Tailored Mobile Messaging Intervention for Waterpipe Tobacco Cessation in Young Adults: A Randomized Trial

Objectives. To test a tailored mobile health (i.e., mHealth) intervention for waterpipe tobacco cessation in young adults. Methods. From 2018 to 2020 at 2 US sites, we conducted a randomized trial with 349 waterpipe tobacco smokers aged 18 to 30 years randomized to control (no intervention), untailored, or tailored intervention arms. Intervention arms received a 6-week mHealth intervention conveying risks of waterpipe tobacco through text and images and strategies to enhance motivation and support quitting. The tailored intervention was personalized to baseline measures and intervention text message responses. Risk appraisals, motivation to quit, waterpipe smoking frequency, and cessation were assessed at 6 weeks, 3 months, and 6 months. Results. At 6 months, cessation was higher in the tailored (49%) than the control arm (29%; odds ratio = 2.4; 95% confidence interval = 1.3, 4.2) and smoking frequency was lower in the tailored (mean = 3.5 days) than the control arm (mean = 4.3 days; P = .006). At interim follow-ups, significant differences in other outcomes favored the tailored intervention. Conclusions. Tailored mobile messaging can help young adult waterpipe tobacco smokers quit. This scalable intervention is poised for population implementation.

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Results of a Single Arm Pilot Study of a Mobile Messaging Intervention for Hookah Tobacco Cessation in Young Adults

Tobacco Use Insights ◽

10.1177/1179173x20915200 ◽

2020 ◽

Vol 13 ◽

pp. 1179173X2091520

Author(s):

Darren Mays ◽

Lilianna Phan ◽

Andrea C Johnson ◽

Kenneth P Tercyak ◽

Kylie Snow ◽

...

Keyword(s):

Young Adults ◽

Pilot Study ◽

Tobacco Use ◽

Risk Perceptions ◽

Text Message ◽

Text Messages ◽

Post Intervention ◽

Risk Beliefs ◽

Motivation To Quit ◽

Risk Appraisals

Background: Hookah tobacco use is common among young adults. Unlike cigarette smoking, there is limited evidence on mobile (ie, mHealth) interventions to promote cessation. Objectives: This pilot study tested the preliminary effects of mobile messaging for cessation in young adult hookah smokers. Methods: Young adults (N = 20) aged 18 to 30 years who smoke hookah at least monthly and have done so at least once in the past 30 days received a 6-week mHealth multimedia messaging (text and images) intervention. Message scheduling (2 days/week × 6 weeks) was based on the literature. Content was developed iteratively by the study team and focused on health harms and addictiveness of hookah. Content was individually tailored by baseline hookah use frequency, risk beliefs, and responses to interactive text messages assessing participants’ hookah tobacco use behavior and beliefs to maximize impact. Engagement was assessed during the intervention, and we examined effects on risk perceptions, risk beliefs, and risk appraisals, motivation to quit, and behavior change immediately post-intervention. Results: Participants responded to 11.5 (SD = 0.69) of 12 text message prompts on average, endorsed high message receptivity (M = 6.1, SD = 0.93, range = 1-7), and reported the messages were helpful (M = 8.5, SD = 1.5, range = 1-10). There were significant ( P < .05) increases in risk perceptions (d’s = 0.22-0.88), risk appraisals (d = 0.49), risk beliefs (d = 1.11), and motivation to quit (d = 0.97) post-intervention. Half of participants reported reducing frequency of hookah use (20%) or quitting completely (30%) by end of treatment. Conclusions: These pilot results provide preliminary support for an mHealth messaging intervention about risks of hookah tobacco for promoting cessation. Rigorously examining the efficacy of this promising intervention is warranted.

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Patterns of User Engagement in the BRAVE Study (Preprint)

10.2196/preprints.32138 ◽

2021 ◽

Author(s):

Julia Wrobel ◽

Joshva Silvasstar ◽

Roger Peterson ◽

Kanku Sumbundu ◽

Allyson Kelley ◽

...

Keyword(s):

Young Adults ◽

Alaska Native ◽

Help Seeking ◽

Role Model ◽

Text Message ◽

Poor Mental Health ◽

Text Messages ◽

User Engagement ◽

Mhealth Intervention ◽

The Impact

BACKGROUND Many American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness and help-seeking skills may be an effective strategy for promoting health and wellbeing for AI/AN youth. OBJECTIVE This study explored system data from the BRAVE intervention to determine patterns of user engagement. METHODS The BRAVE study included 1,030 AI/AN teens and young adults nationwide (15-24 years old). The message series in the BRAVE and STEM study arms included 3–5 text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons, a mobile messaging provider that supports text, picture, and video SMS. This study utilized two sets of data. The first dataset included 23,004 records of messages sent teens and young adults and 874 records of messages clicked with time stamp and content. The second dataset was created by aggregating the clicks in the first dataset to calculate a total number of clicks for each user. RESULTS Of the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least one trackable click on a study text message. Of these, 68% were female (n = 184), 19% were male (n = 50), and 13% selected another gender category (n = 36). The average participant was 20.6 years-old, with a minimum and maximum of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2, mean 3.4), while others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing one of 7 role model videos), with 64.8% of total clicks coming from the role model videos, and earlier episodes seeing the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P<.001), with a rate ratio of 0.82 (0.73, 0.92), indicating that each one-unit increase in help-seeking score at baseline was associated with an 18% decrease in the expected number of study clicks. CONCLUSIONS This is the first study to set initial standards for assessing user engagement in an mHealth intervention. Our work underscores the feasibility of exploring the impact of engagement on intended outcomes, allowing for more precise exploration of the dose-response relationship that may be realized through these low-touch interventions that offer promising potential for reaching high numbers of program participants. CLINICALTRIAL 1384639

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Text Message Quit Vaping Intervention for Young Adults

Case Medical Research ◽

10.31525/ct1-nct04251273 ◽

2020 ◽

Author(s):

Keyword(s):

Young Adults ◽

Text Message

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Efficacy and Impact of an mHealth Intervention to promote Mental Wellness for American Indian and Alaska Native Teens and Young Adults: A Randomized Controlled Trial of the BRAVE Study (Preprint)

10.2196/preprints.26158 ◽

2020 ◽

Author(s):

Stephanie Craig Rushing ◽

Allyson Kelley ◽

Sheana Bull ◽

David Stephens ◽

Julia Wrobel ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Young Adults ◽

Alaska Native ◽

Help Seeking ◽

Culturally Relevant ◽

Controlled Trial ◽

Text Message ◽

Text Messages ◽

Randomized Controlled ◽

Mental Wellness

BACKGROUND Culturally-relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teens and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. We R Native – a multimedia health resource for Native teens and young adults – designed an intervention for Native youth, delivered via text message, that includes role model videos, mental wellness strategies, and links to culturally-relevant resources (hotlines, chat-lines, websites, etc.) and social support. OBJECTIVE This study aims to test the efficacy of BRAVE to improve participant’s physical, mental, and spiritual health, their use of mental wellness strategies, their help-seeking skills, and associated factors, including cultural resilience, identity, and cultural pride. METHODS The randomized controlled trial was carried out by the Northwest Portland Area Indian Health Board and the mHealth Impact Lab. The team recruited 2,334 AI/AN teens and young adults nationwide (15-24 years old) via social media channels and text message and enrolled 1,044 to participate. AI/AN teens and young adults enrolled in the study received either: 8 weeks of BRAVE text messages designed to improve mental health, help-seeking skills, and cultural resilience; or 8 weeks of STEM text messages, designed to elevate and re-affirm Native voices in science, technology, engineering, math and medicine (STEM); and then received the other set of messages. Primary and secondary outcomes were tested using linear mixed-effect models and linear regressions. RESULTS A total of 833 AI/AN teens and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all primary outcomes except cultural identity and help seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.027), positive coping (P<.001), self-efficacy (P=.021), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant for those exhibiting risky behavior at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average, but no difference in risky drug and alcohol use (P<.001). The number of participants that used text messages to help themselves increased from 69% at 3-months (427/618) to 75% at 8-months (381/501) (P<.001). Similarly, the number of participants that used text messages to help a friend or family member increased from 22% at 3-months (138/616) to 55% at 8-months (272/498). CONCLUSIONS This is the first nationwide randomized controlled trial for AI/AN teens and young adults to test the efficacy of an mHealth intervention on mental wellness. The findings suggest that culturally-relevant multimedia, mHealth interventions can improve help-seeking behavior. Lessons learned from this study may help other AI/AN-serving organizations, prevention programs, policymakers, researchers, and educators as they support the next generation of AI/AN change-makers.

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Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa278 ◽

2020 ◽

Author(s):

Elaine C Khoong ◽

Valy Fontil ◽

Natalie A Rivadeneira ◽

Mekhala Hoskote ◽

Shantanu Nundy ◽

...

Keyword(s):

Logistic Regression ◽

Randomized Trial ◽

Odds Ratio ◽

Primary Outcome ◽

Mixed Effects ◽

Regression Analyses ◽

Diagnostic Confidence ◽

Diagnostic Uncertainty ◽

Intervention Impact ◽

High Uncertainty

Abstract Objective The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. Materials and Methods This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. Results Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). Conclusions Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.

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Intralymphatic immunotherapy in pollen-allergic young adults with rhinoconjunctivitis and mild asthma: A randomized trial

Journal of Allergy and Clinical Immunology ◽

10.1016/j.jaci.2019.11.017 ◽

2020 ◽

Vol 145 (3) ◽

pp. 1005-1007.e7 ◽

Cited By ~ 2

Author(s):

Jon R. Konradsen ◽

Jeanette Grundström ◽

Laila Hellkvist ◽

Thi Anh Thu Tran ◽

Niklas Andersson ◽

...

Keyword(s):

Young Adults ◽

Randomized Trial ◽

Mild Asthma ◽

Intralymphatic Immunotherapy

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Effects of Waterpipe Tobacco Smoking on the Spirometric Profile of University Students in Palestine: A Cross-Sectional Study

Canadian Respiratory Journal ◽

10.1155/2020/5949834 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Zaher Nazzal ◽

Deema Odeh ◽

Fatima Azahraa Haddad ◽

Mohammad Berawi ◽

Belal Rahhal ◽

...

Keyword(s):

Young Adults ◽

University Students ◽

Respiratory Health ◽

Cross Sectional Study ◽

Forced Expiratory Volume ◽

Waterpipe Smoking ◽

Sectional Study ◽

Cross Sectional ◽

Lung Functions ◽

Expiratory Flow

Background. Waterpipe smoking in young individuals is increasing with limited studies addressing its respiratory health effects. The aim of the study was to determine the effect of waterpipe smoking on young adults’ lung functions. Spirometric parameters were compared between waterpipe smokers and nonsmokers. Methods. A comparative cross-sectional study of university students, including males and females, was conducted. An interviewer-administered questionnaire was used to record students’ characteristics. The spirometry test was performed to assess students’ lung functions; we recorded the forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow (PEF), and forced expiratory flow between 25 and 75% of FVC (FEF25–75%). Results. A total of 300 apparently healthy students (150 waterpipe smokers and 150 nonsmokers) were included in the study. Waterpipe smokers showed significantly lower values in FEV1, FEV1/FVC ratio, PEF, and FEF25–75% compared to the nonsmoker group (P<0.05 to P<0.001). The subgroup analysis on female students (50 WP smokers and 50 nonsmokers) showed a significant decrease in FEV1/FVC ratio, PEF, and FEF25–75% parameters (P<0.001). Conclusion. Waterpipe smoking is associated with reduced spirometric parameters in healthy young adults with relatively limited smoking years.

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Text-Message-Based Drinking Assessments and Brief Interventions for Young Adults Discharged from the Emergency Department

Alcoholism Clinical and Experimental Research ◽

10.1111/j.1530-0277.2011.01646.x ◽

2011 ◽

Vol 36 (3) ◽

pp. 552-560 ◽

Cited By ~ 118

Author(s):

Brian Suffoletto ◽

Clifton Callaway ◽

Jeff Kristan ◽

Kevin Kraemer ◽

Duncan B. Clark

Keyword(s):

Emergency Department ◽

Young Adults ◽

Text Message ◽

Brief Interventions

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Period-dependent Associations between Hypotension during and for Four Days after Noncardiac Surgery and a Composite of Myocardial Infarction and Death

Anesthesiology ◽

10.1097/aln.0000000000001985 ◽

2018 ◽

Vol 128 (2) ◽

pp. 317-327 ◽

Cited By ~ 76

Author(s):

Daniel I. Sessler ◽

Christian S. Meyhoff ◽

Nicole M. Zimmerman ◽

Guangmei Mao ◽

Kate Leslie ◽

...

Keyword(s):

Myocardial Infarction ◽

Blood Pressure ◽

Systolic Blood Pressure ◽

Randomized Trial ◽

Odds Ratio ◽

Relative Effect ◽

Noncardiac Surgery ◽

Binary Variable ◽

Perioperative Morbidity ◽

Exposure Variable

Abstract Background The relative contributions of intraoperative and postoperative hypotension to perioperative morbidity remain unclear. We determined the association between hypotension and a composite of 30-day myocardial infarction and death over three periods: (1) intraoperative, (2) remaining day of surgery, and (3) during the initial four postoperative days. Methods This was a substudy of POISE-2, a 10,010-patient factorial-randomized trial of aspirin and clonidine for prevention of myocardial infarction. Clinically important hypotension was defined as systolic blood pressure less than 90 mmHg requiring treatment. Minutes of hypotension was the exposure variable intraoperatively and for the remaining day of surgery, whereas hypotension status was treated as binary variable for postoperative days 1 to 4. We estimated the average relative effect of hypotension across components of the composite using a distinct effect generalized estimating model, adjusting for hypotension during earlier periods. Results Among 9,765 patients, 42% experienced hypotension, 590 (6.0%) had an infarction, and 116 (1.2%) died within 30 days of surgery. Intraoperatively, the estimated average relative effect across myocardial infarction and mortality was 1.08 (98.3% CI, 1.03, 1.12; P < 0.001) per 10-min increase in hypotension duration. For the remaining day of surgery, the odds ratio was 1.03 (98.3% CI, 1.01, 1.05; P < 0.001) per 10-min increase in hypotension duration. The average relative effect odds ratio was 2.83 (98.3% CI, 1.26, 6.35; P = 0.002) in patients with hypotension during the subsequent four days of hospitalization. Conclusions Clinically important hypotension—a potentially modifiable exposure—was significantly associated with a composite of myocardial infarction and death during each of three perioperative periods, even after adjustment for previous hypotension.

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