored as a relapse prevention technique. Conclusions: To our knowledge, this is the first and largest study examining the online behavior and preferences regarding technology-based substance use disorder treatment interventions in a population of patients enrolled in community outpatient treatment programs. Patients were generally receptive to using relapse prevention apps and text messaging interventions and a substantial proportion supported social media surveillance tools. However, the design of technology-based interventions remains as many participants have monthly telephone plans which may limit continuity. ",
doi="10.2196/jmir.9172",
url="http://www.jmir.org/2018/3/e84/",
url="https://doi.org/10.2196/jmir.9172",
url="http://www.ncbi.nlm.nih.gov/pubmed/29510968"
}


@Article{info:doi/10.2196/mhealth.8388,
author="Han, Hui
and Zhang, Jing Ying
and Hser, Yih-Ing
and Liang, Di
and Li, Xu
and Wang, Shan Shan
and Du, Jiang
and Zhao, Min",
title="Feasibility of a Mobile Phone App to Support Recovery From Addiction in China: Secondary Analysis of a Pilot Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Feb",
day="27",
volume="6",
number="2",
pages="e46",
keywords="mHealth; substance use; heroin dependence; amphetamine-type stimulant (ATS) dependence; mobile app; China",
abstract="Background: Mobile health technologies have been found to improve the self-management of chronic diseases. However, there is limited research regarding their feasibility in supporting recovery from substance use disorders (SUDs) in China. Objective: The objective of this study was to examine the feasibility of a mobile phone-based ecological momentary assessment (EMA) app by testing the concordance of drug use assessed by the EMA, urine testing, and a life experience timeline (LET) assessment. Methods: A total of 75 participants dependent on heroin or amphetamine-type stimulant (ATS) in Shanghai were recruited to participate in a 4-week pilot study. Of the participants, 50 (67{\%} [50/75]) were randomly assigned to the experimental group and 25 (33{\%} [25/75]) were assigned to the control group. The experimental group used mobile health (mHealth) based EMA technology to assess their daily drug use in natural environments and received 2 short health messages each day, whereas the control group only received 2 short health messages each day from the app. Urine tests and LET assessments were conducted each week and a post-intervention survey was administered to both groups. The correlations among the EMA, the LET assessment, and the urine test were investigated. Results: The mean age of the participants was 41.6 (SD 8.0) years, and 71{\%} (53/75) were male. During the 4 weeks of observation, 690 daily EMA survey data were recorded, with a response rate of 49.29{\%} (690/1400). With respect to drug use, the percent of agreement between the EMA and the LET was 66.7{\%}, 79.2{\%}, 72.4{\%}, and 85.8{\%}, respectively, for each of the 4 weeks, whereas the percent of agreement between the EMA and the urine test was 51.2{\%}, 65.1{\%}, 61.9{\%}, and 71.5{\%}, respectively. The post-intervention survey indicated that 46{\%} (32/70) of the participants preferred face-to-face interviews rather than the mHealth app. Conclusions: This study demonstrated poor agreement between the EMA data and the LET and found that the acceptance of mHealth among individuals with SUDs in China was not positive. Hence, greater efforts are needed to improve the feasibility of mHealth in China. ",
doi="10.2196/mhealth.8388",
url="http://mhealth.jmir.org/2018/2/e46/",
url="https://doi.org/10.2196/mhealth.8388",
url="http://www.ncbi.nlm.nih.gov/pubmed/29487040"
}


@Article{info:doi/10.2196/jmir.7121,
author="Lopez-Rodriguez, Juan A
and Rubio Valladolid, Gabriel",
title="Web-Based Alcohol, Smoking, and Substance Involvement Screening Test Results for the General Spanish Population: Cross-Sectional Study",
journal="J Med Internet Res",
year="2018",
month="Feb",
day="16",
volume="20",
number="2",
pages="e57",
keywords="screening; substance-related disorders; Web-based systems; primary health care; ASSIST",
abstract="Background: Information technology in health sciences could be a screening tool of great potential and has been shown to be effective in identifying single-drug users at risk. Although there are many published tests for single-drug screening, there is a gap for concomitant drug use screening in general population. The ASSIST (Alcohol, Smoking and Substance Involvement Screening Test) website was launched on February 2015 in Madrid, Spain, as a tool to identify those at risk. Objective: The aim of this study was to describe the use of a tool and to analyze profiles of drug users, their consumption patterns, and associated factors. Methods: Government- and press-released launching of a Spanish-validated ASSIST test from the World Health Organization (WHO) was used for voluntary Web-based screening of people with drug-related problems. The tests completed in the first 6 months were analyzed . Results: A total of 1657 visitors of the 15,867 visits (1657/15,867, 10.44{\%}) completed the whole Web-based screening over a 6-month period. The users had an average age of 37.4 years, and 78.87{\%} (1307/1657) screened positive for at least one of the 9 drugs tested. The drugs with higher prevalence were tobacco (840/1657, 50.69{\%}), alcohol (437/1657, 26.37{\%}), cannabis (361/1657, 21.79{\%}), and sedatives or hypnotics (192/1657, 11.59{\%}). Polyconsumption or concomitant drug use was stated by 31.80{\%} (527/1657) of the users. Male respondents had a higher risk of having alcohol problems (odds ratio, OR 1.55, 95{\%} CI 1.18-2.04; P=.002) and double the risk for cannabis problems (OR 2.07, 95{\%} CI 1.46-2.92; P<.001). Growing age increased by 3 times the risk of developing alcohol problems for people aged between 45 and 65 years (OR 3.01, 95{\%} CI 1.89-4.79; P<.001). Conclusions: A Web-based screening test could be useful to detect people at risk. The drug-related problem rates detected by the study are consistent with the current literature. This tool could be useful for users, who use information technology on a daily basis, not seeking medical attention. ",
doi="10.2196/jmir.7121",
url="http://www.jmir.org/2018/2/e57/",
url="https://doi.org/10.2196/jmir.7121",
url="http://www.ncbi.nlm.nih.gov/pubmed/29453188"
}


@Article{info:doi/10.2196/resprot.9385,
author="Zhang, Melvyn
and Ying, JiangBo
and Song, Guo
and Ho, Roger CM
and Fung, Daniel SS
and Smith, Helen",
title="Attention Bias in Individuals with Addictive Disorders: Systematic Review Protocol",
journal="JMIR Res Protoc",
year="2018",
month="Feb",
day="08",
volume="7",
number="2",
pages="e41",
keywords="attention bias; substance addiction; systematic review",
abstract="Background: Globally, substance disorders, particularly that of opiate use, cannabis use, and stimulant use disorders, are highly prevalent. Psychological treatments are an integral aspect of intervention, but a proportion of individuals still relapse despite having received such an intervention. Recently, the dual-process theory proposed that the unconscious processes of attention biases are responsible for these relapses. Prior meta-analyses have reported the presence of attention bias in alcohol and tobacco use disorders. More recent research has examined attention bias and its effectiveness in opiate use, cannabis use, and stimulant use disorder. The evidence syntheses to date have not examined whether attention bias is present in these disorders and could be subjected to manipulation. This is important information and would support the introduction of psychological interventions for attention bias for such patients. Such psychological interventions would help individuals maintain their abstinence and minimize the risk of relapse. Objective: This paper aims to undertake a systematic review to synthesize the existing evidence for the presence of attention bias in all the disorders mentioned above, and to determine the clinical efficacy of attention bias modification. Methods: A systematic review will be conducted. A search will be conducted on the respective databases up till 2017. Selection of the studies will be determined by the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Quality assessment of the included studies will be assessed using the Cochrane Risk of Bias tool. A narrative synthesis will be conducted, with a meta-analysis considered only if there are sufficient studies for statistical analysis. Results: The results of the systematic review will be available 12 months after the publication of this protocol. Conclusions: This review is important as it will support the introduction of psychological interventions for attention bias for such patients. Such psychological interventions would help individuals maintain their abstinence and minimize the risk of relapse. ",
doi="10.2196/resprot.9385",
url="http://www.researchprotocols.org/2018/2/e41/",
url="https://doi.org/10.2196/resprot.9385",
url="http://www.ncbi.nlm.nih.gov/pubmed/29422449"
}


@Article{info:doi/10.2196/resprot.9012,
author="Snijder, Mieke
and Stapinski, Lexine
and Lees, Briana
and Newton, Nicola
and Champion, Katrina
and Chapman, Catherine
and Ward, James
and Teesson, Maree",
title="Substance Use Prevention Programs for Indigenous Adolescents in the United States of America, Canada, Australia and New Zealand: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2018",
month="Feb",
day="01",
volume="7",
number="2",
pages="e38",
keywords="prevention; Indigenous population; minority groups; Indians; North American; Alaska Natives; Aborigines; Australian; adolescent alcohol use; substance abuse; tobacco; marijuana smoking",
abstract="Background: Indigenous adolescents are at a higher risk of experiencing harms related to substance use compared with their non-Indigenous counterparts as a consequence of earlier onset and higher rates of substance use. Early onset of substance use has been identified as a risk factor for future substance use problems and other health, social, and family outcomes. Therefore, prevention of substance use among adolescents has been identified as a key area to improve health of Indigenous Peoples. Evidence exists for the effectiveness of prevention approaches for adolescents in mainstream populations and, most recently, for the use of computer- and Internet-delivered interventions to overcome barriers to implementation. However, there is currently no conclusive evidence about the effectiveness of these approaches for Indigenous adolescents. Objective: The purpose of this review is to synthesize the international evidence regarding the effectiveness of substance use prevention programs for Indigenous adolescents in the United States, Canada, Australia, and New Zealand. Methods: A total of 8 peer-reviewed databases and 20 gray literature databases will be searched, using search terms in line with the aims of this review and based on previous relevant reviews of substance use prevention. Studies will be included if they evaluate a substance use prevention program with Indigenous adolescents (aged 10 to 19 years) as the primary participant group and are published between January 1, 1990 and August 31, 2017. Results: A narrative synthesis will be provided about the effectiveness of the programs, the type of program (whether culture-based, adapted, or unadapted), delivery of the program (computer- and Internet-delivered or traditional), and the setting in which the programs are delivered (community, school, family, clinical, or a combination). Conclusions: The study will identify core elements of effective substance use prevention programs among Indigenous adolescents and appraise the methodological quality of the studies. This review will provide researchers, policy makers, and program developers with evidence about the potential use of prevention approaches for Indigenous adolescents. ",
doi="10.2196/resprot.9012",
url="http://www.researchprotocols.org/2018/2/e38/",
url="https://doi.org/10.2196/resprot.9012",
url="http://www.ncbi.nlm.nih.gov/pubmed/29391343"
}


@Article{info:doi/10.2196/resprot.9484,
author="Amann, Manuel
and Haug, Severin
and Wenger, Andreas
and Baumgartner, Christian
and Ebert, David D
and Berger, Thomas
and Stark, Lars
and Walter, Marc
and Schaub, Michael P",
title="The Effects of Social Presence on Adherence-Focused Guidance in Problematic Cannabis Users: Protocol for the CANreduce 2.0 Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Jan",
day="31",
volume="7",
number="1",
pages="e30",
keywords="cannabis; mental disorders; adherence; social presence; mobile health; cognitive behavioral therapy",
abstract="Background: In European countries, including Switzerland, cannabis is the most commonly used illicit drug. Offering a Web-based self-help tool could potentially reach users who otherwise would not seek traditional help. However, such Web-based self-help tools often suffer from low adherence. Objective: Through adherence-focused guidance enhancements, the aim of this study was to increase adherence in cannabis users entering a Web-based self-help tool to reduce their cannabis use and, in this way, augment its effectiveness. Methods: This paper presents the protocol for a three-arm randomized controlled trial (RCT) to compare the effectiveness of (1) an adherence-focused, guidance-enhanced, Web-based self-help intervention with social presence; (2) an adherence-focused, guidance-enhanced, Web-based self-help intervention without social presence; and (3) a treatment-as-usual at reducing cannabis use in problematic users. The two active interventions, each spanning 6 weeks, consist of modules designed to reduce cannabis use and attenuate common mental disorder (CMD) symptoms, including depression, anxiety, and stress-related disorder symptoms based on the approaches of motivational interviewing and cognitive behavioral therapy. With a target sample size of 528, data will be collected at baseline, 6 weeks, and 3 months after baseline. The primary outcome measurement will be the number of days of cannabis use on the preceding 7 days. Secondary outcomes will include the quantity of cannabis used in standardized cannabis joints, the severity of cannabis dependence, changes in CMD symptoms, and adherence to the program. Data analysis will follow the intention-to-treat principle and employ (generalized) linear mixed models. Results: The project commenced in August 2016; recruitment is anticipated to end by December 2018. First results are expected to be submitted for publication in summer 2019. Conclusions: This study will provide detailed insights on if and how the effectiveness of a Web-based self-help intervention aiming to reduce cannabis use in frequent cannabis users can be improved by theory-driven, adherence-focused guidance enhancement. Trial Registration: International Standard Randomized Controlled Trial Number Registry: ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185 (Archived by WebCite at http://www.webcitation.org/6wspbuQ1M) ",
doi="10.2196/resprot.9484",
url="http://www.researchprotocols.org/2018/1/e30/",
url="https://doi.org/10.2196/resprot.9484",
url="http://www.ncbi.nlm.nih.gov/pubmed/29386176"
}


@Article{info:doi/10.2196/ijmr.6573,
author="Barbieri, Stefania
and Feltracco, Paolo
and Lucchetta, Vittorio
and Gaudio, Rosa Maria
and Tredese, Alberto
and Bergamini, Mauro
and Vettore, Gianna
and Pietrantonio, Vincenzo
and Avato, Francesco Maria
and Donato, Daniele
and Boemo, Deris Gianni
and Nesoti, Maria Vittoria
and Snenghi, Rossella",
title="A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments",
journal="Interact J Med Res",
year="2018",
month="Jan",
day="31",
volume="7",
number="1",
pages="e2",
keywords="alcohol drinking; drinking behavior; underage drinking; binge drinking; alcoholic intoxication; adolescent; neknomination; alcoholic games; social network",
abstract="Background: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network--based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication. Objective: The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today's teenagers and young people up to the age of 23 years. Methods: Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge. Results: A total of 450 young patients (male 277/450, 61.5{\%}, female 173/450, 38.5{\%}; age 15 to 16 years 15/450, 3.3{\%}, age 17 to 18 years 184/450, 40.9{\%}, age 19 to 23 years 251/450, 55.8{\%}) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6{\%} (7/450) of cases; binge drinking and other alcoholic games caused 23.3{\%} (105/450) and 23.8{\%} (107/450) of hospitalizations, respectively. On admission, 44.2{\%} (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14{\%} of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units. Conclusions: Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. The potential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes. ",
doi="10.2196/ijmr.6573",
url="http://www.i-jmr.org/2018/1/e2/",
url="https://doi.org/10.2196/ijmr.6573",
url="http://www.ncbi.nlm.nih.gov/pubmed/29386170"
}


@Article{info:doi/10.2196/jmir.8928,
author="Quanbeck, Andrew
and Gustafson, David H
and Marsch, Lisa A
and Chih, Ming-Yuan
and Kornfield, Rachel
and McTavish, Fiona
and Johnson, Roberta
and Brown, Randall T
and Mares, Marie-Louise
and Shah, Dhavan V",
title="Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study",
journal="J Med Internet Res",
year="2018",
month="Jan",
day="30",
volume="20",
number="1",
pages="e37",
keywords="mobile health; mHealth; evidence-based practice; behavioral medicine",
abstract="Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. Methods: In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: The outcomes according to the RE-AIM framework are as follows: Reach---Seva reached 8.31{\%} (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness---Patients who were given Seva had significant improvements in their risky drinking days (44{\%} reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34{\%} reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption---Patients sustained high levels of Seva use---between 53{\%} and 60{\%} of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation---At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance---Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Conclusions: Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge. ",
doi="10.2196/jmir.8928",
url="http://www.jmir.org/2018/1/e37/",
url="https://doi.org/10.2196/jmir.8928",
url="http://www.ncbi.nlm.nih.gov/pubmed/29382624"
}


@Article{info:doi/10.2196/resprot.7650,
author="Long, Ju
and Yuan, Juntao Michael
and Johnson, Ron Kim",
title="A Shared Decision-Making Tool to Prevent Substance Abuse: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2018",
month="Jan",
day="11",
volume="7",
number="1",
pages="e5",
keywords="SBIRT; substance abuse; SUD; primary care brief intervention",
abstract="Background: Substance use disorder (SUD) affects over 20 million adults and costs over {\$}700 billion annually in the United States. It is one the greatest health care challenges we face. Objective: This research project seeks to enhance the standard practice of Screening, Brief Intervention, and Referral to Treatment (SBIRT) through a mobile solution easily incorporated into primary care that will promote shared decision making and increase referral and adherence to specialty care through continued follow-up care. Methods: This research will conduct an Office of Management and Budget (OMB)--approved randomized controlled trial (RCT) in primary care and SUD specialty service providers. The RCT will recruit a total of 500 SUD patients. Recruited patients will be randomized into control and intervention arms. Both arms will take initial baseline and exit (30 days) surveys to evaluate self-reported substance use and specialty service utilization. The control arm patients will receive usual care. The intervention group patients will receive technology-enhanced SBIRT and a mobile follow-up program to track goals and substance use at home. The RCT tracks participants for 30 days after the primary care encounter. We will collect feedback from the patients during the 30 days and count the number of patients who use specialty care services in specialty care programs for tobacco, alcohol, and drug abuse (both from self-reporting and from the service providers). Results: RCT and data collection are underway. We expect to report the data results in 2018. Conclusions: We expect that significantly more intervention group patients will receive specialty SUD care within 30 days following the SBIRT encounter at the primary care clinic compared to the control group. We also expect that the intervention group patients will report a greater reduction in substance use and a greater drop in Drug Abuse Screening Test and Addition Severity Index scores within 30 days. ",
doi="10.2196/resprot.7650",
url="http://www.researchprotocols.org/2018/1/e5/",
url="https://doi.org/10.2196/resprot.7650",
url="http://www.ncbi.nlm.nih.gov/pubmed/29326094"
}


@Article{info:doi/10.2196/publichealth.7726,
author="Simpson, Sean S
and Adams, Nikki
and Brugman, Claudia M
and Conners, Thomas J",
title="Detecting Novel and Emerging Drug Terms Using Natural Language Processing: A Social Media Corpus Study",
journal="JMIR Public Health Surveill",
year="2018",
month="Jan",
day="08",
volume="4",
number="1",
pages="e2",
keywords="natural language processing; street drugs; social media; vocabulary",
abstract="Background: With the rapid development of new psychoactive substances (NPS) and changes in the use of more traditional drugs, it is increasingly difficult for researchers and public health practitioners to keep up with emerging drugs and drug terms. Substance use surveys and diagnostic tools need to be able to ask about substances using the terms that drug users themselves are likely to be using. Analyses of social media may offer new ways for researchers to uncover and track changes in drug terms in near real time. This study describes the initial results from an innovative collaboration between substance use epidemiologists and linguistic scientists employing techniques from the field of natural language processing to examine drug-related terms in a sample of tweets from the United States. Objective: The objective of this study was to assess the feasibility of using distributed word-vector embeddings trained on social media data to uncover previously unknown (to researchers) drug terms. Methods: In this pilot study, we trained a continuous bag of words (CBOW) model of distributed word-vector embeddings on a Twitter dataset collected during July 2016 (roughly 884.2 million tokens). We queried the trained word embeddings for terms with high cosine similarity (a proxy for semantic relatedness) to well-known slang terms for marijuana to produce a list of candidate terms likely to function as slang terms for this substance. This candidate list was then compared with an expert-generated list of marijuana terms to assess the accuracy and efficacy of using word-vector embeddings to search for novel drug terminology. Results: The method described here produced a list of 200 candidate terms for the target substance (marijuana). Of these 200 candidates, 115 were determined to in fact relate to marijuana (65 terms for the substance itself, 50 terms related to paraphernalia). This included 30 terms which were used to refer to the target substance in the corpus yet did not appear on the expert-generated list and were therefore considered to be successful cases of uncovering novel drug terminology. Several of these novel terms appear to have been introduced as recently as 1 or 2 months before the corpus time slice used to train the word embeddings. Conclusions: Though the precision of the method described here is low enough as to still necessitate human review of any candidate term lists generated in such a manner, the fact that this process was able to detect 30 novel terms for the target substance based only on one month's worth of Twitter data is highly promising. We see this pilot study as an important proof of concept and a first step toward producing a fully automated drug term discovery system capable of tracking emerging NPS terms in real time. ",
doi="10.2196/publichealth.7726",
url="http://publichealth.jmir.org/2018/1/e2/",
url="https://doi.org/10.2196/publichealth.7726",
url="http://www.ncbi.nlm.nih.gov/pubmed/29311050"
}


@Article{info:doi/10.2196/medinform.7355,
author="Levesque, Deborah
and Umanzor, Cindy
and de Aguiar, Emma",
title="Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability",
journal="JMIR Med Inform",
year="2018",
month="Jan",
day="02",
volume="6",
number="1",
pages="e1",
keywords="pilot projects; substance use disorders; primary care; behavioral medicine; expert system",
abstract="Background: In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10{\%} to 11{\%} of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients. Objective: The objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient's SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions. Methods: A total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute's Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items. Results: For providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, ``The program can give me helpful information about my patient.'' For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was ``The program could help me make some positive changes'' (4.5). Conclusions: The SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients. ",
doi="10.2196/medinform.7355",
url="http://medinform.jmir.org/2018/1/e1/",
url="https://doi.org/10.2196/medinform.7355",
url="http://www.ncbi.nlm.nih.gov/pubmed/29295811"
}


@Article{info:doi/10.2196/mhealth.7927,
author="Gray, Justin
and Beatty, Jessica R
and Svikis, Dace S
and Puder, Karoline S
and Resnicow, Ken
and Konkel, Janine
and Rice, Shetoya
and McGoron, Lucy
and Ondersma, Steven J",
title="Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Nov",
day="08",
volume="5",
number="11",
pages="e172",
keywords="pregnancy; marijuana; intervention study; text messaging",
abstract="Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. Objective: The objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: The findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate. ",
doi="10.2196/mhealth.7927",
url="http://mhealth.jmir.org/2017/11/e172/",
url="https://doi.org/10.2196/mhealth.7927",
url="http://www.ncbi.nlm.nih.gov/pubmed/29117931"
}


@Article{info:doi/10.2196/publichealth.8391,
author="Yom-Tov, Elad
and Lev-Ran, Shaul",
title="Adverse Reactions Associated With Cannabis Consumption as Evident From Search Engine Queries",
journal="JMIR Public Health Surveill",
year="2017",
month="Oct",
day="26",
volume="3",
number="4",
pages="e77",
keywords="cannabis; search engines; pharmacovigilance",
abstract="Background: Cannabis is one of the most widely used psychoactive substances worldwide, but adverse drug reactions (ADRs) associated with its use are difficult to study because of its prohibited status in many countries. Objective: Internet search engine queries have been used to investigate ADRs in pharmaceutical drugs. In this proof-of-concept study, we tested whether these queries can be used to detect the adverse reactions of cannabis use. Methods: We analyzed anonymized queries from US-based users of Bing, a widely used search engine, made over a period of 6 months and compared the results with the prevalence of cannabis use as reported in the US National Survey on Drug Use in the Household (NSDUH) and with ADRs reported in the Food and Drug Administration's Adverse Drug Reporting System. Predicted prevalence of cannabis use was estimated from the fraction of people making queries about cannabis, marijuana, and 121 additional synonyms. Predicted ADRs were estimated from queries containing layperson descriptions to 195 ICD-10 symptoms list. Results: Our results indicated that the predicted prevalence of cannabis use at the US census regional level reaches an R2 of .71 NSDUH data. Queries for ADRs made by people who also searched for cannabis reveal many of the known adverse effects of cannabis (eg, cough and psychotic symptoms), as well as plausible unknown reactions (eg, pyrexia). Conclusions: These results indicate that search engine queries can serve as an important tool for the study of adverse reactions of illicit drugs, which are difficult to study in other settings. ",
doi="10.2196/publichealth.8391",
url="http://publichealth.jmir.org/2017/4/e77/",
url="https://doi.org/10.2196/publichealth.8391",
url="http://www.ncbi.nlm.nih.gov/pubmed/29074469"
}


@Article{info:doi/10.2196/mhealth.8474,
author="Haug, Severin
and Paz Castro, Raquel
and Meyer, Christian
and Filler, Andreas
and Kowatsch, Tobias
and Schaub, Michael P",
title="A Mobile Phone-Based Life Skills Training Program for Substance Use Prevention Among Adolescents: Pre-Post Study on the Acceptance and Potential Effectiveness of the Program, Ready4life",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Oct",
day="04",
volume="5",
number="10",
pages="e143",
keywords="coping skills; social skills; substance use disorder; adolescents; students; mobile phone",
abstract="Background: Substance use and misuse often first emerge during adolescence. Generic life skills training that is typically conducted within the school curriculum is effective at preventing the onset and escalation of substance use among adolescents. However, the dissemination of such programs is impeded by their large resource requirements in terms of personnel, money, and time. Life skills training provided via mobile phones might be a more economic and scalable approach, which additionally matches the lifestyle and communication habits of adolescents. Objective: The aim of this study was to test the acceptance and initial effectiveness of an individually tailored mobile phone--based life skills training program in vocational school students. Methods: The fully automated program, named ready4life, is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Program participants received up to 3 weekly text messages (short message service, SMS) over 6 months. Active program engagement was stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition with prizes in which program users collected credits with each interaction. Generalized estimating equation (GEE) analyses were used to investigate for changes between baseline and 6-month follow-up in the following outcomes: perceived stress, self-management skills, social skills, at-risk alcohol use, tobacco smoking, and cannabis use. Results: The program was tested in 118 school classes at 13 vocational schools in Switzerland. A total of 1067 students who owned a mobile phone and were not regular cigarette smokers were invited to participate in the life skills program. Of these, 877 (82.19{\%}, 877/1067; mean age=17.4 years, standard deviation [SD]=2.7; 58.3{\%} females) participated in the program and the associated study. A total of 43 students (4.9{\%}, 43/877) withdrew their program participation during the intervention period. The mean number of interactive program activities that participants engaged in was 15.5 (SD 13.3) out of a total of 39 possible activities. Follow-up assessments were completed by 436 of the 877 (49.7{\%}) participants. GEE analyses revealed decreased perceived stress (odds ratio, OR=0.93; 95{\%} CI 0.87-0.99; P=.03) and increases in several life skills addressed between baseline and the follow-up assessment. The proportion of adolescents with at-risk alcohol use declined from 20.2{\%} at baseline to 15.5{\%} at follow-up (OR 0.70, 95{\%} CI 0.53-0.93; P=.01), whereas no significant changes were obtained for tobacco (OR 0.94, 95{\%} CI 0.65-1.36; P=.76) or cannabis use (OR 0.91, 95{\%} CI 0.67-1.24; P=.54). Conclusions: These results reveal high-level acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented. A reasonable next step would be to test the efficacy of this program within a controlled trial. ",
doi="10.2196/mhealth.8474",
url="https://mhealth.jmir.org/2017/10/e143/",
url="https://doi.org/10.2196/mhealth.8474",
url="http://www.ncbi.nlm.nih.gov/pubmed/28978498"
}


@Article{info:doi/10.2196/jmir.7897,
author="Iorfino, Frank
and Davenport, Tracey A
and Ospina-Pinillos, Laura
and Hermens, Daniel F
and Cross, Shane
and Burns, Jane
and Hickie, Ian B",
title="Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="12",
volume="19",
number="7",
pages="e247",
keywords="suicidal ideation; mental health; primary health care; telemedicine; health services",
abstract="Background: Suicidal thoughts are common among young people presenting to face-to-face and online mental health services. The early detection and rapid response to these suicidal thoughts and other suicidal behaviors is a priority for suicide prevention and early intervention efforts internationally. Establishing how best to use new and emerging technologies to facilitate person-centered systematic assessment and early intervention for suicidality is crucial to these efforts. Objective: The aim of this study was to examine the use of a suicidality escalation protocol to respond to suicidality among help-seeking young people. Methods: A total of 232 young people in the age range of 16-25 years were recruited from either a primary mental health care service or online in the community. Each young person used the Synergy Online System and completed an initial clinical assessment online before their face-to-face or online clinical appointment. A suicidality escalation protocol was used to identify and respond to current and previous suicidal thoughts and behaviors. Results: A total of 153 young people (66{\%}, 153/232) reported some degree of suicidality and were provided with a real-time alert online. Further levels of escalation (email or phone contact and clinical review) were initiated for the 35 young people (15{\%}, 35/232) reporting high suicidality. Higher levels of psychological distress (P<.001) and a current alcohol or substance use problem (P=.02) predicted any level of suicidality compared with no suicidality. Furthermore, predictors of high suicidality compared with low suicidality were higher levels of psychological distress (P=.01), psychosis-like symptoms in the last 12 months (P=.01), a previous mental health problem (P=.01), and a history of suicide planning or attempts (P=.001). Conclusions: This study demonstrates the use of new and emerging technologies to facilitate the systematic assessment and detection of help-seeking young people presenting with suicidality. This protocol empowered the young person by suggesting pathways to care that were based on their current needs. The protocol also enabled an appropriate and timely response from service providers for young people reporting high suicidality that was associated with additional comorbid issues, including psychosis-like symptoms, and a history of suicide plans and attempts. ",
doi="10.2196/jmir.7897",
url="http://www.jmir.org/2017/7/e247/",
url="https://doi.org/10.2196/jmir.7897",
url="http://www.ncbi.nlm.nih.gov/pubmed/28701290"
}


@Article{info:doi/10.2196/jmir.7828,
author="Lucas, Gale
and Neeper, Michael
and Linde, Brittany
and Bennett, Joel",
title="Preventing Prescription Drug Misuse in Work Settings: Efficacy of a Brief Intervention in Health Consciousness",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="06",
volume="19",
number="7",
pages="e242",
keywords="prescription drugs; health; consciousness; education; workplace; substance-related disorders",
abstract="Background: It is becoming more commonplace for employees to use prescription medication outside of intended use. Opioid and other prescription misuse has implications for the health and productivity of workers. Easy-to-access webinars that help employees learn about alternatives to prescription use may decrease risk. Objective: The aim of this study was to examine the efficacy of an interactive but brief health consciousness and prescription drug intervention for a diverse sample of employees and show effectiveness via both Internet-delivered webinar and classroom delivery. Methods: Employees from a variety of workplaces filled out pre- and post-questionnaires upon completion of a one-hour long intervention. Results: A total of 114 participants completed the pre- and post-questionnaires. Results showed that, compared with before the training, participants reported significantly more knowledge about prescription drug misuse and alternatives to prescription drug use after the training (t113=7.91, P<.001). Moreover, the medium of presentation (ie, face-to-face vs webinar) did not significantly impact effectiveness of the training (F1,98=1.15, P=.29). Conclusions: In both webinar and classroom formats, participants gained knowledge about alternatives to prescription drug use. This intervention appears to be beneficial to employees and assists in the awareness of prescription drug use in general and in the workplace. ",
doi="10.2196/jmir.7828",
url="http://www.jmir.org/2017/7/e242/",
url="https://doi.org/10.2196/jmir.7828",
url="http://www.ncbi.nlm.nih.gov/pubmed/28684383"
}


@Article{info:doi/10.2196/jmir.7137,
author="Peiper, Nicholas C
and Baumgartner, Peter M
and Chew, Robert F
and Hsieh, Yuli P
and Bieler, Gayle S
and Bobashev, Georgiy V
and Siege, Christopher
and Zarkin, Gary A",
title="Patterns of Twitter Behavior Among Networks of Cannabis Dispensaries in California",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="04",
volume="19",
number="7",
pages="e236",
keywords="cannabis; marijuana; social networking; social media; Internet",
abstract="Background: Twitter represents a social media platform through which medical cannabis dispensaries can rapidly promote and advertise a multitude of retail products. Yet, to date, no studies have systematically evaluated Twitter behavior among dispensaries and how these behaviors influence the formation of social networks. Objectives: This study sought to characterize common cyberbehaviors and shared follower networks among dispensaries operating in two large cannabis markets in California. Methods: From a targeted sample of 119 dispensaries in the San Francisco Bay Area and Greater Los Angeles, we collected metadata from the dispensary accounts using the Twitter API. For each city, we characterized the network structure of dispensaries based upon shared followers, then empirically derived communities with the Louvain modularity algorithm. Principal components factor analysis was employed to reduce 12 Twitter measures into a more parsimonious set of cyberbehavioral dimensions. Finally, quadratic discriminant analysis was implemented to verify the ability of the extracted dimensions to classify dispensaries into their derived communities. Results: The modularity algorithm yielded three communities in each city with distinct network structures. The principal components factor analysis reduced the 12 cyberbehaviors into five dimensions that encompassed account age, posting frequency, referencing, hyperlinks, and user engagement among the dispensary accounts. In the quadratic discriminant analysis, the dimensions correctly classified 75{\%} (46/61) of the communities in the San Francisco Bay Area and 71{\%} (41/58) in Greater Los Angeles. Conclusions: The most centralized and strongly connected dispensaries in both cities had newer accounts, higher daily activity, more frequent user engagement, and increased usage of embedded media, keywords, and hyperlinks. Measures derived from both network structure and cyberbehavioral dimensions can serve as key contextual indicators for the online surveillance of cannabis dispensaries and consumer markets over time. ",
doi="10.2196/jmir.7137",
url="http://www.jmir.org/2017/7/e236/",
url="https://doi.org/10.2196/jmir.7137",
url="http://www.ncbi.nlm.nih.gov/pubmed/28676471"
}


@Article{info:doi/10.2196/mental.7839,
author="Evans, William
and Andrade, Elizabeth
and Goldmeer, Sandra
and Smith, Michelle
and Snider, Jeremy
and Girardo, Gunilla",
title="The Living the Example Social Media Substance Use Prevention Program: A Pilot Evaluation",
journal="JMIR Ment Health",
year="2017",
month="Jun",
day="27",
volume="4",
number="2",
pages="e24",
keywords="substance use prevention; peer-to-peer education; social media; adolescence",
abstract="Background: Adolescent substance use rates in rural areas of the United States, such as upstate New York, have risen substantially in recent years, calling for new intervention approaches in response to this trend. The Mentor Foundation USA conducts the Living the Example (LTE) campaign to engage youth in prevention using an experiential approach. As part of LTE, youth create their own prevention messages following a training curriculum in techniques for effective messaging and then share them via social media. This paper reports on a pilot evaluation of the LTE program. Objective: To conduct a pilot test of LTE in two rural high schools in upstate New York. We hypothesized that positive antidrug brand representations could be promoted using social media strategies to complement the Shattering the Myths (STM) in-person, event-based approach (hypothesis 1, H1), and that youth would respond positively and engage with prevention messages disseminated by their peers. We also hypothesized that exposure to the social media prevention messages would be associated with more positive substance use avoidance attitudes and beliefs, reductions in future use intentions, and decreased substance use at posttest (hypothesis 2, H2). Methods: We adapted a previously published curriculum created by the authors that focuses on branding, messaging, and social media for prevention. The curriculum consisted of five, one-hour sessions. It was delivered to participating youth in five sequential weeks after school at the two high schools in late October and early November 2016. We designed a pre- and posttest pilot implementation study to evaluate the effects of LTE on student uptake of the intervention and short-term substance use and related outcomes. Working at two high schools in upstate New York, we conducted a pilot feasibility evaluation of LTE with 9th-grade students (ie, freshmen) at these high schools. We administered a 125-item questionnaire online to capture data on media use; attitudes toward social media; next 30-day personal drug use intentions; personal reasons to use drugs; reasons participants believe their peers would use drugs; self-reported exposure to the LTE program; and receptivity to the LTE program, among those reporting exposure. We constructed multivariable logistic regression models to analyze the relationship between program receptivity and outcomes. First, in a cross-sectional logistic regression model, we regressed self-reported LTE message receipt on drug use intent and actions related to LTE messaging. Then, for analysis of participants with matched pre- and posttest responses, we used multilevel generalized estimating equation (GEE) techniques to model changes in behavior from baseline to follow-up. Results: Youth reported increased intentions to use marijuana (odds ratio [OR] 2.134, P=.02) between pre- and posttest. However, youth who reported exposure and receptivity to LTE reported a significant decrease in intentions (OR 0.239, P=.008). We observed a similar pattern for sedatives/sleeping pills---an increase in intentions overall (OR 1.886, P=.07), but a decrease among youth who reported exposure and receptivity to LTE (OR 0.210, P=.02). We saw the same pattern for use of any drug---an increase in reported intentions overall (OR 2.141, P=.02), but a decrease among youth who reported exposure and receptivity to LTE (OR 0.111, P=.004). Conclusions: We observed some evidence of significant LTE program effects. Social media may be an effective strategy for peer-to-peer substance use prevention in the future. These findings point both to the potential of LTE and the social media diffusion model and to the need for more research on a larger scale with an expanded youth population in the future. ",
doi="10.2196/mental.7839",
url="http://mental.jmir.org/2017/2/e24/",
url="https://doi.org/10.2196/mental.7839",
url="http://www.ncbi.nlm.nih.gov/pubmed/28655704"
}


@Article{info:doi/10.2196/mental.7435,
author="McCrabb, Sam
and Baker, Amanda L
and Attia, John
and Balogh, Zsolt J
and Lott, Natalie
and Palazzi, Kerrin
and Naylor, Justine
and Harris, Ian A
and Doran, Christopher
and George, Johnson
and Wolfenden, Luke
and Skelton, Eliza
and Bonevski, Billie",
title="Who is More Likely to Use the Internet for Health Behavior Change? A Cross-Sectional Survey of Internet Use Among Smokers and Nonsmokers Who Are Orthopedic Trauma Patients",
journal="JMIR Ment Health",
year="2017",
month="May",
day="30",
volume="4",
number="2",
pages="e18",
keywords="Internet; health; eHealth; health care; smoking; orthopedic trauma",
abstract="Background: eHealth presents opportunities to provide population groups with accessible health interventions, although knowledge about Internet access, peoples' interest in using the Internet for health, and users' characteristics are required prior to eHealth program development. Objective: This study surveyed hospital patients to examine rates of Internet use, interest in using the Internet for health, and respondent characteristics related to Internet use and interest in using the Internet for health. For patients who smoke, preferences for types of smoking cessation programs for use at home and while in hospital were also examined. Methods: An online cross-sectional survey was used to survey 819 orthopedic trauma patients (response rate: 72.61{\%}, 819/1128) from two public hospitals in New South Wales, Australia. Logistic regressions were used to examine associations between variables. Results: A total of 72.7{\%} (574/790) of respondents had at least weekly Internet access and more than half (56.6{\%}, 357/631) reported interest in using the Internet for health. Odds of at least weekly Internet usage were higher if the individual was born overseas (OR 2.21, 95{\%} CI 1.27-3.82, P=.005), had a tertiary education (OR 3.75, 95{\%} CI 2.41-5.84, P<.001), or was a nonsmoker (OR 3.75, 95{\%} CI 2.41-5.84, P<.001). Interest in using the Internet for health increased with high school (OR 1.85, 95{\%} CI 1.09-3.15, P=.02) or tertiary education (OR 2.48, 95{\%} CI 1.66-3.70, P<.001), and if household incomes were more than AUS {\$}100,000 (OR 2.5, 95{\%} CI 1.25-4.97, P=.009). Older individuals were less interested in using the Internet for health (OR 0.98, 95{\%} CI 0.97-0.99, P<.001). Conclusions: Online interventions may be a potential tool for health care in this hospitalized population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001147673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366829{\&}isReview=true (Archived by WebCite at http://www.webcitation.org/6qg26u3En) ",
doi="10.2196/mental.7435",
url="http://mental.jmir.org/2017/2/e18/",
url="https://doi.org/10.2196/mental.7435",
url="http://www.ncbi.nlm.nih.gov/pubmed/28559228"
}


@Article{info:doi/10.2196/resprot.6907,
author="Fielenbach, Sandra
and Donkers, Franc CL
and Spreen, Marinus
and Bogaerts, Stefan",
title="Neurofeedback as a Treatment for Impulsivity in a Forensic Psychiatric Population With Substance Use Disorder: Study Protocol of a Randomized Controlled Trial Combined With an N-of-1 Clinical Trial",
journal="JMIR Res Protoc",
year="2017",
month="Jan",
day="25",
volume="6",
number="1",
pages="e13",
keywords="impulsive behavior; substance use disorders; neurofeedback; craving; offenders",
abstract="Background: Impulsivity and substance use disorder (SUD) are strongly interconnected, with persons scoring high on impulsivity being more vulnerable to develop substance abuse, facing more challenges for successful treatment, and being more prone to engage in criminal behavior. Studies have shown that impulsivity and craving for substances are strongly correlated. Neurofeedback is an effective treatment to reduce impulsive behavior. This study intends to determine to what extent a neurofeedback-intervention that is aimed at reducing impulsivity can also reduce levels of craving in forensic patients with SUD and comorbid Axis I and/or II diagnoses. Objective: The main objective of this study is to investigate to what extent a reduction in impulsivity by a sensorimotor rhythm (SMR)-neurofeedback intervention will lead to a reduction in craving in a population of forensic psychiatric patients with a diagnosis of SUD. Methods: Participants will be male SUD patients with various comorbidities residing in an inpatient forensic treatment facility approached through treatment supervisors for participation. Participants have tested positive for drug use in the past 24 months. The study consists of 2 parts: a randomized controlled trial (RCT) and a n-of-1 clinical series. In the RCT, 50 patients will be randomly assigned to an intervention (n=25) or a control (n=25) condition. Patients in the intervention group will receive 20 SMR neurofeedback sessions aimed at reducing impulsivity; participants in the control group receive treatment-as-usual (TAU). Additionally, 4 in depth n-of-1 clinical trials will be conducted where effects of an SMR neurofeedback intervention will be compared to effects of sham neurofeedback. Results: Results of this study are expected by the end of 2017. Conclusions: This protocol describes the design of a study testing the effects of an impulsivity-based neurofeedback protocol among forensic patients with SUD and various comorbidities. We expect a significant reduction in impulsive behavior, level of craving, and actual drug-use for participants receiving the SMR neurofeedback protocol. The n-of-1 approach might help to explain effects possibly found in the RCT study since it allows for a more direct focus on treatment effects by following participants more closely and thereby being able to directly attribute behavioral and neurophysiological change to the SMR neurofeedback protocol employed. ClinicalTrial: Dutch National Trial Register NTR5386; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5386 (Archived by WebCite at http://www.webcitation.org/6nXLQuoLl) ",
doi="10.2196/resprot.6907",
url="http://www.researchprotocols.org/2017/1/e13/",
url="https://doi.org/10.2196/resprot.6907",
url="http://www.ncbi.nlm.nih.gov/pubmed/28122696"
}


@Article{info:doi/10.2196/mental.6001,
author="Tiburcio, Marcela
and Lara, Ma Asunci{\'o}n
and Aguilar Abrego, Araceli
and Fern{\'a}ndez, Morise
and Mart{\'i}nez V{\'e}lez, Nora
and S{\'a}nchez, Alejandro",
title="Web-Based Intervention to Reduce Substance Abuse and Depressive Symptoms in Mexico: Development and Usability Test",
journal="JMIR Ment Health",
year="2016",
month="Sep",
day="29",
volume="3",
number="3",
pages="e47",
keywords="substance abuse; depressive symptoms; Internet; cognitive behavioral therapy; usability",
abstract="Background: The development of Web-based interventions for substance abuse in Latin America is a new field of interest with great potential for expansion to other Spanish-speaking countries. Objective: This paper describes a project aimed to develop and evaluate the usability of the Web-based Help Program for Drug Abuse and Depression (Programa de Ayuda para Abuso de Drogas y Depresi{\'o}n, PAADD, in Spanish) and also to construct a systematic frame of reference for the development of future Web-based programs. Methods: The PAADD aims to reduce substance use and depressive symptoms with cognitive behavioral techniques translated into Web applications, aided by the participation of a counselor to provide support and guidance. This Web-based intervention includes 4 steps: (1) My Starting Point, (2) Where Do I Want to Be? (3) Strategies for Change, and (4) Maintaining Change. The development of the program was an interactive multistage process. The first stage defined the core structure and contents, which were validated in stage 2 by a group of 8 experts in addiction treatment. Programming of the applications took place in stage 3, taking into account 3 types of end users: administrators, counselors, and substance users. Stage 4 consisted of functionality testing. In stage 5, a total of 9 health professionals and 20 drug users currently in treatment voluntarily interacted with the program in a usability test, providing feedback about adjustments needed to improve users' experience. Results: The main finding of stage 2 was the consensus of the health professionals about the cognitive behavioral strategies and techniques included in PAADD being appropriate for changing substance use behaviors. In stage 5, the health professionals found the functionalities easy to learn; their suggestions were related to the page layout, inclusion of confirmation messages at the end of activities, avoiding ``read more'' links, and providing feedback about every activity. On the other hand, the users said the information presented within the modules was easy to follow and suggested more dynamic features with concrete instructions and feedback. Conclusions: The resulting Web-based program may have advantages over traditional face-to-face therapies owing to its low cost, wide accessibility, anonymity, and independence of time and distance factors. The detailed description of the process of designing a Web-based program is an important contribution to others interested in this field. The potential benefits must be verified in specific studies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 25429892; http://www.controlled-trials.com/ISRCTN25429892 (Archived by WebCite at http://www.webcitation.org/6ko1Fsvym) ",
doi="10.2196/mental.6001",
url="http://mental.jmir.org/2016/3/e47/",
url="https://doi.org/10.2196/mental.6001",
url="http://www.ncbi.nlm.nih.gov/pubmed/27687965"
}


@Article{info:doi/10.2196/jmir.5802,
author="Zhang, Zhu
and Zheng, Xiaolong
and Zeng, Daniel Dajun
and Leischow, Scott J",
title="Tracking Dabbing Using Search Query Surveillance: A Case Study in the United States",
journal="J Med Internet Res",
year="2016",
month="Sep",
day="16",
volume="18",
number="9",
pages="e252",
keywords="marijuana; information seeking behavior; surveillance; search engine; time series analysis; spatial analysis",
abstract="Background: Dabbing is an emerging method of marijuana ingestion. However, little is known about dabbing owing to limited surveillance data on dabbing. Objective: The aim of the study was to analyze Google search data to assess the scope and breadth of information seeking on dabbing. Methods: Google Trends data about dabbing and related topics (eg, electronic nicotine delivery system [ENDS], also known as e-cigarettes) in the United States between January 2004 and December 2015 were collected by using relevant search terms such as ``dab rig.'' The correlation between dabbing (including topics: dab and hash oil) and ENDS (including topics: vaping and e-cigarette) searches, the regional distribution of dabbing searches, and the impact of cannabis legalization policies on geographical location in 2015 were analyzed. Results: Searches regarding dabbing increased in the United States over time, with 1,526,280 estimated searches during 2015. Searches for dab and vaping have very similar temporal patterns, where the Pearson correlation coefficient (PCC) is .992 (P<.001). Similar phenomena were also obtained in searches for hash oil and e-cigarette, in which the corresponding PCC is .931 (P<.001). Dabbing information was searched more in some western states than other regions. The average dabbing searches were significantly higher in the states with medical and recreational marijuana legalization than in the states with only medical marijuana legalization (P=.02) or the states without medical and recreational marijuana legalization (P=.01). Conclusions: Public interest in dabbing is increasing in the United States. There are close associations between dabbing and ENDS searches. The findings suggest greater popularity of dabs in the states that legalized medical and recreational marijuana use. This study proposes a novel and timely way of cannabis surveillance, and these findings can help enhance the understanding of the popularity of dabbing and provide insights for future research and informed policy making on dabbing. ",
doi="10.2196/jmir.5802",
url="http://www.jmir.org/2016/9/e252/",
url="https://doi.org/10.2196/jmir.5802",
url="http://www.ncbi.nlm.nih.gov/pubmed/27637361"
}


@Article{info:doi/10.2196/jmir.6200,
author="Brown, Menna
and Glendenning, Alexander
and Hoon, Alice E
and John, Ann",
title="Effectiveness of Web-Delivered Acceptance and Commitment Therapy in Relation to Mental Health and Well-Being: A Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2016",
month="Aug",
day="24",
volume="18",
number="8",
pages="e221",
keywords="acceptance and commitment therapy; systematic review; meta-analysis; depression; anxiety; quality of life; Internet-based; mobile-based",
abstract="Background: The need for effective interventions to improve mental health and emotional well-being at a population level are gaining prominence both in the United Kingdom and globally. Advances in technology and widespread adoption of Internet capable devices have facilitated rapid development of Web-delivered psychological therapies. Interventions designed to manage a range of affective disorders by applying diverse therapeutic approaches are widely available. Objective: The main aim of this review was to evaluate the evidence base of acceptance and commitment therapy (ACT) in a Web-based delivery format. Method: A systematic review of the literature and meta-analysis was conducted. Two electronic databases were searched for Web-delivered interventions utilizing ACT for the management of affective disorders or well-being. Only Randomized Controlled Trials (RCTs) were included. Results: The search strategy identified 59 articles. Of these, 10 articles met the inclusion criteria specified. The range of conditions and outcome measures that were identified limited the ability to draw firm conclusions about the efficacy of Web-delivered ACT-based intervention for anxiety or well-being. Conclusions: ACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high overall suggesting that this therapeutic approach is highly acceptable for patients and the general public. ",
doi="10.2196/jmir.6200",
url="http://www.jmir.org/2016/8/e221/",
url="https://doi.org/10.2196/jmir.6200",
url="http://www.ncbi.nlm.nih.gov/pubmed/27558740"
}


@Article{info:doi/10.2196/mental.4927,
author="Lord, Sarah
and Moore, Sarah K
and Ramsey, Alex
and Dinauer, Susan
and Johnson, Kimberly",
title="Implementation of a Substance Use Recovery Support Mobile Phone App in Community Settings: Qualitative Study of Clinician and Staff Perspectives of Facilitators and Barriers",
journal="JMIR Ment Health",
year="2016",
month="Jun",
day="28",
volume="3",
number="2",
pages="e24",
keywords="substance abuse; relapse prevention; mobile apps",
abstract="Background: Research supports the effectiveness of technology-based treatment approaches for substance use disorders. These approaches have the potential to broaden the reach of evidence-based care. Yet, there is limited understanding of factors associated with implementation of technology-based care approaches in different service settings. Objectives: In this study, we explored provider and staff perceptions of facilitators and barriers to implementation of a mobile phone substance use recovery support app with clients in 4 service settings. Methods: Interviews were conducted with leadership and provider stakeholders (N=12) from 4 agencies in the first year of an implementation trial of the mobile phone app. We used the Consolidated Framework for Implementation Research as the conceptual foundation for identifying facilitators and barriers to implementation. Results: Implementation process facilitators included careful planning of all aspects of implementation before launch, engaging a dedicated team to implement and foster motivation, working collaboratively with the app development team to address technical barriers and adapt the app to meet client and agency needs, and consistently reviewing app usage data to inform progress. Implementation support strategies included training all staff to promote organization awareness about the recovery support app and emphasize its priority as a clinical care tool, encouraging clients to try the technology before committing to use, scaling rollout to clients, setting clear expectations with clients about use of the app, and using peer coaches and consistent client-centered messaging to promote engagement. Perceived compatibility of the mobile phone app with agency and client needs and readiness to implement emerged as salient agency-level implementation facilitators. Facilitating characteristics of the recovery support app itself included evidence of its impact for recovery support, perceived relative advantage of the app over usual care, the ability to adapt the app to improve client use, and its ease of use. The mobile phone itself was a strong motivation for clients to opt in to use the app in settings that provided phones. App access was limited in settings that did not provide phones owing to lack of mobile phone ownership or incompatibility of the app with clients' mobile phones. Individual differences in technology literacy and provider beliefs about substance use care either facilitated or challenged implementation. Awareness of patient needs and resources facilitated implementation, whereas external policies and regulations regarding technology use introduced barriers to implementation. Conclusions: The conceptually grounded facilitators and barriers identified in this study can guide systematic targeting of strategies to improve implementation of mobile phone interventions in community treatment settings. Results also inform the design of technology-based therapeutic tools. This study highlights directions for research with regard to implementation of technology-based behavioral health care approaches. ",
doi="10.2196/mental.4927",
url="http://mental.jmir.org/2016/2/e24/",
url="https://doi.org/10.2196/mental.4927",
url="http://www.ncbi.nlm.nih.gov/pubmed/27352884"
}


@Article{info:doi/10.2196/resprot.5407,
author="Glasner-Edwards, Suzette
and Patrick, Kevin
and Ybarra, Michele L
and Reback, Cathy J
and Rawson, Richard A
and Chokron Garneau, Helene
and Chavez, Kathryn
and Venegas, Alexandra",
title="A Cognitive Behavioral Therapy--Based Text Messaging Intervention Versus Medical Management for HIV-Infected Substance Users: Study Protocol for a Pilot Randomized Trial",
journal="JMIR Res Protoc",
year="2016",
month="Jun",
day="24",
volume="5",
number="2",
pages="e131",
keywords="SMS; medication adherence; HIV; relapse prevention; text messaging; CBT; ART",
abstract="Background: Evidence-based psychosocial interventions for addictions and related conditions such as cognitive behavioral therapy (CBT) are underutilized. Obstacles to implementation of CBT in clinical settings include limited availability of quality training, supervision, and certification in CBT for clinicians; high rates of clinician turnover and high caseloads; and limited qualifications of the workforce to facilitate CBT expertise. Objective: Mobile phone--based delivery of CBT, if demonstrated to be feasible and effective, could be transformative in broadening its application and improving the quality of addiction treatment. No experimental interventions that deliver CBT targeting both drug use and medication adherence using text messaging have been previously reported; as such, the objective of this study is to develop and test an SMS-based treatment program for HIV-positive adults with comorbid substance use disorders. Methods: With user input, we developed a 12-week CBT-based text messaging intervention (TXT-CBT) targeting antiretroviral (ART) adherence, risk behaviors, and drug use in a population of HIV-infected substance users. Results: The intervention has been developed and is presently being tested in a pilot randomized clinical trial. Results will be reported later this year. Conclusions: This investigation will yield valuable knowledge about the utility of a cost-effective, readily deployable text messaging behavioral intervention for HIV-infected drug users. ",
doi="10.2196/resprot.5407",
url="http://www.researchprotocols.org/2016/2/e131/",
url="https://doi.org/10.2196/resprot.5407",
url="http://www.ncbi.nlm.nih.gov/pubmed/27341852"
}


@Article{info:doi/10.2196/mhealth.5368,
author="Rowe, Christopher
and Hern, Jaclyn
and DeMartini, Anna
and Jennings, Danielle
and Sommers, Mathew
and Walker, John
and Santos, Glenn-Milo",
title="Concordance of Text Message Ecological Momentary Assessment and Retrospective Survey Data Among Substance-Using Men Who Have Sex With Men: A Secondary Analysis of a Randomized Controlled Trial",
journal="JMIR mHealth uHealth",
year="2016",
month="May",
day="26",
volume="4",
number="2",
pages="e44",
keywords="data collection; cell phones; drug users; drinking behavior; homosexuality, male",
abstract="Background: Alcohol and illicit drug use is more prevalent among men who have sex with men (MSM) compared to the general population and has been linked to HIV transmission in this population. Research assessing individual patterns of substance use often utilizes questionnaires or interviews that rely on retrospective self-reported information, which can be subject to recall bias. Ecological momentary assessment (EMA) is a set of methods developed to mitigate recall bias by collecting data about subjects' mental states and behaviors on a near real-time basis. EMA remains underutilized in substance use and HIV research. Objective: To assess the concordance between daily reports of substance use collected by EMA text messages (short message service, SMS) and retrospective questionnaires and identify predictors of daily concordance in a sample of MSM. Methods: We conducted a secondary analysis of EMA text responses (regarding behavior on the previous day) and audio computer-assisted self-interview (ACASI) survey data (14-day recall) from June 2013 to September 2014 as part of a randomized controlled trial assessing a pharmacologic intervention to reduce methamphetamine and alcohol use among nondependent MSM in San Francisco, California. Reports of daily methamphetamine use, alcohol use, and binge alcohol use (5 or more drinks on one occasion) were collected via EMA and ACASI and compared using McNemar's tests. Demographic and behavioral correlates of daily concordance between EMA and ACASI were assessed for each substance, using separate multivariable logistic regression models, fit with generalized estimating equations. Results: Among 30 MSM, a total of 994 days were included in the analysis for methamphetamine use, 987 for alcohol use, and 981 for binge alcohol use. Methamphetamine (EMA 20{\%}, ACASI 11{\%}, P<.001) and alcohol use (EMA 40{\%}, ACASI 35{\%}, P=.001) were reported significantly more frequently via EMA versus ACASI. In multivariable analysis, text reporting of methamphetamine (adjusted odds ratio 0.06, 95{\%} CI 0.04-0.10), alcohol (0.48, 0.33-0.69), and binge alcohol use (0.27, 0.17-0.42) was negatively associated with daily concordance in the reporting of each respective substance. Compared to white participants, African American participants were less likely to have daily concordance in methamphetamine (0.15, 0.05-0.43) and alcohol (0.2, 0.05-0.54) reporting, and other participants of color (ie, Asian, Hispanic, multi-racial) were less likely to have daily concordance in methamphetamine reporting (0.34, 0.12-1.00). College graduates were more likely to have daily concordance in methamphetamine reporting (6.79, 1.84-25.04) compared to those with no college experience. Conclusions: We found that methamphetamine and alcohol use were reported more frequently with daily EMA texts compared to retrospective ACASI, concordance varied among different racial/ethnic subgroups and education levels, and reported substance use by EMA text was associated with lower daily concordance with retrospective ACASI. These findings suggest that EMA methods may provide more complete reporting of frequent, discrete behaviors such as substance use. ",
doi="10.2196/mhealth.5368",
url="http://mhealth.jmir.org/2016/2/e44/",
url="https://doi.org/10.2196/mhealth.5368",
url="http://www.ncbi.nlm.nih.gov/pubmed/27230545"
}


@Article{info:doi/10.2196/jmir.4643,
author="Arnaud, Nicolas
and Baldus, Christiane
and Elg{\'a}n, Tobias H
and De Paepe, Nina
and T{\o}nnesen, Hanne
and Cs{\'e}my, Ladislav
and Thomasius, Rainer",
title="Effectiveness of a Web-Based Screening and Fully Automated Brief Motivational Intervention for Adolescent Substance Use: A Randomized Controlled Trial",
journal="J Med Internet Res",
year="2016",
month="May",
day="24",
volume="18",
number="5",
pages="e103",
keywords="substance use; adolescents; brief intervention; web-based intervention; motivational interviewing; randomized controlled trial",
abstract="Background: Mid-to-late adolescence is a critical period for initiation of alcohol and drug problems, which can be reduced by targeted brief motivational interventions. Web-based brief interventions have advantages in terms of acceptability and accessibility and have shown significant reductions of substance use among college students. However, the evidence is sparse among adolescents with at-risk use of alcohol and other drugs. Objective: This study evaluated the effectiveness of a targeted and fully automated Web-based brief motivational intervention with no face-to-face components on substance use among adolescents screened for at-risk substance use in four European countries. Methods: In an open-access, purely Web-based randomized controlled trial, a convenience sample of adolescents aged 16-18 years from Sweden, Germany, Belgium, and the Czech Republic was recruited using online and offline methods and screened online for at-risk substance use using the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument. Participants were randomized to a single session brief motivational intervention group or an assessment-only control group but not blinded. Primary outcome was differences in past month drinking measured by a self-reported AUDIT-C-based index score for drinking frequency, quantity, and frequency of binge drinking with measures collected online at baseline and after 3 months. Secondary outcomes were the AUDIT-C-based separate drinking indicators, illegal drug use, and polydrug use. All outcome analyses were conducted with and without Expectation Maximization (EM) imputation of missing follow-up data. Results: In total, 2673 adolescents were screened and 1449 (54.2{\%}) participants were randomized to the intervention or control group. After 3 months, 211 adolescents (14.5{\%}) provided follow-up data. Compared to the control group, results from linear mixed models revealed significant reductions in self-reported past-month drinking in favor of the intervention group in both the non-imputed (P=.010) and the EM-imputed sample (P=.022). Secondary analyses revealed a significant effect on drinking frequency (P=.037) and frequency of binge drinking (P=.044) in the non-imputation-based analyses and drinking quantity (P=.021) when missing data were imputed. Analyses for illegal drug use and polydrug use revealed no significant differences between the study groups (Ps>.05). Conclusions: Although the study is limited by a large drop-out, significant between-group effects for alcohol use indicate that targeted brief motivational intervention in a fully automated Web-based format can be effective to reduce drinking and lessen existing substance use service barriers for at-risk drinking European adolescents. Trial Registration: International Standard Randomized Controlled Trial Registry: ISRCTN95538913; http://www.isrctn.com/ISRCTN95538913 (Archived by WebCite at http://www.webcitation.org/6XkuUEwBx) ",
doi="10.2196/jmir.4643",
url="http://www.jmir.org/2016/5/e103/",
url="https://doi.org/10.2196/jmir.4643",
url="http://www.ncbi.nlm.nih.gov/pubmed/27220276"
}


@Article{info:doi/10.2196/mental.4875,
author="Takano, Ayumi
and Miyamoto, Yuki
and Kawakami, Norito
and Matsumoto, Toshihiko",
title="Web-Based Cognitive Behavioral Relapse Prevention Program With Tailored Feedback for People With Methamphetamine and Other Drug Use Problems: Development and Usability Study",
journal="JMIR Mental Health",
year="2016",
month="Jan",
day="06",
volume="3",
number="1",
pages="e1",
keywords="web-based; drug dependence; relapse prevention; cognitive behavioral therapy; motivational interviewing; self-monitoring; Internet",
abstract="Background: Although drug abuse has been a serious public health concern, there have been problems with implementation of treatment for drug users in Japan because of poor accessibility to treatment, concerns about stigma and confidentiality, and costs. Therapeutic interventions using the Internet and computer technologies could improve this situation and provide more feasible and acceptable approaches. Objective: The objective of the study was to show how we developed a pilot version of a new Web-based cognitive behavioral relapse prevention program with tailored feedback to assist people with drug problems and assessed its acceptance and usability. Methods: We developed the pilot program based on existing face-to-face relapse prevention approaches using an open source Web application to build an e-learning website, including relapse prevention sessions with videos, exercises, a diary function, and self-monitoring. When users submitted exercise answers and their diary, researchers provided them with personalized feedback comments using motivational interviewing skills. People diagnosed with drug dependence were recruited in this pilot study from a psychiatric outpatient ward and nonprofit rehabilitation facilities and usability was evaluated using Internet questionnaires. Overall, website usability was assessed by the Web Usability Scale. The adequacy of procedures in the program, ease of use, helpfulness of content, and adverse effects, for example, drug craving, mental distress, were assessed by original structured questionnaires and descriptive form questions. Results: In total, 10 people participated in the study and completed the baseline assessment, 60{\%} completed all relapse prevention sessions within the expected period. The time needed to complete one session was about 60 minutes and most of the participants took 2 days to complete the session. Overall website usability was good, with reasonable scores on subscales of the Web Usability Scale. The participants felt that the relapse prevention sessions were easy to use and helpful, but that the length of the videos was too long. The participant who until recently used drugs was satisfied with the self-monitoring, but others that had already maintained abstinence for more than a year felt this activity was unhelpful and were bored tracking and recording information on daily drug use. Feedback comments from researchers enhanced participants' motivation and further insight into the disease. Serious adverse effects caused by the intervention were not observed. Some possible improvements to the program were suggested. Conclusions: The Web-based relapse prevention program was easy to use and acceptable to drug users in this study. This program will be helpful for drug users who do not receive behavioral therapy. After the pilot program is revised, further large-scale research is needed to assess its efficacy among drug users who have recently used drugs. ",
doi="10.2196/mental.4875",
url="http://mental.jmir.org/2016/1/e1/",
url="https://doi.org/10.2196/mental.4875",
url="http://www.ncbi.nlm.nih.gov/pubmed/26740264"
}


@Article{info:doi/10.2196/mhealth.4620,
author="Cordova, David
and Bauermeister, Jose A
and Fessler, Kathryn
and Delva, Jorge
and Nelson, Annabelle
and Nurenberg, Rachel
and Mendoza Lua, Frania
and Alers-Rojas, Francheska
and Salas-Wright, Christopher P",
title="A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study",
journal="JMIR mHealth uHealth",
year="2015",
month="Dec",
day="18",
volume="3",
number="4",
pages="e106",
keywords="adolescent; primary prevention; HIV; STI; mHealth; telemedicine; primary health care; drug users; sexually transmitted infections",
abstract="Background: Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care. Objectives: The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as ``S4E''). Methods: A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5{\%}) and female (n=21, 72.4{\%}) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis. Results: A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app. Conclusions: There is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances. ",
doi="10.2196/mhealth.4620",
url="http://mhealth.jmir.org/2015/4/e106/",
url="https://doi.org/10.2196/mhealth.4620",
url="http://www.ncbi.nlm.nih.gov/pubmed/26685288"
}


@Article{info:doi/10.2196/mhealth.4405,
author="Ramo, Danielle E
and Popova, Lucy
and Grana, Rachel
and Zhao, Shirley
and Chavez, Kathryn",
title="Cannabis Mobile Apps: A Content Analysis",
journal="JMIR mHealth uHealth",
year="2015",
month="Aug",
day="12",
volume="3",
number="3",
pages="e81",
keywords="cell phones; mobile apps; cannabis",
abstract="Background: Mobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior. Objective: We investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014. Methods: The Apple and Google Play app stores were searched using the terms ``cannabis'' and ``marijuana.'' Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers. Results: Total apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9{\%}), facts about cannabis (20.3{\%}), and games (20.3{\%}). In the Apple App Store, most apps were free (77{\%}), all were rated ``17+'' years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50{\%}), dispensary information (27{\%}), or general facts about cannabis (27{\%}). Only one app (3{\%}) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93{\%}), rated ``high maturity'' (79{\%}), and the average user rating was 4.1/5. The most popular app types offered games (28{\%}), phone utilities (eg, wallpaper, clock; 21{\%}) and cannabis food recipes (21{\%}); no apps addressed abuse, addiction, or treatment. Conclusions: Cannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations. ",
doi="10.2196/mhealth.4405",
url="http://mhealth.jmir.org/2015/3/e81/",
url="https://doi.org/10.2196/mhealth.4405",
url="http://www.ncbi.nlm.nih.gov/pubmed/26268634"
}


@Article{info:doi/10.2196/resprot.3852,
author="Babson, Kimberly A
and Ramo, Danielle E
and Baldini, Lisa
and Vandrey, Ryan
and Bonn-Miller, Marcel O",
title="Mobile App-Delivered Cognitive Behavioral Therapy for Insomnia: Feasibility and Initial Efficacy Among Veterans With Cannabis Use Disorders",
journal="JMIR Res Protoc",
year="2015",
month="Jul",
day="17",
volume="4",
number="3",
pages="e87",
keywords="cannabis; marijuana; sleep; CBT-I; intervention",
abstract="Background: Cannabis is the most frequently used illicit substance in the United States resulting in high rates of cannabis use disorders. Current treatments for cannabis use are often met with high rates of lapse/relapse, tied to (1) behavioral health factors that impact cannabis use such as poor sleep, and (2) access, stigma, supply, and cost of receiving a substance use intervention. Objective: This pilot study examined the feasibility, usability, and changes in cannabis use and sleep difficulties following mobile phone--delivered Cognitive Behavioral Therapy for Insomnia (CBT-I) in the context of a cannabis cessation attempt. Methods: Four male veterans with DSM-5 cannabis use disorder and sleep problems were randomized to receive a 2-week intervention: CBT-I Coach mobile app (n=2) or a placebo control (mood-tracking app) (n=2). Cannabis and sleep measures were assessed pre- and post-treatment. Participants also reported use and helpfulness of each app. Changes in sleep and cannabis use were evaluated for each participant individually. Results: Both participants receiving CBT-I used the app daily over 2 weeks and found the app user-friendly, helpful, and would use it in the future. In addition, they reported decreased cannabis use and improved sleep efficiency; one also reported increased sleep quality. In contrast, one participant in the control group dropped out of the study, and the other used the app minimally and reported increased sleep quality but also increased cannabis use. The mood app was rated as not helpful, and there was low likelihood of future participation. Conclusions: This pilot study examined the feasibility and initial patient acceptance of mobile phone delivery of CBT-I for cannabis dependence. Positive ratings of the app and preliminary reports of reductions in cannabis use and improvements in sleep are both encouraging and support additional evaluation of this intervention. ",
doi="10.2196/resprot.3852",
url="http://www.researchprotocols.org/2015/3/e87/",
url="https://doi.org/10.2196/resprot.3852",
url="http://www.ncbi.nlm.nih.gov/pubmed/26187404"
}


@Article{info:doi/10.2196/mhealth.3437,
author="Genz, Andrew
and Kirk, Gregory
and Piggott, Damani
and Mehta, Shruti H
and Linas, Beth S
and Westergaard, Ryan P",
title="Uptake and Acceptability of Information and Communication Technology in a Community-Based Cohort of People Who Inject Drugs: Implications for Mobile Health Interventions",
journal="JMIR mHealth uHealth",
year="2015",
month="Jun",
day="25",
volume="3",
number="2",
pages="e70",
keywords="substance abuse; intravenous; Internet; cellular phone; text messaging; telemedicine",
abstract="Background: Mobile phone and Internet-based technologies are increasingly used to disseminate health information and facilitate delivery of medical care.  While these strategies hold promise for reducing barriers to care for medically-underserved populations, their acceptability among marginalized populations such as people who inject drugs is not well-understood. Objective: To understand patterns of mobile phone ownership, Internet use and willingness to receive health information via mobile devices among people who inject drugs. Methods: We surveyed current and former drug injectors participating in a longitudinal cohort study in Baltimore, Maryland, USA. Respondents completed a 12-item, interviewer-administered questionnaire during a regular semi-annual study visit that assessed their use of mobile technology and preferred modalities of receiving health information. Using data from the parent study, we used logistic regression to evaluate associations among participants' demographic and clinical characteristics and their mobile phone and Internet use. Results: The survey was completed by 845 individuals, who had a median age of 51 years. The sample was 89{\%} African-American, 65{\%} male, and 33{\%} HIV-positive. Participants were generally of low education and income levels. Fewer than half of respondents (40{\%}) indicated they had ever used the Internet. Mobile phones were used by 86{\%} of respondents. Among mobile phone owners, 46{\%} had used their phone for text messaging and 25{\%} had accessed the Internet on their phone. A minority of respondents (42{\%}) indicated they would be interested in receiving health information via phone or Internet. Of those receptive to receiving health information, a mobile phone call was the most favored modality (66{\%}) followed by text messaging (58{\%}) and Internet (51{\%}). Conclusions: Utilization of information and communication technology among this cohort of people who inject drugs was reported at a lower level than what has been estimated for the general U.S. population. Our findings identify a potential barrier to successful implementation of  mobile health and Internet-based interventions for people who inject drugs, particularly those who are older and have lower levels of income and educational attainment. As mobile communication technology continues to expand, future studies should re-examine whether mHealth applications become more accessible and accepted by socioeconomically disadvantaged groups. ",
doi="10.2196/mhealth.3437",
url="http://mhealth.jmir.org/2015/2/e70/",
url="https://doi.org/10.2196/mhealth.3437",
url="http://www.ncbi.nlm.nih.gov/pubmed/26111915"
}


@Article{info:doi/10.2196/jmir.3778,
author="Tait, Robert J
and McKetin, Rebecca
and Kay-Lambkin, Frances
and Carron-Arthur, Bradley
and Bennett, Anthony
and Bennett, Kylie
and Christensen, Helen
and Griffiths, Kathleen M",
title="Six-Month Outcomes of a Web-Based Intervention for Users of Amphetamine-Type Stimulants: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2015",
month="Apr",
day="29",
volume="17",
number="4",
pages="e105",
keywords="amphetamine-related disorders; Internet; randomized controlled trial; intervention studies; cognitive therapy",
abstract="Background: The use of amphetamine-type stimulants (ATS) places a large burden on health services. Objective: The aim was to evaluate the effectiveness of a self-guided Web-based intervention (``breakingtheice'') for ATS users over 6 months via a free-to-access site. Methods: We conducted a randomized trial comparing a waitlist control with a fully automated intervention containing 3 modules derived from cognitive behavioral therapy and motivation enhancement. The main outcome was self-reported ATS use in the past 3 months assessed at 3- and 6-month follow-ups using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Secondary outcomes were help-seeking intentions (general help-seeking questionnaire), actual help seeking (actual help-seeking questionnaire), psychological distress (Kessler 10), polydrug use (ASSIST), quality of life (European Health Interview Survey), days out of role, and readiness to change. Follow-up data were evaluated using an intention-to-treat (ITT) analysis with a group by time interaction. Results: We randomized 160 people (intervention: n=81; control: n=79). At 6 months, 38 of 81 (47{\%}) intervention and 41 of 79 (52{\%}) control participants provided data. ATS scores significantly declined for both groups, but the interaction effect was not significant. There were significant ITT time by group interactions for actual help seeking (rate ratio [RR] 2.16; d=0.45) and help-seeking intentions (RR 1.17; d=0.32), with help seeking increasing for the intervention group and declining for the control group. There were also significant interactions for days completely (RR 0.50) and partially (RR 0.74) out of role favoring the intervention group. However, 37{\%} (30/81) of the intervention group did not complete even 1 module. Conclusions: This self-guided Web-based intervention encouraged help seeking associated with ATS use and reduced days out of role, but it did not reduce ATS use. Thus, this program provides a means of engaging with some sections of a difficult-to-reach group to encourage treatment, but a substantial minority remained disengaged. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343307 (Archived by WebCite at http://www.webcitation.org/6Y0PGGp8q). ",
doi="10.2196/jmir.3778",
url="http://www.jmir.org/2015/4/e105/",
url="https://doi.org/10.2196/jmir.3778",
url="http://www.ncbi.nlm.nih.gov/pubmed/25925801"
}


@Article{info:doi/10.2196/mental.4355,
author="Elison, Sarah
and Davies, Glyn
and Ward, Jonathan",
title="Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users",
journal="JMIR Mental Health",
year="2015",
month="Apr",
day="23",
volume="2",
number="2",
pages="e13",
keywords="substance misuse; computer-assisted therapy; treatment; psychosocial interventions",
abstract="Background: Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help. Objective: The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO. Methods: Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined. Results: Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety (P=<.001 across all aspects of functioning). Additionally, significant improvements were found within specific subgroups of participants, including females (P=.001-<.001), males (P=.004-<.001), service users reporting alcohol dependence (P=.002-<.001), opiate and crack dependence (P=.014-<.001), and those seeking support for other substances that may be less well represented in the substance misuse sector (P=.001-<.001). Conclusions: Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program. ",
doi="10.2196/mental.4355",
url="http://mental.jmir.org/2015/2/e13/",
url="https://doi.org/10.2196/mental.4355",
url="http://www.ncbi.nlm.nih.gov/pubmed/26543918"
}


@Article{info:doi/10.2196/mental.3278,
author="Tait, Robert J
and McKetin, Rebecca
and Kay-Lambkin, Frances
and Carron-Arthur, Bradley
and Bennett, Anthony
and Bennett, Kylie
and Christensen, Helen
and Griffiths, Kathleen M",
title="A Web-Based Intervention for Users of Amphetamine-Type Stimulants: 3-Month Outcomes of a Randomized Controlled Trial",
journal="JMIR Mental Health",
year="2014",
month="Sep",
day="11",
volume="1",
number="1",
pages="e1",
keywords="amphetamine related disorders; Internet; World Wide Web; randomized control trial; cognitive therapy; online; Web-based; motivational enhancement; intervention",
abstract="Background: Among illicit drugs, the prevalence of amphetamine-type stimulant (ATS) use is second only to cannabis. Currently, there are no approved pharmacotherapies for ATS problems, but some face-to-face psychotherapies are effective. Web-based interventions have proven to be effective for some substance use problems, but none has specifically targeted ATS users. Objective: The objective of the study was to evaluate the effectiveness of a Web-based intervention for ATS problems on a free-to-access site compared with a waitlist control group. Methods: We used a randomized controlled trial design. The primary outcome measure was self-reported ATS use in the past three months assessed using the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST). Other measures included quality of life (EUROHIS score), psychological distress (K-10 score), days out of role, poly-drug use, general help-seeking intentions, actual help-seeking, and ``readiness to change''. The intervention consisted of three fully automated, self-guided modules based on cognitive behavioral therapy and motivation enhancement. The analysis was an intention-to-treat analysis using generalized estimating equation models, with a group by time interaction as the critical assessment. Results: We randomized 160 people (intervention n=81, control n=79). At three months, 35/81 (43{\%}) intervention and 45/79 (57{\%}) control participants provided follow-up data. In the intervention group, 51/81 (63{\%}) completed at least one module. The only significant group by time interaction was for days out of role. The pre/post change effect sizes showed small changes (range d=0.14 to 0.40) favoring the intervention group for poly-drug use, distress, actual help-seeking, and days out of role. In contrast, the control group was favored by reductions in ATS use, improvements in quality of life, and increases in help-seeking intentions (range d=0.09 to 0.16). Conclusions: This Web-based intervention for ATS use produced few significant changes in outcome measures. There were moderate, but nonsignificant reductions in poly-drug use, distress, days partially out of role, and increases in help-seeking. However, high levels of participant attrition, plus low levels of engagement with the modules, preclude firm conclusions being drawn on the efficacy of the intervention and emphasize the problems of engaging this group of clients in a fully automated program. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN 12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000947909 (Archived by WebCite at http://www.webcitation.org/6SHTxEnzP). ",
doi="10.2196/mental.3278",
url="https://mental.jmir.org/2014/1/e1/",
url="https://doi.org/10.2196/mental.3278",
url="http://www.ncbi.nlm.nih.gov/pubmed/26543901"
}