%0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e68814 %T Adolescents’ and Parents’ Perspectives on Using the MedSMARxT Families Intervention in Emergency Departments for Opioid Medication Safety Education: Mixed Methods Study %A Abraham,Olufunmilola %A Nadi,Sara %A Hurst,Irene %K opioid medication safety %K family medication safety %K educational intervention %K serious games %K emergency department %K MedSMA℞T %K MedSMARxT %D 2025 %7 26.6.2025 %9 %J JMIR Serious Games %G English %X Background: The opioid crisis has significantly impacted adolescents and their families. This is attributed in part to increased opioid prescriptions in pediatric emergency departments (EDs) due to acute pain conditions and injuries. Although EDs frequently prescribe opioids, no effective preventative interventions have been implemented to educate adolescents and their families on safe opioid use. This study evaluates the MedSMA℞T Families intervention, which consists of an engaging serious game, Adventures in PharmaCity, and a personalized Family Medication Safety Plan (FMSP) with the aim of reducing opioid misuse and promoting opioid medication safety. The MedSMA℞T Families intervention was developed to educate adolescents and adults prescribed opioids on safe practices such as opioid storage and disposal. Objective: This study aimed to explore and characterize adolescents’ and parents’ experiences and perspectives on implementing the MedSMA℞T Families intervention in the ED to improve opioid education and safety among adolescents. Methods: A total of 93 participants, including 16 children and 77 parents, were recruited from the pediatric ED at a tertiary academic hospital to play the MedSMA℞T game in the ED. A total of 16 participants, including 8 children and 8 parents, were followed up with interviews to gather qualitative feedback. Participants engaged with the MedSMA℞T game—Adventures in PharmaCity—and the FMSP. Data were collected through gameplay observation and 75-minute semistructured interviews via Zoom. Quantitative in-game data were analyzed using descriptive analysis and qualitative data were analyzed using thematic analysis with NVivo (version 14; Lumivero). Results: Parents spent an average of 22.16 (SD 4.97) minutes playing the game, while children spent an average of 21.99 (SD 8.06) minutes. Families appreciated the game’s design and noted usability challenges and suggested enhancements for clearer gameplay instructions. Participants reported increased knowledge of opioid safety, highlighted the importance of communication with health care providers, and a desire for a mobile app to assist with medication management. The FMSP was perceived as valuable for promoting awareness of safe practices and connected well to the knowledge gained from the game. Conclusions: The MedSMA℞T Families intervention was well received as a beneficial educational tool to educate adolescents and their families on safe opioid use. Additionally, it highlights a clear need for more accessible digital tools to increase opioid education. This feedback indicates a strong interest in improving educational resources to ensure safe opioid management within families. %R 10.2196/68814 %U https://games.jmir.org/2025/1/e68814 %U https://doi.org/10.2196/68814 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e72631 %T Reducing Heavy Drinking Through the “Sober Curious” Movement in Australia: Protocol for a Mixed Methods Study %A Ward,Paul Russell %A Savic,Michael %A MacLean,Sarah %A Lunnay,Belinda %A Lyons,Antonia %A Hughes,Tonda %A London,Kerry %A Caluzzi,Gabriel %A Pettigrew,Simone %A Pennay,Amy %A Meyer,Samantha %A Duncan,Tristan %A Lee,Nicole %+ Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, 88 Wakefield Street, Adelaide, 5001, Australia, 61 434187054, paul.ward@torrens.edu.au %K alcohol reduction %K sober curiosity %K public health %K co-design %K abstinence, alcohol %K qualitative research %D 2025 %7 10.6.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol consumption is a major public health problem. Its socially engrained nature adds complexity to designing successful reduction approaches. Rather than implementing another intervention, we will undertake a natural experiment on the “sober curious” movement, which gained momentum through social media influencers promoting the idea of reducing alcohol consumption for wellness. We focus on ways to reduce alcohol consumption, through sober curiosity, with 4 heavy-drinking population groups: male construction workers; lesbian, gay, or bisexual women; hospitality workers; and tertiary education students. Objective: Aim 1 analyzes the sober curious movement from the “supply side” using qualitative interviews with sober curious stakeholders and a citizen science study of social media content with the 4 case study groups. We will also undertake citizen science and social media studies with a representative sample of the population. Aim 2 examines the sober curious movement from the “demand side” using qualitative interviews with the 4 case study groups to investigate their knowledge and attitudes toward sober curiosity. We will also undertake a representative national survey and ethnography with a representative sample of the population. For aim 3, we will develop evidence-based interventions leveraging sober curiosity and using citizens’ juries, industry symposia, and policy symposia to develop feasible public health measures and options tailored to the needs of the 4 case study groups. Methods: The project involves 3 stages. Stage 1 will examine the supply side of alcohol-free products. A social media analysis of marketing by alcohol-free producers and distributors will generate an understanding of their techniques and population groups they target. In-depth interviews with producers will create evidence on the intentions behind making alcohol-free products available, their target market, and if and how they balance providing nonalcoholic products alongside alcohol. Stage 2 will be a qualitative study with 4 case study groups with high alcohol consumption: male construction workers; lesbian, gay, or bisexual women; hospitality workers; and tertiary education students. This stage will provide a deep understanding of the reasons for alcohol consumption, potential for alcohol-free product use, and possible interventions to sustainably reduce consumption. Stage 3 will involve deliberative symposia with non-alcoholic beverage producers and distributors, representatives from our case study groups, public health professionals, and policy makers to develop co-designed interventions for alcohol reduction. Results: This 3-year research protocol was funded by the Australian National Health and Medical Research Council via their Ideas Grants funding scheme (grant ID GNT2038211). The study will commence in July 2025. Human Research Ethics Committee approval has been granted. Conclusions: Our study will provide a template for interventions designed to enable reduced drinking within heavy-drinking social worlds with huge potential for scalability of knowledge, expanding the economic, environmental, social, and cultural benefits within and across Australia and internationally. International Registered Report Identifier (IRRID): PRR1-10.2196/72631 %M 40493391 %R 10.2196/72631 %U https://www.researchprotocols.org/2025/1/e72631 %U https://doi.org/10.2196/72631 %U http://www.ncbi.nlm.nih.gov/pubmed/40493391 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59085 %T Impact of Computer-Mediated Versus Face-to-Face Motivational-Type Interviews on Participants’ Language and Subsequent Cannabis Use: Randomized Controlled Trial %A Llanes,Karla D %A Amastae,Jon %A Amrhein,Paul C %A Lisha,Nadra %A Arteaga,Katherina %A Lopez,Eugene %A Moran,Roberto A %A Cohn,Lawrence D %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Ave., Suite 366, San Francisco, CA, 94143, United States, 1 415 476 0140, Karla.llanes@ucsf.edu %K motivational interviews %K computer-mediated %K commitment language %K change talk %K sustain talk %K marijuana use %K cannabis use %K behavior change %K randomized study %K young adults %K marijuana users %K substance use %D 2025 %7 25.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Motivational interviewing (MI) is frequently used to facilitate behavior change. The use of change talk during motivational interviews can predict subsequent behavior change. However, no studies have compared the information obtained from traditional face-to-face motivational interviews and computer-mediated motivational interviews or resulted in the same amount of behavior change. Objective: This study aimed to investigate if face-to-face motivational-type interviews (MTIs) and computer-mediated MTIs elicit the same amount of “change talk” and behavior change when young adults discuss their ambivalence about using marijuana. Methods: A total of 150 users, including frequent marijuana users, occasional marijuana users, and non–marijuana users, participated in the study. All participants reported being at least moderately ambivalent about their current level of marijuana use. Participants were randomly assigned to complete a brief MTI using either the standard face-to-face format or a computer-mediated format. Amrhein’s manual for assessing the presence of “change talk” and “sustain talk” was used to code the language produced by respondents in each interview format. A reduction in marijuana use was assessed at a 2-month follow-up. Results: The word count was significantly higher in face-to-face MTIs compared with computer-mediated MTIs (P<.001). After controlling for verbosity, face-to-face MTIs, and computer-mediated MTIs did not differ statistically in the overall amount of change talk (P=.47) and sustain talk (P=.05). Face-to-face MTIs elicited significantly more reasons for reducing future marijuana use (ie, change talk; P=.02) and readiness toward not using marijuana (ie, change talk; P=.009), even after controlling for verbosity. However, these differences were not statistically significant after using a conservative Bonferroni correction (P<.004). After controlling for marijuana use at Time 1, the relationship between the strength of commitment language at Time 1 and marijuana use at Time 2 was not statistically significant (semipartial correlation r=0.03, P=.57). The association between Time 1 change talk and Time 2 marijuana use depended on the type of motivational interview that participants experienced: face-to-face MTI versus computer-mediated MTI (B=0.45, P=.01). A negative binomial regression with a log link function was used to probe this relationship after controlling for 2 covariates: gender and Time 1 (baseline assessment) marijuana use. Among participants in the face-to-face MTI condition, Time 2 (follow-up) marijuana use decreased as the strength of Time 1 change talk increased, although this finding was not significant (B=–0.21, P=.08). However, among participants in the computer-mediated MTI condition, Time 2 marijuana use was not significantly related to the strength of Time 1 change talk (B=0.13, P=.16). Conclusions: Computer-mediated MTIs and face-to-face MTIs elicit both change talk and sustain talk, which suggests that motivational interviews could potentially be adapted for delivery via text-based computer platforms. However, further research is needed to enhance the predictive validity of the type of language obtained via computer-delivered MI. Trial Registration: ClinicalTrials.gov NCT06945471; https://clinicaltrials.gov/study/NCT06945471 %M 40279644 %R 10.2196/59085 %U https://www.jmir.org/2025/1/e59085 %U https://doi.org/10.2196/59085 %U http://www.ncbi.nlm.nih.gov/pubmed/40279644 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67637 %T Evaluating the Acceptability of a Brief Web-Based Alcohol Misuse Prevention Program Among US Military Cadets: Mixed Methods Formative Evaluation %A Schmied,Emily %A Hurtado,Lauren %A Robinson,W Ken %A Simon-Arndt,Cynthia M %A Moyer III,Richard %A Wilson,Leslie %A Reed,Mark %A Blakey,Shannon M %A Kan,Marni %K alcohol misuse prevention %K digital interventions %K formative research %K military health %K acceptability %K alcohol prevention %K US military %K military %K United States %K formative evaluation %K alcohol use %K evidence-based prevention %K alcohol intervention %K mixed methods study %K survey %K alcohol use disorder %K alcohol misuse %K heavy drinker %K educational web-based intervention %K web-based intervention %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: As alcohol misuse remains pervasive within the military, evidence-based prevention programs that are feasible to implement and appropriately tailored to meet the needs and norms of military personnel are critically needed. Further, programs that target future military leaders, such as trainees, recruits, and cadets, may be especially impactful. eCHECKUP TO GO is a web-based, evidence-based brief alcohol intervention designed to reduce alcohol misuse through education and personalized feedback that may be suitable for military trainees. However, because it was developed for civilian students, efforts to adapt the content for military settings are needed. Objective: This study aimed to evaluate the acceptability of a military version of eCHECKUP TO GO, tailored to include military-specific terminology and alcohol use statistics. Methods: US Air Force Academy cadets were recruited to participate in a single-arm, mixed methods study. Following the completion of eCHECKUP TO GO, participants completed a survey that assessed satisfaction with specific aspects of the user experience, including ease of use, design, and relevance of the information and personalized feedback (range: 1=strongly disagree to 7=strongly agree). A subset of cadets also participated in a focus group to expound on the survey responses. Results: Survey participants included 22 cadets (n=12, 55% male; mean age 19.6, SD 1.8 years). In addition, 6 (27%) cadets participated in the focus group. Participants were satisfied with the program overall (mean 5.8, SD 0.9) and gave the highest ratings to ease of use (mean 6.6, SD 0.7), site design (mean 6.5, SD 0.6), and site interactivity (mean 6.4, SD 1.0). Items pertaining to tailoring, relevance, and amount of content specific to cadets scored lowest (mean 5.8, SD 1.4; mean 5.6, SD 1.4; and mean 5.5, SD 1.5, respectively). Most (n=15, 68%) participants said they would act upon the information they were provided. Focus group participants made suggestions for improved tailoring, such as increasing content on social aspects of drinking and military-specific risks of alcohol misuse (eg, Uniform Code of Military Justice violations). Conclusions: Although the acceptability of eCHECKUP TO GO was high, continued efforts are needed to ensure the content accurately reflects the experiences of cadets. Researchers who design military health promotion interventions need to consider the varied contexts within the force and rigorously evaluate the acceptability of all content before implementation. %R 10.2196/67637 %U https://formative.jmir.org/2025/1/e67637 %U https://doi.org/10.2196/67637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55621 %T Demographics and Use of an Addiction Helpline for Concerned Significant Others: Observational Study %A Chernick,Rachel %A Sy,Amanda %A Dauber,Sarah %A Vuolo,Lindsey %A Allen,Bennett %A Muench,Fred %+ Partnership to End Addiction, 711 Third Avenue, Fifth Floor, New York, NY, 10017, United States, 1 212 973 3526, rchernick@toendaddiction.org %K family %K hotline %K helpline %K warmline %K crisis continuum %K substance abuse %K addiction %K youth %K concerned significant other %K digital behavioral health %K parents %K substance use disorders %K well-being %K public health intervention %K cannabis %K treatment %K opioids %K men %K women %K assessments %D 2025 %7 14.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Concerned significant others (CSOs) play a significant role in supporting individuals with substance use disorders. There is a lack of tailored support services for these CSOs, despite their substantial contributions to the well-being of their loved ones (LOs). The emergence of helplines as a potential avenue for CSO support is outlined, culminating in the focus on the Partnership to End Addiction’s helpline service, an innovative public health intervention aimed at aiding CSOs concerned about an LO’s substance use. Objective: The article analyzes the demographics and use patterns of the Partnership to End Addiction’s helpline service, highlighting the critical role of such services, and advocating for expanded, tailored support models. Methods: This observational study draws data from 8 data platforms spanning April 2011 to December 2021, encompassing 24,096 client records. Surveys were completed by helpline specialists during synchronous telephone calls or self-reported by CSOs before helpline engagement. Collected information encompasses demographics, interaction language, substance of concern, CSO-LO relationship, and the LO’s “use state,” that is, their location on the continuum of substance use. Results: CSOs primarily comprised women (13,980/18,373, 76.1%) seeking support for their children (1062/1542, 68.9%). LOs were mostly male (1090/1738, 62.7%), aged 18-25 years (2380/7208, 33%), with primary substance concerns being cannabis (5266/12,817, 40.9%), opioids (2445/12,817, 19%), and stimulants (1563/12,817, 12.1%). CSOs primarily sought aid for LOs struggling with substances who were not in treatment (1102/1753, 62.9%). The majority of CSOs were looking for support in English (14,738/17,920, 82.2%), while the rest (3182/17,920, 17.8%) preferred to communicate in Spanish. Spanish-speaking CSOs were significantly more likely to call about cannabis (n=963, 53.7% vs n=4026, 38.6%) and stimulants (n=304, 16.9% vs n=1185, 11.3%) than English-speaking CSOs (P<.001). On the other hand, English-speaking CSOs were more likely to be concerned about opioids than Spanish-speaking CSOs (n=2215, 21.3% vs n=94, 5.2%; P<.001). Conclusions: The study illuminates the helpline’s pioneering role in aiding CSOs grappling with an LO’s substance use. It highlights helplines as crucial resources for CSOs, revealing key demographic, substance-related, and use-state trends. The dominant presence of women among users aligns with other helpline patterns and reflects traditional caregiving roles. While parents form a significant percentage of those reaching out, support is also sought by siblings, friends, and other family members, emphasizing the need for assistance for other members of an LO’s social network. Spanish-speaking individuals’ significant outreach underscores the necessity for bilingual support services. Substance concerns revolve around cannabis, opioids, and stimulants, influenced by age and language preferences. The helpline serves as an essential intermediary for CSOs, filling a gap between acute crisis intervention services and formalized health care and treatment services. Overall, the study highlights this helpline’s crucial role in aiding CSOs with tailored, accessible support services. %M 40228240 %R 10.2196/55621 %U https://www.jmir.org/2025/1/e55621 %U https://doi.org/10.2196/55621 %U http://www.ncbi.nlm.nih.gov/pubmed/40228240 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e69873 %T A Novel Just-in-Time Intervention for Promoting Safer Drinking Among College Students: App Testing Across 2 Independent Pre-Post Trials %A Chow,Philip I %A Smith,Jessica %A Saini,Ravjot %A Frederick,Christina %A Clark,Connie %A Ritterband,Maxwell %A Halbert,Jennifer P %A Cheney,Kathryn %A Daniel,Katharine E %A Ingersoll,Karen S %K alcohol %K college students %K smartphone intervention %K binge drinking %K safe drinking %D 2025 %7 10.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Binge drinking, which is linked to various immediate and long-term negative outcomes, is highly prevalent among US college students. Behavioral interventions delivered via mobile phones have a strong potential to help decrease the hazardous effects of binge drinking by promoting safer drinking behaviors. Objective: This study aims to evaluate the preliminary efficacy of bhoos, a novel smartphone app designed to promote safer drinking behaviors among US college students. The app offers on-demand educational content about safer alcohol use, provides dynamic feedback as users log their alcohol consumption, and includes an interactive drink tracker that estimates blood alcohol content in real time. Methods: The bhoos app was tested in 2 independent pre-post studies each lasting 4 weeks, among US college students aged 18‐35 years. The primary outcome in both trials was students’ self-reported confidence in using protective behavioral strategies related to drinking, with self-reported frequency of alcohol consumption over the past month examined as a secondary outcome. Results: In study 1, bhoos was associated with increased confidence in using protective behavioral strategies. Students also endorsed the high usability of the app and reported acceptable levels of engagement. Study 2 replicated findings of increased confidence in using protective behavioral strategies, and demonstrated a reduction in the self-reported frequency of alcohol consumption. Conclusions: Bhoos is a personalized, accessible, and highly scalable digital intervention with a strong potential to effectively address alcohol-related behaviors on college campuses. %R 10.2196/69873 %U https://humanfactors.jmir.org/2025/1/e69873 %U https://doi.org/10.2196/69873 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e64720 %T The Color of Drinking Survey Questionnaire for Measuring the Secondhand Impacts of High-Risk Drinking in College Settings: Validation Study %A Marconi,Agustina %A Washington,Reonda %A Jovaag,Amanda %A Blomme,Courtney %A Knobeloch,Ashley %A Irazola,Vilma %A Muros Cortés,Carolina %A Gutierrez,Laura %A Elorriaga,Natalia %K validation study %K alcohol drinking in college %K microaggression %K university %K student %K young adult %K undergraduate %K survey %K questionnaire %K reliability %K consistency %D 2025 %7 7.4.2025 %9 %J Interact J Med Res %G English %X Background: The “Color of Drinking” is a study conducted at the University of Wisconsin-Madison. It examines the secondhand harms of high-risk drinking on college students of color and explores the connection between alcohol use and the campus racial climate. Since its findings were released in 2018, this study has received significant attention from other college settings around the country. Objective: This study aims to describe the development of the most recent version of the Color of Drinking questionnaire and to assess its internal consistency, test-retest reliability, and construct validity in a sample of undergraduate students attending the University of Wisconsin-Madison. Methods: This is an observational, analytic study. Questionnaire design experts revised the original instrument, and in-depth cognitive interviews with students were conducted to evaluate comprehensibility and acceptability. The revised questionnaire was administered 2 times, 3 to 4 weeks apart, in a sample of undergraduate students. The following properties were studied: internal consistency in 4 sets of items (Cronbach α), test-retest reliability among closed-ended questions (κ statistics and intraclass correlation coefficient), and construct validity (associations with other validated instruments, such as the Alcohol Use Disorders Identification Test). For a section of questions showing low reliability, the answers to open questions and other in-depth interviews were carried out, and online surveys were conducted with another sample of undergraduate students to evaluate reliability after changes. Results: Eight students participated in the in-depth interviews, 177 responses from the online survey were included for the analysis of internal consistency, 115 for test-retest reliability, and 98 for construct validity. The 4 sets of items (sections) evaluated (“impact of alcohol consumption on academics,” “impact of microaggressions,” “witnessing microaggressions and alcohol intoxication,” and “bystanders’ interventions on alcohol intoxication”) presented good internal consistency (Cronbach α between 0.723 and 0.898). Most items showed moderate to substantial test-retest reliability; agreement was from 68.1% to 95.2%, and κ coefficients ranged from 0.214 to 0.8. For construct validity, correlations between the number of drinking days, the maximum number of drinks in a day and the Alcohol Use Disorders Identification Test score were moderate to high, r=0.630 (95% CI 0.533-0.719) and r=0.647 (95% CI 0.548-0.741), respectively. Due to low reliability, a section regarding “health impacts” has been redesigned, including 8 items for the personal consumption of alcohol and the consumption of others (Cronbach α 0.735 and 0.855, respectively; agreement between the first and the second time the questionnaire was administered were 83.4% and 99.1%, and most of the items with κ coefficient from 0.476 to 0.877). Conclusions: The revised version of the Color of Drinking questionnaire showed acceptable to adequate reliability and construct validity. %R 10.2196/64720 %U https://www.i-jmr.org/2025/1/e64720 %U https://doi.org/10.2196/64720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62805 %T Machine Learning–Based Prediction of Substance Use in Adolescents in Three Independent Worldwide Cohorts: Algorithm Development and Validation Study %A Kim,Soeun %A Kim,Hyejun %A Kim,Seokjun %A Lee,Hojae %A Hammoodi,Ahmed %A Choi,Yujin %A Kim,Hyeon Jin %A Smith,Lee %A Kim,Min Seo %A Fond,Guillaume %A Boyer,Laurent %A Baik,Sung Wook %A Lee,Hayeon %A Park,Jaeyu %A Kwon,Rosie %A Woo,Selin %A Yon,Dong Keon %+ Department of Pediatrics, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 269352476, yonkkang@gmail.com %K adolescents %K machine learning %K substance %K prediction %K XGBoost %K random forest %K ML %K substance use %K adolescents %K adolescent %K South Korea %K United States %K Norway %K web-based survey %K survey %K risk behavior %K smoking %K alcohol %K intervention %K interventions %D 2025 %7 24.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: To address gaps in global understanding of cultural and social variations, this study used a high-performance machine learning (ML) model to predict adolescent substance use across three national datasets. Objective: This study aims to develop a generalizable predictive model for adolescent substance use using multinational datasets and ML. Methods: The study used the Korea Youth Risk Behavior Web-Based Survey (KYRBS) from South Korea (n=1,098,641) to train ML models. For external validation, we used the Youth Risk Behavior Survey (YRBS) from the United States (n=2,511,916) and Norwegian nationwide Ungdata surveys (Ungdata) from Norway (n=700,660). After developing various ML models, we evaluated the final model’s performance using multiple metrics. We also assessed feature importance using traditional methods and further analyzed variable contributions through SHapley Additive exPlanation values. Results: The study used nationwide adolescent datasets for ML model development and validation, analyzing data from 1,098,641 KYRBS adolescents, 2,511,916 YRBS participants, and 700,660 from Ungdata. The XGBoost model was the top performer on the KYRBS, achieving an area under receiver operating characteristic curve (AUROC) score of 80.61% (95% CI 79.63-81.59) and precision of 30.42 (95% CI 28.65-32.16) with detailed analysis on sensitivity of 31.30 (95% CI 29.47-33.20), specificity of 99.16 (95% CI 99.12-99.20), accuracy of 98.36 (95% CI 98.31-98.42), balanced accuracy of 65.23 (95% CI 64.31-66.17), F1-score of 30.85 (95% CI 29.25-32.51), and area under precision-recall curve of 32.14 (95% CI 30.34-33.95). The model achieved an AUROC score of 79.30% and a precision of 68.37% on the YRBS dataset, while in external validation using the Ungdata dataset, it recorded an AUROC score of 76.39% and a precision of 12.74%. Feature importance and SHapley Additive exPlanation value analyses identified smoking status, BMI, suicidal ideation, alcohol consumption, and feelings of sadness and despair as key contributors to the risk of substance use, with smoking status emerging as the most influential factor. Conclusions: Based on multinational datasets from South Korea, the United States, and Norway, this study shows the potential of ML models, particularly the XGBoost model, in predicting adolescent substance use. These findings provide a solid basis for future research exploring additional influencing factors or developing targeted intervention strategies. %M 39993291 %R 10.2196/62805 %U https://www.jmir.org/2025/1/e62805 %U https://doi.org/10.2196/62805 %U http://www.ncbi.nlm.nih.gov/pubmed/39993291 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59338 %T Teenager Substance Use on Reddit: Mixed Methods Computational Analysis of Frames and Emotions %A Zhang,Xinyu %A Zhu,Jianfeng %A Kenne,Deric R %A Jin,Ruoming %+ , Department of Computer Science, Kent State University, 241 Mathematical Sciences Building, Kent, OH, 44224, United States, 1 330 672 9980, jzhu10@kent.edu %K teenager %K substance use %K Reddit %K emotional analysis %K bidirectional encoder representations from transformers %K BERT %K frame approach %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent substance use disorder is a pressing public health issue, with increasing prevalence as individuals age. Social media platforms like Reddit (Reddit Inc) serve as significant venues for teenagers to discuss and navigate substance use. Social media platforms, such as Reddit, serve as increasingly important spaces where teenagers discuss, share, and navigate their experiences with substance use, presenting unique opportunities and challenges for understanding and addressing this issue. Objective: This study aims to explore how teenagers frame substance-use discussions on the r/teenagers subreddit, focusing on their personal interpretations, causal attributions, and the social and psychological contexts that shape these online support groups. By identifying these interpretive frames, we aimed to better understand the complex drivers of adolescent substance use behavior and their potential interventions. Methods: Using natural language processing techniques, we analyzed 32,674 substance use–related posts from 2018 to 2022. A framing approach was used to identify and categorize prevalent themes, supplemented by emotional profiling using the EmoLLaMA-chat-13B model developed by Liu and colleagues. Results: In total, 7 primary frames emerged: normalization, risk awareness, social integration, autonomy and rebellion, coping mechanisms, media influence, and stigmatization. These frames varied in prevalence and were associated with distinct emotional profiles, highlighting the complex interplay between substance use and adolescent experiences. We observed that, for example, the normalization frame was often associated with a mix of sadness and anxiety, while the coping frame exhibited elevated levels of anger, sadness, and anxiety. These distinctive emotional landscapes associated with each frame reveal unique insights into the mental state of adolescents navigating substance use. Conclusions: The findings underscore the multifaceted nature of adolescent substance-use discussions on social media. Interventions must address underlying emotional and social factors as well as identity to effectively mitigate substance use disorder among adolescents. By understanding the frames teenagers use to interpret substance use, we can pave the way for more effective and personalized public health campaigns, and support services designed to resonate with adolescents’ unique lived experiences. %M 39970428 %R 10.2196/59338 %U https://www.jmir.org/2025/1/e59338 %U https://doi.org/10.2196/59338 %U http://www.ncbi.nlm.nih.gov/pubmed/39970428 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55541 %T Smartphone-Based Intervention Targeting Norms and Risk Perception Among University Students with Unhealthy Alcohol Use: Secondary Mediation Analysis of a Randomized Controlled Trial %A Studer,Joseph %A Cunningham,John A %A Schmutz,Elodie %A Gaume,Jacques %A Adam,Angéline %A Daeppen,Jean-Bernard %A Bertholet,Nicolas %+ Addiction Medicine, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Rue du Bugnon 23A, Lausanne, 1011, Switzerland, 41 213149033, joseph.studer@chuv.ch %K brief intervention %K alcohol use %K mechanism of action %K mediation analysis %K personalized feedback %K smartphone app %K students %K Switzerland %K mobile phone %K mediation %K feedback %K student %K health risk %K drinking %K drinker %K support %K feedback intervention %D 2025 %7 6.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Many digital interventions for unhealthy alcohol use are based on personalized normative feedback (PNF) and personalized feedback on risks for health (PFR). The hypothesis is that PNF and PFR affect drinkers’ perceptions of drinking norms and risks, resulting in changes in drinking behaviors. This study is a follow-up mediation analysis of the primary and secondary outcomes of a randomized controlled trial testing the effect of a smartphone-based intervention to reduce alcohol use. Objective: This study aimed to investigate whether perceptions of drinking norms and risks mediated the effects of a smartphone-based intervention to reduce alcohol use. Methods: A total of 1770 students from 4 higher education institutions in Switzerland (mean age 22.35, SD 3.07 years) who screened positive for unhealthy alcohol use were randomized to receive access to a smartphone app or to the no-intervention control condition. The smartphone app provided PNF and PFR. Outcomes were drinking volume (DV) in standard drinks per week and the number of heavy drinking days (HDDs) assessed at baseline and 6 months. Mediators were perceived drinking norms and perceived risks for health measured at baseline and 3 months. Parallel mediation analyses and moderated mediation analyses were conducted to test whether (1) the intervention effect was indirectly related to lower DV and HDDs at 6 months (adjusting for baseline values) through perceived drinking norms and perceived risks for health at 3 months (adjusting for baseline values) and (2) the indirect effects through perceived drinking norms differed between participants who overestimated or who did not overestimate other people’s drinking at baseline. Results: The intervention’s total effects were significant (DV: b=–0.85, 95% bootstrap CI –1.49 to –0.25; HDD: b=–0.44, 95% bootstrap CI –0.72 to –0.16), indicating less drinking at 6 months in the intervention group than in the control group. The direct effects (ie, controlling for mediators) were significant though smaller (DV: b=–0.73, 95% bootstrap CI –1.33 to –0.16; HDD: b=–0.39, 95% bootstrap CI –0.66 to –0.12). For DV, the indirect effect was significant through perceived drinking norms (b=–0.12, 95% bootstrap CI –0.25 to –0.03). The indirect effects through perceived risk (for DV and HDD) and perceived drinking norms (for HDD) were not significant. Results of moderated mediation analyses showed that the indirect effects through perceived drinking norms were significant among participants overestimating other people’s drinking (DV: b=–0.17, 95% bootstrap CI –0.32 to –0.05; HDD: b=–0.08, 95% bootstrap CI –0.15 to –0.01) but not significant among those not overestimating. Conclusions: Perceived drinking norms, but not perceived risks, partially mediated the intervention’s effect on alcohol use, confirming one of its hypothesized mechanisms of action. These findings lend support to using normative feedback interventions to discourage unhealthy alcohol use. Trial Registration: ISRCTN Registry 10007691; https://doi.org/10.1186/ISRCTN10007691 %M 39914807 %R 10.2196/55541 %U https://www.jmir.org/2025/1/e55541 %U https://doi.org/10.2196/55541 %U http://www.ncbi.nlm.nih.gov/pubmed/39914807 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63399 %T Examining Caregiver Practices During Adolescent Outpatient Alcohol Use and Co-Occurring Mental Health Treatment: Protocol for a Dyadic Ecological Momentary Assessment Study %A Meisel,Samuel N %A Hogue,Aaron %A Kelly,John F %A McQuaid,Elizabeth %A Miranda Jr,Robert %+ Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA, 02215, United States, 1 6173539610, smeisel@bu.edu %K adolescent %K caregiver %K ecological momentary assessment %K alcohol %K co-occurring disorders treatment %K treatment %K older adult %K aging %K alcohol use %K mental health %K assessment %K protocol %K alcohol use disorder %K drinking %K substance use %K data collection %D 2024 %7 20.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Caregiver-involved treatments for adolescents with alcohol use disorder and co-occurring disorders (AUD+CODs) are associated with the best treatment outcomes. Understanding what caregiving practices during treatment improve core adolescent treatment targets may facilitate the refinement and scalability of caregiver-involved interventions. Caregiving is dynamic, varying by context, affect, and adolescent behavior. Caregiver-involved treatments seek to change momentary interactions between caregivers and their adolescents. Accordingly, this protocol outlines a dyadic ecological momentary assessment (EMA) study to examine caregiving practices during AUD+CODs treatment and their associations with adolescent core treatment targets (eg, alcohol craving and use, motivation to reduce or stop drinking, and internalizing and externalizing symptoms). Objective: This paper aims to describe the methods for examining momentary caregiving practices and adolescent core treatment targets during adolescent outpatient AUD+CODs treatment. Methods: We will recruit 75 caregiver-adolescent dyads from outpatient mental health clinics providing AUD+CODs treatment. Eligible families will have an adolescent who (1) is aged between 13 and 18 years; (2) meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for AUD; (3) is enrolled in outpatient treatment at the time of recruitment; and (4) has a legal guardian willing to participate in the study. Caregivers and adolescents will complete an eligibility screening, followed by a baseline assessment during or as close as possible to the second week of treatment. During the baseline assessment, caregivers and adolescents will receive formal training in EMA procedures. Next, caregivers and adolescents will complete a 15-week EMA burst design consisting of three 21-day EMA periods with 3-week breaks between periods. Throughout the study, participants will also complete weekly reports regarding the skills learned or practiced during therapy. The three overarching aims to the proposed study are as follows: (1) examine momentary caregiving practices (eg, support, monitoring, substance use communication quality) and their associations with core treatment targets, (2) examine how these associations change throughout treatment, and (3) examine whether a caregiver report of learning or practicing parenting- or family-focused behaviors in treatment sessions is associated with changes in the use of caregiving practices in daily life. Results: The proposed study was informed by a pilot study assessing the feasibility and acceptability of dyadic EMA during adolescent AUD+COD treatment. Some benchmarks were met during this study (eg, ≥80% caregiver retention rate), although most benchmarks were not (eg, adolescent [772/1622, 47.6%] and caregiver [1331/1881, 70.76%] random prompt compliance was below the ≥80% target). Data collection is anticipated to begin in December of 2024. The proposed study is designed to be completed over 3 years. Conclusions: Examining momentary caregiving practices using EMA has important implications for refining and scaling caregiver-involved interventions for AUD+CODs so that families who would benefit from caregiver-involved treatments can have access to them. International Registered Report Identifier (IRRID): PRR1-10.2196/63399 %M 39705699 %R 10.2196/63399 %U https://www.researchprotocols.org/2024/1/e63399 %U https://doi.org/10.2196/63399 %U http://www.ncbi.nlm.nih.gov/pubmed/39705699 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53401 %T An Ecological Momentary Assessment Approach of Environmental Triggers in the Role of Daily Affect, Rumination, and Movement Patterns in Early Alcohol Use Among Healthy Adolescents: Exploratory Study %A Prignitz,Maren %A Guldner,Stella %A Lehmler,Stephan Johann %A Aggensteiner,Pascal-M %A Nees,Frauke %A , %+ Institute of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5, Mannheim, 68159, Germany, 49 62117036313, maren.prignitz@zi-mannheim.de %K alcohol use %K adolescence %K affect %K rumination %K ecological momentary assessment %K geospatial measures %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescence is a period characterized by an increased susceptibility to developing risky alcohol consumption habits. This susceptibility can be influenced by social and situational factors encountered in daily life, which, in conjunction with emotions and thoughts, contribute to behavioral patterns related to alcohol use even in the early stages of alcohol experimentation, when initial experiences with alcohol are formed, and regular consumption is still evolving. Objective: This study aimed to examine the association between detailed behavioral and movement patterns, along with emotional and cognitive factors, and the early onset of alcohol use in the everyday lives of adolescents. Methods: A total of 65 healthy adolescents (33 male, twenty-nine 14-year-olds, and thirty-six 16-year-olds) underwent mobile-based ecological momentary assessments on alcohol (once a day at 9 AM, assessing alcohol use the day before), positive and negative affect, craving, rumination, and social context (6 prompts/day at 9 AM, 11 AM, 2 PM, 4 PM, 6 PM and 8 PM), type of day (weekdays or weekends, with weekend including Fridays, Saturdays, and Sundays), and using geospatial measures (specifically roaming entropy and number and type of trigger points for alcohol use met) over 14 days. After adjusting for a compliance rate of at least 50%, 52 participants (26 male and twenty-four 14-year-olds) were included in the analyses. Results: Generalized linear multilevel models revealed that higher positive affect (b=0.685, P=.007), higher rumination (b=0.586, P=.02), and a larger movement radius (roaming entropy) (b=8.126, P=.02) were positively associated with alcohol use on the same day. However, social context (b=–0.076, P=.90), negative affect (b=–0.077, P=.80), or potential trigger points (all P>.05) did not show significant associations. Alcohol use varied depending on the type of day, with more alcohol use on weekends (b=1.082, P<.001) and age (t50=–2.910, P=.005), with 16-year-olds (mean 1.61, SD 1.66) reporting more days of alcohol consumption than 14-year-olds (mean 0.548, SD 0.72). Conclusions: Our findings support previously identified factors as significant contributors to very early and low levels of alcohol consumption through fine-grained analysis of daily behaviors. These factors include positive affect, rumination, weekend days, and age. In addition, we emphasize that exploratory environmental movement behavior (roaming entropy) is also significantly associated with adolescent alcohol use, highlighting its importance as an additional factor. %M 39657181 %R 10.2196/53401 %U https://mhealth.jmir.org/2024/1/e53401 %U https://doi.org/10.2196/53401 %U http://www.ncbi.nlm.nih.gov/pubmed/39657181 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58499 %T Avatar Intervention in Virtual Reality for Cannabis Use Disorder in Individuals With Severe Mental Disorders: Results From a 1-Year, Single-Arm Clinical Trial %A Giguere,Sabrina %A Beaudoin,Mélissa %A Dellazizzo,Laura %A Phraxayavong,Kingsada %A Potvin,Stéphane %A Dumais,Alexandre %K cannabis use disorder %K cannabis use %K virtual reality therapy %K virtual reality %K addiction intervention %K relational therapy %K avatar %K digital mental health %D 2024 %7 27.11.2024 %9 %J JMIR Ment Health %G English %X Background: The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD. Objective: This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD. Methods: Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model. Results: Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms. Conclusions: Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention. Trial Registration: ClinicalTrials.gov NCT05726617; https://clinicaltrials.gov/study/NCT05726617 %R 10.2196/58499 %U https://mental.jmir.org/2024/1/e58499 %U https://doi.org/10.2196/58499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51870 %T Concurrent Mentions of Vaping and Alcohol on Twitter: Latent Dirichlet Analysis %A Ranker,Lynsie R %A Tofu,David Assefa %A Lu,Manyuan %A Wu,Jiaxi %A Bhatnagar,Aruni %A Robertson,Rose Marie %A Wijaya,Derry %A Hong,Traci %A Fetterman,Jessica L %A Xuan,Ziming %+ Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th Floor, Boston, MA, 02215, United States, 1 617 358 2310, lranker@bu.edu %K e-cigarettes %K alcohol %K social media %K vape %K tweet %K vaping %K alcohol use %K co-use %K substance use disorder %K social networking site %K insight %K regulation %K youth %K vaping policy %D 2024 %7 12.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use. Objective: The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic. Methods: Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described. Results: Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre– and post–regulatory change and pre– and post–COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time. Conclusions: Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances—particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility. %M 39531640 %R 10.2196/51870 %U https://www.jmir.org/2024/1/e51870 %U https://doi.org/10.2196/51870 %U http://www.ncbi.nlm.nih.gov/pubmed/39531640 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57664 %T A Personalized Data Dashboard to Improve Compliance with Ecological Momentary Assessments in College Students: Protocol for a Microrandomized Trial %A Lanza,Stephanie T %A Linden-Carmichael,Ashley N %A Wang,Danny %A Bhandari,Sandesh %A Stull,Samuel W %+ Department of Biobehavioral Health, Pennsylvania State University, 129 Biobehavioral Health Building, University Park, PA, 16802, United States, 1 814 865 7095, SLanza@psu.edu %K ecological momentary assessments %K data dashboard %K study compliance %K microrandomized trial %K intensive longitudinal data %K EMA %K adolescents %K substance use %K wearables %D 2024 %7 11.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ecological momentary assessments (EMA) are ideal for capturing the dynamic nature of young adult substance use behavior in daily life and identifying contextual risk factors that signal higher-risk episodes. These methods could provide a signal to trigger real-time intervention delivery. Study compliance and engagement are common barriers to participation but may be improved by personalizing messages. This study compares compliance outcomes between one group of young adults receiving standard (generic) prompts at each assessment and another group that received additional personalization and an updated data dashboard (DD) showing study progress to date at 1 randomly selected prompt per day. Objective: The primary objectives are to (1) develop a real-time DD for giving participants personalized updates on their progress in the study and (2) examine its preliminary overall effects on study compliance and experiences. Secondary objectives are to identify person-, day-, and moment-level characteristics associated with study compliance and person-level characteristics associated with perceived usefulness of the DD. Methods: This is a protocol for Project ENGAGE, a 2-arm randomized controlled trial. Arm 1 (EMA group) is engaged in a standard EMA protocol, and arm 2 (EMA+DD group) is engaged in the same study but with additional personalization and feedback. Inclusion criteria are (1) previous participation in a recent college student survey about health behavior and mental health who indicated willingness to participate in future research studies and (2) indicated past-month alcohol use; lifetime marijuana, hashish, or Delta-8-tetrahydrocannabinol (THC) use; or some combination of these on that survey. All participants in this study completed a baseline survey; EMA at 11 AM, 2 PM, 5 PM, and 8 PM each day for 21 days; and an exit survey. Participants in arm 2 engaged in a microrandomized trial, receiving a personalized DD at 1 randomly selected prompt per day. Primary outcomes include whether a survey was completed, time to complete a survey, and subjective experiences in the study. Primary analyses will compare groups on overall study compliance and, for arm 2, use marginal models to assess the momentary effect of receiving 1 updated DD per day. Results: Approval was granted by the university’s institutional review board on February 8, 2023. Recruitment via direct email occurred on March 30 and April 6, 2023; data collection was completed by April 29, 2023. A total of 91 individuals participated in the study. Results have been accepted for publication in JMIR Formative Research. Conclusions: Results from the evaluation of this study will indicate whether providing (at randomly selected prompts) real-time, personalized feedback on a participant’s progress in an EMA study improves study compliance. Overall, this study will inform whether a simple, automated DD presenting study compliance and incentives earned to date may improve young adults’ compliance and engagement in intensive longitudinal studies. International Registered Report Identifier (IRRID): DERR1-10.2196/57664 %M 39527809 %R 10.2196/57664 %U https://www.researchprotocols.org/2024/1/e57664 %U https://doi.org/10.2196/57664 %U http://www.ncbi.nlm.nih.gov/pubmed/39527809 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55555 %T Tobacco and Alcohol Content in Top Vietnamese YouTube Music Videos: Content Analysis %A Tran,Thi Phuong Thao %A Vu,Thu Trang %A Li,Yachao %A Popova,Lucy %+ School of Public Health, Georgia State University, 140 Decatur St. SE, Atlanta, GA, 30303, United States, 1 4709626086, ttran217@gsu.edu %K risk %K risk factor %K tobacco content %K alcohol content %K tobacco %K alcohol %K tobacco portrayal %K alcohol portrayal %K music video %K Vietnam %K Vietnamese %K YouTube %K social media %K socials %K youth %K adolescent %K teen %K teenager %K young adult %D 2024 %7 8.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeing portrayals of tobacco and alcohol in music videos (MVs) may reduce perceived risks, increase susceptibility, and lead to the initiation of tobacco and alcohol use among adolescents and young adults. Previous studies have predominantly concentrated on assessing tobacco and alcohol contents in English-language MVs within Western countries. However, many other countries have not only been influenced by the English music market but have also produced music in their native languages, and this content remains underexamined. Objective: This study aims to investigate the prevalence of tobacco- and alcohol-related content in top Vietnamese MVs on YouTube from 2013 to 2021, to describe how tobacco and alcohol are portrayed in these MVs, and to examine associations between these portrayals and MV characteristics. Methods: A total of 410 Vietnamese MVs, including the top 40 or 50 most viewed released each year between 2013 and 2021, were analyzed. General information, such as the song name, its release date and ranking, age restriction, musical genre, and type of MV, was collected. We examined tobacco and alcohol content in the MVs, with specific details such as tobacco types, their brands, as well as the number, age, sex, and roles of individuals smoking or drinking. Results: Among the 410 MVs, 36 (8.8%) contained tobacco-related content and 136 (33.2%) featured alcohol-related content. Additionally, 28 (6.8%) out of 410 MVs included both tobacco and alcohol content. The prevalence of videos with tobacco and alcohol content fluctuated over the years. In MVs with tobacco-related content, a higher proportion of hip-hop or rap songs contained tobacco-related content (n=6, 30%) compared to other music genres. In MVs with tobacco-related content, cigarettes were the most frequently shown product (n=28, 77.8%), and smoking scenes were often depicted at parties (n=13, 36.1%) and during dancing and singing scenes (n=12, 33.3%). Among the 31 MVs portraying actual tobacco use, tobacco use was typically depicted with 1 person, often a young adult male, while 38.7% (n=12) showed singer(s) smoking. For MVs with alcohol-related content, there was a high proportion showing alcohol images at parties, bars, or pubs (n=96, 70.6%). Among 87 MVs containing drinking scenes, 60.9% (n=53) involved groups of young adults of both sexes, and 64% (n=56) depicted singers drinking. Additionally, only 2 (5.6%) MVs included health warnings about tobacco harm, and 2 MVs (1.5%) included warnings about drinking restricted to individuals 18 years and above. Conclusions: The notable prevalence of tobacco and alcohol content in leading Vietnamese YouTube MVs raises concerns, especially as most of this content is portrayed without any warnings. The study underscores a regulatory gap in addressing such content on the internet, emphasizing the urgent need for stricter regulations and age restrictions on platforms such as YouTube. %M 39514854 %R 10.2196/55555 %U https://www.jmir.org/2024/1/e55555 %U https://doi.org/10.2196/55555 %U http://www.ncbi.nlm.nih.gov/pubmed/39514854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63156 %T Desires and Needs for Quitting Both e-Cigarettes and Cigarettes Among Young Adults: Formative Qualitative Study Informing the Development of a Smartphone Intervention for Dual Tobacco Cessation %A Nguyen,Nhung %A Koester,Kimberly A %A Tran,Christine %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, San Francisco, CA, 94502, United States, 1 6508889207, Nhung.Nguyen@ucsf.edu %K smoking cessation %K vaping cessation %K mHealth intervention %K mobile health %K e-cigarettes %K cigarettes %K smartphone intervention %K nicotine dependence %K additive adverse health effects %K tobacco cessation %D 2024 %7 22.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Dual use of both e-cigarettes and cigarettes is popular among young adults and may lead to greater nicotine dependence and additive adverse health effects than single-product use. However, existing cessation programs target quitting either e-cigarettes or cigarettes, highlighting a need for interventions to help young adults quit both products (ie, dual tobacco cessation). Objective: This formative study is part of a larger project to develop a smartphone intervention for dual tobacco cessation among young adults. This study aimed to (1) explore desires for and experiences with quitting both e-cigarettes and cigarettes and (2) identify needs and preferences for dual tobacco cessation intervention programming. Methods: Semistructured interviews were conducted to elicit the need for and experience with dual tobacco cessation among 14 young adults (18-29 years old) recruited through Instagram (Meta) advertisements in 2023. We conducted a thematic analysis to identify common themes related to quitting experiences and cessation needs. Results: Participants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly “cold turkey.” The priority product for quitting first varied by the individual’s perceived harm or level of consumption. Targets for dual tobacco cessation interventions included (1) highlighting the health effects of dual tobacco use compared with single product use, (2) providing cessation support to quit one prioritized product while cutting down the other product with the explicit goal to quit both, (3) emphasizing unique facilitators and barriers to quitting each product (eg, unpleasant smell of cigarettes facilitating smoking cessation and accessibility and flavors of e-cigarettes hindering vaping cessation), and (4) addressing co-use of tobacco with alcohol or cannabis. Participants wanted personalized interventions through smartphone apps that would tailor support to their tobacco use patterns and unique quitting goals and needs. They also suggested presenting intervention content in multimedia (eg, videos, graphic pictures, quizzes, and games) to increase engagement. Conclusions: This study provides important insights into young adults’ experiences, needs, and preferences for dual tobacco product cessation. We highlight important targets for future smartphone apps to deliver personalized and tailored support to meet the heterogeneous needs and preferences of young people who want to quit using both e-cigarettes and cigarettes. %M 39437386 %R 10.2196/63156 %U https://formative.jmir.org/2024/1/e63156 %U https://doi.org/10.2196/63156 %U http://www.ncbi.nlm.nih.gov/pubmed/39437386 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e49779 %T Social Media Exposure and Other Correlates of Increased e-Cigarette Use Among Adolescents During Remote Schooling: Cross-Sectional Study %A Pravosud,Vira %A Ling,Pamela M %A Halpern-Felsher,Bonnie %A Gribben,Valerie %K adolescents %K social media use %K e-cigarette use %K mental health %K COVID-19 shelter-in-place orders %K remote schooling %K smoking %K vape %K e-cigarette implications %K COVID-19 %K anxiety %K depression %D 2024 %7 21.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Little is known about the role of exposure to e-cigarette–related digital content, behavioral and mental health factors, and social environment on the change in adolescent e-cigarette use during COVID-19 shelter-in-place orders and remote schooling. Objective: The aim of the study was to examine changes in adolescent e-cigarette use during shelter-in-place and remote schooling in association with exposure to e-cigarette–related digital content and other correlates: stronger e-cigarette dependence, feeling lonely, inability to socialize, e-cigarette use to cope with shelter-in-place, and the number of family members aware of participants’ e-cigarette use. Methods: A cross-sectional survey conducted between August 2020 and March 2021 included 85 California adolescents (mean age 16.7, SD 1.2 years; 39/85, 46% identified as female and 37/85, 44% as Hispanic) who reported e-cigarette use in the past 30 days. Multivariable penalized logistic regressions determined associations adjusted for age, race and ethnicity, and mother’s education. The outcome of increased e-cigarette use was defined as more frequent use of e-cigarettes of the same or stronger nicotine or tetrahydrocannabinol concentration. Results: Almost all respondents (83/85, 98%) reported using social media more since shelter-in-place, and 74% (63/85) reported seeing e-cigarette digital content. More than half (46/85, 54%) reported increased e-cigarette use during shelter-in-place. Most individuals who increased use were exposed to e-cigarette digital content (38/46, 83%) compared to those who did not increase e-cigarette use (25/39, 64%), but the association was nonsignificant after adjusting for demographics (adjusted odds ratio [AOR] 2.34, 95% CI 0.71‐8.46). Respondents who felt lonely (AOR 3.33, 95% CI 1.27‐9.42), used e-cigarettes to cope with shelter-in-place (AOR 4.06, 95% CI 1.39‐13.41), or had ≥2 family members aware of participants’ e-cigarette use (AOR 6.42, 95% CI 1.29‐39.49) were more likely to report increased e-cigarette use. Conclusions: Almost all participants reported using social media more during shelter-in-place, with many respondents reporting increased e-cigarette use, and significant associations with loneliness and use to cope with shelter-in-place. Future interventions should consider leveraging digital platforms for e-cigarette use prevention and cessation and address the mental health consequences of the COVID-19 pandemic. %R 10.2196/49779 %U https://pediatrics.jmir.org/2024/1/e49779 %U https://doi.org/10.2196/49779 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e52735 %T Disclosure Patterns of Opioid Use Disorders in Perinatal Care During the Opioid Epidemic on X From 2019 to 2021: Thematic Analysis %A Wu,Dezhi %A Ng,Minnie %A Gupta,Saborny Sen %A Raynor,Phyllis %A Tao,Youyou %A Ren,Yang %A Hung,Peiyin %A Qiao,Shan %A Zhang,Jiajia %A Fillo,Jennifer %A Li,Xiaoming %A Guille,Constance %A Eichelberger,Kacey %A Olatosi,Bankole %+ Department of Integrated Information Technology, University of South Carolina, 550 Assembly Street, Columbia, SC, 29298, United States, 1 803 777 4691, dezhiwu@cec.sc.edu %K X %K Twitter %K opioid use disorder %K thematic analysis %K pregnancy %K perinatal care %K women and child health %K maternal health %K COVID-19 %K opioid epidemic %D 2024 %7 7.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In 2021, the United States experienced a 14% rise in fatal drug overdoses totaling 106,699 deaths, driven by harmful opioid use, particularly among individuals in the perinatal period who face increased risks associated with opioid use disorders (OUDs). Increased concerns about the impacts of escalating harmful opioid use among pregnant and postpartum persons are rising. Most of the current limited perinatal OUD studies were conducted using traditional methods, such as interviews and randomized controlled trials to understand OUD treatment, risk factors, and associated adverse effects. However, little is known about how social media data, such as X, formerly known as Twitter, can be leveraged to explore and identify broad perinatal OUD trends, disclosure and communication patterns, and public health surveillance about OUD in the perinatal period. Objective: The objective is 3-fold: first, we aim to identify key themes and trends in perinatal OUD discussions on platform X. Second, we explore user engagement patterns, including replying and retweeting behaviors. Third, we investigate computational methods that could potentially streamline and scale the labor-intensive manual annotation effort. Methods: We extracted 6 million raw perinatal-themed tweets posted by global X users during the opioid epidemic from May 2019 to October 2021. After data cleaning and sampling, we used 500 tweets related to OUD in the perinatal period by US X users for a thematic analysis using NVivo (Lumivero) software. Results: Seven major themes emerged from our thematic analysis: (1) political views related to harmful opioid and other substance use, (2) perceptions of others’ substance use, (3) lived experiences of opioid and other substance use, (4) news reports or papers related to opioid and other substance use, (5) health care initiatives, (6) adverse effects on children’s health due to parental substance use, and (7) topics related to nonopioid substance use. Among these 7 themes, our user engagement analysis revealed that themes 4 and 5 received the highest average retweet counts, and theme 3 received the highest average tweet reply count. We further found that different computational methods excel in analyzing different themes. Conclusions: Social media platforms such as X can serve as a valuable tool for analyzing real-time discourse and exploring public perceptions, opinions, and behaviors related to maternal substance use, particularly, harmful opioid use in the perinatal period. More health promotion strategies can be carried out on social media platforms to provide educational support for the OUD perinatal population. %M 39374068 %R 10.2196/52735 %U https://pediatrics.jmir.org/2024/1/e52735 %U https://doi.org/10.2196/52735 %U http://www.ncbi.nlm.nih.gov/pubmed/39374068 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58685 %T Examining the Impact of Simultaneous Alcohol and Cannabis Use on Alcohol Consumption and Consequences: Protocol for an Observational Ambulatory Assessment Study in Young Adults %A Gunn,Rachel L %A Metrik,Jane %A Barnett,Nancy P %A Jackson,Kristina M %A Lipperman-Kreda,Sharon %A Miranda Jr,Robert %A Trull,Timothy J %A Fernandez,Mary Ellen %+ Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University, 121 S Main St, Providence, RI, United States, 1 401 863 6630, rachel_gunn@brown.edu %K ecological momentary assessment %K alcohol %K cannabis %K consequences %K transdermal alcohol biosensors %K ambulatory assessment %K mobile phone %D 2024 %7 25.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is significant conflicting evidence as to how using cannabis while drinking alcohol (ie, simultaneous alcohol and cannabis use) impacts alcohol volume consumed, patterns of drinking, and alcohol-related consequences. The impact of simultaneous use on drinking outcomes may be influenced by several within-person (eg, contextual) and between-person (individual) factors. Objective: This study was designed to examine naturalistic patterns of alcohol and cannabis use to understand how simultaneous use may impact drinking outcomes. The primary aims were to understand the following: (1) if simultaneous use is associated with increased alcohol consumption and riskier patterns of drinking, (2) if simultaneous use leads to increased alcohol consequences, and (3) how contextual circumstances moderate the impact of simultaneous use on consumption and consequences. Methods: Data collection involves a 28-day ambulatory assessment protocol in which a sample of non–treatment-seeking young adults who report simultaneous use of alcohol and cannabis complete ecological momentary assessments (random, event-contingent, and time-contingent surveys) of alcohol and cannabis use, contexts, motives, and consequences on their personal smartphones while continuously wearing an alcohol biosensor bracelet. Participants also complete a baseline assessment, brief internet-based check-in on day 14, and a final session on day 28. Community-based recruitment strategies (eg, social media and flyers) were used to enroll 95 participants to obtain a target sample of 80, accounting for attrition. Results: Recruitment and data collection began in May 2021 and continued through June 2024. Initial results for primary aims are expected in October 2024. As of March 2024, the project had recruited 118 eligible participants, of whom 94 (79.7%) completed the study, exceeding initial projections for the study time frame. Remaining recruitment will provide the capacity to probe cross-level interactions that were not initially statistically powered. Strengths of the project include rigorous data collection, good retention and compliance rates, faster-than-expected enrollment procedures, use of a novel alcohol biosensor, and successful adaptation of recruitment and data collection procedures during the COVID-19 pandemic. Conclusions: This is the first investigation to assess the key momentary predictors and outcomes of simultaneous use as well as self-reported and objective (via alcohol biosensor) measures of alcohol consumption and patterns. The results of this study will inform prevention efforts and studies of individuals who use cannabis who are engaged in alcohol treatment. International Registered Report Identifier (IRRID): DERR1-10.2196/58685 %M 39321460 %R 10.2196/58685 %U https://www.researchprotocols.org/2024/1/e58685 %U https://doi.org/10.2196/58685 %U http://www.ncbi.nlm.nih.gov/pubmed/39321460 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51273 %T The Use of Noncommercial Parent-Focused mHealth Interventions for Behavioral Problems in Youth: Systematic Review %A Magnuson,Katherine I %A Li,Kexin %A Beuley,Grace %A Ryan-Pettes,Stacy R %+ Department of Psychology and Neuroscience, Baylor University, Baylor Sciences Building, 101 Bagby Ave, Waco, TX, 76706, United States, 1 (254) 710 2961, katherine.magnuson@childrens.com %K behavioral parent training %K mobile health %K mHealth %K mobile app %K adolescent %K substance use %K child mental health condition %K mobile phone %D 2024 %7 24.9.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The rates of substance use among adolescents are alarmingly high, and current treatment options lack integration of parent-focused interventions, despite evidence that effective parenting practices can mediate treatment outcomes for adolescents involved in substance use. Accessibility and other barriers to parental interventions may be mitigated through mobile health (mHealth); however, few mHealth platforms target substance use behaviors for adolescents through the implementation of behavioral parent training strategies. Objective: This study seeks to review current mHealth platforms within empirical literature that are designed to increase effective parenting through behavioral parent training techniques. Because of the paucity of mHealth modalities that use parenting strategies to target substance use in adolescents, the objective was expanded to include mHealth platforms addressing behavior problems among youth, given that parent-targeted treatments for these clinical presentations overlap with those for adolescent substance use. Overall, the systematic review was conducted to inform the development of mHealth apps for parents of youth involved in substance use, improve accessibility, and better align with parental needs. Methods: This systematic review was conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method to select relevant articles across several databases. Each study was assessed for relevance and inclusion. Each study was reviewed for demographics, delivery medium, intervention status as stand-alone treatment or as an enhancement to treatment, mobile device used, mental health condition targeted, intervention type, underlying intervention theory, behavior change theory applied in design, behavior change techniques, parent training techniques, youth outcomes, parent outcomes, visual design, content, and features. Results: Overall, 11 studies were included. Nearly all studies (9/11, 82%) predominantly sampled female caregivers. Most of the studies (6/11, 55%) integrated social learning theory. Only a few of the studies (2/11, 18%) discussed the embedded behavior change theories, whereas all the studies (11/11, 100%) used at least one behavior change technique to encourage change in parental behaviors. Many of the studies (7/11, 64%) tailored design features to the end user. Of the various behavioral parent training techniques, nearly all studies (10/11, 91%) included the skill of strengthening the parent-child relationship. A preliminary evaluation of treatment outcomes suggests a positive impact of parent-targeted mHealth interventions. When reported, the effect sizes for treatment ranged from Cohen d=0.38 to Cohen d=1.58 for youth and from Cohen d=0.13 to Cohen d=2.59 for parents. Conclusions: Although features and techniques were referenced, only a few of the studies provided specific information related to behavior change theory (2/11, 18%), visual design (2/11, 18%), and the translation of parent-targeted interventions to mHealth platforms. Such information would be useful for the development of mHealth apps. Preliminary outcomes for youth and parents are encouraging, but future studies should consider conducting a meta-analysis as the body of studies grows to determine aggregate statistical findings. %M 39316435 %R 10.2196/51273 %U https://mhealth.jmir.org/2024/1/e51273 %U https://doi.org/10.2196/51273 %U http://www.ncbi.nlm.nih.gov/pubmed/39316435 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64332 %T Family Support Protocol for Adolescent Internalizing Disorders: Protocol for a Pre-Post Quantitative Treatment Development Study %A Hogue,Aaron %A Bobek,Molly %A Porter,Nicole P %A MacLean,Alexandra %A Henderson,Craig E %A Jensen-Doss,Amanda %A Diamond,Gary M %A Southam-Gerow,Michael A %A Ehrenreich-May,Jill %+ Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, 711 Third Avenue, Suite 500, New York, NY, 10017, United States, 1 2126559566, ahogue@toendaddiction.org %K adolescent substance use %K adolescent anxiety and depression %K cooccurring disorders %K adjunctive treatment %K family-based interventions %K usual care %D 2024 %7 16.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Internalizing disorders (IDs), primarily depression and anxiety, are highly prevalent among adolescents receiving community-based treatment for substance use disorders (SUDs). For such clients, interventions that do not holistically address both SUDs and IDs are less effective. Objective: This pilot treatment development study aims to develop and test a modular treatment protocol for addressing cooccurring IDs among adolescents (aged 13 to 18 years) enrolled in routine care for substance use problems: Family Support Protocol for Adolescent Internalizing Disorders (Fam-AID). As an adjunctive protocol, Fam-AID will not require clinicians to markedly alter existing base practices for SUD. It will be anchored by 3 evidence-based foundations for treating cooccurring adolescent IDs: family engagement techniques, transdiagnostic individual cognitive behavioral therapy techniques, and family psychoeducation and safety planning. Methods: This quasi-experimental study will proceed in 2 stages. The pilot stage will use rapid-cycle prototyping methods in collaboration with end-user stakeholders to draft protocol delivery and fidelity guidelines adapted from existing resources, solicit provider and client input on protocol content and delivery via cognitive interviewing, and pilot prototype components on 4 to 6 cases. The second stage will be an interrupted time series study for 60 comorbid SUD+ID cases across 2 sites serving diverse adolescents: 30 will receive treatment as usual (TAU); following clinician training in the protocol, 30 new cases will receive TAU enhanced by Fam-AID. For aim 1, the focus is on evaluating the acceptability of the Fam-AID protocol through therapist and client interviews as well as assessing fidelity benchmarks using therapist- and observer-reported protocol fidelity data. For aim 2, the plan is to compare the effects of TAU only cases versus TAU+Fam-AID cases on family treatment attendance and on adolescent ID and substance use symptoms, with measurements taken at baseline and at 3-month and 6-month follow-ups. Results: Study recruitment will begin in April 2025. Conclusions: We anticipate that Fam-AID will contain 5 treatment modules that can be delivered in any sequence to meet client needs: family engagement of primary supports in treatment planning and services; relational reframing of family constraints, resiliencies, and social capital connected to the adolescent’s ID symptoms; functional analysis of the adolescent’s ID symptoms and related behaviors; cognitive behavioral therapy to address the adolescent’s ID symptoms and functional needs, featuring 3 core techniques (emotion acceptance, emotional exposure, and behavioral activation) to address negative affect and emotional dysregulation; and family psychoeducation and safety planning focused on education about comorbid SUD+ID and prevention of adolescent self-harm. If the abovementioned modules are found to be feasible and effective, Fam-AID will offer a set of pragmatic interventions to SUD clinicians for treating cooccurring IDs in adolescent clients. Trial Registration: ClinicalTrials.gov NCT06413979; https://www.clinicaltrials.gov/study/NCT06413979 International Registered Report Identifier (IRRID): PRR1-10.2196/64332 %M 39284179 %R 10.2196/64332 %U https://www.researchprotocols.org/2024/1/e64332 %U https://doi.org/10.2196/64332 %U http://www.ncbi.nlm.nih.gov/pubmed/39284179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55591 %T The Normalization of Vaping on TikTok Using Computer Vision, Natural Language Processing, and Qualitative Thematic Analysis: Mixed Methods Study %A Jung,Sungwon %A Murthy,Dhiraj %A Bateineh,Bara S %A Loukas,Alexandra %A Wilkinson,Anna V %+ School of Journalism and Media, University of Texas at Austin, 300 W Dean Keeton St, Austin, TX, 78712, United States, 1 512 749 3267, sungwon.jung@utexas.edu %K electronic cigarettes %K vaping %K social media %K natural language processing %K computer vision %D 2024 %7 11.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media posts that portray vaping in positive social contexts shape people’s perceptions and serve to normalize vaping. Despite restrictions on depicting or promoting controlled substances, vape-related content is easily accessible on TikTok. There is a need to understand strategies used in promoting vaping on TikTok, especially among susceptible youth audiences. Objective: This study seeks to comprehensively describe direct (ie, explicit promotional efforts) and indirect (ie, subtler strategies) themes promoting vaping on TikTok using a mixture of computational and qualitative thematic analyses of social media posts. In addition, we aim to describe how these themes might play a role in normalizing vaping behavior on TikTok for youth audiences, thereby informing public health communication and regulatory policies regarding vaping endorsements on TikTok. Methods: We collected 14,002 unique TikTok posts using 50 vape-related hashtags (eg, #vapetok and #boxmod). Using the k-means unsupervised machine learning algorithm, we identified clusters and then categorized posts qualitatively based on themes. Next, we organized all videos from the posts thematically and extracted the visual features of each theme using 3 machine learning–based model architectures: residual network (ResNet) with 50 layers (ResNet50), Visual Geometry Group model with 16 layers, and vision transformer. We chose the best-performing model, ResNet50, to thoroughly analyze the image clustering output. To assess clustering accuracy, we examined 4.01% (441/10,990) of the samples from each video cluster. Finally, we randomly selected 50 videos (5% of the total videos) from each theme, which were qualitatively coded and compared with the machine-derived classification for validation. Results: We successfully identified 5 major themes from the TikTok posts. Vape product marketing (1160/10,990, 8.28%) reflected direct marketing, while the other 4 themes reflected indirect marketing: TikTok influencer (3775/14,002, 26.96%), general vape (2741/14,002, 19.58%), vape brands (2042/14,002, 14.58%), and vaping cessation (1272/14,002, 9.08%). The ResNet50 model successfully classified clusters based on image features, achieving an average F1-score of 0.97, the highest among the 3 models. Qualitative content analyses indicated that vaping was depicted as a normal, routine part of daily life, with TikTok influencers subtly incorporating vaping into popular culture (eg, gaming, skateboarding, and tattooing) and social practices (eg, shopping sprees, driving, and grocery shopping). Conclusions: The results from both computational and qualitative analyses of text and visual data reveal that vaping is normalized on TikTok. Our identified themes underscore how everyday conversations, promotional content, and the influence of popular figures collectively contribute to depicting vaping as a normal and accepted aspect of daily life on TikTok. Our study provides valuable insights for regulatory policies and public health initiatives aimed at tackling the normalization of vaping on social media platforms. %M 39259963 %R 10.2196/55591 %U https://www.jmir.org/2024/1/e55591 %U https://doi.org/10.2196/55591 %U http://www.ncbi.nlm.nih.gov/pubmed/39259963 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e60052 %T Ecological Momentary Assessment of Alcohol Marketing Exposure, Alcohol Use, and Purchases Among University Students: Prospective Cohort Study %A Zhang,Min Jin %A Luk,Tzu Tsun %A Ho,Sai Yin %A Wang,Man Ping %A Lam,Tai Hing %A Cheung,Yee Tak Derek %+ School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 5/F, Academic Building 3 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176652, derekcheung@hku.hk %K alcohol marketing %K drinking %K ecological momentary assessment %K health behaviors %K young adults %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The relationships between alcohol marketing exposure, alcohol use, and purchase have been widely studied. However, prospective studies examining the causal relationships in real-world settings using mobile health tools are limited. Objective: We used ecological momentary assessment (EMA) to examine both the within-person– and between-person–level effects of alcohol marketing exposure on any alcohol use, amount of alcohol use, any alcohol purchase, and frequency of alcohol purchase among university students. Methods: From January to June 2020, we conducted a prospective cohort study via EMA among university students in Hong Kong who reported current drinking. Over 14 consecutive days, each participant completed 5 fixed-interval, signal-contingent EMAs daily via a smartphone app. Each EMA asked about the number and types of alcohol marketing exposures, the amount and types of alcohol used, and whether any alcohol was purchased, all within the past 3 hours. We used 2-part models, including multilevel logistic regressions and multilevel gamma regressions, to examine if the number of alcohol marketing exposure was associated with subsequent alcohol use and alcohol purchase. Results: A total of 49 students participated, with 33% (16/49) being male. The mean age was 22.6 (SD 2.6) years. They completed 2360 EMAs (completion rate: 2360/3430, 68.8%). Participants reported exposure to alcohol marketing in 5.9% (140/2360), alcohol use in 6.1% (145/2360), and alcohol purchase in 2.4% (56/2360) of all the EMAs. At the between-person level, exposure to more alcohol marketing predicted a higher likelihood of alcohol use (adjusted odd ratio [AOR]=3.51, 95% CI 1.29-9.54) and a higher likelihood of alcohol purchase (AOR=4.59, 95% CI 1.46-14.49) the following day. Exposure to more alcohol marketing did not increase the amount of alcohol use or frequency of alcohol purchases the following day in participants who used or purchased alcohol. At the within-person level, exposure to more alcohol marketing was not associated with a higher likelihood of alcohol use, amount of alcohol use, higher likelihood of alcohol purchase, or frequency of alcohol purchases the following day (all Ps>.05). Each additional exposure to alcohol marketing within 1 week predicted an increase of 0.85 alcoholic drinks consumed in the following week (adjusted B=0.85, 95% CI 0.09-1.61). On days of reporting alcohol use, the 3 measures for alcohol marketing receptivity were not associated with more alcohol use or purchase (all Ps>.05). Conclusions: By using EMA, we provided the first evidence for the effect of alcohol marketing exposure on initiating alcohol use and purchase in current-drinking university students. Our findings provide evidence of the regulation of alcohol marketing for the reduction of alcohol use and purchase among young adults. %M 39226102 %R 10.2196/60052 %U https://mhealth.jmir.org/2024/1/e60052 %U https://doi.org/10.2196/60052 %U http://www.ncbi.nlm.nih.gov/pubmed/39226102 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51307 %T Mobile App Intervention to Reduce Substance Use, Gambling, and Digital Media Use in Vocational School Students: Exploratory Analysis of the Intervention Arm of a Randomized Controlled Trial %A Grahlher,Kristin %A Morgenstern,Matthis %A Pietsch,Benjamin %A Gomes de Matos,Elena %A Rossa,Monika %A Lochbühler,Kirsten %A Daubmann,Anne %A Thomasius,Rainer %A Arnaud,Nicolas %+ German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany, 49 40741059307, n.arnaud@uke.de %K prevention %K vocational students %K adolescents %K mobile intervention %K voluntary commitment %K substance use %K internet-related problems %K mobile phone %K adolescent %K youths %K student %K students %K use %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: During adolescence, substance use and digital media exposure usually peak and can become major health risks. Prevention activities are mainly implemented in the regular school setting, and youth outside this system are not reached. A mobile app (“Meine Zeit ohne”) has been developed specifically for vocational students and encourages participants to voluntarily reduce or abstain from a self-chosen addictive behavior including the use of a substance, gambling, or a media-related habit such as gaming or social media use for 2 weeks. Results from a randomized study indicate a significant impact on health-promoting behavior change after using the app. This exploratory study focuses on the intervention arm of this study, focusing on acceptance and differential effectiveness. Objective: The aims of this study were (1) to examine the characteristics of participants who used the app, (2) to explore the effectiveness of the mobile intervention depending on how the app was used and depending on participants’ characteristics, and (3) to study how variations in app use were related to participants’ baseline characteristics. Methods: Log data from study participants in the intervention group were analyzed including the frequency of app use (in days), selection of a specific challenge, and personal relevance (ie, the user was above a predefined risk score for a certain addictive behavior) of challenge selection (“congruent use”: eg, a smoker selected a challenge related to reducing or quitting smoking). Dichotomous outcomes (change vs no change) referred to past-month substance use, gambling, and media-related behaviors. The relationship between these variables was analyzed using binary, multilevel, mixed-effects logistic regression models. Results: The intervention group consisted of 2367 vocational students, and 1458 (61.6%; mean age 19.0, SD 3.5 years; 830/1458, 56.9% male) of them provided full data. Of these 1458 students, 894 (61.3%) started a challenge and could be included in the analysis (mean 18.7, SD 3.5 years; 363/894, 40.6% female). Of these 894 students, 466 (52.1%) were considered frequent app users with more than 4 days of active use over the 2-week period. The challenge area most often chosen in the analyzed sample was related to social media use (332/894, 37.1%). A total of 407 (45.5%) of the 894 students selected a challenge in a behavioral domain of personal relevance. The effects of app use on outcomes were higher when the area of individual challenge choice was equal to the area of behavior change, challenge choice was related to a behavior of personal relevance, and the individual risk of engaging in different addictive behaviors was high. Conclusions: The domain-specific effectiveness of the program was confirmed with no spillover between behavioral domains. Effectiveness appeared to be dependent on app use and users’ characteristics. Trial Registration: German Clinical Trials Register DRKS00023788; https://tinyurl.com/4pzpjkmj International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06231-x %M 39042436 %R 10.2196/51307 %U https://mhealth.jmir.org/2024/1/e51307 %U https://doi.org/10.2196/51307 %U http://www.ncbi.nlm.nih.gov/pubmed/39042436 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60671 %T Leveraging Parents and Peer Recovery Supports to Increase Recovery Capital in Emerging Adults With Polysubstance Use: Protocol for a Feasibility, Acceptability, and Appropriateness Study of Launch %A Drazdowski,Tess K %A Castedo de Martell,Sierra %A Sheidow,Ashli J %A Chapman,Jason E %A McCart,Michael R %+ Lighthouse Institute, Chestnut Health Systems, 1003 Martin Luther King Jr Dr., Bloomington, IL, 61701, United States, 1 541 525 0821, tkdrazdowski@chestnut.org %K peer recovery support services %K contingency management %K emerging adults %K rural %D 2024 %7 22.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Emerging adults (aged 18-26 years) are the most at-risk yet underserved age group among people with substance use disorder, especially rural emerging adults, and polysubstance use is common. Recovery capital is lower among emerging adults than older adults, and evidence-based treatments are typically unavailable or not developmentally tailored, especially in rural areas. Both supportive parents (or parental figures) and peer recovery support services (PRSS) can be leveraged to better support these emerging adults. Previous research indicates parents can be engaged to deliver contingency management (CM), an extensively researched evidence-based intervention for substance use. Objective: This protocol describes a funded pilot of Launch, a novel, scalable service package that pairs web-based coaching for parents to deliver CM for emerging adults (CM-EA) at home and in-person PRSS with educational and vocational goal setting. Specifically, this protocol describes feasibility, acceptability, and appropriateness testing (implementation-related outcomes) and steps taken to prepare for a future large-scale trial of Launch. Methods: Upon the recruitment of 48 emerging adult and parent pairs from sites serving primarily rural clients, participants will be randomized into 1 of 3 conditions for this randomized controlled trial: virtual parent coaching to deliver CM-EA, in-person PRSS for emerging adults, or both sets of services. Emerging adult eligibility includes polysubstance use, a substance use disorder, and availability of a consenting parent. Emerging adults will be interviewed at baseline and 6 months about substance use, quality of life, recovery capital, parental relationship, and Launch implementation-related outcomes (6-month follow-up only). Parents, peer workers delivering PRSS, and parent CM-EA coaches will be interviewed about implementation-related outcomes at the end of the study period. Peer workers and CM-EA coaches will be asked to complete checklists of services delivered after each session. Finally, payers and providers will be interviewed for additional insights into Launch implementation and to identify key outcomes of Launch. Data analysis for emerging adult outcomes will be primarily descriptive, but parent CM-EA training adherence will be assessed using nested mixed-effects regression models of repeated measures. Results: Launch is currently ongoing, with funding received in August 2023, and is expected to end in September 2025, with data analysis and results in December 2026. Participants are expected to begin enrolling in June 2024. Conclusions: While this pilot is limited by the small sample size and restriction to emerging adults with an involved parent, this is mitigated by the study’s strengths and is appropriate for the pilot stage. Launch uses an innovative combination of existing strategies to generate better outcomes for emerging adults while remaining scalable. This pilot will provide insights into the feasibility and acceptability of Launch from the perspectives of service recipients, providers, and payers to inform a larger-scale effectiveness trial. Trial Registration: ClinicalTrials.gov NCT06414993; https://clinicaltrials.gov/study/NCT06414993 International Registered Report Identifier (IRRID): PRR1-10.2196/60671 %M 39037768 %R 10.2196/60671 %U https://www.researchprotocols.org/2024/1/e60671 %U https://doi.org/10.2196/60671 %U http://www.ncbi.nlm.nih.gov/pubmed/39037768 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58322 %T Using the Preparation Phase of the Multiphase Optimization Strategy to Design an Antiextremism Program in Bahrain: Formative and Pilot Research %A Rulison,Kelly %A Weaver,GracieLee %A Milroy,Jeffrey %A Beamon,Emily %A Kelly,Samantha %A Ameeni,Ali %A Juma,Amina %A Abualgasim,Fadhel %A Husain,Jaafar %A Wyrick,David %+ Prevention Strategies, 9 Provence Ct, Greensboro, NC, 27410, United States, 1 3366885770, kelly@preventionstrategies.com %K Antiextremism %K peaceful coexistence %K intervention %K evaluation %K international %K multiphase optimization strategy %K preparation phase %K extremism %K extremist %K peace %K peaceful %K resistance %K violent %K violence %K radical %K radicalism %K Bahrain %K education %K educational %K school %K schools %K student %K students %K drug %K drugs %K abuse %K substance %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Extremism continues to raise concerns about conflict and violent attacks that can lead to deaths, injuries, trauma, and stress. Adolescents are especially vulnerable to radicalization by extremists. Given its location in a region that often experiences extremism, Bahrain developed 4 peaceful coexistence lessons and 4 antiextremism lessons to be implemented as part of their Drug Abuse Resistance Education (D.A.R.E.) program. Objective: The aim of this study is to report the results of the preparation phase of the multiphase optimization strategy (MOST) to develop a peaceful coexistence program and an antiextremism program implemented by D.A.R.E. officers in Bahrain. Methods: We developed conceptual models for the peaceful coexistence and antiextremism programs, indicating which mediators each lesson should target, the proximal outcomes that should be shaped by these mediators, and the distal and ultimate outcomes that the intervention should change. We recruited 20 middle schools to pilot test our research protocol, survey measures, and the existing intervention lessons. A total of 854 seventh and ninth grade students completed a pretest survey, 4 peaceful coexistence intervention lessons, and an immediate posttest survey; and a total of 495 ninth grade students completed the pretest survey, 4 antiextremism lessons, and an immediate posttest survey. A series of 3-level models, nesting students within classrooms within schools, tested mean differences from pretest to posttest. Results: Pilot test results indicated that most measures had adequate reliability and provided promising evidence that the existing lessons could change some of the targeted mediators and proximal outcomes. Specifically, students who completed the peaceful coexistence lessons reported significant changes in 5 targeted mediating variables (eg, injunctive norms about intolerance, P<.001) and 3 proximal outcomes [eg, social skills empathy (P=.008); tolerance beliefs (P=.041)]. Students who completed the antiextremism lessons reported significant changes in 3 targeted mediators [eg, self-efficacy to use resistance skills themselves (P<.001)], and 1 proximal outcome (ie, social skills empathy, P<.001). Conclusions: An effective antiextremism program has the potential to protect youth from radicalization and increase peaceful coexistence. We used the preparation phase of MOST to (1) develop a conceptual model, (2) identify the 4 lessons in each program as the components we will evaluate in the optimization phase of MOST, (3) pilot test the existing lessons, our newly developed measures, and research protocol, and (4) determine that our optimization objective will be all effective components. We will use these results to revise the existing lessons and conduct optimization trials to evaluate the efficacy of the individual lessons. %M 39018090 %R 10.2196/58322 %U https://formative.jmir.org/2024/1/e58322 %U https://doi.org/10.2196/58322 %U http://www.ncbi.nlm.nih.gov/pubmed/39018090 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54486 %T Standard Versus Family-Based Screening, Brief Intervention, and Referral to Treatment for Adolescent Substance Use in Primary Care: Protocol for a Multisite Randomized Effectiveness Trial %A Hogue,Aaron %A Porter,Nicole P %A Ozechowski,Timothy J %A Becker,Sara J %A O'Grady,Megan A %A Bobek,Molly %A Cerniglia,Monica %A Ambrose,Kevin %A MacLean,Alexandra %A Hadland,Scott E %A Cunningham,Hetty %A Bagley,Sarah M %A Sherritt,Lon %A O'Connell,Maddie %A Shrier,Lydia A %A Harris,Sion Kim %+ Family and Adolescent Clinical Technology & Science, Partnership to End Addiction, 711 Third Avenue, Suite 500, New York, NY, 10017, United States, 1 2126559566, nporter@toendaddiction.org %K adolescent substance use %K pediatric primary care %K screening %K brief intervention %K referral to treatment %K family-based %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Screening, brief intervention, and referral to treatment for adolescents (SBIRT-A) is widely recommended to promote detection and early intervention for alcohol and other drug (AOD) use in pediatric primary care. Existing SBIRT-A procedures rely almost exclusively on adolescents alone, despite the recognition of caregivers as critical protective factors in adolescent development and AOD use. Moreover, controlled SBIRT-A studies conducted in primary care have yielded inconsistent findings about implementation feasibility and effects on AOD outcomes and overall developmental functioning. There is urgent need to investigate the value of systematically incorporating caregivers in SBIRT-A procedures. Objective: This randomized effectiveness trial will advance research and scope on SBIRT-A in primary care by conducting a head-to-head test of 2 conceptually grounded, evidence-informed approaches: a standard adolescent-only approach (SBIRT-A-Standard) versus a more expansive family-based approach (SBIRT-A-Family). The SBIRT-A-Family approach enhances the procedures of the SBIRT-A-Standard approach by screening for AOD risk with both adolescents and caregivers; leveraging multidomain, multireporter AOD risk and protection data to inform case identification and risk categorization; and directly involving caregivers in brief intervention and referral to treatment activities. Methods: The study will include 2300 adolescents (aged 12-17 y) and their caregivers attending 1 of 3 hospital-affiliated pediatric settings serving diverse patient populations in major urban areas. Study recruitment, screening, randomization, and all SBIRT-A activities will occur during a single pediatric visit. SBIRT-A procedures will be delivered digitally on handheld tablets using patient-facing and provider-facing programming. Primary outcomes (AOD use, co-occurring behavior problems, and parent-adolescent communication about AOD use) and secondary outcomes (adolescent quality of life, adolescent risk factors, and therapy attendance) will be assessed at screening and initial assessment and 3-, 6-, 9-, and 12-month follow-ups. The study is well powered to conduct all planned main and moderator (age, sex, race, ethnicity, and youth AOD risk status) analyses. Results: This study will be conducted over a 5-year period. Provider training was initiated in year 1 (December 2023). Participant recruitment and follow-up data collection began in year 2 (March 2024). We expect the results from this study to be published in early 2027. Conclusions: SBIRT-A is widely endorsed but currently underused in pediatric primary care settings, and questions remain about optimal approaches and overall effectiveness. In particular, referral to treatment procedures in primary care remains virtually untested among youth. In addition, whereas research strongly supports involving families in interventions for adolescent AOD, SBIRT-A effectiveness trial testing approaches that actively engage family members in primary care are absent. This trial is designed to help fill these research gaps to inform the critical health decision of whether and how to include caregivers in SBIRT-A activities conducted in pediatric primary care. Trial Registration: ClinicalTrials.gov NCT05964010; https://www.clinicaltrials.gov/study/NCT05964010 International Registered Report Identifier (IRRID): PRR1-10.2196/54486 %M 38819923 %R 10.2196/54486 %U https://www.researchprotocols.org/2024/1/e54486 %U https://doi.org/10.2196/54486 %U http://www.ncbi.nlm.nih.gov/pubmed/38819923 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55470 %T Brief Parent-Child Substance Use Education Intervention for Black Families in Urban Cities in New Jersey: Protocol for a Formative Study Design %A Opara,Ijeoma %A Pierre,Kimberly %A Cayo,Sandy %A Aneni,Kammarauche %A Mwai,Catherine %A Hogue,Aaron %A Becker,Sara %+ Yale University School of Public Health, 60 College Street, New Haven, CT, 06510, United States, 1 2037852867, ijeoma.opara@yale.edu %K black families %K parents %K drug use %K prevention %K urban community %D 2024 %7 9.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Substance use continues to remain a public health issue for youths in the United States. Black youths living in urban communities are at a heightened risk of poor outcomes associated with substance use and misuse due to exposure to stressors in their neighborhoods, racial discrimination, and lack of prevention education programs specifically targeting Black youths. Many Black youths, especially those who live in urban communities, do not have access to culturally tailored interventions, leaving a critical gap in prevention. Since family is a well-known protective factor against substance misuse for Black youths, it is essential to create sustainable and accessible programming that incorporates Black youths’ and their families’ voices to develop a suitable prevention program for them. Objective: We aim to understand the cultural and environmental level factors that influence substance use among Black youths and develop a prevention program to increase parent-child substance use education among Black families. Methods: This study will take place within urban cities in New Jersey such as Paterson and East Orange, New Jersey, which will be the main study sites. Both cities have a large population of Black youths and this study’s team has strong ties with youths-serving organizations there. A formative, qualitative study will be conducted first. Using the first 3 steps of the ADAPT-ITT (Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing) framework we begin the development of an intervention for Black families. Three aims will be described: aim 1, collect qualitative data from Black parents and youths aged 11-17 years from parent-child dyads (N=20) on the challenges, barriers, and facilitators to communicating about substance use; aim 2, adapt a selected evidence-based intervention for Black families and develop a family advisory board to guide the adaptation; and aim 3 assess the feasibility of the intervention through theater testing, involving the family and community advisory board. Results: This study is part of a 2-year research pilot study award from the National Institutes of Drug Abuse. Data collection began in May 2023, and for aim 1, it is 95% complete. All aim 1 data collection is expected to be complete by December 30, 2023. Data analysis will immediately follow. Aim 2 activity will occur in spring 2024. Aim 3 activity may begin in fall 2024 and conclude in 2025. Conclusions: This study will be one of the few interventions that address substance use among youths and uses parents and families in urban communities as a protective factor within the program. We anticipate that the intervention will benefit Black youths not only in New Jersey but across the nation, working on building culturally appropriate, community-specific prevention education and building on strong families’ relationships, resulting in a reduction of or delayed substance use. International Registered Report Identifier (IRRID): DERR1-10.2196/55470 %M 38722676 %R 10.2196/55470 %U https://www.researchprotocols.org/2024/1/e55470 %U https://doi.org/10.2196/55470 %U http://www.ncbi.nlm.nih.gov/pubmed/38722676 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e56188 %T Factors Associated With Risky Drinking Decisions in a Virtual Reality Alcohol Prevention Simulation: Structural Equation Model %A Hrynyschyn,Robert %A Guldager,Julie Dalgaard %A Schulze,Daniel %A Lyk,Patricia Bianca %A Majgaard,Gunver %A Stock,Christiane %+ Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, Augustenburger Platz 1, Berlin, 13353, Germany, 49 30450529030, robert.hrynyschyn@charite.de %K alcohol %K prevention %K virtual reality %K risk behavior %K structural equation model %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Risky alcohol consumption among adolescents is a significant public health concern in most Western countries. Various motives and factors (eg, sensation seeking, gender, reduced self-efficacy) known in the literature are associated with risky drinking decisions in real life. Efforts to tackle risky drinking decisions in real life through skills training to deal with social pressures have been successful. However, interventions of this nature require significant resources. Technological solutions, such as virtual reality (VR), offer advantages, as they enable immersive experiences that replicate real-life scenarios. However, a question persists pertaining to the fidelity of real-world behaviors within virtual environments. Objective: This study is exploratory and aims to ascertain if the established drinking motives and factors for risky drinking decisions are transferrable to the virtual environment in the simulation game VR FestLab and to uncover determinants linked to risky drinking decisions within the simulation. Methods: The study analyzed data from the intervention arm of a cluster-randomized study of 161 Danish students aged 14-18 years who tested the virtual alcohol prevention simulation VR FestLab. At baseline and before playing VR FestLab, independent variables such as age, gender, alcohol consumption, use of other drugs, sensation seeking, drinking refusal skills, knowledge of blood alcohol concentration, and refusal communication skills were recorded. The dependent variable, virtual risk decisions, was measured immediately after the gameplay. Confirmatory factor analysis and structural equation modeling were used to examine the latent variables in relation to virtual risk decisions. Moderation analyses for age and gender in relation to the latent characteristics and the primary outcome were also conducted. Results: The data indicate that 73.9% (119/161) of the participants engaged in binge drinking at least once in their lifetime. The confirmatory factor analysis demonstrated a good fit of the items for their respective constructs; therefore, they were adopted without modification in the structural equation model. The data suggest that individuals with prior alcohol experience are 4 times more likely to engage in virtual risk decisions within the simulated environment (odds ratio 4.31, 95% CI 1.70-10.84; P=.01). Knowledge and awareness of blood alcohol concentration were associated with a lower chance to engage in virtual risk decisions (odds ratio 0.32, 95% CI 0.11-0.93; P=.04). However, no significant associations were found between virtual risk decisions and other latent variables. Gender and age did not moderate the associations. Conclusions: The immersive and lifelike properties of VR partially reflected risk-related decisions. However, it remains unclear which factors favor the mapping of real-world behaviors in virtual simulations. Therefore, future research should address the mechanisms underlying behavioral dynamics in virtual simulations and explore the translation of virtual behaviors into real behaviors to gain a comprehensive understanding of the potential of virtual simulations for alcohol prevention. %R 10.2196/56188 %U https://xr.jmir.org/2024/1/e56188 %U https://doi.org/10.2196/56188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55031 %T Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies %A Côté,José %A Chicoine,Gabrielle %A Vinette,Billy %A Auger,Patricia %A Rouleau,Geneviève %A Fontaine,Guillaume %A Jutras-Aswad,Didier %+ Research Centre of the Centre Hospitalier de l’Université de Montréal, 850 Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000, jose.cote@umontreal.ca %K cannabis %K young adults %K digital intervention %K systematic review %K meta-analysis %K behavior change technique analysis %K mobile phone %D 2024 %7 17.4.2024 %9 Review %J J Med Internet Res %G English %X Background: The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. Objective: We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. Methods: We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. Results: Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by −6.79 days of use in the previous month (95% CI −9.59 to −4.00; P<.001). Conclusions: Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. Trial Registration: PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959 %M 38630515 %R 10.2196/55031 %U https://www.jmir.org/2024/1/e55031 %U https://doi.org/10.2196/55031 %U http://www.ncbi.nlm.nih.gov/pubmed/38630515 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55039 %T Computer-Facilitated Screening and Brief Intervention for Alcohol Use Risk in Adolescent Patients of Pediatric Primary Care Offices: Protocol for a Cluster Randomized Controlled Trial %A Shrier,Lydia A %A O'Connell,Madison M %A Torres,Alessandra %A Shone,Laura P %A Fiks,Alexander G %A Plumb,Julia A %A Maturo,Jessica L %A McCaskill,Nicholas H %A Harris,Donna %A Burke,Pamela J %A Felt,Thatcher %A Murphy,Marie Lynd %A Sherritt,Lon %A Harris,Sion Kim %+ Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, 300 Longwood Ave, Mailstop 3189, Boston, MA, 02115, United States, 1 617 355 8306, lydia.shrier@childrens.harvard.edu %K alcohol %K substance use %K adolescent %K primary care %K prevention %K intervention %K screening %K brief intervention %K computer-facilitated screening and brief intervention %K cSBI %K mobile phone %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol and other substance use disorders usually begin with substance use in adolescence. Pediatric primary care offices, where most adolescents receive health care, are a promising venue for early identification of substance use and for brief intervention to prevent associated problems and the development of substance use disorder. Objective: This study tests the effects of a computer-facilitated screening and brief intervention (cSBI) system (the CRAFFT [Car, Relax, Alone, Forget, Family/Friends, Trouble] Interactive System [CRAFFT-IS]) on heavy episodic drinking, riding with a driver who is substance impaired, or driving while substance impaired among adolescents aged 14 to 17 years presenting for a well visit at pediatric primary care practices. Methods: We are conducting a cluster randomized controlled trial of the CRAFFT-IS versus usual care and recruiting up to 40 primary care clinicians at up to 20 pediatric primary care practices within the American Academy of Pediatrics (AAP) Pediatric Research in Office Settings network. Clinicians are randomized 1:1 within each practice to implement the CRAFFT-IS or usual care with a target sample size of 1300 adolescent patients aged 14 to 17 years. At study start, intervention clinicians complete web-based modules, trainer-led live sessions, and mock sessions to establish baseline competency with intervention counseling. Adolescents receive mailed recruitment materials that invite adolescents to complete an eligibility survey. Eligible and interested adolescents provide informed assent (parental permission requirement has been waived). Before their visit, enrolled adolescents seeing intervention clinicians complete a self-administered web-based CRAFFT screening questionnaire and view brief psychoeducational content illustrating substance use–associated health risks. During the visit, intervention clinicians access a computerized summary of the patient’s screening results and a tailored counseling script to deliver a motivational interviewing–based brief intervention. All participants complete previsit, postvisit, and 12-month follow-up study assessments. Primary outcomes include past 90-day heavy episodic drinking and riding with a driver who is substance impaired at 3-, 6-, 9-, and 12-month follow-ups. Multiple logistic regression modeling with generalized estimating equations and mixed effects modeling will be used in outcomes analyses. Exploratory aims include examining other substance use outcomes (eg, cannabis and nicotine vaping), potential mediators of intervention effect (eg, self-efficacy not to drink), and effect moderation by baseline risk level and sociodemographic characteristics. Results: The AAP Institutional Review Board approved this study. The first practice and clinicians were enrolled in August 2022; as of July 2023, a total of 6 practices (23 clinicians) had enrolled. Recruitment is expected to continue until late 2024 or early 2025. Data collection will be completed in 2025 or 2026. Conclusions: Findings from this study will inform the promotion of high-quality screening and brief intervention efforts in pediatric primary care with the aim of reducing alcohol-related morbidity and mortality during adolescence and beyond. Trial Registration: ClinicalTrials.gov NCT04450966; https://www.clinicaltrials.gov/study/NCT04450966 International Registered Report Identifier (IRRID): DERR1-10.2196/55039 %M 38530346 %R 10.2196/55039 %U https://www.researchprotocols.org/2024/1/e55039 %U https://doi.org/10.2196/55039 %U http://www.ncbi.nlm.nih.gov/pubmed/38530346 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e47216 %T Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial %A Cordova,David %A Bauermeister,José A %A Warner,Sydni %A , %A Wells,Patricia %A MacLeod,Jennifer %A Neilands,Torsten B %A Mendoza Lua,Frania %A Delva,Jorge %A Fessler,Kathryn Bondy %A Smith Jr,Versell %A Khreizat,Sarah %A Boyer,Cherrie %+ School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, United States, 1 734 763 6201, cordovad@umich.edu %K youth %K mHealth %K HIV %K STI %K illicit drugs %K primary care %K prevention %K public health %K USA %K teens %K drugs %K drug use %K sex %K racial minority %K risk behavior %K engagement %K tool %K substance use disorder %D 2024 %7 19.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents. Objective: To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan. Methods: In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices. Results: This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024. Conclusions: This study has the potential to improve public health by preventing HIV/STI and substance use disorders. Trial Registration: ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456 International Registered Report Identifier (IRRID): DERR1-10.2196/47216 %M 38373025 %R 10.2196/47216 %U https://www.researchprotocols.org/2024/1/e47216 %U https://doi.org/10.2196/47216 %U http://www.ncbi.nlm.nih.gov/pubmed/38373025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51812 %T Assessing the Impact of a Serious Game (MedSMARxT: Adventures in PharmaCity) in Improving Opioid Safety Awareness Among Adolescents and Parents: Quantitative Study %A Abraham,Olufunmilola %A McCarthy,Tyler James %A Zaborek,Jen %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Room 2515 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, United States, 1 608 263 4498, olufunmilola.abraham@wisc.edu %K adolescent %K opioid %K medication safety %K serious games %K gamification %K health behavior %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The opioid crisis continues to worsen across the United States, affecting people of all demographics. Few evidence-based interventions exist for educating families, particularly those with adolescents, about opioid prescription safety. Serious games have demonstrated impacts in improving medication-related outcomes for various health conditions. The characterizing goal of this serious game is to improve opioid safety knowledge and awareness among adolescents and their families. Objective: This study evaluated the impact of a serious game, MedSMARxT: Adventures in PharmaCity, designed to foster opioid safety awareness among adolescents and their parents. Methods: A national sample of parents and their adolescent children was recruited through Qualtrics research panels, social media, listservs, and snowball sampling. Eligible participants were adolescents aged between 12 and 18 years and their parents. Study participants were required to reside in the United States; speak, read, and understand English; and have access to a computer with a webcam. Parent-child dyads completed pregame and postgame surveys and participated in gameplay for up to 30 minutes. Primary outcome scales have been previously evaluated by the study team. Results: A total of 60 adolescent participants and 68 parent participants met full attention criteria for inclusion in this study. Statistical analysis confirmed that both adolescents’ and parents’ concept scores improved from baseline regarding opioid safety self-efficacy (adolescent: mean 0.35, SD 0.60; P<.001; parent: mean 0.28, SD 0.42; P<.001), perceived knowledge (adolescent: mean 1.08, SD 1.04; P<.001; parent: mean 0.56, SD 0.55; P<.001), behavioral intent (adolescent: mean 0.26, SD 0.39; P<.001; parent: mean 0.25, SD 0.32; P<.001), safe storage (adolescent: mean 0.12, SD 0.27; P<.001; parent: mean 0.03, SD 0.11; P=.03), disposal knowledge (adolescent: mean 0.10, SD 0.27; P=.006; parent: mean 0.07, SD 0.16; P<.001), and knowledge about misuse behavior (adolescent: mean 0.05, SD 0.14; P=.002; parent: mean 0.04, SD 0.10; P<.001). Participant groups, stratified by who completed and who did not complete gameplay, improved their knowledge and awareness, with no significant differences between subgroups. Conclusions: The use of this serious game to improve opioid prescription safety practices among parents and adolescents was supported by the study findings. MedSMARxT: Adventures in PharmaCity is an intervention with the capability of teaching parents and adolescents about safe opioid prescription practices. Further studies and game refinement are needed to demonstrate the effectiveness of a game-based intervention in clinical settings and community pharmacies. %M 38060287 %R 10.2196/51812 %U https://formative.jmir.org/2023/1/e51812 %U https://doi.org/10.2196/51812 %U http://www.ncbi.nlm.nih.gov/pubmed/38060287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47354 %T Integrated Alcohol Use and Sexual Assault Prevention Program for College Men Who Engage in Heavy Drinking: Randomized Pilot Study %A Orchowski,Lindsay M %A Merrill,Jennifer E %A Oesterle,Daniel W %A Barnett,Nancy P %A Borsari,Brian %A Zlotnick,Caron %A Haikalis,Michelle P %A Bekowitz,Alan D %+ Rhode Island Hospital, 146 West River Street, Suite 11A, Providence, RI, 02904, United States, 1 401 444 7021, lindsay_orchowski@brown.edu %K sexual assault %K alcohol use %K prevention %K student %K men %K alcoholism %K college %K intervention %K program %K peer engagement %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing. Objective: This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking. Methods: This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined. Results: The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months. Conclusions: The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink. Trial Registration: ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027 %M 37995129 %R 10.2196/47354 %U https://formative.jmir.org/2023/1/e47354 %U https://doi.org/10.2196/47354 %U http://www.ncbi.nlm.nih.gov/pubmed/37995129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50833 %T An eHealth Prevention Program for Substance Use, Sexual Assault, and Sexual Risk Behaviors for Adolescents in Primary Care: Pilot Feasibility Randomized Controlled Trial of Teen Well Check %A Gilmore,Amanda K %A Fortson,Kennicia %A Mullican,K Nicole %A García-Ramírez,Grisel %A Hutchins,Anna %A Bartlett,Alyssa M %A Gooding,Holly C %A Wallis,Elizabeth %A Levy,Sharon %A Ruggiero,Kenneth J %A Kaysen,Debra %A Danielson,Carla Kmett %A Platner,Robert %A Hartman,April %A Self-Brown,Shannon %+ Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302, United States, agilmore12@gsu.edu %K prevention %K adolescents %K eHealth %K drug use %K sexual assault %K sexual health %D 2023 %7 2.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use, sexual assault, and sexual risk behaviors are common among adolescents and are interrelated. Nearly 1 in 5 adolescents use substances before sexual encounters, placing these young people at risk for both sexual assault and sexual risk behaviors. Primary care visits present a unique opportunity to address multiple health risk behaviors. Objective: Teen Well Check is a web-based integrated prevention program for substance use, sexual assault, and sexual risk behaviors with demonstrated usability and acceptability among patients and providers. The aim of this study was to conduct a pilot randomized controlled trial to assess feasibility. Methods: Adolescents (n=123) aged 14 to 18 years from diverse backgrounds were recruited from primarily Medicaid-serving pediatric primary care clinics. Participants completed a baseline survey; were randomized to receive Teen Well Check or an assessment-only control; and completed 1-, 3-, and 6-month follow-up surveys. Feasibility was assessed in terms of recruitment and retention rates. Preliminary changes from baseline to follow-up periods were examined separately in the Teen Well Check and control conditions. Results: We recruited 123 participants (Teen Well Check: n=61, 49.6%; control: n=62, 50.4%). Of the 61 participants assigned to the Teen Well Check condition, 55 (90%) completed the full program and viewed all intervention content. Of the 123 participants, 105 (85.4%) were retained across at least 1 follow-up period, and there was no difference in follow-up rates between the conditions (χ21=0.6; P=.43). The completion of Teen Well Check took an average of 6.2 (SD 5.8) minutes. Preliminary analyses revealed that there were significant reductions in perceived peer norms (descriptive norms) for substance use before sex across follow-ups among participants in the Teen Well Check condition (P=.001 from baseline to 6 months), whereas there were significant increases among participants in the control condition (P=.003 from baseline to 6 months). In addition, there were nonsignificant reductions in substance misuse risk from baseline to the 6-month follow-up among participants in the Teen Well Check condition (P=.16). Conclusions: These findings support the feasibility of Teen Well Check delivery within pediatric primary care clinics. A randomized clinical trial is needed to assess efficacy. Trial Registration: ClinicalTrials.gov NCT3489434; https://www.clinicaltrials.gov/study/NCT03489434 %M 37917146 %R 10.2196/50833 %U https://formative.jmir.org/2023/1/e50833 %U https://doi.org/10.2196/50833 %U http://www.ncbi.nlm.nih.gov/pubmed/37917146 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46008 %T Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study %A Prior,Katrina %A Salemink,Elske %A Piggott,Monique %A Manning,Victoria %A Wiers,Reinout W %A Teachman,Bethany A %A Teesson,Maree %A Baillie,Andrew J %A Mahoney,Alison %A McLellan,Lauren %A Newton,Nicola C %A Stapinski,Lexine A %+ Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell building (G02), Sydney, 2006, Australia, 61 286279032, katrina.prior@sydney.edu.au %K alcohol %K anxiety %K cognitive bias modification %K interpretation bias %K approach bias %K young adult %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample. Objective: This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use (“Re-Train Your Brain”) when delivered in conjunction with treatment as usual (TAU). Methods: The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the “integrated” Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the “alternating” Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline. Results: Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes. Conclusions: Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non–labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): RR2-10.2196/28667 %M 37878363 %R 10.2196/46008 %U https://formative.jmir.org/2023/1/e46008 %U https://doi.org/10.2196/46008 %U http://www.ncbi.nlm.nih.gov/pubmed/37878363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45216 %T Evaluating a Peer-Support Mobile App for Mental Health and Substance Use Among Adolescents Over 12 Months During the COVID-19 Pandemic: Randomized Controlled Trial %A Birrell,Louise %A Debenham,Jennifer %A Furneaux-Bate,Ainsley %A Prior,Katrina %A Spallek,Sophia %A Thornton,Louise %A Chapman,Catherine %A Newton,Nicola %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building G02, Sydney, 2006, Australia, 61 2 8627 9003, louise.birrell@sydney.edu.au %K mental health %K substance use %K prevention %K school-based %K peer support %K anxiety %K social support %K psychosocial support systems %K depression %K adolescent %K mobile apps %K eHealth %K mHealth %K mobile phone %K COVID-19 %D 2023 %7 27.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Although it is well known that adolescents frequently turn to their friends for support around mental health and substance use problems, there are currently no evidence-based digital programs to support them to do this. Objective: The aim of this study was to evaluate the efficacy of the Mind your Mate program, a digital peer-support program, in improving mental health symptoms, reducing the uptake of substance use, and increasing help seeking. The Mind your Mate program consists of a 40-minute web-based classroom lesson and a companion smartphone mobile app. The active control group received school-based health education as usual. Methods: A cluster randomized controlled trial was conducted with 12 secondary schools and 166 students (mean age 15.3, SD 0.41 years; 72/166, 43.4% female; and 133/166, 80.1% born in Australia). Participants completed self-reported questionnaires assessing symptoms of mental health (depression, anxiety, and psychological distress), substance use (alcohol and other drug use), and help-seeking measures at baseline and at 6-month and 12-month follow-ups. Results: Students who received the Mind your Mate program had greater reductions in depressive symptoms over a 12-month period than controls (b=−1.86, 95% CI −3.73 to 0.02; Cohen d=−0.31). Anxiety symptoms decreased among students in the intervention group; however, these reductions did not meet statistical significance thresholds. No differences were observed in relation to psychological distress or help-seeking. Conclusions: Small to moderate reductions in depression symptoms were observed among students allocated to receive the Mind your Mate intervention. Although the current results are encouraging, there is a need to continue to refine, develop, and evaluate innovative applied approaches for the prevention of mental disorders in real-world settings. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000753954; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000753954 International Registered Report Identifier (IRRID): RR2-10.2196/26796 %M 37756116 %R 10.2196/45216 %U https://www.jmir.org/2023/1/e45216 %U https://doi.org/10.2196/45216 %U http://www.ncbi.nlm.nih.gov/pubmed/37756116 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e49382 %T Parents’ Perceptions of a Serious Game for Educating Families on Prescription Opioid Safety: Qualitative Pilot Study of MedSMARxT: Adventures in PharmaCity %A Abraham,Olufunmilola %A Nixon,Grace Ann %A Seitz,Laura Louise %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin-Madison, Room 2515 Rennebohm Hall, 777 Highland Avenue, Madison, WI, 53705, United States, 1 6082634498, olufunmilola.abraham@wisc.edu %K opioids %K opioid %K parents %K adolescents %K medication safety %K family health %K serious games %K parent %K adolescent %K youths %K gaming %K game %K games %K teenager %K teenagers %K acceptance %K perception %K perceptions %K patient education %K pharmacy %K pharmaceutic %K pharmaceutics %K pharmaceutical %K drug %K safety %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Opioid misuse is a pervasive, worsening problem that affects the health of people throughout the United States, including adolescents. There are few adolescent-focused interventions designed to educate them about opioid medication safety. The MedSMARxT: Adventures in PharmaCity, is a serious educational video game that teaches parents and their youths about safe opioid practices. Objective: This study aimed to elucidate parent’s perceptions of MedSMARxT: Adventures in PharmaCity and its potential use by parents and their adolescents. Methods: Parents of adolescents aged 12 to 18 years who live in the United States were recruited from April to October 2021 via Qualtrics research panels, social media, email listserves, and snowball sampling. The study participants played MedSMARxT: Adventures in PharmaCity for 30 minutes and then participated in a 30-minute postgame interview via WebEx (Cisco). Questions were developed and piloted to examine adults’ perceptions of the game. Participants were asked three sets of open-ended questions: (1) questions about the game and elements of the game, (2) what they learned from the game, and (3) questions about their experience with games. Audio recordings were transcribed verbatim. Interview transcripts were coded using content and thematic analysis by study team members to identify major themes and subthemes from the data. Results: Parent participants (N=67) played MedSMARxT: Adventures in PharmaCity and completed a postgame interview. Analysis extrapolated four primary themes from the data: (1) participant gaming experience, (2) perception of game features, (3) educational purpose of the game, and (4) future use of the game. Most participants (n=56, 84%), had at least some experience with video games. More than half of the participants (n=35, 52%) participants, had positive reactions to the game characters and scenes depicted in MedSMARxT: Adventures in PharmaCity and stated they were realistic for adolescents. Most participants (n=39, 58%), would recommend the game to others. Significant difficulties with gameplay navigation were reported by 38 (57%) participants, as well as a slow game pace. All participants were able to accurately identify the overarching goal of the game: opioid or medication safety. The game reinforced existing knowledge for participants, though many (n=15, 22%), reported a new awareness of the need to store opioid medications in a locked area and the availability of medication disposal drop boxes at pharmacies. Participants stated that they would recommend the game for future use by families and youths in various health care and non–health care settings. Conclusions: The use of a tailored serious game is a novel, engaging tool to educate adolescents on opioid safety. MedSMARxT: Adventures in PharmaCity can be used as a tool for parents and adolescents to facilitate meaningful dialogue about safe and appropriate opioid use. %M 37698899 %R 10.2196/49382 %U https://games.jmir.org/2023/1/e49382 %U https://doi.org/10.2196/49382 %U http://www.ncbi.nlm.nih.gov/pubmed/37698899 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43304 %T Digitally Assisted Peer Recovery Coach to Facilitate Linkage to Outpatient Treatment Following Inpatient Alcohol Withdrawal Treatment: Proof-of-Concept Pilot Study %A Suzuki,Joji %A Loguidice,Frank %A Prostko,Sara %A Szpak,Veronica %A Sharma,Samata %A Vercollone,Lisa %A Garner,Carol %A Ahern,David %+ Department of Psychiatry, Brigham and Women's Hospital, 60 Fenwood Rd, Room 4168, Boston, MA, 02474, United States, 1 6174557981, jsuzuki2@bwh.harvard.edu %K alcohol use disorder %K inpatient detoxification %K peer recovery coach %K smartphone app %K alcohol %K substance use %K substance abuse %K drinking %K recovery %K peer support %K detox %K coaching %K health app %K mobile health %K mHealth %K mobile app %K care coordination %K digitally %K detoxification %K Lifeguard %K peer recovery %K inpatient alcohol %D 2023 %7 5.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD), associated with significant morbidity and mortality, continues to be a major public health problem. The COVID-19 pandemic exacerbated the impact of AUD, with a 25% increase in alcohol-related mortality from 2019 to 2020. Thus, innovative treatments for AUD are urgently needed. While inpatient alcohol withdrawal management (detoxification) is often an entry point for recovery, most do not successfully link to ongoing treatment. Transitions between inpatient and outpatient treatment pose many challenges to successful treatment continuation. Peer recovery coaches—individuals with the lived experience of recovery who obtain training to be coaches—are increasingly used to assist individuals with AUD and may provide a degree of continuity during this transition. Objective: We aimed to evaluate the feasibility of using an existing care coordination app (Lifeguard) to assist peer recovery coaches in supporting patients after discharge and facilitating linkage to care. Methods: This study was conducted on an American Society of Addiction Medicine–Level IV inpatient withdrawal management unit within an academic medical center in Boston, MA. After providing informed consent, participants were contacted by the coach through the app, and after discharge, received daily prompts to complete a modified version of the brief addiction monitor (BAM). The BAM inquired about alcohol use, risky, and protective factors. The coach sent daily motivational texts and appointment reminders and checked in if BAM responses were concerning. Postdischarge follow-up continued for 30 days. The following feasibility outcomes were evaluated: (1) proportion of participants engaging with the coach before discharge, (2) proportion of participants and the number of days engaging with the coach after discharge, (3) proportion of participants and the number of days responding to BAM prompts, and (4) proportion of participants successfully linking with addiction treatment by 30-day follow-up. Results: All 10 participants were men, averaged 50.5 years old, and were mostly White (n=6), non-Hispanic (n=9), and single (n=8). Overall, 8 participants successfully engaged with the coach prior to discharge. Following discharge, 6 participants continued to engage with the coach, doing so on an average of 5.3 days (SD 7.3, range 0-20 days); 5 participants responded to the BAM prompts during the follow-up, doing so on an average of 4.6 days (SD 6.9, range 0-21 days). Half (n=5) successfully linked with ongoing addiction treatment during the follow-up. The participants who engaged with the coach post discharge, compared to those who did not, were significantly more likely to link with treatment (83% vs 0%, χ2=6.67, P=.01). Conclusions: The results demonstrated that a digitally assisted peer recovery coach may be feasible in facilitating linkage to care following discharge from inpatient withdrawal management treatment. Further research is warranted to evaluate the potential role for peer recovery coaches in improving postdischarge outcomes. Trial Registration: ClinicalTrials.gov NCT05393544; https://www.clinicaltrials.gov/ct2/show/NCT05393544 %M 37405844 %R 10.2196/43304 %U https://formative.jmir.org/2023/1/e43304 %U https://doi.org/10.2196/43304 %U http://www.ncbi.nlm.nih.gov/pubmed/37405844 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46486 %T Assessing the Feasibility of Economic Approaches to Prevent Substance Abuse Among Adolescents: Protocol for a Mixed Methods Study %A Brathwaite,Rachel %A Mutumba,Massy %A Nanteza,Jacqueline %A Filiatreau,Lindsey M %A Migadde,Herbert %A Namatovu,Phionah %A Nabisere,Betina %A Mugisha,James %A Mwebembezi,Abel %A Ssewamala,Fred M %+ Brown School, Washington University in St. Louis, Campus Box 1196, One Brookings Drive, St Louis, MO, 63130, United States, 1 3149351775, rachel.brathwaite@wustl.edu %K adolescents living with HIV %K alcohol %K Sub-Saharan Africa %K substance use %K Uganda %D 2023 %7 14.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescent alcohol and drug use (ADU) is a significant public health challenge. Uganda, one of the poorest countries in Sub-Saharan Africa (SSA), has the second-highest rate of per capita alcohol consumption in SSA, and over one-third of Ugandan adolescents have used alcohol in their lifetime (over 50% of them engage in heavy episodic drinking). These estimates further increase in fishing villages, a key HIV-vulnerable population, where ADU is normative. However, few studies have assessed ADU among adolescents and youths living with HIV despite their increased risk for ADU and its impact on engagement in HIV care. Moreover, data on risk and resilience factors for ADU are scarce as only few studies evaluating ADU interventions in SSA have reported positive outcomes. The majority have been implemented in school settings, potentially excluding adolescents in fishing communities with high school dropout rates, and none have targeted risk factors including poverty and mental health, which are rampant among adolescents and youths living with HIV and their families, undermine their coping skills and resources, and have been associated with increased risk for ADU among them. Objective: We propose a mixed methods study with a sample of 200 adolescents and youths living with HIV (aged 18-24 years) seen at 6 HIV clinics in southwestern Uganda’s fishing communities to (1) examine the prevalence and consequences of ADU and identify the multilevel risk and resilience factors associated with ADU among them and (2) explore the feasibility and short-term effects of an economic empowerment intervention on ADU among them. Methods: This study comprises four components: (1) focus group discussions (FGDs) with adolescents and youths living with HIV (n=20) and in-depth qualitative interviews with health providers (n=10) from 2 randomly selected clinics; (2) a cross-sectional survey with 200 adolescents and youths living with HIV; (3) a randomized controlled trial with a subgroup of adolescents and youths living with HIV (n=100); and (4) 2 postintervention FGD with adolescents and youths living with HIV (n=10 per group). Results: Participant recruitment for the first qualitative phase has completed. As of May 4, 2023, ten health providers from 6 clinics have been recruited, provided written consent to participate, and participated in in-depth qualitative interviews. Two FGDs was conducted with 20 adolescents and youths living with HIV from 2 clinics. Data transcription, translation, and analysis of qualitative data has commenced. The cross-sectional survey will commence shortly after and dissemination of the main study findings is targeted for 2024. Conclusions: Our findings will advance our understanding of ADU among adolescents and youths living with HIV and inform the design of future interventions to address ADU among them. Trial Registration: ClinicalTrials.gov NCT05597865; https://clinicaltrials.gov/ct2/show/NCT05597865 International Registered Report Identifier (IRRID): PRR1-10.2196/46486 %M 37314844 %R 10.2196/46486 %U https://www.researchprotocols.org/2023/1/e46486 %U https://doi.org/10.2196/46486 %U http://www.ncbi.nlm.nih.gov/pubmed/37314844 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46136 %T Promoting Social Participation and Recovery Using Virtual Reality–Based Interventions Among People With Mental Health and Substance Use Disorders: Qualitative Study %A Aasen,Jan %A Galaaen,Kari %A Nilsson,Fredrik %A Sørensen,Torgeir %A Lien,Lars %A Leonhardt,Marja %+ Norwegian National Advisory Unit on Concurrent Substance Use and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, Brummundal, 2381, Norway, 47 99428096, jan.aasen@sykehuset-innlandet.no %K mental health disorders and substance use disorders %K MHD %K SUD %K recovery %K social participation %K social functioning impairments %K virtual reality–based interventions %K VRI %K reflexive thematic analysis %K qualitative study %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People with mental health disorders (MHDs) and substance use disorders (SUDs) are a highly vulnerable group, particularly affected by social exclusion, marginalization, and disconnectedness. Virtual reality technology holds a potential for simulating social environments and interactions to mitigate the social barriers and marginalization faced by people recovering from MHDs and SUDs. However, it is still unclear how we can harness the greater ecological validity of virtual reality–based interventions targeting social and functional impairments in individuals with MHDs and SUDs. Objective: The aim of this paper was to explore how service providers in community-based MHD and SUD health care services perceive the barriers to social participation among adults recovering from MHDs and SUDs to provide a broader understanding of how learning experiences can be modeled to promote social participation in virtual reality environments. Methods: Two semistructured, open-ended, and dual-moderator focus group interviews were conducted with participants representing different community-based MHD and SUD health care services. Service providers were recruited from their MHD and SUD services in our collaborating municipality in Eastern Norway. We recruited the first participant group at a municipal MHD and SUD assisted living facility for service users with ongoing excessive substance use and severe social dysfunctionality. We recruited the second participant group at a community-based follow-up care service aimed at clients with a broad range of MHDs and SUDs and various levels of social functioning. The qualitative data extracted in the interviews were analyzed, using reflexive thematic analysis. Results: The analysis of the service providers’ perceptions of the barriers to social participation among clients with MHDs and SUDs revealed the following five main themes: challenging or lacking social connections, impaired cognitive functions, negative self-perception, impaired personal functioning, and insufficient social security. The barriers identified are interrelated in a cluster of cognitive, socioemotional, and functional impairments, leading to a severe and diverse complex of barriers to social participation. Conclusions: Social participation relies on people’s capability to use their present social opportunities. Promoting basic human functioning is key to promoting social participation among people with MHDs and SUDs. The findings in this study indicate a need to address cognitive functioning, socioemotional learning, instrumental skills, and complex social functions to meet the complexity and diversity of the identified barriers to social functioning in our target group. Virtual reality–based interventions for promoting social participation should be sequenced into distinct scenarios dedicated to specific learning goals to build complex learning in a step-by-step process based on successively more complex levels of human and social functioning. %M 37104000 %R 10.2196/46136 %U https://formative.jmir.org/2023/1/e46136 %U https://doi.org/10.2196/46136 %U http://www.ncbi.nlm.nih.gov/pubmed/37104000 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43653 %T Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial %A Karnik,Niranjan S %A Kuhns,Lisa M %A Hotton,Anna L %A Del Vecchio,Natascha %A McNulty,Moira %A Schneider,John %A Donenberg,Geri %A Keglovitz Baker,Kristin %A Diskin,Rose %A Muldoon,Abigail %A Rivera,Juan %A Summersett Williams,Faith %A Garofalo,Robert %+ Institute for Juvenile Research, Department of Psychiatry, University of Illinois Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 3122730185, nkarnik@uic.edu %K HIV prevention %K men who have sex with men %K transgender women %K alcohol intervention %K HIV %K gay %K homosexual %K MSM %K alcohol %K youth %K screening %K sexual behavior %K sexual behavior %K sexual risk %K risky %K pre-exposure prophylaxis %K prophylaxis %K prevention %K efficacy %K adolescent %K young adult %K testing %K risk %D 2023 %7 29.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction. Objective: The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention. Methods: Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy. Results: Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement. Conclusions: We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing. Trial Registration: ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-8154-6 %M 36989027 %R 10.2196/43653 %U https://mental.jmir.org/2023/1/e43653 %U https://doi.org/10.2196/43653 %U http://www.ncbi.nlm.nih.gov/pubmed/36989027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43986 %T Cross-Tailoring Integrative Alcohol and Risky Sexual Behavior Feedback for College Students: Protocol for a Hybrid Type 1 Effectiveness-Implementation Trial %A Ray,Anne E %A Mun,Eun-Young %A Lewis,Melissa A %A Litt,Dana M %A Stapleton,Jerod L %A Tan,Lin %A Buller,David B %A Zhou,Zhengyang %A Bush,Heather M %A Himelhoch,Seth %+ Department of Health, Behavior & Society, College of Public Health, University of Kentucky, 151 Washington Ave, Lexington, KY, 40536, United States, 1 859 218 4944, anne.ray@uky.edu %K alcohol-related risky sexual behavior %K college students %K cross-tailored dynamic feedback %K effectiveness-implementation hybrid designs %K personalized feedback intervention %K underage drinking %D 2023 %7 20.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Underage drinking and related risky sexual behavior (RSB) are major public health concerns on United States college campuses. Although technology-delivered personalized feedback interventions (PFIs) are considered a best practice for individual-level campus alcohol prevention, there is room for improving the effectiveness of this approach with regard to alcohol-related RSB. Objective: The aims of this study are to (1) evaluate the impact of a brief PFI that integrates content on alcohol use and RSB and is adapted to include a novel cross-tailored dynamic feedback (CDF) component for at-risk first-year college students and (2) identify implementation factors critical to the CDF’s success to facilitate future scale-up in campus settings. Methods: This study uses a hybrid type 1 effectiveness-implementation design and will be conducted in 3 phases. Phase 1 is a stakeholder-engaged PFI+CDF adaptation guided by focus groups and usability testing. In phase 2, 600 first-year college students who drink and are sexually active will be recruited from 2 sites (n=300 per site) to participate in a 4-group randomized controlled trial to examine the effectiveness of PFI+CDF in reducing alcohol-related RSB. Eligible participants will complete a baseline survey during the first week of the semester and follow-up surveys at 1, 2, 3, 6, and 13 months post baseline. Phase 3 is a qualitative evaluation with stakeholders to better understand relevant implementation factors. Results: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phases 2 and 3 is planned for the summer of 2023 and 2024, respectively. Upon collection of data, the effectiveness of PFI+CDF will be examined, and factors critical to implementation will be evaluated. Conclusions: This hybrid type 1 trial is designed to impact the field by testing an innovative adaptation that extends evidence-based alcohol programs to reduce alcohol-related RSB and provides insights related to implementation to bridge the gap between research and practice at the university level. Trial Registration: ClinicalTrials.gov NCT05011903; https://clinicaltrials.gov/ct2/show/NCT05011903 International Registered Report Identifier (IRRID): DERR1-10.2196/43986 %M 36716301 %R 10.2196/43986 %U https://www.researchprotocols.org/2023/1/e43986 %U https://doi.org/10.2196/43986 %U http://www.ncbi.nlm.nih.gov/pubmed/36716301 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e37873 %T Effectiveness of a Mobile App to Increase Risk Perception of Tobacco, Alcohol, and Marijuana Use in Mexican High School Students: Quantitative Study %A Fuentes A,Patricia María del Carmen %A Jiménez Tapia,Alberto %A Ruiz-Cortés,Eunice M %A Bolaños-Ceballos,Fernando %A Flores Castro,Julio César %A Gutiérrez,Rafael %A González-Forteza,Catalina %+ Direction of Epidemiological and Psychosocial Research, National Institute of Psychiatry Ramón de la Fuente Muñiz, Calzada Mexico Xochimilco, 101, Mexico City, 14370, Mexico, 52 5541605154, alberjt1969@gmail.com %K adolescents %K students %K risk perception %K tobacco %K alcohol %K marijuana %K mobile apps %K apps %K substance use %K prevention %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young people have the highest rate of drug use worldwide. Recent data from Mexico in this population show that the prevalence of illicit drug use doubled between 2011 and 2016 (2.9%-6.2%), with marijuana being the one with the highest increase (2.4%-5.3%), but also point out that alcohol and tobacco use have remained steady or decreased. Mexican adolescents are at high risk for drug use owing to a low perception of risk and the availability of drugs. Adolescence is an ideal period to reduce or prevent risky behaviors using evidence-based strategies. Objective: In this study, we aimed to test the short-term effectiveness of a mobile intervention app (“What Happens if you Go Too Far?” [“¿Qué pasa si te pasas?”]) that seeks to increase risk perception of tobacco, alcohol, and marijuana use in a sample of Mexican high school students. Methods: A nonexperimental evaluation based on pretest-posttest design was used to measure the effectiveness of a preventive intervention using a mobile app, “What Happens If You Go Too Far?” The dimensions analyzed were knowledge of drugs and their effects, life skills, self-esteem, and risk perception. The intervention was conducted on a high school campus with 356 first-year students. Results: The sample included 359 first-year high school students (mean 15, SD 0.588 years; women: 224/359, 62.4% men: 135/359, 37.6%). The intervention increased the overall risk perception of tobacco (χ24=21.6; P<.001) and alcohol use (χ24=15.3; P<.001). There was no significant difference in the perception that it is dangerous to smoke 5 cigarettes, and there was a marginal difference in the perception that it is very dangerous to smoke 1 cigarette or to use alcohol or marijuana. We used a generalized estimating equation method to determine the impact of the variables on risk perception. The results showed that knowledge about smoking increased the risk perception of smoking 1 cigarette (odds ratio [OR] 1.1065, 95% CI 1.013-1.120; P=.01), and that knowledge about marijuana use (OR 1.109, 95% CI 1.138-1.185; P=.002) and self-esteem (OR 1.102, 95% CI 1.007-1.206; P=.04) produced significant increases in the risk perception of consuming 5 cigarettes. Resistance to peer pressure and assertiveness also increased the perceived risk of using tobacco and alcohol. Conclusions: The intervention has the potential to increase the perception of risk toward drug use in high school students by providing knowledge about the effects and psychosocial risks of drug use and by strengthening life skills that are associated with increased risk perception. The use of mobile technologies in intervention processes may broaden the scope of preventive work for adolescents. %M 36892918 %R 10.2196/37873 %U https://mhealth.jmir.org/2023/1/e37873 %U https://doi.org/10.2196/37873 %U http://www.ncbi.nlm.nih.gov/pubmed/36892918 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42538 %T Perceptions and Aspirations Toward Peer Mentoring in Social Media–Based Electronic Cigarette Cessation Interventions for Adolescents and Young Adults: Focus Group Study %A Lyu,Joanne Chen %A Afolabi,Aliyyat %A White,Justin S %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, San Francisco, CA, 94143-1390, United States, 1 415 502 4181, chenjoanne.lyu@ucsf.edu %K peer mentoring %K electronic nicotine delivery systems %K cessation %K social media %K adolescents and young adults %D 2022 %7 1.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media offer a promising channel to deliver e-cigarette cessation interventions to adolescents and young adults (AYAs); however, interventions delivered on social media face challenges of low participant retention and decreased engagement over time. Peer mentoring has the potential to ameliorate these challenges. Objective: The aim of this study was to understand, from both the mentee and potential mentor perspective, the needs, expectations, and concerns of AYAs regarding peer mentoring to inform the development of social media–based peer mentoring interventions for e-cigarette cessation among AYAs. Methods: Seven focus groups, including four mentee groups and three potential mentor groups, were conducted with 26 AYAs who had prior experience with e-cigarette use and attempts to quit in the context of a social media–based e-cigarette cessation intervention. Discussion focused on preferred characteristics of peer mentors, expectations about peer mentoring, mentoring mode, mentor training, incentives for peer mentors, preferred social media platforms for intervention delivery, supervision, and concerns. Focus group transcripts were coded and analyzed using a thematic analysis approach. Results: Overall, participants were receptive to peer mentoring in social media–based cessation interventions and believed they could be helpful in assisting e-cigarette cessation. Participants identified the most important characteristics of peer mentors to be of similar age and to be abstinent from e-cigarette use. Participants expected peer mentors would share personal experiences, provide emotional support, and send check-ins and reminders. Peer mentors supporting a group of mentees in combination with one-on-one mentoring as needed was the preferred mentoring mode. A group of 10 mentees with a mentor:mentee ratio of 1:3-5 was deemed acceptable for most participants. Participants expressed that mentor training should include emotional intelligence, communication skills, and the scientific evidence about e-cigarettes. Although monetary incentives were not the main motivating factor for being a peer mentor, they were viewed as a good way to compensate mentors’ time. Instagram was considered an appropriate social media platform to deliver a peer-mentored intervention due to its functionality. Participants did not express many privacy concerns about social media–based peer mentoring, but mentioned that boundaries and community agreements should be set to keep relationships professional. Conclusions: This study reflects the needs and preferences of young people for a peer mentoring intervention to complement a social media program to support e-cigarette cessation. The next step will be to establish the feasibility, acceptability, and preliminary efficacy of such a peer mentoring program. %M 36454628 %R 10.2196/42538 %U https://formative.jmir.org/2022/12/e42538 %U https://doi.org/10.2196/42538 %U http://www.ncbi.nlm.nih.gov/pubmed/36454628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42441 %T Themes in TikTok Videos Featuring Little Cigars and Cigarillos: Content Analysis %A Vassey,Julia %A Donaldson,Scott I %A Dormanesh,Allison %A Allem,Jon-Patrick %+ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 3rd Floor, SSB 312D, 1845 N Soto St, Los Angeles, CA, 90032, United States, 1 323 442 7921, allem@usc.edu %K cigarillo %K little cigar %K social media %K TikTok %K video %K cigar %K cigarette %K smoker %K smoking %K tobacco %K social media %K content analysis %K youth %K young adult %K adolescent %K user generated content %D 2022 %7 16.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Little cigars and cigarillos (LCCs) are popular tobacco products among youth (ie, adolescents and young adults). A variety of LCC-related promotional and user-generated content is present on social media. However, research on LCC-related posts on social media has been largely focused on platforms that are primarily text- or image-based, such as Twitter and Instagram. Objective: This study analyzed LCC-related content on TikTok, an audio and video–based platform popular among youth. Methods: Publicly available posts (N=811) that contained the LCC-related hashtags #swishersweets or #backwoods were collected on TikTok from January 2019 to May 2021. Metadata were also collected, including numbers of likes, comments, shares, and views per video. Using an inductive approach, a codebook consisting of 26 themes was developed to help summarize the underlying themes evident in the TikTok videos and corresponding captions. A pairwise co-occurrence analysis of themes was also conducted to evaluate connections among themes. Results: Among the 811 posts, the LCC presence theme (ie, a visible LCC) occurred in the most prominent number of posts (n=661, 81.5%), followed by music (n=559, 68.9%), youth (n=332, 40.9%), humor (n=263, 32.4%), LCC use (n=242, 29.8%), flavors (n=232, 28.6%), branding (n=182, 22.4%), paraphernalia (n=137, 16.9%), blunt rolling (n=94, 11.6%), and price (n=84, 10.4%). Product reviews had the highest engagement, with a median 44 (mean 2857, range 36,499) likes and median 491 (mean 15,711, range 193,590) views; followed by product comparisons, with a median 44 (mean 1920, range 36,500) likes and median 671 (mean 11,277, range 193,798) views. Promotions had the lowest engagement, with a median 4 (mean 8, range 34) likes and median 78 (mean 213, range 1131) views. The most prevalent themes co-occurring with LCC presence were (1) music (434/811, 53.5%), (2) youth (264/811, 32.6%), (3) humor (219/811, 27%), (4) flavors (214/811, 26.4%), and (5) LCC use (207/811, 25.5%). Conclusions: LCC-related marketing and user-generated content was present on TikTok, including videos showing youth discussing, displaying, or using LCCs. Such content may be in violation of TikTok’s community guidelines prohibiting the display, promotion, or posting of tobacco-related content on its platform, including the display of possession or consumption of tobacco by a minor. Further improvement in the enforcement of TikTok community guidelines and additional scrutiny from public health policy makers may be necessary for protecting youth from future exposure to tobacco-related posts. Observational and experimental studies are needed to understand the impact of exposure to LCC-related videos on attitudes and behaviors related to LCC use among youth. Finally, there may be a need for engaging antitobacco videos that appeal to youth on TikTok to counter the protobacco content on this platform. %M 36383406 %R 10.2196/42441 %U https://www.jmir.org/2022/11/e42441 %U https://doi.org/10.2196/42441 %U http://www.ncbi.nlm.nih.gov/pubmed/36383406 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e34721 %T Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study %A Stapinski,Lexine Ann %A Nepal,Smriti %A Guckel,Tara %A Grummitt,Lucinda Rachel %A Chapman,Cath %A Lynch,Samantha Jane %A Lawler,Siobhan Maree %A Teesson,Maree %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6 Jane Foss Russell Building, G02, Camperdown, 2006, Australia, 61 0426200221, tara.guckel@sydney.edu.au %K alcohol and other drugs %K prevention %K adolescence %K schools %K drug prevention %K drug prevention website %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To prevent adolescents from initiating alcohol and other drug use and reduce the associated harms, effective strategies need to be implemented. Despite their availability, effective school-based programs and evidence-informed parental guidelines are not consistently implemented. The Positive Choices alcohol and other drug prevention initiative and website was launched to address this research and practice gap. The intended end users were school staff, parents, and school students. An 8-month postlaunch evaluation of the website showed that end users generally had positive feedback on the website’s usability, and following its use, most of them would consider the evidence base and effectiveness of drug education resources. This study extends this initial evaluation by examining the effectiveness and impact of the Positive Choices initiative over a 3-year period. Objective: Guided by the five dimensions of the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the study assessed the impact of the Positive Choices initiative in increasing awareness and implementation of evidence-based drug prevention. Methods: Data were collected between 2017 and 2019, using web-based evaluation and community awareness surveys. Data from the surveys were merged to examine reach, effectiveness, adoption, implementation, and maintenance using descriptive statistics. Google Analytics was used to further understand the reach of the website. The System Usability Scale was used to measure website usability. In addition, inductive analysis was used to assess the participants’ feedback about Positive Choices. Results: A total of 5 years after launching, the Positive Choices website has reached 1.7 million users. A national Australian campaign increased awareness from 8% to 14% among school staff and from 15% to 22% among parents after the campaign. Following a brief interaction with the website, most participants, who were not already following the recommended strategies, reported an intention to shift toward evidence-based practices. The System Usability Scale score for the website was good for both user groups. The participants intended to maintain their use of the Positive Choices website in the future. Both user groups reported high level of confidence in communicating about topics related to alcohol and other drugs. Participants’ suggestions for improvement informed a recent website update. Conclusions: The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information and resources widely. The findings highlight the importance of investing in ongoing maintenance and promotion to enhance awareness of health websites. With the increased use and acceptability of health education websites, teams should ensure that websites are easy to navigate, are engaging, use simple language, contain evidence-informed resources, and are supported by ongoing promotional activities. %M 36018617 %R 10.2196/34721 %U https://pediatrics.jmir.org/2022/3/e34721 %U https://doi.org/10.2196/34721 %U http://www.ncbi.nlm.nih.gov/pubmed/36018617 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e39086 %T Serious Games Supporting the Prevention and Treatment of Alcohol and Drug Consumption in Youth: Scoping Review %A Martínez-Miranda,Juan %A Espinosa-Curiel,Ismael Edrein %+ Centro de Investigación Científica y de Educación Superior de Ensenada, Unidad de Transferencia Tecnológica Tepic, Andador 10, Ciudad del Conocimiento, Tepic, 63173, Mexico, 52 3111295930 ext 28602, jmiranda@cicese.mx %K serious games %K substance use %K alcohol and drugs %K young population %K mobile phone %D 2022 %7 25.8.2022 %9 Review %J JMIR Serious Games %G English %X Background: The consumption of alcohol and drugs, particularly in adolescents and young adults, has increased worldwide in the last several years, representing a significant public health challenge. Serious games have the potential to support preventive and treatment interventions for substance use, facilitating the acquisition of relevant knowledge and the motivation for changes in attitudes and behaviors regarding substance consumption. Objective: This scoping review aims to analyze a set of 7 relevant characteristics of current serious games designed to support the prevention and treatment of alcohol and drug consumption in adolescents and young adults—the substance addressed, the type of intervention, the theoretical basis, the computational techniques used, the mechanism for data security and privacy, the evaluation procedure followed, and the main results obtained. Methods: The review was performed by following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Data were retrieved from January 2010 to May 2022, using PubMed, Scopus (Elsevier), IEEE Xplore, and ACM Digital as data sources. The eligibility criteria included studies that described serious games designed to support the prevention or treatment of alcohol and drug consumption, targeted a population aged between 12 and 30 years, and included an evaluation procedure. Authors (JMM and IEEC) individually screened the titles and abstracts, and then full articles were reviewed for a final inclusion decision. Results: A total of 629 records were obtained, and 29 (4.6%) fulfilled the inclusion criteria. Most of the serious games (14/29, 48%) were focused on the prevention or treatment of alcohol use. The type of intervention that was the most supported was prevention (18/29, 62%), and most studies mentioned the theory, theoretical construct, or therapeutic technique used as a foundation (22/29, 76%). Most of the studies only provided information about the platform for execution (23/29, 79%), and few described the use of computational techniques, such as virtual reality or motion-based interaction (5/29, 17%). A small set of studies (10/29, 34%) explicitly mentioned how data security and privacy were addressed. Most of the reported evaluation protocols were pilot studies (11/29, 38%), followed by randomized controlled trials (10/29, 34%), and the reported results were positive in terms of acceptability, usability, and efficacy. However, more research is needed to assess long-term effects. Conclusions: Given the increasing interest in the use of serious games as digital interventions to support the prevention or treatment of substance use, knowing their main features is highly important. This review highlights whether and how current serious games incorporate 7 key features that are useful to consider for the further development of the area. %M 36006694 %R 10.2196/39086 %U https://games.jmir.org/2022/3/e39086 %U https://doi.org/10.2196/39086 %U http://www.ncbi.nlm.nih.gov/pubmed/36006694 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e40451 %T Risk and Resilience Pathways, Community Adversity, Decision-making, and Alcohol Use Among Appalachian Adolescents: Protocol for the Longitudinal Young Mountaineer Health Study Cohort %A Kristjansson,Alfgeir L %A Santilli,Annette M %A Mills,Rosalina %A Layman,Hannah M %A Smith,Megan L %A Mann,Michael J %A MacKillop,James %A James,Jack E %A Lilly,Christa L %A Kogan,Steven M %+ Department of Social and Behavioral Sciences, School of Public Health, West Virginia University, 64 Medical Center Drive, Morgantown, WV, 26506, United States, 1 3042933129, alkristjansson@hsc.wvu.edu %K adolescence %K middle school %K Appalachia %K caffeine %K alcohol use %K Young Mountaineer Health Study %K prevention %D 2022 %7 5.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alcohol use impairs psychosocial and neurocognitive development and increases the vulnerability of youth to academic failure, substance use disorders, and other mental health problems. The early onset of alcohol use in adolescents is of particular concern, forecasting substance abuse in later adolescence and adulthood. To date, evidence suggests that youth in rural areas are especially vulnerable to contextual and community factors that contribute to the early onset of alcohol use. Objective: The objective of the Young Mountaineer Health Study is to investigate the influence of contextual and health behavior variables on the early onset of alcohol use among middle school–aged youth in resource-poor Appalachian rural communities. Methods: This is a program of prospective cohort studies of approximately 2200 middle school youth from a range of 20 rural, small town, and small city (population <30,000) public schools in West Virginia. Students are participating in 6 waves of data collection (2 per year) over the course of middle school (sixth to eighth grades; fall and spring) from 2020 to 2023. On the basis of an organizational arrangement, which includes a team of local data collection leaders, supervising contact agents in schools, and an honest broker system to deidentify data linked via school IDs, we are able to collect novel forms of data (self-reported data, teacher-reported data, census-linked area data, and archival school records) while ensuring high rates of participation by a large majority of youth in each participating school. Results: In the spring of 2021, 3 waves of student survey data, 2 waves of data from teachers, and a selection of archival school records were collected. Student survey wave 1 comprised 1349 (response rate 80.7%) participants, wave 2 comprised 1649 (response rate 87%) participants, and wave 3 comprised 1909 (response rate 83.1%) participants. The COVID-19 pandemic has had a negative impact on the sampling frame size, resulting in a reduced number of eligible students, particularly during the fall of 2020. Nevertheless, our team structure and incentive system have proven vitally important in mitigating the potentially far greater negative impact of the pandemic on our data collection processes. Conclusions: The Young Mountaineer Health Study will use a large data set to test pathways linking rural community disadvantage to alcohol misuse among early adolescents. Furthermore, the program will test hypotheses regarding contextual factors (eg, parenting practices and neighborhood collective efficacy) that protect youth from community disadvantage and explore alcohol antecedents in the onset of nicotine, marijuana, and other drug use. Data collection efforts have been successful despite interruptions caused by the COVID-19 pandemic in 2020 and 2021. International Registered Report Identifier (IRRID): DERR1-10.2196/40451 %M 35930337 %R 10.2196/40451 %U https://www.researchprotocols.org/2022/8/e40451 %U https://doi.org/10.2196/40451 %U http://www.ncbi.nlm.nih.gov/pubmed/35930337 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e30944 %T HIV and Sexually Transmitted Infection Testing Among Substance-Using Sexual and Gender Minority Adolescents and Young Adults: Baseline Survey of a Randomized Controlled Trial %A Parker,Jayelin N %A Choi,Seul Ki %A Bauermeister,Jose A %A Bonar,Erin E %A Carrico,Adam W %A Stephenson,Rob %+ Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls, Room 3340, Ann Arbor, MI, 48109, United States, 1 7347644646, jayelinp@umich.edu %K testing %K substance use %K sexual minority %K social determinants %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gay, bisexual, and other men who have sex with men and transgender individuals are more heavily affected by HIV and other sexually transmitted infections (STIs) than their cisgender, heterosexual peers. In addition, sexual and gender minorities who use substances are often at a further increased risk of HIV and other STIs. Increasing testing for HIV and other STIs allows this hardly reached population to receive early intervention, prevention, and education. Objective: We explored HIV and STI testing patterns among 414 sexual and gender minority adolescents and young adults aged 15 to 29 years who self-reported substance use and lived in southeastern Michigan. Methods: We analyzed data from the baseline survey of a 4-arm randomized controlled trial that aimed to examine the efficacy of a brief substance use intervention for creating gains in engagement in HIV prevention. We fit multinomial logistic regression models to 2 categorical HIV and STI testing variables (lifetime and previous 12 months) based on self-reports of testing (never, STIs only, HIV only, or both). In addition, we compared HIV and STI testing behaviors across demographic characteristics, structural factors, psychosocial barriers, substance use, and sexual behaviors. Results: Our findings showed that 35.5% (147/414) of adolescents and young adults reported not being tested for either HIV or STIs in the previous year, and less than half (168/414, 40.6%) of the sample achieved the Centers for Disease Control and Prevention recommendation of HIV and STI testing once per year. We observed HIV and STI testing disparities across sociodemographic (eg, sexual identity, education, and income) and health (eg, substance use) correlates. Specifically, cisgender gay men who have sex with men were more likely to report being tested for HIV compared with bisexual men and transgender individuals, who were more likely to be tested for STIs. Conclusions: This study illustrates the results of an HIV prevention intervention in southeastern Michigan showing the need for HIV prevention interventions that leverage structural factors, psychosocial barriers, and substance use as key drivers to achieve HIV and STI testing rates to meet the Centers for Disease Control and Prevention guidelines. Trial Registration: ClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9414 %M 35776441 %R 10.2196/30944 %U https://publichealth.jmir.org/2022/7/e30944 %U https://doi.org/10.2196/30944 %U http://www.ncbi.nlm.nih.gov/pubmed/35776441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33693 %T Online Knowledge Translation Program Involving Video Games and University Student–Led Tutorials About Cannabis and Psychosis for Black Youth: Mixed Method Feasibility Study %A Jani,Payal %A Song,Nuri %A Artna,Erin %A Lyeo,Joonsoo %A Assam,Ashley %A Maelzer,Faith %A Murphy,Andriene %A Grant,Angelo %A Archie,Suzanne %+ Faculty of Health Sciences, McMaster University, East Region Mental Health Services, King Campus - St Joseph's Healthcare Hamilton, 2757 King St East, Hamilton, ON, L8N 3K7, Canada, 1 905 573 4801, archies@mcmaster.ca %K knowledge translation %K Black youth %K video game %K psychosis %K cannabis use %K knowledge %K young adult %K race %K demographic %K minority %K gaming %K mental health %K drug %K cannabis %K acceptability %K feasibility %K risk %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: We have piloted a new online knowledge translation (KT) program created to educate youth about cannabis effects, which uniquely focuses on mental health risks for Black youth. Youth are generally unaware of the research linking underage usage and the risk of psychosis. Youth from some Black racialized communities in Ontario may be disproportionately affected and in need of this knowledge. Objective: Because very little is known about the acceptability and feasibility of programs educating Black youth about cannabis and psychosis risk, we evaluated this KT program, which consists of tutorials facilitated by university students and video games. Methods: This mixed methods pilot study evaluates the transfer of knowledge about cannabis and psychosis risk before and after the online KT program and, at the same time, explores participant satisfaction with the program and views about underage use. Eligible participants were youth 16-19 years of age of Black African or Caribbean descent. Trained undergraduate students from McMaster University administered a quiz (psychosis and cannabis test; PCT) to evaluate knowledge before and after the KT program. After playing the psychoeducational video games, participants attended two tutorial group sessions led by undergraduate students. The undergraduate students facilitated the online tutorials about cannabis and psychosis. The tutorials augmented the educational content embedded within the gameplay: participants discussed what they learned from the video games and their understanding of psychosis and the effects of cannabis. In addition, undergraduate students qualitatively analyzed the tutorial discussions for themes, and the prequiz and postquiz scores were analyzed for significant differences in scores. Results: A total of 9 Black youth were recruited and completed this pilot study. The mean PCT scores were 5.67 (SD 1.7) and 7.78 (SD 1.8) before and after the KT program, respectively. There was a significant improvement in scores (P<.05) post-KT program. Thematic analysis of the facilitated tutorials revealed three major themes: video game satisfaction, marijuana and psychosis literacy, and help-seeking awareness. Overall, participants showed an increased awareness and understanding of the subject matter after the gameplay and tutorial intervention. Conclusions: When supplemented with tutorial sessions, the Back to Reality Series shows promise for addressing the gap in knowledge about cannabis and psychosis, and the results provide preliminary evidence that the games appeal to Black youth. %M 35315782 %R 10.2196/33693 %U https://formative.jmir.org/2022/6/e33693 %U https://doi.org/10.2196/33693 %U http://www.ncbi.nlm.nih.gov/pubmed/35315782 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e36239 %T #BingeDrinking—Using Social Media to Understand College Binge Drinking: Qualitative Study %A Cirillo,Madison N %A Halbert,Jennifer P %A Smith,Jessica Gomez %A Alamiri,Nour Sami %A Ingersoll,Karen S %+ Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, 560 Ray C Hunt Dr, Charlottesville, VA, 22903, United States, 1 434 243 0581, KES7A@hscmail.mcc.virginia.edu %K college students %K binge drinking %K social media %K young adults %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hazardous drinking among college students persists, despite ongoing university alcohol education and alcohol intervention programs. College students often post comments or pictures of drinking episodes on social media platforms. Objective: This study aimed to understand one university’s student attitudes toward alcohol use by examining student posts about drinking on social media platforms and to identify opportunities to reduce alcohol-related harm and inform novel alcohol interventions. Methods: We analyzed social media posts from 7 social media platforms using qualitative inductive coding based on grounded theory to identify the contexts of student drinking and the attitudes and behaviors of students and peers during drinking episodes. We reviewed publicly available social media posts that referenced alcohol, collaborating with undergraduate students to select their most used platforms and develop locally relevant search terms; all posts in our data set were generated by students associated with a specific university. From the codes, we derived themes about student culture regarding alcohol use. Results: In total, 1151 social media posts were included in this study. These included 809 Twitter tweets, 113 Instagram posts, 100 Greekrank posts, 64 Reddit posts, 34 College Confidential posts, 23 Facebook posts, and 8 YouTube posts. Posts included both implicit and explicit portrayals of alcohol use. Across all types of posts reviewed, positive drinking attitudes were most common, followed by negative and then neutral attitudes, but valence varied by platform. Posts that portrayed drinking positively received positive peer feedback and indicate that drinking is viewed by students as an essential and positive part of university student culture. Conclusions: Social media provide a real-time picture of students’ behavior during their own and others’ heavy drinking. Posts portray heavy drinking as a normal part of student culture, reinforced by peers’ positive feedback on posts. Interventions for college drinking should help students manage alcohol intake in real time, provide safety information during alcohol use episodes, and raise student awareness of web-based privacy concerns and reputation management. Additional interventions for students, alumni, and parents are needed to address positive attitudes about and traditions of drinking. %M 35635740 %R 10.2196/36239 %U https://humanfactors.jmir.org/2022/2/e36239 %U https://doi.org/10.2196/36239 %U http://www.ncbi.nlm.nih.gov/pubmed/35635740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32922 %T Web-Based Independent Versus Laboratory-Based Stop-Signal Task Performance: Within-Subjects Counterbalanced Comparison Study %A Poulton,Antoinette %A Chen,Li Peng Evelyn %A Dali,Gezelle %A Fox,Michael %A Hester,Robert %+ Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, 3010, Australia, 61 3 8344 6377, antoinette.poulton@unimelb.edu.au %K Stop-Signal Task %K response inhibition %K inhibitory control %K online assessment %K web-based assessment %K cognition %D 2022 %7 30.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Considered a facet of behavioral impulsivity, response inhibition facilitates adaptive and goal-directed behavior. It is often assessed using the Stop-Signal Task (SST), which is presented on stand-alone computers under controlled laboratory conditions. Sample size may consequently be a function of cost or time and sample diversity constrained to those willing or able to attend the laboratory. Statistical power and generalizability of results might, in turn, be impacted. Such limitations may potentially be overcome via the implementation of web-based testing. Objective: The aim of this study was to investigate if there were differences between variables derived from a web-based SST when it was undertaken independently—that is, outside the laboratory, on any computer, and in the absence of researchers—versus when it was performed under laboratory conditions. Methods: We programmed a web-based SST in HTML and JavaScript and employed a counterbalanced design. A total of 166 individuals (mean age 19.72, SD 1.85, range 18-36 years; 146/166, 88% female) were recruited. Of them, 79 undertook the independent task prior to visiting the laboratory and 78 completed the independent task following their laboratory visit. The average time between SST testing was 3.72 (SD 2.86) days. Dependent samples and Bayesian paired samples t tests were used to examine differences between laboratory-based and independent SST variables. Correlational analyses were conducted on stop-signal reaction times (SSRT). Results: After exclusions, 123 participants (mean age 19.73, SD 1.97 years) completed the SST both in the laboratory and independently. While participants were less accurate on go trials and exhibited reduced inhibitory control when undertaking the independent—compared to the laboratory-based—SST, there was a positive association between the SSRT of each condition (r=.48; P<.001; 95% CI 0.33-0.61). Conclusions: Findings suggest a web-based SST, which participants undertake on any computer, at any location, and in the absence of the researcher, is a suitable measure of response inhibition. %M 35635745 %R 10.2196/32922 %U https://www.jmir.org/2022/5/e32922 %U https://doi.org/10.2196/32922 %U http://www.ncbi.nlm.nih.gov/pubmed/35635745 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38543 %T A Parent-Based Intervention for Reducing High-risk Social Media Cognitions, Alcohol Use, and Negative Consequences Among Adolescents: Protocol for a Randomized Controlled Pilot Study %A Litt,Dana M %A Geusens,Femke %A Seamster,Abby %A Lewis,Melissa A %+ School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, EAD 709E, Fort Worth, TX, 76107, United States, 1 817 735 5453, dana.litt@unthsc.edu %K parent-based interventions %K alcohol %K pilot study %K social media %K mobile phone %D 2022 %7 17.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of adolescent alcohol use continues to be a public health concern. Although adolescents spend an increasing amount of time with their friends, parents remain an important source of support and continue to play a key role in the lives of their adolescents. Extensive research in this area has resulted in parent-based intervention (PBI) efforts to prevent or reduce adolescent alcohol use. However, one major limitation of PBIs is that they do not currently consider the large role that social media plays in adolescents’ lives and in relation to their alcohol use. We will add to the literature by developing and refining a web-based PBI designed to reduce both high-risk social media cognitions and alcohol use among adolescents. Objective: The central goal of the proposed study is to develop, refine, and pilot a web-based PBI to reduce both high-risk social media cognitions and alcohol use among adolescents. Methods: A total of 100 parent-teen dyads will be randomly assigned to one of the following 2 conditions: intervention or control. Parents in the intervention group will be given access to the web-based PBI and suggestions for working through the PBI modules with their teens. The parent-teen dyads will fill out 3 questionnaires: a baseline questionnaire, 1-month questionnaire, and 6-month questionnaire. Results: Recruitment and enrollment will begin in August 2022. Upon completion of the intervention trial, we will examine the feasibility, acceptability, and preliminary effect sizes of the newly developed web-based PBI. Conclusions: This study has the potential to open doors for future studies examining the clinical implications of an efficacious web-based PBI to reduce alcohol use and high-risk cognitions about alcohol displays on social media. Trial Registration: ClinicalTrials.gov NCT04333966; https://clinicaltrials.gov/ct2/show/NCT04333966 International Registered Report Identifier (IRRID): PRR1-10.2196/38543 %M 35579931 %R 10.2196/38543 %U https://www.researchprotocols.org/2022/5/e38543 %U https://doi.org/10.2196/38543 %U http://www.ncbi.nlm.nih.gov/pubmed/35579931 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e37106 %T Investigating Why and How Young Adults Use Protective Behavioral Strategies for Alcohol and Marijuana Use: Protocol for Developing a Randomized Controlled Trial %A Lewis,Melissa A %A Litt,Dana M %A Fairlie,Anne M %A Kilmer,Jason R %A Kannard,Emma %A Resendiz,Raul %A Walker,Travis %+ Health Behavior and Health Systems, University of North Texas Health Science Center, 3500 Camp Bowie BLVD, Fort Worth, TX, 76107, United States, 1 817 735 5136, melissa.lewis@unthsc.edu %K alcohol use %K marijuana use %K protective behavioral strategies %K intervention development %K young adults %D 2022 %7 19.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adulthood is associated with increased alcohol and marijuana use compared with other developmental periods. Alcohol and marijuana use place individuals at high risk for acute and long-term negative consequences. Despite the relatively large cross-sectional and longitudinal literature on protective behavioral strategies (PBS; behaviors that individuals can use to limit consequences and reduce substance use), little is known about why young adults choose to use PBS on specific occasions or why they might use PBS differently across occasions (ie, quality and consistency). There is significant room for improvement in the conceptualization, application, and understanding of PBS. Objective: This study aims to develop a novel, brief web-based and SMS text messaging intervention, with input from young adults who use alcohol and marijuana, which addresses the extent to which motivations for PBS use and nonuse (marijuana or alcohol) and the quality of PBS use (the degree of effectiveness or degree of implementation) differ when using alcohol alone versus concurrently or simultaneously with marijuana. Methods: This research will be conducted in 2 phases. Phase 1 will involve web-based focus groups (N=100) and cognitive interviews (N=10) to determine why young adults (aged 18-24 years) use or do not use specific PBS related to alcohol and marijuana use and elicit feedback on how motivations and the quality of PBS could be incorporated into a web-based and SMS text messaging PBS intervention as well as elicit feedback on developed intervention material. In phase 2, young adults (N=200; aged 18-24 years), who typically use alcohol and marijuana for at least 2 days per week, will be randomized to either the intervention or waitlist control group. The intervention will be brief, web-based, focusing on self-selected alcohol and marijuana PBS messages and motives for using alcohol- and marijuana-related PBS, and including intervention content delivered via SMS text messages 3 days a week (random day, Friday, and Saturday) over 8 consecutive weeks. All participants will report on PBS use, motivations for PBS use (and nonuse), quality of PBS use, and alcohol and marijuana use in morning surveys timed to occur the day after the intervention SMS text messages for those in the intervention group. Results: Recruitment and enrollment for phase 1 began in January 2022. Recruitment for phase 2 is anticipated to begin in January 2023. Upon completion of the phase 2 pilot, we will examine the feasibility, acceptability, and preliminary effect sizes of the newly developed brief web-based and SMS text messaging intervention. Conclusions: This study will provide an in-depth understanding of young adults’ PBS use and has the potential to develop a more efficacious intervention for co-occurring or simultaneous alcohol and marijuana behaviors. Trial Registration: ClinicalTrials.gov NCT04978129; https://clinicaltrials.gov/ct2/show/NCT04978129 International Registered Report Identifier (IRRID): DERR1-10.2196/37106 %M 35438642 %R 10.2196/37106 %U https://www.researchprotocols.org/2022/4/e37106 %U https://doi.org/10.2196/37106 %U http://www.ncbi.nlm.nih.gov/pubmed/35438642 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35402 %T Developing a Smartphone-Based Adjunct Intervention to Reduce Cannabis Use Among Juvenile Justice-Involved Adolescents: Protocol for a Multiphase Study %A Helseth,Sarah A %A Guigayoma,John %A Price,Dayna %A Spirito,Anthony %A Clark,Melissa A %A Barnett,Nancy P %A Becker,Sara J %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, 5th Floor, Providence, RI, , United States, 1 401 863 6881, sarah_helseth@brown.edu %K mobile intervention %K juvenile justice %K justice %K court %K adolescent %K teenager %K substance use %K cannabis %K youth %K adolescence %K protocol %K mHealth %K mobile health %K substance use %K user design %K behavioral app %K health app %K development %K pilot %K prototype %K feasibility %K acceptability %K smartphone app %K marijuana %K mobile phone %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents involved in the juvenile justice system who use cannabis are at an increased risk of future substance use disorders and rearrest. Many court-involved, nonincarcerated (CINI) youth are referred for services in the community and often encounter multiple barriers to care, highlighting the need for minimally burdensome services that can be delivered in justice settings. Digital health interventions are accessible, easy to implement, and can provide ongoing support but have not been developed to address the unique needs of CINI youth who use cannabis. Objective: This multiphase study will aim to develop, implement, and pilot test a novel smartphone app, Teen Empowerment through Computerized Health (TECH), to reduce cannabis and other substance use among CINI youth. TECH is conceptualized as a digital adjunct to a brief computerized intervention delivered by our family court partner. Methods: Following the principles of user-centered design, phase I interviews with CINI youth aged 14-18 years (n=14-18), their caregivers (n=6-8), and behavioral health app developers (n=6-8) will guide the TECH design decisions. Next, in phase II, CINI youth (n=10) will beta test the TECH app prototype for 1 month; their feedback regarding feasibility and acceptability will directly inform the app refinement process. Finally, in phase III, CINI youth (n=60) will participate in a pilot randomized controlled trial for 6 months, comparing the preliminary effectiveness of the adjunctive TECH app on cannabis use outcomes. Results: Phase I data collection began in September 2020 and was completed in December 2021; 14 CINI youth, 8 caregivers, and 11 behavioral health app developers participated in the study. Phases II and III will occur in 2022 and 2023 and 2023 and 2025, respectively. Conclusions: This body of work will provide insight into the feasibility and acceptability of a smartphone-based adjunctive intervention designed for CINI youth. Phase III results will offer a preliminary indication of the effectiveness of the TECH app in reducing cannabis use among CINI youth. International Registered Report Identifier (IRRID): DERR1-10.2196/35402 %M 35275086 %R 10.2196/35402 %U https://www.researchprotocols.org/2022/3/e35402 %U https://doi.org/10.2196/35402 %U http://www.ncbi.nlm.nih.gov/pubmed/35275086 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e35934 %T Parent SMART (Substance Misuse in Adolescents in Residential Treatment): Protocol of a Randomized Effectiveness Trial of a Technology-Assisted Parenting Intervention %A Becker,Sara J %A Helseth,Sarah A %A Kelly,Lourah M %A Janssen,Tim %A Wolff,Jennifer C %A Spirito,Anthony %A Wright,Thomas %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903-2905, United States, 1 4018636604, sara_becker@brown.edu %K adolescent %K residential %K technology-assisted %K substance use %K parent %K randomized controlled trial %K RCT %K intervention %K eHealth %K problem behaviour %K problem behavior %D 2022 %7 28.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents in residential substance use treatment are at extremely high risk for relapse following discharge to the community. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent substance use outcomes and relapse. However, traditional office-based therapy may not be feasible for parents who face structural and systemic barriers. There is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential substance use treatment. In a prior pilot randomized controlled trial, we tested Parent SMART (Substance Misuse among Adolescents in Residential Treatment)—a technology-assisted parenting intervention informed by extensive formative research—as an adjunct to residential treatment as usual (TAU). Parent SMART demonstrated high feasibility and acceptability, as well as evidence of effectiveness in improving parental monitoring and communication. Objective: This protocol paper describes a fully-powered randomized controlled pragmatic effectiveness trial of Parent SMART as an adjunct to residential TAU. We hypothesize that families who receive Parent SMART will demonstrate greater improvements in parenting skills, reductions in adolescent substance use, and reductions in adolescent problem behaviors relative to families that receive residential TAU. We will test the exploratory hypothesis that reductions in adolescent substance use will be partially mediated by improvements in parenting skills. Methods: Adolescent-parent dyads (n = 220 dyads; 440 total) will be randomized to either residential TAU only or Parent SMART+TAU. Parents randomized to Parent SMART will receive access to a networking forum, an off-the-shelf computer program called Parenting Wisely, and up to four telehealth coaching calls. Multimethod follow-up assessments consisting of self-reported parent and adolescent measures, a parent-adolescent in vivo interaction task, and 8-panel urine screens will be conducted 6, 12, and 24 weeks postdischarge from residential care. Measures will assess parenting skills, adolescent substance use, and adolescent problem behaviors. Analyses will be conducted using latent change score structural equation modeling. Results: The trial was funded in August 2021; ethics approval was obtained in August 2020, prior to funding. Due to concerns with the administrative interface in the pilot trial, the Parent SMART networking forum is currently being rebuilt by a different vendor. The programming is scheduled to be completed by December 2021, with recruitment beginning in February 2022. Conclusions: The proposed research has the potential to advance the field by serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent substance use outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model. Trial Registration: ClinicalTrials.gov NCT05169385; https://clinicaltrials.gov/ct2/show/NCT05169385 International Registered Report Identifier (IRRID): PRR1-10.2196/35934 %M 35225821 %R 10.2196/35934 %U https://www.researchprotocols.org/2022/2/e35934 %U https://doi.org/10.2196/35934 %U http://www.ncbi.nlm.nih.gov/pubmed/35225821 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e28638 %T Engagement With a Mobile Phone–Based Life Skills Intervention for Adolescents and Its Association With Participant Characteristics and Outcomes: Tree-Based Analysis %A Paz Castro,Raquel %A Haug,Severin %A Debelak,Rudolf %A Jakob,Robert %A Kowatsch,Tobias %A Schaub,Michael P %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8051, Switzerland, 41 444481180, raquel.paz@isgf.uzh.ch %K engagement %K life skills %K adolescents %K mobile phone %K machine learning %K decision tree %K mobile phone %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X 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 (βs=.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. %M 35044309 %R 10.2196/28638 %U https://www.jmir.org/2022/1/e28638 %U https://doi.org/10.2196/28638 %U http://www.ncbi.nlm.nih.gov/pubmed/35044309 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34530 %T A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial %A Stapinski,Lexine %A Routledge,Kylie %A Snijder,Mieke %A Doyle,Michael %A Champion,Katrina %A Chapman,Cath %A Ward,James %A Baumgart,Amanda %A Lee,K S Kylie %A Teesson,Maree %A Newton,Nicola %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Lvl 6, Jane Foss Russell Building G02, Darlington, 2006, Australia, 61 286279039, lexine.stapinski@sydney.edu.au %K Aboriginal and Torres Strait Islander %K prevention %K alcohol %K tobacco %K substance use %K universal prevention %K well-being %K harm minimization %K Indigenous %K web-based %D 2022 %7 7.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective: This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods: The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results: The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions: This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/34530 %M 34994696 %R 10.2196/34530 %U https://www.researchprotocols.org/2022/1/e34530 %U https://doi.org/10.2196/34530 %U http://www.ncbi.nlm.nih.gov/pubmed/34994696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30268 %T Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design %A Adams,Zachary %A Grant,Miyah %A Hupp,Samantha %A Scott,Taylor %A Feagans,Amanda %A Phillips,Meredith Lois %A Bixler,Kristina %A Nallam,Phani Teja %A La Putt,Dorothy %+ Department of Psychiatry, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN, 46202, United States, 1 317 278 0591, zwadams@iu.edu %K mobile health %K user-centered design %K adolescents %K substance use disorders %K mental health %K mHealth %K cognitive behavioral therapy %K homework %K technology acceptance model %K trauma %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. %M 34951593 %R 10.2196/30268 %U https://formative.jmir.org/2021/12/e30268 %U https://doi.org/10.2196/30268 %U http://www.ncbi.nlm.nih.gov/pubmed/34951593 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e33975 %T Investigating the Use of a Serious Game to Improve Opioid Safety Awareness Among Adolescents: Quantitative Study %A Abraham,Olufunmilola %A Rosenberger,Claire %A Tierney,Kathleen %A Birstler,Jen %+ Social and Administrative Sciences Division, School of Pharmacy, University of Wisconsin–Madison, 777 Highland Ave, Madison, WI, 53705, United States, 1 6082634498, olufunmilola.abraham@wisc.edu %K opioids %K adolescents %K opioid safety %K medication safety %K opioid knowledge %K serious games %K naloxone %K Narcan %K youth %K technology %K safety %K gaming %K addiction %K drug %K young adult %K teenager %K survey %K awareness %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The misuse of opioid medications among adolescents is a serious problem in the United States. Serious games (SGs) are a novel way to promote the safe and responsible management of opioid medications among adolescents, thereby reducing the number of adolescent opioid misuse cases reported annually. Objective: This study aimed to examine the effect of the SG MedSMART: Adventures in PharmaCity on adolescents’ opioid safety knowledge, awareness, behavioral intent, and self-efficacy. Methods: A nationally representative sample of adolescents aged 12 to 18 years were recruited online through Qualtrics panels from October to November 2020. Data collection consisted of a pregame survey, 30 minutes of gameplay, and a postgame survey. The pregame and postgame surveys included 66 items examining the participants’ baseline opioid knowledge, safety, use, and demographic information. The postgame survey had 25 additional questions regarding the MedSMART game. Gameplay scenarios included 5 levels intended to mimic adolescents’ daily life while educating the players about appropriate opioid storage and disposable practices, negative consequences of sharing opioid medications, and the use of Narcan. Survey questions were divided into 10 categories to represent key concepts and were summarized into concept scores. Differences in concept scores were described by overall mean (SD) when stratified by gender, race, school, grade, and age. Differences of change in concept score were analyzed using the Kruskal-Wallis and correlation tests. Results: A total of 117 responses were analyzed. The results showed significant improvement on all concept scores except for Narcan knowledge (mean change -0.04, SD 0.29; P=.60) and safe storage (mean change 0.03, SD 0.20; P=.09). Female participants had greater improvement than males for safe disposal (female mean 0.12, SD 0.25 vs male mean 0.04, SD 0.17; P=.05). Male participants had higher improvement than female participants for misuse behavior (female mean 0.05, SD 0.28 vs male mean 0.14, SD 0.27; P=.04). Perceived knowledge for participants who had non-White or Hispanic racial backgrounds had higher improvement than for non-Hispanic White participants (non-White mean 1.10, SD 1.06 vs White mean 0.75, SD 0.91; P=.03). Older grades were associated with greater improvement in opioid knowledge (correlation coefficient -0.23, 95% CI -0.40 to -0.05; P=.01). There were 28 (23.9%) participants who played all 5 levels of the game and had better improvement in opioid use self-efficacy. Conclusions: Our findings suggest MedSMART: Adventures in PharmaCity can be used as an effective tool to educate adolescents on the safe and responsible use of prescribed opioid medications. Future testing of the effectiveness of this SG should involve a randomized controlled trial. Additionally, the feasibility of implementing and disseminating MedSMART: Adventures in PharmaCity in schools and health care settings such as adolescent health or primary care clinics, emergency departments, and pharmacies should be investigated. %M 34747712 %R 10.2196/33975 %U https://games.jmir.org/2021/4/e33975 %U https://doi.org/10.2196/33975 %U http://www.ncbi.nlm.nih.gov/pubmed/34747712 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e25618 %T Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk %A Prokhorov,Alexander V %A Calabro,Karen Sue %A Arya,Ashish %A Russell,Sophia %A Czerniak,Katarzyna W %A Botello,Gabrielle C %A Chen,Minxing %A Yuan,Ying %A Perez,Adriana %A Vidrine,Damon J %A Perry,Cheryl L %A Khalil,Georges Elias %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Clinical and Translational Science Building, 2004 Mowry Road Office 2252, Gainesville, FL, 32610, United States, 1 3522948415, gkhalil@ufl.edu %K tobacco use %K risk communication %K text messaging %K message framing %K regulatory science %K young adults %K vaping %K mobile phone %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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<.007 (.05 divided by 7). Results: A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). Conclusions: In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. Trial Registration: ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 International Registered Report Identifier (IRRID): RR2-10.2196/10977 %M 34822339 %R 10.2196/25618 %U https://mhealth.jmir.org/2021/11/e25618 %U https://doi.org/10.2196/25618 %U http://www.ncbi.nlm.nih.gov/pubmed/34822339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28237 %T Causal Effects of Alcohol-Related Facebook Posts on Drinking Behavior: Longitudinal Experimental Study %A Hendriks,Hanneke %A de Nooy,Wouter %A Gebhardt,Winifred A %A van den Putte,Bas %+ Behavioural Science Institute, Radboud University, Thomas van Aquinostraat 4, Nijmegen, 6525 GD, Netherlands, 31 24 3612372, hanneke.hendriks@ru.nl %K social media %K social networking site (SNS) %K alcohol-related posts %K alcoholposts %K alcohol consumption %D 2021 %7 11.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents and young adults frequently post alcohol-related content (ie, alcoholposts) on social media. This is problematic because both social norms theory and social learning theory suggest that viewing alcoholposts of peers could increase drinking behavior. It is therefore paramount to understand the effects of exposure to alcoholposts on viewers. Objective: This study aimed to investigate the causal effects of exposure to alcoholposts on alcohol consumption by using a rigorous design. Methods: We conducted a 6-week longitudinal study during which alcoholposts were measured by a newly developed app that copied Facebook posts shared by participants (n=281) to a new social media environment. In addition, daily questionnaires assessed alcohol use. Effects of natural alcoholposts (ie, posted by the participants) were assessed in phase 1, and effects of experimental posts (ie, posted by fake participants) were explored in phase 2. Results: Results showed that natural alcoholposts increased the occurrence and quantity of drinking the following day. That is, exposure to a single additional alcoholpost increased the log odds of drinking the next day by 0.27 (b=.27, credible interval [CI] .18 to .35). Furthermore, the number of natural alcoholposts had a positive (predictive) effect on the number of glasses drunk the next day (b=.21, CI .14 to .29). In phase 2 when experimental posts were also present, these effects decreased. Experimental posts themselves had hardly any effects. Conclusions: This study illustrates clear and direct effects of exposure to alcoholposts on next-day alcohol consumption and suggests that alcoholposts represent an important societal problem that interventions need to address. %M 34762061 %R 10.2196/28237 %U https://www.jmir.org/2021/11/e28237 %U https://doi.org/10.2196/28237 %U http://www.ncbi.nlm.nih.gov/pubmed/34762061 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30681 %T Videos With the Hashtag #vaping on TikTok and Implications for Informed Decision-making by Adolescents: Descriptive Study %A Basch,Corey H %A Fera,Joseph %A Pellicane,Alessia %A Basch,Charles E %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K vaping %K TikTok %K social media %K misinformation %K decision-making %K adolescents %K young adults %K e-cigarettes %K public health %K informed decision-making %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the public health importance of vaping and the widespread use of TikTok by adolescents and young adults, research is lacking on the nature and scope of vaping content on this networking service. Objective: The purpose of this study is to describe the content of TikTok videos related to vaping. Methods: By searching the hashtag #vaping in the discover feature, ~478.4 million views were seen during the time of data collection. The first 100 relevant videos under that hashtag were used in this study. Relevance was determined by simply noting if the video was related in any way to vaping. Coding consisted of several categories directly related to vaping and additional categories, including the number of likes, comments, and views, and if the video involved music, humor, or dance. Results: The 100 videos included in the sample garnered 156,331,347 views; 20,335,800 likes; and 296,460 comments. The majority of the videos (n=59) used music and over one-third (n=37) used humor. The only content category observed in the majority of the videos sampled was the promotion of vaping, which was included in 57 videos that garnered over 74 million views (47.5% of cumulative views). A total of 42% (n=42) of the 100 videos sampled featured someone vaping or in the presence of vape pens, and these videos garnered over 22% (>35 million) of the total views. Conclusions: It is necessary for public health agencies to improve understanding of the nature and content of videos that attract viewers’ attention and harness the strength of this communication channel to promote informed decision-making about vaping. %M 34694231 %R 10.2196/30681 %U https://pediatrics.jmir.org/2021/4/e30681 %U https://doi.org/10.2196/30681 %U http://www.ncbi.nlm.nih.gov/pubmed/34694231 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25405 %T Collecting Social Media Information in a Substance Use Intervention Trial With Adolescent Girls With Lifetime Substance Use History: Observational Study %A Ramos,Lili M C %A Delgadillo,Joseline %A Vélez,Sarah %A Dauria,Emily %A Salas,Jamie %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 (628) 206 2212, Marina.Tolou-Shams@ucsf.edu %K adolescent girls %K legal involvement %K substance use %K social media %K health intervention %D 2021 %7 10.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with juvenile legal system contact face numerous barriers to participation in behavioral health intervention research, including housing disruption, legal privacy concerns, and systems mistrust. Technology, such as social media, may be a novel and developmentally appropriate adolescent research study engagement and retention tool. Objective: We examined data on social media information collected for study retention purposes from adolescents participating in a substance use intervention trial. Methods: Data were collected as part of a randomized controlled trial determining efficacy of a group-based substance use intervention for girls and young women (12-24 years) with substance use histories referred from legal and school systems in the United States. Baseline demographic and social media information was analyzed from the subset of 114 adolescent girls (mean age 15.7 years; range 13-18 years), of whom 31.6% (36/114) were legally involved, 87.7% (100/114) belonged to minoritized racial/ethnic groups, and 32.5% (37/114) received public assistance. Results: Most girls (74/114, 64.9%) provided at least one social media account (Instagram, 95% [70/74]; Facebook, 27% [20/74]; and Twitter, 11% [8/74]) during study enrollment. Legally involved girls were significantly less likely to provide social media information than school-referred girls (44% [16/36] versus 74% [58/78]; χ21 [N=114]=9.68, P=.002). Conclusions: Obtaining social media information for study retention purposes from adolescent girls with lifetime substance use appears possible; however, particular subgroups (ie, legally involved girls) may be less likely to provide accounts. Factors shaping legally involved girls’ willingness to provide social media information, including mistrust and privacy concerns, and the impact of researcher’s access to social media information on study retention are critical directions for future research. Trial Registration: ClinicalTrials.gov NCT02293057; https://clinicaltrials.gov/ct2/show/NCT02293057 %M 34505833 %R 10.2196/25405 %U https://formative.jmir.org/2021/9/e25405 %U https://doi.org/10.2196/25405 %U http://www.ncbi.nlm.nih.gov/pubmed/34505833 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e26796 %T A Mobile Peer Intervention for Preventing Mental Health and Substance Use Problems in Adolescents: Protocol for a Randomized Controlled Trial (The Mind Your Mate Study) %A Birrell,Louise %A Furneaux-Bate,Ainsley %A Chapman,Cath %A Newton,Nicola C %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, Sydney, 2006, Australia, 61 8627 6904, ainsley.furneaux-bate@sydney.edu.au %K prevention %K mental health %K substance use %K peer support %K depression %K anxiety %K help-seeking %K mobile phone %D 2021 %7 30.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety, mood, and substance use disorders have significant social and economic impacts, which are largely attributable to their early age of onset and chronic disabling course. Therefore, it is critical to intervene early to prevent chronic and debilitating trajectories. Objective: This paper describes the study protocol of a CONSORT (Consolidated Standards of Reporting Trials)-compliant randomized controlled trial for evaluating the effectiveness of the Mind your Mate program, a mobile health (mHealth) peer intervention that aims to prevent mental health (focusing on anxiety and depression) and substance use problems in adolescents. Methods: Participants will consist of approximately 840 year 9 or year 10 students (60 students per grade per school) from 14 New South Wales high schools in Sydney, Australia. Schools will be recruited from a random selection of independent and public schools across the New South Wales Greater Sydney Area by using publicly available contact details. The intervention will consist of 1 introductory classroom lesson and a downloadable mobile app that will be available for use for 12 months. Schools will be randomly allocated to receive either the mHealth peer intervention or a waitlist control (health education as usual). All students will be given web-based self-assessments at baseline and at 6- and 12-month follow-ups. The primary outcomes of the trial will be the self-reported use of alcohol and drugs, anxiety and depression symptoms, knowledge about mental health and substance use, motives for not drinking, and willingness to seek help. Secondary outcomes will include positive well-being, the quality of life, and the impact of the COVID-19 pandemic. Analyses will be conducted using mixed-effects linear regression analyses for normally distributed data and mixed-effects logistic regression analyses for categorical data. Results: The Mind your Mate study was funded by an Australian Rotary Health Bruce Edwards Postdoctoral Research Fellowship from 2019 to 2022. Some of the development costs for the Mind your Mate intervention came from a seed funding grant from the Brain and Mind Centre of the University of Sydney. The enrollment of schools began in July 2020; 12 of 14 schools were enrolled at the time of submission. Baseline assessments are currently underway, and the first results are expected to be submitted for publication in 2022. Conclusions: The Mind your Mate study will generate vital new knowledge about the effectiveness of a peer support prevention strategy in real-world settings for the most common mental disorders in youth. If effective, this intervention will constitute a scalable, low-cost prevention strategy that has significant potential to reduce the impact of mental and substance use disorders. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000753954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379738&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/26796 %M 34328426 %R 10.2196/26796 %U https://www.researchprotocols.org/2021/7/e26796 %U https://doi.org/10.2196/26796 %U http://www.ncbi.nlm.nih.gov/pubmed/34328426 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 7 %P e26951 %T A Mobile Phone–Based Life-Skills Training Program for Substance Use Prevention Among Adolescents: Cluster-Randomized Controlled Trial %A Haug,Severin %A Paz Castro,Raquel %A Wenger,Andreas %A Schaub,Michael Patrick %+ Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, Zurich, 8005, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K life skills %K substance use %K prevention %K adolescents %K mobile phone %D 2021 %7 13.7.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %M 34255703 %R 10.2196/26951 %U https://mhealth.jmir.org/2021/7/e26951 %U https://doi.org/10.2196/26951 %U http://www.ncbi.nlm.nih.gov/pubmed/34255703 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29427 %T Understanding Neighborhoods’ Impact on Youth Substance Use and Mental Health Outcomes in Paterson, New Jersey: Protocol for a Community-Based Participatory Research Study %A Opara,Ijeoma %A R Leonard,Noelle %A Thorpe,Daneele %A Kershaw,Trace %+ School of Public Health, Yale University, 60 George Street, New Haven, CT, 06510, United States, 1 (203) 785 2867, ijeoma.opara@yale.edu %K protocol %K substance use %K mental health %K venue-based sampling %K community %D 2021 %7 28.5.2021 %9 Proposal %J JMIR Res Protoc %G English %X Background: Substance use among youth is a major public health concern. Of note, substance use among youth is increasing in prevalence, and the incidence of substance use at earlier ages is rising. Given the long-term consequences of early substance use, it is important to identify factors that increase youth vulnerability to drug use, as they may be important targets for future interventions. Objective: This study aims to use innovative methods, such as venue-based sampling, to recruit youth who are disconnected from school and use community-based participatory research to gain a better understanding of the prevalence of substance use and important correlates among youth aged between 13 and 21 years in Paterson, New Jersey, a low-income, urban community. The study will use a convergent, mixed methods design involving multiple data collection components and the analysis of a ministrative data source, designed with the strengths of complex intervention frameworks in mind. The overall aims of the study are to identify the prevalence of substance use among youth who are engaged in school and not engaged in school; to understand important antecedents and correlates of substance use; and to use this information to inform social, environmental, and culturally appropriate interventions to address substance use and its correlates among youths in a lower-resourced urban community. Methods: This study will use both qualitative and quantitative methods to address important questions. Specifically, semistructured interviews using focus group and interview methodologies will be used to assess youths’ lived experiences and will account for specific details that quantitative methods may not be able to attain. In addition, quantitative methods will be used to examine direct and multilevel associations between neighborhood factors and youth substance use and mental health outcomes. Results: A previous analysis from a substance use initiative in Paterson, New Jersey found that youth who use substances such as marijuana and alcohol are more likely to have higher rates of depression and anxiety. On the basis of the research questions, this study will examine the association between neighborhood characteristics, substance use, and mental health symptoms among youth in Paterson by using quantitative and qualitative methods and will use these findings to inform the adaptation of a community- and evidence-based substance use prevention intervention for these youths. Conclusions: The findings of this study will provide an important contribution to understanding the role of socioecological factors in predicting substance use and mental health outcomes among youth in a lower-resourced, urban community. Furthermore, these findings will serve as evidence for the development of a culturally informed, community-based prevention program to address substance use disparities for youth, including those who are truant in Paterson, New Jersey. International Registered Report Identifier (IRRID): PRR1-10.2196/29427 %M 34047712 %R 10.2196/29427 %U https://www.researchprotocols.org/2021/5/e29427 %U https://doi.org/10.2196/29427 %U http://www.ncbi.nlm.nih.gov/pubmed/34047712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25583 %T A Digital Health Tool to Understand and Prevent Cannabis-Impaired Driving Among Youth: A Cross-sectional Study of Responses to a Brief Intervention for Cannabis Use %A Moreno,Georgina %A van Mierlo,Trevor %+ Department of Economics, California State University, Long Beach, 1250 Bellflower Blvd MS-4607, Long Beach, CA, 90840-4607, United States, 1 310 600 1767, gigi.moreno@csulb.edu %K cannabis use %K driving after cannabis use %K internet %K intervention %K online intervention %K digital health %K cannabis %K drug %K online tool %K youth %K adolescent %K Canada %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cannabis legalization has raised concern about an increased risk of cannabis-impaired driving, particularly among youth. Youth advocates and policy makers require cost-effective tools to target educational resources to promote responsible cannabis use. Objective: The objective of this paper is threefold. First, it describes how a youth advocacy organization disseminated a low-cost digital brief intervention to educate and inform young people about responsible cannabis use. Second, it illustrates how digital tools can help promote understanding about attitudes and behaviors toward cannabis while simultaneously offering tailored education. Finally, this paper contributes to examining behavioral factors associated with youth cannabis-impaired driving by quantifying relationships between cannabis users' willingness to drive impaired and self-reported demographic and behavioral factors. Methods: This paper analyzed data from 1110 completed Check Your Cannabis (CYC) brief interventions between March 2019 and October 2020. The CYC asks respondents a brief set of questions about their cannabis use and their personal beliefs and behaviors. Respondents receive comprehensive feedback about their cannabis use and how it compares with others. They also receive a summary of reported behaviors with brief advice. An ordered probit model was used to test relationships between cannabis use, demographics, and driving behaviors to gain further insights. Results: The vast majority (817/1110, 73.6%) of respondents reported using cannabis. However, a much smaller share of respondents reported problems associated with their cannabis use (257/1110, 23.2%) or driving after cannabis use (342/1110, 30.8%). We found statistically significant relationships between driving after cannabis use and age; Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) risk score; and polysubstance use. However, we did not find gender to be a significant determinant of driving after cannabis use. We estimated that every 10-point increase in the ASSIST score increased the probability of sometimes driving after cannabis use by 7.3% (P<.001). Relative to respondents who reported never drinking alcohol or using other substances with cannabis, those who sometimes drink or use other substances with cannabis were 13% (P<.001) more likely to sometimes or always drive after using cannabis. Conclusions: The digital health tool cost the youth advocacy organization approximately Can $0.90 (US $0.71) per use. Due to the tool's unlimited use structure, the per-use cost would further decrease with increased use by the organization’s target population. Based on our results, public health campaigns and other interventions may consider tailoring resources to frequent cannabis users, youth with high ASSIST scores, and those with polysubstance abuse. The cost-effectiveness of delivering digital brief interventions with unlimited use is attractive, as increased use decreases the per-user cost. Further research examining the efficacy of digital health interventions targeting problematic cannabis use is required. %M 33650982 %R 10.2196/25583 %U https://formative.jmir.org/2021/3/e25583 %U https://doi.org/10.2196/25583 %U http://www.ncbi.nlm.nih.gov/pubmed/33650982 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e18487 %T Evaluating the Effectiveness of a Web-Based Program (POP4Teens) to Prevent Prescription Opioid Misuse Among Adolescents: Randomized Controlled Trial %A Marsch,Lisa A %A Moore,Sarah K %A Grabinski,Michael %A Bessen,Sarah Y %A Borodovsky,Jacob %A Scherer,Emily %+ Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, 46 Centerra Pkwy, Lebanon, NH, 03766, United States, 1 9176789280, sarah.k.moore@dartmouth.edu %K opioids %K prevention and control %K adolescent %K randomized controlled trial %K internet %D 2021 %7 25.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Prescription opioid (PO) use is common among adolescents in the United States. Despite recent declines from unprecedented peaks in adolescent PO use (eg, in 2012-2013), there is seemingly paradoxical evidence that PO-related consequences (eg, opioid use disorder and overdoses) are increasing. These trends and their possible consequences emphasize the importance of prevention efforts targeting PO misuse. To our knowledge, we have developed the first interactive web-based program (POP4Teens [P4T]) focused specifically on the prevention of PO misuse among adolescents. Objective: This study aimed to evaluate the effectiveness of P4T, a web-based program designed to prevent adolescent PO misuse, in comparison with JustThinkTwice (JTT), an active control website, on PO-related attitudes, knowledge, risk perception, and intentions to use. Methods: We conducted a web-based randomized controlled trial in 2018. A total of 406 adolescents (aged 12-17 years) were randomly assigned to either P4T or JTT. The outcome variables were attitudes, knowledge, and risk perceptions associated with PO misuse, intentions to use POs, and program feedback. Data were collected at baseline and at 1, 3, and 6 months. Results: Both programs resulted in significant and sustained improvements in intention to use POs, increased perceived risk, impacted expectancies consistent with prevention, and improved PO refusal skills. P4T produced significantly greater increases in PO-related knowledge than JTT did, and it was reportedly easier to use and more liked. Baseline scores for youth reporting past-year medical use of POs, friends who engage in nonmedical use of POs, and/or poor mental health underscored their at-risk status compared with youth from the other groups. Conclusions: P4T positively impacted all study variables that are known to prevent PO misuse among teens. Moreover, its web-based nature simplifies the dissemination and implementation of this novel tool designed to help meet the challenges of the evolving national opioid crisis. Trial Registration: ClinicalTrials.gov NCT02737696; https://clinicaltrials.gov/ct2/show/NCT02737696 %M 33629961 %R 10.2196/18487 %U https://publichealth.jmir.org/2021/2/e18487 %U https://doi.org/10.2196/18487 %U http://www.ncbi.nlm.nih.gov/pubmed/33629961 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24472 %T Acceptability, Validity, and Engagement With a Mobile App for Frequent, Continuous Multiyear Assessment of Youth Health Behaviors (mNCANDA): Mixed Methods Study %A Cummins,Kevin M %A Brumback,Ty %A Chung,Tammy %A Moore,Raeanne C %A Henthorn,Trevor %A Eberson,Sonja %A Lopez,Alyssa %A Sarkissyan,Tatev %A Nooner,Kate B %A Brown,Sandra A %A Tapert,Susan F %+ Department of Psychology, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 8582952763, kcummins@ucsd.edu %K mobile applications %K young adults %K smartphone %K health behavior %K underage drinking %K alcohol drinking %K self-report %K illicit drugs %K mobile phone %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Longitudinal studies of many health behaviors often rely on infrequent self-report assessments. The measurement of psychoactive substance use among youth is expected to improve with more frequent mobile assessments, which can reduce recall bias. Researchers have used mobile devices for longitudinal research, but studies that last years and assess youth continuously at a fine-grained, temporal level (eg, weekly) are rare. A tailored mobile app (mNCANDA [mobile National Consortium on Alcohol and Neurodevelopment in Adolescence]) and a brief assessment protocol were designed specifically to provide a feasible platform to elicit responses to health behavior assessments in longitudinal studies, including NCANDA (National Consortium on Alcohol and Neurodevelopment in Adolescence). Objective: This study aimed to determine whether an acceptable mobile app system could provide repeatable and valid assessment of youth’s health behaviors in different developmental stages over extended follow-up. Methods: Participants were recruited (n=534; aged 17-28 years) from a larger longitudinal study of neurodevelopment. Participants used mNCANDA to register reports of their behaviors for up to 18 months. Response rates as a function of time measured using mNCANDA and participant age were modeled using generalized estimating equations to evaluate response rate stability and age effects. Substance use reports captured using mNCANDA were compared with responses from standardized interviews to assess concurrent validity. Reactivity was assessed by evaluating patterns of change in substance use after participants initiated weekly reports via mNCANDA. Quantitative feedback about the app was obtained from the participants. Qualitative interviews were conducted with a subset of participants who used the app for at least one month to obtain feedback on user experience, user-derived explanations of some quantitative results, and suggestions for system improvements. Results: The mNCANDA protocol adherence was high (mean response rate 82%, SD 27%) and stable over time across all age groups. The median time to complete each assessment was 51 s (mean response time 1.14, SD 1.03 min). Comparisons between mNCANDA and interview self-reports on recent (previous 30 days) alcohol and cannabis use days demonstrate close agreement (eg, within 1 day of reported use) for most observations. Models used to identify reactivity failed to detect changes in substance use patterns subsequent to enrolling in mNCANDA app assessments (P>.39). Most participants (64/76, 84%) across the age range reported finding the mNCANDA system acceptable. Participants provided recommendations for improving the system (eg, tailoring signaling times). Conclusions: mNCANDA provides a feasible, multi-year, continuous, fine-grained (eg, weekly) assessment of health behaviors designed to minimize respondent burden and provides acceptable regimes for long-term self-reporting of health behaviors. Fine-grained characterization of variability in behaviors over relatively long periods (eg, up to 18 months) may, through the use of mNCANDA, improve our understanding of the relationship between substance use exposure and neurocognitive development. %M 33565988 %R 10.2196/24472 %U http://mhealth.jmir.org/2021/2/e24472/ %U https://doi.org/10.2196/24472 %U http://www.ncbi.nlm.nih.gov/pubmed/33565988 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e22946 %T Instagram Posts Related to Backwoods Cigarillo Blunts: Content Analysis %A Kim,Stephanie %A Mourali,Alia %A Allem,Jon-Patrick %A Unger,Jennifer B %A Boley Cruz,Tess %A Smiley,Sabrina L %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, CA, 90032, United States, 1 3234427367, slsmiley@usc.edu %K Instagram %K blunts %K Backwoods cigarillos %K smoking %D 2021 %7 9.2.2021 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Instagram, one of the most popular social media platforms among youth, offers a unique opportunity to examine blunts—partially or fully hollowed-out large cigars, little cigars, and cigarillos that are filled with marijuana. Cigarillo brands like Backwoods (Imperial Tobacco Group Brands LLC) have product features that facilitate blunt making, including a variety of brand-specific flavors that enhance the smoking experience (eg, honey, dark stout). Backwoods has an active online presence with a user-friendly website. Objective: This study examined the extent to which Backwoods cigarillo–related posts on Instagram showed blunt making. Instagram offers a unique opportunity to examine blunt making as Instagram accounts will contain images reflective of behavior occurring without the prime of a researcher. Methods: Data consisted of publicly available Instagram posts with the hashtag #backwoods collected from August 30 to September 12, 2018. Inclusion criteria for this study included an Instagram post with the hashtag “#backwoods”. Rules were established to content analyze posts. Categories included Type of post (ie, photo, video, or both); Blunt-related hashtags (ie, the corresponding post caption contained one or more hashtags like #blunts, #cannabis, and #weed that were identified in previous social media research); Rolling blunts (ie, the post contained an image of one or more individuals rolling a Backwoods cigarillo visibly containing marijuana); and Smoking blunts (ie, the post contained an image of one or more individuals blowing smoke or holding a lit blunt). We coded images for Product flavor reference, where a code of 1 showed a Backwoods cigarillo pack with a brand-specific flavor (eg, honey, dark stout, Russian crème) visible in the blunt-related image, and a code of 0 indicated that it was not visible anywhere in the image. Results: Among all posts (N=1206), 871 (72.2%) were coded as Blunt-related hashtags. A total of 125 (10.4%) images were coded as Smoking blunts, and 25 (2.1%) were coded as Rolling blunts (ie, Backwoods cigarillo explicitly used to roll blunts). Among blunt images, 434 of 836 (51.9%) were coded as Product flavor (ie, a Backwoods pack with a brand-specific flavor was visible). Conclusions: Most Backwoods cigarillo–related Instagram images were blunt-related, and these blunt-related images showed Backwoods packages indicating flavor preference. Continued monitoring and surveillance of blunt-related posts on Instagram is needed to inform policies and interventions that reduce the risk that youth may experiment with blunts. Specific policies could include restrictions on product features (eg, flavors, perforated lines, attractive resealable foil pouches, sale as singles) that facilitate blunt making. %M 33560242 %R 10.2196/22946 %U http://publichealth.jmir.org/2021/2/e22946/ %U https://doi.org/10.2196/22946 %U http://www.ncbi.nlm.nih.gov/pubmed/33560242 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e24424 %T Developing an Adaptive Mobile Intervention to Address Risky Substance Use Among Adolescents and Emerging Adults: Usability Study %A Coughlin,Lara N %A Nahum-Shani,Inbal %A Philyaw-Kotov,Meredith L %A Bonar,Erin E %A Rabbi,Mashfiqui %A Klasnja,Predrag %A Murphy,Susan %A Walton,Maureen A %+ Department of Psychiatry, Addiction Center, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 615 4774, laraco@med.umich.edu %K mHealth %K adolescents %K young adults %K just-in-time adaptive intervention %K alcohol misuse %K cannabis %K mobile phone %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 33448931 %R 10.2196/24424 %U http://mhealth.jmir.org/2021/1/e24424/ %U https://doi.org/10.2196/24424 %U http://www.ncbi.nlm.nih.gov/pubmed/33448931 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e19749 %T Qualitative Evaluation of Web-Based Digital Intervention to Prevent and Reduce Excessive Alcohol Use and Harm Among Young People Aged 14-15 Years: A “Think-Aloud” Study %A Tinner,Laura Elizabeth %A Kaner,Eileen %A Garnett,Claire %A Mitchell,Siobhan %A Hickman,Matthew %A Campbell,Rona %A MacArthur,Georgina %+ Department of Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, United Kingdom, 44 117 33 13401, laura.tinner@bristol.ac.uk %K public health %K adolescent %K mobile phone %K alcoholic intoxication %K internet %D 2020 %7 15.12.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In the United Kingdom, despite some downward trends in alcohol use among young people, over one-fifth of young people reported excessive alcohol use in the past month, which is associated with short- and long-term harm to health. Digital interventions to reduce alcohol use, such as websites, among young people present an appealing and cost-effective mode of intervention that can be integrated into the education system. However, relatively few school-based digital alcohol-focused interventions have been developed and evaluated for young people in the United Kingdom. Objective: This study aims to develop a novel web-based intervention, Rethink Alcohol, to prevent and reduce excessive alcohol use and related harm among young people aged between 14 and 15 years, and explore the views of young people, teachers, and youth workers in relation to the content, design, and usability of the intervention. Methods: Intervention development followed the person-based approach, using theories of social norms and social influence. Qualitative “Think-Aloud” interviews, either one-to-one or paired, were conducted while participants perused and worked through the web-based intervention, talking aloud. Participants included 20 young people (12 female, 8 male), 5 youth workers (4 female, 1 male), 3 teachers (2 male, 1 female), and 1 (male) clinical professional, recruited via youth groups and professional networks. Interviews were audio recorded, transcribed verbatim, and analyzed thematically. Results: The prototype web-based intervention included normative feedback, information, a quiz, interactive activities, and scenarios. On a rating scale of impressions from poor (1) to excellent (5), participants gave an average score of 3.6/5. A total of 5 themes were identified: content, credibility of the website, making the website easy to understand, design and navigation, and suitability for the audience. These themes reflected views that the content was interesting, credible, informative, and embodied a neutral and nonjudgmental tone, but stronger messaging was needed regarding social pressures and short-term risks regarding safety and risk behavior alongside clarity around pathways of risk; credibility and trustworthiness of information were critical features, determined in part, by the professionalism of design and referencing of sources of information provided; and messages should be succinct and come to life through design and interactive features. Conclusions: Together, the data illustrated the importance and challenge of communicating nuanced alcohol-focused public health messages to young people in concise, clear, nonjudgmental, and appealing ways. Young people report interest in clear, credible, neutral, and interactive messages regarding social pressures and short-term risks of alcohol use via a web-based intervention. There is scope for optimization and feasibility testing of the Rethink Alcohol intervention. %M 33320100 %R 10.2196/19749 %U http://pediatrics.jmir.org/2020/2/e19749/ %U https://doi.org/10.2196/19749 %U http://www.ncbi.nlm.nih.gov/pubmed/33320100 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e22368 %T Identifying Targets for Substance Use Prevention in Young People Exposed to Childhood Adversity: Protocol for a Systematic Review %A Grummitt,Lucinda Rachel %A Kelly,Erin Veronica %A Barrett,Emma Louise %A Keyes,Katherine M %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, Sydney, 2006, Australia, 61 0286279048, lucinda.grummitt@sydney.edu.au %K adverse childhood experiences %K substance use %K adolescence %K mediation %K moderation %D 2020 %7 4.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adverse childhood experiences are prevalent robust risk factors for the development of substance use problems. However, less is known about the causal mechanisms that explain these relationships. While directly preventing adverse childhood experiences is ideal, it is not always possible. In such cases, the mechanisms themselves may be amenable to intervention, allowing for the effective prevention of problematic substance use among children exposed to adversity. Identifying such mechanisms is therefore a critical step for efforts aiming to reduce the high individual and societal burdens associated with substance use globally. Objective: This study aims to systematically identify and synthesize evidence on the modifiable mediators and moderators of the relationship between adverse childhood experiences and substance use outcomes in young people (age 10-24 years). Methods: A systematic review will be conducted using PubMed, MEDLINE, PsycINFO, Web of Science, and CINAHL databases to determine the modifiable mediators and moderators of the relationship between adverse childhood experiences and substance use in young people. Data from the review will be qualitatively synthesized, unless we identify a sufficient number of studies (at least five) that examine the same type of adversity (eg, physical or sexual abuse) and the same mediator/moderator, in which case a quantitative synthesis (meta-analysis) will be conducted. If a quantitative synthesis is warranted, standardized effect estimates of the indirect (mediated) effect between adverse childhood experiences and substance use outcomes will be combined using a random-effects meta-analysis. Mediators/moderators will be grouped according to a socioecological perspective, using the four levels of individual, interpersonal, community, and public policy/culture. Results: Electronic searches were completed in August 2019. A total of 4004 studies were included for screening after removing duplicates. After evaluating titles and abstracts against eligibility criteria, a further 3590 studies were excluded, leaving 415 studies for full-text screening. The results of the review are expected to be available by December 2020. Conclusions: The mechanisms linking adverse childhood experiences and substance use outcomes in young people are vital targets for substance use prevention efforts. This review will provide evidence to inform the development of prevention strategies in order to interrupt the negative life trajectory that can begin with childhood adversity. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020148773; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020148773 International Registered Report Identifier (IRRID): DERR1-10.2196/22368 %M 33275102 %R 10.2196/22368 %U http://www.researchprotocols.org/2020/12/e22368/ %U https://doi.org/10.2196/22368 %U http://www.ncbi.nlm.nih.gov/pubmed/33275102 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 11 %P e21015 %T Reducing Alcohol and Opioid Use Among Youth in Rural Counties: An Innovative Training Protocol for Primary Health Care Providers and School Personnel %A Francis,Erica %A Shifler Bowers,Kara %A Buchberger,Glenn %A Ryan,Sheryl %A Milchak,William %A Kraschnewski,Jennifer %+ College of Medicine, Penn State University, 90 Hope Drive, Hershey, PA, 17033, United States, 1 17175990866, kbowers1@pennstatehealth.psu.edu %K alcoholism %K adolescent behavior %K binge drinking %K rural health %K underage drinking %K adolescent %K young adult %K alcohol %K drinking %K behavior %K screening %K intervention %K referral %D 2020 %7 6.11.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Given that youth alcohol use is more common in rural communities, such communities can play a key role in preventing alcohol use among adolescents. Guidelines recommend primary care providers incorporate screening, brief intervention, and referral to treatment (SBIRT) into routine care. Objective: The aim is to train primary care providers and school nurses within a rural 10-county catchment area in Pennsylvania to use SBIRT and facilitate collaboration with community organizations to better coordinate substance use prevention efforts. Methods: To build capacity to address underage drinking and opioid use among youth aged 9-20 years, this project uses telehealth, specifically Project ECHO (Extension for Community Healthcare Outcomes), to train primary care providers and school nurses to address substance use with SBIRT. Our project will provide 120 primary care providers and allied health professionals as well as 20 school nurses with SBIRT training. Community-based providers will participate in weekly virtual ECHO sessions with a multidisciplinary team from Penn State College of Medicine that will provide SBIRT training and facilitate case discussions among participants. Results: To date, we have launched one SBIRT ECHO project with school personnel, enrolling 34 participants. ECHO participants are from both rural (n=17) and urban (n=17) counties and include school nurses (n=15), school counselors (n=8), teachers (n=5), administrators (n=3), and social workers (n=3). Before the study began, only 2/13 (15.5%) of schools were screening for alcohol use. Conclusions: This project teaches primary care clinics and schools to use SBIRT to prevent the onset and reduce the progression of substance use disorders, reduce problems associated with substance use disorders, and strengthen communities’ prevention capacity. Ours is an innovative model to improve rural adolescent health by reducing alcohol and opioid use. International Registered Report Identifier (IRRID): DERR1-10.2196/21015 %M 33155572 %R 10.2196/21015 %U http://www.researchprotocols.org/2020/11/e21015/ %U https://doi.org/10.2196/21015 %U http://www.ncbi.nlm.nih.gov/pubmed/33155572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e16632 %T Usability and Acceptability of a Mobile App to Help Emerging Adults Address their Friends' Substance Use (Harbor): Quantitative Study %A Bennett,Kyle Michael %A Clary,Kelly Lynn %A Smith,Douglas Cary %A Lee,Carol Ann %+ University of Illinois Urbana-Champaign, 1010 West Nevada Street, Urbana, IL, 61801, United States, 1 2177660755, kmbennet@illinois.edu %K young adults %K substance abuse %K peer influence %K mobile applications %K mobile phone %K community-based participatory research %K crowdsourcing %D 2020 %7 5.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-assisted intervention and prevention strategies present opportunities for substance use–related research with emerging adults (EAs) and their peers. Emerging adulthood is a developmentally distinct period in which individuals between the ages of 18 and 29 years undergo unique emotional, cultural, developmental, and biological changes as they transition into adulthood. Crowdsourcing, or gathering feedback from a large group within web-based communities, offers researchers a unique and cost-effective way to obtain large amounts of information in a short period. Objective: This paper presents market feedback obtained via Amazon’s Mechanical Turk from EAs (N=458) on the acceptability and utility of brief intervention scripts for a smartphone app currently under development. The mobile app, Harbor, teaches friends of EAs with substance use problems effective and supportive strategies for helping their friend make changes in their substance use behavior. Methods: We examined feedback on the wording of the intervention scripts and estimated the market size of EAs who may use this app. Furthermore, we calculated correlations between script ratings and measures of personal risky drinking (ie, Alcohol Use Disorder Identification Test) and the participants’ use of confrontational, enabling, or supportive behaviors with an existing friend. Results: Approximately half of our sample (208/458, 45.4%) indicated that they had a close friend for whom they had concerns about their substance use, suggesting a potentially high demand for an app such as Harbor. Initial findings suggest that peers who engage in less enabling behaviors with friends who have a substance use problem exhibited lower risky drinking behaviors overall (r206=−0.501; P<.001). Concerning acceptability, 98.0% (449/458) of the sample rated the scripts’ dialogue as either somewhat, moderately, or extremely realistic (mean 3.92, SD 0.48) on 5-point Likert scale items. Finally, 95.4% (437/454) of respondents indicated that the scripts would be at least slightly helpful for training peers to help their friends with substance use issues. Finally, individuals who were better able to identify enabling language in enabling scripts self-reported fewer enabling behaviors toward their friend’s substance use (r206=−0.236; P=.001). Conclusions: There exists a demonstrated level of desirability and acceptability among EAs for a mobile app such as Harbor. EAs who wish to engage in more supportive behaviors with their friends who engage in substance use and who are amenable to assisting their friends with sobriety likely would use and benefit from this app. %M 33151158 %R 10.2196/16632 %U https://www.jmir.org/2020/11/e16632 %U https://doi.org/10.2196/16632 %U http://www.ncbi.nlm.nih.gov/pubmed/33151158 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20976 %T Repeated Psychosocial Screening of High School Students Using YouthCHAT: Cohort Study %A Thabrew,Hiran %A Kumar,Harshali %A Goldfinch,Mary %A Cavadino,Alana %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, The University of Auckland, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 21402055, h.thabrew@auckland.ac.nz %K mass screening %K mental health %K school health services %K eHealth %D 2020 %7 26.10.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Psychosocial problems are common during adolescence and can have long-lasting effects on health and on academic and social functioning. YouthCHAT, an electronic HEEADSSS (home, education, eating, activities, drugs and alcohol, suicide and depression, sexuality and safety)-aligned instrument, has recently been demonstrated to be an acceptable and effective school-based psychosocial screener for 13-year-old (Year 9) high school students. Objective: This study aims to compare acceptability and detection rates with repeated YouthCHAT screenings of high school students when they are 13 years old (Year 9) and 14 years old (Year 10). Methods: We invited all Year-10 students to complete a YouthCHAT screening in 2018. Rates of positively identified issues were compared between the subset of students screened in both 2017 and 2018. Student acceptability toward YouthCHAT was investigated through focus group sessions. Onward clinical referral rates in 2018 were also investigated to explore the potential referral burden following screening. Data analysis for rates of positively identified issues were conducted with the McNemar test. Chi-square, Fisher exact test, and Kruskal-Wallis test were used to analyze the focus group data. Results: Of 141 eligible Year-10 students, 114 (81%) completed a YouthCHAT screening during 2018, and 97 (85%) of them completed it for a second time. Apart from depression, which increased (P=.002), and perceived life stress, which decreased (P=.04), rates of identified issues were broadly similar between 13 and 14 years of age. Repeated screenings via YouthCHAT was acceptable to students and time-efficient (mean, 6 minutes and 32 seconds) but did not reduce the overall number of individuals with identified issues. Onward clinical referrals from positive screens were mostly managed by school-based health services without the need for external referrals. Conclusions: Although further evaluation is needed, our results support the value of YouthCHAT as an acceptable and effective instrument with which to achieve routine identification of psychosocial issues and early intervention within a high school environment. %M 33104007 %R 10.2196/20976 %U http://pediatrics.jmir.org/2020/2/e20976/ %U https://doi.org/10.2196/20976 %U http://www.ncbi.nlm.nih.gov/pubmed/33104007 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e23463 %T Patient and Clinician Perspectives on Adolescent Opioid Use Disorder Treatment During a Pandemic: One Step Back, but Two Forward? %A Stull,Samuel W %A McKnight,Erin R %A Bonny,Andrea E %+ Department of Biobehavioral Health, The Pennsylvania State University, Biobehavioral Health Building, University Park, PA, 16802, United States, 1 6145518640, sws6084@psu.edu %K adolescent %K opioid use disorder %K treatment %K telehealth %K drug %K perspective %K opioid %K COVID-19 %K young adult %D 2020 %7 9.10.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X Opioid use disorder (OUD) is one of the most pressing public health problems in the United States and is highly prevalent among adolescents and young adults (AYAs). However, only a small percentage of AYAs with OUD ever receive treatment. Further, among those that do receive treatment, a substantial proportion of patients continue to struggle with OUD, and many prematurely drop out of treatment. These challenges have only been heightened in the face of the COVID-19 pandemic, but greater utilization of telehealth and mobile technologies by OUD patients may help counter these barriers, which ultimately may improve AYA OUD treatment in the postpandemic period. This viewpoint presents the perspective of a person in OUD recovery using online and mobile technology to support his own OUD recovery combined with thoughts from two clinicians supporting AYAs with OUD. Their perspectives may provide insights to help counter COVID-19–related consequences and offer clues to improving AYA OUD treatment in the long term. %M 33016885 %R 10.2196/23463 %U http://pediatrics.jmir.org/2020/2/e23463/ %U https://doi.org/10.2196/23463 %U http://www.ncbi.nlm.nih.gov/pubmed/33016885 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21676 %T Development and Acceptability of a Method to Investigate Prescription Drug Misuse in Daily Life: Ecological Momentary Assessment Study %A Papp,Lauren M %A Barringer,Alexandra %A Blumenstock,Shari M %A Gu,Pamela %A Blaydes,Madison %A Lam,Jaime %A Kouros,Chrystyna D %+ Department of Human Development and Family Studies, University of Wisconsin-Madison, 1300 Linden Drive, Madison, WI, 53706, United States, 1 608 262 8611, papp@wisc.edu %K compliance %K ecological momentary assessment %K prescription drug misuse %K young adult %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prescription drug misuse and abuse is an established public health challenge, and young adults are particularly affected. There is a striking lack of real-time, naturalistic data collection assessing intentions to misuse and other precipitating factors at the time of actual misuse, leaving the conditions under which individuals are most likely to misuse prescription medications unknown. Ecological momentary assessment (EMA) apps and protocols designed to capture this information would accelerate and expand the knowledge base and could directly contribute to prevention and treatment efforts. Objective: The objectives of this study are to describe the development and administration of a mobile app and the EMA protocol designed to collect real-time factors associated with college students’ prescription drug misuse intentions and behaviors in daily life; present completion rates, compliance, acceptability, and reactivity associated with the EMA protocol for participants who endorsed recent prescription drug misuse at screening (ie, risk group; n=300) and those who did not (ie, nonrisk group; n=55); and establish initial construct validity by linking the reports of misuse behaviors in daily life collected via the EMA app to prescription drug misuse reported on a standard survey. Methods: An EMA data collection app and protocol were designed specifically to capture hypothesized contextual factors along with prescription drug misuse intentions and behaviors in daily life. Using this protocol, young adult college students (N=352) completed signal- and event-contingent reports over a 28-day period. When the intention to misuse a prescription drug was endorsed, a brief follow-up prompt was sent 15 min later to collect participants’ indications of whether or not misuse had occurred. Results: Risk-group participants were significantly more likely than nonrisk counterparts to endorse any prescription drug misuse intentions in daily life (P<.001), to complete one or more follow-up reports (P<.001), and to endorse any prescription drug misuse behavior in daily life on the follow-ups (P<.001). Overall, participants demonstrated consistent engagement with the EMA procedures and returned an average of 74.5 (SD 23.82; range 10-122) reports. Participants in the risk and nonrisk groups did not differ in the number of reports they completed (P=.12), the number of their reporting days (P=.32), or their average completion rates (P=.14). The results indicated some evidence of reactivity to the momentary reporting procedure. Participants reported uniformly positive experiences and remained highly engaged throughout the reporting protocol and broader study. Conclusions: The novel EMA app and protocol provide an effective way to assess real-time factors associated with prescription drug misuse intentions and behaviors in daily life. The resulting investigations offer the potential to provide highly translatable information for research and prevention efforts. %M 32877351 %R 10.2196/21676 %U https://mhealth.jmir.org/2020/10/e21676 %U https://doi.org/10.2196/21676 %U http://www.ncbi.nlm.nih.gov/pubmed/32877351 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16725 %T Meeting Kids Where They Are At–A Substance Use and Sexual Risk Prevention Program via Telemedicine for African American Girls: Usability and Acceptability Study %A Lopez,Cristina %A Gilmore,Amanda K %A Moreland,Angela %A Danielson,Carla Kmett %A Acierno,Ron %+ Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 161, Charleston, SC, 29425, United States, 1 8438761034, lopezcm@musc.edu %K adolescents %K substance use %K sexual risk reduction %K telehealth %K prevention programs %K mobile phone %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Rural African American youth lack access to drug and sexual risk–taking prevention programs available in more urban areas. Recent data indicate that rural youth now use substances at higher rates and at younger ages than their urban peers. Objective: This study aims to evaluate the initial usability and acceptability of a low-cost, technology-based approach to delivering effective, culturally tailored, integrated substance use disorder (SUD) and HIV risk behavior prevention programs to African American female youth to inform the use of this intervention via telemedicine for rural youth. Methods: Effective SUD prevention strategies and emotion regulation skills were integrated into an existing evidence-based HIV risk reduction program culturally tailored for African American female adolescents—Sisters Informing, Healing, Living, and Empowering (SIHLE)—and delivered to 39 African American female youth via group telehealth. The evaluation of the resulting program, 12-session SIHLEplus, was completed by 27 girls who also completed self-report measures that assessed sexual risk behaviors (eg, number of partners and age of sex initiation), substance use, exposure to traumatic events, and emotion regulation. Results: The descriptive and qualitative results of the pilot study demonstrate the initial usability and acceptability of delivering evidence-based prevention successfully via telehealth to help address health disparities in this vulnerable population. Conclusions: Although more research is needed, the findings from this study suggest that SIHLEplus has demonstrated initial usability and acceptability. %M 32780022 %R 10.2196/16725 %U http://www.jmir.org/2020/8/e16725/ %U https://doi.org/10.2196/16725 %U http://www.ncbi.nlm.nih.gov/pubmed/32780022 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e15803 %T A Web-Based Program for Cannabis Use and Psychotic Experiences in Young People (Keep It Real): Protocol for a Randomized Controlled Trial %A Hides,Leanne %A Baker,Amanda %A Norberg,Melissa %A Copeland,Jan %A Quinn,Catherine %A Walter,Zoe %A Leung,Janni %A Stoyanov,Stoyan R %A Kavanagh,David %+ Lives Lived Well Group, National Centre for Youth Substance Use Research, School of Psychology, The University of Queensland, St Lucia, Brisbane, 4072, Australia, 61 733656230, l.hides@uq.edu.au %K cannabis %K marijuana %K substance use %K psychotic %K psychotic experiences %K psychosis %K digital intervention %K web-based program %K eHealth %K adolescent %K CBT %K motivational interviewing %K mindfulness %K education %K well-being %D 2020 %7 29.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young Australians (16-25 years) have the highest rates of past-month cannabis use in the world. Cannabis use increases the risk of alcohol and other drug disorders and depressive disorders, and has a robust dose-response association with psychotic experiences (PEs) and disorders. PEs are subthreshold positive psychotic symptoms, including delusions and hallucinations, which increase the risk of substance use, depressive or anxiety disorders, and psychotic disorders. Access to effective web-based early interventions targeting both cannabis use and PEs could reduce such risk in young people. Objective: The objective of this study is to determine the efficacy and cost-effectiveness of the Keep it Real web-based program compared to an information-only control website among young cannabis users (16-25 years) with PEs. Methods: Participants are recruited online, and consenting individuals meeting inclusion criteria (aged 16-25 years, who have used cannabis in the past month and experienced PEs in the past 3 months) are automatically randomized to either the Keep it Real web-based program (n=249) or an information-only control website (n=249). Both websites are self-guided (fully automated). The baseline and follow-up assessments at 3, 6, 9, and 12 months are self-completed online. Primary outcome measures are weekly cannabis use, PEs, and the relative cost-effectiveness for quality-adjusted life years. Secondary outcomes include other substance use and related problems, PE-related distress, cannabis intoxication experiences, severity of cannabis dependence, depression/anxiety symptoms, suicidality, and mental well-being and functioning. Results: Recruitment commenced in February 2019, and the results are expected to be submitted for publication in mid-2021. Conclusions: This study protocol describes a large randomized controlled trial of a new web-based program for young cannabis users experiencing PEs. If effective, the accessibility and scalability of Keep it Real could help reduce growing public health concerns about the significant social, economic, and health impacts of cannabis use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001107213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374800 International Registered Report Identifier (IRRID): DERR1-10.2196/15803 %M 32723727 %R 10.2196/15803 %U https://www.researchprotocols.org/2020/7/e15803 %U https://doi.org/10.2196/15803 %U http://www.ncbi.nlm.nih.gov/pubmed/32723727 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19485 %T A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program %A Champion,Katrina Elizabeth %A Gardner,Lauren Anne %A McGowan,Cyanna %A Chapman,Cath %A Thornton,Louise %A Parmenter,Belinda %A McBride,Nyanda %A Lubans,David R %A McCann,Karrah %A Spring,Bonnie %A Teesson,Maree %A , %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, The Matilda Centre, Level 6, Jane Foss Russell Building (G02), University of Sydney, NSW, Sydney, 2006, Australia, 61 286279006, katrina.champion@sydney.edu.au %K primary prevention %K schools %K eHealth %K chronic disease %K mobile phone %K health promotion %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. %M 32720898 %R 10.2196/19485 %U http://formative.jmir.org/2020/7/e19485/ %U https://doi.org/10.2196/19485 %U http://www.ncbi.nlm.nih.gov/pubmed/32720898 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18446 %T Recruiting and Retaining Youth and Young Adults in the Policy and Communication Evaluation (PACE) Vermont Study: Randomized Controlled Trial of Participant Compensation %A Villanti,Andrea C %A Vallencourt,Christie P %A West,Julia C %A Peasley-Miklus,Catherine %A LePine,S Elisha %A McCluskey,Caitlin %A Klemperer,Elias %A Priest,Jeffrey S %A Logan,Alison %A Patton,Bill %A Erickson,Nancy %A Hicks,Jennifer %A Horton,Kathleen %A Livingston,Shayla %A Roemhildt,Maria %A Singer,Erin %A Trutor,Megan %A Williams,Rhonda %+ Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont Larner College of Medicine, 1 South Prospect Street, MS 482, Burlington, VT, 05401, United States, 1 8026561187, avillant@uvm.edu %K recruitment %K retention %K adolescents %K young adults %K prevention %D 2020 %7 20.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The standard approach for evaluating the effects of population-level substance use prevention efforts on youth and young adult perceptions and behaviors has been to compare outcomes across states using national surveillance data. Novel surveillance methods that follow individuals over shorter time intervals and capture awareness of substance use prevention policy and communication efforts may provide a stronger basis for their evaluation than annual cross-sectional studies. Objective: This study aimed to identify a combination of strategies to recruit a sample of youth and young adults sufficiently representative of the Vermont population and determine how best to retain a web-based panel of youth and young adults over a 6-month period. Methods: Eligible participants were Vermont residents aged 12 to 25 years who were willing to complete three 10 to 15-minute web-based surveys over a 6-month period. Recruitment was conducted via the following three main mechanisms: (1) web-based recruitment (paid and unpaid), (2) community-based recruitment through partners, and (3) participant referrals via a personalized link. Upon completion of the baseline survey, participants were randomly assigned to one of the following three retention incentive conditions: (1) guaranteed incentive (US $10), (2) lottery incentive (US $50 weekly lottery drawing), and (3) preferred method (guaranteed or lottery). Analyses examined cost per survey start by recruitment source, distribution of demographic characteristics across incentive conditions, and retention by study condition at 3-month and 6-month follow-ups. Results: Over a 10-week period in 2019, we recruited 480 eligible youth (aged 12-17 years) and 1037 eligible young adults (aged 18-25 years) to the Policy and Communication Evaluation (PACE) Vermont Study. Facebook and Instagram advertising produced the greatest number of survey starts (n=2013), followed by posts to a state-wide web-based neighborhood forum (n=822) and Google advertisements (n=749). Retention was 78.11% (1185/1517) at 3 months and 72.18% (1095/1517) at 6 months. Retention was equivalent across all incentive study conditions at both waves, despite a strong stated preference among study participants for the guaranteed payment at baseline. Youth had greater retention than young adults at both waves (wave 2: 395/480, 82.3% vs 790/1037, 76.18%; wave 3: 366/480, 76.3% vs 729/1037, 70.30%). Substance use prevalence in this cohort was similar to national and state-level surveillance estimates for young adults, but was lower than state-level surveillance estimates for youth. Most participants retained at wave 3 provided positive qualitative feedback on their experience. Conclusions: Our study supports the feasibility of recruiting a web-based cohort of youth and young adults with representation across an entire state to evaluate substance use prevention efforts. Findings suggest that a guaranteed payment immediately upon survey completion coupled with a bonus for completing all survey waves and weekly survey reminders may facilitate retention in a cohort of youth and young adults. %M 32706681 %R 10.2196/18446 %U http://www.jmir.org/2020/7/e18446/ %U https://doi.org/10.2196/18446 %U http://www.ncbi.nlm.nih.gov/pubmed/32706681 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17702 %T Effectiveness of the InCharge Prevention Program to Promote Healthier Lifestyles: Protocol for a Randomized Controlled Trial %A Mesman,Mathijs %A Onrust,Simone %A Verkerk,Renée %A Hendriks,Hanneke %A Van den Putte,Bas %+ Amsterdam School of Communication Research, University of Amsterdam, Nieuwe achtergracht 166, Amsterdam, , Netherlands, 31 0641711825, m.mesman@uva.nl %K school-based health intervention %K adolescents %K health behavior %K healthy lifestyle %K quality of life %K behavior change %D 2020 %7 8.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: InCharge is a newly developed school-based health intervention aimed at older adolescents. It aims to promote a healthier lifestyle by increasing self-regulation skills. After the InCharge program’s effectiveness was previously investigated in a pilot study, the content of the program was adapted. Objective: This study describes the protocol of a cluster randomized controlled trial that aims to investigate the effectiveness of the InCharge program. Methods: A cluster randomized controlled trial including 70 classes with older adolescents (aged 16 years or older) in the Netherlands will be conducted to test the effectiveness of the InCharge program. After schools are recruited, randomization occurs at the class level. The trial consists of the following two conditions: an experimental condition and a control condition. Participants in the experimental condition will be given the InCharge intervention, consisting of four lessons of 50 minutes, with each lesson containing three assignments of approximately 15 minutes. While participants in the experimental condition will receive InCharge, participants in the control condition will receive regular academic school courses. Surveys are administered 1 week before the intervention (baseline), 1 week after the intervention (posttest), and 12 weeks after the intervention (follow-up). Variables of interest include, but are not limited to, self-regulation; predictors of snack intake, physical activity, and alcohol use; and interpersonal communication regarding these health behaviors. In addition to surveys, observations will be conducted during the first and fourth lessons, teachers will be interviewed, and focus groups will be held with a selection of students from the intervention condition. Results: Enrollment started in September 2017. As of June 2019, a total of 1216 participants were enrolled for this trial. Findings will be published in peer-reviewed journals and presented at conferences. The trial has been approved by the Ethics Review Board of the Faculty of Social and Behavioral Sciences of the University of Amsterdam (reference no.: 2017-PC-8244). Conclusions: In this study protocol, the design of a cluster randomized controlled trial is described, which assesses how effectively the school-based intervention InCharge stimulates healthier lifestyles in late adolescents. We hypothesize that participants in the experimental condition will consume less alcohol, eat fewer unhealthy snacks, and be more physically active compared with participants in the control condition. Trial Registration: Netherlands Trial Register (NL6654); https://www.trialregister.nl/trial/6654 International Registered Report Identifier (IRRID): RR1-10.2196/17702 %M 32673278 %R 10.2196/17702 %U http://www.researchprotocols.org/2020/7/e17702/ %U https://doi.org/10.2196/17702 %U http://www.ncbi.nlm.nih.gov/pubmed/32673278 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16937 %T Assessment of the Efficacy of a Mobile Phone–Delivered Just-in-Time Planning Intervention to Reduce Alcohol Use in Adolescents: Randomized Controlled Crossover Trial %A Haug,Severin %A Paz Castro,Raquel %A Scholz,Urte %A Kowatsch,Tobias %A Schaub,Michael Patrick %A Radtke,Theda %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8005, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K alcohol %K adolescents %K planning intervention %K just-in-time intervention %K crossover trial %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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 %M 32452818 %R 10.2196/16937 %U http://mhealth.jmir.org/2020/5/e16937/ %U https://doi.org/10.2196/16937 %U http://www.ncbi.nlm.nih.gov/pubmed/32452818 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 5 %P e16688 %T Social Media Interventions for Risky Drinking Among Adolescents and Emerging Adults: Protocol for a Randomized Controlled Trial %A Bonar,Erin E %A Schneeberger,Diane M %A Bourque,Carrie %A Bauermeister,Jose A %A Young,Sean D %A Blow,Frederic C %A Cunningham,Rebecca M %A Bohnert,Amy SB %A Zimmerman,Marc A %A Walton,Maureen A %+ Department of Psychiatry, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, Ann Arbor, MI, 48109, United States, 1 7347647936, erinbona@med.umich.edu %K social media %K alcohol consumption %K adolescents %K emerging adults %K internet-based intervention %D 2020 %7 13.5.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite intervention efforts to date, the prevalence of risky drinking among adolescents and emerging adults remains high, increasing the risk for health consequences and the development of alcohol use disorders. Peer influences are particularly salient among this age group, including via social media. Thus, the development of efficacious early interventions for youth, delivered with a broad reach via trained peers on social media, could have an important role in addressing risky drinking and concomitant drug use. Objective: This paper describes the protocol of a randomized controlled trial (RCT) testing the efficacy of a social media intervention among adolescents and emerging adults who meet the criteria for risky drinking (using the Alcohol Use Disorders Identification Test-Consumption [AUDIT-C]), delivered with and without financial incentives for participation, compared with an attention placebo control condition (ie, entertaining social media content), on alcohol consumption and consequences. Methods: This RCT involved recruiting 955 youths (aged 16-24 years) via advertisements on Facebook and Instagram to self-administer a brief web-based screening survey. Those screening positive for past 3-month risky drinking (AUDIT-C positive: ages 16-17 years: ≥3 females and ≥4 males; and ages 18-24 years: ≥4 females and ≥5 males) were eligible for the RCT. After providing consent (a waiver of parental consent was obtained for minors), participants completed a web-based baseline survey and several verification procedures, including a selfie photo matched to Facebook profile photos. Participants were then randomized to join invitation-only secret Facebook groups, which were not searchable or viewable by parents, friends, or anyone not recruited by the study. The 3 conditions were social media intervention with incentives, social media intervention without incentives (SMI), and attention placebo control. Each condition lasted 8 weeks and consisted of bachelor’s-level and master’s-level therapist electronic coaches posting relevant content and responding to participants’ posts in a manner consistent with Motivational Interviewing. Participants in the control condition and SMI condition did not receive payments but were blind to condition assignment between these 2 conditions. Follow-ups are ongoing and occur at 3, 6, and 12 months poststart of the groups. Results: We enrolled 955 participants over 10 waves of recruitment who screened positive for risky drinking into the RCT. Conclusions: The findings of this study will provide the critical next step in delivering early alcohol interventions to the youth, capitalizing on social media platforms, which could have significant public health impact by altering alcohol use trajectories of adolescents and emerging adults engaged in risky drinking. Trial Registration: ClinicalTrials.gov NCT02809586; https://clinicaltrials.gov/ct2/show/NCT02809586. International Registered Report Identifier (IRRID): DERR1-10.2196/16688 %M 32401225 %R 10.2196/16688 %U https://www.researchprotocols.org/2020/5/e16688 %U https://doi.org/10.2196/16688 %U http://www.ncbi.nlm.nih.gov/pubmed/32401225 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e16207 %T Peer-to-Peer Social Media as an Effective Prevention Strategy: Quasi-Experimental Evaluation %A Evans,William %A Andrade,Elizabeth %A Pratt,Michaela %A Mottern,Alexandra %A Chavez,Sergio %A Calzetta-Raymond,Anthony %A Gu,Jiayan %+ Milken Institute School of Public Health, George Washington University, Washington, DC, United States, 1 2023519546, wdevans@gwu.edu %K social media %K substance use %K prevention %K marijuana %K opioids %K adolescent health %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Substance use by adolescents remains to be at unacceptably high levels, and there is evidence that teens’ social norms are becoming more favorable toward recreational use and perceived safety of substances such as marijuana and prescription opioids. Social media offer a low-cost, potentially high-impact approach to disseminate prevention messages. Objective: Living the Example (LTE) is a program that trains adolescent youth ambassadors to develop and disseminate prevention messages within their own social media networks and through in-school activities. This study aimed to evaluate the effects of exposure to LTE-based social media on students in the youth ambassadors’ networks. Methods: The George Washington (GW) University designed and implemented a quasi-experimental evaluation of the LTE program in 3 Maryland high schools. Before program launch, a sample of 826 students (wave 1) at the 3 schools, drawn from a census of freshmen enrolled in a class attended by all students at the grade level, completed a survey. A total of 584 students were surveyed at the wave 2 program midpoint and 542 at the wave 3 endpoint. The survey contained questions on drug use–related attitudes, beliefs, intentions, and behaviors, all based on validated measures. We evaluated the effects of LTE on the intended next 30-day drug use, and controlling for LTE self-reported exposure, age, and gender from waves 2 and 3 was appended into a single dataset. We first conducted ordinal logistic regressions for each drug use intention in wave 3 (ie, sell or distribute illegal drugs, smoke cigarettes, drink beer/wine/hard liquor when parents do not know about it, use marijuana, use lysergic acid diethylamide, cocaine, amphetamines or other illegal drugs, use heroin, use synthetic drugs, and use any prescription pills without a prescription) to examine the association between LTE exposure and drug use intentions. We included an interaction term for the study wave to examine intervention effects. Results: We found a significant positive effect of LTE exposure on all 8 measured drug use intentions: sell/distribute illegal drugs; smoke cigarettes; drink beer, wine, or liquor when my parents do not know about it; use marijuana; use cocaine, amphetamines, or other illegal drug; use heroin; use synthetic drugs; use any prescription pills without a prescription (all P<.05; odds ratios ranging from 2.12 to 3.71). We also found that boys were more likely than girls to exhibit reduced drug use intentions. We also found reductions in 30-day intentions between the second and third survey waves for all 8 measured drug use variables. Conclusions: Overall, the results are consistent with and indicate a stronger LTE effect in this study compared with a previous pilot study. LTE appears to offer a protective effect, with exposure to program messages leading to reduced/improved drug use intentions. %M 32374270 %R 10.2196/16207 %U https://mhealth.jmir.org/2020/5/e16207 %U https://doi.org/10.2196/16207 %U http://www.ncbi.nlm.nih.gov/pubmed/32374270 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15568 %T Mental Health Therapy Protocols and eHealth Design: Focus Group Study %A van Dooren,Marierose M M %A Visch,Valentijn %A Spijkerman,Renske %A Goossens,Richard H M %A Hendriks,Vincent M %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 15 27 87660, m.m.m.vandooren@tudelft.nl %K eHealth design %K mental health care %K personalization %K protocol %K youth addiction care %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective: The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods: Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results: Therapists used the protocol as a “toolbox” comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions: A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process. %M 32374271 %R 10.2196/15568 %U https://formative.jmir.org/2020/5/e15568 %U https://doi.org/10.2196/15568 %U http://www.ncbi.nlm.nih.gov/pubmed/32374271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e17688 %T Online Interventions for the Selective Prevention of Illicit Drug Use in Young Drug Users: Exploratory Study %A Tomazic,Tina %A Jerkovic,Olivera Stanojevic %+ Institute of Media Communications, Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroska 46, Maribor, 2000, Slovenia, 386 41704302, tina.tomazic@um.si %K web-based %K intervention %K prevention %K internet %D 2020 %7 22.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies have a major impact on the daily lives of young people and are also used to seek information on and help with drug-related issues online. Objective: The aim of this article was to analyze current online interventions for young drug users in Slovenia, with the purpose of contributing to the development of guidelines and key recommendations for effective online interventions. Methods: This study was part of the project Click for Support. We performed a keyword search, received input from national experts in the field of drug prevention, and conducted an assessment of recognized national online interventions through workshop-based discussions with the target group of 20 young drug users. Results: The current online intervention services in Slovenia are satisfactory but are still not sufficiently recognized. The most important issues for young drug users were the design and functionality of the online intervention, presence of a clear structure, possibility of using it on smartphones, comprehensive and quick professional feedback, and data security. Playful elements and the ability to share (experiences) with other or former users were also recognized as important. Conclusions: With effective online interventions, we can include more young drug users, facilitate access to a more affordable service, provide quick professional feedback on patterns of consumption, increase knowledge about the effects and consequences of drugs, and support the reduction or cessation of drug use. From the public health perspective, it is challenging to provide drug interventions broadly to the target group and, hence, decrease inequities. %M 32319962 %R 10.2196/17688 %U http://www.jmir.org/2020/4/e17688/ %U https://doi.org/10.2196/17688 %U http://www.ncbi.nlm.nih.gov/pubmed/32319962 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 3 %P e14190 %T Effectiveness of an Ecological Momentary Intervention for Reducing Risky Alcohol Consumption Among Young Adults: Protocol for a Three-Arm Randomized Controlled Trial %A Wright,Cassandra %A Dietze,Paul M %A Kuntsche,Emmanuel %A Livingston,Michael %A Agius,Paul A %A Room,Robin %A Raggatt,Michelle %A Hellard,Margaret %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol %K brief intervention %K young adult %K alcohol drinking %K prevention and control %K mobile phone %D 2020 %7 31.3.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent research has investigated the utility of mobile phone–delivered interventions for reducing risky single-occasion drinking, also known as binge drinking. In the past five years, focus has been placed on ecological momentary interventions (EMIs), which aim to deliver intervention content in correspondence to real-time assessments of behavior, also known as ecological momentary assessments (EMAs). Objective: This study aims to assess the effect of a fully automated, tailored, mobile phone–delivered EMI termed Mobile Intervention for Drinking in Young people (MIDY) on young people's risky single-occasion drinking behavior. Methods: We will use a three-armed randomized controlled trial design to determine the impact of MIDY on peak consumption of alcohol among young people. A list of mobile telephone numbers for random digit dialing will be generated, and researchers will telephone potential participants to screen for eligibility. Participants will be randomized into one of three intervention groups. For 6 weeks, EMI, EMA, and attention control groups will complete hourly EMA surveys on their mobile phones on Friday and Saturday nights. EMI participants will receive personalized feedback in the form of text messages corresponding to their EMA survey responses, which focus on alcohol consumption, spending, and mood. EMA participants will not receive feedback. A third group will also complete EMA and receive feedback text messages at the same time intervals, but these will be focused on sedentary behavior and technology use. All groups will also complete a short survey on Saturday and Sunday mornings, with the primary outcome measure taken on Sunday mornings. A more detailed survey will be sent on the final Sunday of the 6-week period, and then again 1 year after recruitment. Results: The primary outcome measure will be an observed change (ie, reduction) in the mean peak number of drinks consumed in a single night over the 6-week intervention period between the EMI and attention control groups as measured in the weekly EMA. We expect to see a greater reduction in mean peak drinking in the EMI group compared to that in the attention control group. As a secondary aim, we will assess whether mean peak drinking is reduced in the EMA group compared to the attention control group. We will use a random-effects mixed-modeling approach using maximum-likelihood estimation to provide estimates of differences in peak drinking across time periods between those receiving the intervention (EMI) and attention control participants. An intention-to-treat approach will be taken for the analysis. Individuals and study groups will be modeled as random and fixed factors, respectively. Conclusions: This study extends our previous work investigating the efficacy of a mobile EMI (MIDY) for reducing risky drinking among young adults in Australia, and will add to the expanding literature on the use of mobile interventions for reducing risky alcohol consumption. Trial Registration: Australian New Zealand Clinical Trials Registration (ANZCTR): ACTRN12617001509358p; http://www.anzctr.org.au/ACTRN12617001509358p.aspx International Registered Report Identifier (IRRID): DERR1-10.2196/14190 %M 32229471 %R 10.2196/14190 %U http://www.researchprotocols.org/2020/3/e14190/ %U https://doi.org/10.2196/14190 %U http://www.ncbi.nlm.nih.gov/pubmed/32229471 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e16191 %T Exploring Substance Use Tweets of Youth in the United States: Mixed Methods Study %A Stevens,Robin C %A Brawner,Bridgette M %A Kranzler,Elissa %A Giorgi,Salvatore %A Lazarus,Elizabeth %A Abera,Maramawit %A Huang,Sarah %A Ungar,Lyle %+ Department of Family and Community Health, University of Pennsylvania School of Nursing, 418 Fagin Hall, Philadelphia, PA, United States, 1 2158984063, robin2@nursing.upenn.edu %K social media %K illicit drug %K youth %K adolescent %D 2020 %7 26.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Substance use by youth remains a significant public health concern. Social media provides the opportunity to discuss and display substance use–related beliefs and behaviors, suggesting that the act of posting drug-related content, or viewing posted content, may influence substance use in youth. This aligns with empirically supported theories, which posit that behavior is influenced by perceptions of normative behavior. Nevertheless, few studies have explored the content of posts by youth related to substance use. Objective: This study aimed to identify the beliefs and behaviors of youth related to substance use by characterizing the content of youths’ drug-related tweets. Using a sequential explanatory mixed methods approach, we sampled drug-relevant tweets and qualitatively examined their content. Methods: We used natural language processing to determine the frequency of drug-related words in public tweets (from 2011 to 2015) among youth Twitter users geolocated to Pennsylvania. We limited our sample by age (13-24 years), yielding approximately 23 million tweets from 20,112 users. We developed a list of drug-related keywords and phrases and selected a random sample of tweets with the most commonly used keywords to identify themes (n=249). Results: We identified two broad classes of emergent themes: functional themes and relational themes. Functional themes included posts that explicated a function of drugs in one’s life, with subthemes indicative of pride, longing, coping, and reminiscing as they relate to drug use and effects. Relational themes emphasized a relational nature of substance use, capturing substance use as a part of social relationships, with subthemes indicative of drug-related identity and companionship. We also identified topical areas in tweets related to drug use, including reference to polysubstance use, pop culture, and antidrug content. Across the tweets, the themes of pride (63/249, 25.3%) and longing (39/249, 15.7%) were the most popular. Most tweets that expressed pride (46/63, 73%) were explicitly related to marijuana. Nearly half of the tweets on coping (17/36, 47%) were related to prescription drugs. Very few of the tweets contained antidrug content (9/249, 3.6%). Conclusions: Data integration indicates that drugs are typically discussed in a positive manner, with content largely reflective of functional and relational patterns of use. The dissemination of this information, coupled with the relative absence of antidrug content, may influence youth such that they perceive drug use as normative and justified. Strategies to address the underlying causes of drug use (eg, coping with stressors) and engage antidrug messaging on social media may reduce normative perceptions and associated behaviors among youth. The findings of this study warrant research to further examine the effects of this content on beliefs and behaviors and to identify ways to leverage social media to decrease substance use in this population. %M 32213472 %R 10.2196/16191 %U http://publichealth.jmir.org/2020/1/e16191/ %U https://doi.org/10.2196/16191 %U http://www.ncbi.nlm.nih.gov/pubmed/32213472 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e16251 %T Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial %A Cordova,David %A Munoz-Velazquez,Jaime %A Mendoza Lua,Frania %A Fessler,Kathryn %A Warner,Sydni %A Delva,Jorge %A Adelman,Nicole %A , %A Fernandez,Angela %A Bauermeister,Jose %+ School of Social Work, University of Michigan, 1080 S University Ave, Room 2772, Ann Arbor, MI, 48109, United States, 1 734 763 6201, cordovad@umich.edu %K youth %K mHealth %K illicit drugs %K sex behavior %K HIV %K primary care %D 2020 %7 17.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings. Objective: This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing. Methods: Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV. Results: Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (∆ score mean 0.36, SD 0.51) and self-efficacy (∆ score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95% CI −0.39 to 0.73), and drug use (Cohen h=1.28, 95% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95% CI −0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95% CI −0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95% CI −0.39 to 0.72). Conclusions: The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted. Trial Registration: ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410. %M 32181747 %R 10.2196/16251 %U https://mhealth.jmir.org/2020/3/e16251 %U https://doi.org/10.2196/16251 %U http://www.ncbi.nlm.nih.gov/pubmed/32181747 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e14035 %T The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study %A Savolainen,Iina %A Oksanen,Atte %A Kaakinen,Markus %A Sirola,Anu %A Paek,Hye-Jin %+ Faculty of Social Sciences, Tampere University, Kalevantie 4, Tampere, 33014, Finland, 358 504377111, iina.savolainen@tuni.fi %K youth %K problem behavior %K excessive alcohol consumption %K internet %K gambling %K loneliness %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the ever-growing and technologically advancing world, an increasing amount of social interaction takes place through the Web. With this change, loneliness is becoming an unprecedented societal issue, making youth more susceptible to various physical and mental health problems. This societal change also influences the dynamics of addiction. Objective: Employing the cognitive discrepancy loneliness model, this study aimed to provide a social psychological perspective on youth addictions. Methods: A comprehensive survey was used to collect data from American (N=1212; mean 20.05, SD 3.19; 608/1212, 50.17% women), South Korean (N=1192; mean 20.61, SD 3.24; 601/1192, 50.42% women), and Finnish (N=1200; mean 21.29, SD 2.85; 600/1200, 50.00% women) youths aged 15 to 25 years. Perceived loneliness was assessed with the 3-item Loneliness Scale. A total of 3 addictive behaviors were measured, including excessive alcohol use, compulsive internet use, and problem gambling. A total of 2 separate models using linear regression analyses were estimated for each country to examine the association between perceived loneliness and addiction. Results: Loneliness was significantly related to only compulsive internet use among the youth in all 3 countries (P<.001 in the United States, South Korea, and Finland). In the South Korean sample, the association remained significant with excessive alcohol use (P<.001) and problem gambling (P<.001), even after controlling for potentially confounding psychological variables. Conclusions: The findings reveal existing differences between youths who spend excessive amounts of time online and those who engage in other types of addictive behaviors. Experiencing loneliness is consistently linked to compulsive internet use across countries, although different underlying factors may explain other forms of addiction. These findings provide a deeper understanding in the mechanisms of youth addiction and can help improve prevention and intervention work, especially in terms of compulsive internet use. %M 31895044 %R 10.2196/14035 %U https://mental.jmir.org/2020/1/e14035 %U https://doi.org/10.2196/14035 %U http://www.ncbi.nlm.nih.gov/pubmed/31895044 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e13911 %T Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial %A Thabrew,Hiran %A D'Silva,Simona %A Darragh,Margot %A Goldfinch,Mary %A Meads,Jake %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Department of Psychological Medicine, University of Auckland, Level 12, Support Block, Auckland Hospital, 2 Park Road, Grafton, Auckland, 1142, New Zealand, 64 21402055, h.thabrew@auckland.ac.nz %K mass screening %K adolescents %K anxiety %K depression %K substance-related disorders %K primary health care %K school health services %K eHealth %D 2019 %7 3.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet–based composite screener for identifying similar psychosocial issues to HEEADSSS Objective: This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. Methods: A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly Māori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. Results: YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. Conclusions: This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check. Trial Registration: Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422. %M 31793890 %R 10.2196/13911 %U https://www.jmir.org/2019/12/e13911 %U https://doi.org/10.2196/13911 %U http://www.ncbi.nlm.nih.gov/pubmed/31793890 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e14751 %T A Parenting Behavior Intervention (the Strengthening Families Program) for Families: Noninferiority Trial of Different Program Delivery Methods %A Kumpfer,Karol Linda %A Brown,Jaynie Litster %+ Health Sciences Center, University of Utah, 5215 Pioneer Fork Rd, Salt Lake City, UT, 84108, United States, 1 435 740 1453, kkumpfer@xmission.com %K parenting %K youth drug prevention %K family skills %K DVD %K Strengthening Families Program %K internet %K noninferiority trial %D 2019 %7 18.11.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The Strengthening Families Program (SFP) is an evidence-based parent training and youth life skills and drug prevention program traditionally delivered in group settings. Families attend parent and youth classes conducted by trained facilitators. Recently, a 2-disk home-use DVD series was created with the same SFP skills as the group classes for parents and the youth to watch together at home. Additional lesson material was added that included healthy brain development, school success, anger management, dangers of alcohol and drugs, and mindfulness. The SFP DVD reduces SFP delivery costs for agencies and logistic burdens to families. Creative applications of the DVD include holding SFP DVD family discussion groups of multiple families and using SFP DVD video clips as part of a shorter 10-week group class version for parents and the youth. Objective: This study aimed to examine three different DVD implementation scenarios using a noninferiority trial, contrasting target outcomes with an age-matched sample culled from a national norm database of families who completed a standard SFP 14-week class. Methods: The partial eta-square was used to compare effect sizes between the different delivery modalities for relevant programmatic outcomes. We adjusted the effect sizes by demographic measures to determine whether there were site-specific features influencing program outcomes. Results: For the unadjusted effect size comparisons, 13 of the 15 indicated that the home-use DVD outperformed group norms with an average 0.13 effect size estimate difference across the comparisons (28% improvement in the effect size for DVD condition). Comparisons of the home-use DVD condition with the mixed DVD use conditions showed no discernable pattern where one condition consistently outperformed another. Adjusted effect sizes still reinforced the superiority of the DVD conditions; however, there was some shrinkage in the effect sizes as expected with the inclusion of relevant covariates. Conclusions: The home-use DVD shows that it is possible to effectively deliver an affordable family-based intervention using alternative technology outside of the traditional group-based class format. In almost all of the comparisons, the DVD conditions outperformed the group norms, underscoring that low-cost DVDs or viewing the videos on the Web may provide a useful surrogate for costly group-based formats. Future studies may want to improve on the quasi-experimental design by examining programmatic differences based on delivery format using a randomized controlled trial, thus strengthening the causal framework regarding program effects. In addition, the assessment protocol relied on retrospective reporting, which, although this can limit response shift bias, does not separate data collection in time as with a true pre- and posttest design. %M 31738176 %R 10.2196/14751 %U http://pediatrics.jmir.org/2019/2/e14751/ %U https://doi.org/10.2196/14751 %U http://www.ncbi.nlm.nih.gov/pubmed/31738176 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14906 %T Formative Evaluation to Build an Online Parenting Skills and Youth Drug Prevention Program: Mixed Methods Study %A Scheier,Lawrence Matthew %A Kumpfer,Karol L %A Brown,Jaynie Litster %A Hu,QingQing %+ LARS Research Institute, 15029 North Thompson Peak Blvd, Suite B111-443, Scottsdale, AZ, 85260, United States, 1 702 630 7584, scheier@larsri.org %K formative evaluation %K parenting skills %K drug prevention %K focus groups %K key stakeholders %K consumer preference survey %K internet intervention %D 2019 %7 5.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Family-based drug prevention programs that use group-based formats with trained facilitators, such as the Strengthening Families Program (SFP), are effective in preventing underage drinking and youth drug use. However, these programs are resource-intensive and have high costs and logistical demands. Tailoring them for Web-based delivery is more cost-effective and makes it easier to scale these programs for widespread dissemination. This requires the active involvement of all key stakeholders to determine content and delivery format. Objective: The aim was to obtain consumer, agency stakeholder, and expert input into the design of a Web-based parenting skills training and youth drug prevention program. Methods: We conducted 10 focus groups with 85 adults (range 4-10, average 8 per group), 20 stakeholder interviews with family services agency staff, and discussed critical design considerations with 10 prevention scientists and e-learning experts to determine the optimal program content and technology features for SFP Online. Focus group participants also answered survey questions on perceived barriers to use, desired navigational features, preferred course format, desired content, preferred reward structures, course length, interactive components, computer efficacy, and technology use. Descriptive statistics were used to examine consumer characteristics; linear regression was used to examine relations between SFP exposure and four continuous outcome measures, including desired program content, interactive technology, and concerns that may inhibit future use of SFP Online. Logistic regression was used as a binary measure of whether consumers desired fun games in the SFP Online program. Results: Three broad thematic categories emerged from the qualitative interviews enumerating the importance of (1) lesson content, (2) logistics for program delivery, and (3) multimedia interactivity. Among the many significant relations, parents who viewed more SFP lessons reported more reasons to use an online program (beta=1.48, P=.03) and also wanted more interactivity (6 lessons: beta=3.72, P=.01; >6 lessons: beta=2.39, P=.01), parents with less interest in a mixed delivery format (class and online) reported fewer reasons to use the online program (beta=−3.93, P=.01), comfort using computers was negatively associated with concerns about the program (beta=−1.83, P=.01), having mobile phone access was related to fewer concerns about online programs (beta=−1.63, P=.02), willingness to view an online program using a mobile phone was positively associated with wanting more online components (beta=1.95, P=.02), and parents who wanted fun games wanted more interactivity (beta=2.28, P=.01). Conclusions: Formative evaluation based on user-centered approaches can provide rich information that fuels development of an online program. The user-centered strategies in this study lay the foundation for improving SFP Online and provide a means to accommodate user interests and ensure the product serves as an effective prevention tool that is attractive to consumers, engaging, and can overcome some of the barriers to recruitment and retention that have previously affected program outcomes in family-based prevention. %M 31687934 %R 10.2196/14906 %U http://formative.jmir.org/2019/4/e14906/ %U https://doi.org/10.2196/14906 %U http://www.ncbi.nlm.nih.gov/pubmed/31687934 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e13593 %T Using Web-Based Pin-Drop Maps to Capture Activity Spaces Among Young Adults Who Use Drugs in Rural Areas: Cross-Sectional Survey %A Cooper,Hannah Luke Fenimore %A Crawford,Natalie D %A Haardörfer,Regine %A Prood,Nadya %A Jones-Harrell,Carla %A Ibragimov,Umedjon %A Ballard,April M %A Young,April M %+ College of Public Health, University of Kentucky, 111 Washington Avenue, Office 211C, Lexington, KY, 40536, United States, 1 859 218 2090, april.young@uky.edu %K rural %K substance use disorder %K Web-based data collection %K geospatial methods %K risk environment %K activity spaces %D 2019 %7 18.10.2019 %9 Review %J JMIR Public Health Surveill %G English %X Background: Epicenters of harmful drug use are expanding to US rural areas, with rural young adults bearing a disproportionate burden. A large body of work suggests that place characteristics (eg, spatial access to health services) shape vulnerability to drug-related harms among urban residents. Research on the role of place characteristics in shaping these harms among rural residents is nascent, as are methods of gathering place-based data. Objective: We (1) analyzed whether young rural adults who used drugs answered self-administered Web-based mapping items about locations where they engaged in risk behaviors and (2) determined the precision of mapped locations. Methods: Eligible individuals had to report recently using opioids to get high; be aged between 18 and 35 years; and live in the 5-county rural Appalachian Kentucky study area. We used targeted outreach and peer-referral methods to recruit participants. The survey asked participants to drop a pin in interactive maps to mark where they completed the survey, and where they had slept most; used drugs most; and had sex most in the past 6 months. Precision was assessed by (1) determining whether mapped locations were within 100 m of a structure and (2) calculating the Euclidean distance between the pin-drop home location and the street address where participants reported sleeping most often. Measures of central tendency and dispersion were calculated for all variables; distributions of missingness for mapping items and for the Euclidean distance variable were explored across participant characteristics. Results: Of the 151 participants, 88.7% (134/151) completed all mapping items, and ≥92.1% (>139/151) dropped a pin at each of the 4 locations queried. Missingness did not vary across most participant characteristics, except that lower percentages of full-time workers and peer-recruited participants mapped some locations. Two-thirds of the pin-drop sex and drug use locations were less than 100 m from a structure, as were 92.1% (139/151) of pin-drop home locations. The median distance between the pin-drop and street-address home locations was 2.0 miles (25th percentile=0.8 miles; 75th percentile=5.5 miles); distances were shorter for high-school graduates, staff-recruited participants, and participants reporting no technical difficulties completing the survey. Conclusions: Missingness for mapping items was low and unlikely to introduce bias, given that it varied across few participant characteristics. Precision results were mixed. In a rural study area of 1378 square miles, most pin-drop home addresses were near a structure; it is unsurprising that fewer drug and sex locations were near structures because most participants reported engaging in these activities outside at times. The error in pin-drop home locations, however, might be too large for some purposes. We offer several recommendations to strengthen future research, including gathering metadata on the extent to which participants zoom in on each map and recruiting participants via trusted staff. %M 31628787 %R 10.2196/13593 %U https://publichealth.jmir.org/2019/4/e13593 %U https://doi.org/10.2196/13593 %U http://www.ncbi.nlm.nih.gov/pubmed/31628787 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 4 %P e11151 %T A Game to Deal With Alcohol Abuse (Jib): Development and Game Experience Evaluation %A Carvalho,Darlinton Barbosa Feres %A Domingueti,Daniel Bueno %A Almeida Santos,Sandro Martins De %A Dias,Diego Roberto Colombo %+ Federal University of São João del-Rei, Departament of Computer Science, Prédio de Ciência da Computação, 3° andar, Av Visconde do Rio Preto, s/nº, Colônia do Bengo, São João del-Rei, Brazil, 55 3379 4935, darlinton@acm.org %K alcohol abuse %K serious game %K software design %K proof of concept evaluation %D 2019 %7 15.10.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Alcohol abuse is the primary cause of (public) health problems in most parts of the world. However, it is undeniable that alcohol consumption is a practice that is widely accepted socially in many places, even being protected by law as a cultural and historical heritage. The issue of alcohol abuse is complex and urgent, and consequently, it is necessary to create innovative approaches such as the proposal explored in this study. Objective: This study aimed to explore the development and evaluation of a serious game for smartphones to present a novel approach to address the issue of alcohol abuse. Methods: A serious game was developed to instill the consequences of alcohol abuse into the player through experimentation in the game. In the game, the consequences of alcohol use are demonstrated by increasing the game speed that gives an illusion of fun but also leads to a premature death. The evaluation employed an assessment based on the Alcohol Use Disorders Identification Test (AUDIT) and the Game Experience Questionnaire (GEQ). The participants belonged to the university student’s house. Results: The game development process has been presented, including its mechanics and gameplay. The game has the style of action and adventure games in which the player controls an indigenous avatar that can deflect or attack opponents coming his or her way. The game evaluation comprised an assessment based on 23 participants, aged 20 to 29 years. According to the AUDIT assessment, 18 participants reported having a low or nonexistent degree of alcohol dependence and 5 declared average dependence. Regarding their habit of playing games on smartphones, 9 participants declared they have this habit of playing (habitual players), and among the 14 that did not have this habit of playing (nonhabitual players), 3 participants declared not having a smartphone at all. The GEQ core assessment showed a higher positive affect among the participants with a habit of playing games, scoring 2.80 (habitual players) on a scale of 4.0 versus 1.61 (nonhabitual players), and higher tension as an opposite relationship of 0.81 (nonhabitual players) versus 0.37 (habitual players). The overall GEQ evaluation showed that the game presents a more positive than negative affect on all users, besides showing the other desirable characteristics of serious games. Conclusions: We present a new way of dealing with the issue of alcohol abuse through a game designed for smartphones. It promotes an overall positive user experience, having a greater impact on users accustomed to games. The proposed approach has its niche, though it is still a minority in the evaluated population. Further research should explore new game features, such as new styles, to make the game more attractive to a wider audience, in addition to performing an in-depth study on the effects of playing it. %M 31617849 %R 10.2196/11151 %U https://games.jmir.org/2019/4/e11151 %U https://doi.org/10.2196/11151 %U http://www.ncbi.nlm.nih.gov/pubmed/31617849 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e13691 %T End User–Informed Mobile Health Intervention Development for Adolescent Cannabis Use Disorder: Qualitative Study %A Bagot,Kara %A Hodgdon,Elizabeth %A Sidhu,Natasha %A Patrick,Kevin %A Kelly,Mikaela %A Lu,Yang %A Bath,Eraka %+ University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, MC 0405, La Jolla, CA, 92093, United States, 1 8582462553, kbagot@ucsd.edu %K adolescent %K cannabis %K mobile health %K treatment %K smartphone %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The rates of cannabis use continue to increase among adolescents and the current interventions have modest effects and high rates of relapse following treatment. There is increasing evidence for the efficacy of mobile technology–based interventions for adults with substance use disorders, but there is limited study of this technology in adolescents who use cannabis. Objective: The goal of our study was to elucidate elements of an app-based adjunctive intervention for cannabis cessation that resonate with adolescents who use cannabis. Methods: Adolescents, aged between 14 and 17 years, who used cannabis were recruited from San Diego County high schools. Semistructured focus groups (6 total; N=37) were conducted to examine the ways in which participants used smartphones, including the use of any health behavior change apps, as well as to elicit opinions about elements that would promote engagement with an app-based intervention for adolescent cannabis cessation. An iterative coding structure was used with first cycle structural coding, followed by pattern coding. Results: Themes that emerged from the analysis included (1) youth valued rewards to incentivize the progressive reduction of cannabis use, which included both nontangible rewards that mimic those obtained on social media platforms and prosocial activity-related rewards, (2) having the ability to self-monitor progression, (3) peer social support, (4) privacy and confidentiality discrete logo and name and usernames within the app, and (5) individualizing frequency and content of notifications and reminders. Conclusions: Integrating content, language, interfaces, delivery systems, and rewards with which adolescents who use cannabis are familiar, engage with on a day-to-day basis, and identify as relevant, may increase treatment engagement and retention for adolescents in substance use treatment. We may increase treatment effectiveness by adapting and individualizing current evidence-based interventions, so that they target the needs of adolescents and are more easily incorporated into their everyday routines. %M 31588909 %R 10.2196/13691 %U https://mhealth.jmir.org/2019/10/e13691 %U https://doi.org/10.2196/13691 %U http://www.ncbi.nlm.nih.gov/pubmed/31588909 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12407 %T Mobile Phone Access and Preference for Technology-Assisted Aftercare Among Low-Income Caregivers of Teens Enrolled in Outpatient Substance Use Treatment: Questionnaire Study %A Ryan-Pettes,Stacy R %A Lange,Lindsay L %A Magnuson,Katherine I %+ Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798-7334, United States, 1 2547102544, stacy_ryan@baylor.edu %K mobile phones %K text messaging %K substance use treatment %K mhealth %K parenting %K aftercare %D 2019 %7 26.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Improvements in parenting practices can positively mediate the outcomes of treatment for adolescent substance use disorder. Given the high rates of release among adolescents (ie, 60% within three months and 85% within one year), there is a critical need for interventions focused on helping parents achieve and maintain effective parenting practices posttreatment. Yet, research suggests that engaging parents in aftercare services is difficult, partly due to systemic-structural and personal barriers. One way to increase parent use of aftercare services may be to offer mobile health interventions, given the potential for wide availability and on-demand access. However, it remains unclear whether mobile phone–based aftercare support for caregivers of substance-using teens is feasible or desired. Therefore, formative work in this area is needed. Objective: This study aims to determine the feasibility and acceptability of mobile phone–based aftercare support in a population of caregivers with teens in treatment for substance use. Methods: Upon enrollment in a treatment program, 103 caregivers completed a mobile phone use survey, providing information about mobile phone ownership, access, and use. Caregivers also provided a response to items assessing desire for aftercare services, in general; desire for mobile phone–based aftercare services specifically; and desire for parenting specific content as part of aftercare services. Research assistants also monitored clinic calls made to caregivers’ mobile phones to provide an objective measure of the reliability of phone service. Results: Most participants were mothers (76.7%) and self-identified as Hispanic (73.8%). The average age was 42.60 (SD 9.28) years. A total of 94% of caregivers owned a mobile phone. Most had pay-as-you-go phone service (67%), and objective data suggest this did not impede accessibility. Older caregivers more frequently had a yearly mobile contract. Further, older caregivers and caregivers of adolescent girls had fewer disconnections. Bilingual caregivers used text messaging less often; however, caregivers of adolescent girls used text messaging more often. Although 72% of caregivers reported that aftercare was needed, 91% of caregivers endorsed a desire for mobile phone–based aftercare support in parenting areas that are targets of evidence-based treatments. Conclusions: The results suggest that mobile phones are feasible and desired to deliver treatments that provide support to caregivers of teens discharged from substance use treatment. Consideration should be given to the age of caregivers when designing these programs. Additional research is needed to better understand mobile phone use patterns based on a child’s gender and among bilingual caregivers. %M 31573920 %R 10.2196/12407 %U https://mhealth.jmir.org/2019/9/e12407 %U https://doi.org/10.2196/12407 %U http://www.ncbi.nlm.nih.gov/pubmed/31573920 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12389 %T Web-Based Prescription Opioid Abuse Prevention for Adolescents: Program Development and Formative Evaluation %A Moore,Sarah K %A Grabinski,Michael %A Bessen,Sarah %A Borodovsky,Jacob T %A Marsch,Lisa A %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, EverGreen Suite 315, Lebanon, NH, 03766, United States, 1 9176789280, sarah.k.moore@dartmouth.edu %K opioids %K prevention and control %K adolescent %K randomized controlled trial %K internet %D 2019 %7 19.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The unprecedented number of youths engaged in nonmedical use of prescription opioids (POs), as well as the myriad negative consequences of such misuse, emphasizes the importance of prevention efforts targeting this public health crisis. Although there are several science-based, interactive drug abuse prevention programs focused on preventing the use of nonprescription drugs in youths, to our knowledge, there are no science-based interactive programs that focus on the prevention of PO abuse among adolescents. Objective: The aim of this study was to develop and conduct a formative evaluation of a science-based interactive Web-based program focused on the prevention of PO abuse among adolescents aged 12 to 17 years (Pop4Teens). This study was conducted to prepare for a randomized controlled trial designed to evaluate the effectiveness of Pop4Teens compared with an active control website, JustThinkTwice.com (Drug Enforcement Administration), in impacting knowledge and attitudes about POs and perceptions of risk associated with the abuse of POs, as well as intentions to use and actual use of POs. Methods: We conducted 6 focus groups with 30 youths (a mean of 5 per group: the eligibility being aged 12-19 years) along a continuum of exposure to POs (in treatment for opioid use disorder, in general treatment for other substance use disorder, prescribed an opioid, and opioid-naïve) and writing sessions with 30 youths in treatment for opioid use disorder (12-19 years) to inform the development of the Web-based prevention tool. Feasibility and acceptability of a prototype of the Web-based intervention were then assessed through individual feedback sessions with 57 youths (drawn from the same populations as the focus groups). Results: We successfully completed the development of a Web-based PO abuse prevention program (Pop4Teens). Analyses of focus group transcripts informed the development of the program (eg, quiz content/format, script writing, and story editing). Selected writing session narratives anchored the planned scientific content by lending credibility and informing the development of compelling storylines intended to motivate the youth to engage with the program. Feedback session data indicated that the Web-based tool could be potentially useful and acceptable. In addition, feedback session participants demonstrated significant increases in their knowledge of key topics related to the prevention of PO abuse after the exposure to sections of the Web-based program. Conclusions: The opioid crisis is predicted to get worse before it gets better. An effective response will likely require a multipronged strategy inclusive of effective evidence-based prevention programs acceptable to, and accessible by, a majority of youths. %M 31325289 %R 10.2196/12389 %U http://formative.jmir.org/2019/3/e12389/ %U https://doi.org/10.2196/12389 %U http://www.ncbi.nlm.nih.gov/pubmed/31325289 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e11716 %T A Motion-Activated Video Game for Prevention of Substance Use Disorder Relapse in Youth: Pilot Randomized Controlled Trial %A Abroms,Lorien C %A Fishman,Marc %A Vo,Hoa %A Chiang,Shawn C %A Somerville,Victoria %A Rakhmanov,Lawrence %A Ruggiero,Michael %A Greenberg,Daniel %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW Floor 3, Washington, DC, 20037, United States, 1 2029943518, lorien@gwu.edu %K youth %K addiction treatment %K opioid %K marijuana %K video game %K technology %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Body motion-activated video games are a promising strategy for promoting engagement in and adherence to addiction treatment among youth. Objective: This pilot randomized trial (N=80) investigated the feasibility of a body motion–activated video game prototype, Recovery Warrior 2.0, targeting relapse prevention in the context of a community inpatient care program for youth. Methods: Participants aged 15-25 years were recruited from an inpatient drug treatment program and randomized to receive treatment as usual (control) or game play with treatment as usual (intervention). Assessments were conducted at baseline, prior to discharge, and at 4 and 8 weeks postdischarge. Results: The provision of the game play intervention was found to be feasible in the inpatient setting. On an average, participants in the intervention group played for 36.6 minutes and on 3.6 different days. Participants in the intervention group mostly agreed that they would use the refusal skills taught by the game. Participants in the intervention group reported attending more outpatient counseling sessions than those in the control group (10.8 versus 4.8), but the difference was not significant (P=.32). The game had no effect on drug use at 4 or 8 weeks postdischarge, with the exception of a benefit reported at the 4-week follow-up among participants receiving treatment for marijuana addiction (P=.04). Conclusions: Preliminary evidence indicates that a motion-activated video game for addiction recovery appears to be feasible and acceptable for youth within the context of inpatient treatment, but not outpatient treatment. With further development, such games hold promise as a tool for the treatment of youth substance use disorder. Trial Registration: ClinicalTrials.gov NCT03957798; https://clinicaltrials.gov/show/NCT03957798 (Archived by WebCite at http://www.webcitation.org/78XU6ENB4) %M 31124471 %R 10.2196/11716 %U http://games.jmir.org/2019/2/e11716/ %U https://doi.org/10.2196/11716 %U http://www.ncbi.nlm.nih.gov/pubmed/31124471 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12132 %T An E-Learning Adaptation of an Evidence-Based Media Literacy Curriculum to Prevent Youth Substance Use in Community Groups: Development and Feasibility of REAL Media %A Ray,Anne E %A Greene,Kathryn %A Hecht,Michael L %A Barriage,Sarah C %A Miller-Day,Michelle %A Glenn,Shannon D %A Banerjee,Smita C %+ Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane West, Piscataway, NJ, 08854, United States, 1 732 235 5716, aer108@sph.rutgers.edu %K substance use %K prevention %K media literacy %K e-learning %K adaptation %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking. Objective: Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization. Methods: An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders. Results: Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback. Conclusions: The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations. %M 31094328 %R 10.2196/12132 %U http://formative.jmir.org/2019/2/e12132/ %U https://doi.org/10.2196/12132 %U http://www.ncbi.nlm.nih.gov/pubmed/31094328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e13050 %T Comparison of Smartphone Ownership, Social Media Use, and Willingness to Use Digital Interventions Between Generation Z and Millennials in the Treatment of Substance Use: Cross-Sectional Questionnaire Study %A Curtis,Brenda L %A Ashford,Robert D %A Magnuson,Katherine I %A Ryan-Pettes,Stacy R %+ Department of Psychology and Neuroscience, Baylor University, One Bear Place 97334, Waco, TX, 76798-7334, United States, 1 2547102544, stacy_ryan@baylor.edu %K social media, mHealth, substance use treatment, digital health, recovery %K social networking sites %K substance use disorder %D 2019 %7 17.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Problematic substance use in adolescence and emerging adulthood is a significant public health concern in the United States due to high recurrence of use rates and unmet treatment needs coupled with increased use. Consequently, there is a need for both improved service utilization and availability of recovery supports. Given the ubiquitous use of the internet and social media via smartphones, a viable option is to design digital treatments and recovery support services to include internet and social media platforms. Objective: Although digital treatments delivered through social media and the internet are a possibility, it is unclear how interventions using these tools should be tailored for groups with problematic substance use. There is limited research comparing consumer trends of use of social media platforms, use of platform features, and vulnerability of exposure to drug cues online. The goal of this study was to compare digital platforms used among adolescents (Generation Zs, age 13-17) and emerging adults (Millennials, age 18-35) attending outpatient substance use treatment and to examine receptiveness toward these platforms in order to support substance use treatment and recovery. Methods: Generation Zs and Millennials enrolled in outpatient substance use treatment (n=164) completed a survey examining social media use, digital intervention acceptability, frequency of substance exposure, and substance use experiences. Generation Zs (n=53) completed the survey in July 2018. Millennials (n=111) completed the survey in May 2016. Results: Generation Zs had an average age of 15.66 (SD 1.18) years and primarily identified as male (50.9%). Millennials had an average age of 27.66 (SD 5.12) years and also primarily identified as male (75.7%). Most participants owned a social media account (Millennials: 82.0%, Generation Zs: 94.3%) and used it daily (Millennials: 67.6%, Generation Zs: 79.2%); however, Generation Zs were more likely to use Instagram and Snapchat, whereas Millennials were more likely to use Facebook. Further, Generation Zs were more likely to use the features within social media platforms (eg, instant messaging: Millennials: 55.0%, Generation Zs: 79.2%; watching videos: Millennials: 56.8%, Generation Zs: 81.1%). Many participants observed drug cues on social media (Millennials: 67.5%, Generation Zs: 71.7%). However, fewer observed recovery information on social media (Millennials: 30.6%, Generation Zs: 34.0%). Participants felt that social media (Millennials: 55.0%, Generation Zs: 49.1%), a mobile phone app (Millennials: 36.9%, Generation Zs: 45.3%), texting (Millennials: 28.8%, Generation Zs: 45.3%), or a website (Millennials: 39.6%, Generation Zs: 32.1%) would be useful in delivering recovery support. Conclusions: Given the high rates of exposure to drug cues on social media, disseminating recovery support within a social media platform may be the ideal just-in-time intervention needed to decrease the rates of recurrent drug use. However, our results suggest that cross-platform solutions capable of transcending generational preferences are necessary and one-size-fits-all digital interventions should be avoided. %M 30994464 %R 10.2196/13050 %U http://www.jmir.org/2019/4/e13050/ %U https://doi.org/10.2196/13050 %U http://www.ncbi.nlm.nih.gov/pubmed/30994464 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e12370 %T Protocol for the Inroads Study: A Randomized Controlled Trial of an Internet-Delivered, Cognitive Behavioral Therapy–Based Early Intervention to Reduce Anxiety and Hazardous Alcohol Use Among Young People %A Stapinski,Lexine A %A Prior,Katrina %A Newton,Nicola C %A Deady,Mark %A Kelly,Erin %A Lees,Briana %A Teesson,Maree %A Baillie,Andrew J %+ The Matilda Centre, University of Sydney, Level 6, Jane Foss Russell Building (G02), Sydney, NSW 2006, Australia, 61 2 8627 9039, lexine.stapinski@sydney.edu.au %K alcohol abuse %K alcohol-related disorders %K anxiety %K comorbidity %K early medical intervention %K cognitive behavioral therapy %K young adult %D 2019 %7 12.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: The transition to adulthood is a unique developmental period characterized by numerous personal and social role changes and increased opportunities for alcohol consumption. Using alcohol to cope with anxiety symptoms is commonly reported, and young people with anxiety are at a greater risk of hazardous alcohol use and progression to alcohol use disorder. Anxiety and alcohol use tend to fuel each other in an exacerbating feed-forward cycle, leading to difficult-to-treat chronic problems. The peak in onset of anxiety and alcohol disorders suggests this developmental window represents a promising opportunity for early intervention before these problems become entrenched. Objective: This study aims to evaluate the efficacy of the Inroads program, a therapist-supported, internet-delivered early intervention for young adults that targets alcohol use, anxiety symptoms, and the interconnections between these problems. Methods: A randomized controlled trial will be conducted nationally among young Australians (aged 17-24 years) who experience anxiety symptoms and drink alcohol at hazardous or harmful levels. Participants will be individually randomized on a 1:1 basis to receive the Inroads intervention or assessment plus alcohol guidelines. Participants randomized to the Inroads intervention will receive access to 5 Web-based cognitive behavioral therapy (CBT) modules and weekly therapist support via email and/or phone. The primary outcome assessment will be 8 weeks post baseline, with follow-up assessment 6 months post baseline to determine the sustainability of the intervention effects. Primary outcomes will be the total number of standard drinks consumed in the past month (assessed by the Timeline Follow-Back procedure), severity of alcohol-related harms (assessed by the Brief Young Adult Alcohol Consequences Questionnaire), and anxiety symptoms across multiple disorders (assessed by the Generalized Anxiety Disorder-7). Secondary outcomes will include alcohol outcome expectancies; functional impairment and quality of life; and symptoms of social anxiety, anxious arousal, and depression. Results will be analyzed by intention-to-treat using multilevel mixed effects analysis for repeated measures. Results: The study is funded from 2017 to 2020 by Australian Rotary Health. Recruitment is expected to be complete by late-2018, with the 6-month follow-ups to be completed by mid-2019. Results are expected to be published in 2020. Conclusions: The study will be the first to evaluate the benefits of a youth-focused early intervention that simultaneously targets anxiety and hazardous alcohol use. By explicitly addressing the interconnections between anxiety and alcohol use and enhancing CBT coping skills, the Inroads program has the potential to interrupt the trajectory toward co-occurring anxiety and alcohol use disorders. The Web-based format of the program combined with minimal therapist support means that if effective, the program could be widely disseminated to reach young people who are not currently able or willing to access face-to-face treatment. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617001609347; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372748&isReview=true (Archived by WebCite at http://www.webcitation.org/77Au19jmf) International Registered Report Identifier (IRRID): DERR1-10.2196/12370 %M 30977742 %R 10.2196/12370 %U http://www.researchprotocols.org/2019/4/e12370/ %U https://doi.org/10.2196/12370 %U http://www.ncbi.nlm.nih.gov/pubmed/30977742 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e19 %T Potential of an Interactive Drug Prevention Mobile Phone App (Once Upon a High): Questionnaire Study Among Students %A Kapitány-Fövény,Máté %A Vagdalt,Eszter %A Ruttkay,Zsófia %A Urbán,Róbert %A Richman,Mara J %A Demetrovics,Zsolt %+ Department of Addiction, Semmelweis University Faculty of Health Sciences, Vas Street 17, Budapest, 1088, Hungary, 36 20 5221850, m.gabrilovics@gmail.com %K secondary prevention %K adolescent %K mHealth %K energy drinks %K substance use %K alcohol abuse %K cannabis %D 2018 %7 04.12.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: In recent years, drug prevention networks and drug education programs have started using Web-based or mobile phone apps as novel prevention tools, testing their efficacy compared with face-to-face prevention. Objective: The aim of this study was to assess the potential of an interactive app called Once Upon a High (VoltEgySzer). Methods: The app approaches drug prevention from 6 different aspects, and it addresses youngsters with 6 different modules: (1) interactive comics/cartoons, telling stories of recovery; (2) quiz game; (3) roleplay game; (4) introduction of psychoactive drugs; (5) information on the somatic and psychological effects of psychoactive substances; (6) list of available treatment units, rehabs, and self-support groups in Hungary. Students of 2 vocational schools and 2 high schools filled out a questionnaire at a baseline (T0) and a 2-month follow-up (T1) data collection session. Students of 1 vocational school and 1 high school downloaded the Once Upon a High app (app group), whereas students from the other vocational school and high school did not (nonapp group). The time points of T0 and T1 questionnaires contained demographic variables, items with regard to substance use characteristics for both legal and illegal substances, including novel psychoactive substance, exercise habits, knowledge about psychoactive substances, attitudes toward substance users and validated instruments measuring the severity of tobacco (Fagerström Test for Nicotine Dependence), alcohol (Alcohol Use Disorder Identification Test), cannabis (Cannabis Abuse Screening Test), and synthetic cannabinoid consumption. Beliefs about substance use (Beliefs About Substance Abuse) and perceived self-efficacy (General Perceived Self-Efficacy) were also measured. At T1, members of the app group provided additional evaluation of the app. Results: There were 386 students who participated in the T0 session. After dropout, 246 students took part in T1 data collection procedure. Alcohol was the most frequently consumed psychoactive substance (334/364, 91.8% lifetime use), followed by tobacco (252/386, 65.3%, lifetime use) and cannabis (43/323, 13.3% lifetime use). Decreased self-efficacy (beta=−.29, P=.04) and increased daily physical exercise frequencies (beta=.04, P<.001) predicted higher frequencies of past month energy drink consumption, whereas elevated past month alcohol consumption was mainly predicted by a decrease in negative attitudes toward substance users (beta=−.13, P=.04) in the regression models. Once Upon a High was found to be effective only in reducing energy drink consumption (beta=−1.13, P=.04) after controlling for design effect, whereas perceived utility of the app showed correlation with a decreasing alcohol use (rS(44)=.32, P=.03). The roleplay module of the app was found to be the most preferred aspect of the app by the respondents. Conclusions: The Once Upon a High app can be a useful tool to assist preventive intervention programs by increasing knowledge and self-efficacy; however, its efficacy in reducing or preventing substance use needs to be improved and further studied. Additional potential impacts of the app need further testing. %M 30514697 %R 10.2196/games.9944 %U http://games.jmir.org/2018/4/e19/ %U https://doi.org/10.2196/games.9944 %U http://www.ncbi.nlm.nih.gov/pubmed/30514697 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 9 %P e10460 %T The Remote Food Photography Method and SmartIntake App for the Assessment of Alcohol Use in Young Adults: Feasibility Study and Comparison to Standard Assessment Methodology %A Fazzino,Tera L %A Martin,Corby K %A Forbush,Kelsie %+ Department of Psychology, University of Kansas, Fraser Hall, 4th Floor, 1415 Jayhawk Boulevard, Lawrence, KS, 66045, United States, 1 7858640062, tfazzino@ku.edu %K alcohol consumption %K alcohol college students %K alcohol assessment %K dietary assessment %K self report %K mobile phone %K mobile health %K ehealth %K photography %K young adults %D 2018 %7 24.9.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Heavy drinking is prevalent among young adults and may contribute to obesity. However, measurement tools for assessing caloric intake from alcohol are limited and rely on self-report, which is prone to bias. Objective: The purpose of our study was to conduct feasibility testing of the Remote Food Photography Method and the SmartIntake app to assess alcohol use in young adults. Aims consisted of (1) quantifying the ability of SmartIntake to capture drinking behavior, (2) assessing app usability with the Computer System Usability Questionnaire (CSUQ), (3) conducting a qualitative interview, and (4) comparing preference, usage, and alcohol use estimates (calories, grams per drinking episode) between SmartIntake and online diet recalls that participants completed for a parent study. Methods: College students (N=15) who endorsed a pattern of heavy drinking were recruited from a parent study. Participants used SmartIntake to send photographs of all alcohol and food intake over a 3-day period and then completed a follow-up interview and the CSUQ. CSUQ items range from 1-7, with lower scores indicating greater usability. Total drinking occasions were determined by adding the number of drinking occasions captured by SmartIntake plus the number of drinking occasions participants reported that they missed capturing. Usage was defined by the number of days participants provided food/beverage photos through the app, or the number of diet recalls completed. Results: SmartIntake captured 87% (13/15) of total reported drinking occasions. Participants rated the app as highly usable in the CSUQ (mean 2.28, SD 1.23). Most participants (14/15, 93%) preferred using SmartIntake versus recalls, and usage was significantly higher with SmartIntake than recalls (42/45, 93% vs 35/45, 78%; P=.04). Triple the number of participants submitted alcohol reports with SmartIntake compared to the recalls (SmartIntake 9/15, 60% vs recalls 3/15, 20%; P=.06), and 60% (9/15) of participants reported drinking during the study. Conclusions: SmartIntake was acceptable to college students who drank heavily and captured most drinking occasions. Participants had higher usage of SmartIntake compared to recalls, suggesting SmartIntake may be well suited to measuring alcohol consumption in young adults. However, 40% (6/15) did not drink during the brief testing period and, although findings are promising, a longer trial is needed. %M 30249590 %R 10.2196/10460 %U http://mhealth.jmir.org/2018/9/e10460/ %U https://doi.org/10.2196/10460 %U http://www.ncbi.nlm.nih.gov/pubmed/30249590 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e10849 %T Internet-Based Universal Prevention for Students and Parents to Prevent Alcohol and Cannabis Use Among Adolescents: Protocol for the Randomized Controlled Trial of Climate Schools Plus %A Newton,Nicola Clare %A Chapman,Cath %A Slade,Tim %A Conroy,Chloe %A Thornton,Louise %A Champion,Katrina Elizabeth %A Stapinski,Lexine %A Koning,Ina %A Teesson,Maree %+ National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, 2031, Australia, 61 93850333, n.newton@unsw.edu.au %K alcohol %K Australia %K cannabis %K parents %K prevention %K school %K internet-based intervention %D 2018 %7 17.08.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early initiation of alcohol and cannabis use markedly increases the risk of harms associated with use, including the development of substance use and mental health disorders. To interrupt this trajectory, effective prevention during the adolescent period is critical. Despite evidence showing that parents can play a critical role in delaying substance use initiation, the majority of prevention programs focus on adolescents only. Accordingly, the Climate Schools Plus (CSP) program was developed to address this gap. Objective: This paper outlines the protocol for a cluster randomized controlled trial (RCT) of the CSP program, a novel internet-based program for parents and students to prevent adolescent substance use and related harms. The CSP program builds on the success of the Climate Schools student programs, with the addition of a newly developed parenting component, which allows parents to access the internet-based content to equip them with knowledge and skills to help prevent substance use in their adolescents. Methods: A cluster RCT is being conducted with year 8 students (aged 12-14 years) and their parents from 12 Australian secondary schools between 2018 and 2020. Using blocked randomization, schools are assigned to one of the two groups to receive either the CSP program (intervention) or health education as usual (control). The primary outcomes of the trial will be any student alcohol use (≥1 standard alcoholic drink/s) and any student drinking to excess (≥5 standard alcoholic drinks). Secondary outcomes will include alcohol- and cannabis-related knowledge, alcohol use-related harms, frequency of alcohol consumption, frequency of drinking to excess, student cannabis use, parents’ self-efficacy to stop their children using alcohol, parental supply of alcohol, and parent-adolescent communication. All students and their parents will complete assessments on three occasions—baseline and 12 and 24 months postbaseline. In addition, students and parents in the intervention group will be asked to complete program evaluations on two occasions—immediately following the year 8 program and immediately following the year 9 program. Results: Analyses will be conducted using multilevel, mixed-effects models within an intention-to-treat framework. It is expected that students in the intervention group will have less uptake and excessive use of alcohol compared with the students in the control group. Conclusions: This study will provide the first evaluation of a combined internet-based program for students and their parents to prevent alcohol and cannabis use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000153213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374178 (Archived by WebCite at http://www.webcitation.org/71E0prqfQ) Registered Report Identifier: RR1-10.2196/10849 %M 30120084 %R 10.2196/10849 %U http://www.researchprotocols.org/2018/8/e10849/ %U https://doi.org/10.2196/10849 %U http://www.ncbi.nlm.nih.gov/pubmed/30120084 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e10 %T Training Working Memory in Adolescents Using Serious Game Elements: Pilot Randomized Controlled Trial %A Boendermaker,Wouter J %A Gladwin,Thomas E %A Peeters,Margot %A Prins,Pier J M %A Wiers,Reinout W %+ Department of Interdisciplinary Social Science, Utrecht University, Heidelberglaan 1, Utrecht, 3584 CS, Netherlands, 31 302531897, w.j.boendermaker@uu.nl %K cognitive function %K memory %K video games %K motivation %D 2018 %7 23.05.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Working memory capacity has been found to be impaired in adolescents with various psychological problems, such as addictive behaviors. Training of working memory capacity can lead to significant behavioral improvements, but it is usually long and tedious, taxing participants’ motivation to train. Objective: This study aimed to evaluate whether adding game elements to the training could help improve adolescents’ motivation to train while improving cognition. Methods: A total of 84 high school students were allocated to a working memory capacity training, a gamified working memory capacity training, or a placebo condition. Working memory capacity, motivation to train, and drinking habits were assessed before and after training. Results: Self-reported evaluations did not show a self-reported preference for the game, but participants in the gamified working memory capacity training condition did train significantly longer. The game successfully increased motivation to train, but this effect faded over time. Working memory capacity increased equally in all conditions but did not lead to significantly lower drinking, which may be due to low drinking levels at baseline. Conclusions: We recommend that future studies attempt to prolong this motivational effect, as it appeared to fade over time. %M 29792294 %R 10.2196/games.8364 %U http://games.jmir.org/2018/2/e10/ %U https://doi.org/10.2196/games.8364 %U http://www.ncbi.nlm.nih.gov/pubmed/29792294 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e184 %T Internet and Social Media Access Among Youth Experiencing Homelessness: Mixed-Methods Study %A VonHoltz,Lauren A Houdek %A Frasso,Rosemary %A Golinkoff,Jesse M %A Lozano,Alicia J %A Hanlon,Alexandra %A Dowshen,Nadia %+ Children's Hospital of Philadelphia, 3401 Civic Center Blvd, 9th Floor, Philadelphia, PA,, United States, 1 267 760 7680, vonholtzl@email.chop.edu %K adolescent %K homeless youth %K internet %K social media %K smartphone %K health %D 2018 %7 22.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Youth experiencing homelessness are at a risk for a variety of adverse outcomes. Given the widespread use of the internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources. Objective: This study investigated how homeless adolescents use these technologies for general and health-related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness. Methods: A convenience sample of youth aged 18 to 21 years was recruited from a youth-specific homeless shelter. All participants completed a 47-item survey, with 10 individuals completing a semistructured interview. Descriptive statistics, exact testing, logistic regression, and generalized estimating equation modeling was performed for quantitative data analysis. Interviews were transcribed verbatim, and NVivo 10 (QSR International) was employed to facilitate double coding and thematic analysis. Results: A total of 87 participants completed the survey with a mean age of 19.4 (SD 1.1) years. While experiencing homelessness, 56% (49/87) accessed the internet at least once a day, with 86% (75/87) accessing once a week. Access to a smartphone was associated with a 3.03 greater odds of accessing the internet and was the most frequently used device (66% of participants, 57/87). While experiencing homelessness, subjects reported a 68% decreased odds in internet access frequency (odds ratio [OR] 0.32, P<.001), 75% decreased odds in spending greater amounts of time on the internet (OR 0.25, P<.001), and an 87% decreased odds of social media use (OR 0.13, P=.01). Ten participants completed the semistructured interview. Several themes were identified, including (1) changes in internet behaviors while experiencing homelessness, (2) health status as a major concern and reason for Internet use, and (3) interest in a website dedicated to youth experiencing homelessness. While experiencing homelessness, participants indicated their behaviors were more goal-oriented and less focused on leisure or entertainment activities. Conclusions: While homeless youth experience changes in the frequency, amount of time, and specific uses of the internet and social media, study participants were able to access the internet regularly. The internet was used to search health-related topics. Given the importance of smartphones in accessing the internet, mobile-optimized websites may be an effective method for reaching this group. %M 29789281 %R 10.2196/jmir.9306 %U http://www.jmir.org/2018/5/e184/ %U https://doi.org/10.2196/jmir.9306 %U http://www.ncbi.nlm.nih.gov/pubmed/29789281 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 4 %P e114 %T Intervention to Increase HIV Testing Among Substance-Using Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial %A Stephenson,Rob %A Bonar,Erin E %A Carrico,Adam %A Hunter,Alexis %A Connochie,Daniel %A Himmelstein,Rebecca %A Bauermeister,Jose %+ Center for Sexuality & Health Disparities, University of Michigan, 400 North Ingalls Building, Room 3303, Ann Arbor, MI, 48109, United States, 1 734 615 0149, rbsteph@umich.edu %K HIV %K men who have sex with men %K drug abuse %K substance use disorders %K motivational interviewing %D 2018 %7 30.04.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young men who have sex with men (YMSM) and transgender people in the Detroit Metro Area are the only risk group for whom the incidence of HIV and sexually transmitted infections (STI) has increased since 2000, with HIV incidence nearly doubling among youth. Substance use (including alcohol), which is relatively frequent among YMSM and transgender people, creates barriers to the optimal delivery of HIV prevention and care services. Standard HIV counseling, testing, and referral (CTR) is limited in providing strategies to identify and address substance use. Hence, in its current form, CTR may not be serving the prevention needs of substance-using YMSM and transgender people. Brief counseling interventions, grounded in principles of motivational interviewing, may offer a mechanism to meet the HIV prevention and care needs of substance-using YMSM and transgender people. Objective: This prospective, 4-arm, factorial randomized controlled trial aims to examine the efficacy of an motivational interviewing–based substance use brief intervention (SUBI) on participants’ substance use and engagement in HIV prevention. Methods: The research implements a prospective randomized controlled trial (Project Swerve) of 600 YMSM and transgender people recruited both online and in person. Eligibility criteria include participants who (1) are between the ages of 15 to 29 years, (2) live in the Detroit Metro Area, (3) self-identify as a man or transgender man or woman, (4) have had sexual contact with a man in the 6 months before enrollment, (5) self-report binge drinking or any substance use in the 3 months before enrollment, and (6) self-report an unknown or negative HIV status upon enrollment. Participants are randomized to receive, 3-months apart starting at baseline, 2 individual sessions. Sessions are CTR-only, SUBI-only, CTR followed by SUBI, or SUBI followed by CTR. Results: Project Swerve was launched in April 2017 and enrollment is ongoing. Conclusions: Incorporating a SUBI that utilizes the principles of motivational interviewing into HIV CTR provides an opportunity to tailor counseling services for YMSM and transgender people to address additional client barriers to HIV and STI testing. Trial Registration: ClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436 (Archived by WebCite at http://www.webcitation.org/6yFyOK57w) %M 29712625 %R 10.2196/resprot.9414 %U http://www.researchprotocols.org/2018/4/e114/ %U https://doi.org/10.2196/resprot.9414 %U http://www.ncbi.nlm.nih.gov/pubmed/29712625 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e4 %T The Rise of New Alcoholic Games Among Adolescents and the Consequences in the Emergency Department: Observational Retrospective Study %A Barbieri,Stefania %A Omizzolo,Luca %A Tredese,Alberto %A Vettore,Gianna %A Calaon,Alberto %A Behr,Astrid Ursula %A Snenghi,Rossella %A Montisci,Massimo %A Gaudio,Rosa Maria %A Paoli,Andrea %A Pietrantonio,Vincenzo %A Santi,Jacopo %A Donato,Daniele %A Carretta,Giovanni %A Dolcet,Annalisa %A Feltracco,Paolo %+ Department of Urgent and Emergency Care, University of Padova, Via Giustiniani, 2, Padova,, Italy, 39 04 98074414, stefibarbieri118@gmail.com %K adolescent %K neknomination %K binge drinking %K alcoholic games %K social network %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The links between the internet and teenager behavior are difficult situations to control and may lead to the development of new and excessive methods of drinking alcohol during alcoholic games. Findings indicate that reported cases are very useful sources for better understanding of alcoholic games, yielding successful measures promoting health among adolescents. Admittance of adolescents to hospital emergency departments (EDs) after consumption of excessive amounts of alcohol has become the norm in developed countries. The harmful effects of acute alcohol abuse are reported in this paper. Objective: The aim of this work was to investigate the close connections between new drinking behaviors among adolescents and study the increase in new alcoholic games, together with the challenges that cause acute alcohol intoxication, the influence of the internet and social networks, and their consequences for public health services. Methods: Data came from prehospital and intrahospital admissions attributable to alcohol consumption. From 2013 to 2015, 3742 patients were admitted to EDs due to acute alcohol intoxication: 830 of them were aged 15 to 30 years, and 225 were adolescents and young adults between 15 and 20 years who had been playing alcoholic games. Retrospectively, diagnostic data associated with extrahospital anamneses were selected by one of the hospital management information systems, Qlik. As a result of our previous experience, questionnaires and face-to-face interviews were performed at a later stage, when a clinical audit for intoxicated adolescent patients was described, with the overall goal of establishing a potential methodological workflow and adding important information to research carried out so far. Results: Between 2013 and 2015, 830 young patients aged 15 to 30 years were admitted to EDs for acute alcohol intoxication. About 20% (166/830) of the sample confirmed that they had drunk more than 5 alcoholic units within 2 hours twice during the past 30 days as a result of binge drinking. Referring to new alcoholic games, 41% of the sample stated that they knew what neknomination is and also that at least one of their friends had accepted this challenge, describing symptoms such as vomiting, headache, altered behavior, increased talkativeness, and sociability. The median value of the weighted average cost of the diagnosis-related group relating to interventions provided by hospitals was the same for both genders, €46,091 (US $56,497; minimum €17,349 and maximum €46,091). Conclusions: Drinking games encourage young people to consume large quantities of alcohol within a short period of time putting them at risk of alcohol poisoning, which can potentially lead to accidental injuries, unsafe sex, suicide, sexual assault, and traffic accidents. The spread of these games through the internet and social networks is becoming a serious health problem facing physicians and medical professionals every day, especially in the ED; for this reason, it is necessary to be aware of the risks represented by such behaviors in order to recognize and identify preliminary symptoms and develop useful prevention programs. The strategic role of emergency services is to monitor and define the problem right from the start in order to control the epidemic, support planning, coordinate the delivery of assistance in the emergency phase, and provide medical education. Hospital-based interdisciplinary health care researchers collected specific data on hazardous drinking practices linked to evaluation of increased alcohol-related consequences and cases admitted to the ED. %M 31518328 %R 10.2196/pediatrics.6578 %U http://pediatrics.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/pediatrics.6578 %U http://www.ncbi.nlm.nih.gov/pubmed/31518328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e69 %T Reported Theory Use by Digital Interventions for Hazardous and Harmful Alcohol Consumption, and Association With Effectiveness: Meta-Regression %A Garnett,Claire %A Crane,David %A Brown,Jamie %A Kaner,Eileen %A Beyer,Fiona %A Muirhead,Colin %A Hickman,Matthew %A Redmore,James %A de Vocht,Frank %A Beard,Emma %A Michie,Susan %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 20 7679 1742, c.garnett@ucl.ac.uk %K alcohol drinking %K behavior, addictive %K regression analysis %K meta-analysis %K randomized controlled trial %K Internet %D 2018 %7 28.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Applying theory to the design and evaluation of interventions is likely to increase effectiveness and improve the evidence base from which future interventions are developed, though few interventions report this. Objective: The aim of this paper was to assess how digital interventions to reduce hazardous and harmful alcohol consumption report the use of theory in their development and evaluation, and whether reporting of theory use is associated with intervention effectiveness. Methods: Randomized controlled trials were extracted from a Cochrane review on digital interventions for reducing hazardous and harmful alcohol consumption. Reporting of theory use within these digital interventions was investigated using the theory coding scheme (TCS). Reported theory use was analyzed by frequency counts and descriptive statistics. Associations were analyzed with meta-regression models. Results: Of 41 trials involving 42 comparisons, half did not mention theory (50% [21/42]), and only 38% (16/42) used theory to select or develop the intervention techniques. Significant heterogeneity existed between studies in the effect of interventions on alcohol reduction (I2=77.6%, P<.001). No significant associations were detected between reporting of theory use and intervention effectiveness in unadjusted models, though the meta-regression was underpowered to detect modest associations. Conclusions: Digital interventions offer a unique opportunity to refine and develop new dynamic, temporally sensitive theories, yet none of the studies reported refining or developing theory. Clearer selection, application, and reporting of theory use is needed to accurately assess how useful theory is in this field and to advance the field of behavior change theories. %M 29490895 %R 10.2196/jmir.8807 %U http://www.jmir.org/2018/2/e69/ %U https://doi.org/10.2196/jmir.8807 %U http://www.ncbi.nlm.nih.gov/pubmed/29490895 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 1 %P e2 %T A Social Media-Based Acute Alcohol Consumption Behavior (NekNomination): Case Series in Italian Emergency Departments %A Barbieri,Stefania %A Feltracco,Paolo %A Lucchetta,Vittorio %A Gaudio,Rosa Maria %A Tredese,Alberto %A Bergamini,Mauro %A Vettore,Gianna %A Pietrantonio,Vincenzo %A Avato,Francesco Maria %A Donato,Daniele %A Boemo,Deris Gianni %A Nesoti,Maria Vittoria %A Snenghi,Rossella %+ Department of Urgent and Emergency Care, University of Padova, Via Giustiniani 2, Padova,, Italy, 39 3479812611, stefibarbieri118@gmail.com %K alcohol drinking %K drinking behavior %K underage drinking %K binge drinking %K alcoholic intoxication %K adolescent %K neknomination %K binge drinking %K alcoholic games %K social network %D 2018 %7 31.01.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: NekNomination, also known as NekNominate, Neck and Nominate, or Neck Nomination, is a social network–based drinking game which is thought to have originated in Australia and spread all over the world between 2013 and 2014. Individuals record videos of themselves while rapidly drinking excessive quantities of alcoholic drinks (necking) and then nominate friends to outdo them within 24 hours; the videos are then posted on social media such as Facebook or YouTube. The consequences of this drinking game have been very dangerous; at least 5 people under age 30 years have died after drinking deadly cocktails, and many others have suffered from alcohol intoxication. Objective: The goal of the research is to evaluate data about clinically important acute alcohol intoxication among teenagers and young adults and inform and educate the general public, especially parents, teachers, and health workers, about the spreading craze of dangerous Internet-related behavior among today’s teenagers and young people up to the age of 23 years. Methods: Patients aged 15 to 23 years with acute alcohol intoxication who came to the emergency department (ED) of 2 major hospitals in Italy from January 1, 2011, to June 30, 2014, were included in this study. Data were retrieved from prehospital and intrahospital medical records and included personal information, methods of intoxication, triage color code, date and time of access to the ED, any relevant signs and symptoms, blood alcohol concentration, and diagnosis at discharge. Results: A total of 450 young patients (male 277/450, 61.5%, female 173/450, 38.5%; age 15 to 16 years 15/450, 3.3%, age 17 to 18 years 184/450, 40.9%, age 19 to 23 years 251/450, 55.8%) were recruited. The causes of intoxication were happy hour, binge drinking, NekNominate, eyeballing, other alcoholic games, or a mix of them. Happy hour was found to be more common among the older patients, whereas NekNominate accounted for almost half of the youngest group of hospitalizations. Eyeballing occurred in 1.6% (7/450) of cases; binge drinking and other alcoholic games caused 23.3% (105/450) and 23.8% (107/450) of hospitalizations, respectively. On admission, 44.2% (199/450) of patients were assigned a red or yellow color code requiring immediate medical attention; about 14% of them required additional medical assistance (after being in the ED) or hospitalization, some in semi-intensive care units. Conclusions: Our study shows that the increased numbers of hospitalizations due to alcohol intoxication in the adolescent age group, as a consequence of NekNominate or other drinking games, is alarming and represents a serious public health issue. The potential markers of improper use of social networks must be clearly identified, including categories at risk of alcohol abuse, in order to develop intervention and prevention strategies in terms of education and awareness, which may help in averting potentially fatal episodes. %M 29386170 %R 10.2196/ijmr.6573 %U http://www.i-jmr.org/2018/1/e2/ %U https://doi.org/10.2196/ijmr.6573 %U http://www.ncbi.nlm.nih.gov/pubmed/29386170 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e143 %T 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 %A Haug,Severin %A Paz Castro,Raquel %A Meyer,Christian %A Filler,Andreas %A Kowatsch,Tobias %A Schaub,Michael P %+ Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, Zurich, 8031, Switzerland, 41 444481174, severin.haug@isgf.uzh.ch %K coping skills %K social skills %K substance use disorder %K adolescents %K students %K mobile phone %D 2017 %7 04.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 28978498 %R 10.2196/mhealth.8474 %U https://mhealth.jmir.org/2017/10/e143/ %U https://doi.org/10.2196/mhealth.8474 %U http://www.ncbi.nlm.nih.gov/pubmed/28978498 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e103 %T An Internet-Based Intervention to Promote Alcohol-Related Attitudinal and Behavioral Change Among Adolescents: Protocol of a Cluster Randomized Controlled Trial %A Ip,Patrick %A Chan,Ko-Ling %A Chow,Chun-Bong %A Lam,Tai-Hing %A Ho,Sai-Yin %A Wong,Wilfred Hing-Sang %A Wong,Margaret Fung-Yee %+ The University of Hong Kong, Department of Paediatrics and Adolescent Medicine, 1/F, New Clinical Building, Queen Mary Hospital, Pokfulam, Hong Kong,, China (Hong Kong), 852 28198501, patricip@hku.hk %K Internet viral marketing %K attitude change %K behavioural change %K underage drinking %K risk behaviour %K Internet intervention %D 2016 %7 01.06.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Underage drinking is a prevalent risk behavior and common public health problem. Research shows that alcohol abuse not only affects the quality of life of drinkers themselves. The problems resulting from underage drinking pose substantial costs to society as well. The proposed study will address underage drinking with the use of an Internet campaign, which is a cost-effective way of tackling the problem. Objective: The aims of this study are to test the effectiveness of an online quiz competition in changing adolescents’ alcohol-related attitudes and behavior and to explore the feasibility of using Internet viral marketing to reach a significant number of adolescents. Methods: The study will constitute a cluster randomized controlled trial for 20 secondary schools (6720 Grade 7-9 students). Schools will be randomized to intervention or control arm with equal likelihood. Students in intervention schools will be invited to take part in the Internet campaign, whereas those in control schools will receive relevant promotional leaflets. Results: Alcohol-related attitude and behavior will be the primary outcome measures. The results of the proposed study will provide evidence on the efficacy of an Internet intervention in modifying adolescents’ attitudes and behavior and guide further investigation into the prevention of and intervention in such risk behaviors as underage drinking. The project was funded July 2015, enrollment started September 2015, and results are expected July 2017. Conclusions: With the Internet increasingly being recognized as a practical and cost-effective platform for health information delivery, the proposed Internet-based intervention is expected to be more effective in altering adolescents’ alcohol-related attitudes and behaviors than traditional health promotion. ClinicalTrial: ClinicalTrials.gov NCT02450344; https://clinicaltrials.gov/ct2/show/NCT02450344 (Archived by WebCite at http://www.webcitation.org/6heB2zMBD) %M 27252072 %R 10.2196/resprot.5001 %U http://www.researchprotocols.org/2016/2/e103/ %U https://doi.org/10.2196/resprot.5001 %U http://www.ncbi.nlm.nih.gov/pubmed/27252072 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e103 %T Effectiveness of a Web-Based Screening and Fully Automated Brief Motivational Intervention for Adolescent Substance Use: A Randomized Controlled Trial %A Arnaud,Nicolas %A Baldus,Christiane %A Elgán,Tobias H %A De Paepe,Nina %A Tønnesen,Hanne %A Csémy,Ladislav %A Thomasius,Rainer %+ German Centre for Addiction Research in Childhood and Adolescence (DZSKJ), Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 040 7410 59861, n.arnaud@uke.de %K substance use %K adolescents %K brief intervention %K web-based intervention %K motivational interviewing %K randomized controlled trial %D 2016 %7 24.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mid-to-late adolescence is a critical period for initiation of alcohol and drug problems, which can be reduced by targeted brief motivational interventions. Web-based brief interventions have advantages in terms of acceptability and accessibility and have shown significant reductions of substance use among college students. However, the evidence is sparse among adolescents with at-risk use of alcohol and other drugs. Objective: This study evaluated the effectiveness of a targeted and fully automated Web-based brief motivational intervention with no face-to-face components on substance use among adolescents screened for at-risk substance use in four European countries. Methods: In an open-access, purely Web-based randomized controlled trial, a convenience sample of adolescents aged 16-18 years from Sweden, Germany, Belgium, and the Czech Republic was recruited using online and offline methods and screened online for at-risk substance use using the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument. Participants were randomized to a single session brief motivational intervention group or an assessment-only control group but not blinded. Primary outcome was differences in past month drinking measured by a self-reported AUDIT-C-based index score for drinking frequency, quantity, and frequency of binge drinking with measures collected online at baseline and after 3 months. Secondary outcomes were the AUDIT-C-based separate drinking indicators, illegal drug use, and polydrug use. All outcome analyses were conducted with and without Expectation Maximization (EM) imputation of missing follow-up data. Results: In total, 2673 adolescents were screened and 1449 (54.2%) participants were randomized to the intervention or control group. After 3 months, 211 adolescents (14.5%) provided follow-up data. Compared to the control group, results from linear mixed models revealed significant reductions in self-reported past-month drinking in favor of the intervention group in both the non-imputed (P=.010) and the EM-imputed sample (P=.022). Secondary analyses revealed a significant effect on drinking frequency (P=.037) and frequency of binge drinking (P=.044) in the non-imputation-based analyses and drinking quantity (P=.021) when missing data were imputed. Analyses for illegal drug use and polydrug use revealed no significant differences between the study groups (Ps>.05). Conclusions: Although the study is limited by a large drop-out, significant between-group effects for alcohol use indicate that targeted brief motivational intervention in a fully automated Web-based format can be effective to reduce drinking and lessen existing substance use service barriers for at-risk drinking European adolescents. Trial Registration: International Standard Randomized Controlled Trial Registry: ISRCTN95538913; http://www.isrctn.com/ISRCTN95538913 (Archived by WebCite at http://www.webcitation.org/6XkuUEwBx) %M 27220276 %R 10.2196/jmir.4643 %U http://www.jmir.org/2016/5/e103/ %U https://doi.org/10.2196/jmir.4643 %U http://www.ncbi.nlm.nih.gov/pubmed/27220276 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 4 %P e93 %T A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits %A Drost,Ruben MWA %A Paulus,Aggie TG %A Jander,Astrid F %A Mercken,Liesbeth %A de Vries,Hein %A Ruwaard,Dirk %A Evers,Silvia MAA %+ Department of Health Services Research, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229 GT, Netherlands, 31 433881729, r.drost@maastrichtuniversity.nl %K adolescents %K alcohol use %K cluster randomized controlled trial %K game %K computer tailoring %K education %K criminal justice %K costs and cost analysis %K economic evaluation %K intersectoral costs and benefits %D 2016 %7 21.04.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Preventing excessive alcohol use among adolescents is important not only to foster individual and public health, but also to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, also known as intersectoral costs and benefits (ICBs). Objective: The aim was to assess the cost-effectiveness of a Web-based computer-tailored intervention for reducing alcohol use and binge drinking by adolescents from a health care perspective (excluding ICBs) and from a societal perspective (including ICBs). Methods: Data used were from the Alcoholic Alert study, a cluster randomized controlled trial with randomization at the level of schools into two conditions. Participants either played a game with tailored feedback on alcohol awareness after the baseline assessment (intervention condition) or received care as usual (CAU), meaning that they had the opportunity to play the game subsequent to the final measurement (waiting list control condition). Data were recorded at baseline (T0=January/February 2014) and after 4 months (T1=May/June 2014) and were used to calculate incremental cost-effectiveness ratios (ICERs), both from a health care perspective and a societal perspective. Stochastic uncertainty in the data was dealt with by using nonparametric bootstraps (5000 simulated replications). Additional sensitivity analyses were conducted based on excluding cost outliers. Subgroup cost-effectiveness analyses were conducted based on several background variables, including gender, age, educational level, religion, and ethnicity. Results: From both the health care perspective and the societal perspective for both outcome measures, the intervention was more costly and more effective in comparison with CAU. ICERs differed for both perspectives, namely €40 and €79 from the health care perspective to €62 and €144 for the societal perspective per incremental reduction of one glass of alcohol per week and one binge drinking occasion per 30 days, respectively. Subgroup analyses showed, from both perspectives and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19 years) and those at a lower educational level and, from a health care perspective, the male and nonreligious adolescent subgroups. Conclusions: Computer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents. Including ICBs in the economic evaluation had an impact on the cost-effectiveness results of the analysis. It could be worthwhile to aim the intervention specifically at specific subgroups. Trial Registration: Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG) %M 27103154 %R 10.2196/jmir.5223 %U http://www.jmir.org/2016/4/e93/ %U https://doi.org/10.2196/jmir.5223 %U http://www.ncbi.nlm.nih.gov/pubmed/27103154 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e29 %T Effects of a Web-Based Computer-Tailored Game to Reduce Binge Drinking Among Dutch Adolescents: A Cluster Randomized Controlled Trial %A Jander,Astrid %A Crutzen,Rik %A Mercken,Liesbeth %A Candel,Math %A de Vries,Hein %+ School for Public Health and Primary Care CAPHRI, Department of Health Promotion, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433884279, astrid.jander@maastrichtuniversity.nl %K adolescents %K alcohol drinking %K binge drinking %K cluster randomized controlled trial %K serious games %K computer tailoring %D 2016 %7 03.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Binge drinking among Dutch adolescents is among the highest in Europe. Few interventions so far have focused on adolescents aged 15 to 19 years. Because binge drinking increases significantly during those years, it is important to develop binge drinking prevention programs for this group. Web-based computer-tailored interventions can be an effective tool for reducing this behavior in adolescents. Embedding the computer-tailored intervention in a serious game may make it more attractive to adolescents. Objective: The aim was to assess whether a Web-based computer-tailored intervention is effective in reducing binge drinking in Dutch adolescents aged 15 to 19 years. Secondary outcomes were reduction in excessive drinking and overall consumption during the previous week. Personal characteristics associated with program adherence were also investigated. Methods: A cluster randomized controlled trial was conducted among 34 Dutch schools. Each school was randomized into either an experimental (n=1622) or a control (n=1027) condition. Baseline assessment took place in January and February 2014. At baseline, demographic variables and alcohol use were assessed. Follow-up assessment of alcohol use took place 4 months later (May and June 2014). After the baseline assessment, participants in the experimental condition started with the intervention consisting of a game about alcohol in which computer-tailored feedback regarding motivational characteristics was embedded. Participants in the control condition only received the baseline questionnaire. Both groups received the 4-month follow-up questionnaire. Effects of the intervention were assessed using logistic regression mixed models analyses for binge and excessive drinking and linear regression mixed models analyses for weekly consumption. Factors associated with intervention adherence in the experimental condition were explored by means of a linear regression model. Results: In total, 2649 adolescents participated in the baseline assessment. At follow-up, 824 (31.11%) adolescents returned. The intervention was effective in reducing binge drinking among adolescents aged 15 years (P=.03) and those aged 16 years when they participated in at least 2 intervention sessions (P=.04). Interaction effects between excessive drinking and educational level (P=.08) and between weekly consumption and age (P=.09) were found; however, in-depth analyses revealed no significant subgroup effects for both interaction effects. Additional analyses revealed that prolonged use of the intervention was associated with stronger effects for binge drinking. Yet, overall adherence to the intervention was low. Analyses revealed that being Protestant, female, younger, a nonbinge drinker, and having a higher educational background were associated with adherence. Conclusions: The intervention was effective for adolescents aged 15 and 16 years concerning binge drinking. Prevention messages may be more effective for those at the start of their drinking career, whereas other methods may be needed for those with a longer history of alcohol consumption. Despite using game elements, intervention completion was low. Trial Registration: Dutch Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by WebCite® at http://www.webcitation.org/6eSJD3FiY) %M 26842694 %R 10.2196/jmir.4708 %U http://www.jmir.org/2016/2/e29/ %U https://doi.org/10.2196/jmir.4708 %U http://www.ncbi.nlm.nih.gov/pubmed/26842694 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e285 %T Potential and Challenges in Collecting Social and Behavioral Data on Adolescent Alcohol Norms: Comparing Respondent-Driven Sampling and Web-Based Respondent-Driven Sampling %A Hildebrand,Janina %A Burns,Sharyn %A Zhao,Yun %A Lobo,Roanna %A Howat,Peter %A Allsop,Steve %A Maycock,Bruce %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, GPO Box U1987, Bentley, 6845, Australia, 61 9266 7988, b.maycock@curtin.edu.au %K Internet %K respondent-driven sampling (RDS) %K WebRDS %K adolescent %K alcohol %K social media %K participant recruitment %D 2015 %7 24.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Respondent-driven sampling (RDS) is a method successfully used to research hard-to-access populations. Few studies have explored the use of the Internet and social media with RDS, known as Web-based RDS (WebRDS). This study explored the use of combining both “traditional” RDS and WebRDS to examine the influences on adolescent alcohol use. Objective: This paper reports on the recruitment processes and the challenges and enablers of both RDS and WebRDS. It details comparative recruitment data and provides a summary of the utility of both methods for recruiting adolescents to participate in an online survey investigating youth alcohol norms. Methods: Process evaluation data collected from research staff throughout the study were used to assess the challenges and solutions of RDS and WebRDS. Pearson chi-square test (Fisher’s exact test if applicable) was used to compare the differences in sociodemographics and drinking behavior between data collected by RDS and WebRDS. Results: Of the total sample (N=1012), 232 adolescents were recruited by RDS and 780 by WebRDS. A significantly larger proportion of Aboriginal or Torres Strait Islander (P<.001) participants who spoke English as their main language at home (P=.03), and of middle and lower socioeconomic status (P<.001) was found in the RDS sample. The RDS sample was also found to have a higher occurrence of past 7-day drinking (P<.001) and past 7-day risky drinking (P=.004). No significant differences in gender, age, past month alcohol use, and lifetime alcohol use were observed between the RDS and WebRDS samples. This study revealed RDS and WebRDS used similar lengths of chains for recruiting participants; however, WebRDS conducted a faster rate of recruitment at a lower average cost per participant compared to RDS. Conclusions: Using WebRDS resulted in significant improvements in the recruitment rate and was a more effective and efficient use of resources than the traditional RDS method. However, WebRDS resulted in partially different sample characteristics to traditional RDS. This potential effect should be considered when selecting the most appropriate data collection method. %M 26704736 %R 10.2196/jmir.4762 %U http://www.jmir.org/2015/12/e285/ %U https://doi.org/10.2196/jmir.4762 %U http://www.ncbi.nlm.nih.gov/pubmed/26704736 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 2 %P e13 %T Development and Acceptability of a Co-Produced Online Intervention to Prevent Alcohol Misuse in Adolescents: A Think Aloud Study %A Davies,Emma Louise %A Martin,Jilly %A Foxcroft,David R %+ Department of Psychology, Social Work and Public Health, Oxford Brookes University, Headington Campus, Oxford, OX3 0BP, United Kingdom, 44 18654484056, edavies@brookes.ac.uk %K adolescents %K alcohol %K intervention development %K prevention %K think aloud %D 2015 %7 29.07.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: The prototype willingness model (PWM) may offer an appropriate basis for explaining and preventing adolescent alcohol misuse. An intervention was developed using a co-production approach, and consisted of an online quiz featuring 10 questions linked to the PWM. Objective: This study sought to determine the acceptability and relevance of the intervention content to young people, to incorporate their feedback into a final version. Methods: A qualitative think aloud study with follow-up semistructured interviews was undertaken with 16 young people aged 11-15 (50%). Transcripts were analyzed using thematic analysis. Results: The following 3 main themes relating the acceptability of the intervention were identified: “challenging expectations of alcohol education”; “motivations for drinking or not drinking,” and “the inevitability of drinking.” Participants found the intervention appealing because it was counter to their expectations. The content appeared to reflect their experiences of social pressure and drinking encounters. There was evidence that a focus on drinker/nondrinker prototypes was too narrow and that because adolescents perceived drinking as inevitable, it would be challenging to enact any plans to resist pressure to drink. Conclusions: An online intervention based on the PWM has the potential to engage and interest adolescents. A wide range of alcohol prototypes should be targeted and a focus on short-term harms should ensure that the intervention is credible to young people. %M 27025403 %R 10.2196/humanfactors.4452 %U http://humanfactors.jmir.org/2015/2/e13/ %U https://doi.org/10.2196/humanfactors.4452 %U http://www.ncbi.nlm.nih.gov/pubmed/27025403