Abstract
BackgroundReal-time ecological momentary interventions have shown promising effects in domains other than alcohol use; however, only few studies regarding ecological momentary interventions for alcohol use have been conducted thus far. The increasing popularity of smartphones offers new avenues for intervention and innovation in data collection.ObjectiveWe aimed to test the efficacy of an ecological momentary intervention, comprising mobile Web-based ecological momentary assessments (EMAs) and text messaging (short message service, SMS) brief interventions, delivered during drinking events using participants’ mobile phones.MethodsWe conducted a three-armed randomized controlled trial to assess the effect of a mobile Web-based ecological momentary assessment with texting feedback on self-reported alcohol consumption and alcohol-related harms in young adults. Participants were enrolled from an existing observational cohort study of young adults screened for risky drinking behavior. The intervention group (ecological momentary intervention group) completed repeated ecological momentary assessments during 6 drinking events and received immediate texting-based feedback in response to each ecological momentary assessment. The second group (ecological momentary assessment group) completed ecological momentary assessments without the brief intervention, and the third did not receive any contact during the trial period. Recent peak risky single-occasion drinking was assessed at the baseline and follow-up using telephone interviews. We used a random effects mixed modeling approach using maximum likelihood estimation to provide estimates of differences in mean drinking levels between groups between baseline and 12-week follow-up.ResultsA total of 269 participants were randomized into the 3 groups. The ecological momentary intervention group exhibited a small and nonsignificant increase between baseline and follow-up in (geometric) the mean number of standard drinks consumed at the most recent heavy drinking occasion (mean 12.5 vs 12.7). Both ecological momentary assessment and control groups exhibited a nonsignificant decrease (ecological momentary assessment: mean 13.8 vs 11.8; control: mean 12.3 vs 11.6); these changes did not differ significantly between groups (Wald χ22 1.6; P=.437) and the magnitude of the effects of the intervention were markedly small. No other significant differences between groups on measures of alcohol consumption or related harms were observed. The intervention acceptability was high despite the technical problems in delivery.ConclusionsWith a small number of participants, this study showed few effects of an SMS-based brief intervention on peak risky single-occasion drinking. Nevertheless, the study highlights areas for further investigation into the effects of EMI on young adults with heavy alcohol consumption.Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12616001323415; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369534 (Archived by WebCite at http://www.webcitation.org/7074mqwcs)
Highlights
Risky single-occasion drinking (RSOD, defined as ≥5 Australian standard drinks, ie, 50 g of alcohol in one session) is a significant cause of preventable morbidity and mortality in Australia and contributes to further social, economic, and legal harms
This study addresses a gap in this emerging area of research, contributing to the literature on mobile phone-delivered, real-time alcohol Ecological momentary intervention (EMI)
Of the 314 eligible participants, 269 participants agreed to be contacted about the trial and were randomized into 3 groups as follows: EMI (n=90); ecological momentary assessments (EMAs) (n=89); and no-contact control (n=90)
Summary
Risky single-occasion drinking (RSOD, defined as ≥5 Australian standard drinks, ie, 50 g of alcohol in one session) is a significant cause of preventable morbidity and mortality in Australia and contributes to further social, economic, and legal harms. Similar patterns are observed among 25- to 29-year-olds, with almost 40% engaging in RSOD at least monthly and approximately 20% at least weekly [1]. Brief interventions (BIs) are one of few individual-level strategies that have demonstrated efficacy for reducing alcohol consumption in young people [2,3]; these interventions commonly involve screening and assessing drinking behavior and providing personalized feedback. Research has revealed that BIs can be feasibly and acceptably delivered through Web-based technologies; these innovations reduce cost, enhance convenience, and expand intervention reach. Kypri et al [5] and Voogt et al [6] have demonstrated the efficacy of Web-based BIs for reducing RSOD. The increasing popularity of smartphones offers new avenues for intervention and innovation in data collection
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