Pilot test of an mHealth Intervention for Reducing Alcohol Use among Rural Adolescent and Young Adult Cancer Survivors

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ABSTRACT Adolescent and young adult (AYA) survivors of cancer have poorer health than their peers who have not been diagnosed with cancer and are more likely to die from non-cancer related causes. Researchers have called for health promotion interventions to improve outcomes and reduce risk behaviors among this population; however, one key risk factor—alcohol consumption—has been largely unstudied. Most AYA survivors are current drinkers, and over a third report engaging in binge drinking. Survivors living in rural areas may be even more at risk, as they have limited access to health and psychological care and many youth in these areas report more frequent alcohol consumption than their urban counterparts. Given that alcohol use is associated with increased risk of cancer recurrence, poorer survival, and other comorbidities, it is important to explore interventions for reducing this behavior among rural AYA survivors. The proposed research will test a mobile health (mHealth) intervention for reducing alcohol use, called TRAC: Tracking and Reducing Alcohol Consumption. This intervention, which is currently being implemented among a sample of people living with HIV/AIDS, is based on principles of motivational interviewing. It utilizes weekly phone conversations with an interventionist over an 8-week period and twice-daily self-monitoring of alcohol consumption using mobile surveys and Bluetooth breathalyzers. The intervention has strong potential for acceptability among rural AYAs given this populations’ high digital literacy, and will also reduce barriers to care experienced by those in rural areas, who often have to travel long distances to see providers in-person. Through key informant interviews, the TRAC intervention will be adapted and refined for rural AYA survivors. Then, it will be tested through a pilot randomized controlled trial with a monitoring and education comparison group. This pilot trial will assess intervention retention, adherence, and acceptability, and provide preliminary data regarding impact on alcohol use. Overall, the proposed research will yield valuable feasibility data to inform a definitive randomized controlled trial of this intervention to test efficacy among a larger sample of rural AYA survivors. If TRAC is shown to be successful in this population, it could be implemented in rural cancer clinics across the country and reduce risky alcohol consumption among the over 2 million AYAs in the United States.