A text message intervention aimed at nurturing peer outreach to help meet drinking limit goals: A remote pilot randomized trial in non-collegiate young adults.

OBJECTIVE: Scalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals. METHOD: Non-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks. RESULTS: We enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups. CONCLUSIONS: Preliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption.

Prediction Rules Identify Which Young Adults Have Higher Rates of Heavy Episodic Drinking After Exposure to 12-Week Text Message Interventions.

BACKGROUND: An alcohol text message intervention recently demonstrated effects in reducing heavy episodic drinking (HED) days at the three month follow-up in young adults with a history of hazardous drinking. An important next step in understanding intervention effects involves identifying baseline participant characteristics that predict who will benefit from intervention exposure to support clinical decision-making and guide further intervention development. To identify baseline characteristics that predict HED, this exploratory study used a prediction rule ensemble (PRE). Compared to more complex decision-tree methods (e.g., random forest), PREs have comparable performance, while generating simpler rules that can directly identify subgroups that do or do not respond to intervention. METHODS: This secondary analysis examined data from 916 young adults who reported HED (68.5% female, mean age = 22.1, SD = 2.1), were enrolled in an alcohol text message randomized clinical trial and who completed baseline assessment and the three month follow-up. A PRE with ten fold cross-validation, which included 21 baseline variables representing sociodemographic characteristics (e.g., sex, age, race, ethnicity, college enrollment), alcohol consumption (frequency of alcohol consumption, quantity consumed on a typical drinking day, frequency of HED), impulsivity subscales (i.e., negative urgency, positive urgency, lack of premeditation, lack of perseverance, sensation seeking), readiness to change, perceived peer drinking and HED-related consequences, and intervention status were used to predict HED at the three month follow-up. RESULTS: The PRE identified 12 rules that predicted HED at three months (R2 = 0.23) using 7 baseline features. Only two cases (0.2%) were not classified by the 12 rules. The most important features for predicting three month HED included baseline alcohol consumption, negative urgency score, and perceived peer drinking. CONCLUSIONS: The rules provide interpretable decision-making tools that predict who has higher alcohol consumption following exposure to alcohol text message interventions using baseline participant characteristics (prior to intervention), which highlight the importance of interventions related to negative urgency and peer alcohol use.

Automated, tailored adaptive mobile messaging to reduce alcohol consumption in help-seeking adults: A randomized controlled trial.

AIMS: To test differential outcomes between three 6-month text-messaging interventions to reduce at-risk drinking in help-seeking adults. DESIGN: A three-arm single-blind randomized controlled trial with 1-, 3-, 6- and 12-month follow-ups. SETTING: United States. A fully remote trial without human contact, with participants recruited primarily via social media outlets. PARTICIPANTS: Seven hundred and twenty-three adults (mean = 39.9 years, standard deviation = 10.0; 62.5% female) seeking to reduce their drinking were allocated to 6 months of baseline 'tailored statically' messaging (TS; n = 240), 'tailored adaptive' messaging (TA; n = 239) or 'drink tracking' messaging (DT; n = 244). INTERVENTIONS: TS consisted of daily text messages to reduce harmful drinking that were tailored to demographics and alcohol use. TA consisted of daily, tailored text messages that were also adapted based on goal achievement and proactive prompts. DT consisted of a weekly assessment for self-reported drinking over the past 7 days. MEASUREMENTS: The primary outcome measure was weekly sum of standard drinks (SSD) at 6-month follow-up. Secondary outcome measures included drinks per drinking day (DDD), number of drinking days (NDD) per week and heavy drinking days (HDD) at 1-, 3-, 6- and 12-month follow-ups. FINDINGS: At 6 months, compared with DT, TA resulted in significant SSD reductions of 16.2 (from 28.7 to 12.5) drinks [adjusted risk ratio (aRR) = 0.80, 95% confidence interval (CI) = 0.71, 0.91] using intent-to-treat analysis. TA also resulted in significant improvements in DDD (aRR = 0.84; 95% CI = 0.77-0.92) and drinking days per week (b = -0.39; 95% CI = -0.67, -0.10), but not HDD compared with DT at 6 months. TA was not significantly different from TS at any time-point, except DDD at 6 months. All groups made improvements in SSD at 12-month follow-up compared with baseline with an average reduction of 12.9 drinks per week across groups. CONCLUSIONS: Automated tailored mobile messaging interventions are scalable solutions that can reduce weekly alcohol consumption in remote help-seeking drinkers over time.

Automated Messaging Program to Facilitate Systematic Home Blood Pressure Monitoring: Qualitative Analysis of Provider Interviews.

BACKGROUND: Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support. OBJECTIVE: We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices. METHODS: Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs. RESULTS: Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient's home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member. CONCLUSIONS: In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education. TRIAL REGISTRATION: ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4.

Feasibility of a pragmatic randomized adaptive clinical trial to evaluate a brief negotiational interview for harmful and hazardous alcohol use in Moshi, Tanzania.

INTRODUCTION: Low-resourced settings often lack personnel and infrastructure for alcohol use disorder treatment. We culturally adapted a Brief Negotiational Interview (BNI) for Emergency Department injury patients, the "Punguza Pombe Kwa Afya Yako (PPKAY)" ("Reduce Alcohol For Your Health") in Tanzania. This study aimed to evaluate the feasibility of a pragmatic randomized adaptive controlled trial of the PPKAY intervention. MATERIALS AND METHODS: This feasibility trial piloted a single-blind, parallel, adaptive, and multi-stage, block-randomized controlled trial, which will subsequently be used to determine the most effective intervention, with or without text message booster, to reduce alcohol use among injury patients. We reported our feasibility pilot study using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with recruitment and retention rates being our primary and secondary outcomes. We enrolled adult patients seeking care for an acute injury at the Kilimanjaro Christian Medical Center in Tanzania if they (1) exhibited an Alcohol Use Disorder Identification Test (AUDIT) ≥8, (2) disclosed alcohol use prior to injury, or (3) had a breathalyzer ≥0.0 on arrival. Intervention arms were usual care (UC), PPKAY, PPKAY with standard text booster, or a PPKAY with a personalized text booster. RESULTS: Overall, 181 patients were screened and 75 enrolled with 80% 6-week, 82.7% 3-month and 84% 6-month follow-up rates showing appropriate Reach and retention. Adoption measures showed an overwhelmingly positive patient acceptance with 100% of patients perceiving a positive impact on their behavior. The Implementation and trial processes were performed with high rates of PPKAY fidelity (76%) and SMS delivery (74%). Intervention nurses believed Maintenance and sustainability of this 30-minute, low-cost intervention and adaptive clinical trial were feasible. CONCLUSIONS: Our intervention and trial design are feasible and acceptable, have evidence of good fidelity, and did not show problematic deviations in protocol. Results suggest support for undertaking a full trial to evaluate the effectiveness of the PPKAY, a nurse-driven BNI in a low-income country. TRIAL REGISTRATION: Trial registration number NCT02828267. https://classic.clinicaltrials.gov/ct2/show/NCT02828267.

Detection of Alcohol Intoxication Using Voice Features: A Controlled Laboratory Study.

OBJECTIVE: Devices such as mobile phones and smart speakers could be useful to remotely identify voice alterations associated with alcohol intoxication that could be used to deliver just-in-time interventions, but data to support such approaches for the English language are lacking. In this controlled laboratory study, we compare how well English spectrographic voice features identify alcohol intoxication. METHOD: A total of 18 participants (72% male, ages 21-62 years) read a randomly assigned tongue twister before drinking and each hour for up to 7 hours after drinking a weight-based dose of alcohol. Vocal segments were cleaned and split into 1-second windows. We built support vector machine models for detecting alcohol intoxication, defined as breath alcohol concentration > .08%, comparing the baseline voice spectrographic signature to each subsequent timepoint and examined accuracy with 95% confidence intervals (CIs). RESULTS: Alcohol intoxication was predicted with an accuracy of 98% (95% CI [97.1, 98.6]); mean sensitivity = .98; specificity = .97; positive predictive value = .97; and negative predictive value = .98. CONCLUSIONS: In this small, controlled laboratory study, voice spectrographic signatures collected from brief recorded English segments were useful in identifying alcohol intoxication. Larger studies using varied voice samples are needed to validate and expand models.

Trajectory classes of engagement with an alcohol text message intervention and predictors of intervention engagement.

Digital interventions have increased our capacity to reach young adults who have hazardous alcohol use. Alcohol text message interventions have shown small effects in reducing hazardous drinking, leaving room for improvement. An important challenge to address in improving digital interventions is maintaining engagement, which reflects the "dose" of intervention received. This study aimed to identify trajectory classes of engagement with an alcohol text message intervention, and baseline predictors of the trajectory classes to determine "for whom" the digital intervention was more versus less engaging, to guide further intervention tailoring. This secondary analysis examined data from a study that compared five 12-week alcohol text message interventions designed to reduce hazardous drinking in young adults (aged 18-25; N = 1,131, 68% female) recruited from Emergency Departments in Western Pennsylvania. Engagement with the intervention was based on response (present/absent) to text message queries delivered twice per week during 2-week run-in and 12-week intervention. Repeated measures latent profile analysis identified five latent trajectory classes as having the best fit to the data: "High engagement" (55.1%), "Slow decrease, moderate engagement" (23.2%); "Mid-way decrease in engagement" (8.9%), "Steadily decreasing engagement" (8.1%); and "Fluctuating, moderate engagement" (4.6%). Females and individuals enrolled in college were overrepresented in the high engagement trajectory class, whereas individuals higher in impulsivity were more likely to be in decreasing (versus high) engagement trajectory classes. Methods to boost engagement using, for example, motivational enhancement for young adults with higher levels of impulsivity, at specific time points, such as the mid-point of the intervention, warrant consideration.

Desire to get drunk partially mediates effects of a combined text message-based alcohol intervention for young adults.

BACKGROUND: This study aimed to test the causal effect of different text message interventions on reducing alcohol consumption indirectly by altering desire to get drunk. METHODS: Participants were young adults randomized to interventions with different behavior change techniques: self-monitoring alone (TRACK); pre-drinking plan feedback (PLAN); post-drinking alcohol consumption feedback (USE); pre- and post-drinking goal feedback (GOAL); and a combination of techniques (COMBO) who completed at least 2 days of both pre- and post-drinking assessments over 12 weeks of intervention exposure. On the two days per week they planned to drank alcohol, participants were asked to report desire to get drunk (0 "none" to 8 "completely"). The next day, participants reported drinking quantity. Outcomes included binge drinking (defined as 4+ drinks for a woman and 5+ drinks for a man) and drinks per drinking day. Mediation was tested using path models of simultaneous between-person and within-person effects using maximum likelihood estimation. RESULTS: At the between-person level, controlling for race and baseline AUDIT-C and within-person associations, 35.9 % of the effects of USE and 34.4 % of the effects of COMBO on reducing binge drinking were mediated through desire to get drunk. 60.8 % of the effects of COMBO on reducing drinks per drinking day were mediated through desire to get drunk. We did not find significant indirect effects for any other text-message intervention. DISCUSSION: Findings support the hypothesized mediation model where desire to get drunk partially mediates the effects of a text message intervention using a combination of behavior change techniques on reducing alcohol consumption.

Goal commitment and goal confidence mediate the path between desire to get drunk and binge drinking among young adults receiving text message goal-related feedback.

BACKGROUND: Counteracting desires to drink are cognitive processes that exert self-control to mitigate impulses or strengthen other, perhaps more distal, goals to limit consumption. Young adults are particularly challenged by mismatches between self-regulation and desires to drink that make them susceptible to hazardous alcohol use. METHODS: We assessed whether drinking limit goal commitment and goal confidence mediate the association between desire to get drunk and binge drinking (4+ drinks for females and 5+ drinks for males on a given occasion) among young adults exposed to text message goal-related feedback. We randomized 297 young adults to one of two text message interventions that incorporated drinking limit goal-related assessments and feedback over 12 weeks of intervention exposure. On the 2 days per week that they typically drank alcohol, participants were asked to report plans to drink (yes/no). If a drinking plan was endorsed, participants reported their desire to get drunk (0 [not at all] to 8 [completely]), willingness to commit to a drinking limit goal (yes/no), and (contingent on goal commitment) goal confidence (0 [not at all] to 8 [completely]). The next day, participants reported their drinking quantity, coded as a binge drinking day (yes/no). Mediation was tested using path models of simultaneous between- and within-person effects using maximum likelihood. RESULTS: At both within- and between-person levels, we found significant indirect path effects of goal commitment and goal confidence between desire to get drunk and binge drinking. Greater than usual desire to get drunk was associated with lower drinking limit goal commitment and confidence, whereas greater than usual goal commitment and confidence were associated with lower likelihood of same-day binge drinking. DISCUSSION: Findings support a mechanistic model where contextual variations in same-day drinking limit goal commitment and confidence mitigate the path between desire to get drunk and binge drinking among young adults. Employing just-in-time strategies to reinforce drinking limit goal commitment and goal confidence could reduce hazardous drinking and related harms.

Leveraging Mobile Phone Sensors, Machine Learning, and Explainable Artificial Intelligence to Predict Imminent Same-Day Binge-drinking Events to Support Just-in-time Adaptive Interventions: Algorithm Development and Validation Study.

BACKGROUND: Digital just-in-time adaptive interventions can reduce binge-drinking events (BDEs; consuming ≥4 drinks for women and ≥5 drinks for men per occasion) in young adults but need to be optimized for timing and content. Delivering just-in-time support messages in the hours prior to BDEs could improve intervention impact. OBJECTIVE: We aimed to determine the feasibility of developing a machine learning (ML) model to accurately predict future, that is, same-day BDEs 1 to 6 hours prior BDEs, using smartphone sensor data and to identify the most informative phone sensor features associated with BDEs on weekends and weekdays to determine the key features that explain prediction model performance. METHODS: We collected phone sensor data from 75 young adults (aged 21 to 25 years; mean 22.4, SD 1.9 years) with risky drinking behavior who reported their drinking behavior over 14 weeks. The participants in this secondary analysis were enrolled in a clinical trial. We developed ML models testing different algorithms (eg, extreme gradient boosting [XGBoost] and decision tree) to predict same-day BDEs (vs low-risk drinking events and non-drinking periods) using smartphone sensor data (eg, accelerometer and GPS). We tested various "prediction distance" time windows (more proximal: 1 hour; distant: 6 hours) from drinking onset. We also tested various analysis time windows (ie, the amount of data to be analyzed), ranging from 1 to 12 hours prior to drinking onset, because this determines the amount of data that needs to be stored on the phone to compute the model. Explainable artificial intelligence was used to explore interactions among the most informative phone sensor features contributing to the prediction of BDEs. RESULTS: The XGBoost model performed the best in predicting imminent same-day BDEs, with 95% accuracy on weekends and 94.3% accuracy on weekdays (F1-score=0.95 and 0.94, respectively). This XGBoost model needed 12 and 9 hours of phone sensor data at 3- and 6-hour prediction distance from the onset of drinking on weekends and weekdays, respectively, prior to predicting same-day BDEs. The most informative phone sensor features for BDE prediction were time (eg, time of day) and GPS-derived features, such as the radius of gyration (an indicator of travel). Interactions among key features (eg, time of day and GPS-derived features) contributed to the prediction of same-day BDEs. CONCLUSIONS: We demonstrated the feasibility and potential use of smartphone sensor data and ML for accurately predicting imminent (same-day) BDEs in young adults. The prediction model provides "windows of opportunity," and with the adoption of explainable artificial intelligence, we identified "key contributing features" to trigger just-in-time adaptive intervention prior to the onset of BDEs, which has the potential to reduce the likelihood of BDEs in young adults. TRIAL REGISTRATION: ClinicalTrials.gov NCT02918565; https://clinicaltrials.gov/ct2/show/NCT02918565.

A longitudinal assessment of posttraumatic stress symptoms and pain catastrophizing after injury.

PURPOSE/OBJECTIVE: Identifying individuals with high levels of pain catastrophizing (PC) may inform early psychological interventions to prevent the transition from acute to chronic post-injury pain. We examined whether pre-and post-injury posttraumatic stress symptoms (PTSS) predict post-injury PC among emergency department (ED) patients following acute motor vehicle crash (MVC). RESEARCH METHOD/DESIGN: This study represents secondary data analysis of a randomized clinical trial (NCT03247179) examining the efficacy of the PTSD Coach app on post-injury PTSS (PTSSpost). Among 63 injured ED patients (63% female; 57% non-White; average age = 37) with moderate pain (≥4 of 10), we assessed recall of pre-injury PTSS (PTSSrecall: stemming from preexisting exposures) and baseline PC within 24 hr post-MVC; PTSSpost stemming from the MVC was assessed 30-days later, and the outcome of PC was assessed at 90-days post-injury. We controlled for group assignment (intervention vs. control) in all analyses. RESULTS: Results revealed that at baseline and 90-days, PC was higher among non-White versus White participants. After adjusting for relevant covariates, PTSSrecall uniquely predicted post-injury PC and each subscale of PC (helplessness, magnification, and rumination). Similarly, after controlling for PTSSrecall and relevant covariates, PTSSpost uniquely predicted total and subscale post-injury PC. Intervention group participants reported less rumination than control group participants. CONCLUSIONS/IMPLICATIONS: These novel findings highlight that injured Black patients may be vulnerable to post-injury PC, and that both PTSSrecall and PTSSpost significantly predict post-injury PC. Brief PTSS assessment in the ED can identify high-risk patients who may benefit from early intervention. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Examining the prevalence and health impairment associated with subthreshold PTSD symptoms (PTSS) among frontline healthcare workers during the COVID-19 pandemic.

The COVID-19 pandemic has increased healthcare workers' (HCWs) risk for posttraumatic stress disorder (PTSD). Although subthreshold PTSD symptoms (PTSS) are common and increase vulnerability for health impairments, they have received little attention. We examined the prevalence of subthreshold PTSS and their relationship to physical health symptoms and sleep problems among HCWs during the pandemic's second wave (01/21-02/21). Participants (N = 852; 63.1% male; Mage = 38.34) completed the Short-Form PTSD Checklist (SF-PCL), the Cohen-Hoberman Inventory of Physical Symptoms, and the PROMIS Sleep-Related Impairment-Short-Form 4a. We created three groups with the SF-PCL: scores ≥11 = probable PTSD (5.5%); scores between 1 and 10 = subthreshold PTSS (55.3%); scores of 0 = no PTSS (39.2%). After controlling for demographics, occupational characteristics, and COVID-19 status, HCWs with subthreshold PTSS experienced greater physical health symptoms and sleep problems than HCWs with no PTSS. While HCWs with PTSD reported the greatest health impairment, HCWs with subthreshold PTSS reported 88% more physical health symptoms and 36% more sleep problems than HCWs with no PTSS. Subthreshold PTSS are common and increase risk for health impairment. Interventions addressing HCWs' mental health in response to the COVID-19 pandemic must include subthreshold PTSS to ensure their effectiveness.

Effectiveness of text message interventions with different behavior change techniques on alcohol consumption among young adults: a five-arm randomized controlled trial.

AIMS: This studys aim is to test the effectiveness of five interventions each utilizing a unique set of behavior change techniques on reducing alcohol consumption at 3 and 6 months among young adults with hazardous drinking. DESIGN, SETTING AND PARTICIPANTS: This study used a five-arm parallel randomized controlled trial with 3- and 6-month follow-ups. Recruitment occurred at four emergency departments in Pittsburgh, PA, USA. Participants were non-treatment-seeking young adults (mean age = 22.1 years; 68.5% female; 37.1% black) who reported hazardous drinking. INTERVENTIONS: Participants were randomized to one of five automated text message interventions for 12 weeks that interacted with participants on the 2 days per week that they typically drank: assisted self-monitoring (TRACK: control condition; n = 245), pre-drinking cognition feedback (PLAN; n = 226), alcohol consumption feedback (USE; n = 235), adaptive goal support (GOAL; n = 214) and a combination of interventions (COMBO; n = 221). MEASUREMENTS: Primary outcome was number of past month binge drinking days at 3-month post-randomization calculated from a 30-day time-line follow-back. Primary intention-to-treat analysis compared PLAN, USE, GOAL and COMBO against TRACK (control condition). The four active conditions were not compared against each other. A secondary outcome, durability of effects, was measured at 6 months. FINDINGS: From baseline to 3-month follow-up (retention = 81.1%), compared with TRACK, in which past-month mean binge drinking days increased from 2.7 to 3.4, mean binge drinking days decreased in COMBO from 3.0 to 2.3 [adjusted ß = -0.52; 95% confidence interval (CI) = -0.77, -0.26], GOAL from 3.0 to 2.6 (adjusted ß = -0.34; 95% CI = -0.59, -0.10) and USE from 3.3 to 2.9 (adjusted ß = -0.38; 95% CI = -0.62, -0.14). At 6 months (retention = 73.8%), COMBO, GOAL, USE and PLAN had significantly lower mean binge drinking days compared with TRACK. CONCLUSION: Text message interventions incorporating feedback on either drinking plans and/or alcohol consumption and/or drinking limit goal support produced small yet durable reductions in binge drinking days in non-treatment-seeking young adults with hazardous drinking.

Effectiveness of a Text Message Intervention Promoting Seat Belt Use Among Young Adults: A Randomized Clinical Trial.

Importance: Approximately 1 in 10 adults do not always wear a seat belt, with the lowest use rates reported among young adults. Objective: To determine the efficacy of a 6-week automated behavioral text message program promoting seat belt use compared with an attention control. Design, Setting, and Participants: This parallel, 2-group, single-blind, individually randomized clinical trial included a convenience sample of patients recruited from 4 emergency departments in 2 cities in Pennsylvania from December 2019 to September 2021, with follow-ups at 6 and 12 weeks after randomization. Patients in stable condition aged 18 to 25 years who, in standardized screening, reported driving or being a passenger in a car without always using a seat belt in the past 2 weeks were eligible for recruitment. Participants who completed a 2-week trial run-in phase were randomly assigned 1:1 to the intervention or the assessment control. Data were analyzed from October 2019 to January 2020. Interventions: The intervention group received Safe Vehicle Engagement (SAVE), a 6-week automated interactive text message program, including weekly seat belt use queries with feedback and goal support to promote consistent use of a seat belt. The control group received identical weekly seat belt use queries but no additional feedback. Main Outcomes and Measures: The primary outcome was the proportion of young adults reporting always wearing a seat belt over the past 2 weeks, collected at 6 weeks (after a 2-week run-in) via web-based self-assessments and analyzed under intent-to-treat models using multiple imputation procedures. Sensitivity analyses included complete-case analyses of ordered categorical outcomes by vehicle seat position. Secondary outcomes included seatbelt use at 12 weeks and select cognitive constructs related to seat belt use. Results: A total of 218 participants (mean [SD] age, 21.5 [2.1] years; 139 [63.8%] women) were randomized, with 110 randomized to SAVE and 108 randomized to the control group. A total of 158 individuals (72.4%) were included in the 6-week follow-up. The rate of always using a seat belt over the past 2 weeks at the 6-week follow-up was 41.3% (95% CI, 30.6%-52.0%) among SAVE participants and 20.0% (95% CI, 10.6%-29.3%) among control participants (odds ratio [OR], 2.8; 95% CI, 1.4-5.8; P = .005). A total of 140 individuals (64.2%) participated in the 12-week follow-up. At 12 weeks, the rate of always using a seat belt over the past 2-weeks was 42.8% (95% CI, 31.2%-54.2%) among SAVE participants and 30.7% (95% CI, 19.6%-41.6%) among control participants (OR, 1.7; 95% CI, 0.9-3.4; P = .13). When examining ordered categories of seat belt use by seat position, there were significantly greater odds of wearing a seat belt at 6 and 12 weeks among SAVE participants vs control participants (eg, 6 weeks for driver: OR, 5.2; 95% CI, 2.6-10.5; 6 weeks for front passenger: OR, 4.3; 95% CI, 2.2-8.2; 6 weeks for back passenger: OR, 4.3; 95% CI, 2.2-8.2). Conclusions and Relevance: In this randomized clinical trial, an interactive text message intervention was more effective at promoting seat belt use among targeted young adults than an attention control at 6 weeks. There was no significant difference between groups in always wearing a seat belt at 12 weeks. These findings, if replicated in a larger sample, suggest a scalable approach to improve seat belt use. Trial Registration: ClinicalTrials.gov Identifier: NCT03833713.

Effectiveness of a Text Message Intervention to Reduce Texting While Driving Among Targeted Young Adults: A Randomized Controlled Trial.

PURPOSE: This randomized clinical trial tested the efficacy of a 6-week text message program to reduce texting while driving (TWD) for young adults. METHODS: Eligible individuals recruited from four emergency departments from December 2019 to June 2021 were aged 18-25 years who reported TWD in the past 2 weeks. Participants were randomly assigned 1:1 to intervention:assessment control. The intervention arm (n = 57) received an automated interactive text message program, including weekly queries about TWD for 6 weeks with feedback and goal support to promote cessation of TWD. The assessment control arm (n = 55) received identical weekly TWD queries but no additional feedback. Outcomes were collected via web-based self-assessments at 6- and 12 weeks and analyzed under intent-to-treat models, presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The mean (SD) age was 21.7 (2.1) years, 73 (65%) were female, and 40 (36%) were White. The 6-week follow-up rate was 77.7% (n = 87) and 12-week follow-up rate was 64.3% (n = 72). At 6 weeks, 52.6% (95% CI, 39.0%-66.0%) of intervention participants reported TWD versus 63.6% (95% CI, 49.6%-76.2%) of control participants (adjusted OR, 0.71; 95% CI, 0.32-1.59). At 12 weeks, 38.2% (95% CI, 22.8%-53.5%) of intervention participants reported TWD versus 69.3% (95% CI, 53.8%-84.7%) of control participants (adjusted OR, 0.29; 95% CI, 0.11-0.80). DISCUSSION: An interactive text message intervention was more effective at reducing self-reported TWD among young adults than assessment control at 12 weeks.

Predicting falls within 3 months of emergency department discharge among community-dwelling older adults using self-report tools versus a brief functional assessment.

BACKGROUND: Identifying older adults with risk for falls prior to discharge home from the Emergency Department (ED) could help direct fall prevention interventions, yet ED-based tools to assist risk stratification are under-developed. The aim of this study was to assess the performance of self-report and functional assessments to predict falls in the 3 months post-ED discharge for older adults. METHODS: A prospective cohort of community-dwelling adults age 60 years and older were recruited from one urban ED (N = 134). Participants completed: a single item screen for mobility (SIS-M), the 12-item Stay Independent Questionnaire (SIQ-12), and the Timed Up and Go test (TUG). Falls were defined through self-report of any fall at 1- and 3-months and medical record review for fall-related injury 3-months post-discharge. We developed a hybrid-convolutional recurrent neural network (HCRNN) model of gait and balance characteristics using truncal 3-axis accelerometry collected during the TUG. Internal validation was conducted using bootstrap resampling with 1000 iterations for SIS-M, FRQ, and GUG and leave-one-out for the HCRNN. We compared performance of M-SIS, FRQ, TUG time, and HCRNN by calculating the area under the receiver operating characteristic area under the curves (AUCs). RESULTS: 14 (10.4%) of participants met our primary outcome of a fall or fall-related injury within 3-months. The SIS-M had an AUC of 0.42 [95% confidence interval (CI) 0.19-0.65]. The SIQ-12 score had an AUC of 0.64 [95% confidence interval (CI) 0.49-0.80]. The TUG had an AUC of 0.48 (95% CI 0.29-0.68). The HCRNN model using generated accelerometer features collected during the TUG had an AUC of 0.99 (95% CI 0.98-1.00). CONCLUSION: We found that self-report and functional assessments lack sufficient accuracy to be used in isolation in the ED. A neural network model using accelerometer features could be a promising modality but research is needed to externally validate these findings.

Randomized feasibility trial of a digital intervention for hypertension self-management.

Home blood pressure monitoring (HBPM) can improve hypertension management. Digital tools to facilitate routinized HBPM and patient self-care are underutilized and lack evidence of effectiveness. MyBP provides video-based education and automated text messaging to support continuous BP self-monitoring with recurring feedback. In this pragmatic trial, we sought to generate preliminary evidence of feasibility and efficacy in community-dwelling adults ≥55 y/o with hypertension recruited from primary care offices. Enrollees were provided a standard automatic BP cuff and randomized 2:1 to MyBP vs treatment-as-usual (control). Engagement with MyBP was defined as the proportion of BP reading prompts for which a reading was submitted, tracked over successive 2-week monitoring periods. Preliminary measures of efficacy included BP readings from phone-supervised home measurements and a self-efficacy questionnaire. Sixty-two participants (40 women, 33 Blacks, mean age 66, mean office BP 164/91) were randomized to MyBP (n = 41) or a control group (n = 21). Median follow-up was 22.9 (SD = 6.7) weeks. In the MyBP group, median engagement with HBPM was 82.7% (Q1 = 52.5, Q3 = 89.6) and sustained over time. The decline in systolic [12 mm Hg (SD = 17)] and diastolic BP [5 mm Hg (SD = 7)] did not differ between the two treatment groups. However, participants with higher baseline systolic BP assigned to MyBP had a greater decline compared to controls [interaction effect estimate -0.56 (-0.96, -0.17)]. Overall hypertension self-efficacy improved in the MyBP group. In conclusion, trial results show that older hypertensive adults with substantial minority representation had sustained engagement with this digital self-monitoring program and may benefit clinically.