%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67637 %T Evaluating the Acceptability of a Brief Web-Based Alcohol Misuse Prevention Program Among US Military Cadets: Mixed Methods Formative Evaluation %A Schmied,Emily %A Hurtado,Lauren %A Robinson,W Ken %A Simon-Arndt,Cynthia M %A Moyer III,Richard %A Wilson,Leslie %A Reed,Mark %A Blakey,Shannon M %A Kan,Marni %K alcohol misuse prevention %K digital interventions %K formative research %K military health %K acceptability %K alcohol prevention %K US military %K military %K United States %K formative evaluation %K alcohol use %K evidence-based prevention %K alcohol intervention %K mixed methods study %K survey %K alcohol use disorder %K alcohol misuse %K heavy drinker %K educational web-based intervention %K web-based intervention %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: As alcohol misuse remains pervasive within the military, evidence-based prevention programs that are feasible to implement and appropriately tailored to meet the needs and norms of military personnel are critically needed. Further, programs that target future military leaders, such as trainees, recruits, and cadets, may be especially impactful. eCHECKUP TO GO is a web-based, evidence-based brief alcohol intervention designed to reduce alcohol misuse through education and personalized feedback that may be suitable for military trainees. However, because it was developed for civilian students, efforts to adapt the content for military settings are needed. Objective: This study aimed to evaluate the acceptability of a military version of eCHECKUP TO GO, tailored to include military-specific terminology and alcohol use statistics. Methods: US Air Force Academy cadets were recruited to participate in a single-arm, mixed methods study. Following the completion of eCHECKUP TO GO, participants completed a survey that assessed satisfaction with specific aspects of the user experience, including ease of use, design, and relevance of the information and personalized feedback (range: 1=strongly disagree to 7=strongly agree). A subset of cadets also participated in a focus group to expound on the survey responses. Results: Survey participants included 22 cadets (n=12, 55% male; mean age 19.6, SD 1.8 years). In addition, 6 (27%) cadets participated in the focus group. Participants were satisfied with the program overall (mean 5.8, SD 0.9) and gave the highest ratings to ease of use (mean 6.6, SD 0.7), site design (mean 6.5, SD 0.6), and site interactivity (mean 6.4, SD 1.0). Items pertaining to tailoring, relevance, and amount of content specific to cadets scored lowest (mean 5.8, SD 1.4; mean 5.6, SD 1.4; and mean 5.5, SD 1.5, respectively). Most (n=15, 68%) participants said they would act upon the information they were provided. Focus group participants made suggestions for improved tailoring, such as increasing content on social aspects of drinking and military-specific risks of alcohol misuse (eg, Uniform Code of Military Justice violations). Conclusions: Although the acceptability of eCHECKUP TO GO was high, continued efforts are needed to ensure the content accurately reflects the experiences of cadets. Researchers who design military health promotion interventions need to consider the varied contexts within the force and rigorously evaluate the acceptability of all content before implementation. %R 10.2196/67637 %U https://formative.jmir.org/2025/1/e67637 %U https://doi.org/10.2196/67637 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e69873 %T A Novel Just-in-Time Intervention for Promoting Safer Drinking Among College Students: App Testing Across 2 Independent Pre-Post Trials %A Chow,Philip I %A Smith,Jessica %A Saini,Ravjot %A Frederick,Christina %A Clark,Connie %A Ritterband,Maxwell %A Halbert,Jennifer P %A Cheney,Kathryn %A Daniel,Katharine E %A Ingersoll,Karen S %K alcohol %K college students %K smartphone intervention %K binge drinking %K safe drinking %D 2025 %7 10.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Binge drinking, which is linked to various immediate and long-term negative outcomes, is highly prevalent among US college students. Behavioral interventions delivered via mobile phones have a strong potential to help decrease the hazardous effects of binge drinking by promoting safer drinking behaviors. Objective: This study aims to evaluate the preliminary efficacy of bhoos, a novel smartphone app designed to promote safer drinking behaviors among US college students. The app offers on-demand educational content about safer alcohol use, provides dynamic feedback as users log their alcohol consumption, and includes an interactive drink tracker that estimates blood alcohol content in real time. Methods: The bhoos app was tested in 2 independent pre-post studies each lasting 4 weeks, among US college students aged 18‐35 years. The primary outcome in both trials was students’ self-reported confidence in using protective behavioral strategies related to drinking, with self-reported frequency of alcohol consumption over the past month examined as a secondary outcome. Results: In study 1, bhoos was associated with increased confidence in using protective behavioral strategies. Students also endorsed the high usability of the app and reported acceptable levels of engagement. Study 2 replicated findings of increased confidence in using protective behavioral strategies, and demonstrated a reduction in the self-reported frequency of alcohol consumption. Conclusions: Bhoos is a personalized, accessible, and highly scalable digital intervention with a strong potential to effectively address alcohol-related behaviors on college campuses. %R 10.2196/69873 %U https://humanfactors.jmir.org/2025/1/e69873 %U https://doi.org/10.2196/69873 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e64720 %T The Color of Drinking Survey Questionnaire for Measuring the Secondhand Impacts of High-Risk Drinking in College Settings: Validation Study %A Marconi,Agustina %A Washington,Reonda %A Jovaag,Amanda %A Blomme,Courtney %A Knobeloch,Ashley %A Irazola,Vilma %A Muros Cortés,Carolina %A Gutierrez,Laura %A Elorriaga,Natalia %K validation study %K alcohol drinking in college %K microaggression %K university %K student %K young adult %K undergraduate %K survey %K questionnaire %K reliability %K consistency %D 2025 %7 7.4.2025 %9 %J Interact J Med Res %G English %X Background: The “Color of Drinking” is a study conducted at the University of Wisconsin-Madison. It examines the secondhand harms of high-risk drinking on college students of color and explores the connection between alcohol use and the campus racial climate. Since its findings were released in 2018, this study has received significant attention from other college settings around the country. Objective: This study aims to describe the development of the most recent version of the Color of Drinking questionnaire and to assess its internal consistency, test-retest reliability, and construct validity in a sample of undergraduate students attending the University of Wisconsin-Madison. Methods: This is an observational, analytic study. Questionnaire design experts revised the original instrument, and in-depth cognitive interviews with students were conducted to evaluate comprehensibility and acceptability. The revised questionnaire was administered 2 times, 3 to 4 weeks apart, in a sample of undergraduate students. The following properties were studied: internal consistency in 4 sets of items (Cronbach α), test-retest reliability among closed-ended questions (κ statistics and intraclass correlation coefficient), and construct validity (associations with other validated instruments, such as the Alcohol Use Disorders Identification Test). For a section of questions showing low reliability, the answers to open questions and other in-depth interviews were carried out, and online surveys were conducted with another sample of undergraduate students to evaluate reliability after changes. Results: Eight students participated in the in-depth interviews, 177 responses from the online survey were included for the analysis of internal consistency, 115 for test-retest reliability, and 98 for construct validity. The 4 sets of items (sections) evaluated (“impact of alcohol consumption on academics,” “impact of microaggressions,” “witnessing microaggressions and alcohol intoxication,” and “bystanders’ interventions on alcohol intoxication”) presented good internal consistency (Cronbach α between 0.723 and 0.898). Most items showed moderate to substantial test-retest reliability; agreement was from 68.1% to 95.2%, and κ coefficients ranged from 0.214 to 0.8. For construct validity, correlations between the number of drinking days, the maximum number of drinks in a day and the Alcohol Use Disorders Identification Test score were moderate to high, r=0.630 (95% CI 0.533-0.719) and r=0.647 (95% CI 0.548-0.741), respectively. Due to low reliability, a section regarding “health impacts” has been redesigned, including 8 items for the personal consumption of alcohol and the consumption of others (Cronbach α 0.735 and 0.855, respectively; agreement between the first and the second time the questionnaire was administered were 83.4% and 99.1%, and most of the items with κ coefficient from 0.476 to 0.877). Conclusions: The revised version of the Color of Drinking questionnaire showed acceptable to adequate reliability and construct validity. %R 10.2196/64720 %U https://www.i-jmr.org/2025/1/e64720 %U https://doi.org/10.2196/64720 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63184 %T Smartwatch-Based Ecological Momentary Assessment for High-Temporal-Density, Longitudinal Measurement of Alcohol Use (AlcoWatch): Feasibility Evaluation %A Stone,Chris %A Adams,Sally %A Wootton,Robyn E %A Skinner,Andy %+ School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 07983 317748, cstone2@btinternet.com %K smartwatch %K ecological momentary assessment %K μEMA %K alcohol %K ALSPAC %D 2025 %7 25.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment methods have recently been adapted for use on smartwatches. One particular class of these methods, developed to minimize participant burden and maximize engagement and compliance, is referred to as microinteraction-based ecological momentary assessment (μEMA). Objective: This study explores the feasibility of using these smartwatch-based μEMA methods to capture longitudinal, high-temporal-density self-report data about alcohol consumption in a nonclinical population selected to represent high- and low-socioeconomic position (SEP) groups. Methods: A total of 32 participants from the Avon Longitudinal Study of Parents and Children (13 high and 19 low SEP) wore a smartwatch running a custom-developed μEMA app for 3 months between October 2019 and June 2020. Every day over a 12-week period, participants were asked 5 times a day about any alcoholic drinks they had consumed in the previous 2 hours, and the context in which they were consumed. They were also asked if they had missed recording any alcoholic drinks the day before. As a comparison, participants also completed fortnightly online diaries of alcohol consumed using the Timeline Followback (TLFB) method. At the end of the study, participants completed a semistructured interview about their experiences. Results: The compliance rate for all participants who started the study for the smartwatch μEMA method decreased from around 70% in week 1 to 45% in week 12, compared with the online TLFB method which was flatter at around 50% over the 12 weeks. The compliance for all participants still active for the smartwatch μEMA method was much flatter, around 70% for the whole 12 weeks, while for the online TLFB method, it varied between 50% and 80% over the same period. The completion rate for the smartwatch μEMA method varied around 80% across the 12 weeks. Within high- and low-SEP groups there was considerable variation in compliance and completion at each week of the study for both methods. However, almost all point estimates for both smartwatch μEMA and online TLFB indicated lower levels of engagement for low-SEP participants. All participants scored “experiences of using” the 2 methods equally highly, with “willingness to use again” slightly higher for smartwatch μEMA. Conclusions: Our findings demonstrate the acceptability and potential utility of smartwatch μEMA methods for capturing data on alcohol consumption. These methods have the benefits of capturing higher-temporal-density longitudinal data on alcohol consumption, promoting greater participant engagement with less missing data, and potentially being less susceptible to recall errors than established methods such as TLFB. Future studies should explore the factors impacting participant attrition (the biggest reason for reduced engagement), latency issues, and the validity of alcohol data captured with these methods. The consistent pattern of lower engagement among low-SEP participants than high-SEP participants indicates that further work is warranted to explore the impact and causes of these differences. %M 40131326 %R 10.2196/63184 %U https://formative.jmir.org/2025/1/e63184 %U https://doi.org/10.2196/63184 %U http://www.ncbi.nlm.nih.gov/pubmed/40131326 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e57084 %T Real-World Data on Alcohol Consumption Behavior Among Smartphone Health Care App Users in Japan: Retrospective Study %A Eguchi,Kana %A Kubota,Takeaki %A Koyanagi,Tomoyoshi %A Muto,Manabu %+ Department of Informatics, Graduate School of Informatics, Kyoto University, Yoshida-Hommachi, Sakyo-ku,, Kyoto, 606-8501, Japan, 81 75 753 3369, kana.eguchi@ieee.org %K alcohol consumption %K individual behavior %K mobile health %K mobile health app %K mobile health care app log-based survey %K real-world data %K RWD %K RWD analysis %K smartphone health care app %K surveillance system %K health care app %D 2025 %7 25.3.2025 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Although many studies have used smartphone apps to examine alcohol consumption, none have clearly delineated long-term (>1 year) consumption among the general population. Objective: The objective of our study is to elucidate in detail the alcohol consumption behavior of alcohol drinkers in Japan using individual real-world data. During the state of emergency associated with the COVID-19 outbreak, the government requested that people restrict social gatherings and stay at home, so we hypothesize that alcohol consumption among Japanese working people decreased during this period due to the decrease in occasions for alcohol consumption. This analysis was only possible with individual real-world data. We also aimed to clarify the effects of digital interventions based on notifications about daily alcohol consumption. Methods: We conducted a retrospective study targeting 5-year log data from January 1, 2018, to December 31, 2022, obtained from a commercial smartphone health care app (CALO mama Plus). First, to investigate the possible size of the real-world data, we investigated the rate of active users of this commercial smartphone app. Second, to validate the individual real-world data recorded in the app, we compared individual real-world data from 9991 randomly selected users with government-provided open data on the number of daily confirmed COVID-19 cases in Japan and with nationwide alcohol consumption data. To clarify the effects of digital interventions, we investigated the relationship between 2 types of notification records (ie, “good” and “bad”) and a 3-day daily alcohol consumption log following the notification. The protocol of this retrospective study was approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine (R4699). %M 40131328 %R 10.2196/57084 %U https://ojphi.jmir.org/2025/1/e57084 %U https://doi.org/10.2196/57084 %U http://www.ncbi.nlm.nih.gov/pubmed/40131328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64459 %T A Brief Cognitive Behavioral Therapy–Based Digital Intervention for Reducing Hazardous Alcohol Use in South Korea: Development and Prospective Pilot Study %A Kwon,Manjae %A Moon,Daa Un %A Kang,Minjae %A Jung,Young-Chul %K alcohol %K hazardous alcohol use %K digital intervention %K cognitive behavioral therapy %K mobile apps %K prevention %K therapy-based %K cognitive behavioral %K alcohol use %K South Korea %K prospective pilot study %K pilot study %K alcohol consumption %K death %K disability %K chronic medical condition %K digital health interventions %K traditional treatment methods %K Korean %K hazardous drinking %K acceptability %K feasibility %K smartphone app %K alcohol use disorder %K psychiatric symptoms %K mobile phone %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Alcohol consumption is a leading cause of death and disability worldwide, associated with numerous acute and chronic medical conditions. Digital health interventions offer a promising solution to overcome barriers associated with traditional treatment methods, providing accessible, scalable, and cost-effective means to support individuals in reducing hazardous drinking. Objective: This pilot study aims to evaluate the feasibility, acceptability, and preliminary efficacy of the Sober smartphone app in individuals with hazardous alcohol use. Methods: This single-group, pre- and postpilot study included 20 participants with risky alcohol use, identified using the Alcohol Use Disorder Identification Test. Participants used the Sober app for 4 weeks, incorporating cognitive behavioral therapy–based interventions. Feasibility was assessed by study and session completion rates, acceptability by participant satisfaction and perceived usefulness, and preliminary efficacy by changes in alcohol consumption and psychiatric symptoms. Semistructured interviews with participants and clinicians provided qualitative perspectives on the app’s usability, efficacy, and areas for improvement. Results: Of the 20 enrolled participants, 17 completed the study. The app demonstrated high feasibility with an 85% (17/20) study completion rate, and 59% (10/17) completed all cognitive behavioral therapy sessions. Participants reported positive acceptability, with average satisfaction and usefulness ratings of 3.8 and 3.7 of 5, respectively. Preliminary efficacy outcomes showed significant improvements: abstinence days increased from 67% to 85% (z=−3.17; P=.002), heavy drinking episodes decreased from 3.3 to 1.9 (t16=−2.97; P=.003), and total alcohol consumption reduced from 456.8 to 195.9 mL (t16=3.16; P=.002). Alcohol Use Disorder Identification Test scores dropped from 17.5 to 10.7 (t16=4.51; P<.001). Additionally, depression (Patient Health Questionnaire-9) scores decreased from 5.8 to 4.4 (t16=2.91; P=.01), and anxiety (Generalized Anxiety Disorder-7) scores from 3.4 to 2.1 (z=−2.80; P=.005). No adverse events were reported. Qualitative analysis found participants valued daily logging but noted usability issues, while clinicians called for tailored goals, enhanced communication features, and age-specific content. Conclusions: The mobile app Sober shows promise as an effective tool for reducing hazardous alcohol consumption and improving related psychiatric symptoms. The study demonstrated high feasibility and positive acceptability, with significant preliminary efficacy in reducing alcohol use. Qualitative findings provided actionable evidence for refining the app’s usability and clinical integration. Further research through a randomized controlled trial is warranted to confirm these findings and optimize the app’s features and content. Trial Registration: ClinicalTrials.gov NCT06502756; https://clinicaltrials.gov/study/NCT06502756 %R 10.2196/64459 %U https://formative.jmir.org/2024/1/e64459 %U https://doi.org/10.2196/64459 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e63148 %T Preferences for Mobile Apps That Aim to Modify Alcohol Use: Thematic Content Analysis of User Reviews %A Kirouac,Megan %A Gillezeau,Christina %K alcohol mobile app %K mHealth %K alcohol use disorder %K user-centered design %K alcohol %K user-centered %K user %K reviews %K usefulness %K mobile health app %K content analysis %K drinking %K health tool %D 2025 %7 19.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Nearly one-third of adults in the United States will meet criteria for alcohol use disorder in their lifetime, yet fewer than 10% of individuals who meet for alcohol use disorder criteria will receive treatment for it. Mobile health (mHealth) applications (apps) have been suggested as a potential mechanism for closing this treatment gap, yet there is a wide variety of quality and integrity within these apps, leading to potential harms to users. Objectives: The aim of this paper is to systematically record and qualitatively examine user reviews or mHealth apps to identify features in the existing apps that may impact usefulness and adoption of them. Methods: The researchers used Apple App and Google Play stores to identify mHealth apps that were focused on modifying alcohol use and treating common comorbidities. Apps that were free without in-app purchases and provided multiple features for users were included. User reviews from the apps were downloaded and coded using content analysis. Results: A total of 425 unique apps were found in our search. Of these, the majority of apps (n=301) were excluded from the present analyses for not focusing on reducing alcohol-related concerns (eg, many apps were for purchasing alcohol). Eight apps were identified and had user reviews downloaded. The apps examined in this study were VetChange, SMART, DrinkCoach, SayingWhen, AlcoStat, Celebrate Recovery, TryDry, and Construction Industry Helpline. A total of 370 reviews were downloaded and 1353 phrases were coded from those reviews into a total of 11 codes. The 5 most common themes identified were praise (498 counts coded; 36.831%), tools (150 counts coded; 11.062%), suggestions for improvement (118 counts coded; 8.756%), criticism (105 counts coded; 7.768%), and tracking (104 counts coded; 7.724%). Conclusions: The current findings suggest that alcohol mobile app users broadly found the apps helpful in reducing their drinking or meeting their drinking goals. Users were able to identify features that they liked or found helpful in the apps, as well as provide concrete feedback about features that they would like included or improved. Specifically, flexible and expansive tracking features and comprehensive whole health tools were cited as valuable and desired. App developers and those looking to expand access to and uptake of alcohol reduction apps may find these user reviews helpful in guiding their app development. %R 10.2196/63148 %U https://mhealth.jmir.org/2025/1/e63148 %U https://doi.org/10.2196/63148 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64664 %T Use of Wearable Transdermal Alcohol Sensors for Monitoring Alcohol Consumption After Detoxification With Contingency Management: Pilot Randomized Feasibility Trial %A Brobbin,Eileen %A Drummond,Colin %A Parkin,Stephen %A Deluca,Paolo %+ King's College London, 4 Windswor Walk, Denmark Hill, London, SE5 8BB, United Kingdom, 44 07758287265, eileen.brobbin@kcl.ac.uk %K alcohol %K alcohol dependence %K alcohol monitoring %K alcohol treatment %K contingency management %K transdermal alcohol sensor %K transdermal technology %K wearable %K wearable alcohol biosensor %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Wearable transdermal alcohol sensor (TAS) devices generate continuous data on alcohol consumption through the indiscernible sweat vapors on the skin. This continuous alcohol monitoring capability could provide a new method for alcohol services to monitor service users at various stages of their alcohol treatment. Objective: We aimed to assess the feasibility of using a TAS as part of alcohol treatment with alcohol service users using the device with or without contingency management (CM). Methods: A feasibility study was conducted of a convenience sample of 29 current service users from 3 South London alcohol services. Participants were randomized into either a control (treatment as usual) or CM group (treatment as usual+CM). We assessed the feasibility of enrollment, participation, device tampering and return, and device wearability and the accuracy of data capture. These data were reported descriptively where appropriate, the groups were compared, and alcohol self-report data were compared to the transdermal alcohol concentration to assess accuracy. Results: A total of 34 individuals were approached, and 32 (94%) were enrolled and randomized (n=17, 53% to the control group and n=15, 47% to the CM group) over 5 months. In total, 3 participants withdrew (n=2, 67% from the control group and n=1, 33% from the CM group). There was a total of 203 meetings arranged (29 participants × 7 meetings), and 185 (91.1%) were attended. Only 1 of the 29 participants (3%) admitted to turning the TAS off to avoid monitoring. There were some issues with the TAS not functioning properly and not being able to be cleaned. Removals were recorded, but the definition of TAS removal may need to be improved for future trials. There was a high TAS return rate (28/29, 97% of the participants returned the TAS). Secondary outcomes suggest that the BACtrack Skyn remains an accurate tool to monitor alcohol consumption compared to self-report data and that it is acceptable to wearers over 2 weeks, with many participants (27/28, 96%) answering that they would wear it again and for longer but that the CM procedure could be made clearer. Conclusions: The delivery of CM via a TAS was feasible in this study, but recommendations for a future larger trial include that the study design should be changed to provide an operationalized rather than manual method of checking whether TAS data meet CM criteria. This would reduce researcher burden and researcher and participant time. Current recruitment and research meeting design seem suitable for a future larger trial. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361 %M 40085839 %R 10.2196/64664 %U https://humanfactors.jmir.org/2025/1/e64664 %U https://doi.org/10.2196/64664 %U http://www.ncbi.nlm.nih.gov/pubmed/40085839 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63282 %T Using a Sober Curious Framework to Explore Barriers and Facilitators to Helping Sexual Minority Women Reduce Alcohol-Related Harms: Protocol for a Descriptive Study %A Hughes,Tonda L %A Bochicchio,Lauren %A Drabble,Laurie A %A Lunnay,Belinda %A Whiteley,David %A Scheer,Jillian R %A Meadows,Beth %A Ward,Paul %A Emslie,Carol %+ Center for Sexual and Gender Minority Health Research, School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2035242408, lab2223@cumc.columbia.edu %K sexual minority women %K drinking %K sober curiosity %K women %K sober %K minority %K alcohol %K protocol %K barriers %K facilitators %K disparities %D 2025 %7 3.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, women consume less alcohol than men, but alcohol consumption among women has declined less in recent years than among men. Drinking rates and alcohol-related harms vary substantially across population groups of women, and sexual minority women (eg, lesbian, bisexual, and queer) are at notably high risk. An emerging body of literature suggests that in addition to minority stress (eg, stigma, discrimination), drinking norms and drinking cultures likely influence sexual minority women’s drinking. Almost no research has explored these factors as possible targets of interventions. Sober curiosity is a rapidly growing wellness movement that may be particularly salient for sexual minority women. It encourages individuals to be “curious” about the reasons they choose to drink and alcohol’s effects on their life and health. Objective: The aims of this research are to (1) explore the perspectives of the drinking social worlds of sexual minority women, their awareness of the sober curious movement, perceptions of their own and their peers’ drinking and desire to drink less, and perceived barriers and facilitations to changing their drinking behaviors and (2) identify key elements of an alcohol reduction intervention tailored for sexual minority women. Methods: We conducted a comprehensive review of the literature on alcohol interventions with sexual minority women. The handful of studies we found paid scant attention to drinking cultures, normative beliefs, or other key elements of sober curiosity. To address the study aims, we are conducting 2 descriptive studies with adult (>18 years) sexual minority women using mixed methods. One includes focus group interviews (n=24-36) and a national survey (n=100-120) with sexual minority women in Scotland. The other includes in-depth interviews (n=18-20) with sexual minority women in the United States. Data from the 2 countries and 3 sources will be analyzed using qualitative and quantitative methods to identify patterns and relationships across data to validate or corroborate findings. Results: Each of the studies received ethics approval in August 2023 and is currently open for recruitment. We anticipate completing data collection in spring 2025. The results of qualitative analyses will be summarized as themes, and results of survey data analyses will be summarized in tables. Findings will be presented to 2 panels of international experts who will assist in identifying critical elements of an alcohol reduction intervention tailored to the unique needs of sexual minority women. Conclusions: With the assistance of the expert panels, we will use Acceptability, Practicability, Effectiveness, Affordability, Side-Effects, and Equity criteria to inform the development of a tailored intervention building on tenants of sober curiosity to assist sexual minority women in reducing harmful drinking. International Registered Report Identifier (IRRID): DERR1-10.2196/63282 %M 40053757 %R 10.2196/63282 %U https://www.researchprotocols.org/2025/1/e63282 %U https://doi.org/10.2196/63282 %U http://www.ncbi.nlm.nih.gov/pubmed/40053757 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65187 %T Text Messaging Interventions for Unhealthy Alcohol Use in Emergency Departments: Mixed Methods Assessment of Implementation Barriers and Facilitators %A O'Grady,Megan %A Harrison,Laura %A Suleiman,Adekemi %A Hutchison,Morica %A Kwon,Nancy %A Muench,Frederick %A Kapoor,Sandeep %K unhealthy alcohol use %K text messaging intervention %K emergency department %K barriers and facilitators %K implementation %K alcohol use %K unhealthy %K mixed methods assessment %K mixed methods %K assessment %K facilitators %K alcohol %K health care %K scalable supports %K text messaging %K patient outcomes %K health system %K electronic health record %K EHR %K alcohol screening %K acceptability %K feasibility %K survey %K health-related goals %D 2025 %7 3.3.2025 %9 %J JMIR Form Res %G English %X Background: Many patients with unhealthy alcohol use (UAU) access health care in emergency departments (EDs). Scalable supports, such as SMS text messaging interventions, are acceptable and feasible to enhance care delivery for many health issues, including substance use. Further, SMS text messaging interventions have been shown to improve patient outcomes related to alcohol consumption (eg, reduced consumption compared to no intervention, basic health information, or drink tracking), but they are rarely offered in clinical settings. Objective: This paper describes a mixed methods study using the Integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. The goal of this study was to use a stakeholder-engaged mixed methods design to assess barriers and facilitators to the implementation of SMS text messaging interventions for UAU in EDs with a focus on the recipient’s characteristics, the innovation’s degree of fit within the existing practice, and the unique nature of the inner and outer context. Methods: This study was conducted in a large health system in the northeastern United States. We examined electronic health record data on alcohol screening in 17 EDs; surveyed 26 ED physician chairpersons on implementation feasibility, acceptability, and appropriateness; and interviewed 18 ED staff and 21 patients to understand barriers and facilitators to implementation. Interviews were analyzed according to the i-PARIHS framework to assess recipient characteristics, innovation degree of fit, and inner and outer context. Results: Electronic health record data revealed high variability in alcohol screening completion (mean 73%, range 35%‐93%), indicating potential issues in identifying patients eligible to offer the intervention. The 26 ED chair surveys revealed a relatively high level of implementation confidence (mean 4, SD 0.81), acceptability (mean 4, SD 0.71), and appropriateness (mean 3.75, SD 0.69) regarding the UAU SMS text messaging intervention; feasibility (mean 3.5, SD 0.55) had the lowest mean, indicating concerns about integrating the text intervention in the busy ED workflow. Staff were concerned about staff buy-in and adding additional discussion points to already overwhelmed patients during their ED visit but saw the need for additional low-threshold services for UAU. Patients were interested in the intervention to address drinking and health-related goals. Conclusions: ED visits involving UAU have increased in the United States. The results of this formative study on barriers and facilitators to the implementation of UAU SMS text messaging interventions in EDs indicate both promise and caution. In general, we found that staff viewed offering such interventions as appropriate and acceptable; however, there were concerns with feasibility (eg, low alcohol risk screening rates). Patients also generally viewed the SMS text messaging intervention positively, with limited drawbacks (eg, slight concerns about having time to read messages). The results provide information that can be used to develop implementation strategies that can be tested in future studies. Trial Registration: ClinicalTrials.gov NCT05350878; http://clinicaltrials.gov/ct2/show/NCT05350878 %R 10.2196/65187 %U https://formative.jmir.org/2025/1/e65187 %U https://doi.org/10.2196/65187 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63819 %T A Web-Based Resource Informed by Cognitive Behavioral Therapy and Positive Psychology to Address Stress, Negative Affect, and Problematic Alcohol Use: A Usability and Descriptive Study %A Serck-Hanssen,Ingrid %A Solheim-Witt,Marit %A Anker,Justin J %A Sugarman,Dawn E %K alcohol misuse %K stress %K drinking to cope %K DTC %K negative affect %K positive psychology intervention %K PPI %K cognitive behavior therapy %K CBT %K alcohol use %K drinking %K usability %K descriptive study %K behavior %K emotion %K coping skill %K positive psychology %K psychology %K online resource %K mobile phone %D 2025 %7 10.2.2025 %9 %J JMIR Form Res %G English %X Background: Research documents that drinking to cope behavior can be disrupted by enhancing emotion regulation and coping skills related to the experience of stress and negative affect. The Alpha Element Self-Coaching Plan incorporates principles of positive psychology and cognitive behavioral therapy to redirect negative thinking and emotions and, therefore, has the potential to benefit individuals who use alcohol to cope with stress. Objective: This study aimed to evaluate satisfaction and usability of the web-based Alpha Element Self-Coaching Plan in order to inform the development of an expanded digital platform based on the Alpha Element framework. Methods: Participants enrolled in the web-based program as part of their clinical care were eligible to participate. A total of 20 individuals (14 women and 6 men) between ages 30 and 79 (mean 54.5, SD 14.14) years completed web-based questionnaires to assess product performance in areas such as ease of technology use, quality of videos and handouts, and the value of the activities. Participants also completed the System Usability Scale (SUS) and provided background and demographic information, including alcohol use. Results: Only 1 participant reported no alcohol use in the past year; 55% (11/20) of participants drank alcohol 2‐4 times per month or less and 45% (9/20) reported drinking alcohol 2‐3 times per week or more. The average SUS score of 76.38 (SD 17.85) was well above the commonly accepted threshold of 68, indicating high system usability. A majority of the sample (16/19, 84%) agreed or strongly agreed that the activities in the program inspired behavioral changes; and most agreed or strongly agreed that the program was engaging (16/20, 80%), well-organized (18/20, 90%), and easy to follow (17/20, 85%). Only 2 participants endorsed experiencing difficulty using the program on a smartphone. Suggestions for program improvements included expanding the platform, updating the web format, adding user interactivity, and enhancing navigation. Conclusions: These data suggest that participants were generally satisfied with the web-based Alpha Element Self-Coaching Plan, and rated usability of the program as favorable. Importantly, a significant portion of participants reported that the program inspired behavioral changes. More research is needed with a larger sample to obtain specific data about alcohol consumption and investigate associations between alcohol use and program components, as well as examine gender differences. Data collected from this study will be used to expand the platform and improve user experience. %R 10.2196/63819 %U https://formative.jmir.org/2025/1/e63819 %U https://doi.org/10.2196/63819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62915 %T Women Empowered to Connect With Addiction Resources and Engage in Evidence-Based Treatment (WE-CARE)—an mHealth Application for the Universal Screening of Alcohol, Substance Use, Depression, and Anxiety: Usability and Feasibility Study %A Isaacs,Krystyna %A Shifflett,Autumn %A Patel,Kajal %A Karpisek,Lacey %A Cui,Yi %A Lawental,Maayan %A Tzilos Wernette,Golfo %A Borsari,Brian %A Chang,Katie %A Ma,Tony %+ Benten Technologies, 9408 Grant Ave, Unit 206, Manassas, VA, 20110, United States, 1 7036625858, krysisaacs@gmail.com %K service linkage %K digital health %K education %K mental health %K substance use disorder %K SUD %K alcohol use disorder %K chatbot %K childbearing women %K women %K alcohol %K substance use %K empowerment %K evidence-based treatment %K usability %K feasibility %K mobile health %K mhealth %K app %K depression %K anxiety %K screening %K e-screening %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Women of childbearing age (aged 18-44 years) face multiple barriers to receiving screening and treatment for unhealthy alcohol and substance use, depression, and anxiety, including lack of screening in the primary care setting and lack of support in accessing care. The Women Empowered to Connect with Addiction Resources and Engage in Evidence-based Treatment (WE-CARE) mobile app was developed to test universal screening with women of childbearing age and linkage to care after an anonymous assessment. Objective: In this study, we aimed to investigate the feasibility and acceptability of providing anonymous screening instruments through mobile phones for alcohol and substance use, as well as depression and anxiety, for women of childbearing age. Methods: We used agile development principles based on previous formative research to test WE-CARE mobile health app with women of childbearing age (N=30) who resided in 1 of 6 counties in central Florida. WE-CARE included screening instruments (for alcohol, substance use, depression, and anxiety), a moderated discussion forum, educational microlearning videos, a frequently asked questions section, and resources for linkage to treatment. Individuals were recruited using flyers, academic listserves, and a commercial human subject recruiting company (Prolific). Upon completion of the screening instruments, women explored the educational and linkage to care features of the app and filled out a System Usability Scale to evaluate the mobile health app’s usability and acceptability. Postpilot semistructured interviews (n=4) were conducted to further explore the women’s reactions to the app. Results: A total of 77 women downloaded the application and 30 completed testing. Women of childbearing age gave the WE-CARE app an excellent System Usability Scale score of 86.7 (SD 12.43). Our results indicate elevated risk for substance use in 18 of the 30 (60%) participants, 9/18 (50%) also had an elevated risk for anxiety or depression, and 11/18 (61%) had an elevated risk for substance use, anxiety, or depression. Participants reported that WE-CARE was easy to navigate and use but they would have liked to see more screening questions and more educational content. Linkage to care was an issue; however, as none of the women identified as “at-risk” for substance use disorders contacted the free treatment clinic for further evaluation. Conclusions: The mobile health app was highly rated for acceptability and usability, but participants were not receptive to seeking help at a treatment center after only a few brief encounters with the app. The linkage to care design features was likely insufficient to encourage them to seek treatment. The next version of WE-CARE will include normative scores for participants to self-evaluate their screening status compared with their age- and gender-matched peers and enhanced linkages to care features. Future development will focus on enhancing engagement to improve change behaviors and assess readiness for change. %M 39918861 %R 10.2196/62915 %U https://formative.jmir.org/2025/1/e62915 %U https://doi.org/10.2196/62915 %U http://www.ncbi.nlm.nih.gov/pubmed/39918861 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55541 %T Smartphone-Based Intervention Targeting Norms and Risk Perception Among University Students with Unhealthy Alcohol Use: Secondary Mediation Analysis of a Randomized Controlled Trial %A Studer,Joseph %A Cunningham,John A %A Schmutz,Elodie %A Gaume,Jacques %A Adam,Angéline %A Daeppen,Jean-Bernard %A Bertholet,Nicolas %+ Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 23A, Lausanne, 1011, Switzerland, 41 213149033, joseph.studer@chuv.ch %K brief intervention %K alcohol use %K mechanism of action %K mediation analysis %K personalized feedback %K smartphone app %K students %K Switzerland %K mobile phone %K mediation %K feedback %K student %K health risk %K drinking %K drinker %K support %K feedback intervention %D 2025 %7 6.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Many digital interventions for unhealthy alcohol use are based on personalized normative feedback (PNF) and personalized feedback on risks for health (PFR). The hypothesis is that PNF and PFR affect drinkers’ perceptions of drinking norms and risks, resulting in changes in drinking behaviors. This study is a follow-up mediation analysis of the primary and secondary outcomes of a randomized controlled trial testing the effect of a smartphone-based intervention to reduce alcohol use. Objective: This study aimed to investigate whether perceptions of drinking norms and risks mediated the effects of a smartphone-based intervention to reduce alcohol use. Methods: A total of 1770 students from 4 higher education institutions in Switzerland (mean age 22.35, SD 3.07 years) who screened positive for unhealthy alcohol use were randomized to receive access to a smartphone app or to the no-intervention control condition. The smartphone app provided PNF and PFR. Outcomes were drinking volume (DV) in standard drinks per week and the number of heavy drinking days (HDDs) assessed at baseline and 6 months. Mediators were perceived drinking norms and perceived risks for health measured at baseline and 3 months. Parallel mediation analyses and moderated mediation analyses were conducted to test whether (1) the intervention effect was indirectly related to lower DV and HDDs at 6 months (adjusting for baseline values) through perceived drinking norms and perceived risks for health at 3 months (adjusting for baseline values) and (2) the indirect effects through perceived drinking norms differed between participants who overestimated or who did not overestimate other people’s drinking at baseline. Results: The intervention’s total effects were significant (DV: b=–0.85, 95% bootstrap CI –1.49 to –0.25; HDD: b=–0.44, 95% bootstrap CI –0.72 to –0.16), indicating less drinking at 6 months in the intervention group than in the control group. The direct effects (ie, controlling for mediators) were significant though smaller (DV: b=–0.73, 95% bootstrap CI –1.33 to –0.16; HDD: b=–0.39, 95% bootstrap CI –0.66 to –0.12). For DV, the indirect effect was significant through perceived drinking norms (b=–0.12, 95% bootstrap CI –0.25 to –0.03). The indirect effects through perceived risk (for DV and HDD) and perceived drinking norms (for HDD) were not significant. Results of moderated mediation analyses showed that the indirect effects through perceived drinking norms were significant among participants overestimating other people’s drinking (DV: b=–0.17, 95% bootstrap CI –0.32 to –0.05; HDD: b=–0.08, 95% bootstrap CI –0.15 to –0.01) but not significant among those not overestimating. Conclusions: Perceived drinking norms, but not perceived risks, partially mediated the intervention’s effect on alcohol use, confirming one of its hypothesized mechanisms of action. These findings lend support to using normative feedback interventions to discourage unhealthy alcohol use. Trial Registration: ISRCTN Registry 10007691; https://doi.org/10.1186/ISRCTN10007691 %M 39914807 %R 10.2196/55541 %U https://www.jmir.org/2025/1/e55541 %U https://doi.org/10.2196/55541 %U http://www.ncbi.nlm.nih.gov/pubmed/39914807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54438 %T Translation Effectiveness of Offset Heart Rate Biofeedback as a Mindless Intervention for Alcohol Craving Among Risky Drinkers: Controlled Experiment %A Zhao,Yiran %A Arora,Jatin %A Tao,Yujie %A Miller,Dave B %A Adams,Alexander T %A Choudhury,Tanzeem %+ Department of Information Science, Cornell University, 2 West Loop Rd, New York, NY, 10044, United States, 1 240 888 3213, yz2647@cornell.edu %K wearable device %K alcohol craving %K risky drinking %K digital intervention %K entrainment %K offset heart rate biofeedback %K mindless intervention %D 2024 %7 31.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital and wearable intervention systems promise to improve how people manage their behavioral health conditions by making interventions available when the user can best benefit from them. However, existing interventions are obtrusive because they require attention and motivation to engage in, limiting the effectiveness of such systems in demanding contexts, such as when the user experiences alcohol craving. Mindless interventions, developed by the human-computer interaction community, offer an opportunity to intervene unobtrusively. Offset heart rate biofeedback is an iconic type of mindless intervention powered by entrainment and can mitigate the physiological and psychological response to stressors. Objective: This work aimed to characterize the translational effectiveness of offset heart rate biofeedback on cue-elicit alcohol craving among risky drinkers. Methods: We conducted an out-of-lab, between-group, controlled experiment with 26 participants who performed harmful or hazardous drinking. The control group served as negative control and received no intervention, while the experimental group received offset heart rate biofeedback during alcohol exposure and recovery. We elicited alcohol cravings through a series of alcohol cues, including performing mental imagery, viewing alcohol images, and sniffing alcohol. We measured the physiological response to alcohol (ie, heart rate variability), self-reported craving, and self-reported anxiety. We constructed linear mixed-effects models to understand the effect of intervention during alcohol exposure and alcohol recovery after exposure. Following the linear mixed effect model, we conducted pair-wise comparisons for measures between the control and experimental groups. Results: We found that offset heart rate biofeedback significantly reduced the increase in heart rate variability (P=.01 and P=.052) and self-reported craving (P=.04 and P=.02) in response to alcohol cues. Participants’ anxiety was not affected by either the alcohol cues or the offset heart rate biofeedback. Conclusions: Offset heart rate biofeedback has the potential to immediately and unobtrusively mitigate cue-elicit alcohol craving among risky drinkers. The results of this study opened new opportunities for digital and wearable interventions to mitigate alcohol craving, either as wellness apps for risky drinkers or as digital prescriptions and integration with sensing systems for people with alcohol dependency. %M 39740221 %R 10.2196/54438 %U https://formative.jmir.org/2024/1/e54438 %U https://doi.org/10.2196/54438 %U http://www.ncbi.nlm.nih.gov/pubmed/39740221 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62995 %T Supplemental Intervention for Alcohol Use Disorder Treatment Patients With a Co-Occurring Anxiety Disorder: Technical Development and Functional Testing of an Autonomous Digital Program %A Rinehart,Linda Marie %A Anker,Justin %A Unruh,Amanda %A Degeneffe,Nikki %A Thuras,Paul %A Norden,Amie %A Hartnett,Lilly %A Kushner,Matt %K alcohol use disorder %K anxiety disorder %K comorbidity %K digital intervention %K psychological treatments %K addiction %K community-based practice %K therapy %K stress %K depression %K therapist-delivered therapies %D 2024 %7 31.12.2024 %9 %J JMIR Form Res %G English %X Background: Anxiety disorders are common in alcohol use disorder (AUD) treatment patients. Such co-occurring conditions (“comorbidity”) have negative prognostic implications for AUD treatment outcomes, yet they commonly go unaddressed in standard AUD care. Over a decade ago, we developed and validated a cognitive behavioral therapy intervention to supplement standard AUD care that, when delivered by trained therapists, improves outcomes in comorbid patients. However, this validated intervention, like many others in addiction care, has not been taken up in community-based AUD treatment programs. This phenomenon—empirically validated treatments that fail to be widely adopted in community care—has been termed the “research-to-practice gap.” Researchers have suggested that the availability of fully autonomous digital equivalents of validated therapist-delivered therapies could reduce some barriers underlying the research-to-practice gap, especially by eliminating the need for costly and intensive therapist training and supervision. Objective: With this in mind, we obtained a Program Development Grant (R34) to conduct formative work in the development of a fully autonomous digital version of our previously validated therapist-delivered intervention for AUD treatment patients with a comorbid anxiety disorder. Methods: In the first phase of the project, we developed the digital intervention. This process included: (1) identifying appropriate collaborators and vendors; (2) consultation with an e-learning expert to develop a storyboard and accompanying graphics and narrative; (3) video production and editing; and (4) interactive programming. The second phase of the project was functional testing of the newly developed digital intervention conducted in 52 residential AUD treatment patients with a comorbid anxiety disorder. Patients underwent the 3 one-hour segments of the newly developed intervention and completed user surveys, knowledge quizzes, and behavioral competence tests. Results: While the development of the digital intervention was successful, the timeline was approximately double that projected (1 vs 2 years) due to false starts and inefficiencies that we describe, including lessons learned. Functional testing of the newly developed digital intervention showed that, on average, patients rated the user experience in the upper (favorable) 20% of the response scales. Knowledge quizzes and behavioral demonstrations showed that over 80% of participants gained functional mastery of the key skills and information taught in the program. Conclusions: Functional testing results in this study justify a randomized controlled trial of the digital intervention’s efficacy, which is currently ongoing. In sharing the details of our challenges and solutions in developing the digital intervention, we hope to inform others developing digital tools. The extent to which the availability of empirically validated, fully autonomous digital interventions achieves their potential to reduce the research-to-practice gap remains an open but important empirical question. The present work stands as a necessary first step toward that end. %R 10.2196/62995 %U https://formative.jmir.org/2024/1/e62995 %U https://doi.org/10.2196/62995 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63399 %T Examining Caregiver Practices During Adolescent Outpatient Alcohol Use and Co-Occurring Mental Health Treatment: Protocol for a Dyadic Ecological Momentary Assessment Study %A Meisel,Samuel N %A Hogue,Aaron %A Kelly,John F %A McQuaid,Elizabeth %A Miranda Jr,Robert %+ Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA, 02215, United States, 1 6173539610, smeisel@bu.edu %K adolescent %K caregiver %K ecological momentary assessment %K alcohol %K co-occurring disorders treatment %K treatment %K older adult %K aging %K alcohol use %K mental health %K assessment %K protocol %K alcohol use disorder %K drinking %K substance use %K data collection %D 2024 %7 20.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Caregiver-involved treatments for adolescents with alcohol use disorder and co-occurring disorders (AUD+CODs) are associated with the best treatment outcomes. Understanding what caregiving practices during treatment improve core adolescent treatment targets may facilitate the refinement and scalability of caregiver-involved interventions. Caregiving is dynamic, varying by context, affect, and adolescent behavior. Caregiver-involved treatments seek to change momentary interactions between caregivers and their adolescents. Accordingly, this protocol outlines a dyadic ecological momentary assessment (EMA) study to examine caregiving practices during AUD+CODs treatment and their associations with adolescent core treatment targets (eg, alcohol craving and use, motivation to reduce or stop drinking, and internalizing and externalizing symptoms). Objective: This paper aims to describe the methods for examining momentary caregiving practices and adolescent core treatment targets during adolescent outpatient AUD+CODs treatment. Methods: We will recruit 75 caregiver-adolescent dyads from outpatient mental health clinics providing AUD+CODs treatment. Eligible families will have an adolescent who (1) is aged between 13 and 18 years; (2) meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for AUD; (3) is enrolled in outpatient treatment at the time of recruitment; and (4) has a legal guardian willing to participate in the study. Caregivers and adolescents will complete an eligibility screening, followed by a baseline assessment during or as close as possible to the second week of treatment. During the baseline assessment, caregivers and adolescents will receive formal training in EMA procedures. Next, caregivers and adolescents will complete a 15-week EMA burst design consisting of three 21-day EMA periods with 3-week breaks between periods. Throughout the study, participants will also complete weekly reports regarding the skills learned or practiced during therapy. The three overarching aims to the proposed study are as follows: (1) examine momentary caregiving practices (eg, support, monitoring, substance use communication quality) and their associations with core treatment targets, (2) examine how these associations change throughout treatment, and (3) examine whether a caregiver report of learning or practicing parenting- or family-focused behaviors in treatment sessions is associated with changes in the use of caregiving practices in daily life. Results: The proposed study was informed by a pilot study assessing the feasibility and acceptability of dyadic EMA during adolescent AUD+COD treatment. Some benchmarks were met during this study (eg, ≥80% caregiver retention rate), although most benchmarks were not (eg, adolescent [772/1622, 47.6%] and caregiver [1331/1881, 70.76%] random prompt compliance was below the ≥80% target). Data collection is anticipated to begin in December of 2024. The proposed study is designed to be completed over 3 years. Conclusions: Examining momentary caregiving practices using EMA has important implications for refining and scaling caregiver-involved interventions for AUD+CODs so that families who would benefit from caregiver-involved treatments can have access to them. International Registered Report Identifier (IRRID): PRR1-10.2196/63399 %M 39705699 %R 10.2196/63399 %U https://www.researchprotocols.org/2024/1/e63399 %U https://doi.org/10.2196/63399 %U http://www.ncbi.nlm.nih.gov/pubmed/39705699 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57403 %T Assessing the Feasibility and Acceptability of the Daybreak Drink Tracker: Prospective Observational Study %A Fletcher,Kathryn %A Robert-Hendren,Dominique %K app %K alcohol use %K self-monitoring %K tracker %K digital health %D 2024 %7 18.12.2024 %9 %J JMIR Form Res %G English %X Background: Excessive alcohol use is associated with significant harms, with wide-ranging social and economic impacts. Efforts to prevent and reduce the harmful use of alcohol are a public health priority. Smartphone apps have the potential to provide accessible and cost-effective support to those seeking to reduce alcohol consumption; however, the evidence base regarding which components are effective is lacking. Self-monitoring is considered as one of the most effective components for behavior change across multiple health domains, yet there is mixed evidence for its role in the alcohol use space. An improved understanding of the use, acceptability, and outcomes of smartphone apps and their inherent components is required to determine their potential role in alcohol behavior change. Objective: We investigated the feasibility and acceptability of the Drink Tracker, a novel feature of the commercially available Daybreak (Hello Sunday Morning) app. Methods: The Daybreak app is accessible worldwide via major app stores and is offered free of charge to Australian residents. Individuals (aged over 18 years) registering for Daybreak were invited to access the Drink Tracker to monitor their alcohol consumption as part of an uncontrolled observational prospective study. Feasibility was assessed via uptake and frequency of use of the Drink Tracker. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the Drink Tracker to others. Self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) and psychological distress (Kessler Psychological Distress Scale score) at 3-month follow-up were also measured. Preliminary data collected for the first 4 months (October 2023 to February 2024) of the study were reported, including 3-month follow-up outcomes. Results: Feasibility was demonstrated, with almost 70% (2847/4119) of those registering for Daybreak going on to access the Drink Tracker. Of those accessing the Drink Tracker, 71.1% (n=2024) consented to research, comprising the final participant sample. Frequency of use was high, with over half of participants (1112/2024, 54.9%) using the Drink Tracker more than once, and more than one-third (757/2024, 37.4%) using the Drink Tracker more than 5 times. Of the 30 participants completing a 3-month follow-up, acceptability was high, with 73% (n=22) reporting high satisfaction levels with the Drink Tracker overall, 87% (n=26) indicating it was easy to use and rating a mean score of 7.7 (SD 2.8) out of 10 in terms of likelihood of recommending to others. Significant reductions in alcohol consumption (P<.001) and psychological distress scores (P<.001) were observed at the 3-month follow-up. Conclusions: Our results suggest that the Daybreak Drink Tracker is highly feasible and acceptable in supporting individuals accessing commercially available smartphone apps to change their relationship with alcohol. While positive clinical outcomes were observed, the absence of a control group disallows any conclusions with regard to the efficacy of the Drink Tracker. Further testing via a randomized controlled trial is required. %R 10.2196/57403 %U https://formative.jmir.org/2024/1/e57403 %U https://doi.org/10.2196/57403 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53401 %T An Ecological Momentary Assessment Approach of Environmental Triggers in the Role of Daily Affect, Rumination, and Movement Patterns in Early Alcohol Use Among Healthy Adolescents: Exploratory Study %A Prignitz,Maren %A Guldner,Stella %A Lehmler,Stephan Johann %A Aggensteiner,Pascal-M %A Nees,Frauke %A , %+ Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, Mannheim, 68159, Germany, 49 62117036313, maren.prignitz@zi-mannheim.de %K alcohol use %K adolescence %K affect %K rumination %K ecological momentary assessment %K geospatial measures %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescence is a period characterized by an increased susceptibility to developing risky alcohol consumption habits. This susceptibility can be influenced by social and situational factors encountered in daily life, which, in conjunction with emotions and thoughts, contribute to behavioral patterns related to alcohol use even in the early stages of alcohol experimentation, when initial experiences with alcohol are formed, and regular consumption is still evolving. Objective: This study aimed to examine the association between detailed behavioral and movement patterns, along with emotional and cognitive factors, and the early onset of alcohol use in the everyday lives of adolescents. Methods: A total of 65 healthy adolescents (33 male, twenty-nine 14-year-olds, and thirty-six 16-year-olds) underwent mobile-based ecological momentary assessments on alcohol (once a day at 9 AM, assessing alcohol use the day before), positive and negative affect, craving, rumination, and social context (6 prompts/day at 9 AM, 11 AM, 2 PM, 4 PM, 6 PM and 8 PM), type of day (weekdays or weekends, with weekend including Fridays, Saturdays, and Sundays), and using geospatial measures (specifically roaming entropy and number and type of trigger points for alcohol use met) over 14 days. After adjusting for a compliance rate of at least 50%, 52 participants (26 male and twenty-four 14-year-olds) were included in the analyses. Results: Generalized linear multilevel models revealed that higher positive affect (b=0.685, P=.007), higher rumination (b=0.586, P=.02), and a larger movement radius (roaming entropy) (b=8.126, P=.02) were positively associated with alcohol use on the same day. However, social context (b=–0.076, P=.90), negative affect (b=–0.077, P=.80), or potential trigger points (all P>.05) did not show significant associations. Alcohol use varied depending on the type of day, with more alcohol use on weekends (b=1.082, P<.001) and age (t50=–2.910, P=.005), with 16-year-olds (mean 1.61, SD 1.66) reporting more days of alcohol consumption than 14-year-olds (mean 0.548, SD 0.72). Conclusions: Our findings support previously identified factors as significant contributors to very early and low levels of alcohol consumption through fine-grained analysis of daily behaviors. These factors include positive affect, rumination, weekend days, and age. In addition, we emphasize that exploratory environmental movement behavior (roaming entropy) is also significantly associated with adolescent alcohol use, highlighting its importance as an additional factor. %M 39657181 %R 10.2196/53401 %U https://mhealth.jmir.org/2024/1/e53401 %U https://doi.org/10.2196/53401 %U http://www.ncbi.nlm.nih.gov/pubmed/39657181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51870 %T Concurrent Mentions of Vaping and Alcohol on Twitter: Latent Dirichlet Analysis %A Ranker,Lynsie R %A Tofu,David Assefa %A Lu,Manyuan %A Wu,Jiaxi %A Bhatnagar,Aruni %A Robertson,Rose Marie %A Wijaya,Derry %A Hong,Traci %A Fetterman,Jessica L %A Xuan,Ziming %+ Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th Floor, Boston, MA, 02215, United States, 1 617 358 2310, lranker@bu.edu %K e-cigarettes %K alcohol %K social media %K vape %K tweet %K vaping %K alcohol use %K co-use %K substance use disorder %K social networking site %K insight %K regulation %K youth %K vaping policy %D 2024 %7 12.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use. Objective: The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic. Methods: Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described. Results: Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre– and post–regulatory change and pre– and post–COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time. Conclusions: Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances—particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility. %M 39531640 %R 10.2196/51870 %U https://www.jmir.org/2024/1/e51870 %U https://doi.org/10.2196/51870 %U http://www.ncbi.nlm.nih.gov/pubmed/39531640 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55555 %T Tobacco and Alcohol Content in Top Vietnamese YouTube Music Videos: Content Analysis %A Tran,Thi Phuong Thao %A Vu,Thu Trang %A Li,Yachao %A Popova,Lucy %+ School of Public Health, Georgia State University, 140 Decatur St. SE, Atlanta, GA, 30303, United States, 1 4709626086, ttran217@gsu.edu %K risk %K risk factor %K tobacco content %K alcohol content %K tobacco %K alcohol %K tobacco portrayal %K alcohol portrayal %K music video %K Vietnam %K Vietnamese %K YouTube %K social media %K socials %K youth %K adolescent %K teen %K teenager %K young adult %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeing portrayals of tobacco and alcohol in music videos (MVs) may reduce perceived risks, increase susceptibility, and lead to the initiation of tobacco and alcohol use among adolescents and young adults. Previous studies have predominantly concentrated on assessing tobacco and alcohol contents in English-language MVs within Western countries. However, many other countries have not only been influenced by the English music market but have also produced music in their native languages, and this content remains underexamined. Objective: This study aims to investigate the prevalence of tobacco- and alcohol-related content in top Vietnamese MVs on YouTube from 2013 to 2021, to describe how tobacco and alcohol are portrayed in these MVs, and to examine associations between these portrayals and MV characteristics. Methods: A total of 410 Vietnamese MVs, including the top 40 or 50 most viewed released each year between 2013 and 2021, were analyzed. General information, such as the song name, its release date and ranking, age restriction, musical genre, and type of MV, was collected. We examined tobacco and alcohol content in the MVs, with specific details such as tobacco types, their brands, as well as the number, age, sex, and roles of individuals smoking or drinking. Results: Among the 410 MVs, 36 (8.8%) contained tobacco-related content and 136 (33.2%) featured alcohol-related content. Additionally, 28 (6.8%) out of 410 MVs included both tobacco and alcohol content. The prevalence of videos with tobacco and alcohol content fluctuated over the years. In MVs with tobacco-related content, a higher proportion of hip-hop or rap songs contained tobacco-related content (n=6, 30%) compared to other music genres. In MVs with tobacco-related content, cigarettes were the most frequently shown product (n=28, 77.8%), and smoking scenes were often depicted at parties (n=13, 36.1%) and during dancing and singing scenes (n=12, 33.3%). Among the 31 MVs portraying actual tobacco use, tobacco use was typically depicted with 1 person, often a young adult male, while 38.7% (n=12) showed singer(s) smoking. For MVs with alcohol-related content, there was a high proportion showing alcohol images at parties, bars, or pubs (n=96, 70.6%). Among 87 MVs containing drinking scenes, 60.9% (n=53) involved groups of young adults of both sexes, and 64% (n=56) depicted singers drinking. Additionally, only 2 (5.6%) MVs included health warnings about tobacco harm, and 2 MVs (1.5%) included warnings about drinking restricted to individuals 18 years and above. Conclusions: The notable prevalence of tobacco and alcohol content in leading Vietnamese YouTube MVs raises concerns, especially as most of this content is portrayed without any warnings. The study underscores a regulatory gap in addressing such content on the internet, emphasizing the urgent need for stricter regulations and age restrictions on platforms such as YouTube. %M 39514854 %R 10.2196/55555 %U https://www.jmir.org/2024/1/e55555 %U https://doi.org/10.2196/55555 %U http://www.ncbi.nlm.nih.gov/pubmed/39514854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58622 %T Couple-Focused Smartphone Intervention to Reduce Problem Drinking: Pilot Randomized Control Trial %A Gustafson Sr,David H %A Gustafson Jr,David H %A Mares,Marie-Louise %A Johnston,Darcie C %A Vjorn,Olivia J %A Curtin,John J %A Epstein,Elizabeth E %A Bailey,Genie L %+ Center for Health Enhancement Systems Studies, University of Wisconsin–Madison, Mechanical Engineering, Room 4127, 1513 University Ave, Madison, WI, 53706, United States, 1 608 890 2615, dcjohnston@wisc.edu %K alcohol use disorder %K AUD %K mHealth %K mobile health %K mobile phone %K smartphone %K couple therapy %K Comprehensive Health Enhancement Support System %K A-CHESS %K Alcohol Behavioral Couple Therapy %K ABCT %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder is among the most pervasive substance use disorders in the United States, with a lifetime prevalence of 30%. Recommended treatment options include evidence-based behavioral interventions; smartphone-based interventions confer a number of benefits such as portability, continuous access, and stigma avoidance; and research suggests that interventions involving couples may outperform those for patients only. In this context, a behavioral intervention delivered to couples through smartphones may serve as an effective adjunct to alcohol use disorder treatment. Objective: This pilot study aimed to (1) evaluate the feasibility of comparing a patient-only (Addiction version of the Comprehensive Health Enhancement Support System; A-CHESS) versus a couple-focused (Partner version of the Comprehensive Health Enhancement Support System; Partner-CHESS) eHealth app for alcohol misuse delivered by smartphone, (2) assess perceptions about and use of the 2 apps, and (3) examine initial indications of differences in primary clinical outcomes between patient groups using the 2 apps. Broadly, these aims serve to assess the feasibility of the study protocol for a larger randomized controlled trial. Methods: A total of 33 romantic couples were randomized to 6 months of A-CHESS app use (active treatment control) or Partner-CHESS app use (experimental). Couples comprised a patient with current alcohol use disorder (25/33, 76% male) and a romantic partner (26/33, 79% female). Patients and partners in both arms completed outcome measure surveys at 0, 2, 4, and 6 months. Primary outcomes were patients’ percentage of days with heavy drinking and percentage of days with any drinking, measured by timeline follow back. Secondary outcomes included app use and perceptions, and multiple psychosocial variables. Results: At 6 months, 78% (14/18) of Partner-CHESS patients and 73% (11/15) of A-CHESS patients were still using the intervention. The apps were rated helpful on a 5-point scale (1=not at all helpful, 5=extremely helpful) by 89% (29/33) of both Partner-CHESS patients (mean 3.7, SD 1) and partners (mean 3.6, SD 0.9) and by 87% (13/15) of A-CHESS patients (mean 3.1, SD 0.9). At 6 months, Partner-CHESS patients had a nonsignificantly lower percentage of days with heavy drinking compared with A-CHESS patients (β=–17.4, 95% CI –36.1 to 1.4; P=.07; Hedges g=–0.53), while the percentage of drinking days was relatively equal between patient groups (β=–2.1, 95% CI –24.8 to 20.7; P=.85; Hedges g=–0.12). Conclusions: Initial results support the feasibility of evaluating patient-only and couple-focused, smartphone-based interventions for alcohol misuse. Results suggest that both interventions are perceived as helpful and indicate maintained engagement of most participants for 6 months. A future, fully powered trial is warranted to evaluate the relative effectiveness of both interventions. Trial Registration: ClinicalTrials.gov NCT04059549; https://clinicaltrials.gov/ct2/show/NCT04059549 %M 39486022 %R 10.2196/58622 %U https://formative.jmir.org/2024/1/e58622 %U https://doi.org/10.2196/58622 %U http://www.ncbi.nlm.nih.gov/pubmed/39486022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60370 %T Interest in the Use of Herbal Supplements to Close the Treatment Gap for Hazardous Alcohol Use Among Men Who Have Sex With Men: Secondary Analysis of a Cross-Sectional Study %A Hernandez,Christopher %A Rowe,Christopher %A Ikeda,Janet %A Arenander,Justine %A Santos,Glenn-Milo %+ David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States, 1 (310) 825 6373, chrishernandezb@berkeley.edu %K alcohol use disorder %K herbal supplements %K HIV %K herbal %K supplement %K alcohol %K alcoholic %K alcohol use %K alcohol consumption %K cross-sectional study %K California %K USA: binge drinking %K alcohol dependence %K men %K social %K clinical %K logistic regression %K drinking %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hazardous alcohol consumption is highly prevalent for men who have sex with men (MSM). The 4 treatments currently approved by the Food and Drug Administration for alcohol use are reaching an alarmingly low percentage of people who would benefit from a reduction in their alcohol use. There is increasing interest in alternative methods of treatment, such as herbal supplements, to address hazardous drinking. However, research on the acceptability of alternative pharmacotherapies among MSM remains limited. Objective: We examined the prevalence and correlates of expressing interest in using herbal supplements for alcohol treatment among MSM with hazardous alcohol consumption. Methods: We conducted a secondary data analysis from a cross-sectional study of MSM who use alcohol, conducted from March 2015 to July 2017 in San Francisco, California, to assess the overall prevalence of interest in using herbal supplements to help reduce alcohol consumption. Associations between expressing interest in herbal supplements and demographic, social, and clinical characteristics were examined using bivariate and multivariable logistic regression models. Results: One-third (66/200, 33%) of the participants expressed interest in an herbal supplement for reducing alcohol consumption. In the multivariable analyses, weekly binge drinking (adjusted odds ratio [aOR] 2.85, 95% CI 1.17-6.93), interest in abstaining from alcohol use (aOR 5.04, 95% CI 1.46-17.40), higher severity of alcohol dependence score (aOR 1.22, 95% CI 1.04-1.41), and interest in naltrexone (aOR 3.22, 95% CI 2.12-4.91) were independently associated with higher odds of being interested in using an herbal supplement to reduce alcohol consumption, adjusting for age, race or ethnicity, and education. Conclusions: We found that MSM who have hazardous drinking habits, more severe alcohol dependence, and interest in pharmacotherapy were more likely to express interest in using an herbal supplement for reducing alcohol consumption. To our knowledge, this is the first study that has evaluated correlates of interest in herbal supplements for alcohol use among MSM. As researchers implement novel alcohol treatment studies, they should focus on recruitment efforts among MSM with a motivation to reduce their alcohol use patterns. %M 39471379 %R 10.2196/60370 %U https://formative.jmir.org/2024/1/e60370 %U https://doi.org/10.2196/60370 %U http://www.ncbi.nlm.nih.gov/pubmed/39471379 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50131 %T Optimizing the Measurement of Information on the Context of Alcohol Consumption Within the Drink Less App Among People Drinking at Increasing and Higher Risk Levels: Mixed-Methods Usability Study %A Stevely,Abigail K %A Garnett,Claire %A Holmes,John %A Jones,Andrew %A Dinu,Larisa %A Oldham,Melissa %+ Sheffield Addictions Research Group, School of Medicine and Population Health, University of Sheffield, 30 Regent St, Sheffield City Centre, Sheffield, S1 4DA, United Kingdom, 44 114 222 552, a.stevely@sheffield.ac.uk %K alcohol use disorder %K substance use disorder %K alcohol consumption %K mobile app %K mHealth %K mobile health %K diary %K health behavior change %K usability %K user engagement %D 2024 %7 24.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing public health evidence base focused on understanding the links between drinking contexts and alcohol consumption. However, the potential value of developing context-based interventions to help people drinking at increasing and higher risk levels to cut down remains underexplored. Digital interventions, such as apps, offer significant potential for delivering context-based interventions as they can collect contextual information and flexibly deliver personalized interventions while addressing barriers associated with face-to-face interventions, such as time constraints. Objective: This early phase study aimed to identify the best method for collecting information on the contexts of alcohol consumption among users of an alcohol reduction app by comparing 2 alternative drinking diaries in terms of user engagement, data quality, usability, and acceptability. Methods: Participants were recruited using the online platform Prolific and were randomly assigned to use 1 of the 2 adapted versions of the Drink Less app for 14 days. Tags (n=31) included tags for location, motivation, and company that participants added to drink records. Occasion type (n=31) included a list of occasion types that participants selected from when adding drink records. We assessed engagement and data quality with app data, usability with a validated questionnaire, and acceptability with semistructured interviews. Results: Quantitative findings on engagement, data quality, and app usability were good overall, with participants using the app on most days (tags: mean 12.23, SD 2.46 days; occasion type: mean 12.39, SD 2.12 days). However, around 40% of drinking records in tags did not include company and motivation tags. Mean usability scores were similar across app versions (tags: mean 72.39, SD 8.10; occasion type: mean 74.23, SD 6.76). Qualitative analysis found that both versions were acceptable to users and were relevant to their drinking occasions, and participants reported increased awareness of their drinking contexts. Several participants reported that the diary helped them to reduce alcohol consumption in some contexts (eg, home or lone drinking) more than others (eg, social drinking) and suggested that they felt less negative affect recording social drinking contexts out of their home. Participants also suggested the inclusion of “work drinks” in both versions and “habit” as a motivation in the tags version. Conclusions: There was no clearly better method for collecting data on alcohol consumption as both methods had good user engagement, usability, acceptability, and data quality. Participants recorded sufficient data on their drinking contexts to suggest that an adapted version of Drink Less could be used as the basis for context-specific interventions. The occasion type version may be preferable owing to lower participant burden. A more general consideration is to ensure that context-specific interventions are designed to minimize the risk of unintended positive reinforcement of drinking occasions that are seen as sociable by users. %M 39446464 %R 10.2196/50131 %U https://formative.jmir.org/2024/1/e50131 %U https://doi.org/10.2196/50131 %U http://www.ncbi.nlm.nih.gov/pubmed/39446464 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47083 %T Patient Perspectives on Blended Internet-Based and Face-to-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study %A Tarp,Kristine %A Christiansen,Regina %A Bilberg,Randi %A Borkner,Simone %A Dalsgaard,Caroline %A Paldam Folker,Marie %A Søgaard Nielsen,Anette %+ Psychiatric University Hospital, University Function, Region of Southern Denmark, J.B. Winsløws Vej 18, Odense, 5000, Denmark, 45 6550 7221, reginachristiansen@health.sdu.dk %K internet-based %K alcohol use disorder treatment %K user perspective %K qualitative %K blended treatment %K blended learning %K cognitive behavioral therapy %K alcoholism %K alcohol use disorder %K treatment %K barriers %K patient perspectives %K rehabilitation %D 2024 %7 23.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Harmful alcohol consumption has been identified as a major contributor to disease, mortality, and social harm, accounting for 5.3% of worldwide deaths annually. In Denmark, an estimated 150,000 people suffer from alcohol use disorder (AUD), but a low proportion seek treatment due to person- and treatment-related barriers. Internet-based cognitive behavioral therapy (iCBT) has shown positive effects on the treatment gap, with patients reporting benefits such as increased knowledge and flexibility. However, there is a lack of research on blended cognitive behavioral therapy (bCBT), which combines face-to-face CBT (FtF CBT) and iCBT for AUD. Objective: This study aims to investigate user experiences of bCBT. More specifically, it seeks to explore the advantages and disadvantages that users have experienced with bCBT for AUD, as well as their motivations for choosing this treatment format. Methods: A total of 30 patients who had participated in the Blend-A (Blending Internet Treatment into Conventional Face-to-Face Treatment for AUD) study and received the intervention were contacted and offered the opportunity to participate in semistructured individual telephone interviews. Of these, 12 patients consented to participate. Furthermore, an additional participant was approached at a municipal clinic and agreed to engage in an individual FtF interview. Thus, the final sample consisted of 13 patients. The interviews explored their background, experiences with digital technology, motivations for choosing internet-based treatment, and experiences with the program during AUD treatment. The interviews were audio-recorded and transcribed in full length and analyzed using thematic analysis. All data were anonymized and securely stored. Results: We found that users experienced several advantages of iCBT over a larger part of the treatment course, including increased anonymity and privacy. Most importantly, it offered flexibility, allowing patients to focus on their rehabilitation process at their own pace. Patients appreciated the availability of written text in the online program, finding it helpful for gaining knowledge and understanding of AUD and its impact on the individual with the condition. They emphasized how the assignments helped them fully engage in treatment by first acknowledging their problem with alcohol and then dedicating time to self-reflection before FtF sessions, allowing for more in-depth discussions with the therapist. They also appreciated the reminders, which motivated them to complete their assignments. Conclusions: Overall, patients perceived more benefits than disadvantages in using bCBT. Essentially, bCBT offers a form of assisted autonomy that cannot be fully achieved through iCBT or FtF CBT alone. It is only through their combination that patients can fully appreciate the benefits of the treatment, as they have time for self-reflection, with guidance from the therapist between FtF CBT sessions. Trial Registration: ClinicalTrials.gov NCT04535258; https://clinicaltrials.gov/ct2/show/NCT04535258 %M 39441642 %R 10.2196/47083 %U https://www.jmir.org/2024/1/e47083 %U https://doi.org/10.2196/47083 %U http://www.ncbi.nlm.nih.gov/pubmed/39441642 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58685 %T Examining the Impact of Simultaneous Alcohol and Cannabis Use on Alcohol Consumption and Consequences: Protocol for an Observational Ambulatory Assessment Study in Young Adults %A Gunn,Rachel L %A Metrik,Jane %A Barnett,Nancy P %A Jackson,Kristina M %A Lipperman-Kreda,Sharon %A Miranda Jr,Robert %A Trull,Timothy J %A Fernandez,Mary Ellen %+ Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, 121 S Main St, Providence, RI, United States, 1 401 863 6630, rachel_gunn@brown.edu %K ecological momentary assessment %K alcohol %K cannabis %K consequences %K transdermal alcohol biosensors %K ambulatory assessment %K mobile phone %D 2024 %7 25.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is significant conflicting evidence as to how using cannabis while drinking alcohol (ie, simultaneous alcohol and cannabis use) impacts alcohol volume consumed, patterns of drinking, and alcohol-related consequences. The impact of simultaneous use on drinking outcomes may be influenced by several within-person (eg, contextual) and between-person (individual) factors. Objective: This study was designed to examine naturalistic patterns of alcohol and cannabis use to understand how simultaneous use may impact drinking outcomes. The primary aims were to understand the following: (1) if simultaneous use is associated with increased alcohol consumption and riskier patterns of drinking, (2) if simultaneous use leads to increased alcohol consequences, and (3) how contextual circumstances moderate the impact of simultaneous use on consumption and consequences. Methods: Data collection involves a 28-day ambulatory assessment protocol in which a sample of non–treatment-seeking young adults who report simultaneous use of alcohol and cannabis complete ecological momentary assessments (random, event-contingent, and time-contingent surveys) of alcohol and cannabis use, contexts, motives, and consequences on their personal smartphones while continuously wearing an alcohol biosensor bracelet. Participants also complete a baseline assessment, brief internet-based check-in on day 14, and a final session on day 28. Community-based recruitment strategies (eg, social media and flyers) were used to enroll 95 participants to obtain a target sample of 80, accounting for attrition. Results: Recruitment and data collection began in May 2021 and continued through June 2024. Initial results for primary aims are expected in October 2024. As of March 2024, the project had recruited 118 eligible participants, of whom 94 (79.7%) completed the study, exceeding initial projections for the study time frame. Remaining recruitment will provide the capacity to probe cross-level interactions that were not initially statistically powered. Strengths of the project include rigorous data collection, good retention and compliance rates, faster-than-expected enrollment procedures, use of a novel alcohol biosensor, and successful adaptation of recruitment and data collection procedures during the COVID-19 pandemic. Conclusions: This is the first investigation to assess the key momentary predictors and outcomes of simultaneous use as well as self-reported and objective (via alcohol biosensor) measures of alcohol consumption and patterns. The results of this study will inform prevention efforts and studies of individuals who use cannabis who are engaged in alcohol treatment. International Registered Report Identifier (IRRID): DERR1-10.2196/58685 %M 39321460 %R 10.2196/58685 %U https://www.researchprotocols.org/2024/1/e58685 %U https://doi.org/10.2196/58685 %U http://www.ncbi.nlm.nih.gov/pubmed/39321460 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54005 %T Assessment of a Pilot Program for Remote Support on Mental Health for Young Physicians in Rural Settings in Peru: Mixed Methods Study %A De la Cruz-Torralva,Kelly %A Escobar-Agreda,Stefan %A Riega López,Pedro %A Amaro,James %A Reategui-Rivera,C Mahony %A Rojas-Mezarina,Leonardo %+ Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av Grau 755, Cercado de Lima, 15001, Peru, 51 619 7000 ext 4650, priegal@unmsm.edu.pe %K telemedicine %K screening %K treatment %K mental health %K suicide %K depression %K anxiety %K alcoholism %K physicians %K rural areas %K Peru %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited. Objective: This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health. Methods: A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided. Results: Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website. Conclusions: The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants. %M 39255480 %R 10.2196/54005 %U https://formative.jmir.org/2024/1/e54005 %U https://doi.org/10.2196/54005 %U http://www.ncbi.nlm.nih.gov/pubmed/39255480 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e60052 %T Ecological Momentary Assessment of Alcohol Marketing Exposure, Alcohol Use, and Purchases Among University Students: Prospective Cohort Study %A Zhang,Min Jin %A Luk,Tzu Tsun %A Ho,Sai Yin %A Wang,Man Ping %A Lam,Tai Hing %A Cheung,Yee Tak Derek %+ School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176652, derekcheung@hku.hk %K alcohol marketing %K drinking %K ecological momentary assessment %K health behaviors %K young adults %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The relationships between alcohol marketing exposure, alcohol use, and purchase have been widely studied. However, prospective studies examining the causal relationships in real-world settings using mobile health tools are limited. Objective: We used ecological momentary assessment (EMA) to examine both the within-person– and between-person–level effects of alcohol marketing exposure on any alcohol use, amount of alcohol use, any alcohol purchase, and frequency of alcohol purchase among university students. Methods: From January to June 2020, we conducted a prospective cohort study via EMA among university students in Hong Kong who reported current drinking. Over 14 consecutive days, each participant completed 5 fixed-interval, signal-contingent EMAs daily via a smartphone app. Each EMA asked about the number and types of alcohol marketing exposures, the amount and types of alcohol used, and whether any alcohol was purchased, all within the past 3 hours. We used 2-part models, including multilevel logistic regressions and multilevel gamma regressions, to examine if the number of alcohol marketing exposure was associated with subsequent alcohol use and alcohol purchase. Results: A total of 49 students participated, with 33% (16/49) being male. The mean age was 22.6 (SD 2.6) years. They completed 2360 EMAs (completion rate: 2360/3430, 68.8%). Participants reported exposure to alcohol marketing in 5.9% (140/2360), alcohol use in 6.1% (145/2360), and alcohol purchase in 2.4% (56/2360) of all the EMAs. At the between-person level, exposure to more alcohol marketing predicted a higher likelihood of alcohol use (adjusted odd ratio [AOR]=3.51, 95% CI 1.29-9.54) and a higher likelihood of alcohol purchase (AOR=4.59, 95% CI 1.46-14.49) the following day. Exposure to more alcohol marketing did not increase the amount of alcohol use or frequency of alcohol purchases the following day in participants who used or purchased alcohol. At the within-person level, exposure to more alcohol marketing was not associated with a higher likelihood of alcohol use, amount of alcohol use, higher likelihood of alcohol purchase, or frequency of alcohol purchases the following day (all Ps>.05). Each additional exposure to alcohol marketing within 1 week predicted an increase of 0.85 alcoholic drinks consumed in the following week (adjusted B=0.85, 95% CI 0.09-1.61). On days of reporting alcohol use, the 3 measures for alcohol marketing receptivity were not associated with more alcohol use or purchase (all Ps>.05). Conclusions: By using EMA, we provided the first evidence for the effect of alcohol marketing exposure on initiating alcohol use and purchase in current-drinking university students. Our findings provide evidence of the regulation of alcohol marketing for the reduction of alcohol use and purchase among young adults. %M 39226102 %R 10.2196/60052 %U https://mhealth.jmir.org/2024/1/e60052 %U https://doi.org/10.2196/60052 %U http://www.ncbi.nlm.nih.gov/pubmed/39226102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56119 %T Web-Based Coping Skills Training and Coach Support for Women Living With a Partner With an Alcohol Use Disorder: Randomized Controlled Trial %A Rychtarik,Robert G %A Danaher,Brian G %A McGillicuddy,Neil B %A Tyler,Milagra S %A Barrick,Christopher %A Leong,Florence %A Kosty,Derek B %+ Department of Psychiatry and Clinical and Research Institute on Addictions, University at Buffalo, The State University of New York, 1021 Main Street, Buffalo, NY, 14203, United States, 1 7168872591, rgr@buffalo.edu %K alcohol use disorder %K AUD %K spouses %K coping skills training %K eHealth %K coaching %K telehealth %K web-based %K women %K randomized controlled trial %K RCT %K mobile phone %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals living with a partner with an alcohol use disorder (AUD) can experience significant psychological distress and use health care more than those without a partner with an AUD. However, the prevailing treatment system’s focus on the partner and personal barriers limit these individuals from getting help for themselves. Preliminary work on a self-directed, web-based coping skills training program, Stop Spinning My Wheels (SSMW), shows promise in broadening available treatments for this population. In this study, we conducted a robust evaluation of SSMW primary outcomes. Objective: The study aims to test whether women with a partner with an AUD assigned to SSMW experienced a greater reduction in negative affect (depression and anger) (1) than a usual web care (UWC) control and (2) with brief phone coach support (SSMW+coach) rather than without (SSMW only) and (3) whether baseline negative affect moderated treatment effects. Methods: Women (mean age 45.7, SD 10.8 years; Black: 17/456, 3.7%; White: 408/456, 89.5%) were randomized to SSMW only, SSMW+coach, or UWC. Depression (Beck Depression Inventory–II) and anger (State-Trait Anger Expression Inventory 2–State Anger) were assessed at baseline, 12-week posttest, and 6- and 12-month follow-ups. Results: Participants in all conditions decreased in depression from baseline to posttest and from baseline to follow-up; SSMW-only and SSMW+coach participants decreased in anger, but UWC participants did not. Compared to UWC participants, SSMW-only participants experienced greater anger reduction (P=.03), and SSMW+coach participants experienced a greater reduction in depression (P<.001) from baseline to posttest. However, from baseline to follow-up, only a greater, but not statistically significant (P=.052), reduction in anger occurred in SSMW+coach compared to UWC. Although the SSMW conditions did not differ from each other in negative affect outcomes (P=.06-.57), SSMW+coach had higher program engagement and satisfaction (all P<.004). Baseline negative affect did not moderate effects, although remission from baseline clinically relevant depressive symptoms (Beck Depression Inventory≥14) was higher in SSMW only (33/67, 49%; odds ratio 2.13, 95% CI 1.05-4.30; P=.03) and SSMW+coach (46/74, 62%; odds ratio 3.60, 95% CI 1.79-7.23; P<.001) than in UWC (21/67, 31%); remission rates did not differ between the SSMW conditions (P=.12). Conclusions: The results partially supported the hypotheses. The SSMW conditions had earlier effects than UWC, but positive change in UWC mitigated the hypothesized long-term SSMW-UWC differences. The results highlight the importance of incorporating active controls in web-based clinical trials. Although SSMW+coach showed benefits over SSMW only on engagement and satisfaction measures and in the number needed to treat (5.6 for SSMW only; 3.2 for SSMW+coach), the SSMW conditions were comparable and superior to UWC on depressive symptom remission levels. Overall, SSMW with or without a coach can reduce clinically meaningful distress and add to available treatment options for this large, underserved group. Trial Registration: ClinicalTrials.gov NCT02984241; https://www.clinicaltrials.gov/study/NCT02984241 %M 39208412 %R 10.2196/56119 %U https://www.jmir.org/2024/1/e56119 %U https://doi.org/10.2196/56119 %U http://www.ncbi.nlm.nih.gov/pubmed/39208412 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48339 %T Parental Patterns of Alcohol Consumption During the COVID-19 Pandemic: Scoping Review %A Ou,Christine %A Corby,Kathryn %A Booth,Kelsey %A Ou,Hui-Hui %+ Canadian Institute for Substance Use Research, School of Nursing, University of Victoria, HSD Building Room 402, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada, 1 250 721 7954, christineou@uvic.ca %K parent %K alcohol use %K COVID-19 %K scoping review %K parenting %K alcohol %K addict %K addiction %K substance use %K health behavior %K health behaviors %K scoping %K review methods %K review methodology %K drink %K drinking %K alcoholic %K alcoholism %D 2024 %7 26.8.2024 %9 Review %J Interact J Med Res %G English %X Background: The declaration of the COVID-19 pandemic led to public health restrictions that impacted the lives of people across the globe. Parents were particularly burdened with balancing multiple responsibilities, such as working from home while caring for and educating their children. Alcohol use among parents is an area that warrants further exploration. Objective: This study aimed to investigate patterns of parental alcohol consumption during the COVID-19 pandemic, focusing on relative changes in the frequency and quantity of alcohol use compared to prepandemic use, nonparent adult samples, or both. Methods: A scoping review informed by the methodology of Arksey and O’Malley explored patterns of parental alcohol consumption during the COVID-19 pandemic. Searches were conducted in CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms were created using the Joanna Briggs Institute framework of Population, Concept, and Context, with the population being parents and the concept being alcohol consumption during the COVID-19 pandemic. Results: The database search yielded 3568 articles, which were screened for eligibility. Of the 3568 articles, 40 (1.12%) met the inclusion criteria and were included in the scoping review. Findings indicated the following: (1) having children at home was a factor associated with parental patterns of alcohol use; (2) mixed findings regarding gender-related patterns of alcohol consumption; and (3) linkages between parental patterns of alcohol use and mental health symptoms of stress, depression, and anxiety. Conclusions: This scoping review revealed heterogeneous patterns in parental alcohol use across sociocultural contexts during the COVID-19 pandemic. Given the known harms of alcohol use, it is worthwhile for clinicians to assess parental drinking patterns and initiate conversations regarding moderation in alcohol use. %M 39186759 %R 10.2196/48339 %U https://www.i-jmr.org/2024/1/e48339 %U https://doi.org/10.2196/48339 %U http://www.ncbi.nlm.nih.gov/pubmed/39186759 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59993 %T Reducing Alcohol Misuse and Promoting Treatment Initiation Among Veterans Through a Brief Internet-Based Intervention: Protocol for a Randomized Controlled Trial %A Pedersen,Eric R %A Davis,Jordan P %A Hummer,Justin F %A Bouskill,Kathryn %A Buch,Keegan D %A Shute,Ireland M %A Fitzke,Reagan E %A Tran,Denise D %A Neighbors,Clayton %A Saba,Shaddy %+ Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Los Angeles, CA, 90089, United States, 1 3234424046, eric.pedersen@med.usc.edu %K military %K mental health %K substance use %K mobile %K PTSD %K posttraumatic stress disorder %K drinking %K mobile intervention %K digital intervention %K alcohol %K alcohol misuse %K veterans %K young adults %K depression %K alcohol use %K veteran health %K veteran %D 2024 %7 22.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adult veterans who served after the September 11 attacks on the United States in 2001 (ie, post-9/11) are at heightened risk for experiencing behavioral health distress and disorders including hazardous drinking, posttraumatic stress disorder, and depression. These veterans often face significant barriers to behavioral health treatment, and reaching them through brief mobile phone–based interventions may help reduce drinking and promote treatment engagement. Objective: Following a successful pilot study, this randomized controlled trial (RCT) aims to further test the efficacy of a brief (ie, single session) mobile phone–delivered personalized normative feedback intervention enhanced with content to promote treatment engagement. Methods: We will conduct an RCT with 800 post-9/11 young adult veterans (aged 18 to 40 years) with potentially hazardous drinking and who have not recently received treatment for any behavioral health problems. Participants will be randomly assigned to the personalized intervention or a control condition with resources for seeking care. The personalized normative feedback module in the intervention focuses on the correction of misperceived norms of peer alcohol use and uses empirically informed approaches to increase motivation to address alcohol use and co-occurring behavioral health problems. Past 30-day drinking, alcohol-related consequences, and treatment-seeking behaviors will be assessed at baseline and 3, 6, 9, and 12 months post intervention. Sex, barriers to care, posttraumatic stress disorder, depression, and severity of alcohol use disorder symptoms will be explored as potential moderators of outcomes. Results: We expect recruitment to be completed within 6 months, with data collection taking 12 months for each enrolled participant. Analyses will begin within 3 months of the final data collection point (ie, 12 months follow-up). Conclusions: This RCT will evaluate the efficacy of a novel intervention for non–treatment-seeking veterans who struggle with hazardous drinking and possible co-occurring behavioral health problems. This intervention has the potential to improve veteran health outcomes and overcome significant barriers to treatment. Trial Registration: ClinicalTrials.gov NCT04244461; https://clinicaltrials.gov/study/NCT04244461 International Registered Report Identifier (IRRID): DERR1-10.2196/59993 %M 39173142 %R 10.2196/59993 %U https://www.researchprotocols.org/2024/1/e59993 %U https://doi.org/10.2196/59993 %U http://www.ncbi.nlm.nih.gov/pubmed/39173142 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57653 %T Use of Transdermal Alcohol Sensors in Conjunction With Contingency Management to Reduce Alcohol Consumption in People With Alcohol Dependence Attending Alcohol Treatment Services: Protocol for a Pilot Feasibility Randomized Controlled Trial %A Brobbin,Eileen %A Deluca,Paolo %A Parkin,Stephen %A Drummond,Colin %+ Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, United Kingdom, 44 07758287265, eileen.brobbin@kcl.ac.uk %K accuracy %K addiction %K alcohol %K alcohol monitoring %K alcohol treatment %K contingency management %K transdermal alcohol sensors %K wearables %K mobile phone %K transdermal %K TAS %K wearable technology %K alcohol use disorders %K AUD %K RCT %K randomized controlled trial %K abstinence %K community-based %K residential rehabilitation %K consumption %K alcohol consumption %K low-risk consumption %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Wearable technology for objective, continuous, and reliable alcohol monitoring has been developed. These are known as transdermal alcohol sensors (TASs). They can be worn on the wrist or ankle with the sensor pressed against the skin and can measure sweat vapors being emitted from the skin, to record transdermal alcohol concentration (TAC). Previous studies have investigated the accuracy and acceptability of the available TAS brands, but there has been little research into their use in people with alcohol use disorders (AUD). Objective: This feasibility randomized controlled trial aims to explore the feasibility, strengths, and limitations of using a TAS to monitor alcohol consumption in individuals in treatment for AUD with or without contingency management (CM) to promote abstinence or low-level alcohol consumption. Methods: The target sample size is 30 (15 randomized to each group). Participants will be recruited through poster adverts at alcohol services. Both groups (control and CM) will wear the TAS (BACtrack Skyn) for 2 weeks in the context of their usual treatment, meeting with the researcher every other weekday. In the last meeting, the participants will complete a postwear survey on their experience of wearing the TAS. The CM group will also receive small financial incentives for low or no alcohol consumption, as measured by the TAS. On days where the TAC peak is below a set threshold (<115.660 g/L), CM group participants will be rewarded with a £5 (US $6.38) voucher. There are financial bonuses if this target is achieved on consecutive days. The researcher will monitor TAC for each day of the study at each research visit and allocate financial incentives to participants according to a set reinforcement schedule. Results: The first participant was enrolled in June 2023, and the last in December 2023. Data analysis is underway and is estimated to be completed by June 2024. A total of 32 participants were enrolled. Conclusions: Most TAS brands have had limited application in clinical settings, and most studies have included healthy adults rather than people with AUD. TAS has the potential to enhance treatment outcomes in clinical alcohol treatment. The accuracy, acceptability, and feasibility of TAS for people with AUD in clinical settings need to be investigated. This is the first study to use TAS in specialized alcohol services with diagnosed AUD individuals currently receiving treatment from a south London alcohol service. Trial Registration: ISRCTN Registry ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361 International Registered Report Identifier (IRRID): DERR1-10.2196/57653 %M 39083798 %R 10.2196/57653 %U https://www.researchprotocols.org/2024/1/e57653 %U https://doi.org/10.2196/57653 %U http://www.ncbi.nlm.nih.gov/pubmed/39083798 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49826 %T Impact of Alcohol-Induced Facial Flushing Phenotype on Alcohol Consumption Among Korean Adults: 2-Year Cross-Sectional Study %A Kang,Bossng %A Kim,Changsun %A Shin,Seon-Hi %A Shin,Hyungoo %A Cho,Yongil %+ Biostatistical Consulting and Research Lab, Medical Research Collaborating Center, Hanyang University, 222 Wangsimni-ro,, Seongdong-gu, Seoul, 04763, Republic of Korea, 82 31 560 2059, shinseonhi@gmail.com %K facial flushing %K alcohol consumption %K drinking behavior %K alcohol %K acetaldehyde %K aldehyde dehydrogenase 2 polymorphism %K East Asian %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The alcohol-induced facial flushing phenotype (flushing) is common among East Asians. Despite a small intake of alcohol, they experience heightened levels of acetaldehyde, a group-1 carcinogen, which, in turn, causes unpleasant symptoms such as redness, acting as a robust protective mechanism against consuming alcohol. However, some individuals with this genetic trait exhibit weakened alcohol restraint, which increases the risk of developing alcohol-related cancers, such as esophageal and head or neck cancer, by several times. Although this flushing phenomenon is crucial for public health, there is a paucity of studies that have comprehensively investigated the effect of flushing or its genotype on alcohol consumption in a large group of East Asians while controlling for various sociodemographic and health-related variables at a country level. Objective: This 2-year cross-sectional study aims to explore the effect of flushing on drinking behavior in Koreans and to examine whether the effect varies across sociodemographic and health-related factors. Methods: We used data from the Korea National Health and Nutrition Examination Survey (KNHANES) for 2019 and 2020 conducted by the Korea Disease Control and Prevention Agency. Our sample comprised 10,660 Korean adults. The study investigated the association of 26 variables, including flushing, with drinking frequency and amount. The effect of flushing was examined with and without adjusting for the other 25 variables using multinomial logistic regression analysis. In addition, we tested the interaction effect with flushing and conducted a simple effect analysis. We used complex sample design elements, including strata, clusters, and weights, to obtain unbiased results for the Rao-Scott χ2 test, 2-tailed t test, and multinomial logistic regression analysis. Results: The suppressive effect of flushing was significant (P<.001) across all pronounced categories of alcohol consumption in 2019. The ranges of standardized regression slopes and odds ratios (ORs) were –6.70≥β≥–11.25 and 0.78≥OR≥0.50 for frequency and –5.37≥β≥–17.64 and 0.73≥OR≥0.36 for amount, respectively. The effect became somewhat stronger when adjusted for confounders. The effect also exhibited an overall stronger trend as the severity of alcohol consumption increased. The β values and ORs were consistently smaller in 2020 compared to the previous year. A simple effect analysis revealed a diminished alcohol-suppressive effect of flushing on alcohol consumption for specific groups (eg, those with low levels of education, limited family support, physical labor, or health-related issues). Conclusions: Our findings suggest that flushing suppresses drinking in Koreans overall but has little or no effect in certain susceptible populations. Therefore, health authorities should conduct targeted epidemiological studies to assess drinking patterns and disease profiles, particularly regarding alcohol-related cancers, and establish effective preventive measures tailored to this population. %M 38796304 %R 10.2196/49826 %U https://publichealth.jmir.org/2024/1/e49826 %U https://doi.org/10.2196/49826 %U http://www.ncbi.nlm.nih.gov/pubmed/38796304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52101 %T Equivalence of Alcohol Use Disorder Symptom Assessments in Routine Clinical Care When Completed Remotely via Online Patient Portals Versus In Clinic via Paper Questionnaires: Psychometric Evaluation %A Matson,Theresa E %A Lee,Amy K %A Oliver,Malia %A Bradley,Katharine A %A Hallgren,Kevin A %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1360, Seattle, WA, 98101, United States, 1 2062872699, tessa.e.matson@kp.org %K alcohol %K alcohol use disorder %K assessment %K symptom checklist %K electronic health record %K patient portal %K item response theory %K differential item functioning %K alcohol use %K patient portals %K in-clinic %K psychometric evaluation %K alcoholism %K cross-sectional %K United States %D 2024 %7 22.7.2024 %9 Short Paper %J J Med Internet Res %G English %X Background: The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends the paper-based or computerized Alcohol Symptom Checklist to assess alcohol use disorder (AUD) symptoms in routine care when patients report high-risk drinking. However, it is unknown whether Alcohol Symptom Checklist response characteristics differ when it is administered online (eg, remotely via an online electronic health record [EHR] patient portal before an appointment) versus in clinic (eg, on paper after appointment check-in). Objective: This study evaluated the psychometric performance of the Alcohol Symptom Checklist when completed online versus in clinic during routine clinical care. Methods: This cross-sectional, psychometric study obtained EHR data from the Alcohol Symptom Checklist completed by adult patients from an integrated health system in Washington state. The sample included patients who had a primary care visit in 2021 at 1 of 32 primary care practices, were due for annual behavioral health screening, and reported high-risk drinking on the behavioral health screen (Alcohol Use Disorder Identification Test–Consumption score ≥7). After screening, patients with high-risk drinking were typically asked to complete the Alcohol Symptom Checklist—an 11-item questionnaire on which patients self-report whether they had experienced each of the 11 AUD criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) over a past-year timeframe. Patients could complete the Alcohol Symptom Checklist online (eg, on a computer, smartphone, or tablet from any location) or in clinic (eg, on paper as part of the rooming process at clinical appointments). We examined sample and measurement characteristics and conducted differential item functioning analyses using item response theory to examine measurement consistency across these 2 assessment modalities. Results: Among 3243 patients meeting eligibility criteria for this secondary analysis (2313/3243, 71% male; 2271/3243, 70% White; and 2014/3243, 62% non-Hispanic), 1640 (51%) completed the Alcohol Symptom Checklist online while 1603 (49%) completed it in clinic. Approximately 46% (752/1640) and 48% (764/1603) reported ≥2 AUD criteria (the threshold for AUD diagnosis) online and in clinic (P=.37), respectively. A small degree of differential item functioning was observed for 4 of 11 items. This differential item functioning produced only minimal impact on total scores used clinically to assess AUD severity, affecting total criteria count by a maximum of 0.13 criteria (on a scale ranging from 0 to 11). Conclusions: Completing the Alcohol Symptom Checklist online, typically prior to patient check-in, performed similarly to an in-clinic modality typically administered on paper by a medical assistant at the time of the appointment. Findings have implications for using online AUD symptom assessments to streamline workflows, reduce staff burden, reduce stigma, and potentially assess patients who do not receive in-person care. Whether modality of DSM-5 assessment of AUD differentially impacts treatment is unknown. %M 39038284 %R 10.2196/52101 %U https://www.jmir.org/2024/1/e52101 %U https://doi.org/10.2196/52101 %U http://www.ncbi.nlm.nih.gov/pubmed/39038284 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42319 %T Evaluating the Acceptability of the Drink Less App and the National Health Service Alcohol Advice Web Page: Qualitative Interview Process Evaluation %A Oldham,Melissa %A Dina,Larisa-Maria %A Loebenberg,Gemma %A Perski,Olga %A Brown,Jamie %A Angus,Colin %A Beard,Emma %A Burton,Robyn %A Field,Matt %A Greaves,Felix %A Hickman,Matthew %A Kaner,Eileen %A Michie,Susan %A Munafò,Marcus R %A Pizzo,Elena %A Garnett,Claire %+ Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 883, m.oldham@ucl.ac.uk %K alcohol reduction %K digital intervention %K acceptability %K mobile health %K mHealth %K mobile phone %D 2024 %7 18.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The extent to which interventions are perceived as acceptable to users impacts engagement and efficacy. Objective: In this study, we evaluated the acceptability of (1) the smartphone app Drink Less (intervention) and (2) the National Health Service (NHS) alcohol advice web page (usual digital care and comparator) among adult drinkers in the United Kingdom participating in a randomized controlled trial evaluating the effectiveness of the Drink Less app. Methods: A subsample of 26 increasing- and higher-risk drinkers (Alcohol Use Disorders Identification Test score≥8) assigned to the intervention group (Drink Less; n=14, 54%; female: n=10, 71%; age: 22-72 years; White: n=9, 64%) or usual digital care group (NHS alcohol advice web page; n=12, 46%; female: n=5, 42%; age: 23-68 years: White: n=9, 75%) took part in semistructured interviews. The interview questions were mapped on to the 7 facets of acceptability according to the Theoretical Framework of Acceptability: affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Alongside these constructs, we also included a question on perceived personal relevance, which previous research has linked to acceptability and engagement. Framework and thematic analysis of data was undertaken. Results: The Drink Less app was perceived as being ethical, easy, user-friendly, and effective for the period the app was used. Participants reported particularly liking the tracking and feedback sections of the app, which they reported increased personal relevance and which resulted in positive affect when achieving their goals. They reported no opportunity cost. Factors such as negative affect when not meeting goals and boredom led to disengagement in the longer term for some participants. The NHS alcohol advice web page was rated as being easy and user-friendly with no opportunity costs. However, the information presented was not perceived as being personally relevant or effective in changing drinking behavior. Most participants reported neutral or negative affect, most participants thought the alcohol advice web page was accessible, and some participants reported ethical concerns around the availability of suggested resources. Some participants reported that it had acted as a starting point or a signpost to other resources. Participants in both groups discussed motivation to change and contextual factors such as COVID-19 lockdowns, which influenced their perceived self-efficacy regardless of their assigned intervention. Conclusions: Drink Less appears to be an acceptable digital intervention among the recruited sample. The NHS alcohol advice web page was generally considered unacceptable as a stand-alone intervention among the recruited sample, although it may signpost and help people access other resources and interventions. %M 39024575 %R 10.2196/42319 %U https://www.jmir.org/2024/1/e42319 %U https://doi.org/10.2196/42319 %U http://www.ncbi.nlm.nih.gov/pubmed/39024575 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e51074 %T Technologies for Supporting Individuals and Caregivers Living With Fetal Alcohol Spectrum Disorder: Scoping Review %A Chu,Joanna Ting Wai %A Wilson,Holly %A Cai,Cynthia Zhiyin %A McCormack,Jessica C %A Newcombe,David %A Bullen,Chris %K fetal alcohol %K scoping review %K technology %K caregivers %K diagnosis %K support %K intervention %K fetal alcohol spectrum disorder %K FASD %K developmental disability %K lifelong support %K caregiver %K accessibility %K alcohol %K alcohol intake %K pregnant substance %K pregnant %K fetal %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses %K mobile phone %D 2024 %7 11.7.2024 %9 %J JMIR Ment Health %G English %X Background: Fetal alcohol spectrum disorder (FASD) is a common developmental disability that requires lifelong and ongoing support but is often difficult to find due to the lack of trained professionals, funding, and support available. Technology could provide cost-effective, accessible, and effective support to those living with FASD and their caregivers. Objective: In this review, we aimed to explore the use of technology available for supporting people living with FASD and their caregivers. Methods: We conducted a scoping review to identify studies that included technology for people with FASD or their caregivers; focused on FASD; used an empirical study design; were published since 2005; and used technology for assessment, diagnosis, monitoring, or support for people with FASD. We searched MEDLINE, Web of Science, Scopus, Embase, APA PsycINFO, ACM Digital Library, JMIR Publications journals, the Cochrane Library, EBSCOhost, IEEE, study references, and gray literature to find studies. Searches were conducted in November 2022 and updated in January 2024. Two reviewers (CZC and HW) independently completed study selection and data extraction. Results: In total, 17 studies exploring technology available for people with FASD showed that technology could be effective at teaching skills, supporting caregivers, and helping people with FASD develop skills. Conclusions: Technology could provide support for people affected by FASD; however, currently there is limited technology available, and the potential benefits are largely unexplored. Trial Registration: PROSPERO CRD42022364885; https://tinyurl.com/3zaatu9u %R 10.2196/51074 %U https://mental.jmir.org/2024/1/e51074 %U https://doi.org/10.2196/51074 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54587 %T Availability of Alcohol on an Online Third-Party Delivery Platform Across London Boroughs, England: Exploratory Cross-Sectional Study %A Sharpe,Casey %A Bhuptani,Saloni %A Jecks,Mike %A Sheron,Nick %A Henn,Clive %A Burton,Robyn %+ Institute for Social Marketing and Health, University of Stirling, Stirling, FK9 4LA, United Kingdom, 44 7595 417304, robyn.burton@stir.ac.uk %K alcohol %K availability %K online %K third-party delivery platforms %K England %K cross-sectional study %K exploratory %K licensing %K public health %K policy %D 2024 %7 28.6.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Higher availability of alcohol is associated with higher levels of alcohol consumption and harm. Alcohol is increasingly accessible online, with rapid delivery often offered by a third-party driver. Remote delivery and online availability are important from a public health perspective, but to date, relatively little research has explored the availability of alcohol offered by online platforms. Objective: This cross-sectional exploratory study describes the availability of alcohol on the third-party platform Deliveroo within London, England. Methods: We extracted the number of outlets offering alcohol on Deliveroo for each London borough and converted these into crude rates per 1000 population (18-64 years). Outlets were grouped as outlets exclusively selling alcohol, off-licenses, and premium. We calculated Pearson correlation coefficients to explore the association between borough’s crude rate of outlets per 1000 population and average Indices of Multiple Deprivation (IMD) 2019 scores. We extracted the number of outlets also selling tobacco or e-cigarettes and used non-Deliveroo drivers. We searched addresses of the top 20 outlets delivering to the most boroughs by outlet type (60 total) to determine their associated premise. Results: We identified 4277 total Deliveroo-based outlets offering alcohol across London, including outlets delivering in multiple boroughs. The crude rate of outlets per 1000 population aged 18-64 years was 0.73 and ranged from 0.22 to 2.29 per borough. Most outlets exclusively sold alcohol (3086/4277, 72.2%), followed by off-licenses (770/4277, 18.0%) and premium (421/4277, 9.8%). The majority of outlets exclusively selling alcohol sold tobacco or e-cigarettes (2951/3086, 95.6%) as did off-licenses to a lesser extent (588/770, 76.4%). Most outlets exclusively offering alcohol used drivers not employed by Deliveroo (2887/3086, 93.6%), and the inverse was true for premium outlets (50/421, 11.9%) and off-licenses (73/770, 9.5%). There were 1049 unique outlets, of which 396 (37.8%) were exclusively offering alcohol—these outlets tended to deliver across multiple boroughs unlike off-licenses and premium outlets. Of outlets with confirmed addresses, self-storage units were listed as the associated premise for 85% (17/20) of outlets exclusively offering alcohol, 11% (2/19) of off-licenses, and 12% (2/17) of premium outlets. We found no significant relationship between borough IMD scores and crude rate of outlets per 1000 population overall (P=.87) or by any outlet type: exclusively alcohol (P=.41), off-license (P=.58), and premium (P=.18). Conclusions: London-based Deliveroo outlets offering alcohol are common and are sometimes operating from self-storage units that have policies prohibiting alcohol storage. This and the potential for increased alcohol accessibility online have implications for public health given the relationship between alcohol’s availability and consumption or harm. There is a need to ensure that regulations for delivery are adequate for protecting children and vulnerable adults. The Licensing Act 2003 may require modernization in the digital age. Future research must explore a relationship between online alcohol availability and deprivation. %M 38941596 %R 10.2196/54587 %U https://formative.jmir.org/2024/1/e54587 %U https://doi.org/10.2196/54587 %U http://www.ncbi.nlm.nih.gov/pubmed/38941596 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e58056 %T Analyzing Questions About Alcohol in Pregnancy Using Web-Based Forum Topics: Qualitative Content Analysis %A Frennesson,Nessie Felicia %A Barnett,Julie %A Merouani,Youssouf %A Attwood,Angela %A Zuccolo,Luisa %A McQuire,Cheryl %+ Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 1173746633, felicia.frennesson@bristol.ac.uk %K social media %K web-based forum %K alcohol %K pregnancy %K prenatal health %K prenatal alcohol exposure %D 2024 %7 20.6.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Prenatal alcohol exposure represents a substantial public health concern as it may lead to detrimental outcomes, including pregnancy complications and fetal alcohol spectrum disorder. Although UK national guidance recommends abstaining from alcohol if pregnant or planning a pregnancy, evidence suggests that confusion remains on this topic among members of the public, and little is known about what questions people have about consumption of alcohol in pregnancy outside of health care settings. Objective: This study aims to assess what questions and topics are raised on alcohol in pregnancy on a web-based UK-based parenting forum and how these correspond to official public health guidelines with respect to 2 critical events: the implementation of the revised UK Chief Medical Officers’ (CMO) low-risk drinking guidelines (2016) and the first COVID-19 pandemic lockdown (2020). Methods: All thread starts mentioning alcohol in the “Pregnancy” forum were collected from Mumsnet for the period 2002 to 2022 and analyzed using qualitative content analysis. Descriptive statistics were used to characterize the number and proportion of thread starts for each topic over the whole study period and for the periods corresponding to the change in CMO guidance and the COVID-19 pandemic. Results: A total of 395 thread starts were analyzed, and key topics included “Asking for advice on whether it is safe to consume alcohol” or on “safe limits” and concerns about having consumed alcohol before being aware of a pregnancy. In addition, the Mumsnet thread starts included discussions and information seeking on “Research, guidelines, and official information about alcohol in pregnancy.” Topics discussed on Mumsnet regarding alcohol in pregnancy remained broadly similar between 2002 and 2022, although thread starts disclosing prenatal alcohol use were more common before the introduction of the revised CMO guidance than in later periods. Conclusions: Web-based discussions within a UK parenting forum indicated that users were often unclear on guidance and risks associated with prenatal alcohol use and that they used this platform to seek information and reassurance from peers. %M 38900536 %R 10.2196/58056 %U https://infodemiology.jmir.org/2024/1/e58056 %U https://doi.org/10.2196/58056 %U http://www.ncbi.nlm.nih.gov/pubmed/38900536 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50650 %T Detecting and Understanding Social Influence During Drinking Situations: Protocol for a Bluetooth-Based Sensor Feasibility and Acceptability Study %A Jackson,Kristina %A Meisel,Matthew %A Sokolovsky,Alexander %A Chen,Katie %A Barnett,Nancy %+ Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, Box G-S121-4, Providence, RI, 02912, United States, 1 (401) 863 6617, kristina_jackson@brown.edu %K Bluetooth technology %K passive sensing %K social influence %K alcohol use %K ecological momentary assessment %K social network %K feasibility %K acceptability %K mobile phone %D 2024 %7 6.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: High-risk alcohol consumption among young adults frequently occurs in the presence of peers who are also drinking. A high-risk drinking situation may consist of particular social network members who have a primary association with drinking. Fine-grained approaches such as ecological momentary assessment (EMA) are growing in popularity for studying real-time social influence, but studies using these approaches exclusively rely on participant self-report. Passive indicators of peer presence using Bluetooth-based technology to detect real-time interactions have the potential to assist in the development of just-in-time interventions. Objective: This study seeks to examine the feasibility and acceptability of using a Bluetooth-based sensor and smartphone app to measure social contact in real-world drinking situations. Methods: Young adults (N=20) who drink heavily and report social drinking will be recruited from the community to participate in a 3-week EMA study. Using a social network interview, index participants will identify and recruit 3 of their friends to carry a Bluetooth beacon. Participants will complete a series of EMA reports on their own personal Android devices including random reports; morning reports; first-drink reports; and signal-contingent reports, which are triggered following the detection of a beacon carried by a peer participant. EMA will assess alcohol use and characteristics of the social environment, including who is nearby and who is drinking. For items about peer proximity and peer drinking, a customized peer list will be presented to participants. Feedback about the study protocol will be ascertained through weekly contact with both index and peer participants, followed by a qualitative interview at the end of the study. We will examine the feasibility and acceptability of recruitment, enrollment of participants and peers, and retention. Feasibility will be determined using indexes of eligibility, enrollment, and recruitment. Acceptability will be determined through participant enrollment and retention, protocol compliance, and participant-reported measures of acceptability. Feasibility and acceptability for peer participants will be informed by enrollment rates, latency to enrollment, compliance with carrying the beacon, and self-reported reasons for compliance or noncompliance with beacon procedures. Finally, EMA data about peer proximity and peer drinking will support the validity of the peer selection process. Results: Participant recruitment began in February 2023, and enrollment was completed in December 2023. Results will be reported in 2025. Conclusions: The protocol allows us to examine the feasibility and acceptability of a Bluetooth-based sensor for the detection of social contact between index participants and their friends, including social interactions during real-world drinking situations. Data from this study will inform just-in-time adaptive interventions seeking to address drinking in the natural environment by providing personalized feedback about a high-risk social context and alerting an individual that they are in a potentially unsafe situation. International Registered Report Identifier (IRRID): DERR1-10.2196/50650 %M 38842927 %R 10.2196/50650 %U https://www.researchprotocols.org/2024/1/e50650 %U https://doi.org/10.2196/50650 %U http://www.ncbi.nlm.nih.gov/pubmed/38842927 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e56188 %T Factors Associated With Risky Drinking Decisions in a Virtual Reality Alcohol Prevention Simulation: Structural Equation Model %A Hrynyschyn,Robert %A Guldager,Julie Dalgaard %A Schulze,Daniel %A Lyk,Patricia Bianca %A Majgaard,Gunver %A Stock,Christiane %+ Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30450529030, robert.hrynyschyn@charite.de %K alcohol %K prevention %K virtual reality %K risk behavior %K structural equation model %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Risky alcohol consumption among adolescents is a significant public health concern in most Western countries. Various motives and factors (eg, sensation seeking, gender, reduced self-efficacy) known in the literature are associated with risky drinking decisions in real life. Efforts to tackle risky drinking decisions in real life through skills training to deal with social pressures have been successful. However, interventions of this nature require significant resources. Technological solutions, such as virtual reality (VR), offer advantages, as they enable immersive experiences that replicate real-life scenarios. However, a question persists pertaining to the fidelity of real-world behaviors within virtual environments. Objective: This study is exploratory and aims to ascertain if the established drinking motives and factors for risky drinking decisions are transferrable to the virtual environment in the simulation game VR FestLab and to uncover determinants linked to risky drinking decisions within the simulation. Methods: The study analyzed data from the intervention arm of a cluster-randomized study of 161 Danish students aged 14-18 years who tested the virtual alcohol prevention simulation VR FestLab. At baseline and before playing VR FestLab, independent variables such as age, gender, alcohol consumption, use of other drugs, sensation seeking, drinking refusal skills, knowledge of blood alcohol concentration, and refusal communication skills were recorded. The dependent variable, virtual risk decisions, was measured immediately after the gameplay. Confirmatory factor analysis and structural equation modeling were used to examine the latent variables in relation to virtual risk decisions. Moderation analyses for age and gender in relation to the latent characteristics and the primary outcome were also conducted. Results: The data indicate that 73.9% (119/161) of the participants engaged in binge drinking at least once in their lifetime. The confirmatory factor analysis demonstrated a good fit of the items for their respective constructs; therefore, they were adopted without modification in the structural equation model. The data suggest that individuals with prior alcohol experience are 4 times more likely to engage in virtual risk decisions within the simulated environment (odds ratio 4.31, 95% CI 1.70-10.84; P=.01). Knowledge and awareness of blood alcohol concentration were associated with a lower chance to engage in virtual risk decisions (odds ratio 0.32, 95% CI 0.11-0.93; P=.04). However, no significant associations were found between virtual risk decisions and other latent variables. Gender and age did not moderate the associations. Conclusions: The immersive and lifelike properties of VR partially reflected risk-related decisions. However, it remains unclear which factors favor the mapping of real-world behaviors in virtual simulations. Therefore, future research should address the mechanisms underlying behavioral dynamics in virtual simulations and explore the translation of virtual behaviors into real behaviors to gain a comprehensive understanding of the potential of virtual simulations for alcohol prevention. %R 10.2196/56188 %U https://xr.jmir.org/2024/1/e56188 %U https://doi.org/10.2196/56188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52118 %T Effectiveness of a Web-Based Individual Coping and Alcohol Intervention Program for Children of Parents With Alcohol Use Problems: Randomized Controlled Trial %A Wall,Håkan %A Hansson,Helena %A Zetterlind,Ulla %A Kvillemo,Pia %A Elgán,Tobias H %+ Stockholm Prevents Alcohol and Drug Problems, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, Stockholm, 11364, Sweden, 46 700011003, tobias.elgan@ki.se %K adolescent %K adolescents %K alcoholic %K alcoholics %K CBT %K children of impaired parents %K cognitive behavioral therapy %K coping %K digital intervention %K mental health %K randomized controlled trial %K RCT %K self-management %K substance abuse %K substance use %K therapist %K web-based intervention %K youth %D 2024 %7 10.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Children whose parents have alcohol use problems are at an increased risk of several negative consequences, such as poor school performance, an earlier onset of substance use, and poor mental health. Many would benefit from support programs, but the figures reveal that only a small proportion is reached by existing support. Digital interventions can provide readily accessible support and potentially reach a large number of children. Research on digital interventions aimed at this target group is scarce. We have developed a novel digital therapist-assisted self-management intervention targeting adolescents whose parents had alcohol use problems. This program aims to strengthen coping behaviors, improve mental health, and decrease alcohol consumption in adolescents. Objective: This study aims to examine the effectiveness of a novel web-based therapist-assisted self-management intervention for adolescents whose parents have alcohol use problems. Methods: Participants were recruited on the internet from social media and websites containing health-related information about adolescents. Possible participants were screened using the short version of the Children of Alcoholics Screening Test-6. Eligible participants were randomly allocated to either the intervention group (n=101) or the waitlist control group (n=103), and they were unblinded to the condition. The assessments, all self-assessed, consisted of a baseline and 2 follow-ups after 2 and 6 months. The primary outcome was the Coping With Parents Abuse Questionnaire (CPAQ), and secondary outcomes were the Center for Epidemiological Studies Depression Scale, Alcohol Use Disorders Identification Test (AUDIT-C), and Ladder of Life (LoL). Results: For the primary outcome, CPAQ, a small but inconclusive treatment effect was observed (Cohen d=–0.05 at both follow-up time points). The intervention group scored 38% and 46% lower than the control group on the continuous part of the AUDIT-C at the 2- and 6-month follow-up, respectively. All other between-group comparisons were inconclusive at either follow-up time point. Adherence was low, as only 24% (24/101) of the participants in the intervention group completed the intervention. Conclusions: The findings were inconclusive for the primary outcome but demonstrate that a digital therapist-assisted self-management intervention may contribute to a reduction in alcohol consumption. These results highlight the potential for digital interventions to reach a vulnerable, hard-to-reach group of adolescents but underscore the need to develop more engaging support interventions to increase adherence. Trial Registration: ISRCTN Registry ISRCTN41545712; https://www.isrctn.com/ISRCTN41545712?q=ISRCTN41545712 International Registered Report Identifier (IRRID): RR2-10.1186/1471-2458-12-35 %M 38598286 %R 10.2196/52118 %U https://www.jmir.org/2024/1/e52118 %U https://doi.org/10.2196/52118 %U http://www.ncbi.nlm.nih.gov/pubmed/38598286 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55166 %T Combined Motivational Interviewing and Ecological Momentary Intervention to Reduce Hazardous Alcohol Use Among Sexual Minority Cisgender Men and Transgender Individuals: Protocol for a Randomized Controlled Trial %A Lauckner,Carolyn %A Takenaka,Bryce Puesta %A Sesenu,Fidelis %A Brown,Jaime S %A Kirklewski,Sally J %A Nicholson,Erin %A Haney,Kimberly %A Adatorwovor,Reuben %A Boyd,Donte T %A Fallin-Bennett,Keisa %A Restar,Arjee Javellana %A Kershaw,Trace %+ Center for Health Equity Transformation, University of Kentucky, 465 Healthy Kentucky Bldg, 760 Press Ave, Lexington, KY, 40536, United States, 1 859 562 3335, carolyn.lauckner@uky.edu %K alcohol use %K sexual minority %K transgender %K young adults %K mobile health %K mHealth %K HIV risk behaviors %K sexual risk behaviors %K motivational interviewing %K ecological momentary interventions %K mobile phone %D 2024 %7 5.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual minority cisgender men and transgender (SMMT) individuals, particularly emerging adults (aged 18-34 years), often report hazardous drinking. Given that alcohol use increases the likelihood of HIV risk behaviors, and HIV disproportionately affects SMMT individuals, there is a need to test interventions that reduce hazardous alcohol use and subsequent HIV risk behaviors among this population. Ecological momentary interventions (EMIs), which use mobile phones to deliver risk reduction messages based on current location and behaviors, can help to address triggers that lead to drinking in real time. Objective: This study will test an EMI that uses motivational interviewing (MI), smartphone surveys, mobile breathalyzers, and location tracking to provide real-time messaging that addresses triggers for drinking when SMMT individuals visit locations associated with hazardous alcohol use. In addition, the intervention will deliver harm reduction messaging if individuals report engaging in alcohol use. Methods: We will conduct a 3-arm randomized controlled trial (N=405 HIV-negative SMMT individuals; n=135, 33% per arm) comparing the following conditions: (1) Tracking and Reducing Alcohol Consumption (a smartphone-delivered 4-session MI intervention), (2) Tracking and Reducing Alcohol Consumption and Environmental Risk (an EMI combining MI with real-time messaging based on geographic locations that are triggers to drinking), and (3) a smartphone-based alcohol monitoring–only control group. Breathalyzer results and daily self-reports will be used to assess the primary and secondary outcomes of drinking days, drinks per drinking day, binge drinking episodes, and HIV risk behaviors. Additional assessments at baseline, 3 months, 6 months, and 9 months will evaluate exploratory long-term outcomes. Results: The study is part of a 5-year research project funded in August 2022 by the National Institute on Alcohol Abuse and Alcoholism. The first 1.5 years of the study will be dedicated to planning and development activities, including formative research, app design and testing, and message design and testing. The subsequent 3.5 years will see the study complete participant recruitment, data collection, analyses, report writing, and dissemination. We expect to complete all study data collection in or before January 2027. Conclusions: This study will provide novel evidence about the relative efficacy of using a smartphone-delivered MI intervention and real-time messaging to address triggers for hazardous alcohol use and sexual risk behaviors. The EMI approach, which incorporates location-based preventive messaging and behavior surveys, may help to better understand the complexity of daily stressors among SMMT individuals and their impact on hazardous alcohol use and HIV risk behaviors. The tailoring of this intervention toward SMMT individuals helps to address their underrepresentation in existing alcohol use research and will be promising for informing where structural alcohol use prevention and treatment interventions are needed to support SMMT individuals. Trial Registration: ClinicalTrials.gov NCT05576350; https://www.clinicaltrials.gov/study/NCT05576350 International Registered Report Identifier (IRRID): PRR1-10.2196/55166 %M 38578673 %R 10.2196/55166 %U https://www.researchprotocols.org/2024/1/e55166 %U https://doi.org/10.2196/55166 %U http://www.ncbi.nlm.nih.gov/pubmed/38578673 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53684 %T Experimentally Induced Reductions in Alcohol Consumption and Brain, Cognitive, and Clinical Outcomes in Older Persons With and Those Without HIV Infection (30-Day Challenge Study): Protocol for a Nonrandomized Clinical Trial %A Cook,Robert L %A Richards,Veronica L %A Gullett,Joseph M %A Lerner,Brenda D G %A Zhou,Zhi %A Porges,Eric C %A Wang,Yan %A Kahler,Christopher W %A Barnett,Nancy P %A Li,Zhigang %A Pallikkuth,Suresh %A Thomas,Emmanuel %A Rodriguez,Allan %A Bryant,Kendall J %A Ghare,Smita %A Barve,Shirish %A Govind,Varan %A Dévieux,Jessy G %A Cohen,Ronald A %A , %+ Southern HIV and Alcohol Research Consortium, University of Florida, 2004 Mowry Road, Department of Epidemiology, Gainesville, FL, 32610, United States, 1 3522735869, cookrl@ufl.edu %K alcohol %K contingency management %K biosensor %K HIV infection %K cognitive function %D 2024 %7 2.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Both alcohol consumption and HIV infection are associated with worse brain, cognitive, and clinical outcomes in older adults. However, the extent to which brain and cognitive dysfunction is reversible with reduction or cessation of drinking is unknown. Objective: The 30-Day Challenge study was designed to determine whether reduction or cessation of drinking would be associated with improvements in cognition, reduction of systemic and brain inflammation, and improvement in HIV-related outcomes in adults with heavy drinking. Methods: The study design was a mechanistic experimental trial, in which all participants received an alcohol reduction intervention followed by repeated assessments of behavioral and clinical outcomes. Persons were eligible if they were 45 years of age or older, had weekly alcohol consumption of 21 or more drinks (men) or 14 or more drinks (women), and were not at high risk of alcohol withdrawal. After a baseline assessment, participants received an intervention consisting of contingency management (money for nondrinking days) for at least 30 days followed by a brief motivational interview. After this, participants could either resume drinking or not. Study questionnaires, neurocognitive assessments, neuroimaging, and blood, urine, and stool samples were collected at baseline, 30 days, 90 days, and 1 year after enrollment. Results: We enrolled 57 persons with heavy drinking who initiated the contingency management protocol (mean age 56 years, SD 4.6 years; 63%, n=36 male, 77%, n=44 Black, and 58%, n=33 people with HIV) of whom 50 completed 30-day follow-up and 43 the 90-day follow-up. The planned study procedures were interrupted and modified due to the COVID-19 pandemic of 2020-2021. Conclusions: This was the first study seeking to assess changes in brain (neuroimaging) and cognition after alcohol intervention in nontreatment-seeking people with HIV together with people without HIV as controls. Study design strengths, limitations, and lessons for future study design considerations are discussed. Planned analyses are in progress, after which deidentified study data will be available for sharing. Trial Registration: ClinicalTrials.gov NCT03353701; https://clinicaltrials.gov/study/NCT03353701 International Registered Report Identifier (IRRID): DERR1-10.2196/53684 %M 38564243 %R 10.2196/53684 %U https://www.researchprotocols.org/2024/1/e53684 %U https://doi.org/10.2196/53684 %U http://www.ncbi.nlm.nih.gov/pubmed/38564243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44574 %T Digital Alcohol Interventions Could Be Part of the Societal Response to Harmful Consumption, but We Know Little About Their Long-Term Costs and Health Outcomes %A Ulfsdotter Gunnarsson,Katarina %A Henriksson,Martin %A Bendtsen,Marcus %+ Department of Health, Medicine, and Caring Sciences, Linköping University, Campus US, Linköping, 58183, Sweden, 46 13281000, katarina.ulfsdotter.gunnarsson@liu.se %K alcohol %K health economics %K telemedicine %K psychological harm %K eHealth %K digital intervention %K decision-making %D 2024 %7 27.3.2024 %9 Viewpoint %J J Med Internet Res %G English %X Alcohol consumption causes both physical and psychological harm and is a leading risk factor for noncommunicable diseases. Digital alcohol interventions have been found to support those looking for help by giving them tools for change. However, whether digital interventions can help tackle the long-term societal consequences of harmful alcohol consumption in a cost-effective manner has not been adequately evaluated. In this Viewpoint, we propose that studies of digital alcohol interventions rarely evaluate the consequences of wider dissemination of the intervention under study, and that when they do, they do not take advantage of modeling techniques that allow for appropriately studying consequences over a longer time horizon than the study period when the intervention is tested. We argue that to help decision-makers to prioritize resources for research and dissemination, it is important to model long-term costs and health outcomes. Further, this type of modeling gives important insights into the context in which interventions are studied and highlights where more research is required and where sufficient evidence is available. The viewpoint therefore invites the researcher not only to reflect on which interventions to study but also how to evaluate their long-term consequences. %M 38536228 %R 10.2196/44574 %U https://www.jmir.org/2024/1/e44574 %U https://doi.org/10.2196/44574 %U http://www.ncbi.nlm.nih.gov/pubmed/38536228 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55039 %T Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial %A Shrier,Lydia A %A O'Connell,Madison M %A Torres,Alessandra %A Shone,Laura P %A Fiks,Alexander G %A Plumb,Julia A %A Maturo,Jessica L %A McCaskill,Nicholas H %A Harris,Donna %A Burke,Pamela J %A Felt,Thatcher %A Murphy,Marie Lynd %A Sherritt,Lon %A Harris,Sion Kim %+ Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, Mailstop 3189, Boston, MA, 02115, United States, 1 617 355 8306, lydia.shrier@childrens.harvard.edu %K alcohol %K substance use %K adolescent %K primary care %K prevention %K intervention %K screening %K brief intervention %K computer-facilitated screening and brief intervention %K cSBI %K mobile phone %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. Objective: This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. Methods: We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use–associated health risks. During the visit, intervention clinicians access a computerized summary of the patient’s screening results and a tailored counseling script to deliver a motivational interviewing–based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. Results: The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. Conclusions: Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. Trial Registration: ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966 International Registered Report Identifier (IRRID): DERR1-10.2196/55039 %M 38530346 %R 10.2196/55039 %U https://www.researchprotocols.org/2024/1/e55039 %U https://doi.org/10.2196/55039 %U http://www.ncbi.nlm.nih.gov/pubmed/38530346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55041 %T Developing a Text Messaging Intervention to Prevent Binge and Heavy Drinking in a Military Population: Mixed Methods Development Study %A Aycock,Chase A %A Mallawaarachchi,Indika %A Wang,Xin-Qun %A Cassidy,Daniel G %A Ellis,Jordan M %A Klesges,Robert C %A Talcott,G Wayne %A Wiseman,Kara %+ Department of Public Health Sciences, University of Virginia, P.O. Box 800717, Charlottesville, VA, 22908, United States, 1 4342348126, kara.wiseman@virginia.edu %K text messaging %K alcohol reduction %K binge drinking %K US %K United States %K US military %K alcohol misuse %K military %K functioning %K readiness %K health %K career %K careers %K text message %K text messages %K short message service %K SMS %K SMS intervention %K drinking %K Air Force %K Airmen %K mixed methods approach %K message %K messages %K development study %K qualitative coding %K drinking alcohol %K alcohol consumption %K survey %K descriptive statistics %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol misuse is the fourth leading cause of death in the United States and a significant problem in the US military. Brief alcohol interventions can reduce negative alcohol outcomes in civilian and military populations, but additional scalable interventions are needed to reduce binge and heavy drinking. SMS text messaging interventions could address this need, but to date, no programs exist for military populations. Objective: We aimed to develop an SMS text messaging intervention to address binge and heavy drinking among Airmen in Technical Training in the US Air Force. Methods: We implemented a 2-phase, mixed methods study to develop the SMS text messaging intervention. In phase 1, a total of 149 respondents provided feedback about the persuasiveness of 49 expert-developed messages, preferences regarding message frequency, timing and days to receive messages, and suggested messages, which were qualitatively coded. In phase 2, a total of 283 respondents provided feedback about the persuasiveness of 77 new messages, including those developed through the refinement of messages from phase 1, which were coded and assessed based on the Behavior Change Technique Taxonomy (BCTT). For both phases, mean persuasiveness scores (range 1-5) were calculated and compared according to age (aged <21 or ≥21 years) and gender. Top-ranking messages from phase 2 were considered for inclusion in the final message library. Results: In phase 1, top-rated message themes were about warnings about adverse outcomes (eg, impaired judgment and financial costs), recommendations to reduce drinking, and invoking values and goals. Through qualitative coding of suggested messages, we identified themes related to warnings about adverse outcomes, recommendations, prioritizing long-term goals, team and belonging, and invoking values and goals. Respondents preferred to receive 1 to 3 messages per week (124/137, 90.5%) and to be sent messages on Friday, Saturday, and Sunday (65/142, 45.8%). In phase 2, mean scores for messages in the final message library ranged from 3.31 (SD 1.29) to 4.21 (SD 0.90). Of the top 5 highest-rated messages, 4 were categorized into 2 behavior change techniques (BCTs): valued self-identity and information about health consequences. The final message library includes 28 BCTT-informed messages across 13 BCTs, with messages having similar scores across genders. More than one-fourth (8/28, 29%) of the final messages were informed by the suggested messages from phase 1. As Airmen aged <21 years face harsher disciplinary action for alcohol consumption, the program is tailored based on the US legal drinking age. Conclusions: This study involved members from the target population throughout 2 formative stages of intervention development to design a BCTT-informed SMS text messaging intervention to reduce binge and heavy drinking, which is now being tested in an efficacy trial. The results will determine the impact of the intervention on binge drinking and alcohol consumption in the US Air Force. %M 38502165 %R 10.2196/55041 %U https://formative.jmir.org/2024/1/e55041 %U https://doi.org/10.2196/55041 %U http://www.ncbi.nlm.nih.gov/pubmed/38502165 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52949 %T Identifying and Validating Alcohol Diagnostics for Injury-Related Trauma in South Africa: Protocol for a Mixed Methods Study %A Petersen Williams,Petal %A Prinsloo,Megan %A Peden,Margaret M %A Neethling,Ian %A Mhlongo,Shibe %A Maqungo,Sithombo %A Parry,Charles %A Matzopoulos,Richard %+ Mental Health, Alcohol, Substance use and Tobacco Research Unit, South African Medical Research Council, PO Box 19070 Francie van Zijl Drive, Tygerberg, Cape Town, 7505, South Africa, 27 219380337, petal.petersen@mrc.ac.za %K alcohol %K diagnostic %K surveillance %K injuries %K violence %K road traffic %K Africa %K South Africa %K alcohol misuse %K alcohol diagnostics %K addiction %K mixed methods %K trauma %K risk %K injury %K diagnostic tools %K diagnostic tool %K clinical management %K injury %K injury prevention %K accident %K accidents %D 2024 %7 11.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The burden of alcohol use among patients with trauma and the relative injury risks is not routinely measured in South Africa. Given the prominent burden of alcohol on hospital trauma departments, South Africa needs practical, cost-effective, and accurate alcohol diagnostic tools for testing, surveillance, and clinical management of patients with trauma. Objective: This study aims to validate alcohol diagnostics for injury-related trauma and assess its use for improving national health practice and policy. Methods: The Alcohol Diagnostic Validation for Injury-Related Trauma study will use mixed methods across 3 work packages. Five web-based focus group discussions will be conducted with 6 to 8 key stakeholders, each across 4 areas of expertise (clinical, academic, policy, and operational) to determine the type of alcohol information that will be useful for different stakeholders in the injury prevention and health care sectors. We will then conduct a small pilot study followed by a validation study of alcohol diagnostic tools (clinical assessment, breath analysis, and fingerprick blood) against enzyme immunoassay blood concentration analysis in a tertiary hospital trauma setting with 1000 patients. Finally, selected alcohol diagnostic tools will be tested in a district hospital setting with a further 1000 patients alongside community-based participatory research on the use of the selected tools. Results: Pilot data are being collected, and the protocol will be modified based on the results. Conclusions: Through this project, we hope to identify and validate the most appropriate methods of diagnosing alcohol-related injury and violence in a clinical setting. The findings from this study are likely to be highly relevant and could influence our primary beneficiaries—policy makers and senior health clinicians—to adopt new practices and policies around alcohol testing in injured patients. The findings will be disseminated to relevant national and provincial government departments, policy experts, and clinicians. Additionally, we will engage in media advocacy and with our stakeholders, including community representatives, work through several nonprofit partners to reach civil society organizations and share findings. In addition, we will publish findings in scientific journals. International Registered Report Identifier (IRRID): DERR1-10.2196/52949 %M 38466974 %R 10.2196/52949 %U https://www.researchprotocols.org/2024/1/e52949 %U https://doi.org/10.2196/52949 %U http://www.ncbi.nlm.nih.gov/pubmed/38466974 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49557 %T Web-Based Screening, Brief Intervention, and Referral to Treatment for Traumatic Stress and Alcohol Misuse Among Survivors of Sexual Assault and Intimate Partner Violence: Usability and Acceptability Study %A Hahn,Christine %A Tilstra-Ferrell,Emily %A Salim,Selime %A Goodrum,Nada %A Rheingold,Alyssa %A Gilmore,Amanda K %A Barber,Sara %A Moreland,Angela %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St. MSC 861, Charleston, SC, 29425, United States, 1 8437928209, hahnc@musc.edu %K screening, brief intervention, and referral to treatment %K brief intervention %K intimate partner violence %K sexual assault %K substance use %K alcohol use %K mobile phone %D 2024 %7 15.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent survivors of intimate partner violence (IPV) and sexual assault (SA) are at a high risk for traumatic stress and alcohol misuse. IPV and SA survivors face barriers to services for traumatic stress and alcohol misuse and have low service utilization rates. One way to increase access to services for this population is the use of web-based screening, brief intervention, and referral to treatment (SBIRT), an evidence-informed approach for early identification of traumatic stress and alcohol and drug misuse and connecting individuals to treatment. Objective: This study aims to assess the usability and acceptability of a web-based SBIRT called CHAT (Choices For Your Health After Trauma) tailored to address traumatic stress and alcohol misuse following past-year IPV, SA, or both. Methods: Phase 1 involved gathering feedback about usability and acceptability from focus groups with victim service professionals (22/52, 42%) and interviews with past-year survivors of IPV, SA, or both (13/52, 25%). Phase 2 involved gathering feedback about the acceptability of an adapted version of CHAT in an additional sample of recent survivors (17/52, 33%). Survey data on history of IPV and SA, posttraumatic stress disorder symptoms, alcohol and drug use, and service use were collected from survivors in both phases to characterize the samples. Qualitative content and thematic analyses of the interviews and focus group data were conducted using a coding template analysis comprising 6 a priori themes (usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance). Results: Six themes emerged during the focus groups and interviews related to CHAT: usability, visual design, user engagement, content, therapeutic persuasiveness, and therapeutic alliance. Phase 1 providers and survivors viewed CHAT as acceptable, easy to understand, and helpful. Participants reported that the intervention could facilitate higher engagement in this population as the web-based modality is anonymous, easily accessible, and brief. Participants offered helpful suggestions for improving CHAT by updating images, increasing content personalization, reducing text, and making users aware that the intervention is confidential. The recommendations of phase 1 participants were incorporated into CHAT. Phase 2 survivors viewed the revised intervention and found it highly acceptable (mean 4.1 out of 5, SD 1.29). A total of 4 themes encapsulated participant’s favorite aspects of CHAT: (1) content and features, (2) accessible and easy to use, (3) education, and (4) personalization. Six survivors denied disliking any aspect. The themes on recommended changes included content and features, brevity, personalization, and language access. Participants provided dissemination recommendations. Conclusions: Overall, CHAT was acceptable among victim service professionals and survivors. Positive reactions to CHAT show promise for future research investigating the efficacy and potential benefit of CHAT when integrated into services for people with traumatic stress and alcohol misuse after recent IPV and SA. %M 38358791 %R 10.2196/49557 %U https://formative.jmir.org/2024/1/e49557 %U https://doi.org/10.2196/49557 %U http://www.ncbi.nlm.nih.gov/pubmed/38358791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45471 %T Nonuse of Blended Web-Based and Face-To-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study %A Tarp,Kristine %A Christiansen,Regina %A Bilberg,Randi %A Borkner,Simone %A Dalsgaard,Caroline %A Folker,Marie Paldam %A Nielsen,Anette Søgaard %+ The National Research Centre for the Working Environment, Lersø Parkallé 105, Copenhagen, 2100, Denmark, 45 21292332, ket@nfa.dk %K alcohol use disorder %K blended internet-based and face-to-face cognitive behavioral therapy %K nonuse %K patient perceptions %K qualitative %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital technologies for health care has been the focus of social studies, which have concentrated on the digital divide between individuals who use technology and those who do not—with the latter often being considered as individuals with shortcomings. In Denmark, 91% of the population have computers and 97 out of 100 families have internet access, indicating that lack of access to technology is not the primary reason for nonuse. Although previous studies have primarily focused on participants' perspectives of using internet-based treatment for alcohol use disorder (AUD), no study has investigated individuals’ reasons to prefer face-to-face treatment over blended face-to-face and internet-based cognitive behavioral therapy (bCBT) for AUD among treatment-seeking populations. Objective: The aim of this qualitative study was to investigate the nonuse of bCBT among patients with AUD. Specifically, this study aims to explore patients' reasons for choosing not to receive treatment via this format. Methods: This study was conducted among Danish patients with AUD who were enrolled in the study “Blending internet treatment into conventional face-to-face treatment for alcohol use disorder (Blend-A)” but had not used bCBT. The participant group consisted of 11 patients with AUD: 3 women and 8 men. The age range of the participants was 29-78 years (mean 59 years). Individual semistructured interviews were conducted using cell phones to gather participants’ reasons for not choosing bCBT. The interviews were recorded, transcribed, and analyzed using thematic analysis. Five authors performed the analysis in 3 steps: (1) two authors read the transcripts and coded themes from their immediate impression of the material, (2) one author provided feedback, which was used to group overlapping themes together or create new themes that better reflected the content, and (3) the remaining two authors provided feedback on the analysis to improve its structure, readability, and relevance to the research aim. Results: We found that the participants had various reasons for choosing face-to-face treatment over bCBT; these reasons were more related to personal matters and lesser to digital health literacy. We identified 4 themes related to personal matters for choosing face-to-face treatment over bCBT: (1) patients’ need for attending sessions in person, (2) preference for verbal communication, (3) desire for immediate feedback, and (4) feeling more empowered and motivated with face-to-face sessions. Conclusions: This study provides valuable insight into participants’ perspectives on blended therapy for AUD and highlights the importance of considering personal factors when designing digital health interventions. Our study indicates that most of the participants choose not to use bCBT for AUD because they perceive such treatment formats as impersonal. Instead, they prefer direct communication with the therapist, including the ability to express and comprehend facial expressions and body language. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03122-4 %M 38349711 %R 10.2196/45471 %U https://formative.jmir.org/2024/1/e45471 %U https://doi.org/10.2196/45471 %U http://www.ncbi.nlm.nih.gov/pubmed/38349711 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49680 %T Professional Development to Improve Responsible Beverage Service Training: Formative Research Results and Protocol for a Randomized Controlled Trial %A Woodall,W Gill %A Buller,David %A Saltz,Robert %A Martinez,Lila %+ Klein Buendel, Inc, 1667 Cole Blvd, Ste 220, Golden, CO, 80401, United States, 1 303 565 4321, dbuller@kleinbuendel.com %K alcohol %K driving while intoxicated %K responsible beverage service %K training %K prevention %K professional development %K social media %D 2024 %7 24.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Improved interventions are needed to reduce the rate of driving while intoxicated. Responsible beverage service (RBS) training has reduced service to intoxicated patrons in licensed premises in several studies. Its efficacy might be improved by increasing the proper application and continued use of RBS with a professional development program in the 3 to 5 years between the required RBS retraining. Objective: This study aims to develop and evaluate a professional development component for an RBS training that aims to improve the effectiveness of the web-based training alone. Methods: In a 2-phase project, we are creating a professional development component for alcohol servers after completing an RBS training. The first phase involved formative research on the feasibility, acceptability, and potential effectiveness of components. Semistructured interviews with owners and managers of licensed establishments and focus groups and a survey with alcohol servers in New Mexico and Washington State examined support for RBS and the need for ongoing professional development to support RBS. A prototype of a professional development component, WayToServe Plus, was produced for delivery in social media posts on advanced RBS skills, support from experienced servers, professionalism, and basic management training. The prototype was evaluated in a usability survey and a field pilot study with alcohol servers in California, New Mexico, and Washington State. The second phase of the project will include full production of the professional development component. It will be delivered in Facebook private groups over 12 months and evaluated with a sample of licensed premises (ie, bars and restaurants) in California, New Mexico, and Washington State (n=180) in a 2-group randomized field trial (WayToServe training only vs WayToServe training and WayToServe Plus). Licensed establishments will be assessed for refusal of sales to apparently intoxicated pseudopatrons at baseline and 12 months after the intervention commences. Results: Although owners and managers (n=10) and alcohol servers (n=43) were favorable toward RBS, they endorsed the need for ongoing support for RBS for servers and identified topics of interest. A prototype with 50 posts was successfully created. Servers felt that it was highly usable and appropriate for themselves and the premises in the usability survey (n=20) and field pilot test (n=110), with 85% (17/20) and 78% (46/59), respectively, saying they would use it. Servers receiving the professional development component had higher self-efficacy (d=0.30) and response efficacy (d=0.38) for RBS compared with untreated controls. Conclusions: Owners, managers, and servers believed that an ongoing professional development component on RBS would benefit servers and licensed premises. Servers were interested in using such a program, a large majority engaged with the prototype, and servers receiving it improved on theoretic mediators of RBS. Thus, the professional development component may improve RBS training. Trial Registration: ClinicalTrials.gov NCT05779774; http://tinyurl.com/4mw6d2vk International Registered Report Identifier (IRRID): DERR1-10.2196/49680 %M 38265847 %R 10.2196/49680 %U https://www.researchprotocols.org/2024/1/e49680 %U https://doi.org/10.2196/49680 %U http://www.ncbi.nlm.nih.gov/pubmed/38265847 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50399 %T Feasibility, Acceptability, and Potential Efficacy of a Self-Guided Internet-Delivered Dialectical Behavior Therapy Intervention for Substance Use Disorders: Randomized Controlled Trial %A Daros,Alexander R %A Guimond,Timothy H %A Yager,Christina %A Palermo,Emma H %A Wilks,Chelsey R %A Quilty,Lena C %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J1H1, Canada, 1 5192533000 ext 2236, daros.alexander@gmail.com %K depression %K anxiety %K emotion dysregulation %K digital interventions %K dialectical behavior therapy %K substance use disorder %K alcohol use disorder %K randomized controlled trial %K eHealth %K mobile phone %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: People with alcohol and substance use disorders (SUDs) often have underlying difficulties in regulating emotions. Although dialectical behavioral therapy is effective for SUDs, it is often difficult to access. Self-guided, internet-delivered dialectical behavioral therapy (iDBT) allows for expanded availability, but few studies have rigorously evaluated it in individuals with SUDs. Objective: This study examines the feasibility, acceptability, and potential efficacy of an iDBT intervention in treatment-seeking adults with SUDs. We hypothesized that iDBT would be feasible, credible, acceptable, and engaging to people with SUDs. We also hypothesized that the immediate versus delayed iDBT group would show comparatively greater improvements and that both groups would show significant improvements over time. Methods: A 12-week, single-blinded, parallel-arm, randomized controlled trial was implemented, with assessments at baseline and at 4 (acute), 8, and 12 weeks (follow-up). A total of 72 community adults aged 18 to 64 years were randomized. The immediate group (n=38) received access to iDBT at baseline, and the delayed group (n=34) received access after 4 weeks. The intervention (Pocket Skills 2.0) was a self-guided iDBT via a website, with immediate access to all content, additional text and email reminders, and additional support meetings as requested. Our primary outcome was substance dependence, with secondary outcomes pertaining to feasibility, clinical outcomes, functional disability, and emotion dysregulation, among other measures. All outcomes were assessed using self-report questionnaires. Results: iDBT was perceived as a credible and acceptable treatment. In terms of feasibility, 94% (68/72) of the participants started iDBT, 13% (9/68) were early dropouts, 35% (24/68) used it for the recommended 8 days in the first month, and 50% (34/68) were still active 4 weeks later. On average, the participants used iDBT for 2 hours and 24 minutes across 10 separate days. In the acute period, no greater benefit was found for the immediate group on substance dependence, although we did find lower depression (b=−2.46; P=.02) and anxiety (b=−2.22; P=.02). At follow-up, there were greater benefits in terms of reduced alcohol (b=−2.00; P=.02) and nonalcoholic substance (b=−3.74; P=.01) consumption in the immediate access group. Both groups demonstrated improvements in substance dependence in the acute (b=−1.73; P<.001) and follow-up period (b=−2.09; P<.001). At follow-up, both groups reported reduced depression, anxiety, suicidal behaviors, emotional dysregulation, and functional disability. Conclusions: iDBT is a feasible and acceptable intervention for patients with SUDs, although methods for improving engagement are warranted. Although results did not support efficacy for the primary outcome at 4 weeks, findings support reductions in substance dependence and other mental health concerns at 12 weeks. Notwithstanding the limitations of this study, the results suggest the potential value of iDBT in the treatment of SUDs and other mental health conditions. Trial Registration: ClinicalTrials.gov NCT05094440; https://clinicaltrials.gov/show/NCT05094440 %M 38227362 %R 10.2196/50399 %U https://mental.jmir.org/2024/1/e50399 %U https://doi.org/10.2196/50399 %U http://www.ncbi.nlm.nih.gov/pubmed/38227362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51839 %T Methodological Insights on Recruitment and Retention From a Remote Randomized Controlled Trial Examining the Effectiveness of an Alcohol Reduction App: Descriptive Analysis Study %A Oldham,Melissa %A Dinu,Larisa %A Loebenberg,Gemma %A Field,Matt %A Hickman,Matthew %A Michie,Susan %A Brown,Jamie %A Garnett,Claire %+ University College London, London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 883, m.oldham@ucl.ac.uk %K alcohol reduction %K alcohol %K digital care %K digital intervention %K ethnic minority %K methods %K mHealth %K randomised controlled trial %K recruitment %K retention %K social media %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Randomized controlled trials (RCTs) with no in-person contact (ie, remote) between researchers and participants offer savings in terms of cost and time but present unique challenges. Objective: The goal of this study is to examine the differences between different forms of remote recruitment (eg, National Health Service [NHS] website, social media, and radio advertising) in the proportion of participants recruited, demographic diversity, follow-up rates, and cost. We also examine the cost per participant of sequential methods of follow-up (emails, phone calls, postal surveys, and postcards). Finally, our experience with broader issues around study advertising and participant deception is discussed. Methods: We conducted a descriptive analysis of 5602 increasing-and-higher-risk drinkers (Alcohol Use Disorders Identification Test score ≥8), taking part in a 2-arm, parallel group, remote RCT with a 1:1 allocation, comparing the intervention (Drink Less app) with usual digital care (NHS alcohol advice web page). Participants were recruited between July 2020 and March 2022 and compensated with gift vouchers of up to £36 (a currency exchange rate of £1=US $1.26988 is applicable) for completing follow-up surveys, with 4 stages of follow-up: email reminders, phone calls, postal survey, and postcard. Results: The three main recruitment methods were advertisements on (1) social media (2483/5602, 44.32%), (2) the NHS website (1961/5602, 35.01%), and (3) radio and newspapers (745/5602, 13.3%), with the remaining methods of recruitment accounting 7.37% (413/5602) of the sample. The overall recruitment cost per participant varied from £0 to £11.01. Costs were greater when recruiting participants who were men (£0-£28.85), from an ethnic minority group (£0-£303.81), and more disadvantaged (£0-£49.12). Targeted approaches were useful for recruiting more men but less useful in achieving diversity in ethnicity and socioeconomic status. Follow-up at 6 months was 79.58% (4458/5602). Of those who responded, 92.4% (4119/4458) responded by email. Each additional stage of follow-up resulted in an additional 2-3 percentage points of the overall sample being followed up, although phone calls, postal surveys, and postcards were more resource intensive than email reminders. Conclusions: For remote RCTs, researchers could benefit from using a range of recruitment methods and cost-targeted approaches to achieve demographic diversity. Automated emails with substantial financial incentives for prompt completion can achieve good follow-up rates, and sequential, offline follow-up options, such as phone calls and postal surveys, can further increase follow-up rates but are comparatively expensive. We also make broader recommendations focused on striking the right balance when designing remote RCTs. Careful planning, ongoing maintenance, and dynamic decision-making are required throughout a trial to balance the competing demands of participation among those eligible, deceptive participation among those who are not eligible, and ensuring no postrandomization bias is introduced by data-checking protocols. %M 38180802 %R 10.2196/51839 %U https://formative.jmir.org/2024/1/e51839 %U https://doi.org/10.2196/51839 %U http://www.ncbi.nlm.nih.gov/pubmed/38180802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44762 %T Narrowing the Patient–Physician Gap Based on Self-Reporting and Monthly Hepatologist Feedback for Patients With Alcohol-Related Liver Disease: Interventional Pilot Study Using a Journaling Smartphone App %A Yamashiki,Noriyo %A Kawabata,Kyoko %A Murata,Miki %A Ikeda,Shunichiro %A Fujimaki,Takako %A Suwa,Kanehiko %A Seki,Toshihito %A Aramaki,Eiji %A Naganuma,Makoto %+ Department of Gastroenterology and Hepatology, Kansai Medical University Medical Center, Fumizono 10-15, Moriguchi, Osaka, 570-8507, Japan, 81 6 6992 1001, yamashno@takii.kmu.ac.jp %K alcohol-related liver disease %K alcohol use disorder %K alcoholism %K smartphone %K mobile health %D 2023 %7 19.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Screening and intervention for alcohol use disorders (AUDs) are recommended to improve the prognosis of patients with alcohol-related liver disease (ALD). Most patients’ smartphone app diaries record drinking behavior for self-monitoring. A smartphone app can be expected to also be helpful for physicians because it can provide rich patient information to hepatologists, leading to suitable feedback. We conducted this prospective pilot study to assess the use of a smartphone app as a journaling tool and as a self-report–based feedback source for patients with ALD. Objective: The aims of this study were assessment of whether journaling (self-report) and self-report–based feedback can help patients maintain abstinence and improve liver function data. Methods: This pilot study used a newly developed smartphone journaling app for patients, with input data that physicians can review. After patients with ALD were screened for harmful alcohol use, some were invited to use the smartphone journaling app for 8 weeks. Their self-reported alcohol intake, symptoms, and laboratory data were recorded at entry, week 4, and week 8. Biomarkers for alcohol use included gamma glutamyl transferase (GGT), percentage of carbohydrate-deficient transferrin to transferrin (%CDT), and GGT-CDT (GGT-CDT= 0.8 × ln[GGT] + 1.3 × ln[%CDT]). At each visit, their recorded data were reviewed by a hepatologist to evaluate changes in alcohol consumption and laboratory data. The relation between those outcomes and app usage was also investigated. Results: Of 14 patients agreeing to participate, 10 completed an 8-week follow-up, with diary input rates between 44% and 100% of the expected days. Of the 14 patients, 2 withdrew from clinical follow-up, and 2 additional patients never used the smartphone journaling app. Using the physician’s view, a treating hepatologist gave feedback via comments to patients at each visit. Mean self-reported alcohol consumption dropped from baseline (100, SD 70 g) to week 4 (13, SD 25 g; P=.002) and remained lower at week 8 (13, SD 23 g; P=.007). During the study, 5 patients reported complete abstinence. No significant changes were found in mean GGT and mean %CDT alone, but the mean GGT-CDT combination dropped significantly from entry (5.2, SD 1.2) to the week 4 visit (4.8, SD 1.1; P=.02) and at week 8 (4.8, SD 1.0; P=.01). During the study period, decreases in mean total bilirubin (3.0, SD 2.4 mg/dL to 2.4, SD 1.9 mg/dL; P=.01) and increases in mean serum albumin (3.0, SD 0.9 g/dL to 3.3, SD 0.8 g/dL; P=.009) were recorded. Conclusions: These pilot study findings revealed that a short-term intervention with a smartphone journaling app used by both patients and treatment-administering hepatologists was associated with reduced drinking and improved liver function. Trial Registration: UMIN CTR UMIN000045285; http://tinyurl.com/yvvk38tj %R 10.2196/44762 %U https://formative.jmir.org/2023/1/e44762/ %U https://doi.org/10.2196/44762 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51531 %T Digital Therapeutic Intervention for Women in the UK Armed Forces Who Consume Alcohol at a Hazardous or Harmful Level: Protocol for a Randomized Controlled Trial %A Williamson,Grace %A Carr,Ewan %A Fear,Nicola T %A Dymond,Simon %A King,Kate %A Simms,Amos %A Goodwin,Laura %A Murphy,Dominic %A Leightley,Daniel %+ King's Centre for Military Health Research, King's College London, Strand, London, SE5 9RJ, United Kingdom, 44 (0)20 7123 4843, daniel.leightley@kcl.ac.uk %K mental health %K digital health %K DrinksRation %K women %K woman %K United Kingdom %K Armed Forces %K alcohol %K randomized controlled trial %K RCT %K controlled trials %K study protocol %K alcohol misuse %K smartphone app %K mobile app %K mobile health %K mHealth %K veterans %K women veterans %K mobile phone %K digital therapeutic %D 2023 %7 19.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol misuse is common in the United Kingdom Armed Forces (UKAF), with prevalence significantly higher than in the general population. To date, digital health initiatives to support alcohol misuse have focused on male individuals, who represent approximately 89% of the UKAF. However, female veterans drink disproportionally more than female members of the public. Objective: This 2-arm participant-blinded (single-blinded) confirmatory randomized controlled trial (RCT) aims to assess the efficacy of a brief alcohol intervention (DrinksRation) in reducing weekly self-reported alcohol consumption between baseline and a 3-month follow-up (day 84) among women who have served in the UKAF. Methods: In this 2-arm single-blinded RCT, a smartphone app that includes interactive user-focused features tailored toward the needs of female veterans and designed to enhance participants’ motivations to reduce the amount of alcohol they consume is compared with the UK Chief Medical Officer guidance on alcohol consumption. The trial will be conducted among women who have served at least 1 day of paid service in the UKAF. Recruitment, consent, and data collection will be carried out automatically through the DrinksRation app or the BeAlcoholSmart platform. The primary outcome is change in self-reported weekly alcohol consumption between baseline (day 0) and the 3-month follow-up (day 84) measured using the Timeline Follow Back for alcohol consumption. The secondary outcome is the change in the Alcohol Use Disorders Identification Test score measured at baseline and 3-month follow-up between the control and intervention groups. The process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. Results: RCT recruitment will begin in January 2024 and last for 5 months. We aim to complete all data collection, including interviews, by May 2024. Conclusions: This study will assess whether a smartphone app tailored to the needs of women who have served in the UKAF is efficacious in reducing self-reported alcohol consumption. If successful, the digital therapeutics platform could be used not only to support women who have served in the UKAF but also for other conditions and disorders. Trial Registration: ClinicalTrials.gov NCT05970484; https://www.clinicaltrials.gov/study/NCT05970484 International Registered Report Identifier (IRRID): PRR1-10.2196/51531 %M 38113103 %R 10.2196/51531 %U https://www.researchprotocols.org/2023/1/e51531 %U https://doi.org/10.2196/51531 %U http://www.ncbi.nlm.nih.gov/pubmed/38113103 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47354 %T Integrated Alcohol Use and Sexual Assault Prevention Program for College Men Who Engage in Heavy Drinking: Randomized Pilot Study %A Orchowski,Lindsay M %A Merrill,Jennifer E %A Oesterle,Daniel W %A Barnett,Nancy P %A Borsari,Brian %A Zlotnick,Caron %A Haikalis,Michelle P %A Bekowitz,Alan D %+ Rhode Island Hospital, 146 West River Street, Suite 11A, Providence, RI, 02904, United States, 1 401 444 7021, lindsay_orchowski@brown.edu %K sexual assault %K alcohol use %K prevention %K student %K men %K alcoholism %K college %K intervention %K program %K peer engagement %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing. Objective: This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking. Methods: This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined. Results: The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months. Conclusions: The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink. Trial Registration: ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027 %M 37995129 %R 10.2196/47354 %U https://formative.jmir.org/2023/1/e47354 %U https://doi.org/10.2196/47354 %U http://www.ncbi.nlm.nih.gov/pubmed/37995129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47404 %T Testing a Digital Health App for Patients With Alcohol-Associated Liver Disease: Mixed Methods Usability Study %A Park,Linda S %A Kornfield,Rachel %A Yezihalem,Mihret %A Quanbeck,Andrew %A Mellinger,Jessica %A German,Margarita %+ Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin-Madison, 610 N. Whitney Way #200, Madison, WI, 53705, United States, 1 608 345 6859, linda.park@fammed.wisc.edu %K alcohol-associated liver disease %K ALD %K alcohol use disorder %K AUD %K mobile health %K mHealth %K digital tools %K alcohol cessation %K usability test %K mobile phone %D 2023 %7 15.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol-associated liver disease (ALD) is increasingly common and associated with serious and costly health consequences. Cessation of drinking can improve ALD morbidity and mortality; however, support for cessation is not routinely offered to those diagnosed with ALD, and continued drinking or resumption of drinking after diagnosis is common. Mobile health (mHealth) has the potential to offer convenient and scalable support for alcohol cessation to those diagnosed with ALD, but mHealth interventions for alcohol cessation have not been designed for or evaluated in a population with ALD. Objective: This study aims to understand how individuals with ALD would perceive and use an mHealth tool for alcohol cessation and to gather their perspectives on potential refinements to the tool that would allow it to better meet their needs. Methods: We interviewed 11 individuals who attended clinic visits related to their ALD to elicit their needs related to support for alcohol cessation and views on how mHealth could be applied. After completing initial interviews (pre), participants were provided with access to an mHealth app designed for alcohol cessation, which they used for 1 month. Afterward, they were interviewed again (post) to give feedback on their experiences, including aspects of the app that met their needs and potential refinements. We applied a mixed methods approach, including a qualitative analysis to identify major themes from the interview transcripts and descriptive analyses of use of the app over 1 month. Results: First, we found that a diagnosis of ALD is perceived as a motivator to quit drinking but that patients had difficulty processing the overwhelming amount of information about ALD they received and finding resources for cessation of alcohol use. Second, we found that the app was perceived as usable and useful for supporting drinking recovery, with patients responding favorably to the self-tracking and motivational components of the app. Finally, patients identified areas in which the app could be adapted to meet the needs of patients with ALD, such as providing information on the medical implications of an ALD diagnosis and how to care for their liver as well as connecting individuals with ALD to one another via a peer-to-peer support forum. Rates of app use were high and sustained across the entire study, with participants using the app a little more than half the days during the study on average and with 100% (11/11) of participants logging in each week. Conclusions: Our results highlight the need for convenient access to resources for alcohol cessation after ALD diagnosis and support the potential of an mHealth approach to integrate recovery support into care for ALD. Our findings also highlight the ways the alcohol cessation app should be modified to address ALD-specific concerns. %M 37966869 %R 10.2196/47404 %U https://formative.jmir.org/2023/1/e47404 %U https://doi.org/10.2196/47404 %U http://www.ncbi.nlm.nih.gov/pubmed/37966869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42194 %T Effectiveness of Reducing Craving in Alcohol Use Disorder Using a Serious Game (SALIENCE): Randomized Controlled Trial %A Weber,Antonia %A Shevchenko,Yury %A Gerhardt,Sarah %A Hoffmann,Sabine %A Kiefer,Falk %A Vollstädt-Klein,Sabine %+ Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, 68159, Germany, 49 1792011684, sabine.vollstaedt-klein@zi-mannheim.de %K alcohol approach bias %K alcohol attentional bias %K alcohol use disorder %K alcohol %K attention %K cognitive bias modification therapy %K craving %K cue-exposure therapy %K decision-making training %K decision-making %K incentive salience %K serious games %K therapy %K training %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders. Objective: This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated. Methods: In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions. Results: We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F1,47=4.31; P=.04), whereas the interaction effect was not statistically significant (F1,47=0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (β=4.12; t36=2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (β=.38; t36=3.01; P=.005) more than people with higher drinking in negative situations. Conclusions: The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation. Trial Registration: ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476 %M 37934561 %R 10.2196/42194 %U https://formative.jmir.org/2023/1/e42194 %U https://doi.org/10.2196/42194 %U http://www.ncbi.nlm.nih.gov/pubmed/37934561 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46008 %T Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study %A Prior,Katrina %A Salemink,Elske %A Piggott,Monique %A Manning,Victoria %A Wiers,Reinout W %A Teachman,Bethany A %A Teesson,Maree %A Baillie,Andrew J %A Mahoney,Alison %A McLellan,Lauren %A Newton,Nicola C %A Stapinski,Lexine A %+ Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell building (G02), Sydney, 2006, Australia, 61 286279032, katrina.prior@sydney.edu.au %K alcohol %K anxiety %K cognitive bias modification %K interpretation bias %K approach bias %K young adult %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample. Objective: This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use (“Re-Train Your Brain”) when delivered in conjunction with treatment as usual (TAU). Methods: The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the “integrated” Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the “alternating” Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline. Results: Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes. Conclusions: Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non–labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): RR2-10.2196/28667 %M 37878363 %R 10.2196/46008 %U https://formative.jmir.org/2023/1/e46008 %U https://doi.org/10.2196/46008 %U http://www.ncbi.nlm.nih.gov/pubmed/37878363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48245 %T Preliminary Clinical Outcomes of the Hello Sunday Morning Alcohol and Wellbeing Self-Assessment: Feasibility and Acceptability Study %A Fletcher,Kathryn %A Moran-Pryor,Alex %A Robert-Hendren,Dominique %+ Hello Sunday Morning, 103 Alexander Street Crows Nest NSW, Sydney, 2065, Australia, 61 1300 403 196, kat.fletcher@hellosundaymorning.org %K web-based %K screening %K alcohol use %K brief intervention %K well-being %K psychological distress %K digital health %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol-related injuries and diseases are a leading cause of morbidity and mortality worldwide. Early intervention is essential given the chronic, relapsing nature of alcohol use disorders. There is significant potential for widely accessible web-based screening tools to help individuals determine where they stand in terms of alcohol use and provide support recommendations. Screening and brief interventions (SBIs) provide individuals with a stigma-free opportunity to learn and think about the potential risks of drinking and prompt help-seeking behavior by incorporating behavior change techniques. Furthermore, as excessive alcohol use and mental health problems often occur concurrently, SBIs for both conditions simultaneously can potentially address a critical gap in alcohol and mental health treatment. Objective: We investigated the feasibility, acceptability, and clinical outcomes of participants completing the Alcohol and Wellbeing Self-assessment (A&WS), a web-based SBI. Methods: The A&WS is freely available on the Hello Sunday Morning website as part of an uncontrolled observational prospective study. Feasibility was assessed based on the number of respondents who commenced and subsequently completed the A&WS. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the A&WS to others. Clinical outcomes were measured in two ways: (1) self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) or psychological distress (Kessler Psychological Distress Scale score) over time and (2) help seeking—both self-reported and immediate web-based help seeking. Preliminary baseline data collected for the first 9 months (March 2022 to December 2022) of the study were reported, including the 3-month follow-up outcomes. Results: A total of 17,628 participants commenced the A&WS, and of these, 14,419 (81.8%) completed it. Of those 14,419 who completed the A&WS, 1323 (9.18%) agreed to participate in the follow-up research. Acceptability was high, with 78.46% (1038/1323) reporting high satisfaction levels overall; 95.62% (1265/1323) found the A&WS easy to use and would recommend the tool to others. The 1-, 2-, and 3-month follow-ups were completed by 28.57% (378/1323), 21.09% (279/1323), and 17.61% (233/1323) of the participants, respectively. Significant reductions in the Alcohol Use Disorders Identification Test Consumption subscale (P<.001) and Kessler Psychological Distress Scale scores (P<.001) were observed over the 3-month follow-up period. Conclusions: Our results suggest that the A&WS is a highly feasible and acceptable digital SBI that may support individuals in making changes to their alcohol consumption and improve their psychological well-being. In the absence of a control group, positive clinical outcomes cannot be attributed to the A&WS, which should now be subjected to a randomized controlled trial. This scalable, freely available tool has the potential to reach a large number of adults who might not otherwise access help while complementing the alcohol and mental health treatment ecosystem. %M 37874615 %R 10.2196/48245 %U https://formative.jmir.org/2023/1/e48245 %U https://doi.org/10.2196/48245 %U http://www.ncbi.nlm.nih.gov/pubmed/37874615 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49918 %T The DrinksRation Smartphone App for Modifying Alcohol Use Behaviors in UK Military Service Personnel at Risk of Alcohol-Related Harm: Protocol for a Randomized Controlled Trial %A King,Kate %A Leightley,Daniel %A Greenberg,Neil %A Fear,Nicola %+ Academic Department of Military General Practice, Research & Clinical Innovation, Defence Medical Services, ICT Centre, Birmingham Research Park, Vincent Drive, Birmingham, B152SQ, United Kingdom, 44 7901221593, kboddy@doctors.org.uk %K alcohol drinking %K alcohol brief intervention %K digital intervention %K military %D 2023 %7 13.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Consumption of alcohol is synonymous with military populations, and studies have shown that serving personnel drink more than age- and sex-matched civilian populations. While ingrained in the military culture, excessive alcohol use is associated with increased rates of disciplinary issues, sickness absence, and loss of productivity, as well as contributing to a burden of acute and chronic health problems. Alcohol brief interventions can reduce alcohol use in civilian populations, but there is a paucity of evidence relating to the effectiveness of similar interventions in military populations. The DrinksRation smartphone app was designed to have a basis in behavior change technique theory and focuses on providing interactive behavioral prompts tailored to a military population. It has previously been shown to be effective in a help-seeking veteran population. Objective: The primary aim of the Military DrinksRation randomized controlled trial study is to determine whether it is similarly effective in a serving military population. Methods: We compare the effectiveness of the DrinksRation smartphone app with treatment as usual for personnel identified at risk of alcohol-related harm using the Military DrinksRation study that is a 2-arm, single-blind, 1:1 randomized controlled trial of the UK Armed Forces population. It is hypothesized that the DrinksRation app will be more efficacious at reducing alcohol consumption compared to treatment as usual. Recruitment will be predominantly from routine, periodic dental inspections all service personnel regularly undertake, supplemented by recruitment from military-targeted media messaging. The primary outcome is the change in alcohol units consumed per week between baseline and day 84, measured using the timeline follow-back method. Secondary outcome measures are a change in the Alcohol Use Disorders Identification Test score, a change in the quality of life assessment, and a change in drinking motivations and app usability (intervention arm only) between baseline and day 84. A final data collection at 168 days will assess the persistence of any changes over a longer duration. Results: The study is expected to open in August 2023 and aims to enroll 728 participants to allow for a study sample size requirement of 218 per arm and a 40% attrition rate. It is expected to take up to 12 months to complete. The results will be published in 2024. Conclusions: The Military DrinksRation study will assess the efficacy of the smartphone app on changing alcohol use behaviors in service personnel. If a positive effect is shown, the UK Defence Medical Services would have an effective, evidence-based tool to use as part of an alcohol management clinical pathway, thereby providing better support for military personnel at risk of harm from alcohol drinking. Trial Registration: ISRCTN Registry 42646;. https://doi.org/10.1186/ISRCTN14977034 International Registered Report Identifier (IRRID): PRR1-10.2196/49918 %M 37831507 %R 10.2196/49918 %U https://www.researchprotocols.org/2023/1/e49918 %U https://doi.org/10.2196/49918 %U http://www.ncbi.nlm.nih.gov/pubmed/37831507 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47109 %T Transient Elastography and Video Recovery Narrative Access to Support Recovery From Alcohol Misuse: Development of a Novel Intervention for Use in Community Alcohol Treatment Services %A Rennick-Egglestone,Stefan %A Subhani,Mohsan %A Knight,Holly %A Jones,Katy A %A Hutton,Clare %A Jackson,Tracey %A Hutton,Matthew %A Wragg,Andrew %A Morling,Joanne R %A Sprange,Kirsty %A Ryder,Stephen D %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 82 ext 30926, stefan.egglestone@nottingham.ac.uk %K recovery narrative %K recovery story %K alcohol misuse %K alcohol use disorder %K feasibility trial %K complex intervention %K KLIFAD intervention %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mortality from alcohol-related liver disease has risen significantly for 3 decades. Transient elastography (TE) is a noninvasive test providing a numerical marker of liver disease. Preliminary evidence suggests that TE can reduce alcohol consumption. The KLIFAD (does knowledge of liver fibrosis affect high-risk drinking behavior?) study has developed a complex intervention wherein people receiving alcohol treatment are provided with access to TE, accompanied by scripted feedback tailored to their disease state, and access to video narratives describing alcohol misuse recovery after receiving TE. Recovery narratives are included due to preliminary evidence from mental health studies which suggest that access to digital narratives describing recovery from mental health problems can help people affected by mental health problems, including through mechanisms with the potential to be transferable to an alcohol treatment setting, for example, by increasing hope for the future, enabling learning from the experience of others, or promoting help-seeking behaviors. Objective: We aimed to develop the KLIFAD intervention to the point that it could be delivered in a feasibility trial and to produce knowledge relevant to clinicians and researchers developing interventions making use of biomarkers of disease. Methods: In research activity 1, standardized scripted feedback was developed by this study, and then iterated through focus groups with people who had experienced alcohol misuse and TE, and key alcohol workers with experience in delivering TE. We report critical design considerations identified through focus groups, in the form of sensitizing concepts. In research activity 2, a video production guide was coproduced to help produce impactful video-based recovery narratives, and a patient and public involvement (PPI) panel was consulted for recommendations on how best to integrate recovery narratives into an alcohol treatment setting. We report PPI recommendations and an overview of video form and content. Results: Through research activity 1, we learnt that patient feedback has not been standardized in prior use of TE, that receiving a numeric marker can provide an objective target that motivates and rewards recovery, and that key alcohol workers regularly tailor information to their clients. Through research activity 2, we developed a video production guide asking narrators what recovery means to them, what helped their recovery, and what they have learned about recovery. We produced 10 recovery narratives and collected PPI recommendations on maximizing impact and safety. These led to the production of unplanned videos presenting caregiver and clinician perspectives, and a choice to limit narrative availability to alcohol treatment settings, where support is available around distressing content. These choices have been evaluated through a feasibility randomized controlled trial [ISRCTN16922410]. Conclusions: Providing an objective target that motivates and rewards recovery is a candidate change mechanism for complex interventions integrating biomarkers of disease. Recovery narratives can contain distressing content; intervention developers should attend to safe usage. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054954 %M 37792440 %R 10.2196/47109 %U https://formative.jmir.org/2023/1/e47109 %U https://doi.org/10.2196/47109 %U http://www.ncbi.nlm.nih.gov/pubmed/37792440 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41833 %T Acceptability of Personal Sensing Among People With Alcohol Use Disorder: Observational Study %A Wyant,Kendra %A Moshontz,Hannah %A Ward,Stephanie B %A Fronk,Gaylen E %A Curtin,John J %+ Department of Psychology, University of Wisconsin-Madison, 1202 W Johnson St, Madison, WI, 53706, United States, 1 (608) 262 1040, jjcurtin@wisc.edu %K personal sensing %K digital therapeutics %K mobile health %K smartphone %K alcohol use disorder %K self-report %K alcohol use %K symptom monitoring %K mental health %K acceptability %K alcohol intake %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personal sensing may improve digital therapeutics for mental health care by facilitating early screening, symptom monitoring, risk prediction, and personalized adaptive interventions. However, further development and the use of personal sensing requires a better understanding of its acceptability to people targeted for these applications. Objective: We aimed to assess the acceptability of active and passive personal sensing methods in a sample of people with moderate to severe alcohol use disorder using both behavioral and self-report measures. This sample was recruited as part of a larger grant-funded project to develop a machine learning algorithm to predict lapses. Methods: Participants (N=154; n=77, 50% female; mean age 41, SD 11.9 years; n=134, 87% White and n=150, 97% non-Hispanic) in early recovery (1-8 weeks of abstinence) were recruited to participate in a 3-month longitudinal study. Participants were modestly compensated for engaging with active (eg, ecological momentary assessment [EMA], audio check-in, and sleep quality) and passive (eg, geolocation, cellular communication logs, and SMS text message content) sensing methods that were selected to tap into constructs from the Relapse Prevention model by Marlatt. We assessed 3 behavioral indicators of acceptability: participants’ choices about their participation in the study at various stages in the procedure, their choice to opt in to provide data for each sensing method, and their adherence to a subset of the active methods (EMA and audio check-in). We also assessed 3 self-report measures of acceptability (interference, dislike, and willingness to use for 1 year) for each method. Results: Of the 192 eligible individuals screened, 191 consented to personal sensing. Most of these individuals (169/191, 88.5%) also returned 1 week later to formally enroll, and 154 participated through the first month follow-up visit. All participants in our analysis sample opted in to provide data for EMA, sleep quality, geolocation, and cellular communication logs. Out of 154 participants, 1 (0.6%) did not provide SMS text message content and 3 (1.9%) did not provide any audio check-ins. The average adherence rate for the 4 times daily EMA was .80. The adherence rate for the daily audio check-in was .54. Aggregate participant ratings indicated that all personal sensing methods were significantly more acceptable (all P<.001) compared with neutral across subjective measures of interference, dislike, and willingness to use for 1 year. Participants did not significantly differ in their dislike of active methods compared with passive methods (P=.23). However, participants reported a higher willingness to use passive (vs active) methods for 1 year (P=.04). Conclusions: These results suggest that active and passive sensing methods are acceptable for people with alcohol use disorder over a longer period than has previously been assessed. Important individual differences were observed across people and methods, indicating opportunities for future improvement. %M 37639300 %R 10.2196/41833 %U https://mhealth.jmir.org/2023/1/e41833 %U https://doi.org/10.2196/41833 %U http://www.ncbi.nlm.nih.gov/pubmed/37639300 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45717 %T Stimulant Use Associated With Psychosocial Factors, HIV Risk, and Concurrent Hazardous Alcohol Use Among US Adults: Exploratory Cross-Sectional Questionnaire Study %A Lee,Frank %A Jain,Jennifer Payaal %A Duthely,Lunthita M %A Ikeda,Janet %A Santos,Glenn-Milo %+ Center on Substance Use and Health, San Francisco Department of Public Health, 25 Van Ness Ave, San Francisco, CA, 94102, United States, 1 8587361717, franklee@berkeley.edu %K Amazon Mechanical Turk %K stimulant use %K alcohol use %K craving %K men who have sex with men %K MSM %K depression %K affect %K HIV %K public health %K gender minority %K psychosocial %K addiction %D 2023 %7 17.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Stimulant use is a major public health problem that contributes to morbidity and mortality among men who have sex with men (MSM) in the United States. To reduce the harms associated with stimulant use, there is a need to identify the factors associated with stimulant use to inform interventions. Additionally, there is a need to use large crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to engage more individuals who use substances across the United States. Objective: We identified the correlates of stimulant use among people who use alcohol or stimulants in the United States recruited using MTurk. Methods: Participants who were aged ≥18 years in the United States and reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use were deemed eligible and recruited via the web platform MTurk. Participants completed a baseline survey, which assessed sociodemographics, psychosocial (ie, depression, affect, self-esteem, and stress) factors, substance use, and sexual behaviors. Data were collected and analyzed with STATA (version 17; StataCorp). Stratifying by MSM status, bivariate and multivariable logistic regression models were built in STATA to examine the correlates of stimulant use. Multivariable models controlled for age, race, health insurance, and relationship status. Results: Of 272 participants, 201 (73.9%) identified as male, 134 (49.2%) were MSM, 52 (19.1%) were from racial and ethnic minoritized communities, and 158 (58%) were in a relationship. The mean age was 36.10 (SD 10.3) years. A total of 40 (14.7%) participants reported stimulant use in the past 6 months. Factors significantly associated with stimulant use were being MSM (adjusted odds ratio [aOR] 4.61, 95% CI 1.97-10.81), a higher Alcohol Use Disorders Identification Test-Concise score (aOR 1.24, 95% CI 1.08-1.42), more intense cravings for alcohol in the past 24 hours (aOR 1.03, 95% CI 1.01-1.04), a higher depression score (aOR 1.06, 95% CI 1.01-1.12), a greater number of male partners in the last 6 months (aOR 1.32, 95% CI 1.08-1.61), a greater number of female partners in the last 6 months (aOR 1.42, 95% CI 1.04-1.92), and being diagnosed with a sexually transmitted infection (eg, syphilis, gonorrhea, chlamydia, herpes simplex virus, human papillomavirus, and other) in the last 6 months (aOR 14.61, 95% CI 3.45-61.87). Additionally, there was a significant additive interaction between MSM status and negative affect, such that the impact of negative affect on stimulant use was significantly greater among MSM compared with non-MSM (relative excess risk due to interaction 0.085, 95% CI 0.037-0.13). Conclusions: Interventions that address stimulant use should use evidence-based approaches that reduce negative affect, depression, and cravings for alcohol. Additionally, interventions should be customized for MSM populations. %M 37590045 %R 10.2196/45717 %U https://formative.jmir.org/2023/1/e45717 %U https://doi.org/10.2196/45717 %U http://www.ncbi.nlm.nih.gov/pubmed/37590045 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 6 %N %P e42532 %T Reducing Alcohol Use Before and After Surgery: Qualitative Study of Two Treatment Approaches %A Chapman,Lyndsay %A Ren,Tom %A Solka,Jake %A Bazzi,Angela R %A Borsari,Brian %A Mello,Michael J %A Fernandez,Anne C %+ Department of Psychiatry, University of Michigan Medical School, North Campus Research Complex, 2800 Plymouth Rd, Bldg 16, Ann Arbor, MI, 48109, United States, 1 734 763 9600, acfernan@umich.edu %K alcohol use %K brief intervention %K surgery %K preoperative %K alcohol use disorder %K alcohol %K substance use %K substance abuse %K postoperative %K perioperative %K counseling %K surgical %D 2023 %7 26.7.2023 %9 Original Paper %J JMIR Perioper Med %G English %X Background: High-risk alcohol use is a common preventable risk factor for postoperative complications, admission to intensive care, and longer hospital stays. Short-term abstinence from alcohol use (2 to 4 weeks) prior to surgery is linked to a lower likelihood of postoperative complications. Objective: The study aimed to explore the acceptability and feasibility of 2 brief counseling approaches to reduce alcohol use in elective surgical patients with high-risk alcohol use in the perioperative period. Methods: A semistructured interview study was conducted with a group of “high responders” (who reduced alcohol use ≥50% postbaseline) and “low responders” (who reduced alcohol use by ≤25% postbaseline) after their completion of a pilot trial to explore the acceptability and perceived impacts on drinking behaviors of the 2 counseling interventions delivered remotely by phone or video call. Interview transcripts were analyzed using thematic analysis. Results: In total, 19 participants (10 high responders and 9 low responders) from the parent trial took part in interviews. Three main themes were identified: (1) the intervention content was novel and impactful, (2) the choice of intervention modality enhanced participant engagement in the intervention, and (3) factors external to the interventions also influenced alcohol use. Conclusions: The findings support the acceptability of both high- and low-intensity brief counseling approaches. Elective surgical patients are interested in receiving alcohol-focused education, and further research is needed to test the effectiveness of these interventions in reducing drinking before and after surgery. Trial Registration: ClinicalTrials.gov NCT03929562; https://clinicaltrials.gov/ct2/show/NCT03929562 %M 37494103 %R 10.2196/42532 %U https://periop.jmir.org/2023/1/e42532 %U https://doi.org/10.2196/42532 %U http://www.ncbi.nlm.nih.gov/pubmed/37494103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45041 %T Predicting Fetal Alcohol Spectrum Disorders Using Machine Learning Techniques: Multisite Retrospective Cohort Study %A Oh,Sarah Soyeon %A Kuang,Irene %A Jeong,Hyewon %A Song,Jin-Yeop %A Ren,Boyu %A Moon,Jong Youn %A Park,Eun-Cheol %A Kawachi,Ichiro %+ Artificial Intelligence and Big-Data Convergence Center, Gil Medical Center, Gachon University College of Medicine, 191 Hambangmoe-ro, Yeonsu-gu, Incheon, 21936, Republic of Korea, 82 1021245754, moonjy@gachon.ac.kr %K fetal alcohol syndrome %K machine learning %K algorithm %K development %K fetal %K fetus %K maternal %K obstetric %K gynecology %K pregnant %K prenatal %K antenatal %K postnatal %K predict %K developmental disability %K prenatal alcohol exposure %K alcohol %K alcohol exposure %K developmental %K disability %K pregnancy %K age %K race %K diagnosis %K diagnostic %K treatment %D 2023 %7 18.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Fetal alcohol syndrome (FAS) is a lifelong developmental disability that occurs among individuals with prenatal alcohol exposure (PAE). With improved prediction models, FAS can be diagnosed or treated early, if not completely prevented. Objective: In this study, we sought to compare different machine learning algorithms and their FAS predictive performance among women who consumed alcohol during pregnancy. We also aimed to identify which variables (eg, timing of exposure to alcohol during pregnancy and type of alcohol consumed) were most influential in generating an accurate model. Methods: Data from the collaborative initiative on fetal alcohol spectrum disorders from 2007 to 2017 were used to gather information about 595 women who consumed alcohol during pregnancy at 5 hospital sites around the United States. To obtain information about PAE, questionnaires or in-person interviews, as well as reviews of medical, legal, or social service records were used to gather information about alcohol consumption. Four different machine learning algorithms (logistic regression, XGBoost, light gradient-boosting machine, and CatBoost) were trained to predict the prevalence of FAS at birth, and model performance was measured by analyzing the area under the receiver operating characteristics curve (AUROC). Of the total cases, 80% were randomly selected for training, while 20% remained as test data sets for predicting FAS. Feature importance was also analyzed using Shapley values for the best-performing algorithm. Results: Overall, there were 20 cases of FAS within a total population of 595 individuals with PAE. Most of the drinking occurred in the first trimester only (n=491) or throughout all 3 trimesters (n=95); however, there were also reports of drinking in the first and second trimesters only (n=8), and 1 case of drinking in the third trimester only (n=1). The CatBoost method delivered the best performance in terms of AUROC (0.92) and area under the precision-recall curve (AUPRC 0.51), followed by the logistic regression method (AUROC 0.90; AUPRC 0.59), the light gradient-boosting machine (AUROC 0.89; AUPRC 0.52), and XGBoost (AUROC 0.86; AURPC 0.45). Shapley values in the CatBoost model revealed that 12 variables were considered important in FAS prediction, with drinking throughout all 3 trimesters of pregnancy, maternal age, race, and type of alcoholic beverage consumed (eg, beer, wine, or liquor) scoring highly in overall feature importance. For most predictive measures, the best performance was obtained by the CatBoost algorithm, with an AUROC of 0.92, precision of 0.50, specificity of 0.29, F1 score of 0.29, and accuracy of 0.96. Conclusions: Machine learning algorithms were able to identify FAS risk with a prediction performance higher than that of previous models among pregnant drinkers. For small training sets, which are common with FAS, boosting mechanisms like CatBoost may help alleviate certain problems associated with data imbalances and difficulties in optimization or generalization. %M 37463016 %R 10.2196/45041 %U https://www.jmir.org/2023/1/e45041 %U https://doi.org/10.2196/45041 %U http://www.ncbi.nlm.nih.gov/pubmed/37463016 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48875 %T Mediators and Moderators in the Co-Occurring Anxiety and Alcohol Use Relationship: Protocol for a Systematic Review and Meta-Analysis %A Guckel,Tara %A Prior,Katrina %A Newton,Nicola Clare %A Stapinski,Lexine Ann %+ The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6 Jane Foss Russell Building GO2, Camperdown, 2006, Australia, 61 426200221, tara.guckel@sydney.edu.au %K alcohol use %K alcohol %K anxiety %K comorbidity %K drinking %K electronic databases %K mediator %K meta-analysis %K moderator %K prevention %K systematic review %D 2023 %7 13.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety and alcohol use commonly co-occur. Previous research has demonstrated the bidirectional and mutually reinforcing nature of this relationship, with an increasing body of research investigating the mediating and moderating mechanisms driving this association. Within the existing mediation and moderation research, however, there have been contrasting findings and, at times, null results among some population groups. Objective: This protocol outlines a systematic review and meta-analysis aiming to synthesize and clarify mediators and moderators in the anxiety-alcohol and alcohol-anxiety relationships. Methods: Systematic searches will be conducted in the electronic databases Medline, PsycINFO, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science to identify studies that investigated mediators and moderators of the relationship between anxiety and alcohol use, including clinical and subclinical levels. Studies that look at the relationship between anxiety and alcohol use outcomes, as well as alcohol use and anxiety outcomes, will be included in order to capture an in-depth understanding of the mechanisms driving the association in either direction. No limits will be placed on study year or study language. Included study designs will be observational studies, including cohort, cross-sectional, and longitudinal studies, and secondary analyses of randomized controlled trials reporting quantitative results. Selected studies will also have their reference lists hand-searched for other relevant papers. Study quality will be assessed with the Joanna Briggs Institute Checklists for Analytical Cross-Sectional Studies and Cohort Studies. Mediators and moderators will be narratively synthesized in line with the biopsychosocial framework, where results will be grouped into biological, psychological, and social or environmental factors. If the data are sufficiently homogeneous, a meta-analysis will be conducted with mediation and moderation analyses synthesized separately. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework will also be used to assess the strength of cumulative evidence. Results: Electronic database searches were conducted in September 2022. After duplicates were removed, a total of 7330 titles and abstracts were screened. Full-text reviewing is currently under way, with the results expected to be available by the end of 2023. Conclusions: Given the significant individual and societal impacts of co-occurring anxiety and alcohol use, this review will help clarify mechanisms linking these two concerns. Identified mechanisms, where possible, can then be targeted in prevention, early intervention, and treatment approaches to improve the outcomes for individuals experiencing co-occurring anxiety and alcohol use. Trial Registration: PROSPERO CRD42023358402; https://tinyurl.com/2m2e3enp International Registered Report Identifier (IRRID): DERR1-10.2196/48875 %M 37440283 %R 10.2196/48875 %U https://www.researchprotocols.org/2023/1/e48875 %U https://doi.org/10.2196/48875 %U http://www.ncbi.nlm.nih.gov/pubmed/37440283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43304 %T Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study %A Suzuki,Joji %A Loguidice,Frank %A Prostko,Sara %A Szpak,Veronica %A Sharma,Samata %A Vercollone,Lisa %A Garner,Carol %A Ahern,David %+ Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Rd, Room 4168, Boston, MA, 02474, United States, 1 6174557981, jsuzuki2@bwh.harvard.edu %K alcohol use disorder %K inpatient detoxification %K peer recovery coach %K smartphone app %K alcohol %K substance use %K substance abuse %K drinking %K recovery %K peer support %K detox %K coaching %K health app %K mobile health %K mHealth %K mobile app %K care coordination %K digitally %K detoxification %K Lifeguard %K peer recovery %K inpatient alcohol %D 2023 %7 5.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID-19 pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. Thus, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches—individuals with the lived experience of recovery who obtain training to be coaches—are increasingly used to assist individuals with AUD and may provide a degree of continuity during this transition. Objective: We aimed to evaluate the feasibility of using an existing care coordination app (Lifeguard) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care. Methods: This study was conducted on an American Society of Addiction Medicine–Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge, received daily prompts to complete a modified version of the brief addiction monitor (BAM). The BAM inquired about alcohol use, risky, and protective factors. The coach sent daily motivational texts and appointment reminders and checked in if BAM responses were concerning. Postdischarge follow-up continued for 30 days. The following feasibility outcomes were evaluated: (1) proportion of participants engaging with the coach before discharge, (2) proportion of participants and the number of days engaging with the coach after discharge, (3) proportion of participants and the number of days responding to BAM prompts, and (4) proportion of participants successfully linking with addiction treatment by 30-day follow-up. Results: All 10 participants were men, averaged 50.5 years old, and were mostly White (n=6), non-Hispanic (n=9), and single (n=8). Overall, 8 participants successfully engaged with the coach prior to discharge. Following discharge, 6 participants continued to engage with the coach, doing so on an average of 5.3 days (SD 7.3, range 0-20 days); 5 participants responded to the BAM prompts during the follow-up, doing so on an average of 4.6 days (SD 6.9, range 0-21 days). Half (n=5) successfully linked with ongoing addiction treatment during the follow-up. The participants who engaged with the coach post discharge, compared to those who did not, were significantly more likely to link with treatment (83% vs 0%, χ2=6.67, P=.01). Conclusions: The results demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving postdischarge outcomes. Trial Registration: ClinicalTrials.gov NCT05393544; https://www.clinicaltrials.gov/ct2/show/NCT05393544 %M 37405844 %R 10.2196/43304 %U https://formative.jmir.org/2023/1/e43304 %U https://doi.org/10.2196/43304 %U http://www.ncbi.nlm.nih.gov/pubmed/37405844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44400 %T mHealth Early Intervention to Reduce Posttraumatic Stress and Alcohol Use After Sexual Assault (THRIVE): Feasibility and Acceptability Results From a Pilot Trial %A Dworkin,Emily R %A Schallert,Macey %A Lee,Christine M %A Kaysen,Debra %+ Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St., Box 356560, Seattle, WA, 98195, United States, 1 206 221 6932, edworkin@uw.edu %K mobile health %K mHealth %K mobile apps %K prevention %K alcohol use %K trauma %K sexual violence %K rape %K mobile phone %D 2023 %7 4.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual assault is associated with increased risk for both posttraumatic stress (PTS) and alcohol misuse. Mobile health interventions have shown promise in addressing PTS and substance use in trauma survivors and might be a promising strategy in extending the reach of early interventions to individuals who have recently experienced trauma. Objective: This study assesses the feasibility and acceptability of THRIVE, a mobile health early intervention for recent survivors of sexual assault involving a cognitive behavioral app used daily over 21 days with weekly telephone coaching. Methods: Twenty adult female survivors of past–10-week sexual assault with elevated PTS and alcohol use were randomized to receive the THRIVE intervention as part of a pilot randomized controlled trial. We sought to understand feasibility by examining rates of completion of intervention activities and testing changes in participants’ self-reported knowledge of key intervention concepts from baseline to after the intervention. We assessed acceptability by collecting self-report ratings of satisfaction with the intervention and app usability in a follow-up survey. The coach took notes during coaching calls to track call content and record participant feedback; these notes were qualitatively analyzed to elaborate on the aforementioned domains. Results: Feasibility was demonstrated by moderate rates of activity completion: all participants at least opened the app, 19 (95%) of the 20 participants completed at least 1 cognitive behavioral exercise, and 16 (80%) of the 20 participants attended all 4 coaching calls. Participants completed cognitive behavioral exercises on an average of 10.40 (SD 6.52) out of 21 days. The coaching call notes documented participant comments that app-generated reminders increased completion rates. Feasibility was also demonstrated by the finding that knowledge changes occurred from baseline to after the intervention; this indicated that THRIVE was successful in conveying key concepts. Acceptability was demonstrated by high participant ratings of THRIVE’s usability; the ratings corresponded to a B+ usability grade. The coaching call notes documented that usability was increased by the coaching calls, the app exercises’ clarity, and the app exercises’ inclusion of suggestions; however, the coaching call notes also documented that some of the participants found aspects of the app exercises to be difficult or confusing. Acceptability was also demonstrated by participant ratings of satisfaction: most of the participants (15/16, 94%) rated the app as either moderately helpful or very helpful. The coaching call notes documented that the cognitive behavioral activity modules were seen as appealing and that the positive impact of the intervention contributed to participants’ satisfaction. Conclusions: These findings suggest that THRIVE is feasible and acceptable to survivors of recent sexual assault and that further testing of THRIVE is warranted. Trial Registration: ClinicalTrials.gov NCT03703258; https://clinicaltrials.gov/ct2/show/NCT03703258 %M 37402144 %R 10.2196/44400 %U https://formative.jmir.org/2023/1/e44400 %U https://doi.org/10.2196/44400 %U http://www.ncbi.nlm.nih.gov/pubmed/37402144 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46486 %T Assessing the Feasibility of Economic Approaches to Prevent Substance Abuse Among Adolescents: Protocol for a Mixed Methods Study %A Brathwaite,Rachel %A Mutumba,Massy %A Nanteza,Jacqueline %A Filiatreau,Lindsey M %A Migadde,Herbert %A Namatovu,Phionah %A Nabisere,Betina %A Mugisha,James %A Mwebembezi,Abel %A Ssewamala,Fred M %+ Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St Louis, MO, 63130, United States, 1 3149351775, rachel.brathwaite@wustl.edu %K adolescents living with HIV %K alcohol %K Sub-Saharan Africa %K substance use %K Uganda %D 2023 %7 14.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them. Objective: We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda’s fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them. Methods: This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group). Results: Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024. Conclusions: Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them. Trial Registration: ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865 International Registered Report Identifier (IRRID): PRR1-10.2196/46486 %M 37314844 %R 10.2196/46486 %U https://www.researchprotocols.org/2023/1/e46486 %U https://doi.org/10.2196/46486 %U http://www.ncbi.nlm.nih.gov/pubmed/37314844 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e38342 %T How Notifications Affect Engagement With a Behavior Change App: Results From a Micro-Randomized Trial %A Bell,Lauren %A Garnett,Claire %A Bao,Yihan %A Cheng,Zhaoxi %A Qian,Tianchen %A Perski,Olga %A Potts,Henry W W %A Williamson,Elizabeth %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 02035495303, h.potts@ucl.ac.uk %K mobile health %K mHealth %K digital health %K behavior change %K behavior change %K digital behavior change %K engagement %K micro-randomized trial %K randomized trial %K randomization %K just-in-time adaptive intervention %K adaptive intervention %K push notification %K notification %K excessive alcohol consumption %K smartphone app %K alcohol %K drinking %K drinker %K mobile phone %D 2023 %7 9.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Drink Less is a behavior change app to help higher-risk drinkers in the United Kingdom reduce their alcohol consumption. The app includes a daily notification asking users to “Please complete your drinks and mood diary,” yet we did not understand the causal effect of the notification on engagement nor how to improve this component of Drink Less. We developed a new bank of 30 new messages to increase users’ reflective motivation to engage with Drink Less. This study aimed to determine how standard and new notifications affect engagement. Objective: Our objective was to estimate the causal effect of the notification on near-term engagement, to explore whether this effect changed over time, and to create an evidence base to further inform the optimization of the notification policy. Methods: We conducted a micro-randomized trial (MRT) with 2 additional parallel arms. Inclusion criteria were Drink Less users who consented to participate in the trial, self-reported a baseline Alcohol Use Disorders Identification Test score of ≥8, resided in the United Kingdom, were aged ≥18 years, and reported interest in drinking less alcohol. Our MRT randomized 350 new users to test whether receiving a notification, compared with receiving no notification, increased the probability of opening the app in the subsequent hour, over the first 30 days since downloading Drink Less. Each day at 8 PM, users were randomized with a 30% probability of receiving the standard message, a 30% probability of receiving a new message, or a 40% probability of receiving no message. We additionally explored time to disengagement, with the allocation of 60% of eligible users randomized to the MRT (n=350) and 40% of eligible users randomized in equal number to the 2 parallel arms, either receiving the no notification policy (n=98) or the standard notification policy (n=121). Ancillary analyses explored effect moderation by recent states of habituation and engagement. Results: Receiving a notification, compared with not receiving a notification, increased the probability of opening the app in the next hour by 3.5-fold (95% CI 2.91-4.25). Both types of messages were similarly effective. The effect of the notification did not change significantly over time. A user being in a state of already engaged lowered the new notification effect by 0.80 (95% CI 0.55-1.16), although not significantly. Across the 3 arms, time to disengagement was not significantly different. Conclusions: We found a strong near-term effect of engagement on the notification, but no overall difference in time to disengagement between users receiving the standard fixed notification, no notification at all, or the random sequence of notifications within the MRT. The strong near-term effect of the notification presents an opportunity to target notifications to increase “in-the-moment” engagement. Further optimization is required to improve the long-term engagement. International Registered Report Identifier (IRRID): RR2-10.2196/18690 %M 37294612 %R 10.2196/38342 %U https://mhealth.jmir.org/2023/1/e38342 %U https://doi.org/10.2196/38342 %U http://www.ncbi.nlm.nih.gov/pubmed/37294612 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39862 %T Leveraging Mobile Phone Sensors, Machine Learning, and Explainable Artificial Intelligence to Predict Imminent Same-Day Binge-drinking Events to Support Just-in-time Adaptive Interventions: Algorithm Development and Validation Study %A Bae,Sang Won %A Suffoletto,Brian %A Zhang,Tongze %A Chung,Tammy %A Ozolcer,Melik %A Islam,Mohammad Rahul %A Dey,Anind K %+ Human-Computer Interaction and Human-Centered AI Systems Lab, AI for Healthcare Lab, School of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 4122658616, sbae4@stevens.edu %K alcohol consumption %K binge-drinking event %K BDE %K behavioral prediction model %K machine learning %K smartphone sensors %K passive sensing %K explainable artificial intelligence %K XAI %K just-in-time adaptive interventions %K JITAIs %K mobile phone %D 2023 %7 4.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital just-in-time adaptive interventions can reduce binge-drinking events (BDEs; consuming ≥4 drinks for women and ≥5 drinks for men per occasion) in young adults but need to be optimized for timing and content. Delivering just-in-time support messages in the hours prior to BDEs could improve intervention impact. Objective: We aimed to determine the feasibility of developing a machine learning (ML) model to accurately predict future, that is, same-day BDEs 1 to 6 hours prior BDEs, using smartphone sensor data and to identify the most informative phone sensor features associated with BDEs on weekends and weekdays to determine the key features that explain prediction model performance. Methods: We collected phone sensor data from 75 young adults (aged 21 to 25 years; mean 22.4, SD 1.9 years) with risky drinking behavior who reported their drinking behavior over 14 weeks. The participants in this secondary analysis were enrolled in a clinical trial. We developed ML models testing different algorithms (eg, extreme gradient boosting [XGBoost] and decision tree) to predict same-day BDEs (vs low-risk drinking events and non-drinking periods) using smartphone sensor data (eg, accelerometer and GPS). We tested various “prediction distance” time windows (more proximal: 1 hour; distant: 6 hours) from drinking onset. We also tested various analysis time windows (ie, the amount of data to be analyzed), ranging from 1 to 12 hours prior to drinking onset, because this determines the amount of data that needs to be stored on the phone to compute the model. Explainable artificial intelligence was used to explore interactions among the most informative phone sensor features contributing to the prediction of BDEs. Results: The XGBoost model performed the best in predicting imminent same-day BDEs, with 95% accuracy on weekends and 94.3% accuracy on weekdays (F1-score=0.95 and 0.94, respectively). This XGBoost model needed 12 and 9 hours of phone sensor data at 3- and 6-hour prediction distance from the onset of drinking on weekends and weekdays, respectively, prior to predicting same-day BDEs. The most informative phone sensor features for BDE prediction were time (eg, time of day) and GPS-derived features, such as the radius of gyration (an indicator of travel). Interactions among key features (eg, time of day and GPS-derived features) contributed to the prediction of same-day BDEs. Conclusions: We demonstrated the feasibility and potential use of smartphone sensor data and ML for accurately predicting imminent (same-day) BDEs in young adults. The prediction model provides “windows of opportunity,” and with the adoption of explainable artificial intelligence, we identified “key contributing features” to trigger just-in-time adaptive intervention prior to the onset of BDEs, which has the potential to reduce the likelihood of BDEs in young adults. Trial Registration: ClinicalTrials.gov NCT02918565; https://clinicaltrials.gov/ct2/show/NCT02918565 %M 36809294 %R 10.2196/39862 %U https://formative.jmir.org/2023/1/e39862 %U https://doi.org/10.2196/39862 %U http://www.ncbi.nlm.nih.gov/pubmed/36809294 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42523 %T Development of an Alcohol Refusal Training in Immersive Virtual Reality for Patients With Mild to Borderline Intellectual Disability and Alcohol Use Disorder: Cocreation With Experts in Addiction Care %A Langener,Simon %A Kolkmeier,Jan %A VanDerNagel,Joanne %A Klaassen,Randy %A van Manen,Jeannette %A Heylen,Dirk %+ Department of Human Media Interaction, University of Twente, Hallenweg 15, Enschede, 7522NH, Netherlands, 31 534898771, s.langener@utwente.nl %K virtual reality %K conversational agent %K embodied agent %K persuasion %K peer pressure %K addiction %K alcohol %K intellectual disability %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People with mild to borderline intellectual disability (MBID; IQ=50-85) are at risk for developing an alcohol use disorder (AUD). One factor contributing to this risk is sensitivity to peer pressure. Hence, tailored trainings are needed to practice alcohol refusal in impacted patients. Immersive virtual reality (IVR) appears promising to engage patients in dialogs with virtual humans, allowing to practice alcohol refusal realistically. However, requirements for such an IVR have not been studied for MBID/AUD. Objective: This study aims to develop an IVR alcohol refusal training for patients with MBID and AUD. In this work, we cocreated our peer pressure simulation with experienced experts in addiction care. Methods: We followed the Persuasive System Design (PSD) model to develop our IVR alcohol refusal training. With 5 experts from a Dutch addiction clinic for patients with MBID, we held 3 focus groups to design the virtual environment, persuasive virtual human(s), and persuasive dialog. Subsequently, we developed our initial IVR prototype and conducted another focus group to evaluate IVR and procedures for clinical usage, resulting in our final peer pressure simulation. Results: Our experts described visiting a friend at home with multiple friends as the most relevant peer pressure situation in the clinical setting. Based on the identified requirements, we developed a social-housing apartment with multiple virtual friends present. Moreover, we embedded a virtual man with generic appearance to exert peer pressure using a persuasive dialog. Patients can respond to persuasive attempts by selecting (refusal) responses with varying degrees of risk for relapse in alcohol use. Our evaluation showed that experts value a realistic and interactable IVR. However, experts identified lacking persuasive design elements, such as paralanguage, for our virtual human. For clinical usage, a user-centered customization is needed to prevent adverse effects. Further, interventions should be therapist delivered to avoid try-and-error in patients with MBID. Lastly, we identified factors for immersion, as well as facilitators and barriers for IVR accessibility. Conclusions: Our work establishes an initial PSD for IVR for alcohol refusal trainings in patients with MBID and AUD. With this, scholars can create comparable simulations by performing an analogous cocreation, replicate findings, and identify active PSD elements. For peer pressure, conveying emotional information in a virtual human’s voice (eg, paralanguage) seems vital. However, previous rapport building may be needed to ensure that virtual humans are perceived as cognitively capable entities. Future work should validate our PSD with patients and start developing IVR treatment protocols using interdisciplinary teams. %M 37099362 %R 10.2196/42523 %U https://formative.jmir.org/2023/1/e42523 %U https://doi.org/10.2196/42523 %U http://www.ncbi.nlm.nih.gov/pubmed/37099362 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44722 %T The Impacts of a Psychoeducational Alcohol Resource During Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety: Observational Study %A Peynenburg,Vanessa %A Sapkota,Ram P %A Lozinski,Tristen %A Sundström,Christopher %A Wilhelms,Andrew %A Titov,Nickolai %A Dear,Blake %A Hadjistavropoulos,Heather %+ University of Regina, 3737 Wascana Parkway, Regina, SK, Canada, 1 306 585 5133, hadjista@uregina.ca %K internet-delivered cognitive behavioral therapy %K transdiagnostic %K depression %K anxiety %K alcohol %K drinking %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Problematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown. Objective: This observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety. Methods: All patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients’ use and perceptions of the resource; client characteristics associated with reviewing the resource; and whether reviewing the resource was associated with decreases in clients’ alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into low-risk and hazardous drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores. Results: During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older (P=.004) and separated, divorced, or widowed (P<.001). Reviewers also consumed more weekly drinks (P<.001), scored higher on the AUDIT (P<.001), and were more likely to exhibit hazardous drinking (P<.001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores (P=.004), depression (P<.001), and anxiety (P<.001) over time; in contrast, there was no change in clients’ drinks per week over time (P=.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week. Conclusions: Overall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource. %M 37071454 %R 10.2196/44722 %U https://mental.jmir.org/2023/1/e44722 %U https://doi.org/10.2196/44722 %U http://www.ncbi.nlm.nih.gov/pubmed/37071454 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44275 %T Wearable Sensor and Mobile App–Based mHealth Approach for Investigating Substance Use and Related Factors in Daily Life: Protocol for an Ecological Momentary Assessment Study %A Takano,Ayumi %A Ono,Koki %A Nozawa,Kyosuke %A Sato,Makito %A Onuki,Masaki %A Sese,Jun %A Yumoto,Yosuke %A Matsushita,Sachio %A Matsumoto,Toshihiko %+ Department of Mental Health and Psychiatric Nursing, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan, 81 3 5803 5348, ayumi-takano@umin.ac.jp %K alcohol and drug use %K alcoholism %K digital health %K drug use %K ecological momentary assessment %K ecological momentary intervention %K electronic health record %K Fitbit %K machine learning %K mHealth %K mobile app %K self-monitoring %K wearables devices %D 2023 %7 11.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health technologies using mobile apps and wearable devices are a promising approach to the investigation of substance use in the real world and for the analysis of predictive factors or harms from substance use. Moreover, consecutive repeated data collection enables the development of predictive algorithms for substance use by machine learning methods. Objective: We developed a new self-monitoring mobile app to record daily substance use, triggers, and cravings. Additionally, a wearable activity tracker (Fitbit) was used to collect objective biological and behavioral data before, during, and after substance use. This study aims to describe a model using machine learning methods to determine substance use. Methods: This study is an ongoing observational study using a Fitbit and a self-monitoring app. Participants of this study were people with health risks due to alcohol or methamphetamine use. They were required to record their daily substance use and related factors on the self-monitoring app and to always wear a Fitbit for 8 weeks, which collected the following data: (1) heart rate per minute, (2) sleep duration per day, (3) sleep stages per day, (4) the number of steps per day, and (5) the amount of physical activity per day. Fitbit data will first be visualized for data analysis to confirm typical Fitbit data patterns for individual users. Next, machine learning and statistical analysis methods will be performed to create a detection model for substance use based on the combined Fitbit and self-monitoring data. The model will be tested based on 5-fold cross-validation, and further preprocessing and machine learning methods will be conducted based on the preliminary results. The usability and feasibility of this approach will also be evaluated. Results: Enrollment for the trial began in September 2020, and the data collection finished in April 2021. In total, 13 people with methamphetamine use disorder and 36 with alcohol problems participated in this study. The severity of methamphetamine or alcohol use disorder assessed by the Drug Abuse Screening Test-10 or the Alcohol Use Disorders Identification Test-10 was moderate to severe. The anticipated results of this study include understanding the physiological and behavioral data before, during, and after alcohol or methamphetamine use and identifying individual patterns of behavior. Conclusions: Real-time data on daily life among people with substance use problems were collected in this study. This new approach to data collection might be helpful because of its high confidentiality and convenience. The findings of this study will provide data to support the development of interventions to reduce alcohol and methamphetamine use and associated negative consequences. International Registered Report Identifier (IRRID): DERR1-10.2196/44275 %M 37040162 %R 10.2196/44275 %U https://www.researchprotocols.org/2023/1/e44275 %U https://doi.org/10.2196/44275 %U http://www.ncbi.nlm.nih.gov/pubmed/37040162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43165 %T Using the Pan American Health Organization Digital Conversational Agent to Educate the Public on Alcohol Use and Health: Preliminary Analysis %A Monteiro,Maristela Goldnadel %A Pantani,Daniela %A Pinsky,Ilana %A Hernandes Rocha,Thiago Augusto %+ Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, 525 23rd St NW, Washington, DC, 20037, United States, 1 2029743108, monteirm@paho.org %K alcohol use %K alcohol risk assessment %K digital health worker %K artificial intelligence %K health literacy %K digital health %K chatbot %K misinformation %K online health information %K digital health education %K alcohol use %K health risk %K COVID-19 %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There is widespread misinformation about the effects of alcohol consumption on health, which was amplified during the COVID-19 pandemic through social media and internet channels. Chatbots and conversational agents became an important piece of the World Health Organization (WHO) response during the COVID-19 pandemic to quickly disseminate evidence-based information related to COVID-19 and tobacco to the public. The Pan American Health Organization (PAHO) seized the opportunity to develop a conversational agent to talk about alcohol-related topics and therefore complement traditional forms of health education that have been promoted in the past. Objective: This study aimed to develop and deploy a digital conversational agent to interact with an unlimited number of users anonymously, 24 hours a day, about alcohol topics, including ways to reduce risks from drinking, that is accessible in several languages, at no cost, and through various devices. Methods: The content development was based on the latest scientific evidence on the impacts of alcohol on health, social norms about drinking, and data from the WHO and PAHO. The agent itself was developed through a nonexclusive license agreement with a private company (Soul Machines) and included Google Digital Flow ES as the natural language processing software and Amazon Web Services for cloud services. Another company was contracted to program all the conversations, following the technical advice of PAHO staff. Results: The conversational agent was named Pahola, and it was deployed on November 19, 2021, through the PAHO website after a launch event with high publicity. No identifiable data were used and all interactions were anonymous, and therefore, this was not considered research with human subjects. Pahola speaks in English, Spanish, and Portuguese and interacts anonymously with a potentially infinite number of users through various digital devices. Users were required to accept the terms and conditions to enable access to their camera and microphone to interact with Pahola. Pahola attracted good attention from the media and reached 1.6 million people, leading to 236,000 clicks on its landing page, mostly through mobile devices. Only 1532 users had a conversation after clicking to talk to Pahola. The average time users spent talking to Pahola was 5 minutes. Major dropouts were observed in different steps of the conversation flow. Some questions asked by users were not anticipated during programming and could not be answered. Conclusions: Our findings showed several limitations to using a conversational agent for alcohol education to the general public. Improvements are needed to expand the content to make it more meaningful and engaging to the public. The potential of chatbots to educate the public on alcohol-related topics seems enormous but requires a long-term investment of resources and research to be useful and reach many more people. %M 36961920 %R 10.2196/43165 %U https://formative.jmir.org/2023/1/e43165 %U https://doi.org/10.2196/43165 %U http://www.ncbi.nlm.nih.gov/pubmed/36961920 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44867 %T A Brief Intervention for Improving Alcohol Literacy and Addressing Harmful Alcohol Use Among Women Attending an Australian Breast Screening Service (Health4her): Protocol for a Hybrid Effectiveness-Implementation Trial %A Grigg,Jasmin %A Manning,Victoria %A Lockie,Darren %A Giles,Michelle %A Bell,Robin %A Stragalinos,Peta %A Bernard,Chloe %A Volpe,Isabelle %A Greenwood,Christopher J %A Smith,Liam %A Bragge,Peter %A Lubman,Dan I %+ Turning Point, Eastern Health, 110 Church Street, Richmond, Melbourne, 3121, Australia, 61 8413 8413, jasmin.grigg@monash.edu %K alcohol %K alcohol literacy %K alcohol brief intervention %K breast cancer %K women’s health %K randomized controlled trial %K hybrid effectiveness-implementation trial %K protocol %D 2023 %7 30.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol consumption is a major modifiable risk factor for female breast cancer, even in small amounts. However, awareness of this risk remains low. National breast screening programs are uniquely positioned to provide timely and targeted health information and behavior change strategies to improve alcohol literacy and reduce consumption. A breast screening service is a novel health care setting for brief alcohol intervention, with the potential for extensive reach. Objective: This study aimed to conduct a formative evaluation with breast screening service consumers to understand the need for, and acceptability of, brief alcohol intervention in the breast screening setting and collaboratively design a brief alcohol intervention (Health4Her); to test the effectiveness of Health4Her in improving knowledge of alcohol as a breast cancer risk factor (primary outcome), improving alcohol literacy, and reducing consumption among women attending a breast screening service; and to examine the implementation strategy through process evaluation. Methods: This was a hybrid type II effectiveness-implementation trial comprising a randomized controlled trial (RCT) alongside a mixed methods program evaluation guided by applicable elements of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework and Consolidated Framework for Implementation Research. Formative evaluation comprised a retrospective analysis of alcohol consumption data (n=49,240), a web-based survey (n=391), and focus groups and interviews (n=31) with breast screening service consumers. Women attending routine mammography, drinking at any level, were recruited to the single-site, double-blind RCT (n=558), and completed a baseline assessment before randomization (1:1) to receive Health4Her (alcohol brief intervention + lifestyle information) or control (lifestyle information) via animation on an iPad. Follow-up assessments were performed 4 and 12 weeks after randomization. The process evaluation included evaluation of trial administrative data, participant quantitative (n=497) and qualitative feedback (n=30), and site staff qualitative feedback (n=11). Results: This research was funded in March and May 2019. Data collection for the formative evaluation and trial recruitment occurred between January and April 2020 and February and August 2021, respectively, with finalization of follow-up data collection in December 2021. Quantitative process evaluation data were collected during trial implementation, and collection of participant and staff feedback was finalized in December 2021. Results of the retrospective analysis of alcohol consumption data from breast screening service consumers is anticipated to be published in March 2023 and the results of the RCT to be published in March 2023. Conclusions: This study is anticipated to generate new substantial knowledge on the alcohol consumption and literacy needs of women attending breast screening and the extent to which these can be addressed using a novel, tailored brief alcohol intervention. The study design permits the evaluation of the effectiveness and implementation of Health4Her to predict and facilitate uptake in breast screening services. Trial Registration: ClinicalTrials.gov NCT04715516; https://clinicaltrials.gov/ct2/show/NCT04715516 International Registered Report Identifier (IRRID): RR1-10.2196/44867 %M 36995739 %R 10.2196/44867 %U https://www.researchprotocols.org/2023/1/e44867 %U https://doi.org/10.2196/44867 %U http://www.ncbi.nlm.nih.gov/pubmed/36995739 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43653 %T Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial %A Karnik,Niranjan S %A Kuhns,Lisa M %A Hotton,Anna L %A Del Vecchio,Natascha %A McNulty,Moira %A Schneider,John %A Donenberg,Geri %A Keglovitz Baker,Kristin %A Diskin,Rose %A Muldoon,Abigail %A Rivera,Juan %A Summersett Williams,Faith %A Garofalo,Robert %+ Institute for Juvenile Research, Department of Psychiatry, University of Illinois Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 3122730185, nkarnik@uic.edu %K HIV prevention %K men who have sex with men %K transgender women %K alcohol intervention %K HIV %K gay %K homosexual %K MSM %K alcohol %K youth %K screening %K sexual behavior %K sexual behavior %K sexual risk %K risky %K pre-exposure prophylaxis %K prophylaxis %K prevention %K efficacy %K adolescent %K young adult %K testing %K risk %D 2023 %7 29.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction. Objective: The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention. Methods: Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy. Results: Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement. Conclusions: We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing. Trial Registration: ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-8154-6 %M 36989027 %R 10.2196/43653 %U https://mental.jmir.org/2023/1/e43653 %U https://doi.org/10.2196/43653 %U http://www.ncbi.nlm.nih.gov/pubmed/36989027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43986 %T Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial %A Ray,Anne E %A Mun,Eun-Young %A Lewis,Melissa A %A Litt,Dana M %A Stapleton,Jerod L %A Tan,Lin %A Buller,David B %A Zhou,Zhengyang %A Bush,Heather M %A Himelhoch,Seth %+ Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 151 Washington Ave, Lexington, KY, 40536, United States, 1 859 218 4944, anne.ray@uky.edu %K alcohol-related risky sexual behavior %K college students %K cross-tailored dynamic feedback %K effectiveness-implementation hybrid designs %K personalized feedback intervention %K underage drinking %D 2023 %7 20.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. Objective: The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF’s success to facilitate future scale-up in campus settings. Methods: This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. Results: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. Conclusions: This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. Trial Registration: ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903 International Registered Report Identifier (IRRID): DERR1-10.2196/43986 %M 36716301 %R 10.2196/43986 %U https://www.researchprotocols.org/2023/1/e43986 %U https://doi.org/10.2196/43986 %U http://www.ncbi.nlm.nih.gov/pubmed/36716301 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e41088 %T Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment %A Bertholet,Nicolas %A Schmutz,Elodie %A Cunningham,John A %A McNeely,Jennifer %A Gmel,Gerhard %A Daeppen,Jean-Bernard %A Grazioli,Véronique S %+ Addiction Medicine Unit, Department of Psychiatry, Lausanne University Hospital, Bugnon 23 A, Lausanne, 1011, Switzerland, 41 0213148400, Nicolas.Bertholet@chuv.ch %K app %K alcohol-related secondary prevention %K university students %K tertiary students %K qualitative %K alcohol %K mHealth %K mobile app %K smartphone %K mobile phone %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. Objective: This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. Methods: The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ≥18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. Results: The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: “General Acceptance of the App,” “Importance of the Targeted and Relevant App Content,” “Importance of Credibility,” “Importance of the App Usability,” “Importance of a Simple and Attractive Design,” “Importance of Notifications to Ensure App Use over Time.” Besides a general acceptance of the app, these themes reflected participants’ recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. Conclusions: Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. Trial Registration: ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4145-2 %M 36881448 %R 10.2196/41088 %U https://humanfactors.jmir.org/2023/1/e41088 %U https://doi.org/10.2196/41088 %U http://www.ncbi.nlm.nih.gov/pubmed/36881448 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40207 %T Perceptions of Using Instant Messaging Apps for Alcohol Reduction Intervention Among University Student Drinkers: Semistructured Interview Study With Chinese University Students in Hong Kong %A Chau,Siu Long %A Wong,Yiu Cheong %A Zeng,Ying Pei %A Lee,Jung Jae %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 5/F, Academic Building, 3 Sassoon Road, Pokfulam, Hong Kong, Hong Kong, 852 3917 6636, mpwang@hku.hk %K instant messaging apps %K mobile phone %K WhatsApp %K alcohol reduction intervention %K alcohol use %K university students %K young adults %K instant messaging %K alcohol reduction %K adverse lifestyle %K intervention %K health promotion %K text messages %K health behaviours %K health behaviors %K apps %D 2023 %7 27.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile instant messaging (IM) apps (eg, WhatsApp and WeChat) have been widely used by the general population and are more interactive than text-based programs (SMS text messaging) to modify unhealthy lifestyles. Little is known about IM app use for health promotion, including alcohol reduction for university students. Objective: This study aims to explore university student drinkers' perceptions of using IM apps for alcohol reduction as they had high alcohol exposure (eg, drinking invitations from peers and alcohol promotion on campus) and the proportion of IM app use in Hong Kong. Methods: A qualitative study was conducted with 20 Hong Kong Chinese university students (current drinkers) with Alcohol Use Disorder Identification test scores of ≥8 recruited using purposive sampling. Semistructured individual interviews were conducted from September to October 2019. Interview questions focused on drinking behaviors, quitting history, opinions toward IM app use as an intervention tool, perceived usefulness of IM apps for alcohol reduction, and opinions on the content and design of IM apps for alcohol reduction. Each interview lasted approximately 1 hour. All interviews were audio-taped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. Results: Participants considered IM apps a feasible and acceptable platform for alcohol reduction intervention. They preferred to receive IMs based on personalized problem-solving and drinking consequences with credible sources. Other perceived important components of instant messages included providing psychosocial support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of IM interventions, in which they preferred simple and concise messages, chat styles based on participants' preferences (eg, adding personalized emojis and stickers in the chat), and peers as counselors. Conclusions: Qualitative interviews with Chinese university student drinkers showed high acceptability, engagement, and perceived utility of IM apps for alcohol reduction intervention. IM intervention can be an alternative for alcohol reduction intervention apart from traditional text-based programs. The study has implications for developing the IM intervention for other unhealthy behaviors and highlights important topics that warrant future research, including substance use and physical inactivity. Trial Registration: ClinicalTrials.gov NCT04025151; https://clinicaltrials.gov/ct2/show/NCT04025151?term=NCT04025151 %M 36848207 %R 10.2196/40207 %U https://formative.jmir.org/2023/1/e40207 %U https://doi.org/10.2196/40207 %U http://www.ncbi.nlm.nih.gov/pubmed/36848207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44059 %T Direct and Indirect Predictors of Medication Adherence With Bipolar Disorder: Path Analysis %A Cohen,Bar %A Sixsmith,Andrew %A Pollock Star,Ariel %A Haglili,Ophir %A O'Rourke,Norm %+ Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Building M6, Room #308, P.O. Box 653, Be'er Sheva, 8421637, Israel, 972 8 6477301, ORourke@bgu.ac.il %K alcohol misuse %K bipolar disorder %K cognitive loss %K depression %K hypo/mania %K mania %K medication adherence %K mental health %K path analysis %K perceived cognitive failures %K polypharmacy %K psychiatric disorder %K psychosocial %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the efficacy of treatment and severity of symptoms, medication adherence by many with bipolar disorder (BD) is variable at best. This poses a significant challenge for BD care management. Objective: For this study, we set out to identify psychosocial and psychiatric predictors of medication adherence with BD. Methods: Using microtargeted social media advertising, we recruited an international sample of young and older adults with BD living in North America (Canada and the United States), Western Europe (eg, United Kingdom and Ireland), Australia and New Zealand (N=92). On average, participants were 55.35 (SD 9.65; range 22-73) years of age, had been diagnosed with BD 14.25 (SD 11.14; range 1-46) years ago, and were currently prescribed 2.40 (SD 1.28; range 0-6) psychotropic medications. Participants completed questionnaires online including the Morisky Medication Adherence Scale. Results: Medication adherence did not significantly differ across BD subtypes, country of residence, or prescription of lithium versus other mood stabilizers (eg, anticonvulsants). Path analyses indicate that alcohol misuse and subjective or perceived cognitive failures are direct predictors of medication adherence. BD symptoms, psychological well-being, and the number of comorbid psychiatric conditions emerged as indirect predictors of medication adherence via perceived cognitive failures. Conclusions: Alcohol misuse did not predict perceived cognitive failures. Nor did age predict medication adherence or cognitive failures. This is noteworthy given the 51-year age range of participants. That is, persons in their 20s with BD reported similar levels of medication adherence and perceived cognitive failures as those in their 60s. This suggests that perceived cognitive loss is a facet of adult life with BD, in contrast to the assumption that accelerated cognitive aging with BD begins in midlife. %M 36749623 %R 10.2196/44059 %U https://formative.jmir.org/2023/1/e44059 %U https://doi.org/10.2196/44059 %U http://www.ncbi.nlm.nih.gov/pubmed/36749623 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38713 %T Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor–Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily %A Richards,Veronica L %A Rajendran,Saahas %A Cook,Robert L %A Leeman,Robert F %A Wang,Yan %A Prins,Cindy %A Cook,Christa %+ Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, 320 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 867 2119, vlr5157@psu.edu %K transdermal %K biosensor %K alcohol %K intervention %K qualitative interview %K patient preferences %K mobile phone %D 2023 %7 2.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol misuse is highly prevalent in the United States and results in a huge financial and public health burden. Current alcohol reduction treatments are underused, and there is a critical need for innovation in the field. Transdermal alcohol biosensors measure alcohol use passively and continuously and may be helpful tools in alcohol interventions. To date, however, alcohol biosensors have not been widely used to directly intervene on alcohol use. There is a new wrist-worn biosensor that could be used to help people reduce their drinking, although it is unclear how best to incorporate such a device into an alcohol intervention. Objective: We aimed to identify desired features that would be acceptable and helpful in a wrist-worn biosensor–based alcohol intervention for adults who drink heavily. Methods: Participants were recruited through an alcohol contingency management study, a contact registry, and participant referral. To qualify, participants had to be aged at least 40 years, report drinking at least twice per week, and indicate interest in reducing their drinking. We conducted a semistructured interview with each participant via Zoom (Zoom Video Communications, Inc). The interview guide addressed general thoughts on the wrist-worn biosensor, how participants thought a wrist-worn biosensor could be used to help people quit or reduce drinking, types of information that participants would want to receive from the biosensor, how they would want to receive this information, and how they thought this information could be used to change their behavior. Interviews were transcribed verbatim and analyzed using thematic analysis. Results: The sample comprised 20 adults (mean age 55.1, SD 6.1 years; 11/20, 55%, women; and 17/20, 85%, Black). Of the 20 participants, 9 (45%) had previous experience with the Secure Continuous Remote Alcohol Monitor continuous alcohol monitoring ankle biosensor from participating in an alcohol contingency management study. The desirable features could be grouped into 5 main themes: features that would influence willingness to use the biosensor (it should look attractive and be both comfortable to wear and accessible), personalized messaging (personalized biosensor-based prompts and feedback could be helpful), preference for time wearing the biosensor (for some, just wearing the biosensor could have an intervention effect), sharing data with others (this was appealing to many but not to all), and mental health support (many felt that mental health support could be incorporated into the biosensor). Conclusions: Five main themes that would maximize interest in using a wrist-worn biosensor for alcohol intervention were identified. Taken together, the identified themes could inform the development of a just-in-time adaptive intervention that uses a wrist-worn biosensor to help adults who drink heavily reduce their alcohol use. %M 36729576 %R 10.2196/38713 %U https://www.jmir.org/2023/1/e38713 %U https://doi.org/10.2196/38713 %U http://www.ncbi.nlm.nih.gov/pubmed/36729576 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e34842 %T The Effects of a Web-Based Intervention to Reduce Alcohol Consumption Among Middle-Aged Women: Protocol for a Randomized Controlled Trial %A Miller,Mia %A Wright,Cassandra %A Kuntsche,Emmanuel %A Kuntsche,Sandra %+ Menzies School of Health Research, Charles Darwin University, John Mathews Building Royal Darwin Hospital Campus, 58 Rocklands Dr, Tiwi, Darwin, 0810, Australia, 61 (08) 8946 8600, mia.miller@menzies.edu.au %K alcohol consumption %K web-based %K online intervention %K middle-aged women %K Australia %K intervention %K alcohol research %K alcohol %K ecological momentary assessment %K EMA %D 2023 %7 2.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the last decade, alcohol consumption among middle-aged women (40-65 years old) in Australia increased, despite declines in overall population consumption. Web-based, brief interventions are promising for reducing alcohol consumption, with efficacy shown in a wide range of populations. However, no published interventions have been designed specifically for and tested with middle-aged women. Objective: This study aims to design and implement a web-based intervention intended to reduce alcohol consumption among middle-aged women. Methods: The study is a 3-arm randomized controlled trial with a web-based intervention plus ecological momentary assessment (EMA) group compared to an EMA-only and a pre-post only control group. The study is aimed at middle-aged women, defined as women aged between 40 and 65 years, who consume alcohol at least weekly or who have consumed 4 or more drinks on 1 occasion in the last month. The intervention aims to reduce alcohol consumption through 4 modules that provide information on the health impacts of alcohol, mindfulness, social influences, and alcohol marketing. Intervention participants will also fill out biweekly EMA assessments. The comparators are EMA-only and pre-post control only. The primary outcome is alcohol consumption at 8 weeks compared between groups. Secondary outcomes are awareness of alcohol-related harms, readiness to change alcohol consumption, health status, mental health, and social support. Results: Ethics approval for this project was received on September 11, 2019. The trial was registered on August 14, 2020. Recruitment has commenced, and the expected results will be available in 2022. Conclusions: This web-based intervention aims to reduce alcohol consumption among middle-aged women, a currently understudied cohort in alcohol research. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000814976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000814976 International Registered Report Identifier (IRRID): DERR1-10.2196/34842 %M 36729575 %R 10.2196/34842 %U https://www.researchprotocols.org/2023/1/e34842 %U https://doi.org/10.2196/34842 %U http://www.ncbi.nlm.nih.gov/pubmed/36729575 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44694 %T Developing and Implementing a Web-Based Relapse Prevention Psychotherapy Program for Patients With Alcohol Use Disorder: Protocol for a Randomized Controlled Trial %A Eadie,Jazmin %A Gutierrez,Gilmar %A Moghimi,Elnaz %A Stephenson,Callum %A Khalafi,Payam %A Nikjoo,Niloofar %A Jagayat,Jasleen %A Gizzarelli,Tessa %A Reshetukha,Taras %A Omrani,Mohsen %A Yang,Megan %A Alavi,Nazanin %+ Department of Psychiatry, Queen's University, 166 Brock street, Kingston, ON, K7L 5G2, Canada, 1 613 544 3310, nazanin.alavitabari@kingstonhsc.ca %K mental health %K alcohol use disorder %K psychotherapy %K eHealth %K cognitive behavioral therapy %K online %K internet %K treatment %K electronic care %D 2023 %7 25.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background:  Alcohol use disorder (AUD) is characterized by problematic alcohol use accompanied by clinically substantial distress. Patients with AUD frequently experience high relapse rates, and only 1 in 5 remain abstinent 12 months post treatment. Traditional face-to-face relapse prevention therapy (RPT) is a form of cognitive behavioral therapy (CBT) that examines one's situational triggers, maladaptive thought processes, self-efficacy, and motivation. However, access to this treatment is frequently limited due to its high cost, long waitlists, and inaccessibility. A web-based adaptation of RPT (e-RPT) could address these limitations by providing a more cost-effective and accessible delivery method for mental health care in this population. Objective:  This study protocol aims to establish the first academic e-RPT program to address AUD in the general population. The primary objective of this study is to compare the efficacy of e-RPT to face-to-face RPT in decreasing relapse rates. The secondary objective is to assess the effects of e-RPT on quality of life, self-efficacy, resilience, and depressive symptomatology. The tertiary objective is to evaluate the cost-effectiveness of e-RPT compared to face-to-face RPT. Methods:  Adult participants (n=60) with a confirmed diagnosis of AUD will be randomly assigned to receive 10 sessions of e-RPT or face-to-face RPT. e-RPT will consist of 10 predesigned modules and homework with asynchronous, personalized feedback from a therapist. Face-to-face RPT will comprise 10 one-hour face-to-face sessions with a therapist. The predesigned modules and the face-to-face sessions will present the same content and structure. Self-efficacy, resilience, depressive symptomatology, and alcohol consumption will be measured through various questionnaires at baseline, amid treatment, and at the end of treatment. Results:  Participant recruitment is expected to begin in October 2022 through targeted advertisements and physician referrals. Completed data collection and analysis are expected to conclude by October 2023. Outcome data will be assessed using linear and binomial regression (for continuous and categorical outcomes, respectively). Qualitative data will be analyzed using thematic analysis methods. Conclusions:  This study will be the first to examine the effectiveness of e-RPT compared to face-to-face RPT. It is posited that web-based care can present benefits in terms of accessibility and affordability compared to traditional face-to-face psychotherapy. Trial Registration: ClinicalTrials.gov NCT05579210; https://clinicaltrials.gov/ct2/show/NCT05579210 International Registered Report Identifier (IRRID): PRR1-10.2196/44694 %M 36567076 %R 10.2196/44694 %U https://www.researchprotocols.org/2023/1/e44694 %U https://doi.org/10.2196/44694 %U http://www.ncbi.nlm.nih.gov/pubmed/36567076 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40210 %T Acceptability and Feasibility of Wearable Transdermal Alcohol Sensors: Systematic Review %A Brobbin,Eileen %A Deluca,Paolo %A Hemrage,Sofia %A Drummond,Colin %+ Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Addiction Science Building, 4 Windsor Walk, London, SE5 8BB, United Kingdom, 44 0207 836 545, eileen.brobbin@kcl.ac.uk %K alcohol consumption %K alcohol monitoring %K digital technology %K transdermal alcohol sensors %K wearables %K acceptability %K feasibility %K monitoring %K sensors %K real-time feedback %K health promotion %K alcohol intake %D 2022 %7 23.12.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Transdermal alcohol sensors (TASs) have the potential to be used to monitor alcohol consumption objectively and continuously. These devices can provide real-time feedback to the user, researcher, or health professional and measure alcohol consumption and peaks of use, thereby addressing some of the limitations of the current methods, including breathalyzers and self-reports. Objective: This systematic review aims to evaluate the acceptability and feasibility of the currently available TAS devices. Methods: A systematic search was conducted in CINAHL, EMBASE, Google Scholar, MEDLINE, PsycINFO, PubMed, and Scopus bibliographic databases in February 2021. Two members of our study team independently screened studies for inclusion, extracted data, and assessed the risk of bias. The study’s methodological quality was appraised using the Mixed Methods Appraisal Tool. The primary outcome was TAS acceptability. The secondary outcome was feasibility. The data are presented as a narrative synthesis. Results: We identified and analyzed 22 studies. Study designs included laboratory- and ambulatory-based studies, mixed designs, randomized controlled trials, and focus groups, and the length the device was worn ranged from days to weeks. Although views on TASs were generally positive with high compliance, some factors were indicated as potential barriers and there are suggestions to overcome these. Conclusions: There is a lack of research investigating the acceptability and feasibility of TAS devices as a tool to monitor alcohol consumption in clinical and nonclinical populations. Although preliminary evidence suggests their potential in short-term laboratory-based studies with volunteers, more research is needed to establish long-term daily use with other populations, specifically, in the clinical and the criminal justice system. Trial Registration: PROSPERO CRD42021231027; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231027 %M 36563030 %R 10.2196/40210 %U https://humanfactors.jmir.org/2022/4/e40210 %U https://doi.org/10.2196/40210 %U http://www.ncbi.nlm.nih.gov/pubmed/36563030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40730 %T Avoiding Under- and Overrecruitment in Behavioral Intervention Trials Using Bayesian Sequential Designs: Tutorial %A Bendtsen,Marcus %+ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 581 83, Sweden, 46 13 28 10 00, marcus.bendtsen@liu.se %K digital alcohol intervention %K Bayesian sequential design %K sample size %K randomized controlled trial %K trial recruitment %K behavioural intervention %K participant recruitment %K research participants %K research methods %K effect size %K trial procedure %D 2022 %7 16.12.2022 %9 Tutorial %J J Med Internet Res %G English %X Reducing research waste and protecting research participants from unnecessary harm should be top priorities for researchers studying interventions. However, the traditional use of fixed sample sizes exposes trials to risks of under- and overrecruitment by requiring that effect sizes be determined a priori. One mitigating approach is to adopt a Bayesian sequential design, which enables evaluation of the available evidence continuously over the trial period to decide when to stop recruitment. Target criteria are defined, which encode researchers’ intentions for what is considered findings of interest, and the trial is stopped once the scientific question is sufficiently addressed. In this tutorial, we revisit a trial of a digital alcohol intervention that used a fixed sample size of 2129 participants. We show that had a Bayesian sequential design been used, the trial could have ended after collecting data from approximately 300 participants. This would have meant exposing far fewer individuals to trial procedures, including being allocated to the waiting list control condition, and the evidence from the trial could have been made public sooner. %M 36525297 %R 10.2196/40730 %U https://www.jmir.org/2022/12/e40730 %U https://doi.org/10.2196/40730 %U http://www.ncbi.nlm.nih.gov/pubmed/36525297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42320 %T The Effect of the First UK COVID-19 Lockdown on Users of the Drink Less App: Interrupted Time Series Analysis of Sociodemographic Characteristics, Engagement, and Alcohol Reduction %A Oldham,Melissa %A Perski,Olga %A Loebenberg,Gemma %A Brown,Jamie %A Garnett,Claire %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Pl, London, WC1E 7HB, United Kingdom, 44 7507712530, m.oldham@ucl.ac.uk %K alcohol reduction %K COVID-19 %K digital intervention %K smartphone app %K United Kingdom %K alcohol %K app %K Drink Less %K engagement %K users %K lockdown %K female %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The first UK COVID-19 lockdown had a polarizing impact on drinking behavior and may have impacted engagement with digital interventions to reduce alcohol consumption. Objective: We examined the effect of lockdown on engagement, alcohol reduction, and the sociodemographic characteristics of users of the popular and widely available alcohol reduction app Drink Less. Methods: This was a natural experiment. The study period spanned 468 days between March 24, 2019, and July 3, 2020, with the introduction of UK lockdown measures beginning on March 24, 2020. Users were 18 years or older, based in the United Kingdom, and interested in drinking less. Interrupted time series analyses using generalized additive mixed models (GAMMs) were conducted for each outcome variable (ie, sociodemographic characteristics, app downloads and engagement levels, alcohol consumption, and extent of alcohol reduction) for existing (downloaded the app prelockdown) and new (downloaded the app during the lockdown) users of the app. Results: Among existing users of the Drink Less app, there were increases in the time spent on the app per day (B=0.01, P=.01), mean units of alcohol recorded per day (B>0.00 P=.02), and mean heavy drinking (>6 units) days (B>0.00, P=.02) during the lockdown. Previous declines in new app downloads plateaued during the lockdown (incidence rate ratio [IRR]=1.00, P=.18). Among new app users, there was an increase in the proportion of female users (B>0.00, P=.04) and those at risk of alcohol dependence (B>0.00, P=.01) and a decrease in the proportion of nonmanual workers (B>–0.00, P=.04). Among new app users, there were step increases in the mean number of alcohol units per day (B=20.12, P=.03), heavy-drinking days (B=1.38, P=.01), and the number of days the app was used (B=2.05, P=.02), alongside a step decrease in the percentage of available screens viewed (B=–0.03, P=.04), indicating users were using less of the intervention components within the app. Conclusions: Following the first UK lockdown, there was evidence of increases in engagement and alcohol consumption among new and existing users of the Drink Less app. %M 36240461 %R 10.2196/42320 %U https://www.jmir.org/2022/11/e42320 %U https://doi.org/10.2196/42320 %U http://www.ncbi.nlm.nih.gov/pubmed/36240461 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e32888 %T Excessive Drinking Among Men Who Have Sex With Men Recruited From Web-Based Resources: Cross-sectional Questionnaire Study %A Pérez-Romero,César %A Guerras,Juan-Miguel %A Hoyos,Juan %A Donat,Marta %A Barrio,Gregorio %A de la Fuente,Luis %A Palma,David %A García de Olalla,Patricia %A Belza,María-José %A , %+ Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Avenida Monforte de Lemos 5, Madrid, 28029, Spain, 34 918222699, guerrasmoreira@hotmail.com %K alcohol use %K men who have sex with men %K MSM %K dating apps or websites %K new recruitment methods %K Alcohol Use Disorders Identification Test %K AUDIT %K hazardous drinking %K harmful drinking %K binge drinking %K alcohol-related problems %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: US and Northern European studies have found a higher prevalence of alcohol-related problems among men who have sex with men (MSM) than among the general population of men (GPM). However, most of them relied on traditional sampling methods, not profiting from MSM dating apps and websites for recruitment. Besides, analogous comparisons in Southern Europe are lacking. Objective: This study aimed to compare several indicators of excessive drinking between MSM and GPM in Spain. Methods: Overall, 5862 MSM were recruited through dating apps or websites for the Méthysos Project, and 10,349 GPM were recruited using probability sampling via the Household Survey on Alcohol and Drugs in Spain from 2018 to 2020. The outcomes were the prevalence of hazardous or harmful drinking (Alcohol Use Disorders Identification Test [AUDIT] ≥8), hazardous drinking (AUDIT-Consumption ≥4), harmful drinking (AUDIT-Problem ≥4), regular hazardous drinking (>14 standard drinks per week), and monthly binge drinking. The prevalence of excessive drinking indicators was calculated for MSM and GPM and compared using the adjusted prevalence ratio (aPR). Two different aPRs and their 95% CIs were estimated using Poisson regression models with robust variance. The first was adjusted for sociodemographic characteristics, and the second was adjusted for the aforementioned covariates plus other drug use. Results: The prevalence of hazardous or harmful drinking was 15.6% (913/5862) among MSM versus 7.7% (902/10,349) among GPM. After adjusting for sociodemographic covariates, the risk was higher in MSM than in GPM for harmful or hazardous drinking (aPR 1.8, 95% CI 1.6-2.0), harmful drinking (aPR 2.3, 95% CI 2.0-2.7), and binge drinking (aPR 1.7, 95% CI 1.5-1.9); the same in both populations for hazardous drinking (aPR 0.9, 95% CI 0.9-1.0); and higher in GPM than in MSM for regular hazardous drinking (aPR 0.7, 95% CI 0.6-0.9). The relative excess risk of harmful drinking and binge drinking among MSM tended to increase with increasing education level and size of the place of residence, and the opposite was true for the deficit risk in regular hazardous drinking. Additional adjustment for other drug use greatly buffered the relative excess risk in harmful drinking and binge drinking in MSM, while it deepened its deficit risk in regular hazardous drinking. Conclusions: The use of web-based resources allowed recruiting a large sample of MSM. The risk of hazardous or harmful drinking was 80% greater in MSM than in GPM, which was mainly because of the higher risk of harmful drinking and binge drinking among MSM. Nearly 1 in 6 MSM would benefit from early brief alcohol intervention procedures. The subgroup with harmful or binge drinking combined with other drug use is an important contributor to excess MSM risk in hazardous or harmful drinking and must be a priority target for harm reduction interventions. %M 36315235 %R 10.2196/32888 %U https://publichealth.jmir.org/2022/10/e32888 %U https://doi.org/10.2196/32888 %U http://www.ncbi.nlm.nih.gov/pubmed/36315235 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e42535 %T Examining Emailed Feedback as Boosters After a College Drinking Intervention Among Fraternities and Sororities: Rationale and Protocol for a Remote Controlled Trial (Project Greek) %A Braitman,Abby L %A Shipley,Jennifer L %A Strowger,Megan %A Ayala Guzman,Rachel %A Whiteside,Alina %A Bravo,Adrian J %A Carey,Kate B %+ Department of Psychology, Old Dominion University, 250 Mills Godwin Building, Old Dominion University, Norfolk, VA, 23529, United States, 1 757 683 3708, abraitma@odu.edu %K college drinking %K fraternities %K sororities %K web-based intervention %K boosters %D 2022 %7 28.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: College students involved in Greek life (ie, members of fraternities and sororities) tend to engage in more high-risk alcohol use and experience more negative consequences than those not involved in Greek life. Web-based alcohol interventions, such as Alcohol eCHECKUP TO GO, have been successful in reducing alcohol use and consequences among the general college student population, but interventions targeting alcohol reduction among those involved in Greek life have had limited success. Booster emails including personalized feedback regarding descriptive norms and protective behavioral strategies have shown potential in increasing the effectiveness of web-based interventions among college drinkers. Studies are needed to determine the efficacy of these boosters among those involved in Greek life. Objective: The primary objective of this study is to assess the efficacy of booster emails sent to Greek life students who complete Alcohol eCHECKUP TO GO. Specifically, we expect that participants who receive the booster emails will reduce their alcohol consumption and related problems (primary aim 1), reduce perceived peer drinking, and increase the number of protective behavioral strategies they use over time (primary aim 2) relative to those who do not receive boosters. Contingent upon finding the emailed booster efficacious and sufficient enrollment of members from each organization, an exploratory aim is to examine social mechanisms of change (ie, through selection vs socialization). Methods: This study is a remote, controlled intervention trial following participants for up to 6 months. Participants must be aged at least 18 years, undergraduate students, and members of a participating fraternity or sorority. Eligible participants complete a web-based baseline survey to assess their alcohol consumption behaviors and beliefs, including norms and protective behavioral strategies, and information about their social networks. After completing the baseline survey, they participate in the web-based intervention. Follow-up surveys are sent 1, 3, and 6 months after the intervention. Those in the booster condition also receive emails containing personalized feedback at 2 weeks and 14 weeks after the intervention. Latent growth models and R-Simulation Investigation for Empirical Network Analysis will be used to analyze the data. Results: As of September 2022, we have enrolled 18 participants from 2 fraternities and 2 sororities, and they have completed the baseline survey. Overall, 72% (13/18) of participants have completed the 1-month follow-up. Enrollment will continue through December 2022. Conclusions: This study aims to examine the effectiveness of personalized feedback booster emails sent after an alcohol intervention among members of college Greek life. A secondary, exploratory aim is to provide information about social mechanisms of change (if possible). The current methodology targets whole network recruitment, with chapter presidents serving as gatekeepers and facilitators. Unique challenges of recruiting whole networks and working with campus administrators are discussed. Trial Registration: ClinicalTrials.gov NCT05107284; https://clinicaltrials.gov/ct2/show/NCT05107284 International Registered Report Identifier (IRRID): DERR1-10.2196/42535 %M 36306162 %R 10.2196/42535 %U https://www.researchprotocols.org/2022/10/e42535 %U https://doi.org/10.2196/42535 %U http://www.ncbi.nlm.nih.gov/pubmed/36306162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e35926 %T A Smartphone Physical Activity App for Patients in Alcohol Treatment: Single-Arm Feasibility Trial %A Abrantes,Ana M %A Meshesha,Lidia Z %A E Blevins,Claire %A Battle,Cynthia L %A Lindsay,Clifford %A Marsh,Eliza %A Feltus,Sage %A Buman,Matthew %A Agu,Emmanuel %A Stein,Michael %+ Butler Hospital, 345 Blackstone Blvd, Providence, RI, 02906, United States, 1 4014556440, Ana_Abrantes@Brown.edu %K alcohol use disorder %K AUD %K physical activity %K smartphone app %K Fitbit %K feasibility study %K mobile phone %D 2022 %7 19.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) is a significant public health concern worldwide. Alcohol consumption is a leading cause of death in the United States and has a significant negative impact on individuals and society. Relapse following treatment is common, and adjunct intervention approaches to improve alcohol outcomes during early recovery continue to be critical. Interventions focused on increasing physical activity (PA) may improve AUD treatment outcomes. Given the ubiquity of smartphones and activity trackers, integrating this technology into a mobile app may be a feasible, acceptable, and scalable approach for increasing PA in individuals with AUD. Objective: This study aims to test the Fit&Sober app developed for patients with AUD. The goals of the app were to facilitate self-monitoring of PA engagement and daily mood and alcohol cravings, increase awareness of immediate benefits of PA on mood and cravings, encourage setting and adjusting PA goals, provide resources and increase knowledge for increasing PA, and serve as a resource for alcohol relapse prevention strategies. Methods: To preliminarily test the Fit&Sober app, we conducted an open pilot trial of patients with AUD in early recovery (N=22; 13/22, 59% women; mean age 43.6, SD 11.6 years). At the time of hospital admission, participants drank 72% of the days in the last 3 months, averaging 9 drinks per drinking day. The extent to which the Fit&Sober app was feasible and acceptable among patients with AUD during early recovery was examined. Changes in alcohol consumption, PA, anxiety, depression, alcohol craving, and quality of life were also examined after 12 weeks of app use. Results: Participants reported high levels of satisfaction with the Fit&Sober app. App metadata suggested that participants were still using the app approximately 2.5 days per week by the end of the intervention. Pre-post analyses revealed small-to-moderate effects on increase in PA, from a mean of 5784 (SD 2511) steps per day at baseline to 7236 (SD 3130) steps per day at 12 weeks (Cohen d=0.35). Moderate-to-large effects were observed for increases in percentage of abstinent days (Cohen d=2.17) and quality of life (Cohen d=0.58) as well as decreases in anxiety (Cohen d=−0.71) and depression symptoms (Cohen d=−0.58). Conclusions: The Fit&Sober app is an acceptable and feasible approach for increasing PA in patients with AUD during early recovery. A future randomized controlled trial is necessary to determine the efficacy of the Fit&Sober app for long-term maintenance of PA, ancillary mental health, and alcohol outcomes. If the efficacy of the Fit&Sober app could be established, patients with AUD would have a valuable adjunct to traditional alcohol treatment that can be delivered in any setting and at any time, thereby improving the overall health and well-being of this population. Trial Registration: ClinicalTrials.gov NCT02958280; https://www.clinicaltrials.gov/ct2/show/NCT02958280 %M 36260381 %R 10.2196/35926 %U https://formative.jmir.org/2022/10/e35926 %U https://doi.org/10.2196/35926 %U http://www.ncbi.nlm.nih.gov/pubmed/36260381 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e40215 %T Population Health Metrics During the Early Stages of the COVID-19 Pandemic: Correlative Pilot Study %A Severson,Marie A %A Cassada,David A %A Huber,Victor C %A Snow,Daniel D %A McFadden,Lisa M %+ Division of Basic Biomedical Sciences, University of South Dakota, 414 East Clark Street, Vermillion, SD, 57069, United States, 1 605 658 6476, lisa.mcfadden@usd.edu %K COVID-19 %K ethyl glucuronide %K wastewater %K stress %K helpline %D 2022 %7 17.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 has caused nearly 1 million deaths in the United States, not to mention job losses, business and school closures, stay-at-home orders, and mask mandates. Many people have suffered increased anxiety and depression since the pandemic began. Not only have mental health symptoms become more prevalent, but alcohol consumption has also increased during this time. Helplines offer important insight into both physical and mental wellness of a population by offering immediate, anonymous, cheap, and accessible resources for health and substance use disorders (SUD) that was unobstructed by many of the mandates of the pandemic. Further, the pandemic also launched the use of wastewater surveillance, which has the potential for tracking not only population infections but also consumption of substances such as alcohol. Objective: This study assessed the feasibility of using multiple public surveillance metrics, such as helpline calls, COVID-19 cases, and alcohol metabolites in wastewater, to better understand the need for interventions or public health programs in the time of a public health emergency. Methods: Ethanol metabolites were analyzed from wastewater collected twice weekly from September 29 to December 4, 2020, in a Midwestern state. Calls made to the helpline regarding housing, health care, and mental health/SUD were correlated with ethanol metabolites analyzed from wastewater samples, as well as the number of COVID-19 cases during the sampling period. Results: Correlations were observed between COVID-19 cases and helpline calls regarding housing and health care needs. No correlation was observed between the number of COVID-19 cases and mental health/SUD calls. COVID-19 cases on Tuesdays were correlated with the alcohol metabolite ethyl glucuronide (EtG). Finally, EtG levels were negatively associated with mental health/SUD helpline calls. Conclusions: Although helpline calls provided critical services for health care and housing-related concerns early in the pandemic, evidence suggests helpline calls for mental health/SUD-related concerns were unrelated to COVID-19 metrics. Instead, COVID metrics were associated with alcohol metabolites in wastewater. Although this research was formative, with continued and expanded monitoring of population metrics, such as helpline usage, COVID-19 metrics, and wastewater, strategies can be implemented to create precision programs to address the needs of the population. %M 36219745 %R 10.2196/40215 %U https://formative.jmir.org/2022/10/e40215 %U https://doi.org/10.2196/40215 %U http://www.ncbi.nlm.nih.gov/pubmed/36219745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e35015 %T Digital Health Screening in People With HIV in Uganda to Increase Alcohol Use Reporting: Qualitative Study on the Development and Testing of the Self-administered Digital Screener for Health %A Emenyonu,Nneka %A Kekibiina,Allen %A Woolf-King,Sarah %A Kyampire,Catherine %A Fatch,Robin %A Dawson-Rose,Carol %A Muyindike,Winnie %A Hahn,Judith %+ Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, 550 16th Street, UCSF Mission Hall, 3rd Floor, San Francisco, CA, 94158, United States, 1 6505751465, nneka.emenyonu@ucsf.edu %K unhealthy alcohol use %K HIV %K digital screening %K Uganda %K mobile phone %D 2022 %7 1.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol consumption is a critical driver of the HIV epidemic worldwide, particularly in sub-Saharan Africa, where unhealthy alcohol use and HIV are prevalent. Brief alcohol interventions are effective in reducing alcohol use; however, they depend on effective screening for unhealthy alcohol use, which is often underreported. Thus, there is a need to develop methods to improve reporting of unhealthy alcohol use as an essential step toward referral to brief alcohol interventions. Self-administered digital health screeners may improve reporting. Objective: This study aimed to develop and test a digital, easy-to-use self-administered health screener. The health screener was designed to be implemented in a busy, underresourced HIV treatment setting and used by patients with varying levels of literacy. Methods: We conducted a qualitative study at the Immune Suppression Syndrome (ISS) Clinic of Mbarara Regional Referral Hospital in Uganda to develop and test a digital self-administered health screener. The health screener included a training module and assessed behaviors regarding general health, HIV care, and mental health as well as sensitive topics such as alcohol use and sexual health. We conducted focus group discussions with clinicians and patients with HIV of the Mbarara ISS Clinic who consumed alcohol to obtain input on the need for and content, format, and feasibility of the proposed screener. We iteratively revised a tablet-based screener with a subset of these participants, piloted the revised screener, and conducted individual semistructured in-depth interviews with 20 participants who had taken part in our previous studies on alcohol and HIV, including those who had previously underreported alcohol use and with low literacy. Results: A total of 45 people (n=5, 11% clinicians and n=40, 89% Mbarara ISS Clinic patients) participated in the study. Of the patient participants, 65% (26/40) were male, 43% (17/40) had low literacy, and all (40/40, 100%) had self-reported alcohol use in previous studies. Clinicians and patients cited benefits such as time savings, easing of staff burden, mitigation of patient-provider tension around sensitive issues, and information communication, but also identified areas of training required, issues of security of the device, and confidentiality concerns. Patients also stated fear of forgetting how to use the tablet, making mistakes, and losing information as barriers to uptake. In pilot tests of the prototype, patients liked the feature of a recorded voice in the local language and found the screener easy to use, although many required additional help and training from the study staff to complete the screener. Conclusions: We found a self-administered digital health screener to be appealing to patients and clinicians and usable in a busy HIV clinic setting, albeit with concerns about confidentiality and training. Such a screener may be useful in improving reporting of unhealthy alcohol use for referral to interventions. %M 36048519 %R 10.2196/35015 %U https://formative.jmir.org/2022/9/e35015 %U https://doi.org/10.2196/35015 %U http://www.ncbi.nlm.nih.gov/pubmed/36048519 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e34721 %T Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study %A Stapinski,Lexine Ann %A Nepal,Smriti %A Guckel,Tara %A Grummitt,Lucinda Rachel %A Chapman,Cath %A Lynch,Samantha Jane %A Lawler,Siobhan Maree %A Teesson,Maree %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6 Jane Foss Russell Building, G02, Camperdown, 2006, Australia, 61 0426200221, tara.guckel@sydney.edu.au %K alcohol and other drugs %K prevention %K adolescence %K schools %K drug prevention %K drug prevention website %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To prevent adolescents from initiating alcohol and other drug use and reduce the associated harms, effective strategies need to be implemented. Despite their availability, effective school-based programs and evidence-informed parental guidelines are not consistently implemented. The Positive Choices alcohol and other drug prevention initiative and website was launched to address this research and practice gap. The intended end users were school staff, parents, and school students. An 8-month postlaunch evaluation of the website showed that end users generally had positive feedback on the website’s usability, and following its use, most of them would consider the evidence base and effectiveness of drug education resources. This study extends this initial evaluation by examining the effectiveness and impact of the Positive Choices initiative over a 3-year period. Objective: Guided by the five dimensions of the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the study assessed the impact of the Positive Choices initiative in increasing awareness and implementation of evidence-based drug prevention. Methods: Data were collected between 2017 and 2019, using web-based evaluation and community awareness surveys. Data from the surveys were merged to examine reach, effectiveness, adoption, implementation, and maintenance using descriptive statistics. Google Analytics was used to further understand the reach of the website. The System Usability Scale was used to measure website usability. In addition, inductive analysis was used to assess the participants’ feedback about Positive Choices. Results: A total of 5 years after launching, the Positive Choices website has reached 1.7 million users. A national Australian campaign increased awareness from 8% to 14% among school staff and from 15% to 22% among parents after the campaign. Following a brief interaction with the website, most participants, who were not already following the recommended strategies, reported an intention to shift toward evidence-based practices. The System Usability Scale score for the website was good for both user groups. The participants intended to maintain their use of the Positive Choices website in the future. Both user groups reported high level of confidence in communicating about topics related to alcohol and other drugs. Participants’ suggestions for improvement informed a recent website update. Conclusions: The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information and resources widely. The findings highlight the importance of investing in ongoing maintenance and promotion to enhance awareness of health websites. With the increased use and acceptability of health education websites, teams should ensure that websites are easy to navigate, are engaging, use simple language, contain evidence-informed resources, and are supported by ongoing promotional activities. %M 36018617 %R 10.2196/34721 %U https://pediatrics.jmir.org/2022/3/e34721 %U https://doi.org/10.2196/34721 %U http://www.ncbi.nlm.nih.gov/pubmed/36018617 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e39086 %T Serious Games Supporting the Prevention and Treatment of Alcohol and Drug Consumption in Youth: Scoping Review %A Martínez-Miranda,Juan %A Espinosa-Curiel,Ismael Edrein %+ Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Andador 10, Ciudad del Conocimiento, Tepic, 63173, Mexico, 52 3111295930 ext 28602, jmiranda@cicese.mx %K serious games %K substance use %K alcohol and drugs %K young population %K mobile phone %D 2022 %7 25.8.2022 %9 Review %J JMIR Serious Games %G English %X Background: The consumption of alcohol and drugs, particularly in adolescents and young adults, has increased worldwide in the last several years, representing a significant public health challenge. Serious games have the potential to support preventive and treatment interventions for substance use, facilitating the acquisition of relevant knowledge and the motivation for changes in attitudes and behaviors regarding substance consumption. Objective: This scoping review aims to analyze a set of 7 relevant characteristics of current serious games designed to support the prevention and treatment of alcohol and drug consumption in adolescents and young adults—the substance addressed, the type of intervention, the theoretical basis, the computational techniques used, the mechanism for data security and privacy, the evaluation procedure followed, and the main results obtained. Methods: The review was performed by following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Data were retrieved from January 2010 to May 2022, using PubMed, Scopus (Elsevier), IEEE Xplore, and ACM Digital as data sources. The eligibility criteria included studies that described serious games designed to support the prevention or treatment of alcohol and drug consumption, targeted a population aged between 12 and 30 years, and included an evaluation procedure. Authors (JMM and IEEC) individually screened the titles and abstracts, and then full articles were reviewed for a final inclusion decision. Results: A total of 629 records were obtained, and 29 (4.6%) fulfilled the inclusion criteria. Most of the serious games (14/29, 48%) were focused on the prevention or treatment of alcohol use. The type of intervention that was the most supported was prevention (18/29, 62%), and most studies mentioned the theory, theoretical construct, or therapeutic technique used as a foundation (22/29, 76%). Most of the studies only provided information about the platform for execution (23/29, 79%), and few described the use of computational techniques, such as virtual reality or motion-based interaction (5/29, 17%). A small set of studies (10/29, 34%) explicitly mentioned how data security and privacy were addressed. Most of the reported evaluation protocols were pilot studies (11/29, 38%), followed by randomized controlled trials (10/29, 34%), and the reported results were positive in terms of acceptability, usability, and efficacy. However, more research is needed to assess long-term effects. Conclusions: Given the increasing interest in the use of serious games as digital interventions to support the prevention or treatment of substance use, knowing their main features is highly important. This review highlights whether and how current serious games incorporate 7 key features that are useful to consider for the further development of the area. %M 36006694 %R 10.2196/39086 %U https://games.jmir.org/2022/3/e39086 %U https://doi.org/10.2196/39086 %U http://www.ncbi.nlm.nih.gov/pubmed/36006694 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e32768 %T Exploring Factors Associated With Mobile Phone Behaviors and Attitudes Toward Technology Among Adults With Alcohol Use Disorder and Implications for mHealth Interventions: Exploratory Study %A Sillice,Marie Aline %A Stein,Michael %A Battle,Cynthia L %A Meshesha,Lidia Z %A Lindsay,Clifford %A Agu,Emmanuel %A Abrantes,Ana M %+ City University of New York School of Public Health & Health Policies, Center for Systems and Community Design, 55 W 125th St, New York, NY, 10027, United States, 1 646 364 0281, marie.sillice@sph.cuny.edu %K mobile phone use patterns %K substance use %K alcohol %K technological attitude %K alcohol use disorder %K demographic differences %K anxiety %K depression %K mobile phone %K patient attitude %D 2022 %7 15.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) is associated with severe chronic medical conditions and premature mortality. Expanding the reach or access to effective evidence-based treatments to help persons with AUD is a public health objective. Mobile phone or smartphone technology has the potential to increase the dissemination of clinical and behavioral interventions (mobile health interventions) that increase the initiation and maintenance of sobriety among individuals with AUD. Studies about how this group uses their mobile phone and their attitudes toward technology may have meaningful implications for participant engagement with these interventions. Objective: This exploratory study examined the potential relationships among demographic characteristics (race, gender, age, marital status, and income), substance use characteristics (frequency of alcohol and cannabis use), and clinical variables (anxiety and depression symptoms) with indicators of mobile phone use behaviors and attitudes toward technology. Methods: A sample of 71 adults with AUD (mean age 42.9, SD 10.9 years) engaged in an alcohol partial hospitalization program completed 4 subscales from the Media Technology Usage and Attitudes assessment: Smartphone Usage measures various mobile phone behaviors and activities, Positive Attitudes and Negative Attitudes measure attitudes toward technology, and the Technological Anxiety/Dependence measure assesses level of anxiety when individuals are separated from their phone and dependence on this device. Participants also provided demographic information and completed the Epidemiologic Studies Depression Scale (CES-D) and the Generalized Anxiety Disorder (GAD-7) scale. Lastly, participants reported their frequency of alcohol use over the past 3 months using the Drug Use Frequency Scale. Results: Results for the demographic factors showed a significant main effect for age, Smartphone Usage (P=.003; ηp2=0.14), and Positive Attitudes (P=.01; ηp2=0.07). Marital status (P=.03; ηp2=0.13) and income (P=.03; ηp2=0.14) were associated only with the Technological Anxiety and Dependence subscale. Moreover, a significant trend was found for alcohol use and the Technological Anxiety/Dependence subscale (P=.06; R2=0.02). Lastly, CES-D scores (P=.03; R2=0.08) and GAD symptoms (P=.004; R2=0.13) were significant predictors only of the Technological Anxiety/Dependence subscale. Conclusions: Findings indicate differences in mobile phone use patterns and attitudes toward technology across demographic, substance use, and clinical measures among patients with AUD. These results may help inform the development of future mHealth interventions among this population. %M 35969449 %R 10.2196/32768 %U https://formative.jmir.org/2022/8/e32768 %U https://doi.org/10.2196/32768 %U http://www.ncbi.nlm.nih.gov/pubmed/35969449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36969 %T Development of a Dynamically Tailored mHealth Intervention (What Do You Drink) to Reduce Excessive Drinking Among Dutch Lower-Educated Students: User-Centered Design Approach %A van Keulen,Hilde %A Voogt,Carmen %A Kleinjan,Marloes %A Kramer,Jeannet %A Andree,Rosa %A van Empelen,Pepijn %+ Department of Child Health, TNO (Netherlands Organization for Applied Scientific Research), Schipholweg 77-79, Leiden, 2316 ZL, Netherlands, 31 652803631, hilde.vankeulen@tno.nl %K alcohol consumption %K excessive drinking %K lower-educated students %K adolescents %K young adults %K dynamic tailoring %K mobile health intervention %K intervention mapping %K health promotion %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The high prevalence and adverse consequences of excessive drinking among lower-educated adolescents and young adults are public concerns in the Netherlands. Evidence-based alcohol prevention programs targeting adolescents and young adults with a low educational background are sparse. Objective: This study aimed to describe the planned process for the theory- and evidence-based development, implementation, and evaluation of a dynamically tailored mobile alcohol intervention, entitled What Do You Drink (WDYD), aimed at lower-educated students from secondary vocational education and training (Middelbaar Beroepsonderwijs in Dutch). Methods: We used intervention mapping as the framework for the systematic development of WDYD. It consists of the following six steps: assessing needs (step 1), formulating intervention objectives (step 2), translating theoretical methods into practical applications (step 3), integrating these into a coherent program (step 4), anticipating future implementation and adoption (step 5), and developing an evaluation plan (step 6). Results: Reducing excessive drinking among Dutch lower-educated students aged 16 to 24 years was defined as the desired behavioral outcome and subdivided into the following five program objectives: make the decision to reduce drinking, set realistic drinking goals, use effective strategies to achieve drinking goals, monitor own drinking behavior, and evaluate own drinking behavior and adjust goals. Risk awareness, motivation, social norms, and self-efficacy were identified as the most important and changeable individual determinants related to excessive drinking and, therefore, were incorporated into WDYD. Dynamic tailoring was selected as the basic intervention method for changing these determinants. A user-centered design strategy was used to enhance the fit of the intervention to the needs of students. The intervention was developed in 4 iterations, and the prototypes were subsequently tested with the students and refined. This resulted in a completely automated, standalone native app in which students received dynamically tailored feedback regarding their alcohol use and goal achievement via multiple sessions within 17 weeks based on diary data assessing their alcohol consumption, motivation, confidence, and mood. A randomized controlled trial with ecological momentary assessments will be used to examine the effects, use, and acceptability of the intervention. Conclusions: The use of intervention mapping led to the development of an innovative, evidence-based intervention to reduce excessive alcohol consumption among lower-educated Dutch adolescents and young adults. Developing an intervention based on theory and empirical evidence enables researchers and program planners to identify and retain effective intervention elements and to translate the intervention to new populations and settings. This is important, as black boxes, or poorly described interventions, have long been a criticism of the eHealth field, and effective intervention elements across mobile health alcohol interventions are still largely unknown. Trial Registration: Netherlands Trial Registry NTR6619; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6619 %M 35969428 %R 10.2196/36969 %U https://formative.jmir.org/2022/8/e36969 %U https://doi.org/10.2196/36969 %U http://www.ncbi.nlm.nih.gov/pubmed/35969428 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e40451 %T Risk and Resilience Pathways, Community Adversity, Decision-making, and Alcohol Use Among Appalachian Adolescents: Protocol for the Longitudinal Young Mountaineer Health Study Cohort %A Kristjansson,Alfgeir L %A Santilli,Annette M %A Mills,Rosalina %A Layman,Hannah M %A Smith,Megan L %A Mann,Michael J %A MacKillop,James %A James,Jack E %A Lilly,Christa L %A Kogan,Steven M %+ Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, United States, 1 3042933129, alkristjansson@hsc.wvu.edu %K adolescence %K middle school %K Appalachia %K caffeine %K alcohol use %K Young Mountaineer Health Study %K prevention %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use impairs psychosocial and neurocognitive development and increases the vulnerability of youth to academic failure, substance use disorders, and other mental health problems. The early onset of alcohol use in adolescents is of particular concern, forecasting substance abuse in later adolescence and adulthood. To date, evidence suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to the early onset of alcohol use. Objective: The objective of the Young Mountaineer Health Study is to investigate the influence of contextual and health behavior variables on the early onset of alcohol use among middle school–aged youth in resource-poor Appalachian rural communities. Methods: This is a program of prospective cohort studies of approximately 2200 middle school youth from a range of 20 rural, small town, and small city (population <30,000) public schools in West Virginia. Students are participating in 6 waves of data collection (2 per year) over the course of middle school (sixth to eighth grades; fall and spring) from 2020 to 2023. On the basis of an organizational arrangement, which includes a team of local data collection leaders, supervising contact agents in schools, and an honest broker system to deidentify data linked via school IDs, we are able to collect novel forms of data (self-reported data, teacher-reported data, census-linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school. Results: In the spring of 2021, 3 waves of student survey data, 2 waves of data from teachers, and a selection of archival school records were collected. Student survey wave 1 comprised 1349 (response rate 80.7%) participants, wave 2 comprised 1649 (response rate 87%) participants, and wave 3 comprised 1909 (response rate 83.1%) participants. The COVID-19 pandemic has had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system have proven vitally important in mitigating the potentially far greater negative impact of the pandemic on our data collection processes. Conclusions: The Young Mountaineer Health Study will use a large data set to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Furthermore, the program will test hypotheses regarding contextual factors (eg, parenting practices and neighborhood collective efficacy) that protect youth from community disadvantage and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. Data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic in 2020 and 2021. International Registered Report Identifier (IRRID): DERR1-10.2196/40451 %M 35930337 %R 10.2196/40451 %U https://www.researchprotocols.org/2022/8/e40451 %U https://doi.org/10.2196/40451 %U http://www.ncbi.nlm.nih.gov/pubmed/35930337 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33345 %T The Moderating Effect of Educational Background on the Efficacy of a Computer-Based Brief Intervention Addressing the Full Spectrum of Alcohol Use: Randomized Controlled Trial %A Staudt,Andreas %A Freyer-Adam,Jennis %A Meyer,Christian %A Bischof,Gallus %A John,Ulrich %A Baumann,Sophie %+ Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Fetscherstr 74, Dresden, 01307, Germany, 49 351 3177 452, andreas.staudt@tu-dresden.de %K drinking %K brief intervention %K screening %K school education %K public health %K prevention %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The alcohol-attributable burden of disease is high among socially disadvantaged individuals. Interventional efforts intending to have a public health impact should also address the reduction of social inequalities due to alcohol. Objective: The aim was to test the moderating role of educational background on the efficacy of a computer-based brief intervention addressing the full spectrum of alcohol use. Methods: We recruited 1646 adults from the general population aged 18 to 64 years (920 women, 55.9%; mean age 31 years; 574 with less than 12 years of school education, 34.9%) who reported alcohol use in the past year. The participants were randomly assigned a brief alcohol intervention or to assessment only (participation rate, 66.9%, 1646/2463 eligible persons). Recruitment took place in a municipal registry office in one German city. All participants filled out a self-administered, tablet-based survey during the recruitment process and were assessed 3, 6, and 12 months later by study assistants via computer-assisted telephone interviews. The intervention consisted of 3 computer-generated and individualized feedback letters that were sent via mail at baseline, month 3, and month 6. The intervention was based on the transtheoretical model of behavior change and expert system software that generated the feedback letters automatically according to previously defined decision rules. The outcome was self-reported change in number of alcoholic drinks per week over 12 months. The moderator was school education according to highest general educational degree (less than 12 years of education vs 12 years or more). Covariates were sex, age, employment, smoking, and alcohol-related risk level. Results: Latent growth modeling revealed that the intervention effect after 12 months was moderated by educational background (incidence rate ratio 1.38, 95% CI 1.08-1.76). Individuals with less than 12 years of school education increased their weekly alcohol use to a lesser extent when they received the intervention compared to assessment only (incidence rate ratio 1.30, 95% CI 1.05-1.62; Bayes factor 3.82). No difference was found between groups (incidence rate ratio 0.95, 95% CI 0.84-1.07; Bayes factor 0.30) among those with 12 or more years of school education. Conclusions: The efficacy of an individualized brief alcohol intervention was moderated by the participants’ educational background. Alcohol users with less than 12 years of school education benefited, whereas those with 12 or more years did not. People with lower levels of education might be more receptive to the behavior change mechanisms used by brief alcohol interventions. The intervention approach may support the reduction of health inequalities in the population at large if individuals with low or medium education can be reached. Trial Registration: German Clinical Trials Register DRKS00014274; https://www.drks.de/DRKS00014274 %M 35771621 %R 10.2196/33345 %U https://publichealth.jmir.org/2022/6/e33345 %U https://doi.org/10.2196/33345 %U http://www.ncbi.nlm.nih.gov/pubmed/35771621 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e38991 %T Evaluating the Efficacy of the Drinks:Ration Mobile App to Reduce Alcohol Consumption in a Help-Seeking Military Veteran Population: Randomized Controlled Trial %A Leightley,Daniel %A Williamson,Charlotte %A Rona,Roberto J %A Carr,Ewan %A Shearer,James %A Davis,Jordan P %A Simms,Amos %A Fear,Nicola T %A Goodwin,Laura %A Murphy,Dominic %+ Institute of Psychiatry, Psychology & Neuroscience, King’s Centre for Military Health Research, King's College London, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 78485351, daniel.leightley@kcl.ac.uk %K military %K veteran %K digital health %K alcohol misuse %K smartphone %K mobile health %K mHealth %K alcohol intervention %K digital intervention %K mental health %K smartphone application %K health intervention %K alcohol consumption %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol misuse is higher in the UK armed forces (AF) than in the general population. Research demonstrates that alcohol misuse persists after an individual leaves service, and this is notably the case for those who are seeking help for a mental health difficulty. Despite this, there is no work on testing a mobile alcohol reduction intervention that is personalized to support the UK AF. Objective: To address this gap, we investigated the efficacy of a 28-day brief alcohol intervention delivered via a mobile app in reducing weekly self-reported alcohol consumption among UK veterans seeking help for mental health difficulties. Methods: We performed a 2-arm participant-blinded randomized controlled trial (RCT). We compared a mobile app that included interactive features designed to enhance participants’ motivation and personalized messaging (intervention arm) with a version that provided government guidance on alcohol consumption only (control arm). Adults were eligible if they had served in the UK AF, were currently receiving or had received clinical support for mental health symptoms, and consumed 14 units (approximately 112 g of ethanol) or more of alcohol per week. Participants received the intervention or the control mobile app (1:1 ratio). The primary outcome was a change in self-reported weekly alcohol consumption between baseline and day 84 assessed using the validated Timeline Follow Back for Alcohol Consumption (TLFB) (prior 7 days), with a secondary outcome exploring self-reported change in the Alcohol Use Disorder Identification Test (AUDIT) score. Results: Between October 2020 and April 2021, 2708 individuals were invited to take part, of which 2531 (93.5%) did not respond, 54 (2%) were ineligible, and 123 (4.5%) responded and were randomly allocated (62, 50.4%, intervention; 61, 49.6%, control). At day 84, 41 (66.1%) participants in the intervention arm and 37 (60.7%) in the control arm completed the primary outcome assessment. Between baseline and day 84, weekly alcohol consumption reduced by –10.5 (95% CI –19.5 to –1.5) units in the control arm and –28.2 (95% CI –36.9 to –19.5) units in the intervention arm (P=.003, Cohen d=0.35). We also found a significant reduction in the AUDIT score of –3.9 (95% CI –6.2 to –1.6) in the intervention arm (Cohen d=0.48). Our primary and secondary effects did not persist over the longer term (day 168). Two adverse events were detected during the trial. Conclusions: This study examined the efficacy of a fully automated 28-day brief alcohol intervention delivered via a mobile app in a help-seeking sample of UK veterans with hazardous alcohol consumption. We found that participants receiving Drinks:Ration reduced their alcohol consumption more than participants receiving guidance only (at day 84). In the short term, we found Drinks:Ration is efficacious in reducing alcohol consumption in help-seeking veterans. Trial Registration: ClinicalTrials.gov NCT04494594; https://tinyurl.com/34em6n9f International Registered Report Identifier (IRRID): RR2-10.2196/19720 %M 35724966 %R 10.2196/38991 %U https://mhealth.jmir.org/2022/6/e38991 %U https://doi.org/10.2196/38991 %U http://www.ncbi.nlm.nih.gov/pubmed/35724966 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e32218 %T The Role of Agency and Threat Immediacy in Interactive Digital Narrative Fear Appeals for the Prevention of Excessive Alcohol Use: Randomized Controlled Trial %A Engelbrecht,Hendrik %A van der Laan,Laura Nynke %A van Enschot,Renske %A Krahmer,Emiel %+ Tilburg School of Humanities and Digital Sciences, Tilburg University, Warandelaan 2, Tilburg, 5037AB, Netherlands, 31 134663383, h.engelbrecht@tilburguniversity.edu %K young adults %K college students %K alcohol abuse %K drinking %K EPPM %K fear appeals %K agency %K serious games %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games for the training of prevention behaviors have been widely recognized as potentially valuable tools for adolescents and young adults across a variety of risk behaviors. However, the role of agency as a distinguishing factor from traditional health interventions has seldom been isolated and grounded in the persuasive health communication theory. Fear appeals have different effects on intentions to perform prevention behaviors depending on the immediacy of the consequences. Looking into how to increase self-efficacy beliefs for health behavior with distant consequences is the first step toward improving game-based interventions for adverse health outcomes. Objective: This study aimed to investigate the effect of agency on self-efficacy and the intention to drink less alcohol in an interactive digital narrative fear appeal. Furthermore, the communicated immediacy of threat outcomes was evaluated as a potential moderator of the effect of agency on self-efficacy. Methods: A web-based experimental study was conducted with university students (N=178). The participants were presented with a fear appeal outlining the consequences of excessive alcohol use in a fully automated web-based interactive narrative. Participants either had perceived control over the outcome of the narrative scenario (high agency) or no control over the outcome (low agency). The threat was either framed as a short-term (high immediacy) or long-term (low immediacy) negative health outcome resulting from the execution of the risk behavior (drinking too much alcohol). Results: A total of 123 valid cases were analyzed. Self-efficacy and intention to limit alcohol intake were not influenced by the agency manipulation. Self-efficacy was shown to be a significant predictor of behavioral intention. The immediacy of the threat did not moderate the relationship between agency and self-efficacy. Conclusions: Although agency manipulation was successful, we could not find evidence of an effect of agency or threat immediacy on self-efficacy. The implications for different operationalizations of different agency concepts, as well as the malleability of self-efficacy beliefs for long-term threats, are discussed. The use of repeated versus single interventions and different threat types (eg, health and social threats) should be tested empirically to establish a way forward for diversifying intervention approaches. Trial Registration: ClinicalTrials.gov NCT05321238; https://www.clinicaltrials.gov/ct2/show/NCT05321238 %M 35699976 %R 10.2196/32218 %U https://games.jmir.org/2022/2/e32218 %U https://doi.org/10.2196/32218 %U http://www.ncbi.nlm.nih.gov/pubmed/35699976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33793 %T General Demographics and Behavioral Patterns of Visitors Using a Self-help Website for Identification of and Intervention in Alcoholism and Common Mental Disorders in Suriname: Descriptive Study %A Jadnanansing,Raj %A Dekker,Jack %A Etwaroo,Kajal %A Dwarkasing,Rudi %A Lumsden,Vincent %A Bipat,Robbert %A Blankers,Matthijs %+ Psychiatrisch Centrum Suriname, L. Vriesdelaan, Paramaribo, Suriname, 597 8781948, raj.jadnanansing@pcs.sr %K eHealth %K mental health %K alcohol use disorder %K depression %K anxiety %K Facebook %K alcohol disorder %K alcohol %K self-help %K alcoholism %K Suriname %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health applications have been shown to be an accepted means to provide mental health information and advice in various high- and middle-income countries. Started in 2015, ehealth.sr was the first website to offer preventive information, self-tests, and unguided digital self-help for depression, anxiety symptoms, and problematic alcohol use in Suriname, an upper middle-income country in South America. Objective: This study aimed to assess the general demographics and behavioral patterns of the visitors of ehealth.sr, as well as to evaluate different promotional channels to attract the target audience to the website. Methods: Data collection for this study took place between August 2015 and December 2020. Conventional promotion channels such as newspaper and radio advertisements as well as social media advertisements were used to attract users to the website. The number of visits and activity on the website was registered using Google analytics and the website’s internal activity log. Results: On average, about 115 unique visitors accessed the website per month. The average number of visits to the website increased notably when social media advertisement campaigns were conducted (266 per month in 2018) compared to when traditional advertisements campaigns through papers, radio, and television were used (34 per month in 2019). Of the 1908 new visitors, 1418 (74.32%) were female. On average, visitors accessed 2 (SD 0.3) pages of the website and a session lasted 2.6 (SD 0.9) minutes. The most popular pages for intervention on the website were those for the mood or anxiety screening (731/942, 77.6%) as opposed to those for alcohol screening (211/942, 22.4%). People aged <45 years (on average, 2.2 pages per session for 3.2 minutes) made more use of the website than people aged ≥45 years (on average, 1.7 pages per session for 2 minutes). Conclusions: Promotion via social media led to more visitors to the website than newspaper or radio advertisements. Younger age groups and females visited the website more often. The pages on preventive information and brief self-tests were visited more frequently than the self-help modules. In general, user adherence to the website in terms of the average session duration and number of viewed pages per session is low and is a key point of concern for the successful implementation of digital mental health websites. %M 35679108 %R 10.2196/33793 %U https://formative.jmir.org/2022/6/e33793 %U https://doi.org/10.2196/33793 %U http://www.ncbi.nlm.nih.gov/pubmed/35679108 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e36239 %T #BingeDrinking—Using Social Media to Understand College Binge Drinking: Qualitative Study %A Cirillo,Madison N %A Halbert,Jennifer P %A Smith,Jessica Gomez %A Alamiri,Nour Sami %A Ingersoll,Karen S %+ Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 560 Ray C Hunt Dr, Charlottesville, VA, 22903, United States, 1 434 243 0581, KES7A@hscmail.mcc.virginia.edu %K college students %K binge drinking %K social media %K young adults %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hazardous drinking among college students persists, despite ongoing university alcohol education and alcohol intervention programs. College students often post comments or pictures of drinking episodes on social media platforms. Objective: This study aimed to understand one university’s student attitudes toward alcohol use by examining student posts about drinking on social media platforms and to identify opportunities to reduce alcohol-related harm and inform novel alcohol interventions. Methods: We analyzed social media posts from 7 social media platforms using qualitative inductive coding based on grounded theory to identify the contexts of student drinking and the attitudes and behaviors of students and peers during drinking episodes. We reviewed publicly available social media posts that referenced alcohol, collaborating with undergraduate students to select their most used platforms and develop locally relevant search terms; all posts in our data set were generated by students associated with a specific university. From the codes, we derived themes about student culture regarding alcohol use. Results: In total, 1151 social media posts were included in this study. These included 809 Twitter tweets, 113 Instagram posts, 100 Greekrank posts, 64 Reddit posts, 34 College Confidential posts, 23 Facebook posts, and 8 YouTube posts. Posts included both implicit and explicit portrayals of alcohol use. Across all types of posts reviewed, positive drinking attitudes were most common, followed by negative and then neutral attitudes, but valence varied by platform. Posts that portrayed drinking positively received positive peer feedback and indicate that drinking is viewed by students as an essential and positive part of university student culture. Conclusions: Social media provide a real-time picture of students’ behavior during their own and others’ heavy drinking. Posts portray heavy drinking as a normal part of student culture, reinforced by peers’ positive feedback on posts. Interventions for college drinking should help students manage alcohol intake in real time, provide safety information during alcohol use episodes, and raise student awareness of web-based privacy concerns and reputation management. Additional interventions for students, alumni, and parents are needed to address positive attitudes about and traditions of drinking. %M 35635740 %R 10.2196/36239 %U https://humanfactors.jmir.org/2022/2/e36239 %U https://doi.org/10.2196/36239 %U http://www.ncbi.nlm.nih.gov/pubmed/35635740 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35835 %T Acceptability, Adaptability, and Feasibility of a Novel Computer-Based Virtual Counselor–Delivered Alcohol Intervention: Focus Group and In-depth Interview Study Among Adults With HIV or Tuberculosis in Indian Clinical Settings %A Suryavanshi,Nishi %A Dhumal,Gauri %A Cox,Samyra R %A Sangle,Shashikala %A DeLuca,Andrea %A Santre,Manjeet %A Gupta,Amita %A Chander,Geetanjali %A Hutton,Heidi %+ Byramjee Jeejeebhoy Government Medical College–Johns Hopkins University Clinical Trials Unit, Jaiprakesh Narayan Road, Pune, 411001, India, 91 9823 248979, nishisuryavanshi@hotmail.com %K computer-based-intervention %K HIV/TB clinical setting %K alcohol use disorder (AUD) %K alcohol %K India %K HIV %K TB %K feasibility %K acceptability %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Unhealthy alcohol use is associated with increased morbidity and mortality among persons with HIV and tuberculosis (TB). Computer-based interventions (CBIs) can reduce unhealthy alcohol use, are scalable, and may improve outcomes among patients with HIV or TB. Objective: We assessed the acceptability, adaptability, and feasibility of a novel CBI for alcohol reduction in HIV and TB clinical settings in Pune, India. Methods: We conducted 10 in-depth interviews with persons with alcohol use disorder (AUD): TB (6/10), HIV (2/10), or HIV-TB co-infected (1/10) selected using convenience sampling method, no HIV or TB disease (1/10), 1 focus group with members of Alcoholics Anonymous (AA; n=12), and 2 focus groups with health care providers (HCPs) from a tertiary care hospital (n=22). All participants reviewed and provided feedback on a CBI for AUD delivered by a 3D virtual counselor. Qualitative data were analyzed using structured framework analysis. Results: The majority (9/10) of in-depth interview respondents were male, with median age 42 (IQR 38-45) years. AA focus group participants were all male (12/12), and HCP focus group participants were predominantly female (n=15). Feedback was organized into 3 domains: (1) virtual counselor acceptability, (2) intervention adaptability, and (3) feasibility of the CBI intervention in clinic settings. Overall, in-depth interview participants found the virtual counselor to be acceptable and felt comfortable honestly answering alcohol-related questions. All focus group participants preferred a human virtual counselor to an animal virtual counselor so as to potentially increase CBI engagement. Additionally, interaction with a live human counselor would further enhance the program’s effectiveness by providing more flexible interaction. HCP focus group participants noted the importance of adding information on the effects of alcohol on HIV and TB outcomes because patients were not viewed as appreciating these linkages. For local adaptation, more information on types of alcoholic drinks, additional drinking triggers, motivators, and activities to substitute for drinking alcohol were suggested by all focus group participants. Intervention duration (about 20 minutes) and pace were deemed appropriate. HCPs reported that the CBI provides systematic, standardized counseling. All focus group and in-depth interview participants reported that the CBI could be implemented in Indian clinical settings with assistance from HIV or TB program staff. Conclusions: With cultural tailoring to patients with HIV and TB in Indian clinical care settings, a virtual counselor–delivered alcohol intervention is acceptable and appears feasible to implement, particularly if coupled with person-delivered counseling. %M 35622406 %R 10.2196/35835 %U https://formative.jmir.org/2022/5/e35835 %U https://doi.org/10.2196/35835 %U http://www.ncbi.nlm.nih.gov/pubmed/35622406 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38543 %T A Parent-Based Intervention for Reducing High-risk Social Media Cognitions, Alcohol Use, and Negative Consequences Among Adolescents: Protocol for a Randomized Controlled Pilot Study %A Litt,Dana M %A Geusens,Femke %A Seamster,Abby %A Lewis,Melissa A %+ School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, EAD 709E, Fort Worth, TX, 76107, United States, 1 817 735 5453, dana.litt@unthsc.edu %K parent-based interventions %K alcohol %K pilot study %K social media %K mobile phone %D 2022 %7 17.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of adolescent alcohol use continues to be a public health concern. Although adolescents spend an increasing amount of time with their friends, parents remain an important source of support and continue to play a key role in the lives of their adolescents. Extensive research in this area has resulted in parent-based intervention (PBI) efforts to prevent or reduce adolescent alcohol use. However, one major limitation of PBIs is that they do not currently consider the large role that social media plays in adolescents’ lives and in relation to their alcohol use. We will add to the literature by developing and refining a web-based PBI designed to reduce both high-risk social media cognitions and alcohol use among adolescents. Objective: The central goal of the proposed study is to develop, refine, and pilot a web-based PBI to reduce both high-risk social media cognitions and alcohol use among adolescents. Methods: A total of 100 parent-teen dyads will be randomly assigned to one of the following 2 conditions: intervention or control. Parents in the intervention group will be given access to the web-based PBI and suggestions for working through the PBI modules with their teens. The parent-teen dyads will fill out 3 questionnaires: a baseline questionnaire, 1-month questionnaire, and 6-month questionnaire. Results: Recruitment and enrollment will begin in August 2022. Upon completion of the intervention trial, we will examine the feasibility, acceptability, and preliminary effect sizes of the newly developed web-based PBI. Conclusions: This study has the potential to open doors for future studies examining the clinical implications of an efficacious web-based PBI to reduce alcohol use and high-risk cognitions about alcohol displays on social media. Trial Registration: ClinicalTrials.gov NCT04333966; https://clinicaltrials.gov/ct2/show/NCT04333966 International Registered Report Identifier (IRRID): PRR1-10.2196/38543 %M 35579931 %R 10.2196/38543 %U https://www.researchprotocols.org/2022/5/e38543 %U https://doi.org/10.2196/38543 %U http://www.ncbi.nlm.nih.gov/pubmed/35579931 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e33037 %T Contrasting a Mobile App With a Conversational Chatbot for Reducing Alcohol Consumption: Randomized Controlled Pilot Trial %A Dulin,Patrick %A Mertz,Robyn %A Edwards,Alexandra %A King,Diane %+ Department of Psychology, University of Alaska Anchorage, 3211 Providence Drive, Anchorage, AK, 99508, United States, 1 907 786 1653, aehauser@alaska.edu %K alcohol %K hazardous drinking %K smartphone app %K chatbot %K brief intervention %K effectiveness %K utilization %K mobile phone %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps have shown considerable promise for reducing alcohol consumption among problem drinkers, but like many mobile health apps, they frequently report low utilization, which is an important limitation, as research suggests that effectiveness is related to higher utilization. Interactive chatbots have the ability to provide a conversational interface with users and may be more engaging and result in higher utilization and effectiveness, but there is limited research into this possibility. Objective: This study aimed to develop a chatbot alcohol intervention based on an empirically supported app (Step Away) for reducing drinking and to conduct a pilot trial of the 2 interventions. Included participants met the criteria for hazardous drinking and were interested in reducing alcohol consumption. The study assessed utilization patterns and alcohol outcomes across the 2 technology conditions, and a waitlist control group. Methods: Participants were recruited using Facebook advertisements. Those who met the criteria for hazardous consumption and expressed an interest in changing their drinking habits were randomly assigned to three conditions: the Step Away app, Step Away chatbot, and waitlist control condition. Participants were assessed on the web using the Alcohol Use Disorders Identification Test, Adapted for Use in the United States, Readiness to Change Questionnaire, Short Inventory of Problems-Revised, and Timeline Followback at baseline and at 12 weeks follow-up. Results: A total of 150 participants who completed the baseline and follow-up assessments were included in the final analysis. ANOVA results indicated that participants in the 3 conditions changed their drinking from baseline to follow-up, with large effect sizes noted (ie, η2=0.34 for change in drinks per day across conditions). However, the differences between groups were not significant across the alcohol outcome variables. The only significant difference between conditions was in the readiness to change variable, with the bot group showing the greatest improvement in readiness (F2,147=5.6; P=.004; η2=0.07). The results suggested that the app group used the app for a longer duration (mean 50.71, SD 49.02 days) than the bot group (mean 27.16, SD 30.54 days; P=.02). Use of the interventions was shown to predict reduced drinking in a multiple regression analysis (β=.25, 95% CI 0.00-0.01; P=.04). Conclusions: Results indicated that all groups in this study reduced their drinking considerably from baseline to the 12-week follow-up, but no differences were found in the alcohol outcome variables between the groups, possibly because of a combination of small sample size and methodological issues. The app group reported greater use and slightly higher usability scores than the bot group, but the bot group demonstrated improved readiness to change scores over the app group. The strengths and limitations of the app and bot interventions as well as directions for future research are discussed. Trial Registration: ClinicalTrials.gov NCT04447794; https://clinicaltrials.gov/ct2/show/NCT04447794 %M 35576569 %R 10.2196/33037 %U https://formative.jmir.org/2022/5/e33037 %U https://doi.org/10.2196/33037 %U http://www.ncbi.nlm.nih.gov/pubmed/35576569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34853 %T A Gamified Personalized Normative Feedback App to Reduce Drinking Among Sexual Minority Women: Randomized Controlled Trial and Feasibility Study %A Boyle,Sarah C %A LaBrie,Joseph W %A Trager,Bradley M %A Costine,Lauren D %+ HeadsUp Labs, Department of Psychology, Loyola Marymount University, 1 LMU Drive, Suite 3787, Los Angeles, CA, 90045, United States, 1 310 568 6681, sarah.boyle@lmu.edu %K sexual minority women %K alcohol %K intervention %K social norms %K gamification %K mobile phone %K smartphone %D 2022 %7 13.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual minority women disproportionately engage in heavy drinking and shoulder the burden of alcohol dependence. Although several intensive interventions are being developed to meet the needs of treatment-seeking sexual minority women, there remains a lack of preventive interventions to reduce drinking and its consequences among women not yet motivated to reduce their alcohol consumption. Objective: We aimed to examine the feasibility and efficacy of reducing alcohol-related risks via personalized normative feedback (PNF) on alcohol use and coping delivered within LezParlay, a social media–inspired digital competition designed to challenge negative stereotypes about lesbian, bisexual, and queer (LBQ)–identified sexual minority women. Methods: Feasibility was assessed by examining engagement with LezParlay outside the context of an incentivized research study, assessing the characteristics of the LBQ women taking part, and examining the competition’s ability to derive risk-reducing actual norms as well as levels of acceptability and perceived benefits reported by participants. Intervention efficacy was examined by randomizing a subsample of 499 LBQ alcohol consumers (ie, drinkers) already taking part in the competition to receive sexual identity–specific PNF on alcohol use and coping, alcohol use only, or control topics over only 2 rounds of play. Changes in alcohol use and negative consequences were examined 2 and 4 months after the delivery of treatment PNF. Results: A total of 2667 diverse LBQ women played ≥1 round of LezParlay. The competition attracted large numbers of moderate and heavy drinkers; however, risk-reducing actual norms could still be derived from competition rounds and featured in PNF. Efficacy results revealed that drinkers who received PNF on alcohol use and both alcohol use and coping had similar reductions in their weekly drinks (P=.003; P<.001), peak drinks (P<.001; P<.001), and negative consequences (P<.001; P<.001) relative to those who received PNF on control topics at the 2-month follow-up. However, at the 4-month follow-up, reductions in alcohol consumption outcomes faded among those who received alcohol PNF only (weekly: P=.06; peak: P=.11), whereas they remained relatively robust among those who received PNF on both alcohol use and coping (weekly: P=.02; peak: P=.03). Finally, participants found the competition highly acceptable and psychologically beneficial as a whole. Conclusions: The LezParlay competition was found to be a feasible and efficacious means of reducing alcohol-related risks in this population. Our findings demonstrate the utility of correcting sexual identity–specific drinking and coping norms to reduce alcohol-related risks among LBQ women and suggest that this approach may also prove fruitful in other stigmatized health disparity populations. To engage these populations in the real world and expand the psychological benefits associated with PNF, our findings also point to packaging PNF within a broader, culturally tailored competition designed to challenge negative group stereotypes. Trial Registration: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478 International Registered Report Identifier (IRRID): RR2-10.2196/24647 %M 35559854 %R 10.2196/34853 %U https://www.jmir.org/2022/5/e34853 %U https://doi.org/10.2196/34853 %U http://www.ncbi.nlm.nih.gov/pubmed/35559854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e17761 %T Blended Treatment for Alcohol Use Disorder (Blend-A): Explorative Mixed Methods Pilot and Feasibility Study %A Tarp,Kristine %A Rasmussen,Johan %A Mejldal,Anna %A Folker,Marie Paldam %A Nielsen,Anette Søgaard %+ Centre for Telepsychiatry, Mental Health Services, Region of Southern Denmark, Heden 11, Odense, 5000, Denmark, 45 24661404, kristine.tarp@rsyd.dk %K alcohol use disorder %K blended treatment %K usability %K patient perceptions %K therapist perspectives %K mobile phone %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Denmark, approximately 150,000 people have alcohol use disorder (AUD). However, only approximately 10% seek AUD treatment, preferably outside conventional health care settings and opening hours. The AUD treatment area experiences low adherence to treatment, as well as high numbers of no-show and premature dropouts. Objective: The purpose of the Blend-A (Blended Treatment for Alcohol Use Disorder) feasibility and pilot study was to describe the process of translating and adapting the Dutch treatment protocol into Danish and Danish culture with a high amount of user involvement and to report how patients and therapists perceived the adapted version, when trying it out. Methods: The settings were 3 Danish public municipal outpatient alcohol clinics. Study participants were patients and therapists from the 3 settings. Data consisted of survey data from the System Usability Scale, individual patient interviews, and therapist group interviews. Statistical analyses were conducted using the Stata software and Excel. Qualitative analysis was conducted using a theoretical thematic analysis. Results: The usability of the treatment platform was rated above average. The patients chose to use the blended treatment format because it ensured anonymity and had a flexible design. Platform use formed the basis of face-to-face sessions. The use of the self-determined platform resulted in a more thorough process. Patient involvement qualified development of a feasible system. Managerial support for time use was essential. Guidance from an experienced peer was useful. Conclusions: This study indicates that, during the processes of translating, adapting, and implementing blended, guided, internet-based, and face-to-face AUD treatment, it is relevant to focus on patient involvement, managerial support, and guidance from experienced peers. Owing to the discrete and flexible design of the blended offer, it appears that it may reach patient groups who would not otherwise have sought treatment. Therefore, blended treatment may increase access to treatment and contribute to reaching people affected by excessive alcohol use, who would not otherwise have sought treatment. In addition, it seems that the blended offer may enhance the participants’ perceived satisfaction and the effect of the treatment course. Thus, it appears that Blend-A may be able to contribute to existing treatment offers. Such findings highlight the need to determine the actual effect of the Blend-A offer; therefore, an effectiveness study with a controlled design is warranted. %M 35468082 %R 10.2196/17761 %U https://formative.jmir.org/2022/4/e17761 %U https://doi.org/10.2196/17761 %U http://www.ncbi.nlm.nih.gov/pubmed/35468082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e35178 %T Accuracy of Wearable Transdermal Alcohol Sensors: Systematic Review %A Brobbin,Eileen %A Deluca,Paolo %A Hemrage,Sofia %A Drummond,Colin %+ Department of Addictions, King's College London, Addiction Science Building, 4 Windsor Walk, London, SE5 8BB, United Kingdom, 44 0207 836 5454, eileen.brobbin@kcl.ac.uk %K alcohol consumption %K alcohol detection %K alcohol monitoring %K alcohol treatment %K digital technology %K ecologic momentary assessment %K transdermal alcohol sensors %K wearables %K mobile phone %D 2022 %7 14.4.2022 %9 Review %J J Med Internet Res %G English %X Background: There are a range of wearable transdermal alcohol sensors that are available and are being developed. These devices have the potential to monitor alcohol consumption continuously over extended periods in an objective manner, overcoming some of the limitations of other alcohol measurement methods (blood, breath, and urine). Objective: The objective of our systematic review was to assess wearable transdermal alcohol sensor accuracy. Methods: A systematic search of the CINAHL, Embase, Google Scholar, MEDLINE, PsycINFO, PubMed, and Scopus bibliographic databases was conducted in February 2021. In total, 2 team members (EB and SH) independently screened studies for inclusion, extracted data, and assessed the risk of bias. The methodological quality of each study was appraised using the Mixed Methods Appraisal Tool. The primary outcome was transdermal alcohol sensor accuracy. The data were presented as a narrative synthesis. Results: We identified and analyzed 32 studies. Study designs included laboratory, ambulatory, and mixed designs, as well as randomized controlled trials; the length of time for which the device was worn ranged from days to weeks; and the analyzed sample sizes ranged from 1 to 250. The results for transdermal alcohol concentration data from various transdermal alcohol sensors were generally found to positively correlate with breath alcohol concentration, blood alcohol concentration, and self-report (moderate to large correlations). However, there were some discrepancies between study reports; for example, WrisTAS sensitivity ranged from 24% to 85.6%, and specificity ranged from 67.5% to 92.94%. Higher malfunctions were reported with the BACtrack prototype (16%-38%) and WrisTAS (8%) than with SCRAM (2%); however, the former devices also reported a reduced time lag for peak transdermal alcohol concentration values when compared with SCRAM. It was also found that many companies were developing new models of wearable transdermal alcohol sensors. Conclusions: As shown, there is a lack of consistency in the studies on wearable transdermal alcohol sensor accuracy regarding study procedures and analyses of findings, thus making it difficult to draw direct comparisons between them. This needs to be considered in future research, and there needs to be an increase in studies directly comparing different transdermal alcohol sensors. There is also a lack of research investigating the accuracy of transdermal alcohol sensors as a tool for monitoring alcohol consumption in clinical populations and use over extended periods. Although there is some preliminary evidence suggesting the accuracy of these devices, this needs to be further investigated in clinical populations. Trial Registration: PROSPERO CRD42021231027; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=231027 %M 35436239 %R 10.2196/35178 %U https://www.jmir.org/2022/4/e35178 %U https://doi.org/10.2196/35178 %U http://www.ncbi.nlm.nih.gov/pubmed/35436239 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e36849 %T Adaptive Text Messaging for Postpartum Risky Drinking: Conceptual Model and Protocol for an Ecological Momentary Assessment Study %A Dauber,Sarah %A Beacham,Alexa %A Hammond,Cori %A West,Allison %A Thrul,Johannes %+ Partnership to End Addiction, 711 Third Avenue, New York, NY, 10017, United States, 1 212 841 5270, sdauber@toendaddiction.org %K postpartum %K alcohol use %K risky drinking %K mobile health %K ecologic momentary assessment %K mobile phone %D 2022 %7 4.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Risky drinking is prevalent among women of childbearing age. Although many women reduce their drinking during pregnancy, more than half return to prepregnancy levels during the early postpartum period. Risky drinking in new mothers may be associated with negative child and maternal health outcomes; however, new mothers are unlikely to seek treatment for risky drinking because of stigma and fear of child protective service involvement. SMS text messaging is a promising approach for reaching non–treatment-seeking new mothers at risk because of risky drinking. SMS text messaging interventions (TMIs) are empirically supported for alcohol use, but a tailored intervention for new mothers does not exist. This study aims to fill this gap by developing a just-in-time adaptive TMI for postpartum risky drinking. Objective: The objectives of this paper are to present a preliminary conceptual model of postpartum risky drinking and describe the protocol for conducting an ecological momentary assessment (EMA) study with new mothers to inform the refinement of the conceptual model and development of the TMI. Methods: This paper presents a preliminary conceptual model of postpartum risky drinking based on the motivational model of alcohol use, social cognitive theory, and temporal self-regulation theory. The model proposes three primary intervention targets: motivation, self-efficacy, and self-regulation. Theoretical and empirical literature in support of the conceptual model is described. The paper also describes procedures for a study that will collect EMA data from 30 participants recruited via social media and the perinatal Central Intake system of New Jersey. Following the baseline assessment, EMA surveys will be sent 5 times per day for 14 days. The assessment instruments and data analysis procedures are described. Results: Recruitment is scheduled to begin in January 2022 and is anticipated to conclude in March 2022. Study results are estimated to be published in July 2022. Conclusions: The study findings will enhance our understanding of daily and momentary fluctuations in risk and protective factors for risky drinking during the early postpartum period. The findings will be used to refine the conceptual model and inform the development of the TMI. The next steps for this work include the development of intervention components via an iterative participatory design process and testing of the resulting intervention in a pilot microrandomized trial. International Registered Report Identifier (IRRID): PRR1-10.2196/36849 %M 35373778 %R 10.2196/36849 %U https://www.researchprotocols.org/2022/4/e36849 %U https://doi.org/10.2196/36849 %U http://www.ncbi.nlm.nih.gov/pubmed/35373778 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33493 %T Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use %A Menon,Rijuta %A Meyer,Julien %A Nippak,Pria %A Begum,Housne %+ School of Health Services Management, Ted Rogers School of Management, Ryerson University, 350 Victoria Street, Office: TRS 3-081, Toronto, ON, M5B 2K3, Canada, 1 4169951338, julien.meyer@ryerson.ca %K mobile health %K alcohol use disorder %K disease management %K mobile apps %K Unified Theory of Acceptance and Use of Technology %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. Objective: The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. Methods: We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. Results: The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. Conclusions: This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA. %M 35363145 %R 10.2196/33493 %U https://humanfactors.jmir.org/2022/2/e33493 %U https://doi.org/10.2196/33493 %U http://www.ncbi.nlm.nih.gov/pubmed/35363145 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28927 %T Digital Assessment Tools Using Animation Features to Quantify Alcohol Consumption: Systematic App Store and Literature Review %A Wiemker,Veronika %A Neufeld,Maria %A Bunova,Anna %A Danquah,Ina %A Ferreira-Borges,Carina %A Konigorski,Stefan %A Rastogi,Ankit %A Probst,Charlotte %+ Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 5040, charlotte.probst@uni-heidelberg.de %K alcohol consumption %K harmful and hazardous drinking %K screening %K assessment methods %K eHealth %K mobile apps %K visualization %K animation features %K AUDIT %K primary health care %D 2022 %7 23.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Accurate and user-friendly assessment tools for quantifying alcohol consumption are a prerequisite for effective interventions to reduce alcohol-related harm. Digital assessment tools (DATs) that allow the description of consumed alcoholic drinks through animation features may facilitate more accurate reporting than conventional approaches. Objective: This review aims to identify and characterize freely available DATs in English or Russian that use animation features to support the quantitative assessment of alcohol consumption (alcohol DATs) and determine the extent to which such tools have been scientifically evaluated in terms of feasibility, acceptability, and validity. Methods: Systematic English and Russian searches were conducted in iOS and Android app stores and via the Google search engine. Information on the background and content of eligible DATs was obtained from app store descriptions, websites, and test completions. A systematic literature review was conducted in Embase, MEDLINE, PsycINFO, and Web of Science to identify English-language studies reporting the feasibility, acceptability, and validity of animation-using alcohol DATs. Where possible, the evaluated DATs were accessed and assessed. Owing to the high heterogeneity of study designs, results were synthesized narratively. Results: We identified 22 eligible alcohol DATs in English, 3 (14%) of which were also available in Russian. More than 95% (21/22) of tools allowed the choice of a beverage type from a visually displayed selection. In addition, 36% (8/22) of tools enabled the choice of a drinking vessel. Only 9% (2/22) of tools allowed the simulated interactive pouring of a drink. For none of the tools published evaluation studies were identified in the literature review. The systematic literature review identified 5 exploratory studies evaluating the feasibility, acceptability, and validity of 4 animation-using alcohol DATs, 1 (25%) of which was available in the searched app stores. The evaluated tools reached moderate to high scores on user rating scales and showed fair to high convergent validity when compared with established assessment methods. Conclusions: Animation-using alcohol DATs are available in app stores and on the web. However, they often use nondynamic features and lack scientific background information. Explorative study data suggest that such tools might enable the user-friendly and valid assessment of alcohol consumption and could thus serve as a building block in the reduction of alcohol-attributable health burden worldwide. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020172825; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172825 %M 35319472 %R 10.2196/28927 %U https://www.jmir.org/2022/3/e28927 %U https://doi.org/10.2196/28927 %U http://www.ncbi.nlm.nih.gov/pubmed/35319472 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33038 %T Lessons for Uptake and Engagement of a Smartphone App (SURE Recovery) for People in Recovery From Alcohol and Other Drug Problems: Interview Study of App Users %A Neale,Joanne %A Bowen,Alice May %+ National Addiction Centre, King's College London, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, United Kingdom, 44 7511319855, alice.m.bowen@kcl.ac.uk %K apps %K digital literacy %K mHealth %K substance use %K recovery %K qualitative %K mobile phone %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile health apps promoting health and well-being have substantial potential but low uptake and engagement. Barriers common to addiction treatment app uptake and engagement include poor access to mobile technology, Wi-Fi, or mobile data, plus low motivation among non–treatment-seeking users to cut down or quit. Working with people who used substances, we had previously designed and published an app to support recovery from alcohol and other drug problems. The app, which is available for free from the Apple App Store and Google Play, is called SURE Recovery. Objective: The aim of this paper is to undertake a qualitative study to ascertain end users’ views and experiences of the SURE Recovery app, including how it might be improved, and present the findings on uptake and engagement to assist other researchers and app developers working on similar apps for people experiencing alcohol and other drug problems. Methods: Semistructured telephone interviews were conducted with 20 people (n=12, 60%, men and n=8, 40%, women aged 25-63 years; all identifying as White British) who had varied patterns of using the app. The audio recordings were transcribed, and the data were coded and analyzed through Iterative Categorization. Results: Analyses identified three main factors relevant to uptake (discoverability of the app, personal relevance, and expectations and motivations) and three main factors relevant to engagement (the appeal and relevance of specific features, perceived benefits, and the need for improvements). The findings on uptake and engagement were largely consistent with our own earlier developmental work and with other published literature. However, we additionally found that uptake was strongly affected by first impressions, including trust and personal recommendations; that users were attracted to the app by their need for support and curiosity but had relatively modest expectations; that engagement increased if the app made users feel positive; and that people were unlikely to download, or engage with, the app if they could not relate to, or identify with, aspects of its content. Conclusions: Incorporating end-user views into app design and having a network of supportive partners (ie, credible organizations and individuals who will champion the app) seem to increase uptake and engagement among people experiencing alcohol and other drug problems. Although better digital literacy and access to devices and mobile data are needed if addiction recovery apps are to reach their full potential, we should not evaluate them based only on observable changes in substance use behaviors. How using an app makes a person feel is more transient and difficult to quantify but also relevant to uptake and engagement. %M 35258474 %R 10.2196/33038 %U https://humanfactors.jmir.org/2022/1/e33038 %U https://doi.org/10.2196/33038 %U http://www.ncbi.nlm.nih.gov/pubmed/35258474 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31109 %T Testing an mHealth System for Individuals With Mild to Moderate Alcohol Use Disorders: Protocol for a Type 1 Hybrid Effectiveness-Implementation Trial %A Park,Linda S %A Chih,Ming-Yuan %A Stephenson,Christine %A Schumacher,Nicholas %A Brown,Randall %A Gustafson,David %A Barrett,Bruce %A Quanbeck,Andrew %+ Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin–Madison, Ste 210, 800 University Bay Dr, Madison, WI, 53705, United States, 1 608 345 6859, linda.park@wisc.edu %K mHealth %K mobile health %K alcohol use disorder %K alcohol reduction %K wellness %K risky drinking %K quality of life %K protocol %D 2022 %7 18.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The extent of human interaction needed to achieve effective and cost-effective use of mobile health (mHealth) apps for individuals with mild to moderate alcohol use disorder (AUD) remains largely unexamined. This study seeks to understand how varying levels of human interaction affect the ways in which an mHealth intervention for the prevention and treatment of AUDs works or does not work, for whom, and under what circumstances. Objective: The primary aim is to detect the effectiveness of an mHealth intervention by assessing differences in self-reported risky drinking patterns and quality of life between participants in three study groups (self-monitored, peer-supported, and clinically integrated). The cost-effectiveness of each approach will also be assessed. Methods: This hybrid type 1 study is an unblinded patient-level randomized clinical trial testing the effects of using an evidence-based mHealth system on participants’ drinking patterns and quality of life. There are two groups of participants for this study: individuals receiving the intervention and health care professionals practicing in the broader health care environment. The intervention is a smartphone app that encourages users to reduce their alcohol consumption within the context of integrative medicine using techniques to build healthy habits. The primary outcomes for quantitative analysis will be participant data on their risky drinking days and quality of life as well as app use from weekly and quarterly surveys. Cost measures include intervention and implementation costs. The cost per participant will be determined for each study arm, with intervention and implementation costs separated within each group. There will also be a qualitative assessment of health care professionals’ engagement with the app as well as their thoughts on participant experience with the app. Results: This protocol was approved by the Health Sciences Minimal Risk Institutional Review Board on November 18, 2019, with subsequent annual reviews. Recruitment began on March 6, 2020, but was suspended on March 13, 2020, due to the COVID-19 pandemic restrictions. Limited recruitment resumed on July 6, 2020. Trial status as of November 17, 2021, is as follows: 357 participants were enrolled in the study for a planned enrollment of 546 participants. Conclusions: The new knowledge gained from this study could have wide and lasting benefits related to the integration of mHealth systems for individuals with mild to moderate AUDs. The results of this study will guide policy makers and providers toward cost-effective ways to incorporate technology in health care and community settings. Trial Registration: ClinicalTrials.gov NCT04011644; https://clinicaltrials.gov/ct2/show/NCT04011644 International Registered Report Identifier (IRRID): DERR1-10.2196/31109 %M 35179502 %R 10.2196/31109 %U https://www.researchprotocols.org/2022/2/e31109 %U https://doi.org/10.2196/31109 %U http://www.ncbi.nlm.nih.gov/pubmed/35179502 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32716 %T Think-Aloud Testing of a Novel Safer Drinking App for College Students During COVID-19: Usability Study %A Smith,Jessica Gomez %A Alamiri,Nour Sami %A Biegger,Grace %A Frederick,Christina %A Halbert,Jennifer P %A Ingersoll,Karen S %+ Center for Behavioral Health & Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 560 Ray C Hunt Dr, Charlottesville, VA, 22903, United States, 1 434 243 0581, KES7A@hscmail.mcc.virginia.edu %K app development %K college binge drinking %K think aloud testing %K formative research %K mobile phone %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hazardous alcohol consumption, and binge drinking in particular, continues to be common among college students, posing the greatest risk for their health and safety. Despite widespread exposure to evidence-based preventive interventions among US undergraduates, only modest and temporary effects on risky drinking occur. Formative studies have demonstrated that students want a more engaging intervention tool for risky drinking that can be used just in time. Objective: The purpose of this study is to test the appeal, relevance, and perceived utility of a draft mobile app for safer student drinking at a public university in Virginia. Methods: Undergraduate student participants tested the draft mobile app via a web-based prototype that tailors to individual feedback with hot spots that responded to their taps to mimic app functionality. They narrated their impressions, navigation, and comments in a standardized think-aloud procedure. After each round of think-aloud interviews, researchers debriefed the investigators and developers to discuss findings and brainstorm app modifications. Results: Minor changes to the functionality and aesthetics would improve usability of the app (eg, option for light mode in app settings). Student testers recommended tailoring the app to the needs of college students and to aspects of the local university’s drinking culture. Conclusions: Findings from this study will be synthesized with information gained from other formative work to determine the final app features. We will test the app in a pilot randomized trial to assess app use and the impact of the app on college student drinking behavior over several months. %M 35175210 %R 10.2196/32716 %U https://formative.jmir.org/2022/2/e32716 %U https://doi.org/10.2196/32716 %U http://www.ncbi.nlm.nih.gov/pubmed/35175210 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30095 %T Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Alcohol Moderation Intervention for Cancer Survivors: Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial %A Mujcic,Ajla %A Blankers,Matthijs %A Boon,Brigitte %A Berman,Anne H %A Riper,Heleen %A van Laar,Margriet %A Engels,Rutger %+ Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 30 29 59 256, amujcic@trimbos.nl %K alcohol %K brief interventions %K cancer survivors %K effectiveness %K cost-effectiveness %K eHealth %K mobile phone %D 2022 %7 1.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol moderation (AM) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors. Objective: This study evaluates the effectiveness, cost-effectiveness, and cost-utility of MyCourse, a digital AM intervention, compared with a noninteractive digital information brochure for cancer survivors. Methods: A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months after randomization. The study was conducted on the web in the Netherlands from 2016 to 2019. Participants were adult 10-year cancer survivors drinking over the Dutch-recommended drinking guidelines (≤7 standard units [10 g of alcohol] per week) with the intention to moderate or quit drinking. Overall, 103 participants were randomized and analyzed: 53 (51.5%) in the MyCourse group and 50 (48.5%) in the control group. In the MyCourse group, participants had access to a newly developed, digital, minimally guided AM intervention, MyCourse–Moderate Drinking. The primary outcome was the self-reported number of standard drinks (10 g of ethanol) consumed in the past 7 days at the 6-month follow-up. The secondary outcome measures were alcohol-related problems as measured by the Alcohol Use Disorders Identification Test (AUDIT) and treatment satisfaction. For the health economic evaluation, health care costs, costs because of productivity losses, and intervention costs were assessed over a 12-month horizon. Results: Alcohol use at the 6-month follow-up decreased by 38% in the MyCourse group and by 33% in the control group. No difference in 7-day alcohol use was found between the groups (B=2.1, 95% CI −7.6 to 3.1; P=.22) at any of the follow-ups. AUDIT scores for alcohol-related problems decreased over time in both groups, showing no significant difference between the groups (Cohen d=0.3, 95% CI −0.1 to 0.6; P=.21). Intervention costs per participant were estimated at US $279 for the MyCourse group and US $74 for the control group. The mean societal costs were US $18,092 (SD 25,662) and US $23,496 (SD 34,327), respectively. The MyCourse group led to fewer gained quality-adjusted life years at lower societal costs in the cost-utility analysis. In the cost-effectiveness analysis, the MyCourse group led to a larger reduction in drinking units over time at lower societal costs (incremental cost-effectiveness ratio per reduced drink: US $ −1158, 95% CI −1609 to −781). Conclusions: At 6 months, alcohol use was reduced by approximately one-third in both groups, with no significant differences between the digital intervention MyCourse and a noninteractive web-based brochure. At 12 months, cost-effectiveness analyses showed that MyCourse led to a larger reduction in drinking units over time, at lower societal costs. The MyCourse group led to marginally fewer gained quality-adjusted life years, also at lower societal costs. Trial Registration: Netherlands Trial Register NTR6010; https://www.trialregister.nl/trial/5433 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-018-4206-z %M 35103605 %R 10.2196/30095 %U https://www.jmir.org/2022/2/e30095 %U https://doi.org/10.2196/30095 %U http://www.ncbi.nlm.nih.gov/pubmed/35103605 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e31712 %T Social Equity in the Efficacy of Computer-Based and In-Person Brief Alcohol Interventions Among General Hospital Patients With At-Risk Alcohol Use: A Randomized Controlled Trial %A Freyer-Adam,Jennis %A Baumann,Sophie %A Bischof,Gallus %A Staudt,Andreas %A Goeze,Christian %A Gaertner,Beate %A John,Ulrich %+ Institute for Medical Psychology, University Medicine Greifswald, Walther-Rathenau-Str. 48, Greifswald, 17475, Germany, 49 3834865606, Jennis.Freyer-Adam@med.uni-greifswald.de %K brief alcohol intervention %K electronic %K eHealth %K digital %K motivational interviewing %K socioeconomic status %K equity %K social inequality %K transtheoretical model %K moderator %K mental health %K public health %K alcohol interventions %K digital intervention %K digital health intervention %K alcohol use %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social equity in the efficacy of behavior change intervention is much needed. While the efficacy of brief alcohol interventions (BAIs), including digital interventions, is well established, particularly in health care, the social equity of interventions has been sparsely investigated. Objective: We aim to investigate whether the efficacy of computer-based versus in-person delivered BAIs is moderated by the participants’ socioeconomic status (ie, to identify whether general hospital patients with low-level education and unemployed patients may benefit more or less from one or the other way of delivery compared to patients with higher levels of education and those that are employed). Methods: Patients with nondependent at-risk alcohol use were identified through systematic offline screening conducted on 13 general hospital wards. Patients were approached face-to-face and asked to respond to an app for self-assessment provided by a mobile device. In total, 961 (81% of eligible participants) were randomized and received their allocated intervention: computer-generated and individually tailored feedback letters (CO), in-person counseling by research staff trained in motivational interviewing (PE), or assessment only (AO). CO and PE were delivered on the ward and 1 and 3 months later, were based on the transtheoretical model of intentional behavior change and required the assessment of intervention data prior to each intervention. In CO, the generation of computer-based feedback was created automatically. The assessment of data and sending out feedback letters were assisted by the research staff. Of the CO and PE participants, 89% (345/387) and 83% (292/354) received at least two doses of intervention, and 72% (280/387) and 54% (191/354) received all three doses of intervention, respectively. The outcome was change in grams of pure alcohol per day after 6, 12, 18, and 24 months, with the latter being the primary time-point of interest. Follow-up interviewers were blinded. Study group interactions with education and employment status were tested as predictors of change in alcohol use using latent growth modeling. Results: The efficacy of CO and PE did not differ by level of education (P=.98). Employment status did not moderate CO efficacy (Ps≥.66). Up to month 12 and compared to employed participants, unemployed participants reported significantly greater drinking reductions following PE versus AO (incidence rate ratio 0.44, 95% CI 0.21-0.94; P=.03) and following PE versus CO (incidence rate ratio 0.48, 95% CI 0.24–0.96; P=.04). After 24 months, these differences were statistically nonsignificant (Ps≥.31). Conclusions: Computer-based and in-person BAI worked equally well independent of the patient’s level of education. Although findings indicate that in the short-term, unemployed persons may benefit more from BAI when delivered in-person rather than computer-based, the findings suggest that both BAIs have the potential to work well among participants with low socioeconomic status. Trial Registration: ClinicalTrials.gov NCT01291693; https://clinicaltrials.gov/ct2/show/NCT01291693 %M 35089156 %R 10.2196/31712 %U https://mental.jmir.org/2022/1/e31712 %U https://doi.org/10.2196/31712 %U http://www.ncbi.nlm.nih.gov/pubmed/35089156 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e30186 %T Preliminary Effectiveness of a Remotely Monitored Blood Alcohol Concentration Device as Treatment Modality: Protocol for a Randomized Controlled Trial %A Buono,Frank D %A Gleed,Colette %A Boldin,Martin %A Aviles,Allison %A Wheeler,Natalie %+ Department of Psychiatry, Yale School of Medicine, 300 George Street, New Haven, CT, 06510, United States, 1 2039372309 ext 118, frank.buono@yale.edu %K alcohol use disorder %K wireless breathalyzer %K treatment %K clinical trial %K alcohol abuse %K relapse %K patient monitoring %K mobile app %K breathalyzer %K sobriety %K continuous monitoring %K blood alcohol concentration %K blood alcohol %K alcohol %K alcohol use %K substance use %K adherence %D 2022 %7 14.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use disorder is a chronic disorder with a high likelihood of relapse. The consistent monitoring of blood alcohol concentration through breathalyzers is critical to identifying relapse or misuse. Smartphone apps as a replacement of or in conjunction with breathalyzers have shown limited effectiveness. Yet, there has been little research that has effectively utilized wireless or Wi-Fi–enabled breathalyzers that can accurately, securely, and reliably measure blood alcohol concentration. Objective: The purpose of this study is to evaluate the impact of a wireless blood alcohol concentration device in collaboration with long-term treatment on dropout rates, psychological distress, treatment motivation, quality of life, and need for higher levels of follow-up care for patients with alcohol use disorder. Methods: The randomized clinical trial will include two arms, access to the wireless breathalyzer versus no access to the breathalyzer, while both groups have access to treatment. Evaluation will last 3 months with a 6-week follow-up, during which each participant will be interviewed at admission, 1 month in, 2 months in, 3 months in, and follow-up. Individuals will be recruited online through a secure telehealth meeting invitation. Outcomes will focus on the impact of the wireless breathalyzer within the alcohol use disorder population, and the combined effect on psychological distress, treatment motivation, and quality of life. In addition, we intend to investigate the impact of the breathalyzer on dropout rates and participants’ need for higher levels of follow-up care and treatment. Results: The recruitment of this study started in July 2020 and will run until 2022. Conclusions: This information will be important to develop cost-effective treatments for alcohol dependence. Ongoing monitoring allows treatment providers to take an individualized disease management approach and facilitates timely intervention by the treatment provider. Trial Registration: ClinicalTrials.gov NCT04380116; http://clinicaltrials.gov/ct2/show/NCT04380116 International Registered Report Identifier (IRRID): DERR1-10.2196/30186 %M 35029534 %R 10.2196/30186 %U https://www.researchprotocols.org/2022/1/e30186 %U https://doi.org/10.2196/30186 %U http://www.ncbi.nlm.nih.gov/pubmed/35029534 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e31058 %T Russian-Language Mobile Apps for Reducing Alcohol Use: Systematic Search and Evaluation %A Bunova,Anna %A Wiemker,Veronika %A Gornyi,Boris %A Ferreira-Borges,Carina %A Neufeld,Maria %+ National Research Center for Therapy and Preventive Medicine of the Ministry of Health of the Russian Federation, Petroverigskiy Pereulok 10, Moscow, 101990, Russian Federation, 7 9151416154, asbunova@gmail.com %K alcohol %K mHealth %K mobile applications %K screening and brief intervention %K Mobile Application Rating Scale %K App Behavior Change Scale %K mobile phone %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Personalized prevention tools such as mobile apps designed to reduce alcohol consumption are widespread in mobile app stores accessible in Russia. However, the quality and content of these mobile apps have not been systematically evaluated. Objective: This study aimed to identify Russian-language mobile apps for reducing alcohol use and to evaluate their quality and potential to change alcohol-related health behavior. It further aimed to identify apps that could facilitate screening and brief interventions in primary health care in Russia. Methods: A systematic search for mobile apps available in Russia was carried out between April 1 and 15, 2020, December 1 and 15, 2020, and in March 2021 in the iPhone App Store, Google Play Store, and the 4PDA forum. App quality was assessed using the Mobile App Rating Scale (MARS), and structured searches in electronic libraries and bibliographic databases were used to evaluate the apps’ evidence base. The number of features facilitating changes in lifestyle behavior was assessed using the App Behavior Change Scale (ABACUS). Results: We identified 63 mobile apps for reducing alcohol use. The mean MARS quality ratings were high for the subscales of functionality (3.92 out of 5, SD 0.58) and aesthetics (2.96, SD 0.76) and low for engagement (2.42, SD 0.76) and information (1.65, SD 0.60). Additional searches in electronic libraries and bibliographic databases (eLibrary, CyberLeninka, Google Scholar) yielded no studies involving the identified apps. ABACUS scores ranged from 1 to 15 out of 25, with a mean of 5 (SD 3.24). Two of the identified apps might be useful for screening and brief interventions in Russian primary health care after improvements in content and scientific testing. Conclusions: Russian-language mobile apps for reducing alcohol use are accessible in the app stores. Many of them are aesthetically pleasing, functional, and easy to use. However, information about their scientific trialing or testing is lacking. Most apps contain a low number of features that facilitate changes in lifestyle behavior. Further research should examine the context of Russian-language mobile apps for reducing alcohol use. Our findings underline the need to develop evidence-based apps to mitigate alcohol consumption in Russia and elsewhere. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020167458; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=167458 %M 35006083 %R 10.2196/31058 %U https://mhealth.jmir.org/2022/1/e31058 %U https://doi.org/10.2196/31058 %U http://www.ncbi.nlm.nih.gov/pubmed/35006083 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34530 %T A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial %A Stapinski,Lexine %A Routledge,Kylie %A Snijder,Mieke %A Doyle,Michael %A Champion,Katrina %A Chapman,Cath %A Ward,James %A Baumgart,Amanda %A Lee,K S Kylie %A Teesson,Maree %A Newton,Nicola %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Lvl 6, Jane Foss Russell Building G02, Darlington, 2006, Australia, 61 286279039, lexine.stapinski@sydney.edu.au %K Aboriginal and Torres Strait Islander %K prevention %K alcohol %K tobacco %K substance use %K universal prevention %K well-being %K harm minimization %K Indigenous %K web-based %D 2022 %7 7.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective: This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods: The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results: The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions: This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/34530 %M 34994696 %R 10.2196/34530 %U https://www.researchprotocols.org/2022/1/e34530 %U https://doi.org/10.2196/34530 %U http://www.ncbi.nlm.nih.gov/pubmed/34994696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30408 %T Game Plan—a Brief Web-Based Intervention to Improve Uptake and Use of HIV Pre-exposure Prophylaxis (PrEP) and Reduce Alcohol Use Among Gay and Bisexual Men: Content Analysis %A Wray,Tyler B %A Chan,Philip A %A Guigayoma,John P %A Kahler,Christopher W %+ Department of Behavioral and Social Sciences, School of Public Health, Brown University, 121 S. Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 4018636659, tyler_wray@brown.edu %K HIV %K pre-exposure prophylaxis %K alcohol use %K mHealth %K eHealth %K intervention %K mobile phone %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV pre-exposure prophylaxis (PrEP) has considerable potential for reducing incidence among high-risk groups, such as gay, bisexual, and other men who have sex with men (GBM). However, PrEP’s effectiveness is closely linked with consistent use, and a variety of individual-level barriers, including alcohol use, could impede optimal uptake and use. Web-based interventions can encourage medication adherence, HIV prevention behaviors, and responsible drinking and may help support PrEP care, particularly in resource-limited settings. Objective: We previously developed a web application called Game Plan that was designed to encourage heavy drinking GBM to use HIV prevention methods and reduce their alcohol use and was inspired by brief motivational interventions. This paper aims to describe the web-based content we designed for integration into Game Plan to help encourage PrEP uptake and consistent use among GBM. In this paper, we also aim to describe this content and its rationale. Methods: Similar to the original site, these components were developed iteratively, guided by a thorough user-centered design process involving consultation with subject-matter experts, usability interviews and surveys, and user experience surveys. Results: In addition to Game Plan’s pre-existing content, the additional PrEP components provide specific, personal, and digestible feedback to users about their level of risk for HIV without PrEP and illustrate how much consistent PrEP use could reduce it; personal feedback about their risk for common sexually transmitted infections to address low-risk perceptions; content challenging common beliefs and misconceptions about PrEP to reduce stigma; content confronting familiar PrEP and alcohol beliefs; and a change planning module that allows users to select specific goals for starting and strategies for consistent PrEP use. Users can opt into a weekly 2-way SMS text messaging program that provides similar feedback over a 12-week period after using Game Plan and follows up on the goals they set. Conclusions: Research preliminarily testing the efficacy of these components in improving PrEP outcomes, including uptake, adherence, sexually transmitted infection rates, and alcohol use, is currently ongoing. If supported, these components could provide a scalable tool that can be used in resource-limited settings in which face-to-face intervention is difficult. %M 34989679 %R 10.2196/30408 %U https://formative.jmir.org/2022/1/e30408 %U https://doi.org/10.2196/30408 %U http://www.ncbi.nlm.nih.gov/pubmed/34989679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e23513 %T The Long-Term Effectiveness of Internet-Based Interventions on Multiple Health Risk Behaviors: Systematic Review and Robust Variance Estimation Meta-analysis %A Tzelepis,Flora %A Mitchell,Aimee %A Wilson,Louise %A Byrnes,Emma %A Haschek,Alexandra %A Leigh,Lucy %A Oldmeadow,Christopher %+ School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 49246275, flora.tzelepis@newcastle.edu.au %K internet %K multiple health behaviors %K tobacco %K nutrition %K alcohol %K physical activity %D 2021 %7 21.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Smoking tobacco, poor nutrition, risky alcohol use, and physical inactivity (SNAP) behaviors tend to cluster together. Health benefits may be maximized if interventions targeted multiple health risk behaviors together rather than addressing single behaviors. The internet has wide reach and is a sustainable mode for delivery of interventions for multiple health behaviors. However, no systematic reviews have examined the long-term effectiveness of internet-based interventions on any combination of or all SNAP behaviors in adults aged 18 years or older. Objective: This systematic review examined, among adults (aged ≥18 years), the effectiveness of internet-based interventions on SNAP behaviors collectively in the long term compared with a control condition. Methods: The electronic databases Medline, PsycINFO, Embase, CINAHL, and Scopus were searched to retrieve studies describing the effectiveness of internet-based interventions on ≥2 SNAP behaviors published by November 18, 2019. The reference lists of retrieved articles were also checked to identify eligible publications. The inclusion criteria were randomized controlled trials or cluster randomized controlled trials with adults examining an internet-based intervention measuring the effect on ≥2 SNAP behaviors at least 6 months postrecruitment and published in English in a peer-reviewed journal. Two reviewers independently extracted data from included studies and assessed methodological quality using the Quality Assessment Tool for Quantitative Studies. A robust variance estimation meta-analysis was performed to examine the long-term effectiveness of internet-based interventions on all 4 SNAP risk behavior outcomes. All SNAP outcomes were coded so they were in the same direction, with higher scores equating to worse health risk behaviors. Results: The inclusion criteria were met by 11 studies: 7 studies measured the effect of an internet-based intervention on nutrition and physical activity; 1 study measured the effect on smoking, nutrition, and physical activity; and 3 studies measured the effect on all SNAP behaviors. Compared with the control group, internet-based interventions achieved an overall significant improvement across all SNAP behaviors in the long term (standardized mean difference –0.12 [improvement as higher scores = worse health risk outcomes], 95% CI –0.19 to –0.05; I2=1.5%, P=.01). The global methodological quality rating was “moderate” for 1 study, while the remaining 10 studies were rated as “weak.” Conclusions: Internet-based interventions were found to produce an overall significant improvement across all SNAP behaviors collectively in the long term. Internet-based interventions targeting multiple SNAP behaviors have the potential to maximize long-term improvements to preventive health outcomes. %M 34931990 %R 10.2196/23513 %U https://www.jmir.org/2021/12/e23513 %U https://doi.org/10.2196/23513 %U http://www.ncbi.nlm.nih.gov/pubmed/34931990 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e31275 %T Global Melanoma Correlations With Obesity, Smoking, and Alcohol Consumption %A Batta,Nisha %A Shangraw,Sarah %A Nicklawsky,Andrew %A Yamauchi,Takeshi %A Zhai,Zili %A Ravindran Menon,Dinoop %A Gao,Dexiang %A Dellavalle,Robert P %A Fujita,Mayumi %+ Department of Dermatology, University of Colorado Anschutz Medical Campus, 12801 E. 17th Avenue, RC-1 South, Rm 4124, Aurora, CO, 80045, United States, 1 303 724 4045, mayumi.fujita@cuanschutz.edu %K melanoma incidence %K melanoma mortality %K non-UV risk factors %K obesity %K alcohol consumption %K smoking %K wine %K World Health Organization %K WHO %K Global Cancer Observatory %K GCO %K Global Health Observatory %K GHO %K aldehyde dehydrogenase 2 %K ALDH2 %K polymorphism %D 2021 %7 13.12.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 35990801 %R 10.2196/31275 %U https://derma.jmir.org/2021/2/e31275 %U https://doi.org/10.2196/31275 %U http://www.ncbi.nlm.nih.gov/pubmed/35990801 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e31353 %T A Personalized Approach Bias Modification Smartphone App (“SWiPE”) to Reduce Alcohol Use: Open-Label Feasibility, Acceptability, and Preliminary Effectiveness Study %A Manning,Victoria %A Piercy,Hugh %A Garfield,Joshua Benjamin Bernard %A Clark,Stuart Gregory %A Andrabi,Mah Noor %A Lubman,Dan Ian %+ Turning Point, Eastern Health, 110 Church St, Richmond, Melbourne, 3121, Australia, 61 0428337961, victoria.manning@monash.edu %K alcohol %K hazardous alcohol use %K alcohol use disorder %K approach bias modification %K cognitive bias modification %K smartphone app %K ehealth %K mobile phone app %K mhealth %K digital health %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Approach bias modification (ApBM), a computerized cognitive intervention that trains people to “avoid” alcohol-related images and “approach” nonalcohol images, reduces the likelihood of relapse when administered during residential alcohol treatment. However, most individuals experiencing alcohol problems do not require, do not seek, or have difficulty accessing residential treatment. Smartphone-delivered ApBM could offer an easily accessible intervention to reduce alcohol consumption that can be personalized (eg, allowing selection of personally relevant alcohol and positive nonalcohol training images) and gamified to optimize engagement. Objective: We examined the feasibility, acceptability, and preliminary effectiveness of “SWiPE,” a gamified, personalized alcohol ApBM smartphone app, and explored alcohol consumption and craving outcomes in people drinking at hazardous levels or above (Alcohol Use Disorders Identification Test [AUDIT] score ≥8) who wanted to reduce their alcohol use. Methods: In this open-label trial, frequency and quantity of alcohol consumption, alcohol dependence severity, and craving were measured prior to participants downloading SWiPE. Participants (n=1309) were instructed to complete at least 2 sessions per week for 4 weeks. Recruitment and completion rates were indicators of feasibility. Functionality, aesthetics, and quality ratings were indicators of acceptability. Participants were prompted to report frequency and quantity of alcohol consumption weekly during training and 1 month after training. They completed measures of craving and dependence after 4 weeks of training. Results: We recruited 1309 participants (mean age 47.0, SD 10.0 years; 758/1309, 57.9% female; mean AUDIT score 21.8, SD 6.5) over 6 months. Participants completed a median of 5 sessions (IQR 2-9); 31.2% (409/1309) completed ≥8 sessions; and 34.8% (455/1309) completed the posttraining survey. Mean Mobile Application Rating Scale scores indicated good acceptability for functionality and aesthetics and fair acceptability for subjective quality. Among those who completed the posttraining assessment, mean past-week drinking days reduced from 5.1 (SD 2.0) pre-training to 4.2 (SD 2.3) in week 4 (t454=7.87; P<.001), and mean past-week standard drinks reduced from 32.8 (SD 22.1) to 24.7 (SD 20.1; t454=8.58; P<.001). Mean Craving Experience Questionnaire frequency scores reduced from 4.5 (SD 2.0) to 2.8 (SD 1.8; t435=19.39; P<.001). Severity of Dependence scores reduced from 7.7 (SD 3.0) to 6.0 (SD 3.2; t435=12.44; P<.001). For the 19.4% (254/1309) of participants who completed a 1-month follow-up, mean past-week drinking days and standard drinks were 3.9 (SD 2.5) and 23.9 (SD 20.7), respectively, both significantly lower than at baseline (P<.001). Conclusions: The findings suggest SWiPE is feasible and acceptable and may be effective at reducing alcohol consumption and craving in a predominantly nontreatment-seeking sample of adult Australians drinking at hazardous levels. SWiPE’s efficacy, relative to a control condition, now needs establishing in a randomized controlled trial. Smartphone-delivered personalized ApBM could be a highly scalable, widely accessible support tool for reducing alcohol use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000638932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID): RR2-10.2196/21278 %M 34890355 %R 10.2196/31353 %U https://mhealth.jmir.org/2021/12/e31353 %U https://doi.org/10.2196/31353 %U http://www.ncbi.nlm.nih.gov/pubmed/34890355 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e33125 %T Drinking and Social Media Use Among Workers During COVID-19 Pandemic Restrictions: Five-Wave Longitudinal Study %A Oksanen,Atte %A Oksa,Reetta %A Savela,Nina %A Celuch,Magdalena %A Savolainen,Iina %+ Tampere University, Faculty of Social Sciences, Kalevantie 5, Tampere, 33014, Finland, 358 503187279, atte.oksanen@tuni.fi %K excessive drinking %K alcohol %K COVID-19 %K social media %K remote work %K psychological distress %K distress %K pattern %K trend %K prediction %K survey %K app %K risk %D 2021 %7 2.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic restricted everyday life during 2020-2021 for many people worldwide. It also affected alcohol consumption patterns and leisure activities, including the use of social media. Objective: The aim of this study was to analyze whether social media use predicts increased risky drinking over time and during the COVID-19 pandemic restrictions in particular. Methods: This 5-wave longitudinal survey study, based on a nationwide sample of workers, was conducted in Finland in 2019-2021. A total of 840 respondents (male: 473/840, 56.31%; age range 18-64 years; mean age 43.90, SD 11.14 years) participated in all 5 waves of the study. The outcome variable was risky drinking, measured using the 3-item Alcohol Use Disorders Identification Test (AUDIT-C). Multilevel linear hybrid modeling enabled the investigation of both within-person and between-person effects. Predictors included social media use and communication, involvement in social media identity bubbles, psychological distress, and remote working. Controls included sociodemographic factors and the Big Five personality traits. Results: Increased involvement in social media identity bubbles was associated with an increase in risky drinking behavior. Of all social media platforms examined, online dating app use was associated with riskier use of alcohol over time during the COVID-19 crisis. Daily social media communication with colleagues about nonwork topics was associated with risky drinking. Female gender, younger age, university education, nonindustrial occupational field, conscientiousness, agreeableness, and neuroticism were associated with lower levels of risky drinking. Conclusions: Social media use during a pandemic carries some risks for alcohol consumption. Involvement in social media identity bubbles and online dating are risk factors for excessive drinking during the COVID-19 pandemic. %M 34662290 %R 10.2196/33125 %U https://www.jmir.org/2021/12/e33125 %U https://doi.org/10.2196/33125 %U http://www.ncbi.nlm.nih.gov/pubmed/34662290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29687 %T Initial Feasibility of the “Families Moving Forward Connect” Mobile Health Intervention for Caregivers of Children With Fetal Alcohol Spectrum Disorders: Mixed Method Evaluation Within a Systematic User-Centered Design Approach %A Petrenko,Christie Lynn McGee %A Kautz-Turnbull,Carson Christine %A Roth,Alicia Rose %A Parr,Jennifer Elizabeth %A Tapparello,Cristiano %A Demir,Utku %A Olson,Heather Carmichael %+ Mt. Hope Family Center, University of Rochester, 187 Edinburgh St, Rochester, NY, 14608, United States, 1 585 275 2991, christie.petrenko@rochester.edu %K fetal alcohol spectrum disorders %K fetal alcohol syndrome %K intervention %K mobile health %K mHealth %K parenting %K children %K prenatal alcohol %K digital health %K user-centered design %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Fetal alcohol spectrum disorders (FASD) are prevalent neurodevelopmental conditions. Significant barriers prevent family access to FASD-informed care. To improve accessibility, a scalable mobile health intervention for caregivers of children with FASD is under development. The app, called Families Moving Forward (FMF) Connect, is derived from the FMF Program, a parenting intervention tailored for FASD. FMF Connect has 5 components: Learning Modules, Family Forum, Library, Notebook, and Dashboard. Objective: This study assesses the feasibility of FMF Connect intervention prototypes. This includes examining app usage data and evaluating user experience to guide further refinements. Methods: Two rounds of beta-testing were conducted as part of a systematic approach to the development and evaluation of FMF Connect: (1) an iOS prototype was tested with 20 caregivers of children (aged 3-17 years) with FASD and 17 providers for the first round (April-May 2019) and (2) iOS and Android prototypes were tested with 25 caregivers and 1 provider for the second round (November-December 2019). After each 6-week trial, focus groups or individual interviews were completed. Usage analytics and thematic analysis were used to address feasibility objectives. Results: Across beta-test trials, 84% (38/45) of caregivers and 94% (17/18) of providers installed the FMF Connect app. Technological issues were tracked in real time with updates to address problems and expand app functionalities. On use days, caregivers averaged 20 minutes using the app; most of the time was spent watching videos in Learning Modules. Caregiver engagement with the Learning Modules varied across 5 usage pattern tiers. Overall, 67% (30/45) of caregivers posted at least once in the Family Forum. Interviews were completed by 26 caregivers and 16 providers. App evaluations generally did not differ according to usage pattern tier or demographic characteristics. Globally, app users were very positive, with 2.5 times more positive- than negative-coded segments across participants. Positive evaluations emphasized the benefits of accessible information and practical utility of the app. Informational and video content were described as especially valuable to caregivers. A number of affective and social benefits of the app were identified, aligning well with the caregivers’ stated motivators for app use. Negative evaluations of user experience generally emphasized technical and navigational aspects. Refinements were made on the basis of feedback during the first beta test, which were positively received during the second round. Participants offered many valuable recommendations for continuing app refinement, which is useful in improving user experience. Conclusions: The results demonstrate that the FMF Connect intervention is acceptable and feasible for caregivers raising children with FASD. They will guide subsequent app refinement before large-scale randomized testing. This study used a systematic, user-centered design approach for app development and evaluation. The approach used here may illustrate a model that can broadly inform the development of mobile health and digital parenting interventions. %M 34860661 %R 10.2196/29687 %U https://formative.jmir.org/2021/12/e29687 %U https://doi.org/10.2196/29687 %U http://www.ncbi.nlm.nih.gov/pubmed/34860661 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29666 %T Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial %A Johansson,Magnus %A Berman,Anne H %A Sinadinovic,Kristina %A Lindner,Philip %A Hermansson,Ulric %A Andréasson,Sven %+ Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, Stockholm, 11365, Sweden, 46 727249971, magnus.johansson.1@ki.se %K alcohol dependence %K alcohol use disorders %K internet-based interventions %K internet-based cognitive behavioral therapy %K ICBT %K cognitive behavioral therapy %K CBT %K eHealth %K alcohol use %K substance abuse %K outcomes %K help-seeking behavior %K internet-based interventions %K alcohol dependence %K mobile phone %D 2021 %7 24.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear. Objective: This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers. Methods: A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment. Results: During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (−3.84, 95% Cl −6.53 to −1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%). Conclusions: In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions. Trial Registration: ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726 %M 34821563 %R 10.2196/29666 %U https://www.jmir.org/2021/11/e29666 %U https://doi.org/10.2196/29666 %U http://www.ncbi.nlm.nih.gov/pubmed/34821563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31843 %T Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing %A Wray,Tyler B %A Chan,Philip A %A Kahler,Christopher W %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 4018636659, tyler_wray@brown.edu %K pre-exposure prophylaxis %K HIV %K HIV prevention %K mHealth %K mobile health %K eHealth %K mobile phone %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective: The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods: In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results: Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site’s content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website’s esthetics to the participants’ engagement with it and its credibility in prompting genuine reflection. Conclusions: GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors. %M 34783662 %R 10.2196/31843 %U https://formative.jmir.org/2021/11/e31843 %U https://doi.org/10.2196/31843 %U http://www.ncbi.nlm.nih.gov/pubmed/34783662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28237 %T Causal Effects of Alcohol-Related Facebook Posts on Drinking Behavior: Longitudinal Experimental Study %A Hendriks,Hanneke %A de Nooy,Wouter %A Gebhardt,Winifred A %A van den Putte,Bas %+ Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, 6525 GD, Netherlands, 31 24 3612372, hanneke.hendriks@ru.nl %K social media %K social networking site (SNS) %K alcohol-related posts %K alcoholposts %K alcohol consumption %D 2021 %7 11.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents and young adults frequently post alcohol-related content (ie, alcoholposts) on social media. This is problematic because both social norms theory and social learning theory suggest that viewing alcoholposts of peers could increase drinking behavior. It is therefore paramount to understand the effects of exposure to alcoholposts on viewers. Objective: This study aimed to investigate the causal effects of exposure to alcoholposts on alcohol consumption by using a rigorous design. Methods: We conducted a 6-week longitudinal study during which alcoholposts were measured by a newly developed app that copied Facebook posts shared by participants (n=281) to a new social media environment. In addition, daily questionnaires assessed alcohol use. Effects of natural alcoholposts (ie, posted by the participants) were assessed in phase 1, and effects of experimental posts (ie, posted by fake participants) were explored in phase 2. Results: Results showed that natural alcoholposts increased the occurrence and quantity of drinking the following day. That is, exposure to a single additional alcoholpost increased the log odds of drinking the next day by 0.27 (b=.27, credible interval [CI] .18 to .35). Furthermore, the number of natural alcoholposts had a positive (predictive) effect on the number of glasses drunk the next day (b=.21, CI .14 to .29). In phase 2 when experimental posts were also present, these effects decreased. Experimental posts themselves had hardly any effects. Conclusions: This study illustrates clear and direct effects of exposure to alcoholposts on next-day alcohol consumption and suggests that alcoholposts represent an important societal problem that interventions need to address. %M 34762061 %R 10.2196/28237 %U https://www.jmir.org/2021/11/e28237 %U https://doi.org/10.2196/28237 %U http://www.ncbi.nlm.nih.gov/pubmed/34762061 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29319 %T Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey %A Monnig,Mollie A %A Treloar Padovano,Hayley %A Sokolovsky,Alexander W %A DeCost,Grace %A Aston,Elizabeth R %A Haass-Koffler,Carolina L %A Szapary,Claire %A Moyo,Patience %A Avila,Jaqueline C %A Tidey,Jennifer W %A Monti,Peter M %A Ahluwalia,Jasjit S %+ Department of Behavioral and Social Sciences, Brown University, Box G-S121-5, Providence, RI, 02912, United States, 1 4018633491, mollie_monnig@brown.edu %K SARS-CoV-2 %K novel coronavirus %K COVID-19 %K alcohol use %K alcohol drinking %K opioid use %K stimulant use %K nicotine %K smoking %K survey %K substance abuse %K addiction %K mental health %K pandemic %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Substance use is a risk factor for COVID-19 infection and adverse outcomes. However, reasons for elevated risk for COVID-19 in substance users are not well understood. Objective: The aim of this study was to evaluate whether alcohol or other drug use is associated with adherence to Centers for Disease Control and Prevention (CDC) guidelines for COVID-19 mitigation. Preregistered analyses tested the hypothesis that greater use of alcohol and other drugs would be associated with lower CDC guideline adherence. A secondary objective was to determine whether substance use was associated with the likelihood of COVID-19 testing or outcome. Methods: A cross-sectional web-based survey was administered to a convenience sample recruited through Amazon’s Mechanical Turk platform from June 18 to July 19, 2020. Individuals aged 18 years or older and residing in Connecticut, Massachusetts, New Jersey, New York, or Rhode Island were eligible to participate. The exposure of interest was past 7-day use of alcohol, cigarettes, electronic cigarettes, cannabis, stimulants, and nonmedical opioids. The primary outcome was CDC guideline adherence measured using a scale developed from behaviors advised to reduce the spread of COVID-19. Secondary outcomes were likelihood of COVID-19 testing and a positive COVID-19 test result. All analyses accounted for the sociodemographic characteristics. Results: The sample consisted of 1084 individuals (mean age 40.9 [SD 13.4] years): 529 (48.8%) men, 543 (50.1%) women, 12 (1.1%) other gender identity, 742 (68.5%) White individuals, 267 (24.6%) Black individuals, and 276 (25.5%) Hispanic individuals. Daily opioid users reported lower CDC guideline adherence than nondaily users (B=–0.24, 95% CI –0.44 to –0.05) and nonusers (B=–0.57, 95% CI –0.76 to –0.38). Daily alcohol drinkers reported lower adherence than nondaily drinkers (B=–0.16, 95% CI –0.30 to –0.02). Nondaily alcohol drinkers reported higher adherence than nondrinkers (B=0.10, 95% CI 0.02-0.17). Daily opioid use was related to greater odds of COVID-19 testing, and daily stimulant use was related to greater odds of a positive COVID-19 test. Conclusions: In a regionally-specific, racially, and ethnically diverse convenience sample, adults who engaged in daily alcohol or opioid use reported lower CDC guideline adherence for COVID-19 mitigation. Any opioid use was associated with greater odds of COVID-19 testing, and daily stimulant use was associated with greater odds of COVID-19 infection. Cigarettes, electronic cigarettes, cannabis, or stimulant use were not statistically associated with CDC guideline adherence, after accounting for sociodemographic covariates and other substance use variables. Findings support further investigation into whether COVID-19 testing and vaccination should be expanded among individuals with substance-related risk factors. %M 34591780 %R 10.2196/29319 %U https://publichealth.jmir.org/2021/11/e29319 %U https://doi.org/10.2196/29319 %U http://www.ncbi.nlm.nih.gov/pubmed/34591780 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e33022 %T Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study %A Bhalla,Sameer %A Sharma,Brihat %A Smith,Dale %A Boley,Randy %A McCluskey,Connor %A Ilyas,Yousaf %A Afshar,Majid %A Balk,Robert %A Karnik,Niranjan %A Keshavarzian,Ali %+ Center for Circadian Rhythm and Alcohol-Induced Tissue Injury, Rush University Medical Center, 1725 W Harrison St, Chicago, IL, United States, 1 (312) 942 5861, Ali_Keshavarzian@rush.edu %K unhealthy alcohol use %K COVID-19 %K SARS-CoV-2 %K acute respiratory distress syndrome %K substance misuse %K mechanical ventilation %K substance use %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Unhealthy alcohol use (UAU) is known to disrupt pulmonary immune mechanisms and increase the risk of acute respiratory distress syndrome in patients with pneumonia; however, little is known about the effects of UAU on outcomes in patients with COVID-19 pneumonia. To our knowledge, this is the first observational cross-sectional study that aims to understand the effect of UAU on the severity of COVID-19. Objective: We aim to determine if UAU is associated with more severe clinical presentation and worse health outcomes related to COVID-19 and if socioeconomic status, smoking, age, BMI, race/ethnicity, and pattern of alcohol use modify the risk. Methods: In this observational cross-sectional study that took place between January 1, 2020, and December 31, 2020, we ran a digital machine learning classifier on the electronic health record of patients who tested positive for SARS-CoV-2 via nasopharyngeal swab or had two COVID-19 International Classification of Disease, 10th Revision (ICD-10) codes to identify patients with UAU. After controlling for age, sex, ethnicity, BMI, smoking status, insurance status, and presence of ICD-10 codes for cancer, cardiovascular disease, and diabetes, we then performed a multivariable regression to examine the relationship between UAU and COVID-19 severity as measured by hospital care level (ie, emergency department admission, emergency department admission with ventilator, or death). We used a predefined cutoff with optimal sensitivity and specificity on the digital classifier to compare disease severity in patients with and without UAU. Models were adjusted for age, sex, race/ethnicity, BMI, smoking status, and insurance status. Results: Each incremental increase in the predicted probability from the digital alcohol classifier was associated with a greater odds risk for more severe COVID-19 disease (odds ratio 1.15, 95% CI 1.10-1.20). We found that patients in the unhealthy alcohol group had a greater odds risk to develop more severe disease (odds ratio 1.89, 95% CI 1.17-3.06), suggesting that UAU was associated with an 89% increase in the odds of being in a higher severity category. Conclusions: In patients infected with SARS-CoV-2, UAU is an independent risk factor associated with greater disease severity and/or death. %M 34665758 %R 10.2196/33022 %U https://publichealth.jmir.org/2021/11/e33022 %U https://doi.org/10.2196/33022 %U http://www.ncbi.nlm.nih.gov/pubmed/34665758 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29397 %T Predictors of Booster Engagement Following a Web-Based Brief Intervention for Alcohol Misuse Among National Guard Members: Secondary Analysis of a Randomized Controlled Trial %A Coughlin,Lara N %A Blow,Frederic C %A Walton,Maureen %A Ignacio,Rosalinda V %A Walters,Heather %A Massey,Lynn %A Barry,Kristen L %A McCormick,Richard %+ Addiction Center, Department of Psychiatry, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 615 4774, laraco@med.umich.edu %K alcohol use %K National Guard %K brief intervention %K boosters %K engagement %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions to enhance effectiveness, solidify gains, and reinforce changes. However, little is known about who will engage in booster sessions. Objective: This study aims to evaluate booster engagement across booster delivery modalities (Web and Peer) and identify participant-specific factors associated with booster session engagement. Methods: Following a brief web-based alcohol misuse intervention in National Guard members (N=739), we examined engagement in a series of three booster sessions. Using unadjusted and adjusted models, demographic and clinical characteristics that may serve as predictors of booster session engagement were examined across the 2 arms of the trial with different types of booster sessions: peer-delivered (N=245) and web-delivered (N=246). Results: Booster session completion was greater for Peer than Web Booster sessions, with 142 (58%) service members in the Peer Booster arm completing all three boosters compared with only 108 (44%) of participants in the Web Booster arm (χ23=10.3; P=.006). In a model in which the 2 groups were combined, socioeconomic factors predicted booster engagement. In separate models, the demographic and clinical predictors of booster engagement varied between the 2 delivery modalities. Conclusions: The use of peer-delivered boosters, especially among subsets of reserve members at risk of lack of engagement, may foster greater uptake and improve treatment outcomes. Trial Registration: ClinicalTrials.gov NCT02181283; https://clinicaltrials.gov/ct2/show/NCT02181283 %M 34698652 %R 10.2196/29397 %U https://mental.jmir.org/2021/10/e29397 %U https://doi.org/10.2196/29397 %U http://www.ncbi.nlm.nih.gov/pubmed/34698652 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28080 %T The Chicago Health and Life Experiences of Women Couples Study: Protocol for a Study of Stress, Hazardous Drinking, and Intimate Partner Aggression Among Sexual Minority Women and Their Partners %A Veldhuis,Cindy B %A Porsch,Lauren M %A Bochicchio,Lauren A %A Campbell,Jacquelyn %A Johnson,Timothy P %A LeBlanc,Allen J %A Leonard,Kenneth E %A Wall,Melanie %A Wilsnack,Sharon C %A Xu,Mariah %A Hughes,Tonda L %+ School of Nursing, Columbia University, 630 W. 168th St, New York, NY, 10032, United States, 1 312 307 0673, c.veldhuis@columbia.edu %K lesbian %K bisexual women %K intimate partner aggression %K partner violence %K same-sex couples %D 2021 %7 19.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Large gaps exist in research on alcohol use and intimate partner aggression (IPA) among sexual minority women (SMW; eg, lesbian, bisexual). Dyadic research with SMW and their partners can illuminate how couple-level factors operate in conjunction with individual-level factors to shape well-being in this understudied and vulnerable population. Given the traditionally gendered lens with which women are primarily viewed as victims and men as perpetrators, understanding the dynamics of IPA in same-sex female couples can also advance research and practice related to IPA more generally. Objective: Guided by a recent extension of the minority stress model that includes relational (couple-level) sexual minority stress and the I-cubed theoretical perspective on IPA, we will collect individual and dyadic data to better characterize the links between hazardous drinking and IPA among SMW and their partners. First, this study aims to examine the associations among minority stress, hazardous drinking, and IPA in SMW and their partners. Minority stressors will be assessed as both individual and couple-level constructs, thus further extending the minority stress model. Second, we aim to examine potential mediators and moderators of the associations among minority stress, hazardous drinking, and IPA. Finally, we aim to test models guided by the I-cubed theoretical perspective that includes instigating (eg, relationship conflict), impelling (eg, negative affect and trait anger), and inhibiting (eg, relationship commitment and emotion regulation) or disinhibiting (eg, hazardous drinking) influences on IPA perpetration. Methods: This United States National Institutes of Health–funded project will draw from a large and diverse cohort of SMW currently enrolled in the Chicago Health and Life Experiences of Women (CHLEW) study—a 21-year longitudinal study of risk factors and consequences associated with SMW hazardous drinking. SMW currently enrolled in the CHLEW and their partners will be invited to participate in the CHLEW Couples Study. By analyzing dyadic data using actor-partner interdependence models, we will examine how each partner’s minority stress, hazardous drinking, and IPA experiences are associated with both her own and her partner’s minority stress, hazardous drinking, and IPA perpetration. Results: Data collection began in February 2021 and will likely continue through 2023. Initial results should be available by mid-2024. Conclusions: The CHLEW Couples Study will fill important gaps in knowledge and provide the basis for future research aimed at clarifying the causal pathways linking hazardous drinking and IPA among SMW. This will support the development of culturally appropriate targeted individual and dyadic prevention and intervention strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/28080 %M 34665154 %R 10.2196/28080 %U https://www.researchprotocols.org/2021/10/e28080 %U https://doi.org/10.2196/28080 %U http://www.ncbi.nlm.nih.gov/pubmed/34665154 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e26418 %T Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial %A Wisk,Lauren E %A Magane,Kara M %A Nelson,Eliza B %A Tsevat,Rebecca K %A Levy,Sharon %A Weitzman,Elissa R %+ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, United States, 1 3102675308, lwisk@mednet.ucla.edu %K adolescent %K young adult %K diabetes mellitus %K type 1 %K binge drinking %K alcohol drinking %K self care %K risk-taking %K universities %K students %K attitude %K mobile phone %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating. Objective: The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician). Methods: We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery. Results: Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator. Conclusions: The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator. Trial Registration: ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829 International Registered Report Identifier (IRRID): RR2-10.1177/1932296819839503 %M 34591022 %R 10.2196/26418 %U https://www.jmir.org/2021/9/e26418 %U https://doi.org/10.2196/26418 %U http://www.ncbi.nlm.nih.gov/pubmed/34591022 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e25837 %T Development, Feasibility, Acceptability, and Utility of an Expressive Speech-Enabled Digital Health Agent to Deliver Online, Brief Motivational Interviewing for Alcohol Misuse: Descriptive Study %A Boustani,Maya %A Lunn,Stephanie %A Visser,Ubbo %A Lisetti,Christine %+ Department of Psychology, Loma Linda University, 11130 Anderson St, Suite 117, Loma Linda, CA, 92350, United States, 1 909 558 7680, mboustani@llu.edu %K digital health agent %K virtual health assistant %K online intervention %K alcohol abuse %K brief intervention %K motivational interviewing %K intelligent virtual agent %K embodied conversational agent %D 2021 %7 29.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health agents — embodied conversational agents designed specifically for health interventions — provide a promising alternative or supplement to behavioral health services by reducing barriers to access to care. Objective: Our goals were to (1) develop an expressive, speech-enabled digital health agent operating in a 3-dimensional virtual environment to deliver a brief behavioral health intervention over the internet to reduce alcohol use and to (2) understand its acceptability, feasibility, and utility with its end users. Methods: We developed an expressive, speech-enabled digital health agent with facial expressions and body gestures operating in a 3-dimensional virtual office and able to deliver a brief behavioral health intervention over the internet to reduce alcohol use. We then asked 51 alcohol users to report on the digital health agent acceptability, feasibility, and utility. Results: The developed digital health agent uses speech recognition and a model of empathetic verbal and nonverbal behaviors to engage the user, and its performance enabled it to successfully deliver a brief behavioral health intervention over the internet to reduce alcohol use. Descriptive statistics indicated that participants had overwhelmingly positive experiences with the digital health agent, including engagement with the technology, acceptance, perceived utility, and intent to use the technology. Illustrative qualitative quotes provided further insight about the potential reach and impact of digital health agents in behavioral health care. Conclusions: Web-delivered interventions delivered by expressive, speech-enabled digital health agents may provide an exciting complement or alternative to traditional one-on-one treatment. They may be especially helpful for hard-to-reach communities with behavioral workforce shortages. %M 34586074 %R 10.2196/25837 %U https://www.jmir.org/2021/9/e25837 %U https://doi.org/10.2196/25837 %U http://www.ncbi.nlm.nih.gov/pubmed/34586074 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27314 %T Deep Learning for Identification of Alcohol-Related Content on Social Media (Reddit and Twitter): Exploratory Analysis of Alcohol-Related Outcomes %A Ricard,Benjamin Joseph %A Hassanpour,Saeed %+ Department of Biomedical Data Science, Dartmouth College, Williamson Translational Research Building, One Medical Center Drive HB 7261, Lebanon, NH, 03756, United States, 1 603 650 1983, saeed.hassanpour@dartmouth.edu %K social media %K natural language processing %K alcohol abuse %K machine learning %D 2021 %7 15.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many social media studies have explored the ability of thematic structures, such as hashtags and subreddits, to identify information related to a wide variety of mental health disorders. However, studies and models trained on specific themed communities are often difficult to apply to different social media platforms and related outcomes. A deep learning framework using thematic structures from Reddit and Twitter can have distinct advantages for studying alcohol abuse, particularly among the youth in the United States. Objective: This study proposes a new deep learning pipeline that uses thematic structures to identify alcohol-related content across different platforms. We apply our method on Twitter to determine the association of the prevalence of alcohol-related tweets with alcohol-related outcomes reported from the National Institute of Alcoholism and Alcohol Abuse, Centers for Disease Control Behavioral Risk Factor Surveillance System, county health rankings, and the National Industry Classification System. Methods: The Bidirectional Encoder Representations From Transformers neural network learned to classify 1,302,524 Reddit posts as either alcohol-related or control subreddits. The trained model identified 24 alcohol-related hashtags from an unlabeled data set of 843,769 random tweets. Querying alcohol-related hashtags identified 25,558,846 alcohol-related tweets, including 790,544 location-specific (geotagged) tweets. We calculated the correlation between the prevalence of alcohol-related tweets and alcohol-related outcomes, controlling for confounding effects of age, sex, income, education, and self-reported race, as recorded by the 2013-2018 American Community Survey. Results: Significant associations were observed: between alcohol-hashtagged tweets and alcohol consumption (P=.01) and heavy drinking (P=.005) but not binge drinking (P=.37), self-reported at the metropolitan-micropolitan statistical area level; between alcohol-hashtagged tweets and self-reported excessive drinking behavior (P=.03) but not motor vehicle fatalities involving alcohol (P=.21); between alcohol-hashtagged tweets and the number of breweries (P<.001), wineries (P<.001), and beer, wine, and liquor stores (P<.001) but not drinking places (P=.23), per capita at the US county and county-equivalent level; and between alcohol-hashtagged tweets and all gallons of ethanol consumed (P<.001), as well as ethanol consumed from wine (P<.001) and liquor (P=.01) sources but not beer (P=.63), at the US state level. Conclusions: Here, we present a novel natural language processing pipeline developed using Reddit’s alcohol-related subreddits that identify highly specific alcohol-related Twitter hashtags. The prevalence of identified hashtags contains interpretable information about alcohol consumption at both coarse (eg, US state) and fine-grained (eg, metropolitan-micropolitan statistical area level and county) geographical designations. This approach can expand research and deep learning interventions on alcohol abuse and other behavioral health outcomes. %M 34524095 %R 10.2196/27314 %U https://www.jmir.org/2021/9/e27314 %U https://doi.org/10.2196/27314 %U http://www.ncbi.nlm.nih.gov/pubmed/34524095 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30367 %T Adapting to the Pandemic: Protocol of a Web-Based Perinatal Health Study to Improve Maternal and Infant Outcomes %A Tzilos Wernette,Golfo %A Countryman,Kristina %A Mmeje,Okeoma %A Ngo,Quyen M %A Zlotnick,Caron %+ Department of Family Medicine, University of Michigan Medical School, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 17349987120, gtzilos@med.umich.edu %K COVID-19 %K pregnancy %K COVID-19 pandemic %K alcohol use %K drug use %K sexually transmitted infections %K technology-delivered interventions %D 2021 %7 10.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The identification of interconnected health risks during the perinatal period offers an opportunity to prevent negative maternal and infant health outcomes. Marijuana, opioid, and other substance use during pregnancy is a rapidly growing public health concern with significant and costly health consequences for the woman and the developing fetus. Pregnant persons who misuse substances are disproportionately more likely to engage in risky sexual behaviors resulting in sexually transmitted infections (STIs), which are on the rise in this population and can lead to adverse effects on maternal health and on fetal development. Objective: Our goal is to continue testing an innovative and low-cost technology-delivered intervention, the Health Check-Up for Expectant Moms (HCEM), which simultaneously targets alcohol and drug use and STI risk during pregnancy, both of which are on the rise during the COVID-19 pandemic. Methods: We describe the ways in which we have adapted the web-based HCEM intervention to continue recruitment and study enrollment during the pandemic. Results: Study recruitment, visits, and participant safety assessments were all successfully modified during the initial year of the COVID-19 pandemic. Compared to in-person recruitment that occurred prepandemic, remote recruitment yielded a greater proportion of women enrolled in the study (83/136, 61.0% vs 43/52, 83%) in a shorter period (12 months vs 7 months). Conclusions: Despite study challenges related to the pandemic, including time and effort adapting to a remote protocol, remote recruitment and visits for this study were found to constitute a successful approach. Trial Registration: ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/ct2/show/NCT03826342 International Registered Report Identifier (IRRID): DERR1-10.2196/30367 %M 34351867 %R 10.2196/30367 %U https://www.researchprotocols.org/2021/9/e30367 %U https://doi.org/10.2196/30367 %U http://www.ncbi.nlm.nih.gov/pubmed/34351867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e21686 %T The Effectiveness of a Web-Based Self-Help Program to Reduce Alcohol Use Among Adults With Drinking Patterns Considered Harmful, Hazardous, or Suggestive of Dependence in Four Low- and Middle-Income Countries: Randomized Controlled Trial %A Schaub,Michael P %A Tiburcio,Marcela %A Martínez-Vélez,Nora %A Ambekar,Atul %A Bhad,Roshan %A Wenger,Andreas %A Baumgartner,Christian %A Padruchny,Dzianis %A Osipchik,Sergey %A Poznyak,Vladimir %A Rekve,Dag %A Landi Moraes,Fabricio %A Monezi Andrade,André Luiz %A Oliveira Souza-Formigoni,Maria Lucia %A , %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8005, Switzerland, 41 44 448 22 60, michael.schaub@isgf.uzh.ch %K alcohol %K internet %K public health %K self-help %K World Health Organization %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program “Alcohol e-Health.” Objective: We aimed to test the effectiveness of the Alcohol e-Health program in a randomized controlled trial. Methods: This was a two-arm, individually randomized, and controlled trial across four LMICs comparing the self-help program and a psychoeducation and internet access as usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India, and Mexico from January 2016 through January 2019. The primary outcome measure was change in the Alcohol Use Disorders Identification Test (AUDIT) score with a time frame of 6 months between baseline and follow-up. Secondary outcomes included self-reported numbers of standard drinks over the previous week and cessation of harmful or hazardous drinking (AUDIT score <8). Results: For this study, we recruited 1400 predominantly male (n=982, 70.1%) at least harmful or hazardous alcohol drinkers. The mean age was 37.6 years (SD 10.5). The participants were recruited from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall, complete case analysis identified higher AUDIT changes in the intervention group (B=−4.18, 95% CI −5.42 to −2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard drinks (B=−9.34, 95% CI −15.90 to −2.77, P=.005, d=0.28) and cessation rates for harmful or hazardous drinking (χ21=14.56, N=561, P<.001). The supplementary intention-to-treat analyses largely confirmed these initial results. Conclusions: The expansion of the Alcohol e-Health program to other LMICs with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results. Trial Registration: ISRCTN ISRCTN14037475; https://www.isrctn.com/ISRCTN14037475 International Registered Report Identifier (IRRID): RR2-10.1111/add.14034 %M 34448710 %R 10.2196/21686 %U https://www.jmir.org/2021/8/e21686 %U https://doi.org/10.2196/21686 %U http://www.ncbi.nlm.nih.gov/pubmed/34448710 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e17971 %T Attitudes of Patients and Health Professionals Regarding Screening Algorithms: Qualitative Study %A Oxholm,Christina %A Christensen,Anne-Marie Soendergaard %A Christiansen,Regina %A Wiil,Uffe Kock %A Nielsen,Anette Søgaard %+ Department for the Study of Culture, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 65503630, amsc@sdu.dk %K screening %K algorithms %K alcohol %K qualitative study %K attitudes %K opinions %K patients %K health professionals %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As a preamble to an attempt to develop a tool that can aid health professionals at hospitals in identifying whether the patient may have an alcohol abuse problem, this study investigates opinions and attitudes among both health professionals and patients about using patient data from electronic health records (EHRs) in an algorithm screening for alcohol problems. Objective: The aim of this study was to investigate the attitudes and opinions of patients and health professionals at hospitals regarding the use of previously collected data in developing and implementing an algorithmic helping tool in EHR for screening inexpedient alcohol habits; in addition, the study aims to analyze how patients would feel about asking and being asked about alcohol by staff, based on a notification in the EHR from such a tool. Methods: Using semistructured interviews, we interviewed 9 health professionals and 5 patients to explore their opinions and attitudes about an algorithm-based helping tool and about asking and being asked about alcohol usage when being given a reminder from this type of tool. The data were analyzed using an ad hoc method consistent with a close reading and meaning condensing. Results: The health professionals were both positive and negative about a helping tool grounded in algorithms. They were optimistic about the potential of such a tool to save some time by providing a quick overview if it was easy to use but, on the negative side, noted that this type of helping tool might take away the professionals’ instinct. The patients were overall positive about the helping tool, stating that they would find this tool beneficial for preventive care. Some of the patients expressed concerns that the information provided by the tool could be misused. Conclusions: When developing and implementing an algorithmic helping tool, the following aspects should be considered: (1) making the helping tool as transparent in its recommendations as possible, avoiding black boxing, and ensuring room for professional discretion in clinical decision making; and (2) including and taking into account the attitudes and opinions of patients and health professionals in the design and development process of such an algorithmic helping tool. %M 34383666 %R 10.2196/17971 %U https://formative.jmir.org/2021/8/e17971 %U https://doi.org/10.2196/17971 %U http://www.ncbi.nlm.nih.gov/pubmed/34383666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27891 %T Associations Between Physiological Signals Captured Using Wearable Sensors and Self-reported Outcomes Among Adults in Alcohol Use Disorder Recovery: Development and Usability Study %A Alinia,Parastoo %A Sah,Ramesh Kumar %A McDonell,Michael %A Pendry,Patricia %A Parent,Sara %A Ghasemzadeh,Hassan %A Cleveland,Michael John %+ Department of Human Development, Washington State University, 501 Johnson Tower, Pullman, WA, 99164, United States, 1 509 335 2870, michael.cleveland@wsu.edu %K alcohol relapse prevention %K stress markers %K alcohol consumption %K electrodermal activity %K heart rate variability %K emotion %K mobile phone %D 2021 %7 21.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous research has highlighted the role of stress in substance misuse and addiction, particularly for relapse risk. Mobile health interventions that incorporate real-time monitoring of physiological markers of stress offer promise for delivering tailored interventions to individuals during high-risk states of heightened stress to prevent alcohol relapse. Before such interventions can be developed, measurements of these processes in ambulatory, real-world settings are needed. Objective: This research is a proof-of-concept study to establish the feasibility of using a wearable sensor device to continuously monitor stress in an ambulatory setting. Toward that end, we first aimed to examine the quality of 2 continuously monitored physiological signals—electrodermal activity (EDA) and heart rate variability (HRV)—and show that the data follow standard quality measures according to the literature. Next, we examined the associations between the statistical features extracted from the EDA and HRV signals and self-reported outcomes. Methods: Participants (N=11; female: n=10) were asked to wear an Empatica E4 wearable sensor for continuous unobtrusive physiological signal collection for up to 14 days. During the same time frame, participants responded to a daily diary study using ecological momentary assessment of self-reported stress, emotions, alcohol-related cravings, pain, and discomfort via a web-based survey, which was conducted 4 times daily. Participants also participated in structured interviews throughout the study to assess daily alcohol use and to validate self-reported and physiological stress markers. In the analysis, we first used existing artifact detection methods and physiological signal processing approaches to assess the quality of the physiological data. Next, we examined the descriptive statistics for self-reported outcomes. Finally, we investigated the associations between the features of physiological signals and self-reported outcomes. Results: We determined that 87.86% (1,032,265/1,174,898) of the EDA signals were clean. A comparison of the frequency of skin conductance responses per minute with previous research confirmed that the physiological signals collected in the ambulatory setting were successful. The results also indicated that the statistical features of the EDA and HRV measures were significantly correlated with the self-reported outcomes, including the number of stressful events marked on the sensor device, positive and negative emotions, and experienced pain and discomfort. Conclusions: The results demonstrated that the physiological data collected via an Empatica E4 wearable sensor device were consistent with previous literature in terms of the quality of the data and that features of these physiological signals were significantly associated with several self-reported outcomes among a sample of adults diagnosed with alcohol use disorder. These results suggest that ambulatory assessment of stress is feasible and can be used to develop tailored mobile health interventions to enhance sustained recovery from alcohol use disorder. %M 34287205 %R 10.2196/27891 %U https://formative.jmir.org/2021/7/e27891 %U https://doi.org/10.2196/27891 %U http://www.ncbi.nlm.nih.gov/pubmed/34287205 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25796 %T Development of Automated Reinforcement Management System (ARMS): Protocol for a Phase I Feasibility and Usability Study %A Miguel,Andre %A Smith,Crystal %A Perea,Nicole %A Johnson,Kim %A McDonell,Michael %A McPherson,Sterling %+ Elson S Floyd College of Medicine, Washington State University, 665 N Riverpoint Blvd, Office 406, Spokane, WA, 99202, United States, 1 5096866896, andre.miguel@wsu.edu %K alcohol use disorder %K contingency management %K ecological momentary assessment %K treatment %D 2021 %7 19.7.2021 %9 Protocol %J JMIR Form Res %G English %X Background: Alcohol use is directly related to over 3 million deaths worldwide every year. Contingency management is a cost-effective treatment for substance use disorders; however, few studies have examined its efficacy for alcohol use disorder. Recent technological advances have enabled the combined use of mobile apps and low-cost electronic breathalyzer devices to remotely monitor alcohol use. Leveraging this type of technology, our study group has recently developed an integrated contingency management system that would enable community treatment programs to remotely deliver contingency management to anyone who owns a smartphone. Objective: In this paper, we present a full description of our integrated contingency management system, Automated Reinforcement Management System (ARMS), and describe a protocol that will evaluate its feasibility and usability. Methods: Initially, 6 clinicians will participate in a 1-hour focus group where the study staff will navigate through ARMS as it would be used by clinicians and patients. Clinicians will provide feedback on the intervention in general, which will be used to modify ARMS to make it more user friendly, time saving, and relevant to treatment. A second focus group will summarize the changes made following the initial clinician feedback and will provide additional input regarding the potential utilization of ARMS. Thereafter, the clinicians’ acceptability of ARMS will be evaluated using the System Usability Scale. Following the clinicians’ assessments of ARMS and final modifications, the system will be evaluated in terms of feasibility and patient usability by using an A-B-A within-subject experimental design wherein 20 treatment-seeking individuals with alcohol use disorder will be recruited. The two A phases (control conditions) will each last 2 weeks, and the B phase (contingency management condition) will last 4 weeks. During all phases, participants will be asked to use the ARMS app to submit three breathalyzer samples per day (at 10 AM, 2 PM, and 8 PM). Participants will be prompted by the ARMS app at these predetermined times to record and submit their breathalyzer samples. During the A phases, participants will earn vouchers for every breathalyzer sample submitted, independent of their sample results. During the B phase, vouchers will be provided contingent upon the submission of alcohol-negative breathalyzer samples (breath alcohol content = 0.00). At the end of the A-B-A experiment trial, patients’ usability of the ARMS app will be evaluated using the System Usability Scale. Feasibility will be measured based on whether the ARMS app helped significantly increase alcohol abstinence. Results: Recruitment for this study began in January 2021 and is expected to be completed by December 2021. Conclusions: This study will provide the baseline capability for the implementation of a remotely monitored contingency management platform. If successful, ARMS has the potential to provide effective treatment for alcohol use disorders to individuals living in remote rural areas. %M 34279238 %R 10.2196/25796 %U https://formative.jmir.org/2021/7/e25796 %U https://doi.org/10.2196/25796 %U http://www.ncbi.nlm.nih.gov/pubmed/34279238 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28667 %T A Web-Based Cognitive Bias Modification Intervention (Re-train Your Brain) for Emerging Adults With Co-occurring Social Anxiety and Hazardous Alcohol Use: Protocol for a Multiarm Randomized Controlled Pilot Trial %A Prior,Katrina %A Salemink,Elske %A Wiers,Reinout W %A Teachman,Bethany A %A Piggott,Monique %A Newton,Nicola C %A Teesson,Maree %A Baillie,Andrew J %A Manning,Victoria %A McLellan,Lauren F %A Mahoney,Alison %A Stapinski,Lexine A %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell building (G02), Sydney, 2006, Australia, 61 02 8627 9032, katrina.prior@sydney.edu.au %K alcohol %K anxiety %K cognitive bias modification %K interpretation bias %K approach bias %K emerging adults %D 2021 %7 7.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use and anxiety disorders commonly co-occur, resulting in a more severe clinical presentation and poorer response to treatment. Research has shown that approach bias modification (ApBM) and interpretation bias modification (IBM) cognitive retraining interventions can be efficacious adjunctive treatments that improve outcomes for alcohol use and social anxiety, respectively. However, the acceptability, feasibility, and clinical utility of combining ApBM and IBM programs to optimize treatments among comorbid samples are unknown. It is also unclear whether integrating ApBM and IBM within each training session or alternating them between each session is more acceptable and efficacious. Objective: This paper describes the protocol for a randomized controlled pilot trial investigating the feasibility, acceptability, and preliminary efficacy of the Re-train Your Brain intervention—an adjunct web-based ApBM+IBM program—among a clinical sample of emerging adults with hazardous alcohol use and social anxiety. Methods: The study involves a three-arm randomized controlled pilot trial in which treatment-seeking emerging adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety will be individually randomized to receive the Re-train Your Brain integrated program, delivered with 10 biweekly sessions focusing on both social anxiety and alcohol each week, plus treatment as usual (TAU; ie, the model of care provided in accordance with standard practice at their service; n=30); the Re-train Your Brain alternating program, delivered with 10 biweekly sessions focusing on social anxiety one week and alcohol the next week, plus TAU (n=30); or TAU only (n=30). Primary outcomes include feasibility (uptake, follow-up rates, treatment adherence, attrition, and adverse events) and acceptability (system usability, client satisfaction, user experience, and training format preference). Secondary efficacy outcomes include changes in alcohol approach and interpretation biases, social anxiety, and alcohol use (eg, drinks per day, binge drinking, drinking motives, severity of dependence, and cravings). The primary end point will be posttreatment (6 weeks postbaseline), with a secondary end point at 3 months postbaseline. Descriptive statistics will be conducted for primary outcomes, whereas intention-to-treat, multilevel mixed effects analysis for repeated measures will be performed for secondary outcomes. Results: This study is funded from 2019 to 2023 by Australian Rotary Health. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023. Conclusions: This study will be the first to evaluate whether an ApBM+IBM program is acceptable to treatment-seeking, emerging adults and whether it can be feasibly delivered via the web, in settings where it will ultimately be used (eg, at home). The findings will broaden our understanding of the types of programs that emerging adults will engage with and whether the program may be an efficacious treatment option for this comorbidity. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): PRR1-10.2196/28667 %M 34255726 %R 10.2196/28667 %U https://www.researchprotocols.org/2021/7/e28667 %U https://doi.org/10.2196/28667 %U http://www.ncbi.nlm.nih.gov/pubmed/34255726 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e20658 %T Executive Function After Prenatal Alcohol Exposure in Children in a South African Population: Cross-sectional Study %A Louw,Jacobus Gidion %A van Heerden,Alastair %A Olivier,Leana %A Lambrechts,Tersius %A Broodryk,Mandi %A Bunge,Liska %A Vosloo,Martlé %A Tomlinson,Mark %+ Foundation for Alcohol Related Research, 42 Bloemhof Street, Bellville, Cape Town, 7535, South Africa, 27 216862646, jl@farrsa.org.za %K fetal alcohol spectrum disorders %K FASD %K cognitive %K executive function %K experimental games %K brain drug effects %K child development %K serious games %K games %K alcohol %K training %D 2021 %7 2.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol is a teratogen; its consumption during pregnancy can lead to negative birth outcomes, collectively referred to as fetal alcohol spectrum disorders. Neurodevelopmental delays in higher-order cognitive functions that affect development of executive functions are a common feature. Studies on executive function in children have focused on children diagnosed with fetal alcohol spectrum disorder, and there is a lack of information on the impact on children not diagnosed with fetal alcohol spectrum disorder but who had been exposed to alcohol. Objective: The aim of this study was to compare the development of executive function in children between 4 and 6 years of age with and without prenatal exposure to alcohol. Methods: Children both exposed and not exposed to alcohol were recruited as part of a feasibility RCT evaluating a computer-based cognitive training program for improving executive function development. The study was conducted in a low–socioeconomic status community in South Africa with a high prevalence of fetal alcohol spectrum disorder. Neurodevelopment was assessed in participating children; NEPSY-II standardized scores for executive function domains were compared using a multivariate analysis of variance with group membership as the predictor variable. Results: No significant differences in executive functions assessments (P=.39) were found between children in the alcohol-exposed group (n=76) and those in the nonexposed group (n=40). Both groups showed moderate to severe delays in domains. In all but one subtest, the average score for both groups was below the 25th percentile of expected norms. Conclusions: We expected that alcohol exposure would have a measurable impact on executive function development. The lack of differences highlights the prevalence of developmental delays in low–socioeconomic status communities in South Africa and suggests that children are exposed to various threats to cognitive development. International Registered Report Identifier (IRRID): RR2-10.2196/14489 %M 34255647 %R 10.2196/20658 %U https://formative.jmir.org/2021/7/e20658 %U https://doi.org/10.2196/20658 %U http://www.ncbi.nlm.nih.gov/pubmed/34255647 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e23986 %T Factors Predicting Trial Engagement, Treatment Satisfaction, and Health-Related Quality of Life During a Web-Based Treatment and Social Networking Trial for Binge Drinking and Depression in Young Adults: Secondary Analysis of a Randomized Controlled Trial %A Sanatkar,Samineh %A Heinsch,Milena %A Baldwin,Peter Andrew %A Rubin,Mark %A Geddes,Jenny %A Hunt,Sally %A Baker,Amanda L %A Woodcock,Kathryn %A Lewin,Terry J %A Brady,Kathleen %A Deady,Mark %A Thornton,Louise %A Teesson,Maree %A Kay-Lambkin,Frances %+ Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 02 9065 9179, samineh.sanatkar@uon.edu.au %K digital mental health %K personality %K negative affect %K study engagement %K life quality %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health and alcohol use problems are among the most common causes of disease burden in young Australians, frequently co-occur (comorbidity), and lead to significant lifetime burden. However, comorbidities remain significantly underdetected and undertreated in health settings. Digital mental health tools designed to identify at-risk individuals, encourage help-seeking, or deliver treatment for comorbidity have the potential to address this service gap. However, despite a strong body of evidence that digital mental health programs provide an effective treatment option for a range of mental health and alcohol use problems in young adults, research shows that uptake rates can be low. Thus, it is important to understand the factors that influence treatment satisfaction and quality-of-life outcomes for young adults who access e–mental health interventions for comorbidity. Objective: In this study, we seek to understand the factors that influence treatment satisfaction and quality-of-life outcomes for young adults who access e–mental health interventions for comorbid alcohol and mood disorders. The aim is to determine the importance of personality (ie, Big Five personality traits and intervention attitudes), affective factors (ie, depression, anxiety, and stress levels), and baseline alcohol consumption in predicting intervention trial engagement at sign-up, satisfaction with the online tool, and quality of life at the end of the iTreAD (Internet Treatment for Alcohol and Depression) trial. Methods: Australian adults (N=411) aged between 18 and 30 years who screened positive for depression and alcohol use problems signed up for the iTreAD project between August 2014 and October 2015. During registration, participants provided information about their personality, current affective state, alcohol use, treatment expectations, and basic demographic information. Subsequent follow-up surveys were used to gauge the ongoing trial engagement. The last follow-up questionnaire, completed at 64 weeks, assessed participants’ satisfaction with web-based treatment and quality-of-life outcomes. Results: Multiple linear regression analyses were used to assess the relative influence of predictor variables on trial engagement, treatment satisfaction, and quality-of-life outcomes. The analyses revealed that the overall predictive effects of personality and affective factors were 20% or lower. Neuroticism constituted a unique predictor of engagement with the iTreAD study in that neuroticism facilitated the return of web-based self-assessments during the study. The return of incentivized follow-up assessments predicted treatment satisfaction, and state-based depression predicted variance in quality-of-life reports at study completion. Conclusions: Our findings suggest that traditional predictors of engagement observed in face-to-face research may not be easily transferable to digital health interventions, particularly those aimed at comorbid mental health concerns and alcohol misuse among young adults. More research is needed to identify what determines engagement in this population to optimally design and execute digital intervention studies with multiple treatment aims. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12614000310662; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=365137&isReview=true. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-015-2365-2 %M 34096873 %R 10.2196/23986 %U https://mental.jmir.org/2021/6/e23986 %U https://doi.org/10.2196/23986 %U http://www.ncbi.nlm.nih.gov/pubmed/34096873 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29750 %T A Mobile Intervention to Promote Low-Risk Drinking Habits in Young Adults: Protocol for a Randomized Controlled Trial %A Boumparis,Nikolaos %A Schulte,Mieke H %A Kleiboer,Annet %A Huizink,Anja %A Riper,Heleen %+ Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 631673537, h.riper@vu.nl %K alcohol %K lifestyle %K drinking %K young adults %K digital %K mobile app %K COVID-19 %D 2021 %7 7.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adults’ drinking habits commonly exceed recommendations for low-risk drinking, which may have a negative effect on their mental, social, and physical health. As smartphones are highly accessible to young adults, mobile apps could be used to support young adults to develop low-risk drinking habits and improve their general health. Objective: The objective of this study is to evaluate the effectiveness of Boozebuster, a self-guided mobile app based on healthy lifestyle–related components that aim to develop and maintain low-risk drinking habits among young adults. Methods: This two-arm, parallel-group randomized controlled trial will investigate whether a 6-week self-guided mobile intervention (Boozebuster) targeting drinking behavior is more effective than a minimal intervention consisting of an educational website on alcohol use and its consequences for young adults. We will recruit 506 young adults (aged 18-30 years) from the Netherlands via an open recruitment strategy by using an open access website. All outcomes will be self-assessed through questionnaires. The primary outcome is the quantity and frequency of alcohol consumption in standard drinks (10 g ethanol per standard drink) per month (timeline follow-back [TLFB]). Secondary outcomes include binge-drinking sessions per month, alcohol-related problem severity (Rutgers Alcohol Problem Index), cannabis use frequency and quantity in grams (TLFB), depressive symptoms (Center for Epidemiological Studies Depression Scale), perceived stress (Perceived Stress Scale), engagement (Twente Engagement with eHealth Technologies Scale), readiness to change (Readiness to Change Questionnaire), mental well-being (Warwick-Edinburgh Mental Wellbeing Scale), trauma and COVID-19–related trauma (Short-Form Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), impulsivity (Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency Impulsive Behavior Scale), study or work performance (Individual Work Performance Questionnaire), and treatment adherence. Baseline (T0), 6-week postbaseline (T1), and 3-month postbaseline (T2) assessments will be conducted and analyzed on the basis of the intention-to-treat principle using multilevel mixed modeling analyses. Results: Recruitment began in September 2020. We received 933 registrations via our study information website; 506 participants have completed the T0 assessment, 336 participants have completed the T1 assessment, and 308 participants have completed the T2 assessment as of May 2021. The study is still in progress, and results will be reported in 2021 and 2022. Conclusions: Self-guided mobile interventions based on a lifestyle approach might be an attractive approach for young adults due to their preference on self-reliance, healthy living, and increased perceived anonymity. Such interventions are yet understudied, and it is known that interventions addressing solely problem drinking are less appealing to young adults. We hypothesize that the Boozebuster mobile app will effectively reduce drinking levels compared to an alcohol educational website (control condition). If effective, our intervention could be an inexpensive and scalable public health intervention to improve drinking habits in young adults. Trial Registration: Netherlands Trial Register NL8828; https://www.trialregister.nl/trial/8828 International Registered Report Identifier (IRRID): DERR1-10.2196/29750 %M 34033583 %R 10.2196/29750 %U https://www.researchprotocols.org/2021/6/e29750 %U https://doi.org/10.2196/29750 %U http://www.ncbi.nlm.nih.gov/pubmed/34033583 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e28991 %T Use of the Instagram Hashtags #winemom and #momjuice Among Mothers During the COVID-19 Pandemic: Descriptive, Cross-sectional Study %A Basch,Corey H %A Meleo-Erwin,Zoe C %A Mohlman,Jan %A Fera,Joseph %A Quinones,Nasia %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, United States, 1 973 720 2603, baschc@wpunj.edu %K Instagram %K alcohol consumption %K COVID-19 %K social media %K communication %K parenting %D 2021 %7 18.5.2021 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: The tendency of parents to consume alcohol during the COVID-19 pandemic is likely to be moderated by pandemic-related stress combined with the ongoing demands of childcare and home-based education, which are reported to be more burdensome for females than males. Objective: The purpose of this study was to describe alcohol-related content posted by mothers on Instagram during the COVID-19 pandemic. Methods: Using two popular hashtags, #momjuice and #winemom, 50 Instagram posts on each were collected from the “top posts” tab. The coding categories were created inductively and were as follows: displays alcohol (drinking/holding alcohol or alcohol itself), person is making alcoholic beverages, type of alcohol featured or discussed, highlights anxiety and/or depression/mental state, highlights struggling (in general), highlights parenting challenges, encourages alcohol consumption, discourages alcohol consumption, features a person wearing clothing or shows products promoting alcohol, promotes alcohol rehabilitation, highlights caffeine to alcohol daily transition throughout the day, and highlights other drugs besides caffeine and alcohol. Results: Overall, the 100 selected posts had a total of 5108 comments and 94,671 likes. The respective averages were 51.08 (SD 77.94) and 946.71 (SD 1731.72). A majority (>50%) of the posts reviewed encouraged alcohol consumption (n=66) and/or displayed alcohol (n=56). Of the 66 that encouraged and/or displayed alcohol, the common type of alcohol discussed or featured was wine (n=55). Only 6 posts discouraged alcohol use and only 4 provided the audience with a disclaimer. None of the videos promoted or endorsed alcohol rehabilitation in any way. Only 37 posts highlighted struggle. However, these posts garnered more than a majority of the likes (n=50,034, 52.3%). Posts that showed struggle received an average of 1359.57 (SD 2108.02) likes. Those that did not show struggle had an average of 704.24 (SD 1447.46) likes. An independent one-tailed t test demonstrated this difference to be statistically significant (P=.0499). Conclusions: The findings of this investigation suggest that though these hashtags ostensibly exist to valorize excess alcohol consumption, they may be serving as a support system for mothers who are experiencing increased burdens and role stress during the pandemic. Given the strains placed on mothers overall and especially during the COVID-19 pandemic, efforts must be taken to increase access to and affordability of telehealth-based mental health care. %M 33848257 %R 10.2196/28991 %U https://pediatrics.jmir.org/2021/2/e28991 %U https://doi.org/10.2196/28991 %U http://www.ncbi.nlm.nih.gov/pubmed/33848257 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e19688 %T Effectiveness of Digital Interventions for Reducing Behavioral Risks of Cardiovascular Disease in Nonclinical Adult Populations: Systematic Review of Reviews %A Gold,Natalie %A Yau,Amy %A Rigby,Benjamin %A Dyke,Chris %A Remfry,Elizabeth Alice %A Chadborn,Tim %+ Public Health England, Wellington House, 133-155 Waterloo Road, London, SE1 8UG, United Kingdom, 44 9767839044, n.gold@lse.ac.uk %K alcohol %K behavior change %K cardiovascular disease %K diet %K digital interventions %K digital medicine %K internet interventions %K mHealth %K mobile interventions %K physical activity %K smoking %K tobacco %K mobile phone %D 2021 %7 14.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions are increasingly being used as a supplement or replacement for face-to-face services as a part of predictive prevention. They may be offered to those who are at high risk of cardiovascular disease and need to improve their diet, increase physical activity, stop smoking, or reduce alcohol consumption. Despite the popularity of these interventions, there is no overall summary and comparison of the effectiveness of different modes of delivery of a digital intervention to inform policy. Objective: This review aims to summarize the effectiveness of digital interventions in improving behavioral and health outcomes related to physical activity, smoking, alcohol consumption, or diet in nonclinical adult populations and to identify the effectiveness of different modes of delivery of digital interventions. Methods: We reviewed articles published in the English language between January 1, 2009, and February 25, 2019, that presented a systematic review with a narrative synthesis or meta-analysis of any study design examining digital intervention effectiveness; data related to adults (≥18 years) in high-income countries; and data on behavioral or health outcomes related to diet, physical activity, smoking, or alcohol, alone or in any combination. Any time frame or comparator was considered eligible. We searched MEDLINE, Embase, PsycINFO, Cochrane Reviews, and gray literature. The AMSTAR-2 tool was used to assess review confidence ratings. Results: We found 92 reviews from the academic literature (47 with meta-analyses) and 2 gray literature items (1 with a meta-analysis). Digital interventions were typically more effective than no intervention, but the effect sizes were small. Evidence on the effectiveness of digital interventions compared with face-to-face interventions was mixed. Most trials reported that intent-to-treat analysis and attrition rates were often high. Studies with long follow-up periods were scarce. However, we found that digital interventions may be effective for up to 6 months after the end of the intervention but that the effects dissipated by 12 months. There were small positive effects of digital interventions on smoking cessation and alcohol reduction; possible effectiveness in combined diet and physical activity interventions; no effectiveness for interventions targeting physical activity alone, except for when interventions were delivered by mobile phone, which had medium-sized effects; and no effectiveness observed for interventions targeting diet alone. Mobile interventions were particularly effective. Internet-based interventions were generally effective. Conclusions: Digital interventions have small positive effects on smoking, alcohol consumption, and in interventions that target a combination of diet and physical activity. Small effects may have been due to the low efficacy of treatment or due to nonadherence. In addition, our ability to make inferences from the literature we reviewed was limited as those interventions were heterogeneous, many reviews had critically low AMSTAR-2 ratings, analysis was typically intent-to-treat, and follow-up times were relatively short. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019126074; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=126074. %M 33988126 %R 10.2196/19688 %U https://www.jmir.org/2021/5/e19688 %U https://doi.org/10.2196/19688 %U http://www.ncbi.nlm.nih.gov/pubmed/33988126 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e23872 %T The Psychosocial Predictors and Day-Level Correlates of Substance Use Among Participants Recruited via an Online Crowdsourcing Platform in the United States: Daily Diary Study %A Jain,Jennifer Payaal %A Offer,Claudine %A Rowe,Christopher %A Turner,Caitlin %A Dawson-Rose,Carol %A Hoffmann,Thomas %A Santos,Glenn-Milo %+ San Francisco Department of Public Health, 101 Grove Street, San Francisco, CA, 94102, United States, 1 415 640 0674, jennifer.jain@ucsf.edu %K Amazon Mechanical Turk %K stimulant use %K alcohol use %K craving %K depression %K affect %K self-esteem %K men who have sex with men %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Alcohol consumption and stimulant use are major public health problems and contribute to morbidity and mortality in the United States. To inform interventions for substance use, there is a need to identify the day-level correlates of substance use by collecting repeated measures data in one’s natural environment. There is also a need to use crowdsourcing platforms like Amazon Mechanical Turk (MTurk) to efficiently engage larger populations of people who use alcohol and stimulants in research. Objective: We aimed to (1) utilize daily diaries to examine the temporal relationship between day-level cravings for alcohol and stimulant/substance use (ie, heavy drinking or any drug use) in a given day over 14 days and (2) assess whether depression, negative affect, and self-esteem measured at baseline predict substance use in a given day over 14 days among people who use alcohol and/or stimulants in the United States. Methods: Individuals aged ≥18 years in the United States, who reported alcohol or stimulant (ie, cocaine, crack cocaine, and methamphetamine) use in the past year, were recruited using MTurk between March 26 and April 13, 2018. Eligible participants completed a baseline survey and 14 daily surveys online. The baseline survey assessed sociodemographics and psychosocial (ie, depression, affect, self-esteem, and stress) factors. Daily surveys assessed substance use and cravings for alcohol and stimulants. Four multivariable random-intercept logistic regression models were built to examine psychosocial constructs separately along with other significant predictors from bivariate analyses while controlling for age and education. Results: Among a total of 272 participants, 220 were White, 201 were male, and 134 were men who have sex with men (MSM). The mean age was 36.1 years (SD 10.5). At baseline, 173 participants engaged in any current or past hazardous alcohol consumption, 31 reported using cocaine, 19 reported using methamphetamine, 8 reported using crack cocaine, and 104 reported any noninjection or injection drug use in the past 6 months. Factors independently associated with substance use were depression (adjusted odds ratio [aOR] 1.11, 95% CI 1.02-1.21; P=.01), negative affect (aOR 1.08, 95% CI 1.01-1.16; P=.01), lower levels of self-esteem (aOR 0.90, 95% CI 0.82-0.98; P=.02), and cravings for alcohol (aOR 1.02, 95% CI 1.01-1.03; P<.001) and stimulants (aOR 1.03, 95% CI 1.01-1.04; P=.01). MSM had higher odds of engaging in substance use in all models (model 1: aOR 4.90, 95% CI 1.28-18.70; P=.02; model 2: aOR 5.47, 95% CI 1.43-20.87; P=.01; model 3: aOR 5.99, 95% CI 1.55-23.13; P=.009; and model 4: aOR 4.94, 95% CI 1.29-18.84; P=.01). Conclusions: Interventions for substance use should utilize evidenced-based approaches to reduce depression, negative affect, and cravings; increase self-esteem; and engage MSM. Interventions may also consider leveraging technology-based approaches to reduce substance use among populations who use crowdsourcing platforms. %M 33904828 %R 10.2196/23872 %U https://publichealth.jmir.org/2021/4/e23872 %U https://doi.org/10.2196/23872 %U http://www.ncbi.nlm.nih.gov/pubmed/33904828 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24647 %T A Gamified, Social Media–Inspired, Web-Based Personalized Normative Feedback Alcohol Intervention for Lesbian, Bisexual, and Queer-Identified Women: Protocol for a Hybrid Trial %A Boyle,Sarah C %A LaBrie,Joseph W %+ HeadsUp Labs, Department of Psychology, Loyola Marymount University, 1 LMU Drive, Suite 3787, Los Angeles, CA, 90045, United States, 1 8182909940, sarah.boyle@lmu.edu %K sexual minority women %K alcohol %K intervention %K social norms %K gamification %K protocol %K mobile phone %D 2021 %7 16.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual minority women are more likely to drink alcohol, engage in heavy drinking, and experience alcohol-related problems than heterosexual women. However, culturally tailored interventions for this population have been slow to emerge. Objective: This type 1 effectiveness-implementation trial examines the feasibility and efficacy of a gamified, culturally tailored, personalized normative feedback (PNF) alcohol intervention for sexual minority women who psychologically identify as lesbian, bisexual, or queer (LBQ). Methods: The core components of a PNF intervention were delivered within LezParlay, a fun, social media–inspired, digital competition designed to challenge negative stereotypes about LBQ women and increase visibility. The competition was advertised on the web through social media platforms and collaboration with LBQ community organizations. After 2 rounds of play by a large cohort of LBQ women, a subsample of 500 drinkers already taking part in the competition were invited to participate in the evaluation study. Study participants were randomized to receive 1 of 3 unique sequences of PNF (ie, alcohol and stigma coping, alcohol and control, or control topics only) over 2 intervention rounds. Randomization was fully automated by the web app, and both researchers and participants were blinded. Results: Analyses will evaluate whether PNF on alcohol use reduces participants’ drinking and negative consequences at 2 and 4 months postintervention; examine whether providing PNF on stigma-coping behaviors, in addition to alcohol use, further reduces alcohol use and consequences beyond PNF on alcohol alone; identify mediators and moderators of intervention efficacy; and examine broader LezParlay app engagement, acceptability, and perceived benefits. Conclusions: This incognito intervention approach is uniquely oriented toward engaging and preventing alcohol-related risks among community populations of LBQ women who may view their heavy drinking as normative and not in need of change because of the visibility of alcohol use in sexual minority community spaces. Thus, this intervention strategy diverges from, and is intended to complement, more intensive programs being developed to meet the needs of LBQ women already motivated to reduce their consumption. Trial Registration: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478 International Registered Report Identifier (IRRID): DERR1-10.2196/24647 %M 33861212 %R 10.2196/24647 %U https://www.researchprotocols.org/2021/4/e24647 %U https://doi.org/10.2196/24647 %U http://www.ncbi.nlm.nih.gov/pubmed/33861212 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 4 %P e25927 %T Usability and Acceptability of a Mobile App for the Self-Management of Alcohol Misuse Among Veterans (Step Away): Pilot Cohort Study %A Malte,Carol A %A Dulin,Patrick L %A Baer,John S %A Fortney,John C %A Danner,Anissa N %A Lott,Aline M K %A Hawkins,Eric J %+ Center of Excellence in Substance Addiction Treatment and Education (CESATE), Veterans Affairs Puget Sound Health Care System, 1660 S Columbian Way, MS 116 ATC, Seattle, WA, 98108, United States, 1 206 277 3780, carol.malte@va.gov %K mobile apps %K alcohol misuse %K smartphone %K veterans %K access %D 2021 %7 8.4.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol misuse is common among Operation Enduring Freedom and Operation Iraqi Freedom veterans, yet barriers limit treatment participation. Mobile apps hold promise as means to deliver alcohol interventions to veterans who prefer to remain anonymous, have little time for conventional treatments, or live too far away to attend treatment in person. Objective: This pilot study evaluated the usability and acceptability of Step Away, a mobile app designed to reduce alcohol-related risks, and explored pre-post changes on alcohol use, psychological distress, and quality of life. Methods: This single-arm pilot study recruited Operation Enduring Freedom and Operation Iraqi Freedom veterans aged 18 to 55 years who exceeded National Institute on Alcohol Abuse and Alcoholism drinking guidelines and owned an iPhone. Enrolled veterans (N=55) completed baseline and 1-, 3-, and 6-month assessments. The System Usability Scale (scaled 1-100, ≥70 indicating acceptable usability) assessed the effectiveness, efficiency, and satisfaction dimensions of usability, while a single item (scaled 1-9) measured the attractiveness of 10 screenshots. Learnability was assessed by app use during week 1. App engagement (proportion of participants using Step Away, episodes of use, and minutes per episode per week) over 6 months measured acceptability. Secondary outcomes included pre-post change on heavy drinking days (men: ≥5 drinks per day; women: ≥4 drinks per day) and Short Inventory of Problems–Revised, Kessler-10, and brief World Health Organization Quality of Life Questionnaire scores. Results: Among the 55 veterans enrolled in the study, the mean age was 37.4 (SD 7.6), 16% (9/55) were women, 82% (45/55) were White, and 82% (45/55) had an alcohol use disorder. Step Away was used by 96% (53/55) of participants in week 1, 55% (30/55) in week 4, and 36% (20/55) in week 24. Step Away use averaged 55.1 minutes (SD 57.6) in week 1 and <15 minutes per week in weeks 2 through 24. Mean System Usability Scale scores were 69.3 (SD 19.7) and 71.9 (SD 15.8) at 1 and 3 months, respectively. Median attractiveness scores ranged from 5 to 8, with lower ratings for text-laden screens. Heavy drinking days decreased from 29.4% (95% CI 23.4%-35.4%) at baseline to 16.2% (95% CI 9.9%-22.4%) at 6 months (P<.001). Likewise, over 6 months, Short Inventory of Problems–Revised scores decreased from 6.3 (95% CI 5.1-7.5) to 3.6 (95% CI 2.4-4.9) (P<.001) and Kessler-10 scores decreased from 18.8 (95% CI 17.4-20.1) to 17.3 (95% CI 15.8-18.7) (P=.046). Changes were not detected on quality of life scores. Conclusions: Operation Enduring Freedom and Operation Iraqi Freedom veterans found the usability of Step Away to be acceptable and engaged in the app over the 6-month study. Reductions were seen in heavy drinking days, alcohol-related problems, and Kessler-10 scores. A larger randomized trial is warranted to confirm our findings. %M 33830064 %R 10.2196/25927 %U https://mhealth.jmir.org/2021/4/e25927 %U https://doi.org/10.2196/25927 %U http://www.ncbi.nlm.nih.gov/pubmed/33830064 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e25202 %T The Nature and Extent of Online Marketing by Big Food and Big Alcohol During the COVID-19 Pandemic in Australia: Content Analysis Study %A Martino,Florentine %A Brooks,Ruby %A Browne,Jennifer %A Carah,Nicholas %A Zorbas,Christina %A Corben,Kirstan %A Saleeba,Emma %A Martin,Jane %A Peeters,Anna %A Backholer,Kathryn %+ Deakin University, Global Obesity Centre, Institute for Health Transformation, 1 Gheringhap Street, Geelong, 3220, Australia, 61 3 924 43836, kathryn.backholer@deakin.edu.au %K alcohol %K food and beverage %K COVID-19 %K marketing %K social media %D 2021 %7 12.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Emerging evidence demonstrates that obesity is associated with a higher risk of COVID-19 morbidity and mortality. Excessive alcohol consumption and “comfort eating” as coping mechanisms during times of high stress have been shown to further exacerbate mental and physical ill-health. Global examples suggest that unhealthy food and alcohol brands and companies are using the COVID-19 pandemic to further market their products. However, there has been no systematic, in-depth analysis of how “Big Food” and “Big Alcohol” are capitalizing on the COVID-19 pandemic to market their products and brands. Objective: We aimed to quantify the extent and nature of online marketing by alcohol and unhealthy food and beverage companies during the COVID-19 pandemic in Australia. Methods: We conducted a content analysis of all COVID-19-related social media posts made by leading alcohol and unhealthy food and beverage brands (n=42) and their parent companies (n=12) over a 4-month period (February to May 2020) during the COVID-19 pandemic in Australia. Results: Nearly 80% of included brands and all parent companies posted content related to COVID-19 during the 4-month period. Quick service restaurants (QSRs), food and alcohol delivery companies, alcohol brands, and bottle shops were the most active in posting COVID-19-related content. The most common themes for COVID-19-related marketing were isolation activities and community support. Promotion of hygiene and home delivery was also common, particularly for QSRs and alcohol and food delivery companies. Parent companies were more likely to post about corporate social responsibility (CSR) initiatives, such as donations of money and products, and to offer health advice. Conclusions: This is the first study to show that Big Food and Big Alcohol are incessantly marketing their products and brands on social media platforms using themes related to COVID-19, such as isolation activities and community support. Parent companies are frequently posting about CSR initiatives, such as donations of money and products, thereby creating a fertile environment to loosen current regulation or resist further industry regulation. “COVID-washing” by large alcohol brands, food and beverage brands, and their parent companies is both common and concerning. The need for comprehensive regulations to restrict unhealthy food and alcohol marketing, as recommended by the World Health Organization, is particularly acute in the COVID-19 context and is urgently required to “build back better” in a post-COVID-19 world. %M 33709935 %R 10.2196/25202 %U https://publichealth.jmir.org/2021/3/e25202 %U https://doi.org/10.2196/25202 %U http://www.ncbi.nlm.nih.gov/pubmed/33709935 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e26557 %T A Multimodal Mobile Sleep Intervention for Young Adults Engaged in Risky Drinking: Protocol for a Randomized Controlled Trial %A Fucito,Lisa M %A Ash,Garrett I %A DeMartini,Kelly S %A Pittman,Brian %A Barnett,Nancy P %A Li,Chiang-Shan R %A Redeker,Nancy S %A O'Malley,Stephanie S %+ Department of Psychiatry, Yale University School of Medicine, 20 York Street, Fitkin Building, F619, New Haven, CT, 06510, United States, 1 2032001470, lisa.fucito@yale.edu %K sleep %K binge drinking %K young adults %K mHealth %K biosensor %K behavior therapy %K mobile phone %D 2021 %7 26.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: This paper describes the research protocol for a randomized controlled trial of a multimodal mobile sleep intervention for heavy-drinking young adults. Young adults report the highest rates of heavy, risky alcohol consumption and are a priority population for alcohol prevention and intervention efforts. Alcohol strategies that leverage other health concerns and use technology may offer an innovative solution. Poor sleep is common among young adults and is a risk factor for developing an alcohol use disorder. Moreover, young adults are interested in information to help them sleep better, and behavioral sleep interventions address alcohol use as a standard practice. Objective: The primary aim of this study is to assess the effectiveness of a 2-week multimodal mobile sleep intervention for reducing drinks consumed per week among heavy-drinking young adults. We will explore the effects on alcohol-related consequences, assessing quantitative and qualitative sleep characteristics as secondary aims. The study’s goals are to identify the optimal combination of sleep intervention components for improving drinking outcomes, the feasibility and acceptability of these components, and the potential mechanisms by which these components may promote alcohol behavior change. Methods: Young adults (aged 18-25 years) who report recent heavy drinking will be randomly assigned to one of three conditions: mobile sleep hygiene advice (n=30), mobile sleep hygiene advice and sleep and alcohol diary self-monitoring (n=30), or mobile sleep hygiene advice, sleep and alcohol diary self-monitoring, and sleep and alcohol data feedback (n=60). For the feedback component, participants will complete two web-based sessions with a health coach during which they will receive summaries of their sleep and alcohol data, and the potential association between them along with brief advice tailored to their data. All participants will wear sleep and alcohol biosensors daily for 2 weeks for objective assessments of these outcomes. Results: The study was funded by the National Institutes of Health in May 2018. Recruitment began in December 2018 and will be concluded in Spring 2021. As of February 4, 2021, we have enrolled 110 participants. Conclusions: Ultimately, this research could result in an efficacious, low-cost intervention with broad population reach through the use of technology. In addition, this intervention may substantially impact public health by reducing alcohol use disorder risk at a crucial developmental stage. Trial Registration: ClinicalTrials.gov NCT03658954; https://clinicaltrials.gov/ct2/show/NCT03658954 International Registered Report Identifier (IRRID): DERR1-10.2196/26557 %M 33635276 %R 10.2196/26557 %U https://www.researchprotocols.org/2021/2/e26557 %U https://doi.org/10.2196/26557 %U http://www.ncbi.nlm.nih.gov/pubmed/33635276 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24472 %T Acceptability, Validity, and Engagement With a Mobile App for Frequent, Continuous Multiyear Assessment of Youth Health Behaviors (mNCANDA): Mixed Methods Study %A Cummins,Kevin M %A Brumback,Ty %A Chung,Tammy %A Moore,Raeanne C %A Henthorn,Trevor %A Eberson,Sonja %A Lopez,Alyssa %A Sarkissyan,Tatev %A Nooner,Kate B %A Brown,Sandra A %A Tapert,Susan F %+ Department of Psychology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 8582952763, kcummins@ucsd.edu %K mobile applications %K young adults %K smartphone %K health behavior %K underage drinking %K alcohol drinking %K self-report %K illicit drugs %K mobile phone %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Longitudinal studies of many health behaviors often rely on infrequent self-report assessments. The measurement of psychoactive substance use among youth is expected to improve with more frequent mobile assessments, which can reduce recall bias. Researchers have used mobile devices for longitudinal research, but studies that last years and assess youth continuously at a fine-grained, temporal level (eg, weekly) are rare. A tailored mobile app (mNCANDA [mobile National Consortium on Alcohol and Neurodevelopment in Adolescence]) and a brief assessment protocol were designed specifically to provide a feasible platform to elicit responses to health behavior assessments in longitudinal studies, including NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence). Objective: This study aimed to determine whether an acceptable mobile app system could provide repeatable and valid assessment of youth’s health behaviors in different developmental stages over extended follow-up. Methods: Participants were recruited (n=534; aged 17-28 years) from a larger longitudinal study of neurodevelopment. Participants used mNCANDA to register reports of their behaviors for up to 18 months. Response rates as a function of time measured using mNCANDA and participant age were modeled using generalized estimating equations to evaluate response rate stability and age effects. Substance use reports captured using mNCANDA were compared with responses from standardized interviews to assess concurrent validity. Reactivity was assessed by evaluating patterns of change in substance use after participants initiated weekly reports via mNCANDA. Quantitative feedback about the app was obtained from the participants. Qualitative interviews were conducted with a subset of participants who used the app for at least one month to obtain feedback on user experience, user-derived explanations of some quantitative results, and suggestions for system improvements. Results: The mNCANDA protocol adherence was high (mean response rate 82%, SD 27%) and stable over time across all age groups. The median time to complete each assessment was 51 s (mean response time 1.14, SD 1.03 min). Comparisons between mNCANDA and interview self-reports on recent (previous 30 days) alcohol and cannabis use days demonstrate close agreement (eg, within 1 day of reported use) for most observations. Models used to identify reactivity failed to detect changes in substance use patterns subsequent to enrolling in mNCANDA app assessments (P>.39). Most participants (64/76, 84%) across the age range reported finding the mNCANDA system acceptable. Participants provided recommendations for improving the system (eg, tailoring signaling times). Conclusions: mNCANDA provides a feasible, multi-year, continuous, fine-grained (eg, weekly) assessment of health behaviors designed to minimize respondent burden and provides acceptable regimes for long-term self-reporting of health behaviors. Fine-grained characterization of variability in behaviors over relatively long periods (eg, up to 18 months) may, through the use of mNCANDA, improve our understanding of the relationship between substance use exposure and neurocognitive development. %M 33565988 %R 10.2196/24472 %U http://mhealth.jmir.org/2021/2/e24472/ %U https://doi.org/10.2196/24472 %U http://www.ncbi.nlm.nih.gov/pubmed/33565988 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22694 %T Identification of Behavior Change Techniques From Successful Web-Based Interventions Targeting Alcohol Consumption, Binge Eating, and Gambling: Systematic Review %A Humphreys,Gabrielle %A Evans,Rebecca %A Makin,Harriet %A Cooke,Richard %A Jones,Andrew %+ School of Psychology, University of Liverpool, Eleanor Rathbone Building, L69 7ZT, Liverpool, United Kingdom, 44 07311550101, gabrielle.humphreys@liverpool.ac.uk %K systematic review %K web-based intervention %K behavior and behavior mechanism %K behavior change technique %K alcohol consumption %K binge eating %K gambling %D 2021 %7 9.2.2021 %9 Review %J J Med Internet Res %G English %X Background: Web-based interventions are thought to overcome barriers to treatment, such as accessibility and geographical location, which can undermine the effectiveness of traditional face-to-face interventions. Owing to these features, researchers are increasingly testing the efficacy of web-based interventions as ways to reduce alcohol misuse, binge eating, and gambling. However, many web-based interventions have poorly defined mechanisms of action; therefore, it is often uncertain how they propose to bring about behavior change. Objective: This systematic review aims to identify effective behavior change techniques (BCTs) present in web-based interventions aimed at reducing alcohol consumption, binge eating, or gambling. Methods: This systematic review covered research conducted in the last 20 years. Inclusion criteria for interventions were web-based administration; targeting alcohol use, binge eating, and/or gambling; and reporting on baseline and postintervention measures of behavior. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. We coded intervention effectiveness, study quality, and BCTs present in the interventions. Results: Following removal of 4152 ineligible articles, 45 were included in the review: 32 (71%) targeted alcohol misuse, 6 (13%) targeted binge eating, and 7 (16%) targeted gambling. In total, 5 frequency counts were performed to identify the most commonly used BCTs: all studies, effective interventions, high-quality studies at 2 thresholds, and both high quality and effective studies. The results obtained from this were integrated to identify 7 BCTs. These 7 BCTs were problem solving, feedback on behavior, self-monitoring of behavior, self-monitoring of outcomes, instruction on how to perform a behavior, information about social and health consequences, and social comparison. A total of 4 BCTs were found in all frequency counts: feedback on behavior, self-monitoring of behavior, instruction on how to perform a behavior, and social comparison. Self-monitoring of outcomes of behavior was found in 3 of the 5 frequency counts, problem solving was found in 2 frequency counts, and information about social and health consequences was found in 1 frequency count. Conclusions: This systematic review identified 7 of the most frequently used BCTs used in web-based interventions focused on alcohol misuse, binge eating, and gambling. These results can inform the development of evidence-based eHealth interventions that have the potential to lead to effective, positive behavior changes in all 3 areas. %M 33560243 %R 10.2196/22694 %U http://www.jmir.org/2021/2/e22694/ %U https://doi.org/10.2196/22694 %U http://www.ncbi.nlm.nih.gov/pubmed/33560243 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26130 %T A Couples-Based Intervention (Ghya Bharari Ekatra) for the Primary Prevention of Intimate Partner Violence in India: Pilot Feasibility and Acceptability Study %A Kalokhe,Ameeta Shivdas %A Iyer,Sandhya %A Gadhe,Keshav %A Katendra,Tuman %A Kolhe,Ambika %A Rahane,Girish %A Stephenson,Rob %A Sahay,Seema %+ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 5003 CNR Building, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 712 1924, akalokh@emory.edu %K intimate partner violence %K prevention %K pilot study %K gender-based violence %K domestic violence %K violence %K India %K intervention %K prevalence %K mental health %K acceptance %K safety %K feasibility %K efficacy %D 2021 %7 1.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The high global prevalence of intimate partner violence (IPV) and its association with poor physical and mental health underscore the need for effective primary prevention. We previously developed Ghya Bharari Ekatra (GBE), a couples-based primary prevention intervention for IPV among newly married couples residing in slum communities in Pune, India. Objective: Through this pilot study, we aimed to explore the acceptance, safety, feasibility, and preliminary efficacy of GBE. Methods: Between January and May 2018, we enrolled and assigned 20 couples to receive GBE plus information on IPV support services and 20 control couples to receive information on IPV support services alone. The GBE intervention was delivered over 6 weekly sessions to groups of 3 to 5 couples by lay peer educators in the communities in which the participants resided. Intervention components addressed relationship quality, resilience, communication and conflict negotiation, self-esteem, sexual communication and sexual health knowledge, and norms around IPV. Outcome evaluation included exit interviews with participants and peers to examine acceptance and feasibility challenges and baseline and 3-month follow-up interviews to examine change in IPV reporting and mental health (by women) and alcohol misuse (by men). The process evaluation examined dose delivered, dose received, fidelity, recruitment, participation rate, and context. Results: Half (40/83) of the eligible couples approached agreed to participate in the GBE intervention. Retention rates were high (17/20, 85% across all 6 sessions), feedback from exit interviews suggested the content and delivery methods were very well received, and the community was highly supportive of the intervention. The principal feasibility challenge involved recruiting men with the lowest income who were dependent on daily wages. No safety concerns were reported by female participants over the course of the intervention or at the 3-month follow-up. There were no reported physical or sexual IPV events in either group, but there were fewer incidents of psychological abuse in GBE participants (3/17, 18%) versus control participants (4/16, 25%) at 3-month follow-up. There was also significant improvement in the overall mental health of female intervention participants and declines in the control participants (change in mean General Health Questionnaire-12 score: –0.13 in intervention vs 0.13 in controls; P=.10). Conclusions: GBE has high acceptance, feasibility, and preliminary efficacy in preventing IPV and improving mental health among women. Next steps include refining the intervention content based on pilot findings and examining intervention efficacy through a large-scale randomized trial with longer follow-up. Trial Registration: ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134. Clinical Trials Registry of India CTRI/2018/01/011596; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=21443 International Registered Report Identifier (IRRID): RR2-10.2196/11533 %M 33459278 %R 10.2196/26130 %U https://formative.jmir.org/2021/2/e26130 %U https://doi.org/10.2196/26130 %U http://www.ncbi.nlm.nih.gov/pubmed/33459278 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e18482 %T Virtual Reality Cognitive Training Among Individuals With Alcohol Use Disorder Undergoing Residential Treatment: Pilot Randomized Controlled Trial %A Gamito,Pedro %A Oliveira,Jorge %A Matias,Marcelo %A Cunha,Elsa %A Brito,Rodrigo %A Lopes,Paulo Ferreira %A Deus,Alberto %+ School of Psychology and Life Sciences, Lusófona University, Campo Grande, 376, Lisboa, 1749-024, Portugal, 351 217515500, jorge.oliveira@ulusofona.pt %K alcohol use disorder %K cognitive training %K virtual reality %D 2021 %7 29.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol use disorder (AUD) has been associated with diverse physical and mental morbidities. Among the main consequences of chronic and excessive alcohol use are cognitive and executive deficits. Some of these deficits may be reversed in specific cognitive and executive domains with behavioral approaches consisting of cognitive training. The advent of computer-based interventions may leverage these improvements, but randomized controlled trials (RCTs) of digital interactive-based interventions are still scarce. Objective: The aim of this study is to explore whether a cognitive training approach using VR exercises based on activities of daily living is feasible for improving the cognitive function of patients with AUD undergoing residential treatment, as well as to estimate the effect size for this intervention to power future definitive RCTs. Methods: This study consisted of a two-arm pilot RCT with a sample of 36 individuals recovering from AUD in a therapeutic community; experimental group participants received a therapist-guided, VR-based cognitive training intervention combined with treatment as usual, and control group participants received treatment as usual without cognitive training. A comprehensive neuropsychological battery of tests was used both at pre- and postassessments, including measurement of global cognition, executive functions, attention, visual memory, and cognitive flexibility. Results: In order to control for potential effects of global cognition and executive functions at baseline, these domains were controlled for in the statistical analysis for each individual outcome. Results indicate intervention effects on attention in two out of five outcomes and on cognitive flexibility in two out of six outcomes, with effect sizes in significant comparisons being larger for attention than for cognitive flexibility. Patient retention in cognitive training was high, in line with previous studies. Conclusions: Overall, the data suggest that VR-based cognitive training results in specific contributions to improving attention ability and cognitive flexibility of patients recovering from AUD. Trial Registration: ClinicalTrials.gov NCT04505345; https://clinicaltrials.gov/show/NCT04505345 %M 33512329 %R 10.2196/18482 %U http://www.jmir.org/2021/1/e18482/ %U https://doi.org/10.2196/18482 %U http://www.ncbi.nlm.nih.gov/pubmed/33512329 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e17662 %T Workshop on Implementation Science and Digital Therapeutics for Behavioral Health %A Lord,Sarah E %A Campbell,Aimee N C %A Brunette,Mary F %A Cubillos,Leonardo %A Bartels,Sophia M %A Torrey,William C %A Olson,Ardis L %A Chapman,Steven H %A Batsis,John A %A Polsky,Daniel %A Nunes,Edward V %A Seavey,Katherine M %A Marsch,Lisa A %+ Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, Suite 301, Lebanon, NH, 03766, United States, 1 603 646 7089, sarah.e.lord@dartmouth.edu %K mHealth %K mobile health %K digital health %K telemedicine %K eHealth %K behavioral sciences %K substance-related disorders %K mental health %K implementation science %D 2021 %7 28.1.2021 %9 Viewpoint %J JMIR Ment Health %G English %X Digital therapeutics can overcome many of the barriers to translation of evidence-based treatment for substance use, mental health, and other behavioral health conditions. Delivered via nearly ubiquitous platforms such as the web, smartphone applications, text messaging, and videoconferencing, digital therapeutics can transcend the time and geographic boundaries of traditional clinical settings so that individuals can access care when and where they need it. There is strong empirical support for digital therapeutic approaches for behavioral health, yet implementation science with regard to scaling use of digital therapeutics for behavioral health is still in its early stages. In this paper, we summarize the proceedings of a day-long workshop, “Implementation Science and Digital Therapeutics,” sponsored and hosted by the Center for Technology and Behavioral Health at Dartmouth College. The Center for Technology and Behavioral Health is an interdisciplinary P30 Center of Excellence funded by the National Institute on Drug Abuse, with the mission of promoting state-of-the-technology and state-of-the-science for the development, evaluation, and sustainable implementation of digital therapeutic approaches for substance use and related conditions. Workshop presentations were grounded in current models of implementation science. Directions and opportunities for collaborative implementation science research to promote broad adoption of digital therapeutics for behavioral health are offered. %M 33507151 %R 10.2196/17662 %U https://mental.jmir.org/2021/1/e17662 %U https://doi.org/10.2196/17662 %U http://www.ncbi.nlm.nih.gov/pubmed/33507151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e15402 %T Ride-Hailing Services and Alcohol Consumption: Longitudinal Analysis %A Burtch,Gordon %A Greenwood,Brad N %A McCullough,Jeffrey S %+ Department of Health Management and Policy, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, United States, 1 734 936 1189, jemccull@umich.edu %K binge drinking %K drunk driving %K road traffic safety %K ride-hailing %K alcohol consumption %K difference in differences %K Uber %D 2021 %7 27.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol consumption is associated with a wide range of adverse health consequences and a leading cause of preventable deaths. Ride-hailing services such as Uber have been found to prevent alcohol-related motor vehicle fatalities. These services may, however, facilitate alcohol consumption generally and binge drinking in particular. Objective: The goal of the research is to measure the impact of ride-hailing services on the extent and intensity of alcohol consumption. We allow these associations to depend on population density as the use of ride-hailing services varies across markets. Methods: We exploit the phased rollout of the ride-hailing platform Uber using a difference-in-differences approach. We use this variation to measure changes in alcohol consumption among a local population following Uber’s entry. Data are drawn from Uber press releases to capture platform entry and the Behavioral Risk Factor Surveillance Systems (BRFSS) Annual Survey to measure alcohol consumption in 113 metropolitan areas. Models are estimated using fixed-effects Poisson regression. Pre- and postentry trends are used to validate this approach. Results: Ride-hailing has no association with the extent of alcohol consumption in high (0.61 [95% CI –0.05% to 1.28%]) or low (0.61 [95% CI –0.05% to 1.28%]) density markets, but is associated with increases in the binge drinking rate in high-density markets (0.71 [95% CI 0.13% to 1.29%]). This corresponds to a 4% increase in binge drinking within a Metropolitan Statistical Area. Conclusions: Ride-hailing services are associated with an increase in binge drinking, which has been associated with a wide array of adverse health outcomes. Drunk driving rates have fallen for more than a decade, while binge drinking continues to climb. Both trends may be accelerated by ride-hailing services. This suggests that health information messaging should increase emphasis on the direct dangers of alcohol consumption and binge drinking. %M 33502328 %R 10.2196/15402 %U http://www.jmir.org/2021/1/e15402/ %U https://doi.org/10.2196/15402 %U http://www.ncbi.nlm.nih.gov/pubmed/33502328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e19737 %T Uptake of Proactively Offered Online and Telephone Support Services Targeting Multiple Health Risk Behaviors Among Vocational Education Students: Process Evaluation of a Cluster Randomized Controlled Trial %A Atorkey,Prince %A Paul,Christine %A Bonevski,Billie %A Wiggers,John %A Mitchell,Aimee %A Byrnes,Emma %A Lecathelinais,Christophe %A Tzelepis,Flora %+ School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, Newcastle, 2308, Australia, 61 0249246565, prince.atorkey@uon.edu.au %K uptake %K proactive offer %K online support services %K telephone support services %K multiple health risk behaviors %K vocational education students %D 2021 %7 6.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A high proportion of vocational education students smoke tobacco, have inadequate nutrition (ie, low fruit and vegetable intake), drink alcohol at risky levels, or are physically inactive. The extent to which vocational education students will sign up for proactively offered online and telephone support services for multiple health risk behaviors is unknown. Objective: The aim of this study is to examine the uptake of proactively offered online and telephone support services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors, individually and in combination, among vocational education students in the Technical and Further Education (TAFE) setting. The characteristics associated with the uptake of online or telephone services for smoking, nutrition, alcohol consumption, and physical activity risk behaviors were also examined. Methods: Vocational education students enrolled in a TAFE class in New South Wales, Australia, which ran for 6 months or more, were recruited to participate in a cluster randomized controlled trial from May 2018 to May 2019. In the intervention arm, participants who did not meet the Australian health guidelines for each of the smoking, nutrition, alcohol consumption, and physical activity risk behaviors were provided electronic feedback and proactively offered online and telephone support services. Uptake of support was measured by whether participants signed up for the online and telephone services they were offered. Results: Vocational education students (N=551; mean age 25.7 years, SD 11.1; 310/551, 56.3% male) were recruited into the intervention arm. Uptake of the proactive offer of either online or telephone services was 14.5% (59/406) for fruit and vegetables, 12.7% (29/228) for physical activity, 6.8% (13/191) for smoking, and 5.5% (18/327) for alcohol use. Uptake of any online or telephone service for at least two health behaviors was 5.8% (22/377). Participants who were employed (odds ratio [OR] 0.10, 95% CI 0.01-0.72) and reported not being anxious (OR 0.11, 95% CI 0.02-0.71) had smaller odds of signing up for online or telephone services for smoking, whereas participants who reported not being depressed had greater odds (OR 10.25, 95% CI 1.30-80.67). Participants who intended to change their physical activity in the next 30 days had greater odds (OR 4.01, 95% CI 1.33-12.07) of signing up for online or telephone services for physical activity. Employed participants had smaller odds (OR 0.18, 95% CI 0.06-0.56) of signing up for support services for at least two behaviors. Conclusions: Although the uptake of proactively offered online and telephone support services is low, these rates appear to be higher than the self-initiated use of some of these services in the general population. Scaling up the proactive offer of online and telephone services may produce beneficial health outcomes. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618000723280; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375001. %M 33404504 %R 10.2196/19737 %U https://www.jmir.org/2021/1/e19737 %U https://doi.org/10.2196/19737 %U http://www.ncbi.nlm.nih.gov/pubmed/33404504 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e23669 %T Mining Electronic Health Records to Promote the Reach of Digital Interventions for Cancer Prevention Through Proactive Electronic Outreach: Protocol for the Mixed Methods OptiMine Study %A Amato,Michael S %A El-Toukhy,Sherine %A Abroms,Lorien C %A Goodfellow,Henry %A Ramsey,Alex T %A Brown,Tracey %A Jopling,Helena %A Khadjesari,Zarnie %+ Behavioural and Implementation Science research group, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 59 7648, Z.Khadjesari@uea.ac.uk %K EHR %K electronic health record %K smoking cessation %K alcohol reduction %K proactive outreach %K proactive messages %K electronic messages %D 2020 %7 31.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital behavior change interventions have demonstrated effectiveness for smoking cessation and reducing alcohol intake, which ultimately reduce cancer risk. Leveraging electronic health records (EHR) to identify at-risk patients and increasing the reach of digital interventions through proactive electronic outreach provide a novel approach that may increase the number of individuals who engage with evidence-based treatment. Objective: This study aims to increase the reach of digital behavior change interventions by implementing a proactive electronic message system for smoking cessation and alcohol reduction among a large, at-risk population identified through an acute hospital EHR. Methods: This protocol describes a 3-phase, mixed-methods implementation study to assess the acceptability, feasibility, and reach of a proactive electronic message system to digital interventions using a hospital’s EHR system to identify eligible patients. In Phase 1, we will conduct focus group discussions with patients and hospital staff to assess the overall acceptability of the electronic message system. In Phase 2, we will conduct a descriptive analysis of the patient population in the hospital EHR regarding target risk behaviors and other person-level characteristics to determine the project’s feasibility and potential reach. In Phase 3, we will send proactive messages to patients identified as smokers or risky drinkers. Messages will encourage and provide access to behavior change mobile apps via an embedded link; the primary outcome will be the proportion of participants who click on the link to access information about the apps. Results: At the time of initial protocol submission, data collection was complete, but analysis had not begun. This study was funded by Cancer Research UK from April 2019 to March 2020. Health Research Authority approval was granted in June 2019. Conclusions: Increasing the reach of digital behavior change interventions can improve population health by reducing the burden of preventable death and disease. International Registered Report Identifier (IRRID): DERR1-10.2196/23669 %M 33382041 %R 10.2196/23669 %U http://www.researchprotocols.org/2020/12/e23669/ %U https://doi.org/10.2196/23669 %U http://www.ncbi.nlm.nih.gov/pubmed/33382041 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e19749 %T Qualitative Evaluation of Web-Based Digital Intervention to Prevent and Reduce Excessive Alcohol Use and Harm Among Young People Aged 14-15 Years: A “Think-Aloud” Study %A Tinner,Laura Elizabeth %A Kaner,Eileen %A Garnett,Claire %A Mitchell,Siobhan %A Hickman,Matthew %A Campbell,Rona %A MacArthur,Georgina %+ Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, United Kingdom, 44 117 33 13401, laura.tinner@bristol.ac.uk %K public health %K adolescent %K mobile phone %K alcoholic intoxication %K internet %D 2020 %7 15.12.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In the United Kingdom, despite some downward trends in alcohol use among young people, over one-fifth of young people reported excessive alcohol use in the past month, which is associated with short- and long-term harm to health. Digital interventions to reduce alcohol use, such as websites, among young people present an appealing and cost-effective mode of intervention that can be integrated into the education system. However, relatively few school-based digital alcohol-focused interventions have been developed and evaluated for young people in the United Kingdom. Objective: This study aims to develop a novel web-based intervention, Rethink Alcohol, to prevent and reduce excessive alcohol use and related harm among young people aged between 14 and 15 years, and explore the views of young people, teachers, and youth workers in relation to the content, design, and usability of the intervention. Methods: Intervention development followed the person-based approach, using theories of social norms and social influence. Qualitative “Think-Aloud” interviews, either one-to-one or paired, were conducted while participants perused and worked through the web-based intervention, talking aloud. Participants included 20 young people (12 female, 8 male), 5 youth workers (4 female, 1 male), 3 teachers (2 male, 1 female), and 1 (male) clinical professional, recruited via youth groups and professional networks. Interviews were audio recorded, transcribed verbatim, and analyzed thematically. Results: The prototype web-based intervention included normative feedback, information, a quiz, interactive activities, and scenarios. On a rating scale of impressions from poor (1) to excellent (5), participants gave an average score of 3.6/5. A total of 5 themes were identified: content, credibility of the website, making the website easy to understand, design and navigation, and suitability for the audience. These themes reflected views that the content was interesting, credible, informative, and embodied a neutral and nonjudgmental tone, but stronger messaging was needed regarding social pressures and short-term risks regarding safety and risk behavior alongside clarity around pathways of risk; credibility and trustworthiness of information were critical features, determined in part, by the professionalism of design and referencing of sources of information provided; and messages should be succinct and come to life through design and interactive features. Conclusions: Together, the data illustrated the importance and challenge of communicating nuanced alcohol-focused public health messages to young people in concise, clear, nonjudgmental, and appealing ways. Young people report interest in clear, credible, neutral, and interactive messages regarding social pressures and short-term risks of alcohol use via a web-based intervention. There is scope for optimization and feasibility testing of the Rethink Alcohol intervention. %M 33320100 %R 10.2196/19749 %U http://pediatrics.jmir.org/2020/2/e19749/ %U https://doi.org/10.2196/19749 %U http://www.ncbi.nlm.nih.gov/pubmed/33320100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23369 %T Engagement With a Behavior Change App for Alcohol Reduction: Data Visualization for Longitudinal Observational Study %A Bell,Lauren %A Garnett,Claire %A Qian,Tianchen %A Perski,Olga %A Williamson,Elizabeth %A Potts,Henry WW %+ Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 02076368636, lauren.bell@lshtm.ac.uk %K mobile health %K behavior change %K apps %K digital health %K data visualizations %K engagement %K micro-randomized trial %K push notifications %K just-in-time adaptive interventions %D 2020 %7 11.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Behavior change apps can develop iteratively, where the app evolves into a complex, dynamic, or personalized intervention through cycles of research, development, and implementation. Understanding how existing users engage with an app (eg, frequency, amount, depth, and duration of use) can help guide further incremental improvements. We aim to explore how simple visualizations can provide a good understanding of temporal patterns of engagement, as usage data are often longitudinal and rich. Objective: This study aims to visualize behavioral engagement with Drink Less, a behavior change app to help reduce hazardous and harmful alcohol consumption in the general adult population of the United Kingdom. Methods: We explored behavioral engagement among 19,233 existing users of Drink Less. Users were included in the sample if they were from the United Kingdom; were 18 years or older; were interested in reducing their alcohol consumption; had a baseline Alcohol Use Disorders Identification Test score of 8 or above, indicative of excessive drinking; and had downloaded the app between May 17, 2017, and January 22, 2019 (615 days). Measures of when sessions begin, length of sessions, time to disengagement, and patterns of use were visualized with heat maps, timeline plots, k-modes clustering analyses, and Kaplan-Meier plots. Results: The daily 11 AM notification is strongly associated with a change in engagement in the following hour; reduction in behavioral engagement over time, with 50.00% (9617/19,233) of users disengaging (defined as no use for 7 or more consecutive days) 22 days after download; identification of 3 distinct trajectories of use, namely engagers (4651/19,233, 24.18% of users), slow disengagers (3679/19,233, 19.13% of users), and fast disengagers (10,903/19,233, 56.68% of users); and limited depth of engagement with 85.076% (7,095,348/8,340,005) of screen views occurring within the Self-monitoring and Feedback module. In addition, a peak of both frequency and amount of time spent per session was observed in the evenings. Conclusions: Visualizations play an important role in understanding engagement with behavior change apps. Here, we discuss how simple visualizations helped identify important patterns of engagement with Drink Less. Our visualizations of behavioral engagement suggest that the daily notification substantially impacts engagement. Furthermore, the visualizations suggest that a fixed notification policy can be effective for maintaining engagement for some users but ineffective for others. We conclude that optimizing the notification policy to target both effectiveness and engagement is a worthwhile investment. Our future goal is to both understand the causal effect of the notification on engagement and further optimize the notification policy within Drink Less by tailoring to contextual circumstances of individuals over time. Such tailoring will be informed from the findings of our micro-randomized trial (MRT), and these visualizations were useful in both gaining a better understanding of engagement and designing the MRT. %M 33306026 %R 10.2196/23369 %U http://www.jmir.org/2020/12/e23369/ %U https://doi.org/10.2196/23369 %U http://www.ncbi.nlm.nih.gov/pubmed/33306026 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23579 %T How Internet Contracts Impact Research: Content Analysis of Terms of Service on Consumer Product Websites %A Weiger,Caitlin %A Smith,Katherine C %A Cohen,Joanna E %A Dredze,Mark %A Moran,Meghan Bridgid %+ Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 (410) 955 3543, cweiger2@jhmi.edu %K marketing %K contracts %K internet %K jurisprudence %K ethics %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Companies use brand websites as a promotional tool to engage consumers on the web, which can increase product use. Given that some products are harmful to the health of consumers, it is important for marketing associated with these products to be subject to public health surveillance. However, terms of service (TOS) governing the use of brand website content may impede such important research. Objective: The aim of this study is to explore the TOS for brand websites with public health significance to assess possible legal and ethical challenges for conducting research on consumer product websites. Methods: Using Statista, we purposefully constructed a sample of 15 leading American tobacco, alcohol, psychiatric pharmaceutical, fast-food, and gun brands that have associated websites. We developed and implemented a structured coding system for the TOS on these websites and coded for the presence versus absence of different types of restriction that might impact the ability to conduct research. Results: All TOS stated that by accessing the website, users agreed to abide by the TOS (15/15, 100%). A total of 11 out of 15 (73%) websites had age restrictions in their TOS. All alcohol brand websites (5/15, 33%) required users to enter their age or date of birth before viewing website content. Both websites for tobacco brands (2/15, 13%) further required that users register and verify their age and identity to access any website content and agree that they use tobacco products. Only one website (1/15, 7%) allowed users to display, download, copy, distribute, and translate the website content as long as it was for personal and not commercial use. A total of 33% (5/15) of TOS unconditionally prohibited or put substantial restrictions on all of these activities and/or failed to specify if they were allowed or prohibited. Moreover, 87% (13/15) of TOS indicated that website access could be restricted at any time. A total of 73% (11/15) of websites specified that violating TOS could result in deleting user content from the website, revoking access by having the user’s Internet Protocol address blocked, terminating log-in credentials, or enforcing legal action resulting in civil or criminal penalties. Conclusions: TOS create complications for public health surveillance related to e-marketing on brand websites. Recent court opinions have reduced the risk of federal criminal charges for violating TOS on public websites, but this risk remains unclear for private websites. The public health community needs to establish standards to guide and protect researchers from the possibility of legal repercussions related to such efforts. %M 33263555 %R 10.2196/23579 %U http://publichealth.jmir.org/2020/4/e23579/ %U https://doi.org/10.2196/23579 %U http://www.ncbi.nlm.nih.gov/pubmed/33263555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21652 %T The Role of Enjoyment in a Serious Game for Binge Drinking Prevention: Pretest-Posttest Quasi-Experimental Study %A Hong,Traci %A Cabrera,Joshua %A Beaudoin,Christopher E %+ College of Communication, Boston University, 640 Commonwealth Ave, Boston, MA, 02215, United States, 1 6173533450, tjhong@bu.edu %K alcohol prevention %K binge drinking %K serious game %D 2020 %7 30.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although binge drinking peaks at age 21 to 25 years, there is limited research on the effects of serious games in this population, as well as on the process by which playing serious games impacts alcohol-related outcomes. Designed with both health behavioral theory and game theory, One Shot is an online serious game that aims to prevent binge drinking. Objective: This study utilized a conceptual model for serious video game processes. Using One Shot, the model assessed the following process stages: (1) Alcohol Use Disorders Identification Test-Concise (AUDIT-C); (2) in-game factors of game time and risky alcohol decisions; (3) game enjoyment; and (4) postgame outcomes of intention to drink less and drinking refusal self-efficacy. Methods: In a one-group pretest-posttest quasi-experimental design, a sample (N=550) of young adults (age 21-25 years) who reported recent binge drinking played the One Shot game. Intention to drink less and drinking refusal self-efficacy were measured at pregame and postgame, with their effects lagged in statistical analysis. Participants were presented with various scenarios in the game that pertained to risky alcohol decisions, which, along with game time, were unobtrusively recorded by the server. A structural equation model (SEM) was used to test the conceptual model, with assessments made to determine if enjoyment mediated the effects of game time and risky alcohol decisions on the 2 postgame alcohol-related outcomes. Results: A well-fitting SEM demonstrated support for the multistep model, with AUDIT-C predicting risky alcohol decisions (β=.30). Risky alcohol decisions (β=−.22) and game time (β=.18) predicted enjoyment, which, in turn, predicted intention to drink less (β=.21) and drinking refusal self-efficacy (β=.16). Enjoyment significantly (P<.001) mediated the effects of game time and risky alcohol decision on intention to drink less and drinking refusal self-efficacy. Conclusions: The results support a conceptual model in which staggered individual and in-game factors influence alcohol-related outcomes. Enjoyment is important for participants’ intentions to drink less and beliefs that they can refuse alcohol. %M 33252348 %R 10.2196/21652 %U http://www.jmir.org/2020/11/e21652/ %U https://doi.org/10.2196/21652 %U http://www.ncbi.nlm.nih.gov/pubmed/33252348 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e24175 %T The Effect of Question Order on Outcomes in the Core Outcome Set for Brief Alcohol Interventions Among Online Help-Seekers: Protocol for a Factorial Randomized Trial %A Bendtsen,Marcus %A Garnett,Claire %A Toner,Paul %A Shorter,Gillian W %+ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, 58183, Sweden, 46 13286975, marcus.bendtsen@liu.se %K order effects %K question order bias %K brief alcohol intervention %K outcomes %K factorial trial %K randomized trial %K online intervention %K alcohol %K protocol %K effectiveness %K efficacy %D 2020 %7 26.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: A core outcome set (COS) for trials and evaluations of the effectiveness and efficacy of alcohol brief interventions (ABIs) has recently been established through international consensus to address the variability of outcomes evaluated. Objective: This is a protocol for studies to assess if there are order effects among the questions included in the COS. Methods: The 10 items of the COS are organized into 4 clusters. A factorial design will be used with 24 arms, where each arm represents 1 order of the 4 clusters. Individuals searching online for help will be asked to complete a questionnaire, and consenting participants will be randomized to 1 of the 24 arms (double-blind with equal allocation). Participants will be included if they are 18 years or older. The primary analyses will (1) estimate how the order of the clusters of outcomes affects how participants respond and (2) investigate patterns of abandonment of the questionnaire. Results: Data collection is expected to commence in November 2020. A Bayesian group sequential design will be used with interim analyses planned for every 50 participants completing the questionnaire. Data collection will end no more than 24 months after commencement, and the results are expected to be published no later than December 2023. Conclusions: Homogenizing the outcomes evaluated in studies of ABIs is important to support synthesis, and the COS is an important step toward this goal. Determining whether there may be issues with the COS question order may improve confidence in using it and speed up its dissemination in the research community. We encourage others to adopt the protocol as a study within their trial as they adopt the ORBITAL (Outcome Reporting in Brief Intervention Trials: Alcohol) COS to build a worldwide repository and provide materials to support such analysis. Trial Registration: ISRCTN Registry ISRCTN17954645; http://www.isrctn.com/ISRCTN17954645 International Registered Report Identifier (IRRID): PRR1-10.2196/24175 %M 33242024 %R 10.2196/24175 %U http://www.researchprotocols.org/2020/11/e24175/ %U https://doi.org/10.2196/24175 %U http://www.ncbi.nlm.nih.gov/pubmed/33242024 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e17156 %T Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade %A Staiger,Petra Karin %A O'Donnell,Renee %A Liknaitzky,Paul %A Bush,Rachel %A Milward,Joanna %+ School of Psychology, Deakin University, Faculty of Health, Locked Bag 20000, Geelong, 3220, Australia, 61 3 9244 6876, petra.staiger@deakin.edu.au %K smartphone app %K mobile phone %K mobile app %K problematic substance use %K addiction %K systematic review %K mHealth %K ecological momentary intervention %K alcohol %K tobacco %K smoking %K illicit drugs %D 2020 %7 24.11.2020 %9 Review %J J Med Internet Res %G English %X Background: Mobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release of the first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear. Objective: This study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit drug use. Methods: The review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile app study was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes. Results: A total of 20 studies met eligibility criteria across a range of substances: alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1), and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizes ranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation to multicomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to 35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substance use at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reported significant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components. Conclusions: Although most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better than the comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcohol and illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk of bias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack of relevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventions are most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targeting problematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compare efficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substance use can be fulfilled. %M 33231555 %R 10.2196/17156 %U http://www.jmir.org/2020/11/e17156/ %U https://doi.org/10.2196/17156 %U http://www.ncbi.nlm.nih.gov/pubmed/33231555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e18826 %T Engagement With a Web-Based Intervention to Reduce Harmful Drinking: Secondary Analysis of a Randomized Controlled Trial %A Nordholt,Paul U %A Christalle,Eva %A Zill,Jördis M %A Dirmaier,Jörg %+ Institute and Outpatient Clinic of Medical Psychology, University Medical Center Hamburg-Eppendorf, Department of Medical Psychology, Martinistr 52, Hamburg, 20246, Germany, 49 407410 ext 59137, dirmaier@uke.de %K engagement %K usage %K alcohol %K eHealth %K mHealth %K readiness to change %K self-efficacy %K outcome expectancy %D 2020 %7 20.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Engagement with digital behavior change interventions (DBCIs) is considered a prerequisite for intervention efficacy. However, in many trials on DBCIs, participants use the intervention either only little or not at all. Objective: To analyze engagement with a web-based intervention to reduce harmful drinking, we explored (1) whether engagement with a web-based alcohol intervention is related to drinking outcomes, (2) which user characteristics are associated with measures of engagement, and (3) whether reported outcomes are associated with data captured by voluntary intervention questionnaires. Methods: We analyzed data of the intervention arm of a randomized controlled trial on a DBCI to reduce risky alcohol consumption. Data were collected at baseline (T0), after 90 days (T1), and at the end of the 180-day usage period (T2). Engagement with the intervention was measured via system usage data as well as self-reported usage. Drinking behavior was measured as average daily alcohol consumption as well as the number of binge drinking days. User characteristics included demographics, baseline drinking behavior, readiness to change, alcohol-related outcome expectancies, and alcohol abstinence self-efficacy. Following a bivariate approach, we performed two-tailed Welch’s t tests and Wilcoxon signed rank/Mann-Whitney U tests or calculated correlation coefficients. Results: The data of 306 users were analyzed. Time spent engaging with the intervention as measured by system usage did not match self-reported usage. Higher self-reported usage was associated with higher reductions in average daily alcohol consumption (T1: ρ=0.39, P<.001; T2: ρ=0.29, P=.015) and in binge drinking days (T1: ρ=0.62, P<.001; T2: ρ=0.3, P=.006). Higher usage was reported from users who were single (T1: P<.001; T2: P<.001), users without children (T1: P<.001; T2: P<.001), users who did not start or finish secondary education (T1: P<.001; T2: P<.001), users without academic education (T1: P<.001; T2: P<.001), and those who worked (T1: P=.001; T2: P=.004). Relationships between self-reported usage and clinical or psychological baseline characteristics were complex. For system usage, the findings were mixed. Reductions in drinking captured by intervention questionnaires were associated with reported outcomes. Conclusions: Though self-reported usage could be consistently linked to better outcomes and multiple user characteristics, our findings add to the overall inconclusive evidence that can be found throughout the literature. Our findings indicate potential benefits of self-reports as measures of engagement and intervention questionnaires as a basis for tailoring of intervention content. Future studies should adopt a theory-driven approach to engagement research utilizing psychometrically sound self-report questionnaires and include short ecological momentary assessments within the DBCIs. Trial Registration: German Clinical Trials Register DRKS00006104; https://tinyurl.com/y22oc5jo %M 33216008 %R 10.2196/18826 %U https://www.jmir.org/2020/11/e18826 %U https://doi.org/10.2196/18826 %U http://www.ncbi.nlm.nih.gov/pubmed/33216008 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e22047 %T Implementation and Evaluation of a Text Message–Based Addiction Counseling Program (Text4Hope-Addiction Support): Protocol for a Questionnaire Study %A Agyapong,Vincent Israel Opoku %A Hrabok,Marianne %A Vuong,Wesley %A Gusnowski,April %A Shalaby,Reham %A Surood,Shireen %A Greenshaw,Andrew J %A Aulakh,Avininder %A Abba-Aji,Adam %A Singh,Mohit %+ Division of Community Psychiatry, Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K addiction %K support drugs %K alcohol %K Text4Hope %K mobile phones %K text messaging %K anxiety %K depression %K mHealth %K COVID-19 %D 2020 %7 17.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: With the emergence of the COVID-19 pandemic, providing counseling to people with drug or alcohol addiction while maintaining physical distance has been challenging. This protocol describes the use of text messaging (as used in the Text4Hope-Addiction Support program) as a convenient, evidence-based, cost-effective, and accessible population-level mental health intervention with high user satisfaction proven in prior research. Objective: The project goal is to implement a program of daily supportive text messaging (Text4Hope-Addiction Support) to reduce drug or alcohol cravings as well as anxiety and depression, typically associated with alcohol and substance use disorders. The aim of this study is to evaluate the prevalence of cravings, anxiety, and depressive symptoms; demographic correlates of the same; and the outcomes of the Text4Hope-Addiction Support intervention in mitigating cravings, anxiety, and depressive symptoms. Methods: Self-administered, anonymous, online questionnaires will be used to assess cravings for the primary substance of addiction (Brief Substance Craving Scale), anxiety (Generalized Anxiety Disorder-7), and depressive symptoms (Patient Health Questionnaire-9). Data will be collected at baseline (onset of receiving text messages), program midpoint (6 weeks), and program end (12 weeks). Results: As of October 2020, data collection is in progress; and it is expected to be completed by fall 2021. Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, cravings, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Conclusions: This Text4Hope-Addiction Support project will provide key information regarding the prevalence rates of cravings, anxiety, and depressive symptoms among persons with alcohol and substance use disorders; demographic correlates of cravings, anxiety, and depression; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for addiction care practitioners; it will inform the policy and decision making regarding population-level addiction treatment and support during emergencies. International Registered Report Identifier (IRRID): DERR1-10.2196/22047 %M 33200993 %R 10.2196/22047 %U http://www.researchprotocols.org/2020/11/e22047/ %U https://doi.org/10.2196/22047 %U http://www.ncbi.nlm.nih.gov/pubmed/33200993 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e22733 %T Event-Level Association Between Daily Alcohol Use and Same-Day Nonadherence to Antiretroviral Therapy Among Young Men Who Have Sex With Men and Trans Women Living With HIV: Intensive Longitudinal Study %A Turner,Caitlin Marie %A Trujillo,Dillon %A Le,Victory %A Wilson,Erin C %A Arayasirikul,Sean %+ Trans Research Unit for Equity, Center for Public Health Research, San Francisco Department of Public Health, 25 Van Ness, Ste 500, San Francisco, CA, 94102, United States, 1 4155549018, caitlin.turner@sfdph.org %K ecological momentary assessment %K event-level %K alcohol %K antiretroviral therapy %K men who have sex with men %K trans women %K adherence %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young trans women (TW) and men who have sex with men (MSM) are disproportionately impacted by HIV. Optimizing adherence to antiretroviral therapy (ART) is one mechanism by which public health experts aim to achieve favorable HIV health outcomes while reducing disease transmission. However, alcohol use is prevalent among young TW and MSM and threatens optimal adherence. In addition, the daily variations in alcohol use and ART adherence and their association with each other are poorly understood, warranting more appropriate methodological approaches, such as analysis of ecological momentary assessment (EMA) data. Objective: The aim of this analysis is to characterize the association between daily alcohol use and same-day ART nonadherence captured by an EMA study of young MSM and TW living with HIV in San Francisco. Methods: Young MSM and TW enrolled in the Health eNav digital HIV care navigation intervention were included in the analytic sample (N=113). Data on alcohol and ART use were collected by daily EMA surveys administered via text messaging and were analyzed over 30 days of follow-up. A multivariable mixed-effects logistic regression model adjusting for baseline sociodemographic characteristics was specified to investigate whether daily alcohol use was associated with same-day ART nonuse. Results: Daily alcohol use was associated with higher same-day ART nonuse. On average, participants drank alcohol on 15.20 (SD 8.93) days and used ART on 15.19 (SD 10.16) days out of 30 days. Daily alcohol use was associated with 1.89 (95% CI 1.14-3.15) times the adjusted odds of same-day ART nonuse for each participant. Conclusions: Results are consistent with other analyses of daily alcohol and ART use and underscore the importance of individually targeted interventions that are sensitive to each participant’s dynamic risk environment. International Registered Report Identifier (IRRID): RR2-10.2196/16406 %M 33055070 %R 10.2196/22733 %U http://mhealth.jmir.org/2020/10/e22733/ %U https://doi.org/10.2196/22733 %U http://www.ncbi.nlm.nih.gov/pubmed/33055070 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e19720 %T Evaluating the Efficacy of a Mobile App (Drinks:Ration) and Personalized Text and Push Messaging to Reduce Alcohol Consumption in a Veteran Population: Protocol for a Randomized Controlled Trial %A Leightley,Daniel %A Rona,Roberto J %A Shearer,James %A Williamson,Charlotte %A Gunasinghe,Cerisse %A Simms,Amos %A Fear,Nicola T %A Goodwin,Laura %A Murphy,Dominic %+ King's College London, King's Centre for Military Health Research, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 20 7848 5351, daniel.leightley@kcl.ac.uk %K alcohol misuse %K smartphone %K intervention %K SMS text messaging %K push notifications %D 2020 %7 2.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol misuse is higher in the UK Armed Forces than in the general population. Previous research has shown that interventions delivered via smartphones are efficacious in promoting self-monitoring of alcohol use, have utility in reducing alcohol consumption, and have a broad reach. Objective: This single-blinded randomized controlled trial (RCT) aims to assess the efficacy of a 28-day brief alcohol intervention delivered via a smartphone app (Drinks:Ration) in reducing weekly self-reported alcohol consumption between baseline and 3-month follow-up among veterans who drink at a hazardous or harmful level and receive or have received support for mental health symptoms in a clinical setting. Methods: In this two-arm, single-blinded RCT, a smartphone app that includes interactive features designed to enhance participants’ motivation and personalized messaging is compared with a smartphone app that provides only government guidance on alcohol consumption. The trial will be conducted in a veteran population that has sought help through Combat Stress, a UK veteran’s mental health charity. Recruitment, consent, and data collection will be carried out automatically through the Drinks:Ration platform. The primary outcome is the change in self-reported weekly alcohol consumption between baseline (day 0) and 3-month follow-up (day 84) as measured using the Time-Line Follow back for Alcohol Consumption. Secondary outcome measures include (1) change in the baseline to 3-month follow-up (day 84) Alcohol Use Disorder Identification Test score and (2) change in the baseline to 3-month follow-up (day 84) World Health Organization Quality of Life-BREF score to assess the quality of adjusted life years. Process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire. The primary and secondary outcomes will also be reassessed at the 6-month follow-up (day 168) to assess the longer-term benefits of the intervention, which will be reported as a secondary outcome. Results: The study will begin recruitment in October 2020 and is expected to require 12 months to complete. The study results will be published in 2022. Conclusions: This study assesses whether a smartphone app is efficacious in reducing self-reported alcohol consumption in a veteran population that has sought help through Combat Stress using personalized messaging and interactive features. This innovative approach, if successful, may provide a means to deliver a low-cost health promotion program that has the potential to reach large groups, in particular those who are geographically dispersed, such as military personnel. Trial Registration: ClinicalTrials.gov NCT04494594; https://clinicaltrials.gov/ct2/show/NCT04494594 International Registered Report Identifier (IRRID): PRR1-10.2196/19720 %M 33006569 %R 10.2196/19720 %U https://www.researchprotocols.org/2020/10/e19720 %U https://doi.org/10.2196/19720 %U http://www.ncbi.nlm.nih.gov/pubmed/33006569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19378 %T Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study %A van der Windt,Melissa %A van der Kleij,Rianne Maria %A Snoek,Katinka Marianne %A Willemsen,Sten Paul %A Dykgraaf,Ramon Henny Maria %A Laven,Joop Stephanus Elisabeth %A Schoenmakers,Sam %A Steegers-Theunissen,Régine Patricia Maria %+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, PO Box 2040, Rotterdam, 3000CA, Netherlands, +31 107038255, r.steegers@erasmusmc.nl %K eHealth %K periconception period %K lifestyle intervention %D 2020 %7 30.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Periconception lifestyle behaviors affect maternal, paternal, offspring, and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions, in which face-to-face counseling and eHealth (“blended care”) are combined, may effectively target these lifestyle behaviors. Objective: We aimed to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components. Methods: A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counseling service “Healthy Pregnancy” with the eHealth platform “Smarter Pregnancy” (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (≤12 weeks of gestation) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (BMI ≥30 kg/m2), women pregnant at the start of the intervention, and those participating as a couple. Results: A total of 539 women were screened for eligibility, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4% (263/450) were included in the preconception period. Moreover, 78.9% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2%) and men (58/61, 95.1%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P<.001) and median vegetable intake increased from 151 to 165 grams/day (P<.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P<.001), and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P=.002) and from 0.20 to 0.15 (P=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively. Conclusions: We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further. %M 32996885 %R 10.2196/19378 %U http://www.jmir.org/2020/9/e19378/ %U https://doi.org/10.2196/19378 %U http://www.ncbi.nlm.nih.gov/pubmed/32996885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21916 %T Associations Between Substance Use and Instagram Participation to Inform Social Network–Based Screening Models: Multimodal Cross-Sectional Study %A Bergman,Brandon G %A Wu,Weiyi %A Marsch,Lisa A %A Crosier,Benjamin S %A DeLise,Timothy C %A Hassanpour,Saeed %+ Recovery Research Institute, Center for Addiction Medicine, Massachusetts General Hospital, & Harvard Medical School, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 617 643 7563, bgbergman@mgh.harvard.edu %K substance use %K social network sites %K health risk %K screening %K machine learning %K social media %K Instagram %K alcohol %K drug %D 2020 %7 16.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-based computational strategies that leverage social network site (SNS) data to detect substance use are promising screening tools but rely on the presence of sufficient data to detect risk if it is present. A better understanding of the association between substance use and SNS participation may inform the utility of these technology-based screening tools. Objective: This paper aims to examine associations between substance use and Instagram posts and to test whether such associations differ as a function of age, gender, and race/ethnicity. Methods: Participants with an Instagram account were recruited primarily via Clickworker (N=3117). With participant permission and Instagram’s approval, participants’ Instagram photo posts were downloaded with an application program interface. Participants’ past-year substance use was measured with an adapted version of the National Institute on Drug Abuse Quick Screen. At-risk drinking was defined as at least one past-year instance having “had more than a few alcoholic drinks a day,” drug use was defined as any use of nonprescription drugs, and prescription drug use was defined as any nonmedical use of prescription medications. We used logistic regression to examine the associations between substance use and any Instagram posts and negative binomial regression to examine the associations between substance use and number of Instagram posts. We examined whether age (18-25, 26-38, 39+ years), gender, and race/ethnicity moderated associations in both logistic and negative binomial models. All differences noted were significant at the .05 level. Results: Compared with no at-risk drinking, any at-risk drinking was associated with both a higher likelihood of any Instagram posts and a higher number of posts, except among Hispanic/Latino individuals, in whom at-risk drinking was associated with a similar number of posts. Compared with no drug use, any drug use was associated with a higher likelihood of any posts but was associated with a similar number of posts. Compared with no prescription drug use, any prescription drug use was associated with a similar likelihood of any posts and was associated with a lower number of posts only among those aged 39 years and older. Of note, main effects showed that being female compared with being male and being Hispanic/Latino compared with being White were significantly associated with both a greater likelihood of any posts and a greater number of posts. Conclusions: Researchers developing computational substance use risk detection models using Instagram or other SNS data may wish to consider our findings showing that at-risk drinking and drug use were positively associated with Instagram participation, while prescription drug use was negatively associated with Instagram participation for middle- and older-aged adults. As more is learned about SNS behaviors among those who use substances, researchers may be better positioned to successfully design and interpret innovative risk detection approaches. %M 32936081 %R 10.2196/21916 %U http://www.jmir.org/2020/9/e21916/ %U https://doi.org/10.2196/21916 %U http://www.ncbi.nlm.nih.gov/pubmed/32936081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18621 %T Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review %A Byaruhanga,Judith %A Atorkey,Prince %A McLaughlin,Matthew %A Brown,Alison %A Byrnes,Emma %A Paul,Christine %A Wiggers,John %A Tzelepis,Flora %+ Hunter New England Population Health, Locked Bag 10, Wallsend, , Australia, 61 249246454, judith.byaruhanga@uon.edu.au %K telehealth %K videoconferencing %K smoking cessation %K diet %K alcohol drinking %K physical activity %K obesity %K mobile phone %D 2020 %7 11.9.2020 %9 Review %J J Med Internet Res %G English %X Background: Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Objective: This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Methods: The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication. Results: A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating. Conclusions: Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility. %M 32915156 %R 10.2196/18621 %U http://www.jmir.org/2020/9/e18621/ %U https://doi.org/10.2196/18621 %U http://www.ncbi.nlm.nih.gov/pubmed/32915156 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17285 %T Engagement With Motivational Interviewing and Cognitive Behavioral Therapy Components of a Web-Based Alcohol Intervention, Elicitation of Change Talk and Sustain Talk, and Impact on Drinking Outcomes: Secondary Data Analysis %A Mujcic,Ajla %A Linke,Stuart %A Hamilton,Fiona %A Phillips,Alexandria %A Khadjesari,Zarnie %+ Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, Netherlands, 31 030 29 59 256, amujcic@trimbos.nl %K eHealth %K digital health %K self-management %K alcohol use %K motivational interviewing %K cognitive behavioural therapy %K engagement %D 2020 %7 1.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Down Your Drink (DYD) is a widely used unguided web-based alcohol moderation program for the general public based on cognitive behavioral therapy (CBT) and motivational interviewing (MI); it provides users with many opportunities to enter free-text responses. Objective: The aim of this study was to assess participants’ use of key CBT and MI components, the presence of change talk and sustain talk within their responses, and whether these data are associated with drinking outcomes after 3 months. Methods: An exploratory secondary data analysis was conducted on data collected in 2008 from the definitive randomized trial of DYD (N=503). Past week alcohol use at baseline and 3-month follow-up were measured with the TOT-AL. Covariates included baseline alcohol use, age, gender, education level, and word count of the responses. Use of MI and CBT components and presence of change talk and sustain talk were coded by two independent coders (Cohen κ range 0.91-1). Linear model regressions on the subsample of active users (n=410) are presented along with a negative binomial regression. Results: The most commonly used component was the listing of pros and cons of drinking. The number of listed high-risk situations was associated with lower alcohol use at 3-month follow-up (Badj −2.15, 95% CI −3.92 to −0.38, P=.02). Findings on the effects of the percentage of change talk and the number of listed strategies to deal with high-risk situations were inconsistent. Conclusions: An unguided web-based alcohol moderation program can elicit change talk and sustain talk. This secondary analysis suggests that the number of listed high-risk situations can predict alcohol use at 3-month follow-up. Other components show inconsistent findings and should be studied further. %M 32870162 %R 10.2196/17285 %U https://www.jmir.org/2020/9/e17285 %U https://doi.org/10.2196/17285 %U http://www.ncbi.nlm.nih.gov/pubmed/32870162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20368 %T e-INEBRIA Special Interest Group Roadmap for Best Practices for Research on Brief Digital Interventions for Problematic Alcohol and Illicit Drug Use %A Schaub,Michael Patrick %A Berman,Anne H %A López Pelayo,Hugo %A Boumparis,Nikolaos %A Khadjesari,Zarnie %A Blankers,Matthijs %A Gual,Antoni %A Riper,Heleen %A Pas,Lodewijk %+ Swiss Research Institute for Public Health and Addiction ISGF, University of Zurich, Konradstrasse 32, Zurich, 8005, Switzerland, 41 (0) 44 4481165, michael.schaub@isgf.uzh.ch %K brief interventions %K mobile applications %K good practice %K implementation research %K quality assurance %D 2020 %7 14.8.2020 %9 Viewpoint %J J Med Internet Res %G English %X There is great potential for scaling up the delivery of brief interventions for alcohol and illicit drug use, given the increasing coverage of mobile devices and technologies for digital interventions, including apps for smartphones and tablets. However, while the number of digital interventions is increasing rapidly, the involvement of brief-intervention researchers and the development of good practices has just begun. In 2018, the Special Interest Group on digital interventions of the International Network on Brief Interventions for Alcohol & Other Drugs (e-INEBRIA SIG) initiated a conversation regarding possible avenues of future research, which subsequently became a roadmap for digital interventions. This roadmap consists of points considered relevant for future research, ongoing technological developments, and their implementation across a continuum of prevention and care. Moreover, it outlines starting points for the diversification of brief digital interventions, as well as next steps for quality improvement and implementation in public health and clinical practice. The roadmap of the e-INEBRIA SIG on digital interventions is a starting point that indicates relevant next steps and provides orientation for researchers and interested practitioners with regard to the ambiguous literature and the complexity of current digital interventions. %M 32586786 %R 10.2196/20368 %U http://www.jmir.org/2020/8/e20368/ %U https://doi.org/10.2196/20368 %U http://www.ncbi.nlm.nih.gov/pubmed/32586786 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e21278 %T Personalized Approach Bias Modification Smartphone App (“SWIPE”) to Reduce Alcohol Use Among People Drinking at Hazardous or Harmful Levels: Protocol for an Open-Label Feasibility Study %A Manning,Victoria %A Piercy,Hugh %A Garfield,Joshua Benjamin Bernard %A Lubman,Dan Ian %+ Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Turning Point, 110 Church Street, Richmond, Victoria, 3121, Australia, 61 3 8413 8724, victoria.manning@monash.edu %K alcohol %K hazardous alcohol use %K alcohol use disorder %K approach bias modification %K cognitive bias modification %K smartphone app %K eHealth %K mobile phone app %K mHealth %K digital health %D 2020 %7 14.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol accounts for 5.1% of the global burden of disease and injury, and approximately 1 in 10 people worldwide develop an alcohol use disorder. Approach bias modification (ABM) is a computerized cognitive training intervention in which patients are trained to “avoid” alcohol-related images and “approach” neutral or positive images. ABM has been shown to reduce alcohol relapse rates when delivered in residential settings (eg, withdrawal management or rehabilitation). However, many people who drink at hazardous or harmful levels do not require residential treatment or choose not to access it (eg, owing to its cost, duration, inconvenience, or concerns about privacy). Smartphone app–delivered ABM could offer a free, convenient intervention to reduce cravings and consumption that is accessible regardless of time and place, and during periods when support is most needed. Importantly, an ABM app could also easily be personalized (eg, allowing participants to select personally relevant images as training stimuli) and gamified (eg, by rewarding participants for the speed and accuracy of responses) to encourage engagement and training completion. Objective: We aim to test the feasibility and acceptability of “SWIPE,” a gamified, personalized alcohol ABM smartphone app, assess its preliminary effectiveness, and explore in which populations the app shows the strongest indicators of effectiveness. Methods: We aim to recruit 500 people who drink alcohol at hazardous or harmful levels (Alcohol Use Disorders Identification Test score≥8) and who wish to reduce their drinking. Recruitment will be conducted through social media and websites. The participants’ intended alcohol use goal (reduction or abstinence), motivation to change their consumption, and confidence to change their consumption will be measured prior to training. Participants will be instructed to download the SWIPE app and complete at least 2 ABM sessions per week for 4 weeks. Recruitment and completion rates will be used to assess feasibility. Four weeks after downloading SWIPE, participants will be asked to rate SWIPE’s functionality, esthetics, and quality to assess acceptability. Alcohol consumption, craving, and dependence will be measured prior to commencing the first session of ABM and 4 weeks later to assess whether these variables change significantly over the course of ABM. Results: We expect to commence recruitment in August 2020 and complete data collection in March 2021. Conclusions: This will be the first study to test the feasibility, acceptability, and preliminary effectiveness of a personalized, gamified ABM intervention smartphone app for hazardous or harmful drinkers. Results will inform further improvements to the app, as well as the design of a statistically powered randomized controlled trial to test its efficacy relative to a control condition. Ultimately, we hope that SWIPE will extend the benefits of ABM to the millions of individuals who consume alcohol at hazardous levels and wish to reduce their use but cannot or choose not to access treatment. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000638932p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000638932p International Registered Report Identifier (IRRID): PRR1-10.2196/21278 %M 32795989 %R 10.2196/21278 %U http://www.researchprotocols.org/2020/8/e21278/ %U https://doi.org/10.2196/21278 %U http://www.ncbi.nlm.nih.gov/pubmed/32795989 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e17145 %T Effectiveness of Combining Organizational Alcohol Policy and Skills Training for Managers to Reduce Hazardous Alcohol Consumption in Swedish Workplaces: Study Protocol for a Cluster Randomized Study %A Elling,Devy Lysandra %A Wilson,Martina %A Carlbring,Per %A Wennberg,Peter %A Sundqvist,Kristina %+ Department of Public Health Sciences, Stockholm University, Sveavagen 160, Stockholm, SE-106 91, Sweden, 46 8 16 20 00, devy.elling@su.se %K alcohol prevention %K health promotion %K workplace intervention %K hazardous alcohol use %K alcohol use %K intervention %K workplace %D 2020 %7 12.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: High alcohol consumption poses risks to individual health and society. Previous alcohol interventions have mainly focused on high-risk consumers or young adults in school-based settings. Since the majority of the adult population is in the workforce, the workplace can be considered a favorable arena for implementing interventions. Objective: This protocol describes a project aimed at increasing knowledge of the effectiveness of combining the implementation of an organizational alcohol policy with skills training for managers as a workplace alcohol prevention program, by evaluating the intervention and exploring managers’ perceptions of the intervention. Methods: Organizations with at least 100 employees were invited to take part in the project. A total of 11 organizations (744 managers and 11,761 employees) were included in the project. Data are collected through self-administered online surveys at baseline, 12 months, and 24 months. The primary outcome is managers’ inclination to initiate an early alcohol intervention (eg, by initiating a dialogue) when concern regarding employees’ hazardous alcohol consumption arises. The secondary outcomes of interest are managers’ and employees’ organizational alcohol policy knowledge and changes in alcohol consumption, as measured using the Alcohol Use Disorder Identification Test (AUDIT) score. A linear mixed-model framework will be used to model variability on different levels. Primary analysis will follow an intention-to-treat approach. Additionally, managers’ responses from semistructured interviews will be analyzed using thematic analysis to explore managers’ experiences regarding the prevention program. Results: This study is ongoing. The overall study start was on January 2018, and the study is planned to end in December 2020. Baseline and 12-month follow-up measurements have been collected. Conclusions: This project is designed to evaluate the effectiveness of an alcohol prevention program regarding higher inclination to initiate early alcohol interventions after policy implementation and skills training among managers, compared to the usual practices in the workplace. The results from this study can contribute to increased knowledge about alcohol interventions and future prevention programs in the workplace. Trial Registration: ISRCTN17250048; http://www.isrctn.com/ISRCTN17250048 International Registered Report Identifier (IRRID): DERR1-10.2196/17145 %M 32784185 %R 10.2196/17145 %U https://www.researchprotocols.org/2020/8/e17145 %U https://doi.org/10.2196/17145 %U http://www.ncbi.nlm.nih.gov/pubmed/32784185 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 8 %P e16969 %T Designing a Clinician-Facing Tool for Using Insights From Patients’ Social Media Activity: Iterative Co-Design Approach %A Yoo,Dong Whi %A Birnbaum,Michael L %A Van Meter,Anna R %A Ali,Asra F %A Arenare,Elizabeth %A Abowd,Gregory D %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, 756 W Peachtree St NW, Atlanta, GA, 30308, United States, 1 4043858603, yoo@gatech.edu %K social media %K psychotic disorders %K information technology %D 2020 %7 12.8.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Recent research has emphasized the need for accessing information about patients to augment mental health patients’ verbal reports in clinical settings. Although it has not been introduced in clinical settings, computational linguistic analysis on social media has proved it can infer mental health attributes, implying a potential use as collateral information at the point of care. To realize this potential and make social media insights actionable to clinical decision making, the gaps between computational linguistic analysis on social media and the current work practices of mental health clinicians must be bridged. Objective: This study aimed to identify information derived from patients’ social media data that can benefit clinicians and to develop a set of design implications, via a series of low-fidelity (lo-fi) prototypes, on how to deliver the information at the point of care. Methods: A team of clinical researchers and human-computer interaction (HCI) researchers conducted a long-term co-design activity for over 6 months. The needs-affordances analysis framework was used to refine the clinicians’ potential needs, which can be supported by patients’ social media data. On the basis of those identified needs, the HCI researchers iteratively created 3 different lo-fi prototypes. The prototypes were shared with both groups of researchers via a videoconferencing software for discussion and feedback. During the remote meetings, potential clinical utility, potential use of the different prototypes in a treatment setting, and areas of improvement were discussed. Results: Our first prototype was a card-type interface that supported treatment goal tracking. Each card included attribute levels: depression, anxiety, social activities, alcohol, and drug use. This version confirmed what types of information are helpful but revealed the need for a glanceable dashboard that highlights the trends of these information. As a result, we then developed the second prototype, an interface that shows the clinical state and trend. We found that focusing more on the changes since the last visit without visual representation can be more compatible with clinicians’ work practices. In addition, the second phase of needs-affordances analysis identified 3 categories of information relevant to patients with schizophrenia: symptoms related to psychosis, symptoms related to mood and anxiety, and social functioning. Finally, we developed the third prototype, a clinical summary dashboard that showed changes from the last visit in plain texts and contrasting colors. Conclusions: This exploratory co-design research confirmed that mental health attributes inferred from patients’ social media data can be useful for clinicians, although it also revealed a gap between computational social media analyses and clinicians’ expectations and conceptualizations of patients’ mental health states. In summary, the iterative co-design process crystallized design directions for the future interface, including how we can organize and provide symptom-related information in a way that minimizes the clinicians’ workloads. %M 32784180 %R 10.2196/16969 %U http://mental.jmir.org/2020/8/e16969/ %U https://doi.org/10.2196/16969 %U http://www.ncbi.nlm.nih.gov/pubmed/32784180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17449 %T Using Web-Based Social Media to Recruit Heavy-Drinking Young Adults for Sleep Intervention: Prospective Observational Study %A Ash,Garrett I %A Robledo,David S %A Ishii,Momoko %A Pittman,Brian %A DeMartini,Kelly S %A O'Malley,Stephanie S %A Redeker,Nancy S %A Fucito,Lisa M %+ Department of Psychiatry, Yale School of Medicine, 300 George Street, #901, New Haven, CT, 06511, United States, 1 2034443079, garrett.ash@yale.edu %K substance abuse %K social media %K alcohol drinking %K sleep %K mobile phone %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Novel alcohol prevention strategies are needed for heavy-drinking young adults. Sleep problems are common among young adults who drink heavily and are a risk factor for developing an alcohol use disorder (AUD). Young adults, interested in the connection between sleep and alcohol, are open to getting help with their sleep. Therefore, sleep interventions may offer an innovative solution. This study evaluates social media advertising for reaching young adults and recruiting them for a new alcohol prevention program focused on sleep. Objective: This study aims to evaluate the effectiveness and cost of using Facebook, Instagram, and Snapchat advertising to reach young adults who drink heavily for a sleep intervention; characterize responders’ sleep, alcohol use, and related concerns and interests; and identify the most appealing advertising content. Methods: In study 1, advertisements targeting young adults with sleep concerns, heavy alcohol use, or interest in participating in a sleep program ran over 3 months. Advertisements directed volunteers to a brief web-based survey to determine initial sleep program eligibility and characterize the concerns or interests that attracted them to click the advertisement. In study 2, three advertisements ran simultaneously for 2 days to enable us to compare the effectiveness of specific advertising themes. Results: In study 1, advertisements generated 13,638 clicks, 909 surveys, and 27 enrolled volunteers in 3 months across the social media platforms. Fees averaged US $0.27 per click, US $3.99 per completed survey, US $11.43 per volunteer meeting initial screening eligibility, and US $106.59 per study enrollee. On average, those who completed the web-based survey were 21.1 (SD 2.3) years of age, and 69.4% (631/909) were female. Most reported sleep concerns (725/909, 79.8%) and an interest in the connection between sleep and alcohol use (547/909, 60.2%), but few had drinking concerns (49/909, 5.4%). About one-third (317/909, 34.9%) were identified as being at risk for developing an AUD based on a validated alcohol screener. Among this subsample, 8.5% (27/317) met the final criteria and were enrolled in the trial. Some volunteers also referred additional volunteers by word of mouth. In study 2, advertisements targeting sleep yielded a higher response rate than advertisements targeting alcohol use (0.91% vs 0.56% click rate, respectively; P<.001). Conclusions: Social media advertisements designed to target young adults with sleep concerns reached those who also drank alcohol heavily, despite few being concerned about their drinking. Moreover, advertisements focused on sleep were more effective than those focused on drinking. Compared with previous studies, cost-effectiveness was moderate for engagement (impressions to clicks), excellent for conversion (clicks to survey completion), and reasonable for enrollment. These data demonstrate the utility of social media advertising focused on sleep to reach young adults who drink heavily and recruit them for intervention. %M 32780027 %R 10.2196/17449 %U https://www.jmir.org/2020/8/e17449 %U https://doi.org/10.2196/17449 %U http://www.ncbi.nlm.nih.gov/pubmed/32780027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e18690 %T Notifications to Improve Engagement With an Alcohol Reduction App: Protocol for a Micro-Randomized Trial %A Bell,Lauren %A Garnett,Claire %A Qian,Tianchen %A Perski,Olga %A Potts,Henry W W %A Williamson,Elizabeth %+ Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 02076368636, lauren.bell@lshtm.ac.uk %K mobile health %K digital behavior change %K engagement %K micro-randomized trial %K push notifications %K excessive alcohol consumption %K smartphone app %K alcohol %K mHealth %D 2020 %7 7.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Drink Less is a behavior change app that aims to help users in the general adult population reduce hazardous and harmful alcohol consumption. The app includes a daily push notification, delivered at 11 am, asking users to “Please complete your mood and drinking diaries.” Previous analysis of Drink Less engagement data suggests the current notification strongly influences how users engage with the app in the subsequent hour. To exploit a potential increase of vulnerability of excess drinking and opportunity to engage with the app in the evenings, we changed the delivery time from 11 am to 8 pm. We now aim to further optimise the content and sequence of notifications, testing 30 new evidence-informed notifications targeting the user’s perceived usefulness of the app. Objective: The primary objective is to assess whether sending a notification at 8 pm increases behavioral engagement (opening the app) in the subsequent hour. Secondary objectives include comparing the effect of the new bank of messages with the standard message and effect moderation over time. We also aim to more generally understand the role notifications have on the overall duration, depth, and frequency of engagement with Drink Less over the first 30 days after download. Methods: This is a protocol for a micro-randomized trial with two additional parallel arms. Inclusion criteria are Drink Less users who (1) consent to participate in the trial; (2) self-report a baseline Alcohol Use Disorders Identification Test score of 8 or above; (3) reside in the United Kingdom; (4) age ≥18 years and; (5) report interest in drinking less alcohol. In the micro-randomized trial, participants will be randomized daily at 8 pm to receive no notification, a notification with text from the new message bank, or the standard message. The primary outcome is the time-varying, binary outcome of “Did the user open the app in the hour from 8 pm to 9 pm?”. The primary analysis will estimate the marginal relative risk for the notifications using an estimator developed for micro-randomized trials with binary outcomes. Participants randomized to the parallel arms will receive no notifications (Secondary Arm A), or the standard notification delivered daily at 11 am (Secondary Arm B) over 30 days, allowing the comparison of overall engagement between different notification delivery strategies. Results: Approval was granted by the University College of London’s Departmental Research Ethics Committee (CEHP/2016/556) on October 11, 2019, and The London School of Hygiene and Tropical Medicine Interventions Research Ethics Committee (17929) on November 27, 2019. Recruitment began on January 2, 2020, and is ongoing. Conclusions: Understanding how push notifications may impact engagement with a behavior change app can lead to further improvements in engagement, and ultimately help users reduce their alcohol consumption. This understanding may also be generalizable to other apps that target a variety of behavior changes. International Registered Report Identifier (IRRID): DERR1-10.2196/18690 %M 32763878 %R 10.2196/18690 %U https://www.researchprotocols.org/2020/8/e18690 %U https://doi.org/10.2196/18690 %U http://www.ncbi.nlm.nih.gov/pubmed/32763878 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e16180 %T Characteristics of Neuropsychiatric Mobile Health Trials: Cross-Sectional Analysis of Studies Registered on ClinicalTrials.gov %A Minen,Mia Tova %A Reichel,Julia Frederica %A Pemmireddy,Pallavi %A Loder,Elizabeth %A Torous,John %+ NYU Langone Health, 222 E 41st Street,, New York, NY, 10017, United States, 1 2122637744, minenmd@gmail.com %K smartphones %K mobile phones %K apps %K mental health %K regulation %K stroke %K migraine %K major depressive disorder %K Alzheimer disease %K anxiety disorders %K alcohol use disorders %K opioid use disorders %K epilepsy %K schizophrenia %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The development of mobile health (mHealth) technologies is progressing at a faster pace than that of the science to evaluate their validity and efficacy. Under the International Committee of Journal Medical Editors (ICMJE) guidelines, clinical trials that prospectively assign people to interventions should be registered with a database before the initiation of the study. Objective: The aim of this study was to better understand the smartphone mHealth trials for high-burden neuropsychiatric conditions registered on ClinicalTrials.gov through November 2018, including the number, types, and characteristics of the studies being conducted; the frequency and timing of any outcome changes; and the reporting of results. Methods: We conducted a systematic search of ClinicalTrials.gov for the top 10 most disabling neuropsychiatric conditions and prespecified terms related to mHealth. According to the 2016 World Health Organization Global Burden of Disease Study, the top 10 most disabling neuropsychiatric conditions are (1) stroke, (2) migraine, (3) major depressive disorder, (4) Alzheimer disease and other dementias, (5) anxiety disorders, (6) alcohol use disorders, (7) opioid use disorders, (8) epilepsy, (9) schizophrenia, and (10) other mental and substance use disorders. There were no date, location, or status restrictions. Results: Our search identified 135 studies. A total of 28.9% (39/135) of studies evaluated interventions for major depressive disorder, 14.1% (19/135) of studies evaluated interventions for alcohol use disorders, 12.6% (17/135) of studies evaluated interventions for stroke, 11.1% (15/135) of studies evaluated interventions for schizophrenia, 8.1% (11/135) of studies evaluated interventions for anxiety disorders, 8.1% (11/135) of studies evaluated interventions for other mental and substance use disorders, 7.4% (10/135) of studies evaluated interventions for opioid use disorders, 3.7% (5/135) of studies evaluated interventions for Alzheimer disease or other dementias, 3.0% (4/135) of studies evaluated interventions for epilepsy, and 3.0% (4/135) of studies evaluated interventions for migraine. The studies were first registered in 2008; more than half of the studies were registered from 2016 to 2018. A total of 18.5% (25/135) of trials had results reported in some publicly accessible location. Across all the studies, the mean estimated enrollment (reported by the study) was 1078, although the median was only 100. In addition, across all the studies, the actual reported enrollment was lower, with a mean of 249 and a median of 80. Only about a quarter of the studies (35/135, 25.9%) were funded by the National Institutes of Health. Conclusions: Despite the increasing use of health-based technologies, this analysis of ClinicalTrials.gov suggests that only a few apps for high-burden neuropsychiatric conditions are being clinically evaluated in trials. %M 32749230 %R 10.2196/16180 %U https://mhealth.jmir.org/2020/8/e16180 %U https://doi.org/10.2196/16180 %U http://www.ncbi.nlm.nih.gov/pubmed/32749230 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17915 %T Evidence Regarding Automatic Processing Computerized Tasks Designed For Health Interventions in Real-World Settings Among Adults: Systematic Scoping Review %A Jayasinghe,Harshani %A Short,Camille E %A Braunack-Mayer,Annette %A Merkin,Ashley %A Hume,Clare %+ School of Public Health, The University of Adelaide, Level 9, Adelaide Health and Medical Sciences Building, The University of Adelaide, Adelaide, 5000, Australia, 61 8313 4634, harshani.jayasinghepedige@adelaide.edu.au %K automatic processing %K computerized tasks %K health interventions %K real-world %K adult %K behavior change, mobile phone %D 2020 %7 29.7.2020 %9 Review %J J Med Internet Res %G English %X Background: Dual process theories propose that the brain uses 2 types of thinking to influence behavior: automatic processing and reflective processing. Automatic processing is fast, immediate, nonconscious, and unintentional, whereas reflective processing focuses on logical reasoning, and it is slow, step by step, and intentional. Most digital psychological health interventions tend to solely target the reflective system, although the automatic processing pathway can have strong influences on behavior. Laboratory-based research has highlighted that automatic processing tasks can create behavior change; however, there are substantial gaps in the field on the design, implementation, and delivery of automatic processing tasks in real-world settings. It is important to identify and summarize the existing literature in this area to inform the translation of laboratory-based research to real-world settings. Objective: This scoping review aims to explore the effectiveness of automatic training tasks, types of training tasks commonly used, mode of delivery, and impacts of gamification on automatic processing tasks designed for digital psychological health interventions in real-world settings among adults. Methods: The scoping review methodology proposed by Arskey and O’Malley and Colquhoun was applied. A scoping review was chosen because of the novelty of the digital automatic processing field and to encompass a broad review of the existing evidence base. Electronic databases and gray literature databases were searched with the search terms “automatic processing,” “computerised technologies,” “health intervention,” “real-world,” and “adults” and synonyms of these words. The search was up to date until September 2018. A manual search was also completed on the reference lists of the included studies. Results: A total of 14 studies met all inclusion criteria. There was a wide variety of health conditions targeted, with the most prevalent being alcohol abuse followed by social anxiety. Attention bias modification tasks were the most prevalent type of automatic processing task, and the majority of tasks were most commonly delivered over the web via a personal computer. Of the 14 studies included in the review, 8 demonstrated significant changes to automatic processes and 4 demonstrated significant behavioral changes as a result of changed automatic processes. Conclusions: This is the first review to synthesize the evidence on automatic processing tasks in real-world settings targeting adults. This review has highlighted promising, albeit limited, research demonstrating that automatic processing tasks may be used effectively in a real-world setting to influence behavior change. %M 32499213 %R 10.2196/17915 %U http://www.jmir.org/2020/7/e17915/ %U https://doi.org/10.2196/17915 %U http://www.ncbi.nlm.nih.gov/pubmed/32499213 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e19081 %T The Kaiser Permanente Northern California Adult Alcohol Registry, an Electronic Health Records-Based Registry of Patients With Alcohol Problems: Development and Implementation %A Palzes,Vanessa A %A Weisner,Constance %A Chi,Felicia W %A Kline-Simon,Andrea H %A Satre,Derek D %A Hirschtritt,Matthew E %A Ghadiali,Murtuza %A Sterling,Stacy %+ Division of Research, Kaiser Permanente Northern California, 2000 Broadway, Oakland, CA, 94612, United States, 1 510 891 3743, vanessa.a.palzes@kp.org %K electronic health records %K alcohol %K registry %K unhealthy alcohol use %K alcohol use disorder %K recovery %K secondary data %D 2020 %7 22.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic health record (EHR)–based disease registries have aided health care professionals and researchers in increasing their understanding of chronic illnesses, including identifying patients with (or at risk of developing) conditions and tracking treatment progress and recovery. Despite excessive alcohol use being a major contributor to the global burden of disease and disability, no registries of alcohol problems exist. EHR-based data in Kaiser Permanente Northern California (KPNC), an integrated health system that conducts systematic alcohol screening, which provides specialty addiction medicine treatment internally and has a membership of over 4 million members that are highly representative of the US population with access to care, provide a unique opportunity to develop such a registry. Objective: Our objectives were to describe the development and implementation of a protocol for assembling the KPNC Adult Alcohol Registry, which may be useful to other researchers and health systems, and to characterize the registry cohort descriptively, including underlying health conditions. Methods: Inclusion criteria were adult members with unhealthy alcohol use (using National Institute on Alcohol Abuse and Alcoholism guidelines), an alcohol use disorder (AUD) diagnosis, or an alcohol-related health problem between June 1, 2013, and May 31, 2019. We extracted patients’ longitudinal, multidimensional EHR data from 1 year before their date of eligibility through May 31, 2019, and conducted descriptive analyses. Results: We identified 723,604 adult patients who met the registry inclusion criteria at any time during the study period: 631,780 with unhealthy alcohol use, 143,690 with an AUD diagnosis, and 18,985 with an alcohol-related health problem. We identified 65,064 patients who met two or more criteria. Of the 4,973,195 adult patients with at least one encounter with the health system during the study period, the prevalence of unhealthy alcohol use was 13% (631,780/4,973,195), the prevalence of AUD diagnoses was 3% (143,690/4,973,195), and the prevalence of alcohol-related health problems was 0.4% (18,985/4,973,195). The registry cohort was 60% male (n=432,847) and 41% non-White (n=295,998) and had a median age of 41 years (IQR=27). About 48% (n=346,408) had a chronic medical condition, 18% (n=130,031) had a mental health condition, and 4% (n=30,429) had a drug use disorder diagnosis. Conclusions: We demonstrated that EHR-based data collected during clinical care within an integrated health system could be leveraged to develop a registry of patients with alcohol problems that is flexible and can be easily updated. The registry’s comprehensive patient-level data over multiyear periods provides a strong foundation for robust research addressing critical public health questions related to the full course and spectrum of alcohol problems, including recovery, which would complement other methods used in alcohol research (eg, population-based surveys, clinical trials). %M 32706676 %R 10.2196/19081 %U http://medinform.jmir.org/2020/7/e19081/ %U https://doi.org/10.2196/19081 %U http://www.ncbi.nlm.nih.gov/pubmed/32706676 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e15878 %T Methodological Challenges in Web-Based Trials: Update and Insights From the Relatives Education and Coping Toolkit Trial %A Robinson,Heather %A Appelbe,Duncan %A Dodd,Susanna %A Flowers,Susan %A Johnson,Sonia %A Jones,Steven H %A Mateus,Céu %A Mezes,Barbara %A Murray,Elizabeth %A Rainford,Naomi %A Rosala-Hallas,Anna %A Walker,Andrew %A Williamson,Paula %A Lobban,Fiona %+ Division of Health Research, Spectrum Centre for Mental Health Research, Lancaster University, Bailrigg, Lancaster LA1 4YW, Lancaster, , United Kingdom, 44 (0)1524 593, s.jones7@lancaster.ac.uk %K randomized controlled trial %K research design %K methods %K internet %K web %K mental health %K relatives %K carers %D 2020 %7 17.7.2020 %9 Tutorial %J JMIR Ment Health %G English %X There has been a growth in the number of web-based trials of web-based interventions, adding to an increasing evidence base for their feasibility and effectiveness. However, there are challenges associated with such trials, which researchers must address. This discussion paper follows the structure of the Down Your Drink trial methodology paper, providing an update from the literature for each key trial parameter (recruitment, registration eligibility checks, consent and participant withdrawal, randomization, engagement with a web-based intervention, retention, data quality and analysis, spamming, cybersquatting, patient and public involvement, and risk management and adverse events), along with our own recommendations based on designing the Relatives Education and Coping Toolkit randomized controlled trial for relatives of people with psychosis or bipolar disorder. The key recommendations outlined here are relevant for future web-based and hybrid trials and studies using iterative development and test models such as the Accelerated Creation-to-Sustainment model, both within general health research and specifically within mental health research for relatives. Researchers should continue to share lessons learned from conducting web-based trials of web-based interventions to benefit future studies.International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-016965 %M 32497018 %R 10.2196/15878 %U https://mental.jmir.org/2020/7/e15878 %U https://doi.org/10.2196/15878 %U http://www.ncbi.nlm.nih.gov/pubmed/32497018 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e18693 %T Internet-Delivered Cognitive Behavioral Therapy for Problematic Alcohol Use in a Workplace Setting: Protocol for Quantitative and Qualitative Evaluation of Feasibility and Outcomes %A Forsström,David %A Sundström,Christopher %A Berman,Anne H %A Sundqvist,Kristina %+ Department of Psychology, Stockholm University, Frescati Hagväg 8, Stockholm, 10691, Sweden, 46 708112319, david.forsstrom@su.se %K workplace setting %K ICBT %K alcohol %K protocol %K mental health %K feasibility %K CBT %K cognitive behavioral therapy %K intervention %K workplace %D 2020 %7 15.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Internet-based cognitive behavioral therapy (ICBT) for mental health issues has been successfully implemented in routine health care settings, and research indicates that ICBT can also be applied to decrease problematic alcohol use in workplace settings. However, studies investigating the feasibility of implementing ICBT in a workplace setting have been lacking. Objective: The current study aims to investigate the feasibility of delivering ICBT for problematic alcohol use within an employee assistance program (EAP). Methods: The study has a quantitative naturalistic design, quantitively comparing ICBT and face-to-face treatment, and allowing for qualitative interviews with employees and employers. Recruitment of participants follows a five-session in-person psychological assessment at an EAP regarding an employee’s presumed problematic alcohol consumption. All assessed employees referred to ICBT or face-to-face treatment will be offered participation in the study. Interviews will be held with employees and their employer representatives following ICBT to elucidate both stakeholders’ experience and perception of ICBT and its context. Outcome comparisons between ICBT and face-to-face treatment will be assessed quantitatively using a Reliable Change Index and analysis of variance. Thematic analysis and Grounded Theory will be used to analyze the interview material. Results: The study is set to begin in April 2020 and to end in September 2021. The aim is to recruit up to 150 participants to the quantitative part of the study and 45 participants (15 employees and 30 employer representatives) to the qualitative part of the study. Conclusions: The current study will provide knowledge that is lacking and urgently needed on how to implement ICBT for problematic alcohol use in a workplace setting. International Registered Report Identifier (IRRID): PRR1-10.2196/18693 %M 32673266 %R 10.2196/18693 %U https://www.researchprotocols.org/2020/7/e18693 %U https://doi.org/10.2196/18693 %U http://www.ncbi.nlm.nih.gov/pubmed/32673266 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e16964 %T Remote Monitoring Telemedicine (REMOTE) Platform for Patients With Anxiety Symptoms and Alcohol Use Disorder: Protocol for a Case-Control Study %A Pastor,Núria %A Khalilian,Elizabeth %A Caballeria,Elsa %A Morrison,Danielle %A Sanchez Luque,Unai %A Matrai,Silvia %A Gual,Antoni %A López-Pelayo,Hugo %+ HumanITcare - FOLLOWHEALTH SL, C/ Pau Gargallo, 30 (entrance Pascual i Vila), StartUB Building, Barcelona, 08028, Spain, 34 628994983, nuria.pastor@humanitcare.com %K digital health %K digital biomarkers %K digital phenotype %K mental health %D 2020 %7 24.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Monitoring mental health outcomes has traditionally been based on heuristic decisions, often based on scarce, subjective evidence, making the clinical decisions made by professionals, as well as the monitoring of these diseases, subject to flaws. However, the digital phenotype, which refers to the analysis of data collected by measuring human behavior with mobile sensors and smart bracelets, is a promising tool for filling this gap in current clinical practice. Objective: The objectives of this study are to develop the digital phenotyping of patients with alcohol use disorder and anxiety symptoms using data collected from a mobile device (ie, smartphone) and a wearable sensor (ie, Fitbit) and to analyze usability and patient satisfaction with the data collection service provided by the app. Methods: We propose to conduct a study among a group of 60 participants split into two subgroups—experimental and control—of 30 participants each. The experimental group will be recruited by physicians from the Hospital Clínic de Barcelona, and the control group will be recruited on a volunteer basis through fliers and social media. All participants will go through pretraining to ensure technological capability and understanding of tasks, then each participant will download the HumanITcare app and will be given a wearable sensor (ie, Fitbit). Throughout the 4-month period, participants will be monitored on a range of factors, including sleep cycle, heart rate, movement patterns, and sociability. All data from the wearable sensors and the mobile devices will be saved and sent to the HumanITcare server. Participants will be asked to complete weekly questionnaires about anxiety, depression, and alcohol use disorder symptoms. Research assistants will ensure timely responses. The data from both sensors will then be compared to the questionnaire responses to determine how accurately the devices can predict the same symptoms. Results: The recruitment phase was completed in November 2019 and all the data were collected by the end of December 2019. Data are being processed; this process is expected to be completed by October 2020. Conclusions: This study was created and conducted as a pilot study with the Hospital Clínic de Barcelona, with the purpose of exploring the feasibility of our approach. The study is focused on patients diagnosed with anxiety and alcohol use disorder, but participants were also monitored for depressive symptoms throughout the trial, although these were not part of the initial inclusion criteria. A limitation to our study was the exclusive use of Android smartphones over iOS devices; this could result in a potential selection bias, due to the accessibility and affordability of Android phones as opposed to iOS-based phones. Another limitation might be that reviews of usability and satisfaction could be confounded by factors such as age and familiarity. An additional function that we might add in future studies is the ability for patients to manage their own data. International Registered Report Identifier (IRRID): DERR1-10.2196/16964 %M 32579124 %R 10.2196/16964 %U https://www.researchprotocols.org/2020/6/e16964 %U https://doi.org/10.2196/16964 %U http://www.ncbi.nlm.nih.gov/pubmed/32579124 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17557 %T Feasibility and Acceptability of a Text Message–Based Intervention to Reduce Overuse of Alcohol in Emergency Department Patients: Controlled Proof-of-Concept Trial %A Burner,Elizabeth %A Zhang,Mark %A Terp,Sophie %A Ford Bench,Kelsey %A Lee,Joshua %A Lam,Chun Nok %A Torres,Jesus R %A Menchine,Michael %A Arora,Sanjay %+ Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 N State Street, Los Angeles, CA, 90033, United States, 1 323 409 6638, eburner@usc.edu %K mhealth %K alcohol misuse %K emergency department %K alcohol intervention %D 2020 %7 4.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emergency department (ED) patients have high rates of risky alcohol use, and an ED visit offers an opportunity to intervene. ED-based screening, brief intervention, and referral to treatment (SBIRT) reduces alcohol use and health care costs. Mobile health (mHealth) interventions may expand the impact of SBIRTs but are understudied in low-resource ED populations. Objective: The objective of this study was to assess the feasibility of and patient satisfaction with a text-based mHealth extension of an ED screening program to reduce risky alcohol use in low-income, urban patients. Methods: Research assistants screened a convenience sample of ED patients in person for risky alcohol use via the Alcohol Use Disorders Identification Test (AUDIT). Patients who reported AUDIT scores ≥8 and <20 were informed of their AUDIT score and risk. RAs invited patients with SMS text message–capable phones to receive mROAD (mobilizing to Reduce Overuse of Alcohol in the ED), an SMS text message–based extension of the ED screening program. mROAD is a 7-day program of twice-daily SMS text messages based on the National Institutes of Health’s Rethinking Drinking campaign. Participants were allocated to a control group (daily sham text messages without specific guidance on behaviors, such as “Thanks for taking part!”) or to the mROAD intervention group. Patients were interviewed at 30 days to assess acceptability, satisfaction, and changes in drinking behavior. Satisfaction was examined descriptively. Pre and post measurements of drinking behaviors and motivation were compared, as were differences in change scores between the intervention arms. Results: Of 1028 patients screened, 95 (9.2%) exhibited risky alcohol use based on AUDIT, and 23/95 (24%) of those patients did not own an SMS text messaging–capable phone; this left 72/95 (76%) eligible patients. Among eligible participants, 48/72 (67%) agreed to enroll; 31/48 (65%) achieved follow-up (18/24 (75%) in the intervention group and 13/24 (55%) in the control group). Participants who completed follow-up reported high satisfaction. Changes in behavior were similar between the arms. Overall, the number of drinking days reported in the prior 30 days decreased by 5.0 (95% CI 1.7-8.3; P=.004), and the number of heavy drinking days decreased by 4.1 (95% CI 1.0 to 7.15, P=.01). Patients reported an 11-point increase (95% CI 2.6-20, P=.01, 10% overall increase) in motivation to change alcohol use via the Change Questionnaire. The were no statistical differences in drinking days, heavy drinking days, or motivation to change between the arms. Conclusions: The mROAD trial was feasible. Over three-quarters of ED patients with risky alcohol use owned a text message–capable phone, and two-thirds of these patients were willing to participate; only 1 patient opted out of the intervention. Although 35% of patients were lost to follow-up at 30 days, those patients who did follow up had favorable impressions of the program; more than 90% reported that SMS text messages were a “good way to teach,” and 89% of intervention arm participants enjoyed the program and found that the messages were motivating. Both the mROAD and sham message groups showed promising changes in alcohol use and motivation to change. mROAD is a feasible intervention that may reduce rates of risky alcohol use in ED patients. Trial Registration: ClinicalTrials.gov NCT02158949; https://clinicaltrials.gov/ct2/show/NCT02158949 %M 32496203 %R 10.2196/17557 %U http://mhealth.jmir.org/2020/6/e17557/ %U https://doi.org/10.2196/17557 %U http://www.ncbi.nlm.nih.gov/pubmed/32496203 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16937 %T Assessment of the Efficacy of a Mobile Phone–Delivered Just-in-Time Planning Intervention to Reduce Alcohol Use in Adolescents: Randomized Controlled Crossover Trial %A Haug,Severin %A Paz Castro,Raquel %A Scholz,Urte %A Kowatsch,Tobias %A Schaub,Michael Patrick %A Radtke,Theda %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8005, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K alcohol %K adolescents %K planning intervention %K just-in-time intervention %K crossover trial %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interventions to reduce alcohol use typically include several elements, such as information on the risks of alcohol consumption, planning for sensible drinking, and training of protective behavioral strategies. However, the effectiveness of these individual intervention elements within comprehensive programs has not been addressed so far, but it could provide valuable insights for the development of future interventions. Just-in-time interventions provided via mobile devices are intended to help people make healthy decisions in the moment and thus could influence health behavior. Objective: The aim of this study was to test the proximal effects of a mobile phone–delivered, just-in-time planning intervention to reduce alcohol use in adolescents who reported recent binge drinking. The efficacy of this individual intervention element was tested within a comprehensive intervention program to reduce problem drinking in adolescents. Methods: The study had an AB/BA crossover design, in which participants were randomly allocated to (1) a group receiving the planning intervention (A) in period 1 and assessment only (B) in period 2 or (2) a group receiving assessment only (B) in period 1 and the planning intervention (A) in period 2. The planning intervention included a text message to choose one of two predetermined if-then plans to practice sensible drinking with friends or when going out and a prompt to visualize the chosen plan. There was a washout period of at least 1 week between period 1 and period 2. Results: Out of 633 program participants who recently binge drank, 136 (21.5%) were receptive in both periods of time and provided data on the proximal outcome, which was the number of alcoholic drinks consumed with friends or when going out. After the planning intervention, the number of alcoholic drinks consumed was approximately one standard drink lower compared with the finding without the intervention (P=.01). Conclusions: A mobile phone–delivered, just-in-time, if-then planning intervention to practice sensible drinking with friends or when going out is effective in reducing alcohol consumption among adolescents who report recent binge drinking. Based on the relatively low percentage of participants with self-reported receptivity for the planning intervention, measures to increase the population impact of similar planning interventions should be implemented and tested in future trials. Trial Registration: ISRCTN Registry ISRCTN52150713; http://www.isrctn.com/ISRCTN52150713 %M 32452818 %R 10.2196/16937 %U http://mhealth.jmir.org/2020/5/e16937/ %U https://doi.org/10.2196/16937 %U http://www.ncbi.nlm.nih.gov/pubmed/32452818 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e16688 %T Social Media Interventions for Risky Drinking Among Adolescents and Emerging Adults: Protocol for a Randomized Controlled Trial %A Bonar,Erin E %A Schneeberger,Diane M %A Bourque,Carrie %A Bauermeister,Jose A %A Young,Sean D %A Blow,Frederic C %A Cunningham,Rebecca M %A Bohnert,Amy SB %A Zimmerman,Marc A %A Walton,Maureen A %+ Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI, 48109, United States, 1 7347647936, erinbona@med.umich.edu %K social media %K alcohol consumption %K adolescents %K emerging adults %K internet-based intervention %D 2020 %7 13.5.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficacious early interventions for youth, delivered with a broad reach via trained peers on social media, could have an important role in addressing risky drinking and concomitant drug use. Objective: This paper describes the protocol of a randomized controlled trial (RCT) testing the efficacy of a social media intervention among adolescents and emerging adults who meet the criteria for risky drinking (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), delivered with and without financial incentives for participation, compared with an attention placebo control condition (ie, entertaining social media content), on alcohol consumption and consequences. Methods: This RCT involved recruiting 955 youths (aged 16-24 years) via advertisements on Facebook and Instagram to self-administer a brief web-based screening survey. Those screening positive for past 3-month risky drinking (AUDIT-C positive: ages 16-17 years: ≥3 females and ≥4 males; and ages 18-24 years: ≥4 females and ≥5 males) were eligible for the RCT. After providing consent (a waiver of parental consent was obtained for minors), participants completed a web-based baseline survey and several verification procedures, including a selfie photo matched to Facebook profile photos. Participants were then randomized to join invitation-only secret Facebook groups, which were not searchable or viewable by parents, friends, or anyone not recruited by the study. The 3 conditions were social media intervention with incentives, social media intervention without incentives (SMI), and attention placebo control. Each condition lasted 8 weeks and consisted of bachelor’s-level and master’s-level therapist electronic coaches posting relevant content and responding to participants’ posts in a manner consistent with Motivational Interviewing. Participants in the control condition and SMI condition did not receive payments but were blind to condition assignment between these 2 conditions. Follow-ups are ongoing and occur at 3, 6, and 12 months poststart of the groups. Results: We enrolled 955 participants over 10 waves of recruitment who screened positive for risky drinking into the RCT. Conclusions: The findings of this study will provide the critical next step in delivering early alcohol interventions to the youth, capitalizing on social media platforms, which could have significant public health impact by altering alcohol use trajectories of adolescents and emerging adults engaged in risky drinking. Trial Registration: ClinicalTrials.gov NCT02809586; https://clinicaltrials.gov/ct2/show/NCT02809586. International Registered Report Identifier (IRRID): DERR1-10.2196/16688 %M 32401225 %R 10.2196/16688 %U https://www.researchprotocols.org/2020/5/e16688 %U https://doi.org/10.2196/16688 %U http://www.ncbi.nlm.nih.gov/pubmed/32401225 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15568 %T Mental Health Therapy Protocols and eHealth Design: Focus Group Study %A van Dooren,Marierose M M %A Visch,Valentijn %A Spijkerman,Renske %A Goossens,Richard H M %A Hendriks,Vincent M %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 15 27 87660, m.m.m.vandooren@tudelft.nl %K eHealth design %K mental health care %K personalization %K protocol %K youth addiction care %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective: The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods: Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results: Therapists used the protocol as a “toolbox” comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions: A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process. %M 32374271 %R 10.2196/15568 %U https://formative.jmir.org/2020/5/e15568 %U https://doi.org/10.2196/15568 %U http://www.ncbi.nlm.nih.gov/pubmed/32374271 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 4 %P e15610 %T Reducing Drinking Among People Experiencing Homelessness: Protocol for the Development and Testing of a Just-in-Time Adaptive Intervention %A Businelle,Michael S %A Walters,Scott T %A Mun,Eun-Young %A Kirchner,Thomas R %A Hébert,Emily T %A Li,Xiaoyin %+ Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK, 73104, United States, 1 4052718001 ext 50460, michael-businelle@ouhsc.edu %K alcohol use disorder %K mobile health %K smartphone %K ecological momentary assessment %K homeless persons %D 2020 %7 16.4.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adults who are homeless are more likely to have alcohol use disorders (AUDs) compared with domiciled adults. Although AUD treatments are commonly available, many factors (eg, transportation limitations and inability to schedule appointments) contribute to low treatment completion rates and low success rates of these interventions among adults experiencing homelessness. Most adults who are homeless own mobile phones; however, no interventions have been developed that use mobile devices to deliver and support AUD interventions for this population. Mobile phone–based AUD interventions may reduce barriers that have limited the use and utility of traditional interventions. Objective: The aim of this study is to (1) identify variables (eg, affect, stress, geolocation, and cravings) that predict drinking among homeless adults (phase I), (2) develop a mobile intervention that utilizes an algorithm to identify moments of risk for drinking and deliver treatment messages that are tailored to the individual’s current needs in real time (phase II), and (3) pilot test the intervention app (phase III). Methods: In phase I, adults experiencing homelessness with an AUD (N=80) will complete baseline, equipment, 2-week, and 4-week follow-up visits in person. Participants will be prompted to complete five daily ecological momentary assessments on a study-provided smartphone for 28 days. The smartphone app will collect GPS coordinates every 5 min for the entire 28-day study period. Participants will wear a transdermal alcohol sensor that will objectively measure alcohol use. In phase II, we will use phase I data to develop an algorithm that identifies moments of heightened risk for drinking and develop treatment messages that address risk factors for drinking. Phase III will pilot test the intervention in 40 adults experiencing homelessness with AUD. Results: This project was funded in June 2018. IRB approval was obtained in October 2018, and data collection for phase I began in February 2019. Phase III data collection is expected to conclude in 2020. To date, 80 participants have consented to the study, and data analysis for phase I will begin in early 2020. Conclusions: This research will highlight intervention targets and develop a novel intervention for understudied and underserved adults experiencing homelessness with AUD. International Registered Report Identifier (IRRID): DERR1-10.2196/15610 %M 32297874 %R 10.2196/15610 %U http://www.researchprotocols.org/2020/4/e15610/ %U https://doi.org/10.2196/15610 %U http://www.ncbi.nlm.nih.gov/pubmed/32297874 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e16217 %T Alcohol Avoidance Training as a Mobile App for Problem Drinkers: Longitudinal Feasibility Study %A Laurens,Melissa C %A Pieterse,Marcel E %A Brusse-Keizer,Marjolein %A Salemink,Elske %A Ben Allouch,Somaya %A Bohlmeijer,Ernst T %A Postel,Marloes G %+ Centre for eHealth and Well-being Research, University of Twente, PO Box 217, Enschede, 7500 AE, Netherlands, 31 626990064, m.c.laurens@utwente.nl %K mobile alcohol avoidance training %K approach bias %K cognitive bias modification %K alcohol %D 2020 %7 14.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol use is associated with an automatic tendency to approach alcohol, and the retraining of this tendency (cognitive bias modification [CBM]) shows therapeutic promise in clinical settings. To improve access to training and to enhance participant engagement, a mobile version of alcohol avoidance training was developed. Objective: The aims of this pilot study were to assess (1) adherence to a mobile health (mHealth) app; (2) changes in weekly alcohol use from before to after training; and (3) user experience with regard to the mHealth app. Methods: A self-selected nonclinical sample of 1082 participants, who were experiencing problems associated with alcohol, signed up to use the alcohol avoidance training app Breindebaas for 3 weeks with at least two training sessions per week. In each training session, 100 pictures (50 of alcoholic beverages and 50 of nonalcoholic beverages) were presented consecutively in a random order at the center of a touchscreen. Alcoholic beverages were swiped upward (away from the body), whereas nonalcoholic beverages were swiped downward (toward the body). During approach responses, the picture size increased to mimic an approach movement, and conversely, during avoidance responses, the picture size decreased to mimic avoidance. At baseline, we assessed sociodemographic characteristics, alcohol consumption, alcohol-related problems, use of other substances, self-efficacy, and craving. After 3 weeks, 37.89% (410/1082) of the participants (posttest responders) completed an online questionnaire evaluating adherence, alcohol consumption, and user satisfaction. Three months later, 19.03% (206/1082) of the participants (follow-up responders) filled in a follow-up questionnaire examining adherence and alcohol consumption. Results: The 410 posttest responders were older, were more commonly female, and had a higher education as compared with posttest dropouts. Among those who completed the study, 79.0% (324/410) were considered adherent as they completed four or more sessions, whereas 58.0% (238/410) performed the advised six or more training sessions. The study identified a significant reduction in alcohol consumption of 7.8 units per week after 3 weeks (95% CI 6.2-9.4, P<.001; n=410) and another reduction of 6.2 units at 3 months for follow-up responders (95% CI 3.7-8.7, P<.001; n=206). Posttest responders provided positive feedback regarding the fast-working, simple, and user-friendly design of the app. Almost half of the posttest responders reported gaining more control over their alcohol use. The repetitious and nonpersonalized nature of the intervention was suggested as a point for improvement. Conclusions: This is one of the first studies to employ alcohol avoidance training in a mobile app for problem drinkers. Preliminary findings suggest that a mobile CBM app fulfils a need for problem drinkers and may contribute to a reduction in alcohol use. Replicating these findings in a controlled study is warranted. %M 32286235 %R 10.2196/16217 %U https://mhealth.jmir.org/2020/4/e16217 %U https://doi.org/10.2196/16217 %U http://www.ncbi.nlm.nih.gov/pubmed/32286235 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 3 %P e14190 %T Effectiveness of an Ecological Momentary Intervention for Reducing Risky Alcohol Consumption Among Young Adults: Protocol for a Three-Arm Randomized Controlled Trial %A Wright,Cassandra %A Dietze,Paul M %A Kuntsche,Emmanuel %A Livingston,Michael %A Agius,Paul A %A Room,Robin %A Raggatt,Michelle %A Hellard,Margaret %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol %K brief intervention %K young adult %K alcohol drinking %K prevention and control %K mobile phone %D 2020 %7 31.3.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent research has investigated the utility of mobile phone–delivered interventions for reducing risky single-occasion drinking, also known as binge drinking. In the past five years, focus has been placed on ecological momentary interventions (EMIs), which aim to deliver intervention content in correspondence to real-time assessments of behavior, also known as ecological momentary assessments (EMAs). Objective: This study aims to assess the effect of a fully automated, tailored, mobile phone–delivered EMI termed Mobile Intervention for Drinking in Young people (MIDY) on young people's risky single-occasion drinking behavior. Methods: We will use a three-armed randomized controlled trial design to determine the impact of MIDY on peak consumption of alcohol among young people. A list of mobile telephone numbers for random digit dialing will be generated, and researchers will telephone potential participants to screen for eligibility. Participants will be randomized into one of three intervention groups. For 6 weeks, EMI, EMA, and attention control groups will complete hourly EMA surveys on their mobile phones on Friday and Saturday nights. EMI participants will receive personalized feedback in the form of text messages corresponding to their EMA survey responses, which focus on alcohol consumption, spending, and mood. EMA participants will not receive feedback. A third group will also complete EMA and receive feedback text messages at the same time intervals, but these will be focused on sedentary behavior and technology use. All groups will also complete a short survey on Saturday and Sunday mornings, with the primary outcome measure taken on Sunday mornings. A more detailed survey will be sent on the final Sunday of the 6-week period, and then again 1 year after recruitment. Results: The primary outcome measure will be an observed change (ie, reduction) in the mean peak number of drinks consumed in a single night over the 6-week intervention period between the EMI and attention control groups as measured in the weekly EMA. We expect to see a greater reduction in mean peak drinking in the EMI group compared to that in the attention control group. As a secondary aim, we will assess whether mean peak drinking is reduced in the EMA group compared to the attention control group. We will use a random-effects mixed-modeling approach using maximum-likelihood estimation to provide estimates of differences in peak drinking across time periods between those receiving the intervention (EMI) and attention control participants. An intention-to-treat approach will be taken for the analysis. Individuals and study groups will be modeled as random and fixed factors, respectively. Conclusions: This study extends our previous work investigating the efficacy of a mobile EMI (MIDY) for reducing risky drinking among young adults in Australia, and will add to the expanding literature on the use of mobile interventions for reducing risky alcohol consumption. Trial Registration: Australian New Zealand Clinical Trials Registration (ANZCTR): ACTRN12617001509358p; http://www.anzctr.org.au/ACTRN12617001509358p.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/14190 %M 32229471 %R 10.2196/14190 %U http://www.researchprotocols.org/2020/3/e14190/ %U https://doi.org/10.2196/14190 %U http://www.ncbi.nlm.nih.gov/pubmed/32229471 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17046 %T Mobile Apps for Health Behavior Change in Physical Activity, Diet, Drug and Alcohol Use, and Mental Health: Systematic Review %A Milne-Ives,Madison %A Lam,Ching %A De Cock,Caroline %A Van Velthoven,Michelle Helena %A Meinert,Edward %+ Digitally Enabled Preventative Health Research Group, Department of Paediatrics, University of Oxford, Headley Way, Headington, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K telemedicine %K evidence-based medicine %K mobile health %K digital health %K mobile applications %K app %K cell phone %K smartphone %K mobile phone %K health behavior %K intervention %K behavior change %K systematic review %D 2020 %7 18.3.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X 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. %M 32186518 %R 10.2196/17046 %U http://mhealth.jmir.org/2020/3/e17046/ %U https://doi.org/10.2196/17046 %U http://www.ncbi.nlm.nih.gov/pubmed/32186518 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 3 %P e14698 %T Stakeholder Perceptions of Internet-Delivered Cognitive Behavior Therapy as a Treatment Option for Alcohol Misuse: Qualitative Analysis %A Hadjistavropoulos,Heather D %A Gullickson,Kirsten M %A Adrian-Taylor,Shelley %A Wilhelms,Andrew %A Sundström,Christopher %A Nugent,Marcie %+ Online Therapy Unit, Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, hadjista@uregina.ca %K internet intervention %K cognitive behavioral therapy %K alcohol consumption %K stakeholder participation %K qualitative research %K implementation science %D 2020 %7 3.3.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-delivered cognitive behavior therapy (ICBT) has been found to be effective for treating alcohol misuse in research trials, but it is not available as part of routine care in Canada. Recent recommendations in the literature highlight the importance of integrating perspectives from both patient and health care stakeholders when ICBT is being implemented in routine practice settings. Objective: This study aimed to gain an understanding of how ICBT is perceived as a treatment option for alcohol misuse by interviewing diverse stakeholders. Specifically, the objectives were to (1) learn about the perceived advantages and disadvantages of ICBT for alcohol misuse and (2) elicit recommendations to inform implementation efforts in routine practice. Methods: A total of 30 participants representing six stakeholder groups (ie, patients, family members, academic experts, frontline managers, service providers, and health care decision makers) participated in semistructured interviews. To be included in the study, stakeholders had to reside in Saskatchewan, Canada, and have personal or professional experience with alcohol misuse. Interviews were transcribed verbatim, anonymized, and analyzed using thematic analysis. Results: Stakeholders identified numerous advantages of ICBT for alcohol misuse (eg, accessibility, convenience, privacy, relevance to technology-based culture, and fit with stepped care) and several disadvantages (eg, lack of internet access and technological literacy, isolation, less accountability, and unfamiliarity with ICBT). Stakeholders also provided valuable insight into factors to consider when implementing ICBT for alcohol misuse in routine practice. In terms of intervention design, stakeholders recommended a 6- to 8-week guided program that uses Web-based advertising, point-of-sale marketing, and large-scale captive audiences to recruit participants. With regard to treatment content, stakeholders recommended that the program focus on harm reduction rather than abstinence; be evidence based; appeal to the diverse residents of Saskatchewan; and use language that is simple, encouraging, and nonjudgmental. Finally, in terms of population characteristics, stakeholders felt that several features of the alcohol misuse population, such as psychiatric comorbidity, readiness for change, and stigma, should be considered when developing an ICBT program for alcohol misuse. Conclusions: Stakeholders’ insights will help maximize the acceptability, appropriateness, and adoption of ICBT for alcohol misuse and in turn contribute to implementation success. The methodology and findings from this study could be of benefit to others who are seeking to implement ICBT in routine practice. %M 32130151 %R 10.2196/14698 %U https://mental.jmir.org/2020/3/e14698 %U https://doi.org/10.2196/14698 %U http://www.ncbi.nlm.nih.gov/pubmed/32130151 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 2 %P e16062 %T From “Step Away” to “Stand Down”: Tailoring a Smartphone App for Self-Management of Hazardous Drinking for Veterans %A Blonigen,Daniel %A Harris-Olenak,Brooke %A Kuhn,Eric %A Humphreys,Keith %A Timko,Christine %A Dulin,Patrick %+ Department of Veterans Affairs Palo Alto Health Care System, 795 Willow Road, MPD-152, Menlo Park, CA, 94025, United States, 1 6504935000 ext 27828, daniel.blonigen@va.gov %K veterans %K hazardous drinking %K Step Away %K Stand Down %K peer support %D 2020 %7 13.2.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: US military veterans who screen positive for hazardous drinking during primary care visits may benefit from a mobile app. Step Away is an evidence-based mobile intervention system for the self-management of hazardous drinking. However, Step Away was not designed for veterans, and differences between veterans and civilians could limit the reach and effectiveness of the app with this population. Objective: The primary objective of this study was to repurpose Step Away to address the needs and preferences of the veteran primary care population. The Method for Program Adaptation through Community Engagement (M-PACE) model was used to guide the adaptation process. This model can serve as a generalizable approach that other researchers and intervention developers can follow to systematically tailor mobile health tools for a new population. Methods: Veteran patients who screened positive for hazardous drinking during a primary care visit (n=12) and peer providers employed by the US Veterans Health Administration (n=11) were recruited to systematically review Step Away and provide feedback on its content and presentation via Web-based surveys and a semistructured interview. Participant feedback was reviewed through an iterative process by key stakeholders who adjudicated which suggested modifications to the app could enhance engagement and effectiveness with veterans while maintaining program integrity. Results: Usability ratings of the individual modules of Step Away were uniformly positive across patients and peers, as was the perceived utility of the app overall. Personalized feedback on the health consequences and costs of drinking, options for customization, and the measurement-based care capabilities of the app were viewed as facilitators of engagement. Conversely, lengthy text, small font, and a lack of interactive features were viewed as potential barriers with the older primary care population. Modifications to create a veteran version of the app (Stand Down: Think Before You Drink) included altering the appearance of the app to incorporate more veteran-centric content, adding links and options for resources and activities for veterans, and reducing the amount of text and adding veteran-specific references and common concerns and triggers for drinking in this population. Conclusions: The M-PACE model provided a systematic approach to repurpose Step Away to fit the needs and preferences of veteran primary care patients who engage in hazardous drinking. Stand Down may serve as an innovative, low-cost means of expanding access to care for veterans who engage in hazardous drinking. %M 32053118 %R 10.2196/16062 %U http://mhealth.jmir.org/2020/2/e16062/ %U https://doi.org/10.2196/16062 %U http://www.ncbi.nlm.nih.gov/pubmed/32053118 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e13252 %T Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review %A Kruse,Clemens Scott %A Lee,Kimberly %A Watson,Jeress B %A Lobo,Lorraine G %A Stoppelmoor,Ashton G %A Oyibo,Sabrina E %+ School of Health Administration, Texas State University, 601 University Drive, Encino Hall, Room 250, San Marcos, TX, 78666, United States, 1 2103554743, scottkruse@txstate.edu %K telemedicine %K telehealth %K mHealth %K alcohol abuse %K rehabilitation %K alcohol use disorder %D 2020 %7 31.1.2020 %9 Review %J J Med Internet Res %G English %X Background: More than 18 million Americans are currently suffering from alcohol use disorder (AUD): a compulsive behavior of alcohol use as a result of a chronic, relapsing brain disease. With alcohol-related injuries being one of the leading causes of preventable deaths, there is a dire need to find ways to assist those suffering from alcohol dependence. There still exists a gap in knowledge as to the potential of telemedicine in improving health outcomes for those patients suffering from AUD. Objective: The purpose of this systematic review was to evaluate the measures of effectiveness, efficiency, and quality that result from the utilization of telemedicine in the management of alcohol abuse, addiction, and rehabilitation. Methods: This review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles used in this analysis were gathered using keywords inclusive of both telemedicine and alcohol abuse, which were then searched in the Cumulative Index to Nursing and Allied Health Literature, Cochrane, and MEDLINE (PubMed) databases. A total of 22 articles were chosen for analysis. Results: The results indicated that telemedicine reduced alcohol consumption. Other common outcomes included reduced depression (4/35, 11%), increased patient satisfaction (3/35, 9%), increase in accessibility (3/35, 9%), increased quality of life (2/35, 6%), and decreased cost (1/35, 3%). Interventions included mobile health (11/22, 50%), electronic health (6/22, 27%), telephone (3/33, 14%), and 2-way video (2/22, 9%). Studies were conducted in 3 regions: the United States (13/22, 59%), the European Union (8/22, 36%), and Australia (1/22, 5%). Conclusions: Telemedicine was found to be an effective tool in reducing alcohol consumption and increasing patients’ accessibility to health care services or health providers. The group of articles for analysis suggested that telemedicine may be effective in reducing health care costs and improving the patient’s quality of life. Although telemedicine shows promise as an effective way to manage alcohol-related disorders, it should be further investigated before implementation. %M 32012048 %R 10.2196/13252 %U http://www.jmir.org/2020/1/e13252/ %U https://doi.org/10.2196/13252 %U http://www.ncbi.nlm.nih.gov/pubmed/32012048 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15438 %T A Web-Based, Computer-Tailored Intervention to Reduce Alcohol Consumption and Binge Drinking Among Spanish Adolescents: Cluster Randomized Controlled Trial %A Martinez-Montilla,José Manuel %A Mercken,Liesbeth %A de Vries,Hein %A Candel,Math %A Lima-Rodríguez,Joaquín Salvador %A Lima-Serrano,Marta %+ Department of Nursing, School of Nursing, Physiotherapy and Podiatry, University of Seville, Street Avenzoar nº 6, Seville, 41009, Spain, 34 669955295, josmarmon3@alum.us.es %K adolescents %K alcohol consumption %K binge drinking %K cluster randomized controlled trial %K computer tailoring %D 2020 %7 24.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol consumption, including binge drinking (BD) and heavy episodic drinking (HED), is one of the leading risk factors among Spanish adolescents leading to significant social, health, and economic consequences. Reduction of BD and HED in adolescents can be achieved using Web-based, computer-tailored (CT) interventions, providing highly personalized feedback that is adapted to a person’s individual characteristics and needs. Randomized controlled trials assessing the effects of tailored BD reduction programs among Spanish adolescents are scarce. Objective: The aim of this study was to test the effectiveness of the Web-based, CT intervention Alerta Alcohol, aimed at the prevention of BD in Spanish adolescents. As a secondary outcome, effects on HED, weekly consumption, and any consumption were also assessed. The adherence and process evaluation were assessed. Methods: A cluster randomized controlled trial conducted among 15 Spanish schools was developed. Each school was randomized into either an experimental condition (EC) (N=742) or a control condition (CC) (N=505). Finally, 351 participants for the EC and 261 for the CC were included in the analysis (N=612). Baseline assessment took place in January and February 2017. Demographic variables and alcohol use were assessed at baseline. Follow-up assessment of alcohol use took place 4 months later in May and June 2017. Participants were compared according to their randomization group (EC versus CC). After the baseline assessment, participants in the EC started the intervention, which consisted of short stories about BD, in which CT feedback was based on the I-Change Model for behavior change. Participants in the CC group only received the baseline questionnaire. Effects of the intervention were assessed using a three-level mixed logistic regression analysis for BD, HED, and any consumption, and a three-level mixed linear regression analysis for weekly consumption. Results: In total, 1247 adolescents participated in the baseline assessment and 612 participated in the follow-up assessment; the attrition rate was 50.92%. The intervention was effective in reducing HED among adolescents; the odds of HED in the CC was nine times that in the experimental condition (P=.04). No effects were found for BD, weekly consumption, and any consumption. Process evaluations revealed that the adolescents were satisfied with the program (68.8%), would use the program again (52.9%), and would recommend it to someone else (62.8%). Females and non-binge drinkers showed better responses in the process evaluation. Conclusions: Our intervention was effective regarding HED but not regarding BD, weekly consumption, and any consumption. It may be that limiting alcohol consumption to prevent HED was easier in the Spanish context than it was to carry out further steps, such as reducing other patterns of alcohol consumption. Hence, additional actions are needed to accomplish these latter goals, including community approaches and policy actions aimed at denormalizing alcohol consumption among Spanish adolescents. Trial Registration: ClinicalTrials.gov NCT03288896; https://clinicaltrials.gov/ct2/show/NCT03288896 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5346-4 %M 32012064 %R 10.2196/15438 %U http://www.jmir.org/2020/1/e15438/ %U https://doi.org/10.2196/15438 %U http://www.ncbi.nlm.nih.gov/pubmed/32012064 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e14580 %T A Context-Specific Digital Alcohol Brief Intervention in Symptomatic Breast Clinics (Abreast of Health): Development and Usability Study %A Sinclair,Julia M A %A Dutey-Magni,Peter F %A Anderson,Annie S %A Baird,Janis %A Barker,Mary E %A Cutress,Ramsey I %A Kaner,Eileen F S %A McCann,Mark %A Priest,Caspian K %A Copson,Ellen R %+ Faculty of Medicine, University of Southampton, Academic Centre, College Keep, 4-12 Terminus Terrace, Southampton, SO14 3DT, United Kingdom, 44 (023) 8231 0779, julia.sinclair@soton.ac.uk %K cancer %K information seeking behavior %K health risk behaviors %K secondary prevention %K alcohol drinking %K health knowledge %K attitudes %K practice %K health promotion %K health literacy %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Potentially modifiable risk factors account for approximately 23% of breast cancer cases. In the United Kingdom, alcohol consumption alone is held responsible for 8% to 10% of cases diagnosed every year. Symptomatic breast clinics focus on early detection and treatment, but they also offer scope for delivery of low-cost lifestyle interventions to encourage a cancer prevention culture within the cancer care system. Careful development work is required to effectively translate such interventions to novel settings. Objective: The aim of this study was to develop a theory of change and delivery mechanism for a context-specific alcohol and lifestyle brief intervention aimed at women attending screening and symptomatic breast clinics. Methods: A formative study combined evidence reviews, analysis of mixed method data, and user experience research to develop an intervention model, following the 6 Steps in Quality Intervention Development (6SQuID) framework. Results: A Web app focused on improving awareness, encouraging self-monitoring, and reframing alcohol reduction as a positive choice to improve health was found to be acceptable to women. Accessing this in the clinic waiting area on a tablet computer was shown to be feasible. An important facilitator for change may be the heightened readiness to learn associated with a salient health visit (a teachable moment). Women may have increased motivation to change if they can develop a belief in their capability to monitor and, if necessary, reduce their alcohol consumption. Conclusions: Using the 6SQuID framework supported the prototyping and maximized acceptability and feasibility of an alcohol brief intervention for women attending symptomatic breast clinics, regardless of their level of alcohol consumption. %M 32012091 %R 10.2196/14580 %U https://www.researchprotocols.org/2020/1/e14580 %U https://doi.org/10.2196/14580 %U http://www.ncbi.nlm.nih.gov/pubmed/32012091 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e16320 %T Testing the Effectiveness of Enhanced Alcohol Warning Labels and Modifications Resulting From Alcohol Industry Interference in Yukon, Canada: Protocol for a Quasi-Experimental Study %A Vallance,Kate %A Stockwell,Timothy %A Hammond,David %A Shokar,Simran %A Schoueri-Mychasiw,Nour %A Greenfield,Thomas %A McGavock,Jonathan %A Zhao,Jinhui %A Weerasinghe,Ashini %A Hobin,Erin %+ Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 2504725934, vallance@uvic.ca %K alcohol warning labels %K alcohol policy %K alcohol %K cancer %K national drinking guidelines %K standard drink labels %K alcohol industry %D 2020 %7 10.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol warning labels are a promising, well-targeted strategy to increase public awareness of alcohol-related health risks and support more informed and safer use. However, evidence of their effectiveness in real-world settings remains limited and inconclusive. Objective: This paper presents a protocol for a real-world study examining the population-level impact of enhanced alcohol warning labels with a cancer message; national drinking guidelines; and standard drink information on attention, processing, and alcohol-related behaviors among consumers in Canada. Postimplementation modifications to the original protocol due to interference by national alcohol industry representatives are also described. Methods: This quasi-experimental study involved partnering with local governments in two northern Canadian territories already applying alcohol warning labels on alcohol containers for sale in liquor stores. The study tested an 8-month intervention consisting of three new enhanced, rotating alcohol warning labels in an intervention site (Whitehorse, Yukon) relative to a comparison site (Yellowknife, Northwest Territories) where labelling practices would remain unchanged. Pre-post surveys were conducted at both sites to measure changes in awareness and processing of label messages, alcohol-related knowledge, and behaviors. Liquor store transaction data were collected from both sites to assess changes in population-level alcohol consumption. The intervention was successfully implemented for 1 month before it was halted due to complaints from the alcohol industry. The government of the intervention site allowed the study to proceed after a 2-month pause, on the condition that the cancer warning label was removed from rotation. Modifications to the protocol included applying the two remaining enhanced labels for the balance of the intervention and adding a third wave of surveys during the 2-month pause to capture any impact of the cancer label. Results: This study protocol describes a real-world quasi-experimental study that aimed to test the effectiveness of new enhanced alcohol warning labels as a tool to support consumers in making more informed and safer alcohol choices. Alcohol industry interference shortly after implementation compromised both the intervention and the original study design; however, the study design was modified to enable completion of three waves of surveys with cohort participants (n=2049) and meet the study aims. Conclusions: Findings from this study will directly inform alcohol labelling policies in Canada and internationally and provide further insight into the alcohol industry’s attempts to disrupt research in this area. Additional unimpeded real-world evaluations of enhanced alcohol warning labels are recommended. International Registered Report Identifier (IRRID): RR1-10.2196/16320 %M 31922493 %R 10.2196/16320 %U https://www.researchprotocols.org/2020/1/e16320 %U https://doi.org/10.2196/16320 %U http://www.ncbi.nlm.nih.gov/pubmed/31922493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13224 %T A Web-Based Alcohol Risk Communication Tool: Development and Pretesting Study %A Kool,Bridget %A Dobson,Rosie %A Sharpe,Sarah %A Humphrey,Gayl %A Whittaker,Robyn %A Ameratunga,Shanthi %+ School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 021524802, b.kool@auckland.ac.nz %K alcohol drinking %K risk assessment %K risk communication %K harm minimization, primary care %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use is a major public health concern associated with an increased risk of morbidity and mortality. Health professionals in primary care commonly see patients with a range of alcohol-related risks and problems, providing an ideal opportunity for screening and brief intervention (BI). Objective: This study aimed to develop a prototype for a Web-based tool for use by primary care health professionals (eg, doctors and nurses) to communicate alcohol harm risk to their patients and to engage with them regarding ways this risk could be reduced. Methods: Following conceptualization and development of prototype wireframes, formative work and pretesting were undertaken. For the formative work, focus groups and key informant interviews were conducted with potential end users of the risk communication tool, including health professionals and consumers. The focus groups and interviews explored perceptions of alcohol risk communication and obtained feedback on the initial prototype. For pretesting, participants (primary care doctors and nurses) completed a Web-based survey followed by a period of pretesting before completion of a follow-up survey. The study was designed to gain feedback on the tool’s performance in real-world settings as well as its relevance, ease of use, and any suggested refinements. Results: In the formative work stage, 11 key informants and 7 consumers participated in either focus groups or individual interviews. Participants were very positive about the prototype and believed that it would be useful and acceptable in practice. Key informants identified that the key point of difference with the tool was that it provided all the pieces in 1 place (ie, assessment, interpretation, and resources to support change). Participants provided feedback on how the tool could be improved, and these suggestions were incorporated into the prototype where possible. In the pretesting stage, 7 people (5 doctors and 2 primary care nurses) completed the pretesting. Participants reported that the tool provided a useful framework for an intervention, that it would be acceptable to patients, that it was easy to use, that they would be likely to use it in practice, and that there were no technical issues. Conclusions: The alcohol risk communication tool was found to be acceptable and has the potential to increase the confidence of health professionals in assessing risk and providing BI. %M 31895043 %R 10.2196/13224 %U https://formative.jmir.org/2020/1/e13224 %U https://doi.org/10.2196/13224 %U http://www.ncbi.nlm.nih.gov/pubmed/31895043 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e14420 %T An Electronic Screening and Brief Intervention for Hazardous and Harmful Drinking Among Swedish University Students: Reanalysis of Findings From a Randomized Controlled Trial Using a Bayesian Framework %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Sandbäcksgatan 7, University Hospital Campus, Linköping, 58183, Sweden, 46 13281000, marcus.bendtsen@liu.se %K Bayesian analysis %K telemedicine %K digital health %K internet interventions %K alcohol %K randomized controlled trial %D 2019 %7 17.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to a resurgent debate on the misuse of P values, the Journal of Medical Internet Research is hosting a standing theme issue inviting the reanalysis of (primarily digital health) trial data using a Bayesian framework. This first paper in this series focuses on an electronic screening and brief intervention (eSBI), targeting harmful and hazardous alcohol consumption, which student health care centers across Sweden have routinely administerd to all students during the past decade. The second Alcohol Email Assessment and Feedback Study Dismantling Effectiveness for University Students (AMADEUS-2) trial aimed to assess the effect of the eSBI on alcohol consumption among students who were harmful and hazardous drinkers. A two-arm randomized controlled trial design was employed, randomizing eligible participants to either a waiting list or direct access to an eSBI. Follow-up assessments were conducted 2 months after randomization. Subsequent analysis of the trial followed the conventional null hypothesis approach, and no statistical significance was found between groups at follow-up with respect to the number of standard drinks consumed weekly. However, in an unspecified sensitivity analysis, it was discovered that removing three potential outliers made the difference between the groups significant. Objective: The objective of this study is to reperform the primary and sensitivity analysis of the AMADEUS-2 trial using a Bayesian framework and to compare the results with those of the original analysis. Methods: The same regression models used in the original analysis were employed in this reanalysis (negative binomial regression). Model parameters were given uniform priors. Markov chain Monte Carlo was used for Bayesian inference, and posterior probabilities were calculated for prespecified thresholds of interest. Results: Null hypothesis tests did not identify a statistically significant difference between the intervention and control groups, potentially due to a few extreme data points. The Bayesian analysis indicated a 93.6% probability that there was a difference in grams of alcohol consumed at follow-up between the intervention and control groups and a 71.5% probability that the incidence rate ratio was <0.96. Posterior probabilities increased when excluding three potential outliers, yet such post hoc analyses were not necessary to show the preference toward offering an eSBI to harmful and hazardous drinkers among university students. Conclusions: The null hypothesis framework relies on point estimates of parameters. P values can therefore swing heavily, depending on a single or few data points alone, casting doubt on the value of the analysis. Bayesian analysis results in a distribution over parameter values and is therefore less sensitive to outliers and extreme values. Results from analyses of trials of interventions where small-to-modest effect sizes are expected can be more robust in a Bayesian framework, making this a potentially better approach for analyzing digital health research data. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 02335307; http://www.isrctn.com/ISRCTN02335307 %M 31845903 %R 10.2196/14420 %U http://www.jmir.org/2019/12/e14420/ %U https://doi.org/10.2196/14420 %U http://www.ncbi.nlm.nih.gov/pubmed/31845903 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e16197 %T Assessing the Psychometric Properties of the Digital Behavior Change Intervention Engagement Scale in Users of an App for Reducing Alcohol Consumption: Evaluation Study %A Perski,Olga %A Lumsden,Jim %A Garnett,Claire %A Blandford,Ann %A West,Robert %A Michie,Susan %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 1258, olga.perski@ucl.ac.uk %K engagement %K digital behaviour change interventions %K mHealth %K psychometrics %K self-report scale %K smartphone apps %K excessive alcohol consumption %D 2019 %7 20.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The level and type of engagement with digital behavior change interventions (DBCIs) are likely to influence their effectiveness, but validated self-report measures of engagement are lacking. The DBCI Engagement Scale was designed to assess behavioral (ie, amount, depth of use) and experiential (ie, attention, interest, enjoyment) dimensions of engagement. Objective: We aimed to assess the psychometric properties of the DBCI Engagement Scale in users of a smartphone app for reducing alcohol consumption. Methods: Participants (N=147) were UK-based, adult, excessive drinkers recruited via an online research platform. Participants downloaded the Drink Less app and completed the scale immediately after their first login in exchange for a financial reward. Criterion variables included the objectively recorded amount of use, depth of use, and subsequent login. Five types of validity (ie, construct, criterion, predictive, incremental, divergent) were examined in exploratory factor, correlational, and regression analyses. The Cronbach alpha was calculated to assess the scale’s internal reliability. Covariates included motivation to reduce alcohol consumption. Results: Responses on the DBCI Engagement Scale could be characterized in terms of two largely independent subscales related to experience and behavior. The experiential and behavioral subscales showed high (α=.78) and moderate (α=.45) internal reliability, respectively. Total scale scores predicted future behavioral engagement (ie, subsequent login) with and without adjusting for users’ motivation to reduce alcohol consumption (adjusted odds ratio [ORadj]=1.14; 95% CI 1.03-1.27; P=.01), which was driven by the experiential (ORadj=1.19; 95% CI 1.05-1.34; P=.006) but not the behavioral subscale. Conclusions: The DBCI Engagement Scale assesses behavioral and experiential aspects of engagement. The behavioral subscale may not be a valid indicator of behavioral engagement. The experiential subscale can predict subsequent behavioral engagement with an app for reducing alcohol consumption. Further refinements and validation of the scale in larger samples and across different DBCIs are needed. %M 31746771 %R 10.2196/16197 %U http://www.jmir.org/2019/11/e16197/ %U https://doi.org/10.2196/16197 %U http://www.ncbi.nlm.nih.gov/pubmed/31746771 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e13765 %T Real-Time Mobile Monitoring of Drinking Episodes in Young Adult Heavy Drinkers: Development and Comparative Survey Study %A Fridberg,Daniel J %A Faria,James %A Cao,Dingcai %A King,Andrea C %+ Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S Maryland Ave, MC 3077, Chicago, IL, 60637, United States, 1 7738343598, dfridberg@bsd.uchicago.edu %K ecological momentary assessment %K young adults %K binge drinking %D 2019 %7 20.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Binge drinking, defined as consuming five or more standard alcoholic drinks for men (four for women) within a 2-hour period, is common among young adults and is associated with significant alcohol-related morbidity and mortality. To date, most research on this problem in young adults has relied upon retrospective questionnaires or costly laboratory-based procedures. Smartphone-based ecological momentary assessment (EMA) may address these limitations by allowing researchers to measure alcohol use and related consequences in real time and in drinkers’ natural environments. To date, however, relatively less research has systematically examined the utility of this approach in a sample of young adults targeting real-world heavy drinking episodes specifically. Objective: This study aimed to evaluate the feasibility, acceptability, and safety of a smartphone-based EMA method targeting binge drinking and related outcomes in heavy drinking young adults during real-world drinking occasions. Methods: Young adult binge drinkers in the smartphone group (N=83; mean 25.4 (SD 2.6) years; 58% (48/83) male; bingeing on 23.2% (6.5/28) days in the past month) completed baseline measures of alcohol use and drinking-related consequences, followed by up to two smartphone-based EMA sessions of typical drinking behavior and related outcomes in their natural environments. They also completed next-day and two-week follow-up surveys further assessing alcohol use and related consequences during the EMA sessions and two weeks after study participation, respectively. A separate demographic- and drinking-matched safety comparison group (N=25) completed the baseline and two-week follow-up surveys but did not complete EMA of real-world drinking behavior. Results: Most participants (71%, 59/83) in the smartphone group engaged in binge drinking during at least one 3-hour EMA session, consuming 7.3 (SD 3.0) standard alcoholic drinks. They completed 87.2% (507/581) system-initiated EMA prompts during the real-world drinking episode, supporting the feasibility of this approach. The procedure was acceptable, as evidenced by high participant ratings for overall satisfaction with the EMA software and study procedures and low ratings for intrusiveness of the mobile surveys. Regarding safety, participants endorsed few drinking-related consequences during or after the real-world drinking episode, with no adverse or serious adverse events reported. There were no differences between the groups in terms of changes in drinking behavior or consequences from baseline to two-week follow-up. Conclusions: This study provided preliminary support for the feasibility, acceptability, and safety of a smartphone-based EMA of real-time alcohol use and related outcomes in young adult heavy drinkers. The results suggest that young adults can use smartphones to safely monitor drinking even during very heavy drinking episodes. Smartphone-based EMA has strong potential to inform future research on the epidemiology of and intervention for alcohol use disorder by providing researchers with an efficient and inexpensive way to capture large amounts of data on real-world drinking behavior and consequences. %M 31746774 %R 10.2196/13765 %U https://mhealth.jmir.org/2019/11/e13765 %U https://doi.org/10.2196/13765 %U http://www.ncbi.nlm.nih.gov/pubmed/31746774 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e16325 %T Making Sense of Negative Findings from Mobile Attention Bias Modification Interventions for Individuals with Addictive Disorders: Quantitative Feasibility Study %A Zhang,Melvyn %A Ying,Jiangbo %A Amron,Syidda B %A Mahreen,Zaakira %A Song,Guo %A Fung,Daniel SS %A Smith,Helen E %+ National Addictions Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63802504, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K psychiatry %D 2019 %7 12.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 31714248 %R 10.2196/16325 %U http://mhealth.jmir.org/2019/11/e16325/ %U https://doi.org/10.2196/16325 %U http://www.ncbi.nlm.nih.gov/pubmed/31714248 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14419 %T Electronic Screening for Alcohol Use and Brief Intervention by Email for University Students: Reanalysis of Findings From a Randomized Controlled Trial Using a Bayesian Framework %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Linköping, 58183, Sweden, 46 13281000, marcus.bendtsen@liu.se %K Bayesian analysis %K telemedicine %K alcohol %K randomized controlled trial %D 2019 %7 7.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Almost a decade ago, Sweden became the first country to implement a national system enabling student health care centers across all universities to routinely administer (via email) an electronic alcohol screening and brief intervention to their students. The Alcohol email assessment and feedback study dismantling effectiveness for university students (AMADEUS-1) trial aimed to assess the effect of the student health care centers’ routine practices by exploiting the lack of any standard timing for the email invitation and by masking trial participation from students. The original analyses adopted the conventional null hypothesis framework, and the results were consistently in the expected direction. However, since for some tests the P values did not pass the conventional .05 threshold, some of the analyses were necessarily inconclusive. Objective: The outcomes of the AMADEUS-1 trial were derived from the first 3 items of the Alcohol Use Disorders Identification Test (AUDIT-C). The aim of this paper was to reanalyze the two primary outcomes of the AMADEUS-1 trial (AUDIT-C scores and prevalence of risky drinking), using the same models used in the original publication but applying a Bayesian inference framework and interpretation. Methods: The same regression models used in the original analysis were employed in this reanalysis (linear and logistic regression). Model parameters were given uniform priors. Markov chain Monte Carlo was used for Bayesian inference, and posterior probabilities were calculated for prespecified thresholds of interest. Results: Where the null hypothesis tests showed inconclusive results, the Bayesian analysis showed that offering an intervention at baseline was preferable compared to offering nothing. At follow-up, the probability of a lower AUDIT-C score among those who had been offered an intervention at baseline was greater than 95%, as was the case when comparing the prevalence of risky drinking. Conclusions: The Bayesian analysis allows for a more consistent perspective of the data collected in the trial, since dichotomization of evidence is not looked for at some arbitrary threshold. Results are presented that represent the data collected in the trial rather than trying to make conclusions about the existence of a population effect. Thus, policy makers can think about the value of keeping the national system without having to navigate the treacherous landscape of statistical significance. Trial Registration: ISRCTN Registry ISRCTN28328154; http://www.isrctn.com/ISRCTN28328154 %M 31697242 %R 10.2196/14419 %U https://www.jmir.org/2019/11/e14419 %U https://doi.org/10.2196/14419 %U http://www.ncbi.nlm.nih.gov/pubmed/31697242 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e11963 %T A Web-Based Alcohol Screening and Brief Intervention Training Module Within Physician Assistant Programs in the Midwest to Increase Knowledge, Attitudes, and Confidence: Evaluation Study %A Tenkku Lepper,Leigh E %A Cleveland,Tracy %A DelRosario,Genevieve %A Ervie,Katherine %A Link,Catherine %A Oakley,Lara %A Elfagir,Abdelmoneim %A Sprague,Debra J %+ School of Social Work and Public Health Program, University of Missouri-Columbia, 707 Clark Hall, Columbia, MO, 65211, United States, 1 5738845459, tenkkul@missouri.edu %K alcohol education %K alcohol screening and brief intervention %K Web-based training %K standardized patient %K physician assistant %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Preventing and reducing risky alcohol use and its side effects remains a public health priority. Discussing alcohol use with patients can be difficult; dedicated training for health care providers is needed to facilitate these conversations. A Web-based alcohol screening and brief intervention (SBI), comprising didactic and skills application training, was designed for physician assistant students. Objective: This paper details experiences and outcomes in developing an alcohol SBI training curriculum and coordinating virtual encounters with standardized patients. We also explain challenges faced with developing an alcohol SBI training and a Web-based learning management site to fit the needs of 5 different physician assistant programs. Methods: Training development comprised 3 phases—precourse, development, and implementation. The precourse phase included developing the initial training curriculum, building a website, and testing with a pilot group. The development phase refined the training curriculum based on user feedback and moved into a three-component module: didactic training module, guided interactive encounter with a simulated patient, and live encounter with a standardized patient. A learning management system website was also created. In the implementation phase, 5 physician assistant schools incorporated the Web-based training into curricula. Each school modified the implementation method to suit their organizational environment. Evaluation methods included pre- and postchange over time on trainee attitudes, knowledge, and skills (confidence) on talking to patients about alcohol use, trainee self-reported proficiency on the standardized patient encounter, standardized patient evaluation of the trainee proficiency during the alcohol use conversation, user evaluation of the type of technology mode for the standardized patient conversation, and overall trainee satisfaction with the Web-based training on alcohol SBI. Results: Final evaluation outcomes indicated a significant (P<.01) change over time in trainee knowledge and skills (confidence) in the conduct of the alcohol SBI with a standardized patient, regardless of the program implementation method. Trainees were generally satisfied with the Web-based training experience and rated the use of the videoconference medium as most useful when conducting the alcohol SBI conversation with the standardized patient. Training that included a primer on the importance of screening, individual participation in the Web-based didactic alcohol SBI modules, and virtual encounters with standardized patients through a university-based simulation center was the most widely accepted. Successful implementation included program investment and curriculum planning. Implementation barriers involved technical challenges with standardized patient encounters and simulation center logistics, and varying physician assistant school characteristics. Conclusions: Development and implementation of Web-based educational modules to educate health care professionals on alcohol SBI is effective, easy to reproduce, and readily accessible. Identifying challenges affecting development, implementation, and utilization of learned techniques in practice, enhances facilitation of learning and training efficacy. As the value of technology-based learning becomes more apparent, reports detailing what has worked versus what has not may help guide the process. %M 31647473 %R 10.2196/11963 %U http://mental.jmir.org/2019/10/e11963/ %U https://doi.org/10.2196/11963 %U http://www.ncbi.nlm.nih.gov/pubmed/31647473 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 4 %P e11151 %T A Game to Deal With Alcohol Abuse (Jib): Development and Game Experience Evaluation %A Carvalho,Darlinton Barbosa Feres %A Domingueti,Daniel Bueno %A Almeida Santos,Sandro Martins De %A Dias,Diego Roberto Colombo %+ Federal University of São João del-Rei, Departament of Computer Science, Prédio de Ciência da Computação, 3° andar, Av Visconde do Rio Preto, s/nº, Colônia do Bengo, São João del-Rei, Brazil, 55 3379 4935, darlinton@acm.org %K alcohol abuse %K serious game %K software design %K proof of concept evaluation %D 2019 %7 15.10.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Alcohol abuse is the primary cause of (public) health problems in most parts of the world. However, it is undeniable that alcohol consumption is a practice that is widely accepted socially in many places, even being protected by law as a cultural and historical heritage. The issue of alcohol abuse is complex and urgent, and consequently, it is necessary to create innovative approaches such as the proposal explored in this study. Objective: This study aimed to explore the development and evaluation of a serious game for smartphones to present a novel approach to address the issue of alcohol abuse. Methods: A serious game was developed to instill the consequences of alcohol abuse into the player through experimentation in the game. In the game, the consequences of alcohol use are demonstrated by increasing the game speed that gives an illusion of fun but also leads to a premature death. The evaluation employed an assessment based on the Alcohol Use Disorders Identification Test (AUDIT) and the Game Experience Questionnaire (GEQ). The participants belonged to the university student’s house. Results: The game development process has been presented, including its mechanics and gameplay. The game has the style of action and adventure games in which the player controls an indigenous avatar that can deflect or attack opponents coming his or her way. The game evaluation comprised an assessment based on 23 participants, aged 20 to 29 years. According to the AUDIT assessment, 18 participants reported having a low or nonexistent degree of alcohol dependence and 5 declared average dependence. Regarding their habit of playing games on smartphones, 9 participants declared they have this habit of playing (habitual players), and among the 14 that did not have this habit of playing (nonhabitual players), 3 participants declared not having a smartphone at all. The GEQ core assessment showed a higher positive affect among the participants with a habit of playing games, scoring 2.80 (habitual players) on a scale of 4.0 versus 1.61 (nonhabitual players), and higher tension as an opposite relationship of 0.81 (nonhabitual players) versus 0.37 (habitual players). The overall GEQ evaluation showed that the game presents a more positive than negative affect on all users, besides showing the other desirable characteristics of serious games. Conclusions: We present a new way of dealing with the issue of alcohol abuse through a game designed for smartphones. It promotes an overall positive user experience, having a greater impact on users accustomed to games. The proposed approach has its niche, though it is still a minority in the evaluated population. Further research should explore new game features, such as new styles, to make the game more attractive to a wider audience, in addition to performing an in-depth study on the effects of playing it. %M 31617849 %R 10.2196/11151 %U https://games.jmir.org/2019/4/e11151 %U https://doi.org/10.2196/11151 %U http://www.ncbi.nlm.nih.gov/pubmed/31617849 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14098 %T Do Daily Fluctuations in Psychological and App-Related Variables Predict Engagement With an Alcohol Reduction App? A Series of N-Of-1 Studies %A Perski,Olga %A Naughton,Felix %A Garnett,Claire %A Blandford,Ann %A Beard,Emma %A West,Robert %A Michie,Susan %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 02076791258, olga.perski@ucl.ac.uk %K apps %K behavior change %K excessive alcohol consumption %K engagement %K mHealth %K n-of-1 %K time series analysis %D 2019 %7 2.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Previous studies have identified psychological and smartphone app–related predictors of engagement with alcohol reduction apps at a group level. However, strategies to promote engagement need to be effective at the individual level. Evidence as to whether group-level predictors of engagement are also predictive for individuals is lacking. Objective: The aim of this study was to examine whether daily fluctuations in (1) the receipt of a reminder, (2) motivation to reduce alcohol, (3) perceived usefulness of the app, (4) alcohol consumption, and (5) perceived lack of time predicted within-person variability in the frequency and amount of engagement with an alcohol reduction app. Methods: We conducted a series of observational N-of-1 studies. The predictor variables were measured twice daily for 28 days via ecological momentary assessments. The outcome variables were measured through automated recordings of the participants’ app screen views. A total of nine London-based adults who drank alcohol excessively and were willing to set a reduction goal took part. Each participant’s dataset was analyzed separately using generalized additive mixed models to derive incidence rate ratios (IRRs) for the within-person associations of the predictor and outcome variables. Debriefing interviews, analyzed using thematic analysis, were used to contextualize the findings. Results: Predictors of the frequency and amount of engagement differed between individuals, and for the variables 'perceived usefulness of the app' and 'perceived lack of time', the direction of associations also differed between individuals. The most consistent predictors of within-person variability in the frequency of engagement were the receipt of a daily reminder (IRR=1.80-3.88; P<.05) and perceived usefulness of the app (IRR=0.82-1.42; P<.05). The most consistent predictors of within-person variability in the amount of engagement were motivation to reduce alcohol (IRR=1.67-3.45; P<.05) and perceived usefulness of the app (IRR=0.52-137.32; P<.05). Conclusions: The utility of the selected psychological and app-related variables in predicting the frequency and amount of engagement with an alcohol reduction app differed at the individual level. This highlights that key within-person associations may be masked in group-level designs and suggests that different strategies to promote engagement may be required for different individuals. %M 31579022 %R 10.2196/14098 %U https://mhealth.jmir.org/2019/10/e14098 %U https://doi.org/10.2196/14098 %U http://www.ncbi.nlm.nih.gov/pubmed/31579022 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e15465 %T A Smartphone Attention Bias App for Individuals With Addictive Disorders: Feasibility and Acceptability Study %A Zhang,Melvyn %A Ying,Jiangbo %A Amron,Syidda B %A Mahreen,Zaakira %A Song,Guo %A Fung,Daniel S S %A Smith,Helen Elizabeth %+ National Addiction Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 529747, Singapore, 65 98556631, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K psychiatry %K substance abuse %K alcohol abuse %K opioid abuse %K cannabis abuse %K addiction %K digital health %K mhealth %D 2019 %7 12.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %M 31586359 %R 10.2196/15465 %U http://mhealth.jmir.org/2019/9/e15465/ %U https://doi.org/10.2196/15465 %U http://www.ncbi.nlm.nih.gov/pubmed/31586359 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e14967 %T A Digital Intervention Addressing Alcohol Use Problems (the “Daybreak” Program): Quasi-Experimental Randomized Controlled Trial %A Tait,Robert J %A Paz Castro,Raquel %A Kirkman,Jessica Jane Louise %A Moore,Jamie Christopher %A Schaub,Michael P %+ National Drug Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U 1981, Perth, 6845, Australia, 61 892661610, robert.tait@curtin.edu.au %K alcohol consumption %K internet %K digital health %K intervention study %K social marketing %K health promotion %D 2019 %7 04.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol use is prevalent in many societies and has major adverse impacts on health, but the availability of effective interventions limits treatment options for those who want assistance in changing their patterns of alcohol use. Objective: This study evaluated the new Daybreak program, which is accessible via mobile app and desktop and was developed by Hello Sunday Morning to support high-risk drinking individuals looking to change their relationship with alcohol. In particular, we compared the effect of adding online coaching via real-time chat messages (intervention group) to an otherwise self-guided program (control group). Methods: We designed the intervention as a randomized control trial, but as some people (n=48; 11.9%) in the control group were able to use the online coaching, the main analysis comprised all participants. We collected online surveys at one-month and three-months follow-up. The primary outcome was change in alcohol risk (measured with the alcohol use disorders identification test–consumption [AUDIT–C] score), but other outcomes included the number of standard drinks per week, alcohol-related days out of role, psychological distress (Kessler-10), and quality of life (EUROHIS-QOL). Markers of engagement with the program included posts to the site and comments on the posts of others. The primary analysis used Weighted Generalized Estimating Equations. Results: We recruited 398 people to the intervention group (50.2%) and 395 people to the control group (49.8%). Most were female (71%) and the mean age was 40.1 years. Most participants were classified as probably dependent (550, 69%) on the AUDIT–10, with 243 (31%) classified with hazardous or harmful consumption. We followed up with 334 (42.1%) participants at one month and 293 (36.9%) at three months. By three months there were significant improvements in AUDIT–C scores (down from mean 9.1 [SD 1.9] to 5.8 [SD 3.1]), alcohol consumed per week (down from mean 37.1 [SD 28.3] to mean 17.5 [SD 18.9]), days out of role (down from mean 1.6 [SD 3.6] to 0.5 [SD 1.6]), quality of life (up from 3.2 [SD 0.7] to 3.6 [SD 0.7]) and reduced distress (down from 24.8 [SD 7.0] to 19.0 [SD 6.6]). Accessing online coaching was not associated with improved outcomes, but engagement with the program (eg, posts and comments on the posts of others) were significantly associated with improvements (eg, in AUDIT–C, alcohol use and EUROHIS-QOL). Reduced alcohol use was found for both probably dependent (estimated marginal mean of 40.8 to 20.1 drinks) and hazardous or harmful alcohol users (estimated marginal mean of 22.9 to 11.9 drinks). Conclusions: Clinically significant reductions in alcohol use were found, as well as reduced alcohol risk (AUDIT–C) and days out of role. Importantly, improved alcohol-related outcomes were found for both hazardous or harmful and probably dependent drinkers. Since October 2016, Daybreak has reached more than 50,000 participants. Therefore, there is the potential for the program to have an impact on alcohol-related problems at a population health level, importantly including an effect on probably dependent drinkers. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110 International Registered Report Identifier (IRRID): RR2-10.2196/9982 %M 31486406 %R 10.2196/14967 %U https://www.jmir.org/2019/9/e14967/ %U https://doi.org/10.2196/14967 %U http://www.ncbi.nlm.nih.gov/pubmed/31486406 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13793 %T A Mobile Phone App Featuring Cue Exposure Therapy As Aftercare for Alcohol Use Disorders: An Investigator-Blinded Randomized Controlled Trial %A Mellentin,Angelina Isabella %A Nielsen,Bent %A Nielsen,Anette Søgaard %A Yu,Fei %A Mejldal,Anna %A Nielsen,Dorthe Grüner %A Stenager,Elsebeth %+ Unit for Clinical Alcohol Research, Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløwsvej 18, Odense Center, 5000, Denmark, 45 50517901, amellentin@health.sdu.dk %K alcohol use disorder %K aftercare %K cue exposure therapy %K cognitive behavior therapy %K randomized controlled trial %K mobile phone app %D 2019 %7 16.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cue exposure therapy (CET) is a psychological approach developed to prepare individuals with alcohol use disorder (AUD) for confronting alcohol and associated stimuli in real life. CET has shown promise when treating AUD in group sessions, but it is unknown whether progressing from group sessions to using a mobile phone app is an effective delivery pathway. Objective: The objectives of this study were to investigate (1) whether CET as aftercare would increase the effectiveness of primary treatment with cognitive behavior therapy, and (2) whether CET delivered through a mobile phone app would be similarly effective to CET via group sessions. Methods: A total of 164 individuals with AUD were randomized to one of three groups: CET as group aftercare (CET group), CET as fully automated mobile phone app aftercare (CET app), or aftercare as usual. Study outcomes were assessed face-to-face at preaftercare, postaftercare, and again at 6 months after aftercare treatment. Generalized mixed models were used to compare the trajectories of the groups over time on drinking, cravings, and use of urge-specific coping skills (USCS). Results: In all, 153 of 164 individuals (93%) completed assessments both at posttreatment and 6-month follow-up assessments. No differences in the trajectories of predicted means were found between the experimental groups (CET group and app) compared with aftercare as usual on drinking and craving outcomes over time. Both CET group (predicted mean difference 5.99, SE 2.59, z=2.31, P=.02) and the CET app (predicted mean difference 4.90, SE 2.26, z=2.31, P=.02) showed increased use of USCS compared to aftercare as usual at posttreatment, but this effect was reduced at the 6-month follow-up. No differences were detected between the two experimental CET groups on any outcomes. Conclusions: CET with USCS delivered as aftercare either via group sessions or a mobile phone app did not increase the effectiveness of primary treatment. This suggests that CET with USCS may not be an effective psychological approach for the aftercare of individuals treated for AUD. Trial Registration: ClinicalTrials.gov NCT02298751; https://clinicaltrials.gov/ct2/show/NCT02298751 %M 31420960 %R 10.2196/13793 %U http://mhealth.jmir.org/2019/8/e13793/ %U https://doi.org/10.2196/13793 %U http://www.ncbi.nlm.nih.gov/pubmed/31420960 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e12267 %T A Qualitative Evaluation of the Acceptability of a Tailored Smartphone Alcohol Intervention for a Military Population: Information About Drinking for Ex-Serving Personnel (InDEx) App %A Puddephatt,Jo-Anne %A Leightley,Daniel %A Palmer,Laura %A Jones,Norman %A Mahmoodi,Toktam %A Drummond,Colin %A Rona,Roberto J %A Fear,Nicola T %A Field,Matt %A Goodwin,Laura %+ Department of Psychological Sciences, Institute of Life and Human Sciences, University of Liverpool, Eleanor Rathbone Building, Bedford Street South, Liverpool, L69 7ZA, United Kingdom, 44 151 794 1401, joannep@liverpool.ac.uk %K behavior %K alcohol drinking %K veterans %K interview %K smartphone %D 2019 %7 24.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Alcohol consumption in the UK Armed Forces is higher than in the general population, and this pattern continues after leaving the service. Smartphone apps may be useful to increase ex-serving personnel’s awareness of their alcohol consumption, support self-monitoring, and prompt a change in behavior. Objective: The study aimed to explore the acceptability of Information about Drinking in Ex-serving personnel (InDEx), a tailored smartphone app, combined with personalized short message service (SMS) text messaging designed to target ex-serving personnel who meet the criteria for hazardous alcohol use. Methods: The InDEx intervention included 4 key modules: (1) assessment and normative feedback, (2) self-monitoring and feedback, (3) goal setting and review, and (4) personalized SMS text messaging. A semistructured telephone interview study was conducted with ex-serving personnel after using the app for a 28-day period. Interviews were used to explore the acceptability of app modules and its functionality and the perceived changes in participant’s drinking. Interview transcripts were analyzed using inductive thematic analysis. Results: Overall, 94% (29/31) participants who used InDEx agreed to take part in a telephone interview. Overall, 4 themes were identified: Credibility, Meeting their needs, Simplicity, and Helpful for ex-serving personnel. The importance of credibility, functionality, and meeting the individual needs of ex-serving personnel was emphasized. Acceptability and engagement with specific modules of the app and text messages were influenced by the following: (1) if they felt it provided credible information, (2) whether the content was appropriately personalized to them, (3) the ease of use, and (4) beliefs about their own drinking behaviors. Participants recommended that the app would be most suitable for personnel about to leave the Armed Forces. Conclusions: InDEx was an acceptable smartphone app for ex-serving personnel for monitoring alcohol consumption and in providing meaningful feedback to the individual. Pages that met the participant’s interests and provided real time personalized, credible feedback on their drinking and text messages tailored to participant’s interactions with the app were particularly favored. %M 31127726 %R 10.2196/12267 %U http://mhealth.jmir.org/2019/5/e12267/ %U https://doi.org/10.2196/12267 %U http://www.ncbi.nlm.nih.gov/pubmed/31127726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e10946 %T Internet Searches for Medical Symptoms Before Seeking Information on 12-Step Addiction Treatment Programs: A Web-Search Log Analysis %A Nitzburg,George %A Weber,Ingmar %A Yom-Tov,Elad %+ Teachers College, Columbia University, 525 West 120th Street, New York, NY, 10027, United States, 1 212 678 3267, nitzburg@tc.columbia.edu %K alcohol use disorder %K substance use disorder %K 12-step programs %K brief intervention %K brief physician advice %K anonymized internet search log data %D 2019 %7 03.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Brief intervention is a critical method for identifying patients with problematic substance use in primary care settings and for motivating them to consider treatment options. However, despite considerable evidence of delay discounting in patients with substance use disorders, most brief advice by physicians focuses on the long-term negative medical consequences, which may not be the best way to motivate patients to seek treatment information. Objective: Identification of the specific symptoms that most motivate individuals to seek treatment information may offer insights for further improving brief interventions. To this end, we used anonymized internet search engine data to investigate which medical conditions and symptoms preceded searches for 12-step meeting locators and general 12-step information. Methods: We extracted all queries made by people in the United States on the Bing search engine from November 2016 to July 2017. These queries were filtered for those who mentioned seeking Alcoholics Anonymous (AA) or Narcotics Anonymous (NA); in addition, queries that contained a medical symptom or condition or a synonym thereof were analyzed. We identified medical symptoms and conditions that predicted searches for seeking treatment at different time lags. Specifically, symptom queries were first determined to be significantly predictive of subsequent 12-step queries if the probability of querying a medical symptom by those who later sought information about the 12-step program exceeded the probability of that same query being made by a comparison group of all other Bing users in the United States. Second, we examined symptom queries preceding queries on the 12-step program at time lags of 0-7 days, 7-14 days, and 14-30 days, where the probability of asking about a medical symptom was greater in the 30-day time window preceding 12-step program information-seeking as compared to all previous times that the symptom was queried. Results: In our sample of 11,784 persons, we found 10 medical symptoms that predicted AA information seeking and 9 symptoms that predicted NA information seeking. Of these symptoms, a substantial number could be categorized as nonsevere in nature. Moreover, when medical symptom persistence was examined across a 1-month time period, a substantial number of nonsevere, yet persistent, symptoms were identified. Conclusions: Our results suggest that many common or nonsevere medical symptoms and conditions motivate subsequent interest in AA and NA programs. In addition to highlighting severe long-term consequences, brief interventions could be restructured to highlight how increasing substance misuse can worsen discomfort from common medical symptoms in the short term, as well as how these worsening symptoms could exacerbate social embarrassment or decrease physical attractiveness. %M 31066685 %R 10.2196/10946 %U https://www.jmir.org/2019/5/e10946/ %U https://doi.org/10.2196/10946 %U http://www.ncbi.nlm.nih.gov/pubmed/31066685 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e12898 %T Text Messaging Interventions for Reducing Alcohol Consumption Among Harmful and Hazardous Drinkers: Protocol for a Systematic Review and Meta-Analysis %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Linköping University, Linköping, 58183, Sweden, 46 733140708, marcus.bendtsen@gmail.com %K text messaging %K SMS %K risky drinking %K harmful drinking %K hazardous drinking %K intervention %K systematic review %K meta-analysis %D 2019 %7 23.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mobile phone-based interventions have become popular for lifestyle behavior change, particularly the use of text messaging as it is a technology ubiquitous in mobile phones. Reviews and meta-analyses of digital interventions for reducing harmful and hazardous use of alcohol have mainly focused on Web-based interventions; thus, there is a need for a body of evidence to guide health practitioners, policy makers, and researchers with respect to the efficacy of available text messaging interventions. Objective: The aim of this systematic review and meta-analysis is to assess the effectiveness of text messaging interventions for reducing the amount of alcohol consumed among harmful and hazardous drinkers; this is compared to receiving no, minimal, or unrelated health information. Specifically, we ask the following questions: (1) Can interventions consisting of only text messages be effective in reducing alcohol consumption compared to no intervention or a minimal or unrelated intervention? (2) Can interventions consisting of only text messages be effective in reducing the prevalence of risky drinking compared to no intervention or a minimal or unrelated intervention? Methods: Several databases will be searched, including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, the Conference Proceedings Citation Index, ClinicalTrials.gov, OpenGrey, among others. Reports of studies that evaluate text messaging interventions for reducing the amount of alcohol consumed will be included. Primary outcomes of interest will be weekly alcohol consumption and frequency of heavy episodic drinking. The Cochrane Collaboration Risk of Bias tool will be used to assess bias in reports, and the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach will be used to assess the quality of the body of evidence. A narrative review will be presented, and a meta-analysis will be conducted in case of homogeneity among included studies. Results: The systematic review has not yet begun but is expected to start in May of 2019; publication of the final review and meta-analysis is expected at the end of 2019. Conclusions: The technology for text messaging is ubiquitous in mobile phones; thus, the potential reach of interventions utilizing this technique is great. However, there are no meta-analyses to date that limit the scope to the use of text messaging interventions for alcohol consumption reduction. Therefore, the proposed systematic review and meta-analysis will help health practitioners, policy decision makers, researchers, and others to better understand the effects of these interventions. International Registered Report Identifier (IRRID): PRR1-10.2196/12898 %M 31012866 %R 10.2196/12898 %U http://www.researchprotocols.org/2019/4/e12898/ %U https://doi.org/10.2196/12898 %U http://www.ncbi.nlm.nih.gov/pubmed/31012866 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11831 %T Smartphone Apps Targeting Alcohol and Illicit Substance Use: Systematic Search in in Commercial App Stores and Critical Content Analysis %A Tofighi,Babak %A Chemi,Chemi %A Ruiz-Valcarcel,Jose %A Hein,Paul %A Hu,Lu %+ Department of Population Health, New York University School of Medicine, 227 East 30th Street, Room 713, New York, NY, 10016, United States, 1 6468017345, babak.tofighi@nyumc.org %K mHealth %K substance use disorder %K mobile health %K alcohol abuse %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 31008713 %R 10.2196/11831 %U https://mhealth.jmir.org/2019/4/e11831/ %U https://doi.org/10.2196/11831 %U http://www.ncbi.nlm.nih.gov/pubmed/31008713 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e13119 %T Reducing Alcohol Consumption Among Risky Drinkers in the General Population of Sweden Using an Interactive Mobile Health Intervention: Protocol for a Randomized Controlled Trial %A Bendtsen,Marcus %A McCambridge,Jim %+ Department of Medical and Health Sciences, Linköping University, Linköping University, Linköping, 58183, Sweden, 46 733140708, marcus.bendtsen@liu.se %K telemedicine %K alcohol drinking %K randomized controlled trial %D 2019 %7 18.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Harmful use of alcohol continues to be a leading contributor to premature deaths globally. Not only does harmful drinking have consequences for the individuals consuming at increased levels, but it may also result in a range of negative consequences for their family members and friends. Interventions delivered via mobile phones (mobile health [mHealth] interventions) could potentially support risky drinkers seeking help to reduce their alcohol consumption. Objective: This protocol describes a randomized controlled trial that aims to validly estimate the effect of a novel mHealth intervention targeting risky drinkers in the general population of Sweden. Nested within the trial are 3 substudies that focus on methodological and user satisfaction research questions. Methods: A 2-arm parallel group randomized controlled trial will be employed to estimate the effect of the novel intervention. Participants will be recruited through Web advertisements and social media. The inclusion criteria are as follows: 18 years or older, ownership of a mobile phone, and being classified as a risky drinker according to Swedish guidelines. Participants allocated to the intervention group will receive a novel mHealth intervention. The intervention consists of weekly screening, personalized feedback on current consumption, functions allowing for planning of future consumption, as well as a series of messages delivered throughout the week. Participants allocated to the control group will receive a short message regarding negative consequences of alcohol consumption and a hyperlink that offers more information. Following 2 and 4 months after randomization, both groups will be asked to complete follow-up questionnaires (2-month interval being primary). Primary outcomes are weekly alcohol consumption and heavy episodic drinking. Participants in the control group will be given access to the novel intervention after completing the 4-month follow-up. The trial includes 3 substudies: We will explore whether the mode of presenting information before participants giving informed consent affects participation rates and recall of trial parameters, investigate if the content of the short message received by the control group affects study outcomes and requests for more information, and explore user satisfaction with the intervention and reactions of the control group. Results: Participant recruitment is planned to begin in April 2019 and to last for a maximum of 24 months. The first dataset will be available approximately 2 months after the final participant has been recruited, and the final dataset will be available approximately 2 months later. No participants had been recruited at the time of submitting this protocol. Conclusions: If found effective, the intervention has the potential to reduce negative consequences of alcohol consumption for individuals. The technology has been designed to have potential for extensive reach among those who may benefit. Trial Registration: ISRCTN Registry ISRCTN48317451; http://www.isrctn.com/ISRCTN48317451 (Archived by WebCite at http://www.webcitation.org/779tKLsu3) International Registered Report Identifier (IRRID): PRR1-10.2196/13119 %M 30998221 %R 10.2196/13119 %U http://www.researchprotocols.org/2019/4/e13119/ %U https://doi.org/10.2196/13119 %U http://www.ncbi.nlm.nih.gov/pubmed/30998221 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e12370 %T Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy–Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People %A Stapinski,Lexine A %A Prior,Katrina %A Newton,Nicola C %A Deady,Mark %A Kelly,Erin %A Lees,Briana %A Teesson,Maree %A Baillie,Andrew J %+ The Matilda Centre, University of Sydney, Level 6, Jane Foss Russell Building (G02), Sydney, NSW 2006, Australia, 61 2 8627 9039, lexine.stapinski@sydney.edu.au %K alcohol abuse %K alcohol-related disorders %K anxiety %K comorbidity %K early medical intervention %K cognitive behavioral therapy %K young adult %D 2019 %7 12.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: The transition to adulthood is a unique developmental period characterized by numerous personal and social role changes and increased opportunities for alcohol consumption. Using alcohol to cope with anxiety symptoms is commonly reported, and young people with anxiety are at a greater risk of hazardous alcohol use and progression to alcohol use disorder. Anxiety and alcohol use tend to fuel each other in an exacerbating feed-forward cycle, leading to difficult-to-treat chronic problems. The peak in onset of anxiety and alcohol disorders suggests this developmental window represents a promising opportunity for early intervention before these problems become entrenched. Objective: This study aims to evaluate the efficacy of the Inroads program, a therapist-supported, internet-delivered early intervention for young adults that targets alcohol use, anxiety symptoms, and the interconnections between these problems. Methods: A randomized controlled trial will be conducted nationally among young Australians (aged 17-24 years) who experience anxiety symptoms and drink alcohol at hazardous or harmful levels. Participants will be individually randomized on a 1:1 basis to receive the Inroads intervention or assessment plus alcohol guidelines. Participants randomized to the Inroads intervention will receive access to 5 Web-based cognitive behavioral therapy (CBT) modules and weekly therapist support via email and/or phone. The primary outcome assessment will be 8 weeks post baseline, with follow-up assessment 6 months post baseline to determine the sustainability of the intervention effects. Primary outcomes will be the total number of standard drinks consumed in the past month (assessed by the Timeline Follow-Back procedure), severity of alcohol-related harms (assessed by the Brief Young Adult Alcohol Consequences Questionnaire), and anxiety symptoms across multiple disorders (assessed by the Generalized Anxiety Disorder-7). Secondary outcomes will include alcohol outcome expectancies; functional impairment and quality of life; and symptoms of social anxiety, anxious arousal, and depression. Results will be analyzed by intention-to-treat using multilevel mixed effects analysis for repeated measures. Results: The study is funded from 2017 to 2020 by Australian Rotary Health. Recruitment is expected to be complete by late-2018, with the 6-month follow-ups to be completed by mid-2019. Results are expected to be published in 2020. Conclusions: The study will be the first to evaluate the benefits of a youth-focused early intervention that simultaneously targets anxiety and hazardous alcohol use. By explicitly addressing the interconnections between anxiety and alcohol use and enhancing CBT coping skills, the Inroads program has the potential to interrupt the trajectory toward co-occurring anxiety and alcohol use disorders. The Web-based format of the program combined with minimal therapist support means that if effective, the program could be widely disseminated to reach young people who are not currently able or willing to access face-to-face treatment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001609347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372748&isReview=true (Archived by WebCite at http://www.webcitation.org/77Au19jmf) International Registered Report Identifier (IRRID): DERR1-10.2196/12370 %M 30977742 %R 10.2196/12370 %U http://www.researchprotocols.org/2019/4/e12370/ %U https://doi.org/10.2196/12370 %U http://www.ncbi.nlm.nih.gov/pubmed/30977742 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e10859 %T Technology-Based Alcohol Interventions in Primary Care: Systematic Review %A Ramsey,Alex T %A Satterfield,Jason M %A Gerke,Donald R %A Proctor,Enola K %+ Department of Psychiatry, Washington University School of Medicine, 660 South Euclid, Campus Box 8134, St Louis, MO, 63110, United States, 1 3143625370, aramsey@wustl.edu %K alcohol drinking %K risky health behavior %K alcohol-related disorders %K internet %K computers %K mobile health %K primary health care %K implementation science %K review %D 2019 %7 08.04.2019 %9 Review %J J Med Internet Res %G English %X Background: Primary care settings are uniquely positioned to reach individuals at risk of alcohol use disorder through technology-delivered behavioral health interventions. Despite emerging effectiveness data, few efforts have been made to summarize the collective findings from these delivery approaches. Objective: The aim of this study was to review recent literature on the use of technology to deliver, enhance, or support the implementation of alcohol-related interventions in primary care. We focused on addressing questions related to (1) categorization or target of the intervention, (2) descriptive characteristics and context of delivery, (3) reported efficacy, and (4) factors influencing efficacy. Methods: We conducted a comprehensive search and systematic review of completed studies at the intersection of primary care, technology, and alcohol-related problems published from January 2000 to December 2018 within EBSCO databases, ProQuest Dissertations, and Cochrane Reviews. Of 2307 initial records, 42 were included and coded independently by 2 investigators. Results: Compared with the years of 2000 to 2009, published studies on technology-based alcohol interventions in primary care nearly tripled during the years of 2010 to 2018. Of the 42 included studies, 28 (64%) were randomized controlled trials. Furthermore, studies were rated on risk of bias and found to be predominantly low risk (n=18), followed by moderate risk (n=16), and high risk (n=8). Of the 24 studies with primary or secondary efficacy outcomes related to drinking and drinking-related harms, 17 (71%) reported reduced drinking or harm in all primary and secondary efficacy outcomes. Furthermore, of the 31 studies with direct comparisons with treatment as usual (TAU), 13 (42%) reported that at least half of the primary and secondary efficacy outcomes of the technology-based interventions were superior to TAU. High efficacy was associated with provider involvement and the reported use of an implementation strategy to deliver the technology-based intervention. Conclusions: Our systematic review has highlighted a pattern of growth in the number of studies evaluating technology-based alcohol interventions in primary care. Although these interventions appear to be largely beneficial in primary care, outcomes may be enhanced by provider involvement and implementation strategy use. This review enables better understanding of the typologies and efficacy of these interventions and informs recommendations for those developing and implementing technology-based alcohol interventions in primary care settings. %M 30958270 %R 10.2196/10859 %U https://www.jmir.org/2019/4/e10859/ %U https://doi.org/10.2196/10859 %U http://www.ncbi.nlm.nih.gov/pubmed/30958270 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11157 %T A Smartphone App to Assess Alcohol Consumption Behavior: Development, Compliance, and Reactivity %A Poulton,Antoinette %A Pan,Jason %A Bruns Jr,Loren Richard %A Sinnott,Richard O %A Hester,Robert %+ Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, 3010, Australia, 61 83446377, antoinette.poulton@unimelb.edu.au %K alcohol drinking %K smartphone apps %K smartphone %K mobile phone %K research app development %K compliance %K reactivity %D 2019 %7 25.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are disadvantages—largely related to cost, participant burden, and missing data—associated with traditional electronic methods of assessing drinking behavior in real time. This potentially diminishes some of the advantages—namely, enhanced sample size and diversity—typically attributed to these methods. Download of smartphone apps to participants’ own phones might preserve these advantages. However, to date, few researchers have detailed the process involved in developing custom-built apps for use in the experimental arena or explored methodological concerns regarding compliance and reactivity. Objective: The aim of this study was to describe the process used to guide the development of a custom-built smartphone app designed to capture alcohol intake behavior in the healthy population. Methodological issues related to compliance with and reactivity to app study protocols were examined. Specifically, we sought to investigate whether hazard and nonhazard drinkers would be equally compliant. We also explored whether reactivity in the form of a decrease in drinking or reduced responding (“yes”) to drinking behavior would emerge as a function of hazard or nonhazard group status. Methods: An iterative development process that included elements typical of agile software design guided the creation of the CNLab-A app. Healthy individuals used the app to record alcohol consumption behavior each day for 21 days. Submissions were either event- or notification-contingent. We considered the size and diversity of the sample, and assessed the data for evidence of app protocol compliance and reactivity as a function of hazard and nonhazard drinker status. Results: CNLab-A yielded a large and diverse sample (N=671, mean age 23.12). On average, participants submitted data on 20.27 (SD 1.88) out of 21 days (96.5%, 20.27/21). Both hazard and nonhazard drinkers were highly compliant with app protocols. There were no differences between groups in terms of number of days of app use (P=.49) or average number of app responses (P=.54). Linear growth analyses revealed hazardous drinkers decreased their alcohol intake by 0.80 standard drinks over the 21-day experimental period. There was no change to the drinking of nonhazard individuals. Both hazard and nonhazard drinkers showed a slight decrease in responding (“yes”) to drinking behavior over the same period. Conclusions: Smartphone apps participants download to their own phones are effective and methodologically sound means of obtaining alcohol consumption information for research purposes. Although further investigation is required, such apps might, in future, allow for a more thorough examination of the antecedents and consequences of drinking behavior. %M 30907738 %R 10.2196/11157 %U https://mhealth.jmir.org/2019/3/e11157/ %U https://doi.org/10.2196/11157 %U http://www.ncbi.nlm.nih.gov/pubmed/30907738 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 2 %P e11718 %T Rationale and Design of a Remote Web-Based Daily Diary Study Examining Sexual Minority Stress, Relationship Factors, and Alcohol Use in Same-Sex Female Couples Across the United States: Study Protocol of Project Relate %A Heron,Kristin E %A Lewis,Robin J %A Shappie,Alexander T %A Dawson,Charlotte A %A Amerson,Rachel %A Braitman,Abby L %A Winstead,Barbara A %A Kelley,Michelle L %+ Department of Psychology, Old Dominion University, 250 Mills Godwin Building, Norfolk, VA, 23529, United States, 1 7576835214, kheron@odu.edu %K sexual and gender minorities %K ecological momentary assessment %K alcohol drinking %K family relations %K stress, psychological %D 2019 %7 04.02.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Healthy People 2020 initiative aims to reduce health disparities, including alcohol use, among sexual minority women (SMW; eg, lesbian, bisexual, queer, and pansexual). Compared with heterosexual women, SMW engage in more hazardous drinking and report more alcohol-related problems. Sexual minority stress (ie, the unique experiences associated with stigmatization and marginalization) has been associated with alcohol use among SMW. Among heterosexuals, relationship factors (eg, partner violence and drinking apart vs together) have also been associated with alcohol use. Negative affect has also been identified as a contributor to alcohol use. To date, most studies examining alcohol use among SMW have used cross-sectional or longitudinal designs. Objective: Project Relate was designed to increase our understanding of alcohol use among young SMW who are at risk for alcohol problems. The primary objectives of this study are to identify daily factors, as well as potential person-level risk and protective factors, which may contribute to alcohol use in SMW. Secondary objectives include examining other physical and mental concerns in this sample (eg, other substance use, eating, physical activity, and stress). Methods: Both partners of a female same-sex couple (aged 18-35 years; n=150 couples) are being enrolled in the study following preliminary screening by a market research firm that specializes in recruiting sexual minority individuals. Web-based surveys are being used to collect information about the primary constructs of interest (daily experiences of alcohol use, sexual minority stress, relationship interactions, and mood) as well as secondary measures of other physical and mental health constructs. Data are collected entirely remotely from women across the United States. Each member of eligible couples completes a baseline survey and then 14 days of daily surveys each morning. Data will be analyzed using multilevel structural equation modeling. Results: To date, 208 women (ie, 104 couples) were successfully screened and enrolled into the study. In total, 164 women have completed the 14-day daily protocol. Compliance with completing the daily diaries has been excellent, with participants on average completing 92% of the daily diaries. Data collection will be completed in fall 2018, with results published as early as 2019 or 2020. Conclusions: Project Relate is designed to increase our understanding of between- and within-person processes underlying hazardous drinking in understudied, at-risk SMW. The study includes a remote daily diary methodology to provide insight into variables that may be associated with daily hazardous alcohol use. Before the development of programs that address hazardous alcohol use among young SMW, there is a need for better understanding of individual and dyadic variables that contribute to risk in this population. The unique challenges of recruiting and enrolling SMW from across the United States in a daily diary study are discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/11718 %M 30714946 %R 10.2196/11718 %U http://www.researchprotocols.org/2019/2/e11718/ %U https://doi.org/10.2196/11718 %U http://www.ncbi.nlm.nih.gov/pubmed/30714946 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10899 %T Mobile Health Interventions for Self-Control of Unhealthy Alcohol Use: Systematic Review %A Song,Ting %A Qian,Siyu %A Yu,Ping %+ Centre for IT-Enabled Transformation, School of Computing and Information Technology, Faculty of Engineering and Information Sciences, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 2 4221 5412, ping@uow.edu.au %K systematic review %K alcohol drinking %K self-control %K mobile health %K mHealth %K treatment outcome %D 2019 %7 29.01.2019 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Unhealthy alcohol use (UAU) is one of the major causes of preventable morbidity, mortality, and associated behavioral risks worldwide. Although mobile health (mHealth) interventions can provide consumers with an effective means for self-control of UAU in a timely, ubiquitous, and cost-effective manner, to date, there is a lack of understanding about different health outcomes brought by such interventions. The core components of these interventions are also unclear. Objective: This study aimed to systematically review and synthesize the research evidence about the efficacy of mHealth interventions on various health outcomes for consumer self-control of UAU and to identify the core components to achieve these outcomes. Methods: We systematically searched 7 electronic interdisciplinary databases: Scopus, PubMed, PubMed Central, CINAHL Plus with full text, MEDLINE with full text, PsycINFO, and PsycARTICLES. Search terms and Medical Subject Headings “mHealth,” “text message,” “SMS,” “App,” “IVR,” “self-control,” “self-regulation,” “alcohol*,” and “intervention” were used individually or in combination to identify peer-reviewed publications in English from 2008 to 2017. We screened titles and abstracts and assessed full-text papers as per inclusion and exclusion criteria. Data were extracted from the included papers according to the Consolidated Standards of Reporting Trials-EHEALTH checklist (V 1.6.1) by 2 authors independently. Data quality was assessed by the Mixed Methods Appraisal Tool. Data synthesis and analyses were conducted following the procedures for qualitative content analysis. Statistical testing was also conducted to test differences among groups of studies. Results: In total, 19 studies were included in the review. Of these 19 studies, 12 (63%) mHealth interventions brought significant positive outcomes in improving participants’ health as measured by behavioral (n=11), physiological (n=1), and cognitive indicators (n=1). No significant health outcome was reported in 6 studies (6/19, 32%). Surprisingly, a significant negative outcome was reported for the male participants in the intervention arm in 1 study (1/19, 5%), but no change was found for the female participants. In total, 5 core components reported in the mHealth interventions for consumer self-control of UAU were context, theoretical base, delivery mode, content, and implementation procedure. However, sound evidence is yet to be generated about the role of each component for mHealth success. The health outcomes were similar regardless of types of UAU, deployment setting, with or without nonmobile cointervention, and with or without theory. Conclusions: Most studies reported mHealth interventions for self-control of UAU appeared to be improving behavior, especially the ones delivered by short message service and interactive voice response systems. Further studies are needed to gather sound evidence about the effects of mHealth interventions on improving physiological and cognitive outcomes as well as the optimal design of these interventions, their implementation, and effects in supporting self-control of UAU. %M 30694200 %R 10.2196/10899 %U http://mhealth.jmir.org/2019/1/e10899/ %U https://doi.org/10.2196/10899 %U http://www.ncbi.nlm.nih.gov/pubmed/30694200 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11175 %T Predictors of Engagement, Response to Follow Up, and Extent of Alcohol Reduction in Users of a Smartphone App (Drink Less): Secondary Analysis of a Factorial Randomized Controlled Trial %A Garnett,Claire %A Perski,Olga %A Tombor,Ildiko %A West,Robert %A Michie,Susan %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076791742 ext 41742, c.garnett@ucl.ac.uk %K smartphone %K mobile phone %K alcohol drinking %K mobile apps %K engagement %D 2018 %7 14.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital interventions for alcohol can help achieve reductions in hazardous and harmful alcohol consumption. The Drink Less app was developed using evidence and theory, and a factorial randomized controlled trial (RCT) suggested that 4 of its intervention modules may assist with drinking reduction. However, low engagement is an important barrier to effectiveness, and low response to follow up is a challenge for intervention evaluation. Research is needed to understand what factors influence users’ level of engagement, response to follow up, and extent of alcohol reduction. Objective: This study aimed to investigate associations between user characteristics, engagement, response to follow up, and extent of alcohol reduction in an app-based intervention, Drink Less. Methods: This study involved a secondary data analysis of a factorial RCT of the Drink Less app. Participants (N=672) were aged 18 years or older, lived in the United Kingdom, and had an Alcohol Use Disorders Identification Test score >7 (indicative of excessive drinking). Sociodemographic and drinking characteristics were assessed at baseline. Engagement was assessed in the first month of use (number of sessions, time on app, number of days used, and percentage of available screens viewed). Response to follow up and extent of alcohol reduction (change in past week consumption) were measured after 1 month. Associations were assessed using unadjusted and adjusted linear or logistic regression models. Results: Age (all unstandardized regression coefficients [B] >.02, all P<.001) and post-16 educational qualifications (all B>.18, all P<.03) were positively associated with all engagement outcomes. Age (odds ratio [OR] 1.04, P<.001), educational qualifications (OR 2.11, P<.001), and female gender (OR 1.58, P=.02) were positively associated with response to follow up. Engagement outcomes predicted response to follow up (all OR>1.02, all P<.001) but not the extent of alcohol reduction (all −.14.07). Baseline drinking characteristics were the only variables associated with the extent of alcohol reduction among those followed up (all B>.49, all P<.001). Conclusions: Users of the alcohol reduction app, Drink Less, who were older and had post-16 educational qualifications engaged more and were more likely to respond at 1-month follow up. Higher baseline alcohol consumption predicted a greater extent of alcohol reduction among those followed up but did not predict engagement or response to follow up. Engagement was associated with response to follow up but was not associated with the extent of alcohol reduction, which suggests that the Drink Less app does not have a dose-response effect. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN40104069; http://www.isrctn.com/ISRCTN40104069 (Archived by WebCite at http://www.webcitation.org/746HqygIV) %M 30552081 %R 10.2196/11175 %U https://mhealth.jmir.org/2018/12/e11175/ %U https://doi.org/10.2196/11175 %U http://www.ncbi.nlm.nih.gov/pubmed/30552081 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11692 %T Developing Typologies of User Engagement With the BRANCH Alcohol-Harm Reduction Smartphone App: Qualitative Study %A Milward,Joanna %A Deluca,Paolo %A Drummond,Colin %A Kimergård,Andreas %+ Addictions Department, King's College London, Addictions Sciences Building, 4 Windsor Walk, London, SE58BB, United Kingdom, 44 02087 848 0437, joanna.milward@kcl.ac.uk %K young adults %K binge drinking %K drinking %K smartphone %K mobile phone %K mHealth %D 2018 %7 13.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Understanding how users engage with electronic screening and brief intervention (eSBI) is a critical research objective to improve effectiveness of app-based interventions to reduce harmful alcohol consumption. Although quantitative measures of engagement provide a strong indicator of how the user engages with an app at the group level, they do not elucidate finer-grained details of how apps function from an individual, experiential perspective and why, or how, users engage with an intervention in a particular manner. Objective: The aim of this study was to (1) understand why and how participants engaged with the BRANCH app, (2) explore facilitators and barriers to engagement with app features, (3) explore how the BRANCH app impacted drinking behavior, (4) use these data to identify typologies of users of the BRANCH app in terms of engagement behaviors, and (5) identify future eSBI app design implications. Methods: In total, 20 one-to-one semistructured telephone interviews were conducted with participants recruited from a randomized controlled trial, which evaluated the effectiveness of engagement-promoting strategies in the BRANCH app targeting harmful drinking in young adults (aged 18-30 years). The topic guide explored users’ current engagement levels with existing health promotion apps, their views toward the effectiveness of such apps, and what they liked and disliked about BRANCH, specifically focusing on how they engaged with the app. Framework analysis was used to develop typologies of user engagement. Results: The study identified 3 typologies of engagers. Trackers were defined by their motivations to use health-tracking apps to monitor and understand quantified self-data. They did not have intentions necessarily to cut down and predominantly used only the drinking diary. Cut-downers were motivated to use the app because they wanted to reduce their alcohol consumption Unlike Trackers, they did not use a range of different health apps daily, but saw the BRANCH app as an opportunity to test out a different method of trying to cut down their alcohol use. This typology used more features than Trackers, such as the goal setting function. Noncommitters were characterized as a group of users who were initially enthusiastic about using the app; however, this enthusiasm quickly waned and they gained no benefit from it. Conclusions: This was the first study to identify typologies of user engagement with eSBI apps. Although in need of replication, it provides a first step in understanding independent categories of eSBI users, who may benefit from apps tailored to a user’s typology or motivation. It also provides new evidence to suggest that apps may be used more effectively as a tool to raise awareness of drinking, instead of reducing alcohol use, and be a step in the care pathway, identifying at-risk individuals and signposting them to more intensive treatment. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN70980706; http://www.isrctn.com /ISRCTN70980706 (Archived by WebCite at http://www.webcitation.org/73vfDXYEZ) %M 30545806 %R 10.2196/11692 %U https://mhealth.jmir.org/2018/12/e11692/ %U https://doi.org/10.2196/11692 %U http://www.ncbi.nlm.nih.gov/pubmed/30545806 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e19 %T Potential of an Interactive Drug Prevention Mobile Phone App (Once Upon a High): Questionnaire Study Among Students %A Kapitány-Fövény,Máté %A Vagdalt,Eszter %A Ruttkay,Zsófia %A Urbán,Róbert %A Richman,Mara J %A Demetrovics,Zsolt %+ Department of Addiction, Semmelweis University Faculty of Health Sciences, Vas Street 17, Budapest, 1088, Hungary, 36 20 5221850, m.gabrilovics@gmail.com %K secondary prevention %K adolescent %K mHealth %K energy drinks %K substance use %K alcohol abuse %K cannabis %D 2018 %7 04.12.2018 %9 Original Paper %J JMIR Serious Games %G English %X 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 6 different 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 psychological effects 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 (Fagerström 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. %M 30514697 %R 10.2196/games.9944 %U http://games.jmir.org/2018/4/e19/ %U https://doi.org/10.2196/games.9944 %U http://www.ncbi.nlm.nih.gov/pubmed/30514697 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 11 %P e11822 %T A Smartphone Attention Bias Intervention for Individuals With Addictive Disorders: Protocol for a Feasibility Study %A Zhang,Melvyn %A Ying,Jiangbo %A Amron,Syidda B %A Mahreen,Zaakira %A Song,Guo %A Fung,Daniel SS %A Smith,Helen %+ National Addictions Management Service (NAMS), Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K addiction %K approach bias %K attention bias %K bias modification %K feasibility %K pilot %K psychiatry %K mobile phone %K mHealth %K eHealth %D 2018 %7 19.11.2018 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 30455170 %R 10.2196/11822 %U http://www.researchprotocols.org/2018/11/e11822/ %U https://doi.org/10.2196/11822 %U http://www.ncbi.nlm.nih.gov/pubmed/30455170 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10022 %T Users’ Intrinsic Goals Linked to Alcohol Dependence Risk Level and Engagement With a Health Promotion Website (Hello Sunday Morning): Observational Study %A Bradshaw,Emma L %A Sahdra,Baljinder K %A Calvo,Rafael A %A Mrvaljevich,Alex %A Ryan,Richard M %+ Institute for Positive Psychology and Education, Level 8, 33 Berry Street, North Sydney,, Australia, 61 0402940263, emma.bradshaw@myacu.edu.au %K alcohol dependence %K aspirations %K goals %K self-determination theory %K website engagement %D 2018 %7 22.10.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Hello Sunday Morning (HSM) is a self-guided health promotion website with the aim to improve drinking culture. Members are encouraged to sign up for a 3-month period of alcohol abstention and record and track their progress and goals. Objective: This study used self-determination theory (SDT) to examine the nature of goals subscribed by HSM users to test the extent to which intrinsic goal pursuit was linked to lower alcohol dependency risk and higher engagement with the HSM website. Methods: HSM users (N=2216; 59.75%, 1324/2216, females; aged 18-79 years) completed the World Health Organization’s Alcohol Use Disorders Identification Test (WHO-AUDIT, which measures alcohol dependence risk level) at sign-up and at 4 and 6 months after sign-up. In addition, the website had a goals-subscription feature that allowed participants to share their goals. Two independent raters classified the goals according to a coding system we devised based on SDT, which proposes that intrinsic goals (eg, growth, relationships, community, and health) better promote positive outcomes than extrinsic goals (eg, wealth, fame, and image). Results: Although there was substantial (1016/2216, 45.84%) attrition of HSM users from sign-up to 6 months, the attrition rate could not be attributed to alcohol dependency risk because people in different WHO-AUDIT risk zones were equally likely to be missing at 4 and 6 months after sign-up. The SDT-driven coding of goals yielded the following categories: wealth and image (extrinsic goals); relationships, personal growth, community engagement, and physical health (intrinsic goals); and alcohol use-related goals (which were hard to classify as either extrinsic or intrinsic). Alcohol dependence risk level correlated positively with goals related to money (r=.16), personal growth (r=.17), relationships (r=.10), and alcohol use (r=.25). Website engagement correlated negatively with alcohol dependence risk level (r=.10) and positively with relationship (r=.10) and community goals (r=.12). Conclusions: HSM users with higher alcohol dependence risk tended to engage with the website less, but to the extent that they did, they tended to subscribe to goals related to alcohol use and improving their personal growth, relationships, and finances. In line with SDT, engagement with goals—particularly the intrinsic goals of connecting with close-others and the broader community—related to increased website engagement. Web-based tools intended to promote healthy behaviors in users may be effective in engaging their users if the users’ experience on the website supports the pursuit of intrinsic goals. %M 30348624 %R 10.2196/10022 %U http://mental.jmir.org/2018/4/e10022/ %U https://doi.org/10.2196/10022 %U http://www.ncbi.nlm.nih.gov/pubmed/30348624 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10460 %T The Remote Food Photography Method and SmartIntake App for the Assessment of Alcohol Use in Young Adults: Feasibility Study and Comparison to Standard Assessment Methodology %A Fazzino,Tera L %A Martin,Corby K %A Forbush,Kelsie %+ Department of Psychology, University of Kansas, Fraser Hall, 4th Floor, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, United States, 1 7858640062, tfazzino@ku.edu %K alcohol consumption %K alcohol college students %K alcohol assessment %K dietary assessment %K self report %K mobile phone %K mobile health %K ehealth %K photography %K young adults %D 2018 %7 24.9.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heavy drinking is prevalent among young adults and may contribute to obesity. However, measurement tools for assessing caloric intake from alcohol are limited and rely on self-report, which is prone to bias. Objective: The purpose of our study was to conduct feasibility testing of the Remote Food Photography Method and the SmartIntake app to assess alcohol use in young adults. Aims consisted of (1) quantifying the ability of SmartIntake to capture drinking behavior, (2) assessing app usability with the Computer System Usability Questionnaire (CSUQ), (3) conducting a qualitative interview, and (4) comparing preference, usage, and alcohol use estimates (calories, grams per drinking episode) between SmartIntake and online diet recalls that participants completed for a parent study. Methods: College students (N=15) who endorsed a pattern of heavy drinking were recruited from a parent study. Participants used SmartIntake to send photographs of all alcohol and food intake over a 3-day period and then completed a follow-up interview and the CSUQ. CSUQ items range from 1-7, with lower scores indicating greater usability. Total drinking occasions were determined by adding the number of drinking occasions captured by SmartIntake plus the number of drinking occasions participants reported that they missed capturing. Usage was defined by the number of days participants provided food/beverage photos through the app, or the number of diet recalls completed. Results: SmartIntake captured 87% (13/15) of total reported drinking occasions. Participants rated the app as highly usable in the CSUQ (mean 2.28, SD 1.23). Most participants (14/15, 93%) preferred using SmartIntake versus recalls, and usage was significantly higher with SmartIntake than recalls (42/45, 93% vs 35/45, 78%; P=.04). Triple the number of participants submitted alcohol reports with SmartIntake compared to the recalls (SmartIntake 9/15, 60% vs recalls 3/15, 20%; P=.06), and 60% (9/15) of participants reported drinking during the study. Conclusions: SmartIntake was acceptable to college students who drank heavily and captured most drinking occasions. Participants had higher usage of SmartIntake compared to recalls, suggesting SmartIntake may be well suited to measuring alcohol consumption in young adults. However, 40% (6/15) did not drink during the brief testing period and, although findings are promising, a longer trial is needed. %M 30249590 %R 10.2196/10460 %U http://mhealth.jmir.org/2018/9/e10460/ %U https://doi.org/10.2196/10460 %U http://www.ncbi.nlm.nih.gov/pubmed/30249590 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10074 %T A Smartphone App and Personalized Text Messaging Framework (InDEx) to Monitor and Reduce Alcohol Use in Ex-Serving Personnel: Development and Feasibility Study %A Leightley,Daniel %A Puddephatt,Jo-Anne %A Jones,Norman %A Mahmoodi,Toktam %A Chui,Zoe %A Field,Matt %A Drummond,Colin %A Rona,Roberto J %A Fear,Nicola T %A Goodwin,Laura %+ King's Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 78485334, daniel.leightley@kcl.ac.uk %K behavior change techniques %K smartphone %K alcohol misuse %K binge drinking %K text messaging %K ex-serving %K armed forces %K mobile phones %D 2018 %7 11.09.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Self-reported alcohol misuse remains high in armed forces personnel even after they have left service. More than 50% of ex-serving personnel meet the criteria for hazardous alcohol use; however, many fail to acknowledge that they have a problem. Previous research indicates that interventions delivered via smartphone apps are suitable in promoting self-monitoring of alcohol use, have a broad reach, and may be more cost-effective than other types of brief interventions. There is currently no such intervention specifically designed for the armed forces. Objective: This study sought to describe the development of a tailored smartphone app and personalized text messaging (short message service, SMS) framework and to test the usability and feasibility (measured and reported as user engagement) of this app in a hard-to-engage ex-serving population. Methods: App development used Agile methodology (an incremental, iterative approach used in software development) and was informed by behavior change theory, participant feedback, and focus groups. Participants were recruited between May 2017 and June 2017 from an existing United Kingdom longitudinal military health and well-being cohort study, prescreened for eligibility, and directed to download either Android or iOS versions of the ”Information about Drinking for Ex-serving personnel” (InDEx) app. Through the app, participants were asked to record alcohol consumption, complete a range of self-report measures, and set goals using implementation intentions (if-then plans). Alongside the app, participants received daily automated personalized text messages (SMS) corresponding to specific behavior change techniques with content informed by the health action process approach with the intended purpose of promoting the use of the drinks diary, suggesting alternative behaviors, and providing feedback on goals setting. Results: Invitations to take part in the study were sent to ex-serving personnel, 22.6% (31/137) of whom accepted and downloaded the app. Participants opened the InDEx app a median of 15.0 (interquartile range [IQR] 8.5-19.0) times during the 4 week period (28 days), received an average of 36.1 (SD 3.2) text messages (SMS), consumed alcohol on a median of 13.0 (IQR 11.0-15.0) days, and consumed a median of 5.6 (IQR 3.3-11.8) units per drinking day in the first week, which decreased to 4.7 (IQR 2.0-6.9) units by the last week and remained active for 4.0 (IQR 3.0-4.0) weeks. Conclusions: Personnel engaged and used the app regularly as demonstrated by the number of initializations, interactions, and time spent using InDEx. Future research is needed to evaluate the engagement with and efficacy of InDEx for the reduction of alcohol consumption and binge drinking in an armed forces population. %M 30206054 %R 10.2196/10074 %U http://mhealth.jmir.org/2018/9/e10074/ %U https://doi.org/10.2196/10074 %U http://www.ncbi.nlm.nih.gov/pubmed/30206054 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10125 %T Game Plan: Development of a Web App Designed to Help Men Who Have Sex With Men Reduce Their HIV Risk and Alcohol Use %A Wray,Tyler %A Kahler,Christopher W %A Simpanen,Erik M %A Operario,Don %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI,, United States, 1 401 863 6659, tyler_wray@brown.edu %K alcohol %K HIV risk %K internet %K intervention %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Men who have sex with men (MSM) are at high risk for HIV, and alcohol use is a major risk factor for HIV infection. Internet-facilitated brief interventions have been shown to reduce alcohol use and HIV-risk behavior in other at-risk populations, but have so far incorporated limited content and have not been tested among MSM. Objective: This manuscript describes Game Plan, an interactive, tablet-optimized web application designed to help heavy drinking, high-risk MSM consider reducing their alcohol use and sexual risk behavior. In this paper, we discuss the rationale, goals, and flow for each of Game Plan’s components, which were modelled after common in-person and web-based brief motivational interventions for these behaviors. Methods: The development of Game Plan was informed by a thorough user-focused design research process that included (1) audits of existing interventions, (2) focus groups with stakeholders and (3) intended users (high-risk, heavy drinking MSM), and (4) usability testing. The aesthetic, features, and content of the app were designed iteratively throughout this process Results: The fully-functional Game Plan app provides (1) specific and personal feedback to users about their level of risk, (2) exercises to help prompt users to reflect on whether their current behavior aligns with other important life goals and values, and for those open to change, (3) exercises to help users understand factors that contribute to risk, and (4) a change planning module. In general, this flow was constructed to roughly align with the two phases described in early accounts of motivational interviewing (MI): (1) Content intended to elicit intrinsic motivation for change, and when/if sufficient motivation is present, (2) content intended to translate that motivation into specific goals and plans for change. This sequence first focuses on the user’s HIV risk behavior, followed by their alcohol use and the connection between the two. The app’s overall aesthetic (eg, branding, color palettes, icons/graphics) and its onboarding sequence was also designed to align with the “spirit” of MI by conveying respect for autonomy, open-mindedness (ie, avoiding judgment), and empathy. Conclusions: Should future research support its efficacy in facilitating behavior change, Game Plan could represent a wide-reaching and scalable tool that is well-suited for use in settings where delivering evidence-based, in-person interventions would be difficult or cost-prohibitive. %M 30684415 %R 10.2196/10125 %U http://formative.jmir.org/2018/2/e10125/ %U https://doi.org/10.2196/10125 %U http://www.ncbi.nlm.nih.gov/pubmed/30684415 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e10748 %T Veterans’ Attitudes Toward Smartphone App Use for Mental Health Care: Qualitative Study of Rurality and Age Differences %A Connolly,Samantha L %A Miller,Christopher J %A Koenig,Christopher J %A Zamora,Kara A %A Wright,Patricia B %A Stanley,Regina L %A Pyne,Jeffrey M %+ Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S Huntington Avenue, Building 9 Room 208F, Boston, MA, 02130, United States, 1 857 364 5987, Samantha.connolly@va.gov %K smartphone apps %K mobile phone %K mhealth %K mental health %K qualitative analysis %K rurality %K age %K veterans %K depression %K anxiety disorders %K posttraumatic stress disorder %K PTSD %K alcohol abuse %D 2018 %7 22.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health smartphone apps provide support, skills, and symptom tracking on demand and come at minimal to no additional cost to patients. Although the Department of Veterans Affairs has established itself as a national leader in the creation of mental health apps, veterans’ attitudes regarding the use of these innovations are largely unknown, particularly among rural and aging populations who may benefit from increased access to care. Objective: The objective of our study was to examine veterans’ attitudes toward smartphone apps and to assess whether openness toward this technology varies by age or rurality. Methods: We conducted semistructured qualitative interviews with 66 veterans from rural and urban areas in Maine, Arkansas, and California. Eligible veterans aged 18 to 70 years had screened positive for postraumatic stress disorder (PTSD), alcohol use disorder, or major depressive disorder, but a history of mental health service utilization was not required. Interviews were digitally recorded, professionally transcribed, and coded by a research team using an established codebook. We then conducted a thematic analysis of segments pertaining to smartphone use, informed by existing theories of technology adoption. Results: Interviews revealed a marked division regarding openness to mental health smartphone apps, such that veterans either expressed strongly positive or negative views about their usage, with few participants sharing ambivalent or neutral opinions. Differences emerged between rural and urban veterans’ attitudes, with rural veterans tending to oppose app usage, describe smartphones as hard to navigate, and cite barriers such as financial limitations and connectivity issues, more so than urban populations. Moreover, rural veterans more often described smartphones as being opposed to their values. Differences did not emerge between younger and older (≥50) veterans regarding beliefs that apps could be effective or compatible with their culture and identity. However, compared with younger veterans, older veterans more often reported not owning a smartphone and described this technology as being difficult to use. Conclusions: Openness toward the use of smartphone apps in mental health treatment may vary based on rurality, and further exploration of the barriers cited by rural veterans is needed to improve access to care. In addition, findings indicate that older patients may be more open to integrating technology into their mental health care than providers might assume, although such patients may have more trouble navigating these devices and may benefit from simplified app designs or smartphone training. Given the strong opinions expressed either for or against smartphone apps, our findings suggest that apps may not be an ideal adjunctive treatment for all patients, but it is important to identify those who are open to and may greatly benefit from this technology. %M 30135050 %R 10.2196/10748 %U http://mhealth.jmir.org/2018/8/e10748/ %U https://doi.org/10.2196/10748 %U http://www.ncbi.nlm.nih.gov/pubmed/30135050 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e10849 %T 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 %A Newton,Nicola Clare %A Chapman,Cath %A Slade,Tim %A Conroy,Chloe %A Thornton,Louise %A Champion,Katrina Elizabeth %A Stapinski,Lexine %A Koning,Ina %A Teesson,Maree %+ National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, 2031, Australia, 61 93850333, n.newton@unsw.edu.au %K alcohol %K Australia %K cannabis %K parents %K prevention %K school %K internet-based intervention %D 2018 %7 17.08.2018 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 30120084 %R 10.2196/10849 %U http://www.researchprotocols.org/2018/8/e10849/ %U https://doi.org/10.2196/10849 %U http://www.ncbi.nlm.nih.gov/pubmed/30120084 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e149 %T Mobile Phone-Based Ecological Momentary Intervention to Reduce Young Adults’ Alcohol Use in the Event: A Three-Armed Randomized Controlled Trial %A Wright,Cassandra %A Dietze,Paul M %A Agius,Paul A %A Kuntsche,Emmanuel %A Livingston,Michael %A Black,Oliver C %A Room,Robin %A Hellard,Margaret %A Lim,Megan SC %+ Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol %K brief intervention %K ecological momentary assessment %K randomized controlled trial %K mHealth %K mobile phone %K young adults %D 2018 %7 20.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Real-time ecological momentary interventions have shown promising effects in domains other than alcohol use; however, only few studies regarding ecological momentary interventions for alcohol use have been conducted thus far. The increasing popularity of smartphones offers new avenues for intervention and innovation in data collection. Objective: We aimed to test the efficacy of an ecological momentary intervention, comprising mobile Web-based ecological momentary assessments (EMAs) and text messaging (short message service, SMS) brief interventions, delivered during drinking events using participants’ mobile phones. Methods: We conducted a three-armed randomized controlled trial to assess the effect of a mobile Web-based ecological momentary assessment with texting feedback on self-reported alcohol consumption and alcohol-related harms in young adults. Participants were enrolled from an existing observational cohort study of young adults screened for risky drinking behavior. The intervention group (ecological momentary intervention group) completed repeated ecological momentary assessments during 6 drinking events and received immediate texting-based feedback in response to each ecological momentary assessment. The second group (ecological momentary assessment group) completed ecological momentary assessments without the brief intervention, and the third did not receive any contact during the trial period. Recent peak risky single-occasion drinking was assessed at the baseline and follow-up using telephone interviews. We used a random effects mixed modeling approach using maximum likelihood estimation to provide estimates of differences in mean drinking levels between groups between baseline and 12-week follow-up. Results: A total of 269 participants were randomized into the 3 groups. The ecological momentary intervention group exhibited a small and nonsignificant increase between baseline and follow-up in (geometric) the mean number of standard drinks consumed at the most recent heavy drinking occasion (mean 12.5 vs 12.7). Both ecological momentary assessment and control groups exhibited a nonsignificant decrease (ecological momentary assessment: mean 13.8 vs 11.8; control: mean 12.3 vs 11.6); these changes did not differ significantly between groups (Wald χ22 1.6; P=.437) and the magnitude of the effects of the intervention were markedly small. No other significant differences between groups on measures of alcohol consumption or related harms were observed. The intervention acceptability was high despite the technical problems in delivery. Conclusions: With a small number of participants, this study showed few effects of an SMS-based brief intervention on peak risky single-occasion drinking. Nevertheless, the study highlights areas for further investigation into the effects of EMI on young adults with heavy alcohol consumption. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12616001323415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/7074mqwcs) %M 30030211 %R 10.2196/mhealth.9324 %U http://mhealth.jmir.org/2018/7/e149/ %U https://doi.org/10.2196/mhealth.9324 %U http://www.ncbi.nlm.nih.gov/pubmed/30030211 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 3 %P e23 %T A Text Message–Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study %A Müssener,Ulrika %A Thomas,Kristin %A Linderoth,Catharina %A Leijon,Matti %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, S-58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K students %K text messages %K mobile phones %K SMS %K alcohol consumption intervention %D 2018 %7 10.07.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Heavy consumption of alcohol among university students is a global problem, with excessive drinking being the social norm. Students can be a difficult target group to reach, and only a minority seek alcohol-related support. It is important to develop interventions that can reach university students in a way that does not further stretch the resources of the health services. Text messaging (short message service, SMS)–based interventions can enable continuous, real-time, cost-effective, brief support in a real-world setting, but there is a limited amount of evidence for effective interventions on alcohol consumption among young people based on text messaging. To address this, a text messaging–based alcohol consumption intervention, the Amadeus 3 intervention, was developed. Objective: This study explored self-reported changes in drinking habits in an intervention group and a control group. Additionally, user satisfaction among the intervention group and the experience of being allocated to a control group were explored. Methods: Students allocated to the intervention group (n=460) were asked about their drinking habits and offered the opportunity to give their opinion on the structure and content of the intervention. Students in the control group (n=436) were asked about their drinking habits and their experience in being allocated to the control group. Participants received an email containing an electronic link to a short questionnaire. Descriptive analyses of the distribution of the responses to the 12 questions for the intervention group and 5 questions for the control group were performed. Results: The response rate for the user feedback questionnaire of the intervention group was 38% (176/460) and of the control group was 30% (129/436). The variation in the content of the text messages from facts to motivational and practical advice was appreciated by 77% (135/176) participants, and 55% (97/176) found the number of messages per week to be adequate. Overall, 81% (142/176) participants stated that they had read all or nearly all the messages, and 52% (91/176) participants stated that they were drinking less, and increased awareness regarding negative consequences was expressed as the main reason for reduced alcohol consumption. Among the participants in the control group, 40% (52/129) stated that it did not matter that they had to wait for access to the intervention. Regarding actions taken while waiting for access, 48% (62/129) participants claimed that they continued to drink as before, whereas 35% (45/129) tried to reduce their consumption without any support. Conclusions: Although the main randomized controlled trial was not able to detect a statistically significant effect of the intervention, most participants in this qualitative follow-up study stated that participation in the study helped them reflect upon their consumption, leading to altered drinking habits and reduced alcohol consumption. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/705putNZT) %M 29991469 %R 10.2196/humanfactors.9641 %U http://humanfactors.jmir.org/2018/3/e23/ %U https://doi.org/10.2196/humanfactors.9641 %U http://www.ncbi.nlm.nih.gov/pubmed/29991469 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e10078 %T Reaching Those At Risk for Psychiatric Disorders and Suicidal Ideation: Facebook Advertisements to Recruit Military Veterans %A Teo,Alan R %A Liebow,Samuel BL %A Chan,Benjamin %A Dobscha,Steven K %A Graham,Amanda L %+ HSR&D Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, 3710 SW US Veterans Hospital Road (R&D 66), Portland, OR, 97239-2964, United States, 1 503 220 8262 ext 52461, teoa@ohsu.edu %K Facebook %K social media %K methodology %K Veterans Affairs %K veterans %D 2018 %7 05.07.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Younger military veterans are at high risk for psychiatric disorders and suicide. Reaching and engaging veterans in mental health care and research is challenging. Social media platforms may be an effective channel to connect with veterans. Objective: This study tested the effectiveness of Facebook advertisements in reaching and recruiting Iraq and Afghanistan-era military veterans in a research study focused on mental health. Methods: Facebook ads requesting participation in an online health survey ran for six weeks in 2017. Ads varied imagery and headlines. Validated instruments were used to screen for psychiatric disorders and suicidality. Outcomes included impressions, click-through rate, survey completion, and cost per survey completed. Results: Advertisements produced 827,918 impressions, 9,527 clicks, and 587 survey completions. Lack of enrollment in Veterans Affairs health care (193/587, 33%) and positive screens for current mental health problems were common, including posttraumatic stress disorder (266/585, 45%), problematic drinking (243/584, 42%), major depression (164/586, 28%), and suicidality (132/585, 23%). Approximately half of the survey participants (285/587, 49%) were recruited with just 2 of the 15 ads, which showed soldiers marching tied to an “incentive” or “sharing” headline. These 2 ads were also the most cost-effective, at US $4.88 and US $5.90 per participant, respectively. Among veterans with current suicidal ideation, the survey-taking image resulted in higher survey completion than the soldiers marching image (P=.007). Conclusions: Facebook advertisements are effective in rapidly and inexpensively reaching military veterans, including those at risk for mental health problems and suicidality, and those not receiving Veterans Affairs health care. Advertisement image and headlines may help optimize the effectiveness of advertisements for specific subgroups. %M 29980498 %R 10.2196/10078 %U http://mental.jmir.org/2018/3/e10078/ %U https://doi.org/10.2196/10078 %U http://www.ncbi.nlm.nih.gov/pubmed/29980498 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e146 %T Effectiveness of a Text Messaging–Based Intervention Targeting Alcohol Consumption Among University Students: Randomized Controlled Trial %A Thomas,Kristin %A Müssener,Ulrika %A Linderoth,Catharina %A Karlsson,Nadine %A Bendtsen,Preben %A Bendtsen,Marcus %+ Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, 58183, Sweden, 46 733140708, marcus.bendtsen@liu.se %K alcohol consumption intervention %K text message-based intervention %K university students %K brief intervention %D 2018 %7 25.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Excessive drinking among university students is a global challenge, leading to significant health risks. However, heavy drinking among students is widely accepted and socially normalized. Mobile phone interventions have attempted to reach students who engage in excessive drinking. A growing number of studies suggest that text message–based interventions could potentially reach many students and, if effective, such an intervention might help reduce heavy drinking in the student community. Objective: The objective of this study was to test the effectiveness of a behavior change theory–based 6-week text message intervention among university students. Methods: This study was a two-arm, randomized controlled trial with an intervention group receiving a 6-week text message intervention and a control group that was referred to treatment as usual at the local student health care center. Outcome measures were collected at baseline and at 3 months after the initial invitation to participate in the intervention. The primary outcome was total weekly alcohol consumption. Secondary outcomes were frequency of heavy episodic drinking, highest estimated blood alcohol concentration, and number of negative consequences attributable to excessive drinking. Results: A total of 896 students were randomized to either the intervention or control group. The primary outcome analysis included 92.0% of the participants in the intervention group and 90.1% of the control group. At follow-up, total weekly alcohol consumption decreased in both groups, but no significant between-group difference was seen. Data on the secondary outcomes included 49.1% of the participants in the intervention group and 41.3% of the control group. No significant between-group difference was seen for any of the secondary outcomes. Conclusions: The present study was under-powered, which could partly explain the lack of significance. However, the intervention, although theory-based, needs to be re-assessed and refined to better support the target group. Apart from establishing which content forms an effective intervention, the optimal length of an alcohol intervention targeting students also needs to be addressed in future studies. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/70Ax4vXhd) %M 29941417 %R 10.2196/mhealth.9642 %U http://mhealth.jmir.org/2018/6/e146/ %U https://doi.org/10.2196/mhealth.9642 %U http://www.ncbi.nlm.nih.gov/pubmed/29941417 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e226 %T Social Drinking on Social Media: Content Analysis of the Social Aspects of Alcohol-Related Posts on Facebook and Instagram %A Hendriks,Hanneke %A Van den Putte,Bas %A Gebhardt,Winifred A %A Moreno,Megan A %+ Amsterdam School of Communication Research, University of Amsterdam, Nieuwe Achtergracht 166, Amsterdam,, Netherlands, 31 64 710 9985, h.hendriks@uva.nl %K social media %K alcohol drinking %K social interaction %D 2018 %7 22.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol is often consumed in social contexts. An emerging social context in which alcohol is becoming increasingly apparent is social media. More and more young people display alcohol-related posts on social networking sites such as Facebook and Instagram. Objective: Considering the importance of the social aspects of alcohol consumption and social media use, this study investigated the social content of alcohol posts (ie, the evaluative social context and presence of people) and social processes (ie, the posting of and reactions to posts) involved with alcohol posts on social networking sites. Methods: Participants (N=192; mean age 20.64, SD 4.68 years, 132 women and 54 men) gave researchers access to their Facebook and/or Instagram profiles, and an extensive content analysis of these profiles was conducted. Coders were trained and then coded all screenshotted timelines in terms of evaluative social context, presence of people, and reactions to post. Results: Alcohol posts of youth frequently depict alcohol in a positive social context (425/438, 97.0%) and display people holding drinks (277/412, 67.2%). In addition, alcohol posts were more often placed on participants’ timelines by others (tagging; 238/439, 54.2%) than posted by participants themselves (201/439, 45.8%). Furthermore, it was revealed that such social posts received more likes (mean 35.50, SD 26.39) and comments than nonsocial posts (no people visible; mean 10.34, SD 13.19, P<.001). Conclusions: In terms of content and processes, alcohol posts on social media are social in nature and a part of young people’s everyday social lives. Interventions aiming to decrease alcohol posts should therefore focus on the broad social context of individuals in which posting about alcohol takes place. Potential intervention strategies could involve making young people aware that when they post about social gatherings in which alcohol is visible and tag others, it may have unintended negative consequences and should be avoided. %M 29934290 %R 10.2196/jmir.9355 %U http://www.jmir.org/2018/6/e226/ %U https://doi.org/10.2196/jmir.9355 %U http://www.ncbi.nlm.nih.gov/pubmed/29934290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e142 %T Tobacco-Smoking, Alcohol-Drinking, and Betel-Quid-Chewing Behaviors: Development and Use of a Web-Based Survey System %A Hsu,Kuo-Yao %A Tsai,Yun-Fang %A Huang,Chu-Ching %A Yeh,Wen-Ling %A Chang,Kai-Ping %A Lin,Chen-Chun %A Chen,Ching-Yen %A Lee,Hsiu-Lan %+ School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Tao-Yuan, 333, Taiwan, 886 32118800 ext 3204, yftsai@mail.cgu.edu.tw %K tobacco smoking %K alcohol drinking %K betel-quid chewing %K Web-based survey system %D 2018 %7 11.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 29891467 %R 10.2196/mhealth.9783 %U http://mhealth.jmir.org/2018/6/e142/ %U https://doi.org/10.2196/mhealth.9783 %U http://www.ncbi.nlm.nih.gov/pubmed/29891467 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e148 %T A Participatory Health Promotion Mobile App Addressing Alcohol Use Problems (The Daybreak Program): Protocol for a Randomized Controlled Trial %A Tait,Robert J %A Kirkman,Jessica J L %A Schaub,Michael P %+ National Drug Research Institute, Faculty of Health Sciences, Curtin University, 7 Parker Place, Bentley, GPO Box U1987, Perth, 6845, Australia, 61 92661610, robert.tait@curtin.edu.au %K alcohol drinking %K internet %K evaluation studies %K social marketing %K health promotion %D 2018 %7 31.05.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: At-risk patterns of alcohol use are prevalent in many countries with significant costs to individuals, families, and society. Screening and brief interventions, including with Web delivery, are effective but with limited translation into practice to date. Previous observational studies of the Hello Sunday Morning approach have found that their unique Web-based participatory health communication method has resulted in a reduction of at-risk alcohol use between baseline and 3 months. The Hello Sunday Morning blog program asks participants to publicly set a personal goal to stop drinking or reduce their consumption for a set period of time, and to record their reflections and progress on blogs and social networks. Daybreak is Hello Sunday Morning’s evidence-based behavior change program, which is designed to support people looking to change their relationship with alcohol. Objective: This study aims to systematically evaluate different versions of Hello Sunday Morning’s Daybreak program (with and without coaching support) in reducing at-risk alcohol use. Methods: We will use a between groups randomized control design. New participants enrolling in the Daybreak program will be eligible to be randomized to receive either (1) the Daybreak program, including peer support plus behavioral experiments (these encourage and guide participants in developing new skills in the areas of mindfulness, connectedness, resilience, situational strategies, and health), or (2) the Daybreak program, including the same peer support plus behavioral experiments, but with online coaching support. We will recruit 467 people per group to detect an effect size of f=0.10. To be eligible, participants must be resident in Australia, aged ≥18 years, score ≥8 on the alcohol use disorders identification test (AUDIT), and not report prior treatment for cardiovascular disease. Results: The primary outcome measure will be reduction in the AUDIT-Consumption (AUDIT-C) scores. Secondary outcomes include mental health (Kessler’s K-10), days out of role (Kessler), alcohol consumed (measured with a 7-day drinking diary in standard 10 g drinks), and alcohol-related harms (CORE alcohol and drug survey). We will collect data at baseline and 1, 3, and 6 months and analyze them with random effects models, given the correlated data structure. Conclusions: A randomized trial is required to provide robust evidence of the impact of the online coaching component of the Daybreak program, including over an extended period. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110 (Archived by WebCite at http://www.webcitation.org/6zKRmp0aC) Registered Report Identifier: RR1-10.2196/9982 %R 10.2196/resprot.9982 %U http://www.researchprotocols.org/2018/5/e148/ %U https://doi.org/10.2196/resprot.9982 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e10650 %T The Efficacy of a Web-Based Screening and Brief Intervention for Reducing Alcohol Consumption Among Japanese Problem Drinkers: Protocol for a Single-Blind Randomized Controlled Trial %A Hamamura,Toshitaka %A Suganuma,Shinichiro %A Takano,Ayumi %A Matsumoto,Toshihiko %A Shimoyama,Haruhiko %+ Division of Clinical Psychology, Department of Integrated Educational Sciences, University of Tokyo, 7-3-1 Hongo, Tokyo, 113-0033, Japan, 81 3 5841 3904, hamamura@g.ecc.u-tokyo.ac.jp %K problem drinking %K Web-based interventions %K personalized normative feedback %K Japanese drinkers %K randomized controlled trial %D 2018 %7 30.05.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: The literature shows that computer-delivered interventions with personalized normative feedback can reduce problem drinking for up to 6 months in the West. Meanwhile, no studies have been conducted to examine the effects of such interventions among Japanese problem drinkers. Possible moderators associated with effectiveness of the intervention need to be also explored. Objective: The purpose of this study is to conduct a trial and examine the efficacy of a brief intervention with personal normative feedback and psychoeducation on several measures of alcohol consumption among Japanese problem drinkers. Additionally, this study will examine whether the level of alcohol use disorder and beliefs about the physical and psychological outcomes of drinking moderate the effect of the intervention on outcome measures. Methods: This study will conduct a single-blind, 2-armed randomized controlled trial. Japanese adults with an Alcohol Use Disorder Identification Test score of 8 or higher will be enrolled in the trial. Participants allocated to the intervention group will receive the intervention immediately after the baseline measurements, and participants allocated to the waitlist group will receive the intervention at the end of the trial. Outcome measures include drinking quantity, drinking frequency, and alcohol-related consequences. Follow-up assessment will take place at 1 month, 2 months, and 6 months following the baseline measurement. The authors will not know the group allocation during trial. The authors will plan to collect a sample of 600 participants. Mixed-effect analyses of variance will be used to examine the main effects of condition, the main effects of time, and the interaction effects between condition and time on outcome variables. Results: Enrollment for the trial began on January 6, 2018 and data are expected to be available by August 2018. Conclusions: This study will contribute to the literature by demonstrating the efficacy of Web-based screenings and brief interventions among Japanese problem drinkers and indicating several possible moderators between the intervention and outcomes. This type of Web-based brief intervention has the possibility of being implemented in Japanese schools and workplaces as a prevention tool. Trial Registration: UMIN Clinical Trials Registry R000034388; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi? recptno=R000034388 (Archived by WebCite at http://www.webcitation.org/6xmOoTfTI) Registered Report Identifier: RR1-10.2196/10650 %R 10.2196/10650 %U http://www.researchprotocols.org/2018/5/e10650/ %U https://doi.org/10.2196/10650 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10034 %T Attention and Cognitive Bias Modification Apps: Review of the Literature and of Commercially Available Apps %A Zhang,Melvyn %A Ying,JiangBo %A Song,Guo %A Fung,Daniel SS %A Smith,Helen %+ National Addictions Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K smartphone %K mHealth %K psychiatry %K telemedicine %K mobile applications %D 2018 %7 24.05.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Automatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically. Objective: The objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically. Methods: To identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were “attention bias” OR “cognitive bias” AND “smartphone” OR “smartphone application” OR “smartphone app” OR “mobile phones” OR “mobile application” OR mobile app” OR “personal digital assistant.” To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were “attention bias” and “cognitive bias.” We also conducted a manual search on the apps with published evaluations. Results: The effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature. Conclusions: This is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically. %M 29793899 %R 10.2196/10034 %U http://mhealth.jmir.org/2018/5/e10034/ %U https://doi.org/10.2196/10034 %U http://www.ncbi.nlm.nih.gov/pubmed/29793899 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e196 %T Alcohol Consumption Reduction Among a Web-Based Supportive Community Using the Hello Sunday Morning Blog Platform: Observational Study %A Kirkman,Jessica Jane Louise %A Leo,Briony %A Moore,Jamie Christopher %+ Hello Sunday Morning, 3/487 Elizabeth St, Surry Hills, 2010, Australia, 61 1300 403 196, jessica@hellosundaymorning.org %K alcohol drinking %K internet %K Web-based brief alcohol intervention %K moderate drinking %K alcohol use %K alcohol abuse %K binge drinking %K internet intervention %K relapse prevention %K drinking behavior %K alcoholic intoxication %K social network %K blogging %K blog search %K internet media %K platforms %K community %K engagement %D 2018 %7 17.5.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol misuse is a major social and public health issue in Australia, with an estimated cost to the community of Aus $30 billion per annum. Until recently, a major barrier in addressing this significant public health issue is the fact that the majority of individuals with alcohol use disorders and alcohol misuse are not receiving treatment. Objective: This study aimed to assess whether alcohol consumption changes are associated with participation in Hello Sunday Morning’s blog platform, an online forum discussing experiences in abstaining from alcohol. Methods: The study reports on Hello Sunday Morning participants who signed up for a 3-month period of abstinence from November 2009 to November 2016. The sample comprised 1917 participants (female: 1227/1917, 64.01%; male: 690/1917, 35.99%). Main outcome measures were Alcohol Use Disorders Identification Test (AUDIT) scores, mood, program engagement metrics, and slip-ups. Results: Individuals who reported hazardous (preprogram AUDIT mean 11.92, SD 2.25) and harmful consumption levels (preprogram AUDIT mean 17.52, SD 1.08) and who engaged in the Hello Sunday Morning program reported a significant decrease in alcohol consumption, moving to lower risk consumption levels (hazardous, mean 7.59, SD 5.70 and harmful, mean 10.38, SD 7.43), 4 months following program commencement (P<.001). Those who reported high-risk or dependent consumption levels experienced the biggest reduction (preprogram mean 25.38, SD 4.20), moving to risky consumption (mean 15.83, SD 11.11), 4 months following program commencement (P<.001). These reductions in risk were maintained by participants in each group, 7 months following program commencement. Furthermore, those who engaged in the program more (as defined by more sign-ins, blogs posted, check-ins completed, and engagement with the community through likes and following) had lower alcohol consumption. Finally, those who experienced more slip-ups had lower alcohol consumption. Conclusions: Participation in an online forum can support long-term behavior change in individuals wishing to change their drinking behavior. Importantly, reductions in AUDIT scores appeared larger for those drinking at high-risk and hazardous levels before program commencement. This has promising implications for future models of alcohol reduction treatment, as online forums are an anonymous, accessible, and cost-effective alternative or adjunct to treatment-as-usual. Further research is needed into the specific mechanisms of change within a Web-based supportive community, as well as the role of specific mood states in predicting risky drinking behavior. %R 10.2196/jmir.9605 %U http://www.jmir.org/2018/5/e196/ %U https://doi.org/10.2196/jmir.9605 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e4 %T The Rise of New Alcoholic Games Among Adolescents and the Consequences in the Emergency Department: Observational Retrospective Study %A Barbieri,Stefania %A Omizzolo,Luca %A Tredese,Alberto %A Vettore,Gianna %A Calaon,Alberto %A Behr,Astrid Ursula %A Snenghi,Rossella %A Montisci,Massimo %A Gaudio,Rosa Maria %A Paoli,Andrea %A Pietrantonio,Vincenzo %A Santi,Jacopo %A Donato,Daniele %A Carretta,Giovanni %A Dolcet,Annalisa %A Feltracco,Paolo %+ Department of Urgent and Emergency Care, University of Padova, Via Giustiniani, 2, Padova,, Italy, 39 04 98074414, stefibarbieri118@gmail.com %K adolescent %K neknomination %K binge drinking %K alcoholic games %K social network %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The links between the internet and teenager behavior are difficult situations to control and may lead to the development of new and excessive methods of drinking alcohol during alcoholic games. Findings indicate that reported cases are very useful sources for better understanding of alcoholic games, yielding successful measures promoting health among adolescents. Admittance of adolescents to hospital emergency departments (EDs) after consumption of excessive amounts of alcohol has become the norm in developed countries. The harmful effects of acute alcohol abuse are reported in this paper. Objective: The aim of this work was to investigate the close connections between new drinking behaviors among adolescents and study the increase in new alcoholic games, together with the challenges that cause acute alcohol intoxication, the influence of the internet and social networks, and their consequences for public health services. Methods: Data came from prehospital and intrahospital admissions attributable to alcohol consumption. From 2013 to 2015, 3742 patients were admitted to EDs due to acute alcohol intoxication: 830 of them were aged 15 to 30 years, and 225 were adolescents and young adults between 15 and 20 years who had been playing alcoholic games. Retrospectively, diagnostic data associated with extrahospital anamneses were selected by one of the hospital management information systems, Qlik. As a result of our previous experience, questionnaires and face-to-face interviews were performed at a later stage, when a clinical audit for intoxicated adolescent patients was described, with the overall goal of establishing a potential methodological workflow and adding important information to research carried out so far. Results: Between 2013 and 2015, 830 young patients aged 15 to 30 years were admitted to EDs for acute alcohol intoxication. About 20% (166/830) of the sample confirmed that they had drunk more than 5 alcoholic units within 2 hours twice during the past 30 days as a result of binge drinking. Referring to new alcoholic games, 41% of the sample stated that they knew what neknomination is and also that at least one of their friends had accepted this challenge, describing symptoms such as vomiting, headache, altered behavior, increased talkativeness, and sociability. The median value of the weighted average cost of the diagnosis-related group relating to interventions provided by hospitals was the same for both genders, €46,091 (US $56,497; minimum €17,349 and maximum €46,091). Conclusions: Drinking games encourage young people to consume large quantities of alcohol within a short period of time putting them at risk of alcohol poisoning, which can potentially lead to accidental injuries, unsafe sex, suicide, sexual assault, and traffic accidents. The spread of these games through the internet and social networks is becoming a serious health problem facing physicians and medical professionals every day, especially in the ED; for this reason, it is necessary to be aware of the risks represented by such behaviors in order to recognize and identify preliminary symptoms and develop useful prevention programs. The strategic role of emergency services is to monitor and define the problem right from the start in order to control the epidemic, support planning, coordinate the delivery of assistance in the emergency phase, and provide medical education. Hospital-based interdisciplinary health care researchers collected specific data on hazardous drinking practices linked to evaluation of increased alcohol-related consequences and cases admitted to the ED. %M 31518328 %R 10.2196/pediatrics.6578 %U http://pediatrics.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/pediatrics.6578 %U http://www.ncbi.nlm.nih.gov/pubmed/31518328 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e7 %T Virtual Reality Cue Refusal Video Game for Alcohol and Cigarette Recovery Support: Summative Study %A Metcalf,Mary %A Rossie,Karen %A Stokes,Katie %A Tallman,Christina %A Tanner,Bradley %+ Clinical Tools, Inc, 101 Market Street, Suite A, Chapel Hill, NC,, United States, 1 919 960 8118, metcalf@clinicaltools.com %K addiction treatment %K Kinect %K serious games %K motion control games %K virtual reality %D 2018 %7 16.04.2018 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 29661748 %R 10.2196/games.9231 %U http://games.jmir.org/2018/2/e7/ %U https://doi.org/10.2196/games.9231 %U http://www.ncbi.nlm.nih.gov/pubmed/29661748 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e24 %T Standalone Effects of a Cognitive Behavioral Intervention Using a Mobile Phone App on Psychological Distress and Alcohol Consumption Among Japanese Workers: Pilot Nonrandomized Controlled Trial %A Hamamura,Toshitaka %A Suganuma,Shinichiro %A Ueda,Mami %A Mearns,Jack %A Shimoyama,Haruhiko %+ Division of Clinical Psychology, University of Tokyo, 7-3-1 Hongo, Bunkyo, Tokyo, 113-0033, Japan, 81 3 5841 3904, hamamura@g.ecc.u-tokyo.ac.jp %K mobile phone intervention %K cognitive behavioral therapy %K psychological distress %K drinking %K Japanese workers %D 2018 %7 22.03.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Research that investigates standalone effects of a mobile phone-based cognitive behavioral therapy without any human contact for reducing both psychological distress and risky drinking has been advancing; however, the number of studies is still limited. A mobile phone app called Self Record that facilitates cognitive restructuring through self-monitoring of daily thoughts and activities was developed in Japan. Objective: This study conducted a nonrandomized controlled pilot trial of the Self Record app to investigate standalone effects of the intervention on psychological distress and alcohol consumption among Japanese workers. Additionally, we examined moderating effects of negative mood regulation expectancies, which are beliefs about one’s ability to control one’s negative mood. Methods: A quasi-experimental design with a 1-month follow-up was conducted online in Japan from February 2016 to March 2016. A research marketing company recruited participants. The selection criteria were being a Japanese full-time worker (age 20-59 years), experiencing mild to moderate psychological distress, and having some interest in self-record apps. Assignment to group was based on participants’ willingness to use the app in the study. All participants completed outcome measures of negative mood regulation expectancies, positive well-being, general distress, depression, anxiety, and typical/most weekly alcohol consumption. Results: From the recruitment, 15.65% (1083/6921) of participants met the inclusion criteria. Of these, 51.43% (557/1083) enrolled in the study: 54.9% (306/557) in the intervention group and 45.1% (251/557) in the control group. At the 1-month follow-up, 15.3% (85/557) of participants had dropped out. Intention-to-treat analyses revealed that participants in the intervention group reported increased typical drinking (η2=.009) and heavy drinking (η2=.001). Adherence to using the app was low; 64.8% (199/306) of participants in the intervention group discontinued using the app on the first day. Additionally, 65.7% (366/557) of the total sample did not correctly answer the validity checks in the outcome measures (eg, “Please select ‘mildly agree’ for this item”). Therefore, per-protocol analyses were conducted after removing these participants. Results showed that continuing app users (42/127) in the intervention group reported increases in anxiety (η2=.006), typical drinking (η2=.005), and heavy drinking (η2=.007) compared to those in the control group (85/127). Negative mood regulation expectancies moderated the effects of the intervention for general distress (beta=.39). Conclusions: Results were contrary to our hypotheses. Self-recording methods of standalone mobile phone interventions may heighten individuals’ awareness of their pathological thought and drinking behavior, but may be insufficient to decrease them unless combined with a more intense or face-to-face intervention. Limitations include high attrition in this study; measures to improve the response rate are discussed. %M 29567634 %R 10.2196/mental.8984 %U http://mental.jmir.org/2018/1/e24/ %U https://doi.org/10.2196/mental.8984 %U http://www.ncbi.nlm.nih.gov/pubmed/29567634 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e23 %T Acute Effect of Alcohol Intake on Cardiovascular Autonomic Regulation During the First Hours of Sleep in a Large Real-World Sample of Finnish Employees: Observational Study %A Pietilä,Julia %A Helander,Elina %A Korhonen,Ilkka %A Myllymäki,Tero %A Kujala,Urho M %A Lindholm,Harri %+ Faculty of Biomedical Sciences and Engineering, BioMediTech Institute, Tampere University of Technology, Korkeakoulunkatu 3, Tampere, 33720, Finland, 358 405475334, julia.pietila@tut.fi %K heart rate %K heart rate variability %K sleep %K alcohol drinking %K autonomic nervous system %K wearable electronic device %D 2018 %7 16.03.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Sleep is fundamental for good health, and poor sleep has been associated with negative health outcomes. Alcohol consumption is a universal health behavior associated with poor sleep. In controlled laboratory studies, alcohol intake has been shown to alter physiology and disturb sleep homeostasis and architecture. The association between acute alcohol intake and physiological changes has not yet been studied in noncontrolled real-world settings. Objective: The aim of this study was to assess the effects of alcohol intake on the autonomic nervous system (ANS) during sleep in a large noncontrolled sample of Finnish employees. Methods: From a larger cohort, this study included 4098 subjects (55.81%, 2287/4098 females; mean age 45.1 years) who had continuous beat-to-beat R-R interval recordings of good quality for at least 1 day with and for at least 1 day without alcohol intake. The participants underwent continuous beat-to-beat R-R interval recording during their normal everyday life and self-reported their alcohol intake as doses for each day. Heart rate (HR), HR variability (HRV), and HRV-derived indices of physiological state from the first 3 hours of sleep were used as outcomes. Within-subject analyses were conducted in a repeated measures manner by studying the differences in the outcomes between each participant’s days with and without alcohol intake. For repeated measures two-way analysis of variance, the participants were divided into three groups: low (≤0.25 g/kg), moderate (>0.25-0.75 g/kg), and high (>0.75 g/kg) intake of pure alcohol. Moreover, linear models studied the differences in outcomes with respect to the amount of alcohol intake and the participant’s background parameters (age; gender; body mass index, BMI; physical activity, PA; and baseline sleep HR). Results: Alcohol intake was dose-dependently associated with increased sympathetic regulation, decreased parasympathetic regulation, and insufficient recovery. In addition to moderate and high alcohol doses, the intraindividual effects of alcohol intake on the ANS regulation were observed also with low alcohol intake (all P<.001). For example, HRV-derived physiological recovery state decreased on average by 9.3, 24.0, and 39.2 percentage units with low, moderate, and high alcohol intake, respectively. The effects of alcohol in suppressing recovery were similar for both genders and for physically active and sedentary subjects but stronger among young than older subjects and for participants with lower baseline sleep HR than with higher baseline sleep HR. Conclusions: Alcohol intake disturbs cardiovascular relaxation during sleep in a dose-dependent manner in both genders. Regular PA or young age do not protect from these effects of alcohol. In health promotion, wearable HR monitoring and HRV-based analysis of recovery might be used to demonstrate the effects of alcohol on sleep on an individual level. %M 29549064 %R 10.2196/mental.9519 %U http://mental.jmir.org/2018/1/e23/ %U https://doi.org/10.2196/mental.9519 %U http://www.ncbi.nlm.nih.gov/pubmed/29549064 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 3 %P e55 %T Augmenting Outpatient Alcohol Treatment as Usual With Online Alcohol Avoidance Training: Protocol for a Double-Blind Randomized Controlled Trial %A Bratti-van der Werf,Marleen KJ %A Laurens,Melissa C %A Postel,Marloes G %A Pieterse,Marcel E %A Ben Allouch,Somaya %A Wiers,Reinout W %A Bohlmeijer,Ernst T %A Salemink,Elske %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, PO Box 70.000, Enschede, 7500 KB, Netherlands, 31 88 019 3789, m.c.laurens@saxion.nl %K cognitive bias modification %K alcohol %K Alcohol Avoidance Training %K Approach-Avoidance Task %K treatment as usual %K cognitive behavioral treatment %D 2018 %7 01.03.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent theoretical models emphasize the role of impulsive processes in alcohol addiction, which can be retrained with computerized Cognitive Bias Modification (CBM) training. In this study, the focus is on action tendencies that are activated relatively automatically. Objective: The aim of the study is to examine the effectiveness of online CBM Alcohol Avoidance Training using an adapted Approach-Avoidance Task as a supplement to treatment as usual (TAU) in an outpatient treatment setting. Methods: The effectiveness of 8 online sessions of CBM Alcohol Avoidance Training added to TAU is tested in a double-blind, randomized controlled trial with pre- and postassessments, plus follow-up assessments after 3 and 6 months. Participants are adult patients (age 18 years or over) currently following Web-based or face-to-face TAU to reduce or stop drinking. These patients are randomly assigned to a CBM Alcohol Avoidance or a placebo training. The primary outcome measure is a reduction in alcohol consumption. We hypothesize that TAU + CBM will result in up to a 13-percentage point incremental effect in the number of patients reaching the safe drinking guidelines compared to TAU + placebo CBM. Secondary outcome measures include an improvement in health status and a decrease in depression, anxiety, stress, and possible mediation by the change in approach bias. Finally, patients’ adherence, acceptability, and credibility will be examined. Results: The trial was funded in 2014 and is currently in the active participant recruitment phase (since May 2015). Enrolment will be completed in 2019. First results are expected to be submitted for publication in 2020. Conclusions: The main purpose of this study is to increase our knowledge about the added value of online Alcohol Avoidance Training as a supplement to TAU in an outpatient treatment setting. If the added effectiveness of the training is proven, the next step could be to incorporate the intervention into current treatment. Trial Registration: Netherlands Trial Register NTR5087; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5087 (Archived at WebCite http://www.webcitation.org/6wuS4i1tH) %M 29496657 %R 10.2196/resprot.9287 %U https://www.researchprotocols.org/2018/3/e55/ %U https://doi.org/10.2196/resprot.9287 %U http://www.ncbi.nlm.nih.gov/pubmed/29496657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e69 %T Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression %A Garnett,Claire %A Crane,David %A Brown,Jamie %A Kaner,Eileen %A Beyer,Fiona %A Muirhead,Colin %A Hickman,Matthew %A Redmore,James %A de Vocht,Frank %A Beard,Emma %A Michie,Susan %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 1742, c.garnett@ucl.ac.uk %K alcohol drinking %K behavior, addictive %K regression analysis %K meta-analysis %K randomized controlled trial %K Internet %D 2018 %7 28.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Applying theory to the design and evaluation of interventions is likely to increase effectiveness and improve the evidence base from which future interventions are developed, though few interventions report this. Objective: The aim of this paper was to assess how digital interventions to reduce hazardous and harmful alcohol consumption report the use of theory in their development and evaluation, and whether reporting of theory use is associated with intervention effectiveness. Methods: Randomized controlled trials were extracted from a Cochrane review on digital interventions for reducing hazardous and harmful alcohol consumption. Reporting of theory use within these digital interventions was investigated using the theory coding scheme (TCS). Reported theory use was analyzed by frequency counts and descriptive statistics. Associations were analyzed with meta-regression models. Results: Of 41 trials involving 42 comparisons, half did not mention theory (50% [21/42]), and only 38% (16/42) used theory to select or develop the intervention techniques. Significant heterogeneity existed between studies in the effect of interventions on alcohol reduction (I2=77.6%, P<.001). No significant associations were detected between reporting of theory use and intervention effectiveness in unadjusted models, though the meta-regression was underpowered to detect modest associations. Conclusions: Digital interventions offer a unique opportunity to refine and develop new dynamic, temporally sensitive theories, yet none of the studies reported refining or developing theory. Clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behavior change theories. %M 29490895 %R 10.2196/jmir.8807 %U http://www.jmir.org/2018/2/e69/ %U https://doi.org/10.2196/jmir.8807 %U http://www.ncbi.nlm.nih.gov/pubmed/29490895 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e57 %T Web-Based Alcohol, Smoking, and Substance Involvement Screening Test Results for the General Spanish Population: Cross-Sectional Study %A Lopez-Rodriguez,Juan A %A Rubio Valladolid,Gabriel %+ Primary Care Research Unit, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Calle San Martín de Porres 6, Madrid, 28035, Spain, 34 913700696, juanantonio.lopez@salud.madrid.org %K screening %K substance-related disorders %K Web-based systems %K primary health care %K ASSIST %D 2018 %7 16.02.2018 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 29453188 %R 10.2196/jmir.7121 %U http://www.jmir.org/2018/2/e57/ %U https://doi.org/10.2196/jmir.7121 %U http://www.ncbi.nlm.nih.gov/pubmed/29453188 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e35 %T A Text Message Intervention with Adaptive Goal Support to Reduce Alcohol Consumption Among Non-Treatment-Seeking Young Adults: Non-Randomized Clinical Trial with Voluntary Length of Enrollment %A Suffoletto,Brian %A Chung,Tammy %A Muench,Frederick %A Monti,Peter %A Clark,Duncan B %+ Department of Emergency Medicine, University of Pittsburgh, Suite 400, Iroquois Building, 3600 Forbes Avenue, Pittsburgh, PA, 15261, United States, 1 412 901 6892, suffbp@upmc.edu %K binge drinking %K young adult %K text messaging %D 2018 %7 16.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stand-alone text message–based interventions can reduce binge drinking episodes (≥4 drinks for women and ≥5 drinks for men) among nontreatment-seeking young adults, but may not be optimized. Adaptive text message support could enhance effectiveness by assisting context-specific goal setting and striving, but it remains unknown how to best integrate it into text message interventions. Objective: The objective of this study was to evaluate young adults’ engagement with a text message intervention, Texting to Reduce Alcohol Consumption 2 (TRAC2), which focuses on reducing weekend alcohol consumption. TRAC2 incorporated preweekend drinking-limit goal-commitment ecological momentary assessments (EMA) tailored to past 2-week alcohol consumption, intraweekend goal reminders, self-efficacy EMA with support tailored to goal confidence, and maximum weekend alcohol consumption EMA with drinking limit goal feedback. Methods: We enrolled 38 nontreatment-seeking young adults (aged 18 to 25 years) who screened positive for hazardous drinking in an urban emergency department. Following a 2-week text message assessment-only run-in, subjects were given the opportunity to enroll in 4-week intervention blocks. We examined patterns of EMA responses and voluntary re-enrollment. We then examined how goal commitment and goal self-efficacy related to event-level alcohol consumption. Finally, we examined the association of length of TRAC2 exposure with alcohol-related outcomes from baseline to 3-month follow-up. Results: Among a diverse sample of young adults (56% [28/50] female, 54% [27/50] black, 32% [12/50] college enrolled), response rates to EMA queries were, on average, 82% for the first 4-week intervention block, 75% for the second 4-week block, and 73% for the third 4-week block. In the first 4 weeks of the intervention, drinking limit goal commitment was made 68/71 times it was prompted (96%). The percentage of subjects being prompted to commit to a drinking limit goal above the binge threshold was 52% (15/29) in week 1 and decreased to 0% (0/15) by week 4. Subjects met their goal 130/146 of the times a goal was committed to (89.0%). There were lower rates of goal success when subjects reported lower confidence (score <4) in meeting the goal (76% [32/42 weekends]) compared with that when subjects reported high confidence (98% [56/57 weekends]; P=.001). There were reductions in alcohol consumption from baseline to 3 months, but reductions were not different by length of intervention exposure. Conclusions: Preliminary evidence suggests that nontreatment-seeking young adults will engage with a text message intervention incorporating self-regulation support features, resulting in high rates of weekend drinking limit goal commitment and goal success. %M 29453191 %R 10.2196/mhealth.8530 %U http://mhealth.jmir.org/2018/2/e35/ %U https://doi.org/10.2196/mhealth.8530 %U http://www.ncbi.nlm.nih.gov/pubmed/29453191 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e18 %T Mobile Phone Apps for Behavioral Interventions for At-Risk Drinkers in Australia: Literature Review %A Choo,Carol C %A Burton,André A D %+ College of Healthcare Sciences, James Cook University, 149 Sims Drive, Singapore, 387380, Singapore, 65 67093760, carol.choo@jcu.edu.au %K problem drinking %K alcohol drinking %K eHealth %K telemedicine %K smartphone %K mobile applications %K behavioral intervention %K risk reduction behavior %K review %D 2018 %7 13.02.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The mobile technology era has ushered in the use of mobile phone apps for behavioral intervention for at-risk drinkers. Objective: Our objective was to review recent research relevant to mobile phone apps that can be used for behavioral intervention for at-risk drinkers in Australia. Methods: The inclusion criteria for this review were articles published in peer-reviewed journals from 2001 to 2017 with use of the search terms “smartphone application,” “alcohol,” “substance,” “behavioural intervention,” “electronic health,” and “mobile health.” Results: In total, we identified 103 abstracts, screened 90 articles, and assessed 50 full-text articles that fit the inclusion criteria for eligibility. We included 19 articles in this review. Conclusions: This review highlighted the paucity of evidence-based and empirically validated research into effective mobile phone apps that can be used for behavioral interventions with at-risk drinkers in Australia. %M 29439946 %R 10.2196/mhealth.6832 %U https://mhealth.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/mhealth.6832 %U http://www.ncbi.nlm.nih.gov/pubmed/29439946 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e2 %T A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments %A Barbieri,Stefania %A Feltracco,Paolo %A Lucchetta,Vittorio %A Gaudio,Rosa Maria %A Tredese,Alberto %A Bergamini,Mauro %A Vettore,Gianna %A Pietrantonio,Vincenzo %A Avato,Francesco Maria %A Donato,Daniele %A Boemo,Deris Gianni %A Nesoti,Maria Vittoria %A Snenghi,Rossella %+ Department of Urgent and Emergency Care, University of Padova, Via Giustiniani 2, Padova,, Italy, 39 3479812611, stefibarbieri118@gmail.com %K alcohol drinking %K drinking behavior %K underage drinking %K binge drinking %K alcoholic intoxication %K adolescent %K neknomination %K binge drinking %K alcoholic games %K social network %D 2018 %7 31.01.2018 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 29386170 %R 10.2196/ijmr.6573 %U http://www.i-jmr.org/2018/1/e2/ %U https://doi.org/10.2196/ijmr.6573 %U http://www.ncbi.nlm.nih.gov/pubmed/29386170 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 10 %P e207 %T Internet-Delivered Dialectical Behavioral Therapy Skills Training for Suicidal and Heavy Episodic Drinkers: Protocol and Preliminary Results of a Randomized Controlled Trial %A Wilks,Chelsey %A Yin,Qingqing %A Ang,Sin Yee %A Matsumiya,Brandon %A Lungu,Anita %A Linehan,Marsha %+ Behavioral Research and Therapy Clinics, Department of Psychology, University of Washington, 3935 University Way, Seattle, WA, 98195, United States, 1 7027156241, wilksc@u.washington.edu %K dialectical behavioral therapy %K randomized controlled trial %K eMental health %K suicide %K heavy episodic drinking %K emotion dysregulation %D 2017 %7 25.10.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: The need to develop effective and accessible interventions for suicidal individuals engaging in heavy episodic drinking (HED) cannot be understated. While the link between alcohol use and suicidality is a complex one that remains to be elucidated, emotion dysregulation may play a key role in alcohol-related suicide risk in these individuals. Objective: In the current study, an 8-week Internet-delivered dialectical behavior therapy (DBT) skills training intervention was developed and preliminarily evaluated for suicidal individuals who engage in HED to regulate emotions. The aim of the study is to evaluate the feasibility and effectiveness of the therapist-assisted and Internet-delivered intervention, and to inform the design of a subsequent full-scale study. Methods: The study was a pilot randomized controlled trial comparing participants receiving immediate-treatment (n=30) to waitlist controls (n=29) over a period of 16 weeks. Intervention effects will be assessed longitudinally using hierarchical linear modeling and generalized estimating equations, along with analyses of effect sizes and clinically significant change. The primary outcomes are suicidal ideation, alcohol problems, and emotion dysregulation. Secondary outcomes include alcohol-related consequences, reasons for living, skills use, and depression. Results: The trial is ongoing. A total of 60 individuals returned their informed consent and were randomized, of whom 59 individuals were intended to treat. A total of 50 participants in the study were retained through the 16-week enrollment. Conclusions: There is a dearth of evidence-based treatment for individuals presenting with high risk and complex behaviors. Furthermore, computerized interventions may provide a beneficial alternative to traditional therapies. The particular clinical features and treatment needs of suicidal individuals who also engage in HED constitute key domains for further investigation that are needed to consolidate the design of appropriate interventions for this high-risk population. Trial Registration: Clinicaltrials.gov NCT02932241; https://clinicaltrials.gov/ct2/show/NCT02932241 (Archived by WebCite at http://www.webcitation.org/6uJHdQsC2) %M 29070480 %R 10.2196/resprot.7767 %U http://www.researchprotocols.org/2017/10/e207/ %U https://doi.org/10.2196/resprot.7767 %U http://www.ncbi.nlm.nih.gov/pubmed/29070480 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e38 %T Effectiveness of Optional Videoconferencing-Based Treatment of Alcohol Use Disorders: Randomized Controlled Trial %A Tarp,Kristine %A Bojesen,Anders Bo %A Mejldal,Anna %A Nielsen,Anette Søgaard %+ Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, Indgang 220B, Odense C, 5000, Denmark, 45 6550 9359, ktarp@health.sdu.dk %K treatment of alcohol use disorders %K alcoholism %K videoconferencing %K effectiveness %K adherence %K patient compliance %K premature dropout %K patient dropouts %D 2017 %7 29.09.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Treatment of alcohol use disorders (AUDs) is characterized by an adherence rate below 50%. Clinical research has found that patient adherence enhances treatment effect; hence, health authorities, clinicians, and researchers strive to explore initiatives contributing to patients receiving treatment. Concurrently, videoconferencing-based treatment is gaining ground within other addiction and psychiatric areas. Objective: The aim of this study was to test whether optional videoconferencing increases adherence to and effectiveness of AUD treatment in a randomized controlled trial (RCT). We hypothesized that the intervention would decrease premature dropout (the primary outcome), as well as increase successful treatment termination, treatment duration, and treatment outcome (secondary outcomes). Methods: We conducted this study in the public outpatient alcohol clinic in Odense, Denmark, between September 2012 and April 2013. It was an RCT with 2 groups: treatment as usual (TAU) and treatment as usual with add-on intervention (TAU+I). The TAU+I group had the option, from session to session, to choose to receive treatment as usual via videoconferencing. Data consisted of self-reported responses to the European version of the Addiction Severity Index (EuropASI). We collected data at baseline, at follow-up at 3, 6, and 12 months, and at discharge. Results: Among consecutive patients attending the clinic, 128 met the inclusion criteria, and 71 of them were included at baseline. For the primary outcome, after 180 days, 2 of 32 patients (6%) in the TAU+I group and 12 of 39 patients (31%) in the TAU group had dropped out prematurely. The difference is significant (P=.008). After 365 days, 8 patients (25%) in the TAU+I group and 17 patients (44%) in the TAU group had dropped out prematurely. The difference is significant (P=.02). For the secondary outcomes, significantly more patients in the TAU+I group were still attending treatment after 1 year (P=.03). We found no significant differences between the 2 groups with regard to successful treatment termination and treatment outcome. Conclusions: The results indicate that offering patients optional videoconferencing may prevent premature dropouts from treatment and prolong treatment courses. However, the small sample size precludes conclusions regarding the effect of the intervention, which was not detectable in the patients’ use of alcohol and severity of problems. Trial Registration: The Regional Health Research Ethics Committee System in Denmark: S-20110052; https://komite.regionsyddanmark.dk/wm258128 (Archived by WebCite at http://www.webcitation.org/6tTL3CO6u) %M 28963093 %R 10.2196/mental.6713 %U http://mental.jmir.org/2017/3/e38/ %U https://doi.org/10.2196/mental.6713 %U http://www.ncbi.nlm.nih.gov/pubmed/28963093 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e3 %T Videoconferencing-Based Treatment of Alcohol Use Disorders: Analyses of Nonparticipation %A Tarp,Kristine %A Mejldal,Anna %A Nielsen,Anette Søgaard %+ Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, Indgang 220B, Odense C, 5000, Denmark, 45 6550 9359, ktarp@health.sdu.dk %K nonparticipation %K refusal to participate %K barriers %K treatment of alcohol use disorders %K alcoholism %K treatment refusal %K videoconferencing %K effectiveness %K treatment outcome %D 2017 %7 28.09.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: We recently conducted a small randomized controlled trial (RCT) aiming to examine the effectiveness of videoconferencing-based treatment of alcohol use disorders in a real-life setting. The patient and participation rates were lower than anticipated. Objective: The objectives of our study were (1) to examine differences between participants and nonparticipants, and (2) to examine the characteristics of nonparticipants and their reported reasons for not participating. Methods: First, we analyzed nonparticipation through a comparative analysis of participants and nonparticipants using data from a clinical database, covering all patients starting treatment at the clinic. Second, on the basis of data from an anonymous questionnaire filled out by nonparticipants, we analyzed barriers to participating and the descriptive sociodemographics of nonparticipants who reported technical barriers versus those who did not. Results: Of 128 consecutive patients starting treatment during the study period, we found no significant differences between participants (n=71) and nonparticipants (n=51) according to sociodemographics, alcohol measures, and composite scores. Of 51 nonparticipants, 43 filled out the questionnaire with reasons for not participating. We derived 2 categories of barriers from the questionnaire: scientific barriers, which were barriers to the scientific study in general (n=6), and technical barriers, which were barriers to using a laptop or videoconferencing specifically (n=27). We found no significant differences in sociodemographics between nonparticipants who reported technical barriers to participating in the study and those who did not note technical barriers. A total of 13 patients elaborated on technical barriers, and 9 patients found videoconferencing impersonal, preferred personal contact, and would rather attend face-to-face treatment at the clinic. Conclusions: Patient barriers to participating in the RCT were mainly concerned with the technology. There were no significant differences between participants and nonparticipants, nor between nonparticipants who noted technical barriers to participating and those who did not. If a similar study is to be conducted or the solution is to be upscaled and implemented, attention should be given to the user friendliness of the technical equipment and the recruitment process, preparing the patients by emphasizing the information given to them about the technical equipment and its advantages. %M 30684431 %R 10.2196/formative.6715 %U http://formative.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/formative.6715 %U http://www.ncbi.nlm.nih.gov/pubmed/30684431 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e49 %T The Use of Facebook Advertising for Communicating Public Health Messages: A Campaign Against Drinking During Pregnancy in New Zealand %A Parackal,Mathew %A Parackal,Sherly %A Eusebius,Shobhit %A Mather,Damien %+ Department of Marketing, University of Otago, Suite 6.35, Commerce Building, 60 Clyde Street, Dunedin, 9035, New Zealand, 64 34797696, mathew.parackal@otago.ac.nz %K social media %K health promotion %K alcohol %K pregnancy %K New Zealand %D 2017 %7 10.08.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media is gaining recognition as a platform for delivering public health messages. One area attracting attention from public health researchers and professionals is Facebook’s advertising channel. This channel is reported to have a broad reach and generate high user engagement with the disseminated campaign materials. However, to date, no study has examined the communication process via this channel which this study aimed to address. Objective: The specific objectives of the study were to (1) examine user engagement for a public health campaign based on the metadata provided by Facebook, (2) analyze comments generated by the campaign materials using text mining, and (3) investigate the relationship between the themes identified in the comments and the message and the sentiments prevalent in the themes that exhibited significant relationships. Methods: This study examined a New Zealand public health pilot campaign called “Don’t Know? Don’t Drink,” which warned against drinking alcohol during pregnancy. The campaign conveyed the warning through a video and three banner ads that were delivered as news feeds to women aged 18-30 years. Thematic analysis using text mining performed on the comments (n=819) identified four themes. Logistic regression was used to identify meaning-making themes that exhibited association with the message. Results: The users’ engagement was impressive with the video receiving 203,754 views. The combined likes and shares for the promotional materials (video and banner ads) amounted to 6125 and 300, respectively. The logistic regression analysis showed two meaning-making themes, namely, risk of pregnancy (P=.003) and alcohol and culture (P<.001) exhibited association with the message. The sentiment analysis carried out on the two themes revealed there were more negative than positive comments (47% vs 28%). Conclusions: The user engagement observed in this study was consistent with previous research. The numbers reported for views, likes, and shares may be seen as unique interactions over the fixed period of the campaign; however, survey research would be required to find out the true evaluative worth of these metadata. A close examination of the comments, employing text mining, revealed that the message was not accepted by a majority of the target segment. Self-identity and conformity theories may help to explain these observed reactions, albeit warrant further investigations. Although the comments were predominantly negative, they provide opportunities to engage back with the women. The one-way communication format followed in this campaign did not support any two-way engagement. Further investigation is warranted to establish whether using a two-way communication format would have improved the acceptability of such public health messages delivered via social media. The findings of this study caution using a one-way communication format to convey public health messages via Facebook’s advertising channel. %M 28798011 %R 10.2196/publichealth.7032 %U http://publichealth.jmir.org/2017/3/e49/ %U https://doi.org/10.2196/publichealth.7032 %U http://www.ncbi.nlm.nih.gov/pubmed/28798011 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e109 %T Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults %A Milward,Joanna %A Deluca,Paolo %A Drummond,Colin %A Watson,Rod %A Dunne,Jacklyn %A Kimergård,Andreas %+ Addictions Department, King's College London, 4 Windsor Walk, Denmark Hill, London, SE58BB, United Kingdom, 44 7590829898, joanna.milward@kcl.ac.uk %K alcohol %K drinking %K young adults %K mHealth %K brief intervention %K apps %K usability testing %K user experience %K focus group %D 2017 %7 08.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As “Digital Natives,” young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. Objective: The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. Methods: The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. Results: The first theme, “Functionality” referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, “Design” described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, “Content” described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. Conclusions: There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization. %M 28790022 %R 10.2196/mhealth.7836 %U http://mhealth.jmir.org/2017/8/e109/ %U https://doi.org/10.2196/mhealth.7836 %U http://www.ncbi.nlm.nih.gov/pubmed/28790022 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e90 %T Mobile Health Technology Using a Wearable Sensorband for Female College Students With Problem Drinking: An Acceptability and Feasibility Study %A Leonard,Noelle Regina %A Silverman,Michelle %A Sherpa,Dawa Phuti %A Naegle,Madeline A %A Kim,Hyorim %A Coffman,Donna L %A Ferdschneider,Marcy %+ Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, 433 1st Avenue, 6th Floor, New York, NY, 10010, United States, 1 212 992 7167, nrl4@nyu.edu %K wearable sensors %K ecological momentary intervention %K college students %K alcohol use %K feasibility studies %K acceptability studies %D 2017 %7 07.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: An increasing number of mobile app interventions have been developed for problem drinking among college students; however, few studies have examined the integration of a mobile app with continuous physiological monitoring and alerting of affective states related to drinking behaviors. Objective: The aim of this paper was to evaluate the acceptability and feasibility of Mind the Moment (MtM), a theoretically based intervention for female college students with problem drinking that combines brief, in-person counseling with ecological momentary intervention (EMI) on a mobile app integrated with a wearable sensorband. Methods: We recruited 10 non-treatment seeking, female undergraduates from a university health clinic who scored a 3 or higher on the Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) to participate in this pilot study. Study activities involved an in-person baseline intake and 1 follow-up assessment, 2 in-person alcohol brief intervention counseling sessions, and use of MtM technology components (sensorband and EMI on a mobile app) for approximately 3-4 weeks. The intervention used motivational interviewing (MI) and cognitive behavioral therapy (CBT) strategies for reducing risks associated with drinking. We used both qualitative and quantitative assessments to measure acceptability of the intervention and feasibility of delivery. Use patterns of the sensorband and mobile app were also collected. Results: Quantitative and qualitative data indicated high levels of acceptability for the MtM intervention. Altogether, participants made reports on the app on 26.7% (78/292) the days the technology was available to them and completed a total of 325 reports with wide variation between participants. Qualitative findings indicated that sensorband-elicited alerts promoted an increase in awareness of thoughts, feelings, and behaviors related to current environmental stressors and drinking behaviors in theoretically meaningful ways. Specific challenges related to functionality and form of the sensorband were identified. Conclusions: Delivering intervention material “just-in-time,” at the moment participants need to use behavioral strategies has great potential to individualize behavioral interventions for reducing problem drinking and other health behaviors. These findings provide initial evidence for the promise of wearable sensors for increasing potency of theoretically grounded mobile health interventions and point to directions for future research and uptake of these technologies. %M 28687533 %R 10.2196/mhealth.7399 %U http://mhealth.jmir.org/2017/7/e90/ %U https://doi.org/10.2196/mhealth.7399 %U http://www.ncbi.nlm.nih.gov/pubmed/28687533 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e123 %T The Feasibility and Acceptability of a Web-Based Alcohol Management Intervention in Community Sports Clubs: A Cross-Sectional Study %A McFadyen,Tameka %A Wolfenden,Luke %A Wiggers,John %A Tindall,Jenny %A Yoong,Sze Lin %A Lecathelinais,Christophe %A Gillham,Karen %A Sherker,Shauna %A Rowland,Bosco %A McLaren,Nicola %A Kingsland,Melanie %+ School of Medicine and Public Health, Faculty of Health, The University of Newcastle, Booth Building, Longworth Avenue, Wallsend,, Australia, 61 2 4926 6499 ext 6499, tameka-rae.small@hnehealth.nsw.gov.au %K alcohol %K sports %K implementation %K technology %K TAM %K Web %K Internet %K eHealth %D 2017 %7 30.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The implementation of comprehensive alcohol management strategies can reduce excessive alcohol use and reduce the risk of alcohol-related harm at sporting venues. Supporting sports venues to implement alcohol management strategies via the Web may represent an effective and efficient means of reducing harm caused by alcohol in this setting. However, the feasibility and acceptability of such an approach is unknown. Objective: This study aimed to identify (1) the current access to and use of the Web and electronic devices by sports clubs; (2) the perceived usefulness, ease of use, and intention to use a Web-based program to support implementation of alcohol management policies in sports clubs; (3) the factors associated with intention to use such a Web-based support program; and (4) the specific features of such a program that sports clubs would find useful. Methods: A cross-sectional survey was conducted with club administrators of community football clubs in the state of New South Wales, Australia. Perceived usefulness, ease of use and intention to use a hypothetical Web-based alcohol management support program was assessed using the validated Technology Acceptance Model (TAM) instrument. Associations between intention to use a Web-based program and club characteristics as well as perceived ease of use and usefulness was tested using Fisher’s exact test and represented using relative risk (RR) for high intention to use the program. Results: Of the 73 football clubs that were approached to participate in the study, 63 consented to participate and 46 were eligible and completed the survey. All participants reported having access to the Web and 98% reported current use of electronic devices (eg, computers, iPads/tablets, smartphones, laptops, televisions, and smartboards). Mean scores (out of a possible 7) for the TAM constructs were high for intention to use (mean 6.25, SD 0.87), perceived ease of use (mean 6.00, SD 0.99), and perceived usefulness (mean 6.17, SD 0.85). Intention to use the Web-based alcohol management program was significantly associated with perceived ease of use (P=.02, RR 1.4, CI 1.0-2.9), perceived usefulness (P=.03, RR 1.5, CI 1.0-6.8) and club size (P=.02, RR 0.8, CI 0.5-0.9). The most useful features of such a program included the perceived ability to complete program requirements within users’ own time, complete program accreditation assessment and monitoring online, develop tailored action plans, and receive email reminders and prompts to complete action. Conclusions: A Web-based alcohol management approach to support sports clubs in the implementation of recommended alcohol management policies appears both feasible and acceptable. Future research should aim to determine if such intended use leads to actual use and club implementation of alcohol management policies. %M 28666977 %R 10.2196/resprot.6859 %U http://www.researchprotocols.org/2017/6/e123/ %U https://doi.org/10.2196/resprot.6859 %U http://www.ncbi.nlm.nih.gov/pubmed/28666977 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e25 %T Initial Progress Toward Development of a Voice-Based Computer-Delivered Motivational Intervention for Heavy Drinking College Students: An Experimental Study %A Kahler,Christopher W %A Lechner,William J %A MacGlashan,James %A Wray,Tyler B %A Littman,Michael L %+ Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Box G-S121-4, Providence, RI, RI/02912, United States, 1 401 863 6651, Christopher_Kahler@brown.edu %K Computer-delivered intervention %K voice-based systems %K alcohol intervention %K heavy drinking %D 2017 %7 28.06.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Computer-delivered interventions have been shown to be effective in reducing alcohol consumption in heavy drinking college students. However, these computer-delivered interventions rely on mouse, keyboard, or touchscreen responses for interactions between the users and the computer-delivered intervention. The principles of motivational interviewing suggest that in-person interventions may be effective, in part, because they encourage individuals to think through and speak aloud their motivations for changing a health behavior, which current computer-delivered interventions do not allow. Objective: The objective of this study was to take the initial steps toward development of a voice-based computer-delivered intervention that can ask open-ended questions and respond appropriately to users’ verbal responses, more closely mirroring a human-delivered motivational intervention. Methods: We developed (1) a voice-based computer-delivered intervention that was run by a human controller and that allowed participants to speak their responses to scripted prompts delivered by speech generation software and (2) a text-based computer-delivered intervention that relied on the mouse, keyboard, and computer screen for all interactions. We randomized 60 heavy drinking college students to interact with the voice-based computer-delivered intervention and 30 to interact with the text-based computer-delivered intervention and compared their ratings of the systems as well as their motivation to change drinking and their drinking behavior at 1-month follow-up. Results: Participants reported that the voice-based computer-delivered intervention engaged positively with them in the session and delivered content in a manner consistent with motivational interviewing principles. At 1-month follow-up, participants in the voice-based computer-delivered intervention condition reported significant decreases in quantity, frequency, and problems associated with drinking, and increased perceived importance of changing drinking behaviors. In comparison to the text-based computer-delivered intervention condition, those assigned to voice-based computer-delivered intervention reported significantly fewer alcohol-related problems at the 1-month follow-up (incident rate ratio 0.60, 95% CI 0.44-0.83, P=.002). The conditions did not differ significantly on perceived importance of changing drinking or on measures of drinking quantity and frequency of heavy drinking. Conclusions: Results indicate that it is feasible to construct a series of open-ended questions and a bank of responses and follow-up prompts that can be used in a future fully automated voice-based computer-delivered intervention that may mirror more closely human-delivered motivational interventions to reduce drinking. Such efforts will require using advanced speech recognition capabilities and machine-learning approaches to train a program to mirror the decisions made by human controllers in the voice-based computer-delivered intervention used in this study. In addition, future studies should examine enhancements that can increase the perceived warmth and empathy of voice-based computer-delivered intervention, possibly through greater personalization, improvements in the speech generation software, and embodying the computer-delivered intervention in a physical form. %M 28659259 %R 10.2196/mental.7571 %U http://mental.jmir.org/2017/2/e25/ %U https://doi.org/10.2196/mental.7571 %U http://www.ncbi.nlm.nih.gov/pubmed/28659259 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e217 %T Web-Based Alcohol Intervention: Study of Systematic Attrition of Heavy Drinkers %A Radtke,Theda %A Ostergaard,Mathias %A Cooke,Richard %A Scholz,Urte %+ Department of Psychology, Applied Social and Health Psychology, University of Zurich, Binzmühlestrasse 14/14, Zurich, 8050, Switzerland, 41 44 635 72 55, theda.radtke@uzh.ch %K attrition %K dropout %K alcohol drinking %K intervention study %K Internet %K surveys and questionnaires %K university student drinking %K motivation %D 2017 %7 28.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based alcohol interventions are a promising way to reduce alcohol consumption because of their anonymity and the possibility of reaching a high numbers of individuals including heavy drinkers. However, Web-based interventions are often characterized by high rates of attrition. To date, very few studies have investigated whether individuals with higher alcohol consumption show higher attrition rates in Web-based alcohol interventions as compared with individuals with lower alcohol consumption. Objectives: The aim of this study was to examine the attrition rate and predictors of attrition in a Web-based intervention study on alcohol consumption. Methods: The analysis of the predictors of attrition rate was performed on data collected in a Web-based randomized control trial. Data collection took place at the University of Konstanz, Germany. A total of 898 people, which consisted of 46.8% males (420/898) and 53.2% females (478/898) with a mean age of 23.57 years (SD 5.19), initially volunteered to participate in a Web-based intervention study to reduce alcohol consumption. Out of the sample, 86.9% (781/898) were students. Participants were classified as non-completers (439/898, 48.9%) if they did not complete the Web-based intervention. Potential predictors of attrition were self-reported: alcohol consumption in the last seven days, per week, from Monday to Thursday, on weekends, excessive drinking behavior measured with the Alcohol Use Disorder Identification Test (AUDIT), and drinking motives measured by the Drinking Motive Questionnaire (DMQ-R SF). Results: Significant differences between completers and non-completers emerged regarding alcohol consumption in the last seven days (B=−.02, P=.05, 95% CI [0.97-1.00]), on weekends (B=−.05, P=.003, 95% CI [0.92-0.98]), the AUDIT (B=−.06, P=.007, 95% CI [0.90-0.98], and the status as a student (B=.72, P=.001, 95% CI [1.35-3.11]). Most importantly, non-completers had a significantly higher alcohol consumption compared with completers. Conclusions: Hazardous alcohol consumption appears to be a key factor of the dropout rate in a Web-based alcohol intervention study. Thus, it is important to develop strategies to keep participants who are at high risk in Web-based interventions. %M 28659251 %R 10.2196/jmir.6780 %U http://www.jmir.org/2017/6/e217/ %U https://doi.org/10.2196/jmir.6780 %U http://www.ncbi.nlm.nih.gov/pubmed/28659251 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e79 %T Beyond Basic Feedback in Mobile Brief Interventions: Designing SMS Message Content for Delivery to Young Adults During Risky Drinking Events %A Wright,Cassandra J C %A Dietze,Paul M %A Lim,Megan S C %+ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne,, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol drinking %K young adult %K mHealth %K text messaging %K motivational interviewing %K community-based participatory research %D 2017 %7 20.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Brief interventions can reduce alcohol consumption in young people through screening and delivery of personally relevant feedback. Recently, Web and mobile platforms have been harnessed to increase the reach of brief interventions. Existing literature on mobile-based alcohol brief interventions indicates mixed use of theory in developing interventions. There is no research available to guide the development of SMS text messaging (short message service, SMS) interventions delivered during risky drinking events. Objective: The aim of this study was to develop and pilot an alcohol-related risk-reduction brief intervention delivered by SMS to Australian young adults during drinking events. This paper describes the development of intervention message content, with specific focus on the context of delivery during drinking events. Methods: A sample of 42 young adults attended 4 workshops; these comprised focus-group style discussion on drinking habits and motivations, discussion of intervention design, analysis of existing alcohol media campaigns, and participant development of message content. Data were analyzed thematically. Results: Participants described a focus on having fun and blocking out any incongruent negative influences during drinking episodes. For content to be acceptable, nonjudgmental and non-authoritative language was deemed essential. A preference for short, actionable messages was observed, including suggestions for reminders around drinking water, organizing transport home, checking on friends, and plans the next day. Participants were excited about the potential for messages to be tailored to individuals, as previous alcohol-related campaigns were deemed too generic and often irrelevant. Normative-based messages were also perceived as largely irrelevant as participants felt that they understood the drinking-related norms of their immediate peers already. Conclusions: Findings from this study offer insights into young adults’ drinking events and practical advice for designing alcohol-related brief interventions. During our formative development process, we demonstrated a neat correspondence between young people’s preferences for alcohol harm reduction interventions and the theoretical principles of brief interventions, including acceptable topics and message style. %M 28634153 %R 10.2196/mhealth.6497 %U http://mhealth.jmir.org/2017/6/e79/ %U https://doi.org/10.2196/mhealth.6497 %U http://www.ncbi.nlm.nih.gov/pubmed/28634153 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e95 %T An Ecological Momentary Intervention to Reduce Alcohol Consumption in Young Adults Delivered During Drinking Events: Protocol for a Pilot Randomized Controlled Trial %A Wright,Cassandra JC %A Dietze,Paul M %A Agius,Paul A %A Kuntsche,Emmanuel %A Room,Robin %A Livingston,Michael %A Hellard,Margaret %A Lim,Megan SC %+ School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne,, Australia, 61 3 9282 2173, cassandra.wright@burnet.edu.au %K alcohol drinking %K young adult %K mHealth %K text messaging %K ecological momentary intervention %D 2017 %7 25.05.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Risky drinking is a significant public health issue in young Australian adults. Brief interventions are one of few effective methods of reducing risky drinking but are time and cost intensive; innovative methods of delivery are therefore of interest. Mobile phones offer new opportunities to collect data and intervene during risky drinking events. Mobile phones have successfully been used for delivery of alcohol-related brief interventions and data collection but not in combination with or during drinking events. Objective: This pilot study will investigate the efficacy of an ecological momentary intervention (EMI), with combined ecological momentary assessment (EMA) and brief intervention delivered by mobile phones to young adults during risky drinking events. Methods: We will use a 3-armed randomized controlled trial to investigate the efficacy of the intervention for reducing peak single occasion drinking. Our sample is recruited from an observational cohort study of young, risky drinkers. Participants will be randomized into 1 of 3 intervention arms. On 6 nights across a 12-week study period, EMI and EMA groups will complete hourly EMA surveys on their mobile phone. EMI participants will receive tailored feedback short message service (SMS) texts corresponding to their EMA survey responses. The EMI participants will not receive feedback SMS. A third group will have no contact (no-contact control). All groups will then be contacted for a follow-up interview within 4 weeks of the 12-week study period ending. Results: The primary outcome is mean reduction in standard drinks consumed during their most recent heavy drinking occasion as measured at follow-up. Secondary outcomes include alcohol consumption over the previous 6 months, experiences of alcohol-related harms, attitudes toward drinking and drunkenness, hazardous drinking and use of tobacco and illicit drugs. A random effects mixed modelling approach using maximum likelihood estimation will be used to provide estimates of differences in mean drinking levels between those receiving the intervention and control participants. Conclusions: This study is novel in that, unlike previous work, it will intervene repeatedly during single occasion drinking events. Further, it extends previous research in this area, which has applied limited tailoring of message content for SMS-based brief interventions. The findings of this study will contribute to the growing body of evidence to inform the use of mobile health interventions for reducing alcohol consumption and harms. Trial Registration: Australian New Zealand Clinical Trials ACTRN12616001323415; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/ 6qDqBZV9b) %M 28546136 %R 10.2196/resprot.6760 %U http://www.researchprotocols.org/2017/5/e95/ %U https://doi.org/10.2196/resprot.6760 %U http://www.ncbi.nlm.nih.gov/pubmed/28546136 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e119 %T Health Evaluation and Referral Assistant: A Randomized Controlled Trial of a Web-Based Screening, Brief Intervention, and Referral to Treatment System to Reduce Risky Alcohol Use Among Emergency Department Patients %A Haskins,Brianna L %A Davis-Martin,Rachel %A Abar,Beau %A Baumann,Brigitte M %A Harralson,Tina %A Boudreaux,Edwin D %+ University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211400, brianna.haskins@umassmed.edu %K alcohol consumption %K intervention study %K emergency medicine %K referral and consultation %D 2017 %7 01.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Computer technologies hold promise for implementing alcohol screening, brief intervention, and referral to treatment (SBIRT). Questions concerning the most effective and appropriate SBIRT model remain. Objective: The aim of this study was to evaluate the impact of a computerized SBIRT system called the Health Evaluation and Referral Assistant (HERA) on risky alcohol use treatment initiation. Methods: Alcohol users (N=319) presenting to an emergency department (ED) were considered for enrollment. Those enrolled (n=212) were randomly assigned to the HERA, to complete a patient-administered assessment using a tablet computer, or a minimal-treatment control, and were followed for 3 months. Analyses compared alcohol treatment provider contact, treatment initiation, treatment completion, and alcohol use across condition using univariate comparisons, generalized estimating equations (GEEs), and post hoc chi-square analyses. Results: HERA participants (n=212; control=115; intervention=97) did not differ between conditions on initial contact with an alcohol treatment provider, treatment initiation, treatment completion, or change in risky alcohol use behavior. Subanalyses indicated that HERA participants, who accepted a faxed referral, were more likely to initiate contact with a treatment provider and initiate treatment for risky alcohol use, but were not more likely to continue engaging in treatment, or to complete treatment and change risky alcohol use behavior over the 3-month period following the ED visit. Conclusions: The HERA promoted initial contact with an alcohol treatment provider and initiation of treatment for those who accepted the faxed referral, but it did not lead to reduced risky alcohol use behavior. Factors which may have limited the HERA’s impact include lack of support for the intervention by clinical staff, the low intensity of the brief and stand-alone design of the intervention, and barriers related to patient follow-through, (eg, a lack of transportation or childcare, fees for services, or schedule conflicts). Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): NCT01153373; https://clinicaltrials.gov/ct2/show/NCT01153373 (Archived by WebCite at http://www.webcitation.org/6pHQEpuIF) %M 28461283 %R 10.2196/jmir.6812 %U http://www.jmir.org/2017/5/e119/ %U https://doi.org/10.2196/jmir.6812 %U http://www.ncbi.nlm.nih.gov/pubmed/28461283 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e55 %T A Digital Tool to Promote Alcohol and Drug Use Screening, Brief Intervention, and Referral to Treatment Skill Translation: A Mobile App Development and Randomized Controlled Trial Protocol %A Satre,Derek D %A Ly,Khanh %A Wamsley,Maria %A Curtis,Alexa %A Satterfield,Jason %+ Weill Institute for Neurosciences, Department of Psychiatry, University of California, 401 Parnassus Avenue, Box 0984, San Francisco, CA, 94143, United States, 1 415 476 7382, Derek.Satre@ucsf.edu %K SBIRT %K mobile app %K digital health %K training, implementation %K alcohol %K drug %K depression %K anxiety %D 2017 %7 18.04.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Translation of knowledge and skills from classroom settings to clinical practice is a major challenge in healthcare training, especially for behavioral interventions. For example, screening, brief intervention, and referral to treatment (SBIRT) is a highly-promoted approach to identifying and treating individuals at risk for alcohol or drug problems, yet effective, routine use of SBIRT has lagged. Objective: The objective of this paper is to describe the development, pilot testing, and trial protocol of a mobile app based on the theory of planned behavior (TPB) to promote SBIRT skill translation and application. Methods: Intended for use after classroom training occurs, the mobile app has three primary functions designed to increase behavioral intent to deliver SBIRT: (1) review skills (ie, address knowledge and beliefs about SBIRT), (2) apply skills with patients (ie, build confidence and perceived behavioral control), and (3) report performance data (ie, increase accountability and social norms and/or influence). The app includes depression and anxiety screening tools due to high comorbidity with substance use. A randomized controlled trial (RCT) is in progress among health and social service learners (N=200) recruited from 3 universities and 6 different training programs in nursing, social work, internal medicine, psychiatry, and psychology. Participants are randomized to SBIRT classroom instruction alone or classroom instruction plus app access prior to beginning their field placement rotations. TPB-based data are collected via Qualtrics or via the mobile app pre-post and SBIRT utilization, weekly for 10 weeks. Key outcomes include the frequency of and self-reported confidence in delivery of SBIRT. Results: Beta testing with advanced practice nursing students (N=22) indicated that the app and its associated assessment tools were acceptable and useful. The system usability scale (SUS) mean was 65.8 (n=19), which indicated that the SBIRT app was acceptable but could benefit from improvement. Indeed, modifications were implemented prior to starting the trial. Enrollment of trial participants began in September 2016. Results are expected by December 2017. Conclusions: This report describes the process of TPB-based app development and testing, and the protocol for a RCT to determine the effectiveness of the app in enhancing skill translation. If effective, this approach could improve SBIRT implementation, fidelity, and clinical outcomes. %M 28420604 %R 10.2196/resprot.7070 %U http://www.researchprotocols.org/2017/4/e55/ %U https://doi.org/10.2196/resprot.7070 %U http://www.ncbi.nlm.nih.gov/pubmed/28420604 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 4 %P e49 %T The Impact of Mobile Apps on Alcohol Use Disorder: A Systematic Review Protocol %A Sawares,Antoine SA %A Shen,Nelson %A Xue,Yunlin %A Abi-Jaoude,Alexxa %A Wiljer,David %+ University Health Network, 190 Elizabeth Street, Room 441, Toronto, ON, M5G 2C4, Canada, 1 416 340 6322, David.wiljer@uhn.ca %K mobile health %K apps %K alcohol use disorder %K systematic review %K protocol %K mental health %K addiction %K alcoholism %D 2017 %7 04.04.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use disorder (AUD) is among the most prevalent mental disorders worldwide and is associated with a diverse range of physical and psychological comorbidities. Despite various types of treatment, there are many barriers to accessing treatment (ie, stigma, cost, accessibility of service, etc). Mobile apps have the potential to overcome these barriers and provide support to those who need it. Objective: The purpose of this systematic review is to assess the effectiveness of mobile apps in reducing alcohol consumption for individuals with AUD and understand the psychological outcomes of using the apps (ie, client empowerment, self-efficacy, etc). Methods: The search strategy was applied to 7 health sciences and interdisciplinary databases. Two reviewers will independently assess all titles and abstracts for relevance and then full texts of relevant articles for eligibility. To be included, the article must be a quantitative evaluation of clinical outcomes using the intervention and the intervention must be a consumer-facing app focused on supporting individuals with AUD. Two reviewers will independently extract data from all eligible articles using a standardized extraction worksheet and will independently assess the study quality. A meta-analysis will be conducted if appropriate. Depending on outcomes reported, pooled risk ratios or standardized mean differences will be calculated and reported in the review. Results: The search strategy yielded 699 unique citations. Of those, 63 (9.0%, 63/699) articles were assessed as relevant for full-text review. The full-text reviews are currently underway and the final review is projected to be completed in the summer of 2017. Conclusions: There is potential for mobile apps to support individuals with AUD to reduce their alcohol consumption. This review will be the first to assess the effectiveness of AUD mobile apps and client experiences using the apps. %M 28377366 %R 10.2196/resprot.6975 %U http://www.researchprotocols.org/2017/4/e49/ %U https://doi.org/10.2196/resprot.6975 %U http://www.ncbi.nlm.nih.gov/pubmed/28377366 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 1 %P e8 %T Current Views and Perspectives on E-Mental Health: An Exploratory Survey Study for Understanding Public Attitudes Toward Internet-Based Psychotherapy in Germany %A Apolinário-Hagen,Jennifer %A Vehreschild,Viktor %A Alkoudmani,Ramez M %+ Institute for Psychology, Department of Health Psychology, University of Hagen, Faculty of Humanities and Social Sciences, Bldg B, 1th Fl, Universitätsstraße 33, Hagen, 58097, Germany, 49 2331 987 2272, jennifer.apolinario-hagen@fernuni-hagen.de %K telemedicine %K mental health %K online self-help %K attitude to computers %K acceptability of health care %K patient acceptance of health care %K cognitive therapy %K stress, psychological %K diffusion of innovation %D 2017 %7 23.02.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the advanced development of evidence-based psychological treatment services, help-seeking persons with mental health problems often fail to receive appropriate professional help. Internet-delivered psychotherapy has thus been suggested as an efficient strategy to overcome barriers to access mental health care on a large scale. However, previous research indicated poor public acceptability as an issue for the dissemination of Internet-delivered therapies. Currently, little is known about the expectations and attitudes toward Internet-delivered therapies in the general population. This is especially the case for countries such as Germany where electronic mental health (e-mental health) treatment services are planned to be implemented in routine care. Objective: This pilot study aimed to determine the expectations and attitudes toward Internet-based psychotherapy in the general population in Germany. Furthermore, it aimed to explore the associations between attitudes toward Internet-based therapies and perceived stress. Methods: To assess public attitudes toward Internet-based psychotherapy, we conducted both Web-based and paper-and-pencil surveys using a self-developed 14-item questionnaire (Cronbach alpha=.89). Psychological distress was measured by employing a visual analogue scale (VAS) and the 20-item German version of the Perceived Stress Questionnaire (PSQ). In addition, we conducted explorative factor analysis (principal axis factor analysis with promax rotation). Spearman’s rank correlations were used to determine the associations between attitudes toward Internet-based therapies and perceived stress. Results: Descriptive analyses revealed that most respondents (N=1558; female: 78.95%, 1230/1558) indicated being not aware of the existence of Internet-delivered therapies (83.46%, 1141/1367). The average age was 32 years (standard deviation, SD 10.9; range 16-76). Through exploratory factor analysis, we identified 3 dimensions of public attitudes toward Internet-based therapies, which we labeled “usefulness or helpfulness,” “relative advantage or comparability,” and “accessibility or access to health care.” Analyses revealed negative views about Internet-based therapies on most domains, such as perceived helpfulness. The study findings further indicated ambivalent attitudes: Although most respondents agreed to statements on expected improvements in health care (eg, expanded access), we observed low intentions to future use of Internet-delivered therapies in case of mental health problems. Conclusions: This pilot study showed deficient “e-awareness” and rather negative or ambivalent attitudes toward Internet-delivered therapies in the German-speaking general population. However, research targeting determinants of the large-scale adoption of Internet-based psychotherapy is still in its infancy. Thus, further research is required to explore the “black box” of public attitudes toward Internet-delivered therapies with representative samples, validated measures, and longitudinal survey designs. %M 28232298 %R 10.2196/mental.6375 %U http://mental.jmir.org/2017/1/e8/ %U https://doi.org/10.2196/mental.6375 %U http://www.ncbi.nlm.nih.gov/pubmed/28232298 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 1 %P e5 %T A Smarter Pathway for Delivering Cue Exposure Therapy? The Design and Development of a Smartphone App Targeting Alcohol Use Disorder %A Mellentin,Angelina Isabella %A Stenager,Elsebeth %A Nielsen,Bent %A Nielsen,Anette Søgaard %A Yu,Fei %+ Unit of Clinical Alcohol Research, Unit of Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Department of Psychiatry, 220, Sdr Boulevard 29, Odense C, 5000, Denmark, 45 50517901, amellentin@health.sdu.dk %K alcohol use disorder %K exposure therapy %K mobile application %K smartphone %D 2017 %7 30.01.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although the number of alcohol-related treatments in app stores is proliferating, none of them are based on a psychological framework and supported by empirical evidence. Cue exposure treatment (CET) with urge-specific coping skills (USCS) is often used in Danish treatment settings. It is an evidence-based psychological approach that focuses on promoting “confrontation with alcohol cues” as a means of reducing urges and the likelihood of relapse. Objective: The objective of this study was to describe the design and development of a CET-based smartphone app; an innovative delivery pathway for treating alcohol use disorder (AUD). Methods: The treatment is based on Monty and coworkers’ manual for CET with USCS (2002). It was created by a multidisciplinary team of psychiatrists, psychologists, programmers, and graphic designers as well as patients with AUD. A database was developed for the purpose of registering and monitoring training activities. A final version of the CET app and database was developed after several user tests. Results: The final version of the CET app includes an introduction, 4 sessions featuring USCS, 8 alcohol exposure videos promoting the use of one of the USCS, and a results component providing an overview of training activities and potential progress. Real-time urges are measured before, during, and after exposure to alcohol cues and are registered in the app together with other training activity variables. Data packages are continuously sent in encrypted form to an external database and will be merged with other data (in an internal database) in the future. Conclusions: The CET smartphone app is currently being tested at a large-scale, randomized controlled trial with the aim of clarifying whether it can be classified as an evidence-based treatment solution. The app has the potential to augment the reach of psychological treatment for AUD. %M 28137701 %R 10.2196/mhealth.6500 %U http://mhealth.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/mhealth.6500 %U http://www.ncbi.nlm.nih.gov/pubmed/28137701 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e243 %T Investigation of the Association Between Alcohol Outlet Density and Alcohol-Related Hospital Admission Rates in England: Study Protocol %A Maheswaran,Ravi %A Holmes,John %A Green,Mark %A Strong,Mark %A Pearson,Tim %A Meier,Petra %+ Public Health GIS Unit, School of Health and Related Research, University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, United Kingdom, 44 1142220681, r.maheswaran@sheffield.ac.uk %K alcohol %K outlets %K hospital %K admissions %K geography %K epidemiology %D 2016 %7 16.12.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Availability of alcohol is a major policy issue for governments, and one of the availability factors is the density of alcohol outlets within geographic areas. Objective: The aim of this study is to investigate the association between alcohol outlet density and hospital admissions for alcohol-related conditions in a national (English) small area level ecological study. Methods: This project will employ ecological correlation and cross-sectional time series study designs to examine spatial and temporal relationships between alcohol outlet density and hospital admissions. Census units to be used in the analysis will include all Lower and Middle Super-Output Areas (LSOAs and MSOAs) in England (53 million total population; 32,482 LSOAs and 6781 MSOAs). LSOAs (approximately 1500 people per LSOA) will support investigation at a fine spatial resolution. Spatio-temporal associations will be investigated using MSOAs (approximately 7500 people per MSOA). The project will use comprehensive coverage data on alcohol outlets in England (from 2003, 2007, 2010, and 2013) from a commercial source, which has estimated that the database includes 98% of all alcohol outlets in England. Alcohol outlets may be classified into two broad groups: on-trade outlets, comprising outlets from which alcohol can be purchased and consumed on the premises (eg, pubs); and off-trade outlets, in which alcohol can be purchased but not consumed on the premises (eg, off-licenses). In the 2010 dataset, there are 132,989 on-trade and 51,975 off-trade outlets. The longitudinal data series will allow us to examine associations between changes in outlet density and changes in hospital admission rates. The project will use anonymized data on alcohol-related hospital admissions in England from 2003 to 2013 and investigate associations with acute (eg, admissions for injuries) and chronic (eg, admissions for alcoholic liver disease) harms. The investigation will include the examination of conditions that are wholly and partially attributable to alcohol, using internationally standardized alcohol-attributable fractions. Results: The project is currently in progress. Results are expected in 2017. Conclusions: The results of this study will provide a national evidence base to inform policy decisions regarding the licensing of alcohol sales outlets. %M 27986646 %R 10.2196/resprot.6300 %U http://www.researchprotocols.org/2016/4/e243/ %U https://doi.org/10.2196/resprot.6300 %U http://www.ncbi.nlm.nih.gov/pubmed/27986646 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e20 %T Attentional Bias Modification With Serious Game Elements: Evaluating the Shots Game %A Boendermaker,Wouter J %A Sanchez Maceiras,Soraya %A Boffo,Marilisa %A Wiers,Reinout W %+ Department of Child and Adolescent Studies, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands, 31 302534742, w.j.boendermaker@uu.nl %K cognitive training %K cognitive bias modification (CBM) %K attentional bias %K adolescents %K serious games %K motivation %D 2016 %7 06.12.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Young adults often experiment with heavy use of alcohol, which poses severe health risks and increases the chance of developing addiction problems. In clinical patients, cognitive retraining of automatic appetitive processes, such as selective attention toward alcohol (known as “cognitive bias modification of attention,” or CBM-A), has been shown to be a promising add-on to treatment, helping to prevent relapse. Objective: To prevent escalation of regular use into problematic use in youth, motivation appears to play a pivotal role. As CBM-A is often viewed as long and boring, this paper presents this training with the addition of serious game elements as a novel approach aimed at enhancing motivation to train. Methods: A total of 96 heavy drinking undergraduate students carried out a regular CBM-A training, a gamified version (called “Shots”), or a placebo training version over 4 training sessions. Measures of motivation to change their behavior, motivation to train, drinking behavior, and attentional bias for alcohol were included before and after training. Results: Alcohol attentional bias was reduced after training only in the regular training condition. Self-reported drinking behavior was not affected, but motivation to train decreased in all conditions, suggesting that the motivational features of the Shots game were not enough to fully counteract the tiresome nature of the training. Moreover, some of the motivational aspects decreased slightly more in the game condition, which may indicate potential detrimental effects of disappointing gamification. Conclusions: Gamification is not without its risks. When the motivational value of a training task with serious game elements is less than expected by the adolescent, effects detrimental to their motivation may occur. We therefore advise caution when using gamification, as well as underscore the importance of careful scientific evaluation. %M 27923780 %R 10.2196/games.6464 %U http://games.jmir.org/2016/2/e20/ %U https://doi.org/10.2196/games.6464 %U http://www.ncbi.nlm.nih.gov/pubmed/27923780 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 2 %N 2 %P e15 %T Alcohol Intake Among Breast Cancer Survivors: Change in Alcohol Use During a Weight Management Intervention %A Fazzino,Tera L %A Fleming,Kimberly %A Befort,Christie %+ Department of Preventive Medicine and Public Health, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS, United States, 1 9135883030, tfazzino@kumc.edu %K alcohol drinking %K breast cancer %K weight loss %K weight reduction programs %K obesity %D 2016 %7 09.11.2016 %9 Original Paper %J JMIR Cancer %G English %X Background: Daily alcohol intake in quantities as small as half a drink/day significantly increases the risk of breast cancer recurrence for postmenopausal survivors. Interventions designed to modify alcohol use among survivors have not been studied; however, lifestyle interventions that target change in dietary intake may affect alcohol intake. Objective: To evaluate change in alcohol use during a weight loss intervention for obese, rural-dwelling breast cancer survivors. Methods: Data were derived from an 18-month trial that included a 6-month weight loss intervention delivered via group conference calls, followed by a 12-month randomized weight loss maintenance phase in which participants received continued group calls or mailed newsletters. Participants who reported regular alcohol use at baseline (N=37) were included in this study. Results: Mean daily alcohol intake significantly decreased from baseline to 6 months during the weight loss intervention (19.6-2.3 g; P=.001). Mean alcohol intake did not significantly increase (b=0.99, P=.12) during the weight loss maintenance phase (months 6-18) and did not depend on randomization group (b=0.32, P=.799). Conclusions: Findings provide preliminary evidence that a weight loss intervention may address obesity and alcohol use risk factors for cancer recurrence. Minimal mail-based contact post weight loss can maintain alcohol use reductions through 18 months, suggesting durability in these effects. These results highlight a possibility that lifestyle interventions for survivors may modify health behaviors that are not the main foci of an intervention but that coincide with intervention goals. Trial Registration: Clinicaltrials.gov NCT01441011; https://clinicaltrials.gov/ct2/show/NCT01441011 (Archived by WebCite at http://www.webcitation.org/6lsJ9dMa9) %M 28410181 %R 10.2196/cancer.6295 %U http://cancer.jmir.org/2016/2/e15/ %U https://doi.org/10.2196/cancer.6295 %U http://www.ncbi.nlm.nih.gov/pubmed/28410181 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e119 %T Text Message-Based Intervention Targeting Alcohol Consumption Among University Students: Findings From a Formative Development Study %A Thomas,Kristin %A Linderoth,Catharina %A Bendtsen,Marcus %A Bendtsen,Preben %A Müssener,Ulrika %+ Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, 58183, Linköping,, Sweden, 46 13282546, kristin.thomas@liu.se %K SMS intervention %K university student drinking %K formative research %D 2016 %7 20.10.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Drinking of alcohol among university students is a global phenomenon; heavy episodic drinking is accepted despite several potential negative consequences. There is emerging evidence that short message service (SMS) text messaging interventions are effective to promote behavior change among students. However, it is still unclear how effectiveness can be optimized through intervention design or how user interest and adherence can be maximized. Objective: The objective of this study was to develop an SMS text message-based intervention targeting alcohol drinking among university students using formative research. Methods: A formative research design was used including an iterative revision process based on input from end users and experts. Data were collected via seven focus groups with students and a panel evaluation involving students (n=15) and experts (n=5). Student participants were recruited from five universities in Sweden. A semistructured interview guide was used in the focus groups and included questions on alcohol culture, message content, and intervention format. The panel evaluation asked participants to rate to what degree preliminary messages were understandable, usable, and had a good tone on a scale from 1 (very low degree) to 4 (very high degree). Participants could also write their own comments for each message. Qualitative data were analyzed using qualitative descriptive analysis. Quantitative data were analyzed using descriptive statistics. The SMS text messages and the intervention format were revised continuously in parallel with data collection. A behavior change technique (BCT) analysis was conducted on the final version of the program. Results: Overall, students were positive toward the SMS text message intervention. Messages that were neutral, motivated, clear, and tangible engaged students. Students expressed that they preferred short, concise messages and confirmed that a 6-week intervention was an appropriate duration. However, there was limited consensus regarding SMS text message frequency, personalization of messages, and timing. Overall, messages scored high on understanding (mean 3.86, SD 0.43), usability (mean 3.70, SD 0.61), and tone (mean 3.78, SD 0.53). Participants added comments to 67 of 70 messages, including suggestions for change in wording, order of messages, and feedback on why a message was unclear or needed major revision. Comments also included positive feedback that confirmed the value of the messages. Twenty-three BCTs aimed at addressing self-regulatory skills, for example, were identified in the final program. Conclusions: The formative research design was valuable and resulted in significant changes to the intervention. All the original SMS text messages were changed and new messages were added. Overall, the findings showed that students were positive toward receiving support through SMS text message and that neutral, motivated, clear, and tangible messages promoted engagement. However, limited consensus was found on the timing, frequency, and tailoring of messages. %M 27765732 %R 10.2196/mhealth.5863 %U http://mhealth.jmir.org/2016/4/e119/ %U https://doi.org/10.2196/mhealth.5863 %U http://www.ncbi.nlm.nih.gov/pubmed/27765732 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e262 %T Overcoming Addictions, a Web-Based Application, and SMART Recovery, an Online and In-Person Mutual Help Group for Problem Drinkers, Part 2: Six-Month Outcomes of a Randomized Controlled Trial and Qualitative Feedback From Participants %A Campbell,William %A Hester,Reid K %A Lenberg,Kathryn L %A Delaney,Harold D %+ Behavior Therapy Associates, LLC, Research Division, 9426 Indian School NE, Albuquerque, NM,, United States, 1 505 345 6100, william.campbell.iv@gmail.com %K alcohol addiction %K intervention study %K psychological techniques %K digital interventions %K engagement %K online program %K self-help %D 2016 %7 04.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite empirical evidence supporting the use of Web-based interventions for problem drinking, much remains unknown about factors that influence their effectiveness. Objective: We evaluated the performance of 2 resources for people who want to achieve and maintain abstinence: SMART Recovery (SR) and Overcoming Addictions (OA). OA is a Web application based on SR. We also examined participant and intervention-related factors hypothesized to impact clinical outcomes of Web-based interventions. Methods: We recruited 189 heavy drinkers through SR’s website and in-person meetings throughout the United States. We began by randomly assigning participants to (1) SR meetings alone, (2) OA alone, and (3) OA and SR (OA+SR). Recruitment challenges compelled us to assign participants only to SR (n=86) or OA+SR (n=102). The experimental hypotheses were as follows: (1) Both groups will reduce their drinking and alcohol-related consequences at follow-up compared with their baseline levels, and (2) The OA+SR condition will reduce their drinking and alcohol or drug-related consequences more than the SR only condition. Additionally, we derived 3 groups empirically (SR, OA, and OA+SR) based on the participants’ actual use of each intervention and conducted analyses by comparing them. Primary outcome measures included percent days abstinent (PDA), mean drinks per drinking day (DDD), and alcohol or drug-related consequences. Postbaseline assessments were conducted by phone at 3 and 6 months. Secondary analyses explored whether clinical issues (eg, severity of alcohol problems, level of distress, readiness to change) or intervention-related factors (eg, Internet fluency, satisfaction with site) affected outcomes. Results: Both intent-to-treat analyses and the actual-use analyses showed highly significant improvement from baseline to follow-ups for all 3 groups. Mean within-subject effect sizes were large (d>0.8) overall. There was no significant difference between groups in the amount of improvement from baseline to the average of the follow-ups. We found that participants who stopped drinking before joining the clinical trial had significantly better outcomes than participants who were still drinking when they joined the study. Neither Internet fluency nor participants’ reported ease of navigating the site had an impact on outcomes. Conclusions: These results support our first experimental hypothesis but not the second. On average, participants improved on all dependent measures. Both SR and OA helped participants recover from their problem drinking. Web-based interventions can help even those individuals with lengthy histories of heavy drinking to make clinically significant reductions in their consumption and related problems. These interventions work well for individuals in the action stage of change. Trial Registration: Clinicaltrials.gov NCT01389297; https://clinicaltrials.gov/ct2/show/NCT01389297 (Archived by WebCite at http://www.webcitation.org/6kLNUNDcc) %M 27701064 %R 10.2196/jmir.5508 %U http://www.jmir.org/2016/10/e262/ %U https://doi.org/10.2196/jmir.5508 %U http://www.ncbi.nlm.nih.gov/pubmed/27701064 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 4 %N 3 %P e24 %T A Semi-Supervised Learning Approach to Enhance Health Care Community–Based Question Answering: A Case Study in Alcoholism %A Wongchaisuwat,Papis %A Klabjan,Diego %A Jonnalagadda,Siddhartha Reddy %+ Department of Industrial Engineering and Management Sciences, Northwestern University, 2145 Sheridan Rd, Evanston, IL, 60208, United States, 1 847 491 3383, PapisWongchaisuwat2013@u.northwestern.edu %K machine learning %K natural language processing %K question answering %K Web-based health communities %K consumer health informatics %D 2016 %7 02.08.2016 %9 Original Paper %J JMIR Med Inform %G English %X Background: Community-based question answering (CQA) sites play an important role in addressing health information needs. However, a significant number of posted questions remain unanswered. Automatically answering the posted questions can provide a useful source of information for Web-based health communities. Objective: In this study, we developed an algorithm to automatically answer health-related questions based on past questions and answers (QA). We also aimed to understand information embedded within Web-based health content that are good features in identifying valid answers. Methods: Our proposed algorithm uses information retrieval techniques to identify candidate answers from resolved QA. To rank these candidates, we implemented a semi-supervised leaning algorithm that extracts the best answer to a question. We assessed this approach on a curated corpus from Yahoo! Answers and compared against a rule-based string similarity baseline. Results: On our dataset, the semi-supervised learning algorithm has an accuracy of 86.2%. Unified medical language system–based (health related) features used in the model enhance the algorithm’s performance by proximately 8%. A reasonably high rate of accuracy is obtained given that the data are considerably noisy. Important features distinguishing a valid answer from an invalid answer include text length, number of stop words contained in a test question, a distance between the test question and other questions in the corpus, and a number of overlapping health-related terms between questions. Conclusions: Overall, our automated QA system based on historical QA pairs is shown to be effective according to the dataset in this case study. It is developed for general use in the health care domain, which can also be applied to other CQA sites. %M 27485666 %R 10.2196/medinform.5490 %U http://medinform.jmir.org/2016/3/e24/ %U https://doi.org/10.2196/medinform.5490 %U http://www.ncbi.nlm.nih.gov/pubmed/27485666 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e73 %T Optimizing a Text Message Intervention to Reduce Heavy Drinking in Young Adults: Focus Group Findings %A Suffoletto,Brian %A Kristan,Jeffrey %A Person Mecca,Laurel %A Chung,Tammy %A Clark,Duncan B %+ University of Pittsburgh, Department of Emergency Medicine, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA, 15261, United States, 1 412 901 6892, suffbp@upmc.edu %K alcohol %K young adult %K text messages %K qualitative %D 2016 %7 22.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent trial results show that an interactive short message service (SMS) text message intervention, Texting to Reduce Alcohol Consumption (TRAC), is effective in reducing heavy drinking in non-treatment-seeking young adults, but may not be optimized. Objective: To assess the usability of the TRAC intervention among young adults in an effort to optimize future intervention design. Methods: We conducted five focus groups with 18 young adults, aged 18-25 years, who had a history of heavy drinking and had been randomized to 12 weeks of the TRAC intervention as part of a clinical trial. A trained moderator followed a semistructured interview guide. Focus groups were audiotaped, transcribed, and analyzed to identify themes. Results: We identified four themes regarding user experiences with the TRAC intervention: (1) ease of use, (2) comfort and confidentiality, (3) increased awareness of drinking behavior, and (4) accountability for drinking behavior. Participants’ comments supported the existing features of the TRAC intervention, as well as the addition of other features to increase personalization and continuing engagement with the intervention. Conclusions: Young adults perceived the TRAC intervention as a useful way to help them reduce heavy drinking on weekends. Components that promote ease of use, ensure confidentiality, increase awareness of alcohol consumption, and increase accountability were seen as important. %M 27335099 %R 10.2196/mhealth.5330 %U http://mhealth.jmir.org/2016/2/e73/ %U https://doi.org/10.2196/mhealth.5330 %U http://www.ncbi.nlm.nih.gov/pubmed/27335099 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e103 %T An Internet-Based Intervention to Promote Alcohol-Related Attitudinal and Behavioral Change Among Adolescents: Protocol of a Cluster Randomized Controlled Trial %A Ip,Patrick %A Chan,Ko-Ling %A Chow,Chun-Bong %A Lam,Tai-Hing %A Ho,Sai-Yin %A Wong,Wilfred Hing-Sang %A Wong,Margaret Fung-Yee %+ The University of Hong Kong, Department of Paediatrics and Adolescent Medicine, 1/F, New Clinical Building, Queen Mary Hospital, Pokfulam, Hong Kong,, China (Hong Kong), 852 28198501, patricip@hku.hk %K Internet viral marketing %K attitude change %K behavioural change %K underage drinking %K risk behaviour %K Internet intervention %D 2016 %7 01.06.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Underage drinking is a prevalent risk behavior and common public health problem. Research shows that alcohol abuse not only affects the quality of life of drinkers themselves. The problems resulting from underage drinking pose substantial costs to society as well. The proposed study will address underage drinking with the use of an Internet campaign, which is a cost-effective way of tackling the problem. Objective: The aims of this study are to test the effectiveness of an online quiz competition in changing adolescents’ alcohol-related attitudes and behavior and to explore the feasibility of using Internet viral marketing to reach a significant number of adolescents. Methods: The study will constitute a cluster randomized controlled trial for 20 secondary schools (6720 Grade 7-9 students). Schools will be randomized to intervention or control arm with equal likelihood. Students in intervention schools will be invited to take part in the Internet campaign, whereas those in control schools will receive relevant promotional leaflets. Results: Alcohol-related attitude and behavior will be the primary outcome measures. The results of the proposed study will provide evidence on the efficacy of an Internet intervention in modifying adolescents’ attitudes and behavior and guide further investigation into the prevention of and intervention in such risk behaviors as underage drinking. The project was funded July 2015, enrollment started September 2015, and results are expected July 2017. Conclusions: With the Internet increasingly being recognized as a practical and cost-effective platform for health information delivery, the proposed Internet-based intervention is expected to be more effective in altering adolescents’ alcohol-related attitudes and behaviors than traditional health promotion. ClinicalTrial: ClinicalTrials.gov NCT02450344; https://clinicaltrials.gov/ct2/show/NCT02450344 (Archived by WebCite at http://www.webcitation.org/6heB2zMBD) %M 27252072 %R 10.2196/resprot.5001 %U http://www.researchprotocols.org/2016/2/e103/ %U https://doi.org/10.2196/resprot.5001 %U http://www.ncbi.nlm.nih.gov/pubmed/27252072 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e44 %T 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 %A Rowe,Christopher %A Hern,Jaclyn %A DeMartini,Anna %A Jennings,Danielle %A Sommers,Mathew %A Walker,John %A Santos,Glenn-Milo %+ San Francisco Department of Public Health, 25 Van Ness, Suite 500, San Francisco, CA, 94102, United States, 1 415 437 6283, chris.rowe@sfdph.org %K data collection %K cell phones %K drug users %K drinking behavior %K homosexuality, male %D 2016 %7 26.05.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X 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. %M 27230545 %R 10.2196/mhealth.5368 %U http://mhealth.jmir.org/2016/2/e44/ %U https://doi.org/10.2196/mhealth.5368 %U http://www.ncbi.nlm.nih.gov/pubmed/27230545 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e103 %T Effectiveness of a Web-Based Screening and Fully Automated Brief Motivational Intervention for Adolescent Substance Use: A Randomized Controlled Trial %A Arnaud,Nicolas %A Baldus,Christiane %A Elgán,Tobias H %A De Paepe,Nina %A Tønnesen,Hanne %A Csémy,Ladislav %A Thomasius,Rainer %+ German Centre for Addiction Research in Childhood and Adolescence (DZSKJ), Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 040 7410 59861, n.arnaud@uke.de %K substance use %K adolescents %K brief intervention %K web-based intervention %K motivational interviewing %K randomized controlled trial %D 2016 %7 24.05.2016 %9 Original Paper %J J Med Internet Res %G English %X 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) %M 27220276 %R 10.2196/jmir.4643 %U http://www.jmir.org/2016/5/e103/ %U https://doi.org/10.2196/jmir.4643 %U http://www.ncbi.nlm.nih.gov/pubmed/27220276 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e107 %T Exploring the Utility of Web-Based Social Media Advertising to Recruit Adult Heavy-Drinking Smokers for Treatment %A Bold,Krysten W %A Hanrahan,Tess H %A O'Malley,Stephanie S %A Fucito,Lisa M %+ Yale School of Medicine, Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, United States, 1 2039747603, krysten.bold@yale.edu %K smoking %K alcohol drinking %K social media %K research subject recruitment %D 2016 %7 18.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Identifying novel ways to recruit smokers for treatment studies is important. In particular, certain subgroups of adult smokers, such as heavy-drinking smokers, are at increased risk for serious medical problems and are less likely to try quitting smoking, so drawing this hard-to-reach population into treatment is important for improving health outcomes. Objective: This study examined the utility of Facebook advertisements to recruit smokers and heavy-drinking smokers for treatment research and evaluated smoking and alcohol use and current treatment goals among those who responded to the Web-based survey. Methods: Using Facebook’s advertising program, 3 separate advertisements ran for 2 months targeting smokers who were thinking about quitting. Advertisements were shown to adult (at least 18 years of age), English-speaking Facebook users in the greater New Haven, Connecticut, area. Participants were invited to complete a Web-based survey to determine initial eligibility for a smoking cessation research study. Results: Advertisements generated 1781 clicks and 272 valid, completed surveys in 2 months, with one advertisement generating the most interest. Facebook advertising was highly cost-effective, averaging $0.27 per click, $1.76 per completed survey, and $4.37 per participant meeting initial screening eligibility. On average, those who completed the Web-based survey were 36.8 (SD 10.4) years old, and 65.8% (179/272) were female. Advertisements were successful in reaching smokers; all respondents reported daily smoking (mean 16.2 [SD 7.0] cigarettes per day). The majority of smokers (254/272, 93.4%) were interested in changing their smoking behavior immediately. Many smokers (161/272, 59.2%) also reported heavy alcohol consumption at least once a month. Among smokers interested in reducing their alcohol use, more were heavy drinkers (45/56, 80.4%) compared to non-heavy drinkers (11/56, 19.6%; χ2[1,N=272]=13.0, P<.001). Of those who met initial screening eligibility from the Web-based survey, 12.7% (14/110) attended an in-person follow-up appointment. Conclusions: Social media advertisements designed to target smokers were cost-effective and successful for reaching adult smokers interested in treatment. Additionally, recruiting for smokers reached those who also drink alcohol heavily, many of whom were interested in changing this behavior as well. However, additional social media strategies may be needed to engage individuals into treatment after completion of Web-based screening surveys. %M 27194456 %R 10.2196/jmir.5360 %U http://www.jmir.org/2016/5/e107/ %U https://doi.org/10.2196/jmir.5360 %U http://www.ncbi.nlm.nih.gov/pubmed/27194456 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e93 %T A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits %A Drost,Ruben MWA %A Paulus,Aggie TG %A Jander,Astrid F %A Mercken,Liesbeth %A de Vries,Hein %A Ruwaard,Dirk %A Evers,Silvia MAA %+ Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, Netherlands, 31 433881729, r.drost@maastrichtuniversity.nl %K adolescents %K alcohol use %K cluster randomized controlled trial %K game %K computer tailoring %K education %K criminal justice %K costs and cost analysis %K economic evaluation %K intersectoral costs and benefits %D 2016 %7 21.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Preventing excessive alcohol use among adolescents is important not only to foster individual and public health, but also to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, also known as intersectoral costs and benefits (ICBs). Objective: The aim was to assess the cost-effectiveness of a Web-based computer-tailored intervention for reducing alcohol use and binge drinking by adolescents from a health care perspective (excluding ICBs) and from a societal perspective (including ICBs). Methods: Data used were from the Alcoholic Alert study, a cluster randomized controlled trial with randomization at the level of schools into two conditions. Participants either played a game with tailored feedback on alcohol awareness after the baseline assessment (intervention condition) or received care as usual (CAU), meaning that they had the opportunity to play the game subsequent to the final measurement (waiting list control condition). Data were recorded at baseline (T0=January/February 2014) and after 4 months (T1=May/June 2014) and were used to calculate incremental cost-effectiveness ratios (ICERs), both from a health care perspective and a societal perspective. Stochastic uncertainty in the data was dealt with by using nonparametric bootstraps (5000 simulated replications). Additional sensitivity analyses were conducted based on excluding cost outliers. Subgroup cost-effectiveness analyses were conducted based on several background variables, including gender, age, educational level, religion, and ethnicity. Results: From both the health care perspective and the societal perspective for both outcome measures, the intervention was more costly and more effective in comparison with CAU. ICERs differed for both perspectives, namely €40 and €79 from the health care perspective to €62 and €144 for the societal perspective per incremental reduction of one glass of alcohol per week and one binge drinking occasion per 30 days, respectively. Subgroup analyses showed, from both perspectives and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19 years) and those at a lower educational level and, from a health care perspective, the male and nonreligious adolescent subgroups. Conclusions: Computer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents. Including ICBs in the economic evaluation had an impact on the cost-effectiveness results of the analysis. It could be worthwhile to aim the intervention specifically at specific subgroups. Trial Registration: Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG) %M 27103154 %R 10.2196/jmir.5223 %U http://www.jmir.org/2016/4/e93/ %U https://doi.org/10.2196/jmir.5223 %U http://www.ncbi.nlm.nih.gov/pubmed/27103154 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e71 %T An Online Intervention for Co-Occurring Depression and Problematic Alcohol Use in Young People: Primary Outcomes From a Randomized Controlled Trial %A Deady,Mark %A Mills,Katherine L %A Teesson,Maree %A Kay-Lambkin,Frances %+ National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Kensington, 2052, Australia, 61 293850320, m.deady@unsw.edu.au %K depression %K alcohol use, alcohol abuse, problem drinking %K young people at risk populations %K Internet %K intervention online therapy, eHealth %K comorbidity %D 2016 %7 23.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and problematic alcohol use represent two of the major causes of disease burden in young adults. These conditions frequently co-occur and this is associated with increased harm and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective; however, there remains a significant gap between those in need of treatment and those receiving it. The increased availability of eHealth programs presents a unique opportunity to treat these conditions. Objective: This study aimed to evaluate the feasibility and preliminary efficacy of an automated Web-based self-help intervention (DEAL Project) in treating co-occurring depressive symptoms and problematic alcohol use in young people. Methods: Young people (aged 18 to 25 years) with moderate depression symptoms and drinking at hazardous levels (recruited largely via social media) were randomly allocated to the DEAL Project (n=60) or a Web-based attention-control condition (HealthWatch; n=44). The trial consisted of a 4-week intervention phase with follow-up assessment at posttreatment and at 3 and 6 months postbaseline. The primary outcomes were change in depression severity according to the Patient Health Questionnaire-9 as well as quantity and frequency of alcohol use (TOT-AL). Results: The DEAL Project was associated with statistically significant improvement in depression symptom severity (d=0.71) and reductions in alcohol use quantity (d=0.99) and frequency (d=0.76) in the short term compared to the control group. At 6-month follow-up, the improvements in the intervention group were maintained; however, the differences between the intervention and control groups were no longer statistically significant, such that between-group effects were in the small to moderate range at 6 months (depression symptoms: d=0.39; alcohol quantity: d=–0.09; alcohol frequency: d=0.24). Conclusions: Overall, the DEAL Project was associated with more rapid improvement in both depression symptoms and alcohol use outcomes in young people with these co-occurring conditions relative to an attention-control condition. However, long-term outcomes are less clear. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000033741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363461 (Archived by WebCite at http://www.webcitation.org/6fpsLEGOy) %M 27009465 %R 10.2196/jmir.5178 %U http://www.jmir.org/2016/3/e71/ %U https://doi.org/10.2196/jmir.5178 %U http://www.ncbi.nlm.nih.gov/pubmed/27009465 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e27 %T Development, Validation, and Implementation of an Innovative Mobile App for Alcohol Dependence Management: Protocol for the SIDEAL Trial %A Barrio,Pablo %A Ortega,Lluisa %A Bona,Xavier %A Gual,Antoni %+ Addictions Unit, Clinical Neuroscience Institute, Hospital Clinic of Barcelona, Villarroel 170, Barcelona, 08036, Spain, 34 932275400 ext 2891, pablobarriogimenez@gmail.com %K alcohol dependence %K alcoholism %K telemedicine %K mobile applications %K eHealth %K adherence %K patient compliance %K consumption register %D 2016 %7 17.02.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Information and communication technologies (ICT) have become one of the main pathways to the new paradigm of increased self-management of chronic conditions such as alcohol dependence. Validation of some mobile phone apps has begun, while validation of many others is forthcoming. Objective: To describe the protocol for validation of a new app called SIDEAL (an acronym of the Spanish name “Soporte Innovador a la persona con DEpendencia del ALcohol,” or innovative support for people with alcohol dependence). Methods: The project consists of 3 complementary, consecutive studies, including a pilot feasibility study, a qualitative study using focus groups, and, finally, a randomized controlled trial where patients will be randomized to standard treatment or standard treatment plus SIDEAL. During the pilot study, feasibility, usability, and acceptance by users will be the main outcomes explored. An electronic questionnaire will be sent to patients asking for their opinions. Focus groups will be the next step, after which improvements and refinements will be implemented in the app. During the final phase, consumption variables (heavy drinking days per month, mean standard drinks per day) will be investigated, in order to test app efficacy. Results: Because of the encouraging results with previous similar apps, we expect patients to widely accept and incorporate SIDEAL into their therapeutic options. Significant reductions in drinking-related variables are also expected. The pilot study has concluded with the inclusion of 29 patients. Results are expected to be available soon (expected mid-2016). Conclusions: SIDEAL may represent a useful, reliable, effective, and efficient tool to complement therapeutic options available to both patients and professionals. %M 26888196 %R 10.2196/resprot.5002 %U http://www.researchprotocols.org/2016/1/e27/ %U https://doi.org/10.2196/resprot.5002 %U http://www.ncbi.nlm.nih.gov/pubmed/26888196 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e29 %T Effects of a Web-Based Computer-Tailored Game to Reduce Binge Drinking Among Dutch Adolescents: A Cluster Randomized Controlled Trial %A Jander,Astrid %A Crutzen,Rik %A Mercken,Liesbeth %A Candel,Math %A de Vries,Hein %+ School for Public Health and Primary Care CAPHRI, Department of Health Promotion, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433884279, astrid.jander@maastrichtuniversity.nl %K adolescents %K alcohol drinking %K binge drinking %K cluster randomized controlled trial %K serious games %K computer tailoring %D 2016 %7 03.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Binge drinking among Dutch adolescents is among the highest in Europe. Few interventions so far have focused on adolescents aged 15 to 19 years. Because binge drinking increases significantly during those years, it is important to develop binge drinking prevention programs for this group. Web-based computer-tailored interventions can be an effective tool for reducing this behavior in adolescents. Embedding the computer-tailored intervention in a serious game may make it more attractive to adolescents. Objective: The aim was to assess whether a Web-based computer-tailored intervention is effective in reducing binge drinking in Dutch adolescents aged 15 to 19 years. Secondary outcomes were reduction in excessive drinking and overall consumption during the previous week. Personal characteristics associated with program adherence were also investigated. Methods: A cluster randomized controlled trial was conducted among 34 Dutch schools. Each school was randomized into either an experimental (n=1622) or a control (n=1027) condition. Baseline assessment took place in January and February 2014. At baseline, demographic variables and alcohol use were assessed. Follow-up assessment of alcohol use took place 4 months later (May and June 2014). After the baseline assessment, participants in the experimental condition started with the intervention consisting of a game about alcohol in which computer-tailored feedback regarding motivational characteristics was embedded. Participants in the control condition only received the baseline questionnaire. Both groups received the 4-month follow-up questionnaire. Effects of the intervention were assessed using logistic regression mixed models analyses for binge and excessive drinking and linear regression mixed models analyses for weekly consumption. Factors associated with intervention adherence in the experimental condition were explored by means of a linear regression model. Results: In total, 2649 adolescents participated in the baseline assessment. At follow-up, 824 (31.11%) adolescents returned. The intervention was effective in reducing binge drinking among adolescents aged 15 years (P=.03) and those aged 16 years when they participated in at least 2 intervention sessions (P=.04). Interaction effects between excessive drinking and educational level (P=.08) and between weekly consumption and age (P=.09) were found; however, in-depth analyses revealed no significant subgroup effects for both interaction effects. Additional analyses revealed that prolonged use of the intervention was associated with stronger effects for binge drinking. Yet, overall adherence to the intervention was low. Analyses revealed that being Protestant, female, younger, a nonbinge drinker, and having a higher educational background were associated with adherence. Conclusions: The intervention was effective for adolescents aged 15 and 16 years concerning binge drinking. Prevention messages may be more effective for those at the start of their drinking career, whereas other methods may be needed for those with a longer history of alcohol consumption. Despite using game elements, intervention completion was low. Trial Registration: Dutch Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by WebCite® at http://www.webcitation.org/6eSJD3FiY) %M 26842694 %R 10.2196/jmir.4708 %U http://www.jmir.org/2016/2/e29/ %U https://doi.org/10.2196/jmir.4708 %U http://www.ncbi.nlm.nih.gov/pubmed/26842694 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e11 %T Assessing the Usability of Web-Based Alcohol Education for Older Adults: A Feasibility Study %A Fink,Arlene %A Kwan,Lorna %A Osterweil,Dan %A Van Draanen,Jenna %A Cooke,Alexis %A Beck,John C %+ Arlene Fink Associates, 1562 Casale Road, Pacific Palisades, CA, 90272, United States, 1 3104544296, arlene.fink@gmail.com %K alcohol %K older adults %K elderly %K web-based %K education %K online alcohol education %D 2016 %7 01.02.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Older adults can experience unfavorable health effects from drinking at relatively low consumption levels because of age-related physiological changes and alcohol’s potentially adverse interactions with declining health, increased medication-use and diminishing functional status. At the same time, alcohol use in older adults may be protective against heart disease, stroke, and other disorders associated with aging. We developed “A Toast to Health in Later Life! Wise Drinking as We Age,” a web-based educational intervention to teach older adults to balance drinking risks and benefits. Objective: To examine the intervention’s feasibility in a sample of community-dwelling current drinkers ≥55 years of age and examine its effects on their quantity and frequency of alcohol use, adherence to standard drinking guidelines, and alcohol-related risks. Methods: Participants were recruited in person, by mail and by telephone between September and October 2014 from a community-based social services organization serving Los Angeles County. Once enrolled, participants were randomly assigned to the intervention or to a control group. The conceptual frameworks for the intervention were the Health Belief Model, models of adult learning, and the US Department of Health and Human Services guidelines for designing easy-to-use websites. The intervention’s content focuses on the relationship between drinking and its effects on older adults’ medical conditions, use of medications, and ability to perform daily activities. It also addresses quantity and frequency of alcohol use, drinking and driving and binge drinking. The control group did not receive any special intervention. Data on alcohol use and risks for both groups came from the online version of the Alcohol-Related Problems Survey and were collected at baseline and four weeks later. Data on usability were collected online from the intervention group immediately after it completed its review of the website. Results: The 49 intervention and 47 control participants did not differ at baseline in age, ethnicity, medication use, medical conditions, or alcohol use and both groups were mostly female, college-educated, and in good health. Of the intervention participants, 94% (46/49) had little or no difficulty using the website, with 67% (33/49) reporting that they will change the way they think about drinking because of their exposure to the education. At the 4-week follow-up, the intervention group reported drinking less (P=.02). No changes between groups were found in quantity and frequency, adherence to recommended guidelines, or risk status. Conclusions: Community-dwelling older adults are receptive to online alcohol education. To be most effective, the education should be included as a component of a larger effort consisting of screening and counseling preferably in a health care setting. %M 26832213 %R 10.2196/resprot.4545 %U http://www.researchprotocols.org/2016/1/e11/ %U https://doi.org/10.2196/resprot.4545 %U http://www.ncbi.nlm.nih.gov/pubmed/26832213 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e285 %T Potential and Challenges in Collecting Social and Behavioral Data on Adolescent Alcohol Norms: Comparing Respondent-Driven Sampling and Web-Based Respondent-Driven Sampling %A Hildebrand,Janina %A Burns,Sharyn %A Zhao,Yun %A Lobo,Roanna %A Howat,Peter %A Allsop,Steve %A Maycock,Bruce %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Bentley, 6845, Australia, 61 9266 7988, b.maycock@curtin.edu.au %K Internet %K respondent-driven sampling (RDS) %K WebRDS %K adolescent %K alcohol %K social media %K participant recruitment %D 2015 %7 24.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Respondent-driven sampling (RDS) is a method successfully used to research hard-to-access populations. Few studies have explored the use of the Internet and social media with RDS, known as Web-based RDS (WebRDS). This study explored the use of combining both “traditional” RDS and WebRDS to examine the influences on adolescent alcohol use. Objective: This paper reports on the recruitment processes and the challenges and enablers of both RDS and WebRDS. It details comparative recruitment data and provides a summary of the utility of both methods for recruiting adolescents to participate in an online survey investigating youth alcohol norms. Methods: Process evaluation data collected from research staff throughout the study were used to assess the challenges and solutions of RDS and WebRDS. Pearson chi-square test (Fisher’s exact test if applicable) was used to compare the differences in sociodemographics and drinking behavior between data collected by RDS and WebRDS. Results: Of the total sample (N=1012), 232 adolescents were recruited by RDS and 780 by WebRDS. A significantly larger proportion of Aboriginal or Torres Strait Islander (P<.001) participants who spoke English as their main language at home (P=.03), and of middle and lower socioeconomic status (P<.001) was found in the RDS sample. The RDS sample was also found to have a higher occurrence of past 7-day drinking (P<.001) and past 7-day risky drinking (P=.004). No significant differences in gender, age, past month alcohol use, and lifetime alcohol use were observed between the RDS and WebRDS samples. This study revealed RDS and WebRDS used similar lengths of chains for recruiting participants; however, WebRDS conducted a faster rate of recruitment at a lower average cost per participant compared to RDS. Conclusions: Using WebRDS resulted in significant improvements in the recruitment rate and was a more effective and efficient use of resources than the traditional RDS method. However, WebRDS resulted in partially different sample characteristics to traditional RDS. This potential effect should be considered when selecting the most appropriate data collection method. %M 26704736 %R 10.2196/jmir.4762 %U http://www.jmir.org/2015/12/e285/ %U https://doi.org/10.2196/jmir.4762 %U http://www.ncbi.nlm.nih.gov/pubmed/26704736 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e139 %T Mobile Phone Apps for University Students With Hazardous Alcohol Use: Study Protocol for Two Consecutive Randomized Controlled Trials %A Berman,Anne H %A Gajecki,Mikael %A Fredriksson,Morgan %A Sinadinovic,Kristina %A Andersson,Claes %+ Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, plan 7, Stockholm, 11364, Sweden, 46 704245360, anne.h.berman@ki.se %K randomized controlled trial, universities, alcohol abuse, prevention, mobile phone, eHealth, mHealth %D 2015 %7 22.12.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: About 50% of university students overconsume alcohol, and drinking habits in later adulthood are to some extent established during higher educational studies. Several studies have demonstrated that Internet-based interventions have positive effects on drinking habits among university students. Our recent study evaluated two mobile phone apps targeting drinking choices at party occasions via personalized feedback on estimated blood alcohol concentration (eBAC) for students with hazardous drinking. No changes in drinking parameters were found over a seven-week period apart from an increase in number of drinking occasions among men for one of the apps tested. Up to 30% of the study participants drank at potentially harmful levels: higher than the national recommended number of standard drinks per week (a maximum of 9 for women and 14 for men) in Sweden. Objective: (1) To evaluate improved versions of the two mobile phone apps tested in our prior trial, in a new, 3-armed randomized controlled trial among university students with at least hazardous drinking habits according to the Alcohol Use Disorders Identifications Test (AUDIT; Study 1). (2) After 6 weeks, to target study participants showing alcohol consumption higher than the national recommended levels for standard drinks per week by offering them participation in a second, 2-armed randomized trial evaluating an additional mobile phone app with skill enhancement tasks (Study 2). (3) To follow participants at 6, 12 and 18 weeks after recruitment to Study 1 and at 6 and 12 weeks after recruitment to Study 2. Methods: Two randomized controlled trials are conducted. Study 1: Students are recruited at four Swedish universities, via direct e-mail and advertisements on Facebook and student union web sites. Those who provide informed consent, have a mobile phone, and show at least hazardous alcohol consumption according to the AUDIT (≥6 for women; ≥8 points for men) are randomized into three groups. Group 1 has access to the Swedish government alcohol monopoly’s app, Promillekoll, offering real-time estimated eBAC calculation; Group 2 has access to a Web-based app, PartyPlanner, developed by the research group, offering real-time eBAC calculation with planning and follow-up functions; and Group 3 participants are controls. Follow-up is conducted at 6, 12 and 18 weeks. Study 2. Participants who at the first 6-week follow-up show drinking levels higher than 9 (W) or 14 (M) standard drinks (12 g alcohol) per week, are offered participation in Study 2. Those who consent are randomized to either access to a skills training app, TeleCoach or to a wait-list control group. Results: Latent Markov models for Study 1 and mixed models analyses for Study 2 will be performed. Study 2 data will be analyzed for publication during the spring of 2016; Study 1 data will be analyzed for publication during the fall of 2016. Conclusions: If mobile phone interventions for reducing hazardous alcohol use are found to be effective, the prospects for positively influencing substance use-related health among university students can considerably improve. Trial Registration: ClinicalTrials.gov http://clinicaltrials.gov/ct2/show/NCT02064998 (Archived by WebCite at http://www.webcitation.org/6dy0AlVRP) %M 26693967 %R 10.2196/resprot.4894 %U http://www.researchprotocols.org/2015/4/e139/ %U https://doi.org/10.2196/resprot.4894 %U http://www.ncbi.nlm.nih.gov/pubmed/26693967 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e278 %T Preventing Alcohol Abuse Through Social Networking Sites: A First Assessment of a Two-Year Ecological Approach %A Flaudias,Valentin %A de Chazeron,Ingrid %A Zerhouni,Oulmann %A Boudesseul,Jordane %A Begue,Laurent %A Bouthier,Renaud %A Lévrier,Christel %A Llorca,Pierre Michel %A Brousse,Georges %+ CHU Clermont-Ferrand, Pôle Psychiatrie B, 58 Rue Montalembert, Clermont-Ferrand, F-63000, France, 33 473752072, vflaudias@chu-clermontferrand.fr %K social networking %K primary prevention %K alcohol consumption %K students %D 2015 %7 10.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Prevention strategies to reduce alcohol use/consumption among young people are crucial to reducing alcohol-related deaths and preventing disease. This paper focuses on the effectiveness of a social networking site (SNS) alcohol prevention program targeted toward young people. Objective: We hypothesized that the program would diminish the relation made by participants between alcohol and festive moments, and would result in a reduction of their declared consumption of alcohol at festive moments during the program. We also explored the interaction with the prevention program that was the most efficient. Methods: The prevention program took the form of 3 lotteries over 2 years. The participants periodically received prevention messages, particularly on alcohol and festive moments (eg, videos on Facebook and short message service [SMS] text messages on their mobile phones). For the 3 periods, the participants had to answer questions exploring the level of their belief that alcohol consumption and festive moments are highly associated. A control group that did not participate in the prevention program was asked the same questions over the same number of days for the first 2 periods. During the second period, the participants were asked to answer questions about their alcohol consumption during parties. During the third period, we explored the interaction with the prevention program on the reduction of their belief that alcohol consumption and festive moments are associated. Results: A total of 651 participants (age: mean 22.24, SD 4.10 years; women: n=430) during the first period, 301 participants (age: mean 21.27, SD 3.07 years; women n=199) during the second period, and 305 (age: mean 22.41, SD 4.65 years; women: n=190) during the third period correctly completed the survey. For the control group, 69 students completed the survey during the first period (age: mean 18.93, SD 1.14 years; women: n=59) and 50 during the second (age: mean 20.78, SD 1.94 years; women: n=45). We observed a significant reduction in the association of alcohol with festive moments in the participants over the 2 years (period 1: z=–4.80, P<.001; period 2: z=–2.11, P=.04; period 3: z=–2.30; P=.02), but not in the controls. We also observed a reduction in the number of glasses consumed during festive moments for the participants (z=–2.36, P=.02), but not for the controls during the second period. The third period showed that only the number of days since registration in the program had an impact on the reduction of the association of festive moments and alcohol consumption (t21=3.186, P=.005). Conclusions: The findings of this study suggest that the SNS prevention program is promising in preventing the association of alcohol with festive moments and, more generally, in impacting social norms. %M 26681577 %R 10.2196/jmir.4233 %U http://www.jmir.org/2015/12/e278/ %U https://doi.org/10.2196/jmir.4233 %U http://www.ncbi.nlm.nih.gov/pubmed/26681577 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e201 %T Successful Organizational Strategies to Sustain Use of A-CHESS: A Mobile Intervention for Individuals With Alcohol Use Disorders %A Ford II,James H %A Alagoz,Esra %A Dinauer,Susan %A Johnson,Kimberly A %A Pe-Romashko,Klaren %A Gustafson,David H %+ University of Wisconsin - Madison, Center for Health Systems Research and Analysis, 610 Walnut Street, Madison, WI, 53726, United States, 1 608 262 4748, jhfordii@wisc.edu %K mHealth %K substance abuse disorder %K sustainability %K funding %K engagement %K staff %K client %K implementation %D 2015 %7 18.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) services are growing in importance in health care research with the advancement of wireless networks, tablets, and mobile phone technologies. These technologies offer a wide range of applications that cover the spectrum of health care delivery. Although preliminary experiments in mHealth demonstrate promising results, more robust real-world evidence is needed for widespread adoption and sustainment of these technologies. Objective: Our aim was to identify the problems/challenges associated with sustained use of an mHealth addiction recovery support app and to determine strategies used by agencies that successfully sustained client use of A-CHESS. Methods: Qualitative inquiry assessed staff perceptions about organizational attributes and strategies associated with sustained use of the mobile app, A-CHESS. A total of 73 interviews of clinicians and administrators were conducted. The initial interviews (n=36) occurred at the implementation of A-CHESS. Follow-up interviews (n=37) occurred approximately 12 and 24 months later. A coding scheme was developed and Multiuser NVivo was used to manage and analyze the blinded interview data. Results: Successful strategies used by treatment providers to sustain A-CHESS included (1) strong leadership support, (2) use of client feedback reports to follow up on non-engaged clients, (3) identify passionate staff and incorporate A-CHESS discussions in weekly meetings, (4) develop A-CHESS guidelines related to client use, (5) establish internal work groups to engage clients, and (6) establish a financial strategy to sustain A-CHESS use. The study also identified attributes of A-CHESS that enhanced as well as inhibited its sustainability. Conclusions: Mobile apps can play an important role in health care delivery. However, providers will need to develop strategies for engaging both staff and patients in ongoing use of the apps. They will also need to rework business processes to accommodate the changes in communication frequency and style, learn to use app data for decision making, and identify financing mechanisms for supporting these changes. %M 26286257 %R 10.2196/jmir.3965 %U http://www.jmir.org/2015/8/e201/ %U https://doi.org/10.2196/jmir.3965 %U http://www.ncbi.nlm.nih.gov/pubmed/26286257 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 2 %P e13 %T Development and Acceptability of a Co-Produced Online Intervention to Prevent Alcohol Misuse in Adolescents: A Think Aloud Study %A Davies,Emma Louise %A Martin,Jilly %A Foxcroft,David R %+ Department of Psychology, Social Work and Public Health, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, United Kingdom, 44 18654484056, edavies@brookes.ac.uk %K adolescents %K alcohol %K intervention development %K prevention %K think aloud %D 2015 %7 29.07.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: The prototype willingness model (PWM) may offer an appropriate basis for explaining and preventing adolescent alcohol misuse. An intervention was developed using a co-production approach, and consisted of an online quiz featuring 10 questions linked to the PWM. Objective: This study sought to determine the acceptability and relevance of the intervention content to young people, to incorporate their feedback into a final version. Methods: A qualitative think aloud study with follow-up semistructured interviews was undertaken with 16 young people aged 11-15 (50%). Transcripts were analyzed using thematic analysis. Results: The following 3 main themes relating the acceptability of the intervention were identified: “challenging expectations of alcohol education”; “motivations for drinking or not drinking,” and “the inevitability of drinking.” Participants found the intervention appealing because it was counter to their expectations. The content appeared to reflect their experiences of social pressure and drinking encounters. There was evidence that a focus on drinker/nondrinker prototypes was too narrow and that because adolescents perceived drinking as inevitable, it would be challenging to enact any plans to resist pressure to drink. Conclusions: An online intervention based on the PWM has the potential to engage and interest adolescents. A wide range of alcohol prototypes should be targeted and a focus on short-term harms should ensure that the intervention is credible to young people. %M 27025403 %R 10.2196/humanfactors.4452 %U http://humanfactors.jmir.org/2015/2/e13/ %U https://doi.org/10.2196/humanfactors.4452 %U http://www.ncbi.nlm.nih.gov/pubmed/27025403 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e170 %T Online Alcohol Assessment and Feedback for Hazardous and Harmful Drinkers: Findings From the AMADEUS-2 Randomized Controlled Trial of Routine Practice in Swedish Universities %A Bendtsen,Preben %A Bendtsen,Marcus %A Karlsson,Nadine %A White,Ian R %A McCambridge,Jim %+ Medical Faculty, Department of Medical Specialist and Department of Medicine and Health Sciences, Linköping University, Motala, Campus US, Linköping, Se-581 83, Sweden, 46 702324615, preben.bendtsen@liu.se %K alcohol drinking %K behavior therapy %K students %K Internet %K electronic mail, feedback %D 2015 %7 09.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous research on the effectiveness of online alcohol interventions for college students has shown mixed results. Small benefits have been found in some studies and because online interventions are inexpensive and possible to implement on a large scale, there is a need for further study. Objective: This study evaluated the effectiveness of national provision of a brief online alcohol intervention for students in Sweden. Methods: Risky drinkers at 9 colleges and universities in Sweden were invited by mail and identified using a single screening question. These students (N=1605) gave consent and were randomized into a 2-arm parallel group randomized controlled trial consisting of immediate or delayed access to a fully automated online assessment and intervention with personalized feedback. Results: After 2 months, there was no strong evidence of effectiveness with no statistically significant differences in the planned analyses, although there were some indication of possible benefit in sensitivity analyses suggesting an intervention effect of a 10% reduction (95% CI –30% to 10%) in total weekly alcohol consumption. Also, differences in effect sizes between universities were seen with participants from a major university (n=365) reducing their weekly alcohol consumption by 14% (95% CI –23% to –4%). However, lower recruitment than planned and differential attrition in the intervention and control group (49% vs 68%) complicated interpretation of the outcome data. Conclusions: Any effects of current national provision are likely to be small and further research and development work is needed to enhance effectiveness. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 02335307; http://www.isrctn.com/ISRCTN02335307 (Archived by WebCite at http://www.webcitation.org/6ZdPUh0R4). %M 26159179 %R 10.2196/jmir.4020 %U http://www.jmir.org/2015/7/e170/ %U https://doi.org/10.2196/jmir.4020 %U http://www.ncbi.nlm.nih.gov/pubmed/26159179 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 2 %P e73 %T Identification of Behavior Change Techniques and Engagement Strategies to Design a Smartphone App to Reduce Alcohol Consumption Using a Formal Consensus Method %A Garnett,Claire %A Crane,David %A West,Robert %A Brown,Jamie %A Michie,Susan %+ Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 2076795682, c.garnett.12@ucl.ac.uk %K smartphone apps %K alcohol consumption %K consensus %K Delphi technique %K behavior change techniques %D 2015 %7 29.06.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Digital interventions to reduce excessive alcohol consumption have the potential to have a broader reach and be more cost-effective than traditional brief interventions. However, there is not yet strong evidence for their ability to engage users or their effectiveness. Objective: This study aimed to identify the behavior change techniques (BCTs) and engagement strategies most worthy of further study by inclusion in a smartphone app to reduce alcohol consumption, using formal expert consensus methods. Methods: The first phase of the study consisted of a Delphi exercise with three rounds. It was conducted with 7 international experts in the field of alcohol and/or behavior change. In the first round, experts identified BCTs most likely to be effective at reducing alcohol consumption and strategies most likely to engage users with an app; these were rated in the second round; and those rated as effective by at least four out of seven participants were ranked in the third round. The rankings were analyzed using Kendall’s W coefficient of concordance, which indicates consensus between participants. The second phase consisted of a new, independent group of experts (n=43) ranking the BCTs that were identified in the first phase. The correlation between the rankings of the two groups was assessed using Spearman’s rank correlation coefficient. Results: Twelve BCTs were identified as likely to be effective. There was moderate agreement among the experts over their ranking (W=.465, χ211=35.8, P<.001) and the BCTs receiving the highest mean rankings were self-monitoring, goal-setting, action planning, and feedback in relation to goals. There was a significant correlation between the ranking of the BCTs by the group of experts who identified them and a second independent group of experts (Spearman’s rho=.690, P=.01). Seventeen responses were generated for strategies likely to engage users. There was moderate agreement among experts on the ranking of these engagement strategies (W=.563, χ215=59.2, P<.001) and those with the highest mean rankings were ease of use, design – aesthetic, feedback, function, design – ability to change design to suit own preferences, tailored information, and unique smartphone features. Conclusions: The BCTs with greatest potential to include in a smartphone app to reduce alcohol consumption were judged by experts to be self-monitoring, goal-setting, action planning, and feedback in relation to goals. The strategies most likely to engage users were ease of use, design, tailoring of design and information, and unique smartphone features. %M 26123578 %R 10.2196/mhealth.3895 %U http://mhealth.jmir.org/2015/2/e73/ %U https://doi.org/10.2196/mhealth.3895 %U http://www.ncbi.nlm.nih.gov/pubmed/26123578 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e55 %T Supportive Text Messages to Reduce Mood Symptoms and Problem Drinking in Patients With Primary Depression or Alcohol Use Disorder: Protocol for an Implementation Research Study %A Agyapong,Vincent Israel Opoku %A Mrklas,Kelly %A Suen,Victoria Yung Mei %A Rose,Marianne Sarah %A Jahn,Megan %A Gladue,Irene %A Kozak,Jody %A Leslie,Maureen %A Dursun,Serdar %A Ohinmaa,Arto %A Greenshaw,Andrew %+ Faculty of Health Sciences, Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 215 7771, agyapong@ualberta.ca %K depression %K alcohol use disorder %K supportive text messages %K intervention %D 2015 %7 15.05.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression and Alcohol Use Disorders (AUDs) are two leading causes of disability worldwide and are associated with significant treatment challenges requiring new, innovative, cost-effective and technologically-based therapies including the use of supportive text messages. Objective: To determine the feasibility and effectiveness of supportive text messages in long-term follow-up to reduce mood symptoms and problem drinking in patients with Depression or AUD respectively and to explore the usefulness of self-reports of health services utilization as an outcomes measure. Methods: This will be a longitudinal, prospective, parallel-design, two-arm, placebo-controlled single-rater-blinded randomized clinical trial with a recruitment period of 6 months and an observation period of 12 months for each participant, with two strata based on primary diagnosis of Major Depressive Disorder or AUD. The sample size will be 120, with about 60 patients randomized from each primary diagnostic grouping. Patients in all intervention groups will receive twice-daily supportive SMS text messages for 3 months and then daily supportive text messages for the next three months. Patients will also receive a phone call every two weeks from the research assistant assigning treatment allocation to confirm that they are still receiving the text messages and to thank them for taking part in the study. Patients in the control group will receive no text messages but will also receive a phone call from the same research assistant every two weeks to thank them for taking part in the study. Results: The study starts in April 2015 and ends in September 2016. It is envisaged that both qualitative and quantitative primary and secondary outcomes, including patient perceptions of the intervention, will shed light on the feasibility of using automated supportive text message interventions in long term for patients with Depression and AUD. This will inform a full-scale clinical trial. Conclusions: The paradigm for behavior change using text messages as a patient-direct intervention is consistent with a cognitive behavior therapy approach and addictions counselling principles. Given the automaticity of the messages, we anticipate that if the intervention proves successful, it will represent a low cost strategy that will be readily available and can bring relief to patients in hard-to-reach areas with limited access to psychological therapies. Trial Registration: ClinicalTrials.gov: NCT02327858; https://clinicaltrials.gov/ct2/show/NCT02327858 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02327858). %M 25979786 %R 10.2196/resprot.4371 %U http://www.researchprotocols.org/2015/2/e55/ %U https://doi.org/10.2196/resprot.4371 %U http://www.ncbi.nlm.nih.gov/pubmed/25979786 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e118 %T Behavior Change Techniques in Popular Alcohol Reduction Apps: Content Analysis %A Crane,David %A Garnett,Claire %A Brown,James %A West,Robert %A Michie,Susan %+ Department of Clinical, Educational and Health Psychology, University College London, 1 -19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7687 0723, david.crane.13@ucl.ac.uk %K alcohol %K behaviour change %K mHealth %K smartphone %K iPhone %K android %K apps %K digital %K intervention %D 2015 %7 14.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone apps have the potential to reduce excessive alcohol consumption cost-effectively. Although hundreds of alcohol-related apps are available, there is little information about the behavior change techniques (BCTs) they contain, or the extent to which they are based on evidence or theory and how this relates to their popularity and user ratings. Objective: Our aim was to assess the proportion of popular alcohol-related apps available in the United Kingdom that focus on alcohol reduction, identify the BCTs they contain, and explore whether BCTs or the mention of theory or evidence is associated with app popularity and user ratings. Methods: We searched the iTunes and Google Play stores with the terms “alcohol” and “drink”, and the first 800 results were classified into alcohol reduction, entertainment, or blood alcohol content measurement. Of those classified as alcohol reduction, all free apps and the top 10 paid apps were coded for BCTs and for reference to evidence or theory. Measures of popularity and user ratings were extracted. Results: Of the 800 apps identified, 662 were unique. Of these, 13.7% (91/662) were classified as alcohol reduction (95% CI 11.3-16.6), 53.9% (357/662) entertainment (95% CI 50.1-57.7), 18.9% (125/662) blood alcohol content measurement (95% CI 16.1-22.0) and 13.4% (89/662) other (95% CI 11.1-16.3). The 51 free alcohol reduction apps and the top 10 paid apps contained a mean of 3.6 BCTs (SD 3.4), with approximately 12% (7/61) not including any BCTs. The BCTs used most often were “facilitate self-recording” (54%, 33/61), “provide information on consequences of excessive alcohol use and drinking cessation” (43%, 26/61), “provide feedback on performance” (41%, 25/61), “give options for additional and later support” (25%, 15/61) and “offer/direct towards appropriate written materials” (23%, 14/61). These apps also rarely included any of the 22 BCTs frequently used in other health behavior change interventions (mean 2.46, SD 2.06). Evidence was mentioned by 16.4% of apps, and theory was not mentioned by any app. Multivariable regression showed that apps including advice on environmental restructuring were associated with lower user ratings (Β=-46.61, P=.04, 95% CI -91.77 to -1.45) and that both the techniques of “advise on/facilitate the use of social support” (Β=2549.21, P=.04, 95% CI 96.75-5001.67) and the mention of evidence (Β=1376.74, P=.02, 95%, CI 208.62-2544.86) were associated with the popularity of the app. Conclusions: Only a minority of alcohol-related apps promoted health while the majority implicitly or explicitly promoted the use of alcohol. Alcohol-related apps that promoted health contained few BCTs and none referred to theory. The mention of evidence was associated with more popular apps, but popularity and user ratings were only weakly associated with the BCT content. %M 25977135 %R 10.2196/jmir.4060 %U http://www.jmir.org/2015/5/e118/ %U https://doi.org/10.2196/jmir.4060 %U http://www.ncbi.nlm.nih.gov/pubmed/25977135 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e35 %T Drinker Prototype Alteration and Cue Reminders as Strategies in a Tailored Web-Based Intervention Reducing Adults’ Alcohol Consumption: Randomized Controlled Trial %A van Lettow,Britt %A de Vries,Hein %A Burdorf,Alex %A Boon,Brigitte %A van Empelen,Pepijn %+ TNO, Research Group Life Style, Schipholweg 77-89, Leiden, 2316 ZL Leiden, Netherlands, 31 888662711, pepijn.vanempelen@tno.nl %K Internet %K intervention studies %K prototypes %K drinking %K intention %K willingness %K adults %K randomized controlled trial %D 2015 %7 04.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Excessive alcohol use is a prevalent and worldwide problem. Excessive drinking causes a significant burden of disease and is associated with both morbidity and excess mortality. Prototype alteration and provision of a cue reminder could be useful strategies to enhance the effectiveness of online tailored interventions for excessive drinking. Objective: Through a Web-based randomized controlled trial, 2 strategies (ie, prototype alteration and cue reminders) within an existing online personalized feedback intervention (Drinktest) aimed to reduce adults’ excessive drinking. It was expected that both strategies would add to Drinktest and would result in reductions in alcohol consumption by intrinsic motivation and the seizure of opportunities to act. Methods: Participants were recruited online and through printed materials. Excessive drinking adults (N=2634) were randomly assigned to 4 conditions: original Drinktest, Drinktest plus prototype alteration, Drinktest plus cue reminder, and Drinktest plus prototype alteration and cue reminder. Evaluation took place at 1-month posttest and 6-month follow-up. Differences in drinking behavior, intentions, and behavioral willingness (ie, primary outcomes) were assessed by means of longitudinal multilevel analyses using a last observation carried forward method. Measures were based on self-reports. Results: All conditions showed reductions in drinking behavior and willingness to drink, and increased intentions to reduce drinking. Prototype alteration (B=–0.15, P<.05) and cue reminder usage (B=–0.15, P<.05) were both more effective in reducing alcohol consumption than when these strategies were not provided. Combining the strategies did not produce a synergistic effect. No differences across conditions were found regarding intentions or willingness. Conclusions: Although individuals’ awareness of their cue was reasonable, their reported alcohol consumption was nevertheless reduced. Individuals appeared to distance their self-image from heavier drinking prototypes. Thus, prototype alteration and cue reminder usage may be feasible and simple intervention strategies to promote reductions in alcohol consumption among adults, with an effect up to 6 months. Trial Registration: Nederlands Trial Register (NTR): 4169; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4169 (Archived by WebCite at http://www.webcitation.org/6VD2jnxmB). %M 25653199 %R 10.2196/jmir.3551 %U http://www.jmir.org/2015/2/e35/ %U https://doi.org/10.2196/jmir.3551 %U http://www.ncbi.nlm.nih.gov/pubmed/25653199 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e274 %T Reducing Alcohol Use During Pregnancy Via Health Counseling by Midwives and Internet-Based Computer-Tailored Feedback: A Cluster Randomized Trial %A van der Wulp,Nickie Y %A Hoving,Ciska %A Eijmael,Kim %A Candel,Math JJM %A van Dalen,Wim %A De Vries,Hein %+ Dutch Institute for Alcohol Policy STAP, P.O. Box 9769, Utrecht, 3506 GT, Netherlands, 31 306565041, nvanderwulp@stap.nl %K alcohol drinking %K pregnancy %K counseling %K telemedicine %K midwifery %D 2014 %7 05.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective interventions are needed to reduce neurobehavioral impairments in children due to maternal alcohol use during pregnancy. Currently, health-counseling interventions have shown inconsistent results to reduce prenatal alcohol use. Thus, more research using health counseling is needed to gain more knowledge about the effectiveness of this type of intervention on reducing alcohol use during pregnancy. An alternative and promising strategy is computer tailoring. However, to date, no study has shown the effectiveness of this intervention mode. Objective: The aim was to test the effectiveness of health counseling and computer tailoring on stopping and reducing maternal alcohol use during pregnancy in a Dutch sample of pregnant women using alcohol. Methods: A total of 60 Dutch midwifery practices, randomly assigned to 1 of 3 conditions, recruited 135 health counseling, 116 computer tailoring, and 142 usual care respondents from February to September 2011. Health-counseling respondents received counseling from their midwife according to a health-counseling protocol, which consisted of 7 steps addressed in 3 feedback sessions. Computer-tailoring respondents received usual care from their midwife and 3 computer-tailored feedback letters via the Internet. Usual care respondents received routine alcohol care from their midwife. After 3 and 6 months, we assessed the effect of the interventions on alcohol use. Results: Multilevel multiple logistic regression analyses showed that computer-tailoring respondents stopped using alcohol more often compared to usual care respondents 6 months after baseline (53/68, 78% vs 51/93, 55%; P=.04). Multilevel multiple linear regression analyses showed that computer-tailoring respondents (mean 0.35, SD 0.31 units per week) with average (P=.007) or lower (P<.001) alcohol use before pregnancy or with average (P=.03) or lower (P=.002) social support more strongly reduced their alcohol use 6 months after baseline compared to usual care respondents (mean 0.48, SD 0.54 units per week). Six months after baseline, 72% (62/86) of the health-counseling respondents had stopped using alcohol. This 17% difference with the usual care group was not significant. Conclusions: This is the first study showing that computer tailoring can be effective to reduce alcohol use during pregnancy; health counseling did not effectively reduce alcohol use. Future researchers developing a health-counseling intervention to reduce alcohol use during pregnancy are recommended to invest more in recruitment of pregnant women and implementation by health care providers. Because pregnant women are reluctant to disclose their alcohol use to health professionals and computer tailoring preserves a person’s anonymity, this effective computer-tailoring intervention is recommended as an attractive intervention for pregnant women using alcohol. Trial Registration: Dutch Trial Register NTR 2058; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2058 (Archived by WebCite at http://www.webcitation.org/6NpT1oHol) %M 25486675 %R 10.2196/jmir.3493 %U http://www.jmir.org/2014/12/e274/ %U https://doi.org/10.2196/jmir.3493 %U http://www.ncbi.nlm.nih.gov/pubmed/25486675 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e30 %T Feasibility and User Perception of a Fully Automated Push-Based Multiple-Session Alcohol Intervention for University Students: Randomized Controlled Trial %A Bendtsen,Marcus %A Bendtsen,Preben %+ Medical Faculty, Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Linköping, 581 83, Sweden, 46 702324615, preben.bendtsen@liu.se %K alcohol intervention %K text messages %K SMS %K email %K students %K multiple-session intervention %K push-based intervention %D 2014 %7 23.06.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers. Objective: This study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email. Methods: A total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded. Results: No difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group. Conclusions: Based on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted. %M 25098296 %R 10.2196/mhealth.3233 %U http://mhealth.jmir.org/2014/2/e30/ %U https://doi.org/10.2196/mhealth.3233 %U http://www.ncbi.nlm.nih.gov/pubmed/25098296 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 6 %P e142 %T The Effectiveness of Electronic Screening and Brief Intervention for Reducing Levels of Alcohol Consumption: A Systematic Review and Meta-Analysis %A Donoghue,Kim %A Patton,Robert %A Phillips,Thomas %A Deluca,Paolo %A Drummond,Colin %+ Institute of Psychiatry, Addictions Department, King's College London, Addiction Sciences Building, 4 Windsor Walk, London, SE5 8BB, United Kingdom, 44 207 848 0437, kim.donoghue@kcl.ac.uk %K alcohol drinking %K intervention studies %K Internet %K computers %K meta-analysis %D 2014 %7 02.06.2014 %9 Review %J J Med Internet Res %G English %X Background: Electronic screening and brief intervention (eSBI) has been shown to reduce alcohol consumption, but its effectiveness over time has not been subject to meta-analysis. Objective: The current study aims to conduct a systematic review and meta-analysis of the available literature to determine the effectiveness of eSBI over time in nontreatment-seeking hazardous/harmful drinkers. Methods: A systematic review and meta-analysis of relevant studies identified through searching the electronic databases PsychINFO, Medline, and EMBASE in May 2013. Two members of the study team independently screened studies for inclusion criteria and extracted data. Studies reporting data that could be transformed into grams of ethanol per week were included in the meta-analysis. The mean difference in grams of ethanol per week between eSBI and control groups was weighted using the random-effects method based on the inverse-variance approach to control for differences in sample size between studies. Results: There was a statistically significant mean difference in grams of ethanol consumed per week between those receiving an eSBI versus controls at up to 3 months (mean difference –32.74, 95% CI –56.80 to –8.68, z=2.67, P=.01), 3 to less than 6 months (mean difference –17.33, 95% CI –31.82 to –2.84, z=2.34, P=.02), and from 6 months to less than 12 months follow-up (mean difference –14.91, 95% CI –25.56 to –4.26, z=2.74, P=.01). No statistically significant difference was found at a follow-up period of 12 months or greater (mean difference –7.46, 95% CI –25.34 to 10.43, z=0.82, P=.41). Conclusions: A significant reduction in weekly alcohol consumption between intervention and control conditions was demonstrated between 3 months and less than 12 months follow-up indicating eSBI is an effective intervention. %M 24892426 %R 10.2196/jmir.3193 %U http://www.jmir.org/2014/6/e142/ %U https://doi.org/10.2196/jmir.3193 %U http://www.ncbi.nlm.nih.gov/pubmed/24892426 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 4 %P e102 %T Executive Functioning in Alcoholics Following an mHealth Cognitive Stimulation Program: Randomized Controlled Trial %A Gamito,Pedro %A Oliveira,Jorge %A Lopes,Paulo %A Brito,Rodrigo %A Morais,Diogo %A Silva,Diana %A Silva,Ana %A Rebelo,Sara %A Bastos,Marta %A Deus,Alberto %+ Lusophone University of Humanities and Technologies, Campo Grande, 376, Lisbon, 1749 - 024, Portugal, 351 217 515 500, pedro.gamito@ulusofona.pt %K alcohol %K addiction %K cognitive stimulation %K executive function %K mobile health %K serious games %D 2014 %7 17.04.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The consequences of alcohol dependence are severe and may range from physical disease to neuropsychological deficits in several cognitive domains. Alcohol abuse has also been related to brain dysfunction specifically in the prefrontal cortex. Conventional neuropsychological interventions (paper-and-pencil cognitive stimulation training) have a positive effect but are time-consuming, costly, and not motivating for patients. Objective: Our goal was to test the cognitive effects of a novel approach to neuropsychological intervention, using mobile technology and serious games, on patients with alcohol dependence. Methods: The trial design consisted of a two-arm study assessing the cognitive outcomes of neuropsychological intervention with mobile serious games (mHealth) versus control (treatment-as-usual with no neuropsychological intervention) in patients undergoing treatment for alcohol dependence syndrome. Sixty-eight patients were recruited from an alcohol-rehab clinic and randomly assigned to the mHealth (n=33) or control condition (n=35). The intervention on the experimental group consisted of a therapist-assisted cognitive stimulation therapy for 4 weeks on a 2-3 days/week basis. Results: Fourteen patients dropped out of the study. The results of the neuropsychological assessments with the remaining 54 patients showed an overall increase (P<.05) of general cognitive abilities, mental flexibility, psychomotor processing speed, and attentional ability in both experimental (n=26) and control groups (n=28). However, there was a more pronounced improvement (P=.01) specifically in frontal lobe functions from baseline (mean 13.89, SE 0.58) to follow-up (mean 15.50, SE 0.46) in the experimental group but not in the control group. Conclusions: The overall increase in general cognitive function for both experimental and control groups supports the beneficial role of existing alcohol treatment protocols aimed at minimizing withdrawal symptoms, but the differential improvements observed in frontal lobe functioning supports the use of mobile serious games for neuropsychological stimulation to overcome executive dysfunction in patients with alcohol dependence. This trial was negative on two neuropsychological/cognitive tests, and positive on one. Trial Registration: ClinicalTrials.gov NCT01942954; http://www.clinicaltrials.gov/ct2/show/NCT01942954 (Archived by WebCite at http://www.webcitation.org/6OYDqHLwB). %M 24742381 %R 10.2196/jmir.2923 %U http://www.jmir.org/2014/4/e102/ %U https://doi.org/10.2196/jmir.2923 %U http://www.ncbi.nlm.nih.gov/pubmed/24742381 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 1 %P e6 %T Evaluating a Brief, Internet-Based Intervention for Co-Occurring Depression and Problematic Alcohol Use in Young People: Protocol for a Randomized Controlled Trial %A Deady,Mark %A Teesson,Maree %A Kay-Lambkin,Frances %A Mills,Katherine L %+ National Drug and Alcohol Research Centre, University of New South Wales (UNSW), 22-32 King Street, Randwick NSW 2031, Sydney, 2052, Australia, 61 293850320, m.deady@unsw.edu.au %K depression %K alcohol %K young people %K Internet-based %K comorbidity %D 2014 %7 27.02.2014 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression and alcohol misuse represent two of the major causes of disease burden in young adults. These conditions frequently co-occur and this co-occurrence is associated with increased risks and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective, however, there remains a significant gap between those in need of treatment and those receiving it, particularly in young people. The increased availability of Internet-based programs to complement health care presents a unique opportunity in the treatment of these conditions. Objective: The objective of our study was to evaluate whether a brief, Internet-based, self-help intervention (the DEAL [DEpression-ALcohol] Project) can be effective in treating co-occurring depression and problematic alcohol use in young people (18-25 years old). Methods: The evaluation will take the form of a randomized controlled trial (RCT), comparing the DEAL Project with an attention-control condition (HealthWatch). The RCT will consist of a four-week intervention phase and a 24-week follow-up. It will be entirely Internet-based and open Australia-wide to young people 18 to 25 years old. The primary outcomes will be change in depression symptoms and alcohol use at 5, 12, and 24 weeks post baseline. Secondary outcomes include change in general functioning and quality of life, anxiety/stress symptomatology, and a number of other depression/alcohol related outcomes. Process analysis will also measure engagement across the conditions. Results: This study is currently ongoing with preliminary results expected in late 2014. Conclusions: This study, to our knowledge, will be the first RCT of a Internet-based treatment for comorbid depression and problematic alcohol use in any age group. If successful, the program represents a novel and innovative approach to addressing the significant harms associated with these conditions and will be an invaluable resource to those not receiving help elsewhere. Trial Registration: Australian New Zealand Clinical Trials Registry; ACTRN12613000033741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363461 (Archived by WebCite at http://www.webcitation.org/6Mrg9VFX4). %M 24583824 %R 10.2196/resprot.3192 %U http://www.researchprotocols.org/2014/1/e6/ %U https://doi.org/10.2196/resprot.3192 %U http://www.ncbi.nlm.nih.gov/pubmed/24583824 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e5 %T Using Ecological Momentary Assessment to Test the Effectiveness of a Web-Based Brief Alcohol Intervention Over Time Among Heavy-Drinking Students: Randomized Controlled Trial %A Voogt,Carmen %A Kuntsche,Emmanuel %A Kleinjan,Marloes %A Poelen,Evelien %A Engels,Rutger %+ Behavioural Science Institute, Radboud University Nijmegen, Montessorilaan 3, Nijmegen, 9104 6500 HE, Netherlands, 31 24 36 12705, c.voogt@bsi.ru.nl %K intervention study %K drinking %K students %D 2014 %7 08.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based brief alcohol interventions are effective in reducing alcohol use among students when measured at limited follow-up time points. To date, no studies have tested Web-based brief alcohol intervention effectiveness over time by using a large number of measurements. Objective: Testing whether the What Do You Drink (WDYD) Web-based brief alcohol intervention can sustain a reduction in alcohol use among heavy-drinking students aged 18-24 years at 1-, 3-, and 6-month follow-up intervals. Methods: A purely Web-based, 2-arm, parallel-group randomized controlled trial applying an ecological momentary assessment approach with 30 weekly measurements was conducted in the Netherlands (2010-2011). Participants were recruited offline and online. A total of 907 participants were randomized into the experimental condition (n=456) including the single-session and fully automated WDYD intervention, or into the control condition (n=451) including assessment only. Weekly alcohol consumption and frequency of binge drinking were the self-assessed outcome measures. Results: Attrition rates of the 907 participants were 110 (12.1%), 130 (14.3%), and 162 (17.9%) at 1-, 3-, and 6-month follow-up intervals, respectively. Latent growth curve analyses according to the intention-to-treat principle revealed that participants in the experimental condition had significantly lower weekly alcohol consumption compared to participants in the control condition that was sustained at 3-month follow-up (intercept=–2.60, P<.001; slope=0.16, P=.08). Additional linear regression analyses indicated that this intercept difference resulted from significantly higher levels of alcohol units per week for participants in the control condition compared to those in the experimental condition at 1-month (beta=–2.56, SE 0.74, Cohen’s d=0.20, P=.001), 3-month (beta=–1.76, SE 0.60, Cohen’s d=0.13, P=.003), and 6-month (beta=–1.21, SE 0.58, Cohen’s d=0.09, P=.04) follow-up intervals. Latent growth curve analyses further indicated that participants in the experimental condition had a significantly lower frequency of binge drinking compared to participants in the control condition that was sustained at 6-month follow-up (intercept=–0.14, P=.01; slope=0.004, P=.19). This intercept difference resulted from higher levels in this outcome for participants in the control condition relative to participants in the experimental condition at 1-month (beta=–1.15, SE 0.06, Cohen’s d=0.16, P=.01), 3-month (beta=–0.12, SE 0.05, Cohen’s d=0.09, P=.01), and 6-month (beta=–0.09, SE 0.05, Cohen’s d=0.03, P=.045) follow-up intervals. Conclusions: The WDYD intervention was shown to be effective in preventing an increase in weekly alcohol consumption and frequency of binge drinking directly after the intervention. This effect was sustained 3 and 6 months after the intervention. Trial Registration: Netherlands Trial Register NTR2665; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2665 (Archived by WebCite at http://webcitation.org/6LuQVn12M). %M 24401555 %R 10.2196/jmir.2817 %U http://www.jmir.org/2014/1/e5/ %U https://doi.org/10.2196/jmir.2817 %U http://www.ncbi.nlm.nih.gov/pubmed/24401555 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e36 %T Development of an Electronic Alcohol Screening and Brief Intervention Program for Hospital Outpatients With Unhealthy Alcohol Use %A Johnson,Natalie A %A Kypri,Kypros %A Attia,John %+ School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, HMRI Building, Callaghan, NSW, 2308, Australia, 61 240420552, natalie.johnson@newcastle.edu.au %K alcohol %K drinking %K screening %K brief intervention %K hospital %K outpatients %K Internet %D 2013 %7 20.09.2013 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Alcohol screening and brief intervention is recommended for widespread implementation in health care systems, but it is not used routinely in most countries for a variety of reasons. Electronic screening and brief intervention (e-SBI), in which patients complete a Web-based questionnaire and are provided with personalized feedback on their drinking, is a promising alternative to practitioner delivered intervention, but its efficacy in the hospital outpatient setting has not been established. Objective: The objective of our study was to establish the feasibility of conducting a full-scale randomized controlled trial to determine whether e-SBI reduces alcohol consumption in hospital outpatients with hazardous or harmful drinking. Methods: The study was conducted in the outpatient department of a large public hospital in Newcastle (population 540,000), Australia. Adults with appointments at a broad range of medical and surgical outpatient clinics were invited to complete an e-SBI program on a laptop, and to report their impressions via a short questionnaire. Follow-up assessments were conducted 2-8 weeks later by email and post. Results: We approached 172 outpatients and 108/172 (62.8%) agreed to participate. Of the 106 patients capable of self-administering the e-SBI, 7/106 (6.6%) did not complete it (3 due to technical problems and 4 because they were called for their appointment), 15/106 (14.2%) indicated that they had not consumed any alcohol in the past 12 months, 43/106 (40.6%) screened negative for unhealthy alcohol use (scored less than 5 on the Alcohol Use Disorders Identification Test Consumption [AUDIT-C] questions), 33/106 (31.1%) screened positive for hazardous or harmful drinking (AUDIT-C score 5-9), and 8/106 (7.5%) screened positive for possible alcohol dependence (AUDIT-C score 10-12). Among the subgroup with hazardous or harmful drinking, 27/33 (82%) found the feedback on their drinking very, quite, or somewhat useful, 33/33 (100%) thought the intervention would appeal to most or some of the people who attend the service, and 22/30 (73%) completed the follow-up. We also found that some well established procedures used in trials of e-SBI in the primary care setting did not translate to the hospital outpatient setting (1) we experienced delays because the e-SBI program had to be developed and maintained by the health service’s information technology staff for security reasons, (2) recruiting patients as they left the reception desk was impractical because patients tended to arrive at the beginning of the clinics with few arrivals thereafter, and (3) use of a laptop in a fixed location resulted in some patients rushing through the e-SBI so they could return to their seat in the area they had been advised to wait in. Conclusions: e-SBI is acceptable to outpatients and with some adaptation to organizational and physical conditions, it is feasible to recruit and screen patients and to deliver the intervention without disrupting normal service provision. This suggests that e-SBI could be provided routinely in this important setting if shown to be efficacious. %M 24055787 %R 10.2196/resprot.2697 %U http://www.researchprotocols.org/2013/2/e36/ %U https://doi.org/10.2196/resprot.2697 %U http://www.ncbi.nlm.nih.gov/pubmed/24055787 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e206 %T Effects of a Web-Based Tailored Intervention to Reduce Alcohol Consumption in Adults: Randomized Controlled Trial %A Schulz,Daniela N %A Candel,Math JJM %A Kremers,Stef PJ %A Reinwand,Dominique A %A Jander,Astrid %A de Vries,Hein %+ CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, P Debyeplein 1, Maastricht, 6229 HA, Netherlands, 31 43 3882832, dn.schulz@maastrichtuniversity.nl %K alcohol intake %K adults %K eHealth %K computer tailoring %K Web-based intervention %K tailoring methods %K effectiveness %D 2013 %7 17.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based tailored interventions provide users with information that is adapted to their individual characteristics and needs. Randomized controlled trials assessing the effects of tailored alcohol self-help programs among adults are scarce. Furthermore, it is a challenge to develop programs that can hold respondents’ attention in online interventions. Objective: To assess whether a 3-session, Web-based tailored intervention is effective in reducing alcohol intake in high-risk adult drinkers and to compare 2 computer-tailoring feedback strategies (alternating vs summative) on behavioral change, dropout, and appreciation of the program. Methods: A single-blind randomized controlled trial was conducted with an experimental group and a control group (N=448) in Germany in 2010-2011. Follow-up took place after 6 months. Drinking behavior, health status, motivational determinants, and demographics were assessed among participants recruited via an online access panel. The experimental group was divided into 2 subgroups. In the alternating condition (n=132), the tailored feedback was split into a series of messages discussing individual topics offered while the respondent was filling out the program. Participants in the summative condition (n=181) received all advice at once after having answered all questions. The actual texts were identical for both conditions. The control group (n=135) only filled in 3 questionnaires. To identify intervention effects, logistic and linear regression analyses were conducted among complete cases (n=197) and after using multiple imputation. Results: Among the complete cases (response rate: 197/448, 44.0%) who did not comply with the German national guideline for low-risk drinking at baseline, 21.1% of respondents in the experimental group complied after 6 months compared with 5.8% in the control group (effect size=0.42; OR 2.65, 95% CI 1.14-6.16, P=.02). The experimental group decreased by 3.9 drinks per week compared to 0.4 drinks per week in the control group, but this did not reach statistical significance (effect size=0.26; beta=−0.12, 95% CI −7.96 to 0.03, P=.05). Intention-to-treat analyses also indicated no statistically significant effect. Separate analyses of the 2 experimental subgroups showed no differences in intervention effects. The dropout rate during the first visit to the intervention website was significantly lower in the alternating condition than in the summative condition (OR 0.23, 95% CI 0.08-0.60, P=.003). Program appreciation was comparable for the 2 experimental groups. Conclusions: Complete case analyses revealed that Web-based tailored feedback can be an effective way to reduce alcohol intake among adults. However, this effect was not confirmed when applying multiple imputations. There was no indication that one of the tailoring strategies was more effective in lowering alcohol intake. Nevertheless, the lower attrition rates we found during the first visit suggest that the version of the intervention with alternating questions and advice may be preferred. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 91623132; http://www.controlled-trials.com/ISRCTN91623132 (Archived by WebCite at http://www.webcitation.org/6J4QdhXeG). %M 24045005 %R 10.2196/jmir.2568 %U http://www.jmir.org/2013/9/e206/ %U https://doi.org/10.2196/jmir.2568 %U http://www.ncbi.nlm.nih.gov/pubmed/24045005 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e196 %T A Pre-Post Study on the Appropriateness and Effectiveness of a Web- and Text Messaging-Based Intervention to Reduce Problem Drinking in Emerging Adults %A Haug,Severin %A Schaub,Michael P %A Venzin,Vigeli %A Meyer,Christian %A John,Ulrich %A Gmel,Gerhard %+ Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, Zurich, 8031, Switzerland, 41 44 448 11 74, severin.haug@isgf.uzh.ch %K alcohol intervention %K problem drinking %K young people %K text messaging %K Internet %D 2013 %7 02.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Problem drinking, particularly risky single-occasion drinking (RSOD), also called “binge drinking”, is widespread among adolescents and young adults in most Western countries. Few studies have tested the effectiveness of interventions to reduce RSOD in young people with heterogeneous and particularly lower educational background. Objective: To test the appropriateness and initial effectiveness of a combined, individually tailored Web- and text messaging (SMS)–based intervention program to reduce problem drinking in vocational school students. Methods: The fully automated program provided: (1) online feedback about an individual’s drinking pattern compared to the drinking norms of an age- and gender-specific reference group, and (2) recurrent individualized SMS messages over a time period of 3 months. Generalized Estimating Equation (GEE) analyses were used to investigate the longitudinal courses of the following outcomes over the study period of 3 months: RSOD, alcohol-related problems, mean number of standard drinks per week, and maximum number of standard drinks on an occasion. Results: The program was tested in 36 school classes at 7 vocational schools in Switzerland. Regardless of their drinking behavior, 477 vocational school students who owned a mobile phone were invited to participate in the program. Of these, 364 (76.3%) participated in the program. During the intervention period, 23 out of 364 (6.3%) persons unsubscribed from participating in the program. The GEE analyses revealed decreases in the percentage of persons with RSOD from baseline (75.5%, 210/278) to follow-up assessment (67.6%, 188/278, P<.001), in the percentage of persons with alcohol-related problems (20.4%, 57/280 to 14.3%, 40/280, P=.009), and in the mean number of standard drinks per week: 13.4 (SD 15.3) to 11.3 (SD 14.0), P=.002. They also revealed a trend toward a decrease in the mean of the maximum number of drinks consumed on an occasion: 11.3 (SD 10.3) to 10.5 (SD 10.3), P=.08. Conclusions: The results show high acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented within school classes. %M 23999406 %R 10.2196/jmir.2755 %U http://www.jmir.org/2013/9/e196/ %U https://doi.org/10.2196/jmir.2755 %U http://www.ncbi.nlm.nih.gov/pubmed/23999406 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 8 %P e162 %T Attrition Revisited: Adherence and Retention in a Web-Based Alcohol Trial %A Murray,Elizabeth %A White,Ian R %A Varagunam,Mira %A Godfrey,Christine %A Khadjesari,Zarnie %A McCambridge,Jim %+ e-Health Unit, Research Department of Primary Care and Population Health, University College London, Upper Floor 3, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 2077940500 ext 36747, elizabeth.murray@ucl.ac.uk %K Internet %K eHealth %K attrition %K adherence %K retention %K follow-up %D 2013 %7 30.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Attrition is a noted feature of eHealth interventions and trials. In 2005, Eysenbach published a landmark paper calling for a “science of attrition,” suggesting that the 2 forms of attrition—nonusage attrition (low adherence to the intervention) and dropout attrition (poor retention to follow-up)—may be related and that this potential relationship deserved further study. Objective: The aim of this paper was to use data from an online alcohol trial to explore Eysenbach’s hypothesis, and to answer 3 research questions: (1) Are adherence and retention related? If so, how, and under which circumstances? (2) Do adherence and retention have similar predictors? Can these predictors adequately explain any relationship between adherence and retention or are there additional, unmeasured predictors impacting on the relationship? (3) If there are additional unmeasured predictors impacting on the relationship, are there data to support Eysenbach’s hypothesis that these are related to overall levels of interest? Methods: Secondary analysis of data from an online trial of an online intervention to reduce alcohol consumption among heavy drinkers. The 2 outcomes were adherence to the intervention measured by number of log-ins, and retention to the trial measured by provision of follow-up data at 3 months (the primary outcome point). Dependent variables were demographic and alcohol-related data collected at baseline. Predictors of adherence and retention were modeled using logistic regression models. Results: Data were available on 7932 participants. Adherence and retention were related in a complex fashion. Participants in the intervention group were more likely than those in the control group to log in more than once (42% vs 28%, P<.001) and less likely than those in the control group to respond at 3 months (40% vs 49%, P<.001). Within each randomized group, participants who logged in more frequently were more likely to respond than those who logged in less frequently. Response rates in the intervention group for those who logged in once, twice, or ≥3 times were 34%, 46%, and 51%, respectively (P<.001); response rates in the control group for those who logged in once, twice, or ≥3 times were 44%, 60%, and 67%, respectively (P<.001). Relationships between baseline characteristics and adherence and retention were also complex. Where demographic characteristics predicted adherence, they tended also to predict retention. However, characteristics related to alcohol consumption and intention or confidence in reducing alcohol consumption tended to have opposite effects on adherence and retention, with factors that predicted improved adherence tending to predict reduced retention. The complexity of these relationships suggested the existence of an unmeasured confounder. Conclusions: In this dataset, adherence and retention were related in a complex fashion. We propose a possible explanatory model for these data. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 31070347; http://www.controlled-trials.com/ISRCTN31070347 (Archived by WebCite at http://www.webcitation.org/6IEmNnlCn). %M 23996958 %R 10.2196/jmir.2336 %U http://www.jmir.org/2013/8/e162/ %U https://doi.org/10.2196/jmir.2336 %U http://www.ncbi.nlm.nih.gov/pubmed/23996958 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e26 %T Psychosocial Interventions for Alcohol Use Among Problem Drug Users: Protocol for a Feasibility Study in Primary Care %A Klimas,Jan %A Anderson,Rolande %A Bourke,Margaret %A Bury,Gerard %A Field,Catherine Anne %A Kaner,Eileen %A Keane,Rory %A Keenan,Eamon %A Meagher,David %A Murphy,Brian %A O'Gorman,Clodagh SM %A O'Toole,Thomas P %A Saunders,Jean %A Smyth,Bobby P %A Dunne,Colum %A Cullen,Walter %+ Centre for Interventions in Infection, Immunity and Inflammation (4i) and Graduate Entry Medical School, Faculty of Education & Health Sciences, University of Limerick, GEMS3-014, Limerick, , Ireland, 353 61 202 812, walter.cullen@ul.ie %K complex intervention %K screening %K brief intervention %K alcohol %K methadone maintenance %K primary health care %K general practice %K substance-related disorders %D 2013 %7 02.08.2013 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use is an important issue among problem drug users. Although screening and brief intervention (SBI) are effective in reducing problem alcohol use in primary care, no research has examined this issue among problem drug users. Objective: The objective of this study is to determine if a complex intervention including SBI for problem alcohol use among problem drug users is feasible and acceptable in practice. This study also aims to evaluate the effectiveness of the intervention in reducing the proportion of patients with problem alcohol use. Methods: Psychosocial intervention for alcohol use among problem drug users (PINTA) is a pilot feasibility study of a complex intervention comprising SBI for problem alcohol use among problem drug users with cluster randomization at the level of general practice, integrated qualitative process evaluation, and involving general practices in two socioeconomically deprived regions. Practices (N=16) will be eligible to participate if they are registered to prescribe methadone and/or at least 10 patients of the practice are currently receiving addiction treatment. Patient must meet the following inclusion criteria to participate in this study: 18 years of age or older, receiving addiction treatment/care (eg, methadone), or known to be a problem drug user. This study is based on a complex intervention supporting SBI for problem alcohol use among problem drug users (experimental group) compared to an “assessment-only” control group. Control practices will be provided with a delayed intervention after follow-up. Primary outcomes of the study are feasibility and acceptability of the intervention to patients and practitioners. Secondary outcome includes the effectiveness of the intervention on care process (documented rates of SBI) and outcome (proportion of patients with problem alcohol use at the follow-up). A stratified random sampling method will be used to select general practices based on the level of training for providing addiction-related care and geographical area. In this study, general practitioners and practice staff, researchers, and trainers will not be blinded to treatment, but patients and remote randomizers will be unaware of the treatment. Results: This study is ongoing and a protocol system is being developed for the study. This study may inform future research among the high-risk population of problem drug users by providing initial indications as to whether psychosocial interventions for problem alcohol use are feasible, acceptable, and also effective among problem drug users attending primary care. Conclusions: This is the first study to examine the feasibility and acceptability of complex intervention in primary care to enhance alcohol SBI among problem drug users. Results of this study will inform future research among this high-risk population and guide policy and service development locally and internationally. %M 23939340 %R 10.2196/resprot.2678 %U http://www.researchprotocols.org/2013/2/e26/ %U https://doi.org/10.2196/resprot.2678 %U http://www.ncbi.nlm.nih.gov/pubmed/23939340 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 7 %P e137 %T The Effectiveness of a Web-Based Personalized Feedback and Social Norms Alcohol Intervention on United Kingdom University Students: Randomized Controlled Trial %A Bewick,Bridgette M %A West,Robert M %A Barkham,Michael %A Mulhern,Brendan %A Marlow,Robert %A Traviss,Gemma %A Hill,Andrew J %+ Academic Unit of Psychiatry and Behavioural Sciences, Leeds Institute of Health Sciences, School of Medicine, University of Leeds, Charles Thackrah Building, 101 Clarendon Road, Leeds, LS2 9LJ, United Kingdom, 44 1133430809, B.M.Bewick@leeds.ac.uk %K personalized feedback %K Web-based intervention %K student alcohol consumption %D 2013 %7 24.07.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol consumption in the student population continues to be cause for concern. Building on the established evidence base for traditional brief interventions, interventions using the Internet as a mode of delivery are being developed. Published evidence of replication of initial findings and ongoing development and modification of Web-based personalized feedback interventions for student alcohol use is relatively rare. The current paper reports on the replication of the initial Unitcheck feasibility trial. Objective: To evaluate the effectiveness of Unitcheck, a Web-based intervention that provides instant personalized feedback on alcohol consumption. It was hypothesized that use of Unitcheck would be associated with a reduction in alcohol consumption. Methods: A randomized control trial with two arms (control=assessment only; intervention=fully automated personalized feedback delivered using a Web-based intervention). The intervention was available week 1 through to week 15. Students at a UK university who were completing a university-wide annual student union electronic survey were invited to participate in the current study. Participants (n=1618) were stratified by sex, age group, year of study, self-reported alcohol consumption, then randomly assigned to one of the two arms, and invited to participate in the current trial. Participants were not blind to allocation. In total, n=1478 (n=723 intervention, n=755 control) participants accepted the invitation. Of these, 70% were female, the age ranged from 17-50 years old, and 88% were white/white British. Data were collected electronically via two websites: one for each treatment arm. Participants completed assessments at weeks 1, 16, and 34. Assessment included CAGE, a 7-day retrospective drinking diary, and drinks consumed per drinking occasion. Results: The regression model predicted a monitoring effect, with participants who completed assessments reducing alcohol consumption over the final week. Further reductions were predicted for those allocated to receive the intervention, and additional reductions were predicted as the number of visits to the intervention website increased. Conclusions: Unitcheck can reduce the amount of alcohol consumed, and the reduction can be sustained in the medium term (ie, 19 weeks after intervention was withdrawn). The findings suggest self-monitoring is an active ingredient to Web-based personalized feedback. %M 23883616 %R 10.2196/jmir.2581 %U http://www.jmir.org/2013/7/e137/ %U https://doi.org/10.2196/jmir.2581 %U http://www.ncbi.nlm.nih.gov/pubmed/23883616 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 1 %P e9 %T “Let’s get Wasted!” and Other Apps: Characteristics, Acceptability, and Use of Alcohol-Related Smartphone Applications %A Weaver,Emma R %A Horyniak,Danielle R %A Jenkinson,Rebecca %A Dietze,Paul %A Lim,Megan SC %+ Burnet Institute, Centre for Population Health, 85 Commercial Rd, Melbourne, 3004, Australia, 61 383442403, lim@burnet.edu.au %K alcohol drinking %K young adult %K mobile phone %K applications %D 2013 %7 25.06.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone applications (“apps”) offer a number of possibilities for health promotion activities. However, young people may also be exposed to apps with incorrect or poor quality information, since, like the Internet, apps are mostly unregulated. Little is known about the quality of alcohol-related apps or what influence they may have on young people’s behavior. Objective: To critically review popular alcohol-related smartphone apps and to explore young people’s opinions of these apps, their acceptability, and use for alcohol-related health promotion. Methods: First, a content analysis of 500 smartphone apps available via Apple iTunes and Android Google Play stores was conducted. Second, all available blood alcohol concentration (BAC) apps were tested against four individual case profiles of known BAC from a previous study. Third, two focus group discussions explored how young people use alcohol-related apps, particularly BAC apps. Results: 384 apps were included; 50% (192) were entertainment apps, 39% (148) were BAC apps, and 11% (44) were health promotion and/or stop drinking–related apps. When testing the BAC apps, there was wide variation in results, with apps tending to overestimate BAC scores compared with recorded scores. Participants were skeptical of the accuracy of BAC apps, and there was an overall concern that these apps would be used as a form of entertainment, further encouraging young people to drink, rather than reduce their drinking and risk taking. Conclusions: The majority of popular alcohol-related apps encouraged alcohol consumption. Apps estimating blood alcohol concentration were widely available but were highly unreliable. Health departments and prominent health organizations need to endorse alcohol smartphone apps that are accurate and evidence-based to give specific apps credibility in the ever-expanding market of unregulated apps. %M 25100681 %R 10.2196/mhealth.2709 %U http://mhealth.jmir.org/2013/1/e9/ %U https://doi.org/10.2196/mhealth.2709 %U http://www.ncbi.nlm.nih.gov/pubmed/25100681 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e110 %T Two Fully Automated Web-Based Interventions for Risky Alcohol Use: Randomized Controlled Trial %A Tensil,Marc-Dennan %A Jonas,Benjamin %A Strüber,Evelin %+ Delphi-Gesellschaft, Kaiserdamm 8, Berlin, 14057, Germany, 49 30 39 40 97 85, tensil@delphi-gesellschaft.de %K alcohol abuse %K binge drinking %K Internet intervention %K relapse prevention %K randomized controlled trial %D 2013 %7 06.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Excessive alcohol use is a widespread problem in many countries, especially among young people. To reach more people engaging in high-risk drinking behaviors, a number of online programs have been developed in recent years. Change Your Drinking is a German, diary-based, fully automated alcohol intervention. In 2010, a revised version of the program was developed. It is more strongly oriented to concepts of relapse prevention than the previous version, includes more feedback, and offers more possibilities to interact with the program. Moreover, the program duration was extended from 10 to 14 days. Objective: This paper examines whether the revised version of Change Your Drinking is more effective in reducing alcohol consumption than the original version. Methods: The effectiveness of both program versions was compared in a Web-based, open, randomized controlled trial with follow-up surveys 6 weeks and 3 months after registration. Participants were recruited online and were randomly assigned to either the original or the revised version of Change Your Drinking. The following self-assessed outcomes were used: alcohol use days, alcohol intake in grams, the occurrence of binge drinking and risky drinking (all referring to the past 7 days prior to each survey), and the number of alcohol-related problems. Results: A total of 595 participants were included in the trial. Follow-up rates were 58.0% after 6 weeks and 49.6% after 3 months. No significant group differences were found in any of the outcomes. However, the revised version was used by more participants (80.7%) than the original version (55.7%). A significant time effect was detected in all outcomes (alcohol use days: P=.002; alcohol intake in grams: P<.001; binge drinking: P<.001; alcohol-related problems: P=.004; risky drinking: P<.001). Conclusions: The duration and complexity of the program played a minor role in reducing alcohol consumption. However, differences in program usage between the versions suggest the revised version was more attractive to participants. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 31586428; http://www.controlled-trials.com/ISRCTN31586428/ (Archived by WebCite at http://www.webcitation.org/6BFxApCUT) %M 23742808 %R 10.2196/jmir.2489 %U http://www.jmir.org/2013/6/e110/ %U https://doi.org/10.2196/jmir.2489 %U http://www.ncbi.nlm.nih.gov/pubmed/23742808 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T Constructing a Theory- and Evidence-Based Treatment Rationale for Complex eHealth Interventions: Development of an Online Alcohol Intervention Using an Intervention Mapping Approach %A Brendryen,Håvar %A Johansen,Ayna %A Nesvåg,Sverre %A Kok,Gerjo %A Duckert,Fanny %+ The Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1039 Blindern, Oslo, 0315, Norway, 47 23 36 89 00, haavabre@medisin.uio.no %K early intervention %K at-risk drinkers %K hazardous drinking %K harmful drinking %K intervention mapping %K Internet, cell phone, eHealth, short message service %D 2013 %7 23.01.2013 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Due to limited reporting of intervention rationale, little is known about what distinguishes a good intervention from a poor one. To support improved design, there is a need for comprehensive reports on novel and complex theory-based interventions. Specifically, the emerging trend of just-in-time tailoring of content in response to change in target behavior or emotional state is promising. Objective: The objective of this study was to give a systematic and comprehensive description of the treatment rationale of an online alcohol intervention called Balance. Methods: We used the intervention mapping protocol to describe the treatment rationale of Balance. The intervention targets at-risk drinking, and it is delivered by email, mobile phone text messaging, and tailored interactive webpages combining text, pictures, and prerecorded audio. Results: The rationale of the current treatment was derived from a self-regulation perspective, and the overarching idea was to support continued self-regulation throughout the behavior change process. Maintaining the change efforts over time and coping adaptively during critical moments (eg, immediately before and after a lapse) are key factors to successful behavior change. Important elements of the treatment rationale to achieving these elements were: (1) emotion regulation as an inoculation strategy against self-regulation failure, (2) avoiding lapses by adaptive coping, and (3) avoiding relapse by resuming the change efforts after a lapse. Two distinct and complementary delivery strategies were used, including a day-to-day tunnel approach in combination with just-in-time therapy. The tunnel strategy was in accordance with the need for continuous self-regulation and it functions as a platform from which just-in-time therapy was launched. Just-in-time therapy was used to support coping during critical moments, and started when the client reports either low self-efficacy or that they were drinking above target levels. Conclusions: The descriptions of the treatment rationale for Balance, the alcohol intervention reported herein, provides an intervention blueprint that will aid in interpreting the results from future program evaluations. It will ease comparisons of program rationales across interventions, and may assist intervention development. By putting just-in-time therapy within a complete theoretical and practical context, including the tunnel delivery strategy and the self-regulation perspective, we have contributed to an understanding of how multiple delivery strategies in eHealth interventions can be combined. Additionally, this is a call for action to improve the reporting practices within eHealth research. Possible ways to achieve such improvement include using a systematic and structured approach, and for intervention reports to be published after peer-review and separately from evaluation reports. %M 23612478 %R 10.2196/resprot.2371 %U http://www.researchprotocols.org/2013/1/e6/ %U https://doi.org/10.2196/resprot.2371 %U http://www.ncbi.nlm.nih.gov/pubmed/23612478 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e142 %T Effectiveness of a Proactive Mail-Based Alcohol Internet Intervention for University Students: Dismantling the Assessment and Feedback Components in a Randomized Controlled Trial %A Bendtsen,Preben %A McCambridge,Jim %A Bendtsen,Marcus %A Karlsson,Nadine %A Nilsen,Per %+ Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Hälsouniversitetet, Kansliet, Linköping, SE-581 83, Sweden, 46 702324615, preben.bendtsen@liu.se %K Alcohol drinking %K Web-based intervention %K proactive intervention %K university students %D 2012 %7 31.10.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: University students in Sweden routinely receive proactive mail-based alcohol Internet interventions sent from student health services. This intervention provides personalized normative feedback on alcohol consumption with suggestions on how to decrease drinking. Earlier feasibility trials by our group and others have examined effectiveness in simple parallel-groups designs. Objective: To evaluate the effectiveness of electronic screening and brief intervention, using a randomized controlled trial design that takes account of baseline assessment reactivity (and other possible effects of the research process) due to the similarity between the intervention and assessment content. The design of the study allowed for exploration of the magnitude of the assessment effects per se. Methods: This trial used a dismantling design and randomly assigned 5227 students to 3 groups: (1) routine practice assessment and feedback, (2) assessment-only without feedback, and (3) neither assessment nor feedback. At baseline all participants were blinded to study participation, with no contact being made with group 3. We approached students 2 months later to participate in a cross-sectional alcohol survey. All interventions were fully automated and did not have any human involvement. All data used in the analysis were based on self-assessment using questionnaires. The participants were unaware that they were participating in a trial and thus were also blinded to which group they were randomly assigned. Results: Overall, 44.69% (n = 2336) of those targeted for study completed follow-up. Attrition was similar in groups 1 (697/1742, 40.01%) and 2 (737/1742, 42.31% retained) and lower in group 3 (902/1743, 51.75% retained). Intention-to-treat analyses among all participants regardless of their baseline drinking status revealed no differences between groups in all alcohol parameters at the 2-month follow-up. Per-protocol analyses of groups 1 and 2 among those who accepted the email intervention (36.2% of the students who were offered the intervention in group 1 and 37.3% of the students in group2 ) and who were risky drinkers at baseline (60.7% follow-up rate in group 1 and 63.5% in group 2) suggested possible small beneficial effects on weekly consumption attributable to feedback. Conclusions: This approach to outcome evaluation is highly conservative, and small benefits may follow the actual uptake of feedback intervention in students who are risky drinkers, the precise target group. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 24735383; http://www.controlled-trials.com/ISRCTN24735383 (Archived by WebCite at http://www.webcitation.org/6Awq7gjXG) %M 23113955 %R 10.2196/jmir.2062 %U http://www.jmir.org/2012/5/e142/ %U https://doi.org/10.2196/jmir.2062 %U http://www.ncbi.nlm.nih.gov/pubmed/23113955 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e134 %T Economic Evaluation of Internet-Based Interventions for Harmful Alcohol Use Alongside a Pragmatic Randomized Controlled Trial %A Blankers,Matthijs %A Nabitz,Udo %A Smit,Filip %A Koeter,Maarten WJ %A Schippers,Gerard M %+ Department Jellinek, Arkin Mental Health Care, PO Box 75848, Amsterdam, 1070 AV, Netherlands, 31 611785270, m.blankers@amc.uva.nl %K Cost-benefit analysis %K randomized controlled trial %K alcohol-induced disorders %K self-help %K computer-assisted therapy %D 2012 %7 29.10.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet interventions with and without therapist support have been found to be effective treatment options for harmful alcohol users. Internet-based therapy (IT) leads to larger and longer-lasting positive effects than Internet-based self-help (IS), but it is also more costly to provide. Objective: To evaluate the cost effectiveness and cost utility of Internet-based interventions for harmful use of alcohol through the assessment of the incremental cost effectiveness of IT compared with IS. Methods: This study was performed in a substance abuse treatment center in Amsterdam, the Netherlands. We collected data over the years 2008–2009. A total of 136 participants were included, 70 (51%) were female, and mean age was 41.5 (SD 9.83) years. Reported alcohol consumption and Alcohol Use Disorders Identification Test (AUDIT) scores indicated harmful drinking behavior at baseline. We collected self-reported outcome data prospectively at baseline and 6 months after randomization. Cost data were extracted from the treatment center’s cost records, and sex- and age-specific mean productivity cost data for the Netherlands. Results: The median incremental cost-effectiveness ratio was estimated at €3683 per additional treatment responder and €14,710 per quality-adjusted life-year (QALY) gained. At a willingness to pay €20,000 for 1 additional QALY, IT had a 60% likelihood of being more cost effective than IS. Sensitivity analyses attested to the robustness of the findings. Conclusions: IT offers better value for money than IS and might therefore be considered as a treatment option, either as first-line treatment in a matched-care approach or as a second-line treatment in the context of a stepped-care approach. Trial Registration: Netherlands Trial Register NTR-TC1155; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1155 (Archived by WebCite at http://www.webcitation.org/6AqnV4eTU) %M 23103771 %R 10.2196/jmir.2052 %U http://www.jmir.org/2012/5/e134/ %U https://doi.org/10.2196/jmir.2052 %U http://www.ncbi.nlm.nih.gov/pubmed/23103771 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e107 %T Comparison of Two Internet-Based Interventions for Problem Drinkers: Randomized Controlled Trial %A Cunningham,John Alastair %+ Social and Epidemiological Research, Centre for Addiction and Mental Health, 33 Russell St, Toronto, ON, M5S 2S1, Canada, 1 416 535 8501 ext 4682, john_cunningham@camh.net %K Randomized controlled trial %K problem drinking %K alcohol abuse %K Internet-based intervention %K eHealth %K brief intervention %D 2012 %7 01.08.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol problems are a serious public health concern, and few problem drinkers ever seek treatment. The Internet is one means of promoting access to care, but more research is needed to test the best types of interventions to employ. Evaluation of Internet-based interventions that contain a variety of research-validated cognitive-behavioral tools, which have been shown to be helpful to those with more severe alcohol concerns, should be a priority. Objective: To evaluate whether providing access to an extended Internet intervention for alcohol problems offers additional benefits in promoting reductions in alcohol consumption compared with a brief Internet intervention. The hypothesis for the current trial was that respondents who were provided with access to an extended Internet intervention (the Alcohol Help Center [AHC]) would display significantly improved drinking outcomes at 6-month follow-up, compared with respondents who were provided with access to a brief Internet intervention (the Check Your Drinking [CYD] screener). Methods: A single-blinded randomized controlled trial with a 6-month follow-up. A general population sample of problem drinkers was recruited through newspaper advertisements in a large metropolitan city. Baseline and follow-up data were collected by postal mail. Results: A volunteer sample of problem drinkers of legal drinking age with home access to the Internet were recruited for the trial. Of 239 potential respondents recruited in 2010, 170 met inclusion criteria (average age 45 years; 101/170, 59.4% male; average Alcohol Use Disorders Identification Test [AUDIT] score of 22). Follow-up rates were 90.0% (153/170) with no adverse effects of the interventions reported. A repeated-measures multivariate analysis of variance of the outcome measures using an intent-to-treat approach found a significantly greater reduction in amount of drinking among participants provided access to the AHC than among participants provided access to the CYD (P = .046). Conclusions: The provision of the AHC gave additional benefit in the short term to problem drinkers over that seen from the research-validated CYD, indicating the benefits of promoting access to these interventions as one means of helping people with problem drinking concerns. Trial Registration: ClinicalTrials.gov NCT01114919; http://clinicaltrials.gov/ct2/show/NCT01114919 (Archived by WebCite at http://www.webcitation.org/68t1dCkRZ) %M 22954459 %R 10.2196/jmir.2090 %U http://www.jmir.org/2012/4/e107/ %U https://doi.org/10.2196/jmir.2090 %U http://www.ncbi.nlm.nih.gov/pubmed/22954459 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e98 %T Internet-Based Brief Personalized Feedback Intervention in a Non-Treatment-Seeking Population of Adult Heavy Drinkers: A Randomized Controlled Trial %A Hansen,Anders Blædel Gottlieb %A Becker,Ulrik %A Nielsen,Anette Søgaard %A Grønbæk,Morten %A Tolstrup,Janne Schurmann %A Thygesen,Lau Caspar %+ National Institute of Public Health, Faculty of Health Sciences, University of Southern Denmark, Øster Farimagsgade 5 A, 2nd floor, Copenhagen, 1353, Denmark, 45 6550 7777 ext 7729, ago@niph.dk %K Internet-based personalized feedback %K normative feedback %K alcohol %K heavy drinking %K adult %K Internet-based personalized brief advice, brief intervention %D 2012 %7 30.07.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based interventions for heavy drinkers show promising results, but existing research is characterized by few studies in nonstudent adult populations and few comparisons with appropriate control groups. Objective: To test whether a fully automated Internet-based brief personalized feedback intervention and a fully automated Internet-based personalized brief advice intervention in a non-treatment-seeking population of heavy drinkers would result in a reduced alcohol intake. Methods: We conducted a 3-arm parallel randomized controlled trial in a general population-based sample of heavy drinkers. The 54,157 participants (median age of 58 years) were screened for heavy drinking. Of the 3418 participants who had a weekly alcohol consumption above 14 drinks for women and 21 drinks for men, 1380 (619 women) consented to take part in the trial and were randomly assigned to an Internet-based brief personalized feedback intervention group (normative feedback, n = 476), an Internet-based personalized brief advice intervention group (n = 450), or a nonintervention control group (n = 454). Follow-up after 6 and 12 months included 871 and 1064 participants, respectively, of all groups combined. The outcome measure was self-reported weekly alcohol consumption. We analyzed the data according to the intention-to-treat principle. To examine changes over time and to account for the multiple time measurements, we used a multilevel linear mixed model. To take attrition into account, we used multiple imputation to address missing data. Results: The intervention effect of the Internet-based brief personalized feedback intervention, determined as the mean additional difference in changes in alcohol consumption in the Internet-based brief personalized feedback intervention compared with the control group, was –1.8 drinks/week after 6 months and –1.4 drinks/week after 12 months; these effects were nonsignificant (95% confidence interval –4.0 to 0.3 at 6 months, –3.4 to 0.6 at 12 months). The intervention effect of the Internet-based personalized brief advice intervention was –0.5 drinks/week after 6 months and –1.2 drinks/week after 12 months; these effects were nonsignificant (95% confidence interval –2.7 to 1.6 at 6 months, –3.3 to 0.9 at 12 months). Conclusions: In this randomized controlled trial we found no evidence that an Internet-based brief personalized feedback intervention was effective in reducing drinking in an adult population of heavy drinkers. Trial registration: ClinicalTrials.gov NCT00751985; http://clinicaltrials.gov/ct2/show/NCT00751985 (Archived by WebCite at http://www.webcitation.org/68WCRLyaP) %M 22846542 %R 10.2196/jmir.1883 %U http://www.jmir.org/2012/4/e98/ %U https://doi.org/10.2196/jmir.1883 %U http://www.ncbi.nlm.nih.gov/pubmed/22846542 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 1 %N 1 %P e4 %T Harm Reduction Text Messages Delivered During Alcohol Drinking: Feasibility Study Protocol %A Renner,Karen Adell %A , %A , %A , %+ General Practice and Primary Health Care, School of Population Health, University of Auckland, Bldg 730, 261 Morrin Road, Glen Innes, Auckland, , New Zealand, 64 21440501, k.renner@auckland.ac.nz %K harm reduction %K alcohol %K eHealth %K mobile phone %K brief intervention %K smartphone %D 2012 %7 23.05.2012 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent research using mobile phone interventions to address public health issues such as smoking, obesity, depression, and diabetes provides a basis for trialing a similar approach toward reducing the negative consequences of risky drinking. Objective: This feasibility study aims to recruit drinkers between 18–34 years to a website where they will design and enter their own personal messages (repeating or one-off) to be sent to their mobile phones when they are drinking to remind them of their pre-drinking safety intentions. Methods/Design: Participants in the treatment group will have access to the messaging function for 3 months and will be compared to a control group who will have 3 months access to a web chat site only. Data collection will occur at baseline, 3 months, and 6 months. The primary outcome is a change in unintended negative consequences from drinking at 3 months. Secondary outcomes include the acceptability of the intervention to this population, recruitment rate, participant retention, reduction in alcohol consumption, and the self-motivation discourse in participant messages. Discussion: Existing alcohol interventions in New Zealand attempt to reduce alcohol consumption in the population, but with little effect. This study aims to target unintended negative consequences resulting from drinking by empowering the drinkers themselves to deliver safety messages during the drinking session. If proven effective, this strategy could provide a cost-effective means of reducing the public health burden associated with risky drinking. Trial Registration: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12611000242921 %M 23611773 %R 10.2196/resprot.1970 %U http://www.researchprotocols.org/2012/1/e4/ %U https://doi.org/10.2196/resprot.1970 %U http://www.ncbi.nlm.nih.gov/pubmed/23611773 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 2 %P e56 %T How is an Electronic Screening and Brief Intervention Tool on Alcohol Use Received in a Student Population? A Qualitative and Quantitative Evaluation %A Fraeyman,Jessica %A Van Royen,Paul %A Vriesacker,Bart %A De Mey,Leen %A Van Hal,Guido %+ Epidemiology and Social Medicine, Medical Sociology and Health Policy, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk (Antwerp), 2610, Belgium, 32 32652855, jessica.fraeyman@ua.ac.be %K Alcohol %K students %K intervention %D 2012 %7 23.04.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: A previous study among Antwerp college and university students showed that more male (10.2%–11.1%) than female (1.8%–6.2%) students are at risk for problematic alcohol use. The current literature shows promising results in terms of feasibility and effectiveness for the use of brief electronic interventions to address this health problem in college and university students. We evaluated this type of intervention and cite existing literature on the topic. Objective: To develop a website, www.eentjeteveel.be, to motivate college and university students with problematic alcohol use to reduce alcohol consumption and increase their willingness to seek help. Method: The website contained a questionnaire (Alcohol Use Disorders Identification Test [AUDIT]) for students to test their alcohol use. According to their answers, the students immediately received personalized feedback (personal AUDIT score and additional information on risks associated with alcohol use) and a suggestion for further action. Afterward, students could send an email to a student counselor for questions, guidance, or advice. To obtain in-depth qualitative information on the opinions and experiences of students, we held 5 focus group discussions. The topics were publicity, experiences, impressions, and effects of the website. We analyzed the quantitative results of the online test in SPSS 15.0. Results: More than 3500 students visited www.eentjeteveel.be; over half were men (55.0%). A total of 34 students participated in the focus group discussions. The mixture of quantitative and qualitative methods to evaluate the intervention allowed a thorough analysis and provided complementary results. The intervention was well received by the student population. However, some minor aspects should be reconsidered, such as website publicity and providing students with options that were added after intermediate evaluation. The intervention increased the motivation of students to think about their alcohol use but could not stimulate them to change their behavior. The website attracted relatively more male than female students and more students in the high-risk group than in the low-risk group. The high-risk group was more inclined to seek advice or guidance (23/400, 6%; χ22 = 32.4, P < .001) than the low-risk group (34/1714, 2%; χ22 = 32.4, P < .001). Conclusions: We gained unique insight into students’ experiences, opinions, and perceptions with regard to the intervention. The results show that the intervention was positively received in the population, and the willingness to seek help was increased. However, real behavior change needs further research. The results of this study can assist health providers and researchers in better understanding college and university students’ perceptions of eHealth initiatives. %M 22525340 %R 10.2196/jmir.1869 %U http://www.jmir.org/2012/2/e56/ %U https://doi.org/10.2196/jmir.1869 %U http://www.ncbi.nlm.nih.gov/pubmed/22525340 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e117 %T Attrition in Web-Based Treatment for Problem Drinkers %A Postel,Marloes G %A de Haan,Hein A %A ter Huurne,Elke D %A van der Palen,Job %A Becker,Eni S %A de Jong,Cor AJ %+ Tactus Addiction Treatment, Institutenweg 1, Enschede, 7521 PH, Netherlands, 31 534824750, m.postel@tactus.nl %K Web-based treatment %K online treatment %K problem drinking %K alcohol %K attrition %K dropout %D 2011 %7 27.12.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions for problem drinking are effective but characterized by high rates of attrition. There is a need to better understand attrition rates in order to improve the completion rates and the success of Web-based treatment programs. Objective: The objectives of our study were to (1) examine attrition prevalence and pretreatment predictors of attrition in a sample of open-access users of a Web-based program for problem drinkers, and (2) to further explore attrition data from our randomized controlled trial (RCT) of the Web-based program. Methods: Attrition data from two groups of Dutch-speaking problem drinkers were collected: (1) open-access participants enrolled in the program in 2009 (n = 885), and (2) RCT participants (n = 156). Participants were classified as noncompleters if they did not complete all 12 treatment sessions (9 assignments and 3 assessments). In both samples we assessed prevalence of attrition and pretreatment predictors of treatment completion. Logistic regression analysis was used to explore predictors of treatment completion. In the RCT sample, we additionally measured reasons for noncompletion and participants’ suggestions to enhance treatment adherence. The qualitative data were analyzed using thematic analysis. Results: The open-access and RCT group differed significantly in the percentage of treatment completers (273/780, 35.0% vs 65/144, 45%, χ21 = 5.4, P = .02). Logistic regression analysis revealed a significant contribution of treatment readiness, gender, education level, age, baseline alcohol consumption, and readiness to change to predict treatment completion. The key reasons for noncompletion were personal reasons, dissatisfaction with the intervention, and satisfaction with their own improvement. The main suggestions for boosting strategies involved email notification and more flexibility in the intervention. Conclusions: The challenge of Web-based alcohol treatment programs no longer seems to be their effectiveness but keeping participants involved until the end of the treatment program. Further research should investigate whether the suggested strategies to improve adherence decrease attrition rates in Web-based interventions. If we can succeed in improving attrition rates, the success of Web-based alcohol interventions will also improve and, as a consequence, their public health impact will increase. Trial: International Standard Randomized Controlled Trial Number (ISRCTN): 39104853; http://www.controlled-trials.com/ISRCTN39104853 (Archived by WebCite at http://www.webcitation.org/63IKDul1T) %M 22201703 %R 10.2196/jmir.1811 %U http://www.jmir.org/2011/4/e117/ %U https://doi.org/10.2196/jmir.1811 %U http://www.ncbi.nlm.nih.gov/pubmed/22201703 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e56 %T Modeling the Cost-Effectiveness of Health Care Systems for Alcohol Use Disorders: How Implementation of eHealth Interventions Improves Cost-Effectiveness %A Smit,Filip %A Lokkerbol,Joran %A Riper,Heleen %A Majo,Maria Cristina %A Boon,Brigitte %A Blankers,Matthijs %+ Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Centre of Prevention and Brief Intervention, P.O. Box 725, Utrecht, 1400 AS, Netherlands, 31 629735268, fsmit@trimbos.nl %K Alcohol-related disorders %K early intervention %K health care systems %K cost-effectiveness %D 2011 %7 11.08.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Informing policy decisions about the cost-effectiveness of health care systems (ie, packages of clinical interventions) is probably best done using a modeling approach. To this end, an alcohol model (ALCMOD) was developed. Objective: The aim of ALCMOD is to estimate the cost-effectiveness of competing health care systems in curbing alcohol use at the national level. This is illustrated for scenarios where new eHealth technologies for alcohol use disorders are introduced in the Dutch health care system. Method: ALCMOD assesses short-term (12-month) incremental cost-effectiveness in terms of reductions in disease burden, that is, disability adjusted life years (DALYs) and health care budget impacts. Results: Introduction of new eHealth technologies would substantially increase the cost-effectiveness of the Dutch health care system for alcohol use disorders: every euro spent under the current system returns a value of about the same size (€ 1.08, ie, a “surplus” of 8 euro cents) while the new health care system offers much better returns on investment, that is, every euro spent generates € 1.62 in health-related value. Conclusion: Based on the best available evidence, ALCMOD's computations suggest that implementation of new eHealth technologies would make the Dutch health care system more cost-effective. This type of information may help (1) to identify opportunities for system innovation, (2) to set agendas for further research, and (3) to inform policy decisions about resource allocation. %M 21840836 %R 10.2196/jmir.1694 %U http://www.jmir.org/2011/3/e56/ %U https://doi.org/10.2196/jmir.1694 %U http://www.ncbi.nlm.nih.gov/pubmed/21840836 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 3 %P e46 %T Persuasive Features in Web-Based Alcohol and Smoking Interventions: A Systematic Review of the Literature %A Lehto,Tuomas %A Oinas-Kukkonen,Harri %+ Oulu Advanced Research on Software and Information Systems, Department of Information Processing Science, University of Oulu, Rakentajantie 3, Oulu, 90570, Finland, 358 8 553 1900, tuomas.lehto@oulu.fi %K Web-based %K online %K Internet %K alcohol %K smoking %K intervention %K behavior change %K persuasive %K PSD model %K review %D 2011 %7 22.07.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: In the past decade, the use of technologies to persuade, motivate, and activate individuals’ health behavior change has been a quickly expanding field of research. The use of the Web for delivering interventions has been especially relevant. Current research tends to reveal little about the persuasive features and mechanisms embedded in Web-based interventions targeting health behavior change. Objectives: The purpose of this systematic review was to extract and analyze persuasive system features in Web-based interventions for substance use by applying the persuasive systems design (PSD) model. In more detail, the main objective was to provide an overview of the persuasive features within current Web-based interventions for substance use. Methods: We conducted electronic literature searches in various databases to identify randomized controlled trials of Web-based interventions for substance use published January 1, 2004, through December 31, 2009, in English. We extracted and analyzed persuasive system features of the included Web-based interventions using interpretive categorization. Results: The primary task support components were utilized and reported relatively widely in the reviewed studies. Reduction, self-monitoring, simulation, and personalization seem to be the most used features to support accomplishing user’s primary task. This is an encouraging finding since reduction and self-monitoring can be considered key elements for supporting users to carry out their primary tasks. The utilization of tailoring was at a surprisingly low level. The lack of tailoring may imply that the interventions are targeted for too broad an audience. Leveraging reminders was the most common way to enhance the user-system dialogue. Credibility issues are crucial in website engagement as users will bind with sites they perceive credible and navigate away from those they do not find credible. Based on the textual descriptions of the interventions, we cautiously suggest that most of them were credible. The prevalence of social support in the reviewed interventions was encouraging. Conclusions: Understanding the persuasive elements of systems supporting behavior change is important. This may help users to engage and keep motivated in their endeavors. Further research is needed to increase our understanding of how and under what conditions specific persuasive features (either in isolation or collectively) lead to positive health outcomes in Web-based health behavior change interventions across diverse health contexts and populations. %M 21795238 %R 10.2196/jmir.1559 %U http://www.jmir.org/2011/3/e46/ %U https://doi.org/10.2196/jmir.1559 %U http://www.ncbi.nlm.nih.gov/pubmed/21795238 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 2 %P e43 %T Curbing Alcohol Use in Male Adults Through Computer Generated Personalized Advice: Randomized Controlled Trial %A Boon,Brigitte %A Risselada,Anneke %A Huiberts,Annemarie %A Riper,Heleen %A Smit,Filip %+ Trimbos-institute, Department of Public Mental Health, POBox 725, Utrecht, 3500 AS, Netherlands, 31 302971145, bboon@trimbos.nl %K Web-based personalized feedback %K alcohol %K Internet %K heavy drinking %K problem drinking %K adult %D 2011 %7 30.06.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, interventions that deliver online personalized feedback on alcohol use have been developed and appear to be a feasible way to curb heavy drinking. Randomized controlled trials (RCTs) among the general adult population, however, are scarce. The present study offers an RCT of Drinktest.nl, an online personalized feedback intervention in the Netherlands. Objective: The aim of this study was to assess the effectiveness of computer-based personalized feedback on heavy alcohol use in male adults. Methods: Randomization stratified by age and educational level was used to assign participants to either the intervention consisting of online personalized feedback or an information-only control condition. Participants were told as a cover story that they would evaluate newly developed health education materials. Participants were males (n = 450), aged 18 to 65 years, presenting with either heavy alcohol use (> 20 units of alcohol weekly) and/or binge drinking (> 5 units of alcohol at a single occasion at least 1 day per week) in the past 6 months. They were selected with a screener from a sampling frame of 25,000 households. The primary outcome measure was the percentage of the participants that had successfully reduced their drinking levels to below the Dutch guideline threshold for at-risk drinking. Results: Intention-to-treat analysis showed that in the experimental condition, 42% (97/230) of the participants were successful in reducing their drinking levels to below the threshold at the 1-month follow-up as compared with 31% (67/220) in the control group (odds ratio [OR] = 1.7, number needed to treat [NNT] = 8.6), which was statistically significant (χ21 = 6.67, P = .01). At the 6-month follow-up, the success rates were 46% (105/230) and 37% (82/220) in the experimental and control conditions, respectively (OR = 1.4, NNT = 11.9), but no longer statistically significant (χ21 = 3.25, P = .07). Conclusions: Personalized online feedback on alcohol consumption appears to be an effective and easy way to change unhealthy drinking patterns in adult men, at least in the short-term. Trial registration: International Standard Randomized Controlled Trial Number: NTR836; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=836 (Archived by WebCite at http://www.webcitation.org/5ytnEz2vp) %M 21719412 %R 10.2196/jmir.1695 %U http://www.jmir.org/2011/2/e43/ %U https://doi.org/10.2196/jmir.1695 %U http://www.ncbi.nlm.nih.gov/pubmed/21719412 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 2 %P e42 %T Effectiveness of E-Self-help Interventions for Curbing Adult Problem Drinking: A Meta-analysis %A Riper,Heleen %A Spek,Viola %A Boon,Brigitte %A Conijn,Barbara %A Kramer,Jeannet %A Martin-Abello,Katherina %A Smit,Filip %+ Department of Clinical Psychology, VU University Amsterdam, Van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 20 5988757, h.riper@psy.vu.nl %K Meta-analysis %K alcohol %K problem drinking %K randomized controlled trial %K self-help %K e-self-help %K intervention %K unguided self-help %K low intensity interventions %K Internet %K adults %D 2011 %7 30.06.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-help interventions without professional contact to curb adult problem drinking in the community are increasingly being delivered via the Internet. Objective: The objective of this meta-analysis was to assess the overall effectiveness of these eHealth interventions. Methods: In all, 9 randomized controlled trials (RCTs), all from high-income countries, with 9 comparison conditions and a total of 1553 participants, were identified, and their combined effectiveness in reducing alcohol consumption was evaluated by means of a meta-analysis. Results: An overall medium effect size (g = 0.44, 95% CI 0.17-0.71, random effect model) was found for the 9 studies, all of which compared no-contact interventions to control conditions. The medium effect was maintained (g = 0.39; 95% CI 0.23-0.57, random effect model) after exclusion of two outliers. Type of control group, treatment location, type of analysis, and sample size did not have differential impacts on treatment outcome. A significant difference (P = .04) emerged between single-session personalized normative feedback interventions (g = 0.27, 95% CI 0.11-0.43) and more extended e- self-help (g = 0.61, 95% CI 0.33-0.90). Conclusion: E-self-help interventions without professional contact are effective in curbing adult problem drinking in high-income countries. In view of the easy scalability and low dissemination costs of such interventions, we recommend exploration of whether these could broaden the scope of effective public health interventions in low- and middle-income countries as well. %M 21719411 %R 10.2196/jmir.1691 %U http://www.jmir.org/2011/2/e42/ %U https://doi.org/10.2196/jmir.1691 %U http://www.ncbi.nlm.nih.gov/pubmed/21719411