Healthy Campus Trial: a multiphase optimization strategy (MOST) fully factorial trial to optimize the smartphone cognitive behavioral therapy (CBT) app for mental health promotion among university students: study protocol for a randomized controlled trial.

BACKGROUND: Youth in general and college life in particular are characterized by new educational, vocational, and interpersonal challenges, opportunities, and substantial stress. It is estimated that 30-50% of university students meet criteria for some mental disorder, especially depression, in any given year. The university has traditionally provided many channels to promote students' mental health, but until now only a minority have sought such help, possibly owing to lack of time and/or to stigma related to mental illness. Smartphone-delivered cognitive behavioral therapy (CBT) shows promise for its accessibility and effectiveness. However, its most effective components and for whom it is more (or less) effective are not known. METHODS/DESIGN: Based on the multiphase optimization strategy framework, this study is a parallel-group, multicenter, open, fully factorial trial examining five smartphone-delivered CBT components (self-monitoring, cognitive restructuring, behavioral activation, assertion training, and problem solving) among university students with elevated distress, defined as scoring 5 or more on the Patient Health Questionnaire-9 (PHQ-9). The primary outcome is change in PHQ-9 scores from baseline to week 8. We will estimate specific efficacy of the five components and their interactions through the mixed-effects repeated-measures analysis and propose the most effective and efficacious combinations of components. Effect modification by selected baseline characteristics will be examined in exploratory analyses. DISCUSSION: The highly efficient experimental design will allow identification of the most effective components and the most efficient combinations thereof among the five components of smartphone CBT for university students. Pragmatically, the findings will help make the most efficacious CBT package accessible to a large number of distressed university students at reduced cost; theoretically, they will shed light on the underlying mechanisms of CBT and help further advance CBT for depression. TRIAL REGISTRATION: UMIN, CTR-000031307 . Registered on February 14, 2018.

Multiphasic epidemiological analyses on smoking habits among undergraduate students in Japan.

Little is known about the prevalence and dynamics of smoking habits among university students in Japan, and their association with other lifestyle parameters and biological markers. Data on undergraduate students were here extracted from the questionnaire and laboratory tests of the periodic health checkup of Kyoto University in 2000 and 2001. In addition to simple statistics, longitudinal analyses were performed using logistic regression, and the odds ratio (OR) and its 95% confidence interval (CI) were calculated for each item. Among 11,203 subjects, 12.1% had a smoking habit. The smoking rate was higher in men than in women (14.4% vs 2.4%, P<0.001) and increased from 2.5% (freshmen) to 18.3% (seniors) with advance in year. During one year of follow-up, 5.8% of students newly acquired a smoking habit, and 12.4% of smokers abandoned the habit. Compared with students majoring in natural sciences, the majors in humanities or social sciences were more likely to begin smoking (OR=1.32, 95% CI=1.06-1.65). Taking up smoking was more common among those who consumed alcohol (OR=1.98, 95% Cl=1.56-2.51), and skipped breakfast and dined out more frequently (trend P<0.001 for both), but less common among regular exercisers (OR=0.71, 95% Cl=0.56-0.90). Smoking habits tended to be associated with subsequent proteinuria (adjusted OR=1.39, 95% Cl=0.96-2.00) and subsequent cough or phlegm (adjusted OR=1.56, 95% Cl=0.91-2.67). This study revealed that the proportion of student smokers increases with the year in university, in association with several other lifestyle parameters. Measures should be taken against smoking behavior focusing on freshmen and considering their lifestyle.