Publications by authors named "Michael P Schaub"

68 Publications

The Effectiveness of a Web-Based Self-Help Program to Reduce Alcohol Use Among Adults With Drinking Patterns Considered Harmful, Hazardous, or Suggestive of Dependence in Four Low- and Middle-Income Countries: Randomized Controlled Trial.

J Med Internet Res 2021 08 27;23(8):e21686. Epub 2021 Aug 27.

Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.

Background: Given the scarcity of alcohol prevention and use disorder treatments in many low- and middle-income countries (LMICs), the World Health Organization has launched an eHealth portal that includes the web-based self-help program "Alcohol e-Health."

Objective: We aimed to test the effectiveness of the Alcohol e-Health program in a randomized controlled trial.

Methods: This was a two-arm, individually randomized, and controlled trial across four LMICs comparing the self-help program and a psychoeducation and internet access as usual waiting list. Participants were broadly recruited from community samples in Belarus, Brazil, India, and Mexico from January 2016 through January 2019. The primary outcome measure was change in the Alcohol Use Disorders Identification Test (AUDIT) score with a time frame of 6 months between baseline and follow-up. Secondary outcomes included self-reported numbers of standard drinks over the previous week and cessation of harmful or hazardous drinking (AUDIT score <8).

Results: For this study, we recruited 1400 predominantly male (n=982, 70.1%) at least harmful or hazardous alcohol drinkers. The mean age was 37.6 years (SD 10.5). The participants were recruited from Brazil (n=587), Mexico (n=509), India (n=212), and Belarus (n=92). Overall, complete case analysis identified higher AUDIT changes in the intervention group (B=-4.18, 95% CI -5.42 to -2.93, P<.001, d=0.56) that were mirrored by changes in weekly standard drinks (B=-9.34, 95% CI -15.90 to -2.77, P=.005, d=0.28) and cessation rates for harmful or hazardous drinking (χ=14.56, N=561, P<.001). The supplementary intention-to-treat analyses largely confirmed these initial results.

Conclusions: The expansion of the Alcohol e-Health program to other LMICs with underdeveloped alcohol prevention and treatment systems for alcohol use disorders should be considered after successful replication of the present results.

Trial Registration: ISRCTN ISRCTN14037475; https://www.isrctn.com/ISRCTN14037475.

International Registered Report Identifier (irrid): RR2-10.1111/add.14034.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/21686DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8433861PMC
August 2021

Stakeholders' views on online interventions to prevent common mental health disorders in adults implemented into existing healthcare systems in Europe.

Eur J Public Health 2021 07;31(31 Suppl 1):i55-i63

Ferdinand Porsche FernFH-Distance Learning University of Applied Sciences, Wiener Neustadt 2700, Austria.

Background: Online preventive interventions can help to reduce the incidence of mental disorders. Whereas knowledge on stakeholders' attitudes and factors relevant for successfully integrating online treatment into existing healthcare systems is available, knowledge is scarce for online prevention.

Methods: Stakeholders from Germany, Switzerland, Austria and Spain were surveyed. Potential facilitators/delivery staff (e.g. psychologists, psychotherapists) completed an online questionnaire (n = 183), policy makers (i.e. from the governing sector or health insurance providers) participated in semi-structured interviews (n = 16) and target groups/potential users of mental illness prevention (n = 49) participated in ten focus groups. Thematic analysis was used to identify their experiences with and attitudes and needs regarding online programmes to prevent mental disorders. Additionally, it was examined which groups they consider underserved and which factors they consider as fostering and hindering for reach, adoption, implementation and maintenance (cf. RE-AIM model) when integrating online prevention into existing healthcare systems.

Results: Main advantages of online mental illness prevention are perceived in low structural and psychological barriers. Lack of personal contact, security, privacy and trust concerns were discussed as disadvantages. Relevant needs are high usability and target group appropriateness, evidence for effectiveness and the use of motivational tools.

Conclusions: Positive attitudes among stakeholders are the key for successful integration of online mental illness prevention into existing healthcare systems. Potential facilitators/delivery staff must receive training and support to implement these programmes; the programmes must be attractive and continuously evaluated, updated and promoted to ensure ongoing reach; and existing infrastructure and contextual factors must be considered.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurpub/ckab043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495679PMC
July 2021

Online prevention programmes for university students: stakeholder perspectives from six European countries.

Eur J Public Health 2021 07;31(31 Suppl 1):i64-i70

King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.

Background: Students beginning university are at a heightened risk for developing mental health disorders. Online prevention and early intervention programmes targeting mental health have the potential to reduce this risk, however, previous research has shown uptake to be rather poor. Understanding university stakeholders' (e.g. governing level and delivery staff [DS] and students) views and attitudes towards such online prevention programmes could help with their development, implementation and dissemination within university settings.

Methods: Semi-structured interviews, focus groups and online surveys were completed with staff at a governing level, university students and DS (i.e. student health or teaching staff) from six European countries. They were asked about their experiences with, and needs and attitudes towards, online prevention programmes, as well as the factors that influence the translation of these programmes into real-world settings. Results were analyzed using thematic analysis.

Results: Participating stakeholders knew little about online prevention programmes for university settings; however, they viewed them as acceptable. The main themes to emerge were the basic conditions and content of the programmes, the awareness and engagement, the resources needed, the usability and the responsibility and ongoing efforts to increase reach.

Conclusions: Overall, although these stakeholders had little knowledge about online prevention programmes, they were open to the idea of introducing them. They could see the potential benefits that these programmes might bring to a university setting as a whole and the individual students and staff members.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/eurpub/ckab040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8495721PMC
July 2021

Effects of a minimal-guided on-line intervention for alcohol misuse in Estonia: a randomized controlled trial.

Addiction 2021 Jun 29. Epub 2021 Jun 29.

National Institute for Health Development; Centre for Health Marketing, Tallinn, Estonia.

Background And Aims: Estonia has one of the highest alcohol-attributable mortality rates within the European Union. The aim of this study was to estimate the efficacy of an on-line self-help intervention to reduce problem drinking at the population level.

Design: On-line open randomized controlled trial with an 8-week intervention and an active control group (intervention n = 303, control n = 286). Assessments took place at baseline and at 6 months follow-up.

Setting: On- and offline channels were used for population-based recruitment within a nation-wide prevention campaign in Estonia.

Participants: Inclusion criteria were age ≥ 18 years, heavy drinking [Alcohol Use Disorders Identification (AUDIT) test score ≥ 8], literacy in Estonian and at least weekly access to the internet; n = 589 participants were randomized (50% male, 1% other; mean age 37.86 years; 45% with higher level of education).

Intervention And Comparator: The intervention consisted of 10 modules based on principles of cognitive-behavioral therapy and motivational interviewing. The active control group received access to a website with a self-test including personalized normative feedback and information for standard alcohol treatment.

Measurements: The primary outcome was AUDIT scores at 6 months follow-up adjusted for baseline scores.

Findings: Intention-to-treat analyses were applied. Missing data were addressed by using baseline observation carried forward (BOCF) and multiple imputation by chained equations (MI); 175 completed follow-up in the intervention group and 209 in the control group. AUDIT score at follow-up was significantly smaller in the intervention [BOCF mean = 13.91, standard deviation (SD) = 7.61, MI mean = 11.03, SD = 6.55] than control group (BOCF mean = 15.30, SD = 7.31; MI mean = 14.30, SD = 7.21), with a group difference of -1.38 [95% confidence interval (CI) = -2.58, -0.18], P = 0.02 for BOCF and -3.26 (95% CI = -2.01, -4.51), P < 0.001 for MI.

Conclusions: A randomized controlled trial has found that an on-line self-help intervention with minimal guidance was effective at reducing problem drinking in Estonia.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/add.15633DOI Listing
June 2021

"Take Care of You" - Efficacy of integrated, minimal-guidance, internet-based self-help for reducing co-occurring alcohol misuse and depression symptoms in adults: Results of a three-arm randomized controlled trial.

Drug Alcohol Depend 2021 08 18;225:108806. Epub 2021 Jun 18.

Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.

Background: Depression and harmful alcohol use are two of the top five leading causes of years of life lost to disability in high-income countries. Integrated treatment targeting both at the same time is often considered more complicated and difficult and, therefore, more expensive. Consequently, integrated internet-based interventions could be a valuable addition to traditional care.

Methods: A three-arm randomized controlled trial was conducted comparing the effectiveness of (1) an integrated, minimal-guidance, adherence-focused self-help intervention designed to reduce both alcohol use and depression symptoms (AFGE-AD); (2) a similar intervention designed to reduce alcohol use only (AFGE-AO), and (3) internet access as usual (IAU) as a control condition, in at least moderately depressed alcohol misusers from February 2016-March 2020. We recruited 689 alcohol misusers (51.6 % males, mean age = 42.8 years) with at least moderate depression symptoms not otherwise in treatment from the general population. Six months after baseline, 288 subjects (41.8 %) were reachable for the final assessment.

Results: All interventions yielded reduced alcohol-use after six months (AFGE-AD: -16.6; AFGE-AO: -19.8; IAU: -13.2). Those who undertook active-interventions reported significantly fewer standard drinks than controls (AFGE-AD: p = .048, d=0.10; AFGE-AO: p = .004, d=0.20). The two active-intervention groups also reported significantly less severe depression symptoms than controls (AFGE-AD: p = .006, d=0.41; AFGE-AO: p = .008, d=0.43). Testing revealed noninferiority between the two interventions.

Conclusions: This study documented sustained effectiveness of the first integrated, fully internet-based self-help intervention developed for the reduction of both alcohol use and depression symptoms in at least moderately depressed adult alcohol misusers recruited from the general population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugalcdep.2021.108806DOI Listing
August 2021

Effectiveness of a digital alcohol moderation intervention as an add-on to depression treatment for young adults: study protocol of a multicentre pragmatic randomized controlled trial.

BMC Psychiatry 2021 05 22;21(1):265. Epub 2021 May 22.

Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands.

Background: Depressive disorders and problematic drinking often co-occur, also among young adults. These co-occurring conditions are associated with various negative health outcomes compared to both conditions alone. Early intervention by addressing alcohol use and depressive symptoms simultaneously in the same treatment might improve both conditions. However, evidence on the (cost-) effectiveness of digital combined depression and alcohol interventions for young adults is currently insufficient. We therefore developed an add-on digital alcohol moderation adherence-focussed guided intervention to complement treatment as usual (TAU) for depressive disorders. The digital intervention is a web-app, including 6 modules based on motivational interviewing and cognitive behavioural therapy. This study aims to evaluate the (cost-)effectiveness of a digital alcohol moderation intervention + TAU compared to TAU on alcohol and depression outcomes among young adults with co-occurring depressive disorders and problematic alcohol use.

Methods: One hundred fifty-six participants, aged 18-35 years, with problematic alcohol use and a diagnosed depressive disorder will participate in a pragmatic multicentre two-arm randomized controlled trial. Problematic alcohol use is operationalised as scoring ≥5 for women and ≥ 8 for men on the Alcohol Use Disorder Identification Test (AUDIT). Participants will be randomized to either the experimental group (digital alcohol intervention + TAU) or control group (TAU only). Participants will be recruited at three Dutch mental health care centres and through social media. Assessments take place at baseline and after 3, 6 and 12 months post-randomization. The primary outcome is treatment response at 6-month follow-up, operationalized as a composite score that combines alcohol use and depression measures and indicates whether treatment has been successful or not. Secondary outcomes are depressive symptoms and alcohol use (i.e. number of weekly standard drinks and AUDIT score). An economic evaluation will be conducted alongside the trial.

Discussion: This study evaluates the (cost-) effectiveness of an add-on digital alcohol moderation intervention for young adults who are in treatment for depressive disorders. If proven effective, the digital intervention could be implemented in mental health care and improve treatment for people with co-occurring depressive disorders and problematic alcohol use.

Trial Registration: Pre-registered on October 29, 2019 in The Netherlands Trial Register ( NL8122 ).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12888-021-03222-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8140318PMC
May 2021

An adapted smoking-cessation intervention for Turkish-speaking migrants in Switzerland: Predictors of smoking outcomes at one-year follow-up.

PLoS One 2021 18;16(3):e0247157. Epub 2021 Mar 18.

Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich, Switzerland.

Background: Migrant populations usually report higher smoking rates. Among those migrant populations, Turkish- and Kurdish-speaking migrants are often overrepresented. Providing equal access to health services is one of the major challenges of our time. The need for adapted smoking-cessation treatments for Turkish-speaking populations to achieve equity in health led, in 2006, to the development and implementation of the Tiryaki-Kukla smoking-cessation program. The aims of the current study were to evaluate one-year quit rates for smoking-cessation courses held from 2006-2018 and investigate whether certain characteristics predict long-term smoking cessation or reduction.

Methods: Program evaluation included a pre/post questionnaire (session 1/ 3 months after the quit day) and a follow-up telephone call twelve months after the quit day. To elucidate factors associated with long-term smoking cessation and reduction, Cox regression analysis and Weighted Generalized Equation Models were used.

Results: Of the 478 who participated in smoking-cessation courses, 45.4% declared themselves non-smokers at one-year follow-up. This quit rate is higher than that achieved during the preliminary evaluation of the program involving 61 participants (37.7%). Predictors of long-term smoking cessation were course length (eight vs. six sessions) (95% CI = 1.04-1.36, p = .01), adherence to the course (95% CI = 0.98-0.99, p<0.01), use of pharmacotherapy or nicotine replacement therapy products (95% CI = 0.74-0.98, p = .02), and time passed in the morning until the first cigarette is smoked (95% CI5min = 1.17-1.77, p<0.001; 95% CI30min = 1.09-1.65, p<0.01). Predictors of change in cigarettes smoked per day among smokers were-the time passed until the first cigarette in the morning (5min p < .001; 30min p < .001; 60min p < .01)-, gender (p < .001), and level of motivation to quit at baseline (p = .04).

Conclusions: Our findings are consistent with existing evidence supporting adapted smoking cessation interventions to reduce health inequity in migrant populations. However, achieving harm reduction in smokers with higher dependence scores remains challenging.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247157PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971503PMC
August 2021

Efficacy of a smartphone-based coaching program for addiction prevention among apprentices: study protocol of a cluster-randomised controlled trial.

BMC Public Health 2020 Dec 14;20(1):1910. Epub 2020 Dec 14.

Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, 8005, Zurich, Switzerland.

Background: A large proportion of apprentices shows addictive behaviours like cigarette smoking, alcohol, cannabis, or compulsive Internet use, others do not show such behaviours at all. ready4life is a smartphone application-based coaching program for apprentices, which takes into account the heterogeneity of adolescent addictive behaviour by promoting life skills and reducing risk behaviours. The main objective of the planned study is to test the efficacy of ready4life for addiction prevention among apprentices in Switzerland within a controlled trial.

Methods/design: The efficacy of the ready4life coaching program will be tested in comparison to an assessment only control group, within a cluster-randomised controlled trial with one follow-up assessment after 6 months. At the beginning of the program, participants of the intervention group will receive an individual profile, showing areas in which they have sufficient resources and in which there is a need for coaching. Based on this feedback, they can select two out of the following six program modules: stress, social skills, Internet use, tobacco/e-cigarettes, cannabis, and alcohol. Participants of the intervention group will receive individualised coaching by a conversational agent (chatbot) for a period of four months. The coaching relies on motivational and social-cognitive principles of behaviour change. Within weekly dialogues, the coach provides individually tailored information in different formats, such as videoclips, texts, or pictures. Study participants will be 1318 apprentices with a minimum age of 15, recruited in approximately 100 vocational school classes in Switzerland. Primary outcome will be a composite measure for addictive behaviours including (1) at risk-drinking, (2) tobacco/e-cigarette smoking, (3) cannabis use, and (4) problematic Internet use.

Discussion: The study will reveal whether this universally implementable but individually tailored intervention approach is effective in preventing the onset and escalation of addictive behaviors among apprentices.

Trial Registration: ISRCTN59908406 (registration date: 21/10/2020).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-020-09995-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7734780PMC
December 2020

Developing and testing the effectiveness of a novel online integrated treatment for problem gambling and tobacco smoking: a protocol for an open-label randomized controlled trial.

Trials 2020 Nov 19;21(1):937. Epub 2020 Nov 19.

Department of Psychology, York University, 4700 Keele St, North York, ON, M3J 1P3, Canada.

Background: Gambling and tobacco smoking are highly comorbid among North American adults. However, there is a paucity of treatment options that are integrated (i.e. targeting both gambling and tobacco smoking simultaneously), accessible, and evidence based.

Methods: The aim of this two-arm open-label randomized controlled trial is to examine the effectiveness of an online, self-guided integrated treatment for problem gambling and tobacco smoking. A target sample of 214 participants will be recruited and be randomized into either an 8-week integrated or gambling only control condition. Both conditions will consist of seven online modules following cognitive behavioural therapy and motivational interviewing principles. Our three primary outcomes are (1) the number of days gambled, (2) money spent on gambling activities, and (3) time spent in gambling activities. Secondary outcomes include gambling disorder symptoms, cigarette use, and nicotine dependence symptoms. Assessments will be completed at baseline, at completion (i.e. 8 weeks from baseline), and at follow-up (i.e. 24 weeks from baseline). Generalized linear mixed modelling will be used to evaluate our primary and secondary outcomes. We expect that participants receiving online integrated treatment will show larger reductions in gambling relative to those receiving a control gambling only intervention. We further hypothesize that reductions in smoking will mediate these group differences.

Discussion: The rates of problem gambling and tobacco smoking are high in North America; yet, the treatment options for both are limited, with no integrated treatments available. If supported, our pilot study will be a cost-effective and accessible way to improve treatments for co-occurring problem gambling and tobacco use.

Trial Registration: ClinicalTrials.gov NCT03614884 . Registered on August 3, 2019.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13063-020-04867-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7678080PMC
November 2020

User Experience and Effects of an Individually Tailored Transdiagnostic Internet-Based and Mobile-Supported Intervention for Anxiety Disorders: Mixed-Methods Study.

J Med Internet Res 2020 09 16;22(9):e16450. Epub 2020 Sep 16.

Clinical, Neuro- & Development Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.

Background: Internet interventions have been shown to be effective in treating anxiety disorders. Most interventions to date focus on single disorders and disregard potential comorbidities.

Objective: The aim of this mixed-methods study was to investigate feasibility, user experience, and effects of a newly developed individually tailored transdiagnostic guided internet intervention for anxiety disorders.

Methods: This study is an uncontrolled, within-group, baseline, postintervention pilot trial with an embedded qualitative and quantitative process and effect evaluation. In total, 49 adults with anxiety disorders (generalized anxiety disorder n=20, social phobia n=19, agoraphobia without panic n=12, panic with agoraphobia n=6, panic without agoraphobia n=4, subclinical depression n=41) received access to the 7-session intervention. We examined motivation and expectations, intervention use, user experience, impact, and modification requests. Qualitative data were assessed using semistructured interviews and analyzed by qualitative content analysis. Quantitative outcomes included symptom severity of anxiety and depression (Hamilton Anxiety Rating Scale [HAM-A], Quick Item Inventory of Depressive Symptomatology clinician rating [QIDS-C]), diagnostic status in clinical interviews (Mini International Neuropsychiatric Interview [MINI]), and web-based self-reports (Generalized Anxiety Disorder-7 [GAD-7], Center for Epidemiological Studies Depression Scale [CES-D], Beck Anxiety Inventory [BAI], Panic and Agoraphobia Scale [PAS], Social Phobia Scale [SPS], Patient Health Questionnaire-9 [PHQ-9]) at baseline and postassessment. Quantitative data was analyzed by comparing within-group means expressed as Cohen d.

Results: Anxiety symptom severity (HAM-A d=1.19) and depressive symptoms (QIDS-C d=0.42) improved significantly, and 54% (21/39) no longer were diagnosed as having any anxiety disorder. The main positive effects were the general improvement of disease burden and attentiveness to feelings and risk situations while the main negative effects experienced were lack of change in disease burden and symptom deterioration. The most prevalent reasons for participation were the advantages of online treatment, symptom burden, and openness toward online treatment. Helpful factors included support, psychoeducation and practicing strategies in daily life; the main hindering factors were too little individualization and being overwhelmed by the content and pace.

Conclusions: The intervention was found to be feasible and results show preliminary data indicating potential efficacy for improving anxiety and depression. The next step should be the evaluation within a randomized controlled trial. Concerning intervention development, it was found that future interventions should emphasize individualization even more in order to further improve the fit to individual characteristics, preferences, and needs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/16450DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527916PMC
September 2020

The concept of buying-shopping disorder: Comparing latent classes with a diagnostic approach for in-store and online shopping in a representative sample in Switzerland.

J Behav Addict 2020 Oct 11;9(3):808-817. Epub 2020 Sep 11.

1Swiss Research Institute for Public Health and Addiction ISGF at Zurich University, Konradstrasse 32, 8005, Zurich, Switzerland.

Background And Aims: Buying-shopping disorder and its transferability to the online sector is controversial. This study investigates in-store and online shopping patterns by comparing data-based modeling to a diagnostic cut-off approach. Further aims were to test model equivalence for gender and identify socio-demographic risk factors.

Methods: In a representative survey, the Bergen Shopping Addiction Scale (BSAS) was applied, using both an online and in-store version. Latent class analyses were followed by multinomial logistic regression analyses to investigate socio-demographic variables. Measurement invariance across genders was tested with multi-group comparisons.

Results: With N = 1,012, 3-class solutions provided the best model fit for both in-store and online shopping. Most individuals (76, 86%) were grouped in non-addicted classes, followed by risky (21, 11%) and addicted classes (both 3%). Twenty-eight percent of individuals in the online addicted shopping class remained unidentified using the cut-off. For online shopping, only lower age and education differentiated classes significantly.

Discussion: Results indicate a close link between online and in-store shopping, albeit with distinguishing features. The cut-off yielded findings discrepant from class probabilities. That buying-shopping disorder mainly affects younger women of lower educational level must be questioned, given the limited associations identified.

Conclusions: It is important not only to consider different settings of pathological shopping, but also to focus on groups that may not have appeared at risk in previous investigations (e.g., men, older age). The BSAS cut-off warrants further research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1556/2006.2020.00051DOI Listing
October 2020

The concept of buying-shopping disorder: Comparing latent classes with a diagnostic approach for in-store and online shopping in a representative sample in Switzerland.

J Behav Addict 2020 Oct 11;9(3):808-817. Epub 2020 Sep 11.

1Swiss Research Institute for Public Health and Addiction ISGF at Zurich University, Konradstrasse 32, 8005, Zurich, Switzerland.

Background And Aims: Buying-shopping disorder and its transferability to the online sector is controversial. This study investigates in-store and online shopping patterns by comparing data-based modeling to a diagnostic cut-off approach. Further aims were to test model equivalence for gender and identify socio-demographic risk factors.

Methods: In a representative survey, the Bergen Shopping Addiction Scale (BSAS) was applied, using both an online and in-store version. Latent class analyses were followed by multinomial logistic regression analyses to investigate socio-demographic variables. Measurement invariance across genders was tested with multi-group comparisons.

Results: With N = 1,012, 3-class solutions provided the best model fit for both in-store and online shopping. Most individuals (76, 86%) were grouped in non-addicted classes, followed by risky (21, 11%) and addicted classes (both 3%). Twenty-eight percent of individuals in the online addicted shopping class remained unidentified using the cut-off. For online shopping, only lower age and education differentiated classes significantly.

Discussion: Results indicate a close link between online and in-store shopping, albeit with distinguishing features. The cut-off yielded findings discrepant from class probabilities. That buying-shopping disorder mainly affects younger women of lower educational level must be questioned, given the limited associations identified.

Conclusions: It is important not only to consider different settings of pathological shopping, but also to focus on groups that may not have appeared at risk in previous investigations (e.g., men, older age). The BSAS cut-off warrants further research.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1556/2006.2020.00051DOI Listing
October 2020

Testing the efficacy of a minimal-guidance online self-help intervention for alcohol misuse in Estonia: study protocol of a randomized controlled trial.

BMC Public Health 2020 May 27;20(1):790. Epub 2020 May 27.

Estonian National Institute for Health Development, Tallinn, Estonia.

Background: Despite an initial steep decrease in alcohol misuse among Estonians through structural intervention means and the scaling up of alcohol counselling in the mid-2000's, most of the country's alcohol misuse indicators remain clearly higher than European averages. Consequently, an online self-help program was launched as part of an initial behavioral intervention initiative to foster progress in alcohol prevention on a population level.

Methods: A two-arm randomized controlled trial (RCT) has been designed to compare the efficacy of a culturally-adapted minimal-guidance online self-help program, the 8-week "Selge" online program against a control condition that consists of a self-administered test of alcohol use and advice regarding usual treatment in Estonia. A target sample of 600 individuals will be recruited and randomly assigned to either condition. The program will contain 10 modules based on principles of cognitive behavioural therapy (CBT) and motivational interviewing (MI). Participants in the control group will have access to the full treatment after they complete their final follow-up assessment. The primary outcome will be change in the Alcohol Use Disorders Identification Test (AUDIT) score between the 6-month follow-up and baseline assessments. Secondary outcomes will include the number of standard drinks consumed and alcohol-free days, drinking motives and motivation for change, as well as changes in mental health. Assessments will be completed at baseline, at the end of treatment, and at 6 months follow-up. Data analysis will follow the intention-to-treat principle and employ (generalised) linear mixed models.

Discussion: The "Selge" program is the first and only internet program for the intervention of alcohol misuse in Estonia. If proven effective, it will foster progress in the intervention of alcohol misuse in the Estonian population and be implemented as a standard program amidst the continuum of intervention and care.

Trial Registration: Current Controlled Trials ISRCTN48753339 registered 04/06/2019 retrospectively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-020-08791-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7251728PMC
May 2020

Efficacy of a web-based self-help tool to reduce problem gambling in Switzerland: study protocol of a two-armed randomised controlled trial.

BMJ Open 2019 12 8;9(12):e032110. Epub 2019 Dec 8.

Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.

Introduction: The past-year prevalence of problem gambling worldwide averages 2.3%. Switzerland exhibits a slightly lower past-year prevalence rate, of 1.1%, among adults. Only a minority of these adults attend outpatient treatment. Surveyed problem gamblers have explained that they wanted to handle the problem on their own. The option of a web-based self-help programme could potentially reach those users who hesitate to approach treatment centres and help them to reduce or stop their problem gambling. The effectiveness of such web-based interventions has been shown in other countries.

Methods And Analysis: This two-armed randomised controlled trial (RCT) will examine the efficacy of a web-based self-help intervention, relative to an active control condition with a self-help manual, at reducing problem gambling. The active intervention programme, spanning 8 weeks, consists of nine modules developed to reduce gambling and attenuate psychopathological comorbidity, including depression, anxiety and stress-related disorder symptoms, relying on motivational interviewing and cognitive behavioural therapy. With a target sample size of 352, questionnaire data will be collected at baseline, and at 8 and 24 weeks after baseline. Primary outcomes will be the number of days one has gambled in the last 30 days. Secondary outcomes will include money and time spent on gambling activities, changes in gambling-related problems (Problem Gambling Severity Index, Gambling Symptom Assessment Scale), use of alcohol and cigarettes, and psychopathological comorbidity. All data analysis will comply with the intention-to-treat principle.

Ethics And Dissemination: The RCT will be conducted in accordance with the Declaration of Helsinki; the consort eHealth Guidelines for studies on medical devices; the European Directive on medical devices 93/42/EEC, Swiss Law and Swiss Regulatory Authority requirements. The study was approved by the ethics committee of the Canton of Zurich. Results will be published in a scientific peer-reviewed journal. Participants will be informed via e-mail about study results via a lay-person-friendly summary of trial findings.

Trial Registration Number: Current Controlled Trials registry (ISRCTN16339434).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/bmjopen-2019-032110DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6924842PMC
December 2019

A Digital Intervention Addressing Alcohol Use Problems (the "Daybreak" Program): Quasi-Experimental Randomized Controlled Trial.

J Med Internet Res 2019 09 4;21(9):e14967. Epub 2019 Sep 4.

Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.

Background: Alcohol use is prevalent in many societies and has major adverse impacts on health, but the availability of effective interventions limits treatment options for those who want assistance in changing their patterns of alcohol use.

Objective: This study evaluated the new Daybreak program, which is accessible via mobile app and desktop and was developed by Hello Sunday Morning to support high-risk drinking individuals looking to change their relationship with alcohol. In particular, we compared the effect of adding online coaching via real-time chat messages (intervention group) to an otherwise self-guided program (control group).

Methods: We designed the intervention as a randomized control trial, but as some people (n=48; 11.9%) in the control group were able to use the online coaching, the main analysis comprised all participants. We collected online surveys at one-month and three-months follow-up. The primary outcome was change in alcohol risk (measured with the alcohol use disorders identification test-consumption [AUDIT-C] score), but other outcomes included the number of standard drinks per week, alcohol-related days out of role, psychological distress (Kessler-10), and quality of life (EUROHIS-QOL). Markers of engagement with the program included posts to the site and comments on the posts of others. The primary analysis used Weighted Generalized Estimating Equations.

Results: We recruited 398 people to the intervention group (50.2%) and 395 people to the control group (49.8%). Most were female (71%) and the mean age was 40.1 years. Most participants were classified as probably dependent (550, 69%) on the AUDIT-10, with 243 (31%) classified with hazardous or harmful consumption. We followed up with 334 (42.1%) participants at one month and 293 (36.9%) at three months. By three months there were significant improvements in AUDIT-C scores (down from mean 9.1 [SD 1.9] to 5.8 [SD 3.1]), alcohol consumed per week (down from mean 37.1 [SD 28.3] to mean 17.5 [SD 18.9]), days out of role (down from mean 1.6 [SD 3.6] to 0.5 [SD 1.6]), quality of life (up from 3.2 [SD 0.7] to 3.6 [SD 0.7]) and reduced distress (down from 24.8 [SD 7.0] to 19.0 [SD 6.6]). Accessing online coaching was not associated with improved outcomes, but engagement with the program (eg, posts and comments on the posts of others) were significantly associated with improvements (eg, in AUDIT-C, alcohol use and EUROHIS-QOL). Reduced alcohol use was found for both probably dependent (estimated marginal mean of 40.8 to 20.1 drinks) and hazardous or harmful alcohol users (estimated marginal mean of 22.9 to 11.9 drinks).

Conclusions: Clinically significant reductions in alcohol use were found, as well as reduced alcohol risk (AUDIT-C) and days out of role. Importantly, improved alcohol-related outcomes were found for both hazardous or harmful and probably dependent drinkers. Since October 2016, Daybreak has reached more than 50,000 participants. Therefore, there is the potential for the program to have an impact on alcohol-related problems at a population health level, importantly including an effect on probably dependent drinkers.

Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110.

International Registered Report Identifier (irrid): RR2-10.2196/9982.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/14967DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753690PMC
September 2019

Web-based self-help with and without chat counseling to reduce cocaine use in cocaine misusers: Results of a three-arm randomized controlled trial.

Internet Interv 2019 Sep 22;17:100251. Epub 2019 May 22.

Swiss Research Institute for Public Health and Addiction at the University of Zurich, Konradstrasse 32, P. O. Box, 8005 Zurich, Switzerland.

Background: In recent years, cocaine use has increased in many countries, but only a minority of users seek treatment. Cognitive behavioral therapy (CBT) is seen as first-choice face-to-face treatment. However, a web-based intervention might serve as an alternative.

Aims: To test the efficacy of a web-based self-help intervention, with and without chat counseling, grounded in CBT, at reducing cocaine use in cocaine misusers not in treatment for a substance use disorder.

Methods: Subjects were randomly assigned to (1) a self-help intervention with chat support, (2) a self-help intervention without chat support, or (3) a waiting list control group. The fully-automated self-help program consisted of eight modules based on motivational interviewing, self-control practices and CBT. The primary outcome was the quantity of cocaine use per week. Secondary outcomes included frequency of cocaine and other substance use and mental health symptoms. Linear regression analysis was performed to investigate changes in primary and secondary outcomes.

Results: In total, 416 users registered online for the trial, of whom 311 completed the baseline assessment. Participants were predominantly male (73%) and averaged 33 years old (SD = 7.6). Despite considerable efforts on our part, only 47 of 311 (15.1%) subjects completed the 6-month follow-up assessment. Frequency of cocaine use and severity of cocaine dependence decreased only in the intervention groups. No significant difference in the primary outcome was observed between the study arms, but several differences in secondary outcomes were observed by complete case analyses.

Conclusions: Many cocaine misusers from the general population and not otherwise in treatment could be reached and decreased their cocaine use utilizing a CBT-based online intervention. However, due to the high percentage of dropouts and serious difficulties reaching subjects for follow-up assessments, no conclusions can be drawn regarding study arm differences. Implications for future studies are discussed.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.invent.2019.100251DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536739PMC
September 2019

Short- and long-term effects of digital prevention and treatment interventions for cannabis use reduction: A systematic review and meta-analysis.

Drug Alcohol Depend 2019 07 14;200:82-94. Epub 2019 May 14.

Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands.

Background: Frequent Cannabis use has been linked to a variety of negative mental, physical, and social consequences. We assessed the effects of digital prevention and treatment interventions on Cannabis use reduction in comparison with control conditions.

Methods: Systematic review with two separate meta-analyses. Thirty randomized controlled trials met the inclusion criteria for the review, and 21 were included in the meta-analyses. Primary outcome was self-reported Cannabis use at post-treatment and follow-up. Hedges's g was calculated for all comparisons with non-active control. Risk of bias was examined with the Cochrane risk-of-bias tool.

Results: The systematic review included 10 prevention interventions targeting 8138 participants (aged 12 to 20) and 20 treatment interventions targeting 5195 Cannabis users (aged 16 to 40). The meta-analyses showed significantly reduced Cannabis use at post-treatment in the prevention interventions (6 studies, N = 2564, g = 0.33; 95% CI 0.13 to 0.54, p =  0.001) and in the treatment interventions (17 comparisons, N = 3813, g = 0.12; 95% CI 0.02 to 0.22, p =  0.02) as compared with controls. The effects of prevention interventions were maintained at follow-ups of up to 12 months (5 comparisons, N = 2445, g = 0.22; 95% CI 0.12 to 0.33, p <  0.001) but were no longer statistically significant for treatment interventions.

Conclusions: Digital prevention and treatment interventions showed small, significant reduction effects on Cannabis use in diverse target populations at post-treatment compared to controls. For prevention interventions, the post-treatment effects were maintained at follow-up up to 12 months later.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.drugalcdep.2019.03.016DOI Listing
July 2019

Efficacy and cost-effectiveness of guided and unguided internet- and mobile-based indicated transdiagnostic prevention of depression and anxiety (ICare Prevent): A three-armed randomized controlled trial in four European countries.

Internet Interv 2019 Apr 15;16:52-64. Epub 2018 Apr 15.

Department of Clinical Psychology and Psychotherapy, Nägelsbachstraße 25a, Germany.

Background: Depression and anxiety are highly prevalent and often co-occur. Several studies indicate the potential of disorder-specific psychological interventions for the prevention of each of these disorders. To treat comorbidity, transdiagnostic treatment concepts seem to be a promising approach, however, evidence for transdiagnostic concepts of prevention remains inconclusive. Internet- and mobile-based interventions (IMIs) may be an effective means to deliver psychological interventions on a large scale for the prevention of common mental disorders (CMDs) such as depression and anxiety. IMIs have been shown to be effective in treating CMDs, e.g. in reducing symptoms of depression and anxiety. However, there is a lack of studies examining the efficacy of interventions reducing the incidence of CMDs. Moreover, the comparative cost-effectiveness of guided versus unguided IMIs for the prevention of depression and anxiety has not been studied yet. Hence, this study aims at investigating the (cost-) effectiveness of guided and unguided internet- and mobile-based transdiagnostic individually tailored indicated prevention of depression and anxiety.

Methods: A multi-country three-armed randomized controlled trial will be conducted to compare a guided and unguided intervention to treatment as usual (TAU). Both active conditions are based on the same intervention, , and differ only with regard to guidance format. Altogether, 954 individuals with subclinical symptoms of depression (CES-D ≥ 16) and anxiety (GAD-7 ≥ 5) who do not have a full-blown disorder will be recruited in Germany, Switzerland, Spain and the Netherlands, and randomized to one of three conditions (guided intervention, unguided intervention, or TAU). The TAU arm will receive access to the training after a 12-month waiting period. The primary outcome will be time to CMD onset (any depression/anxiety disorder) within a follow-up period of 12 months after baseline. Secondary outcomes will include disorder-specific symptom severity (depression/anxiety) assessed by diagnostic raters blinded to intervention condition at post-intervention, self-reports, acceptability, health related quality of life, and psychosocial variables associated with developing a CMD. Assessments will take place at baseline, mid-intervention (5 weeks into the intervention), post-intervention (8 weeks after randomization) and follow-up (6 and 12 months after randomization). Data will be analyzed on an intention-to-treat basis and per protocol. Cost-effectiveness will be evaluated from a public health and a societal perspective, including both direct and indirect costs.

Discussion: The present study will further enhance the evidence-base for transdiagnostic preventive interventions and provide valuable information about optimal trade-off between treatment outcome and costs.

Trial Registration: German Clinical Trial Registration (DRKS - http://www.drks.de/drks_web/): DRKS00011099.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.invent.2018.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364519PMC
April 2019

An Internet based intervention for improving resilience and coping strategies in university students: Study protocol for a randomized controlled trial.

Internet Interv 2019 Apr 22;16:43-51. Epub 2018 Mar 22.

University Jaume, Castellón, Spain.

Background: The literature shows a high prevalence of depression and anxiety in young people. The university represents a change in the lives of students, and is considered a stress factor. Therefore, it is particularly relevant to develop interventions specifically addressed to students and foster supportive environments and resilient communities. As students are "digital natives", online interventions offer several potential advantages in doing this. This study aims to develop and evaluate the efficacy of an Internet-based intervention (CORE: Cultivating our Resilience), based on the Ryff model of well-being, to promote resilience and coping skills, decrease symptoms of depression and anxiety, and increase overall wellbeing in young people confronting a crucial life event (the university). This paper summarizes the study protocol.

Method: The design of the planned study is a randomized controlled trial. A minimum of 464 participants will be randomly assigned to two conditions: 1) an unguided Internet-based intervention to enhance resilience (N = 232); 2) a care-as-usual condition (CAU) (N = 232). The primary outcome will be the Connor-Davidson resilience scale. Secondary outcomes will - among others - include other relevant clinical measures, such as anxiety and depressive symptoms, quality of life, and social support. Outcomes will be assessed 4 and 8 weeks, and 6 and 12-months follow-ups. Intention-to-treat and per-protocol analyses will be performed.

Discussion: The results of this study will contribute to the growing research on Internet-delivered interventions. The expected results may have a major impact on the prevention of mental disorders and possible negative consequences in at-risk populations, such as college students.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.invent.2018.03.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6364440PMC
April 2019

Efficacy of an Online Self-Help Treatment for Comorbid Alcohol Misuse and Emotional Problems in Young Adults: Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2018 Nov 1;7(11):e11298. Epub 2018 Nov 1.

Department of Psychology, University of Manitoba, Winnipeg, MB, Canada.

Background: Alcohol misuse and emotional problems (ie, depression and anxiety) are highly comorbid among Canadian young adults. However, there is a lack of integrated, accessible, and evidence-based treatment options for these young adults.

Objective: The main goal of this study is to develop and test the efficacy of an integrated, online self-help program designed to target both alcohol misuse and emotional problems.

Methods: A two-arm randomized controlled trial design will be used to compare the efficacy of the online integrated treatment to a psychoeducational control group. A target sample of 214 participants will be recruited and randomly assigned to either condition. The integrated treatment will last 8 weeks, and participants will work through 12 modules. Modules will incorporate content based on principles of cognitive behavioral therapy and motivational interviewing. Participants in the control group will receive links to psychoeducational resources and will have access to the full treatment after follow-up. The primary outcome will be the number of Canadian standard drinks consumed in the week leading up the assessment. Secondary outcomes of interest include symptoms of depression, anxiety, alcohol-related problems, quality of life, and use of other drugs. Assessments will be completed at 3 time-points: at baseline, at the end of treatment (ie, 8 weeks), and at follow-up (ie, 24 weeks). Upon completion, data will be analyzed using generalized linear mixed models.

Results: Data collection began in June 2018 and will continue until January 2020. Final study results will be submitted for publication by July 2020.

Conclusions: Currently, there are no integrated treatments designed to target alcohol misuse and the range of emotional problems experienced by young adults. This research stands to provide an effective, accessible (ie, Web-based), and feasible option to treat the many struggling young adults in this country.

Trial Registration: ClinicalTrials.gov ID NCT03406039; https://clinicaltrials.gov/ct2/show/NCT03406039 (Archived by WebCite at http://www.webcitation.org/72fDefnrh).

Registered Report Identifier: PRR1-10.2196/11298.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/11298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6238101PMC
November 2018

Efficacy of a mobile phone-based life-skills training program for substance use prevention among adolescents: study protocol of a cluster-randomised controlled trial.

BMC Public Health 2018 Sep 10;18(1):1102. Epub 2018 Sep 10.

Swiss Research Institute for Public Health and Addiction, Zurich University, Konradstrasse 32, 8005, Zurich, Switzerland.

Background: Life-skills trainings conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones might represent a more economic and scalable approach. The main objective of the planned study is to test the efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents within a controlled trial.

Methods/design: The efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents will be tested in comparison to an assessment only control group, within a cluster-randomised controlled trial with two follow-up assessments after 6 and 18 months. The fully automated program is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Participants of the intervention group will receive up to 4 weekly text messages over 6 months in order to stimulate (1) positive outcome expectations, e.g., on using self-management skills to cope with stress, (2) self-efficacy, e.g., to resist social pressure, (3) observational learning, e.g. of interpersonal competences, (4) facilitation, e.g., of strategies to cope with negative emotions, and (5) self-regulation, e.g., by self-monitoring of stress and emotions. Active program engagement will be stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition with prizes in which program users collect credits with each interaction. Study participants will be 1312 students between the ages of 14 and 16 years from approximately 100 secondary school classes. Primary outcome criteria will be problem drinking according to the short form of the Alcohol Use Disorders Identification Test and cigarette smoking within the last 30 days preceding the follow-up assessment at month 18.

Discussion: This is the first study testing the efficacy of a mobile phone-based life-skills training for substance use prevention among adolescents within a controlled trial. Given that this intervention approach proves to be effective, it could be easily implemented in various settings and would reach large numbers of young people in a cost-effective way.

Trial Registration: ISRCTN41347061 (registration date: 21/07/2018).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12889-018-5969-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6131936PMC
September 2018

Transdiagnostic Tailored Internet- and Mobile-Based Guided Treatment for Major Depressive Disorder and Comorbid Anxiety: Study Protocol of a Randomized Controlled Trial.

Front Psychiatry 2018 4;9:274. Epub 2018 Jul 4.

Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.

Depression is highly prevalent and often accompanied by comorbid anxiety disorder. Internet-based interventions have shown to be one effective treatment modality; however, comorbidities are often not targeted. Transdiagnostic tailored internet-and mobile-based interventions (IMIs) might be promising to overcome such issues. This study aims to evaluate the efficacy, moderators, and cost-effectiveness of a transdiagnostic tailored internet- and mobile-based guided intervention for depression and comorbid anxiety in individuals with major depressive disorder (MDD). Two-hundred participants with MDD will be randomly assigned to an 8-week guided self-help internet intervention (IC) or a 6-month wait-list control group (WLC). Participants of the IC will receive weekly content-focused feedback on module completion as well as monitored adherence reminders from an eCoach. The primary outcome is clinician-rated depression severity (QIDS-C) at post-assessment assessed by diagnostic raters blind to study condition. Secondary outcomes include, e.g., change in diagnostic status (MDD and anxiety disorders), remission and response rates, disorder symptom severity, health related quality of life, incongruence related to needs and values, and behavioral activation. Assessments will take place at baseline (T1), post-assessment (T2), 6-month follow-up (T3), and 12-month follow-up in the IC. Data will be analyzed on an intention-to-treat basis and per protocol. A large number of a priori defined moderators of treatment outcome will be assessed at baseline and tested in predicting treatment outcome. Cost-effectiveness will be evaluated from a societal perspective. The present study will provide evidence on the efficacy, potential cost-effectiveness, and moderators of a transdiagnostic tailored guided internet- and mobile-based treatment protocol.

Trial Registration: German Register of Clinical Studies DRKS00011690 (https://www.drks.de/drks_web/).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpsyt.2018.00274DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6039558PMC
July 2018

A Participatory Health Promotion Mobile App Addressing Alcohol Use Problems (The Daybreak Program): Protocol for a Randomized Controlled Trial.

JMIR Res Protoc 2018 May 31;7(5):e148. Epub 2018 May 31.

Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.

Background: At-risk patterns of alcohol use are prevalent in many countries with significant costs to individuals, families, and society. Screening and brief interventions, including with Web delivery, are effective but with limited translation into practice to date. Previous observational studies of the Hello Sunday Morning approach have found that their unique Web-based participatory health communication method has resulted in a reduction of at-risk alcohol use between baseline and 3 months. The Hello Sunday Morning blog program asks participants to publicly set a personal goal to stop drinking or reduce their consumption for a set period of time, and to record their reflections and progress on blogs and social networks. Daybreak is Hello Sunday Morning's evidence-based behavior change program, which is designed to support people looking to change their relationship with alcohol.

Objective: This study aims to systematically evaluate different versions of Hello Sunday Morning's Daybreak program (with and without coaching support) in reducing at-risk alcohol use.

Methods: We will use a between groups randomized control design. New participants enrolling in the Daybreak program will be eligible to be randomized to receive either (1) the Daybreak program, including peer support plus behavioral experiments (these encourage and guide participants in developing new skills in the areas of mindfulness, connectedness, resilience, situational strategies, and health), or (2) the Daybreak program, including the same peer support plus behavioral experiments, but with online coaching support. We will recruit 467 people per group to detect an effect size of f=0.10. To be eligible, participants must be resident in Australia, aged ≥18 years, score ≥8 on the alcohol use disorders identification test (AUDIT), and not report prior treatment for cardiovascular disease.

Results: The primary outcome measure will be reduction in the AUDIT-Consumption (AUDIT-C) scores. Secondary outcomes include mental health (Kessler's K-10), days out of role (Kessler), alcohol consumed (measured with a 7-day drinking diary in standard 10 g drinks), and alcohol-related harms (CORE alcohol and drug survey). We will collect data at baseline and 1, 3, and 6 months and analyze them with random effects models, given the correlated data structure.

Conclusions: A randomized trial is required to provide robust evidence of the impact of the online coaching component of the Daybreak program, including over an extended period.

Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000010291; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373110 (Archived by WebCite at http://www.webcitation.org/6zKRmp0aC).

Registered Report Identifier: RR1-10.2196/9982.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/resprot.9982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6002672PMC
May 2018

Drinking Goal Trajectories and Their Association with Client Characteristics and Outcomes among Clients in Outpatient Alcohol Treatment.

Subst Use Misuse 2018 11 13;53(13):2140-2151. Epub 2018 Apr 13.

a Swiss Research Institute for Public Health and Addiction at Zurich University , Zurich , Switzerland.

Background: Drinking goal preferences could change over time in alcohol treatment and during follow up.

Objectives: To examine the stability of drinking goals over time, types of drinking goal trajectory, and the associations between drinking goal trajectories and baseline client characteristics and treatment outcomes.

Methods: We performed secondary analysis of a dataset from a multicenter longitudinal study on the effectiveness of outpatient alcohol treatment (n = 543). Drinking goals (abstinence, controlled drinking, nonrestricted drinking, undecided) and alcohol use were assessed at treatment admission, discharge, and 6- and 12-month follow up.

Results: At admission, 32% of the subjects aimed for abstinence and 57% for controlled drinking, while 10% were undecided, and 1% did not want to restrict themselves. The proportions of clients aiming for abstinence and controlled drinking were relatively stable across the four assessments, and the proportion of clients who changed their drinking goal from abstinence to controlled drinking did not differ significantly from the number who changed in the opposite direction. Clients with abstinence-focused trajectories reported higher baseline alcohol use than those focused primarily on controlled drinking. Meanwhile, attaining nonhazardous drinking and reduced alcohol use at 12-month follow up were more likely among clients with abstinence-focused trajectories than those focused on controlled drinking.

Conclusions: Since the majority of clients maintain their initially selected drinking goal, counsellors might inform them at treatment admission about the various probabilities of achieving nonhazardous drinking depending on their selected drinking goal.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/10826084.2018.1461222DOI Listing
November 2018

The Effects of Social Presence on Adherence-Focused Guidance in Problematic Cannabis Users: Protocol for the CANreduce 2.0 Randomized Controlled Trial.

JMIR Res Protoc 2018 Jan 31;7(1):e30. Epub 2018 Jan 31.

Swiss Research Institute for Public Health and Addiction, University of Zurich, Zurich, Switzerland.

Background: In European countries, including Switzerland, cannabis is the most commonly used illicit drug. Offering a Web-based self-help tool could potentially reach users who otherwise would not seek traditional help. However, such Web-based self-help tools often suffer from low adherence.

Objective: Through adherence-focused guidance enhancements, the aim of this study was to increase adherence in cannabis users entering a Web-based self-help tool to reduce their cannabis use and, in this way, augment its effectiveness.

Methods: This paper presents the protocol for a three-arm randomized controlled trial (RCT) to compare the effectiveness of (1) an adherence-focused, guidance-enhanced, Web-based self-help intervention with social presence; (2) an adherence-focused, guidance-enhanced, Web-based self-help intervention without social presence; and (3) a treatment-as-usual at reducing cannabis use in problematic users. The two active interventions, each spanning 6 weeks, consist of modules designed to reduce cannabis use and attenuate common mental disorder (CMD) symptoms, including depression, anxiety, and stress-related disorder symptoms based on the approaches of motivational interviewing and cognitive behavioral therapy. With a target sample size of 528, data will be collected at baseline, 6 weeks, and 3 months after baseline. The primary outcome measurement will be the number of days of cannabis use on the preceding 7 days. Secondary outcomes will include the quantity of cannabis used in standardized cannabis joints, the severity of cannabis dependence, changes in CMD symptoms, and adherence to the program. Data analysis will follow the intention-to-treat principle and employ (generalized) linear mixed models.

Results: The project commenced in August 2016; recruitment is anticipated to end by December 2018. First results are expected to be submitted for publication in summer 2019.

Conclusions: This study will provide detailed insights on if and how the effectiveness of a Web-based self-help intervention aiming to reduce cannabis use in frequent cannabis users can be improved by theory-driven, adherence-focused guidance enhancement.

Trial Registration: International Standard Randomized Controlled Trial Number Registry: ISRCTN11086185; http://www.isrctn.com/ISRCTN11086185 (Archived by WebCite at http://www.webcitation.org/6wspbuQ1M).
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/resprot.9484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5812982PMC
January 2018

Engagement Within a Mobile Phone-Based Smoking Cessation Intervention for Adolescents and its Association With Participant Characteristics and Outcomes.

J Med Internet Res 2017 11 1;19(11):e356. Epub 2017 Nov 1.

Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland.

Background: Although mobile phone-delivered smoking cessation programs are a promising way to promote smoking cessation among adolescents, little is known about how adolescents might actually use them.

Objective: The aim of this study was to determine adolescents' trajectories of engagement with a mobile phone-delivered smoking cessation program over time and the associations these trajectories have with baseline characteristics and treatment outcomes.

Methods: We performed secondary data analysis on a dataset from a study that compared a mobile phone-delivered integrated smoking cessation and alcohol intervention with a smoking cessation only intervention for adolescents recruited in vocational and upper secondary school classes (N=1418). Throughout the 3-month intervention, participants in both intervention groups received one text message prompt per week that either assessed smoking-related target behaviors or encouraged participation in a quiz or a message contest. Sequence analyses were performed to identify engagement trajectories. Analyses were conducted to identify predictors of engagement trajectory and associations between engagement trajectories and treatment outcomes.

Results: Three engagement trajectories emerged: (1) stable engagement (646/1418, 45.56%), (2) decreasing engagement (501/1418, 35.33%), and (3) stable nonengagement (271/1418, 19.11%). Adolescents who were younger, had no immigrant background, perceived more benefits of quitting smoking, and reported binge drinking preceding the baseline assessment were more likely to exhibit stable engagement. Due to different reach of more engaged and less engaged participants at follow-up, three statistical models (complete-cases, last-observation-carried-forward, and multiple imputation) for the associations of engagement trajectory and smoking outcome were tested. For 7-point smoking abstinence, no association was revealed to be statistically significant over all three models. However, decreasing engagement with the program was associated over all three models, with greater reductions in daily tobacco use than nonengagement.

Conclusions: The majority of tobacco-smoking adolescents engaged extensively with a mobile phone-based smoking cessation program. However, not only stable engagement but also decreasing engagement with a program might be an indicator of behavioral change. Measures to avoid nonengagement among adolescents appear especially necessary for older smokers with an immigrant background who do not drink excessively. In addition, future studies should not only examine the use of specific program components but also users' engagement trajectories to better understand the mechanisms behind behavioral change.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/jmir.7928DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688246PMC
November 2017

Efficacy of a technology-based, integrated smoking cessation and alcohol intervention for smoking cessation in adolescents: Results of a cluster-randomised controlled trial.

J Subst Abuse Treat 2017 11 14;82:55-66. Epub 2017 Sep 14.

Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, 8031 Zurich, Switzerland. Electronic address:

Objective: To test the efficacy of a technology-based integrated smoking cessation and alcohol intervention versus a smoking cessation only intervention in adolescents.

Methods: This was a two-arm, parallel-group, cluster-randomised controlled trial with assessments at baseline and six months follow-up. Subjects in both groups received tailored mobile phone text messages to support smoking cessation for 3months, and the option of registering for a program incorporating strategies for smoking cessation centred around a self-defined quit date. Subjects in the integrated intervention group also received tailored feedback regarding their consumption of alcohol and, for binge drinkers, tailored mobile phone text messages encouraging them to maintain their drinking within low-risk limits over a 3-month period. Primary outcome measures were the 7-day point prevalence of smoking abstinence and change in cigarette consumption.

Results: In 360 Swiss vocational and upper secondary school classes, 2127 students who smoked tobacco regularly and owned a mobile phone were invited to participate in the study. Of these, 1471 (69.2%) participated and 6-month follow-up data were obtained for 1116 (75.9%). No significant group differences were observed for any of the primary or secondary outcomes. Moderator analyses revealed beneficial intervention effects concerning 7-day smoking abstinence in participants with higher versus lower alcohol consumption.

Conclusions: Overall, the integrated smoking cessation and alcohol intervention exhibited no advantages over a smoking cessation only intervention, but it might be more effective for the subgroup of adolescent smokers with higher alcohol consumption. Providing a combined smoking cessation and alcohol intervention might be recommended for adolescent smokers with higher-level alcohol consumption.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jsat.2017.09.008DOI Listing
November 2017

A Mobile Phone-Based Life Skills Training Program for Substance Use Prevention Among Adolescents: Pre-Post Study on the Acceptance and Potential Effectiveness of the Program, Ready4life.

JMIR Mhealth Uhealth 2017 Oct 4;5(10):e143. Epub 2017 Oct 4.

Swiss Research Institute for Public Health and Addiction at the University of Zurich, Zurich University, Zurich, Switzerland.

Background: Substance use and misuse often first emerge during adolescence. Generic life skills training that is typically conducted within the school curriculum is effective at preventing the onset and escalation of substance use among adolescents. However, the dissemination of such programs is impeded by their large resource requirements in terms of personnel, money, and time. Life skills training provided via mobile phones might be a more economic and scalable approach, which additionally matches the lifestyle and communication habits of adolescents.

Objective: The aim of this study was to test the acceptance and initial effectiveness of an individually tailored mobile phone-based life skills training program in vocational school students.

Methods: The fully automated program, named ready4life, is based on social cognitive theory and addresses self-management skills, social skills, and substance use resistance skills. Program participants received up to 3 weekly text messages (short message service, SMS) over 6 months. Active program engagement was stimulated by interactive features such as quiz questions, message- and picture-contests, and integration of a friendly competition with prizes in which program users collected credits with each interaction. Generalized estimating equation (GEE) analyses were used to investigate for changes between baseline and 6-month follow-up in the following outcomes: perceived stress, self-management skills, social skills, at-risk alcohol use, tobacco smoking, and cannabis use.

Results: The program was tested in 118 school classes at 13 vocational schools in Switzerland. A total of 1067 students who owned a mobile phone and were not regular cigarette smokers were invited to participate in the life skills program. Of these, 877 (82.19%, 877/1067; mean age=17.4 years, standard deviation [SD]=2.7; 58.3% females) participated in the program and the associated study. A total of 43 students (4.9%, 43/877) withdrew their program participation during the intervention period. The mean number of interactive program activities that participants engaged in was 15.5 (SD 13.3) out of a total of 39 possible activities. Follow-up assessments were completed by 436 of the 877 (49.7%) participants. GEE analyses revealed decreased perceived stress (odds ratio, OR=0.93; 95% CI 0.87-0.99; P=.03) and increases in several life skills addressed between baseline and the follow-up assessment. The proportion of adolescents with at-risk alcohol use declined from 20.2% at baseline to 15.5% at follow-up (OR 0.70, 95% CI 0.53-0.93; P=.01), whereas no significant changes were obtained for tobacco (OR 0.94, 95% CI 0.65-1.36; P=.76) or cannabis use (OR 0.91, 95% CI 0.67-1.24; P=.54).

Conclusions: These results reveal high-level acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented. A reasonable next step would be to test the efficacy of this program within a controlled trial.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2196/mhealth.8474DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5647461PMC
October 2017

Alcohol e-Help: study protocol for a web-based self-help program to reduce alcohol use in adults with drinking patterns considered harmful, hazardous or suggestive of dependence in middle-income countries.

Addiction 2018 02 26;113(2):346-352. Epub 2017 Oct 26.

Departamento de Psicobiologia, Escola Paulista de Medicina, Universidad Federal de São Paulo, São Paulo, Brazil.

Background And Aims: Given the scarcity of alcohol prevention and alcohol use disorder treatments in many low and middle-income countries, the World Health Organization launched an e-health portal on alcohol and health that includes a Web-based self-help program. This paper presents the protocol for a multicentre randomized controlled trial (RCT) to test the efficacy of the internet-based self-help intervention to reduce alcohol use.

Design: Two-arm randomized controlled trial (RCT) with follow-up 6 months after randomization.

Setting: Community samples in middle-income countries.

Participants: People aged 18+, with Alcohol Use Disorders Identification Test (AUDIT) scores of 8+ indicating hazardous alcohol consumption.

Intervention And Comparator: Offer of an internet-based self-help intervention, 'Alcohol e-Health', compared with a 'waiting list' control group. The intervention, adapted from a previous program with evidence of effectiveness in a high-income country, consists of modules to reduce or entirely stop drinking.

Measurements: The primary outcome measure is change in the Alcohol Use Disorders Identification Test (AUDIT) score assessed at 6-month follow-up. Secondary outcomes include self-reported the numbers of standard drinks and alcohol-free days in a typical week during the past 6 months, and cessation of harmful or hazardous drinking (AUDIT < 8).

Analysis: Data analysis will be by intention-to-treat, using analysis of covariance to test if program participants will experience a greater reduction in their AUDIT score than controls at follow-up. Secondary outcomes will be analysed by (generalized) linear mixed models. Complier average causal effect and baseline observations carried forward will be used in sensitivity analyses.

Comments: If the Alcohol e-Health program is found to be effective, the potential public health impact of its expansion into countries with underdeveloped alcohol prevention and alcohol use disorder treatment systems world-wide is considerable.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/add.14034DOI Listing
February 2018

Moderators of outcome in a technology-based intervention to prevent and reduce problem drinking among adolescents.

Addict Behav 2017 09 24;72:64-71. Epub 2017 Mar 24.

Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, 8031 Zurich, Switzerland. Electronic address:

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.addbeh.2017.03.013DOI Listing
September 2017
-->