Gain and Loss Framed Text Messaging to Reduce Drinking Among Older Adults (GLOSS)

The goal of this study is to evaluate effectiveness of scalable, tailored text- messaging programs for alcohol use among older adults. This study focuses on gain and loss framing of behavior change goals (i.e., the positives of change and the negatives of remaining with the status quo), critical components of behavioral science and health behavioral interventions. Loss-framing is used to motivate individuals to avoid future problems by focusing on the consequences of no change in behavior, and gain-framing is used to facilitate progress by focusing on the benefits of change. The investigators will design and evaluate three text-messaging programs using a randomized controlled trial: (A) Loss-framed messaging (B) Gain-framed messaging; and (C) Combined (loss and gain) messaging among a sample of 150 older adults with hazardous drinking. Participants will be randomized to one of the three conditions, each of which will include 8 weeks of text-messaging. During the study participants will completed assessments online and via text messages to track drinking.

Study Overview

• Status: Completed
• Conditions: Alcohol Consumption
• Intervention / Treatment: Behavioral: Brief Normative Feedback; Behavioral: Loss-framed Text-messaging; Behavioral: Gain-framed Text-messaging

Detailed Description

There is an urgent call for efficient and effective assessment, prevention, and intervention among older adults (age 50 and older) to reduce health risk of hazardous drinking, encourage healthy aging, and reduce burden on healthcare systems. Brief, low-burden, low-cost, digital interventions among older adults can answer this call. Text-messaging health interventions are considered an effective, scalable way to deliver behavioral health interventions, and they have been used as evidence-based solutions in primary care settings among older adults for behaviors other than alcohol use to supplement traditional care. Contrary to stereotypes, older adults use mobile technology, seek online and mobile interventions, and often engage longer compared to younger populations. The primary objective of the proposed study is to evaluate effectiveness of scalable, tailored text- messaging programs for alcohol use among older adults. This study focuses on gain and loss framing of behavior change goals (i.e., the positives of change and the negatives of remaining with the status quo), critical components of behavioral science and health behavioral interventions. Loss-framing is used to motivate individuals to avoid future problems by focusing on the consequences of no change in behavior, and gain-framing is used to facilitate progress by focusing on the benefits of change. The investigators will design and evaluate three text-messaging programs using a randomized controlled trial: (A) Loss-framed messaging (B) Gain-framed messaging; and (C) Combined (loss and gain) messaging among a sample of 150 older adults with hazardous drinking. Participants will be randomized to one of the three conditions, each of which will last 8 weeks. Participants will undergo cross- sectional online assessments (baseline, week 4, week 8 and week 16), and they will also complete a mobile assessment (via text message) once per week to track drinking. The effects of condition on drinking behavior will be compared at weeks 4, 8 and 16. In addition, attrition from the study will be closely tracked. Finally, the investigators will explore how the effects condition are impacted by gender and age (via moderation analysis).

• Study Type: Interventional
• Enrollment (Actual): 133
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • New York
    • New York, New York, United States, 10035
      • Hunter College of CUNY

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Be fluent in and able to read English at the eighth grade level
• Between the ages 50 and 85
• Have an estimated average weekly consumption of greater than, for women and men 65 and older, 12, or for men 64 and younger, 15 standard drinks per week
• Be willing to reduce their drinking to non-hazardous levels
• Be willing to provide informed consent
• Own a mobile phone with SMS capability and have an active email address.
• Be willing to receive and respond to up to 120 text messages total per month, as well as four online, web- based surveys.

Exclusion Criteria:

• Demonstrate physiological dependence on alcohol, as evidenced by current or a history of serious physical withdrawal symptoms (e.g., measured by SAWS)
• Present with significant substance use (greater than weekly use) or a current substance use disorder (for any substance other than alcohol, nicotine, or caffeine, measured by self report on Form-90 based questions)
• Present with a serious psychiatric illness or suicide risk, as measured by previous inpatient treatment, medications for mood disorder or psychosis, recent suicidality, and the PHQ-9.
• Unable to understand research study procedures as evidenced by failing a short quiz at the end of reviewing the consent form.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Loss-framed Messaging; Daily text messages on the consequences of hazardous drinking (e.g., "Think of all you have lost as a result of drinking too much. Make today a day that sets the stage for change.")	Behavioral: Brief Normative Feedback; Once a participant has completed the assessment of their drinking during the baseline battery, the participant will receive brief normative feedback about how their drinking compares to their peers.; Behavioral: Loss-framed Text-messaging; Daily text-messages on the consequence of hazardous drinking.
Active Comparator: Gain-framed Messaging; Daily text messages on the benefits of reducing drinking to safe guidelines (e.g., "Think of all you can achieve if you can control your drinking. Make today a day that sets the stage for change.")	Behavioral: Brief Normative Feedback; Once a participant has completed the assessment of their drinking during the baseline battery, the participant will receive brief normative feedback about how their drinking compares to their peers.; Behavioral: Gain-framed Text-messaging; Daily text messages on the benefits of reducing drinking to safe guidelines.
Active Comparator: Gain-framed and Loss-framed Messaging; Daily text messages that alternate between loss-framed (e.g., "Think of all you have lost as a result of drinking too much. Make today a day that sets the stage for change.") and gain-framed messaging (e.g., "Think of all you can achieve if you can control your drinking. Make today a day that sets the stage for change.")	Behavioral: Brief Normative Feedback; Once a participant has completed the assessment of their drinking during the baseline battery, the participant will receive brief normative feedback about how their drinking compares to their peers.; Behavioral: Loss-framed Text-messaging; Daily text-messages on the consequence of hazardous drinking.; Behavioral: Gain-framed Text-messaging; Daily text messages on the benefits of reducing drinking to safe guidelines.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Weekly sum of standard drinks	Measure 1 of drinking, average of weekly sum of standard drinks	baseline, week 4, week 8, and week 16
Weekly sum of heavy drinking days	Measure 2 of drinking, average of weekly heavy drinking days	baseline, week 4, week 8, and week 16

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Percent adherence to daily drinking assessment via text messages	Responses to text messages (via text message) are considered "adherence" to the daily drinking assessment. This measure is akin to compliance.	once daily, starting at baseline, lasting for 8 weeks
Percent adherence to weekly drinking assessment via web	Responses to text messages (via text message) are considered "adherence" to the weekly drinking assessment. This measure is akin to compliance.	once weekly, starting at baseline, lasting 8 weeks
Percent willingness to continue the program for another 8 weeks	Participants are asked, "would you like to continue to receive text messages for the next 8 weeks?" If participants report yes, that is willingness to continue in the program. If no, then participants are not willing to continue in the program.	At week 8 assessment

Collaborators and Investigators

• Sponsor: Hunter College of City University of New York
• Investigators: Principal Investigator: Alexis Kuerbis, LCSW, PhD, Silberman School of Social Work at Hunter College City, University of New York

Study record dates

Study Major Dates

• Study Start (Actual): February 26, 2024
• Primary Completion (Actual): December 10, 2024
• Study Completion (Actual): December 10, 2024

Study Registration Dates

• First Submitted: November 1, 2023
• First Submitted That Met QC Criteria: November 8, 2023
• First Posted (Actual): November 13, 2023

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: March 10, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Keywords: older adults; Mobile Health; Behavioral economics; Text messaging
• Additional Relevant MeSH Terms: Drinking Behavior; Alcohol Drinking
• Other Study ID Numbers: 2023-0653-Hunter

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No