mHealth Delivery of a Motivational Intervention to Address Heavy Drinking Among College Students (North Carolina)

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Large numbers of underage students drink heavily, often in binges, which can lead to negative consequences such as blackouts, rape, HIV-related sexual risk-taking, academic failure, suicide, and violence. While interventions such as the Brief Motivational Intervention (BMI) have decreased alcohol misuse, widespread implementation of this intervention has been slow due to challenges and high costs of implementing and sustaining them. Motivational intervention is a therapeutic style with demonstrated effectiveness to reduce ambivalence, bolster motivation, and induce commitment to changing a behavior. Because smartphones (SPs) are ubiquitous among college students, they may offer a more efficient and cost-effective means to deliver an alcohol BMI than in-person interventions. In this project, researchers at the University of North Carolina at Charlotte developed and tested a SP application (app) designed to reduce risky drinking among college students.

The specific aims are of this project were as follows:

  • Develop a SP application by adapting a BMI intervention to create the pBMI+SP using mHealth technology. 
  • Test the pBMI+SP feasibility and initial efficacy among heavy-drinking college students. 

In stage one of the project, the team developed the pBMI+SP app application by adapting a proven in-person BMI intervention. Iterative testing and focus groups were conducted to identify needed modifications. The pBMI+SP was found to be acceptable with good usability and was determined to be a feasible intervention for targeting risky alcohol use among college students. In stage two, the team conducted a randomized controlled trial (RCT) to test the efficacy of pBMI+SP where students participated in either the in-person BMI intervention or the app-based intervention. A comparison of change from baseline to 6 weeks between the two groups did not detect a statistically significant difference in alcohol use or alcohol-related consequences, indicating the app performed as well as the in-person BMI intervention.

The team concluded that a SP app designed to address risky alcohol use in college students may be effective for reaching a larger population than traditional in-person approaches. Reduced costs, less time to train staff, and decreased need for physical space make mobile health interventions a prime delivery method for alcohol interventions as compared to in-person interventions. The team plans to test the pBMI+SP app in a larger RCT and recommends modification of the app for use in other health issues, including risky sexual behavior, HIV risk reduction, smoking cessation, and obesity.

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mHealth Delivery of a Motivational Intervention to Address Heavy Drinking Among College Freshmen - Final Report

Kazemi, D. mHealth Delivery of a Motivational Intervention to Address Heavy Drinking Among College Freshmen - Final Report. (Prepared by University of North Carolina at Charlotte under Grant No. R21 HS023875). Rockville, MD: Agency for Healthcare Research and Quality, 2018. (PDF, 279.84 KB)

The findings and conclusions in this document are those of the author(s), who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.
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Reducing Risky College Drinking Through The Use of Cutting Edge mHealth Technology

Key Finding and Impact

Apps to address dangerous alcohol use in college age adults may be as effective, and more cost-effective, as traditional in-person interventions.

Heavy alcohol use and its related consequences are major health problems for U.S. universities.

High-risk drinking in college students has dangerous and numerous consequences. Addressing alcohol use in college students has often relied on in-person interventions, which are expensive, difficult to sustain, and often inaccessible. Recognizing the almost universal use of smartphones (SP) and “apps” (applications) in this young adult population, researchers at the University of North Carolina at Charlotte hoped to reduce high-risk drinking through the use of a proven, evidence-based alcohol intervention using mHealth technology.

Using an adapted Brief Motivational Interviewing Smartphone App (BMI+SP) as a real-time alcohol intervention.

In addition to academic failure, the consequences of alcohol abuse can include blackouts, violence, suicide, HIV-related sexual risk-taking, and sexual assault.

Dr. Kazemi and her national interdisciplinary team of researchers, including experts in psychology, computer science, mathematics, and nursing, aimed to address the cost and accessibility challenges of in-person alcohol interventions by developing BMI+SP, a smartphone app that uses an adapted Brief Motivational Interviewing (BMI) intervention to encourage users to change their high-risk drinking behaviors. BMI+SP has multiple interactive components designed to engage the user and provide customized messaging based on user characteristics. Dr. Kazemi and team found a significant reduction in alcohol use and alcohol-related consequences in students who used the app for 6 weeks compared to students who did not use the app.

mHealth apps can reach youth to reduce alcohol use and intervention costs.

This study suggested that mHealth apps can help to address dangerous alcohol use in young adults. BMI+SP and similar apps have the potential to reduce alcohol intervention costs, reach more individuals than traditional in-person interventions, and be adapted for use across other areas of health concerns. Dr. Kazemi reports that these findings will inform future, more extensive studies looking at the usability, sustainability, efficacy, and cost-effectiveness of mHealth interventions to address hazardous drinking among young adults. This innovative approach also has the potential to be translated to address other important health issues in vulnerable populations.

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