Shrier Lydia A, Burke Pamela J, Kells Meredith, Scherer Emily A, Sarda Vishnudas, Jonestrask Cassandra, Xuan Ziming, Harris Sion Kim
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA.
Mhealth. 2018 Jul 30;4:29. doi: 10.21037/mhealth.2018.07.04. eCollection 2018.
Ecological momentary interventions (EMIs) influence behavior in real time, in real life. We evaluated trial feasibility and preliminary efficacy of MOMENT, a counseling-plus-EMI to reduce frequent marijuana use in youth in primary care.
Primary care patients age 15-24 years using marijuana at least 3 times/week were randomized to MOMENT [motivational enhancement therapy (MET)/smartphone-based momentary assessment/responsive motivational messaging] No-messages (MET/momentary assessment) MET-only. In MOMENT, two MET sessions were followed by 2 weeks of momentary assessment of marijuana use and factors related to use, with motivational messaging displayed after report of marijuana triggers, desire, use, and effort to avoid use. We evaluated study feasibility (recruitment, retention, and response rates; feedback survey responses) and explored intervention effects on marijuana desire and use at three months with linear mixed effects modeling.
Seventy youth [mean (M) =20.7 years, 60% female] were assigned to MOMENT (n=27), No-messages (n=15; assignment suspended to enrich other arms), or MET-only (n=28). Most attrition occurred during baseline, before MET. Of those completing MET session 1, 82% completed their assigned treatment and 79% provided 3-month data. Participants highly rated acceptability; comments reflected changing motivation and behavior. Across arms, participants reported significantly lower marijuana use, desire, and problems at follow-up baseline. Momentary marijuana desire declined more in MOMENT MET-only. Marijuana use following a targeted context or behavior was less likely in MOMENT and No-messages, MET-only.
The MOMENT intervention is feasible to deliver, acceptable, and potentially efficacious in reducing marijuana desire and use among adolescent and young adults in primary care. A larger randomized trial to evaluate efficacy is warranted.
生态瞬时干预（EMIs）可在现实生活中实时影响行为。我们评估了MOMENT（一种结合咨询与生态瞬时干预的方法）在初级保健中减少青少年频繁使用大麻的试验可行性和初步疗效。
年龄在15 - 24岁、每周至少使用3次大麻的初级保健患者被随机分为MOMENT组[动机增强疗法（MET）/基于智能手机的瞬时评估/响应式动机信息传递]、无信息组（MET/瞬时评估）和仅MET组。在MOMENT组中，先进行两次MET治疗，随后进行为期2周的大麻使用及相关使用因素的瞬时评估，在报告大麻触发因素、欲望、使用情况及避免使用的努力后显示动机信息。我们评估了研究可行性（招募、留存和响应率；反馈调查回复），并通过线性混合效应模型探索了干预对三个月时大麻欲望和使用的影响。
70名青少年[平均年龄（M）=20.7岁，60%为女性]被分配到MOMENT组（n = 27）、无信息组（n = 15；暂停该组分配以充实其他组）或仅MET组（n = 28）。大多数失访发生在基线期，即MET治疗之前。完成第一次MET治疗的患者中，82%完成了指定治疗，79%提供了三个月的数据。参与者对可接受性给予高度评价；评论反映出动机和行为的改变。在所有组中，参与者在随访时报告的大麻使用、欲望和问题均显著低于基线。MOMENT组的瞬时大麻欲望下降幅度大于仅MET组。在特定情境或行为后，MOMENT组和无信息组使用大麻的可能性低于仅MET组。
MOMENT干预在初级保健中对青少年和年轻成年人实施是可行的、可接受的，并且在减少大麻欲望和使用方面可能有效。有必要进行一项更大规模的随机试验来评估其疗效。
