The symbolic consumption processes associated with 'low-calorie' and 'low-sugar' alcohol products and Australian women.

The influence of commercial actors, practices and processes on the health and wellbeing of women is still not well understood. The alcohol industry has developed a range of products to appeal to new 'health conscious' markets, such as 'low-calorie' and 'low-sugar' products. While these products may have specific appeal for women, there has been little in-depth research that has sought to understand how women conceptualize these products and the range of symbolic meanings that women associate with these products. An online qualitatively led survey was conducted with n = 497 Australian women who had consumed alcohol in the last year. Questions related to the reasons for and influences on alcohol use, the purchasing of 'low-calorie' or 'low-sugar' products and the influence that these products might have on women's alcohol use. Data were interpreted using reflexive thematic analysis. Women consumed alcohol to relax, cope with everyday stressors and because of the alignment with social practices and social connection. Women perceived that these products provided a healthier alternative to traditional alcohol products and that they aligned with women's values relating to weight and the thin ideal. Some women were concerned that these products could increase alcohol consumption by reducing the perceptions of risk associated with alcohol. Policy consideration is needed to address how product claims and attributes may influence population groups' interpretations of the risks and benefits of these alcohol products, including the illusion that these products have protective potential and are better for overall health and wellbeing.

Trends in and factors associated with parental provision of alcohol to minors in Western Australia, 2013-2019.

INTRODUCTION: Some parents provide alcohol to their underage children, despite a range of negative outcomes being associated with this practice. The present study aimed to assess factors associated with and changes in parental provision behaviours from 2013 to 2019 in Western Australia. METHODS: Annual cross-sectional online surveys were conducted (total n = 2635). Assessed variables included parents' demographic characteristics, alcohol use, awareness of the relevant Australian alcohol guideline, attitudes to parental provision of alcohol and provision behaviours. A binary logistic generalised linear model was used to identify factors associated with parental provision of alcohol. RESULTS: Parental provision of alcohol prevalence decreased from 40% in 2013 to 27% in 2019. The following variables were significantly associated with parental provision: permissive attitudes to provision (ß = 2.82); older parental age (ß = 1.28); a lack of knowledge of the relevant guideline (ß = 0.78); survey year (ß = 0.083); and greater alcohol use (ß = 1.12). Socioeconomic position was not associated with parental provision. Female parents were more likely to report that an adult in the household provided children with alcohol (ß = 1.3) DISCUSSION AND CONCLUSIONS: The findings suggest that (i) although still commonplace, parental provision of alcohol to minors in Western Australia has declined over time; and (ii) the effectiveness of campaigns aiming to reduce this behaviour may be enhanced by targeting households with parents who are older and heavier drinkers and by including content that challenges permissive views on alcohol provision to minors.

Evaluation outcomes of an alcohol and pregnancy campaign targeting multiple audiences.

INTRODUCTION: The aim of this study was to evaluate the effectiveness of a mass media campaign alerting the public to the potential harms of alcohol to unborn babies and to inform future intervention efforts. METHOD: An online survey was administered to 889 adult Western Australians. The survey assessed demographic characteristics, typical alcohol use, recognition and perceptions of the campaign, and behavioural changes resulting from campaign exposure. A multiple regression analysis was conducted to identify factors associated with perceived campaign effectiveness. RESULTS: Most respondents reported having seen/heard the campaign on at least one form of media (71%). Most considered the campaign to be believable (89%), clear (88%), trustworthy (87%), memorable (82%) and among the best they had seen (78%). As a result of campaign exposure, a large majority reported increased concern about drinking during pregnancy (85%) and most female respondents reported being much less likely to use alcohol during a pregnancy (83%). One-third of female respondents (33%) reported that as a result of being exposed to the campaign they had decided not to consume alcohol while pregnant. Confidence to abstain, awareness of strategies to abstain, lower socioeconomic position, residing in the metropolitan area and recognising the campaign were significantly associated with greater perceived campaign effectiveness. DISCUSSION AND CONCLUSIONS: Results indicate the campaign was well received by respondents, increased concern about drinking alcohol during pregnancy and positively influenced women's intentions to refrain from drinking while pregnant. Well-designed campaigns on alcohol avoidance during pregnancy can be considered acceptable and effective by target audiences.

Alcohol brands' use of age-restriction controls on Facebook and Instagram in Australia.

OBJECTIVES: Since 2017, the self-regulatory alcohol advertising system in Australia has required alcohol marketers to activate age-restriction controls on social networking sites to prevent access to children. With no monitoring mechanisms, the level of compliance with this requirement is unknown. We aimed to identify the extent to which the dominant alcohol companies in Australia have activated age-restriction controls on their official brand accounts on Facebook and Instagram. STUDY TYPE: Nonexperimental descriptive study. METHODS: We identified the brands owned by the top three beer, wine and spirit companies by market share in Australia, and located their official Facebook and Instagram accounts. International accounts were used when Australia-specific accounts did not exist. Two researchers independently attempted to access all accounts on a computer by entering the URL into a web browser that was not logged into either platform. We recorded the accessibility and audience size of each account. RESULTS: For the 195 alcohol brands that were available for sale in Australia through the nine top companies, we identified 153 Facebook accounts (84 Australian, 69 international) and 151 Instagram accounts (77 Australian, 74 international). We found 28% of Instagram and 5% of Facebook accounts did not have age-restriction controls activated. Similar proportions of Australian and international accounts on both platforms were not using controls. Only two companies were compliant across all of their accounts. CONCLUSIONS: Compliance with the industry marketing code requirement for age-restriction controls is inconsistent among the largest alcohol companies operating in Australia. The industry-managed regulatory system is not preventing children's access to alcohol content on social networking sites.

Do different actors submit different evidence to alcohol advertising policy consultations?

INTRODUCTION: This study examined the extent to which industry and non-industry actors draw from the same (vs. different) bodies of peer-reviewed evidence in submissions to alcohol advertising policy consultations. METHODS: Submissions (n = 71) to two Australian public consultations about alcohol advertising policy were classified as submitted by industry or non-industry actors. Details of cited journal articles were extracted. Articles were coded according to whether: (i) cited in industry and/or non-industry actor submission/s; (ii) findings were supported or contested by the submitter; and (iii) the article was a systematic review. The most frequently cited first authors were identified. RESULTS: In total, 126 articles were cited in 45 industry actor submissions and 159 articles were cited in 26 non-industry actor submissions. Only seven articles were cited by both groups. Authors cited most frequently by one actor group were rarely cited by the other group. The first author most cited by industry actors declared alcohol industry links in two articles. Industry actors cited three systematic reviews (and contested the findings); non-industry actors cited (and supported) seven systematic reviews. DISCUSSION AND CONCLUSION: There was a low degree of overlap in peer-reviewed evidence cited by industry and non-industry actors in submissions to Australian alcohol advertising policy consultations. Industry actors often omitted or contested high-quality evidence. Industry actors placed greater emphasis on evidence published by one industry-linked researcher than on evidence from systematic reviews and researchers with no apparent conflicts of interest. The findings raise questions about the suitability of industry actors to participate in evidence-informed policymaking processes.

Health halo or genuine product development: Are better-for-you alcohol products actually healthier?

ISSUE ADDRESSED: Alcoholic products marketed as better-for-you is an emerging trend in Australia that has received limited research attention to date. This study aimed to examine the nutrient profiles of alcoholic products marketed as better-for-you that are available in the Australian market. METHODS: We extracted the details of alcoholic product announcements published on the Drinks Trade website in 2019 and 2020 containing at least one keyword used to promote better-for-you products. The alcohol, energy, carbohydrate and sugar content of each product was recorded and assessed against existing classifications for alcohol strength and sugar and carbohydrate content. RESULTS: We identified 144 products promoted as better-for-you. The majority of products (85%, n = 122) were classified as full-strength, and the median alcohol content across each alcohol product category was classified as full-strength. Most of the energy content came from alcohol, with 62% of products deriving at least 75% of their energy content from alcohol. CONCLUSIONS: Alcoholic products marketed as better-for-you appear to rely on an illusion of healthfulness, without addressing the ingredient of most concern to health, the alcohol content. SO WHAT?: Controls on alcohol marketing should be expanded to limit the use of health and nutrient claims. Mandatory labelling of alcoholic products with nutrition information would support consumers to be better informed about the contents of alcoholic products.

An evaluation of the evidence submitted to Australian alcohol advertising policy consultations.

BACKGROUND: Industry self-regulation is the dominant approach to managing alcohol advertising in Australia and many other countries. There is a need to explore the barriers to government adoption of more effective regulatory approaches. This study examined relevance and quality features of evidence cited by industry and non-industry actors in their submissions to Australian alcohol advertising policy consultations. METHODS: Submissions to two public consultations with a primary focus on alcohol advertising policy were analysed. Submissions (n = 71) were classified into their actor type (industry or non-industry) and according to their expressed support for, or opposition to, increased regulation of alcohol advertising. Details of cited evidence were extracted and coded against a framework adapted from previous research (primary codes: subject matter relevance, type of publication, time since publication, and independence from industry). Evidence was also classified as featuring indicators of higher quality if it was either published in a peer-reviewed journal or academic source, published within 10 years of the consultation, and/or had no apparent industry connection. RESULTS: Almost two-thirds of submissions were from industry actors (n = 45 submissions from alcohol, advertising, or sporting industries). With few exceptions, industry actor submissions opposed increased regulation of alcohol advertising and non-industry actor submissions supported increased regulation. Industry actors cited substantially less evidence than non-industry actors, both per submission and in total. Only 27% of evidence cited by industry actors was highly relevant and featured at least two indicators of higher quality compared to 58% of evidence cited by non-industry actors. CONCLUSIONS: Evaluation of the value of the evidentiary contribution of industry actors to consultations on alcohol advertising policy appears to be limited. Modifications to consultation processes, such as exclusion of industry actors, quality requirements for submitted evidence, minimum standards for referencing evidence, and requirements to declare potential conflicts, may improve the public health outcomes of policy consultations.

Public opinion of alcohol industry corporate political activities.

OBJECTIVES: This study explores Australian public awareness and attitudes towards political donations from the alcohol industry and the 'revolving door' of politicians into industry or lobbyist positions. METHODS: Data were collected via a nationwide online panel. RESULTS: In total, n=1,044 participants completed the survey. More than half of the participants agreed that donations are made to influence government policy and to support the interests of the industry. More than half of the participants did not believe that it is appropriate for political parties to accept donations from the alcohol industry or for politicians to attend alcohol industry-hosted events. One-third of the participants agreed that public officials (including politicians) with a role in health policy should never be allowed to work or lobby for the alcohol industry (31.7%) and one-third endorsed a waiting time of 4-5 years. DISCUSSION: There were demographic differences in the views that participants held of the alcohol industry and the relationship between the government and the alcohol industry. The findings suggest that the laws and controls governing industry-government relationships should be reviewed to ensure they are in line with public expectations, accompanied by education programs including a focus on corporate political activity by the alcohol industry.

Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial.

BACKGROUND: Stress is an important transdiagnostic risk factor in adolescence and predicts a host of physical and psychological problems in adolescence and adulthood. Adolescence is also a developmental stage in which people may be more sensitive or reactive to stress. Indeed, research has shown that adolescents report high levels of stress, particularly when enrolled in school. However, adolescents report engaging in few, if any, stress management techniques. Consequently, the development of effective programs to help address adolescent stress is particularly important. To date, most stress management programs for adolescents are delivered within schools, and the evidence for such programs is mixed. Furthermore, most of these programs rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to or exacerbate the effects of perceived stress. OBJECTIVE: The aim of this study is to test the short-term effects of a digital mental health program designed for adolescents aged 13-17 years on perceived stress and rumination. METHODS: This is a randomized controlled trial in which adolescents between the ages of 13 and 17 years, with elevated levels of perceived stress and brooding, will be randomly assigned to complete 8 weeks of a digital mental health program (Happify for Teens) or to a corresponding wait-list control group. The study will take place over 3 months, including the 8-week intervention period and 1-month postintervention follow-up. The primary outcome, perceived stress, along with secondary and exploratory outcomes (ie, brooding, optimism, sleep disturbance, and loneliness) will be assessed via self-report at baseline, 4 weeks, 8 weeks, and 12 weeks to compare changes in these outcomes across conditions. RESULTS: Recruitment is expected to begin in the second quarter of 2021, with a target sample size of 800 participants (400 per condition). Participants will begin the study as they are recruited and will finish in waves, with the first wave of data expected 8 weeks after recruitment begins and the final wave of data expected by the end of the third quarter of 2021. CONCLUSIONS: Although school-based stress management programs for adolescents are common, research suggests that they may be limited in their reach and more effective for school-based stress than other types of stress. This trial will be one of the first attempts to examine the potential benefits of a digital mental health program on adolescents to address stress along with negative cognitive processes such as rumination. If successful, this would help introduce a more scalable alternative to school-based programs that offers adolescents greater privacy while also providing insight into novel ways to target adolescent mental health more generally. TRIAL REGISTRATION: ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/25545.

The Impact of a Digital Intervention (Happify) on Loneliness During COVID-19: Qualitative Focus Group.

BACKGROUND: Loneliness is a growing area of concern, attracting attention as a public health concern due to its association with a variety of psychological and physical health problems. However, interventions targeting loneliness are less common than interventions for other mental health problems, such as depression and anxiety, and existing interventions focus primarily on building social skills and increasing opportunities for social interaction despite research suggesting these techniques are not the most effective. Furthermore, although there is an increasing need for scalable and convenient interventions, digital interventions for loneliness are even less common. OBJECTIVE: Using a qualitative approach, we explore how adults (18-64 years of age) who express wanting to be more connected to others experience loneliness and react to a digital mental health intervention targeting loneliness. METHODS: A total of 11 participants were recruited from a pilot randomized controlled trial exploring the impact of a digital mental health intervention, Happify Health, on loneliness among adults aged 18-64 years who indicated wanting to feel more connected to others when signing up for the platform. Participants were invited to participate in a 3-day asynchronous focus group about their experiences with loneliness, with Happify Health, and with social distancing during the COVID-19 pandemic. All 11 participants completed the focus group in May 2020. RESULTS: Participants' responses were coded using thematic analysis, which led to identifying five themes, each with separate subthemes, that could be applied across the 3-day focus group: loneliness, relationships, social distancing, skill acquisition, and coping. Overall, we observed variability across participants in terms of the source of their loneliness, their perceptions of their social connections, and their motivation to reduce feelings of loneliness; however, participants commonly referred to negative self-perceptions as a cause or consequence of loneliness. Participants also varied in the extent to which they felt social distancing increased or decreased feelings of loneliness. In regard to the intervention, participants showed evidence of adopting skills they used to address their loneliness, particularly mindfulness and gratitude, and then using these skills to shift toward more active coping strategies following the intervention, including during the COVID-19 pandemic. CONCLUSIONS: The heterogeneity in participants' experiences with loneliness described during this focus group emphasizes the subjective and complex nature of loneliness. This highlights the importance of developing loneliness interventions that use a variety of strategies, including both direct and indirect strategies for reducing loneliness. However, based on our data, a key component to loneliness interventions is incorporating strategies for addressing underlying negative self-perceptions that stem from, but also contribute to, loneliness. This data also provides preliminary evidence that digital platforms may be an effective tool for disseminating loneliness interventions while providing the added benefit of offering a productive distraction when feeling lonely.

Are Australian regulatory codes adequate in scope to protect youth from alcohol advertising?

ISSUE ADDRESSED: Exposure to alcohol advertising has been found to be associated with more positive attitudes toward alcohol and heavier drinking among youth. Appropriate regulation of alcohol advertising is thus crucial for reducing use among members of this population group. To assist policy makers in their alcohol control efforts, this study explored the scope of Australian alcohol advertising codes and the extent to which they address issues relating to youth exposure. METHODS: Two researchers assessed 628 unique alcohol advertisements against youth-related provisions of the Alcohol Advertising Review Board (AARB) Code and Alcohol Beverages Advertising Code (ABAC). A third researcher resolved discrepancies. The ads sampled were those that had been the subject of formal complaints to the AARB. RESULTS: Most (94%) ads were assessed as violating at least one of the AARB Code provisions relating to youth, while 36% were found to violate at least one of the ABAC youth provisions. The most frequently violated AARB Code provision related to placement, with 88% of ads located in places or broadcast at times where young people were likely to be exposed. The most frequently violated ABAC provision related to appeal to minors (33%). CONCLUSIONS: Results indicate that self-regulation is an ineffective means of protecting youth from alcohol advertising, with the ABAC failing to capture many ads featuring content that appeals to youth. SO WHAT?: Greater efforts are required to protect youth from alcohol advertising. Findings from the present study reinforce calls for mandatory, evidence-based regulation that is administered independently of the alcohol industry. SUMMARY: An analysis of 628 unique alcohol advertisements found that the vast majority were in violation of the AARB Code's youth-related provisions whereas substantially fewer were in violation of the ABAC, supporting arguments that self-regulation is an ineffective means of protecting youth from alcohol advertising.

Alcohol industry arguments for putting profit before health in the midst of a pandemic: The Western Australian experience.

In an effort to limit the impact of alcohol on the Western Australian (WA) health system during the coronavirus disease (COVID-19) pandemic, the WA Government introduced temporary restrictions on takeaway alcohol purchases for several weeks in March and April 2020. In response, alcohol industry representatives encouraged the WA Government to remove the restrictions and replace them with a voluntary alcohol industry initiative. We looked at alcohol industry representatives' comments in media and online publications during this period. We found that the industry framed alcohol as an essential product, focused on the impact of the restrictions on WA businesses and framed the restrictions as complex and ineffective. The themes and arguments we identified are commonly used by the alcohol industry and are not unique to the pandemic. The alcohol industry's response to the COVID-19 restrictions in Australia provides a unique case study of how the alcohol industry attempts to interfere in public health policy.

Industry Actor Use of Research Evidence: Critical Analysis of Australian Alcohol Policy Submissions.

OBJECTIVE: Governments' limited adoption of evidence-based policies to reduce alcohol-related harm has been partly attributed to alcohol industry influence. A better understanding of industry political strategy may help protect public policy against vested interests. We examined how industry actors used scientific evidence in their submissions to government alcohol policy consultations. METHOD: We conducted a content analysis of 214 submissions from industry actors in 21 Australian public consultations between 2013 and 2017. Represented industry actors included alcohol producers and retailers, trade associations, licensees, and associated entities that derive commercial benefit from alcohol (e.g., advertising companies). Adapting an existing framework, we classified industry practices into two categories: (a) misuse of evidence and (b) denial of the effectiveness of evidence-based strategies. RESULTS: Almost all submissions (91%) denied the effectiveness of evidence-based strategies; the most common denial practices were making unsubstantiated claims about adverse effects of policies (76%) and promoting alternatives without evidence (71%). The misuse of scientific evidence was apparent in 66% of submissions. Trade associations, producers, and retailers were most likely to use such practices. CONCLUSIONS: The extent to which the examined industry actors misused scientific evidence in their submissions to a wide range of alcohol policy consultations in Australia suggests the need for governments to consider excluding the industry from consultation on the regulation of alcohol.

Immediate and Long-Term Effects of an 8-Week Digital Mental Health Intervention on Adults With Poorly Managed Type 2 Diabetes: Protocol for a Randomized Controlled Trial.

BACKGROUND: Diabetes is a leading cause of years of life lost and accounts for approximately one-fourth of health care dollars spent in the United States. Many of these costs are related to poor medication adherence and lack of self-care behaviors and are thus preventable. Depression, which is more prevalent among people with diabetes than in the general population, predicts poorer management of one's diabetes, whereas positive affect predicts engaging in more positive health behaviors. Consequently, interventions that improve depression and positive affect may also improve diabetes-related outcomes among people with diabetes. Although preliminary research on the impact of such interventions among people with diabetes is promising, these studies focused primarily on in-person interventions, have had small samples, and lack long-term follow-up. OBJECTIVE: This study aims to examine the short- and long-term effects of a digital therapeutic platform focused on mental health among adults with poorly managed type 2 diabetes and elevated levels of depression. METHODS: This is a randomized controlled trial in which adults with a type 2 diabetes diagnosis, elevated hemoglobin A1c (HbA1c) levels (≧7), and moderate to severe depressive symptoms will be randomly assigned to a positive emotion regulation skills intervention group or a sham digital intervention with only psychoeducational content. The study will take place over 14 months, including the 8-week intervention (or control) delivered via a digital therapeutic platform (Happify Health) and follow-up assessments at 3, 6, and 12 months postintervention. Throughout the intervention and for 1 week at each postintervention follow-up, participants will complete daily assessments of diabetes-related distress, diabetes regimen adherence, and mood. Our primary outcome, HbA1c, will be self-reported every 3 months throughout the study. Secondary and exploratory outcomes will be assessed at baseline; at 8 weeks; and at 3, 6, and 12 months postintervention. RESULTS: Recruitment is expected to begin in June 2020. Participants will begin the study as they are recruited and will finish in waves. The final wave of data collection from the 8-week intervention is expected for winter 2020, with the completion of the 12-month follow-up in winter 2021. CONCLUSIONS: Although previous research suggests that in-person psychological interventions have promising effects on both psychological and physical outcomes among adults with diabetes, digital interventions can be advantageous because they are easily scalable and reduce many barriers that prevent people from seeking treatment. This trial will provide important information about the effects of a digital mental health intervention among adults with type 2 diabetes, assessing both short- and long-term effects of this intervention on HbA1c, depressive symptoms, and other diabetes-specific outcomes. If successful, this may introduce a scalable intervention that would help reduce some of the preventable costs associated with diabetes. TRIAL REGISTRATION: ClinicalTrials.gov NCT04068805; https://clinicaltrials.gov/ct2/show/NCT04068805. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/18578.

Get Them Laughing to Get Them Drinking: An Analysis of Alcohol Advertising Themes Across Multiple Media in Australia.

OBJECTIVE: Efforts to develop and implement effective advertising regulations require a comprehensive understanding of alcohol promotion techniques used across a rapidly growing range of media platforms. The aim of this study was to analyze themes commonly used in alcohol ads in order to identify commonalities and differences by media type and the implications for existing regulatory frameworks. METHOD: In total, 628 Australian alcohol advertisements were coded according to media used for dissemination and themes known to be attractive to children and young people or problematic in other ways (humor, sport, mateship/friendship, manliness, value for money, buying in bulk, partying, sexual attraction, and adrenaline activities). RESULTS: The largest proportion of analyzed ads belonged to the out-of-home category (41%), followed by the online category (27%), indicating the importance of ensuring that these media are appropriately covered by regulations. Overall, humor was the most common theme (present in 18% of ads), followed by value for money (14%), sports (14%), and bulk purchases (10%). Humor often co-occurred with other themes: 59% of ads with a sexual attraction theme, 40% of ads depicting mateship/friendship, 31% of ads depicting manliness, and 27% of ads with a partying theme also featured humor. Trends were evident in the types of themes most commonly used in ads disseminated via specific media, indicating that alcohol marketers are strategically selecting media platforms for particular themes. CONCLUSIONS: The results of this study demonstrate that alcohol advertising controls need to cover all media, be clear in delineating inappropriate themes, and be adequately authorized to ensure compliance.

Alcohol advertisement characteristics that increase the likelihood of code breaches.

BACKGROUND: Exposure to alcohol advertising is associated with adverse outcomes among youth. Alcohol advertising codes attempt to ensure that alcohol promotion meets community standards, especially in relation to minimising the exposure of children and young people. The aim of the present study was to assess the characteristics of Australian alcohol advertisements that breach the Alcohol Advertising Review Board's (AARB) Code, with a particular focus on provisions relating to youth exposure. METHODS: The sample comprised 628 unique ads that were the subject of complaints to the AARB in its first five years of operation. The assessed characteristics were product type, company type, media type, and ad themes used. All ads were coded by two coders, with a third coder resolving any disagreements. RESULTS: On average, each of the assessed ads breached four AARB provisions, of which three breaches pertained to youth-related provisions. Across all categories, the proportion of youth-related provisions violated was significantly larger than the proportion of total provisions violated. CONCLUSION: Results suggest beer and spirits producers that use partying ad themes, engage in sponsorship arrangements, and use online advertising platforms should be a particular focus of alcohol advertising regulations.

The Effects of a Digital Well-Being Intervention on Patients With Chronic Conditions: Observational Study.

BACKGROUND: Chronic conditions account for 75% of health care costs, and the impact of chronic illness is expected to grow over time. Although subjective well-being predicts better health outcomes, people with chronic conditions tend to report lower well-being. Improving well-being might mitigate costs associated with chronic illness; however, existing interventions can be difficult to access and draw from a single theoretical approach. Happify, a digital well-being intervention program drawing from multiple theoretical traditions to target well-being, has already been established as an efficacious means of improving well-being in both distressed and nondistressed users. OBJECTIVE: This study aimed to compare change in well-being over time after using Happify for users with and without a chronic condition. METHODS: Data were obtained from Happify users, a publicly available digital well-being program accessible via website or mobile phone app. Users work on tracks addressing a specific issue (eg, conquering negative thoughts) composed of games and activities based on positive psychology, cognitive behavioral therapy, and mindfulness principles. The sample included 821 users receiving at least 6 weeks' exposure to Happify (ranging from 42 to 179 days) who met other inclusion criteria. As part of a baseline questionnaire, respondents reported demographic information (age and gender) and whether they had any of the prespecified chronic conditions: arthritis, diabetes, insomnia, multiple sclerosis, chronic pain, psoriasis, eczema, or some other condition (450 reported a chronic condition, whereas 371 did not). Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction. To evaluate changes in well-being over time, a mixed effects linear regression model was fit for subjective well-being, controlling for demographics and platform usage. RESULTS: At baseline, users with a chronic condition had significantly lower subjective well-being (mean 38.34, SD 17.40) than users without a chronic condition (mean 43.65, SD 19.13). However, change trajectories for users with or without a chronic condition were not significantly different; both groups experienced equivalent improvements in well-being. We also found an effect for time from baseline (b=0.071; SE=0.010; P<.01) and number of activities completed (b=0.03; SE=0.009; P<.01), and a 2-way interaction between number of activities completed and time from baseline (b=0.0002; SE=0.00006; P<.01), such that completing more activities and doing so over increasingly longer periods produced improved well-being scores. CONCLUSIONS: Data from this study support the conclusion that users with a chronic condition experienced significant improvement over time. Despite reporting lower subjective well-being on the whole, their change trajectory while using Happify was equivalent to those without a chronic condition. Consistent with past research, users who completed more activities over a longer period showed the most improvement. In short, the presence of a chronic condition did not prevent users from showing improved well-being when using Happify.