Systematic Review of Smartphone Apps as a mHealth Intervention to Address Substance Abuse in Adolescents and Adults.

BACKGROUND: Substance abuse represents a foremost national concern for adolescents and adults; investigators have implemented a variety of interventions, delivered with both in-person and mobile-based apps' modalities. The electronic techniques could be more effective because they avoid the cost, privacy, and accessibility issues associated with in-person intervention. To address this issue, a systematic review of the scientific evidence relative to the efficacy of app-based interventions delivered by mobile devices (smartphones) to reduce substance abuse in adolescents and adults was carried out. METHODS: To identify relevant studies published from 2005 to 2019, a comprehensive search was conducted. Databases that were searched include CINAHL, Cochrane CENTRAL, Embase, PsycINFO, PubMed, and Web of Science. Keywords and relevant controlled vocabulary terms related to substance abuse and technology were included. Studies were included if they had examined reductions in substance abuse and problem behaviors as a primary outcome with app-based interventions delivered to adolescents and adults. RESULTS: The initial search yielded 21,641 articles, duplicates were removed, and 14,797 citations remained; title/abstract screening yielded 190 full-text articles. One hundred seventy-three were excluded because they did not meet the inclusion criteria, leaving 17 final articles to be analyzed in this review. Use of app-based interventions showed some evidence of effectiveness in reducing substance abuse in the adolescent adult population. CONCLUSION: Most intervention studies analyzed focused on alcohol reduction. Further research is needed on diverse substance abuse utilizing larger sample sizes, longitudinal studies, and theoretical foundations on the practice of delivering interventions using mobile-based apps.

Effectiveness of a Theory-Based mHealth Intervention for High-Risk Drinking in College Students.

Background: College students are among the most vulnerable groups to problems associated with high-risk drinking consequences such as illness, injury, sexual abuse, and death. Promising mobile health (mHealth) approaches, such as smartphone (SP) apps, can be used in interventions to address or prevent excessive drinking. Method: The aim of the investigation was to examine the efficacy of a theoretically based mHealth SP app for alcohol intervention in two independent samples (N = 379): Mandated participants (Study 1) and voluntary participants (Study 2). Study 1 included a controlled trial with Mandated participants randomized into either an in-person Brief Motivational Interviewing BMI (n = 70) or BMI + SP app intervention (n = 71). Study 2 included Voluntary participants who participated in either a Control group (n = 157) or the BMI + SP app intervention (n = 81). Participants in both studies completed baseline and 6-week assessments. Results: In Study 1, peak Blood Alcohol Concentration (BAC) of participants in the in-person BMI group had increased slightly at six weeks, while it had decreased for the app-based BMI + SP group. Study 2 participants using the BMI + SP app reported significant reductions in drinking and consequences; there were no changes in the (AO) Control group. Conclusions: The BMI + SP app was effective with both Mandated and Voluntary participants. Future testing with the BMI + SP app is needed to assess whether reach, adoptability, portability, and sustainability are greater with the mHealth smartphone app for alcohol intervention than in-person approaches.

Real-time demonstration of a mHealth app designed to reduce college students hazardous drinking.

Heavy alcohol use is a serious health issue in the United States with consequences such as illness, injury, and death. College students are among the most vulnerable to problems associated with risky drinking. This demographic is known as the Net Generation because members have grown up with digital technologies such as smartphones and apps. Thus, mobile health (mHealth) applications, successful in the delivery of health information and interventions to tech-savvy individuals, are a promising means of reaching them. To that end, we developed a smartphone application (SmarTrek) that targets college students and aims to reduce risky alcohol use. SmarTrek features are easy to use and have interactive components including text messages that incorporate motivational interviewing and ecological momentary interventions. We conducted iterative theater testing, field testing, and focus groups to evaluate the acceptability of SmarTrek with college students. We identified salient issues that might arise from SmarTrek use and modified the app based on feedback from participants. Participants were assigned to 2 groups (Group 1 [n = 4] and Group 2 [n = 6]). At baseline, participants completed 2 standardized surveys. Following their field testing, each group of participants was then invited to a focus group session of the app in which they provided feedback. The majority of participants (90%) agreed that SmarTrek was easy to use and that the information provided was useful and had a positive effect on decreasing their drinking. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

REMIT: Development of a mHealth theory-based intervention to decrease heavy episodic drinking among college students.

mHealth apps are an effective means of delivering health interventions, and the college-age population is particularly proficient at using apps. Informed by current theories of Ecological Momentary Interventions (EMI), Motivational Interviewing (MI), and the Transtheoretical Model (TTM) of Change, investigators have developed a self-monitoring app-Reductions through Ecological Momentary/Motivational Intervention/Transtheoretical (REMIT)-with the aim of reducing hazardous drinking among college students. The app was developed using the Integrate, Design, Assess, and Share (IDEAS) framework. This step-by-step process for developing digital behavior change interventions was conducted in five phases to: (1) understand the users, (2) determine target behavior, (3) base the intervention in behavioral theory; (4) create delivery strategies, and (5) develop the REMIT prototype. REMIT uses assessments (informed by EMI) and components of MI and TTM to guide administration of nine modules designed to engage users in reducing alcohol use and related problems. REMIT users self-monitor their alcohol consumption and develop strategies to change drinking behaviors using a range of easy-to-use features, such as the Virtual Coach, automated text messages, interactive gaming mechanisms (gamification), drink consumption tracking, and Blood Alcohol Concentration (BAC) calculators. mHealth interventions have been shown to reduce alcohol use among college students when they are applied in real-life, real-time contexts. REMIT is a theory-based app that incorporates user-friendly features to reduce hazardous drinking among college students. The next step is to conduct a pilot trial to test the efficacy of the app and enhance the REMIT prototype.

A Systematic Review of the mHealth Interventions to Prevent Alcohol and Substance Abuse.

Substance abuse in young adults is a public health issue with costs to the individual and society. There is mounting evidence that the increased uses of mHealth approaches have promise as a way to facilitate reductions in substance use. This systematic review evaluated the recent body of research on mHealth-based interventions for substance use, with aims of (a) examining the functionality and effectiveness of these interventions, (b) evaluating the available research on the effectiveness of these interventions for substance use, and (c) evaluating the design, methodology, results, theoretical grounding, limitations, and implications of each study. We identified eligible studies by searching electronic databases using Boolean methods. The reviewed studies (N = 12) indicated that that a wide range of Internet-based, text messaging, and smartphone application interventions have been developed to address substance use. Interventions had an assortment of features; participants in each study highlighted the ease and convenience of the interventions; and the majority of studies provided support for the efficacy of mHealth in reducing substance use. Mobile technology is a promising tool for reducing substance use and warrants further development. Future practice including the use of mHealth interventions can be an integral part of reducing substance use.

Systematic review of surveillance by social media platforms for illicit drug use.

Background: The use of social media (SM) as a surveillance tool of global illicit drug use is limited. To address this limitation, a systematic review of literature focused on the ability of SM to better recognize illicit drug use trends was addressed. Methods: A search was conducted in databases: PubMed, CINAHL via Ebsco, PsychINFO via Ebsco, Medline via Ebsco, ERIC, Cochrane Library, Science Direct, ABI/INFORM Complete and Communication and Mass Media Complete. Included studies were original research published in peer-reviewed journals between January 2005 and June 2015 that primarily focused on collecting data from SM platforms to track trends in illicit drug use. Excluded were studies focused on purchasing prescription drugs from illicit online pharmacies. Results: Selected studies used a range of SM tools/applications, including message boards, Twitter and blog/forums/platform discussions. Limitations included relevance, a lack of standardized surveillance systems and a lack of efficient algorithms to isolate relevant items. Conclusion: Illicit drug use is a worldwide problem, and the rise of global social networking sites has led to the evolution of a readily accessible surveillance tool. Systematic approaches need to be developed to efficiently extract and analyze illicit drug content from social networks to supplement effective prevention programs.

Brief motivational intervention for heavy drinking mandated and voluntary freshmen: A 1-year follow-up assessment.

BACKGROUND: Alcohol abuse among freshmen university students is a major public health issue with associated costs to individuals and the society of substantial morbidity, high-risk negative behaviors (e.g., blackouts, rape, suicide, and violence), and mortality. This longitudinal study compared the effectiveness of a brief motivational intervention (MI) in decreasing alcohol consumption and related consequences among mandated students and voluntary students. Readiness to change drinking behaviors was compared between the groups. METHODS: Eligible participants (710 voluntary and 190 mandated, N = 900) received MI at baseline and again at 2 weeks with boosters at 3, 6, and 12 months. Repeated-measures analysis of variance was used to compare the two groups. RESULTS: Alcohol use and related consequences in both groups decreased significantly between baseline and 12 months. At baseline, a significantly larger percent of students from the mandated group than the voluntary group were in the action stage of change (52.1% vs. 27.5%), and a significantly smaller percentage of mandated students were in the precontemplation stage (p < .0001). DISCUSSION: MI effects were sustained over 12 months. Alcohol consumption and related consequences decreased significantly among the freshmen who were mandated to attend the program as well as among students who volunteered to participate in the study. The findings support the importance of advanced practice nurses conducting MI as an intervention with college students.

Health behaviors of mandated and voluntary students in a motivational intervention program.

UNLABELLED: College students engage in many unhealthy behaviors, one of these, heavy alcohol use, is a major global public health problem. OBJECTIVE: This longitudinal study examined whether students' mandated/voluntary status in a program to reduce college drinking was associated with overall health, ethnicity, gender, and personality traits. Both mandated and voluntary groups participated in the Motivational Intervention (MI) program to prevent high risk drinking. METHODS: Freshmen (710 voluntary, 190 mandated, n = 900) between the ages of 18 and 21, received the MI at baseline and again at 2 weeks, with boosters at 3, 6 and 12 months. Participants completed three measures: the Daily Drinking Questionnaire (DDQ); the Substance Use Risk Profile Scale (SURPS), and the Health Promoting Lifestyle Profile II (HPLPII). Mandated and voluntary participants were compared at baseline and following the intervention using two sample t-tests for continuous variables (overall health, personality traits, drinking measures), and chi-square for categorical variables (gender, ethnicity). Linear mixed models were used to identify associations between HPLP II scores and mandated/voluntary status, time, ethnicity gender and SURPS scale scores. RESULTS: In both groups, alcohol consumption dropped significantly by 12 months. Overall health-promoting behaviors, physical activity, stress management, and interpersonal relations improved in both groups between baseline and 12 months. Associations were found between alcohol consumption, personality traits, gender, and lifestyle health-promoting behaviors. In particular, impulsivity and hopelessness were associated with poor health behaviors. CONCLUSIONS: Intervention programs to reduce drinking by college students need to address developmental dynamics of freshmen students, including gender, psychosocial factors, personality, and lifestyle health-promoting behaviors.

Personality risk for alcohol consequences among college freshmen.

Drinking is pervasive in the lifestyle of many college students. This study investigated the relationship between drinking and students' impulsivity, sensation seeking, alcohol consequences, and expectancies. The study was based on the Acquired Preparedness Model, which posits that personality constructs like impulsivity and sensation seeking influence drinking through the formation of positive expectancies about the effects of drinking. Freshmen (N = 260) from a large public university volunteered for the study and were administered three surveys. Structural equation modeling was used to examine the study variables. The findings showed that the total effect of impulsivity was mediated by positive alcohol expectancies. The total effect of sensation seeking was mediated by alcohol expectancies. Freshmen who were more impulsive and sensation seeking had more positive alcohol expectancies and experienced more negative consequences related to alcohol use. These findings suggest that the risk of alcohol consequences was associated with personality constructs and alcohol expectancies.

Personality Risk Factors and Readiness to Change in Mandated and Voluntary College Students Enrolled in an Alcohol Intervention Program.

This study compared personality risk factors and readiness to change drinking behavior among mandated and volunteer college students. The sample (N = 583) completed three measures of motivation to change and personality risk factors at baseline, 3 months, and 6 months between 2011 and 2012. Linear mixed models were used to determine an association of continuous outcome variable(s) with covariates over time. Participants in the action stage had lower impulsivity scores. Gender was significant, with females showing the highest anxiety and lowest sensation seeking. The findings indicate a number of future directions to advance innovative alcohol intervention and treatment programs on college campuses.

Effects of motivational interviewing intervention on blackouts among college freshmen.

PURPOSE: Alcohol and illicit drug abuse is a serious public health issue facing college students. This study examined the impact of motivational interviewing (MI) as an intervention on the rate of blackouts among freshmen who engaged in high-risk drinking and illicit drug use. DESIGN: A sample of 188 volunteer freshmen from a university were administered the Daily Drinking Questionnaire, the Rutgers Alcohol Problem Index, and the Government Performance and Results Act at baseline and again at 6 months postintervention. MI was applied at baseline and then again at 2 weeks, 3 months, and 6 months. METHODS: Generalized estimated equations and logistic regression models were used to determine associations between the rate of blackouts and time, ethnicity, gender, illicit drug use, and alcohol consumption. FINDINGS: At 6 months, the rate of blackouts decreased from 40% at baseline to 16% (p < .0001). The average number, time, and days of drinking and frequency of drug use also decreased significantly (p < .0001). An association between rate of blackouts and gender was observed, but not with ethnicity. CONCLUSIONS: MI had an impact on reducing alcohol consumption and the rate of blackouts among college freshmen who were engaging in high-risk drinking and illicit drug use. CLINICAL RELEVANCE: The findings support the importance of using MI with freshmen college students to decrease drinking and the associated negative consequences, including blackouts, which has particular relevance for advanced practice registered nurses, physicians, and community health nurses who conduct MI as an intervention with college students.