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View (E10) Jennifer Apolinário-Hagen, Jessica Kemper, Carolina Stürmer JMIR Mental Health Internet interventions, technologies and digital innovations for mental health and behaviour change Volume 4 (2017), Issue 2 ISSN: 2368-7959 Editor in Chief: John Torous, MD Contents Original Papers The Living the Example Social Media Substance Use Prevention Program: A Pilot Evaluation (e24) William Evans, Elizabeth Andrade, Sandra Goldmeer, Michelle Smith, Jeremy Snider, Gunilla Girardo. 3 Gathering Opinions on Depression Information Needs and Preferences: Samples and Opinions in Clinic Versus Web-Based Surveys (e13) Matthew Bernstein, John Walker, Kathryn Sexton, Alan Katz, Brooke Beatie, Mobilizing Minds Research Group. 13 Delivering Cognitive Behavior Therapy to Young Adults With Symptoms of Depression and Anxiety Using a Fully Automated Conversational Agent (Woebot): A Randomized Controlled Trial (e19) Kathleen Fitzpatrick, Alison Darcy, Molly Vierhile. 28 Who is More Likely to Use the Internet for Health Behavior Change? A Cross-Sectional Survey of Internet Use Among Smokers and Nonsmokers Who Are Orthopedic Trauma Patients (e18) Sam McCrabb, Amanda Baker, John Attia, Zsolt Balogh, Natalie Lott, Kerrin Palazzi, Justine Naylor, Ian Harris, Christopher Doran, Johnson George, Luke Wolfenden, Eliza Skelton, Billie Bonevski. 39 Clinical Insight Into Latent Variables of Psychiatric Questionnaires for Mood Symptom Self-Assessment (e15) Athanasios Tsanas, Kate Saunders, Amy Bilderbeck, Niclas Palmius, Guy Goodwin, Maarten De Vos. 63 Initial Progress Toward Development of a Voice-Based Computer-Delivered Motivational Intervention for Heavy Drinking College Students: An Experimental Study (e25) Christopher Kahler, William Lechner, James MacGlashan, Tyler Wray, Michael Littman. 83 Health App Use Among Individuals With Symptoms of Depression and Anxiety: A Survey Study With Thematic Coding (e22) Caryn Rubanovich, David Mohr, Stephen Schueller. 94 Diversity in eMental Health Practice: An Exploratory Qualitative Study of Aboriginal and Torres Strait Islander Service Providers (e17) Jennifer Bird, Darlene Rotumah, James Bennett-Levy, Judy Singer. 108 Use of New Technologies in the Prevention of Suicide in Europe: An Exploratory Study (e23) Juan-Luis Muñoz-Sánchez, Carmen Delgado, Andrés Sánchez-Prada, Mercedes Pérez-López, Manuel Franco-Martín. 119 Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review (e10) Jennifer Apolinário-Hagen, Jessica Kemper, Carolina Stürmer. 130 JMIR Mental Health 2017 | vol. 4 | iss. 2 | p.1 XSL·FO RenderX Perspectives of Family Members on Using Technology in Youth Mental Health Care: A Qualitative Study (e21) Shalini Lal, Winnie Daniel, Lysanne Rivard. 145 Preferences for Internet-Based Mental Health Interventions in an Adult Online Sample: Findings From an Online Community Survey (e26) Philip Batterham, Alison Calear. 155 A Systematic Review and Meta-Analysis of e-Mental Health Interventions to Treat Symptoms of Posttraumatic Stress (e14) Sara Simblett, Jennifer Birch, Faith Matcham, Lidia Yaguez, Robin Morris. 166 Internet Addiction Through the Phase of Adolescence: A Questionnaire Study (e11) Silvana Karacic, Stjepan Oreskovic. 182 A Mixed-Methods Study Using a Nonclinical Sample to Measure Feasibility of Ostrich Community: A Web-Based Cognitive Behavioral Therapy Program for Individuals With Debt and Associated Stress (e12) Dawn Smail, Sarah Elison, Linda Dubrow-Marshall, Catherine Thompson. 193 Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial (e16) Sara Simblett, Matthew Yates, Adam Wagner, Peter Watson, Fergus Gracey, Howard Ring, Andrew Bateman. 207 Viewpoint Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps (e20) Wei Tang, David Kreindler. 53 JMIR Mental Health 2017 | vol. 4 | iss. 2 | p.2 XSL·FO RenderX JMIR MENTAL HEALTH Evans et al Original Paper The Living the Example Social Media Substance Use Prevention Program: A Pilot Evaluation William Evans1, PhD; Elizabeth Andrade1, DrPH; Sandra Goldmeer2; Michelle Smith2; Jeremy Snider3, PhD; Gunilla Girardo2 1Milken Institute School of Public Health, Department of Prevention and Community Health, The George Washington University, Washington, DC, United States 2Mentor Foundation USA, Washington, DC, United States 3School of Public Health, University of Washington, Seattle, WA, United States Corresponding Author: William Evans, PhD Milken Institute School of Public Health Department of Prevention and Community Health The George Washington University 950 New Hampshire Avenue Washington, DC, 20052 United States Phone: 1 2029943632 Email: [email protected] Abstract Background: Adolescent substance use rates in rural areas of the United States, such as upstate New York, have risen substantially in recent years, calling for new intervention approaches in response to this trend. The Mentor Foundation USA conducts the Living the Example (LTE) campaign to engage youth in prevention using an experiential approach. As part of LTE, youth create their own prevention messages following a training curriculum in techniques for effective messaging and then share them via social media. This paper reports on a pilot evaluation of the LTE program. Objective: To conduct a pilot test of LTE in two rural high schools in upstate New York. We hypothesized that positive antidrug brand representations could be promoted using social media strategies to complement the Shattering the Myths (STM) in-person, event-based approach (hypothesis 1, H1), and that youth would respond positively and engage with prevention messages disseminated by their peers. We also hypothesized that exposure to the social media prevention messages would be associated with more positive substance use avoidance attitudes and beliefs, reductions in future use intentions, and decreased substance use at posttest (hypothesis 2, H2). Methods: We adapted a previously published curriculum created by the authors that focuses on branding, messaging, and social media for prevention. The curriculum consisted of five, one-hour sessions. It was delivered to participating youth in five sequential weeks after school at the two high schools in late October and early November 2016. We designed a pre- and posttest pilot implementation study to evaluate the effects of LTE on student uptake of the intervention and short-term substance use and related outcomes. Working at two high schools in upstate New York, we conducted a pilot feasibility evaluation of LTE with 9th-grade students (ie, freshmen) at these high schools. We administered a 125-item questionnaire online to capture data on media use; attitudes toward social media; next 30-day personal drug use intentions; personal reasons to use drugs; reasons participants believe their peers would use drugs; self-reported exposure to the LTE program; and receptivity to the LTE program, among those reporting exposure. We constructed multivariable logistic regression models to analyze the relationship between program receptivity and outcomes. First, in a cross-sectional logistic regression model, we regressed self-reported LTE message receipt on drug use intent and actions related to LTE messaging. Then, for analysis of participants with matched pre- and posttest responses, we used multilevel generalized estimating equation (GEE) techniques to model changes in behavior from baseline to follow-up. Results: Youth reported increased intentions to use marijuana (odds ratio [OR] 2.134, P=.02) between pre- and posttest. However, youth who reported exposure and receptivity to LTE reported a significant decrease in intentions (OR 0.239, P=.008). We observed a similar pattern for sedatives/sleeping pillsÐan increase in intentions overall (OR 1.886, P=.07), but a decrease among youth who reported exposure and receptivity to LTE (OR 0.210, P=.02). We saw the same pattern for use of any drugÐan increase in http://mental.jmir.org/2017/2/e24/ JMIR Ment Health 2017 | vol. 4 | iss. 2 | e24 | p.3 (page number not for citation purposes) XSL·FO RenderX JMIR MENTAL HEALTH Evans et al reported intentions overall (OR 2.141, P=.02), but a decrease among youth who reported exposure and receptivity to LTE (OR 0.111, P=.004). Conclusions: We observed some evidence of significant LTE program effects. Social media may be an effective strategy for peer-to-peer substance use prevention in the future. These findings point both to the potential of LTE and the social media diffusion model and to the need for more research on a larger scale with an expanded youth population in the future. (JMIR Ment Health 2017;4(2):e24) doi:10.2196/mental.7839 KEYWORDS substance use prevention; peer-to-peer education; social media; adolescence messaging. We conducted a pilot study in Columbia County, Introduction New York, to evaluate the efficacy of LTE with the added social Background media component. We also assessed the utility of this novel approach using social media strategies and branding principles Adolescent substance use rates in rural areas of the United to reach at-risk youth with prevention messages, engage youth States, such as upstate New York, have risen substantially in in the program's brand, and monitor exposure to specific social recent years [1], calling for new intervention approaches in media channels. response to this trend. There is growing evidence that substance use, including marijuana and other drug use, has negative health Potential of Social Media for Prevention consequences for adolescents, especially when
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