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

间歇性酗酒及其相关的健康和社会后果是重大的公共卫生问题，在年轻人中的流行率很高。这在美国军事人员中尤其如此。虽然美国军队的饮酒量很高，而且很正常，但对饮酒时陷入法律麻烦的行为是零容忍的，而确实陷入与酒精相关的法律麻烦(如酒后驾车、性侵犯)的飞行员通常会收到所谓的酒精相关事件(ARI)。在其他人群中，针对酒精滥用的短暂酒精干预(BAIS)已被证实是有效的，有强有力的证据表明，大多数大学生年轻人报告了间歇性大量饮酒。许多BAI研究针对的是危险饮酒的年轻人；这些人通常对戒酒不感兴趣，但为了减少有害后果，他们往往愿意减少饮酒量或改变饮酒方式。我们之前已经公布了一项基于BAI组的干预结果，该干预被证明在超过15万人中(不仅仅是高风险饮酒者)ARI平均减少16%。自从我们从2010年开始，BAI已经传播给了大多数在美国空军接受技术(高级)培训的飞行员。然而，很明显，需要更多的研究来增强我们的BAI干预的有效性，并降低与问题饮酒行为相关的风险。一种可以改善健康促进结果的这样的策略是及时、量身定做的自动短信。在我们的初步研究基础上，短信减少了酒后驾车和开车前的总饮酒量(参见之前的工作)，短信可能非常有效，因为飞行员获得酒精的准确时间(当他们第一次被允许离开基地)是已知的，并且对于所有飞行员来说是相同的时间。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，用于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，也是第一次大规模的、动力充足的试验，干预效果将被追踪到一年的跟踪。我们的发现将对在平民和军事人群中进行研究具有重要意义。因此，我们提出了以下具体目标：(1)我们将把大约3000名飞行员随机分为当前管理的BAI组和BAI+互动顾问组，这些组的短信定时发生在飞行员饮酒之前、期间和之后；以及(2)在3个月、6个月、9个月和12个月的跟踪调查中，使用具有唯一标识的重复匿名调查来评估干预的有效性，使我们能够匹配调查，同时保持匿名。

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.