Pilot Study of a Multilevel Mobile Health App for Substance Use, Sexual Risk Behaviors, and Testing for Sexually Transmitted Infections and HIV Among Youth: Randomized Controlled Trial

Abstract

Background Preventing and reducing substance use disorders, sexually transmitted infections (STIs)/HIV, and teen pregnancy, and the associated risk behaviors (ie, substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among the youth. Mobile health (mHealth) apps may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated efficacy in reducing substance use or sexual risk behaviors or improving the uptake of STI/HIV testing among the youth, particularly in clinic settings. Objective This small-scale study aimed to examine the feasibility of conducting a pilot randomized controlled trial (RCT). We evaluated the effects of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, on the potential mechanisms by which behavior change occurs, namely clinician-youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. We also assessed the ability to measure targeted outcomes of past 30-day substance use (ie, alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use before sex, as well as the uptake of STI/HIV testing. Methods Employing community-based participatory research principles, 50 youths aged 13 to 21 years were recruited from a youth-centered community health clinic in Southeast Michigan, randomized sequentially to either S4E or enhanced usual practice, and assessed at baseline, immediately postintervention, and 30 days postintervention. S4E consists of 3 modules, including alcohol and drug use, tobacco, and STI/HIV. Results Relative to youth in the enhanced usual practice group, S4E participants demonstrated higher youth-clinician risk communication (mean 3.22, SD 1.67) and increases in prevention knowledge (∆ score mean 0.36, SD 0.51) and self-efficacy (∆ score mean 0.16, SD 0.47). In addition, youth in the S4E group showed reductions in the proportions of past 30-day overall substance use (Cohen h=0.71, 95% CI 0.15 to 1.27), as well as past 30-day alcohol (Cohen h=0.71, 95% CI 0.15 to 1.27), tobacco (Cohen h=0.17, 95% CI −0.39 to 0.73), and drug use (Cohen h=1.28, 95% CI 0.72 to 1.84). The results also suggest a reduction in the proportion of youths who reported past 30-day condomless sex (Cohen h=0.18, 95% CI −0.38 to 0.74) and alcohol use before sex (Cohen h=0.44, 95% CI −0.12 to 1.00). Finally, the findings also demonstrated an increase in the proportion of youths who reported STI/HIV testing over time (Cohen h=0.16, 95% CI −0.39 to 0.72). Conclusions The findings suggest the feasibility of a small-scale pilot RCT. S4E demonstrated shifts in the hypothesized direction, reducing substance use, sexual risk behaviors, and improving the uptake of STI/HIV testing among youth in a clinic setting. The findings suggest that a larger RCT may be warranted. Trial Registration ClinicalTrails.gov NCT03855410, https://clinicaltrials.gov/ct2/show/NCT03855410.

Lifestyle Interventions through Participatory Research: A Mixed-Methods Systematic Review of Alcohol and Other Breast Cancer Behavioural Risk Factors

“…Studies with less than a 100% consent rate have the potential for selection bias of participants. The studies’ response rates, defined as eligible participants consented to participate, were 85% [ 48 ], 64% [ 49 ], 47% [ 50 ], 35% [ 51 ], and 24% [ 52 ]. The response rates were not provided by three studies reducing ability to assess selection bias [ 53 , 54 , 55 ].…”

“…High retention rates were achieved by two studies, reported as 98% [ 52 ] and 96% [ 49 ], reducing the selection bias in the analysis. Moderate retention rates were achieved at 79% [ 48 ] and 68% was reported by two studies [ 50 , 51 ].The Thai-based community cluster RCT study used a second random sample for the follow-up survey from the intervention and control communities, and therefore retention rates were not applicable [ 53 ].…”

“…The literature was dominated by alcohol-use interventions (as seen in Table 2 ) with seven of the eight studies, the exception being a study focused on nutrition and breast cancer prevention [ 49 ]. However, the literature was diverse in terms of study designs, settings, and populations, reducing the ability to interpret effectiveness.…”

Identification of young people at risk of sexual ill health : implementing a new tool in youth clinics

“…The app, developed in Spain, consists of a brief risk behaviour survey and targeted interactive content based on the youth's specific risk behaviours. The app was developed together with youth, and small-scale feasibility studies of the app have shown promising results, including more youth-clinician risk communication [85].…”

Perspectives of Girls and Young Women Affected by Commercial Sexual Exploitation: mHealth as a Tool to Increase Engagement in Care

“…27 mHealth has been shown to facilitate access to health care and health-related information, promote communication with health care professionals, and improve healthy lifestyle behaviors and sexual attitudes among underserved and transient youth populations. [28][29][30][31][32][33][34][35] These advantages, coupled with most youths' familiarity with technology, 36 illustrate the potential for mHealth applications to be effective in supporting the delivery of services to youth with histories of CSE. Although concerns regarding access to technology among underserved populations exist, available research consistently documents that individuals in underserved communities frequently access the Internet and use mobile devices, 32,[37][38][39] including youth seeking health-related information.…”