Texting to Reduce Alcohol Consumption 2 (TRAC2) is an adaptive text message intervention that uses texts and ecological momentary assessments (EMAs) to reduce weekend alcohol consumption in at-risk nontreatment-seeking young adults.
Over a 12-week period, TRAC2 sent users a voluntary pre-weekend drinking limit goal EMA (a 2-week average of the maximum number of alcoholic drinks consumed at one time by the individual). Participants received intra-weekend goal reminders and completed a self-efficacy EMA (queried user confidence in goal success and sent tailored self-efficacy support based on user response). A final EMA queried maximum alcohol consumption at any one time over the past week (individualized feedback celebrated success, reframed failure, or offered information on amount consumed). Users received TRAC2 messages 4 days per week: Thursday (voluntary pre-weekend drinking limit goal EMA), Friday and Saturday (intra-weekend goal reminders and self-efficacy EMA), and Sunday (weekly maximum drinks consumed EMA). If the user had a 2-week maximum consumption average that exceeded 10 drinks, TRAC2 defaulted to a drinking limit goal of 10 drinks. If the user had a 2-week maximum consumption average that was ≤ 10 drinks but exceeded the binge drinking threshold (women: ≥4 drinks, men: ≥5 drinks), TRAC2 defaulted to a drinking limit goal of 1 drink less than the past 2-week maximum consumption average. Informed by behavioral theory, the adaptive drinking limit goal encouraged small sequential shifts toward a lower-risk drinking limit goal.
Mobile application (app)
Ecological Momentary Assessment (EMA)
Reduction in quantity of alcohol consumption
A text message intervention with adaptive goal support to reduce alcohol consumption among non-treatment-seeking young adults: Non-randomized clinical trial with voluntary length of enrollment
Suffoletto B, Chung T, Muench F, Monti P, Clark D. JMIR Mhealth Uhealth. 2018. 6(2): e35. doi: 10.2196/mhealth.8530
Summary: Researchers recruited 38 non-treatment seeking young adults aged 18 to 25 years with hazardous alcohol use through medical record review at an urban emergency department to participate in a pilot study to evaluate the impact of Texting to Reduce Alcohol Consumption 2 (TRAC2) on participant engagement and weekend alcohol consumption. After a 2-week text message-only repeated baseline assessment (n = 50), researchers invited engaged participants (responded to at least 50% of queries) to enroll in the TRAC2 intervention (n = 38). TRAC2 EMA queries yielded an 82% participant response rate at 4 weeks, a 75% response rate at 8 weeks, and a 73% response rate at 12 weeks. In the first 4 weeks of intervention, 96% of EMA drinking limit prompts elicited participant commitment. Participants met individual drinking limit goals almost every weekend (89%). Within the 12-week intervention period, median number of reported drinks consumed over weekends decreased, independent of intervention exposure length. The percent of participants with a drinking limit goal above binge drinking threshold decreased from 52% of participants in Week 1 to 0% of participants in Week 4. Researchers also observed a significant decrease in participant intention to drink over the weekend from Week 1 (78% of participants) to Week 4 (46% of participants). Participants who reported lower confidence in goal (score <4) on Friday or Saturday achieved lower levels of goal success (goal achieved 76% of weekends) compared with participants who reported high confidence in goal (achieved 98% of weekends).
Take Away: TRAC2 appeared to engage participants and reduce high-risk weekend alcohol consumption in non-treatment seeking young adults.