The effectiveness of text-based messaging strategies for preventing subsequent problematic alcohol use among technical trainees in the U.S. Air force

间歇性的大量或狂饮以及相关的健康和社会后果是重大的公共卫生问题，在年轻人中发病率很高。在美国军事人员中尤其如此。虽然美国军队的饮酒量很高，也很规范，但他们对喝酒时惹上法律麻烦是零容忍的，而与酒精有关的法律麻烦（例如，酒后驾车，性侵犯）通常会被称为酒精相关事件（ARI）。在其他人群中，针对酒精滥用的简短酒精干预（BAIs）已被证实是有效的，有强有力的证据表明，大多数大学年轻人报告间歇性大量饮酒。许多BAI研究的目标是酗酒的年轻人；这些人通常对戒酒不感兴趣，但通常愿意减少饮酒量或改变饮酒方式，以减少有害后果。我们之前已经发表了一项基于BAI小组的干预结果，该结果已被证明可以普遍（不仅仅是高危饮酒者）减少超过15万人的ARIs，平均减少16%。自2010年开始以来，BAI已分发给美国空军技术（高级）培训的大多数飞行员。然而，很明显，需要进一步的研究来提高我们的BAI干预的有效性，并降低与问题饮酒行为相关的风险。其中一种可以改善健康促进结果的策略是适时和量身定制的自动短信。根据我们的初步研究，短信减少了酒后驾驶以及驾驶前的总饮酒量（见之前的工作），短信可能是非常有效的，因为已知飞行员获得酒精的精确时间（当他们第一次被允许离开基地时），并且对所有飞行员来说都是相同的时间。在军队中进行酒精研究的挑战之一是缺乏特权交流。因此，由于拒绝或尽量减少使用的倾向，很难获得有效的自我报告。幸运的是，我们最近验证了我们的研究团队开发的一种方法，该方法可以随着时间的推移收集匿名数据。我们建议在军队中进行第一次研究，同时也是第一次大规模的、有充分动力的试验，其中干预效果将被追踪到一年的随访。我们的研究结果将对在平民和军事人群中进行研究具有重要意义。因此，我们提出以下具体目标：(1)我们将随机抽取大约3000名飞行员，将其分为当前管理的BAI组和BAI +互动辅导员辅助短信组，这些短信在飞行员饮酒之前、期间和之后定时发生；(2)在3个月、6个月、9个月和12个月的随访中评估干预措施的效果，使用具有唯一标识符的重复匿名调查，使我们能够在保持匿名的同时匹配调查。

Episodic heavy or binge drinking and the associated health and social consequences are substantial public health concerns, with a high prevalence among young adults. This is particularly true among US military personnel. While alcohol consumption in the US military is very high and normative, there is zero tolerance for getting in legal trouble while drinking, and Airmen who do get in alcohol-related legal trouble (e.g., DUI, sexual assault) typically receive what is called an Alcohol Related Incident (ARI). In other populations, Brief Alcohol Interventions (BAIs) for alcohol misuse have been validated as efficacious with robust evidence for mostly college young adults who report episodic heavy drinking. Many BAI studies have targeted young adults who drink hazardously; these individuals are generally not interested in abstaining from alcohol, but are often willing to decrease the amount they drink or change the manner in which they drink in order to reduce harmful consequences. We have previously published1 the results of a BAI group- based intervention that has been shown to reduce ARIs universally (not in just high risk drinkers) in over 150,000 on average by 16%. Since we began in 2010, the BAI has been disseminated to most Airmen in Technical (Advanced) Training in the USAF. However, it is clear that additional research is needed to enhance the efficacy of our BAI intervention and to reduce the risk associated with problem drinking behavior. One such strategy that could improve health promotion outcomes is well timed and tailored automated text messages. Building on our preliminary study where text messages reduced driving after drinking as well as total drinks consumed before driving (See Previous Work), text messaging may be highly effective as the precise time that Airmen gain access to alcohol (when they are allowed off base for the first time) is known and is the same time for all Airmen. One of the challenges to conducting alcohol research in the military is the lack of privileged communication. As a result, it is difficult to obtain valid self-reports due to a tendency to deny or minimize use. Fortunately, we have recently validated a method developed by our research team for collecting anonymous data over time. We propose to conduct what is the first study in the military, as well as the first large scale, adequately powered trial, where intervention effects will be tracked out to a one year follow-up. Our findings would have strong implications for conducting research in both civilian and military populations. Thus, we propose the following Specific Aims: (1) We will randomize approximately 3000 Airmen to either the currently administered group BAI versus the BAI + Interactive Counselor Facilitated Text messages timed to occur before, during, and after Airmen have access to alcohol; and (2) To evaluate the efficacy of the intervention at a 3-, 6-, 9- and 12-month follow-up using repeated anonymous surveys with unique identifiers allowing us to match up surveys while simultaneously maintaining anonymity.