Integrating mHealth Mobile Applications to Reduce High Risk Drinking Among Underage Students

Donna M. Kazemi, Ph.D.

Allyson R. Cochran, MPH

John F. Kelly, Ph.D.

Judith B. Cornelius, Ph.D

Catherine Belk, MSN

Alcohol High-Risk Drinking Issues: Some Important Facts Freshmen binge drink and use Illicit drug at higher rates

than non-freshmen.1,2,3,4,5,6

First 6 to 8 weeks critical transition period new independence, living arrangements, peer pressure, psychosocial factors, accessibility to outlets.7,8,9,10

Blackouts, mental health problems, assaults, unprotected sex, sex with multiple partners, rape, suicides, violence, STI’s, and automobile accidents. 6,7,8

mHealth Applications: Some Important Facts Mobile health (mhealth) is a term commonly used in association with

mobile communication devices, such as mobile phones. 11

mHealth communication devices are used to deliver health services and information through technology .11

College students embrace Mobile Cell Phones (MCPs) as their primary communication and entertainment device.12

mhealth may be an effective way to reach and engage college-age students with alcohol intervention .13,14

Aim of the Study

The aim of this study was to investigate college student’s perceptions toward using mHealth technology to deliver interventions to prevent high risk drinking and associated consequences.

Explore the feasibility of delivering alcohol interventions to underage college students using mHealth technology.

To offer suggestions for future research on the use of mHealth technology with college students.

BASICS

NIH NIAAA task force rated Brief Alcohol Screening and Intervention of College Students (BASICS) Tier 1 intervention for college students.15

BASICS with college students includes cognitive-behavioral skills training, brief motivational interventions, and challenging alcohol expectancies.16

BASICS has demonstrated effectiveness in decreasing high-risk drinking among college students.17,18

Research Findings Summary

Limited research on the effects of mHealth interventions on behavioral changes among college students.13,14

Few studies have investigated the use of mobile technologies to address college students’ drinking. These studies used computer screens and handheld devices for electronic interviews. 19,20

Need for more empirical support for BASICS delivery with technology.

Design of the Study:

Moderated focus groups were conducted with BASICS participants who had completed the face-to-face program for over 1 year (Baseline, 2 weeks, 3, 6, 12 months sessions)

12 questions were developed to obtain views of the focus groups on the use of mHealth technology to deliver the BASICS intervention.

Participants (N=26) were college juniors between the ages of 19 and 21, mostly Caucasian and female (30% males).

Participants Demographic Characteristics

Study Method

Focus groups were 60 minutes and were audiotaped, moderator asked the same sequence of questions.

Codebook thematic analysis of the content in the transcriptions was used to analyze the data. 21

Three examiners independently read and coded each of the focus group transcripts.

Master list of themes was developed with supporting extracts from the transcripts.

RESULTS: Major Themes and Subthemes

Summary of Study Findings

Students identified practical applications of mHealth to alcohol interventions.

Expressed interest in specific features provided by mobile app; BAC, Alcohol and health facts, Alcohol drink-tracking.

Most preferred face-to-face session for initial meetings. Social networking produced mixed responses, concerns expressed for confidentiality.

All indicated they would participate in a BASICS intervention using mHealth technology.

Study Limitations

More women (73%) than men in the focus groups of men (27%) and the junior year status of all participants.

All focus group participants were active in BASICS intervention program.

Participants understanding of technology applications may be limited.

Study Implications

Technology using mHealth offers a possible shift in the current clinical practice paradigm.

The potential exists for creating novel treatment interventions pairing mHealth technologies with face-to-face modalities.

Potential cost savings by taking advantage of students’ technology.

Future research should explore the use of mobile technologies to provide intervention for students engaging in high risk drinking.

Future research should explore the issues with participants who are not active in face-to-face BASICS program.

References

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2Caldeira, K. M., Arria, A. M., O’Grady, K. E., Vincent, K. B., & Wish, E. D. (2008). The occurrence of cannabis use disorders and other cannabis-related problems among first-year college students. Addictive Behaviors, 33, 397-411.

3Grossbard, J. R., Mastroleo, N. R., Kilmer, J. R., Lee, C. M., Turrisi, R., Larimer, M. E., & Ray, A. (2010). Substance use patterns among first-year college students: Secondary effects of a combined alcohol intervention. Journal of Substance Abuse Treatment, 39(4), 1-7.

4Jung, J. R. (2003). Changing the focus of college alcohol prevention programs. Journal of American College Health, 52(2), 92-95.

References

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6White, H. R., Labouvie, E. W., & Papadaratsakis, V. (2005). Changes in substance use during the transition to adulthood: A comparison of college students and their noncollege age peers. Journal of Drug Issues, 35(2), 281-306.

7Leeman, R. F., Toll, B. A., & Volpicelli, J. R. (2007). The Drinking-Induced Disinhibition Scale (DIDS): A measure of three types of disinhibiting effects. Addictive Behaviors, 32(6), 1200-1219.

8Lindsay, V. (2006). Factors That Predict Freshmen College Student's Preference to Drink Alcohol. Journal of Alcohol and Drug Education, 50(4), 7-19. Retrieved from EBSCOhost.

References

9Timberlake, D. S., Hopfer, C. J., Rhee, S. H., Friedman, N. P., Haberstick, B. C., Lessem, J. M., & Hewitt, J. K. (2007). College attendance and its effect on drinking behaviors in a longitudinal study of adolescents. Alcoholism: Clinical and Experimental Research, 31(6), 1020-1030.

10Westmaas, J., Moeller, S., & Woicik, P. B. (2007). Validation of a measure of college students’ intoxicated behaviors: Associations with alcohol outcome expectancies, drinking motives, and personality. Journal of American College Health, 55(4), 227-237.

11Free, C., Phillips, G., Felix, L., Galli, L., Patel, V., & Edwards, P. (2010). The effectiveness of M-health technologies for improving health and health services: a systematic review protocol. BMC Res Notes, 3, 250. doi: 10.1186/1756-0500-3-250.

12Robinson, E. (2011). Generation mobile: Cellphone use overwhelming in college students. Retrieved from http://www.wxyz.com/dpp/news/generation-mobile%3A-cellphone-use-overwhelming-in-college-students.

References

13Harley, D., Winn, S., Pemberton, S. P., & Wilcox, P. (2007). Using texting to support students' transition to university. Innovations in Education and Teaching International, 44(3), 229-241.

14Whittaker, R., Maddison, R., McRobbie, H., Bullen, C., Denny, S., Dorey, E., . . . Rodgers, A. (2008). A multimedia mobile phone-based youth smoking cessation intervention: findings from content development and piloting studies. Journal of Medical Internet Research, 10(5), e49-e49.

15Substance Abuse and Mental Health Services Administration. (2010). National Registry of Evidence-Based Programs and Practices (NREPP) No.: 93.243. Retrieved from http://www.nrepp.samhsa.gov.

16Baer, J. S., Kivlahan, D. R., Blume, A. W., McKnight, P., & Marlatt, G. A. (2001). Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. American Journal of Public Health, 91(8), 1310-1316.

References

17Dimeff, L. A., Baer, J. S., Kivlahan, D. R., & Marlatt, G. A. (1999). Brief alcohol screening and intervention for college students (BASICS): a harm reduction approach. New York, New York: Guilford Publications The Guilford Press.

18Larimer, M. E., & Cronce, J. M. (2007). Identification, prevention, and treatment revisited: Individual-focused college drinking prevention strategies 1999-2006. Addictive Behaviors, 32(11), 2439-2468.

19Bernhardt, J. M., Usdan, S., Mays, D., Martin, R., Cremeens, J., & Arriola, K. J. (2009). Alcohol assessment among college students using wireless mobile technology. Journal of Studies on Alcohol & Drugs, 70(5), 771-775.

20Mays, D., Cremeens, J., Usdan, S., Martin, R. J., Arriola, K. J., & Bernhardt, J. M. (2010). The feasibility of assessing alcohol use among college students using wireless mobile devices: Implications for health education and behavioural research. Health Education Journal, 69(3), 311-320. doi: 10.1177/0017896910364831.

References

21Krueger, R. A. (1998). Analyzing & reporting focus group results [Focus Group Kit, Volume 6]. Thousand Oaks, CA: Sage.