Seiterö Anna, Henriksson Pontus, Thomas Kristin, Henriksson Hanna, Löf Marie, Bendtsen Marcus, Müssener Ulrika
Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
J Med Internet Res. 2025 Apr 22;27:e69425. doi: 10.2196/69425.
Although mobile health (mHealth) interventions have demonstrated effectiveness in modifying 1 or 2 health-risk behaviors at a time, there is a knowledge gap regarding the effects of stand-alone mHealth interventions on multiple health risk behaviors.
This study aimed to estimate the 2- and 4-month effectiveness of an mHealth intervention (LIFE4YOUth) targeting alcohol consumption, diet, physical activity, and smoking among Swedish high school students, compared with a waiting-list control condition.
A 2-arm parallel group, single-blind randomized controlled trial (1:1) was conducted from September 2020 to June 2023. Eligibility criteria included nonadherence to guidelines related to the primary outcomes, such as weekly alcohol consumption (standard drinks), monthly frequency of heavy episodic drinking (ie, ≥4 standard drinks), daily intake of fruit and vegetables (100-g portions), weekly consumption of sugary drinks (33-cL servings), weekly duration of moderate to vigorous physical activity (minutes), and 4-week point prevalence of smoking abstinence. The intervention group had 16 weeks of access to LIFE4YOUth, a fully automated intervention including recurring screening, text message services, and a web-based dashboard. Intention-to-treat analysis was conducted on available and imputed 2- and 4-month self-reported data from participants at risk for each outcome respectively, at baseline. Effects were estimated using multilevel models with adaptive intercepts (per individual) and time by group interactions, adjusted for baseline age, sex, household economy, and self-perceived importance, confidence, and know-how to change behaviors. Bayesian inference with standard (half-)normal priors and null-hypothesis testing was used to estimate the parameters of statistical models.
In total, 756 students (aged 15-20, mean 17.1, SD 1.2 years; 69%, 520/756 females; 31%, 236/756 males) from high schools across Sweden participated in the trial. Follow-up surveys were completed by 71% (539/756) of participants at 2 months and 57% (431/756) of participants at 4 months. Most participants in the intervention group (219/377, 58%) engaged with the intervention at least once. At 2 months, results indicated positive effects in the intervention group, with complete case data indicating median between-group differences in fruit and vegetable consumption (0.32 portions per day, 95% CI 0.13-0.52), physical activity (50 minutes per week, 95% CI -0.2 to 99.7), and incidence rate ratio for heavy episodic drinking (0.77, 95% CI 0.55-1.07). The odds ratio for smoking abstinence (1.09, 95% CI 0.34-3.64), incidence rate ratio for weekly alcohol consumption (0.69, 95% CI 0.27-1.83), and the number of sugary drinks consumed weekly (0.89, 95% CI 0.73-1.1) indicated inconclusive evidence for effects due to uncertainty in the estimates. At 4 months, a remaining effect was observed on physical activity only.
Although underpowered, our findings suggest modest short-term effects of the LIFE4YOUth intervention, primarily on physical activity and fruit and vegetable consumption. Our results provide inconclusive evidence regarding weekly alcohol consumption and smoking abstinence.
ISRCTN Registry ISRCTN34468623; https://doi.org/10.1186/ISRCTN34468623.
尽管移动健康（mHealth）干预措施已证明一次可改变一两种健康风险行为，但关于独立的mHealth干预措施对多种健康风险行为的影响，仍存在知识空白。
本研究旨在评估一种针对瑞典高中生饮酒、饮食、体育活动和吸烟的mHealth干预措施（LIFE4YOUth）与等待名单对照条件相比，在2个月和4个月时的效果。
2020年9月至2023年6月进行了一项双臂平行组单盲随机对照试验（1:1）。纳入标准包括未遵守与主要结局相关的指南，如每周饮酒量（标准饮酒单位）、每月重度饮酒发作频率（即≥4个标准饮酒单位）、每日水果和蔬菜摄入量（100克份）、每周含糖饮料消费量（33厘升份）、每周中等至剧烈体育活动时长（分钟）以及4周戒烟点患病率。干预组有16周时间使用LIFE4YOUth，这是一种全自动干预措施，包括定期筛查、短信服务和基于网络的仪表盘。分别对基线时各结局有风险的参与者在2个月和4个月时可获得的和推算的自我报告数据进行意向性分析。使用具有自适应截距（按个体）和组间时间交互作用的多级模型估计效果，并对基线年龄、性别、家庭经济状况以及自我感知的改变行为的重要性、信心和知识进行调整。采用标准（半）正态先验和零假设检验的贝叶斯推断来估计统计模型的参数。
瑞典各地高中的756名学生（年龄15 - 20岁，平均17.1岁，标准差1.2岁；69%，520/756为女性；31%，236/756为男性）参与了试验。2个月时71%（539/756）的参与者和4个月时57%（431/756）的参与者完成了随访调查。干预组中的大多数参与者（219/377，58%）至少参与了一次干预。在2个月时，结果表明干预组有积极效果，完整病例数据显示组间在水果和蔬菜消费量（每天0.32份，95%置信区间0.13 - 0.52）、体育活动（每周50分钟，95%置信区间 - 0.2至99.7）以及重度饮酒发作发病率比（0.77，95%置信区间0.55 - 1.07）方面存在中位数差异。戒烟优势比（1.09，95%置信区间0.34 - 3.64）、每周饮酒发病率比（0.69，95%置信区间0.27 - 1.83）以及每周含糖饮料消费量（0.89，95%置信区间0.73 - 1.1）因估计值的不确定性而表明效果证据不明确。在4个月时，仅观察到体育活动方面存在残余效果。
尽管样本量不足，但我们的研究结果表明LIFE4YOUth干预措施有适度的短期效果，主要体现在体育活动以及水果和蔬菜消费方面。我们的结果关于每周饮酒量和戒烟提供了不明确的证据。
ISRCTN注册库ISRCTN34468623；https://doi.org/10.1186/ISRCTN34468623 。
