Objective Opportunistic brief in-person Emergency Department (ED) interventions can be effective at reducing hazardous alcohol use in young adult drinkers, but require resources frequently unavailable. Mobile phone text messaging (SMS) could sustainably deliver behavioral support to young adult patients, but efficacy remains unknown. We report 3-month outcome data of a randomized controlled trial testing a novel SMS-delivered intervention in hazardous drinking young adults. Methods We randomized 765 young adult ED patients who screened positive for past hazardous alcohol use to one of three groups: SMS Assessments + Feedback (SA+F) intervention who were asked to respond to drinking-related queries and received realtime feedback through SMS each Thursday and Sunday for 12 weeks (n=384); SMS Assessments (SA) who were asked to respond to alcohol consumption queries each Sunday but did not receive any feedback (N=196); and a control group who did not participate in any SMS (n=185). Primary outcomes were number of binge drinking days and number of drinks per drinking day in the past 30 days collected by web-based Timeline Follow-Back method and analyzed with regression models. Secondary outcomes were the proportion of participants with weekend binge episodes and most drinks consumed per drinking occasion over 12 weekends collected by SMS. Results Using web-based data, there were decreases in the number of binge drinking days from baseline to 3 months in the SA+F group (-.51 [95% confidence interval {CI} -.10 to -.95]), whereas there were increases in the SA group (.90 [95% CI .23 to 1.6]) and the control group (.41 [95% CI -.20 to 1.0]). There were also decreases in the number of drinks per drinking day from baseline to 3 months in the SA+F group (-.31 [95% CI -.07 to -.55]), whereas there were increases in the SA group (.10 [95% CI -.27 to .47]) and the control group (.39 [95% CI .06 to .72]). Using SMS data, there was a lower mean proportion of SA+F participants reporting a weekend binge over 12 weeks (30.5% [95% CI 25% to 36%) compared to the SA participants (47.7% [95% CI 40% to 56%]). There was also a lower mean drinks consumed per weekend over 12 weeks in the SA+F group (3.2 [95%CI 2.6 to 3.7]) compared to the SA group (4.8 [95% CI 4.0 to 5.6]). Conclusion A text message intervention can produce small reductions in binge drinking and the number of drinks consumed per drinking day in hazardous drinking young adults after ED discharge.

TM can be used to assess drinking in young adults and can deliver brief interventions to young adults discharged from the ED. TM-based interventions have the potential to reduce heavy drinking among young adults but larger studies are needed to establish efficacy.

BackgroundBinge drinking is associated with numerous negative consequences. The prevalence and intensity of binge drinking is highest among young adults. This randomized trial tested the efficacy of a 12-week interactive text message intervention to reduce binge drinking up to 6 months after intervention completion among young adults.Methods and FindingsYoung adult participants (18–25 y; n = 765) drinking above the low-risk limits (AUDIT-C score >3/4 women/men), but not seeking alcohol treatment, were enrolled from 4 Emergency Departments (EDs) in Pittsburgh, PA. Participants were randomized to one of three conditions in a 2:1:1 allocation ratio: SMS Assessments + Feedback (SA+F), SMS Assessments (SA), or control. For 12 weeks, SA+F participants received texts each Thursday querying weekend drinking plans and prompting drinking limit goal commitment and each Sunday querying weekend drinking quantity. SA+F participants received tailored feedback based on their text responses. To contrast the effects of SA+F with self-monitoring, SA participants received texts on Sundays querying drinking quantity, but did not receive alcohol-specific feedback. The control arm received standard care. Follow-up outcome data collected through web-based surveys were provided by 78% of participants at 3- months, 63% at 6-months and 55% at 9-months. Multiple imputation-derived, intent-to-treat models were used for primary analysis. At 9-months, participants in the SA+F group reported greater reductions in the number of binge drinking days than participants in the control group (incident rate ratio [IRR] 0.69; 95% CI .59 to.79), lower binge drinking prevalence (odds ratio [OR] 0.52; 95% CI 0.26 to 0.98]), less drinks per drinking day (beta -.62; 95% CI -1.10 to -0.15) and lower alcohol-related injury prevalence (OR 0.42; 95% CI 0.21 to 0.88). Participants in the SA group did not reduce drinking or alcohol-related injury relative to controls. Findings were similar using complete case analyses.ConclusionsAn interactive text-message intervention was more effective than self-monitoring or controls in reducing alcohol consumption and alcohol-related injury prevalence up to 6 months after intervention completion. These findings, if replicated, suggest a scalable approach to help achieve sustained reductions in binge drinking and accompanying injuries among young adults.Trial RegistrationClinicalTrials.gov NCT01688245

Those receiving the text messaging-based education and support had fewer and less severe postconcussive symptoms than the controls but none of the differences reached statistical significance. Further evaluation of more robust mobile interventions and larger sample of participants are still needed.

Including prehospital provider impression to objective physiologic factors identified three more patients with infection at the cost of overtriaging five. Future research should determine the effect of training or diagnostic aids for improving the sensitivity of prehospital identification of patients with serious infection.

Objective-To evaluate a text message (SMS) program as a booster to an in-person alcohol intervention with mandated college students.Participants-Undergraduates (n=224; 46% female) who violated an on-campus alcohol policy over a 2 semester period in 2014.Methods-The SMS program sent drinking-related queries each Thursday and Sunday and provided tailored feedback for 6 weeks. We examined response rates to SMS drinking-related queries and the associations between weekend drinking plans, drinking-limit goal commitment and alcohol consumption. Gender differences were explored.Results-90% of SMS queries were completed. Weekend binge drinking decreased over 6 weeks, and drinking-limit goal commitment was associated with less alcohol consumption. Compared with women, men had greater reductions in alcohol consumption when they committed to a drinking-limit goal.Conclusions-Preliminary evidence suggests that an SMS program could be useful as a booster for helping mandated students reduce weekend binge drinking. Keywordsalcohol; text message; college student; mandated Alcohol use is a major contributor to student morbidity and mortality 1 and there are thousands of alcohol policy violations per year on college campuses. 2,3 College students who violate campus alcohol policies have been shown to drink at higher quantities than general college populations, 4 and are therefore an important sub-population to target for interventions aimed at reducing consumption. 5 Individual-level interventions have been Corresponding Author Contact: Brian Suffoletto. Iroquois Building, Suite 400A; 3600 Forbes Avenue; Pittsburgh, PA 15261. HHS Public AccessAuthor manuscript J Am Coll Health. Author manuscript; available in PMC 2017 August 01. Author Manuscript Author ManuscriptAuthor Manuscript Author Manuscriptshown to produce small reductions in alcohol consumption and alcohol-related problems in general college student populations, 6 but exhibit diminished effects over time and may be less effective for mandated college students. 7In non-college settings, investigators have attempted to boost the effects of in-person alcohol interventions by incorporating booster sessions, either through letters, 8 face-to-face sessions, 9 or over the phone. 10,11,12 There have also been in-person boosters added to alcohol interventions in college settings, but little evidence of effect. 13 One potential explanation for sub-optimal effects may be the relatively low frequency of booster delivery. 14 A communication modality that may help boost effects of interventions for mandated students is mobile phone text messaging (e.g. short message service: SMS). SMS programs have been shown to be effective at reducing hazardous alcohol use in young adult emergency department populations as a stand-alone intervention, 15,16 and are beginning to be explored in college students. 17,18 To our knowledge, no study has reported on the implementation of an SMS program with college students who violate a campus alcohol policy.The present study analyzes anonymous da...

BackgroundHeavy episodic (binge) drinking is common among young adults and can lead to injury and illness. Young adults who seek care in the Emergency Department (ED) may be disproportionately affected with binge drinking behavior, therefore provide an opportunity to reduce future risk through screening, brief intervention and referral to treatment (SBIRT). Mobile phone text messaging (SMS) is a common form of communication among young adults and has been shown to be effective at providing behavioral support to young adult drinkers after ED discharge. Efficacy of SMS programs to reduce binge drinking remains unknown.Methods/DesignWe will conduct a three parallel arm, randomized trial. A convenience sample of adults aged 18 to 25 years attending three EDs in Pittsburgh, PA and willing to participate in the study will be screened for hazardous alcohol consumption. Participants identified as hazardous drinkers will then be allocated to either 12 weeks of weekly SMS drinking assessments with feedback (SA+F), SMS drinking assessments without feedback (SA), or a control group. Randomization will be via an independent and remote computerized randomization and will be stratified by study site. The SA+F group will be asked to provide pre-weekend drinking intention as well as post-weekend consumption via SMS and will receive feedback messages focused on health consequences of alcohol consumption, personalized normative feedback, protective drinking strategies and goal setting. Follow-up data on alcohol use and injury related to alcohol will be collected through a password-protected website three, six and nine months later. The primary outcome for the study is binge drinking days (≥4 drinks for women; ≥5 drinks for men) during the previous month, and the main secondary outcome is the proportion of participants who report any injury related to alcohol in the prior three months.DiscussionThis study will test the hypothesis that a mobile phone text-messaging program will result in immediate and durable reductions in binge drinking among at-risk young adults. By testing an intervention group to an assessment-only and control group, we will be able to separate the effect of assessment reactivity. By collecting pre-weekend drinking intentions and post-weekend consumption data in the SA+F group, we will be able to better understand mechanism of change.Trial registrationClinicaltrials.gov NCT01688245

Text message delivered prevention interventions have the potential to improve health behaviors on a large scale, including reducing hazardous alcohol consumption in young adults. Online crowdsourcing can be used to efficiently develop relevant messages, but remains largely understudied. This study aims to use online crowdsourcing to evaluate young adult attitudes toward expert-authored messages and to collect peer-authored messages. We designed an online survey with four drinking scenarios and a demographic questionnaire. We made it available to people who reported age 18-25 years, residence in the US, and any lifetime alcohol consumption via the Amazon Mechanical Turk crowdsourcing platform. Participants rated 71 sample text messages on instrumental (helpful) and affective (interesting) attitude scales and generated their own messages. All messages were coded as informational, motivational, or strategy facilitating. We examined differences in attitudes by message type and by drinking status and sex. We surveyed 272 participants in 48 h, and 222 were included in analysis for a total participant payment cost of $178. Sample mean age was 23 years old, with 50 % being female, 65 % being of white race, and 78 % scored as hazardous drinkers. Informational messages were rated the most helpful, whereas motivational messages were rated the most interesting. Hazardous drinkers rated informational messages less helpful than non-hazardous drinkers. Men reported messages less helpful and interesting than women for most categories. Young adults authored 161 messages, with the highest proportion being motivational. Young adults had variable instrumental and affective attitudes toward expert-authored messages. They generated a substantial number of peer-authored messages that could enhance relevance of future alcohol prevention interventions.