Severin Haug

Continuous individual support of smoking cessation using text messaging: A pilot experimental study

INTRODUCTION The objective of this study was to test the feasibility and acceptance of an intervention using text messaging (short message service [SMS]) for continuous individual support of smoking cessation in young adults. Additionally, the optimal feedback intensity was investigated, and short-term efficacy of the intervention was explored. METHODS In a cafeteria of the University of Greifswald, 575 visitors were screened for smoking status and usage of text messaging. From these, 194 persons who fulfilled the inclusion criteria of daily smoking and weekly usage of SMS were invited for participation in an SMS-based intervention. From these, 174 (90%) consented to participate. The participants were randomly allocated to one of three study groups: (a) control condition without intervention, (b) intervention with one weekly SMS feedback (1SMS), or (c) intervention with three weekly SMS feedbacks (3SMS). In study groups (b) and (c), individualized SMS feedbacks were sent to the participants weekly, based on data from the baseline assessment and a weekly SMS assessment of the stages of change according to the transtheoretical model. Program use and acceptance were compared between the two intervention groups differing in support intensity. An exploration of the short-term efficacy of the program was conducted by comparing the three study groups at the end of the 3-month intervention program on smoking variables. RESULTS The median number of replies to the weekly SMS assessments was 12.5 in the 1SMS group and 13.0 in the 3SMS group (not significant). The acceptance of the program did not differ between the intervention groups. At postassessment, no significant differences between the three study groups emerged on the examined smoking variables. DISCUSSION The high participation and retention rates suggest that SMS-based smoking cessation interventions are attractive for young adults. Support intensity did not affect the acceptance of the program. Longer follow-up periods and larger samples are required to obtain conclusive results about the efficacy of this intervention approach.

Computergestützte quantitative Textanalyse. Äquivalenz und Robustheit der deutschen Version des Linguistic Inquiry and Word Count

Zusammenfassung. Im Beitrag wird die deutsche Adaptation des Linguistic Inquiry and Word Count (LIWC) vorgestellt. Das LIWC ist ein computergestutztes Textanalyseprogramm mit integriertem Worterbuch, das von Pennebaker und Kollegen (2001) entwickelt wurde, um Essays aus Experimenten zum expressiven Schreiben zu untersuchen. Es werden zwei Studien zur Gute und Praktikabilitat des deutschen LIWC berichtet: (1) An einer Stichprobe zweisprachig vorliegender Texte (N = 122) wird die Aquivalenz der deutschen Ubersetzung mit dem Original uberpruft. (2) An einer Stichprobe von N = 104 E-Mails wird die Robustheit des Verfahrens gegenuber Schreibfehlern untersucht. Fur die meisten LIWC-Kategorien zeigt sich eine gute Aquivalenz. Des Weiteren erweist sich das LIWC als robust gegenuber Schreibfehlern. Diese Befunde sprechen fur die Brauchbarkeit des LIWC fur die Analyse deutscher Texte. Die beobachtete Robustheit ist von erheblicher praktischer Bedeutung fur die Analyse naturlicher geschriebener Sprache aus der compu...

Efficacy of a Text Message-Based Smoking Cessation Intervention for Young People: A Cluster Randomized Controlled Trial

Background Smoking prevalence remains high, particularly among adolescents and young adults with lower educational levels, posing a serious public health problem. There is limited evidence of effective smoking cessation interventions in this population. Objective To test the efficacy of an individually tailored, fully automated text messaging (short message service, SMS)–based intervention for smoking cessation in young people. Methods A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment-only control group. Students who smoked were proactively recruited via online screening in vocational school classes. Text messages, tailored to demographic and smoking-related variables, were sent to the participants of the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was performed 6 months after study inclusion. The primary outcome measure was 7-day smoking abstinence. Secondary outcomes were 4-week smoking abstinence, cigarette consumption, stage of change, and attempts to quit smoking. We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention. Both complete-case analyses (CCA) and intention-to-treat analyses (ITT) were performed. Subgroup analyses were conducted for occasional and daily smokers. Results A total of 2638 students in 178 vocational school classes in Switzerland participated in the online screening. Overall, 1012 persons met the inclusion criteria for study participation, and 755 persons (74.6%) participated in the study (intervention: n=372; control: n=383). Of the 372 program participants, 9 (2.4%) unsubscribed from the program during the intervention period. Six-month follow-up data were obtained for 559 study participants (74.0%). The 7-day smoking abstinence rate at follow-up was 12.5% in the intervention group and 9.6% in the control group (ITT: P=.92). No differences between the study groups were observed in 4-week point prevalence abstinence rates. The decrease in the mean number of cigarettes smoked per day from baseline to follow-up was higher in the intervention group than in the control group (ITT: P=.002). No differences between the groups were observed in stage of change (ITT: P=.82) and quit attempts (ITT: P=.38). The subgroup analyses revealed lower cigarette consumption in both occasional and daily smokers in the intervention group compared to the control group. Occasional smokers in the intervention group made more attempts to quit smoking than occasional smokers in the control group. Conclusions This study demonstrated the potential of an SMS text message–based intervention to reach a high proportion of young smokers with low education levels. The intervention did not have statistically significant short-term effects on smoking cessation; however, it resulted in statistically significant lower cigarette consumption. Additionally, it resulted in statistically significant more attempts to quit smoking in occasional smokers. Trial Registration International Standard Randomized Controlled Trial Number (ISRCTN): 19739792; http://www.controlled-trials.com/ISRCTN19739792 (Archived by WebCite at http://webcitation.org/6IGETTHmr).

ES(S)PRIT an Internet-based programme for the prevention and early intervention of eating disorders in college students

ABSTRACT New communication technologies offer novel possibilities for the prevention of mental illness, in which geographical and psychosocial distances often hamper help-seeking. This paper introduces ES[S]PRIT, an Internet-based eating disorders (ED) prevention programme for university students. The programme follows a stepped-care approach combining various support components of increasing intensity. These components comprise psychoeducation, symptom monitoring, supportive feedback, peer support, and professional online counselling. Participants who develop substantial ED symptoms during their participation are referred to the University Student Counselling Center. We outline the underlying concepts and various components of the programme and report first experiences with the approach in a sample of German college students. Finally, potentials of the approach are highlighted and the need for further research is stressed.

The effectiveness of internet chat groups in relapse prevention after inpatient psychotherapy

Abstract The majority of patients benefit from psychotherapeutic treatment. However, many fail to maintain their treatment gains following discharge. In a controlled study, we investigated the effectiveness of internet chat groups in preventing relapse following inpatient treatment. One hundred and fifty-two patients were assessed with the Longitudinal Follow-up Evaluation (LIFE) 1 year after discharge from the hospital. Kaplan Meier survival analyses showed that significantly fewer chat participants (22.2%) than control participants (46.5%) experienced a relapse. Additional analyses yielded a significant difference in the relapse rates of chat and control participants depending on their utilization of outpatient treatment after discharge. The results confirm that technology-enhanced interventions are effective in maintaining treatment gains. Implications of the findings for health care provision are discussed.

Predictors and moderators of outcome in different brief interventions for smoking cessation in general medical practice.

OBJECTIVE To explore demographic-, health-, and smoking-related predictors and moderators of outcome in smokers who participated in two different brief smoking cessation interventions. METHODS Data were acquired using a quasi-randomized controlled trial that tested the efficacy of computer-generated tailored letters and physician-delivered brief advice against assessment only. Daily smokers (n=1499) were recruited from 34 general medical practices. We used Generalized Estimating Equation analyses to investigate the relationship between 6-month prolonged smoking abstinence assessed at 12-, 18-, and 24-month follow-ups and potential predictors and moderators. RESULTS Female gender (OR=1.49, 95% CI=1.01-2.19), higher level of education (OR=1.82, 95% CI=1.18-2.82), intention to quit smoking (OR=1.66, 95% CI=1.16-2.38), and smoking cessation self-efficacy (OR=1.30, 95% CI=1.03-1.64) were positively, nicotine dependence (OR=0.84, 95% CI=0.76-0.94) and the presence of a smoking partner (OR=0.60, 95% CI=0.42-0.85) were negatively associated with smoking abstinence. Compared to assessment only, physician advice was less effective for people without an intention to quit smoking and for unemployed. CONCLUSION Smoking cessation interventions might be improved by tailoring them to demographic- and smoking-related variables which were identified as predictors in this study. PRACTICE IMPLICATIONS The results suggest that tailored letters are a more universally applicable brief intervention in general medical practice than physician advice.

Web-Based Cognitive Behavioral Self-Help Intervention to Reduce Cocaine Consumption in Problematic Cocaine Users: Randomized Controlled Trial

Background Web-based self-help programs that reduce problematic substance use are able to reach hidden consumer groups in the general population. These programs are characterized by their low treatment threshold and nonrestrictive intervention settings. They are also cost effective, making them of interest to both low-income and high-income industrialized countries with ever-increasing health costs. Objective To test the feasibility and effectiveness of an anonymous, fully automated, Web-based self-help intervention as an alternative to outpatient treatment services for cocaine users. Methods A total of 196 cocaine-using participants were recruited through various online and offline media for a randomized controlled trial. Participants in the intervention group received interactive cognitive behavioral modules and a consumption diary to reduce cocaine use, whereas participants in the control group received online psychoeducative information modules. Web-based follow-up assessments were conducted after 4 weeks, 6 weeks, and 6 months. Treatment retention was examined and compared between the intervention and control groups. Severity of cocaine dependence was the main outcome measure. Secondary outcomes were cocaine craving, depression symptoms, and alcohol and other substance use. Results This Web-based intervention attracted older and more educated participants than existing outpatient treatment programs for which cocaine is the primary substance of abuse. Participants in the intervention group showed greater treatment retention compared with the control group (P = .04). Low response rates at the follow-up assessments restricted the explanatory power of the analyses. At the follow-up assessments, the severity of cocaine dependence did not differ between the intervention and control groups (P = .75). Furthermore, there were no differences in cocaine craving, depression, or alcohol and other substance use. Using the consumption diaries, the average number of cocaine-free days per week did not change significantly, whereas the weekly quantity of cocaine used decreased equally in both groups (P = .009). Conclusions For cocaine users with low dependence severity, a fully automated Web-based cognitive behavioral self-help intervention is a feasible alternative with limited effectiveness in outpatient treatment services. However, this type of intervention may attract specific user groups that are rarely reached by existing outpatient treatment and may help them to control their cocaine consumption anonymously. Trial Registration ISRCTN93702927; http://www.controlled-trials.com/ISRCTN93702927 (Archived by WebCite at http://www.webcitation.org/6CTMM10MR)

Das Klinisch Psychologische Diagnosesystem 38 (KPD-38)

Zusammenfassung. Mit dem KPD-38 steht ein neues Instrument fur die Qualitatssicherung und das Ergebnismonitoring in der Psychotherapie und psychosomatischen Medizin zur Verfugung. Im vorliegenden Beitrag werden die Entwicklung des KPD-38 und erste Erfahrungen aus dem Einsatz in der Qualitatssicherung beschrieben. Das Instrument wurde einer Bevolkerungsstichprobe (N = 2066) sowie einem Patientenkollektiv aus der stationaren Psychotherapie (N = 351) vorgelegt. Es wurden Prufungen der Validitat, Reliabilitat, der computergestutzten Vorgabe, Sensitivitat und Spezifitat durchgefuhrt. Neben testokonomischen Gesichtspunkten sprechen insbesondere die deutlichen Belege der Validitat des KPD-38 fur den Einsatz in diesem speziellen Anwendungsbereich. Die vielversprechenden Hinweise auf seinen Nutzen fur die Behandlungs- und Versorgungsplanung durch therapiebegleitende Ruckmeldungen lassen weitere Detailstudien als lohnend erscheinen.

A Pre-Post Study on the Appropriateness and Effectiveness of a Web- and Text Messaging-Based Intervention to Reduce Problem Drinking in Emerging Adults

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.

A surveillance tool using mobile phone short message service to reduce alcohol consumption among alcohol-dependent patients.

BACKGROUND In public health settings, short message service (SMS) appears to be a promising low-cost modality for reducing alcohol consumption. Here, we test a simple interactive SMS-based helpline with detoxified alcohol-dependent patients to extend findings to curative settings. METHODS This controlled, prospective, 2-group before-after block-assignment, open pilot study tested the feasibility and efficacy of an 8-week outpatient interactive mobile phone SMS intervention (n = 42) against treatment as usual (TAU; n = 38) after inpatient detoxification. Patients were asked whether they needed any help via an automatically generated text message twice a week. A therapist called the individual back when notified. Alcohol consumption was assessed using the telephone version of Form-90 4 and 8 weeks after discharge from inpatient detoxification. The primary end point was defined as attaining low-risk consumption (males ≤30 g or 3.75 units per drinking day (DDD); females ≤20 g or 2.5 units per DDD) 8 weeks after discharge. Missing data were replaced by multiple imputation. RESULTS Among all messages sent, 20.5% were followed by a phone call. Feasibility and acceptability were good, as indicated by successful implementation of the SMS procedure and the rapid inclusion of patients. Adherence was satisfactory with 57.14% of the participants replying to at least 50% of the prompts. Patients reported a typical preadmission DDD of 281.25 ± 244.61 g. In the SMS group, 55.7% of 42 patients, and 40% of 38 patients in the TAU group, achieved low-risk consumption (risk diff: 0.16; 95% CI -0.06 to 0.37; p = 0.122). CONCLUSIONS In detoxified alcohol-dependent patients, relapse prevention based on SMS was well received and implemented efficiently and rapidly. An adequately powered multicenter study is currently being conducted to test the nonsignificant but encouraging findings of this exploratory study with more rigorous trial methods (ISRCTN78350716).