Andreas Filler

Efficacy of a Web- and Text Messaging-Based Intervention to Reduce Problem Drinking in Adolescents: Results of a Cluster-Randomized Controlled Trial

Objective: To test the efficacy of a combined web- and text messaging-based intervention to reduce problem drinking in young people compared to assessment only. Method: Two-arm, parallel-group, cluster-randomized controlled trial with assessments at baseline and 6-month follow up. The automated intervention included online feedback, based on the social norms approach, and individually tailored text messages addressing social norms, outcome expectations, motivation, self-efficacy, and planning processes, provided over 3 months. The main outcome criterion was the prevalence of risky single-occasion drinking (RSOD, defined as drinking at least 5 standard drinks on a single occasion in men and 4 in women) in the past 30 days. Irrespective of alcohol consumption, 1,355 students from 80 Swiss vocational and upper secondary school classes, all of whom owned a mobile phone, were invited to participate in the study. Of these, 1,041 (76.8%) students participated in the study. Results: Based on intention-to-treat analyses, RSOD prevalence decreased by 5.9% in the intervention group and increased by 2.6% in the control group, relative to that of baseline assessment (odds ratio [OR] = 0.62, 95% confidence interval [CI] = 0.44–0.87). No significant group differences were observed for the following secondary outcomes: RSOD frequency, quantity of alcohol consumed, estimated peak blood alcohol concentration, and overestimation of peer drinking norms. Conclusions: The intervention program reduced RSOD, which is a major indicator of problem drinking in young people, effectively.

MobileCoach: A novel open source platform for the design of evidence-based, scalable and low-cost behavioral health interventions: Overview and preliminary evaluation in the public health context

Effective and efficient behavioral interventions are important and of high interest today. Due to shortcomings of related approaches, we introduce MobileCoach (mobile-coach.eu) as novel open source behavioral intervention platform. With its modular architecture, its rule-based engine that monitors behavioral states and triggers state transitions, we assume MobileCoach to lay a fruitful ground for evidence-based, scalable and low-cost behavioral interventions in various application domains. The code basis is made open source and thus, MobileCoach can be used and revised not only by interdisciplinary research teams but also by public bodies or business organizations without any legal constraints. Technical details of the platform are presented as well as preliminary empirical findings regarding the acceptance of one particular intervention in the public health context. Future work will integrate Internet of Things services that sense and process data streams in a way that MobileCoach interventions can be further tailored to the needs and characteristics of individual participants.

Moderators of outcome in a technology-based intervention to prevent and reduce problem drinking among adolescents

Introduction Moderators of outcome are investigated in a technology-based intervention that has been shown to effectively reduce binge drinking among adolescents. Methods Secondary data analyses were performed on socio-demographic, health-related, and socio-cognitive moderators of intervention efficacy. Students attending 80 vocational and upper secondary school classes with different levels of alcohol use were randomized to either a web- and text messaging-based intervention (n = 547) or an assessment-only control group (n = 494). Moderators of outcome were analysed across the entire sample, and separately for lower-risk and higher-risk drinkers. Results Based on an intention-to-treat analysis, we identified smoking status and educational level to moderate the intervention effectiveness across the total sample and in the lower-risk subsample, with a greater reduction in binge-drinking prevalence in smokers versus non-smokers, and in more highly-educated versus less-educated adolescents. Conclusions Technology-based interventions targeting heavy drinking might be especially effective in smokers and highly-educated adolescents. Interventions can prevent low-risk drinkers that smoke from developing a problematic alcohol use.

Personal MobileCoach: tailoring behavioral interventions to the needs of individual participants

MobileCoach, an open source behavioral intervention platform, has been developed to provide health professionals with an authoring tool to design evidence-based, scalable and low-cost digital health interventions (DHI). Its potential meets the lack in resources and capacity of health care systems to provide DHI for the treatment of noncommunicable diseases. In the current work, we introduce the first personalization approach for MobileCoach with the purpose of identifying the needs of participants, tailoring the treatment and, as a consequence, enhancing the capability of MobileCoach-based DHIs. The personalization approach is then exemplified by a very first prototype of a DHI for people with asthma that is able to detect coughing by just using a smartphones microphone. First empirical results with five healthy subjects and 80 coughs indicate its technical feasibility as the detection accuracy yielded 83.3%. Future work will focus on the integration of personalized sensing and supporting applications for MobileCoach.

Efficacy of a technology-based, integrated smoking cessation and alcohol intervention for smoking cessation in adolescents: Results of a cluster-randomised controlled trial

OBJECTIVE To test the efficacy of a technology-based integrated smoking cessation and alcohol intervention versus a smoking cessation only intervention in adolescents. METHODS This was a two-arm, parallel-group, cluster-randomised controlled trial with assessments at baseline and six months follow-up. Subjects in both groups received tailored mobile phone text messages to support smoking cessation for 3months, and the option of registering for a program incorporating strategies for smoking cessation centred around a self-defined quit date. Subjects in the integrated intervention group also received tailored feedback regarding their consumption of alcohol and, for binge drinkers, tailored mobile phone text messages encouraging them to maintain their drinking within low-risk limits over a 3-month period. Primary outcome measures were the 7-day point prevalence of smoking abstinence and change in cigarette consumption. RESULTS In 360 Swiss vocational and upper secondary school classes, 2127 students who smoked tobacco regularly and owned a mobile phone were invited to participate in the study. Of these, 1471 (69.2%) participated and 6-month follow-up data were obtained for 1116 (75.9%). No significant group differences were observed for any of the primary or secondary outcomes. Moderator analyses revealed beneficial intervention effects concerning 7-day smoking abstinence in participants with higher versus lower alcohol consumption. CONCLUSIONS Overall, the integrated smoking cessation and alcohol intervention exhibited no advantages over a smoking cessation only intervention, but it might be more effective for the subgroup of adolescent smokers with higher alcohol consumption. Providing a combined smoking cessation and alcohol intervention might be recommended for adolescent smokers with higher-level alcohol consumption.

A Mobile Phone-Based Life Skills Training Program for Substance Use Prevention Among Adolescents: Pre-Post Study on the Acceptance and Potential Effectiveness of the Program, Ready4life

Background Substance use and misuse often first emerge during adolescence. Generic life skills training that is typically conducted within the school curriculum is effective at preventing the onset and escalation of substance use among adolescents. However, the dissemination of such programs is impeded by their large resource requirements in terms of personnel, money, and time. Life skills training provided via mobile phones might be a more economic and scalable approach, which additionally matches the lifestyle and communication habits of adolescents. Objective The aim of this study was to test the acceptance and initial effectiveness of an individually tailored mobile phone–based life skills training program in vocational school students. Methods The fully automated program, named ready4life, is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Program participants received up to 3 weekly text messages (short message service, SMS) over 6 months. Active program engagement was stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition with prizes in which program users collected credits with each interaction. Generalized estimating equation (GEE) analyses were used to investigate for changes between baseline and 6-month follow-up in the following outcomes: perceived stress, self-management skills, social skills, at-risk alcohol use, tobacco smoking, and cannabis use. Results The program was tested in 118 school classes at 13 vocational schools in Switzerland. A total of 1067 students who owned a mobile phone and were not regular cigarette smokers were invited to participate in the life skills program. Of these, 877 (82.19%, 877/1067; mean age=17.4 years, standard deviation [SD]=2.7; 58.3% females) participated in the program and the associated study. A total of 43 students (4.9%, 43/877) withdrew their program participation during the intervention period. The mean number of interactive program activities that participants engaged in was 15.5 (SD 13.3) out of a total of 39 possible activities. Follow-up assessments were completed by 436 of the 877 (49.7%) participants. GEE analyses revealed decreased perceived stress (odds ratio, OR=0.93; 95% CI 0.87-0.99; P=.03) and increases in several life skills addressed between baseline and the follow-up assessment. The proportion of adolescents with at-risk alcohol use declined from 20.2% at baseline to 15.5% at follow-up (OR 0.70, 95% CI 0.53-0.93; P=.01), whereas no significant changes were obtained for tobacco (OR 0.94, 95% CI 0.65-1.36; P=.76) or cannabis use (OR 0.91, 95% CI 0.67-1.24; P=.54). Conclusions These results reveal high-level acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented. A reasonable next step would be to test the efficacy of this program within a controlled trial.

Design and Evaluation of a Mobile Chat App for the Open Source Behavioral Health Intervention Platform MobileCoach

The open source platform MobileCoach (mobile-coach.eu) has been used for various behavioral health interventions in the public health context. However, so far, MobileCoach is limited to text message-based interactions. That is, participants use error-prone and laborious text-input fields and have to bear the SMS costs. Moreover, MobileCoach does not provide a dedicated chat channel for individual requests beyond the processing capabilities of its chatbot. Intervention designers are also limited to text-based self-report data. In this paper, we thus present a mobile chat app with pre-defined answer options, a dedicated chat channel for patients and health professionals and sensor data integration for the MobileCoach platform. Results of a pretest (N = 11) and preliminary findings of a randomized controlled clinical trial (N = 14) with young patients, who participate in an intervention for the treatment of obesity, are promising with respect to the utility of the chat app.

Engagement within a mobile phone–based smoking cessation intervention for adolescents and its association with participant characteristics and outcomes

Background Although mobile phone–delivered smoking cessation programs are a promising way to promote smoking cessation among adolescents, little is known about how adolescents might actually use them. Objective The aim of this study was to determine adolescents’ trajectories of engagement with a mobile phone–delivered smoking cessation program over time and the associations these trajectories have with baseline characteristics and treatment outcomes. Methods We performed secondary data analysis on a dataset from a study that compared a mobile phone–delivered integrated smoking cessation and alcohol intervention with a smoking cessation only intervention for adolescents recruited in vocational and upper secondary school classes (N=1418). Throughout the 3-month intervention, participants in both intervention groups received one text message prompt per week that either assessed smoking-related target behaviors or encouraged participation in a quiz or a message contest. Sequence analyses were performed to identify engagement trajectories. Analyses were conducted to identify predictors of engagement trajectory and associations between engagement trajectories and treatment outcomes. Results Three engagement trajectories emerged: (1) stable engagement (646/1418, 45.56%), (2) decreasing engagement (501/1418, 35.33%), and (3) stable nonengagement (271/1418, 19.11%). Adolescents who were younger, had no immigrant background, perceived more benefits of quitting smoking, and reported binge drinking preceding the baseline assessment were more likely to exhibit stable engagement. Due to different reach of more engaged and less engaged participants at follow-up, three statistical models (complete-cases, last-observation-carried-forward, and multiple imputation) for the associations of engagement trajectory and smoking outcome were tested. For 7-point smoking abstinence, no association was revealed to be statistically significant over all three models. However, decreasing engagement with the program was associated over all three models, with greater reductions in daily tobacco use than nonengagement. Conclusions The majority of tobacco-smoking adolescents engaged extensively with a mobile phone–based smoking cessation program. However, not only stable engagement but also decreasing engagement with a program might be an indicator of behavioral change. Measures to avoid nonengagement among adolescents appear especially necessary for older smokers with an immigrant background who do not drink excessively. In addition, future studies should not only examine the use of specific program components but also users’ engagement trajectories to better understand the mechanisms behind behavioral change.