Mobile App-Based Coaching for Alcohol Prevention among Adolescents: Pre-Post Study on the Acceptance and Effectiveness of the Program "MobileCoach Alcohol".

BACKGROUND: At-risk alcohol use, particularly binge drinking, is widespread among adolescents and young adults in most Western countries. MobileCoach Alcohol is a mobile app-based program for alcohol prevention that provides individualized coaching using a conversational agent. The current study tested the acceptance, use, and evaluation of this newly developed program and explored its potential effectiveness. METHODS: Longitudinal pre-post study among upper secondary and vocational school students in Switzerland. Within the MobileCoach Alcohol prevention program, a virtual coach motivated participants to deal with alcohol sensitively, and provided feedback on alcohol use and strategies to resist alcohol for a period of 10 weeks. Information was provided in weekly dialogs, within contests with other participants, and interactive challenges. By means of a follow-up survey after the end of the 10-week program, indicators of the use, acceptance, and effectiveness of the program were examined. RESULTS: Between October 2020 and July 2022, the program was advertised in upper secondary and vocational schools. Recruiting schools and school classes was difficult due to the COVID-19 containment measures in place during this period. Nevertheless, the program could be implemented in 61 upper secondary and vocational school classes with a total of 954 participating students. Three out of four students who were present in the school classes participated in the MobileCoach Alcohol program and the associated study. Online follow up assessment at week 10 was completed by 272 program participants (28.4%). Based on program use and evaluations by the participants, the overall acceptance of the intervention was good. The proportion of students who engaged in binge drinking was significantly reduced from 32.7% at baseline to 24.3% at follow up. Furthermore, the longitudinal analyses revealed decreases in the maximum number of alcoholic drinks consumed on an occasion and the mean number of standard drinks per month, whereas self-efficacy to resist alcohol increased between baseline and follow up. CONCLUSIONS: The mobile app-based MobileCoach Alcohol program proved to be an attractive intervention, in which the majority of students were interested when proactively recruited at school classes. It allows for individualized coaching in large groups of adolescents and young adults and is promising for reducing at-risk alcohol use.

Efficacy of a Mobile App-Based Coaching Program for Addiction Prevention among Apprentices: A Cluster-Randomized Controlled Trial.

BACKGROUND: Addictive behaviors such as tobacco/e-cigarette smoking, at-risk alcohol consumption, cannabis use or compulsive internet use are common among apprentices. ready4life is a mobile app-based preventive intervention program for apprentices that promotes life skills and reduces risky behavior. The present study tested the efficacy of ready4life for addiction prevention among apprentices in Switzerland within a controlled trial. METHODS: Two-arm, cluster-randomized controlled trial including assessments at baseline and follow-up after 6 months. Participants of the intervention group received coaching by a conversational agent for 16 weeks. The main outcome measure was a composite score for addictive behaviors, which included (1) at-risk drinking, (2) tobacco/e-cigarette smoking, (3) cannabis use and (4) problematic internet use. RESULTS: A total of 2275 students from 159 vocational school classes in Switzerland, were invited for study participation. Of these, 1351 (59.4%) students with a mean age of 17.3 years and a male proportion of 56.6% provided informed consent to participate. The follow up assessment at month 6 was completed by 962 (71.2%) study participants. The results concerning the primary outcome showed a stronger decrease of addictive behaviors between baseline and follow up in the intervention group compared to the control group. In particular, significant effects were observed for at-risk drinking and problematic Internet use, while no significant effects were observed for tobacco/e-cigarette smoking and cannabis use. CONCLUSIONS: The majority of apprentices invited for program participation within vocational schools participated in the ready4life program for addiction prevention. The mobile app-based coaching was effective in reducing risk behaviors such as at-risk drinking and problematic Internet use in a group of adolescents who have an especially high risk of engaging in addictive activities.

Longer-Term Efficacy of a Digital Life-Skills Training for Substance Use Prevention.

INTRODUCTION: The main objective of this study was to test the longer-term and differential efficacy of a mobile phone‒based life-skills training program designed to prevent substance use among adolescents. STUDY DESIGN: A 2-arm, parallel-group, cluster RCT with assessments at baseline and follow-up after 6 and 18 months was conducted. The efficacy of the intervention was compared with that of an assessment-only control condition. SETTING/PARTICIPANTS: A total of 1,473 students with a mean age of 15.4 years were recruited in 2019/2020 within 89 Swiss secondary and upper secondary school classes. INTERVENTION: The automated intervention program included online feedback and individually tailored text messages provided over 22 weeks. The contents were based on social cognitive theory and addressed self-management, social, and substance use resistance skills. MAIN OUTCOME MEASURES: Primary outcomes included 30-day prevalence rates for problem drinking and tobacco use. RESULTS: The 18-month follow-up assessments were completed by 1,232 study (83.6%) participants. Those in the intervention group reported lower tobacco-smoking prevalence than the controls (OR=0.67; 95% CI=0.47, 0.96), but no significant difference in problem drinking (OR=0.84; 95% CI=0.61, 1.17) was observed. Among secondary outcomes, the intervention was effective at reducing cannabis-smoking prevalence (OR=0.55; 95% CI=0.39, 0.76) and cannabis use days (Cohen's d= -0.19; 95% CI= -0.29, -0.09), whereas no effects were observed for quantity of alcohol use, quantity of cigarettes smoked, well-being, or social skills. No significant moderators of the primary outcomes were observed. CONCLUSIONS: An automated mobile phone‒based life-skills training program produced longer-term effectiveness in preventing tobacco smoking and cannabis use, whereas no effects were observed for problem drinking. These results suggest that digitally delivered life-skills training programs are similarly effective and are an easy-to-implement alternative to training conducted within a school curriculum. TRIAL REGISTRATION: This study is registered at ISRCTN41347061 (registration date: 21/07/2018).

Engagement With a Mobile Phone-Based Life Skills Intervention for Adolescents and Its Association With Participant Characteristics and Outcomes: Tree-Based Analysis.

BACKGROUND: Mobile phone-delivered life skills programs are an emerging and promising way to promote mental health and prevent substance use among adolescents, but little is known about how adolescents actually use them. OBJECTIVE: The aim of this study is to determine engagement with a mobile phone-based life skills program and its different components, as well as the associations of engagement with adolescent characteristics and intended substance use and mental health outcomes. METHODS: We performed secondary data analysis on data from the intervention group (n=750) from a study that compared a mobile phone-based life skills intervention for adolescents recruited in secondary and upper secondary school classes with an assessment-only control group. Throughout the 6-month intervention, participants received 1 SMS text message prompt per week that introduced a life skills topic or encouraged participation in a quiz or individual life skills training or stimulated sharing messages with other program participants through a friendly contest. Decision trees were used to identify predictors of engagement (use and subjective experience). The stability of these decision trees was assessed using a resampling method and by graphical representation. Finally, associations between engagement and intended substance use and mental health outcomes were examined using logistic and linear regression analyses. RESULTS: The adolescents took part in half of the 50 interactions (mean 23.6, SD 15.9) prompted by the program, with SMS text messages being the most used and contests being the least used components. Adolescents who did not drink in a problematic manner and attended an upper secondary school were the ones to use the program the most. Regarding associations between engagement and intended outcomes, adolescents who used the contests more frequently were more likely to be nonsmokers at follow-up than those who did not (odds ratio 0.86, 95% CI 0.76-0.98; P=.02). In addition, adolescents who read the SMS text messages more attentively were less likely to drink in a problematic manner at follow-up (odds ratio 0.43, 95% CI 1.29-3.41; P=.003). Finally, participants who used the program the most and least were more likely to increase their well-being from baseline to 6-month follow-up compared with those with average engagement (ßs=.39; t586=2.66; P=.008; R2=0.24). CONCLUSIONS: Most of the adolescents participating in a digital life skills program that aimed to prevent substance use and promote mental health engaged with the intervention. However, measures to increase engagement in problem drinkers should be considered. Furthermore, efforts must be made to ensure that interventions are engaging and powerful across different educational levels. First results indicate that higher engagement with digital life skills programs could be associated with intended outcomes. Future studies should apply further measures to improve the reach of lower-engaged participants at follow-up to establish such associations with certainty.

Changes in attitudes towards smoking during smoking cessation courses for Turkish- and Albanian-speaking migrants in Switzerland and its association with smoking behavior: A latent change score approach.

Introduction: Migrant populations usually report higher smoking rates than locals. At the same time, people with a migration background have little or no access to regular smoking cessation treatment. In the last two decades, regular smoking cessation courses were adapted to reach out to Turkish- and Albanian-speaking migrants living in Switzerland. The main aims of the current study were (1) to analyze the effects of an adapted smoking cessation course for Turkish- and Albanian-speaking migrants in Switzerland on attitudes toward smoking and smoking behavior; and (2) to elucidate whether changes in attitudes toward smoking were associated to changes in smoking behavior in the short- and in the long-term. Methods: A total of 59 smoking cessation courses (Turkish: 37; Albanian: 22) with 436 participants (T: 268; A: 168) held between 2014 and 2019 were evaluated. Attitudes toward smoking and cigarettes smoked per day were assessed at baseline and 3-months follow-up. One-year follow-up calls included assessment of cigarettes smoked per day. Data were analyzed by means of structural equation modeling with latent change scores. Results: Participation in an adapted smoking cessation course led to a decrease of positive attitudes toward smoking (T: ß = -0.65, p < 0.001; A: ß = -0.68, p < 0.001) and a decrease of cigarettes smoked per day in the short-term (T: ß = -0.58, p < 0.001; A: ß = -0.43, p < 0.001) with only Turkish-speaking migrants further reducing their smoking in the long-term (T: ß = -0.59, p < 0.001; A: ß = -0.14, p = 0.57). Greater decreases in positive attitudes were associated with greater reductions of smoking in the short-term (T: r = 0.39, p < 0.001; A: r = 0.32, p = 0.03), but not in the long-term (T: r = -0.01, p = 0.88; A: r = -0.001, p = 0.99). Conclusion: The adapted smoking cessation courses fostered changes in positive attitudes toward smoking that were associated with intended behavior change in the short-term. The importance of socio-cognitive characteristics related to behavior change maintenance to further increase treatment effectiveness in the long-term is discussed.

A Mobile Phone-Based Life-Skills Training Program for Substance Use Prevention Among Adolescents: Cluster-Randomized Controlled Trial.

BACKGROUND: Life skills are abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life. Life-skills training programs conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones may provide a more economic and scalable approach. OBJECTIVE: The goal of this study was to test the appropriateness (ie, acceptance, use, and evaluation) and short-term efficacy of a mobile phone-based life-skills training program to prevent substance use among adolescents within a controlled trial. METHODS: The study design was a two-arm, parallel-group, cluster-randomized controlled trial with assessments at baseline and follow-up assessments after 6 and 18 months. This report includes outcomes measured up to the 6-month follow-up. The efficacy of the intervention was tested in comparison to an assessment-only control group. The automated intervention program SmartCoach included online feedback and individually tailored text messages provided over 22 weeks. The contents were based on social cognitive theory and addressed self-management skills, social skills, and substance use resistance skills. Linear mixed models and generalized linear mixed models, as well as logistic or linear regressions, were used to investigate changes between baseline and 6-month follow-up in the following outcomes: 30-day prevalence rates of problem drinking, tobacco use, and cannabis use as well as quantity of alcohol use, quantity of cigarettes smoked, cannabis use days, perceived stress, well-being, and social skills. RESULTS: A total of 1759 students from 89 Swiss secondary and upper secondary school classes were invited to participate in the study. Of these, 1473 (83.7%) students participated in the study; the mean age was 15.4 years (SD 1.0) and 55.2% (813/1473) were female. Follow-up assessments at 6 months were completed by 1233 (83.7%) study participants. On average, program participants responded to half (23.6 out of 50) of the prompted activities. Program evaluations underlined its appropriateness for the target group of secondary school students, with the majority rating the program as helpful and individually tailored. The results concerning the initial effectiveness of this program based on 6-month follow-up data are promising, with three of nine outcomes of the intention-to-treat analyses showing beneficial developments of statistical significance (ie, quantity of alcohol use, quantity of tobacco use, and perceived stress; P<.05) and another three outcomes (ie, problem drinking prevalence, cannabis use days, and social skills) showing beneficial developments of borderline significance (P<.10). CONCLUSIONS: The results showed good acceptance of this intervention program that could be easily and economically implemented in school classes. Initial results on program efficacy indicate that it might be effective in both preventing or reducing substance use and fostering life skills; however, data from the final 18-month follow-up assessments will be more conclusive. TRIAL REGISTRATION: ISRCTN Registry ISRCTN41347061; https://doi.org/10.1186/ISRCTN41347061.

An adapted smoking-cessation intervention for Turkish-speaking migrants in Switzerland: Predictors of smoking outcomes at one-year follow-up.

BACKGROUND: Migrant populations usually report higher smoking rates. Among those migrant populations, Turkish- and Kurdish-speaking migrants are often overrepresented. Providing equal access to health services is one of the major challenges of our time. The need for adapted smoking-cessation treatments for Turkish-speaking populations to achieve equity in health led, in 2006, to the development and implementation of the Tiryaki-Kukla smoking-cessation program. The aims of the current study were to evaluate one-year quit rates for smoking-cessation courses held from 2006-2018 and investigate whether certain characteristics predict long-term smoking cessation or reduction. METHODS: Program evaluation included a pre/post questionnaire (session 1/ 3 months after the quit day) and a follow-up telephone call twelve months after the quit day. To elucidate factors associated with long-term smoking cessation and reduction, Cox regression analysis and Weighted Generalized Equation Models were used. RESULTS: Of the 478 who participated in smoking-cessation courses, 45.4% declared themselves non-smokers at one-year follow-up. This quit rate is higher than that achieved during the preliminary evaluation of the program involving 61 participants (37.7%). Predictors of long-term smoking cessation were course length (eight vs. six sessions) (95% CI = 1.04-1.36, p = .01), adherence to the course (95% CI = 0.98-0.99, p<0.01), use of pharmacotherapy or nicotine replacement therapy products (95% CI = 0.74-0.98, p = .02), and time passed in the morning until the first cigarette is smoked (95% CI5min = 1.17-1.77, p<0.001; 95% CI30min = 1.09-1.65, p<0.01). Predictors of change in cigarettes smoked per day among smokers were-the time passed until the first cigarette in the morning (5min p < .001; 30min p < .001; 60min p < .01)-, gender (p < .001), and level of motivation to quit at baseline (p = .04). CONCLUSIONS: Our findings are consistent with existing evidence supporting adapted smoking cessation interventions to reduce health inequity in migrant populations. However, achieving harm reduction in smokers with higher dependence scores remains challenging.

Stigmatizing attitudes of Swiss youth towards peers with mental disorders.

BACKGROUND: Previous research on public stigma towards people with mental disorders has mostly targeted adult samples and focused on depression, schizophrenia or mental disorders in general. Hence, the present study aimed to investigate predictors of stigmatizing attitudes towards different mental disorders (including less researched ones) in a representative sample of adolescents and young adults. METHODS: Data from the Swiss Youth Mental Health Literacy and Stigma Survey were used (analytical sample: n = 4,932). Each participant was randomly presented with one of five vignettes (depression; alcohol abuse; depression and alcohol abuse combined; schizophrenia; social anxiety). The structure of stigmatizing attitudes was assessed using confirmatory factor analysis. Regression models, implemented within a structural equation framework, were used to study predictors for the identified latent variables. RESULTS: A three-factor model for stigmatizing attitudes-consisting of 'dangerous/unpredictable', 'weak-no-sick', and 'social distance' factors-best fitted the data. Female gender was associated with less stigmatizing attitudes. Associations in opposite directions with different latent factors were found for educational and migration background. Exposure to mental disorders (being personally affected, personally having received professional help or knowing someone close who has received treatment for a mental disorder) was either not or was negatively associated with stigmatizing attitudes. In contrast, current mental health symptoms (heightened levels of psychological distress, problematic alcohol use) were generally not or were positively associated with stigmatizing attitudes. Even though the included predictors had some predictive value, the variance explained by the models was rather small (the adjusted R2 varied between 0.03 and 0.26). CONCLUSIONS: The current study indicates that contact with someone who has received treatment for a mental disorder might be an important component of programs aiming to decrease stigmatizing attitudes towards people with mental disorders, since this exposure variable predicted lower levels of stigmatizing attitudes. Furthermore, the findings suggest that target-group interventions for specific subgroups need to be considered, as the process leading to stigmatizing attitudes towards people with mental disorders appears to differ between specific sociodemographic subgroups.

Assessment of the Efficacy of a Mobile Phone-Delivered Just-in-Time Planning Intervention to Reduce Alcohol Use in Adolescents: Randomized Controlled Crossover Trial.

BACKGROUND: Interventions to reduce alcohol use typically include several elements, such as information on the risks of alcohol consumption, planning for sensible drinking, and training of protective behavioral strategies. However, the effectiveness of these individual intervention elements within comprehensive programs has not been addressed so far, but it could provide valuable insights for the development of future interventions. Just-in-time interventions provided via mobile devices are intended to help people make healthy decisions in the moment and thus could influence health behavior. OBJECTIVE: The aim of this study was to test the proximal effects of a mobile phone-delivered, just-in-time planning intervention to reduce alcohol use in adolescents who reported recent binge drinking. The efficacy of this individual intervention element was tested within a comprehensive intervention program to reduce problem drinking in adolescents. METHODS: The study had an AB/BA crossover design, in which participants were randomly allocated to (1) a group receiving the planning intervention (A) in period 1 and assessment only (B) in period 2 or (2) a group receiving assessment only (B) in period 1 and the planning intervention (A) in period 2. The planning intervention included a text message to choose one of two predetermined if-then plans to practice sensible drinking with friends or when going out and a prompt to visualize the chosen plan. There was a washout period of at least 1 week between period 1 and period 2. RESULTS: Out of 633 program participants who recently binge drank, 136 (21.5%) were receptive in both periods of time and provided data on the proximal outcome, which was the number of alcoholic drinks consumed with friends or when going out. After the planning intervention, the number of alcoholic drinks consumed was approximately one standard drink lower compared with the finding without the intervention (P=.01). CONCLUSIONS: A mobile phone-delivered, just-in-time, if-then planning intervention to practice sensible drinking with friends or when going out is effective in reducing alcohol consumption among adolescents who report recent binge drinking. Based on the relatively low percentage of participants with self-reported receptivity for the planning intervention, measures to increase the population impact of similar planning interventions should be implemented and tested in future trials. TRIAL REGISTRATION: ISRCTN Registry ISRCTN52150713; http://www.isrctn.com/ISRCTN52150713.

A Digital Intervention Addressing Alcohol Use Problems (the "Daybreak" Program): Quasi-Experimental Randomized Controlled Trial.

BACKGROUND: Alcohol use is prevalent in many societies and has major adverse impacts on health, but the availability of effective interventions limits treatment options for those who want assistance in changing their patterns of alcohol use. OBJECTIVE: This study evaluated the new Daybreak program, which is accessible via mobile app and desktop and was developed by Hello Sunday Morning to support high-risk drinking individuals looking to change their relationship with alcohol. In particular, we compared the effect of adding online coaching via real-time chat messages (intervention group) to an otherwise self-guided program (control group). METHODS: We designed the intervention as a randomized control trial, but as some people (n=48; 11.9%) in the control group were able to use the online coaching, the main analysis comprised all participants. We collected online surveys at one-month and three-months follow-up. The primary outcome was change in alcohol risk (measured with the alcohol use disorders identification test-consumption [AUDIT-C] score), but other outcomes included the number of standard drinks per week, alcohol-related days out of role, psychological distress (Kessler-10), and quality of life (EUROHIS-QOL). Markers of engagement with the program included posts to the site and comments on the posts of others. The primary analysis used Weighted Generalized Estimating Equations. RESULTS: We recruited 398 people to the intervention group (50.2%) and 395 people to the control group (49.8%). Most were female (71%) and the mean age was 40.1 years. Most participants were classified as probably dependent (550, 69%) on the AUDIT-10, with 243 (31%) classified with hazardous or harmful consumption. We followed up with 334 (42.1%) participants at one month and 293 (36.9%) at three months. By three months there were significant improvements in AUDIT-C scores (down from mean 9.1 [SD 1.9] to 5.8 [SD 3.1]), alcohol consumed per week (down from mean 37.1 [SD 28.3] to mean 17.5 [SD 18.9]), days out of role (down from mean 1.6 [SD 3.6] to 0.5 [SD 1.6]), quality of life (up from 3.2 [SD 0.7] to 3.6 [SD 0.7]) and reduced distress (down from 24.8 [SD 7.0] to 19.0 [SD 6.6]). Accessing online coaching was not associated with improved outcomes, but engagement with the program (eg, posts and comments on the posts of others) were significantly associated with improvements (eg, in AUDIT-C, alcohol use and EUROHIS-QOL). Reduced alcohol use was found for both probably dependent (estimated marginal mean of 40.8 to 20.1 drinks) and hazardous or harmful alcohol users (estimated marginal mean of 22.9 to 11.9 drinks). CONCLUSIONS: Clinically significant reductions in alcohol use were found, as well as reduced alcohol risk (AUDIT-C) and days out of role. Importantly, improved alcohol-related outcomes were found for both hazardous or harmful and probably dependent drinkers. Since October 2016, Daybreak has reached more than 50,000 participants. Therefore, there is the potential for the program to have an impact on alcohol-related problems at a population health level, importantly including an effect on probably dependent drinkers. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/9982.

Efficacy of a mobile phone-based life-skills training program for substance use prevention among adolescents: study protocol of a cluster-randomised controlled trial.

BACKGROUND: Life-skills trainings conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones might represent a more economic and scalable approach. The main objective of the planned study is to test the efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents within a controlled trial. METHODS/DESIGN: The efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents will be tested in comparison to an assessment only control group, within a cluster-randomised controlled trial with two follow-up assessments after 6 and 18 months. The fully automated program is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Participants of the intervention group will receive up to 4 weekly text messages over 6 months in order to stimulate (1) positive outcome expectations, e.g., on using self-management skills to cope with stress, (2) self-efficacy, e.g., to resist social pressure, (3) observational learning, e.g. of interpersonal competences, (4) facilitation, e.g., of strategies to cope with negative emotions, and (5) self-regulation, e.g., by self-monitoring of stress and emotions. Active program engagement will be stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition with prizes in which program users collect credits with each interaction. Study participants will be 1312 students between the ages of 14 and 16 years from approximately 100 secondary school classes. Primary outcome criteria will be problem drinking according to the short form of the Alcohol Use Disorders Identification Test and cigarette smoking within the last 30 days preceding the follow-up assessment at month 18. DISCUSSION: This is the first study testing the efficacy of a mobile phone-based life-skills training for substance use prevention among adolescents within a controlled trial. Given that this intervention approach proves to be effective, it could be easily implemented in various settings and would reach large numbers of young people in a cost-effective way. TRIAL REGISTRATION: ISRCTN41347061 (registration date: 21/07/2018).

Efficacy of a web-based intervention with and without guidance for employees with risky drinking: results of a three-arm randomized controlled trial.

AIMS: To test the efficacy of a web-based alcohol intervention with and without guidance. DESIGN: Three parallel groups with primary end-point after 6 weeks. SETTING: Open recruitment in the German working population. PARTICIPANTS: Adults (178 males/256 females, mean age 47 years) consuming at least 21/14 weekly standard units of alcohol (SUA) and scoring ≥ 8/6 on the Alcohol Use Disorders Identification Test. INTERVENTION: Five web-based modules including personalized normative feedback, motivational interviewing, goal setting, problem-solving and emotion regulation during 5 weeks. One intervention group received an unguided self-help version (n=146) and the second received additional adherence-focused guidance by eCoaches (n=144). Controls were on a waiting list with full access to usual care (n=144). MEASUREMENTS: Primary outcome was weekly consumed SUA after 6 weeks. SUA after 6 months was examined as secondary outcome, next to numbers of participants drinking within the low-risk range, and general and work-specific mental health measures. FINDINGS: All groups showed reductions of mean weekly SUA after 6 weeks (unguided: -8.0; guided: -8.5; control: -3.2). There was no significant difference between the unguided and guided intervention (P=0.324). Participants in the combined intervention group reported significantly fewer SUA than controls [B=-4.85, 95% confidence interval (CI)=-7.02 to -2.68, P < 0.001]. The intervention groups also showed significant reductions in SUA consumption after 6 months (B=-5.72, 95% CI=-7.71 to -3.73, P < 0.001) and improvements regarding general and work-related mental health outcomes after 6 weeks and 6 months. CONCLUSIONS: A web-based alcohol intervention, administered with or without personal guidance, significantly reduced mean weekly alcohol consumption and improved mental health and work-related outcomes in the German working population.

Engagement Within a Mobile Phone-Based Smoking Cessation Intervention for Adolescents and its Association With Participant Characteristics and Outcomes.

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

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

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

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

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

Efficacy of a web- and text messaging-based intervention to reduce problem drinking in adolescents: Results of a cluster-randomized controlled trial.

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