Text-Based Messaging Strategies for Preventing Subsequent Problematic Alcohol Use

Official title

The Effectiveness of Text-Based Messaging Strategies for Preventing Subsequent Problematic Alcohol Use Among Technical Trainees in the US Air Force

Overview

Binge drinking, and its health/social consequences are substantial public health concerns, with a high prevalence in young adults, especially in the US military. Alcohol consumption in the military is very high and normative, but there is zero tolerance for alcohol-related legal trouble, and Air Force Airmen who experience this (e.g., DUI, sexual assault) typically receive a disciplinary action referred to as an Alcohol Related Incident (ARI). Brief Alcohol Interventions (BAIs) for alcohol misuse are effective in young adults who report binge drinking. Many BAI studies targeted young adults who drink hazardously; these individuals are typically not interested in abstaining but may try decreasing the amount or change the manner in which they drink in order to reduce harmful consequences. The investigators previously published the results of a BAI group-based intervention that reduced ARIs in over 150,000 Airmen on average by 16%. Since 2010, the BAI has been disseminated to most USAF Airmen in Technical Training. However, it is clear additional research is needed to enhance the efficacy of the intervention and reduce risks associated with problem drinking. One strategy to improve health outcomes is well-timed, tailored, and automated text messages. Building on the researchers' preliminary study where text messages reduced driving after drinking as well as total drinks consumed before driving, text messaging may be highly effective when sent at the precise time that Airmen gain access to alcohol (the first time they are allowed off base), a standard time for all Technical Trainees. One challenge to conducting alcohol research in the military is the lack of privileged communication. As a result, it is difficult to obtain valid self-reports due to a tendency to deny or minimize use. The investigators recently developed and validated a method for collecting anonymous data over time. This will be the first study in the military, as well as the first large scale, adequately powered trial, where intervention effects will be tracked out to a 6-month follow-up. The study's Specific Aims are to randomize approximately 7000 Airmen to either the current BAI versus the BAI+Text messages timed to occur before, during, and after Airmen have access to alcohol; and to evaluate the efficacy of the intervention at the end of training and 6 months post-training using repeated surveys with unique identifiers allowing researchers to match surveys while maintaining anonymity.

Detailed description

Episodic heavy or binge drinking and the associated health and social consequences are substantial public health concerns, with a high prevalence among young adults. This is particularly true among US military personnel. While alcohol consumption in the US military is very high and normative, there is zero tolerance for getting in legal trouble while drinking, and Airmen who do get in alcohol-related legal trouble (e.g., DUI, sexual assault) typically receive what is called an Alcohol Related Incident (ARI).

In other populations, Brief Alcohol Interventions (BAIs) for alcohol misuse have been validated as efficacious with robust evidence for mostly college young adults who report episodic heavy drinking. Many BAI studies have targeted young adults who drink hazardously; these individuals are generally not interested in abstaining from alcohol but are often willing to decrease the amount they drink or change the manner in which they drink in order to reduce harmful consequences. The investigators have previously published the results of a BAI group-based intervention that has been shown to reduce ARIs universally (not in just high-risk drinkers) in over 150,000 on average by 16%. Since this intervention began in 2010, the BAI has been disseminated to most Airmen in Technical (Advanced) Training in the US Air Force. However, it is clear that additional research is needed to enhance the efficacy of the BAI intervention and to reduce the risk associated with problem drinking behavior. One such strategy that could improve health promotion outcomes is well timed and tailored automated text messages. Building on the preliminary study where text messages reduced driving after drinking as well as total drinks consumed before driving, text messaging may be highly effective as the precise time that Airmen gain access to alcohol (when they are allowed off base for the first time) is known and is the same time point for all Airmen.

One of the challenges to conducting alcohol research in the military is the lack of privileged communication. As a result, it is difficult to obtain valid self-reports due to a tendency to deny or minimize use. Fortunately, the research team has recently validated a method for collecting anonymous data over time.

This study will randomize approximately 7000 Airmen to either the currently administered group BAI versus the BAI + Interactive Counselor Facilitated Text messages timed to occur before, during, and after Airmen have access to alcohol; and (2) To evaluate the efficacy of the intervention at an end of training and 6-month follow-up using repeated anonymous surveys with unique identifiers allowing investigators to match up surveys while simultaneously maintaining anonymity.

Interventions

• Behavioral Brief Alcohol Intervention
  All Airmen will receive a standard BAI during the 4th week of Technical Training, the last week of enforced abstinence. The BAI is a group-based, one-hour session which includes the following components: Interactive discussion of the positives and negatives of drinking during training and heavy vs. moderate drinking; Discussion of USAF rules on alcohol use and penalties for violations; Discussion of impact of alcohol on military readiness; effects of alcohol and hangover on performance; Review o
• Behavioral Automated and Targeted Text Messages
  All messages are pre-written, and their timing is pre-planned - All Airmen will start receiving 3-5 text messages per week starting the Monday after they received the Brief Alcohol Intervention and lasting for six weeks. The intervention is also targeted to age, with some messaging differing for Airmen less than 21 years and those already 21 years old or who will turn 21 during the intervention period. All Airmen randomized to the text message arm will be enroll into the supplemental program, an

Primary outcome measures

• NIAAA Single Alcohol Screening Question (SASQ) [Time frame: Baseline, 60 days, 6 months]

Secondary outcome measures (1)

• AUDIT- C [Time frame: Baseline, 60 days, 6 months]

Eligibility criteria

Inclusion criteria

• Must be a United States Air Force Technical Training student in one of the following training groups or wings: 37th Training Wing, 81st Training Wing, 82nd Training Wing, or 59th Training Group.
• Must be 18 years of Age
• Must be able to understand English
• Must be able to receive text messages

Exclusion criteria

• Under 18 years of age
• Not in the specified Technical Training groups or wings

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Prevention

Study locations

United States · 1 center

• JBSA Lackland — San Antonio

Identifiers

NCT: NCT06318975 · RAPTOR · R01AA029074

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗