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Kevin J Duffy, Katharyn L Flickinger, Jeffrey T Kristan, Melissa J Repine, Alexandro Gianforcaro, Rebecca B Hasley, Saad Feroz, Jessica M Rupp, Jumana Al-Baghli, Maria L Pacella, Brian P Suffoletto, Clifton W Callaway Department of Emergency Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA Background: Refining and individualizing treatment of acute pain in the emergency department (ED) is a high priority, given that painful complaints are the most common reasons for ED visits. Few tools exist to objectively measure pain perception in the ED setting. We speculated that variation in perception of fixed painful stimuli would explain individual variation in reported pain and response to treatment among ED patients. Materials and methods: In three studies, we 1) describe performance characteristics of brief quantitative sensory testing (QST) in 50 healthy volunteers, 2) test effects of 10 mg oxycodone versus placebo on QST measures in 18 healthy volunteers, and 3) measure interindividual differences in nociception and treatment responses in 198 ED patients with a painful complaint during ED treatment. QST measures adapted for use in the ED included pressure sensation threshold, pressure pain threshold (PPT), pressure pain response (PPR), and cold pain tolerance (CPT) tests. Results: First, all QST measures had high inter-rater reliability and test–retest reproducibility. Second, 10 mg oxycodone reduced PPR, increased PPT, and prolonged CPT. Third, baseline PPT and PPR revealed hyperalgesia in 31 (16%) ED subjects relative to healthy volunteers. In 173 (88%) ED subjects who completed repeat testing 30 minutes after pain treatment, PPT increased and PPR decreased (Cohen’s dz 0.10–0.19). Verbal pain scores (0–10) for the ED complaint decreased by 2.2 (95% confidence intervals [CI]: 1.9, 2.6) (Cohen’s dz 0.97) but did not covary with the changes in PPT and PPR (r=0.05–0.13). Treatment effects were greatest in ED subjects with a history of treatment for anxiety or depression (Cohen’s dz 0.26–0.43) or with baseline hyperalgesia (Cohen’s dz 0.40–0.88). Conclusion: QST reveals individual differences in perception of fixed painful stimuli in ED patients, including hyperalgesia. Subgroups of ED patients with hyperalgesia and psychiatric history report larger treatment effects on ED pain and QST measures. Keywords: emergency department, quantitative sensory testing, hyperalgesia, opioid, anxiety, depression

Study Objectives: To examine the feasibility, acceptability, and impact of a Sleep Promotion Program (SPP)., Methods: This pilot trial randomized adolescents (13-15y) with insufficient sleep duration and irregular sleep timing to SPP-continuation (n=24; SPP in month 1, continuation treatment in month 2) or monitoring-SPP (n=20; monitoring in month 1, SPP in month 2). SPP included one clinician session and at-home delivery of web-based reports of each youth's sleep diary data with accompanying intervention questions that prompt youth to engage in sleep behavior change. Attrition rate primarily measured feasibility. Program satisfaction measured acceptability. Total sleep time (TST), sleep timing, and sleep timing regularity were measured via sleep diary at baseline, follow-up 1, and follow-up 2 (each ∼1 month apart). Linear mixed effects models compared treatment arms on changes in sleep from baseline to follow-up 1 (month 1). We also compared changes in sleep during month 1 to changes in sleep during month 2 among SPP-continuation participants., Results: Attrition rate was 8.5%. 96.5% participants rated the quality of care received as good or excellent. In month 1, SPP-continuation youth showed a significantly greater increase in mean TST than monitoring-SPP youth (0.57 vs. -0.38 hours; contrast=0.95; CI =0.14, 1.76, p =0.024). SPP-continuation participants showed an increase in TST during month 1 (0.51h) but a decrease during month 2 (-0.74 h; contrast=-1.24, CI =-2.06, -0.42, p =0.005). No other significant effects were observed., Conclusions: SPP is highly feasible, acceptable, and associated with a significant increase in TST early in treatment., Clinical Trial Registration: Registry: ClinicalTrials.gov; Name: Targeted Intervention for Insufficient Sleep among Typically-Developing Adolescents; Identifier: NCT04163003; URL: https://clinicaltrials.gov/ct2/show/NCT04163003., (© 2024 American Academy of Sleep Medicine.)

Introduction: Effective interventions show heterogeneity in treatment response. Addressing this heterogeneity involves identifying which intervention works best for whom. One method to address this heterogeneity identifies treatment-subgroup interactions to determine which of two interventions has greater effect for certain individuals based on their profile of pre-treatment characteristics. This secondary analysis of a randomized clinical trial (RCT) to address binge drinking examined whether two of the RCT's interventions, GOAL and COMBO, which produced similar reductions in drinking outcomes, might have involved treatment-subgroup interactions. Identifying treatment-subgroup interactions can inform efficient patient-treatment matching that optimizes individual outcomes., Methods: These secondary analyses included young adults (n = 344; 68.6 % female, ages 18-25) randomized to GOAL or COMBO 12-week alcohol text message interventions and who completed 3-month follow-up (end of intervention). GOAL provided weekly support for drinking limit goals. COMBO included all GOAL features, in addition to pre-event feedback on drinking plans and post-event feedback on alcohol consumption. QUINT, a tree-based algorithm, aimed to identify treatment-subgroup interactions using 21 pre-treatment (baseline) characteristics (e.g., demographics, perceived risk of binge-drinking related harm, perceived number of peers drinking to intoxication) that predicted the primary outcome of binge drinking at follow-up., Results: The algorithm used five pre-treatment characteristics (sex, race, perceived risk of binge drinking-related harm, perceived number of peers drinking to intoxication, and any cannabis use in the past 3 months) to identify 7 treatment-subgroup interactions. COMBO had greater effectiveness than GOAL, for example, for females who reported lower risk of binge-drinking related harm and no cannabis use in the past 3 months, whereas GOAL had greater effectiveness for females who reported higher risk of binge-drinking related harm and more peers who drank to intoxication. In comparison, GOAL had greater effectiveness than COMBO among White males, whereas males of other racial backgrounds benefitted more from COMBO than GOAL., Conclusions: The identified treatment-subgroup interactions involving GOAL and COMBO indicated which intervention had greater effectiveness for which subgroups of individuals based on pre-treatment characteristics. These findings can help efficiently match individuals to effective interventions, bringing the field closer to personalized, precision care., Clinical Trials Registration Number: NCT02918565., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Older adults discharged from the emergency department (ED) face elevated risk of falls and functional decline. Smartphones might enable remote monitoring of mobility after ED discharge, yet their application in this context remains underexplored., Objective: This study aimed to assess the feasibility of having older adults provide weekly accelerometer data from an instrumented Timed Up-and-Go (TUG) test over an 11-week period after ED discharge., Methods: This single-center, prospective, observational, cohort study recruited patients aged 60 years and older from an academic ED. Participants downloaded the GaitMate app to their iPhones that recorded accelerometer data during 11 weekly at-home TUG tests. We measured adherence to TUG test completion, quality of transmitted accelerometer data, and participants' perceptions of the app's usability and safety., Results: Of the 617 approached patients, 149 (24.1%) consented to participate, and of these 149 participants, 9 (6%) dropped out. Overall, participants completed 55.6% (912/1639) of TUG tests. Data quality was optimal in 31.1% (508/1639) of TUG tests. At 3-month follow-up, 83.2% (99/119) of respondents found the app easy to use, and 95% (114/120) felt safe performing the tasks at home. Barriers to adherence included the need for assistance, technical issues with the app, and forgetfulness., Conclusions: The study demonstrates moderate adherence yet high usability and safety for the use of smartphone TUG tests to monitor mobility among older adults after ED discharge. Incomplete TUG test data were common, reflecting challenges in the collection of high-quality longitudinal mobility data in older adults. Identified barriers highlight the need for improvements in user engagement and technology design., (© Brian Suffoletto, David Kim, Caitlin Toth, Waverly Mayer, Sean Glaister, Chris Cinkowski, Nick Ashenburg, Michelle Lin, Michael Losak. Originally published in JMIR Aging (https://aging.jmir.org).)

This paper examines the use of text message (SMS) interventions for health-related behavioral support. It first outlines the historical progress in SMS intervention research publications and the variety of funds from US government agencies. A narrative review follows, highlighting the effectiveness of SMS interventions in key health areas, such as physical activity, diet and weight loss, mental health, and substance use, based on published meta-analyses. It then outlines advantages of text messaging compared to other digital modalities, including the real-time capability to collect information and deliver microdoses of intervention support. Crucial design elements are proposed to optimize effectiveness and longitudinal engagement across communication strategies, psychological foundations, and behavior change tactics. We then discuss advanced functionalities, such as the potential for generative artificial intelligence to improve user interaction. Finally, major challenges to implementation are highlighted, including the absence of a dedicated commercial platform, privacy and security concerns with SMS technology, difficulties integrating SMS interventions with medical informatics systems, and concerns about user engagement. Proposed solutions aim to facilitate the broader application and effectiveness of SMS interventions. Our hope is that these insights can assist researchers and practitioners in using SMS interventions to improve health outcomes and reducing disparities., (©Brian Suffoletto. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 27.08.2024.)

Alcohol use is a risk factor for death and disability and is attributed to almost one-third of injury deaths globally. This highlights the need for interventions aimed at alcohol reduction, especially in areas with high rates of injury with concurrent alcohol use, such as Tanzania. The aim of this study is to create a culturally appropriate text messages as a booster to a brief negotiational intervention (BNI), to in the Emergency Department of the Kilimanjaro Christian Medical Centre, Moshi, Tanzania. Creation of text message boosters for an ED-based intervention expands the window of opportunity for alcohol use reduction in this high-risk population. The study followed a two-step approach to create the text message content in English and then translate and culturally adapt to Tanzanian Swahili. The culturalization process followed the World Health Organization's process of translation and adaptation of instruments. Translation, back translation, and qualitative focus groups were used for quality control to ensure text message content accuracy and cultural appropriateness. In total, nearly 50 text messages were initially developed in English, yet only 29 text messages were successfully translated and adapted; they were focused on the themes of Self-awareness, Goal setting and Motivation. We developed culturally appropriate text message boosters in Swahili for injury patients in Tanzania coupled with a BNI for alcohol use reduction. We found it important to evaluate content validation for interventions and measurement tools because the intended text message can often be lost in translation. The process of culturalization is critical in order to create interventions that are applicable and beneficial to the target population. Trial registration: Clinical Trials Registration Number: NCT02828267, NCT04535011., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Staton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Scalable interventions attempting to nurture peer outreach to help young adults meet drinking limit goals remain under-developed. To address this gap, we developed ASPIRE, a text message intervention focused on coaching individuals to engage with close peers to assist them in meeting drinking limit goals., Method: Non-collegiate young adults who had reported one or more heavy drinking days in the preceding month and were at least contemplating change were recruited through social media. Participants were randomly assigned to one of three 6-week text message interventions: Control, Goal Support, or ASPIRE. All groups completed baseline assessments and received weekly text message assessments on Thursdays and Sundays. Control and ASPIRE groups were prompted to complete web-based outcome assessments at 6- and 12-weeks., Results: We enrolled 92 young adults from 31 US states (65% female; 73% White). All groups had high text response rates but intervention usability was sub-optimal. Follow-up rates were 87% at 6-weeks and 79% at 12-weeks. Compared to Control, ASPIRE participants reported significantly more peer support and less peer pressure to drink. ASPIRE exhibited higher goal confidence compared to the Goal Support group. Using multiple imputation, there were no significant differences in drinking outcomes between groups., Conclusions: Preliminary findings from this pilot study suggest that a text message intervention focused on nurturing peer outreach to help meet drinking limit goals holds promise in altering peer support and pressure as well as boosting drinking limit goal confidence. Design improvements are needed to reduce alcohol consumption., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Aims: To test differential outcomes between three 6-month text-messaging interventions to reduce at-risk drinking in help-seeking adults., Design: A three-arm single-blind randomized controlled trial with 1-, 3-, 6- and 12-month follow-ups., Setting: United States. A fully remote trial without human contact, with participants recruited primarily via social media outlets., Participants: Seven hundred and twenty-three adults (mean = 39.9 years, standard deviation = 10.0; 62.5% female) seeking to reduce their drinking were allocated to 6 months of baseline 'tailored statically' messaging (TS; n = 240), 'tailored adaptive' messaging (TA; n = 239) or 'drink tracking' messaging (DT; n = 244)., Interventions: TS consisted of daily text messages to reduce harmful drinking that were tailored to demographics and alcohol use. TA consisted of daily, tailored text messages that were also adapted based on goal achievement and proactive prompts. DT consisted of a weekly assessment for self-reported drinking over the past 7 days., Measurements: The primary outcome measure was weekly sum of standard drinks (SSD) at 6-month follow-up. Secondary outcome measures included drinks per drinking day (DDD), number of drinking days (NDD) per week and heavy drinking days (HDD) at 1-, 3-, 6- and 12-month follow-ups., Findings: At 6 months, compared with DT, TA resulted in significant SSD reductions of 16.2 (from 28.7 to 12.5) drinks [adjusted risk ratio (aRR) = 0.80, 95% confidence interval (CI) = 0.71, 0.91] using intent-to-treat analysis. TA also resulted in significant improvements in DDD (aRR = 0.84; 95% CI = 0.77-0.92) and drinking days per week (b = -0.39; 95% CI = -0.67, -0.10), but not HDD compared with DT at 6 months. TA was not significantly different from TS at any time-point, except DDD at 6 months. All groups made improvements in SSD at 12-month follow-up compared with baseline with an average reduction of 12.9 drinks per week across groups., Conclusions: Automated tailored mobile messaging interventions are scalable solutions that can reduce weekly alcohol consumption in remote help-seeking drinkers over time., (© 2023 Society for the Study of Addiction.)

Background: An alcohol text message intervention recently demonstrated effects in reducing heavy episodic drinking (HED) days at the three month follow-up in young adults with a history of hazardous drinking. An important next step in understanding intervention effects involves identifying baseline participant characteristics that predict who will benefit from intervention exposure to support clinical decision-making and guide further intervention development. To identify baseline characteristics that predict HED, this exploratory study used a prediction rule ensemble (PRE). Compared to more complex decision-tree methods (e.g., random forest), PREs have comparable performance, while generating simpler rules that can directly identify subgroups that do or do not respond to intervention., Methods: This secondary analysis examined data from 916 young adults who reported HED (68.5% female, mean age = 22.1, SD = 2.1), were enrolled in an alcohol text message randomized clinical trial and who completed baseline assessment and the three month follow-up. A PRE with ten fold cross-validation, which included 21 baseline variables representing sociodemographic characteristics (e.g., sex, age, race, ethnicity, college enrollment), alcohol consumption (frequency of alcohol consumption, quantity consumed on a typical drinking day, frequency of HED), impulsivity subscales (i.e., negative urgency, positive urgency, lack of premeditation, lack of perseverance, sensation seeking), readiness to change, perceived peer drinking and HED-related consequences, and intervention status were used to predict HED at the three month follow-up., Results: The PRE identified 12 rules that predicted HED at three months ( R 2 = 0.23) using 7 baseline features. Only two cases (0.2%) were not classified by the 12 rules. The most important features for predicting three month HED included baseline alcohol consumption, negative urgency score, and perceived peer drinking., Conclusions: The rules provide interpretable decision-making tools that predict who has higher alcohol consumption following exposure to alcohol text message interventions using baseline participant characteristics (prior to intervention), which highlight the importance of interventions related to negative urgency and peer alcohol use., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Hypertension is a leading cause of cardiovascular and kidney disease in the United States, yet blood pressure (BP) control at a population level is poor and worsening. Systematic home BP monitoring (HBPM) programs can lower BP, but programs supporting HBPM are not routinely used. The MyBP program deploys automated bidirectional text messaging for HBPM and disease self-management support., Objective: We aim to produce a qualitative analysis of input from providers and staff regarding implementation of an innovative HBPM program in primary care practices., Methods: Semistructured interviews (average length 31 minutes) were conducted with physicians (n=11), nurses, and medical assistants (n=6) from primary care settings. The interview assessed multiple constructs in the Consolidated Framework for Implementation Research domains of intervention characteristics, outer setting, inner setting, and characteristics of individuals. Interviews were transcribed verbatim and analyzed using inductive coding to organize meaningful excerpts and identify salient themes, followed by mapping to the updated Consolidated Framework for Implementation Research constructs., Results: Health care providers reported that MyBP has good ease of use and was likely to engage patients in managing their high BP. They also felt that it would directly support systematic BP monitoring and habit formation in the convenience of the patient's home. This could increase health literacy and generate concrete feedback to raise the day-to-day salience of BP control. Providers expressed concern that the cost of BP devices remains an encumbrance. Some patients were felt to have overriding social or emotional barriers, or lack the needed technical skills to interact with the program, use good measurement technique, and input readings accurately. With respect to effects on their medical practice, providers felt MyBP would improve the accuracy and frequency of HBPM data, and thereby improve diagnosis and treatment management. The program may positively affect the patient-provider relationship by increasing rapport and bidirectional accountability. Providers appreciated receiving aggregated HBPM data to increase their own efficiency but also expressed concern about timely routing of incoming HBPM reports, lack of true integration with the electronic health record, and the need for a dedicated and trained staff member., Conclusions: In this qualitative analysis, health care providers perceived strong relative advantages of using MyBP to support patients. The identified barriers suggest the need for corrective implementation strategies to support providers in adopting the program into routine primary care practice, such as integration into the workflow and provider education., Trial Registration: ClinicalTrials.gov NCT03650166; https://tinyurl.com/bduwn6r4., (©Julian Einhorn, Andrew R Murphy, Shari S Rogal, Brian Suffoletto, Taya Irizarry, Bruce L Rollman, Daniel E Forman, Matthew F Muldoon. Originally published in JMIR Cardio (https://cardio.jmir.org), 04.12.2023.)

Objective: Devices such as mobile phones and smart speakers could be useful to remotely identify voice alterations associated with alcohol intoxication that could be used to deliver just-in-time interventions, but data to support such approaches for the English language are lacking. In this controlled laboratory study, we compare how well English spectrographic voice features identify alcohol intoxication., Method: A total of 18 participants (72% male, ages 21-62 years) read a randomly assigned tongue twister before drinking and each hour for up to 7 hours after drinking a weight-based dose of alcohol. Vocal segments were cleaned and split into 1-second windows. We built support vector machine models for detecting alcohol intoxication, defined as breath alcohol concentration > .08%, comparing the baseline voice spectrographic signature to each subsequent timepoint and examined accuracy with 95% confidence intervals (CIs)., Results: Alcohol intoxication was predicted with an accuracy of 98% (95% CI [97.1, 98.6]); mean sensitivity = .98; specificity = .97; positive predictive value = .97; and negative predictive value = .98., Conclusions: In this small, controlled laboratory study, voice spectrographic signatures collected from brief recorded English segments were useful in identifying alcohol intoxication. Larger studies using varied voice samples are needed to validate and expand models.

Introduction: Low-resourced settings often lack personnel and infrastructure for alcohol use disorder treatment. We culturally adapted a Brief Negotiational Interview (BNI) for Emergency Department injury patients, the "Punguza Pombe Kwa Afya Yako (PPKAY)" ("Reduce Alcohol For Your Health") in Tanzania. This study aimed to evaluate the feasibility of a pragmatic randomized adaptive controlled trial of the PPKAY intervention., Materials and Methods: This feasibility trial piloted a single-blind, parallel, adaptive, and multi-stage, block-randomized controlled trial, which will subsequently be used to determine the most effective intervention, with or without text message booster, to reduce alcohol use among injury patients. We reported our feasibility pilot study using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, with recruitment and retention rates being our primary and secondary outcomes. We enrolled adult patients seeking care for an acute injury at the Kilimanjaro Christian Medical Center in Tanzania if they (1) exhibited an Alcohol Use Disorder Identification Test (AUDIT) ≥8, (2) disclosed alcohol use prior to injury, or (3) had a breathalyzer ≥0.0 on arrival. Intervention arms were usual care (UC), PPKAY, PPKAY with standard text booster, or a PPKAY with a personalized text booster., Results: Overall, 181 patients were screened and 75 enrolled with 80% 6-week, 82.7% 3-month and 84% 6-month follow-up rates showing appropriate Reach and retention. Adoption measures showed an overwhelmingly positive patient acceptance with 100% of patients perceiving a positive impact on their behavior. The Implementation and trial processes were performed with high rates of PPKAY fidelity (76%) and SMS delivery (74%). Intervention nurses believed Maintenance and sustainability of this 30-minute, low-cost intervention and adaptive clinical trial were feasible., Conclusions: Our intervention and trial design are feasible and acceptable, have evidence of good fidelity, and did not show problematic deviations in protocol. Results suggest support for undertaking a full trial to evaluate the effectiveness of the PPKAY, a nurse-driven BNI in a low-income country., Trial Registration: Trial registration number NCT02828267. https://classic.clinicaltrials.gov/ct2/show/NCT02828267., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Staton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Digital just-in-time adaptive interventions can reduce binge-drinking events (BDEs; consuming ≥4 drinks for women and ≥5 drinks for men per occasion) in young adults but need to be optimized for timing and content. Delivering just-in-time support messages in the hours prior to BDEs could improve intervention impact., Objective: We aimed to determine the feasibility of developing a machine learning (ML) model to accurately predict future, that is, same-day BDEs 1 to 6 hours prior BDEs, using smartphone sensor data and to identify the most informative phone sensor features associated with BDEs on weekends and weekdays to determine the key features that explain prediction model performance., Methods: We collected phone sensor data from 75 young adults (aged 21 to 25 years; mean 22.4, SD 1.9 years) with risky drinking behavior who reported their drinking behavior over 14 weeks. The participants in this secondary analysis were enrolled in a clinical trial. We developed ML models testing different algorithms (eg, extreme gradient boosting [XGBoost] and decision tree) to predict same-day BDEs (vs low-risk drinking events and non-drinking periods) using smartphone sensor data (eg, accelerometer and GPS). We tested various "prediction distance" time windows (more proximal: 1 hour; distant: 6 hours) from drinking onset. We also tested various analysis time windows (ie, the amount of data to be analyzed), ranging from 1 to 12 hours prior to drinking onset, because this determines the amount of data that needs to be stored on the phone to compute the model. Explainable artificial intelligence was used to explore interactions among the most informative phone sensor features contributing to the prediction of BDEs., Results: The XGBoost model performed the best in predicting imminent same-day BDEs, with 95% accuracy on weekends and 94.3% accuracy on weekdays (F 1 -score=0.95 and 0.94, respectively). This XGBoost model needed 12 and 9 hours of phone sensor data at 3- and 6-hour prediction distance from the onset of drinking on weekends and weekdays, respectively, prior to predicting same-day BDEs. The most informative phone sensor features for BDE prediction were time (eg, time of day) and GPS-derived features, such as the radius of gyration (an indicator of travel). Interactions among key features (eg, time of day and GPS-derived features) contributed to the prediction of same-day BDEs., Conclusions: We demonstrated the feasibility and potential use of smartphone sensor data and ML for accurately predicting imminent (same-day) BDEs in young adults. The prediction model provides "windows of opportunity," and with the adoption of explainable artificial intelligence, we identified "key contributing features" to trigger just-in-time adaptive intervention prior to the onset of BDEs, which has the potential to reduce the likelihood of BDEs in young adults., Trial Registration: ClinicalTrials.gov NCT02918565; https://clinicaltrials.gov/ct2/show/NCT02918565., (©Sang Won Bae, Brian Suffoletto, Tongze Zhang, Tammy Chung, Melik Ozolcer, Mohammad Rahul Islam, Anind K Dey. Originally published in JMIR Formative Research (https://formative.jmir.org), 04.05.2023.)

Background: This study aimed to test the causal effect of different text message interventions on reducing alcohol consumption indirectly by altering desire to get drunk., Methods: Participants were young adults randomized to interventions with different behavior change techniques: self-monitoring alone (TRACK); pre-drinking plan feedback (PLAN); post-drinking alcohol consumption feedback (USE); pre- and post-drinking goal feedback (GOAL); and a combination of techniques (COMBO) who completed at least 2 days of both pre- and post-drinking assessments over 12 weeks of intervention exposure. On the two days per week they planned to drank alcohol, participants were asked to report desire to get drunk (0 "none" to 8 "completely"). The next day, participants reported drinking quantity. Outcomes included binge drinking (defined as 4+ drinks for a woman and 5+ drinks for a man) and drinks per drinking day. Mediation was tested using path models of simultaneous between-person and within-person effects using maximum likelihood estimation., Results: At the between-person level, controlling for race and baseline AUDIT-C and within-person associations, 35.9 % of the effects of USE and 34.4 % of the effects of COMBO on reducing binge drinking were mediated through desire to get drunk. 60.8 % of the effects of COMBO on reducing drinks per drinking day were mediated through desire to get drunk. We did not find significant indirect effects for any other text-message intervention., Discussion: Findings support the hypothesized mediation model where desire to get drunk partially mediates the effects of a text message intervention using a combination of behavior change techniques on reducing alcohol consumption., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Brian Suffoletto reports financial support was provided by National Institute on Alcohol Abuse and Alcoholism. Tammy Chung reports financial support was provided by National Institute on Alcohol Abuse and Alcoholism., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Counteracting desires to drink are cognitive processes that exert self-control to mitigate impulses or strengthen other, perhaps more distal, goals to limit consumption. Young adults are particularly challenged by mismatches between self-regulation and desires to drink that make them susceptible to hazardous alcohol use., Methods: We assessed whether drinking limit goal commitment and goal confidence mediate the association between desire to get drunk and binge drinking (4+ drinks for females and 5+ drinks for males on a given occasion) among young adults exposed to text message goal-related feedback. We randomized 297 young adults to one of two text message interventions that incorporated drinking limit goal-related assessments and feedback over 12 weeks of intervention exposure. On the 2 days per week that they typically drank alcohol, participants were asked to report plans to drink (yes/no). If a drinking plan was endorsed, participants reported their desire to get drunk (0 [not at all] to 8 [completely]), willingness to commit to a drinking limit goal (yes/no), and (contingent on goal commitment) goal confidence (0 [not at all] to 8 [completely]). The next day, participants reported their drinking quantity, coded as a binge drinking day (yes/no). Mediation was tested using path models of simultaneous between- and within-person effects using maximum likelihood., Results: At both within- and between-person levels, we found significant indirect path effects of goal commitment and goal confidence between desire to get drunk and binge drinking. Greater than usual desire to get drunk was associated with lower drinking limit goal commitment and confidence, whereas greater than usual goal commitment and confidence were associated with lower likelihood of same-day binge drinking., Discussion: Findings support a mechanistic model where contextual variations in same-day drinking limit goal commitment and confidence mitigate the path between desire to get drunk and binge drinking among young adults. Employing just-in-time strategies to reinforce drinking limit goal commitment and goal confidence could reduce hazardous drinking and related harms., (© 2023 Research Society on Alcohol.)

Aims: This studys aim is to test the effectiveness of five interventions each utilizing a unique set of behavior change techniques on reducing alcohol consumption at 3 and 6 months among young adults with hazardous drinking., Design, Setting and Participants: This study used a five-arm parallel randomized controlled trial with 3- and 6-month follow-ups. Recruitment occurred at four emergency departments in Pittsburgh, PA, USA. Participants were non-treatment-seeking young adults (mean age = 22.1 years; 68.5% female; 37.1% black) who reported hazardous drinking., Interventions: Participants were randomized to one of five automated text message interventions for 12 weeks that interacted with participants on the 2 days per week that they typically drank: assisted self-monitoring (TRACK: control condition; n = 245), pre-drinking cognition feedback (PLAN; n = 226), alcohol consumption feedback (USE; n = 235), adaptive goal support (GOAL; n = 214) and a combination of interventions (COMBO; n = 221)., Measurements: Primary outcome was number of past month binge drinking days at 3-month post-randomization calculated from a 30-day time-line follow-back. Primary intention-to-treat analysis compared PLAN, USE, GOAL and COMBO against TRACK (control condition). The four active conditions were not compared against each other. A secondary outcome, durability of effects, was measured at 6 months., Findings: From baseline to 3-month follow-up (retention = 81.1%), compared with TRACK, in which past-month mean binge drinking days increased from 2.7 to 3.4, mean binge drinking days decreased in COMBO from 3.0 to 2.3 [adjusted β = -0.52; 95% confidence interval (CI) = -0.77, -0.26], GOAL from 3.0 to 2.6 (adjusted β = -0.34; 95% CI = -0.59, -0.10) and USE from 3.3 to 2.9 (adjusted β = -0.38; 95% CI = -0.62, -0.14). At 6 months (retention = 73.8%), COMBO, GOAL, USE and PLAN had significantly lower mean binge drinking days compared with TRACK., Conclusion: Text message interventions incorporating feedback on either drinking plans and/or alcohol consumption and/or drinking limit goal support produced small yet durable reductions in binge drinking days in non-treatment-seeking young adults with hazardous drinking., (© 2022 Society for the Study of Addiction.)

Alcohol use is associated with 3 million annual deaths globally. Harmful alcohol use, which is associated with a high burden of disease in low- and middle-income countries (LMICs), often increases the probability of traumatic injury. Treatments for harmful alcohol use in LMICs, such as Tanzania, lack trained personnel and adequate infrastructure. The aim of this study was to assess the feasibility of using SMS boosters to augment a hospital based brief negotiational intervention (BNI) in this low resourced setting. We conducted a three stage, four arm feasibility trial of a culturally adapted BNI for injury patients with harmful and hazardous drinking admitted to Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. Post hospital discharge, two of the four arms included patients receiving either a standard or personalized short message service (SMS) booster to enhance and or perpetuate the effect of the in-hospital BNI. Text messages were sent weekly throughout a 3-month follow-up period. SMS feasibility was assessed according to the TIDier checklist evaluating what, when, how much, tailoring processes, modifications and how well (intervention fidelity). Data was collected with SMS logs and short answer surveys to participants. A total of 41 study participants were assigned to each receive 12 SMS over a three-month period; 38 received messages correctly, 3 did not receive intended messages, and 1 received a message who was not intended to. Of the 258 attempted texts, 73% were successfully sent through the messaging system. Of the messages that failed delivery, the majority were not able to be sent due to participants traveling out of cellular service range or turning off their phones. Participants interviewed in both booster arms reported that messages were appropriate, and that they would appreciate the continuation of such reminders. At 6-month follow-up, 100% (n = 11) of participants interviewed believed that the boosters had a positive impact on their behavior, with 90% reporting a large impact. This study demonstrated feasibility and acceptability of the integration of SMS mobile health technology to supplement this type of nurse-led BNI. SMS booster is a practical tool that can potentially prolong the impact of a brief hospital based intervention to enact behavioral change in injury patients with AUD., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Staton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: This randomized clinical trial tested the efficacy of a 6-week text message program to reduce texting while driving (TWD) for young adults., Methods: Eligible individuals recruited from four emergency departments from December 2019 to June 2021 were aged 18-25 years who reported TWD in the past 2 weeks. Participants were randomly assigned 1:1 to intervention:assessment control. The intervention arm (n = 57) received an automated interactive text message program, including weekly queries about TWD for 6 weeks with feedback and goal support to promote cessation of TWD. The assessment control arm (n = 55) received identical weekly TWD queries but no additional feedback. Outcomes were collected via web-based self-assessments at 6- and 12 weeks and analyzed under intent-to-treat models, presented as adjusted odds ratios (ORs) with 95% confidence intervals (CIs)., Results: The mean (SD) age was 21.7 (2.1) years, 73 (65%) were female, and 40 (36%) were White. The 6-week follow-up rate was 77.7% (n = 87) and 12-week follow-up rate was 64.3% (n = 72). At 6 weeks, 52.6% (95% CI, 39.0%-66.0%) of intervention participants reported TWD versus 63.6% (95% CI, 49.6%-76.2%) of control participants (adjusted OR, 0.71; 95% CI, 0.32-1.59). At 12 weeks, 38.2% (95% CI, 22.8%-53.5%) of intervention participants reported TWD versus 69.3% (95% CI, 53.8%-84.7%) of control participants (adjusted OR, 0.29; 95% CI, 0.11-0.80)., Discussion: An interactive text message intervention was more effective at reducing self-reported TWD among young adults than assessment control at 12 weeks., (Copyright © 2022 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Importance: Approximately 1 in 10 adults do not always wear a seat belt, with the lowest use rates reported among young adults., Objective: To determine the efficacy of a 6-week automated behavioral text message program promoting seat belt use compared with an attention control., Design, Setting, and Participants: This parallel, 2-group, single-blind, individually randomized clinical trial included a convenience sample of patients recruited from 4 emergency departments in 2 cities in Pennsylvania from December 2019 to September 2021, with follow-ups at 6 and 12 weeks after randomization. Patients in stable condition aged 18 to 25 years who, in standardized screening, reported driving or being a passenger in a car without always using a seat belt in the past 2 weeks were eligible for recruitment. Participants who completed a 2-week trial run-in phase were randomly assigned 1:1 to the intervention or the assessment control. Data were analyzed from October 2019 to January 2020., Interventions: The intervention group received Safe Vehicle Engagement (SAVE), a 6-week automated interactive text message program, including weekly seat belt use queries with feedback and goal support to promote consistent use of a seat belt. The control group received identical weekly seat belt use queries but no additional feedback., Main Outcomes and Measures: The primary outcome was the proportion of young adults reporting always wearing a seat belt over the past 2 weeks, collected at 6 weeks (after a 2-week run-in) via web-based self-assessments and analyzed under intent-to-treat models using multiple imputation procedures. Sensitivity analyses included complete-case analyses of ordered categorical outcomes by vehicle seat position. Secondary outcomes included seatbelt use at 12 weeks and select cognitive constructs related to seat belt use., Results: A total of 218 participants (mean [SD] age, 21.5 [2.1] years; 139 [63.8%] women) were randomized, with 110 randomized to SAVE and 108 randomized to the control group. A total of 158 individuals (72.4%) were included in the 6-week follow-up. The rate of always using a seat belt over the past 2 weeks at the 6-week follow-up was 41.3% (95% CI, 30.6%-52.0%) among SAVE participants and 20.0% (95% CI, 10.6%-29.3%) among control participants (odds ratio [OR], 2.8; 95% CI, 1.4-5.8; P = .005). A total of 140 individuals (64.2%) participated in the 12-week follow-up. At 12 weeks, the rate of always using a seat belt over the past 2-weeks was 42.8% (95% CI, 31.2%-54.2%) among SAVE participants and 30.7% (95% CI, 19.6%-41.6%) among control participants (OR, 1.7; 95% CI, 0.9-3.4; P = .13). When examining ordered categories of seat belt use by seat position, there were significantly greater odds of wearing a seat belt at 6 and 12 weeks among SAVE participants vs control participants (eg, 6 weeks for driver: OR, 5.2; 95% CI, 2.6-10.5; 6 weeks for front passenger: OR, 4.3; 95% CI, 2.2-8.2; 6 weeks for back passenger: OR, 4.3; 95% CI, 2.2-8.2)., Conclusions and Relevance: In this randomized clinical trial, an interactive text message intervention was more effective at promoting seat belt use among targeted young adults than an attention control at 6 weeks. There was no significant difference between groups in always wearing a seat belt at 12 weeks. These findings, if replicated in a larger sample, suggest a scalable approach to improve seat belt use., Trial Registration: ClinicalTrials.gov Identifier: NCT03833713.

Background: Identifying older adults with risk for falls prior to discharge home from the Emergency Department (ED) could help direct fall prevention interventions, yet ED-based tools to assist risk stratification are under-developed. The aim of this study was to assess the performance of self-report and functional assessments to predict falls in the 3 months post-ED discharge for older adults., Methods: A prospective cohort of community-dwelling adults age 60 years and older were recruited from one urban ED (N = 134). Participants completed: a single item screen for mobility (SIS-M), the 12-item Stay Independent Questionnaire (SIQ-12), and the Timed Up and Go test (TUG). Falls were defined through self-report of any fall at 1- and 3-months and medical record review for fall-related injury 3-months post-discharge. We developed a hybrid-convolutional recurrent neural network (HCRNN) model of gait and balance characteristics using truncal 3-axis accelerometry collected during the TUG. Internal validation was conducted using bootstrap resampling with 1000 iterations for SIS-M, FRQ, and GUG and leave-one-out for the HCRNN. We compared performance of M-SIS, FRQ, TUG time, and HCRNN by calculating the area under the receiver operating characteristic area under the curves (AUCs)., Results: 14 (10.4%) of participants met our primary outcome of a fall or fall-related injury within 3-months. The SIS-M had an AUC of 0.42 [95% confidence interval (CI) 0.19-0.65]. The SIQ-12 score had an AUC of 0.64 [95% confidence interval (CI) 0.49-0.80]. The TUG had an AUC of 0.48 (95% CI 0.29-0.68). The HCRNN model using generated accelerometer features collected during the TUG had an AUC of 0.99 (95% CI 0.98-1.00)., Conclusion: We found that self-report and functional assessments lack sufficient accuracy to be used in isolation in the ED. A neural network model using accelerometer features could be a promising modality but research is needed to externally validate these findings., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest related to this work., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Competing Interests: Declaration of interests KH has been supported by the Esther Ting Memorial Professorship at Stanford University School of Medicine and research grants from the US Veterans Administration Health Services Research and Development Service (RCS 04-141-3, HX-12-001, and HX002714-01A2), the US National Institute on Drug Abuse (3UG1 DA015815-17S4 and 2UG1DA015815-19), the US Food and Drug Administration, Wu Tsai Neurosciences Institute, the Silicon Valley Community Foundation, the County of Santa Clara California, and the American Board of Family Medicine. He has received speaking honoraria and travel expenses from the American College of Medical Toxicology, Arizona State University, Barclays Bank, Caron Foundation, the University of Florida, the New York Museum of Modern Art, Syracuse University, West Virginia University School of Medicine, and the West Virginia Medical Professionals Health Program. He has received writing honoraria or royalties from the Association of Psychological Science, American Academy of Political and Social Science, Brookings Institution, Cambridge University Press, and Washington Monthly. He has been a paid consultant to AELIS Pharma, Harvard Medical School, and Harvard University Press. CLS has been employed by Stanford University, the University of California, Los Angeles (UCLA), the Los Angeles County Department of Public Health, Heluna Health, and the Los Angeles LGBT Center. She has received research funding or stipends from the US National Institute on Drug Abuse (K01DA050771, T32DA035165), the RAND Opioid Policy Tools and Information Center), Wu Tsai Neurosciences Institute, and UCLA David Geffen School of Medicine, and speaking honoraria or travel expenses from Emory University, New York University, UCLA, the University of North Carolina at Chapel Hill, the University of Southern California, the University of Pittsburgh, the University of Chicago, the University of Western Ontario, the Nevada State Medical Association, RAND, the University of California, Irvine, the US Centers for Disease Control and Prevention, College on Problems of Drug Dependence, the Conference on Retroviruses and Opportunistic Infections, HIV Research for Prevention, Addiction Health Services Research, and the American Psychopathological Association. CMA has been supported by the Arnold School of Public Health at the University of South Carolina, and by research grants from the US National Institute on Drug Abuse (R01DA034634, K01DA041628, U2CDA050097, R01DA049776, and R01DA052425), the US National Institute on Alcoholism and Alcohol Abuse (R01AA029097 and R01AA029821), and the South Carolina Department of Alcohol and Other Drug Abuse Services, and has been a paid consultant to the Robert Wood Johnson Foundation, RTI International, the Medical University of South Carolina, the State of Pennsylvania Department of Public Health, and the State of Illinois Division of Health Care and Family Services. ASBB has been supported by grants from the US National Institutes for Health (R01 DA045705), the US Veterans Health Administration (IIR 13-322 and C19 21-278), the US Centers for Disease Control and Prevention (U01CE002780), Blue Cross Blue Shield of Michigan, the US Department of Defense, the Patient-Centered Outcomes Research Institute, the Michigan Health Endowment Fund, and the Substance Abuse and Mental Health Services Administration via sub-contracts from the Michigan Department of Health and Human Services, has received speaker honoraria or travel expenses from the Illinois Health and Hospital Association, the International Summit on Suicide Research, the Washington State Department of Labor & Industries, the American Psychopathological Association, and the High Intensity Drug Trafficking Area program, has been paid as a consultant by New York University, and has received products from Fitbit at a reduced cost and Headspace for free for research purposes. MLB has been supported by research grants from the US Department of Veterans Affairs and the US National Institute on Drug Abuse (R37-DA15612), and a Koret Foundation gift for Smart Cities and Digital Living, has received travel expenses from the University of Maryland, the University of Auckland, Massachusetts Institute of Technology, the European Working Group on Stochastic Modeling, INSEAD, the University of Michigan, and the University of Oklahoma, and has been a paid consultant to Compass Lexecon and DE Shaw. JPC has received a National Science Foundation EAGER Grant on Detecting and Disrupting Illicit Supply Networks via Traffic Distribution Systems, is a consultant to the RAND Corporation's Drug Policy Research Center, has consulted with or received honoraria from the Actis—Norwegian Policy Network on Alcohol and Drugs, the Arnold Foundation, Bank of Montreal, Boston University, the Foreign Affairs, Justice Research and Statistics Association, Lisbon Addictions Conference, Massachusetts Institute of Technology, National Affairs, the National Institute of Justice, Oxford University Press, Pew, PIRE, the Russell Sage Foundation, Springer Verlag, Stanford University, the US State Department, Texas Research Society on Alcoholism, the US Veteran's Administration, Washington Monthly, and the WT Grant Foundation. JHC has received research support or funding from the US National Institutes of Health and National Library of Medicine (R56LM013365), the Gordon and Betty Moore Foundation (GBMF8040), the US National Science Foundation (SPO181514); Google (SPO13604), the Stanford Clinical Excellence Research Center, the Stanford Department of Medicine and Department of Pathology, and the Stanford Aging and Ethnogeriatrics Research Center (P30AG059307), which is part of the Resource Centers for Minority Aging Research programme led by the US National Institute on Aging at the National Institutes of Health, is the co-founder of Reaction Explorer (which develops and licenses organic chemistry education software), and has been paid consulting or speaker fees by the US National Institute of Drug Abuse Clinical Trials Network, Tuolc, Roche, and Younker Hyde MacFarlane. M-FC has served as president of the Carnegie Endowment for International Peace, a justice of the Supreme Court of California, the Herman Phleger Professor at Stanford Law School, a distinguished visiting jurist at the New York University School of Law, the Castle Distinguished Lecturer in Ethics, Politics, and Economics at Yale University, a member of the President & Fellows of Harvard College (the Harvard Corporation), a member of the board of directors of the William and Flora Hewlett Foundation, a member of the Council of the American Law Institute, chair of the board of directors of the Center for Advanced Study in the Behavioral Sciences, chair of the advisory board of the Seed Initiative at the Stanford Graduate School of Business, and a member of the advisory board at the Stanford Human-Centered Artificial Intelligence Institute. His work has been supported by Stanford Law School and by a grant from the Stanford Human-Centered Artificial Intelligence Institute, and he was previously chair of the advisory board of the AI Now Institute at New York University. YLH has received research grants from the US National Institute on Drug Abuse (DA050323, DA048613, DA008227, DA043247, DA030359, DA037317, and DA15446), research funding from GW Pharmaceuticals, speaking honoraria or travel expenses, or both, from the University of North Carolina, the American Society for the Advancement of Science, the Society for Neuroscience Public Education & Communication Committee, Washington University in St Louis, Temple University, Tufts School of Medicine, Indiana University, the American College of Neuropsychopharmacology, the Iowa Neuroscience Institute, the Franklin Institute, State University of New York Upstate Medical University, the Canadian Consortium for the Investigation of Cannabinoids, the University of Michigan, Cold Spring Harbor Laboratory, the US National Institutes of Health, Penn State Hershey College of Medicine, the US National Academy of Medicine, the Mediterranean Neuroscience Society, the Wu Tsai Neurosciences Institute, Society of Biological Psychiatry, International College of Neuropharmacology, the Federation of European Neuroscience Societies, Gordon Research Conference, the National Institutes of Health Center for Scientific Research Council, and the Society of Neuroscience. DNJ has received research grants from the Canadian Institutes for Health Research and the Ontario Ministry of Health, financial support from the departments of medicine at both the University of Toronto and Sunnybrook Health Sciences Centre, travel expenses or speaking honoraria from Dalhousie University, the University of Ottawa, the University of Saskatchewan, the University of Calgary, the Bloomberg Johns Hopkins School of Public Health, the American College of Physicians, the University of Alabama at Birmingham, the American Society of Nephrology, the Canadian Society of Internal Medicine, the Canadian Anesthesiologists' Society, The Canadian Society of Obstetricians and Gynecologists, the Western Canada Addiction Forum, and the Canadian House of Commons Standing Committee on Health, and payment for expert witness testimony from (and has been retained by) Sanis, a generic drug manufacturer and distributor to provide advice related to an ongoing Canadian class action, and is a volunteer member of Physicians for Responsible Opioid Prescribing. HKK has been supported by grants from the Robert Wood Johnson Foundation (77667, 74275, and 73359), the John Templeton Foundation (52125), the JPB Foundation (1085 and 439), and the Association of State and Territorial Health Officers (1584), has received honoraria from Jefferson University, Jefferson Health, the Perelman School of Medicine at the University of Pennsylvania, MaineHealth Center for Tobacco Independence, Harvard University Memorial Church, the Association of State and Territorial Health Officials, the University of Wisconsin Medical School, Wake Forest Baptist Health (in partnership with Shaw University), the Robert Wood Johnson Foundation advisory committee, the American College of Gastroenterology, and Tufts University School of Medicine, has been a consultant to the Commonwealth Fund, and is a member of the Community COVID Coalition Advisory Group, Phillips Academy Public Health Expert Advisory Panel, the Policy Advisory Group, the board of the Bipartisan Policy Center, the Palliative and Advanced Illness Research Center External Advisory Board (at the Perelman School of Medicine), the American Cancer Society Eastern New England Area Council of Advisors, the American University of Beirut International Advisory Council, the US National Advisory Board, the Culture of Health Year in Review Advisory Committee and Culture of Health as a Business Imperative Initiative of the Robert Wood Johnson Foundation, the editorial board of the Journal of the American Medical Association, the New England Donor Services board of trustees, the Josiah Macy Jr Foundation board of directors, and the Lancet–O'Neill Institute, Georgetown University Commission on Global Health and the Law. EEK has received research funding from the US Department of Veterans Affairs Health Services Research and Development (COR 19-489, 1I01HX003063-01A1, 5I01HX001752-05, 5I01HX002737-02, 5I01HX001288-05, and 5I01HX000911-06), the Patient Centered Outcomes Research Institute (OPD-1511-33052), the US National Center for Complementary and Integrative Health (5R01AT008387-04, 5UH3AT009761- 04/5UG3AT009761-02, and 4UH3AT009765-03/5UG3AT009765-02), and the US National Institute of Diabetes and Digestive and Kidney Diseases (1U01DK123816-01), and travel expenses from the law firm Nix Patterson representing the state of Oklahoma (to serve as an expert witness in support of the state's litigation against opioid manufacturers), the American Society of Health-System Pharmacists, the Association of Academic Physiatrists, the Australian Pain Society, the Cleveland VA Medical Research and Education Foundation, the Duke-Margolis Center for Health Policy, the Foundation for Medical Excellence, the Foundation for Opioid Response Efforts, the Friends of VA Medical Care and Health Research, the Hennepin Healthcare Research Institute, the Indiana Institute for Medical Research, the US National Academies of Medicine, the US National Center for Complementary and Integrative Health, the National Governors Association, the North American Spine Society, the Patient Centered Outcomes Research Institute at Stanford University, the US Food and Drug Administration, and the Washington State Department of Labor & Industries. AL has received consulting fees for her work as a medical expert witness in federal and state litigation against opioid manufacturers, distributors, and pharmacies, book royalties from Johns Hopkins University Press and Dutton Penguin Random House, speaking honoraria or travel expenses, or both, from the Vanderbilt University School of Medicine, the Ohio State University School of Medicine, the University of Kansas School of Medicine (sponsorship of the Alpha Omega Alpha Visiting Professorship), the Oregon Pain Guidance, the Indiana Prosecuting Attorneys Council, the Perrin's Opioid Litigation Conference, the Public Funds Forum, the Baton Rouge Health District, the Montrose Colorado Annual Continuing Medical Education Conference, the PerformRX Pharmacy Benefits Manager Annual Conference, the American Academy of Psychiatry and the Law, the Psych Congress, the 69th Annual Canadian Refresher Course for Family Physicians, the Ohio State University Inter-Professional Summit, the University of Texas, the Geminus Community Partners Annual Conference of Indiana, the National Council on Alcoholism and Drug Abuse, the Stanford Sierra Camp Womens' Alumni Wellness Retreat, the American Psychiatric Association, the Association for Medical Education and Research in Substance Abuse, and the Southwestern Gynecologic Assembly. SCM has been supported by the Redlich Professorship and the Rosekrans Pain Research Endowment Fund at Stanford University School of Medicine and research grants awarded to Stanford University from the US National Institutes of Health (R61NS118651, R03HD094577, R01DA045027, R01NS109450, R01AT008561, K24DA02926207, R01DA035484, and P01AT00665105), the Patient Centered Outcomes Research Institute (PCORI OPD-1610- 370707), the Stanford Wu Tsai Neurosciences Institute, and the University of California, San Francisco–Stanford Center of Excellence in Regulatory Science and Innovation (FDA) (2U01FD005978-06), has received speaking honoraria or travel expenses from Walter Reed, Harvard University, the American Academy of Pain Medicine, Washington University, the US Food and Drug Administration, the US National Institutes of Health, the US National Institute of Neurological Disorders and Stroke, the University of Washington, George Washington University, New York University, Weill Cornell Medical College, Duke University, the University of Utah, the World Institute of Pain, and the Canadian Pain Society, has received payment for testimony (unrelated to opioids) from Lauria Tokunaga Gates and Linn, and has received payment for consulting (unrelated to opioids) from the American Society of Anesthesiology; Favros Law; Fain Anderson VanDerhoef Rosendahl O'Halloran Spillane; Cox, Wootton, Lerner, Griffin & Hansen; Lewis Brisbois Bisgaard & Smith; Muro & Lampe; McCormick Barstow; Schmid & Voiles; and the University of Oklahoma Health Sciences Center. LLO has received travel expenses or honoraria from Cardozo Law School, Claremont McKenna College, Duke University, ETH Zürich, Georgetown University, Harvard University, the Los Angeles Intellectual Property Law Association, Michigan State University, New York University, Northwestern University, the University of Chicago, the University of Houston, the University of Kansas, the University of Nebraska, the University of San Diego, the University of Texas, the University of Villanova, the World Intellectual Property Organization, and Yale University, has received a writing honoraria from the Brookings Institution (to write a policy proposal for the Hamilton Project), and is a paid consultant to the MITRE Corporation (to assist with evaluations of the US Patent and Trademark Office requested by the Department of Commerce). BS has received research support from the US National Institute on Alcohol Abuse and Alcoholism (R01 AA023650 and K23 AA023284), the US National Institute of Drug Abuse (R21 DA043181), the US National Institute of Mental Health (P50MH115838), and the US National Highway Transportation Safety Authority, has received royalties from a software licence to healthStratica, and has several invention disclosures with the University of Pittsburgh for digital behavioral interventions. CT has been supported by the US Department of Veterans Affairs (VA HSR&D IIR 15-298, IIR 18-253, IIR 20-058, and PPO 16-337) and the US National Institutes of Health (NIAAA 1R01AA024136-01).

Background: Alcohol and cannabis use frequently co-occur, which can result in problems from social and academic impairment to dependence (i.e., alcohol use disorder [AUD] and/or cannabis use disorder [CUD]). The Emergency Department (ED) is an excellent site to identify adolescents with alcohol misuse, conduct a brief intervention, and refer to treatment; however, given time constraints, alcohol use may be the only substance assessed due to its common role in unintentional injury. The current study, a secondary data analysis, assessed the relationship between adolescent alcohol and cannabis use by examining the National Institute of Alcohol Abuse and Alcoholism (NIAAA) two question screen's (2QS) ability to predict future CUD at one, two, and three years post-ED visit. Methods: At baseline, data was collected via tablet self-report surveys from medically and behaviorally stable adolescents 12-17 years old ( n  = 1,689) treated in 16 pediatric EDs for non-life-threatening injury, illness, or mental health condition. Follow-up surveys were completed via telephone or web-based survey. Logistic regression compared CUD diagnosis odds at one, two, or three-year follow-up between levels constituting a single-level change in baseline risk categorization on the NIAAA 2QS (nondrinker versus low-risk, low- versus moderate-risk, moderate- versus high-risk). Receiver operating characteristic curve methods examined the predictive ability of the baseline NIAAA 2QS cut points for CUD at one, two, or three-year follow-up. Results: Adolescents with low alcohol risk had significantly higher rates of CUD versus nondrinkers (OR range: 1.94-2.76, p < .0001). For low and moderate alcohol risk, there was no difference in CUD rates (OR range: 1.00-1.08). CUD rates were higher in adolescents with high alcohol risk versus moderate risk (OR range: 2.39-4.81, p < .05). Conclusions: Even low levels of baseline alcohol use are associated with risk for a later CUD. The NIAAA 2QS is an appropriate assessment measure to gauge risk for future cannabis use.

Background: Many adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care., Objective: In this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers., Methods: In phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks., Results: In phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5% (1/20) reported that it was scheduled for a future date, 10% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15% (3/20) reported that they were no longer interested in receiving mental health care., Conclusions: The findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation., (©Brian Suffoletto, Tina Goldstein, David Brent. Originally published in JMIR Formative Research (https://formative.jmir.org), 09.11.2021.)

Background: Given possible impairment in psychomotor functioning related to acute cannabis intoxication, we explored whether smartphone-based sensors (e.g., accelerometer) can detect self-reported episodes of acute cannabis intoxication (subjective "high" state) in the natural environment., Methods: Young adults (ages 18-25) in Pittsburgh, PA, who reported cannabis use at least twice per week, completed up to 30 days of daily data collection: phone surveys (3 times/day), self-initiated reports of cannabis use (start/stop time, subjective cannabis intoxication rating: 0-10, 10 = very high), and continuous phone sensor data. We tested multiple models with Light Gradient Boosting Machine (LGBM) in distinguishing "not intoxicated" (rating = 0) vs subjective cannabis "low-intoxication" (rating = 1-3) vs "moderate-intensive intoxication" (rating = 4-10). We tested the importance of time features (i.e., day of the week, time of day) relative to smartphone sensor data only on model performance, since time features alone might predict "routines" in cannabis intoxication., Results: Young adults (N = 57; 58 % female) reported 451 cannabis use episodes, mean subjective intoxication rating = 3.77 (SD = 2.64). LGBM, the best performing classifier, had 60 % accuracy using time features to detect subjective "high" (Area Under the Curve [AUC] = 0.82). Combining smartphone sensor data with time features improved model performance: 90 % accuracy (AUC = 0.98). Important smartphone features to detect subjective cannabis intoxication included travel (GPS) and movement (accelerometer)., Conclusions: This proof-of-concept study indicates the feasibility of using phone sensors to detect subjective cannabis intoxication in the natural environment, with potential implications for triggering just-in-time interventions., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: The Brief Alcohol Screening and Intervention for College Students (BASICS; Dimeff et al., 1999) is an evidence-based approach to reduce high-risk drinking and associated harms; however, implementation may present challenges for community colleges (CCs) that have limited budgets and mostly non-residential students. We examined feasibility, acceptability, and efficacy of BASICS for CC students (BASICCS) delivered remotely via web-conferencing with supporting automated text messages. Method: Participants included 142 CC students who reported exceeding National Institute on Alcohol Abuse and Alcoholism (NIAAA's) weekly low-risk drinking recommendations and/or heavy episodic drinking (HED). Participants were randomized to BASICCS or assessment-only control (AOC) and completed 1- and 3-month follow-up assessments. Results: Most students liked the personalized information in the program and found the web-conferencing platform useful, however intervention completion rate was 56%. Significant differences were found between BASICCS and AOC. At 1-month, individuals in BASICCS had 33% fewer alcohol consequences than those in AOC. At 3-month follow-up, individuals in BASICCS had lower estimated peak blood alcohol concentration, 29% fewer drinks per week, 62% fewer episodes of HED, and 24% fewer consequences than those in AOC. Conclusions: BASICCS showed evidence of being acceptable and the technology proved feasible, although the intervention completion rate in the non-treatment-seeking volunteer sample was modest. Preliminary evidence does suggest BASICCS shows promise in reducing alcohol use and consequences. Technology-based platforms could be a viable prevention solution for CC students. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation., Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college., Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85% female [45/52], 91% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months., Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed., Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed., Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075., (©Brian Suffoletto, Tina Goldstein, Dawn Gotkiewicz, Emily Gotkiewicz, Brandie George, David Brent. Originally published in JMIR Formative Research (https://formative.jmir.org), 14.10.2021.)

Managing acute pain in individuals with a history of substance use disorders (SUD) is complex. Distress tolerance (DT) (e.g., the ability to handle uncomfortable sensations) may serve as an ideal non-pharmacological intervention target in this population. Among 293 emergency department (ED) patients seeking treatment for pain (M age  = 41; 42% Female; 43% Black), we examined rates of SUD treatment and DT, whether an objective DT task is feasible to conduct in the ED, and relationships between DT and SUD. Patients completed a self-report DT survey, an objective DT task, and brief surveys of pain, drug use, current or past SUD treatment, and depression/anxiety. Average DT was 18.50 (SD = 9.4) out of 50; patients with past or current SUD treatment (n = 43; 14.7%) reported lower DT than patients with no SUD treatment history (n = 250; 85.3%). Controlling for demographics, depression/anxiety, and pain severity, lower subjective DT (adjusted odds ratio [aOR] = 1.05) and objective DT (aOR = 1.02) was associated a current or past history or SUD treatment. Assessing subjective and objective DT in ED patients with acute pain is feasible; interventions aimed at boosting DT may improve outcomes among patients with acute pain and SUD., (© 2020 John Wiley & Sons Ltd.)

Alcohol-specific attentional biases (AttB) and approach biases (AppB) are postulated to play a role in alcohol use disorders but their association with drinking in young adults remains unknown. A subsample of young adults with risky alcohol use ( N = 296) enrolled in a randomized trial, testing different text message interventions completed weekly tasks via a mobile app for up to 14 weeks: Alcohol Stroop was used to measure AttB and Approach-Avoidance Task was used to measure AppB. Participants also provided reports of their alcohol consumption up to twice per week. We analyzed feasibility of measuring alcohol biases on mobile phones, whether repeated testing and conditions of testing affected mean reaction times (RTs), and whether mean AttB and AppB scores were associated with baseline alcohol use severity and same-day binge drinking (4+/5+ drinks per occasion for women/men). Task completion decreased from 93% on Week 1% to 39% by Week 14 with a mean of 8.2 weeks completed. Mean RTs for Alcohol Stroop decreased over weeks assessed. RTs to Stroop and Approach-Avoid tasks were longer when participants reported distractions or after alcohol and/or drug use. Mean AttB and AppB scores were not associated with baseline drinking, and within-day fluctuations of AttB and AppB scores did not predict same day binge drinking. Barriers to measuring alcohol biases in the natural environment include learning effects, contextual influences of distractions and prior alcohol/drug use, and absence of robust associations of RTs to alcohol cues with either baseline or same-day alcohol consumption. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Background: End-of-shift assessments (ESA) can provide representative data on medical trainee performance but do not occur routinely and are not documented systematically., Objective: To evaluate the implementation of a web-based tool with text message prompts to assist mobile ESA (mESA) in an emergency medicine (EM) residency program., Methods: mESA used timed text messages to prompt faculty/trainees to expect in-person qualitative ESA in a milestone content area and for the faculty to record descriptive performance data through a web-based platform. We assessed implementation between January 2018 and November 2019 using the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance)., Results: Reach : 96 faculty and 79 trainees participated in the mESA program. Effectiveness : From surveys, approximately 72% of faculty and 58% of trainees reported increases in providing and receiving ESA feedback after program implementation. From ESA submissions, trainees reported receiving in-person feedback on 90% of shifts. Residency leadership confirmed perceived utility of the mESA program. Adoption : mESA prompts were sent on 7792 unique shifts across 4 EDs, all days of week, and different times of day. Faculty electronically submitted ESA feedback on 45% of shifts. Implementation quality : No technological errors occurred. Maintenance : Completion of in-person ESA feedback and electronic submission of feedback by faculty was stable over time., Conclusions: We found mixed evidence in support of using a web-based tool with text message prompts for mESA for EM trainees., Competing Interests: Conflict of interest: The authors declare they have no competing interests., (© 2020.)

Objective: To determine the feasibility, acceptability, and potential impact of using audit and feedback (A&F) with or without peer norm comparison on opioid prescribing by emergency medicine providers., Methods: A convenience sample of 37 emergency medicine providers were recruited from 16 emergency departments in Western Pennsylvania for a pilot randomized controlled trial. Participants completed a baseline survey, were randomly allocated to A&F (N = 17) or A&F with peer norm comparison (N = 20), and were asked to complete a postintervention survey. We matched each participant 1:1 to a control who was not exposed to either intervention., Results: At baseline, 57% of participants perceived that they prescribed opioids at the same frequency as their peers, whereas 32% perceived prescribing less than and 11% perceived prescribing more than their peers. Most participants rated the interventions as helpful, with no differences between conditions. For the A&F with peer norm comparison condition, from pre- to postintervention, there was a relative increase of 20% in the percentage of participants who perceived that they prescribed more opioids than their peers but no change in the A&F condition (P = 0.02). 56.8% of controls, 52.9% of A&F participants, and 75.5% of A&F with peer norm comparison participants reduced their opioid prescribing (P = 0.33). The mean reduction in opioid prescriptions (SD) was 3.3. (9.6) for controls, 3.9 (10.5) for A&F, and 7.3 (7.8) for A&F with peer norm comparison (P = 0.31)., Conclusions: Audit and feedback interventions with peer norm comparisons are helpful to providers, can alter perceptions about prescribing norms, and are a potentially effective way to alter ED providers' opioid prescribing behavior., (© 2019 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)