Article

Internet and Mobile Phone Text Messaging Intervention for College Smokers

September 2008
Journal of American College Health 57(2):245-8

September 2008
57(2):245-8

DOI:10.3200/JACH.57.2.245-248

Source
PubMed

Authors:

William T Riley

James Madison University

Jami L Obermayer

Pics, Inc.

The authors developed a smoking cessation program using mobile phone text messaging to provide tailored and stage-specific messages to college smokers. The authors recruited 31 daily smokers who desired to quit from a college campus and asked them to use an Internet and mobile phone text messaging program to quit smoking. Six weeks after program initiation, 45% reported abstinence with 42% abstinent based on cotinine verification. Continued smokers reported significantly reduced smoking rates and dependence. Overall, participants accepted the text messages. These results replicate findings from an earlier study and indicate that mobile phone text messaging is a potentially efficacious and easily disseminated method for providing cessation interventions to young adult smokers.

The effectiveness of digital health technologies for reducing substance use among young people: a systematic review & meta-analysis

Article

Full-text available

Sep 2023
J Ment Health

Background: Substance use amongst young people poses developmental and clinical challenges, necessitating early detection and treatment. Considering the widespread use of technology in young people, delivering interventions digitally may help to reduce and monitor their substance use. Aims: We conducted a systematic review and two meta-analyses to assess the effectiveness of digital interventions for reducing substance use (alcohol, smoking, and other substances) among young people aged 10 to 24 years old. Method: Embase, Global Health, Medline, PsychINFO, Web of Science and reference lists of relevant papers were searched in November 2020. Studies were included if they quantitatively evaluated the effectiveness of digital health technologies for treating substance use. A narrative synthesis and meta-analysis were conducted. Results: Forty-two studies were included in the systematic review and 18 in the meta-analyses. Digital interventions showed small, but statistically significant reductions in weekly alcohol consumption compared to controls (SMD= -0.12, 95% CI= -0.17 to -0.06, I2=0%), but no overall effect was seen on 30-day smoking abstinence (OR = 1.12, 95% CI = 0.70 to 1.80, I2=81%). The effectiveness of digital interventions for reducing substance use is generally weak, however, promising results such as reducing alcohol use were seen. Large-scale studies should investigate the viability of digital interventions, collect user feedback, and determine cost-effectiveness. Prisma/prospero: This systematic review was conducted following Cochrane methodology PRISMA guidelines. The review was registered with PROSPERO in November 2020 (CRD42020218442).

Bibliometric Analysis of Interventional Literature on Mobile Health: The Most Highly Cited Articles

Article

Full-text available

Apr 2021

Introduction: Advances in mobile health have led to numerous relevant studies in diagnosis, treatment, and controlling of various diseases. One of the criteria indicating the quality of the previously published studies is the number of citations. Therefore, investigating the features of highly cited articles and identifying the most frequently used mobile technological interventions can affect future research ideas. This study aimed at identifying 100 highly cited interventional studies on mobile health, type of used mobile technologies, and effect of these technologies in various diseases in top-cited articles. Methods: The database employed in this study was the Web of Science, which without limitations was analysed in April 2020 to identify 100 highly cited interventional studies in the field of mobile health. The identified studies were classified based on the number of citations, year of publication, country of the first author, type of disease, and use of mobile technology. Results: A great majority of the studies in the field of interventional mobile health focused on obesity (n=18), addiction (n=15), diabetes (n=13) and mental health disorders (n=12), respectively. Many studies employed mobile technologies to promote lifestyle (weight loss and increased physical activity) (n=20), disease controls (n=20), and treatment adherence (n=18). The mean number of citations per study was 146±97. The most cited study was in the category of viral disease treatment adherence (n=703), and the most cited articles were published in 2012. Conclusions: Among the reviewed 100 studies, many of the interventional studies regarding mobile health focused on obesity, addiction, diabetes and mental health disorders. Promotion of lifestyle, disease controls, and treatment adherence were effects of mobile technologies in top-cited articles. Text messaging service was used as intervention in most of the studies. Thus, future studies may focus on the use of various mobile applications on different diseases’ prevention, control, and treatment.

Perceived usefulness of receiving a potential smoking cessation intervention via mobile phones among smokers in Indonesia

Article

Full-text available

Jun 2019

Background: The use of technology to support healthcare in Indonesia holds new promise in light of decreasing costs of owning mobile devices and ease of access to internet. However, it is necessary to assess end-user perceptions regarding mobile health interventions prior to its implementation. This would throw light on the acceptability of mobile phone communication in bringing about behavioural changes among the target Indonesian population. The aim of this study was to explore the perceived usefulness of receiving a potential smoking cessation intervention via mobile phones. Methods: This is an exploratory cross-sectional study involving current and former adult tobacco smokers residing in Indonesia. Online advertisement and snowballing were used to recruit respondents. Data was collected using a web-based survey over a period of 4 weeks. Those willing to participate signed an online consent and were subsequently directed to the online questionnaire that obtained demographics, tobacco usage patterns, perceived usefulness of a mobile phone smoking cessation application and its design. Results: A total of 161 people who smoked tobacco responded to the online survey. The mean age of the participants was 29.4. Of the 123 respondents, 102 were men. Prior experience with using a mobile phone for health communication (OR 3.6, P =0.014) and those willing to quit smoking (OR 5.1, P =0.043) were likely to perceive a mobile phone smoking cessation intervention as useful. A smartphone application was preferred over text messages, media messages or interactive voice response technology. Content comprising of motivational messages highlighting the methods and benefits of quitting smoking were requested. Conclusion: People who smoke in Indonesia perceived receiving a potential smoking cessation intervention via mobile phones as useful. A multi-component, personalized smartphone application was the desired intervention technique. Such an intervention developed and implemented within a public health program could help address the tobacco epidemic in Indonesia.

The Dosing of Mobile-Based Just-in-Time Adaptive Self-Management Prompts for Caregivers: Preliminary Findings From a Pilot Microrandomized Study

Article

Full-text available

Sep 2023

Background Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers’ health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood. Objective The primary objective of this study is to evaluate the dose-response relationship of a fully automated JITAI-based self-management intervention involving personalized mobile app notifications targeted at decreasing the level of caregiver strain, anxiety, and depression. The secondary objective is to investigate whether the effectiveness of this mobile health intervention was moderated by the caregiver group. We also explored whether the effectiveness of this intervention was moderated by (1) previous HRQOL measures, (2) the number of weeks in the study, (3) step count, and (4) minutes of sleep. Methods We examined 36 caregivers from 3 disease groups (10 from spinal cord injury, 11 from Huntington disease, and 25 from allogeneic hematopoietic cell transplantation) in the intervention arm of a larger randomized controlled trial (subjects in the other arm received no prompts from the mobile app) designed to examine the acceptability and feasibility of this intensive type of trial design. A series of multivariate linear models implementing a weighted and centered least squares estimator were used to assess the JITAI efficacy and effect. Results We found preliminary support for a positive dose-response relationship between the number of administered JITAI messages and JITAI efficacy in improving caregiver strain, anxiety, and depression; while most of these associations did not meet conventional levels of significance, there was a significant association between high-frequency JITAI and caregiver strain. Specifically, administering 5-6 messages per week as opposed to no messages resulted in a significant decrease in the HRQOL score of caregiver strain with an estimate of –6.31 (95% CI –11.76 to –0.12; P=.046). In addition, we found that the caregiver groups and the participants’ levels of depression in the previous week moderated JITAI efficacy. Conclusions This study provides preliminary evidence to support the effectiveness of the self-management JITAI and offers practical guidance for designing future personalized JITAI strategies for diverse caregiver groups. Trial Registration ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591

Using a complexity science approach to evaluate the effectiveness of just-in-time adaptive interventions: A meta-analysis

Article

Full-text available

Jul 2023

Objective Just-in-time adaptive interventions (JITAIs), which allow individuals to receive the right amount of tailored support at the right time and place, hold enormous potential for promoting behavior change. However, research on JITAIs’ implementation and evaluation is still in its early stages, and more empirical evidence is needed. This meta-analysis took a complexity science approach to evaluate the effectiveness of JITAIs that promote healthy behaviors and assess whether key design principles can increase JITAIs’ impacts. Methods We searched five databases for English-language papers. Study eligibility required that interventions objectively measured health outcomes, had a control condition or pre-post-test design, and were conducted in the real-world setting. We included randomized and non-randomized trials. Data extraction encompassed interventions’ features, methodologies, theoretical foundations, and delivery modes. RoB 2 and ROBINS-I were used to assess risk of bias. Results The final analysis included 21 effect sizes with 592 participants. All included studies used pre- and post-test design. A three-level random meta-analytic model revealed a medium effect of JITAIs on objective behavior change ( g = 0.77 (95% confidence interval (CI); 0.32 to 1.22), p < 0.001). The summary effect was robust to bias. Moderator analysis indicated that design principles, such as theoretical foundations, targeted behaviors, and passive or active assessments, did not moderate JITAIs’ effects. Passive assessments were more likely than a combination of passive and active assessments to relate to higher intervention retention rates. Conclusions This review demonstrated some evidence for the efficacy of JITAIs. However, high-quality randomized trials and data on non-adherence are needed.

New opportunities for the early detection and treatment of cognitive decline: adherence challenges and the promise of smart and person-centered technologies

Article

Full-text available

Feb 2023

Early detection of age-related cognitive decline has transformative potential to advance the scientific understanding of cognitive impairments and possible treatments by identifying relevant participants for clinical trials. Furthermore, early detection is also key to early intervention once effective treatments have been developed. Novel approaches to the early detection of cognitive decline, for example through assessments administered via mobile apps, may require frequent home testing which can present adherence challenges. And, once decline has been detected, treatment might require frequent engagement with behavioral and/or lifestyle interventions (e.g., cognitive training), which present their own challenges with respect to adherence. We discuss state-of-the-art approaches to the early detection and treatment of cognitive decline, adherence challenges associated with these approaches, and the promise of smart and person-centered technologies to tackle adherence challenges. Specifically, we highlight prior and ongoing work conducted as part of the Adherence Promotion with Person-centered Technology (APPT) project, and how completed work will contribute to the design and development of a just-in-time, tailored, smart reminder system that infers participants’ contexts and motivations, and how ongoing work might build toward a reminder system that incorporates dynamic machine learning algorithms capable of predicting and preventing adherence lapses before they happen. APPT activities and findings will have implications not just for cognitive assessment and training, but for technology-mediated adherence-support systems to facilitate physical exercise, nutrition, medication management, telehealth, and social connectivity, with the potential to broadly improve the engagement, health, and well-being of older adults.

2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

Article

Apr 2021

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health (“mHealth”) technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

An App-Based Just-in-Time-Adaptive Self-Management Intervention for Care Partners: The CareQOL Feasibility Pilot Study

Article

Full-text available

Nov 2022

Purpose/objective: The primary objective of this study was to establish the feasibility and acceptability of an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention (JITAI) in three distinct groups of care partners (care partners of persons with spinal cord injury [SCI], Huntington's disease [HD], or hematopoietic cell transplantation [HCT]). Research method/design: Seventy care partners were enrolled in this study (n = 19 SCI; n = 21 HD, n = 30 HCT). This three-month (90 day) randomized control trial involved wearing a Fitbit to track sleep and steps, providing daily reports of health-related quality of life (HRQOL), and completing end of month HRQOL surveys. Care partners in the JITAI group also received personalized pushes (i.e., text-based phone notifications that include brief tips or suggestions for improving self-care). At the end of three-months, care partners in both groups completed a feasibility and acceptability questionnaire. Results: Most (98.6%) care partners completed the study, average compliance was 88% for daily HRQOL surveys, 96% for daily steps, and 85% for daily sleep (from wearing the Fitbit), and all monthly surveys were completed with the exception of one missed 3-month assessment. The acceptability of the protocol was high; ratings exceeded 80% agreement for the different elements of the study. Improvements were seen for the majority of the HRQOL measures. There was no evidence of measurement reactivity. Conclusions/implications: Findings provide strong support for the acceptability and feasibility of an intensive data collection protocol that involved the administration of a JITAI. Although this trial was not powered to establish efficacy, findings indicated improvements across a variety of different HRQOL measures (~1/3 of which were statistically significant). (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Values-Based Interventions Increase Reenrollment and Equity among Community College Pre-Allied Health Students

Article

Full-text available

Apr 2022

Addressing labor shortages within nursing and allied health professions, which have been exacerbated by the COVID-19 pandemic, requires increasing persistence and equity among community college students pursuing these fields. In this study, we adapted and combined three values-based interventions (values affirmation, goal congruence, and utility values) into one treatment, delivered via interactive text messages, with the goal to support reenrollment among pre-allied health students during the pandemic. Using institutional data from a statewide community college system, we randomized pre-allied health students who were enrolled in Fall 2019 and/or Spring 2020, and who had a valid mobile number on file, into treatment (n = 1,649) or control (n = 1,650) groups. Fully treated students received an average of 17 text messages over 8 weeks of Summer 2020; control students received business as usual support from the college. After adjusting for baseline differences in prior enrollment, the treatment significantly increased reenrollment by 3 percentage points (74% vs. 71%). Examination of individual differences revealed that effects were concentrated among men (+11 percentage points), Black/African American students (+7 percentage points), and students who were not enrolled in Spring 2020 (+13 percentage points). Values-based interventions, therefore, can be an important tool for addressing shortages and inequities in healthcare education and the labor force, an important step toward improving public health. Moreover, community colleges seeking to engage students who withdrew before or during the COVID-19 pandemic should leverage evidence-based practices to boost reenrollment.

Multiple lifestyle behaviour mHealth intervention targeting Swedish college and university students: protocol for the Buddy randomised factorial trial

Article

Full-text available

Dec 2021

Introduction The time during which many attend college or university is an important period for developing health behaviours, with potentially major implications for future health. Therefore, it is concerning that many Swedish students excessively consume alcohol, have unhealthy diets, are not physical active and smoke. The potential of digital interventions which integrate support for change of all of these behaviours is largely unexplored, as are the dismantled effects of the individual components that make up digital lifestyle behaviour interventions. Methods and analysis A factorial randomised trial (six factors with two levels each) will be employed to estimate the effects of the components of a novel mHealth multiple lifestyle intervention on alcohol consumption, diet, physical activity and smoking among Swedish college and university students. A Bayesian group sequential design will be employed to periodically make decisions to continue or stop recruitment, with simulations suggesting that between 1500 and 2500 participants will be required. Multilevel regression models will be used to analyse behavioural outcomes collected at 2 and 4 months postrandomisation. Ethics and dissemination The study was approved by the Swedish Ethical Review Authority on 2020-12-15 (Dnr 2020-05496). The main concern is the opportunity cost if the intervention is found to only have small effects. However, considering the lack of a generally available evidence-based multiple lifestyle behaviour support to university and college students, this risk was deemed acceptable given the potential benefits from the study. Recruitment will begin in March 2021, and it is expected that recruitment will last no more than 24 months. A final data set will, therefore, be available in July 2023, and findings will be reported no later than December 2023. Trial registration number ISRCTN23310640 ; Pre-results.

Tele-mental health services: a rapid umbrella review of pre-COVID-19 literature (Preprint)

Article

Full-text available

Dec 2020
J MED INTERNET RES

Background: Tele-mental health care has been rapidly adopted to maintain services during the COVID-19 pandemic, and there is now substantial interest in its future role. Service planning and policy making for recovery from the pandemic and beyond should draw not only on COVID-19 experiences, but also on the substantial research evidence accumulated prior to this. Objective: To conduct an umbrella review of systematic reviews of research literature and evidence-based guidance on tele-mental health, including both qualitative and quantitative literature. Methods: Three databases were searched between January 2010 and August 2020 for systematic reviews meeting pre-defined criteria. Reviews retrieved were independently screened and those meeting inclusion criteria were synthesised and assessed for risk of bias. Narrative synthesis was used to report findings. Results: Nineteen systematic reviews met the inclusion criteria. Fifteen examined clinical effectiveness, eight reported on aspects of tele-mental health implementation, ten reported on acceptability to service users and clinicians, two on cost-effectiveness and one on guidance. Most reviews were assessed as low quality. Findings suggested that video-based communication could be as effective and acceptable as face-to-face formats, at least in the short-term. Evidence was lacking on the extent of digital exclusion and how it can be overcome, and on some significant contexts such as children and young people's services and inpatient settings. Conclusions: This umbrella review suggests that tele-mental health has potential to be an effective and acceptable form of service delivery. However, we found limited evidence on impacts of large-scale implementation across catchment areas. Combining previous evidence and COVID-19 experiences may allow realistic planning for future tele-mental health implementation. Clinicaltrial:

Detecting Receptivity for mHealth Interventions in the Natural Environment

Article

Full-text available

Jun 2021

Just-In-Time Adaptive Intervention (JITAI) is an emerging technique with great potential to support health behavior by providing the right type and amount of support at the right time. A crucial aspect of JITAIs is properly timing the delivery of interventions, to ensure that a user is receptive and ready to process and use the support provided. Some prior works have explored the association of context and some user-specific traits on receptivity, and have built post-study machine-learning models to detect receptivity. For effective intervention delivery, however, a JITAI system needs to make in-the-moment decisions about a user’s receptivity. To this end, we conducted a study in which we deployed machine-learning models to detect receptivity in the natural environment, i.e., in free-living conditions. We leveraged prior work regarding receptivity to JITAIs and deployed a chatbot-based digital coach – Ally – that provided physical-activity interventions and motivated participants to achieve their step goals. We extended the original Ally app to include two types of machine-learning model that used contextual information about a person to predict when a person is receptive: a static model that was built before the study started and remained constant for all participants and an adaptive model that continuously learned the receptivity of individual participants and updated itself as the study progressed. For comparison, we included a control model that sent intervention messages at random times. The app randomly selected a delivery model for each intervention message. We observed that the machine-learning models led up to a 40% improvement in receptivity as compared to the control model. Further, we evaluated the temporal dynamics of the different models and observed that receptivity to messages from the adaptive model increased over the course of the study.

Domestic and International College Students: Health Insurance Information Seeking and Use

Article

Jul 2018

This study aimed to explore perceived barriers to using health insurance and identify discriminant factors between health insurance information seekers and non-seekers. A total of 615 domestic and international college students from a large university in the Southwest completed a cross-sectional survey. Findings imply that campus health providers and staff in international student services should be working closely to communicate to students about health insurance because they are both trying to solve the same basic problems.

2021 ISHNE/HRS/EHRA/APHRS Expert Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society

Article

Full-text available

Feb 2021

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia-Pacific Heart Rhythm Society describes the current status of mobile health technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mobile health. The promises of predictive analytics but also operational challenges in embedding mobile health into routine clinical care are explored.

2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

Article

Full-text available

Jan 2021

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mo- bile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and life- style management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of pre- dictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

2021 ISHNE/ HRS/ EHRA/ APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

Article

Full-text available

Jan 2021
ANN NONINVAS ELECTRO

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/ Heart Rhythm Society/ European Heart Rhythm Association/ Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self‐management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

2021 ISHNE/HRS/EHRA/APHRS collaborative statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals: From the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society

Article

Full-text available

Jan 2021

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health (“mHealth”) technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self‐management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

2021 ISHNE/HRS/EHRA/APHRS Collaborative Statement on mHealth in Arrhythmia Management: Digital Medical Tools for Heart Rhythm Professionals

Article

Full-text available

Jan 2021

This collaborative statement from the International Society for Holter and Noninvasive Electrocardiology/Heart Rhythm Society/European Heart Rhythm Association/Asia Pacific Heart Rhythm Society describes the current status of mobile health ("mHealth") technologies in arrhythmia management. The range of digital medical tools and heart rhythm disorders that they may be applied to and clinical decisions that may be enabled are discussed. The facilitation of comorbidity and lifestyle management (increasingly recognized to play a role in heart rhythm disorders) and patient self-management are novel aspects of mHealth. The promises of predictive analytics but also operational challenges in embedding mHealth into routine clinical care are explored.

Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study

Article

Full-text available

Jan 2021

Background Substance use among adolescents and emerging adults continues to be an important public health problem associated with morbidity and mortality. Mobile health (mHealth) provides a promising approach to deliver just-in-time adaptive interventions (JITAIs) to prevent escalation of use and substance use–related consequences. Objective This pilot study aims to describe the iterative development and initial feasibility and acceptability testing of an mHealth smartphone app, called MiSARA, designed to reduce escalation in substance use. Methods We used social media advertisements to recruit youth (n=39; aged 16-24 years, who screened positive for past-month binge drinking or recreational cannabis use) with a waiver of parental consent. Participants used the MiSARA app for 30 days, with feasibility and acceptability data reported at a 1-month follow-up. We present descriptive data regarding behavior changes over time. Results The results show that most participants (31/39, 79%) somewhat liked the app at least, with most (29/39, 74%) rating MiSARA as 3 or more stars (out of 5). Almost all participants were comfortable with self-reporting sensitive information within the app (36/39, 92%); however, most participants also desired more interactivity (27/39, 69%). In addition, participants’ substance use declined over time, and those reporting using the app more often reported less substance use at the 1-month follow-up than those who reported using the app less often. Conclusions The findings suggest that the MiSARA app is a promising platform for JITAI delivery, with future trials needed to optimize the timing and dose of messages and determine efficacy.

Micro-Randomized Trial Design for Evaluating Just-In-Time-Adaptive-Interventions Through Mobile Health Technologies for Cardiovascular Disease

Article

Jan 2021

Smartphone and wearable device use is rising broadly and can be leveraged for chronic disease management. Just-In-Time Adaptive Interventions (JITAIs) promise to deliver personalized, dynamic interventions directly to patients through use of push notifications from mobile devices. While JITAIs are a powerful tool for shaping health behavior, their application to cardiovascular disease management has been limited as they can be challenging to design. Herein we provide a general overview and conceptual framework for micro-randomized trials, a novel experimental study design that can be used to optimize JITAIs. Micro-randomized trials leverage mobile devices to sequentially randomize participants to types or levels of an intervention to determine the effectiveness of an intervention and time-varying moderators of those effects. Micro-randomized trials are an efficient study design that can be used to determine which intervention components to include in JITAI and to optimize their decision rules while maintaining the strength of causal inference associated with traditional randomized controlled trials.

Korean American Smokers’ Perspectives on Mobile Smoking Cessation Applications

Article

Full-text available

Dec 2020

Introduction The primary purpose of this research is to investigate the adoption process of mobile smoking cessation apps for Korean American smokers with the eventual purpose of proposing a new combined model of smartphone smoking cessation adoption. Methods From September 2018 to March 2019, a total of 227 Korean American smokers responded to surveys regarding the effectiveness of mobile applications for smoking cessation. A path analysis was used to analyze the predictors of adopting and using smoking cessation applications available via smartphones. Results Perceived benefits and self-efficacy were important factors for influencing the perceived usefulness of a smoking cessation mobile app. Moreover, the perceived usefulness of a smoking cessation mobile app was also positively related to intention to use a smoking cessation mobile app. Conclusion Although mobile smoking cessation apps can help many individuals quit smoking, most Korean American smokers are not current users of smoking cessation mobile apps. Therefore, there is a strong need to use strategic evidence-based communication interventions for promoting the widespread adoption of smoking cessation applications.

Detecting Receptivity for mHealth Interventions in the Natural Environment

Preprint

Full-text available

Nov 2020

JITAI is an emerging technique with great potential to support health behavior by providing the right type and amount of support at the right time. A crucial aspect of JITAIs is properly timing the delivery of interventions, to ensure that a user is receptive and ready to process and use the support provided. Some prior works have explored the association of context and some user-specific traits on receptivity, and have built post-study machine-learning models to detect receptivity. For effective intervention delivery, however, a JITAI system needs to make in-the-moment decisions about a user's receptivity. To this end, we conducted a study in which we deployed machine-learning models to detect receptivity in the natural environment, i.e., in free-living conditions. We leveraged prior work regarding receptivity to JITAIs and deployed a chatbot-based digital coach -- Walkie -- that provided physical-activity interventions and motivated participants to achieve their step goals. The Walkie app included two types of machine-learning model that used contextual information about a person to predict when a person is receptive: a static model that was built before the study started and remained constant for all participants and an adaptive model that continuously learned the receptivity of individual participants and updated itself as the study progressed. For comparison, we included a control model that sent intervention messages at random times. The app randomly selected a delivery model for each intervention message. We observed that the machine-learning models led up to a 40% improvement in receptivity as compared to the control model. Further, we evaluated the temporal dynamics of the different models and observed that receptivity to messages from the adaptive

mHealth for pediatric chronic pain: state of the art and future directions

Article

Sep 2020

Introduction: Chronic pain conditions are common among children and engender cascading effects across social, emotional, and behavioral domains for the child and family. Mobile health (mHealth) describes the practice of delivering healthcare via mobile devices and may be an ideal solution to increase access and reach of evidence-based behavioral health interventions. Areas covered: The aim of this narrative review is to present a state-of-the-art overview of evidence-based mHealth efforts within the field of pediatric chronic pain and consider new and promising directions for study. Given the nascent nature of the field, published mHealth interventions in all stages of development are discussed. Literature was identified through a non-systematic search in PubMed and Google Scholar, and a review of reference lists of papers that were identified as particularly relevant or foundational (within and outside of the chronic pain literature). Expert opinion: mHealth is a promising interventional modality with early evidence suggesting it is primed to enhance behavioral health delivery and patient outcomes. There are many exciting future directions to be explored including drawing inspiration from digital health technology to generate new ways of thinking about the optimal treatment of pediatric chronic pain.

Weekend Text Messages Increase Protective Behavioral Strategies and Reduce Harm Among College Drinkers

Article

Full-text available

Dec 2020

The current study examined whether a brief text messaging intervention compared to an assessment only/no treatment control would differentially increase protective behavioral strategies (PBS) that were associated with reducing negative alcohol-related negative consequences during football game weekends. Eligible participants (n = 161) were college students who had at least one drinking occasion in the past 30 days. Participants completed a baseline assessment prior to the experimental weekend before being randomly assigned to receive either a text-message condition that instructed students to use PBS or an assessment only/no treatment condition. Participants in the text messaging condition received a message on Thursday, Friday, and Saturday of a game weekend. Follow-up assessments were completed within 3 days following the experimental weekend. After controlling for amount of use, results suggest that for game day, those in the text-messaging condition reported significantly higher utilization of PBS and significantly lower negative alcohol-related consequences as compared with the assessment only/no treatment condition. Overall, the results highlight the importance of text messaging as an alternative intervention method that minimizes harm associated with drinking during football game weekends.

A Systematic Review of Recent Methodological Approaches for Using Ecological Momentary Assessment to Examine Outcomes in U.S. Based HIV Research

Article

Full-text available

Aug 2020
Curr HIV AIDS Rep

Purpose of review: In recent years, researchers have been adopting and using ecological momentary assessment (EMA) methods via technology devices for real-time measurement of exposures and outcomes in HIV research. To assess and critically evaluate how EMA methods are currently being used in HIV research, we systematically reviewed recent published literature (October 2017-October 2019) and searched select conference databases for 2018 and 2019. Recent findings: Our searches identified 8 published articles that used EMA via smartphone app, a handheld Personal Digital Assistant, and web-based survey programs for real-time measurement of HIV-related exposures and outcomes in behavioral research. Overall trends include use of EMA and technology devices to address substance use, HIV primary prevention (e.g., condom use and preexposure prophylaxis), and HIV treatment (medication adherence). This review supports the use of EMA methods in HIV research and recommends that researchers use EMA methods to measure psychosocial factors and social contexts and with Black and Latinx samples of gay and bisexual men, transgender women, and cisgendered women to reflect current HIV disparities in the U.S.A.

Virtual reality smartphone-based smoking cessation: A pilot RCT on initial clinical efficacy and adherence (Preprint)

Article

Full-text available

Dec 2019
J MED INTERNET RES

Background: Obstacles to current tobacco cessation programs include limited access and adherence to effective interventions. Digital interventions offer a great opportunity to overcome these difficulties, yet virtual reality has not been used as a remote and self-administered tool to help increase adherence and effectiveness of digital interventions for tobacco cessation. Objective: This study aimed to evaluate participant adherence and smoking cessation outcomes in a pilot randomized controlled trial of the digital intervention Mindcotine (MindCotine Inc) using a self-administered treatment of virtual reality combined with mindfulness. Methods: A sample of 120 participants was recruited in the city of Buenos Aires, Argentina (mean age 43.20 years, SD 9.50; 57/120, 47.5% female). Participants were randomly assigned to a treatment group (TG), which received a self-assisted 21-day program based on virtual reality mindful exposure therapy (VR-MET) sessions, daily surveys, and online peer-to-peer support moderated by psychologists, or a control group (CG), which received the online version of the smoking cessation manual from the Argentine Ministry of Health. Follow-up assessments were conducted by online surveys at postintervention and 90-day follow-up. The primary outcome was self-reported abstinence at postintervention, with missing data assumed as still smoking. Secondary outcomes included sustained abstinence at 90-day follow-up, adherence to the program, and readiness to quit. Results: Follow-up rates at day 1 were 93% (56/60) for the TG and 100% (60/60) for the CG. At postintervention, the TG reported 23% (14/60) abstinence on that day compared with 5% (3/60) in the CG. This difference was statistically significant (χ21=8.3; P=.004). The TG reported sustained abstinence of 33% (20/60) at 90 days. Since only 20% (12/60) of participants in the CG completed the 90-day follow-up, we did not conduct a statistical comparison between groups at this follow-up time point. Among participants still smoking at postintervention, the TG was significantly more ready to quit compared to the CG (TG: mean 7.71, SD 0.13; CG: mean 7.16, SD 0.13; P=.005). A total of 41% (23/56) of participants completed the treatment in the time frame recommended by the program. Conclusions: Results provide initial support for participant adherence to and efficacy of Mindcotine and warrant testing the intervention in a fully powered randomized trial. However, feasibility of trial follow-up assessment procedures for control group participants needs to be improved. Further research is needed on the impact of VR-MET on long-term outcomes. Trial registration: ISRCTN Registry ISRCTN50586181; http://www.isrctn.com/ISRCTN50586181.

Classroom-Based Integration of Text-Messaging in Mathematics Teaching-Learning Process

Article

Full-text available

Jan 2016

Launching a Text Message Intervention to Assist Student Loan Borrowers with Repayment Decisions: LAUNCHING A TEXT MESSAGE INTERVENTION

Article

Jan 2020
Fam Consum Sci Res J

Student loan debt has become a financial burden for many young adults in the United States. Previous research has found that many college student borrowers do not understand repayment terms and options. This multistate collaboration among Cooperative Extension Specialists sought to develop a way of supporting and informing recent college graduates on the process of student loan repayment. Text messaging was used as the intervention strategy. The purpose of this article is (i) to explain the process and methods of developing the student loan repayment text messaging campaign and (ii) present suggestions for someone interested in launching this type of intervention. Also, the article provides initial participation numbers across the nine land‐grant universities that were participants in the intervention.

The JITAI Code: A Primer on Just-In-Time-Adaptive Interventions

Chapter

Jan 2020

This chapter is a primer on just‐in‐time adaptive interventions (JITAIs), an intervention design concerned with using ongoing information about the individual and her environment to inform the effective and timely delivery of treatment. JITAIs are motivated by the necessity of intervening on risk and/or protective factors that occur frequently and unpredictably in one's natural environment. JITAIs' goal of providing the right treatment whenever and wherever needed is made possible by recent advances in mobile and wearable technologies. The goal of this chapter is to provide a brief introduction to JITAIs. This includes discussing the motivation underlying this intervention design, highlighting its key elements, and discussing opportunities and challenges relating to the construction of empirically based JITAIs. Throughout, we refer readers to additional reading for in‐depth discussion of these topics.

Virtual reality smartphone-based smoking cessation program: A pilot RCT on initial clinical efficacy and adherence (Preprint)

Preprint

Full-text available

Dec 2019

BACKGROUND Obstacles to current tobacco cessation programs include limited access and adherence to effective interventions. Digital interventions offer a great opportunity to overcome these difficulties, yet virtual reality has not been used as a remote and self-administered tool to help increase adherence and effectiveness. OBJECTIVE This study aimed to evaluate participant adherence and smoking cessation outcomes in a randomized pilot trial of the digital intervention Mindcotine® utilizing a self-administered treatment using virtual reality combined with mindfulness. METHODS A sample of 120 participants was recruited in the City of Buenos Aires, Argentina (age M = 43.20 years, SD = 9.50; 57/120 (47.5%) female). Participants were randomly assigned to a treatment group (TG), which received a self-assisted 21-day program based on Virtual Reality Mindful Exposure Therapy (VR-MET) sessions, daily surveys, and online peer-to-peer support moderated by psychologists; and a control group (CG), which received a smoking cessation manual from the Argentine Ministry of Health. Follow-up assessments were conducted by online surveys at days 1 and 90 post-intervention. The primary outcome was abstinence at day 1 follow-up, with missing data assumed as still smoking. Secondary outcomes included sustained abstinence at 90-day follow-up, adherence to the program, and readiness to quit. RESULTS Follow-up rates at day-1 were 93% (56/60) for the TG and 100% (60/60) for the CG. At day-1 follow-up, the TG reported 23.3% (14/60) abstinence on that day compared to 5.0% (3/60) in the CG. This difference was statistically significant (Chi2 (1) =8.3; P = .004). The TG reported sustained abstinence of 33% (20/60) at 90 days. Among participants still smoking at day-1 follow-up, the TG was significantly more ready to quit compared to the CG (TG: M = 7.71; SD = 0.13; CG: M = 7.16; SD = 0.13; P = 0.005). A total of 41.1% (23/56) of participants completed the treatment in the time frame recommended by the program. CONCLUSIONS Results provide initial support for participant adherence and efficacy of Mindcotine® and warrant testing the intervention in a fully powered randomized trial. Further research is needed on ways to promote app engagement. CLINICALTRIAL ID ISRCTN50586181

Exploring the State-of-Receptivity for mHealth Interventions (Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies (IMWUT) 3(4): Article 140)

Article

Full-text available

Dec 2019

Recent advancements in sensing techniques for mHealth applications have led to successful development and deployments of several mHealth intervention designs, including Just-In-Time Adaptive Interventions (JITAI). JITAIs show great potential because they aim to provide the right type and amount of support, at the right time. Timing the delivery of a JITAI such as the user is receptive and available to engage with the intervention is crucial for a JITAI to succeed. Although previous research has extensively explored the role of context in users’ responsiveness towards generic phone notifications, it has not been thoroughly explored for actual mHealth interventions. In this work, we explore the factors affecting users’ receptivity towards JITAIs. To this end, we conducted a study with 189 participants, over a period of 6 weeks, where participants received interventions to improve their physical activity levels. The interventions were delivered by a chatbot-based digital coach ś Ally ś which was available on Android and iOS platforms. We define several metrics to gauge receptivity towards the interventions, and found that (1) several participant-specific characteristics (age, personality, and device type) show significant associations with the overall participant receptivity over the course of the study, and that (2) several contextual factors (day/time, phone battery, phone interaction, physical activity, and location), show significant associations with the participant receptivity, in-the-moment. Further, we explore the relationship between the effectiveness of the intervention and receptivity towards those interventions; based on our analyses, we speculate that being receptive to interventions helped participants achieve physical activity goals, which in turn motivated participants to be more receptive to future interventions. Finally, we build machine-learning models to detect receptivity, with up to a 77% increase in F1 score over a biased random classifier.

Mobile messaging and smartphone apps for patient communication and engagement in spine surgery

Article

Sep 2019

Mobile health (mHealth) applications are rapidly becoming increasingly available to patients. These interventions utilize simple mobile messaging (SMS) and software applications on mobile devices for a variety of purposes. In the surgical population mHealth applications have shown promise in increasing medication and protocol adherence, monitoring patients after surgery, and helping modify behaviors associated with poor surgical outcomes. There is a paucity of spine specific applications at this time. Further development and study of efficacy of spine specific mHealth applications is needed.

Time2Stop: Adaptive and Explainable Human-AI Loop for Smartphone Overuse Intervention

Conference Paper

May 2024

Efficient evaluation of natural stochastic policies in off-line reinforcement learning

Article

Sep 2023

We study the efficient off-policy evaluation of natural stochastic policies, which are defined in terms of deviations from the unknown behaviour policy. This is a departure from the literature on off-policy evaluation that largely considers the evaluation of explicitly specified policies. Crucially, off-line reinforcement learning with natural stochastic policies can help alleviate issues of weak overlap, lead to policies that build upon current practice and improve policies’ implementability in practice. Compared with the classic case of a prespecified evaluation policy, when evaluating natural stochastic policies, the efficiency bound, which measures the best-achievable estimation error, is inflated since the evaluation policy itself is unknown. In this paper we derive the efficiency bounds of two major types of natural stochastic policies: tilting policies and modified treatment policies. We then propose efficient nonparametric estimators that attain the efficiency bounds under lax conditions and enjoy a partial double robustness property.

Applying the Just-In-Time Adaptive Intervention Framework to the Development of Gambling Interventions

Article

Full-text available

Sep 2023
J GAMBL STUD

Just-In-Time Adaptive Interventions (JITAIs) are emerging “push” mHealth interventions that provide the right type, timing, and amount of support to address the dynamically-changing needs for each individual. Although JITAIs are well-suited to the delivery of interventions for the addictions, few are available to support gambling behaviour change. We therefore developed GamblingLess: In-The-Moment and Gambling Habit Hacker, two smartphone-delivered JITAIs that differ with respect to their target populations, theoretical underpinnings, and decision rules. We aim to describe the decisions, methods, and tools we used to design these two treatments, with a view to providing guidance to addiction researchers who wish to develop JITAIs in the future. Specifically, we describe how we applied a comprehensive, organising scientific framework to define the problem, define just-in-time in the context of the identified problem, and formulate the adaptation strategies. While JITAIs appear to be a promising design in addiction intervention science, we describe several key challenges that arose during development, particularly in relation to applying micro-randomised trials to their evaluation, and offer recommendations for future research. Issues including evaluation considerations, integrating on-demand intervention content, intervention optimisation, combining active and passive assessments, incorporating human facilitation, adding cost-effectiveness evaluations, and redevelopment as transdiagnostic interventions are discussed.

Barriers to and facilitators of a just-in-time adaptive intervention for respiratory illness in cerebral palsy: a qualitative study

Article

Full-text available

Aug 2023

Objective To understand caregiver, healthcare professional and national expert perspectives on implementation of a just-in-time adaptive intervention, RE-PACT (Respiratory Exacerbation-Plans for Action and Care Transitions) to prevent respiratory crises in severe cerebral palsy. Design Qualitative research study. Setting Paediatric complex care programmes at two academic medical institutions. Participants A total of n=4 focus groups were conducted with caregivers of children with severe cerebral palsy and chronic respiratory illness, n=4 with healthcare professionals, and n=1 with national experts. Methods Participants viewed a video summarising RE-PACT, which includes action planning, mobile health surveillance of parent confidence to avoid hospitalisation and rapid clinical response at times of low confidence. Moderated discussion elicited challenges and benefits of RE-PACT’s design, and inductive thematic analysis elicited implementation barriers and facilitators. Results Of the 19 caregivers recruited, nearly half reported at least one hospitalisation for their child in the prior year. Healthcare professionals and national experts (n=26) included physicians, nurses, respiratory therapists, social workers and researchers. Four overarching themes and their barriers/facilitators emphasised the importance of design and interpersonal relationships balanced against health system infrastructure constraints. Intervention usefulness in crisis scenarios relies on designing action plans for intuitiveness and accuracy, and mobile health surveillance tools for integration into daily life. Trust, knowledge, empathy and adequate clinician capacity are essential components of clinical responder-caregiver relationships. Conclusions RE-PACT’s identified barriers are addressable. Just-in-time adaptive interventions for cerebral palsy appear well-suited to address families’ need to tailor intervention content to levels of experience, preference and competing demands.

Websites as Pioneers for Covid-19 Information Dissemination in Higher Education: The Case of Tertiary Institutions in KwaZulu-Natal: -

Article

Jul 2023

This paper sought to explore the dissemination of Covid-19-related information through websites in tertiary institutions in KwaZulu-Natal. The paper adopted a qualitative content analysis research method to collect Covid-19-related data from universities’ websites. The paper sought to identify patterns in recorded communication, thus it systematically collected data from a set of texts. The paper targeted all the universities in KwaZulu-Natal, namely: the University of Zululand, University of KwaZulu-Natal, Mangosuthu University of Technology, and Durban University of Technology. Therefore, a census sampling was adopted to include all of them. The paper found that universities used their websites as pioneers for disseminating Covid-19-related information resources to their communities. The information posted on the universities’ websites was used to educate staff and students about how to prevent themselves from contracting the Covid-19 pandemic. In addition, the paper noted that universities were playing a crucial role in protecting students and staff members, and slowing the spread of the Covid-19 pandemic by encouraging vaccinations within the institutions. Therefore, the paper concluded that universities were strategically positioned to help the country in the fight against the spread of the Covid-19 pandemic by increasing vaccine uptake among students and staff members, providing relevant and crucial information about Covid-19 vaccination, promoting vaccine trust and confidence, and establishing supportive policies and practices that made getting vaccinated as easy and convenient as possible.

Improving outcomes for care partners of persons with traumatic brain injury: Protocol for a randomized control trial of a just-in-time-adaptive self-management intervention

Article

Full-text available

Jun 2022
PLOS ONE

Informal family care partners of persons with traumatic brain injury (TBI) often experience intense stress resulting from their caregiver role. As such, there is a need for low burden, and easy to engage in interventions to improve health-related quality of life (HRQOL) for these care partners. This study is designed to evaluate the effectiveness of a personalized just-in-time adaptive intervention (JITAI) aimed at improving the HRQOL of care partners. Participants are randomized either to a control group, where they wear the Fitbit ® and provide daily reports of HRQOL over a six-month (180 day) period (without the personalized feedback), or the JITAI group, where they wear the Fitbit ® , provide daily reports of HRQOL and receive personalized self-management pushes for 6 months. 240 participants will be enrolled (n = 120 control group; n = 120 JITAI group). Outcomes are collected at baseline, 1-, 2-, 3-, 4-, 5- & 6-months, as well as 3- and 6-months post intervention. We hypothesize that the care partners who receive the intervention (JITAI group) will show improvements in caregiver strain (primary outcome) and mental health (depression and anxiety) after the 6-month (180 day) home monitoring period. Participant recruitment for this study started in November 2020. Data collection efforts should be completed by spring 2025; results are expected by winter 2025. At the conclusion of this randomized control trial, we will be able to identify care partners at greatest risk for negative physical and mental health outcomes, and will have demonstrated the efficacy of this JITAI intervention to improve HRQOL for these care partners. Trial registration : ClinicalTrial.gov NCT04570930 ; https://clinicaltrials.gov/ct2/show/NCT04570930 .

Mobile Text Messaging for Tobacco Risk Communication among Young-Adult Community College Students: A Randomized Trial of Project DEBUNK (Preprint)

Article

Full-text available

Nov 2020

Background The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. Objective Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. Methods With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P

Acceptability and feasibility of an app-based just-in-time-adaptive self-management intervention for care partners: Protocol for the CareQOL pilot trial (Preprint)

Article

Full-text available

Aug 2021

Background: Care partners (ie, informal family caregivers) of individuals with health problems face considerable physical and emotional stress, often with a substantial negative impact on the health-related quality of life (HRQOL) of both care partners and care recipients. Given that these individuals are often overwhelmed by their caregiving responsibilities, low-burden self-management interventions are needed to support care partners to ensure better patient outcomes. Objective: The primary objective of this study is to describe an intensive data collection protocol that involves the delivery of a personalized just-in-time adaptive intervention that incorporates passive mobile sensor data feedback (sleep and activity data from a Fitbit [Fitbit LLC]) and real time self-reporting of HRQOL via a study-specific app called CareQOL (University of Michigan) to provide personalized feedback via app alerts. Methods: Participants from 3 diverse care partner groups will be enrolled (care partners of persons with spinal cord injury, care partners of persons with Huntington disease, and care partners of persons with hematopoietic cell transplantation). Participants will be randomized to either a control group, where they will wear the Fitbit and provide daily reports of HRQOL over a 3-month (ie, 90 days) period (without personalized feedback), or the just-in-time adaptive intervention group, where they will wear the Fitbit, provide daily reports of HRQOL, and receive personalized push notifications for 3 months. At the end of the study, participants will complete a feasibility and acceptability questionnaire, and metrics regarding adherence and attrition will be calculated. Results: This trial opened for recruitment in November 2020. Data collection was completed in June 2021, and the primary results are expected to be published in 2022. Conclusions: This trial will determine the feasibility and acceptability of an intensive app-based intervention in 3 distinct care partner groups: care partners for persons with a chronic condition that was caused by a traumatic event (ie, spinal cord injury); care partners for persons with a progressive, fatal neurodegenerative disease (ie, Huntington disease); and care partners for persons with episodic cancer conditions that require intense, prolonged inpatient and outpatient treatment (persons with hematopoietic cell transplantation). Trial registration: ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591. International registered report identifier (irrid): DERR1-10.2196/32842.

2021 ISHNE/HRS/EHRA/APHRS Expert collaborative statement on mhealth in arrhythmia management: Digital medical tools for heart rhythm professionals: From the international society for holter and noninvasive electrocardiology/heart rhythm society/european heart rhythm association/asia-pacific heart rhythm society

Article

Jan 2021

Micro‐Randomized Trial

Chapter

Apr 2014

This article reviews the micro‐randomized trial, an experimental design developed to support mobile intervention development in modern mobile health applications. The article first gives an introduction to mobile health and the motivation for the micro‐randomized trial and then describes the design of micro‐randomized trials, including an overview of the data analysis and an example.

The effectiveness of technology‐based interventions for smoking cessation: An umbrella review and quality assessment of systematic reviews

Article

Apr 2021

Issues With the advancement and rapid increase in the public's interest in utilisation of Internet and mobile phones, technology‐based interventions are being implemented across a range of health conditions to improve patient outcomes. The aim of this review was to summarise findings from systematic reviews that evaluated the effectiveness of technology‐based smoking cessation interventions and to critically appraise their methodological qualities. Approach An umbrella review was conducted using studies identified from a comprehensive literature search of six databases and grey literature. All included systematic reviews were checked for eligibility criteria and quality using the Assessment of Multiple Systematic Reviews tool. The level of evidence for each intervention category was assessed, citation matrices were generated and corrected covered area was calculated. Key Findings Five systematic reviews with a total of 212 randomised controlled trials and 237 760 participants were included. Fourteen intervention approaches were identified and classified into three categories: stand‐alone web‐based; stand‐alone mobile phone‐based and multicomponent interventions. Incorporating web and/or mobile‐based interventions with face‐to‐face approach improved the rate of smoking cessation. However, there was no consistent evidence regarding the effectiveness of stand‐alone Internet or mobile‐based interventions. Implications Policymakers are recommended to develop strategies that enable health professionals to integrate these approaches with face‐to‐face smoking cessation support. Health professionals are recommended to be trained and equipped for online and mobile‐based interventions. Conclusion Adding technology‐based intervention to face‐to‐face smoking cessation support improves smoking cessation. Further research is needed to evaluate stand‐alone web‐based and mobile phone‐based interventions.

Context-aware notification management systems for just-in-time adaptive interventions

Conference Paper

Mar 2019

Florian Kunzler

Perceived usefulness of receiving a potential smoking cessation intervention via mobile phones among smokers in Indonesia

Article

Full-text available

Aug 2020

Background: The use of technology to support healthcare in Indonesia holds new promise in light of decreasing costs of owning mobile devices and ease of access to internet. However, it is necessary to assess end-user perceptions regarding mobile health interventions prior to its implementation. This would throw light on the acceptability of mobile phone communication in bringing about behavioral changes among the target Indonesian population. The aim of this study was to explore the perceived usefulness of receiving a potential smoking cessation intervention via mobile phones. Methods: This is an exploratory cross-sectional study involving current and former adult tobacco smokers residing in Indonesia. Online advertisement and snowballing were used to recruit respondents. Data was collected using a web-based survey over a period of 4 weeks. Those willing to participate signed an online consent and were subsequently directed to the online questionnaire that obtained demographics, tobacco usage patterns, perceived usefulness of a mobile phone smoking cessation application and its design. Results: A total of 161 people who smoked tobacco responded to the online survey. The mean age of the participants was 29.4. Of the 123 respondents, 102 were men. Prior experience with using a mobile phone for health communication (OR 3.6, P =0.014) and those willing to quit smoking (OR 5.1, P =0.043) were likely to perceive a mobile phone smoking cessation intervention as useful. A smartphone application was preferred over text messages, media messages or interactive voice response technology. Content consisting of motivational messages highlighting the methods and benefits of quitting smoking were requested. Conclusion: People who smoke in Indonesia perceived receiving a potential smoking cessation intervention via mobile phones as useful. A multi-component, personalized smartphone application was the desired intervention technique. Such an intervention developed and implemented within a public health program could help address the tobacco epidemic in Indonesia.

Micro-Randomized Trials for Promoting Engagement in Mobile Health Data Collection: Adolescent/Young Adult Oral Chemotherapy Adherence as an Example

Article

Jul 2020

Long-term engagement with mobile health (mHealth) apps can provide critical data for improving empirical models for real-time health behaviors. To learn how to improve and maintain mHealth engagement, micro-randomized trials (MRTs) can be used to optimize different engagement strategies. In MRTs, participants are sequentially randomized, often hundreds or thousands of times, to different engagement strategies or treatments. The data gathered are then used to decide which treatment is optimal in which context. In this paper, we discuss an example MRT for youth with cancer, where we randomize different engagement strategies to improve self-reports on factors related to medication adherence. MRTs, moreover, can go beyond improving engagement, and we reference other MRTs to address substance abuse, sedentary behavior, and so on.

Toward a unifying theory of dysregulated behaviors

Article

Jun 2020
CLIN PSYCHOL REV

Konrad Bresin

Dysregulated behaviors, defined as active behaviors that have short-term benefits but cause serious recurrent long-term distress or impairment to the individual and/or those around them, include behaviors such as suicidal and nonsuicidal self-injury, aggression, and substance use. These behaviors are common and costly to the individual, their friends and family, and society. Despite similar etiological models and interventions, dysregulated behaviors have largely been studied in isolation from one another. The goals of this paper were to a) define dysregulated behaviors as a coherent class of behaviors, b) review the prevalence and consequences of dysregulated behaviors, c) outline how dysregulated behaviors fit into current models of psychopathology, and d) describe the key questions to be addressed by future research in this area. It is argued that integrating across theories of discrete dysregulated behaviors can help provide aid in the development of etiological models, which in turn can improve prevention and intervention for dysregulated behaviors.

Proactive text messaging (GetReady2Quit) and nicotine replacement therapy to promote smoking cessation among smokers in primary care: A pilot randomized trial protocol

Article

May 2019

Introduction: Most smokers see a physician each year, but few use any assistance when they try to quit. Text messaging programs improve smoking cessation in community and school settings; however, their efficacy in a primary care setting is unclear. The current trial assesses the feasibility and preliminary clinical outcomes of text messaging and mailed nicotine replacement therapy (NRT) among smokers in primary care. Methods: In this single-center pilot randomized trial, eligible smokers in primary care are offered brief advice by phone and randomly assigned to one of four interventions: (1) Brief advice only, (2) text messages targeted to primary care patients and tailored to quit readiness, (3) a 2-week supply of nicotine patches and/or lozenges (NRT), and (4) both text messaging and NRT. Randomization is stratified by practice and intention to quit. The text messages (up to 5/day) encourage those not ready to quit to practice a quit attempt, assist those with a quit date through a quit attempt, and promote NRT use. The 2-week supply of NRT is mailed to patients' homes. Results: Feasibility outcomes include recruitment rates, study retention, and treatment adherence. Clinical outcomes are assessed at 1, 2, 6, and 12-weeks post-enrollment. The primary outcome is ≥1self-reported quit attempt(s). Secondary clinical outcomes include self-reported past 7- and 30-day abstinence, days not smoked, NRT adherence, and exhaled carbon monoxide. Conclusions: This pilot assesses text messaging plus NRT, as a proactively offered intervention for smoking cessation support in smokers receiving primary care and will inform full-scale randomized trial planning. Trial registration: ClinicalTrials.govNCT03174158.

Mobile phone text messaging and app-based interventions for smoking cessation

Article

Oct 2019

Background: Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor settings. This is an update of a Cochrane Review first published in 2006, and previously updated in 2009 and 2012. Objectives: To determine whether mobile phone-based smoking cessation interventions increase smoking cessation rates in people who smoke. Search methods: For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register, along with clinicaltrials.gov and the ICTRP. The date of the most recent searches was 29 October 2018. Selection criteria: Participants were smokers of any age. Eligible interventions were those testing any type of predominantly mobile phone-based programme (such as text messages (or smartphone app) for smoking cessation. We included randomised controlled trials with smoking cessation outcomes reported at at least six-month follow-up. Data collection and analysis: We used standard methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We performed both study eligibility checks and data extraction in duplicate. We performed meta-analyses of the most stringent measures of abstinence at six months' follow-up or longer, using a Mantel-Haenszel random-effects method, pooling studies with similar interventions and similar comparators to calculate risk ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses including all randomised (with dropouts counted as still smoking) and complete cases only. Main results: This review includes 26 studies (33,849 participants). Overall, we judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high-income countries. There was moderate-certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate-certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). Two studies comparing text messaging with other smoking cessation interventions, and three studies comparing high- and low-intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. Five studies compared a smoking cessation smartphone app with lower-intensity smoking cessation support (either a lower-intensity app or non-app minimal support). We pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so we did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings. Authors' conclusions: There is moderate-certainty evidence that automated text message-based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate-certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.

Just-in-the-Moment Adaptive Interventions (JITAI): A Meta-Analytical Review

Article

Full-text available

Sep 2019

A just-in-time, adaptive intervention (JITAI) is an emerging type of intervention that provides tailored support at the exact time of need. It does so using enabling new technologies (e.g., mobile phones, sensors) that capture the changing states of individuals. Extracting effect sizes of primary outcomes produced by 33 empirical studies that used JITAIs, we found moderate to large effect sizes of JITAI treatments compared to (1) waitlist-control conditions (k = 9), Hedges’s g = 1.65 and (2) non-JITAI treatments (k = 21), g = 0.89. Also, participants of JITAI interventions showed significant changes (k = 13) in the positive direction (g = 0.79). A series of sensitivity tests suggested that those effects persist. Those effects also persist despite differences in the behaviors of interests (e.g., blood glucose control, recovering alcoholics), duration of the treatments, and participants’ age. Two aspects of tailoring, namely: (1) tailoring to what (i.e., both people’s previous behavioral patterns and their current need states; with these effects additive) and (2) approach to tailoring (i.e., both using a human agent and an algorithm to decide tailored feedback; with these effects additive), are significantly associated with greater JITAI efficacy.

The Internet Goes to College: How Students Are Living in the Future with Today's Technology.

Article

Full-text available

Jan 2002

Stages and Processes of Self-Change of Smoking - Toward An Integrative Model of Change

Article

Full-text available

Jul 1983

An integrative model of change was applied to the study of 872 Ss (mean age 40 yrs) who were changing their smoking habits on their own. Ss represented the following 5 stages of change: precontemplation, contemplation, action, maintenance, and relapse. 10 processes of change were expected to receive differential emphases during particular stages of change. Results indicate that Ss (a) used the fewest processes of change during precontemplation; (b) emphasized consciousness raising during the contemplation stage; (c) emphasized self-reevaluation in both contemplation and action stages; (d) emphasized self-liberation, a helping relationship, and reinforcement management during the action stage; and (e) used counterconditioning and stimulus control the most in both action and maintenance stages. Relapsers responded as a combination of contemplaters and people in action would. Results are discussed in terms of developing a model of self-change of smoking and enhancing a more integrative general model of change. (14 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)

Sobell LC, Brown J, Leo GI, Sobell MB. The reliability of the alcohol timeline followback when administered by telephone and by computer. Drug Alcohol Depend 42: 49-54

Article

Full-text available

Oct 1996
DRUG ALCOHOL DEPEN

The Alcohol Timeline Followback (TLFB) has been shown to be a psychometrically sound assessment instrument for obtaining retrospective daily estimates of alcohol consumption. These evaluations, however, have been limited to face-to-face paper-and-pencil interviews. As use of the TLFB method has increased, investigators have reported using the method to collect follow-up data by telephone. Also, as with many assessment instruments, a computerized version of the TLFB method has been developed. The psychometric characteristics of the TLFB method under these administration conditions have not been evaluated. This paper presents results from two studies showing that the Alcohol TLFB method can obtain reliable drinking data when administered over the telephone and by computer.

College Smoking Policies and Smoking Cessation Programs: Results of a Survey of College Health Center Directors

Article

Full-text available

Apr 2001

College students' cigarette smoking rose dramatically during the 1990s. Little is known about what colleges do to address the problem. Health center directors at 393 4-year US colleges provided information (response rate: 65.1%) about college policies addressing smoking and the availability of smoking cessations programs. Of the health center directors surveyed, 85% considered students' smoking a problem; yet only 81% of colleges prohibit smoking in all public areas and only 27% ban smoking in all indoor areas, including students' rooms in dormitories and in private offices. More than 40% of the respondents reported that their schools did not offer smoking cessation programs and that the demand for existing program was low. Colleges need to do more to discourage student tobacco use. Recommended actions include campus-wide no-smoking policies that apply to student residences and identification of new ways of providing smoking prevention and cessation services.

Evaluation of an Internet-based smoking cessation program: Lessons learned from a pilot study

Article

Full-text available

May 2003

The potential contribution of the Internet to smoking cessation seems huge, given that a majority of Americans now have both computers and telephones. Despite the proliferation of Web sites offering smoking cessation support, there is little empirical evidence regarding the efficacy of Internet-delivered cessation programs. We developed a cessation Web site and conducted a short-term evaluation of it, examining recruitment approaches, Web site use patterns, alternative retention incentives and re-contact modes, satisfaction, and cessation rate. The intervention included modules on social support and cognitive-behavioral coping skills configured to take advantage of the interactive and multimedia capabilities of the Internet. Cessation and satisfaction data were obtained from a subsample of 370 subjects followed for 3 months. The program was rated as easy to use, and the social support group component was used most frequently. The cessation rate (abstinence for the previous 7 days) at 3 months was 18%, with nonrespondents (n=161) considered smokers. Among a variety of traditional and Internet-based recruitment strategies, the most successful made use of Internet user groups and search engines. Methodological and procedural issues posed in conducting research on the Internet are discussed.

The Nicotine Dependence Syndrome Scale: A multidimensional measure of nicotine dependence

Article

Full-text available

May 2004

We report the development of a new multidimensional questionnaire to measure nicotine dependence, based on Edwards's syndromal conceptualization of dependence. We present three studies. In study 1, we administered the Nicotine Dependence Syndrome Scale (NDSS) to 317 smokers in a smoking cessation study. Factor analysis of the NDSS revealed five factors: Drive (craving and withdrawal, and subjective compulsion to smoke), priority (preference for smoking over other reinforcers), tolerance (reduced sensitivity to the effects of smoking), continuity (regularity of smoking rate), and stereotypy (invariance of smoking). A single overall score based on the first principal component, NDSS-T, was retained as a single core measure of dependence. The NDSS showed promising psychometric properties: NDSS-T and factor scores showed strong associations with dependence-relevant measures, even when we controlled for scores on the Fagerström Tolerance Questionnaire (FTQ); and the NDSS predicted urges when smoking, withdrawal in acute abstinence, and outcome in cessation. The five factor scores showed differential patterns of correlations with external validators, supporting the multidimensionality of the measure. In study 2, we revised the NDSS to expand some subscales and administered it to 802 smokers in a cessation study. The same five factors were extracted, the internal reliability of some subscales was improved, and the factor scores again showed associations with dependence-relevant validators, which were largely maintained when we controlled for FTQ scores. In study 3, with 91 smokers in a cessation trial, we established that the test-retest reliability of the subscales was adequate. Thus, the NDSS presents a valid multidimensional assessment of nicotine dependence that may expand on current measures.

Back from the Beach but Hanging on the Telephone? English Adolescents' Attitudes and Experiences of Mobile Phones and the Internet

Article

Full-text available

Jul 2004

Recently, a number of commentators have suggested that growth in use of the Internet may be slowing, and its impact may have been exaggerated. However, a disproportionate number of the nonusers tend to be those over the age of 50, and the young are most likely to go online eventually. Therefore, the most appropriate people to survey with regard to Internet use are adolescents and young adults who are likely to be the Internet users or nonusers of the future. This survey was conducted to find out more about the activities and opinions of secondary-school aged children who do, and do not, use the Internet. Mobile phone use was also examined in this survey as this has also shown a meteoric rise in adults and more particularly in young people. Generally, the survey revealed that children aged between 11 and 16 years old are quite comfortable with the Internet, use it a moderate amount and for a variety of purposes. However, boys were more likely to use the Internet than girls and sometimes for slightly different purposes. Reasons for not using the Internet generally revolved around a lack of access to equipment. Furthermore, a higher percentage of adolescents have mobile phones than adults and girls are more likely to own a mobile phone than boys. Mobile phones were also used for a variety of purposes, most notably making and receiving calls and text-messaging. The most common reasons for children not owning a mobile phone was because they had no need for one. Finally, a significant positive relationship between the use of emails and text messaging suggests that the mobile phone may supplement some of the previous functions of the Internet.

College Smoking-Cessation Using Cell Phone Text Messaging

Article

Full-text available

Sep 2004

Although rates of smoking among college-aged students continue to rise, few interventions that focus on college smokers' unique motivations and episodic smoking patterns exist. The authors developed and evaluated a prototype program targeting college students that integrates Web and cell phone technologies to deliver a smoking-cessation intervention. To guide the user through the creation and initialization of an individualized quitting program delivered by means of cell phone text messaging, the program uses assessment tools delivered with the program Web site. Forty-six regular smokers were recruited from local colleges and provided access to the program. At 6-week follow-up, 43% had made at least one 24-hour attempt to quit, and 22% were quit--based on a 7-day prevalence criterion. The findings provide support for using wireless text messages to deliver potentially effective smoking-cessation behavioral interventions to college students.

Initial Evaluation of a Real-World Internet Smoking Cessation System

Article

Full-text available

May 2005

To significantly reduce smoking prevalence, treatments must balance reach, efficacy, and cost. The Internet can reach millions of smokers cost-effectively. Many cessation Web sites exist, but few have been evaluated. As a result, the potential impact of the Internet on smoking prevalence remains unknown. The present study reports the results, challenges, and limitations of a preliminary, large-scale evaluation of a broadly disseminated smoking cessation Web site used worldwide (QuitNet). Consecutive registrants (N=1,501) were surveyed 3 months after they registered on the Web site to assess 7-day point prevalence abstinence. Results must be interpreted cautiously because this is an uncontrolled study with a 25.6% response rate. Approximately 30% of those surveyed indicated they had already quit smoking at registration. Excluding these participants, an intention-to-treat analysis yielded 7% point prevalence abstinence (for the responders only, abstinence was 30%). A range of plausible cessation outcomes (9.8%-13.1%) among various subgroups is presented to illustrate the strengths and limitations of conducting Web-based evaluations, and the tensions between clinical and dissemination research methods. Process-to-outcome analyses indicated that sustained use of QuitNet, especially the use of social support, was associated with more than three times greater point prevalence abstinence and more than four times greater continuous abstinence. Despite its limitations, the present study provides useful information about the potential efficacy, challenging design and methodological issues, process-to-outcome mechanisms of action, and potential public health impact of Internet-based behavior change programs for smoking cessation.

Do U smoke after TXT? Results of a randomised trial of smoking cessation using mobile phone text messaging

Article

Full-text available

Aug 2005
TOB CONTROL

To determine the effectiveness of a mobile phone text messaging smoking cessation programme. Randomised controlled trial New Zealand 1705 smokers from throughout New Zealand who wanted to quit, were aged over 15 years, and owned a mobile phone were randomised to an intervention group that received regular, personalised text messages providing smoking cessation advice, support, and distraction, or to a control group. All participants received a free month of text messaging; starting for the intervention group on their quit day to assist with quitting, and starting for the control group at six months to encourage follow up. Follow up data were available for 1624 (95%) at six weeks and 1265 (74%) at six months. The main trial outcome was current non-smoking (that is, not smoking in the past week) six weeks after randomisation. Secondary outcomes included current non-smoking at 12 and 26 weeks. More participants had quit at six weeks in the intervention compared to the control group: 239 (28%) v 109 (13%), relative risk 2.20 (95% confidence interval 1.79 to 2.70), p < 0.0001. This treatment effect was consistent across subgroups defined by age, sex, income level, or geographic location (p homogeneity > 0.2). The relative risk estimates were similar in sensitivity analyses adjusting for missing data and salivary cotinine verification tests. Reported quit rates remained high at six months, but there was some uncertainty about between group differences because of incomplete follow up. This programme offers potential for a new way to help young smokers to quit, being affordable, personalised, age appropriate, and not location dependent. Future research should test these findings in different settings, and provide further assessment of long term quit rates.

Prevalence and Predictors of Transitions in Smoking Behavior Among College Students

Article

Full-text available

Mar 2004

The prevalence of smoking among college students is surprisingly high and represents a significant public health issue. However, there are few longitudinal studies of smoking in this population. This study examined the prevalence and predictors of transitions in smoking behavior among a cohort of 548 college students. Over the course of 4 years, 87% of daily smokers and almost 50% of occasional smokers continued to smoke. Among nonsmokers, 11.5% began smoking occasionally and none became daily smokers. In general, predictors of smoking behavior change were significant only among baseline occasional smokers and included gender, smoking outcome expectancies, and affect regulation expectations. Peer and parental smoking, demographics, affect, stress, and alcohol use were generally not predictive of change. Tobacco control interventions targeted at college students are clearly warranted.

Youth are leading the transition to a fully wired and mobile nation

Article

Jan 2005

Relapse prevention - An overview of Marlatt's cognitive-behavioral model

Article

Jan 1999
Alcohol Health Res World

Relapse prevention (RP) is an important component of alcoholism treatment. The RP model proposed by Marlatt and Gordon suggests that both immediate determinants (e.g., high-risk situations, coping skills, outcome expectancies, and the abstinence violation effect) and covert antecedents (e.g., lifestyle factors and urges and cravings) can contribute to relapse. The RP model also incorporates numerous specific and global intervention strategies that allow therapist and client to address each step of the relapse process. Specific interventions include identifying specific high-risk situations for each client and enhancing the client's skills for coping with those situations, increasing the client's self-efficacy, eliminating myths regarding alcohol's effects, managing lapses, and restructuring the client's perceptions of the relapse process. Global strategies comprise balancing the client's lifestyle and helping him or her develop positive addictions, employing stimulus control techniques and urge-management techniques, and developing relapse road maps. Several studies have provided theoretical and practical support for the RP model.

Monitoring the Future. National Survey Results on Drug Use

Article

Jan 2003

Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviors

Article

Jan 1985

Monitoring the Future National Survey Results on Drug Use, 1975–2007

Article

Jan 2013

Increased Levels of Cigarette Use Among College Students

Article

Dec 1998

Adolescent smoking prevalence is tracked annually and has increased since 1991. In contrast, little is known about trends in smoking among college students, a group that has previously been more resistant to tobacco use than other young adults. To examine changes in cigarette smoking among college students between 1993 and 1997 and among different types of students and colleges. Self-administered survey (Harvard School of Public Health College Alcohol Study). One hundred sixteen nationally representative 4-year colleges. A total of 15103 randomly selected students in 1993 (70% response rate) and 14251 students in 1997 (60% response rate). Self-reports of cigarette smoking in the past 30 days and in the past year, age at smoking first cigarette, and number of attempts to quit. Over 4 years, the prevalence of current (30-day) cigarette smoking rose by 27.8%, from 22.3% to 28.5% (P<.001). The increase was observed in 99 of 116 colleges and was statistically significant (P<.05) in 27 (23%) of them. Current smoking increased across all student subgroups (defined by sex, race/ethnicity, and year in school) and in all types of colleges. Smoking is rising faster in public schools (from 22.0% to 29.3%) than in private schools (from 22.9% to 26.8%). Eleven percent of college smokers had their first cigarette and 28% began to smoke regularly at or after age 19 years, by which time most were already in college. Half of current smokers tried to quit in the previous year; 18% had made 5 or more attempts to quit. Cigarette use is increasing on campuses nationwide in all subgroups and types of colleges. Substantial numbers of college students are both starting to smoke regularly and trying to stop. National efforts to reduce smoking should be extended to college students.

Smoking-Cessation Programs Need to Target College Students

Article

Apr 1999

Deborah Christie-Smith

US College Students' Use of Tobacco Products

Article

Aug 2000

Adults aged 18 to 24 years, many of whom are in college, represent the youngest legal targets for tobacco industry marketing. Cigarette smoking has been described among college students, but little is known about non-cigarette tobacco use by college students or cigar use by adults of any age. To assess the prevalence of all forms of tobacco use (cigarettes, cigars, pipes, and smokeless tobacco) among US college students and to identify student- and college-level factors associated with use of each product. The Harvard College Alcohol Survey, a self-administered survey conducted in 1999. One hundred nineteen nationally representative US 4-year colleges. A total of 14,138 randomly selected students (60% response rate). Self-report of current (in the past 30 days), past-year, and lifetime use of cigarettes, cigars, pipes, smokeless tobacco, and all tobacco products. Nearly half (45.7%) of respondents had used a tobacco product in the past year and one third (32.9%) currently used tobacco. Cigarettes accounted for most of the tobacco use (28.5% current prevalence), but cigar use was also substantial (37.1% lifetime prevalence, 23.0% past-year prevalence, and 8.5% current prevalence) and combinations of the 2 were common. Total tobacco use was higher in men than in women (37. 9% vs 29.7%; P<.001), despite nearly identical current cigarette smoking rates between the sexes (28.5% for women vs 28.4% for men), because of greater use of cigars (current prevalence, 15.7% vs 3.9%; P<.001) and smokeless tobacco (current prevalence, 8.7% vs 0.4%; P<. 001) by men. Tobacco use was significantly higher among white students (P<.001), users of other substances (alcohol and marijuana) (P<.001), and students whose priorities were social rather than educational or athletic (P<.05). Among students who had used both cigars and cigarettes, only 8.9% smoked cigars at an earlier age than they had smoked cigarettes. Our study indicates that tobacco use is common among college students and is not limited to cigarettes. College appears to be a time when many students are trying a range of tobacco products and are in danger of developing lifelong nicotine dependence. National efforts to monitor and reduce tobacco use of all types should expand to focus on college students and other young adults. JAMA. 2000;284:699-705

Applying the Transtheoretical Model to Tobacco Cessation and Prevention: A Review of Literature

Article

Sep 2002

To comprehensively review all published, peer-reviewed research on the Transtheoretical Model (TTM) and tobacco cessation and prevention by exploring the validity of its constructs, the evidence for use of interventions based on the TTM, the description of populations using TTM constructs, and the identification of areas for further research. The three research questions answered were: "How is the validity of the TTM as applied to tobacco supported by research?" "How does the TTM describe special populations regarding tobacco use?" "What is the nature of evidence supporting the use of stage-matched tobacco interventions?" Computer Database search (PsychInfo, Medline, Current Contents, ERIC, CINAHL-Allied Health, and Pro-Quest Nursing) and manual journal search. INCLUSION/EXCLUSION CRITERIA: All English, original, research articles on the TTM as it relates to tobacco use published in peer-reviewed journals prior to March 1, 2001, were included. Commentaries, editorials, and books were not included. Articles were categorized as TTM construct validation, population descriptions using TTM constructs, or intervention evaluation using TTM constructs. Summary tables including study design, research rating, purpose, methods, findings, and implications were created. Articles were further divided into groups according to their purpose. Considering both the findings and research quality of each, the three research questions were addressed. The 148 articles reviewed included 54 validation studies, 73 population studies, and 37 interventions (some articles fit two categories). Overall, the evidence in support of the TTM as applied to tobacco use was strong, with supportive studies being more numerous and of a better design than nonsupportive studies. Using established criteria, we rated the construct validity of the entire body of literature as good; however, notable concerns exist about the staging construct. A majority of stage-matched intervention studies provided positive results and were of a better quality than those not supportive of stage-matched interventions; thus, we rated the body of literature using stage-matched tobacco interventions as acceptable and the body of literature using non-stage-matched interventions as suggestive. Population studies indicated that TTM constructs are applicable to a wide variety of general and special populations both in and outside of the United States, although a few exceptions exist. Evidence for the validity of the TTM as it applies to tobacco use is strong and growing; however, it is not conclusive. Eight different staging mechanisms were identified, raising the question of which are most valid and reliable. Interventions tailored to a smoker's stage were successful more often than nontailored interventions in promoting forward stage movement. Stage distribution is well-documented for U.S. populations; however, more research is needed for non-U.S. populations, for special populations, and on other TTM constructs.

Smoking on the rise among young adults: Implications for research and policy

Article

Jul 2003
TOB CONTROL

Paula Lantz

This paper investigates hypotheses regarding the cause of the recent apparent increase in young adult smoking, compares trends in smoking among young adults with trends in the use of other substances, and considers the implications for youth tobacco control research and policy. Time series analyses of national data suggest that the recent observed increase in smoking among young adults is primarily an artefact of the almost simultaneous increase in smoking among high school students. In addition, however, it also appears that there have been real changes in smoking patterns among young adults. While many questions remain regarding recent trends in tobacco and other drug use among adolescents and young adults, what is known leads to a clarion call for increased intervention and policy action for the prevention and control of tobacco use among young adults in the USA.

Development and process evaluation of a Web-based smoking cessation program for college smokers: Innovative tool for education

Article

Jun 2004
PATIENT EDUC COUNS

Smoking cessation interventions are needed for young adults. Innovative approaches to behavior change for this population should be tested. Formative research and process evaluation of those approaches would result in more effective programs. This paper presents the development process and process evaluation of a web-based smoking cessation program. A description of the stages of development is presented with formative research, development of the web-based intervention, formative evaluation, and process evaluation. The smokers reported high usage of the intervention and satisfaction with the intervention in that it helped to raise their consciousness about quitting, encouraged them to set behavioral goals, provided stages of change feedback, and offered interactivity in presenting information and strategies about quitting. The Internet may be a promising tool for patient education according to the process results.

Intensity of Mobile Phone Use and Health Com-promising Behaviors—How Is Information and Communication Technology Connected to Health-Related Lifestyle in Adolescence?

Article

Mar 2005

The association of mobile phone use with health compromising behaviours (smoking, snuffing, alcohol) was studied in a survey comprising a representative sample of 14-16-year-olds (N=3485) in 2001. Mobile phone was used by 89% of respondents and by 13% for at least 1h daily. The intensity of use was positively associated with health compromising behaviours. The associations remained, although somewhat reduced, after including weekly spending money in the models. This study concludes that, at least in the present developmental level of communication technologies, intensive mobile phone use seems to be part of the same health-related lifestyle as health compromising behaviours.

A Review of Interventions to Reduce Tobacco Use in Colleges and Universities

Article

Mar 2005
AM J PREV MED

Interventions have been designed to reduce the prevalence of smoking in college/university students. This review presents a summary and synthesis of the interventions published in English from 1980 to the present. Seven databases were searched for relevant published articles, and reference lists were examined for additional published studies. The studies were categorized as (1) individual approaches, such as on-campus cessation programs, and (2) institutional approaches, such as smoke-free policies. The studies were categorized by type of institution and geographic location, study design, sample demographics, and outcomes. Fourteen studies were identified; only five received a "satisfactory" rating based on evaluation criteria. Most studies were based on convenience samples, and were conducted in 4-year institutions. Seven studies used comparison groups, and three were multi-institutional. Individual approaches included educational group sessions and/or individual counseling that were conducted on campus mostly by healthcare personnel. None used nicotine replacement or other medications for cessation. The quit rates for both smokeless tobacco and cigarette users varied, depending on definitions and duration of follow-up contact. Institutional interventions focused mainly on campus smoking restrictions, smoke-free policies, antitobacco messages, and cigarette pricing. Results indicated that interventions can have a positive influence on student behavior, specifically by reducing tobacco use (i.e., prevalence of cigarette smoking and use of smokeless products, amount smoked) among college students, and increasing acceptability of smoking policies and campus restrictions among both tobacco users and nonusers. While some promising results have been noted, rigorous evaluations of a wider range of programs are needed, along with studies that address cultural and ethnic diversity on campuses.

Comparing the Efficacy of Two Internet-Based, Computer-Tailored Smoking Cessation Programs: A Randomized Trial

Article

Feb 2005
J MED INTERNET RES

Jean-François Etter

Online computer-tailored smoking cessation programs have not yet been compared directly. To compare the efficacy of two Internet-based, computer-tailored smoking cessation programs. Randomized controlled trial conducted in 2003-2004. Visitors to a smoking cessation website were randomly assigned to either an original online, interactive smoking cessation program or to a modified program. Both programs consisted of tailored, personalized counseling letters based on participants' characteristics, followed by monthly email reminders. The original program was based on psychological and addiction theory, and on preliminary research conducted in the same population. The modified program was shorter and contained more information on nicotine replacement therapy and nicotine dependence, and less information on health risks and coping strategies. In both programs, 1 month and 2 months after entering the study, participants were invited by email to answer the same tailoring questionnaire again in order to receive a second counseling letter. Participants in both programs obtained, on average, 1.2 feedback counseling letters over 2.5 months, and 84% received only 1 feedback letter. The outcome was self-reported smoking abstinence (no puff of tobacco in the previous 7 days), assessed 2.5 months after entry in the program. We report results from intention-to-treat (ITT) analyses, where all non-respondents at follow-up were counted as smokers. The baseline questionnaire was answered by a total of 11969 current (74%) and former (26%) smokers, and the follow-up survey by 4237 people (35%). In an ITT analysis, abstinence rates in baseline current smokers were respectively 10.9% and 8.9% (odds ratio [OR]=1.24, 95% confidence interval [CI]1.08-1.43, P=.003) in the original and modified programs, and 25.2% and 15.7% (OR=1.81, CI 1.51-2.16, P<.001) in baseline former smokers. While we found statistically significant differences in quit rates in smokers in the contemplation stage favoring the original program (OR=1.54, CI 1.18-2.02, P=.002), no between-group differences in quit rates were observed in smokers in the precontemplation (OR=1.07, CI 0.36-3.14, P=.91) and preparation (OR=1.15, CI 0.97-1.37, P=.10) stages of change. In smokers in the contemplation stage of change and in former smokers, the original program produced higher smoking abstinence rates than the modified program.

Randomized controlled trial of a web-based computer-tailored smoking cessation program as a supplement to nicotine patch therapy

Article

Jun 2005

To assess the efficacy of World Wide Web-based tailored behavioral smoking cessation materials among nicotine patch users. Two-group randomized controlled trial. World Wide Web in England and Republic of Ireland. A total of 3971 subjects who purchased a particular brand of nicotine patch and logged-on to use a free web-based behavioral support program. Web-based tailored behavioral smoking cessation materials or web-based non-tailored materials. Twenty-eight-day continuous abstinence rates were assessed by internet-based survey at 6-week follow-up and 10-week continuous rates at 12-week follow-up. Using three approaches to the analyses of 6- and 12-week outcomes, participants in the tailored condition reported clinically and statistically significantly higher continuous abstinence rates than participants in the non-tailored condition. In our primary analyses using as a denominator all subjects who logged-on to the treatment site at least once, continuous abstinence rates at 6 weeks were 29.0% in the tailored condition versus 23.9% in the non-tailored condition (OR = 1.30; P = 0.0006); at 12 weeks continuous abstinence rates were 22.8% versus 18.1%, respectively (OR = 1.34; P = 0.0006). Moreover, satisfaction with the program was significantly higher in the tailored than in the non-tailored condition. The results of this study demonstrate a benefit of the web-based tailored behavioral support materials used in conjunction with nicotine replacement therapy. A web-based program that collects relevant information from users and tailors the intervention to their specific needs had significant advantages over a web-based non-tailored cessation program.

Developing and evaluating a smoking cessation program combined with Internet-assisted-instruction for adolescents with smoking

Article

Jul 2006
PATIENT EDUC COUNS

The purpose of this study was to develop a smoking cessation program combined with an Internet-assisted instruction (IAI) program to help youth smokers quit smoking, and to evaluate the effectiveness of the program in changing youth's attitudes toward smoking, smoking behavior, and self-efficacy for smoking cessation. To achieve this goal, a comparative study of 77 senior high students divided into two groups was conducted. One group, designated as the experimental group, accepted a 6-week smoking cessation program plus an IAI program and the other group did not receive any intervention as the comparison group. All participants completed questionnaires before and after the program. The results showed that the strategy of combining the smoking cessation program and an IAI program was highly effective in terms of effects upon the youth's attitude towards smoking, smoking behavior, and self-efficacy. There was a highly positive correlation between the participants' attitude toward smoking and self-efficacy. In contrast, cigarette consumption was in a strongly negative correlation with self-efficacy. Most of all participants in the experimental group recognized the effectiveness of the program, and thought the smoking cessation program with an IAI program was helpful and welcomed by youth. This study can serve as reference for future design and implementation of IAI programs for youth smoking cessation.

What fraction of young adults are at risk for future smoking and why?

Article

Nov 2005

Recent evidence indicates that higher smoking rates among young adults in the United States may be related in part to increased initiation during young adulthood. The tobacco industry, restricted from overtly targeting adolescents, appears to be focusing on young adults. Thus it is important to estimate the percentage and identify the characteristics of the young adult population (aged 18-29 years) at risk for future smoking. This group would include all current established smokers (smoked at least 100 cigarettes in their lifetime), current experimenters, former established smokers, and former experimenters at risk for smoking again, as well as never-smokers who do not rule out future smoking. Using data from the population-based 2002 California Tobacco Survey (N = 9,364 young adults aged 18-29 years), we designated groups of young adults at risk and identified factors associated with risk. Altogether, 86.7+/-1.5% of current and former established smokers were at risk for future smoking, and 59.6+/-4.3% of former established smokers were at risk. Over half (52.2+/-2.0%) of all experimenters but only 9.0+/-1.2% of never-smokers were at risk. Overall, 43.0+/-1.2% of the young adult population was at risk. Although different demographic and other factors were associated with risk among former established smokers, experimenters, and never-smokers, three factors were consistently associated in each group: Younger age, not having a smoke-free home, and going to bars and clubs. We conclude that the group of young adults at risk for future smoking is sizable and presents a fertile target for tobacco industry efforts to promote smoking. Counter-efforts might include promotion of smoke-free environments.

Evaluation of an Adolescent Smoking-Cessation Media Campaign: GottaQuit.com

Article

Nov 2005
Pediatrics

To evaluate the impact of a smoking-cessation media campaign for teens on utilization of a cessation Web site, GottaQuit.com. Telephone surveys were conducted before and after the implementation of a countywide media campaign to promote the use of a smoking-cessation Web site for youths. The surveys were designed to assess teen awareness and utilization of the Web site, as well as tobacco use and cessation attempts. Supplemental 2003 Youth Risk Behavior Survey items also assessed use of the Web site. Most teen smokers reported that they wanted to quit smoking. Almost all teens reported exposure to GottaQuit.com ads and accurately identified GottaQuit.com as a Web site that offers cessation help for youths. Nearly 1 in 4 smokers who were trying to quit had visited GottaQuit.com or another Web site for cessation assistance. The GottaQuit.com campaign effectively reached almost all teens, regardless of smoking status. Smokers were more likely than nonsmokers to have visited the Web site for help with quitting. Web adjuncts are likely to be used by adolescents who seek assistance in quitting.

Prevalence and predictors of transitions in smoking behavior among college stu-dents

Jan 2004
168-177

Wetter Dw
Kenford
Sl
Welsch
Sk

Wetter DW, Kenford SL, Welsch SK, et al. Prevalence and predictors of transitions in smoking behavior among college stu-dents. Health Psychol. 2004;23:168–177.

Cigarette smoking among adults-United States

Jan 2002
427-431

Centers for Disease Control and Prevention. Cigarette smoking among adults-United States, 2002. MMWR. 2004;53:427-431.

US college students' use of tobacco products: results of a national survey

Jan 2000
699-705

N A Rigotti
J E Lee
H Wechsler

Rigotti NA, Lee JE, Wechsler H. US college students' use of tobacco products: results of a national survey. JAMA. 2000;284:699-705.

Larimer ME, Palmer RS, Marlatt GA. Relapse prevention: an overview of Marlatt's cognitive-behavioral model

Jan 1999
AM J HEALTH PROMOT
151-160

L Spencer
F Pagell
M E Hallion
T B Adams

Spencer L, Pagell F, Hallion ME, Adams TB. Applying the transtheoretical model to tobacco cessation and prevention: a review of the literature. Am J Health Promot. 2002;17:7-71. 29. Larimer ME, Palmer RS, Marlatt GA. Relapse prevention: an overview of Marlatt's cognitive-behavioral model. Alcohol Res Health. 1999;23:151-160.

DC: Pew Internet and American Life Project

S Jones
Washington

DC: Pew Internet and American Life Project

A Lenhart
M Madden
P Hitlin
Washington

Internet and Mobile Phone Text Messaging Intervention for College Smokers

Abstract

No full-text available

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