Stephanie A. Spohr

Efficacy of SMS Text Message Interventions for Smoking Cessation: A Meta-Analysis

BACKGROUND Mobile technology provides new opportunities for health promotion communication. The purpose of this study was to conduct a current and extensive meta-analytic review of SMS (short message service) text message-based interventions for individual smoking cessation. METHODS Academic Search Complete, PsycINFO, PubMed, and Scopus were reviewed for articles meeting selection criteria: 1) randomized controlled trials, 2) measured smoking cessation, and 3) intervention primarily delivered through SMS text messaging. Three and 6month follow-up of 7-day point prevalence or continuous abstinence was considered from studies meeting criteria. All analyses were conducted with intention-to-treat. Both fixed and random effects models were used to calculate the global outcome measure and confidence intervals. RESULTS Thirteen studies were identified that met inclusion criteria. The studies were found to be homogeneous [Q12=12.47, p=0.14]. Odds ratios based on the random effects models suggested that interventions generally increased quit rates compared to controls, 1.36 [95% CI=1.23, 1.51]. Intervention efficacy was higher in studies with a 3month follow-up compared to 6month follow-up. Text plus programs (e.g., text messaging plus Web or in-person intervention modalities) performed only slightly better than text only programs. Pooled results also indicate message frequency schedule can affect quit rates, in which fixed schedules performed better than decreasing or variable schedules. The use of quit status assessment messages was not related to intervention efficacy. CONCLUSION Smoking quit rates for the text messaging intervention group were 36% higher compared to the control group quit rates. Results suggest that SMS text messaging may be a promising way to improve smoking cessation outcomes. This is significant given the relatively wide reach and low cost of text message interventions. Identifying the components that make interventions efficacious will help to increase the effectiveness of such interventions.

Motivational Interviewing Fidelity in a Community Corrections Setting: Treatment Initiation and Subsequent Drug Use

INTRODUCTION Although substance use is common among people in the U.S. criminal justice system, treatment initiation remains an ongoing problem. This study assessed the reliability and predictive validity of the Motivational Interviewing Treatment Integrity 3.1.1. (MITI) coding instrument in a community corrections sample. METHODS We used data from 80 substance-using clients who were participating in a clinical trial of MI in a probation setting. We analyzed 124 MI counseling sessions using the MITI, a coding system for documenting MI fidelity. Bivariate associations and logistic regression modeling were used to determine if MI-consistent behaviors predicted substance use or treatment initiation at a 2-month follow-up. RESULTS We found a high level of agreement between coders on behavioral utterance counts. Counselors met at least beginning proficiency on most MITI summary scores. Probationers who initiated treatment at 2-month follow-up had significantly higher ratings of clinician empathy and MI spirit than clients who did not initiate treatment. Other MITI summary scores were not significantly different between clients who had initiated treatment and those who did not. MI spirit and empathy ratings were entered into a forward logistic regression in which MI spirit significantly predicted 2-month treatment initiation (χ(2) (1)=4.10, p<.05, R(2)=.05) but counselor empathy did not. MITI summary scores did not predict substance use at 2-month follow-up. CONCLUSIONS Counselor MI-consistent relational skills were an important predictor of client treatment initiation. Counselor behaviors such as empathy and MI spirit may be important for developing client rapport with people in a probation setting.

The relationship between electronic goal reminders and subsequent drug use and treatment initiation in a criminal justice setting

INTRODUCTION Opportunities to influence behavior through the use of electronic reminders has not been examined in a criminal justice population. The purpose of this study was to assess probationer preferences for short-term goals from a web-based program and evaluate the role of voluntary electronic reminders (e.g., text messaging, email) in achieving early treatment and probation tasks. METHODS We used data from drug-involved offenders (n=76) participating in a clinical trial of a 2-session motivational computer program. As part of the program, participants could choose to receive text or email reminders about their probation and treatment goals for the next month. Poisson regression models were utilized to evaluate goal and reminder selection in relation to the days of substance use and treatment attendance at two-month follow-up. RESULTS The most common goals were related to probation and treatment tasks, relationships, and cognitive reappraisals. Forty-five percent of probationers elected to receive electronic goal reminders at Session 1 with a slight increase at Session two (49%). Probationers who opted to receive electronic goal reminders at Session one selected significantly more goals on average (M=4.4, SD=2.1) than probationers who did not want reminders (M=3.4, SD=1.8), (t=2.41, p=.019). Reminder selection and total number of goals selected predicted days of substance use and treatment attendance at a two-month follow-up. Probationers who opted not to receive electronic reminders and those who only chose to receive reminders at one visit had more days of substance use compared to those who chose to receive reminders at both visits, 1.66 and 2.31 times respectively. Probationers who chose not to receive electronic reminders attended 56% fewer days of treatment compared to those who chose to receive reminders at both visits. CONCLUSIONS Peoples choice of short-term goals and reminders can provide advance notification of the likelihood of substance use and treatment initiation. Probation systems might use such information to triage at-risk probationers to a higher level of service, before problems have emerged.

Social support quality and availability affects risk behaviors in offenders

Background People involved in the justice system are at 2.5 times the risk of HIV infection compared to the general population, which is further complicated by substance abuse. The purpose of this study was to evaluate the role of social network quality and quantity on unprotected sex, criminal risk, and substance use.MethodsWe used data from 330 drug-involved offenders. Structural equation modeling (SEM) was used to model and test path directionality and magnitude between the latent constructs of social support quality and quantity on risky behaviors.ResultsThe SEM indicated the latent construct of social support quality was significantly associated with reduced sexual risk behavior (β = −0.27), criminal risk (β = −0.26), and reduced substance use (β = −0.33). Additionally, the proposed model found that social support quantity was significantly positively associated with increased sexual risk behavior (β = 0.40) and substance use (β = 0.20).ConclusionsSocial support quality is an important predictor of risky behaviors; as the quality of an offender’s social support increases, engagement in risky behaviors decreases. Probationers who had broader social support availability also had increased substance use and unprotected sex. Probation systems may be able to reduce substance use and STD/HIV infection risk in offenders by strengthening the quality of social support networks.

What’s the influence of social interactions on substance use and treatment initiation? A prospective analysis among substance-using probationers

INTRODUCTION A persons social environment greatly affects the likelihood of substance use, which in turn affects risk for criminal behavior. This study examined how peoples social environment early in probation contributed to later substance use and treatment outcome, both of which predict probation success. METHODS Data were analyzed from a randomized controlled trial of substance-using probationers (N = 316). Moderation analyses assessed the relationship between social support near the start of probation and substance use and treatment initiation after 2 and 6 months. RESULTS Abstinence at 2-months was associated with better baseline measures of support quality (more positive support, fewer negative interactions, and reduced conflict). Similar associations were identified for 6-month abstinence including better baseline quality, more positive support, and less family and peer conflict. There were no significant associations between the baseline social support and treatment initiation at 2-months. However, poorer baseline quality support and more negative interactions predicted increased treatment initiation at 6-months. CONCLUSIONS Social support and the quality of an offenders social network have important implications for substance use and treatment compliance. The criminal justice system emphasizes ways to minimize negative social influences among offenders (i.e., probation conditions that limit contact with other offenders). However, this study suggests that behavior change is a function of not only reducing negative influences but also increasing positive or good quality supports.

The Effect of Childhood Household Dysfunction on Future HIV Risk among Probationers

Introduction. Adverse childhood events (ACE) can lead to numerous health risks in adulthood. ACEs coupled with increased risk-taking behaviors can lead to increased risk for HIV infection, particularly in vulnerable populations. The purpose of this study was to determine if mental health symptom severity mediates the relationship between childhood household dysfunction and adult HIV risk among a group of probationers. Methods. T-tests were used to evaluate associations between demographic characteristics and cumulative engagement in sexual risk behaviors in 282 drug-involved probationers. A mediation analysis was conducted to determine the direct and indirect effect of cumulative household dysfunction and high-risk sexual behaviors through mental health symptom severity. Results. We found significant differences in the occurrence of different childhood household dysfunction problems by probationer gender, race, and criminal risk level. Mental health symptom severity demonstrated a significant indirect mediation effect of household dysfunction adverse events and engagement in sexual risky behaviors, b = .03, 95% BCa CI [.007, .057]. Conclusions. Given the high prevalence of childhood trauma in probationers and the direct associations with mental illness and sexual risk-taking behaviors, the need for offenders to have access to and receive mental health treatment while under community supervision is evident. Mental health and substance abuse treatment services can not only reduce risks for recidivism but also HIV infection and transmission within this population.

Client involvement in a web-based intervention targeting substance abuse treatment in the criminal justice system

Results This study uses data from the first 84 clients who completed the web-based program. The data provided from this study covers probationer involvement with the MAPIT intervention in relation to early goal planning and electronic reminder selection on positive 2-month outcomes. In terms of early goal planning, clients were most likely to select goals such as “Make a list of things I could do to stay sober” (62%); “Write down the date and time of my first PO visit” (52%); and “Get a binder to keep my probation documents in” (50%). In terms of reminder preference, 51 percent wanted to receive text or email reminders about their goals (31% requested text; 20% requested email). Most clients wanted reminders early in the week, and in the morning. Women, low/moderate risk, and older clients (> 35 years old) were more likely to ask for reminders. Those who selected to receive email reminders selected the greatest number of goals (M = 5.3) compared to those who chose text (M = 4.1) or no reminder (M = 3.0), F = 6.20, p = .004. In term of positive 2-month outcomes, probationers in the email reminder group were significantly more likely to be abstinent and were significantly more likely to initiate treatment at follow-up (c = 6.25, df = 2, p < .05 and c = 6.51, df = 2, p < .05, respectively), compared to the text reminder and no reminder groups. Early signs of non-responding were indicated by participants choosing the minimum number of goals (2), not selecting to receive electronic reminders, and not completing any goals by visit two, and were indicative of poorer outcomes.