An Interactive Text Message Intervention to Reduce Binge Drinking in Young Adults: A Randomized Controlled Trial with 9-Month Outcomes

Brian Suffoletto, Jeffrey Kristan, Tammy Chung, Kwonho Jeong, Anthony Fabio, Peter Monti, Duncan B Clark, Brian Suffoletto, Jeffrey Kristan, Tammy Chung, Kwonho Jeong, Anthony Fabio, Peter Monti, Duncan B Clark

Abstract

Background: Binge drinking is associated with numerous negative consequences. The prevalence and intensity of binge drinking is highest among young adults. This randomized trial tested the efficacy of a 12-week interactive text message intervention to reduce binge drinking up to 6 months after intervention completion among young adults.

Methods and findings: Young adult participants (18-25 y; n = 765) drinking above the low-risk limits (AUDIT-C score >3/4 women/men), but not seeking alcohol treatment, were enrolled from 4 Emergency Departments (EDs) in Pittsburgh, PA. Participants were randomized to one of three conditions in a 2:1:1 allocation ratio: SMS Assessments + Feedback (SA+F), SMS Assessments (SA), or control. For 12 weeks, SA+F participants received texts each Thursday querying weekend drinking plans and prompting drinking limit goal commitment and each Sunday querying weekend drinking quantity. SA+F participants received tailored feedback based on their text responses. To contrast the effects of SA+F with self-monitoring, SA participants received texts on Sundays querying drinking quantity, but did not receive alcohol-specific feedback. The control arm received standard care. Follow-up outcome data collected through web-based surveys were provided by 78% of participants at 3- months, 63% at 6-months and 55% at 9-months. Multiple imputation-derived, intent-to-treat models were used for primary analysis. At 9-months, participants in the SA+F group reported greater reductions in the number of binge drinking days than participants in the control group (incident rate ratio [IRR] 0.69; 95% CI .59 to.79), lower binge drinking prevalence (odds ratio [OR] 0.52; 95% CI 0.26 to 0.98]), less drinks per drinking day (beta -.62; 95% CI -1.10 to -0.15) and lower alcohol-related injury prevalence (OR 0.42; 95% CI 0.21 to 0.88). Participants in the SA group did not reduce drinking or alcohol-related injury relative to controls. Findings were similar using complete case analyses.

Conclusions: An interactive text-message intervention was more effective than self-monitoring or controls in reducing alcohol consumption and alcohol-related injury prevalence up to 6 months after intervention completion. These findings, if replicated, suggest a scalable approach to help achieve sustained reductions in binge drinking and accompanying injuries among young adults.

Trial registration: ClinicalTrials.gov NCT01688245.

Conflict of interest statement

Competing Interests: Dr. Suffoletto has a copyright for a “Text Message system to longitudinally assess alcohol consumption and provide psycho-educational feedback” which was licensed to HealthStratica LLC. BS is a consultant for HealthStratica, with no equity or management. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials. HelathStratica was not involved in the design, conduct, analysis or reporting of this trial.

Figures

Fig 1. CONSORT Diagram.
Fig 1. CONSORT Diagram.
SA + F, SMS Assessments + Feedback intervention; SA, SMS Assessments.
Fig 2. Self-reported alcohol consumption and alcohol-related…
Fig 2. Self-reported alcohol consumption and alcohol-related injuries at 3-, 6- and 9-months follow-ups.

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