JMIR Publications

ABSTRACT

Background:

Life-skills trainings conducted within the school curriculum are effective in preventing the onset and escalation of substance use among adolescents. However, their dissemination is impeded due to their large resource requirements. Life-skills training provided via mobile phones may provide a more economic and scalable approach.

Objective:

To test the appropriateness (acceptance, use, evaluation) and short-term efficacy of a mobile phone-based life-skills training to prevent substance use among adolescents within a controlled trial.

Methods:

Two-arm, parallel-group, cluster-randomized controlled trial with assessments at baseline and 6-month follow up. The automated intervention program SmartCoach included online feedback and individually tailored text messages provided over 6 months. The contents were based on social cognitive theory and addressed self-management skills, social skills, and substance use resistance skills. (Generalized) Linear mixed models as well as logistic or linear regressions were used to investigate changes between baseline and 6-month follow-up in the following outcomes: 30-days prevalence rates of problem drinking, tobacco, cannabis use as well as alcohol use quantity, quantity of cigarettes smoked, cannabis use days, perceived stress, well-being, and social skills.

Results:

A total of 1,759 students from 89 Swiss secondary and upper secondary school classes, were invited to participate in the study. Of these, 1,473 (83.7%) students (mean age 15.4 years, 55.2% female) participated in the study. Six-month follow-up assessments were completed by 1,233 (83.7%) study participants. Concerning program use and engagement, the overall results were positive, with the majority of students (94.8%) remaining registered for the program for the total duration of six months. On average, program participants responded to half (23.6/50) of the prompted activities. Program evaluations underlined its appropriateness for the target group of secondary school students with the majority rating the program as helpful and individually tailored. Regarding efficacy, prevalence of problem drinking increased by 2.5% (from 15.2% to 17.7%) in the intervention group and by 3.4% (from 20.7% to 24.1%) in the control group, relative to that observed at baseline (OR=0.71, p=.07). The prevalence of tobacco smoking increased by 3.4% (15.1% to 18.5%) in the control group and by 2.4% (12.1% to 14.5%) in the intervention group (OR=0.83, p=.46). Cannabis use prevalence increased by 2.3% in the control group and by 1.3% in the intervention group (OR=1.24, p=.21). Quantity of alcohol consumed per month decreased by 0.6 standard drinks in the intervention group and increased by 0.7 standard drinks in the control group (p=.03). Further significant group effects were observed for pre-post difference in cigarettes smoking (-1.7 cigarettes per month in the intervention group and +5.0 in the control group, p = .01) and reported stress (p = .02). No significant group effects were observed in the frequency of cannabis use (p=0.053), well-being (p=.16) and social skills (p=.20).

Conclusions:

The results show good acceptance of this intervention program that could be easily and economically implemented in school classes. Initial results on program efficacy indicate that it might be effective in both preventing or reducing substance use and fostering life skills, however, data of the final 18-months follow-up assessments will be more conclusive. Clinical Trial: ISRCTN41347061 (registration date: 21/07/2018)