%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e73382 %T Short, Animated Storytelling Video to Reduce Addiction Stigma in 13,500 Participants Across Multiple Countries Through an Online Approach: Protocol for a Randomized Controlled Trial %A Adam,Maya %A Klapow,Maxwell %A Greuel,Merlin %A Seeff,Misha %A Rohr,Julia K %A Gordon,Andrew %A Amsalem,Doron %A Bärnighausen,Till %+ , Department of Pediatrics, Stanford University School of Medicine, 453 Quarry Rd, Palo Alto, Stanford, CA, 94304, United States, 1 6508393600, madam@stanford.edu %K stigma reduction %K addiction %K health communication %K social media %K animation %K video %K storytelling. %D 2025 %7 5.5.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stigma toward people with addiction is a well-documented phenomenon that dramatically impacts help-seeking, treatment, and recovery. Interventions aimed at reducing stigma toward those with addiction must overcome the frequent mischaracterization of addiction as a failure of judgment rather than a chronic, treatable illness. Previous research has demonstrated that social contact with people recovering from addiction can promote empathy and reduce stigma, but social contact is difficult to scale. Short, animated storytelling (SAS) is a novel health communication approach that scales easily because it can leapfrog barriers associated with language, culture, literacy, and education levels. Objective: This study will investigate the effect of a cross-culturally accessible SAS video intervention aimed at reducing stigma and increasing empathy toward people with addiction. We also seek to gain insight into the mechanisms of action of this SAS intervention by measuring the contribution of sound design to their effect. Methods: We will conduct a randomized controlled trial with 13,500 adult participants from the United States, the United Kingdom, and South Africa, recruited online via Prolific Academic and randomized into 3 arms, per country. The 2 intervention arms will receive a wordless, social contact–based SAS video, one arm with a soundtrack and one without. The third arm will receive an educational video about addiction. Validated questionnaires will be used to assess our primary outcome, addiction stigma, and secondary outcomes, optimism, warmth toward the subject, and hopefulness, at baseline, immediately post exposure, and 2 weeks later. Ethics clearance was obtained on August 15, 2024, from the Stanford University institutional review board (protocol 76457). Results: This trial was funded in January 2025 by the Heidelberg Institute of Global Health, the Faculty of Medicine at Heidelberg University, in Germany. As of March 2025, no data have been collected. The estimated start date for this trial is May 15, 2025. We expect to complete data collection by July 1, 2025, and expect results to be published in the spring of 2026. Conclusions: Here, we present the protocol for an online, multicountry, randomized controlled trial. This trial is designed to measure the effect of an innovative approach to global health communication (wordless, short, and animated storytelling) on addiction stigma in 3 global regions. These findings will inform the design of future scalable, digital health storytelling interventions for global audiences while exploring the capacity of SAS to shift public health attitudes and perceptions. Furthermore, if effective, the intervention described here could be disseminated broadly via social media and other online platforms. Trial Registration: ClinicalTrials.gov NCT06705205; https://clinicaltrials.gov/study/NCT06705205 International Registered Report Identifier (IRRID): PRR1-10.2196/73382 %M 40324168 %R 10.2196/73382 %U https://www.researchprotocols.org/2025/1/e73382 %U https://doi.org/10.2196/73382 %U http://www.ncbi.nlm.nih.gov/pubmed/40324168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55621 %T Demographics and Use of an Addiction Helpline for Concerned Significant Others: Observational Study %A Chernick,Rachel %A Sy,Amanda %A Dauber,Sarah %A Vuolo,Lindsey %A Allen,Bennett %A Muench,Fred %+ Partnership to End Addiction, 711 Third Avenue, Fifth Floor, New York, NY, 10017, United States, 1 212 973 3526, rchernick@toendaddiction.org %K family %K hotline %K helpline %K warmline %K crisis continuum %K substance abuse %K addiction %K youth %K concerned significant other %K digital behavioral health %K parents %K substance use disorders %K well-being %K public health intervention %K cannabis %K treatment %K opioids %K men %K women %K assessments %D 2025 %7 14.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Concerned significant others (CSOs) play a significant role in supporting individuals with substance use disorders. There is a lack of tailored support services for these CSOs, despite their substantial contributions to the well-being of their loved ones (LOs). The emergence of helplines as a potential avenue for CSO support is outlined, culminating in the focus on the Partnership to End Addiction’s helpline service, an innovative public health intervention aimed at aiding CSOs concerned about an LO’s substance use. Objective: The article analyzes the demographics and use patterns of the Partnership to End Addiction’s helpline service, highlighting the critical role of such services, and advocating for expanded, tailored support models. Methods: This observational study draws data from 8 data platforms spanning April 2011 to December 2021, encompassing 24,096 client records. Surveys were completed by helpline specialists during synchronous telephone calls or self-reported by CSOs before helpline engagement. Collected information encompasses demographics, interaction language, substance of concern, CSO-LO relationship, and the LO’s “use state,” that is, their location on the continuum of substance use. Results: CSOs primarily comprised women (13,980/18,373, 76.1%) seeking support for their children (1062/1542, 68.9%). LOs were mostly male (1090/1738, 62.7%), aged 18-25 years (2380/7208, 33%), with primary substance concerns being cannabis (5266/12,817, 40.9%), opioids (2445/12,817, 19%), and stimulants (1563/12,817, 12.1%). CSOs primarily sought aid for LOs struggling with substances who were not in treatment (1102/1753, 62.9%). The majority of CSOs were looking for support in English (14,738/17,920, 82.2%), while the rest (3182/17,920, 17.8%) preferred to communicate in Spanish. Spanish-speaking CSOs were significantly more likely to call about cannabis (n=963, 53.7% vs n=4026, 38.6%) and stimulants (n=304, 16.9% vs n=1185, 11.3%) than English-speaking CSOs (P<.001). On the other hand, English-speaking CSOs were more likely to be concerned about opioids than Spanish-speaking CSOs (n=2215, 21.3% vs n=94, 5.2%; P<.001). Conclusions: The study illuminates the helpline’s pioneering role in aiding CSOs grappling with an LO’s substance use. It highlights helplines as crucial resources for CSOs, revealing key demographic, substance-related, and use-state trends. The dominant presence of women among users aligns with other helpline patterns and reflects traditional caregiving roles. While parents form a significant percentage of those reaching out, support is also sought by siblings, friends, and other family members, emphasizing the need for assistance for other members of an LO’s social network. Spanish-speaking individuals’ significant outreach underscores the necessity for bilingual support services. Substance concerns revolve around cannabis, opioids, and stimulants, influenced by age and language preferences. The helpline serves as an essential intermediary for CSOs, filling a gap between acute crisis intervention services and formalized health care and treatment services. Overall, the study highlights this helpline’s crucial role in aiding CSOs with tailored, accessible support services. %M 40228240 %R 10.2196/55621 %U https://www.jmir.org/2025/1/e55621 %U https://doi.org/10.2196/55621 %U http://www.ncbi.nlm.nih.gov/pubmed/40228240 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e64720 %T The Color of Drinking Survey Questionnaire for Measuring the Secondhand Impacts of High-Risk Drinking in College Settings: Validation Study %A Marconi,Agustina %A Washington,Reonda %A Jovaag,Amanda %A Blomme,Courtney %A Knobeloch,Ashley %A Irazola,Vilma %A Muros Cortés,Carolina %A Gutierrez,Laura %A Elorriaga,Natalia %K validation study %K alcohol drinking in college %K microaggression %K university %K student %K young adult %K undergraduate %K survey %K questionnaire %K reliability %K consistency %D 2025 %7 7.4.2025 %9 %J Interact J Med Res %G English %X Background: The “Color of Drinking” is a study conducted at the University of Wisconsin-Madison. It examines the secondhand harms of high-risk drinking on college students of color and explores the connection between alcohol use and the campus racial climate. Since its findings were released in 2018, this study has received significant attention from other college settings around the country. Objective: This study aims to describe the development of the most recent version of the Color of Drinking questionnaire and to assess its internal consistency, test-retest reliability, and construct validity in a sample of undergraduate students attending the University of Wisconsin-Madison. Methods: This is an observational, analytic study. Questionnaire design experts revised the original instrument, and in-depth cognitive interviews with students were conducted to evaluate comprehensibility and acceptability. The revised questionnaire was administered 2 times, 3 to 4 weeks apart, in a sample of undergraduate students. The following properties were studied: internal consistency in 4 sets of items (Cronbach α), test-retest reliability among closed-ended questions (κ statistics and intraclass correlation coefficient), and construct validity (associations with other validated instruments, such as the Alcohol Use Disorders Identification Test). For a section of questions showing low reliability, the answers to open questions and other in-depth interviews were carried out, and online surveys were conducted with another sample of undergraduate students to evaluate reliability after changes. Results: Eight students participated in the in-depth interviews, 177 responses from the online survey were included for the analysis of internal consistency, 115 for test-retest reliability, and 98 for construct validity. The 4 sets of items (sections) evaluated (“impact of alcohol consumption on academics,” “impact of microaggressions,” “witnessing microaggressions and alcohol intoxication,” and “bystanders’ interventions on alcohol intoxication”) presented good internal consistency (Cronbach α between 0.723 and 0.898). Most items showed moderate to substantial test-retest reliability; agreement was from 68.1% to 95.2%, and κ coefficients ranged from 0.214 to 0.8. For construct validity, correlations between the number of drinking days, the maximum number of drinks in a day and the Alcohol Use Disorders Identification Test score were moderate to high, r=0.630 (95% CI 0.533-0.719) and r=0.647 (95% CI 0.548-0.741), respectively. Due to low reliability, a section regarding “health impacts” has been redesigned, including 8 items for the personal consumption of alcohol and the consumption of others (Cronbach α 0.735 and 0.855, respectively; agreement between the first and the second time the questionnaire was administered were 83.4% and 99.1%, and most of the items with κ coefficient from 0.476 to 0.877). Conclusions: The revised version of the Color of Drinking questionnaire showed acceptable to adequate reliability and construct validity. %R 10.2196/64720 %U https://www.i-jmr.org/2025/1/e64720 %U https://doi.org/10.2196/64720 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e60620 %T Evaluating the Effect of the JUUL2 System With 5 Flavors on Cigarette Smoking and Tobacco Product Use Behaviors Among Adults Who Smoke Cigarettes: 6-Week Actual Use Study %A Goldenson,Nicholas I %A Shiffman,Saul %A Sembower,Mark A %A Selya,Arielle %A Pype,Steve %A Black,Ryan A %+ , Juul Labs, Inc, 1000 F Street NW, Suite 800, Washington, DC, 20004, United States, 1 510 501 5964, nicholas.goldenson@juul.com %K cigarette %K smoking %K electronic nicotine delivery system %K switching %K actual use study %K real world %D 2025 %7 26.3.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Adults who switch completely from smoking cigarettes to using electronic nicotine delivery systems (ENDS) substantially reduce their exposure to toxicants and carcinogens that are associated with smoking-related diseases. Objective: This 6-week actual use study—a prospective uncontrolled real-world study designed to evaluate quasi-naturalistic product use—aimed to assess switching behavior among US adults who smoked cigarettes and were provided with JUUL2 ENDS products. Methods: US adults who smoked cigarettes every day but were predominantly not ready to quit (N=1160; mean age 39.42, SD 11.03 years; 641/1160, 55.26% female participants; 667/1160, 57.5% non-Hispanic White; mean cigarettes per day 14.11, SD 8.96; only 1% [11/1160] planning to stop smoking within 30 days; and 481/1160, 41.47% dual users) were recruited to use JUUL2 ENDS products (18 mg/mL nicotine) in 1 of 5 flavors in real-world environments for 6 weeks. Participants who expressed sufficient interest in using JUUL2 products were enrolled at 24 different consumer research sites across the United States into one of the two following study arms: (1) traditional flavors (Virginia Tobacco and Polar Menthol, 10 sites); or (2) complex flavors (Autumn Tobacco, Summer Menthol, and Ruby Menthol, 14 sites). No instructions regarding JUUL2 product use or cigarette smoking were provided. After a 1-week trial period, participants were provided with their preferred flavor for 6 weeks of ad libitum use (10 pods per week). In total, 6 weekly web-based surveys were used to assess switching (smoking abstinence) and smoking reduction; dependence and respiratory symptoms were assessed at baseline and week 6. Results: Across the 5 flavor groups at week 6, the rates of complete past-7-day switching away from cigarettes ranged from 38.2% (79/207) to 47.3% (95/201), and 24.3% (55/226) to 33.9% (74/218) of participants reported complete past-30-day switching. Participants who used the 3 menthol-flavored (vs 2 tobacco-flavored) JUUL2 products had significantly higher rates of past-30-day switching at week 6 (odds ratio 1.36, 95% CI 1.04-1.78). Compared to their baseline values when they were smoking, the past-30-day switchers at week 6 had significantly reduced their dependence (mean differences in dependence, cigarettes – JUUL2: 0.57-0.99; P<.001) and self-reported frequency of respiratory symptoms (P<.05). Among participants who continued to smoke at week 6, 50.9% (59/116) to 62.9% (73/116) reduced their daily cigarette consumption by at least 50% from baseline. Conclusions: Adoption of JUUL2 ENDS products can likely help substantial proportions of US adults who smoke to switch completely away from cigarettes or meaningfully reduce their cigarette consumption, thereby reducing their dependence on tobacco products and improving their respiratory symptoms. %M 40138686 %R 10.2196/60620 %U https://www.i-jmr.org/2025/1/e60620 %U https://doi.org/10.2196/60620 %U http://www.ncbi.nlm.nih.gov/pubmed/40138686 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 17 %N %P e57084 %T Real-World Data on Alcohol Consumption Behavior Among Smartphone Health Care App Users in Japan: Retrospective Study %A Eguchi,Kana %A Kubota,Takeaki %A Koyanagi,Tomoyoshi %A Muto,Manabu %+ Department of Informatics, Graduate School of Informatics, Kyoto University, Yoshida-Hommachi, Sakyo-ku,, Kyoto, 606-8501, Japan, 81 75 753 3369, kana.eguchi@ieee.org %K alcohol consumption %K individual behavior %K mobile health %K mobile health app %K mobile health care app log-based survey %K real-world data %K RWD %K RWD analysis %K smartphone health care app %K surveillance system %K health care app %D 2025 %7 25.3.2025 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Although many studies have used smartphone apps to examine alcohol consumption, none have clearly delineated long-term (>1 year) consumption among the general population. Objective: The objective of our study is to elucidate in detail the alcohol consumption behavior of alcohol drinkers in Japan using individual real-world data. During the state of emergency associated with the COVID-19 outbreak, the government requested that people restrict social gatherings and stay at home, so we hypothesize that alcohol consumption among Japanese working people decreased during this period due to the decrease in occasions for alcohol consumption. This analysis was only possible with individual real-world data. We also aimed to clarify the effects of digital interventions based on notifications about daily alcohol consumption. Methods: We conducted a retrospective study targeting 5-year log data from January 1, 2018, to December 31, 2022, obtained from a commercial smartphone health care app (CALO mama Plus). First, to investigate the possible size of the real-world data, we investigated the rate of active users of this commercial smartphone app. Second, to validate the individual real-world data recorded in the app, we compared individual real-world data from 9991 randomly selected users with government-provided open data on the number of daily confirmed COVID-19 cases in Japan and with nationwide alcohol consumption data. To clarify the effects of digital interventions, we investigated the relationship between 2 types of notification records (ie, “good” and “bad”) and a 3-day daily alcohol consumption log following the notification. The protocol of this retrospective study was approved by the Ethics Committee of the Kyoto University Graduate School and Faculty of Medicine (R4699). %M 40131328 %R 10.2196/57084 %U https://ojphi.jmir.org/2025/1/e57084 %U https://doi.org/10.2196/57084 %U http://www.ncbi.nlm.nih.gov/pubmed/40131328 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e49844 %T The Virtual Client Experience Survey for Mental Health and Addictions: Revalidation of a Survey to Measure Client and Family Experiences of Virtual Care %A Crawford,Allison %A Kirvan,Anne %A Sanches,Marcos %A Gambin,Amanda %A Canso,Denise %A Serhal,Eva %+ Centre for Addiction and Mental Health, 60 White Squirrel Way, Office 223, Toronto, ON, M6J1H4, Canada, 1 416 535 8501, allison.crawford@utoronto.ca %K virtual care %K digital health %K mental health %K client satisfaction %K health care quality %K Virtual Client Experience Survey %K telehealth %K telemedicine %K eHealth %D 2025 %7 3.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients’ perspectives on virtual mental health care quality will be critical to informing future policies and practices. Objective: This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care. Methods: The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach α coefficient. Results: The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an α lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001). Conclusions: This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances. %M 39752192 %R 10.2196/49844 %U https://www.jmir.org/2025/1/e49844 %U https://doi.org/10.2196/49844 %U http://www.ncbi.nlm.nih.gov/pubmed/39752192 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54438 %T Translation Effectiveness of Offset Heart Rate Biofeedback as a Mindless Intervention for Alcohol Craving Among Risky Drinkers: Controlled Experiment %A Zhao,Yiran %A Arora,Jatin %A Tao,Yujie %A Miller,Dave B %A Adams,Alexander T %A Choudhury,Tanzeem %+ Department of Information Science, Cornell University, 2 West Loop Rd, New York, NY, 10044, United States, 1 240 888 3213, yz2647@cornell.edu %K wearable device %K alcohol craving %K risky drinking %K digital intervention %K entrainment %K offset heart rate biofeedback %K mindless intervention %D 2024 %7 31.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital and wearable intervention systems promise to improve how people manage their behavioral health conditions by making interventions available when the user can best benefit from them. However, existing interventions are obtrusive because they require attention and motivation to engage in, limiting the effectiveness of such systems in demanding contexts, such as when the user experiences alcohol craving. Mindless interventions, developed by the human-computer interaction community, offer an opportunity to intervene unobtrusively. Offset heart rate biofeedback is an iconic type of mindless intervention powered by entrainment and can mitigate the physiological and psychological response to stressors. Objective: This work aimed to characterize the translational effectiveness of offset heart rate biofeedback on cue-elicit alcohol craving among risky drinkers. Methods: We conducted an out-of-lab, between-group, controlled experiment with 26 participants who performed harmful or hazardous drinking. The control group served as negative control and received no intervention, while the experimental group received offset heart rate biofeedback during alcohol exposure and recovery. We elicited alcohol cravings through a series of alcohol cues, including performing mental imagery, viewing alcohol images, and sniffing alcohol. We measured the physiological response to alcohol (ie, heart rate variability), self-reported craving, and self-reported anxiety. We constructed linear mixed-effects models to understand the effect of intervention during alcohol exposure and alcohol recovery after exposure. Following the linear mixed effect model, we conducted pair-wise comparisons for measures between the control and experimental groups. Results: We found that offset heart rate biofeedback significantly reduced the increase in heart rate variability (P=.01 and P=.052) and self-reported craving (P=.04 and P=.02) in response to alcohol cues. Participants’ anxiety was not affected by either the alcohol cues or the offset heart rate biofeedback. Conclusions: Offset heart rate biofeedback has the potential to immediately and unobtrusively mitigate cue-elicit alcohol craving among risky drinkers. The results of this study opened new opportunities for digital and wearable interventions to mitigate alcohol craving, either as wellness apps for risky drinkers or as digital prescriptions and integration with sensing systems for people with alcohol dependency. %M 39740221 %R 10.2196/54438 %U https://formative.jmir.org/2024/1/e54438 %U https://doi.org/10.2196/54438 %U http://www.ncbi.nlm.nih.gov/pubmed/39740221 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62995 %T Supplemental Intervention for Alcohol Use Disorder Treatment Patients With a Co-Occurring Anxiety Disorder: Technical Development and Functional Testing of an Autonomous Digital Program %A Rinehart,Linda Marie %A Anker,Justin %A Unruh,Amanda %A Degeneffe,Nikki %A Thuras,Paul %A Norden,Amie %A Hartnett,Lilly %A Kushner,Matt %K alcohol use disorder %K anxiety disorder %K comorbidity %K digital intervention %K psychological treatments %K addiction %K community-based practice %K therapy %K stress %K depression %K therapist-delivered therapies %D 2024 %7 31.12.2024 %9 %J JMIR Form Res %G English %X Background: Anxiety disorders are common in alcohol use disorder (AUD) treatment patients. Such co-occurring conditions (“comorbidity”) have negative prognostic implications for AUD treatment outcomes, yet they commonly go unaddressed in standard AUD care. Over a decade ago, we developed and validated a cognitive behavioral therapy intervention to supplement standard AUD care that, when delivered by trained therapists, improves outcomes in comorbid patients. However, this validated intervention, like many others in addiction care, has not been taken up in community-based AUD treatment programs. This phenomenon—empirically validated treatments that fail to be widely adopted in community care—has been termed the “research-to-practice gap.” Researchers have suggested that the availability of fully autonomous digital equivalents of validated therapist-delivered therapies could reduce some barriers underlying the research-to-practice gap, especially by eliminating the need for costly and intensive therapist training and supervision. Objective: With this in mind, we obtained a Program Development Grant (R34) to conduct formative work in the development of a fully autonomous digital version of our previously validated therapist-delivered intervention for AUD treatment patients with a comorbid anxiety disorder. Methods: In the first phase of the project, we developed the digital intervention. This process included: (1) identifying appropriate collaborators and vendors; (2) consultation with an e-learning expert to develop a storyboard and accompanying graphics and narrative; (3) video production and editing; and (4) interactive programming. The second phase of the project was functional testing of the newly developed digital intervention conducted in 52 residential AUD treatment patients with a comorbid anxiety disorder. Patients underwent the 3 one-hour segments of the newly developed intervention and completed user surveys, knowledge quizzes, and behavioral competence tests. Results: While the development of the digital intervention was successful, the timeline was approximately double that projected (1 vs 2 years) due to false starts and inefficiencies that we describe, including lessons learned. Functional testing of the newly developed digital intervention showed that, on average, patients rated the user experience in the upper (favorable) 20% of the response scales. Knowledge quizzes and behavioral demonstrations showed that over 80% of participants gained functional mastery of the key skills and information taught in the program. Conclusions: Functional testing results in this study justify a randomized controlled trial of the digital intervention’s efficacy, which is currently ongoing. In sharing the details of our challenges and solutions in developing the digital intervention, we hope to inform others developing digital tools. The extent to which the availability of empirically validated, fully autonomous digital interventions achieves their potential to reduce the research-to-practice gap remains an open but important empirical question. The present work stands as a necessary first step toward that end. %R 10.2196/62995 %U https://formative.jmir.org/2024/1/e62995 %U https://doi.org/10.2196/62995 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51833 %T Study to Evaluate the Comparative Efficacy of Medhya Rasayana (Pharmacological) Versus Nonpharmacological Interventions in Management of Gadget Addiction in Children: Protocol for Parallel, Triple-Arm, Randomized Clinical Trial %A Yewale,Prasad %A Rathi,Renu %A Mate,Swapnali %+ Mahatma Gandhi Ayurved College Hospital and Research Centre, Datta Meghe Institute of Higher Education and Research (Deemed to be University) Sawangi Meghe, Maharashtra, Wardha, 442001, India, 91 9096165511, prasad.kaumarbhritya@dmiher.edu.in %K addiction %K Ayurveda %K gadget addiction %K children %K Kaumarbhritya %K Medhya Rasayana %K yoga %K complementary and alternative medicine %D 2024 %7 11.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gadget addiction is a common behavioral problem among children. It is known to hamper social and academic life as well as adversely affect the lives of children. Ayurveda offers many therapeutic modalities and Ayurvedic medicines that can be used in the management of gadget addiction in children. The purpose of this study is to evaluate and compare the effectiveness of nonpharmacological therapies and the pharmaceutical intervention Medhya Rasayana in treating childhood gadget addiction. Objective: This study aims to provide a detailed description of the study methodology that will be used to compare the efficacy of nonpharmacological versus pharmaceutical interventions in the treatment of children’s gadget addiction. Methods: A randomized, parallel, triple-arm interventional study will be conducted on diagnosed participants of gadget addiction with an age group of 6- to 16-year-old children, which will be selected and equally distributed in 2 groups. Group P will be given Medhya Rasayana (pharmacological intervention), group N will be nonpharmacological Ayurveda intervention, and group C (cognitive behavioral therapy) will be an external group. The Study duration is 180 days with assessment at baseline, midpoint, and endpoint Appropriate statistical techniques, such as ANOVA and regression analysis, will be used to examine the data and evaluate the efficacy of the 3 groups’ interventions. We will perform subgroup analysis according to initial addiction severity, gender, and age. Primary outcome measures include a reduction in gadget addiction and changes in the psychosocial well-being of participants. Standardized questionnaires and instruments will be used to collect data. Results: In December 2023, the randomized controlled study got underway. Since participants may begin at any time, our goal is for everyone to be finished by December 2024. Conclusions: This research will provide crucial new information about the relative effectiveness of Ayurveda nonpharmacological therapies and Medhya Rasayana in treating children’s gadget addiction. The results will guide evidence-based treatments aimed at reducing the negative impact of excessive gadget use on this susceptible population’s psychosocial development. In the end, the findings are meant to help policy makers and medical professionals create sensible plans to deal with the rising issue of childhood gadget addiction. International Registered Report Identifier (IRRID): PRR1-10.2196/51833 %M 39527798 %R 10.2196/51833 %U https://www.researchprotocols.org/2024/1/e51833 %U https://doi.org/10.2196/51833 %U http://www.ncbi.nlm.nih.gov/pubmed/39527798 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58203 %T The Rutgers Omnibus Study: Protocol for Quarterly Web-Based Surveys to Promote Rapid Tobacco Research %A Bover Manderski,Michelle T %A Young,William J %A Ganz,Ollie %A Delnevo,Cristine D %+ Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences (Rutgers Health), Rutgers, The State University of New Jersey, 303 George Street, Suite 405, New Brunswick, NJ, 08901, United States, 1 732 235 9727, bovermi@ints.rutgers.edu %K survey %K tobacco %K nicotine %K young adults %K adults %K protocol %K Rutgers Omnibus Study %K Amazon Mechanical Turk %K MTurk %D 2024 %7 16.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rapid and flexible data collection efforts are necessary for effective monitoring and research on tobacco and nicotine product use in a constantly evolving marketplace. The Rutgers Omnibus Survey (1) provides timely data on awareness and use of new and emerging tobacco products among adults in a rapid manner, (2) provides a platform for measurement experiments to help develop and refine measures of tobacco use that reflect the current marketplace, and (3) generates pilot data for grant applications and scientific manuscripts. Objective: This study aims to document the first 2 years of the Rutgers Omnibus Study through the reporting of methodology, fielding summaries, and sample characteristics. Methods: Launched in February 2022 and fielded quarterly thereafter, we survey convenience samples of 2000 to 3000 US adults aged 18-45 years recruited from Amazon Mechanical Turk (MTurk) using the MTurk Toolkit by CloudResearch. The questionnaire includes core and rotating modules and is designed to take approximately 10 minutes to complete through Qualtrics. The fielding duration is approximately 10 days per wave. Each wave includes both unique and repeating participants, and responses can be linked across waves by an anonymous ID. Results: Sample sizes ranged from 2082 (wave 8, December 2023) to 2989 (wave 1, February 2022), and the 8-wave longitudinal dataset included 10,334 participants, of whom 2477 had 3 or more data points. The cost per complete at each wave was low, ranging from US $2.46 to US $3.27 across waves. Key demographics were consistent across waves and similar to that of the general population, while tobacco product trial and past–30-day use were generally higher. Conclusions: The Rutgers Omnibus Study is a quarterly survey that is effective for rapidly assessing the use of emerging tobacco and nicotine products and can also be leveraged to conduct survey experiments, generate pilot data, and address both cross-sectional and longitudinal research questions. International Registered Report Identifier (IRRID): RR1-10.2196/58203 %M 39413372 %R 10.2196/58203 %U https://www.researchprotocols.org/2024/1/e58203 %U https://doi.org/10.2196/58203 %U http://www.ncbi.nlm.nih.gov/pubmed/39413372 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e58201 %T Detection and Characterization of Online Substance Use Discussions Among Gamers: Qualitative Retrospective Analysis of Reddit r/StopGaming Data %A Le,Nicolette %A McMann,Tiana %A Yang,Luning %A Li,Zhuoran %A Cuomo,Raphael E %A Mackey,Tim K %+ Global Health Program, Department of Anthropology, University of California San Diego, 9500 Gilman Drive, MC: 0505, La Jolla, CA, 92093, United States, 1 9514914161, tmackey@ucsd.edu %K internet gaming disorder %K gaming disorder %K substance use %K alcohol use %K nicotine use %K stimulants %K gaming %K internet gaming %K video games %K addiction %K addiction medicine %K digital mental health %K reddit %D 2024 %7 2.10.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Video games have rapidly become mainstream in recent decades, with over half of the US population involved in some form of digital gaming. However, concerns regarding the potential harms of excessive, disordered gaming have also risen. Internet gaming disorder (IGD) has been proposed as a tentative psychiatric disorder that requires further study by the American Psychological Association (APA) and is recognized as a behavioral addiction by the World Health Organization. Substance use among gamers has also become a concern, with caffeinated or energy drinks and prescription stimulants commonly used for performance enhancement. Objective: This study aimed to identify substance use patterns and health-related concerns among gamers among a population of Reddit users. Methods: We used the public streaming Reddit application programming interface to collect and analyze all posts from the popular subreddit, r/StopGaming. From this corpus of posts, we filtered the dataset for keywords associated with common substances that may be used to enhance gaming performance. We then applied an inductive coding approach to characterize substance use behaviors, gaming genres, and physical and mental health concerns. Potential disordered gaming behavior was also identified using the tentative IGD guidelines proposed by the APA. A chi-square test of independence was used to assess the association between gaming disorder and substance use characteristics, and multivariable logistic regression was used to analyze whether mental health discussion or the mention of any substance with sufficient sample size was significantly associated with IGD. Results: In total, 10,551 posts were collected from Reddit from June 2017 to December 2022. After filtering the dataset for substance-related keywords, 1057 were included for further analysis, of which 286 mentioned both gaming and the use of ≥1 substances. Among the 286 posts that discussed both gaming and substance use, the most mentioned substances were alcohol (n=132), cannabis (n=104), and nicotine (n=48), while the most mentioned genres were role-playing games (n=120), shooters (n=90), and multiplayer online battle arenas (n=43). Self-reported behavior that aligned with the tentative guidelines for IGD was identified in 66.8% (191/286) posts. More than half, 62.9% (180/286) of the posts, discussed a health issue, with the majority (n=144) cited mental health concerns. Common mental health concerns discussed were depression and anxiety. There was a significant association between IGD and substance use (P<.001; chi-square test), and there were significantly increased odds of IGD among those who self-reported substance use (odds ratio 2.29, P<.001) and those who discussed mental health (odds ratio 1.64, P<.03). Conclusions: As gaming increasingly becomes highly prevalent among various age groups and demographics, a better understanding of the interplay and convergence among disordered gaming, substance use, and negative health impacts can inform the development of interventions to mitigate risks and promote healthier gaming habits. %M 39357050 %R 10.2196/58201 %U https://infodemiology.jmir.org/2024/1/e58201 %U https://doi.org/10.2196/58201 %U http://www.ncbi.nlm.nih.gov/pubmed/39357050 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51025 %T Feasibility and Engagement of a Mobile App Preparation Program (Kwit) for Smoking Cessation in an Ecological Context: Quantitative Study %A Bustamante Perez,Luz Adriana %A Romo,Lucia %A Zerhouni,Oulmann %+ Laboratoire EA 4430-Clinique Psychanalyse Developpement, Department of Psychology, University of Paris Nanterre, 200 avenue de la République, Nanterre, 92001, France, 33 783192547, adriana.bustamante93@gmail.com %K smoking cessation %K digital intervention %K behavior change techniques %K attrition rate %K mobile app %K preparation program %K motivation %K quit smoking %K ecological settings %K mobile phone %D 2024 %7 2.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps can facilitate access to effective treatment and therapeutic information services. However, the real-world effectiveness of mobile apps for smoking cessation and their potential impact in everyday settings remain unclear. Objective: In an ecological context, this study aimed to estimate the engagement rate of a mobile app–based smoking cessation preparation program and its potential impact on users’ willingness, ability, and readiness to quit smoking. Methods: A total of 2331 “organic users” (ie, users who discover and install a mobile app on their own, without any prompts) chose 1 of 2 program versions of the mobile app (Kwit): the basic version or the premium version. Both versions were identical in design, with 4 more evidence-based content items and strategies in the premium version. Outcomes were analyzed based on automated data registered in the app (engagement rate, motivation to quit, motivation type, motivation levels, and satisfaction level). Mann-Whitney and χ2 tests were used to compare the results of both groups. Results: As expected, in the ecological context, a high dropout rate was observed at different moments. A significant difference was observed between the 2 versions (n=2331; χ21=5.4; P=.02), with a proportionally higher engagement rate in the premium version (premium=4.7% vs basic=2%). Likewise, differences were also observed between the 2 groups in terms of reasons to quit (n=2331; χ24=19; P≤.001; V=0.08), motivation type (n=2331; χ27=14.7; P=.04), and motivation level. Users of the app’s premium version more frequently reported “well-being” (23.3% vs 17.9%) and “planning a pregnancy” (7.4% vs 4.4%) as their primary reasons for quitting smoking compared to those with the basic version. Moreover, they reported being more likely to be driven in the smoking cessation process by intrinsic motivation (premium=28% vs basic=20.4%), as well as feeling significantly more willing (z score=156,055; P≤.001; Cohen d=0.15), able (z score=172,905; P=.04; Cohen d=0.09), and ready (z score=166,390; P=.005; Cohen d=0.12) to stop smoking than users who had the basic version before completion of the preparation program. Among participants who finished each version of the program (premium: 9/189, 4.8%; basic: 47/2142, 2.19%), significant improvements in motivation levels were observed in both groups, although in different areas for each group (willingness levels for the premium group and ability for the basic group). Conclusions: These results suggest that even in ecological contexts where engagement rates are meager, the Kwit preparation program can address ambivalence by increasing willingness to change, self-confidence, and readiness to quit among its users, especially those who feel less able to do so. Further development and evaluations are needed to better understand determinants for regular mobile health apps. %M 39357053 %R 10.2196/51025 %U https://mhealth.jmir.org/2024/1/e51025 %U https://doi.org/10.2196/51025 %U http://www.ncbi.nlm.nih.gov/pubmed/39357053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57970 %T Understanding e-Cigarette Addictiveness: Triangulation of Focus Group and Netnographic Data %A Andreas,Marike %A Grundinger,Nadja %A Wolber,Nadine %A Szafran,Daria %A Görig,Tatiana %A Mons,Ute %A Lohner,Valerie %A Vollstädt-Klein,Sabine %A Schneider,Sven %+ Division of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Straße 13-17, Mannheim, 68167, Germany, 49 621 383 71814, marikeandreas@gmail.com %K e-cigarettes %K online forums %K netnographic analysis %K addictive %K addiction %K smoking cessation %K smoker %K user %K focus group %K nicotine %K public health %K prevalence %K smoking behavior %D 2024 %7 1.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous studies have shown that e-cigarettes are addictive. For example, we previously showed that users of e-cigarette online forums discuss experiences of addiction in a netnographic analysis. However, it is unclear what makes e-cigarettes addictive apart from nicotine. In a focus group analysis, we recently identified 3 unique features of e-cigarettes that users linked to experiences of addiction: the pleasant taste, unobtrusiveness, and unlimited usability of e-cigarettes. Objective: This study aimed to validate the previously identified features of e-cigarette addictive potential by triangulating data from the netnographic analysis and focus group discussions. Methods: Drawing on a netnographic analysis of 3 popular, German-language e-cigarette forums, we studied whether experiences of addiction were linked to specific e-cigarette features. We included 451 threads in the analysis that had been coded for addictive experiences in a previous study by our team. First, we conducted a deductive analysis with preregistered codes to determine whether the features of pleasant taste, unobtrusiveness, and unlimited usability were mentioned in relation to the addictive potential of e-cigarettes in the online forums. Second, an inductive approach was chosen to identify further possible addictive features of e-cigarettes. Results: Our deductive analysis confirmed that the features highlighted in our previous focus group study (pleasant taste, unobtrusiveness, and unlimited usability) were also frequently discussed in online forums in connection to addictive symptoms. In addition, our inductive analysis identified nicotine dosage as a significant feature linked to addiction. Users reported varying their nicotine doses for different reasons, leading to the identification of four distinct user types based on dosing patterns: (1) high doses for intermittent, (2) high doses for constant use, (3) low doses for constant use, and (4) switching between high and low doses depending on the situation. Conclusions: Our comprehensive analysis of online forum threads revealed that users’ experiences of addiction are linked to 4 specific features unique to e-cigarettes: pleasant taste, unobtrusiveness, unlimited usability, and nicotine dosage. Recognizing these addictive features of e-cigarettes is crucial for designing cessation programs and informing public health policies to reduce the addictiveness of e-cigarettes. %M 39353183 %R 10.2196/57970 %U https://www.jmir.org/2024/1/e57970 %U https://doi.org/10.2196/57970 %U http://www.ncbi.nlm.nih.gov/pubmed/39353183 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63193 %T Association Between Cigarette and Bidi Purchase Behavior (Loose vs Pack) and Health Warning Label Exposure: Findings From the Tobacco Control Policy India Survey and In-Depth Interviews With People Who Smoke %A Sakhuja,Mayank %A Friedman,Daniela B %A Macauda,Mark M %A Hebert,James R %A Pednekar,Mangesh S %A Gupta,Prakash C %A Fong,Geoffrey T %A Thrasher,James F %+ UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 323A Rosenau Hall CB #7440, Chapel Hill, NC, 27599, United States, 1 8034468063, msakhuja@unc.edu %K loose cigarettes %K singles %K health warning labels %K tobacco control %K India %K mixed methods %K purchase behavior %K tobacco users %K cigarette %K qualitative research %K thematic analysis %K prevention %K health promotion %K public health %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The sale of loose cigarettes or bidis can undermine the purpose of requiring health warning labels (HWLs) on cigarette packs and bidi bundles by diminishing their visibility and legibility. Objective: This mixed-methods study aims to examine the association between purchase behavior (loose vs pack or bundle), HWL exposure, and responses to HWLs among Indian adults who smoke. Methods: Data were analyzed from the 2018-2019 India Tobacco Control Policy Survey and from 28 in-depth interviews conducted with Indian adults who smoked in 2022. The Tobacco Control Policy Survey sample included tobacco users who bought cigarettes (n=643) or bidis (n=730), either loose or in packs or bundles at their last purchase. Ordinal regression models were fit separately for cigarettes and bidis, whereby HWL variables (noticing HWLs, reading and looking closely at HWLs, forgoing a cigarette or bidi because of HWLs, thinking about health risks of smoking, and thinking about quitting smoking cigarettes or bidis because of HWLs) were regressed on last purchase (loose vs packs or bundles). In-depth interviews with participants from Delhi and Mumbai who purchased loose cigarettes in the last month were conducted, and thematic analysis was used to analyze the interview data. Results: Survey findings indicated that about 74.3% (478/643) of cigarette users and 11.8% (86/730) of bidi users reported having bought loose sticks at their last purchase. Those who purchased loose cigarettes (vs packs) noticed HWLs less often (estimate –0.830, 95% CI –1.197 to –0.463, P<.001), whereas those who purchased loose bidis (vs bundles) read and looked closely at HWLs (estimate 0.646, 95% CI 0.013-1.279, P=.046), thought about the harms of bidi smoking (estimate 1.200, 95% CI 0.597-1.802, P<.001), and thought about quitting bidi smoking (estimate 0.871, 95% CI 0.282-1.461, P=.004) more often. Interview findings indicated lower exposure to HWLs among those who purchased loose cigarettes, primarily due to vendors distributing loose cigarettes without showing the original cigarette pack, storing them in separate containers, and consumers’ preference for foreign-made cigarette brands, which often lack HWLs. While participants were generally aware of the contents of HWLs, many deliberately avoided them when purchasing loose cigarettes. In addition, they believed that loose cigarette purchases reduced the HWLs’ potential to deliver consistent reminders about the harmful effects of cigarette smoking due to reduced exposure, an effect more common among those who purchased packs. Participants also noted that vendors, especially small ones, did not display statutory health warnings at their point of sale, further limiting exposure to warning messages. Conclusions: Survey and interview findings indicated that those who purchased loose cigarettes noticed HWLs less often. Loose purchases likely decrease the frequency of exposure to HWLs’ reminders about the harmful effects of smoking, potentially reducing the effectiveness of HWLs. %M 39320944 %R 10.2196/63193 %U https://publichealth.jmir.org/2024/1/e63193 %U https://doi.org/10.2196/63193 %U http://www.ncbi.nlm.nih.gov/pubmed/39320944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54754 %T Introducing and Evaluating the Effectiveness of Online Cognitive Behavior Therapy for Gambling Disorder in Routine Addiction Care: Comparative Cohort Study %A Molander,Olof %A Berman,Anne H %A Jakobson,Miriam %A Gajecki,Mikael %A Hällström,Hanna %A Ramnerö,Jonas %A Bjureberg,Johan %A Carlbring,Per %A Lindner,Philip %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stationsgatan 69, 7th floor, Stockholm, SE-113 64, Sweden, 46 700011241, olof.molander@ki.se %K gambling disorder %K internet-delivered cognitive behavioral therapy %K routine addiction care %K registry study %K gambling %K addiction %K health care setting %K iCBT %K Sweden %K feasibility %K clinic %K hospital %K psychological treatment %K digital intervention %K addictive disorder %K eHealth %K digital care %K survival analysis %K comorbidity %D 2024 %7 18.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Several treatment-related challenges exist for gambling disorder, in particular at-scale dissemination in health care settings. Objective: This study describes the introduction of a newly developed internet-delivered cognitive behavioral therapy (iCBT) program for gambling disorder (GD), provided with therapist support in routine addiction care, in a nationally recruited sample in Sweden. The study details the introduction of the iCBT program, evaluates its effectiveness and acceptability, and compares registry outcomes among iCBT patients with other patients with GD at the clinic who received face-to-face psychological treatment as usual. Methods: The study site was the Stockholm Addiction eClinic, which offers digital interventions for addictive disorders in routine care. The iCBT program was introduced nationally for treatment-seeking patients through the Swedish eHealth platform. After approximately 2 years of routine treatment provision, we conducted a registry study, including ordinary patients in routine digital care (n=218), and a reference sample receiving face-to-face psychological treatment for GD (n=216). Results: A statistically significant reduction in the Gambling Symptom Assessment Scale scores during the treatment was observed (B=–1.33, SE=0.17, P<.001), corresponding to a large within-group Cohen d effect size of d=1.39. The iCBT program was rated high for satisfaction. A registry-based survival analysis, controlling for psychiatric comorbidity, showed that patients receiving iCBT exhibited posttreatment outcomes (re-engagement in outpatient addiction care, receiving new psychiatric prescriptions, enrollment in psychiatric inpatient care, and care events indicative of contact with social services) similar to comparable patients who underwent face-to-face treatment-as-usual. Conclusions: A lack of randomized allocation notwithstanding, the iCBT program for GD evaluated in this study was well-received by patients in routine addiction care, was associated with the expected symptom decrease during treatment, and appears to result in posttreatment registry outcomes similar to face-to-face treatment. Future studies on treatment mechanisms and moderators are warranted. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00647-5 %M 39293054 %R 10.2196/54754 %U https://www.jmir.org/2024/1/e54754 %U https://doi.org/10.2196/54754 %U http://www.ncbi.nlm.nih.gov/pubmed/39293054 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e44662 %T Design and Implementation of an Opioid Scorecard for Hospital System–Wide Peer Comparison of Opioid Prescribing Habits: Observational Study %A Slovis,Benjamin Heritier %A Huang,Soonyip %A McArthur,Melanie %A Martino,Cara %A Beers,Tasia %A Labella,Meghan %A Riggio,Jeffrey M %A Pribitkin,Edmund deAzevedo %K opioids %K peer comparison %K quality %K scorecard %K prescribing %K design %K implementation %K opioid %K morbidity %K mortality %K opioid usage %K opioid dependence %K drug habits %D 2024 %7 9.9.2024 %9 %J JMIR Hum Factors %G English %X Background: Reductions in opioid prescribing by health care providers can lead to a decreased risk of opioid dependence in patients. Peer comparison has been demonstrated to impact providers’ prescribing habits, though its effect on opioid prescribing has predominantly been studied in the emergency department setting. Objective: The purpose of this study is to describe the development of an enterprise-wide opioid scorecard, the architecture of its implementation, and plans for future research on its effects. Methods: Using data generated by the author’s enterprise vendor–based electronic health record, the enterprise analytics software, and expertise from a dedicated group of informaticists, physicians, and analysts, the authors developed an opioid scorecard that was released on a quarterly basis via email to all opioid prescribers at our institution. These scorecards compare providers’ opioid prescribing habits on the basis of established metrics to those of their peers within their specialty throughout the enterprise. Results: At the time of this study’s completion, 2034 providers have received at least 1 scorecard over a 5-quarter period ending in September 2021. Poisson regression demonstrated a 1.6% quarterly reduction in opioid prescribing, and chi-square analysis demonstrated pre-post reductions in the proportion of prescriptions longer than 5 days’ duration and a morphine equivalent daily dose of >50. Conclusions: To our knowledge, this is the first peer comparison effort with high-quality evidence-based metrics of this scale published in the literature. By sharing this process for designing the metrics and the process of distribution, the authors hope to influence other health systems to attempt to curb the opioid pandemic through peer comparison. Future research examining the effects of this intervention could demonstrate significant reductions in opioid prescribing, thus potentially reducing the progression of individual patients to opioid use disorder and the associated increased risk of morbidity and mortality. %R 10.2196/44662 %U https://humanfactors.jmir.org/2024/1/e44662 %U https://doi.org/10.2196/44662 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48339 %T Parental Patterns of Alcohol Consumption During the COVID-19 Pandemic: Scoping Review %A Ou,Christine %A Corby,Kathryn %A Booth,Kelsey %A Ou,Hui-Hui %+ Canadian Institute for Substance Use Research, School of Nursing, University of Victoria, HSD Building Room 402, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada, 1 250 721 7954, christineou@uvic.ca %K parent %K alcohol use %K COVID-19 %K scoping review %K parenting %K alcohol %K addict %K addiction %K substance use %K health behavior %K health behaviors %K scoping %K review methods %K review methodology %K drink %K drinking %K alcoholic %K alcoholism %D 2024 %7 26.8.2024 %9 Review %J Interact J Med Res %G English %X Background: The declaration of the COVID-19 pandemic led to public health restrictions that impacted the lives of people across the globe. Parents were particularly burdened with balancing multiple responsibilities, such as working from home while caring for and educating their children. Alcohol use among parents is an area that warrants further exploration. Objective: This study aimed to investigate patterns of parental alcohol consumption during the COVID-19 pandemic, focusing on relative changes in the frequency and quantity of alcohol use compared to prepandemic use, nonparent adult samples, or both. Methods: A scoping review informed by the methodology of Arksey and O’Malley explored patterns of parental alcohol consumption during the COVID-19 pandemic. Searches were conducted in CINAHL, Ovid MEDLINE, PsycINFO, and Web of Science. Search terms were created using the Joanna Briggs Institute framework of Population, Concept, and Context, with the population being parents and the concept being alcohol consumption during the COVID-19 pandemic. Results: The database search yielded 3568 articles, which were screened for eligibility. Of the 3568 articles, 40 (1.12%) met the inclusion criteria and were included in the scoping review. Findings indicated the following: (1) having children at home was a factor associated with parental patterns of alcohol use; (2) mixed findings regarding gender-related patterns of alcohol consumption; and (3) linkages between parental patterns of alcohol use and mental health symptoms of stress, depression, and anxiety. Conclusions: This scoping review revealed heterogeneous patterns in parental alcohol use across sociocultural contexts during the COVID-19 pandemic. Given the known harms of alcohol use, it is worthwhile for clinicians to assess parental drinking patterns and initiate conversations regarding moderation in alcohol use. %M 39186759 %R 10.2196/48339 %U https://www.i-jmr.org/2024/1/e48339 %U https://doi.org/10.2196/48339 %U http://www.ncbi.nlm.nih.gov/pubmed/39186759 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57653 %T Use of Transdermal Alcohol Sensors in Conjunction With Contingency Management to Reduce Alcohol Consumption in People With Alcohol Dependence Attending Alcohol Treatment Services: Protocol for a Pilot Feasibility Randomized Controlled Trial %A Brobbin,Eileen %A Deluca,Paolo %A Parkin,Stephen %A Drummond,Colin %+ Department of Addiction, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, United Kingdom, 44 07758287265, eileen.brobbin@kcl.ac.uk %K accuracy %K addiction %K alcohol %K alcohol monitoring %K alcohol treatment %K contingency management %K transdermal alcohol sensors %K wearables %K mobile phone %K transdermal %K TAS %K wearable technology %K alcohol use disorders %K AUD %K RCT %K randomized controlled trial %K abstinence %K community-based %K residential rehabilitation %K consumption %K alcohol consumption %K low-risk consumption %D 2024 %7 31.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Wearable technology for objective, continuous, and reliable alcohol monitoring has been developed. These are known as transdermal alcohol sensors (TASs). They can be worn on the wrist or ankle with the sensor pressed against the skin and can measure sweat vapors being emitted from the skin, to record transdermal alcohol concentration (TAC). Previous studies have investigated the accuracy and acceptability of the available TAS brands, but there has been little research into their use in people with alcohol use disorders (AUD). Objective: This feasibility randomized controlled trial aims to explore the feasibility, strengths, and limitations of using a TAS to monitor alcohol consumption in individuals in treatment for AUD with or without contingency management (CM) to promote abstinence or low-level alcohol consumption. Methods: The target sample size is 30 (15 randomized to each group). Participants will be recruited through poster adverts at alcohol services. Both groups (control and CM) will wear the TAS (BACtrack Skyn) for 2 weeks in the context of their usual treatment, meeting with the researcher every other weekday. In the last meeting, the participants will complete a postwear survey on their experience of wearing the TAS. The CM group will also receive small financial incentives for low or no alcohol consumption, as measured by the TAS. On days where the TAC peak is below a set threshold (<115.660 g/L), CM group participants will be rewarded with a £5 (US $6.38) voucher. There are financial bonuses if this target is achieved on consecutive days. The researcher will monitor TAC for each day of the study at each research visit and allocate financial incentives to participants according to a set reinforcement schedule. Results: The first participant was enrolled in June 2023, and the last in December 2023. Data analysis is underway and is estimated to be completed by June 2024. A total of 32 participants were enrolled. Conclusions: Most TAS brands have had limited application in clinical settings, and most studies have included healthy adults rather than people with AUD. TAS has the potential to enhance treatment outcomes in clinical alcohol treatment. The accuracy, acceptability, and feasibility of TAS for people with AUD in clinical settings need to be investigated. This is the first study to use TAS in specialized alcohol services with diagnosed AUD individuals currently receiving treatment from a south London alcohol service. Trial Registration: ISRCTN Registry ISRCTN46845361; https://www.isrctn.com/ISRCTN46845361 International Registered Report Identifier (IRRID): DERR1-10.2196/57653 %M 39083798 %R 10.2196/57653 %U https://www.researchprotocols.org/2024/1/e57653 %U https://doi.org/10.2196/57653 %U http://www.ncbi.nlm.nih.gov/pubmed/39083798 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54951 %T Probing the Role of Digital Payment Solutions in Gambling Behavior: Preliminary Results From an Exploratory Focus Group Session With Problem Gamblers %A Lakew,Nathan %A Jonsson,Jakob %A Lindner,Philip %+ Department of Clinical Neuroscience, Karolinska Institutet, Norra Stationsgatan 69, Plan 7, Stockholm, 113 64, Sweden, 46 852483391, nathan.lakew@ki.se %K digital payment solutions %K online gambling behavior %K sociotechnical %K subjective experience %K focus group %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Technology has significantly reshaped the landscape and accessibility of gambling, creating uncharted territory for researchers and policy makers involved in the responsible gambling (RG) agenda. Digital payment solutions (DPS) are the latest addition of technology-based services in gambling and are now prominently used for deposit and win withdrawal. The seamless collaboration between online gambling operators and DPS, however, has raised concerns regarding the potential role of DPS platforms in facilitating harmful behavior. Objective: Using a focus group session with problem gamblers, this study describes a preliminary investigation of the role of DPS in the online gambling context and its influence on players’ gambling habits, financial behavior, choices of gambling environment, and the overall outcome of gambling subjective experiences. Methods: A total of 6 problem gamblers participated in a one-and-half-hour focus group session to discuss how DPSs are integrated into their everyday gambling habits, what motivates them to use DPS, and what shifts they observe in their gambling behavior. Thematic analysis was used to analyze the empirical evidence with a mix of inductive and deductive research approaches as a knowledge claim strategy. Results: Our initial findings revealed that the influence of DPSs in online gambling is multifaced where, on the one hand, their ability to integrate with players’ existing habits seamlessly underscores the facilitating role they play in potentially maximizing harm. On the other hand, we find preliminary evidence that DPSs can have a direct influence on gambling outcomes in both subtle and pervasive ways—nudging, institutionalizing, constraining, or triggering players’ gambling activities. This study also highlights the increasingly interdisciplinary nature of online gambling, and it proposes a preliminary conceptual framework to illustrate the sociotechnical interplay between DPS and gambling habits that ultimately capture the outcome of gambling’s subjective experience. Conclusions: Disguised as a passive payment enabler, the role of DPS has so far received scant attention; however, this exploratory qualitative study demonstrates that given the technological advantage and access to customer financial data, DPS can become a potent platform to enable and at times trigger harmful gambling. In addition, DPS’s bird’s-eye view of cross-operator gambling behavior can open up an opportunity for researchers and policy makers to explore harm reduction measures that can be implemented at the digital payment level for gambling customers. Finally, more interdisciplinary studies are needed to formulate the sociotechnical nature of online gambling and holistic harm minimization strategy. %M 39042438 %R 10.2196/54951 %U https://humanfactors.jmir.org/2024/1/e54951 %U https://doi.org/10.2196/54951 %U http://www.ncbi.nlm.nih.gov/pubmed/39042438 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44414 %T A Novel, Expert-Endorsed, Neurocognitive Digital Assessment Tool for Addictive Disorders: Development and Validation Study %A Lee,Rico S C %A Albertella,Lucy %A Christensen,Erynn %A Suo,Chao %A Segrave,Rebecca A %A Brydevall,Maja %A Kirkham,Rebecca %A Liu,Chang %A Fontenelle,Leonardo F %A Chamberlain,Samuel R %A Rotaru,Kristian %A Yücel,Murat %+ QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, 4006, Australia, 61 412494834, muratyucel40@gmail.com %K cognitive neuroscience %K addictive behaviors %K mental health %K gaming %K gamified %K gamification %K development %K assessment %K software %K addiction %K mental disorder %K neurocognition %K neurocognitive %K brain health %K gamified task %K psychometric %K game developer %K game development %K validation %K validate %K validity %D 2023 %7 25.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people with harmful addictive behaviors may not meet formal diagnostic thresholds for a disorder. A dimensional approach, by contrast, including clinical and community samples, is potentially key to early detection, prevention, and intervention. Importantly, while neurocognitive dysfunction underpins addictive behaviors, established assessment tools for neurocognitive assessment are lengthy and unengaging, difficult to administer at scale, and not suited to clinical or community needs. The BrainPark Assessment of Cognition (BrainPAC) Project sought to develop and validate an engaging and user-friendly digital assessment tool purpose-built to comprehensively assess the main consensus-driven constructs underpinning addictive behaviors. Objective: The purpose of this study was to psychometrically validate a gamified battery of consensus-based neurocognitive tasks against standard laboratory paradigms, ascertain test-retest reliability, and determine their sensitivity to addictive behaviors (eg, alcohol use) and other risk factors (eg, trait impulsivity). Methods: Gold standard laboratory paradigms were selected to measure key neurocognitive constructs (Balloon Analogue Risk Task [BART], Stop Signal Task [SST], Delay Discounting Task [DDT], Value-Modulated Attentional Capture [VMAC] Task, and Sequential Decision-Making Task [SDT]), as endorsed by an international panel of addiction experts; namely, response selection and inhibition, reward valuation, action selection, reward learning, expectancy and reward prediction error, habit, and compulsivity. Working with game developers, BrainPAC tasks were developed and validated in 3 successive cohorts (total N=600) and a separate test-retest cohort (N=50) via Mechanical Turk using a cross-sectional design. Results: BrainPAC tasks were significantly correlated with the original laboratory paradigms on most metrics (r=0.18-0.63, P<.05). With the exception of the DDT k function and VMAC total points, all other task metrics across the 5 tasks did not differ between the gamified and nongamified versions (P>.05). Out of 5 tasks, 4 demonstrated adequate to excellent test-retest reliability (intraclass correlation coefficient 0.72-0.91, P<.001; except SDT). Gamified metrics were significantly associated with addictive behaviors on behavioral inventories, though largely independent of trait-based scales known to predict addiction risk. Conclusions: A purpose-built battery of digitally gamified tasks is sufficiently valid for the scalable assessment of key neurocognitive processes underpinning addictive behaviors. This validation provides evidence that a novel approach, purported to enhance task engagement, in the assessment of addiction-related neurocognition is feasible and empirically defensible. These findings have significant implications for risk detection and the successful deployment of next-generation assessment tools for substance use or misuse and other mental disorders characterized by neurocognitive anomalies related to motivation and self-regulation. Future development and validation of the BrainPAC tool should consider further enhancing convergence with established measures as well as collecting population-representative data to use clinically as normative comparisons. %M 37624635 %R 10.2196/44414 %U https://www.jmir.org/2023/1/e44414 %U https://doi.org/10.2196/44414 %U http://www.ncbi.nlm.nih.gov/pubmed/37624635 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44219 %T Strengthening Addiction Care Continuum Through Community Consortium in Vietnam: Protocol for a Cluster-Randomized Controlled Trial %A Li,Li %A Nguyen,Tuan Anh %A Liang,Li-Jung %A Lin,Chunqing %A Pham,Thang Hong %A Nguyen,Ha Thi Thanh %A Kha,Steven %+ University of California, Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA, 90024, United States, 1 3107942446, lililili@ucla.edu %K addiction service %K community consortium %K drug addiction %K health care worker %K health %K family %K Vietnam %D 2023 %7 22.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: A chronic condition, drug addiction, requires long-term multipronged health care and treatment services. Community-based approaches can offer the advantages of managing integrated care along the care continuum and improving clinical outcomes. However, scant rigorous research focuses on sustainable, community-based care and service delivery. Objective: This protocol describes a study aiming to develop and test an intervention that features the alliance of community health workers and family members to provide integrated support and individualized services and treatment for people who use drugs (PWUD) in community settings. Methods: Based on the National Institute on Drug Abuse’s Seek-Test-Treat-Retain (STTR) framework, an intervention that provides training to community health workers will be developed and piloted before an intervention trial. Trained community health workers will conduct home visits and provide support for PWUD and their families. The intervention trial will be conducted in 3 regions in Vietnam, with 60 communities (named communes). These communes will be randomized to either an intervention or control condition. Intervention outcomes will be evaluated at baseline and at 3, 6, 9, and 12 months. The primary outcome measure is PWUD’s STTR fulfillment, consisting of multiple individual fulfillment indicators across 5 domains: Seek, Test, Treat, Retain, and Health. The secondary outcomes of interest are the community health workers’ service provision and family members’ support. The primary analysis will follow an intention-to-treat approach. Generalized mixed-effects regression models will be used to compare changes in the outcome measures from baseline between intervention and control conditions. Results: During the first year of the project, we conducted formative studies, including in-depth interviews and focus groups, to identify service barriers and intervention strategies. The intervention and assessment pilots are scheduled in 2023 before commencing the trial. Reports based on the baseline data will be distributed in early 2024. The intervention outcome results will be available within 6 months of the final data collection date, that is, the main study findings are expected to be available in early 2026. Conclusions: This study will inform the establishment of community health workers and family members alliance, a locally available infrastructure, to support addiction services and care for PWUD. The methodology, findings, and lessons learned are expected to shed light on the addiction service continuum’s implementation and demonstrate a community-based addiction service delivery model that can be transferable to other countries. Trial Registration: ClinicalTrials.gov NCT05315492; https://clinicaltrials.gov/ct2/show/NCT05315492 International Registered Report Identifier (IRRID): DERR1-10.2196/44219 %M 36947125 %R 10.2196/44219 %U https://www.researchprotocols.org/2023/1/e44219 %U https://doi.org/10.2196/44219 %U http://www.ncbi.nlm.nih.gov/pubmed/36947125 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35125 %T Implementation of Smartphone Systems to Improve Quality of Life for People With Substance Use Disorder: Interim Report on a Randomized Controlled Trial %A Gustafson Sr,David %A Horst,Julie %A Boss,Deanne %A Fleddermann,Kathryn %A Jacobson,Nora %A Roosa,Mathew %A Ross,J Charles %A Gicquelais,Rachel %A Vjorn,Olivia %A Siegler,Tracy %A Molfenter,Todd %+ Department of Industrial and Systems Engineering, University of Wisconsin-Madison, 1513 University Ave, Madison, WI, 53706, United States, 1 608 239 5535, dhgustaf@wisc.edu %K mobile technology %K coaching %K substance use disorder (SUD) treatment %K technology implementation model %K NIATx %D 2022 %7 14.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Researchers have conducted numerous studies seeking to understand how to improve the implementation of changes in health care organizations, but less focus has been given to applying lessons already learned from implementation science. Finding innovative ways to apply these findings efficiently and consistently will improve current research on implementation strategies and allow organizations utilizing these techniques to make changes more effectively. Objective: This research aims to compare a practical implementation approach that uses principles from prior implementation studies to more traditional ways of implementing change. Methods: A total of 43 addiction treatment sites in Iowa were randomly assigned to 2 different implementation strategies in a randomized comparative effectiveness trial studying the implementation of an eHealth substance use disorder treatment technology. One strategy used an adaptation of the Network for the Improvement of Addiction Treatment (NIATx) improvement approach, while the other used a traditional product training model. This paper discusses lessons learned about implementation. Results: This midterm report indicates that use of the NIATx approach appears to be leading to improved outcomes on several measures, including initial and sustained use of new technology by both counselors and patients. Additionally, this research indicates that seamlessly integrating organizational changes into existing workflows and using coaching to overcome hurdles and assess progress are important to improve implementation projects. Conclusions: At this interim point in the study, it appears that the use of the NIATx improvement process leads to better outcomes in implementation of changes within health care organizations. Moreover, some strategies used in this improvement process are particularly useful and should be drawn on more heavily in future implementation efforts. Trial Registration: ClinicalTrials.gov NCT03954184; https://clinicaltrials.gov/ct2/show/NCT03954184 %M 35834315 %R 10.2196/35125 %U https://humanfactors.jmir.org/2022/3/e35125 %U https://doi.org/10.2196/35125 %U http://www.ncbi.nlm.nih.gov/pubmed/35834315 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33656 %T Agreement Between Self-reports and Photos to Assess e-Cigarette Device and Liquid Characteristics in Wave 1 of the Vaping and Patterns of e-Cigarette Use Research Study: Web-Based Longitudinal Cohort Study %A Crespi,Elizabeth %A Hardesty,Jeffrey J %A Nian,Qinghua %A Sinamo,Joshua %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Baltimore, MD, 21205, United States, 1 410 614 5378, ecrespi2@jhu.edu %K tobacco %K e-cigarette %K methodology %K internet %K photo %K survey %K self-report %D 2022 %7 27.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette device and liquid characteristics are highly customizable; these characteristics impact nicotine delivery and exposure to toxic constituents. It is critical to understand optimal methods for measuring these characteristics to accurately assess their impacts on user behavior and health. Objective: To inform future survey development, we assessed the agreement between responses from survey participants (self-reports) and photos uploaded by participants and the quantity of usable data derived from each approach. Methods: Adult regular e-cigarette users (≥5 days per week) aged ≥21 years (N=1209) were asked questions about and submitted photos of their most used e-cigarette device (1209/1209, 100%) and liquid (1132/1209, 93.63%). Device variables assessed included brand, model, reusability, refillability, display, and adjustable power. Liquid variables included brand, flavor, nicotine concentration, nicotine formulation, and bottle size. For each variable, percentage agreement was calculated where self-report and photo data were available. Krippendorff α and intraclass correlation coefficient (ICC) were calculated for categorical and continuous variables, respectively. Results were stratified by device (disposable, reusable with disposable pods or cartridges, and reusable with refillable pods, cartridges, or tanks) and liquid (customized and noncustomized) type. The sample size for each calculation ranged from 3.89% (47/1209; model of disposable devices) to 95.12% (1150/1209; device reusability). Results: Percentage agreement between photos and self-reports was substantial to very high across device and liquid types for all variables except nicotine concentration. These results are consistent with Krippendorff α calculations, except where prevalence bias was suspected. ICC results for nicotine concentration and bottle size were lower than percentage agreement, likely because ICC accounts for the level of disagreement between values. Agreement varied by device and liquid type. For example, percentage agreement for device brand was higher among users of reusable devices (94%) than among users of disposable devices (75%). Low percentage agreement may result from poor participant knowledge of characteristics, user modifications of devices inconsistent with manufacturer-intended use, inaccurate or incomplete information on websites, or photo submissions that are not a participant’s most used device or liquid. The number of excluded values (eg, self-report was “don’t know” or no photo submitted) differed between self-reports and photos; for questions asked to participants, self-reports had more usable data than photos for all variables except device model and nicotine formulation. Conclusions: Photos and self-reports yield data of similar accuracy for most variables assessed in this study: device brand, device model, reusability, adjustable power, display, refillability, liquid brand, flavor, and bottle size. Self-reports provided more data for all variables except device model and nicotine formulation. Using these approaches simultaneously may optimize data quantity and quality. Future research should examine how to assess nicotine concentration and variables not included in this study (eg, wattage and resistance) and the resource requirements of these approaches. %M 35475727 %R 10.2196/33656 %U https://www.jmir.org/2022/4/e33656 %U https://doi.org/10.2196/33656 %U http://www.ncbi.nlm.nih.gov/pubmed/35475727 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33493 %T Smartphone Alcohol Use Disorder Recovery Apps: Cross-sectional Survey of Behavioral Intention to Use %A Menon,Rijuta %A Meyer,Julien %A Nippak,Pria %A Begum,Housne %+ School of Health Services Management, Ted Rogers School of Management, Ryerson University, 350 Victoria Street, Office: TRS 3-081, Toronto, ON, M5B 2K3, Canada, 1 4169951338, julien.meyer@ryerson.ca %K mobile health %K alcohol use disorder %K disease management %K mobile apps %K Unified Theory of Acceptance and Use of Technology %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Alcohol use disorder (AUD) carries a huge health and economic cost to society. Effective interventions exist but numerous challenges limit their adoption, especially in a pandemic context. AUD recovery apps (AUDRA) have emerged as a potential complement to in-person interventions. They are easy to access and show promising results in terms of efficacy. However, they rely on individual adoption decisions and remain underused. Objective: The aim of this survey study is to explore the beliefs that determine the intention to use AUDRA. Methods: We conducted a cross-sectional survey study of people with AUD. We used the Unified Theory of Acceptance and Use of Technology, which predicts use and behavioral intention to use based on performance expectancy, effort expectancy, social influence, and facilitating conditions. Participants were recruited directly from 2 sources; first, respondents at addiction treatment facilities in Ontario, Canada, were contacted in person, and they filled a paper form; second, members from AUD recovery support groups on social media were contacted and invited to fill an internet-based survey. The survey was conducted between October 2019 and June 2020. Results: The final sample comprised 159 participants (124 involved in the web-based survey and 35 in the paper-based survey) self-identifying somewhat or very much with AUD. Most participants (n=136, 85.5%) were aware of AUDRA and those participants scored higher on performance expectancy, effort expectancy, and social influence. Overall, the model explains 35.4% of the variance in the behavioral intention to use AUDRA and 11.1% of the variance in use. Social influence (P=.31), especially for women (P=.23), and effort expectancy (P=.25) were key antecedents of behavioral intention. Facilitating conditions were not significant overall but were moderated by age (P=.23), suggesting that it matters for older participants. Performance expectancy did not predict behavioral intention, which is unlike many other technologies but confirms other findings associated with mobile health (mHealth). Open-ended questions suggest that privacy concerns may significantly influence the use of AUDRA. Conclusions: This study suggests that unlike many other technologies, the adoption of AUDRA is not mainly determined by utilitarian factors such as performance expectancy. Rather, effort expectancy and social influence play a key role in determining the intention to use AUDRA. %M 35363145 %R 10.2196/33493 %U https://humanfactors.jmir.org/2022/2/e33493 %U https://doi.org/10.2196/33493 %U http://www.ncbi.nlm.nih.gov/pubmed/35363145 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e25390 %T Integrated Smoking Cessation for Smokers With Serious Mental Illness: Protocol for a Convergent Mixed Methods Implementation Evaluation Study %A Schnitzer,Kristina %A Maravić,Melissa Culhane %A Arntz,Diana %A Phillips,Nathaniel L %A Pachas,Gladys %A Evins,A Eden %A Fetters,Michael %+ Center for Addiction Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States, 1 6177262000, kschnitzer@partners.org %K mixed methods implementation evaluation %K pharmacotherapeutic smoking cessation aids %K serious mental illness %K smoking cessation %K tobacco %D 2021 %7 27.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco smoking is associated with significant morbidity and premature mortality in individuals with serious mental illness. A 2-year pragmatic clinical trial (PCORI PCS-1504-30472) that enrolled 1100 individuals with serious mental illness in the greater Boston area was conducted to test 2 interventions for tobacco cessation for individuals with serious mental illness: (1) academic detailing, which delivers education to primary care providers and highlights first-line pharmacotherapy for smoking cessation, and (2) provision of community health worker support to smoker participants. Implementing and scaling this intervention in other settings will require the systematic identification of barriers and facilitators, as well as the identification of relevant subgroups, effective and unique components, and setting-specific factors. Objective: This protocol outlines the proposed mixed methods evaluation of the pragmatic clinical trial to (1) identify barriers and facilitators to effective implementation of the interventions, (2) examine group differences among primary care physicians, and (3) identify barriers that stakeholders such as clinical, payor, and policy leaders would anticipate to impact the implementation of effective components of the intervention. Methods: Qualitative interviews will be conducted with all study community health workers and selected smoker participants, primary care providers, and other stakeholders. Measures of performance and engagement will guide purposive sampling. The Consolidated Framework for Implementation Research will guide qualitative data collection and analysis in accordance with the following framework approach: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Joint display analyses will be constructed to analyze and draw conclusions across the quantitative and qualitative data. Results: The 3-year cluster-randomized trial has concluded, and the analysis of primary outcomes is underway. Results from the pragmatic trial and this mixed methods implementation evaluation will be used to help disseminate, scale, and expand a systems intervention. Conclusions: The results of this mixed methods implementation evaluation will inform strategies for dissemination and solutions to potential barriers to the implementation of interventions from a smoking cessation trial for individuals with serious mental illness. International Registered Report Identifier (IRRID): DERR1-10.2196/25390 %M 34313603 %R 10.2196/25390 %U https://www.researchprotocols.org/2021/7/e25390 %U https://doi.org/10.2196/25390 %U http://www.ncbi.nlm.nih.gov/pubmed/34313603 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e25866 %T Approaches for Implementing App-Based Digital Treatments for Drug Use Disorders Into Primary Care: A Qualitative, User-Centered Design Study of Patient Perspectives %A Glass,Joseph E %A Matson,Theresa E %A Lim,Catherine %A Hartzler,Andrea L %A Kimbel,Kilian %A Lee,Amy K %A Beatty,Tara %A Parrish,Rebecca %A Caldeiro,Ryan M %A Garza McWethy,Angela %A Curran,Geoffrey M %A Bradley,Katharine A %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, United States, 1 734 678 3709, Joseph.E.Glass@kp.org %K user-centered design %K qualitative %K drug use disorders %K stimulants %K cannabis %K opioids %K primary care %K mHealth %K mobile phone %D 2021 %7 6.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions, such as websites and smartphone apps, can be effective in treating drug use disorders (DUDs). However, their implementation in primary care is hindered, in part, by a lack of knowledge on how patients might like these treatments delivered to them. Objective: This study aims to increase the understanding of how patients with DUDs prefer to receive app-based treatments to inform the implementation of these treatments in primary care. Methods: The methods of user-centered design were combined with qualitative research methods to inform the design of workflows for offering app-based treatments in primary care. Adult patients (n=14) with past-year cannabis, stimulant, or opioid use disorder from 5 primary care clinics of Kaiser Permanente Washington in the Seattle area participated in this study. Semistructured interviews were recorded, transcribed, and analyzed using qualitative template analysis. The coding scheme included deductive codes based on interview topics, which primarily focused on workflow design. Inductive codes emerged from the data. Results: Participants wanted to learn about apps during visits where drug use was discussed and felt that app-related conversations should be incorporated into the existing care whenever possible, as opposed to creating new health care visits to facilitate the use of the app. Nearly all participants preferred receiving clinician support for using apps over using them without support. They desired a trusting, supportive relationship with a clinician who could guide them as they used the app. Participants wanted follow-up support via phone calls or secure messaging because these modes of communication were perceived as a convenient and low burden (eg, no copays or appointment travel). Conclusions: A user-centered implementation of treatment apps for DUDs in primary care will require health systems to design workflows that account for patients’ needs for structure, support in and outside of visits, and desire for convenience. %M 34255666 %R 10.2196/25866 %U https://www.jmir.org/2021/7/e25866 %U https://doi.org/10.2196/25866 %U http://www.ncbi.nlm.nih.gov/pubmed/34255666 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25468 %T Potential Correlates of Internet Gaming Disorder Among Indonesian Medical Students: Cross-sectional Study %A Siste,Kristiana %A Hanafi,Enjeline %A Sen,Lee Thung %A Wahjoepramono,Petra Octavian Perdana %A Kurniawan,Andree %A Yudistiro,Ryan %+ Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospitals, Jl Siloam No 6, Tangerang, 15811, Indonesia, 62 811971169, petra.wahjoepramono@uph.edu %K internet gaming disorder %K medical students %K psychopathology %K temperament %K risk factors %D 2021 %7 19.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet gaming disorder has been a controversial topic for nearly a decade. Although internet addiction has been studied in medical students, there is a paucity of evidence regarding internet gaming disorder. Previous studies in Indonesia explored only the prevalence rate and characteristics. Objective: This study aimed to determine the prevalence rate of internet gaming disorder and correlations between internet gaming disorder, temperament, and psychopathology among Indonesian medical students. Methods: A cross-sectional study was performed from August 2019 to September 2019 using total and convenience sampling at a private university and a public university, respectively. The study variables were measured using the Indonesian version of the 10-item Internet Gaming Disorder Test, the Temperament and Character Inventory, and the Symptoms Checklist 90. Chi-square and logistic regression analyses were conducted to examine the relationships between demographic factors, temperament, psychopathology, and the presence of internet gaming disorder. Results: Among the 639 respondents, the prevalence rate of internet gaming disorder was 2.03% (n=13), with a mean age of 20.23 (SD 0.13) years and an average gaming duration of 19.0 (SD 0.96) hours/week. Up to 71.2% respondents played using their mobile phones, and respondents with internet gaming disorder reported experiencing all psychopathologies assessed, except phobic anxiety. Bivariate analysis demonstrated that internet gaming disorder was associated with gender, gaming duration, gaming community affiliation, and 9 out of 10 domains of psychopathology. In a logistic regression model, internet gaming disorder was correlated with weekly gaming hours ≥20 hours (odds ratio [OR] 4.21, 95% CI 1.08-16.38, P=.04). Conclusions: These findings suggest that the prevalence of internet gaming disorder among medical students in Jakarta, Indonesia is similar to that in other populations of Asian countries. The predisposing factor for internet gaming disorder was weekly gaming duration, while other demographic, temperament, and psychopathology variables acted as probable moderators. Strategies should, therefore, be developed and integrated into medical curriculum to screen and aid individuals with these predisposing factors. %M 33871379 %R 10.2196/25468 %U https://www.jmir.org/2021/4/e25468 %U https://doi.org/10.2196/25468 %U http://www.ncbi.nlm.nih.gov/pubmed/33871379 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e13252 %T Measures of Effectiveness, Efficiency, and Quality of Telemedicine in the Management of Alcohol Abuse, Addiction, and Rehabilitation: Systematic Review %A Kruse,Clemens Scott %A Lee,Kimberly %A Watson,Jeress B %A Lobo,Lorraine G %A Stoppelmoor,Ashton G %A Oyibo,Sabrina E %+ School of Health Administration, Texas State University, 601 University Drive, Encino Hall, Room 250, San Marcos, TX, 78666, United States, 1 2103554743, scottkruse@txstate.edu %K telemedicine %K telehealth %K mHealth %K alcohol abuse %K rehabilitation %K alcohol use disorder %D 2020 %7 31.1.2020 %9 Review %J J Med Internet Res %G English %X Background: More than 18 million Americans are currently suffering from alcohol use disorder (AUD): a compulsive behavior of alcohol use as a result of a chronic, relapsing brain disease. With alcohol-related injuries being one of the leading causes of preventable deaths, there is a dire need to find ways to assist those suffering from alcohol dependence. There still exists a gap in knowledge as to the potential of telemedicine in improving health outcomes for those patients suffering from AUD. Objective: The purpose of this systematic review was to evaluate the measures of effectiveness, efficiency, and quality that result from the utilization of telemedicine in the management of alcohol abuse, addiction, and rehabilitation. Methods: This review was conducted utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The articles used in this analysis were gathered using keywords inclusive of both telemedicine and alcohol abuse, which were then searched in the Cumulative Index to Nursing and Allied Health Literature, Cochrane, and MEDLINE (PubMed) databases. A total of 22 articles were chosen for analysis. Results: The results indicated that telemedicine reduced alcohol consumption. Other common outcomes included reduced depression (4/35, 11%), increased patient satisfaction (3/35, 9%), increase in accessibility (3/35, 9%), increased quality of life (2/35, 6%), and decreased cost (1/35, 3%). Interventions included mobile health (11/22, 50%), electronic health (6/22, 27%), telephone (3/33, 14%), and 2-way video (2/22, 9%). Studies were conducted in 3 regions: the United States (13/22, 59%), the European Union (8/22, 36%), and Australia (1/22, 5%). Conclusions: Telemedicine was found to be an effective tool in reducing alcohol consumption and increasing patients’ accessibility to health care services or health providers. The group of articles for analysis suggested that telemedicine may be effective in reducing health care costs and improving the patient’s quality of life. Although telemedicine shows promise as an effective way to manage alcohol-related disorders, it should be further investigated before implementation. %M 32012048 %R 10.2196/13252 %U http://www.jmir.org/2020/1/e13252/ %U https://doi.org/10.2196/13252 %U http://www.ncbi.nlm.nih.gov/pubmed/32012048 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 1 %P e14035 %T The Role of Perceived Loneliness in Youth Addictive Behaviors: Cross-National Survey Study %A Savolainen,Iina %A Oksanen,Atte %A Kaakinen,Markus %A Sirola,Anu %A Paek,Hye-Jin %+ Faculty of Social Sciences, Tampere University, Kalevantie 4, Tampere, 33014, Finland, 358 504377111, iina.savolainen@tuni.fi %K youth %K problem behavior %K excessive alcohol consumption %K internet %K gambling %K loneliness %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the ever-growing and technologically advancing world, an increasing amount of social interaction takes place through the Web. With this change, loneliness is becoming an unprecedented societal issue, making youth more susceptible to various physical and mental health problems. This societal change also influences the dynamics of addiction. Objective: Employing the cognitive discrepancy loneliness model, this study aimed to provide a social psychological perspective on youth addictions. Methods: A comprehensive survey was used to collect data from American (N=1212; mean 20.05, SD 3.19; 608/1212, 50.17% women), South Korean (N=1192; mean 20.61, SD 3.24; 601/1192, 50.42% women), and Finnish (N=1200; mean 21.29, SD 2.85; 600/1200, 50.00% women) youths aged 15 to 25 years. Perceived loneliness was assessed with the 3-item Loneliness Scale. A total of 3 addictive behaviors were measured, including excessive alcohol use, compulsive internet use, and problem gambling. A total of 2 separate models using linear regression analyses were estimated for each country to examine the association between perceived loneliness and addiction. Results: Loneliness was significantly related to only compulsive internet use among the youth in all 3 countries (P<.001 in the United States, South Korea, and Finland). In the South Korean sample, the association remained significant with excessive alcohol use (P<.001) and problem gambling (P<.001), even after controlling for potentially confounding psychological variables. Conclusions: The findings reveal existing differences between youths who spend excessive amounts of time online and those who engage in other types of addictive behaviors. Experiencing loneliness is consistently linked to compulsive internet use across countries, although different underlying factors may explain other forms of addiction. These findings provide a deeper understanding in the mechanisms of youth addiction and can help improve prevention and intervention work, especially in terms of compulsive internet use. %M 31895044 %R 10.2196/14035 %U https://mental.jmir.org/2020/1/e14035 %U https://doi.org/10.2196/14035 %U http://www.ncbi.nlm.nih.gov/pubmed/31895044 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e16325 %T Making Sense of Negative Findings from Mobile Attention Bias Modification Interventions for Individuals with Addictive Disorders: Quantitative Feasibility Study %A Zhang,Melvyn %A Ying,Jiangbo %A Amron,Syidda B %A Mahreen,Zaakira %A Song,Guo %A Fung,Daniel SS %A Smith,Helen E %+ National Addictions Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63802504, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K psychiatry %D 2019 %7 12.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in experimental psychology have led to a better understanding of unconscious, automatic processes that result in individuals relapsing into their substance-using habits. While some reviews have demonstrated the effectiveness of bias retraining of these unconscious biases, there have been other reviews that have highlighted that bias retraining is not always effective. Other studies have revealed there was no baseline biases among some participants. An examination of mobile bias retraining interventions has also revealed mixed results, with some reporting effectiveness and others null findings. A recent feasibility and acceptability study, done by the authors, revealed that 53% of participants have had no baseline biases and 21% of those with positive baseline biases did not have a positive change in magnitude following intervention. Objective: The aim of this paper was to explore potential variables (demographic and clinical) that could account for the negative baseline biases in the prior feasibility and acceptability study, and to discuss some of the factors that could account for the absence of baseline biases. We also explored potential reasons for why there was no reduction in the magnitude of attentional biases among individuals with baseline biases. Methods: Participants who were in the rehabilitation phase of their treatment were invited to participate. During the study they had to complete a set of baseline questionnaires, and on each day that they were on the ward they had to complete an attention bias assessment and modification task and rate their cravings using a visual analogue scale. Attention bias was deemed to be present if individuals had a positive score. Results: In our study, 53% (16/30) of individuals did not present with baseline attentional biases, and among those with positive baseline biases a total of 21% (3/14) of participants did not have a reduction in the overall magnitude of attentional biases. Chi-square analyses undertaken to compare the demographic characteristics of participants with and without baseline biases did not reveal any significant findings. However, with respect to clinical characteristics, those who had positive baseline biases had experimented with more substances. Conclusions: Our study is one of the first to have explored negative findings in attention bias modification interventions for individuals with addictive disorders. We postulate that several factors could account for the absence of baseline biases and there being no changes following bias retraining. Future research ought to take into consideration these factors. %M 31714248 %R 10.2196/16325 %U http://mhealth.jmir.org/2019/11/e16325/ %U https://doi.org/10.2196/16325 %U http://www.ncbi.nlm.nih.gov/pubmed/31714248 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e15465 %T A Smartphone Attention Bias App for Individuals With Addictive Disorders: Feasibility and Acceptability Study %A Zhang,Melvyn %A Ying,Jiangbo %A Amron,Syidda B %A Mahreen,Zaakira %A Song,Guo %A Fung,Daniel S S %A Smith,Helen Elizabeth %+ National Addiction Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 529747, Singapore, 65 98556631, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K psychiatry %K substance abuse %K alcohol abuse %K opioid abuse %K cannabis abuse %K addiction %K digital health %K mhealth %D 2019 %7 12.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Conventional psychology therapies are unable to address automatic biases that result in individuals relapsing into their substance use disorder. Advances in experimental psychology have led to a better understanding of attention and approach biases and methods to modify these biases. Several studies have demonstrated the effectiveness of bias modification among clinical cohorts. The advances in mobile health technologies have allowed remote delivery of these interventions. To date, there is a lack of studies examining bias modification in a substance-using non-Western sample. Objective: This study was designed to determine the feasibility of an attention bias modification intervention and an attention bias modification smartphone app for the reduction of attention biases among treatment-seeking individuals. The secondary aim is to determine the acceptability of the intervention. Methods: A feasibility study was conducted among inpatients who were in their rehabilitation phase at the National Addictions Management Service. Participants were to complete a set of baseline questionnaires, and on each day that they are in the study, undertake an attention bias assessment and modification task while completing a visual analogue scale to assess their craving. Feasibility was determined by the acceptance rate of participation and participants’ adherence to the interventions. Acceptability was assessed by a perception questionnaire. Descriptive statistical analyses were performed using SPSS version 22. A thematic analysis approach was used in the qualitative synthesis of users’ perceptions. Results: Of the 40 participants invited to participate in the feasibility study, 10 declined, yielding an acceptance rate of 75%. Of the recruited participants, 6 participants were diagnosed with alcohol dependence; 17, with opioid dependence; 2, with cannabis dependence; and 5, with stimulant dependence. In addition, of the final 30 participants, 11 (37%) failed to complete all the planned interventions and 22 (73%) completed the perspective questionnaires; of these 22 participants, 100% rated the app as extremely and very easy, 77% rated it as extremely or very interactive, 54% rated it as extremely or very motivating, and 33% reported a change in their confidence levels. Conclusions: Our results highlight the feasibility of recruiting participants to undertake attention bias modification interventions. Participants generally accept use of a mobile version of such an intervention. Nevertheless, our acceptability data indicate that there could be improvements in the existing app, and a participatory design approach might be helpful in its future conceptualization. International Registered Report Identifier (IRRID): RR2-10.2196/11822 %M 31586359 %R 10.2196/15465 %U http://mhealth.jmir.org/2019/9/e15465/ %U https://doi.org/10.2196/15465 %U http://www.ncbi.nlm.nih.gov/pubmed/31586359 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e12110 %T Detection of Spatiotemporal Prescription Opioid Hot Spots With Network Scan Statistics: Multistate Analysis %A Basak,Arinjoy %A Cadena,Jose %A Marathe,Achla %A Vullikanti,Anil %+ Network Systems Science and Advanced Computing Division, Biocomplexity Institute and Initiative, University of Virginia, PO Box 400298, Charlottesville, VA, 22904, United States, 1 434 982 2200, vsakumar@virginia.edu %K opiate dependence %K spatial temporal analysis %K network scan statistics %K medical specialty %D 2019 %7 17.06.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Overuse and misuse of prescription opioids have become significant public health burdens in the United States. About 11.5 million people are estimated to have misused prescription opioids for nonmedical purposes in 2016. This has led to a significant number of drug overdose deaths in the United States. Previous studies have examined spatiotemporal clusters of opioid misuse, but they have been restricted to circular shaped regions. Objective: The goal of this study was to identify spatiotemporal hot spots of opioid users and opioid prescription claims using Medicare data. Methods: We examined spatiotemporal clusters with significantly higher number of beneficiaries and rate of prescriptions for opioids using Medicare payment data from the Centers for Medicare & Medicaid Services. We used network scan statistics to detect significant clusters with arbitrary shapes, the Kulldorff scan statistic to examine the significant clusters for each year (2013, 2014, and 2015) and an expectation-based version to examine the significant clusters relative to past years. Regression analysis was used to characterize the demographics of the counties that are a part of any significant cluster, and data mining techniques were used to discover the specialties of the anomalous providers. Results: We examined anomalous spatial clusters with respect to opioid prescription claims and beneficiary counts and found some common patterns across states: the counties in the most anomalous clusters were fairly stable in 2014 and 2015, but they have shrunk from 2013. In Virginia, a higher percentage of African Americans in a county lower the odds of the county being anomalous in terms of opioid beneficiary counts to about 0.96 in 2015. For opioid prescription claim counts, the odds were 0.92. This pattern was consistent across the 3 states and across the 3 years. A higher number of people in the county with access to Medicaid increased the odds of the county being in the anomalous cluster to 1.16 in both types of counts in Virginia. A higher number of people with access to direct purchase of insurance plans decreased the odds of a county being in an anomalous cluster to 0.85. The expectation-based scan statistic, which captures change over time, revealed different clusters than the Kulldorff statistic. Providers with an unusually high number of opioid beneficiaries and opioid claims include specialties such as physician’s assistant, nurse practitioner, and family practice. Conclusions: Our analysis of the Medicare claims data provides characteristics of the counties and provider specialties that have higher odds of being anomalous. The empirical analysis identifies highly refined spatial hot spots that are likely to encounter prescription opioid misuse and overdose. The methodology is generic and can be applied to monitor providers and their prescription behaviors in regions that are at a high risk of abuse. %M 31210142 %R 10.2196/12110 %U http://publichealth.jmir.org/2019/2/e12110/ %U https://doi.org/10.2196/12110 %U http://www.ncbi.nlm.nih.gov/pubmed/31210142 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13301 %T Using Stakeholder Values to Promote Implementation of an Evidence-Based Mobile Health Intervention for Addiction Treatment in Primary Care Settings %A Quanbeck,Andrew %+ Department of Family Medicine and Community Health, University of Wisconsin-Madison, 800 University Bay Drive, Madison, WI, 53705, United States, 1 608 609 7308, arquanbe@wisc.edu %K implementation models %K implementation strategies %K mHealth %K behavioral economics %K game theory %K decision-framing %K primary care %K stakeholder engagement %D 2019 %7 07.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most evidence-based practices (EBPs) do not find their way into clinical use, including evidence-based mobile health (mHealth) technologies. The literature offers implementers little practical guidance for successfully integrating mHealth into health care systems. Objective: The goal of this research was to describe a novel decision-framing model that gives implementers a method of eliciting the considerations of different stakeholder groups when they decide whether to implement an EBP. Methods: The decision-framing model can be generally applied to EBPs, but was applied in this case to an mHealth system (Seva) for patients with addiction. The model builds from key insights in behavioral economics and game theory. The model systematically identifies, using an inductive process, the perceived gains and losses of different stakeholder groups when they consider adopting a new intervention. The model was constructed retrospectively in a parent implementation research trial that introduced Seva to 268 patients in 3 US primary care clinics. Individual and group interviews were conducted to elicit stakeholder considerations from 6 clinic managers, 17 clinicians, and 6 patients who were involved in implementing Seva. Considerations were used to construct decision frames that trade off the perceived value of adopting Seva versus maintaining the status quo from each stakeholder group’s perspective. The face validity of the decision-framing model was assessed by soliciting feedback from the stakeholders whose input was used to build it. Results: Primary considerations related to implementing Seva were identified for each stakeholder group. Clinic managers perceived the greatest potential gain to be better care for patients and the greatest potential loss to be cost (ie, staff time, sustainability, and opportunity cost to implement Seva). All clinical staff considered time their foremost consideration—primarily in negative terms (eg, cognitive burden associated with learning a new system) but potentially in positive terms (eg, if Seva could automate functions done manually). Patients considered safety (anonymity, privacy, and coming from a trusted source) to be paramount. Though payers were not interviewed directly, clinic managers judged cost to be most important to payers—whether Seva could reduce total care costs or had reimbursement mechanisms available. This model will be tested prospectively in a forthcoming mHealth implementation trial for its ability to predict mHealth adoption. Overall, the results suggest that implementers proactively address the cost and burden of implementation and seek to promote long-term sustainability. Conclusions: This paper presents a model implementers may use to elicit stakeholders’ considerations when deciding to adopt a new technology, considerations that may then be used to adapt the intervention and tailor implementation, potentially increasing the likelihood of implementation success. Trial Registration: ClinicalTrials.gov NCT01963234; https://clinicaltrials.gov/ct2/show/NCT01963234 (Archived by WebCite at http://www.webcitation.org/78qXQJvVI) %M 31237841 %R 10.2196/13301 %U http://mhealth.jmir.org/2019/6/e13301/ %U https://doi.org/10.2196/13301 %U http://www.ncbi.nlm.nih.gov/pubmed/31237841 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 11 %N 1 %P e9808 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2019 %7 ..2019 %9 %J Online J Public Health Inform %G English %X ObjectiveTo use novel technologies to develop a rapid response framework to reach opioid overdose patients in an area which is challenging from both a geography and population distribution standpoint.IntroductionClark County, Indiana is geographically located in between the urban area of Louisville, Kentucky and Scott County, Indiana. Scott County is the site for the largest HIV outbreak in the history of the United States, directly related to high rates of IV drug abuse. The unique geographic location of Clark County in combination with the recent HIV and Hepatitis C outbreaks in Clark and neighboring counties has greatly informed the development of an effective response to overdoses and the opioid epidemic in general. Furthermore, Clark County has a unique population distribution, with a population of over 125,000 and a land area of over 300 square miles. Despite this large area, over 80% of the population lives within 9 miles of the southern border of the county. This leads to a mix of both urban and rural challenges. There are several areas of the county that have greater than 15 minute emergency response times, which is often the difference between life and death in an overdose situation. These factors led to the development of the Clark County Rapid Response Project. The rapid response project is a community-based, multidisciplinary framework to address the opioid addicted patient, from initial use to successful recovery. The project uses data driven technology to initiate the care of opiate overdose patients and administer lifesaving interventions.MethodsClark County has partnered with the Indiana State Department of Health utilizing the early notification system that monitors statewide overdose activity. Once an alert is sent out, the response involves the use of two early notification systems. Everbridge is a one touch notification system that allows rapid dissemination of information to various community partners to allow them to initiate the appropriate response. Pulse Point is a smart phone application that allows CPR and trained community laypeople to respond to a cardiac arrest or overdose patient in a public place. It provides directions to the patient as well as to the nearest AED. Clark County has also simultaneously instituted a county-wide CPR training initiative and offered Narcan training as well. This is a major paradigm shift, as prior methods of deployment of trained laypeople essentially relied on the chance that an overdose will be reached by a first responder.ResultsEverbridge has allowed for the rapid notification of county entities and deployment of resources to overdose ‘hot spot’ areas. The Pulse Point initiative has dramatically increased the number of CPR and Narcan trained responders and provided means of delivering them to the appropriate patient population in a timely manner. Both these technologies have dramatically increased the delivery of resources to the overdose patient and decreased response times to the delivery of care.ConclusionsUsing data driven technology to inform how Clark County Health Department and first responders collectively address the opioid crisis is a novel approach. Since January 2018, Clark County Health Department has used ESSENCE (Electronic Surveillance System for the Early Notification of Community-based Epidemics) to determine where and when an increase of drug overdose activity is occurring throughout the county. This affords county health officials the ability to inform in “near real-time” first responders, the emergency department and other community stakeholders, relevant information thus allowing for the rapid deployment of county resources to the areas most affected. Our collective efforts to save lives is further enhanced by the county using of novel technologies like Pulse Point which is used to deploy both CPR and Narcan trained laypersons directly to sites in the community where overdoses are occurring. In a community, which is in large part considered rural and, in many places, has a greater than 15 minute emergency response time, using Pulse Point and Everbridge technologies has uniquely positioned Clark County to be on the cutting edge of saving lives as we leverage data and technology to address the opioid epidemic in our communities. This has markedly improved access to treatment and response times to overdose patients in Clark County, Indiana. %R 10.5210/ojphi.v11i1.9808 %U %U https://doi.org/10.5210/ojphi.v11i1.9808 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 5 %N 1 %P e12474 %T Development and Evaluation of the Online Addiction Medicine Certificate: Free Novel Program in a Canadian Setting %A Gorfinkel,Lauren Renee %A Giesler,Amanda %A Dong,Huiru %A Wood,Evan %A Fairbairn,Nadia %A Klimas,Jan %+ British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada, 1 (778) 945 7616, jan.klimas@bccsu.ubc.ca %K medical education %K substance-related disorders %K education, distance %D 2019 %7 24.05.2019 %9 Original Paper %J JMIR Med Educ %G English %X Background: Despite the enormous bur­den of disease attributable to drug and alcohol addiction, there remain major challenges in implementing evi­dence-based addiction care and treatment modalities. This is partly because of a persistent lack of accessible, specialized training in addiction medicine. In response, a new online certificate in addiction medicine has been established in Vancouver, Canada, free of charge to participants globally. Objective: The objective of this study was to evaluate and examine changes in knowledge acquisition among health care professionals before and after the completion of an online certificate in addiction medicine. Methods: Learners enrolled in a 17-module certificate program and completed pre- and postknowledge tests using online multiple-choice questionnaires. Knowledge acquisition was then evaluated using a repeated measures t test of mean test scores before and after the online course. Following the certificate completion, a subset of learners completed the online course evaluation form. Results: Of the total 6985 participants who registered for the online course between May 15, 2017 and February 22, 2018, 3466 (49.62%) completed the online pretest questionnaire. A total of 1010 participants completed the full course, achieving the required 70% scores. TThe participants self-reported working in a broad range of health-related fields, including nursing (n=371), medicine (n=92), counseling or social work (n=69), community health (n=44), and pharmacy (n=34). The median graduation year was 2010 (n=363, interquartile range 2002-2015). Knowledge of the addiction medicine increased significantly postcertificate (mean difference 28.21; 95% CI 27.32 to 29.10; P<.001). Physicians scored significantly higher on the pretest than any other health discipline, whereas the greatest improvement in scores was seen in the counseling professions and community outreach. Conclusions: This free, online, open-access certificate in addiction medicine appeared to improve knowledge of learners from a variety of disciplines and backgrounds. Scaling up low threshold learning opportunities may further advance addiction medicine training, thereby helping to narrow the evidence-to-practice gap. %M 31127722 %R 10.2196/12474 %U http://mededu.jmir.org/2019/1/e12474/ %U https://doi.org/10.2196/12474 %U http://www.ncbi.nlm.nih.gov/pubmed/31127722 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11107 %T A Mobile App to Provide Evidence-Based Information About Crystal Methamphetamine (Ice) to the Community (Cracks in the Ice): Co-Design and Beta Testing %A Birrell,Louise %A Deen,Hannah %A Champion,Katrina Elizabeth %A Newton,Nicola C %A Stapinski,Lexine A %A Kay-Lambkin,Frances %A Teesson,Maree %A Chapman,Cath %+ National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 22 – 32 King Street, Randwick, Sydney, 2031, Australia, 61 2 8936 1217, h.deen@unsw.edu.au %K internet %K methamphetamine %K mobile apps %K mobile phone %K substance-related disorder %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite evidence of increasing harms and community concern related to the drug crystal methamphetamine (“ice”), there is a lack of easily accessible, evidence-based information for community members affected by its use, and to date, no evidence-based mobile apps have specifically focused on crystal methamphetamine. Objective: This study aims to describe the co-design and beta testing of a mobile app to provide evidence-based, up-to-date information about crystal methamphetamine to the general community. Methods: A mobile app about crystal methamphetamine was developed in 2017. The development process involved multiple stakeholders (n=12), including technology and drug and alcohol experts, researchers, app developers, a consumer expert with lived experience, and community members. Beta testing was conducted with Australian general community members (n=34), largely recruited by the Web through Facebook advertising. Participants were invited to use a beta version of the app and provide feedback about the content, visual appeal, usability, engagement, features, and functions. In addition, participants were asked about their perceptions of the app’s influence on awareness, understanding, and help-seeking behavior related to crystal methamphetamine, and about their knowledge about crystal methamphetamine before and after using the app. Results: The vast majority of participants reported the app was likely to increase awareness and understanding and encourage help-seeking. The app received positive ratings overall and was well received. Specifically, participants responded positively to the high-quality information provided, usability, and visual appeal. Areas suggested for improvement included reducing the amount of text, increasing engagement, removing a profile picture, and improving navigation through the addition of a “back” button. Suggested improvements were incorporated prior to the app’s public release. App use was associated with an increase in perceived knowledge about crystal methamphetamine; however, this result was not statistically significant. Conclusions: The Cracks in the Ice mobile app provides evidence-based information about the drug crystal methamphetamine for the general community. The app is regularly updated, available via the Web and offline, and was developed in collaboration with experts and end users. Initial results indicate that it is easy to use and acceptable to the target group. %M 30573443 %R 10.2196/11107 %U https://mhealth.jmir.org/2018/12/e11107/ %U https://doi.org/10.2196/11107 %U http://www.ncbi.nlm.nih.gov/pubmed/30573443 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 7 %N 2 %P e10313 %T Hepatitis C Prevalence and Management Among Patients Receiving Opioid Substitution Treatment in General Practice in Ireland: Baseline Data from a Feasibility Study %A Murtagh,Ross %A Swan,Davina %A O'Connor,Eileen %A McCombe,Geoff %A Lambert,John S %A Avramovic,Gordana %A Cullen,Walter %+ University College Dublin, Belfield, Dublin, D14 YH57, Ireland, 353 1 4730893, walter.cullen@ucd.ie %K hepatitis C %K integrated HCV care %K people who inject drugs %K primary care %D 2018 %7 19.12.2018 %9 Original Paper %J Interact J Med Res %G English %X Background: Hepatitis C virus (HCV) infection is a major cause of chronic liver disease and death. Injection drug use is now one of the main routes of transmission of HCV in Ireland and globally with an estimated 80% new infections occurring among people who inject drugs (PWID). Objective: We aimed to examine whether patients receiving opioid substitution therapy in primary care practices in Ireland were receiving guideline-adherent care regarding HCV screening. Ireland has developed a model of care for delivering opioid substitution treatment in the primary care setting. We conducted this study given the shift of providing care for PWID from secondary to primary care settings, in light of current guidelines aimed at scaling up interventions to reduce chronic HCV infection and associated mortality. Methods: We included baseline data from the Dublin site of the Heplink study, a feasibility study focusing on developing complex interventions to enhance community-based HCV treatment and improve the HCV care pathway between primary and secondary care. We recruited 14 opioid substitution treatment-prescribing general practices that employed the administration of opioid substitution therapy from the professional networks and databases of members of the research consortium. A standardized nonprobability sampling framework was used to identify 10 patients from each practice to participate in the study. Patients were eligible if aged ≥18 years, on opioid substitution treatment, and attending the practice for any reason during the recruitment period. The baseline data were collected from the clinical records of participating patients. We collected and analyzed data on demographic characteristics, care processes and outcomes regarding HCV and other blood-borne viruses, urinalysis test results, alcohol use disorders, chronic illness, and health service utilization. We examined whether patients received care concordant with guidelines related to HCV screening and care. Results: The baseline data were collected from clinical records of 134 patients; 72.2% (96/134) were males; (mean age 43, SD 7.6; range 27-71 years); 94.8% (127/134) of patients had been tested for anti-HCV antibody in their lifetime; of those, 77.9% (99/127) tested positive. Then, 83.6% (112/134) of patients had received an HIV antibody test in their lifetime; of those, 6.3% (7/112) tested HIV positive. Moreover, 66.4% (89/134) of patients had been tested for hepatitis B virus in their lifetime and 8% (7/89) of those were positive. In the 12 months before the study, 30.6% (41/134) of patients were asked about their alcohol use by their general practitioner, 6.0% (8/134) received a brief intervention, and 2.2% (3/134) were referred to a specialist addiction or alcohol treatment service. Conclusions: With general practice and primary care playing an increased role in HCV care, this study highlights the importance of prioritizing the development and evaluation of real-world clinical solutions that support patients from diagnosis to treatment completion. %M 30567692 %R 10.2196/10313 %U http://www.i-jmr.org/2018/2/e10313/ %U https://doi.org/10.2196/10313 %U http://www.ncbi.nlm.nih.gov/pubmed/30567692 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e10 %T Food Addiction Support: Website Content Analysis %A McKenna,Rebecca A %A Rollo,Megan E %A Skinner,Janelle A %A Burrows,Tracy L %+ School of Health Sciences, Faculty of Health and Medicine, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 249215514, tracy.burrows@newcastle.edu.au %K food addiction %K self-help groups %K social support %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Food addiction has a long history; however, there has been a substantial increase in published literature and public media focus in the past decade. Food addiction has previously demonstrated an overlap with overweight and obesity, a risk for cardiovascular disease. This increased focus has led to the establishment of numerous support options for addictive eating behaviors, yet evidence-based support options are lacking. Objective: This study aimed to evaluate the availability and content of support options, accessible online, for food addiction. Methods: A standardized Web search was conducted using 4 search engines to identify current support availability for food addiction. Through use of a comprehensive data extraction sheet, 2 reviewers independently extracted data related to the program or intervention characteristics, and support fidelity including fundamentals, support modality, social support offered, program or intervention origins, member numbers, and program or intervention evaluation. Results: Of the 800 records retrieved, 13 (1.6%, 13/800) websites met the inclusion criteria. All 13 websites reported originating in the United States, and 1 website reported member numbers. The use of credentialed health professionals was reported by only 3 websites, and 5 websites charged a fee-for-service. The use of the 12 steps or traditions was evident in 11 websites, and 9 websites described the use of food plans. In total, 6 websites stated obligatory peer support, and 11 websites featured spirituality as a main theme of delivery. Moreover, 12 websites described phone meetings as the main program delivery modality, with 7 websites stating face-to-face delivery and 4 opting for online meetings. Newsletters (n=5), closed social media groups (n=5), and retreat programs (n=5) were the most popular forms of social support. Conclusions: This is the first review to analyze online support options for food addiction. Very few online support options include health professionals, and a strengthening argument is forming for an increase in support options for food addiction. This review forms part of this argument by showing a lack of evidence-based options. By reviewing current support availability, it can provide a guide toward the future development of evidence-based support for food addiction. %M 31758778 %R 10.2196/cardio.8718 %U http://cardio.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/cardio.8718 %U http://www.ncbi.nlm.nih.gov/pubmed/31758778